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Association of sitting time with cardiovascular events among manual and non-manual workers: a prospective cohort study (PURE-China).
Get PDFBACKGROUND: Prolonged sitting time is associated with an increased risk of cardiovascular disease (CVD) in the general population. However, it is unclear how these risks differ across occupational groups. This study aimed to investigate the association between sitting time and CVD in manual and non-manual workers among Chinese adults. METHODS: This population-based cohort study recruited 47,931 participants aged 35 to 70 years from 115 communities across 12 provinces in China between 2005 and 2009. Daily sitting time was measured using the International Physical Activity Questionnaire (IPAQ). The main outcome was a major CVD event (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Information on each participant's occupation was collected using standardized questionnaires and categorized into manual and non-manual occupations according to the Italian National Institute of Statistics 2001 (ISTAT-2001) occupational classification standard. Cox frailty models were used to examine the associations. RESULTS: Of 43,256 in the final sample (excluding those with CVD at baseline and missing data), 25,252 (58.4%) were women, and the mean (± SD, Standard Deviation) age was 50.6 ± 9.5 years. During a median follow-up of 11.9 (IQR, Interquartile Range: 9.5-12.6) years, 3,408 major CVD events (899 myocardial infarctions, 2,400 strokes, 240 incident heart failure, and 764 cardiovascular deaths) were documented. Compared with the reference group (< 4 h per day of sitting), the risk of major CVD events was positively associated with increasing sitting time among manual workers (HR, 1.20; 95% CI, 1.05-1.37 for 6-8 h per day; HR, 1.43; 95% CI, 1.12-1.82 for ≥ 8 h per day), while the risk among non-manual workers was greater for those reporting daily sitting times of more than 8 h (HR, 1.86; 95% CI, 1.18-2.95). Similar trends were observed when CVD mortality and incidence were analysed separately. CONCLUSIONS: Longer daily sitting time was associated with an increased risk of major CVD in both manual and non-manual occupational groups, and the risk was especially high among non-manual workers. Our findings highlight the importance of including measures to reduce sedentary behaviour within a comprehensive strategy to reduce the burden of cardiovascular disease in China
Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT-HEART randomised controlled trial in Scotland.
Get PDFBACKGROUND: The Scottish Computed Tomography of the Heart (SCOT-HEART) trial demonstrated that management guided by coronary CT angiography (CCTA) improved the diagnosis, management, and outcome of patients with stable chest pain. We aimed to assess whether CCTA-guided care results in sustained long-term improvements in management and outcomes. METHODS: SCOT-HEART was an open-label, multicentre, parallel group trial for which patients were recruited from 12 outpatient cardiology chest pain clinics across Scotland. Eligible patients were aged 18-75 years with symptoms of suspected stable angina due to coronary heart disease. Patients were randomly assigned (1:1) to standard of care plus CCTA or standard of care alone. In this prespecified 10-year analysis, prescribing data, coronary procedural interventions, and clinical outcomes were obtained through record linkage from national registries. The primary outcome was coronary heart disease death or non-fatal myocardial infarction on an intention-to-treat basis. This trial is registered at ClinicalTrials.gov (NCT01149590) and is complete. FINDINGS: Between Nov 18, 2010, and Sept 24, 2014, 4146 patients were recruited (mean age 57 years [SD 10], 2325 [56·1%] male, 1821 [43·9%] female), with 2073 randomly assigned to standard care and CCTA and 2073 to standard care alone. After a median of 10·0 years (IQR 9·3-11·0), coronary heart disease death or non-fatal myocardial infarction was less frequent in the CCTA group compared with the standard care group (137 [6·6%] vs 171 [8·2%]; hazard ratio [HR] 0·79 [95% CI 0·63-0·99], p=0·044). Rates of all-cause, cardiovascular, and coronary heart disease death, and non-fatal stroke, were similar between the groups (p>0·05 for all), but non-fatal myocardial infarctions (90 [4·3%] vs 124 [6·0%]; HR 0·72 [0·55-0·94], p=0·017) and major adverse cardiovascular events (172 [8·3%] vs 214 [10·3%]; HR 0·80 [0·65-0·97], p=0·026) were less frequent in the CCTA group. Rates of coronary revascularisation procedures were similar (315 [15·2%] vs 318 [15·3%]; HR 1·00 [0·86-1·17], p=0·99) but preventive therapy prescribing remained more frequent in the CCTA group (831 [55·9%] of 1486 vs 728 [49·0%] of 1485 patients with available data; odds ratio 1·17 [95% CI 1·01-1·36], p=0·034). INTERPRETATION: After 10 years, CCTA-guided management of patients with stable chest pain was associated with a sustained reduction in coronary heart disease death or non-fatal myocardial infarction. Identification of coronary atherosclerosis by CCTA improves long-term cardiovascular disease prevention in patients with stable chest pain. FUNDING: The Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Edinburgh and Lothian's Health Foundation Trust, British Heart Foundation, and Heart Diseases Research Fund
The effect of eave and window modifications on house entry behavior of Anopheles gambiae.
