51
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Hynes J, Ridge A, Murphy A. HIV seroconversion during pregnancy: paediatric recurrent candidiasis - a clue for diagnosis. BMJ Case Rep 2024; 17:e259354. [PMID: 38453217 PMCID: PMC10921425 DOI: 10.1136/bcr-2023-259354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Affiliation(s)
- Jason Hynes
- Department of Dermatology, Galway University Hospitals, Galway, Ireland
| | - Amy Ridge
- Department of Dermatology, Galway University Hospitals, Galway, Ireland
| | - Annette Murphy
- Department of Dermatology, Galway University Hospitals, Galway, Ireland
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Kovacevic A, Smith DRM, Rahbé E, Novelli S, Henriot P, Varon E, Cohen R, Levy C, Temime L, Opatowski L. Exploring factors shaping antibiotic resistance patterns in Streptococcus pneumoniae during the 2020 COVID-19 pandemic. eLife 2024; 13:e85701. [PMID: 38451256 PMCID: PMC10923560 DOI: 10.7554/elife.85701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Non-pharmaceutical interventions implemented to block SARS-CoV-2 transmission in early 2020 led to global reductions in the incidence of invasive pneumococcal disease (IPD). By contrast, most European countries reported an increase in antibiotic resistance among invasive Streptococcus pneumoniae isolates from 2019 to 2020, while an increasing number of studies reported stable pneumococcal carriage prevalence over the same period. To disentangle the impacts of the COVID-19 pandemic on pneumococcal epidemiology in the community setting, we propose a mathematical model formalizing simultaneous transmission of SARS-CoV-2 and antibiotic-sensitive and -resistant strains of S. pneumoniae. To test hypotheses underlying these trends five mechanisms were built into the model and examined: (1) a population-wide reduction of antibiotic prescriptions in the community, (2) lockdown effect on pneumococcal transmission, (3) a reduced risk of developing an IPD due to the absence of common respiratory viruses, (4) community azithromycin use in COVID-19 infected individuals, (5) and a longer carriage duration of antibiotic-resistant pneumococcal strains. Among 31 possible pandemic scenarios involving mechanisms individually or in combination, model simulations surprisingly identified only two scenarios that reproduced the reported trends in the general population. They included factors (1), (3), and (4). These scenarios replicated a nearly 50% reduction in annual IPD, and an increase in antibiotic resistance from 20% to 22%, all while maintaining a relatively stable pneumococcal carriage. Exploring further, higher SARS-CoV-2 R0 values and synergistic within-host virus-bacteria interaction mechanisms could have additionally contributed to the observed antibiotic resistance increase. Our work demonstrates the utility of the mathematical modeling approach in unraveling the complex effects of the COVID-19 pandemic responses on AMR dynamics.
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Affiliation(s)
- Aleksandra Kovacevic
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - David RM Smith
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- Health Economics Research Centre, Nuffield Department of Health, University of OxfordOxfordUnited Kingdom
| | - Eve Rahbé
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - Sophie Novelli
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - Paul Henriot
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- PACRI unit, Institut Pasteur, Conservatoire national des arts et métiersParisFrance
| | - Emmanuelle Varon
- Centre National de Référence des Pneumocoques, Centre Hospitalier Intercommunal de CréteilCréteilFrance
| | - Robert Cohen
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles (IMRB-GRC GEMINI), Université Paris Est, 94000CréteilFrance
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200NiceFrance
- Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier, Intercommunal de CréteilCréteilFrance
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000CréteilFrance
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000OrléansFrance
| | - Corinne Levy
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles (IMRB-GRC GEMINI), Université Paris Est, 94000CréteilFrance
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200NiceFrance
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000CréteilFrance
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000OrléansFrance
| | - Laura Temime
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- PACRI unit, Institut Pasteur, Conservatoire national des arts et métiersParisFrance
| | - Lulla Opatowski
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
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Kalandarova M, Ahmad I, Aung TNN, Moolphate S, Shirayama Y, Okamoto M, Aung MN, Yuasa M. Association Between Dietary Habits and Type 2 Diabetes Mellitus in Thai Adults: A Case-Control Study. Diabetes Metab Syndr Obes 2024; 17:1143-1155. [PMID: 38465346 PMCID: PMC10924810 DOI: 10.2147/dmso.s445015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
Background The prevalence of T2DM is escalating in Thailand affecting over 10% of adults aged 20-79 years old. It is imperative to identify modifiable risk factors that can potentially help mitigate the risk of developing diabetes. Objective This study aimed to investigate the relationship between dietary habits and type 2 diabetes in Chiang Mai, Thailand. Methods This case-control study involved 300 individuals aged 25-74 years residing in Chiang Mai, Thailand including 150 newly diagnosed T2DM patients (cases) and 150 community residents without diabetes (controls). Dietary habits were assessed based on Food Frequency Questionnaire (FFQ). Socio-demographic characteristics and anthropometric information of the participants were collected. Data analysis was performed using the STATA-17. Results The case group participants were older and had a higher proportion of males compared to the control group. The case group exhibited a significantly higher consumption of meat, beans, nuts, soft drinks, and topping seasonings (p<0.001), conversely, a lower intake of vegetables (p<0.001), fruits (p=0.006), fish, rice (p<0.001), eggs (p=0.032), milk products, coffee, and tea (p<0.001) compared to the control group. Furthermore, the case group demonstrated a higher level of certain dietary practices such as a greater frequency of having meals with family, not removing visible fat from food (p<0.001), and eating snacks between meals compared to controls. Multiple logistic regression analysis showed that after adjusting for potential confounding factors not removing visible fat from food (aOR 5.61, 95% CI: 2.29-13.7, p<0.001) and using topping seasonings (aOR 3.52 95% CI: 1.69-7.32 p=0.001) were significantly associated with the risk of T2DM, whereas daily vegetable intake (aOR 0.32 95% CI: 0.15-0.68 p=0.003) was inversely associated with T2DM. Conclusion The study findings caution against the consumption of food rich in fat and using salty seasonings, while advocating for an increased intake of vegetables to prevent the prevalence of T2DM.
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Affiliation(s)
- Makhbuba Kalandarova
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Ishtiaq Ahmad
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Thin Nyein Nyein Aung
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Saiyud Moolphate
- Department of Public Health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Chiang Mai, 50300, Thailand
| | - Yoshihisa Shirayama
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, Tokyo, 113-8421, Japan
| | - Miyoko Okamoto
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Myo Nyein Aung
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, Tokyo, 113-8421, Japan
- Juntendo Advanced Research Institute for Health Sciences, Juntendo University, Tokyo, 113-8421, Japan
| | - Motoyuki Yuasa
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, Tokyo, 113-8421, Japan
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Ricciardone MD, Baker L, Twesten J, Parascandola M. Portfolio analysis of global tobacco control research funding at the National Cancer Institute, 2000-2019. Tob Prev Cessat 2024; 10:TPC-10-13. [PMID: 38440159 PMCID: PMC10910547 DOI: 10.18332/tpc/184041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Research in low- and middle-income countries (LMICs), where the majority of global tobacco users reside, is critical to addressing the global tobacco epidemic. This analysis describes the global tobacco control research portfolio funded by the National Cancer Institute from fiscal years 2000 to 2019. METHODS We used the National Institutes of Health Query, View, Report database to identify extramural grants relevant to global tobacco control research. Abstracts were analyzed to describe grant characteristics, including topic areas, tobacco products, countries, and regions of focus. Bibliometric and co-authorship network analyses were performed for publications associated with relevant grants. RESULTS Of the 93 relevant grants with foreign (non-US) involvement, the majority (83.9%) supported research in upper and lower middle-income countries. The majority of grants (86.0%) focused on cigarettes, with a small subset of grants addressing smokeless tobacco, waterpipe use, or other non-cigarette products. Most grants focused on at least one of the six tobacco control policy measures in the World Health Organization MPOWER package; almost half (48.4%) focused on monitoring tobacco use and around one-third (32.3%) focused on offering tobacco cessation treatment, while other MPOWER measures received less attention in the research portfolio. While most of these grants, and the funding initiatives that supported them, emphasized research in low- and middle-income countries (LMICs), only 3 of 93 grants were awarded directly to LMIC-based institutions. CONCLUSIONS There is a critical need for research to develop and test strategies to adapt, implement, and scale up evidence-based interventions across diverse LMIC settings. This study identified gaps in research activity that should be addressed to strengthen global tobacco control research capacity.
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Affiliation(s)
| | - Laura Baker
- Strategix Management, LLC, Washington, DC 20036, USA
| | - Jenny Twesten
- The Bizzell Group, LLC, New Carrollton, MD 20785, USA
| | - Mark Parascandola
- Center for Global Health, National Cancer Institute, Bethesda, MD 20892, USA
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Reza N, Gerada A, Stott KE, Howard A, Sharland M, Hope W. Challenges for global antibiotic regimen planning and establishing antimicrobial resistance targets: implications for the WHO Essential Medicines List and AWaRe antibiotic book dosing. Clin Microbiol Rev 2024:e0013923. [PMID: 38436564 DOI: 10.1128/cmr.00139-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
SUMMARYThe World Health Organisation's 2022 AWaRe Book provides guidance for the use of 39 antibiotics to treat 35 infections in primary healthcare and hospital facilities. We review the evidence underpinning suggested dosing regimens. Few (n = 18) population pharmacokinetic studies exist for key oral AWaRe antibiotics, largely conducted in homogenous and unrepresentative populations hindering robust estimates of drug exposures. Databases of minimum inhibitory concentration distributions are limited, especially for community pathogen-antibiotic combinations. Minimum inhibitory concentration data sources are not routinely reported and lack regional diversity and community representation. Of studies defining a pharmacodynamic target for ß-lactams (n = 80), 42 (52.5%) differed from traditionally accepted 30%-50% time above minimum inhibitory concentration targets. Heterogeneity in model systems and pharmacodynamic endpoints is common, and models generally use intravenous ß-lactams. One-size-fits-all pharmacodynamic targets are used for regimen planning despite complexity in drug-pathogen-disease combinations. We present solutions to enable the development of global evidence-based antibiotic dosing guidance that provides adequate treatment in the context of the increasing prevalence of antimicrobial resistance and, moreover, minimizes the emergence of resistance.
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Affiliation(s)
- Nada Reza
- Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Alessandro Gerada
- Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Katharine E Stott
- Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Alex Howard
- Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - William Hope
- Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Thapa S, Gibbs P, Ross N, Newman J, Allan J, Dalton H, Mahmood S, Kalinna BH, Ross AG. Are adverse childhood experiences (ACEs) the root cause of the Aboriginal health gap in Australia? BMJ Glob Health 2024; 9:e014901. [PMID: 38442985 DOI: 10.1136/bmjgh-2023-014901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
- Subash Thapa
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Peter Gibbs
- Regional Enterprise Development Institute (REDI.E), Dubbo, New South Wales, Australia
| | - Nancy Ross
- School of Social Work, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jamie Newman
- Orange Aboriginal Medical Service, Orange, New South Wales, Australia
| | - Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Hazel Dalton
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Shakeel Mahmood
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Bernd H Kalinna
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Allen G Ross
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
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Rambabu L, Smith BG, Tumpa S, Kohler K, Kolias AG, Hutchinson PJ, Bashford T. Artificial intelligence-enabled ophthalmoscopy for papilledema: a systematic review protocol. Int J Surg Protoc 2024; 28:27-30. [PMID: 38433865 PMCID: PMC10905490 DOI: 10.1097/sp9.0000000000000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/24/2023] [Indexed: 03/05/2024] Open
Abstract
Papilledema is a pathology delineated by the swelling of the optic disc secondary to raised intracranial pressure (ICP). Diagnosis by ophthalmoscopy can be useful in the timely stratification of further investigations, such as magnetic resonance imaging or computed tomography to rule out pathologies associated with raised ICP. In resource-limited settings, in particular, access to trained specialists or radiological imaging may not always be readily available, and accurate fundoscopy-based identification of papilledema could be a useful tool for triage and escalation to tertiary care centres. Artificial intelligence (AI) has seen a rise in neuro-ophthalmology research in recent years, but there are many barriers to the translation of AI to clinical practice. The objective of this systematic review is to garner and present a comprehensive overview of the existing evidence on the application of AI in ophthalmoscopy for papilledema, and to provide a valuable perspective on this emerging field that sits at the intersection of clinical medicine and computer science, highlighting possible avenues for future research in this domain.
