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Findings from the Great British and Northern Ireland Botulinum Toxin Survey: treatment outcomes, patient experience and regulations from a cross-sectional survey
No full textBackground: Given rising demand for Botulinum toxin (BoNT) treatments and limited data on safety, ethics, and regulation, a national survey explored experiences with cosmetic BoNT in the United Kingdon (UK).Objectives: To conduct a national observational survey with the aim to capture real-world experiences of cosmetic BoNT in the UK.Methods: A cross-sectional online survey gathered data on experiences with cosmetic BoNT injections across the UK. Participation was open to adults (≥18 years) who had received cosmetic BoNT treatment.Results: A total of 919 participants completed the survey and were predominantly female, white, and had a high household income. Commonly reported acute complications were bruising/swelling (26.1%), and headache (24.7%). Commonly reported long-term complication were BoNT resistance (2.9%), social withdrawal (2.7%), nerve damage (2.5%), and dry eyes/vision problems (2.5%). In total, 66% stated their treatment was administered by a prescriber, 28% said it was not. Among those treated by a non-prescriber, 40% reported that a prescriber was present during the consultation, 42% said no prescriber was present, and 17% were unsure. Surprisingly a few had not signed a consent form (8%), 11% were not informed of treatment risks and 18% were not told how to respond to complications. A large majority expressed support for enhanced oversight, with 57.8% favouring significantly stricter regulation, and 31.3% somewhat stricter regulation.Conclusions: Cosmetic BoNT can offer high satisfaction and a favourable safety profile when administered appropriately. However, findings highlight key vulnerabilities: inconsistent practitioner qualifications, gaps in informed consent, insufficient complication support, and weak regulation.</p
Live zoster vaccination and the reduced risk of chronic respiratory diseases: an emulated target trial
No full textBackground: Recent previous study suggests that live zoster vaccination may reduce the risk of diseases like dementia and cardiovascular diseases, through prevention of herpes zoster. Thus, this study aims to evaluate whether live zoster vaccination can reduce the risk of chronic respiratory disease including chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease (ILD).Methods: This target trial emulation study utilized a nationwide, population-based cohort of 2,519,582 individuals aged ≥ 50 years in South Korea. The cohort was constructed by integrating health insurance data from the Korea Health Insurance Review and Assessment Service, national health examination data from the Korean National Health Insurance Service, and vaccination records from the Korea Disease Control and Prevention Agency. The exposure was receipt of at least one dose of live zoster vaccination between January 1, 2012, and December 31, 2021. Outcomes included the incidence of newly diagnosed COPD, asthma, and ILD, as well as hospitalizations associated with these conditions. Following stabilized inverse probability of treatment weighting, we employed the Cox proportional hazards model to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) and calculated restricted mean survival time (RMST) for the risk of outcomes associated with live zoster vaccination. The observation period extends from the index date to January 31, 2024.Measurements and Main Results: After stabilized inverse probability of treatment weighting, 745,644 individuals were assigned to the vaccinated group and 1,069,230 to the unvaccinated group, with a mean age of 62.12 years (SD, 3.45) and 49.18% were male. Live zoster vaccination significantly reduced the risk of COPD (aHR, 0.70 [95% CI, 0.69–0.71]; RMST difference, 23.22 days [95% CI, 21.72–24.71]), asthma (0.68 [0.67–0.69]; 25.96 days [24.52–27.40]) and ILD (0.78 [0.73–0.82]; 2.39 days [2.05–2.74]). Additionally, the vaccination significantly reduced the risk of hospital admissions due to these conditions: COPD (0.59 [0.53–0.65]), asthma (0.54 [0.49–0.59]), and ILD (0.68 [0.58–0.79]). The observed protective benefit was more pronounced in non-smokers compared to current smokers. The time-attenuated effect was strongest during 1 to 2 years following live zoster vaccination and remained evident for up to 6 years.Conclusions: Live zoster vaccination significantly reduced the incidence of chronic respiratory disease and related hospitalizations. These findings suggest that live zoster vaccination may provide public health benefits beyond preventing herpes zoster in adults aged ≥ 50 years.</p
Temporal trends in inadequate vegetable and fruit consumption among adolescents aged 12-15 years from 31 countries in Asia, Africa, and the Americas
