Preventive Interventions Research Articles

Data analytics and machine learning for gender-based violence prevention: A framework for policy design and intervention strategies

Gender-based violence (GBV) remains a significant global issue, and the application of data analytics and machine learning (ML) presents new opportunities for more effective prevention and intervention strategies. This paper explores the role of data analytics and ML in addressing GBV, focusing on their application in trend analysis, risk factor prediction, and hotspot mapping. The review examines existing tools and methods used to analyze patterns of GBV, predict high-risk situations, and identify areas with elevated GBV incidence. These technologies can provide valuable insights for stakeholders in law enforcement, social services, and policymaking. The paper proposes a conceptual model for enhancing GBV prevention efforts by integrating predictive algorithms with socio-cultural data. This model aims to create data-driven frameworks for policy design, helping to identify emerging risks, design targeted intervention programs, and assess the effectiveness of prevention initiatives. By combining quantitative data with qualitative insights from community surveys, the model facilitates a more holistic approach to tackling GBV. Furthermore, the study addresses the ethical implications of using data and ML in GBV prevention. Issues such as privacy, data security, and bias in algorithmic decision-making are explored, emphasizing the need for ethical guidelines and transparency in the use of these technologies. The importance of community engagement in data collection, program design, and evaluation is also highlighted. Engaging communities ensures that interventions are culturally sensitive, locally relevant, and more likely to succeed in reducing GBV. In conclusion, data analytics and ML offer promising tools for transforming GBV prevention, but their effective implementation requires careful attention to ethical considerations and active involvement of affected communities. This paper provides a framework for utilizing these technologies to inform policy decisions and create more impactful, evidence-based interventions for GBV prevention. Keywords: Gender-Based Violence, Data Analytics, Machine Learning, Risk Prediction, Hotspot Mapping, Intervention Strategies, Policy Design, Ethical Implications, Community Engagement.

Using a co-design approach to develop a Preventative Online Mental Health Program for Youth (POMHPY): a quality improvement project

BackgroundDuring the COVID-19 pandemic, youth in Ontario, Canada experienced a steep rise in mental health concerns. Preventative intervention programs can address the psychological impact of the pandemic on youth and build resiliency. Co-design approaches to developing such programs actively involve young people, resulting in solutions tailored to their unique needs. The current paper details the co-design approach to creating a Preventative Online Mental Health Program for Youth (POMHPY)—a virtually delivered program designed for Ontario youth ages 12 to 25 that promotes mental, physical, and social wellbeing.MethodsThe Participatory Action Research (PAR) framework guided the development of the initiative. Literature reviews were conducted to identify existing evidence-based programs targeting youth. Youth perspectives were primarily gathered via the Youth Advisory Group, comprising a Youth Resilience Coordinator and a Youth Engagement Lead, who contributed to a literature review, surveys, focus groups, and program assets. Community insights were gathered through Community Reference Group (CRG) meetings, which engaged participants from local and provincial organizations, as well as individuals either directly representing or affiliated at arm's length with youth.ResultsA review of the current literature highlighted the importance of regular physical activity, social connectedness, good sleep hygiene, and healthy family relationships to emotional wellbeing. Survey findings informed program session length, duration, delivery, and activities. Focus groups expanded on the survey findings and provided an in-depth understanding of youth preferences for program delivery. CRG meetings captured community insights on program refinements to better meet the needs of youth. As such, the development of POMHPY was a collaborative effort among researchers, youth, and community partners.ConclusionsThe findings highlight the value of co-design and PAR-informed approaches in developing youth-targeted online wellbeing programs, providing actionable insights for iterative improvements and future pilot testing. The resulting 6-week program, led by youth facilitators, will focus on teaching mental, social, and physical wellness strategies and skills through various evidence-based, interactive activities.

Cardiac Biomarkers and Malnutrition Incidence in Community-Dwelling Older Adults without Cardiovascular Disease: The Seniors-ENRICA-2 Cohort.

