69832 research outputs found
Sort by
Motivational effectiveness of prosocial public health messaging to reduce respiratory infection risk: a systematic review and meta-analysis.
No full textBACKGROUND: Clear communication is essential for the effective uptake of public health interventions promoting protective behaviours for respiratory infection control. The emergence of novel infectious diseases, particularly the COVID-19 pandemic, has highlighted the need for rapid adaptation of established and new behavioural practices. However, there remains limited knowledge concerning effective strategies for disseminating risk-reduction information and predicting population responses. METHODS: This systematic review and meta-analysis (PROSPERO: CRD42020198874) assessed the effectiveness of these interventions using behavioural science frameworks, including MINDSPACE contextual influencers and behaviour change techniques (BCTs), to identify key components and mechanisms of action (MoAs). Twenty-four full-text articles, comprising 36 randomised controlled trials (RCTs) across 11 countries, were included via electronic databases (MEDLINE, EMBASE, PsycINFO, Scopus) and other sources (grey literature, Google Scholar, and reference lists) searched to March 2022. RESULTS: Here, we show that interventions mainly target social distancing, mask wearing, hand washing, and various behavioural intentions and actual behaviours, using a median of three-arm study designs with passive comparators. Interventions include a median of two contextual influencers and four BCTs. Behaviour intention is the most frequently applied mechanism of action. Study quality is moderate. Narrative synthesis of 16 full-texts (26 RCTs) shows significant effects, while network meta-analysis of 16 full-texts (21 RCTs) indicates that prosocial messages, particularly those referencing loved ones, are effective in reducing the risk of respiratory infections (d = 0.09; 95% CrI=0.06-0.14; CINeMA: Low). CONCLUSIONS: Although further research is needed, the review provides insight into designing public health messages that effectively improve protective behaviours for respiratory infection control
Language as control: Decolonising classification for C21st library collection and data management
Get PDFTele-ophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease: HERMES cluster randomised trial with a diagnostic accuracy study.
Get PDFBACKGROUND: Community-based optometrists, a major provider of primary eye care in the United Kingdom, are the main source of referrals to hospital eye services. The widespread introduction of optical coherence tomography devices in community practices provides community-based optometrists with an opportunity to identify a broader range of treatable diseases. Standard referral pathways do not effectively filter unnecessary referrals, with misclassification of urgency, and erroneous diagnoses. OBJECTIVES: To assess the effectiveness of a teleophthalmology referral pathway between community-based optometrists and hospital eye services for retinal diseases. To measure the accuracy of an artificial intelligence decision support system for diagnosis and referral management of retinal disease. DESIGN: A multicentre, superiority cluster randomised controlled trial to assess the effectiveness of a teleophthalmology referral pathway. A prospective, observational diagnostic accuracy study to measure the performance of artificial intelligence decision support system. A comprehensive economic evaluation was conducted. SETTINGS: United Kingdom-based community optometry practices with an optical coherence tomography device and hospital eye services. PARTICIPANTS: Adults requiring referral for retinal disease at the opinion of the community-based optometrists. INTERVENTIONS: Community optometry practices were randomised 1 : 1 to standard care or teleophthalmology. Referrals sent via the teleophthalmology platform were remotely reviewed by human experts based at the corresponding hospital eye services. A referral decision was provided within 48 hours. Suitable optical coherence tomography scans were solely processed by artificial intelligence decision support system (the 'Octane' model). MAIN OUTCOME MEASURES: Cluster randomised controlled trial's primary outcome was the proportion of false-positive referrals (not required or not urgent) per arm in overall participants and in referred-only participants against an independent reference standard. Secondary outcomes included the proportion of wrong diagnosis, wrong referral urgency, false-negative referrals, safely triaged referrals for rare diseases, time from referral to consultation and treatment and cost-effectiveness of teleophthalmology. Primary outcome for the artificial intelligence study was the sensitivity and specificity of artificial intelligence referral decisions against the reference standard. RESULTS: Teleophthalmology significantly reduces the proportion of false-positive urgent referrals by 59% compared to standard care in referred participants. Due to the observed low event rate for false positive referrals, teleophthalmology's role for reducing false positives overall was inconclusive. No significant difference between arms for safety of referral decisions (false negatives) was found. After accounting for external factors, the time to consultation demonstrated both clinically and statistically significant benefits for the teleophthalmology arm. The time to treatment showed a clinically significant benefit. Of 396 recruited participants, the Octane artificial intelligence model processed images contributed by 204 participants (51.5%). For referral decisions, the model showed comparable sensitivity and specificity against its own preset referral rules (rule-based reference standard) (post hoc analysis), but it showed inferior sensitivity and specificity when compared to human expert assessors making these referral decisions (clinical reference standard) (primary AI analysis). The artificial intelligence model presented challenges relating to its generalisability in a real-world evaluation context. LIMITATIONS: Technical limitations in optometry practices, lack of ethnicity data. CONCLUSIONS: Asynchronous teleophthalmology reduces the number of unnecessary urgent referrals, the main drivers of increasing hospital capacity pressures, provides more appropriate referral-to-treatment times and is more cost-effective compared to standard care. The Octane artificial intelligence model could not process images from 48.5% of study participants. Compared to hospital-based experts for referral decisions, Octane was less accurate at making routine and urgent referral decisions and of similar accuracy to community optometrists. FUTURE WORK: Applied health research, human-artificial intelligence interaction and artificial intelligence clinical trial design. TRIAL REGISTRATION: This trial is registered as ISRCTN18106677. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127773) and is published in full in Health Technology Assessment; Vol. 29, No. 69. See the NIHR Funding and Awards website for further award information
Recipient-focused interventions to increase vaccine uptake in high and upper-middle income countries: a systematic review and network meta-analysis.
