69832 research outputs found
Sort by
Vitamin A deficiency in India and seasonality of vitamin A-rich food consumption.
Get PDFVitamin A deficiency (VAD) poses significant health risks and is prevalent in children and adolescents in India. This study aimed to determine the effect of seasonal variation and availability of vitamin A-rich (VA-rich) foods on serum retinol in adolescents. Data on serum retinol levels from adolescents (n 2297, mean age 14 years) from the Comprehensive National Nutrition Survey (2016-2018) in India were analysed, with VAD defined as serum retinol < 0·7 µmol/L. Five states were selected based on a comparable under-five mortality rate and the seasonal spread of the data collection period. Dietary data from adolescents and children ≤ 4 years old were used to assess VA-rich food consumption. A linear mixed model framework was employed to analyse the relationship between serum retinol, month of the year and VA-rich food consumption, with a priori ranking to control for multiple hypothesis testing. Consumption of VA-rich foods, particularly fruits and vegetables/roots and tubers, showed seasonal patterns, with higher consumption during summer and monsoon months. Significant associations were found between serum retinol concentrations and age, month of sampling, consumption of VA-rich foods and fish. VAD prevalence was lowest in August, coinciding with higher consumption of VA-rich fruits and foods. Findings highlight the importance of considering seasonality in assessing VAD prevalence and careful interpretation of survey findings. Intentional design, analysis and reporting of surveys to capture seasonal variation is crucial for accurate assessment and interpretation of VAD prevalence, including during monitoring and evaluation of programmes, and to ensure that public health strategies are appropriately informed
Lived experiences of patients, families and caregivers affected by inherited retinal diseases: A qualitative systematic review.
No full textBACKGROUND: Inherited retinal diseases (IRDs) are a heterogeneous group of genetic disorders, and a leading cause of vision impairment or blindness, affecting millions worldwide. Despite advances in understanding its phenotype, the physical and psychological impacts of IRDs on patients and their families and caregivers remain underexplored. OBJECTIVE: This review thus aimed to summarize the existing literature in this area. METHODS: Following PRISMA guidelines and using search terms such as "inherited retinal disease", "psychological impact", "social impact", and "qualitative research", a systematic search was conducted across PubMed Central, EMBASE, Scopus, and PsycINFO databases up to February 29, 2024, for qualitative studies on the impact of IRDs. The findings were then synthesized narratively to provide a cohesive interpretation. RESULTS: A total of 20 studies involving 474 participants across six countries (Australia, Belgium, Italy, Sweden, the UK, and the US) were included. Key themes included the significant impact on daily living and independence, work and professional life, coping strategies and resilience, and the emotional burden on families and caregivers. Genetic testing and its implications (reproductive decisions and insurance discrimination) also emerged as an area of concern. IRDs profoundly affect patients and their families and caregivers, influencing daily life, well-being, and societal participation. CONCLUSIONS: Despite the challenges, resilience and adaptability are prominent, and the findings emphasize the need for comprehensive care that includes psychological support, work adjustments and policies that address the needs of this population. Understanding these quality-of-life issues and areas of unmet need is relevant for healthcare providers, policymakers, and researchers globally
A cluster-randomized trial of interventions for adolescent mental disorders in Zimbabwe.
Get PDFPURPOSE: Young people have low uptake of mental health. We compared two task-shifted mental health care models, i.e., adult Friendship Bench (FB) delivered by community health workers and Youth Friendship Bench (YouFB) delivered by trained university students in Harare, Zimbabwe. We hypothesised that the peer-delivered YouFB would have greater uptake and effectiveness in managing common mental disorders (CMDs) in 16-19-year-olds compared to the standard FB model. We also aimed to evaluate the reach, fidelity, acceptability and cost of the YouFB compared to standard FB. METHODS: We conducted an open-label cluster-randomised, hybrid type-2 implementation trial with cost analysis in 26 primary care clinics and their surrounding communities. Facilities were randomised 1:1 to FB or YouFB. The primary implementation outcome was uptake, defined as the proportion of adolescents aged 16-19 offered FB sessions for treatment of CMD who completed at least one FB session. Secondary implementation outcomes included reach, fidelity, and acceptability. The main clinical outcome was the clinical effectiveness of YouFB vs. FB at six months, assessed by changes in Shona Symptom Questionnaire (SSQ-14) scores. We also carried out a cost analysis from a societal perspective. Acceptability was evaluated qualitatively using in-depth interviews. Reach was calculated as the number of adolescents receiving FB sessions per clinic day. RESULTS: Uptake in the FB and YouFB arms was 86.6% (187/216) and 95.6% (220/230), respectively (primary outcome). The number of completed FB sessions (feasibility) was higher in the YouFB arm than the FB arm (cluster-level mean prevalence 96.7% vs. 85.8%, prevalence ratio = 1.13; 95% CI:0.98-1.30). Among 528 trial participants, adjusting for baseline score, gender, education, marital status, employment and HIV status, the proportion of participants with SSQ-14 score ≥ 8 was similar by arm after six months, adjusted odds ratio = 0.65 (95% CI: 0.36-1.17). Total program costs were higher in the YouFB arm. Process evaluation found the YouFB to be highly acceptable. CONCLUSIONS: A youth-focused Friendship Bench intervention is feasible and acceptable. Recipients highly valued the ability to connect with a same-age peer and its easy accessibility. However, further intervention optimisation is needed to improve its clinical and cost-effectiveness. TRIAL REGISTRATION: This trial was prospectively registered on 21/08/2018 with the Pan African Clinical Trial Registry database. Registration no PACTR201808181810124
Characterizing trachoma elimination using serology.
