Pub Date : 2025-06-26DOI: 10.1016/j.dialog.2025.100225
Sajal Bint-e-Khalil , Inayat Ali
Beauty is not a static or universal phenomenon. However, it is a dynamic ideal shaped by sociocultural patterns and practices. Particulalry, multiple sociocultural patterns prevail regarding how a female body should be maintained, displayed, and evaluated. Media representations, in particular, play a central role in reinforcing and circulating narrow, idealized, and often unattainable beauty standards, contributing to a system in which women are disproportionately subject to stringent aesthetic scrutiny. This phenomenological study explores the sociocultural construction of beauty and its experience as well as internalization among young women in Azad Jammu & Kashmir, Pakistan. We used in-depth interviews to explore and understand how participants perceive the relationship between beauty and nutrition, revealing a deeply embedded tension between individual experience and cultural expectations. While approximately half of the participants defined beauty in terms of physical appearance, the remainder emphasized internal traits such as personality and behavior. Notably, nearly 45 % of respondents believed that beauty is objective rather than subjective, which suggests a limited engagement with internal or emotional dimensions of self-perception, and reflects the powerful influence of external social and cultural standards.
{"title":"Negotiating beauty in Pakistan: A qualitative exploration of body image, nutrition, and cultural ideals among young women in Azad Jammu & Kashmir","authors":"Sajal Bint-e-Khalil , Inayat Ali","doi":"10.1016/j.dialog.2025.100225","DOIUrl":"10.1016/j.dialog.2025.100225","url":null,"abstract":"<div><div>Beauty is not a static or universal phenomenon. However, it is a dynamic ideal shaped by sociocultural patterns and practices. Particulalry, multiple sociocultural patterns prevail regarding how a female body should be maintained, displayed, and evaluated. Media representations, in particular, play a central role in reinforcing and circulating narrow, idealized, and often unattainable beauty standards, contributing to a system in which women are disproportionately subject to stringent aesthetic scrutiny. This phenomenological study explores the sociocultural construction of beauty and its experience as well as internalization among young women in Azad Jammu & Kashmir, Pakistan. We used in-depth interviews to explore and understand how participants perceive the relationship between beauty and nutrition, revealing a deeply embedded tension between individual experience and cultural expectations. While approximately half of the participants defined beauty in terms of physical appearance, the remainder emphasized internal traits such as personality and behavior. Notably, nearly 45 % of respondents believed that beauty is objective rather than subjective, which suggests a limited engagement with internal or emotional dimensions of self-perception, and reflects the powerful influence of external social and cultural standards.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100225"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536123","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 : 2025-06-16DOI: 10.1016/j.dialog.2025.100222
Jessica Ly , Christopher Blair , Helen Badge , Michael Camit , Khoi Do , Timmy Pham , Nicola Chappelow , Dennis J. Cordato , Mark W. Parsons
{"title":"Corrigendum to “A culturally-specific education strategy to improve stroke health literacy in Vietnamese communities in South Western Sydney” [Dialogues in Health: Volume 6 (2025)- 100211]","authors":"Jessica Ly , Christopher Blair , Helen Badge , Michael Camit , Khoi Do , Timmy Pham , Nicola Chappelow , Dennis J. Cordato , Mark W. Parsons","doi":"10.1016/j.dialog.2025.100222","DOIUrl":"10.1016/j.dialog.2025.100222","url":null,"abstract":"","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100222"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291334","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 : 2025-06-11DOI: 10.1016/j.dialog.2025.100223
Sony K.C. , Christine Bigler , Susan Thieme
The health workers in Nepal have engaged in strikes to protest issues within the healthcare sector, confronting the public, health care management, policymakers and educational institutions. This paper examines the evolution and root causes of these strikes, exploring the motivations behind health workers' participation despite work demands and their pursuit of justice. A qualitative, grounded theory lite approach was employed for data collection. Respondents included doctors, nurses, assistant health workers, government and non-government officials and policymakers. To understand the nature of the strike and validate findings, a participant observant approach was utilized. The first author joined in the protest for three days in September 2023 in Kathmandu Valley to observe the demonstrations and negotiation process. Findings reveal that widespread tension stemming from corruption, privatization and politicization in medical institutions has driven health workers to protest. Their demands have included better salaries, workplace safety, an overdue pandemic allowance, and an end to violence in healthcare institutions. While the management of medical institutions and the state remain silent, public perception of health workers has become negative. This has ignited frustration in the public and a sense of helplessness among health professionals. The strikes have created opportunities dialogue to address systemic flaws in Nepal's health sector. However, significant gaps remain, which requires immediate action from the government and relevant authorities. Without sound reforms, Nepal's healthcare sector foresees migration of health workers, tensions between public and health workers and unstable health sector.
