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Adjusting to the physical and psychological demands of emergency care may be particularly challenging for first-year paramedic trainees and may increase the risk for stress-related disorders, with adverse effects on quality of life (QoL). This longitudinal cohort study aimed to investigate whether psychological distress, resilience, and social support predict changes in QoL among first-year paramedic trainees over a 12-month period. First-year paramedic trainees (N = 103), recruited from a local university, completed the Kessler Psychological Distress Scale (K10), the Connor-Davidson Resilience Scale (CD-RISC), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), at enrolment, 6 months and 12 months. Psychological distress, resilience and social support were analysed as predictors of change in QoL in relation to general activities, such as work, household and leisure time activities, over time, using a mixed linear regression model, adjusting for baseline non-work-related trauma exposure. Higher levels of psychological distress and lower levels of resilience were significant predictors of a decrease in QoL over time. Social support was not a significant predictor of QoL. Higher non-work-related baseline trauma exposure was associated with decreased QoL at 6 months only. Women trainees reported decreased general QoL at 6 months and 12 months, compared to male trainees. Interventions aimed at strengthening resilience may reduce psychological distress and enhance QoL in paramedic trainees. This could form part of existing wellness- and self-care-related psychoeducational components in paramedic training.
Regularly updating repositories of air pollution impacts on health is essential for evidence-based policies, interventions, and progress monitoring. However, this is often time-consuming and labour-intensive. Automation can ensure up-to-date evidence; reduce retrieval, screening time, and costs; and make information accessible to non-academic stakeholders. This study investigated whether a machine learning approach can perform any stages of a traditional scoping review on the health impacts, policies, and interventions related to air pollution due to domestic waste burning. A traditional approach was conducted in parallel with machine learning methods enabling a comparison of the efficiency and quality of the partially automated approach against the manual review. Findings from the two approaches were compared and the final set of included articles were considered for (1) reported impacts of waste burning on health outcomes and (2) recommendations on solutions and interventions to prevent/reduce adverse effects on health from waste burning. We found a range of health impacts associated with waste burning, including low birth weight, hypertensive disorders of pregnancy, adverse respiratory outcomes like asthma and wheeze, cancer risk, and mortality. Few studies proposed solutions or evaluated the effectiveness of interventions. The ML approach showed a tendency towards false positives, which are preferable to false negatives (where relevant papers were excluded). Results showed that the model can conduct initial searches and decisions for the review. However, the articles included in the model should be screened manually for final acceptance. Therefore, we propose a hybrid approach be used until the automated model can be further refined.
Adherence to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement has not been explored in the nutrition field. The objectives of this meta-research were to assess the reporting completeness of systematic reviews with meta-analysis (SRs-MA) of nutrition- and diet-related randomized controlled trials (RCTs), and to identify their main reporting limitations, and potential factors associated with adherence to PRISMA. We analyzed a random sample of 100 SRs-MA of nutrition- and diet-related RCTs published in journals indexed on PubMed between July 2021 and July 2022. Pairs of reviewers read the full texts to independently extract the data. One reviewer collected data on the journal's endorsement of PRISMA guidelines. A reporting completeness (RC) score was created using the data from the evaluations regarding whether each fragmented item of PRISMA 2020, PRISMA 2020 Abstracts, PRISMA-Search, and TIDieR checklists (a total of 114 sub-items) was reported in the SRs-MA and compared the RCs between studies grouped according to predefined characteristics. SRs were published in 63 different journals; most (54%) endorsed the PRISMA guidelines. Most SRs-MA (86%) mentioned the PRISMA, and 21 attached the PRISMA checklist. The mean (±SD) RC score was 53.2 ± 7.1%. None of the PRISMA items were completely reported in all SRs-MA. Only 13 items were completely reported in more than 75% of the SRs-MA. Protocol registration (beta = 3.61; 95% CI 1.22-5.99), self-reporting of PRISMA adherence (beta = 4.21; 95% CI 0.72-7.70), and evaluation of the certainty of the body of evidence (beta = 4.99; 95% CI = 2.42-7.55) were associated with RC. The poor RC in SRs-MA of nutrition- and diet-related interventions demonstrates that research in this field requires improvements. Indicators of research integrity and transparency, such as protocol registration, self-reported adherence to PRISMA, and evaluation of the certainty of the body of evidence, were positively associated with RC.
Exposure to heavy metals is a global health concern, especially for children under the age of five. In South Africa, industrial and mining activities have contributed to environmental accumulation of metals. Early learning programmes (ELPs) or preschools are primary spaces for learning and play, making them critical for mitigating early life metal exposure. This study examined arsenic (As), cadmium (Cd) and lead (Pb) levels in soil and dust from selected ELPs in two metropolitan municipalities in Gauteng Province, South Africa, to assess potential exposure risks for children under five. As part of a nationally represented survey of early childhood outcomes, 70 ELPs were stratified into three fee bands (low, medium, high). Soil and dust samples were collected from outdoor play areas and indoor classrooms and analysed using inductively coupled plasma-optical emission spectroscopy (ICP-OES) and inductively coupled plasma-mass spectrometry (ICP-MS). Dust results were semi-quantitative (no surface area measured) and not used in risk calculations. Potential Pb exposure in children was evaluated using the US EPA Integrated Exposure Uptake Biokinetic (IEUBK) model to predict blood Pb levels. Geographic Information System (GIS) mapping identified spatial patterns and hotspots of metal concentrations relative to potential pollution sources. Soil Pb levels were below South African reference values; however, 9.0
Background: The end of the COVID-19 public health emergency of international concern (PHEIC) in May 2023 marked a transition from disruption to recovery and rebuilding of health systems. The WHO African Region entered this period with declining routine immunization coverage, widening inequities, and fragile surveillance systems. We conducted a critical narrative synthesis of post-PHEIC recovery and the transformation of immunization systems in the region from 2023 to 2025. Methods: We thematically analyzed publicly available data from the WHO and other sources using a systems-oriented framework covering immunization coverage, equity, vaccine introductions, disease control, governance, financing, and data systems. Results: Regional coverage for most antigens was restored to 2019 pre-pandemic levels by 2024, e.g., three doses of diphtheria-tetanus-pertussis-containing vaccines at 76%. However, progress remains insufficient to meet the Immunization Agenda 2030 (IA2030) target of 90% coverage. In addition, there were 6.7 million zero-dose children in the 2024 birth cohort (6.3% higher than the 6.3 million in 2019), concentrated in a few countries. The IA2030 target is a 50% reduction in the number of zero-dose children by 2030, compared to 2019. Recovery initiatives have restored services, while accelerated introductions (e.g., malaria vaccines introduced in 20 new countries in 2024–2025) signal renewed system momentum. Yet, progress has plateaued at pre-pandemic levels, reflecting structural constraints rather than sustained transformation. Concurrently, recurrent outbreaks of measles, yellow fever, and other vaccine-preventable diseases highlight persistent immunity gaps and surveillance limitations. Structural constraints (including financing fragility, subnational inequities, and system fragmentation) continue to limit sustained progress. Conclusion: This study offers important insights that can inform immunization policymaking in the WHO African Region and beyond. Current post-PHEIC trends reflect recovery without transformation. Achieving IA2030 targets will require a shift from broad coverage expansion to precision delivery approaches that prioritize zero-dose and underserved populations. Immunization must be positioned as a central pillar of primary health care and health security systems.
