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Visceral leishmaniasis is a disease caused by Leishmania parasites and transmitted by Phlebotomine sandflies. It affects primarily children and is fatal without treatment but curable with early treatment. Its clinical features are prolonged fever, wasting, hepatosplenomegaly and pancytopenia. Doctors have limited knowledge about its diagnostics. This leads to incorrect diagnoses and deaths, and the disease remains unrecognized. To break this vicious circle, active search of the disease is needed also where environmental factors are conductive to its presence, but it has never been reported. We describe discovering new foci of visceral leishmaniasis in Northern Somalia, Somaliland and Tanzania. 

Structural barriers such as inadequate housing, lack of employment opportunities, and discrimination are known to adversely affect the health of newly settled refugee migrants. However, these barriers remain largely unresolved and unaddressed. Thus, there is a need to better understand how other factors, such as individual-level health resources, may influence health and mitigate ill health in the early post-migration phase. In this study, we aimed to explore the relationship between health outcomes and individual health resources including health literacy, social support, and self-efficacy in newly settled refugee migrants. Survey data was collected from 787 refugee migrants in Sweden. Logistical regression analysis showed that limited health literacy, lack of emotional support, and low self-efficacy were consistently associated with poor health outcomes. Demographic variables such as gender, education, and type of residence permit were not as imperative. Individual-level health resources may play an important role in the general and psychological well-being of newly settled migrants. Promoting health literacy and facilitating the attainment of social support may buffer for structural challenges in the establishment phase and enhance the prospects of later health and social integration.

Structural and contextual factors such as limited work and housing opportunities negatively affect the health and well-being of newly settled refugee migrants in receiving high-income countries. Health promotion initiatives aiming at strengthening health and integration have been tried out within the Swedish Introduction program for refugee migrants. However, longitudinal evaluations of these interventions are rare. The aim of the current study was to compare the effectiveness of a regular and an extended civic orientation course with added health communication and examine whether the latter would improve self-rated health and psychological well-being, health literacy and social capital among newly settled refugee migrants in Sweden. Pre- and post-assessment questionnaires were collected from the intervention group receiving the extended course (n = 143) and a control group receiving the regular course (n = 173). Linear mixed models and chi-square analyses showed a significant increase with a small effect size (0.21) in health literacy in the intervention group. However, there were no significant changes in emotional and practical support, general self-rated health or psychological well-being. The findings indicate that added health communication provided embedded in the civic orientation course can increase health literacy. However, further longitudinal studies are needed to confirm the sustainability of the observed effect and examine whether these short-term improvements in health literacy translate to long-term advances in health and integration.

Background: Newly settled refugee migrants face psychological stressors stemming from pre-, during- and post-migration experiences. In Sweden, mental health promotion is part of the health module in the civic orientation classes for newly settled refugee migrants. Training courses are offered to civic communicators to facilitate communication about mental health; however, the training is seldom evaluated. In the current study, we aim to explore civic communicators’ perceptions and experiences of an in-depth mental health training course in relation to observed needs among newly settled refugee migrants. 

Method: We interviewed ten civic communicators that had partaken in the in-depth training course on mental health. All respondents had prior migratory experience and worked as civic communicators in their native languages. The interviews were semi-structured and data were analyzed using thematic analysis.

Results: Three themes were identified: (1) Intertwined mental health needs related to migration, (2) Multi-layered barriers to addressing mental health, and (3) Becoming aware of the mental health journey. One overarching theme was arrived at through synthesizing the three themes ‘Acquired new tools to lead reflective conversations about mental health and well-being’. 

Conclusion: The in-depth mental health training course led to the attainment of new knowledge and new tools enabling civic communicators to lead reflective conversations about mental health and well-being with newly settled refugee migrants. Mental health needs were related to pre- and post-migration experiences. Barriers to talking about mental health included stigma and a lack of arenas to promote the mental health of refugee migrants. Increasing knowledge among communicators can facilitate the promotion of mental self-help capacity and resilience among newly settled refugee migrants.

