Evaluation of the utility of group-based physical activity among university students: a systematic review protocol.

INTRODUCTION: Sedentary behaviours are a prevalent issue among university students worldwide. The negative impact of low physical activity (PA) levels among university students on mental and physical health is well-documented. Regular PA is linked to numerous health benefits and protects against non-communicable diseases. While group-based physical activity (GBPA) interventions show promise, their effectiveness in increasing PA levels among university students remains uncertain. This review aims to identify, evaluate and elucidate the key determinants of successful GBPA interventions tailored to this population. METHODS AND ANALYSIS: We will search articles from PubMed, Web of Science, SPORTDiscus via EBSCOhost, Africa-Wide, PsycInfo and Cumulative Index to Nursing and Allied Health Literature. We will perform article screening, data extraction and quality assessment of eligible studies in duplicate. The risk of bias in individual studies will be assessed using the Cochrane Collaboration tool for randomised control trials, Risk Of Bias In Non-randomised Studies - of Interventions for non-randomised interventional studies and Risk of Bias in Non-randomised Studies - of Exposure. We will conduct a narrative synthesis of the findings. If there is homogeneity of primary outcomes, we will perform a meta-analysis to appraise evidence across studies. The Grading of Recommendations Assessment, Development and Evaluation will be used to synthesise the quality of evidence across studies. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review protocol; we will analyse published primary studies. Findings will be published in a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER: CRD42024553196

Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): a randomised controlled trial of exercise-based rehabilitation.

OBJECTIVE: Post-COVID syndrome involves prolonged symptoms with multisystem and functional impairment lasting ≥12 weeks after acute coronavirus disease 2019 (COVID-19). We aimed to determine the efficacy of exercise-based rehabilitation interventions, either face-to-face or remote, compared to usual care in individuals experiencing post-COVID syndrome following a hospitalisation with acute COVID-19. DESIGN: This single-blind randomised controlled trial compared two exercise-based rehabilitation interventions (face-to-face or remote) to usual care in participants with post-COVID syndrome following a hospitalisation. The interventions were either a face-to-face or remote 8-week programme of individually prescribed exercise and education. The primary outcome was the change in Incremental Shuttle Walking Test (ISWT) following 8 weeks of intervention (either face-to-face or remote) compared to usual care. Other secondary outcomes were measured including health-related quality of life (HRQoL), and exploratory outcomes included lymphocyte immunotyping. RESULTS: 181 participants (55% male, mean±sd age 59±12 years, length of hospital stay 12±19 days) were randomised. There was an improvement in the ISWT distance following face-to-face rehabilitation (mean 52 m, 95% CI 19-85 m; p=0.002) and remote rehabilitation (mean 34 m, 95% CI 1-66 m; p=0.047) compared to usual care alone. There were no differences between groups for HRQoL self-reported symptoms. Analysis of immune markers revealed significant increases in naïve and memory CD8+ T-cells following face-to-face rehabilitation versus usual care alone (p<0.001, n=31). CONCLUSION: Exercise-based rehabilitation improved short-term exercise capacity in post-COVID syndrome following an acute hospitalisation and showed potential for beneficial immunomodulatory effects

Joint modelling of longitudinal data: a scoping review of methodology and applications for non-time to event data.

