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Fathers’ Experiences of Help-seeking and Support Needs for Themselves and their Children Following Domestic Violence and Abuse: A Qualitative Study
Get PDFMethods: This was a qualitative sub-study nested within a feasibility trial of a domestic abuse intervention targeting mothers and children. We recruited and undertook semi-structured interviews with fathers (n = 5) who self-identified as victims of DA through a men’s service and social media adverts, and analyzed the data using Reflexive Thematic Analysis.
Results: We generated five themes: (1) Male identity and self-acceptance of victim status, (2) The intersection of fatherhood with men’s identity as a victim of DA, (3) Recognition of DA against fathers by professionals, (4) Impacts of DA and subsequent separation from children and (5) Getting help for children. Men discussed challenges in accepting their own victim status alongside a masculine identity, as well as their intersectional identity as fathers. Additionally, they reported challenges in the recognition and acceptance of their identity as a victim by professionals, which impacted support provision for themselves and their children.
Conclusions: This study provides an insight into the range of fathers’ perceived barriers to help-seeking, which in turn, were perceived to influence subsequent support and intervention needs for themselves and their children. We make practical recommendations for future research into service response and intervention development aimed at supporting the recovery of fathers and their children following these experiences
"Who the hell is upstream pushing them all in?" Reclaiming public health's defining metaphor to counter the commercial determinants of health.
Get PDFPublic health policy and practice are often described by means of a metaphor that depicts interventions as "upstream" efforts to prevent people from falling into a river, from which they must be rescued "downstream" by overwhelmed healthcare services. The upstream-downstream metaphor has been described as public health's defining metaphor. We apply a commercial determinants of health lens to re-engage with the initial intentions of McKinlay's seminal 1975 essay from which this metaphor emerged, and to critique its current uses. We examine how the upstream-downstream metaphor has come to be used in ways that depart radically from its original intent, which was to characterise the practices of powerful commercial actors who profit from the production of harm and disease. The subtle but important shift in language from people being pushed, to falling into the river, among other depoliticising processes, contributes to an individualising and victim-blaming approach to health harms, deflecting from the role of commercial power and practices. There is a pressing need to reclaim public health's defining metaphor as part of the wider agenda to address commercial determinants as the major public health challenges of our time
Primary care and community-based screening for Chagas disease in London, United Kingdom, August 2023 to January 2025.
Get PDFBACKGROUNDChagas disease (CD), a tropical parasitic disease caused by Trypanosoma cruzi, is increasingly recognised as a public health concern among Latin American migrants living in non-endemic settings. In London, United Kingdom (UK), home to over 160,000 people from endemic countries, no formal population-level CD screening programmes exist.AIMTo investigate the seroepidemiology of CD infection in Latin American adults living in London, UK.METHODSA cross-sectional, observational study utilising questionnaires and serological (T. cruzi) screening was performed between August 2023 and January 2025. Adults born in South America, Central America or Mexico (or whose mothers were born there) were eligible to participate. Screening was offered in primary care sites and by point-of-care serological testing at community events. Outcomes were seroprevalence, screening yield, positive predictive value of screening tests and linkage to care.RESULTSIn primary care, of 2,739 eligible individuals offered screening, 276 (10.1%) accepted. At community events, 247 were screened. Of the 523 screened, 20 (3.8%) participants had positive screening tests, and CD was confirmed in 14 (2.7%), all born in Bolivia. Seroprevalence was lower in those screened in primary care (1.1%) than at community events (4.5%). The number needed to screen to detect one confirmed case (linked into care) was 37 overall, 92 in primary care and 22 at community events.CONCLUSIONSScreening for CD through primary care in the UK is highly challenging, with both low uptake and low yield amongst those tested. Targeted community-based outreach approaches result in higher screening yield and linkage to care
Rethinking paediatric sepsis care through local provider voices and lived systems: a mixed-methods study in two hospitals in Ghana.
