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Eirik Amundsen, Åse Haugstvedt, Vegard Skogen, Rigmor C. Berg
PLoS One Infectious Diseases, 5.10.2022
Tilføjet 5.10.2022
by Eirik Amundsen, Åse Haugstvedt, Vegard Skogen, Rigmor C. Berg
Background Chemsex typically involves drugs such as GHB/GBL, crystal meth and mephedrone, and is increasingly common among MSM. The behaviour has been found to be associated with sexually transmitted infections (STIs) and mental health problems. We aimed to assess the extent of chemsex engagement and associations with different aspects of health, among MSM attending a free specialist walk-in clinic for STIs in Oslo, Norway. Methods Anonymous cross-sectional survey data was collected from June to October 2016. Differences in STI health (chlamydia, gonorrhoea, syphilis, HIV diagnoses), mental health (depression/anxiety) and internalised homonegativity between MSM using and not using GHB/GBL, crystal meth, mephedrone, cocaine or ketamine with sex in the last year were assessed descriptively and in a multivariate logistic regression model. The predictors were number of self-reported chlamydia, gonorrhoea or syphilis diagnoses, HIV diagnosis, depression/anxiety, and degree of internalised homonegativity. We adjusted for age, education level and having lived abroad. Results Of the 518 MSM respondents, 17% reported sexualised use of either GHB/GBL, crystal meth, mephedrone, cocaine or ketamine in the last year (chemsex). We found significant positive associations between chemsex and self-reported HIV diagnoses (adjusted odds ratio [aOR] = 3.26, 95%CI = 1.37–7.76), number of reported chlamydia, gonorrhoea or syphilis diagnoses in the last year (aOR = 1.63, 95%CI = 1.18–2.12), having lived more than one year abroad (aOR = 2.10, 95%CI = 1.20–3.65), but no significant association with depression/anxiety (aOR = 1.02, 95%CI = 0.53–1.93), nor internalised homonegativity (aOR = 0.62, 95%CI = 0.33–1.19). Conclusion Chemsex engagement in Norway is relatively low compared to findings from STI clinics in other European countries, and GHB/GBL and cocaine the two most commonly used drugs with sex. Chemsex was more common among MSM having lived more than one year abroad, reporting HIV diagnoses and a higher number of either chlamydia, gonorrhoea or syphilis diagnoses in the last year. Health care providers need to be made aware of chemsex as a behavioural phenomenon among MSM, and special care should be afforded to MSM living with HIV and being diagnosed with STIs.
Læs mere Tjek på PubMedPéter Gyula, Tamás Tóth, Teréz Gorcsa, Tünde Nyikó, Anita Sós-Hegedűs, György Szittya
PLoS One Infectious Diseases, 5.10.2022
Tilføjet 5.10.2022
by Péter Gyula, Tamás Tóth, Teréz Gorcsa, Tünde Nyikó, Anita Sós-Hegedűs, György Szittya
Arabidopsis thaliana is one of the most studied model organisms of plant biology with hundreds of geographical variants called ecotypes. One might expect that this enormous genetic variety could result in differential response to pathogens. Indeed, we observed previously that the Bur ecotype develops much more severe symptoms (upward curling leaves and wavy leaf margins) upon infection with two positive-strand RNA viruses of different families (turnip vein-clearing virus, TVCV, and turnip mosaic virus, TuMV). To find the genes potentially responsible for the ecotype-specific response, we performed a differential expression analysis of the mRNA and sRNA pools of TVCV and TuMV-infected Bur and Col plants along with the corresponding mock controls. We focused on the genes and sRNAs that showed an induced or reduced expression selectively in the Bur virus samples in both virus series. We found that the two ecotypes respond to the viral infection differently, yet both viruses selectively block the production of the TAS3-derived small RNA specimen called tasiARF only in the virus-infected Bur plants. The tasiARF normally forms a gradient through the adaxial and abaxial parts of the leaf (being more abundant in the adaxial part) and post-transcriptionally regulates ARF4, a major leaf polarity determinant in plants. The lack of tasiARF-mediated silencing could lead to an ectopically expressed ARF4 in the adaxial part of the leaf where the misregulation of auxin-dependent signaling would result in an irregular growth of the leaf blade manifesting as upward curling leaf and wavy leaf margin. QTL mapping using Recombinant Inbred Lines (RILs) suggests that the observed symptoms are the result of a multigenic interaction that allows the symptoms to develop only in the Bur ecotype. The particular nature of genetic differences leading to the ecotype-specific symptoms remains obscure and needs further study.
Læs mere Tjek på PubMedRon Blonder, Yael Feldman-Maggor, Shelley Rap
PLoS One Infectious Diseases, 5.10.2022
Tilføjet 5.10.2022
by Ron Blonder, Yael Feldman-Maggor, Shelley Rap
The experience of graduate degree lecturers in the natural sciences when they switched to online teaching during the Covid-19 pandemic is described. The shift to online teaching throughout the pandemic provided an opportunity to evaluate how lecturers integrate technology into their teaching and what they need to improve their remote teaching. This study used a twofold perspective of TPACK (Technological Pedagogical Content Knowledge) and self-efficacy in online education. Its data were derived from pre-and post-questionnaires, comprising closed and open-ended questions, given at the start and end of the semester. We found that lecturers focused on learning and applying technological and techno-pedagogical knowledge but paid less attention to the integration of three components: technology, pedagogy, and scientific content. Although no statistically significant differences in lecturers’ perceived self-efficacy was found between the start and the end of the semester, at the end of the semester we found a statistically significant correlation between the variables involved in building self-efficacy in online teaching: (1) satisfaction with online teaching and the belief that (2) technology promotes teaching, student interactions, participation, and engagement. Our results enabled us to identify the knowledge aspects that lecturers implemented initiatively and to better understand what aspects required more professional development training. In addition, the results emphasized the importance of developing the lecturers’ self-efficacy for online teaching. These insights can help to improve and enhance online teaching in higher education.
