bluuebunny/crossref_metadata_2025 huggingface dataset:
A narrative review of high-level isolation unit operational and infrastructure features
Authors: Lukowski Joseph , Vasa Angela , Arguinchona Christa , ElRayes Wael , Frank Maria G , Galdys Alison L , Garcia Mary C , Garland Jennifer A , Kline Susan , Persson Caroline , Ruby Darrell , Sauer Lauren M , Vasistha Sami , Carrasco Sharon , Herstein Jocelyn J
Published: July 2023

High-level isolation units (HLIUs) are specially designed facilities for care and management of patients with suspected or confirmed high-consequence infectious diseases (HCIDs), equipped with unique infrastructure and operational features. While individual HLIUs have published on their experiences caring for patients with HCIDs and two previous HLIU consensus efforts have outlined key components of HLIUs, we aimed to summarise the existing literature that describes best practices, challenges and core features of these specialised facilities. A narrative review of the literature was conducted using keywords associated with HLIUs and HCIDs. A total of 100 articles were used throughout the manuscript from the literature search or from alternate methods like reference checks or snowballing. Articles were sorted into categories (eg, physical infrastructure, laboratory, internal transport); for each category, a synthesis of the relevant literature was conducted to describe best practices, experiences and operational features. The review and summary of HLIU experiences, best practices, challenges and components can serve as a resource for units continuing to improve readiness, or for hospitals in early stages of developing their HLIU teams and planning or constructing their units. The COVID-19 pandemic, a global outbreak of mpox, sporadic cases of viral haemorrhagic fevers in Europe and the USA, and recent outbreaks of Lassa fever, Sudan Ebolavirus, and Marburg emphasise the need for an extensive summary of HLIU practices to inform readiness and response.
Estimating the prevalence of poor-quality anti-TB medicines: a neglected risk for global TB control and resistance
Authors: Tabernero Patricia , Newton Paul N
Published: July 2023

Objectives

Tuberculosis (TB) remains a major global public health problem, especially with the recent emergence of multidrug-resistant TB and extensively drug-resistant TB. There has been little consideration of the extent of substandard and falsified (SF) TB medicines as drivers of resistance. We assessed the evidence on the prevalence of SF anti-TB medicines and discussed their public health impact.

Materials/methods

We searched Web of Science, Medline, Pubmed, Google Scholar, WHO, US Pharmacopeia and Medicines Regulatory Agencies websites for publications on anti-TB medicines quality up to 31 October 2021. Publications reporting on the prevalence of SF anti-TB drugs were evaluated for quantitative analysis.

Results

Of the 530 screened publications, 162 (30.6%) were relevant to anti-TB medicines quality; of those, 65 (40.1%) described one or more TB quality surveys in a specific location or region with enough information to yield an estimate of the local prevalence of poor-quality TB medicines. 7682 samples were collected in 22 countries and of those, 1170 (15.2%) failed at least one quality test. 14.1% (879/6255) of samples failed in quality surveys, 12.5% (136/1086) in bioequivalence studies and 36.9% (87/236) in accelerated biostability studies. The most frequently assessed were rifampicin monotherapy (45 studies, 19.5%) and isoniazid monotherapy (33, 14.3%), rifampicin-isoniazid-pyrazinamide-ethambutol fixed dose combinations (28, 12.1%) and rifampicin-isoniazid (20, 8.6%). The median (IQR) number of samples collected per study was 12 (1–478).

Conclusions

SF, especially substandard, anti-TB medicines are present worldwide. However, TB medicine quality data are few and are therefore not generalisable that 15.2% of global anti-TB medicine supply is SF. The evidence available suggests that the surveillance of the quality of TB medicines needs to be an integral part of treatment programmes. More research is needed on the development and evaluation of rapid, affordable and accurate portable devices to empower pharmacy inspectors to screen for anti-TB medicines.
AVIVA: a telehealth tool to improve cervical cancer screening in resource-constrained settings
Authors: Ogunsola Olabanjo Okunlola , Olawepo John Olajide , Ajayi Oluseye , Osayi Emmanuel , Akinro Yewande Toluwabori , Ifechelobi Chukwuemeka , Chigbu Chibuike , Okonkwo Prosper , Ezeanolue Echezona Edozie
Published: July 2023

Cervical cancer accounts for 21.7% of all cancer deaths in the sub-Saharan Africa with a case fatality rate of 68%. Nigeria’s Federal Ministry of Health has adopted cervical cancer screening (CCS) using visual inspection with acetic acid or Lugol’s iodine (VIA/VILI) and cryotherapy treatment for precancerous lesions as the preferred screening and treatment strategy. Using the Exploration, Preparation, Implementation and Sustainment Framework, our study documents our experience during the development, piloting and roll-out of the APIN Public Health Initiatives (APIN)-developed VIA Visual Application (AVIVA) for CCS using the VIA method in 86 APIN-supported health facilities across 7 states in Nigeria. Between December 2019 and June 2022, with the aid of 9 gynaecologists and 133 case finders, a total of 29 262 women living with HIV received VIA-based CCS and 1609 of them were VIA-positive, corresponding to VIA positivity rate of 5.5%. Over the 30 months duration and the 5 phases of CCS scale-up, AVIVA development and expansion, a total of 1247 cases were shared via the AVIVA App (3741 pictures), with 1058 of such cases undergoing expert review, corresponding to a reviewer rate of 84.8%. Overall, the use of the AVIVA App improved both the VIA-positive and VIA-negative concordance rates by 16 percentage points each (26%–42% and 80%–96%, respectively) from baseline to the end of the study. We concluded that the AVIVA App is an innovative tool to improve CCS rates and diagnostic precision by connecting health facility staff and expert reviewers in resource-limited settings.
Patientsrequestingandreceivingeuthanasia for psychiatric disorders in the Netherlands
Authors: Kammeraat Monique , van Rooijen Geeske , Kuijper Lisette , Kiverstein Julian D , Denys Damiaan A J P
Published: July 2023

