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Mental Health Disorders and Coping Strategies Among Palestinian Refugees in Egypt During the 2023 War on Gaza: A Cross-Sectional Study.
Get PDFBACKGROUND: The ongoing war on Gaza has a devastating impact on Palestinians, particularly on their psychological well-being. AIMS: To assess mental health disorders and coping strategies among Palestinians displaced to Egypt during the 2023 Gaza war.
METHODS: A cross-sectional study included Palestinian refugees older than 18 years. Impact of Event Scale-6, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Coping Strategies Inventory-Short Form were used to assess posttraumatic stress disorder (PTSD), anxiety, depression, and coping mechanisms, respectively.
RESULTS: Among the 558 participants, 62.2% were females, with a mean age of 33.91 ± 11.84 years. Prevalence rates of PTSD, anxiety, and depression were 37.5%, 94.1%, and 94.8%, respectively. Emotion disengagement was the most adopted coping strategy. Multiple linear regression showed that PTSD was positively associated with being female, anxiety, depression, and the use of problem engagement, problem disengagement, and emotion disengagement coping strategies. Very good financial status and difficulty accessing healthcare were negatively associated with PTSD. Anxiety was associated with older age, being female, difficulty finding a job, war-related injury, PTSD, depression, and problem disengagement, while emotion engagement was protective. Depression was associated with a family history of mental illness, housing difficulties, emotion disengagement, anxiety, and PTSD, while problem engagement and being female were protective.
CONCLUSIONS: Context-sensitive psychosocial interventions that strengthen coping strategies are essential to alleviate the psychological burden among this vulnerable population
An urgent need to build climate and health intervention trial capacity.
Get PDFRapid and ambitious adaptation and mitigation actions are urgently needed to address the growing effects of climate change on health. This imperative has been given even greater impetus by both the omission of a specific roadmap to phase out fossil fuels in the final text of COP30, and the agreement to triple climate adaptation funding by 2035, albeit with no clear baseline. However, there are major gaps in the evidence for what works and in which context
Beyond calories: climate-change threats to food safety and nutrition in UK food systems debate
Get PDFThis debate examines how climate change presents complex and compounding challenges to food safety and nutrition within food systems in the United Kingdom. It highlights that risks extend far beyond calories, as environmental hazards such as extreme heat, humidity, drought, flooding, and rising CO₂ levels interact in ways that amplify microbial growth, drive mycotoxin outbreaks, introducing pests, pathogens and microbes to crops and livestock, as well as diluting the micronutrient content of staple crops and altering the nutritional quality and diversity of diets. The overlapping pressures pose a challenge to existing risk assessment models, which were developed in such a way that they handle single hazards at a time. Recent evidence indicates that the compound effect of multiple stressors may destabilize health outcomes, trade systems, and economic stability, as well as exacerbate health inequalities. This necessitates new approaches to food governance and collaboration with food system actors. To address that, this paper recommends the incorporation of climate-hazard tiers into regular food safety checks, revision of food-based dietary guidelines and surveillance systems to incorporate the threat of nutrient dilution of food systems, and investment in predictive analytics, such as AI applications and satellite observations, to forecast food safety crises in the region and globally. It also suggests a compromise between decarbonizing the cold chain and microbiological safety, as well as supporting calls to expand the National Risk Register to consider nutrient security risks, as well as food-borne disease, in times of disaster. This Debate asks how UK food-safety and nutrition governance should evolve in light of compound climate hazards that simultaneously influence microbial risks, mycotoxin pressures and nutritional security and recommends three immediately actionable steps: introduce a climate-hazard tiering approach, deploy redictive analytics for horizon scanning, and validate cold-chain set-points under climate stress
A synthesis of explanations for spatial inequalities in gambling harm: integrating social and material dimensions of place.