Læs mere Tjek på PubMedSonia Ijaz Haider, Farhatulain Ahmed, Hassan Pasha, Hadia Pasha, Nudrat Farheen, Muhammad Talha Zahid
PLoS One Infectious Diseases, 5.10.2022
Tilføjet 5.10.2022
by Sonia Ijaz Haider, Farhatulain Ahmed, Hassan Pasha, Hadia Pasha, Nudrat Farheen, Muhammad Talha Zahid
Purpose Life satisfaction influences well-being. Medical students often experience more stress as compared to their counterparts in other disciplines as they are required to meet the demands of both academic workload and clinical responsibilities. However, during the current pandemic, in addition to academic changes, inability to complete clinical placements, loss of peer interaction and social connectedness and, deployment to areas in times of crisis could exacerbate their stress. This would impact their ability to cope with stress and eventually influence their life satisfaction. Students approach these challenges in various ways, either positively, religiously, or by avoiding. This study aimed to explore the association between resilience, coping mechanisms and life satisfaction in medical students during the pandemic. Methods A cross-sectional web-based survey was conducted from undergraduate medical students from year 1 to year 5. Three instruments were used to measure life satisfaction, resilience, and coping, namely The Brief Resilience Scale, The Satisfaction with Life Scale and the COPE inventory. Mean and standard deviation were calculated for all continuous variables. Robust linear regression model was used for analysis. Hierarchical (forward) stepwise model building technique was used for final model. Alpha cut off was kept at 0.05. Results A total of 351 students (out of 500 students) completed the questionnaires. A moderately negative, slightly linear correlation between life satisfaction and avoidant coping was reported. Life satisfaction showed moderately positive, slightly linear correlation with resilience score. Three variables stayed significant in the final model: Resilience, avoidant coping, and religion coping. Conclusion Life satisfaction can be improved among medical students by focusing on strategies which enhance resilience. Religion is identified as a significant coping strategy among medical students. Students coping mechanism can vary and more research is needed to assess which types of coping strategies could contribute positively to the quality of their personal and professional lives
Læs mere Tjek på PubMedMatteo Guardiani, Philipp Frank, Andrija Kostić, Gordian Edenhofer, Jakob Roth, Berit Uhlmann, Torsten Enßlin
PLoS One Infectious Diseases, 5.10.2022
Tilføjet 5.10.2022
by Matteo Guardiani, Philipp Frank, Andrija Kostić, Gordian Edenhofer, Jakob Roth, Berit Uhlmann, Torsten Enßlin
The viral load of patients infected with SARS-CoV-2 varies on logarithmic scales and possibly with age. Controversial claims have been made in the literature regarding whether the viral load distribution actually depends on the age of the patients. Such a dependence would have implications for the COVID-19 spreading mechanism, the age-dependent immune system reaction, and thus for policymaking. We hereby develop a method to analyze viral-load distribution data as a function of the patients’ age within a flexible, non-parametric, hierarchical, Bayesian, and causal model. The causal nature of the developed reconstruction additionally allows to test for bias in the data. This could be due to, e.g., bias in patient-testing and data collection or systematic errors in the measurement of the viral load. We perform these tests by calculating the Bayesian evidence for each implied possible causal direction. The possibility of testing for bias in data collection and identifying causal directions can be very useful in other contexts as well. For this reason we make our model freely available. When applied to publicly available age and SARS-CoV-2 viral load data, we find a statistically significant increase in the viral load with age, but only for one of the two analyzed datasets. If we consider this dataset, and based on the current understanding of viral load’s impact on patients’ infectivity, we expect a non-negligible difference in the infectivity of different age groups. This difference is nonetheless too small to justify considering any age group as noninfectious.
Læs mere Tjek på PubMedMalaria Journal, 5.10.2022
Tilføjet 5.10.2022
Abstract
Background
Quantifying disease costs is critical for policymakers to set priorities, allocate resources, select control and prevention strategies, and evaluate the cost-effectiveness of interventions. Although malaria carries a very large disease burden, the availability of comprehensive and comparable estimates of malaria costs across endemic countries is scarce.
Methods
A literature review to summarize methodologies utilized to estimate malaria treatment costs was conducted to identify gaps in knowledge.
Results
Only 45 publications met the inclusion criteria. They utilize different methods, include distinct cost components, have varied geographical coverage (a country vs a city), include different periods in the analysis, and focus on specific parasite types or population groups (e.g., pregnant women).
Conclusions
Cost estimates currently available are not comparable, hindering broad statements on the costs of malaria, and constraining advocacy efforts towards investment in malaria control and elimination, particularly with the finance and development sectors of the government.
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BMC Infectious Diseases, 5.10.2022
Tilføjet 5.10.2022
Abstract
Background
Neonatal bacterial meningitis is a common neonatal disease with high morbidity, and can cause serious sequelae when left untreated. Escherichia coli is the common pathogen, and its endotoxin, lipopolysaccharide (LPS) can damage the endothelial cells, increasing the permeability of the blood-brain barrier (BBB), leading to intracranial inflammation. However, the specific mechanism of bacterial meningitis induced by LPS damaging BBB remains unclear. In this study, the mouse brain microvascular endothelial (bEND.3) cells were used as a research object to investigate whether LPS damage BBB through the PI3K/Akt pathway.
Methods
The bEND.3 cells were stimulated with different concentrations of LPS for 12 h, and the expression of tight junction proteins (ZO-1, claudin-5, occludin) was detected using western blotting. The cells were challenged with the same concentration of LPS (1ug/ml) across different timepoints (0, 2 h, 4 h, 6 h, 12 h, 24 h). Expression of TJ proteins and signal pathway molecules (PI3K, p-PI3K, Akt, p-Akt) were detected. The distribution of ZO-1 in bEND.3 cells were detected by immunofluorescence staining.
Results
A negative correlation is observed between ZO-1 and LPS concentration. Moreover, a reduced expression of ZO-1 was most significant under 1 ug/ml of LPS, and the difference was statistically significant (P < 0.05). Additionally, there is a negative correlation between ZO-1 and LPS stimulation time. Meanwhile, the expression of claudin-5 and occludin did not change significantly with the stimulation of LPS concentration and time. The immunofluorescence assay showed that the amount of ZO-1 on the surface of bEND.3 cells stimulated with LPS was significantly lower than that of the control group. After LPS stimulation, p-Akt protein increased at 2 h and peaked at 4 h. The titer of p-PI3K did not change significantly with time.
Conclusion
LPS can downregulate the expression of ZO-1; however, its effect on claudin-5 and occludin is minimal. Akt signal pathway may be involved in the regulation of ZO-1 expression induced by LPS in bEND.3 cells.
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BMC Infectious Diseases, 5.10.2022
Tilføjet 5.10.2022
Abstract
Background
Inappropriate empiric antimicrobial treatment (IET) contributes to worsened outcomes. While IET’s differential impact across types of nosocomial pneumonia (NP: non-ventilated [nvHABP], ventilated [vHABP] hospital-acquired and ventilator-associated [VABP] bacterial pneumonia) is established, its potential interaction with the bacterial etiology is less clear.
Methods
We conducted a multicenter retrospective cohort study in the Premier Healthcare Database using an administrative algorithm to identify NP. We paired respective pathogens with empiric treatments. Antimicrobial coverage was appropriate if a drug administered within 2 days of infection onset covered the recovered organism(s). All other treatment was IET.
Results
Among 17,819 patients with NP, 26.5% had nvHABP, 25.6% vHABP, and 47.9% VABP. Gram-negative (GN) organisms accounted for > 50% of all infections. GN pathogens were ~ 2 × as likely (7.4% vHABP to 10.7% nvHABP) to engender IET than Gram-positive (GP, 2.9% vHABP to 4.9% nvHABP) pathogens. Although rare (5.6% nvHABP to 8.3% VABP), GN + GP infections had the highest rates of IET (6.7% vHABP to 12.9% nvHABP). Carbapenem-resistant GNs were highly likely to receive IET (33.8% nvHABP to 40.2% VABP). Hospital mortality trended higher in the IET group, reaching statistical significance in GN + GP vHABP (47.8% IET vs. 29.3% non-IET, p = 0.016). 30-day readmission was more common with IET (16.0%) than non-IET (12.6%, p = 0.024) in GN VABP. Generally post-infection onset hospital length of stay and costs were higher with IET than non-IET.
