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Cardiovascular risk increases markedly in perimenopausal and postmenopausal women and social disadvantage can intensify barriers to prevention. In these settings, limited health literacy may further restrict women's ability to understand cardiovascular risk, access appropriate services and translate advice into daily behaviours-potentially widening inequalities. This study investigated health literacy profiles among perimenopausal and postmenopausal women living in a socioeconomically vulnerable urban area of Florence, Italy, and examined how these profiles may guide locally tailored cardiovascular prevention strategies using the Ophelia approach. Cross-sectional study including hierarchical cluster analysis of Health Literacy Questionnaire (HLQ) scores. Primary and community health services in a socioeconomically vulnerable neighbourhood of Florence, Italy. Women aged 45-70 years attending the House of the Community 'Le Piagge' between October 2024 and January 2025. Of 188 recruited, 156 provided complete HLQ data and were included in the analysis. Primary outcome: multidimensional health literacy profiles (nine HLQ scales). Secondary outcomes included Nutrition Literacy Instrument, adherence to the Mediterranean diet (MEDI-LITE) and Sense of Coherence. Four distinct health literacy profiles emerged (p<0.001). One profile (16.7%) showed broad strengths across HLQ domains, another (48.7%) combined several strengths with some more selective challenges, a smaller profile (8.3%) showed widespread challenges across domains, and a fourth profile (26.3%) showed mixed strengths and challenges together with more limited social support. Profiles characterised by more marked health literacy challenges were associated with lower education, greater financial difficulty, poorer self-rated health, lower nutrition literacy and weaker adherence to the Mediterranean diet. Among the Sense of Coherence dimensions, meaningfulness was higher in clusters with stronger health literacy profiles (p<0.001). This study identified distinct multidimensional health literacy profiles among perimenopausal and postmenopausal women in a socioeconomically disadvantaged urban setting. These profiles provide locally relevant evidence to inform the subsequent co-design of fit-for-purpose cardiovascular prevention actions within the Ophelia framework.
A strong and growing evidence base across multiple dimensions of health and wellness supports the value of physical activity with cultural or regional relevance, such as ethnic dance and traditional games. Greater inclusion of culturally and regionally relevant physical activity (CURE-PA) into health promotion is concordant with international public health goals, yet CURE-PAs have traditionally been underused in health and physical activity promotion especially at the population level. The specificity of deep community and cultural context of these activities, an important strength for public health promotion, can obscure communalities in approaches, synergies and outcomes across locations, programmes and populations. Following a narrative review method by a multinational expert team as preparation for the development of formal search protocols in this vast, multidisciplinary literature, this paper: (1) provides a preliminary assessment of the potential size and nature of relevant research, (2) develops a definition of CURE-PA and (3) delineates relevant characteristics supporting inclusion of CURE-PA in population level health promotion. Numerous articles and scientific disciplines with vital evidence on CURE-PA were identified, including nature and health, sport(s), dance, Indigenous health, physical literacy, sociology, political science, youth leadership development, resilience models, community design, ecology, leisure studies, cultural revitalisation and decolonialisation in sports. In formal searches, 100 000s of relevant articles would be found, highlighting the importance of clarifying CURE-PA boundaries, definitions and conceptual models in advance of formal search protocols. A synthesising literature about CURE-PA from a global health promotion perspective can guide future work and support engagement, planning, study, uptake, funding and implementation of CURE-PA in population-level public health. Greater inclusion of CURE-PA in health promotion can help to address physical inactivity as well as chronic disease, mental health concerns, loneliness and other global public health challenges, building from community strengths, preferences and knowledge systems.
