Since the emergence of the SARS-CoV-2 in late 2019, there has been an unprecedented global change. Each country took actions to respond to the outbreak including guidance development, surveillance and epidemiology, testing, providing emergency supplies and rapid vaccine development. During this time, governments struggled to keep up with misinformation, conspiracy theories, social media rumours and uncertainty.1 This resulted in misinformation...

Mass vaccination against COVID-19 has been one of the key measures to combat the spread of COVID-19. Initial vaccines have been highly efficacious in reducing infection prevalence and mortality. However, the emergence of variant strains and waning of immunity from initial vaccination...

Regular physical activity is critical to the health and well-being of people living with disabilities (PLWD).1 PLWD are often unable to be as active as they want due to various obstacles, such as a lack of safe and suitable environments,...

Cold housing, driven by poor housing quality and energy poverty, is a significant public health issue in many countries.1 2 Cold housing is known to contribute to many negative physiological health outcomes including: increased risk of cardiovascular events, stroke and myocardial infarction; increased negative effects from chronic and acute respiratory disease; increased colds and influenza; exacerbation of chronic conditions for...

We examined the association between social isolation and loneliness, increasingly recognised but neglected social determinants of health, with being unvaccinated against COVID-19.

This was a cross-sectional study.

A representative cohort of 22 756 individuals (aged 15–81 years) from the general Japanese population who responded to both the Japan COVID-19 and Society Internet Survey 2021 and Japan Society and New Tobacco Internet Survey 2022.

We calculated the ORs of remaining unvaccinated against COVID-19 in 2022, attributable to social isolation as assessed by the Lubben Social Network Scale, or loneliness as evaluated by the University of California, Los Angeles Loneliness Scale version 3. Reasons for abstaining from vaccination were solicited from the unvaccinated respondents. A multivariable logistic regression model was conducted with adjustments for demographic variables. Propensity score-matched comparisons were conducted as part of the sensitivity analysis.

Individuals with social isolation were more likely to be unvaccinated (OR 1.48, 95% CI 1.37 to 1.60), while individuals with loneliness were not (OR 0.96, 95% CI 0.88 to 1.05). Socially isolated individuals were significantly less likely to receive information from people who had been vaccinated (11% vs 15%) and less likely not to trust the vaccine approval process (19% vs 27%) compared with those who were not socially isolated.

Despite not harbouring negative perceptions of the vaccine, socially isolated individuals exhibited lower rates of COVID-19 vaccination. Socially isolated individuals are important targets to reach to increase the number of vaccinated individuals.

Chemsex is defined as drug use to enhance sexual pleasure. Global literature illustrated the pervasiveness of chemsex among men who have sex with men (MSM) and transgender women (hijra) for prolonging anal intercourse, reducing pain and intensifying pleasure, oftentimes without condoms. Global literature highlighted the association between chemsex and unsafe sexual behaviours. These circumstances warrant targeted chemsex research to explore the chemsex situation. The study aims to explore the overall dynamics of chemsex among MSM, male sex workers (MSW) and hijra in Dhaka, Bangladesh and formulate culturally relevant, context-specific, gender-sensitive and evidence-based recommendations for chemsex interventions.

This will be a sequential, exploratory, mixed-methods study. Data will be collected at four drop-in centres in Dhaka in three phases. To explore issues related to chemsex, the formative phase (phase 1) will generate evidence on the overall dynamics of chemsex through a literature review and qualitative interviews. Qualitative data will be manually analysed using thematic analysis. In phase 2, a cross-sectional survey will be conducted among 458 MSM, male sex workers and hijra to measure the prevalence, reasons and sexual risk behaviour associated with chemsex. In phase 3, qualitative interviews will be conducted with the participants involved in chemsex, service providers and relevant stakeholders to add qualitative depth to survey responses. In this phase, service provision will also be investigated for people engaging in chemsex. Moreover, based on the findings of phases 1 and 2, and qualitative interviews of phase 3, a preliminary chemsex intervention model will be developed through a series of intervention design workshops.