Given the close relationship between cardiovascular disease (CVD) and malnutrition, we examined whether higher concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP), which indicate CVD risk in the general population, were prospectively associated with malnutrition incidence in community-dwelling older adults without CVD. We used data from 1490 individuals ≥65 years from the Seniors-ENRICA-2 cohort followed up for 2.2 years. Malnutrition was evaluated by the screening Mini Nutritional Assessment-Short Form (MNA-SF) score, which consists of a short questionnaire, and a complete nutritional assessment according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Associations were summarized with odds ratios (OR) and their 95% confidence interval (CI), obtained from logistic regression and adjusted for the main confounders. NT-proBNP was associated with higher malnutrition incidence assessed by the MNA-SF score and the GLIM criteria, with OR (95% CI) of 1.51 (1.09-2.09) and 1.43 (1.04-1.96) per one logarithmic-unit increment, respectively. Malnutrition incidence according to the GLIM criteria was also higher in participants who had elevated NT-proBNP (heart stress age-specific rule-in cutoffs) vs those who did not, with OR (95% CI) of 1.84 (1.05-3.22). hs-cTnT was not associated with higher malnutrition incidence. In this cohort of older adults without CVD, NT-proBNP was associated with higher malnutrition incidence. Further research is needed to validate our findings, uncover the underlying biological mechanisms, and assess whether preventive interventions can reduce NT-proBNP concentrations and, consequently, reduce the risk of malnutrition.

Mental health in public safety personnel with workplace injuries requiring surgery: a longitudinal population-wide administrative data study in Manitoba, Canada

ObjectivesPublic safety personnel (PSP) are responsible for ensuring the safety and security of communities, often putting their own lives and well-being at risk by performing dangerous and demanding work. As...

Improving NGOs’ participation in implementing HIV preventive interventions: a case of adolescents with high-risk behaviors in Iran

BackgroundThe study aimed to identify the obstacles that NGOs face in their participation in implementing HIV preventive interventions among adolescents with high-risk behaviors in Iran and to propose interventions to enhance their involvement.MethodsThe study employed a qualitative approach in three phases to identify barriers and solutions to NGOs’ participation in HIV preventive interventions. First, 56 semi-structured interviews, four focus group discussions (FGDs), and a document review were conducted with diverse stakeholders, using a purposive sampling strategy combining maximum variation sampling with a snowballing approach. Participants were sampled from relevant backgrounds in health policymaking, public participation, or communicable disease. Data from interviews and FGDs were audio-recorded, transcribed, and analyzed using an inductive content analysis. Second, a scoping review was performed, utilizing databases such as PubMed, Web of Science, ProQuest, and Google Scholar. A policy brief from the first two phases informed a one-day multi-stakeholder policy dialogue with 16 selected policy actors. This session was audio-recorded, transcribed, and analyzed through content analysis.ResultsWe identified various challenges faced by NGOs, including those related to the unique features of HIV services, such as difficulty in case finding and constant provision of preventive care. Severe challenges included weak NGOs’ performance, insufficient capabilities, and insufficient support from the government, resulting in undesirable constructive collaboration. Tailored strategies were developed, such as the empowerment of NGOs, enhancing public health literacy, modifying the process of identifying eligible NGOs, clarifying key processes for NGOs’ involvement, response to COVID-19, increasing adolescent engagement, advocating for removing the stigma from active NGOs, increasing support for active NGOs, organizing communication networks and collaboration, and strengthening governance arrangements.ConclusionsNGOs’ participation in HIV prevention can facilitate the alignment of interventions with the specific needs of at-risk populations. However, there are obstacles to full NGOs’ participation from both NGO and government perspectives, necessitating several measures to address these challenges. These measures are imperative for fostering constructive and sustained collaboration between NGOs and the government. The significance of this study lies in its emphasis on such collaboration, particularly in low-resource settings, which is crucial for nations committed to authentically realizing the goal of ‘health for all, by all,’ alongside genuine community participation.Trial registrationNA.

