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Body Mass Index Trajectories and Association With Tuberculosis Risk in a Cohort of Household Contacts in Southern Africa.
Get PDFBACKGROUND: Studies have demonstrated an inverse log-linear relationship between body mass index (BMI) and tuberculosis incidence. However, a person's BMI is dynamic, and longitudinal changes may be more informative than cross-sectional assessments. We evaluate the association between cross-sectional and changing BMI and risk of tuberculosis and describe longitudinal trajectories in a high-risk cohort. METHODS: ERASE-TB was a prospective longitudinal cohort study of household contacts ≥10 years in Southern Africa (Zimbabwe, Tanzania, and Mozambique), with 6-monthly follow-up up to 24 months. Associations between BMI and tuberculosis were investigated based on baseline (including hemoglobin) and changing BMI, using logistic, Poisson, and Cox models. Prevalent tuberculosis was defined as diagnosis during 10% negative change in BMI during follow-up (adjusted incidence rate ratio: 2.27; 95% confidence interval: 0.22-22.9) were associated with increased risk of incident tuberculosis. The association between continuous BMI-for-age Z-scores were nonlinear, with increased risk of tuberculosis with lower BMI. Four latent groups were defined in the growth mixture modelling: increasing, decreasing, and low/high stable BMI. CONCLUSIONS: Declining BMI, regardless of absolute value, is a strong predictor of tuberculosis among household contacts. Longitudinal measurements should be considered in active case finding among tuberculosis-affected households
A Scoping Review of Choice Architecture to Promote Healthy Nutrition in Health and Care Settings
Get PDFINTRODUCTION: Poor diets are a remediable risk factor for non-communicable diseases. Sickness absence rates for national health service (NHS) staff are substantially higher than the public sector average (5.6% vs. 3.6%). Hospital inpatients are often being treated for the downstream consequences of poor diets. Systematic reviews and meta-analyses support national health recommendations for plant-based diets that emphasise consumption of varied whole plant-source foods with minimal consumption of animal products. These diets are increasingly recognised as compatible with planetary health and are associated with lower greenhouse gas emissions. There is increasing interest in using choice architecture interventions (subtly changing the environment in which individuals make decisions) to encourage healthier plant-based food choices in health and care settings. This approach may prove cost effective, encouraging better choices for staff and inpatients with minimal upfront investment.
OBJECTIVE: To summarise evidence for choice architecture interventions aimed at changing dietary choices made by staff and inpatients in high-income health and care settings. This review aims to inform decision making on food service provision in health and care organisations. METHODS: Medline, CINAHL PLUS, GreenFile, and Web of Science were searched for studies which examined choice architecture on dietary choices in high-income health and care settings. Studies referenced in systematic reviews were examined for inclusion from 4th to 10th June 2024. A typology used in a previous review conducted by Public Health England (categories: availability, positioning, pricing, functionality, presentation, information, sizing) was modified to include a category for using defaults (the action that occurs when no choice is made). Randomised experimental, quasi-experimental, interrupted time series and before and after studies reporting on nutritional measures or a measure of healthy food purchases were included. Studies from non-healthcare settings were excluded.
RESULTS: None of the studies explicitly encouraged plant-based diets or measured environmental impact although 12 studies measured change in plant-based choices using measures such as fruit and vegetable servings. A total of 51 studies were included focused on other healthy dietary interventions. A total of 31 of these studies implemented more than one type of choice architecture. Twenty studies were conducted in cafeterias, eight on hospital vending machines, six in hospital retail stores, three in residential care homes, and five in an inpatient setting. A further nine studies either implemented changes across multiple aspects of healthcare food provision, included non-healthcare workplaces, or examined hospital office-based interventions. Overall, 34 of the 51 studies reported a positive change in healthy food choices and only six studies reported no significant change or an adverse change. Availability, pricing and positioning of items are associated with a change in dietary choices. Evidence for informational changes was mixed and at worst, had a negative reaction, increasing unhealthy purchasing. Few studies used sizing or presentation elements and none of the studies evaluated functionality or default elements. None of the inpatient studies examined persistent change in dietary choices for long-term health.
