69832 research outputs found
Sort by
Reproducibility of the Unaided Subjective Assessment of Orbital Computed X-Ray Tomographic Features in Thyroid Eye Disease.
Get PDFPURPOSE: To assess the reproducibility of subjective interpretation of computed x-ray tomography for 8 features associated with thyroid eye disease. METHODS: Patients with confirmed thyroid eye disease had 3 distinct orbital computed x-ray tomography sections presented as anonymized montages to 3 masked observers (#1 orbital radiologist, #2 general radiologist, and #3 orbital surgeon). Eight features were graded: superior orbital fissure clarity, degree of orbital fat prolapse through the superior orbital fissure, loss of fat space at the apex, muscle enlargement, increase in orbital fat volume, vascular congestion, superior ophthalmic vein size, and lamina papyracea bowing. Thirty montages were randomly triplicated within the completed image-testing-file. RESULTS: Each observer provided 3296 assessments of montages from 146 patients (68% female). Observer #2 had the highest rate of "indeterminate" gradings (13.3%), while #1 had the lowest (6.7%). For intraobserver agreement, the kappa statistics were "substantial" to "almost perfect" for apical crowding, muscular enlargement, and medial bowing, whereas orbital fat expansion and vascular congestion showed only "slight" to "moderate" agreement. Excluding superior ophthalmic vein size (where indeterminacy was too great for statistical analysis), there was a wide and statistically significant interobserver variation for the other 7 features, with no consistent ranking of observer scores. CONCLUSIONS: Subjective interpretation of computed x-ray tomography images for patients with thyroid eye disease has high variability, particularly for interobserver comparisons. Only the assessment of apical crowding, muscular enlargement, and bowing of the lamina papyracea showed fairly consistent intraobserver gradings. The results suggest that variability in the interpretation of such images might only be improved with the use of objective measures applied to the computed x-ray tomography images
Direct-acting antiviral treatment outcomes in people infected with endemic compared to epidemic hepatitis C virus subtypes in England.
Get PDFBACKGROUND: Current evidence suggests reduced efficacy of direct-acting antiviral (DAA) treatment among people with endemic Hepatitis C virus (HCV) subtypes rare to high-income countries. We aimed to determine real-world DAA treatment outcomes of people with endemic HCV subtypes in England. METHODS: Data were collected through a national treatment program. People who had their virus subtyped between 2019-2023, were resident in England and had an outcome recorded for their first DAA treatment episode, were included. Subtypes were divided into epidemic and endemic in England; endemic subtypes were confirmed with whole genome sequencing and resistance associated substitutions (RAS) were determined. Logistic regression was used to determine associations between treatment outcome and exposure variables. RESULTS: In people with an outcome recorded, 93 with an endemic and 8671 with an epidemic HCV subtype were identified, of whom 49.5% (46/93) and 91.8% (7953/8668) achieved a sustained virological response at 12 weeks post end of DAA treatment (SVR12), respectively. In the multivariable model, people with an endemic subtype had 93% (aOR 0.07 95%CI 0.04-0.12, P=<0.001) reduced odds of achieving SVR12. Treatment with sofosbuvir/velpatasvir or glecaprevir/pibrentasvir was successful for genotypes 1, 2, 4 and 5 (SVR12 100%, n=13) but not 3 (27.3%, n=22) endemic subtypes. Sofosbuvir/velpatasvir/voxilaprevir was successful for GT3 endemic subtypes at retreatment (SVR12 11/12, 91.7%). Treatment failures for genotypes 1, 3 and 4 were likely mediated by naturally occurring baseline NS5A RAS (median n=2). DISCUSSION: This study provides further evidence that endemic HCV subtypes lead to sub-optimal DAA efficacy, which may impact global HCV elimination
Evaluation of the utility of group-based physical activity among university students: a systematic review protocol.
