69832 research outputs found
Sort by
Measuring and monitoring child health and well-being-an integral part of the climate change agenda.
No full textClimate change has far-reaching consequences for all aspects of human society (Romanello et al. 2023). Children are uniquely vulnerable to climate change for a multitude of physiological and developmental reasons as well as because of distinctive behaviors such as outdoor play that increase their exposure to climate-related stressors (EPA 2023). Several reviews have summarized the multiple direct and indirect pathways through which climate change negatively affects child health and well-being (Arpin et al. 2021, Helldén et al. 2021, United Nations International Children's Emergency Fund 2021, Orun 2022, Perera and Nadeau 2022, Ahdoot et al. 2024, Etzel et al. 2024, Paz 2024, Proulx et al. 2024, United Nation's International Children's Emergency Fund 2024, Weeda et al. 2024) (Table 1; Supplementary Table S2, Supplementary Figure S1). The evidence suggests that climate change impacts on children accumulate over their life course with both short- and long-term detrimental effects, including those that occur in utero that are linked with women's exposures to excessive heat and experiences of stress due to climate change events during pregnancy (Yarlagadda 2023, Etzel et al. 2024, Proulx et al. 2024). The risks of climate change are not evenly distributed, as countries that emit the lowest greenhouse gas emissions are often the most affected, thereby increasing inequities (Intergovernmental Panel on Climate Change 2024). Climate change also exacerbates child health inequities within countries, increasing the likelihood that children in the most disadvantaged conditions will be left further behind and perpetuating intergenerational cycles of poverty (Arpin et al. 2021, Ahdoot et al. 2024). Children in low-income communities, e.g., are more likely to be homeless or live in houses that are poorly constructed, leaving them exposed to extreme heat, vector-borne diseases, flooding, and air pollution (Williams et al. 2021
Implementing the Chinese mandatory antimicrobial stewardship program: barriers to continuous improvement.
Get PDFThis study aims to investigate the implementation strategy, unintended consequences, and underlying barriers to mandatory antimicrobial stewardship (AMS) programs in China. Face-to-face, in-depth qualitative interviews were conducted in 16 public hospitals in eastern, central, and western China. Hospitals were purposely selected with full consideration to represent both economically developing and developed areas and both secondary and tertiary care hospitals. A total of 111 respondents were interviewed, including 38 doctors, 28 clinical pharmacists, 15 microbiologists, 14 infection prevention and control specialists, 10 experts from medical service departments, and 6 quality improvement experts. A thematic framework analysis was conducted. A common implementation strategy was found among the surveyed hospitals in response to the AMS programs mandated by healthcare authorities. The hospital leadership empowered an AMS team to set AMS-related indicators for each clinical department and each doctor, and adopted core elements of AMS to optimize antimicrobial prescribing. However, the mandatory AMS approach also caused unintended consequences including regulatory circumvention, shift of risk to doctors and patients, and demotivation of healthcare workers. Two key barriers to AMS implementation were identified: (i) poor communication and cooperation between the AMS team and doctors, characterized by a high-power-low-power dynamic within hospital disciplines; and (ii) the profit-driven compensation system, which discourages collaboration and resource distribution for AMS implementation. Mandatory AMS programs should intensify AMS training, promote communication and cooperation between the AMS team and doctors, adjust the compensation system to facilitate better AMS implementation, and offer supportive measures that enable the adoption of strict regulations
Urgent request for pretomanid label expansion to align with WHO guidelines and improve treatment accessibility and efficacy.
Get PDFPretomanid is a key anti-TB drug included in the WHO list of essential medications. The current EMA-approved label for pretomanid restricts its use to the regimen comprising bedaquiline, pretomanid and linezolid (BPaL) and only for extensively drug-resistant-TB or multidrug-resistant TB, "when antibiotics used for the latter form of TB do not work or cause unacceptable side effects." This restricted use implies that the older, prolonged and poorly tolerated regimens remain the recommended treatment for most cases of drug-resistant TB. The authors, representing many respiratory groups and societies, call for the label expansion of pretomanid to align with global guidelines, allowing for broader use
Characteristics of snakebite patients due to Naja samarensis in the Philippines: a prospective hospital-based study.
