bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of lateral tail vein and retro-orbital venous sinus as routes of inoculation to study Group B streptococcal systemic infection
Authors: da Conceição Mendonça Jéssica , Lumsdaine Stephen , Burcham Lindsey R.
Published: November 2024

Murine models are commonly used to understand pathogen and host determinants of systemic infection. While these models have proven beneficial for uncovering bacterial mechanisms required for progression to invasive disease, it can be challenging to draw comparisons across studies as several different routes of infection are standardly used for these experiments. In this study, one of the leading bacterial meningeal pathogens,
Streptococcus agalactiae
, or Group B
Streptococcus
(GBS), was used to compare experimental outcomes of two commonly used routes of hematogenous infection, lateral tail vein injection and retro-orbital venous sinus injection. Here we demonstrate that both routes of infection result in systemic disease and the onset of clinical symptoms of infection. We show that retro-orbital venous sinus injection results in an initial increase in bacterial dissemination to the spleen and brain tissue of GBS-infected mice, while an increased bacterial burden was only detected in brain tissues at a later time point. Despite differences in initial dissemination and brain bacterial burden, we found that the route of infection did not significantly impact bacterial burden in the blood, kidney, spleen, heart, and lung tissues at experimental endpoints; and similarly did not impact animal health scores during infection; cytokine and proinflammatory protein abundance in the brain tissue; or overall animal survival. In summary, these findings suggest that both tail vein injection and retro-orbital venous sinus injection are viable models to study Group B streptococcal systemic infection and result in largely similar disease outcomes within our tested parameters.

IMPORTANCE

Streptococcus agalactiae
or Group B
Streptococcus
(GBS) is the leading cause of invasive disease in neonates and immunocompromised adults and is implicated in severe cases of sepsis, pneumonia, and meningitis. Established murine models of hematogenous systemic infection allow for better understanding and investigation of bacterial dispersion, pathogenesis, meningeal inflammation, and interaction with the host. Here we compared two routes of infection, intravenous lateral tail vein and retro-orbital venous sinus, demonstrating that similar experimental outcomes can be observed, regardless of the route of infection for GBS, specifically. These findings help to reinforce the utility of different systemic infection models and provide insight into comparisons across different established models and how these models can be applied in microbial research.
Legionella pneumophila
IrsA, a novel, iron-regulated exoprotein that facilitates growth in low-iron conditions and modulates biofilm formation
Authors: Lopez Alberto E. , Mayoral Joshua , Zheng Huaixin , Cianciotto Nicholas P.
Published: November 2024

To discover new factors that are involved in iron acquisition by
Legionella pneumophila
, we used RNA-Seq to identify the genes that are most highly induced when virulent strain 130b is cultured in a low-iron chemically defined medium. Among other things, this revealed
14915
, a heretofore uncharacterized gene that is predicted to be transcriptionally regulated by Fur and to encode a novel, ~15 kDa protein.
14915
was present in all
L. pneumophila
strains examined and had homologs in a subset of the other
Legionella
species. Compatible with it containing a classic signal sequence, the 14915 protein was detected in bacterial culture supernatants in a manner dependent upon the
L. pneumophila
type II secretion system. Thus, we designated 14915 as IrsA for
ir
on-
r
egulated,
s
ecreted protein
A
. Based on mutant analysis, the
irsA
gene was not required for optimal growth of strain 130b in low-iron media. However, after discovering that the commonly used laboratory-derived strain Lp02 has a much greater requirement for iron, we uncovered a growth-enhancing role for IrsA after examining an Lp02 mutant that lacked both IrsA and the Fe
2+
-transporter FeoB. The
irsA
mutant of 130b, but not its complemented derivative, did, however, display increased biofilm formation on both plastic and agar surfaces, and compatible with this, the mutant hyper-aggregated. Thus, IrsA is a novel, iron-regulated exoprotein that modulates biofilm formation and, under some circumstances, promotes growth in low-iron conditions. For this study, we determined and deposited in the database a complete and fully assembled genome sequence for strain 130b.

IMPORTANCE

The bacterium
Legionella pneumophila
is the principal cause of Legionnaires’ disease, a potentially fatal form of pneumonia that is increasing in incidence.
L. pneumophila
exists in many natural and human-made water systems and can be transmitted to humans through inhalation of contaminated water droplets.
L. pneumophila
flourishes within its habitats by spreading planktonically, assembling into biofilms, and growing in larger host cells. Iron acquisition is a key determinant for
L. pneumophila
persistence in water and during infection. We previously demonstrated that
L. pneumophila
assimilates iron both by secreting a non-protein iron chelator (siderophore) and by importing iron through membrane transporters. In this study, we uncovered a novel, secreted protein that is highly iron-regulated, promotes
L. pneumophila
’s growth in low-iron media, and impacts biofilm formation. We also identified uncharacterized, IrsA-related proteins in other important human and animal pathogens. Thus, our results have important implications for understanding iron assimilation, biofilm formation, and pathogenesis.
Rapid antibiotic susceptibility testing for urinary tract infections in secondary care in England: a cost-effectiveness analysis
Authors: Booton Ross D , Agnew Emily , Pople Diane , Evans Stephanie , Bock Lucy J , Sutton J Mark , Robotham Julie V , Naylor Nichola R
Published: November 2024

Objectives

To perform a model-based cost-effectiveness evaluation of a rapid antimicrobial susceptibility test.