This commentary focuses on analyzing the potential of citizen science to address legitimacy issues in the knowledge base used to guide transformative governance in the context of the United Nation’s Sustainable Development Goals (henceforth SDGs). The commentary develops two interrelated arguments for better understanding the limits of what we term “traditional” Environmental Monitoring and Assessment (EMA) as well as the potential of citizen science (CS) for strengthening the legitimacy of EMA in the local implementation of SDGs. We start by arguing that there is an urgent need for a profound renewal of traditional EMA to better implement the SDGs. Then, we present CS as a democratic innovation that provides a path to EMA renewal that incorporates, develops, and extends the role of CS in data production and use by EMA. The commentary substantiates such arguments based on current approaches to CS and traditional EMA. From this starting point, we theorize the potential of CS as a democratic innovation that can repurpose EMA as a tool for the implementation of the SDGs. With a focus on the implementation of SDG15 (Life on Land) in local contexts, the commentary presents CS as a democratic innovation for legitimate transformative governance that can affect socio-ecological transitions. We see this approach as especially appropriate to analyze the implementation of SDGs in rural settings where a specific resource nexus can create conflict-laden contexts with much potential for a renewed EMA to support transformative governance towards Agenda 2030.

 Introduction: This article offers an analysis of environmental communication (EC) and citizen science (CS) in the context of Environmental Monitoring and Assessment (EMA) for the implementation of Sustainable Development Goal 15 (Life on Land) in Chile and Sweden.

Methods: The paper is based on fieldwork in two rural study areas of Chile and Sweden where we followed different CS initiatives in relation to EMA and Agenda 2030. We conducted interviews, analyzed documentation and conducted an SDG mapping workshop to understand the implementation of SDG 15 in these two rural forest settings.

Results: Our findings suggest that CS has potential as a democratic innovation for environmental governance in both countries. However, we also found important barriers to the legitimacy of CS as a feature of EMA and local environmental governance in both countries. The paper situates CS in the wider governance and environmental communication processes in regional politics surrounding implementation of national policies for the use of natural resources.

Discussion: The article offers new insights into the barriers and possibilities for public participation in environmental governance and policy at local levels, by addressing the interlinkages between environmental communication and citizen science in rural settings.

Human trafficking survivor service providers are poorly understood societal actors that play an important role in helping victims recover from trauma, build independent productive lives and reintegrate into society. The aim of this case study is to investigate the involvement of trafficking survivors in their own restoration and integration process through holistic care, education, job training and social enterprise development. This study explores how well the business’ service model fits social innovation criteria, beneficiaries’ influence on its development and implementation, opportunities for their improved and future involvement, and ways that the social innovation may strengthen survivors’ social health. The case study utilizes qualitative data collected from interviews, observations and documents to investigate the enterprise’s evolution and implementation, providing unique insights into its collaborative development and how it aims to meet the needs of a hidden and stigmatized population. The study applies theoretical constructs from social innovation, social enterprise and transformational services to the Mexican case study context. Significant findings include the discovery of bi-directional teaching, learning and empowerment among survivors; an increase in co-design and co-production activities in line with mental health improvement and core skill acquisition; the negative effects of poverty and lingering trauma on social innovation co-creation and expansion; and the positive effects the social innovation process, environment, benefits and outcomes have on survivors’ social health. It also suggests the important roles that partnerships, survivor leadership and social learning may play in future innovation co-creation. This study fills a research gap regarding the process, context, limitations and benefits of collaboratively developing social innovations with and for sex trafficking survivors in low-resource settings and demonstrates the importance of considering not only the social innovation co-creation process and criteria, but also context-specific psychosocial supports beneficiaries may require to be active and effective co-creation partners.   

Media plays a crucial role in reshaping societal attitudes and behaviors towards individuals with mental illness. It contributes to improved rights of people living with mental health conditions and access to care services. However, in Ethiopia, mental health advocacy faces obstacles such as deep-rooted misconceptions, fear, and discrimination about mental illness, as well limited engagement of stakeholders and language barriers. Both mainstream and social media play a large role in disseminating mental health topics in Ethiopia. However, they need organized initiatives and efforts in order to be successful in promoting mental health awareness to the public. Implementing a comprehensive strategy comprising public awareness campaigns, policy advocacy, community engagement, stakeholder collaboration, responsible reporting, and increased coverage of mental health topics is crucial. The World Health Organization also emphasizes the role of health ministries in supporting mental health advocacy efforts. By promoting education, challenging stigmas, and improving access to mental health services, media advocacy can contribute to creating a more informed and supportive society for individuals with mental illness in Ethiopia.

