Background: In Greater Monrovia (GM), Liberia, self-medication is a prevalent practice, with individuals often using medications to manage conditions like diarrhoea and respiratory tract infections (RTIs) without professional consultation. Cultural beliefs, perceived cost savings, and a desire for autonomy in health management drive this practice. Commonly used medications include antibiotics like Flagyl, doxycycline, and tetracycline for diarrhoea, and ceftriaxone, erythromycin, and ciprofloxacin for RTIs and typhoid fever. Alongside nonpharmaceutical medicines, herbal remedies such as guava leaves and ginger-lime mixtures are also widely used. However, the unregulated use of these substances contributes to significant public health risks, including antimicrobial resistance (AMR), which is exacerbated by poor access to healthcare and low levels of health literacy in Liberia. Despite the high prevalence of self-medication, there has been limited research into the perceptions, beliefs, and attitudes of Liberians toward this practice. Aim: This thesis aims to explore the perceptions, beliefs, attitudes, and experiences of Liberians regarding self-medication, specifically in the context of managing diarrhoea and RTIs. The research further analyses how these practices contribute to the development of AMR and seeks to propose policy recommendations to mitigate the negative consequences of self-medication in Liberia. Method and Design: The study adopts a qualitative design, using in-depth, semi-structured interviews to collect data from residents in Greater Monrovia (GM). Data were gathered from 26 participants (physicians, pharmacists, patients, and residents) in GM, who were selected using purposive and theoretical sampling methods. The research is underpinned by constructivist grounded theory alongside symbolic interactionism, with Kathy Charmaz's approach providing the methodological framework. The conceptual framework guiding the study is the Socio-Ecological Model (SEM), which helps understand the behavioural factors influencing individuals' decisions to self-medicate. The research follows a constructivist paradigm, utilising an interpretivist approach to explore the social and healthcare barriers contributing to self-medication practices in the region. Findings: Analysis of the interview data revealed three major themes that influence self-medication in GM, Liberia: (1) barriers to accessing healthcare services, (2) the impact of low literacy and education on unsafe medication practices, and (3) the lack of a structured medication dispensing policy. Participants commonly self-medicate for a wide range of conditions, including hypertension, hepatitis-related symptoms, diarrhoea, RTIs, and general body pains. The findings suggest that the practice of self-medication is heavily influenced by socioeconomic factors, the accessibility of medications, and the lack of healthcare infrastructure. Conclusions: The study concludes that self-medication in GM is driven not only by personal beliefs but also by systemic factors such as poor healthcare infrastructure, socioeconomic barriers, and a lack of education regarding the risks of improper medication use. While some participants are aware of the potential dangers of self-medication, they often disregard these risks due to limited healthcare options and perceived autonomy over their health. The study recommends implementing stricter regulations on the sale of antibiotics and other prescription medications, alongside strategies to improve healthcare accessibility and public health promotion education. Monitoring medication sales and enforcing prescriptions could play a crucial role in reducing self-medication practices and mitigating the rise of antimicrobial resistance in Liberia.

Objective: To examine differences in fruit and vegetable intake and food insecurity between Black African and Caribbean and South Asian (Indian, Pakistani and Bangladeshi) ethnic minority groups with a White (British) reference population in the UK. This study was part of the TANGERINE project (nuTritional heAlth aNd aGeing in oldER ethnIc miNoritiEs). Design: Longitudinal analysis using multilevel logistic regression from Understanding Society, and a cross-sectional comparison with UK Biobank. Setting: Understanding Society waves 2 (2010-2012), 5 (2013-2015), 7 (2015-2017), 9 (2017-2019) 11 (2019-2021), and 13 (2021-2023). UK Biobank baseline data (2006-2010). Participants: Understanding Society: adults aged 16 years and above (approximately 44,000 households). UK Biobank: participants aged 37-73 years (n=502,412). Results: At wave 2, African, Caribbean, Pakistani, and Bangladeshi participants in Understanding Society had lower odds of daily vegetable intake than White British/Irish participants, with Pakistanis showing the lowest intake. These disparities persisted after adjusting for socioeconomic position (SEP) at individual and area level, particularly for Caribbean and Pakistani groups. Indians consistently had higher odds of vegetable intake. Ethnic differences in fruit intake were smaller and largely attenuated by SEP adjustment. Food insecurity was more prevalent in all ethnic minority groups (except Indians) and associated with lower vegetable and fruit intake, though SEP explains more of the ethnic difference. Conclusions: Ethnic differences in fruit and vegetable intake are at least partially explained by SEP, with persistent vegetable consumption disparities after adjustment. Culturally tailored interventions addressing affordability, accessibility, and SEP disparities are needed to improve dietary behaviours among minority ethnic groups.

