How social norms influence processes of change related to an economic intervention in Bangladesh

Intimate partner violence (IPV) occurs due to multiple factors at the individual, relational, community and societal levels. Previous research has shown that a cash, food and behaviour change communication programme called the Transfer Modality Research Initiative (TMRI) implemented from 2012 to 2014 in Bangladesh had sustained effects on IPV. We collected qualitative data among former TMRI participants in 2023 that allows exploring how social norms may have played a role in shaping the changes related to IPV along four pathways through which TMRI influenced IPV: 1) economic security, 2) family relationships, 3) women’s empowerment, and 4) social support and community relationships. We conducted nine focus group discussions (FGDs) with 49 women TMRI participants, nine FGDs with 52 husbands of women TMRI participants, 54 in-depth interviews (IDIs) with women TMRI participants, and 10 IDIs with women who did not participate in TMRI. We find: along 1) women’s economic contributions may facilitate weakening of IPV norms, however norms on gender roles and seclusion constrain change; along 2) norms related to family reputation could influence IPV condemnation, however norms on female submission and obedience to in-laws constrain change; along 3) norms on female submission constrain female empowerment but could be weakened if women display knowledge aligning with gender roles; and, along 4) linkages to reduced IPV were less clear, with female seclusion norms constraining change, highlighting the importance of group activities. Our findings draw attention to the potential for economic interventions layered with context-specific norms interventions to achieve longer-term changes in IPV and gender inequalities

Parathyroidectomy and Risk of Incident Diabetes in Patients With Primary Hyperparathyroidism

IMPORTANCE: Primary hyperparathyroidism (PHPT) is linked to insulin resistance, glucose intolerance, and diabetes. Whether parathyroidectomy is associated with lower risk of diabetes has not been evaluated in a large cohort. OBJECTIVE: To examine the independent association between parathyroidectomy and the risk of incident diabetes in patients with PHPT. DESIGN, SETTING, AND PARTICIPANTS: Patients diagnosed with PHPT between January 2006 and December 2023 were identified from a territorywide electronic health database in Hong Kong and classified into surgical and nonsurgical groups based on presence of subsequent parathyroidectomy. They were followed up with from the index date (first diagnosis of PHPT), until the outcome of interest (incident diabetes), death, or end of the study period (December 2023), whichever came first. EXPOSURE: Parathyroidectomy vs nonsurgical management. MAIN OUTCOMES AND MEASURES: The primary outcome of this study was incident diabetes. Inverse probability of treatment weighting was used to balance all baseline characteristics. Cox proportional hazards regression was used to evaluate the hazard of incident diabetes associated with parathyroidectomy. RESULTS: A total of 3135 patients with PHPT were included (596 [19.0%] surgical and 2539 [81.0%] nonsurgical). The mean (SD) age was 67.5 (14.2) years, and 2211 (70.5%) individuals were female. A total of 518 patients in the nonsurgical group developed incident diabetes during a median (IQR) follow-up of 2.2 (0.9-4.3) years, compared to 156 patients in the surgical group during a median (IQR) follow-up of 5.5 (3.3-8.0) years. Parathyroidectomy was associated with lower risk of incident diabetes (hazard ratio [HR], 0.68 [95% CI, 0.65-0.71]; P 65 years: HR, 0.64 [95% CI, 0.60-0.68] vs HR, 0.68 [95% CI, 0.63-0.72]; interaction P  twice the upper limit of normal vs PTH ≤ twice the upper limit of normal: HR, 0.58 [95% CI, 0.53-0.63] vs HR, 0.73 [95% CI, 0.69-0.77]; calcium > 2.8 vs calcium ≤ 2.8 mmol/L : HR, 0.58 [95%CI, 0.54-0.63] vs HR, 0.69 [95%CI, 0.66-0.73]; interaction P < .001). CONCLUSIONS AND RELEVANCE: In this cohort of patients with PHPT, parathyroidectomy was associated with a lower risk of incident diabetes. The association was more prominent in younger patients and those with more severe PHPT. These results may suggest potential additional metabolic benefits of parathyroidectomy in PHPT

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

Helminth driven gut inflammation and microbial translocation associate with altered vaccine responses in rural Uganda.

Vaccine responses are sometimes impaired in rural, low-income settings. Helminth-associated gut barrier dysfunction and microbial translocation (MT) may be implicated. We used samples from a trial of praziquantel treatment-effects on vaccine responses in Schistosoma mansoni (Sm)-endemic Ugandan islands, measuring intestinal fatty acid-binding protein 2 (I-FABP2), lipopolysaccharide-binding protein, anti-endotoxin core antibodies (EndoCab), soluble CD14 (sCD14) in plasma, and faecal lipocalin-2, occult blood (FOB), and calprotectin (fCAL), and evaluating their associations with baseline helminth infection, praziquantel treatment, and responses to BCG, yellow fever, typhoid, HPV, and tetanus-diphtheria vaccines. Sm associated positively with fCAL and FOB, hookworm with I-FABP2, and any helminth with EndoCab IgM, fCAL and FOB. Sm associated inversely with sCD14. Praziquantel treatment reduced all marker concentrations, significantly fCAL and FOB, implying that Sm-associated gut inflammation and MT is reversible. Associations of assessed markers with vaccine-specific responses were predominantly inverse. Interventions to improve gut barrier function may enhance vaccine responsiveness

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

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

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

A new method for detecting mixed Mycobacterium tuberculosis infection and reconstructing constituent strains provides insights into transmission.

