69832 research outputs found
Sort by
Expedited transfer to emergency department vs. cardiac catheter laboratory in a cardiac arrest centre for non-ST-elevation out-of-hospital cardiac arrest: ARREST trial as-treated analysis.
Get PDFAIMS: The ARREST trial demonstrated that in adult patients, transfer to a cardiac catheter laboratory in a cardiac arrest centre (CAC) following resuscitated out-of-hospital cardiac arrest (OHCA) without ST-elevation did not reduce deaths at 30 days compared with delivery to the geographically closest emergency department (standard care). More than half of the CACs had a co-located emergency department to which patients were delivered as part of the standard care arm, which may have influenced outcomes. AIMS: We performed a pre-specified as-treated analysis to determine if a CAC and the location patients were delivered to, either emergency department or cardiac catheter laboratory, reduced deaths. METHODS AND RESULTS: Patients (aged ≥18 years) with resuscitated OHCA without ST elevation who were enrolled in the ARREST trial were grouped according to the location they were to delivered to- either an emergency department with or without a co-located CAC or a cardiac catheter laboratory within a CAC-at one of 35 hospitals in London, UK-by London Ambulance Service irrespective of randomized allocation. The as-treated population was therefore analysed as one of three groups: 1) emergency department in a CAC, 2) direct to a cardiac catheter laboratory in a CAC, and 3) emergency department in a non-CAC. The primary outcome of the trial was all-cause mortality at 30 days. Secondary outcomes included all-cause mortality at 3 months and neurological outcome at discharge and 3 months. A pre-specified analysis adjusting for age, sex, initial shockable rhythm, witnessed cardiac arrest, bystander CPR, the time from cardiac arrest until ROSC, and location of cardiac arrest was performed in the as-treated groups. Between 15 January 2018 and 1 December 2022, a total of 862 participants were enrolled into the trial. Data for the primary outcome for this analysis were available in 818/862 (94.9%). Patients delivered to an ED in a CAC had fewer deaths at 30 days compared with the ED in a non-CAC group (83/182, 45.6% vs. 178/233, 76.4%; adjusted OR 0.43, 95% CI 0.24 to 0.76; P = 0.0039). Patients delivered to a cardiac catheter laboratory in a CAC also had fewer deaths compared with the ED in a non-CAC group, but there was no statistical difference (250/403, 62.0%: adjusted OR 0.72, 95% CI 0.44 to 1.18; P = 0.19). Survival with a favourable neurological outcome at hospital discharge occurred in 88/177 (49.7%) of the ED in a CAC group, 130/406 (32%) of the catheter laboratory in a CAC group, and 42/228 (18.4%) of the ED in a non-CAC group. CONCLUSION: In this as-treated analysis of the ARREST trial, in adult patients with resuscitated OHCA without ST-elevation, we observed a lower 30-day mortality and favourable neurological outcomes following delivery to an ED in a CAC and cardiac catheter laboratory in CAC, when compared with delivery to ED in a non-CAC
Using Model-Based Geostatistics to Refine Population-Based Estimates of Trachoma Prevalence: Update from a Technical Consultation
Get PDFTo explore how model-based geostatistics (MBG) could support trachoma elimination efforts, a technical consultation was held on March 4 and 5, 2024 by the Centre for Health Informatics, Computing, and Statistics at Lancaster University, United Kingdom, a WHO Collaborating Centre on Geostatistical Methods for Neglected Tropical Disease Research. The meeting aimed to foster collaboration for sharing insights on using MBG for decision-making; showcase its applications in assessing trachoma elimination status; address challenges, such as setting the probability threshold for elimination and resolving conflicts between survey and MBG evidence; and discuss considerations for integrating MBG into Tropical Data. Participants, including trachoma program managers, experts, academics, donors, and statisticians, reviewed MBG applications, discussed ongoing studies, identified knowledge gaps, and planned future work. This article summarizes the meeting's presentations, discussions, and outcomes, highlighting current conclusions on and research priorities to evaluate MBG's feasibility and utility in trachoma elimination programs
Leptospirosis Prevalence and Risk Factors Among Patients Presenting With Fever to 4 Healthcare Sites in Sub-Saharan Africa and South East Asia: An International Multisite Observational and Nested Case-Control Study.
