bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence, risk factors and management of common mental health disorders in Cameroon: a systematic review protocol
Authors: Ngwa Che Henry , Njuma Libwea John , Keinamma Marion , Wirsiy Frankline Sevidzem , Nji Kah Emmanuel , Mpofu Limkile 
Published: July 2023

BackgroundMental health disorders (MHDs) are considered a serious public health concern globally. The burden of mental health conditions is estimated to be higher in low-income and middle-income countries, including Cameroon, where reliable estimates are lacking. This review aims to synthesise evidence on the prevalence of MHDs, the effectiveness of mental health management interventions and identify risk factors for MHDs in Cameroon.MethodThis review will systematically search electronic databases for studies focusing on one or more MHDs of interest within the context of Cameroon. We will include cohort, case–control and cross-sectional studies which assessed the prevalence or risk factors for MHDs in Cameroon and intervention studies to provide evidence on the effectiveness of interventions for managing MHDs. Two reviewers will independently perform all screening stages, data extraction and synthesis. We will provide a narrative synthesis and, if we identify enough articles that are homogeneous, we will perform a meta-analysis using a random effect model. The strength of the evidence will be assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach.ConclusionThis review will contribute to the current body of knowledge by providing a synthesis of current evidence on the prevalence of common MHDs, risk factors for different MHDs and the effectiveness of interventions for managing different mental health conditions in Cameroon.Ethics and disseminationThis study will involve synthesis of published literature and does not warrant ethical approval. The findings will be disseminated through internationally peer-reviewed journals related to mental health.PROSPERO registration numberCRD42022348427.
Excess deaths directly and indirectly attributable to COVID-19 using routinely reported mortality data, Bishkek, Kyrgyzstan, 2020: a cross-sectional study
Authors: Bumburidi Yekaterina , Dzhalimbekova Altynai , Malisheva Marina , Moolenaar Ronald L , Horth Roberta , Singer Daniel , Otorbaeva Dinagul 
Published: July 2023

ObjectivesStudies on excess deaths (ED) show that reported deaths from COVID-19 underestimate death. To understand mortality for improved pandemic preparedness, we estimated ED directly and indirectly attributable to COVID-19 and ED by age groups.DesignCross-sectional study using routinely reported individual deaths data.SettingsThe 21 health facilities in Bishkek that register all city deaths.ParticipantsResidents of Bishkek who died in the city from 2015 to 2020.Outcome measureWe report weekly and cumulative ED by age, sex and causes of death for 2020. EDs are the difference between observed and expected deaths. Expected deaths were calculated using the historical average and the upper bound of the 95% CI from 2015 to 2019. We calculated the percentage of deaths above expected using the upper bound of the 95% CI of expected deaths. COVID-19 deaths were laboratory confirmed (U07.1) or probable (U07.2 or unspecified pneumonia).ResultsOf 4660 deaths in 2020, we estimated 840–1042 ED (79–98 ED per 100 000 people). Deaths were 22% greater than expected. EDs were greater for men (28%) than for women (20%). EDs were observed in all age groups, with the highest ED (43%) among people 65–74 years of age. Hospital deaths were 45% higher than expected. During peak mortality (1 July –21 July), weekly ED was 267% above expected, and ED by disease-specific cause of death were above expected: 193% for ischaemic heart diseases, 52% for cerebrovascular diseases and 421% for lower respiratory diseases. COVID-19 was directly attributable to 69% of ED.ConclusionDeaths directly and indirectly associated with the COVID-19 pandemic were markedly higher than reported, especially for older populations, in hospital settings, and during peak weeks of SARS-CoV-2 transmission. These ED estimates can support efforts to prioritise support for persons at greatest risk of dying during surges.
Maternal and environmental Impact assessment on Neurodevelopment in Early childhood years (MINE): a prospective cohort study protocol from a low, middle-income country
Authors: Surani Zoya , Parkar Sadia , Afshan Gul , Elahi Kinza Naseem , Hoodbhoy Zahra , Hilal Kiran , Jafri Sidra Kaleem 
Published: July 2023

