69832 research outputs found
Sort by
Incidence of and outcomes of pregnancy in adolescents with perinatally-acquired HIV infection in Southern Africa.
Get PDFBackgroundThe scale-up of antiretroviral therapy (ART) has enabled more children living with HIV to reach adolescence and become sexually active. We investigated pregnancy incidence and outcomes among adolescents with perinatally acquired HIV enrolled in a multi-country trial of vitamin D and calcium carbonate supplementation (VITALITY; PACTR202009897660297).MethodsBetween February and November 2021, 842 adolescents aged 11-19 years from Zambia and Zimbabwe on ART for at least 6 months were enrolled. Pregnancies occurring during 96 weeks of follow-up (February 2021-October 2023) were identified through self-report or testing. Pregnancy incidence rate was calculated among post-menarche participants using survival time analysis.ResultsThirty-five adolescents (median age 18, range 13-22) became pregnant, 21 in Zambia, 14 in Zimbabwe. Overall pregnancy incidence was 4.6 per 100 person-years (95% CI 3.3-6.4), higher in those ≥15 years (6.8 per 100 person-years, 95% CI 4.8-9.7). Three pregnancies ended in miscarriage; 32 resulted in live births. Of the 30 adolescents with live births and available data, 26 (86.7%) infants were tested for HIV at birth: 24 were HIV-negative, two had unknown results. Twenty-nine received HIV prophylaxis. At 6 weeks, 19/30 infants were retested for HIV: 16 were HIV-negative. Twenty-one of 32 pregnant adolescents were in school at conception, and 4 (19.0%) returned post-pregnancy. Overall, 23/33 (69.7%) started contraception, a median of 9 weeks after delivery/miscarriage.ConclusionPregnancy incidence is high among adolescents with HIV, especially older adolescents. While prevention of vertical HIV transmission is effective, education re-integration and timely contraception uptake remain limited
Pornography Use Among Adults in Britain: A Qualitative Study of Patterns of Use, Motivations, and Stigma Management Strategies.
Get PDFPornography use is common but stigmatized. In this study, we present a qualitative analysis of the patterns of, and motivations for, using pornography and how the stigma of using pornography manifests in participants' accounts. We draw on Meisenbach's (2010) theory of stigma management communication (SMC) to deepen our understanding of how participants managed potential stigma. Data come from 40 semistructured interviews with a diverse sample of adults from across Britain (aged 18-64 years) on the role of digital technologies in their sexual lives. Despite not being a criterion for recruitment, all participants except six women had used pornography and 18 were regular users at time of interview. Pornography was used primarily to facilitate arousal during solo masturbation, and also for mood control, "me time," or exploration of one's sexual identity. Some participants also used pornography with a partner to facilitate arousal and experimentation. An understanding of pornography use as stigmatized was evident in participants' accounts. In terms of SMC theory, "avoiding" strategies were most commonly employed including: hiding pornography use from others; distancing oneself from the stigma of pornography use; and making favorable comparisons between oneself and other users. Other less frequently employed strategies included: "denying" the existence of stigma, reducing the stigma's offensiveness through "minimization" (emphasizing that one's pornography use does not harm others), and "transcendence" (highlighting that pornography use can be a means to a valuable end). The stigma surrounding pornography use may act as a barrier to education interventions addressing pornography and seeking help for problematic use
Risk, determinants, and persistence of long-COVID in a population-based cohort study in Catalonia.