Get PDFPlace matters for understanding patterns of gambling harm as shown by the spatial clustering of both 'vulnerable' people and gambling outlets. Harms are experienced at a community level (and never restricted to individuals) and are spread unequally across communities of place. Following the liberalisation of gambling laws in the UK in the 1990s, gambling outlets and advertising have proliferated in many economically disadvantaged places, with the gambling industries in some cases appearing to target these areas. Despite growing recognition of place-based inequalities in the harms caused by gambling, there have been limited efforts to understand gambling as a spatial practice that reflects and produces inequalities in health. This paper presents a synthesis of theories and explanations in the social science and public health literature about the unequal harms from gambling experienced by people in different places. We draw on a socio-material approach in our synthesis to show how different assemblages of gambling products, venues, marketing materials and collective histories form in different localities to influence different gambling practices with varying consequences for health. The synthesis foregrounds how different levels of power and influence in the production, regulation and experience of space across communities shape i) the meanings of gambling as a social practice and ii) the collective resources of communities to protect themselves from gambling harms. The analysis thus points to socio-material spaces as sites for interventions to reduce inequalities in harm
Rainfall and water-related diseases, malnutrition and mortality in Low- and Middle- Income Countries: a systematic review of the epidemiological evidence
Get PDFBackground Climate change is altering rainfall patterns. Rainfall has been linked to numerous health outcomes, through the impacts on water quality and quantity, but the coherence and strength of evidence across outcomes remain unclear. Objectives Understand and evaluate the strength of evidence on associations between rainfall (both low and heavy events) and health outcomes in Low- and Middle- Income Countries (LMICs). Methods A systematic review of peer-reviewed epidemiological studies quantifying associations between rainfall and human health outcomes in LMIC populations was conducted. Seven databases were searched including MEDLINE and EMBASE. Study quality was evaluated using 9 modified criteria that were previously used to assess environmental epidemiology studies. The strength of evidence for each health outcome was assessed across rainfall exposures. Results Of 23,579 papers identified, 177 met the inclusion criteria. Health outcomes included diarrheal diseases (n = 119); malnutrition (n = 35); mortality (n = 21); helminth infections (n = 6), and eye infections (n = 4). There was moderately strong evidence for positive associations between both heavy and low rainfall and all-cause diarrhea. Evidence for undernutrition was mixed, with moderate evidence of a positive association with low rainfall. Despite sharing causal pathways, diarrheal disease and nutrition studies found contrasting results for heavy rainfall, likely due to differing study designs. Studies were heterogenous in design, rainfall exposure definitions, and lag times. Studies also often lacked a clear hypothesis. Discussion There is substantial evidence that rainfall affects health in LMICs through multiple pathways. Limitations in the data (often from cross-sectional surveys) and study designs, limit the strength of evidence for several health outcomes. Specifically, studies frequently used inappropriate exposures or lags to reflect the causal pathways. In future studies, efforts should be directed to incorporating pathways in models and better defining low rainfall exposures. Conceptualising the interaction between rainfall and inter-related health outcomes can also strengthen future research
HIV testing during systematic screening for tuberculosis among household contacts in high-tuberculosis burden settings: a systematic review and meta-analysis.
Get PDFBACKGROUND: Tuberculosis household contacts are at elevated risk of HIV, and systematic screening for tuberculosis is an opportunity for people to know their status. We aimed to assess the coverage and positivity of HIV testing during household systematic screening for tuberculosis.
METHODS: For this systematic review and meta-analysis (PROSPERO: CRD42024471979), we searched MEDLINE, Embase, Global Health, and Africa Wide databases from Jan 1, 2000, to June 24, 2025. The primary analysis population was household contacts of people with tuberculosis without known HIV. Studies were included if HIV testing was offered to household contacts, and in the primary analysis if people known to be living with HIV were excluded from the population eligible for testing. We extracted or derived coverage (proportion of people eligible for testing who received an HIV test) and positivity (proportion of people tested with a positive result) and calculated pooled proportions using random effects meta-analysis. We narratively summarised themes from qualitative reports. Meta-regression examined the association of national HIV prevalence, time period, and participant age, with coverage and positivity of HIV testing.
FINDINGS: Searches identified 31 quantitative studies (110 090 people), of which 17 (40 407 people) were included in primary analyses. Seven qualitative studies reported community or provider perspectives. The pooled proportion of eligible household contacts tested for HIV was 72·9% (95% CI 60·3-83·9), ranging from 0% to 100%. Pooled positivity of testing was 5·9% (3·6-8·8) overall. Positivity was 9·7% (5·8-14·5; ten studies) in countries with ≥10% national adult HIV prevalence. Qualitative studies highlighted context-dependent facilitators and barriers of household contacts' capability, opportunity, and motivations to engage with HIV testing.
INTERPRETATION: Few studies have evaluated HIV testing for tuberculosis household contacts. Coverage of testing was reasonable but varied substantially across studies. Positivity of testing was high. Further research is needed to understand and optimise acceptability and ensure feasibility of HIV testing within screening of tuberculosis among household contacts, and tuberculosis-HIV programmes in high HIV-incidence settings should consider monitoring implementation of HIV within routine tuberculosis household contact screening.