Design

A Markov model of a cohort of hospital inpatients with urinary tract infection (with inpatient numbers based on national administrative data from 1 April 2017 to 31 March 2019).

Setting

Urinary tract infections (UTI) in acute National Health Service (NHS) Trusts in England, from the perspective of the NHS Healthcare system, at a national level.

Participants

A simulated cohort of approximately 280 000 non-pregnant adult inpatients within secondary care with a clinical suspicion of UTI.

Interventions

Evaluation of the implementation of a fast bacterial impedance cytometry test (BICT) compared with current practice.

Primary and secondary outcome measures

Incremental cost, quality-adjusted life years, net monetary benefit, and bed days and appropriateness of antibiotic use per patient. Costs are presented in 2022 GBP.

Results

Considering benefits arising from reduced time on inappropriate treatment, BICT gives an average net monetary benefit (NMB) over the simulation period of approximately £4.3 million and dominates culture methods (from the healthcare system perspective and with a willingness to pay threshold of £20 000 per quality-adjusted life year). Total inappropriate prescribing days due to the BICT test are reduced by 57%. The extent of the benefit from BICT implementation was strongly dependent on prevalence of resistance, with the NMB increasing sevenfold to over £30 million in a high (40%) resistance prevalence scenario. At the population level, the patient groups with the highest cost and quality-adjusted life year impacts were 65–100-year-old females, followed by males, with uncomplicated UTIs. At an individual patient level, however, 16–64-year-old females with complicated UTIs with oral treatment, followed by 65–100-year-old males with complicated UTIs with oral treatment, were impacted to the greatest degree by the rapid BICT.

Conclusions

Under conservative assumptions and for wide parameter sensitivity, the implementation of BICT would be cost-effective from the NHS healthcare system perspective.
Informed consent and risk communication challenges in antimicrobial clinical trials: a scoping review
Authors: Shou Yiyun , Yeo Joey Elizabeth , Pang Alexander Shao-Rong , Paterson David L. , Mo Yin
Published: November 2024

Objectives

Randomised trials for the management of drug-resistant infections are challenging to conduct as target patient populations often lack decision-making capacity, and enrolment windows are typically short. Improving informed consent and risk communication in these trials is especially crucial for protecting patient interests and maximising trial efficiency. This study aimed to understand challenges in risk communication and informed consent in antimicrobial clinical trials.

Design

Scoping review.

Data sources

Searches were conducted in Embase, Medline, CINAHL and Web of Science Core for peer-reviewed English articles that were published from January 2000 to April 2023.

Eligibility criteria

Included articles were empirical studies or expert opinions that sought experts’, patients’ or representatives’ opinions on informed consent in the context of clinical trials involving antibiotic/anti-infective agents.

Data extraction and synthesis

Abstract screening, full-text review, data extraction and evidence rating were performed by two independent reviewers. Extracted data were summarised and reported qualitatively based on common themes. A total of 2330 records were retrieved, and 29 articles were included in the review.

Results

Half of the articles involving medical experts and one-third involving patients and representatives reported that full comprehension by patients and representatives was challenging or not achievable. Healthcare providers and consent takers were crucial for the quality of informed consent. The level of trust consent givers placed on healthcare providers had a critical influence on the consent rate. Emotional distress was pervasive among patients/representatives.

Conclusion

The findings indicate that strengthening consent takers’ communication skills in providing emotional support to patients and their representatives may improve informed consent. More research is needed to understand informed consent in low-income and middle-income and non-English-speaking countries.
Prevalence of physical inactivity and associated factors among adults in Eastern African countries: a systematic review and meta-analysis protocol
Authors: Abuhay Habtamu Wagnew , Derseh Nebiyu Mekonnen , Kolbe-Alexander Tracy L , Gyawali Prajwal , Yenit Melaku Kindie
Published: November 2024

Introduction

Physical inactivity is a major global public health concern, increasing the risk factor of non-communicable diseases (NCDs) and mortality. The WHO has initiated the Global Action Plan on Physical Activity to reduce global physical inactivity by 15% by 2030. Rapid urbanisation and insufficient physical activity in the Global South have significant implications for public health, leading to increased NCDs. Understanding physical inactivity and related risk factors among adults is essential in addressing the growing NCD epidemic. This study aims to estimate the pooled prevalence of physical inactivity and its associated risk factors among adults in Eastern African countries.

Methods and analysis

This review protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (2020) Guideline. A comprehensive search will be conducted using the CoCoPop (condition, context, population) frameworks to include all observational studies published from 1 January 2010 to 31 October 2024. Databases such as PubMed, Scopus, Embase, CINAHAL, Web of Science, Science Direct and Google Scholar will be searched. Studies with citations without an abstract or full text and qualitative studies will be excluded. The Joanna Briggs Institute critical appraisal tool will be used to assess the quality of each study. The heterogeneity of studies will be quantified using the I2statistic, and a fixed-effects or random-effects model will be used for the pooled analysis. Publication bias will be assessed using visual (funnel plot) and statistical methods. The study countries will be the basis for subgroup analysis, and sensitivity analysis will be used to see how one study’s results may affect the estimate as a whole.