Antimicrobial resistance occurs when microorganisms survive exposure and proliferate in the presence of therapeutic levels of antimicrobial drugs. Because antimicrobial resistance is increasing, it is vital to encourage consumers to change and adopt smarter antibiotic behaviour. Despite World Health Organization's efforts to combat antibiotic resistance and their emphasis on the importance of public involvement, the role of consumers has been overlooked. The manifold responsibility for antibiotic resistance extends across different actors, including food retailers and consumers. Given this shared responsibility, a blame game arises and no action occurs. To overcome this status quo situation, we draw attention to the potential role of individual responsibility and social pressure to encourage consumers to adopt smart antibiotic behaviour but also to empower them. Conditions must be put in place to enable consumers' critical evaluation of the health-related and ethical aspects of their food choices. Such behaviour can be facilitated using digital innovations to support informed choices, in store and online.

Background and problem: The concept of sustainability and sustainable development is a broad issue that can be interpreted in many ways. Sustainable development is not only about our environment but also involves social, cultural, and economic issues. In 2023 the Eurobarometer showed that 50 % of the Swedish population consider the environment and climate change the most important issues in Europe today. Media is a cultural entity that can influence people’s perceptions and actions. Therefore, it is relevant how journalists and the media engage with the sustainability issue and how sustainability terminology is managed in media.

Purpose: No previous study on Swedish sustainability communication in newspapers has been found in the literature. This study is addressed to close this research gap concentrating on trends and patterns of how sustainability is communicated in major Swedish newspapers.

Method:  The study is based on mixed research methods by analyses from a media database from the library of Uppsala University. The cornerstones of the research are framing theories and text analysis methods.

Conclusion: There has been a drop in sustainability communication in Swedish newspapers since the year 2021. The downtrend is major in newspapers aligned with the governing parties. The drop is more evident in national newspapers than in regional papers. Swedish newspapers do not connect sustainable development to social or cultural activities to the same extent as to economic and political activities.  The cultural knowledge regarding sustainability is not “renewed” but remains within the domains of classical economic theory and citizens participation is limited.

Aim

We aimed to describe clinical practices and criteria for discharge of very preterm infants in Nordic neonatal units.

Methods

Medical directors of all 89 level-2 and level-3 units in Denmark, Finland, Iceland, Norway and Sweden were invited by e-mail to complete a web-based multiple-choice survey with the option to make additional free-text comments.

Results

We received responses from 83/89 units (93%). In all responding units, discharge readiness was based mainly on clinical assessment with varying criteria. In addition, 36% used formal tests of cardiorespiratory stability and 59% used criteria related to infant weight or growth. For discharge with feeding tube, parental ability to speak the national language or English was mandatory in 45% of units, with large variation among countries. Post-discharge home visits and video-consultations were provided by 59% and 51%, respectively. In 54% of units, parental preparation for discharge were not initiated until the last two weeks of hospital stay.

Conclusion

Discharge readiness was based mainly on clinical assessment, with criteria varying among units despite similar population characteristics and care structures. This variation indicates a lack of evidence base and may unnecessarily delay discharge; further studies of this matter are needed. Earlier parental preparation and use of interpreters might facilitate earlier discharge.

Background

Infant neurodevelopment in the first years after birth is determined by multiple factors, including parental care and maternal mental wellbeing. In this study, we aim to assess the impact of persistent maternal depressive symptoms during the first 3 months postpartum on infant neurodevelopment at 6 months.

