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Malaria Journal, 25.05.2022
Tilføjet 25.05.2022
Abstract
Building on an exercise that identified potential harms from simulated investigational releases of a population suppression gene drive for malaria vector control, a series of online workshops identified nine recommendations to advance future environmental risk assessment of gene drive applications.
Læs mere Tjek på PubMedPande, S. D., Roy, D., Khine, A. A., Win, M. M., Lolong, L., Shan, N. T., Tan, P. T., Tu, T. M.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Introduction
Patients who had a stroke are at increased risk of sepsis, dehydration and fluctuations in blood pressure, which may result in acute kidney injury (AKI). The impact of AKI on long-term stroke survival has not been studied well.
Objective
We aimed to identify incidence of AKI during acute stroke, follow-up period and its impact on long-term survival and development of chronic kidney disease (CKD).
Design, setting and participants
Retrospective analysis of patients who had a stroke admitted at the rehabilitation facility in Changi General Hospital, Singapore, between June 2008 and May 2017, with median follow-up of 141 (95% CI 120 to 163) months.
Outcome measures and results of univariate analysis
Total 681 patients, median age (63.6) years, 173 (28%) died during follow-up. Elevated blood urea (3.02, 95% CI 2.17 to 4.22; p≤0.001) and creatinine (1.96, 95% CI 1.50 to 2.57; p≤0.001) during stroke affected survival adversely.
Excluding patients with CKD, we analysed the remaining 617 patients. AKI was noted in 75 (12.15%) patients during the index admission, and it affected survival adversely (2.16, 95% CI 1.49 to 3.13; p<0.001). Of the patients with AKI, 21 of 75 (28%) progressed to CKD over a median follow-up of 40.7 months.
Conclusions
We found AKI during stroke admission was associated with increased mortality as compared with those without AKI on univariate analysis. AKI without need of renal replacement therapy was also associated with progression to CKD in this cohort. This suggests that patients with AKI need to have their renal function monitored longitudinally for development of CKD.
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Hill, K., McCabe, C., Brenner, M.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Introduction
The emergence of COVID-19 has had a significant impact on hospital services, particularly care delivered to those in intensive care units (ICUs) and paediatric ICUs (PICUs) across the world. Although much has been written about healthcare delivery and the healthcare setting since COVID-19 began, to the authors’ knowledge, this is the first scoping review to investigate the organisation of care and changes implemented in PICUs during the COVID-19 pandemic. The aim is to conduct a scoping review of the literature to map out the existing studies about care delivery in PICUs during the COVID-19 pandemic and the changes made to the organisation of care in these units during the first 18 months of the pandemic. This review will also identify gaps in current knowledge in this area.
Methods and analysis
This study will be guided by the Joanna Briggs Institute’s methodology for scoping reviews, using Arksey and O’Malley’s six-stage scoping review framework: (1) identifying the research question; (2) identifying relevant studies; (3) selecting the studies; (4) data charting; (5) collating, summarising and reporting results; and (6) consulting with experts. A comprehensive search will be conducted using the following databases: CINAHL Complete; MEDLINE; PsycINFO; PsycARTICLES and EMBASE. A search strategy with predefined inclusion and exclusion criteria will be used to uncover relevant research in this area. This study will include quantitative, qualitative and mixed research methods studies published in English from 2019 to May 2021.
Ethics and dissemination
Ethical approval is not required for this scoping review. The results from this study will be disseminated through conferences and in peer-reviewed academic journals for those working in the healthcare arena.
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Lane, S., Yeomans, A., Shakir, S.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Objectives
To combine spontaneously reported data from multiple countries to estimate reporting rate, and better understand risk factors for myocarditis and pericarditis following COVID-19 messenger RNA (mRNA) vaccines.
Design
Systematic review of spontaneously reported data from UK, USA and European Union/European Economic Area (EU/EEA) and of the scientific literature.
Data sources
UK Yellow Card scheme, Vaccine Adverse Event Reporting System (VAERS), EudraVigilance were searched from date of vaccine launch to 14 March 2022–16 March 2022. PubMed/MEDLINE and Embase were searched to 15 March 2022.
Eligibility criteria
We included publicly available spontaneous reporting data for ‘Myocarditis’ and ‘Pericarditis’ from UK, USA and EU/EEA following COVID-19 mRNA vaccines. Pharmacoepidemiological observational studies investigating myocarditis/pericarditis following mRNA COVID-19 vaccines were included (no restrictions on language or date). Critical Appraisal Skills Programme tools assessed study quality.
Data extraction and synthesis
Two researchers extracted data. Events of myocarditis and pericarditis were presented for each data source, stratified by vaccine, age, sex and dose (where available). Reporting rates were calculated for myocarditis and pericarditis for each population. For published pharmacoepidemiological studies, design, participant characteristics, and study results were tabulated.
Results
Overall, 18 204 myocarditis and pericarditis events were submitted to the UK, USA and EU/EEA regulators during the study period. Males represented 62.24% (n=11 331) of myocarditis and pericarditis reports. In the UK and USA, most reports concerned vaccinees aged <40 years (59.7% and 47.3% of reported events, respectively); trends in age were less clear for EU/EEA. Reports were more frequent following a second dose (47.1% of reports, where data available). Reporting rates were consistent between the data sources. Thirty-two pharmacoepidemiological studies were included; results were consistent with our spontaneous report analyses.
