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Inequalities in road traffic noise exposure levels in greenspaces in Greater London
Full text linkExposure to road traffic noise in residential settings has been associated with detrimental effects on health including annoyance, sleep disturbance, cardiometabolic outcomes, and mental health. Conversely, exposure to natural sounds improves cognitive performance and aids in stress recovery in humans. Environmental exposure studies have shown that the distribution of noise exposures is often not equitable across cities, but evidence related to noise in UK greenspaces remains limited. This study provides an analysis of noise variability and inequalities in noise levels for greenspaces in Greater London related to residential addresses. Noise levels from major and minor roads were modelled across 2,532 greenspaces for the daytime and evening period in accordance with the European Commission Common Framework for Noise Assessment (CNOSSOS-EU) methods from Environment Noise Directive 2002/49/EC and the inverse square law of sound attenuation. Using modelled road traffic noise estimates, we found that 28 % of greenspaces exceeded equivalent World Health Organization noise guideline levels during daytime and evening periods. Greenspaces in Central London were more likely to have noise levels that exceeded the WHO noise guidelines. Distance-based proximity analyses showed that for populations in Central London, greenspace areas nearest to residential addresses were more likely to feature high noise levels. As distance travelled from residential locations increased, the distribution of high greenspace noise levels became more dispersed. However, no inequality gradient was observed between different deprivation groups, except for the least deprived communities', who experienced noise levels that were 2 dB lower within greenspace areas within a 5 km radius
Preventing kidney injury using carbon dioxide (KID trial): trial protocol for a multicentre randomised controlled trial
No full textIntroduction Peripheral arterial disease (PAD) commonly coexists with chronic kidney disease (CKD). Patients with symptomatic PAD often require endovascular revascularisation to relieve pain or salvage limbs. However, the iodinated intra-arterial contrast routinely used in these procedures is nephrotoxic, placing patients with CKD at increased risk of acute kidney injury (AKI) and long-term renal decline. Carbon dioxide (CO₂) delivered via automated injection is a potential alternative imaging contrast medium. This trial will evaluate whether using CO₂ instead of iodinated contrast reduces the risk of AKI and short-term renal function decline in this high-risk group.
Methods and analysis This is a multicentre, open-label, prospective randomised controlled trial across six secondary-care National Health Service (NHS) vascular surgery centres. A total of 174 patients with PAD and CKD undergoing endovascular intervention will be randomised 1:1 to receive iodinated contrast (standard of care) or CO₂ via automated injector (Angiodroid). All perioperative care will follow local NHS protocols.
The primary outcome is log serum creatinine at 2, 30 and 90 days postprocedure. Key secondary outcomes include: incidence and severity of AKI within 48 hours postprocedure, major adverse kidney events (death, dialysis or >25% estimated glomerular filtration rate decline) by 90 days, inpatient length of stay, procedural pain, quality of life, procedural success, reinterventions, acceptability and feasibility (patient/practitioner questionnaires) of using CO2, and cost-effectiveness (healthcare resource use analysis). A mixed-methods process evaluation will be undertaken with patients and clinicians.
Ethics and dissemination The trial has been approved by an NHS ethical review committee (24/WA/0332) and patients have been involved in trial design. Findings will be disseminated to participants, clinicians and the wider public through patient groups, lay summaries, social media, conferences, peer-reviewed journals and NHS policy channels.
Trial registration number ISRCTN23564393
Predictors of suicidal ideation in UK doctors: retrospective case–control study from NHS Practitioner Health
Full text linkBackground
Depression severity is a well-established risk factor for suicidal ideation, but the extent to which sociodemographic and employment-related factors contribute independently remains unclear.
Aims
Complete data from doctors (N = 4055) presenting to National Health Service Practitioner Health (NHS-PH) in 2022–2023 were used to test the hypothesis that depression severity is the largest determinant of suicide ideation risk (defined by Patient Health Questionnaire 9 (PHQ-9) question 9 score) among doctors.
