69832 research outputs found
Sort by
Bridging the equity gap in colorectal cancer screening: A comparative analysis across high-income countries.
Get PDFBACKGROUND: Despite the availability of colorectal cancer (CRC) screening programs in high-income countries (HICs), disparities in access and outcomes persist. Equity-focused policies are essential to ensure that CRC prevention reaches all population groups, particularly those underserved or marginalized. METHODS: We conducted a comparative policy analysis of CRC screening systems across ten HICs using peer-reviewed literature, national cancer agency reports, and updated screening data. Two summary tables were developed: one detailing screening modalities, coverage rates, and intervals; the other outlining equity-focused policies, gaps, and country-specific recommendations. RESULTS: The analysis revealed substantial variation in screening modalities and coverage rates, with organized, population-based programs generally achieving higher uptake. Equity-focused policies varied widely, with common gaps including limited outreach in rural areas, under-screening among minority populations, and insufficient equity data collection. Recommendations included expanding culturally tailored education, improving data systems, and embedding equity metrics into national strategies. CONCLUSION: This study contributes to the growing evidence base on health equity in cancer prevention by offering a replicable framework for cross-country policy benchmarking. The findings underscore the importance of integrating equity into CRC screening programs to reduce disparities and improve outcomes across diverse health systems
Concussion in Grassroots Sport: an evaluation of the implementation of the UK Concussion Guidelines for Non-Elite (Grassroots) Sport
Get PDFSport-related injuries are the leading cause
of concussion among children and young
people and there is growing awareness of the
possible long-term impacts of concussion on
brain health, including dementia. Although the
evidence of a causal link between selected
sporting activities and dementia remains
uncertain, what is known provides grounds for
taking a precautionary approach when providing
guidance on concussion management in sport.
It is against this background that, in April
2023, the UK Government and the Sport
and Recreation Alliance published the
‘UK Concussion Guidelines for Non-Elite
(Grassroots) Sports’. Using the strapline ‘If
in doubt, sit them out’, the UK Guidelines
aim to improve concussion awareness and
management among players, coaches, parents,
and sports bodies across England, Scotland,
Wales and Northern Ireland.
There is now the opportunity to systematically
assess how different sports have implemented
the guidelines and understand how widely
they are known. This study was commissioned
by the Department of Health and Social Care
(DHSC) in collaboration with the Department
for Culture, Media and Sport (DCMS) to help
fill this important knowledge gap
Discontinuity of social support among US adults with cognitive impairment before and after the confirmed diagnosis of dementia: a matched ambidirectional cohort study.
Get PDFBACKGROUND: Despite increased attention on dementia, much remains unknown about the integration of clinical and non-clinical care, particularly regarding long-term social support, a primary source of non-clinical care. This study uniquely examines the effect of receiving a formal dementia diagnosis on the continuity of social support, an understudied transition point in dementia care pathways. METHODS: In this ambidirectional cohort study, we examined ten waves of data from the Health and Retirement Survey(HRS) for US adults over 50 through 2000-2018. Eligibility was limited to participants with cognitive impairment. The exposure group were people with a confirmed dementia diagnosis (N = 1261), and the control group were matched by age, sex, race/ethnicity, and survey wave, but without a confirmed diagnosis (N = 12,604). Unmet social support was defined as reporting physical disability without receiving corresponding social support. Physical disability was assessed using measures of basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). The data were fitted using controlled interrupted time series analysis to explore the continuity of unmet social support before and after a diagnosis. RESULTS: After dementia diagnosis, adults experienced a significant increase in unmet IADL support needs (coef = 0.10, 95% CI [0.07, 0.13]), particularly for making phone calls (coef = 0.74, 95% CI [0.16, 1.33]). By race/ethnicity, Hispanics showed a significant rise in unmet BADL support needs (coef = 0.74, 95% CI [0.03, 1.46]), especially for eating assistance (coef = 1.58, 95% CI [0.17, 2.99]). Blacks experienced increased unmet BADL needs in toileting (coef = 1.52, 95% CI [0.57, 2.47]) and IADL support (coef = 0.09, 95% CI [0.00, 0.17]). Sex disparities were also identified, with females showing decreased unmet BADL support(coef = - 0.55, 95% CI [- 1.03, - 0.06]) but increased unmet IADL support (coef = 0.08, 95% CI [0.04, 0.11]), while males experienced increased unmet toileting (coef = 0.78, 95% CI [0.03, 1.53]) and IADLs support (coef = 0.14, 95% CI [0.10, 0.18]). CONSLUSIONS: Our study identifies a disconnect in the care provided to individuals with dementia before and after their diagnosis. Notably, post-diagnosis, we observed substantial disparities in unmet social support needs across various racial groups. This highlights the need for more cohesive and equitable care strategies in the dementia care continuum
Impact of the dual rapid diagnostic test for HIV and syphilis among pregnant women: a before and after health center-based study in Central Uganda (2018-2019).