Get PDFBACKGROUND: We investigated the prevalence, diversity, and risk factors for acute leptospirosis in the Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study. METHODS: Febrile patients aged ≥2 months in Laos, Malawi, Mozambique, and Zimbabwe underwent a standardized clinical and exposure assessment. Acute and convalescent serum were tested by Leptospira microscopic agglutination test (MAT) and acute plasma by lfb1 polymerase chain reaction. A ≥4-fold rise in antibody titer, or a single reciprocal titer ≥800, or Leptospira PCR positive defined confirmed leptospirosis. The identity of possible infecting strains was investigated by MAT and sequencing of PCR products. RESULTS: Of 7851 febrile participants enrolled, 134 (1.7%) had confirmed leptospirosis: 88 (4.6%) in Laos, 17 (1.0%) Malawi, 7 (0.3%) Mozambique, and 22 (1.2%) Zimbabwe, and 23 (0.8%) had supportive evidence of leptospirosis. Participants with leptospirosis had greater odds of headache (adjusted odds ratio [aOR] 2.20, P < .001), rash (aOR 1.45, P < .001), conjunctivitis (aOR 3.33, P < .001), and jaundice (aOR 1.75, P < .001); and had greater odds of being older (aOR 1.02 per year, P < .001), working in rice fields (aOR 6.24, P < .001), drinking river water (aOR 5.11, P = .001). Predominant reactive Leptospira serogroups were Ballum and Icterohemorrhagiae at African sites, and Australis in Laos. Identified species were Leptospira borgpetersenii, L. interrogans, and L. kirschneri. CONCLUSIONS: Leptospirosis was a cause of febrile illness at all sites. Some clinical features helped to identify patients with leptospirosis. Interventions related to rice field work and river exposure may prevent disease. Diverse Leptospira serogroup reactivity was observed and may suggest potential hosts
Combining demographic shifts with age-based resistance prevalence to estimate future antimicrobial resistance burden in Europe and implications for targets: A modelling study.
Get PDFBACKGROUND: Antimicrobial Resistance (AMR) is a global public health crisis. Evaluating intervention impact requires accurate estimates of how the AMR burden will change over time, given likely demographic shifts. This study aimed to provide an estimate of future AMR burden in Europe, investigating resistance variation by age and sex and the impact of interventions to achieve the proposed United Nations (UN) political declaration targets. METHODS AND FINDINGS: Using data from 12,807,473 bloodstream infection (BSI) susceptibility tests from routine surveillance in Europe, we estimate age- and sex-specific rates of change in BSI incidence for the 8 bacteria included in European Antimicrobial Resistance Surveillance Network (EARS-Net) surveillance over 2015-2019. This was used to project incidence rates by age and sex for 2022-2050 and, with demographic projections, to generate estimates of BSI burden (2022-2050). Two Bayesian hierarchical models were fitted across 38 bacteria-antibiotic combinations to the 2015-2019 resistance proportion of BSI by year and at the country-level with and without age and sex disaggregation. Inputting the incidence estimates into the "agesex" and "base" model, respectively, we sampled 1,000 model estimates of resistant BSI burden by age, sex, and country to determine the importance of age and sex disaggregation. We explored Intervention scenarios consisting of a 1, 5, or 20 per 100,000 per year reduction in infection incidence rate of change or 5 per 100,000 per year reduction in those older than 64 years. Overall, in Europe, BSI incidence rates are predicted to increase more in men than women across 6 of the 8 bacteria (Pseudomonas aeruginosa and Enterococcus faecium were the exception) and are projected to increase more dramatically in older age groups (74+ years) but stabilise or decline in younger age groups. We project huge country-level variation in resistance burden to 2050, with opposing trends in different countries for the same bacteria-antibiotic combinations (e.g., aminoglycoside-resistant Acinetobacter spp. ranged from a relative difference of 0.34 to 15.38 by 2030). Not accounting for age and sex results in differing resistance burden projections, with 47% of bacteria-antibiotic combinations estimated to have fewer resistant BSIs by 2030 compared to a model with age and sex. Not including age or sex resistance patterns results in fewer male cases for 76% (29/38) of the combinations compared to 11% (4/38) for women. We also saw age-based associations in projections with bigger differences at older ages. Achieving a 10% reduction in resistant BSI incidence by 2030 (equivalent to the UN 10% mortality target) was possible only for 68.4% (26/38) of bacteria-antibiotic combinations even with large reductions in BSI incidence rate of change of -20 per 100,000 per year. In some cases, a 10% reduction was followed by a rebound, with the resistant BSI burden exceeding previous levels by 2050. Limitations include reliance on European data and current trends, and the exclusion of factors such as comorbidities or ethnicity. CONCLUSIONS: Including country-specific, age- and sex-specific resistance levels alongside projected demographic shifts has a large impact on resistant BSI burden projections in Europe to 2030. Reducing this AMR infection burden by 10% will require substantial reductions in infection incidence rates
"A heart of the man is lighter than that of the woman…" exploring men's motivation and capability to access HIV services in Lusaka, Zambia: findings from the Yaba Guy Che study.
