69832 research outputs found
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Exploring ways to improve healthcare service access for people experiencing homelessness in Manchester, UK.
Get PDFHomelessness is a significant social issue in the UK, affecting the health and life chances of ∼320 000 people annually. This study aims to explore primary healthcare provision from the perspectives of people experiencing homelessness (PEH) in the Greater Manchester area. We conducted a qualitative multimethod study, including unstructured observations and semistructured interviews with 20 PEH across four homelessness day facilities in Greater Manchester during April-May 2023 and analysed data thematically using inductive coding. We generated five inductive themes consisting of PEH fears around communication, challenges navigating the health system, insufficient service signposting, travel as a barrier to healthcare access, and the crucial importance of outreach. The findings indicate that general practitioners can improve communication approaches, clarify pathways to care for PEH, and increase outreach services where feasible to help ensure PEH are better able to access needed services
Hospitalisation, mortality and years of life lost among chikungunya and dengue cases in Brazil: a nationwide cohort study, 2015-2024.
Get PDFBACKGROUND: The incidence of infections from arthropod-borne viruses, including chikungunya and dengue, is increasing globally. We used nationwide data collected over a decade in Brazil to examine the factors associated with hospitalisation, in-hospital mortality, and the years of life lost from these diseases in Brazil. METHODS: Using nationwide de-identified chikungunya and dengue disease records registered from 1st January 2015 to 31 December 2024, we estimated the risk factors for hospitalisation and in-hospital mortality via logistic regression and the Fine and Gray model, respectively. We also calculated the years of life lost for each disease and the average of years of life lost (aYLL), stratified by geographic region, sex and race/ethnicity. FINDINGS: We studied 1,125,209 chikungunya cases: 21,336 (1.9%) required hospitalisations. Among hospitalised cases, 1044 (4.9%) deaths occurred within 84 days of symptom onset, of which 728 (69.7%) were attributed to chikungunya. We studied 13,741,408 dengue cases: 455,899 (3.3%) required hospitalisation, with 12,969 (2.8%) deaths among the hospitalised cases, with 9989 (77.0%) attributed to dengue. Age (<1 or ≥70 years), sex (male), and the presence of diabetes and kidney disease were risk factors for hospitalisation and in-hospital mortality in both diseases. The aYLL for chikungunya was 16.0 years, and for dengue, 14.5 years; however, the burden was not evenly distributed across the population. For chikungunya, Black participants experienced the highest aYLL of 22.0 years, while White participants were the least affected (aYLL: 13.0). For dengue, the most affected group was Indigenous (aYLL: 22.5) and the least White (aYLL: 12.6). INTERPRETATION: Infants, older people (≥70 years), male sex and the presence of comorbidities are associated with increased severity in cases of chikungunya and dengue. These diseases disproportionately affect historically minoritised populations, with participants who self-identified as Black and Indigenous experiencing significantly greater years of life lost compared to the white population. Mitigating the impacts of chikungunya and dengue necessitates addressing health and social inequities. FUNDING: Royal Society, Wellcome Trust, CNPq
Effectiveness of School-Based Nutrition Interventions in Italy: A Scoping Review.
