Background: To eliminate hepatitis C (HCV) infection as a public health concern by 2030, there is a need to develop comprehensive programs among key populations such as people who use drugs (PWUD). Two highly effective regimens are available for initial therapy: glecaprevir/pibrentasvir (G/P) given as 3 tablets/day for 8 weeks and sofosbuvir/velpatasvir (S/V) given as 1 tablet/day for 12 weeks. Data evaluating the safety and efficacy comparing one regimen over another in a population of PWUD is limited. Methods: Patients were identified through outreach events. Viremic patients were offered HCV treatment within a multidisciplinary program. This retrospective comparison analysis focuses on the first 120 sequential individuals who chose either treatment and in whom a definitive outcome of treatment was available between March 1, 2019 and February 29, 2024. The primary outcomes of the analysis were cure of HCV infection and its corelates, as well as safety of the individual regimens. Results: We successfully identified 120 within each of the G/P and S/V treatment groups. Of those on G/P, we note 28.3 % female, 20.9 % Indigenous, 70.8 % using fentanyl, and 51.3 % with unstable housing. Of those on S/V, we note 25.8 % female, 20.8 % Indigenous, and 75 % using fentanyl and 56.7 % with unstable housing. Overall, 118 and 115 patients completed therapy on G/P and S/V, respectively. A total of 118 and 115 completed therapy on G/P and S/V, with virologic relapse documented in 3 and 2 participants on G/P and S/V, respectively. The ITT/mITT cure rates for G/P and S/V were 95.0 %/97.4 % and 94.2 %/98.3 %, respectively. There were 5 drug overdose deaths among those who initiated treatment, one on G/P and 4 on S/V. Conclusion: We have evaluated two highly effective regimens in a group of inner-city PWUD, with comparable success rates well in excess of 90 %. Our data supports the offer of both options for the treatment of PWUD with HCV infection.
Jethel Hernandez, Stephanie Batio, Rebecca Mullen Lovett
et al.
Introduction: Missed visits have been estimated to cost the U.S. healthcare system $50 billion annually and have been linked to healthcare inefficiency, higher rates of emergency department visits, and worse outcomes. COVID-19 disrupted existing outpatient healthcare utilization patterns. In our study, we sought to examine the frequency of missed outpatient visits over the course of the COVID-19 pandemic and to examine patient-level characteristics associated with non-attendance. Methods: This study utilized data from a longitudinal cohort study (the Chicago COVID-19 Comorbidities (C3) study). C3 participants were enrollees in 1 of 4 active, “parent” studies; they were rapidly enrolled in C3 at the onset of the pandemic. Multiple waves of telephone-based interviews were conducted to collect experiences with the pandemic, as well as socio-demographic and health characteristics, health literacy, patient activation, and depressive and anxiety symptoms. For the current analysis, data from waves 3 to 8 (05/01/20-05/19/22) were analyzed. Participants included 845 English or Spanish-speaking adults with 1 or more chronic conditions. Results: The percentage of participants reporting missed visits due to COVID-19 across study waves ranged from 3.1 to 22.4%. Overall, there was a decline in missed visits over time. No participant sociodemographic or health characteristic was consistently associated with missed visits across the study waves. In bivariate and multivariate analysis, only patient-reported anxiety was significantly associated with missed visits across all study waves. Conclusion: Findings reveal that anxiety was consistently associated with missed visits during the COVID-19 pandemic, but not sociodemographic or health characteristics. Results can inform future public health initiatives to reduce absenteeism by considering patients’ emotional state during times of uncertainty.
Computer applications to medicine. Medical informatics, Public aspects of medicine
LakKumar Fernando, Randee Kastner, Pujitha Wickramasinghe
et al.