Get PDFOBJECTIVES: Systematic testing of antenatal clinic attendees using dual HIV and syphilis rapid diagnostic tests (RDT) can improve syphilis screening and reduce mother-to-child transmission. We assessed the effect of the dual HIV/syphilis RDT on syphilis care and adverse birth outcomes (ABOs), including congenital syphilis (CS) in Central Uganda. METHODS: Eleven antenatal clinics were selected from Kalungu and Masaka districts. First-visit records were extracted on syphilis testing, positivity and treatment over two 9-month periods, pre- and post-introduction, with a 3-month buffer. Syphilis cascade indicators were calculated for the two periods. The World Health Organization CS Estimation Tool evaluated impact on CS cases and ABOs. RESULTS: A total of 6011 records were extracted, 2660 pre-test introduction and 3351 post-introduction. Syphilis testing increased from 49.1% pre-test to 84.0% post-introduction, an increased testing rate ratio of 1.71 (95% confidence interval 1.64-1.78). Treatment coverage modestly increased post-introduction (rate ratio = 1.19, 0.94-1.50), resulting in an absolute rate difference of 31.4% (20.5-41.6%, P <0.001). This resulted in a modeled 41% decline in CS cases and 39% decline in ABOs. CONCLUSIONS: This is the first demonstration of the impact of dual HIV/syphilis RDT in routine antenatal clinics in Uganda, which could reduce CS and ABOs
Development and evaluation of an online cardiotocography course tailored to LMIC settings: a feasibility study conducted in a tertiary care hospital in Sri Lanka.
Get PDFOBJECTIVE: Effective cardiotocography (CTG) training is crucial for accurate interpretation and timely interventions in low-resource settings. This mixed-method study in Sri Lanka developed and assessed an online CTG course to address training gaps and improve neonatal outcomes. The study involved a clinical audit, course development, implementation, and evaluation via the Kirkpatrick model. RESULTS: The audit revealed lapses in CTG documentation, interpretation, and interventions. The posttest scores improved by 40.6% (152.8%), but some participants did not complete the course because of a lack of motivation, time constraints, and inadequate facilities. Postimplementation audits revealed improvements in practices, although uterine contraction documentation and overall impression recording declined. The findings suggest the feasibility and effectiveness of online self-learning courses in improving CTG knowledge and practices in Sri Lanka. However, motivation, incentives, and reinforcement measures are needed for better outcomes
'It was just the given thing to do': exploring enablers for high childhood vaccination uptake in East London's Bangladeshi community-a qualitative study.
Get PDFBACKGROUND: Despite being an underserved ethnic minority group, characteristics which have been associated with low vaccine uptake, the Bangladeshi community in the UK exhibits high childhood vaccination uptake for several vaccines, including measles, mumps and rubella compared with several ethnic groups. This study explored key enablers for early childhood vaccination uptake among the Bangladeshi community in East London, UK. METHODS: A qualitative study using semi-structured interviews was conducted with 23 Bangladeshi parents 11 primary healthcare professionals (HCPs) and 5 community service providers (CSPs) involved in delivering childhood vaccination services, predominantly in the East London borough of Tower Hamlets. Parents were recruited purposively from the community while HCPs and CSPs were recruited from relevant organisations. The Social Ecological Model (SEM) was used as a theoretical framework for data collection and analysis. Data were analysed thematically. RESULTS: Multilevel vaccination enablers identified by parents, HCPs and CSPs across the different levels of the SEM included: parental trust in the immunisation programme and HCPs; a rigorous call and recall service; the normalisation of receiving childhood vaccinations within the Bangladeshi community and the availability of culturally tailored and accessible vaccination services. CONCLUSIONS: This study highlights how multi-level trust in a vaccination programme can propel positive vaccine uptake in an underserved, ethnic minority population. Our findings suggest culturally sensitive, person-centred delivery of vaccination services, alongside leveraging community dynamics and trusted social networks, are imperative to meeting the informational, linguistic and cultural needs that facilitate vaccine uptake within the Bangaldeshi community. We recommend using existing trusted community networks to disseminate tailored vaccine information and actively reminding parents about due vaccinations to promote uptake amongst other underserved, ethnic minority communities with low uptake in high-income settings. Further research involving non-immunising parents is recommended to gain more comprehensive insight into vaccine decision-making within this community
Farm-level greenhouse gas mitigation: Understanding the effect of interactions and heterogeneity