Conclusions
IET is ~ 2 × more common in GN than GP infections. Although the magnitude of its impact varies by NP type, IET contributes to worsened clinical and economic outcomes.
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BMC Infectious Diseases, 4.10.2022
Tilføjet 5.10.2022
Abstract
Background
The clinical presentation of hospital-acquired pneumonia (HAP) in older patients is often complex and non-specific, posing a diagnostic challenge. This study evaluates the value of serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and heparin-binding protein (HBP) in combination with traditional inflammatory markers procalcitonin (PCT) and C-reactive protein (CRP) in diagnosing HAP in older patients.
Methods
Thirty-eight elderly male patients with HAP (≥ 80 years old) and 46 age-matched controls, who were hospitalized for other reasons than HAP, were enrolled. The serum sTREM-1, HBP, PCT and CRP levels were measured by ELISA on the first day after enrollment. In addition, routine blood test, blood gas, sputum analysis, clinical pulmonary infection score (CPIS) assessment, and chest X-ray were performed, and the correlations with HAP were analyzed.
Results
The serum sTREM-1 (n = 38, 170.75 ± 158.33 pg/ml), HBP (2.08 ± 0.50), PCT (9.44 ± 17.73) and CRP (79.63 ± 71.37) were all significantly higher in the HAP group, when compared to the control group (P < 0.05). Furthermore, the values were positively correlated with the CPIS. The ROC curve analysis revealed that the AUC for sTREM-1 (0.667) and HBP (0.711) were lower, when compared to that for PCT (AUC = 0.839) and CRP (AUC = 0.840). The combination of PCT and CRP with sTREM-1 (AUC = 0.927) or HBP (AUC = 0.930) had the highest AUC values.
Conclusion
Serum sTREM-1, HBP, PCT and CRP can all be used as diagnostic markers for HAP in the elderly. The combination of traditional inflammatory markers PCT and CRP with novel inflammatory marker sTREM-1 or HBP further improves the diagnostic performance.
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Pham, P. N., Keegan, K., Johnston, L. G., Rodas, J., Restrepo, M. A., Wei, C., Vinck, P.
BMJ Open, 5.10.2022
Tilføjet 5.10.2022
Objectives
To determine factors associated with adherence to COVID-19 mitigation measures, related symptoms and testing, as well as pandemic-related income loss among Venezuelan refugee and migrant adults in urban and border areas of Colombia.
Design
Phone-based respondent-driven sampling
Setting
Bogotá and Norte de Santander, Colombia.
Participants
605 adult Venezuelan refugees and migrants residing in Bogotá (n=305) and Norte de Santander (n=300), who arrived in Colombia after 2014 and completed the survey in August and September 2020.
Primary and secondary outcome measures
Full COVID-19 compliance (vs incomplete or no compliance), any COVID-19-related symptoms (vs none) and income loss due to isolation measures in Colombia (vs no income change or increase in income).
Results
Older age was associated with lower odds of compliance with physical distancing measures (0.94, 0.90–0.99; p=0.01) for those in Bogotá. Nearly 15% of refugees and migrants in both locations (81 of 605) experienced at least one symptom consistent with COVID-19. Having a health condition was associated with higher odds of experiencing COVID-19-related symptoms in Bogotá (4.00, 1.22–13.06; p=0.02) and Norte de Santander (6.99, 1.95–24.99; p=0.003). Around 8% in both locations (48 of 605) were tested for COVID-19. Around 90% in both locations (537 of 605) had trouble earning an income after the introduction of isolation measures, and the median reported monthly income decreased by half in Bogotá and by 30% in Norte de Santander. A higher level of education (3.46, 1.02–11.75; p=0.05) was associated with higher odds of income loss among participants in Norte de Santander.
Conclusions
Results indicate high compliance with COVID-19 mitigation measures, low testing rates and high pandemic-related income loss among Venezuelan refugees and migrants in Colombia. This study provides insights into a hard-to-reach refugee and migrant population in Colombia; additional study on the effects of the pandemic on hidden populations is warranted.
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Part, C., Filippi, V., Cresswell, J. A., Ganaba, R., Hajat, S., Nakstad, B., Roos, N., Kadio, K., Chersich, M., Lusambili, A., Kouanda, S., Kovats, S.
BMJ Open, 5.10.2022
Tilføjet 5.10.2022
Objective
To examine the effects of high ambient temperature on infant feeding practices and childcare.
Design
Secondary analysis of quantitative data from a prospective cohort study.
Setting
Community-based interviews in the commune of Bobo-Dioulasso, Burkina Faso. Exclusive breastfeeding is not widely practised in Burkina Faso.
Participants
866 women (1:1 urban:rural) were interviewed over 12 months. Participants were interviewed at three time points: cohort entry (when between 20 weeks’ gestation and 22 weeks’ postpartum), three and nine months thereafter. Retention at nine-month follow-up was 90%. Our secondary analysis focused on postpartum women (n=857).
Exposure
Daily mean temperature (°C) measured at one weather station in Bobo-Dioulasso. Meteorological data were obtained from publicly available archives (TuTiempo.net).
Primary outcome measures
Self-reported time spent breastfeeding (minutes/day), exclusive breastfeeding of infants under 6 months (no fluids other than breast milk provided in past 24 hours), supplementary feeding of infants aged 6–12 months (any fluid other than breast milk provided in past 24 hours), time spent caring for children (minutes/day).
Results
The population experienced year-round high temperatures (daily mean temperature range=22.6°C–33.7°C). Breastfeeding decreased by 2.3 minutes/day (95% CI -4.6 to 0.04, p=0.05), and childcare increased by 0.6 minutes/day (0.06 to 1.2, p=0.03), per 1°C increase in same-day mean temperature. Temperature interacted with infant age to affect breastfeeding duration (p=0.02), with a stronger (negative) association between temperature and breastfeeding as infants aged (0–57 weeks). Odds of exclusive breastfeeding very young infants (0–3 months) tended to decrease as temperature increased (OR=0.88, 0.75 to 1.02, p=0.09). There was no association between temperature and exclusive breastfeeding at 3–6 months or supplementary feeding (6–12 months).
Conclusions
Women spent considerably less time breastfeeding (~25 minutes/day) during the hottest, compared with coolest, times of the year. Climate change adaptation plans for health should include advice to breastfeeding mothers during periods of high temperature.
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Havelaar, A. H., Brhane, M., Ahmed, I. A., Kedir, J., Chen, D., Deblais, L., French, N., Gebreyes, W. A., Hassen, J. Y., Li, X., Manary, M. J., Mekuria, Z., Ibrahim, A. M., Mummed, B., Ojeda, A., Rajashekara, G., Roba, K. T., Saleem, C., Singh, N., Usmane, I. A., Yang, Y., Yimer, G., McKune, S.
