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Genomic and clinical epidemiology of SARS-CoV-2 in coastal Kenya: insights into variant circulation, reinfection, and multiple lineage importations during a post-pandemic wave
Get PDFBetween November 2023 and March 2024, coastal Kenya experienced another wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections detected through our continued genomic surveillance. Herein, we report the clinical and genomic epidemiology of SARS-CoV-2 infections from 179 individuals (a total of 185 positive samples) residing in the Kilifi Health and Demographic Surveillance System (KHDSS) area (~ 900 km 2).
METHODS: We analyzed genetic, clinical, and epidemiological data from SARS-CoV-2 positive cases across pediatric inpatient, health facility outpatient, and homestead community surveillance platforms. Phylogenetic analyses were performed using maximum-likelihood and Bayesian frameworks. Temporal trends were summarized, comparisons conducted using Kruskal–Wallis and Wilcoxon tests, and associations examined using univariate and multivariable logistic regression models.
RESULTS: Sixteen SARS-CoV-2 lineages within 3 subvariants [XBB.2.3-like (58.4%), JN.1-like (40.5%), and XBB.1-like (1.1%)] were identified. The symptomatic infection rate was estimated at 16.0% (95% CI, 11.1–23.9%) based on community testing regardless of symptom status and did not differ across the subvariants ( p = 0.13). The most common infection symptoms in community cases were cough (49.2%), fever (27.0%), sore throat (7.3%), headache (6.9%), and difficulty in breathing (5.5%). One case succumbed to the infection. Genomic analysis of the virus from serial positive samples confirmed repeat infections among 5 participants under follow-up (median interval 21 days, range 16–95 days); in 4 participants, the same virus lineage was responsible in both episodes, whereas 1 participant had a different lineage in the second compared with the first episode. Phylogenetic analysis including > 18,000 contemporaneous global sequences provided evidence for at least 38 independent virus introduction events into the study area (KHDSS) during the wave, the majority likely originating in North America and Europe.
CONCLUSIONS: Our study highlights that coastal Kenya, like most other localities, continues to face new SARS-CoV-2 infection waves characterized by circulation of new variants, multiple lineage importations, and reinfections. Locally, the virus may circulate unrecognized, as most infections are asymptomatic in part due to high population immunity after several waves of infection. Our findings highlight the need for sustained SARS-CoV-2 surveillance to inform appropriate public health responses, such as scheduled vaccination for populations at risk of severe infection
Informing Hospital Physician Well-Being Interventions in Europe and the US.
Get PDFIMPORTANCE: Physician burnout and retention problems are threatening workforce stability and patient care.
OBJECTIVE: To compare physician well-being in multiple European countries and the US to inform physician well-being interventions and evaluate whether modifiable aspects of hospital care environments are associated with physician job outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted at 49 hospitals in 6 European countries (Belgium, England, Germany, Ireland, Sweden, and Norway) and 56 US hospitals. European data from physicians and nurses were collected in 2023; US data were collected in 2021. Data were analyzed from February through August 2025.
EXPOSURES: Three explanatory variables were measured at the hospital level: nurse staffing adequacy, clinical care environment, and physician and nurse teamwork.
MAIN OUTCOMES AND MEASURES: Primary outcomes include individual-level measures of physician well-being and job outcomes (eg, high burnout, job dissatisfaction, intention to leave employer, and willingness to recommend employer).