Ethical approval has been attained from the Ethical Review Committee of icddr,b. Informed consent will be obtained from the participants, and confidentiality will be maintained during data collection and storage. Findings will be disseminated via several platforms including dissemination seminars, scientific articles and study report.

The minimum age for cigarette sales in Thailand was increased from 18 to 20 years, as stipulated in the Tobacco Products Control Act B.E. 2017. This study investigated tobacco retailers’ perceptions, cigarette sales behaviour and other factors relevant to selling cigarettes to people younger than 20 years in areas surrounding schools in Thailand.

Cross-sectional survey.

Tobacco shops within a radius of 500 m of secondary schools across four regions of Thailand. Data collection took place between May and August 2019.

1440 tobacco retailers (grocery or convenience stores) were sampled via a stratified, two-stage cluster sampling method. 1021 retailers completed the self-administered questionnaire.

Tobacco sales to people younger than 20 years.

The prevalence of the retailers’ cigarette sales to youth younger than 20 years was 38.20% (95% CI 35.2% to 41.3%). Multivariable logistic regression analysis revealed associations with sale of single cigarettes (adjusted OR (AOR) 23.14, 95% CI 15.13 to 35.39), self-service sale of cigarettes (4.21, 2.59 to 6.86) and display of cigarettes at the point of sale (2.39, 1.47 to 3.89). Cigarette sales to underage youth were higher among retailers located in the northeast region (AOR 2.09, 95% CI 1.20 to 3.64) and among those who did not perceive the prosecution of violators in the past year (1.85, 1.16 to 2.96).

A large percentage of cigarette retailers violated the laws related to underage cigarette sales. Measures to minimise retailers’ legally non-compliant sales behaviours should be implemented along with improved legal enforcement.

The history of African health is closely entwined with the history of the continent itself—from precolonial times to the present day. A study of African health histories is critical to understanding the complex interplay between social, economic, environmental and political factors that have shaped health outcomes on the continent. Furthermore, it can shed light on the successes and failures of past health interventions, inform current healthcare policies and practices, and guide future efforts to address the persistent health challenges faced by African populations. This scoping review aims to identify existing literature on African health histories.

The Arksey and O’Malley’s framework for conducting scoping reviews will be utilised for the proposed review, which will be reported in compliance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The main review question is ‘What literature exists on the history of health practices and healthcare delivery systems in Africa from the precolonial era through to the sustainable development goal era?’ Keywords such as Africa, health and histories will be used to develop a search strategy to interrogate selected databases and grey literature repositories such as PubMed, Scopus, Web of Science and WHOLIS. Two authors will independently screen titles and abstracts of retrieved records. One author will extract data from articles that meet the inclusion criteria using a purposively designed data charting. The data would be coded and analysed thematically, and the findings presented narratively.

The scoping review is part of a larger project which has approval from the WHO AFRO Ethics Research Committee (Protocol ID: AFR/ERC/2022/11.3). The protocol and subsequent review will be submitted to the integrated African Health Observatory and published in a peer-reviewed journal.

https://osf.io/xsaez/

Systematic review of SARS-CoV-2 seroprevalence studies undertaken in the WHO European Region to measure pre-existing and cumulative seropositivity prior to the roll out of vaccination programmes.

A systematic review of the literature.

We searched MEDLINE, EMBASE and the preprint servers MedRxiv and BioRxiv in the WHO ‘COVID-19 Global literature on coronavirus disease’ database using a predefined search strategy. Articles were supplemented with unpublished WHO-supported Unity-aligned seroprevalence studies and other studies reported directly to WHO Regional Office for Europe and European Centre for Disease Prevention and Control.

Studies published before the widespread implementation of COVID-19 vaccination programmes in January 2021 among the general population and blood donors, at national and regional levels.

