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Post-tuberculosis lung disease in children and adolescents: A scoping review of definitions, measuring tools, and research gaps.
Get PDFTuberculosis (TB) survivors, especially children and adolescents, can develop chronic respiratory problems called post-tuberculosis lung disease (PTLD). We conducted a scoping review to identify the current knowledge gaps on PTLD definitions, measuring tools, and research specific to this age group. We searched MEDLINE, EMBASE, Global Health, CINAHL, and Web of Science for studies published between January 1, 2000, and March 1, 2024, and identified 16 studies. Our review found that no consistent definition of PTLD was used in the studies, and the measurement tools used varied widely. Moreover, there was a lack of research on children under five years old, who are disproportionately affected by TB. Also, symptom screening tools designed for adults were frequently used in these studies, raising concerns about their accuracy in detecting PTLD in children and adolescents. Several critical research gaps require attention to improve our understanding and treatment of PTLD. Firstly, the use of inconsistent definitions of PTLD across studies makes it challenging to compare research findings and gain a clear understanding of the condition. Therefore, we need to include an objective measurement of respiratory health, such as a comprehensive post-TB lung function assessment for children and adolescents. It is also crucial to determine the optimal timing and frequency of post-TB assessments for effective PTLD detection. Furthermore, we need more knowledge of the modifiable risk factors for PTLD. The scarcity of prospective studies makes it difficult to establish causality and track the long-term course of the disease in children and adolescents. Finally, current approaches to PTLD management often fail to consider patient-reported outcomes and strategies for social support. Addressing these research gaps in future studies can improve our understanding and management of paediatric PTLD, leading to better long-term health outcomes for this vulnerable population
Investigating the relationship between corruption and health system outcomes in Central and Eastern Europe.
Get PDFCorruption in the health sector wastes precious resources and threatens progress to universal health coverage (UHC). Countries of Central and Eastern Europe (CEE) have undertaken extensive health system reforms, many including measures to tackle informal payments and other forms of corruption. We asked whether there is evidence linking perceived corruption in twelve CEE countries between 2012 and 2020 with two health system-related outcomes, out-of-pocket payments and avoidable mortality. We analyse panel data and adjust for national characteristics in the political, economic, and social domains. We find a significant association between perceived corruption and health system outcomes after accounting for time-variant and in-variant factors using fixed-effects analysis. The political, economic, and social determinants of health, including quality of government, public health expenditure, national income, inequality, and urbanisation have stronger associations with each health system outcome. The results suggest that while corruption is detrimental to population health, it is one of a number of political and economic factors that must be addressed to accelerate progress towards equitable and universal health coverage. The direct and indirect effects of corruption on factors outside the health system that impact health outcomes cannot be ignored. Intersectional and global anti-corruption, accountability, and transparency initiatives remain a critical priority for achieving UHC in CEE and ensuring health systems keep pace with economic growth and population expectations
Human helminth infections above latitude 60°N: reports published 2001-2024.
