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Navigating DNACPR decisions: a qualitative study of DNACPR factor variability and implementation among NHS Doctors.
Full text linkBACKGROUND: The ongoing absence of a national Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policy means that there remains a lack of explicit guidance on how clinicians should select, measure and assess relevant factors when deciding whether to implement a DNACPR order. Although previous studies have raised this as a concern, this qualitative study explores the extent to which individual clinicians not only adopt personal strategies to assess patients, but also value having a degree of professional autonomy when making DNACPR decisions.
METHODS: Sixteen semi-structured interviews were conducted with National Health Service (NHS) clinicians via video calls. Participants were recruited via snowball sampling. Thematic analysis was conducted using an inductive approach. Initial codes were generated from the interview transcripts, which were then organised into overarching themes based on patterns and relationships identified across the coded data.
RESULTS: Four main groupings summarise the different considerations adopted by doctors when making DNACPR decisions: age, frailty, assessment of quality of life, and perceived outcome. However, whilst the same general areas for consideration were drawn on, the participating doctors nevertheless assessed them differently and often prioritised them in different ways. In the absence of explicit, standardised guidance for weighting these factors, decisions were often made on the basis of individual judgement and local convention.
CONCLUSION: This study demonstrates that physician-level variation in DNACPR decision-making reflects the inherent tension clinicians experience when balancing individual patient needs with the absence of explicit, standardised guidance. The ability to make decisions on a case-by-case basis, with the freedom to weigh diverse factors in a nuanced way is an important aspect of clinical decision-making. However, this can lead to inadvertent bias if decisions are based on factors not necessarily supported by established evidence. RECOMMENDATIONS: Our findings highlight a clear need for a more robust and equitable framework for these critical conversations, whilst also enabling clinicians to be able to make case-by-case decisions. The development of a national DNAPR policy that integrates evidence-based data may help doctors select and weigh factors appropriately, and provide a framework for the initiation of DNACPR discussions. However, such a policy must nevertheless be sufficiently flexible to permit doctors the autonomy required to make nuanced decisions on the basis of a range of patient-specific contextual assessments. Our key recommendation, therefore, is that clinicians should be supported not only by improved procedures and processes, but also by confidence that their professional judgement is rooted in the most current clinical evidence
Finding hybrid schistosomes in genital schistosomiasis: are we missing their clinical relevance?
Full text linkGenital schistosomiasis is a parasitic disease that affects both men and women as male and female genital schistosomiasis (MGS and FGS), respectively. Symptoms mimic sexually transmitted infections in men and women, owing to inflammation in the genital organs caused by migrating and trapped parasite ova. Schistosoma haematobium is the main causative organism, with an estimated 75% of infected women experiencing FGS, equating to approximately 56 million women mainly in sub-Saharan Africa. Estimates for MGS are mostly lacking, but numbers may be equivalent. S. haematobium has been found in hybridized forms with other Schistosoma animal species such as S. bovis, S. curassoni, S. mattheei and human schistosomes like S. mansoni. It is currently unclear what the impact of these species might be on genital schistosomiasis, including on clinical presentation, prognosis and management. In this review, we explore genital schistosomiasis and hypothesize the potential morbidity impact of hybrid species, along with highlighting future research needs. This article is part of the Royal Society Science+ meeting issue 'Parasite evolution and impact in action: exploring the importance and control of hybrid schistosomes in Africa and beyond'
Genetic divergence and lower frequencies of insecticide resistance markers in the novel Anopheles gambiae Bissau molecular form in The Gambia.
