69832 research outputs found
Sort by
Serotype-specific pneumococcal invasiveness: a global meta-analysis of paired estimates of disease incidence and carriage prevalence.
Full text linkBACKGROUND: Serotype-specific estimates of pneumococcal invasiveness used in pneumococcal carriage transmission models to predict changes in disease incidence post-vaccination are largely derived from high-income settings. We conducted a systematic review of carriage prevalence and invasive pneumococcal disease (IPD) incidence to calculate case-carrier ratios (CCRs) in different income settings. METHODS: We conducted a systematic search of MEDLINE, Embase, and Global Health databases on March 14, 2022, to identify publications on pneumococcal carriage prevalence or IPD incidence; we requested individual-level data from authors of relevant texts. Serotype-specific CCRs, calculated as IPD incidence divided by carriage prevalence, were pooled across settings using random effects meta-analyses, stratified by before versus after pneumococcal conjugate vaccine (PCV) introduction, country income group, age group, sex, and HIV status. FINDINGS: We identified 80 publications from 18 countries (13 upper-middle-income countries [UMICS] or high-income countries [HICs], five low-income countries [LICs] or lower-middle-income countries [LMICs]) reporting carriage prevalence or IPD incidence in overlapping geographical areas, time periods, and age groups. We calculated CCRs for more than 70 serotypes, stratified by age group, income setting, and pre-PCV versus post-PCV introduction. In children younger than 5 years, pre-PCV CCRs for non-vaccine serotypes not included in the 13-valent PCV were higher in LICs and LMICs than in UMICs and HICs (177 [95% CI 124-251] vs 103 [60-176], respectively). Post-PCV CCRs for non-PCV13 serotypes dropped in UMICs and HICs (26 [22-30]) but not in LICs and LMICs (173 [139-216]). Pre-PCV versus post-PCV changes varied by serotype and age group. CCRs were lowest in 5-14-year-olds and were higher in HIV-positive than HIV-negative individuals. There were no differences in CCRs by sex. INTERPRETATION: Pneumococcal invasiveness varies by serotype, age group, country income group, HIV status, and over time; however, substantial variation remains unexplained. Our CCRs represent the most representative estimates of invasiveness currently available for use in statistical or mathematical prediction models of disease incidence, where only carriage prevalence data are available. FUNDING: Wellcome Trust
Incremental Carbon Footprint Effectiveness Ratio in Ophthalmology.
Full text linkThis Viewpoint describes the incremental carbon footprint effectiveness ratio (ICFER) as a measure to assess the environmental impact of interventions in terms of carbon footprint per quality-adjusted life-year
Addressing the balance between fairness and performance in glioma grade prediction using bias mitigation techniques.
Full text linkThis research paper investigates the impact of demographic biases, specifically race and gender, on machine learning-based glioma grading, using the TCGA data set compiled from The Cancer Genome Atlas. The study applies three common classifiers (logistic regression, random forests, and extreme gradient boosting) and explores pre-processing (reweighting) and post-processing (equalized odds) strategies for bias mitigation. It evaluates prediction performance metrics (Matthews correlation coefficient, recall, specificity) and fairness metrics (disparate impact, equal opportunity difference, error rate difference), highlighting the trade-offs between fairness and accuracy across different demographic groups. For the most severe bias (race), the pre-trained logistic regression model using the reweighting algorithm shows some deterioration in prediction outcomes for the under-represented group and even an increase in unfairness, while the post-processing approach improves results for the under-represented group and provides significant improvements in fairness. These results are interesting because they could be taken into account in real-world clinical decision-making or in outcomes for under-represented patient groups
Associations of common infections with frailty and mortality in two UK cohort studies.
Full text linkBACKGROUND: Some common infections are associated with poorer age-related health outcomes; however, findings are limited to a small number of pathogens and frequently inconclusive. This study aimed to expand the range of pathogens investigated in relation to frailty and mortality in older age.
METHODS: We investigated relationships between seropositivity for 18 viruses, bacteria and protozoa with concurrent frailty and prospective mortality in middle-aged and older adults within two UK population-based cohorts: UK Biobank (N = 9,427; aged 40-70 years) and MRC NSHD (N = 1,791; aged 60-65 years). Multiplex serological assays were used to identify seropositivity for each pathogen and frailty was assessed using a frailty index measuring the accumulation of age-related health deficits. Mortality was determined from linked administrative records.
