69832 research outputs found
Sort by
Development of a non-specialist worker delivered psychological intervention to address alcohol use disorders and psychological distress among conflict-affected populations in Uganda and Ukraine.
Get PDFBACKGROUND: Despite the significant burden of alcohol use disorders (AUD), there is a large treatment gap, especially in settings and populations affected by armed conflict. A key barrier to care is the lack of contextually relevant interventions and adequately skilled human resources to deliver them. This paper describes the systematic development of the CHANGE intervention, a potentially scalable psychological intervention for people with co-existing AUD and psychological distress in conflict-affected populations, delivered by non-specialist workers (NSWs). METHODS: CHANGE was developed in sequential steps: (1) identifying potential treatment strategies through a meta-review and Delphi survey with international experts; (2) in-depth interviews (IDIs) with key stakeholders from the study settings in Uganda and Ukraine; and (3) three consultative workshops with international experts and experts from Uganda and Ukraine to develop a theoretical framework for the intervention informed by outputs of the Delphi and IDIs. RESULTS: In the Delphi survey, experts reached agreement on the acceptability, feasibility and potential effectiveness of the following components: identify high-risk situations, problem solving skills, assessment, handling drinking urges, communication skills, pros and cons of drinking, and identifying high-risk situations. From the IDIs we identified (a) causal attributions for using alcohol e.g., psychosocial stressors; (b) cultural norms related to alcohol consumption such as patriarchal stereotypes; and (c) coping strategies to deal with drinking problems such as distraction. The CHANGE intervention developed through the consultative workshops can be delivered in three sequential phases focussed on assessment, feedback, and information (Phase 1); providing the client with need-based skills for dealing with high-risk situations related to alcohol use (Phase 2), and relapse prevention and management (Phase 3). CONCLUSIONS: CHANGE is a contextually relevant and potentially scalable treatment for co-existing AUD and psychological distress to be delivered by NSWs to conflict-affected populations. Effectiveness and cost-effectiveness of CHANGE will be tested in Uganda and Ukraine
Co-creating strategies to promote uptake of HIV self-testing among young adults in Mecklenburg county, North Carolina: a protocol for a pilot implementation study.
Get PDFBACKGROUND: HIV testing is the gateway to entering HIV care and prevention services. However, HIV testing rates remain low among young adults (18-29 years old) in Mecklenburg County, North Carolina (NC), an ending the HIV epidemic (EHE) priority jurisdiction. We aim to utilize community-engaged and participatory approaches to co-create implementation strategies to promote the reach and uptake of HIV self-testing (HIVST) among young adults in the region. This study protocol outlines the phases of the project and the proposed outcomes. METHODS: The Community-engaged Approaches to Expand HIV Self-Testing among Young Adults in Mecklenburg County, North Carolina (CATEST) project will be conducted in three phases, guided by the Consolidated Framework for Implementation Research (CFIR), Community-based Participatory Research (CBPR), and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) frameworks. The formative phase of the study, guided by CFIR, will focus on understanding the barriers, facilitators, and opportunities for implementing HIVST among young adults in Mecklenburg County, North Carolina. The second phase, guided by CBPR, will utilize participatory approaches such as crowdsourcing open calls and charrettes to co-create implementation strategies for HIVST. Then, the final pilot implementation phase, guided by CFIR and RE-AIM, will use mixed methods to evaluate the success of the co-created HIVST implementation strategies using a pre-post design. Participants in the study will complete a baseline survey and a follow-up survey immediately following intervention completion. In addition, a purposive sample of participants and representatives at the participating community organization will complete qualitative exit interviews within 1 month of intervention completion. DISCUSSION: This study protocol outlines the co-creation of implementation strategies, tests their feasibility, and explores preliminary effectiveness in promoting HIVST uptake among young adults in Mecklenburg County, NC. The study will yield insights on the feasibility of leveraging the capabilities of community and youth innovation to promote young adults-centered implementation strategies to advance the reach and adoption of HIVST among young adults. REGISTRATION: Registered on Open Science Forum-DOI 10.17605/OSF.IO/2BZWV
A Bayesian life-course linear structural equations model (BLSEM) to explore the development of body mass index (BMI) from the prenatal stage until middle age.