Full text linkThe members of Anopheles gambiae species complex are ubiquitous in Afro-tropics. They have been exposed continuously to insecticides, contributing to evolution of resistance within the complex. This study used whole genome sequence data from phase 3 of the An. gambiae 1000 Genomes Project to investigate the population structure and resistance mechanisms of a newly identified species, An. gambiae Bissau molecular form (Bissau) in The Gambia. Bissau exhibited subtle divergence from sister taxa An. coluzzii (Fixation index (FST) of 0.013) and An. gambiae s.s. (FST of 0.023), suggesting ongoing geneflow among them. It also displayed a low but evident level of sub-clustering correlating with geographical location, contrary to sister taxa whose populations were not spatially structured. Additionally, Bissau displayed a higher number of substitutions, though at very low frequencies, in target site regions (specifically Vgsc and Ace-1) of the genome compared to its sister taxa. The well-established Vgsc-L995F mutation, normally associated with dichloro-diphenyl-trichloroethane (DDT) and pyrethroid resistance, was detected in all taxa. Also present, but at a lower frequency (< 20%) was N1570Y allele, normally associated with increased level of pyrethroid resistance when it co-occurs with L995F. Additionally, variants T791M and A1746S were found to occur alongside L995F in Bissau population at an elevated linkage disequilibrium (LD r2 = 0.7). These findings accentuate the critical role this novel species could play on the emergence and spread of insecticide resistance in The Gambia
Development of the INDIGO partnership knowledge exchange strategy
Full text linkBackground: Knowledge exchange, a process of equitable learning, is an important aspect of research. However, there is limited published evidence about whether and how researchers plan for and document this process. This paper describes the collaborative development of the knowledge exchange strategy for a mental health research programme (the INDIGO Partnership), including monitoring and evaluation methods. Method: Knowledge gaps and needs were identified through surveys completed by 59 key stakeholders (advocates, service providers, policymakers and researchers) across the five INDIGO Partnership implementation sites (i.e. China, Ethiopia, India, Nepal, and Tunisia). A strategy was then developed by the international members of the INDIGO research team, based on stakeholder preferences for engagement and the types of information desired. Results: The goal of the INDIGO Partnership knowledge exchange strategy is to enable access to and use of evidence for reducing mental health stigma and discrimination. This will be addressed through describes four processes: (a) convening stakeholders from multiple backgrounds to exchange ideas; (b) creating opportunities for interaction within and between stakeholder groups to improve mental health outcomes; (c) building stakeholder capacity for participating in the generation and use of knowledge; and (d) developing tailored dissemination materials. Monitoring and evaluation indicators and outcomes are proposed to assess the impact of the strategy. Conclusion: This paper illustrates the planning and development of a knowledge exchange procedure and provides a framework upon which knowledge exchange activities can be assessed
Prevalence and Management of Nonepithelial Ovarian Cancer in a Sub-Saharan African Setting.
Full text linkBACKGROUND: Nonepithelial ovarian cancers (NEOCs) comprise a group of uncommon malignancies which can be challenging to treat. This broad term includes germ cell tumors, sex cord-stromal tumors, and rare types of ovarian cancer, such as small-cell carcinomas and sarcomas. It is imperative that these rare tumors are managed with accurate diagnosis, staging, and treatment in order to optimize patient outcomes. The aim of this study was to describe the prevalence, pathology, and therapeutic interventions for NEOC in a Sub-Saharan African setting.
METHODS: This is a 5-year retrospective review of NEOC cases managed at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia, from September 2016 to September 2020. Data on NEOCs including clinical presentation, pathology, therapeutic interventions, staging status, type of surgery, histological subtype, and current disease status were extracted from patients' records. Data were collected using a structured data extraction format. Data were analyzed using Stata release 15 (College Station, TX: StataCorp LLC).
RESULTS: The prevalence of NEOC was 17.3% (80 out of 264 cases of ovarian cancer). Among the types of NEOC, sex cord-stromal tumors were most common (46.2%) followed by germ cell tumors (43.8%). Of the germ cell tumors, yolk-sac tumor was the common histologic subtype, representing 15% of all NEOC cases. Sixty-five percent of cases were managed with staging surgery while 27% underwent fertility sparing surgery. There was no statistically significant association between patients' age and type of tumor (p = 0.08).
CONCLUSION: In this study, the prevalence of NEOC was 17.3%, which is higher than in other previous reports in the literature. Yolk-sac tumor was the most common histologic subtype among germ cell tumors
Artificial intelligence and machine learning across vaccine lifecycle: a systematic review
Full text linkIntroduction: Recurrent global health emergencies have intensified interest in the application of artificial intelligence (AI) and machine learning (ML) to all stages of the vaccine life cycle. This systematic review synthesizes the available evidence and maps the current breakthroughs, persistent gaps, and future opportunities for AI- and ML-enabled vaccinology.
Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we searched PubMed, Scopus, Embase, ScienceDirect, Cochrane Library, and Google Scholar for peer-reviewed articles published from January 2010 to April 2025. Eligible studies reported any AI/ML application in vaccine discovery, development, manufacturing, supply chain management, or equitable deployment. Two reviewers independently screened the titles, abstracts, and full texts, extracted the data, and assessed the risk of bias using Joanna Briggs Institute tools. The findings were collated using qualitative synthesis.
Results: A total of 119 studies examined AI/ML applications across the vaccine lifecycle, including innovation and discovery, development, supply chain optimization, and equitable deployment. AI/ML approaches have improved epitope mapping, candidate screening, safety prediction, demand forecasting, and delivery efficiency, demonstrating their potential to accelerate vaccine development and enhance equitable access.
Conclusion: AI/ML tools are transforming the vaccine lifecycle by accelerating epitope prediction, candidate screening, demand forecasting, and equitable allocation; however, their full potential is limited by data silos, algorithmic bias, and uneven validation across populations and settings. Recognizing their impact requires equity-focused strategies, cross-disciplinary collaboration, ethical governance, open data standards, and research on implementation, cost-effectiveness, and explainable AI to ensure equitable and trustworthy vaccine systems
Teaching public health humanities: innovations from the field
Full text linkThis article offers a comprehensive definition and illustration of the field of public health humanities. Ranging across the disciplines and educational settings of seven different scholar-educators, it offers a clear and detailed discussion of this often-overlooked branch of the wider health humanities, with a focus on teaching. Public health humanities brings the theories, methods and resources of arts and humanities disciplines into conversation with the core activities and frameworks associated with public health. This means that approaches from fields including literature studies, creative writing, history and philosophy engage with concepts including the social and structural determinants of health, health equity, health promotion, epidemiology and risk, surveillance and screening, disaster management and social medicine. Public health humanities focuses humanistic inquiry on the systems and structures that impact health, the values and challenges of population-based approaches, and the interconnectedness of illness and health with environments, ecologies, and large-scale social, economic and political factors. We introduce the shared themes that unite our case studies and then go on to describe seven different approaches to teaching public health humanities, across a variety of contexts from undergraduate arts programmes to specialist training in public health. We offer seven individual accounts with concrete examples to illustrate the models and methods taught, in the hope that these will assist and inspire others. Useful frameworks of wide applicability include a socioecological model of health inequity and an ‘iceberg model’: a metaphor for analysing what lies below the surface for specific learners
Economic Evaluation of Breast Cancer Screening in China: A Systematic Review of Costs and Cost-Effectiveness.
Full text linkOBJECTIVES: This study systematically reviewed evidence on the cost and cost-effectiveness of breast cancer screening programs in China to support the development of structured, population-based screening initiatives and guide future economic evaluations. METHODS: A comprehensive search was conducted across Web of Science, CINAHL, PubMed, Embase, Medline, Google Scholar, PsycINFO, Cochrane, Scopus, and China National Knowledge Infrastructure for studies published up to June 2025. Eligible studies reported costs or cost-effectiveness of breast cancer screening in China. Data extraction followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and study quality was assessed using the Consensus Health Economic Criteria extended checklist. RESULTS: Seventeen studies met the inclusion criteria, examining mammography, ultrasound, and clinical breast examinations. The studies varied in screening strategies, cost components, and analytic methods. Eighty percent concluded that breast cancer screening was cost-effective compared with no screening, typically at thresholds between 1 and 3 times China's gross domestic product (GDP) per capita (US$13 300-39 900 per quality-adjusted life-years) in 2024. Population-based programs are generally cost-effective for women aged around 35 to 74 and have shown favorable results mainly in urban or economically developed regions. Recommendations varied by target population, screening tools, screening delivery models, intervals, and uptake. Ten articles were rated as good or excellent, 5 as moderate, and 2 as low quality. CONCLUSIONS: This review summarizes evidence to inform the development of regionally adapted, cost-effective screening policies and support evidence-based decision making in breast cancer control. It also identifies methodological inconsistencies and limited rural evaluations, emphasizing the need for more robust and context-specific economic analyses
Epidemiology of Schistosoma haematobium infection and microhaematuria among schoolchildren in a setting of sustained mass drug administration in Banfora, Burkina Faso.