Parkinsons Detection from Gait Time Series Classification Using Modified Metaheuristic Optimized Long Short Term Memory

Neurodegenerative conditions are defined by the progressive deterioration and death of nerve cells in the core neural system. Most neurodegenerative conditions are not curable. While there have been significant improvements and techniques used to treat these diseases early diagnosis continues to play a crucial role in the entire approach. Conditions are often diagnosed only once they start negatively impacting the daily life of those affected. Early detection and timely preventative treatment can help improve patient subjective well-being. This study examines the application of a non-invasive gait analysis technique for the detection of Parkinson’s disease. Publicly available data collected from patients suffering from Parkinson’s along with control groups is utilized and combined with long-short-term neural networks to construct models capable of detecting signs on Parkinson’s disorder. However, because of the significant reliance of models on appropriate parameters selection, metaheuristic algorithms are used to fine tune the selection process, and a modified variation of the strongly founded PSO algorithm was proposed. Several contemporary optimizers are compared based on their ability to optimize model performance. This suggested approach achieved the superior outcomes with an accuracy of 89.92%. The constructed models have been evaluated to determine feature importance using game theory based methods.

Process Evaluations of Interventions for the Prevention of Type 2 Diabetes in Women With Gestational Diabetes Mellitus: Systematic Review.

Gestational diabetes mellitus (GDM) is characterized by hyperglycemia in pregnancy and typically resolves after birth. Women with GDM have an increased risk of developing type 2 diabetes mellitus (T2DM) later in life compared to those with normoglycemic pregnancy. While diabetes prevention interventions (DPIs) have been developed to delay or prevent the onset of T2DM, few studies have provided process evaluation (PE) data to assess the mechanisms of impact, quality of implementation, or contextual factors that may influence the effectiveness of the intervention. This study aims to identify and evaluate PE data and how these link to outcomes of randomized controlled trials (RCTs) of T2DM prevention interventions for women with GDM. A systematic review was conducted to identify studies published from 2005 to 2020 aiming to capture the most recent DPIs. Five electronic bibliographic databases (Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, Embase, PubMed, and MEDLINE) were searched to identify relevant studies. Inclusion criteria were published (peer-reviewed) RCTs of DPIs in women with a current diagnosis or history of GDM. Exclusion criteria were studies not published in English; studies where the target population was women who had a family history of T2D or women who were menopausal or postmenopausal; and gray literature, including abstracts in conference proceedings. The Medical Research Council's PE framework of complex interventions was used to identify key PE components. The Mixed Method Appraisal Tool was used to assess the quality of included studies. A total of 24 studies were included; however, only 5 studies explicitly reported a PE theoretical framework. The studies involved 3 methods of intervention delivery, including in person (n=7), digital (n=7), and hybrid (n=9). Two of the studies conducted pilot RCTs assessing the feasibility and acceptability of their interventions, including recruitment, participation, retention, program implementation, adherence, and satisfaction, and 1 study assessed the efficacy of a questionnaire to promote food and vegetable intake. While most studies linked PE data with study outcomes, it was unclear which of the reported PE components were specifically linked to the positive outcomes. While the Medical Research Council's framework is a valuable source for conducting systematic reviews on PEs, it has been criticized for lacking practical advice on how to conduct them. The lack of information on PE frameworks in our review also made it difficult to categorize individual PE components against the framework. We need clearer guidance and robust frameworks for conducting PEs for the development and reporting of DPIs for women with GDM. PROSPERO International Prospective Register of Systematic Reviews CRD42020208212; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=208212. RR2-https://doi.org/10.1177/16094069211034010.

Dysglycaemia and incident aortic stenosis: a cohort study

BackgroundAortic stenosis is a degenerative condition with high mortality in its severe stages and no preventive treatment. While diabetes is a known risk factor, the role of elevated glucose levels...

