340880 research outputs found
Sort by
Prevalence and Sociodemographic Factors Associated with Co-Vaccination Against Seasonal Influenza and COVID-19 and Reasons for Vaccine Hesitancy in the Albanian Adult Population
No full textBackground: Vaccination is a crucial public health measure to control infectious diseases, including seasonal influenza. Yet, vaccine uptake varies globally due to sociodemographic factors, misinformation, and access disparities. Objectives: The objective of this study was to assess the prevalence and sociodemographic factors associated with vaccination and the main reasons for vaccine hesitancy in Albania. Methods: A cross-sectional study, conducted in Albania in November-December 2021, included a sample of 1302 individuals aged >= 18 years (approximate to 57% females; mean age: 38.3 +/- 15.0 years; response rate: approximate to 87%). A structured questionnaire was administered inquiring about co-vaccination status against seasonal influenza and COVID-19, reasons for not being vaccinated, and sociodemographic characteristics of participants. Binary logistic regression was used to assess the association of co-vaccination status with sociodemographic factors. Results: Overall, about 28% of individuals were co-vaccinated against seasonal influenza and COVID-19 at least with one dose (25% in males vs. 29% in females; 22% among 18-24-year-olds vs. 54% among those aged >= 65 years). Independent positive and significant correlates of being co-vaccinated included older age (OR = 7.0, 95%CI = 3.7-12.9) and a higher educational attainment (OR = 2.3, 95%CI = 1.4-3.6). The main reasons for vaccine hesitancy among non-vaccinated individuals included the belief that vaccines are: harmful (72%), not effective (66%), weaken the immune system (58%), are not safe (56%), and preference to recover naturally (52%). Conclusions: This study evidenced a relatively low co-vaccination rate in Albania with significant sociodemographic disparities, notwithstanding the availability of vaccines and their free-of-charge provision to the overall population. Older age and higher educational attainment were identified as independent positive predictors of co-vaccination uptake, suggesting the need for targeted public health strategies to address vaccine hesitancy, particularly among younger and less-educated population categories. Our findings emphasize the importance of tailored communication campaigns and community-based interventions to improve vaccine coverage and mitigate the impact of infectious diseases in Albania and elsewhere
A discourse analysis of social inequities, gender, and stigma in tuberculosis policies of seven countries from Africa, Asia, Europe and South America
No full textBackgroundInterventions tackling the social aspects of tuberculosis (TB) are widely suggested, yet we miss insights into how policies incorporate these. The language and framing of policies to address TB can lend important insights into how these social drivers are perceived, problematized, and responded to.ObjectiveTo understand how discourses in current TB policies frame social dimensions of TB, especially concepts of social inequity, gender, and stigma.MethodsWe conducted a comparative critical discourse analysis of twenty-one publicly available TB-related policies from Belarus, Brazil, Indonesia, Mozambique, Netherlands, Portugal, and Romania, countries with diverse epidemiological, geographical and sociopolitical contexts. Documents were sourced from public websites from May - September 2024. The Bacchi approach was used to analyze policy framings of social inequities, gender, and stigma.ResultWhile policies from Brazil and Indonesia showed greater attention to social inequities, gender, and stigma, and were more explicitly reflective of an equity-oriented and people-centered approach, overall, a dominant biomedical perspective was observed that individualizes responsibility for cure. This tends to disregard issues of social inequity, obscures gender relationships and the multiple dimensions of stigma. At the same time, allocation of individual as well as structural responsibility for TB risk and outcomes co-existed.ConclusionsExplicit and implicit discourses about TB within health-related policies can influence the nature of attention given to the social dimensions of TB and can shape corresponding responses to the disease. We recommend a participative policy process that includes a broader set of actors to ensure documents are responsive to social realities
Surgical myectomy for hypertrophic cardiomyopathy:procedural volume and outcomes