Conclusions
Younger vaccinees more frequently report myocarditis and pericarditis following mRNA COVID-19 vaccines than older vaccinees. Results from published literature supported the results of our analyses.
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Armstrong-Hough, M., Ggita, J., Gupta, A. J., Shelby, T., Nangendo, J., Ayen, D. O., Davis, J. L., Katamba, A.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Introduction
HIV status awareness is important for household contacts of patients with tuberculosis (TB). Home HIV testing during TB contact investigation increases HIV status awareness. Social interactions during home visits may influence perceived stigma and uptake of HIV testing. We designed an intervention to normalise and facilitate uptake of home HIV testing with five components: guided selection of first tester; prosocial invitation scripts; opt-out framing; optional sharing of decisions to test; and masking of decisions not to test.
Methods and analysis
We will evaluate the intervention effect in a household-randomised controlled trial. The primary aim is to assess whether contacts offered HIV testing using the norming strategy will accept HIV testing more often than those offered testing using standard strategies. Approximately 198 households will be enrolled through three public health facilities in Kampala, Uganda. Households will be randomised to receive the norming or standard strategy and visited by a community health worker (CHW) assigned to that strategy. Eligible contacts ≥15 years will be offered optional, free, home HIV testing. The primary outcome, proportion of contacts accepting HIV testing, will be assessed by CHWs and analysed using an intention-to-treat approach. Secondary outcomes will be changes in perceived HIV stigma, changes in perceived TB stigma, effects of perceived HIV stigma on HIV test uptake, effects of perceived TB stigma on HIV test uptake and proportions of first-invited contacts who accept HIV testing. Results will inform new, scalable strategies for delivering HIV testing.
Ethics and dissemination
This study was approved by the Yale Human Investigation Committee (2000024852), Makerere University School of Public Health Institutional Review Board (661) and Uganda National Council on Science and Technology (HS2567). All participants, including patients and their household contacts, will provide verbal informed consent. Results will be submitted to a peer-reviewed journal and disseminated to national stakeholders, including policy-makers and representatives of affected communities.
Trial registration number
ClinicalTrials.gov Identifier: NCT05124665.
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Ziyad Al-Aly, Benjamin Bowe, Yan Xie
Nature, 25.05.2022
Tilføjet 25.05.2022
Nature Medicine, Published online: 25 May 2022; doi:10.1038/s41591-022-01840-0A new analysis using the US Department of Veterans Affairs national healthcare databases demonstrates that Long COVID can occur after breakthrough SARS-CoV-2 infection; however, the risk of death attributable to COVID and incidence of post-acute sequelae were substantially reduced (but not fully eliminated) compared to unvaccinated individuals.
Læs mere Tjek på PubMedSina A. Tegethoff, Guy Danziger, Dennis Kühn, Charlotte Kimmer, Thomas Adams, Lena Heintz, Carlos Metz, Katharina Reifenrath, Rebecca Angresius, Sebastian Mang, Torben Rixecker, André Becker, Jürgen Geisel, Christophe Jentgen, Frederik Seiler, Matthias C. Reichert, Franziska Fröhlich, Sascha Meyer, Jürgen Rissland, Sebastian Ewen, Gudrun Wagenpfeil, Katharina Last, Sigrun Smola, Robert Bals, Frank Lammert, Sören L. Becker, Marcin Krawczyk, Philipp M. Lepper, Cihan Papan
International Journal of Infectious Diseases, 25.05.2022
Tilføjet 25.05.2022
Katsuhiro Inoue, Keiji Muramatsu, Takehiro Nishimura, Yoshihisa Fujino, Shinya Matsuda, Kiyohide Fushimi, Masayuki Kamochi
International Journal of Infectious Diseases, 25.05.2022
Tilføjet 25.05.2022
The incidence of invasive pulmonary aspergillosis (IPA) among patients without immunocompromised host factors (ICHF) has been described extensively. However, its diagnosis remains challenging. To date, no study has statistically confirmed the efficacy of early IPA diagnosis in patients without ICHF.
Læs mere Tjek på PubMedBMC Infectious Diseases, 25.05.2022
Tilføjet 25.05.2022
Abstract
Background
Understanding the characteristics and natural history of novel pathogens is crucial to inform successful control measures. Japan was one of the first affected countries in the COVID-19 pandemic reporting their first case on 14 January 2020. Interventions including airport screening, contact tracing, and cluster investigations were quickly implemented. Here we present insights from the first 3 months of the epidemic in Japan based on detailed case data.
Methods
We conducted descriptive analyses based on information systematically extracted from individual case reports from 13 January to 31 March 2020 including patient demographics, date of report and symptom onset, symptom progression, travel history, and contact type. We analysed symptom progression and estimated the time-varying reproduction number, Rt, correcting for epidemic growth using an established Bayesian framework. Key delays and the age-specific probability of transmission were estimated using data on exposures and transmission pairs.