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Affiliation(s)
- Lekaashree Rambabu
- University of Leicester, Leicester
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
| | - Brandon G. Smith
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge
| | - Stasa Tumpa
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- West Suffolk NHS Foundation Trust, Bury Saint Edmunds, Suffolk
| | - Katharina Kohler
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge
- Division of Anaesthesia, Addenbrooke’s Hospital, Cambridge
| | - Angelos G. Kolias
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- Division of Academic Neurosurgery, Addenbrooke’s Hospital, Cambridge, UK
| | - Peter J. Hutchinson
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- Division of Academic Neurosurgery, Addenbrooke’s Hospital, Cambridge, UK
| | - Tom Bashford
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge
- Division of Anaesthesia, Addenbrooke’s Hospital, Cambridge
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Gavilanes JS, Saengpattrachai M, Rivera-Tutsch AS, Robinson L, Petchkrua W, Gold JA. A Train-the-Trainer Simulation Program Implemented Between Two International Partners. ATS Sch 2024; 5:32-44. [PMID: 38585578 PMCID: PMC10994222 DOI: 10.34197/ats-scholar.2023-0025ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 10/10/2023] [Indexed: 04/09/2024] Open
Abstract
With the expansion of global health initiatives focused on healthcare professional training, it is important to ensure that such training is scalable and sustainable. Simulation-based education (SBE) is a highly effective means to achieve these goals. Although SBE is widely used in the United States, its integration globally is limited, which can impact the potential of SBE in many countries. The purpose of this perspective piece is to demonstrate how a train-the-trainer program can help in the development of an international SBE program and specifically what unique issues must be considered in operationalizing this strategy.
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Affiliation(s)
| | | | | | - Lish Robinson
- Oregon Health & Science University, Portland, Oregon; and
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Kobashi Y, Goto A, Chi C. The role of stakeholder structure in fostering community ownership: A case study of community-based projects. Int J Health Plann Manage 2024; 39:593-601. [PMID: 38155527 DOI: 10.1002/hpm.3750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023] Open
Abstract
Community health projects have played a crucial role in improving health issues. Listening to communities' voices and achieving community ownership are essential for conducting effective health projects. However, there are limited studies on the frameworks for collecting, aggregating, and operationalizing community preferences and values. In this study, we selected two cases of community field surveys from Japan and Cambodia to discuss who may represent a community and propose a practical approach to achieving community ownership. Both cases involved various stakeholders. From the insights of these two cases, we suggested the following three key components in the community project: the community representative, the communicator, and the institute outside the community. Notably, the community representative's role as the community's direct voice should be properly recognized and institutionalised to establish community ownership. We proposed the following key terms of the qualifications of community representatives: they should be able to represent voices from the community, should have extensive experience to decide the project direction and manage the project, and should be independent of outside actors. Our theoretical model of the structure of different stakeholder groups in community-based projects will be helpful to accelerate community capacity strengthening; moreover, it can help build the appropriate community institution and process, including multi-stakeholder groups to promote community ownership in health programs.
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Affiliation(s)
| | - Aya Goto
- Center for Integrated Science and Humanities, Fukushima Medical University, Fukushima, Japan
| | - Chunhuei Chi
- Center for Global Health, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
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Jephcott FL, Wood JLN, Cunningham AA, Bonney JHK, Nyarko-Ameyaw S, Maier U, Geissler PW. Ineffective responses to unlikely outbreaks: Hypothesis building in newly-emerging infectious disease outbreaks. Med Anthropol Q 2024; 38:67-83. [PMID: 37948592 DOI: 10.1111/maq.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/20/2023] [Indexed: 11/12/2023]
Abstract
Over the last 30 years, there has been significant investment in research and infrastructure aimed at mitigating the threat of newly emerging infectious diseases (NEID). Core epidemiological processes, such as outbreak investigations, however, have received little attention and have proceeded largely unchecked and unimproved. Using ethnographic material from an investigation into a cryptic encephalitis outbreak in the Brong-Ahafo Region of Ghana in 2010-2013, in this paper we trace processes of hypothesis building and their relationship to the organizational structures of the response. We demonstrate how commonly recurring features of NEID investigations produce selective pressures in hypothesis building that favor iterations of pre-existing "exciting" hypotheses and inhibit the pursuit of alternative hypotheses, regardless of relative likelihood. These findings contribute to the growing anthropological and science and technology studies (STS) literature on the epistemic communities that coalesce around suspected NEID outbreaks and highlight an urgent need for greater scrutiny of core epidemiological processes.
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Affiliation(s)
- Freya L Jephcott
- Centre for the Study of Existential Risk (CSER), University of Cambridge, Cambridge, UK
- Institute of Zoology, Zoological Society of London, London, UK
| | - James L N Wood
- Centre for the Study of Existential Risk (CSER), University of Cambridge, Cambridge, UK
| | | | - J H Kofi Bonney
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Stephen Nyarko-Ameyaw
- Disease Control Unit, Techiman Municipal Health Directorate, Ghana Health Service, Techiman, Ghana
| | - Ursula Maier
- Paediatrics Department, Holy Family Hospital, Techiman, Ghana
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Mwakisha J, Adika B, Nyawade S, Phori PM, Nidjergou NN, Silouakadila C, Fawcett S. Kenya's Experience: Factors Enabling and Impeding the COVID-19 Response. Health Promot Pract 2024; 25:220-226. [PMID: 36734323 PMCID: PMC9899671 DOI: 10.1177/15248399221117566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This case study describes the country-level response to the COVID-19 pandemic in Kenya between February 2020 and May 2021. We organize the presentation of COVID-19 response strategies across the five stages of (a) engagement, (b) assessment, (c) planning, (d) action/implementation, and (e) evaluation. We describe the participatory monitoring and evaluation (M&E) process implemented in collaboration with the WHO Regional Office for Africa Monitoring and Evaluation Team. The M&E system was used to organize and make sense of emerging data regarding specific response activities and changing COVID incidence. We share the results of that collaborative sensemaking, with particular attention to our analysis of the factors that facilitated and those that impeded our pandemic response. We conclude with lessons learned and practical implications from Kenya's experience to help guide future country-level responses to rapidly changing public health crises.
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Affiliation(s)
| | - Ben Adika
- World Health Organization, Kenya
Country Office Nairobi, Kenya
| | | | | | | | - Cleph Silouakadila
- World Health Organization Regional
Office for Africa, Brazzaville, Congo
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Binda CJ, Adams J, Livergant R, Lam S, Panchendrabose K, Joharifard S, Haji F, Joos E. Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships: A Modified Delphi Study. Ann Surg 2024; 279:549-553. [PMID: 37539584 PMCID: PMC10829902 DOI: 10.1097/sla.0000000000006058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVE The aim of this study was to use expert consensus to build a concrete and realistic framework and checklist to evaluate sustainability in global surgery partnerships (GSPs). BACKGROUND Partnerships between high-resourced and low-resourced settings are often created to address the burden of unmet surgical need. Reflecting on the negative, unintended consequences of asymmetrical partnerships, global surgery community members have proposed frameworks and best practices to promote sustainable engagement between partners, though these frameworks lack consensus. This project proposes a cohesive, consensus-driven framework with accompanying evaluation metrics to guide sustainability in GSPs. METHODS A modified Delphi technique with purposive sampling was used to build consensus on the definitions and associated evaluation metrics of previously proposed pillars (Stakeholder Engagement, Multidisciplinary Collaboration, Context-Relevant Education and Training, Bilateral Authorship, Multisource Funding, Outcome Measurement) of sustainable GSPs. RESULTS Fifty global surgery experts from 34 countries with a median of 9.5 years of experience in the field of global surgery participated in 3 Delphi rounds. Consensus was achieved on the identity, definitions, and a 47-item checklist for the evaluation of the 6 pillars of sustainability in GSPs. In all, 29% of items achieved consensus in the first round, whereas 100% achieved consensus in the second and third rounds. CONCLUSIONS We present the first framework for building sustainable GSPs using the input of experts from all World Health Organization regions. We hope this tool will help the global surgery community to find noncolonial solutions to addressing the gap in access to quality surgical care in low-resource settings.
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Affiliation(s)
- Catherine J. Binda
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jayd Adams
- Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel Livergant
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sheila Lam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Shahrzad Joharifard
- Department of Surgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Faizal Haji
- Department of Surgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Emilie Joos
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Keita AM, Doh S, Juma J, Nasrin D, Traoré A, Onwuchekwa U, Maguire R, Haidara FC, Sow SO, Kotloff KL, Tapia MD. The Enterics for Global Health (EFGH) Shigella Surveillance Study in Mali. Open Forum Infect Dis 2024; 11:S107-S112. [PMID: 38532954 PMCID: PMC10962726 DOI: 10.1093/ofid/ofae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Background In 2002, the Centre pour le Développement des Vaccins du Mali (CVD-Mali) was established as a partnership between the Mali Ministry of Health and the University of Maryland, Baltimore. Since its creation, CVD-Mali has been dedicated to describing the epidemiology of infectious diseases, supporting the development of vaccines, and training a team of local researchers. CVD-Mali participated in the Global Enteric Multicenter Study from 2007 to 2010 and the Vaccine Impact on Diarrhea in Africa study from 2015 to 2018, where the importance of Shigella as an enteric pathogen was established. Methods In the Enterics for Global Health (EFGH) Shigella surveillance study, CVD-Mali will conduct Shigella surveillance at 4 health centers serving the population currently participating in a demographic surveillance system and will measure the local incidence of Shigella diarrhea and related outcomes in 6- to 35-month-old children. Antibiotic sensitivity patterns and the costs related to these cases will also be measured. Results We anticipate reporting the number of diarrhea episodes that are positive by stool culture, the antibiotic susceptibility of these isolates, and the management and outcomes of these cases. Conclusions In Mali, the EFGH study will contribute valuable information to understanding the burden of Shigella in this population. These data will inform the evaluation of vaccine candidates.
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Affiliation(s)
- Adama Mamby Keita
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Sanogo Doh
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Jane Juma
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Dilruba Nasrin
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Awa Traoré
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Rebecca Maguire
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Fadima C Haidara
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Berkey B. Ethical consumerism, human rights, and Global Health Impact. Dev World Bioeth 2024; 24:31-36. [PMID: 37462879 DOI: 10.1111/dewb.12415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 03/03/2024]
Abstract
In this paper, I raise some doubts about Nicole Hassoun's account of the obligations of states, pharmaceutical firms, and consumers with regard to global health, presented in Global Health Impact. I argue that it is not necessarily the case, as Hassoun claims, that if states are just, and therefore satisfy all of their obligations, then consumers will not have strong moral reasons, and perhaps obligations, to make consumption choices that are informed by principles and requirements of justice. This is because there may be justice-based limits on what states can permissibly and feasibly do both to promote access to existing drugs for all of those who need them, and to promote research and development for new drugs that could treat diseases that primarily affect the global poor. One important upshot of my argument is that there can be reasons for organizations like the Global Health Impact Organization to exist, and to do the kind of work that Hassoun argues is potentially valuable in our deeply unjust world, even in much less unjust worlds in which states and firms largely, or even entirely, comply with their obligations.
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Ghimire A, Shah S, Okpechi IG, Ye F, Tungsanga S, Vachharajani T, Levin A, Johnson D, Ravani P, Tonelli M, Thompson S, Jha V, Luyckx V, Jindal K, Shah N, Caskey FJ, Kazancioglu R, Bello AK. Global variability of vascular and peritoneal access for chronic dialysis. Nephrology (Carlton) 2024; 29:135-142. [PMID: 38018697 DOI: 10.1111/nep.14259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
AIM Vascular and peritoneal access are essential elements for sustainability of chronic dialysis programs. Data on availability, patterns of use, funding models, and workforce for vascular and peritoneal accesses for dialysis at a global scale is limited. METHODS An electronic survey of national leaders of nephrology societies, consumer representative organizations, and policymakers was conducted from July to September 2018. Questions focused on types of accesses used to initiate dialysis, funding for services, and availability of providers for access creation. RESULTS Data from 167 countries were available. In 31 countries (25% of surveyed countries), >75% of patients initiated haemodialysis (HD) with a temporary catheter. Seven countries (5% of surveyed countries) had >75% of patients initiating HD with arteriovenous fistulas or grafts. Seven countries (5% of surveyed countries) had >75% of their patients starting HD with tunnelled dialysis catheters. 57% of low-income countries (LICs) had >75% of their patients initiating HD with a temporary catheter compared to 5% of high-income countries (HICs). Shortages of surgeons to create vascular access were reported in 91% of LIC compared to 46% in HIC. Approximately 95% of participating countries in the LIC category reported shortages of surgeons for peritoneal dialysis (PD) access compared to 26% in HIC. Public funding was available for central venous catheters, fistula/graft creation, and PD catheter surgery in 57%, 54% and 54% of countries, respectively. CONCLUSION There is a substantial variation in the availability, funding, workforce, and utilization of vascular and peritoneal access for dialysis across countries regions, with major gaps in low-income countries.
