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Sexual and reproductive health challenges among adolescents and young people with spina bifida and hydrocephalus disability in Uganda: A qualitative study.
Get PDFINTRODUCTION: Globally, 180 million young people aged 10-24 live with a physical or mental health disability. Their rights to sexual and reproductive health have been denied often overshadowed by the societal negative knowledge, beliefs, and attitudes. This study sough to explore sexual and reproductive health challenges among adolescents and young people with spina bifida and hydrocephalus disability in Uganda. METHODS: This was an exploratory community based cross-sectional qualitative study among adolescents in Uganda. We conducted 60 semi structured interviews, 30 with Adolescents and young people with spina bifida and hydrocephalus and 30 with caregivers between March 2021 and February 2022 to explore their sexual and reproductive health challenges. Through thematic analysis, we identified common themes across the interviews regarding their challenges. RESULTS: Participants reported a number of sexual and reproductive health challenges including sexual violence and abuse, incontinence and stigma, Inability to feel sexually empowered, other adolescents are coerced to take birth control methods without their informed decision. Negative Socio-cultural beliefs, lack of and inaccessible sexual reproductive health information and poor menstrual health management. CONCLUSION: Adolescents and young people with spina bifida experience a number of sexual and reproductive challenges that are not given attention and often overshadowed by the negative knowledge, beliefs, attitudes, and practices within the society. Therefore, there is need to develop and implement programs and awareness campaigns aimed for the empowerment of individuals with SB to seek knowledge and skill building regarding sexual and reproductive health
The association between proton pump inhibitors and the risk of gastrointestinal bleeding in oral anticoagulants users.
Get PDFCurrent evidence of whether proton pump inhibitor (PPI) reduces the risk of gastrointestinal bleeding (GIB) associated with oral anticoagulants (OACs) is limited. Propensity score-weighted cohort and case-crossover studies were conducted separately in England and Hong Kong between 2011.01.01 and 2019.12.31. In the cohort design, we compared the hazards of hospitalised GIB in OAC + PPI users with OAC only users in people with atrial fibrillation and found higher hazard of GIB in OAC + PPI users in both settings. In the case-crossover design, elevated odds of exposure to PPI only , OAC only and OAC + PPI associated with GIB between 30-day hazard and referent periods were similarly found in both settings. Overall, the evidence of an elevated risk of OAC + PPI associated with GIB compared with OAC only was modest in the cohort study. Our case-crossover study suggested that residual confounding is likely to explain the association, suggesting that concomitant prescription of PPI with OAC did not modify GIB
Target-agnostic identification of human antibodies to Plasmodium falciparum sexual forms reveals cross-stage recognition of glutamate-rich repeats.
Get PDFCirculating sexual stages of Plasmodium falciparum (Pf) can be transmitted from humans to mosquitoes, thereby furthering the spread of malaria in the population. It is well established that antibodies can efficiently block parasite transmission. In search for naturally acquired antibodies targets on sexual stages, we established an efficient method for target-agnostic single B cell activation followed by high-throughput selection of human monoclonal antibodies (mAbs) reactive to sexual stages of Pf in the form of gametes and gametocyte extracts. We isolated mAbs reactive against a range of Pf proteins including well-established targets Pfs48/45 and Pfs230. One mAb, B1E11K, was cross-reactive to various proteins containing glutamate-rich repetitive elements expressed at different stages of the parasite life cycle. A crystal structure of two B1E11K Fab domains in complex with its main antigen, RESA, expressed on asexual blood stages, showed binding of B1E11K to a repeating epitope motif in a head-to-head conformation engaging in affinity-matured homotypic interactions. Thus, this mode of recognition of Pf proteins, previously described only for Pf circumsporozoite protein (PfCSP), extends to other repeats expressed across various stages. The findings augment our understanding of immune-pathogen interactions to repeating elements of the Plasmodium parasite proteome and underscore the potential of the novel mAb identification method used to provide new insights into the natural humoral immune response against Pf
Soap and water cleaning versus bleach-based cleaners for eliminating SARS-CoV-2 infection.
