69832 research outputs found
Sort by
Research on eye health 2000-2019: a global bibliometric analysis with a focus on equity.
Get PDFOBJECTIVE: To summarise global peer-reviewed primary research on eye health published from 2000 to 2019. METHODS AND ANALYSIS: We used the 'explode eye disease' function on MEDLINE to obtain all articles reporting primary research studies on eye health published between 1 January 2000 and 31 December 2019. We were intentionally broad and included population, clinical, animal and laboratory studies. We categorised the main eye condition of the paper from Medical Subject Headings (MeSH) terms, and the country of the study from the first country listed in the abstract (or if this was absent, the affiliation of the first author). A validated algorithm was used to assign gender to authors. RESULTS: We included 158 697 publications from 178 countries. Across the period, annual research output increased globally (4.2% per annum, 5057 publications in 2000 to 10 875 in 2019) and in 20 of 21 regions. There was substantial geographical maldistribution, with research output ranging from 1.0 publication/million population in Central Sub-Saharan Africa to 165.8/million in Australasia; 70% of research identified was conducted in high-income countries (n=1 11 417). 42% of publications focused on one of the five leading causes of vision impairment. Of the 789 463 authorships assigned a gender, women held 33% of all (n=261 636/789 463), 36% of first (n=47 729/131 664) and 24% of last authorships (n=31 720/129 800). Women formed 50% of authorship teams when the last author was a woman (IQR 38-71%), compared with 20% of teams when the last author was a man (IQR 0-40%). CONCLUSION: The annual research output doubled globally over the two decades, with a disproportionate output from high-income countries and slow progress towards gender parity. The main limitations of our study included the use of a single database, which may have led to an underestimation of all outputs, particularly from low- or middle-income countries
The joint impact of temperature, humidity, and air pollution on COVID-19 incidence: a multi-country time-series study in 439 cities.
Get PDFSeveral studies have explored the short-term effects of environmental stressors on coronavirus disease 2019 (COVID-19) transmission and severity. However, evidence on the interactive effects of meteorological conditions and air pollution remains limited and geographically variable. We therefore aimed to quantify the independent and interactive effects of short-term exposure to humidex, a composite index of temperature and relative humidity, and fine particulate matter ≤ 2.5 μm (PM2.5) on daily COVID-19 incidence across multiple cities and in multiple countries. Daily time-series data on confirmed COVID-19 cases, meteorological factors, and PM2.5 concentrations were collected from 439 cities in 22 countries during January 2020-August 2022 as part of the Multi-Country Multi-City Collaborative Research Network. A two-stage design was applied: first, city-specific quasi-Poisson models with distributed lag non-linear models estimated exposure-response associations; second, multilevel random-effects meta-analyses pooled city-specific estimates. Effect modification by PM2.5 was assessed using a product term between non-linear humidex function and linear PM2.5 function. Approximately 95.1 million confirmed COVID-19 cases were analyzed. Lower humidex values (0.1 °C versus 15.1 °C) were associated with increased daily cases (relative risk [RR]: 1.1192, 95% confidence interval [CI]: 1.0214-1.2262). A 10 μg/m3increase in PM2.5 over the current and preceding 2 days was associated with a modest increase in daily cases (RR: 1.0079, 95% CI: 1.0001-1.0161). No statistically significant interaction between humidex and PM2.5 was observed. Short-term exposure to cold-dry conditions and elevated PM2.5 independently increased COVID-19 incidence, highlighting the need to consider both thermal environment and air quality when designing climate-resilient public health responses. These findings enhance understanding of how climate-related environmental stressors influence COVID-19 transmission
The Influence of Innate Immunity, Adaptive Immunity and Diet on Intestinal Microbiota Following Trichuris muris Infection.