RESULTS: Among a total of 21 396 physicians and nurses, 1149 European physicians (mean [SD] age, 41.3 [10.6] years; 536 female [46.5%] and 609 male [52.9%]) and 5334 US physicians (mean [SD] age, 44.5 [11.8] years; 1861 female [34.9%] and 2373 male [44.5%]) reported on their well-being and 3044 European nurses and 11 869 US nurses reported on hospital care environments. Poor well-being was common among hospital physicians in the US and Europe; for example, 324 of 1083 physicians in Europe with responses to the question (29.9%) and 1178 of 4959 physicians with responses to the question (23.8%) intended to leave their job within a year. Improvements in nurse staffing adequacy, clinical care environments, and clinician teamwork were associated with favorable physician job outcomes in the US and Europe. For example, among US hospitals, a 10% increase in favorable care environments was associated with lower odds of physicians intending to leave (odds ratio [OR], 0.78; 95% CI, 0.68-0.90), not recommending their hospital (OR, 0.75; 95% CI, 0.61-0.92), experiencing high burnout (OR, 0.90; 95% CI, 0.83-0.98), and having job dissatisfaction (OR, 0.81; 95% CI, 0.69-0.95). Among European hospitals, a 10% increase in hospital-level reports of nurse staffing adequacy was associated with lower odds of physicians intending to leave (OR, 0.80; 95% CI, 0.71-0.91), not recommending their hospital (OR, 0.73; 95% CI, 0.61-0.88), reporting high burnout (OR, 0.88; 95% CI, 0.78-0.99), and reporting job dissatisfaction (OR, 0.85; 95% CI, 0.73-0.98).
CONCLUSIONS AND RELEVANCE: In this study, improved hospital nurse work environments were associated with more favorable physician outcomes, and modifiable features of the hospital environment, including having adequate numbers of direct care nurses and strong physician and nurse teamwork, were associated with greater physician well-being. These findings may inform the development and implementation of evidence-based interventions to improve physician well-being and retention
Agro-morphological diversity and yield potential of Bambara groundnut ( <i>Vigna subterranea</i> L. Verdc.) recombinant inbred lines evaluated across multiple environments in KwaZulu-Natal, South Africa
Get PDFAbstract
Bambara groundnut (
Vigna subterranea
L. Verdc.) is a resilient, nutrient-rich legume with significant potential for diversification in climate-resilient agriculture and food systems. However, its improvement has been limited by a lack of formal breeding programs and genetic characterization. This study evaluated the agro-morphological diversity of 44 recombinant inbred lines (RILs) and 10 check genotypes developed through single seed descent, assessed across three environments in KwaZulu-Natal, South Africa. Eleven quantitative and five qualitative traits were measured following BAMNET descriptors. Analysis of variance revealed significant genotypic differences (P < 0.01) for most traits and strong genotype × environment interactions for seed length, seed width, grain yield, and related components. Principal component analysis (PCA) showed that the first three principal components explained over 72% of the total variation, with PC1 strongly associated with yield-related traits such as grain yield (GY), unthreshed grain yield (UGY), grain yield per plant (GYPP), and shelling percentage (SHLP). Cluster analysis grouped the genotypes into distinct clusters, separating high-yielding from low-yielding lines. Genotypes (G23, G39, G40 and P3) demonstrated superior yield performance and were identified as promising candidates for future breeding efforts. Correlation analysis highlighted strong positive associations between yield traits and seed size parameters, while early emergence and flowering were associated with higher germination rates. The findings demonstrate substantial genetic diversity among the evaluated Bambara groundnut genotypes and provide critical insights for developing high-yielding, climate-resilient cultivars. These results contribute towards positioning Bambara groundnut as a strategic crop aligned with the Vision for Adapted Crops and Soils (VACS) agenda, promoting food and nutritional security under changing climatic conditions
Exploring sex and gender differences in the Alzheimer's disease patient journey: A survey study
Get PDFIntroduction: The present study investigates differences between men and women in the Alzheimer's disease (AD) patient journey, aiming to improve early detection and patient care.
Methods: A sample of men and women (N = 142) at different stages of the AD journey were invited to complete an online survey. A series of logistic regressions and Cox regressions were used to examine sex and gender differences in diagnosis and treatment.
Results: Men showed greater awareness of sedentary lifestyle risks (p = 0.005). Diagnosis was more often by referral for women (p = 0.015). Women were more likely to be treated with reminiscence therapy (p = 0.029) and life story work (p = 0.025). Time to diagnosis was shorter when diagnosed directly by specialists (hazard ratio = 0.59, p = 0.022).
