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La pandemia y la salud mental: un estudio basado en experiencias vividas por jóvenes peruanas vulnerables
Get PDFLa pandemia de covid-19 exacerbó los problemas de salud mental en todo el mundo y tuvo efectos particularmente severos en las poblaciones vulnerables. En el Perú, las tasas de ansiedad y depresión entre mujeres jóvenes aumentaron de manera significativa durante la crisis
sanitaria, alcanzando 48 % y 36 % respectivamente. El objetivo de este
estudio es comprender cómo la pandemia impactó en la salud mental
de las mujeres jóvenes en situación de vulnerabilidad, para lo cual se
analizan los factores que mediaron sus experiencias y las estrategias de
afrontamiento desarrolladas.
Esta investigación cualitativa adopta un diseño de estudio de casos múltiples con enfoque fenomenológico-hermenéutico, explorando las trayectorias de salud mental de dos jóvenes peruanas –una de
contexto urbano y otra rural– participantes del estudio Niños del
Milenio (NdM), quienes reportaron un deterioro significativo en su
bienestar como consecuencia de la pandemia. El análisis integra datos
longitudinales recolectados entre 2007 y 2023, incluyendo entrevistas
en profundidad pre- y pospandémicas, lo que permite contextualizar
los cambios tanto en las condiciones de vida como en la salud mental
de las participantes.
A partir del análisis de estos datos, se identifican tres ejes clave:
(i) el confinamiento y las responsabilidades domésticas como factores
de estrés sostenido, (ii) la inestabilidad económica y la sobrecarga de
tareas como elementos asociados al malestar emocional, y (iii) las difcultades para acceder a atención psicológica. Asimismo, se observa que
las experiencias previas de violencia, pobreza y desigualdad influyeron
en la manera en que cada joven afrontó los desafíos derivados de la crisis sanitaria. Se evidencia que la pandemia actuó como un amplificador
de vulnerabilidades preexistentes, acentuando desigualdades de género
y afectando la funcionalidad cotidiana de las jóvenes.
La relevancia de este estudio radica en su aproximación a la salud mental desde las experiencias vividas, que revela la complejidad de
su deterioro en contextos de múltiples privaciones. Los hallazgos permiten comprender la intersección entre salud mental y determinantes
sociales, así como la importancia de fortalecer políticas públicas que
amplíen el acceso a servicios psicológicos en comunidades en situación
de vulnerabilidad. A pesar de los desafíos, las narrativas muestran cómo
el apoyo familiar y comunitario, junto con estrategias individuales de
afrontamiento, han sido fundamentales en la reconstrucción del bienestar. Este estudio enfatiza, además, la urgencia de fortalecer políticas
públicas que garanticen el acceso equitativo a servicios de salud mental en poblaciones en situación de vulnerabilidad
Unintended consequences of a financial incentive scheme for fruit and vegetable purchasing in an unorganised retail setting in rural India
Get PDFConsumption of fruits and vegetables in rural India is among the lowest in the world. We assessed how a financial incentive scheme influenced purchasing of fruits and vegetables in an unorganised retail setting in rural India and explored any unintended consequences. We used a mixed-methods approach, triangulating between in-depth interviews with community members, vendors, local leaders, and intervention implementors (N = 21) and fruit and vegetable purchasing surveys (N = 1109), vendor sales surveys (N = 36), and routine coupon use data. The intervention led households to use their own budgets to buy fruits and vegetables and receive the cashback. This was used to buy more fruits and vegetables (45 % and 77 % of intervention participants, respectively). Changes in purchasing behaviours unexpectedly increased farmer-to-consumer sales in the village markets. This increased the variety of fruit and vegetables purchased locally (baseline-adjusted mean difference of 2.2 items in intervention versus control villages (95 % CI: −0.7 to 5.1)) but may have negatively impacted the sales of existing vendors (baseline-adjusted mean difference of −150₹ in intervention versus control villages (95 % CI: −296 to −0.1). Financial incentive schemes have the potential to change the food environment in unorganised retail settings, which could have major consequences for diets
A survey of indoor and outdoor Anopheles density, species composition and circumsporozoite rate of malaria vectors on the Bijagós Archipelago, Guinea-Bissau.
