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Codesign of Mental Health Interventions With Young People From Racially Minoritised Populations: A Systematic Review of Methods and Outcomes.
Get PDFBACKGROUND: Codesign of mental health interventions entails the active involvement of end users and other stakeholders in various stages of the developmental process. This has emerged as a promising approach for developing evidence-based mental health interventions aligned with minoritised populations' needs and preferences. However, key questions remain about the methods and outcomes of codesign studies focused on young people from racially minoritised groups. The current review aimed to explore the codesign approaches and phases used in developing mental health interventions with young people from racially minoritised populations, analyse the codesign outcomes for participants and examine the contextual enablers and barriers impacting the codesign process. METHODS: A systematic search was conducted across MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science and Scopus. Citations and references of included studies were also checked. Study quality and reporting of codesign were assessed using the Mixed Method Appraisal Tools and the Guidance for Reporting Involvement of Patients and the Public-2 checklist. Data were synthesised using narrative synthesis, content analysis and meta-synthesis. RESULTS: Eighteen eligible studies reported various codesign and participatory approaches, including community-based participatory research, co-production, human-centred design, youth and family codesign model, community engagement research, community development model, participatory evaluation model, participatory research design approach and community participatory research partnership. The most common codesign stages followed were exploring problems and solutions, ideating and creating, and refining. In terms of outcomes, the reported benefits of codesign for young people included personal development and well-being, enhanced knowledge and career skills, and better mental health outcomes. Codesigning with youth and other stakeholders (e.g., family members, other caregivers, community members and practitioners) also improved the research projects by identifying specific problems, increasing participant recruitment and enhancing data collection. Additionally, other stakeholders gained a platform to share their expertise, understand youth mental health and build capacity through codesign. Regarding enablers and barriers, reducing power differentials, fostering community engagement and collaboration with other stakeholders facilitated the codesign process, whereas barriers included lack of resources, power imbalances, lack of rapport building and selection bias. CONCLUSIONS: This review outlines the potential benefits of codesign for developing mental health interventions for racially minoritised youth. These benefits include continuous stakeholder engagement to understand community needs better, reducing power differentials and building trust through culturally tailored activities and communication strategies. PATIENT AND PUBLIC CONTRIBUTION: Patients and the public did not contribute directly to this review though the reviewed literature was specifically concerned with participatory research activities
The role of puppetry in mental health promotion: A scoping review of its efficacy and applications
Get PDFPuppetry-based interventions have gained recognition as a potential tool in therapeutic, educational, and social contexts, offering unique benefits in emotional expression, anxiety reduction, and social skills development, thereby contributing to mental health promotion. This review aims to bridge the gap between practice and theory, providing a comprehensive understanding of the role of puppetry in therapeutic and educational settings for promoting mental health. A scoping review was conducted using the PICOS framework and PRISMA-ScR guidelines, examining studies across 16 databases up to August 2024. This review evaluated 30 studies to assess the effectiveness of puppetry-based interventions across diverse populations, including children, adolescents, and vulnerable groups such as refugees and the elderly. The findings demonstrate significant improvements in emotional regulation, anxiety management, and social interaction, particularly in pediatric and educational settings. However, the review also identifies critical gaps in the literature, including the limited use of large-scale randomized controlled trials, a scarcity of longitudinal studies, and inconsistent application of theoretical frameworks. These gaps highlight the need for more rigorous and theoretically grounded research to fully optimize the benefits of puppetry-based interventions. This review consolidates existing evidence and offers a roadmap for future research, emphasizing the importance of standardized protocols and long-term outcome evaluations. The findings contribute to the growing recognition of puppetry as a valuable tool in therapeutic and educational practices, offering insights into how these interventions can be effectively tailored to meet the needs of diverse populations
Projected uptake of sulfadoxine-pyrimethamine for perennial malaria chemoprevention in children under 2 years of age in nine sub-Saharan African countries: an epidemiologically-based 5-year forecast analysis.