Results
The corrected fitted mean onset-to-reporting delay after the peak was 4 days (standard deviation: ± 2 days). Early transmission was driven primarily by returning travellers with Rt peaking at 2.4 (95% CrI: 1.6, 3.3) nationally. In the final week of the trusted period (16–23 March 2020), Rt accounting for importations diverged from overall Rt at 1.1 (95% CrI: 1.0, 1.2) compared to 1.5 (95% CrI: 1.3, 1.6), respectively. Household (39.0%) and workplace (11.6%) exposures were the most frequently reported potential source of infection. The estimated probability of transmission was assortative by age with individuals more likely to infect, and be infected by, contacts in a similar age group to them. Across all age groups, cases most frequently onset with cough, fever, and fatigue. There were no reported cases of patients < 20 years old developing pneumonia or severe respiratory symptoms.
Conclusions
Information collected in the early phases of an outbreak are important in characterising any novel pathogen. The availability of timely and detailed data and appropriate analyses is critical to estimate and understand a pathogen’s transmissibility, high-risk settings for transmission, and key symptoms. These insights can help to inform urgent response strategies.
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BMC Infectious Diseases, 24.05.2022
Tilføjet 25.05.2022
Abstract
Background
Increased and inappropriate antimicrobial use are the key drivers of the emergence of antimicrobial resistance, and there have been widespread concerns around potential antimicrobial misuse, overuse and their consequences during the COVID-19 pandemic. To better understand the impact of the pandemic on antimicrobial use, particularly in light of the resurgence of COVID-19 cases since the summer of 2020, we assessed trends in antimicrobial prescription fills and hospital requisitions in Sweden during 2020 against those of preceding years.
Methods
We performed a descriptive study using population-based data from the Swedish Prescribed Drug Register and the Swedish e-Health Agency. The weekly number of prescriptions filled and the total volume sold to inpatient care institutions in defined daily doses (DDDs) per 1000 inhabitants for systemic antibacterials (Anatomical Therapeutic Chemical therapeutic subgroup J01 excluding J01XX), antimycotics (J02), antivirals (J05) and antiprotozoals (P01) were computed and evaluated from time series graphs. A time series linear regression with ordinary least squares (OLS) estimation was used to model 2015–2019 data and predict the expected number of prescriptions filled and volumes sold in DDDs per 1000 inhabitants during 2020 with 95% confidence limits.
Results
From mid-March 2020, the weekly rate of antibiotic and antiprotozoal prescriptions filled plummeted to unprecedentedly low levels for the rest of the year; while unprecedentedly high numbers of antiviral prescriptions were filled weekly between mid-February and mid-March 2020. There was a net reduction in annual dispensing of antibiotics by 17%; of antiprotozoals by 21%; and of antivirals by 0.3% during 2020 compared to 2019. Inpatient care requisitions of antiprotozoals and antibiotics surged to 6-year highs during March 2020, resulting in a 127% increase in DDDs of antiprotozoals sold from 2019. The volume of antibiotics and antivirals sold to inpatient care institutions in 2020 decreased by 3% and 13% compared to 2019, respectively.
Conclusions
The overall decline in antimicrobial prescriptions filled in Sweden during 2020 were in part, collateral dividends of the COVID-19 pandemic.
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Infection, 24.05.2022
Tilføjet 25.05.2022
Abstract
Mycobacterium marinum is a nontuberculous mycobacterium responsible of infections in humans, ranging from skin infection to disseminated infection in immunocompromised hosts. Clinical suspicion and prompt diagnosis are crucial to prescribe appropriate antimycobacterial treatment and avoid sequelae.
Læs mere Tjek på PubMedMohammad Ali, Atia Sharmin Bonna, Abu-sufian Sarkar, Md. Ariful Islam, Nur-A- Safrina Rahman
International Journal of Infectious Diseases, 25.05.2022
Tilføjet 25.05.2022
Low back pain (LBP) is a widespread public health concern and the leading cause of disability worldwide (Hartvigsen et al., 2018). The monetary influence of LBP is inter-sectoral since it raises expenses in both healthcare and social support systems (Carregaro et al., 2020). A 2015 study revealed that 540 million people were affected by activity-limiting LBP at any one time, giving a global prevalence of 7.3% (Vos et al., 2016). In Bangladesh, the prevalence of LBP was 36.6% among sedentary office workers (Ali et al., 2020, 2021c).
Læs mere Tjek på PubMedGideon Loevinsohn, Mutinta Hamahuwa, Justin Hardick, Pamela Sinywimaanzi, Katherine Z. J. Fenstermacher, Passwell Munachoonga, Austin Weynand, Mwaka Monze, Yukari C. Manabe, Charlotte A. Gaydos, Richard E. Rothman, Andrew Pekosz, Philip E. Thuma, Edgar Simulundu, Catherine G. Sutcliffe
Tropical Medicine & International Health, 25.05.2022
Tilføjet 25.05.2022
Habib, A., Nausheen, S., Nooruddin, S., Javed, T., Samejo, T., Hussain, A., Namdev, S., Amirali, S., Umer, M., Sheikh, L., Hussain, I., Ariff, S., Soofi, S.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Introduction
The oral polio vaccine (OPV) has substantial results in eliminating wild poliovirus and the vaccine of choice in polio eradication. However, the mucosal immunity induced by the OPV is still uncertain. Literature has shown that bovine lactoferrin (BLF) is a safe and useful protein found in cow’s milk with extraordinary antimicrobial, antiviral, antiinflammatory and immune-modulatory functions that help children’s gut to fight against micro-organisms like poliovirus. However, limited data exist regarding the effect of BLF on polio vaccine immune response. The primary objective is to evaluate the effect of BLF in enhancing mucosal and humoral immunity in children following the administration of oral and inactivated polio vaccines.