Co-creation and application of a framework for the de-prioritization of urban communities during insecticide-treated bed net mass campaigns for malaria prevention and control in Kwara State, Nigeria

BackgroundMalaria continues to be a major cause of illness and death worldwide, particularly affecting children under the age of five and those living in high-burden countries like Nigeria. Long-lasting insecticidal nets (LLINs) are one of the effective interventions for malaria control and prevention. In response to funding constraints in the Global Fund Grant Cycle 7, Nigeria’s National Malaria Elimination Programme (NMEP) aimed to develop an approach that maximizes the impact of limited malaria interventions by focusing on areas with the greatest need. We developed an urban LLINs distribution framework and a novel strategy, which was piloted in Ilorin, the capital of Kwara State.MethodsA participatory action research approach, combined with abductive inquiry, was employed to co-design a framework for guiding bed net distribution. The final framework consisted of three phases: planning, data review and co-decision-making, and implementation. During the framework’s operationalization, malaria risk scores were computed at the ward level using four key variables, including malaria case data and environmental factors, and subsequently mapped. A multistakeholder dialogue facilitated the selection of the final malaria risk maps. Additionally, data from an ongoing study were analyzed to determine whether local definitions of formal, informal, and slum settlements could inform community-level stratification of malaria risk in cities.ResultsAkanbi 4, a ward located in Ilorin South and Are 2, a ward in Ilorin East consistently had lower risk scores, a finding corroborated during the multistakeholder dialogue. A map combining malaria test positivity rates among children under five and the proportion of poor settlements was identified as the most accurate depiction of ward-level malaria risk. Malaria prevalence varied significantly across the categories of formal, informal, and slum settlements, resulting in specific definitions developed for Ilorin. Thirteen communities classified as formal settlements in Are 2 were de-prioritized during the bed net distribution campaign.ConclusionsThe framework shows promise in facilitating evidence-based decision-making under resource constraints. The findings highlight the importance of stakeholder engagement in evaluating data outputs, particularly in settings with limited and uncertain data. Enhancing surveillance systems is crucial for a more comprehensive approach to intervention tailoring, in alignment with WHO’s recommendations.

Glaucoma animal models in rabbits: State of the art and perspectives-A review.

Glaucoma, a visual thief, is characterized by elevated intraocular pressure (IOP) and the loss of retinal ganglion cells (RGCs). Selecting suitable animals for preclinical models is of great significance in research on the prevention, early screening, and effective treatments of glaucoma. Rabbit eyeballs possess similar vascularity and aqueous humor outflow pathways to those of humans. Thus, they are among the earliest invivo models used in glaucoma research. Over the years, rabbit models have made substantial contributions to understanding glaucomatous pathophysiology, surgical adaptations, biomedical device development, and drug development for reducing IOP, protecting RGCs, and inhibiting fibrosis. Compared to other animals, rabbits fit better with surgical operations and cost less. This review summarizes the merits and demerits of different ways to produce glaucomatous rabbit models, such as intracameral injection, vortex vein obstruction, Trendelenburg position, laser photo-coagulation, glucocorticoid induction, limbal buckling induction, retinal ischemia-reperfusion models, and spontaneous models. We analyzed their mechanisms in the hope of providing more references for experimental design and promoting the understanding of glaucoma treatment strategies.

Refining the Make My Day stroke prevention intervention for primary healthcare through co-creation with stakeholders

