A mixed methods PAR study investigating social capital as a resource for Black and other racially minoritised communities in the UK: A study protocol

Understanding how different Black and other racially minoritised communities thrive is an emerging priority area in mental health promotion. Literature demonstrates health benefits of social capital (social resources embedded within social networks). However, its effects are not always positive, particularly for certain subpopulations who are already disadvantaged.The CONtributions of social NEtworks to Community Thriving (CONNECT) study will use Participatory Action Research (PAR) to investigate social capital as a resource that benefits (or hinders) racially minoritised communities and their mental health. The CONNECT study was designed within a partnership with community organisations and responds to local policy in two South-East London Boroughs, thereby providing potential channels for the action component of PAR. Taking an anti-racism lens, we acknowledge the underpinning role of racism in creating health inequities. We apply an intersectional framework to be considerate of overlapping forms of oppression such as age, gender, socioeconomic status, and sexual orientation as an essential part of developing effective strategies to tackle health inequities. Key components of this mixed methods PAR study include (1) involving racialised minority community members as peer researchers in the team (2) collecting and analysing primary qualitative data via interviews, photovoice, and community mapping workshops, (3) developing relevant research questions guided by peer researchers and collaborating organisations and analysing secondary quantitative data accordingly, (4) integrating qualitative and quantitative phases, and (5) working closely with community and policy partners to act on our findings and use our research for social change.The PAR approach will allow us to engage community (voluntary sector and government) and academic partners in decision making and help address imbalances in power and resource allocation. Knowledge generated through this collaborative approach will contribute to existing community initiatives, policies, and council strategies. This will ensure the views and experiences of racially minoritised communities drive the changes we are collaboratively committed to achieving.

Automated Segmentation of Levator Ani Muscle from 3D Endovaginal Ultrasound Images

Levator ani muscle (LAM) avulsion is a common complication of vaginal childbirth and is linked to several pelvic floor disorders. Diagnosing and treating these conditions require imaging of the pelvic floor and examination of the obtained images, which is a time-consuming process subjected to operator variability. In our study, we proposed using deep learning (DL) to automate the segmentation of the LAM from 3D endovaginal ultrasound images (EVUS) to improve diagnostic accuracy and efficiency. Over one thousand images extracted from the 3D EVUS data of healthy subjects and patients with pelvic floor disorders were utilized for the automated LAM segmentation. A U-Net model was implemented, with Intersection over Union (IoU) and Dice metrics being used for model performance evaluation. The model achieved a mean Dice score of 0.86, demonstrating a better performance than existing works. The mean IoU was 0.76, indicative of a high degree of overlap between the automated and manual segmentation of the LAM. Three other models including Attention UNet, FD-UNet and Dense-UNet were also applied on the same images which showed comparable results. Our study demonstrated the feasibility and accuracy of using DL segmentation with U-Net architecture to automate LAM segmentation to reduce the time and resources required for manual segmentation of 3D EVUS images. The proposed method could become an important component in AI-based diagnostic tools, particularly in low socioeconomic regions where access to healthcare resources is limited. By improving the management of pelvic floor disorders, our approach may contribute to better patient outcomes in these underserved areas.

Policies regulating retail environment to reduce tobacco availability: A scoping review

Background

In 2005, the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) entered into force. This treaty was developed in response to the global tobacco epidemic, and it includes measures to reduce both demand for and supply of tobacco. The measures related to demand reduction include raising tax, providing cessation services, promoting smoke free public places, banning advertising, and raising awareness. However, there are a limited number of measures for supply reduction, and these mainly include fighting illicit trade, banning sales to minors and providing alternatives to tobacco workers and growers. Unlike regulation of many other goods and services that have been subjected to retail restrictions, there is a lack of resources about restricting tobacco availability through regulation of tobacco retail environment. Considering the potential of retail environment regulations in reducing tobacco supply and consequently reducing tobacco use, this scoping review aims to identify relevant measures.

Methods

This review examines interventions, policies, and legislations to regulate tobacco retail environment to reduce tobacco availability. This was done by searching the WHO FCTC and its Conference of Parties decisions, a gray literature search including tobacco control databases, a scoping communication with the Focal Points of the 182 WHO FCTC Parties, and a databases search in PubMed, EMBASE, Cochrane Library, Global Health, and Web of Science.