No full textBACKGROUND: Perennial malaria chemoprevention (PMC) with sulfadoxine-pyrimethamine (SP) is recommended for children under 2 years of age living in areas of perennial malaria transmission. Initially delivered through the Expanded Programme of Immunization (EPI), recent pilot studies explored PMC delivery via the vitamin A supplementation programme or community health workers (CHWs). Understanding SP demand across the various delivery channels is key to implementing PMC. METHODS: A 5-year epidemiologically-based forecasting model was developed to estimate SP volumes required for nine sub-Saharan countries based on seven different scenarios considering the EPI, vitamin A or CHWs delivery channels, alone or in combination. Model inputs were secondary data sources, enhanced with information from a field survey conducted among 40 national decision-makers and 176 healthcare providers. Projected SP volumes were estimated based on expected coverage and uptake within the eligible population. The efficiency of meeting the need versus demand was calculated for each scenario. A sensitivity analysis was performed for base, low and high estimates of the coverage and uptake rates. The forecasting period was 2023 to 2027. RESULTS: The eligible population in the study countries was estimated at 21 million children in 2023. Estimated demand in 2027 ranged from 17.8 million SP doses for EPI to 49.6 million when combining all delivery channels. These results were highly dependent on the coverage and uptake rate of each delivery channel. The sensitivity analysis showed that uncertainty around the estimates ranged from twofold (Vitamin A), to 3.4-fold (CHWs). EPI was the most efficient channel overall (53%), but the efficiency of each scenario varied by country depending on local contexts. CONCLUSIONS: The model provides a tool to anticipate SP needs and demand for PMC under various scenarios, aiding manufacturers, donors, partners, governments, and procurement organizations in effective planning for PMC implementation
Climate-Sensitive Health Outcomes in Kenya: A Scoping Review of Environmental Exposures and Health Outcomes Research, 2000–2024
Get PDFClimate change threatens health and social development gains in Kenya, necessitating health policy planning for risk reduction and mitigation. To understand the state of knowledge on climate-related health impacts in Kenya, a scoping review of 25 years of environmental health research was conducted. In compliance with a pre-registered protocol, nine bibliographic databases and grey literature sources were searched for articles published from 2000 to 2024. Of 19,234 articles screened, 816 full texts were reviewed in duplicate, and a final 348 articles underwent data extraction for topic categorisation, trend analysis, and narrative summary. Most of the studies (97%, n = 336) were journal articles, with 64% published after 2014 (n = 224). The health topics centred on vector-borne diseases (45%, n = 165), primarily vector abundance (n = 111) and malaria (n = 67), while mental health (n = 12) and heat exposure (n = 9) studies were less frequent. The research was geographically concentrated on the Lake Victoria Basin, Rift Valley, and Coastal regions, with fewer studies from the northern arid and semi-arid regions. The findings show a shift from a focus on infectious diseases towards broader non-communicable outcomes, as well as regional disparities in research coverage. This review highlights the development of baseline associations between environmental exposures and health outcomes in Kenya, providing a necessary foundation for evidence-informed climate change and health policy. However, challenges in data and study designs limit some of the evidentiary value
Healthy lifestyle knowledge and age at hypertension diagnosis: a primary health care based survey in Bangladesh.
Get PDFThis study examined the relationship between knowledge of healthy lifestyles and the age of hypertension diagnosis among hypertensive individuals within Bangladeshi rural population. This cross-section study was conducted among hypertensive adults (18-80 years) in a rural population. We obtained data from 3600 adults with hypertension from 40 randomly selected community pharmacies. We gathered data on demographics, health knowledge, and measured vital signs, including hypertension diagnosis year. Multinomial logistic regression analysis was used to identify the lifestyle and knowledge factors about hypertension with the age of diagnosis of hypertension. The mean age of hypertension diagnosis was 45.84 years. The mean age of hypertension diagnosis of male participants was higher than female (48.1 vs 44.4 years). Our study found that males and individuals with primary education are more likely to receive a later hypertension diagnosis (odds ratio = 2.32; 95% confidence interval: 1.75-3.10 and odds ratio = 5.96; 95% confidence interval: 3.09-11.48 respectively) for those aged ≥65. The poorest and those lacking physical exercise faced higher odds of later diagnosis (odds ratio = 2.20; 95% confidence interval: 1.53-3.15 and odds ratio = 2.37; 95% confidence interval: 1.78-3.17 respectively). Conversely, a family history of hypertension reduces the odds (odds ratio = 0.38; 95% confidence interval: 0.27-0.55). Increased knowledge of healthy lifestyle factors and engagement with health-related media correlate with later diagnosis, highlighting the influence of education and awareness on hypertension detection age. Our study reveals that knowledge of a healthy lifestyle is associated with the age of hypertension diagnosis. Targeting specific age groups based on health education programs may reduce hypertension-related complications
Association between gestational age-specific weight gain in pregnancy and risk of adverse perinatal outcomes: a secondary analysis of the INTERBIO-21st Fetal Study.