Get PDFBACKGROUND: Households and community settings are important hubs for the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As understanding of viral transmission improves, infection prevention and control (IPC) policies need to be updated. AIM: To compare the effectiveness of soap and water alone to bleach-based cleaners in eliminating SARS-CoV-2 infection in households and community settings. SETTING: We conducted a virtual search through the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane database of systematic reviews, PubMed, EMBASE, and Effective Practice and Organisation of Care (EPOC). METHODS: We assessed studies which compared the effect of soap and water cleaning on SARS-CoV-2 among humans to that of bleach-based cleaning, both in households and communities. We prioritised systematic reviews and randomised studies and only included other study designs, such as laboratory studies, which had interventions of relevant interest. RESULTS: We retrieved 1192 articles from the search. We summarised evidence from three laboratory studies as there were no randomised controlled trials (RCTs) or comparative effectiveness studies that met our inclusion criteria. Indirect evidence suggests that soap and bleach-based cleaners were effective at different concentrations. Substantial heterogeneity between the cited studies precludes any inference on effectiveness in reducing risk of SARS-CoV-2 infection in humans. Both interventions remain important components of IPC measures. CONCLUSION: There was no evidence for comparison of soap and water versus bleach-based cleaners against SARS-CoV-2 in humans in household and community settings. Indirect evidence shows both interventions to be effective against the virus. CONTRIBUTIONS: Primary studies addressing this critical question are required to guide public health recommendations and policies
The Minha Casa Minha Vida social housing programme and leprosy in Brazil: an analysis of the 100 Million Brazilian Cohort (2010-2015).
Get PDFBACKGROUND: Ensuring housing interventions can contribute to improved living conditions which are strong socioeconomic determinants of leprosy. We estimated the association between the social housing programme Minha Casa Minha Vida (MCMVP) and leprosy new cases. METHODS: We followed families registered in the 100 Million Brazilian Cohort linked with MCMVP receipt and nationwide registries of leprosy between 2010 and 2015. We used Cox regression weighted by stabilized inverse probability of treatment weighting (IPTW) to assess the hazard ratio (HR) for the effect of MCMVP on leprosy. Weights were obtained by propensity score using demographic and socioeconomic covariates at baseline. Sensitivity analyses were done considering potential delays to receiving MCMVP, municipality of residence population size and by controlling by the baseline risk of leprosy among potential recipients. RESULTS: We followed up 24,584,768 individuals, of which 618,883 (2.5%) were MCMVP recipients, and detected 8,874 new leprosy cases during the study period. Leprosy incidence was higher among MCMVP recipients (13.32/100,000 pyr; 95%CI = 11.45-15.49) compared to non-recipients (11.72/100,000 pyr; 95%CI = 11.47-11.97). MCMVP recipients had higher leprosy incidence (HR = 1.66; 95%CI = 1.34-2.06), compared to non-recipients. Point estimates were lower when considering a delay of 6 or 12 months to moving into the new household (HR = 1.53; 95%CI = 1.20-1.95 and HR = 1.37; 95%CI = 1.05-1.78, respectively), in small/medium municipalities (≤ 300,000 inhabitants) (HR = 1.95; 95%CI = 1.51-2.52), and higher among individuals who subsequently became MCMVP beneficiaries before receiving the benefit (HR = 2.29; 95%CI = 1.93-2.72). CONCLUSIONS: This study found a higher risk of leprosy associated with MCMVP that may reflect reverse causality. Our findings suggest the programme is, in fact, reaching the most vulnerable individuals, as intended in its objectives. Besides, the higher risk of leprosy among MCMVP beneficiaries even before receiving the benefit observed in sensitivity analysis may reflect residual confounding factors related
All-cause and non-colorectal cancer 1-year mortality among people having a faecal immunochemical test in primary care for investigation of symptoms of suspected colorectal cancer: an English cohort study
Get PDFBackground: High blood concentrations in stool, as determined by the faecal immunochemical test (FIT), in individuals screened for colorectal cancer are associated with increased mortality. To our knowledge, no studies to date have assessed whether this association is present in symptomatic individuals. Our objective was to estimate the risk of all-cause and non-colorectal cancer 1-year mortality in adults who have undergone a FIT after symptomatic presentation to primary care.
Methods: In this regional retrospective cohort study, all adults (age ≥18 years) with symptoms of colorectal cancer who were tested with FIT in primary care in Nottingham, UK, between Nov 1, 2017, and Nov 30, 2022 were included. Patient data were retrieved from existing medical records. Associations between FIT and mortality were examined using Cox regression to produce adjusted hazard ratios (aHRs) comparing those with FIT results of 10 μg of haemoglobin per g or higher against those with results lower than 10 μg of haemoglobin per g. Standardised mortality ratios (SMRs) were derived using English data from the UK Office for National Statistics.