Get PDFOBJECTIVE AND METHODS: We have developed a novel Bayesian Linear Structural Equations Model (BLSEM) with variable selection priors (available as an R package) to build directed acyclic graphs to delineate complex variable associations and pathways to BMI development. Conditional on standard assumptions used in causal inference, the model provides interpretable estimates with uncertainty for natural direct, indirect (mediated) and total effects. RESULTS: We showcase our method using data on 4119 offspring followed from the pre-pregnancy period to age 46 years (y) in a Finnish population-based birth cohort. The BLSEM enabled efficiently to analyse all available data over the long-time span, identifying factors to distil potential causal pathways contributing to adult BMI development. All of the associations between early childhood and adolescence variables with adult BMI at 46 y (BMI46) were indirect via multiple paths. For example, maternal prepregnancy BMI, smoking and socioeconomic position are associated with BMI46 through 35, 31 and 26 paths. Another notable feature was that the contribution of very early life factors, particularly prenatal, was captured by growth patterns along childhood, which were the strongest early predictors of middle age BMI46 (the age at adiposity rebound (AgeAR), early growth parameters between the AgeAR to 11 y). BMI and blood pressure measured 15 y earlier also predicted BMI46, all other factors held constant. Genetic predisposition by the polygenic risk score for BMI showed an indirect effect that became apparent at AgeAR and thereafter. CONCLUSIONS: The Bayesian approach we present and the BLSEM software developed advances methodologies for the analysis of complex, multifaceted life-course data prior to the estimation of potential causal pathways. Our results, although exploratory in nature, suggest that the effective interventions to tackle adverse BMI development could be designed throughout childhood, though the period by AgeAR may be paramount. We feature the importance of integrated life-course analyses that help to understand the contribution of life-stage factors of development
Risk of endometrial cancer among breast cancer survivors in Japan: a matched cohort study.
Get PDFBACKGROUND: Breast cancer (BC) survivors may have an increased risk of endometrial cancer due to shared risk factors and tamoxifen use. However, the risk among women in Japan and that for each endocrine therapy regimen remains unknown when comparing BC survivors to women without BC. METHODS: We conducted a matched-cohort study using the JMDC claims database, covering company employees and their family members in Japan. Between January 2005 and December 2019, women aged 18-74 years with BC were matched to women without BC in a 1:4 ratio by age and database entry timing. Endometrial cancer risk was compared using stratified Cox regression. In addition, starting the follow-up at one year after matching, we assessed risk by endocrine treatment (tamoxifen, aromatase inhibitor [AI], and no endocrine therapy) using unstratified Cox regression. RESULTS: Among 23,729 BC survivors and 95,659 matched women (median age, 49.5 years), there were 56 vs 40 endometrial cancer cases (0.73 vs 0.13 cases/1,000 person-years, respectively), with adjusted hazard ratios of 7.71 (95% confidence interval 4.56-13.0). In the analysis by endocrine treatment, tamoxifen (n = 9,183; median 46.3 years), AI (n = 4,582; 58.1 years), and no endocrine therapy (n = 5,763; 49.4 years) cases were 26, 5, and 10 (0.92, 0.43, and 0.61 cases/1,000 person-years, respectively), and the adjusted hazard ratios were 5.67 (3.20-10.0), 2.17 (0.79-5.95), and 3.56 (1.66-7.65), respectively, compared to women without BC. CONCLUSIONS: BC survivors in Japan had an increased risk of endometrial cancer compared to women without BC. The risk was higher in women prescribed tamoxifen and those with no endocrine therapy
Mapping play-based interventions for children with disabilities in LMICs: a scoping review on cultural relevance, implementation, and impact.
Get PDFBACKGROUND: Over 90% of children with disabilities live in low- and middle-income countries (LMICs) and experience worse health outcomes than their peers. Play-based interventions may improve the well-being and quality of life of children with disabilities and their caregivers. We aimed to identify and map the evidence on play-based interventions for children with disabilities in LMICs. METHODS: Following a systematic search of Medline, Embase, PsycINFO, African Journals Online, and LILACS, we screened 2577 studies for inclusion in October 2024. We used thematic analysis to summarise the data. FINDINGS: Twenty eligible studies were identified that targeted children with disabilities, aged 2-12 years. Most studies (55%) focused on how play supports therapy, communication, and skills development, while fewer studies (15%) explored feasibility, developmental outcomes, or parental support. A substantial proportion of studies took place in upper-middle-income countries (60%) and 50% were from Central and South America. Many interventions were delivered by researchers (55%), with some involving parents (25%), community members (5%), or health professionals (10%). Cultural and contextual adaptations were noted in 40% of studies, and these changes were typically confined to surface features such as use of local languages, traditional games, and culturally relevant illustrations. While most studies reported positive outcomes, concerns were raised about limited parental engagement and challenges in adaptation. Only one study conducted a cost analysis. Ten grey literature resources met inclusion criteria. These resources offered practical guidance, mainly for caregivers and educators, on making play accessible for children with disabilities. Most emphasised play's role in development and inclusion, with 80% providing specific strategies, though none addressed cultural adaptation. INTERPRETATION: Play-based interventions have the potential to enhance therapy, communication, and social inclusion, although gaps remain in understanding their feasibility and scalability. The lack of economic evaluations also limits the understanding of how these interventions can be implemented in low-resource settings. Our review highlights critical gaps in play-based interventions for children with disabilities in LMICs. Despite growing interest since the UNCRPD, play remains under-researched, with most studies being small-scale, short-term, and lacking cost analysis. Interventions rarely involved communities or addressed cultural relevance in depth. Future research should prioritise inclusive, community-driven, and culturally adapted approaches. Clearer documentation, economic evaluations, and rigorous methods are needed to ensure effective, scalable, and meaningful support. Promoting culturally grounded play can improve social inclusion, development, and dignity for children with disabilities. FUNDING: The scoping review was supported by the United Kingdom Medical Research Council (UKRI165) awarded to Prof Tracey Smythe in collaboration with the London School of Hygiene & Tropical Medicine
Is Checking for Sequential Positivity Violations Getting You Down? Try sPoRT!
