Pub Date : 2024-09-18DOI: 10.1101/2024.09.17.24313569
Shu Jiang, Debbie Lee Bennett, Graham A Colditz
Screening digital breast tomosynthesis (DBT) aims to identify breast cancer early when treatment is most effective leading to reduced mortality. In addition to early detection, the information contained within DBT images may also inform subsequent risk stratification and guide risk reducing management. We obtained a 5-year area under the curve (AUC) = 0.78 (95% confidence interval (CI) = 0.75, 0.80) in the internal validation. The model validated in external data (n=6,553 women; AUC = 0.77 (95% CI, 0.74, 0.80). There was no change in the AUC when age and BI-RADS density are added to the synthetic DBT image. The model significantly outperforms the Tyrer-Cuzick model (p<0.01). Our model extends risk prediction applications to synthetic DBT, provides 5-year risk estimates, and is readily calibrated to national risk strata for clinical translation and application in the setting of US risk management guidelines. The model could be implemented within any digital mammography program.
{"title":"Development and validation of a 5-year risk model using mammogram risk scores generated from screening digital breast tomosynthesis","authors":"Shu Jiang, Debbie Lee Bennett, Graham A Colditz","doi":"10.1101/2024.09.17.24313569","DOIUrl":"https://doi.org/10.1101/2024.09.17.24313569","url":null,"abstract":"Screening digital breast tomosynthesis (DBT) aims to identify breast cancer early when treatment is most effective leading to reduced mortality. In addition to early detection, the information contained within DBT images may also inform subsequent risk stratification and guide risk reducing management. We obtained a 5-year area under the curve (AUC) = 0.78 (95% confidence interval (CI) = 0.75, 0.80) in the internal validation. The model validated in external data (n=6,553 women; AUC = 0.77 (95% CI, 0.74, 0.80). There was no change in the AUC when age and BI-RADS density are added to the synthetic DBT image. The model significantly outperforms the Tyrer-Cuzick model (p<0.01). Our model extends risk prediction applications to synthetic DBT, provides 5-year risk estimates, and is readily calibrated to national risk strata for clinical translation and application in the setting of US risk management guidelines. The model could be implemented within any digital mammography program.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1101/2024.09.17.24313836
Kristen Sportiello, Mina Shah, Alexandra Buda, Isaiah Mwanza, Manoj Mathews, David R Bearden
Background While childhood mortality has been declining in Zambia, it remains high at 58 per 1000 live births. Importantly, many leading causes of mortality in Zambia are preventable. This study was conducted to identify clusters of childhood mortality, causes of death of recently deceased children, barriers to care, and risk factors for mortality in Lusaka, Zambia. Methods This study was conducted as a prospective cohort study. Family members or lawfully authorized representatives (LARs) were interviewed when they came to pick up death certificates for recently deceased children from Lusaka Childrens Hospital. Each interview included a verbal autopsy, determination of the childs location of residence, and collection of demographic information. Demographic data was also collected from a healthy control group. Quantitative Geographic Information Systems was used to visualize mortality and evaluate for clustering. Results Leading primary causes of death included malnutrition (21%), complications of chronic illnesses (16%), and central nervous system infections (13%), while the leading barriers to care were cost (58%) and difficulties with travel (53%). Compared to controls, recently deceased children came from families with significantly lower incomes (1905 Kwacha vs. 2412 Kwacha, p = 0.03) and were significantly more likely to have a history of malnutrition (16.7% vs. 1.4%, p = 0.005). Mortality was clustered in two high-population density, low-income neighborhoods in Lusaka. Conclusions Systems to reduce financial barriers to care and improve access to transportation could reduce childhood mortality in Lusaka. The aforementioned neighborhoods are ideal locations for public health interventions or improved healthcare services.
