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35 emner vises.
Zhang, J., Ji, S., Ma, X., Yu, L., Jing, Y.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objective
We aimed to determine the association between meteorological factors and sudden sensorineural hearing loss (SSNHL) audiogram configurations.
Design
Retrospective review of medical records from 1 October 2007 to 31 December 2018.
Setting
A tertiary hospital.
Participants
510 patients with SSNHL who had data on the exact date of SSNHL onset and underwent audiological evaluation within 14 days were included.
Primary and secondary outcome measures
Daily values of meteorological factors, including maximum and minimum temperature, mean temperature and its day-to-day change, diurnal temperature range, atmospheric pressure, mean and maximum wind speed and relative humidity, and seasonal distributions.
Results
Among the 510 patients (259 women (50.8%); mean (SD) age, 46.4 (15.5) years), 108 (21.2%) displayed ascending patterns, 143 (28.0%) displayed descending patterns, 129 (25.3%) displayed flat patterns and 130 (25.5%) displayed profound patterns of audiograms. The diurnal temperature range on the day of SSNHL onset in patients with profound patterns was significantly higher than that in patient with ascending (mean difference (MD), 2.2°C; 95% CI, 0.7°C to 3.7°C; p=0.001) and descending (MD, 1.5°C; 95% CI, 0.1°C to 2.9°C; p=0.031) patterns. The relative humidity was the highest on the day of SSNHL onset in patients with ascending patterns and showed a significant difference compared with that in patients with profound patterns (MD, 8.0%; 95% CI, 0.7% to 15.3%; p=0.026). Seasonal distribution did not differ among patients with different audiogram configurations.
Conclusions
Profound audiogram patterns correlated with high diurnal temperature range, while ascending audiogram patterns correlated with high relative humidity in patients with SSNHL. No correlation was observed between seasons and audiogram configurations.
Læs mere Tjek på PubMedKausto, J., Rosenström, T. H., Ervasti, J., Pietiläinen, O., Kaila-Kangas, L., Rahkonen, O., Harkko, J., Väänänen, A., Kouvonen, A., Lallukka, T.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objective
An intervention was carried out at the occupational healthcare services (OHS) of the City of Helsinki beginning in 2016. We investigated the association between the intervention and employee sick leaves using interrupted time series analysis.
Design
Register-based cohort study with a quasi-experimental study design.
Setting
Employees of the City of Helsinki.
Participants
We analysed individual-level register-based data on all employees who were employed by the city for any length of time between 2013 and 2018 (a total 86 970 employees and 3 014 075 sick leave days). Sick leave days and periods that were OHS-based constituted the intervention time series and the rest of the sick leave days and periods contributed to the comparison time series.
Intervention
Recommendations provided to physicians on managing pain and prescribing sick leave for low back, shoulder and elbow pain.
Outcome measures
Number of sick leave days per month and sick leave periods per year.
Results
For all sick leave days prescribed at OHS, there was no immediate change in sick leave days, whereas a gradual change showing decreasing number of OHS-based sick leave days was detected. On average, the intervention was estimated to have saved 2.5 sick leave days per year per employee. For other sick leave days, there was an immediate increase in the level of sick leave days after the intervention and a subsequent gradual trend showing decreasing number of sick leave days.
Conclusions
The intervention may have reduced employee sick leaves and therefore it is possible that it had led to direct cost savings. However, further evidence for causal inferences is needed.
Læs mere Tjek på PubMedSt John, P. D., Menec, V., Tate, R., Newall, N. E., Cloutier, D., O'Connell, M.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objectives
Previous studies on depression in rural areas have yielded conflicting results. Features of rural areas may be conducive or detrimental to mental health. Our objective for this study was to determine if there are rural–urban disparities in depressive symptoms between those living in rural and urban areas of Canada.
Design
We conducted a cross-sectional analysis of a prospective cohort study, which is as representative as possible of the Canadian population—the Tracking Cohort of the Canadian Longitudinal Study on Aging. For this cohort, data were collected from 2010 to 2014. Data were analysed and results were obtained in 2020.
Participants
21 241 adults aged 45–85.
Measures
Rurality was grouped as urban (n=11 772); peri-urban (n=2637); mixed (n=2125; postal codes with both rural and urban areas); and rural (n=4707). Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression. We considered age, sex, education, marital status and disease states as potential confounding factors.
Results
The adjusted beta coefficient was –0.24 (95% CI –0.42 to –0.07; p=0.01) for rural participants, –0.17 (95% CI –0.40 to 0.05; p=0.14) for peri-urban participants and –0.30 (95% CI –0.54 to –0.05; p=0.02) for participants in mixed regions, relative to urban regions. Risk factors associated with depressive symptoms were similar in rural and urban regions.
Conclusions
The small differences in depressive symptoms among those living in rural and urban regions are unlikely to be relevant at a clinical or population level. The findings do suggest some possible approaches to reducing depressive symptoms in both rural and urban populations. Future research is needed in other settings and on change in depressive symptoms over time.
Læs mere Tjek på PubMedFalcaro, M., Osborn, D., Hayes, J., Coyle, G., Couperthwaite, L., Weich, S., Walters, K. R.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objectives
To investigate delivery of smoking cessation interventions, recorded quit attempts and successful quitting rates within primary care in smokers with depression or severe mental illness (SMI) compared with those without.