Methods and analysis
This is a two-arm double-blinded randomised controlled trial comparing 462 neonates (231 in both groups) receiving either BLF or placebo with breast milk. The intervention is administered from day 1 till 6 weeks of age to a full-term healthy singleton newborn born at the Aga Khan University Hospitals, Karachi, Pakistan. The primary outcome is the seroconversion, 1 month after the receipt of two doses of OPV (at 10 weeks). For descriptive statistical analysis, Stata will be used, the frequency with percentages will be reported to describe baseline characteristics of the participants. A 2 test will be used to compare categorical variables and a simple t test to compare continuous variables. The proportion of seroconversion and shedding will be compared using 2 test or Fisher’s exact test.
Ethics and dissemination
The Ethics approval has been granted by the Ethics Review Committee (ERC) of Aga Khan University for the proposed trial (ID: 2019-1955-5013). Furthermore, the National Bioethics Committee (NBC) of Pakistan has also approved the study for human subject research (ID: 4–87/NBC-443/19/669). Study findings will be disseminated through presentations at scientific conferences and educational practice workshops and will be published in an international peer-reviewed scientific journal.
Trial registration number
NCT04432935; ClinicalTrials.gov.
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Sujarwoto, S., Maharani, A.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Objectives
This study aims to examine sociodemographic characteristics and health access associated with COVID-19 infection and death in Malang District, Indonesia.
Design
A non-random cross-sectional study.
Setting
Population in 390 villages in Malang District, East Java Province, Indonesia.
Participants
We used Malang District government COVID-19 contact tracing data from 14 264 individuals, spanning from 1 March 2020 to 29 July 2020.
Primary outcome measures
The outcome variables in this study are COVID-19 infections and COVID-19 deaths. The associations between sociodemographic characteristics and health access of COVID-19 infection and death were analysed using multilevel logistic regression.
Results
Among the 14 264 samples, 551 individuals were confirmed as being infected with COVID-19; 62 individuals died of COVID-19. Women, individuals with direct contact with confirmed COVID-19 cases and individuals with hypertension constituted the groups most vulnerable to COVID-19 infection. Among respondents with confirmed COVID-19 cases, men, individuals aged 61 years and older, individuals with hypertension, and those diagnosed with pneumonia and respiratory failure were at higher risk of death. The number of community-based healthcare interventions was significantly associated with lower COVID-19 infection and COVID-19 mortality. Greater distance to a COVID-19 referral hospital increased risk of COVID-19 mortality.
Conclusions
COVID-19 infection and death were related not only to sociodemographic characteristics of individuals but also to the presence of community-based healthcare interventions and access to hospital care. Strategies in public health, including improving healthcare access, are required to reduce COVID-19 infections among the most susceptible groups in Indonesia.
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Atzl, M., Muendlein, A., Winder, T., Fraunberger, P., Brandtner, E.-M., Geiger, K., Klausberger, M., Duerkop, M., Sprenger, L., Mutschlechner, B., Volgger, A., Benda, M., Severgnini, L., Jaeger, J. B., Drexel, H., Lang, A., Leiherer, A.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Objectives
Austria, and particularly its westernmost federal state Vorarlberg, developed an extremely high incidence rate during the COVID-19 pandemic. Healthcare workers (HCWs) worldwide are known to have an increased risk of contracting the disease within the working environment and, therefore, the seroprevalence in this population is of particular interest. We thus aimed to analyse SARS-CoV-2-specific antibody dynamics in Vorarlberg HCWs.
Design
Prospective cohort study of HCWs including testing at three different time points for the prevalence of anti-SARS-CoV-2 IgG antibodies specific for nucleocapsid protein (NP) and receptor-binding domain (RBD).
Setting
All five state hospitals of Vorarlberg.
Participants
A total of 395 HCWs, enrolled in June 2020 (time point 1 (t1)), 2 months after the end of the first wave, retested between October and November at the beginning of the second wave (time point 2 (t2)) and again at the downturn of the second wave in January 2021 (time point 3 (t3)).
Main outcomes
We assessed weak and strong seropositivity and associated factors, including demographic and clinical characteristics, symptoms consistent with COVID-19 infection, infections verified by reverse transcription PCR (RT-PCR) and vaccinations.
Results
At t1, 3% of HCWs showed strong IgG-specific responses to either NP or RBD. At t2, the rate had increased to 4%, and at t3 to 14%. A strong response was found to be stable for up to 10 months. Overall, only 55% of seropositive specimen had antibodies against both antigens RBD and NP; 29% had only RBD-specific and 16% only NP-specific antibodies. Compared with the number of infections found by RT-PCR, the number of HCWs being seropositive was 38% higher.
