Subcutaneous depot medroxyprogesterone acetate, or DMPA-SC, is an injectable contraceptive that can be administered by any trained person, including for self-injection. When scaling in-service healthcare worker training on DMPA-SC between 2019 and 2021, Ghana Health Service tasked a cohort of formally-trained healthcare workers to transfer their training 'on-the-job' to colleagues at their facilities, to save costs while improving training coverage. This cross-sectional mixed-methods implementation study explored the consistency of this approach in practice and how healthcare worker knowledge of DMPA-SC differed between healthcare workers receiving formal and on-the-job training. The study, conducted in 2021, included a structured survey of healthcare workers (N = 192) across trained facilities in four regions in Ghana, plus key informant interviews with regional resource team members (n = 8), facility in-charges (n = 8), and formally-trained or on-the-job trained healthcare workers (n = 16). Descriptive statistics, equality-of-proportions tests, and logistic regressions (adjusting for clustering by facility) were used to compare quantitative outcomes between formally-trained and on-the-job trained healthcare workers. Qualitative results were analysed thematically and triangulated with quantitative results. Only 62% of eligible healthcare workers surveyed reported receiving any on-the-job training on DMPA-SC from a formally-trained colleague. Where implemented, on-the-job training was reported to vary in length and depth, with on-the-job trained healthcare workers typically reporting fewer training components and lower satisfaction with training than formally-trained counterparts. Both cohorts scored comparably in injectables counselling role-plays and demonstrated comparable attitudes towards injectables. However, formally-trained healthcare workers scored better in overall correct knowledge of DMPA-SC (59.6% versus 26.4%, aOR: 4.68, 95%CI: 1.98-11.07, p < 0.01) and recall of all five critical self-injection steps (65.4% versus 37.9%, aOR 3.52, 95%CI: 1.53-8.10 p < 0.01). This study found that on-the-job training had been inconsistently implemented, seemingly leading to incomplete knowledge transfer on DMPA-SC between healthcare workers. The authors recommended standardising on-the-job training and increasing supportive supervision to strengthen the approach.
This study aims to describe healthcare resource utilization (HCRU) and cost burden associated with COVID-19 cases in Ontario, Canada, and assess variations by vaccination status. We conducted a population-based retrospective cohort study using administrative health data from Ontario, focusing on COVID-19 cases from January 1, 2021, to May 31, 2023. Cases were identified by their first positive PCR test, and their healthcare interactions were followed for up to 12 months post-infection. All-cause HCRU and direct healthcare cost were compared before and after infection using generalized linear models. Data from a total of 1,321,174 COVID-19 cases were analyzed, with 87% having at least one healthcare interaction in the year preceding their infection. All-cause HCRU increased post-infection, with the greatest rise observed in the first month, largely attributable to hospitalizations (Mean [SD] hospitalizations per person per month [PPPM] at Month 1 vs. Look-back: 1.1 [0.3] vs. 0.1 [0.1], p < .0001) and ICU admissions (mean [SD] admissions PPPM at Month 1 vs. Look-back: 1.0 [0.1] vs. 0.1 [0.0], p < .0001). The healthcare cost per person rose in both the six and twelve months pre- versus post-infection. This increase is primarily attributable to ICU admission, hospitalization, and mechanical ventilation costs. On average, vaccinated individuals exhibited smaller increases in ICU costs (vaccinated: + CAD 5,838 to CAD 18,730 vs. unvaccinated: + CAD 24,597) and hospitalization costs (vaccinated: + CAD 623 to CAD 5,201 vs. unvaccinated: + CAD 9,072) six months post-infection compared to unvaccinated cases. Data from this study cohort suggests that COVID-19 strains healthcare resources, namely as a result of hospitalization and mechanical ventilation. Vaccinated individuals demonstrated a reduced burden compared to their unvaccinated counterparts. These findings underscore the importance of vaccination in reducing severe outcomes and healthcare costs, providing insights for public health strategies and individual patient counseling.