Get PDFBACKGROUND: Anopheles gambiae mosquitoes transmit malaria parasites to humans mostly by biting them indoors at night, entering houses predominantly through ventilation openings such as open eaves and windows. In the study reported here, we studied how flying An. gambiae approach and enter a house, and whether barriers to reduce mosquito house entry alter mosquito flight patterns. METHODS: Stereoscopic high-speed videography was used to reconstruct nearly 70,000 three-dimensional tracks of mosquitoes flying around a house during 30 experimental nights, with five combinations of closed or screened eaves and windows (eaves open - windows open; eaves open - windows closed; eaves open - windows screened; eaves closed - windows screened; eaves screened - windows screened). RESULTS: In this study the eave and window treatments did not affect the number of mosquitoes attracted to the house. In all cases, mosquitoes were most active during the early evening, with lower but sustained activity throughout the night. Most An. gambiae mosquitoes approached the house by flying directly towards the eave in an upward sloping path with minimal left-right deviations, and most flight activity near the house was directly in front of the eave. Due to the highly attractive nature of the eave area of the house, window treatments had limited to no effect on the number of house entries when eaves were left open, highlighting the importance of closing or screening eaves to prevent mosquito house entry. For the screened eave treatment, An. gambiae spent about 10-fold more time near the eave over the course of the night compared to the time spent near the eave in the open or closed eave treatments. Moreover, these mosquitoes returned multiple times, persistently trying to enter the house. When the eaves were fully closed, mosquitoes ultimately diverted from the eave area towards the screened window, but the initial approach flights remained towards the closed eave. CONCLUSIONS: Taken together, these results demonstrate the tendency of An. gambiae to direct house entry toward the eaves, and to only divert to other house entry points as a secondary option. The persistent mosquito flight near screened eaves may provide guidance for the placement of outdoor vector control tools
Advancing Women’s Access to Menstrual-Friendly Toilets towards Ending Period Poverty: A Public Health Imperative in the Philippines
Get PDFMenstrual health and hygiene (MHH) remains critically neglected in the Philippines despite its fundamental role in promoting the well-being, dignity, and empowerment of women and girls. This persistent lapse disproportionately impacts the well-being, education, and social mobility of women and girls across the country. Deep-rooted stigma, outdated land-use practices, and a lack of gender-sensitive planning have resulted in fragmented and inconsistent menstrual hygiene infrastructure. While promising initiatives—such as localized policies, educational campaigns, and innovative digital tools like period tracking apps—have begun to surface, these efforts remain isolated, lack scalability, and often face resistance from conservative sectors. This perspective article highlights the urgent need to mainstream MHH within the country’s public health and development frameworks. By institutionalizing gender-sensitive sanitation infrastructure, ensuring privacy and dignity in public spaces, and adopting inclusive tools such as the Menstrual-Friendly Public Toilet (MFPT) Toolkit, the Philippines can begin to dismantle systemic barriers in advancing access to MFPT. Tackling period poverty is an integral step towards building a more equitable and inclusive society for all
Consensus on Adolescent and Young Adult HIV Research Consent in Low- and Middle-Income Countries.
