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The global prevalence of Chlamydia trachomatis genital infection in pregnant women: A meta-analysis
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the copyright holder. To view a copy of this licence, visit http://crea tivecommons.org/licenses/by-nc-nd/4.0/BACKGROUND: Chlamydia trachomatis genital infection is one of the most common sexually transmitted bacterial infections with severe detrimental effects on pregnant women and fetuses. CTGI increases the risk of ectopic pregnancy, exogenous fetal infection, and respiratory complications such as bronchitis and pneumonia. According to the different published reports, this systematic review and meta-analysis study aimed to evaluate the global prevalence of CTGI in pregnant women. METHODS: Initial searching was applied using valid databases of PubMed, ScienceDirect, Embase, WoS, Scopus, and Google Scholar using MeSH keywords (by October 2023). Following duplicate detection and data exclusion, the Title and Abstract of other remaining papers were evaluated (primary screening). Full-texts of selected papers were assessed (secondary screening) and eligible studies were included for data extraction (total No of investigated pregnant women and the number of positive cases). The PRISMA approach was used for paper selection, and the quality assessment was determined according to the STROBE checklist. Data meta-analysis, heterogeneity, publication bias, and the factors affecting heterogeneity index were analyzed using CMA software. The findings were presented in the Forest Plot diagram and Static tables. Besides, heterogeneity was analyzed using I(2) test and diffusion bias was demonstrated in Funnel Plot. RESULTS: Among 1061 selected articles, 44 eligible investigations were enrolled for meta-analysis. The global prevalence of chlamydia trachomatis genital infection (CTGI) was found 8.4% (95% CI 5.8 - 12.1). Meta-regression analysis showed that following the increase in sample size and year of paper publication, the prevalence of Chlamydia trachomatis genital infection in pregnant women decreased significantly (p < 0.05). CONCLUSION: The global prevalence of Chlamydia trachomatis genital infection in pregnant women is considerably influenced by some interfering factors including Age, Socioeconomic status, Geographic region, and Individual behaviors. Thus, the implementation of more comprehensive health programs for prevention, screening, and treatment seems necessary, especially for high-risk pregnant cases.https://link.springer.com/article/10.1007/s00404-024-07928-
Investigating neurometabolite changes in response to median nerve stimulation
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© 2025 The Author(s). Brain and Behavior published by Wiley Periodicals LLCBACKGROUND: Rhythmic median nerve stimulation (MNS) at 10 Hz has been shown to cause a substantial reduction in tic frequency in individuals with Tourette syndrome. The mechanism of action is currently unknown but is hypothesized to involve entrainment of oscillations within the sensorimotor cortex. OBJECTIVE: We used functional magnetic resonance spectroscopy (fMRS) to explore the dynamic effects of MNS on neurometabolite concentrations. METHODS: Here, we investigated the effects of rhythmic and arrhythmic 10 Hz MNS on glutamate (Glu) and GABA concentrations in the contralateral sensorimotor cortex in 15 healthy controls, using a blocked fMRS design. We used a Mescher-Garwood-semi-localized by adiabatic selective refocusing (MEGA-sLASER) sequence at 7 T. RESULTS: Our results show no difference in the difference-from-baseline measures between the two stimulation conditions. Looking at the effect of MNS over both conditions there is a trend for an initial increase in Glu/tCr (total creatine) followed by a decrease over time, whereas GABA/tCr decreased during each stimulation block. CONCLUSIONS: These results suggest that despite entrainment of oscillations during rhythmic MNS, there are no significant differences in the tonic neuromodulatory effects of rhythmic and arrhythmic stimulation. The reduction in Glu over the course of stimulation may reflect a decrease in the glutamatergic firing due to adaptation. This may make it less likely that an involuntary movement is generated during continuous stimulation.https://onlinelibrary.wiley.com/doi/10.1002/brb3.7025
Unified protocol vs mentalization-based therapy for adolescents with borderline personality disorder: A randomized controlled trial
