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A systematic review and equity analysis of school-based violence prevention interventions evaluated in randomised controlled trials.
Get PDFBACKGROUND: Experiencing violence in school is a violation of a child’s rights and can increase school absence, affect academic achievement, employment prospects, and later-life health. Effective school-based violence prevention interventions are crucial, however, most are universally targeted. It is less clear if current interventions to prevent violence in schools ensure subgroups of children benefit equitably.
METHODS: We conducted a systematic review. We drew on professional networks and searched Medline, Cochrane Library, Embase, Global Health, PsycINFO, and Web of Science to identify systematic reviews (n = 29) which included randomised controlled trials (RCTs) of school-based violence prevention interventions. Reviews conducted searches until December 2023. We screened all included articles within the final review sample to identify all RCTs of universal school-based violence prevention interventions. We examined what sociodemographic characteristics were measured, assessed intervention effectiveness by subgroups, and applied criteria to assess equity.
RESULTS: Out of 160 articles of RCTs evaluating violence prevention interventions in schools, we identified 19 articles reporting on 16 trials that reported effects by the following subgroups: sex (n = 16), disability (n = 1), sexuality (n = 1), race/ethnicity (n = 1) and socioeconomic status (n = 1). Subgroup and moderation analysis found mixed results of intervention effectiveness by subgroups, with some evidence of heterogeneity.
CONCLUSIONS: Most trials of school-based violence prevention interventions do not report whether they are effective for subgroups of minoritised children, or children at higher risk of experiencing violence, and therefore may not contribute to advancing health equity. Ensuring a commitment to equity in the design, delivery, and impact of school-based violence prevention is essential to achieving the Sustainable Development Goals.
REVIEW REGISTRATION: PROSPERO: CRD42023463384.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-26142-1
Latent tuberculosis infection in high TB disease burden countries dysregulates cellular and immunological profiles which is further enhanced with uncontrolled hyperglycemia.
Get PDFUNLABELLED: Tuberculosis (TB) and diabetes mellitus (DM) are both highly prevalent in Pakistan. Latent Mycobacterium tuberculosis (Mtb) infection is common however the effect of DM and latent TB infection (LTBI) is less understood. We used RNA arrays to study host transcriptional responses to investigate this. Participants were controls (EC) and with DM, sub-classified to LTBI and DM-LTBI. Host blood transcriptomes were studied using microarrays followed by GO, WikiPathway and reactome pathway analyses. Gene expression compared with EC revealed 187 differentially expressed genes (DEGs) associated with LTBI; 182 DEGs with DM and 13 DEGs with DM-LTBI. In LTBI and DM, downregulation of antigen presentation and upregulation of inflammatory genes was evident whilst in DM, mostly immune related genes were downregulated. Comparison between LTBI-DM and LTBI revealed 321 up- and 12 downregulated DEGs, with upregulated immune response and inflammatory genes whilst a downregulation of genes associated with insulin metabolism and oxidative stress were observed. The impact of uncontrolled hyperglycemia was seen as downregulation in protein synthesis and oxidative phosphorylation in the host. This effect was further enhanced in those with hyperglycemia within the LTBI-DM group. Importantly, our observations of dysregulated pathways observed in diabetic individuals fit with earlier reports. We show that LTBI and DM synergistically increase host inflammatory and metabolic processes whilst reducing innate immunity. Such dysregulation by uncontrolled hyperglyemia highlights increased risk of progression of Mtb infection in this cohort and emphasizes the need for diabetes control in a TB endemic population. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1038/s41598-025-34370-z
Rapid review: health and maximum indoor temperature thresholds in high income countries
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There are currently no formal guidelines on maximum indoor temperature thresholds in household, community or workplace settings in the UK, despite the built environment being a major determinant of heat-related mortality and morbidity. This rapid review considered at what temperature threshold(s) hot indoor environments begin to harm human health in high income countries, with a view to informing potential future recommendations and UK policy on this topic. We looked for articles measuring human health and high indoor temperatures in high income countries. Searches of Medline, Embase, Web of Science and Scopus identified 5,642 articles published between 2017–2024, of which 12 articles were included. Countries, populations, settings, and methods of exposure measurement differed within the final set of studies. Health outcomes were varied and included measures such as risk or odds of death, indicators of morbidity, ambulance calls, and self-reported