Health Recommendations Research Articles

Aboriginal and Torres Strait Islander community experiences and recommendations for health and medical research: a mixed methods study.

To describe Aboriginal and Torres Strait Islander communities' processes, positioning and experiences of health and medical research and their recommendations. A cross-sectional online and paper-based survey. Representatives from Aboriginal and Torres Strait Islander health services and community-controlled organisations in Australia. Responses to a 33-item mixed methods survey that explored communities' positioning and processes relating to health and medical research and their experiences of health and medical research in the previous 5 years. Recommendations for improving health and medical research were elicited via two open-ended questions. Fifty-one community representatives nationally responded to the survey. Most representatives reported feeling slightly or very positive about research (37, 73%). More than half (33, 65%) reported having formal governance processes, and two-thirds of those without governance processes were interested in establishing such processes (12, 67%). Almost half reported that research has sometimes or never had benefit (25, 49%). Ethical principles that were most often reported as essential included those relating to sharing results back with community (45, 88%), translating research into policy and practice (37, 73%), employing Aboriginal and Torres Strait Islander staff (37, 73%), Indigenous data sovereignty and governance (36, 71%) and research agreements (35, 69%). Community representatives reported being approached frequently and in the later stages of research, with little input during the development and design stages of research. Most representatives reported that their communities had participated in Indigenous-led research (39, 76%). Community representatives highlighted the need for appropriate resourcing and funding to drive and lead their own research agendas. Aboriginal and Torres Strait Islander communities continue to have negative experiences of research despite four decades of advocating for control, ownership and leadership of health and medical research. Researchers, funding bodies and institutions must examine current funding and research structures that reinforce current practices, to ensure transparency and accountability to communities by repositioning and giving power to communities to direct and lead their own health and medical research agendas.

Fostering Trust in Public Health Messaging: Tailoring Communication for Rural Parents.

As pandemic-related mistrust of public health recommendations in rural communities may compound gaps in pediatric immunizations, our team explored parents' perceptions of trustworthiness in messaging. Qualitative study using 4 virtual focus groups. Rural Wisconsin. Participants (n = 25) were parents or guardians of children recruited through our contacts with community-based organizations serving rural communities. Researchers used task-oriented elicitation techniques to initiate discussion on the trustworthiness of messengers and messages providing health recommendations. Participants were asked to (1) review existing public health messaging on a range of topics and from a range of sponsors; and (2) rank a list of potential messengers in terms of trustworthiness (eg, local health department, Centers for Disease Control). Discussions were recorded, and audio files transcribed, to facilitate a team-based, thematic analysis. Competency in medical knowledge and parenting experience contributed to estimations of trustworthiness. Participants also responded well to messages and messengers that were able to project recognition of their children's uniqueness and their experience as parents. Participants distrusted messengers who were seen as biased or "one-sided" in their perspectives. For successful health promotion for rural-living parents, messengers must be recognized as "competent" to provide pediatric health advice and to avoid blanket recommendations that may undermine parents' experience and feelings of being "understood" and affect perceptions of trustworthiness.

Management of women with abnormal cervical cytology: Update of INCa recommendations after the implementation of HPV screening

To update the recommendations issued by the National Cancer Institute (INCa) on the management of women with abnormal cervical cytology. INCa recommendations on the management of women with abnormal cervical cytology were published in 2016. In 2019, the High Authority of Health (HAS) recommends HPV test for cervical cancer screening in women over 30. It was therefore necessary to update the initial management and follow-up of women with a reflex cytology abnormality after a positive HPV test. We used the modified Delphi method. Each decision tree was modified by the 3 members of the organizing committee and then presented to 35 experts over 2 rounds, in order to obtain their agreement in terms of validity and clarity. This formalized consensus of experts allowed the creation of 17 decision trees instead of 15 previously: 13 on the diagnostic management of abnormal cytology, stratified according to age, and 4 on therapeutic indications in abnormal histology. The median agreement scores were 89% (81-97). These 17 decision trees respond to the different situations that health professionals may encounter in order to enable them to act, to follow-up or delegate according to their specialties.

Dynamic neurocognitive adaptation in aging: Development and validation of a new scale.