At least two independent researchers extracted the eligible studies; a third researcher resolved any disagreements. Study risk of bias was assessed using a quality scoring system based on sample size, sampling and testing methodologies.

In total, 111 studies from 26 countries published or conducted between 1 January 2020 and 31 December 2020 across the WHO European Region were included. A significant heterogeneity in implementation was noted across the studies, with a paucity of studies from the east of the Region. Sixty-four (58%) studies were assessed to be of medium to high risk of bias. Overall, SARS-CoV-2 seropositivity prior to widespread community circulation was very low. National seroprevalence estimates after circulation started ranged from 0% to 51.3% (median 2.2% (IQR 0.7–5.2%); n=124), while subnational estimates ranged from 0% to 52% (median 5.8% (IQR 2.3%–12%); n=101), with the highest estimates in areas following widespread local transmission.

The low levels of SARS-CoV-2 antibody in most populations prior to the start of vaccine programmes underlines the critical importance of targeted vaccination of priority groups at risk of severe disease, while maintaining reduced levels of transmission to minimise population morbidity and mortality.

The WHO has stated that vaccine hesitancy is a serious threat to overcoming COVID-19. Vaccine hesitancy among underserved and at-risk communities is an ongoing challenge in Canada. Public confidence in vaccine safety and effectiveness and the principles of equity need to be considered in vaccine distribution. In Canada, governments of each province or territory manage their own healthcare system, providing an opportunity to compare and contrast distribution strategies. The overarching objective of this study is to identify effective vaccine distribution approaches and advance knowledge on how to design and implement various strategies to meet the different needs of underserved communities.

Multiple case studies in seven Canadian provinces will be conducted using a mixed-methods design. The study will be informed by Experience-Based CoDesign techniques and theoretically guided by the Socio-Ecological Model and the Vaccine Hesitancy Matrix frameworks. Phase 1 will involve a policy document review to systematically explore the vaccine distribution strategy over time in each jurisdiction. This will inform the second phase, which will involve (2a) semistructured, in-depth interviews with policymakers, public health officials, researchers, providers, groups representing patients, researchers and stakeholders and (2b) an analysis of population-based administrative health data of vaccine administration. Integration of qualitative and quantitative data will inform the identification of effective vaccine distribution approaches for various populations. Informed by this evidence, phase 3 of the study will involve conducting focus groups with multiple stakeholders to codesign recommendations for the design and implementation of effective vaccine delivery strategies for equity-deserving and at-risk populations.

This study is approved by the University of Toronto’s Health Sciences Research Ethics Board (#42643), University of British Columbia Behavioural Research Ethics Board (#H22-01750-A002), Research Ethics Board of the Nova Scotia Health Authority (#48272), Newfoundland and Labrador Health Research Ethics Board (#2022.126), Conjoint Health Research Ethics Board, University of Calgary (REB22-0207), and University of Manitoba Health Research Board (H2022-239). The outcome of this study will be to produce a series of recommendations for implementing future vaccine distribution approaches from the perspective of various stakeholders, including equity-deserving and at-risk populations.

Provide insights into the experiences and perspectives of healthcare staff who treated scabies or managed outbreaks in formal and informal refugee/migrant camps in Europe 2014–2017.

Retrospective qualitative study using semistructured telephone interviews and framework analysis. Recruitment was done primarily through online networks of healthcare staff involved in medical care in refugee/migrant settings.

Formal and informal refugee/migrant camps in Europe 2014–2017.

Twelve participants (four doctors, four nurses, three allied health workers, one medical student) who had worked in camps (six in informal camps, nine in formal ones) across 15 locations within seven European countries (Greece, Serbia, Macedonia, Turkey, France, the Netherlands, Belgium).