RESULTS: Adjusting for sex, age, income and education, previous infection with Toxoplasma gondii ((β = 0.77%; 95% CI: 0.42, 1.11) and Helicobacter pylori (0.63%; 95% CI: 0.28, 0.97) were associated with higher frailty equivalent to 3.8 or 3.1 years of aging, as was inflammation-weighted pathogen burden (0.41%/SD, 95% CI: 0.25, 0.57; 0.42%/SD, 95% CI: 0.26, 0.58). Previous infection with Chlamydia trachomatis, human herpes simplex virus 1 and cytomegalovirus were associated with increased frailty after adjustment for sex and age, although relationships were confounded by socioeconomic circumstances. No common infections were robustly associated with mortality.
CONCLUSIONS: Our results indicate that infection with H. pylori and T. gondii, and the combined burden of infection may detrimentally impact ageing health. These pathogens may warrant targeting beyond current clinical measures to mitigate the development of frailty
Determinants and outcomes of ovarian cancer diagnosis following an emergency presentation: a systematic review.
Full text linkOBJECTIVE: This study aimed to identify the clinical and sociodemographic risk factors and compare cancer stage, treatment, and survival outcomes associated with ovarian cancer diagnosed following an emergency presentation versus other routes. METHODS: A systematic search of Embase and MEDLINE was conducted from January 2000 to August 2025, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (PROSPERO: CRD420251111636). Studies were included if they examined risk factors associated with ovarian cancer diagnosis following an emergency presentation. Studies were also included if they compared treatment or survival outcomes between those diagnosed after an emergency presentation and those diagnosed via other routes. The quality of the studies was assessed using the Newcastle-Ottawa scale. RESULTS: Of the 3499 studies identified, 12 met the inclusion criteria and included a total of 127,395 women. All of the studies were conducted in high-income countries. Older age and socioeconomic deprivation were the most common determinants of an ovarian cancer diagnosis following an emergency presentation, although most studies did not adjust for key confounders. This diagnostic route was associated with advanced tumor stage, lower rates of treatment, shorter intervals between diagnosis and treatment initiation, and poorer survival outcomes. While the included studies were at low risk of bias, substantial heterogeneity made cross-study comparison challenging, especially as contradictory findings between larger population-based studies and single-center studies were noted. CONCLUSIONS: Women diagnosed with ovarian cancer following an emergency admission have a poor prognosis in many high-income countries. Urgent concerted action is needed to both decrease the number of women diagnosed through this diagnostic pathway and increase their treatment rates to improve survival outcomes
Exploring influence and knowledge on family planning among internally displaced men: a qualitative exploration of attitudes, norms and beliefs in Twic, South Sudan.
Full text linkINTRODUCTION: Engaging men in family planning (FP) is widely recognised to be important for improving FP uptake as men are the primary household decision makers. In South Sudan, a setting where long-term conflict has impacted the health system, men's influence on FP decision-making their knowledge of FP remains challenging, shaped by tradition and gender norms. METHODS: This qualitative study among internally displaced men and service providers in Twic county of South Sudan aimed to explore the attitudes, behaviours and norms related to FP among men, so as to identify potential strategies to improve FP uptake. It is based on focus group discussions with men in two camps and interviews with service providers. FINDINGS: Our study finds that despite the longstanding norm of child spacing in South Sudan, modern contraceptive methods are not seen as acceptable methods of spacing. We also find the existence of a strong norm around the importance of having a larger family size. While men do often lead FP decision-making, in some cases women do engage in decision-making about FP. Our study highlights how men's exclusion from programming and discussions around FP is a key challenge, however the broader issue in IDP camps is economic instability, which means that for these men, FP is not a priority. DISCUSSION AND CONCLUSIONS: Our research emphasises the importance of buy-in from community leaders, FP activities that reach across communities (including those in hard-to-reach areas), engagement with children and youth and engagement with faith leaders. We suggest peer-to-peer activities and radio as promising modalities to engage these groups
Neutralization and ADCC reveal divergent spike-subdomain targeting across SARS-CoV-2 vaccine platforms in an African cohort.
Full text linkEvaluating demographically diverse antibody response dynamics remains relevant to developing better vaccines against SARS-CoV-2 and related coronaviruses. Here, in 80 Ugandan study participants vaccinated with BNT162b2, CoronaVac or ChAdOx1-S, we investigated longitudinal neutralization and antibody-dependent cellular cytotoxicity (ADCC) functions, correlating these with immunoglobulin G (IgG) binding dynamics to spike subdomains, receptor-binding domain, N-terminal domain, and S2, across variants. Neutralizing and ADCC responses differed by vaccine type and IgG subdomain binding profiles. S2-IgG binding and ADCC effector function dominated the immune response to CoronaVac vaccination, while BNT162b2 induced the most potent neutralizing antibodies. Overall, we reveal intra-population diversity in antibody binding, neutralization and ADCC among vaccinated individuals, many of whom exhibited elevated pre-vaccination S2-IgG, despite presumed absence of prior infection. There was confounding by vaccination scheduling amidst ongoing waves of infection. These data reveal distinct immunogenetic patterns in a sub-Saharan African population that could inform regionally tailored vaccine strategies and global pan-coronavirus vaccine development
Anti-racist recommendations in medical education journals in 2023: A content analysis.
