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Cognitive impairment in Chagas disease patients in Brazil, 2007-2021: A cross-sectional study.
Get PDFINTRODUCTION: Chagas Disease (CD) is frequently associated with heart failure (HF). Cognitive impairment is reported, but whether it results from CD or is a nonspecific symptom of HF is unknown. We aimed to compare cognitive function of HF patients with or without CD. METHODS: Multicenter cross-sectional study of HF patients. Investigators blinded to the etiology of HF evaluated global cognition and domains of memory, executive and visuospatial function. Logistic regression tested the association between CD and cognitive impairment (Z-score < -1.5) in each domain adjusted for age, sex, educational level and left ventricular ejection fraction. RESULTS: We recruited 518 patients, 250 (48.3%) with CD. Cognitive impairment was more common in CD vs. non-CD patients (27.1% vs 13.1%, p < 0.001), mostly in memory (10.4% vs 5.0%, p = 0.022) and visuospatial function (45.2% vs 29.6%, p < 0.001). In the multivariable analysis, CD remained associated with global cognitive impairment (odds ratio 1.90; 95% CI 1.13-3.21, p = 0.016) and visuospatial function impairment (OR 1.56; 95% CI 1.02-2.39, p = 0.039). DISCUSSION: Chagas disease is associated with cognitive impairment independently of heart failure severity, suggesting other competing mechanisms
Medical Students' Perceptions of an Assessment Program in the New Doctor of Medicine Curriculum.
Get PDFPURPOSE: We evaluated the perspectives of medical students on the roles of formative assessments (FAs) and their impact on academic performance, with the goal of identifying areas for improvement. METHODS: This cross-sectional study assessed the perspectives of students related to congruence, authenticity, consultation, transparency, and accommodation. Additionally, it explored students' preferences for FA, the usefulness of FA, and students' views and ideas on the effects of summative assessments (SAs) on their learning. A survey consisting of 36 items was distributed to medical students in their second and third years of medical school. RESULTS: Most of the 40 participating students had a positive attitude toward their perceptions of FA, ranging from 78.13% to 93.33%. In addition, the students expressed that FA was beneficial to their academic experience. There were varying viewpoints on the level of stress caused by FA and which specific aspects of FA could be enhanced. CONCLUSIONS: FAs were feasible and beneficial. Most students viewed FAs favorably because they promoted learning experiences and achievements, and helped identify support needs for SAs, despite some concerns about them being time-consuming and stressful. The use of SAs facilitated better study strategies. However, potential improvements to FAs regarding the feedback process, assessment schedules, and alignment with teaching objectives were suggested to increase their usefulness
Disparities in inpatient treatment and expenditures among lung cancer patients under tiered social health insurance: a population-based study in China.
Get PDFINTRODUCTION: Tiered social health insurance (SHI) schemes exist in many countries and may lead to significant disparities of healthcare and financial protection. The degree of cancer care inequalities under tiered SHI in China and other low- and middle-income countries (LMICs) remain poorly understood. METHODS: We obtained hospital discharged summary for 319,677 patients diagnosed with lung cancer between 2017 and 2021 in Shandong, China, and established propensity score-matched samples under the Urban and Rural Resident Basic Medical Insurance (URRBMI) and those under the Urban Employee Basic Medical Insurance (UEBMI). We ran multivariable regressions to assess the effects of SHI schemes on cancer treatment and expenditures. Subgroup analyses of cancer treatment were conducted based on whether the cancer had metastasized. RESULTS: In the matched samples, utilization of inpatient cancer care increased under both schemes from 2017 to 2021. Higher proportions of inpatient cancer care utilization were seen in those under UEBMI compared those under URRBMI, consistently with statistical significance. UEBMI was associated with a higher probability of receiving surgery in patients without metastasis, and higher probabilities of receiving radiotherapy or chemotherapy, targeted therapy, and immunotherapy in patients with metastasis. Patients under UEBMI were also less likely to be discharged against medical advice than those under URRBMI. Furthermore, UEBMI beneficiaries had 13.3% higher total expenditures but 19.1% lower out-of-pocket expenditures. CONCLUSIONS: Significant gaps remained in access to inpatient treatment and financial protection for lung cancer, particularly in surgery for non-metastatic cancer. Targeted harmonization of benefit packages is needed to address pressing disparities in cancer care in LMICs with tiered SHI. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12939-025-02533-z
Exposure to high levels of perfluoroalkyl substances through drinking water and risk of cardiovascular morbidity and mortality in a Swedish register-based study.