BMJ Open, 5.10.2022
Tilføjet 5.10.2022
Introduction
Undernutrition is an underlying cause of mortality in children under five (CU5) years of age. Animal-source foods have been shown to decrease malnutrition in CU5. Livestock are important reservoirs for Campylobacter bacteria, which are recognised as risk factors for child malnutrition. Increasing livestock production may be beneficial for improving nutrition of children but these benefits may be negated by increased exposure to Campylobacter and research is needed to evaluate the complex pathways of Campylobacter exposure and infection applicable to low-income and middle-income countries. We aim to identify reservoirs of infection with Campylobacter spp. of infants in rural Eastern Ethiopia and evaluate interactions with child health (environmental enteric dysfunction and stunting) in the context of their sociodemographic environment.
Methods and analysis
This longitudinal study involves 115 infants who are followed from birth to 12 months of age and are selected randomly from 10 kebeles of Haramaya woreda, East Hararghe zone, Oromia region, Ethiopia. Questionnaire-based information is obtained on demographics, livelihoods, wealth, health, nutrition and women empowerment; animal ownership/management and diseases; and water, sanitation and hygiene. Faecal samples are collected from infants, mothers, siblings and livestock, drinking water and soil. These samples are analysed by a range of phenotypic and genotypic microbiological methods to characterise the genetic structure of the Campylobacter population in each of these reservoirs, which will support inference about the main sources of exposure for infants.
Ethics and dissemination
Ethical approval was obtained from the University of Florida Internal Review Board (IRB201903141), the Haramaya University Institutional Health Research Ethics Committee (COHMS/1010/3796/20) and the Ethiopia National Research Ethics Review Committee (SM/14.1/1059/20). Written informed consent is obtained from all participating households. Research findings will be disseminated to stakeholders through conferences and peer-reviewed journals and through the Feed the Future Innovation Lab for Livestock Systems.
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Debellut, F., Tang, K., Clark, A., Pecenka, C., Assao, B., Guindo, O., Grais, R. F., Isanaka, S.
BMJ Open, 5.10.2022
Tilføjet 5.10.2022
Objectives
To evaluate the cost-effectiveness of alternative rotavirus vaccines in Niger, using UNIVAC, a proportionate outcomes model.
Setting
The study leverages global, regional and local data to inform cost-effectiveness modelling. Local data were collected as part of a clinical trial taking place in the Madarounfa district, Maradi region, Niger.
Participants
The study models impact of infants vaccination on rotavirus gastroenteritis in children under 5 years of age.
Interventions
We compared the use of ROTARIX (GlaxoSmithKline, Belgium), ROTAVAC (Bharat Biotech, India) and ROTASIIL (Serum Institute, India) to no vaccination and to each other over a 10-year period starting in 2021.
Results
We estimated that ROTARIX, ROTAVAC and ROTASIIL would each prevent 13 million cases and 20 000 deaths of children under 5 years over a 10-year period in Niger. Compared with no vaccination, the cost to avert a disability-adjusted life-year was US$146 with ROTARIX, US$107 with ROTASIIL and US$76 with ROTAVAC from the government perspective. ROTAVAC dominated ROTARIX and ROTASIIL (eg, provided similar or higher benefits at a lower cost) and had 90% chance to be cost-effective at a US$100 willingness-to-pay threshold.
Conclusions
This study can inform decision-making around rotavirus vaccination policy in Niger, demonstrating that ROTAVAC is likely the most cost-effective option. Alternative products (ROTASIIL and ROTARIX) may also be considered by decision-makers if they are priced more competitively, or if their cold chain requirements could bring additional economic benefits.
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Sakr, F., Toufaili, Z., Akiki, Z., Akel, M., Malaeb, D., Dabbous, M., Salameh, P.
BMJ Open, 5.10.2022
Tilføjet 5.10.2022
Objectives
This study investigated parental knowledge, attitudes and practices towards fever in preschool children to help address gaps in public health and provide information with the aim of supporting clinical reports for parental education.
Design
A cross-sectional study design was used to explore parental experiences with fever.
Setting
Participants were recruited randomly from schools all over Lebanon targeting the preschool divisions.
Participants
Parents of children aged 5 years or less.
Interventions
An electronic self-administered questionnaire was sent to the parents through the schools’ emails and e-learning mobile applications.
Primary and secondary outcomes
The primary outcome measure was to assess parental knowledge about the precise definition of fever, correct use of medications and to evaluate the impact of sociodemographic factors on this knowledge. The secondary outcome measures were to assess parental attitudes and practices of fever management, sources of information and reasons to seek primary medical attention.
Results
A total of 733 parents were included in the study. Only 44% identified fever correctly according to the recognised definition by international guidelines. A significant association between parents’ knowledge of antibiotics and years of parenting experience was found (adjusted OR, ORa=4.23, 95% CI 1.41 to 12.68, p=0.01). Other sociodemographic factors that were significantly associated with parents’ knowledge of antibiotics were age (ORa=3.42, 95% CI 1.09 to 10.73, p=0.036) and education level (ORa=7.99, 95% CI 3.71 to 17.23, p<0.001). Greater than 75% usually give their children antipyretics without consulting a doctor. Approximately one-quarter of parents (26.3%) consulted different doctors at the same time, of which more than half (58.4%) had received different medical information.
Conclusions
This research determines deficiencies in parents’ knowledge of fever with some malpractices in its management particularly regarding antipyretic use. It provides insight for healthcare providers to empower parental experiences by offering the necessary information to enhance general outcomes of febrile sickness.
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Seid, A. A., Aychiluhm, S. B., Mohammed, A. A.
BMJ Open, 5.10.2022
Tilføjet 5.10.2022
Objectives
To determine the pooled effectiveness and feasibility of telerehabilitation in patients with COVID-19.
Design
Systematic review and meta-analysis of randomised controlled trials (RCTs).
Data sources
PubMed, CINAHL, Science Direct, PEDro, Google Scholar and Cochrane Library databases were systematically searched to the end of March 2022.
Eligibility criteria and outcomes
RCTs investigating the effects of telerehabilitation in the management of patients with COVID-19 were included. The outcomes of interest were functional capacity, cardiopulmonary exercise tests, quality of life and other variables where data are available.
Data extraction and synthesis
Two reviewers screened, extracted data and performed methodological quality assessment independently. The revised Cochrane Risk of Bias tool was used to assess the risk of bias. Review Manager V.5.4 and Stata V.14.0 software were used for statistical analysis. Mean difference (MD) with 95% CI and the corresponding p value were used to determine the treatment effect between groups. A fixed-effect model was used for all variables as no significant heterogeneity was observed.
Results
Four studies with 334 patients with COVID-19 were included. The pooled result of telerehabilitation showed statistically significant improvement on 6-minute walking test (MD 75.50; 95% CI 54.69 to 96.30; p=0.48), 30-second sit-to-stand test (MD 1.76; 95% CI 1.47 to 2.04; p=0.30), Borg Scale (MD 2.49; 95% CI 2.16 to 2.83; p=0.28) and level of dyspnoea (MD 6.26; 95% CI 5.42 to 7.10; p=0.66). The overall treatment completion rate was 88.46%, and the most common reason for withdrawal after randomisation was lost to follow-up or uncooperativeness.