Get PDFBACKGROUND: Vaccination is a highly effective public health tool. However, uptake of many vaccines has declined globally over the past decade, exacerbated by the COVID-19 pandemic, with coverage often falling short of critical thresholds. There is a large evidence-base of vaccine uptake interventions targeting vaccine recipients. Here we aim to synthesise evidence on the comparative effectiveness of these interventions, assess variations by age, and evaluate the impact of the COVID-19 pandemic on intervention effectiveness. METHODS: We conducted a systematic review, searching nine databases and grey literature for randomised controlled trials from high and upper-middle income countries, published from 2000 to April 2024. We included interventions targeted at vaccine recipients of any age (or their caregivers) living in the community, aimed at increasing uptake of routine or selective/targeted vaccinations on the UK schedule and categorised them into six intervention categories (access, affordability, education, reminder, education and reminder, and multi-component). Our outcome was number vaccinated. We estimated odds ratios (ORs) using Bayesian random effects network meta-analysis (NMA) combining all direct and indirect evidence on relative intervention effects in a single coherent analysis. Risk of bias was assessed using the Cochrane RoB 2 tool and certainty in the evidence using CINeMA. This review is registered with PROPSERO (CRD42022369139). FINDINGS: We included 268 studies (6,243,118 participants; 39% male, 61% female) with 223 eligible for analysis. Studies not eligible for analysis are narratively reported. Of those eligible for analysis, we assessed 105 studies as low risk of bias, 87 as some concerns, and 31 as high risk. Our NMA produced ORs and 95% credible intervals (CrI) > 1 for all six intervention categories, indicating favourable vaccine uptake compared to control (standard practice, no intervention, or attention placebo), with multicomponent (OR: 2.09, 95% CrI: 1.66-2.63), access (OR: 1.74, 95% CrI: 1.35-2.26), and affordability (OR: 1.87, 95% CrI: 1.47-2.40) interventions appearing most effective followed by education and reminder (OR: 1.47, 95% CrI: 1.29-1.67), reminder (OR: 1.36, 95% CrI: 1.22-1.50), and education (OR: 1.33, 95% CrI: 1.19-1.49). We judged the evidence for all six interventions as moderate certainty. Subgroup analyses exploring the effect of the COVID-19 pandemic suggest that affordability interventions may be less effective post-2020 (OR: 1.35, 95% CrI: 0.94-1.94) than pre-2020 (OR: 2.32, 95% CrI:1.72-3.19), similarly multicomponent interventions appear less effective post-2020 (OR: 1.45, 95% CrI: 1.00-2.10) than pre-2020 (OR: 2.50, 95% CrI: 1.89-3.33) whilst access, education, reminder, and education and reminder intervention effects remained stable. INTERPRETATION: Vaccination programmes in high and upper-middle income countries should prioritise ensuring vaccines are accessible, convenient, and affordable for the recipient. Efforts should be directed towards further investigating and optimising access and affordability interventions. The possible negative impacts of the COVID-19 pandemic on the effectiveness of affordability and multicomponent interventions should be monitored. FUNDING: NIHR Public Health Research Programme (NIHR135130)
Primary caregivers' acceptance of gendered human papillomavirus (HPV) vaccination across The Gambia
Get PDFIntroduction/background: Human papillomavirus (HPV) is one of the most common sexually transmitted infections associated with cervical cancer. In The Gambia, it is estimated that 770,927 women aged 15 years and above are at risk of cervical cancer with approximately 286 new cases being diagnosed annually. Despite the effectiveness of the HPV vaccine, uptake has remained low since its introduction in 2019. This qualitative study explored the potential impact of age (adults versus adolescents versus infants) and gender (boys and girls versus girls only) on caregivers' acceptance of the HPV vaccine. Understanding caregivers' reasons for acceptance and refusal can help HPV vaccine programme managers to address issues that may prevent uptake.