IntroductionEnvironmental and psychosocial adversities negatively impact children’s developmental outcomes. When these factors are experienced in early childhood—a sensitive period of development—the developing brain can be altered. While these associations have been drawn in high-income countries, it is necessary to understand child growth, neurodevelopment, and the role of environmental factors in developmental trajectories in low-income settings. The objective of this study is to longitudinally assess how demographic factors, maternal health, maternal development, and child health, are related to child development on a behavioural, cognitive, and neuroimaging level in low-socioeconomic communities.Methods and analysisMother–child dyads will be identified in the peri-urban field sites of Rehri Goth and Ibrahim Hyderi, Karachi, Pakistan. Dyads will undergo yearly assessments for 4 years beginning when the child is 1 month, 3 months or 6 months of age (+≤30 days of age) (depending on group assignment). Maternal assessments include anthropometry, behavioural, cognitive, and developmental assessments (Edinburgh Postnatal Depression Scale; Parenting Stress Index; Maternal Autonomy Index; Hurt, Insult, Threaten, Scream Tool; Reynolds Intellectual Assessment Scales (RIAS)), and biological samples collection (breast milk, blood, stool, hair). Children’s assessments include anthropometry, developmental assessments (Global Scales for Early Development (GSED); RIAS), MRI brain assessments, and biological sample collection (blood, stool, hair). Using cross-sectional and longitudinal data with statistical analysis tools, associations will be quantified between brain structure (MRI) and connectivity (resting state connectivity and diffusion tensor imaging), general cognitive skills (RIAS, GSED) and environmental influences (nutrition via biological samples, maternal mental health via questionnaires) through repeated measures analysis of variance tests and χ2tests. Quantile regression and cortical analyses will be conducted to understand how demographic factors are related to the associations found.Ethics and disseminationThe study has received ethical approval from the Aga Khan University Ethics Review Committee. The study’s findings will be disseminated through scientific publications and project summaries for the participants.
Identifying efficient linkage strategies for men (IDEaL): a study protocol for an individually randomised control trial
Authors: Dovel Kathryn , Balakasi Kelvin , Hubbard Julie , Phiri Khumbo , Nichols Brooke E , Coates Thomas J , Kulich Michal , Chikuse Elijah , Phiri Sam , Long Lawrence C , Hoffman Risa M , Choko Augustine T 
Published: July 2023

IntroductionMen in sub-Saharan Africa are less likely than women to initiate antiretroviral therapy (ART) and more likely to have longer cycles of disengagement from ART programmes. Treatment interventions that meet the unique needs of men are needed, but they must be scalable. We will test the impact of various interventions on 6-month retention in ART programmes among men living with HIV who are not currently engaged in care (never initiated ART and ART clients with treatment interruption).Methods and analysisWe will conduct a programmatic, individually randomised, non-blinded, controlled trial. ‘Non-engaged’ men will be randomised 1:1:1 to either a low-intensity, high-intensity or stepped arm. The low-intensity intervention includes one-time male-specific counseling+facility navigation only. The high-intensity intervention offers immediate outside-facility ART initiation+male-specific counselling+facility navigation for follow-up ART visits. In the stepped arm, intervention activities build in intensity over time for those who do not re-engage in care with the following steps: (1) one-time male-specific counselling+facility navigation→(2) ongoing male mentorship+facility navigation→(3) outside-facility ART initiation+male-specific counselling+facility navigation for follow-up ART visits. Our primary outcome is 6-month retention in care. Secondary outcomes include cost-effectiveness and rates of adverse events. The primary analysis will be intention to treat with all eligible men in the denominator and all men retained in care at 6 months in the numerator. The proportions achieving the primary outcome will be compared with a risk ratio, corresponding 95% CI and p value computed using binomial regression accounting for clustering at facility level.Ethics and disseminationThe Institutional Review Board of the University of California, Los Angeles and the National Health Sciences Research Council in Malawi have approved the trial protocol. Findings will be disseminated rapidly in national and international forums and in peer-reviewed journals and are expected to provide urgently needed information to other countries and donors.Trial registration numberNCT05137210.Date and version5 May 2023; version 3.
PupillOmetry for preDIction of DeliriUM in ICU (PODIUM): protocol for a prospective multicentre cohort study
Authors: Jaquet Pierre , Couffignal Camille , Tardivon Coralie , Godard Virginie , Bellot Romane , Assouline Benjamin , Benghanem Sarah , Da Silva Daniel , Decavèle Maxens , Dessajan Julien , Hermann Bertrand , Rambaud Thomas , Voiriot Guillaume , Sonneville Romain 
Published: July 2023