Get PDFBACKGROUND: Sequential positivity is often a necessary assumption for drawing causal inferences, such as through marginal structural modeling. Unfortunately, verification of this assumption can be challenging because it usually relies on multiple parametric propensity score models, unlikely to all be correctly specified. Therefore, we propose a new algorithm, called sequential Positivity Regression Tree (sPoRT), to overcome this issue and identify the subgroups found to be violating this assumption, allowing for insights about the nature of the violations and potential solutions. METHODS: We present different versions of sPoRT based on either stratifying or pooling over time under static or dynamic treatment strategies. This methodologic development was motivated by a real-life application of the impact of the timing of initiation of HIV treatment with and without smoothing over time, which we also use to demonstrate the method. RESULTS: The illustration of sPoRT demonstrates its easy use and the interpretability of the results for applied epidemiologists. Furthermore, an R notebook showing how to use sPoRT in practice is available at github.com/ArthurChatton/sPoRT-notebook. CONCLUSIONS: The sPoRT algorithm provides interpretable subgroups violating the sequential positivity violation, allowing patterns and trends in the confounders to be easily identified. We finally provided practical implications and recommendations when positivity violations are identified
An Inventory of Clinical Sarcoidosis Status in the United States.
No full textBACKGROUND: The landscape of sarcoidosis in the United States is unclear, which makes it difficult to optimize the allocation of health care resources, clinical care programs, and research activities for sites that specialize in sarcoidosis. RESEARCH QUESTION: Can the features of sarcoidosis be defined in patients requiring specialty care in the United States to inform the design of clinical management and research programs? STUDY DESIGN AND METHODS: Adult patients with sarcoidosis were enrolled in this multicenter, longitudinal cohort study. Demographic and clinical characteristics, including lung function and imaging features, were recorded at baseline. Patients were followed up for a median of 21 months (interquartile range, 9-27 months). RESULTS: The cohort comprised 2,034 patients from 39 states. Even when excluding lymph node involvement, 51.8% of patients had multi-organ disease, and sarcoidosis was chronic (≥ 3 years) for 66.5% of patients. Pulmonary fibrosis was present in 35.9% of those with lung involvement and was associated with worse lung function, an effect most pronounced when bronchiectasis was present. Slightly more than one-half (53.4%) of the cohort required treatment at the time of study entry; of those, 24.8% were on a steroidal regimen alone, 39.7% were on a nonsteroidal regimen alone, and 35.5% were on a combination regimen. During follow-up, there were 120 new organ events, resulting in a new organ rate of 5.5 per 100 patient-years (95% CI, 4.6-6.6). Cardiac sarcoidosis was present in 16.2% of patients at baseline, and emergent cardiac involvement was the most common new organ phenotype during follow-up. INTERPRETATION: Sarcoidosis is frequently chronic and dynamic. These data support the need for programs aimed at preventing and treating pulmonary fibrosis and cardiac sarcoidosis, as well as the development of long-term, multidisciplinary management strategies
Combining target trial emulation and qualitative research to understand the effect of health visiting on child hospital admissions in England.
Get PDFHealth visiting is a complex public health intervention in which specialist nurses work with families to support the healthy development of children up to 5 years of age. Using routinely collected administrative health data, we emulated a target trial to estimate the effect of enhanced health visiting services on potentially avoidable hospital admissions for children born in 10 local areas in England between 2016 and 2019. We found that receiving additional support from the health visiting team in the early weeks of life was associated with an increased odds of a child experiencing a potentially avoidable hospitalization (OR, 1.28; 95% CI, 1.02-1.60). Health visiting may encourage families to seek secondary health care, for example by building confidence in public services or heightening parental anxiety about the risks of childhood health conditions. However, qualitative research and sensitivity analyses indicated that our effect estimate may have been subject to residual confounding, selection bias or both. An in-depth understanding of the intervention and the mechanisms through which treatments are assigned is essential for generating valid estimates of causal effects
The use of Qualitative Comparative Analysis (QCA) in child well-being research: a scoping review of research on child well-being research and interventions.