Findings: 49 889 patients were included following their first FIT to investigate symptoms of colorectal cancer. The median age was 65 years (IQR 53–79); 27 912 (55·9%) patients were female and 21 977 (44·1%) were male. In the year following a symptomatic FIT, 1971 (4·0%) patients died, including 864 (8·3%) of 10 352 patients with a FIT result of 10 μg of haemoglobin per g or higher and 1107 (2·8%) of 39 537 with a FIT result lower than 10 μg of haemoglobin per g. After adjusting for age, sex, and year, there was evidence of increased all-cause mortality (aHR 1·96 [95% CI 1·79–2·14]) and non-colorectal cancer mortality (1·70 [1·55–1·88]) in those with a FIT result of 10 μg of haemoglobin per g or higher compared with those with a FIT result lower than 10 μg of haemoglobin per g. The overall cohort had higher mortality than the general English population (SMR 1·50 [95% CI 1·44–1·57]). The magnitude of the increase in mortality following a FIT result of 10 μg of haemoglobin per g or higher was greater in younger than in older patients and in female than in male patients compared with those with a FIT result lower than 10 μg of haemoglobin per g (HR for all-cause mortality was 3·83 [2·86–5·14] in female patients and 2·91 [2·21–3·85] in male patients at age 50 years vs 2·27 [1·98–2·60] in female patients and 1·73 [1·53–1·95] in male patients at age 80 years).
Interpretation: Further understanding of the cause-specific mortality associations with symptomatic FIT has the potential to transform diagnostic pathways and subsequent treatment—particularly in younger and female patients, for whom the greatest excess all-cause mortality risks were observed at 1 year of follow-up.
Funding: None
Post-acute sequelae of hospitalised COVID-19 re-infection compared with hospitalised first-time infection: a population-based retrospective cohort study in Hong Kong.
Get PDFINTRODUCTION: COVID-19 infection is associated with post-acute adverse outcomes affecting multiple organ systems. Although preliminary studies have suggested that COVID-19 re-infection may have a cumulative effect on long-term outcome, differential effects of COVID-19 re-infection severe enough to be hospitalised on post-acute sequelae compared with hospitalised first-time infection have not been explored.
METHODS: Retrospective cohort study using territory-wide electronic medical records databases in Hong Kong. Adults hospitalised with COVID-19 between 1 January and 30 November 2022, who survived the first 28 days after infection and was discharged, were categorised into re-infection and first-time infection groups. Individuals with reinfection were compared with those with first-time infection for all-cause mortality, all-cause hospital readmission, attendance to the emergency department and complications during the post-acute period using propensity-score-weighted Cox regression. Subgroup analyses were conducted by age (<65 and ≥65 years), sex, Charlson Comorbidity Index (0-4, ≥5), COVID-19 vaccination (0-1, 2+doses) and hospitalisation status of previous infection.
RESULTS: 2244 patients with hospitalised COVID-19 re-infection and 58 894 patients with hospitalised first-time COVID-19 infection were included. After a median follow-up of 170 days, re-infection was associated with a significantly higher risk of post-acute all-cause mortality compared with first-time infection (adjusted HR (95% CI): 1.366 (1.166 to 1.600); incidence rate (95% CI): 7.3 (7.1 to 7.5) vs 4.6 (4.4 to 4.7) per 10 000 person-days), all-cause hospital readmission (1.297 (1.200 to 1.403); 50.5 (49.8 to 51.1) vs 28.1 (27.8 to 28.5)), and attendance to emergency departments (1.307 (1.199 to 1.425); 35.4 (34.8 to 35.9) vs 21.9 (21.6 to 22.2)). Findings were consistent across subgroups of age, sex, health status and vaccination status. A greater magnitude of increased risk was observed especially among those hospitalised during a previous infection.
CONCLUSION: Among patients with COVID-19 infection requiring hospitalisation, COVID-19 re-infection was associated with increased post-acute mortality and morbidity compared with first-time infection. Further studies are warranted to delineate the effects on complications
Community perspectives on access to maternal health services during the COVID-19 pandemic in rural Western Kenya: a qualitative study.
