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Surgical recovery from the COVID-19 pandemic in English adult neurosurgical centres.
Get PDFOBJECTIVES: The COVID-19 pandemic required a change in resource priority from Neurosurgical care in order to treat medically unwell patients suffering from the complications of COVID-19 infections. We demonstrate the impact of COVID-19 on total bed days in 24 Neurosurgical centres in England offering adult Neurosurgery as well as the total spells (single inpatient episodes) for operative Neurosurgical patients between 2020 and 2022 when compared with 2019.
METHODS: We used Capse Healthcare Knowledge System software iCompare in order to show the change in total spells for patients undergoing a primary or secondary Neurosurgical procedure as defined using the National Neurosurgical Audit Programme (NNAP) OPCS-4 coding framework between 2019 and 2022.
RESULTS: The overall mortality rate of COVID-19 patients was 12.3% and the percentage of total bed days taken up by COVID-19 patients in hospitals at large was on average 7.7%. The total number of spells for all procedures over the 24 centres in 2022 was 39,019 compared with 45,742 in 2019. There was a cumulative deficit of 24,904 spells. The loss of spells was not equally distributed across regions and hospital Trusts. The average number of referral to treatment pathways completed within 18 weeks has declined from 76% to 57% over the study period and the referral to treatment clearance time has risen from 17 to 24 weeks.
CONCLUSIONS: The mean elective cranial output in 2022 compared with 2019 is at 88% with spinal output lagging at 69%. If the rate of change year on year were to remain at current levels then we would reach pre-pandemic levels of output by 2026
Early-life exposure to mixtures of endocrine-disrupting chemicals and a multi-domain health score in preschool children.
Get PDFBACKGROUND: Early-life exposure to endocrine-disrupting chemicals, such as phenols and phthalates, is suspected to impact various dimensions of child health. Using a multi-outcome approach, this study aimed to estimate their cumulative effect on the child cardiometabolic, respiratory and neurodevelopmental health. METHODS: In 373 children of 3 years old from the SEPAGES cohort, a multi-domain health score was built from twenty-three health parameters. Fourteen metabolites of parabens, phenols, and phthalate/DINCH were measured several times during pregnancy (trimester 2 and 3) and infancy (2 and 12 months of age). Two mixture models, quantile g computation (q-gcomp) and Bayesian Kernel Machine Regression (BKMR), estimated associations between increased concentration of parabens, phenols, and phthalates/DINCH and the child health score. RESULTS: Q-gcomp showed that the paraben mixture and the phthalate mixture were associated with a poorer health score (β = -0.11, 95% Confidence Interval (CI): -0.22, 0.00; β = -0.14, 95% CI: -0.27, -0.01, respectively), while no significant association was found for the mixture of phenols (β = -0.06, 95% CI: -0.18, 0.06). A trend for an association was observed between the whole mixture (parabens, phenols and phthalates combined) with a poorer health score (β = -0.14, 95% CI: -0.32, 0.04). Similar patterns of association, while subject to large uncertainty, have been observed with BKMR. DISCUSSION: This study provides further evidence for the adverse health effects of early-life exposure to parabens and phthalates. Based on their potential impact on multiple areas of child health, public health policies targeting these chemical compounds are recommended
Uncertainty around Health State Values Used in Cost-Effectiveness Analysis: How It Arises and How to Deal with It.
Get PDFHealth state values, often in the form of value sets that list values applied to particular health states, are used in cost-effectiveness analyses of health care to calculate gains in quality-adjusted life-years. These values are subject to several sources of uncertainty, arising from the fact that values are not constants but variables and are of different types including variability, heterogeneity, statistical uncertainty, and methodological variation. Currently, these sources are not fully documented and are not fully accounted for when creating and analyzing economic evaluation models. This may provide to users of such models a false sense of the precision of quality-adjusted life-year gain estimates and therefore of cost-effectiveness. This article provides a comprehensive account of such sources of uncertainty and how they interact. It also provides a more detailed account of how uncertainty arises in studies that elicit and model value sets. Its aim is to encourage research to measure and report uncertainty around health state values so it can be better accounted for in cost-effectiveness analyses.HighlightsHealth state values (HSVs) used in cost-effectiveness analysis are subject to multiple types of uncertainty, including variability, heterogeneity, statistical uncertainty, and methodological variation.Current reporting and guidelines often fail to fully document or address all sources of uncertainty in HSVs, which can mislead users about the precision of QALY and cost-effectiveness estimates.Valuation studies should report measures of uncertainty (such as standard errors or variance/covariance matrices) for HSVs, not just point estimates.Researchers, decision modellers, and guideline developers should recognise, measure, and report HSV uncertainty more thoroughly to improve the reliability of cost-effectiveness analyses
Evidencing work: implementing HIV pre-exposure prophylaxis and on-demand dosing in Australia.