{"title":"Causes of Pediatric Deaths in Lusaka, Zambia: A Quantitative Geographic Information Systems Approach","authors":"Kristen Sportiello, Mina Shah, Alexandra Buda, Isaiah Mwanza, Manoj Mathews, David R Bearden","doi":"10.1101/2024.09.17.24313836","DOIUrl":"https://doi.org/10.1101/2024.09.17.24313836","url":null,"abstract":"Background\u0000While childhood mortality has been declining in Zambia, it remains high at 58 per 1000 live births. Importantly, many leading causes of mortality in Zambia are preventable. This study was conducted to identify clusters of childhood mortality, causes of death of recently deceased children, barriers to care, and risk factors for mortality in Lusaka, Zambia. Methods\u0000This study was conducted as a prospective cohort study. Family members or lawfully authorized representatives (LARs) were interviewed when they came to pick up death certificates for recently deceased children from Lusaka Childrens Hospital. Each interview included a verbal autopsy, determination of the childs location of residence, and collection of demographic information. Demographic data was also collected from a healthy control group. Quantitative Geographic Information Systems was used to visualize mortality and evaluate for clustering. Results\u0000Leading primary causes of death included malnutrition (21%), complications of chronic illnesses (16%), and central nervous system infections (13%), while the leading barriers to care were cost (58%) and difficulties with travel (53%). Compared to controls, recently deceased children came from families with significantly lower incomes (1905 Kwacha vs. 2412 Kwacha, p = 0.03) and were significantly more likely to have a history of malnutrition (16.7% vs. 1.4%, p = 0.005). Mortality was clustered in two high-population density, low-income neighborhoods in Lusaka. Conclusions\u0000Systems to reduce financial barriers to care and improve access to transportation could reduce childhood mortality in Lusaka. The aforementioned neighborhoods are ideal locations for public health interventions or improved healthcare services.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1101/2024.09.17.24313840
Olasehinde Ben Adebayo, Teresa Innis
The ongoing Canadian opioid crisis has resulted in alarming rates of overdoses and related harms. Harm reduction programs have emerged as a crucial public health strategy to mitigate these risks. The Nēwo-Yōtina Friendship Centre (NYFC) offers harm reduction programs that provide a safe injection site and clean supplies to reduce substance use-associated harm. Researchers have not extensively studied the effectiveness and user experience of this program. Studies have demonstrated the effectiveness of harm reduction programs in mitigating adverse effects of drug use, such as disease transmission and overdose. This in-depth study looked at what program users went through in the NYFC harm reduction program. This was done by looking at the program environment, unexpected outcomes, reasons for seeking services, and obstacles to access. The study used a phenomenological approach, utilising semi-structured interviews with 13 participants and analysing interview data using thematic analysis2 through NVivo. The motivations for seeking services were safety, access to clean supplies, and a non-judgmental environment. Findings revealed that users valued a safe and welcoming atmosphere fostered by friendly, supportive, and non-judgmental staff. The program's positive outcomes included reduced harm, access to resources, and emotional support. Nevertheless, limited operating hours, stigma, small space, and a lack of awareness were identified as barriers to access. The study recommends improving accessibility, enhancing support systems, and addressing unanticipated outcomes like drug use enablement to optimise the program's effectiveness. This study provides valuable insights into user experience within the NYFC program. The findings inform program improvements, enhance service delivery, and contribute to a broader understanding of harm reduction strategies for addressing the opioid crisis. It emphasises the importance of user-centred approaches in developing and implementing effective harm reduction programs.
{"title":"A Qualitative Study of User Experiences in Harm Reduction Programs","authors":"Olasehinde Ben Adebayo, Teresa Innis","doi":"10.1101/2024.09.17.24313840","DOIUrl":"https://doi.org/10.1101/2024.09.17.24313840","url":null,"abstract":"The ongoing Canadian opioid crisis has resulted in alarming rates of overdoses and related harms. Harm reduction programs have emerged as a crucial public health strategy to mitigate these risks. The Nēwo-Yōtina Friendship Centre (NYFC) offers harm reduction programs that provide a safe injection site and clean supplies to reduce substance use-associated harm. Researchers have not extensively studied the effectiveness and user experience of this program. Studies have demonstrated the effectiveness of harm reduction programs in mitigating adverse effects of drug use, such as disease transmission and overdose. This in-depth study looked at what program users went through in the NYFC harm reduction program. This was done by looking at the program environment, unexpected outcomes, reasons for seeking services, and obstacles to access. The study used a phenomenological approach, utilising semi-structured interviews with 13 participants and analysing interview data using thematic analysis2 through NVivo. The motivations for seeking services were safety, access to clean supplies, and a non-judgmental environment. Findings revealed that users valued a safe and welcoming atmosphere fostered by friendly, supportive, and non-judgmental staff. The program's positive outcomes included reduced harm, access to resources, and emotional support. Nevertheless, limited operating hours, stigma, small space, and a lack of awareness were identified as barriers to access. The study recommends improving accessibility, enhancing support systems, and addressing unanticipated outcomes like drug use enablement to optimise the program's effectiveness. This study provides valuable insights into user experience within the NYFC program. The findings inform program improvements, enhance service delivery, and contribute to a broader understanding of harm reduction strategies for addressing the opioid crisis. It emphasises the importance of user-centred approaches in developing and implementing effective harm reduction programs.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1101/2024.09.17.24313392
Angie Pitt, Richard Amlot, Catherine Heffernan, Gideon James Rubin, Louise E Smith
Vaccination was a key measure to tackle the Covid-19 pandemic, however adolescents were less likely than adults to accept the vaccine. Low vaccine uptake reduces the effectiveness of vaccination campaigns and threatens global public health. Understanding why adolescents are hesitant to accept new vaccines is therefore crucial to support the development of novel vaccine uptake interventions. Prior reviews have included far fewer citations, excluded qualitative data, studies after 2022 and have not mapped adolescent Covid-19 vaccine behaviour onto psychological models. This systematic review investigates psychological factors influencing attitudes and intentions toward and uptake of Covid-19 vaccines in adolescents aged 10 to 19 years globally. Next, we mapped results onto the COM-B framework to inform future interventions. Our search identified 25,354 citations, and included 77 in this review. The quality of studies was mixed, predominantly cross-sectional in design. According to our review, key influences on adolescent Covid-19 vaccine behaviour were: i) Reflective motivation (safety concerns, perceived susceptibility to/severity of Covid-19, perceived vaccine effectiveness, ii) Social opportunity (social norms, autonomy and prosocial attitudes), iii) Psychological capability (attitude and knowledge about vaccines). To improve vaccine uptake, interventions should help adolescents critically weigh vaccine pros and cons and consider external influences on their decisions. IMPLICATIONS AND CONTRIBUTION Our review provides new insights into psychological factors influencing adolescent Covid-19 vaccine behaviour, and maps factors to the COM-B model of behaviour change. To improve vaccine uptake, future vaccine interventions should support adolescents to think critically about the pros and cons of vaccines and consider external influences on their decisions.