IntroductionDelirium is a severe complication that is associated with short-term adverse events, prolonged hospital stay and neurological sequelae in survivors. Automated pupillometry is an easy-to-use device that allows for accurate objective assessment of the pupillary light responses in comatose patients in the intensive care unit (ICU). Whether automated pupillometry might predict delirium in critically ill patients is not known. We hypothesise that automated pupillometry could predict the occurrence of delirium in critically ill patients without primary brain injury, requiring more than 48 hours of invasive mechanical ventilation in the ICU.Methods and analysisThe PupillOmetry for preDIction of DeliriUM in ICU (PODIUM) study is a prospective cohort study, which will be conducted in eight French ICUs in the Paris area. We aim to recruit 213 adult patients requiring invasive mechanical ventilation for more than 48 hours. Automated pupillometry (Neurological Pupil Index; NPi-200, Neuroptics) will be assessed two times per day for 7 days. Delirium will be assessed using the Confusion Assessment Method in ICU two times per day over 14 days in non-comatose patients (Richmond Agitation and Sedation Scale ≥−3).The predictive performances of the seven automated pupillometry parameters (ie, pupillary diameter, variation of the pupillary diameter, pupillary constriction speed, pupillary dilatation speed, photomotor reflex latency, NPi and symmetry of pupillary responses) measured to detect the delirium occurrence within 14 days will be the main outcomes. Secondary outcomes will be the predictive performances of the seven automated pupillometry parameters to detect complications related to delirium, ICU length of stay, mortality, functional and cognitive outcomes at 90 days.Ethics and disseminationThe PODIUM study has been approved by an independent ethics committee, the Comité de Protection des Personnes (CPP) OUEST IV—NANTES (CPP21.02.15.45239 32/21_3) on 06 April 2021). Participant recruitment started on 15 April 2022. Results will be published in international peer-reviewed medical journals and presented at conferences.Trial registration numberNCT05248035; clinicaltrials.gov.
Assessing tobacco use in Swedish young adults from self-report and urinary cotinine: a validation study using the BAMSE birth cohort
Authors: Zettergren Anna , Sompa Shanzina , Palmberg Lena , Ljungman Petter , Pershagen Göran , Andersson Niklas , Lindh Christian , Georgelis Antonios , Kull Inger , Melen Erik , Ekström Sandra , Bergstrom Anna 
Published: July 2023

ObjectivesStudies on health effects of tobacco often rely on self-reported exposure data, which is subjective and can lead to misclassification. The aim of this study was to describe the prevalence of cigarette smoking, snus and e-cigarette use, as well as to validate self-reported tobacco use among young adults in Sweden.MethodParticipants of a population-based Swedish cohort (n=3052), aged 22–25 years, assessed their tobacco use in a web questionnaire. Urinary cotinine was analysed in a subsample of the study population (n=998). The agreement between self-reported tobacco use and urinary cotinine was assessed using Cohen’s Kappa coefficient (κ) at a cut-off level of 50 ng/mL.ResultsPatterns of tobacco use differed between men and women. Among men, 20.0% reported daily snus use, 5.8% daily cigarette smoking and 5.6% any e-cigarette use. In contrast, 3.2% of the women reported daily snus use, 9.0% daily cigarette smoking and 2.4% any e-cigarette use. Among the tobacco use categories, daily snus users had the highest levels of cotinine. Of reported non-tobacco users, 3.5% had cotinine levels above the cut-off, compared with 68.0% among both occasional cigarette smokers and snus users, 67.5% among all e-cigarette users and 94.7% and 97.8% among daily cigarette smokers and snus users, respectively. Agreement between self-reported tobacco use and urinary cotinine was classified as strong for daily use of cigarettes (κ=0.824) and snus (κ=0.861), while moderate to weak for occasional smoking (κ=0.618), occasional snus use (κ=0.573) and any e-cigarette use (κ=0.576).ConclusionsWe found high validity of self-reported tobacco use in our study population, particularly for daily tobacco use. Further, we found that daily snus users were exposed to high levels of cotinine. Together with previous findings, our results indicate good validity of self-reported tobacco use among young adults.
Readiness of health facilities to provide services related to non-communicable diseases in Nepal: evidence from nationally representative Nepal Health Facility Survey 2021
Authors: Adhikari Bikram , Pandey Achyut Raj , Lamichhane Bipul , KC Saugat Pratap , Joshi Deepak , Regmi Shophika , Giri Santosh , Baral Sushil Chandra 
Published: July 2023