Methods: 23 qualitative in-depth interviews and 10 focus group discussions with a total of 83 caregivers were conducted in urban and rural settlements located across five regions of the Gambia (West Coast, North Bank, Lower River, Central River and Upper River). Male and female caregivers aged 18 and above were recruited through convenience and snowball sampling. NVivo 14 qualitative data analysis software was used for data management and thematic analysis.
Results: Knowledge of HPV, cervical cancer, and the HPV vaccine was scarce. Participants highlighted the need for greater sensitisation on HPV and the vaccine. Despite this, all participants accepted the HPV vaccine regardless of the age or gender of the individual receiving the vaccine. Motives for vaccine acceptance included ensuring the wellbeing of their children and trust in healthcare workers. Vaccine hesitancy was prompted by a lack of sensitisation and fear of infertility.
Conclusion: HPV vaccine acceptance is high across the different regions although there is a need for widespread sensitisation. Such findings can inform the implementation of future vaccination programmes to improve sensitization messaging, plan for effective vaccination rollout and subsequently increase uptake and coverage of HPV vaccines
Exploring Emotional and Cognitive Perceptions of Cervical Cancer Screening and Self-Sampling Among Vulnerable Romanian Women: A Qualitative Study.
Get PDFINTRODUCTION: This study aimed to explore the emotional and cognitive perceptions of cervical cancer screening (CCS), with a focus on self-sampling for human papillomavirus (HPV) by vulnerable Romanian women.
METHODOLOGY: Eighteen semi-structured individual interviews were conducted with vulnerable women, defined by their low socioeconomic status (SES), residence in rural areas and membership in ethnic minorities. Participants were recruited using snowball sampling. Interviews followed a guide designed to assess constructs from the Health Belief Model (knowledge, barriers, evaluation of vulnerability) as they relate to women's views of prevention, the healthcare system and CCS. A Think Aloud protocol was used with a subsample of six women to identify potential barriers, opportunities and attitudes related to the use of self-sampling kits. A reflexive thematic analysis was conducted to identify the primary themes related to with women's perceptions of CCS and self-sampling.
RESULTS: Four major themes emerged: (a) risk, fear and other emotional experiences; (b) women's perception of barriers; (c) knowledge, personal control and cues to action; and (d) women's perception of self-sampling. Participants unravelled emotional and logistical barriers to CCS and self-sampling. Limited health literacy, fear and shame influenced risk perceptions, hindering CCS participation. Logistical challenges and financial constraints further impeded access, while women often prioritized the needs of their families over their own health. The Think Aloud protocol revealed that initial concerns regarding self-sampling could be alleviated by having clear instructions, highlighting the importance of support during the decision-making process.
CONCLUSION: This study identified diverse barriers preventing vulnerable Romanian women from engaging in CCS, including logistical challenges, financial constraints and emotional factors.
PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not involved in the design, conduct, analysis or interpretation of the study
Characteristics associated with women undergoing their first mammography screening at a younger age.
Get PDFBreast cancer is the most commonly diagnosed cancer and a leading cause of cancer death among women. Kuwait has among the highest age-standardized incidence in the Gulf, yet mammography uptake remains low. The 2024 USPSTF recommends routine screening from age 40 for average-risk women. To identify characteristics associated with undergoing first-time mammography at ages 40-49 versus ≥50 in Kuwait. Cross-sectional analysis of 5,242 asymptomatic Kuwaiti women aged ≥40 with no prior screening in the Kuwait National Mammography Screening Program, 2014-2019. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% CIs. Overall, 65.0% had their first screen at 40-49. Younger screening increased over time (per-year aOR 1.10, 95% CI 1.06-1.14; Cuzick z = 4.56, p < 0.001). Higher odds were observed with university or postgraduate education versus illiterate to secondary (aOR 4.53, 3.71-5.53; p < 0.001), parity 3-5 versus none (2.66, 1.85-3.82; p < 0.001), clinical breast examination (1.39, 1.11-1.74; p = 0.004), hormone replacement therapy use (1.69, 1.28-2.23; p < 0.001), and citing social media as the main information source (2.58, 1.28-5.19; p = 0.008; n = 94, 1.8%). Lower odds were seen for overweight (0.67, 0.53-0.85; p = 0.001) and obesity (0.53, 0.42-0.66; p < 0.001) versus normal BMI, hysterectomy (0.51, 0.34-0.76; p = 0.001), and longer breastfeeding (≥24 months versus never to <1 month: 0.41, 0.30-0.57; p < 0.001). Earlier first screening was associated with higher education, greater parity, clinical contact, hormone therapy use, and digital information sources, and was less likely with higher BMI, hysterectomy, and prolonged breastfeeding. Targeted, culturally tailored outreach to women with lower education or higher BMI, along with evaluated digital strategies, may promote earlier participation. Prospective follow-up is needed to determine whether earlier first screening leads to down-staging and improved outcomes
Democratising Artificial Intelligence for Pandemic Preparedness and Global Governance in Latin American and Caribbean Countries.