Get PDFBACKGROUND: Paediatric sepsis remains a significant cause of mortality in low- and middle-income countries (LMICs), where health systems are often resource-constrained. Global sepsis protocols, although effective in high-income settings, may not be well-suited to LMIC contexts. METHODS: We conducted a mixed-methods study in two hospitals in the Ashanti Region of Ghana: Komfo Anokye Teaching Hospital (KATH) and Presbyterian Hospital, Agogo (PreHA). Specifically, we conducted a retrospective chart review, followed by key informant interviews with clinical staff, and integrated our findings with a previously published situational analysis. Qualitative data analysis employed the Three Delays Framework and the Donabedian Model to identify locations and causes of delays in care. RESULTS: Seventy-one charts met the inclusion criteria for review, having a history of fever or hypothermia and complete vital signs documented (16 from PreHA, 55 from KATH). Despite KATH managing more severely ill patients with higher sepsis scores and longer stays, mortality rates were similar at both sites. The chart review highlighted gaps in documentation and inconsistent care processes. Key informant interviews revealed themes such as provider altruism, community financial support and the positive role of research collaborations, while also illustrating systemic delays linked to financial and resource constraints. CONCLUSION: Paediatric sepsis care in Ghana is influenced by complex and interconnected structural, cultural and procedural factors. Our findings indicate that contextually adapted care pathways are crucial for improving sepsis outcomes in resource-constrained settings. Co-designed interventions, rather than wholly imported protocols, may offer a more sustainable approach to strengthening health systems in LMICs
A Call for International Collaboration to Improve Definitions for the Surveillance of Congenital Syphilis.
Get PDFDelirium identification, prevention and management in intensive care units in England, Wales and Northern Ireland: a survey of practice.
Get PDFINTRODUCTION: Delirium is the most common sign of acute brain dysfunction and is prevalent in ICUs. This work is part of a UK National Institute of Health and Social Care Research-funded Programme Development Grant to identify optimal approaches to prevent, identify and manage ICU delirium in the UK. This survey aimed to provide a baseline for contemporary practice.
METHODS: A structured online survey was designed and sent to all ICUs in England, Wales and Northern Ireland, identified through the Intensive Care National Audit and Research Centre Case Mix Programme. Participants were asked to provide a response that reflected ICU-level care.
RESULTS: The ICU participant response rate was 249/268 (93%). Of these, 222/249 (89%) ICUs screened for ICU delirium routinely and 208/222 (94%) used the CAM-ICU tool. Delirium care packages were applied by 125/249 (50%) ICUs, but 81/125 (68%) conveyed that this was not consistent for all patients. Both antipsychotics and benzodiazepines are used commonly to manage delirium. All respondents stated that early mobilisation; early removal of invasive catheters; maintenance of hearing aids/glasses; regular mealtimes; and daytime activity were used as non-pharmaceutical delirium management strategies. Enhanced follow-up was reported by 195/249 (79%) respondents, either routinely or for selected cases.
DISCUSSION: Only half of UK ICUs use a standardised care package to prevent and manage ICU delirium, with inconsistent implementation. Future work should focus on the development and evaluation of an evidence-based and sustainable care package
Understanding measurement of postural hypotension: a nationwide survey of general practice in England.
Get PDFBACKGROUND: Postural hypotension is associated with excess mortality, falls, and cognitive decline. Postural hypotension is poorly recorded in routine general practice records. Few studies have explored measurement and diagnosis of postural hypotension in general practice. AIM: To understand how postural hypotension is measured, diagnosed, and managed in general practice.
DESIGN AND SETTING: This was an online survey of general practice staff in England.
METHOD: Clinical research networks distributed the survey to practices, seeking individual responses from any clinical staff involved in routine blood pressure (BP) measurement. Responses were analysed according to role and demographic data using descriptive statistics. Multivariable modelling of checking for postural BP measurements was performed.