Composite health scores are useful in public health research, but components must be operationalised to be feasible in community settings. This paper compared multiple methods to calculate the World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) 2018 Cancer Prevention Recommendations Adherence Score, which scores recommendations to: (1) be a healthy weight; (2) be physically active (PA); (3) eat whole grains, fruit and vegetables (FV) and beans; (4) limit fast/processed foods; (5) limit red/processed meat; (6) limit sugar-sweetened beverages (SSBs) and (7) limit alcohol. We conducted cross-sectional comparisons of validated surveys and alternate measurements (pedometer readings, 24-hour diet recall) for 181 US adults. Across measurement approaches, we calculated percentage agreement and linear weighted kappa statistics for component classifications, and compared composite scores using Spearman's rank-order correlations (rs), paired t-tests and intraclass correlation coefficients (ICC). Survey and alternate measures had slight agreement for adherence scoring of FV and alcohol (p<0.001), red/processed meat and fast/processed foods (p<0.01) and fibre and PA (p<0.05), and no agreement for SSBs. WCRF/AICR composite scores using alternate measures were moderately or strongly correlated (rs=0.44-0.87) to a survey-only composite. Mean WCRF/AICR composite score was 3.34 based on survey data, but lower when substituting pedometer readings (-0.36, p<0.001) and higher with the 24-hour diet recall (+0.54, p<0.001). Reliability of composite scores was moderate to excellent (ICC=0.63-0.94), with no evidence of systematic bias. In this sample, measurement approach influenced WCRF/AICR component adherence classifications substantially and composite scores somewhat. Self-reported data are a cornerstone of community-based research, but unequal units and reference periods and biases in self-reported data all likely contributed to observed discordance in component adherence and composite scores. Future research is needed to identify feasible and accurate approaches to collecting data for composite health metrics.
Sub-Saharan Africa (SSA), including Tanzania, is double-burdened with high rates of teenage pregnancy and new HIV infections among adolescent girls and young women (AGYW) aged 15-24 years. Moreover, pregnant AGYW living with HIV in SSA have poorer adherence and retention on HIV treatment and elevated risks of vertical HIV transmission to their infants, as compared with older women. This paper describes the methods for the ENGAGE project, aiming to investigate and optimise healthcare for prevention of vertical HIV transmission (commonly prevention of mother-to-child transmission (PMTCT)) for AGYW living with HIV in Tanzania. ENGAGE uses a mixed-methods design to co-create and prototype an intervention package for pregnant/postpartum AGYW living with HIV through three phases in three Tanzanian regions. Phase 1 characterises the problem by investigating care engagement and outcomes in a cohort of N=10 147 AGYW receiving PMTCT services in routine healthcare. Phase 2 uses qualitative interviews to understand the social-structural drivers of care engagement from the perspective of AGYW, healthcare providers and community stakeholders and an evidence review of potential solutions. In phase 3, we will use findings from phase 1 and 2 to co-create (together with AGYW and healthcare providers) an intervention package to optimise PMTCT care for most at-risk AGYW. The co-creation will be done through an intervention development action cycle, where ideas are presented, feedback sought and refinements made iteratively via several workshops over about 6 months. The resulting co-created intervention package will be prototyped at selected facilities/communities and refined into a final version, ready for piloting for feasibility, acceptability and preliminary effect in a later phase. This protocol focuses on the co-creation phase 3 and its preceding phases 1 and 2. ENGAGE has received ethical approval from the Tanzania National Health Research Ethics Committee (NIMR/HQ/R.8a/Vol.IX/4637), and the Swedish Ethical Review Authority (2024-05745-01) for analysis of data in Sweden. Findings will be disseminated to AGYW, healthcare providers, community stakeholders, health officials, researchers, policy makers and the wider local and global scientific community.
Adolescent obesity is increasing worldwide, and a minority of adolescents are meeting recommended physical activity (PA) and dietary guidelines, particularly among adolescents from low socioeconomic areas. There are limited studies qualitatively investigating the engagement in healthy lifestyle behaviours in this population. Therefore, this study aimed to gain a greater understanding of perceived barriers and facilitators of healthy lifestyle behaviours, specifically PA and dietary behaviours, in this under-represented population. Eight semistructured qualitative focus groups with 35 adolescents aged 13-15 years old were conducted across four European countries (Spain, the Netherlands, Greece, UK) following the Theory of Planned Behaviour framework which states that individual behavioural intentions are grounded on attitudes, subjective norms and perceived behavioural control. Discussions were centred on adolescents' PA and healthy eating behaviours and were thematically analysed. Regarding attitudes, adolescents understood the importance of healthy lifestyle behaviours but often failed to engage in them. Concerning subjective norms, friends and peers were perceived as barriers to PA, except during physical education (PE) classes. Positive relationships between pupils and teachers facilitated PA, and family influence primarily affected dietary behaviours. Regarding perceived behavioural control, the school structures including lack of space and time, as well as limited healthy food options in canteens and the COVID-19 pandemic were barriers to healthy lifestyle behaviours, while mandatory PE classes and school clubs facilitated PA. In conclusion, despite adolescents recognising the significance of healthy lifestyle behaviours they often fail to engage in them. Their healthy lifestyle behaviours were influenced by their friends, families and teachers. The school structure and the COVID-19 pandemic were considered barriers to healthy lifestyle behaviours among adolescents. NCT05002049.
