69832 research outputs found
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Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): a randomised controlled trial of exercise-based rehabilitation.
Get PDFOBJECTIVE: Post-COVID syndrome involves prolonged symptoms with multisystem and functional impairment lasting ≥12 weeks after acute coronavirus disease 2019 (COVID-19). We aimed to determine the efficacy of exercise-based rehabilitation interventions, either face-to-face or remote, compared to usual care in individuals experiencing post-COVID syndrome following a hospitalisation with acute COVID-19. DESIGN: This single-blind randomised controlled trial compared two exercise-based rehabilitation interventions (face-to-face or remote) to usual care in participants with post-COVID syndrome following a hospitalisation. The interventions were either a face-to-face or remote 8-week programme of individually prescribed exercise and education. The primary outcome was the change in Incremental Shuttle Walking Test (ISWT) following 8 weeks of intervention (either face-to-face or remote) compared to usual care. Other secondary outcomes were measured including health-related quality of life (HRQoL), and exploratory outcomes included lymphocyte immunotyping. RESULTS: 181 participants (55% male, mean±sd age 59±12 years, length of hospital stay 12±19 days) were randomised. There was an improvement in the ISWT distance following face-to-face rehabilitation (mean 52 m, 95% CI 19-85 m; p=0.002) and remote rehabilitation (mean 34 m, 95% CI 1-66 m; p=0.047) compared to usual care alone. There were no differences between groups for HRQoL self-reported symptoms. Analysis of immune markers revealed significant increases in naïve and memory CD8+ T-cells following face-to-face rehabilitation versus usual care alone (p<0.001, n=31). CONCLUSION: Exercise-based rehabilitation improved short-term exercise capacity in post-COVID syndrome following an acute hospitalisation and showed potential for beneficial immunomodulatory effects
Explanatory models of common mental disorders among South Asians in high-income countries: A systematic review.
Get PDFMental health service use by individuals of South Asian origin living outside of South Asia is influenced by cultural factors such as endorsing psycho-social-spiritual over biological explanations, somatisation, and stigma. The aim of this review is to synthesise the evidence about (a) explanatory models of common mental disorders (CMDs) among people of South Asian origin residing in high-income countries, and (b) their help-seeking for CMDs, including formal and informal care. The systematic review protocol was registered a priori on Prospero (registration number CRD42021287583). We ran extensive searches on explanatory models and help-seeking of people of South Asian origin across five databases (MEDLINE, Embase, Cumulated Index to Nursing and Allied Health (CINAHL), PsycINFO, and Global Health). We extracted the data and conducted a narrative synthesis. We included 33 reports and 29 studies (9,030 participants). The participants in the included studies viewed CMDs through a psychosocial rather than a biological lens (e.g., resulting from family issues vs. neurotransmitters). Causal attributions included life stressors and attitudinal and religious/spiritual factors. Commonly used help-seeking strategies included private coping (i.e., crying or praying), speaking to friends and family, and visiting their General Practitioner. We can conclude that cultural factors play an important role in how South Asian individuals experience and understand CMDs. To cope, they use pluralistic help-seeking strategies. Implications for clinical practice and policy include increasing research on the explanatory models of CMDs, involving family in services, and developing community-based interventions for individuals who do not engage with formal care
The public health co-benefits of strategies consistent with net-zero emissions: a systematic review.
Get PDFMoving towards net-zero emission societies is projected to provide human health co-benefits. However, the magnitude of these co-benefits is poorly documented and might be context specific. Synthesising the evidence on these co-benefits could enhance the engagement of decision makers and populations in climate mitigation actions. We performed database searches of PubMed, Web of Science, and Scopus for studies published between database inception and Jan 1, 2024, identifying 3976 papers. Of these, 58 quantitative studies met our inclusion criteria and were included in this systematic review. These 58 papers explored 125 net-zero emission scenarios and considered various pathways by which climate policies can affect human health. Pathways addressing air quality, physical activity, and dietary changes found substantial health co-benefits, with a median mortality reduction of 1·5%. National or sub-national studies showed that net-zero policies would yield substantial local air quality benefits, independently of the actions taken in neighbouring countries. However, these co-benefits varied with explored emission sector, decarbonisation levers, modelling approach, and location. Studies that included a cost-benefit analysis estimated that monetised benefits outweighed the costs of implementing climate policies. This systematic review highlights the need for a standardised framework to assess and compare health impacts of climate mitigation actions across sectors and confirms that achieving net-zero goals supports far-reaching public health policies. TRANSLATION: For the French translation of the abstract see Supplementary Materials section
Potential interactions between digoxin and direct oral anticoagulants: application of cohort & novel case-crossover designs.
