The Scoping Review Method: Mapping the Literature in “Structural Change” Public Health Interventions

This case discusses how we used scoping review methodology to map the literature in an emergent area of research, “structural change” public health interventions. Scoping reviews are similar to systematic reviews in both scale and rigor; both of these literature review methodologies are comprehensive approaches to reviewing the literature on a topic. However, while a systematic review attempts to answer a specific, targeted research question, a scoping review is designed to map and categorize all of the literature on a broad topic. For this reason, it is an excellent method to employ in emergent research areas, in which researchers have not yet conducted systematic reviews or otherwise attempted to record the entirety of a scholarly conversation. In this case report, we discuss advantages and disadvantages to the methodology, as well as the lessons we learned from our experience, and our recommendations for researchers who utilize this method. We encountered challenges including time limitations, finding a balance between a search strategy that was neither too narrow nor too broad, and adjusting the search throughout the process to accommodate new vocabulary terms as we discovered them

Building menstrual health and hygiene-supportive environments: exploring teachers’ experience in rural Western Kenya

Introduction: Existing school environments and staff play a critical role in Menstrual Health and Hygiene (MHH) for school aged girls in middle and low-income countries. This paper leverages teachers’ perspectives on menstruation and the impact of the Menstrual Solutions (MS) study, an open cluster randomized controlled feasibility study to determine the impact of puberty education, nurses support, and menstrual product provision on girls’ academic performance and emotional well-being. Methods: Seventeen focus group discussions were conducted from October 2012 through November 2013 with teachers at six participating schools, held at three different time points during the study period. Results: Key themes that emerged were emotions and blood, absenteeism, the role of teachers in MHH, and the impact of sensitization. Teachers noted that poor MHH had an impact on school attendance, transparency and openness with teachers, and student behavior in class. It was reported that adolescent girls would absent themselves for 3–5 days during their menstrual cycle depending on what materials they could use, and they would often shy away from teachers, when possible, only speaking to them about their menses if it was urgent or they needed to go home. Emotions such as fear and embarrassment were commonly associated with bleeding. At the midpoint and end of the study, teachers noted that the puberty education and menstrual product provision (where applicable) had a positive impact on girls’ attendance, attention, and comfort in the classroom. Girls became more open with both male and female teachers about their menses, and more comfortable and confident in the classroom among all classmates. Discussion: This research highlights the importance of building an MHH-supportive environment with multiple school personnel within schools to develop a gender-equitable environment for girls to learn confidently without undue interference. Teachers are key adults in adolescent girls’ lives, having the potential to foster an environment that empowers girls with greater autonomy to manage their menses. This highlights a need to consider their perspectives in intervention development. Sensitization of teachers and puberty education across both genders are key components to developing the MHH-supportive environment in schools

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

‘When I die, let me be the last.’ Community health worker perspectives on past Ebola and Marburg outbreaks in Uganda

Uganda suffered four Ebola and five Marburg virus outbreaks from 2000 to 2012 with significant health worker mortality. This paper describes findings from 41 interviews with health workers from three outbreaks. Interviewees frequently encountered stigma from their communities, sometimes accompanied by mistrust and violence. These difficulties were defined as ‘challenges of society.’ Health workers also suffered emotional trauma, depressive symptoms, and fear classified as ‘challenges of psyche.’ As the incidence of such outbreaks will likely increase due to ecological and economic trends, health workers require greater access to personal protective equipment (PPE) and knowledge of viral containment. Such improvements would create an optimal psychosocial climate for managing infectious patients ultimately decreasing the severity of future outbreaks

Beyond role strain: Work–family sacrifice among underrepresented minority faculty

Objective This study describes the perceived work demands and family caregiving obligations associated with work–family life among URM faculty and the coping strategies used to negotiate the integration of roles. Background Past research on families focuses primarily on professional majority-culture families and often fails to include traditionally and historically underrepresented minority (URM) families. The study of how URM professionals negotiate work and family obligations and economic and institutional constraints remains relatively absent in the family science discourse. Method In-depth individual and group interviews (N = 58) were conducted with US-born African American, Mexican American, and Puerto Rican faculty at research universities. Results The overarching theorizing anchor that grounded the themes was sacrifice. Three themes emerged: excessive work demands/role strain; commitments and caregiving obligations to family of origin and nuclear family; and few coping strategies and resources to maintain a balanced life. Conclusion This analysis offers insight into the multiple factors that affect the experiences of URM academics in their workplaces that deeply influence work roles and self-care and its impact on family roles. These data fill a gap by applying alternative frameworks to explore the work–family nexus among racialized groups. Implications New research frontiers are offered to study the work–family nexus for URM faculty and how higher education can respond to alleviate excessive work demands and work–family life conflicts.https://doi.org/10.1111/jomf.1286

The sexual health needs of sexual minority women in Western Kenya: An exploratory community assessment and public policy analysis

Sexual health and rights are a core feature of human development. Yet, most work on sexual health and wellbeing in the Global South and elsewhere has historically focused on heterosexual, cisgender people, as well as sexual minority cisgender men and transgender women. This exploratory study includes an analysis of comments made during a facilitated community forum and an examination of the sociopolitical and legal environment relevant to sexual minority women’s health in Kenya. Through analysis of the group discussion hosted by a sexual minority women’s group, we identified multiple sexual health-related issues, including concerns related to healthcare access, healthy sexual relationships, economic instability, and freedom from violence. Based on issues identified by the forum, we conducted an analysis of law and policy in the areas of community need. The legal and policy analysis indicated that the public policy and health policy context is complicated by the presence of hostile laws regarding same-sex sexuality, an absence of economic policies to protect women, and yet some existing health policy inclusive of sexual and gender minorities that nonetheless render sexual minority women invisible. The findings indicate a need for focus on public opinion, health services, legislation, and health policy as sites of intervention