No full textBACKGROUND: Despite several treatments, e.g., mentalization-based therapy (MBT) and Unified Protocol (UP), being adapted to treat adolescents with borderline personality disorder (BPD), there exists a dearth of literature regarding their relative efficacy. In this study modified forms of MBT and UP - MBT-A and UP-A respectively-were compared in their ability to reduce borderline symptoms in a sample of 91 Iranian adolescents (two-thirds female) with a BPD diagnosis. METHODS: Individuals randomly allocated to one of two treatment groups, MBT-A (N = 45) or UP-A (N = 46) were followed up across 36 months following treatment. A MIXED ANCOVA was applied to compare the effectiveness of these interventions in reducing severity of borderline symptoms (the primary outcome), impulsivity, self-harm, emotion dysregulation and anger (secondary outcomes). The trial was retrospectively registered at IRCT20231106059970N1. RESULTS: Both primary outcomes and secondary outcomes decreased significantly following both MBT-A and UP-A. In comparison with MBT-A, UP-A was more effective in reducing emotional dysregulation, but levels of remission declined progressively up to 36 months of follow-up following both treatments. CONCLUSIONS: UP-A appears to be more effective than MBT-A in reducing emotional dysregulation in adolescents with BPD, despite being a shorter and less intensive treatment. An important caveat is that the treatment induced changes were largely limited to the emotion dysregulation aspect of BPD; other aspects (interpersonal and identity disturbances) were largely unchanged by either treatment.https://onlinelibrary.wiley.com/doi/10.1002/cpp.7003
The role of processed electroencephalography in the detection and management of acute cerebral ischemia: A scoping review
No full textAvailable to read at the publisher's website here: https://doi.org/10.1097/ana.0000000000001018.Processed electroencephalography (pEEG) is increasingly used to titrate the depth of anesthesia. Whether such intra-procedural pEEG monitoring can offer additional information on cerebral perfusion or acute focal or global cerebral ischemia is unknown. This scoping review aimed to provide a narrative analysis of the current literature reporting the potential role of pEEG in adults with acute cerebral ischemia. In keeping with the scoping review methodology, a broad search strategy was defined, including descriptions of encephalography in acute ischemic stroke, carotid endarterectomy, cardiac surgery, and cardiac arrest. Additional screening of citations was conducted by 2 independent assessors. From 310 records, 28 full-text articles met inclusion criteria. Most identified studies were observational in design, and described the diagnostic ability of pEEG to identify cerebral hypoperfusion or its prognostic sensitivity after stroke or carotid surgery. No studies were identified that evaluated pEEG in the specific setting of endovascular therapy for acute ischemic stroke. Low sensitivity associations between pEEG indices and cerebral blood flow were highlighted, which may be influenced by cerebral autoregulatory thresholds. Despite the associations reported in observational studies, this review identified significant uncertainty in the role of pEEG during cerebral ischemia. There is a paucity of high-level observational (cohort or case-control) or randomized trial research examining the possible role of pEEG for the detection and management of cerebral ischemia during acute stroke, including during endovascular therapy, or in other common scenarios of acute cerebral ischemia.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.https://doi.org/10.1097/ana.000000000000101
Outcome 1 year after ICH: Data from the Tranexamic acid for IntraCerebral Haemorrhage 2 (TICH-2) trial
Get PDFIntroduction: The Tranexamic acid for IntraCerebral Haemorrhage-2 (TICH-2) trial reported no significant improvement in death and dependency at day 90 despite reductions in haematoma expansion, early neurological deterioration and early death. However, significant recovery after stroke, particularly intracerebral haemorrhage (ICH), may take more than 3 months. Here we report the participant outcomes at 1 year after stroke. Patients and Methods: TICH-2 was a prospective randomised controlled trial that tested the efficacy and safety of tranexamic acid in spontaneous ICH when given within 8 h of onset. Patients with ICH on anticoagulation were excluded. Centralised blinded telephone follow up was performed for patients from the United Kingdom at 1 year. The primary outcome was modified Rankin Scale at 1 year. Secondary outcomes included Barthel index, Telephone Interview Cognitive Status-modified, EuroQoL-5D and Zung Depression Scale. This was a prespecified secondary analysis of the TICH-2 trial. Result(s): About 2325 patients were recruited into the trial (age 68.9 +/- 13.8 years; 1301 male, 56%). About 1910 participants (82.2%) were eligible for day 365 follow up. 57 patients (3.0%) were lost to follow up. Tranexamic acid did not reduce the risk of poor functional outcome at 1 year (adjusted OR 0.91 95% CI 0.77-1.09; p = 0.302). However, Cox proportional hazard analysis revealed significant survival benefit in the tranexamic acid group (adjusted HR 0.83, 95% CI 0.70-0.99; p = 0.038). Conclusion(s): There was no difference in functional outcome at 1 year after ICH. Tranexamic acid may reduce mortality at 1 year without an increase in severely dependent survivors. But this should be interpreted with caution as this is a result of secondary analysis in a neutral trial.Copyright © European Stroke Organisation 2024.https://doi.org/10.1177/2396987324126593
