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1
Efficacy of 3-day low dose quinine plus clindamycin versus artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Kenyan children (CLINDAQUINE): an open-label randomized trial
Malaria Journal, 2.02.2022
Tilføjet 2.02.2022
Abstract
Background
The World Health Organization recommends quinine plus clindamycin as first-line treatment of malaria in the first trimester of pregnancy and as a second-line treatment for uncomplicated falciparum malaria when artemisinin-based drug combinations are not available. The efficacy of quinine plus clindamycin was compared with that of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in children below 5 years of age.
Methods
An open-label, phase 3, randomized trial was conducted in western Kenya. Children aged 6–59 months with uncomplicated falciparum malaria were randomly assigned (1:1) via a computer-generated randomization list to receive 3 days of twice a day treatment with either oral quinine (20 mg/kg/day) plus clindamycin (20 mg/kg/day) or artemether-lumefantrine (artemether 20 mg, lumefantrine 120 mg) as one (for those weighing 5–14 kg) or two (for those weighing 15–24 kg) tablets per dose. The primary outcome was a PCR-corrected rate of adequate clinical and parasitological response (ACPR) on day 28 in the per-protocol population.
Results
Of the 384 children enrolled, 182/192 (94.8%) receiving quinine plus clindamycin and 171/192 (89.1%) receiving artemether-lumefantrine completed the study. The PCR-corrected ACPR rate was 44.0% (80 children) in the quinine plus clindamycin group and 97.1% (166 children) in the artemether-lumefantrine group (treatment difference − 53.1%, 95% CI − 43.5% to − 62.7%). At 72 h after starting treatment, 50.3% (94 children) in the quinine plus clindamycin group were still parasitaemic compared with 0.5% (1 child) in the artemether-lumefantrine group. Three cases of severe malaria were recorded as serious adverse events in the quinine plus clindamycin group.
Conclusions
The study found no evidence to support the use of a 3-day low dose course of quinine plus clindamycin in the treatment of uncomplicated falciparum malaria in children under 5 years of age in Kenya, where artemether-lumefantrine is still effective.
Trial Registration: This trial is registered with the Pan-African Clinical Trials Registry, PACTR20129000419241.
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2
Malaria prevention interventions beyond long-lasting insecticidal nets and indoor residual spraying in low- and middle-income countries: a scoping review
Malaria Journal, 2.02.2022
Tilføjet 2.02.2022
Abstract
Background
Significant progress in malaria prevention during the past two decades has prompted increasing global dialogue on malaria elimination. Recent reviews on malaria strategies have focused mainly on long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), with little emphasis on other prevention methods. This article is a scoping review of literature on malaria prevention methods beyond LLINs and IRS in low- and middle-income countries (LMICs).
Methods
This scoping review found articles published between from 1994 to 2020. Studies were obtained from a search of the PubMed, the Cochrane Library and Social Science abstracts. Grey literature and manual search of secondary references was also done. The search strategy included all study designs but limited only to English. Three independent reviewers performed the selection and characterization of articles, and the data collected were synthesized qualitatively.
Results
A total of 10,112 studies were identified among which 31 met the inclusion criteria. The results were grouped by the 3 emerging themes of: housing design; mosquito repellents; and integrated vector control. Housing design strategies included closing eves, screening of houses including windows, doors and ceilings, while mosquito repellents were mainly spatial repellents, use of repellent plants, and use of plant-based oils. Integrated vector control included larvae source management. Evidence consistently shows that improving housing design reduced mosquito entry and malaria prevalence. Spatial repellents also showed promising results in field experiments, while evidence on repellent plants is limited and still emerging. Recent literature shows that IVM has been largely ignored in recent years in many LMICs. Some malaria prevention methods such as spatial repellents and IVM are shown to have the potential to target both indoor and outdoor transmission of malaria, which are both important aspects to consider to achieve malaria elimination in LMICs.
