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Characteristics and outcomes of men presenting with complications of metastatic prostate cancer.
Get PDFOBJECTIVES: To describe the incidence, characteristics and mortality of men who present with complications of metastatic prostate cancer, a previously under-reported population. We investigate men who present with and without malignant ureteric obstruction (MUO) and skeletal-related events (SREs), collectively termed 'metastatic-related events' (MREs). PATIENTS AND METHODS: We used the English Cancer Registry linked to hospital administrative data to identify men diagnosed with metastatic prostate cancer between January 2015 and December 2022. Poisson regression models estimated adjusted relative risks (aRRs) of presenting with MREs. The cumulative incidences of overall and prostate cancer-specific death were estimated for each MRE subgroup (metastatic without MRE, MUO, SRE, and MUO and SRE in combination). RESULTS: Of 48 171 men diagnosed with primary metastatic disease, 4272 (8.9%) presented with MREs. Of these men, 2453 (57.4%) had MUO, 1738 (40.7%) had a SRE, and 81 (1.9%) had both. Men aged ≥80 years had the highest risk (9.8% [1604/16452]) of presenting with MREs. Men aged 70-79 years (8.0% [1470/18397]) (aRR 0.82, 95% confidence interval [CI] 0.77-0.88) and men aged 60-69 years (8.9% [916/10297]) (aRR 0.91, 95%CI 0.84-0.98) had lower risks. Men from the most deprived neighbourhoods (9.3% [706/7609]) (aRR 1.27, 95% CI 1.15-1.40) had greater risks of presenting with MREs than those from the least deprived neighbourhoods (8.0% [868/10865]). The proportion of men presenting with MREs varied across geographical regions, ranging from 4.6% (288/6233) to 11.7% (461/3951). The 5-year overall mortality for men presenting without MREs was 57.8% (95% CI 57.2-58.4%), compared to 77.1% (95% CI 74.9-79.2%) with MUO, 66.8% (95% CI 64.1-69.4%) with a SRE and 84.4% (95% CI 74.1-94.7%) with both. CONCLUSIONS: The risk of presenting with metastatic prostate cancer and MREs varies according to age, socioeconomic deprivation, and residential region. These men have poorer survival outcomes than men diagnosed without MREs at diagnosis
Consensus for integrating the point-of-care Genital Inflammation Test (GIFT) into sexually transmitted infection management guidelines: results from a two-round modified Delphi survey.
No full textBACKGROUND: Sexually transmitted infections (STIs) and bacterial vaginosis (BV) are frequently asymptomatic in women, causing genital inflammation and increasing transmission and acquisition of HIV. The Genital Inflammation Test (GIFT) is a novel, point-of-care (POC) device under development for detecting genital inflammation in women. We aimed to obtain consensus to inform the integration of GIFT into STI management guidelines. METHODS: We employed a Delphi technique through two rounds of online surveys. Respondents included service providers, health programmers, researchers and policy makers. Round one questions generated ideas, and round two built consensus on strategies from round one. Survey sections included participant demographics and test implementation, integration into current guidelines and purpose. The round two survey employed a five-point Likert scale from strongly agree to strongly disagree. Consensus was reached if ≥70% of participants selected strongly agreed or agreed. RESULTS: We received 28 responses in the first round and 68 in the second. In both rounds, participants were healthcare providers (41%) or researchers (26%), residing in Africa (57%), Europe (21%) and America (10%). Most participants agreed that GIFT should be used as a screening tool to be followed by confirmatory STI testing before treatment: 75% (round 1), 69% (round 2). There was consensus that populations that would benefit most from GIFT would be young asymptomatic women (16-24 years) in high HIV prevalence settings and high-risk women of any age, such as female sex workers and those with multiple partners. Attributes of GIFT ranked as most important included ease-of-use, stability at room temperature and high diagnostic accuracy. Barriers were test stock-outs, complexity of use and high cost. CONCLUSION: While Delphi consensus was for GIFT as a POC screening tool, factors such as supply chain, storage and stakeholder engagement are crucial for its integration into STI management guidelines
Resilience and residuals beyond containment — The hidden burden of Bundibugyo Ebola virus survivorship sixteen years on: A cross-sectional observational study
Get PDFBackground:
Long-term effects of Ebola disease (EBOD) are well documented for Ebolavirus (EBOV), but limited data exist for Bundibugyo virus disease (BVD) caused by Bundibugyo Ebola virus (BDBV), a genetically distinct strain.