{"title":"Claiming justice in the health sector of Nepal: Exploring causes and consequences of protests among health care workers","authors":"Sony K.C. , Christine Bigler , Susan Thieme","doi":"10.1016/j.dialog.2025.100223","DOIUrl":"10.1016/j.dialog.2025.100223","url":null,"abstract":"<div><div>The health workers in Nepal have engaged in strikes to protest issues within the healthcare sector, confronting the public, health care management, policymakers and educational institutions. This paper examines the evolution and root causes of these strikes, exploring the motivations behind health workers' participation despite work demands and their pursuit of justice. A qualitative, grounded theory lite approach was employed for data collection. Respondents included doctors, nurses, assistant health workers, government and non-government officials and policymakers. To understand the nature of the strike and validate findings, a participant observant approach was utilized. The first author joined in the protest for three days in September 2023 in Kathmandu Valley to observe the demonstrations and negotiation process. Findings reveal that widespread tension stemming from corruption, privatization and politicization in medical institutions has driven health workers to protest. Their demands have included better salaries, workplace safety, an overdue pandemic allowance, and an end to violence in healthcare institutions. While the management of medical institutions and the state remain silent, public perception of health workers has become negative. This has ignited frustration in the public and a sense of helplessness among health professionals. The strikes have created opportunities dialogue to address systemic flaws in Nepal's health sector. However, significant gaps remain, which requires immediate action from the government and relevant authorities. Without sound reforms, Nepal's healthcare sector foresees migration of health workers, tensions between public and health workers and unstable health sector.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100223"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279493","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 : 2025-05-28DOI: 10.1016/j.dialog.2025.100221
Abdul Hakeem , Masood Sadiq , Javerya Hassan , Isbaah Tejani , Ijaz Hussain , Jalil Khan , Mohammad Waleed , Sabha Bhatti , Sana Sheikh , Sobia Masood , Ali H. Mokdad , Aziz Sheikh , Zafar Mirza , Zainab Samad
Despite its high prevalence, Acute rheumatic fever (ARF) and Rheumatic heart disease (RHD) is underrepresented in Pakistan's national and federal health plans. To address this gap, we gathered multi-geographic and specialty perspectives from frontline clinicians in Pakistan'. Major challenges in RHD diagnosis and care include regional healthcare disparities, diagnostic limitations, scarcity of Benzathine Penicillin G (BPG) for prophylaxis, and lack of multidisciplinary RHD teams.
Our practitioner-informed recommendations emphasize community outreach, targeted screening, and surveillance, and comprehensive training for healthcare providers in the diagnosis and management of GAS infections and ARF. Strengthening multidisciplinary care and ensuring stable BPG supplies are essential, as is integrating RHD care into Universal Health Coverage (UHC) models currently being implemented to reduce patient financial burdens. Improving RHD management requires systemic changes to healthcare infrastructure, practitioner training, and coordinated policy efforts. Crucially, these proposals align with WHO's latest RHD guidelines on primary (treating GAS infections) and secondary prevention (antibiotic prophylaxis and screening). By translating local clinical wisdom into actionable policies, this viewpoint yields practical interventions tailored to Pakistan that are also adaptable to similar LMIC settings.
