69832 research outputs found
Sort by
Immunogenicity of one and two doses of Gardasil®9 in Tanzanian girls in the DoRIS Trial.
No full textTanzanian girls received one to three doses of Gardasil®9 in the DoRIS randomised trial. Blood samples from one and two-dose Gardasil®9 recipients were collected at months (M)0, M7, M12, M24, and M36 for testing via an HPV Multiplex immunoassay. All participants were HPV 16, HPV 31, and HPV 58 seropositive at M36. For the one-dose group, 96.8-98.2% of girls were seropositive for HPV 11, HPV 18, and HPV 33 and 73.0-87.7% seropositive for HPV 6, HPV 45 and HPV 52. For the two-dose group, all participants were HPV 6, HPV 11, HPV 18, and HPV 33 seropositive, while 98.6% seropositive for HPV 45 and HPV 52. Geometric mean concentrations (GMCs) were higher in the two-dose group compared to the one-dose group but all GMCs in the one-dose group had plateaued by M24 and remained stable to M36. HPV vaccine immune responses in this study will continue through nine years post-vaccination. ClinicalTrials.gov ID: NCT02834637; Registration Date: 2016-06-29; https://www.clinicaltrials.gov/study/NCT02834637
Menstrual Pain Management, School Absenteeism and Educational Performance Among Adolescent Students: Cross-Sectional Mixed-Methods Analysis Nested Within a Cluster Randomised Trial.
Get PDFOBJECTIVE: To describe menstrual pain and pain management, and the associations of pain relief with school absenteeism and educational performance, among Ugandan adolescents. DESIGN: Cross-sectional mixed-methods study, nested within a school-based cluster randomised controlled trial. SETTING AND POPULATION: Adolescent girls in 60 secondary schools in Uganda. METHODS: Quantitative surveys, focus group discussions and in-depth interviews were conducted. Data were analysed using thematic framework analysis for qualitative data, and random-effects regression analysis for quantitative data. MAIN OUTCOME MEASURES: Self-reported pain during the last menstrual period (LMP), school absenteeism and educational performance. RESULTS: Among 2683 participants, the majority (n = 2227; 83.0%) reported pain during their LMP and were more likely to miss school than those without pain (mean days missed per month 2.1 vs. 1.4; adjusted incidence rate ratio [aIRR] = 1.46, 95% CI 1.30-1.65). Participants reported that menstrual pain hindered their ability to engage at school, leading to reduced class attendance and participation. Pain management strategies (painkillers, warm water bottles, stretching, or exercise) were reported by 1587 (71.3%) participants with pain at LMP, and were less commonly reported among participants with mental health problems and poorer menstrual self-efficacy. Participants who did not report pain relief missed more school days than those who did report pain relief (aIRR = 1.39, 95% CI 1.11-1.74). CONCLUSION: Menstrual pain without effective relief was associated with increased school absenteeism. There is a need to improve the uptake of effective pain relief strategies in Ugandan schools and similar settings
“Uncertainty, stress, unpredictability, and worry”: A qualitative study exploring public trust, emotions and willingness to comply with government-led COVID-19 mitigation measures during the pandemic in France, Italy and Hungary
Get PDFIntroduction During the pandemic, European governments implemented multi-layered public health measures, including vaccination, to mitigate the spread of coronavirus disease 2019 (COVID-19). These measures stimulated a range of public attitudes and responses towards the pandemic and governmental actions to control it. This study sought to explore public perceptions and feelings about the handling of the COVID-19 pandemic by governments and leading authorities in three European cities, with specific attention to prevention policies and vaccine mandates, trust dynamics, and perspectives on the future. Methods As part of a larger mixed-methods study, 60 qualitative interviews (20 per country) were conducted with adults in three European capital cities - Paris, France; Budapest, Hungary; and Rome, Italy. Results Findings showed that in the early stages of the pandemic, there was greater commonality of perspective and motivation, with participants expressing a sense of fear and readiness to receive guidance from governments and authorities. Over time, emotions and frustrations borne out by imposed restrictions undermined people's abilities and willingness to follow formal guidance. Despite some positive views, trust in governments and leading authorities was eroded where implementation was considered irrational or excessive, and there are reservations about how well countries would be able to respond to future pandemics. Conclusions To inform future pandemic preparedness efforts it is vital to take heed of how government actions taken during the COVID-19 pandemic were felt and rationalised within the lived experiences of the public and any lasting impacts that may influence the effectiveness of future response efforts
Data science without borders: bridging the divide in data science capacity across African health institutions.