Forty-five percent of Alzheimer's disease (AD) cases may have been preventable through protective factors. Reserve, resilience, and resistance share common neurocognitive adaptive processes, acting through protective mechanisms. In this article we propose the development and validation of a new scale, called dynamic Neurocognitive Adaptation, developed in this direction. We included 815 participants (50% women; 65+ years inclusive of age), divided into two subsamples for exploratory and confirmatory factor analysis. Our initial scale was composed of 30 items, investigating seven dimensions, explored by a 5-point Likert scale reflecting the frequency of activities, for seven time windows. Our final scale had 20 items divided among four dimensions: physical, cognitive, creative, and social. There were no issues related to multi-collinearity or non-collinearity. Kaiser-Meyer-Olkin (KMO) = 0.80 and Bartlett's test of sphericity indicated all values ≤0.01; Cronbach's alpha = 0.83. We have validated a reliable, novel, easy to complete, and comprehensive scale to assess lifetime behaviors, which can be applied in research on AD risk reduction, mild cognitive impairment, and in clinical practice. Reserve, resistance, and resilience share similar adaptive mechanisms.Dynamic Neurocognitive Adaptation is a new scale to assess lifetime protective factors.Dynamic Neurocognitive Adaptation is a reliable, novel, and easy to complete scale.This approach can characterize specific life stages that are ripe for risk-reduction interventions.Our scale can be used to personalize health recommendations in aging.

Patient perspective: Is intensive screening of women at high risk of breast cancer evidence-based medicine or déjà vu?

In 2023, a breast cancer risk assessment and a subsequent positive test for the BRCA-2 genetic mutation brought me to the uncomfortable intersection of a longstanding career as an advocate for high-quality medical evidence to support shared patient-provider decision making and a new role as a high-risk patient. My search for studies of available risk-management options revealed that the most commonly recommended approach for women with a ⩾20% lifetime breast cancer risk, intensive screening including annual mammography and/or magnetic resonance imaging beginning at age 25-40 years, was supported only by cancer-detection statistics, with almost no evidence on patient-centered outcomes-mortality, physical and psychological morbidity, or quality of life-compared with standard screening or a surgical alternative, bilateral risk-reducing mastectomy. In this commentary, I explore parallels between the use of the intensive screening protocol and another longstanding women's health recommendation based on limited evidence, the use of hormone therapy (HT) for postmenopausal chronic disease prevention, which was sharply curtailed after the publication of the groundbreaking Women's Health Initiative trial in 2002. These declines in HT utilization were followed by marked decreases in breast cancer incidence, providing a compelling lesson on the critical importance of a solid evidentiary basis for women's health decisions. Known harms accompanying the benefits of breast screening-overdiagnosis, psychological effects, and mammography-associated radiation-exposure risks-make empirical measurement of patient-centered outcomes essential. Yet, published research on intensive screening of women at high breast cancer risk has largely ignored these outcomes, leaving patients, providers, and guideline developers lacking the evidence needed for best practice. Outcomes research is both feasible and urgently needed to inform care decisions and health policy for this patient population.

P-1959. B.1.617.2 Outbreak Mitigation on an International Steel Cargo Ship Utilizing a Multidisciplinary Approach

Abstract Background The SARS-CoV-2 B.1.617.2 (Delta) variant emerged in India and became widespread in the United States in 2021. Evidence suggested it was more transmissible than other variants.Figure 1:SARS-CoV-2 Cases on the Steel Cargo Ship Timeline Methods From 01 May to 22 May 2021, 14 cases of COVID-19 were linked to an international steel cargo ship docked on the Detroit River, after 5 new members joined the crew from India. Cases were reported to the Detroit Health Department (DHD) on 08 May 2021. A strict weekly testing schedule was maintained by DHD. Control measures included a multidisciplinary partnership between DHD, local universities and hospitals. The multidisciplinary team (MDT) considered environmental health, infection control and behavioral health interventions. Measures for control included testing, and quarantine, vaccine, antibody therapy, and access to hospital care. Results 14 out of 21 total crew members were confirmed positive (attack rate 67%). Once no new cases were found, a 14-day working quarantine was applied per the Centers for Disease Control (CDC) guidance. On 13 May 2021, the DHD vaccine outreach team administered Janssen COVID-19 vaccine, without incident, to all medically eligible crew (n = 19). Janssen was selected considering the ship’s upcoming departure from Detroit and the limitation for follow-up doses. Conclusion Response measures taken for this ship involved quarantine, isolation, disinfection and ventilation protocols, installation of filter units, behavioral health recommendations for anxiety-reducing strategies, antibody therapy, hospital care, vaccine administration and education. A MDT approach and multicomponent control strategy was critical to mitigate further spread. DHD’s communicable diseases investigations, vaccination, and testing capabilities were essential, including continued guidance from the Michigan Department of Health and Human Services (MDHHS) and CDC. Full transparency from the ship crew prevented potential spread of the variant in Detroit. On 02 June 2021, the ship was cleared by DHD, MDHHS, and CDC to depart. This incident led to the approval and vaccination of 3 subsequent ships whose crews also originated from the Indian subcontinent. This study provides a model for investigation and control of infection related to international ships. Disclosures Seema Joshi, MD, AbbVie: Grant/Research Support Marcus Zervos, MD, Johnson and johnson: Grant/Research Support|Moderna: Grant/Research Support