Background

Euthanasia and assisted suicide (EAS) for patients with psychiatric disorders occupies a prominent place in the public debate, but little is known about the psychiatric patients requesting and receiving EAS.

Objective

To compare the social demographic and psychiatric profile of the patients who make a request for EAS and those who receive it.

Method

We carried out a review of records from 1122 patients with psychiatric disorders who have filed a potentially eligible request for EAS at Expertise Centrum for Euthanasia (EE) in the period 2012–2018.

Findings

The majority of the patients requesting EAS were single females, living independently with a comorbid diagnosis of depression with a history of undergoing psychiatric treatment for more than 10 years. From the small number of patients who went on to receive EAS in our sample, the majority were also single women, with a diagnosis of depressive disorder. A small subgroup of patients whose diagnoses included somatic disorders, anxiety disorders, obsessive-compulsive disorders and neurocognitive disorders were over-represented in the group of patients receiving EAS compared with the applicant group.

Conclusion

The average demographic and psychiatric profile of patients requesting and receiving EAS were found to be broadly similar. The majority of patients requesting EAS had received a comorbid diagnosis, making this a difficult-to-treat patient group. Only a small number of patients requesting had their requests granted. Patients from different diagnostic groups showed patterns in why their requests were not granted.

Clinical implications

Many of the patients who withdrew their requests for EAS benefited from being able to discuss dying with end of life experts at EE. Health professionals can make a difference to a vulnerable group of patients, if they are trained to discuss end of life.
Anatomical distribution and clinical significance of middle cerebral artery M2 segment vessel occlusions and its cortical branches in acute ischaemic stroke patients
Authors: Gruber Philipp , Valbuena Paola , Sassenburg Renske , Anon Javier , Andereggen Lukas , Berberat Jatta , Remonda Luca
Published: July 2023

Background

Characterisation of anatomical distribution and the clinical impact of middle cerebral artery M2 (MCA-M2) segment occlusion and its subsequent cortical branches (CBs) in acute ischaemic stroke patients (AIS).

Methods

Retrospective, monocentric study analysing radiological and clinical data of AIS patients with MCA-M2 segment occlusion with regard to the anatomic distribution of MCA-M2 occlusion and its subsequent CB.

Results

A total of 203 patients (median age 77 (IQR 66–83) years, 112 women) were included. There was an equal distribution of right-sided versus left-sided MCA-M2 vessel occlusions (right: n=97; left: n=106), as well as with a median number of affected MCA-M2 CBs of 4 (IQR, 3–6) and a median National Institute of Health Stroke Scale score (NIHSS) on admission of 9 (3–15). For both hemispheres, CBs of the inferior trunks were significantly more affected than the superior trunks. Endovascular treatment (EVT, n=94) was associated with a significant better outcome compared with patients with medical management alone (p=0.027).

Conclusion

In acute MCA-M2 segment occlusions, inferior trunks are significantly more affected compared with the superior trunks. The subsequent CBs of the paracentral region of both hemispheres are more commonly involved. In eloquent vascular territories, EVT was more often performed.
Role of optical coherence tomography in depression detection: a protocol of systematic review and meta-analysis
Authors: Xiao Xili , Zhong Dongling , Liu Huan , Fan Rong , Jiang Chengzhi , Zheng Zhong , Li Yuxi , Wan Li
Published: July 2023

Introduction

Optical coherence tomography (OCT) is a non-invasive approach for detecting changes in the retinal layers, which may also reflect changes in brain structure and function. As one of the leading causes of disability worldwide, depression has been associated with alteration of brain neuroplasticity. However, the role of OCT measurements in detecting depression remains unknown. This study aims to employ a systematic review and meta-analysis approach to explore ocular biomarkers measured by OCT for detecting depression.

Methods and analysis

We will search studies describing the relationship between OCT and depression across seven electronic databases, and retrieve articles published from database inception to date. We will also manually search grey literature and reference lists included in the retrieved studies. Two independent reviewers will screen studies, extract data and assess risk of bias. Target outcomes will include peripapillary retinal nerve fibre layer thickness, macular ganglion cell complex thickness and macular volume, as well as other related indicators. Next, we will conduct subgroup analysis and meta-regression to explore study heterogeneity, then perform sensitivity analysis to investigate the robustness of the synthesised results. Meta-analysis will be performed using Review Manager (V.5.4.1) and STATA (V.12.0), and the certainty of evidence will be graded according to the Grading of Recommendations Assessment, Development and Evaluation system.