Full text linkBACKGROUND: Limited evidence exists regarding the current epidemiology of Schistosoma (S.) haematobium infection following decades of mass drug administration implementation in many areas of Burkina Faso, including the Cascades region, which is predominantly a riverine community with a high risk of schistosomiasis. This study aimed to determine the prevalence and correlates of S. haematobium infection and microhaematuria among schoolchildren in the municipality of Banfora, southwestern Burkina Faso. METHODS: An analytical cross-sectional study was conducted in November 2024 among schoolchildren aged 5-15 years in the Banfora municipality. Sociodemographic and water contact data were collected using a pre-tested structured questionnaire. Each consenting child provided a freshly voided urine sample, which was examined for the presence of S. haematobium eggs and microhaematuria using the urine filtration technique and urine multistix reagent test strips, respectively. Correlates of S. haematobium infection and microhaematuria were determined using multivariable logistic regression. RESULTS: The mean age of the children was 8.79 ± 2.22 years. Of the 300 school children tested, 11 (3.67 %) were found to be infected with S. haematobium eggs. The geometric mean intensity of S. haematobium infection was 14.94 eggs/10 mL of urine (95 % CI: 4.96-44.98), and 27.27 % of the infected participants (3/11) had a heavy infection. The prevalence of microhaematuria was 13.33 % (40/300). Being a boy was the main risk factor for S. haematobium infection (adjusted OR: 11.0, 95 % CI: 2.5-48.2), while having a urinary tract infection was significantly associated with S. haematobium infection (adjusted OR: 59.6, 95 % CI: 6.9-515.7). Risk factors for microhaematuria included living in rural areas (adjusted OR: 8.3, 95 % CI: 2.4-28.6) and S. haematobium infection (adjusted OR: 31.3, 95 % CI: 5.9-165.8). CONCLUSIONS: Our findings show that S. haematobium infection is hypoendemic in the Banfora municipality. However, the high prevalence of heavy infections is a particular concern, and targeted treatment strategies and complementary measures, including health education, should prioritize school-aged children living in rural areas
Tree pollen and asthma-related hospital admissions in England: a national case time series analysis.
Full text linkOBJECTIVE: Evidence linking pollen exposure to asthma exacerbations is limited and inconsistent across regions, pollen types, and age groups. We assessed the association between pollen concentrations and asthma-related hospital admissions across England at high spatial resolution. MATERIALS AND METHODS: We use unplanned asthma admissions records (2008-2022) from Hospital Episode Statistics, linked to 10-km gridded data on alder and birch pollen. Tree pollen exposure was categorised as low, medium, or high. Age-specific case time series analyses were conducted using conditional Poisson regression, controlling for temperature and air pollutants (PM2.5 and NO2). Analyses were restricted to January-August, when tree pollen is present. RESULTS: Elevated asthma admission risk was associated with both pollen types, with a non-linear exposure-response that increased sharply at low levels and attenuated at higher exposures. For alder pollen, relative risks (RRs) across all ages were 1.014 (95%CI: 0.998, 1.031) for low, 1.026 (1.007, 1.046) for medium, and 1.019 (0.995, 1.044) for high exposure. For birch, RRs were 1.016 (0.996, 1.037), 1.041 (1.019, 1.06), and 1.032 (1.005, 1.060), respectively. Risks were mostly limited to children, with medium alder pollen exposure associated with RRs of 1.047 (0.993, 1.105) and 1.112 (1.066, 1.159), and birch with RRs of 1.131 (1.066, 1.201) and 1.079 (1.029, 1.131) in 0-4 and 5-14-year-olds, respectively. No evidence of association was found in older groups. CONCLUSION: Moderate tree pollen levels are associated with increased asthma admissions in younger populations in England. Further work is needed to understand group and individual susceptibility