Get PDFOBJECTIVES: Direct oral anticoagulants (DOACs) are commonly co-prescribed with digoxin, but whether there is a drug interaction between them is unclear. We aimed to investigate potential drug interactions between DOACs and digoxin. STUDY DESIGN AND SETTING: We identified DOAC users during January 1, 2011-December 31, 2019 using data from Clinical Practice Research Datalink Aurum in cohort design with propensity score to compare the hazards of effectiveness cardiovascular and mortality outcomes and safety bleeding outcomes, respectively, in DOAC + digoxin users versus DOAC + beta-blocker users. A case-crossover design was conducted to compare odds of exposure to different drug initiation patterns in hazard period versus referent period. RESULTS: Of 397,459 DOAC users, we identified 25,251 co-prescribed digoxin and 109,779 co-prescribed beta-blockers in cohort study. A lower proportion of DOAC + digoxin users were men (46%) in contrast with that of DOAC + beta-blocker users (53%). Mean age of DOAC + digoxin users (77.1 years) were higher than DOAC + beta-blocker users (74.5 years). No increased risk of pharmacologically predictable DOAC safety outcomes or specific effectiveness outcomes was seen with DOAC + digoxin. A higher risk of all-cause mortality (hazard ratio: 1.35; 99% confidence interval [CI]: 1.14-1.61) was observed with DOAC + digoxin versus DOAC + beta-blockers. In the case-crossover study, a 24% higher odds of all-cause mortality was seen with initiating digoxin while taking DOAC (odds ratio: 1.24; 99% CI: 1.06-1.45); and a 63% higher odds was also seen with initiating DOAC while taking digoxin (odds ratio: 1.63; 99% CI: 1.41-1.88). CONCLUSION: We found no increased risk of bleeding when DOACs are used with digoxin, suggesting combined use does not lead to drug-drug interaction. Future work is recommended to investigate the underlying mechanism of association with all-cause mortality. PLAIN LANGUAGE SUMMARY: This study aimed to examine potential drug interactions between direct oral anticoagulants (DOACs) (a drug class to prevent blood clots) and digoxin (treatment of abnormal heart rhythms). We compared a range of clinical outcomes in people prescribed DOAC and digoxin with people prescribed DOAC and beta-blockers (a treatment alternative to digoxin). We also used a new study design (case-crossover design) to compare the risk of clinical outcomes between different periods within a person as a validation. In both study designs, we found no increased risk of bleeding when DOACs are used with digoxin, suggesting combined use does not lead to drug-drug interaction. However, we found an increased risk of all-cause death associated with digoxin in DOAC users which requires further investigation
"I have to be strong": A qualitative study of parental bereavement experiences in Uganda following the death of their baby.
Get PDFBACKGROUND: The death of a child is profoundly distressing for parents, often leading to acute grief and psychological complications. Most bereavement research is from high-income countries, with limited generalisability to low- and middle-income contexts where 98 % of newborn deaths occur. We explore the experiences of parents in Uganda following the death of their baby. METHODS: Qualitative interviews were conducted with 11 bereaved parents whose newborn participated in the OMWaNA trial and died while enrolled or shortly thereafter. In-depth interviews explored the experience of bereavement, the psychosocial impact, and economic consequences. Data were analysed using a deductive thematic approach. RESULTS: The death of a baby was consistently associated with parental stress, information delays, and uncertainty regarding the cause of death. While respondents reported a period of acute grief, many relied on their faith and social support to cope. Expectations for bereavement care from health professionals were low and instead parents focused on health professionals' efforts to keep their baby alive and advice regarding future pregnancies. Despite financial precarity, costs and loss of income, many parents appeared comforted that they had done all they could to ensure the baby's survival. CONCLUSION: These findings illustrate the importance of understanding parental bereavement in different settings and circumstances. Rather than health worker-led models of active bereavement care, respondents relied on social support, their faith, and a focus on future pregnancies to 'become strong.' Further research to understand the longer-term impact of bereavement, men's experiences and coping strategies could inform more contextually appropriate bereavement care
Development of a curriculum to educate religious leaders about blood pressure using community-based participatory research and educational theory in Mwanza, Tanzania.
Get PDFHypertension is a leading cause of premature mortality in Tanzania, but low trust and awareness of biomedical healthcare and prioritization of spiritual over physical health hinders uptake of care. Religious leaders are highly respected community members and are eager to collaborate with health professionals. Few community health worker training programs utilize evidence-based pedagogical recommendations in combination with theology specific to their students' backgrounds. Our team of health research professionals and religious leaders developed a curriculum to teach local religious leaders to address and screen their communities for hypertension.We use a Community Based Participatory Research framework and evidence-based educational strategies (Kern's framework for medical education, Bloom's learning domains, and Knowles adult learning principles) to build a curriculum optimized to partner with religious leaders. Previously assessed attitudes toward and knowledge of hypertension in the community determined objectives and content, and religious leaders on the team determined appropriate religious aspects to incorporate. Through an evidence-based process, we hope to maximize efficacy of the intervention.Recognizing religious leaders as unique learners, we utilize well-tested educational theory and strategies to create a comprehensive curriculum prioritizing student input. The curriculum aligns with adult learning theories, is culturally tailored to meet the needs of the communities involved and equips religious leaders to promote blood pressure management through screening and lifestyle interventions. The curriculum addresses healthcare through a religious lens, fostering trust between healthcare professionals, patients, and religious leaders through interdisciplinary collaboration
From colonization to causation: the links between Group B Streptococcus colonization, invasive disease, and preterm birth.