Discussion: This study reports sex‐ and gender‐based differences in AD diagnosis and treatment. Expanding this research with diverse populations is essential to improve early detection and personalized care, ultimately enhancing patient outcomes.
Highlights:
We identified sex‐ and gender‐based differences in the Alzheimer's disease (AD) patient journey across diagnosis and treatment.
Shorter time to diagnosis was observed when a specialist directly diagnosed patients.
Women showed stronger responses to life story work therapy and were diagnosed after primary care referrals.
Men and women had comparable awareness of AD risk factors, but men were more aware of lifestyle risks.
This study highlights the need for sex‐ and gender‐specific diagnostic tools and personalized treatment approaches
COVID-19 testing acceptance among symptomatic individuals screened for a randomized clinical trial in The Gambia.
No full textBACKGROUND: Testing is a critical component to control disease outbreaks. The screening process required to enrol study participants from individuals with suspected COVID-19 disease in a clinical trial, presented an opportunity to explore factors that influence the willingness to be tested for COVID-19. METHODS: We analyzed data from individuals with symptoms suggestive of mild-moderate COVID-19 in two different health facilities in Western Gambia. As part of pre-enrollment screening for recruitment into a COVID-19 drug trial, we recorded clinical, epidemiological, and demographic information. Individuals who consented had a nasopharyngeal and/or oropharyngeal sample collected for SARS-CoV-2 testing. We compared consenting and non-consenting individuals using univariate and multivariable logistic regression and calculated adjusted odds ratio. Over-time trends were visualised using a 30-day moving sum for participants who consented. RESULTS: Among the 1361 suspected COVID-19 individuals identified between January 2021 and August 2022, 33.4 % (458/1361) consented to be tested for SARS-CoV-2. In the multivariate analysis, history of smoking (aOR: 3.07, 95 %CI: 1.60-5.88 p < 0.001), high educational level (aOR: 6.32, 95 %CI: 3.84-10.39 p < 0.001), history of travel (aOR: 2.94, 95 %CI: 1.20-7.22, p = 0.019), and loss of smell (aOR: 4.00, 95 %CI: 2.24-7.17 p = 0.002,) were significantly associated with acceptance to COVID-19 testing. The 30-day moving sum showed a downward trend of testing acceptance over time. CONCLUSION: Although testing acceptance was very low, individuals with recognised risk factors for COVID-19 were more likely to accept testing. Early and sustained information about these risk factors particularly targeting individuals in low-education cadres may enhance testing uptake during a pandemic
Exploring the potential of IP-10 and sCD14 as inflammatory biomarkers in HIV–TB co-infection: a systematic review
Get PDFBackground: Human Immunodeficiency Virus (HIV) and tuberculosis (TB) are major global health challenges, especially in sub-Saharan Africa and Southeast Asia, where their co-infection greatly increases illness and death. People living with HIV are far more likely to develop TB, and the interaction between the two infections worsens immune dysfunction and complicates management.
Methods: This systematic review followed PRISMA 2020 guidelines to assess the roles of Interferon-γ–induced Protein 10 (IP-10) and Soluble Cluster of Differentiation 14 (sCD14) as inflammatory biomarkers in HIV-TB co-infection. A comprehensive search of PubMed, Scopus, and Google Scholar was conducted for studies published between 2014 and 2024. Eligible interventional and observational studies involving adults with HIV-TB co-infection were included based on predefined inclusion criteria. Data extraction covered study characteristics, biomarker levels, and their associations with inflammation, disease progression, and clinical outcomes.
Results: Six studies met the inclusion criteria, all assessing IP-10, while only one measured sCD14. Most studies reported significantly elevated IP-10 levels in HIV–TB co-infected individuals, linking it to systemic inflammation, disease progression, and poor clinical outcomes, highlighting its potential as a predictive and prognostic biomarker. The single study evaluating sCD14 found increased levels indicating generalized immune activation but limited specificity for distinguishing Tuberculosis-Immune Reconstitution Inflammatory Syndrome, suggesting its broader role as a nonspecific marker of inflammation.