The Impact of Selected Comorbidities on the Necessity for Physiotherapy in Patients Hospitalised with COVID-19

Abstract Data from 5173 patients hospitalized for COVID-19 at the University Hospital of Ostrava (UHO) between March 2020 and December 2021 were analysed in this retrospective study. The research aimed to find out whether the comorbidities being present increased the need for acute rehabilitation during COVID-19 hospitalization. Data were examined using descriptive statistics, Spearman's correlation coefficient, and binomial logistic regression. Among the total patient cohort (n = 5173), 27% required rehabilitation (RHB). The average age of patients was 64.9 ± 16.9 years, with rehabilitation durations ranging from 1 to 102 days. Of the rehabilitated patients, 92% (n = 1302) had hospital stays from 1 to 15 days, while 8% (n = 114) stayed more than 15 days. Patients had a median of 4 diagnoses each, with approximately one-fifth having more than six diagnoses. A weak but statistically significant positive association was observed for the length of rehabilitation and the number of diagnoses (Spearman’s correlation coefficient rs = 0.24). Adjusted statistical analysis revealed that patients with concomitant neurological conditions (G62, G81 according to ICD-10) (OR = 8.4; 95% CI 4.82–14.67) and certain respiratory diseases had the highest likelihood of requiring rehabilitation during their COVID-19 hospitalization. Additionally, patients with obesity were approximately 1.4 times more likely to need RHB than non-obese patients. The need for rehabilitation increased with the number of comorbidities, with the greatest need connected with neurological diagnosis. In light of these findings, more effective strategies for diagnosis, treatment and prevention can be developed for future epidemics or pandemics. It is imperative to reinforce health recommendations. The analysis of data enables the formulation of evidence-based public health guidelines that can serve as the foundation for a prompt and effective response in the event of another pandemic.

Healthcare workers’ perspectives on trauma and mental health access for Rohingya refugees in Cox’s Bazar

BackgroundIn August 2017, the Rohingya population of northern Rakhine State in Myanmar fled to Bangladesh following “clearance operations” by the Myanmar security forces that were characterized by widespread and systematic violence, constituting severe human rights violations. The “clearance operations” were preceded by years of consistent denial of the human rights of the Rohingya people in Myanmar. This study examines the impact of these human rights violations on the trauma experiences of Rohingya survivors, their resulting mental health, and the availability and access to post-migration mental health services.MethodsQualitative one-on-one interviews were conducted with 26 health care professionals who cared for Rohingya refugees after their arrival in Bangladesh.ResultsTrauma experienced by the Rohingya spanned the period before, during, and following migration and was ongoing at the time of data collection. The impact of Rohingya survivors’ concurrent grief and trauma in relation to the violence they experienced in Myanmar as well as during and after their journey to Bangladesh that, at times, exacerbated survivors’ trauma presentation. There were limited mental health services available in Bangladesh and additional structural and procedural barriers to care that limited responsiveness to Rohingya survivors’ mental health needs.ConclusionThe Rohingya experienced traumatic human rights violations in Myanmar that led to their forced migration to Bangladesh. The Rohingya continued to experience trauma during their forced migration to Bangladesh and were exposed to additional stressors in the post-migration settings in refugee camps, including lack of access to adequate mental health services. These experiences have resulted in a spectrum of stress-and trauma-related symptoms. These findings show the mental health impact of protracted human rights violations on the Rohingya, revealing how trauma is not a singular event but a continuous experience. Detailing the limited mental health infrastructure and structural barriers facing Rohingya refugees in Bangladesh, the findings underscore the urgent need for trauma-informed interventions that address the complex psychological consequences of systemic violence and displacement. The findings emphasize the critical importance of holistic mental health support in refugee settings, providing evidence-based recommendations for the public health and humanitarian sector to consider when designing programs to address the mental health and psychosocial support needs of sexual violence survivors living in conditions of displacement.

