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Disparities in Stillbirths in England: Analysis of A Population‐Based Study of 1.3 Million Births
Get PDFObjective
To examine the variation in stillbirth rates between different ethnic and socioeconomic groups within each organisational hospital group (health trust).
Design
National registry study.
Setting
All health trusts (HT) in National Health Service England.
Population
All mothers and babies born between April 2015 and March 2017.
Methods
This observational study examined ethnic and socioeconomic disparities in stillbirth rates for 1 268 367 births in 133 HTs compared to the national average.
Outcome
Stillbirth at or after 24 gestational weeks.
Results
The average stillbirth rates ranged from 3.4/1000 births for White women up to 7.1/1000 births for Black women. The rates ranged from 2.9/1000 births for women living in the least deprived areas to 4.7/1000 births for those in the most deprived. The proportions of HTs with stillbirth rates well above the national average (more than 2 standard deviations) for White, Asian and Black women were 0.8%, 21.8% and 38.6%, respectively. When HTs were ranked by stillbirth rate, there were notable variations, with some trusts demonstrating lower than average stillbirth rates for White women while concurrently having higher than average stillbirth rates for Asian and/or Black women. There were no units exhibiting lower than national average stillbirth rates for Asian/Black women while concurrently having higher than average stillbirth rates for White women.
Conclusions
These findings suggest that access to and delivery of maternity care vary depending on the mother's ethnicity and level of socioeconomic deprivation. Social factors are likely determinants of inequality in stillbirth rather than maternity care alone
Sociodemographic Factors Associated With Established and Novel Antenatal Vaccination Uptake in a Cohort of Pregnant Women in Uganda.
Get PDFINTRODUCTION: Vaccination is a key strategy to safeguard the health of pregnant women and newborns. Although vaccine acceptance is often higher in low- and middle-income countries, the COVID-19 pandemic has highlighted increasing vaccine hesitancy. Vaccine hesitancy, specifically in pregnant women, must be understood to increase uptake. We used data from a Ugandan pregnancy registry study to examine sociodemographic factors linked to uptake of vaccines (tetanus toxoid and later COVID-19) in pregnancy. METHODS: Pregnant women were recruited in Kampala, Uganda, as part of the PREPARE (Prevention of invasive Group B Streptococcus disease in young infants: a pathway for the evaluation & licensure of an investigational maternal GBS vaccine) study from September 1, 2020 until February 24, 2022. Demographic, socioeconomic and obstetric data were collected alongside COVID-19 and tetanus vaccination. RESULTS: One thousand five hundred sixty-eight participants were included: 151 (10%) were unvaccinated, 11 (1%) received COVID-19 vaccine only, 1230 (78%) received a tetanus vaccine only and 176 (11%) received both. Lower vaccination rates were seen in participants attending fewer than 4 antenatal care episodes (P < 0.001), and those with higher parity (P = 0.036). Higher vaccination rates were seen with a managerial or professional occupation or higher maternal education level, but paternal occupation was not significantly associated with maternal vaccination. Parish vaccination rates varied from 0% to 100%, with 49 (29%) of parishes showing a vaccination rate <90%. CONCLUSIONS: This study highlights antenatal care as a key route for health promotion, and the stark difference in uptake between new and established antenatal vaccines. Further qualitative studies should investigate effective interventions to establish the safety and benefit of newer maternal vaccines across all demographic groups
Population Pharmacokinetics of Rifampicin in Plasma and Cerebrospinal Fluid in Adults With Tuberculosis Meningitis
Get PDFBackground
Several ongoing clinical trials are evaluating high-dose rifampicin (up to 35 mg/kg) for tuberculous meningitis (TBM). However, rifampicin pharmacokinetics at higher doses is not fully characterized, particularly in cerebrospinal fluid (CSF), the site of TBM disease.