Get PDFINTRODUCTION: Epidemiological studies focusing on the association of exposure to perfluoroalkyl substances (PFAS) with cardiovascular disease (CVD) morbidity and mortality are limited, with inconsistent findings. OBJECTIVES: This register-based study aimed to investigate the associations between exposure to PFAS and the risk of CVD morbidity and mortality in a Swedish population exposed to PFAS, dominated by perfluorohexane sulfonic acid (PFHxS) and perfluorooctane sulfonic acid (PFOS), through drinking water for decades. METHODS: The study included 46,553 individuals aged ≥30 who lived in Ronneby (1985-2013). Individual exposure status was evaluated based on yearly residential address and categorized into 'ever-high' and 'never-high'. Incident CVD morbidity (acute myocardial infarction [AMI], ischemic [IS] and hemorrhagic stroke [HS]), and CVD mortality were retrieved from national registries. Cox proportional hazards models estimated hazard ratios (HR). Further stratified analyses were performed by calendar year, sex and age (75 years). RESULTS: Elevated risks were found for AMI (HR 1.10, 95 % confidence interval 1.01-1.19), IS (1.10, 1.00-1.22), HS (1.28, 1.03-1.59), and CVD mortality (1.15, 1.08-1.23) among individuals who had lived in the area with PFAS contaminated drinking water. Females showed higher risks for AMI and CVD mortality, while the risk of HS was higher among men. Stronger associations between PFAS and AMI and HS were observed in the age group 50-75 years. For PFAS-related CVD mortality, the point estimates increased with age though no significant interaction was observed. CONCLUSION: Our study suggests an association between high-level PFAS exposure and elevated risk of CVD morbidity and mortality
Towards Malaria Elimination: A Nationwide Case-Control Study to Assess Risk Factors for Severe Malaria-Related Deaths in Brazil.
Get PDFOBJECTIVE: The objective of this study is to describe malaria-related deaths and assess their risk factors. METHODS: This is a case-control study using data from Brazil's Ministry of Health (2011-2020) on malaria-related deaths (ICD-10: B50-B54). A probabilistic record linkage was performed to match epidemiological data (Sivep-Malaria and Sinan) with death records from the Mortality Information System (SIM). Cases were defined as individuals who died of malaria, and controls were malaria cases that did not result in death. Logistic regression models were used to identify the factors associated with malaria mortality. RESULTS: A total of 632 malaria-related deaths were recorded, with 454 (71.8%) occurring in the Amazon region and 178 (28.1%) outside it. Risk factors in the Amazon included age ( 60 years; p ≤ 0.01), delayed treatment (> 48 h; p < 0.001), illiteracy (p = 0.01), and living in indigenous population villages (p < 0.001), while active case detection was protective (p = 0.01). In the Extra-Amazon, risk factors included delayed treatment (p = 0.049), P. falciparum or mixed infections (p < 0.049), foreign-acquired infections (p = 0.01), and higher education level (p = 0.03)-which is a proxy for increased income and travel frequency, which may increase the likelihood of exposure in endemic areas and delayed diagnosis upon return. CONCLUSION: This nationwide record-linkage study shows that malaria deaths remain concentrated in socially vulnerable groups: infants, older adults, and especially indigenous populations living in the Amazon. Delayed treatment is also a determinant for deaths, in both endemic and non-endemic regions, while active case detection markedly reduces the odds of death. To reach Brazil's zero-malaria-death target by 2030, it is needed to improve timely diagnosis and treatment, to enhance epidemiological information systems along with active surveillance amplification in remote communities. Finally, integrating national health-information systems allows real-time monitoring, and with coordinated action, eliminating malaria deaths remains achievable
What are 'dark kitchens'? A consensus definition from public, local authority, business and academic stakeholders in the United Kingdom
Get PDFBACKGROUND: 'Dark kitchens' are an innovative and potentially disruptive addition to the global food environment with potential implications for policy, practice and public health. In the UK, dark kitchens currently represent approximately 15% of all food retailers across the three major online food delivery platforms in England (e.g. Just Eat, Deliveroo, Uber Eats), contributing significantly to the digital food environment. To date, dark kitchens have been poorly defined, under-researched and their wider impact poorly understood.