Design
Longitudinal cohort study using primary healthcare records.
Setting
English primary care.
Participants
882 849 patients registered with participating practices recorded as current smokers during 2007–2014, including three groups: (1) 13 078 with SMI, (2) 55 630 with no SMI but recent depression and (3) 814 141 with no SMI nor recent depression.
Outcomes
Recorded advice to quit smoking, referrals to smoking cessation services, prescriptions for smoking cessation medication, recorded quit attempts and changes of smoking status.
Results
The majority (>70%) of smokers had recorded smoking cessation advice. This was consistently higher in those with SMI than the other cohorts of patients, although the gap greatly reduced in more recent years. Increases in smoking cessation advice over time were not accompanied by increases in recorded attempts to quit or changes of smoking status. Overall nicotine replacement therapy prescribing by general practitioners (GPs) was higher in those with SMI (10.1%) and depression (8.7%) than those without (5.9%), but a downward time trend was observed in all groups. Bupropion and varenicline prescribing was very low and lower for those with SMI. Few smokers (<5%) had referrals to stop smoking services, though this increased over time, but no significant differences were observed between those with and without mental health problems.
Conclusions
There was no evidence of consistent inequalities in access to GP-delivered smoking cessation interventions for people with mental health conditions. Smoking cessation advice was widely reported as taking place in all groups. In order to address the widening gap in smoking prevalence in those with poor mental health compared with those without, the emphasis should be on addressing the quality of advice and support given.
Læs mere Tjek på PubMedNatalia C. Rosas, Trevor Lithgow
Trends in Microbiology, 3.12.2021
Tilføjet 4.12.2021
The cell envelope is essential for survival and adaptation of bacteria. Bacterial membrane proteins include the major porins that mediate the influx of nutrients and several classes of antimicrobial drugs. Consequently, membrane remodelling is closely linked to antimicrobial resistance (AMR). Knowledge of bacterial membrane protein biogenesis and turnover underpins our understanding of bacterial membrane remodelling and the consequences that this process have in the evolution of AMR phenotypes. At the population level, the evolution of phenotypes is a reversible process, and we can use these insights to deploy evolutionary principles to resensitize bacteria to existing antimicrobial drugs.
Læs mere Tjek på PubMedMalaria Journal, 3.12.2021
Tilføjet 4.12.2021
Abstract
Background
Thailand is committed to eliminating malaria by 2024. From 2013 to 2020, the total number of malaria cases have decreased, from 37,741 to 4474 (an 88.1% reduction). However, infections with Plasmodium knowlesi, a monkey malarial pathogen that can also infect humans, have been increasingly observed. This study focused on the molecular analysis of P. knowlesi parasites causing malaria in Thailand.
Methods
Under Thailand’s integrated Drug Efficacy Surveillance (iDES), which includes drug-resistance monitoring as part of routine case-based surveillance and responses, specimens were collected from malaria patients (n = 966) between 2018 and 2020. Thirty-one mono P. knowlesi infections (3.1%), most of which were from eastern and southern Thailand, were observed and confirmed by nested PCR assay and DNA sequencing. To evaluate whether these pathogens were from different lineages, cluster analysis based on seven microsatellite genotyping markers and the merozoite surface protein 1 (pkmsp1) gene was carried out. The P. knowlesi pyrimethamine resistance gene dihydrofolate reductase (pkdhfr) was sequenced and homology modelling was constructed.
Results
The results of analysing the seven microsatellite markers and pkmsp1 sequence demonstrated that P. knowlesi parasites from eastern Thailand were of the same lineage as those isolated in Cambodia, while the parasites causing malaria in southern Thailand were the same lineage as those isolated from Malaysia. The sequencing results for the pkdhfr genes indicated the presence of two mutations, Arg34Leu and a deletion at position 105. On analysis with homology modelling, the two mutations were not associated with anti-malarial drug resistance.
Conclusions
This report compared the genetic populations of P. knowlesi parasites in Thailand from 2018 to 2020 and have shown similar lineages as those isolated in Cambodia and Malaysia of P. knowlesi infection in Thailand and demonstrated that the P. knowlesi parasites were of the same lineages as those isolated in Cambodia and Malaysia. The parasites were also shown to be sensitive to pyrimethamine.
Læs mere Tjek på PubMedMalaria Journal, 3.12.2021
Tilføjet 4.12.2021
Abstract
Background
As part of malaria prevention and control efforts, the distribution and density of malaria mosquitoes requires continuous monitoring. Resources for long-term surveillance of malaria vectors, however, are often limited. The aim of the research was to evaluate the value of citizen science in providing insight into potential malaria vector hotspots and other malaria relevant information, and to determine predictors of malaria vector abundance in a region where routine mosquito monitoring has not been established to support vector surveillance.
Methods
A 1-year citizen science programme for malaria mosquito surveillance was implemented in five villages of the Ruhuha sector in Bugesera district, Rwanda. In total, 112 volunteer citizens were enrolled and reported monthly data on mosquitoes collected in their peridomestic environment using handmade carbon-dioxide baited traps. Additionally, they reported mosquito nuisance experienced as well as the number of confirmed malaria cases in their household.