Background: Long-acting reversible contraceptives (LARCs), including hormonal implants and intrauterine devices, are highly effective pregnancy prevention methods. Aside its advantages over other hormonal methods, LARCs are cost-effective, easy to maintain, and have a low risk of non-compliance-related method failure. Besides, LARCs are also relatively safe for all sexually active women in the postpartum or post-abortion period. However, despite its effectiveness, most sexually active women use other short-term methods, such as condoms and contraceptive pills, which are associated with high discontinuation rates. Thus, this study examines the spatial distribution and multilevel factors associated with LARC use among sexually active reproductive-age women in Nigeria. Methods: This is a cross-sectional analysis of a population-based study from the 2018 Nigeria Demographic Health Survey (NDHS). The NDHS is a nationally representative survey that collects data on socio-demographic characteristics, sexual and reproductive health-related indicators such as contraceptive use and child & maternal health. A sample of 3,978 sexually active reproductive-age women (15–49 years) in Nigeria was used in the analysis. Frequency distribution and spatial analysis of LARC use were displayed with tables and maps, respectively, while multilevel analysis at a 95% confidence interval (CI) and a p-value of less than 0.05 was used to determine factors associated with LARC use among the sample. Results: The spatial distribution of LARC use among sexually active women of reproductive age in Nigeria ranges between 20 and 34.8%. Fifteen of the 36 states (excluding the Federal Capital Territory, FCT) recorded low utilization of LARCs. These states include Adamawa, Lagos, Ogun, Enugu, Anambra, Imo, Abia, Rivers, Kogi, Taraba, Yobe, Gombe, Jigawa, Borno, and Kebbi. Besides, the likelihood of LARC use was lower among participants with a prior history of pregnancy termination [aOR = 0.62; 95%(CI = 0.48–0.80)] compared to their counterparts without pregnancy termination history. Also, participants with no fertility intention had a higher likelihood of using LARCs [aOR = 1.65; 95%(CI = 1.30–2.08)] compared to those with fertility intention. At the community level, women with higher socioeconomic status were less likely to use LARCs [aOR = 0.66; 95%(CI = 0.45–0.97)] compared to women with lower socioeconomic status. Conclusions: This study showed a relatively low utilisation of LARC among sexually active reproductive-age women in Nigeria. Notably, this low utilisation is also common in states that could be described as cosmopolitan, indicating a need for closer investigation to understand context-specific factors associated with LARC use. Population-specific family planning education and counselling for this population are important to address common misconceptions about LARCs in particular and modern contraceptive use in general.