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Affiliation(s)
- Anukul Ghimire
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samveg Shah
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Somkanya Tungsanga
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Tushar Vachharajani
- School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Pietro Ravani
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Vivekananda Jha
- George Institute of Global Health, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Valerie Luyckx
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kailash Jindal
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Nikhil Shah
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J Caskey
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Rumeyza Kazancioglu
- School of Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Aminu K Bello
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
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Nizeyimana F, Pendergrast J, Ntegerejuwampayee A, Lin Y, Kanyamuhunga A, Gashaija C, Masaisa F, Uzamukunda C, Mutuyimana G, Ndicunguye F, Gaseminari A, Mulindwa B, Muyombo T, Chargé S, Skelton T. Transfusion Camp Rwanda 2023: A train-the-trainer workshop establishing locally driven leadership in knowledge translation and sustainability in transfusion medicine education. Vox Sang 2024. [PMID: 38425034 DOI: 10.1111/vox.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Blood transfusion is performed daily in hospitals. Gaps exist between transfusion guidelines and day-to-day clinical care. These gaps are prevalent in resource-limited settings due to scarce continuing medical education. Transfusion Camp Rwanda aims to bridge this gap by (1) delivering context-appropriate up-to-date education, (2) teaching participants how to independently deliver a case-based curriculum and (3) identifying strategies to promote change in transfusion practice in Rwanda. MATERIALS AND METHODS In May 2023, a multidisciplinary team from Canada and Rwanda carried out a Transfusion Camp train-the-trainer workshop for clinicians from all five provinces in Rwanda. Participants attended in-person lectures, seminars and workshop group discussions on the implementation of the Rwanda National Directives on Rational Use of Blood and Blood Components. Course feedback was based on the Kirkpatrick Model of Training and Evaluation. RESULTS Fifty-one physicians and laboratory technicians participated in the course. Confidence in caring for patients based on transfusion guidelines was self-rated as 'excellent' by 23% of participants before and 77% after, while 84% reported they planned to teach Transfusion Camp to others and 100% responded that they will apply course content to clinical practice. Workshop groups recommended strategies to improve transfusion medicine practice in Rwanda in four domains: Communication, Institutional Approval, Practice Audits and Education. CONCLUSION Transfusion medicine education in Rwanda using a train-the-trainer approach was well-received by participants and allowed for a more detailed understanding of the local medical and educational environment. These observations can inform the further expansion of the Transfusion Camp Rwanda project.
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Affiliation(s)
- Francoise Nizeyimana
- Department of Anesthesia and Critical Care, University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Jacob Pendergrast
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, Ontario, Canada
| | - Angelique Ntegerejuwampayee
- Department of Anesthesia and Critical Care, University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Yulia Lin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, Ontario, Canada
- Precision Diagnostics and Therapeutic Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aimable Kanyamuhunga
- Department of Pediatrics, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Christopher Gashaija
- National Centre for Blood Transfusion, Rwanda Biomedical Centre, University of Rwanda, Kigali, Rwanda
| | - Florence Masaisa
- Department of Internal Medicine, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Claudine Uzamukunda
- Department of Anesthesia and Critical Care, University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Grace Mutuyimana
- Department of Anesthesia and Critical Care, University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Fabrice Ndicunguye
- National Centre for Blood Transfusion, Rwanda Biomedical Centre, University of Rwanda, Kigali, Rwanda
| | - Alexis Gaseminari
- National Centre for Blood Transfusion, Rwanda Biomedical Centre, University of Rwanda, Kigali, Rwanda
| | - Bruce Mulindwa
- National Centre for Blood Transfusion, Rwanda Biomedical Centre, University of Rwanda, Kigali, Rwanda
| | - Thomas Muyombo
- National Centre for Blood Transfusion, Rwanda Biomedical Centre, University of Rwanda, Kigali, Rwanda
| | - Sophie Chargé
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Teresa Skelton
- Department of Anesthesiology, Pharmacology, and Therapeutics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Ožegić O, Bedenić B, Sternak SL, Sviben M, Talapko J, Pažur I, Škrlec I, Segedi I, Meštrović T. Antimicrobial Resistance and Sports: The Scope of the Problem, Implications for Athletes' Health and Avenues for Collaborative Public Health Action. Antibiotics (Basel) 2024; 13:232. [PMID: 38534667 DOI: 10.3390/antibiotics13030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
Antimicrobial resistance (AMR) poses a global threat, leading to increased mortality and necessitating urgent action-however, its impact on athletes and the world of sports has hitherto been neglected. Sports environments (including athletic and aquatic) exhibit high levels of microbial contamination, potentially contributing to the spread of resistant microorganisms during physical activities. Moreover, the literature suggests that travel for sports events may lead to changes in athletes' gut microbiomes and potentially impact their antibiotic resistance profiles, raising questions about the broader implications for individual and public/global health. The prevalence of Staphylococcus aureus (S. aureus) among athletes (particularly those engaged in contact or collision sports) ranges between 22.4% and 68.6%, with MRSA strains being isolated in up to 34.9% of tested individuals. Factors such as training frequency, equipment sharing, delayed post-training showers, and a history of certain medical conditions are linked to higher colonization rates. Moreover, MRSA outbreaks have been documented in sports teams previously, highlighting the importance of implementing preventive measures and hygiene protocols in athletic settings. In light of the growing threat of AMR, there is a critical need for evidence-based treatment guidelines tailored to athletes' unique physiological demands to ensure responsible antibiotic use and mitigate potential health risks. While various initiatives-such as incorporating AMR awareness into major sporting events-aim to leverage the broad audience of sports to communicate the importance of addressing AMR, proactive measures (including improved AMR surveillance during large sporting events) will be indispensable for enhancing preparedness and safeguarding both athletes' and the general public's health. This narrative review thoroughly assesses the existing literature on AMR and antibiotic usage in the context of sports, aiming to illuminate areas where information may be lacking and underscoring the significance of promoting global awareness about AMR through sports.
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Affiliation(s)
- Ognjen Ožegić
- Department of Anaesthesiology, Intensive Medicine and Pain Management, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia
| | - Branka Bedenić
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- BIMIS-Biomedical Research Center Šalata, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Sunčanica Ljubin Sternak
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Clinical Microbiology Department, Teaching Institute of Public Health "Dr Andrija Štampar", 10000 Zagreb, Croatia
| | - Mario Sviben
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Parasitology Department, Microbiology Service, Croatian National Institute of Public Health, 10000 Zagreb, Croatia
| | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Iva Pažur
- Department of Anaesthesiology, Intensive Medicine and Pain Management, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ivan Segedi
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Meštrović
- University Centre Varaždin, University North, 42000 Varaždin, Croatia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
- Department for Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA 98195, USA
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Djuric O, Larosa E, Cassinadri M, Cilloni S, Bisaccia E, Pepe D, Bonvicini L, Vicentini M, Venturelli F, Giorgi Rossi P, Pezzotti P, Mateo Urdiales A, Bedeschi E. Effect of an enhanced public health contact tracing intervention on the secondary transmission of SARS-CoV-2 in educational settings: The four-way decomposition analysis. eLife 2024; 13:e85802. [PMID: 38416129 PMCID: PMC10901504 DOI: 10.7554/elife.85802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
Background The aim of our study was to test the hypothesis that the community contact tracing strategy of testing contacts in households immediately instead of at the end of quarantine had an impact on the transmission of SARS-CoV-2 in schools in Reggio Emilia Province. Methods We analysed surveillance data on notification of COVID-19 cases in schools between 1 September 2020 and 4 April 2021. We have applied a mediation analysis that allows for interaction between the intervention (before/after period) and the mediator. Results Median tracing delay decreased from 7 to 3.1 days and the percentage of the known infection source increased from 34-54.8% (incident rate ratio-IRR 1.61 1.40-1.86). Implementation of prompt contact tracing was associated with a 10% decrease in the number of secondary cases (excess relative risk -0.1 95% CI -0.35-0.15). Knowing the source of infection of the index case led to a decrease in secondary transmission (IRR 0.75 95% CI 0.63-0.91) while the decrease in tracing delay was associated with decreased risk of secondary cases (1/IRR 0.97 95% CI 0.94-1.01 per one day of delay). The direct effect of the intervention accounted for the 29% decrease in the number of secondary cases (excess relative risk -0.29 95%-0.61 to 0.03). Conclusions Prompt contact testing in the community reduces the time of contact tracing and increases the ability to identify the source of infection in school outbreaks. Although there are strong reasons for thinking it is a causal link, observed differences can be also due to differences in the force of infection and to other control measures put in place. Funding This project was carried out with the technical and financial support of the Italian Ministry of Health - CCM 2020 and Ricerca Corrente Annual Program 2023.
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Affiliation(s)
- Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
- Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), University of Modena and Reggio EmiliaModenaItaly
| | - Elisabetta Larosa
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Mariateresa Cassinadri
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Silvia Cilloni
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Eufemia Bisaccia
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Davide Pepe
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di SanitàRomeItaly
| | | | - Emanuela Bedeschi
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
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Worku A, Haisch D, Parekh M, Sultan A, Shumet A, G/Selassie K, O'Donnell M, Binegdie A, Sherman CB, Schluger NW. Epidemiology and Outcomes of Critical Illness and Novel Predictors of Mortality in an Ethiopian Medical Intensive Care Unit. J Intensive Care Med 2024:8850666241233481. [PMID: 38414379 DOI: 10.1177/08850666241233481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Low- and middle-income countries (LMICs) bear most of the global burden of critical illness. Managing this burden requires improved understanding of epidemiology and outcomes in LMIC intensive care units (ICUs), including LMIC-specific mortality prediction scores. This study was a retrospective observational study at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, examining all consecutive medical ICU admissions from June 2014 to April 2015. The primary outcome was ICU mortality; secondary outcomes were prolonged ICU stay and prolonged mechanical ventilation. ICU mortality prediction models were created using multivariable logistic regression and compared with the Mortality Probability Model-II (MPM-II). Associations with secondary outcomes were examined with multivariable logistic regression. There were 198 admissions during the study period; mortality was 35%. Age, shock on admission, mechanical ventilation, human immunodeficiency virus, and Glasgow Coma Scale ≤8 were associated with ICU mortality. The receiver operating characteristic curve for this 5-factor model had an AUC of 0.8205 versus 0.7468 for MPM-II, favoring the simplified new model. Mechanical ventilation and lack of shock were associated with prolonged ICU stays. Mortality in an LMIC medical ICU was high. This study examines an LMIC medical ICU population, showing a simplified prediction model may predict mortality as well as complex models.
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Affiliation(s)
- Aschalew Worku
- Division of Pulmonary and Critical Care, Department of Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Deborah Haisch
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Madhavi Parekh
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Amir Sultan
- Division of Gastroenterology, Department of Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Abebe Shumet
- Department of Medicine, Bahir Dar University College of Health Science, Bahir Dar, Ethiopia
| | - Kibrom G/Selassie
- Department of Medicine, Mekele University College of Sciences, Mekele, Ethiopia
| | - Max O'Donnell
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Amsalu Binegdie
- Division of Pulmonary and Critical Care, Department of Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Charles B Sherman
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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Adams V, Chandler C, Kelly AH, Livingston J. A pandemic of metrics. Med Anthropol Q 2024. [PMID: 38416990 DOI: 10.1111/maq.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/22/2023] [Indexed: 03/01/2024]
Abstract
The COVID-19 pandemic prompted critical attention to the performative power of metrics. We suggest that the existential capacities of metrics as a means of pandemic living warrant further consideration. We describe how the COVID-19 pandemic that came into existence as a public health and political event could only have occurred because of the anticipatory metrical practices that were used to transform SARS-COV-2 into a matter of global health concern. By exploring the affective potencies of COVID-19 metrics we show their abilities to engage the public in ways that cannot be contained; in detailing the narrative arcs created through metrics we show their opportunities, misdirections, and erasures. A pandemic way of life persists: a pandemic of metrics.
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Affiliation(s)
- Vincanne Adams
- Centre for Humanities and Social Sciences, University of California San Francisco, San Francisco, California, USA
| | - Clare Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ann H Kelly
- Department of Global Helath and Social Medicine, School of Global Affairs, King's College London, London, UK
| | - Julie Livingston
- Department of Social and Cultural Analysis, New York University, New York, New York, USA
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Nyberg J, Jonsson EN, Karlsson MO, Häggström J. Properties of the full random-effect modeling approach with missing covariate data. Stat Med 2024; 43:935-952. [PMID: 38128126 DOI: 10.1002/sim.9979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
During drug development, a key step is the identification of relevant covariates predicting between-subject variations in drug response. The full random effects model (FREM) is one of the full-covariate approaches used to identify relevant covariates in nonlinear mixed effects models. Here we explore the ability of FREM to handle missing (both missing completely at random (MCAR) and missing at random (MAR)) covariate data and compare it to the full fixed-effects model (FFEM) approach, applied either with complete case analysis or mean imputation. A global health dataset (20 421 children) was used to develop a FREM describing the changes of height for age Z-score (HAZ) over time. Simulated datasets (n = 1000) were generated with variable rates of missing (MCAR) covariate data (0%-90%) and different proportions of missing (MAR) data condition on either observed covariates or predicted HAZ. The three methods were used to re-estimate model and compared in terms of bias and precision which showed that FREM had only minor increases in bias and minor loss of precision at increasing percentages of missing (MCAR) covariate data and performed similarly in the MAR scenarios. Conversely, the FFEM approaches either collapsed at≥ $$ \ge $$ 70% of missing (MCAR) covariate data (FFEM complete case analysis) or had large bias increases and loss of precision (FFEM with mean imputation). Our results suggest that FREM is an appropriate approach to covariate modeling for datasets with missing (MCAR and MAR) covariate data, such as in global health studies.