No full textPURPOSE: Although racism has received growing attention in medical education in recent years, there remains a lack of clarity about the central recommendations for policy and practice. This study synthesises anti-racist recommendations from the literature to address this gap.
METHODS: We searched twenty-four medical education journals to identify articles published in the year 2023 focusing primarily on race and racism. Policy and practice recommendations from these articles were analysed using content analysis.
RESULTS: Across the 107 included articles, anti-racist recommendations were organised into seven themes: (1) Increasing cross-cultural and historical research; (2) Changing culture and mission of institutions; (3) Enhancing patient and community involvement; (4) Developing greater community solidarity; (5) Redesigning student and faculty recruitment; (6) Expanding antiracist content in curricula; (7) Reforming assessment and course evaluation.
CONCLUSIONS: Recommendations to tackle racism in medical education focus both on symbolic changes that send signals to stakeholders such as rewriting mission statements, and on structural changes that rewire existing systems to make them fairer, such as redefining recruitment criteria. Medical education leaders can consider whether their interventions align with these recommendation categories, and medical education researchers can critically interrogate whether they should be refined as geopolitical and sociocultural contexts rapidly shift
The Role of miRNAs and memiRNAs in Gut–Brain Communication and Their Therapeutic Potential
Full text linkMicroRNAs (miRNAs) are key regulators of host–microbiome interactions. They influence diverse physiological processes through post-transcriptional gene regulation. Growing evidence indicates that host-derived miRNAs and microbially encoded miRNA-like molecules contribute to bidirectional signaling between the gut microbiota and the central nervous system. These interactions play a role in gut–brain axis communication. This review summarizes current findings on how host miRNAs shape microbial composition and function. It also examines emerging evidence that microbial miRNA-like molecules can modulate host gene expression. Particular attention is given to pathways involved in metabolic regulation, immune signaling, and neuroinflammatory processes relevant to gut–brain communication. In addition, we discuss the role of extracellular vesicles in miRNA transport and signaling. We critically assess the translational potential of miRNA-based biomarkers and therapeutic strategies, highlighting both their promise and current limitations. Overall, this review provides an integrated overview of miRNA-mediated host–microbiome interactions within the gut–brain axis and outlines key conceptual and experimental challenges that remain unresolved
Two-to-three-year effectiveness and safety of nurse-led accelerated corneal crosslinking for progressive keratoconus: The Birmingham and Midland Eye Centre Study.
Full text linkBACKGROUND/OBJECTIVES: To examine the two-to-three-year effectiveness and safety of accelerated corneal crosslinking (CXL) treatment performed by ophthalmic nurses for progressive keratoconus and to evaluate the potential prognostic factors for disease progression. METHODS: All consecutive eligible patients with progressive keratoconus who underwent nurse-led CXL between February 2019 and December 2021 at the Birmingham and Midland Eye Centre, UK, were included. A standardised accelerated, epithelium-off CXL protocol was employed, using 10 mW/cm2 ultraviolet-A irradiation for 9 min (5.4 J/cm2). Relevant data, including demographics, corrected-distance-visual-acuity (CDVA), corneal tomographic findings, outcomes and adverse event, were analysed. Only patients that had completed at least a 2-year follow-up post-CXL were included. RESULTS: We included 97 patients (n = 97 eyes); mean age was 26.4±6.5 years and 52.6% were female. Most patients had mild (stage I) keratoconus (49.5%). From baseline to 24-month post-CXL (n = 97 eyes), there was a significant improvement in CDVA, (0.30 ± 0.22 logMAR vs. 0.20±0.18 logMAR; p 0.05). There were three (3.1%) cases of clinically significant transient corneal haze noted at 1-week post-CXL. No significant adverse events such as corneal infection/melting were observed. At 36-month post-CXL (n = 31 eyes), the CDVA remained stable, with a significant improvement in Kmax (p < 0.001) and K2 measurements (p = 0.038) from baseline. CONCLUSIONS: This study highlights the efficacy, safety and feasibility of nurse-led CXL, serving as a valuable initiative in addressing the increased service demand for keratoconus management and preserving the vision of patients with keratoconus