Conclusion: Although the current evidence base is limited, IP-10 shows promise as a diagnostic and prognostic biomarker, and sCD14 may complement its use as a marker of immune activation. Further large-scale, standardized studies are needed to validate these biomarkers in HIV–TB co-infection
Role of nanotechnology in climate change mitigation: Opportunities, challenges, and future directions
Get PDFClimate change, recognized as one of the most critical global public health emergencies, has led to extreme weather events and caused thousands of deaths annually, particularly in underserved areas due to limited financial resources. Nanotechnology, with its unique quantum properties, enhanced surface area, and heightened reactivity, has emerged as a promising tool for climate crisis management. The aim of this study was to explore the role of nanotechnology in mitigating climate change, offering insights into the opportunities and challenges associated with its deployment. Nanotechnology has transformed the renewable energy field by advancing sustainability, improving efficiency, and reducing costs. Nanomaterial also enhances the effectiveness of carbon capture and conversion processes, providing a viable path in the fight against climate change. Additional opportunities include lowering greenhouse gas emissions, improving energy conservation, and enabling cleaner technologies. Furthermore, nanotechnology holds the potential to revolutionize the mitigation of air, water, and land pollution, contributing to a more climate-resilient environment and supporting global climate goals. Despite these opportunities, its integration into climate change mitigation poses significant obstacles. Concerns include the generation of reactive oxygen species that may induce cellular dysfunction and carcinogenesis, as well as challenges related to sophisticated manufacturing processes, high material costs, and inadequate policy frameworks. While nanotechnology demonstrates significant potential in mitigating the effects of climate change, future studies should focus on comprehensive safety evaluations, cost-effective production methods, and strategies to minimize long-term environmental and health effects to ensure its sustainable and responsible application
Associations of body composition at birth and accretion from 0 to 5 years with kidney function and volume at the 10-year follow-up: the Ethiopian Infant Anthropometry and Body Composition birth cohort.
Get PDFBACKGROUND: Fat mass (FM) and fat-free mass (FFM) in early life are associated with later obesity and cardiometabolic disease. OBJECTIVES: This study aimed to assess the associations of FM and FFM at birth and conditional FM and FFM accretion from 0 to 5 y with kidney outcomes at the 10-y follow-up. METHODS: The Ethiopian Infant Anthropometry and Body Composition birth cohort included term infants born in Jimma town, with a birth weight ≥1500 g, and having no congenital malformations. Air-displacement plethysmography was used to measure body composition. Serum cystatin C was determined and kidney dimensions were assessed by ultrasound when children were aged ∼10 y. Conditional growth modeling was used to compute FM and FFM accretion between different time points over 0-5 y. Multiple linear regression analysis was used to examine associations of birth FM and FFM and conditional FM and FFM accretion in selected age periods with serum cystatin C and total kidney volume at the 10-y follow-up. RESULTS: A total of 350 children were followed up at a mean age of 9.8 (±1.0) y. A 1 standard deviation (SD) higher conditional FFM accretion from 3 to 6 mo was associated with 7.6% [95% confidence interval (CI): 1.9%, 13.0%) lower serum cystatin C but higher conditional FFM accretion 48-60 mo was associated with 5.3% (95% CI: 1.9%, 9.0%) higher serum cystatin C. A 1 SD higher conditional FM accretion in the periods 6-48 mo and 48-60 mo was associated with β = 7.7 (95% CI: 4.8, 10.7) and β = 6.4 (95% CI: 1.6, 11.1) cm3 greater kidney volume, respectively. A 1 SD higher birth FFM and FFM accretion in the periods 3-6 mo, 6-48 mo, and 48-60 mo was associated with β = 4.7 (95% CI: 2.1, 7.2), 14.1 (95% CI: 6.3, 22.0), 4.2 (95% CI: 0.9, 7.4), and 7.1 (95% CI: 2.5, 11.7) cm3 greater kidney volume, respectively. CONCLUSIONS: A higher conditional FFM gain in age from 3 to 6 mo results in better kidney function at the 10-y follow-up, whereas a higher conditional FFM gain in age from 4 to 5 y results in a lower kidney function. Kidney volume at the 10-y follow-up is associated with higher birth FFM and higher conditional FM or FFM growth in most growth periods
Changes in global quality of life after treatment with immune checkpoint inhibitors in patients receiving different treatment regimens for advanced stage lung cancer in the Netherlands: a 2015-2021 cohort study.