CONCLUSIONS: In this review, the evidence indicates that choice architecture interventions can support healthier food choices in health and care settings. However, there is limited research and nutritional evaluation of choice architecture interventions that encourage plant-based diets. Further well-conducted studies are needed in health and care settings to determine optimal typologies, or combined approaches, for making healthier dietary choices. Given the established evidence of plant-based diets for long-term health, and the lower environmental impact of these diets, studies using choice architecture to encourage plant-based choices in health and care settings should be conducted and should evaluate nutritional, financial, and environmental outcomes. The effectiveness of choice architecture techniques in inpatient catering to encourage and role model healthier diets should be investigated to tackle dietary inequality and the burden of diet-related chronic disease
Advancing maternal and newborn healthcare measurement: developing quality of care indices for postnatal and small and/or sick newborn care in low- and middle-income countries.
Get PDFBACKGROUND: High-quality healthcare for pregnant women and newborns, particularly postnatal care (PNC) and small and/or sick newborn care (SSNC), is essential to reducing maternal and newborn morbidity and mortality in low- and middle-income countries (LMICs). Poor quality of care (QoC) is a major contributor to preventable morbidity and mortality, emphasising the need for its improvement in health service delivery through systematic measurement and monitoring. Although indicators measuring QoC have been identified, there is a current gap in the availability of composite indicators that can summarise its complex, multidimensional nature. Here we present three systematically developed composite QoC indices for maternal PNC, newborn PNC, and SSNC, feasible to measure using existing data in LMICs. METHODS: We developed a four-step process to define the indices. First, we identified interventions by reviewing global clinical guidelines and QoC frameworks. Second, we extracted discrete items recommended for delivery of each of the selected interventions from intervention-specific guidelines. Third, we mapped these items to health facility survey data to assess their alignment with standardised tools. Finally, we developed a quality readiness index (QRI) for each service area based on QoC frameworks, available data, and clinical guidelines. RESULTS: The maternal PNC-QRI includes 12 interventions and contains 24 items, the newborn PNC-QRI includes three interventions and contains 16 items, and the SSNC-QRI includes eight interventions and contains 48 items. Data gaps across all three indices led us to exclude some evidence-based interventions and include a limited number of items. No data on provision/experience of care were available for maternal PNC, newborn PNC, or SSNC, so the indices reflect only facility readiness. CONCLUSIONS: The three QRIs provide composite measures for maternal and newborn PNC and SSNC readiness that could be adapted at the country level and operationalised using health facility assessment survey data, facilitating their use by decision-makers for planning and resource allocation. Revision of existing health facility assessments to address gaps in readiness and provision/experience of care measurement for PNC and SSNC would bolster efforts to monitor and improve care quality for mothers and newborns
Psychological support for people affected by scandals caused by serious and sustained failings of statutory services and government: lessons from the infected blood scandal and Infected Blood Inquiry.
Get PDFBACKGROUND: Several independent reviews in the UK have recently investigated sustained, systemic failings by statutory services and government departments. These reviews document severe psychological impacts on people affected by these scandals, which have been exacerbated by miscarriages of justice, denials of accountability and lack of formal support. There is evidence that impacted people have significant, unmet mental health needs. AIMS: To explore the psychological support needs of people infected and affected by the infected blood scandal in England, their experiences of seeking support and how insights from this research could inform responses to people affected by similar failings, including the Hillsborough Disaster, Windrush Scandal and Post Office Horizon IT Scandal. METHOD: We used a qualitative design involving semi-structured interviews with infected and affected people in England and with mental health practitioners to explore experiences, psychological impacts and perspectives on existing support services. Our analysis was thematic, adopting an empathetic interpretive orientation toward participants' experiences. RESULTS: We identified significant unmet mental health needs among infected and affected people, including those who had been in contact with NHS or private psychological support services. Historically, infected and affected people have rarely accessed effective mental health support. CONCLUSIONS: Insights from the Infected Blood Inquiry and the subsequent development of a bespoke psychological support service could inform the setting up of skilled, tailored psychological support for people affected by other severe, systemic state failings. This response could address complex, unmet mental health needs and increase understanding of the psychological impacts of scandals resulting from systemic, statutory failings
Separating Myths From Facts About Bread and Health.