ObjectivesTo describe and explore the refinement of a stroke prevention intervention and conditions for implementation in primary healthcare by utilising co-creation with stakeholders.MethodThis was an iterative co-creation process of five collaborative workshops engaging stakeholders; healthcare professionals (HP), and persons at risk for stroke, who participated in or delivered a stroke prevention intervention in primary healthcare.ResultsThrough co-creation with stakeholders key components for revision were identified in the Make My Day intervention. The overall pedagogics, which was recognised as overarching, and three additional key components: the HP education, the intervention sessions, and the digital tool were identified. Moreover, the co-creation process rendered refinements of the prevention program addressing the key components representing stakeholder experiences. Refinements encompass delivering and receiving the Make My Day intervention, material ownership, and the interprofessional team.ConclusionsThe co-creation process revealed the importance of applying a strategic pedagogic approach in a complex intervention. The process underscored the need to augment a sense of material ownership and to improve interprofessional collaboration in primary healthcare, ultimately enhancing the intervention experience and facilitating the change process for individuals at risk of stroke. Utelising a co-creation process in this current intervention allowed for creation of refinements to the intervention optimising conditions for implementation.

Status of sleeping habits and its influence on growth and metabolism of children in Beijing: a population-based cross-sectional study

BackgroundSleep disturbances are associated with poor health outcomes in children. However, the sleep problems that occur in children’s growth and metabolism need to be further studied. The aim of the present study was to assess the effects of sleep habits on the growth and metabolism in school-aged children.MethodsThis cross-sectional study included 5832 children and adolescents aged 6–18 years from 10 primary and secondary schools in a district in Beijing between 2022 and 2023. Children’s sleep characteristics were evaluated using the Children’s Sleep Habits Questionnaire (CSHQ). Body composition, body mass index (BMI), blood pressure, fasting plasma glucose, and blood lipid levels were assessed.ResultsGirls had a greater rate of sleep anxiety, while boys had a greater rate of sleep-disordered breathing (SDB) across all age groups. Linear regression analysis showed that poor sleep habits were negatively correlated with height for age (HAZ) and systolic blood pressure (SBP) (β = −0.111 and − 0.459, respectively; p < 0.05). SDB was significantly associated with BMI, fat mass percentage (FMP), waist-to-height ratio (WHtR), SBP, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) across all age groups (p < 0.05), while SDB was positively correlated with HAZ only in children aged 6–11 years (β = 0.240, p < 0.05). Logistic regression analysis showed that insufficient sleep was associated with FMP, WHtR, and overweight/obesity in children aged 6–11 years (p < 0.05). SDB was a risk factor for hypertension in children aged 12–18 years (OR = 1.847, p < 0.05).ConclusionsEvaluating the multiple aspects of childhood sleep habits is crucial for improving sleep-related children’s growth and metabolism. Age differences in sleep-related growth and cardiometabolic abnormalities should be considered in preventive interventions. Our study provides new insights into age differences in the influence of sleep habits on the growth and metabolism of children.

The 6-months follow-up of the TREAT-CAD trial: Aspirin versus anticoagulation for stroke prevention in patients with cervical artery dissection.

Cervical artery dissection is a major cause of stroke in the young. The optimal choice and duration of antithrombotic treatment for stroke prevention are debated, particularly beyond 3 months after symptom onset. TREAT-CAD (TREATment of Cervical Artery Dissection) was a randomized controlled trial with blinded outcome assessment comparing non-inferiority of aspirin to anticoagulation (Vitamin-K-antagonists) in participants with symptomatic, Magnetic-Resonance-(MR)-imaging-verified cervical artery dissection. TREAT-CAD could not establish non-inferiority of aspirin to anticoagulation at 3 months. Thereafter participants could continue antithrombotic medication and obtained a standardized assessment of clinical and MR-Imaging outcomes between 3 and 6 months. As crossover to the other treatment arm was possible, we performed an as-treated analysis as main analysis. The main outcomes were new clinical (ischemic stroke, intracranial/major extracranial bleeding, or death) and new MR-Imaging outcomes (ischemic or hemorrhagic brain lesions). Among the 122 participants in the as-treated analysis, 3/93 (3.2%) aspirin-treated participants had new clinical (n = 1) and MRI-outcomes (n = 2) between 3 and 6 months while 1/29 (3.4%) anticoagulated participants had an MRI-outcome (n = 1). All outcome events were hemorrhagic while ischemic events were absent. No deaths occurred. This yields an absolute difference of 0.2% (95% CI -8.0% to 7.5%, p = 1.0). During the extended follow-up period of a controlled randomized trial comparing aspirin to anticoagulation in cervical artery dissection, outcomes between 3 and 6 months after randomization occurred rarely, similarly often in both groups and were exclusively hemorrhagic events. Thus, studies balancing benefits versus harms of antithrombotic treatment beyond 3 months are warranted. Registration: ClinicalTrials.gov: NCT02046460. https://clinicaltrials.gov/ct2/show/NCT02046460.