<h4>Background</h4>Outbreaks of dengue can overburden hospital systems, drastically reducing capacity for other care. The 2017 dengue serotype 2 (DENV-2) outbreak in Sri Lanka coincided with vaccination in an ongoing phase 3 efficacy trial of a tetravalent dengue vaccine, TAK-003 (NCT02747927). Here, we present data on the efficacy of TAK-003 following two doses of the vaccine administered 3 months apart in participants aged 4-16 years in Sri Lanka. In addition, we have used the 2017 outbreak dynamics to model the potential impact of TAK-003 on virologically confirmed dengue (VCD) cases and hospitalizations during an outbreak situation.<h4>Methodology/principal findings</h4>Modeling was performed using an age-structured, host-vector, spatial and stochastic transmission model, assuming 65% vaccine coverage and 30 days until initiation of vaccination. Efficacy of TAK-003 against VCD and hospitalized VCD cases was based on data against DENV-2 from the first year of the phase 3 trial. Vaccine efficacy and safety findings in Sri Lanka were in line with those of the overall trial population. The efficacy estimates in Sri Lanka up to the first 12 months after the second dose of TAK-003 were 94.7% and 95.7% against VCD and hospitalized VCD cases, respectively. Modeling of the trial data over an extended geographic area showed a substantial reduction in cases and a flattening of outbreak curves from TAK-003 use. The baseline vaccination scenario (initiation at 30 days, 65% target coverage, vaccine effective at 14 days, 70% hospitalization rate, VE of 95% for VCD and 97% for hospitalized VCD, and 47% for asymptomatic) resulted in a 69.1% reduction in VCD cases and 72.7% reduction in VCD hospitalizations compared with no vaccination. An extreme high scenario (vaccination initiated at Day 15, 80% coverage rate, baseline VE) resulted in 80.3% and 82.3% reduction in VCD and VCD hospitalizations, respectively. Vaccine performance, speed of vaccination campaign initiation, and vaccine coverage were key drivers in reducing VCD cases and hospitalizations.<h4>Conclusions/significance</h4>Overall, the study and modeling results indicate that TAK-003 has the potential of meaningful utility in dengue outbreaks in endemic areas.
Arctic medicine. Tropical medicine, Public aspects of medicine
Gena A. Rojas, Silvera Erari, Yvette C. Paulino
et al.
Abstract Background The Betel Nut Intervention Trial (BENIT; ClinicalTrials.gov - NCT02942745) is the first known randomized intervention trial specifically designed for areca nut chewers in the western Pacific region who want to quit. The current study is a separate, exploratory study that examined the experiences of the BENIT facilitators during its implementation in Guam and Saipan of the Northern Mariana Islands and the extent to which the BENIT protocol was adapted to meet the participants’ and facilitators’ needs. Methods All six BENIT program facilitators completed an online survey consisting of quantitative (Likert scale) and qualitative (open-ended) questions. Survey items were grouped as follows: facilitator demographics, prior training and preparation, BENIT experience, beliefs about the program’s effectiveness, and beliefs about protocol adaptations. Results Most of the facilitators felt prepared to deliver the BENIT program after several weeks of moderately intensive training. Facilitators felt the BENIT program was generally effective and that the “trigger logs” and “self-monitoring logs” worked as intended. However, they also noted that more time and support would have been helpful to overcome some of the obstacles inherent to implementing a novel program. Conclusion The current findings can be used to inform, modify, and tailor subsequent areca nut cessation programs in Micronesian communities and to improve future versions of BENIT.
BackgroundThe current rate of organ donation in China falls significantly below the global average and the actual demand. Nursing students play a crucial role in supporting and promoting social and public welfare activities. This study primary aims to analyze the levels of knowledge, attitudes, willingness toward organ donation, and attitudes toward death among nursing students, and investigate the mediating role of attitude in the relationship between knowledge and willingness. The secondary aims to identify factors that may influence the willingness.MethodsA convenience sample of nursing students completed online-administered questionnaires measuring the level of knowledge, attitudes, and willingness toward organ donation before and after clinical internship. Spearman correlation and mediation analyses were used for data analyses.ResultsBefore the clinical internship, there were 435 nursing students who had not yet obtained their degrees and were completing their clinical internships. After the internship, this number decreased to 323. The mean score for knowledge before and after the clinical internship (7.17 before and 7.22 after, with no significant difference), the attitude (4.58 before and 4.36 after, with significant difference), the willingness (12.41% before and 8.67% after, with significant difference), the Death Attitude Profile-Revised (DAP-R) score (94.41 before and 92.56 after, with significant difference). The knowledge indirectly affected nursing students’ willingness to organ donation through attitude. Knowledge had a direct and positive impact on attitudes (β = 1.564). Additionally, nursing students’ attitudes positively affected their willingness (β = 0.023). Attitudes played a mediating role in the relationship between knowledge and willingness (β = 0.035). Additionally, attitude toward death, fear of death, and acceptance of the concept of escape were found to be correlated with their willingness.ConclusionOrgan donation willingness was found to be low among nursing students. Positive attitudes were identified as a mediating factor between knowledge and willingness. Additionally, DAP-R was a related factor. Therefore, it is recommended to focus on improving knowledge and attitude, as well as providing death education to help nursing students establish a positive attitude toward death. These efforts can contribute to the promotion of organ donation.