Conclusions
The findings showed that telerehabilitation interventions could improve functional capacity and exercise perception among patients affected by COVID-19 and can be implemented with a high completion rate and minimal adverse events. However, more studies are required to investigate the effects on cardiopulmonary function, quality of life, anxiety, depression and other variables.
PROSPERO registration number
CRD42021287975.
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Harrigan, S. P., Tsang, V. W. L., Yassi, A., Zungu, M., Spiegel, J. M.
BMJ Open, 5.10.2022
Tilføjet 5.10.2022
Objectives
To assess the extent to which protection of healthcare workers (HCWs) as COVID-19 emerged was associated with economic inequality among and within countries.
Design
Cross-sectional analysis of associations of perceptions of workplace risk acceptability and mitigation measure adequacy with indicators of respondents’ respective country’s economic income level (World Bank assessment) and degree of within-country inequality (Gini index).
Setting
A global self-administered online survey.
Participants
4977 HCWs and healthcare delivery stakeholders from 161 countries responded to health and safety risk questions and a subset of 4076 (81.2%) answered mitigation measure questions. The majority (65%) of study participants were female.
Results
While the levels of risk being experienced at the pandemic’s onset were consistently deemed as unacceptable across all groupings, participants from countries with less income inequality were somewhat less likely to report unacceptable levels of risk to HCWs regarding both workplace environment (OR=0.92, p=0.012) and workplace organisational factors (OR=0.93, p=0.017) compared with counterparts in more unequal national settings. In contrast, considerable variation existed in the degree to which mitigation measures were considered adequate. Adjusting for other influences through a logistic regression analysis, respondents from lower middle-income and low-income countries were comparatively much more likely to assess both occupational health and safety (OR=10.91, p≤0.001) and infection prevention and control (IPC) (OR=6.61, p=0.001) protection measures as inadequate, despite much higher COVID-19 rates in wealthier countries at the time of the survey. Greater within-country income inequality was also associated with perceptions of less adequate IPC measures (OR=0.94, p=0.025). These associations remained significant when accounting for country-level differences in occupational and gender composition of respondents, including specifically when only female care providers, our study’s largest and most at-risk subpopulation, were examined.
Conclusions
Economic inequality threatens resilience of health systems that rely on health workers working safely to provide needed care during emerging pandemics.
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Hailu Tesfaye, A., Alemayehu, M., Abere, G., Kabito, G. G.
BMJ Open, 5.10.2022
Tilføjet 5.10.2022
Objective
This study was conducted to assess the prevalence and risk factors of poor sleep quality (SQ) among the academic staff at the University of Gondar, Northwestern Ethiopia.
Design
An institution-based cross-sectional study was conducted from March to April 2021. A validated, self-administered, standardised Pittsburgh Sleep Quality Index (PSQI) was used to quantify the amount of self-reported poor SQ. The collected data were entered into EpiData V.4.6 and analysed using Stata V.14 software. Binary logistic regressions were computed to determine the association between variables. The association was determined using an adjusted OR (AOR) with a 95% CI at a p value of <0.05.
Setting
The study was conducted at the University of Gondar, Northwestern Ethiopia.
Participants
A total of 607 lecturers participated in this study.
Outcome measures
The primary outcome is the prevalence of poor SQ, which was measured using the PSQI.
Results
Overall response rate was 95.60% (N=607). The age of the participants ranges from 21 to 70 with a mean of 32.39 (SD±6.80) years. The magnitude of poor SQ during the COVID-19 pandemic in the last month was 60.30% (95% CI (56.28% to 64.21%)). Working greater than 10 hours per day (AOR=2.19, 95% CI (1.16 to 4.27)), electronic device use before bedtime (AOR=1.53, 95% CI (1.04 to 2.27)), high-risk perception of COVID-19 infections (AOR=1.60, 95% CI (1.04 to 2.46)) and perceived job stress (AOR=2.15 (95% CI (1.50 to 3.08)) were risk factors for poor SQ.
Conclusion
The study revealed that the prevalence of poor SQ was high during the COVID-19 pandemic. The finding highlights the importance of optimising the working hours per day, minimising electronic device use before bedtime, promoting risk perception toward COVID-19 infection and developing workplace coping strategies for stress, which play a substantial role in minimising poor SQ.
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Evelina Tacconelli, Marc Mendelson, Elena Carrara
Lancet Infectious Diseases, 5.10.2022
Tilføjet 5.10.2022
Evidence from the past 20 years has made us confident that antibiotic stewardship interventions should be considered the gold standard for patient care, being safe and effective in improving the quality of antibiotic prescribing.1 However, how to successfully translate evidence for antibiotic stewardship interventions to implementation into practice still requires research.2
Læs mere Tjek på PubMedAna Estela Gamiño-Arroyo, Paola Del Carmen Guerra de Blas
Lancet Infectious Diseases, 5.10.2022
Tilføjet 5.10.2022
Worldwide, influenza virus accounts for 7% of all acute lower respiratory tract infections, and 4% of deaths due to acute lower respiratory tract infections in children younger than 5 years.1 In The Lancet Infectious Diseases, Annette K Regan and colleagues2 report the results of an interesting multicentre, multicountry, surveillance study aiming to assess whether influenza vaccination is associated with illness attenuation. The study involved 41 sentinel sites across four countries in South America as part of REVELAC-i (Red para la Evaluación de Vacunas En Latino América y el Caribe—influenza), a network that annually evaluates influenza vaccine effectiveness using a test-negative design.
Læs mere Tjek på PubMedMartin J Llewelyn, Eric P Budgell, Magda Laskawiec-Szkonter, Elizabeth L A Cross, Rebecca Alexander, Stuart Bond, Phil Coles, Geraldine Conlon-Bingham, Samantha Dymond, Morgan Evans, Rosemary Fok, Kevin J Frost, Veronica Garcia-Arias, Stephen Glass, Cairine Gormley, Katherine Gray, Clare Hamson, David Harvey, Tim Hills, Shabnam Iyer, Alison Johnson, Nicola Jones, Parmjit Kang, Gloria Kiapi, Damien Mack, Charlotte Makanga, Damian Mawer, Bernie McCullagh, Mariyam Mirfenderesky, Ruth McEwen, Sath Nag, Aaron Nagar, John Northfield, Jean O'Driscoll, Amanda Pegden, Robert Porter, Neil Powell, David Price, Elizabeth Sheridan, Mandy Slatter, Bruce Stewart, Cassandra Watson, Immo Weichert, Katy Sivyer, Sarah Wordsworth, Jack Quaddy, Marta Santillo, Adele Krusche, Laurence S J Roope, Fiona Mowbray, Kieran S Hand, Melissa Dobson, Derrick W Crook, Louella Vaughan, Susan Hopkins, Lucy Yardley, Timothy E A Peto, Ann Sarah Walker
Lancet Infectious Diseases, 5.10.2022
Tilføjet 5.10.2022
The antibiotic review kit intervention resulted in sustained reductions in antibiotic use among adult acute general medical inpatients. The weak, inconsistent intervention effects on mortality are probably explained by the onset of the COVID-19 pandemic. Hospitals should use the antibiotic review kit to reduce antibiotic overuse.