Ethics and dissemination

Ethical approval is not required for this systematic review. The results will be disseminated through peer-reviewed publications and conference presentations. Furthermore, this systematic review and meta-analysis will be used to generate comprehensive and robust evidence for public health interventions.

PROSPERO registration number

CRD42024567592
Cost-effectiveness of C-reactive protein point of care testing for safely reducing antibiotic consumption for acute exacerbations of chronic obstructive pulmonary disease as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial
Authors: Sewell Bernadette , Francis Nick , Harris Shaun , Gillespie David , Bates Janine , White Patrick , Alam Mohammed Fasihul , Hood Kerenza , Butler Christopher C , Fitzsimmons Deborah
Published: November 2024

Objectives

Many patients presenting with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in primary care do not benefit from antibiotics. Excessive use wastes resources, promotes antimicrobial resistance and can harm patients.

Design

We conducted a within-trial economic evaluation, using a UK National Health Service perspective, as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial.

Setting

Participating general practices in primary care.

Participants

PACE included 324 and 325 consenting participants presenting with AECOPD in the usual-care and CRP-guided groups, respectively.

Intervention

We assessed the cost-effectiveness (CE) of a C-reactive protein point-of-care-test (CRP-POCT) in addition to usual clinical assessment to guide antibiotic prescribing for AECOPD in primary care.

Primary and secondary outcome measures

A cost-effectiveness analysis (CEA) of incremental cost per 1% antibiotic consumption reduction at 4 weeks and a cost-utility analysis (CUA) at 6 months were performed, based on a modified intention-to-treat population. Sensitivity analyses assessed the impact of uncertainty on the results. CE acceptability curves represent the probability of CRP-POCT being cost-effective at different willingness-to-pay (WTP) thresholds.

Results

Both groups had similar clinical outcomes, but a 20% absolute reduction in antibiotic consumption was observed in the CRP-guided group. CRP-POCT costs of £11.31 per test were largely offset by savings in healthcare resource use related to COPD. The mean incremental CE ratios of CRP-POCT were £120 per 1% absolute reduction in antibiotic consumption at 4 weeks and £1054 per quality-adjusted life-year (QALY) gained at 6 months. Sensitivity analysis showed that the CEA results were most affected by changes in healthcare costs, while CUA was sensitive due to marginal differences in costs and outcomes. There is a 73% probability of CRP-POCT being cost-effective at WTP ≤£20 000 per QALY gained.

Conclusion

CRP-POCT is a cost-effective intervention for safely reducing antibiotic consumption in patients with AECOPD.

Trial registration number

NCT24346473
Cohort profile: the WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort (WHO-CMRS) to identify predictors of mortality through early childhood
Authors: Schwinger Catherine , Kaldenbach Siri , Berkley James A , Walson Judd L , Argaw Alemayehu , Chowdhury Ranadip , Strand Tor A , Rollins Nigel
Published: November 2024

Purpose

To provide details of a pooled data set that will be used to estimate absolute and relative mortality risks and other outcomes among children less than 59 months of age and the predictive performance of common risk exposures, both individually and in combination.

Participants

Children from birth to 5 years of age recruited at health facilities or community settings into 33 longitudinal observational or intervention studies in 17 low- and middle-income countries.

Findings to date

The data set includes 75 287 children with a median age of 3 months (IQR 1–12) at first measurement. In the pooled sample, 2805 (3.7%) of the study children died. Data on birth weight was recorded in 19 studies, and gestational age in 13 studies. Among these, 14% of the included children were reported as having low birth weight, and 14% had preterm birth. At first measurement, 33% of the children were stunted, 24% were wasted and 35% underweight. 13% and 7% of caregivers reported that their child had acute diarrhoea or acute lower respiratory tract infection before the study visit, respectively. The proportion of children reported as breastfed at any study visit decreased from 99% at age <6 months to 77% in the age group 12–23 months. Child characteristics differed considerably between studies in the community and healthcare settings. The median study period was 15 months (IQR 7.6–18.4 months).

Future plans

Planned analyses will examine knowledge gaps with the aim of informing global guidelines and their derivatives such as clinical management tools and implementation guidance, and to inform future research agendas. We aim to estimate absolute mortality risks associated with child age, anthropometry, birth characteristics and feeding practices as planned by the WHO-Risk Stratification Working Group. In the future, other data sets may be added and further questions on survival and growth will be investigated.
Sustained impacts of the COVID-19 pandemic on medical student learning and well-being in rural Australia: findings from a repeated national multicentre survey
Authors: Martin Priya , McGrail Matthew R , Fox Jordan , Doyle Zelda , Ostini Remo , Beattie Jessica , Fuller Lara , Allen Penny , Kondalsamy-Chennakesavan Srinivas
Published: November 2024

Objective

The impact of COVID-19 on medical students has predominantly been assessed by one-off survey studies at the pandemic onset. This national study investigated the sustained impacts of the COVID-19 pandemic on medical students’ rural clinical placement learning and well-being.

Design

Repeated cross-sectional survey design.

Setting

Annual Federation of Rural Australian Medical Educators (FRAME) survey across 2020 to 2022.

Participants

Medical students completing an extended (mostly 12 months) rural placement.