People seeking asylum (PSA) often experience complex health needs and barriers to healthcare access, yet no "gold-standard" framework for healthcare delivery exists. From July 2021 to March 2023, the 'Respond' service provided community-based holistic health assessments for PSA in temporary accommodation in North-Central London. This paper aims to describe the experience of the Respond pilot by analysing routinely collected retrospective clinical data and semi-structured interviews with service-users and key stakeholders. 86.2% of those eligible (1497/1736) attended the appointment. The majority of service-users were adults travelling alone (75.1%; 1125/1497) and male (75.9%; 1136/1497), with median age 28 years (IQR 23-36). Thirteen percent were children within 116 family units. Most common countries of origin were Iran (24%, 344/1497), Iraq (11.7%, 168/1497), and Afghanistan (9.5%, 136/1497). At least one health need was identified in 83.2% (1246/1497), of which 19.7% (201/1020) were acute health concerns. Half of all adults (52.6%, 634/1206) and 24.0% of children (29/121) had at least one asymptomatic infection. Mental health concerns were reported by 55.9% (669/1197) of adults. Developmental, behavioural or emotional concerns were raised by parents for 17.2% (26/151) of children. Safety concerns were reported by 14.6% (17/116) of families and 7.9% (94/1184) of adults. Service-users and stakeholders reported a positive experience of the holistic approach. Safety and rapport with staff were identified as key to disclosure of sensitive topics. Challenges were highlighted in provision of care for this population and the importance of cross-sectoral collaboration. We demonstrate high rates of engagement and acceptability of a bespoke, holistic healthcare service for PSA. We identified significant physical and mental health needs, and frequent asymptomatic infection in our population. Proactive assessment, by appropriately trained staff within dedicated, funded services is vital to address health needs and inequalities for this vulnerable population.
A public health emergency operations centre (PHEOC) is a hub for effective coordination of information and resources. Countries have established PHEOCs as part of the effort to strengthen their emergency management capabilities. However, there is limited documented evidence of best practices in PHEOC implementation in accordance with the world health organization PHEOC framework. A survey was conducted to document best practices and experiences in implementing PHEOCs in Ethiopia, Nigeria, and Senegal. Institutional and individual-level data on PHEOC implementation were collected between 6 December 2020 and 25 March 2021 through structured survey administered to regular and surge staff. An accuracy rate above 70% was considered adequate for knowledge of PHEOC operations, while individual emergency management competency was classified as adequate if the score was at least 3.5. Ethiopia and Nigeria established PHEOCs with legislation, while Senegal issued a ministerial directive. Senegal's PHEOC had better facilities, whereas the PHEOC in Ethiopia and Nigeria had facilities with limited capacity to meet surge demands. Plans and procedures were in place to guide the PHEOC operations and an incident management system to coordinate responses. The PHEOCs had skilled staff but were inadequate for large-scale emergencies. Senegal and Nigeria had well-established information systems to support PHEOC operations. All activated their PHEOC before detecting a coronavirus disease 2019 (COVID-19) case to coordinate readiness efforts. The staff was knowledgeable in PHEOC operations, with demonstrated capacity in emergency management. There were constraints in developing hazard-specific plans and funding. Overall, the three countries improved multisectoral coordination and emergency response capacity. Key lessons highlight the importance of strong legal mandates, standardized plans and procedures, trained routine and surge workforce, and functional information systems. These experiences provide valuable insights for other countries, although further efforts are needed to strengthen PHEOC systems.