Stigma and fear during the COVID-19 pandemic: a qualitative study on the perceptions of healthcare workers in Canada and Singapore

IntroductionWe sought to explore healthcare providers (HCPs)' perceptions of and experiences with stigma during the COVID-19 pandemic in Canada and Singapore.MethodsWe conducted a qualitative study (May 2020–February 2021) with HCPs in Canada and Singapore and developed a semi-structured interview guide rooted in the Health Stigma and Discrimination Framework (HSDF). We recruited participants online and through word of mouth via newsletters, blogs and social media. Participants were eligible to participate if they worked as a healthcare provider in Singapore or Canada during COVID-19. Following participant consent, data were recorded, transcribed verbatim, and coded using a framework approach. Coded data were charted into a framework matrix and used to compare themes in each country.ResultsWe conducted 51 interviews (23 in Canada; 28 in Singapore). HCPs perceived that patient fears coupled with mistrust of the health system impacted health behaviors. HCPs reported discrimination and stigmatization of population subsets. In Singapore, this included Chinese tourists and migrant workers and in Canada, this included people of Chinese ethnicity and people experiencing homelessness. This stigma was often attributed to pre-existing prejudices including perceptions that these populations were at increased risk of COVID-19 or not adhering to public health recommendations. HCPs feared spreading COVID-19 to family, peers and patients, often resulting in participants choosing to isolate from social circles. HCPs in both countries experienced occupation-based stigma, including stigma related to public health practices (masking, testing); in Canada, this intersected with race-based prejudice for participants of Chinese ethnicity. HCPs in both samples witnessed and experienced stigmatizing behavior; some participants also experienced discrimination.ConclusionsSecondary stigma related to occupation was experienced by HCPs during COVID-19. HCPs experienced intersecting stigma based on race/ethnicity and observed stigmatization of marginalized patient populations. Most themes were consistent across Canada and Singapore. Strategies to mitigate COVID-19 related stigma toward HCPs and at-risk patient populations are warranted.

N25 A qualitative study exploring health professionals’ experiences and understanding of the sexual health and associated care needs in men with Inflammatory Bowel Disease

Abstract Background Inflammatory Bowel Disease (IBD) can negatively affect men’s sexual well-being and alter the way in which they engage in sexual activities (1). People with IBD in the UK have reported that health professionals are reticent to initiate discussions about their sexual health (1, 2). There is a paucity of research exploring men’s sexual health in IBD (3). This study aimed to describe and interpret the experiences of healthcare practitioners (HCPs) working in IBD within the UK to explore current practice in relation to the assessment of sexual health of men with IBD, understand the perceived barriers and facilitators to engaging with men about their sexual health and inform recommendations for clinical practice, education, and research. Methods A qualitative interpretive description design (4) using individual, online semi-structured interviews. Participants were UK health professionals purposively sampled and recruited through advertising the study through professional IBD organisations, conferences and online networks. Interviews were transcribed verbatim and analysed using thematic analysis. Results 19 HCPs participated in the study: 10 nurses, 6 medical doctors, 2 clinical psychologists and 1 dietitian. Participants had worked with IBD patients for between 6 months and 22 years (mean 13 years, SD 9.66),14 were female, 5 were male. Participants’ experiences of sexual health discussions, assessment, and provision of care were apparent through two emergent themes. The first theme, ‘it’s difficult to discuss sex’ represented personal, professional, and societal barriers to discussing sexual health with male IBD patients. The second theme, ‘service transformation is needed’, encapsulated the service-related barriers faced by both patients and HCPs and the possible adjustments required to facilitate the identification and support of men’s sexual health and well-being needs within clinical practice. Several sub-themes reflected the perceived barriers faced by HCPs including: 'feeling ill-equipped', 'ask the IBD nurses, they’ll know', 'men tend to bravado', 'a fire-fighting service', and 'creating a safe environment'. Conclusion IBD healthcare practitioners working in the UK may face personal, professional, organisation, and societal barriers to providing assessment and support for the sexual health and care needs of men with IBD. It is likely that these barriers may be moderated by improving the availability of sexual healthcare resources and developing treatment pathways that promote cohesive multi-disciplinary working. Future research should focus on how HCPs can be supported to become comfortable and proficient at initiating sexual health conversations that are inclusive of psychosocial-sexual needs. References (1)Ma S, Knapp P, Galdas P. "My sexual desires, everything, my normal life just stops"; a qualitative study of male sexual health in inflammatory bowel disease. Journal of Clinical Nursing. 2024. doi:10.1111/jocn.17292 (2)Fourie S, Norton C, Jackson D, Czuber-Dochan W. "These discussions aren’t happening". Experiences of people living with inflammatory bowel disease talking about sexual well-being with healthcare professionals. Journal of Crohn’s and Colitis. 2021;15(10):1641-1648. doi:10.1093/ecco-jcc/jjab043 (3)Ma S, Veysey M, Ersser S, Mason-Jones A, Galdas P. The impact of inflammatory bowel disease on sexual health in men: A scoping review. Journal of Clinical Nursing. 2020:(19-20):3638-3652. doi:10.1111/jocn.15418 (4)Thorne S. Interpretive Description: Qualitative Research for Applied Practice. Routledge; 2016.