{"title":"A systematic review of psychological factors influencing attitudes and intentions toward, and uptake of, Covid-19 vaccines in adolescents","authors":"Angie Pitt, Richard Amlot, Catherine Heffernan, Gideon James Rubin, Louise E Smith","doi":"10.1101/2024.09.17.24313392","DOIUrl":"https://doi.org/10.1101/2024.09.17.24313392","url":null,"abstract":"Vaccination was a key measure to tackle the Covid-19 pandemic, however adolescents were less likely than adults to accept the vaccine. Low vaccine uptake reduces the effectiveness of vaccination campaigns and threatens global public health. Understanding why adolescents are hesitant to accept new vaccines is therefore crucial to support the development of novel vaccine uptake interventions. Prior reviews have included far fewer citations, excluded qualitative data, studies after 2022 and have not mapped adolescent Covid-19 vaccine behaviour onto psychological models. This systematic review investigates psychological factors influencing attitudes and intentions toward and uptake of Covid-19 vaccines in adolescents aged 10 to 19 years globally. Next, we mapped results onto the COM-B framework to inform future interventions. Our search identified 25,354 citations, and included 77 in this review. The quality of studies was mixed, predominantly cross-sectional in design. According to our review, key influences on adolescent Covid-19 vaccine behaviour were: i) Reflective motivation (safety concerns, perceived susceptibility to/severity of Covid-19, perceived vaccine effectiveness, ii) Social opportunity (social norms, autonomy and prosocial attitudes), iii) Psychological capability (attitude and knowledge about vaccines). To improve vaccine uptake, interventions should help adolescents critically weigh vaccine pros and cons and consider external influences on their decisions. IMPLICATIONS AND CONTRIBUTION\u0000Our review provides new insights into psychological factors influencing adolescent Covid-19 vaccine behaviour, and maps factors to the COM-B model of behaviour change. To improve vaccine uptake, future vaccine interventions should support adolescents to think critically about the pros and cons of vaccines and consider external influences on their decisions.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We investigated the effect of exposure to pesticide mixtures during pregnancy on the placental transcriptome, to link these exposures and placental functions. The Study of Asian Women and their Offspring's Development and Environmental Exposures (SAWASDEE) enrolled pregnant farmworkers from Thailand (n=248), who were primarily exposed to organophosphate (OP) and pyrethroid pesticides. We measured maternal urinary levels of six non-specific OP metabolites expressed as three summary measures (dimethylalkylphosphates (DMAP), diethylalkylphosphates (DEAP), and dialkylphosphates (DAP) and three pyrethroid metabolites (3-phenoxybenzoic acid (3-PBA), cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (Cis-DCCA, Trans-DCCA) during early, middle, and late pregnancy, and adjusted for urine dilution using creatinine. RNA-sequencing was used to profile the placental transcriptome from which 21 co-expression network modules were identified by Weighted Gene Co-expression Network Analysis. Quantile g-computation analysis identified an average pregnancy positive mixture exposure effect on the E2f Target Module (β=0.013, p=0.012) and a negative mixture exposure effect (β=-0.016, p=0.008) on the Myogenesis Module. The pesticide metabolites driving the associations differed for each module, highlighting differential susceptibilities within the placental transcriptome to various pesticides. When stratifying by infant sex, the average pregnancy mixture exhibited a significant negative effect (β=-0.018, P=0.016) on the Myogenesis Module only in females; other modules, such as epithelial-mesenchymal transition, though not demonstrating an overall mixture effect, did demonstrate differential impacts of the mixture by sex. Pesticide mixtures in both the second trimester (β=-0.013, p=0.015) and the third trimester (β =-0.012, p=0.028) exhibited consistently significant negative associations with the Myogenesis module. These findings underscore the importance of considering the prenatal environment more holistically, understanding the placenta's susceptibility to contaminants, and incorporating sex-specific analyses to understand differential impacts.