ObjectiveTo assess the readiness of public and private health facilities (HFs) in delivering services related to non-communicable diseases (NCDs) in Nepal.MethodsWe analysed data from nationally representative Nepal Health Facility Survey 2021 to determine the readiness of HFs for cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic respiratory diseases (CRDs) and mental health (MH)-related services using Service Availability and Readiness Assessment Manual of the WHO. Readiness score was measured as the average availability of tracer items in per cent, and HFs were considered ‘ready’ for NCDs management if they scored ≥70 (out of 100). We performed weighted univariate and multivariable logistic regression to determine the association of HFs readiness with province, type of HFs, ecological region, quality assurance activities, external supervision, client’s opinion review and frequency of meetings in HFs.ResultsThe overall mean readiness score of HFs offering CRDs, CVDs, DM and MH-related services was 32.6, 38.0, 38.4 and 24.0, respectively. Guidelines and staff training domain had the lowest readiness score, whereas essential equipment and supplies domain had the highest readiness score for each of the NCD-related services. A total of 2.3%, 3.8%, 3.6% and 3.3% HFs were ready to deliver CRDs, CVDs, DM and MH-related services, respectively. HFs managed by local level were less likely to be ready to provide all NCD-related services compared with federal/provincial hospitals. HFs with external supervision were more likely to be ready to provide CRDs and DM-related services and HFs reviewing client’s opinions were more likely to be ready to provide CRDs, CVDs and DM-related services.ConclusionReadiness of the HFs managed by local level to provide CVDs, DM, CRDs and MH-related services was relatively poor compared with federal/provincial hospitals. Prioritisation of policies to reduce the gaps in readiness and capacity strengthening of the local HFs is essential for improving their overall readiness to provide NCD-related services.
Perspectives of key decision makers on out-of-pocket payments for medicines in the Ethiopian healthcare system: a qualitative interview study
Authors: Mekuria Getahun Asmamaw , Achalu Daniel Legese , Tewuhibo Dinksew , Ayenew Wondim , Ali Eskinder Eshetu 
Published: July 2023

ObjectiveThis study aimed to explore the perspectives of key decision makers on out-of-pocket (OOP) payment for medicines and its implications in the Ethiopian healthcare system.DesignA qualitative design that employed audiorecorded semistructured in-depth interviews was used in this study. The framework thematic analysis approach was followed in the analysis.SettingInterviewees came from five federal-level institutions engaged in policymaking (three) and tertiary referral-level healthcare service provision (two) in Ethiopia.ParticipantsSeven pharmacists, five health officers, one medical doctor and one economist who held key decision-making positions in their respective organisations participated in the study.ResultThree major themes were identified in the areas of the current context of OOP payment for medicines, its aggravating factors and a plan to reduce its burden. Under the current context, participants’ overall opinions, circumstances of vulnerability and consequences on households were identified. Factors identified as aggravating the burden of OOP payment were deficiencies in the medicine supply chain and limitations in the health insurance system. Suggested mitigation strategies to be implemented by the health providers, the national medicines supplier, the insurance agency and the Ministry of Health were categorised under plans to reduce OOP payment.ConclusionThe findings of this study indicate that there is widespread OOP payment for medicines in Ethiopia. System level constraints such as weaknesses in the supply system at the national and health facility levels have been identified as critical factors that undermine the protective effects of health insurance in the Ethiopian context. Ensuring steady access to essential medicines requires addressing health system and supply constraints in addition to a well-functioning financial risk protection systems.
Breastfeeding initiation and duration through the COVID-19 pandemic, a linked population-level routine data study: the Born in Wales Cohort 2018–2021
Authors: Jones Hope Eleri , Seaborne Mike J , Mhereeg Mohamed R , James Michaela , Kennedy Natasha L , Bandyopadhyay Amrita , Brophy Sinead 
Published: July 2023

