11237 research outputs found
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Evaluation of determinants, acceptability and effectiveness of community-based management of multidrug-resistant tuberculosis (MDR-TB) in Nigeria
No full textBackground: Growing multidrug-resistant tuberculosis (MDR-TB) worldwide and new effective and affordable treatment modalities required exploration of options such as the community model of MDR-TB treatment (CM), as introduced in Nigeria. This study explores its acceptability implementation and follow-up for infection control, programme characteristics influencing the model outcomes, economic impact, and cost-effectiveness. The study also evaluates the Nigerian experience of the End TB Strategy target of impoverishment due to MDR-TB.Methods: Mixed methods were employed. Qualitative data were obtained from semi-structured interviews with 21 MDR-TB patients in Nigeria. An iterative interview process with adapted topic guides led to data saturation, and themes emerged inductively from thematic analysis. Effectiveness and cost-effectiveness analysis compares community (CM) and hospital-based MDR-TB care (HM). We assessed treatment outcomes data from the medical records of 423 MDR-TB patients to evaluate the effectiveness of HM and CM based on WHO treatment criteria. Treatment success” is defined as the sum of cure and treatment completion. “Cure” is the “treatment completion” with at least three negative cultures taken at least 30 days apart after the intensive phase in the absence of “treatment failure. Costs were assessed from a societal perspective and included health system costs and a cross-sectional survey of MDR-TB patients at different stages of treatment to obtain direct and indirect costs. Cost-effectiveness was calculated as the cost per patient successfully treated and incremental cost-effectiveness ratio (ICER) per patient cured or successful treatment. We also assessed the expected costs and health effects of HM vs CM using a decision-analytic model from the perspective of the Nigerian national healthcare system.Findings: Emergent themes indicate strong patient preference and acceptability of CM; mixed feelings about the risk and points of MDR-TB transmission; stigma influencing infection control and community support worker attitudes influencing the expansion of resistance. The median monthly cost incurred by patients was higher in HM than in CM, with US 28.72 (IQR: 13.68–38.40) (p Conclusion: Community-based-MDR-TB was seen as the patients' most preferred and acceptable model because of its convenience, which enhanced recovery, enabled social interaction, and promoted mental health. It also allowed economic productivity and earning potential. It improved the health system, patient affordability, and cost-effectiveness at ICER of US $-1190. However, CM was challenged by ineffective supervision and the need for more commitment among patients and community support workers to reducing community transmission. Despite social protection, patients experienced further impoverishment. The level of impoverishment experienced by MDR-TB patients in Nigeria suggests that it requires appropriate innovative patient-centred social protection for the Nigerian TB control programme to achieve the End TB Strategy targets and UHC. The findings also point to a need for continuous patient counselling and education to reduce stigma and improve coordination between patients and support workers to help patients comply with guidelines and impact the treatment outcome.</p
Evaluation of a virtual practice placement: a model to increase student capacity
No full textAim: To describe the development and evaluation of a novel virtual practice placement.Background: Health systems around the world face the challenge of recruiting and retaining sufficient nursing staff to provide high quality care. The need to train more nurses makes it hard to provide sufficient and varied high quality student placements to all students. This paper reports the result of one approach to the provision of a novel virtual placement for pre-registration student nurses.Design: Online virtual placement evaluated by a questionnaire conducted after the placement.Methods: A total of 195 students attended the virtual practice placement between 10th October 2022 and the 10th of March 2023. The survey consisted of eight questions, of which one invited a qualitative response.Results: A total of 188 students completed the questionnaire and provided feedback. Of these 84 were adult nursing students, 67 child, 36 mental health and one learning disability student. The virtual placement required considerable resources to run, however was deemed a valuable by most students. When asked to rate the overall experience out of 5, the median scores were consistently high: adult (Mdn=5), child (Mdn=4), learning disability (Mdn=5) and mental health (Mdn=5) and mean values consistently high across fields: adult (M=4.73), child (M=5), learning disability (M=5) and mental health (M=4.67). Qualitatively, there were four main themes that emerged from the questionnaire responses: increased understanding of community healthcare and holistic approaches to care; developing interpersonal skills; a positive impact on their future career opportunities and the value of realistic case studies.Conclusions: Virtual placements are a viable addition to traditional placements. However, they require careful planning and considerable resources including experienced and dedicated facilitators. Principles for the delivery of virtual placements were produced to replicate and share best practice.</p