Zeynab Arbabi, Abdolali Banaiefar, Sajjad Arshadi
et al.
Background and Aim: Metabolic syndrome refers to a set of metabolic disorders related to obesity, such as abdominal obesity, increased body fat mass, lipid disorders, hypertension, increased blood glucose, and insulin resistance. The present study was conducted with the aim of determining the effect of 8 weeks of CXWORX exercises combined with inulin consumption on some indicators of oxidative stress in obese women with metabolic syndrome.
Materials and Methods: Forty eight obese women with metabolic syndrome in the age range of 30 to 40 years were randomly divided into Control, inulin, CX exercise and combined groups were included. Subjects were present in the laboratory environment and 5 cc of blood was taken from their brachial vein. Blood sample was taken to measure malondialdehyde and xanthine oxidase (pre-test). Then the aforementioned interventions were performed on the studied groups for a period of 8 weeks. Finally, blood sampling was done again to measure the variables (post-test).
Results: The results of the correlated t-test revealed that in all three groups, the intervention led to a significant decrease in malondialdehyde compared to the pre-test; However, xanthine oxidase variable did not change significantly in the exercise group and significantly decreased in the inulin and combined groups compared to the pre-test. ANOVA results revealed that compared to the control group, the amount of malondialdehyde is significant only in the combined group (P≤0.05). The amount of this variable in the combined group decreased significantly compared to the exercise and inulin group (P≤0.05). No significant difference was observed between the exercise and inulin groups (P>0.05). Amount of xanthine oxidase, a significant difference had between the inulin and combination groups with the control group (P≤0.05). No significant difference was observed between the exercise and inulin groups (P>0.05). Despite this, a significant difference in xanthine oxidase levels was observed between the combined group with the exercise and inulin groups (P≤0.05).
Conclusion: Based on the available findings, it is concluded that the implementation of CX exercises combined with the use of inulin reduces the oxidative stress function more than the application of each of them alone in women with metabolic syndrome.
Isadora Cristina de Siqueira, Breno Lima de Almeida, Maria Lucia Costa Lage
et al.
Background: Despite growing scientific knowledge of Zika virus (ZIKV) infection, questions remain regarding ZIKV infection in pregnancy and congenital ZIKV syndrome (CZS). Methods: The ZIKAction Paediatric Registry is an international registry of children with documented ZIKV exposure in utero and/or with confirmed or suspected CZS. Its aim is to characterize these children (i.e., clinical, radiological, neurodevelopmental features) and describe outcomes, longer-term sequelae and management through retrospective case note review. This analysis described the maternal and perinatal characteristics of children in the Registry’s Bahia arm, assessed their neuroimaging, ophthalmic, hearing and electroencephalography abnormalities by microcephaly classification and reported on hospitalisations. Children born in 2015-2018 and enrolled 2020-2021 in three public health facilities in Salvador were included. Results: Of 129 (57% female) children, 15 (11·6%) had laboratory-confirmed congenital ZIKV infection and 114 (88·4%) suspected CZS. At delivery, 15 (11·6%) were normocephalic, 30 (23·3%) moderately microcephalic, and 84 (65·1%) severely microcephalic. Median birth head circumference z-score was -3·51 [IQR, -4·69,-2·73]. During follow-up, all children had abnormal neuroimaging, 80·3% (94/117) abnormal electroencephalogram, 62·2% (77/120) ophthalmic abnormalities, and 27·4% (34/124) hearing impairment. Microcephaly classification was significantly associated with gestational age, and ophthalmological and electroencephalography abnormalities. Of 125 children with hospitalisation data, 52 (41·6%) had been hospitalised by most recent follow-up, at median age of 15·8 [4·0, 34·4] months; infections were the leading cause. Conclusion: Congenital ZIKV infection is an emerging disease with a varied and incompletely understood spectrum. Continued long-term follow-up is essential to understand longer-term prognosis and to inform future health and educational needs.