{"title":"Addressing the challenge of rheumatic heart disease in Pakistan: A call to action","authors":"Abdul Hakeem , Masood Sadiq , Javerya Hassan , Isbaah Tejani , Ijaz Hussain , Jalil Khan , Mohammad Waleed , Sabha Bhatti , Sana Sheikh , Sobia Masood , Ali H. Mokdad , Aziz Sheikh , Zafar Mirza , Zainab Samad","doi":"10.1016/j.dialog.2025.100221","DOIUrl":"10.1016/j.dialog.2025.100221","url":null,"abstract":"<div><div>Despite its high prevalence, Acute rheumatic fever (ARF) and Rheumatic heart disease (RHD) is underrepresented in Pakistan's national and federal health plans. To address this gap, we gathered multi-geographic and specialty perspectives from frontline clinicians in Pakistan'. Major challenges in RHD diagnosis and care include regional healthcare disparities, diagnostic limitations, scarcity of Benzathine Penicillin G (BPG) for prophylaxis, and lack of multidisciplinary RHD teams.</div><div>Our practitioner-informed recommendations emphasize community outreach, targeted screening, and surveillance, and comprehensive training for healthcare providers in the diagnosis and management of GAS infections and ARF. Strengthening multidisciplinary care and ensuring stable BPG supplies are essential, as is integrating RHD care into Universal Health Coverage (UHC) models currently being implemented to reduce patient financial burdens. Improving RHD management requires systemic changes to healthcare infrastructure, practitioner training, and coordinated policy efforts. Crucially, these proposals align with WHO's latest RHD guidelines on primary (treating GAS infections) and secondary prevention (antibiotic prophylaxis and screening). By translating local clinical wisdom into actionable policies, this viewpoint yields practical interventions tailored to Pakistan that are also adaptable to similar LMIC settings.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"6 ","pages":"Article 100221"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170382","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 : 2025-04-28DOI: 10.1016/j.dialog.2025.100220
Anna Khoziasheva
Background
The prevalent use of smartphones has contributed to a rise in mobile gaming addiction, especially in young people. This study aimed to describe the design of an enhanced version of the AI-based mGaming Wellness mobile app, to support young individuals in developing healthy mobile gaming habits.
Methods
The study utilised a 4-phased methodology, based on user-centred design principles, the Mobile App Rating Scale, a focus group and in-depth interviews with the app's target audience, and a think-aloud method.
Results
The first round of refinement of mGaming Wellness, guided by input from an expert panel, focused on enhancing engagement and information quality. Feedback led to the identification of 5 key components for digital interventions, including mood and sleep trackers, a statistics dashboard, and educational modules tailored to young users' needs. Subsequent user research prompted the simplification of mood trackers and adjustments in educational content to align closely with adolescents' experiences. Usability testing of a high-fidelity prototype highlighted the app's ease of use and identified areas for further improvement, particularly in understanding how to reduce gaming time and effectively manage gaming-related notifications. The refined mGaming Wellness app can be a valuable resource for mental health professionals, educators, and youngsters seeking support with problematic mobile gaming or interested in building healthy digital habits.
Discussion
The findings advocate for the user-centred techniques in developing digital health interventions, contributing valuable input for research in mental health app development targeted at adolescents. Future research will evaluate the app's effectiveness in reducing problematic gaming behaviour.
{"title":"Applying user-centred techniques and expert feedback to refine an AI-based app for addressing mobile gaming addiction in adolescents","authors":"Anna Khoziasheva","doi":"10.1016/j.dialog.2025.100220","DOIUrl":"10.1016/j.dialog.2025.100220","url":null,"abstract":"<div><h3>Background</h3><div>The prevalent use of smartphones has contributed to a rise in mobile gaming addiction, especially in young people. This study aimed to describe the design of an enhanced version of the AI-based mGaming Wellness mobile app, to support young individuals in developing healthy mobile gaming habits.</div></div><div><h3>Methods</h3><div>The study utilised a 4-phased methodology, based on user-centred design principles, the Mobile App Rating Scale, a focus group and in-depth interviews with the app's target audience, and a think-aloud method.</div></div><div><h3>Results</h3><div>The first round of refinement of mGaming Wellness, guided by input from an expert panel, focused on enhancing engagement and information quality. Feedback led to the identification of 5 key components for digital interventions, including mood and sleep trackers, a statistics dashboard, and educational modules tailored to young users' needs. Subsequent user research prompted the simplification of mood trackers and adjustments in educational content to align closely with adolescents' experiences. Usability testing of a high-fidelity prototype highlighted the app's ease of use and identified areas for further improvement, particularly in understanding how to reduce gaming time and effectively manage gaming-related notifications. The refined mGaming Wellness app can be a valuable resource for mental health professionals, educators, and youngsters seeking support with problematic mobile gaming or interested in building healthy digital habits.</div></div><div><h3>Discussion</h3><div>The findings advocate for the user-centred techniques in developing digital health interventions, contributing valuable input for research in mental health app development targeted at adolescents. Future research will evaluate the app's effectiveness in reducing problematic gaming behaviour.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"6 ","pages":"Article 100220"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899455","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 : 2025-04-20DOI: 10.1016/j.dialog.2025.100219