B-OK: a visual and tactile tool for improving HIV mental models in a United States urban center

ABSTRACT Lack of adherence to antiretroviral therapy (ART) and poor retention in care are significant barriers to ending HIV epidemics. Treatment adherence support effectiveness may be constrained by limited understanding of the benefits of ART. We evaluated a visual and tactile tool, the B-OK Bottles (“B-OK”), that incorporates human-centered design and behavioral economics principles and is designed to change and strengthen mental models about HIV. We enrolled 118 adults living with HIV who were clients of medical case managers in Philadelphia. All participants completed a pre-intervention survey, a B-OK intervention and a post-intervention survey. A subset (N = 52) completed qualitative interviews. Co-primary outcomes were differences pre- to post-intervention for 11 questions about HIV awareness, knowledge, attitudes, intentions and perception. Qualitative interviews were assessed using an integrated analysis approach. Participants had a median age of 55 years (IQR 47–60), 65% were male sex (N = 77), and 72% identified as non-Hispanic Black (N = 85). B-OK was associated with improved awareness and understanding of HIV terminology, changes in HIV treatment attitudes, and increased intention to rely on HIV treatment for transmission prevention. Qualitative interview results aligned with the quantitative findings. These findings provide a strong rationale to further evaluate the potential for B-OK to improve HIV treatment adherence support.

Context makes a difference: a qualitative study exploring how to implement a multifactorial falls prevention intervention in the community

BackgroundFalls are a major problem in community-dwelling older people. Multifactorial falls prevention interventions are recommended as intervention. However, poor implementation impacts successful outcomes of multifactorial falls prevention interventions. The context is critical to understand variation in implementation and clinical outcomes. This study aims to analyze and describe determinants at all levels of the context that influence the implementation of a multifactorial falls prevention intervention in the community in Flanders (Belgium).MethodsThis study consists of semi-structured interviews with 6 key persons, 3 focus group interviews with healthcare professionals (n = 16), 1 focus group with local policy makers (n = 6) and 4 semi-structured interviews and 1 focus group (n = 3) with older people. The Integrated Checklist of Determinants of Practice (TICD checklist) was used to develop the interview guide and to make sure that there was enough understanding of the contextual determinants at the different domains. The interviews and focus groups were verbatim transcribed and analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL). To clarify themes, data were coded in NVivo 12™.ResultsWe identified 4 key themes related to successful implementation of a multifactorial falls prevention intervention in the community setting: (1) stakeholder involvement and participation, (2) Fostering awareness, beliefs, knowledge, and skills for falls prevention, (3) working proactively and (4) communication, collaboration, coordination and financing care. This study identified 33 determinants of the TICD checklist and all 7 domains were represented.ConclusionsUnderstanding the existing structures, norms, policies and contextual factors allows us to proactively tailor the implementation strategies and a multifactorial falls prevention intervention to the community context.

Strategies to manage the adverse effects of immunotherapy with dinutuximab beta in neuroblastoma: an Italian experience and literature review.