我们研究了孕期接触农药混合物对胎盘转录组的影响，以便将这些接触与胎盘功能联系起来。亚洲妇女及其后代发育与环境暴露研究（SAWASDEE）招募了来自泰国的怀孕农工（248 人），她们主要暴露于有机磷（OP）和拟除虫菊酯农药。我们测量了母体尿液中六种非特异性 OP 代谢物的水平，这六种代谢物分别是二甲基烷基磷酸盐 (DMAP)、二乙基烷基磷酸盐 (DEAP) 和二烷基磷酸盐 (DAP)，以及三种拟除虫菊酯代谢物（3-苯氧基苯甲酸 (3-PBA)、顺式和反式-3-(3-PBA)）、在妊娠早期、中期和晚期，对顺式和反式-3-(2,2-二氯乙烯基)-2,2-二甲基环丙烷羧酸（顺式-DCCA、反式-DCCA）进行检测，并使用肌酐对尿液稀释度进行调整。利用 RNA 测序分析胎盘转录组，并通过加权基因共表达网络分析确定了 21 个共表达网络模块。量子 g 计算分析确定了妊娠期平均正混合物暴露对 E2f 目标模块的影响（β=0.013，p=0.012）和负混合物暴露对 Myogenesis 模块的影响（β=-0.016，p=0.008）。每个模块中产生关联的农药代谢物各不相同，这表明胎盘转录组对各种农药的易感性不同。当按婴儿性别分层时，平均妊娠混合物仅对女性的肌生成模块有显著的负效应（β=-0.018，P=0.016）；其他模块，如上皮-间质转化，虽然没有显示出混合物的整体效应，但确实显示出混合物对不同性别的不同影响。杀虫剂混合物在妊娠后三个月（β=-0.013，p=0.015）和妊娠后三个月（β=-0.012，p=0.028）都表现出与肌生成模块持续显著的负相关。这些发现强调了更全面地考虑产前环境、了解胎盘对污染物的易感性以及纳入性别特异性分析以了解不同影响的重要性。
{"title":"Prenatal Exposure of Pesticide Mixtures and the Placental Transcriptome: Insights from Trimester-specific, Sex-Specific and Metabolite-Scaled Analyses in the SAWASDEE Cohort","authors":"Yewei Wang, Karen Hermetz, Amber Burt, Corina Lesseur, Parinya Panuwet, Nancy Fiedler, Tippawan Prapamontol, Panrapee Suttiwan, Pimjuta Nimmapirat, Supattra Sittiwang, Warangkana Naksen, Volha Yakimavets, Dana Boyd Barr, Ke Hao, Jia Chen, Carmen Marsit","doi":"10.1101/2024.09.16.24313768","DOIUrl":"https://doi.org/10.1101/2024.09.16.24313768","url":null,"abstract":"We investigated the effect of exposure to pesticide mixtures during pregnancy on the placental transcriptome, to link these exposures and placental functions. The Study of Asian Women and their Offspring's Development and Environmental Exposures (SAWASDEE) enrolled pregnant farmworkers from Thailand (n=248), who were primarily exposed to organophosphate (OP) and pyrethroid pesticides. We measured maternal urinary levels of six non-specific OP metabolites expressed as three summary measures (dimethylalkylphosphates (DMAP), diethylalkylphosphates (DEAP), and dialkylphosphates (DAP) and three pyrethroid metabolites (3-phenoxybenzoic acid (3-PBA), cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (Cis-DCCA, Trans-DCCA) during early, middle, and late pregnancy, and adjusted for urine dilution using creatinine. RNA-sequencing was used to profile the placental transcriptome from which 21 co-expression network modules were identified by Weighted Gene Co-expression Network Analysis. Quantile g-computation analysis identified an average pregnancy positive mixture exposure effect on the E2f Target Module (β=0.013, p=0.012) and a negative mixture exposure effect (β=-0.016, p=0.008) on the Myogenesis Module. The pesticide metabolites driving the associations differed for each module, highlighting differential susceptibilities within the placental transcriptome to various pesticides. When stratifying by infant sex, the average pregnancy mixture exhibited a significant negative effect (β=-0.018, P=0.016) on the Myogenesis Module only in females; other modules, such as epithelial-mesenchymal transition, though not demonstrating an overall mixture effect, did demonstrate differential impacts of the mixture by sex. Pesticide mixtures in both the second trimester (β=-0.013, p=0.015) and the third trimester (β =-0.012, p=0.028) exhibited consistently significant negative associations with the Myogenesis module. These findings underscore the importance of considering the prenatal environment more holistically, understanding the placenta's susceptibility to contaminants, and incorporating sex-specific analyses to understand differential impacts.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1101/2024.09.17.24313804
Paskari Odoi, Stella Neema, Fred Bateganya, Birgitte Vennervald, Shona Wilson
Background: Our primary focus was Schistosoma mansoni infection and schoolchildren. Within communities the social environment may promote individual risk of infection for the school-aged children. There will also be demographic groups who are not targeted or reached by preventive chemotherapy campaigns. The behaviours of these other groups will interact with those of school-aged children, resulting in further infection risk through exposure-related behaviours. Furthermore, the perception of the disease may significantly influence the schoolchildren's lived experience of the infection and associated disease. It is therefore crucial to document the daily experiences of schoolchildren living in schistosomiasis high transmission areas. Methods: An ethnographic study explored schoolchildren's perspectives and daily life organisations that shape their risk of schistosomiasis and their perceptions of the disease. The study was conducted between November 2022 and August 2023 along Lake Albert, Hoima District. it involved in-depth interviews with schoolchildren and their parents, key informant interviews, focus group discussions with schoolchildren, and participant observations. Data was analysed using reflexive thematic analysis. Code reported were generated inductively using ATLAS.ti (version 7). Results: The study revealed a significant level of knowledge and awareness about schistosomiasis among schoolchildren. They had understanding of the risk factors, continued exposure, and experiences of illness, though they had little autonomy to address these through their own behaviour as they were influenced by the behaviour of others and macro-factors such as WASH provision and economic need. Study participants experienced individual-level effects of schistosomiasis such as educational impacts and isolation as a significant form of stigma. Conclusions: There is a need for continued community sensitisation and awareness campaigns to address social stigma, educational impact, and the contamination and exposure-related behaviours. National and regional policies and programmes on WASH, livelihood and poverty eradication programmes need to be revisited in schistosomiasis high transmission areas to help provide alternatives and improve schoolchildren's lived experiences.
