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A roadmap for integrating nutritional assessment, counselling, and support into the care of people with tuberculosis.
Get PDFUndernutrition-the leading risk factor for tuberculosis worldwide-is associated with impaired immunity, more extensive disease, delayed sputum conversion, and worse treatment outcomes, including mortality. In this Health Policy, we propose a comprehensive roadmap for integrating nutritional assessment, counselling, and support into tuberculosis treatment as part of person-centred care. At treatment initiation, we recommend standard nutritional assessment with anthropometric measurements and haemoglobin estimation, in addition to macronutrient and micronutrient support alongside nutritional counselling. Weight should be monitored during treatment and lack of weight gain at the end of the intensive phase should prompt an investigation of causes, such as food insecurity, poor treatment adherence, malabsorption, uncontrolled diabetes, or drug resistance. At the end of treatment, we recommend reassessing anthropometric measures to assess nutritional recovery. People with tuberculosis who remain underweight should receive close follow-up to detect early relapse. We call for annual reporting of nutritional metrics by WHO, explicit inclusion of nutritional assessment and care in national strategic plans, domestic or international support of nutritional programmes for people with tuberculosis, increased support for operational research initiatives, and integration of nutritional care into the WHO Multisectoral Accountability Framework at national and regional levels
Unseen scars: Understanding the mental health burdens of climate change on indigenous and rural Peruvian women
Get PDFClimate change is disproportionately affecting the mental health of marginalised populations, particularly women in the Global South. Peru, highly vulnerable to environmental hazards, presents a complex landscape where rural and indigenous women face intersecting ecological and social stressors. This study investigates the nexus between climate change impacts and mental health among underserved Peruvian women. It explores their coping mechanisms, community support systems, barriers to formal mental health services, and potential community-driven solutions. Between April and June 2022, we conducted 48 in-depth walking interviews with adult women from the Peruvian north coast, Amazon rainforest, and central and southern Andes regions. We recruited our participants using purposive and iterative snowball sampling, targeting key community informants. Data were analysed thematically. We identified six main themes: (1) Direct mental health impacts of climate change, manifesting as psychological distress and trauma responses; (2) Complex local issues, including gender-based vulnerabilities and male outmigration; (3) Indirect impacts through livelihood loss and food insecurity; (4) Community coping mechanisms, centred on women’s leadership and spiritual traditions; (5) Barriers to mental health support, including institutional mistrust and stigma; and (6) Community-based solutions emphasising culturally responsive interventions. Participants reported acute psychological responses to environmental disasters while demonstrating resilience through adherence to spiritual traditions and social networks, with women emerging as environmental leaders despite facing disproportionate climate-related burdens. This study emphasises the urgent need to integrate mental health considerations for rural and indigenous women into climate adaptation strategies in Peru. Climate change exacerbates social inequities, significantly impacting mental wellbeing through the erosion of traditional practices, particularly in Indigenous communities. Culturally responsive, community-based interventions that amplify women’s leadership and address structural barriers to mental health care are essential for inclusive, equitable climate solutions
Regional variations in the impacts of high temperature on hospital admissions in Brazil.
Get PDFBACKGROUND: High temperatures driven by climate change significantly threaten global health. Their impact on health systems, particularly within low- and middle-income countries, remains underexplored. METHODS: Daily non-elective hospital admissions were collected from the Brazil Hospital Information System for 5,459 (98%) Brazilian municipalities, 2008-2019. Gridded daily maximum temperatures were obtained from the European Centre for Medium-Range Weather Forecasts Reanalysis V5 for the historical period (2008-2023) and projected up to 2060 under three SSP emission scenarios. Population projections were derived from WorldPop. We used a case time-series design and distributed lag non-linear models to examine the relationship between temperature and hospitalisation risk for each state, estimating the number of heat-attributable hospitalisations from 2008 to 2060. Related economic costs were estimated using a cost-of-illness approach including direct and indirect costs. FINDINGS: Without adaptation, high-temperature-related annual hospitalisations were projected to reach 51 (95 % CI: 19-103), 54 (21-106), and 59 (25-112) per 100,000 population in the 2050s under SSP1-2.6, SSP2-4.5, and SSP5-8.5 scenarios, respectively, representing 54 %, 62 %, and 78 % increases from the 2010s baseline of 33 (9-67) per 100,000. Annual economic costs were projected to reach 264 million in the 2050s, with higher absolute costs in the South and faster relative increases in the North. INTERPRETATION: The substantial impact of heat on hospitalisations, and its associated costs to the health sector and wider economy, worsen under future climate and demographic change. Regional adaptation and targeted healthcare investments are crucial to manage rising health burdens. FUNDING: UK Research and Innovation; China Scholarship Council
Complete genomes of 568 diverse Klebsiella pneumoniae species complex isolates from humans, animals, and marine sources in Norway from 2001 to 2020.
