W-DARE: a three-year program of participatory action research to improve the sexual and reproductive health of women with disabilities in the Philippines

BACKGROUND: In many contexts, women with disability have less access to sexual and reproductive health information, screening, prevention, and care services than women without disability. Women with disability are also known to be more likely to experience physical and sexual violence than women without disability. In the Philippines, health service providers often have little awareness of the sexual and reproductive experiences of women with disability and limited capacity to provide services in response to their needs. Very limited data are available to inform development of disability-inclusive sexual and reproductive health, and violence prevention and response, services in the country. This paper presents the protocol for W-DARE (Women with Disability taking Action on REproductive and sexual health), a three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disability in the Philippines. DESIGN: W-DARE is a disability-inclusive program that will use mixed methods to 1) increase understanding of factors influencing the sexual and reproductive health of women with disability, and 2) develop, implement and evaluate local interventions to increase supply of and demand for services. W-DARE will generate data on the prevalence of disability in two districts; the wellbeing and community participation of people with and without disability, and identify barriers to community; and describe the sexual and reproductive health needs and experiences, and service-related experiences of women with disability. These data will inform the development and evaluation of interventions aiming to improve access to sexual and reproductive health services, and violence prevention and response services, for women with disability. Local women with disabilities, their representative organisations, and SRH service providers will be involved as members of the research team across all stages of the research. DISCUSSION: This three-year study will provide evidence about factors undermining the sexual and reproductive health of women with disability in a lower-middle income country, and provide new insights about what may be effective in increasing access to services in settings of limited resources. Findings will be relevant across Asia and the Pacific. Analysis of the program will also provide evidence about disability-inclusion in participatory action research approaches

Bullying Among Pregnant Teens: A Pilot Study

Victims of bullying are more likely to experience various health outcomes. The relationship between bullying and teen pregnancy is understudied. This pilot study surveyed pregnant adolescents (12-21 years) at a clinic about bullying related behaviors. The survey asked about the frequency of fighting, peer victimization and bullying behaviors in the last 30 days. Participants (n=78) reported fighting by “hitting back” (62.8%) and bullying by “being mean” (45.5%). Participants reported victimization by being made fun of (35.9%), being called names (38.5%) and being picked on (37.2%). Many (n=32) reported a decrease in the behaviors since becoming pregnant; however, some (n=24) indicated no change. This pilot study reveals bullying is common in this group of adolescents and typically occurred before pregnancy

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Pathogens and Public Swimming Pools

Swimming pools are increasingly recognised as an important transmission route of cryptosporidiosis. Swimmers are infected through ingestion of waterborne faecal matter. The infective oocycts resulting from one Accidental Faecal Release (AFR) may be prolific. A swimmer swallowing just 10 ml of water would ingest an average of 200 oocysts, which is well above the dose capable of causing infection.

Which Way? Experiences of Aboriginal and Torres Strait Islander People Who Are Deaf or Hard of Hearing Attaining Supports to Meet Their Interwoven Socio-Cultural, Health and Disability-Related Needs and Aspirations Within the Context of Australia’s National Disability Insurance Scheme

The life experiences of Aboriginal and Torres Strait Islander people who are Deaf or Hard of Hearing are often more complex than for Aboriginal and Torres Strait Islander people who are hearing, or non-Aboriginal Australians who are Deaf or Hard of Hearing. In turn, this can make engaging with and benefiting from policies and programs such as Australia’s National Disability Insurance Scheme (NDIS) more complex, particularly for individuals living in remote settings. To understand more about these complexities, yarnings were held with 15 Aboriginal and Torres Strait Islander NDIS participants who are Deaf or Hard of Hearing living in rural and remote communities in the Northern Territory. Alongside analysis of the emerging narratives, we analysed NDIS quantitative data to examine how NDIS plan budgets were being utilised by this group in comparison to the wider NDIS population. This paper’s focus is on yarning participants’ experiences navigating the NDIS to gain supports that meet their interwoven socio-cultural, health and disability-related needs and aspirations. We highlight that with sufficient cultural and communication supports, some yarning participants were able to effectively utilise their NDIS plan to attain supports to achieve positive socio-cultural, health and disability-related outcomes. However, the NDIS must enhance collaboration with participants, local communities and Aboriginal Community Controlled Organisations, disability service providers, and interfacing systems such as the health system, to develop more locally led solutions that empower Aboriginal and Torres Strait Islander Deaf or Hard of Hearing participants to achieve better outcomes

Reciprocal impact of mental health and quality of life in children and adolescents—a cross-lagged panel analysis