Get PDFWhite bread remains a staple food in many countries and global consumption continues to increase. However, there is an increasingly contentious debate, carried out particularly in social media and the popular press, about the adverse effects on health of factory-produced sliced white bread as opposed to the whole grain breads made with traditional processes, with the classification of factory-produced sliced bread as 'ultra-processed' adding to these concerns. We examine the scientific basis for this debate and conclude that, despite the loss of bran and germ components during milling and the use of additives, factory-produced white bread is not intrinsically unhealthy. We therefore conclude that while wholegrain bread is generally recommended as a healthier choice, both white and wholegrain breads have a place in a healthy diet when consumed in moderation and as part of an overall nutrient-rich eating pattern
School Meals Case Study: Republic of Korea
Get PDFThis school meals case study forms part of a collection led by the Research Consortium for School Health and Nutrition’s "Good Examples" Community of Practice. The School Meals Case Study of the Republic of Korea serves to document how the national school meals programme is organized, funded, and monitored throughout the country. The objectives of this case study include presenting an introduction to the country profile, outlining the design and implementation of school feeding programmes, describing their monitoring and evaluation processes, and highlighting lessons learned, best practices, and challenges. This case study is written as a working paper, and can be updated to reflect evolving circumstances. The ‘Good Examples’ Community of Practice supports the evidence generation of the Research Consortium for School Health and Nutrition, the evidence-generating arm of the School Meals Coalition. The Research Consortium’s objective is to carry out independent research across diverse sectors and generate solid, compelling, and actionable evidence regarding the benefits of school food programs to inform evidence-based decision-making on school health and nutrition policies and practices
Assessing the impact of heat waves on childhood immunization coverage in Sindh, Pakistan: Insights from 132.4 million doses recorded in the provincial electronic immunization registry (2018-2024).
Get PDFINTRODUCTION: Heat waves, intensified by climate change, are increasingly challenging health systems, particularly in low- and middle-income countries (LMICs). Pakistan, ranked among the top 10 most climate-vulnerable nations, faces significant challenges in maintaining routine immunization coverage rates amid soaring temperatures. This study examines the impact of heat waves on immunization delivery in Sindh Province of Pakistan, a region highly vulnerable to climate-induced disruptions. METHODS: We analyzed child-level data from the provincial electronic immunization registry for 132.4 million immunization doses administered between January 1, 2018, to July 31, 2024. We used the clustered panel univariate and multivariable Poisson and negative binomial regressions to analyze the association between high temperature alert days (33 °C to 39.9 °C) and heat waves (> 40 °C) and immunizations, by vaccination modality (fixed site, routine outreach, enhanced outreach). The analysis controlled for external shocks, such as floods, the COVID-19 pandemic, and vaccinators' strikes, and accounted for geographic and temporal variation. RESULTS: Heat waves and high temperature alert days (≥33 °C) significantly reduced immunizations, with routine and enhanced outreach activities being most affected (13.6 % and 21.2 % decline respectively). Fixed-site immunizations witnessed a comparatively lower decline i.e. 5.8 %. Rural Divisions Larkana and Sukkur were disproportionately affected, while Karachi exhibited minimal impact. Despite the negative impact of heat waves, immunization efforts intensified during external shocks like floods and the COVID-19 pandemic, particularly through prolonged and frequent outreach activities. DISCUSSION: Heat waves disrupted vaccine service delivery leading to reduced immunization coverage in Sindh, disproportionately affecting immunizations administered through outreach activities. Geographic and temporal variations highlight the need for localized strategies, including improved infrastructure, optimized outreach schedules, and robust vaccine cold chains. Future research should explore long-term adaptive strategies for maintaining vaccination coverage amid increasing impact of climate change, especially in low-resource settings
Accelerated long-term forgetting as a predictor of clinical onset in presymptomatic autosomal dominant Alzheimer’s disease
No full textBackground
In Alzheimer’s disease (AD), sensitive measures of cognitive decline prior to overt symptoms are urgently needed. Accelerated long-term forgetting (ALF), where new information is retained normally over conventional testing intervals but is then lost at an accelerated rate over the following days and weeks, has been identified cross-sectionally in presymptomatic autosomal dominant and sporadic AD cohorts. We aimed to assess whether ALF testing is predictive of proximity to future symptom onset.
Methods
20 asymptomatic autosomal dominant AD mutation carriers who performed normally on standard cognitive testing underwent ALF assessment with (1) a list, (2) a story and (3) a visual figure, with the testing of 30-min recall and 7-day recall. Participants were followed up annually for a median of 7 years and assessed each time with the Clinical Dementia Rating (CDR) scale.