BACKGROUND: Joint models are powerful statistical models that allow us to define a joint likelihood for quantifying the association between two or more outcomes. Joint modelling has been shown to reduce bias in parameter estimates, increase the efficiency of statistical inference by incorporating the correlation between measurements, and allow borrowing of information in cases where data is missing for variables of interest. Most joint modelling methods and applications involve time-to-event data. There is less awareness about the amount of literature available for joint models of non-time-to-event data. Therefore, this review's main objective is to summarise the current state of joint modelling of non-time-to-event longitudinal data. METHODS: We conducted a search in PubMed, Embase, Medline, Scopus, and Web of Science following the PRISMA-ScR guidelines for articles published up to 28 January 2024. Studies were included if they focused on joint modelling of non-time-to-event longitudinal data and published in English. Exclusions were made for time-to-event articles, conference abstracts, book chapters, and studies without full text. We extracted information on statistical methods, association structure, estimation methods, software, etc. RESULTS: We identified 4,681 studies from the search. After removing 2,769 duplicates, 1,912 were reviewed by title and abstract, and 190 underwent full-text review. Ultimately, 74 studies met inclusion criteria and spanned from 2001 to 2024, with the majority (64 studies; 86%) published between 2014 and 2024. Most joint models were based on a frequentist approach (48 studies; 65%) and applied a linear mixed-effects model. The random effect was the most commonly applied association structure for linking two sub-models (63 studies; 85%). Estimation of model parameters was commonly done using Markov Chain Monte Carlo with Gibbs sampler algorithm (10 studies; 38%) for the Bayesian approach, whereas maximum likelihood was the most common (33 studies; 68.75%) for the frequentist approach. Most studies used R statistical software (33 studies; 40%) for analysis. CONCLUSION: A wide range of methods for joint-modelling non-time-to-event longitudinal data exist and have been applied to various areas. An exponential increase in the application of joint modelling of non-time-to-event longitudinal data has been observed in the last decade. There is an opportunity to leverage potential benefits of joint modelling for non-time-to-event longitudinal data for reducing bias in parameter estimates, increasing efficiency of statistical inference by incorporating the correlation between measurements, and allowing borrowing of information in cases with missing data

Participant perceptions of disability training for health workers: a qualitative study in Ghana.

BACKGROUND: Disabled people often report poor treatment by health workers, and health workers often report wanting more training about how to care for disabled people. However, existing disability training for health workers is usually delivered in one-off interventions, with little follow-up, evaluation, and focus on long-term learning. This insufficiency makes it important to understand how disability training for health workers can be more effective. Therefore, we interviewed stakeholders involved in an existing disability training intervention in Ghana. The aim of the study was to understand how disability training for health workers could be improved by exploring the perspectives of individuals who were involved in previous training interventions. METHODS: A phenomenological study was conducted. In-depth, qualitative interviews were conducted with 33 people (17 trainers and 16 trainees) involved in disability training in Ghana. Data were analysed using thematic analysis. RESULTS: Participants spoke about the challenges with existing training, namely how the current approach was insufficient, the consequences of informality in running training and the need for more sign language instruction. Several participants suggested improvements for training, including having external motivation (i.e., professional development credits, monetary benefits, etc.), more collaborative initiatives across institutions and government, and curriculum integration. We developed a theory of change model to show how different components of disability training support learning. CONCLUSIONS: These results show that disability training for health workers is important and that there is scope to refine and standardize training. In particular, the findings demonstrate how future initiatives to train health workers can be developed and implemented. They also emphasize the need to solicit perspectives from individuals who have experienced training in order to improve future iterations

The overlapping global distribution of dengue, chikungunya, Zika and yellow fever.

Arboviruses transmitted mainly by Aedes (Stegomyia) aegypti and Ae. albopictus, including dengue, chikungunya, and Zika viruses, and yellow fever virus in urban settings, pose an escalating global threat. Existing risk maps, often hampered by surveillance biases, may underestimate or misrepresent the true distribution of these diseases and do not incorporate epidemiological similarities despite shared vector species. We address this by generating new global environmental suitability maps for Aedes-borne arboviruses using a multi-disease ecological niche model with a nested surveillance model fit to a dataset of over 21,000 occurrence points. This reveals a convergence in suitability around a common global distribution with recent spread of chikungunya and Zika closely aligning with areas suitable for dengue. We estimate that 5.66 (95% confidence interval 5.64-5.68) billion people live in areas suitable for dengue, chikungunya and Zika and 1.54 (1.53-1.54) billion people for yellow fever. We find large national and subnational differences in surveillance capabilities with higher income more accessible areas more likely to detect, diagnose and report viral diseases, which may have led to overestimation of risk in the United States and Europe. When combined with estimates of uncertainty, these suitability maps can be used by ministries of health to target limited surveillance and intervention resources in new strategies against these emerging threats

Progress and challenges in Nipah vaccine development and licensure for epidemic preparedness and response.