No full textBackground and Aims: A low intake of fruit and vegetable consumption has been found to be associated with a plethora of negative health outcomes in adolescents. However, there is a scarcity of literature on long-term trends in fruit and vegetable intake in the adolescent population. Therefore, we examined this trend in a nationally representative sample of adolescents (12–15 years) attending school in 31 countries, including Africa, Asia, and the Americas, where investigation of such trends has been scarce.Methods: The present study analyzed data from the Global School-based Student Health Survey 2003–2017. The prevalence (95% CI) of inadequate fruit and vegetable intake (i.e., consumption Results: We analyzed data from students (n = 193,388) aged 12–15 years [mean (SD) age 13.7 (1.0) years; 49.0% boys]. A high overall prevalence of inadequate fruit and vegetable consumption was found (75%). We observed increasing, decreasing, and stable trends in 6, 3, and 22 countries, respectively. In countries where decreasing trends were found, this decrease was minimal. Moreover, the majority of countries with stable trends exhibited a high prevalence of inadequate fruit and vegetable intake across multiple years.Conclusion: Our data show that inadequate fruit and vegetable consumption among adolescents is a major global problem with almost no improvements being observed in recent years. Intensification of global efforts to combat inadequate fruit and vegetable consumption is necessary.</p
Leadership knowledge and behaviours: Outcomes of a full-day leadership workshop focusing on personal growth in foundation doctors
No full textBackground Effective clinical leadership is required at every level, including in Foundation doctors. Most leadership programmes neglect self-awareness and personal growth aspects of leadership training. We modified the Basildon Leadership Hub to focus on these aspects and evaluated the new programme.Methods Large group sessions were led by speakers with varied leadership roles, interspersed by breakout sessions incorporating experiential and reflective learning. Attendees answered anonymous surveys before, immediately after, and 2 months after the workshop, with 5-point Likert-scale responses (1=strongly disagree to 5=strongly agree) designed around reaction, knowledge and behaviour levels of evaluation. We assessed differences in median responses using the Mann-Whitney U test with Bonferroni-Holm correction.Results The full-day workshop was attended by 27 trainees, 93% of whom considered it enjoyable and relevant. Attendees agreed more strongly to the statements ‘I am a leader’ and ‘I know how I can demonstrate and develop my own leadership knowledge, skills and behaviours’ in postcourse versus precourse surveys (pConclusion A full-day leadership workshop for Foundation doctors focusing on personal growth resulted in improvement in self-assessed precourse and postcourse knowledge and attitudes; however, poor follow-up response rate limited demonstration of sustained outcomes or changes in behaviour.</p
Meigs Syndrome in low-resource setting: a pediatric case report
No full textMeigs syndrome is a rare condition characterized by the presence of a benign fibroma of the ovary, ascites, and pleural effusion. It is very uncommon and the diagnosis is made with difficulty based on symptoms that usually mimic disseminated malignancy or tuberculosis. Although it is a benign and treatable condition, extreme presentations of late-stage diseases occur with high mortality and morbidity rates. We report on a case of a 13-year-old female presenting with misdiagnosed late-stage Meigs Syndrome in a low-resource setting.</p
The REVIVE Project: From Survival to Holistic Recovery—A Prospective Multicentric Evaluation of Cognitive, Emotional, and Quality-of-Life Outcomes in Out-of-Hospital Cardiac Arrest Survivors
No full textBackground/Objectives: Most survivors of out-of-hospital cardiac arrest (OHCA) may suffer from cognitive, mental difficulties, and fatigue, which negatively impact their quality of life, despite a good physical recovery. However, no definitive data are available on this topic, so this study aims to assess the feasibility and acceptability of a centralized, sub-regional screening system for OHCA survivors in Italy and the prevalence of these disorders. Methods: OHCA survivors discharged with good neurological outcomes (Cerebral Performance Category (CPC) ≤ 2 and modified Ranking Scale (mRS) ≤ 3) from hospitals in the “Lombardia CARe” registry will be evaluated by a clinical psychologist using the Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS), EQ-5D-5L for quality of life, and the Impact of Event Scale-Revised (IES-R) at pre-discharge or within 15 days and then at 1, 3, 6, and 12 months. Patients with clinical issues will be referred for psychological support or to a community rehabilitation program. Feasibility will be defined as a recruitment rate ≥ 80% and acceptability as a retention rate ≥ 50% over 12 months. Results: Based on historical data from the Lombardia CARe, an estimated 350 eligible survivors are expected, which will allow estimation of a prevalence ranging between 20% and 30% with 5% precision and 95% confidence. Conclusions: This study will be the first in Italy to evaluate the feasibility and acceptability of a centralized, sub-regional system for pre-/post-discharge evaluation of cognitive impairment, mental health, and quality of life in a large cohort of OHCA survivors, documenting the prevalence of these disorders.</p