Conclusion
The scoping review shows that other malaria prevention strategies beyond LLINs and IRS have increasingly become important in LMICs. These methods have a significant role in contributing to malaria elimination in endemic countries if they are adequately promoted alongside other conventional approaches.
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3
Low-dosage ethambutol, less than 12.5 mg/kg/day, does not worsen the clinical outcomes of pulmonary Mycobacterium avium and Mycobacterium intracellulare disease: a retrospective cohort study
Infection, 1.02.2022
Tilføjet 2.02.2022
Abstract
Objectives
Multidrug chemotherapy is recommended for treating pulmonary Mycobacterium avium and Mycobacterium intracellulare disease. Although ethambutol has been demonstrated to inhibit macrolide resistance, the ethambutol dosage is sometimes decreased due to concerns about optic neuropathy. We aimed to assess whether lower ethambutol doses impact treatment outcomes.
Methods
Patients treated over 12 months between 2016 and 2020 were collected retrospectively. Clinical outcomes, including negative culture conversion, microbiological cure, adverse events, resistance to macrolides, and recurrence, were compared according to daily ethambutol dosage.
Results
Among 146 patients, 42 were treated with ethambutol dosages over 12.5 mg/kg/day, and 104 were treated with lower dosages. Negative culture conversion was achieved for 125 patients, and 90 patients achieved microbiological cure. Recurrence was identified in 16 patients who achieved microbiological cure. No macrolide resistance was observed, and no significant difference was observed in the percentage of negative culture conversion (P = 1.00) or microbiological cure (P = 0.67) between the high- and low-dosage ethambutol groups. Sputum smear positivity was associated with a lower adjusted odds ratio (aOR) of negative culture conversion (aOR: 0.48, 95% CI: 0.29–0.80). A lower aOR of microbiological cure was independently associated with sputum smear positivity (aOR: 0.52, 95% CI: 0.37–0.74) and with the use of an intermittent regimen (aOR: 0.60, 95% CI: 0.41–0.87). Daily ethambutol dosage was not identified as a prognostic factor for any of the outcomes. Optic neuropathy was observed in 7.1% of the high-dose ethambutol group and 1.0% of the low-dosage ethambutol group (P = 0.07).
Conclusion
An ethambutol dosage of 12.5 mg/kg/day or less in guideline-based chemotherapy may reduce optic neuropathy without worsening clinical outcomes.
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4
Rickettsioses and Q Fever in Tanzania: Estimating the Burden of Pervasive and Neglected Causes of Severe Febrile Illness in Sub-Saharan Africa
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 371-372
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5
Multibacillary Mid-Borderline Leprosy with Type 1 Lepra Reaction and Concurrent Latent Tuberculosis
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 373-375
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6
Uncommon Presentation of Tuberculosis as an Incidentally Discovered Solitary Pleural Tuberculoma
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 376-377
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7
Diffuse Non-Genital Cutaneous Warts
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 378-379
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8
Chilblains Associated with Chronic Chikungunya
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 380-381
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9
Being Present in the Silence
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 382-383
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10
Snakebite Management and One Health in Asia Using an Integrated Historical, Social, And Ecological Framework
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 384-388
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11
Resilient Clinical Trial Infrastructure in Response to the COVID-19 Pandemic: Lessons Learned from the TOGETHER Randomized Platform Clinical Trial
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 389-393
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12
Melioidosis in Africa: Time to Raise Awareness and Build Capacity for Its Detection, Diagnosis, and Treatment
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 394-397
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13
American Medical Trainee Perspectives on Ethical Conflicts during a Short-Term Global Health Rotation in Ethiopia: A Qualitative Analysis of 30 Cases
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 398-411
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14
Global Health Training Collaborations: Lessons Learned and Best Practices
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 412-418
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15
Expanding Global Health Engagement through Fogarty Fellowship Programs
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 419-423
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16
U-Shaped Association between Maternal Hemoglobin and Low Birth Weight in Rural Bangladesh
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 424-431
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17
Underutilization and Quality Gaps in Blood Culture Processing in Public Hospitals of Peru
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 432-440
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18