Outcome measure

A mixed-methods survey with closed-ended and open-ended question. Quantitative data were analysed using χ2and Kruskal-Wallis tests. Qualitative responses were analysed through content analysis.

Results

Quantitative findings: in 2022 (43%), respondents were more likely to interact with COVID-19 patients in a clinical capacity compared with 2020 (26%) and 2021 (23%; p<0.001). Respondents were more likely to be concerned about missed clinical learning in 2020 (58%) than in 2021 (40%) and 2022 (44%; p<0.001). Respondents in 2020 (41%) and 2022 (39%) were more likely to feel that their performance on assessments was affected by COVID-19 compared with 2021 respondents (28%; p<0.001). Respondents in 2022 (38%) and 2021 (31%) were more likely to report being exposed to an increased breadth of cases than 2020 respondents (13%; p<0.001) and also reported more exposure to community-based placements (2022: 38%, 2021: 31%, 2020: 19%; p<0.001).

Qualitative findings: three categories were developed from the data—mental health and well-being impacts, learning preferences at play, and concerns about flow-on effects.

Conclusions

While the pandemic has now become the ‘new normal’, the mental well-being and learning concerns raised by students in rural Australia, and their concerns about sustained impacts into their internship cannot be ignored. Healthcare organisations need to ensure that when impacted students enter the workforce the practice context is supportive, with mechanisms such as effective clinical supervision in place.
Effectiveness of glucagon-like peptide-1 receptor agonists for reduction of body mass index and blood glucose control in patients with type 2 diabetes mellitus and obesity: A retrospective cohort study and difference-in-difference analysis
Authors: Siriyotha Sukanya , Anothaisintawee Thunyarat , Looareesuwan Panu , Nimitphong Hataikarn , McKay Gareth J , Attia John , Thakkinstian Ammarin
Published: November 2024

Objective

This study aimed to evaluate the effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RA) in reducing body mass index (BMI) and blood glucose levels in individuals with type 2 diabetes mellitus (T2DM) using the difference-in-differences (DID) technique.

Research design and methods

This retrospective cohort study included patients with T2DM, receiving GLP1-RA or other second-line antidiabetic treatments between 2010 and 2023. A linear mixed-effect regression with heterogeneous augmented inverse probability weighting DID analysis was used to compare the effectiveness of GLP-1RA and other second-line treatments in reducing BMI, fasting plasma glucose (FPG) and haemoglobin A1C (HbA1c) in patients with T2DM. An average treatment effect on the treated (ATET) for each outcome was estimated.

Results

1000 patients with T2DM (GLP-1RA=220, non-GLP-1RA=880) were included. Compared with other second-line drugs, GLP-1RA significantly reduced BMI by approximately 1.02 kg/m
2
(95% CI −1.46 to –0.58) over 24 months of treatment. Additionally, GLP-1RA significantly decreased FPG and HbA1c levels, compared with other second-line treatments with overall ATETs (95% CI) of −21.34 mg/dL (−29.53 to –13.15) and −0.58% (–0.77% to –0.38%), respectively.

Conclusions

Our results indicate that patients with T2DM treated with GLP-1RA had a significantly greater reduction in BMI, FPG and HbA1C levels compared with those receiving other second-line antidiabetic therapies. As such, GLP-1RA might be considered the preferred treatment for obese patients with T2DM who fail to sufficiently respond to metformin monotherapy.
iDiabetes platform—enhanced phenotyping of patients with diabetes for precision diagnosis, prognosis and treatment: study protocol for a cluster-randomised controlled study in Tayside, Scotland
Authors: Lin YeunYi , Leith Damien , Abbott Michael , Barrett Rachael , Bell Samira , Croudace Tim J , Cunningham Scott , Dillon John , Donnan Peter , Farre Albert , Hernández Rodolfo , Lang Chim , McKenzie Stephanie , Mordi Ify , Morrow Susan , Munro Cameron , Philip Sam , Ryan Mandy , Wake Deborah , Wang Huan , Win Mya , Pearson Ewan
Published: November 2024

Introduction and aim

Diabetes is a global health emergency with increasing prevalence and diabetes-associated morbidity and mortality. One of the challenges in optimising diabetes care is translating research advances in this heterogeneous disease into clinical care. A potential solution is the introduction of precision medicine approaches into diabetes care.

We aim to develop a digital platform called ‘intelligent Diabetes’ (iDiabetes) to support a precision diabetes care model in Scotland and assess its impact on the primary composite outcome of all-cause mortality, hospitalisation rate, renal function decline and glycaemic control.

Methods and analysis

The impact of iDiabetes will be evaluated through a cluster-randomised controlled study, recruiting up to 22 500 patients with diabetes. Primary care general practices (GPs) in the National Health Service (NHS) Scotland Tayside Health Board are the units (clusters) of randomisation. Each primary care GP will form one cluster (approximately 400 patients per cluster), with up to 60 clusters recruited. Randomisation will be toiDiabetes (guideline support),iDiabetesPlusorusual diabetes care(control arm). Patients of participating primary care GPs are automatically enrolled on the study when they attend for their annual diabetes screening or are newly diagnosed with diabetes. A composite hierarchical primary outcome, evaluated using Win-Ratio statistical methodology, will consist of (1) all-cause mortality, (2) all-cause hospitalisation rate, (3) proportion with >40% estimated glomerular filtration rate [eGFR] reduction from baseline or new development of end-stage renal disease, (4) proportion with absolute HbA1C reduction >0.5%. Outcomes will be evaluated after a 2-year median follow-up period. Comprehensive qualitative and health economic analyses will be conducted, assessing the cost-effectiveness, budget impact and user acceptability of the iDiabetes platform.