Participants reported that in camps they had worked, scabies diagnosis was primarily clinical (without dermatoscopy), and treatment and outbreak management varied highly. Seven stated scabicides were provided, while five reported that only symptomatic management was offered. They described camps as difficult places to work, with poor living standards for residents. Key perceived barriers to scabies control were (1) lack of water, sanitation and hygiene, specifically: absent/limited showers (difficult to wash off topical scabicides), and inability to wash clothes and bedding (may have increased transmission/reinfestation); (2) social factors: language, stigma, treatment non-compliance and mobility (interfering with contact tracing and follow-up treatments); (3) healthcare factors: scabicide shortages and diversity, lack of examination privacy and staff inexperience; (4) organisational factors: overcrowding, ineffective interorganisational coordination, and lack of support and maltreatment by state authorities (eg, not providing basic facilities, obstruction of self-care by camp residents and non-governmental organisation (NGO) aid).

We recommend development of accessible scabies guidelines for camps, use of consensus diagnostic criteria and oral ivermectin mass treatments. In addition, as much of the work described was by small, volunteer-staffed NGOs, we in the wider healthcare community should reflect how to better support such initiatives and those they serve.

Poor medication adherence remains highly prevalent and adversely affects health outcomes. Patients frequently describe properties of the pills themselves, like size and shape, as barriers, but this has not been evaluated objectively. We sought to determine the extent to which oral medication properties thought to be influential translate into lower objectively-measured adherence.

Retrospective cohort study.

US nationwide commercial claims database, 2016–2019.

Among patients initiating first-line hypertension, diabetes or hyperlipidaemia treatment based on clinical guidelines, we measured pill size, shape, colour and flavouring, number of pills/day and fixed-dose combination status as properties.

Outcomes included discontinuation after the first fill (ie, never filling again over a minimum of 1-year follow-up) and long-term non-adherence (1-year proportion of days covered

Across 604 323 patients, 14.6% discontinued after filling once (ie, were non-persistent), and 54.0% were non-adherent over 1-year follow-up. Large pill size was associated with non-adherence, except for thiazides (eg, metformin adjusted OR (aOR): 1.12, 95% CI: 1.06 to 1.18). Greater pill burden was associated with a higher risk of non-adherence across all classes (eg, metformin aOR: 1.58, 95% CI: 1.53 to 1.64 for two pills/day). Taking less than one pill/day was also associated with higher risk of non-adherence and non-persistence (eg, non-persistence statin aOR: 1.29, 95% CI: 1.20 to 1.38). Pill shape, colour, flavouring and combination status were associated with mixed effects across classes.

Pill burden and pill size are key properties affecting adherence for almost all classes; others, like size and combination, could modestly affect medication adherence. Clinical interventions could screen patients for potential intolerance to medication and potentially implement more convenient dosing schedules.

The changes that retirees experience during their retirement years will challenge their ability to cope, potentially endangering their health and quality of life. This study aims to design and evaluate a theory-based health promotion programme to improve retirees’ psychological well-being and quality of life.

This mixed-method, non-blinded study uses an embedded design. The purposive sampling method will be employed for the qualitative aspect of the study. Qualitative data will be collected at baseline, focusing on retirement adjustment, through semistructured, in-depth individual interviews and focus group discussions. The data will be analysed using Graneheim and Lundman’s qualitative content analysis method. A pre–post test controlled group design will be conducted for the quantitative part of the study. A sample size of 80 is estimated for both the intervention and control groups. Systematic sampling and the block randomisation method will be employed for sampling. The training programme in the intervention group will consist of eight 60 min sessions and environmental support, implemented after assessing the research environment and obtaining approval from the relevant officials. A brief training programme unrelated to the intervention group’s focus (home safety) will be implemented for the control group. Quantitative measures will be collected in both groups at baseline, 3 months and 6 months after the intervention. These measures will include self-administered questionnaires covering demographic variables, retirement adjustment, retirement resources, quality of life, coping methods, spiritual well-being and psychological well-being. Analytical statistics will be performed using the generalised linear model, with p values≤0.05 considered significant.