Cognitive Outcomes at 18 Months: Findings from the Early Life Interventions for Childhood Growth and Development in Tanzania (ELICIT) Trial
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 441-445
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19
Healthcare Seeking and Access to Care for Pneumonia, Sepsis, Meningitis, and Malaria in Rural Gambia
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 446-453
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20
Detection of Pathogens of Acute Febrile Illness Using Polymerase Chain Reaction from Dried Blood Spots
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 454-456
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21
Clinical, Sociodemographic and Environmental Risk Factors for Acute Bacterial Diarrhea among Adults and Children over Five Years in Bangladesh
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 457-463
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22
An Application of the Integrated Behavioral Model for Water, Sanitation and Hygiene to Assess Perceived Community Acceptability and Feasibility of the Biosand Filter among Maasai Pastoralists in Rural Tanzania
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 464-478
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23
School Sanitation-Related Psychosocial Stressors among Nigerian Students
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 479-485
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24
Clinical Evaluation of the Modified Faine Criteria in Patients Admitted with Suspected Leptospirosis to the Territorial Hospital, New Caledonia, 2018 to 2019
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 486-493
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25
Incidence Estimates of Acute Q Fever and Spotted Fever Group Rickettsioses, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 494-503
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26
Nontyphoidal Salmonella among Children under 5 Years Old in Sub-Saharan Africa and South Asia in the Global Enteric Multicenter Study
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 504-512
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27
Ruminant-Related Risk Factors are Associated with Shiga Toxin–Producing Escherichia coli Infection in Children in Southern Ghana
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 513-522
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28
Detection of Enterotoxigenic Escherichia coli in Rotavirus-Infected Ghanaian Children Diagnosed with Acute Gastroenteritis
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 523-524
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29
Prior Carriage Predicts Intensive Care Unit Infections Caused by Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 525-531
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30
Impact of Temperature and Rainfall on Typhoid/Paratyphoid Fever in Taizhou, China: Effect Estimation and Vulnerable Group Identification
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 532-542
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31
Assessment of Rapid Diagnostic Tests for Typhoid Diagnosis and Assessment of Febrile Illness Outbreaks in Fiji
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 543-549
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32
Case Report: Severe Dental Abscess Complications in Rural Sierra Leone
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 550-555
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33
Immunogenicity of Oxford-AstraZeneca COVID-19 Vaccine in Vietnamese Health-Care Workers
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 556-561
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34
COVID-19 Serology Control Panel Using the Dried-Tube Specimen Method
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 562-565
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35
Case Report: Rhino-orbital Mucormycosis Related to COVID-19: A Case Series Exploring Risk Factors
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 566-570
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36
COVID-19-Associated Pulmonary Aspergillosis in a Series of Complete Autopsies from the Brazilian Amazon
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 571-573
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37
Case Report: Cerebral Phaeohyphomycosis Due to Chaetomium strumarium in a Child with Visceral Heterotaxy Syndrome
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 574-577
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38
Case Report: Dengue Hemorrhagic Fever with Ischemic Stroke
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 578-581
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39
First Record of Natural Transovarial Transmission of Dengue Virus in Aedes albopictus from Cuba
American Journal of Tropical Medicine and Hygiene, 2.02.2022
Tilføjet 2.02.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 106Issue: 2Pages: 582-584
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40
School closures and reopenings during the COVID-19 pandemic: a scoping review protocol
Li, D., Nyhan, K., Zhou, X., Zhu, Y., Castro, D., Vermund, S. H., Brault, M.
BMJ Open, 2.02.2022
Tilføjet 2.02.2022
Objective
The objective of this scoping review is to provide an overview of existing studies and evidence on the impact of school closures and reopenings during the pandemic.