Læs mere Tjek på PubMedAnnette K Regan, Carmen Sofia Arriola, Paula Couto, Lindsey Duca, Sergio Loayza, Francisco Nogareda, Walquiria Aparecida Ferreira de Almeida, Julian Antman, Soraya Araya, Marcela Alejandra Avendaño Vigueras, Silvia Carolina Battaglia Paredes, Ivan Fedor Brstilo, Patricia Bustos, Maria Eugenia Fandiño, Rodrigo Fasce, Carlos Maria Giovacchini, Cecilia Isaura González Caro, Marta von Horoch, Maria del Valle Juarez, Nathalia Katz, Maria Fernanda Olivares, Daiana Araújo da Silva, Erica Tatiane da Silva, Viviana Sotomayor, Natalia Vergara, Eduardo Azziz-Baumgartner, Alba Maria Ropero
Lancet Infectious Diseases, 5.10.2022
Tilføjet 5.10.2022
Influenza vaccination was associated with illness attenuation among those hospitalised with influenza, although results differed by vaccine target group. These findings might suggest that attenuation of disease severity might be specific to certain target groups, seasons, or settings.
Læs mere Tjek på PubMedHuiling Tan, Xin Wang, Kaiyou Ye, Jianmin Lin, E. Song, Lihua Gong
PLoS One Infectious Diseases, 4.10.2022
Tilføjet 4.10.2022
by Huiling Tan, Xin Wang, Kaiyou Ye, Jianmin Lin, E. Song, Lihua Gong
Background To investigate the prevalence and risk factors of diabetic retinopathy (DR) in a Chinese population with type 2 diabetes mellitus (T2DM) in a suburb (Qingpu) of Shanghai, China. Methods A population-based cross-sectional study. A total of 7462 residents with T2DM in Qingpu were enrolled according to the resident health archives from January 2020 to December 2020. Blood and urine samples of the subjects were collected. Disc- and macula-centred retinal images were taken to assess DR. SPSS was used to analyse and investigate the prevalence and risk factors of DR. Results The fundus images of 6380 (85.5%) subjects were of sufficiently good quality for grading. The average (range) age of 6380 subjects was 63.46±7.77 (28–92) years. Six hundred forty-four subjects were diagnosed with DR. The prevalence of DR was 10.1% (95% CI 9.4%-10.8%), with mild, moderate, and severe non-proliferative retinopathy and proliferative retinopathy being 2.1%, 6.3%, 1.3% and 0.4%, respectively. The prevalence of bilateral DR was 6.5%. Higher T2DM duration (OR, 1.057), fasting plasma glucose (OR, 1.063), glycated hemoglobinA1c (OR, 1.269), urea nitrogen (OR, 1.059), and urinary albumin (OR, 1.001) were associated with the higher DR prevalence. Conclusion The prevalence of DR among Chinese adults with T2DM in Qingpu was 10.1%, in which non-proliferative DR was more common. Higher fasting plasma glucose and glycated hemoglobinA1c are well-known risk factors of DR, consistent with the findings in our study. Our study didn’t find the risk between lipid indicators and DR. However, several renal function indicators, like higher urea nitrogen and urinary albumin, were risk factors for DR in this study. Appropriate diagnosis and intervention should be taken in time to prevent and control DR development.
Læs mere Tjek på PubMedGideon Awenabisa Atanuriba, Felix Apiribu, Veronica Millicent Dzomeku, Philemon Adoliwine Amooba, Adwoa Bemah Boamah Mensah, Richard Adongo Afaya, Timothy Gazari, Timothy Tienbia Laari, Moses Haruna Akor, Linda Abnory
PLoS One Infectious Diseases, 4.10.2022
Tilføjet 4.10.2022
by Gideon Awenabisa Atanuriba, Felix Apiribu, Veronica Millicent Dzomeku, Philemon Adoliwine Amooba, Adwoa Bemah Boamah Mensah, Richard Adongo Afaya, Timothy Gazari, Timothy Tienbia Laari, Moses Haruna Akor, Linda Abnory
Background HIV/AIDS is now a chronic disease, as adherence to anti-retrovirals impacts positively on the quality as well as expectancy of life. However, there exist multifaceted barriers to treatments for which children are most disadvantaged. Since Ghana subscribed to the “treat all” policy less percentage (25.5%) of children (2–14 years) living with HIV/AIDS have been enrolled on the antiretroviral program compared to other categories of the population by 2019. At present no study has explored these barriers to children living with HIV/AIDS enrollment and adherence. This study aims to explore the perceived barriers of caregivers of children living with HIV/AIDS in the Tamale Metropolis. Methods We used descriptive phenomenology to explore the phenomena. Caregivers were purposively selected and interviewed till information became repetitive at the ninth (9th) caregiver. A semi-structured interview guide was used to collect data through face-to-face in-depth interviews which were audio recorded. The interviews lasted an average of 47 minutes. Audio interviews were transcribed verbatim (English) and translated back-to-back (Daghani) before analysis was done manually according to Collaizi’s seven-step approach. We used the Guba and Lincoln guidelines to ensure the rigour of the study and its findings. Results are presented in themes and supported with quotes. Results Six themes emerged from the analysis of the caregivers’ transcripts; (1) denial of HIV/AID diagnosis, (2) stock-outs and privacy at the clinic, (3) busy schedule and poor support, (4) ignorance and alternative herbal cure, (5) stigma and discrimination, (6) transportation and distance. Conclusion Perceived barriers are multi-dimensional and encountered by all PLWHA, especially children. These barriers could derail the gains of HIV/AIDS interventions among children. Adherence counselling among caregivers alongside campaigns among faith and herbal healers are of grave concern to reduce myths of cure.