Childhood overweight and obesity (OWO) in China, especially in urban areas, has become a significant public health challenge. Recent studies indicate a high prevalence of OWO in both children and adults, exacerbated by urbanisation and economic development. This trend poses a threat to health outcomes, including neurocognitive functioning, socio-emotional development and risk of chronic conditions. Recognising the limitations of high-income country prevention models, the Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI) was established to evaluate a multifaceted intervention aimed at mitigating childhood OWO and related non-communicable disease risks. This protocol outlines the economic evaluation component of the SCHeLTI trial. A within-trial economic evaluation and long-term model from both a healthcare/personal social services perspective and a broader societal perspective will be undertaken alongside the SCHeLTI study, comparing the multifaceted intervention to usual care. Costs will include intervention provision, implementation and household expenditures. Outcome measures span child and maternal health-related quality of life, growth indicators, cognitive and behavioural development, nutritional status and metabolic dysfunction indicators. Cost-effectiveness and cost-utility analyses will be performed, with incremental cost-effectiveness ratios calculated for primary outcomes and quality-adjusted life years. A decision-analytical model will also project long-term economic and health impacts. Equity impact analysis will assess the intervention's effects across socioeconomic strata. Sensitivity analyses, including one-way and probabilistic approaches, will be conducted to ensure robust results. The study has been approved by the Medical Research Ethics Committees of the International Peace Maternity and Child Health Hospital in Shanghai, China (GKLW2017-01) and the CIUSSS de l'Estrie-CHUS in Sherbrooke, Canada (MP-31-2019-2967). Results will be disseminated through academic publications, policy briefs, stakeholder meetings and community engagement to inform early childhood development policy in China and similar settings globally. ChiCTR1800017773.
Preconception iron and folic acid supplementation (IFAS) is a key intervention to prevent neural tube defects (NTDs) and maternal and child iron deficiency anaemia (IDA). Despite its potential benefits, many healthcare systems rarely provide preconception IFAS to women who plan to become pregnant and mothers with a history of spontaneous abortion who declined contraceptive use. The aim of this study was to explore stakeholder perspectives on the challenges and opportunities for implementing preconception IFAS for these high-risk groups in the Ethiopian healthcare system, a country with a high burden of NTDs and IDA. An exploratory qualitative study was conducted among 45 participants, including women attending antenatal care, women planning pregnancy including mothers with a history of spontaneous abortion who declined contraceptive use, healthcare providers and maternal and child care experts. Participants were selected using purposive sampling. Data were first analysed separately for each participant group and then triangulated to synthesise a comprehensive understanding of practices, challenges and opportunities. Major barriers operate at policy, health system and individual levels, including the absence of a structured national preconception care programme, inadequate health system capacity, limited knowledge among women and providers, behavioural constraints to preconception care utilisation and a high prevalence of unplanned pregnancies. However, existing health extension programme, family planning clinic and gynaecology department with supportive policy frameworks offer viable entry points for integrating preconception IFAS. This study identified major gaps in the implementation of preconception IFAS within the Ethiopian healthcare system. Women with a history of spontaneous abortion who decline contraceptive use represent an overlooked group with unmet preconception nutritional needs. Strengthening policy, training and community awareness is essential. Future implementation research is needed to support integration of preconception IFAS and improve maternal and neonatal outcomes, contributing to Sustainable Development Goals for maternal and child health.
Unhealthy diets are a leading cause of death, yet nutrition education for medical and healthcare professionals remains inadequate internationally. Beyond 'top-down' curriculum and accreditation initiatives, student-led teaching and learning initiatives typically commence to fill curricular gaps. This scoping review aimed to synthesise evidence on student-led nutrition education initiatives for medical and health students. Following JBI methodology for scoping reviews, MEDLINE, Embase, CINAHL, ERIC and Web of Science were searched for studies from any country and year that related to student-led nutrition education initiatives for medical and health students. A grey literature search ensured a comprehensive overview of available literature. Data were synthesised narratively. Twenty articles published between 2012 and 2024 were included, and most were from the USA (n=15). Student-led nutrition education initiatives included culinary education (n=11, 55%), placement opportunities (n=10, 50%), lecture series (n=7, 35%) and student interest groups (n=6, 30%). Twelve studies (60%) included more than one type of initiative. Initiatives mostly targeted medical students (n=13, 65%), and four were interdisciplinary (20%). Studies included students from undergraduate or preclinical years through to practising health professionals. Initiatives were delivered by students, physicians, dietitians, and other health professionals, mostly in-person (n=12, 60%) within university (n=12, 60%) or community (n=7, 35%) settings. Thirteen studies evaluated the initiative(s) using questionnaires (n=10, 50%), informal feedback (n=2, 10%) or focus groups (n=1, 5%). Of these, seven studies (54%) reported improved confidence and competence in nutrition among the students involved. Student-led nutrition education initiatives are likely to be well received and may improve nutrition competence. These initiatives are a promising approach to address the persistent gap in nutrition education for medical and health students.