Get PDFInfectious diseases continue to pose a significant global health challenge, necessitating innovative approaches for predicting outbreaks, detecting variants, conducting contact tracing, discovering new drugs and managing misinformation. Artificial intelligence (AI) has significantly supported work in these areas, particularly during the COVID-19 pandemic. However, the benefits of AI must be equitably distributed, and its use must be responsible and inclusive. As various nations implement AI regulations, the global nature of AI necessitates international collaboration to establish ethical guidelines and governance frameworks. In response to these needs, the Global South AI for Pandemic & Epidemic Preparedness & Response Network (AI4PEP) is leading a multinational effort across 16 countries to strengthen public health systems through responsible, Southern-led AI solutions. This opinion piece highlights AI4PEP's initiatives in Latin America and the Caribbean (LAC), examining the region's AI governance models and the challenges they present. By lowering barriers to AI adoption and fostering equitable access to AI-driven public health innovations, our network empowers researchers, healthcare professionals and policymakers in LAC to harness AI for infectious disease preparedness and response, ultimately improving health outcomes in low- and middle-income countries
Neonatal unit human resources: coverage for six cadres and trends for staff-to-baby ratios in 65 neonatal units implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania.
Get PDFBACKGROUND: Implementing small and sick newborn care (SSNC) requires skilled health workers; however, there is a shortage, adversely impacting patient outcomes and health worker well-being. There are limited data and no current World Health Organization (WHO) standards for staff-to-baby ratios in neonatal units in low- and middle-income countries (LMICs) to inform policy, planning, and investment. METHODS: In 65 neonatal units (36 in Malawi, 13 in Kenya, 7 in Tanzania, and 9 in Nigeria), a health facility assessment (HFA) for SSNC and government-led quality improvement (QI) processes were implemented. Staffing data were collated from baseline HFA (Sept 2019-March 2021) and mid-2023 HFAs, and quarterly QI processes. The unit of analysis was the neonatal unit with day and night staff-to-baby ratios calculated. Ratios were aggregated overall, by country, by hospital level, and by neonatal unit occupancy rates. Staff coverage and skill-mix were also analysed for nurses, doctors, clinical officers, laboratory technicians, data clerks, biomedical technicians, and engineers. RESULTS: For 65 neonatal units, the median time between baseline and 2023 HFAs was 31 months (Interquartile Range (IQR) 29-34 months). In 2023, only 3 (5%) neonatal units had zero neonatal ward-specific nurses compared to 8 (12%) at baseline during the day. Between baseline and 2023 HFAs, median nurse-to-baby ratios were 1:6 (IQR 1:3-1:11) during the day and 1:10 (IQR 1:6-1:17) at night, with consistency over time. At baseline, only one third of neonatal units had a doctor providing care, or on-call coverage, at all times of day and night (n = 20, 31%), and half of hospitals lacked 24 h laboratory coverage (n = 25, 45%) with no change over time. There were improvements in neonatal data clerk (n = 32, 49% to n = 58, 89%) and biomedical technician (n = 45, 69% to n = 56, 86%) coverage between baseline and 2023 HFAs. DISCUSSION: Evaluation revealed variability by country and hospital level, and important shortfalls remain in the number of staff providing care. Neonatal survival in hospitals requires better staff-to-baby ratios and more skilled staff. To meet the projected shortfall in the health workforce, governments must invest in training more health workers for neonatal care
Climate Change and Maternal Newborn and Child Health: Time for Action
Get PDFAcross the world and particularly in the global south, climate change has placed the health and survival of mothers, newborns and children under increasing threat. These threats manifest as immediate climate hazards and long-term impacts that threaten future decades.
Researchers at LSHTM present the latest global evidence on climate-related threats to maternal, newborn and child health in a white paper, funded by The Gates Foundation.
The paper presents evidence on proven and emerging climate-related MNCH risks, projections of future health burdens across scenarios, adaptation and mitigation recommendations, and concrete policy steps for COP30 and beyond