Introduction
The COVID-19 pandemic has necessitated widespread school closures, and reopening schools safely has a pivotal role in the well-being of children and teachers, SARS-CoV-2 transmission control and optimal societal functioning. Widespread school closures in response to the COVID-19 pandemic have caused adverse effects on the education, physical health and mental well-being of children. An understanding of the impact of school closures and reopenings as well as factors influencing school safety is critical to bringing schools’ operational status back to normal. Despite the implication of individual concerns and knowledge on disease prevention practices, there is a paucity of research on individual knowledge, needs and behaviours in the context of school reopenings. In the proposed study, we will conduct a scoping review to identify and provide inventory of the current research and evidence on the impact of COVID-19 on K-12 schools (primary and secondary schools) and vice versa.
Methods and analysis
Eligible studies/literature include members of K-12 (primary and secondary) schools (students, parents, staff, faculty, COVID-19 coordinator, school nurses) in countries affected by the COVID-19 pandemic. We will exclude university or college students. There will be no exclusion based on methods, timing or school operational status.
All concepts regarding school closures and reopenings will be considered, and all types of research will be considered.
This scoping review will follow the Joanna Briggs Institute methodology for scoping reviews. Sources of evidence published from 2020 to 31 October 2021 will be included. The search will include PubMed, preprints in EuropePMC, ERIC, Scopus, Web of Science Core Collection, PsycINFO, Embase, CINAHL and VHL. We will cover grey literature in Harvard Think Tank Database, COVID-19 Evidence Hub like COVID-END and Google Scholar. The abstract and title screening, full-text screening and data extraction will be done by two independent reviewers.
Disagreements will be resolved by an independent third reviewer. Data extract will be done on Qualtrics form to ensure accurate extraction. Citation chaining will be performed on key articles identified. A critical appraisal will be performed.
The scoping review will take place from 1 August 2021 to 15 November 2021. We will perform a final round of updated search and citation chaining.
Ethics and dissemination
The review will be based on published works and grey literature, thus it is exempt from formal ethical approval. This protocol cannot be registered in the Prospective Register of Systematic Reviews because this registry is not for scoping reviews. We will register it in OSF Registration. The paper will appear in a peer-reviewed, open-access journal to ensure a broad dissemination.
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41
Demographic, clinical guideline criteria, Medicaid expansion and state of residency: a multilevel analysis of PrEP use on a large US sample
Carneiro, P. B., Mirzayi, C., Jones, S., Rendina, J., Grov, C.
BMJ Open, 2.02.2022
Tilføjet 2.02.2022
Objective
To explore the association of clinical guideline-related variables, demographics and Medicaid expansion on pre-exposure prophylaxis (PrEP) uptake in one of the largest US sample of men who have sex with men(MSM) and transgender and gender non-binary (TGNB) people ever analysed.
Methods
We cross-sectionally analysed predictors of current PrEP use using demographic and HIV risk-related variables (level-1), as well as state-level variables (level-2) (ie, Medicaid expansion status). We further explored the role state of residence plays in PrEP uptake disparities across the USA.
Results
We found that the odds of PrEP use were significantly greater in older age, white, cisgender men. Moreover, individuals who reported recent post-exposure prophylaxis use, a recent sexually transmitted infection diagnosis and recent drug use were significantly more likely to report PrEP use. Finally, we found that the median odds of PrEP use between similar individuals from different states were 1.40 for the ones living in the Medicaid expansion states, compared with those not living in Medicaid expansion states. State of residence did not play a significant role in explaining PrEP disparities overall.
Conclusion
Our analysis showed that PrEP use is less common in communities standing to benefit the most from it—young MSM and TGNB of colour. However, individuals meeting federal guidelines for PrEP were significantly more likely to use PrEP. Though we found a positive association between living in Medicaid expansion states and PrEP use; that variable, as well as one’s state of residency, were not suitable to explain variations in PrEP use in the US.