Results
In total, 3793 female mosquitoes were collected, of which 10.8% were anophelines. For the entire period, 16% of the volunteers reported having at least one confirmed malaria case per month, but this varied by village and month. During the study year 66% of the households reported at least one malaria case. From a sector perspective, a higher mosquito and malaria vector abundance was observed in the two villages in the south of the study area. The findings revealed significant positive correlations among nuisance reported and confirmed malaria cases, and also between total number of Culicidae and confirmed malaria cases, but not between the numbers of the malaria vector Anopheles gambiae and malaria cases. At the sector level, of thirteen geographical risk factors considered for inclusion in multiple regression, distance to the river network and elevation played a role in explaining mosquito and malaria mosquito abundance.
Conclusions
The study demonstrates that a citizen science approach can contribute to mosquito monitoring, and can help to identify areas that, in view of limited resources for control, are at higher risk of malaria.
Læs mere Tjek på PubMedMalaria Journal, 3.12.2021
Tilføjet 4.12.2021
Abstract
Background
Access to healthcare is important in controlling malaria burden and, as a result, distance or travel time to health facilities is often a significant predictor in modelling malaria prevalence. Adding new health facilities may reduce overall travel time to health facilities and may decrease malaria transmission. To help guide local decision-makers as they scale up community-based accessibility, the influence of the spatial allocation of new health facilities on malaria prevalence is evaluated in Bunkpurugu-Yunyoo district in northern Ghana. A location-allocation analysis is performed to find optimal locations of new health facilities by separately minimizing three district-wide objectives: malaria prevalence, malaria incidence, and average travel time to health facilities.
Methods
Generalized additive models was used to estimate the relationship between malaria prevalence and travel time to the nearest health facility and other geospatial covariates. The model predictions are then used to calculate the optimisation criteria for the location-allocation analysis. This analysis was performed for two scenarios: adding new health facilities to the existing ones, and a hypothetical scenario in which the community-based healthcare facilities would be allocated anew. An interactive web application was created to facilitate efficient presentation of this analysis and allow users to experiment with their choice of health facility location and optimisation criteria.
Results
Using malaria prevalence and travel time as optimisation criteria, two locations that would benefit from new health facilities were identified, regardless of scenarios. Due to the non-linear relationship between malaria incidence and prevalence, the optimal locations chosen based on the incidence criterion tended to be inequitable and was different from those based on the other optimisation criteria.
Conclusions
This study findings underscore the importance of using multiple optimisation criteria in the decision-making process. This analysis and the interactive application can be repurposed for other regions and criteria, bridging the gap between science, models and decisions.
Læs mere Tjek på PubMedCarlucci, James G.; De Schacht, Caroline; Graves, Erin; González, Purificación; Bravo, Magdalena; Yu, Zhihong; Amorim, Gustavo; Arinze, Folasade; Silva, Wilson; Tique, Jose A.; Sardella Alvim, Maria Fernanda; Simione, Beatriz; Fernando, Anibal Naftal; Wester, C. William
Journal of Acquired Immune Deficiency Syndromes, 24.11.2021
Tilføjet 4.12.2021
Background:
Historically, antiretroviral therapy (ART) initiation was based on CD4 criteria, but this has been replaced with "Test-and-Start" (T&S) wherein all people living with HIV are offered ART. We describe the baseline immunologic status among children relative to evolving ART policies in Mozambique.
Methods:
This retrospective evaluation was performed using routinely collected data. Children living with HIV (CLHIV; 5-14 years) with CD4 data in the period of 2012-2018 were included. ART initiation “policy periods” corresponded to implementation of evolving guidelines: in Period 1 (2012-2016), ART was recommended for CD4
Læs mere Tjek på PubMedDong, Tony; Rana, Mariam N.; Longenecker, Chris T.; Rajagopalan, Sanjay; Kim, Chang H.; Al-Kindi, Sadeer G.
Journal of Acquired Immune Deficiency Syndromes, 24.11.2021
Tilføjet 4.12.2021
Introduction:
Low-density lipoprotein cholesterol (LDL-C) is typically estimated from total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). The Friedewald, Martin-Hopkins, and National Institute of Health [NIH] equations are widely used but may estimate LDL-C inaccurately in certain patient populations, such as those with HIV. We sought to investigate the utility of machine learning for LDL-C estimation in a large cohort of women with and without HIV.
Methods:
We identified 7397 direct LDL-C measurements (5219 HIV, 2127 uninfected controls, 51 seroconvertors) from 2414 participants (age 39.4 ± 9.3 years) in the Women's Interagency HIV Study, and estimated LDL-C using the Friedewald, Hopkins and NIH equations. We also optimized five machine learning methods (Linear Regression, Random Forest, Gradient Boosting, Support Vector Machine and Neural Network) using 80% of the data (training set). We compared the performance of each method utilizing root mean square error (RMSE), mean absolute error (MAE) and coefficient of determination (R2) in the holdout (20%) set.
Results:
Support Vector Machine (SVM) outperformed all 3 existing equations and other machine learning methods, achieving lowest RMSE, MAE and highest R2 (11.79, 7.98 mg/dL, 0.87 respectively, compared with Friedewald equation: 12.45, 9.14 mg/dL, 0.87). SVM performance remained superior in subgroups with and without HIV, with non-fasting measurements, in LDL 400 mg/dL.
Conclusions:
In this proof-of-concept study, SVM is a robust method that predicts directly measured LDL-C more accurately than clinically used methods in women with and without HIV. Further studies should explore the utility in broader populations.