Get PDFBACKGROUND: The malaria-endemic Bijagós Archipelago is situated 50 km off the coast of mainland Guinea-Bissau. It is a seasonal malaria transmission setting, with insecticide-treated bed nets as its primary control strategy. Little is known about the vector diversity and behaviour across the Archipelago. METHODS: In 2019, a survey took place on 16 of the inhabited islands across the Archipelago. Adult mosquitoes were collected using odour-baited outdoor light traps and indoor light traps at houses selected at random. Larval surveys were conducted for each village sampled. Anopheles adults caught were morphologically identified and a sub-sample was analysed to identify species within the Anopheles gambiae complex using RFLP-PCR. Sporozoite positivity was detected within a sub-sample by CSP-ELISA. RESULTS: Anopheles gambiae sensu lato was present on all islands sampled. Anopheles density varied between islands, with densities ranging from 0.0 to 98.7 per trapping night from indoor traps and 0.1-165.2 per trapping night from outdoor traps. Anopheles melas was the most commonly observed species, accounting for 85.2% of all Anopheles caught from both indoor and outdoor light traps. A high level of hybridization between An. gambiae sensu stricto and Anopheles coluzzii was seen on some islands across the Archipelago. The overall sporozoite rate was 0.86% (0.2% for indoor traps; 1.4% for outdoor traps). CONCLUSIONS: Species within An. gambiae s.l. are the primary vectors on the Bijagós. Anopheles melas may contribute to transmission throughout the year in the Bijagós. The vector species composition, abundance and infection rates uncovered in this study are useful for informing tailored, effective vector control programme in the Bijagos
An Assessment of the Maturity of Cancer Survival Data Used in Economic Models for the National Institute for Health and Care Excellence's Single Technology Appraisals.
Get PDFOBJECTIVES: This study examines the maturity of survival data used in cancer drug appraisals by the National Institute for Health and Care Excellence (NICE) and the implications for decision making. METHODS: We assessed the maturity of survival data used in economic models within NICE single technology appraisals published between January 1, 2011 and December 31, 2023 (n = 301). We categorized these survival data according to whether they were "highly immature" (50%). We applied multinomial logistic regression analysis to assess the association of factors such as time period, the introduction of the Cancer Drugs Fund (CDF), cancer type, disease severity/stage, technology type, and trial design (single-arm or randomized controlled trial), with the maturity of the survival data. We then assessed the association of the maturity of the survival data with the subsequent recommendation of the NICE appraisal committee. RESULTS: After adjusting for potential confounders, the percentage of appraisals with highly immature survival data increased from 25.1% (pre-CDF) to 40.4% (post-CDF) (P = .105). Appraisals that used single-arm trials or were for early-stage cancers were more likely to use highly immature survival data. Those technologies with highly immature data were more likely to receive CDF recommendations (30.4% vs 11.5%, P = .007). CONCLUSIONS: The trend toward more NICE single technology appraisals of cancer drugs relying on immature survival data are consistent with moves by regulatory agencies to encourage expedited approvals for innovative therapies. For Health Technology Assessment decision-making, it is essential to balance early drug access with the use of robust evidence
Machine learning to optimize use of natriuretic peptides in the diagnosis of acute heart failure.