Melissa Judith Chalada
In 2022, the World Health Organization acknowledged menstrual health as a global human right and encouraged a shift in responsibility from individuals to the community. Globally, menstrual products are rarely included in workplace policies, hindering equitable well-being by placing disproportionate burden on menstruating workers. This exploratory study in Queensland, Australia supplied a public sector workplace with menstrual products for two months in 2023. A questionnaire with qualitative and quantitative aspects assessed the experiences of 21 menstruating workers. Before the supply, 94.7 % had experienced menstruation at work without access to products, leading to mental distress. Additionally, 71.4 % worried about lacking products when needed and 38.1 % believed this worry decreased their mental well-being or concentration. After the supply, 94.1 % reported improved emotions, 70.6 % perceived improved concentration and 64.7 % felt improved mental well-being. However, only 57.1 % believed that menstrual product supply should be mandated by workplace policy. Factors contributing to exclusion of menstrual products from global workplace policies are discussed, such as limited awareness, poor workplace infrastructure and persistent stigma. This study was limited by a small sample size and self-reporting bias. Regardless, the findings highlight the respective positive and negative impacts of including or omitting menstrual products in workplace policy, even in a socioeconomically privileged country like Australia. This emphasises the underestimation of menstrual health as a basic human right in workplace health and safety, urging more research on workplace menstrual product provision and related feminine sanitary infrastructure especially in low-resourced nations.
{"title":"Workplace menstrual product policies and worker well-being: Insights from Queensland, Australia","authors":"Melissa Judith Chalada","doi":"10.1016/j.dialog.2025.100219","DOIUrl":"10.1016/j.dialog.2025.100219","url":null,"abstract":"<div><div>In 2022, the World Health Organization acknowledged menstrual health as a global human right and encouraged a shift in responsibility from individuals to the community. Globally, menstrual products are rarely included in workplace policies, hindering equitable well-being by placing disproportionate burden on menstruating workers. This exploratory study in Queensland, Australia supplied a public sector workplace with menstrual products for two months in 2023. A questionnaire with qualitative and quantitative aspects assessed the experiences of 21 menstruating workers. Before the supply, 94.7 % had experienced menstruation at work without access to products, leading to mental distress. Additionally, 71.4 % worried about lacking products when needed and 38.1 % believed this worry decreased their mental well-being or concentration. After the supply, 94.1 % reported improved emotions, 70.6 % perceived improved concentration and 64.7 % felt improved mental well-being. However, only 57.1 % believed that menstrual product supply should be mandated by workplace policy. Factors contributing to exclusion of menstrual products from global workplace policies are discussed, such as limited awareness, poor workplace infrastructure and persistent stigma. This study was limited by a small sample size and self-reporting bias. Regardless, the findings highlight the respective positive and negative impacts of including or omitting menstrual products in workplace policy, even in a socioeconomically privileged country like Australia. This emphasises the underestimation of menstrual health as a basic human right in workplace health and safety, urging more research on workplace menstrual product provision and related feminine sanitary infrastructure especially in low-resourced nations.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"6 ","pages":"Article 100219"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860679","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 : 2025-04-19DOI: 10.1016/j.dialog.2025.100218
Anita Raj , Nicole Johns , Florin Vaida , Mohan Ghule , Namratha Rao , Jay G. Silverman
Background
Effective family planning interventions may have inadvertent effects on births of girls given son preference in India. We conducted 36 and 48-month follow-ups to our CHARM2 family planning study to determine long-term intervention effects on births and sex of children.
Methods
Our non-blinded two-armed cluster RCT randomized young married couples (N = 1201 couples) from 20 geographic clusters (60–61 couples per cluster) into either the CHARM2 intervention or control (referral to local care) condition. CHARM2 offers 5-session gender-synchronized family planning and gender equity counseling delivered by trained local medical providers. Data were collected at baseline in September 2018–June 2019 and then follow-ups at 9, 18, 36 and 48 months, up to September 2023. We retained 88 %–91 % of women across follow-ups with no difference in retention by treatment group. We used adjusted mixed-effects logistic regression models examining sex composition of births at each follow-up and over the total 48-month follow-up to assess differences in all births of boys and girls by treatment group. We adjusted for treatment condition, cluster, and relevant demographics in adjusted models.