Get PDFBACKGROUND: Long-COVID has mostly been investigated in clinical settings. We aimed to assess the risk, subtypes, persistence, and determinants of long-COVID in a prospective population-based study of adults with a history of SARS-CoV-2 infection in Catalonia. METHODS: We examined 2764 infected individuals from a population-based cohort (COVICAT) established before the pandemic and followed up three times across the pandemic (2020, 2021, 2023). We assessed immunoglobulin (Ig)G levels against SARS-CoV-2, clinical, vaccination, sociodemographic, and lifestyle factors. Long-COVID risk and subtypes were defined based on participant-reported symptoms and electronic health records. We identified a total of 647 long-COVID cases and compared them with 2117 infected individuals without the condition. RESULTS: Between 2021 and 2023, 23% of infected subjects developed long-COVID symptoms. In 56% of long-COVID cases in 2021, symptoms persisted for 2 years. Long-COVID presented clinically in three subtypes, mild neuromuscular, mild respiratory, and severe multi-organ. The latter was associated with persistent long-COVID. Risk was higher among females, participants under 50 years, of low socioeconomic status, severe COVID-19 infection, elevated pre-vaccination IgG levels, obesity, and prior chronic disease, particularly asthma/chronic obstructive pulmonary disease and mental health conditions. A lower risk was associated to pre-infection vaccination, infection after omicron became the dominant variant, higher physical activity levels, and sleeping 6-8 h. Vaccination during the 3 months post-infection was also protective against long-COVID. CONCLUSIONS: Long-COVID persisted for up to 2 years in half of the cases, and risk was influenced by multiple factors
Effectiveness and safety of shortened intensive treatment for children with tuberculous meningitis (SURE): a protocol for a phase 3 randomised controlled trial evaluating 6 months of antituberculosis therapy and 8 weeks of aspirin in Asian and African children with tuberculous meningitis.
Get PDFINTRODUCTION: Childhood tuberculous meningitis (TBM) is a devastating disease. The long-standing WHO recommendation for treatment is 2 months of intensive phase with isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E), followed by 10 months of isoniazid and rifampicin. In 2022, WHO released a conditional recommendation that 6 months of intensified antituberculosis therapy (ATT) could be used as an alternative for drug-susceptible TBM. However, this has never been evaluated in a randomised clinical trial. Trials evaluating ATT shortening regimens using high-dose rifampicin and drugs with better central nervous system penetration alongside adjuvant anti-inflammatory therapy are needed to improve outcomes.
METHODS AND ANALYSIS: The Shortened Intensive Therapy for Children with Tuberculous Meningitis (SURE) trial is a phase 3, randomised, partially blinded, factorial trial being conducted in Asia (India and Vietnam) and Africa (Uganda, Zambia and Zimbabwe). It is coordinated by the Medical Research Council Clinical Trial Unit at University College London (MRCCTU at UCL). 400 children (aged 29 days to <18 years) with clinically diagnosed TBM will be randomised, using a factorial design, to either a 24-week intensified regimen (isoniazid (20 mg/kg), rifampicin (30 mg/kg), pyrazinamide (40 mg/kg) and levofloxacin (20 mg/kg)) or the standard 48-week ATT regimen and 8 weeks of high-dose aspirin or placebo. The primary outcome for the first randomisation is all-cause mortality, and for the second randomisation is the paediatric modified Rankin Scale (mRS), both at 48 weeks. Nested substudies include pharmacokinetics, pharmacogenetics, pathophysiology, diagnostics and prognostic biomarkers, in-depth neurodevelopmental outcomes, MRI and health economics.
ETHICS AND DISSEMINATION: Local ethics committees at all participating study sites and respective regulators approved the SURE protocol. Ethics approval was also obtained from UCL, UK (14935/001). Informed consent from parents/carers and assent from age-appropriate children are required for all participants. Results will be published in international peer-reviewed journals, and appropriate media will be used to summarise results for patients and their families and policymakers.
TRIAL REGISTRATION: ISRCTN40829906 (registered 13 November 2018)
HIV risk perception, trust and PrEP adherence among participants in an HIV prevention trial: a qualitative longitudinal study, South Africa.
Get PDFINTRODUCTION: Ensuring the effectiveness of HIV prevention and treatment methods requires high levels of adherence. Studies have recognised the significance of trust in shaping HIV risk perception. AIM: In this qualitative analysis, our aim was to explore risk perceptions and understand how individuals assess and respond to HIV risks, as well as their uptake and adherence to oral pre-exposure prophylaxis (PrEP). SETTING: The study was based on the setting of an HIV prevention trial conducted in South Africa. METHODS: Thirty individuals, 9% of the total clinical trial participants, enrolled in the clinical trial were purposively selected and interviewed at three time points within the trial during the follow-up phase. Data analysis was conducted using the Trust, Confidence and Cooperation framework that included constructs of trust, confidence and cooperation. RESULTS: The findings show that the ongoing participation in the clinical trial played a significant role in influencing participants' decision to continue PrEP as HIV prevention. This decision was grounded in their trust that PrEP would effectively reduce their vulnerability to HIV and infection. CONCLUSION: Clear and consistent health-promoting initiatives enhance participants' self-awareness of HIV risks and promote understanding (uptake) and effectiveness of HIV prevention methods. TRIAL REGISTRATION NUMBER: NCT04066881
Global clubfoot treatment in 2023: an overview of advances and outcomes.