Impact of the SARS-CoV-2/COVID-19 pandemic on the patient journeys of those with a newly diagnosed paediatric brain tumour in the UK: A qualitative study
Get PDFObjectives To explore the impact of the SARS-CoV-2/COVID-19 pandemic on the diagnosis, management and patient journey for children and young people with a newly diagnosed brain tumour in the UK. Design Exploratory qualitative study focused on patient journeys from multiple perspectives, conducted as part of a wider mixed-methods study. Setting Three paediatric oncology tertiary centres in the UK. Participants 10 children and young people with brain tumours (n=6 females, n=4 males), 20 caregivers (n=16 females, n=4 males) and 16 stakeholders (specialist nurses, consultant neurosurgeons and oncologists, and representatives from brain tumour charities) were interviewed between January 2022 and June 2023. Results The paper incorporates multiple perspectives, including those of children and young people, parents/caregivers, clinical staff and charity representatives, to explore the patient journey. Five themes describe the journey for new patients with paediatric brain tumour during the pandemic, focusing on (1) challenges getting into the healthcare system, (2) managing as a family during restrictions imposed by the pandemic, (3) complexities of building a cohesive and supportive healthcare team, (4) difficulties caregivers experienced in accessing practical and emotional support in hospital and (5) ongoing difficulties experienced by families in the community. Conclusions Findings from this study offer practical insights from children, parents/caregivers and relevant stakeholders to improve the healthcare system during future disruptions. Overall, this study not only sheds light on the challenges faced by families during the pandemic but also provides suggestions for improving healthcare services to ensure a more comprehensive and effective response in times of crisis.Copyright © Author(s) (or their employer(s)) 2025.https://doi.org/10.1136/bmjopen-2024-08611
Enhancing maternity healthcare workers' wellbeing using insider participatory action research.
Get PDFBACKGROUND: Good healthcare worker (HCW) wellbeing positively impacts service user outcomes, yet the United Kingdom (UK) National Health Service (NHS) is suffering workforce burnout and retention issues. While urgently needing evidence-based wellbeing strategies, participatory interventions using positive psychology have been under-investigated. We aimed to develop a caring, collegial NHS labour ward environment wherein HCWs created paths to enhancing individual and collective workplace wellbeing. METHODS: Insider Participatory Action Research (IPAR) used positive psychology within a social constructionist, pragmatic approach. All clinical and non-clinical HCWs on a consultant-led labour ward in the East Midlands, England, UK were invited to identify current sources of workplace wellbeing on which to collectively construct future ways of working. Qualitative data from several methods (below) were inductively thematically analysed. RESULTS: Between October 2018 and July 2020, data were generated from 83 paper and 13 online questionnaires; 59 interviews; three action groups; six peer participant reviewers; 16 comments on data displays; and three emails. Three themes represented sources of workplace wellbeing: emotional, professional, and physical nourishment. Culture shifted to be more compassionate and inclusive, and morale, positivity, and atmosphere improved. Ways of working changed. Colleagues more proactively cared for each other, worked well together in teams, expressed thanks and feedback, and instigated interventions for colleagues' and women's welfare. Participants proposed that IPAR activities prompted change including: the researcher being considered an accessible colleague wellbeing resource; raised awareness of the importance of HCW wellbeing; and strengthened HCW relationships. The HEARS wellbeing intervention model (HCW driven, Everyone involved, Ask what makes a person feel good at work, Responses displayed, Steps taken) was developed to frame processes by which HCW participation catalysed impact towards workplace wellbeing. CONCLUSIONS: To our knowledge, this is the first English language study using IPAR to enhance HCW wellbeing. Colleagues from diverse occupational groups improved individual and collective wellbeing through self-determined action. Using participatory methodology and positive psychology encouraged a more compassionate and inclusive culture. Subject to implementation research evaluating these strategies' impact in different settings, we propose the HEARS wellbeing intervention model and workplace-based Colleague Support Volunteers as actions towards wellbeing and retention in healthcare organisations
Severe accidental poisonings in children: a British Paediatric Surveillance Unit nationwide prospective study.