Results
We saw no treatment effects on total births or boy births, but lower likelihood of a girl birth was seen at 9-month follow-up and for the total 48-month follow-up period. We found at 9-month follow-up a girl birth was less likely for intervention compared with control participants (7.1 % vs. 10.3 %, respectively, p = 0.06), and the male to female sex ratio of births born between baseline and 9-month follow-up was also significantly higher for intervention vs. comparison participants (1.50 [95 % CI 1.00–2.26] vs. 0.83 [95 % CI 0.56–1.21], p = 0.04). We conducted a sensitivity analysis to determine treatment effects on boy births and girl births over the 48-month follow-up and again found no effects on boy births, but a significantly lower likelihood of a girl birth for the intervention group (22 % vs 29 %, p = 0.03).
Conclusion
The CHARM2 family planning intervention, previously demonstrating significant effects on contraceptive use and women's reproductive agency in rural India, resulted in lower likelihood of girl births over time, suggesting that family planning programs can contribute to sex ratio imbalances if broader social changes eliminating son preference and improving value of a girl child do not occur.
Funding
National Institutes of Health, Grant R01HD084453 Bill and Melinda Gates Foundation. INV002967. The funders had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. [ClinicalTrials.gov
在印度，由于重男轻女，有效的计划生育干预措施可能会对女孩的出生产生无意的影响。我们对CHARM2计划生育研究进行了36个月和48个月的随访，以确定长期干预对出生和儿童性别的影响。方法采用非盲双臂随机对照试验，将20个地理分组（每组60-61对）的年轻已婚夫妇（N = 1201对）随机分为CHARM2干预组和对照组（转到当地护理）。CHARM2提供由训练有素的当地医疗提供者提供的五期性别同步计划生育和性别平等咨询。在2018年9月至2019年6月期间收集基线数据，然后在9个月、18个月、36个月和48个月进行随访，直至2023年9月。在随访期间，我们保留了88% - 91%的女性保留率，不同治疗组的保留率没有差异。我们使用调整后的混合效应logistic回归模型，检查每次随访和48个月随访期间出生的性别组成，以评估治疗组所有男孩和女孩出生的差异。在调整后的模型中，我们调整了治疗条件、集群和相关人口统计数据。结果：我们没有看到治疗对总出生数或男孩出生数的影响，但在9个月的随访和48个月的随访期间，发现女孩出生的可能性较低。我们发现，在9个月的随访中，与对照组相比，女孩出生的可能性更小（分别为7.1%和10.3%,p = 0.06），在基线和9个月随访期间出生的男女性别比，干预组也显著高于对照组（1.50 [95% CI 1.00-2.26]比0.83 [95% CI 0.56-1.21], p = 0.04）。在48个月的随访中，我们进行了敏感性分析，以确定治疗对男孩出生和女孩出生的影响，再次发现对男孩出生没有影响，但干预组出生女孩的可能性显着降低（22%对29%，p = 0.03）。CHARM2计划生育干预措施在印度农村对避孕药具的使用和妇女生殖机构产生了显著影响，但随着时间的推移，该措施导致女孩出生的可能性降低，这表明，如果不发生更广泛的社会变革，消除重男轻女和提高女孩的价值，计划生育计划可能会导致性别比例失衡。美国国立卫生研究院，拨款R01HD084453比尔和梅林达·盖茨基金会。INV002967。资助者在研究的设计和实施、数据的收集、管理、分析和解释中没有任何作用；或手稿的准备、审查或批准；或决定投稿发表。[ClinicalTrials.gov标识符：NCT03514914.]
