Harvard Global Health Institute

Nutrition insecurity is a major driver of poor cardiovascular health in Indigenous communities. Medically tailored meals may improve heart failure outcomes and quality of life. There is growing momentum among Indigenous communities to reclaim traditional precontact foods to improve cardiovascular health. In this context, utilizing community-based-participatory methods, we designed MUTTON-HF (Medically Utilized Tailored Traditional Foods to Optimize Nutrition in Heart Failure)-an Indigenous culturally and medically tailored meals program that locally sources Native produce and meat and incorporates traditional Diné (Navajo) foods and recipes. The MUTTON-HF trial is a 2-center, pragmatic, open-label randomized controlled trial to determine the efficacy and safety of MUTTON-HF among Diné patients with heart failure and hospitalization, or emergency room visit in the last 12 months. Two hundred and four subjects at 2 Indian Health Service sites will be randomized in a 1:1 stratified fashion by sex, age (<65 versus ≥65 years), and left ventricular ejection fraction (<50% versus ≥50%). Study subjects will receive either culturally and medically tailored meals that incorporate traditional Diné recipes and foods or usual dietary advice for 8 weeks. Data analysts will be blinded to group assignment until study completion. The primary efficacy end point is the proportion of patients with a hospitalization or emergency room visit (all-cause) within 90 days. Secondary outcomes will include hospitalizations or emergency room visits for heart failure specifically; Kansas City Cardiomyopathy Questionnaire scores for health-related quality of life; measures of food insecurity; Indigenous nourishment; diet quality; financial strain; and clinical biomarkers from study enrollment to 8 weeks. Community-based interventions that leverage the protective assets of Indigenous communities are needed to improve cardiovascular health among Native populations. This pragmatic randomized controlled trial will target a rural tribal population and be the first to evaluate the efficacy of an Indigenous food is medicine intervention to improve Indigenous cardiovascular health outcomes for patients with heart failure. URL: https://www.clinicaltrials.gov; Unique identifier: NCT06549699.

IntroductionAs the population rapidly ages, older adults are faced with a multitude of physical, psychological, and social challenges that limit their ability to age well. Intergenerational programs have gained traction as a potential solution to address social isolation and loneliness among older adults, while also improving intergenerational solidarity among young adults. The study aimed to explore and compare the experiences, facilitators, and barriers to intergenerational relationships and participation in intergenerational programs, from the perspectives of young and older adults in Singapore.MethodsA qualitative descriptive approach with semi-structured interviews was conducted with 14 young adults and 15 older adults via purposive sampling. Data were analyzed thematically using inductive coding.ResultsThree themes emerged: (1) intergenerational perceptions and attitudes towards intergenerational interactions; (2) language, interpersonal traits, and responsibility to bridge the intergenerational gap as facilitators and barriers towards intergenerational relationships; and (3) the role and impact of intergenerational programs on intergenerational relationships.ConclusionThis study highlighted the complex interplay of interpersonal, structural, and cultural factors that shape intergenerational relationships and the effectiveness of intergenerational programs in Singapore. To foster authentic and reciprocal intergenerational relationships, intergenerational programs must be intentionally designed to promote equal status, cooperation, and culturally sensitive practices that reflect the lived realities of both young adults and older adults.

The COVID-19 pandemic caused widespread social disruption, with stigma emerging as a significant challenge for individuals who survived infection. This qualitative study explored the forms, drivers, and impacts of COVID-19-related stigma among survivors in Eastern Nepal. In-depth interviews were conducted with 15 COVID-19 survivors who had reported stigma in a preceding cross-sectional survey. Due to pandemic-related restrictions, interviews were conducted over the phone. Data were analysed thematically following the process outlined by Braun and Clarke. COVID-19 stigma was multifaceted, including social rejection, internalized stigma, and discriminatory practices by community members. Key drivers of stigma included self-directed fear of infection and death, misinformation and limited awareness about COVID-19 transmission and prevention, and a fragile health system and policy responses. Although COVID-19-related stigma may have declined as the pandemic evolved, the findings illustrate how stigma can emerge rapidly during health emergencies that can have social consequences related to trust, disclosure, and help-seeking behavior in future crisis. The study highlights the importance of outbreak preparedness strategies that integrate clear communication, strengthened health system capacity, and social protection measures to mitigate stigma and its harms during future public health crises.

While higher pyrazinamide and isoniazid exposures and slow NAT2 acetylator status were each associated with increased hepatotoxicity, only pyrazinamide exposure was associated when considering pharmacokinetic variables together. Rifampin exposure was not associated with hepatotoxicity, supporting further evaluation of doses up to 20 mg/kg/day in a larger trial.