Get PDFBACKGROUND: Gestational weight gain (GWG) is a potentially modifiable factor that can influence perinatal health outcomes. OBJECTIVES: This study aims to investigate the association between gestational age (GA)-specific weight gain and adverse perinatal outcomes. METHODS: This study is a secondary analysis of the INTERBIO-21st Fetal Study, a prospective, longitudinal cohort conducted from 8 February, 2012 to 30 November, 2019, across 6 sites in Brazil, Kenya, Pakistan, South Africa, Thailand, and the United Kingdom. A total of 3354 pregnant females, aged ≥18 y with a body mass index (BMI) 90th centile. RESULTS: Inadequate GWG was prevalent, with 53% (n = 1767) below the 25th centile of INTERGROWTH-21st standards and 62% (n = 2079) below IOM guidelines. Compared with GWG between 25th and 75th centile (n = 370), females with GWG 75th centile (n = 458) had higher odds for emergency cesarean section (OR: 1.7, 95% CI: 1.1, 2.7) and PIH (OR: 1.5, 95% CI: 1.1, 1.9). CONCLUSIONS: Appropriate-for-age-specific GWG between the 25th and 75th centiles standards is associated with reduced adverse outcomes, highlighting the importance of tailored guidelines for optimal maternal and neonatal health
Association of knockdown resistance mutations with pyrethroid resistance in Aedes aegypti, a major arbovirus vector in Cameroon.
Get PDFBACKGROUND: The development of insecticide resistance in Aedes mosquitoes has been reported in several African countries. However, information about the mechanisms involved remains scarce. This study aimed to address this issue by updating the resistance profile of A. aegypti and evaluating the role of known knockdown resistance (kdr) mutations in the observed phenotypic resistance in Ae. aegypti in Cameroon. METHODS: Larvae and pupae of Aedes were collected in 2022 in four sites in Cameroon and reared to adulthood. Adult mosquitoes were tested using World Health Organization (WHO) tube bioassays for pyrethroids, bendiocarb and fenitrothion, synergist assays with piperonyl butoxide (PBO) and WHO bottle tests for clothianidin following WHO recommendations. Dead and live mosquitoes after exposure to deltamethrin and permethrin insecticides were used for the genotyping of the F1534C, V1016I and V410L mutations, sequencing of fragments of the voltage-gated sodium channel (VGSC) gene and assessment their association with observed resistance. RESULTS: The analyses revealed that A. aegypti exhibited high resistance to all of the tested pyrethroids. Mortality rates ranged from 0% for alphacypermethrin 0.05% in Douala to 63.57% for deltamethrin 0.3% in Yaoundé. An increase in resistance was also observed for 0.1% bendiocarb, with mortality rates ranging from 50.54% in Douala to 68.31% in Garoua. Full susceptibility was observed with 1% fenitrothion. Partial or full recovery of mortality was reported following pre-exposure to a synergist. This suggests the involvement of cytochrome P450 genes in the observed resistance, although other mechanisms may also be involved. The F1534C, V1016I and V410L mutations were found in live and dead mosquitoes in Douala, Yaoundé and Bertoua. However, the V1016I and V410L mutations were more prevalent in alive mosquitoes than in dead ones, indicating an association between pyrethroid resistance and these mutations. After a 1 h exposure, clothianidin showed full susceptibility in samples from Bertoua, Douala and Garoua after 7 days of observation. In Yaoundé, probable resistance was observed with a mortality rate of 94.3%. CONCLUSIONS: These findings provide evidence that metabolic and kdr resistance are both involved in A. aegypti resistance to insecticides in Cameroon. This should be considered when implementing arbovirus vector control strategies and insecticide resistance management in the country
The relative importance of fecal and urinary excretion of perfluorooctane sulfonic acid and perfluorooctanoic acid after high exposure - An observational study in Ronneby, Sweden.