Methods

Using a longitudinal cohort design, 1253 mother-infant pairs were followed up at 7, 45, and 90 days to assess postpartum depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS); infants were followed up at 6 months to assess neuro-developmental status using the WHO's Infant and Young Child Development (IYCD) tool. A generalized linear regression model was used to assess the association between persistent postpartum depressive symptoms and infant neurodevelopmental delay at 6 months. A generalized linear mixed model (GLMM) with a hospital as a random intercept was used to assess the persistent postpartum depressive symptoms with an IYCD score. Linear regression was used to compare the IYCD scores between exposure groups.

Results

In the study population, 7.5% of mothers had persistent depressive symptoms, and 7.5% of infants had neurodevelopmental delay. Infants born to mothers with persistent depressive symptoms had a higher proportion of neurodevelopmental delay than infants born to women without persistent symptoms (48.6% vs 5.1%; p < 0.001). In the adjusted regression model, infants whose mothers had persistent depressive symptoms at 7, 45, and 90 days had a 5.21-fold increased risk of neurodevelopmental delay (aRR, 5.21; 95% CI, 3.17, 8.55). Mean scores in the motor domain (12.7 vs 15.2; p < 0.001) and language domain (6.4 vs 8.5; p < 0.001) were significant when a mother had persistent depression vs. no depression. Mean scores in the general behavioral domain (5.9 vs 10.4, p < 0.001) and the socio-emotional domain (15.4 vs 17.7; p < 0.001) were significantly different when a mother had persistent depression vs no persistent depression.

Conclusions

Our results suggest that 6-month-old infants are at higher risk for neurodevelopment delays if their mother reports persistent symptoms of depression from 7 to 90 days postpartum. The neurodevelopmental delay can be observed in all functional domains. Preventive intervention to reduce maternal postpartum depression may reduce the impact on infant developmental delay.

AIMS: The aim of this study was to examine the potential association of family-centred care as perceived by parents during a NICU stay with parents' depressive symptoms at discharge and at 4 months corrected for infant age.

DESIGN: A longitudinal, multicentre cohort study was conducted from 2018 to 2020 in 23 NICUs across 15 countries.

METHODS: Parents (n = 635 mothers, n = 466, fathers) of infants (n = 739) born before 35 weeks of gestation and admitted to the participating NICUs were enrolled to the study during the first weeks of their infants' hospitalizations. They responded to Digi-FCC daily text messages inquiring about their perception of family-centred care provided by NICU staff. In addition, they completed a questionnaire assessing their overall perception of family-centred care at discharge. Parents' depressive symptoms were measured by the Edinburgh Postnatal Depression Scale at discharge and again after discharge when their infants were at 4 months corrected for age.

RESULTS: The mothers' and the fathers' perceptions of family-centred care were associated with their depressive symptoms at discharge and at 4 months corrected age, controlling for gestational age, multiple birth, parent education and relationship status. Parents' participation in infant care, care-related decisions and emotional support provided to parents by staff explained the variation in the parents' perceptions of family-centred care. The factors facilitating the implementation of family-centred care included unlimited access to the unit for the parents and for their significant others, as well as amenities for parents.

CONCLUSIONS: Our study shows that family-centred NICU care associates with parents' depressive symptoms after a NICU stay.

IMPACT: Depression is common in parents of preterm infants. The provision of family-centred care may protect the mental well-being of parents of preterm infants.

Background

Attention deficit hyperactivity disorder (ADHD) is a class of neurodevelopmental disorders which is commonly diagnosed in school-age children, but it can occur in any age group. To provide a robust synthesis of published evidence on the prevalence of ADHD in adults, we conducted an umbrella review of systematic reviews and meta-analyses.

Methods

The review was guided by preferred reporting items for systematic review and meta-analysis (PRISMA). We searched PsychINFO, Web of Science, PubMed, and Scopus to retrieve pertinent studies. The review protocol was registered with PROSPERO (CRD42023389704). A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used to assess the quality of the included studies. A random-effects model was used to perform a meta-analysis.

Results

Five systematic reviews and meta-analyses (57 unique primary studies) with data on 21,142,129 adult participants were eligible for inclusion in this umbrella review. Inverse variance weighted random effect meta-analysis of these studies indicated that the pooled prevalence of ADHD in adults was 3.10% (95%CI 2.60–3.60%). ADHD-I (the inattentive type of ADHD) remained the commonest type of ADHD, followed by ADHD-HI (the hyperactive type) and ADHD-C (the combined type).