Ethics and dissemination

This study was reviewed by the NHS Health Research Authority and approved by the East of Scotland Research Ethics Committee (reference: 23/ES/0008). Study findings will be disseminated via publications, presented at scientific conferences and shared with patients and the public on the study website and social media.

Trial registration number

ISRCTN18000901.
Does hospital strategic alliance affect the paediatric service capacity of local hospitals? A difference-in-differences econometric analysis
Authors: Zhang Li , Xiao Cuiping , Fu Qian , Yang Cuili , Yu Xiaolu , Feng Zhanchun
Published: November 2024

Background

Health inequality caused by the scarcity and uneven distribution of paediatric service resources is common worldwide. The hospital strategic alliance may improve paediatric service capacity and health equity, but this hypothesis has not yielded consistent results. Here, we examine the hospital strategic alliance’s effect on local hospitals’ paediatric service capacity.

Methods

The paediatric monitoring data of 119 local hospitals from 14 cities between 2015 and 2019 were obtained from the Hubei Pediatric Quality Control Center and the Provincial Statistical Yearbook. We employed the difference-in-differences model with multiple periods. The samples were divided into three groups—close cooperation group, loose-knit cooperation group and control group—differentiated by hierarchical clustering based on the implementation of core initiatives. The number of outpatient visits and the number of inpatient visits were used as the outcomes. The ‘available beds’ and the ‘health personnel per 1000 resident population’ were chosen as the control variables.

Results

The cross-over Treat×Post coefficient was significantly positive at a 1% level in Models 1 and 3, with or without control variables. Specifically, the coefficient for the number of outpatients in Model 2 was significantly positive at the 5% level, supporting Hypothesis H1. Model 4 confirmed a significantly positive cross-over Treat×Post coefficient at a 1% level, and Model 3 showed a larger coefficient than Model 2, indicating greater benefits for the loose-knit cooperation model, supporting Hypothesis H2.

Conclusions

The hospital strategic alliance enhanced the paediatric service capacity of local hospitals. Furthermore, the close cooperation model appears to be a more effective solution for addressing health inequality caused by the scarcity and uneven distribution of paediatric service resources.
Virological failure and associated factors among patients receiving anti-retroviral therapy in Ethiopia: A systematic review and meta-analysis
Authors: Aytenew Tigabu Munye , Asferie Worku Necho , Ejigu Netsanet , Birhane Binyam Minuye , Tiruneh Yenework Mulu , Kassaw Amare , Asnakew Sintayehu , Legas Getasew , Munie Birhanu Mengist , Belay Bekalu Mekonnen , Ewunetu Mengistu , Kefale Demewoz , Kebede Solomon Demis
Published: November 2024

Objective

This study aimed to pool the prevalence of virological failure and associated factors.

Design

Systematic review and meta-analysis.

Primary outcome measure

Prevalence of virological failure.

Secondary outcome measure

Factors affecting virological failure.

Analysis

The extracted data were exported to STATA V.17 for statistical analysis. A random-effects DerSimonian-Laird model was used to compute the pooled prevalence of virological failure.

Setting

Ethiopia.

Participants

Patients receiving anti-retroviral therapy.

Results

A total of 51 primary studies with a sample size of 38, 789 participants were included in the final meta-analysis. The pooled prevalence of virological failure among patients receiving anti-retroviral therapy (ART) in Ethiopia was 15.95% (95% CI: 12.63, 19.27; I2=97.99%; p<0.001). Substance use (adjusted OR (AOR)=2.37, 95% CI: 1.28, 4.39), non-disclosure of HIV status (AOR=4.63, 95% CI: 3.51, 6.11), interruption of ART (AOR=2.61, 95% CI: 1.55, 4.40), poor adherence to ART (AOR=4.31, 95% CI: 2.73, 6.79), baseline CD4 cell count <200 cells/mm3(AOR=2.65, 95% CI: 1.62, 4.33), baseline advanced WHO clinical stage (WHO clinical stages III and IV) (AOR=3.02, 95% CI: 1.67, 5.45), baseline viral load >1000 copies/mL (AOR=4.63, 95% CI: 2.60, 8.26), opportunistic infections (AOR=3.58, 95% CI: 2.58, 4.96) and TB-HIV coinfection (AOR=3.97, 95% CI: 2.41, 6.54) were significantly associated with virological failure among patients receiving anti-retroviral therapy in Ethiopia.

Conclusions

The pooled prevalence of virological failure among patients receiving anti-retroviral therapy was high in Ethiopia. Therefore, due attention should be given to patients with these identified factors. Moreover, we recommend researchers to conduct a triangulated study that can address additional factors associated with virological failure.