Get PDFINTRODUCTION: Approximately 200 000 children are born each year with clubfoot, the majority of whom live in low-income and middle-income countries (LMICs). If untreated, clubfoot causes pain and reduced mobility, leading to activity limitations and disability. The Ponseti method is a highly effective and minimally invasive treatment. This observational study aims to quantify the countries providing clubfoot services and the children receiving treatment in 2023 and compares progress since data were first collected in 2005. METHODS: In January and February 2024, data on clubfoot treatment in 2023 were collected from 70 countries. Informants completed a survey about new cases enrolled, treatment outcomes and health system integration. Data were analysed using descriptive statistics, with adjustments made for duplicates, and included clinic locations, the number and ages of children starting treatment, types of support available and Ministry of Health involvement. We compared coverage trends over time and used a cartogram to visualise the extent of clubfoot programme coverage across countries. RESULTS: Responding countries accounted for 83% of all expected cases in LMICs. There was an increase in enrolment numbers, to 40 382, in 2023. Despite this progress, treatment coverage remained low at approximately 22% across respondent countries. While integration of clubfoot services into national healthcare systems varied widely, strong public-private partnerships in many countries suggest a foundation for sustainable, long-term treatment programmes. However, quality care remained a challenge, with only 67% of children receiving their first foot abduction brace, indicating gaps in ensuring comprehensive treatment necessary for successful clubfoot management. Lingering effects of COVID-19 restrictions include a higher percentage of cases enrolled after 1 year of age. CONCLUSIONS: A larger proportion of children in LMICs received Ponseti treatment in 2023 compared with 2005. However, more work is needed to expand national programmes, build sustainable, high-quality treatment capacity and ensure all children get the care they need to avoid lifelong disability
Healthcare responding to violence and abuse in Brazil: a quasi-experimental difference-in-differences analysis.
Get PDFBACKGROUND: Domestic violence against women (DVAW) is a public health issue and a breach of human rights, yet evidence on effective interventions remains limited, particularly in low-income and middle-income countries. This study aimed to evaluate changes in identification and referral to specialist support associated with system-level strategies implemented within Brazilian primary healthcare (PHC) to strengthen the response to DVAW. The strategies comprised an intervention called Healthcare Responding to Violence and Abuse (HERA). METHODS: Using a quasi-experimental design, HERA was implemented in eight PHC clinics, while 33 served as controls. Data on DVAW identification and referral were obtained from the national Epidemiological Surveillance System. Difference-in-differences analysis, using negative binomial regression, assessed HERA's impact, controlling for patient inflow, clinical supervision, COVID-19 lockdown, region, and clinic. Results are reported as marginal effects with 95% confidence intervals (CI). FINDINGS: There was an increase in the probability of DVAW identification (0.47; 95% CI 0.18-0.77) and referral to support services (0.38; 95% CI 0.03-0.73), when adjusting for panel effects and time. The results were even larger when further controlling for additional variables (0.82 for identification [95% CI 0.44-1.21] and 0.87 for referrals [95% CI 0.47-1.29]). INTERPRETATION: HERA strategies increased DVAW identification and referral in PHC settings. Clinics implementing HERA were already more likely to identify and refer cases before the implementation, suggesting that HERA's strategies may be more effective in clinics that find DVAW interventions more acceptable, at least in Brazil. FUNDING: NIHR Global Health Research Group Award
Maternal Experiences and Perspectives of Marketing and Regulation of Commercial Milk Formula in Thailand: A Qualitative Study.