A Systematic Review of Evaluated Labor Market Initiatives Addressing Precarious Employment: Findings and Public Health Implications.

Precarious employment (PE) is a major determinant of population health and contributor to health and social inequities. The purpose of this article is to synthesize and critically appraise available evidence on labor market initiatives addressing PE identified through a systematic review. Of the 21 initiatives reviewed, grouped into four categories-labor market policies, legislation, and reforms; union strategies; apprenticeships and other youth programs; social protection programs-10 showed consistently positive outcomes and 11 a combination of negative, mixed, or inconclusive outcomes. In addition to reviewing the key findings, we discuss public health implications and recommendations related to PE and the implementation and evaluation of initiatives. Given the wide diversity of initiatives, implementation approaches, evaluation methods, and socioeconomic and historical contexts characterizing the labor markets of the countries studied, we refrain from making recommendations regarding the most effective initiatives to address PE. Instead, we discuss several implications concerning the four types of initiatives to further support those searching for solutions to address PE. We strongly recommend tailoring adopted initiatives to local contexts to match a country's specific PE problems and unique labor market and socioeconomic context.

Vitamin D: Evidence-Based Health Benefits and Recommendations for Population Guidelines.

Vitamin D offers numerous under-recognized health benefits beyond its well-known role in musculoskeletal health. It is vital for extra-renal tissues, prenatal health, brain function, immunity, pregnancy, cancer prevention, and cardiovascular health. Existing guidelines issued by governmental and health organizations are bone-centric and largely overlook the abovementioned extra-skeletal benefits and optimal thresholds for vitamin D. In addition, they rely on randomized controlled trials (RCTs), which seldom show benefits due to high baseline 25-hydroxyvitamin D [25(OH)D] concentrations, moderate supplementation doses, and flawed study designs. This review emphasizes the findings from prospective cohort studies showing that higher 25(OH)D concentrations reduce the risks of major diseases and mortality, including pregnancy and birth outcomes. Serum concentrations > 30 ng/mL (75 nmol/L) significantly lower disease and mortality risks compared to <20 ng/mL. With 25% of the U.S. population and 60% of Central Europeans having levels <20 ng/mL, concentrations should be raised above 30 ng/mL. This is achievable through daily supplementation with 2000 IU/day (50 mcg/day) of vitamin D3, which prevent diseases and deaths. Furthermore, a daily dose between 4000 and 6000 IU of vitamin D3 to achieve serum 25(OH)D levels between 40 and 70 ng/mL would provide greater protection against many adverse health outcomes. Future guidelines and recommendations should integrate the findings from observational prospective cohort studies and well-designed RCTs to improve public health and personalized care.

TRADITION MEETS INNOVATION: THE ROLE OF DIGITAL TOOLS IN HOLIS-TIC HEALTH

Ayurveda, the ancient Indian system of medicine, emphasises personalised care through Prakriti (individual constitution) and Dosha (physiological energies). The integration of modern technology has led to Digital Ayurveda, combining traditional wisdom with tools like artificial intelligence (AI), telemedicine, wearable devices, and mobile applications. Key findings reveal that telemedicine democratizes access to Ayurvedic care, particularly in underserved areas, while AI enhances diagnostics and provides personalised health recommendations. Wearable devices monitor realtime health metrics aligned with Dosha balances, such as heart rate variability and sleep patterns, helping identify imbalances early. Mobile apps offer holistic health guidance, including dietary suggestions, yoga, and meditation practices, empowering individuals to engage proactively with Ayurveda. This technological integration improves accessibility, precision, and preventive healthcare while preserving Ayurveda’s core principles. However, data privacy, authenticity, and regulation must be addressed. Digital Ayurveda represents a transformative step toward modern, holistic healthcare.

Human-centered design of a health recommender system for orthopaedic shoulder treatment