This protocol has received approval from the ethics committee of Shiraz University of Medical Sciences. The research findings will be disseminated through peer-reviewed manuscripts, presentation in abstracts at National and International Scientific Conferences, and data sharing among researchers.

IRCT20180516039690N2.

The Abilitator is a recently developed self-reported measurement tool for work ability and functioning of people in a weak labour market position. The aim of this study was to describe how self-reported information gathered with the Abilitator corresponds to information drawn from national registers.

Participants (n=669, mean age 44 years, 55% women) took part in the Work Ability Programme (2020–2023) that provided services for unemployed people with reduced work ability. They filled in the Abilitator questionnaire at the start of the service. Register-based data on participants’ health, income and received benefits was drawn from national registers. We evaluated how the different types of indicators concurred.

Statistically significant correlations (from weak to moderate) were found between different domains of the Abilitator and register-based data. Also, participants’ health status (information on mental health or musculoskeletal disorders) was displayed coherently in the results of the Abilitator. Overall, diagnosed mental health disorders distinguished participants’ Abilitator responses more strongly than diagnosed musculoskeletal disorders.

These findings provide further evidence on the applicability of the Abilitator as an instrument to evaluate work ability and functioning of people outside the work force.

Breastfeeding has health benefits for infants and mothers, yet the UK has low rates with marked social inequalities. The Assets-based feeding help Before and After birth (ABA) feasibility study demonstrated the acceptability of a proactive, assets-based, woman-centred peer support intervention, inclusive of all feeding types, to mothers, peer supporters and maternity services. The ABA-feed study aims to assess the clinical and cost-effectiveness of the ABA-feed intervention compared with usual care in first-time mothers in a full trial.

A multicentre randomised controlled trial with economic evaluation to explore clinical and cost-effectiveness, and embedded process evaluation to explore differences in implementation between sites. We aim to recruit 2730 primiparous women, regardless of feeding intention. Women will be recruited at 17 sites from antenatal clinics and various remote methods including social media and invitations from midwives and health visitors. Women will be randomised at a ratio of 1.43:1 to receive either ABA-feed intervention or usual care. A train the trainer model will be used to train local Infant Feeding Coordinators to train existing peer supporters to become ‘infant feeding helpers’ in the ABA-feed intervention. Infant feeding outcomes will be collected at 3 days, and 8, 16 and 24 weeks postbirth. The primary outcome will be any breastfeeding at 8 weeks postbirth. Secondary outcomes will include breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support and healthcare utilisation. All analyses will be based on the intention-to-treat principle.

The study protocol has been approved by the East of Scotland Research Ethics Committee. Trial results will be available through open-access publication in a peer-reviewed journal and presented at relevant meetings and conferences.

ISRCTN17395671.

Cyberbullying is a growing public health concern with clear, negative impacts on the mental, physical and social health of targeted victims. Previous research on cyberbullying has largely focused on examining its occurrence among children and adolescents. The present study aims to examine the prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in Selangor, Malaysia.

A cross-sectional study was conducted in a locality within Selangor, sampling a total of 1449 young adults. The Cyberbullying and Online Aggression Survey was used to measure cyberbullying victimisation. The Family APGAR scale, General Health Questionnaire, Pittsburgh Sleep Quality Index and single-item measures were used to assess family dysfunction, psychological distress and health behaviour, respectively.

The 1-month prevalence of cyberbullying victimisation among young adults was 2.4%. The most common cyberbullying act experienced was mean or hurtful comments about participants online (51.7%), whereas the most common online environment for cyberbullying to occur was social media (45.8%). Male participants (adjusted OR (AOR)=3.60, 95% CI=1.58 to 8.23) had at least three times the odds of being cyberbullied compared with female participants. Meanwhile, participants with higher levels of psychological distress had increased probability of being cyberbullied compared with their peers (AOR=1.13, 95% CI=1.05 to 1.21).