Corresponding author: Sadeer Al-Kindi, MD, Assistant Professor of Medicine, Harrington Heart and Vascular Institute, University Hospitals/Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, Email: sadeer.al-kindi@uhhospitals.org, Phone: 216-844-1000
Conflicts of interest: There are no potential conflicts (financial, professional, or personal) to disclose by any of the authors.
* Chang Kim and Sadeer Al-Kindi contributed equally.
Funding: Sadeer Al-Kindi is funded by the University Hospitals Informatics Research Grant and the Visconsi Research Scholar Fund.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedIoanna A. Rota, Adam E. Handel, Stefano Maio, Fabian Klein, Fatima Dhalla, Mary E. Deadman, Stanley Cheuk, Joseph A. Newman, Yale S. Michaels, Saulius Zuklys, Nicolas Prevot, Philip Hublitz, Philip D. Charles, Athina Soragia Gkazi, Eleni Adamopoulou, Waseem Qasim, Edward Graham Davies, Imelda Hanson, Alistair T. Pagnamenta, Carme Camps, Helene M. Dreau, Andrea White, Kieran James, Roman Fischer, Opher Gileadi, Jenny C. Taylor, Tudor Fulga, B. Christoffer Lagerholm, Graham Anderson, Erdinc Sezgin, Georg A. Holländer
Science Advances, 3.12.2021
Tilføjet 3.12.2021
Science Advances, <a href="https://www.science.org/toc/sciadv/7/49">Volume 7, Issue 49</a>, December 2021.
Læs mere Tjek på PubMedJacob T. Heggestad, Rhett J. Britton, David S. Kinnamon, Simone A. Wall, Daniel Y. Joh, Angus M. Hucknall, Lyra B. Olson, Jack G. Anderson, Anna Mazur, Cameron R. Wolfe, Thomas H. Oguin, Bruce A. Sullenger, Thomas W. Burke, Bryan D. Kraft, Gregory D. Sempowski, Christopher W. Woods, Ashutosh Chilkoti
Science Advances, 3.12.2021
Tilføjet 3.12.2021
Science Advances, <a href="https://www.science.org/toc/sciadv/7/49">Volume 7, Issue 49</a>, December 2021.
Læs mere Tjek på PubMedRacila, A.-M., O'Shea, A. M. J., Nair, R., Dukes, K., Herwaldt, L. A., Boyken, L., Diekema, D., Ward, M. A., Cobb, J., Jacob, J., Pegues, D., Bleasdale, S., Vijayan, A., Mutneja, A., Fraer, M., O'Connell-Moore, D., Tolomeo, P., Mendez, M., Jaworski, E., Schweizer, M. L.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Introduction
Approximately 38% of haemodialysis patients carry Staphylococcus aureus in their noses, and carriers have a nearly four-fold increased risk of S. aureus access-related bloodstream infections (BSIs) compared with non-carriers. Our objective is to determine the clinical efficacy and effectiveness of a novel intervention using nasal povidone-iodine (PVI) to prevent BSIs among patients in haemodialysis units. We will survey patients and conduct qualitative interviews with healthcare workers to identify barriers and facilitators to implementing the intervention.
Methods and analysis
We will perform an open-label, stepped-wedge cluster randomised trial to assess the effectiveness of nasal PVI compared with standard care. Sixteen outpatient haemodialysis units will participate in the study. The 3-year trial period will be divided into a 4-month baseline period and eight additional 4-month time blocks. The primary outcome of the study will be S. aureus BSI, defined as a S. aureus positive blood culture collected in the outpatient setting or within one calendar day after a hospital admission. The study team will evaluate characteristics of individual patients and the clusters by exposure status (control or intervention) to assess the balance between groups, and calculate descriptive statistics such as average responses separately for control and intervention survey questions.
Ethics and dissemination
This study has received IRB approval from all study sites. A Data Safety and Monitoring Board will monitor this multicentre clinical trial. We will present our results at international meetings. The study team will publish findings in peer-reviewed journals and make each accepted peer-reviewed manuscript publicly available.
Trial registration number
NCT04210505.
Læs mere Tjek på PubMedBhattarai, N., Bam, K., Acharya, K., Thapa, R., Shrestha, B.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Objectives
This study is set up to explore the factors associated with Human Immunodeficiency Virus (HIV) testing among women and men in Nepal.
Study design
Nepal Demographic and Health Survey, 2016 adopts a cross-sectional design.
Setting
Nepal.
Participants
Women and men of age 15–49 years.
Primary outcome measures
Our primary outcome was ever tested for HIV. We used multivariable analysis at a 95% level of significance to measure the effect in outcome variables.
Results
About one in 10 women (10.8%) and one in five men (20.5%) ever tested for HIV. Women who had media exposure at least once a week ((adjusted odds ratio (aOR)=2.8; 95% CI: 1.4 to 5.3) were more likely to get tested for HIV compared with those who had no media exposure at all. Similarly, those who had their recent delivery in the health facility (aOR=3.9; 95% CI: 2.4 to 6.3) were more likely to get tests for HIV compared with those delivered elsewhere. Likewise, among men, compared with adolescents (15–19 years), those from older age groups were more likely to get tested for HIV. Compared with no education, secondary (aOR=2.3; 95% CI: 1.4 to 3.6) and higher education (aOR=1.7; 95% CI: 1.0 to 2.8) had higher odds of getting tested for HIV. Similarly, wealth quintiles in richer and richest groups were more likely to get tested for HIV compared with the poorest quintile. Other characteristics like media exposure, paid sex and 2+ sexual partners were positively associated with being tested for HIV.