Get PDFWe report 578 hybrid genome assemblies (568 complete) of Klebsiella pneumoniae species complex isolates from human, animal, and marine sources in Norway collected from 2001 to 2020, belonging to five phylogroups including K. pneumoniae (n = 492) and K. variicola (n = 69) and 364 unique sequence types
Feasibility study of Learning Together for Mental Health: fidelity, reach and acceptability of a whole-school intervention aiming to promote health and wellbeing in secondary schools.
Get PDFBACKGROUND: Despite high rates of adolescent mental health problems, there are few effective school-based interventions to address this. Whole-school interventions offer a feasible and sustainable means of promoting mental health, but to date, few have been evaluated. Previously we trialled the Learning Together intervention comprising local needs assessment, student and staff participation in decision-making, restorative practice, and a social and emotional skills curriculum. This was effective not only in preventing bullying (primary outcome) but also in promoting mental well-being and psychological functioning (secondary outcomes). We adapted Learning Together to develop Learning Together for Mental Health, focused on promoting mental health. OBJECTIVE: This paper reports on quantitative data on intervention implementation fidelity, reach and acceptability to assess progression to a Phase III trial. DESIGN: We drew on student baseline and follow-up surveys and an integral process evaluation from a non-randomised feasibility study involving four secondary schools. SETTING: Southern England. PARTICIPANTS: Students in year 8 (age 12/13) at baseline and year 10 (age 14/15) at follow-up and school staff and students and intervention trainers and facilitators completing process evaluation tools. INTERVENTIONS: Whole-school intervention featuring student needs assessment, action groups involving staff and students which selected actions from an evidence-based menu, restorative practice to improve relationships and address student behaviour and a social and emotional skills curriculum. RESULTS: Restorative practice training was implemented with fidelity in all schools. Curriculum training was implemented with fidelity in three of four schools. The response rate to the needs survey across the three schools that participated was 79%. Action groups were implemented with fidelity. Action groups at all four schools completed at least one locally decided action and chose at least one action from the menu of evidence-based options. Restorative practice was implemented across all schools. Of lessons that were observed and lessons for which teachers returned logbooks, curriculum delivery was implemented with fidelity. However, two schools delivered 50% or less of the recommended lessons, and not all teachers completed logbooks. All students and staff completing surveys reported finding the Learning Together for Mental Health intervention a good way to promote student mental health. Over a third of students reported definite awareness of actions being undertaken by their schools to improve student mental health. All pre-defined progression criteria to proceed to a Phase III trial were met. The intervention was delivered with good fidelity and had strong acceptability. LIMITATIONS: The schools involved may not be representative of those which we would recruit to a Phase III trial. CONCLUSIONS: The study met all pre-determined progression criteria, and the intervention is ready for a Phase III trial with minor adaptations. FUTURE WORK: A Phase III trial of effectiveness is justified. FUNDING: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131594
Psychometric Evaluation of the Proxy-Reported Pediatric Quality of Life Inventory Generic Core Scales Across the Childhood Lifespan in Australian Children and Adolescents With Specified Health Conditions.