The prevalence of autoimmune diseases (AIDs) in Ethiopian patients with type 1 diabetes (T1D) is mainly unknown. This study aimed to determine the co-occurrence of AIDs in T1D Ethiopian patients and to compare their prevalence to non-Ethiopian Israeli patients. A retrospective cohort analysis of 12,759 T1D patients, of whom 672 (5.3%) were of Ethiopian descent, aged ≥ 18 years, registered in the Clalit Health Services database was conducted. The AID cases were identified by ICD-10 codes from 2000 to 2023. Additionally, data on thyroid peroxidase antibody (TPO) and tissue transglutaminase (TTG) antibodies were extracted and analyzed. The mean age of the entire cohort was 30.4 ± 18.9 years, 54% were male, and the mean follow-up was 10.9 ± 6.1 years. An additional AID was diagnosed among 14% of the Ethiopian and 26% of the non-Ethiopian populations (p < 0.001), respectively. Although the prevalence of coexisting autoimmune conditions was approximately half in the Ethiopian group, the relative distribution pattern of common and less common AIDs remained similar to that observed in the non-Ethiopian population. The prevalence of AIDs in Ethiopians is lower than in non-Ethiopian patients with T1D, indicating the existence of ethnic differences in susceptibility to AIDs. Nevertheless, the low screening rates highlight the need for greater vigilance and adherence to guidelines by medical staff.

Mobile health (mHealth) apps are increasingly leveraged to support community health workers (CHWs) in delivering high-quality care, particularly in low- and middle-income countries. However, despite the proliferation of mHealth tools, few have been implemented at scale, partly due to limited attention to usability and acceptability among end users. In sub-Saharan Africa, mHealth tools designed for CHWs often lack systematic evaluation using validated instruments tailored to local contexts. Without such assessments, it is difficult to ensure that these tools can be integrated effectively into CHW workflows and scaled sustainably. This study aimed to adapt and validate existing mHealth usability and acceptability assessment tools to be contextually appropriate for CHWs in Rwanda. Specifically, we sought to ensure contextual appropriateness for CHWs supporting postoperative home follow-up for women after cesarean delivery. The resulting tool was designed for use in an implementation study of a novel CHW-led mHealth app. This study was conducted in the Kirehe district, Rwanda, from October 2022 to March 2023. We adapted 2 established tools-the mHealth App Usability Questionnaire and selected items from the Practitioner Opinion (Acceptability) Scale-and added new items that reflect core functions of the CHW-focused mHealth app. All items were translated into Kinyarwanda and simplified to align with CHWs' educational levels. We conducted a three-stage validation that consisted of (1) content validity testing with 8 local and international experts using a recommended content validity index threshold of >0.78; (2) face validity testing with 10 CHWs using a recommended face validity index threshold of ≥0.60; and (3) reliability testing using responses from 30 CHWs, with a Cronbach α coefficient of ≥0.70 indicating acceptable internal consistency. Of the 25 items assessed, 22 (88%) achieved a content validity index score of >0.78 for both clarity and relevance. The face validity index across all 22 items was 0.991, indicating strong comprehensibility and relevance to CHWs. Internal consistency was high: the Cronbach α was 0.86 for the mHealth App Usability Questionnaire items, 0.73 for the Practitioner Opinion (Acceptability) Scale items, and 0.87 for the newly developed questions. The final tool-named the Community Health Worker mHealth Usability and Acceptability Assessment Tool-included 22 items with strong content validity, face validity, and internal reliability. This study presents a rigorously adapted and validated tool for assessing mHealth usability and acceptability among CHWs in Rwanda. The Community Health Worker mHealth Usability and Acceptability Assessment Tool can guide future evaluations of mHealth interventions in similar contexts and serve as a model for localizing mHealth assessment tools in low- and middle-income country settings to ensure fit-for-purpose implementation.

Access to specialty surgical care is growing in many low-income countries, but it remains unclear how hospital workforces can leverage technology to manage large numbers of increasingly complex patients. Large language models (LLMs) may be helpful for this type of clinical decision support, but their real-world performance and safety remain uncertain. The objective of this study was to evaluate feasibility, usability, and potential benefits and risks of an LLM-based assistant for postoperative neurosurgical care in the Gambia. A prospective, single-arm implementation study was conducted at the Edward Francis Small Teaching Hospital. A convenience sample of 4 medical officers (MOs) and 5 nurses assigned to the neurosurgical service participated. A prompted GPT-4o Turbo was deployed on OpenAI Pro accounts to support performance. Usability, helpfulness, and safety were the primary outcomes. Cost-effectiveness was a secondary outcome. Participants completed 75 LLM-assisted interactions on 9 postoperative neurosurgery patients. Usability metrics indicated a moderately high cognitive workload, marginally acceptable usability of the LLM system, and high perceived ease of use. Management plan quality improved in 45 of 75 mock rounds interactions (60%), with a mean improvement of 8.5% (P < .001) on mock rounds scoring rubrics. The improvement was greater for MOs (21.0% change) than nurses (6.5% change). In hypothetical case dilemmas, MO plan accuracy improved by 22.7% (P = .001), and critical errors declined from 33.3% to 0%. Fourteen care changes for 9 patients were attributed to LLM suggestions, including 6 that potentially prevented major morbidity. No unsafe outputs were detected. Exploratory cost analysis suggested potential savings from clinical care changes exceeded the labor costs involved in LLM use. LLM use was associated with improved plan quality without observed safety concerns, while also prompting clinically meaningful care changes. Larger, controlled studies are needed to determine generalizability, durability of benefit, and patient-centered outcomes.