Adolescents living with HIV face numerous psychosocial challenges that increase their vulnerability to mental health problems. However, limited evidence exists on the prevalence and contributing factors among this population in the Teso region of Uganda. This study assessed the prevalence of mental health problems and associated factors among adolescents living with HIV in the Teso region. A cross-sectional study was conducted among adolescents aged 10-19 years receiving HIV care in selected high-volume health facilities in the Teso region. Data were collected using the Home, Education/Employment, Activities, Drugs, Sexuality, Suicide/Depression psychosocial assessment tool (HEADSS tool), uploaded onto Kobo Collect for digital data collection. The data were exported to Microsoft Excel, cleaned, and analyzed using STATA version 17. Descriptive statistics were used to summarize sociodemographic characteristics and estimate the prevalence of mental health problems. Logistic regression analysis was used to identify factors associated with mental health problems. The prevalence of mental health problems was 35.2%, with suicidal tendencies being the most common (31%). Factors significantly associated with mental health problems included staying with one parent (AOR = 0.71; 95% CI: 0.55-0.92; p = 0.001) and not working (AOR = 4.4; 95% CI: 1.66-11.62; p = 0.03). Mental health problems are prevalent among adolescents living with HIV in the Teso region. Supportive living arrangements were protective, while employment was associated with increased risk. Peer-led screening can aid early identification, emphasizing the need to integrate mental health services into adolescent HIV care, strengthen family and caregiver support.
Oral diseases are the most prevalent non-communicable diseases worldwide, affecting 3.5 billion people, with a disproportionate impact on those living in low- and middle-income countries. Despite being largely preventable through proper oral hygiene, current oral health promotion strategies rely heavily on plastic and nylon toothbrushes, which present both environmental and accessibility challenges. In response to the growing need for sustainable and affordable preventive oral health solutions, there has been increasing interest in alternatives to conventional toothbrushes. This scoping review aimed to summarize the global literature on silicone toothbrushes, an underutilized tool in preventive oral care. A systematic search of five databases, supplemented by reference screening, identified ten English-language studies investigating silicone toothbrushes. Findings suggest that silicone toothbrushes are effective in plaque removal, have a lower risk of gingival trauma, are well-suited for specific populations, and perform better in environmental impact assessments. This review also demonstrated that silicone toothbrushes remain under-researched and underutilized, highlighting the need for further high-quality studies to evaluate their effectiveness, safety, and broader implementation.
Nature prescriptions allow healthcare providers to recommend nature connection and exposure for health and well-being benefits. However, an accepted interdisciplinary shared definition of nature prescription is currently lacking, as are frameworks to guide the use of nature prescription in healthcare. To help fill this knowledge gap, we used an international modified Delphi technique to develop a framework for nature prescribing in healthcare by interdisciplinary experts. Round 1 consisted of virtual focus groups with an expert panel to generate a preliminary framework and framework statements through a qualitative approach, followed by Round 2 to establish agreement, set a priori as ≥75%, on statements to be included in the presented framework. Eight expert panellists participated in the consensus building process, developing and agreeing on 146 statements. The framework consists of: (1) Defining nature prescriptions; (2) Human benefits and risks; (3) Environment benefits and risks; (4) Society and Culture contextual factors and perspectives, acknowledgement of Indigenous knowledges, and equity; (5) Planetary health as a positive feedback loop between the benefits for people and environments; (6) Future directions to aid moving knowledge and implementation of nature prescribing forward. We report an overview of the benefits and risks of nature prescriptions, their potential planetary health impacts, and how they can be equity-driven by incorporating social and cultural differences. This international and interdisciplinary framework for nature prescribing in healthcare offers itself as a guide for the utilization of nature prescriptions in healthcare, and proposes recommendations for research, education, and clinical practice.