BackgroundRich data on diverse patients and their treatments and outcomes within Electronic Health Record (EHR) systems can be used to generate real world evidence. A health recommender system (HRS) framework can be applied to a decision support system application to generate data summaries for similar patients during the clinical encounter to assist physicians and patients in making evidence-based shared treatment decisions.ObjectiveA human-centered design (HCD) process was used to develop a HRS for treatment decision support in orthopaedic medicine, the Informatics Consult for Individualized Treatment (I-C-IT). We also evaluate the usability and utility of the system from the physician’s perspective, focusing on elements of utility and shared decision-making in orthopaedic medicine.MethodsThe HCD process for I-C-IT included 6 steps across three phases of analysis, design, and evaluation. A team of health informatics and comparative effectiveness researchers directly engaged with orthopaedic surgeon subject matter experts in a collaborative I-C-IT prototype design process. Ten orthopaedic surgeons participated in a mixed methods evaluation of the I-C-IT prototype that was produced.ResultsThe HCD process resulted in a prototype system, I-C-IT, with 14 data visualization elements and a set of design principles crucial for HRS for decision support. The overall standard system usability scale (SUS) score for the I-C-IT Webapp prototype was 88.75 indicating high usability. In addition, utility questions addressing shared decision-making found that 90% of orthopaedic surgeon respondents either strongly agreed or agreed that I-C-IT would help them make data informed decisions with their patients.ConclusionThe HCD process produced an HRS prototype that is capable of supporting orthopaedic surgeons and patients in their information needs during clinical encounters. Future research should focus on refining I-C-IT by incorporating patient feedback in future iterative cycles of system design and evaluation.

Global Prevalence of Long COVID, its Subtypes and Risk factors: An Updated Systematic Review and Meta-Analysis.

Updated knowledge regarding the global prevalence of long COVID (or post-COVID-19 condition), its subtypes, risk factors, and variations across different follow-up durations and geographical regions is necessary for informed public health recommendations and healthcare delivery. The primary objective of this systematic review is to evaluate the global prevalence of long COVID and its subtypes and symptoms in individuals with confirmed COVID-19 diagnosis, while the secondary objective is to assess risk factors for long COVID in the same population. Studies on long COVID published from July 5, 2021, to May 29, 2024, searched from PubMed, Embase, and Web of Science were used for this systematic review. Supplemental updates to the original search period were made. There were four inclusion criteria: (1) human study population with confirmed COVID-19 diagnosis; (2) appropriate index diagnosis date; (3) outcome must include either prevalence, risk factors, duration, or symptoms of long COVID; and (4) follow-up time of at least two months after the index date. The exclusion criteria were: (1) non-human study population; (1) case studies or reviews; (2) studies with imaging, molecular, and/or cellular testing as primary results; (3) studies with specific populations such as healthcare workers, residents of nursing homes, and/or those living in long-term care facilities; and (4) studies that did not meet the sample size threshold needed to estimate overall prevalence with margin of error of 0.05. Two screeners independently performed screenings and data extraction, and decision conflicts were collectively resolved. The data were pooled using a random-effects meta-analysis framework with a DerSimonian-Laird inverse variance weighted estimator. The primary estimand (target population parameter of interest) was the prevalence of long COVID and its subtypes among individuals with confirmed COVID-19 diagnoses, and the secondary estimand was effect sizes corresponding to ten common risk factors of long COVID in the same population. A total of 442 studies were included in this mega-systematic review, and 429 were meta-analyzed for various endpoints, avoiding duplicate estimates from the same study. Of the 442 studies, 17.9% of the studies have a high risk of bias. Heterogeneity is evident among meta-analyzed studies, where the I 2 statistic is nearly 100% in studies that estimate overall prevalence. Global estimated pooled prevalence of long COVID was 36% among COVID-19 positive individuals (95% confidence interval [CI] 33%-40%) estimated from 144 studies. Geographical variation was observed in the estimated pooled prevalence of long COVID: Asia at 35% (95% CI 25%-46%), Europe at 39% (95% CI 31%-48%), North America at 30% (95% CI 24%-38%), and South America at 51% (95% CI 35%-66%). Stratifying by follow-up duration, the estimated pooled prevalence for individuals with longer follow-up periods of 1 to 2 years (47% [95% CI 37%-57%]) compared to those with follow-up times of less than 1 year (35% [95% CI 31%-39%]) had overlapping CI and were therefore not statistically distinguishable. Top five most prevalent long COVID subtypes among COVID-19 positive cases were respiratory at 20% (95% CI 14%-28%) estimated from 31 studies, general fatigue at 20% (95% CI 18%-23%) estimated from 121 studies, psychological at 18% (95% CI 11%-28%) estimated from 10 studies, neurological at 16% (95% CI 8%-30%) estimated from 23 studies, and dermatological at 12% (95% CI 8%-17%) estimated from 10 studies. The most common symptom based on estimated prevalence was memory problems estimated at 11% (95% CI 7%-19%) meta-analyzed from 12 studies. The three strongest risk factors for long COVID were being unvaccinated for COVID-19, pre-existing comorbidity, and female sex. Individuals with any of these risk factors had higher odds of having long COVID with pooled estimated odds ratios of 2.34 (95% CI 1.49-3.67) meta-analyzed from 6 studies, 1.59 (95% CI 1.28-1.97) from 13 studies, and 1.55 (95% CI 1.25-1.92) from 22 studies, respectively. This study shows long COVID is globally prevalent in the COVID-19 positive population with highly varying estimates. The prevalence of long COVID persists over extended follow-up, with a high burden of symptoms 1 to 2 years post-infection. Our findings highlight long COVID and its subtypes as a continuing health challenge worldwide. The heterogeneity of the estimates across populations and geographical regions argues for the need for carefully designed follow-up with representative studies across the world.