heat related illness, among others. Thresholds at which adverse health outcomes were observed spanned a wide range of temperatures, from 17 °C to 31 °C. While there was a correlation between high indoor temperatures and health outcomes, the body of evidence was not coherent or consistent. There remains a dearth of evidence on safe maximum temperatures in indoor settings. Future research should study directly measured or well-modelled indoor temperature with acute health outcomes for groups at highest risk of heat related morbidity and mortality, to inform adaptation policy in the context of a rapidly warming climate. Until there is extensive scientific data to support a maximum indoor temperature threshold, 26 °C may be the most suitable threshold for a maximum indoor temperature threshold for at-risk groups in keeping with the existing guidance
Couples-based interventions for perinatal depression and anxiety: A global systematic review
Get PDFBackground: Globally, perinatal depression and anxiety affect approximately 26% and 12% of women, respectively, with partner support recognized as a protective factor. This systematic review aimed to synthesize the evidence on the effectiveness of couples-based interventions for perinatal depression and/or anxiety. Methods: We searched PsycINFO, Embase, PubMed, CENTRAL, and CINAHL from inception through December 1, 2024, identifying studies published in English that met our eligibility criteria. Two reviewers independently screened records, extracted data, and assessed risk of bias using the Joanna Briggs Institute critical appraisal tools. We conducted a narrative synthesis. Results: From 4733 screened records, 26 studies (23 RCTs, three quasi-experimental) met the inclusion criteria, comprising 4547 women from 14 countries. Fourteen of 26 studies (54%) demonstrated significant reductions in maternal depressive symptoms. Descriptive synthesis suggested effectiveness may depend more on intervention content than partner attendance patterns: interventions teaching specific support skills (symptom recognition, practical assistance, help-seeking facilitation) appeared effective across varying attendance levels, while relationship enhancement approaches showed inconsistent results. Six of 12 studies measuring anxiety reported significant reductions, with mixed evidence regarding the role of partner attendance. Studies reported inconsistent effects on paternal mental health and relationship quality. Risk of bias was low in 52% of RCTs. Conclusion: Couples-based interventions show promise for reducing perinatal depression and anxiety, though substantial heterogeneity prevents identification of optimal approaches. Descriptive patterns suggest effectiveness may depend more on intervention content than on the number of sessions partners attended, though this hypothesis requires formal testing through meta-analysis with moderator analyses. Absence of mediation analyses across all studies prevented understanding of mechanisms, and geographic concentration in high-income settings limited generalizability to LMIC contexts. Prospero registration: CRD42024618459
An age-structured spatially varying coefficient model for high-resolution mapping of vaccination coverage.
Get PDFHigh-resolution maps of vaccination coverage are valuable for uncovering heterogeneities in coverage to inform vaccine delivery strategies. Coverage maps stratified by age can reveal additional heterogeneities in the timeliness of vaccination and critical immunity gaps among birth cohorts. Here, we propose a spatially varying coefficient model relying on a Bayesian approach for age-structured mapping of vaccination coverage using geolocated individual level household survey and geospatial covariate data. Our flexible modelling framework includes parameterizations capturing spatial (non-)stationarity in differences in coverage between age groups, as well as a modification to allow coverage mapping for single age points through the inclusion of a smoother over age. The proposed models are fitted using the INLA-SPDE approach implemented in the inlabru package in R. We choose between competing model parameterizations by examining their out-of-sample predictive performance via cross-validation and using Bayesian model choice criteria. The methodology is applied to age-structured mapping of measles vaccination coverage in Cote d'Ivoire using the 2021 Demographic and Health Survey. Our results reveal a significant delay in measles vaccination in the first year of life and substantial spatial differences in coverage by age, highlighting the need for targeted interventions to achieve equity and attain vaccine-derived immunity goals
Quantifications of CD4+ T-Lymphocytes levels in adult sickle cell patients: Examining immunological vulnerability and Vaso-Occlusive crises in a low-resource setting, northwestern Nigeria.
Get PDFINTRODUCTION: Sickle Cell Disease (SCD) is a chronic genetic disorder that impairs red blood cell function and contributes to recurrent complications, particularly vaso-occlusive crises. AIM: This study evaluates the level of CD4 + T-lymphocyte counts in adult SCD patients in Northwestern Nigeria, assessing their association with clinical states, and epidemiological factors, to better understand immunological vulnerability.