Get PDFAIMS: B-type natriuretic peptide (BNP) and mid-regional pro-atrial natriuretic peptide (MR-proANP) testing are guideline-recommended to aid in the diagnosis of acute heart failure. Nevertheless, the diagnostic performance of these biomarkers is uncertain. METHODS AND RESULTS: We performed a systematic review and individual patient-level data meta-analysis to evaluate the diagnostic performance of BNP and MR-proANP. We subsequently developed and externally validated a decision-support tool called CoDE-HF that combines natriuretic peptide concentrations with clinical variables using machine learning to report the probability of acute heart failure. Fourteen studies from 12 countries provided individual patient-level data in 8493 patients for BNP and 3899 patients for MR-proANP, in whom, 48.3% (4105/8493) and 41.3% (1611/3899) had an adjudicated diagnosis of acute heart failure, respectively. The negative predictive value (NPV) of guideline-recommended thresholds for BNP (100 pg/mL) and MR-proANP (120 pmol/L) was 93.6% (95% confidence interval 88.4-96.6%) and 95.6% (92.2-97.6%), respectively, whilst the positive predictive value (PPV) was 68.8% (62.9-74.2%) and 64.8% (56.3-72.5%). Significant heterogeneity in the performance of these thresholds was observed across important subgroups. CoDE-HF was well calibrated with excellent discrimination in those without prior acute heart failure for both BNP and MR-proANP [area under the curve of 0.914 (0.906-0.921) and 0.929 (0.919-0.939), and Brier scores of 0.110 and 0.094, respectively]. CoDE-HF with BNP and MR-proANP identified 30% and 48% as low-probability [NPV of 98.5% (97.1-99.3%) and 98.5% (97.7-99.0%)], and 30% and 28% as high-probability [PPV of 78.6% (70.4-85.0%) and 75.1% (70.9-78.9%)], respectively, and performed consistently across subgroups. CONCLUSION: The diagnostic performance of guideline-recommended BNP and MR-proANP thresholds for acute heart failure varied significantly across patient subgroups. A decision-support tool that combines natriuretic peptides and clinical variables was more accurate and supports more individualized diagnosis. STUDY REGISTRATION: PROSPERO number, CRD42019159407
How effective are remote and/or digital interventions as part of alcohol and drug treatment and recovery support? A systematic review and meta-analysis.
Get PDFBACKGROUND AND AIMS: Although remote drug/alcohol interventions have been widely reviewed, their effectiveness specifically for people in treatment remains unclear. We aimed to systematically review the effectiveness of remote interventions (delivered by telephone or computer) in alcohol/drug treatment and recovery support. METHODS: We searched 29 databases including Medline and PsycINFO for randomised controlled trials (RCTs) of remote interventions for adults diagnosed with alcohol/drug use disorder conducted in Organization for Economic Co-operation and Development (OECD) countries published 2004-2023. We grouped interventions according to whether they supplemented or replaced/partially replaced in-person care. We used random effects meta-analyses to estimate pooled odds ratios (OR) for relapse, and standardised mean differences (SMD) for days of alcohol/drug use. We appraised outcomes using Cochrane Risk of Bias 2. RESULTS: We identified 34 RCTs (6461 participants) evaluating 42 remote interventions, with diverse therapeutic approaches. Over 70% of outcomes were judged to be at high risk-of-bias. When remote interventions supplemented in-person care, there was a 39% lower odds of relapse [17 interventions; OR 0.61; 95% confidence interval (CI) = 0.46, 0.81; P = 0.001; I2 = 40.3%) and a reduction in the mean days of use (17 interventions; SMD -0.18; 95% CI = -0.28 to -0.08; P = 0.001; I2 = 27.3%) compared with in-person care alone. When remote interventions replaced/partially replaced in-person care, there was a 49% lower odds of relapse (7 interventions; OR 0.51; 95% CI = 0.34, 0.76; P = 0.001; I2 = 39.7%) and a very slight and uncertain reduction in mean days of use (8 interventions; SMD -0.08; 95% CI = -0.24 to 0.07; P = 0.301; I2 = 48.4%) compared with in-person care. Subgroup analyses by type of substance and therapeutic approach were mixed and inconclusive. CONCLUSIONS: Remote interventions which supplement in-person alcohol/drug treatment appear to reduce relapse and days of use. The evidence is less conclusive regarding remote interventions that replace/partially replace in-person care due to a smaller body of evidence and uncertainty (days of use). High risk-of-bias means findings should be interpreted with caution
First referral hospitals in low-resource settings: a narrative review of expectations for clinical service provision.