RESULTS: There were 703 responses from 243 general practices (mean practice-level response rate 17%). Half (362; 51%) of responders were doctors, 196 (28%) nurses, and 77 (11%) healthcare assistants (HCAs). In total, 8% (58/703) did not routinely check for postural hypotension, usually citing time constraints. For the remaining 92%, postural symptoms were the predominant reason for checking (97% responders, 627/645); only 24% cited any other guideline indication for postural hypotension testing. The study found that 77% used sit-to-stand BP measurements; approximately one-quarter measured standing BP for >1 min. On regression modelling, other professionals tested less for postural hypotension than doctors (odds ratios: nurses 0.323, 95% confidence interval [CI] = 0.117 to 0.894, HCAs 0.102, 95% CI = 0.032 to 0.325, and pharmacists 0.099, 95% CI = 0.023 to 0.411).
CONCLUSION: Awareness of reasons, besides symptoms, and adherence to guidelines for postural hypotension testing, are low. Time is the key barrier to improved testing for postural hypotension. Clarity on pragmatic methods of measuring postural hypotension in general practice would also facilitate measurement uptake
Global health burdens of plastics: a lifecycle assessment model from 2016 to 2040.
Get PDFBACKGROUND: Quantifying human health impacts throughout plastics lifecycles can inform global action against pollution that promotes sustainability across environmental, economic, and health concerns. METHODS: We combined material flow analysis, using the Plastics-to-Ocean model, with lifecycle assessment (LCA) to quantitatively compare disability-adjusted life-years (DALYs) associated with plastics lifecycles, under different global consumption and waste management scenarios between 2016 and 2040. We estimated global health effects of greenhouse gases, particulate matter, and specific chemical emissions associated with plastics commonly found in municipal solid waste (approximately 64% of global plastics production), from their production, transportation, recycling, end-of-life fates, and those associated with illustrative alternative single-use materials and glass reuse systems. Direct health effects of exposure to chemicals during product use and microplastics and nanoplastics pollution were not included due to the absence of available inventory data. We conducted the LCA using Ecoinvent version 3.8 and 3.10 (cutoff) data and ReCiPe 2016 impact assessment method, updated with Intergovernmental Panel on Climate Change 2021 global warming characterisation factors. FINDINGS: We estimated a cumulative 83 million DALYs associated with business as usual (BAU) projections of the global plastics system (2016-40), mainly due to the health burdens of global warming, air pollution, and chemical toxic effect-related disease and premature mortality. Compared with BAU, reducing total global primary plastics production, combined with improving waste collection and disposal, increasing recycling, and replacing specific plastics with alternative materials and reuse systems reduced annual DALYs by 43% (46-23% in material substitution ratio sensitivity analyses) in 2040, but still indicated rising global health burdens over time. Reducing primary plastics production, without material substitution, was the most effective single lever for reducing emissions and alleviating associated health burdens. INTERPRETATION: Adverse health effects are associated with emissions throughout plastics lifecycles, particularly from production, though the non-disclosure of plastics chemical composition is severely limiting LCA capacity to inform effective policy. Deep reductions in primary production are needed in leading plastics transition roadmaps, with assessments that account for plastics' functions across sectors, including exposure and health impacts from plastics' use, from chemicals, microplastics, and nanoplastics, facilitated by mandatory transparency and reporting. Globally coordinated policy that addresses these upstream impacts through a full lifecycle approach is crucial to protecting human health. FUNDING: Innovative Methods and Metrics for Agriculture and Nutrition Actions programme, UK Foreign Commonwealth and Development Office, Bill & Melinda Gates Foundation, French National Research Agency and Region Occitanie
Insights on the implementation strategies for a potential new tuberculosis vaccine in South Africa.
