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Water Research Jun 2024Antimicrobial resistance (AMR) is a global public health threat, and the environment has been identified as an important reservoir for resistant microorganisms and... (Review)
Review
Antimicrobial resistance (AMR) is a global public health threat, and the environment has been identified as an important reservoir for resistant microorganisms and genes. Storm overflows (SOs) discharge wastewater and stormwater, and are found throughout many wastewater networks. While there are no data currently showing the impact of SOs on the environment with respect to AMR in the UK, there is a small but growing body of evidence globally highlighting the potential role of SOs on environmental AMR. This review aims to provide an overview of the current state of SOs, describe global data investigating the impact of SOs on environmental AMR, and discuss the implications of SOs regarding AMR and human health. In addition, the complexities of studying the effects of SOs are discussed and a set of priority research questions and policy interventions to tackle a potentially emerging threat to public health are presented.
PubMed: 38906083
DOI: 10.1016/j.watres.2024.121952 -
Social Science & Medicine (1982) Jun 2024Children with experience of maltreatment, abuse or neglect have higher prevalence of poor mental health. In the United Kingdom, child protection services identify...
Children with experience of maltreatment, abuse or neglect have higher prevalence of poor mental health. In the United Kingdom, child protection services identify children at risk of significant harm on the Child Protection Register (CPR) and intervene to reduce risk. Prevalence and incidence of mental health service use among this population of children are not well understood. We analysed records from one Scottish Local Authority's CPR, linked to electronic health records for all children in the broader health board region aged 0-17 years. We described mental health service use among children with a CPR registration using measures of mental health prescribing and referrals to child and adolescent mental health services (CAMHS). We calculated age- and sex-specific incidence rates for comparison with the general population. Between 2012 and 2022, we found 1498 children with a CPR registration, with 69% successfully linked to their health records. 20% were registered before birth and median age at registration was 3 years. Incidence rates in all measures of mental health service use were higher in children with a CPR record across all ages (at outcome) and genders compared to the general population. The largest absolute difference was for boys aged 5-9 with a CPR record, who had 31.8 additional mental health prescriptions per 1000 person-years compared to the general population (50.4 vs. 18.6 prescriptions per 1000 person-years, IRR: 2.7). Girls aged 0-4 years with a CPR registration had the largest relative difference, with a rate of CAMHS referral 5.4 times higher than the general population (12.3 vs. 2.3 per 1000 person-years). Our reproducible record linkage of the CPR to health records reveals an increased risk of mental health service use during childhood. Our findings have relevance to public mental health surveillance, service prioritisation and wider policy aiming to reduce childhood exposure to risk of harm.
PubMed: 38905923
DOI: 10.1016/j.socscimed.2024.117057 -
Journal of Medical Internet Research Jun 2024Parents experience many challenges during the perinatal period. Mobile app-based interventions and chatbots show promise in delivering health care support for parents...
BACKGROUND
Parents experience many challenges during the perinatal period. Mobile app-based interventions and chatbots show promise in delivering health care support for parents during the perinatal period.
OBJECTIVE
This descriptive qualitative process evaluation study aims to explore the perinatal experiences of parents in Singapore, as well as examine the user experiences of the mobile app-based intervention with an in-built chatbot titled Parentbot-a Digital Healthcare Assistant (PDA).
METHODS
A total of 20 heterosexual English-speaking parents were recruited via purposive sampling from a single tertiary hospital in Singapore. The parents (control group: 10/20, 50%; intervention group: 10/20, 50%) were also part of an ongoing randomized trial between November 2022 and August 2023 that aimed to evaluate the effectiveness of the PDA in improving parenting outcomes. Semistructured one-to-one interviews were conducted via Zoom from February to June 2023. All interviews were conducted in English, audio recorded, and transcribed verbatim. Data analysis was guided by the thematic analysis framework. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to guide the reporting of data.
RESULTS
Three themes with 10 subthemes describing parents' perceptions of their parenting journeys and their experiences with the PDA were identified. The main themes were (1) new babies, new troubles, and new wonders; (2) support system for the parents; and (3) reshaping perinatal support for future parents.
CONCLUSIONS
Overall, the PDA provided parents with informational, socioemotional, and psychological support and could be used to supplement the perinatal care provided for future parents. To optimize users' experience with the PDA, the intervention could be equipped with a more sophisticated chatbot, equipped with more gamification features, and programmed to deliver personalized care to parents. Researchers and health care providers could also strive to promote more peer-to-peer interactions among users. The provision of continuous, holistic, and family-centered care by health care professionals could also be emphasized. Moreover, policy changes regarding maternity and paternity leaves, availability of infant care centers, and flexible work arrangements could be further explored to promote healthy work-family balance for parents.