AIM: Therefore, the aim of this work was to coproduce a consensus definition of dark kitchens to be used across multiple disciplines.
METHODS: A series of consultations took place with stakeholders including consumers, local authority representatives, academics, dark kitchen employees, and national governing bodies to understand knowledge and currently used definitions of dark kitchens. Mixed-method approaches were used involving questionnaires, interviews, focus groups, and workshops.
RESULTS: The stakeholder consultation process provided a robust methodology through which a consensus definition of dark kitchens was agreed. Each project group provided a definition which was scribed and annotated to understand the key components of importance within the definitions, while additional and unique components were discussed and debated by the expert working group before being accepted or rejected. In addition, short- and long-term benefits of such a definition were outlined for all stakeholder groups. Following peer-review from local authority, industry and governing body stakeholders, a final definition was produced.
CONCLUSION: The adoption of a consensus definition of dark kitchens is pivotal to the cross-sectoral work and understanding of many stakeholder groups. The definition allows for transparency and improved communication between dark kitchen stakeholders and provides the opportunity to drive public health agendas at multiple points within the food system
Intestinal Mucosal Immune Responses to Novel Oral Poliovirus Vaccine Type 2 in Healthy Newborns.
Get PDFBACKGROUND: Approximately 1.5 billion doses of novel oral polio vaccine type 2 (nOPV2) have been administered in response to circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks since 2021. Although infants are eligible to receive the vaccine from birth, the induction of intestinal mucosal immunity by nOPV2 in newborns has not been directly evaluated. METHODS: In a randomized, placebo-controlled, phase 2 clinical trial in Bangladesh (2020-2021), 215 healthy newborns received 2 doses of either nOPV2 (n = 110) or placebo (sucrose; n = 105), at birth (0-3 days) and 4 weeks later. Intestinal mucosal antibody responses were assessed by measuring poliovirus type 2 (PV2)-specific neutralizing activity and immunoglobulin (Ig)A levels in stool collected biweekly from birth to 8-weeks. RESULTS: Newborns vaccinated with 2 doses of nOPV2 had strong intestinal mucosal antibody responses that differed significantly from the placebo group (P < .0001 for PV2-specific neutralization from 2 weeks onward and P ≤ .007 for PV2-specific IgA from 4 weeks onward). Positive PV2-specific neutralization in stool (titers ≥16) was detected in 51.8% (57/110) of nOPV2-vaccinated newborns at 4 weeks and 90.0% (99/110) at 8 weeks (4 weeks after the second dose). Notably, PV2-specific antibody titers following the second dose were very similar for newborns who did and did not have first dose responses (P = .67 for neutralization and P = .38 for IgA at 8 weeks). CONCLUSIONS: Vaccination with 2 doses of nOPV2 in neonates induced strong intestinal mucosal antibody responses. In cVDPV2 outbreak settings, neonatal administration of nOPV2 may be a strategy to enhance population-level intestinal mucosal immunity
Global, regional and national burden of chikungunya: force of infection mapping and spatial modelling study.