Ethics and dissemination

Ethics approval is not necessary because the data used in this systematic review and meta-analysis will be extracted from published studies. Study results will be disseminated by publishing our findings in a peer-reviewed journal.
Process evaluation in practice based research networks: a study protocol for a mixed-methods implementation study
Authors: Sanftenberg Linda , Dreischulte Tobias , Härdtlein Annette , Kosub Helena , Gagyor Ildiko , Kurotschka Peter Konstantin , Kühlein Thomas , Burggraf Larissa , Eck Stefanie , Roos Marco , Gensichen Jochen
Published: July 2023

Introduction

General practitioners often criticise clinical trials for their poor applicability in primary care, which may at least partially explain why their engagement in primary care research remains limited. In order to enhance primary care research, the German government has funded six regional practice based research networks (PBRNs). Within the Bavarian PBRN (BayFoNet), two cluster-randomised pilot trials will be conducted. This paper presents the protocol of the process evaluation accompanying both trials, which aims to explore relevance, feasibility, acceptability and credibility of clinical research in primary care from the perspectives of BayFoNet researchers, general practitioners, and patients.

Methods and analysis

The BayFoNet will be established by recruiting general practices (GPs) as prospective research collaborators in two cluster randomised pilot trials. Research teams will provide training in good clinical practice, and support practices in patient recruitment, data collection and documentation. Our process evaluation explores barriers and facilitators in the set up of the BayFoNet PBRN and both cluster randomised pilot trials, under the application of the consolidated framework for implementation research and the theoretical domains framework. In a mixed-methods concept, we will use qualitative and quantitative approaches to evaluate both pilot cluster-randomised trials as well as the BayFoNet itself: focus groups with researchers, semi-structured interviews with general practitioners and questionnaires for patients participating in the pilot cluster-randomised trials at three different time points.

Ethics and dissemination

Research ethical approval for this study was granted by the Ethics Committee of the Medical Department, Ludwig-Maximilians-University Munich (AZ 21-1135). Results will be published in international peer-reviewed journals and summaries will be provided to the funders of the study as well as other PBRNs, GP teams and patients.

Trial registration numbers

DRKS00028805,NCT05667207.
Prevalence, risk factors and management of common mental health disorders in Cameroon: a systematic review protocol
Authors: Ngwa Che Henry , Njuma Libwea John , Keinamma Marion , Wirsiy Frankline Sevidzem , Nji Kah Emmanuel , Mpofu Limkile
Published: July 2023

Background

Mental health disorders (MHDs) are considered a serious public health concern globally. The burden of mental health conditions is estimated to be higher in low-income and middle-income countries, including Cameroon, where reliable estimates are lacking. This review aims to synthesise evidence on the prevalence of MHDs, the effectiveness of mental health management interventions and identify risk factors for MHDs in Cameroon.

Method

This review will systematically search electronic databases for studies focusing on one or more MHDs of interest within the context of Cameroon. We will include cohort, case–control and cross-sectional studies which assessed the prevalence or risk factors for MHDs in Cameroon and intervention studies to provide evidence on the effectiveness of interventions for managing MHDs. Two reviewers will independently perform all screening stages, data extraction and synthesis. We will provide a narrative synthesis and, if we identify enough articles that are homogeneous, we will perform a meta-analysis using a random effect model. The strength of the evidence will be assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach.

Conclusion

This review will contribute to the current body of knowledge by providing a synthesis of current evidence on the prevalence of common MHDs, risk factors for different MHDs and the effectiveness of interventions for managing different mental health conditions in Cameroon.

Ethics and dissemination

This study will involve synthesis of published literature and does not warrant ethical approval. The findings will be disseminated through internationally peer-reviewed journals related to mental health.

PROSPERO registration number

CRD42022348427.
Excess deaths directly and indirectly attributable to COVID-19 using routinely reported mortality data, Bishkek, Kyrgyzstan, 2020: a cross-sectional study
Authors: Bumburidi Yekaterina , Dzhalimbekova Altynai , Malisheva Marina , Moolenaar Ronald L , Horth Roberta , Singer Daniel , Otorbaeva Dinagul
Published: July 2023

Objectives

Studies on excess deaths (ED) show that reported deaths from COVID-19 underestimate death. To understand mortality for improved pandemic preparedness, we estimated ED directly and indirectly attributable to COVID-19 and ED by age groups.

Design

Cross-sectional study using routinely reported individual deaths data.

Settings

The 21 health facilities in Bishkek that register all city deaths.

Participants

Residents of Bishkek who died in the city from 2015 to 2020.

Outcome measure

We report weekly and cumulative ED by age, sex and causes of death for 2020. EDs are the difference between observed and expected deaths. Expected deaths were calculated using the historical average and the upper bound of the 95% CI from 2015 to 2019. We calculated the percentage of deaths above expected using the upper bound of the 95% CI of expected deaths. COVID-19 deaths were laboratory confirmed (U07.1) or probable (U07.2 or unspecified pneumonia).

Results

Of 4660 deaths in 2020, we estimated 840–1042 ED (79–98 ED per 100 000 people). Deaths were 22% greater than expected. EDs were greater for men (28%) than for women (20%). EDs were observed in all age groups, with the highest ED (43%) among people 65–74 years of age. Hospital deaths were 45% higher than expected. During peak mortality (1 July –21 July), weekly ED was 267% above expected, and ED by disease-specific cause of death were above expected: 193% for ischaemic heart diseases, 52% for cerebrovascular diseases and 421% for lower respiratory diseases. COVID-19 was directly attributable to 69% of ED.