No full textBackground and Aims Outcomes after surgical myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients have not been investigated in a multicentre registry with detailed clinical data. Hence, the objectives of this multicentre Dutch study are to describe the 30-day clinical outcomes after surgical myectomy, and to assess factors associated with increased 30-day complication rates. Methods All HOCM patients (n = 335) who underwent surgery between 2012 and 2020 across 12 Dutch hospitals were analysed using data from the Netherlands Heart Registration. Multiple logistic regression analyses assessed factors associated with a higher 30-day complication rate. Results Isolated surgical myectomy was performed in 22%, surgical myectomy with one concomitant procedure in 54%, and surgical myectomy with two or more concomitant procedures in 24%. Thirty-day complication rates concerned mortality (5%), ventricular septal defect (2%), stroke (3%), and surgical reoperation (2%). Mean resting left ventricular outflow tract (LVOT) gradient improved from 61 +/- 30 mmHg to 13 +/- 12 mmHg postoperatively, systolic anterior motion from 80% to 8%, and mitral regurgitation grade 3 or 4 from 31% to 6%. Low-volume hospital (<10 surgical myectomy procedures/year), female sex, and >= 2 concomitant procedures were significantly associated with increased 30-day complication rates. The adjusted 30-day complication rate was increased in low-volume hospitals (odds ratio 3.23 (95% confidence interval: 1.43-8.09); P = .007). Conclusions Surgical myectomy with or without concomitant procedures effectively relieved LVOT obstruction in 93% of patients in this multicentre cohort. Female sex, >= 2 concomitant procedures, and low-volume hospitals were associated with higher 30-day complication rates. Although an inverse volume-complication relation was observed, this finding should be interpreted cautiously, and further investigation in larger sample size studies is warranted
General practitioners' educational and training needs and requirements for advising patients with coronary heart disease on physical activity:findings from a qualitative study in Germany
No full textBackgroundThe World Health Organization and German treatment guidelines emphasise integrating physical activity (PA) advice into primary care of patients with coronary heart disease (CHD). However, this is often inadequately implemented in German general practice. A key barrier may be healthcare professionals' limited knowledge and skills in providing effective and efficient PA guidance - both in general as well as for patients with CHD. International guidelines recommend targeted training for general practitioners (GPs). Understanding GPs' specific educational and training needs is crucial to developing tailored training programmes for improving implementation of advising CHD patients on PA.MethodsBetween March and June 2023, 12 problem-centred one-on-one interviews and six moderated focus groups (n = 37 participants) with GPs were conducted in-person (total N = 49 GPs, 37% female, mean age 56 years (36-78 years)). Interview and focus group topic guides were developed and pilot-tested by the multi-professional study team. Transcripts from audio-recorded data were analysed using both deductive and inductive content structuring, within a multi-professional team, with active involvement of GPs. This analysis extends a previous study using the same dataset. ResultsGPs recognise the benefits of PA for CHD patients. Their conceptualisations of PA (e.g., definitions of sport and PA, general statements on PA) vary and the incorporation of PA in everyday activities (e.g., using stairs) to encourage behaviour change is sometimes recommended. GPs identify the following key training needs for providing PA advice to CHD patients: peer exchange and self-reflection, evidence-based knowledge on PA and CHD, practical tools and support materials to facilitate the integration of PA advice into routine practice. These include low-barrier, time-efficient communication techniques, and role-play simulations. ConclusionThis qualitative study provides insights into GPs' needs and preferences regarding the content, didactics, and organisation of training on PA advice. To enhance competence and foster deeper learning, training should combine evidence-based knowledge with practical elements such as simulations and reflective peer exchange. Building on previous findings about GPs' attitudes and experiences, the identified educational needs offer a foundation for developing tailored training to support PA counselling in routine primary CHD care. This training will be implemented and evaluated in a subsequent study
Overcoming tetracycline pollution in soils through the addition of a mycorrhizal fungal species<i> Funneliformis</i><i> mosseae</i>
