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ObjectiveTo examine the effects of short-term, medium-term and long-term resistance exercise training (RET) on measures of cardiometabolic health in adults.DesignIntervention systematic review.Data sourcesMEDLINE and Cochrane Library databases were searched from inception to February 2018. The search strategy included the following keywords: resistance exercise, strength training and randomised controlled trial.Eligibility criteria for selecting studiesRandomised controlled trials published in English comparing RET≥2 weeks in duration with a non-exercising control or usual care group. Participants were non-athletic and aged ≥18 years.ResultsA total of 173 trials were included. Medium-term and long-term RET reduced systolic blood pressure (−4.02 (95% CI −5.92 to −2.11) mm Hg, p<0.0001 and −5.08 (−10.04 to –0.13) mm Hg, p=0.04, respectively) and diastolic blood pressure (−1.73 (−2.88 to –0.57) mm Hg, p=0.003 and −4.93 (−8.58 to –1.28) mm Hg, p=0.008, respectively) versus control. Medium-term RET elicited reductions in fasted insulin and insulin resistance (−0.59 (−0.97 to –0.21) µU/mL, p=0.002 and −1.22 (−2.29 to –0.15) µU/mL, p=0.02, respectively). The effects were greater in those with elevated cardiometabolic risk or disease compared with younger healthy adults. The quality of evidence was low or very low for all outcomes. There was limited evidence of adverse events.ConclusionsRET may be effective for inducing improvements in cardio metabolic health outcomes in healthy adults and those with an adverse cardio metabolic risk profile.PROSPERO registration number CRD42016037946.

BackgroundLong COVID is a rapidly evolving global health crisis requiring interdisciplinary support strategies that incorporate the lived experience of patients. Currently, there is a paucity of research documenting the day-to-day experiences of patients living with Long COVID.ObjectiveTo explore the lived experience of Long COVID patients.Study designLongitudinal, observation study.SettingAn inductive, data-driven, qualitative approach was used to evaluate hand-written diaries obtained from individuals who had been referred to a Derbyshire Long COVID clinic.Participants12 participants (11 females, age 49±10 years, 11 Caucasians) were recruited. Participants were included if they had a previous confirmed or suspected COVID-19 infection with ongoing recovery, >18 years old, understood the study requirements and provided informed consent.MethodParticipants were directed to complete self-report diaries over 16 weeks. Responses were transcribed verbatim and analysed using thematic analysis.ResultsThree key themes were highlighted: (1) understanding who helps patients manage symptoms, (2) daily activities and the impact on quality of life and health status and (3) the effect of turbulent and episodic symptom profiles on personal identity and recovery.ConclusionsThe novel challenges presented by Long COVID are complex with varying inter-related factors that are broadly impacting functional status and quality of life. Support mechanisms must incorporate the lived experiences and foster true collaborations between health professionals, patients and researchers to improve patient outcomes.Trial registration numberNCT04649957.

Objective Globally, millions of cancer cases are diagnosed annually and mortality rates continue to rise with breast (BC), colorectal (CRC) and prostate (PC) cancer among the most prevalent. Race and ethnic disparities in cancer outcomes have been well‐documented; however, the underlying factors contributing to these disparities are currently unknown. Design This study utilised the Genomic Data Commons (GDC) Portal, a publicly accessible repository, therefore ethical approval was not required. Cancer incidence data were collected by prevalent gene mutations associated with BC, CRC and PC within White, Black and Asian populations. Rolling one‐year survival rates were constructed for each genetic mutation. Results For BC, Black and Asian individuals exhibited higher percentages of cases associated with TP53 mutations compared to Whites. CRC incidence showed Black individuals exhibited higher percentages of cases associated with APC, KRAS and PIK3CA mutations compared to Whites and Asians. PC incidence demonstrated that Black individuals had elevated percentages of cases associated with SPOP, ATM and SYNE1 mutations compared to Whites and Asians. Asian individuals displayed significantly lower survival percentages over 10 years compared to White and Black populations across genetic mutations associated with BC. White individuals exhibited significantly higher survival percentages over 10 years compared to Black individuals across genetic mutations associated with CRC. Conclusion Significant disparities exist in cancer incidence and survival rates across White, Black and Asian populations. These findings demonstrate the importance of targeted approaches in cancer prevention, diagnosis and treatment to address disparities and the need for equitable healthcare. Further research is needed to identify mechanisms driving such disparities and to develop effective strategies to improve cancer outcomes across diverse ethnic populations.

Chronic disease pandemics have challenged societies and public health throughout history and remain ever-present. Despite increased knowledge, awareness and advancements in medicine, technology, and global initiatives the state of global health is declining. The coronavirus disease 2019 (COVID-19) pandemic has compounded the current perilous state of global health, and the long-term impact is yet to be realised. A coordinated global infrastructure could add substantial benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical must be supported by unified approaches that maximise public health. We present a call to action for established public health organisations and governments globally to consider the lessons from the COVID-19 pandemic and unite with true collaborative efforts to address current, longstanding, and growing challenges to public health.