{"title":"Four-year follow-up of CHARM2, an effective family planning intervention, on number and sex of births: Findings from an RCT in rural India","authors":"Anita Raj , Nicole Johns , Florin Vaida , Mohan Ghule , Namratha Rao , Jay G. Silverman","doi":"10.1016/j.dialog.2025.100218","DOIUrl":"10.1016/j.dialog.2025.100218","url":null,"abstract":"<div><h3>Background</h3><div>Effective family planning interventions may have inadvertent effects on births of girls given son preference in India. We conducted 36 and 48-month follow-ups to our CHARM2 family planning study to determine long-term intervention effects on births and sex of children.</div></div><div><h3>Methods</h3><div>Our non-blinded two-armed cluster RCT randomized young married couples (<em>N</em> = 1201 couples) from 20 geographic clusters (60–61 couples per cluster) into either the CHARM2 intervention or control (referral to local care) condition. CHARM2 offers 5-session gender-synchronized family planning and gender equity counseling delivered by trained local medical providers. Data were collected at baseline in September 2018–June 2019 and then follow-ups at 9, 18, 36 and 48 months, up to September 2023. We retained 88 %–91 % of women across follow-ups with no difference in retention by treatment group. We used adjusted mixed-effects logistic regression models examining sex composition of births at each follow-up and over the total 48-month follow-up to assess differences in all births of boys and girls by treatment group. We adjusted for treatment condition, cluster, and relevant demographics in adjusted models.</div></div><div><h3>Results</h3><div>We saw no treatment effects on total births or boy births, but lower likelihood of a girl birth was seen at 9-month follow-up and for the total 48-month follow-up period. We found at 9-month follow-up a girl birth was less likely for intervention compared with control participants (7.1 % vs. 10.3 %, respectively, <em>p</em> = 0.06), and the male to female sex ratio of births born between baseline and 9-month follow-up was also significantly higher for intervention vs. comparison participants (1.50 [95 % CI 1.00–2.26] vs. 0.83 [95 % CI 0.56–1.21], <em>p</em> = 0.04). We conducted a sensitivity analysis to determine treatment effects on boy births and girl births over the 48-month follow-up and again found no effects on boy births, but a significantly lower likelihood of a girl birth for the intervention group (22 % vs 29 %, <em>p</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>The CHARM2 family planning intervention, previously demonstrating significant effects on contraceptive use and women's reproductive agency in rural India, resulted in lower likelihood of girl births over time, suggesting that family planning programs can contribute to sex ratio imbalances if broader social changes eliminating son preference and improving value of a girl child do not occur.</div></div><div><h3>Funding</h3><div>National Institutes of Health, Grant R01HD084453 Bill and Melinda Gates Foundation. INV002967. The funders had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. [<span><span>ClinicalTrials.gov</span><svg><path","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"6 ","pages":"Article 100218"},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874672","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 : 2025-04-18DOI: 10.1016/j.dialog.2025.100216
Kwame Owusu-Edusei , Arijita Deb , Elamin H. Elbasha
Background
The risk of disease varies across populations based on factors like age, sex, race, ethnicity, socioeconomic status, and underlying medical conditions. Subgroup or subpopulation data are critical in planning, executing and evaluating public health interventions. However, most studies report the values for the overall (total) population with little or no information on the subgroups. As a result, finding subgroup specific data can be challenging.
Objective
In this report, a set of formulae that can be used to calculate subgroup or subpopulation data using the overall estimates and the reported or assumed relative estimates were derived.
Methods
A simple numerical example was used to illustrate the methodology. Next, symbolic formula for calculating the burden (e.g., incidence, prevalence, or average cost) for 3 (and extended to n number of) subgroups or subpopulations were derived. To account for uncertainty in the data, two statistical methods were used to estimate confidence intervals for the point estimates.
Results
The derived formulae indicated that each subgroup or subpopulation's burden (incidence, prevalence, or average cost) can be calculated as the overall burden adjusted by the ratio of that subgroup or subpopulation's relative burden to the sum of the proportion-weighted relative burden (incidence, prevalence, or average cost) of all the subgroups or subpopulations within the population.
Conclusion
These formulae can help to avoid or minimize potential quantitative and qualitative errors in subgroup or subpopulation disease burden estimates used for health research, interventions and/or policy analyses or deliberations.