To identify clinical checklists of multicomponent non-pharmacological interventions for the prevention and treatment of delirium used in non-intensive care unit inpatient healthcare settings, their content and reported implementation. Rapid review. Medline, Embase, PsycINFO, CINAHL and Cochrane CENTRAL were searched from 1 January 1999 to 31 March 2022 and updated on 16 January 2025. A comprehensive grey literature search, including websites of guideline development groups and international delirium organisations, was conducted on 26 and 27 February 2024. We included records reporting the use of a 'clinical checklist' used by the healthcare team, family carers or adult patient (≥18 years) to prompt and document multicomponent non-pharmacological interventions for the prevention or treatment of delirium. Publication language was restricted to English and French. Using rapid review methodology, two independent reviewers screened the included records. A single reviewer undertook the data extraction, with a third independent reviewer verifying the data extraction for completeness. All included studies were assessed using the JBI critical appraisal tools according to the study design. A narrative synthesis was used to summarise the findings. From the database searches, 4796 records were identified. After the removal of duplicates, 3513 records underwent title and abstract screening, with 344 records undergoing full-text screening. A final 32 records were included. From the grey literature search, 6593 records were reviewed for relevance, from which 62 records were included in full-text screening. No grey literature records were of high enough quality to be included. All studies were published in English, with most studies conducted in the USA, n=12/32 (37.5%). The 32 studies were quasi-experimental (n=18), randomised controlled trials (n=8), qualitative (n=4), expert opinion (n=1) and policy/consensus guidelines (n=1). Clinical checklists included structured protocols, algorithms and order sets, which were paper-based or part of electronic delirium order sets. People with dementia participated as key stakeholders for a guidance document during the COVID-19 pandemic, but the target population was not included in the development phase of other checklists. Target users of clinical checklists were usually healthcare staff and trained volunteers and rarely family carers and study intervention nurses. Four of the 32 studies included all 10 National Institute for Health and Care Excellence clinical factors/preventive strategies for non-pharmacological interventions. For the remaining 28 studies, missing domains varied and included: therapeutic/cognitive activity, hydration, nutrition, constipation, urinary catheterisation, hypoxia, infection, pain and medication review. Only two studies involved family carers as active partners in patient care. Reported formal economic analysis was limited. Codesign of future clinical checklists should involve patients and family carers. Further research is needed on the feasibility of using clinical checklists by all members of the interprofessional team and family carers, the factors needed to ensure high levels of adherence and sustainability of multicomponent non-pharmacological interventions for delirium management, in addition to economic evaluations. CRD42022342328.
Growing evidence suggests that higher ambient temperatures may increase the risk of mental health disorders and exacerbate existing conditions. Despite this, most studies evaluating the association between temperature and mental health rely on hospitalisation records or insurance claims data, which only capture the most severe outcomes. To effectively intervene to prevent mental health crises associated with ambient temperature, it is necessary to identify and develop novel ways to reach patients before they require care. Digital health tools offer a promising way to address these gaps, particularly in communities most affected by climate inequities. This study aims to recruit 70 low-income black women from Chicago who are already enrolled in the Nutrition and Pregnancy Study for a 4-week longitudinal observational study. The primary objective is to examine how ambient temperature affects positive and negative affect (primary outcome), as well as sleep and physiologic markers. Over a 4-week summer period, participants will wear a smartwatch and complete ecological momentary assessment surveys three times daily. We will monitor indoor temperature and humidity using home-based sensors and link these data with wearable and self-reported mental health measures. Daily outdoor ambient temperature will also be linked. Statistical analyses will use mixed-effects longitudinal models with distributed lags to assess delayed and cumulative temperature effects. This study has been reviewed and approved by the Institutional Review Board at the University of Chicago (IRB24-026). At the completion of the study, participants will have the option to receive a summary of their own data, with a plain-language summary of the study findings. Findings will be disseminated through peer-reviewed publications and presentations at national and international conferences. Dissemination efforts will also include engagement with local community stakeholders and public health partners to inform future climate and health efforts.