Conclusions
HIV testing is not widespread and more men than women are accessing HIV services. More than two-thirds of women who delivered at health facilities never tested for HIV. It is imperative to reach out to people engaging in risky sexual behaviour, people with lower educational attainment, and those in the lower wealth quintile for achieving 95–95–95 targets by 2030.
Læs mere Tjek på PubMedLeeuwen, E. H. v., Taris, T., van Rensen, E. L. J., Knies, E., Lammers, J.-W.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Objective
The COVID-19 pandemic places an enormous demand on physicians around the world. The aim of this study was to examine the impact of the COVID-19 pandemic on physicians’ work experiences and their ability and willingness to continue working in their profession until retirement (ie, their employability).
Design
A longitudinal comparative design was used. Survey data were collected on three moments: before (May 2019), in the early phase (May 2020) and in a later phase (November 2020) of the COVID-19 pandemic. Time effects were tested using repeated-measures analyses of variance and one-way analyses of variance.
Setting
This study took place among physicians of two hospitals in a large city in the Netherlands.
Participants
165 hospital physicians with surgical, medical and other specialties participated in this study.
Results
Physicians’ employability significantly increased from the time prior to the COVID-19 pandemic, compared with the period during this pandemic. Employability differs among physicians with surgical, medical and other specialties. Furthermore, physicians experienced a lower emotional, physical and quantitative workload during the first peak of the COVID-19 pandemic, compared with before the pandemic. Moreover, physicians experienced the most stress from the impact of COVID-19 on their work in general and from combining work and private life.
Conclusions
This study shows that physicians’ employability and work experiences are affected by the COVID-19 pandemic. Work experiences vary for physicians with different specialties. These varieties stress the importance of attention for physicians’ individual needs and challenges regarding working during the COVID-19 pandemic and the possibility of continuing work in the aftermath of this crisis. Based on this, physicians can be offered tailor-made solutions. This is important to maintain a healthy and employable workforce, which is essential for a sustainable healthcare system.
Læs mere Tjek på PubMedGomez, G. B., Siapka, M., Conradie, F., Ndjeka, N., Garfin, A. M. C., Lomtadze, N., Avaliani, Z., Kiria, N., Malhotra, S., Cook-Scalise, S., Juneja, S., Everitt, D., Spigelman, M., Vassall, A.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Objectives
Patients with highly resistant tuberculosis have few treatment options. Bedaquiline, pretomanid and linezolid regimen (BPaL) is a new regimen shown to have favourable outcomes after six months. We present an economic evaluation of introducing BPaL against the extensively drug-resistant tuberculosis (XDR-TB) standard of care in three epidemiological settings.
Design
Cost-effectiveness analysis using Markov cohort model.
Setting
South Africa, Georgia and the Philippines.
Participants
XDR-TB and multidrug-resistant tuberculosis (MDR-TB) failure and treatment intolerant patients.
Interventions
BPaL regimen.
Primary and secondary outcome measures
(1) Incremental cost per disability-adjusted life years averted by using BPaL against standard of care at the Global Drug Facility list price. (2) The potential maximum price at which the BPaL regimen could become cost neutral.
Results
BPaL for XDR-TB is likely to be cost saving in all study settings when pretomanid is priced at the Global Drug Facility list price. The magnitude of these savings depends on the prevalence of XDR-TB in the country and can amount, over 5 years, to approximately US$ 3 million in South Africa, US$ 200 000 and US$ 60 000 in Georgia and the Philippines, respectively. In South Africa, related future costs of antiretroviral treatment (ART) due to survival of more patients following treatment with BPaL reduced the magnitude of expected savings to approximately US$ 1 million. Overall, when BPaL is introduced to a wider population, including MDR-TB treatment failure and treatment intolerant, we observe increased savings and clinical benefits. The potential threshold price at which the probability of the introduction of BPaL becoming cost neutral begins to increase is higher in Georgia and the Philippines (US$ 3650 and US$ 3800, respectively) compared with South Africa (US$ 500) including ART costs.
Conclusions
Our results estimate that BPaL can be a cost-saving addition to the local TB programmes in varied programmatic settings.
Læs mere Tjek på PubMedKhare, S., Pathak, A., Purohit, M. R., Sharma, M., Marrone, G., Tamhankar, A. J., Stalsby Lundborg, C., Diwan, V.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Objectives
To explore the healthcare-seeking pathways, antibiotic prescribing and determine the sociodemographic factors associated with healthcare-seeking behaviour (HSB) of caregivers for common illnesses in under-5 (U-5) children in rural Ujjain, India.
Study design
Prospective cohort study.
Study setting and study sample
The cohort included 270 U-5 children from selected six villages in rural demographic surveillance site, of the R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. A community-based cohort was visited two times weekly for over 113 weeks (August 2014 to October 2016) to record the HSB of caregivers using HSB diaries. Sociodemographic information was also solicited.
Primary and secondary outcome measures
Primary outcomes: first point of care, healthcare-seeking pathway and quantify antibiotic prescribing for the common acute illnesses.
