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Support To Rural India's Public Education System (STRIPES2) and impact on numeracy and literacy scores: A cluster randomized trial in rural villages of Madhya Pradesh, India.
Get PDFINTRODUCTION: Rates of primary school enrolment have improved in India, but levels of learning achievement remain low. In the Support To Rural India's Public Education System (STRIPES) trial, a para-instructor intervention improved numeracy and literacy levels in Telangana, India (2008-10). The STRIPES2 trial was designed to assess whether a similar intervention in a younger cohort of children would have similar effects in Satna and Maihar districts of Madhya Pradesh, India, and be cost-effective. METHODS: In this Madhya Pradesh cluster-randomized controlled trial, 196 villages (clusters) were randomized to receive either a health (CHAMPION2: community health promotion and medical provision and impact on neonates) or education (STRIPES2) intervention. Villages receiving the health intervention were controls for the education intervention and vice versa. For children newly enrolled in primary school, the STRIPES2 intervention comprised before/after-school classes (2 hours per day, 6 days a week) given by trained para-instructors from the local community, frequent monitoring, and engagement with caregivers to motivate children, delivered by the Pratham Education Foundation. STRIPES2 activities had to be suspended twice for around ten and a half months, and some components of the intervention modified due to the COVID-19 pandemic. The period of the trial was extended with the primary outcome (a composite literacy and numeracy score of Early Grade Reading and Mathematics Assessments) assessed around 30 months after classes started. RESULTS: Composite test scores were significantly higher in the intervention arm (98 villages; 3054 children) than in the control arm (98 villages; 3275 children) at the end of the trial. The mean difference on a percentage point scale was 14.17; 95% CI 11.36 to 16.97; p < 0.001, equating to a 0.58 (95% CI 0.47 to 0.71) standard deviation difference. The cost per child per 0.1 SD increase in composite test score was INR 2476 (US$33.5). CONCLUSION: Despite COVID-19 interruptions and disruptions, STRIPES2 resulted in a major improvement in children's literacy and numeracy. However, the cost of achieving such benefits was substantial
Effectiveness and cost-effectiveness of a transdiagnostic intervention targeting alcohol misuse and psychological distress for men in Ukraine: study protocol for a randomised controlled trial.
Get PDFBACKGROUND: Ukraine has experienced armed conflict since 2014, with significant escalation in 2022. Since then, an estimated 3.7 million people have been internally displaced. Alcohol misuse remains a substantial public health challenge in Ukraine, with high levels of psychological distress among the displaced population. The current study aims to evaluate the effectiveness and cost-effectiveness of a transdiagnostic intervention (CHANGE) to address alcohol misuse and psychological distress through problem-solving therapy and selected behavioural strategies for managing alcohol misuse. We hypothesize that CHANGE, together with enhanced usual care (EUC), will be more effective in increasing the percentage of days abstinent (PDA) than EUC alone. METHODS: This study is a parallel-arm, single-blind, individually randomised controlled trial across Ukraine government-controlled territories. Following informed consent, we will recruit 500 adult war-affected men, randomised 1:1 to EUC and CHANGE, or EUC alone. Inclusion criteria include elevated levels of alcohol use (between 8 and 19, inclusive, on the Alcohol Use Disorder Identification Test); psychological distress (≥ 16 on the Kessler Psychological Distress Scale) and ability to speak Ukrainian or Russian. CHANGE will be delivered over 6 weeks by 14 community-based facilitators, with outcomes assessed at 3 months post-randomisation. The primary outcome for CHANGE is the PDA from alcohol at 3 months, measured using the Timeline Follow Back. Secondary outcomes include percentage days of heavy drinking, alcohol misuse, psychological distress (depression, anxiety, and posttraumatic stress disorder), functional disability, intimate partner violence perpetration and health economics indicators at 3 months. The primary analysis will follow an intention-to-treat approach. A mixed-methods process evaluation will examine facilitator competency, recruitment, retention/completion, appropriateness, dose received, fidelity and feasibility of delivery and acceptability. DISCUSSION: CHANGE is the first intervention aiming to address alcohol misuse and psychological distress in an active conflict setting. TRIAL REGISTRATION: ISRCTN14881856. Registered on 5th of July 2024
Variation in coronary revascularisation and mortality after myocardial infarction across three public health insurance schemes in Thailand: an observational analysis from nationwide claims data.