Læs mere Tjek på PubMedTejasri Chandrabhatla, Henok Asgedom, Zehra P. Gaudiano, Leyla de Avila, Kenneth L. Roach, Chapy Venkatesan, Ali A. Weinstein, Zobair M. Younossi
PLoS One Infectious Diseases, 4.10.2022
Tilføjet 4.10.2022
by Tejasri Chandrabhatla, Henok Asgedom, Zehra P. Gaudiano, Leyla de Avila, Kenneth L. Roach, Chapy Venkatesan, Ali A. Weinstein, Zobair M. Younossi
Background The increasing number of physicians leaving practice, especially hospitalists, has been well-documented. The most commonly examined factor associated with this exodus has been burnout. The COVID-19 pandemic has put a unique and unprecedented stress on hospitalists who have been at the front lines of patient care. Therefore, the investigation of burnout and its related factors in hospitalists is essential to preventing future physician shortages. Objective This study examined the relationship between burnout, second victim, and moral injury experiences before and during the COVID-19 pandemic among hospitalists. Methods Two anonymous cross-sectional surveys of hospitalists from a community hospital in the metropolitan Washington, DC area were conducted. One was conducted pre-COVID-19 (September-November 2019) and one was conducted during COVID-19 (July-August 2020). The surveys were sent to all full-time hospitalists via an online survey platform. A variety of areas were assessed including demographic (e.g., age, gender), work information (e.g., hours per week, years of experience), burnout, second victim experiences, well-being, and moral injury. Results Burnout rates among providers during these two time periods were similar. Second victim experiences remained prevalent in those who experienced burnout both pre and during COVID-19, but interestingly the prevalence increased in those without burnout during COVID-19. Moral injury was predictive of burnout during COVID-19. Conclusion While there were some factors that predicted burnout that were similar both pre- and during-pandemic, moral injury was unique to predicting burnout during COVID-19. With burnout as a contributing factor to future physician shortages, it is imperative that predictive factors in a variety of different environments are well understood to prevent future shortages. Hospitalists may be an excellent barometer of these factors given their presence on the front line during the pandemic, and their experiences need to be further explored so that targeted interventions aimed at addressing those factors may be created.
Læs mere Tjek på PubMedFatemeh Aliverdi, Zahra Bayat Jozani, Nooshin Ghavidel, Mostafa Qorbani, Nami Mohammadian Khonsari, Farima Mohamadi, Minoo Mohraz, Zohreh Mahmoodi
PLoS One Infectious Diseases, 4.10.2022
Tilføjet 4.10.2022
by Fatemeh Aliverdi, Zahra Bayat Jozani, Nooshin Ghavidel, Mostafa Qorbani, Nami Mohammadian Khonsari, Farima Mohamadi, Minoo Mohraz, Zohreh Mahmoodi
Introduction The COVID-19 pandemic and its consequences have caused fear and anxiety worldwide and imposed a significant physical and psychological burden on people, especially women living with HIV (WLHIV). However, WLHIV were not studied as well as others during the pandemic. Hence, this study aimed to determine the relationships between COVID-19 phobia, health anxiety, and social relations in WLHIV. Materials and methods This cross-sectional study enrolled 300 WLHIV who had records at the Iranian Research Center for HIV/AIDS of Tehran University of Medical Sciences. Data were collected using sociodemographic questionnaire, the fear of COVID-19 scale, the social relations questionnaire, the socioeconomic status scale and the health anxiety inventory. Path-analysis was used to assess the direct and indirct associations between variables. Results Based on the path analysis, among variables that had significant causal relationships with social relations, socioeconomic status (β = -0.14) showed the greatest negative relationship, and health anxiety (β = 0.11) had the strongest positive relationship on the direct path. On the indirect path, fear of COVID-19 (β = 0.049) displayed the greatest positive relationship. The level of education (β = 0.29) was the only variable showing a significant positive relationship with social relations on both direct and indirect paths. Conclusion Our result showed that increased fear and health anxiety related to a higher social relations score in WLHIV. Hence, due to their vulnerability, these people require more support and education to adhere to health protocols in future pandemics and similar situations.
Læs mere Tjek på PubMedVictor Márquez-Alvarez, Joaquín Amigó-Vega, Aramis Rivera, Alfo José Batista-Leyva, Ernesto Altshuler
PLoS One Infectious Diseases, 4.10.2022
Tilføjet 4.10.2022
by Victor Márquez-Alvarez, Joaquín Amigó-Vega, Aramis Rivera, Alfo José Batista-Leyva, Ernesto Altshuler
During the COVID-19 pandemic, the relevance of evaluating the effectiveness of face masks–especially those made at home using a variety of materials–has become obvious. However, quantifying mask protection often requires sophisticated equipment. Using a frugal stain technique, here we quantify the “ballistic” droplets reaching a receptor from a jet-emitting source which mimics a coughing, sneezing or talking human–in real life, such droplets may host active SARS-CoV-2 virus able to replicate in the nasopharynx. We demonstrate that materials often used in home-made face masks block most of the droplets. Mimicking situations eventually found in daily life, we also show quantitatively that less liquid carried by ballistic droplets reaches a receptor when a blocking material is deployed near the source than when located near the receptor, which supports the paradigm that your face mask does protect you, but protects others even better than you. Finally, the blocking behavior can be quantitatively explained by a simple mechanical model.
Læs mere Tjek på PubMedTeija Lund, Dietrich Schlenzka, Martina Lohman, Leena Ristolainen, Hannu Kautiainen, Erkko Klemetti, Kalevi Österman
PLoS One Infectious Diseases, 4.10.2022
Tilføjet 4.10.2022
by Teija Lund, Dietrich Schlenzka, Martina Lohman, Leena Ristolainen, Hannu Kautiainen, Erkko Klemetti, Kalevi Österman
Life-time prevalence of low back pain (LBP) in children and adolescents varies from 7% to 72%. Disc changes on magnetic resonance imaging (MRI) have been reported in up to 44% of children with earliest observations around pre-puberty. In this longitudinal cohort study, our objective was to determine the natural history of disc changes from childhood to early adulthood, and the possible association of these changes to LBP. Healthy 8-year-old schoolchildren were recruited for this longitudinal study consisting of a semi-structured interview, a clinical examination, and an MRI investigation at the age of 8–9 (Y8), 11–12 (Y12) and 18–19 (Y19) years. The interview inquired about LBP without trauma. T2-weighted sagittal MRI of the lumbar spine was acquired. Life-long prevalence of LBP was determined, and the disc signal intensity (SI) at the three lowest lumbar levels was assessed both visually using the Schneiderman classification (Bright-Speckled-Dark), and digitally using the disc to cerebrospinal fluid -SI ratio. Possible associations between SI changes and LBP were analyzed. Ninety-four of 208 eligible children were included at Y8 in 1994, 13 and 23 participants were lost to follow-up at Y12 and Y19, respectively. Prevalence of LBP increased after the pubertal growth spurt reaching 54% at Y19. On MRI, 18%, 10% and 38% of participants had disc SI changes at Y8, Y12 and Y19, respectively. No significant associations between self-reported LBP and either qualitative or quantitative disc SI changes were observed at any age. Life-time prevalence of LBP reached 54% by early adulthood. Disc SI changes on MRI traditionally labeled as degenerative were seen earlier than previously reported. Changes in disc SI were not associated with the presence of LBP in childhood, adolescence or early adulthood.
