Referral of sexual violence against children: How do children and caregivers use a formal child protection mechanism in Harare, Zimbabwe?

Despite widespread expansion of policies to prevent and respond to violence over the past three decades, sexual violence against children remains common globally. Zimbabwe has expansive legal and policy frameworks to prevent, and formal services to respond to, sexual violence. Yet evidence is lacking about how children and caregivers use formal referral mechanisms. This study conducted secondary qualitative analysis of sexual violence cases [N=74] processed in Harare Magistrates Court and referred to Childline Zimbabwe, in October-November 2020, to examine which experiences children and/or their caregivers formally refer as sexual violence; how they perceive and manage these experiences; and how this relates to national policy contexts. Caregivers, particularly female, were central to reporting sexual violence. Data suggested that some forms of sexual violence were formally referred, including community sexual assault and abuse within families, however some adolescent girls faced blame and shame. There were gaps in reporting of sexual violence against boys, and sexual violence from dating partners or authority figures, with data suggesting that gendered stigma, shame, and fears of institutional authority, were barriers for reporting. Caregivers also reported consensual adolescent sexual relationships to police. These findings contribute to the limited evidence on forms of sexual violence that are and are not formally referred globally, and in sub-Saharan African settings. Existing policy frameworks in Zimbabwe can be strengthened around age of maturity, adolescent sexuality, sidelining of boy survivors, and the role of schools in child protection. Interventions should support caregivers’ efforts to report violence, while also addressing gendered blame and stigma, and stigmatisation of adolescent sexuality

Would raising the total cholesterol diagnostic cut-off from 7.5 mmol/L to 9.3 mmol/L improve detection rate of patients with monogenic familial hypercholesterolaemia?

A previous report suggested that 88% of individuals in the general population with total cholesterol (TC)>9.3mmol/L have familial hypercholesterolaemia (FH). We tested this hypothesis in a cohort of 4896 UK civil servants, mean (SD) age 44 (±6) years, using next generation sequencing to achieve a comprehensive genetic diagnosis. 25 (0.5%) participants (mean age 49.2 years) had baseline TC>9.3mmol/L, and overall we found an FH-causing mutation in the LDLR gene in seven (28%) subjects. The detection rate increased to 39% by excluding eight participants with triglyceride levels over 2.3mmol/L, and reached 75% in those with TC>10.4mmol/L. By extrapolation, the detection rate would be ~25% by including all participants with TC>8.6mmol/L (2.5 standard deviations from the mean). Based on the 1/500 FH frequency, 30% of all FH-cases in this cohort would be missed using the 9.3mmol/L cut-off. Given that an overall detection rate of 25% is considered economically acceptable, these data suggest that a diagnostic TC cut-off of 8.6mmol/L, rather than 9.3mmol/L would be clinically useful for FH in the general population

The CLIMATE schools combined study: a cluster randomised controlled trial of a universal Internet-based prevention program for youth substance misuse, depression and anxiety

Background: Anxiety, depressive and substance use disorders account for three quarters of the disability attributed to mental disorders and frequently co-occur. While programs for the prevention and reduction of symptoms associated with (i) substance use and (ii) mental health disorders exist, research is yet to determine if a combined approach is more effective. This paper describes the study protocol of a cluster randomised controlled trial to evaluate the effectiveness of the CLIMATE Schools Combined intervention, a universal approach to preventing substance use and mental health problems among adolescents. Methods/design: Participants will consist of approximately 8400 students aged 13 to 14-years-old from 84 secondary schools in New South Wales, Western Australia and Queensland, Australia. The schools will be cluster randomised to one of four groups; (i) CLIMATE Schools Combined intervention; (ii) CLIMATE Schools - Substance Use; (iii) CLIMATE Schools - Mental Health, or (iv) Control (Health and Physical Education as usual). The primary outcomes of the trial will be the uptake and harmful use of alcohol and other drugs, mental health symptomatology and anxiety, depression and substance use knowledge. Secondary outcomes include substance use related harms, self-efficacy to resist peer pressure, general disability, and truancy. The link between personality and substance use will also be examined.Discussion: Compared to students who receive the universal CLIMATE Schools - Substance Use, or CLIMATE Schools - Mental Health or the Control condition (who received usual Health and Physical Education), we expect students who receive the CLIMATE Schools Combined intervention to show greater delays to the initiation of substance use, reductions in substance use and mental health symptoms, and increased substance use and mental health knowledge