Get PDFBACKGROUND: Evidence on the impact of diverse healthcare insurance arrangements on healthcare variation is limited in low-income and middle-income countries. In Thailand, the Civil Servant Medical Benefit Scheme (CSMBS), Social Health Insurance (SHI) and Universal Coverage Scheme (UCS) have different provider choice and reimbursement arrangements and cover different populations. We explored to what extent use of revascularisation in patients with ST elevation myocardial infarction (STEMI) varied by insurance scheme. METHODS: We used claims data, including all admissions for patients with STEMI between 2015 and 2020. Outcomes were any type of revascularisation, primary percutaneous coronary intervention (PPCI) and mortality. Regression models were used to estimate absolute differences (ADs) by scheme, adjusted for age, sex, comorbidities and admission year. RESULTS: Of 98 142 patients, 75.7% were covered by UCS, 13.3% by CSMBS and 11.0% by SHI. Overall, 76.3% underwent revascularisation and 53.8% received PPCI. Mortality rates were 13.2% in-hospital and 20.7% at 180 days. Compared with UCS, use of revascularisation was slightly higher with CSMBS and slightly lower with SHI (AD: CSMBS 1.3% (95% CI -0.2 to 2.8), SHI -0.8% (-2.6 to 1.0), p=0.0264) and use of PPCI was slightly higher with CSMBS and SHI (AD: CSMBS 2.4% (-0.3 to 5.2), SHI 5.2% (3.1 to 7.2), p<0.0001)). CSMBS and SHI-insured patients had lower mortality compared with UCS (AD for in-hospital: CSMBS -1.3% (-2.1 to -0.5), SHI -0.9% (-1.8 to -0.1), p<0.0001; AD for 180-day mortality: CSMBS -4.5% (-5.3 to -3.6), SHI -1.9% (-3.0 to -0.8), p<0.0001). Effects of insurance scheme varied by hospital type for all outcomes (p for interaction<0.0001). CONCLUSION: Three-quarters of patients with STEMI received coronary revascularisation, suggesting potential undertreatment. We identified relatively small differences in access to revascularisation by insurance scheme which are unlikely to explain the lower mortality with CSMBS and SHI. Claims data can be used to assess the impact of insurance on access to effective treatments
Social determinants of heat-related mortality in England: a time-stratified case-crossover study using primary care records.
Get PDFBACKGROUND: Despite increases in heat-related deaths in England, there has been limited progress in developing interventions in primary care that identify and target individuals at risk. Lack of understanding of individual-level socioenvironmental risk factors limits development of an evidence-based approach to targeted prevention. OBJECTIVE: To identify individual-level non-clinical risk factors for heat-related mortality in England using primary care records and to assess the potential of these socio-environmental factors as effect modifiers for the association between ambient temperature and death. METHODS: A time-stratified case-crossover analysis was undertaken of nine potential risk factors at the individual level and categorised into risk factor subgroups. 430 682 patients with valid records were included in the study population, obtained from the Clinical Practice Research Datalink. Conditional logistic regression was used to characterise associations between temperature and the risk of death on hot days and to investigate the modifying effect of each risk factor. RESULTS: Older ages, females, ethnic minorities and those living in the most deprived areas all had increased risk of death during periods of heat. An increasing trend in ORs was observed with increasing amounts of alcohol intake and increasing body mass index, excluding the obese-3 group. No differences in risks were observed by marital status or frailty category. CONCLUSIONS: This is the first study in England to assess the role of socioenvironmental factors in modifying heat risk at an individual level. The results provide important evidence on the role of disadvantage in driving the inequitable distribution of climate change impacts, and the need for better socioeconomic data linked to health records. For clinical practice, the findings highlight the importance of incorporating an assessment of individual socioenvironmental circumstances when prioritising patients at highest risk during heat events
Children with disabilities are missing from global efforts to address violence.
Get PDFIn November, 2024, the first Global Ministerial Conference on ending violence against children was held in Bogotá, Colombia, and was a landmark event for violence prevention. 101 countries and 21 organisations made commitments to address violence against children at home, in schools, in communities, and online.1 However, despite efforts to get disability on the agenda for the conference by civil society organisations, there was a notable gap in commitments on preventing and responding to violence against children with disabilities
Parathyroidectomy and Risk of Incident Diabetes in Patients With Primary Hyperparathyroidism.