Get PDFHIV pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs to prevent HIV infection, was initially implemented in Australia as a daily regimen, transforming HIV prevention. However, the process of implementation, and key shifts in the delivery of PrEP, such as the introduction of on-demand (non-daily) dosing, are not well understood. This study aimed to understand how key stakeholders put PrEP into practice, and the 'evidencing work' that underpinned these processes. Evidencing work refers to how actors mobilise 'local orders of evidence' to understand and assess how an intervention, like PrEP, performs in its local context. We conducted 21 interviews in 2021-2022 with key stakeholders representing research, clinical practice, policymaking, health education and promotion, and community engagement. The analysis shows how stakeholders worked with and understood evidence, the prominence of (and departure from) clinical guidelines, and the growth in and recognition of on-demand dosing. Participants described translational, authorising, and localising evidencing work, overlapping practices necessary to create 'evidence enough' to proceed with implementation. The generation of national, local, and peer- and expertise-based evidence was particularly important to reassure participants that PrEP use was safe and effective in Australia, and to provide evidence that on-demand dosing could be successfully practiced. Encouraging localising evidencing work with less familiar prescribers (e.g. sharing peer-, patient- and expertise-based evidence about PrEP) could enable PrEP rollout and support for different dosing regimens, such as on-demand dosing
Eligibility criteria for the UK Winter Fuel Payment: are we targeting the right people?
Get PDFBACKGROUND: Cold weather remains a serious health threat in the UK and elsewhere, particularly for older adults. The Winter Fuel Payment has been a key government strategy to mitigate health risks linked to cold homes in the UK, but recent policy shifts have raised questions about whether income-based eligibility criteria effectively identify those most at risk. METHODS: We analysed cold-related mortality in adults aged ≥75 across 324 local authority districts in England (2007-2019) using distributed lag non-linear models in a spatial Bayesian framework. Multivariate meta-regression was used to evaluate modification of cold effects by deprivation, income-based pension credit uptake, home energy efficiency and fuel poverty. RESULTS: Areas in the highest quartile of fuel poverty had significantly greater cold-related mortality risk than those in the lowest quartile, with a 15.3% versus 13.1% increase in mortality risk at the first compared with the 50th percentile of wintertime temperature, ie, an absolute difference of 2.2% (p<0.001). This effect was stronger than the corresponding differences for energy efficiency (1.7%, p=0.04), income as indicated by pension credit uptake (0.6%, p=0.39) and deprivation-based measures, for which differences were minimal. Overall, an estimated 17% of cold-related deaths among people aged ≥75 were attributable to fuel poverty. CONCLUSION: Fuel poverty, an indicator designed to capture both low-income and housing energy efficiency, is a stronger predictor of cold-related mortality than income (as indicated by pension credit update) or deprivation-based indicators alone. Winter energy support schemes should consider fuel poverty metrics in their targeting to more effectively reduce health risks associated with cold homes and improve equity
Generous manuscript review.
Get PDFBACKGROUND: Generous peer review is essential for scientific review, yet many researchers experience the current review culture as unkind. Harsh reviews disproportionately affect women, researchers of color, and other under-represented groups, contributing to reduced confidence, diminished job satisfaction, and delayed career progression. In contrast, generous reviewing strengthens research quality, promotes equity, and reinforces the collaborative foundations of science.
METHODS AND RESULTS: This article outlines four principles to guide a more generous approach to manuscript review: empathizing with authors, providing constructive criticism, focusing on areas of genuine expertise, and advocating for systemic improvements in academic publishing. Empathy encourages reviewers to recognize the emotional and professional labor behind every submission, framing feedback in a manner that supports learning rather than discouragement. Constructive criticism emphasizes specificity, actionable guidance, and a distinction between major and minor concerns. Reviewing within one's expertise enhances accuracy and protects against misplaced or misleading critique, while acknowledging limitations promotes humility and transparency. Finally, reviewers are well positioned to promote broader equity, including advocating for fair article processing charge policies, inclusive language support, and greater recognition of reviewer labor.
CONCLUSIONS: Cultivating generosity in peer review does not diminish rigor; it enhances the effectiveness, fairness, and impact of scholarly communication. By adopting these principles, reviewers can help shift the culture of peer review towards one that encourages improvement, supports diverse researchers, and advances high-quality science
Diagnostic Accuracy of Next-Generation Sequencing: Prevalence of HIV-1 Drug Resistance and Associated Factors Among Adults on Integrase Inhibitors with Virologic Failure.
Get PDFEmerging evidence indicates a high rate (>10%) of drug resistance (DR) associated with integrase strand transfer inhibitors (INSTIs) in developed countries, although there is limited information on DR during INSTI treatment in Uganda. With the increased use of INSTIs as standard first-line treatment, monitoring for DR using next-generation sequencing (NGS) has become essential. NGS can detect the lower-frequency variants that may be missed by traditional Sanger sequencing (SS). This study evaluates the diagnostic accuracy of next-generation sequencing (NGS) compared to Sanger sequencing for detecting HIV-1 INSTI resistance mutations and estimates the prevalence and factors associated with drug resistance among adults with virologic failure on INSTI-based regimens in Uganda. Utilizing the Illumina MiSeq platform for NGS, data was analyzed using STATA V.18 and a logistic regression model at 5% level of significance. This study demonstrates that NGS achieved 100% sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy in detecting major mutations. NGS identified INSTI DRMs in 4% of adults at a ≥20% threshold and was able to detect both high- and low-abundance variants, which could have important implications for clinical outcomes. This study emphasizes the need for HIVDR testing before antiretroviral therapy (ART) initiation, given the increasing use of INSTIs. We recommend that healthcare providers adopt more sensitive diagnostics such as NGS and use detailed resistance profiles to tailor antiretroviral therapies. This approach is critical for effectively managing and preventing drug-resistant HIV strains
Understanding the mental health of adolescents and young adults in rural South Africa through participatory research.