Get PDFBACKGROUND: In southern Africa, men are less likely than women to access HIV services, including HIV testing, antiretroviral therapy (ART), and HIV prevention services. As a result, men living with HIV are less likely to be virally suppressed and more likely to transmit HIV than their female peers. Using the socio-ecological model as a framework, we explored factors that influence men’s motivation and capability to access available HIV services, including how social norms and social networks influence men’s engagement with services, in Lusaka, Zambia. METHODS: We conducted seven focus group discussions (FGDs) with men and women in an urban community in Lusaka. Five FGDs were conducted with men; two with young men aged 20–24; two with men aged 25–35 and one with men aged 20–35. We conducted two FGDs with women, stratified by age 18–24 and 25–35. The total number of participants was 70. Data were coded and analysed thematically. RESULTS: Pervasive negative community narratives around HIV, negative social and gender norms, the influence of men’s social networks, including stigma related to a positive HIV test result and fear of social isolation, were among the key factors influencing men’s access to HIV services. For HIV testing, the organization and delivery of services in health facilities, including location of HIV testing, waiting times, and likelihood of being seen accessing services, dissuaded men from testing for HIV. In general, health facilities were seen as women’s spaces and unresponsive to men’s needs. However, provider-initiated initiatives, including couples testing in antenatal care and an offer of HIV testing prior to medical male circumcision, and community-based HIV testing facilitated service use. Though condoms were the primary HIV prevention tool mentioned by study participants, norms of their use in marriage and sexual relations limited use. CONCLUSIONS: Despite HIV having evolved to a chronic condition and various HIV prevention tools available, fear, social isolation, stigma, and harmful gender norms continue to negatively impact men’s motivation and capability to engage with available HIV services. Measures to facilitate men’s use of these services should consider how to increase social support alongside the delivery of services in spaces that meet men’s needs
Why do female sex workers disengage from targeted reproductive and sexual health services? Experiences from the Sisters with a Voice programme in Zimbabwe.