IntroductionA thorough understanding of the interplay of mental health (MH) and quality of life (QoL) is essential to describe, understand and support the healthy development of children and adolescents. The aim of the study is to analyze the reciprocal and predictive relationship between psychosomatic symptoms, MH problems and QoL in children and adolescents during the COVID-19 pandemic using a cross-lagged panel analysis.MethodsData of n = 323 children and n = 421 adolescents were collected at five measurement points from spring 2020 to autumn 2022 within the population-based longitudinal German COPSY study. Parent proxy ratings were assessed using the KIDSCREEN-10 index (QoL), the Strengths and Difficulties Questionnaire (SDQ; internal and external MH symptoms) and the Health Behavior in School-aged Children Symptom Checklist (HBSC-SCL; psychosomatic symptoms). Adolescents also self-rated the KIDSCREEN-10 Index and the HBSC-SCL. Cross-lagged-panel models, which offer higher internal validity than traditional cross-sectional and longitudinal analyses, were estimated using structural equation modeling (maximum likelihood).ResultsDifferent prediction models proved to be valid for children vs. adolescents (Δχ2df = 48 = 167.84, p  0.05), but was the time-lagged criterion variable most strongly predicted by them (Δχ2df = 12 = 71.58, p <0.001). For adolescents, self-reported QoL cross-predicted psychosomatic symptoms (Δχ2df = 3 = 14.22, p < 0.001). For both children and adolescents, internalizing MH problems cross-predicted QoL and psychosomatic symptoms (Δχ2df = 3 = 9.58–13.69, p < 0.001).DiscussionPsychosomatic and psychological MH symptoms were proven to be significant time-lagged predictors of QoL, particularly in children. Thus, they can serve as preceding indicators for the development of QoL. Since the cross-lagged panel approach provides a higher internal validity than e.g., cross-sectional data analyses, our findings may contribute to an enhanced understanding of mental development processes and, thus may provide evidence for targeted support of healthy development under demanding conditions such as the COVID-19 pandemic

Some peace of mind: assessing a pilot intervention to promote mental health among widows of injecting drug users in north-east India

<p>Abstract</p> <p>Background</p> <p>HIV prevalence in north-east India is high and injecting drug use (IDU) is common. Due to HIV-related deaths there are increasing numbers of IDU widows, many of whom are HIV infected, and experiencing poor health, social isolation, discrimination and poverty, all factors likely to be compromising their mental health. There is increasing recognition of the links between HIV and mental health.</p> <p>Methods</p> <p>The aim of this study was to pilot a peer-facilitated, participatory action group (PAG) process and assess the impact of the intervention on the mental health of participants. The intervention consisted of 10 PAG meetings involving 74 IDU widows. Changes in quality of life (WHOQOL-BREF), mental health (GHQ12) and somatic symptoms were assessed. The value of the intervention from the perspective of the participants was captured using a qualitative evaluation method (Most Significant Change).</p> <p>Results</p> <p>Participants' quality of life, mental health and experience of somatic symptoms improved significantly over the course of the intervention, and the women told stories reflecting a range of 'significant changes'.</p> <p>Conclusion</p> <p>This pilot intervention study demonstrated that a participatory approach to mental health promotion can have a positive impact on the lives of vulnerable women, and the potential to contribute to HIV prevention. Further investigation is warranted.</p

A participatory intervention to improve the mental health of widows of injecting drug users in north-east India as a strategy for HIV prevention

BACKGROUND: Manipur and Nagaland, in the north-east of India, are classified as high prevalence states for HIV, and intravenous drug use is an important route of transmission. Most injecting drug users (IDUs) are men, an estimated 40% are married, and death rates have been high in the last five years, consequently the number of widows of IDUs has increased. Many of these widows and their children are HIV-infected and experience poor health, discrimination, and impoverishment; all factors likely to be compromising their mental health. People with poor mental health are more likely to engage in HIV risk behaviours. Mental health can be promoted by public health actions with vulnerable population groups. METHODS: We designed an intervention study to assess the feasibility and impact of a participatory action process to promote the mental health and well-being of widows of IDUs in Manipur and Nagaland, as a strategy for reducing the risk of engagement in HIV risk behaviours. This paper describes the background and rationale for the study, the intervention, and the study methods in detail. RESULTS: Pending analysis. CONCLUSION: This intervention study will make a significant contribution to the emerging evidence that supports associations between mental health and HIV. The concept of promoting mental health among women who are vulnerable to HIV infection or already infected as a strategy for HIV prevention in a development setting is breaking new ground

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016

© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30–30·30 million) new cases of TBI and 0·93 million (0·78–1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331–412) per 100 000 population for TBI and 13 (11–16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40–57·62 million) and of SCI was 27·04 million (24·98–30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (−0·2% [–2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (−3·6% [–7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0–10·4 million) YLDs and SCI caused 9·5 million (6·7–12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82–141) per 100 000 for TBI and 130 (90–170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. Interpretation: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments. Funding: Bill & Melinda Gates Foundation