Association between lifestyle risk factors and mortality in the Mexico City prospective study

Unhealthy lifestyles risk factors, such as smoking, alcohol consumption, physical inactivity, poor diet, and obesity, have been associated with a higher risk of all-cause and cause-specific mortality. However, composite score of these unhealthy behaviours has not been considered, particularly in Latin American populations. Herein, we examined the association of lifestyle risk factors score with all-cause and cause-specific mortality in Mexican adults. A total of 159,517 adults from the Mexico City Prospective Study (MCPS) were included. Data on sociodemographic, lifestyle risk factors and medical histories was collected through a self-reported baseline questionnaire in a census-style door-to-door interviews. Lifestyle risk factors assessment was based on five modifiable lifestyle risk factors and their respective cut-off points according to current health recommendations, including obesity, physical inactivity, tobacco, alcohol consumption and fruits and vegetables intake. Multivariable Cox regression models were used to estimate the associations of lifestyle risk factor score (ranging from 0 to 5) with all-cause and cause-specific mortality (cardiovascular disease, renal or hepatobiliary diseases, diabetes, respiratory diseases, cancer and all-cause mortality). We excluded the first 2, 5, 10, and 15 years of follow-up to account for reverse causation bias. We found a high prevalence (77%) of Mexican adults, with two or more lifestyle risk factors. Hazard ratio for respiratory diseases and renal or hepatobiliary diseases were 1.86 (95%CI: 1.45–2.39) and 2.00 (95%CI: 1.60–2.52) comparing participants with 4–5 lifestyle risk factors vs. those with none. For all-cause mortality, participants with 4–5 lifestyle risk factors had a 49% (HR: 1.49; 95%CI: 1.03–2.16) higher risk as compared to participants with none. The magnitude of the associations increased as the exclusion of follow-up time increased after 2, 5, 10 and 15 years. There was a positive association between the number of lifestyle risk factors and all-cause and cause-specific mortality, showing the highest rate of respiratory, renal or hepatobiliary and all-cause mortality among participants with 4–5 lifestyle risk factors. After accounting for reverse causation, associations were stronger.

Mental health risk communication and community participation among an Indigenous people in Colombia.

To describe and analyze a community participation process to develop recommendations for adequate communication of mental health risks among the Wayuú people of Colombia. This qualitative study conducted focus groups in the Indigenous cities of Albania and Uribia, Colombia, from January to June 2024, to assess perspectives on mental health risk communication. Participants were adults (>18 years) residing in two municipalities in La Guajira (Uribia and Albania [the Indigenous capital of Colombia]) and included youth group leaders, Indigenous representatives, migrant population representatives, and representatives of official institutions in the region. Thematic analysis was used for data analysis. In total, 42 participants (mean [SD] age, 20.1 years; 24 [57.1%] women and 18 [42.9%] men) participated in four focus groups (two in Albania and two in Uribia). Three main themes were identified in the thematic analysis: consequences of poor communication; community advice for social communication; and recommendations for public mental health in health communication. Based on the data analysis, recommendations for mental health risk communication were proposed for both municipalities and for the territory of La Guajira, Colombia. The findings of this qualitative study highlight the need to improve mental health communication among the Indigenous community by leveraging their perspectives. The involvement of community leaders and the development of mental health communication strategies are needed.

How poser relations impact pregnancy and childbirth: Knowledge, Healthcare and Work in France