Get PDFIMPORTANCE: Many adolescents and young adults (AYAs) in low- and middle-income countries (LMICs) are excluded from HIV research because of challenges with informed consent for study participation, which makes it difficult to understand and improve the lives of AYAs living with HIV and AIDS in a wide variety of settings. OBJECTIVE: To help increase the inclusion of AYAs in HIV research, we developed a consensus statement on practical strategies for improving AYA consent in HIV research in LMICs. EVIDENCE REVIEW: The VOICE (HIV Youth Informed Consent & Ethics in Research) Working Group included AYAs, researchers, community organizers, advocates, research ethics committee members, parents of AYAs, and bioethicists who drafted initial statement items using data from a global open call and scoping review. An adapted Delphi process was then used to develop consensus statement items. The process involved 3 rounds of online Likert-scale questionnaires and a hybrid (online and in-person) consensus summit in Lagos, Nigeria, in 2022, with the total study period lasting from August 23, 2021, to February 10, 2023. FINDINGS: Thirty-five people participated in the final round of the Delphi process, including 14 individuals younger than 35 years (40.0%), 25 HIV researchers (71.4%), and 32 people who worked in an LMIC (91.4%). Twenty-five items reached a predefined threshold for consensus (≥80% agreement). Strong consensus emerged for formal mechanisms (eg, cocreation, crowdsourcing, or youth advisory boards) for AYA engagement in and education about research as well as for strategies to enhance parental and guardian involvement in HIV research when safe and appropriate. Capacity strengthening can allow AYAs to review research protocols, join ethical review committees, and advocate for regulatory change. Two items in the statement (alternatives to parental consent and raising awareness among research ethics committees about AYA-independent consent) required further refinement to reach the agreement threshold for inclusion. CONCLUSIONS AND RELEVANCE: Greater engagement of both AYAs and parents may help to enhance consent processes and increase the inclusion of AYAs in LMIC HIV research studies. The resulting consensus statement provides practical strategies for implementing improved consent processes for AYA research participation at the organizational, community, and policy levels, which may help foster greater inclusion of AYAs in HIV research and address existing data gaps
A Behavioral Activation Digital Intervention Incorporating Gamification and Peer Support for Adolescent Depression in Rural South Africa: A Pilot Randomized Controlled Trial (the DoBAt Study)
Get PDFObjective: Effective and scalable interventions to address adolescent depression are urgently needed. This study evaluated the feasibility, acceptability, and preliminary efficacy of digitally delivered Behavioral Activation therapy. Method: A pilot randomized controlled trial was conducted in rural northeastern South Africa. Adolescents 15 to 19 years of age with mild-to-moderately severe depression on the Xitsonga version of the Patient Health Questionnaire—Adolescent Version (PHQ-A) were recruited from 11 high schools. Participants were randomly assigned (1:1) to receive the Kuamsha app, which delivers Behavioral Activation therapy through an interactive narrative game with telephone guidance from peer mentors or a control app. We used a mixed-methods design to assess the feasibility, acceptability, and preliminary efficacy of the Kuamsha app in reducing symptoms of depression compared to a digital control. Results: Between April and September 2022, a total of 195 adolescents were randomized. Primary outcome data were available on 195 adolescents (100%). In the Kuamsha group, 77 participants (80.2%) adhered to the treatment protocol (completed at least 4 of 6 app modules), indicating favorable engagement. In-depth interviews and questionnaire responses revealed high acceptability. Reductions in depressive symptoms were modest, with no significant between-group differences at 11 weeks (adjusted mean difference = −0.37, 95% CI = −1.96, 1.22) or 24 weeks (adjusted mean difference = −0.11, 95% CI = −1.70, 1.48). Exploratory analyses suggested greater efficacy among participants who met a cut-off for moderate baseline depression symptoms (PHQ-A ≥10) and greater app engagement. Conclusion: The Kuamsha app is a feasible and acceptable treatment for depression among adolescents in rural South Africa. Following adaptations, a larger trial is warranted to assess its effectiveness in reducing symptoms of depression. Plain language summary: This pilot trial (DoBAt) in rural South Africa tested a gamified mental health app named Kuamsha for adolescents with depression. The app, based on principles of behavioral activation and supported by peer mentors, was found to be feasible and acceptable in 195 adolescents with mild to moderate depression, though it was no more effective in reducing depressive symptoms than a control app. Researchers recommend refining the app to improve efficacy. Diversity & Inclusion Statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work
A contemporary genomic snapshot of Salmonella Paratyphi A in Pakistan.