Methods:
We conducted a cross-sectional observational study involving 40 laboratory-confirmed BVD survivors and 23 age- and sex-matched unexposed community controls to evaluate the long-term clinical, biochemical, immunological, and psychosocial sequelae associated with BDBV infection. Participants underwent comprehensive clinical evaluations, laboratory testing, and standardised mental health assessments. Statistical comparisons used rank-sum, chi-squared, and correlation analyses.
Findings:
Survivors exhibited persistent multisystem symptoms, with neurological and musculoskeletal complaints most frequent, headaches (35 %) and visual disturbances (22.5 %). Laboratory findings showed elevated basophils (40 %) and urinary ketones (5 %), indicating possible chronic inflammation and metabolic shifts. Respiratory rates were significantly reduced in survivors (p < 0.001), while other vital signs and biochemical markers were largely within normal ranges. Despite high resilience, 70 % with normal anxiety scores and 62.5 % with normal depression scores, 57.5 % reported persistent stigma. Survivors also exhibited unique physiological correlations, suggestive of post-infectious homeostatic changes.
Conclusion:
BVD survivors experience long-term multisystem sequelae and physiological remodeling. These findings support the need for virus-specific post-BVD care and sustained follow-up to inform survivor health policy
Rapid weight gain in first 2 years of life and BMI trajectories from 3 to <10 years: a population-based longitudinal study of 1.7 million Brazilian children.
Get PDFBACKGROUND: Obesity is considered a disease with negative health impacts at all life stages. Changes in growth patterns, such as postnatal rapid weight gain (RWG), can be important predictors of growth trajectories in children. We investigated the association between RWG during the first two years of life and subsequent BMI trajectories from the age 3-to 9 years, and whether the association differed by birth weight group.
METHODS: We used the data of a population-based cohort from the Cadastro Único (CadÚnico) of the Federal Government, the linkage of the National Live Births System (SINASC) and the National Food and Nutritional Surveillance System (SISVAN). The sample comprised 1.7 million Brazilian children aged from zero to nine years from 2008 to 2017. Mixed-effects models were used to estimate mean age-trajectories for BMI by RWG group.
FINDINGS: Children who experienced RWG during the first two years of life had higher mean BMI trajectories from 3 to 9 years, compared to those who did not. The difference was seen across all birth weight groups, and was more evident for the children with high birth weight. At age 9, the BMI difference between RWG and non-RWG children was 1.31 kg/m2 (boys) and 1.43 kg/m2 (girls) for children with adequate birth weight, 1.27 kg/m2 (boys) and 1.35 kg/m2 (girls) for low birth weight, and 2.25 kg/m2 (boys) and 2.86 kg/m2 (girls) for macrosomia.
INTERPRETATION: Children who experienced RWG during the first two years of life had higher BMI trajectories than children who did not. The finding highlighted the importance of monitoring child growth, which allows the early identification of potential growth deviations and the implementation of necessary interventions to ensure that children grow healthy and reach their full developmental potential.
FUNDING: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-CAPES, CAPES/Print/UFBA; University College London (UCL); National Institute for Health Research (NIHR) Great Ormond Street Hospital Biomedical Research Centre; Fundação de Amparo à Pesquisa do Estado de Minas Gerais-FAPEMIG; National Council for Scientific and Technological Development-CNPq; CNPq/CGFP/DECIT/SECTICS; Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Complexo da Saúde do Ministério da Saúde; Wellcome Trust
Acceptability of COVID-19 self-testing among social and clinical vulnerable populations using a decentralized testing model in Abuja, Nigeria; A mixed methods analysis of an implementation study.