Janki Tailor, Jessica Rodrigues, John Meade
et al.
Policies facilitating access to HIV prevention services, specifically for pre-exposure prophylaxis (PrEP), can foster enabling environments for service uptake. This analysis aims to establish whether policies enabling broad PrEP eligibility, HIV self-testing, and lowered age of consent to HIV testing and treatment services are correlated with PrEP uptake. Ages of consent vary by country, therefore this analysis focused on how age of consent policies, in general, affect adolescent PrEP uptake. Data was collected from the HIV Policy Lab and AVAC's Global PrEP Tracker, a database of approximately 334 PrEP projects operating across 95 countries, and linear regression and correlation analyses were conducted via STATA to examine relationships amongst national oral PrEP eligibility, HIV self-testing, lowered age of consent, and national cumulative oral PrEP initiations, as of December 2021. Of all 194 countries tracked by the HIV Policy Lab, only about 7% have adopted all three policies (HIV self-testing, lowered age of consent, and PrEP eligibility policies). Less than 50% have adopted have adopted at least one of these policies. Of the 54 countries that have fully adopted PrEP eligibility policies, less than 30% have co-adopted HIV self-testing or lowered age of consent policies. About 30% of these 194 countries have yet to adopt any of these policies, of which about 14% have indicated information is "unavailable" for at least one of the policies. Analyses conducted for the 91 countries tracked by both the HIV Policy Lab and the Global PrEP Tracker revealed a significant and positive relationship between cumulative individuals initiated on oral PrEP and adoption of HIV self-testing policies (p = 0.01, r = 0.26), lowered age of consent policies (p = 0.01, r = 0.25), and PrEP eligibility policies (p = 0.01, r = 0.26). Stronger advocacy efforts towards approving public health policies, such as those outlined in our analysis, that enshrine and enable access to HIV prevention are necessary.
Israel Parra-Ortega, Armando Vilchis-Ordoñez, Briceida López-Martínez
et al.
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome 2 coronavirus (SARS-CoV-2) and is currently listed as a global public health emergency. Timely identification and protocol implementations for molecular detection of this virus are vital for medical decision-making. Identification of SARS-CoV-2 infection cases is based on detection of the virus RNA by molecular tests, particularly real-time reverse transcription-polymerase chain reaction (RT-PCR). Technical and operational details specific to each center must be considered to perform the molecular diagnosis of SARS-CoV-2 in pediatric patients. The term “qualified laboratories” involves laboratories in which all users, analysts, and anyone reporting results are trained to develop and interpret results through a procedure implemented previously by an instructor. Such knowledge is essential in detecting and identifying errors during each of its phases: pre-analytical, analytical, and post-analytical, which allow the establishment of continuous improvement policies to ensure the quality of the results, but above all, the physical integrity of health workers.
Mario Sims, Lá Shauntá M. Glover, Samson Y. Gebreab
et al.
