69832 research outputs found
Sort by
Exploring Pregnant Women's Perceptions and Experiences of Adiposity Measurements in Routine Antenatal Care: A Qualitative Study.
Get PDFBackground/objectives: Maternal adiposity is a known risk factor for adverse pregnancy outcomes, yet routine antenatal care primarily relies on body mass index (BMI), which has limitations. This study aimed to explore the acceptability of incorporating a broader range of adiposity measurements into early pregnancy antenatal care, assessing pregnant women's perceptions to inform implementation strategies.
Methods: A qualitative study using semi-structured interviews was conducted with 14 pregnant women purposively sampled to capture variation in BMI, age, and parity. Interviews occurred approximately 4-5 months post-measurement experience. The Theoretical Framework of Acceptability (TFA) guided thematic analysis of transcribed data, with independent coding to ensure rigour.
Results: Participants generally viewed the current reliance on BMI as outdated and expressed neutral to positive attitudes toward the use of more detailed adiposity measurements. Most reported little emotional discomfort with the process. However, some reflected likelihood of more body self-consciousness had it been their first pregnancy. Time involved in measurements was not seen as burdensome, however waiting between procedures was a minor inconvenience. Self-assessing body shape was described as difficult. Women emphasised the importance of choice, autonomy, and informed consent, especially in relation to partner involvement, the gender of the anthropometrist, and the nature of the procedures. Clear, advance communication and supportive explanations during appointments were seen as essential to ensuring a positive experience.
Conclusions: Expanding adiposity assessments in early pregnancy is acceptable to women if implemented ethically, prioritising consent, privacy, emotional safety, and effective communication. Integration into routine care requires staff training and pre-appointment guidance
Efficacy of ceiling-mounted mosquito nets for malaria vector control in a Peruvian Amazon riverine community: A stepped-wedge cluster randomized trial.
Get PDFMalaria remains a major global health concern, especially in tropical regions such as the Peruvian Amazon. Installing ceiling-mounted mosquito nets in houses has been proposed as a strategy to reduce mosquito-human contact and, in turn, lower malaria transmission. We aimed to assess the effectiveness of ceiling-mounted mosquito nets in reducing Anopheles mosquito density in a high-transmission Amazonian setting. We conducted a stepped-wedge cluster-randomized trial from March to December 2024 in the Llanchama community of the San Juan Bautista district, Loreto, Peru. A total of 69 households were randomized into three clusters, receiving the intervention at staggered three-month intervals. We measured entomological indices using human landing catches (HLC) and other standardized methods, focusing on Anopheles mosquito counts, bites per person per night (BPN), and bites per person per hour (BPH), both indoors and peridomestic, derived from the same HLC sessions, using cumulative mosquito captures over 12-hour periods to compute biting indices. Houses were retrofitted with mosquito nets across ceilings and other open structural areas, creating a barrier to prevent mosquito entry and lower exposure. Analysis followed a stepped-wedge mixed-effects negative binomial model adjusting for clustering and time trends. Our per-protocol analysis shows that, compared to non-renovated households, the renovated households experienced a 55% reduction in indoor Anopheles counts (95% CI: 33%-74%; p = 0.004), a 60% decrease in indoor BPN (95% CI: 27%-78%; p = 0.003), and a 61% reduction in indoor BPH (95% CI: 15%-83%; p = 0.018). Peridomestic mosquito counts, BPN, and BPH did not differ significantly between renovated and non-renovated households. Our study provides evidence that installing mosquito nets across household ceilings markedly reduces indoor Anopheles presence and biting rates, suggesting that this structural modification could be a promising strategy for lowering malaria risk in riverine communities
Sensitive near point-of-care detection of asymptomatic and submicroscopic Plasmodium falciparum infections in African endemic countries.