Conclusion and relevance
Serological testing based on only one antigen implicates the risk of missing infections; thus, the set of antigens should be broadened in the future. The seroprevalence among participating HCWs was comparable to the general population in Austria. Nevertheless, in view of undetected infections, monitoring and surveillance should be reconsidered.
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Sohn, H., Aqua, J. K.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Objective
To quantify COVID-19 vulnerabilities for Californian residents by their legal immigration status and place of residence.
Design
Secondary data analysis of cross-sectional population-representative survey data.
Data
All adult respondents in the restricted version of the California Health Interview Survey (2015–2020, n=128 528).
Outcome measure
Relative Social Vulnerability Indices for COVID-19 by legal immigration status and census region across six domains: socioeconomic vulnerability; demography and disability; minority status and language barriers; high housing density; epidemiological risk; and access to care.
Results
Undocumented immigrants living in Southern California’s urban areas (Los Angeles, Orange, San Diego-Imperial) have exceptionally high vulnerabilities due to low socioeconomic status, high language barriers, high housing density and low access to care. San Joaquin Valley is home to vulnerable immigrant groups and a US-born population with the highest demographic and epidemiological risk for severe COVID-19.
Conclusion
Interventions to mitigate public health crises must explicitly consider immigrants’ dual disadvantage from social vulnerability and exclusionary state and federal safety-net policies.
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Kalolo, A., Lalashowi, J., Pamba, D., Shayo, P. J., Gitige, C., Mvungi, H., Ntagazwa, W., Lekule, I., Kisonga, R., Mleoh, L., John, J., Kapologwe, N. A., Mutayoba, B., Matechi, E., Mpagama, S. G., Ntinginya, N. E.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Introduction
Tanzania is adapting a shortened injectable-free multidrug resistant tuberculosis (MDR-TB) regimen, comprising new drugs such as bedaquiline and delamanid and repurposed drugs such as clofazimine and linezolid. The regimen is implemented using a pragmatic prospective cohort study within the National TB and Leprosy Programme and is accompanied by a process evaluation. The process evaluation aims to unpack the implementation processes, their outcomes and the moderating factors in order to understand the clinical effectiveness of the regimen. This protocol describes the methods employed in understanding the implementation processes of the new MDR-TB regimen in 15 regions of Tanzania.
Methods
This study adopts a concurrent mixed-methods design. Using multiple data collection tools, we capture information on: implementation outcomes, stakeholder response to the intervention and the influence of contextual factors. Data will be collected from the 22 health facilities categorised as dispensaries, health centres, district hospitals and referral hospitals. Health workers (n=132) and patients (n=220) will fill a structured questionnaire. For each category of health facility, we will conduct five focus group discussions and in-depth interviews (n=45) for health workers. Participant observations (n=9) and review documents (n=22) will be conducted using structured checklists. Data will be collected at two points over a period of 1 year. We will analyse quantitative data using descriptive and inferential statistical methods. Thematic analysis will be used for qualitative data.
Ethics and dissemination
This study received ethical approval from National Institute of Medical research (NIMR), Ref. NIMR/HQ/R.8a/Vol.IX/3269 and from the Mbeya Medical Research and Ethics Review Committee, Ref. SZEC-2439/R.A/V.I/38. Our findings are expected to inform the wider implementation of the new MDR-TB regimen as it is rolled out countrywide. Dissemination of findings will be through publications, conferences, workshops and implementation manuals for scaling up MDR-TB treatments.
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Mattar, S. A. M., Kan, J. Y. L., Goh, O. Q. M., Tan, Y., Kumaran, S. S., Shum, K. L., Lee, G., Balakrishnan, T., Zhu, L., Chong, C. J., Woong, N. L., Lam, A. Y. R., Kang, M. L.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Objectives
This study aims to report the prevalence of cardiovascular risk factors (CVRFs) and other non-communicable diseases among migrant workers in Singapore admitted for COVID-19 infection, to highlight disease burden and the need for changes in health screening and healthcare delivery in this unique population.
Setting
The study was conducted in the largest tertiary hospital in Singapore.
Design
Retrospective cross-sectional study.
Participants
883 migrant workers who had mild or asymptomatic COVID-19 infection admitted to three isolation wards between 6 April 2020 and 31 May 2020 were included in this study.
Outcome measures
The outcome measures were the prevalence of pre-existing and newly diagnosed comorbid conditions and the prevalence of CVRFs—diabetes mellitus, hypertension and hyperlipidaemia—and non-communicable diseases at the time of discharge. The OR of having specific CVRFs depending on country of origin was generated via multivariate logistic regression analysis.
Results
The median age of our study population was 45 years. 17.0% had pre-existing conditions and 25.9% received new diagnoses. Of the new diagnoses, 15.7% were acute medical conditions and 84.3% chronic medical conditions. The prevalence of CVRFs was higher in Southeast Asian and South Asian migrant workers compared with Chinese. The prevalence of non-communicable diseases on discharge was highest among Southeast Asians (49.4%).
Conclusions
The COVID-19 outbreak in a large number of migrant workers in Singapore unmasked a significant disease burden among them, increasing stakeholders’ interests in their welfare. Moving forward, system-level changes are necessary to deliver healthcare sustainably and effect improvements in migrant workers’ health.