Newer therapeutic options for people with severe haemophilia A (PwSHA), in addition to improved clinical and patient-reported outcomes (PROs), have offered more personalised treatment regimens. This analysis explored mental health, work productivity, and health-related quality of life (HRQoL) among PwSHA in Europe receiving a prophylactic treatment regimen.The Cost of Haemophilia: a Socio-economic Survey (CHESS) study is a retrospective cross-sectional study of adult men with haemophilia in Europe. We analysed data from CHESS participants with severe haemophilia A and no factor VIII (FVIII) inhibitors who received emicizumab or FVIII replacement prophylaxis. Data are from patient questionnaires and their treating health care providers. This analysis focused on PROs, including productivity and activity impairment via the Work Productivity and Activity Impairment, HRQoL via the EQ-5D-5L, and anxiety via the 7-item General Anxiety Disorder questionnaire (GAD-7) and depression via the 8-item Patient Health Questionnaire (PHQ-8). SHA treatment and clinical characteristics were also collected, including bleeding events, joint health, and chronic pain. All findings were analysed descriptively.A total of 350 PwSHA met the inclusion criteria, 94 (27%) of whom provided PROs. Most (68%; n = 64) were receiving emicizumab (FVIII prophylaxis, 32%; n = 30). Clinical characteristics were generally comparable between emicizumab and FVIII prophylaxis groups, including reported chronic pain (63% and 70%) and problem joints (61% and 63%), with on-demand FVIII use for the treatment of breakthrough bleeding events more commonly reported in the FVIII prophylaxis group (34% vs. 56%). Overall, HRQoL showed comparable EQ-5D-5L scores between the treatment groups, with a marginally higher score in the emicizumab group (0.71 vs. 0.69) compared with the FVIII prophylaxis group. Anxiety and depression scores were both numerically lower in the emicizumab group, suggesting a lower burden of disease (anxiety 7-item General Anxiety Disorder questionnaire [GAD-7] mean scores, 6.0 vs. 7.3; depression PHQ-8 mean scores, 6.8 vs. 7.8). Employed PwSHA in the emicizumab group reported a lower impact of SHA on their work impairment (31% vs. 50%), and only 19% (vs. 33%) of the emicizumab group required assistance with daily activities. More PwSHA receiving FVIII prophylaxis reported a negative impact of SHA on their ability to participate in social activities (70% vs. 56%) and on their physical activity (57% vs. 44%).Patients receiving emicizumab prophylaxis appeared to have more favourable mental health, work productivity, and HRQoL-related outcomes than those receiving FVIII prophylaxis. These findings were observed in the context of comparable clinical characteristics between emicizumab and FVIII prophylaxis despite evidence of a more complex treatment history for the emicizumab group. This analysis has limitations, including a lack of adjustment for confounding factors.

Physical inactivity is among the most formidable public health challenges of our time. The World Health Organization recently revealed that physical inactivity is on the rise and predicted that globally, there will be around 500 million new cases of preventable non-communicable diseases between 2020 and 2030 if physical inactivity levels remain as they are. But why? What’s driving this formidable public health challenge? In this commentary article, I illustrate how the continual pursuit of economic growth is a key driver underpinning physical inactivity at the population level. I contend that if the priority really is to address physical inactivity at the population level, then the metrics we use to define social progress will need recalibrating.

Muscular fitness (MF) is an important modifiable factor to improve overall health. Schools offer a unique opportunity to deliver MF activity during physical education (PE) and develop competence to engage in various activities across the life course. However, the implementation of school-based MF activity may be impaired by some teachers reporting a lack of expertise and low confidence in the delivery of MF activity. Understanding teachers’ thoughts and perceptions regarding the delivery of MF in schools may help guide future research and policy to support MF delivery in UK schools. Following ethical approval, a survey of secondary school PE teachers across the UK was distributed via Twitter. Survey responses were analysed and reported descriptively and thematically. Completed surveys were returned by 194 teachers (61.9% male) from England, Scotland, Wales, and Northern Ireland. Relative to less experienced teachers, those with at least five years’ service were 2.2 times more likely to have completed continued professional development (CPD) in MF activity (OR = 2.16; ß = 0.77; 95% CI: 1.25-3.74; p < 0.01), and 1.8 times more likely to use assessments of MF to inform PE programme decision-making (OR = 1.83; ß = 0.60; 95% CI: 1.18-2.82; p < 0.01). Despite the promising contribution school-based PE may have to developing MF, we report a poor understanding of MF activity amongst UK-based PE teachers. CPD is warranted to deliver successful MF interventions in a school setting.

