Dialogues in health最新文献_第5页

Meta-analysis of mortality burden due to Aluminum phosphide poisoning in India: A call for strong policy and decision making 印度磷化铝中毒死亡率负担的荟萃分析：呼吁制定强有力的政策和决策

Dialogues in health

Pub Date : 2025-10-04 DOI: 10.1016/j.dialog.2025.100247

Senthil Kumar , Ashok Kumar Pannu , Ranjit Immanuel James , Amol N. Patil , Gagandeep Kwatra , Ashish Bhalla , Nusrat Shafiq , Samir Malhotra , Navneet Sharma

Introduction

Aluminum phosphide(AlP) insecticide is India's leading cause of poisoning-related mortality. Limited information is available about its mortality burden, common presentation type, and exposure(suicidal/accidental) characteristics. There exists no definite antidote for AlP poisoning management. The study was planned to systematically review the exact mortality burden, type of exposure- accidental/suicidal, commonest presentation in emergency department(ED), and gender difference in poison exposure, if any.

Methods

We conducted comprehensive search in Scopus, PubMed, Web of Science, and Embase, and cross-referencing relevant articles from 1982 to 31 January 2025. Prospective, retrospective, and cross-sectional Indian studies that provided information on mortality data, common clinical presentation, and exposure type-accidental/suicidal were included. Study details- time to reach ED, duration of hospital-stay, average dose consumed, gender distribution in poison exposure, and other relevant information, were also assessed. Random-effects meta-analysis with DerSimonian & Laird estimator, meta-regression, and subgroup analyses were conducted using R.

Results

Forty-two studies involving 3449 Indian patients were included in the analysis. Pooled mortality prevalence was 54 %(95 % CI- 48-61 %) in the primary endpoint evaluation. In secondary endpoints analysis, it was observed that 94 %(95 % CI- 88-97) of the AlP poisonings were intentional(suicide), while accidental exposure accounted for 5 %(95 % CI- 2-12) of cases presenting to ED. Hypotension, with odds of 78 %(95 % CI- 64-88)(p < 0.01) was observed as common presentation type. Odds ratio for male-to-female gender among patients exposed to AlP was not significant, at 89 %(95 % CI- 61-129)(p = 0.86).

Conclusion

Death of every second patient with AlP poisoning in ED room underscores the urgent need for stringent regulatory measures to control its access in India.

磷化铝（AlP）杀虫剂是印度中毒相关死亡的主要原因。关于其死亡率负担、常见表现类型和暴露（自杀/意外）特征的信息有限。AlP中毒治疗尚无明确的解药。该研究计划系统地审查确切的死亡率负担，暴露类型-意外/自杀，在急诊科（ED）最常见的表现，以及中毒暴露的性别差异（如果有的话）。方法综合检索Scopus、PubMed、Web of Science、Embase等数据库，交叉引用1982年至2025年1月31日的相关文献。包括前瞻性、回顾性和横断面的印度研究，这些研究提供了死亡率数据、常见临床表现和暴露类型（意外/自杀）的信息。研究细节——到达ED的时间、住院时间、平均摄入剂量、毒物暴露的性别分布以及其他相关信息，也被评估。随机效应荟萃分析采用DerSimonian & Laird估计量、meta回归和亚组分析。结果纳入42项研究，涉及3449名印度患者。在主要终点评估中，合并死亡率患病率为54% （95% CI- 48- 61%）。在次要终点分析中，观察到94% （95% CI- 88-97）的AlP中毒是故意的（自杀），而意外暴露导致ED的病例占5% （95% CI- 2-12）。低血压是常见的表现类型，其发生率为78% (95% CI- 64-88)（p < 0.01）。暴露于AlP的患者中男性与女性的优势比为89% (95% CI- 61-129)(p = 0.86)，无统计学意义。结论印度急诊室AlP中毒患者的死亡率为1 / 2，迫切需要采取严格的监管措施来控制其使用。

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引用次数: 0

Prevalence of thyroid disorders in a tertiary care hospital in Al Batinah North Governorate, Oman 阿曼北巴蒂纳省一家三级保健医院甲状腺疾病的患病率

Dialogues in health

Pub Date : 2025-10-02 DOI: 10.1016/j.dialog.2025.100246

Vijaya Marakala , Gulam Saidunnisa Begum , Salima Al Maqbali , Elham Said Ahmed Al Risi

Objectives

To assess the prevalence and demographic distribution of thyroid dysfunction in the Al Batinah North Governorate, Oman, and to examine associations between thyroid hormone levels and lipid profiles.