No full textThe presence of residual antibiotics in the black soils of northeastern China poses a significant threat to food safety. This study investigated the potential of Funneliformis mosseae, one of the predominant biocontrol fungi in northeastern China, to mitigate the negative effects of tetracycline contamination (40 mg kg-1) in soil. Advanced biotechnological methods were employed to assess plant growth, soil microbial antioxidant enzyme activity, and soil fertility. Additionally, changes in microbial diversity, composition, and abundance at both the phylum and genus levels were analyzed through high-throughput sequencing of the 16S rRNA and ITS gene regions of soil microorganisms. The results demonstrated that F. mosseae colonization in tetracycline-contaminated soils significantly improved soybean growth. Enhanced antioxidant enzyme activity in the soybean plants further contributed to increased resistance against tetracycline stress. Notably, F. mosseae colonization was associated with lower tetracycline levels, elevated total nitrogen (TN) content in the soil, alongside a shift in microbial diversity and abundance favoring nitrogen-fixing bacteria. This indicated that F. mosseae colonization influenced the bacterial and fungal community composition, altering the relative abundance of dominant microbial taxa and modulating the overall soil microenvironment. In conclusion, the application of F. mosseae effectively mitigated tetracycline-induced stress, improved soil health, and provided a promising strategy for the bioremediation of antibiotic-contaminated agricultural soils
CineECG detects abnormal electrical activity in the 12-lead ECG of preclinical plakophilin-2 variant carriers
No full textBackground: Carriers of (likely) Plakophilin-2 pathogenic variants (PKP2-(L)PV) are at risk of developing arrhythmogenic cardiomyopathy. Early disease detection is crucial because life-threatening arrhythmias may occur early. CineECG is a novel electrocardiogram (ECG) analysis tool that reconstructs the average trajectory of ventricular electrical activity. Objective: The study aimed to describe the electrical depolarization and repolarization CineECG trajectories in PKP2-(L)PV carriers with a normal ECG as per evaluation of 2 cardiologists, who meet no Task Force Criteria other than their PV. Methods: PKP2-(L)PV carriers were 2:1-matched to control subjects, who had atrioventricular nodal reentry tachycardia but no other cardiac abnormalities. Sinus rhythm ECGs of controls were used to create a normal distribution of trajectories. PKP2-(L)PV carriers’ trajectories were compared with the normal distribution. A trajectory was considered abnormal if it fell less than 95% within the normal distribution. Results: Overall, 104 subjects were included (age 24 years [19–36], 43% men): 37 PKP2-(L)PV carriers and 67 controls. Depolarization and repolarization trajectories were abnormal in 51% and 24% of carriers, respectively. In carriers with abnormal depolarization trajectories, significant differences were observed in the direction of the initial depolarization trajectory when compared with controls in the inferior-superior axis (P = .005) and posterior-anterior axis (P = .020). In the left-right axis, the direction significantly differed from carriers with a normal trajectory (P = .020). Conclusion: Abnormal electrical activity was identified in over half of preclinical PKP2-(L)PV carriers with a normal ECG. CineECG could be a sensitive tool to unveil early, subtle abnormalities in ventricular electrical activity that would otherwise not be detected
Green Transformation as New Direction for Techno-Economic Development
No full textThis chapter argues that the ongoing debate about the green transformation and latecomer development must consider two key conditions. First, it must recognize that the green transformation is primarily a direction-driven phenomenon, shaped by aspirational, political, and institutional changes, rather than a technology-driven phenomenon per se. Second, it must acknowledge the potential of information and communication technology (ICT) to both accelerate and deepen the green transition and to foster latecomer development. Governments may unlock crucial synergies and opportunities by pursuing green development with the power of ICT
Experimentally-informed in silico design of melt-electrowritten scaffolds for tissue engineering applications