Results

Themes of policies were identified to reduce tobacco availability by regulating retail environment: four WHO FCTC and twelve non-WHO FCTC policies. The WHO FCTC policies included requiring a license to sell tobacco, banning tobacco sale via vending machines, promoting economically alternative activities to individual sellers, and banning ways of sale that constitute a way of advertising, promotion, and sponsorships. The Non-WHO FCTC policies included banning tobacco home delivery, tray sale, tobacco retail outlets in or within a minimum distance from specific facilities, sale in specific retail outlets, and sale of tobacco or one or more of its products, in addition to restricting tobacco retail outlets per density of population and per geographic area, capping the tobacco amount allowed per purchase, limiting the number of hours or days in which tobacco can be sold, requiring a minimum distance between tobacco retailers, reducing tobacco products availability and proximity within a retail outlet, and restricting sale to government controlled outlets.

Discussion and conclusion

Studies show the effects of regulation of the retail environment in influencing overall tobacco purchases, and there is evidence that having fewer retails reduces the level of impulse purchasing of cigarettes and tobacco goods. The measures covered by WHO FCTC are much more implemented than ones not covered by it. Although not all widely implemented, many themes of limiting tobacco availability by regulating tobacco retail environment are available. Further studies to explore such measures and the adoption of the effective ones under the WHO FCTC decisions, could possibly increase their implementation globally to reduce tobacco availability.

Levator ani muscle volume and architecture in normal vs. muscle damage patients using 3D endovaginal ultrasound: a pilot study

INTRODUCTION AND HYPOTHESIS

This study aimed to compare the difference in levator ani muscle (LAM) volumes between 'normal' and those with sonographically visualized LAM defects. We hypothesized that the 'muscle damage' group would have a significantly lower muscle volume.

METHODS

The study included patients who had undergone a 3D endovaginal ultrasound. The normal (NM) and damage (DM) muscle groups' architectural changes were evaluated based on anterior-posterior (AP), left-right (LR) diameter, and minimal levator hiatus (MLH) area. The puboanalis-puboperinealis (PA), puborectalis (PR), and pubococcygeus-iliococcygeus (PC) were manually segmented using 2.5 vs. 1.0 mm to find the optimal sequence and to compare the volumes between NM and DM groups. POPQs were compared between the NM and DM groups.

RESULTS

The 1.0-mm segmentation volumes created superior volume analysis. Comparing NM to the DM group showed no significant difference in LAM volume. Respectively, the mean total LAM volumes were 17.27 cm³ (SD = 3.97) and 17.04 cm³ (SD = 4.32), p = 0.79. The mean MLH measurements for both groups respectively were 10.06 cm² (SD = 2.93) and 12.18 cm² (SD = 2.93), indicating a significant difference (p = 0.01). POPQ analysis demonstrated statistically significant differences at Ba and Bp parameters suggesting that the DM group had worse prolapse (p = 0.05, 0.01, respectively).

CONCLUSIONS

While LAM volumes are similar, there is a significant difference in the physical architecture of the LAM and the POPQ parameters in muscle-damaged patients compared to the normal group.

Refugee mental health and the role of place in the Global North countries: A scoping review

Post-migration factors significantly influence refugee mental health. This scoping review looks at the role of place in refugee mental health. We included 34 studies in Global North high-income countries that elaborated on the place characteristics of facilities, neighbourhoods, urban and rural areas, and countries. While the role of place remains under-theorised, all studies reveal common characteristics that support a strong relationship between place of residence, refugee mental health and wellbeing outcomes in post-migration context. Given that refugees often have little or no choice of where they ultimately live, we suggest future research should focus on how characteristics of place co-constitute post-migration refugee mental health risks, protections, and outcomes.

Migraine phenotype differentially modulates the attentional network: A cross sectional observation study

Background:

Signs of distinct brain dysfunction in patients where migraine intersects with vertigo (i.e. vestibular migraine (VM)), remain elusive. As migraine and vertigo can both independently modulate attentional processes, here we seek the utility of the attentional network to functionally differentiate patients.

Methods:

We used the Attentional Network Task (ANT) to elucidate three separate functional networks: Alerting, orienting and resolving conflict. 120 participants had to attend to the direction of a target visual stimulus, while other parameters were simultaneously manipulated. Reaction times across the networks were assessed in, (i) 30 healthy controls, (ii) 30 VM patients, (iii) 30 patients with migraine without vertigo, and (iv) 30 patients with benign paroxysmal positional vertigo (BPPV) but no migraine.

Results:

Patients with VM (mean = 737.1 ms, SEM = 28), migraine (mean = 735.3 ms, SEM = 36.4), and BPPV (mean = 720.3 ms SEM = 24.3) all exhibited significantly delayed ANT reaction times compared to healthy controls (mean = 661.3 ms, SEM = 23.4). Specific attentional network deficits were observed for resolving conflict in VM, alerting in migraine and orienting in BPPV.

Conclusion:

VM patients displayed deficits in executive function characterized by an inability to focus attentional resources and suppress peripheral distractors, whereas migraineurs without vertigo exhibited changes in the alerting network that reflects hypervigilance.