Conclusion

The results indicate that ADHD is relatively high in adults, with ADHD-I remaining the most common subtype. Attention should be given to preventing, reducing, identifying, and managing ADHD in adults.

This report outlines the development efforts towards a digital serious game system called MONITOR ECOTECH and presents the game features, components, and architecture, including the game engine, graphics and visualisations, user testing, game structure, as well as game mechanics and functions. The digital prototype featured in this report is a functional “alpha” version that utilises data generated from the playing of the board game version to create a digitised interface. This interface allows for the monitoring and assessment of the performance of different constellations of ecotechnologies when they are exposed to social and biophysical shocks that amplify nutrient emissions in the BSR.

IntroductionContamination with heavy and toxic metals along the food value chain is a public health concern in Bangladesh. MethodsIn this study, 608 fish and chicken samples from traditional and modern retail outlets in urban, peri-urban, and rural areas were collected and analyzed for chromium (Cr), cadmium (Cd), and lead (Pb) contamination, using atomic absorption spectrometry method. The daily intake, target hazard quotient and the target carcinogenic risk (for lead only) as a result of fish and chicken consumption was calculated based on mean results, and by Monte Carlo simulation in @Risk with 100,000 iterations (quantitative risk assessment). ResultsCr and Cd were detected in 80-86% of both chicken meat and fish samples, while Pb positivity found in chicken meat and fish was 54.9 and 23.3%, respectively. The mean concentration (+/- SD) of Cr, Cd, and Pb in chicken meat were 0.66 +/- 0.93, 0.02 +/- 0.03, and 0.09 +/- 0.10 mg/kg, respectively; and in fish were 0.49 +/- 0.62, 0.02 +/- 0.03, and 0.06 +/- 0.09 mg/kg, respectively. The estimated daily intakes of Cr, Cd, and Pb from chicken and fish were lower than the maximum tolerable daily intake in all studied areas. In addition, the target carcinogenic risk for Pb in chicken was lower than the negligible range, which indicated the risk of cancer due to exposure to Pb through chicken meat and fish consumption was very low. DiscussionThe present study concludes that consumption of chicken meat and fish in Bangladesh, currently at very low levels, is unlikely to constitute a major health risk for humans in respect to these metals. However, continuous market surveillance for heavy metals in food stuff is recommended, especially since consumers may increase their meat intake.

Many of the most climate vulnerable countries are also the most fragile and conflict-affected. Despite less capability to adapt to the impacts of climate change, these countries receive less climate finance on average than non-fragile states. The concept of fragility is receiving increased attention in the international community, and research on the climate-conflict nexus and environmental peacebuilding is growing. Yet, a better understanding of how to pursue effective climate action in these contexts is needed. This thesis addresses this knowledge gap by investigating how and to what extent conflict considerations and peacebuilding efforts are integrated in climate change adaptation projects in fragile and conflict-affected settings. A purposive sample of 15 projects approved in 2022-2023 from the three main multilateral climate funds were analyzed through a framework analysis method based on a novel three-step approach to the design of adaptation projects in fragile and-conflict affected settings. The results indicate variability and lack of systematic methodology in how conflict aspects and peacebuilding elements are integrated into project designs, a general tendency of silo-thinking climate-conflict dynamics, but also that a majority of projects engage with the concept of environmental peacebuilding. The findings imply that if conflict considerations and peacebuilding efforts were to be mainstreamed more prevalently in adaptation projects in fragile and conflict-affected settings, there is a critical need to develop suitable policies and guidelines to support this work. This includes more widely accepted frameworks and to generate more robust evidence on the interaction between climate, conflict, fragility and peacebuilding.