Patients with high-risk neuroblastoma (HR NB) frequently present with metastases in the bone marrow and bone. Approximately 15% of these patients are refractory to induction therapy, and 50% relapse. Dinutuximab beta is an anti-GD2 monoclonal antibody approved in Europe for maintenance therapy of pediatric patients with HR NB. Immunotherapy with anti-GD2 antibodies improves the survival of children with HR NB and relapsed or refractory disease. It is associated with adverse events, such as pain, fever, allergic reactions, capillary leak syndrome, and diarrhea. This manuscript aims to propose a practical guide in support and prevention treatment of adverse events. MEDLINE was searched using the terms "GD2," "ch14.18/CHO," "anti-GD2 antibody," "dinutuximab beta," and "neuroblastoma." The experts reappraised available evidence discussing different clinical Italian experiences. Neuropathic pain is the main toxicity associated with dinutuximab beta and can be prevented with analgesics, including intravenous opioids and gabapentin by mouth. The intensity of the supportive treatment decreases from course to course. In the experience of the authors, adverse events associated with dinutuximab beta may be prevented and managed in experienced centers. The supportive therapy may be reduced after the first cycle to improve the quality of life.

Comparative Effectiveness of Pharmacologic Treatments for the Prevention of Episodic Migraine Headache: A Systematic Review and Network Meta-analysis for the American College of Physicians.

Various treatments for preventing episodic migraine are available. To evaluate the comparative effectiveness and harms of pharmacologic prevention of episodic migraine, focusing on treatments already determined to be superior to placebo. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from inception until April 2024. Randomized trials evaluating selected efficacious pharmacologic treatments in adults with episodic migraine. Selection was done independently by 2 reviewers. Data were extracted by 1 reviewer and checked by a second. Risk of bias and certainty of the evidence were assessed using the Cochrane Risk of Bias tool and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, respectively. Sixty-one studies (20 680 patients) evaluating 16 treatments were included. Nineteen studies had low risk of bias. All selected treatments were deemed efficacious against placebo on the basis of previous systematic reviews. In network meta-analyses, calcitonin gene-related peptide antagonist monoclonal antibodies (CGRP-mAbs) probably resulted in fewer discontinuations due to adverse events than topiramate (risk difference, -16.2% [95% CI, -18.4% to -12.8%]; moderate-certainty evidence), and CGRP-mAbs may result in less migraine-related disability and improved quality of life compared with gepants (mean differences, -4.12 [CI, -9.30 to 1.05] and 2.25 [CI, -0.85 to 5.34], respectively; low-certainty evidence). For other outcomes and comparisons, there was moderate- or low-certainty evidence of no clinically important differences, uncertain evidence, or no evidence. Limited literature was available to determine the minimal important differences. The number of head-to-head comparisons of treatments was limited. No high-certainty evidence favored one pharmacologic treatment for prevention of episodic migraine over another. Evidence was mostly insufficient or of low certainty. American College of Physicians. (PROSPERO: CRD42023414305).

The development of opioid vaccines as a novel strategy for the treatment of opioid use disorder and overdose prevention.

Opioid use disorder (OUD) affects over 40 million people worldwide, creating significant social and economic burdens. Medication for opioid use disorder (MOUD) is often considered the primary treatment approach for OUD. MOUD, including methadone, buprenorphine, and naltrexone, is effective for some, but its benefits may be limited by poor adherence to treatment recommendations. Immunopharmacotherapy offers an innovative approach by using vaccines to generate antibodies that neutralize opioids, blocking them from crossing the blood-brain barrier and reducing their psychoactive effects. To date, only 3 clinical trials for opioid vaccines have been published. While these studies demonstrated the potential of opioid vaccines for relapse prevention, there is currently no standardized protocol for evaluating their effectiveness. We have reviewed recent preclinical studies that demonstrated the efficacy of vaccines targeting opioids, including heroin, morphine, oxycodone, hydrocodone, and fentanyl. These studies showed that vaccines against opioids reduced drug reinforcement, decreased opioid-induced antinociception, and increased survival rates against lethal opioid doses. These studies also demonstrated the importance of vaccine formulation and the use of adjuvants in enhancing antibody production and specificity. Finally, we highlighted the strengths and concerns associated with the opioid vaccine treatment, including ethical considerations.