Get PDFSeveral tuberculosis (TB) vaccines intended for adults and adolescents are in late-stage clinical trials, but there is limited research into how a new TB vaccine would be introduced. South Africa is at the forefront of TB vaccine research, with involvement in the clinical trials of leading candidates. We sought to understand what the priorities and implementation approach of a potential new TB vaccine in South Africa would be. We conducted semi-structured interviews with 26 stakeholders with different expertise during April and May 2025. Deductive analysis was used to develop a coding framework for thematic content analysis of the data. Stakeholders supported introducing a new TB vaccine in South Africa due to the high disease burden, but feasibility of the roll out was said to depend on vaccine price, cost-effectiveness, efficacy, regulatory approval, and implementation logistics. Efficacy below 50% could raise concerns unless supported by robust modelling demonstrating significant public health impact and cost-effectiveness. Stakeholders preferred a cheaper vaccine course to enable a broad population-based introduction. Priority populations for vaccination included adolescents and adults for a broad population approach, and high-risk groups such as, people living with HIV, healthcare workers and TB household contacts. Whilst a national broad population-based approach was preferred, constraints may result in a phased introduction in high-burden areas and/or targeted vaccination to high-risk groups first. Strong advocacy, detailed cost effectiveness assessments, regulatory alignment, and integrated service delivery were seen as essential to successful implementation. With the introduction of a new TB vaccine potentially as early as 2030, this study provides valuable insights, particularly regarding target populations, that can be utilised for the implementation of a new TB vaccine in South Africa to ensure a successful introduction. Further research is required on vaccine acceptability, TB infection prevalence and modelling to estimate cost effectiveness and budget impact
Disparities in long-lasting insecticidal bed net usage and malaria burden 2 years after a mass distribution campaign in central Côte d'Ivoire: A cross-sectional survey prior to a cluster randomised trial.
Get PDFIdentifying and tackling inequities in long-lasting insecticidal bed net (LLIN) coverage and usage is key in reducing malaria burden. This baseline study, prior to an LLIN trial, describes factors associated with LLIN usage and malaria infection prevalence, two years after a mass distribution in Côte d'Ivoire. In July 2023, cross-sectional data were obtained from randomly selected individuals of all ages in each of 33 study clusters, capturing information on socio-economic status, LLIN ownership, usage and results of malaria rapid diagnostic tests. Random-effects multivariable logistic regression analyses were used to assess factors associated with LLIN usage and malaria infection. A total of 1,672 participants were recruited. LLIN ownership and access were 66.3% (95% CI: 59.4-73.2) and 27.8% (95%CI: 22.6-33.1), respectively. LLIN usage was 50.0% (adjusted odds ratio [aOR]: 0.50; 95%CI: 0.34-0.75), 44.3% (aOR: 0.41; 95%CI: 0.26-0.62) and 56.9% (aOR: 0.72; 95%CI: 0.53-0.98) in participants aged, 5-9, 10-14 and ≥15years, respectively, compared to 63.2% in under-fives. LLIN usage was lowest in females aged 10-14 years (41.0%) and highest in under-five males (68.9%). The odds of LLIN usage were lowest in the second (aOR: 0.63; 95%CI: 0.44-0.90) and middle wealth quintile (aOR: 0.69; 95%CI: 0.47-1.00) compared to the poorest quintile (58.2%). Malaria infection prevalence was 41.1% (95%CI: 37.2-45.0). When compared to under-fives with a malaria prevalence of 61.3%, 5-9, 10-14 and ≥15years had 75.0% (aOR: 1.86; 95%CI: 1.24-2.78), 67.0% (aOR:1.18; 95%CI: 0.78-1.80) and 23.0% (aOR: 0.17; 95%CI: 0.12-0.23) malaria prevalence, respectively. Males (75.8%) and females (74.1%) aged 5-9 years had the highest malaria risk. LLIN users had an infection prevalence of 38.5% (aOR: 0.74; 95%CI: 0.58-0.94), compared to 44.3% in non-users. School-based net distributions, malaria education, routine screening and treatment and chemoprophylaxis in schools alongside community sensitization campaigns are recommended to improve protection and reduce infection risk among school-aged children