Communicable disease control in Afghanistan has deteriorated amid growing fragility, health system disruption and declining international aid since the 2021 regime change. Outbreaks of measles, pertussis, pneumonia, cholera, malaria, dengue, Crimean-Congo haemorrhagic fever, tuberculosis and polio continue to plague the population in Afghanistan. This study addresses a critical evidence gap by systematically ranking research priorities for communicable diseases in Afghanistan. This study applied the Child Health and Nutrition Research Initiative (CHNRI) methodology, which is a widely used approach for systematic, transparent and collaborative research priority setting. It leverages expert consultation to generate, score and rank research questions. This study identified and invited 303 Afghanistan-health researchers, based globally, to complete the survey which consisted of 33 research questions related to communicable diseases that were submitted by 15 researchers. This CHNRI exercise included 44 respondents, 63.6% of whom were of Afghan origin. The top 10 highest-ranked questions focused on identifying barriers to low measles and polio vaccination coverage, assessing disease burden by region and strategies to reduce the incidence of tuberculosis. Respondents of Afghan origin ranked antibiotic resistance and gender-related disparities in tuberculosis as the highest-priority questions. The majority of priority questions were description questions. Researchers, governments, donors, policy makers and programme implementers can use these findings as a starting point to strategically align research agendas, guide resource allocation, and prioritise evidence-based interventions for life-saving communicable disease prevention and control in Afghanistan.
The Healthy Lifestyle Index (HLI) integrates key behaviours to assess their cumulative impact on health. While higher HLI adherence is linked to lower disease and mortality risk, its long-term trajectory association remains understudied. This study aims to examine the dose-response relationship and long-term association of HLI on mortality risks. Systematic review and dose-response meta-analysis using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. PubMed, Scopus and Web of Science were searched until June 2024. We included observational cohort studies that assessed the relationship of HLI or its trajectories with all-cause, cardiovascular disease (CVD)-cause or cancer-cause of mortality. Analysis of 13.7 million participants demonstrated that higher adherence to the HLI is linked to lower risk of all-cause (HR: 0.48; 95% CI 0.46 to 0.53; GRADE: moderate), CVD-cause (HR: 0.49; 95% CI 0.44 to 0.51; GRADE: moderate) and cancer-cause mortality (HR: 0.55; 95% CI 0.49 to 0.61; GRADE: low). These associations were further confirmed in a dose-response manner. Moreover, compared with maintaining an unhealthy lifestyle, a decline in HLI adherence was associated with a 14% higher risk of all-cause and a 19% higher risk of cancer-related mortality. In contrast, an improvement in HLI adherence was linked to a 20% lower risk of all-cause and a 13% lower risk of cancer-related mortality. Adherence to HLI and its long-term patterns are associated with lower mortality risk. These findings emphasise the importance of lifestyle-based prevention and intervention strategies in reducing mortality. CRD42024500538.
Food insecurity and malnutrition, as well as poor mental health, negatively impact millions of people worldwide and can reinforce each other, compounded by gender inequity. Nutrition-sensitive agriculture interventions have the potential to improve these simultaneously. We analysed the impact of a homestead food production (HFP) programme on women's mental health, including pathways through food insecurity, women's empowerment and dietary diversity. The Food and Agricultural Approaches to Malnutrition cluster-randomised trial allocated 96 settlements in northeastern Bangladesh 1:1 to a HFP programme, implemented 2015-2018, and control. Data were collected at baseline in 2015, at endline in 2019/20 and continuously through a surveillance system. Depressive symptoms were assessed using the Edinburgh Postpartum Depression Scale (EPDS). We quantified the intervention's impact on depressive symptoms at endline, analysing data from 2513 women using multilevel regression. We also examined whether that effect was mediated by household food security, women's empowerment and women's dietary diversity, using sequential mediation analysis with cluster-bootstrapped standard errors, adjusting for baseline covariates. At baseline, 39% of households were severely food insecure and 69% of women did not have minimally diverse diets. At endline, 38% of women in the control and 32% in the intervention arm screened positive for depressive symptoms (EPDS≥12). The intervention reduced the odds of depressive symptoms by 23% (OR 0.77, p=0.03). There was no evidence that the combined pathway reduced depression (OR 0.95, p=0.24). When decomposed, food security was responsible for one-third of the total effect (OR 0.92, p=0.01). Most of the intervention effect on depression was through other pathways (OR 0.81, p=0.08). On average, intervention participants had better mental health 1 year after the programme ended, with some of the effect mediated by increased food security. There are likely other pathways through which nutrition-sensitive agriculture can improve mental health, such as social protection and income, which may act synergistically. NCT02505711.