Get PDFMost mental health problems in adulthood begin during adolescence. Factors such as poverty, violence, and unemployment contribute to the high burden of mental health problems. In Africa, the lack of resources for diagnosis, treatment, and management exacerbates the situation. Research on adolescent mental health has mostly focused on negative psychological effects, while positive attributes like coping, resilience, and emotional growth have been overlooked. This study explored factors affecting the mental health of adolescents and young adults and to collaboratively identify potential interventions using a participatory research approach. After reviewing the literature, we developed scenarios on issues such as unemployment, violence, poverty and HIV, which were adapted by peer supervisors into role-plays that reflect their local realities. We conducted workshops with ten peer navigators and eight young people, who listed problems affecting their mental health and identified possible interventions. Data from the workshops were synthesized to create a preliminary conceptual framework, which was then refined with input from three professional nurses who work in adolescent-friendly clinics. Young people and peer navigators identified romantic relationships and alcohol use as both contributors to mental health problems and coping strategies for stressors like poverty and violence. These behaviours were also linked to sexual and reproductive health (SRH) risks including unprotected sex. Cultural and spiritual experiences, such as the ancestral calling to become a traditional healer were also described as common in the community and were linked to emotional distress. Participants recommended family-strengthening and community-based interventions to build resilience and promote positive parenting, while respecting existing traditional practices. This study enhances our understanding of mental health challenges among young people and emphasizes the importance of strengthening protective factors such as resilience. It offers guidance for developing culturally appropriate mental health interventions. Further research is needed to examine causal pathways and explore how SRH services and traditional healing practices can be integrated into mental health strategies
Development and testing of the IMPRESS hospital management survey (IHMS) to measure hospital management practices in a low-income country setting.
Get PDFBACKGROUND: Strong hospital management has long been recognised by policymakers and the public as important for hospital performance, yet it has received limited empirical research attention. This paper aims to describe the rigorous development and performance testing of a tool to measure hospital management practices in Malawian hospitals.
METHODS: Using a systematic process informed by a scoping review of existing tools, government policies and guidelines, qualitative interviews with hospital managers, a team workshop, and pilot testing, we developed a tool to assess 28 management practices across five domains: clinical care delivery in the neonatal unit, human resource management, target setting and monitoring, financial management, and leadership and governance. The tool was implemented by trained data collectors in 36 Malawian hospitals between April and May 2022, with five managers interviewed per hospital (n = 180). Guided by psychometric techniques and supplemented by qualitative feedback from 36 hospital dissemination meetings, we evaluated the tool’s acceptability, reliability and validity, and compare the primary measure of management with two alternative scoring methods.
FINDINGS: Our findings are threefold: first, the tool was feasible to implement and acceptable to the interviewees. Second, it demonstrated strong psychometric performance: factor analysis showed that one principal component loaded positively on all the management practices, thus the tool measures a single latent factor of hospital management. Results from item analysis indicate that the tool detected variation between the hospitals for each management practice and none of the management practices are redundant, with low inter-item correlation. Finally, the primary management measure was highly correlated with alternative scoring methods.
INTERPRETATION: To our knowledge, this is the first study to describe the systematic development and rigorous validation of a tool that quantitatively measures management practices in a low-resource, hospital setting. We discuss methodological insights and suggest adaptations for implementing the tool in other low-income settings. This paper contributes to the limited evidence base on the development and performance testing of tools for quantitatively measuring management practices in the healthcare sector.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-13704-7
A scoping review and taxonomy of epidemiological-macroeconomic models for livestock diseases.
Get PDFBACKGROUND AND OBJECTIVES: Livestock disease outbreaks can generate significant macroeconomic harms, though few studies have combined epidemiological and macroeconomic analysis in a joint modelling framework. We reviewed existing approaches to epidemiological-macroeconomic modelling for livestock diseases, to identify challenges and opportunities for further model development. METHODS: We systematically searched electronic databases for journal articles, preprints, working papers and grey literature. We assessed model methodologies, scope, and application to empirical data. We analysed results descriptively and provided a critical appraisal of the strength, limitations and use cases of existing methods. RESULTS: We found 17 articles modelling the animal health and macroeconomic outcomes of livestock disease outbreaks. Models used outputs from epidemiological model simulations linked to a macroeconomic model, with no feedback from the economy to epidemiology. Macroeconomic modelling approaches consisted of the use of computable general equilibrium models, input output models and social accounting models. The literature was heavily dominated by considerations for hypothetical foot-and-mouth disease incursions in high-income settings. CONCLUSION: Priority for future research includes efforts to model a wider array of livestock diseases in endemic and low-income settings, further consideration for socioeconomic impacts and the need for improved data