Get PDFBACKGROUND: The introduction of immune checkpoint inhibitors (ICIs) has modified treatment modalities for patients with lung cancer, offering new alternatives for treatment. Despite improved survival benefits, ICIs may cause side effects impacting patients' quality of life (QoL). We aim to study the changes in global QoL (gQoL) of patients with advanced-stage lung cancer up to 18 months after treatment with ICIs between 2015 and 2021. METHODS AND ANALYSIS: A longitudinal cohort study was conducted using the Oncological Life Study: Living well as a cancer survivor data-biobank from the University Medical Center Groningen. Participants completed the European Organisation for Research and Treatment of Cancer QoL 30-item questionnaire, at the beginning of their ICI treatment (baseline) and then at 6, 12 and 18 months. Using joint modelling, changes in predicted mean gQoL were studied by treatment regimens from baseline to 18 months, while accounting for the competing risk of death and adjusting for prespecified covariates. RESULTS: Of the 418 participants with median age of 66 years, 39% were women. Patients receiving first-line immuno-monotherapy with palliative intent had a small improvement in their gQoL within 6 months and no clinically significant change thereafter. Patients receiving first-line immune-chemotherapy with palliative intent had a small improvement in their gQoL within 12 months and no clinically significant change thereafter. Patients with second/further line immunotherapy with palliative intent or first-line chemoradiotherapy followed by durvalumab with curative intent had no clinically significant change in their gQoL over 18 months. CONCLUSION: The changes in gQoL over time among patients with advanced-stage lung cancer may vary by treatment regimens based on drug intensity, line and intent of treatment, which will help clinicians and patients understand the potential dynamic of treatments on QoL. It may further influence treatment decisions and patient management strategies, reflecting the practical implications of different treatment regimens
"It does help but there's a limit …": Young people's perspectives on policies to manage hot food takeaways opening near schools.
Get PDFBACKGROUND: Local authorities (LAs) in England are increasingly using the planning system to manage the proliferation of hot food takeaway outlets ('takeaways') near schools as part of a range of policies to promote healthy weight in children. These takeaway 'management zones' include restrictions on planning permission to open new takeaways within a certain distance of schools. In this qualitative study we explore young people's perspectives of management zones. METHODS: We purposively recruited 46 young people (aged 11-18 years) attending secondary school across two London LAs with operating management zones. We conducted semi-structured, walking group ("go-along") interviews in January-February 2023 in the local food environment close to participants' schools. We analysed data using framework analysis. RESULTS: Participants generally viewed management zones as reasonable and uncontroversial but were not always aware that management zones were in operation. Although participants understood that management zones prevented new outlets from opening, they observed they did not seem to reduce existing provision. This was viewed positively as it did not result in the closure of local takeaways perceived as important components of the social fabric of school life. Participants believed that the potential health impact of management zones is limited by their exclusive focus on takeaways as other food retail commonly patronised by young people, such as convenience stores, are important sources of unhealthy food. Participants also identified inadequacies in the wider food environment, including the school dining environment and access to food delivery apps. CONCLUSIONS: Our findings suggest that although young people find management zones acceptable and believe they have some positive impact on diet, they did not perceive management zones as effective as they could be. Participants articulated that the management of takeaways on their own is unlikely to reduce exposure to unhealthy foods. Widening the remit of planning policy to include outlets selling convenience foods may be important for policy optimisation