PROSPERO registration number

The protocol was registered with the Prospero database (PROSPERO, 2024: CRD42024512411).
Impact of COVID-19 pandemic on traumatic brain injury emergency department visits, interfacility transfer and mortality in the United States, 2016–2020: a cross-sectional study
Authors: Gilkey Sydney , Armstrong Megan , Alexander Robin , Osong Biche , Sribnick Eric A , Stanley Rachel M , Groner Jonathan I , Cook Lawrence J , Lu Bo , Xiang Henry
Published: November 2024

Objective

The aim of this study was to determine how the COVID-19 pandemic affected patient demographics, injury mechanisms, interhospital transfers and mortality of patients with traumatic brain injuries (TBIs) treated in US emergency departments (EDs).

Design

This cross-sectional study analysed 2016–2020 Nationwide Emergency Department Sample (NEDS) data.

Setting

US EDs contained in the NEDS.

Participants

Participants were patients with moderate and severe TBI who visited the ED.

Primary and secondary outcome measures

Probability sampling design and survey weights generated nationally representative estimates of ED visits by patient demographics, hospital characteristics and COVID-19 diagnosis and the top four leading TBI causes. To assess COVID-19 impact, we calculated the per cent change of estimated TBI ED visits and disposition outcomes from 2016 to 2019 and 2019 to 2020, and proportion and 95% CI of injury severity groups and admitted/transfer by hospital type and trauma centre level. A multivariable logistic regression model identified the mortality OR by patient demographics, injury severity, hospital characteristics and COVID-19 positive diagnosis.

Results

In 2020, there were 527 123 ED visits nationally for TBI, 4.3% higher than 2016 but 1.0% lower than 2019. Patients with TBI transferring to short-term hospitals and other facilities increased by 16.0% and 18.2%, respectively, from 2016 to 2019 and were 3.7% and 14.1% higher in 2020 than in 2019. An estimated 3317 patients with TBI died (in ED or later in hospital) in 2020, which is 9.8% higher than 2019. Firearm-related TBI proportion was 15.1% higher in 2020 than in 2019. Patients with TBI with injury severity scores 25–75 were significantly higher at nontrauma (29.4% vs 31.9 %) and level III trauma centres (34.9% vs 38.2%) in 2020 than in 2019. Patients with TBI treated at rural hospitals had significantly higher odds of mortality (OR=1.95, CI=1.58–2.40) than those at urban hospitals.

Conclusions

TBI patient mortality was higher at all US hospital types and almost all trauma centre levels in 2020 than in 2019. Patients with TBI treated at rural hospitals had a significantly higher mortality risk.
Evaluation of BBIBP-CorV Sinopharm COVID-19 vaccine effectiveness in Sri Lanka: a test-negative case control study
Authors: De Silva Shamila Thivanshi , Ediriweera Dileepa Senajith , Wimalasena Wathsala , Kariyawasam Manjula , Kosinna Gihan , Bogoda Gayan , Senaratne Sumudu , Rathnayake Kanchana , Weerarathna Inosha , Premaratna Ranjan , Gunasena Prasanna
Published: November 2024

Objectives

There is limited research on real-world effectiveness of BBIBP-CorV Sinopharm COVID-19 vaccine. This study evaluated real-world effectiveness of Sinopharm vaccine in Sri Lanka by assessing absolute vaccine efficacy.

Design and setting

A retrospective test-negative case-control study was conducted at ten large government hospitals across the country.

Participants

Consecutive adults aged ≥18 years attending outpatient departments who tested reverse-transcription-PCR positive for SARS-CoV-2 during the study period were recruited.

Main outcome measures

An interviewer-administered questionnaire was administered, and outcome of COVID-19 infection was assessed in cases.

Results

Of 1829 recruited, 914 (49.9%) were male, and mean age was 45.2 (SD 15.3) years; 1634 (89.3%) were vaccinated with two doses of BBIBP-CorV Sinopharm vaccine, while 195 (10.1%) were vaccine-naïve. Compared with the vaccinated, unvaccinated persons were older but otherwise similar in their demographic and medical profiles. Unvaccinated were more likely to have fever, shortness of breath and vomiting as symptoms and were more likely to seek treatment. Significantly more vaccinated individuals received treatment at home. After admission, the unvaccinated were more likely to receive oxygen. Significantly more unvaccinated persons died of COVID-19 compared with the vaccinated. Sinopharm vaccine was 78.2% (94% CI 69.0% to 85.0%) effective at preventing COVID-19 infection, 88.7% (81.6%–93.2%) effective at preventing severe infection and 85.6% (69.6%–93.6%) effective at preventing death.

Conclusions

BBIBP-CorV Sinopharm vaccine is effective at mitigating severity of illness and reducing the likelihood of hospitalisation, severe illness and death, in those who received primary vaccination, compared with the unvaccinated.
Identifying practices of information transfer between the hospital and primary care for older adults: a scoping review protocol
Authors: Yang Dimitri , Alkot Martina , Quaiattini Andrea , Lessard Sabrina , Zaripova Aigul , Pavoni Carolyn , Couture Sandrine , Desmarais Philippe , Huang Yu Qing , McDonald Emily G. , Richer Catherine , Chabot Julia , Pageau Felix , Tannou Thomas , Layani Géraldine , Rouabhia Dounia , Calafiore Matthieu , Fink Karin , Yilmaz Gulin , Jean-Baptiste Beuscart , Godard-Sebillotte Claire
Published: November 2024

Introduction

Transition of care from hospital to primary care has been recognised globally as a high-risk scenario for older patients’ safety by the WHO. Indeed, sub-optimal care transitions are associated with increased mortality, morbidity and adverse events.