Get PDFINTRODUCTION: Sedentary behaviours are a prevalent issue among university students worldwide. The negative impact of low physical activity (PA) levels among university students on mental and physical health is well-documented. Regular PA is linked to numerous health benefits and protects against non-communicable diseases. While group-based physical activity (GBPA) interventions show promise, their effectiveness in increasing PA levels among university students remains uncertain. This review aims to identify, evaluate and elucidate the key determinants of successful GBPA interventions tailored to this population. METHODS AND ANALYSIS: We will search articles from PubMed, Web of Science, SPORTDiscus via EBSCOhost, Africa-Wide, PsycInfo and Cumulative Index to Nursing and Allied Health Literature. We will perform article screening, data extraction and quality assessment of eligible studies in duplicate. The risk of bias in individual studies will be assessed using the Cochrane Collaboration tool for randomised control trials, Risk Of Bias In Non-randomised Studies - of Interventions for non-randomised interventional studies and Risk of Bias in Non-randomised Studies - of Exposure. We will conduct a narrative synthesis of the findings. If there is homogeneity of primary outcomes, we will perform a meta-analysis to appraise evidence across studies. The Grading of Recommendations Assessment, Development and Evaluation will be used to synthesise the quality of evidence across studies. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review protocol; we will analyse published primary studies. Findings will be published in a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER: CRD42024553196
A Scoping Review of School‐Based Nutrition Interventions Conducted in Spain
Get PDFABSTRACT
Background
The prevalence of childhood obesity is increasing in Europe, including Spain, leading to early onset chronic diseases. Two enduring risk factors in this phenomenon are unhealthy nutrition and lack of physical activity. The aim of this review is to examine and appraise the literature on the nature and extent (inputs, activities, outputs) of research conducted in school‐based nutrition intervention programs in Spain and their effectiveness (outcomes and impact).
Methods
A review of published studies (2000–2024) using the PRISMA‐ScR guidelines across 14 databases was conducted. Thirty‐one studies met the inclusion criteria, involving a range of 28–2516 youth across many schools in various cities in Spain. Study designs ranged from randomized controlled trials to descriptive projects.
Results
Studies addressed a spectrum of dietary behaviors and knowledge aimed at promoting a healthy lifestyle overall, good nutrition, and adequate physical activity. Almost all studies produced positive changes in youths’ nutrition behavior.
Conclusion
School nutrition intervention programs in Spain have shown significant promise in promoting healthier dietary behaviors and reducing obesity‐related risks among children and adolescents. These programs improved adherence to the Mediterranean diet, increased fruit and vegetable intake, and better body mass index and body composition outcomes. To enhance impact and scalability, future efforts should focus on consistent methodologies and extended follow‐up
Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research.
Get PDFOBJECTIVE: To summarise research on the efficacy and safety of UK physician associates and anaesthetic associates in the context of an ongoing policy review. DESIGN: Rapid systematic review. SEARCH STRATEGY: Keyword and author search of three databases; citation tracking; search of previous systematic reviews. ELIGIBLE STUDIES: Empirical research (any design) on physician associates/anaesthetic associates in UK healthcare published between 2015 and January 2025. MAIN OUTCOMES: Any measure of clinical efficacy or safety. METHODS: Eligible papers were grouped into categories and appraised using Critical Appraisal Skills Programme checklists. Two reviewers independently extracted data on study designs, samples, methods, and findings. Each paper was scored for trustworthiness, generalisability, and relevance; differences were resolved by discussion. Studies meeting a minimum inclusion standard were described and critiqued. RESULTS: Of approximately 5000 titles, 52 papers were eligible (48 on physician associates, four on anaesthetic associates), of which 29 met the inclusion standard. The total number of physician associates studied was very small, especially in primary care; no studies reported direct assessment of anaesthetic associates. Only one study, of four physician associates, involved any assessment by a doctor of their clinical competence by direct observation. No studies examined safety incidents. Some studies suggested that physician associates could support the work of ward based teams and work in emergency departments when appropriately deployed and supervised in low risk clinical settings, but the number of individuals and settings studied was small, and those findings should be considered preliminary. Physician associates seemed to struggle in primary care, however, because the role was more autonomous, the case mix was more diverse, decisions were more uncertain, institutional support was more limited, and supervision arrangements were more challenging. Staff expressed concern about physician associates' and anaesthetic associates' competence to manage undifferentiated, clinically complex, or high dependency patients; order ionising radiation; or prescribe. Physician associates reported a range of experiences and desired a clear role within the team. No evidence was found that physician associates add value in primary care or that anaesthetic associates add value in anaesthetics; some evidence suggested that they do not. CONCLUSIONS: The UK literature on physician associates and anaesthetic associates is sparse and of variable quality, and some is outdated. In this context, the absence of evidence of safety incidents should not be misinterpreted as evidence that deployment of physician associates and anaesthetic associates is safe. Findings of apparent non-inferiority in non-randomised studies may obscure important unmeasured differences in quality of care. New research is urgently needed to explore staff concerns, examine safety incidents, and inform a national scope of practice for these relatively new and contested staff roles. The findings from this UK based study should be interpreted in the context of the wider international evidence base. STUDY REGISTRATION: INPLASY202520039
Creating different global health futures: mapping the health research ecosystem and taking decolonial action.