During outbreaks women struggle to access essential health services, including services for violence. Services may be disrupted or deprioritised, or women may avoid clinical settings. We conducted a scoping review to understand how health services for violence against women (VAW) were affected in low- and middle-income (LMIC) settings during recent outbreaks, and how women sought help following violence. We reviewed published academic literature reporting on primary research from LMIC settings during recent outbreaks (Ebola, Zika and COVID-19). Four databases were searched: Medline, Embase, Global Health, and Global Index Medicus. Thirty two papers met the inclusion criteria. Data were extracted using a thematic framework focusing on both the supply and demand for services. Experiences during COVID-19 were overrepresented, with no studies identified from other outbreaks. Research spanned 20 countries including a range of services and populations. In the face of lockdowns and reorientation of the health system towards COVID-19, VAW services were restricted or closed despite being essential. Many settings reported shifting services online or to telehealth platforms, raising concerns about digital access and safety, particularly when women accessed services from spaces shared with a violent partner. Some other adaptations included the use of community volunteers and the provision of cash assistance for survivors. Help-seeking varied, with some healthcare settings reporting increases and others decreases in the number of survivors presenting, likely reflecting fluctuating restrictions. Women experiencing violence often sought help from informal sources such as community leaders and family. Help-seeking was further constrained by the economic crisis accompanying COVID-19, including food insecurity and transportation challenges. To prepare for future outbreaks, research is needed to identify which services can be safely and equitably delivered online, and which require in-person provision, as well as to understand a broader range of emerging practices for adapting services to physical distancing, movement restrictions, and economic stress.
Despite growing investment in digital health for immunization, there is limited evidence on how gender is considered into design and implementation. In 2022, Ethiopia launched a Gender-intentional Digital Health Information Roadmap with the support of Gavi, the Vaccine Alliance; however, the operationalization of gender strategies remains unclear. This qualitative study explored gender inclusiveness in digital health for immunization in Ethiopia, drawing on document reviews, participatory workshops, key informant interviews, and stakeholder analysis across selected three regions in Ethiopia. Findings revealed that women dominate frontline roles as caregivers and vaccinators but remain underrepresented in supervisory, leadership, and digital system development positions. Although gender strategies and units exist, implementation is weak, with limited gender awareness and no intentional planning. In addition, a notable gender digital divide persists. Senior leadership role assignments, despite competence, depend on ability for women to balance responsibilities and travel with household duties. The routine health data systems, like District Health Information Software, version 2, lack sex-disaggregated immunization data, hindering gender-informed decision making. Enabling factors include national prioritization of gender equity, empowerment programs, and partner support, whereas barriers include cultural norms, inadequate advocacy, weak accountability, and insufficient resources. Embedding gender-transformative approaches is vital for equitable, inclusive digital health information and associated health system and immunization outcomes in Ethiopia.
Although older adults' care extends beyond strictly medical concerns, access to healthcare services remains a major challenge at this stage of life. The increasing demand for healthcare often coincides with declining functional abilities, cessation of income-generating activities, and insufficient coverage by social protection systems. This study aimed to estimate the medical expenses incurred during routine consultations by older adults in Yaoundé, in the absence of universal health coverage, and to identify the methods used to finance these healthcare costs. A descriptive, cross-sectional, quantitative study was conducted in four health facilities in Yaounde between February and March 2023. The study included individuals aged 60 and above who attended outpatient consultations at the selected facilities and were recruited after their medical appointments. A total of 170 participants were included, with a mean age of 68.4 years. Most respondents lived in socially and economically vulnerable conditions, particularly women. Cardiovascular, musculoskeletal, and urological conditions accounted for 70.5% of consultation reasons. Hypertension was the most common comorbidity (28.2%), followed by rheumatic disorders (21.1%) and diabetes (19.7%). The average cost of a routine medical consultation, including medications and diagnostic tests, was 42,958 XAF (approximately €65.49). In 90.6% of cases, care was financed through direct out-of-pocket household payments. In Cameroon, healthcare expenses for older adults are primarily borne by households, which limits access to care for those with low incomes. Implementing a more inclusive and equitable health system, integrated into a comprehensive social protection policy, is essential to meet the growing needs of this vulnerable population.