Improving communication through timely and accurate clinical information transfer has been identified as a key component of optimal care transitions. However, timely and accurate clinical information transfer from hospital to primary care varies across countries and institutions. Information transfer practices are heterogeneous, in some places depending on individual initiative and sometimes not occurring at all.

To improve current practices, we will conduct a scoping review to identify the current and suggested practices of information transfer between hospital-based physicians or pharmacists and the primary care team of older patients.

Methods and analysis

This scoping review will be conducted using Arksey and O’Malley’s methodological framework, augmented by Levacet aland the JBI Manual for Evidence Synthesis, and the findings reported according to the PRISMA extension for Scoping Reviews. We will use a search strategy developed with a specialised librarian to search four databases (MEDLINE, Embase, CINAHL and AgeLine) and reference lists of selected studies. All studies adhering to our iteratively created eligibility criteria outlined by the population, concept and context elements will be included. The data extraction table will also be constructed iteratively with the research team, and results will be presented tabularly and qualitatively.

Ethics and dissemination

Ethics approval was obtained. We plan to disseminate the results as scientific communication (peer-reviewed journal and presentations) and during a deliberative dialogue workshop with key stakeholders in order to generate recommendations to improve current practices in our own clinical setting, potentially to be adapted and scaled up with our collaborators provincially, nationally and internationally.

This protocol has been registered on the Open Science Framework:https://osf.io/eg958.
Investigating the effect of verapamil on preservation of beta-cell function in adults with newly diagnosed type 1 diabetes mellitus (Ver-A-T1D): protocol for a randomised, double-blind, placebo-controlled, parallel-group, multicentre trial
Authors: Wych Julie , Brunner Martina , Stenson Rachel , Chmura Piotr Jaroslaw , Danne Thomas , Mander Adrian Paul , Mathieu Chantal , Dayan Colin , Pieber Thomas R
Published: November 2024

Introduction

Type 1 diabetes mellitus (T1DM) is a disorder that arises following the selective autoimmune destruction of the insulin-producing beta cells. Beta-cell protective or beta-cell regenerative approaches have gained wider attention, and pharmacological approaches to protect the patient’s own insulin-producing beta-cell mass have been proposed. Verapamil is an L-type calcium channel blocker that has been reported to effectively lowers beta-cell thioredoxin-interacting protein expression in rodent beta cells and islets, as well as in human islets, and thus promotes functional beta-cell mass.

Methods and analysis

The trial is a multicentre, randomised, double-blind, placebo-controlled trial in participants with T1DM, investigating the effect of verapamil on preservation of beta-cell function (Ver-A-T1D). A total of 120 participants will be randomised in a 2:1 ratio between 360 mg verapamil and placebo, administered orally once daily. T1DM patients aged ≥18 and <45 years will be eligible for recruitment within 6 weeks of diagnosis (defined as day of starting insulin therapy). The primary objective will be to determine the changes in stimulated C-peptide response during the first 2 hours of a mixed meal tolerance test at baseline and after 12 months for 360 mg verapamil administered orally once daily versus placebo. Secondary objectives include the effects of 360 mg verapamil on (1) fasting C-peptide, (2) dried blood spot C-peptide, (3) glycated haemoglobin, (4) daily total insulin dose, (5) time in range by intermittent continuous glucose monitoring measures, (6) other biomarkers related to immunological changes and beta-cell death and (6) safety (vital signs, ECG).

Ethics and dissemination

Ethics approval was sought from the research ethics committee of all participating countries. All participants provided written informed consent before joining the study. Ver-A-T1D received first regulatory and ethical approvals in Austria. The publication policy is set in the innovative approach towards understanding and arresting type 1 diabetes grant agreement (www.innodia.eu).

Trial registration number

EudraCT, 2020-000435-45; ClinicalTrials.gov,NCT04545151. Protocol version: Version 8.0 (08 November 2021).
‘Counselling is the only thing to do’: healthcare providers’ experience of Kangaroo Mother Care in Bangladesh – a qualitative study
Authors: Sjömar Johanna , Thernström Blomqvist Ylva , Talha Taqbir Us Samad , Rahman Syed Moshfiqur , Målqvist Mats
Published: November 2024

Aim

To explore healthcare providers’ (HCPs) experiences of facility-initiated kangaroo mother care (KMC) in Bangladesh.

Methods

An explorative qualitative study based on 11 semistructured interviews with HCPs from 2 hospitals in Dhaka was conducted. Nurses, medical officers and paediatric consultants were representing the HCPs. Inductive, qualitative content analysis was used.

Results

Supporting KMC needs to be a continuous process that requires a high level of commitment from healthcare staff. Optimal implementation is, however, challenged by structural conditions such as shortage of staff, separation of mother and child, and incomplete follow-up, which need to be addressed to support KMC.