{"title":"Ich-Mupong, a swollen stomach: An ethnographic study of the daily lived experiences of schoolchildren in schistosomiasis high transmission areas along Lake Albert, Hoima District","authors":"Paskari Odoi, Stella Neema, Fred Bateganya, Birgitte Vennervald, Shona Wilson","doi":"10.1101/2024.09.17.24313804","DOIUrl":"https://doi.org/10.1101/2024.09.17.24313804","url":null,"abstract":"Background: Our primary focus was Schistosoma mansoni infection and schoolchildren. Within communities the social environment may promote individual risk of infection for the school-aged children. There will also be demographic groups who are not targeted or reached by preventive chemotherapy campaigns. The behaviours of these other groups will interact with those of school-aged children, resulting in further infection risk through exposure-related behaviours. Furthermore, the perception of the disease may significantly influence the schoolchildren's lived experience of the infection and associated disease. It is therefore crucial to document the daily experiences of schoolchildren living in schistosomiasis high transmission areas.\u0000Methods: An ethnographic study explored schoolchildren's perspectives and daily life organisations that shape their risk of schistosomiasis and their perceptions of the disease. The study was conducted between November 2022 and August 2023 along Lake Albert, Hoima District. it involved in-depth interviews with schoolchildren and their parents, key informant interviews, focus group discussions with schoolchildren, and participant observations. Data was analysed using reflexive thematic analysis. Code reported were generated inductively using ATLAS.ti (version 7).\u0000Results: The study revealed a significant level of knowledge and awareness about schistosomiasis among schoolchildren. They had understanding of the risk factors, continued exposure, and experiences of illness, though they had little autonomy to address these through their own behaviour as they were influenced by the behaviour of others and macro-factors such as WASH provision and economic need. Study participants experienced individual-level effects of schistosomiasis such as educational impacts and isolation as a significant form of stigma.\u0000Conclusions: There is a need for continued community sensitisation and awareness campaigns to address social stigma, educational impact, and the contamination and exposure-related behaviours. National and regional policies and programmes on WASH, livelihood and poverty eradication programmes need to be revisited in schistosomiasis high transmission areas to help provide alternatives and improve schoolchildren's lived experiences.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"197 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Health professionals have previously identified various barriers and factors that would help facilitate preconception care services in healthcare settings. Clinically relevant preconception information and clinical practice guidelines have since been developed to aid health professionals in preconception care delivery. This systematic review aimed to 1) synthesise recent literature (past five years) describing health professionals beliefs and attitudes towards preconception care services or programmes and 2) determine if the experience of health professionals providing preconception care has changed compared to literature reviews conducted more than five years ago. Methods Five databases were searched between 27/01/2016 and 27/01/2022. Primary quantitative and qualitative research studies were included if they examined health professionals beliefs and attitudes towards delivering preconception care services or programmes. Study quality was assessed using the CASP Checklist (qualitative studies) and AXIS tool (quantitative studies). Data synthesis used thematic categorisation adapted from the framework approach. Results Twenty-one studies were included (n=8 qualitative, n=11 quantitative, n=2 mixed-methods studies). Methodological quality was generally good for qualitative studies but varied for quantitative studies. The results covered three categories: 1) addressing preconception care health literacy (i.e. lack of knowledge, awareness, training and resources), 2) clinical practicalities of preconception care (i.e. need for coordination of care and clarity on role responsibility), and 3) the role of the patient (i.e. need for public health education to support patient-led conversations). Conclusions Little has changed regarding the barriers and facilitators to providing preconception care reported by health professionals. To improve the provision of preconception care, there is a need to co-develop professional and public preconception health education, clinical resources, and a coordinated preconception healthcare service model.