Get PDFLimited diagnostic capacity for detecting asymptomatic malaria infections with low parasite densities hinders elimination efforts in Africa. Here, we adapt a near point-of-care, LAMP-based diagnostic platform for malaria diagnosis using capillary blood. This Pan/Pf detection method meets the Malaria Eradication Research Agenda (malERA) criteria for community-level screening, with a limit of detection of 0.6 parasites/μL and a sample-to-result time under 45 minutes. We evaluate its performance on 672 capillary blood samples collected at the community level in The Gambia and Burkina Faso, including 146 Plasmodium falciparum positives confirmed by qPCR. The diagnostic platform achieved 95.2% sensitivity (95% CI: 90.4-98.1) and 96.8% specificity (95% CI: 94.9-98.0). It also detected 94.9% (130/137) of asymptomatic infections and 95.3% (41/43) of submicroscopic cases (<16 parasites/μL), outperforming expert microscopy (70.1% and 0%) and rapid diagnostic tests (49.6% and 4.7%). This field-deployable molecular diagnostic method offers a sensitive, scalable solution to support test-and-treat strategies for malaria elimination across Africa
Associations between PM<sub>2.5</sub> from prescribed burning and emergency department visits in 11 Southeastern US states.
Get PDFLonger, more severe wildfire seasons are becoming the norm in fire-prone areas. Prescribed burning is a tool used to mitigate wildfire spread. However, prescribed burning also contributes to air pollution, including PM2.5 (particulate matter with aerodynamic diameter 2.5 concentrations and employed a time-stratified case-crossover design to quantify the relative risk of emergency department (ED) visits associated with PM2.5 levels lagged 0-3 days. Models adjusted for non-prescribed fire PM2.5 and O3, temperature, humidity, and holidays. We also examined how relative risks varied across population subgroups. PFS-specific PM2.5 was associated with a relative risk of ED visits for non-external causes (1.01, 95 % confidence interval (CI): 1.01, 1.02) comparing 4.3 µg/m3 (95th percentile) versus 0 µg/m3, upper respiratory infections (1.04, 95 % CI: 1.01, 1.07), and ischemic heart disease (1.06, 95 % CI: 1.01, 1.11). We did not observe an increased risk for overall respiratory outcomes, asthma, or COPD, which differs from published WFS findings. Relative risks varied across outcomes and modestly across population subgroups defined by age and markers of social vulnerability. However, after correcting for multiple comparisons, these differences were not significant. Some findings differed from associations previously reported elsewhere for WFS, highlighting the need for direct comparisons of the health impacts of WFS versus PFS for evaluating safety of prescribed burning as a fire management tool
Adapted Safety Plans to Address Self-Harm and Suicide Behaviours in Autistic Adults: single arm feasibility trial and external pilot RCT.
Get PDFBACKGROUND: Suicide prevention is a national priority for United Kingdom government policy, and autistic people have recently been identified as a high-risk group in both the Department of Health and Social Care suicide prevention strategy and National Institute for Health and Care Excellence suicide prevention guidelines. No suicide prevention interventions have been developed specifically for autistic people. Safety plans are a simple, cost-effective, potentially life-saving intervention. AIMS: To evaluate the feasibility and acceptability of the use of Autism Adapted Safety Plans for autistic adults and to undertake an external pilot to explore whether a larger future definitive trial is achievable. METHODS: Stage 1 involved focus groups with autistic adults (n = 15), family members (n = 5) and service providers (n = 10) to inform adaptations to the Autism Adapted Safety Plans. Stage 2 was an interventional single-arm feasibility trial where autistic adults (n = 8) completed an Autism Adapted Safety Plans with a supporter (n = 8). Data on recruitment, completion of study measures and participant feedback informed final adaptations to the Autism Adapted Safety Plans and research methods prior to stage 3. Stage 3 was a pilot feasibility randomised controlled trial of Autism Adapted Safety Plans. Autistic adults were recruited via non-National Health Service organisations and self-referral. Participants were randomised without stratification to usual care ± Autism Adapted Safety Plans. The Autism Adapted Safety Plan was completed by the autistic adults with someone trained to support them. Research