Health system challenges limit uptake of early infant diagnosis of HIV (EID). Context-appropriate strategies are required to achieve global 95% six-week testing target. We evaluated a co-designed context-appropriate enhanced health system (EEHS) intervention to strengthen client identification, appointment booking systems, leadership, and facility-based training to improve enrolment of Infants Exposed to HIV (IEH) in HIV care and testing at six weeks. We conducted a before-after intervention evaluation (15 October 2022-5 June 2023) at one urban and rural primary health facilities in Blantyre, Malawi. During pre-intervention period (15 October 2022-18 January 2023), women received standard-of-care EID services. In post-intervention period (19 January to 5 June 2023), women received EID services with EEHS intervention. Data was extracted for women living with HIV and IEH at birth to six weeks. Outcomes were proportion of IEH tested at six weeks (primary) and enrolled in HIV care at birth (Secondary). Logistic regression models were fitted to compute odds ratios (ORs) and 95% confidence intervals (CI). We enrolled 60 women with IEH: 11/60 (18.3%) in rural and 11/60 (18.3%) urban before intervention versus 6/60 (10%) in rural and 54/60 (90%) in urban post-intervention. Median age was 27.5 (interquartile range (IQR), 23-31) pre-intervention and 28 (IQR, 23-32) post-intervention. Six-weeks HIV testing of IEH improved post intervention versus pre-intervention from 46/58 (79%) to 43/46 (93%) (OR 3.74, 95% CI: 1.10-17.23; p = 0.052), with a statistically significant association in adjusted analysis (aOR 4.35, 95% CI: 1.21-21.25) p = 0.038). Enrolment of IEH in HIV care at birth post-intervention increased from 47/60 (78%) to 55/60 (92%) (OR 3.04: 95% CI 1.06-10.06, p = 0.048), with a statistically significant association in adjusted analysis (aOR 3.33: 95% CI 1.13-11.25, p = 0.036). EEHS intervention, potentially improves IEHs' enrolment in HIV care and six-weeks HIV testing, addressing health system challenges, however it requires validation through randomised studies.
This study aimed to investigate the experiences and perceptions of caregivers seeking healthcare services for children with Down Syndrome, and those of healthcare providers offering these services in Karachi, Pakistan. A total of 23 In-depth interviews were conducted with the study participants comprising of 10 caregivers (mothers and fathers) and 13 healthcare providers (paediatricians and therapists). Participants were selected through purposive sampling and interviewed using a semi-structured interview guide at a private NGO and a tertiary care hospital. The collected data underwent deductive content analysis, guided by the socio-ecological framework, to comprehensively explore the various factors. Experiences clustered across socio‑ecological levels. Intrapersonally, caregivers moved from shock and grief to faith‑based acceptance that sustained caregiving. Interpersonally, delayed/missed diagnosis, inadequate antenatal recognition, and scarce post‑diagnostic counselling forced families to self‑navigate care amid inconsistent provider engagement. Organizationally, high costs prompted reliance on NGOs; limited specialized services, long waits, and therapist burnout constrained individualized therapy. Community factors included service concentration in Karachi, long travel/relocation, financial burden, and pervasive stigma that curtailed social inclusion and lowered parental expectations. Policy gaps included absent DS‑specific clinical/counselling guidelines and poor epidemiologic data; participants prioritized a national registry to enable follow‑up and coordination. Education was a dominant, unmet need restricted by school policies and costs and often overshadowed health concerns. This study emphasizes the urgent need for system-level reforms and coordinated interventions to improve care pathways for children with Down syndrome in Pakistan. These changes are crucial for ensuring equitable access to timely, quality care for affected families, improving health outcomes, and supporting fuller social inclusion.