Methods

This retrospective observational study was conducted at Sohar Hospital, a major referral centre in Al Batinah North. Electronic medical records of 40,390 patients who underwent thyroid function testing between 2020 and 2024 were reviewed. The prevalence of subclinical and overt hypothyroidism and hyperthyroidism, demographic distribution (age, gender), and associations between thyroid hormone levels and lipid profiles were analyzed. Only the first thyroid panel per patient was included to avoid duplication.

Results

Of the 40,390 patients, 78.7 % were euthyroid, 13.9 % had subclinical hypothyroidism, 3.4 % had subclinical hyperthyroidism, 2.1 % had overt hyperthyroidism, and 2.0 % had overt hypothyroidism. Thyroid dysfunction was more prevalent among females (67.5 %) than males (32.5 %). Hypothyroidism was most frequent in individuals aged 0–17 years, while hyperthyroidism was more common in adults aged 36–50 years. A statistically significant inverse correlation was observed between free thyroxine (FT4) and serum lipid levels (cholesterol: r = −0.12, p < 0.001; triglycerides: r = −0.10, p < 0.001).

Conclusions

Thyroid dysfunction, particularly subclinical hypothyroidism, was common in this hospital-based Omani cohort and disproportionately affected females. Associations with lipid abnormalities were statistically significant but weak. Findings should be interpreted with caution due to the retrospective design, hospital-based sampling, and incomplete adjustment for confounders. Population-based studies are required to establish true prevalence and long-term metabolic outcomes.

目的评估阿曼Al Batinah北省甲状腺功能障碍的患病率和人口分布，并研究甲状腺激素水平和血脂之间的关系。方法本回顾性观察研究在Al Batinah北部主要转诊中心Sohar医院进行。对2020年至2024年间接受甲状腺功能检测的40390名患者的电子病历进行了回顾。分析了亚临床和显性甲状腺功能减退和甲状腺功能亢进的患病率、人口分布（年龄、性别）以及甲状腺激素水平和血脂之间的关系。为避免重复，仅包括每位患者的第一次甲状腺检查。结果40390例患者中，78.7%为甲状腺功能正常，13.9%为亚临床甲状腺功能减退，3.4%为亚临床甲状腺功能亢进，2.1%为显性甲状腺功能亢进，2.0%为显性甲状腺功能减退。甲状腺功能障碍在女性（67.5%）中比男性（32.5%）更为普遍。甲状腺功能减退最常见于0-17岁的个体，而甲状腺功能亢进更常见于36-50岁的成年人。游离甲状腺素（FT4）与血脂水平呈显著负相关（胆固醇：r = - 0.12, p < 0.001；甘油三酯：r = - 0.10, p < 0.001）。结论：甲状腺功能障碍，特别是亚临床甲状腺功能减退，在阿曼医院队列中很常见，且不成比例地影响女性。与脂质异常的相关性有统计学意义，但较弱。由于回顾性设计、基于医院的抽样和混杂因素的不完全调整，研究结果应谨慎解释。需要基于人群的研究来确定真正的患病率和长期代谢结果。

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引用次数: 0

Role of comprehensive HIV knowledge as a mediator between receiving HIV information during antenatal care visits and positive attitudes toward people living with HIV among reproductive-age women in Bangladesh 全面的艾滋病毒知识在产前检查期间接受艾滋病毒信息与孟加拉国育龄妇女对艾滋病毒感染者的积极态度之间的中介作用