Conclusion

Deaths directly and indirectly associated with the COVID-19 pandemic were markedly higher than reported, especially for older populations, in hospital settings, and during peak weeks of SARS-CoV-2 transmission. These ED estimates can support efforts to prioritise support for persons at greatest risk of dying during surges.
Maternal and environmental Impact assessment on Neurodevelopment in Early childhood years (MINE): a prospective cohort study protocol from a low, middle-income country
Authors: Surani Zoya , Parkar Sadia , Afshan Gul , Elahi Kinza Naseem , Hoodbhoy Zahra , Hilal Kiran , Jafri Sidra Kaleem
Published: July 2023

Introduction

Environmental and psychosocial adversities negatively impact children’s developmental outcomes. When these factors are experienced in early childhood—a sensitive period of development—the developing brain can be altered. While these associations have been drawn in high-income countries, it is necessary to understand child growth, neurodevelopment, and the role of environmental factors in developmental trajectories in low-income settings. The objective of this study is to longitudinally assess how demographic factors, maternal health, maternal development, and child health, are related to child development on a behavioural, cognitive, and neuroimaging level in low-socioeconomic communities.

Methods and analysis

Mother–child dyads will be identified in the peri-urban field sites of Rehri Goth and Ibrahim Hyderi, Karachi, Pakistan. Dyads will undergo yearly assessments for 4 years beginning when the child is 1 month, 3 months or 6 months of age (+≤30 days of age) (depending on group assignment). Maternal assessments include anthropometry, behavioural, cognitive, and developmental assessments (Edinburgh Postnatal Depression Scale; Parenting Stress Index; Maternal Autonomy Index; Hurt, Insult, Threaten, Scream Tool; Reynolds Intellectual Assessment Scales (RIAS)), and biological samples collection (breast milk, blood, stool, hair). Children’s assessments include anthropometry, developmental assessments (Global Scales for Early Development (GSED); RIAS), MRI brain assessments, and biological sample collection (blood, stool, hair). Using cross-sectional and longitudinal data with statistical analysis tools, associations will be quantified between brain structure (MRI) and connectivity (resting state connectivity and diffusion tensor imaging), general cognitive skills (RIAS, GSED) and environmental influences (nutrition via biological samples, maternal mental health via questionnaires) through repeated measures analysis of variance tests and χ2tests. Quantile regression and cortical analyses will be conducted to understand how demographic factors are related to the associations found.

Ethics and dissemination

The study has received ethical approval from the Aga Khan University Ethics Review Committee. The study’s findings will be disseminated through scientific publications and project summaries for the participants.
Identifying efficient linkage strategies for men (IDEaL): a study protocol for an individually randomised control trial
Authors: Dovel Kathryn , Balakasi Kelvin , Hubbard Julie , Phiri Khumbo , Nichols Brooke E , Coates Thomas J , Kulich Michal , Chikuse Elijah , Phiri Sam , Long Lawrence C , Hoffman Risa M , Choko Augustine T
Published: July 2023

Introduction

Men in sub-Saharan Africa are less likely than women to initiate antiretroviral therapy (ART) and more likely to have longer cycles of disengagement from ART programmes. Treatment interventions that meet the unique needs of men are needed, but they must be scalable. We will test the impact of various interventions on 6-month retention in ART programmes among men living with HIV who are not currently engaged in care (never initiated ART and ART clients with treatment interruption).

Methods and analysis

We will conduct a programmatic, individually randomised, non-blinded, controlled trial. ‘Non-engaged’ men will be randomised 1:1:1 to either a low-intensity, high-intensity or stepped arm. The low-intensity intervention includes one-time male-specific counseling+facility navigation only. The high-intensity intervention offers immediate outside-facility ART initiation+male-specific counselling+facility navigation for follow-up ART visits. In the stepped arm, intervention activities build in intensity over time for those who do not re-engage in care with the following steps: (1) one-time male-specific counselling+facility navigation→(2) ongoing male mentorship+facility navigation→(3) outside-facility ART initiation+male-specific counselling+facility navigation for follow-up ART visits. Our primary outcome is 6-month retention in care. Secondary outcomes include cost-effectiveness and rates of adverse events. The primary analysis will be intention to treat with all eligible men in the denominator and all men retained in care at 6 months in the numerator. The proportions achieving the primary outcome will be compared with a risk ratio, corresponding 95% CI and p value computed using binomial regression accounting for clustering at facility level.

Ethics and dissemination

The Institutional Review Board of the University of California, Los Angeles and the National Health Sciences Research Council in Malawi have approved the trial protocol. Findings will be disseminated rapidly in national and international forums and in peer-reviewed journals and are expected to provide urgently needed information to other countries and donors.

Trial registration number

NCT05137210.

Date and version

5 May 2023; version 3.
PupillOmetry for preDIction of DeliriUM in ICU (PODIUM): protocol for a prospective multicentre cohort study
Authors: Jaquet Pierre , Couffignal Camille , Tardivon Coralie , Godard Virginie , Bellot Romane , Assouline Benjamin , Benghanem Sarah , Da Silva Daniel , Decavèle Maxens , Dessajan Julien , Hermann Bertrand , Rambaud Thomas , Voiriot Guillaume , Sonneville Romain
Published: July 2023

Introduction

Delirium is a severe complication that is associated with short-term adverse events, prolonged hospital stay and neurological sequelae in survivors. Automated pupillometry is an easy-to-use device that allows for accurate objective assessment of the pupillary light responses in comatose patients in the intensive care unit (ICU). Whether automated pupillometry might predict delirium in critically ill patients is not known. We hypothesise that automated pupillometry could predict the occurrence of delirium in critically ill patients without primary brain injury, requiring more than 48 hours of invasive mechanical ventilation in the ICU.