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Affiliation(s)
| | | | - Mats O Karlsson
- Pharmetheus AB, Uppsala, Sweden
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
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Soliman R, Bolous N, Heneghan C, Oke J, Boylan AM, Eweida W, Abouelnaga S, Elhaddad A. An overview of childhood cancer care and outcomes in Egypt: a narrative review. Ecancermedicalscience 2024; 18:1676. [PMID: 38439811 PMCID: PMC10911675 DOI: 10.3332/ecancer.2024.1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Indexed: 03/06/2024] Open
Abstract
Childhood cancer is an urgent priority in Egypt, owing to a large number of children with cancer, the great need and demand for paediatric oncology services, limited resources/funds and inferior survival outcomes. Therefore, an overview of the status of childhood cancer care in Egypt and an evidence-based approach towards optimal utilisation of resources/funds to improve this care are needed. This paper summarises key evidence about childhood cancer care and outcomes in Egypt. We conducted a narrative literature review using a structured search strategy of the MEDLINE database through the PubMed interface. All relevant evidence was summarised under five main sub-topics: (1) burden of childhood cancer in Egypt; (2) treatment approaches; (3) health outcomes; (4) costs and cost-effectiveness of treatment; and (5) barriers and facilitators to optimal childhood cancer care. We found high estimates of disease burden of childhood cancer in Egypt. Furthermore, childhood cancer treatment in Egypt is based on either implementing intensity-regulated protocols or adopting international protocols with or without adaptations to local contexts, leading to varying standards of care among the different treating centres. Limited data about the survival outcomes, costs and cost-effectiveness of treatment exist, although high-quality data from retrospective cohort studies were published from a large paediatric oncology centre (Children's Cancer Hospital Egypt-57357). As Egypt joins the WHO Global Initiative for Childhood Cancers as a focus country, it is prepared to move towards streamlining national efforts to implement a national childhood cancer plan to advance care, improve health outcomes and optimise resource use. Through these efforts, Egypt could become a beacon of hope and a role model to other low- and middle-income countries seeking to improve their childhood cancer care.
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Affiliation(s)
- Ranin Soliman
- Health Economics and Value Unit, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
- Centre for Evidence-Based Medicine, University of Oxford, OX1 2JD Oxford, UK
- Co-first authors
| | - Nancy Bolous
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Co-first authors
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Jason Oke
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Anne-Marie Boylan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Wael Eweida
- Chief Operating Office, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
| | - Sherif Abouelnaga
- Chief Executive Office, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Alaa Elhaddad
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
- Paediatric Oncology Department, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
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73
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Duff R, Awofala O, Arshad MT, Lambourg E, Gallacher P, Dhaun N, Bell S. Global health inequalities of chronic kidney disease: a meta-analysis. Nephrol Dial Transplant 2024:gfae048. [PMID: 38389223 DOI: 10.1093/ndt/gfae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND HYPOTHESIS Chronic kidney disease (CKD) is a significant contributor to global morbidity and mortality. This study investigated disparities in age, sex and socio-economic status in CKD and updated global prevalence estimates through systematic review and meta-analysis. METHODS Five databases were searched from 2014 to 2022, with 14 871 articles screened, 119 papers included and data analysed on 29 159 948 participants. Random effects meta-analyses were conducted to determine overall prevalence, prevalence of stages 3-5 and prevalence in males/females. Influences of age, sex and socio-economic status were assessed in subgroup analyses, and risk of bias assessment and meta-regressions were conducted to explore heterogeneity. RESULTS Overall prevalence of CKD was 13.0% (11.3-14.8%) and 6.6% (5.6-7.8%) for stages 3-5. Prevalence was higher in studies of older populations (19.3% for stages 1-5, 15.0% for stages 3-5) and meta-regression demonstrated association of age, body mass index, diabetes and hypertension with prevalence of stages 3-5. The prevalence of CKD stages 1-5 was similar in males and females (13.1% versus 13.2%) but prevalence of stages 3-5 was higher in females (6.4% versus 7.5%). Overall prevalence was 11.4%, 15.0% and 10.8% in low, middle and high-income countries respectively; for stages 3-5 prevalence was 4.0%, 6.7% and 6.8%, respectively. Included studies were at moderate-high risk of bias in the majority of cases (92%), and heterogeneity was high. CONCLUSION This study provides a comprehensive assessment of CKD prevalence, highlighting important disparities related to age, sex and socio-economic status. Future research should focus on targeted screening and treatment approaches, improving access to care and more effective data monitoring, particularly in low or middle income countries.
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Affiliation(s)
- Rachael Duff
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Omodolapo Awofala
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Muhammad Tahir Arshad
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Emilie Lambourg
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Peter Gallacher
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
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Benboujja F, Hartnick E, Zablah E, Hersh C, Callans K, Villamor P, Yager PH, Hartnick C. Overcoming language barriers in pediatric care: a multilingual, AI-driven curriculum for global healthcare education. Front Public Health 2024; 12:1337395. [PMID: 38454985 PMCID: PMC10917955 DOI: 10.3389/fpubh.2024.1337395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024] Open
Abstract
Background Online medical education often faces challenges related to communication and comprehension barriers, particularly when the instructional language differs from the healthcare providers' and caregivers' native languages. Our study addresses these challenges within pediatric healthcare by employing generative language models to produce a linguistically tailored, multilingual curriculum that covers the topics of team training, surgical procedures, perioperative care, patient journeys, and educational resources for healthcare providers and caregivers. Methods An interdisciplinary group formulated a video curriculum in English, addressing the nuanced challenges of pediatric healthcare. Subsequently, it was translated into Spanish, primarily emphasizing Latin American demographics, utilizing OpenAI's GPT-4. Videos were enriched with synthetic voice profiles of native speakers to uphold the consistency of the narrative. Results We created a collection of 45 multilingual video modules, each ranging from 3 to 8 min in length and covering essential topics such as teamwork, how to improve interpersonal communication, "How I Do It" surgical procedures, as well as focused topics in anesthesia, intensive care unit care, ward nursing, and transitions from hospital to home. Through AI-driven translation, this comprehensive collection ensures global accessibility and offers healthcare professionals and caregivers a linguistically inclusive resource for elevating standards of pediatric care worldwide. Conclusion This development of multilingual educational content marks a progressive step toward global standardization of pediatric care. By utilizing advanced language models for translation, we ensure that the curriculum is inclusive and accessible. This initiative aligns well with the World Health Organization's Digital Health Guidelines, advocating for digitally enabled healthcare education.
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Affiliation(s)
- Fouzi Benboujja
- Department of Otolaryngology, Mass Eye and Ear, Harvard Medical School, Boston, MA, United States
| | | | - Evelyn Zablah
- Department of Otolaryngology, Mass Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Cheryl Hersh
- Pediatric Airway, Voice and Swallowing Center, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Kevin Callans
- Department of Otolaryngology, Mass Eye and Ear, Harvard Medical School, Boston, MA, United States
- Massachusetts General Hospital for Children, Boston, MA, United States
| | - Perla Villamor
- Hospital Serena del Mar, Cartagena, Colombia
- Hospital Infantil Napoleón Franco Pareja, Cartagena, Colombia
| | - Phoebe H. Yager
- Pediatric Intensive Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Christopher Hartnick
- Department of Otolaryngology, Mass Eye and Ear, Harvard Medical School, Boston, MA, United States
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Chocron Y, Rousakis M, Vollenweider P, Vaucher J, Marques-Vidal PM. Blood pressure status, trajectories and cardiovascular disease: the CoLaus|PsyCoLaus prospective study. Open Heart 2024; 11:e002556. [PMID: 38388190 PMCID: PMC10884261 DOI: 10.1136/openhrt-2023-002556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND High blood pressure (BP) is a major risk factor for cardiovascular disease (CVD). Adequate treatment of high BP should reduce the risk of CVD, but this association has seldom been assessed in a general population setting. METHODS Population-based prospective study conducted in Lausanne, Switzerland, with a follow-up between 2003 and 2021. Participants were categorised as normal BP, untreated high BP, treated and uncontrolled BP and treated and controlled BP. Total and CVD mortality as well as any CVD event were assessed. RESULTS 5341 participants (65% normal, 17.4% untreated, 8.8% treated and uncontrolled and 8.8% treated and controlled) were included. After a median follow-up of 14 years (IQR: 11-15), 575 CVD events occurred. Relative to participants with normal BP, multivariable-adjusted HRs (and 95% CI) for total CVD were 1.38 (1.11 to 1.72) for untreated, 1.35 (1.04 to 1.76) for treated and uncontrolled and 1.50 (1.15 to 1.95) for treated and controlled. The corresponding HRs for CVD mortality (112 events) were 0.94 (0.52 to 1.70), 1.77 (1.00 to 3.12) and 2.52 (1.50 to 4.23), respectively. For total mortality (677 events), the HRs were 1.24 (1.01 to 1.52), 1.26 (0.99 to 1.60) and 1.27 (0.99 to 1.62), respectively. Sensitivity analysis using BP status during a 5-year period and categorising participants as always normal, always treated and uncontrolled, always treated and controlled and other led to similar findings. CONCLUSION Over a long follow-up period of 14 years, BP control was not associated with reduction of CVD events, CVD-related or total mortality. This finding should help define further studies on factors affecting CVD and mortality in people treated for hypertension in the general population.
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Affiliation(s)
| | | | | | - Julien Vaucher
- Internal Medicine, CHUV, Lausanne, Switzerland
- Internal Medicine, HFR, Fribourg, Switzerland
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Harb R, Tuggey R, Ladenson JH, Amukele T. Remote support of an external quality assessment program in 10 laboratories in Bhutan, Uganda, and Malawi: Pathologists Overseas experience between 2009 and 2017. Am J Clin Pathol 2024:aqae009. [PMID: 38387037 DOI: 10.1093/ajcp/aqae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES This article describes Pathologists Overseas (PO) experience supporting external quality assessment (EQA) programs in 10 clinical laboratories across 3 countries between 2009 and 2017. METHODS Laboratories were enrolled in the condensed chemical pathology EQA program provided by the Royal College of Pathologists of Australasia Quality Assurance Program. Participants were given an initial 2- to 4-day in-person training, followed by 1 year of active feedback on performance via emails or phone calls by a PO volunteer. RESULTS There were 2 performance metrics: percentage of reported results as a measure of compliance and percentage of acceptable reported results as a measure of accuracy. Laboratories demonstrated high compliance with result reporting, with medians of 69.9%, 71.7%, and 81.3% before, during, and after feedback, respectively. Concomitant medians for the percentage of acceptable reported results were 41.2%, 57.3%, and 53.5%, respectively. Six laboratories had low performance in terms of accuracy at baseline (<60%). Active feedback improved the percentage of acceptable reported results for these lower-performing laboratories. CONCLUSIONS External quality assessment programs can be successfully adopted long term by laboratories in low-resource settings. Active feedback requires significant time and effort but could be especially beneficial for laboratories with poor baseline performance.
