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Empowering voices: Collaborative User Boards as a model for inclusive cancer prevention
Get PDFSummary: Engaging patients, the public, and stakeholders meaningfully is vital for equitable and effective cancer policies. Initiatives like CBIG-SCREEN and ECHoS demonstrate participatory approaches that build trust, legitimacy, and sustainable solutions, particularly for marginalised groups. Barriers to engagement remain including geographic, economic, and institutional constraints, as well as mistrust and power imbalances. Therefore, tailored strategies are essential for addressing these challenges. This article examines how Collaborative User Boards work to overcome contextual challenges and ensure diverse representation within participatory cancer research. It also highlights why overcoming hierarchies is necessary for co-design to work and flouris
Community perceptions and acceptability of insecticide-treated screens for mosquito proofing of unimproved houses in Chalinze district, Tanzania: a mixed-methods study
Get PDFBackground
Unimproved housing is a risk factor for malaria. Therefore, netting incorporated with deltamethrin and piperonyl butoxide, supplied as a roll to screen opened eaves, windows, and holes in the walls of unimproved houses, could offer protection by killing and/or reducing the entry of mosquitoes into a house. This study assessed the community perceptions and the acceptability of insecticide-treated screens (ITS), previously described as insecticide-treated eave nets (ITENs) and insecticide-treated window screens (ITWS).
Methodology
A mixed-methods approach was implemented in three villages of the Chalinze District in Tanzania. This approach comprised in-depth interviews (IDIs) of the local carpenters who installed the ITS, focus group discussions (FGDs) with community members in both the ITS and control arms, and the administration of a structured questionnaire to members in the ITS arm. Data collection was conducted at 6 and 12 months post-installation. A thematic framework approach was used to identify and extract relevant themes from the qualitative data, including but not limited to community perceptions, acceptability, and adverse events, which were quantified using quantitative data. Furthermore, a separate structured questionnaire was administered during ITS installation to collect information on the time required for installation and the amount of netting used per house (214) in order to assess the cost implications of rolling out ITS in the community.
Results
The ITS were perceived to reduce the entry of mosquitoes, other insects, and crawling animals such as snakes and lizards into houses. This intervention was accepted in the community, whereby the majority (95%) of participants expressed willingness to purchase the netting if sold at an affordable price of 1,000–6,000 Tanzanian shillings (USD ≤2.50) per square meter. The average time for ITS installation was 1 h per house, using an average of 29.5 running meters of fabric netting from rolls with a width of 1.5 m. The average material cost of the ITS was USD 1.25 per kilogram in transport. In this study, the average installation cost per house was USD 6.6 using standard Tanzanian salary rates, half the annual cost of insecticide-treated nets (ITNs) for a five-person household.
Conclusion
Insecticide-treated screening for unimproved houses is a promising, adaptable, and acceptable tool to supplement the existing vector control tools. The community perceived the use of ITS as a feasible intervention. This study highlights the importance of intensive community engagement during the development of a novel intervention to promptly address concerns and improve its acceptability
HIV Exposure and Neonatal Sepsis: A Descriptive Etiological Study.
Get PDFBACKGROUND: Low- and middle-income countries lack data on culture-confirmed sepsis in HIV-exposed infants, despite the reported heightened risk of infectious morbidity. This study describes culture-confirmed sepsis and antibiotic resistance patterns among HIV-exposed children in a large etiological cohort study in Kampala, Uganda. METHODS: This was a prospective birth cohort study based at 2 Ugandan sites, as part of the Progressing Group B Streptococcal Vaccines (PROGRESS) study. Any infant with risk factors, signs, or symptoms of infection presenting before 3 months of age had a blood culture and nasopharyngeal swab taken to determine the etiology of neonatal and young infant sepsis. RESULTS: Among 4492 blood cultures, 460 were obtained from HIV-exposed infants. Nine infants (1.9%) had positive blood cultures. The most frequently isolated organisms were Escherichia coli, group B Streptococcus, and Streptococcus viridans, and these organisms demonstrated resistance to the common antibiotics (aminoglycosides, penicillins, and cephalosporins) used for management of suspected sepsis. A higher proportion of the exposed babies died vs HIV-unexposed (15.8 vs 11.2; P = .005). Nasopharyngeal swabs were collected from 114 infants, with 7.9% positive for at least one virus or bacterium. CONCLUSIONS: Future work is needed to investigate why mortality among HIV-exposed infants persists despite maternal antiretroviral treatment. Antimicrobial resistance is an increasing concern in this setting
Mental health and other clinical and social characteristics of young mothers living with HIV in Zimbabwe: a mixed-methods study.