Methods and analysis

The PupillOmetry for preDIction of DeliriUM in ICU (PODIUM) study is a prospective cohort study, which will be conducted in eight French ICUs in the Paris area. We aim to recruit 213 adult patients requiring invasive mechanical ventilation for more than 48 hours. Automated pupillometry (Neurological Pupil Index; NPi-200, Neuroptics) will be assessed two times per day for 7 days. Delirium will be assessed using the Confusion Assessment Method in ICU two times per day over 14 days in non-comatose patients (Richmond Agitation and Sedation Scale ≥−3).

The predictive performances of the seven automated pupillometry parameters (ie, pupillary diameter, variation of the pupillary diameter, pupillary constriction speed, pupillary dilatation speed, photomotor reflex latency, NPi and symmetry of pupillary responses) measured to detect the delirium occurrence within 14 days will be the main outcomes. Secondary outcomes will be the predictive performances of the seven automated pupillometry parameters to detect complications related to delirium, ICU length of stay, mortality, functional and cognitive outcomes at 90 days.

Ethics and dissemination

The PODIUM study has been approved by an independent ethics committee, the Comité de Protection des Personnes (CPP) OUEST IV—NANTES (CPP21.02.15.45239 32/21_3) on 06 April 2021). Participant recruitment started on 15 April 2022. Results will be published in international peer-reviewed medical journals and presented at conferences.

Trial registration number

NCT05248035; clinicaltrials.gov.
Assessing tobacco use in Swedish young adults from self-report and urinary cotinine: a validation study using the BAMSE birth cohort
Authors: Zettergren Anna , Sompa Shanzina , Palmberg Lena , Ljungman Petter , Pershagen Göran , Andersson Niklas , Lindh Christian , Georgelis Antonios , Kull Inger , Melen Erik , Ekström Sandra , Bergstrom Anna
Published: July 2023

Objectives

Studies on health effects of tobacco often rely on self-reported exposure data, which is subjective and can lead to misclassification. The aim of this study was to describe the prevalence of cigarette smoking, snus and e-cigarette use, as well as to validate self-reported tobacco use among young adults in Sweden.

Method

Participants of a population-based Swedish cohort (n=3052), aged 22–25 years, assessed their tobacco use in a web questionnaire. Urinary cotinine was analysed in a subsample of the study population (n=998). The agreement between self-reported tobacco use and urinary cotinine was assessed using Cohen’s Kappa coefficient (κ) at a cut-off level of 50 ng/mL.

Results

Patterns of tobacco use differed between men and women. Among men, 20.0% reported daily snus use, 5.8% daily cigarette smoking and 5.6% any e-cigarette use. In contrast, 3.2% of the women reported daily snus use, 9.0% daily cigarette smoking and 2.4% any e-cigarette use. Among the tobacco use categories, daily snus users had the highest levels of cotinine. Of reported non-tobacco users, 3.5% had cotinine levels above the cut-off, compared with 68.0% among both occasional cigarette smokers and snus users, 67.5% among all e-cigarette users and 94.7% and 97.8% among daily cigarette smokers and snus users, respectively. Agreement between self-reported tobacco use and urinary cotinine was classified as strong for daily use of cigarettes (κ=0.824) and snus (κ=0.861), while moderate to weak for occasional smoking (κ=0.618), occasional snus use (κ=0.573) and any e-cigarette use (κ=0.576).

Conclusions

We found high validity of self-reported tobacco use in our study population, particularly for daily tobacco use. Further, we found that daily snus users were exposed to high levels of cotinine. Together with previous findings, our results indicate good validity of self-reported tobacco use among young adults.
Readiness of health facilities to provide services related to non-communicable diseases in Nepal: evidence from nationally representative Nepal Health Facility Survey 2021
Authors: Adhikari Bikram , Pandey Achyut Raj , Lamichhane Bipul , KC Saugat Pratap , Joshi Deepak , Regmi Shophika , Giri Santosh , Baral Sushil Chandra
Published: July 2023

Objective

To assess the readiness of public and private health facilities (HFs) in delivering services related to non-communicable diseases (NCDs) in Nepal.

Methods

We analysed data from nationally representative Nepal Health Facility Survey 2021 to determine the readiness of HFs for cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic respiratory diseases (CRDs) and mental health (MH)-related services using Service Availability and Readiness Assessment Manual of the WHO. Readiness score was measured as the average availability of tracer items in per cent, and HFs were considered ‘ready’ for NCDs management if they scored ≥70 (out of 100). We performed weighted univariate and multivariable logistic regression to determine the association of HFs readiness with province, type of HFs, ecological region, quality assurance activities, external supervision, client’s opinion review and frequency of meetings in HFs.