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Affiliation(s)
- Roa Harb
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, US
| | | | - Jack H Ladenson
- Pathologists Overseas, Fullerton, CA, US
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine Washington University School of Medicine, St Louis, MO, US
| | - Timothy Amukele
- Pathologists Overseas, Fullerton, CA, US
- ICON Clinical Laboratories, Farmingdale, NY, US
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Guerra S, Roope LS, Tsiachristas A. Assessing the relationship between coverage of essential health services and poverty levels in low- and middle-income countries. Health Policy Plan 2024; 39:156-167. [PMID: 38300510 PMCID: PMC10883664 DOI: 10.1093/heapol/czae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 02/02/2024] Open
Abstract
Universal health coverage (UHC) aims to provide essential health services and financial protection to all. This study aimed to assess the relationship between the service coverage aspect of universal health coverage and poverty in low- and middle-income countries (LMICs). Using country-level data from 96 LMICs from 1990 to 2017, we employed fixed-effects and random-effects regressions to investigate the association of eight service coverage indicators (inpatient admissions; antenatal care; skilled birth attendance; full immunization; cervical and breast cancer screening rates; diarrhoea and acute respiratory infection treatment rates) with poverty headcount ratios and gaps at the $1.90, $3.20 and $5.50 poverty lines. Missing data were imputed using within-country linear interpolation or extrapolation. One-unit increases in seven service indicators (breast cancer screening being the only one with no significant associations) were associated with reduced poverty headcounts by 2.54, 2.46 and 1.81 percentage points at the $1.90, $3.20 and $5.50 lines, respectively. The corresponding reductions in poverty gaps were 0.99 ($1.90), 1.83 ($3.20) and 1.89 ($5.50) percentage points. Apart from cervical cancer screening, which was only significant in one poverty headcount model ($5.50 line), all other service indicators were significant in either the poverty headcount or gap models at both $1.90 and $3.20 poverty lines. In LMICs, higher service coverage rates are associated with lower incidence and intensity of poverty. Further research is warranted to identify the causal pathways and specific circumstances in which improved health services in LMICs might help to reduce poverty.
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Affiliation(s)
- Stefanny Guerra
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, United Kingdom
- Department of Population Health Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, United Kingdom
| | - Laurence Sj Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, United Kingdom
| | - Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom
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Lawson DW, Chen Z, Kilgallen JA, Brand CO, Ishungisa AM, Schaffnit SB, Kumogola Y, Urassa M. Misperception of peer beliefs reinforces inequitable gender norms among Tanzanian men. Evol Hum Sci 2024; 6:e17. [PMID: 38572225 PMCID: PMC10988154 DOI: 10.1017/ehs.2024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/20/2023] [Accepted: 02/02/2024] [Indexed: 04/05/2024] Open
Abstract
Gender role ideology, i.e. beliefs about how genders should behave, is shaped by social learning. Accordingly, if perceptions about the beliefs of others are inaccurate this may impact trajectories of cultural change. Consistent with this premise, recent studies report evidence of a tendency to overestimate peer support for inequitable gender norms, especially among men, and that correcting apparent 'norm misperception' promotes transitions to relatively egalitarian beliefs. However, supporting evidence largely relies on self-report measures vulnerable to social desirability bias. Consequently, observed patterns may reflect researcher measurement error rather than participant misperception. Addressing this shortcoming, we examine men's gender role ideology using both conventional self-reported and a novel wife-reported measure of men's beliefs in an urbanising community in Tanzania. We confirm that participants overestimate peer support for gender inequity. However, the latter measure, which we argue more accurately captures men's true beliefs, implies that this tendency is relatively modest in magnitude and scope. Overestimation was most pronounced among men holding relatively inequitable beliefs, consistent with misperception of peer beliefs reinforcing inequitable norms. Furthermore, older and poorly educated men overestimated peer support for gender inequity the most, suggesting that outdated and limited social information contribute to norm misperception in this context.
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Affiliation(s)
- David W. Lawson
- Department of Anthropology, University of California, Santa Barbara, USA
| | - Zhian Chen
- Department of Anthropology, University of California, Santa Barbara, USA
| | | | - Charlotte O. Brand
- Human Behaviour and Cultural Evolution Group, College of Life and Environmental Sciences, University of Exeter, Penryn, UK
| | - Alexander M. Ishungisa
- National Institute for Medical Research, Mwanza, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Mark Urassa
- National Institute for Medical Research, Mwanza, Tanzania
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79
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Cui Y, Dai Z, Cohen JE, Rosas S, Clegg Smith K, Welding K, Czaplicki L. Culturally specific health-related features on cigarette packs sold in China. Tob Control 2024; 33:232-239. [PMID: 36008126 DOI: 10.1136/tc-2022-057527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND China is the country with the highest burden of tobacco-caused disease. We characterised the extent to which cigarette pack marketing features (eg, imagery, text, pack color) could potentially mislead consumers by suggesting products are healthy. METHODS We used two methods: group concept mapping and content analysis. First, we used a group concept mapping approach to generate and sort Chinese consumer responses to an open-ended prompt asking what marketing features suggest a product is 'healthy' or 'good for you'. Second, based on the concept mapping results, we developed a codebook of health-related features on cigarette packs that were relevant to the unique cultural context of product marketing in China. Two trained coders who were native Chinese speakers double-coded a sample of 1023 cigarette packs purchased in 2013 (wave 1) and 2017 (wave 2). We examined differences in the presence of features overall and over time. RESULTS Overall, 83.5% (n=854) of Chinese cigarette packs in our sample contained at least one 'healthy' or 'good for you' feature, and the presence of health-related features on packs remained constant between wave 1 (83.5%, n=354) and wave 2 (83.5%, n=500; p=1.00). Across both waves, the most common categories of culturally specific health features present related to recycling symbols, rare animal imagery, bright colours (eg, bright yellow) and botanical imagery (eg, bamboo, mint). CONCLUSION Health-related features on cigarette packs sold in China are common. Enhanced policies to address tobacco packaging, labelling and branding could support and facilitate a reduction in the high tobacco burden in China.
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Affiliation(s)
- Yuxian Cui
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zheng Dai
- Department of Applied Economics, Johns Hopkins University Zanvyl Krieger School of Arts and Sciences, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Scott Rosas
- Concept Systems Incorporated, Ithaca, New York, USA
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kevin Welding
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Gallus S, Stival C, McKee M, Carreras G, Gorini G, Odone A, van den Brandt PA, Pacifici R, Lugo A. Impact of electronic cigarette and heated tobacco product on conventional smoking: an Italian prospective cohort study conducted during the COVID-19 pandemic. Tob Control 2024; 33:267-270. [PMID: 36207129 DOI: 10.1136/tc-2022-057368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Debate continues about whether electronic cigarettes (e-cigarettes) and heated tobacco products (HTP) reduce or increase the probability of smoking, with many studies compromised by stated or unstated conflicts of interest. We undertook a longitudinal study in Italy. METHODS 3185 Italian participants aged 18-74 years provided baseline (April-May) and follow-up (November-December) responses in 2020, reporting smoking status and use of e-cigarettes and HTP. We tracked transitions over that period and reported risk ratios (RR) and corresponding 95% CIs for changes in smoking in relation to baseline use of e-cigarettes and HTPs. RESULTS Never cigarette smokers who used e-cigarettes at baseline were much more likely to start smoking (compared with never users, RR 8.78; 95% CI: 5.65 to 13.65) and current HTP users (RR 5.80; 95% CI: 3.65 to 9.20). Among ex-smokers, relapse (17.2%) at follow-up was more likely among e-cigarette (RR 4.25; 95% CI: 2.40 to 7.52) and HTP users (RR 3.32; 95% CI: 2.05 to 5.37). Among current smokers at baseline, those who had continued smoking at follow-up were 85.4% overall. These were more frequently current novel product users (compared with non-users, RR 1.10; 95% CI: 1.02 to 1.19 for e-cigarette users; RR 1.17; 95% CI: 1.10 to 1.23 for HTP users). CONCLUSIONS Both e-cigarette and HTP use predict starting smoking and relapse, and appear to reduce smoking cessation. Due to the limited sample size within specific strata, the association with quitting smoking should be confirmed by larger prospective studies. These findings do not support the use of e-cigarettes and HTPs in tobacco control as a consumer product, at least in Italy.
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Affiliation(s)
- Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Stival
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Giulia Carreras
- Oncologic Network, Prevention and Research Institute, Florence, Italy
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute, Florence, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Piet A van den Brandt
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Roberta Pacifici
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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81
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He Q, Chaillet JK, Labbé F. Antigenic strain diversity predicts different biogeographic patterns of maintenance and decline of antimalarial drug resistance. eLife 2024; 12:RP90888. [PMID: 38363295 PMCID: PMC10942604 DOI: 10.7554/elife.90888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
The establishment and spread of antimalarial drug resistance vary drastically across different biogeographic regions. Though most infections occur in sub-Saharan Africa, resistant strains often emerge in low-transmission regions. Existing models on resistance evolution lack consensus on the relationship between transmission intensity and drug resistance, possibly due to overlooking the feedback between antigenic diversity, host immunity, and selection for resistance. To address this, we developed a novel compartmental model that tracks sensitive and resistant parasite strains, as well as the host dynamics of generalized and antigen-specific immunity. Our results show a negative correlation between parasite prevalence and resistance frequency, regardless of resistance cost or efficacy. Validation using chloroquine-resistant marker data supports this trend. Post discontinuation of drugs, resistance remains high in low-diversity, low-transmission regions, while it steadily decreases in high-diversity, high-transmission regions. Our study underscores the critical role of malaria strain diversity in the biogeographic patterns of resistance evolution.
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Affiliation(s)
- Qixin He
- Department of Biological Sciences, Purdue UniversityWest LafayetteUnited States
| | - John K Chaillet
- Department of Biological Sciences, Purdue UniversityWest LafayetteUnited States
| | - Frédéric Labbé
- Department of Ecology and Evolution, University of ChicagoChicagoUnited States
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82
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Matthes BK, Fabbri A, Dance S, Laurence L, Silver K, Gilmore AB. Seeking to be seen as legitimate members of the scientific community? An analysis of British American Tobacco and Philip Morris International's involvement in scientific events. Tob Control 2024:tc-2022-057809. [PMID: 36737249 DOI: 10.1136/tc-2022-057809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION For decades, tobacco companies manipulated and misused science. They funded and disseminated favourable research and suppressed research that showed the harms of their products, deliberately generating misinformation. While previous work has examined many of the practices involved, their engagement in scientific events has so far not been systematically studied. Here, we examine the involvement of British American Tobacco (BAT) and Philip Morris International (PMI) in scientific events, including conferences, symposia and workshops. METHODS Our analysis involved two steps. First, we collected all available data PMI and BAT provided on their websites to identify events. Second, we extracted information about the nature of tobacco industry involvement from event websites and materials. RESULTS We identified 213 scientific events that BAT and/or PMI representatives attended between April 2012 and September 2021. Most events took place in high-income countries in Europe and North America. They covered a diverse range of fields, including toxicology (n=60, 28.1%), medicine (n=25, 11.7%), biology (n=24, 11.3%), chemistry (n=23, 10.8%) and aerosol science (n=18, 8.5%), as well as dentistry (n=9, 4.2%), pharmaceutical science (n=8, 3.8%) and computing (n=8, 3.8%). We identified 356 posters provided by BAT and PMI that linked to 118 events (55.4%) as well as 77 presentations from 65 events (30.5%). Industry involvement through sponsorship (nine events), exhibition (three events) or organising committee (one event) was rare. CONCLUSION BAT and PMI representatives attended a large number and wide range of scientific events. Given that scientific events could be a crucial platform for building connections in the scientific sphere and disseminating industry's messages, this work highlights the importance of denormalising the tobacco industry's involvement in scientific events.
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Affiliation(s)
| | - Alice Fabbri
- Department for Health, University of Bath, Bath, UK
| | - Sarah Dance
- Department of Psychology, University of Bath, Bath, UK
| | | | - Karin Silver
- Department for Health, University of Bath, Bath, UK
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83
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Rajani AJ, Raval DM, Chitale RA, Kempaiah P, Elwasila SM, Durvasula R, Oring J. Half a Century in Hiding: A Unique Case of Tuberculoid Leprosy with an Unprecedented Incubation Period. Am J Case Rep 2024; 25:e942048. [PMID: 38351602 PMCID: PMC10877640 DOI: 10.12659/ajcr.942048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 01/02/2024] [Accepted: 12/20/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Leprosy, also known as Hansen's disease, is a neglected tropical disease with low prevalence in the United States. The disease's long incubation period can cause delayed presentation, and most affected individuals have a history of travel or work in leprosy-endemic regions. The immune response to Mycobacterium leprae determines the clinical characteristics of leprosy, with tuberculoid leprosy being characterized by well-defined granulomas and involvement of peripheral nerves. The recommended treatment is a combination of dapsone and rifampin for 12 months. CASE REPORT A 78-year-old man with a history of extensive travel to Africa and Asia 50 years ago, presented with a non-tender, non-pruritic, and hypopigmented skin lesion on his left knee. Biopsy results confirmed granulomatous inflammation and the presence of Mycobacterium leprae, leading to a diagnosis of tuberculoid/paucibacillary leprosy. The patient received dapsone and rifampin treatment, which resulted in symptom improvement. CONCLUSIONS The patient's long incubation period of 50 years between exposure and symptom onset is remarkable and possibly one of the longest reported for tuberculoid leprosy. It emphasizes the importance of considering leprosy in cases with an extensive travel history and long incubation periods. Our patient's case presented contradictory staining results, suggesting potential sampling variation or a rare mixed leprosy form. Based on his clinical findings, he was diagnosed with tuberculoid leprosy. Early diagnosis and treatment are crucial to prevent irreversible nerve damage and improve patient outcomes. Healthcare providers should be vigilant in acquiring a detailed travel history to facilitate early diagnosis and appropriate management of leprosy cases.