Dialogues in health

Pub Date : 2025-10-01 DOI: 10.1016/j.dialog.2025.100245

Chowdhury Abdullah Al Asif , Md. Abul Kalam , Nayla Ferdousi Haque , Sabrina Karim , Lima Rahman , Muhammad Imran , Paul Bouey , Rounak Khan , Mohammad Rifat Haider

Objective

Comprehensive knowledge of HIV transmission and positive attitudes toward people with HIV (PWH) are key to HIV prevention and care. This study assessed the potential mediational role of comprehensive HIV knowledge between receiving HIV information during antenatal care (ANC) visits and positive attitudes toward PWH among reproductive-age women in Bangladesh.

Methods

We analyzed the 2019 Multiple Indicator Cluster Survey data (N = 5118). Comprehensive HIV knowledge scale (9-item; Cronbach's alpha = 0.706) and Attitudes toward PWH scale (2-item; Cronbach's alpha = 0.84) were constructed. Receiving HIV information was a dichotomous variable (yes/no). A multivariable structural equation model was controlled for age, ethnicity, education, rural/urban residence, media exposure, marital status, wealth index, and division. All analyses were performed using Stata 18.0.

Results

After adjusting for sociodemographic characteristics, receiving HIV transmission knowledge during ANC was not associated with positive attitudes toward PWH (B = 0.06, p = 0.101). Receiving HIV information was positively associated with comprehensive HIV knowledge (B = 0.39; p < 0.0.001), and comprehensive HIV knowledge was positively associated with positive attitudes toward PWH (B = 0.13; p < 0.001). The indirect effect of comprehensive HIV knowledge on the relationship between receiving HIV information during ANC and positive attitudes toward PWH was statistically significant (B = 0.05, p < 0.001).

Conclusion

Given the mediational role of comprehensive HIV knowledge between receiving HIV information and positive attitudes toward PWH, providing HIV information during ANC should be a routine practice to capture the teachable moments to prevent HIV transmission.

目的全面认识艾滋病毒传播，积极对待艾滋病毒感染者（PWH）是预防和护理艾滋病毒的关键。本研究评估了全面的艾滋病毒知识在产前护理（ANC）访问期间接受艾滋病毒信息和孟加拉国育龄妇女对PWH的积极态度之间的潜在中介作用。方法对2019年多指标聚类调查数据（N = 5118）进行分析。构建HIV知识综合量表（9项，Cronbach’s alpha = 0.706）和PWH态度量表（2项，Cronbach’s alpha = 0.84）。接受艾滋病毒信息是一个二分类变量（是/否）。采用多变量结构方程模型控制年龄、种族、教育程度、城乡居住、媒体接触、婚姻状况、财富指数和划分等因素。所有分析均使用Stata 18.0进行。结果在调整了社会人口学特征后，ANC期间获得HIV传播知识与对PWH的积极态度无关（B = 0.06, p = 0.101）。接受HIV信息与全面的HIV知识呈正相关（B = 0.39; p < 0.0.001），全面的HIV知识与对PWH的积极态度呈正相关（B = 0.13; p < 0.001）。HIV综合知识对ANC期间接受HIV信息与PWH积极态度之间关系的间接影响有统计学意义（B = 0.05, p < 0.001）。结论综合艾滋病毒知识在接受艾滋病毒信息与对PWH的积极态度之间具有中介作用，应在ANC期间定期提供艾滋病毒信息，以抓住预防艾滋病毒传播的教育时刻。

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引用次数: 0

Overhearing hushed voices: Using unobtrusive methods to uncover the work-related sentiments of people with epilepsy 偷听安静的声音：使用不显眼的方法来揭示癫痫患者的工作情绪

Dialogues in health

Pub Date : 2025-10-01 DOI: 10.1016/j.dialog.2025.100244

Asha Rao, Surendra Sarnikar

Purpose

Despite high unemployment and discrimination, disability is often overshadowed by race and gender in workplace diversity discussions. This study sought to uncover the work-related sentiments of people with epilepsy (PWE) in their own voices. Epilepsy is a stigmatized invisible disability wherein first-person accounts are difficult to uncover because of stigma. Hence, the discussion on accommodation, inclusion and access for PWE is driven by others, rather than people with epilepsy. By hearing from PWE, workplace solutions can be more relevant to their needs

