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Characteristics of interventions aimed at reducing inequalities along the cancer continuum: A scoping review.
Get PDFCancer inequalities are wide and enduring, within countries between socio-demographic groups and between countries. These are generated and sustained throughout the key phases of the cancer pathway, from investigation, clinical assessment, decision and access to treatment, and follow-up care. We aimed to describe the characteristics of implemented interventions, evaluated in published controlled experiments in the medical literature, specifically designed to target reductions in inequalities along the cancer pathway. We searched the Ovid Medline and Embase databases from January 2005 to April 2024 for controlled experiments reporting on interventions tackling inequalities. We extracted information on the publication, the aim and type of intervention, its setting, the characteristics of the sample and of the interventions, and summarised their results and limitations. We identified 56 articles reporting on 57 interventions. Of these, 51 (89.5%) focused on access to screening; 56 (98.2%) focused on colorectal, breast, and cervical cancers; 37 (64.9%) concentrated on ethnic inequalities and 48 (84.2%) were based in the USA. In addition, the majority of interventions sought to change individual knowledge, beliefs, and behaviour rather than issues at the system-level. The importance of addressing how healthcare is delivered equitably to all individuals is widely recognised, and there is evidence that individual factors account for only a small part of cancer pathway inequalities. Yet, this scoping review reports a lack of diversity in the implementation of interventions addressing cancer inequalities, and a minority of them target health system issues
Gestational diabetes education management interventions implemented across Arabic-speaking countries: A systematic scoping review.
Get PDFBackground The prevalence of Gestational Diabetes Mellitus (GDM) in Arabic-speaking countries varies from 1.2 % (Jordan) to almost 40 % (Saudi Arabia). Untreated GDM increases the risk of poor maternal and neonatal health outcomes. Objective This systematic scoping review aims to examine the current literature to determine the effectiveness of interventions designed to manage and prevent GDM across Arabic-speaking countries. Design Systematic scoping review. Methods Employing the PRISMA-ScR and the AND-EAL for study quality and bias assessment, a comprehensive review of the literature was conducted using 12 databases and search terms relevant to GDM interventions conducted across the League of Arab states. The search period includes intervention studies published up to and including August 31st, 2024. Findings Eight studies met the inclusion criteria. Interventions conducted included those modeled on the Health Behavior Change model, Theory of Reasoned Action and the PRECEDE model, constructs of Social Cognitive Theory including self-efficacy, GDM self-management, lifestyle management and BASNEF model-based empowerment. The intervention studies had positive effect on GDM knowledge, self-efficacy, A1C levels, quality of life, maternal and neonatal outcomes. Conclusion Prevention and management of GDM is important in addressing maternal and neonatal health outcomes. Interventions designed with a theoretical framework and those that are culturally tailored are more likely to elicit behavior change
Investigating the suitability of dichotomous responses for the Water Insecurity Experiences (WISE) Scales using nationally representative data from 39 countries
Get PDFThe Water Insecurity Experiences (WISE) Scales have been validated to comparably measure water insecurity globally. The scales consist of 12 items that can be administered in approximately 3 minutes. There is interest in developing more rapid versions of the tools for when time is limited. One alternative is to use a subset of 4 items, which has been validated, but has some drawbacks. Here we investigate another alternative: dichotomous (yes/no) response options instead of the original four levels of frequency-based (polytomous) responses. We used nationally representative data from 39 countries to simulate dichotomized responses by collapsing the four levels of frequency (never, rarely, sometimes, often/always) into yes/no. We first explored if “rarely” is meaningful in the gradation of water insecurity, as experiences that occur “rarely” may not be affirmed with dichotomous response options. We tested item-by-item if “rarely” responses predicted dissatisfaction with water quality using logistic regression and found that they were associated with higher odds of dissatisfaction with water quality. As such, some meaningful nuance may be lost if “rare” experiences are not affirmed as “yes”. We then compared the predictive accuracy of WISE scores using simulated dichotomous responses compared to those calculated using polytomous responses. Based on receiver-operator-characteristic (ROC) curves and regression models, scores calculated using dichotomized responses had good predictive accuracy. Scores calculated using the abbreviated 4-item version were similarly accurate. Finally, we examined whether levels of water insecurity, as calculated from the original responses, could be classified using dichotomized responses. Using ROC curves, we found that this approach was effective, offering an advantage over the 4-item scales. While polytomous response options provide more detailed information, dichotomous responses offer the potential advantage of a quicker alternative for measuring water insecurity
Mortality and its predictors among people with dementia receiving psychiatric in-patient care.