Secondary outcome
HSB risk factors were determined using mixed-effects multinomial logistic regression.
Results
A total of 60 228 HSB follow-up time points for 270 children were recorded with a total of 2161 acute illness episodes. The most common illnesses found were respiratory tract infections (RTI) (69%) and gastrointestinal tract infections (8%). No healthcare was sought in 33% of illness episodes, mostly for RTIs. The most common healthcare-seeking pathway was to informal healthcare providers (IHCPs, 49% of illness episodes). The adjusted relative risk for obtaining no treatment, home treatment and treatment by IHCPs was higher for RTIs (aRR=11.54, 1.82 and 1.29, respectively), illiterate mothers (aRR=2.86, 2.38 and 1.93, respectively), and mothers who were homemakers (aRR=2.90, 4.17 and 2.10, respectively). Socioeconomic status was associated with HSB, with the highest aRR for no treatment in the lowest two socioeconomic quintiles (aRR=6.59 and 6.39, respectively). Antibiotics were prescribed in 46% (n=670/1450) illness episodes and the majority (85%, n=572/670) were broad spectrum.
Conclusion
In our rural cohort for many acute episodes of illnesses, no treatment or home treatment was done, which resulted in overall reduced antibiotic prescribing. The most common healthcare-seeking pathway was to visit IHCPs, which indicates that they are major healthcare providers in rural areas. Most of the antibiotics were prescribed by IHCPs and were commonly prescribed for illnesses where they were not indicated.
Læs mere Tjek på PubMedWahidiyat, P. A., Yo, E. C., Wildani, M. M., Triatmono, V. R., Yosia, M.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Introduction
Thalassaemia is an inherited blood disorder, for which definitive treatments remain largely inaccessible. The recommended approach to reduce the disease burden is by prevention through screening. Currently, the implementation of thalassaemia preventive measures is poorly regulated in Indonesia. Thalassaemia prevention and education are best targeted to the youth, but information on their awareness towards thalassaemia is limited. This study aims to investigate the knowledge, attitude and practice (KAP) towards thalassaemia among Indonesian youth.
Methods
This observational study took place between January and May 2021. An online questionnaire was disseminated to Indonesian youth aged 15–24. Eligible respondents included carriers, unaffected individuals and individuals with unknown carrier status. The questionnaire comprised 28 questions to assess KAP. A cut-off of 75% was used to categorise participant’s KAP into poor or negative and good or positive. Descriptive statistics, 2 test, logistic regression and Pearson correlation were performed for data analysis.
Results
A total of 906 responses were gathered, and 878 were analysed. Most respondents had poor knowledge (62.1%), positive attitude (83.3%) and poor practice (54.4%) towards thalassaemia. The results implied that respondents had limited understanding regarding the types of thalassaemia and the difference between asymptomatic carriers and individuals without the thalassaemia trait. Many (82.6%) believed they were not carrying thalassaemia trait despite the fact that most (95.7%) never got tested. Age, education, gender, residence and family income were key factors that correlated with or predicted the youth’s KAP towards thalassaemia. Older respondents and women were more likely to have good KAP.
Conclusion
Thalassaemia screening targeted to the youth is urgently needed, and future interventions must consider sociodemographic factors that may affect how they perceive the disease. Social media appeals to the youth as an important source of information, but school, parents and health professionals should also be involved in delivering education about thalassaemia.
Læs mere Tjek på PubMedShapiro, G. K., Tong, E., Nissim, R., Zimmermann, C., Allin, S., Gibson, J., Li, M., Rodin, G.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Introduction
Canadians have had legal access to medical assistance in dying (MAiD) since 2016. However, despite substantial overlap in populations who request MAiD and who require palliative care (PC) services, policies and recommended practices regarding the optimal relationship between MAiD and PC services are not well developed. Multiple models are possible, including autonomous delivery of these services and formal or informal coordination, collaboration or integration. However, it is not clear which of these approaches are most appropriate, feasible or acceptable in different Canadian health settings in the context of the COVID-19 pandemic and in the post-pandemic period. The aim of this qualitative study is to understand the attitudes and opinions of key stakeholders from the government, health system, patient groups and academia in Canada regarding the optimal relationship between MAiD and PC services.
Methods and analysis
A qualitative, purposeful sampling approach will elicit stakeholder feedback of 25–30 participants using semistructured interviews. Stakeholders with expertise and engagement in MAiD or PC who hold leadership positions in their respective organisations across Canada will be invited to provide their perspectives on the relationship between MAiD and PC; capacity-building needs; policy development opportunities; and the impact of the COVID-19 pandemic on the relationship between MAiD and PC services. Transcripts will be analysed using content analysis. A framework for integrated health services will be used to assess the impact of integrating services on multiple levels.
Ethics and dissemination
This study has received ethical approval from the University Health Network Research Ethics Board (No 19-5518; Toronto, Canada). All participants will be required to provide informed electronic consent before a qualitative interview is scheduled, and to provide verbal consent prior to the start of the qualitative interview. Findings from this study could inform healthcare policy, the delivery of MAiD and PC, and enhance the understanding of the multilevel factors relevant for the delivery of these services. Findings will be disseminated in conferences and peer-reviewed publications.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2021
Tilføjet 3.12.2021
Abstract
Background
Approximately one-fourth of the global population is latently infected with Mycobacterium tuberculosis. An understanding of the burden of latent tuberculosis infection (LTBI) among immigrants compared with the general Korean population should be the first step in identifying priority groups for LTBI diagnosis and treatment. The study aimed to compute the age-standardized LTBI prevalence and predictors among immigrants with LTBI in South Korea.