Method
Using PHQ-8 score (PHQ-9, excluding the item on suicide ideation) as a proxy for depression severity, the case–control discriminatory capacity of receiver operating characteristic curves (AUCs) were evaluated for (a) a univariable model studying modified PHQ-9 alone as the predictor of severe suicide ideation; and (b) a multivariable model integrating modified PHQ-9 and multiple sociodemographic and employment factors as the predictor of severe suicide ideation. Models were compared both descriptively and through a likelihood ratio test.
Results
The univariable model using depression severity alone as the predictor of severe suicide ideation yielded an AUC of 0.921. The addition of sociodemographic and employment factors improved the fit significantly (likelihood ratio test with (χ2(14) = 50.26, P < 0.001), amended AUC 0.930). Having both a disability and a relationship status of ‘no partner’ was significantly independently associated with suicide ideation in the multivariable model.
Conclusions
In this national cohort of doctors, depression severity was strongly associated with suicidal ideation. However, disability and lack of a partner were also independently linked to increased risk, suggesting that suicidal ideation is not solely driven by symptom severity. Social and functional factors may help identify higher-risk individuals and inform targeted support
Improved protocols for isolation of Mycobacterium ulcerans from clinical samples
Full text linkBackground
The isolation and culture of Mycobacterium ulcerans (Mu) as a primary diagnostic modality for Buruli ulcer (BU) disease are limiting due to their low sensitivity and slow-growing nature. M. ulcerans cultures can also be overgrown with other bacteria and fungi. Culture, however, remains an important tool for the study of persisting viable M. ulcerans, drug susceptibility tests, and other molecular assays to improve management of the disease. The challenge of contamination with other fast-growing bacteria necessitates decontamination of clinical samples prior to culturing, but current methods may be too harsh, resulting in low yields of M. ulcerans. We aimed to evaluate a Tika-Kic decontamination process for M. ulcerans that uses supplements to stimulate M. ulcerans growth to improve recovery.
Methods
Swab and Fine Needle Aspirate (FNA) samples were collected from 21 individuals with confirmed BU at baseline (week 0) and weeks 2 and 4 after initiating antibiotic treatment. Samples were decontaminated with Tika-Kic decontamination medium and the modified Petroff (NaOH) methods then inoculated each into Mycobacterium Growth Indicator Tube (MGIT) or Löwenstein Jensen (LJ) medium. Time to growth detection and confirmation by qPCR as well as the proportion of positive cultures for all three methods and the proportion of positive cultures for all three time points were documented. Common contaminating bacteria were also isolated and identified.
Results
The proportion of M. ulcerans positive cultures obtained was higher for Tika-MGIT samples [14/43 (32%)] compared to Petroff-MGIT samples [10/43 (23%)] and Petroff-LJ samples [8/43 (19%)]. Baseline samples had a higher isolate proportion [17 (53%)] compared to samples collected after treatment initiation [9 (28%) for week 2 and 6 (19%) for week 4]. Contaminating bacteria isolated include Burkholderia cepacia, Pseudomonas aeruginosa, Pasteurella pneumotropica, Proteus mirabilis, Morganella morganii, Staphylococcus aureus and Enterococcus.
Conclusion
Our study shows an advantage for culturing Mycobacterium ulcerans from clinical samples using the Tika-Kic decontamination and growth medium. Further research is needed to refine sample processing to improve M. ulcerans recovery
Rapid Point-of-care Testing to Inform Intrapartum Treatment of Group B Streptococcus-Colonized Women in Uganda
Full text linkIntroduction
Maternal Group B Streptococcus (GBS) rectovaginal colonization is an important risk factor for invasive disease in neonates, yet availability of culture-based methods for detection is limited in low-resource settings. We evaluated the diagnostic performance of the HiberGene (HG) GBS loop-mediated isothermal amplification (LAMP) assay for the rapid detection of GBS in rectal/vaginal swabs collected from women in Uganda. This work forms a part of the PROGRESS GBS study.