Design

We use unobtrusive data mining of discussions by PWE by studying anonymous posts on the Epilepsy Foundation community forum over a 16-year period. We examine their sentiments, beliefs, and emotions impacting work for people with epilepsy (PWE), and analyzed perceptions of discrimination to understand what organizations can do better to be inclusive and supportive at work

Findings

We found that PWE sentiments around work were more positive compared to nonwork sentiments. Their work sentiments were analytical, achievement oriented and associated with positive emotions. Work was associated with love and affiliation. However, PWE posts were broadly also more anxious, health centered and tentative reflecting their fears around their health and stigma in employment

Originality

This study is unique in using unobtrusive data mining techniques to analyze the challenges faced by people with disabilities. To our knowledge, there is no such study of adults with epilepsy and the workplace. The methodology used reduces response bias. Questions about disability are difficult to answer for people who face stigma around their disability.

尽管高失业率和高歧视，但在工作场所多样性讨论中，残疾人往往被种族和性别所掩盖。这项研究试图揭示癫痫患者（PWE）在他们自己的声音中与工作有关的情绪。癫痫是一种被污名化的隐形残疾，由于污名，第一人称描述很难发现。因此，关于PWE的住宿、包容和获取的讨论是由其他人而不是癫痫患者推动的。通过听取PWE的意见，工作场所的解决方案可以更符合他们的需求。design通过研究癫痫基金会社区论坛上16年来的匿名帖子，我们对PWE的讨论进行了不显眼的数据挖掘。我们研究了他们的情绪、信仰和情绪对癫痫患者（PWE）工作的影响，并分析了对歧视的看法，以了解组织可以在工作中做得更好，以提供包容和支持。结果发现，与非工作情绪相比，PWE在工作中的情绪更为积极。他们的工作情绪是分析性的，成就导向的，与积极情绪相关。工作与爱情和从属关系联系在一起。然而，PWE的帖子也普遍更焦虑、更以健康为中心、更试探性地反映了他们对自己的健康和就业耻辱的恐惧。原创性：这项研究在使用不引人注目的数据挖掘技术来分析残疾人面临的挑战方面是独一无二的。据我们所知，目前还没有针对成年癫痫患者和工作场所的研究。所使用的方法减少了反应偏差。对于那些因残疾而面临耻辱的人来说，有关残疾的问题很难回答。

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引用次数: 0

Factors influencing well-being among first-generation students of color pursuing graduate-level degrees in public health: A qualitative study 影响第一代有色人种公共卫生研究生幸福感的因素：一项定性研究

Dialogues in health

Pub Date : 2025-09-28 DOI: 10.1016/j.dialog.2025.100242

Kimberly Wu , Sunshine Best , W. Marcus Lambert , Shokufeh Ramirez , Christine M. Arcari , Katherine P. Theall , Dovile Vilda

Diversifying the public health workforce is essential for improving services to all communities. First-generation students of color (FGSOC) are a population who may face unique academic, financial, and health barriers when pursuing graduate-level degrees in public health. This study explored the needs and experiences of 25 recent FGSOC graduates from graduate-level public health programs through interviews. Participants were recruited through snowball and quota sampling to prioritize individuals identifying as Black, Hispanic/Latine, and American Indian/Native Alaskan. Five main themes were developed using reflexive thematic analysis: (1) lived experiences facilitate FGSOC interest in public health, (2) challenges of navigating structural barriers of academic institutions, (3) interplay of support to meet needs and complete graduate degrees, (4) impact of limited resources on health, and (5) coping strategies for maintaining health. Subthemes were also identified and include participants' firsthand experience with health disparities in their families and communities, the additional effort needed to uncover and navigate academic “hidden curricula,” and the importance of cultivating a network to meet emotional and academic needs during their training. Findings highlight how FGSOC are driven by formative experiences to pursue public health, yet face structural barriers and multiple priorities that strain their well-being during their graduate training. Recommendations informed by study findings and existing literature are organized across the following domains: institutional accountability and investment, financial education and transparency, career development and workforce readiness, accessible mental health resources, and food security.