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42
Development of a nomogram for the prediction of in-hospital mortality in patients with acute ST-elevation myocardial infarction after primary percutaneous coronary intervention: a multicentre, retrospective, observational study in Hebei province, China
Wang, Y., Wang, W., Jia, S., Gao, M., Zheng, S., Wang, J., Dang, Y., Li, Y., Qi, X.
BMJ Open, 2.02.2022
Tilføjet 2.02.2022
Objectives
To establish a clinical prognostic nomogram for predicting in-hospital mortality after primary percutaneous coronary intervention (PCI) among patients with ST-elevation myocardial infarction (STEMI).
Design
Retrospective, multicentre, observational study.
Setting
Thirty-nine hospitals in Hebei province.
Participants
Patients with STEMI who underwent PCI from January 2018 to December 2019.
Interventions
A multivariable logistic regression model was used to identify the factors associated with in-hospital mortality, and a nomogram was established using these factors. The performance of the nomogram was evaluated by the discrimination, calibration and clinical usefulness.
Primary and secondary outcome measures
The outcome was the factors associated with in-hospital mortality.
Results
This study included 855 patients, among whom 223 died in hospital. Age, body mass index, systolic pressure on admission, haemoglobin, random blood glucose on admission, ejection fraction after PCI, use aspirin before admission, long lesions, thrombolysis in myocardial infarction flow grade and neutrophils/lymphocytes ratio were independently associated with in-hospital mortality (all p<0.05). In the training set, the nomogram showed a C-index of 0.947, goodness-of-fit of 0.683 and area under the receiver operating characteristic curve (AUC) of 0.947 (95% CI 0.927 to 0.967). In the testing set, the C-index was 0.891, goodness-of-fit was 0.462 and AUC was 0.891 (95% CI 0.844 to 0.939). The results indicate that the nomogram had good discrimination and good prediction accuracy and could achieve a good net benefit.
Conclusions
A nomogram to predict in-hospital mortality in patients with STEMI after PCI was developed and validated in Hebei, China and showed a satisfactory performance. Prospective studies will be necessary to confirm the performance and clinical applicability and practicality of the nomogram.
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43
Changes to postdiagnostic dementia support in England and Wales during the COVID-19 pandemic: a qualitative study
Wheatley, A., Poole, M., Robinson, L., on behalf of the PriDem study team, Robinson, Wheatley, Allan, Bamford, Banerjee, Brunskill, Burns, Dimitriadis, Dening, Griffiths, King, Knapp, Lewins, Manthorpe, Rait, Spencer, Tucker, Walters, Wilcock, Wittenberg
BMJ Open, 2.02.2022
Tilføjet 2.02.2022
Objectives
To explore the impact of COVID-19 on postdiagnostic dementia care and support provision in England and Wales.
Design
Qualitative research using semistructured interviews, via video or telephone conferencing.
Setting
Services providing postdiagnostic support across health, social care and the third sector.
Participants
21 professionals previously recruited to an ongoing research programme on postdiagnostic dementia care (or colleagues, if unavailable).
Results
Key themes identified from the data were: challenges caused by COVID-19; responses to those challenges, including a widespread shift to remote working; and effects of COVID-19 on future postdiagnostic support. Challenges included changing and sometimes conflicting guidelines; a lack of access to support; identifying and responding to emerging needs; emotional and physical impact of COVID-19; and balancing COVID-19 risk with other risks such as deterioration. Some dementia services closed, while others adapted and continued to provide support thus potentially widening existing inequalities. There were also some unintended positive outcomes, including improved cross-sector and multidisciplinary working between professionals.
Conclusion
Delivering postdiagnostic dementia support during COVID-19 required essential adaptations. While some changes were detrimental to service users, others were identified as potentially beneficial and highly likely to become the new ‘norm’, for example, use of blended approaches, combining virtual and face-to-face work, thus allowing more flexible, integrated care. Our data have implications for policy and practice to improve the response to the lingering effects of COVID-19 as well as creating service provision that is more resilient to future pandemics or other periods of disruption.
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