Get PDFFirst referral hospitals (FRHs) have an important role to play in helping many countries achieve 'Health for All'. However, their specific role and the clinical services they are expected to provide to achieve this are evolving. To explore this issue further, we undertook a narrative review to examine the clinical service expectations of FRHs outlined in academic and policy literature, which identified a total of 404 FRH service expectations. At a global level, some categories of services provide extensive specific service recommendations, likely resulting from historical priorities and the influence of vertical programming and professional interests. However, in several important areas we identified few or no recommendations. At the level of individual country case studies undertaken through this review, FRH clinical service recommendations within available policy documents vary considerably. Our findings suggest a disconnect between the ambition for FRH and the difficult, context-specific decision-making needed at the national level on the role of FRHs as a service delivery platform within integrated health systems helping countries achieve universal health coverage
Spatial prediction of immunity gaps during a pandemic to inform decision making: A geostatistical case study of COVID-19 in Dominican Republic.
Get PDFBACKGROUND: To demonstrate the application and utility of geostatistical modelling to provide comprehensive high-resolution understanding of the population's protective immunity during a pandemic and identify pockets with sub-optimal protection. METHODS: Using data from a national cross-sectional household survey of 6620 individuals in the Dominican Republic (DR) from June to October 2021, we developed and applied geostatistical regression models to estimate and predict Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spike (anti-S) antibodies (Ab) seroprevalence at high resolution (1 km) across heterogeneous areas. RESULTS: Spatial patterns in population immunity to SARS-CoV-2 varied across the DR. In urban areas, a one-unit increase in the number of primary healthcare units per population and 1% increase in the proportion of the population aged under 20 years were associated with higher odds ratios of being anti-S Ab positive of 1.38 (95% confidence interval [CI]: 1.35-1.39) and 1.35 (95% CI: 1.32-1.33), respectively. In rural areas, higher odds of anti-S Ab positivity, 1.45 (95% CI: 1.39-1.51), were observed with increasing temperature in the hottest month (per°C), and 1.51 (95% CI: 1.43-1.60) with increasing precipitation in the wettest month (per mm). CONCLUSIONS: A geostatistical model that integrates contextually important socioeconomic and environmental factors can be used to create robust and reliable predictive maps of immune protection during a pandemic at high spatial resolution and will assist in the identification of highly vulnerable areas
Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: A systematic review.
Get PDFThese findings confirm that the rising burden of non-communicable diseases in West Africa, particularly type 2 diabetes, can be tackled by strong functional primary healthcare systems
Changes in local access to mifepristone dispensed by community pharmacies for medication abortion in Ontario: a population-based repeated cross-sectional study.
Get PDFBACKGROUND: Although mifepristone for medication abortion has been available in Canada since a regulatory change in 2017, leading to its rapid uptake, the effects of this availability on regional access to abortion are unknown. We sought to examine how community pharmacy dispensation of mifepristone affected distribution of abortion services over time in Ontario, Canada. METHODS: We used linked health administrative data to identify a cohort of all medication and procedural abortions provided in Ontario from 2017 to 2022, defined by outpatient mifepristone dispensations and abortion billing, diagnostic, and procedure codes. We evaluated changes over time in the annual proportion of community pharmacies that dispensed mifepristone and the availability and distribution of medication and procedural abortion services across geographic regions, defined by postal code forward sortation areas. RESULTS: In 2017, 2% of Ontario pharmacies filled 1 or more prescriptions for mifepristone, which increased to 20% in 2022. In 2017, few regions contained a mifepristone-dispensing pharmacy (19%) or procedural abortion service (18%). By 2022, most regions had local access to a mifepristone-dispensing pharmacy (77%), with geographically distributed abortion services across Ontario. Although only 37% of abortion service users lived in a region with either a mifepristone-dispensing pharmacy or procedural provider in 2017, this increased to 91% by 2022. INTERPRETATION: Access to medication abortion across Ontario increased substantially within 5 years of mifepristone's availability as a normally prescribed and dispensed medication. This regulatory approach appears successful for achieving widespread access to local abortion services