Get PDFBACKGROUND: Qualitative Comparative Analysis (QCA) is a method for examining configurational causality by identifying pathways that lead to an outcome of interest. There is a growing body of literature that uses QCA to measure child well-being due to its ability to generate evidence of causality for complex social phenomena. This scoping review examines how QCA studies are being employed to investigate child well-being and assesses the potential of QCA as a method to produce intervention-focused evidence and to contribute to future methodological development to address the complexity of child well-being. METHOD: We systematically searched Embase, PsyINFO, MEDLINE, Social Policy and Practice, Global Health, Econlit, Scopus and Web of Science for peer-reviewed studies that had used QCA methods in child well-being studies. We searched studies published in English up until 2023. Systematic reviews and meta-analyses using QCA were excluded due to insufficient methodological detail for inclusion in our analysis. We followed the PRISMA-ScR flowchart and guidelines for study screening to ensure a systematic selection process. Data extraction was undertaken to capture information of most relevance to QCA best practice. Data were analysed using a basic qualitative content analysis approach. RESULTS: The search identified 626 papers, of which 28 met our inclusion criteria. Dimensions of well-being included: psychological/mental health (n = 9); physical health (n = 2); language development under education (n = 1); socio-emotional health (n = 7); physical and psychological/mental health (n = 3), psychological/mental health and education (n = 1); and multi-dimensional health (n = 3). Two studies stated explicitly that they used well-being concepts-subjective well-being and psychological well-being. Most studies (n = 23) were predominantly in high income countries (HIC). Commonly reported strengths of QCA were the capacity to a) describe various pathways or combinations of pathways to the same outcome (equifinality); and b) examine conjunctural causation (combination of absent/present conditions), known as 'causal complexity'. Weaknesses related to a) generalisability of the data; and b) the number of causal conditions that can be included in the analysis. Our findings suggest that QCA can be effectively used alongside traditional analyses to provide a more nuanced understanding. CONCLUSION: QCA is a promising method with potential to address complexity when assessing the different dimensions of child well-being. More comprehensive guidelines are now available that offer good practices to enhance the quality of the QCA research. To build greater confidence using this method, scholars are recommended to adhere to these good practices to establish the highest levels of transparency of the analysis
Sample size efficiency of restricting participation in tuberculosis vaccine trials to interferon-gamma release assay-positive participants.
Get PDFBACKGROUND: A common approach to reducing sample sizes for late-stage tuberculosis vaccine trials is to restrict enrolment to interferon-gamma release assay (IGRA)-positive participants to maximize tuberculosis case accrual. The efficiency gain, if any, from this screening strategy is unknown. METHODS: We estimated the age specific IGRA positivity prevalence for transmission levels generally considered in tuberculosis vaccine trials (annual risk of tuberculosis infection [ARTI] 2-6 %) and calculated the expected tuberculosis incidence at each age by IGRA status, using a difference equation model. We modelled scenarios that assumed constant or increasing ARTI during adolescence and differing levels of partial protection afforded by previous Mycobacterium tuberculosis infection. We then estimated sample size requirements for tuberculosis vaccine trials enrolling only IGRA-positive participants or participants without prior IGRA testing ('Mixed' trial). We assumed participants were 15-44 years at enrolment and followed-up for 3 years. RESULTS: Estimated tuberculosis incidence was 4.7 times higher in IGRA-positive compared to IGRA-negative participants at age 15 years, but 0.9 times lower at age 44 years (assuming ARTI 4 %). This age-cohort effect was exacerbated when assuming partial protection and attenuated when assuming increasing ARTI during adolescence. In a model that included both these assumptions, the sample size required for a Mixed trial compared to that for an IGRA-positive participants-only trial was 124 % larger at 2 % ARTI, 36 % larger at 4 % ARTI but only 8 % larger at 6 % ARTI. Prioritizing enrolment of participants aged 15-29 years improved sample size efficiency for an IGRA-positive participants-only trial. These results were largely unaffected by our model assumptions. CONCLUSION: In late-stage tuberculosis vaccine trials among adults and adolescents, pre-enrolment screening by IGRA testing provides a large sample size efficiency when M. tuberculosis transmission levels are relatively low, but modest or no sample size benefits at high transmission levels