Topics: Humans; Mobile Applications; Parents; Parenting; Female; Singapore; Male; Qualitative Research; Adult; Pregnancy
PubMed: 38905628
DOI: 10.2196/56894 -
PLOS Global Public Health 2024Humanitarian health actors are beginning to better consider and manage non-communicable diseases, such as diabetes, in emergency and protracted crisis settings. However,...
Humanitarian health actors are beginning to better consider and manage non-communicable diseases, such as diabetes, in emergency and protracted crisis settings. However, a focus on the more globally prevalent type 2 diabetes (T2D) dominates. Blind spots prevail in the unmet needs for type 1 diabetes (T1D), a chronic autoimmune condition where individuals are unable to produce insulin, thereby dependent on lifelong insulin therapy and blood glucose management. Although some T1D management requirements overlap with those of T2D, the immediate risk of fatal complications following insulin therapy disruption, the earlier age of onset during childhood, adolescence or young adulthood, and its lower prevalence compared to T2D within communities and local health systems mean that T1D requires nuanced consideration and targeted interventions. Intending to inform program and policy design for people with T1D (PWT1D), we synthesized themes of lived experience from PLWT1D and their caregivers, and the tacit working knowledge of health providers and policymakers in the context of local humanitarian operations. Through a strategic search of health databases (up to July 2023), we identified 11 articles that include interview excerpts from PWT1D, caregivers, healthcare providers and policymakers about T1D management in humanitarian settings. We used reflexive thematic analysis to guide data extraction, coding, and synthesis, resulting in the identification of four overarching themes: food and insulin security, family relations, knowledge translation, and response to diagnosis. The narratives highlight harsh trade-offs made by PWT1D and their families in the face of insulin and food insecurity, as well as the damaging impact of low T1D education in families, communities and health systems. Targeted family and community-based solutions are urgently required, alongside systemic reforms and international collaboration to enable better T1D coping and management in humanitarian settings.
PubMed: 38905318
DOI: 10.1371/journal.pgph.0003027 -
PloS One 2024There have been several Viral Hemorrhagic Fever (VHF) outbreaks in Nigeria which remains a public health concern. Despite the increasing number of suspected cases of VHF...
There have been several Viral Hemorrhagic Fever (VHF) outbreaks in Nigeria which remains a public health concern. Despite the increasing number of suspected cases of VHF due to heightened surveillance activities and growing awareness, only a few cases are laboratory-confirmed to be VHF. Routinely, these samples are only tested for Lassa virus and Yellow fever virus with occasional testing for Dengue virus when indicated. The aetiology of the disease in these VHF suspected cases in Nigeria which are negative for Lassa, Yellow fever and Dengue viruses remains a puzzle. Since the clinical features exhibited by suspected VHF cases are like other endemic illnesses such as Hepatitis, there is a need to investigate the diversity and co-infections of hepatitis viruses as differentials and possible co-morbidity in suspected cases of VHFs in Nigeria. A total of three hundred and fifty (350) blood samples of 212 (60.6%) males and 138 (39.4%) females, aged <1-70 years with a mean age of 25 ±14.5, suspected of VHFs and tested negative for Lassa, Yellow fever and Dengue viruses were investigated for Hepatitis A, B, C and E viruses at the Centre for Human and Zoonotic Virology (CHAZVY), College of Medicine, University of Lagos (CMUL) using serologic and molecular techniques. The serologic analysis of these VHF suspected cases samples revealed that 126 (36%) were positive for at least one hepatitis virus. Individual prevalence for each of the hepatitis virus screened for showed that 37 (10.6%), 18 (5.1%) and 71 (20.3%) were positive for HBV, HCV and HEV respectively. All the samples were negative for HAV. A co-infection rate of 11.9% was also observed, with HCV/HEV co-infections being the most prevalent and the Northern region having the greatest burden of infection. The evidence of hepatitis virus infections in suspected cases of VHF was documented. Thus, their associations as co-morbidities and/or mortalities in this category of individuals require further investigations in endemic countries such as Nigeria. Therefore, the possible inclusion of screening for hepatitis viruses and other aetiologic agents that could mimic infections in suspected cases of VHFs in Nigeria should be thoroughly evaluated to guide informed policy on the diagnosis and management of these cases.