ObjectivesThe WHO recommends exclusive breastfeeding for the first 6 months of life. This study aimed to examine the impact the pandemic had on breastfeeding uptake and duration, and whether intention to breastfeed is associated with longer duration of exclusive breastfeeding.MethodsA cohort study using routinely collected, linked healthcare data from the Secure Anonymised Information Linkage databank. All women who gave birth in Wales between 2018 and 2021 recorded in the Maternal Indicators dataset were asked about intention to breastfeed. These data were linked with the National Community Child Health Births and Breastfeeding dataset to examine breastfeeding rates.ResultsIntention to breastfeed was associated with being 27.6 times more likely to continue to exclusively breastfeed for 6 months compared with those who did not intend to breastfeed (OR 27.6, 95% CI 24.9 to 30.7). Breastfeeding rates at 6 months were 16.6% prepandemic and 20.5% in 2020. When compared with a survey population, the initial intention to breastfeed/not breastfeed only changes for about 10% of women.ConclusionWomen were more likely to exclusively breastfeed for 6 months during the pandemic compared with before or after the pandemic. Arguably, interventions which enable families to spend more time with their baby such as maternal and paternal leave may help improve breastfeeding duration. The biggest predictor of breastfeeding at 6 months was intention to breastfeed. Therefore, targeted interventions during pregnancy to encourage motivation to breastfeed could improve duration of breastfeeding.
Effects of high-intensity interval training on cardiac remodelling, function and coronary microcirculation in de novo heart transplant patients: a substudy of the HITTS randomised controlled trial
Authors: Rafique Muzammil , Solberg Ole Geir , Gullestad Lars , Bendz Bjørn , Murbræch Klaus , Nytrøen Kari , Rolid Katrine , Lunde Ketil 
Published: July 2023

ObjectivesHigh-intensity interval training (HIT) improves peak oxygen consumption (VO2peak) in de novo heart transplant (HTx) recipients. It remains unclear whether this improvement early after HTx is solely dependent on peripheral adaptations, or due to a linked chain of central and peripheral adaptations. The objective of this study was to determine whether HIT results in structural and functional adaptations in the cardiovascular system.MethodsEighty-one de novo HTx recipients were randomly assigned to participate in either 9 months of supervised HIT or standard care exercise-based rehabilitation. Cardiac function was assessed by echocardiogram and the coronary microcirculation with the index of microcirculatory resistance (IMR) at baseline and 12 months after HTx.ResultsCardiac function as assessed by global longitudinal strain was significantly better in the HIT group than in the standard care group (16.3±1.2% vs 15.6±2.2%, respectively, treatment effect = –1.1% (95% CI –2.0% to –0.2%), p=0.02), as was the end-diastolic volume (128.5±20.8 mL vs 123.4±15.5 mL, respectively, treatment effect=4.9 mL (95% CI 0.5 to 9.2 mL), p=0.03). There was a non-significant tendency for IMR to indicate improved microcirculatory function (13.8±8.0 vs 16.8±12.0, respectively, treatment effect = –4.3 (95% CI –9.1 to 0.6), p=0.08).ConclusionWhen initiated early after HTx, HIT leads to both structural and functional cardiovascular adaptations.Trial registration numberNCT01796379.