Get PDFYoung women living with HIV (YWLHIV) experience numerous stressors including treatment management and poor parent modelling. We investigated YWLHIV's mental health and other clinical and social characteristics to inform tailored support. YWLHIV (15-24 years old) participating in a peer-support model tailored for young mothers (Young Mentor Mum intervention) completed a self-administered interview and had clinical and psychological assessments in March to April 2019. A subset participated in in-depth interviews and had their partners interviewed. We analysed quantitative and qualitative data using STATA 15 and thematic analysis, respectively. We enrolled 177 YWLHIV. We found high rates of maternal viral suppression (86.9% with viral load <1000 copies/ml). Over half were at risk of common mental disorder (CMD), scoring above the cut-off point (SSQ ≥8, 50.3%) and depression (EPDS ≥12, 55.9%). CMD risk was higher among women who reported intimate partner violence in the past year (64.1% vs 39.4%; adjusted OR 2.48 (1.12, 5.48) for violence 1-2 times and 2.41 (0.99-5.85) for higher frequency; p = .03). HIV status disclosure was limited; only 44.1% had disclosed to their partners. YWLHIV confront challenges which affect their health and that of their children. Youth-focused mental health interventions coupled with couples counselling and violence prevention need to be scaled up
Network analysis of functional disabilities and their association with mental well-being in children and adolescents: multi-country study across low- and middle-income countries.
Get PDFBACKGROUND: To develop effective mental health interventions for children and adolescents, it is essential to understand the intricate link between functional disability and mental well-being in this group. AIMS: To explore the network connections between various aspects of functional disability and mental well-being in young people with disabilities. METHOD: We analysed data from the Multiple Indicator Cluster Surveys in 47 low- and middle-income countries, tracking progress towards health-related sustainable development goals. Our focus was on children and adolescents aged 5-17 with functional disabilities. Mental well-being was gauged using carer-reported signs of depression, anxiety and disability on the Child Functioning Module. Network-analysis techniques were used to examine links between mental well-being and functional disability domains. RESULTS: The study included 32 669 eligible children aged 5-17 with functional disabilities (14 826 females and 17 843 males). The core domains of disability with the strongest connections to poor mental well-being were difficulties in accepting change, making friends, behavioural control (controlling own behaviour) and remembering/concentrating. These associations remained largely consistent across different genders and developmental stages. However, there were notable gender differences and age-related shifts in the relationships between specific disabilities and mental well-being. In particular, signs of anxiety in males and depression in females were most associated with functional disability overall, while signs of depression had the closest links to disability in adolescents. CONCLUSIONS: The network perspective may enable the design of tailored interventions and support services that consider age and gender differences. Further research should continue to explore these complex relationships, incorporating novel methodologies like network-analysis to enhance the understanding of these associations
Factors Associated with the Consumption of Indigenous Crops Among Farming Households in KwaZulu-Natal, South Africa.
Get PDFSouth African farming households face several challenges regarding food security, poverty, micronutrient deficiencies and hidden hunger. This is due to millions of households lacking access to food and an adequate food basket. Consumption of indigenous crops has been proposed to help sustain vulnerable households since these crops have low production costs and are climate-resilient. However, research has found the consumption of these crops across South Africa to be relatively low. This study aims to examine the factors associated with the consumption of indigenous crops among farming households in the KwaZulu-Natal province of South Africa. A sample of 260 farming households was selected using simple random sampling. The results showed that farmers commonly cultivate exotic crops, such as spinach, cabbage, carrot, and butternut, more than any indigenous crops, except for a few cultivating taro and sweet potato. The binomial logit regression results revealed that an increase in the number of females and children within a household and farmers' experience increased the likelihood of consuming indigenous crops, whilst monthly food expenses decreased the likelihood of consuming indigenous crops. There is a considerable gap between the consumption and production of indigenous crops. The findings established that although many farming households indicated that they consume indigenous crops, this was not reflected in their cultivated crops. The study also concluded that farming households may be more aware of the nutritional benefits of indigenous crops, since an increase in the number of children in a household was linked to an increase in consumption of these crops. Additionally, experience in farming is vital, as it increases the consumption of indigenous crops. The study recommends government interventions that include increasing the production of indigenous crops by including them alongside the cultivation of exotic crops. Future work should also focus on awareness programs to promote the nutritional benefits of consuming indigenous crops. This, coupled with training centered on indigenous crops, could incentivize farming households to cultivate more of these crops for easier access
Assessing Whether Providing Regular, Free HIV Self-Testing Kits Reduces the Time to HIV Diagnosis: An Internet-Based, Randomized Controlled Trial in Men Who Have Sex With Men.
Get PDFBACKGROUND: The risk of onward HIV transmission is strongly influenced by the interval between HIV infection and its diagnosis. The SELPHI trial examined whether this interval could be reduced by offering free HIV self-testing kits to men who have sex with men (MSM).
SETTING: Internet-based RCT of MSM aged ≥16 years, resident in England/Wales, recruited through sexual and social networking sites.