Methods
In 2018, the Korea Disease Control and Prevention Agency implemented a pilot LTBI screening project for immigrants using a chest radiography and the QuantiFERON Gold In-Tube assay. A standardized prevalence ratio (SPR) was computed to compare the LTBI burden in immigrants and the general Korean population.
Results
During the duration of the project, a total of 8108 immigrants (5134 males and 2974 females) underwent LTBI screening. The SPR of 1.547 (95% confidence interval [CI] 1.468–1.629) in males and 1.261 (95% CI 1.177–1.349) in females were both higher than the Korean reference population. Furthermore, among the immigrants, those aged < 40 years and Korean diaspora visa holders had a higher SPR.
Conclusion
This study found a higher LTBI prevalence among immigrant population in South Korea compared to that in the general Korean population, and the SPR was higher among those aged < 40 years and the Korean diaspora. The findings can be used as baseline evidence for including immigrants in South Korea in the at-risk group with a priority need for LTBI screening and treatment.
Læs mere Tjek på PubMedXiaoning Wei, Qinghua Lu, Shaowei Wang
Journal of Medical Virology, 3.12.2021
Tilføjet 3.12.2021
Bac Nguyen Hoai, Thang Nguyen Cao, Lan Anh Luong Thi, Minh Nam Nguyen, Hong‐Quan Duong, Van Thai Than
Journal of Medical Virology, 3.12.2021
Tilføjet 3.12.2021
Ousmane Kebe, Maria‐Dolores Fernandez‐Garcia, Boris‐Enock Zinsou, Amadou Diop, Amary Fall, Ndack Ndiaye, Jan Vinjé, Kader Ndiaye
Journal of Medical Virology, 2.12.2021
Tilføjet 3.12.2021
Kadri Kõivumägi, Julia Geller, Karolin Toompere, Hiie Soeorg, Eveli Kallas, Ene‐Ly Jõegeda, Kristi Huik, Irja Lutsar
Journal of Medical Virology, 2.12.2021
Tilføjet 3.12.2021
Shitiz Sriwastava, Erum Khan, Syed Hassan Khalid, Arshdeep Kaur, Parissa Feizi
Journal of Medical Virology, 2.12.2021
Tilføjet 3.12.2021
Xiucai Zhang, Hanyan Meng, Huihui Liu, Qing Ye
Journal of Medical Virology, 2.12.2021
Tilføjet 3.12.2021
Malaria Journal, 2.12.2021
Tilføjet 3.12.2021
Abstract
Background
The devastating public health impact of malaria has prompted the need for effective interventions. Malaria control gained traction after the introduction of artemisinin-based combination therapy (ACT). However, the emergence of artemisinin (ART) partial resistance in Southeast Asia and emerging reports of delayed parasite sensitivity to ACT in African parasites signal a gradual trend towards treatment failure. Monitoring the prevalence of mutations associated with artemisinin resistance in African populations is necessary to stop resistance in its tracks. Mutations in Plasmodium falciparum genes pfk13, pfcoronin and pfatpase6 have been linked with ART partial resistance.
Methods
Findings from published research articles on the prevalence of pfk13, pfcoronin and pfatpase6 polymorphisms in Africa were collated. PubMed, Embase and Google Scholar were searched for relevant articles reporting polymorphisms in these genes across Africa from 2014 to August 2021, for pfk13 and pfcoronin. For pfatpase6, relevant articles between 2003 and August 2021 were retrieved.
Results
Eighty-seven studies passed the inclusion criteria for this analysis and reported 742 single nucleotide polymorphisms in 37,864 P. falciparum isolates from 29 African countries. Five validated-pfk13 partial resistance markers were identified in Africa: R561H in Rwanda and Tanzania, M476I in Tanzania, F446I in Mali, C580Y in Ghana, and P553L in an Angolan isolate. In Tanzania, three (L263E, E431K, S769N) of the four mutations (L263E, E431K, A623E, S769N) in pfatpase6 gene associated with high in vitro IC50 were reported. pfcoronin polymorphisms were reported in Senegal, Gabon, Ghana, Kenya, and Congo, with P76S being the most prevalent mutation.
Conclusions
This meta-analysis provides an overview of the prevalence and widespread distribution of pfk13, pfcoronin and pfatpase6 mutations in Africa. Understanding the phenotypic consequences of these mutations can provide information on the efficacy status of artemisinin-based treatment of malaria across the continent.
Graphical Abstract
Læs mere Tjek på PubMedMalaria Journal, 2.12.2021
Tilføjet 3.12.2021
Abstract
Background
RTS,S/AS01, the leading malaria vaccine has been recommended by the WHO for widespread immunization of children at risk. RTS,S/AS01-induced anti-CSP IgG antibodies are associated with the vaccine efficacy. Here, the long-term kinetics of RTS,S/AS01-induced antibodies was investigated.