Get PDFThis paper promotes reflexive consideration of health research practices using a decolonisation lens. We propose both incremental and more radical action in five domains: knowledge production, funding and programmes, dissemination, uptake, and education and training. We suggest four steps towards transformation and share a reflexive tool to operationalise these steps
Adverse maternal outcomes among women who gave birth at public hospitals in eastern Ethiopia: a cross-sectional study.
Get PDFBACKGROUND: An adverse maternal outcome, such as anemia, postpartum hemorrhage, and postpartum eclampsia, poses a significant risk to women. While studies on the burden of adverse maternal outcomes have been conducted in various countries, including Ethiopia, many predictors beyond obstetric factors have not been fully explored. This study aimed to determine the magnitude and factors associated with adverse maternal outcomes among women who gave birth at selected public hospitals in eastern Ethiopia. METHODS: A hospital-based cross-sectional study was conducted among 2,608 randomly selected women who gave birth in six public hospitals in eastern Ethiopia from November 2023 to March 2024. Data were collected through face-to-face interviews and clinical chart reviews. Factors associated with adverse maternal outcomes were identified using bivariable and multivariable robust Poisson regression analyses. Adjusted relative risk (ARR) with a 95% confidence interval (CI) was used to report the strength of the association. The variables with a p-value of <0.05 were considered statistically significant. RESULTS: The magnitude of adverse maternal outcomes was 15.68% (95% CI: 14.70%-16.66%). A poor wealth index (ARR = 4.41; 95% CI: 3.46-5.62), having danger signs at admission (ARR = 1.86; 95% CI: 1.18-2.91), alcohol use during pregnancy (ARR = 1.86; 95% CI: 1.32-2.62), duration of labor ≥24 h (ARR = 1.69; 95% CI: 1.00-2.85), and maternal age greater than 35 years (ARR = 1.39; 95% CI: 1.03-1.86) increased the risk of adverse maternal outcomes. In contrast, folic acid intake during pregnancy (ARR = 0.47; 95% CI: 0.38-0.57), having partner support (ARR = 0.70; 95% CI: 0.59-0.83), and spontaneous vaginal delivery (ARR = 0.58; 95% CI: 0.49-0.68) reduced the risk of adverse maternal outcomes. CONCLUSION: One in six women who gave birth in eastern Ethiopia experienced adverse maternal outcomes. This rate was determined to be moderate when compared to the WHO projections for lower- and middle-income countries and better than the higher averages reported by the WHO. Targeted intervention programs, such as targeted education and empowerment programs, and the strengthening of the community health worker program would help address socioeconomic disparities and improve early detection and management of danger signs during pregnancy, which would aid in averting the occurrence of adverse outcomes
Hypertension in Sub-Saharan Africa: Burden, Barriers and Priorities for Improving Treatment Outcomes.