Get PDFBACKGROUND: Effective public health data science in Africa requires a comprehensive understanding of institutional capabilities across multiple dimensions. This study conducted a multidimensional assessment of three African health institutions to examine the availability of health data, healthcare training, data governance needs, and infrastructure capabilities, to inform the use of data science tools to address health challenges.
METHODS: The study is a baseline assessment for the Data Science Without Borders Project-a three-year multi-country project implemented in three African health institutions: the Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF) in Senegal, Armauer Hansen Research Institute (AHRI) in Ethiopia, and the Douala General Hospital (DGH) in Cameroon. We designed a baseline structured needs assessment survey to assess: (1) health data availability across sixteen (16) dataset categories; (2) training needs across seven (7) domains, data governance considerations; and (3) infrastructure capabilities, including computing resources, connectivity, and service availability. We then conducted an integrated analysis to identify patterns, gaps, and opportunities across various dimensions, informing project implementation.
RESULTS: The assessment revealed different institutional profiles with complementary strengths and limitations, which are critical for the effective use of data science tools. IRESSEF demonstrated rich data resources (particularly in genomics, maternal health, and geographical health differences), moderate infrastructure limitations (8GB RAM, 67% service capability), and high training needs (data & analytics: 4.7/5.0, data governance: 4.0/5.0). AHRI exhibited superior computing resources (512GB RAM, 64 CPU cores), specialized surveillance data (9.9%), and moderate training needs (average: 3.0/5.0). DGH demonstrated focused strengths in infectious disease research (3.3%), moderate computing resources (32 GB RAM), and large opportunities to use electronic health records for research. Common priorities across institutions included the need for enhancing data & analytical capabilities (average: 4.3/5.0) and use of advanced [artificial intelligence and machine learning analysis techniques (IRESSEF: 5.0, AHRI: 4.0, DGH: 5.0)], and very importantly, the need to establish data governance structures to increase the ability and capacity of the partners to share data for consortium collaborative analyses across Africa.
CONCLUSION: Our integrated assessment suggests that effective capacity building requires moving beyond standardized approaches to embrace a phased model that leverages institutional needs and complementarities. We recommend: (1) establishing robust data governance frameworks as a foundation; (2) implementing a phased and customized approach where institutions receive training according to their immediate demands and strengths; (3) addressing critical infrastructure gaps to support data. We are involved in science projects in Africa that support federated analyses to maintain data sovereignty. This approach offers potential for a varying African approach to health data science, which could extend to AI adoption and broader continental collaboration
Perceptions and experiences of older adults in a youth community health volunteer-led health coaching program in Singapore: A qualitative study.
Get PDFBACKGROUND: With an aging global population, there is a growing emphasis on community-based approaches to preventive health for older adults. While Community Health Volunteers have been found to be effective in empowering older adults to manage their chronic conditions, there is limited research on the role of Youth Community Health Volunteers (YCHVs) and little is known about how older adults perceive their role and effectiveness. OBJECTIVES: This qualitative study explores older adults' experiences and perceptions of a YCHV-led health coaching program following community health screening in Singapore. METHODS: We conducted one-to-one semi-structured interviews with 19 older adults who had participated in HealthStart, a YCHV-led health coaching program. Purposive sampling was used to ensure representation across diverse demographic backgrounds and varying levels of program engagement. Interviews were carried out between November 2023 and January 2024 in community centers, healthcare facilities, or via telephone/Zoom, and explored participants' experiences with the program, perceptions of YCHVs, and health-related outcomes. We analyzed data thematically using deductive and inductive coding. RESULTS: We generated five themes: (1) How YCHV facilitation contributed to prevention outcomes, (2) YCHV facilitation techniques, (3) Intrinsic factors influencing older adults' receptivity towards YCHVs, (4) Older adults' perceptions of YCHVs, and (5) YCHVs' potential to be further empowered as health advocates. Findings provided insights into health behaviors of older adults, the perceived role of YCHVs in influencing these behaviors, and potential and opportunities to strengthen YCHVs' capacity as health advocates. CONCLUSION: Engaging YCHVs as preventive health advocates for older adults appeared both acceptable and promising. This study highlights the potential for YCHV scale-up, while emphasizing the need for targeted training in behavior change and referral to community resources. Beyond individual health gains, such initiatives may help address ageist attitudes, foster intergenerational solidarity, and complement primary care efforts
Using step selection functions to analyse human mobility using telemetry data in infectious disease epidemiology: a case study of leptospirosis.