Background

Universal coverage of evidence-based interventions for perinatal health, often part of evidence-based guidelines, could prevent most perinatal deaths, particularly if entire communities were engaged in the implementation. Social innovations may provide creative solutions to the implementation of evidence-based guidelines, but successful use of social innovations relies on the engagement of communities and health system actors. This proof-of-concept study aimed to assess whether an earlier successful social innovation for improved neonatal survival that employed regular facilitated Plan-Do-Study-Act meetings on the commune level was feasible and acceptable when implemented on multiple levels of the health system (52 health units) and resulted in actions with plausibly favourable effects on perinatal health and survival in Cao Bang province, northern Vietnam.

Methods

The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided the implementation and evaluation of the Perinatal Knowledge-Into-Practice (PeriKIP) project. Data collection included facilitators’ diaries, health workers’ knowledge on perinatal care, structured observations of antenatal care, focus group discussions with facilitators, their mentors and representatives of different actors of the initiated stakeholder groups and an individual interview with the Reproductive Health Centre director. Clinical experts assessed the relevance of the identified problems and actions taken based on facilitators’ diaries. Descriptive statistics included proportions, means, and t-tests for the knowledge assessment and observations. Qualitative data were analysed by content analysis.

Results

The social innovation resulted in the identification of about 500 relevant problems. Also, 75% of planned actions to overcome prioritised problems were undertaken, results presented and a plan for new actions to achieve the group’s goals to enhance perinatal health. The facilitators had significant roles, ensuring that the stakeholder groups were established based on principles of mutual respect. Overall, the knowledge of perinatal health and performance of antenatal care improved over the intervention period.

Conclusions

The establishment of facilitated local stakeholder groups can remedy the need for tailored interventions and grassroots involvement in perinatal health and provide a scalable structure for focused efforts to reduce preventable deaths and promote health and well-being.

This paper examines the relationship between gender and climate change anxiety (CCA) and climate emotions. Previous research indicates a statistical relationship between enhanced CCA and negative climate emotions among women, whereas no such relationship has been found for men. However, this statistical relationship can not be assumed to regard all women, particularly not in affluent countries less exposed to natural disasters. Therefore, this study aims to understand the link between gender, CCA, and climate emotions in a “developed” country. To achieve this, a survey, interviews, and a focus group were conducted among students at Uppsala University in Sweden. The results did not find a particularly strong relationship between gender, CCA, and climate emotions. However, the study revealed other reasons for CCA and climate emotions, such as an overload of negative media coverage on climate change, the feeling of shame due to uncertainty about whether one is doing enough compared to others, and unequal expectations of responsibility on gender roles.

  Introduction

Adherence to intrapartum fetal heart rate monitoring (FHRM) for early decision making in high-risk pregnancies remains a global health challenge. COVID-19 has led to disruption of routine intrapartum care in all income settings. This study aims to evaluate the implementation of quality improvement (QI) intervention to improve intrapartum FHRM and birth outcome before and during pandemic.

Method and materials

We conducted an observational study among 10,715 pregnant women in a hospital of Nepal, over 25 months. The hospital implemented QI intervention i.e facilitated plan-do-study-act (PDSA) meetings before and during pandemic. We assessed the change in intrapartum FHRM, timely action in high-risk deliveries and fetal outcomes before and during pandemic.

Results

The number of facilitated PDSA meetings increased from an average of one PDSA meeting every 2 months before pandemic to an average of one PDSA meeting per month during the pandemic. Monitoring and documentation of intrapartum FHRM at an interval of less than 30 minutes increased from 47% during pre-pandemic to 73.3% during the pandemic (p<0.0001). The median time interval from admission to abnormal heart rate detection decreased from 160 minutes to 70 minutes during the pandemic (p = 0.020). The median time interval from abnormal FHR detection to the time of delivery increased from 122 minutes to 177 minutes during the pandemic (p = 0.019). There was a rise in abnormal FHR detection during the time of admission (1.8% vs 4.7%; p<0.001) and NICU admissions (2.9% vs 6.5%; p<0.0001) during the pandemic.

Conclusion

Despite implementation of QI intervention during the pandemic, the constrains in human resource to manage high risk women has led to poorer neonatal outcome. Increasing human resources to manage high risk women will be key to timely action among high-risk women and prevent stillbirth.