Get PDFThe burden of hypertension is rising rapidly in sub-Saharan Africa (SSA), posing significant health challenges and economic costs that hinder national development. Despite being well-studied in clinical medicine, the detection, treatment, and control of hypertension in SSA remain inadequate. This is due to barriers across the care continuum, including individual-, provider-, and system-level obstacles within the health system. A critical issue is the lack of contextualized mechanistic research to understand the mechanisms, phenotypes, and treatment responses in native SSA populations. Current treatment approaches are often based on data from diaspora Africans, particularly African Americans. Consequently, most guidelines do not recommend angiotensin system drugs as first-line agents for Black patients, a stance that should be reconsidered given some evidence of their effectiveness in native SSA populations. Addressing these barriers requires a comprehensive, multisectoral strategy that includes both preventative and clinical measures at the population and individual levels. Preventative approaches should encompass health and nutrition education, improving food supply quality, and implementing comprehensive transportation and environmental policies. In addition, strategies should be developed to increase the detection of undiagnosed cases through enhanced screening and treatment access to those not receiving care, and revisit current treatment approaches to ensure that they are more tailored to the specific populations and settings. In conclusion, innovative strategies are needed to identify and overcome barriers to hypertension diagnosis and management. A coordinated, multisectoral approach that includes a contextualized mechanistic research agenda, as well as task shifting and task sharing, will help prevent and reduce hypertension in SSA
Organizational Position and Structural Empowerment in Chinese Community Nursing: An Interpretive Case Study.
Get PDFNurse empowerment is widely recognized for advancing professional development and job satisfaction, yet its structural dimensions remain underexplored in China's community nursing sector. Guided by Kanter's structural empowerment theory, this interpretive case study examines how formal hierarchies and informal organizational dynamics converge to shape community nurses' access to power in nonward settings. Drawing on 24 semistructured remote interviews and unstructured observations in Shenzhen, four interrelated themes were identified: (1) dual-function caregiving roles, (2) entitlement to formal power, (3) variation in informal roles, and (4) inequities in informal power. Each theme explicitly connects to core components of structural empowerment, access to supply, information, support, and opportunities, illustrating how organizational structures and interpersonal relationships jointly shape nurses' empowerment experiences. Findings reveal tensions between formal structures intended to promote empowerment and informal dynamics that sustain power asymmetries. By unpacking these layered power relations, the study offers critical insight into structural empowerment in decentralized nursing contexts and calls for both policy and managerial reforms to foster inclusive, ethically grounded organizational cultures
Design of a multi-epitope vaccine against drug-resistant mycobacterium tuberculosis and mycobacterium bovis using reverse vaccinology.
Get PDFThe global burden of Mycobacterium tuberculosis (M. tuberculosis) and Mycobacterium bovis (M. bovis), the rise of drug-resistant strains, necessitates an urgent need for developing more effective vaccines. This study employed an in-silico approach to design a multi-epitope vaccine targeting the PE_PGRS16 protein, a conserved virulence factor found across both species, including drug-resistant strains. PE_PGRS16 was chosen due to its extracellular localization, adhesion properties, and virulence characteristics, making it a promising vaccine target. Epitopes for B-cells, Cytotoxic T Lymphocytes, and Helper T Lymphocytes were selected based on antigenicity, non-toxicity, and immune response potential. The vaccine construct demonstrated favorable properties, including high antigenicity, solubility, and stability, with a low instability index (-31.31) and binding energy (-44.566) when docked to TLR4, suggesting its potential for immune activation. Griselimycin was incorporated as an adjuvant to enhance immunogenicity, as predicted by C-ImmSim simulations. Population coverage analysis for East Africa revealed high applicability, with 98.35% coverage for Class I epitopes, 100% coverage for Class II epitopes, and 100% combined coverage, with average hit values of 8.4, 12.26, and 20.66, respectively. These results suggest broad potential for global vaccine deployment. This study presents a novel multi-epitope vaccine targeting PE_PGRS16, with the potential to combat Mycobacterium tuberculosis and Mycobacterium bovis infections, including drug-resistant forms. Further experimental validation is necessary to confirm its efficacy and safety