Get PDFSalmonella enterica serovar Paratyphi A is a significant but under-characterised cause of enteric fever in South Asia. In Pakistan, where the typhoid conjugate vaccine has been introduced to combat S. Typhi, S. Paratyphi A remains a prominent cause of bacteraemia, raising concerns about shifts in disease burden and antimicrobial resistance (AMR). Here, we provide a comprehensive genomic and phylogenetic analysis of 354 S. Paratyphi A isolates collected from three provinces in Pakistan between 2017 and early 2022. Whole-genome sequencing revealed the dominance of genotypes 2.3.3 and 2.4.5, indicating a largely stable population structure over time, and the presence of widespread fluoroquinolone-associated gyrA mutations. Although multidrug resistance was not detected, we identified one isolate harbouring an acrB-R717Q mutation associated with azithromycin resistance. Plasmid and replicon analysis revealed low prevalence of extrachromosomal elements, including cryptic plasmids with unknown function. Phylogenetic placement of these isolates in a global context demonstrated close relatedness to contemporary South Asian organisms. Our findings establish a genomic baseline for S. Paratyphi A in Pakistan, essential for future surveillance, AMR monitoring, and evaluating the potential impact of forthcoming paratyphoid vaccines
Age-specific chikungunya outbreak response immunisation strategies in Brazil: a modelling study.
Get PDFBACKGROUND: Two chikungunya vaccines, Ixchiq and Vimkunya are licensed. In April 2025, Brazil is the first endemic country to license Ixchiq, but optimal age groups for vaccination remain unclear. Our aim is to model the public health impact of age-specific chikungunya outbreak response immunisation strategies in Brazil and infer broader implications for vaccine use case scenarios in outbreak prone regions. METHODS: We developed an age-structured transmission dynamic model calibrated with state-level Brazilian surveillance data for 2022 and long-term average annual force of infections. We simulated outbreak response immunisation strategies targeting ages 1-11, 12-17, 18-59, and ≥60 years for Ixchiq and Vimkunya across 11 out of 27 states in Brazil. We assessed vaccine impact by symptomatic cases, deaths, and disability-adjusted life years (DALYs) averted and number needed to vaccinate (NNV) based on vaccine protection against disease only and against both disease and infection. FINDINGS: Ixchiq and Vimkunya showed similar vaccine impact. Across strategies, vaccinating children 1-11 years yielded the lowest NNV for both vaccines, whereas vaccinating adults 18-59 years achieved the greatest absolute reduction in symptomatic cases, averting 62.5% (95% Uncertainty Intervals [UI]: 54.2-84.1) of total symptomatic cases with Vimkunya and 66.2% (58.2-86.0) with Ixchiq, under disease and infection blocking mechanism. Vaccinating adults 18-59 years with Ixchiq or Vimkunya yielded similar efficiency, with NNVs to avert a DALY of 339 (39-3412) and 361 (40-3777) respectively, under disease and infection-blocking mechanism. INTERPRETATION: Under current licensure, vaccinating adolescents aged 12-17 years first, followed by 18-59 years are efficient strategies, with similar NNVs for both Ixchiq and Vimkunya. If eligibility expands to younger populations, vaccinating 1-11-year age group will have relatively higher efficiency. FUNDING: International Vaccine Institute and Japan Agency for Medical Research and Development
Health beliefs and their relation to household, necessary, and unnecessary contacts across COVID-19 epidemic waves in Taiwan.