Get PDFTrichuris trichiura infects nearly 500 million people worldwide, causing intestinal inflammation, malnutrition, and growth impairment, particularly in children from low-resource settings. While host immunity is central to parasite clearance, diet and the gut microbiota may also modulate infection. Using the Trichuris muris model, we examined how immune competence and diet interact to influence worm burden, antibody responses, and gut microbiota composition. Wild-type (WT), RAG1-deficient (lacking adaptive immunity), and RAG1/γc-deficient (lacking both adaptive and innate lymphoid immunity) mice were fed either a normal diet (ND) or high-fat diet (HFD) and infected with a low dose of T. muris. WT mice on ND developed chronic infection with strong IgG2a/c responses, consistent with Th1-biased immunity. In contrast, WT mice on HFD achieved near-complete parasite clearance, accompanied by elevated IgG1 and reduced IgG2a/c titres, indicating diet-induced Th2 bias. In RAG1- and RAG1/γc-deficient mice, infection persisted under a normal diet but worm burdens were partially reduced on HFD, indicating that diet enhances parasite control through immune-independent, possibly microbiota-mediated pathways. Microbiota clustered by genotype and diet, with HFD-associated enrichment of Bacteroides, Parabacteroides, and Blautia. These findings demonstrate that diet and immune status jointly shape helminth susceptibility through coordinated effects on host immunity and the gut microbiota
Longitudinal changes in health-related quality of life after a breast cancer diagnosis in sub-Saharan Africa: Evidence from the prospective ABC-DO cohort.
Get PDFBreast cancer and its treatments impact on women's health-related quality of life, but few studies have assessed these outcomes among survivors in sub-Saharan Africa (SSA). We investigated longitudinal changes in Global Health Status (GHS) and their correlates within the African Breast Cancer-Disparities in Outcomes cohort. Newly diagnosed women (≥18 years) across five SSA countries were recruited in 2014-2017. In four countries, follow-up interviews were conducted 3-monthly over 7 years using the European Organisation for Research and Treatment of Cancer Quality of Life 30-item core questionnaire version 3. Multilevel mixed-effects models identified correlates of GHS. Overall, 1358 women from Namibia, Nigeria, Uganda and Zambia were included, with a mean age of 50.6 (SD = 13.7) years. Median follow-up time was 3 (IQR = 2-5) years, with a median of 18 GHS assessments per woman (IQR = 10-23). GHS was lowest in the first 6 months post-diagnosis but improved gradually thereafter. GHS increased with increasing education (p-value for linear trend [pt] < .0001), breast cancer awareness (adjusted-odds ratio: 1.32; 95% confidence interval 1.22-1.42), surgical treatment (1.90; 1.53-2.37), family support (1.46; 1.24-1.71) and maintaining pre-diagnosis employment (1.54; 1.41-1.68). In contrast, GHS decreased with increasing age at diagnosis (pt <.0001), rural residence (0.76; 0.70-0.82), advanced tumour stage at diagnosis (pt <.0001) and having non-HIV comorbidities (0.74; 0.60-0.92). GHS was not affected by HIV status, but it was higher during COVID-19 lockdowns than pre-/post-lockdown (1.27; 1.09-1.49). These patterns were similar at young and older ages, and in the short- and long-term. The potentially modifiable factors associated with GHS are known to influence breast cancer survival in SSA. Addressing them could improve survivorship and survival from this cancer in the region
Consensus on key domains for emergency medical teams deployment evaluation: a Delphi method study.
No full textBACKGROUND: Emergency Medical Teams (EMT) deploy to provide urgent care during and after sudden onset disasters. Although the World Health Organisation has set standards for EMTs on training, personnel, and operations, there is presently no standardised evaluation framework to assess deployments.
METHODS: As a step towards creation of an EMT deployment evaluation framework with an agreed upon common set of criteria, we used a two-round modified Delphi method to elicit perspectives from key stakeholders, including EMT members, researchers, funders, representatives of deploying governments, and host organisations. We asked participants to rate themes and questions relevant to EMT evaluation, derived from a previous study, using a four-point Likert scale, with consensus considered reached when 75% or more respondents rated the themes or questions 'slightly suitable' or 'highly suitable'.
