69832 research outputs found
Sort by
Study protocol for an observational panel study of heat strain in the general adult population in Basse Santa Su, The Gambia
Get PDFHeat is among the most hazardous environmental factors for human health, but humidity’s role in heat-related health effects remains unclear. This study will assess the effect of humid heat and other environmental conditions on health in a representative population in Basse Santa Su, The Gambia, a region at high risk of humid heat exposure. We will examine the association between humid heat exposure and physiological heat strain, identify vulnerable sub-groups, and evaluate adaptive behaviours. We will recruit 60–90 healthy adults from Basse Santa Su and surrounding areas. Participants will be monitored for four non-consecutive weeks across dry (November–May) and rainy (June–October) seasons. Daily questionnaires will assess activities, thermal comfort, adaptation behaviours, heat strain symptoms, mood, and sleep quality. Wearables will collect time-resolved personal and indoor exposure (temperature and humidity), heat strain, and further physiological covariates. A fixed monitoring network will measure outdoor air temperature, humidity, air quality, and environmental noise. Descriptive analyses will assess baseline characteristics, heat stress and heat strain. Case-time series analysis with distributed non-linear lagged models will estimate immediate and delayed associations between exposure to humid heat and physiological heat strain. Stratified analyses by individual characteristics will explore possible vulnerability groups. Multiple exposure models and interaction terms will explore cumulative effects of multiple environmental factors. Multilinear land use regression modelling will develop high-resolution maps of temperature, humidity, and heat stress. This study will provide new insights into humid heat’s effect on health, particularly in low-income, high-exposure settings. This study addresses limitations in prior epidemiological research on heat, humidity, and health, including lack of high-resolution and individual-level data, and limited focus on humidity as a heat-health driver, on non-mortality outcomes and on climate-vulnerable populations. This study combines high-resolution microclimate mapping and individual-level measurements which may inform future epidemiological studies and heat-health interventions
Effects of mosquito-proofing storm drains on adult and larvae mosquito abundance: Protocol of the IDAlErt storm drAin randomiSed controlled trial (IDEAS).
Get PDFAedes and Culex mosquitoes, known for spreading arboviruses like dengue and West Nile, thrive in cities, posing health risks to urban populations. Climate change can create suitable climatic conditions for these vectors to spread further in Europe. Cities contain numerous landscape and infrastructure elements, such as storm drains, that allow stagnant water build-up facilitating mosquito breeding. Modifying urban infrastructure to prevent water accumulation can reduce mosquito populations, but evidence is limited. The Public Health Agency of Barcelona, Spain, introduced a structural modification of storm drains to prevent water accumulation. Together with the Agency, we designed a randomised controlled trial (RCT) to experimentally assess the effectiveness of these modifications on adult Aedes albopictus and Culex pipiens populations. It is a parallel-arm RCT with equal randomization of 44 drains to receive mosquito-proofing modifications (intervention) or not (control). Primary outcomes are adult mosquito counts and secondary outcomes are larvae and mosquito presence, assessed weekly at each drain until no mosquitoes are detected. Data analyses include generalised linear mixed models to estimate the time-averaged and highest intervention effects, subgroup and sensitivity analyses. The trial results will guide a city-wide expansion of the storm drain modifications and provide valuable evidence to enhance existing vector control measures
Conceptualizing Sexual Wellbeing: A Qualitative Investigation to Inform Development of a Measure (Natsal-SW).