Get PDFBACKGROUND: Although dementia is a terminal condition, palliation can be a challenge for clinical services. As dementia progresses, people frequently develop behavioural and psychological symptoms, sometimes so severe they require care in specialist dementia mental health wards. Although these are often a marker of late disease, there has been little research on the mortality of people admitted to these wards. AIMS: We sought to describe the mortality of this group, both on-ward and after discharge, and to investigate clinical features predicting 1-year mortality. METHOD: First, we conducted a retrospective analysis of 576 people with dementia admitted to the Cambridgeshire and Peterborough National Health Service (NHS) Foundation Trust dementia wards over an 8-year period. We attempted to identify predictors of mortality and build predictive machine learning models. To investigate deaths occurring during admission, we conducted a second analysis as a retrospective service evaluation involving mental health wards for people with dementia at four NHS trusts, including 1976 admissions over 7 years. RESULTS: Survival following admission showed high variability, with a median of 1201 days (3.3 years). We were not able to accurately predict those at high risk of death from clinical data. We found that on-ward mortality remains rare but had increased from 3 deaths per year in 2013 to 13 in 2019. CONCLUSIONS: We suggest that arrangements to ensure effective palliation are available on all such wards. It is not clear where discussions around end-of-life care are best placed in the dementia pathway, but we suggest it should be considered at admission
Disability training for healthcare workers in Uganda: qualitative findings from the pilot test.
Get PDFBACKGROUND: People with disabilities experience barriers to healthcare, resulting in poorer health outcomes. There is limited disability training for healthcare workers globally. A disability training was co-developed with people with disabilities and healthcare workers and pilot-tested in Uganda. OBJECTIVE: To use qualitative methods to understand co-learning experiences, identify strengths and areas for improvement, and to explore a disability training's effect on practices in Uganda. METHODS: We conducted a two-day Train-the-Trainer programme in September 2023 with ten trainers (5 people with disabilities, 5 healthcare workers). The trainers then delivered two one-day disability training programmes to 27 healthcare workers. Data on the perceptions and experience of the trainings were collected through focus group discussions with trainers and in-depth interviews with trainers and participants. We used an inductive approach for analysis and Kirkpatrick's Four-Level Training Evaluation Model to assess reactions, learning, behaviour changes, and results. RESULTS: The trainers valued the emphasis on practical application and the collaborative approach used during the sessions. Trainers with disabilities expressed increased confidence and ability to advocate for inclusive healthcare practices. Healthcare workers reported that the training was engaging and relevant to their roles. Three months post-training, healthcare workers reported improved attitudes and skills toward providing care for people with disabilities. Challenges in applying new practices included limitations in facility accommodations and accessibility. Further support and training were requested. CONCLUSION: The co-designed disability training programme can enhance healthcare workers' skills and interactions with patients with disabilities. Policy support is important for the implementation of disability training at scale
All parts of the WHO Mycobacterium tuberculosis mutation catalog need to be applied when evaluating its performance.
Get PDFA limitation of the World Health Organization (WHO) mutation catalog, a global reference for genotypic antimicrobial susceptibility testing for Mycobacterium tuberculosis complex, is that it was derived and tested using the same data set, which may result in overfitting (1–4). Therefore, we welcome the effort by He et al. to assess the performance of both version 1 (V1) and version 2 (V2) catalog using an independent data set from China (5). However, we have concerns about how this was carried out
Trends in Abortion Rates in Ontario, Canada.