使公共卫生人力多样化对于改善向所有社区提供的服务至关重要。第一代有色人种学生（FGSOC）在攻读公共卫生研究生学位时可能面临独特的学术、经济和健康障碍。本研究通过访谈探讨了25名FGSOC毕业生的需求和经历。参与者通过滚雪球和配额抽样的方式被招募，以优先考虑黑人、西班牙裔/拉丁裔和美国印第安人/阿拉斯加原住民。利用反思性主题分析，我们开发了五个主要主题：(1)生活经历促进了FGSOC对公共卫生的兴趣，(2)克服学术机构结构性障碍的挑战，(3)满足需求和完成研究生学位的支持相互作用，(4)有限资源对健康的影响，以及(5)维持健康的应对策略。还确定了次级主题，包括参与者对其家庭和社区健康差异的第一手经验，发现和浏览学术“隐藏课程”所需的额外努力，以及在培训期间培养满足情感和学术需求的网络的重要性。研究结果强调了FGSOC是如何受到追求公共卫生的形成经历的驱动，但在研究生培训期间面临结构性障碍和多重优先事项，这些障碍和优先事项影响了他们的福祉。根据研究结果和现有文献提出的建议涵盖以下领域：机构问责制和投资、金融教育和透明度、职业发展和劳动力准备、可获得的精神卫生资源以及粮食安全。

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引用次数: 0

Proton radiotherapy outperforms medulloblastoma irradiation with photons in economic savings in Brazil (PROMISE) 在巴西，质子放射治疗在节省经济方面优于光子放射治疗髓母细胞瘤（PROMISE）

Dialogues in health

Pub Date : 2025-09-24 DOI: 10.1016/j.dialog.2025.100241

Gustavo A. Viani , Carlos E. Cardoso , Ana Carolina Hamamura , Helio A. Salmon , Gustavo O. Amaral

Objective

This study aimed to evaluate the cost-effectiveness of proton therapy compared to photon therapy for pediatric medulloblastoma treatment from the payer's perspective in Brazil, assessing its economic viability and potential to improve long-term outcomes by reducing late complications.

Materials and methods

A Markov chain model simulated outcomes for a cohort of 5-year-old children with medulloblastoma over a 30-year horizon. The base case involved craniospinal irradiation (36 Gy) with a 54 Gy posterior fossa boost, tracking 11 health states, including hearing loss, cognitive deficit, and coronary artery disease (CAD), with CAD and congestive heart failure (CHF) onset after 10 years. Annual transition probabilities were derived from systematic reviews. Costs (photons: US$3000; protons: US$50,000) reflected Brazilian and international data, with a willingness-to-pay (WTP) threshold of US$50,000/QALY. Incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), and probabilistic sensitivity analysis (PSA) via Monte Carlo simulations (1000 iterations, 25,000 patients) were calculated using Python 3.11.

Results

Proton therapy yielded 20.45 QALYs at US$102,933, versus 16.87 QALYs at US$141,971 for photons, with an ICER of -US$22,857/QALY, indicating dominance. PSA showed a mean NMB of US$70,290 (95 % CI: US$42,377–US$98,662), with protons cost-effective in >95 % of simulations. Survival at 30 years was 40.5 % (protons) versus 27.1 % (photons), driven by reduced late effects (e.g., 68 % vs. 45 % cumulative events).

Conclusion

Proton therapy is a cost-effective, dominant strategy for pediatric medulloblastoma in Brazil, offering superior outcomes and cost savings. These findings support its adoption through innovative funding models like public-private partnerships.