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Abraham, S. A. A., Doe, P. F., Osei Berchie, G., Agyare, E., Ayisi Addo, S., Obiri-Yeboah, D.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Objective
To explore how the COVID-19 pandemic affected access to antiretroviral therapy (ART) services from the perspective of the persons living with HIV (PLWH).
Design
The study adopted an exploratory-descriptive qualitative design that used in-depth interviews as the technique for the data collection. Data analysis was done using conceptual content analysis, following the traditions of Elo and Kyngäs on deductive and Hsieh on inductive content analysis.
Setting
ART clinic, Cape Coast Teaching Hospital, Ghana.
Participants
Twelve participants who had at least 1 year history of accessing ART care before the COVID-19 pandemic and at least one clinic visit during the pandemic were purposively sampled from the ART clinic.
Results
Five concepts of accessing healthcare proposed by Penchansky and Thomas were explored: accessibility, availability, affordability, accommodation and acceptability. The ART unit in the study setting remained open for service delivery throughout the pandemic. However, fear of contracting the virus while patronising services affected the participants’ decision to use the facility. Although all the participants in this study reportedly honoured their refill appointments, they indicated knowledge of other PLWH defaulting. With reference to the availability of resources, a shortage of antiretrovirals was reported, affecting the refill appointment intervals. In spite of the challenges, several strategies were implemented to accommodate the patients’ needs while protecting them from contracting the virus by instituting the stipulated COVID-19 protocols. The study found that some of the strategies impacted the acceptability and affordability of the services as transportation costs increased. Varying levels of accessibility to health workers providing ART services in the study setting was also recorded.
Conclusion
Strategies were implemented to accommodate the effects of the pandemic on ART provision. However, these had deficiencies that must be addressed using appropriate Differentiated Service Delivery (DSD) interventions that will ensure continuous access to service delivery in the ongoing and any similar future occurrences.
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Shi, C., Wu, M., Wang, X., Yang, K.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Introduction
The COVID-19 global pandemic has posed enormous threats to public health around the world. Vaccines are considered the best therapeutic strategy against the COVID-19 pandemic. However, the adverse reactions of vaccines significantly affect the rates of vaccination and may be more serious in patients with non-communicable diseases (NCDs). This protocol aims to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) which analysed the safety of vaccines in patients with NCDs.
Methods and analysis
This study will be according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. A comprehensive search will be carried out to identify registered RCTs in PubMed, Embase, Web of Science, ClinicalTrials.gov and Cochrane Library between 1 January 2020 and 31 May 2022. Selection of trials, data extraction, risk of bias assessment and quality of evidence assessment will be done by two researchers, and disagreements will be resolved by the corresponding author. The primary outcomes are local and systemic adverse events of vaccines in patients with NCDs. Additional outcomes are related events caused by vaccine adverse events, including but not limited to cases of adverse events leading to discontinuation from a dose or withdrawal from participation in the trial. Heterogeneity will be assessed with I2 statistics and data analysis will be conducted with RevMan V.5.4.1.
Ethics and dissemination
This is a protocol and ethical approval is not necessary. The results of this protocol will be disseminated to peer-reviewed publications or conference presentations.
PROSPERO registration number
CRD42021254914.
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Pandolfi, F., Guillemot, D., Watier, L., Brun-Buisson, C.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Objective
This study aims to provide a case definition of sepsis of presumed bacterial aetiology based on 10th revision of the International Classification of Diseases (ICD-10) codes, to assess trends in sepsis incidence and mortality between 2015 and 2019 in France, and to describe the characteristics of affected patients and hospital stays.
Design
Nationwide, population-based, retrospective observational study.
Setting
Metropolitan France between 2015 and 2019.
Participants
Between 2015 and 2019, 1 224 433 patients with sepsis of presumed bacterial aetiology were selected from the French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d’Information) and were identified from corresponding ICD-10 codes for explicit sepsis or implicit sepsis.
Main outcomes measures
Annual overall and age-specific and gender-specific incidence and 95% CI, as well as trends in sepsis incidence and mortality, were estimated. Comorbidities, length of hospital stay and outcomes were described.
Results
The sex-standardised and age-standardised incidence per 100 000 (95% CI) increased from 357 (356.0 to 359.0) in 2015 to 403 (401.9 to 405.0) in 2019 and remained higher for males compared with females. Children under 1 year and patients over 75 years consistently had the highest incidence. The most common comorbidities were cancer and chronic heart failure. The median hospital length of stay was 12 days. Most patients came from home, but only half returned home after their hospital stay and approximately 15% were discharged to long-term care. In-hospital mortality was about 25% and declined along the study period.
Conclusions
Medico-administrative databases can be used to provide nationwide estimates of the in-hospital burden of bacterial sepsis. The results confirm the high burden of sepsis in France. These data should be complemented by estimating the additional burden associated with fungal and viral infections during the COVID-19 pandemic.