Based on a constructivist approach to human reproduction, this focus analyses the ways childbirth in mainland France is framed by natalist and health policies and by social inequalities. Beyond the tension between naturalness and technicality, birth is subject to a diversity of power relations. We focus here on power dynamics around class, sex and race, which impact the access to and the quality of perinatal care. Drawing on qualitative and quantitative studies, we show that women and couples have unequal access to information during pregnancy, for several reasons. Firstly, the standardised length of antenatal consultations. Secondly, differences in understanding of information that is implicitly adapted to the most educated and affluent social classes. Thirdly, the ambivalence of the information, which oscillates between autonomy and injunction in terms of how the baby should be delivered and fed. Fourthly, pregnant workers have little knowledge of their reproductive rights. We also show that the provision of perinatal care is unequal despite a supposedly universal health insurance system. Racially Minoritized women are subject to more complex administrative procedures and to more medical interventions. In addition, health and diet recommendations, and alternative birthing methods, are better suited to the individualistic logic and material conditions of the middle classes than those of the working classes. As far as working conditions are concerned, women in arduous occupations use sick leave as a means of protection, whereas women in less arduous occupations take maternity leave later than the other women. Lastly, men's involvement in domestic tasks during women's pregnancies remains occasional and limited to the physical dimension of those tasks, even more so as this assignment of women to domestic labour is reinforced by healthcare professionals. Finally, we contend that equal care for all pregnant women can only be achieved if the social dimensions of health are fully taken into account.

Health recommender systems to facilitate collaborative decision-making in chronic disease management: A scoping review.

Health recommender systems (HRSs) are increasingly used to complement existing clinical decision-making processes, but their use for chronic diseases remains underexplored. Recognizing the importance of collaborative decision making (CDM) and patient engagement in chronic disease treatment, this review explored how HRSs support patients in managing their illness. A scoping review was conducted using the framework proposed by Arksey and O'Malley, advanced by Levac et al., in line with the PRISMA-ScR checklist. Quantitative (descriptive numerical summary) and qualitative (inductive content analysis) methods wered used to synthesize the data. Forty-five articles were included in the final review, most commonly covering diabetes (9/45, 20%), mental health (9/45, 20.0%), and tobacco dependence (7/45, 15.6%). Behavior change theories (10/45, 22.2%) and authoritative sources (10/45, 22.2%) were the most commonly referenced sources for design and development work. From the thematic analysis, we conclude: (a) the main goal of HRSs is to induce behavior change, but limited research investigates their effectiveness in achieving this aim; (b) studies acknowledge that theories, models, frameworks, and/or guidelines help design HRSs to elicit specific behavior change, but they do not implement them; (c) connections between CDM and HRS purpose should be more explicit; and (d) HRSs can often offer other self-management services, such as progress tracking and chatbots. We recommend a greater emphasis on evaluation outcomes beyond algorithmic performance to determine HRS effectiveness and the creation of an evidence-driven, methodological approach to creating HRSs to optimize their use in enhancing patient care. Our work aims to provide a summary of the current landscape of health recommender system (HRS) use for chronic disease management. HRSs are digital tools designed to help people manage their health by providing personalized recommendations based on their health history, behaviors, and preferences, enabling them to make more informed health decisions. Given the increased use of these tools for personalized care, and especially with advancements in generative artificial intelligence, understanding the current methods and evaluation processes used is integral to optimizing their effectiveness. Our findings show that HRSs are most used for diabetes, mental health, and tobacco dependence, but only a small percentage of publications directly reference and/or use relevant frameworks to help guide their design and evaluation processes. Furthermore, the goal for most of these HRSs is to induce behavior change, but there is limited research investigating how effective they are in accomplishing this. Given these findings, we recommend that evaluations shift their focus from algorithms to more holistic approaches and to be more intentional about the processes used when designing the tool to support an evidence-driven approach and ultimately create more effective and useful HRSs for chronic disease management.

Enhancing Maternal Mental Health Knowledge through Hypnocomfort Pregnancy Multimodal Psychoeducation Media

Educational technology plays an important role in increasing access to information, promoting health awareness, and supporting interactive community learning on health issues. The multimodal psychoeducation approach allows the delivery of information through various channels (audio, visual, digital text), which can increase information absorption and emotional engagement. Maternal mental health is a crucial aspect that affects the well-being of both the mother and the fetus during pregnancy. This study aims to evaluate the impact of using multimodal psychoeducational media, specifically hypnocomfort pregnancy, to enhance maternal mental health knowledge in managing anxiety during pregnancy. The research employs a quasi-experimental design with a pre-test and post-test with a control group design. The sample consists of 20 pregnant women. The intervention group receives training using hypnocomfort pregnancy multimodal psychoeducational media. The results indicate that the intervention group experienced a higher maternal mental health knowledge increase than the control group. The T-test results show a significant P-value (0.000), indicating that the use of hypnocomfort pregnancy multimodal psychoeducational media has a significant effect on improving maternal mental health knowledge. It can be concluded that the development and application of hypnocomfort pregnancy multimodal psychoeducational media is effective in enhancing maternal mental health knowledge. This study supports the use of multimodal media in maternal mental health care and recommends integrating similar methods into pregnancy support programs. In addition, broader contributions include the development of psychoeducational methods that can be implemented in health education with the potential to improve the knowledge and management of community mental education.