目的：本研究旨在评估质子治疗与光子治疗在巴西儿科髓母细胞瘤治疗中的成本-效果，评估其经济可行性和通过减少晚期并发症改善长期预后的潜力。材料和方法马尔可夫链模型模拟了一组5岁成神经管细胞瘤儿童30年的预后。基本病例包括颅脊髓照射（36 Gy）和54 Gy后颅窝增强，追踪11种健康状态，包括听力损失、认知缺陷和冠状动脉疾病（CAD），冠心病和充血性心力衰竭（CHF） 10年后发病。从系统回顾中得出年过渡概率。成本（光子：3000美元；质子：5万美元）反映了巴西和国际数据，支付意愿（WTP）门槛为5万美元/QALY。使用Python 3.11通过蒙特卡罗模拟（1000次迭代，25,000例患者）计算增量成本-效果比（ICER）、净货币效益（NMB）和概率敏感性分析（PSA）。结果质子治疗获得20.45个QALY， 102,933美元，而光子治疗获得16.87个QALY， 141,971美元，ICER为- 22,857美元/QALY，表明优势。PSA显示平均NMB为70,290美元（95% CI: 42,377 - 98,662美元），95%的模拟显示质子具有成本效益。30年生存率为40.5%（质子）对27.1%（光子），这是由于后期效应减少（例如，68%对45%的累积事件）。结论质子治疗是巴西儿童成神经管细胞瘤的一种经济有效的主要治疗策略，具有良好的疗效和成本节约。这些研究结果支持通过公私伙伴关系等创新融资模式采用该方案。

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引用次数: 0

Gaza: Between global silence and the double standards of justice 加沙：在全球沉默和双重正义标准之间

Dialogues in health

Pub Date : 2025-09-19 DOI: 10.1016/j.dialog.2025.100240

Imad Asmar

引用次数: 0

Dialogues in health

Pub Date : 2025-09-15 DOI: 10.1016/j.dialog.2025.100239

Magda Mubarak Merghani , Ragaa Gasim Ahmed Mohmmed , Khaled Mohammed Al-Sayaghi , Nawal Saad M. Alshamrani , Eltayeb Mohammed Awadalkareem , Hassan Shaaib , Ahmed Alharbi , Athbah AlKabi , Sumayah Faqihi , Adil Abdalla , Hammad Ali Fadlalmola

Background

Asthma, affecting 11.6–13.7 % globally, significantly impacts children's education, causing 47.5 % absenteeism, disturbed sleep, and frequent ER visits. These issues, alongside environmental triggers, medication side effects, and socioeconomic factors, hinder academic performance. Racial disparities in healthcare access accentuate the problem, with minorities receiving less preventive care. Family dynamics also play a role, as caregivers often keep children home fearing severe episodes. This review estimates the prevalence of asthma-related absenteeism, acute care needs, preventive drug use, and hospitalizations, emphasizing the need for comprehensive school-based asthma management to improve outcomes.

Methods

We searched for relevant articles up to March 2025 from PubMed, Scopus, Web of Science, and the Cochrane Library. Two independent reviewers extracted data from the selected studies, including baseline information, outcomes, prevalence, risk factors, preventive drug use, ED admission, and hospitalization rates. All data analyses were performed using R version 4.3.3.

Results

We collected 5879 records after excluding 4242 duplicates. Thorough screening resulted in the retrieval of 24 entries eligible for inclusion in our review. Our analysis revealed a prevalence of asthma-related absenteeism of 29 %, with absenteeism among asthmatic students being 3.08 times higher than non-asthmatic students (p = 0.0040). The average duration of asthma-related absenteeism was 4.15 days (p = 0.0068). The rate of preventive drug use, ED admissions, and hospitalization were estimated to be 39 %, 24 %, and 7 %, respectively.

Conclusion

This review highlighted a high burden of asthma-related school absenteeism. While some included studies reported higher burden among Black children, our review did not statistically analyze these disparities. These findings emphasize the need for school-based prevention strategies and policies that address disparities in healthcare access.