FUNDING: National Institute for Health and Care Research and Wellcome Trust
Mortality risks associated with short-term exposure to ultrafine particles in London and the West Midlands.
Get PDFBACKGROUND: Some research has suggested that ultrafine particles (UFP), with an aerodynamic diameter less than 100 nm, might be the most harmful component of ambient particulate matter air pollution on human health. In the United Kingdom, UFP toxicity might also be affected by national vehicle fuel policies passed in 2007. We assessed associations between short-term exposure to UFP and mortality in two metropolitan areas in England.
METHODS: We conducted a time-series analysis of 851,726 deaths in London and the West Midlands between 2003 and 2018. UFP was assessed as particle number concentration lagged 0-1 days. We used quasi-Poisson regression to estimate associations between particle number concentration and nonaccidental, cardiovascular, and respiratory mortality in both locations. Secondarily, we conducted an interrupted time-series analysis to evaluate potential impacts of the 2007 fuel policy.
RESULTS: For all mortality outcomes in both locations, risk ratios ranged from 0.991 (95% confidence interval [CI] = 0.965, 1.019) to 1.001 (0.990, 1.011) for a 10,000 particle/cm3 increase, and all 95% CIs included the null. Null results persisted when lag periods were extended to 0-5 days, linearity assumptions were relaxed, or when co-pollutants PM2.5 and NO2 were included. In the interrupted analysis, there was only evidence of a change in risk ratio for respiratory mortality in London (pdifference = 0.006), and risk ratios before and after the change point were null.
CONCLUSIONS: We found no evidence that suggested that UFP is associated with nonaccidental, cardiovascular, or respiratory death, and little evidence that the fuel policy modifies this association
Egocentric characterisation of the swine trade network in Cambodia and implications for disease surveillance and control.
No full textAcross Southeast Asia, enhanced characterisation of pig value chains is needed to understand disease risk pathways and inform control and surveillance strategies. This study defined a typology of value chain actors in Cambodia and characterised their individual, 'egocentric', swine trade networks. Questionnaire-based cross-sectional surveys were conducted between May 2020 and April 2022 in four south-central provinces, sampling 'egos' via a multi-stage cluster design. We describe networks of 376 egos involving 4705 trade partners ('alters') and 669,363 pigs over six months. Five producer types were identified: company-affiliated large breeding (n = 21) and growing farms (n = 68), independent breeding- (n = 104) and growing-oriented smallholders (n = 77), and boar service providers (BSP; n = 19). Three pig-exchanger types were also identified: 'traders' (n = 11), 'middlemen' (n = 12), and 'butchers' (n = 51). Network analysis revealed BSP, middlemen, and large breeding farms as 'brokers' with many in- and outgoing trade links with producers, increasing their potential for pathogen introduction and onward transmission. Logistic regression supported this risk-profiling: compared to breeding-oriented smallholders, BSP had 8.1 times greater odds (95 % CI: 2.4-27.8) of high pig mortality risk (≥5 % of herd size), while large breeding farms had 6.0 times greater odds (95 % CI: 2.0-18.6) than large growing farms. Large breeding farms supplied pigs to all producer types including smallholders and BSPs (1 % of their aggregate supply), underscoring their dissemination potential. Middlemen and BSP connected otherwise weakly connected smallholders, highlighting opportunities for targeted disease-control. Slaughterhouses acted as network 'sinks', receiving pigs from smallholders and farms associated with different companies, making them key targets for disease surveillance. Large farms transported pigs the furthest distances (median >40 km; max >120 km) while smallholders mostly traded pigs locally (median <5 km; max 114 km). This study demonstrates the value of egocentric sampling for livestock network characterisation and contributes to the limited knowledgebase on swine trade networks in Southeast Asia
Longitudinal assessment of changes in hair cortisol levels and associations with violence, poor mental health and harmful substance use among female sex workers in Nairobi, Kenya.