Human Immunodeficiency Virus, the retrovirus that causes Acquired Immune Deficiency Syndrome, is a major global public health threat. This chronic viral infection diminishes the immune system by attacking CD4 cells. The principal treatment is antiretroviral medication (ART), which significantly increases the life expectancy of HIV patients. However, ART does not address psychological issues, including depression, anxiety, and stress. Psychosocial factors are known to influence HIV disease progression through activation of stress-related biological pathways, including the hypothalamic-pituitary-adrenal (HPA) axis, inflammatory cytokine responses, and monoamine neurotransmitter dysregulation. Mind-body practices such as yoga may modulate these pathways by reducing physiological stress, improving emotional regulation, and enhancing overall well-being. The current trial aims to assess the effectiveness of yoga as an adjunct therapy on psychological parameters (depression, anxiety, and stress), quality of life, and medication adherence of people living with HIV on antiretroviral therapy at a tertiary care hospital in AIIMS, New Delhi, India. This study is a two-arm, parallel-group, open-label, blinded-endpoint, single-center, randomized controlled trial investigating the effects of a yoga therapy as an adjunct therapy in people living with HIV (PLHIV). Participants (n = 192) will be randomized to either 12 weeks of a Yoga therapy program (n = 96) or an Active control group, i.e., a prescribed brisk walk (n = 96). Both groups will receive standard treatment. The primary outcome is anxiety and depression scores (HADS-A and HADS-D), and the secondary outcomes are Stress (PSS), quality of life (WHOQOL-HIV BREF and SF-36 QoL), and medication adherence. The findings of this RCT will help shed light on yoga intervention to address the psychosocial dimensions of HIV. If shown to be effective, yoga as an adjunct intervention may promote a transition in HIV care from a predominantly biomedical framework to a holistic, patient-centered approach encompassing mental health and overall well-being. The study is approved by Institute Research Board Ethics (AIIMSA2969/03.01.2025, RP-46/25, OP-16/02.05.25, OP-18/05.12.2025) and is registered at Clinicaltrials.gov (CTRI/2025/03/081645). CTRI Link- https://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTIyNjUx&Enc=&userName=HIV,%20Yoga.
Hepatitis C virus (HCV) remains a major public health challenge in the Eastern Mediterranean Region (EMR), with prevalence varying across population groups. This umbrella review summarizes the distribution of HCV infection across diverse populations in the region. We conducted an umbrella review of systematic reviews with meta-analyses reporting HCV prevalence in the EMR. PubMed, Web of Science, Scopus, Iranian databases, including Magiran and the Scientific Information Database (SID), were searched. Google Scholar was additionally screened to ensure comprehensive coverage. Pooled estimates were extracted across four population groups: apparently healthy individuals; those with clinical or healthcare-associated exposure risk; patients co-infected with hepatitis viruses or other liver-related diseases; and key populations at increased risk (groups disproportionately affected due to their behaviors and higher vulnerability). For time-period analyses, meta-analyses were grouped into two intervals (before 2015 vs. 2015 and after) based on the median year of data collection of primary studies. Pooled prevalence was calculated using a random-effects model in STATA version 17. A total of 55 meta-analyses were included. The pooled HCV prevalence was 31.0% (95% CI: 27.0-38.0) among key populations, and also 31.0% (95% CI: 12.0-49.0) among patients co-infected with other hepatitis viruses or liver-related diseases. Those with clinical or healthcare-associated exposure risk showed a prevalence of 28.0% (95% CI: 23.0-32.0), whereas the apparently healthy population had the lowest prevalence at 2.0% (95% CI: 1.0-2.0). Subgroup analysis indicated a decline in prevalence among clinically exposed populations after 2015, from 29% to 10%, coinciding with the direct-acting antivirals (DAAs) and strengthened infection-control practices. The highest prevalence was observed among key populations in Libya, healthcare-exposed populations in Morocco, and apparently healthy individuals in Egypt. Variation in HCV prevalence across populations in the EMR highlights the need for population-specific strategies to support progress toward World Health Organization elimination targets.
Melioidosis is a clinical disease in humans and animals following infection with the soil and water bacterium Burkholderia pseudomallei. The global footprint of melioidosis has been rapidly expanding, but it remains unclear how much this represents unmasking of longstanding but previously unrecognised presence of B. pseudomallei and how much is from recent dispersal of B. pseudomallei. What is now clear is that the predicted establishment of B. pseudomallei in the southern United States has eventuated, with melioidosis endemic in Mississippi and likely to be endemic in Georgia and Texas. It is now time to move beyond concern of B. pseudomallei as a biothreat agent and to pivot towards addressing the gaps in public health responses to the enigmatic disease that it causes.