Diet affects oral health locally through interactions with teeth, saliva and plaque as well as systemically through impacts on oral tissues and bone. The indigenous communities of Bangladesh may have more oral health issues as a result of their dietary practices and tobacco use. A cross-sectional study was performed in the outpatient department of Bandarban Sadar Hospital in Bangladesh. A total of 245 indigenous adults aged 18 years and above were recruited using convenience sampling. Data were gathered via a standardised, interviewer-administered questionnaire and clinical oral examination. Oral health outcomes included dental caries, gingivitis, dental plaque, tooth stains, tooth mobility and self-reported oral symptoms. Data were collected using a structured interviewer-administered questionnaire and clinical oral examination. Associations were assessed using χ² tests and ORs with 95% CIs. The average age was 38.25 years (SD 8.83). Gingivitis (p=0.001) and tooth stains (p<0.001) were substantially correlated with smokeless tobacco usage. Users were 2.8 times more likely to have gingivitis (95% CI 1.52 to 5.18) and 3.85 times more likely to have tooth stains (95% CI 1.76 to 8.42). Only tooth stains (p<0.001) and dental caries (p<0.001) were strongly correlated with tobacco use. Dental caries was prevented by eating eggs (OR: 0.45; 95% CI 0.24 to 0.81). Other dietary components, including milk and citrus fruits, showed no significant relationships. Among indigenous people, tobacco use, especially smokeless tobacco, is closely linked to poor dental outcomes. There were conflicting associations between dietary variables and dental caries; however, egg consumption was protective. For Bangladesh's indigenous inhabitants, culturally appropriate tobacco cessation and oral health education programmes are required.
Barbados is currently experiencing an epidemic of childhood obesity, representing an urgent public health concern. The government has implemented policies encouraging healthier lifestyles. Concurrently, civil society organisations have undertaken numerous bottom-up initiatives and advocacy. Despite these efforts, there is little knowledge about how different community partners and sectors experience and perceive these initiatives or how local contextual factors affect their success. Understanding these perspectives is crucial to inform culturally appropriate and sustainable initiatives. Semi-structured interviews were conducted in May 2023 with participants (n=27) who were deemed critical in childhood obesity prevention through purposive and snowball sampling. Recruitment was facilitated by community partners, the Healthy Caribbean Coalition and the Heart and Stroke Foundation of Barbados. Interviews were then transcribed and analysed using an inductive thematic analysis framework along with the socio-ecological model to examine how different actors perceived the contributors, challenges and solutions for childhood obesity. Participants highlighted several interconnected factors that contribute to childhood obesity in Barbados, such as the country's dependence on imported foods, cultural norms and preferences and the long-lasting effects of colonialism. Lack of coordination across sectors as well as a lack of resources were major obstacles to the implementation of successful interventions. Participants described numerous strategies to address childhood obesity, including the School Nutrition Policy, Sugar-Sweetened Beverage Tax, advocacy efforts and targeted community-led programmes, all of which could be striated across the socio-ecological model. Findings from this study show that tackling childhood obesity necessitates culturally responsive and context-specific approaches based on the perceptions and experiences of community members and sector officials. Developing and maintaining successful initiatives requires cross-sectoral collaboration and civil society engagement and buy-in. Long-term and equitable reductions in childhood obesity can be achieved by strengthening the execution of current programmes and policies while continuing to document and understand local experiences and contexts.