Get PDFBACKGROUND: The Sisters programme provides HIV and sexual and reproductive health services for female sex workers (FSW) in Zimbabwe. Many engage with these services only once, while others disengage after repeated visits. Little is known about reasons for disengagement and the extent of service needs after disengaging. METHODS: Programme staff used site- and age-stratified random sampling to identify 1,200 programme records of FSWs who attended one of four Sisters clinics at least once between January 2018 and June 2019, and had no evidence of a further visit before September 2020. Outreach workers attempted to contact these FSWs via home visits, phone tracing and contacting peer educators. We calculated the proportion of FSWs successfully contacted, the level of ongoing engagement in sex work, expressed unmet need for Sisters services and the proportion of FSWs who subsequently made a return visit to the programme. We explored sociodemographic factors associated with these outcomes. RESULTS: Of 1169 FSWs for whom contact was attempted, peer educators or others provided evidence in relation to 16 FSWs thought to have died. Of the 45% (504/1169) of FSWs who were successfully contacted, 37% (188/504) were no longer engaged in sex work, although 83% (156/188) reported that they were still in need of services. Reasons given for disengaging included having migrated (40%; 200/504); work commitments (16%; 79/504) and accessing services elsewhere (10%; 51/504). 62% of FSWs (313/504) said they were still active in sex work, among whom 23% (73/313) revisited the programme within 3 months of contact. FSWs living with HIV were less likely to re-engage with the programme (adjusted odds ratio 0.41, 95% CI 0.20–0.83). Age and site were associated with no longer being in sex work, while other factors showed no strong association. CONCLUSIONS: These findings highlight the need for robust outreach and re-engagement strategies that accommodate the mobility and evolving circumstances of FSWs. In particular, programmes that promote peer-led, community-based microplanning—supported by integrated data management systems—can help address stigma, frequent relocation, and financial constraints that hinder continuous care. By tailoring services to both active and former FSWs, health systems can ensure that essential sexual and reproductive health services remain accessible, even when FSWs exit sex work. Such differentiated approaches ultimately strengthen continuity of care, reduce service gaps, and support broader public health goals by improving health equity and outcomes for this high-risk population. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-12870-y
"A child with severe pneumonia cannot feed, causing malnutrition": exploring health worker and caregiver perspectives and practices for mitigating malnutrition among children with severe pneumonia, a case of Uganda.
Get PDFBACKGROUND: Severe pneumonia remains the leading cause of morbidity and mortality among children worldwide. Severe pneumonia causes death during hospitalization, and survivors are prone to malnutrition after discharge from the hospital. The World Health Organization and United Nations International Children's Fund recommend 'continued' feeding following a severe pneumonia illness without specific recommendations on nutritional support. This recommendation could influence health workers' and caregivers' nutritional practices. This study aimed to explore the perspectives and practices of health workers and caregivers for mitigating malnutrition among children with severe pneumonia. METHODS: We conducted a cross-sectional qualitative study between June and November 2021 among health workers and caregivers of children hospitalized with severe pneumonia at Mulago National Referral Hospital in Kampala, Uganda. The data were collected via focus group discussions involving 17 caregivers and key informant interviews with 12 health workers and were analyzed via the content-thematic analysis approach. Both manual coding and Atlas Ti software were used to support the analysis. RESULTS: Health workers and some caregivers were aware that severe pneumonia predisposes children to malnutrition to various degrees, citing reduced appetite, difficulty breathing, persistent vomiting, and increased metabolic demands as pathways. Caregivers increased breastfeeding and utilized nutrient-rich foods to prevent malnutrition, while health workers applied caregiver education and tailored pneumonia management strategies, including following available guidelines and working with nutritionists. CONCLUSION: Severe pneumonia is recognized among health workers and some caregivers as a risk factor for malnutrition. However, mitigating strategies are not uniformly practiced by caregivers and could be enhanced by effective health education and sensitization. More specific guidelines could further reinforce the beneficial practices of health workers managing children with severe pneumonia who are not severely malnourished, and improve treatment outcomes
Machine Learning Identifies Sexual Behavior Subgroups Among Men Who Have Sex with Men in Switzerland.
Get PDFSexual behavior is heterogeneous and dynamic. Characterization of such complexity constitutes evidence for public health authorities and caregivers concerned with the framing of sexual health messages aimed at specific subgroups. We developed a machine-learning-based methodology for inference and characterization of such subgroups from longitudinal data on men who have sex with men (MSM) attending individual sexual health counseling sessions. Because longitudinal data take time to record, we assessed the ability of first visit data to predict subgroups' membership. Our methodology comprised two main steps: (1) Hierarchical clustering to group 2349 HIV-negative MSM based on their self-reported longitudinal sexual behavior during visits to Swiss sexual health counseling centers between November 2016 and April 2019; and (2) Random forest-based classification to predict subgroup membership from first visit data. We found six subgroups with significant differences in behavioral trends, most of which sharply deviated from the overall trends. Two subgroups, which contained 37% of the study population, accounted for over 70% of the overall increases in condomless anal intercourse with non-steady partners, group sex, and having more than five anal intercourse partners. Subgroup-specific trends in online-dating and group sex were heterogeneous with opposing trends across subgroups. Data from first visits predicted trends of sexual behavior with accuracy ranging from 64 to 86%. This study evidenced specific sexual behavioral subgroups that might benefit from customized sexual health messages, demonstrated that first visit registries could predict subgroups, and contributes an algorithmic alternative for establishing subgroups relevant to inform customized sexual health messages that capture sexual behavioral diversity
School-based mental health and psychosocial support interventions for children and adolescents with developmental disabilities in low- and middle-income countries: A systematic review.