METHODS: The second-stage randomization of SELPHI was open to participants who used an initial free HIV self-test kit, were HIV seronegative, and reported recent condomless anal sex. They were randomized to receive a free HIV self-test kit every 3 months (repeat testing [RT] group) versus no such offer (nRT group). The primary outcome was time from randomization to a confirmed HIV diagnosis, determined from linkage to national HIV surveillance databases. The key secondary outcome was the frequency of HIV testing regardless of test modality.
RESULTS: In total, 2308 eligible participants (1161 RT, 1147 nRT) were randomized between April 2017 and June 2018, and followed for 15-27 months. The proportion of participants reporting an HIV test in the previous 3 months was much higher in the RT group (86%) than in the nRT group (39%). Overall, 16 (9 RT, 7 nRT) confirmed HIV diagnoses were observed (0.35/100 person-years), with no difference between the groups (hazard ratio = 1.27 [95% CI: 0.47 to 3.41], P = 0.63).
CONCLUSIONS: Providing regular free self-testing kits to sexually active MSM was highly acceptable and markedly increased HIV testing. However, in this low incidence cohort, it did not result in a demonstrably more rapid diagnosis of incident infections
Tick-borne encephalitis: from tick surveillance to the first confirmed human cases, the United Kingdom, 2015 to 2023.
Get PDFBackground: Tick-borne encephalitis virus (TBEV) is a flavivirus spread by ticks and can cause tick-borne encephalitis (TBE) in humans. Previously, TBE has been reported in returning travellers in the United Kingdom (UK), but in 2019 and 2020, two probable cases of TBE acquired in the UK were identified.AimThe aim of this study was to investigate TBE cases in the UK between 2015 and 2023, describing the incidence, place and mode of acquisition and diagnostic process.
Methods: A retrospective review of possible, probable and confirmed cases of TBE diagnosed by the Rare and Imported Pathogens Laboratory (RIPL) between January 2015 and December 2023 was performed. For cases identified in 2022 and 2023, clinical data were collected for enhanced surveillance using structured case record forms. Laboratory diagnosis is reviewed and described.
Results: We identified 21 cases: three possible, seven probable and 11 confirmed cases. Of these, 12 were between January 2022 and December 2023: three possible, three probable and six confirmed cases. Two confirmed TBE cases had definite or highly probable acquisition in the UK, in June and August 2022, respectively. One of the possible cases had definite UK acquisition. Cases typically have a biphasic presentation, with encephalitis in the second phase.
Conclusion; Clinicians should be aware of the possibility of TBE when the cause for encephalitis is not identified, even in the absence of travel to previously identified endemic regions
Guidance for protocol content and reporting of factorial randomised trials: explanation and elaboration of the CONSORT 2010 and SPIRIT 2013 extensions.
Get PDFThis report presents the explanation and elaboration paper for the CONSORT (Consolidated Standards of Reporting Trials) 2010 and SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 extensions for factorial trials. Factorial trials involve randomising participants to more than one intervention, often with the aim of evaluating multiple interventions in one study or assessing whether treatments interact. The CONSORT and SPIRIT statements have been extended to allow for the unique features of the factorial design. Reporting items along with detailed explanations and examples of good practice are provided, as well as a glossary of key terms and an overview of the methodological features of factorial trials
Distribution, Risk Factors and Epidemiological Trends of Pancreatic Cancer Across Countries' Income Levels: A Comprehensive Analysis.
Get PDFBACKGROUND: Globally, pancreatic cancer poses a significant concern for public health. AIMS: The objective of this study was to assess the burden of pancreatic cancer on varying income levels.
METHODS AND RESULTS: Data from the Global Burden of Disease Study (GBD) 2021 and Gross Domestic Product Per Capita data were utilised in this study. All countries were categorised into four groups based on their income levels. Age-standardised incidence, mortality and disability-adjusted life years (DALYs) rates were the primary parameters to analyse the burden of pancreatic cancer. The associations between pancreatic cancer burden and countries' economic levels were analysed with linear regression models. High-income-level countries generally had a higher burden compared to other income levels in 2021. Greenland had the highest rate of age-standardised DALYs at 374.93 per 100 000, followed by Uruguay (297.06) and Monaco (290.87). A higher gross domestic product (GDP) per capita was linked to a higher age-standardised incidence (β = 0.77, 95% CI = 0.63, 0.90, p < 0.001), mortality (β = 0.72, 95% CI = 0.59, 0.86, p < 0.001) and DALYs (β = 14.59, 95% CI = 11.38, 17.80, p < 0.001). From 1990 to 2021, the pancreatic cancer burden increased across all income levels, with the most pronounced rise seen in lower-middle-income countries. Smoking-related age-standardised DALYs have decreased since 1990. However, there was a notable increase in males in upper-middle-income countries during the same period.
CONCLUSION: In conclusion, the pancreatic cancer burden has been increasing globally. The burden of pancreatic cancer varies significantly among countries with different income levels. Effective preventions are needed to control the burden of pancreatic cancer