Methods
150 participants were randomly selected from the 447 children who participated in the RTS,S/AS01 phase IIb clinical trial in 2007 from Kilifi-Kenya. Cumulatively, the retrospective follow-up period was 93 months with annual plasma samples collection. The levels of anti-CSP IgM, total IgG, IgG1, IgG2, IgG3, and IgG4 antibodies were then determined using an enzyme-linked immunosorbent assay.
Results
RTS,S/AS01 induced high levels of anti-CSP IgG antibodies which exhibited a rapid waning over 6.5 months post-vaccination, followed by a slower decay over the subsequent years. RTS,S/AS01-induced anti-CSP IgG antibodies remained elevated above the control group levels throughout the 7 years follow-up period. The anti-CSP IgG antibodies were mostly IgG1, IgG3, IgG2, and to a lesser extent IgG4. IgG2 predominated in later timepoints. RTS,S/AS01 also induced high levels of anti-CSP IgM antibodies which increased above the control group levels by month 3. The controls exhibited increasing levels of the anti-CSP IgM antibodies which caught up with the RTS,S/AS01 vaccinees levels by month 21. In contrast, there were no measurable anti-CSP IgG antibodies among the controls.
Conclusion
RTS,S/AS01-induced anti-CSP IgG antibodies kinetics are consistent with long-lived but waning vaccine efficacy. Natural exposure induces anti-CSP IgM antibodies in children, which increases with age, but does not induce substantial levels of anti-CSP IgG antibodies.
Læs mere Tjek på PubMedJohn Zarocostas
Lancet, 4.12.2021
Tilføjet 3.12.2021
As COVID-19, climate change, and conflict drive hunger and malnutrition, the health community looks towards the Nutrition For Growth Summit. John Zarocostas reports.
Læs mere Tjek på PubMedKayvan Bozorgmehr, Rosa Jahn
Lancet, 4.12.2021
Tilføjet 3.12.2021
Ezekiel Emanuel and colleagues1 emphasise the ethical obligations of pharmaceutical companies to combat the COVID-19 pandemic on the basis of four ethical principles: optimising vaccine production; fair distribution; sustainability; and accountability.
Læs mere Tjek på PubMedEzekiel J Emanuel, Cécile Fabre, Lisa Herzog, Ole F Norheim, Govind Persad, G Owen Schaefer, Kok-Chor Tan
Lancet, 4.12.2021
Tilføjet 3.12.2021
We thank Felipe de Carvalho Borges da Fonseca and colleagues, and Kayvan Bozorgmehr and Rosa Jahn for their comments on our Viewpoint.1 We agree with de Carvalho Borges da Fonseca and colleagues about the need for “a more equitable, sustainable, and accountable medical innovation system”. Whether waiving patent rights will meaningfully improve access to COVID-19 vaccines for low-income and middle-income countries (LMICs), particularly in the short term, is an empirical matter. There is wide agreement that intellectual property (IP) for mRNA vaccines is not a primary barrier to vaccinating the world;2,3 vaccine production, distribution, and administration are the rate-limiting steps.
Læs mere Tjek på PubMedMilena Falcaro, Alejandra Castañon, Busani Ndlela, Marta Checchi, Kate Soldan, Jamie Lopez-Bernal, Lucy Elliss-Brookes, Peter Sasieni
Lancet, 4.11.2021
Tilføjet 3.12.2021
We observed a substantial reduction in cervical cancer and incidence of CIN3 in young women after the introduction of the HPV immunisation programme in England, especially in individuals who were offered the vaccine at age 12–13 years. The HPV immunisation programme has successfully almost eliminated cervical cancer in women born since Sept 1, 1995.
Læs mere Tjek på PubMedNoam Barda, Noa Dagan, Cyrille Cohen, Miguel A Hernán, Marc Lipsitch, Isaac S Kohane, Ben Y Reis, Ran D Balicer
Lancet, 30.10.2021
Tilføjet 3.12.2021
Our findings suggest that a third dose of the BNT162b2 mRNA vaccine is effective in protecting individuals against severe COVID-19-related outcomes, compared with receiving only two doses at least 5 months ago.
Læs mere Tjek på PubMedShahad H Al-Matar, Charith Sairam, Lucie Roussel, Mélanie J Langelier, Donald C Vinh
Lancet, 4.12.2021
Tilføjet 3.12.2021
A 53-year-old man presented with a 3-week history of fevers, intermittent abdominal pain, anorexia, arthralgias, fatigue, generalised body swelling, and 6·8 kg of unintentional weight loss.
Læs mere Tjek på PubMedSudhvir Singh, Christine McNab, Rose McKeon Olson, Nellie Bristol, Cody Nolan, Elin Bergstrøm, Michael Bartos, Shunsuke Mabuchi, Raj Panjabi, Abraar Karan, Salma M Abdalla, Mathias Bonk, Margaret Jamieson, George K Werner, Anders Nordström, Helena Legido-Quigley, Alexandra Phelan
Lancet, 9.11.2021
Tilføjet 3.12.2021
Understanding the spread of SARS-CoV-2, how and when evidence emerged, and the timing of local, national, regional, and global responses is essential to establish how an outbreak became a pandemic and to prepare for future health threats. With that aim, the Independent Panel for Pandemic Preparedness and Response has developed a chronology of events, actions, and recommendations, from December, 2019, when the first cases of COVID-19 were identified in China, to the end of March, 2020, by which time the outbreak had spread extensively worldwide and had been characterised as a pandemic.
Læs mere Tjek på PubMed