Get PDFSchool-based nutrition interventions play a crucial role in promoting healthy eating habits among children and adolescents, which are fundamental for preventing chronic diseases and fostering physical and mental development. This scoping review aims to examine the literature on the nature and extent of research conducted in school-based nutrition intervention programs in Italy and their effectiveness. Established and emerging programs and practices are reviewed to identify successful strategies in Italy. A scoping review of published studies using the PRISMA-ScR guidelines across 14 databases for school-based nutrition interventions implemented in Italy was conducted, and the results communicate literature published from 1990 to December 2024. The review included 42 studies, highlighting positive changes in dietary knowledge and behavior, with 33 studies reporting significant improvements. Interventions employing a sequence of education (knowledge), demonstration by teachers, and practice of good nutrition at home and/or school demonstrated sustained behavioral changes. Each study was conducted by a high number of authors, showing healthy collaboration. Studies were mainly applied using a Health Promotion Model, without reference to theories. However, gaps remain in addressing adolescent populations, employing social marketing techniques, and integrating environmental changes. While Italian schools have implemented diverse and culturally tailored interventions, challenges persist, including variability in program implementation, limited follow-up, and underutilized theoretical frameworks. Efforts to enhance collaboration among schools, families, and policymakers are essential for sustainable success. School-based nutrition interventions in Italy have demonstrated substantial potential in improving dietary behaviors among children and adolescents. Addressing identified gaps and promoting comprehensive, multicomponent approaches can further enhance the long-term success of these programs
Shaping the future of medical laboratory practices in Somaliland: a review of the current standards
Get PDFMedical laboratory science has an acknowledged pivotal role in evidence-based practices and patient-centered care, informing clinical decision-making for precise diagnosis and treatment. Laboratory practices’ advancements in sub-Saharan Africa indicate several challenges and limitations, where progress remains slow, hindered by limited accredited laboratories, weak governance, and inadequate national health policies. This review presents the current status of medical laboratory practices in Somaliland, emphasizes the urgent need for reform and adherence to international standards, and provides actionable recommendations for transforming the healthcare system. While strides have been made toward aligning laboratory practices with international standards, inadequate compliance underpins challenges in Somaliland’s medical laboratory practices, highlighting suboptimal management performance and the urgent need for adherence to international benchmarks that fit Somaliland's laboratory landscape and the gap that pertains. This review discusses the Total quality management (TQM) approach, emphasizing a dual focus on quality of management and management of quality, which is vital for ensuring reliable, high-quality services. While compliance with international standards demonstrates significant outcomes, quality management is the key role guiding this compliance and ensuring service quality. Findings demonstrate that quality management and efficient leadership are critical for a successful pre-accreditation and post-accreditation process, indicating the dual focus as the main strategy to ensure Somaliland’s medical laboratories meet global standards of excellence in terms of diagnostic accuracy, operational efficiency, patient outcomes, resilience and sustainability. Finally, effective compliance with international benchmarks that promote the quality management and management of quality standards can ensure the implementation of the dual focus and maintain TQM. International collaboration are necessary for knowledge sharing, resources, and guidance as current practices’ data and information available. Consultation for effective compliance is highly recommended to navigate the challenges of simultaneously considering and implementing the proposed dual focus to obtain accreditation. It promotes continuous evaluation to achieve the targeted improvements and growth
Mortality risks of infants with unmeasured birth weight in 33 sub-Saharan African countries: an observational analysis.
No full textBACKGROUND: Although most infants have their birth weights measured, not all newborns have this opportunity, particularly those in low and middle-income countries. This study evaluates neonatal, infant and child mortality among infants who were not weighed at birth compared with peers weighed at birth and to those identified as having low birth weight. METHODS: A cross-sectional observational study of 308 414 African children in 33 countries from the most recent nationally representative Demographic Health Surveys was conducted between 2011 and 2022. Mixed effect Cox regression was used to estimate HRs and 95% CIs, with adjustments made for socioeconomic and proximate determinants of child survival. FINDINGS: In total, 116 717 (37.84%) infants did not have their birth weight measured. Compared with infants with a measured birth weight, infants without a measured birth weight were at least three and half-times more likely to die within the initial 28 days of life (HR: 3.51; 95% CI 3.18 to 3.88), and approximately two times likely to die by their first birthday (HR: 2.15; 95% CI 2.01 to 2.30) or by their fifth birthday (HR: 1.89; 95% CI 1.78 to 2.00), after adjusting for confounding factors. The disparity in survival rates was consistent between infants who were born at health facilities but were weighed or not weighed at birth. Those unweighed at birth also had a higher risk of death at 28 days of life (HR: 1.76; 95% CI 1.53 to 2.02), by the first birthday (HR: 1.33; 95% CI 1.21 to 1.47) and by the fifth birthday (HR: 1.25; 95% CI 1.14 to 1.37) than infants identified as having low birth weights. INTERPRETATION: Infants whose birth weight is not measured face a higher mortality risk before age 5 compared with those with measured birth weights. The absence of birth weight measurement may indicate a higher risk profile for newborns and their vulnerability to mortality
Global diversity of soil-transmitted helminths reveals population-biased genetic variation that impacts diagnostic targets.