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Banti, A. B., Datiko, D. G., Hinderaker, S. G., Heldal, E., Dangisso, M. H., Mitiku, G. A., White, R. A., Winje, B. A.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Objective
Many individuals with persistent cough and smear microscopy-negative sputum test for tuberculosis (TB) remain at risk of developing the disease. This study estimates the incidence of pulmonary TB (PTB) among initially smear-negative persistent coughers and its risk factors.
Design
A prospective population-based follow-up study.
Setting
Health extension workers visited all households in Dale woreda three times at 4-month intervals in 2016–2017 to identify individuals with symptoms compatible with TB (presumptive TB) using pretested and semistructured questionnaires.
Participants
We followed 3484 presumptive TB cases (≥15 years) with an initial smear-negative TB (PTB) test.
Outcome measures
Bacteriologically confirmed PTB (PTB b+) and clinically diagnosed PTB (PTB c+).
Results
3484 persons with initially smear-negative presumptive PTB were followed for 2155 person-years (median 0.8 years); 90 individuals had PTB b+ and 90 had PTB c+. The incidence rates for PTB b+ and PTB c+ were both 4176 (95% CI 3378 to 5109) per 100 000 person-years. We used penalised (lasso) and non-penalised proportional hazards Cox regression models containing all exposures and outcomes to explore associations between exposures and outcomes. In lasso regression, the risk of development of PTB b+ was 63% (HR 0.37) lower for people aged 35–64 years and 77% (HR 0.23) lower for those aged ≥65 years compared with 15–34 year-olds. Men had a 62% (HR 1.62) greater risk of PTB b+ development than women. The risk of PTB c+ was 39% (HR 0.61) lower for people aged 35–54 years than for those aged 15–34 years. Men had a 56% (HR 1.56) greater risk of PTB c+ development than women.
Conclusions
PTB incidence rate among persistent coughers was high, especially among men and young adults, the latter signifying sustained transmission. Awareness about this among healthcare workers may improve identification of more new TB cases.
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Madhavan, R., Paul, J. S., Babji, S., Kumar, D., Prabhu, S. B., Pulleri, H. K., Annadorai, R., Gowda, S. R., John, J., Kang, G.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Introduction
The incidence of SARS-CoV-2 re-infection has not been widely evaluated in low-income and middle-income countries. Understanding immune responses elicited by SARS-CoV-2 natural infection and factors that lead to re-infection in a community setting is important for public health policy. We aim to investigate the risk of primary infection and re-infection among those without and with evidence of prior infection as defined by the presence of antibodies to SARS-CoV-2 spike protein.
Methods and analysis
A baseline seroprevalence survey will test for SARS-CoV-2 antibodies among healthy adults in Vellore, India. Based on an expected seropositivity rate of 50% in the general population, with annual attack rates of 12%, 6%, 4.8% and 4% among those unvaccinated and seronegative, vaccinated and seronegative, unvaccinated and seropositive, and vaccinated and seropositive, respectively, we will recruit 1200 adults who will be followed up for a total of 24 months. Weekly self-collected saliva samples will be tested by reverse transcription-PCR (RT-PCR) to detect SARS-CoV-2 infections, for a period of 1 year. For any person testing RT-PCR positive, blood samples will be collected within 2 days of RT-PCR positivity and on days 30 and 90 to assess the kinetics and longevity of the antibody responses, B cell memory and T cell memory post-infection. The data will be analysed to estimate seroprevalence at baseline and over time, the risk factors for infection, rates of primary infection and re-infection, and provide a comparison of the rates across groups based on infection and vaccination status.
Ethics and dissemination
The study has been approved by the Institutional Review Board (IRB No: 13585) of Christian Medical College and Hospital, Vellore. The results of the study will be made available through journal publications and conference presentations.
Trial registration number
Central Trial Registry of India: CTRI/2020/11/029438.
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Ebinger, J. E., Joung, S., Liu, Y., Wu, M., Weber, B., Claggett, B., Botting, P. G., Sun, N., Driver, M., Kao, Y. H., Khuu, B., Wynter, T., Nguyen, T.-T., Alotaibi, M., Prostko, J. C., Frias, E. C., Stewart, J. L., Goodridge, H. S., Chen, P., Jordan, S. C., Jain, M., Sharma, S., Fert-Bober, J., Van Eyk, J. E., Minissian, M. B., Arditi, M., Melmed, G. Y., Braun, J. G., McGovern, D. P. B., Cheng, S., Sobhani, K.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Objectives
We sought to understand the demographic and clinical factors associated with variations in longitudinal antibody response following completion of two-dose regiment of BNT162b2 vaccination.
Design
This study is a 10-month longitudinal cohort study of healthcare workers and serially measured anti-spike protein IgG (IgG-S) antibody levels using mixed linear models to examine their associations with participant characteristics.
Setting
A large, multisite academic medical centre in Southern California, USA.
Participants
A total of 843 healthcare workers met inclusion criteria including completion of an initial two-dose course of BNT162b2 vaccination, complete clinical history and at least two blood samples for analysis. Patients had an average age of 45±13 years, were 70% female and 7% with prior SARS-CoV-2 infection.