As evident from this study, cyberbullying victimisation prevails among young adults and is significantly related to gender and psychological distress. Given its devastating effects on targeted victims, a multipronged and collaborative approach is warranted to reduce incidences of cyberbullying and safeguard the health and well-being of young adults.

This study aims to collect data on the experience and impact of gender-based violence experienced by women attending health clinics in Honiara, Solomon Islands.

Any woman over the age of 18 who attended a local health clinic in Honiara, Solomon Islands during the time of recruitment (ten consecutive weekdays in May 2015) was eligible to participate in an interviewer administered, in-person survey, gathering data on gender-based violence over the past 12 months.

A total of 100 women were recruited into this study. Of these women, 47% of women reported experiencing physical or sexual violence in the past 12 months. The most common perpetrators were the woman’s husband or boyfriend. There are low rates of reporting, particularly through formal avenues such as to police or village leaders. Alcohol was involved in more than half the cases of reported violence.

Women in this study report high rates of gender-based violence. To our knowledge, this is the only study examining women’s personal experience of gender-based violence in the Solomon Islands, with self-reported data on the frequency and nature of the violence, and the impact on women, including physical and mental, utilisation of healthcare services, police and legal involvement. Efforts to reduce gender-based violence should aim to reduce intimate partner violence, increase reporting and address wider social attitudes towards gender equality.

Whether the routine delivery of diabetes-related knowledge can change patients’ attitudes and hence influence their self-management activities remains unknown in primary healthcare settings in China. Thus, this study aims to explore the complex transformation process between knowledge, attitude and practice (KAP) among patients with diabetes in a city in China.

A cross-sectional study.

Yuhuan City, Zhejiang Province, China.

A total of 803 patients with diabetes were invited to attend a questionnaire survey and 782 patients with type 2 diabetes completed the survey. The average age of participants was 58.47 years old, 48.21% of whom only attended primary school or below.

A questionnaire based on existing scales and expert consultation was applied to assess patients’ socio-demographic information (SI), disease progression risk and diabetes-related KAP. A structural equation model was built to analyse the relationships between patients’ characteristics and KAP.

No significant association was found between patients’ knowledge and attitude (β=0.01, p=0.43). Better knowledge and attitude were both found to be associated with better diet and physical activities (β=0.58, p

While successful KAP transformation has been achieved in practice for diet and physical activities, there is a need to improve foot care practice. Health education should also prioritise the prevention, detection and care of diabetic foot. Also, appropriate methods should be adopted to deliver health education to vulnerable patients, such as the elderly, those living in rural areas, those with minimal education, the unemployed and low-income patients.

This study was designed to identify the patterns, prevalence and risk factors of intimate partner violence (IPV) against female adolescents and its association with mental health problems.

Cross-sectional survey.

Dumuria Upazila (subdistrict) under the Khulna district of Bangladesh.

A total of 304 participants were selected purposively based on some specifications: they must be female adolescents, residents of Dumuria Upazila and married during the COVID-19 pandemic when under 18 years of age.

By administering a semi-structured interview schedule, data were collected regarding IPV using 12 five-point Likert scale items; a higher score from the summation reflects frequent violence.

The findings suggest that the prevalence of physical, sexual and emotional IPV among the 304 participants, who had an average age of 17.1 years (SD=1.42), was 89.5%, 87.8% and 93.7%, respectively, whereas 12.2% of the participants experienced severe physical IPV, 9.9% experienced severe sexual IPV and 10.5% experienced severe emotional IPV. Stepwise regression models identified age at marriage (p=0.001), number of miscarriages (p=0.005), education of spouse (p=0.001), income of spouse (p=0.016), age gap between spouses (p=0.008), marital adjustment (p

During the COVID-19 pandemic, an increase in IPV and mental health problems among early married adolescents was documented. To reduce physical and mental harm and to assure their well-being, preventive and rehabilitative measures should be devised.