Get PDFDespite increasing scientific and policy interest in sexual wellbeing, it remains poorly conceptualized. Many studies purporting to measure it instead measure related but distinct concepts, such as sexual satisfaction. This lack of conceptual clarity impedes understanding, measuring, and improving sexual wellbeing. We present qualitative research from multi-stage, mixed-methods work to develop a new measure of sexual wellbeing (Natsal-SW) for the fourth British National Survey of Sexual Attitudes & Lifestyles. Literature review and discussion generated a conceptual framework with seven proposed domains: respect, self-esteem, comfort, self-determination, safety and security, forgiveness, and resilience. Semi-structured interviews with 40 adults aged 18-64 then explored whether and how these domains aligned with participants' own understandings, experiences, and language of sexual wellbeing. Data were analyzed thematically. Participants conceptualized sexual wellbeing as distinct from sexual satisfaction and sexual health and as multidimensional, dynamic, and socially and structurally influenced. All seven proposed domains resonated with accounts of sexual wellbeing as a general construct. The personal salience of different domains and their dimensions varied between individuals (especially by gender and sexual orientation) and fluctuated individually over time. This study clarifies dimensions of domains that participants considered important, providing an empirical basis to inform development of a new measure of sexual wellbeing
Rainfall variability and under-five child mortality in 59 low- and middle-income countries
Get PDFClimate change is reshaping the Earth’s hydrological cycle. Such changes impact children’s health through multiple pathways. Here we show that, in 59 low- and middle-income countries, although sufficient annual rainfall decreases under-five child mortality, anomalies in seasonal rainfall could increase under-five mortality. The risk associated with rainfall scarcity (odds ratio 1.15, 95% confidence interval (CI) 1.11–1.20) was much higher than that associated with rainfall surplus (odds ratio 1.04, 95% CI 1.02–1.06). Extreme rainfall amounts and the number of wet days are positively associated with elevated under-five child mortality. These risks were more pronounced for children from rural areas, families with lower educational attainment and households that depend on natural water sources. From 2000 to 2020, rainfall variations, extreme daily rainfall events and the number of wet days are estimated to cause 290 under-five child deaths per 10,000 persons annually (95% CI 177– 417). This investigation provides important insights into the overlooked health consequences of rainfall pattern changes on vulnerable populations
Assessing vulnerability to malaria in the context of climate change: a comprehensive study in northern Benin, West Africa
Get PDFBackground: Malaria remains a pressing public health challenge in sub-Saharan Africa, particularly in West Africa. Benin, a West African country, is currently confronted with the significant challenge of malaria infection, a public health crisis that can be attributed to the impact of climate change. Methods: This study aims to comprehensively assess vulnerability to malaria in the northern region of Benin. The assessment employed a range of exposure, susceptibility, and lack of resilience indicators to quantify vulnerability. Principal component analysis (PCA) is applied to construct a Malaria Vulnerability Index (VI) for geographic visualization. Correlations between VI and various indicators are examined to identify significant contributors to vulnerability through Pearson correlation. Results: The levels of vulnerability to malaria vary within the study area. Materi, Cobli, Boukoumbe, and Perere districts exhibit the highest vulnerability. Contrary, districts like Kerou, Pehonco, Nikki, Ouake, Parakou, Kouande, Copargo, Djougou, and Tchaourou have lower vulnerability owing to factors such as a lower prevalence of household members, and higher use rates of insecticide-treated net (ITN). In addition to some indicators of resilience such as owning mobile phones, livestock, and using natural gas for cooking. Conclusion: These findings are useful tools for policymakers, healthcare practitioners, and organisations dedicated to malaria prevention and control, emphasising the necessity of targeted methods to reduce vulnerability and increase resilience to malaria in northern Benin
Retinomics: a window to multidisease prediction using retinal biomarkers from routine eye imaging.
Get PDFBACKGROUND: The aim of this study is to investigate the potential of retinal biomarkers (retinomics) derived from color fundus photography and optical coherence tomography for predicting multiple diseases. METHODS: Using UK Biobank cohort data, we applied least absolute shrinkage and selection operator regression to address multicollinearity and identify key biomarkers. Cox proportional hazards models, with and without retinomic features. Detection rates (DR) across false positive rates (FPR: 5-40%) were assessed to ensure improved sensitivity without disproportionate false positives. RESULTS: Three retinomic features emerged as top predictors: ganglion cell-inner plexiform layer (37 diseases), retinal pigment epithelium (33 diseases), and central subfield of inner segment/outer segment-RPE (32 diseases). Adding retinomics improved mean C-index from 0.653 to 0.693 (+ 6.4%) in baseline models (age and sex) and from 0.697 to 0.721 (+ 3.5%) in clinical models (traditional common risk factors). A simplified retinal model (retinomics + age/sex) achieved C-index ≥ 0.75 for 13 diseases. Retinomics enhanced prediction by > 5% for 24 diseases in baseline models and 12 diseases in clinical models. DR improvements across FPR ranges confirmed robust performance without excessive false positives. CONCLUSIONS: Retinomics universally enhanced disease prediction, with marked gains for conditions like cardiovascular and metabolic disorders. The onset of presbyopia (~ 50 years)-a common trigger for eye exams-aligns with escalating chronic disease risks, suggesting an opportunity to leverage routine eye care for broader health assessment. While requiring further validation, this approach demonstrates the potential to enhance health screening efficiency using existing ophthalmic infrastructure, offering particular value for resource-limited settings
Molecular insights into silver nanoparticle resistance in Acinetobacter baumannii and unique adaptations to ionic silver.