Cost effectiveness of case-finding strategies for drug treatment in primary prevention of cardiovascular disease: a modelling study

Background: Policies of active case finding for cardiovascular disease (CVD) prevention in healthy adults are common, but economic evaluation has not investigated targeting such strategies at those who are most likely to benefit. Aim: To assess the cost effectiveness of targeted case finding for CVD prevention. Design and setting: Cost-effectiveness modelling in an English primary care population. Method: A cohort of 10 000 individuals aged 30–74 years and without existing CVD or diabetes was sampled from The Health Improvement Network database, a large primary care database. A discrete event simulation was used to model the process of inviting people for assessment, assessing cardiovascular risk, and initiation and persistence with drug treatment. Risk factors and drug cessation rates were obtained from primary care data. Published sources provided estimates of uptake of assessment, treatment initiation, and treatment effects. The researchers determined the lifetime costs and quality adjusted life years (QALYs) with opportunistic case finding and strategies prioritising and targeting patients by age or prior estimate of cardiovascular risk. This study reports on the optimum strategy if a QALY is valued at £20 000. Results: Compared with no case finding, inviting all adults aged 30–74 years in a population of 10 000 yields 30.32 QALYs at a total cost of £705 732. The optimum strategy is to rank patients by prior risk estimate and invite 8% of those who are assessed as being at highest risk (those at ≥12.8% predicted 10-year CVD risk), yielding 17.53 QALYs at a cost of £162 280. There is an 89.4% probability that the optimum strategy is to invite <35% of patients for assessment. Conclusion: Across all age ranges, targeted case finding using a prior estimate of CVD risk is more efficient than universal case finding in healthy adults.Tom Marshall was funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for West Midlands (CLAHRC-WM) programm

Short-term responses of herbaceous vegetation to bush clearing in semi-arid rangelands of South Africa

Abstract Bush thickening reduces herbaceous species diversity and forage production, leading to a decline in grazing capacity. Hence, altering the micro-climate and woody-grass competition in bush-encroached rangelands using bush clearing is instrumental for the restoration of herbaceous vegetation. The short-term recovery potential of herbaceous species composition, basal cover and biomass production was assessed following bush clearing at Makapaanstad, North West province, South Africa. The mean density was 6908 woody plants ha−1, with Vachellia tenuispina encroaching at 6301 plants ha−1. Paired observations were conducted in bush-cleared sites (where woody plants were cut using saws, with stumps treated with picloram at 1% concentration) and uncleared sites (where the woody cover was left intact). Forty-nine different herbaceous species were recorded, with grasses being more abundant in cleared (62%) than in uncleared sites (50%). Herbaceous species showed interspecific responses, with Brachiaria eruciformis and Panicum coloratum colonising in cleared sites, whereas the frequency of other species remained comparable between cleared and uncleared sites. Graminoids, largely bunch grasses, had a significantly greater basal cover in cleared (496 cm2 m−2) compared to uncleared (301 cm2 m−2) sites. Likewise, total biomass production was significantly (p = 0.05) higher in cleared (760 kg DM ha−1) than in uncleared (636 kg DM ha−1) sites. The principal component analysis (PCA) showed that most herbaceous species were associated with soils having high total nitrogen and nitrite. Seedlings of forbs (r 2 = 0.81), grasses (r 2 = 0.97) and succulents (r 2 = 0.98) were highly associated with nitrate-rich soils. Our results revealed that even at a short term, bush clearing is important for the restoration of herbaceous vegetation