staff completing follow-up assessments were blind to participant allocation. Primary outcomes were feasibility and acceptability of the Autism Adapted Safety Plans to inform the parameters of a definitive randomised controlled trial. Participants were assessed at baseline, 1 and 6 months. RESULTS: Stage 1 and 2 interviews highlighted the conditions needed to make the process of creating the Autism Adapted Safety Plans acceptable for autistic adults. Stage 2 also informed modifications to recruitment (to include self-referral) in stage 3. In stage 3, 53 participants consented, 49 were randomised to either Autism Adapted Safety Plans + usual care (n = 25) or usual care (n = 24). Sixty-eight per cent of participants were satisfied with the Autism Adapted Safety Plans and 41% rated it as usable. Feedback on the Autism Adapted Safety Plans and study processes employed in the trial were positive with suggested minor adaptations to some outcome measures. Retention of those randomised was 95% at 6-month follow-up. Completion rates for outcome measures were generally high (> 85%). Fidelity ratings for delivery of the Autism Adapted Safety Plans were 94% for therapeutic components and 91% for adherence to content. CONCLUSION: Autism Adapted Safety Plans are a potentially valuable intervention for autistic adults, provided that the process of creating it is flexible and sensitive to individual needs. The parameters of a future definitive trial of the clinical and cost-effectiveness of Autism Adapted Safety Plans are achievable, with minor recommended adaptations. Further testing of the Autism Adapted Safety Plans to assess its clinical and cost-effectiveness in National Health Service clinical services is urgently needed. LIMITATIONS: The sample size was below the initially intended sample of 70 participants due to difficulties with recruitment during the COVID-19 pandemic. As autistic participants self-referred into the study, data are not available regarding how many participants were approached to take part in the study. The majority of the study sample was White. FUTURE WORK: A full definitive trial testing the clinical and cost-effectiveness of Autism Adapted Safety Plans in National Health Service clinical services is warranted. This fully powered trial will need to recruit a more diverse sample than was possible in the pilot trial. Results suggest that minor adaptations to the Autism Adapted Safety Plans could make this more personalised and accessible, such as through an app or website. FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR129196
Prevalence and associated factors of selling sex among men who have sex with men (MSM) in Latin America: results from the Latin American MSM Internet Survey in 18 countries (LAMIS-2018).
Get PDFINTRODUCTION: Selling sex has been associated with negative social and health outcomes, but most studies have been limited geographically and have not distinguished between selling and buying sex. This study assesses prevalence and factors associated with selling sex in the last 12 months among men who have sex with men (MSM) in 18 Latin American countries. METHODS: Data were collected in 2018 through the Latin American MSM Internet Survey, a cross-sectional online survey. Of 64 655 participants, 9585 were excluded due to data inconsistencies on age and partner status, and 1728 due to missing outcome data, yielding an analytic sample of 53 342. Multivariable logistic regression was used for analysis. RESULTS: Overall, 6.9% (10.3% among MSM aged 18-24) reported selling sex in the previous year. Higher odds of selling sex were associated with younger age, low education, being born abroad, low financial coping, substance use, potential alcohol dependency, early sexual debut with a male partner, low sexual agency and sex with women. High educational level and having a steady male partner were associated with lower odds. CONCLUSIONS: Key factors associated with selling sex among MSM in Latin America include socioeconomic, behavioural and relational variables. Harm reduction and preventive interventions may be particularly needed among younger MSM. Codeveloping these interventions with the MSM community can ensure sustainability, relevance and strengthen providers' ability to offer individualised, respectful care. Longitudinal and qualitative studies are needed to monitor long-term health and tailor interventions to individual needs
Translational framework for implementation evaluation and research: a critical approach to patient-centred equity design.