Get PDFIMPORTANCE: Following decades-long declines, significant increases in abortion rates have been reported in some jurisdictions from 2020 to 2023, but it is not yet known whether these trends are occurring in Canada. OBJECTIVE: To assess abortion rates in Ontario from 2012 to 2022 and to examine trend changes associated with mifepristone availability, the COVID-19 pandemic, and postpandemic periods. DESIGN, SETTING, AND PARTICIPANTS: This population-based interrupted time series cohort study examined all medication and procedural abortions provided in Ontario from January 1, 2012, to December 31, 2022, to females aged 15 to 44 years with provincial insurance coverage, identified using linked health administrative data that included records from practitioner billings, inpatient and outpatient hospital services, same-day surgeries, and outpatient prescription dispensations. EXPOSURE: Availability of mifepristone regulated as a normal (ie, prescribed by an authorized prescriber without additional certification or registration and dispensed by a pharmacist) prescription medication (in November 2017) and the COVID-19 pandemic period (from March 2020 to December 2021). MAIN OUTCOMES AND MEASURES: The main outcome was the abortion rate (number of abortions per 1000 females per year) overall and within age strata, using an interrupted time series design. RESULTS: Of 422 867 medication and procedural abortions identified using data from health records of 225 540 reproductive-aged females (mean [SD] age, 28.5 [6.6] years), the abortion rate declined steadily from 15.6 abortions per year per 1000 females, aged 15 to 44 years, in 2012 to 12.3 in 2021 and then increased to 14.1 in 2022. When mifepristone was introduced in 2017 as a normal prescription medication, no immediate change in the abortion rate (-0.1 [95% CI, -0.7 to 0.8]) and a nonsignificant slope increase (0.6 [95% CI, -0.5 to 0.7]) were found. However, this trend resulted in an additional 1.5 (95% CI, 0.3-2.6) abortions per 1000 females by the first quarter of 2020 compared with premifepristone trends; rates increased more among those aged 15 to 19 years, less among those aged 35 to 44 years, and did not increase for those aged 25 to 29 years. During the pandemic period, abortion rates decreased by 1.2 (95% CI, -2.5 to -0.8), most pronounced among those aged 20 to 34 years. Compared with expected rates based on premifepristone trends, 5-year availability of normally prescribed mifepristone was associated with a rate difference of 1.9 (95% CI, 0.7-5.4) in 2022, with a greater increase among those aged 20 to 24 years (4.2 [95% CI, 1.5-9.0]) and no change among those aged 25 to 29 years (1.0 [95% CI, -1.7 to 6.2]). The increased abortion rate in 2022 was consistent with 5-year trends following normally prescribed mifepristone, although social forces potentially impacting international rates may have contributed. CONCLUSIONS AND RELEVANCE: This study found that, following longstanding declines, abortion rates in Ontario gradually increased with mifepristone availability in 2017 in Ontario. Following a pandemic-related decrease in rates (in 2020 and 2021), substantial increases in abortion rates reported elsewhere from 2020 to 2023 did not occur in Ontario as of 2022, suggesting that Ontario's health services environment and Canada's regulatory and policy approach to preserving reproductive health services may have helped stabilize abortion rates. Future research is needed to understand how sociocultural changes affecting abortion service use elsewhere may be affecting contraception access and use and thus abortion rates in Canada
The role of health systems in shaping vaccine decisions: Insights from Italy, Mexico, the United Kingdom, and the United States.