Get PDFFemale sex workers (FSWs) in sub-Saharan Africa commonly experience violence, mental health problems, and harmful substance use. Stressful life events can harm the functioning of the hypothalamic-pituitary-adrenal (HPA) axis, serving as a pathway to increased poor health, including HIV susceptibility through cortisol levels. In this paper, we examine changes in hair cortisol concentration (HCC) levels and associations with experiences of violence, mental health problems and harmful substance use among FSWs in Nairobi, Kenya. We used baseline and endline data from the Maisha Fiti study of FSWs in Nairobi. Participants reported recent violence, poor mental health, and harmful alcohol/substance use at both time points. Hair samples proximal to the scalp were collected to measure HCC levels determined by ELISA technique. We analysed data from 285 HIV-negative respondents who provided a 2 cm hair sample at baseline and endline. Multivariable linear regression models were used to assess the associations between the trajectory of the main exposure variables and the change in HCC levels at endline. Findings showed that HCC levels decreased significantly (p-value = 0.001) from baseline (mean HCC = 316 ng/g) to endline (mean HCC = 238.1 ng/g). Reported prevalence of violence, mental health problems and harmful alcohol/other substances decreased. There was evidence of associations between change in HCC at endline and the trajectories of physical violence (p-value = 0.007) and physical and/or sexual violence (p-value = 0.048). There was weak evidence of an association between the trajectory of exposure to emotional violence but no evidence of other associations. These findings suggest that physical violence and physical and/or sexual violence may lead to HPA axis dysfunction, possibly serving as a pathway linking violence to increased poor health, including HIV acquisition. However, further research with repeated measurements and a larger sample size is needed to examine the associations between violence, HCC levels, and HIV infection
Effect of repeated mass drug administration on the transmission of yaws: a retrospective genomic epidemiology study.
Get PDFBACKGROUND: Yaws, a neglected tropical disease caused by Treponema pallidum subspecies pertenue (T p pertenue), has evaded eradication, in part due to a high proportion of asymptomatic cases. Repeated mass drug administration (MDA), whereby an entire population is repeatedly treated irrespective of disease, could provide a solution. Here, we aimed to investigate the effect of MDA on the genomic epidemiology of T p pertenue. METHODS: We conducted a retrospective genomic epidemiology study on samples collected during a cluster-randomised trial of mass administration of azithromycin for yaws eradication in the Namatanai District of Papua New Guinea. Participants were in 38 wards (administrative units encompassing several villages) in three local-level government areas (LLGs). The experimental group received an initial round of MDA followed by two further rounds 6 months and 12 months after the first round. The control group received one round of MDA followed by two rounds of treatment targeting clinical cases and contacts only, on the same schedule as the MDA in the experimental group. A follow-up survey on both groups was done 18 months after the first MDA round. Swab samples were collected at each round from ulcerative and nodular skin lesions, and blood was collected by finger-prick for serological testing at 18 months. Metadata on ulcer size (cm) and duration (days) were recorded at each round, and treponemal and non-treponemal antibodies were recorded at 18 months. Samples from swabs positive for T p pertenue underwent library preparation and whole-genome sequencing. We examined the phylogenetic relationships between genomes, linking them with geospatial and patient metadata to understand the impact of MDA on T p pertenue diversity and transmission. FINDINGS: Swabs collected from 297 individuals with active yaws from April 30, 2018, to Nov 2, 2019, yielded 222 good-quality Tp pertenue genomes. We identified 20 sublineages of T p pertenue in the control group and 21 in the experimental group at the beginning of the study. At the end of the study, there were 13 sublineages in the control group and three in the experimental group, of which two persisted in both groups. Three sublineages not detected at baseline were observed in the control group after commencing MDA. The two sublineages that persisted in both groups had non-synonymous mutations in penicillin-binding proteins. One of these sublineages evolved macrolide resistance in three individuals and was associated with lowered treponemal antibody (p=0·0036) and longer ulcer duration (p=0·015). Despite the study taking place within a small island, sublineages were geographically clustered, with pairs of samples from the same ward (odds ratio 7·1, 95% CI 5·7-8·8; p<0·0001) or neighbouring wards (4·3, 3·3-5·4; p<0·0001) more likely to share the same sublineages compared with pairs from different LLGs. Additionally, older individuals were more likely to share sublineages than were younger individuals (1·5, 1·2-1·9; p<0·0001). INTERPRETATION: Repeated MDA was successful in reducing and maintaining the genetic diversity of T p pertenue at a low level but was associated with the development of macrolide resistance. Yaws re-emergence after MDA was attributed to multiple sublineages, of which the majority were detected in the population before MDA. Participants within the same ward were more likely to share sublineages than those that were more widely geographically separated, suggesting that re-emergence was driven by local transmission. These findings could inform future yaws elimination strategies. FUNDING: European Research Council, EU, Provincial Deputation of Barcelona, Barberà Solidària Foundation, Wellcome, and Fundació "la Caixa"