Get PDFOBJECTIVES: Current generic childhood health-related quality-of-life instruments lack comprehensive psychometric evidence across all ages. The Pediatric Quality-of-Life Inventory v4.0 Generic Core Scales (PedsQL GCS) covers ages 2 to 18 years old, but evidence on its psychometric properties is limited to restricted age groups. This study aimed to evaluate the proxy-reported PedsQL GCS across the entire childhood lifespan. METHODS: The study used data from the Longitudinal Study of Australian Children for children aged 2 to 17 years with 1 of 6 health conditions: high weight status, eczema, attention deficit hyperactivity disorder, vision problems, hearing problems, and learning difficulty. Psychometric properties of the proxy-reported PedsQL GCS were assessed in early childhood, middle childhood, and adolescence against established criteria. RESULTS: In analyses of 9317 children with 50 934 total observations, the PedsQL GCS demonstrated good acceptability across the childhood lifespan, except for high rates of missing data in 2 to 9 year olds (range = 12%-30%). Strong internal consistency was evident across health conditions and age (α range = 0.72-0.93; item-total correlations range = 0.28-0.80). Known group validity was strong with differentiation between children with/without the condition across all ages, except for eczema. Responsiveness was variable with inconsistencies mainly in early childhood. CONCLUSIONS: This study adds to the PedsQL psychometric evidence base, finding that the proxy-reported PedsQL GCS demonstrated robust reliability and known group validity, good acceptability, and mixed responsiveness in Australian children with health conditions across age. We propose the PedsQL GCS as a robust instrument to take forward for valuation to directly generate utility values for use in economic evaluations
School-based deworming programmes: Knowledge and perceptions regarding soil-transmitted helminth infections among schoolteachers in Tamil Nadu, India.
Get PDFIn accordance with World Health Organization guidelines, the school-based deworming for soil-transmitted helminths (STH) is being implemented in India since 2015 through teachers on National Deworming Day (NDD). This study aimed to assess teachers' knowledge levels and perception of STH and NDD programmes in southern India using a cross-sectional study design with purposive sampling of teachers involved in the NDD programme. Data from 402 teachers across 221 schools were analysed using STATA 16.0 software. Overall, 37% of the teachers from 52% of schools had attended an NDD training programme. Of a maximum possible score of 32, the knowledge levels were categorised as low (<50%), average (at least 50%), and adequate (70% and above). While 84% of the teachers had an average level of knowledge, only 33% had an adequate level of knowledge. The results showed significant knowledge gaps regarding important aspects of the STH programme including, helminths species being treated, age eligibility of children for treatment, and the name of and side-effects of the deworming tablet distributed. Adequate level of knowledge was more likely among teachers from government schools than those from government-aided/private schools (OR: 3.74; CI: 1.80 - 7.74; p<0.001); those who attended an NDD training programme than those who never attended (OR: 2.69; CI: 1.73 - 4.19; p<0.005); and female teachers compared to male teachers (OR: 1.94; CI: 1.22 - 3.08; p<0.005). A weak but significant positive correlation was observed between knowledge levels and perception (Spearman's rho=0.2075; p=0.002). Teachers from all schools must be encouraged to participate in formal STH training programmes coordinated by the government, and these programmes should be evaluated periodically for effectiveness
Health worker' perceptions of risks, barriers to and facilitators of long-acting injectable antiretroviral therapy delivery to women for prevention of vertical transmission programs.
Get PDFThis study examines the perceptions and experiences of health workers and caregivers regarding the delivery of long-acting antiretroviral therapy (LA-ART) in Uganda, especially for preventing vertical transmission of HIV. Using a qualitative implementation research design informed by the Health Belief Model, the researchers conducted 17 key informant interviews with clinicians, nurses, peer mothers, social workers, department heads, and lead researchers across six study centers between May 2022 and September 2023. The interviews were recorded and transcribed verbatim into English language and analyzed thematically using NVivo 14. Five key themes emerged: perceived benefits, perceived barriers, facility readiness, and recommendations for implementation. Health workers highlighted benefits such as treatment convenience, improved adherence, and patient acceptance. However, they also identified major barriers, including stigma, limited staff training, and financial constraints. Concerns about health facility readiness particularly cold chain storage for the injectable medication were also noted. The findings underscore the importance of addressing these challenges to support effective LA-ART delivery. The study recommends comprehensive training for healthcare workers, patient education, and a phased rollout strategy. Understanding the views of frontline workers is crucial for the successful integration of LA-ART into HIV care and improving health outcomes for people living with HIV
Distinguishing participants, patients and the public: implications of different institutional settings on engagement approaches
Get PDFBackground: There is an established history of patient and public involvement and engagement (PPIE) in academic and clinical research. As the National Institute for Health and Care Research (NIHR) expands its investment in research on and by local authorities (LAs), NIHR PPIE frameworks are increasingly being applied in this new context. This article examines if and how the relationship between the public varies across universities, the NHS and LA and what this means for PPIE.