Get PDFBACKGROUND: Human movement plays a critical role in the transmission of infectious diseases, especially those with environmental drivers like leptospirosis-a zoonotic bacterial infection linked to mud and water contact. Using GPS loggers, we collected detailed telemetry data to understand how fine-scale movements can be analysed in the context of an infectious disease.
METHODS: We recruited individuals living in urban slums in Salvador, Brazil, to analyse how they interact with environmental risk factors such as domestic rubbish piles, open sewers, and a local stream. We aimed to identify differences in movement patterns inside the study areas by gender, age, and leptospirosis serological status. Step selection functions, a spatio-temporal model used in animal movement ecology, estimated selection coefficients to represent the likelihood of movement toward specific environmental factors.
RESULTS: With 128 participants wearing GPS devices for 24-48 hr, recording locations every 35 s during active daytime hours, we segmented movements into morning, midday, afternoon, and evening. Our results suggested women moved closer to the central stream and farther from open sewers compared to men, while serologically positive individuals avoided open sewers.
CONCLUSIONS: This study introduces a novel method for analysing human telemetry data in infectious disease research. FUNDING: Funding provided by Wellcome Trust, UK Medical Research Council, Brazilian National Research Council, Reckitt Global Hygiene Institute, and National Institute of Allergy and Infectious Diseases
Self-reported mistrust in borderline personality disorder: A meta-analytic review.
Get PDFRecent studies indicate that borderline personality disorder (BPD) is marked by chronic interpersonal dysfunction, particularly impairments in trust, which significantly hinder recovery. This review aims to examine the association between mistrust and BPD and explore the potential moderating effects of factors such as age, gender, education, type of measurement of mistrust and BPD, and study design and sample source. This review was pre-registered on PROSPERO. A comprehensive search was conducted across EMBASE, MEDLINE, PsycINFO, Scopus, and Web of Science, with the last search on May 6, 2025. The risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) Checklist for Cross-Sectional Associational Studies and the JBI Checklist for Case-Control Studies. The inclusion criteria encompassed published analytical observational studies in English that utilized psychometrically valid self-report measures of mistrust and BPD, without restrictions on publication date. A three-level meta-analytical model was used to synthesize the extracted effect sizes from the studies. A total of 212 studies (reflecting 254 independent samples, 457 effect sizes, and 119,691 participants) were included. Results showed that the pooled correlation between mistrust and BPD was r = 0.45 (95 % CI [0.43, 0.46], p < .001), with demographic variables having no moderating effect. Despite some limitations with studies included in the meta-analysis, such as the failure to identify and handle confounding variables and the lack of standard criteria to assess BPD, the findings highlight the role of interpersonal mistrust in BPD and underscore the need for further research to clarify its clinical relevance
Cost-benefit analysis of interventions to protect care home residents in England against heat risks.