PurposeThe complexity of long COVID and its diverse symptom profile contributes to unprecedented challenges for patients, clinicians, and healthcare services. The threat of long COVID remains ignored by Governments, the media and public health messaging, and patients’ experiences must be heard through understanding of the lived experience. This study aimed to understand the lived experience of those living with long COVID.MethodsAn online web-based survey was designed using Patient and Public Involvement and Engagement (PPIE) to increase understanding of the lived experiences of long COVID, and was distributed through PPIE groups, social media, and word of mouth. The survey used closed and open questions relating to demographics, pre- and post-COVID-19 health quality of life, daily activities and long COVID experiences.ResultsWithin our sample of 132 people living with long COVID, the findings highlight that individuals are being severely impacted by their symptoms and are unable to or limited in participating in their daily activities, reducing quality of life. Long COVID places strain on relationships, the ability to live life fully and is detrimental to mental health. Varying health care experiences are described by participants, with reports of medical gaslighting and inadequate support received.ConclusionsLong COVID has a severe impact on the ability to live life fully, and strains mental health. The appropriate mechanisms and support services are needed to support those living with long COVID and manage symptoms.

Background Community Health Workers (CHWs) play a crucial role in malaria control efforts, yet their contributions to large-scale field trials remain understudied. This research examined the management of CHWs recruited to support a phase III trial of Attractive Targeted Sugar Baits (ATSBs) in Western Zambia. The study aimed to understand the extent to which CHW involvement in the trial aligned with best practices and challenges faced by CHWs implementing health promotion activities. Methods A literature review, review of Zambia Ministry of Health Guidelines, and review of WHO guidelines was conducted to identify best practices and common challenges for CHWs contributing to the delivery of malaria interventions. Subsequently ATSB trial documents were reviewed to compare CHW involvement and CHW challenges experienced during the ATSB trial from 2021 to 2023. A comparative analysis was utilized to assess the involvement of CHWs in the ATSB trial against literature review findings, specific to CHW recruitment, training, supervision, incentivization, and community support. Results Five best practices for CHW delivery of interventions were identified: participatory and gender equitable recruitment and selection; comprehensive training; incentivization for enhanced motivation and performance; high quality supportive supervision; and fostering community support. Five common challenges for involving CHWs in programme delivery were identified: inadequate and poor-quality supervision of CHWs; low compensation and motivation; logistical constraints; workload and multiplicity of roles, and community challenges. The analysis found that ATSB trial practices largely aligned with literature best practices and established guidelines, particularly in training and incentive structures. However, challenges were identified in achieving gender balance (32% female CHWs in year 2), community involvement in CHW selection, and coordination between CHWs and research team members. CHW involvement was a key factor towards successfully implementing the trial protocol. Conclusions Experiences with CHWs involvement in the ATSB trial in Zambia suggest that some facets of field research readily facilitate adherence to best practices for CHW recruitment and management. Additionally, field research that is adequately funded and characterized by rigorous implementation may avoid some of the common challenges faced by CHWs implementing health promotion activities. Nonetheless, some CHW cadre challenges appear universal to programmatic and research contexts, including an imbalance in gender representation favouring male participation in CHW opportunities. More documentation of research experiences may be needed to understand CHW involvement and experiences in field research outside of randomized controlled trials.

Background Attractive targeted sugar bait (ATSB) stations containing bait (to attract) and ingestion toxicant (to kill) sugar-foraging mosquitoes are hypothesized to reduce malaria transmission by shortening the lifespan of Anopheles vectors. Methods A two-arm cluster-randomized controlled trial (cRCT) was conducted in Western Province Zambia. Seventy clusters of 250–350 households were assigned (1:1) by restricted randomization to an intervention arm (ATSB) or control arm (no ATSB) in the context of standard of care vector control (insecticide-treated nets and/or indoor residual spraying). Two ATSB stations (Westham Sarabi, 0.11% dinotefuran w/w) were maintained on exterior walls of eligible household structures for a 7-month deployment period (December-June) during the high malaria transmission season. The primary outcome was clinical malaria incidence among two consecutive seasonal cohorts of children aged 1–14 years, followed-up monthly from January-June in 2022 and 2023. Secondary outcome was Plasmodium falciparum prevalence among individuals aged over six months. Analysis compared clinical malaria incidence and prevalence between arms among the intention-to-treat population. Results ATSB coverage, assessed by cross-sectional survey, was 98.3% in March–April 2022 and 89.5% in March–April 2023. 4494 children contributed any follow-up time to the cohort, with 2313 incident malaria cases in the intervention arm (1.28 per child per six-month transmission season), and 2449 in the control arm (1.38 per child-season). The incidence rate ratio between the two arms was 0.91 (95% CI 0.72–1.15, p  = 0.42). 2536 individuals participated in cross-sectional surveys, with prevalence of P. falciparum 50.7% in the intervention arm and 53.5% in the control arm. The odds ratio between the two arms was 0.89 (95% CI 0.66–1.18, p  = 0.42). Secondary covariable-adjusted and subgroup analyses did not substantially alter the findings. No serious adverse events associated with the intervention were reported. Conclusions Two ATSB stations deployed per eligible structure for two consecutive transmission seasons did not result in a statistically significant reduction in clinical malaria incidence among children aged 1–14 years or in P. falciparum prevalence in rural western Zambia. Further studies are needed to assess the efficacy of ATSB stations in different settings and with different deployment strategies. Trial registration The trial is registered with Clinicaltrials.gov (NCT04800055).