Conclusion

Findings from this formative research can help in designing interventions for scaling up KMC in Bangladesh by paying attention to the crucial role of HCPs and giving them training on the importance of continuous and repeated counselling to both mother and family. To enhance motivation, involving nurses in follow-up care is essential, alongside strengthening the health system for families living far away and tracking those not attending follow-up. Furthermore, after this study was conducted, the WHO updated its recommendations regarding KMC. This means that the current study, in combination with the WHO’s new recommendations, can be used for the development of new guidelines for KMC in clinical practice in Bangladesh.
Geophagy: uses and perceptions of women of childbearing age in Tshwane District, Gauteng Province—a qualitative study
Authors: Malebatja Mohora Feida , Randa Moreoagae Bertha , Mokgatle Mathildah Mpata , Oguntibeju Oluwafemi Omoniyi
Published: November 2024

Background

Geophagy is a common practice among women of childbearing age across the globe associated with detrimental health effects.

Objective

The study aimed at ascertaining the views and uses of geophagy among women of childbearing age in Tshwane District, Gauteng Province.

Methods

An exploratory qualitative study was conducted among women of childbearing age consulting the reproductive healthcare units in Tshwane District. Focus group discussions and in-depth interviews were conducted in the public healthcare facilities.

Results

The study findings indicate that women of childbearing age lack proper understanding of the dangers associated with the practice of geophagy. Many participants perceived geophagy as a practice that is socially acceptable and harmless, that is mostly practised by pregnant women. It was further revealed that geophagy is practised by people who have iron deficiency anaemia and those who are addicted to feed their cravings.

Conclusion

A conclusion has been made that the practice of geophagy is accelerated by addiction and cravings, pregnancy, social acceptability and accessibility, boredom, fun and entertainment. Influence from family members and peer pressure play a significant role when it comes to the practice of geophagy.
Risk of long-term ophthalmological complications in Taiwanese preterm infants: a nationwide cohort study
Authors: Huang Chia-Yu , Tou Sio-Ian , Lin Heng-Jun , Yen Hung-Rong
Published: November 2024

Objectives

The aim was to determine whether different maturity levels and birth weights could change the risk of long-term ophthalmological complications in preterm infants.

Design

This was a cohort study.

Setting

This was a nationwide population-based study.

Participants

Newborns born between 2009 and 2012 were identified; newborns with congenital deformities, newborns with missing data on urban area, sex, gestational week at birth or birth weight and newborns who died before the age of 8 years were excluded.

Interventions

Infants were divided into full-term, preterm and preterm with retinopathy of prematurity (ROP) cohorts based on their basic characteristics at birth.

Primary outcome measures

The primary outcomes were ophthalmological complications, including strabismus, refractive error, amblyopia, cataracts and glaucoma.

Results

Ultimately, 735 702 infants were included in the analysis. There were 727 403, 7165 and 1134 newborns in the full term, preterm without ROP and preterm with ROP cohorts, respectively. Premature infants, whether without ROP or with ROP, had an elevated risk of various ophthalmic complications, with adjusted ORs (aORs) ranging from 1.48 to 2.74 and 1.90 to 10.34, respectively. Extremely low birth weight contributes to an increased risk of various ophthalmic complications, with aORs ranging from 2.21 to 6.55. Moreover, a higher number of negative variables, such as preterm birth or low body weight, increased the risk of various ophthalmological complications, with the aOR falling within the range of 1.03–23.86.

Conclusions

Immaturity and low body weight were risk factors for ophthalmological complications in preterm infants. The presence of both of these two risk factors increased the risk of ophthalmological complications. Our results are essential for caregivers and health policy-makers to design comprehensive follow-up plans for preterm infants.
Healthcare decision-makers’ perspectives on evaluating conflict management training in paediatric healthcare: a utilisation-focused qualitative study
Authors: Phillipson Juliette , Barclay Sarah , Menson Esse , Lyons Oscar
Published: November 2024

Background

Conflict is prevalent across healthcare settings but is especially common in paediatrics, where high emotional stakes and parental expectations often intensify disagreements. Conflict can lead to negative outcomes for hospitals, staff and patients. Effective conflict management training can mitigate these impacts, but evaluating such training programmes remains challenging due to a lack of standardised tools and best practices.

Methods

This qualitative study aimed to explore healthcare decision-makers' perspectives on what key areas should be evaluated in conflict management training programmes in paediatric healthcare settings, employing Patton’s utilisation-focused evaluation approach. Semi-structured interviews were conducted with 13 healthcare decision-makers and key stakeholders from various healthcare and charitable organisations. Interviews were analysed using reflexive thematic analysis by Braun and Clarke to identify key themes for evaluation.

Results

Four primary themes were generated regarding the key areas that healthcare decision-makers believe should be evaluated in conflict management training. These were experience of training sessions, staff competency and well-being, patient/family experiences of conflict and impact on staff time and on clinical resources. Interviewees identified that the evaluation of training sessions should focus on participant engagement and satisfaction. Codes relating to staff competency and well-being included the acquisition and long-term retention of conflict management skills. Codes relating to patient/family experience focused on the quality of communication and support during conflicts. The theme of resource utilisation included codes relating to the time and cost implications of conflict.

Conclusion

The study identified essential evaluation areas that align with and expand on Kirkpatrick’s framework, suggesting the need for both qualitative and quantitative data and long-term follow-up. Tailoring evaluation frameworks to specific programme contexts can enhance their relevance and utility, contributing to improved conflict management in both paediatric and wider healthcare settings.