Get PDFWe examine the cost-benefit of selected physical and behavioural interventions to reduce indoor temperatures and associated health risks in UK care homes during periods of hot weather typical of the projected future climate. Cases of heat-related mortality under selected temperature scenarios were modelled for three care home settings. Published temperature-mortality functions for care home residents of England and Wales were applied to life tables for care home populations. Building physics modelling was used to assess the effect of interventions on summer indoor temperatures and associated mortality risks. The monetised value of quality-adjusted life years gained was assessed in relation to the capital, energy and maintenance costs of each intervention over its lifespan under a range of assumptions. Sensitivity analyses were used to characterise model uncertainty. Under the assumption that those who die of heat have the life expectancy of an average care home resident, we found evidence for cost-effective interventions. The cost-effectiveness of interventions varied across care homes, depending on each building's specific characteristics. In a large, highly insulated care home with low thermal mass, increased thermal mass combined with window and door opening rules was the most cost-effective intervention; in a small care home with limited insulation and high thermal mass, active cooling in lounges using portable air-conditioners was most cost-effective; and in a medium sized care home with moderate insulation and thermal mass, shading combined with window and door opening rules was most cost-effective. Our results show that several interventions have the potential to be cost-effective in reducing heat-related risks to residents across a range of care home types. They also demonstrate that behavioural interventions, such as window and door opening, may be equally effective as physical interventions at reducing exposure to heat-related risks, provided they are fully adhered to
Development, validation and reliability of knowledge, attitudes and practice questionnaire for people affected by leprosy reactions.
Get PDFLeprosy reactions occur in 20-50% of people affected by leprosy. Previous studies have shown that lack of awareness and understanding of leprosy reactions among affected individuals and healthcare workers. This study aims to design and validate a knowledge, attitudes, and practices (KAP) questionnaire to assess understanding of leprosy reactions among leprosy-affected individuals. This study employed a sequential exploratory design in three phases. During interviews, affected individuals expressed dissatisfaction with the level of information provided by medical practitioners regarding leprosy reactions. People affected by leprosy reactions shared experiences of frustration, treatment barriers, and difficulties with daily activities during interviews and workshops. The pilot test with eight affected individuals let to the removal of one question, the addition of a new question, and adjustment to wording and instructions. Cronbach's alpha was calculated based on data collected from 63 individuals. The overall Cronbach's alpha was 0.71. The final KAP questionnaire consists of 39 questions, is considered clear and acceptable by users and can therefore be used to measure the KAP of individuals with leprosy reactions in Indonesia. KAP questionnaires have the potential to identify gaps in understanding of leprosy reactions and are expected to be helpful in assessing the effectiveness of interventions
Evaluation of community-based heat adaptation interventions: a systematic review
Get PDFIntroduction
Heat adaptation strategies are crucial to minimising the adverse effects of heat on human health. We systematically reviewed published studies till February 2024 to synthesise and evaluate the evidence of the impact of community-based heat adaptation strategies on surface and indoor temperatures and health outcomes.
Methods
Two investigators independently screened relevant databases and extracted data. The review included a total of 141 studies; 124 landscape interventions, out of which 114 focused on green walls/roofs and modified pavements, 21 building modifications including altered construction materials and improved ventilation; and 45 targeted individual-level interventions including heat education and warning systems, heat action plans and modifications in clothing. Meta-analysis was conducted for surface and indoor temperature for each intervention/comparison group for landscape and building modifications, and descriptive analysis was performed on human outcomes for individual-level interventions due to wide variability in reporting of outcomes.
Results
The meta-analysis suggests that green roofs significantly reduced surface temperatures by 10.88°C (95% CI: −15.26°C to –6.50°C) and indoor temperatures by 2.4°C (95% CI: −3.54°C to –1.26°C) compared with conventional roofs. Green walls significantly reduced surface temperatures by 2.39°C (95% CI: −4.03°C to –0.74°C) and indoor temperatures by 2.08°C (95% CI: −3.00°C to –1.16°C) compared with bare walls. Pavements with modified asphalt materials reduced surface temperatures by 5.45°C (95% CI: −6.75°C to –4.15°C) compared with conventional asphalt. Reflective paints significantly reduced surface temperature by 4.55°C (95% CI: −6.74°C to –2.36°C) and indoor temperatures by 1.69°C (95% CI: −3.35°C to –0.02°C) compared with conventional roofs. Most studies examining heat action plans reported a decrease in mortality, and heat education and heat warning systems led to reduced morbidity and mortality and improved heat-related knowledge, attitudes and practices. Studies have reported physical strain alleviation and improvement in body temperature while using modified garments.
Conclusions
With the increasing exposure to extreme heat, contextual evidence will provide valuable insights for effectiveness, acceptance and cost-effectiveness for various interventions