RESULTS: Two rounds of the Delphi process were completed by 15 and 16 participants, respectively, with all first-round participants plus an additional person participating in the second round. Participants reached consensus on all 23 proposed themes and 162 of 165 (98%) proposed questions, with near unanimous views on many: 17 themes and 55 questions reached 100% consensus.
CONCLUSIONS: Based on the consensus findings and guided by the pillar themes and questions outlined in the World Health Organization's After Action Review guidance, we proposed a preliminary structure for an EMT evaluation. These findings can serve as a foundation to inform the future design of a standardised evaluation framework. Further refinement through iterative testing and stakeholder consultation will enhance the framework's practicality and adaptability
One Health antimicrobial resistance modelling: from science to policy.
Get PDFModern human and veterinary medical interventions to combat infectious diseases depend on the continued efficacy of antimicrobial drugs. Antimicrobial resistance (AMR) is the quintessential One Health challenge threatening human and animal health and welfare and has environmental effects on ecological communities in soil and water. Policy guidance on AMR needs to anticipate the likely outcomes of different interventions and courses of action. For that, transdisciplinary collaboration to understand the development, spread, and impacts of AMR is crucial. We report the outcomes of an international workshop that explored the challenges and opportunities for modelling AMR across One Health settings. They include the disparity of data quality and availability, the broader knowledge gaps in key areas such as the relationship between antimicrobial use (AMU) and AMR, and the difficulty of defining AMR as a single outcome given its heterogeneity. Differences between microbial species, resistance genes, environments (i.e., terrestrial vs. aquatic) and practical settings (e.g., human clinical vs. veterinary, or individual vs. population) complicate the generalizability of model applications. However, synoptic AMR metrics are necessary to cut through the complexity for policymaking. We discuss the status of AMR modelling with respect to a hierarchy of modelling evidence for decision-making. Finally, we consider learnings from modelling other wicked environmental challenges to develop a pragmatic approach to inform policy
Catch-Up Screening to Improve Detection of Congenital Chagas Disease in a Nonendemic Setting.
Get PDFMother-to-child transmission of Trypanosoma cruzi, the parasitic cause of Chagas disease, occurs in 5-10% of affected pregnancies. Congenital infection is usually asymptomatic, so if maternal infection is not suspected, the affected newborn may go undetected. As detection and antiparasitic treatment in early life result in much higher cure rates than treatment later in life, it is important to explore opportunities for catch-up testing of children born to women found to have T. cruzi infection. We piloted a multidisciplinary adult-pediatric disease referral pathway and developed a clinic to screen children of women diagnosed with Chagas disease. We evaluated the impact, acceptability, and patient experience of the pathway, including exploration of barriers to accessing prior testing. Of the 28 referred children, 23 (82%) attended the clinic, 22 (79%) were tested, and 1 child was diagnosed with congenital infection. The service was deemed effective and beneficial by both healthcare professionals and parents
International Monetary Fund and World Bank Influence on Domestic Health Financing Sources: A Mixed-Methods Case Study of Senegal
Get PDFBackground: International Monetary Fund (IMF) and World Bank (WB) influence on domestic health financing has been heavily debated. In this debate, in-depth country case studies are lacking.
We conducted a mixed-methods case study of IMF and WB policy recommendations and conditionality in Senegal to better understand their influence on the mix of domestic health financing sources at the country level.
Methods: We performed a purposive document review of reports from IMF, WB and government websites and academic literature from 1966-2024, semi-structured interviews between October 2019 and January 2020 with 25 key informants, and descriptive quantitative analysis of health financing sources from 2000-2022.
Results: Before 2002, IMF/WB policy recommendations and conditionalities promoted public sector austerity, health sector user fees, hospital autonomisation and private health service delivery. After 2002, more targets and safeguards were introduced to protect and increase government health spending within general public sector austerity, expand community-based health insurance, while still building the role of the private health sector. These efforts failed to achieve real-term increases in domestic government health spending between 2006-19, and user fees have prevailed.