Methods
In phase 1, 1294 rectal and vaginal swabs were collected from pregnant women and inoculated in enrichment (Lim) broth, which was then tested using the HG GBS LAMP assay (sip gene target) and culture on chromogenic agar. In phase 2, 166 swabs from nonpregnant women were tested directly (without the enrichment step). For samples with discordant results, an additional method of testing against multiplex real-time polymerase chain reaction assay was used.
Results
Overall, the HG GBS LAMP assay detected more GBS-positive samples (31.3%; 452/1445) than culture-based methods (13.3%; 192/1445). Multiplex polymerase chain reaction–tested results were concordant with LAMP results in 96.3% of cases. The sensitivity and specificity of the LAMP assay, after adjusting for the tiebreaker results of discordant samples, were 94.4% (95% confidence interval, 86.2–99.4) and 99.0% (95% confidence interval, 94.3–100), respectively.
Conclusions
The results of this study demonstrate high sensitivity and specificity of the HG GBS LAMP assay for the detection of GBS rectovaginal colonization in our setting. Given its rapid turnaround time, the HG GBS LAMP assay could appropriately be used to screen women for GBS rectovaginal colonization during labor to enable provision of intrapartum antibiotic prophylaxis
Adverse neonatal outcomes in small-for-gestational age twins identified using twin vs singleton growth charts: systematic review and meta-analysis
Full text linkObjective
To evaluate the use of twin vs singleton growth charts for detecting small‐for‐gestational‐age (SGA) twins at risk of adverse neonatal outcomes.
Methods
MEDLINE, EMBASE, CINAHL, Cochrane and Scopus databases were searched electronically from inception to May 2024. The primary outcome of this meta‐analysis was the risk of composite adverse neonatal outcome in SGA fetuses in a twin pregnancy diagnosed using twin or singleton charts. The secondary outcomes included: neonatal intensive care unit (NICU) admission, oxygen supplementation or continuous positive airway pressure, mechanical ventilation, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, neonatal sepsis and neonatal mortality. Prospective and retrospective studies on neonatal outcomes of monochorionic or diamniotic twins diagnosed with SGA using both singleton and twin charts based on estimated fetal weight or birth weight were considered suitable for inclusion. Quality assessment of the included studies was performed using the Newcastle–Ottawa Scale for cohort studies. Random‐effects head‐to‐head meta‐analyses were used to analyze the data.
Results
Six studies were included in the systematic review and five studies, including 10 554 twin pregnancies, were included in the meta‐analysis. The risk of composite adverse neonatal outcome (OR, 3.11 (95% CI, 1.83–5.26)) and that of most secondary outcomes was significantly higher in SGA fetuses diagnosed using twin charts compared with those diagnosed using singleton charts. Conversely, the risk of composite adverse neonatal outcome (OR, 1.22 (95% CI, 0.73–2.04)) and most secondary outcomes was similar when comparing SGA fetuses diagnosed using singleton charts vs non‐SGA fetuses diagnosed using twin charts, except for the risk of NICU admission, which was significantly higher in SGA fetuses diagnosed using singleton charts. When comparing non‐SGA fetuses diagnosed using twin charts vs non‐SGA fetuses diagnosed using singleton charts, the risk of composite adverse neonatal outcome was significantly lower when using twin charts (OR, 0.90 (95% CI, 0.83–0.97)). Finally, when comparing SGA vs non‐SGA fetuses diagnosed using singleton charts, there was no significant difference for the primary or secondary outcomes, except for a higher risk of NICU admission in the SGA group (OR, 1.54 (95% CI, 1.11–2.12)). Twin charts had lower sensitivity than singleton charts in predicting adverse neonatal outcome (14% (95% CI, 7–26%) vs 32% (95% CI, 24–41%)), but higher specificity (95% (95% CI, 86–98%) vs 71% (95% CI, 63–77%)).