Topics: Humans; Nigeria; Male; Female; Adult; Adolescent; Middle Aged; Hemorrhagic Fevers, Viral; Child; Aged; Child, Preschool; Young Adult; Infant; Hepatitis Viruses; Coinfection
PubMed: 38905317
DOI: 10.1371/journal.pone.0305521 -
Rice farmers' preferences for seed quality, packaging, and source: A study from northern Bangladesh.PloS One 2024The use of quality seeds is crucial to improve rice yield, food security, and farmers' livelihoods. The large informal seed system, limited access to quality seeds, and...
The use of quality seeds is crucial to improve rice yield, food security, and farmers' livelihoods. The large informal seed system, limited access to quality seeds, and low seed replacement rate challenge increasing rice yield. Despite robust government initiatives to support the seed system, progress has been slow. Besides, the need for farmers' behavioural change, enhanced coordination, and communication at the local level has not received adequate attention. We investigate rice farmers' preferences for quality seed, packet sizes, types, and sources, and assess the impact of utilizing good quality seed. We collected quantitative data from 1196 rice farmers in northern Bangladesh in 2019. To identify major factors influencing farmers' preferences regarding quality seed, packet sizes, packet types, and seed sources, we employed ordered logit and multinomial logit models. Additionally, we used the propensity score matching procedure to assess the impact of good quality and formal seed sources on the rice yield. The findings revealed that farmers strongly prefer using seeds from formal sources despite limited accessibility. Of the total farmers, 34% use public source seeds, 33% use private source seeds, and the rest rely on their own saved seeds. The use of good quality seeds increased rice yields from the base yield by 0.07-0.28 t/ha. We found about a 48% gap in accessing good-quality seeds, indicating significant potential for scaling up the seed systems. Farmers using formal seed sources yielded 0.03-0.15 t/ha more than informal seed users. Farmers strongly prefer 5 kg packets due to their cost-effectiveness, easy storage, and handling convenience. Additionally, farmers prefer polycoated jute sacks for their versatility, multi-purpose applications, and resistance to pests. The econometric model results showed that farmers' preferences were significantly influenced by gender, farm type, crop yield, seed price, market distance, various stakeholders' advice, and seed supply systems' constraints. The government should implement policies and programs to strengthen a well-connected seed network in rural areas, promoting inclusivity, and enhancing rice productivity. Besides, farmers' needs and preferences should be considered in designing and implementing seed-related initiatives to foster sustainable agricultural development.
Topics: Oryza; Bangladesh; Farmers; Humans; Seeds; Male; Female; Adult; Middle Aged; Agriculture
PubMed: 38905312
DOI: 10.1371/journal.pone.0306059 -
PloS One 2024Antithrombotics require careful monitoring to prevent adverse events. Safe use can be promoted through so-called antithrombotic stewardship. Clinical decision support...
Antithrombotics require careful monitoring to prevent adverse events. Safe use can be promoted through so-called antithrombotic stewardship. Clinical decision support systems (CDSSs) can be used to monitor safe use of antithrombotics, supporting antithrombotic stewardship efforts. Yet, previous research shows that despite these interventions, antithrombotics continue to cause harm. Insufficient adoption of antithrombotic stewardship and suboptimal use of CDSSs may provide and explanation. However, it is currently unknown to what extent hospitals adopted antithrombotic stewardship and utilize CDSSs to support safe use of antithrombotics. A semi-structured questionnaire-based survey was disseminated to 12 hospital pharmacists from different hospital types and regions in the Netherlands. The primary outcome was the degree of antithrombotic stewardship adoption, expressed as the number of tasks adopted per hospital and the degree of adoption per task. Secondary outcomes included characteristics of CDSS alerts used to monitor safe use of antithrombotics. All 12 hospital pharmacists completed the survey and report to have adopted antithrombotic stewardship in their hospital to a certain degree. The median adoption of tasks was two of five tasks (range 1-3). The tasks with the highest uptake were: drafting and maintenance of protocols (100%) and professional's education (58%), while care transition optimization (25%), medication reviews (8%) and patient counseling (8%) had the lowest uptake. All hospitals used a CDSS to monitor safe use of antithrombotics, mainly via basic alerts and less frequently via advanced alerts. The most frequently employed alerts were: identification of patients using a direct oral anticoagulant (DOAC) or a vitamin K antagonist (VKA) with one or more other antithrombotics (n = 6) and patients using a VKA to evaluate correct use (n = 6), both reflecting basic CDSS. All participating hospitals adopted antithrombotic stewardship, but the adopted tasks vary. CDSS alerts used are mainly basic in their logic.