Get PDFIMPORTANCE: Primary hyperparathyroidism (PHPT) is linked to insulin resistance, glucose intolerance, and diabetes. Whether parathyroidectomy is associated with lower risk of diabetes has not been evaluated in a large cohort. OBJECTIVE: To examine the independent association between parathyroidectomy and the risk of incident diabetes in patients with PHPT. DESIGN, SETTING, AND PARTICIPANTS: Patients diagnosed with PHPT between January 2006 and December 2023 were identified from a territorywide electronic health database in Hong Kong and classified into surgical and nonsurgical groups based on presence of subsequent parathyroidectomy. They were followed up with from the index date (first diagnosis of PHPT), until the outcome of interest (incident diabetes), death, or end of the study period (December 2023), whichever came first. EXPOSURE: Parathyroidectomy vs nonsurgical management. MAIN OUTCOMES AND MEASURES: The primary outcome of this study was incident diabetes. Inverse probability of treatment weighting was used to balance all baseline characteristics. Cox proportional hazards regression was used to evaluate the hazard of incident diabetes associated with parathyroidectomy. RESULTS: A total of 3135 patients with PHPT were included (596 [19.0%] surgical and 2539 [81.0%] nonsurgical). The mean (SD) age was 67.5 (14.2) years, and 2211 (70.5%) individuals were female. A total of 518 patients in the nonsurgical group developed incident diabetes during a median (IQR) follow-up of 2.2 (0.9-4.3) years, compared to 156 patients in the surgical group during a median (IQR) follow-up of 5.5 (3.3-8.0) years. Parathyroidectomy was associated with lower risk of incident diabetes (hazard ratio [HR], 0.68 [95% CI, 0.65-0.71]; P 65 years: HR, 0.64 [95% CI, 0.60-0.68] vs HR, 0.68 [95% CI, 0.63-0.72]; interaction P twice the upper limit of normal vs PTH ≤ twice the upper limit of normal: HR, 0.58 [95% CI, 0.53-0.63] vs HR, 0.73 [95% CI, 0.69-0.77]; calcium > 2.8 vs calcium ≤ 2.8 mmol/L : HR, 0.58 [95%CI, 0.54-0.63] vs HR, 0.69 [95%CI, 0.66-0.73]; interaction P < .001). CONCLUSIONS AND RELEVANCE: In this cohort of patients with PHPT, parathyroidectomy was associated with a lower risk of incident diabetes. The association was more prominent in younger patients and those with more severe PHPT. These results may suggest potential additional metabolic benefits of parathyroidectomy in PHPT
School Meals Case Study: The Philippines
Get PDFThis school meals case study forms part of a collection led by the Research Consortium for School Health and Nutrition’s "Good Examples" Community of Practice. The Schoo Meals Case Study of The Philippines serves to document how the national school meals programme is organized, funded, and monitored throughout the country. The objectives of this case study include presenting an introduction to the country profile, outlining the design and implementation of school feeding programmes, describing their monitoring and evaluation processes, and highlighting lessons learned, best practices, and challenges. This case study is written as a working paper, and can be updated to reflect evolving circumstances. The ‘Good Examples’ Community of Practice supports the evidence generation of the Research Consortium for School Health and Nutrition, the evidence-generating arm of the School Meals Coalition. The Research Consortium’s objective is to carry out independent research across diverse sectors and generate solid, compelling, and actionable evidence regarding the benefits of school food programs to inform evidence-based decision-making on school health and nutrition policies and practices
Die Übersehenen der Pandemie: Eine retrospektive populationsbasierte Datenanalyse der COVID-19-Pandemie aus Hamburg
Get PDFHintergrund: An das Robert Koch-Institut sollen u. a. alle Todesfälle mit Zuständigkeit deutscher Gesundheitsämter, die in Bezug auf COVID-19 verstorben sind, übermittelt werden.
Ziel: Ziel dieser Studie war es, zu ermitteln, ob alle meldepflichtigen COVID-19-Todesfälle mit positivem SARS-CoV-2-Nachweis und Hamburger Zuständigkeit im Zeitraum vom 01.03.2020 bis zum 31.12.2021 an die zuständige Landesbehörde und damit an das Robert Koch-Institut übermittelt worden sind. Zudem sollte überprüft werden, ob und welche Variablen einen Einfluss auf das Endergebnis der Übermittlung hatten.