Conclusions
Twin charts increase the specificity but reduce the sensitivity for the detection of SGA compared with singleton charts. Nevertheless, twin charts detect cases at higher risk of adverse neonatal outcome, which may be the cases that require intervention. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology
Consultation report – considerations for a regulatory pathway for bivalent Salmonella Typhi/Paratyphi A vaccines for use in endemic countries
Full text linkEnteric fever caused by Salmonella enterica serovars Typhi and Paratyphi A and, to a lesser extent, S. Paratyphi B and C, remains a significant cause of mortality and morbidity in resource-constrained settings. Typhoid conjugate vaccines (TCVs) protect against S. Typhi but no vaccine to date protects against paratyphoid fever. There are several bivalent S. Typhi/Paratyphi A products in development; however, the low incidence of paratyphoid fever in many settings limits the feasibility of phase 3 efficacy studies. Two bivalent vaccines adding the S. Paratyphi A-specific O:2 lipopolysaccharide conjugated to a protein carrier to TCV constructs have successfully completed phase 1 studies and will progress rapidly in their development.
The WHO's Product Development for Vaccines Advisory Committee (PDVAC) endorsed a regulatory pathway for a bivalent S. Typhi/Paratyphi A vaccine that contemplates demonstrating protective efficacy against S. Paratyphi A infection in a controlled human infection model (CHIM). Since the use of CHIM data in lieu of phase 3 efficacy studies and to identify markers of immune protection is not yet widely accepted by regulatory bodies, the WHO organized a consultation with vaccine developers, manufacturers, and regulators. The purpose of the meeting was to discuss the feasibility and considerations for the licensure of a bivalent S. Typhi/Paratyphi A vaccine. The aim of the consultation was to gain alignment among key stakeholders and facilitate the pathway to licensure in endemic countries
Optimization of renin-angiotensin-aldosterone inhibitor therapies for evidence-based indications: A call to action from the cardio-kidney community
Full text linkPatient knowledge, attitudes and behaviors related to antimicrobial use in South African primary healthcare settings: development and testing of the CAMUS and its implications
Full text linkBackground: Antimicrobial resistance (AMR) poses a global health threat, particularly in low- and middle-income countries (LMICs) including South Africa where limited resources and knowledge gaps exacerbate inappropriate antimicrobial use. To address this, the community antimicrobial use scale (CAMUS) was developed to assess patients’ knowledge, attitudes and behaviors regarding antimicrobial use in South African primary healthcare (PHC) settings, with the aim of informing antimicrobial stewardship (AMS) strategies.
Methods: Development of the CAMUS was informed by a scoping review and theoretical constructs from the Health Belief Model, Social Cognitive Theory, and Theory of Planned Behavior. A pilot study was subsequently conducted in two South African districts, an urban and a rural district, with 30 adult participants to provide insights into patients’ understanding of the items. Data collection involved administering CAMUS alongside a health literacy test followed by cognitive interviews to refine clarity and ensure understanding. A feasibility assessment was also conducted to evaluate the practical use of CAMUS in PHC settings.
Results: Participants demonstrated varied knowledge of antimicrobial use. While 60% correctly identified antibiotics as effective for bacterial infections, 93.33% incorrectly believed antibiotics could treat viral illnesses such as colds. Marginal health literacy was prevalent (86.67%). The CAMUS demonstrated feasibility, with an average completion time of 10 minutes. Questions were iteratively revised to improve future clarity and relevance based on the results of the cognitive interviews. Key findings highlighted misconceptions about antibiotics and the influence of social norms and systemic barriers on antimicrobial use behaviors.
Conclusion: The CAMUS effectively captures the knowledge, attitudes and behaviors of antimicrobial use in South African PHC settings. Pilot testing demonstrated its feasibility to use it as a tool to assess patient knowledge, attitudes and behaviors related to antimicrobial use in a larger population, to subsequently guide AMS initiatives by addressing knowledge gaps and related barriers to improve future antimicrobial use. Future research will include development of a shorter version of the CAMUS, followed by validation in larger, more diverse populations and in local languages to enhance its usability when investigating antimicrobial use and AMR across LMICs
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