Methods: To analyse differences in institutional structures, we reviewed organisational websites, comparing the purpose and responsibilities of the institution, funding sources, governance structures, ability to directly action research findings, the role of public collaborators and duration of this relationship. We then systematically analysed these differences against the six UK Standards for Public Involvement: inclusive opportunities, working together, support and learning, governance, communications and impact. We also held a group discussion with nine PPIE Research Advisory Panel members to sense check if and how they perceived differences across these three institutional contexts and to refine and identify additional hypotheses about what might need to be adapted for PPIE in a LA setting.
Results: The three institutions generally fall along a continuum, with universities having the most bounded relationship with the public and LAs the most expansive and enduring. The NHS and LAs have statutory responsibilities to the public, who finance their services and whose rights are articulated in institutional constitutions. Reflective of the service delivery responsibilities of both institutions, they are able to directly implement research findings, whereas university research outputs predominantly aim to inform others’ service design and delivery. Given these differences, our analysis suggests that the three standards on working together, governance and PPIE impact may require greater adaptation in LA settings. At the heart of the challenge is role clarification, since public contributors to research may also be council tenants, taxpayers and voters.
Conclusions: PPIE in LA research offers new opportunities and challenges, requiring tailored guidance that accounts for the unique relationship between LAs and the public. We encourage PPIE contributors, coordinators and scholars across institutional settings to work together to fill this gap
Coordinated expression of BMP10/ALK1/endoglin-proteins that drive embryonic cardiac and vascular morphogenesis-in patients with heart failure: The EMPEROR Program.
Get PDFAIMS: Bone morphogenetic protein 10 (BMP10), activin receptor-like kinase 1 (ALK1) and endoglin form a single transforming growth factor-β family signalling complex that is the principal driver of cardiac and vascular morphogenesis and maturation during hypoxic embryonic development. These proteins are down-regulated with the onset of normoxia at birth, but are up-regulated following experimental cardiac injury. Yet, little is known about the expression of this protein complex in patients with heart failure. METHODS AND RESULTS: In the EMPEROR Program, we measured serum levels of BMP10 by electrochemiluminescence immunoassay in 1127 patients in Cohort 1 (n = 1127) and plasma levels of BMP10, ALK1 and endoglin by proximity extension assay in a distinct Cohort 2 (n = 1120). In both cohorts, patients were characterized at baseline and were followed for the occurrence of major adverse heart failure events. Levels of BMP10, ALK1 and endoglin at baseline and changes in these levels during follow-up were closely correlated with each other. Higher levels of BMP10, ALK1 and endoglin were associated with worse functional class, higher likelihood of atrial fibrillation and higher levels of natriuretic peptides and troponin T (p for trend <0.001 for all). Increasing levels of BMP10, ALK1 and endoglin were associated with progressively higher risks of major adverse outcomes (p for trend <0.001 for all three proteins and for all heart failure endpoints). The hazard ratios for the risks associated with tertiles of the three proteins in Cohort 2 were remarkably similar to those seen with BMP10 in Cohort 1. Treatment with empagliflozin had a modest effect to reduce BMP10 in both cohorts. CONCLUSIONS: The coordinated circulating expression of proteins critical to foetal cardiac and vascular development tracks closely with the severity of heart failure, as reflected by symptoms, cardiac injury and stress, prevalence of atrial fibrillation and other comorbidities, and prognosis, suggesting a role of BMP10/ALK1/endoglin signalling in the progression of heart failure