Characterisation, prevalence and severity of skin lesions caused by ophidiomycosis in a population of wild snakes
No full textOphidiomycosis is an emerging infectious disease affecting wild snakes in the Northern Hemisphere. Recently confirmed in Great Britain, the prevalence, severity and significance of ophidiomycosis has yet to be characterised in free-living snakes at a population level in Europe. Therefore, a population of barred grass snakes (Natrix helvetica) in eastern England was monitored for three seasons (May 2019 to October 2021), to investigate the prevalence (25.5%; 191/750 snakes) and severity of skin lesions and their aetiology. The most frequently observed skin lesion characteristics were changes in scale colour, crusting, and scale margin erosion. The majority of such lesions (96.9%; 185/191 snakes) was observed on the ventral surface along the length of the body. The severity of skin lesions was considered mild in more than half of the cases (53.1%; 98/191 snakes). Predominantly, skin lesions were observed in adult snakes (72.8%; 139/191 snakes). Combined histological examinations and qPCR tests of skin lesions from N. helvetica sloughs and/or carcasses confirmed a diagnosis of ophidiomycosis. Further targeted surveillance, supported by molecular and histological examinations to confirm skin lesion aetiology, is required to determine the extent to which our findings reflect the occurrence of ophidiomycosis in populations within wider landscapes.</p
Self-reported side effects of COVID-19 vaccines among health professions students in India
No full textStudies focusing on the safety and common side effects of vaccines play a crucial role in enhancing public acceptance of vaccination. Research is scarce regarding the usage of COVID-19 vaccines and the side effects experienced by health professions students in India and other countries. This study aimed to document self-reported side effects associated with COVID-19 vaccination among medical and dental students of six medical and dental colleges and teaching hospitals in four states (Tamil Nadu, Madhya Pradesh, Gujarat, and West Bengal) of India. A cross-sectional survey using purposive sampling of medical and dental students was conducted from 26 April to 26 May 2021. Data was collected using a Google Forms questionnaire capturing information regarding receiving COVID-19 vaccines, side effects and symptoms, onset and duration of symptoms, use of treatment to alleviate symptoms, awareness of haematologic risks associated with vaccination, and side effects from previous (non-COVID-19) vaccinations. The majority (94.5%) of participants received both doses of the Covishield/AstraZeneca COVID-19 vaccine. Among participants (n = 492), 45.3% (n = 223) reported one or more side effects. The most frequently reported side effects were soreness of the injected arm (80.3%), tiredness (78.5%), fever (71.3%), headache (64.1%), and hypersomnia (58.7%). The two most common severe symptoms were fever (14.8%) and headache (13%). Most side effects appeared on the day of vaccination: soreness of the injection site (57%), fever (43.1%), and tiredness (42.6%). Most reported symptoms persisted for one to three days–soreness of the injection site (53%), fever (47.1%), and headache (42.6%). Logistic regression showed that women were almost 85% less likely to report side effects. The study’s findings corroborate the safety of the Covishield/AstraZeneca vaccine’s first dose, evidenced by the relatively minor and transient nature of the side effects. However, the study underscores the necessity for ongoing research to assess the long-term impacts of COVID-19 vaccines, especially in the context of booster doses, thereby contributing to the global understanding of vaccine safety and efficacy
Teriparatide in Postmenopausal Osteoporosis: Uncovering Novel Insights into Efficacy and Safety Compared to Other Treatments - A Systematic Review and Meta-Analysis
No full textObjective:
To evaluate the efficacy and safety of Teriparatide compared to other treatments for postmenopausal osteoporosis.
Methods:
A review of studies from 2000 to January 2023 analyzed randomized controlled trials (RCTs) on postmenopausal women treated with Teriparatide (PTH-1.34), comparing it to placebo or other osteoporosis treatments. The analysis focused on bone mineral density (BMD), bone turnover markers, and clinical outcomes, employing Review Manager 5.4.1 and the RoB 2 tool for bias assessment.