Get PDFBACKGROUND: The field of implementation research has recently seen much interest in equity, with a strong emphasis on recognising and responding to disparities in care. Recent studies highlight the role of macro-level processes that translate meso-level institutional behaviours to micro-level healthcare practices, and that are generative of health and care inequities. They emphasise challenges patient-centredness and underscore the need for justice-oriented intervention design to address disparities and promote equitable care. AIM: To develop a patient-centred and justice-informed approach to the design of complex healthcare interventions and innovations in service delivery. METHOD: Patient-centred Equity Design was developed in five stages. Sociological, public health, and implementation science theories explaining the generation of modifiable inequities were identified, and relevant explanatory constructs were extracted from them and organised into a determinant framework. Framework elements were then translated into (a) process models characterizing causal mechanisms of systemic inequities; (b) generative principles to guide equity- and patient-centred interventions and services; and (c) critical design questions to appraise the ways that inequities are embedded in healthcare interventions and services. RESULTS: Development work led to a determinant framework linking macro-level processes to meso- and micro-level healthcare inequities, and these were visualized in process models. The framework informed principles for the promotion of equitable, patient-centred interventions: fostering civility and dependability, ensuring clarity and continuity, and reducing workload and complexity. Four critical questions address relational inequalities, participation barriers, role expectations, and restitution for inequities. These were translated into proposed content for a simple appraisal tool to support the equitable design and evaluation of healthcare interventions and services. CONCLUSION: Patient-centred Equity Design integrates sociology, social justice, and implementation science to create equity-focused healthcare interventions. It offers a determinant framework, process models, generative principles, and critical questions to guide design. While not a validated tool, it enhances intervention development and service delivery, with potential for future Medical Research Council Framework integration. Patient- centred Equity Design provides actionable generative design principles to centre patient and caregiver experiences within intervention development, emphasizing restitution for inequities
Youth and Mentor Experiences of a Disability Inclusive Youth Research Training and Mentorship Programme in Uganda
Get PDFYoung persons with disability are often excluded from research, especially in low-income countries. In this study, we evaluated a one-year Disability Inclusive Youth (DIY) training and mentoring programme to build research capacity among Ugandan youths with and without disability. Fourteen youths (seven with a disability and seven peers) received a two-week training course in disability studies and research methods followed by a two-month internship. After completing the internship, they engaged in a nine-month research programme in which they collected and analysed life history data with other youths and co-created a film about their experiences in the programme. We evaluated reactions, learning, behavioural changes and the results of the training programme. Evaluation findings showed that the programme enhanced participants’ research skills, confidence and understanding of disability while fostering advocacy and peer support. Challenges included accessibility and sustained mentorship, although overall trainees and mentors reported improved disability inclusion in their research institution. Most participants secured employment post-programme. The DIY programme is a co-designed capacity-building approach with the potential for scale-up
AmpliconTyper - a tool for analysing ONT multiplex PCR data from environmental and other complex samples.
Get PDFAmplicon sequencing is a popular method for understanding the diversity of bacterial communities in samples containing multiple organisms as exemplified by 16S rRNA sequencing. Another application of amplicon sequencing includes multiplexing both primer sets and samples, allowing sequencing of multiple targets in multiple samples in the same sequencing run. Multiple tools exist to process the amplicon sequencing data produced via the short-read Illumina platform, but there are fewer options for long-read Oxford Nanopore Technologies (ONT) sequencing, or for processing data from environmental surveillance or other sources with many different organisms. We have developed AmpliconTyper (v0.1.28, DOI: 10.5281/zenodo.15045111) for analysing multiplex amplicon sequencing data from environmental (e.g. wastewater) or similarly complex samples, generated using ONT devices. The tool uses machine learning to classify sequencing reads into target and non-target organisms with very high specificity and sensitivity. The user can train models using public and/or user-generated data, which can subsequently be applied to analyse new data. The tool can also generate amplicon consensus sequences, as well as identify SNPs and report their genotype implications, such as association with lineages or antimicrobial resistance (AMR). The tool is freely available via Bioconda and GitHub (https://github.com/AntonS-bio/AmpliconTyper). AmpliconTyper allows robust identification of target organism reads in ONT-sequenced environmental samples and can identify user-specified lineage or AMR markers