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An analysis of publication trends in Science Letters published in Anaesthesia
No full textAnaesthesia has published peer reviewed Science Letters since November 2020. These are brief and concise articles that report original research. This format of scientific reporting is well placed to present information in a rapid and effective manner including initial data from ongoing research; significant findings from a secondary analysis; technical guidance; or opportunities for further investigatio
Costs and cost-effectiveness of community health worker programs on reproductive, maternal, newborn and child health in low- and middle-income countries (2015–2024): A scoping review
Full text linkCommunity Health Workers (CHWs) are vital in delivering primary health care in low- and middle-income countries (LMICs). To inform their broader rollout, this study updates a 2015 review, critically examining the costs, cost-effectiveness and affordability of reproductive, maternal, newborn and child health (RMNCH) CHW programs in LMICs. A scoping review was conducted using ten databases and grey literature, covering studies published between August 2015 and July 2024. Search terms related to “Community Health Workers” and “Economic Evaluations” were used. Studies were screened via Covidence software based on inclusion and exclusion criteria. Data on study methodology, costs, and outcomes were extracted, tabulated in Microsoft Excel, and analysed. Across 53 studies (21 about reproductive health, maternal and newborn care and 32 child health focused), covering 161 scenarios, the most common cost metrics for CHW-led interventions were cost per beneficiary (ranging from 1,547), cost per capita (ranging from 20.25), and cost per consultation (ranging from 52.91). Of 100 scenarios that assessed cost-effectiveness, the majority concluded CHWs were cost-effective, most frequently when compared against an alternative service or delivery modality, such as facility-based care, or the no-longer widely accepted threshold of a country’s gross domestic product per capita. Few studies assessed the affordability of CHW programs for government and/or partners. Evidence suggests that CHWs are often more cost-effective than alternative service or delivery modalities, particularly for child health. The evidence is however constrained by the heterogeneity of methods and reporting standards. To best guide future implementation of CHW programs, future research should focus on whether these interventions are affordable to governments and/or partners.</p
Geographic and Gender Representation in Authors of Editorials on Publications from Low- and Middle-Income Countries
No full textThe selection of authors for editorials reflects perceptions of expertise and influence. Our objectives were to determine author geographic and gender distribution, determine temporal trends in editorial authorship, and identify factors associated with the inclusion of authors affiliated with low- and middle-income countries (LMICs) in editorials on research conducted in LMICs. We conducted a cross-sectional study of editorials on research in LMICs published in 15 global health, pediatrics, and general medicine journals from 2014 to 2024. To assess temporal changes in authorship, we plotted the proportion of editorial authors affiliated with LMICs and those with female names by year. We used multivariable logistic regression to identify factors associated with the inclusion of one or more LMIC-affiliated authors. There were 107,629 publications and 1,350 editorials on research in LMICs with 2,401 authors. Authors of editorials were most often affiliated with institutions in North America (38.1%) and high-income countries (71.6%). The proportion of authors of editorials affiliated with institutions in high-income countries decreased from 84.9% in 2014 to 65.3% in 2024. Authors of editorials more commonly had male names than female (60.1% versus 38.7%, P <0.001). The proportion of editorial authors with female names increased from 32.1% in 2014 to 48.2% in 2024. Editorials accompanying publications reporting studies with larger sample sizes (aOR 5 1.52, 95% CI: 1.03–2.26) and research conducted in sub-Saharan Africa (aOR 5 2.84, 95% CI: 1.74–4.68) were more likely to include LMIC-affiliated authors. Additional efforts are needed to include authors affiliated with LMICs in editorials on research conducted in LMICs.</p