No full textTrachoma is targeted for global elimination as a public health problem by 2030. Measurement of IgG antibodies in children is being considered for surveillance and programmatic decision-making. There are currently no programmatic guidelines based on serology, which represents a generalizable problem in seroepidemiology and disease elimination. Here, we collate Chlamydia trachomatis Pgp3 and CT694 IgG measurements from 48 serosurveys across Africa, Latin America, and the Pacific Islands (41,168 children ages 1-5 years) and propose a novel approach to estimate the probability that population C. trachomatis transmission is below or above levels requiring ongoing programmatic action. We determine that trachoma programs could halt control measures with >90% certainty when seroconversion rates (SCRs) are ≤2.2 per 100 person-years. Conversely, SCRs ≥4.5 per 100 person-years correspond with >90% certainty that further control interventions are needed. More extreme SCR thresholds correspond with higher levels of confidence of elimination (lower SCR) or ongoing action needed (higher SCR). This study demonstrates a robust approach for using trachoma serosurveys to guide elimination program decisions
Intersectoral interventions: integration for impact on preterm birth.
Get PDFPROGRESS: The last two decades have seen a growing focus on intersectoral interventions to improve maternal and newborn health and well-being outcomes, as reflected in efforts to achieve the Millennium Development Goals (MDGs) and advance the Sustainable Development Goals (SDGs). Preterm births are linked to cross-sectoral determinants that affect health outcomes and human capital across the life-course, necessitating an intersectoral approach that addresses these multifaceted challenges. PROGRAMMATIC PRIORITIES: Recognizing that social, biological and economic determinants significantly influence health outcomes, it is critical that robust health systems are reinforced by a comprehensive intersectoral approach. Evidence suggests that the factors influencing preterm birth, and the health of small and sick newborns are vast and varied, requiring interventions that address equity and rights, education, economic factors, environmental conditions, and emergency responses, i.e., a new framework entitled "five Es". PIVOTS: Improving outcomes for newborns, including preterm and small for gestational age babies, and preventing stillbirths, requires enhanced measurement and accountability within intersectoral programs across the 'five Es'. Investment in equity-focused, gender-transformative, and rights-based policies and programs across various sectors is crucial. Priority areas include ensuring equitable and inclusive education, particularly comprehensive sexual and reproductive health education; developing innovative financing schemes that protect and support families with complicated pregnancies and vulnerable infants; creating environmentally adaptive systems that prioritize maternal and newborn health; and implementing emergency response plans that guarantee the continuity of maternal and newborn health services. Evidence-based intersectoral interventions offer a promising pathway to reducing preterm births and improving health outcomes across generations. By addressing the five Es, intersectoral interventions can create a healthier future for preterm babies, children, adolescents, women, and society as a whole
Cost-effectiveness and benefit-risk of rotavirus vaccination in Afghanistan: a modelling analysis informed by post-licensure surveillance.
Get PDFINTRODUCTION: Afghanistan added ROTARIX to the routine national immunization programme in 2018. We aimed to estimate the cost-effectiveness and benefit-risk of ROTARIX and compare its continued use with other rotavirus vaccines that could be used in the future. METHODS: We used a static cohort model with a finely disaggregated age structure (weeks of age < 5 years) to assess the use of ROTARIX (1-dose vial) over a seven-year period (2018-2024) in Afghanistan. The primary outcome measure was the discounted cost (2022 US 4.4 million per year. The cost per DALY averted was US 471 (0.94 times the national GDP per capita) when incorporating the full vaccine price without Gavi's subsidy and excluding household costs averted by vaccination. When assuming continued Gavi support over the period 2025-2034, the dominant product would be ROTARIX. Without Gavi support, ROTASIIL (2-dose vial) dominates. CONCLUSION: Our study supports the sustained use of rotavirus vaccination in Afghanistan. The health benefits of the vaccine greatly exceed the potential risks
The impact of prolonged walking on fasting plasma glucose in type 2 diabetes: A randomised controlled crossover study.
Get PDFAIMS: In many low-income countries, fasting glucose is the primary measure for monitoring glycaemic control. Many patients in these countries walk long distances to the clinic, but the impact of walking on fasting glucose in type 2 diabetes is unknown. We aimed to determine the impact of walking on fasting glucose in people with type 2 diabetes.
METHODS: In a randomised crossover trial, the change in glucose from baseline in the fasting state was compared between walking on a treadmill at a predetermined speed of 4.5 km/h for 1 h and not walking (resting) in people with type 2 diabetes.