Co-opting the ‘public’ in public health: homelessness and the specious logic of discretionary displacement in a mid-sized US city

In the name of public health protection, individuals and communities perceived to be diseased have long been coercively regulated through surveillance, sequestration, or various forms of criminal punishment. In the U.S., people experiencing homelessness (PEH) have been increasingly targeted by social control measures such as containment, banishment, or arrest, often under the guise of public health protection. This study explores how city employees and service providers we term ‘authorities’ use public health justifications to rationalize displacing PEH encamped on public property. We find that authorities draw on sensationalized ‘disease-model’ logics of health risk that pathologize PEH as vectors of infectious disease and drug-related harms. This approach allows authorities to rationalize their decisions to displace, but it locates responsibility for the social challenge of homelessness on homeless people themselves, without providing any resources to mitigate ostensible public health concerns for either PEH or the larger public. We conclude that displacement decisions appear logical only when authorities use a specious logic that disqualifies PEH from the ‘public’ being protected. By identifying coercive patterns in public health history and connecting them with the regulation of unsheltered homelessness, this analysis reveals an all-too-familiar picture, where those with power take coercive action upon those with less power instead of employing preventative or structural interventions that could meaningfully address homelessness.

Metabolomic Insights into Smoking-Induced Metabolic Dysfunctions: A Comprehensive Analysis of Lipid and Amino Acid Metabolomes

Background: Cigarette smoking is a leading cause of preventable mortality, largely due to the absence of effective, non-invasive biomarkers for early disease detection. Profiling serum metabolomics to identify metabolic changes holds the potential to accelerate the detection process and identify individuals at risk of developing smoking-related diseases. Objectives: This study investigated the biochemical and metabolomic changes induced by nicotine exposure, with a focus on disruptions in amino acid, lipid, and carbohydrate metabolism. Methods: Liquid chromatography–tandem mass spectrometry (LC-MS/MS) was employed to observe significant disruptions in lipid and amino acid metabolism, along with alterations in key metabolic pathways. A total of 400 smokers and 100 non-smokers were included to evaluate the biomarkers related to insulin resistance, blood lipid profile, inflammation, and kidney and liver function. Results: The results demonstrated significantly elevated (p &lt; 0.05) levels of glycemic markers in smokers, including fasting blood glucose; glycated hemoglobin (HbA1c); and inflammatory markers such as interleukin-6 (IL-6) and C-reactive protein (CRP). Smokers also exhibited dyslipidemia, with increased total cholesterol (154.888 ± 35.565) and LDL levels (117.545 ± 24.138). Impaired liver and kidney function was evident, with significantly higher levels (p &lt; 0.05) of AST, ALP, ALT, blood urea nitrogen, and creatinine in smokers. A total of 930 metabolites were identified, of which 343 exhibited significant alterations (p &lt; 0.05) in smokers compared to non-smokers. Among these, 116 metabolites were upregulated, and 127 were downregulated. Metabolomic pathway analysis revealed eight significant pathways. The study also identified three lipid metabolites specific to smokers and seven unique to non-smokers. Through LC-MS/MS, fragments of phenylalanine, tryptophan, valine, histidine, carnitine, and sphinganine were detected. Several lipidomic changes associated with insulin resistance and cardiovascular complications were observed. Cadmium (Cd) levels were higher in smokers than non-smokers (1.264 ppb vs. 0.624 ppb) and showed a strong negative correlation (R2 = 0.8061, p-value = 0.015) with serum zinc (Zn), likely due to Cd displacing Zn in proteins and causing nephrotoxicity through accumulation. Conclusions: This study highlights the distinct metabolic disruptions caused by smoking that could serve as potential biomarkers for the early detection of metabolic diseases. It emphasizes the importance of metabolomics in identifying systemic indicators of smoking-related health issues, providing new opportunities for preventive and therapeutic interventions.