Get PDFThis article surveys reports of human helminth infection from geographical regions above latitude 60°N published in the period 2001–2024. We take a global approach encompassing the Americas and Eurasia. The helminth genera thus described herein include nematode (Trichinella, Toxocara, Anisakis, Pseudoterranova), cestode (Echinococcus, Dibothriocephalus) and trematode (Opisthorchis, Trichobilharzia). The primary reports identified infections principally by serology (community-based or individual, including imported cases) and outbreaks. There were also articles reporting national data compiled from official sources. Despite successful local control programmes, these pathogens pose an ongoing risk to human health in this region
Protocol for an economic evaluation of perennial malaria chemoprevention delivered at scale in Benin, Cameroon, and Côte d’Ivoire
Get PDFBackground Malaria continues to impose a significant mortality and morbidity burden, particularly among young African children. Children under two years of age account for one-third of the estimated 597,000 annual global malaria deaths. Perennial malaria chemoprevention (PMC) is a strategy recommended by the World Health Organization to reduce malaria in this high-risk age group. However, uptake remains low in many endemic countries. Given the limited resources available for health and the stagnation of malaria budgets over the last decade, it is important for policymakers to understand the costs and cost-effectiveness of PMC to support future decision making. Methods We describe the design of an economic evaluation of PMC in Benin, Cameroon, and Côte d’Ivoire, where it is being implemented at scale by the ministries of health through the Essential Programme of Immunization (EPI) with support from Population Services International. We will take a disaggregated societal perspective, collecting data on resources provided for PMC by 45 health facilities across 12 districts in these three countries, higher levels of the health services, donor-supported activities, and households. This study will assess the financial and economic costs per dose of PMC and calculate the incremental cost per malaria case averted and per disability-adjusted life-year averted by PMC compared to the usual standard of care. We will model the costs and effects of scaling up PMC to other regions in the three countries where PMC is deemed suitable. Discussion This economic evaluation aims to provide robust evidence from three countries, each implementing different PMC delivery models, regarding whether, where, and under what circumstances investing in PMC may represent an efficient and equitable use of scarce resources. We expect these findings to be valuable for the governments of Benin, Cameroon, and Côte d’Ivoire and other countries and international donors in designing the optimal mix of malaria control interventions.</ns3:p
Person- and family-centred care in neonatology: a scoping review to identify existing definitions, models of care, and related categories of interventions.
Get PDFBACKGROUND: Person- and family-centred care in the field of neonatology (N&FCC) are promoted by many international agencies and scientific societies because of evidence-based benefits for infants, parents and health systems; however, being very broad and evolving concepts, they have not been uniformly defined in operational terms. We conducted a scoping review of literature relevant to N&FCC with the objectives of synthetising: 1) existing definitions; 2) models of care; 3) categories of interventions suggested by each model of care. METHODS: We searched PubMed/MEDLINE, Embase, Web of Science, and Google Scholar for articles and/or grey literature published until 5 February 2024. For each objective, we considered articles and/or other documents, for any type of newborn. RESULTS: The searches yielded 10 771 records. A total of 91 documents were deemed eligible for inclusion. We identified 40 relevant definitions and 28 different models of care of N&FCC. Both definitions and models of care were categorised in four macro-groups, based on their main focus: newborn and developmental care, parental participation to care, no separation between mother-baby, and miscellanea. Out of the 28 models of care, a total of 51 categories of interventions were identified, with a variable number (range 2-17) reported per each model. These were grouped in five macro-categories: individualised neonatal health care; organisation of care, human resources and policies; physical resources; health professionals (HPs) capacity strengthening and support; family empowerment and support. While most models included individualised neonatal care and family empowerment interventions, HPs were frequently neglected as beneficiaries of the intervention: only 11 models incorporated HPs capacity strengthening, only three proposed a wider support for HPs. CONCLUSIONS: We identified and synthetised numerous definitions, models, and categories of interventions, highlighting the need for further conceptualisation and standardisation around the concept of N&FCC, including the perspective from low-middle income countries', and from both parents and staff involved in care
Respiratory conditions and pesticide exposure in British pesticide applicators.
Get PDFBACKGROUND: The relationship between pesticide exposure and respiratory ill-health remains under researched. AIMS: We set out to define the prevalence of respiratory complaints, excluding asthma, and estimates of exposure in a cohort of pesticide applicators based in Great Britain (GB).
METHODS: A baseline cross-sectional study (n = 5817), with follow-up at up to 5 years (n = 2578), was conducted in GB pesticide workers. Demographic and personal factors, details of working hours and practices, exposures to specific pesticide types, self-reported respiratory ill-health and doctor-diagnosed health conditions were recorded. Multivariable logistic regression models were used to assess the association between exposures to pesticides and respiratory health.