No full textMelt electrowriting (MEW) has emerged as an advanced additive manufacturing (AM) technique for fabricating 3D scaffolds with tunable microscale architectures making it highly promising for tissue engineering applications. However, errors in fiber uniformity and placement, which frequently occur during the MEW process, can substantially affect the mechanical and biological performance of the scaffolds. To address this challenge, this study performed an experimentally-informed finite element analysis on tubular MEW scaffolds designed for bone tissue engineering. To quantify the discrepancies between the finite element (FE) models and experiments, the ratio of numerical to experimental scaffold stiffness, called the error coefficient, was calculated. The error coefficient for lateral compression (25% lateral strain), three point bending (12% flexural strain) and uniaxial tension (20% tensile strain) were observed to be 1.15, 14.57 and 8.5 respectively. Further investigation, using a submodeling approach and scanning electron microscopy (SEM) images, identified that the reduction in stiffness in experiments was primarily due to failure of fusion of individual MEW strands, particularly where opposing helices intersected. This study presents an experimentally informed, versatile in silico pipeline that can be applied to optimize the design and mechanical performance of MEW scaffolds for a wide range of tissue engineering applications
Oral anticoagulation in patients with atrial fibrillation and heart valve prosthesis:a substudy from the LAAOS III Trial
No full textObjective: Societal guidelines recommend vitamin K antagonists (VKAs) for patients with atrial fibrillation with recent biological valve implantation, but the safety and efficacy of direct oral anticoagulants (DOACs) in this setting remain uncertain, especially in the early postoperative period. This substudy of the Left Atrial Appendage Occlusion Study (LAAOS) III trial aimed to compare thromboembolic and bleeding outcomes in patients discharged on VKAs versus DOACs after bioprosthesis implantation or mitral valve repair. Methods: A total of 2645 patients were included, with 461 discharged on DOACs and 2184 on VKAs. Patients with mechanical valves or isolated coronary surgery were excluded. The primary end point was stroke or systemic thromboembolism. Major bleeding was a secondary end point. Cox proportional hazard models adjusted for time-dependent covariates and clinical factors (eg, age, previous stroke, left atrial appendage occlusion) were applied to assess outcomes. Results: Patients discharged on DOACs were older, mostly male, and had lower rates of rheumatic heart disease than those on VKAs. During follow-up, no significant differences were observed in thromboembolic (hazard ratio, 0.754; 95% confidence interval, 0.496-1.145; P = .185) or major bleeding events (hazard ratio, 0.760; 95% confidence interval, 0.601-1.153; P = .197) between groups. A nonsignificant trend toward worse outcomes was noted for patients who discontinued or switched anticoagulation. Conclusions: In this large cohort of patients after mitral and/or aortic bioprosthesis implantation or mitral valve repair within the LAAOS III, DOACs showed similar thromboembolic and bleeding risks as VKAs, suggesting they may be a safe alternative.</p
A Novel Untargeted Molecular Detection Technique for Rapid Fecal Microbiota Profiling in Very Preterm Infants:Optimization, Genus-Level Comparison, and Application
No full textGut microbiota profiling shows potential for improving care in the neonatal intensive care unit (NICU). However, common techniques, including 16S rRNA gene and metagenomic sequencing, have limited bedside applicability. The IS-pro microbiota assay provides species-level abundances within 5 h. We aimed to optimize the taxa annotation for preterm infants (phase 1), compare its findings to 16S sequencing on the genus level (phase 2), and apply the assay in a preterm cohort (phase 3). 1445 fecal samples from 479 preterm infants (24-30 weeks gestation) across 10 NICUs were analyzed with IS-pro. For phase 1 (optimization), IS-pro amplicons of 32 fecal samples were additionally analyzed with nanopore sequencing to expand the IS-pro matching database. For phase 2 (comparison), 41 samples were compared to 16S sequencing. In phase 3 (application), the optimized IS-pro assay was applied to the total cohort. Following phase 1, a mean relative abundance of 82.5% was successfully annotated. In phase 2, IS-pro showed high concordance with 16S sequencing, with a strong positive correlation between the two techniques (Pearson's correlation coefficient: 0.77, SD 0.24). In phase 3, IS-pro analysis of the full cohort revealed Staphylococcus, Klebsiella, Enterococcus, Escherichia-Shigella, and Streptococcus as the predominant genera in the first 4 weeks of life. Our findings demonstrate that the IS-pro microbiota assay effectively detects and quantifies key bacterial taxa in fecal samples of preterm infants, with outcomes highly concordant with 16S sequencing. Unlike traditional techniques, IS-pro is a rapid tool, illustrating its potential for clinical practice. Future studies should explore its applications in the NICU