No full textCommercial milk formula (CMF) marketing adversely influences breastfeeding practices globally. Thailand enacted the Control of Marketing Promotion of Infant and Young Child Food Act ('Thai Code') in 2017 to restrict the marketing of CMF for infants aged 0-12 months. This qualitative study aimed to explore mothers' experiences and perspectives of CMF marketing and its regulation by the Thai Code through semistructured interviews with 15 mothers across Thailand between July 2023 and March 2024. Our findings revealed that while traditional advertising and healthcare-setting promotions decreased, CMF marketing strategies evolved toward social media platforms, particularly TikTok and Facebook, and through building relationships with mothers for CMF products for young children. Participants reported varying perceptions toward CMF marketing, with those of lower socioeconomic status appearing to be more susceptible to marketing claims, for example, CMF boosts cognitive development and is equivalent to breast milk. While participants reported receiving strong breastfeeding support from healthcare facilities, subtle CMF promotional practices persisted in private settings through free sample distribution and invitations to join company-sponsored digital platforms. Despite general awareness that some form of CMF marketing regulation exists, participants had limited knowledge of the Thai Code's specific provisions. Therefore, enhanced monitoring of digital marketing and private healthcare settings, alongside improved public communication about the Thai Code, could strengthen its implementation, particularly in lower income settings in which mothers may be more vulnerable to marketing claims
Biodiversity Conservation, a Crucial Step Towards Food and Nutritional Security, Food Justice and Climate Change Resilience in Africa.
Get PDFBiodiversity conservation has been identified as an important climate change mitigation tool. Healthy ecosystems act as natural carbon sinks while also strengthening resilience, making them essential for climate change adaptation. Climate change effects have led to various negative impacts, including biodiversity loss and food insecurity. The loss of forest biodiversity threatens vital wild fruits and vegetables that sustain rural communities, disrupting natural food sources and constituting a form of social injustice for poor, vulnerable, and previously marginalised groups in rural and semi-urban communities. Therefore, this study aimed to investigate the relationship between previous biodiversity conservation outcomes, ecosystem services, highly utilised wild vegetables and fruits, food and nutritional security, climate change effects, and climate resilience. We identified gaps in African biodiversity conservation and developed a conceptual framework to highlight integral principles required for the effective biodiversity conservation of wild forests in Africa. The integral principles are active community engagement, a strong network of stakeholders, sustainable plant resources management practices, legal reforms, and the creation of awareness through various platforms. Conservation policies should prioritise African indigenous wild, drought-tolerant vegetables and fruits that serve as an interface between food and medicine; play various roles in human survival in the form of ecosystem services; and act as carbon sinks to ensure a food-secure future with reduced climate change effects. The African indigenous community's efforts in biodiversity conservation engagements are key to successful outcomes
Repurposing antimalarials: pyrimethamine exhibits superior in vitro activity to metronidazole against Gardnerella while sparing Lactobacillus.
Get PDFBACKGROUND: Bacterial vaginosis (BV) is associated with significant reproductive health risks and high recurrence rates after standard antibiotic treatment. Sulfadoxine/pyrimethamine, an antimalarial drug, demonstrated unexpected clearance of BV in clinical trials, suggesting potential antimicrobial effects. Drug repurposing, which leverages existing drugs for new therapeutic applications, offers a promising approach to address the challenges of antimicrobial resistance and high recurrence rates in BV. OBJECTIVE: To determine the in vitro activity of sulfadoxine/pyrimethamine and its components, sulfadoxine and pyrimethamine, on key species associated with BV. METHODS: Minimum inhibitory concentration (MIC) and minimum bactericidal concentration were determined for sulfadoxine/pyrimethamine (20:1 ratio), sulfadoxine, pyrimethamine, and standard-of-care antibiotics, metronidazole and clindamycin, against BV-associated species (Gardnerella spp., Fannyhessea vaginae, Prevotella bivia) and Lactobacillus crispatus (vaginal health marker). Gardnerella biofilms were also exposed to sulfadoxine/pyrimethamine, pyrimethamine, or metronidazole, and biofilm biomass and biofilm cells culturability were assessed. RESULTS: Sulfadoxine had no effect, while pyrimethamine inhibited all Gardnerella strains with MIC values ranging from 0.125 to 4 mg/L, lower than MICs observed for metronidazole (2-128 mg/L). Pyrimethamine also outperformed metronidazole in inhibiting biofilm mass accumulation and reducing biofilm culturable cells in 3/4 Gardnerella strains. Sulfadoxine/pyrimethamine presented lower MICs than metronidazole for 5/8 Gardnerella strains. Sulfadoxine, pyrimethamine, and sulfadoxine/pyrimethamine showed no activity against other BV-associated species or L. crispatus. CONCLUSIONS: These findings suggest that pyrimethamine (and sulfadoxine/pyrimethamine) could be promising alternative or adjuvant therapies for BV, warranting further clinical trials