Get PDFSoil-transmitted helminths (STHs) are intestinal parasites that affect over a billion people worldwide. STH control relies on microscopy-based diagnostics to monitor parasite prevalence and enable post-treatment surveillance; however, molecular diagnostics are rapidly being developed due to increased sensitivity, particularly in low-STH-prevalence settings. The genetic diversity of helminths and its potential impact on molecular diagnostics remain unclear. Using low-coverage genome sequencing, we assess the genetics of STHs within worm, faecal, and purified egg samples from 27 countries, identifying differences in the genetic connectivity and diversity of STH-positive samples across regions and cryptic diversity between closely related human- and pig-infective species. We define substantial copy number and sequence variants in current diagnostic target regions and validate the impact of genetic variation on qPCR diagnostics using in vitro assays. Our study provides insights into the diversity and genomic epidemiology of STHs, highlighting both the challenges and opportunities for developing molecular diagnostics needed to support STH control efforts
Development of a live-attenuated vaccine challenge model of Yersinia pestis in humans: Expert consultation on clinical trial considerations, January 2025.
Get PDFYersinia pestis is the causative agent of plague - the archetypal bacterial pandemic disease. Plague remains endemic in several countries in Africa, South America, and Asia, posing high risks of zoonotic spill-over and epidemic spread or threat of deliberate release. Plague vaccine development remains a priority for pandemic preparedness initiatives but generating sufficient field data for vaccine licensure is challenging. Controlled human infection studies have been deployed to test candidate vaccines against diseases with low and sporadic incidences of outbreaks where field trials are difficult. Typically, such studies use live attenuated or vaccine-type strains to measure clinical or microbiological end points of interest. To assess the feasibility of conducting a human vaccine-challenge study for Y. pestis, we hosted a one-day expert consultation workshop in January 2025. The aim was to discuss the practical, regulatory landscape and future use-case of such a model. We invited attendees from academia, industry, regulatory bodies, funders, and other stakeholders with expertise in Y. pestis biology and infection. The workshop combined presentations with breakout discussions and was divided into five sessions: i) Introduction to live attenuated Y. pestis vaccines; ii) Update of the contemporary plague vaccine landscape; iii) Assessment of biosafety and bio-security considerations; iv) Clinical and ethical considerations and v) public perceptions. Several challenges were identified, and potential strategies to address them were discussed. This perspective builds on this workshop and lays the foundation for a collaborative consortium to develop a Y. pestis vaccine challenge model. Next steps include early-stage public engagement, strain characterization, and regulatory discussions to define how data from these studies could be used for assessing vaccine efficacy. Our vision is to establish a global network dedicated to advancing new vaccine technologies for an ancient disease
Within-country heterogeneity in patterns of social contact relevant for tuberculosis infection transmission, prevention, and care.
Get PDFMycobacterium tuberculosis (Mtb) transmission is driven by variable social, environmental, and biological factors, including the number and duration of indoor contacts. Social contact data can provide information on potential transmission patterns, but is underutilised outside the field of mathematical modelling. We explore three contexts where contact data can provide valuable insights: 1) household contact tracing; 2) infection prevention and control measures (IPC); and 3) contamination in cluster randomised trials (CRTs). A social contact survey was conducted in adults aged 18 and older from three communities with comparable population sizes in South Africa: an urban township and peri-urban and rural clinic catchment areas. Participants reported congregate settings visited over 24-hours, visit durations, and estimated number of people present. To correspond with the three contexts, we estimated the proportion of contact hours occurring 1) within the home; 2) in congregate settings outside the home; and 3) outside the participants' communities. Participants reported a mean of 27.0 (rural), 55.2 (peri-urban), and 73.0 (urban) contact hours. The proportions of household contact were similar among rural and peri-urban participants (76.8% and 71.7%), compared to urban (48.6%). Congregate settings visited varied; urban participants spent the most contact hours in retail/office settings (19.9%), peri-urban participants in community-service buildings (20.4%), and rural participants in other peoples' homes (25.5%). Urban participants reported the highest proportion of contact outside the community (67.0%) compared to rural (38.8%) and peri-urban (21.5%) participants. The observed heterogeneity in contact patterns has implications for TB interventions. Household contact tracing may be most effective in the rural community where household contact was highest. The diverse range of congregate settings visited suggests that prioritising IPC measures in these locations may enhance their overall efficacy. Considering contact patterns when designing clusters may reduce contamination in CRTs. Tailored interventions, informed by local contexts, are essential to reduce TB burden
Access to opioids for palliative care in humanitarian settings: two case studies of Médecins Sans Frontières (MSF) experience in India and Bangladesh.