Get PDFBACKGROUND: The demographic drivers of vaccine uptake and confidence have been well-documented in diverse contexts. However, the role of health systems in improving vaccine uptake and confidence has been less discussed particularly in the post-pandemic period. METHODS: Using nationally representative surveys of adults conducted between December 2022 and April 2023 in Italy, Mexico, the United Kingdom (UK), and the United States (US), we examined demographic, health, and health system determinants of vaccine confidence and uptake of four vaccines for adult respondents or their children: COVID-19, influenza, human papillomavirus (HPV), and measles, mumps, and rubella (MMR). Logistic and linear regression models explored associations between predictors of interest and vaccine outcomes, with coefficients reported on the risk difference and risk ratio scales. FINDINGS: A total of 5180 respondents were surveyed, one-third of whom had at least one child aged 1-18 years. Having received at least three other preventive health services in the last year was associated with COVID-19 and Flu vaccination in all countries (Risk ratio (RR) 1.04-1.54) and with vaccine confidence in the US (RR 1.10). Having at least three health care visits in the last year and having a regular health provider were also associated with a higher likelihood of vaccine uptake and confidence in some countries. Being confident in one's ability to obtain and afford quality care (i.e. "health security") had a positive association with at least one outcome in all countries except Mexico (RR 1.07-1.36) and with children COVID vaccination in multi-country regression. Having a regular provider was associated with a higher probability of HPV vaccination for children. Health system engagement and health security showed stronger associations with Flu than COVID-19 vaccination and with vaccine uptake compared to vaccine confidence, although these associations varied across countries. Trust in scientists and trusting the national public health agency were also strongly correlated with several vaccine outcomes. INTERPRETATION: Our findings highlight the links between health system engagement, health security, and vaccination rates. Health system engagement may be particularly important to mitigate barriers to vaccination related to 'complacency' and 'convenience'
Gender and exposure pathways to zoonotic infections in communities at the interface of wildlife conservation areas of Uganda: A qualitative study.
Get PDFThe changing climate and increasingly frequent environmental shocks are creating new pressures on land use and intensifying inter-species contact that might foster zoonotic disease transmission. In areas where there are complex interactions between wild/domestic animals and humans, preventing and managing zoonotic infections requires an integrated One Health approach based on interdisciplinary and multisectoral collaboration. We used a One Health approach to investigate how potential zoonotic disease exposures might be gendered based on sociocultural norms. In six conservation areas in Uganda, we focused on three zoonoses: Rift Valley Fever, Brucellosis and Crimean-Congo Haemorrhagic Fever. We conducted in-depth interviews and focus group discussions with 379 purposively selected participants. Interviews/discussions were audio recorded, transcribed, coded and analysed thematically. In all areas, women and girls were responsible for household-related work while men and boys cared for larger livestock outside of the home, with some regional variations in roles. Location-specific cultural norms differentially impacted women's and men's exposures, including male initiation rituals involving consuming raw meat and animal blood reported in one study area. The different activities performed by women and men lead to differential risks of infection, suggesting that gender-sensitive interventions are required to address the risks faced by people living in these settings
The 2023 dengue fatality in Bangladesh: Spatial and demographic insights.
Get PDFOBJECTIVES: In 2023, Bangladesh faced the largest dengue outbreak, resulting in 321,179 confirmed cases and 1705 fatalities. This study aims to characterize dengue fatalities and analyze their determinants and spatial influence. METHODS: Using data from the Management Information System of the Ministry of Health and Family Welfare, we characterized dengue mortality and conducted a linear regression analysis to determine the impact of age groups and gender on case fatality rate (CFR). We used a geographically weighted Poisson regression model to assess the spatial influence and impact of population factors. RESULTS: Women had a higher CFR than men (0.75% vs 0.38%, P <0.05). Among the recorded deaths, 74% (n = 1262) developed dengue shock syndrome, 17% (n = 290) expanded dengue syndrome, and 7% (n = 119) dengue hemorrhagic fever. The 10-year age groups significantly impacted CFR (estimate: 0.03, P <0.01), suggesting that each additional decade increased CFR by 30%, whereas gender was insignificant. Higher deaths were observed in the southern regions, whereas spatial clusters were primarily concentrated around Dhaka City, the epicenter of the outbreak. Substantial effects from neighboring districts were also identified. CONCLUSIONS: Bangladesh's 2023 dengue outbreak resulted in significant mortality, particularly, among older age groups. Fatalities were clustered in Dhaka City and its neighboring districts, especially in the south