RESULTS: In all, 45 participants were enrolled and all completed both visits; 21/45 (46.7%) were women, and the median age was 51. Glucose during and after walking was similar to glucose while at rest; the glucose difference (walking minus rest) was -0.15 (95% CI: -0.55, 0.26) and -0.10 (95% CI: -0.50, 0.31) mmol/L at 1 and 2 h, respectively, p > 0.4 for both.
CONCLUSIONS: Fasting plasma glucose is not meaningfully affected by prolonged walking in participants with type 2 diabetes; therefore, the reliability of fasting glucose for monitoring glycaemic burden is unlikely to be altered in patients who walk to the clinic
The social burden of antimicrobial resistance: what is it, how can we measure it, and why does it matter?
Get PDFAntimicrobial resistance (AMR) is a growing global health threat, which is increasingly quantified in terms of its human health and economic burden. In this article, we highlight that for policy and planning purposes the social burden of AMR is as important to attend to as health and economic burdens, requiring systematic consideration and measurement of multiple dimensions. We provide a conceptual and empirical overview of four dimensions of the social burden of AMR: the distribution of AMR among and between populations; the lived experiences of AMR by patients and carers; how and by whom AMR interventions are shouldered; and how AMR can change society. We illustrate these dimensions through five case studies drawn from research projects in the UK, East Africa, Thailand and Brazil. Drawing on these insights, we discuss challenges and opportunities for documentation and measurement of AMR's social burden going forward. Taking this seriously aligns with the consensus observation that to address AMR requires moving away from pathogen-based and siloed disciplinary perspectives and means embracing different forms of data and evidence from around the world. We propose an interdisciplinary engagement across researchers, policy makers and community stakeholders to arrive at agreed principles and metrics for future monitoring of the social burden. We need to tackle invisibility through lack of data by considering the social burden in design of AMR surveillance and research, includes mainstreaming social science data, and incorporating arts-based approaches to understanding AMR. Recognition, documentation and measurement of the social burdens of AMR will advance AMR approaches and help develop equitable solutions
Assessment of the Maize Crop Water Stress Index (CWSI) Using Drone-Acquired Data Across Different Phenological Stages
Get PDFThe temperature-based crop water stress index (CWSI) is the most robust metric among precise techniques that assess the severity of crop water stress, particularly in susceptible crops like maize. This study used a unmanned aerial vehicle (UAV) to remotely collect data, to use in combination with the random forest regression algorithm to detect the maize CWSI in smallholder croplands. This study sought to predict a foliar temperature-derived maize CWSI as a proxy for crop water stress using UAV-acquired spectral variables together with random forest regression throughout the vegetative and reproductive growth stages. The CWSI was derived after computing the non-water-stress baseline (NWSB) and non-transpiration baseline (NTB) using the field-measured canopy temperature, air temperature, and humidity data during the vegetative growth stages (V5, V10, and V14) and the reproductive growth stage (R1 stage). The results showed that the CWSI (CWSI < 0.3) could be estimated to an R2 of 0.86, RMSE of 0.12, and MAE of 0.10 for the 5th vegetative stage; an R2 of 0.85, RMSE of 0.03, and MAE of 0.02 for the 10th vegetative stage; an R2 of 0.85, RMSE of 0.05, and MAE of 0.04 for the 14th vegetative stage; and an R2 of 0.82, RMSE of 0.09, and MAE of 0.08 for the 1st reproductive stage. The Red, RedEdge, NIR, and TIR UAV-bands and their associated indices (CCCI, MTCI, GNDVI, NDRE, Red, TIR) were the most influential variables across all the growth stages. The vegetative V10 stage exhibited the most optimal prediction accuracies (RMSE = 0.03, MAE = 0.02), with the Red band being the most influential predictor variable. Unmanned aerial vehicles are essential for collecting data on the small and fragmented croplands predominant in southern Africa. The procedure facilitates determining crop water stress at different phenological stages to develop timeous response interventions, acting as an early warning system for crops
The Risks of Risk Assessment: Causal Blind Spots When Using Prediction Models for Treatment Decisions.
Get PDFClinicians increasingly rely on prediction models to guide treatment choices. Most prediction models, however, are developed using observational data that include some patients who have already received the treatment the prediction model is meant to inform. Special attention to the causal role of those earlier treatments is required when interpreting the resulting predictions. "Causal blind spots" were identified in 3 common approaches to handling treatment when developing a prediction model: including treatment as a predictor, restricting to persons taking a certain treatment, and ignoring treatment. Through several real examples, this article illustrates how the risks obtained from models developed using such approaches may be misinterpreted and can lead to misinformed decision making. The discussion covers issues attributable to confounding, selection, mediation, and changes in treatment protocols over time. An extension of guidelines for the development, reporting, and evaluation of prediction models is advocated to avoid such misinterpretations. Developers must ensure that the intended target population for the model, and the treatment conditions under which predictions hold, are clearly communicated. When prediction models are intended to inform treatment decisions, they need to provide estimates of risk under the specific treatment (or intervention) options being considered, known as "prediction under interventions." Next to suitable data, this requires causal reasoning and causal inference techniques during model development and evaluation. Being clear about what a given prediction model can and cannot be used for prevents misinformed treatment decisions and thereby prevents potential harm to patients