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84
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Rose AL, Jack HE, Rasheed MA, Magidson JF. Raising the issue of quality in implementation science reporting in global health: Implications for health planning and practice. Int J Health Plann Manage 2024. [PMID: 38354062 DOI: 10.1002/hpm.3788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024] Open
Abstract
Implementation outcomes, which focus on the barriers to, and facilitators and processes of healthcare delivery, are critical to translating research evidence to health planning and practice and to improving healthcare delivery. This article summarises key quality issues in reporting of implementation science outcomes within global health and describes the ways in which this presents a challenge for shifting health planning and practice across low-resource health systems. This article also suggests that the wider use of reporting guidelines for implementation outcomes could help address this issue.
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Affiliation(s)
- Alexandra L Rose
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Muneera A Rasheed
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jessica F Magidson
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
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85
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Wu AG, Luch S, Slusher TM, Fischer GA, Lunos SA, Bjorklund AR. The novel LESS (low-cost entrainment syringe system) O 2 blender for use in modified bubble CPAP circuits: a clinical study of safety. Front Pediatr 2024; 12:1313781. [PMID: 38410763 PMCID: PMC10894966 DOI: 10.3389/fped.2024.1313781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/25/2024] [Indexed: 02/28/2024] Open
Abstract
Background Bubble continuous positive airway pressure (bCPAP) is used in resource-limited settings for children with respiratory distress. Low-cost modifications of bCPAP use 100% oxygen and may cause morbidity from oxygen toxicity. We sought to test a novel constructible low-cost entrainment syringe system (LESS) oxygen blender with low-cost modified bCPAP in a relevant clinical setting. Methods We conducted a clinical trial evaluating safety of the LESS O2 blender among hospitalized children under five years old in rural Cambodia evaluating the rate of clinical failure within one hour of initiation of the LESS O2 blender and monitoring for any other blender-related complications. Findings Thirty-two patients were included. The primary outcome (clinical failure) occurred in one patient (3.1%, 95% CI = 0.1-16.2%). Clinical failure was defined as intubation, death, transfer to another hospital, or two of the following: oxygen saturation <85% after 30 min of treatment; new signs of respiratory distress; or partial pressure of carbon dioxide ≥60 mmHg and pH <7.2 on a capillary blood gas. Secondary outcomes included average generated FiO2's with blender use, which were 59% and 52% when a 5 mm entrainment was used vs. a 10 mm entrainment port with 5-7 cm H2O of CPAP and 1-7 L/min (LPM) of flow; and adverse events including loss of CPAP bubbling (64% of all adverse events), frequency of repair or adjustment (44%), replacement (25%), and median time of respiratory support (44 h). Interpretation Overall the LESS O2 blender was safe for clinical use. The design could be modified for improved performance including less repair needs and improved nasal interface, which requires modification for the blender to function more consistently.
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Affiliation(s)
- Andrew G Wu
- Division of Critical Care Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Division of Pediatric Critical Care, Hennepin Healthcare, Minneapolis, MN, United States
| | - Sreyleak Luch
- Department of Pediatrics, Chenla Children's Healthcare, Kratie, Cambodia
| | - Tina M Slusher
- Department of Pediatrics, Division of Pediatric Critical Care, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Pediatrics Global Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Department of Pediatrics, Division of Pediatric Critical Care, University of Minnesota, Minneapolis, MN, United States
| | - Gwenyth A Fischer
- Department of Pediatrics, Division of Pediatric Critical Care, University of Minnesota, Minneapolis, MN, United States
| | - Scott A Lunos
- Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, MN, United States
| | - Ashley R Bjorklund
- Department of Pediatrics, Division of Pediatric Critical Care, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Pediatrics Global Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Department of Pediatrics, Division of Pediatric Critical Care, University of Minnesota, Minneapolis, MN, United States
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86
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Weir S, May C, Wills A, Van Zanten E, Nesbit K, Ngalande A, Kanjirawaya R. Building Local Capacity in a Low-Resource Setting to Increase Access to Health Care: An Evaluation of Blood Pressure Monitoring Training. Health Promot Pract 2024:15248399231225444. [PMID: 38339998 DOI: 10.1177/15248399231225444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Cardiovascular risk factors such as hypertension are common and largely uncontrolled in Malawi. In this low-resource setting, Community Health Workers (CHWs) can increase access to home-based blood pressure (BP) monitoring. The purpose of this study is to evaluate the effectiveness of a CHW training focused on BP monitoring and referral criteria, as well as the accuracy of referral decision-making and documentation. The participants were a purposive sample of all active home-based palliative care CHWs at St. Gabriel's Hospital (n = 60) located in Namitete, Malawi, serving over 250,000 people within a 50 km radius. This was a retrospective cross-sectional study conducted in December 2020 using both quantitative (descriptive, paired t-test) and qualitative (thematic) analysis. Participants showed significantly greater knowledge on the post-test (M = 8.98, SD = 1.213) compared to the pretest (M = 7.96, SD = 1.231), t (54)-5.0557.475, p < .001. All participants who attended both days of training demonstrated competency on a skills checklist in 100% of the rehabilitation and BP monitoring skills taught. Through document analysis of record books, referral decisions for patients with hypertension were 87.57% accurate and 81.07% of entries (n = 713) were complete. Participants reported the lack of both transportation and equipment as barriers to their work. They reported trainings, supplies, and support from the hospital as facilitators to their work. This study shows that BP can be monitored in remote villages, accurate referrals can be made, and stroke prevention education can be provided. These interventions increase the chances of more equitable care for this vulnerable population in a resource-limited setting.
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Affiliation(s)
- Sarah Weir
- California Children's Services, Alameda County, CA, USA
| | | | - Alexa Wills
- Renew Physical Therapy, San Francisco, CA, USA
| | | | - Kathryn Nesbit
- University of California San Francisco/San Francisco State Graduate Program in Physical Therapy, San Francisco, CA, USA
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87
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Forte DN, Stoltenberg M, Ribeiro SCDC, de Almeida IM(MO, Jackson V, Daubman BR. The Hierarchy of Communication Needs: A Novel Communication Strategy for High Mistrust Settings Developed in a Brazilian COVID-ICU. Palliat Med Rep 2024; 5:86-93. [PMID: 38415076 PMCID: PMC10898234 DOI: 10.1089/pmr.2023.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/29/2024] Open
Abstract
Context The COVID-19 pandemic presented unique challenges for health care systems. Overcrowded units, extreme illness severity, uncertain prognoses, and mistrust in providers resulted in a "pressure cooker" where traditional communication strategies were often insufficient. Objectives Building on well-studied traditional communication interventions, neurobiology principles were used to create a novel communication strategy designed in the COVID-ICU to respond to the unique communication needs of patients within the context of a high mistrust setting. Methods The hierarchy of communication needs recognizes three specific levels of communication that are essential within high-emotion and low-trust settings. The first level is to establish trust. The second level is to resonate with patients' emotions, helping to reduce arousal and improve empathy. The third level includes the more traditional content of disclosing prognostic information and shared decision-making. When facing communication challenges, clinicians are taught to move back a level and reattune to emotions and/or reestablish trust. Discussion The COVID pandemic revealed the shortcomings of a primarily cognitive communication style. The hierarchy of communication needs emphasizes trust building, and emotional resonance as prerequisites of effective cognitive discussions, resulting in more effective clinician-patient communication that more fully incorporates cultural humility and better meets the needs of diverse patient populations. Additional research is needed to further develop this strategy and evaluate its impact on patient experience and outcomes.
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Affiliation(s)
- Daniel Neves Forte
- Intensive Care Unit, Medical Emergency Department, University of São Paulo Medical School, São Paulo, Brazil
- Teaching and Research Institute, Sírio Libanês Hospital, São Paulo, Brazil
| | - Mark Stoltenberg
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Vicki Jackson
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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88
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Schmit N, Topazian HM, Pianella M, Charles GD, Winskill P, White MT, Hauck K, Ghani AC. Modeling resource allocation strategies for insecticide-treated bed nets to achieve malaria eradication. eLife 2024; 12:RP88283. [PMID: 38329112 PMCID: PMC10957170 DOI: 10.7554/elife.88283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Large reductions in the global malaria burden have been achieved, but plateauing funding poses a challenge for progressing towards the ultimate goal of malaria eradication. Using previously published mathematical models of Plasmodium falciparum and Plasmodium vivax transmission incorporating insecticide-treated nets (ITNs) as an illustrative intervention, we sought to identify the global funding allocation that maximized impact under defined objectives and across a range of global funding budgets. The optimal strategy for case reduction mirrored an allocation framework that prioritizes funding for high-transmission settings, resulting in total case reductions of 76% and 66% at intermediate budget levels, respectively. Allocation strategies that had the greatest impact on case reductions were associated with lesser near-term impacts on the global population at risk. The optimal funding distribution prioritized high ITN coverage in high-transmission settings endemic for P. falciparum only, while maintaining lower levels in low-transmission settings. However, at high budgets, 62% of funding was targeted to low-transmission settings co-endemic for P. falciparum and P. vivax. These results support current global strategies to prioritize funding to high-burden P. falciparum-endemic settings in sub-Saharan Africa to minimize clinical malaria burden and progress towards elimination, but highlight a trade-off with 'shrinking the map' through a focus on near-elimination settings and addressing the burden of P. vivax.
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Affiliation(s)
- Nora Schmit
- MRC Centre for Global Infectious Disease Analysis, Imperial College LondonLondonUnited Kingdom
| | - Hillary M Topazian
- MRC Centre for Global Infectious Disease Analysis, Imperial College LondonLondonUnited Kingdom
| | - Matteo Pianella
- MRC Centre for Global Infectious Disease Analysis, Imperial College LondonLondonUnited Kingdom
| | - Giovanni D Charles
- MRC Centre for Global Infectious Disease Analysis, Imperial College LondonLondonUnited Kingdom
| | - Peter Winskill
- MRC Centre for Global Infectious Disease Analysis, Imperial College LondonLondonUnited Kingdom
| | - Michael T White
- Infectious Disease Epidemiology and Analytics G5 Unit, Department of Global Health, Institut Pasteur, Université de ParisParisFrance
| | - Katharina Hauck
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College LondonLondonUnited Kingdom
| | - Azra C Ghani
- MRC Centre for Global Infectious Disease Analysis, Imperial College LondonLondonUnited Kingdom
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Sharma R, Chen C, Tan L, Rolfe K, Fiţa IG, Jones S, Pingle A, Gibson RA, Goyal N, Sharma H, Bird P. Comment on 'The clinical pharmacology of tafenoquine in the radical cure of Plasmodium vivax malaria: An individual patient data meta-analysis'. eLife 2024; 13:e89263. [PMID: 38323802 PMCID: PMC10849672 DOI: 10.7554/elife.89263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024] Open
Abstract
A single 300 mg dose of tafenoquine, in combination with chloroquine, is currently approved in several countries for the radical cure (prevention of relapse) of Plasmodium vivax malaria in patients aged ≥16 years. Recently, however, Watson et al. suggested that the approved dose of tafenoquine is insufficient for radical cure, and that a higher 450 mg dose could reduce P. vivax recurrences substantially (Watson et al., 2022). In this response, we challenge Watson et al.'s assertion based on empirical evidence from dose-ranging and pivotal studies (published) as well as real-world evidence from post-approval studies (ongoing, therefore currently unpublished). We assert that, collectively, these data confirm that the benefit-risk profile of a single 300 mg dose of tafenoquine, co-administered with chloroquine, for the radical cure of P. vivax malaria in patients who are not G6PD-deficient, continues to be favourable where chloroquine is indicated for P. vivax malaria. If real-world evidence of sub-optimal efficacy in certain regions is observed or dose-optimisation with other blood-stage therapies is required, then well-designed clinical studies assessing safety and efficacy will be required before higher doses are approved for clinical use.
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Watson JA, Commons RJ, Tarning J, Simpson JA, Llanos Cuentas A, Lacerda MVG, Green JA, Koh GCKW, Chu CS, Nosten FH, Price RN, Day NPJ, White NJ. Response to comment on 'The clinical pharmacology of tafenoquine in the radical cure of Plasmodium vivax malaria: An individual patient data meta-analysis'. eLife 2024; 13:e91283. [PMID: 38323801 PMCID: PMC10849674 DOI: 10.7554/elife.91283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
In our recent paper on the clinical pharmacology of tafenoquine (Watson et al., 2022), we used all available individual patient pharmacometric data from the tafenoquine pre-registration clinical efficacy trials to characterise the determinants of anti-relapse efficacy in tropical vivax malaria. We concluded that the currently recommended dose of tafenoquine (300 mg in adults, average dose of 5 mg/kg) is insufficient for cure in all adults, and a 50% increase to 450 mg (7.5 mg/kg) would halve the risk of vivax recurrence by four months. We recommended that clinical trials of higher doses should be carried out to assess their safety and tolerability. Sharma and colleagues at the pharmaceutical company GSK defend the currently recommended adult dose of 300 mg as the optimum balance between radical curative efficacy and haemolytic toxicity (Sharma et al., 2024). We contend that the relative haemolytic risks of the 300 mg and 450 mg doses have not been sufficiently well characterised to justify this opinion. In contrast, we provided evidence that the currently recommended 300 mg dose results in sub-maximal efficacy, and that prospective clinical trials of higher doses are warranted to assess their risks and benefits.