The BioCaPPE (Biomarkers of Prostate Cancer/Prevention and Environment) study is a multicentre prospective observational cohort designed to identify biomarkers associated with prostate cancer (PCa) risk that may be modifiable through lifestyle factors. This paper describes the cohort, along with the data and bio-samples available for future studies in PCa risk assessment. Canadian men at risk of PCa were enrolled based on one of two criteria (1) negative first prostate biopsy within 6 months from enrolment (Group 1); or (2) a prostate-specific antigen (PSA) blood level between 2.5 and 10 ng/mL without prior prostate biopsy (Group 2). At baseline, blood samples and comprehensive data were collected. PCa incidence and lifestyle factors were updated for all participants over 2 years, with extended follow-up for those who provided additional consent. Recruitment was conducted across four health centres in Quebec, Canada. A total of 2053 men were enrolled-1499 in Group 1 and 554 in Group 2. All participants completed the initial visit, which included collection of medical and family history, anthropometric measurements, demographic information, dietary and alcohol intake, physical activity, tobacco use, medication use, and quality of life assessments, and candidate biomarker measurements. At the 2-year mark, 7.2% of participants had developed PCa; this figure has since increased to 15.3% (median follow-up: 6.1 years). Additionally, 84% (n=1718) consented to ongoing annual follow-up. This large, prospective cohort of men at risk of PCa offers valuable resources for risk stratification and primary prevention. The BioCaPPE biosamples and data are available to support the identification of lifestyle-related biomarkers associated with PCa risk in this population. ClinicalTrials.gov Identifier: NCT03383016.
To inform initiatives aiming to address all forms of malnutrition in Guatemala, the degree of overlap of sociodemographic factors between the double burden of malnutrition (DBM) and single forms of malnutrition must be further understood. This study aimed to identify sociodemographic factors uniquely associated with households with DBM and those shared with households with single forms of malnutrition in Guatemala. This secondary data analysis uses nationally representative household data from the Guatemalan Epidemiological Health and Nutrition Surveillance System 2013-2019. DBM was defined as the coexistence of a woman (15-49 years) with overweight/obesity and an infant or young child (6-60 months) with stunting within the same household. Households with single forms of malnutrition were those with only a woman with overweight/obesity or only a child with stunting. Descriptive statistics and multinomial logistic regression were applied. From the 3622 households included, one-fifth of households were identified with DBM. Sociodemographic factors uniquely associated with DBM were having a middle-level of household assets (adjusted odds ratio (aOR): 1.55, 95% CI 1.02 to 2·36) and lack of women's health insurance (aOR: 1.62, 95% CI 1.00 to 2·62). Shared factors for households with DBM and households with a woman with overweight/obesity were residence in the Central region, women aged >25 years and children >18 months. For households with DBM and households with a child with stunting, shared factors were women's primary education and Indigenous ethnicity. Women reporting no academic education, parity >3 and having children aged 18-36 months were shared factors across households with DBM and households with both single forms of malnutrition. These findings emphasise the need for integrated, equity-focused nutrition strategies that address both undernutrition and overnutrition across key life stages. The identified overlapping sociodemographic factors provide actionable opportunities for policymakers to design targeted household-level interventions to reduce both child undernutrition and adult overweight/obesity in Guatemala.
Perinatal depression is a common, yet understudied, mental health disorder among women and contributes to poor engagement in prevention of mother-to-child transmission (PMTCT) of HIV in sub-Saharan Africa. Male partners are positioned to provide critical forms of social and economic support during pregnancy and postpartum, and also may contribute to women's stress, depression and anxiety through intimate partner violence and withholding of social support. Despite the critical role of men in pregnancy outcomes and HIV prevention, few interventions have engaged men around women's depressive symptoms, nutrition and health, and engagement in PMTCT. We will conduct a pilot trial of Mphatso, a couple-based intervention based on problem-solving therapy with couple relationship skills to reduce depressive symptoms in perinatal women, improve food insecurity and prevent HIV transmission to the infant. We will employ a two-arm pilot randomised controlled trial in the Zomba district of Malawi to assess the feasibility and acceptability of Mphatso (meaning 'gift' or the child) and explore health impacts on depressive symptoms, PMTCT engagement and food insecurity. We will enrol 60 pregnant women in the second or third trimester who are living with HIV and meet criteria for probable depression based on the Edinburgh Postnatal Depression Scale and their male partners. Couples will be randomised to receive either five sessions of Mphatso (problem-management skills plus health education and relationship skills) or enhanced usual care. Feasibility and acceptability outcomes will include session attendance rates, satisfaction levels and retention at 3 months and 6 months postpartum. Exploratory analyses using regression models including time and treatment arm will be conducted to explore effects on the mothers' and fathers' depressive symptoms, adherence to PMTCT (antiretroviral therapy, nevirapine use, HIV testing and exclusive breastfeeding) and food insecurity. The pilot trial has been approved by the University of California, San Francisco (Human Research Protection Program (HRPP); Protocol Number 23-40685), and the study has also been approved by the National Health Sciences Research Committee in Malawi (NHSRC; Protocol Number 24/05/4431). Results will be disseminated to study participants, health officials, policymakers, community leaders and care providers, as well as through presentations at conferences and publications in peer-reviewed journals. NCT06659315.