Human population movement across country borders presents a real challenge for malaria control and elimination efforts in Cambodia and its neighbouring countries. To quantify Plasmodium infection among the border-crossing population, including asymptomatic and artemisinin resistant (AR) parasites, three official border crossing points, one from each of Cambodia's borders with Thailand, Laos and Vietnam, were selected for sampling. A total of 3206 participants (of 4110 approached) were recruited as they crossed the border, tested for malaria and interviewed. By real-time polymerase chain reaction (RT-PCR), 5.4% of all screened individuals were found to harbour Plasmodium parasites. The proportion was highest at the Laos border (11.5%). Overall there were 97 P. vivax (55.7%), 55 P. falciparum (31.6%), two P. malariae (1.1%) and 20 mixed infections (11.5%). Of identified infections, only 20% were febrile at the time of screening. Of the 24 P. falciparum samples where a further PCR was possible to assess AR, 15 (62.5%) had mutations in the K13 propeller domain gene, all from participants at the Laos border point. Malaria rapid diagnostic test (RDT) pLDH/HRP-2 identified a positivity rate of 3.2% overall and sensitivity compared to RT-PCR was very low (43.1%). Main individual risk factors for infection included sex, fever, being a forest-goer, poor knowledge of malaria prevention methods and previous malaria infection. Occupation, day of the week and time of crossing (morning vs. afternoon) also appeared to play an important role in predicting positive cases. This study offers a novel approach to identify asymptomatic infections and monitor AR parasite flow among mobile and migrant populations crossing the borders. Similar screening activities are recommended to identify other hot borders and characterise potential hot spots of AR. Targeted \"customised\" interventions and surveillance activities should be implemented in these sites to accelerate elimination efforts in the region.

Long COVID has a complex pathology and a heterogeneous symptom profile that impacts quality of life and functional status. Post‐exertional symptom exacerbation (PESE) affects one‐third of people living with long COVID, but the physiological basis of impaired physical function remains poorly understood. Sixty‐eight people (age (mean ± SD): 50 ± 11 years, 46 females (68%)) were screened for severity of PESE and completed two submaximal cardiopulmonary exercise tests separated by 24 h. Work rate was stratified relative to functional status and was set at 10, 20 or 30 W, increasing by 5 W/min for a maximum of 12 min. At the first ventilatory threshold (VT1), V̇O2 ${\\dot V_{{{\\mathrm{O}}_2}}}$was 0.73 ± 0.16 L/min on Day 1 and decreased on Day 2 (0.68 ± 0.16 L/min; P = 0.003). Work rate at VT1 was lower on Day 2 (Day 1 vs. Day 2; 28 ± 13 vs. 24 ± 12 W; P = 0.004). Oxygen pulse on Day 1 at VT1 was 8.2 ± 2.2 mL/beat and was reduced on Day 2 (7.5 ± 1.8 mL/beat; P = 0.002). The partial pressure of end tidal carbon dioxide was reduced on Day 2 (Day 1 vs. Day 2; 38 ± 3.8 vs. 37 ± 3.2 mmHg; P = 0.010). Impaired V̇O2 ${\\dot V_{{{\\mathrm{O}}_2}}}$is indicative of reduced transport and/or utilisation of oxygen. V̇O2 ${\\dot V_{{{\\mathrm{O}}_2}}}$at VT1 was impaired on Day 2, highlighting worsened function in the 24 h after submaximal exercise. The data suggest multiple contributing physiological mechanisms across different systems and further research is needed to investigate these areas. What is the central question of this study? Can a submaximal 2‐day cardiopulmonary exercise test (CPET) protocol suggest why people living with long COVID experience post‐exertional symptom exacerbation (PESE)? What is the main finding and its importance? A submaximal 2‐day CPET protocol revealed a reduction in oxygen uptake, oxygen pulse and partial pressure of end tidal carbon dioxide, suggesting dysfunctional oxygen transport, utilisation or both may contribute to long COVID PESE. Provided that there are appropriate and detailed screening processes that exclude people living with moderate–severe‐risk post‐exertional malaise, submaximal CPET offers a safe and informative option to investigate long COVID pathophysiology.