Get PDFOBJECTIVES: To identify and evaluate the characteristics and reported effects of school-based mental health and psychosocial support interventions targeting children and adolescents with neurodevelopmental disorders (NDDs) in low- and middle-income countries, as well as those involving their parents, teachers or peers. METHODS: A systematic search of MEDLINE, EMBASE, ERIC, Global Health and PsycINFO was conducted in October 2024. Eligible studies included randomised controlled trials, quasi-experimental and qualitative research on school-based interventions in low- and middle-income countries for children and adolescents with NDDs (including attention deficit hyperactivity disorder [ADHD], autism, intellectual disabilities, epilepsy, cerebral palsy and foetal alcohol syndrome), as well as those involving their caregivers, teachers or peers. Only studies published in English, Spanish or Portuguese were included. A narrative synthesis was performed. RESULTS: A total of 2158 titles were screened, with 29 studies from 13 countries included. Most studies used a quasi-experimental design (n = 19, 66%). Nearly half focused on children and adolescents with NDDs only (n = 14, 48%), with intellectual disabilities being the most targeted condition (n = 12, 34%), followed by autism (n = 8, 23%) and ADHD (n = 8, 23%). Intervention strategies included multimodal approaches (n = 6, 21%) and educational workshops (n = 6, 21%). Targeted outcomes were social skills (n = 7, 16%) and knowledge attitudes and practice (n = 5, 12%). Lifelong learning (n = 11, 33%) and educational system-strengthening interventions (n = 10, 31%) were the primary content areas. The majority of studies exhibited a moderate to high risk of bias. CONCLUSIONS: Schools offer strategic platforms for delivering mental health and psychosocial support interventions to children and adolescents with NDDs in low- and middle-income countries, involving families, teachers and peers. While improvements in social skills and knowledge, attitudes and practices were reported, heterogeneity and methodological limitations constrain the generalisability of findings. Future research should address long-term impacts and expand to underrepresented conditions
Development of START-EDI guidelines for reporting equality, diversity and inclusion in research: a study protocol.
Get PDFINTRODUCTION: Acknowledging equality, diversity and inclusion (EDI) in research is not only a moral imperative but also an important step in avoiding bias and ensuring generalisability of results. This protocol describes the development of STAndards for ReporTing EDI (START-EDI) in research, which will provide a set of minimum standards to help researchers improve their consistency, completeness and transparency in EDI reporting. We anticipate that these guidelines will benefit authors, reviewers, editors, funding organisations, healthcare providers, patients and the public. METHODS AND ANALYSIS: To create START-EDI reporting guidelines, the following five stages are proposed: (i) establish a diverse, multidisciplinary Steering Committee that will lead and coordinate guideline development; (ii) a systematic review to identify the essential principles and methodological approaches for EDI to generate preliminary checklist items; (iii) conduct an international Delphi process to reach a consensus on the checklist items; (iv) finalise the reporting guidelines and create a separate explanation and elaboration document; and (v) broad dissemination and implementation of START-EDI guidelines. We will work with patient and public involvement representatives and under-served groups in research throughout the project stages. ETHICS AND DISSEMINATION: The study has received ethical approval from the Imperial College London Research Ethics Committee (study ID: 7592283). The reporting guidelines will be published in open access peer-reviewed publications and presented in international conferences, and disseminated through community networks and forums. TRIAL REGISTRATION NUMBER: The project is pre-registered within the Open Science Framework (https://osf.io/8udbq/) and the Enhancing the Quality and Transparency of Health Research Network