{"title":"Health professionals beliefs and attitudes towards preconception care: A systematic review","authors":"Cherie Caut, Danielle Schoenaker, Erica McIntyre, Amie Steel","doi":"10.1101/2024.09.16.24313739","DOIUrl":"https://doi.org/10.1101/2024.09.16.24313739","url":null,"abstract":"Background\u0000Health professionals have previously identified various barriers and factors that would help facilitate preconception care services in healthcare settings. Clinically relevant preconception information and clinical practice guidelines have since been developed to aid health professionals in preconception care delivery. This systematic review aimed to 1) synthesise recent literature (past five years) describing health professionals beliefs and attitudes towards preconception care services or programmes and 2) determine if the experience of health professionals providing preconception care has changed compared to literature reviews conducted more than five years ago. Methods\u0000Five databases were searched between 27/01/2016 and 27/01/2022. Primary quantitative and qualitative research studies were included if they examined health professionals beliefs and attitudes towards delivering preconception care services or programmes. Study quality was assessed using the CASP Checklist (qualitative studies) and AXIS tool (quantitative studies). Data synthesis used thematic categorisation adapted from the framework approach.\u0000Results\u0000Twenty-one studies were included (n=8 qualitative, n=11 quantitative, n=2 mixed-methods studies). Methodological quality was generally good for qualitative studies but varied for quantitative studies. The results covered three categories: 1) addressing preconception care health literacy (i.e. lack of knowledge, awareness, training and resources), 2) clinical practicalities of preconception care (i.e. need for coordination of care and clarity on role responsibility), and 3) the role of the patient (i.e. need for public health education to support patient-led conversations).\u0000Conclusions\u0000Little has changed regarding the barriers and facilitators to providing preconception care reported by health professionals. To improve the provision of preconception care, there is a need to co-develop professional and public preconception health education, clinical resources, and a coordinated preconception healthcare service model.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1101/2024.09.16.24313470
Kelvin Jordan, Sara Muller, Muhammad Usman, James Bailey, Claire Burton, Sarah Lawton, Christian Mallen, Kayleigh Mason, Simon Wathall, Danielle van der Windt
Background Waste landfill sites are associated with gaseous emissions and this air pollution can cause unpleasant smells (malodour). This causes concerns about its impact on the health of the local population. This study assessed change in general practice consultation behaviour during a period of increased complaints associated with air pollution at a landfill site in the UK. Methods The study period was October 2020 to December 2021. The age-sex standardised prevalence and incidence of consultations for mental health, respiratory, and other symptoms hypothesised to be impacted by the air pollution issues were determined and compared between: i) 6 practices located close to the landfill site (zone A), ii) 6 practices located a mid-distance from the site (zone B), iii) 6 practices located further away and expected to have had less impact (zone C). Results Whilst there was an increased consultation for mental health problems in practices nearest to the landfill site compared to those furthest away, consultation frequencies for respiratory and other potentially associated symptoms were lower and likelihood of consultation was consistently highest in practices located in zone B. Conclusion This study did not show an increase in recorded primary healthcare contacts for conditions and symptoms hypothesised to be connected to air pollution. It highlighted the challenges of examining the impact of air pollution on the health of local populations. Since this study focussed on coded consultations in primary care and not symptoms present in the general population, an impact on the health of individuals cannot be ruled out.
{"title":"Association of air pollution from a landfill site with primary care consultation","authors":"Kelvin Jordan, Sara Muller, Muhammad Usman, James Bailey, Claire Burton, Sarah Lawton, Christian Mallen, Kayleigh Mason, Simon Wathall, Danielle van der Windt","doi":"10.1101/2024.09.16.24313470","DOIUrl":"https://doi.org/10.1101/2024.09.16.24313470","url":null,"abstract":"Background\u0000Waste landfill sites are associated with gaseous emissions and this air pollution can cause unpleasant smells (malodour). This causes concerns about its impact on the health of the local population. This study assessed change in general practice consultation behaviour during a period of increased complaints associated with air pollution at a landfill site in the UK.\u0000Methods The study period was October 2020 to December 2021. The age-sex standardised prevalence and incidence of consultations for mental health, respiratory, and other symptoms hypothesised to be impacted by the air pollution issues were determined and compared between: i) 6 practices located close to the landfill site (zone A), ii) 6 practices located a mid-distance from the site (zone B), iii) 6 practices located further away and expected to have had less impact (zone C). Results\u0000Whilst there was an increased consultation for mental health problems in practices nearest to the landfill site compared to those furthest away, consultation frequencies for respiratory and other potentially associated symptoms were lower and likelihood of consultation was consistently highest in practices located in zone B. Conclusion\u0000This study did not show an increase in recorded primary healthcare contacts for conditions and symptoms hypothesised to be connected to air pollution. It highlighted the challenges of examining the impact of air pollution on the health of local populations. Since this study focussed on coded consultations in primary care and not symptoms present in the general population, an impact on the health of individuals cannot be ruled out.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1101/2024.09.13.24313643