Material und Methoden: Meldepflichtige Hamburger COVID-19-Todesfälle wurden über die Todesbescheinigungen, die vorliegenden Daten der Gesundheitsämter und des Instituts für Rechtsmedizin in Hamburg identifiziert. Einflussfaktoren verschiedener soziodemographischer und institutioneller Variablen auf das Endergebnis der Übermittlung eines meldepflichtigen COVID-19-Todesfalls an die zuständige Landesbehörde wurden mittels logistischer Regression analysiert.
Ergebnisse und Diskussionen: 2237 meldepflichtige COVID-19-Todesfälle mit positivem SARS-CoV-2-Nachweis wurden in die Studie eingeschlossen. 90,3 % (95 % KI: 88,9–91,4) der meldepflichtigen COVID-19-Todesfälle dieser Studie wurden korrekt an die zuständige Landebehörde übermittelt. Verschiedene medizinische, institutionelle und soziodemographische Variablen waren mit der Chance der Übermittlung assoziiert.
Schlussfolgerung: Zwischen dem 01.03.2020 und dem 31.12.2021 wurden nicht alle meldepflichtigen COVID-19-Todesfälle an die zuständige Landesbehörde übermittelt. Meldestandards und Prozesse sollten vereinheitlicht und digitalisiert werden, um für zukünftige Pandemien ein vollständiges Übermittlungsergebnis zu erreichen
Sexual and reproductive health interventions for mobile adolescents and young people in sub-Saharan Africa: a scoping review.
Get PDFBACKGROUND: Mobility among adolescents and young people (AYP) is a key factor influencing their access to sexual and reproductive health rights (SRHR) services. Young migrants are more likely to experience gender-based violence and their access to SRHR services and education is often limited in their new communities. We conducted a scoping review which aimed to map what is known about the extent and type of interventions focused on SRHR for mobile adolescents and young people (mAYP) in sub-Saharan Africa. METHODS: We followed Arksey and O'Mally's (2005) steps for conducting scoping reviews: 1. Identifying the research question; 2. Identifying relevant studies; 3. Study selection; 4. Charting the data and 5. Collating, summarising and reporting the results. We searched four databases identifying 1,069 articles. After screening, 25 articles were included. RESULTS: Many studies were conducted in Uganda (n = 12), reported on conflict-related mobility (n = 15), and focused on HIV (n = 11). Two main intervention types were identified: Links to service provision and Knowledge, information, and skills development. Implementation facilitators included recruiting community health promoters, mentors and peer supporters. Implementation barriers included limited literacy, social norms, access to facilities and stigma associated with accessing services. CONCLUSIONS: Research exploring SRHR interventions for mAYP is limited in sub-Saharan Africa. Future research and interventions should be underpinned by an understanding of young people's health and wellbeing more broadly, and foreground the social, cultural, religious and economic factors shaping mAYP's SRH needs
"I Didn't Reveal My ART Status Because I Didn't Have Money to Fetch the Transfer Letter"- Understanding Lack of Treatment Disclosure at Presentation to Care in South Africa: A Qualitative Study.
Get PDFWe explored why people may not reveal their antiretroviral therapy (ART) status when presenting for HIV care, and how a linked electronic system may help address this phenomenon. Data were collected from March to October 2023 from people who presented to clinics for an HIV test in KwaZulu-Natal, South Africa but found to be on ART, as well from staff at those clinics. Themes drawn from the Andersen's health service utilization framework and the domains of a HIV self-management framework were used to guide the analysis. Twenty five people participated in the interviews (18 individuals on ART and seven clinic staff). People did not reveal ART use due to fear of being reprimanded by clinic staff for interrupting treatment or missing clinic visits, with the main reason being administrative challenges, such as requiring a transfer letter to be allowed to access treatment at a new clinic. Some felt ashamed about actions such as buying ART from the black market due to challenges finding treatment. Others wished to present to new clinics because of employment changes, overcrowding in present clinics, missing clinic visits and experiencing stigma. Participants supported the use of a linked electronic system because all medical records would be accessible to health workers in all facilities. People in HIV care in our study demonstrated resilience, finding creative solutions by moving to new clinics to access ART. A linked electronic system which combines records at all health facilities in KwaZulu-Natal could enable individuals to access treatment from any clinic