{"title":"Formulae for calculating subgroup disease burden from overall and reported or assumed relative burden estimates","authors":"Kwame Owusu-Edusei , Arijita Deb , Elamin H. Elbasha","doi":"10.1016/j.dialog.2025.100216","DOIUrl":"10.1016/j.dialog.2025.100216","url":null,"abstract":"<div><h3>Background</h3><div>The risk of disease varies across populations based on factors like age, sex, race, ethnicity, socioeconomic status, and underlying medical conditions. Subgroup or subpopulation data are critical in planning, executing and evaluating public health interventions. However, most studies report the values for the overall (total) population with little or no information on the subgroups. As a result, finding subgroup specific data can be challenging.</div></div><div><h3>Objective</h3><div>In this report, a set of formulae that can be used to calculate subgroup or subpopulation data using the overall estimates and the reported or assumed relative estimates were derived.</div></div><div><h3>Methods</h3><div>A simple numerical example was used to illustrate the methodology. Next, symbolic formula for calculating the burden (e.g., incidence, prevalence, or average cost) for 3 (and extended to <em>n</em> number of) subgroups or subpopulations were derived. To account for uncertainty in the data, two statistical methods were used to estimate confidence intervals for the point estimates.</div></div><div><h3>Results</h3><div>The derived formulae indicated that each subgroup or subpopulation's burden (incidence, prevalence, or average cost) can be calculated as the overall burden adjusted by the ratio of that subgroup or subpopulation's relative burden to the sum of the proportion-weighted relative burden (incidence, prevalence, or average cost) of all the subgroups or subpopulations within the population.</div></div><div><h3>Conclusion</h3><div>These formulae can help to avoid or minimize potential quantitative and qualitative errors in subgroup or subpopulation disease burden estimates used for health research, interventions and/or policy analyses or deliberations.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"6 ","pages":"Article 100216"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874671","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 : 2025-04-16DOI: 10.1016/j.dialog.2025.100217
Sabrina Zaman , Tamsel Ahammed , Md Abul Hasan , Md. Enamul Huque
Background
The COVID-19 pandemic has amplified concerns about global food insecurity, with dietary diversity emerging as a critical indicator of nutritional adequacy. These challenges have far-reaching implications for mental health, particularly in vulnerable populations.
Objective
This study delves into the intersection of post-COVID-19 household food insecurity, dietary diversity, and mental depression among affected households.
Methodology
A cross-sectional study conducted with a sample size of COVID 19 affected 500 households. Bivariate linear regression performed to establish associations with food insecurity, dietary diversity, and depression.
Result
The study found that only 33.4 % of households were food secure, while 40.8 % experienced moderate food insecurity. Most households (82.2 %) had a medium level of dietary diversity, and 45.6 % of respondents reported experiencing different level of depression. Urban residency, higher education, stable employment, and higher income were associated with lower food insecurity and better dietary diversity ((p < 0.05), whereas female-headed households, joint families, and older family heads had higher levels of depression. Job losses (63 %) and income reductions (69.8 %) during COVID-19 contributed significantly (p < 0.05) to increased food insecurity and depression. Households with stable jobs, higher incomes, and access to nutritional information enjoyed better food security, greater dietary diversity, and lower depression. In contrast, rising food prices and job changes worsened both food insecurity and mental health outcomes.
Conclusion
The COVID-19 pandemic has impacted food security, dietary diversity and mental health in Jashore, Bangladesh, exacerbating food insecurity and mental depression, especially among vulnerable groups. However, households with stable jobs, better education, and access to information fared better.
{"title":"COVID-19 effect on food security, livelihood, and mental health in affected households of Jashore, Bangladesh","authors":"Sabrina Zaman , Tamsel Ahammed , Md Abul Hasan , Md. Enamul Huque","doi":"10.1016/j.dialog.2025.100217","DOIUrl":"10.1016/j.dialog.2025.100217","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has amplified concerns about global food insecurity, with dietary diversity emerging as a critical indicator of nutritional adequacy. These challenges have far-reaching implications for mental health, particularly in vulnerable populations.</div></div><div><h3>Objective</h3><div>This study delves into the intersection of post-COVID-19 household food insecurity, dietary diversity, and mental depression among affected households.</div></div><div><h3>Methodology</h3><div>A cross-sectional study conducted with a sample size of COVID 19 affected 500 households. Bivariate linear regression performed to establish associations with food insecurity, dietary diversity, and depression.</div></div><div><h3>Result</h3><div>The study found that only 33.4 % of households were food secure, while 40.8 % experienced moderate food insecurity. Most households (82.2 %) had a medium level of dietary diversity, and 45.6 % of respondents reported experiencing different level of depression. Urban residency, higher education, stable employment, and higher income were associated with lower food insecurity and better dietary diversity ((<em>p</em> < 0.05), whereas female-headed households, joint families, and older family heads had higher levels of depression. Job losses (63 %) and income reductions (69.8 %) during COVID-19 contributed significantly (<em>p</em> < 0.05) to increased food insecurity and depression. Households with stable jobs, higher incomes, and access to nutritional information enjoyed better food security, greater dietary diversity, and lower depression. In contrast, rising food prices and job changes worsened both food insecurity and mental health outcomes.</div></div><div><h3>Conclusion</h3><div>The COVID-19 pandemic has impacted food security, dietary diversity and mental health in Jashore, Bangladesh, exacerbating food insecurity and mental depression, especially among vulnerable groups. However, households with stable jobs, better education, and access to information fared better.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"6 ","pages":"Article 100217"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848158","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 : 2025-04-11DOI: 10.1016/j.dialog.2025.100215
Stephanie L. Enkel , Rebecca Dalton , Chicky Clements , Hannah M.M. Thomas , Tracy McRae , Ingrid Amgarth-Duff , Marianne Mullane , Lisa Wiese , Liam Bedford , Nina Lansbury , Jonathan R. Carapetis , Edie Wright , Asha C. Bowen
Background
Aboriginal children and families contend with higher rates of preventable infectious diseases that can be attributed to their immediate living environment. The environments in which children spend most of their time are their homes and schools. We aimed to understand the opportunities in the school setting to support student skin health and wellbeing through environmental health activities, how these activities were completed, and the barriers to their implementation.