Get PDFBACKGROUND: Little is known about snakebites by Naja samarensis, a species unique to the Philippines. The aim here is to describe the clinical and epidemiological characteristics of patients bitten by this medically important cobra in the Eastern Visayas. METHODS: A hospital-based prospective study analysed the features of snakebite patients attending Eastern Visayas Medical Center between June 2022 and May 2023. Logistic regression analysis identified the factors associated with severity. RESULTS: A total of 175 snakebite patients with five fatalities were included. Naja samarensis was most commonly implicated (n=49, 28.0%), although it could be definitively identified, by examining photographs of the snake responsible, in only four cases. The N. samarensis bites occurred in grass or rice fields, in daytime, and during farming activities, but the people bitten were most frequently students (34.7%) who were bitten at home (36.7%). Patients bitten by N. samarensis often presented with cytotoxic (63.3%) and neurotoxic signs (46.9%). Traditional remedies were common, resulting in delayed presentation to the hospital. Bites by N. samarensis, and older age (>44 y) were independently associated with severity (adjusted OR of 10.33 and 7.89, respectively). CONCLUSION: Naja samarensis is a major cause of severe snakebites in this region. Pre-hospital treatment frequently involves wasted time and unproven traditional methods. Enhancement of public awareness is urgently needed. Development of a diagnostic test for species identification is warranted to improve future surveys and management
Core Outcome Set development for LEPtospirosis trials (COS-LEP): a study protocol to develop a core outcome set for the evaluation of clinical therapeutic interventions for human leptospirosis.
Get PDFBACKGROUND: Leptospirosis is a zoonotic bacterial infection occurring worldwide. It is of particular public health concern due to its global distribution, epidemic potential and high mortality without appropriate treatment. The method for the management of leptospirosis, particularly in severe disease, is clouded by methodological inconsistency and a lack of standardized outcome measures. The study this protocol details aims to develop a core outcome set (COS) for leptospirosis research. A COS is a set of outcomes with international consensus as a minimum for reporting in future studies focusing on leptospirosis. Establishing a COS will contribute to harmonizing Leptospirosis treatment research and will be instrumental in constructing a high-quality evidence base to feed into a planned future rigorous international clinical trial on leptospirosis. METHODS: The COS-LEP study will employ a COS development methodology standardized by the COMET initiative framework. This includes (1) a systematic review of available quantitative and qualitative literature reporting therapeutic response and safety outcomes and measures; (2) focused interviews with healthcare professional and people treated for leptospirosis exploring outcomes of interests using qualitative methodology; (3) narrowing the choice of outcomes by international consensus using a Delphi survey process; and (4) undertaking a hybrid consensus meeting with key stakeholders to build the final COS. DISCUSSION: This protocol describes the method to develop the first core outcome set for use in human leptospirosis studies. This will not only be a key feature in the design of a future definitive randomized controlled trial, but also provide a structure for clinicians and researchers collecting treatment cohort data in the various settings where leptospirosis is a public health issue
Rapid climate action is needed: comparing heat vs. COVID-19-related mortality.
Get PDFThe impacts of climate change on human health are often underestimated or perceived to be in a distant future. Here, we present the projected impacts of climate change in the context of COVID-19, a recent human health catastrophe. We compared projected heat mortality with COVID-19 deaths in 38 cities worldwide and found that in half of these cities, heat-related deaths could exceed annual COVID-19 deaths in less than ten years (at + 3.0 °C increase in global warming relative to preindustrial). In seven of these cities, heat mortality could exceed COVID-19 deaths in less than five years. Our results underscore the crucial need for climate action and for the integration of climate change into public health discourse and policy
Association of female genital schistosomiasis and human papillomavirus and cervical pre-cancer: a systematic review.
