Research for Action

Early childhood development (ECD) is critical for lifelong outcomes, especially in low- and middle-income countries. The home environment plays a vital role, with high-quality caregiving practices such as reading, storytelling and interactive play strongly linked to developmental outcomes. The family care indicator (FCI) scale, although widely used to assess caregiving quality, may be outdated due to shifts from traditional print materials to digital media in recent years. This study explores how home environment components, especially reading materials and screen usage, affect ECD in rural China and why the FCI may need to be revised in the near future. Data were collected from 581 children aged 6-24 months in rural Zhejiang Province in 2024. Child development outcomes were measured using the Bayley Scales of Infant Development, Third Edition, and the home environment was assessed via the FCI, supplemented by questions on caregiver and child screen use and caregivers' self-efficacy in accessing online parenting resources. Results show that 40% of children exhibited cognitive delays and 42% language delays, whereas 74% of households lacked magazines or newspapers, and nearly half of caregivers never read books at home. Children were exposed to screens for an average of 22 min per day (SD = 45). The FCI reading material subscale was not significantly associated with developmental outcomes, but when caregivers used educational screen content together with their children, it was positively associated with language development (p < 0.05) and cognitive development (p < 0.10). Caregivers' own screen use for parenting knowledge showed no significant association, likely due to low self-efficacy in navigating online resources. Traditional FCI items on books and newspapers have limited predictive value, whereas educationally oriented screen use appears beneficial, suggesting the FCI should be updated to reflect evolving caregiving practices in the digital age.

The present study was carried out with the aim of (i) evaluating the effect of chitosan on the free radical scavenging activity, ferric reducing antioxidant power (FRAP) activity, 2, 2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity and chitinase activity in T. aestivum L. and (ii) evaluating the effect of different concentration of chitosan on enzyme activities such as phenylalanine ammonia-lyase (PAL) activity and beta- 1, 3-glucanase activity in T. aestivum L. To achieve these goals, the 15-days-old wheat seedlings were treated with different concentrations of chitosan, such as 1-4 mg/mL and further, the enzyme assays were carried out. The results obtained showed that treatment with 0.5 mg/mL of chitosan induced the maximum free radical scavenging activity and DPPH activity in the plant, while treatment with 1.0 mg/mL of chitosan induced the maximum FRAP activity. The response of wheat seedlings to an increase in oxidative stress was correlated with chitosan treatment. Additionally, treatment with 1.0 mg/mL of chitosan to the plant also showed maximum chitinase enzymatic activity in wheat seedlings. Chitosan treatment also elicited enzyme activities such as PAL and beta-1, 3-glucanases. Different concentrations of chitosan treatment showed increasing patterns of PAL activity from 0 hr, which peaked between 24 - 48 hr and thereafter, started decreasing post 72 hr. Similarly, chitosan treatments in wheat seedlings showed an increasing activity of beta-1, 3-glucanase from 0 hr till 48 hr and started decreasing at 72 hr. Overall, the findings showed that chitosan exhibits a protective nature against oxidative stress.

While the Japanese balanced die is a nutritional-related effort recommended in Japan’s health promotion policies, evidence about its association with frailty is scarce. It’s also worth noting the role of social context, given its wide associations with dietary behaviors and frailty. The present study examined the association between an unbalanced diet and frailty, and whether social connections modify this association in older Japanese adults. Data were collected by a cross-sectional survey of 15,302 community-dwelling adults aged ≥ 65 in Osaka, Japan, 2022. Frailty was measured using the validated Kihon Checklist, with a score of ≥ 8 classified as frailty. A balanced meal was defined as a combination of “staple food, main dishes, and vegetables”, in line with Japan’s health promotion policies. Participants without at least one such meal per day were classified as having an “unbalanced diet.” Social connections included social participation, social contact, and social support. Social participation was defined as participation in any of the organizations or groups. Social contact was defined as regular contact with family or friends. Social support was the presence of a supportive social network. Sex-stratified adjusted logistic models were employed to examine the associations between an unbalanced diet and frailty. We further tested interactions between an unbalanced diet and each social connection variable on both multiplicative and additive scales. The overall prevalence of frailty was 23.1%. Men have a higher proportion of unbalanced diet (29.6%) than women (15.1%). We found an unbalanced diet was associated with frailty in men (OR 1.70, 95% CI 1.38–2.11) and women (OR 1.77, 95% CI 1.38–2.26). In men, significant multiplicative and negative additive interactions were observed between an unbalanced diet and social participation, social contact, and social support (all p < 0.05). No significant interactions were found in women. We identified significant associations between an unbalanced diet and frailty in older Japanese adults. This association varied by social connections status specifically in men. Nutrition-related efforts for frailty may need to consider social context in older men. However, our study was limited by its cross-sectional design.