哮喘影响全球11.6 - 13.7%的儿童，严重影响儿童的教育，导致47.5%的儿童缺勤、睡眠障碍和频繁的急诊室就诊。这些问题，加上环境因素、药物副作用和社会经济因素，都会阻碍学习成绩。在获得医疗保健方面的种族差异加剧了这一问题，少数民族获得的预防性保健较少。家庭动态也发挥了作用，因为照顾者经常让孩子呆在家里，担心病情严重。本综述估计了哮喘相关缺勤、急性护理需求、预防性药物使用和住院的患病率，强调需要以学校为基础的全面哮喘管理来改善结果。方法检索PubMed、Scopus、Web of Science和Cochrane图书馆截至2025年3月的相关文章。两名独立评论者从选定的研究中提取数据，包括基线信息、结局、患病率、危险因素、预防性药物使用、急诊科入院和住院率。所有数据分析均使用R 4.3.3版本进行。结果剔除4242条重复记录后，共收集到5879条记录。经过彻底的筛选，我们检索了24个符合纳入我们综述的条目。我们的分析显示，哮喘相关的旷课率为29%，其中哮喘学生的旷课率是非哮喘学生的3.08倍（p = 0.0040）。哮喘相关的平均旷工时间为4.15天（p = 0.0068）。预防性药物使用率、急诊入院率和住院率估计分别为39%、24%和7%。结论本综述强调哮喘相关的旷课负担较高。虽然一些纳入的研究报告黑人儿童的负担更高，但我们的综述没有统计分析这些差异。这些发现强调需要以学校为基础的预防策略和政策，以解决医疗保健获取方面的差异。

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引用次数: 0

Home-learning environment and cognitive and academic outcomes among children aged 4–8 years: A cross-sectional study from South India 4-8岁儿童的家庭学习环境与认知和学业成绩：来自南印度的横断面研究

Dialogues in health

Pub Date : 2025-09-06 DOI: 10.1016/j.dialog.2025.100238

Eunice Lobo , Debarati Mukherjee , Pradeep Kumar Choudhury , Giridhara Rathnaiah Babu , Prashanth Nuggehalli Srinivas , Onno C.P. van Schayck

Purpose

Home-learning environment is critical for cognitive and academic outcomes; yet its impact during the 4–8 years' period remains underexplored, especially in the Global South. This study examines the relationship between the home-learning environment and children's fluid intelligence and early language numeracy outcomes in urban poor households in Bangalore, South India.

Methods

We analysed data from 940 mother-child dyads from the MAASTHI birth cohort when children were 4–8-years old. The Family Care Indicators (FCI) tool assessed the home-learning environment, Raven's Coloured Progressive Matrices (RCPM) measured children's fluid-intelligence, and the preschool Annual Status of Education Report (ASER) tool measured literacy-numeracy skills. Multilevel linear regression models, adjusted for household, maternal, and child factors, were used to examine the associations.

Results

Higher levels of parental education, maternal Intelligence Quotient, and lower maternal depressive symptoms were significantly associated with better cognitive and early language outcomes. A stimulating home-learning environment characterized by the availability of ≥6 age-appropriate books, higher levels of caregiver engagement, and higher overall home environment scores (FCI-Total) was linked to better non-verbal fluid intelligence and early language scores during 4–8 years of age. However, these factors were not significantly associated with numeracy.

Conclusion

This study underscores the sustained benefits of a stimulating home-learning environment in urban poor settings on children's cognitive and academic outcomes between 4 and 8 years of age. Our results reinforce the need for interventions that promote caregiver engagement and access to a variety of books and toys to optimize child outcomes in marginalized settings.