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Affiliation(s)
- James A Watson
- Oxford University Clinical Research Unit, Hospital for Tropical DiseasesHo Chi MinhViet Nam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- WorldWide Antimalarial Resistance NetworkOxfordUnited Kingdom
| | - Robert J Commons
- WorldWide Antimalarial Resistance NetworkOxfordUnited Kingdom
- Global Health Division, Menzies School of Health Research, Charles Darwin UniversityDarwinAustralia
| | - Joel Tarning
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of MelbourneMelbourneAustralia
| | - Alejandro Llanos Cuentas
- Unit of Leishmaniasis and Malaria, Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano HerediaSan Martín de PorresPeru
| | | | | | - Gavin CKW Koh
- Department of Infectious Diseases, Northwick Park HospitalHarrowUnited Kingdom
| | - Cindy S Chu
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Shoklo Malaria Research UnitMae SotThailand
| | - François H Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Shoklo Malaria Research UnitMae SotThailand
| | - Richard N Price
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- WorldWide Antimalarial Resistance NetworkOxfordUnited Kingdom
- Global Health Division, Menzies School of Health Research, Charles Darwin UniversityDarwinAustralia
| | - Nicholas PJ Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
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Pukrittayakamee S, Jittamala P, Watson JA, Hanboonkunupakarn B, Leungsinsiri P, Poovorawan K, Chotivanich K, Bancone G, Chu CS, Imwong M, Day NPJ, Taylor WRJ, White NJ. Primaquine in glucose-6-phosphate dehydrogenase deficiency: an adaptive pharmacometric assessment of ascending dose regimens in healthy volunteers. eLife 2024; 12:RP87318. [PMID: 38319064 PMCID: PMC10945527 DOI: 10.7554/elife.87318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Background Primaquine is an 8-aminoquinoline antimalarial. It is the only widely available treatment to prevent relapses of Plasmodium vivax malaria. The 8-aminoquinolines cause dose-dependent haemolysis in glucose-6-phosphate dehydrogenase deficiency (G6PDd). G6PDd is common in malaria endemic areas but testing is often not available. As a consequence primaquine is underused. Methods We conducted an adaptive pharmacometric study to characterise the relationship between primaquine dose and haemolysis in G6PDd. The aim was to explore shorter and safer primaquine radical cure regimens compared to the currently recommended 8-weekly regimen (0.75 mg/kg once weekly), potentially obviating the need for G6PD testing. Hemizygous G6PDd healthy adult Thai and Burmese male volunteers were admitted to the Hospital for Tropical Diseases in Bangkok. In Part 1, volunteers were given ascending dose primaquine regimens whereby daily doses were increased from 7.5 mg up to 45 mg over 15-20 days. In Part 2 conducted at least 6 months later, a single primaquine 45 mg dose was given. Results 24 volunteers were enrolled in Part 1, and 16 in Part 2 (13 participated in both studies). In three volunteers, the ascending dose regimen was stopped because of haemolysis (n=1) and asymptomatic increases in transaminases (n=2; one was hepatitis E positive). Otherwise the ascending regimens were well tolerated with no drug-related serious adverse events. In Part 1, the median haemoglobin concentration decline was 3.7 g/dL (range: 2.1-5.9; relative decline of 26% [range: 15-40%]). Primaquine doses up to 0.87 mg/kg/day were tolerated subsequently without clinically significant further falls in haemoglobin. In Part 2, the median haemoglobin concentration decline was 1.7 g/dL (range 0.9-4.1; relative fall of 12% [range: 7-30% decrease]). The ascending dose primaquine regimens gave seven times more drug but resulted in only double the haemoglobin decline. Conclusions In patients with Southeast Asian G6PDd variants, full radical cure treatment can be given in under 3 weeks compared with the current 8-week regimen. Funding Medical Research Council of the United Kingdom (MR/R015252/1) and Wellcome (093956/Z/10/C, 223253/Z/21/Z). Clinical trial number Thai Clinical Trial Registry: TCTR20170830002 and TCTR20220317004.
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Affiliation(s)
- Sasithon Pukrittayakamee
- Clinical Therapeutics Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Podjanee Jittamala
- Clinical Therapeutics Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - James A Watson
- Oxford University Clinical Research Unit, Hospital for Tropical DiseasesHo Chi MinhViet Nam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Borimas Hanboonkunupakarn
- Clinical Therapeutics Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Pawanrat Leungsinsiri
- Clinical Therapeutics Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Kittiyod Poovorawan
- Clinical Therapeutics Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Kesinee Chotivanich
- Clinical Therapeutics Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Germana Bancone
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Shoklo Malaria Research UnitMae SotThailand
| | - Cindy S Chu
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Shoklo Malaria Research UnitMae SotThailand
| | - Mallika Imwong
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Nicholas PJ Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Oxford University Clinical Research Unit, Hospital for Tropical DiseasesHo Chi MinhViet Nam
| | - Walter RJ Taylor
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Oxford University Clinical Research Unit, Hospital for Tropical DiseasesHo Chi MinhViet Nam
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Oxford University Clinical Research Unit, Hospital for Tropical DiseasesHo Chi MinhViet Nam
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Rezaei SJ, Cissé FA, Touré ML, Duan R, Rice DR, Ham AS, de Walque D, Mateen FJ. E = mc 2 : Education (E), medication (m), and conditional cash (c 2 ) to improve uptake of antiseizure medications in a low-resource population: Protocol for randomized trial. Epilepsia Open 2024; 9:445-454. [PMID: 38131270 PMCID: PMC10839367 DOI: 10.1002/epi4.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Most people with epilepsy (PWE) could live seizure-free if treated with one or more antiseizure medications (ASMs). The World Health Organization (WHO) estimates that 75% of PWE in low-resource settings lack adequate antiseizure treatment. Limited education surrounding epilepsy and the out-of-pocket costs of ASMs in particular pose barriers to managing epilepsy in resource-poor, low-income settings. The aim of this study is to implement and test a novel strategy to improve outcomes across the epilepsy care cascade marked by (1) retention in epilepsy care, (2) adherence to ASMs, and (3) seizure reduction, with the measured goal of seizure freedom. METHODS A randomized, double-blinded clinical trial will be performed, centered at the Ignace Deen Hospital in Conakry, Republic of Guinea, in Western Sub-Saharan Africa. Two hundred people with clinically diagnosed epilepsy, ages 18 years and above, will receive education on epilepsy and then be randomized to (i) free ASMs versus (ii) conditional cash, conditioned upon return to the epilepsy clinic. Participants will be followed for 360 days with study visits every 90 days following enrollment. SIGNIFICANCE We design a randomized trial for PWE in Guinea, a low-resource setting with a high proportion of untreated PWE and a nearly completely privatized healthcare system. The trial includes a conditional cash transfer intervention, which has yet to be tested as a targeted means to improve outcomes for people with a chronic neurological disorder. The trial aims to provide an evidence base for the treatment of epilepsy in such settings. PLAIN LANGUAGE SUMMARY We present a clinical trial protocol for a randomized, blinded study of 200 people with epilepsy in the low-resource African Republic of Guinea, providing an educational intervention (E), and then randomizing in a 1:1 allocation to either free antiseizure medication (m) or conditional cash (c2 ) for 360 days. Measured outcomes include (1) returning to outpatient epilepsy care, (2) adherence to antiseizure medications (ASMs), and (3) reducing the number of seizures. This study is an initial look at giving small amounts of cash for desired results (or "nudges") for improving epilepsy outcomes in the sub-Saharan African and brain disorder contexts.
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Affiliation(s)
- Shawheen J. Rezaei
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Fodé Abass Cissé
- Department of NeurologyIgnace Deen Teaching HospitalConakryGuinea
| | | | - Rui Duan
- Department of BiostatisticsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Dylan R. Rice
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Andrew Siyoon Ham
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | | | - Farrah J. Mateen
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
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93
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López-Gil JF, Wu SM, Lee TL(I, Shih CW, Tausi S, Sosene V, Maani PP, Tupulaga M, Hsu YT, Chang CR, Shiau SC, Lo YH, Wei CF, Lin PJ, Hershey MS. Higher Imported Food Patterns Are Associated with Obesity and Severe Obesity in Tuvalu: A Latent Class Analysis. Curr Dev Nutr 2024; 8:102080. [PMID: 38351973 PMCID: PMC10862406 DOI: 10.1016/j.cdnut.2024.102080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Background Tuvalu is a Pacific Island country within the small island developing states that has observed a significant and alarming increase in obesity rates over the past 40 years, affecting ∼60 %-70 % of the current population. Objectives This study aimed to investigate the association between food patterns and the proportion of obesity in a Pacific Island country. Methods The 2022 COMmunity-based Behavior and Attitude survey in Tuvalu (COMBAT) included 985 adults with complete data on sociodemographic information and the frequency of consumption of 25 common foods. A latent class analysis determined 4 food patterns. Bayesian multilevel logistic and linear regression models estimated the association between food patterns and the proportion of obesity [body mass index (BMI) ≥30 kg/m2], severe obesity (BMI ≥40 kg/m2), and weight (kg), adjusting for potential confounders and accounting for clustering by region. Results The latent class analysis revealed 4 food patterns with an entropy of 0.94 and an average posterior probability of class assignment for each individual of 0.97, described as follows: 1) local: locally produced foods with moderate food diversity (proportion of individuals = 28 %); 2) diverse-local: local with greater food diversity (17 %); 3) restricted-imported: more imported with restricted diversity (29 %); and 4) imported: heavily imported with high diversity (26 %). Compared to those following the diverse-local pattern, the odds of having obesity were greater for those classified with the imported pattern [odds ratio (OR): 2.52; 95 % credible interval (CrI): 1.59, 3.99], restricted-imported pattern (OR: 1.89; 95 % CrI: 1.59, 3.99), and local pattern (OR: 1.54; 95 % CrI: 0.94, 2.50). Similar trends were observed for severe obesity while body weight was positively associated with both restricted-imported and imported food patterns. Conclusions The high consumption of imported foods, together with the low consumption of plant-based foods and protein-rich foods, could be a relevant modifiable lifestyle factor explaining the high levels of obesity and severe obesity in Tuvalu, a Pacific Island country.
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Affiliation(s)
| | - Stephanie M Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Tai-Lin (Irene) Lee
- Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA, United States
| | - Chih-Wei Shih
- Taiwan International Cooperation and Development Fund (ICDF), Taipei, Taiwan
- Taiwan Technical Mission to Tuvalu, Funafuti, Tuvalu
| | - Selotia Tausi
- Ministry of Local Government and Agriculture, Department of Agriculture, Tuvalu
| | - Vine Sosene
- Department of Public Health, Ministry of Health, Tuvalu
| | - Pauke P Maani
- Department of Public Health, Ministry of Health, Tuvalu
| | - Malo Tupulaga
- Department of Public Health, Ministry of Health, Tuvalu
| | - Yu-Tien Hsu
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Chia-Rui Chang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Shi-Chian Shiau
- Taiwan International Cooperation and Development Fund (ICDF), Taipei, Taiwan
- Taiwan Technical Mission to Tuvalu, Funafuti, Tuvalu
| | - Yuan-Hung Lo
- Taiwan International Cooperation and Development Fund (ICDF), Taipei, Taiwan
- Taiwan Technical Mission to Tuvalu, Funafuti, Tuvalu
| | - Chih-Fu Wei
- Taiwan Technical Mission to Tuvalu, Funafuti, Tuvalu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Po-Jen Lin
- Taiwan International Cooperation and Development Fund (ICDF), Taipei, Taiwan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Department of Medicine, Nuvance Health Danbury Hospital, Danbury, CT, United States
| | - Maria Soledad Hershey
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Creaton A, Naitini I, Lenoa L. Redesigning Prehospital Care: Fiji's Response to the COVID-19 Pandemic. Prehosp Disaster Med 2024; 39:106-110. [PMID: 38284166 PMCID: PMC10882555 DOI: 10.1017/s1049023x24000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
The benefits of emergency care systems in low- and middle-income countries are well-described. Passed in the wake of the coronavirus disease 2019 (COVID-19) pandemic, the World Health Assembly (WHA) Resolution 76.2 emphasizes the importance of communication, transportation and referral mechanisms, and the linkages between communities, primary care, and hospital care. Literature describing prehospital care and ambulance system development is scarce, with little data on the effectiveness and cost effectiveness of different options. Prehospital care systems in Pacific Island countries are under-developed. In Fiji, out-of-hospital care is fragmented with an uncoordinated patchwork of ambulance providers. There is no scope of practice or training requirement for providers and no patient care records. There are no data relating to demand, access, and utilization of ambulance services.In response to a surge of COVID-19 cases in 2021, the Fiji government created a Prehospital Emergency Care Coordination Center (PHECCC) in the capital Suva, which was operational from July-October 2021. Access was via a toll-free number, whereby the public could receive a medical consultation followed by phone advice or dispatch of an ambulance for a home assessment, followed by transportation to hospital, if required. The PHECCC also provided coordination of inter-facility transport and retrieval of the critically ill.The system that was created met many of the prehospital care standards set by emergency care leaders in the region and created the first dataset relating to ambulance demand and utilization. This is the first article to document prehospital system development in the Pacific region.