RESULTS: The mean age was 54.1 years; 98% were male. At baseline, 70 (1.2%) had doctor-diagnosed chronic bronchitis, and 60 (1%) had chronic obstructive pulmonary disease (COPD). Twenty-six (0.4%) reported farmer's lung. In contrast, reported respiratory symptoms were common at follow-up; nasal allergies reported by 541 participants (21%), regular cough by 351 (14%), chest tightness ever by 329 (13%) and work-related chest tightness by 45 (1.8%). Nasal allergies were more common in those not using pesticides in the last 12 months [odds ratio (OR) 1.54 (95% CI 1.14-2.06)], chest tightness was more common in retired workers [OR 1.87 (1.25-2.81)], and work-related chest tightness more common in the current high exposure category [OR 2.68 (1.28-5.60)].
CONCLUSIONS: This study has confirmed low levels of self-reported doctor-diagnosed conditions, but high levels of reported respiratory symptoms. This suggests potential under diagnosis of respiratory ill-health in this sector
Quality Indicators for Renal Cancer Care: A Systematic Review.
Get PDFBACKGROUND AND OBJECTIVE: Quality indicators (QIs) are crucial for evaluating health care delivery, including effectiveness, safety, and patient-centered outcomes. In contrast to other fields, the definition and implementation of QIs for renal cell carcinoma (RCC) present distinct challenges and remain unmet needs. We summarized the available data on QIs for RCC, focusing on their characterization throughout the care pathway and the potential areas for further development.
METHODS: A systematic review of the English-language literature was conducted using the MEDLINE, Embase, and Cochrane databases from January 2000 to March 2025, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (PROSPERO ID: CRD42024511924). Quality assessment was evaluated according to the Appraisal of Indicators through Research and Evaluation (AIRE) instrument.
KEY FINDINGS AND LIMITATIONS: Out of 58948 potentially relevant papers, 12 sets of QIs (including an overall number of 86 distinct QIs) were identified from 12 studies. QI sets had a large variation in development strategy and quality. Only five studies scored a total of ≥50% on the AIRE tool across four domains. The process employed to develop the set of QIs was heterogeneous across the included papers. The number of proposed QIs varied significantly across studies (range: 1-25). Only a few studies specified the target population explicitly. The QIs addressed different stages of RCC care pathways: diagnosis (33%), staging (25%), data collection (25%), treatment (67%), pathology (42%), outcomes (83%), hospital facilities (25%), and follow-up (17%). Although 83% (10/12) sets have been piloted in practice, none of these has been validated externally. Regardless of the domain, most studies did not specifically report any cutoff value to evaluate whether the proposed QIs were fulfilled or not.
CONCLUSIONS AND CLINICAL IMPLICATIONS: Our review found a relative lack of evidence on QIs for RCC, as well as heterogeneity in their development strategy, definition, reporting, and the included domains of the RCC care pathway. Further efforts are needed to reach consensus on the appropriately developed QIs that could define the quality of care for RCC and to assess their association with clinical outcomes
Is an improvement in anaemia and iron levels associated with the risk of early postpartum depression? A cohort study from Lagos, Nigeria.
Get PDFBACKGROUND: Anaemia and depression are common conditions which affect pregnant and postpartum women. Evidence points to associations between anaemia and iron deficiency during pregnancy, and mental health disorders like depression. However, it is unclear the association between improvement in anaemia severity or iron levels during pregnancy and incidence of postpartum depression. OBJECTIVES: This study examined association between improvement in anaemia severity and iron levels during pregnancy after four weeks of treatment and the incidence of depression at two weeks postpartum. METHODS: This cohort study nested within a clinical trial in Lagos Nigeria, included 438 anaemic (haemoglobin concentration 10), was measured at two weeks postpartum using validated Edinburgh Postnatal Depression Scale. Associations between improvement in anaemia severity and iron levels after four weeks post-enrolment versus depression at two weeks postpartum were examined using logistic regression analysis, adjusting for confounders. RESULTS: Mean age of women was 29.5 ± 5.6years. Median haemoglobin concentration of 9.3 (IQR: 8.8-9.8)g/dL and median serum ferritin 44.4 (IQR: 22.1-73.7)ng/mL at enrolment. Prevalence of postpartum depression was 5.8% (95%CI: 3.8-8.5%). There was a non-significant association between improvement in anaemia severity at four weeks post-enrolment and postpartum depression, aOR: 0.15 (95%CI: 0.02-1.15). The odds for postpartum depression was nearly five times higher in women who had postpartum haemorrhage, aOR: 4.90 (95%CI: 1.18-20.36). In the subgroup with iron deficiency (n = 148), no association was found between an improvement in iron levels four weeks post-enrolment and the odds for postpartum depression, aOR: 1.14 (95%CI: 0.09-3.93). CONCLUSION: Improvement in anaemia severity during late pregnancy was non-significantly associated with lower risk for postpartum depression; no association between improvement in iron levels and postpartum depression. It is likely that an improvement in anaemia severity in early pregnancy will lessen the burden of postpartum depression; however, this study is limited by sample size to draw this conclusion
The 1985 Plasmodium vivax malaria elimination campaign in Santa Catarina, Brazil: the feasibility of using serology amid other integrated tools in the last mile.