INTRODUCTION: Nipah virus is a high-consequence pathogen that causes sporadic outbreaks with high mortality, and there are currently no vaccines or therapeutics available for Nipah. Vaccine development against Nipah faces challenges due to its current epidemiology with limited outbreak sizes, which impedes the feasibility of conducting vaccine efficacy trials focused on disease endpoints. AREAS COVERED: We review the progress of Nipah vaccine candidates in human clinical trials and highlight the challenges in evaluating the vaccine efficacy due to the sporadic nature of Nipah outbreaks, given the epidemic potential of Nipah virus and its implications for pandemic preparedness. We examine the alternative regulatory pathways, including the US FDA's Animal Rule and EMA's conditional marketing authorization, which permit vaccine approval based on surrogate markers rather than efficacy data from the large-scale Phase-3 efficacy trials. The need for standardized immune surrogate markers is emphasized, alongside calls for international collaboration to develop such endpoints and manage stockpile strategies. EXPERT OPINION: We recommend alignment among vaccine developers, regulators, and global health stakeholders to incentivize Nipah vaccine development and approval through alternative regulatory pathways, as well as ensuring epidemic preparedness via strategic vaccine stockpiling and response through targeted deployment strategies

Blood Transfusions for Chronic Malaria Anemia in Prisoners of War on the Thai-Burma Railway 1943-1945.

Allied prisoners of war (POWs) working on the Imperial Japanese Army's railroad from Thailand to Burma during 1943-1945 devised a blood transfusion service to rescue severely ill fellow prisoners who were otherwise unlikely to survive the war. Extant transfusion records (1,251 recipients, 1,189 donors) in ledger books held by the United Kingdom National Archives at Kew were accessed and analyzed. Survival to the end of the war in 1945 was determined from Commonwealth War Graves Commission records. The records examined indicate that freshly donated whole blood was manually defibrinated and transfused after crossmatches based on POW medic sera. Overall survival to the end of the war was 74% in recipients and 88% in donors. Postwar survival rates were significantly higher for transfusion recipients with malaria (89.3%) than for other diagnoses: 52.6% for malnutrition, 59.3% for dysentery, 67.2% for skin ulcers, and 75.4% for other causes (odds ratio: 3.97; 95% CI: 2.79-5.28; P <0.0001). By 1945, the vast majority of blood transfusions were given for severe anemia caused by chronic relapsing vivax malaria. Although the POW situation was admittedly extreme, our data provide evidence that blood transfusions to treat severe anemia were associated with higher survival among patients with Plasmodium vivax infection than among those with other morbidities

Hybrid, vaccine-induced and natural immunity against SARS-CoV-2 in traditional food markets in Bolivia (2020-2022): A cross-sectional analysis of a serological survey.