Abstract Background Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects. Methods Using the Jackson Heart Study, we examined the cross-sectional associations of cumulative psychosocial factors with CVD risk factors among 5306 African Americans. We utilized multivariable Poisson regression to estimate sex-stratified prevalence ratios (PR 95% confidence interval-CI) of obesity, hypertension and diabetes prevalence and hypertension and diabetes control with negative affect (cynicism, anger-in, anger-out, depressive symptoms and cumulative negative affect) and stress (global stress, weekly stress, major life events-MLEs and cumulative stress), adjusting for demographics, socioeconomic status, and behaviors. Results After full adjustment, high (vs. low) cumulative negative affect was associated with prevalent obesity among men (PR 1.36 95% CI 1.16–1.60), while high (vs. low) cumulative stress was similarly associated with obesity among men and women (PR 1.24 95% CI 1.01–1.52 and PR 1.13 95% CI 1.03–1.23, respectively). Psychosocial factors were more strongly associated with prevalent hypertension and diabetes among men than women. For example, men who reported high cynicism had a 12% increased prevalence of hypertension (PR 1.12, 95% CI 1.03–1.23). Psychosocial factors were more strongly associated with lower hypertension and diabetes control for women than men. Women who reported high (vs. low) cynicism had a 38% lower prevalence of hypertension control (PR 0.62, 95% CI 0.46–0.84). Conclusions Cumulative psychosocial factors were associated with CVD risk factors and disease management among African Americans. The joint accumulation of psychosocial factors was more associated with risk factors for men than women.
Mardjan Mardjan, Yayi Suryo Prabandari, Mohammad Hakimi
et al.
ABSTRACT
Anxiety during pregnancy in primiparous mother will be a hard burden because of the immature both psycologic and reproductive organs which can increase the risk of maternal mortality, infant mortality, prolonged childbirth, LBW, postpartum depression, etc. An effort to minimize the anxiety is the implementation of EFT (Emotional Freedom Techniques) during the third trimester.
This research purposed to assess the effectiveness of EFT to decrease anxiety in facing childbirth. This research used the quasi-experimental pre-test and post-test method of treatment and control. The treatment was done during the third trimester, started and followed for 3 months ie month 7th, 8th, 9th. The EFT was implemented every month then continued independently by the mother, until before childbirth process. The research instrument used TMAS (Taylor Manifest Anxiety Scale) and cortisol blood test. The subjects were 38 respondents consisted of 19 interventions and 19 controls.
Result with paired t-test, TMAS1,2,3, each stage got significant difference, pre and post blood cortisol level p = 0.0001. Linear regression analysis on TMAS p = 0.001 and R² = 0.57, whereas blood cortisol level p = 0.004 and R² = 0.43. This analysis proved EFT contributed significantly 57% to lower anxiety levels and 43% to lower blood cortisol level, indirectly affected the readiness to face childbirth process.
ABSTRAK
Kecemasan selama kehamilan pada ibu primipara akan memberatkan kondisi bayi dalam kandungan karena secara psikologis kejiwaannya belum siap dan organ reproduksi belum sempurna yang dapat meningkatkan risiko dalam persalinan dan merupakan salah satu faktor penyebab kematian ibu, bayi, partus lama, BBLR, depresi postpartum, dll. Upaya meminimalisasi kecemasan ini dilakukan dengan metode EFT (Emotional Freedom Techniques) selama trimester ketiga.
Tujuan penelitian untuk mengetahui efektivitas EFT terhadap penurunan kecemasan dalam menghadapi persalinan. Penelitian ini menggunakan metode quasi eksperimen pre test dan post terhadap perlakuan dan kontrol. Perlakuan dilakukan selama trimester III, dimulai dan diikuti selama 3 bulan yaitu bulan ke-7, 8, 9. EFT dilakukan setiap bulan dan dilanjutkan secara mandiri oleh ibu, sampai menjelang persalinan. Instrumen penelitian menggunakan TMAS (Taylor Manifest Anexity Scale) dan pemeriksaan darah kortisol. Subyek penelitian 38 responden, terdiri atas 19 intervensi dan 19 kontrol.
Hasil penelitian dengan uji paired t-test, TMAS1,2,3, setiap tahapannya didapatkan perbedaan bermakna yaitu kortisol darah pre dan post p=0,0001, analisa regresi liniear TMAS p = 0,001, dan R² = 0,57; serta kortisol darah p=0,004 dan R²=0,43. Analisa ini membuktikan EFT berkontribusi 57% menurunkan tingkat kecemasan dan 43% dalam menurunkan kortisol darah secara signifikan yang secara tidak langsung berpengaruh terhadap kesiapan menghadapi persalinan.