Conclusions: Instead of broad social sector spending floors at 40% of government expenditure, a specific health expenditure floor at 10-15% of government expenditure could support progress toward the Abuja pledge. Other policy options include a relaxation of general fiscal austerity measures and improved terms of lending to support expansion of government health spending, provided this sector receives government priority.
We encourage further in-depth country-level studies into IMF/WB influence on domestic health financing
The prevalence of mental health-related multimorbidity during pregnancy: a systematic review and meta-analysis.
Get PDFINTRODUCTION: Multimorbidity during pregnancy, defined as the co-occurrence of two or more physical or psychological conditions, is an emerging global health concern associated with adverse birth outcomes. This systematic review addresses gaps in research by determining the global pooled prevalence of mental health-related multimorbidity amongst pregnant women and identifying key populations at higher risk of this type of multimorbidity.
METHODS: This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was pre-registered with PROSPERO (ID: CRD420251023056). A systematic search was conducted across MEDLINE, EMBASE, and Web of Science for peer-reviewed articles from January 1, 2015 to February 10, 2025, to capture the current landscape of mental health-related multimorbidity during pregnancy. Two independent reviewers screened titles and abstracts, full texts, extracted data, and assessed study quality using Covidence software. A proportional random-effects meta-analysis was conducted to calculate the global pooled prevalence of mental health-related multimorbidity during pregnancy.
RESULTS: The original search across databases yielded 5,989 studies. The global pooled prevalence of mental-health related multimorbidity during pregnancy across the eligible 92 studies representing over 357 million pregnant women was 1.90% (95% CI 1.73%-2.07%). The subgroup analysis by geographic region revealed that the prevalence estimate was lowest for Oceania at 0.36% (95% CI: 0.34%-0.37%) while it was the highest for Asia at 6.82% (95% CI: 5.37%-8.43%).
CONCLUSION: Mental health-related multimorbidity during pregnancy is an under-researched issue in global health. Pregnant women would benefit from further studies, development of relevant policy, and greater awareness amongst public health and medical professionals to address needs.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-026-26545-8
Prevalence and Correlates of Probable Depression and Anxiety Among Homeless Individuals During the COVID-19 Pandemic in Germany.
Get PDFOBJECTIVE: Homeless individuals are vulnerable, and a high burden of mental health problems is suspected. We aim to identify the prevalence and key predictors of probable depression and anxiety among homeless individuals in Germany during the Coronavirus disease-2019 (COVID-19) pandemic. STUDY DESIGN: Nationwide multicentre cross-sectional study including clinical, laboratory, and questionnaire-based data on the health of homeless individuals in Germany. METHODS: Data were used from the National Survey on the psychiatric and somatic health of homeless individuals during the COVID-19 pandemic. Probable depression and anxiety were determined using the Patient Health Questionnaire 9 and the General Anxiety Disorder 2 questionnaire. Logistic regression analysis was used to identify key predictors of probable depression and anxiety. RESULTS: A high prevalence of probable depression (26.8% [95% CI: 23.2-30.3]) and anxiety (27.2% [95% CI: 23.7-30.7]) was found. Logistic regressions showed both probable depression and anxiety associated with being female (depression: OR 1.80 [95% CI: 1.06-3.03]; anxiety: OR: 1.69 [95% CI: 1.03-2.76]), daily use of any illegal substances (depression: OR 3.20 [95% CI: 1.87-5.49]; anxiety: OR 2.04 [95% CI: 1.21-3.45]), and fear of contracting COVID-19 (little fear, depression: OR: 1.81 [95% CI 1.01-3.23], some fear, anxiety: OR: 2.52 [95% CI: 1.31-4.83]). Probable depression was associated with longer durations of homelessness (OR: 1.004, [95% CI: 1.001-1.007]. CONCLUSIONS: Probable depression and anxiety are highly prevalent in homeless individuals throughout. Key predictors may help to identify individuals in need and design targeted interventions