Get PDFINTRODUCTION: Chikungunya virus, an arbovirus transmitted by Aedes mosquitoes, causes epidemics in tropical regions with potential risk in higher latitudes. Our aim is to estimate the global, regional and national burden of chikungunya across affected and environmentally suitable at-risk regions. METHODS: We used a random forest model to predict force of infection and estimate chikungunya burden at high spatial resolution (5×5 km) using covariates from climatic, socioeconomic and ecological domains. We used a focal scenario to estimate the observed burden (lower bound) and an at-risk scenario to estimate the potential burden (upper bound) of chikungunya transmission. RESULTS: We predicted global long-term average annual force of infection at 0.012 (95% UI: 0.007 to 0.019) for focal scenario and 0.013 (95% UI: 0.005 to 0.03) for at-risk scenario in 103 countries. We estimated global chikungunya burden annually of 14.4 million (95% UI: 11.0 to 17.8 million) infections and 0.96 million (95% UI: 0.56 to 1.6 million) disability-adjusted life years (DALYs) in the focal scenario, and 34.9 million infections (95% UI: 26.7 to 43.1 million) and 2.3 million DALYs (95% UI: 1.4 to 3.8 million) in the at-risk scenario for 2020. The chronic phase accounts for 54% of chikungunya burden, with relatively higher burden among 40-60-year-old population, with mortality disproportionately affecting children under 10 and adults over 80. CONCLUSION: While chikungunya transmission has high geographical uncertainty, high force of infection is not limited to tropical regions and is distributed across all continents. Our estimates of chikungunya burden are useful for prioritisation of regions and target age groups for chikungunya vaccine introduction
The public health impact of making chloramphenicol an over-the-counter antibiotic: a systematic literature review
Get PDFPURPOSE: Chloramphenicol is an over-the-counter ocular antibiotic in some countries (for example Australia since 2010 and the United Kingdom since 2005), but concerns regarding resistance and adverse effects have prevented other countries from doing the same. Therefore, this systematic review was conducted to answer the question of whether chloramphenicol is a safe and effective topical antibiotic for treating ocular infections, and whether it should be reclassified as an over-the-counter medication.
METHODS: A search of the Medline and Embase databases was conducted to identify articles concerning the effectiveness of chloramphenicol in treating ocular infections, bacterial susceptibility towards chloramphenicol, the risk of adverse effects, and the results of reclassifying chloramphenicol as an over-the-counter antibiotic in the past. A total of 131 articles were evaluated for this systematic review.
RESULTS: The literature did not support any concerns regarding side effects such as aplastic anaemia. Chloramphenicol was comparable in efficacy to other antibiotics in treating ocular infections, and resistance has remained low over the past decade, save for bacterial species with known intrinsic resistance such as Pseudomonas aeruginosa. Chloramphenicol use increased in the first few years following reclassification as an over-the-counter medication, but eventually plateaued.
CONCLUSION: Chloramphenicol is a safe and effective topical antibiotic for treating ocular infections, and there is minimal concern of adverse effects such as aplastic anaemia resulting from topical use. Nonetheless, multiple clinical and socioeconomic factors should be factored in when considering reclassification, and contextual factors such as population density, eye care accessibility and health-seeking behaviours may influence the decision
HIV and Cardiovascular Disease Burden in Young Adults (18-25 years): A Review of Current Evidence
Get PDFPURPOSE OF REVIEW: This review synthesises current evidence on the cardiovascular disease (CVD) burden among young people living with HIV. It explores myocardial and vascular pathology, evaluates the role of advanced imaging, and highlights critical gaps in understanding the mechanisms driving HIV-associated CVD in this population.
RECENT FINDINGS: Emerging data suggest that HIV-associated CVD in youth may be predominantly driven by non-atherosclerotic mechanisms, including direct myocardial injury, fibrosis, and remodelling, rather than traditional coronary atherosclerosis. Imaging studies have revealed subclinical myocardial changes such as increased left ventricular mass and reduced strain. Vascular studies show inconsistent findings. However, longitudinal data and multimodal imaging approaches remain scarce, particularly in high-burden regions like Africa.
SUMMARY: Young adults with HIV face a significant burden of cardiovascular pathology, often subclinical and poorly understood. The prevailing paradigm focused on atherosclerosis may not fully apply to this group, especially in African settings. There is an urgent need for longitudinal, mechanistic research to inform tailored clinical strategies and policy interventions aimed at reducing long-term cardiovascular morbidity in young people with HIV