METHODS: A descriptive cross-sectional study was conducted at Specialist Hospital Sokoto, 45 adult SCD patients were recruited and stratified by clinical status (steady state versus crisis). CD4 + counts were measured via flow cytometry, and data were analyzed for relationships with haemoglobin levels, gender, and age.
RESULTS: Patients in vaso-occlusive crisis observed reduction in CD4 counts compared to those in steady state. However, haemoglobin levels did not show a statistically significant difference between the crisis state (9.43 ± 1.98 g/dL) and steady state (10.08 ± 1.60 g/dL; P = 0.231). Gender-based analysis indicated no significant difference in CD4 + counts (P = 0.403) ++ or haemoglobin levels (P = 0.542) between male and female patients. Age-related analysis showed the highest mean CD4 + count among the 31-40-year age group (1151.80 ± 626.06 cells/µL) and the lowest in patients aged 40 years and above (601.00 ± 0.00 cells/µL). Correlation analysis demonstrated weak and non-significant relationships between CD4 + counts and haemoglobin levels (r = -0.095, P = 0.530), gender (r = -0.126, P = 0.403), and age (r = 0.193, P = 0.198).
CONCLUSION: These findings highlight significant reduced CD4 levels in SCD patients during crises, underscoring the need for regular immunological monitoring
Long-term infection risks in haematological cancer survivors compared with individuals with no cancer history: protocol for a systematic review aided by artificial intelligence-based methods
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Infections are a major cause of morbidity and mortality among individuals with haematological cancers, but the duration of elevated risk in long-term survivors remains uncertain. Although previous attempts to summarise the existing literature on this topic would have been hampered by the sheer volume of studies on cancer and all-cause infections, emerging artificial intelligence tools now offer the ability to streamline the screening process, allowing for broader and more comprehensive reviews.
Methods and analysis
This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. Eligible studies will include original observational data reporting long-term (≥1 year follow-up from diagnosis) infection-related outcomes in haematological cancer survivors compared with a general or cancer-free population. Screening will be supported by ASReview, an artificial intelligence-based tool for abstract prioritisation. An internal validation step will be conducted by comparing artificial intelligence-assisted screening results with manual review performed by two independent researchers on a subset of abstracts. The primary outcomes of infection incidence and infection mortality will be summarised by type of infection, type of haematological cancer and time since cancer diagnosis. Information on anti-cancer treatments received will also be described. Data synthesis will be mostly narrative due to the broad scope of the review, though meta-analyses will be performed in cases where studies are sufficiently homogenous. Risk of bias will be assessed using the Newcastle-Ottawa Scale.
Ethics and dissemination
Ethical approval is not applicable to this study. The results of the review will be disseminated to clinical audiences and submitted to a peer-reviewed journal.
PROSPERO registration number
CRD420251047091
High school students in armed conflict-affected North Wollo, Ethiopia, struggle with lived experiences of depression and academic challenges.
No full textThe ongoing armed conflicts in Northern Ethiopia have been terribly damaging to the psychological health and educational trajectories of the students. There is an urgent need to understand the subjective, lived experiences of students dealing with this crisis. Accordingly, this study aims to explore the lived experience of depression and academic challenges among students because of the armed conflict in the North Wollo Zone, Ethiopia. This study used the Interpretative Phenomenological Analysis (IPA) approach to understand how depression and academic difficulties affect high school students. Data were collected through in-depth interviews with students who had screened positive for depressive symptoms, and the transcripts were analyzed through an iterative process of coding, developing themes, and interpretation. Five main themes emerged: the lived reality of pervasive conflict, a generation in despair, armed conflict sowing the seeds of distrust, an urgent need to be heard, and enduring the pain and seeking relief. These themes offer a deep, contextualized view of the students’ inner and outer worlds. This study found a vicious cycle among armed conflict-affected students, in which depression, academic difficulties, and social isolation all reinforce each other. These findings highlight the importance of integrated interventions that address mental health, educational continuity, and community-based resilience to effectively mitigate the compounding impacts of conflicts.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1038/s41598-026-37463-5
The influence of stigma on PrEP uptake among adolescent girls and young women in Johannesburg, South Africa and Mwanza, Tanzania: Qualitative findings from the EMPOWER study.