O presente artigo tem como objetivo analisar as atividades de redação da revista Minerva, periódico belga de medicina baseada em evidência (MBE), de acordo com as diretrizes da prevenção quaternária. A partir da produção editorial da revista Minerva foi realizada uma análise narrativa de suas atividades de redação em relação ao questionamento clínico, à pesquisa, à crítica e à interpretação de informações clínicas relevantes à prática profissional. São detalhados os limites da MBE e as ferramentas e linhas de reflexão emitidas pela equipe de redação da revista a fim de favorecer a implementação da MBE na prática clínica. Dessa forma, se pretende prevenir o intervencionismo médico desnecessário, ao se fortalecer a prevenção quaternária como uma competência fundamental dos trabalhadores da saúde ao longo de sua vida profissional a serviço dos pacientes, o que pode ser reforçado pelo trabalho da equipe editorial de uma revista de MBE.
A. Julián-Jiménez, J. González del Castillo, M. Martínez Ortíz de Zárate
et al.
Introducción. El objetivo de este artículo es determinar la prevalencia y conocer los cambios epidemiológicos más relevantes en la última década en la neumonía adquirida en la comunidad (NAC) en los servicios de urgencias (SU), así como el perfil y manejo de los pacientes.
Métodos. Estudio descriptivo con análisis transversal, multicéntrico en 49 SU españoles durante 12 meses. Se incluyeron todos los pacientes con el diagnóstico de NAC, de infección respiratoria y de infección. Se registraron todos los pacientes atendidos en los SU.
Resultados. La prevalencia de la NAC ha aumentado entre los pacientes en el SU en la última década del 0,85% al 1,35% (p<0,001). El 51% de los NAC se registraron en pacientes con 70 o más años. El 69,8 % tenían alguna enfermedad de base y el 17,8% en algunos que poseían alguno de los factores de riesgo para desarrollar infección. El 11,7% cumplían criterios de sepsis, 4,6% de sepsis grave y el 3% shock séptico. El 37% de los pacientes recibieron el alta desde el SU.
Conclusiones. El impacto y prevalencia de la NAC en los SU ha aumentado en la última década. Es la causa más frecuente de sepsis, sepsis grave y shock séptico, de ingreso en la unidad de cuidados intensivos y de fallecimiento por enfermedad infecciosa.
<p>Abstract</p> <p>Background</p> <p>Inadequate knowledge, or inappropriate practice, of breastfeeding may lead to undesirable consequences. The aim of this study was to assess breastfeeding knowledge, attitude and practice (KAP) among female teachers in the Abha Female Educational District and identify factors that may affect breastfeeding practice in the study population.</p> <p>Methods</p> <p>A cross-sectional study using a self-administered questionnaire was conducted among school teachers in Abha Female Educational District during the months of April to June, 2011. Breastfeeding KAP of participants who had at least one child aged five years or younger at the time of the study were assessed using a self-administered questionnaire, based on their experience with the last child.</p> <p>Results</p> <p>A total of 384 women made up of 246 (61.1%) primary-, 89 (23.2%) intermediate- and 49 (12.8%) high-school teachers participated in the study. One hundred and nineteen participants (31%) started breastfeeding their children within one hour of delivery, while exclusive breastfeeding for 6 months was reported only by 32 (8.3%) participants. Insufficient breast milk and work related problems were the main reasons given by 169 (44%) and 148 (38.5%) of participants, respectively, for stopping breastfeeding before two years. Only 33 participants (8.6%) had attended classes related to breastfeeding. However, 261 participants (68%) indicated the willingness to attend such classes, if available, in future pregnancies.</p> <p>Conclusions</p> <p>This study revealed that breast milk insufficiency and adverse work related issues were the main reasons for a very low rate of exclusive breastfeeding among female school teachers in Abha female educational district, Saudi Arabia. A very low rate of attending classes addressing the breastfeeding issues during pregnancy, and an alarming finding of a high percentage of babies receiving readymade liquid formula while still in hospital, were also brought out by the present study. Such findings, if addressed comprehensively by health care providers and decision-makers, will lead to the improvement of breastfeeding practices in the study community.</p>
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