Get PDFBACKGROUND: Globally, maternal and child health outcomes were negatively affected during the COVID-19 pandemic. There is limited qualitative evidence focused on access to maternal health services during the COVID-19 pandemic in rural sub-Saharan African populations. This study aims to fill this gap by exploring key community perspectives on access to maternal health services during the COVID-19 pandemic in rural western Kenya. METHODS: We conducted five focus group discussions and sixty one in-depth interviews. Participants were mothers who delivered in 2020 during the acute phase of the COVID-19 pandemic and rural community health workers (CHWs) in Siaya and Kisii counties. The three-delay model framework helped to guide discussions around access to maternal health services during the COVID-19 pandemic in rural western Kenya. We transcribed the data and conducted a thematic content analysis. RESULTS: According to CHWs and expectant mothers, fear and misconceptions about COVID-19 were associated with delays in making the decision to seek maternal health care. Lockdowns, movement restrictions, and curfews made it challenging to physically reach health facilities. The shortage of drugs and supplies and an insufficient number of healthcare workers in health facilities were barriers to care seeking. The quality of maternal health services was perceived to have declined during the COVID-19 pandemic. Mothers reported the Linda Mama health insurance program helped them pay for maternal health services during the COVID-19 pandemic; however, out-of-pocket expenses were common. As reported by mothers, CHWs when engaged and active, helped alleviate access challenges by serving as a link to the health system. There were significant socio-economic difficulties experienced by community members because of closed businesses and schools. CONCLUSIONS: Community perspectives revealed significant challenges with accessing maternal health services during the COVID-19 pandemic in rural western Kenya. The pandemic amplified each of three delays in accessing care leading to poorer access to maternal health services. The overriding perception among mothers was that CHWs helped mitigate challenges around access to health services. CHWs should be included in future pandemic preparedness and response efforts
Current international tools and guidance for the implementation of hand hygiene recommendations in community settings: a scoping review
Get PDFHand hygiene is an important public health measure to prevent disease transmission. This scoping review identifies and summarises current tools and guidance for the implementation of hand hygiene recommendations in community settings. We conducted a scoping review following the Arksey and O’Malley framework. To identify relevant documents, we searched: 1) a grey literature database, 2) Google search engine, and 3) the websites of international organisations in November 2024. We included tools and implementation guidance relevant to hand hygiene in community settings, categorised as domestic, public, or institutional, and published in English by multilateral agencies and international organisations between January 1990 and November 2024. Tools and implementation guidance were mapped to an existing conceptual framework adapted for this review that includes a six-step implementation approach. We included 37 documents, comprising 33 implementation guidance documents and 4 stand-alone tools. Among these 37 documents, we identified 210 implementation recommendations and 24 unique tools for the six implementation steps. The 24 tools include 4 stand-alone tools and 20 tools embedded within guidance documents. Most implementation guidance was mapped to steps 1 (prepare for action), 2 (analyse the situation), 3 (develop an action plan), and 5 (monitor, evaluate, and course correct) of the conceptual framework, with limited guidance for step 4 (executing the action plan) and step 6 (cross-cutting themes). Over half of identified tools are for step 2 (analyse the situation) and primarily for undertaking a situation analysis. Only two documents provided guidance or a tool across the six steps. Implementation guidance for hand hygiene in community settings is available yet inconsistently spread across the six implementation steps. There is also a limited number of tools available to support implementation. Future work should focus on developing comprehensive practical tools for the implementation of hand hygiene recommendations in community settings to support international guidelines
The relationship between general practice characteristics, case-mix, and secondary care attendances/admissions before and after the COVID-19 pandemic: Protocol for an OpenSAFELY cohort study.
Get PDFBACKGROUND: Healthcare services in England experience increased pressure during winter months due to seasonal infectious diseases, increased multimorbidity, and fluctuating demand. Understanding how characteristics of general practices, and their registered patient case-mix contribute to secondary care use-particularly for Ambulatory Care Sensitive Conditions (ACSCs)-is essential for planning and resource allocation. Primary and secondary care activity also significantly changed during the COVID-19 pandemic, and not all activity-types have returned to pre-pandemic levels in the years since, making it critical to examine trends across both pre-and post-pandemic periods. METHODS: OpenSAFELY-TPP was used to access linked electronic health record data, covering approximately 2,600 general practices (about 40% of all practices in England) and 26 million registered patients in England using TPP SystmOne software (2018-2025). Our analysis focused on weekly and aggregated rates of A&E attendances and hospital admissions during the flu and winter months (October to February), comparing patterns before and after the COVID-19 pandemic. Practice-level exposures included consultation rate per capita, practice size, region, and patient case-mix variables (e.g. age, sex, ethnicity, deprivation, multimorbidity). Outcomes included weekly rates of A&E attendances, total hospital admissions, and admissions for ACSCs. ANALYSES: We will summarise variation in practice characteristics, registered patient sociodemographics, case-mix, and service use across time periods. Associations between exposures and outcomes will be examined using generalised linear models, with additional subgroup analyses by age distribution. Sensitivity analyses will assess alternative flu season definitions and account for holiday and extreme weather. DISCUSSION: This high-level descriptive study will provide valuable insights into variation in secondary care use across general practices and identify practice-level and case-mix factors that may contribute to winter pressures. The inclusion of both pre- and post-pandemic data will provide essential benchmarking data for future health system planning and further understanding of how the general practice context and patient case-mix affects hospital demand