Chelsea L Shover, Morgan E. Godvin, Meghan Appley, Elise M. Pyfrom, Fernando Montero Castrillo, Karli Hochstatter, Talia Nadel, Neil Garg, Adam Koncsol, Joseph R. Friendman, Caitlin A. Molina, Ruby Romero, Brendan Harshberger, Jordan Spoliansky, Sarah Laurel, Elham Jalayer, Juan Ruelas, John Gonzales, Soma Snakeoil, Sonya Guerra, Oscar Arellano, Candace Winstead, Margaret Rybak, Joanna Champney, Brent Waninger, Edward Sisco
Background: Changes to the US drug supply historically unfold slowly with predictable patterns of geographic diffusion. Here we draw on drug checking results from around the United States to report a rapid shift in the illicit drug supply with important implications for public health. Bis(2,2,6,6–tetramethyl–4–piperidyl) sebacate, or ″BTMPS″ is a hindered amine light stabilizer with various industrial applications. Animal studies indicate multiple kinds of adverse health effects. Methods: Drug samples collected by community-based drug checking programs in Los Angeles and Philadelphia, along with drug residue samples from other jurisdictions in California, Delaware, Maryland, and Washington, were submitted to the National Institute on Standards and Technology. Samples were qualitatively tested with Direct Analysis in Real Time mass spectrometry, with reflex to liquid chromatography mass spectrometry (LCMS) for confirmatory testing. Quantitation – percent by mass – was performed using LCMS. At both sites where drug samples were collected, participants were asked to respond to a survey that included questions about what the substance was sold as and any unexpected effects. Results: Between June 1, 2024 and August 31, 2024, a total of 178 samples sold as fentanyl were tested. Of these, 43 (24%) contained BTMPS, with the proportion per month rising from 0% in June to more than a third in August. An additional 23 residue samples from sites doing residue testing contained BTMPS. Fentanyl samples with BTMPS also contained many other compounds, including local anesthetics and alpha-2 agonists. Average fentanyl purity was significantly lower in samples with BTMPS compared to samples without. Conclusions: The introduction of an industrial chemical to the illicit drug supply at this speed and scale is unprecedented and concerning. Further research is urgently needed to determine why it is present in the fentanyl supply and characterize effects on human health.
{"title":"Rapid emergence of UV stabilizer Bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate (BTMPS) in the illicit fentanyl supply across the United States in July-August 2024: Results from drug and drug paraphernalia testing","authors":"Chelsea L Shover, Morgan E. Godvin, Meghan Appley, Elise M. Pyfrom, Fernando Montero Castrillo, Karli Hochstatter, Talia Nadel, Neil Garg, Adam Koncsol, Joseph R. Friendman, Caitlin A. Molina, Ruby Romero, Brendan Harshberger, Jordan Spoliansky, Sarah Laurel, Elham Jalayer, Juan Ruelas, John Gonzales, Soma Snakeoil, Sonya Guerra, Oscar Arellano, Candace Winstead, Margaret Rybak, Joanna Champney, Brent Waninger, Edward Sisco","doi":"10.1101/2024.09.13.24313643","DOIUrl":"https://doi.org/10.1101/2024.09.13.24313643","url":null,"abstract":"Background: Changes to the US drug supply historically unfold slowly with predictable patterns of geographic diffusion. Here we draw on drug checking results from around the United States to report a rapid shift in the illicit drug supply with important implications for public health. Bis(2,2,6,6–tetramethyl–4–piperidyl) sebacate, or ″BTMPS″ is a hindered amine light stabilizer with various industrial applications. Animal studies indicate multiple kinds of adverse health effects. Methods: Drug samples collected by community-based drug checking programs in Los Angeles and Philadelphia, along with drug residue samples from other jurisdictions in California, Delaware, Maryland, and Washington, were submitted to the National Institute on Standards and Technology. Samples were qualitatively tested with Direct Analysis in Real Time mass spectrometry, with reflex to liquid chromatography mass spectrometry (LCMS) for confirmatory testing. Quantitation – percent by mass – was performed using LCMS. At both sites where drug samples were collected, participants were asked to respond to a survey that included questions about what the substance was sold as and any unexpected effects. Results: Between June 1, 2024 and August 31, 2024, a total of 178 samples sold as fentanyl were tested. Of these, 43 (24%) contained BTMPS, with the proportion per month rising from 0% in June to more than a third in August. An additional 23 residue samples from sites doing residue testing contained BTMPS. Fentanyl samples with BTMPS also contained many other compounds, including local anesthetics and alpha-2 agonists. Average fentanyl purity was significantly lower in samples with BTMPS compared to samples without.\u0000Conclusions: The introduction of an industrial chemical to the illicit drug supply at this speed and scale is unprecedented and concerning. Further research is urgently needed to determine why it is present in the fentanyl supply and characterize effects on human health.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1101/2024.09.16.24313731