Hepatitis B virus (HBV) infection is a significant occupational risk for laboratory practitioners. Despite proven vaccine effectiveness and global recommendations, HBV vaccine uptake among healthcare workers in Tanzania remains low. This study assessed HBV vaccination uptake and its determinants among laboratory practitioners in tertiary hospitals in Dar es Salaam. An analytical cross-sectional study was conducted from March to June 2025 across four tertiary hospitals, enrolling 130 participants using the Kish-Leslie formula. Data were collected using a structured, pre-tested, interviewer-administered questionnaire and verified vaccination records, and analyzed with IBM SPSS v27. Descriptive statistics summarized participant characteristics, and associations were assessed using chi-square, Fisher's exact tests, and log-binomial regression with robust variance. Of 130 participants (median age 30 years, IQR: 25-36), 54.6% (71/130) completed the three-dose hepatitis B vaccination schedule, 23.8% (31/130) received partial doses, and 21.5% (28/130) were unvaccinated. Among the partially vaccinated, missed appointments (48.4%, 15/31) and lack of vaccine availability (41.9%, 13/31) were the main reasons. Half of the unvaccinated (50.0%, 14/28) cited lack of opportunity. Most participants knew the vaccine is essential (99.2%, 129/130), and 94.1% (96/102) acknowledged three doses are required for full protection. Although females, those with longer work experience, and those perceiving high exposure risk had higher vaccination prevalence, none of these associations reached statistical significance in univariate or multivariable analyses. HBV vaccine uptake among laboratory practitioners in Dar es Salaam is suboptimal, mainly due to structural barriers. Strengthening workplace vaccination programs, ensuring consistent vaccine supply, and implementing reminder systems could improve healthcare worker protection.
During the COVID-19 pandemic, many countries used real-time data analyses, predictive modelling, and COVID-19 case forecasts, to incorporate emerging evidence into their decisions. In Australia, national and jurisdictional public health responses were informed by weekly ensemble forecasts of daily COVID-19 case counts for each of Australia's eight states and territories, produced by a consortium of researchers under contract with the Australian Government. As members of this consortium, who produced these forecasts at each week, we now retrospectively evaluate approximately 100,000 predictions for daily case counts 1-28 days into the future, generated between July 2020 and December 2022, and report here (a) how the ensemble forecasts supported public health responses; (b) how well the ensemble forecast performed, relative to the forecasts produced by each contributing team; and (c) how we refined our reporting and visualisations to ensure that outputs were interpreted appropriately. Similar to COVID-19 forecasting studies in other countries, we found that the ensemble forecast consistently out-performed the individual model forecasts, and that performance was lowest when there were rapid changes in the epidemiology, such as periods around epidemic peaks. Our consortium's internal peer-review process allowed us to explain how features of each ensemble forecast related to the design of the individual models, and this helped enable public health stakeholders to interpret the forecasts appropriately. Ultimately, our forecasts provided information that supported public health responses during periods of different policy goals, and over a wide range of epidemic scenarios.
Occupational diseases affect many workers in the United States, with Latinos disproportionately affected. Small businesses face barriers to implementing workplace health protections that community health workers (CHWs) may help overcome. The objective of this study was to determine whether a CHW-led industrial hygiene intervention could reduce volatile organic compound (VOC) exposure in small auto repair and beauty shops that primarily employ marginalized workers. In this two-arm, parallel, cluster randomized trial, small business (≤25 employees) auto repair and beauty shops in Tucson, AZ were randomized to immediate or delayed intervention, stratified by sector. CHWs assessed shops and provided knowledge of controls and $300 for new ones. Total VOCs (TVOCs) were measured using photoionization detectors placed on or near participants. The primary outcome was the change in TVOCs at the shop level after the intervention, assessed across three timepoints with four workshift measurements per assessment. Mixed-effects models accounted for clustering by shop. We enrolled 38 auto repair shops and 46 beauty shops (73% Latino workers) and analyzed 846 workshift measurements at 236 shop assessments. Adjusted models showed a non-statistically significant intervention effect: auto shops experienced on average an estimated 28% TVOC increase (95% CI: -46% to 203%); beauty shops experienced on average an estimated 27% reduction (95% CI: -55% to 19%). Beauty shops had TVOC concentrations about 10 times higher than auto shops, and 87% of their assessments had ventilation rates below the recommended minimum. Although not statistically significant, the CHW-led intervention may meaningfully reduce VOC exposure in beauty shops. High TVOC concentrations and inadequate ventilation in beauty shops highlight the need for targeted interventions and policy changes to improve the air quality in these underserved small businesses. This trial was registered with clinicaltrials.gov (NCT03455530) on March 6, 2018.