SRQR checklist for <i>Beneficent Disruptors: A qualitative descriptive study of professional advocacy in healthcare</i>
No full textSRQR checklist for ‘Beneficent Disruptors: A qualitative descriptive study of professional advocacy in healthcare’.</p
Feasibility randomized controlled trial of remotely supervised exercise versus self-directed exercise for intermittent claudication
No full textBackground: This trial examined the feasibility of a future trial of remotely supervised exercise (RSE) versus self-directed exercise (SDE) for stable claudication. Methods: Randomized, single center, assessor blind, feasibility trial. In the intervention arm patients received fortnightly video or telephone calls from a physiotherapist with a tailored exercise prescription and review of progress with the aim of a minimum of 120 min of leg exercise per week. In the comparator arm, patients were asked to do this themselves. Both groups had an electronic walking log which was inspected at 3 and 6 months. The primary endpoint was maximum walking distance recorded by a blinded assessor. As this was a feasibility study the randomization target was 40 patients. Results: 44 patients were randomized over a 2 year period. The eligibility rate was 57% of those screened. The participation rate was 100% of those eligible. The withdrawal rate was 27% of those randomized. Maximum walking distance improved, on average, by +369m in the remotely supervised group and by +322m in the SDE group. Quality of life gains were similar in both arms. Conclusion: A large randomized controlled trial comparing RSE with SDE would be difficult using this protocol, because of the high withdrawal rate and small treatment effect.</p
Prevalence of vision loss in Latin America and the Caribbean in 2020: magnitude and temporal trends
No full textPurpose: To estimate the prevalence of vision loss for 2020 in Latin America and the Caribbean(LAC) and analyse evolving trends since 1990.Methods: A meta-analysis using hierarchical models of 37 sources of 33 cross-sectional, population-representative studies from LAC from 1998 to 2018 was undertaken to determine the pre-valence of blindness, moderate and severe vision impairment (MSVI), and mild vision impairment(mild VI), with 95% uncertainty intervals (UIs).Results: In 2020, the age-standardised prevalence rates of blindness, MSVI, moderate vision impairment (VI), severe VI, and mild VI, were 0.51% (95% UI 0.44%–0.57%), 3.73% (95% UI3.38%–4.08%), 3.35% (95% UI 3.00%–3.69%), 0.38% (95% UI 0.34%–0.43%), and 3.19% (95% UI2.87%–3.53%), respectively. In 1990, there were 15.81 million people with blindness and MSVI in LAC, contributing to 8.66% of the global caseload. In 2020, there were 30.42 million people,including 3.82 million (95% UI 3.14–4.55 million) with blindness and 26.6 million (95% UI23.08–30.3 million) with MSVI, who contributed to 8.99% of the global caseload.Conclusion: The contribution of vision loss to the overall global burden from LAC has increased over the last 3 decades, and the numbers of people affected with blindness and VI reported throughout the region have also steadily increased. There needs to be greater attention to providing universal eye health coverage across the region.</p
Artificial intelligence improves follow-up appointment uptake for diabetic retinal assessment: a systematic review and meta-analysis
No full textBackground/Objectives: Artificial intelligence (AI) assessment of diabetic retinopathy (DR) instead of scarce trained specialists could potentially increases the efficiency and accessibility of screening programs. This systematic review aims to systematically examine the uptake of follow-up appointments with initial computer-based AI and human graders of DR.Methods: We conducted a systematic review and meta-analysis by screening articles in any languages in PubMed, MEDLINE (Ovid), EMBASE, Web of Science, Cochrane CENTRAL and CDSR published from database inception up to 20th August 2024. We used random-effects meta-analysis to pool the results as odds ratios (OR) with corresponding 95% confidence intervals (CI).Results: Data from a total of 20,108 patients with diabetes (6476 participants graded using AI and 13,632 participants graded by human-graders; age range of the participants 5 to 67 years) from six studies were included. The result of the pooled meta-analysis showed that initial AI assessment of DR significantly increased uptake of follow-up appointments compared to human grader-based (OR = 1.89, 95% CI 1.78–2.01, P = 0.00001).Conclusions: The present systematic review and meta-analysis suggest that initial AI-based algorithm for screening DR is associated with an increased uptake of follow-up examination. This is most likely due to instant results being made available with AI based algorithms when compared to a delay in assessment with human graders.</p
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