Get PDFMitigation of climate change remains a central focus of the European Union (EU). Under its 2030 Climate Target Plan, the European Commission proposes to raise the EU's ambition in this area, targeting a reduction in greenhouse gas emissions (GHG) of at least 55 % below 1990 levels by 2030. In Ireland, the proportion of GHG emissions from the agricultural sector is high compared to other developed countries, contributing 38.1 % of total economy-wide GHG emissions. The extent to which mitigation measures reduce GHG emissions at the farm level has received limited attention, especially the implications of farm-level heterogeneity on the optimal policy design for emission reduction. Using EU Farm Accountancy Data Network data for the Republic of Ireland in 2020, this study uses Marginal Abatement Cost Curve (MACC) analysis to assess a suite of GHG mitigation measures and accounts for interaction and heterogeneous effects across five different farm system types. The result of the study shows that reducing crude protein in animal diets is the most cost-effective measure for all farm systems. Liming and substitution to protected urea fertilisers are also cost-effective measures for all farm systems. However, some measures fluctuate between cost-intensive and cost-saving depending on the farm system type. The findings show that no two farm-level MACC curves are the same, thus farm heterogeneity needs to be accounted for efficient policy design
Target-agnostic identification of human antibodies to Plasmodium falciparum sexual forms reveals cross-stage recognition of glutamate-rich repeats
Get PDFCirculating sexual stages of
Plasmodium falciparum (Pf
) can be transmitted from humans to mosquitoes, thereby furthering the spread of malaria in the population. It is well established that antibodies can efficiently block parasite transmission. In search for naturally acquired antibodies targets on sexual stages, we established an efficient method for target-agnostic single B cell activation followed by high-throughput selection of human monoclonal antibodies (mAbs) reactive to sexual stages of
Pf
in the form of gametes and gametocyte extracts. We isolated mAbs reactive against a range of
Pf
proteins including well-established targets Pfs48/45 and Pfs230. One mAb, B1E11K, was cross-reactive to various proteins containing glutamate-rich repetitive elements expressed at different stages of the parasite life cycle. A crystal structure of two B1E11K Fab domains in complex with its main antigen, RESA, expressed on asexual blood stages, showed binding of B1E11K to a repeating epitope motif in a head-to-head conformation engaging in affinity-matured homotypic interactions. Thus, this mode of recognition of
Pf
proteins, previously described only for Pf circumsporozoite protein (PfCSP), extends to other repeats expressed across various stages. The findings augment our understanding of immune-pathogen interactions to repeating elements of the
Plasmodium
parasite proteome and underscore the potential of the novel mAb identification method used to provide new insights into the natural humoral immune response against
Pf
Estimating hypothetical estimands with causal inference and missing data estimators in a diabetes trial case study.
Get PDFThe ICH E9 addendum on estimands in clinical trials provides a framework for precisely defining the treatment effect that is to be estimated, but says little about estimation methods. Here, we report analyses of a clinical trial in type 2 diabetes, targeting the effects of randomized treatment, handling rescue treatment and discontinuation of randomized treatment using the so-called hypothetical strategy. We show how this can be estimated using mixed models for repeated measures, multiple imputation, inverse probability of treatment weighting, G-formula, and G-estimation. We describe their assumptions and practical details of their implementation using packages in R. We report the results of these analyses, broadly finding similar estimates and standard errors across the estimators. We discuss various considerations relevant when choosing an estimation approach, including computational time, how to handle missing data, whether to include post intercurrent event data in the analysis, whether and how to adjust for additional time-varying confounders, and whether and how to model different types of intercurrent event data separately
The need for health equitable climate adaptation policies in Northern Europe.
Get PDFSocioeconomic conditions remain an important factor in determining health outcomes in Northern Europe. In this commentary, we argue for evidence-based temperature-related climate adaptation policies in Northern Europe that account for disparities in socioeconomic conditions and aim at universal health coverage. We highlight the role of spatial and occupational disparities in urban areas that can be important factors in increased physical and mental health impacts related to heat and cold. We further highlight how these factors interplay with exposure to air pollution and access to green areas and worsen health conditions. Adaptation to changing climatic conditions requires both physiological acclimatization and behavioral adaptation, both of which are difficult to assess for socioeconomically deprived communities. We argue for more equitable climate adaptation strategies that include i) better integration of health in climate change adaptation plans; ii) building climate resilient communities, and iii) integrated surveillance and health systems. These actions could be vital in spearheading research in new cross-cutting areas like climate change, migration, and health