Get PDFBACKGROUND: The COVID-19 pandemic prompted widespread preventive measures and altered individual contact behaviors. However, limited research has examined how health beliefs shape these behavioral changes. METHODS: This study investigates the association between health beliefs and close contact patterns during two COVID-19 waves in Taiwan, using a longitudinal survey conducted between July 2020 and June 2021 (the 2021 summer wave, n = 728) and a cross-sectional survey conducted between September and November 2022 (the 2022 autumn wave, n = 2,793). Participants reported close contacts from the previous day, categorized as household, non-household necessary, and non-household unnecessary contacts. Generalized estimating equations and zero-inflated Poisson models were applied to assess associations. RESULTS: The results revealed that perceived benefit from COVID-19 preventive measures and perceived severity of infection remained high since the onset of the 2021 summer wave in Taiwan. The number of non-household contacts declined during peak periods and was associated with health beliefs in distinct ways. High perceived barriers to COVID-19 preventive measures and high perceived susceptibility to infection were linked to a greater number of non-household contacts, whereas high perceived benefit from preventive measures correlated with fewer non-household contacts. Additionally, our longitudinal analysis demonstrated that health beliefs are not static but evolve over time in response to changing epidemic conditions and public awareness. CONCLUSION: These findings underscore the dynamic role of health risk perception in shaping contact behavior and highlight the value of distinguishing contact types to guide public health policies and modeling of disease transmission. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-25340-1
Postmalnutrition weight gain is associated with changes to muscle and energy metabolism in adolescence: a cohort analysis.
No full textBACKGROUND: Treatment strategies for severe childhood malnutrition often encourage rapid weight gain and catch-up growth. However, the long-term metabolic consequences of such growth are unclear. OBJECTIVES: This study applied metabolomics to investigate how postmalnutrition weight gain (PMWG) in childhood relates to metabolic variation and physiological state in adolescence. METHODS: In an exploratory cohort study, urine and plasma were collected from adolescents (n = 151) 15 y after hospitalization for childhood malnutrition in Blantyre, Malawi. Analyses included untargeted urinary 1H nuclear magnetic resonance spectroscopy, and targeted plasma liquid chromatography mass spectrometry-based metabolomics and myokine assay. PMWG was assessed using weight-for-age z-score (WAZ) at hospital discharge and 1-y follow-up from earlier studies. Adolescent physiology was measured, including muscle function [standing jump length (cm)]. Associations with PMWG were investigated using orthogonal projection to latent structures (OPLS) and regression models. RESULTS: OPLS demonstrated that a greater increase in WAZ between discharge and 1-y postmalnutrition was associated with distinct plasma and urinary metabolic signatures in adolescence, especially among those with nonedematous malnutrition. This included higher fasting plasma sugars [β = 6.40 × 103 μM; 95% confidence interval (CI): 2.99 × 103, 9.81 × 103], triglycerides, phosphatidylcholines, altered amino acids, and lower urinary muscle- and energy-related metabolites. Findings remained significant following adjustment (age, HIV, disability, sex, puberty, socioeconomic status, and minimum admission WAZ). In regression analyses, several of these metabolites positively associated with muscle outcomes, including creatinine (β = 13.5 cm; 95% CI: 7.87, 19.2) and β-hydroxy-β-methylbutyrate (β = 12.9 cm; 95% CI: 6.97, 18.7) with jump length. CONCLUSIONS: Individuals with greater PMWG exhibited lower muscle-related metabolites and altered energy metabolism in adolescence. It remains unclear whether this reflects inherent differences in how individuals gain weight, or whether early-life weight gain programs future metabolic states. Elucidating these mechanisms will inform interventions to ameliorate long-term health risks, an urgent priority following the growing double burden of malnutrition in low- and middle-income countries