Get PDFDiagnostic testing is critical during infectious disease outbreaks, enabling timely patient management and isolation to reduce transmission and mortality. During the COVID-19 outbreak in Nigeria, testing rates remained low due to limited access to centralized RT-PCR sites. To expand access, the National COVID-19 Testing Strategy (January 2021) introduced decentralized self-testing models targeting vulnerable populations. This study assessed the uptake of decentralized COVID-19 testing and the acceptability of self-testing among socially and clinically vulnerable populations in Abuja, Nigeria. A mixed-methods study was conducted across four primary health centres (PHC), four community pharmacies (CP), and four patent medicine stores (PMS) between October 2022 and May 2023. Symptomatic individuals received provider-delivered testing at PHC or provider-delivered/self-testing at CP and PMS using antigen rapid diagnostic tests (Ag-RDT). Social vulnerability was defined by low education, illiteracy, or low wealth; clinical vulnerability by age ≥ 50, unvaccinated status, or comorbidities. Testing uptake and acceptability were analyzed using logistic regression, while in-depth interviews (IDI) explored preferences for testing sites and methods. Of 1,586 individuals screened, 1,368 were eligible and 1,322 (96.6%) accepted testing. Most tests occurred at PHC (53.5%), followed by PMS (25.9%) and CP (20.7%). Social vulnerability was higher among PMS users than PHC users (OR = 1.37; 95% CI 1.05-1.77), while clinical vulnerability was lower at CP (OR = 0.24; 95% CI 0.16-0.35) and PMS (OR = 0.28; 95% CI 0.19-0.39) compared to PHC. Self-testing acceptability was high (93.4% at CP; 92.1% at PMS). Outcome of IDI highlighted trust in CP/PMS providers, proximity, convenience, and affordability as key drivers of testing uptake, with self-testing widely preferred across vulnerability groups. Decentralized testing through CP and PMS reached more socially vulnerable individuals and demonstrated high self-testing acceptability. Leveraging these outlets in outbreak responses could enhance equitable access to diagnostic testing in future pandemics
Comparing student teachers’ attributions of success or failure of educational interactions involving pupils on the autism spectrum in England, Finland and Sweden
Get PDFThe prevalence of autism is rising. Inclusive education is promoted in England, Finland and Sweden, which means that many pupils on the autism spectrum are taught in the regular classroom. Student teachers’ attributions of success or failure of educational interactions with pupils were sought. Data were collected from student teachers in England (n = 191), Finland (n = 251) and Sweden (n = 262), using the method of empathy stories, in which the students produced imaginary texts based on short frame stories. Drawing on attribution theory, a qualitative deductive analysis was conducted. Causes related to teacher actions and child skills or behaviours were perceived to be the primary causes of success or failure. A key cross-national difference is that the Swedish and English student teachers attributed the causes to teacher actions and child skills in a binary manner, whilst the Finnish student teacher attributions were more diverse. Additionally, the Finnish student teachers wrote longer stories with more detailed descriptions, indicating a more complex understanding of educational interactions with pupils on the autism spectrum
The burden of malaria-attributable maternal anaemia and the impact of preventive treatment across sub-Saharan Africa
Get PDFAbstract
Malaria in pregnancy is a major but poorly quantified contributor to maternal anaemia in sub-Saharan Africa. We combined individual-level data on haemoglobin (Hb), gravidity, gestational age and PCR-confirmed
Plasmodium falciparum
infection from 12,608 pregnancies in 7 African countries with a gravidity-specific model of malaria exposure and immunity linked to contemporary maps of transmission and fertility. For 2023, we estimate that 13.1 million pregnancies in malaria-endemic African regions were exposed to
P. falciparum
. In the absence of preventive measures, this exposure would have resulted in 2.41 million (95% credible interval 1.98–3.04 million) cases of moderate or severe anaemia (Hb < 9 g dl
−1
), including 600,000 (408,000–906,000) severe cases (Hb < 7 g dl
−1
). A counterfactual scenario using 2,000 transmission levels suggests that a 32% reduction in exposure during pregnancy translated into only a 22% decline in intrinsic anaemia burden, reflecting a shift from a concentration of risk in primigravidae to a more even distribution across gravidities as multigravid women acquire less pregnancy-specific immunity. Calibrating our model to randomized trials, we estimate that under current coverage, intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine averted around 1.10 million (0.72–1.61 million) cases of moderate or severe anaemia and 330,000 (225,000–523,000) severe cases in 2023. These findings show that although burden has declined substantially, malaria remains a major driver of maternal anaemia risk. Meanwhile, lower immunity across multigravidae means any interruption to intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine, or other population-based malaria control efforts, risks rapid resurgence of severe maternal anaemia, with substantial consequences for maternal and neonatal health
The epidemiological effect and cost-effectiveness of expanded age eligibility for recombinant zoster vaccination in England.