Methods
In a randomized controlled trial, adults with HIV-associated TBM were assigned to experimental arms of high-dose rifampicin (oral, 35 mg/kg; intravenous, 20 mg/kg) plus linezolid, with or without aspirin, or a control arm that received the standard of care with 10 mg/kg of oral rifampicin. Rifampicin concentrations, including the unbound fraction, were measured on plasma samples, and CSF was collected on days 3 and 28 of study enrollment. Data were analyzed by nonlinear mixed effects modeling.
Results
In total, 400 plasma and 44 CSF rifampicin concentrations from 48 participants were used for model development. The median (range) age and weight were 39 years (25–78) and 60 kg (30–107). Rifampicin pharmacokinetics was best described by a 2-compartment disposition model with first-order transit oral absorption and elimination via saturable hepatic extraction. Typical clearance values for the standard dose for days 3 and 28 were 33.1 and 41.4 L/h, respectively; high-dose values were 46.1 and 70.2 L/h. The CSF-plasma ratio was approximately 6% and the equilibration half-life was 3.2 hours. Simulated standard-dose rifampicin did not reach CSF concentrations above the critical concentration for Mycobacterium tuberculosis.
Conclusions
CSF penetration with standard-dose rifampicin is low. Our findings support continued evaluation of high-dose rifampicin for TBM treatment
Long COVID prevalence and risk factors in adults residing in middle- and high-income countries: secondary analysis of the multinational Anti-Coronavirus Therapies (ACT) trials
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During the recent COVID-19 pandemic, reports of long-term persistence or recurrence of symptoms after SARS-CoV-2 infection emerged, which are now collectively referred to as ‘long COVID’. Most descriptions of long COVID originate from patients residing in high-income countries. We set out to characterise long COVID in a large-scale clinical trial that was conducted in low-middle, high-middle and high-income countries.
Methods
The Anti-Coronavirus Therapies trials enrolled 6528 adult patients with symptomatic COVID-19 in Argentina, Brazil, Canada, Colombia, Ecuador, Egypt, India, Nepal, Pakistan, Philippines, Russia, Saudi Arabia, South Africa and the United Arab Emirates. Long COVID was defined as the presence of patient-reported symptoms at 180 days after enrolment. Multivariable logistic regression was used to evaluate associations of baseline characteristics with long COVID.
Results
Of 4697 included participants, 1181 (25.1%) reported long COVID symptoms. The most frequently reported symptoms were sleeping disorders (n=601; 12.8%), joint pain (n=461; 9.8%), fatigue (n=410; 8.7%) and headaches (n=382; 8.1%). Long COVID prevalence was higher in participants from lower middle-income compared with high-income countries (29.8% (850/2854) vs 14.4% (102/706); adjusted OR (aOR) 1.53 (1.10 to 2.14); p=0.012). Prevalence also varied between participants of different ethnic backgrounds and was highest (36.1% (775/2145)) for patients of Arab/North African ethnicity. Patients requiring inpatient admission were at increased risk of long COVID (aOR: 2.04 (1.63 to 2.54); p<0.001). Other independent predictors of long COVID were male sex, older age and hypertension. Vaccination, prior lung disease, smoking and diabetes mellitus conferred protective effects.
Conclusion
Symptoms of long COVID are reported in a quarter of cases of symptomatic COVID-19 in this study and were significantly more prevalent in participants from countries with lower income status and in patients of Arab/North African ethnicity. Research to further assess the health burden posed by long COVID in low- and middle-income countries is urgently needed
Exploring TikTok's influence on surgical patient education
Get PDFIntroduction
Social media platforms, especially rapidly growing ones like TikTok, are increasingly used to disseminate health information. Its interactive features promote user participation, allowing for the sharing of experiences and raising awareness about specific medical conditions, while also simplifying complex procedures. This study aimed to explore the possible influence of TikTok short-video application on the education of surgical patients.
Methods
A systematic search was performed in compliance with the PRISMA checklist. The research protocol was registered with the PROSPERO register (CRD42024551646). A search was performed in the PubMed and ScienceDirect databases from inception to 2024. The search terms used were “TikTok AND Surgery,” “TikTok AND Surgical Education,” and “TikTok AND surgery AND patient."