In November 2020, an alert for a "mysterious disease" among fishermen was issued. Fishermen are particularly subjected to dermatoses due to their constant contact with seawater, fish, crustaceans, and fishing equipment that may contain harmful agents. The study aimed to examine the alert, identify the causative agent and suggest preventive and control measures. This was a cross-sectional study of dermatoses in Dakar (Senegal) from October 11 to November 30, 2020, using quantitative and qualitative methods within a 'One Health' approach." The investigation included bacterio-virological, anatomopathological and toxicological examinations. Data were analyzed using Epi info and QGIS (case mapping), We observed all confidentiality measures during the study. A total of 555 cases were diagnosed with an attack rate of 5.4% among fishermen and no deaths were reported. There was a delay in epidemic detection and notification. The epidemic was most prevalent among people from coastal areas. Average age of cases was 22 ± 9 years, and all were male and artisanal fishermen by profession. Patients presented with fever (16%), cutaneous pain (100%) and mucocutaneous lesions (100%) consisting of vesicles, papules and ulcerations localized on exposed areas of the body, external genitalia and oral mucosa, with severe cases (8%). Toxicology revealed the presence of a toxic alga (V. rugosum) in marine equipments. The notion of a sea trip in the 24-48 hours before the onset of the disease was found in 92%. Majority of cases (74%) did not have full personal protective equipment (PPE). The proportion of people without full protection was 83% among those who developed severe forms. People without full protection were more exposed to severe forms than those with full PPE; (OR = 1.818; 95% CI [0.829 - 3.988]). The investigation has linked the epidemic to a probable algal origin. We need to promote the use of personal protective equipment and improve the early warning and notification system.
This systematic review examined the effects of yoga interventions on various cardiometabolic health outcomes in adults with overweight or obesity. Seven major electronic databases and two clinical trial databases were searched from inception to November 2024. The search strategy combined keywords related to yoga, blood pressure, lipids, glucose, redox, and inflammation. Two authors independently screened the articles to identify randomized controlled trials that compared yoga alone with either an inactive control group or other types of physical activity interventions among adults with overweight or obesity. Outcome changes were analyzed using a random-effects meta-analysis model. We assessed the risk of bias in individual studies using the Risk of Bias 2 tool and evaluated the quality of evidence for each outcome using GRADEpro. We identified 30 randomized controlled trials comprising a total of 2,689 participants that met our eligibility criteria. Although most studies (25/28) did not explicitly recruit individuals with obesity, the mean baseline BMI of participants met our inclusion criteria for overweight or obesity. Twenty-three randomized controlled trials involving 2,313 participants were included in the meta-analyses, which demonstrated that yoga practices likely have substantial beneficial effects on systolic blood pressure (-4.35 mmHg), diastolic blood pressure (-2.06 mmHg) and modest effects below the minimal clinically important differences on lipid profiles (low-density lipoprotein cholesterol -0.08 mmol/L, high-density lipoprotein cholesterol +0.06 mmol/L) with moderate quality evidence. Yoga may also have positive effects on glucose, redox, and inflammation parameters, although the evidence remains uncertain. Ethnic differences and dose‒response effects were found in subgroup analyses. Further high-quality studies among Asian populations, as well as additional research in non-Asian populations, are needed to strengthen the evidence base and enhance generalizability. This study provides evidence supporting the inclusion of yoga in clinical guidelines for the treatment of individuals with overweight or obesity. Protocol registration: International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) (ID: 2023100068).