Travel-associated carbapenem-resistant organisms at a time of increasing geopolitical instability:a UK perspective
Full text linkBackground: Conflict and catastrophe compromise multi-national healthcare delivery and present risks for the spread of carbapenem-resistant organisms (CROs). The risk of and ability to detect travel-associated CROs in the UK remain unclear. Methods: A 10-question survey was sent to microbiology/infection prevention and control (IPC) practitioners of 108 UK acute NHS Trusts/Regions/Boards, exploring recent experience and IPC practices for travel-associated CROs and approaches to extended-spectrum antimicrobial testing. Additionally, major trauma network centres were invited to review detected carbapenemase-producing organism (CPO) molecular data from March 2022 to April 2024, comparing associated travel by the World Health Organization global region using one-way analysis of variance. Results: Seventy-three surveys were returned. IPC approaches were highly variable, with 19 of 73 (26.0%) centres requiring modification to national screening guidelines. Twenty-four of 73 (32.9%) centres reported CROs associated with recent travel to major conflict areas. Twelve major trauma network centres contributed to review of detected CPOs, finding 297 of 1290 (23.0%) individuals with travel to 52 different countries. In total, 227 of 297 (76.4%) were screening results; 279 of 297 (93.9%) were Enterobacterales. A total of 112 of 297 (37.7%) had travelled to Europe, where carbapenemase diversity was greater than elsewhere (P < 0.001).Interpretation: A considerable range of UK centres are detecting CROs associated with travel to areas of current major conflict. A more didactic approach to travel history on the first contact with healthcare services is required to stratify CPO risk at admission. These data should be collected prospectively in parallel with projects which successfully embed taking an effective travel history to assess the risk of travel-associated infectious disease. This will allow clearer understanding of travel behaviours and trends, delineate risk and inform effective IPC.</p
Asymptomatic school-age children carry the majority of transmissible Plasmodium falciparum infections
No full textBackgroundPersistent human-to-mosquito parasite transmission hinders malaria control in high burden settings. Understanding the human transmission reservoir can support the design of targeted interventions to reduce transmission.MethodsIn a year-long cohort study in rural Malawi, we used molecular methods to detect all Plasmodium falciparum (Pf) infections and those containing gametocytes, the parasite stage required for transmission, longitudinally at routine surveillance and sick visits. Using population-level analyses, we determined the demographic, temporal, and spatial clustering of infections containing gametocytes and gametocyte density, which predicts transmission.ResultsHere we show that gametocytes are not randomly distributed among the population or among individuals with Pf infections; gametocytes are detected in only 23% of the population. Among all participants, school-age children have significantly higher incidence of gametocyte-containing infections and high-density gametocyte infections compared to other groups. The presence of school-age children is a key driver of gametocyte frequencies and densities within households, even after adjusting for Pf infection levels. Based on the total gametocyte abundance in the population, we estimate that clearing infections from asymptomatic school-age children in the rainy season would decrease gametocyte abundance by 67% in the population.ConclusionsSchool-age children are the primary driver of ongoing Pf transmission in Malawi and interventions targeting school-age children are needed to effectively reduce Pf infection risk at a population level
Four-year monitoring of the malaria vector Anopheles funestus in central-west Cameroon reveals an escalation of pyrethroid resistance combined with high malaria transmission