Get PDFBACKGROUND: Adolescent girls and young women (AGYW) in sub-Saharan Africa need HIV prevention options. Stigma may impede uptake and consistent use of oral pre-exposure prophylaxis (PrEP). We sought to understand how stigma manifested and influenced decisions of AGYW participating in a PrEP demonstration trial in Johannesburg, South Africa and Mwanza, Tanzania. METHODS: This paper reports on serial qualitative in-depth interviews (IDI) with AGYW (n = 39) as well as healthcare providers and community stakeholders (n = 30) conducted during a randomized controlled trial that evaluated the effect of empowerment clubs to address harmful gender norms and stigma on PrEP persistence in AGYW aged 16-24 in South Africa and Tanzania. Analysis was thematic and inductive. RESULTS: Stigma manifested in two main ways: HIV-related stigma and sexual behavior stigma. PrEP was often mistaken for antiretroviral therapy, and some participants taking daily PrEP reported that partners or family members thought they were living with HIV. Anticipated PrEP sexual stigma was common and linked with concerns around AGYW being perceived as promiscuous. While most participants anticipated stigma related to PrEP use, experiences of stigma were rare and did not deter AGYW from initiating PrEP. Many participants demonstrated resilience and remained confident in their decision to use PrEP and some developed strategies to avoid stigma, such as hiding pills or taking PrEP when partners or family members were not around. CONCLUSIONS: Our findings suggest that anticipated stigma is a common yet surmountable concern of AGYW initiating PrEP in eastern and southern Africa. Future PrEP implementation should be paired with multi-level activities to reduce stigma including empowerment activities for adolescents, strategies to reduce negative attitudes among health care providers and community-wide education to raise awareness and position PrEP as a responsible choice for young people to protect their health. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR202006754762723
Low-dose yellow fever vaccination in infants: a randomised, double-blind, non-inferiority trial.
Get PDFBACKGROUND: WHO recommends fractional dose vaccination to address yellow fever vaccine shortages during outbreaks. In adults, a 500 IU dose has recently been shown to be non-inferior to the full standard dose, but the minimum effective dose for children is unknown.
METHODS: We conducted a randomised, double-blind, non-inferiority trial at two centres in Kenya and Uganda, including infants aged 9-12 months with no previous yellow fever vaccination or infection. Participants were randomly assigned 1:1 in blocks of variable sizes of four, six, or eight to receive either the standard dose (>13 000 IU) or 500 IU of the Institut Pasteur de Dakar (Dakar, Senegal) 17D-204 yellow fever vaccine, co-administered with the measles-rubella vaccine. The primary outcome was seroconversion 28 days post-vaccination, defined as a four-fold or greater increase in antibody titre at day 28 from baseline (day 0), as measured by the 50% plaque reduction neutralisation test. Non-inferiority was shown if the lower bound of the 95% CI for the difference in seroconversion rates between doses exceeded -10 percentage points. Safety was assessed in the safety population, which included all participants who received a study vaccine dose. This study is registered with ClinicalTrials.gov (NCT04059471) and is complete.
FINDINGS: Between Oct 7, 2021, and June 14, 2023, 420 infants were enrolled and randomly assigned (210 participants in each group). The seroconversion rate at day 28 was 99% (95% CI 96-100; 177 of 179 infants) for the standard dose and 93% (88-96; 166 of 179 infants) for the 500 IU dose in the per-protocol population. The difference in seroconversion rate was -6·15 percentage points (95% CI -10·27 to -2·02); therefore, non-inferiority was not met for the 500 IU dose. 12 serious adverse events were reported in the study (eight in the 500 IU dose group and four in the standard dose group), but all were considered unrelated to vaccination.
INTERPRETATION: Compared with the standard yellow fever vaccine dose, a dose of 500 IU did not meet the non-inferiority criterion, suggesting that minimum dose requirements in adults are not generalisable to infants. Therefore, standard yellow fever doses should be used for infants in the routine WHO Expanded Programme on Immunization.
FUNDING: European and Developing Countries Clinical Trials Partnership and the Wellcome Trust