Get PDFINTRODUCTION: Since September 2023, England's national immunisation programme has offered the recombinant zoster vaccine (RZV) to adults aged 65-79 as a preventative measure against shingles (herpes zoster) and its complications. However, adults aged 80 and over are currently not eligible for the vaccine. We aimed to evaluate the feasibility and cost-effectiveness of providing RZV to adults aged 80 and older in England. METHODS: This cost-utility analysis employs a static cohort model considering herpes zoster (HZ) cases and severe cases leading to post-herpetic neuralgia, HZ-related hospitalisation, and deaths from the perspective of the National Health Service. The long-term impacts of RZV are assessed using the model, accounting for changing population demographics and the previously-offered live zoster vaccine (ZVL). We consider different eligibility scenarios for RZV focusing on the older population (80+ years old) and provide comparisons to the pre-2023 programme. RESULTS: Expanding the current programme to offer a single dose of RZV to people aged 80 and up is likely to be cost-effective relative to the current programme. Offering two doses to this group would be less cost-effective but would offer greater protection against HZ. For preventing health-related quality of life loss, it is most efficient to vaccinate 60-69-year-olds, but for averting hospitalisation costs, it is most efficient to vaccinate 80-89-year-olds. CONCLUSION: Providing one or two doses of RZV for older adults can be cost-effective and would reduce the healthcare burden of shingles
ECG changes and their utility in adult Vietnamese patients with non-severe dengue
Get PDFBackground: Dengue may affect the heart, manifesting as asymptomatic electrocardiographic (ECG) abnormalities to fulminant myocarditis. The role of routine ECG monitoring in dengue management remains unclear. We, therefore, studied ECG changes in patients with non-severe dengue.
Methods: In this observational study, we performed and interpreted 12-lead ECGs (admission, discharge and follow up) on hospitalised Vietnamese adults with confirmed dengue and measured the PR, QRS, and Fridericia-corrected QT intervals (QTcF).
Results: A total of 330 ECGs were performed in 136 patients (64 females; median age, 24 years; range, 16–72 years). Of these, 132 patients had WHO-defined non-severe dengue and 4 had severe dengue. Elevated CK-MB fractions (> 25 IU/L) were detected in 64 of 134 patients (47.8%). The most common ECG abnormality was sinus bradycardia (< 60 beats/min), with 54 episodes occurring in 39 patients (28.7%), most frequently on illness day 10, 9/34 (26.5%) patients. The mean QTcF increased during the first 10 illness days in parallel with a decrease in mean heart rate; only 3 females (461–501 ms) and 1 male (460 ms) had sex-specific QTcF prolongation (≥ 460 ms female, ≥ 450 ms male). Female sex and illness day were significant predictors of QTcF variability over time. Pathological T-wave inversion in the inferior (II, III, aVF) and lateral chest (V5, V6) leads were observed in 12 patients (8.8%), and were mostly transient.
Conclusions: ECG changes associated with nonsevere dengue in predominantly young Vietnamese adults without comorbidities were mostly mild, non-specific, and transient with limited impact on the QTcF interval. Routine ECGs in non-severe dengue in our setting did not provide clinically actionable information