No full textAdvances in the development of vaccines against Group B Streptococcus (GBS) may soon offer an alternative approach to preventing neonatal GBS infections. However, children who are born preterm may not receive full protection from such vaccines, either because they are born before vaccine delivery, or because of less effective maternal antibodies transfer. With this as our motivation, we discuss causal links between maternal GBS colonisation, invasive GBS disease, and preterm birth, together with supporting evidence. Whilst multiple studies indicate that maternal colonisation can cause both disease and preterm birth, we argue that direct causal links between preterm birth and invasive disease require further clarification, in particular with regard to in utero onset versus postnatal early onset disease. Further, recent findings on the role of prematurity as effect modifier of GBS-related outcomes are examined. We discuss implications of these causal links and questions that should be addressed to guide studies and policy
"…pretty much all white, and most of them are psychiatrists and men": Mixed-methods analysis of influence and challenges in global mental health.
Get PDFMental health is increasingly recognised as a global health priority, with 'global mental health' gaining relevance as a field. We thus aimed to identify the most influential actors in global mental health and key challenges in the design and implementation of policies and interventions within this relatively nascent field, to provide suggestions on how mental health could be promoted and diversified at the global level to improve mental health outcomes. We conducted a mixed-methods study, incorporating a social network analysis of 115 experts to identify the most influential mental health actors and elements globally and 30 semi-structured key informant interviews, analysed thematically, to examine key challenges in developing the field. We found concentrated influence among a few actors, with network analysis highlighting psychiatry followed by psychology as most influential specialties, and academia as the most influential sector; limited global collaboration and political engagement; and the need for greater professional, socio-cultural, geographical, and gender diversity. Sustaining mental health prioritisation globally requires directed and coordinated efforts from influential individual and institutional actors in the global mental health field. This requires critical engagement with dominant modes of knowledge production, greater synergy at global, national, and community levels, and agenda setting by a broader and more equitable coalition of global mental health actors across professional, cultural, and gender differences
Social contacts and mixing patterns in rural Gambia.
Get PDFBACKGROUND: Close contact between an infectious and susceptible person is an important factor in respiratory disease transmission. Information on social contacts and mixing patterns in a population is crucial to understanding transmission patterns and informing transmission models of respiratory infections. Although West Africa has one of the highest burdens of respiratory infections, there is a lack of data on interpersonal contact and mixing patterns in this region. METHODS: Between January and November 2022, we conducted a cross-sectional, social contact survey within the population of the Central and Upper River Regions of The Gambia. Selected participants completed a questionnaire about their travel history and social contacts, detailing the number, intensity, location, frequency, duration, and age of contacts. We calculated age-standardized contact matrices to determine contact patterns in the population. RESULTS: Overall, individuals made an average of 12.7 (95% CI: 12.4-13.0) contacts per day. Contact patterns were mostly age-assortative and 84.5% of all contacts were physical. School-aged children (5-14 years) had the highest mean number of physical contacts (11.3, 95% CI: 10.9-11.8) while the < 1-year age group had the fewest contacts (9.4, 95% CI: 9.1-9.8). A large proportion of contacts (78%) occurred at home. Daily number of contacts increased with household size. While we did not observe any effect of gender on contact patterns, there were seasonal variations in contact type. Non-physical contacts were higher during the dry season compared to the rainy season. In contrast, there were more physical contacts in the rainy season compared to the dry season. CONCLUSIONS: In rural Gambia, social contact patterns were primarily driven by household mixing. Most contacts were physical and mostly age-assortative, particularly among school-aged children. Our data can improve infectious disease transmission models of respiratory pathogens in high-transmission settings, which are valuable for optimizing the delivery of different interventions
Primary efficacy endpoints in phase 3 non-inferiority trials to establish new tuberculosis treatment regimens should only include microbiological outcomes.
Get PDFTreatment regimens for tuberculosis remain protracted and burdensome, both for patients to adhere to and for health-care providers to administer. Particularly, many current regimens for drug-resistant tuberculosis are poorly tolerated by patients and carry an unacceptable side-effect profile. The rapid emergence of bedaquiline resistance necessitates treatment regimens that are active against resistant strains, regimens with a high genetic barrier to acquired resistance, and regimens containing antimicrobials for which near-patient drug-susceptibility testing is available. A pressing need therefore exists to develop and evaluate novel tuberculosis treatment regimens