Results:
Our analysis of 23 randomized controlled trials (RCTs) found that PTH (1-34) treatment significantly increased lumbar spine BMD (mean difference [MD] = 0.02, 95% CI: 0.01-0.03) and femoral neck BMD (MD = 0.01, 95% CI: 0.00-0.01). However, there were no significant changes in total hip and radial bone BMD among the 3,536 and 2,046 participants, respectively. We also found that PTH (1-34) increased P1NP in a larger cohort (n=1415) when compared to osteocalcin (n=206). Although the risk of adverse events increased (relative risk [RR] = 1.65, 95% CI: 1.32-2.07), the incidence of fractures decreased significantly (RR = 0.57, 95% CI: 0.45-0.072), with no significant difference observed in mortality rates between treatment and control groups.
Conclusions:
Teriparatide improves lumbar spine and femoral neck BMD in postmenopausal women. Particularly notable is the novel finding regarding its effect on radius BMD, an area less explored in previous research. Despite an uptick in adverse events, the marked decrease in fracture incidence confirms its clinical utility for high-risk osteoporosis patients, highlighting the necessity for ongoing investigations into its full skeletal effects.</p
Everyday violence and care: insights from fictive kin relations between madams and sex workers in India
No full textThis article intervenes in the globally polarised terrain of debates on violence and agency in sex work. With a critical eye on how developmentalism governs these debates, the article explores fictive kin relations between women in Sonagachi, a prominent red-light area in Eastern India. Through an analysis of ethnographic observations and life-history interviews among madams and sex workers across three brothel households, this article argues that the configuration of ‘family-like’ relationships needs to be understood against a backdrop of what ‘family’ implies for socio-economically marginalised women who sell sex in urban India. Specifically, experiences of choice and coercion within these relationships are predicated on how madams and sex workers respond to kosto, a vernacularised articulation of everyday violence in each other’s lives, through jotno or care. Through this, the article sheds light on everyday forms of harm and solidarity between women in a red-light area, challenging institutionalised exceptionalisms of violence within sex work.</p
Biomarkers and related factors for the diagnosis, risk of coronary artery lesions, and resistance to intravenous immunoglobulin in Kawasaki disease: an umbrella review of meta-analyses
No full textKawasaki disease (KD) is a self-limited febrile disease predominantly affecting infants and children under 5 years old. Coronary artery lesions (CAL) are a prevalent complication, highlighting the necessity for swift diagnosis and treatment. A comprehensive review of biomarkers applicable for the diagnosis and treatment of Kawasaki disease (KD) in clinical settings is imperative. To provide a comprehensive review and analysis of biomarkers for diagnosis of KD, incidence of CAL, and intravenous immunoglobulin (IVIG) resistance. The data included in our study were sourced from searches conducted in PubMed/MEDLINE, Embase, EBSCO, and Google Scholar until March 15, 2024. Studies investigating the association with KD or evaluating diagnostic value were included in our study. Eligibility was independently assessed by two authors, with conflicts resolved through discussion. Data extraction was performed by 2 independent authors, following Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guideline. Data were pooled using a random-effects model. We assess biomarkers relevant to KD, categorizing them into three groups: diagnostic, associated with CAL incidence, and linked to IVIG resistance. For studies focusing solely on association, we present standardized mean differences (SMD). For those reporting sensitivity and specificity as diagnostic measures, we calculate the diagnostic odds ratio (DOR) to compare their efficacy. We identified 14 meta-analyses on biomarkers related to KD. 11 biomarkers exhibited diagnostic value for KD, while 21 were associated with its progression. Four biomarkers, including non-coding RNAs (DOR, 19.35 [95% CI, 13.58–27.56]), Serum ferritin (DOR, 24.90 [11.67–53.12]), N terminal proBNP (DOR, 21.03 [9.03–49.00]), and micro RNAs (DOR, 45.28 [6.30–325.52]), have significant diagnostic value for the diagnosis of KD. Seven biomarkers showed significant association with the incidence of CAL. Twenty biomarkers were for the prediction of IVIG resistance, including prognostic nutritional index (DOR, 7.72 [95% CI, 2.37–25.09]), non-coding RNAs (DOR, 14.63 [3.24–66.14]), neutrophil to lymphocyte ratio (DOR, 6.62 [4.05–10.81]), platelet to lymphocyte ratio (DOR, 3.30 [2.10–5.19]), and C reactive protein (DOR, 6.58 [3.69–11.74]). Based on the evidence, we have proposed various biomarkers associated with KD. Our aim is for these biomarkers to have wide applicability in both diagnostic and therapeutic settings.</p