Get PDFThis research provides molecular insights into the evolutionarily adapted defense mechanisms of a bacterial pathogen against the complex antimicrobial activity of silver nanoparticles at the transcriptional level. The Gram-negative, biofilm-forming bacterium Acinetobacter baumannii upregulated outer membrane proteins along with genes involved in membrane and capsule synthesis, suggestive of enhanced cell surface defense. An increase in surface-attached biofilm colonies in nanosilver-resistant A. baumannii (NAgR) appeared to be associated with enhanced cell membrane integrity and a greater production of extracellular polymeric substances (EPS), the matrix that protects the resident colony. In response to reactive oxygen species (ROS), a recognized toxicity characteristic of the nanoparticle, NAgR upregulated its oxidative stress management system, specifically involving ROS scavenger enzymes and opportunistic metal efflux pumps. Majority of these modified defense mechanisms manifested in the resistant bacterium, while absent in the wild-type strain. This study also details the unique defenses of an ionic silver-tolerant A. baumannii (AgT) variant, which evolved from the same parental strain as NAgR. Despite similarities in cell surface and biofilm defense traits, the slower-to-kill tolerant strain exclusively upregulated multidrug efflux systems and respiratory chain enzymes, thought to maintain enhanced respiratory activity, a reported tolerance characteristic. While these findings would benefit from further validating experimental work, identification of these stable defense mechanisms can help better elucidate the complex nature of bacterial NAg adaptation phenomena
Benefits of glucagon-like peptide-1 receptor agonists versus pioglitazone for cardio-hepatic outcomes: a territory-wide target trial emulation.
Get PDFBACKGROUND: Both glucagon-like peptide 1 receptor agonist (GLP1RA) and pioglitazone are associated with cardiovascular and hepatic benefits in patients with type 2 diabetes (T2D). However, studies that directly compare their cardio-hepatic effects are lacking. We emulated a target trial to compare their effects on adverse liver and cardiovascular outcomes in T2D patients.
METHODS: We adopted an "active comparator, new user" design involving T2D patients newly prescribed GLP1RA or pioglitazone between January 2008 and December 2022. The primary outcomes were major adverse liver outcomes (MALO) and cardiovascular events (MACE), with their individual outcomes and heart failure (HF) as secondary outcomes. Cox proportional hazards models were used to estimate hazard ratios (HRs) via intention-to-treat (ITT) and per-protocol (PP) analyses.
RESULTS: A total of 8922 patients (N = 4461 each group) were included. Compared to pioglitazone users, GLP1RA users had comparable risks of incident MALO (ITT: HR 0.94, 95% CI 0.66-1.34; PP: HR 1.13, 95% CI 0.60-2.15) and MACE (ITT: HR 0.99, 95% CI 0.80-1.22; PP: HR 1.10, 95% CI 0.77-1.58). The risk of HF was significantly lower in GLP1RA users in ITT analysis (HR 0.65, 95% CI 0.51-0.83). The results were consistent across most subgroup and sensitivity analyses.
CONCLUSIONS: The effects on incident major adverse liver and cardiovascular outcomes were comparable between GLP1RA and pioglitazone, although the risk of incident HF was lower with GLP1RA. Treatment decisions for T2D patients at risk of adverse cardio-hepatic events should be individualized, considering HF risk and the need for weight loss, which if present, GLP1RA may be preferred
A quadral biosignature of IFN-γ, IL-2, IL-12 and IP-10 increases the diagnostic potential for latent tuberculosis among diabetic patients in Uganda.
Get PDFBACKGROUND: Type 2 diabetes mellitus (DM) increases both the risk of acquiring latent tuberculosis (TB) infection (LTBI) and progression to active TB. The immunological mechanisms underlying the increased susceptibility remain poorly understood. This study aimed to elucidate the impact of DM on Mtb-specific cytokine and chemokine responses and identify potential biomarkers for LTBI regardless of DM status.