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Affiliation(s)
- Anne Creaton
- Fiji National University, Department of Medicine, Nursing and Health Sciences, Suva, Fiji; Monash University, Department of Public Health and Preventative Medicine, Melbourne, Australia; Royal Flying Doctors Service Queensland, Cairns, Australia
| | - Ilikini Naitini
- Fiji National University, Department of Medicine, Nursing and Health Sciences, Suva, Fiji; Assistant Director of Medical Services Aspen Fiji, Ba, Fiji
| | - Lemecki Lenoa
- Director of Volunteer First Responder-Fiji, Suva, Fiji
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95
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Canelas T, Godongwana M, Wayas FA, Lambert EV, Wasnyo Y, Foley L. Charting a Course: Navigating Rigor and Meaning in Global Health Research. J Phys Act Health 2024; 21:113-114. [PMID: 37935191 DOI: 10.1123/jpah.2023-0611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
In the rapidly evolving landscape of global health research, the tension between scientific rigor and contextual meaning presents a critical challenge. Drawing on our work with the Global Diet and Physical Activity Network, this commentary explores the complexities of conducting environmental audits for physical activity and diet in 4 rapidly urbanizing African cities: Yaoundé, Lagos, Cape Town, and Soweto. We illustrate the competing demands and tensions that researchers face in balancing rigor and meaning. We discuss the adaptation of internationally validated audit tools to local contexts and the importance of area-level deprivation in interpreting data. We also examine the feasibility of virtual assessment tools, emphasizing the value of local expertise. We argue for a balanced approach that marries research rigor with contextual meaning, advocating for transparency, humility, and meaningful community engagement.
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Affiliation(s)
- Tiago Canelas
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Motlatso Godongwana
- SAMRC-Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Feyisayo A Wayas
- Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Estelle Victoria Lambert
- Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Yves Wasnyo
- Health of Populations in Transition (HoPiT), University of Yaoundé 1, Yaoundé, Cameroon
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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Carrillo-Larco RM, Guzman-Vilca WC, Xu X, Bernabe-Ortiz A. Mean age and body mass index at type 2 diabetes diagnosis: Pooled analysis of 56 health surveys across income groups and world regions. Diabet Med 2024; 41:e15174. [PMID: 37422703 DOI: 10.1111/dme.15174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Screening for type 2 diabetes mellitus (T2DM) targets people aged 35+ years and those with overweight/obesity. With mounting evidence on young-onset T2DM and T2DM patients with lean phenotypes, it is worth revising the screening criteria to include younger and leaner adults. We quantified the mean age and body mass index (BMI; kg/m2 ) at T2DM diagnosis in 56 countries. METHODS Descriptive cross-sectional analysis of WHO STEPS surveys. We analysed adults (25-69 years) with new T2DM diagnosis (not necessarily T2DM onset) as per fasting plasma glucose ≥126 mg/dL measured during the survey. For people with new T2DM diagnosis, we summarized the mean age and the proportion of each five-year age group; also, we summarized the mean BMI and the proportion of mutually exclusive BMI categories. RESULTS There were 8695 new T2DM patients. Overall, the mean age at T2DM diagnosis was 45.1 years in men and 45.0 years in women; and the mean BMI at T2DM diagnosis was 25.2 in men and 26.9 in women. Overall, in men, 10.3% were 25-29 years and 8.5% were 30-34 years old; in women, 8.6% and 12.5% were 25-29 years and 30-34 years old, respectively. 48.5% of men and 37.3% of women were in the normal BMI category. CONCLUSIONS A non-negligible proportion of new T2DM patients were younger than 35 years. Many new T2DM patients were in the normal weight range. Guidelines for T2DM screening may consider revising the age and BMI criteria to incorporate young and lean adults.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia, USA
| | - Wilmer Cristobal Guzman-Vilca
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Xiaolin Xu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Cientifica del Sur, Lima, Peru
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Prendes CF, Rantner B, Hamwi T, Stana J, Feigin VL, Stavroulakis K, Tsilimparis N. Burden of Stroke in Europe: An Analysis of the Global Burden of Disease Study Findings From 2010 to 2019. Stroke 2024; 55:432-442. [PMID: 38252754 DOI: 10.1161/strokeaha.122.042022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 09/21/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND While most European Regions perform well in global comparisons, large discrepancies within stroke epidemiological parameters exist across Europe. The objective of this analysis was to evaluate the stroke burden across European regions and countries in 2019 and its difference to 2010. METHODS The GBD 2019 analytical tools were used to evaluate regional and country-specific estimates of incidence, prevalence, deaths, and disability-adjusted life years of stroke for the European Region as defined by the World Health Organization, with its 53 member countries (EU-53) and for European Union as defined in 2019, with its 28 member countries (EU-28), between 2010 and 2019. Results were analyzed at a regional, subregional, and country level. RESULTS In EU-53, the absolute number of incident and prevalent strokes increased by 2% (uncertainty interval [UI], 0%-4%), from 1 767 280 to 1 802 559 new cases, and by 4% (UI, 3%-5%) between 2010 and 2019, respectively. In EU-28, the absolute number of prevalent strokes and stroke-related deaths increased by 4% (UI, 2%-5%) and by 6% (UI, 1%-10%), respectively. All-stroke age-standardized mortality rates, however, decreased by 18% (UI, -22% to -14%), from 82 to 67 per 100 000 people in the EU-53, and by 15% (UI, -18% to -11%), from 49.3 to 42.0 per 100 000 people in EU-28. Despite most countries presenting reductions in age-adjusted incidence, prevalence, mortality, and disability-adjusted life year rates, these rates remained 1.4×, 1.2×, 1.6×, and 1.7× higher in EU-53 in comparison to the EU-28. CONCLUSIONS EU-53 showed a 2% increase in incident strokes, while they remained stable in EU-28. Age-standardized rates were consistently lower for all-stroke burden parameters in EU-28 in comparison to EU-53, and huge discrepancies in incidence, prevalence, mortality, and disability-adjusted life-year rates were observed between individual countries.
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Affiliation(s)
- Carlota F Prendes
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
| | - Barbara Rantner
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
| | - Tarek Hamwi
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
| | - Jan Stana
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (V.L.F.)
- Institute for Health Metrics and Evaluation, University of Washington, Seattle (V.L.F.)
- Research Center of Neurology, Moscow, Russia (V.L.F.)
| | - Konstantinos Stavroulakis
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
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Ejaz M, Jabeen M, Sharif M, Syed MA, Shah PT, Faryal R. Human monkeypox: An updated appraisal on epidemiology, evolution, pathogenesis, clinical manifestations, and treatment strategies. J Basic Microbiol 2024; 64:e2300455. [PMID: 37867205 DOI: 10.1002/jobm.202300455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/13/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023]
Abstract
Monkeypox (Mpox) is a zoonotic viral disease caused by the monkeypox virus (MPXV), a member of the Orthopoxvirus genus. The recent occurrence of Mpox infections has become a significant global issue in recent months. Despite being an old disease with a low mortality rate, the ongoing multicountry outbreak is atypical due to its occurrence in nonendemic countries. The current review encompasses a comprehensive analysis of the literature pertaining to MPXV, with the aim of consolidating the existing data on the virus's epidemiological, biological, and clinical characteristics, as well as vaccination and treatment regimens against the virus.
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Affiliation(s)
- Mohammad Ejaz
- Department of Microbiology, Government Postgraduate College Mandian, Abbottabad, Pakistan
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Momina Jabeen
- National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Mehmoona Sharif
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Ali Syed
- Department of Microbiology, The University of Haripur, Haripur, Pakistan
| | - Pir T Shah
- Institute of Biomedical Sciences, Shanxi University, Taiyuan, Shanxi, China
| | - Rani Faryal
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
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Izquierdo-Condoy JS, Vásconez-Gonzáles J, Morales-Lapo E, Tello-De-la-Torre A, Naranjo-Lara P, Fernández R, Hidalgo MR, Escobar A, Yépez VH, Díaz AM, Oliva C, Ortiz-Prado E. Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases. Front Cell Infect Microbiol 2024; 14:1293782. [PMID: 38357446 PMCID: PMC10864624 DOI: 10.3389/fcimb.2024.1293782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Infectious diseases have consistently served as pivotal influences on numerous civilizations, inducing morbidity, mortality, and consequently redirecting the course of history. Their impact extends far beyond the acute phase, characterized by the majority of symptom presentations, to a multitude of adverse events and sequelae that follow viral, parasitic, fungal, or bacterial infections. In this context, myriad sequelae related to various infectious diseases have been identified, spanning short to long-term durations. Although these sequelae are known to affect thousands of individuals individually, a comprehensive evaluation of all potential long-term effects of infectious diseases has yet to be undertaken. We present a comprehensive literature review delineating the primary sequelae attributable to major infectious diseases, categorized by systems, symptoms, and duration. This compilation serves as a crucial resource, illuminating the long-term ramifications of infectious diseases for healthcare professionals worldwide. Moreover, this review highlights the substantial burden that these sequelae impose on global health and economies, a facet often overshadowed by the predominant focus on the acute phase. Patients are frequently discharged following the resolution of the acute phase, with minimal long-term follow-up to comprehend and address potential sequelae. This emphasizes the pressing need for sustained vigilance, thorough patient monitoring, strategic health management, and rigorous research to understand and mitigate the lasting economic and health impacts of infectious diseases more fully.
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100
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Allahbakhshian Farsani L, Riahinia N, Danesh F, Azimi A. Co-Occurrence Analysis of COVID-19 Publications with an Emphasis on the Global Health Governance (GHG). Adv Biomed Res 2024; 13:10. [PMID: 38525400 PMCID: PMC10958719 DOI: 10.4103/abr.abr_344_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/19/2023] [Accepted: 11/22/2023] [Indexed: 03/26/2024] Open
Abstract
Background Analyzing co-occurrence is an effective way to monitor the overview of topic spreading. The present study aimed to conduct a co-occurrence analysis of scientific publications related to COVID-19, emphasizing Global Health Governance (GHG). Materials and Methods This applied research with an analytical approach was carried out on all the scientific publications related to COVID-19, emphasizing GHG (51056 records), extracted from PubMed Central on 26/01/2022. The research population consisted of all the scientific publications related to COVID-19, emphasizing GHG (51056 records), extracted from PubMed Central on 26/01/2022. The data were analyzed using BibExcel, UCINET, Excel, and SPSS software, and Spearman's test was used to confirm correlations. Results The co-word network of the thematic area of COVID-19 includes 226 nodes and 7292 edges. COVID-19 and the pandemic formed the most co-word pairs with 2224 connections. The COVID-19* mental health and COVID-19* anxiety, with 1019 and 925 connections, are ranked next, respectively. The term COVID-19 is ranked first with a centrality index of 225. The keywords of pandemic and public health are ranked second and third with the centrality index of 217 and 206, respectively. Conclusion The global approach of studies related to COVID-19 is more inclined to the epidemiological and public health fields. Assuming the GHG, detailed and comprehensive planning should be performed to strengthen these studies and pave the way for international cooperation, determining research requisites, and developing applied research studies.
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Affiliation(s)
- Leili Allahbakhshian Farsani
- Department of Knowledge and Information Science, Faculty of Education and Psychology, Kharazmi University, Tehran, Iran
| | - Nosrat Riahinia
- Department of Knowledge and Information Science, Faculty of Education and Psychology, Kharazmi University, Tehran, Iran
| | - Farshid Danesh
- Information Management Department, Islamic World Science and Technology Monitoring and Citation Institute (ISC), Shiraz, Iran
| | - Ali Azimi
- Department of Knowledge and Information Science, Faculty of Education and Psychology, Kharazmi University, Tehran, Iran
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