Get PDFBACKGROUND: Alleviating suffering and preserving dignity are essential components of healthcare. Patients in need of palliative care often require opioid medication to relieve breathlessness and pain. However, a lack of access to essential opioids, particularly morphine, remains a major challenge in low- and middle-income countries (LMICs). This is notably critical in the humanitarian context. We conducted two case studies to identify the barriers and facilitators of access to opioids, particularly morphine, for palliative care patients in humanitarian settings while exploring humanitarian healthcare workers' perceptions and experiences with opioids. METHODS: Two case studies were conducted based on two Médecins Sans Frontières (MSF) projects which integrated palliative care: advanced HIV care in Patna, Bihar, India, and paediatric and neonatal care in the refugee context in Cox's Bazar, Bangladesh. Six semi-structured interviews were conducted with key MSF healthcare professionals. Interviews were conducted in English, video- and/or audio-recorded and transcribed verbatim. Transcripts were coded and analysed using the grounded theory approach. RESULTS: Several barriers impeding access to and use of essential opioids in palliative care were reported by the participants. These included limited availability, accessibility obstacles, sociocultural challenges such as low awareness and misconceptions, lack of healthcare providers' training on opioid use, and burdensome regulatory processes. Most participants reported that clinical guidelines, familiarity with the use of opioids and interdisciplinary teamwork were important facilitators of opioid prescribing. Participants expressed the urgency for further educational and advocacy initiatives to improve access to essential opioids for patients requiring palliative care. CONCLUSION: Humanitarian healthcare workers face multiple challenges, leading to inadequate access to essential opioid medication, which undermines effective palliative care delivery. Further training on the use of opioids and strong advocacy efforts led by humanitarian organizations and the medical community are critical to improving access to these essential medicines for the relief of pain and suffering
Segmenting the Global Layers of Malignant Meningioma: A Population-Based Study of Incidence, Risk Factors, and Temporal Trends.
Get PDFBACKGROUND: Malignant meningioma is a rare form of primary central nervous system cancer originating from the meninges membrane layers. Current data remain unmapped to cover trends for particular groups globally. METHODS: This study examined the missing gap for its global burden, country-specific incidence, and risk factor trends, stratified by sex and age. Several databases were retrieved for temporal trend analysis and interpretation: Cancer incidence rates from five continents (CI5 Plus), global cancer observatory (GLOBOCAN), global burden of disease (GBD), and the world bank. association between malignant meningioma's and various factors was determined using linear regression. Meningioma incidence trends were estimated using the average annual percentage change (AAPC) with join point regression, including the shift in cancerous meningioma incidence based on corresponding specific variables. RESULT: New malignant meningioma cases reported in 2020 were estimated to be 14,832 with aged-standardized rates (ASR) of 1.3 per million population. Considerable variations exist among nations for malignant meningioma's, with the highest ASR found in Latvia (6.9 per million population), compared to a 345-fold difference from the lowest ASR found in Fiji (0.02 per million population). Additionally, chronic disease presence such as smoking and hypertension was associated with higher malignant meningioma incidence. The analysis observed increasing rates of malignant meningioma in younger populations. CONCLUSIONS: Overall, this study contributes a global perspective on malignant meningioma incidence and emphasizes further investigation of specific groups that may have been overlooked. The increasing trend of malignant meningioma in younger populations warrants preventive, early diagnosis, and further research initiatives for evidence on risk management