Full text linkBackground: Insecticide resistance presents a critical obstacle to malaria vector control, necessitating ongoing surveillance to guide control strategy. Despite widespread resistance in central Africa, the temporal adaptive changes driving resistance at both phenotypic and genetic levels remain uncharacterised. This study provides a comprehensive, four-year (2020–2023) assessment of Anopheles funestus s.s. in Mibellon, Cameroon, examining sporozoite infection rates and changes in insecticide resistance relative to 2015–2018 data. Methods: Susceptibility profile, resistance intensity and cone assays were conducted following the WHO protocols. Sporozoite infection was detected in the mosquito head/thorax by TaqMan assay, confirmed by nested-PCR. Gene expression was assessed using RT-qPCR while insecticide resistance markers were genotyped using allele-specific PCR and LNA. Results: Plasmodium sporozoite infection rates ranged from 4 to 21% with the predominance of P. falciparum while P. malariae and P. ovale contributed often as mixed infections. Pyrethroid resistance significantly increased over time, with mortalities decreasing from 77.7% in 2015 to 23.2% in 2023 for permethrin and 46.6% in 2016 to just 8.5% in 2023 for deltamethrin, while full susceptibility was noted for organophosphates. Worryingly, high intensity of resistance was recorded for all pyrethroids. Partial recovery of susceptibility with PBO suggests other resistance mechanisms beside P450-based metabolic resistance. PBO-based nets yielded high efficacy which decreases slightly over time contrasting with complete loss in efficacy of pyrethroid-only nets. Monitoring the genetic markers revealed a rapid selection of G454A-CYP9K1 and 4.3 kb SV alleles, which increased considerably and reaching high frequency during the same period in which phenotypic resistance intensified. Other resistance markers (A296S-rdl and L119F-GSTe2) varied slightly in frequency while the N485I-Ace1, 6.5 kb SV, and CYP6P9a/b_R alleles were absent throughout the years. Consistent overexpression of CYP9K1 and CYP6P9a/b genes in pyrethroid-resistant mosquitoes highlights their potential role in resistance intensification. Conclusion: The high infection rate and co-circulation of three Plasmodium species coupled with intense pyrethroid resistance pose a serious menace to malaria control in this region. To address these complex challenges, current vector control strategies should prioritize the deployment of PBO-based nets and organophosphates for IRS.</p
Association between care by hypertension specialists and major adverse cardiovascular events in patients with uncontrolled hypertension
Full text linkBackground: The impact of medical care by hypertension specialists on the risk of subsequent major adverse cardiovascular events (MACE) among uncontrolled hypertensive patients remains unclear. We aimed to investigate the association between care by hypertension specialists and the risk of MACE among patients with uncontrolled hypertension. Methods: Using the Urumqi Hypertension Database (UHDATA), we studied a retrospective cohort of patients aged 45–79 years who were admitted for uncontrolled hypertension at People's Hospital of Xinjiang Uygur Autonomous Region, China, between 2015 and 2019. Based on hospitalization departments, we identified patients who had been exposed to medical care by hypertension specialists at least once and divided patients into a hypertension specialists group and a non-specialists group. Cox proportional hazards modeling was used to estimate the risk for MACE (a four-component outcome of cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, and coronary revascularization) in the cohort using the propensity score method of stabilized inverse probability of treatment weighting (sIPTW). Results: A total of 10,680 patients with uncontrolled hypertension were analyzed, with a median follow-up of 4.0 years. Of these, 5,646 (52.9%) patients received medical care by hypertension specialists and experienced fewer MACE than the non-specialists group [21.5 vs. 39.7 per 1,000-person-year, adjusted hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.57–0.79] after sIPTW. Results persisted for the MACE component, non-fatal stroke (HR 0.62, 95% CI 0.49–0.79), non-fatal myocardial infarction (HR 0.48, 95% CI 0.33–0.69), and coronary revascularization (HR 0.71, 95% CI 0.55–0.93). In subgroup analyses, no significant interaction effect was observed between medical care by hypertension specialists and key subgroup factors on MACE. Conclusions: This study demonstrated a significant association between medical care by hypertension specialists and a reduced risk of MACE in patients with uncontrolled hypertension. Our results suggest that medical care by hypertension specialists may play an essential role in improving cardiovascular outcomes among this high cardiovascular disease risk population.</p
Can commensals alter pathogen’s antibiotic resistance during co-culture?