Topics: Humans; Decision Support Systems, Clinical; Netherlands; Surveys and Questionnaires; Fibrinolytic Agents; Hospitals; Pharmacists; Pharmacy Service, Hospital
PubMed: 38905283
DOI: 10.1371/journal.pone.0306033 -
PloS One 2024Watersheds require collective care and management at local and regional levels to maintain their ecological health. The Chesapeake Bay's last several decades of...
Watersheds require collective care and management at local and regional levels to maintain their ecological health. The Chesapeake Bay's last several decades of stagnantly poor ecological health presents a distinctive case study for explicating the challenges of motivating collective action across a diverse regional natural resource. Our study uses county- and individual-level descriptive analysis to examine interrelated framings of environmental quality, environmental sentiment, and political action at two critical moments in time-the 2016 and 2020 presidential elections. We find that demographic, environmental, and political characteristics vary with distance to the Chesapeake Bay and that linked environmental and political characteristics appeared to become more polarized between 2016 and 2020. We found no evidence that local environmental quality influenced new political actions such as voting; however, people already likely to vote were influenced by their pro-environmental values such as priorities around climate change.
Topics: Politics; Bays; Humans; Climate Change; Conservation of Natural Resources; Maryland
PubMed: 38905270
DOI: 10.1371/journal.pone.0298962 -
PLOS Global Public Health 2024Different provider payment systems generate different incentives for patients, providers, and purchasers. Ghana introduced the National Health Insurance Scheme (NHIS) in...
Different provider payment systems generate different incentives for patients, providers, and purchasers. Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 and has made reforms to its provider payment methods to create incentives in providers for cost containment. Starting with the fee for service method, it shifted to the Diagnostic Related Group (DRG) method in 2008 to improve cost containment. In 2012 the NHIS began piloting capitation method of payment which has been suspended since 2017 to allow for thorough review. This study uncovers the association between capitation payment system and patient health outcomes, utilization of healthcare services and referral patterns in Ghana based on data collected between November 2012 and January 2013. Using a cross-sectional data on 500 malaria patients who were enrollees of the NHIS from the two payment plans (i.e., capitation and DRG plan), ordered logit, negative binomial and logit regression results showed that patients under capitation were 11.9% less likely to report better health and had 1.583 fewer visits relative to patients under DRG. In relation to referrals, capitated providers were more likely to refer patients than under DRG plans. In the capitated region, better health outcomes were reported by patients of private health facilities. Capitation in Ghana was associated with under-provision of care, hence decreasing any efficiency gain from the reform. Implementors of capitation need to ensure a good monitoring and evaluation system for adequate provision of quantity and quality of care. Some limitations of this study include the use of cross sectional rather that panel data which follows individuals over time and therefore may be more able to provide definite information about cause-and-effect relationships. It also does not account for events before and after the introduction of any payment method. Overall, this study provides valuable information on the implementation policy for reintroducing capitation.
PubMed: 38905260
DOI: 10.1371/journal.pgph.0002423 -
PloS One 2024Wars increase the importance of government functions, yet they also constrain their ability to fulfill these functions. In particular, wars hinder economic activity,...
Wars increase the importance of government functions, yet they also constrain their ability to fulfill these functions. In particular, wars hinder economic activity, thereby limiting governments' capacity to raise the revenues required to maintain stability and meet the heightened needs of citizens. Effective governance is therefore severely undermined in times of war. However, empirical research on how wars affect government procurement is limited. We address this gap by exploring procurement dynamics using over one million public purchases of goods and services in Ukraine between January 2021 and October 2022, corresponding to the Russian invasion of the country. We document a large fall in the total number of purchases since the invasion and an increase in the share of successfully completed procurements. This higher success rate comes at the cost of efficiency, with the government paying more to source their goods. This can be attributed to the decline in the share of government purchases via online auctions and the reduced competition. Thus, the prioritization of the quick acquisition of goods and services forced governments to sacrifice cost-effectiveness. In summary, the war did not lower the successful purchasing of private goods and services, and transparency was not decreased. However, the trade-off of speed and transparency for greater costs may become increasingly problematic with the growing budget constraints resulting from the war. This article contributes to our understanding of the Ukrainian government choices during the early phase of the war. The results also highlight the importance of ensuring procurement efficiency and transparency when the war ends as reconstruction efforts will require substantial increases in government procurements.
Topics: Ukraine; Humans; Government; Warfare
PubMed: 38905231
DOI: 10.1371/journal.pone.0305344