目的：家庭学习环境对认知和学业成绩至关重要；但其在4-8年期间的影响仍未得到充分探讨，特别是在全球南方。本研究考察了印度南部班加罗尔城市贫困家庭的家庭学习环境与儿童流动智力和早期语言计算能力之间的关系。方法我们分析了940对出生队列中4 - 8岁儿童的母婴数据。家庭护理指标（FCI）工具评估了家庭学习环境，瑞文彩色递进矩阵（RCPM）测量了儿童的流体智力，学前教育年度状况报告（ASER）工具测量了识字和计算技能。采用多水平线性回归模型，对家庭、母亲和儿童因素进行调整，以检验其相关性。结果较高的父母教育水平、较高的母亲智商和较低的母亲抑郁症状与较好的认知和早期语言结局显著相关。一个以≥6本适龄书籍、更高水平的照顾者参与和更高的整体家庭环境得分（FCI-Total）为特征的激进性家庭学习环境与4-8岁期间更好的非言语流体智力和早期语言得分有关。然而，这些因素与计算能力并没有显著的联系。结论：本研究强调了在城市贫困环境中，刺激的家庭学习环境对4至8岁儿童的认知和学业成绩的持续益处。我们的研究结果强调了干预措施的必要性，这些干预措施可以促进护理人员的参与，并使他们能够获得各种书籍和玩具，以优化边缘化环境中的儿童结果。

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引用次数: 0

Pregnant asylum seekers' perspective on mental health screening: A qualitative study 怀孕寻求庇护者对心理健康筛查的看法：一项质性研究

Dialogues in health

Pub Date : 2025-08-29 DOI: 10.1016/j.dialog.2025.100236

E. Soldati , A.E.H. Verschuuren , I.R. Postma , W. Veling , E.I. Feijen-de Jong , J. Stekelenburg

Purpose

Psychiatric disorders are prevalent among pregnant asylum seekers and can have adverse effects on both the individual and newborns. There is limited research on the perspectives of pregnant asylum seekers on mental health screening. This study investigates whether pregnant asylum seekers consider the Refugee Health Screener 15 (RHS-15) suitable and acceptable as a mental health screening test.

Methods

Eight participants filled out the RHS-15. Semi-structured interviews were conducted in which mental health screening and the acceptability and suitability of the RHS-15 to screen for mental health disorders were discussed. Two researchers performed an inductive thematic analysis.

Results

Three themes were identified: ‘Importance of mental health screening’, ‘Talking about mental health’ and ‘Use of the RHS-15’. Participants recognized how their past experiences and seeking asylum during pregnancy rendered them more susceptible to mental health conditions. Screening was considered important since participants valued talking about mental health with their midwife, but they would not initiate this conversation. Barriers and enablers to these discussions included a language barrier, cultural differences, family support, practical barriers, relationship with healthcare providers and limited access to and unfamiliarity with the Dutch healthcare system. Our participants considered the RHS-15 a suitable instrument for mental health screening.

Conclusions

Pregnant asylum seekers are often marginalized and underserved and experience high rates of psychiatric disorders. Our participants considered mental health screening in the perinatal period acceptable and necessary. Further research should focus on the implementation of the RHS-15 as a screening tool for perinatal care in this population.

目的：精神疾病在怀孕的寻求庇护者中很普遍，对个人和新生儿都有不利影响。关于怀孕寻求庇护者对心理健康筛查的看法的研究有限。本研究调查了怀孕的寻求庇护者是否认为难民健康筛查15 （RHS-15）适合和可接受的心理健康筛查测试。方法8名被试填写RHS-15问卷。进行了半结构化访谈，讨论了精神健康筛查以及RHS-15筛查精神健康障碍的可接受性和适用性。两位研究者进行了归纳性的专题分析。结果确定了三个主题：“心理健康筛查的重要性”、“谈论心理健康”和“RHS-15的使用”。与会者认识到，她们过去的经历和在怀孕期间寻求庇护使她们更容易受到心理健康问题的影响。筛查被认为是重要的，因为参与者重视与助产士谈论心理健康，但他们不会主动提出这种谈话。这些讨论的障碍和推动因素包括语言障碍、文化差异、家庭支持、实际障碍、与医疗保健提供者的关系以及对荷兰医疗保健系统的有限访问和不熟悉。我们的参与者认为RHS-15是一种合适的心理健康筛查工具。结论怀孕寻求庇护者往往被边缘化，得不到充分的服务，精神疾病的发病率很高。我们的参与者认为围产期的心理健康检查是可以接受和必要的。进一步的研究应侧重于将RHS-15作为这一人群围产期护理的筛查工具。

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