Physical activity improves physical and mental well-being and reduces mortality risk. However, only a quarter of adults globally meet recommended physical activity levels for health. Two common initiatives in the UK are Couch-to-5k (an app-assisted 9-week walk/run programme) and parkrun (a free, weekly, timed 5-km walk/run). It is not known how these initiatives are linked, how Couch-to-5k parkrunners compare to parkrunners, and the extent to which this influences their parkrun performance. The aims were to compare the characteristics and motives and to compare physical activity levels, parkrun performance and the impact of parkrun between Couch-to-5k parkrunners and parkrunners. Three thousand two hundred and ninety six Couch-to-5k parkrunners were compared to 55,923 parkrunners to explore age, sex, ethnicity, employment status, neighbourhood deprivation, motives, physical activity levels, parkrun performance and the impact of parkrun. Couch-to-5k parkrunners were slightly older, more likely to be female and work part-time, but similar in ethnicity, and neighbourhood deprivation compared with other parkrunners. Couch-to-5k parkrunners had different motives for participation and reported high levels of physical activity at registration, which remained to the point of survey completion. This group had slower parkrun times but, when registered for a year, completed a similar number of runs (11) per year. Larger proportions of Couch-to-5k parkrunners perceived positive impacts compared with other parkrunners and 65% of Couch-to-5k parkrunners reported improvements to their lifestyle. parkrun appears to be an effective pathway for those on the Couch-to-5k programme, and the promising positive association between the two initiatives may be effective in assisting previously inactive participants to take part in weekly physical activity.

This opinion piece focuses on how in order to improve the nation's poor health, the government needs to place more value on social justice and wellbeing as well as the use of regulation to positively change culture and health behaviour.

The aim of this review is to consider whether the NICE guidelines for Post-Traumatic Stress Disorder (PTSD) can appropriately guide professionals in meeting the needs of refugees, through evaluation, assessment and treatment. In particular, the limited consideration for culture within the guidelines is explored. Of key importance is that the NICE guidelines are based on the diagnostic model of PTSD, which may fail to appreciate the broader ways in which refugees may understand their traumatic experiences, and wish to address the impacts. Furthermore, there is a clear gap in literature concerning PTSD treatment for refugees (Lee & Bowles, 2023). Arguably, this brings into question the validity of the treatment recommendations within the NICE guidelines, for refugees. More broadly, within the global context, the application of western-based mental disorders has been disputed based on the cultural, and philosophical differences, varying interpretations of life and different traditions in relation to expressing distress and seeking support (Summerfield, 2013). This paper suggests that the NICE guidelines fail to consider the depth and complexity of the role of culture within trauma and recommend insufficient flexibility with regards to the mode of treatment delivery, including a lack of consideration for native and culturally grounded methods of intervention.

The Mental Health Bill, 2025, proposes to remove autism and learning disability from the scope of Section 3 of the Mental Health Act, 1983 (MHA). The present article represents a professional and carer consensus statement that raises concerns and identifies probable unintended consequences if this proposal becomes law. Our concerns relate to the lack of clear mandate for such proposals, conceptual inconsistency when considering other conditions that might give rise to a need for detention and the inconsistency in applying such changes to Part II of the MHA but not Part III. If the proposed changes become law, we anticipate that detentions would instead occur under the less safeguarded Deprivation of Liberty Safeguards framework, and that unmanaged risks will eventuate in behavioural consequences that will lead to more autistic people or those with a learning disability being sent to prison. Additionally, there is a concern that the proposed definitional breadth of autism and learning disability gives rise to a risk that people with other conditions may unintentionally be unable to be detained. We strongly urge the UK Parliament to amend this portion of the Bill prior to it becoming law.