Læs mere Tjek på PubMedSachi O’Hoski, Ayse Kuspinar, Joshua Wald, Julie Richardson, Roger Goldstein, Marla K. Beauchamp
PLoS One Infectious Diseases, 4.10.2022
Tilføjet 4.10.2022
by Sachi O’Hoski, Ayse Kuspinar, Joshua Wald, Julie Richardson, Roger Goldstein, Marla K. Beauchamp
Background Participation restriction has detrimental effects for older adults but it is unknown how participation differs for people with chronic obstructive pulmonary disease (COPD) compared to older adults of the same age without respiratory conditions. We compared scores on the Late Life Disability Instrument (LLDI) between people with COPD (study group) and a random sample of older adults (control group). Methods Participants with COPD (study group) were recruited from two hospitals in Ontario and age- and sex-matched with a ratio of 1:2 with participants from a random sample of community-dwelling older adults who did not report having respiratory conditions (control group). The study group completed the LLDI prior to the COVID-19 pandemic and the control group completed the LLDI at the end of the first wave of the pandemic. LLDI frequency and limitation scores were compared between groups using Wilcoxon rank-sum tests. Results Forty-six study group participants (mean age 74.2 (SD 5.5) years) and 92 control group participants (mean age 74.4 (SD 5.4) years) were included. Fifty-four percent of the participants were female. The majority of the study group had severe COPD (median forced expiratory volume in one second of 34.5 (25th-75th percentile 27.0–56.0) % predicted). LLDI sores were lower for the study group compared to the control group for both the frequency (median difference -5.4 points, p<0.001) and limitation (median difference -7.6 points, p<0.001) domains. The personal subscale demonstrated the largest magnitude of difference between groups (median difference -13.4 points) and the social subscale demonstrated the smallest magnitude of difference (-5.2 points). Conclusion People with COPD had greater participation restrictions than a random sample of older adults without ongoing respiratory conditions. The differences seen in participation between the two groups may have been reduced due to temporal confounding from the COVID-19 pandemic. While participation is relevant to all older adults, our results suggest that it is especially important that it be assessed in those with COPD.
Læs mere Tjek på PubMedTsegaye Sewunet, Sriram K. K., Ha Hoang Nguyen, Noikaseumsy Sithivong, Ngoc Thi Bich Hoang, Vanphanom Sychareun, Kokasia Nengmongvang, Mattias Larsson, Linus Olson, Fredrik Westerlund, Christian G. Giske
PLoS One Infectious Diseases, 4.10.2022
Tilføjet 4.10.2022
by Tsegaye Sewunet, Sriram K. K., Ha Hoang Nguyen, Noikaseumsy Sithivong, Ngoc Thi Bich Hoang, Vanphanom Sychareun, Kokasia Nengmongvang, Mattias Larsson, Linus Olson, Fredrik Westerlund, Christian G. Giske
Objectives Carbapenemase-producing Enterobacterales (CPE) are high priority targets of global antimicrobial surveillance. Herein, we determined the colonization rate of CPE on admission to intensive care units in Vientiane, Lao PDR in August-September 2019. Methods Data regarding clinical conditions, infection control, and antibiotic usage were collected during admission. Rectal swab samples (n = 137) collected during admission were inoculated to selective chromogenic agars, followed by confirmatory tests for extended-spectrum beta-lactamases and carbapenemases. All CPE isolates were sequenced on Illumina (HiSeq2500), reads assembled using SPAdes 3.13, and the draft genomes used to query a database (https://www.genomicepidemiology.org) for resistome, plasmid replicons, and sequence types (ST). Optical DNA mapping (ODM) was used to characterize plasmids and to determine location of resistance genes. Minimum spanning tree was generated using the Bacterial Isolate Genome Sequence database (BIGSdb) and annotated using iTOL. Result From 47 Enterobacterales isolated on selective agars, K. pneumoniae (25/47) and E. coli (12/47) were the most prevalent species, followed by K aerogenes (2/47), K. variicola (1/47), and K. oxytoca (1/47). The overall prevalence of ESBLs was 51.0%; E. coli 83.3% (10/12) and Klebsiella spp. 41.3% (12/29). Twenty percent of the K. pneumoniae (5/25) isolates were carbapenem-resistant, and 4/5 contained the blaNDM-1 gene. All blaNDM-1 isolates belonged to ST147 and were indistinguishable with cgMLST. ODM showed that the blaNDM-1 gene was located on identical plasmids in all isolates. Conclusion The prevalence of ESBL-producing Enterobacterales was high, while carbapenemases were less common. However, the detection of clonal dissemination of blaNDM-1-producing K. pneumoniae isolates in one of the intensive care units calls for vigilance. Stringent infection prevention and antimicrobial stewardship strategies are highly important measures.
Læs mere Tjek på PubMedTadesse Awoke Ayele, Tesfa Sewunet Alamneh, Habtewold Shibru, Malede Mequanent Sisay, Tesfahun Melese Yilma, Melkitu Fentie Melak, Telake Azale Bisetegn, Tariku Belachew, Mahteme Haile, Taye Zeru, Mezgebu Selamsew Asres, Kegnie Shitu
PLoS One Infectious Diseases, 4.10.2022
Tilføjet 4.10.2022
by Tadesse Awoke Ayele, Tesfa Sewunet Alamneh, Habtewold Shibru, Malede Mequanent Sisay, Tesfahun Melese Yilma, Melkitu Fentie Melak, Telake Azale Bisetegn, Tariku Belachew, Mahteme Haile, Taye Zeru, Mezgebu Selamsew Asres, Kegnie Shitu
Background COVID-19 had affected the health-care-seeking behavior of people with chronic medical conditions. The impact is even worse in resource-limited settings like Ethiopia. Therefore, this study was aimed to assess the extent and correlates of missed appointments among adults with chronic disease conditions before and during the COVID-19 pandemic in the Northwest Ethiopia. Methods A retrospective chart review and cross-sectional survey were conducted from December 2020 to February 2021. A total of 1833 patients with common chronic disease were included by using a stratified systematic random sampling technique. Web-based data collection was done using Kobo collect. The data were explored using descriptive statistical techniques, the rate of missed appointments s before and during the COVID-19 pandemic was determined. A negative binomial regression model was fitted to identify the factors of missed appointment. An incidence rate ratio with its 95% confidence interval (CI) and p-value of the final model were reported. Results The rate of missed appointments was 12.5% (95% CI: 11.13%, 14.20%) before the pandemic, increased to 26.8% (95% CI: 24.73%, 28.82%) during the pandemic (p-value < 0.001). Fear of COVID-19 infection and lack of transport was the most common reasons for missing appointments. Older patients (Adjusted Incidence Rate Ratio (AIRR) = 1.01, 95% CI: 1.001; 1.015), having treatment follow up more than 5 years (AIRR = 1.36, 95%CI: 1.103; 1.69), shorter frequency of follow-up (AIRR = 2.22, 95% CI: 1.63; 2.49), covering expense out of pocket (AIRR = 2.26, 95%CI: 1.41; 2.95), having a sedentary lifestyle (AIRR = 1.36, 95%CI: 1.12; 1.71), and history of missed appointments before COVID-19 pandemic (AIRR = 4.27, 95%CI: 3.35; 5.43) were positively associated with the incidence of missed appointments. Conclusion The rate of missed appointment increased significantly during the COVID-19 pandemic. Older age, longer duration of follow up, more frequent follow-up, out-of-pocket expenditure for health service, history of poor follow-up, and sedentary lifestyle had positive relationship with missed appointments during the pandemic. Therefore, it is important to give special emphasis to individuals with these risk factors while designing and implementing policies and strategies for peoples with chronic diseases to ensure the continuity of care and to avoid the long-term impact on their health.
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