BACKGROUND: In low-and middle-income countries, market vendors played a crucial role in food security during the coronavirus pandemic. High numbers of contacts, combined with social, political and health system upheaval in Bolivia, meant they were highly exposed to SARS-CoV-2 infections. METHODS: Demographic, clinical and serological data were collected at survey rounds between 2020 and 2022 from a cohort of market vendors in two purposively selected markets where the community and researchers co-promoted health and safety. We used these longitudinal data to examine SARS-CoV-2 anti-spike antibody levels between those vaccinated with and without previous infection and those unvaccinated. The association between antibody levels, and vaccine status, socio-demographic and health information was assessed using linear regression. FINDINGS: A total of 213 market vendors had repeated serological sampling in July, and November 2021, and again in May 2022. In November 2020, 105 (49.3 %) of this cohort had participated in a pre-vaccination municipal serological survey. Seroprevalence then was 45·7 % (95 %CI 36·3-55·4). By November 2021, 67·8 % of the full cohort had one vaccination and seroprevalence was 83·6 %. We showed IgG levels in those seropositive were higher in participants with evidence of vaccination and prior infection compared to those unvaccinated. By May 2022, the majority of participants developed antibodies against SARS-CoV-2, and these differences were attenuated. INTERPRETATION: A substantial proportion of vendors were susceptible to SARS-CoV-2 in late 2020 when, nationally, excess mortality was high. Our analyses suggested a combination of natural infection and vaccination provided better protective antibody levels than natural infection alone at the peak of the pandemic. Future pandemic planning requires timely targeted serological surveys to understand pandemic dynamics and support prompt interventions. In addition, communication with organized communities can inform effectiveness of pandemic mitigation strategies including improved vaccination uptake. Timely quantitative IgG level monitoring can also inform waning immunity. FUNDING: This study was supported by the Medical Research Council and a National Institutes for Health and Care Research (NIHR) Global Effort on COVID-19 (GECO) Health Research award 2020 [MR/V028561/1]

First referral hospitals in low-resource settings: a narrative review of expectations for clinical service provision.

First referral hospitals (FRHs) have an important role to play in helping many countries achieve 'Health for All'. However, their specific role and the clinical services they are expected to provide to achieve this are evolving. To explore this issue further, we undertook a narrative review to examine the clinical service expectations of FRHs outlined in academic and policy literature, which identified a total of 404 FRH service expectations. At a global level, some categories of services provide extensive specific service recommendations, likely resulting from historical priorities and the influence of vertical programming and professional interests. However, in several important areas we identified few or no recommendations. At the level of individual country case studies undertaken through this review, FRH clinical service recommendations within available policy documents vary considerably. Our findings suggest a disconnect between the ambition for FRH and the difficult, context-specific decision-making needed at the national level on the role of FRHs as a service delivery platform within integrated health systems helping countries achieve universal health coverage

The association between residential segregation and stillbirths in Brazil-a cross-sectional study.

BACKGROUND: Segregation is the degree to which two or more groups live separately. While US research has linked segregation to increased stillbirth risk, studies from Latin America have yet to explore this. This study investigated the association between the racial and income segregation index (SI) and stillbirth prevalence in Brazil. METHODS: We used nationwide birth data from Brazil in 2018 (live births from Live Birth Information System, SINASC, and stillbirths from Mortality Information System, SIM). Income and racial SI were calculated using the 2010 national census and analyzed as quintiles with the least segregated group as the reference. Odds ratios were calculated using a logistic regression model, adjusting for infant sex, maternal age, education, previous fetal loss, and the municipal level percentage of the population earning less than half the minimum wage. The sub-analysis was stratified by city size, area-level stillbirth prevalence, and stillbirth type (intrapartum or antepartum). RESULTS: Two million seven hundred seventy-one thousand two hundred seventy-two live-born and stillborn in 2018 were included in the analysis. Women in municipalities with high income and racial SI were older, had more education, and had more previous fetal loss. Women in municipalities with the highest income SI had a 25.1% higher risk of delivering a stillbirth (95% CI: 1.202-1.303). Those in the highest racial SI municipalities had a 5.5% lower risk of delivering a stillbirth compared to those in the quintile with the lowest racial SI (95% CI: 0.908-0.984). In regions with low stillbirth prevalence, a dose-response relationship was observed between income segregation and stillbirth, with the risk of stillbirth among those with the highest income SI being more than twice that of the least segregated (OR 2.086, 95% CI: 1.494-2.911). In larger cities, racial and income segregation were associated with reduced odds of stillbirth. The effect of income SI was larger for intrapartum stillbirths. CONCLUSIONS: We observed that income segregation increases the odds of stillbirth, especially in municipalities with low stillbirth prevalence, while the association for racial segregation was less consistent