Results
The present systematic search resulted in 697 citations, of which 50 relevant citations were included. The search revealed that TikTok has widely used among patients from different surgical specialties and has an influence on their education. The platform facilitates public health awareness, allowing surgeons to share educational content, including surgical techniques and patient-oriented information.
Conclusion
As one of the rapidly growing social media platforms, TikTok is increasingly utilised to disseminate health information. It has been adopted across various surgical specialties. While the platform presents a great opportunity to improve the education of surgical patients, it presents challenges related to the accuracy of information, potential misinformation, and lack of regulation. Surgeons and healthcare professionals should actively participate in creating accurate, evidence-based content that enhances patient education and promotes public health awareness
Self-Administered Etripamil and Emergency Department Visits in Supraventricular Tachycardia A Secondary Analysis of a Randomized Clinical Trial
Get PDFThis secondary analysis of a randomized clinical trial describes the use of emergency care after self-administration of etripamil by patients experiencing paroxysmal supraventricular tachycardia episodes at home
Standardization and quality control of the introduction of a noninvasive cardiac output monitor for pregnancy measurements in a low- and middle-income country
Get PDFIntroduction
There is increasing awareness of the role of the maternal cardiovascular system in complicated pregnancies. Despite the high disease burden, noninvasive cardiac output monitors have not been used extensively in low‐ and middle‐income countries. The aim of this study was to evaluate the quality control of the use of the ultrasonic cardiac output monitor (USCOM) 1A® in a LMIC.
Material and Methods
This was a quality assessment study of the introduction of the USCOM 1A® to measure maternal hemodynamic indices. Inter‐observer agreement was assessed across all four study sites by intraclass correlation coefficient. Quality control was assessed using pre‐defined acceptability criteria, rated by 2 independent scorers.
Results
On average, nurses or midwives needed to obtain 30.4 (range 24–36) Doppler waveform recordings to be deemed competent to undertake USCOM 1A® measurements. There was very good inter‐observer agreement across all 4 sites (intraclass correlation coefficient 0.86–0.93, all p < 0.001). A total of 138 images were randomly selected for quality review. Overall, 79 (89.8%) images were considered acceptable by both scorers; 4 (6.9%) were considered unacceptable by both scorers; and there was disagreement in 5 (5.7%) cases. Overall agreement was 94.3%. Agreement as assessed by Fleiss' kappa, was moderate (0.585 [95% CI 0.376–0.794], p < 0.001).
Conclusions
Using a robust learning package and clearly defined image criteria, a novel cardiac‐output monitor can be successfully introduced into low‐ and middle‐income countries, in the context of research. Ongoing quality control measures are imperative to maintain the integrity of planned future studies using USCOM 1A®
Defining Chronic Myocyte Injury With hs-cTnT: The Importance of Serial Measurements and the Value of hs-cTnI
Get PDFBACKGROUND: There is increasing awareness of the differing characteristics of troponin subunits. CASE SUMMARY: We present a case where an elevation of high-sensitivity troponin T (hs-cTnT) (>6× 99th percentile) beyond the single-sample rule-in threshold led to an erroneous diagnosis of acute coronary syndrome (ACS). After exhaustive biochemical tests proving chronic myocardial injury, we also determined that 4 different high sensitivity assays for troponin I revealed values well below their respective 99th percentiles. This uniquely highlights the difference in troponin subunit characteristics in chronic myocyte injury and dispels any notion that the difference relates to assay characteristics. DISCUSSION: Chronic elevations of hs-cTnT can be sufficiently large to surpass single rule-in thresholds in some ACS pathways, but this case stresses the importance of the delta value regardless of the degree of elevation of the presentation sample. In cases of diagnostic doubt for ACS, clinicians should consider measuring hs-cTnI as an alternative troponin
Risk factors for hospital admission and length of stay for children with and without congenital anomalies: a EUROlinkCAT cohort study.