Methods
Recognising the importance of healthy skin for educational success, this work was embedded within a larger cluster randomised stepped-wedge Trial aimed at reducing the rate of skin infections among Aboriginal children living in the Kimberley region of Western Australia by 50 %. We used qualitative data collected via a culturally appropriate yarning methodology during trial evaluation interviews. The data from 35 yarns with 41 individuals were thematically analysed.
Findings
Data indicated that schools serve as a hub of health and hygiene support and maintenance, with school staff balancing teaching responsibilities while also meeting the basic health and wellbeing needs of students. Uncertainties regarding funding and policies governing these activities remained; ongoing exploration is required.
Interpretation
Staff in remote Kimberley schools devote substantial time and resources to supporting student hygiene needs, often stepping in when health infrastructure at home is inadequate. These activities are seen as necessary to support student wellbeing and participation in learning. While schools are well-positioned to respond in this way, these responsibilities extend beyond their core role and place additional pressure on staff and budgets. There is a need to better understand how such work is resourced and to consider how policy and funding frameworks might more formally support it.
{"title":"‘Beyond core business’: A qualitative review of activities supporting environmental health within remote Western Australian schools","authors":"Stephanie L. Enkel , Rebecca Dalton , Chicky Clements , Hannah M.M. Thomas , Tracy McRae , Ingrid Amgarth-Duff , Marianne Mullane , Lisa Wiese , Liam Bedford , Nina Lansbury , Jonathan R. Carapetis , Edie Wright , Asha C. Bowen","doi":"10.1016/j.dialog.2025.100215","DOIUrl":"10.1016/j.dialog.2025.100215","url":null,"abstract":"<div><h3>Background</h3><div>Aboriginal children and families contend with higher rates of preventable infectious diseases that can be attributed to their immediate living environment. The environments in which children spend most of their time are their homes and schools. We aimed to understand the opportunities in the school setting to support student skin health and wellbeing through environmental health activities, how these activities were completed, and the barriers to their implementation.</div></div><div><h3>Methods</h3><div>Recognising the importance of healthy skin for educational success, this work was embedded within a larger cluster randomised stepped-wedge Trial aimed at reducing the rate of skin infections among Aboriginal children living in the Kimberley region of Western Australia by 50 %. We used qualitative data collected via a culturally appropriate yarning methodology during trial evaluation interviews. The data from 35 yarns with 41 individuals were thematically analysed.</div></div><div><h3>Findings</h3><div>Data indicated that schools serve as a hub of health and hygiene support and maintenance, with school staff balancing teaching responsibilities while also meeting the basic health and wellbeing needs of students. Uncertainties regarding funding and policies governing these activities remained; ongoing exploration is required.</div></div><div><h3>Interpretation</h3><div>Staff in remote Kimberley schools devote substantial time and resources to supporting student hygiene needs, often stepping in when health infrastructure at home is inadequate. These activities are seen as necessary to support student wellbeing and participation in learning. While schools are well-positioned to respond in this way, these responsibilities extend beyond their core role and place additional pressure on staff and budgets. There is a need to better understand how such work is resourced and to consider how policy and funding frameworks might more formally support it.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"6 ","pages":"Article 100215"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848157","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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