Results
Vaccine-induced IgG-S levels remained in the positive range for 99.6% of individuals up to 10 months after initial two-dose vaccination. Prior SARS-CoV-2 infection was the primary correlate of sustained higher postvaccination IgG-S levels (partial R2=0.133), with a 1.74±0.11 SD higher IgG-S response (p<0.001). Female sex (beta 0.27±0.06, p<0.001), younger age (0.01±0.00, p<0.001) and absence of hypertension (0.17±0.08, p=0.003) were also associated with persistently higher IgG-S responses. Notably, prior SARS-CoV-2 infection augmented the associations of sex (–0.42 for male sex, p=0.08) and modified the associations of hypertension (1.17, p=0.001), such that infection-naïve individuals with hypertension had persistently lower IgG-S levels whereas prior infected individuals with hypertension exhibited higher IgG-S levels that remained augmented over time.
Conclusions
While the IgG-S antibody response remains in the positive range for up to 10 months following initial mRNA vaccination in most adults, determinants of sustained higher antibody levels include prior SARS-CoV-2 infection, female sex, younger age and absence of hypertension. Certain determinants of the longitudinal antibody response appear significantly modified by prior infection status. These findings offer insights regarding factors that may influence the ‘hybrid’ immunity conferred by natural infection combined with vaccination.
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Gustafsson, P. E., Nilsson, I., San Sebastian, M.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Objectives
To examine the early impact of the pandemic and of quarantine measures targeting older adults introduced in March 2020 on loneliness among older adults in Sweden.
Design Prospective pretest–posttest and controlled interrupted time series designs.
Setting
The population of older adults receiving home care before and during the emergence of the first COVID-19 pandemic wave in Sweden in Spring 2020.
Participants
Respondents (n=45 123, mean age 85.6 years, 67.6% women) came from two waves of a total population survey targeting all community-dwelling older adults receiving home care for older adults in Sweden in Spring 2019 and 2020.
Outcome
Self-reported loneliness.
Results
Results estimated 14% (95% CI: 10 to 19) higher loneliness in Spring 2020 compared with 2019, taking covariates into account. No impact of the quarantine measure was found (1% increase, 95% CI: –1 to 4).
Conclusions
The results illustrate the broader public health consequences of the COVID-19 pandemic for older adults, but also suggest a relative resilience among older adults in home care to quarantine measures, at least during the first months of the pandemic. Future studies should examine the long-term effects of sustained pandemic and social distancing measures on loneliness among older adults.
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Sljivo, A., Juginovic, A., Ivanovic, K., Quraishi, I., Mulac, A., Kovacevic, Z., Ivanovic, S., Vukovic, M., Aranza, I., Bilos, V., Ljuhar, K., Draskovic, D., Cetkovic, A., Abdulkhaliq, A., Dadic, I., Begic, E., Mujicic, E., Kulo Cesic, A.
BMJ Open, 25.05.2022
Tilføjet 25.05.2022
Objectives
To evaluate the sleep patterns among young West Balkan adults during the third wave of the COVID-19 pandemic.
Design and setting
Cross-sectional study conducted using an anonymous online questionnaire based on established sleep questionnaires Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) (February–August 2021).
Participants
Young adults of Bosnia and Herzegovina, Croatia and Serbia.
Results
Of 1058 subjects, mean age was 28.19±9.29 years; majority were women (81.4%) and students (61.9%). Compared with before the pandemic, 528 subjects (49.9%) reported a change in sleeping patterns during the pandemic, with 47.3% subjects reporting sleeping less. Mean sleeping duration during the COVID-19 pandemic was 7.71±2.14 hours with median sleep latency of 20 (10.0–30.0) min. Only 91 (8.6%) subjects reported consuming sleeping medications. Of all, 574 (54.2%) subjects had ISI score >7, with majority (71.2%) having subthreshold insomnia, and 618 (58.4%) PSQI score ≥5, thus indicating poor sleep quality. Of 656 (62.0%) tested subjects, 464 (43.9%) were COVID-19 positive (both symptomatic and asymptomatic) who were 48.8%, next to women (70%), more likely to have insomnia symptoms; and 66.9% were more likely to have poor sleep quality. Subjects using sleep medication were 44 times, and subjects being positive to ISI 15.36 times more likely to have poor sleep quality. In contrast, being a student was a negative independent predictor for both insomnia symptoms and poor sleep quality, and mental labour and not working were negative independent predictors for insomnia symptoms.
Conclusions
During the third wave of the pandemic, sleep patterns were impaired in about half of young West Balkan adults, with COVID-19-positive subjects and being women as positive independent predictors and being a student as negative independent predictor of impaired sleep pattern. Due to its importance in long-term health outcomes, sleep quality in young adults, especially COVID-19-positive ones, should be thoroughly assessed.
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Xun Qi, Fahong Li, Yao Zhang, Haoxiang Zhu, Feifei Yang, Xinyan Li, Xuhua Jiang, Liang Chen, Yuxian Huang, Jiming Zhang
Journal of Medical Virology, 25.05.2022
Tilføjet 25.05.2022
Manoj Sivan, Nick Preston, Amy Parkin, Sophie Makower, Jeremy Gee, Denise Ross, Rachel Tarrant, Jennifer Davison, Stephen Halpin, Rory J O’Connor, Mike Horton
Journal of Medical Virology, 23.05.2022
Tilføjet 25.05.2022