The aim was to describe the impact of socio-economic inequalities (SEI) on COVID-19 mortality in people aged 45 years and over living with or without diabetes during the two epidemic waves of 2020 (wave 1 (W1): March-May; wave 2 (W2): September-December) in European France. People living with pharmacologically treated diabetes were identified using a validated algorithm from the French National Health Data System. COVID-19 mortality in 2020 was obtained from the French Medical Causes of Death database. SEI were measured using the French Deprivation Index at municipality level (FDep; with Q1 corresponding to people living in the least deprived). Age-standardised COVID-19 mortality was calculated by FDep quintiles for each month of the year and by sex. The relative risk of COVID-19 mortality associated with FDep quintiles (with Q1 as the reference) according to diabetes status and epidemic wave was estimated by sex using an adjusted log-linear Poisson model. During W1, when only collective measures were available (lockdown), no social gradient was observed, and it was even the least deprived women with diabetes (Q1) who had a higher risk of COVID-19 mortality. Among men with diabetes, only the most deprived (Q5) had a slightly higher risk of COVID-19 mortality than the least deprived (Q1). The same results were overall found in people without diabetes.During W2, after the implementation of the first individual preventive measures (mask), COVID-19-related mortality followed a positive SEI gradient among men and women with and without diabetes, with higher rates in the most deprived groups (Q5). Moreover, the influence of SEI was greater in women without diabetes in the most deprived groups (Q3, Q4, Q5) than in women with diabetes. Our study highlights the importance of integrating the principles of equity, which give consideration to the most vulnerable, into the development of individual prevention measures.
To collate and appraise evidence from existing systematic reviews and meta-analyses on interventions to prevent stillbirth and reduce perinatal mortality across the reproductive continuum, including preconception, antenatal, intrapartum and immediate newborn periods. Umbrella review synthesising evidence from systematic reviews, including meta-analyses where available. A comprehensive search was conducted in CENTRAL (via Cochrane Register of Studies Online), PubMed, Embase and Web of Science, along with trial registries (WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ISRCTN Registry), from inception to 12 January 2026. Systematic reviews and meta-analyses synthesising randomised controlled trials or quasi-experimental studies that reported stillbirth, perinatal mortality, fetal loss or fetal death were included. Reviews focused exclusively on predefined high-risk populations were excluded. Two reviewers independently extracted data and assessed methodological quality using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty ratings were extracted as reported by the original review authors. Evidence synthesis followed a structured framework adapted from Ota et al, integrating direction of effect and certainty of evidence based on pooled estimates and GRADE assessments. Publication overlap was assessed using the Corrected Covered Area index where relevant. A total of 116 systematic reviews were included, synthesising evidence from randomised controlled and quasi-experimental studies across preconception, antenatal, intrapartum and immediate newborn periods. Evidence from individual reviews showed clear benefit for several interventions, including balanced energy-protein supplementation, home visits by community health workers, birth preparedness interventions, labour induction at or beyond 37 weeks of gestation and skilled or community-based intrapartum care, primarily for reducing perinatal mortality. Reduced antenatal visit schedules compared with standard care were associated with a possible increase in stillbirth or perinatal mortality, indicating potential harm. Many interventions-such as group antenatal care (ANC), nutritional education, case-note provision, routine ultrasound or Doppler monitoring, antibiotic treatment for bacterial vaginosis, antiretroviral therapy in pregnancy and several pharmacological or hormonal interventions-demonstrated unknown or inconclusive effects on stillbirth or perinatal mortality, largely due to imprecision and heterogeneity. This umbrella review identifies a range of interventions with evidence of effectiveness across the reproductive continuum, particularly those addressing maternal nutrition, continuity of ANC and quality intrapartum and newborn care. However, substantial evidence gaps remain, especially for interventions widely implemented without strong supporting evidence. These findings highlight the need for context-specific implementation research and prioritisation of proven strategies in low- and middle-income countries, where the burden of stillbirth remains highest. CRD42024531100.