BACKGROUND: Mixed infection with multiple strains of the same pathogen in a single host can present clinical and analytical challenges. Whole genome sequence (WGS) data can identify signals of multiple strains in samples, though the precision of previous methods can be improved. Here, we present MixInfect2, a new tool to accurately detect mixed samples from Mycobacterium tuberculosis short-read WGS data. We then evaluate three approaches for reconstructing the underlying mixed constituent strain sequences. This allows these samples to be included in downstream analysis to gain insights into the epidemiology and transmission of mixed infections. METHODS: We employed a Gaussian mixture model to cluster allele frequencies at mixed sites (hSNPs) in each sample to identify signals of multiple strains. Building upon our previous tool, MixInfect, we increased the accuracy of classifying in vitro mixed samples through multiple improvements to the bioinformatic pipeline. Major and minor proportion constituent strains were reconstructed using three approaches and assessed by comparing the estimated sequence to the known constituent strain sequence. Lastly, mixed infections in a real-world Mycobacterium tuberculosis population from Moldova were detected with MixInfect2 and clusters of recent transmission that included major and minor constituent strains were built. RESULTS: All 36/36 in vitro mixed and 12/12 non-mixed samples were correctly classified with MixInfect2, and major strain proportions were estimated with high accuracy (within 3% of the true strain proportion), outperforming previous tools. Reconstructed major strain sequences closely matched the true constituent sequence by taking the allele at the highest frequency at hSNPs, while the best-performing approach to reconstruct the minor proportion strain sequence was identifying the closest non-mixed isolate in the same population, though no approach was effective when the minor strain proportion was at 5%. Finally, fewer mixed infections were identified in Moldova than previous estimates (6.6% vs 17.4%) and we found multiple instances where the constituent strains of mixed samples were present in transmission clusters. CONCLUSIONS: MixInfect2 accurately detects samples with evidence of mixed infection from short-read WGS data and provides an excellent estimate of the mixture proportions. While there are limitations in reconstructing the constituent strain sequences of mixed samples, we present recommendations for the best approach to include these isolates in further analyses

Primary prevention in hospitals in 20 high-income countries in Europe - A case of not "Making Every Contact Count"?

This article provides a snapshot of primary prevention activities in hospitals in 20 European high-income countries, based on inputs from experts of the Observatory's Health Systems and Policies Monitor (HSPM) network using a structured questionnaire. We found that in the vast majority of countries (15), there are no systematic national policies on primary prevention in hospitals. Five countries (Cyprus, Finland, Ireland, Romania and the United Kingdom) reported systematic primary prevention activities in hospitals, although in one of them (Cyprus) this was due to the fact that small hospitals in rural areas or less populated districts host providers of primary care. In two of the five countries with systematic national policies on primary prevention, there are no incentives (financial or otherwise) to provide these interventions. The remaining three countries (Finland, Romania and the United Kingdom) report the existence of incentives, but only two of them (Romania and the United Kingdom) provide financial incentives in the form of additional funding. Only two of the 20 countries (Ireland and the United Kingdom) make explicit use of the Making Every Contact Count (MECC) approach. Overall, it can be concluded that there is little focus on primary prevention in hospitals in Europe, which may be seen as a missed opportunity

Disability-inclusive graduation programme intervention on social participation among ultra-poor people with disability in North Uganda: a cluster randomized trial.

BACKGROUND: People with disabilities encounter significant barriers to social participation due to inaccessible environments and negative attitudes. This study evaluated the effectiveness of a comprehensive disability-inclusive graduation (DIG) programme in enhancing social participation among ultra-poor people with disabilities in rural Uganda. METHODS: A two-arm, cluster-randomized controlled trial was conducted in four Northern Ugandan districts, involving 96 intervention and 89 control clusters. The DIG intervention encompassed four pillars: Livelihoods, Social Protection, Financial Inclusion, and Social Empowerment. The study identified households with disabilities using the Washington Group Short Set questions, verified by BRAC programme managers, comprising 370 working-age people with disabilities in the intervention group and 321 in the control group at baseline. Treatment clusters received an 18-month DIG intervention from December 2020 to June 2022. Social participation was measured using the SINTEF Participation Question Set at baseline, immediately post-intervention, and 16 months post-intervention, covering household and societal participation domains. Intervention effects were analyzed through linear mixed-effects regression models, reporting minimally adjusted and fully adjusted mean differences (MAMD and FAMD) with 95% confidence intervals. RESULTS: Immediately after the intervention, the DIG programme showed a positive trend in overall social participation (3.04 point increase in intervention group vs. - 0.29 in control), though not statistically significant in fully adjusted analysis (FAMD = 3.14, 95% CI = (- 1.26, 7.54); p = 0.17), possibly due to sample size limitations and variability in individual responses. A larger improvement in societal participation was observed favouring the intervention group (5.92 point increase versus 0.21 in control), with the fully adjusted analysis approaching statistical significance (FAMD = 5.84, 95% CI = (- 0.01, 11.69); p = 0.05). No significant differences were found in the domain of household participation. At 16 months post-intervention, no significant differences were observed between the intervention and control groups in overall scores or any subdomain, suggesting challenges in maintaining initial improvements over time. CONCLUSIONS: The DIG programme showed short-term positive effects on social participation among ultra-poor people with disabilities, especially in societal engagement. The absence of long-term sustained improvements underscores the complexity of disability inclusion in resource-constrained settings. Future interventions should develop strategies like extended support or booster sessions to maintain initial gains. TRIAL REGISTRATION: Registry for International Development Impact Evaluations (RIDIE-STUDY-ID-626008898983a) and ISRCTN (ISRCTN-78592382)