Get PDFBACKGROUND: Many poly- and perfluoroalkyl substances (PFAS) are persistent and have long half-lives in the human body. However, there are limited data on the different routes of elimination. Most pharmacokinetic models assume that the urinary route dominates. OBJECTIVES: Our aim was to investigate the relative importance of fecal and urinary elimination for linear perfluorooctane sulfonic acid (L-PFOS), branched PFOS and perfluorooctanoic acid (PFOA), and to estimate volumes of distributions (Vds). METHODS: Drinking water highly contaminated with PFAS from firefighting foam was distributed to many households in Ronneby, Sweden, from the 1980s to December 2013. In 2016, PFAS levels were measured in matched serum, feces and urine samples from 147 subjects. Daily urinary and fecal PFAS elimination was estimated through urinary creatinine elimination and dry fecal mass, respectively. Longitudinal serum PFAS elimination rates were used together with fecal and urinary elimination rates to estimate Vds. RESULTS: In 2016, the median serum concentrations were 100 ng/mL for L-PFOS and 10 ng/mL for PFOA. L-PFOS was eliminated primarily through feces, with a median urinary elimination of 91 ng/day and median fecal elimination of 364 ng/day. The branched PFOS had, similarly, a primarily fecal elimination. In contrast, PFOA had a slightly higher urinary elimination, with median urinary elimination of 26 ng/day and fecal elimination of 15 ng/day. Median Vds were estimated at 93 mL/kg for PFOS and 74 mL/kg for PFOA. CONCLUSION: Fecal elimination was shown to be an important route for PFOS and PFOA elimination. Pharmacokinetic models need to take fecal elimination into consideration
Quantifying the potential relative roles of Aedes aegypti and Ae. albopictus in dengue transmission: A systematic literature review and meta-analysis of dengue virus prevalence in both vectors.
Get PDFOBJECTIVES: Aedes aegypti is the principal dengue virus (DENV) vector, while Ae. albopictus is often considered to have a negligible role. However, limited field data comparing their involvement in DENV transmission hampers accurate evaluation of current interventions targeting only one species and dengue outbreak risk assessments in non-endemic areas. METHODS: We conducted a systematic review and meta-analysis of studies assessing DENV prevalence in both Ae. albopictus and Ae. aegypti. We searched EMBASE, PubMed, SCIELO, and Global Index Medicus up to 15 September 2023. Risk ratios (RR) were calculated using fixed-effects model in meta-analyses, summarizing prevalences in Ae. albopictus vs Ae. aegypti. RESULTS: Of 5,432 records screened, 36 studies from 14 countries and territories were included (covering 96,884 Ae. aegypti and 106,205 Ae. albopictus mosquitoes). Overall, Ae. albopictus showed a 35% lower DENV prevalence than Ae. aegypti (RR=0.65, 95% CI=0.56-0.75, I²=93%). The difference was more pronounced pre-2000 (63% lower; RR=0.37; CI=0.30, 0.46), but post-2000 data showed no significant difference (2000s: RR=1.17; 95% CI=0.81, 1.69; since 2010 RR=0.86; 95% CI=0.68, 1.07). CONCLUSION: While Ae. aegypti remains the primary vector, recent evidence suggests Ae. albopictus plays a more notable role in DENV transmission than previously thought. Effective vector control strategies should therefore target both species
A comparison of the costs and patterns of expenditure for care for severe mental illness in five countries with different levels of economic development.
Get PDFAIMS: The aim of the article is to undertake the first economic analysis exploring the costs of illness (COIs) and factors affecting COIs in people living with mental disorders using individual patient-level data across five countries with different national income levels. This is done by investigating diagnosis-related and sociodemographic factors for country-specific medical and psychosocial service use in these high, lower-middle and low-income countries.
METHODS: Using data from the Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) study, a pragmatic randomized controlled trial, costs for medical and psychosocial services have been estimated over 6 months in 615 people with severe mental illness from Germany (n = 171), Uganda (n = 138), Tanzania (n = 110), India (n = 93) and Israel (n = 103). The primary economic analysis included (1) total COI expressed in 2021 international dollars and (2) proportional cost-type expenditures. Generalized linear regression models were also used to estimate the impact of psychiatric diagnosis, social disability, age and gender on the total COI.
RESULTS: Of the 615 participants (mean [SD] age 38.3 [11.2] years; 335 [54.5%] women), the total 6-month COI ranged from 10,493.19 [±13324.10] in Germany. High-income Germany and low-income Uganda both concentrated >70% of COIs on inpatient care. High-income Israel had the most balanced COI, with the lowest mean share (15.40%) on inpatient care, compared with community (35.12%) and primary care (33.01%). Female gender was associated with lower COI (eb = 0.215; p = 0.000) in Tanzania, while in India diagnosis of depression was associated with lower costs than schizophrenia (eb = 0.363; p = 0.017). Health of the Nation Outcome Scale scores (social disability) were not significantly associated with COIs in any country. In Tanzania, the total mean COI increased by 3.6% for every additional year of age. Compared to Germany, mean COIs were significantly lower by 90%, 99% and 86% in Uganda, Tanzania and India, respectively, and by 50% in Israel, although this difference was not significant.
CONCLUSIONS: National income is correlated with the total COI in people living with mental disorders but is a poor predictor of the sector-specific distribution of these expenditures.
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