Results
9/20 participants developed symptoms (CDR global>0) during follow-up. Those who became symptomatic had lower baseline ALF scores for both the list (progressors=30 (IQR, 30–36.4) and non-progressors=58.3 (IQR, 33–66.7), p=0.03) and story (progressors=58.8 (IQR, 44–66) and non-progressors=81.2 (IQR, 69.1–87.8), p<0.001). Story ALF (area under curve (AUC)=0.82) and list ALF (AUC=0.73) discriminated between those who did and did not develop symptoms.
Conclusions
Severity of ALF is not only associated with the presence of AD pathology but also predictive of clinical onset, identifying those at the highest risk of imminent decline. ALF testing offers promise in aiding presymptomatic trial recruitment, as a presymptomatic cognitive endpoint and potentially as a screening tool in the wider population
4th Annual Research Statement to the Members of the School Meals Coalition
No full textThe Research Consortium for School Health and Nutrition was launched in 2021 as a global initiative
to provide independent, evidence-based guidance to the 109 member states of the School Meals
Coalition as they recover from the COVID-19 pandemic and rebuild the health, education and future
of their schoolchildren and adolescents.
Guided by a 10-year independent research strategy, the Research Consortium aims to consolidate and
distil research findings to guide actionable approaches that policy makers can apply in their own
national contexts. Since its founding in 2021, more than 1,200 academics, practitioners, and
policy advisors from 600 organizations across 120 countries have organically formed a Global
Academy, organized around six thematic Communities of Practice. Broad support from donors
enables the Research Consortium Secretariat to undertake country-based and country-led research
together with members of the Global Academy. In addition, the Research Consortium also partners
with established knowledge hubs—such as National Centres of Excellence and regional bodies—to
expand peer-to-peer learning and share findings more widely.
This is the Research Consortium’s Fourth Annual Research Statement.1 As in previous years, the 2025
Annual Research Statement reports new programmatic and policy insights, as well as building on the
evolving evidence since the Coalition’s Ministerial Meeting in Nairobi, Kenya in 2024. The Statement
expands on this evidence base by exploring the implications for policy, with the aim of contributing to
the reach, quality, and comprehensiveness of national school meals programmes towards 2030.
The Statement was prepared by the Research Consortium as an input to the School Meals Coalition
for the parliamentarians and policymakers of the member countries of the Coalition. The insights
consolidated within this Statement draw from analyses led by the Research Consortium’s Global
Academy, as indicated under each statement below
Provision of gender-affirming care for trans and gender-diverse adults: a systematic review of health and quality of life outcomes, values and preferences, and costs
No full textBackground: There is a substantial evidence base documenting the impact of gender-affirming care on health outcomes among transgender (trans) and gender-diverse people globally, but this rapidly growing body of evidence has not been comprehensively synthesized. Methods: We conducted a systematic review of studies examining outcomes, values and preferences, and costs of gender-affirming care. Protocols were registered in PROSPERO (CRD42024539078 and CRD42024569628). We searched CINAHL, Cochrane Central, Embase, LILACS, PsycINFO, PubMed, and grey literature sources for studies published between 1 January 2018 and 31 March 2024. The outcomes review included data from randomized controlled trials and longitudinal studies that compared health outcomes among adults (age 18+) who received gender-affirming care to those who did not. We synthesized data by subtype (e.g. psychosocial, hormone therapy, surgical) and by study design, using GRADE evidence profiles. We assessed risk of bias with the Cochrane ROB2 and ROBINS-I tools. We summarized values and preferences data qualitatively and provided confidence ratings using GRADE CERQual, and narratively summarized cost data. Findings: Twenty-eight studies, including four randomized controlled trials and 24 longitudinal studies, evaluated health outcomes following gender-affirming care. Moderate to very low certainty evidence from these studies suggests gender-affirming care may improve quality of life, stigma, utilization of health services, and mental health. No studies identified significant negative outcomes or harms. An additional 87 values and preferences studies, six of which also provided cost data, found that gender-affirming care is acceptable and affordable, although costs vary by type of care. Interpretation: Gender-affirming care may improve critical outcomes, including quality of life, among trans and gender-diverse adults who seek this care. Additional data from prospective controlled studies would enhance the evidence base to comprehensively document the impact of gender-affirming care on physical and mental health outcomes. Funding: World Health Organization through a grant from the Elton John AIDS Foundation and the Bill and Melinda Gates Foundation