Prevalence, awareness, treatment, and control of type 2 diabetes in South Korea, 1998–2022: a nationwide cross-sectional study
No full textNo description supplied</p
Global estimates of vaccine-associated hepatic autoimmune disorders and their related vaccines, 1968-2024: an international analysis of the WHO pharmacovigilance database
No full textIntroduction: Previous studies have suggested an association between vaccines and autoimmune diseases, but they were limited by their narrow focus and timeframe. Methods: This study conducted the first large-scale international analysis to investigate the impact of various vaccines on autoimmune liver diseases. Utilizing WHO’s VigiBase data from 1968 to 2024, and the study identified 1,083 (0.012%) cases of vaccine-associated hepatic autoimmune disorders out of 8,562,584 reported vaccine adverse events. Results: The vaccines with the highest risk of hepatic autoimmune disorders were the hepatitis B vaccine (reporting odds ratio [ROR], 3.52; 95% CI, 2.50–4.95), COVID-19 mRNA vaccines (ROR, 2.95; 95% CI, 2.73–3.18), and papillomavirus vaccines (ROR, 2.13; 95% CI, 1.45–3.13). Additionally, when vaccine-associated hepatic autoimmune disorders occurred, hepatobiliary adverse events were frequently observed to occur concurrently.Conclusions: This study suggests that vaccines may induce hepatic autoimmune disorders and highlights the need for enhanced monitoring before and after vaccination. Additionally, it proposes implementing pre-vaccination screening protocols and postvaccination monitoring to address this concern.</p
Impact of COVID-19 and recovery of routine diabetic retinopathy digital screening across different regions in England: an analysis of publicly available data.
No full textObjective: This study aims to examine the reduction and subsequent recovery of routine digital screening (RDS) uptake in England from 2018 to 2022, exploring national, regional and individual Diabetic Eye Screening Programme (DESP) levels. The COVID-19 lockdown in most areas of England was from 26 March 2020 to 23 June 2020 (first national lockdown), 5 November 2020 to 2 December 2020 (second national lockdown) and 6 January 2021 to 8 March 2021 (third national lockdown).Design: Retrospective data analysis.Setting: DESPs of England.Participants: Individuals with diabetes who were invited to take part in the DESP programmes.Methods: Publicly available data from Public Health England (2018–2019) and National Health Service England (2019–2022) were examined to identify the rate of uptake (proportion of those who attended the DESPs to those who were invited) of RDS at national and regional levels and by each DESP in England.Primary outcome measures: Rate of uptake of RDS.Results: The national uptake of RDS decreased from 82% (2019–2020) to 68% (2020–2021) and then increased to 78% (2021–2022). At the regional level, the sharpest drop was in the Midlands which decreased from 79% (2019–2020) to 53% (2020–2021), increasing to 73% (2021–2022) but did not reach pre-COVID-19 levels. At individual DESP levels across England, the greatest drop in attendance (2020–2021) was recorded in Derbyshire (79% to 45%), Barnsley and Rotherham (78% to 45%) and Arden, Herefordshire and Worcestershire (78% to 46%). Although these DESPs showed an increase in 2021–2022 of 33%, 21% and 31%, they did not reach prepandemic (2018–2019) rates of 81%, 85% and 82%, respectively. Data suggest that West Sussex, East Sussex and East and North Hertfordshire DESPs maintained relatively higher uptake rates (86%–89%) in 2020–2021.Conclusion: COVID-19 had an impact on England’s diabetic eye screening attendance, with notable variations across regions and DESPs. Different regions and DESPs showed variable post-COVID-19 recovery. More importantly, what was not evident is the increased uptake that should have occurred after the COVID-19 lockdown to compensate for the low uptake during the lockdown. In some areas, addressing some of the barriers that affect retinal screening uptake may improve future attendance.</p
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