Results

The overall mean readiness score of HFs offering CRDs, CVDs, DM and MH-related services was 32.6, 38.0, 38.4 and 24.0, respectively. Guidelines and staff training domain had the lowest readiness score, whereas essential equipment and supplies domain had the highest readiness score for each of the NCD-related services. A total of 2.3%, 3.8%, 3.6% and 3.3% HFs were ready to deliver CRDs, CVDs, DM and MH-related services, respectively. HFs managed by local level were less likely to be ready to provide all NCD-related services compared with federal/provincial hospitals. HFs with external supervision were more likely to be ready to provide CRDs and DM-related services and HFs reviewing client’s opinions were more likely to be ready to provide CRDs, CVDs and DM-related services.

Conclusion

Readiness of the HFs managed by local level to provide CVDs, DM, CRDs and MH-related services was relatively poor compared with federal/provincial hospitals. Prioritisation of policies to reduce the gaps in readiness and capacity strengthening of the local HFs is essential for improving their overall readiness to provide NCD-related services.
Perspectives of key decision makers on out-of-pocket payments for medicines in the Ethiopian healthcare system: a qualitative interview study
Authors: Mekuria Getahun Asmamaw , Achalu Daniel Legese , Tewuhibo Dinksew , Ayenew Wondim , Ali Eskinder Eshetu
Published: July 2023

Objective

This study aimed to explore the perspectives of key decision makers on out-of-pocket (OOP) payment for medicines and its implications in the Ethiopian healthcare system.

Design

A qualitative design that employed audiorecorded semistructured in-depth interviews was used in this study. The framework thematic analysis approach was followed in the analysis.

Setting

Interviewees came from five federal-level institutions engaged in policymaking (three) and tertiary referral-level healthcare service provision (two) in Ethiopia.

Participants

Seven pharmacists, five health officers, one medical doctor and one economist who held key decision-making positions in their respective organisations participated in the study.

Result

Three major themes were identified in the areas of the current context of OOP payment for medicines, its aggravating factors and a plan to reduce its burden. Under the current context, participants’ overall opinions, circumstances of vulnerability and consequences on households were identified. Factors identified as aggravating the burden of OOP payment were deficiencies in the medicine supply chain and limitations in the health insurance system. Suggested mitigation strategies to be implemented by the health providers, the national medicines supplier, the insurance agency and the Ministry of Health were categorised under plans to reduce OOP payment.

Conclusion

The findings of this study indicate that there is widespread OOP payment for medicines in Ethiopia. System level constraints such as weaknesses in the supply system at the national and health facility levels have been identified as critical factors that undermine the protective effects of health insurance in the Ethiopian context. Ensuring steady access to essential medicines requires addressing health system and supply constraints in addition to a well-functioning financial risk protection systems.
Breastfeeding initiation and duration through the COVID-19 pandemic, a linked population-level routine data study: the Born in Wales Cohort 2018–2021
Authors: Jones Hope Eleri , Seaborne Mike J , Mhereeg Mohamed R , James Michaela , Kennedy Natasha L , Bandyopadhyay Amrita , Brophy Sinead
Published: July 2023

Objectives

The WHO recommends exclusive breastfeeding for the first 6 months of life. This study aimed to examine the impact the pandemic had on breastfeeding uptake and duration, and whether intention to breastfeed is associated with longer duration of exclusive breastfeeding.

Methods

A cohort study using routinely collected, linked healthcare data from the Secure Anonymised Information Linkage databank. All women who gave birth in Wales between 2018 and 2021 recorded in the Maternal Indicators dataset were asked about intention to breastfeed. These data were linked with the National Community Child Health Births and Breastfeeding dataset to examine breastfeeding rates.

Results

Intention to breastfeed was associated with being 27.6 times more likely to continue to exclusively breastfeed for 6 months compared with those who did not intend to breastfeed (OR 27.6, 95% CI 24.9 to 30.7). Breastfeeding rates at 6 months were 16.6% prepandemic and 20.5% in 2020. When compared with a survey population, the initial intention to breastfeed/not breastfeed only changes for about 10% of women.

Conclusion

Women were more likely to exclusively breastfeed for 6 months during the pandemic compared with before or after the pandemic. Arguably, interventions which enable families to spend more time with their baby such as maternal and paternal leave may help improve breastfeeding duration. The biggest predictor of breastfeeding at 6 months was intention to breastfeed. Therefore, targeted interventions during pregnancy to encourage motivation to breastfeed could improve duration of breastfeeding.
Effects of high-intensity interval training on cardiac remodelling, function and coronary microcirculation in de novo heart transplant patients: a substudy of the HITTS randomised controlled trial
Authors: Rafique Muzammil , Solberg Ole Geir , Gullestad Lars , Bendz Bjørn , Murbræch Klaus , Nytrøen Kari , Rolid Katrine , Lunde Ketil
Published: July 2023

Objectives

High-intensity interval training (HIT) improves peak oxygen consumption (VO2peak) in de novo heart transplant (HTx) recipients. It remains unclear whether this improvement early after HTx is solely dependent on peripheral adaptations, or due to a linked chain of central and peripheral adaptations. The objective of this study was to determine whether HIT results in structural and functional adaptations in the cardiovascular system.

Methods

Eighty-one de novo HTx recipients were randomly assigned to participate in either 9 months of supervised HIT or standard care exercise-based rehabilitation. Cardiac function was assessed by echocardiogram and the coronary microcirculation with the index of microcirculatory resistance (IMR) at baseline and 12 months after HTx.