METHODS: This cross-sectional study recruited 164 participants with LTBI-DM (n = 51), LTBI-only (n = 63), DM-only (n = 12) and healthy controls (n = 38) at Kiruddu National Referral Hospital. Cytokine and chemokine responses were measured in ESAT-6 and CFP-10 whole blood stimulated supernatants using the Luminex assay. Linear regression with age as a covariate and false discovery rate (p < 0.050) correction were performed on log2-transformed concentrations. For biomarker analysis, comparisons were performed for LTBI (LTBI-DM + LTBI-only) versus no LTBI (DM-only + healthy controls) groups, and receiver operating characteristic analyses were performed for both univariate and multivariate analyses.
RESULTS: LTBI-DM was associated with decreased Mtb-specific IFN-γ (padjusted=0.006), TNF (padjusted=0.023), IL-12 (padjusted=0.004), IP-10 (padjusted=0.004), IL-8 (padjusted=0.030) and IL-10 (padjusted=0.043) responses compared to LTBI-only. Univariate analysis identified IFN-γ (AUC: 0.80, sensitivity: 81%, specificity: 78%), IL-2 (0.84, 75%, 88%), IL-12 (0.77, 65%, 82%) and IP-10 (0.73, 77%, 62%) as top-performing biomarkers for LTBI identification regardless of DM status. A combined four-marker biosignature yielded an AUC of 0.92 (CI: 0.88-0.97) with 76% sensitivity and 96% specificity.
CONCLUSION: Diabetes mellitus impairs Th1, inflammatory, and regulatory cytokine and chemokine responses during LTBI. A multivariate biosignature of IFN-γ, IL-2, IL-12 and IP-10 outperforms single-marker assays (e.g., variability in IFN-γ due to immunosuppression in DM) and offers robust identification of LTBI regardless of DM status, highlighting the additive value of combining mediators that capture distinct immunological axes. The improved biosignature specificity may minimise false positives in DM populations, who often exhibit comorbidities that could mimic LTBI-associated inflammation. Our findings support validating combined biomarker approaches to enhance LTBI diagnosis and prognosis in the immunocompromised DM population
Interventions for adolescent school boys and young men to reduce gender-based violence in low- and middle-income countries: a systematic review.
Get PDFBACKGROUND: GBV is a widespread issue rooted in gender inequality that disproportionately affects women and girls worldwide. In low- and middle-income countries (LMICs), the problem is even more severe, with some regions reporting GBV rates as high as 50%. While most efforts to combat GBV focus on supporting women and girls, there is growing recognition that engaging boys and young men is essential for addressing the root causes of violence. This review examines interventions designed to reduce GBV perpetration among adolescent boys and young men in LMICs, aiming to identify effective strategies for fostering healthier attitudes and behaviors.
METHODS: We conducted a systematic review of studies published between 2000 and 2023, searching databases such as Embase, Global Health, MEDLINE, APA PsycInfo, and Africa Wide Information. Out of 2,728 records, 53 studies were assessed, and 12 met the criteria for inclusion. These studies included randomized control trials, quantitative and qualitative research, and interventions delivered in schools and communities. The focus was on programs targeting behavioral change, gender norms, and bystander intervention. The data were analyzed to evaluate their impact on GBV perpetration and victimization.
RESULTS: This review revealed that school- and community-based interventions can effectively reduce GBV perpetration and victimization among boys and young men. Most studies concluded that there was significant behavioral change and a reduction in the perpetration and experience of GBV postintervention. There was also a decrease in the perpetration and experience of forced sex, dating violence, and intimate partner violence. The influence of the bystander effect on young men's attitudes toward GBV was also reviewed; however, no statistically significant improvements were identified. Overall, the findings suggest that engaging boys and young men in GBV prevention can make a difference, but more work is needed to ensure a lasting impact.
CONCLUSIONS: This review highlights the importance of including boys and young men in efforts to prevent GBV, particularly in LMICs. Effective interventions sometimes combine education, community engagement, and activities that challenge harmful gender norms. These findings can guide policymakers and practitioners in designing programs that promote gender equality and reduce violence. However, more research is needed to understand how to sustain these changes over time and how to adapt interventions for different cultural contexts. By addressing both perpetrators and victims, we can move closer to achieving global goals such as ending violence against women and girls