Sarah E Jackson, Jamie Brown, Vera Buss, Lion Shahab
Importance: A wide range of medications, non-combustible nicotine products, behavioural support, and alternative treatments are available in England to help people stop smoking. Understanding their effectiveness in the real world can support informed decision-making. Objectives: To provide up-to-date estimates of the prevalence and real-world effectiveness of different smoking cessation aids and explore moderation of effectiveness by socioeconomic position. Design: Population-based survey, 2006-2024. Setting: England. Participants: 25,094 adults (>=16y) who reported having tried to quit smoking in the past year. Main outcomes and measures: The outcome variable was self-reported continuous abstinence from the start of the most recent quit attempt up to the time of survey. Independent variables were use (yes/no) of the following aids in the most recent attempt: nicotine replacement therapy (NRT) obtained on prescription or over-the-counter; varenicline; bupropion; e-cigarettes; face-to-face behavioural support; telephone support; written self-help materials; websites; smartphone apps; hypnotherapy; Allen Carr's Easyway method; heated tobacco products (HTPs); nicotine pouches. Covariates included sociodemographic characteristics and features of the quit attempt. Results: We analysed data from 25,094 participants (mean [SD] age = 38.7y [15.3]; 48.5% women). In 2023/24, the most used aids were e-cigarettes (40.2%) and over-the-counter NRT (17.3%); 40.8% of quit attempts were unaided. While e-cigarette use was associated with higher odds of abstinence after adjustment for use of other aids and covariates (OR=1.95 [1.74-2.17]), use of over-the-counter NRT was not (OR=1.03 [0.93-1.15]). Other aids positively associated with abstinence were websites (used by 4.6% in 2023/24; OR=1.43 [1.03-1.98]), prescription NRT (4.5%; OR=1.33 [1.12-1.58]), varenicline (1.1%; OR=1.80 [1.50-2.18]), and HTPs (0.7%; OR=2.37 [1.24-4.51]). Face-to-face behavioural support (used by 2.2% in 2023/24) was also associated with higher odds of abstinence among those from less advantaged (OR=1.59 [1.19-2.14]) but not more advantaged social grades (OR=0.91 [0.65-1.29]). There was not clear evidence of a benefit of any other aid, although some analyses were inconclusive. Conclusions and relevance: A range of effective smoking cessation aids are available in England, but many people try to quit using less effective forms of support or none at all. Quit success rates could be improved by encouraging people to use more effective methods.
{"title":"Prevalence and real-world effectiveness of popular smoking cessation aids in England: a population-based study","authors":"Sarah E Jackson, Jamie Brown, Vera Buss, Lion Shahab","doi":"10.1101/2024.09.16.24313731","DOIUrl":"https://doi.org/10.1101/2024.09.16.24313731","url":null,"abstract":"Importance: A wide range of medications, non-combustible nicotine products, behavioural support, and alternative treatments are available in England to help people stop smoking. Understanding their effectiveness in the real world can support informed decision-making.\u0000Objectives: To provide up-to-date estimates of the prevalence and real-world effectiveness of different smoking cessation aids and explore moderation of effectiveness by socioeconomic position.\u0000Design: Population-based survey, 2006-2024.\u0000Setting: England.\u0000Participants: 25,094 adults (>=16y) who reported having tried to quit smoking in the past year.\u0000Main outcomes and measures: The outcome variable was self-reported continuous abstinence from the start of the most recent quit attempt up to the time of survey. Independent variables were use (yes/no) of the following aids in the most recent attempt: nicotine replacement therapy (NRT) obtained on prescription or over-the-counter; varenicline; bupropion; e-cigarettes; face-to-face behavioural support; telephone support; written self-help materials; websites; smartphone apps; hypnotherapy; Allen Carr's Easyway method; heated tobacco products (HTPs); nicotine pouches. Covariates included sociodemographic characteristics and features of the quit attempt.\u0000Results: We analysed data from 25,094 participants (mean [SD] age = 38.7y [15.3]; 48.5% women). In 2023/24, the most used aids were e-cigarettes (40.2%) and over-the-counter NRT (17.3%); 40.8% of quit attempts were unaided. While e-cigarette use was associated with higher odds of abstinence after adjustment for use of other aids and covariates (OR=1.95 [1.74-2.17]), use of over-the-counter NRT was not (OR=1.03 [0.93-1.15]). Other aids positively associated with abstinence were websites (used by 4.6% in 2023/24; OR=1.43 [1.03-1.98]), prescription NRT (4.5%; OR=1.33 [1.12-1.58]), varenicline (1.1%; OR=1.80 [1.50-2.18]), and HTPs (0.7%; OR=2.37 [1.24-4.51]). Face-to-face behavioural support (used by 2.2% in 2023/24) was also associated with higher odds of abstinence among those from less advantaged (OR=1.59 [1.19-2.14]) but not more advantaged social grades (OR=0.91 [0.65-1.29]). There was not clear evidence of a benefit of any other aid, although some analyses were inconclusive.\u0000Conclusions and relevance: A range of effective smoking cessation aids are available in England, but many people try to quit using less effective forms of support or none at all. Quit success rates could be improved by encouraging people to use more effective methods.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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