Results

Cardiac function as assessed by global longitudinal strain was significantly better in the HIT group than in the standard care group (16.3±1.2% vs 15.6±2.2%, respectively, treatment effect = –1.1% (95% CI –2.0% to –0.2%), p=0.02), as was the end-diastolic volume (128.5±20.8 mL vs 123.4±15.5 mL, respectively, treatment effect=4.9 mL (95% CI 0.5 to 9.2 mL), p=0.03). There was a non-significant tendency for IMR to indicate improved microcirculatory function (13.8±8.0 vs 16.8±12.0, respectively, treatment effect = –4.3 (95% CI –9.1 to 0.6), p=0.08).

Conclusion

When initiated early after HTx, HIT leads to both structural and functional cardiovascular adaptations.

Trial registration number

NCT01796379.
Health inequalities in post-COVID-19 outcomes among adults aged 50+ in Europe: has COVID-19 exposed divide between postcommunist countries and Western Europe?
Authors: Ohno Maika , Dzurova Dagmar , Smejkal Petr
Published: July 2023

Background

COVID-19 affected people and countries disproportionately and continues to impact the health of people. The aim is to investigate protective health and socio-geographical factors for post-COVID-19 conditions in adults aged 50 years and older in Europe.

Methods

Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe, collected from June to August 2021, protective factors against post-COVID-19 condition among 1909 respondents who self-reported a positive COVID-19 test result were investigated using multiple logistic regression models.

Results

Male adults living outside of Czechia, Poland, Hungary and Slovakia (Visegrad group, V4), who received the COVID-19 vaccination, tertiary or higher education, had a healthy weight (body mass index, BMI 18.5–24.9 kg/m2) and no underlying health condition/s, showed protective effects against post-COVID-19 condition. Health inequalities associated with BMI were observed in education attainment and comorbidities, with higher BMI having lower education attainment and higher comorbidities. Health inequality was particularly evident in individuals in V4 with higher obesity prevalence and lower attainment of higher education than those living in other regions in the study.

Conclusion

Our study suggests that healthy weight and higher education attainment are predictors associated with a lower incidence of post-COVID-19 condition. Health inequality associated with education attainment was particularly relevant in V4. Our results highlight health inequality in which BMI was associated with comorbidities and educational attainment. To reduce obesity prevalence among older people with lower education, raising awareness about the risks of obesity and providing assistance in maintaining a healthy weight are needed.
Impact of qualifying artery on the efficacy of stenting plus medical therapy versus medical therapy alone in patients with symptomatic intracranial stenosis: a post-hoc analysis of the CASSISS trial
Authors: Wu Qiaowei , Wang Jie , Zheng Bingjie , Qi Jingtao , Xu Shancai , Wu Pei , Zhang Guang , Ji Zhiyong , Wang Chunlei , Yao Jinbiao , Jiao Liqun , Gao Peng , Wang Tao , Wang Daming , Li Tianxiao , He Yingkun , Zhao Zhenwei , Cai Yiling , Wu Wei , He Weiwen , Shi Huaizhang , Li Yuchen
Published: July 2023

Background

A recent trial failed to show any benefit of stenting plus medical therapy over medical therapy alone in patients with symptomatic intracranial stenosis. We aimed to examine whether the symptomatic qualifying artery modifies the effect of stenting plus medical therapy.

Methods

This is a post-hoc analysis of the CASSISS trial that included patients with symptomatic intracranial stenosis, randomly assigned to undergo stenting plus medical therapy or medical therapy alone; 358/380 patients were included. Multivariable logistic regression analysis was used with an interaction term to estimate the altered treatment effect by the qualifying artery. The primary outcome was a composite of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. The five secondary outcomes included stroke or death related to the qualifying artery territory at 2 and 3 years.

Results

No significant treatment allocation-by-stenosis site interaction was observed (Pinteraction=0.435). Compared with medical therapy alone, the adjusted ORs for stenting plus medical therapy were 2.73 (95% CI 0.42 to 17.65) for internal carotid artery stenosis, 1.20 (95% CI 0.29 to 4.99) for M1 stenosis, 0.23 (95% CI 0.02 to 2.31) for vertebral artery stenosis, and 1.33 (95% CI 0.34 to 5.28) for basilar artery stenosis. Of the five secondary outcomes, none showed a significant treatment allocation-by-stenosis site interaction including stroke in the qualifying artery territory at 2 years (Pinteraction=0.659) and 3 years (Pinteraction=0.493).

Conclusions

Among patients with transient ischemic attacks or ischemic stroke due to severe intracranial atherosclerotic stenosis, there was no evidence that the symptomatic qualifying artery could determine the addition of stenting to medical therapy.
What makes for a ‘Top Doc’? An analysis of UK press portrayals of so-called top doctors
Authors: Keeley Paul , Taubert Mark , Wardle Emma , Tavabie Simon , Minton Ollie
Published: July 2023

Objective

To determine the characteristics of medical practitioners designated ‘top doctor’ or ‘Top Doc’ in the UK press.

Design

Observational study of news stories related to the term top doctor (or Top Doc) with analysis using data from publicly available databases.

Setting

News reports in the UK press accessed via a database from national newspapers from 1 January 2019 to 31 December 2019, prior to the COVID-19 pandemic. Stories relating to disciplinary/criminal matters were analysed separately.