No full textIntroduction. Bacterial infections of skin wounds can increase hospitalization duration and lead to worse patient prognoses, especially for burn wounds and diabetic foot ulcers. The two main pathogens which infect these wounds are Pseudomonas aeruginosa and Staphylococcus aureus. However, many other species can be present in wound infections, including skin commensal bacteria such as Staphylococcus epidermidis and Micrococcus luteus. Hypothesis. It was hypothesized that co-infection alters the antibiotic resistance of each species present. Aim. To investigate dual-species commensal-pathogen co-culture and assess the potential influence on the antibiotic resistance of each species. Methodology. The commensal and pathogenic species were grown either separately or in dual-species co-culture, potentially allowing biofilm formation for 24 h and were subsequently treated with antibiotics (ciprofloxacin or tobramycin). The impact of the co-culture growth was compared with single species cultures and the effect of the antimicrobial treatment on both conditions were assessed through Minimum Biofilm Eradication Concentrations (MBECs) and bacterial viable counts. Results. The viability of each bacterial species was reduced in the presence of other species, and this translated to reduced antibiotic resistance (lower MBECs) of P. aeruginosa in particular. The resistance of the other species appeared more dependent on the specific inter-species effects. Conclusion. The inclusion of a commensal species with pathogens in co-culture reduced the antibiotic resistance, and interspecies effects influenced the viability of the pathogens. More realistic antimicrobial resistance assessment protocols accounting for microbial communities could therefore lead to more effective treatments.</p
Trimester-specific exposure to multiple heat indicators and adverse birth outcomes across four European countries
Full text linkThe health of pregnant women and their fetuses is increasingly challenged by abnormal heat events. Few studies have disentangled the trimester-specific effects of heat exposure during pregnancy on perinatal outcomes and examined potential differences across multiple heat indicators. This study included singleton births from multiple national and region registries across Europe: Sweden (2014-2019), Belgium (2012-2022), Italy (Lazio Region) (2001-2019), and Greece (1999-2021). We obtained 2-m air temperature, Universal Thermal Climate Index (UTCI), Wet Bulb Globe Temperature (WBGT), and Heat Index data from the ERA5 reanalysis dataset. Our study outcomes were preterm birth (PTB), stillbirth (SB), small for gestational age (SGA), and large for gestational age (LGA). Cox proportional hazard models, with gestational age as the underlying time scale, were applied to evaluate trimester-specific associations between multiple heat indicators and adverse birth outcomes. Country-specific estimates were then combined through meta-analyses. In total, 4,924,422 mother-child pairs were included in the analysis. An increase in mean temperature from the 75th to the 99th percentile in the third trimester was associated with PTB (HR = 1.51, 95% CI: 1.34-1.71), SB (HR = 1.54, 95% CI: 1.44-1.65), SGA (HR = 1.16, 95% CI: 1.11-1.20), and LGA (HR = 1.12, 95% CI: 1.07-1.17). Comparable associations were observed across heat indicators and countries for each trimester. Our findings suggest that the third trimester is a critical exposure window of vulnerability for heat during pregnancy. The comparable effect estimates among heat indicators highlight the usefulness of mean air temperature in Europe.</p
Can commensals alter pathogen’s antibiotic resistance during co-culture?
No full textIntroduction. Bacterial infections of skin wounds can increase hospitalization duration and lead to worse patient prognoses, especially for burn wounds and diabetic foot ulcers. The two main pathogens which infect these wounds are Pseudomonas aeruginosa and Staphylococcus aureus. However, many other species can be present in wound infections, including skin commensal bacteria such as Staphylococcus epidermidis and Micrococcus luteus. Hypothesis. It was hypothesized that co-infection alters the antibiotic resistance of each species present. Aim. To investigate dual-species commensal-pathogen co-culture and assess the potential influence on the antibiotic resistance of each species. Methodology. The commensal and pathogenic species were grown either separately or in dual-species co-culture, potentially allowing biofilm formation for 24 h and were subsequently treated with antibiotics (ciprofloxacin or tobramycin). The impact of the co-culture growth was compared with single species cultures and the effect of the antimicrobial treatment on both conditions were assessed through Minimum Biofilm Eradication Concentrations (MBECs) and bacterial viable counts. Results. The viability of each bacterial species was reduced in the presence of other species, and this translated to reduced antibiotic resistance (lower MBECs) of P. aeruginosa in particular. The resistance of the other species appeared more dependent on the specific inter-species effects. Conclusion. The inclusion of a commensal species with pathogens in co-culture reduced the antibiotic resistance, and interspecies effects influenced the viability of the pathogens. More realistic antimicrobial resistance assessment protocols accounting for microbial communities could therefore lead to more effective treatments.</p