Get PDFBACKGROUND: S. haematobium is a recognized carcinogen and is associated with squamous cell carcinoma of the bladder. Its association with high-risk(HR) human papillomavirus (HPV) persistence, cervical pre-cancer and cervical cancer incidence has not been fully explored. METHODS: We searched OvidSP MEDLINE, OvidSP Embase, Global Index Medicus, PubMed and the Wiley Cochrane library without date or language restrictions up to April 20, 2024 for abstracts evaluating the association of female genital schistosomiasis (FGS) with the prevalence, incidence or persistence of cervical HR-HPV, and incidence of histology-verified cervical pre-cancer or cancer. Cervical pre-cancer defined using cervical cytology or visual inspection with acetic acid (VIA) was also considered, but as lower quality evidence. We assessed the risk of bias of included studies using a modified Newcastle Ottawa scale. This study is registered on PROSPERO: CRD42023389301. RESULTS: We identified 1,170 publications and six studies were eligible for inclusion. Five studies were cross sectional and 1 was prospective. The studies describe 1081 women living in sub-Saharan Africa. One study from Zimbabwe reported an increased risk of HR-HPV prevalence at baseline in women with composite-FGS compared to women without FGS (aOR 1.9, 95% CI 1.1 - 3.6, p = 0.03), however no association was seen after 5 years of follow-up. Another study from KwaZulu-Natal reported an increased odds of any HPV prevalence among women with visual-FGS compared to women without FGS (aOR 1.71 [1.14 - 2.56], p = 0.01). However, a study in Madagascar did not show increased odds of any HPV among women with visual-FGS compared to women without FGS (OR 1.0 [0.82 - 1.2). Of 4 studies evaluating the association of FGS and cervical pre-cancer, one reported an increased risk of VIA abnormalities in women with molecular-FGS compared to those without (aOR 6.08, 95% CI 1.58 - 23.37). Three studies did not report an association between FGS and cervical pre-cancer (cytology defined (n = 2) and histology defined (n = 1)). CONCLUSION: There are limited and low quality data on the risk of HR-HPV infection and cervical pre-cancer and cancer among women with FGS. Given limited data, it was not possible to confirm or exclude an association between FGS and HPV, cervical pre-cancer, and cervical cancer and additional research is needed
Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture-recapture analysis.
Get PDFBACKGROUND: Accurate mortality estimates help quantify and memorialise the impact of war. We used multiple data sources to estimate deaths due to traumatic injury in the Gaza Strip between Oct 7, 2023, and June 30, 2024. METHODS: We used a three-list capture-recapture analysis using data from Palestinian Ministry of Health (MoH) hospital lists, an MoH online survey, and social media obituaries. After imputing missing values, we fitted alternative generalised linear models to the three lists' overlap structure, with each model representing different possible dependencies among lists and including covariates predictive of the probability of being listed; we averaged the models to estimate the true number of deaths in the analysis period (Oct 7, 2023, to June 30, 2024). Resulting annualised age-specific and sex-specific mortality rates were compared with mortality in 2022. FINDINGS: We estimated 64 260 deaths (95% CI 55 298-78 525) due to traumatic injury during the study period, suggesting the Palestinian MoH under-reported mortality by 41%. The annualised crude death rate was 39·3 per 1000 people (95% CI 35·7-49·4), representing a rate ratio of 14·0 (95% CI 12·8-17·6) compared with all-cause mortality in 2022, even when ignoring non-injury excess mortality. Women, children (aged <18 years), and older people (aged ≥65 years) accounted for 16 699 (59·1%) of the 28 257 deaths for which age and sex data were available. INTERPRETATION: Our findings show an exceptionally high mortality rate in the Gaza Strip during the period studied. These results underscore the urgent need for interventions to prevent further loss of life and illuminate important patterns in the conduct of the war. FUNDING: None
A Novel Approach to Assessing the Potential of Electronic Decision Support Systems to Improve the Quality of Antenatal Care in Nepal.
Get PDFINTRODUCTION: Electronic decision-support systems (EDSSs) aim to improve the quality of antenatal care (ANC) through adherence to evidence-based guidelines. We assessed the potential of the mHealth integrated model of hypertension, diabetes, and ANC EDSS and the World Health Organization EDSS to improve the quality of ANC in primary-level health care facilities in Nepal. METHODS: From December 2021 to January 2023, we conducted a mixed-methods evaluation in 19 primary-level ANC facilities in Bagmati Province, Nepal. Implementation was from March 2022 to August 2022. We conducted a health facility survey, ANC clinical observations, longitudinal case studies and validation workshop, in-depth interviews, monitoring visits, research team debriefing meetings, health care provider attitude survey, and stakeholder engagement and feedback meetings. Results were integrated using concurrent triangulation to develop explanations about the EDSS implementation process and the effects observed. RESULTS: We identified 9 themes on implementation challenges that hindered the EDSS from generating the desired improvements to ANC quality. Facility readiness and provider confidence in using the EDSS were mixed. It was not always used or used as intended, and the approach to ANC provision did not change. EDSS inflexibility did not reflect how staff made decisions about pregnant women's needs or ensure that tests were done at the right time. There was mixed evidence that ANC staff believed that the EDSS benefited their work. The EDSS did not become fully integrated into existing health systems. Engagement of essential stakeholders fell short. CONCLUSION: Different understandings of and inconsistent use of the EDSS highlighted the need for increased training and support periods, greater stakeholder engagement, and further integration into existing health systems. Our novel approach to integrating findings from multiple substudies offers uniquely valuable insights into the many factors needed for the successful implementation of an EDSS to improve the quality of ANC in Nepal