Primary health care (PHC) providers play a key role in delivering essential care to people living with HIV (PLWH). In Georgia, as in the Eastern European and Central Asian (EECA) region, the HIV epidemic is associated with rising life expectancy and increasing chronic disease comorbidity among PLWH due to improved access to antiretroviral therapy (ART). These evolving dynamics call for a more inclusive approach to HIV care, addressing the diverse needs of those affected. Strengthening the capacity of PHC providers to deliver integrated care can enhance healthcare systems' responses to the epidemic and improve outcomes for PLWH in Georgia. This cross-sectional study assessed HIV-related knowledge, attitudes and practices and their association with the attitude towards HIV service provision among PHC providers in Georgia. Data were collected through structured interviews with PHC providers from various regions. Bivariate and multivariable ordinal logistic regression analysis were conducted. The study included 256 participants with an average age of 55.4 years (SD = 10.3), predominantly female (96.1%), and from regions outside Tbilisi (94.5%). Majority of the participants demonstrated a lack of correct knowledge about HIV (82.0%) and ART (86.3%), almost 30% exhibited discriminatory belief regarding PLWH separation and more than half perceived health care providers to be at risk of acquiring HIV infection when caring for PLWH (55.1%). While 75.4% agreed or strongly agreed that PHC providers should provide care for HIV patients, 77.0% expressed willingness or strong willingness to do so. In the multivariable regression analysis, being located outside Tbilisi was associated with higher odds of a positive attitude towards HIV service provision (aOR = 6.22, 95% CI: 1.99-19.50). In contrast, respondents who were unsure or disagreed with the need to separate HIV-positive clients from those of unknown HIV status had significantly lower odds of a positive attitude towards HIV care provision (aOR = 0.14, 95% CI: 0.06-0.31 and aOR = 0.43, 95% CI: 0.22-0.86, respectively) compared to those who had such discriminatory belief. This study identified geographic location, discriminatory beliefs, and misperceptions about HIV transmission risk as key factors associated with PHC providers' attitudes towards HIV service provision. Addressing these through evidence-based interventions can foster more inclusive, effective HIV care in Georgia, supporting national targets and global best practices.

ABSTRACT This study mapped the availability, integration, and referral patterns of mental health (MH) and substance use disorder (SUD) services for people living with HIV (PLWH) in Georgia. PLWH face a heightened burden of MH conditions, compounded by systemic and social barriers. In Georgia, these challenges are exacerbated by fragmented healthcare system, centralized HIV care, and limited service integration. Cross-sectional survey was conducted between January-August 2024 using a structured questionnaire distributed to 80 institutions across 11 regions of Georgia, including MH centers, HIV-focused NGOs, PLWH treatment and support organizations, and primary healthcare (PHC) centers. Data analysis included descriptive statistics and social network-informed methods. Findings revealed geographic disparities, with services concentrated in urban centers, particularly Tbilisi. Specialized MH institutions provided most clinical MH and SUD services, while HIV-focused organizations delivered treatment and support services. However, formal service protocols for HIV-related MH care were rare. Referral pathways were siloed, showing strong internal linkages among HIV service providers but weak or absent connections with MH and PHC sectors. These findings highlight the urgent need to integrate MH services into HIV platforms and strengthen inter-organizational referrals ensuring comprehensive, person-centered care for PLWH.

The clinical potential of AI to assist mental health, in particular to help diagnose and treat mental disorders, is increasingly well-researched. However, the wider long-term implications of AI for mental health are less well-researched and raise important policy questions. These include how best to address the potentially harmful effects of social media algorithms, of doomscrolling and technostress, and how to ensure the mental health impact of AI on employment is positive rather than negative. The impact of social media algorithms encouraging eating disorders, self-harm and suicide has already been well publicised. The role of AI in increasing anxiety, for instance through doomscrolling and technostress, is also now being researched. There's also good evidence that job loss is harmful for mental health and evidence that fear of job loss may also be harmful. The pace and nature of change generated by AI can be an issue too, as well as ethical and data privacy concerns. The need for policy to address risks arising from AI has been recognised internationally, as illustrated by the EU’s 2024 AI Act. However, progress elsewhere has been erratic and, as yet, the implications of AI for mental health do not appear to have featured significantly in policy making. This is an important gap that needs to be filled. In the UK there’s currently a policy deficit in this area, only partially addressed by the Online Safety Act. In addition, recent government policy decisions affecting employers have the potential unintended consequence of incentivizing some to use AI to replace staff, with knock-on mental health implications. There’s currently also no powerful national public health government agency in the UK. This leaves a public health policy vacuum regarding the implications of AI for the nation’s health. It will be important to identify those most at risk and to develop strategies and policies to prepare for and cope with the changes ahead. This is important to enable the positive effects of AI to be achieved, while minimising risk. Re-creating a powerful national public health body and ensuring a mental health impact assessment for all proposed AI-related policies would be two useful first steps. Helping create a coalition of willing countries and international bodies to ensure the pursuit of AI is not at the expense of mental health would be another.

ABSTRACT Due to geography, structural, and economic factors, California has been the site of multiple climate crises. Deaf and disabled Californians face especially high health risks in crises, partly due to inaccessible risk communications before, during, and after disasters. California's Offices of Emergency Services (OES) play an important role in ensuring inclusive emergency communication for disabled people. This study examines accessibility of climate‐related risk communications in California's OES for deaf and disabled people and is intended to provide guidance to the cities, counties, and the state to improve risk communication plans for disabled people. Key informants from county ( n = 44) and city ( n = 13) OES offices were surveyed about whether their OES provided accessible emergency communications, had barriers, and had needs to improve accessible communications. Findings reveal that urban OES offices more frequently report using or being aware of accessible communication strategies, while rural offices face challenges due to limited resources and infrastructure. Rural OES have fewer partnerships with deaf‐serving organizations and are less likely to have resources to provide captioning and American Sign Language (ASL) interpreters, compared to urban OES. The study highlights the need for improved training, resource allocation, and policy integration to address accessible communication gaps, especially in rural areas. Recommendations include increased training and funding for rural OES offices, stronger partnerships with disability advocacy groups, and the adoption of universal design principles in climate risk communications. This would ensure that all Californians—regardless of location or ability—receive the information they need to prepare for and respond to climate disasters.