Get PDFThis report outlines the process of malaria elimination in two municipalities, São Francisco do Sul and Araquari, located in Santa Catarina, Southern Brazil, from 1980 to 1985. Before 1948, Santa Catarina reported an annual average of nearly 60,000 malaria cases. The primary vector responsible for transmission was Anopheles (Kerteszia) cruzii, which exhibited high infestation levels in endemic areas. Malaria control measures in the state began in 1941 with the involvement of the National Malaria Service. The elimination process initially targeted Plasmodium falciparum and Plasmodium malariae infections, followed by a focus on Plasmodium vivax infections in 1962. Between 1980 and 1985, comprehensive efforts were undertaken in both municipalities to control and eliminate malaria. These efforts included bromeliad removal, DDT spraying, Malathion fogging, enhanced active and passive detection measures, and serological surveys to guide the radical cure of vivax malaria with chloroquine and primaquine. As a result of these interventions, both cities witnessed a significant decline in malaria incidence, going from 6.7 cases per 1000 residents to 0 cases in 1985. This report documents the first use of serology testing and treating in malaria elimination actions, demonstrating its potential to optimize resources by targeting treatment. The success of the combined interventions underscores the importance of significant resources, sustained effort, and political commitment to achieving elimination. The feasibility of serology-guided strategies in the 1980s highlights their continued relevance today as a model for achieving malaria elimination in endemic regions
Visual acuity outcomes and influencing factors in a cohort of UK real-world diabetic macular oedema patients during the first two years of anti-VEGF treatment.
Get PDFBACKGROUND/OBJECTIVES: The visual acuity (VA) outcomes after the first and second years of anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with diabetic macular oedema (DMO) were evaluated, and the factors associated with treatment success were investigated. METHODS: Using Medisoft electronic medical records (UK), this retrospective cohort study analysed VA outcomes, changes, and determinants in DMO patients at year 1 and year 2 after initial anti-VEGF injection. Descriptive analysis examined baseline demographics and clinical characteristics, while regression models were used to assess associations between these factors and changes in VA. RESULTS: 728 DMO patients (1035 eyes) treated with anti-VEGFs (ranibizumab, aflibercept, or bevacizumab) at the Northern Ireland Mater Macular Clinic from 2008 to 2021 were evaluated. The mean age was 64.5 (SD 12.8) years, and 59.6% were male. In the first year, the median annual injection number and interval were 6.0 (IQR 5.0-8.0) and 6.1 weeks (IQR 5.4-7.8), respectively, and in the second year, they were 3.0 (IQR 2.0-5.0) and 10.0 weeks (IQR 6.5-20.1). In the first two treatment years, 83.4% and 79.8% of eyes had improved/stable VA (ISVA) respectively. The injection number, interval, baseline VA, age, and proliferative diabetic retinopathy (PDR) significantly impacted VA outcomes. CONCLUSIONS: Our study confirms the effectiveness of anti-VEGF treatments in improving or maintaining vision for DMO patients, consistent with previous real-world clinical data. An elder age, a better baseline VA, low annual injection numbers (<5), and less frequent injection intervals (≥12 weeks) were negatively associated with ISVA success in the first two years. These findings have implications for managing patient expectations, allocating resources, and understanding DMO clinical management