Get PDFOBJECTIVE: To evaluate risk factors for hospital admission and length of stay (LOS) among children with and without congenital anomalies (CAs). DESIGN: A population-based linkage cohort study including 50 353 children with major CAs and 1 259 925 children without CAs from four EUROCAT registry areas in three countries. Data on children born 1995-2014 were linked to hospital discharge databases 1995-2015. HRs and incidence rate ratios estimated risk of admission and LOS for children aged <1 and 1-4 years by birth cohort, gestational age, sex, maternal age, multiple births and maternal education. Estimates were pooled using random effects meta-analysis. RESULTS: In children <1 year, twins/triplets with CAs were 34% more likely to be admitted and had over two times the LOS compared with singletons, while twins/triplets without CAs were over two and a half times as likely to be admitted and had six times longer stays. Despite this, a higher proportion of twins/triplets with CAs were admitted compared to those without CAs (91% vs 65%) and had longer LOS (20 days vs 10). Smaller increases in risk of admission or LOS were found in boys, young mothers and low maternal education. Preterm birth was a major risk factor for admission and LOS. CONCLUSIONS: While the impact of risk factors on hospital admission and LOS was generally greater in children without CAs, a higher proportion of children with CAs were admitted and had longer stays. These findings have implications for health care planning and for counselling parents regarding their child's future healthcare needs
Heterologous COVID-19 vaccine schedule with protein-based prime (NVX-CoV2373) and mRNA boost (BNT162b2) induces strong humoral responses: Results from COV-BOOST trial
Get PDFBACKGROUND: Heterologous schedules of booster vaccines for COVID-19 following initial doses of mRNA or adenoviral vector vaccines have been shown to be safe and immunogenic. There are few data on booster doses following initial doses of protein nanoparticle vaccines. METHODS: Participants of the phase 3 clinical trial of the COVID-19 vaccine NVX-CoV2373 (EudraCT 2020-004123-16) enroled between September 28 and November 28, 2020, who received 2 doses of NVX-CoV2373 administered 21 days apart were invited to receive a third dose booster vaccine of BNT162b2 (wild type mRNA vaccine) as a sub-study of the COV-BOOST clinical trial, and were followed up for assessment of safety, reactogenicity and immunogenicity to day 242 post-booster. RESULTS: The BNT162b2 booster following two doses of NVX-COV2373 was well-tolerated. Most adverse events were mild to moderate, with no serious vaccine-related adverse events reported. Immunogenicity analysis showed a significant increase in spike IgG titres and T-cell responses post-third dose booster. Specifically, IgG levels peaked at day 14 with a geometric mean concentration (GMC) of 216,255 ELISA laboratory units (ELU)/mL (95% CI 191,083-244,743). The geometric mean fold increase from baseline to day 28 post-boost was 168.6 (95% CI 117.5-241.8). Spike IgG titres were sustained above baseline levels at day 242 with a GMC of 58,686 ELU/mL (95% CI 48,954-74,652), with significant decay between days 28 and 84 (geometric mean ratio 0.58, 95% CI 0.53-0.63). T-cell responses also demonstrated enhancement post-booster, with a geometric mean fold increase of 5.1 (95% CI 2.9-9.0) at day 14 in fresh samples and 3.0 (95% CI 1.8-4.9) in frozen samples as measured by ELISpot. In an exploratory analysis, participants who received BNT162b2 after two doses of NVX-COV2373 exhibited higher anti-spike IgG at Day 28 than those who received homologous three doses of BNT162b2, with a GMR of 5.02 (95% CI: 3.17-7.94). This trend remained consistent across all time points, indicating a similar decay rate between the two schedules. CONCLUSIONS: A BNT162b2 third dose booster dose in individuals primed with two doses of NVX-COV2373 is safe and induces strong and durable immunogenic responses, higher than seen in other comparable studies. These findings support the use and investigation of heterologous booster strategies and early investigation of heterologous vaccine technology schedules should be a priority in the development of vaccines against new pathogens
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