Main outcome measures

Results were cross-referenced with the General Medical Council register of medical practitioners for gender, year of qualification, whether on the general practitioner (GP) or the specialist register, and if on the specialist register, which specialty.

Results

There was a gender divide, with 80% of so-called top doctors being male. National top doctors had been qualified for a median time of 31 years. Top doctors are widely spread among specialties; 21% of top doctors were on the GP register. Officers of the British Medical Association and the various Royal Colleges are also well represented. ‘Top doctors’ facing disciplinary proceedings are more overwhelmingly male, working in hospital specialties and less obviously eminent in their field.

Conclusion

There is no clear definition of a ‘top doctor’, nor are there objective leadership criteria for journalists to use when applying this label. Establishing a definition of ‘top doctor’, for instance, via the UK Faculty for Medical Leadership and Management, which offers postnominals and accreditation for high-achieving medical professionals, may reduce subjectivity.
Aseismic effect of old single-layer masonry agricultural house structure strengthened with embedded steel frame and steel strip
Authors: Song Bo , Lu Chenhu , Wang Mansheng , Zhou Heng
Published: July 2023

Most of the old rural houses in Beijing are single-layer buildings with double-sloping roofs. Under an earthquake, the gable is prone to an outward tilt, and the structure is prone to collapse as a whole. In view of the structural characteristics of the existing rural houses in Beijing, a reinforcement technology is proposed, in which the embedded steel frame reinforcement is mainly used, supplemented by a steel plate strip reinforcement. A 1/4 masonry structure model is designed for a shaking table test. A full-scale model is established in a finite element simulation analysis. The results show that the longitudinal wall is seriously damaged, and the gable has a considerable outward inclination under earthquakes. However, owing to the reinforcement effect of the steel frame, the overall collapse of the structure is avoided. The steel strip can effectively restrain the outward inclination of the gable and ensure safety of personnel.
Nano-modified cementitious binders reinforced with basalt fiber/polymer pellets as a stabilizer for weak soils
Authors: Eissa A. , Yasien A.M. , Bassuoni M.T. , Alfaro M.
Published: July 2023

Constructing on soft clay entails engineering challenges, such as significant volumetric changes; hence, stabilizing such problematic soil is essential. Since using lime in stabilizing soil is not recommended in some regions (e.g., Manitoba, Canada) due to some environmental concerns, there is a pressing need to explore suitable alternatives. This study investigates the efficiency of stabilizing soft clay using nano-modified cementitious binders (cement, slag, and nano-silica), reinforced with a new class of fibers (basalt fiber pellets). The mechanical and durability properties of the mixtures have been tested in terms of California bearing ratio, unconsolidated–undrained triaxial stresses, and freezing–thawing resistance. Thermogravimetry and scanning electron microscope analyses were performed to interpret the bulk trends. The results showed significant improvement for soft clay specimens stabilized with the nano-modified cementitious binders and reinforced with the pellets. This demonstrates the potential of the proposed reinforced binders for field applications involving the stabilization of soft soils.
Design and numerical analysis of dual-core photonic crystal fiber-based biosensor
Authors: Ademgil Huseyin , Yasli Ahmet , Haxha Shyqyri
Published: July 2023

In this study, the coupling and the relative sensitivity characteristics of a Dual-Core photonic crystal fiber (DC-PCF)-based liquid sensor are evaluated by employing the full-vectorial finite element method (FV-FEM). The simulation results demonstrate that coupling length of the proposed sensor varies between 2[Formula: see text]mm and 0.2[Formula: see text]mm length at wide wavelength range (800–1600[Formula: see text]nm) for low index analytes (1.33–1.36). Besides, birefringence of order [Formula: see text] is reported. It is found that analyte with 1.36 index reaches higher sensitivity levels. On the other hand, the coupling length of the proposed sensor can be optimized with the ellipticity ratio of the central core hole. Bending analysis on coupling length and optical power fluctuations is also reported. It is found that the power flow in one core is increasing almost 90% towards the bending direction. The proposed structure with simple design parameters has a great potential in various biomedical applications including DNA detection and can also be employed as fiber-based refractometer in various sensing applications.
Digital Management Mode of Enterprise Human Resources under the Background of Digital Transformation
Authors: Wang Yi , Li Lei
Published: July 2023

The development of computer technology promotes the emergence of a large amount of data. How to mine the required information from the massive data has become a problem that needs to be considered by enterprise human resources. In view of the data-based requirements of enterprise human resource management in the era of data, this paper studies the use of decision tree technology for data mining of enterprise employees, and on this basis, uses the improved AdaBoost-c4.5 algorithm to carry out experiments on personnel recruitment in human resource departments. The experimental results show that the performance of the algorithm is relatively stable in five cycles, and reaches 83.27% in the fifth cycle. On this basis, the AdaBoost-c4.5 algorithm is compared with ID3 algorithm and C4.5 algorithm. The results show that the performance of AdaBoost-c4.5 algorithm is improved compared with the two algorithms, and in the specific application of enterprise employee recruitment, it can effectively improve the processing of incomplete data in the case of incomplete data, but when the number of iterations reaches more than 10 times, its accuracy will not be improved. This shows that the performance of this algorithm has reached a critical value. If the number of iterations can be reduced, better results can be obtained. At the same time, through comparison with SOC curve, it is found that AdaBoost-c4.5 algorithm has lower cost and is more operable, which has practical significance in actual personnel recruitment.