No full textBACKGROUND: Poisoning in children and young people is common. Understanding the incidence, causes and circumstances of severe accidental poisonings, requiring admission and medical intervention, may help healthcare professionals and shape public health interventions. METHODS: A prospective, population-based surveillance study using the British Paediatric Surveillance Unit (BPSU)'s active surveillance methodology (July 2018-July 2019) in the UK and Ireland. Inclusion criteria were as follows: all children aged <15 years; accidental poisoning requiring intervention; Poisoning Severity Score (PSS) score ≥2 (moderate or severe). Intentional poisonings were excluded. RESULTS: 116 cases of poisoning were reported, and 31 cases met the inclusion criteria. The overall incidence of reported severe accidental poisoning was 2.4 cases per million children (3.2 per million in male, 1.6 per million in female), with 7.3 cases per million in children under 2 years. On PSS scoring, 14 (45%) cases were classified as moderate, 16 (52%) cases severe and 1 (3%) case fatal. The frequency of fatal poisonings reported was 0.08 per million children. Prescription medications were the most common substance implicated (n=13, 42%), with opioids (n=6, 19%) being the most common medication group. Common non-medication causes were illicit drugs or alcohol (n=12, 39%), household or industrial products (n=5, 16%), and carbon monoxide (n=1, 3%). The most cited circumstance was 'the substance being left unattended' (n=8, 26%). CONCLUSION: Severe accidental poisoning remains a significant problem for children, but the most common causes have changed, underscoring the importance of updating public health initiatives
An exploration of successful psychosocial adjustment to long-term in-centre haemodialysis.
Get PDFOBJECTIVES: Haemodialysis extends life for people with end-stage kidney disease (ESKD) worldwide, but it imposes significant psychosocial burdens and there is little evidence about successful adjustment. This study aimed to improve understanding of successful psychosocial adjustment to in-centre haemodialysis (ICHD; dialysis in a hospital or satellite unit). METHODS: Individual semi-structured interviews were conducted with a purposive sample of 18 people with ESKD who had all received in-centre haemodialysis in the UK for at least 90 days in the last two years. An inductive thematic analysis was employed to identify themes from the verbatim interview transcripts. RESULTS: There were four themes: 1) reaching a state of acceptance, which described the importance of accepting the necessity of dialysis; 2) taking an active role in treatment, which described how being actively involved in treatment gave participants greater feelings of autonomy and control; 3) utilising social support networks, which described the benefits of instrumental and emotional support; and 4) building emotional resilience, which described the importance of optimism and positivity. CONCLUSIONS: The themes demonstrated elements of successful adjustment that could be targeted by interventions to promote psychological flexibility and positive adjustment among people receiving in-centre haemodialysis worldwide
The changing landscape of traumatic brain injuries at a district general hospital in a trauma network.
No full textAbstract: Background: Major trauma networks were introduced in 2012 onwards with a major trauma centre (MTC) linked to district general hospitals (DGH). Most traumatic brain injuries (TBI) are managed in DGHs, without on-site neurosurgical services. It is unclear whether the characteristics of TBIs at DGHs have differed since the network was introduced. We compare outcomes of TBI patients pre- (2008-2012) and post-MTC (2013-2021) network implementation. Methods: We conducted a retrospective analysis of TBI patients admitted to a 500-bedded DGH, before and after the introduction of a trauma network. We compared the characteristics of patients, including age, mechanism of injury, imaging findings, and length of stay. All statistical analyses were carried out in SPSS v29 (IBM).Results: Overall, 876 patients (males = 56.1%; median age 67 years) were included. Mean yearly cases pre-MTC was 76 compared to 55 in the post-MTC period. Mean age was significantly higher, and patients had more co-morbidities, in the post-MTC period (p < 0.001). Mean GCS at presentation was not significantly different between the pre- and post-MTC periods (13.7 vs 13.8, respectively). Referrals to the regional neurosurgical centre were significantly higher in the post-MTC period. The overall mortality rate was 33.7%. Increasing age (OR = 1.072), higher comorbidities (OR = 1.243) and intracerebral haematoma (OR = 6.269) were associated with a higher risk of death. The post-MTC period was associated with a lower risk of death (OR = 0.501). Conclusions: Fewer patients with less severe mechanisms of injury, and a more elderly population are now being managed at our DGH in the post-MTC period. Mortality was similar to published literature but the introduction of the trauma system was associated with lower risk of death. Although fewer TBIs help to optimise service delivery by maintaining orthopaedic bed capacity, the reduced exposure to these patients may lead to lowered expertise in managing these complex cases