Introduction Motivated health workers are pivotal in providing adequate health services. This study aims to understand what motivates and demotivates maternal health workers. We do so in Somalia, an understudied country in Africa with pervasive security challenges and one of the highest avoidable maternal mortality rates.Methods This qualitative study explores health workers’ motivation in three tertiary hospitals in the capital, Mogadishu. Twenty skilled healthcare professionals were interviewed, including nurses, midwives, physicians, specialists and supervisors. The interviews were transcribed verbatim and analysed using thematic analysis.Results Key factors influencing healthcare workers’ motivation include job satisfaction, monetary and work-related support, effective managerial practices, career development and intrinsic motivation. Most health workers expressed a powerful combination of altruism, volunteerism and religious conviction, driving their professional commitment to the community. Challenges that led to demotivation included high patient volume, staff shortages, limited supplies, infrastructural constraints, unregulated managerial practices and health system limitations. While most health workers primarily wanted to meet patients’ needs and did not consider salary a decisive motivating factor, others were demotivated by low pay and heavy workload.Conclusion Maternal health workers in Somalia face challenges that impact their motivation. Mitigating burnout through workload management and continued education can contribute to a more motivated and resilient healthcare workforce. Policy recommendations include offering long-term contracts, providing access to training and implementing fair and transparent employment policies. Further research is needed to evaluate the effectiveness of both financial and non-financial incentives in motivating health workers in Somalia.
Medicine (General), Infectious and parasitic diseases
Abstract Infections caused by mosquito-borne viruses such as Dengue virus (DENV), Zika virus (ZIKV), and Japanese encephalitis virus (JEV) have become a global public health issue. However, due to the unclear pathogenic mechanisms, there are currently no specific treatments available for patients infected with these orthoflaviviruses in clinical practice. Metabolomics provides distinct advantages for characterizing infection features and deciphering disease pathogenesis. Therefore, this review summarizes relevant literature on mosquito-borne viruses metabolomics, with a particular focus on elucidating the metabolic characteristics of cells infected by orthoflaviviruses. By conducting a comparative analysis of the metabolomics data from different sample sources infected with DENV, ZIKV, and JEV, we found that several metabolic pathways involved in viral infection, replication, and pathogenesis are commonly disrupted in the metabolomics data of these orthoflaviviruses. These pathways include the reprogramming of lipid metabolism, interference with energy metabolism, and the induction of host inflammatory responses. These findings identify key targets for subsequent mechanistic studies on the persistent replication and transmission of orthoflaviviruses in mosquito vectors and their ability to cause severe pathology in human hosts. Further elucidations of the above mechanisms could provide an effective scheme for preventing orthoflaviviral transmission in mosquito vectors and treating orthoflaviviral infections. In addition, studying these metabolomic changes in human hosts of orthoflaviviral infections may be able to provide relevant biomarkers for accurate diagnosis of the disease.
Abstract Background In recent years, the prevalence of AIDS has shown a high increase, which has become a major public health problem of international concern. According to research, the quality of life(QoL) of AIDS patients is often lower than that of patients with other chronic diseases, so how to improve the QoL of AIDS patients has become a problem that needs to be urgently focused on at present. The purpose of this study is to develop and validate the AIDS scale among the System of Quality of Life Instruments for Chronic Diseases(QLICD), name as QLICD-HIV V2.0. Methods QLICD-HIV V2.0 was developed using a programmed modular approach with multiple nominal and focus group discussions, in-depth interviews and quantitative statistical procedures. Pre-surveys and formal surveys were conducted on the preliminary version of the scale, thus completing the scale development and validation process. The reliability of the scale was analyzed using the correlation coefficient method, the variability method, and the Cronbach’s α coefficient method of classical test theory(CTT), the validity of the scale was analyzed using factor analysis and correlation analysis with the SF-36 as a criterion, and the responsiveness of the scale and of each domain/facet was assessed through paired t-tests of before and after admission scores, and calculation of the standardized response mean (SRM). Results QLICD-HIV V2.0 ultimately retained 43 items, resulting in a structure of 4 domains, subdivided into 12 facets. The scale was shown to have high reliability overall by several methods of CTT. The Cronbach’s α coefficient and test-retest reliability for the total scale were 0.90 and 0.88, respectively, with domain Cronbach’s α coefficient ranging from 0.74 to 0.85 and test-retest reliabilities ranging from 0.69 to 0.89. Factor analysis results showed KMO = 0.852, with three common factors extracted from 15 items of the specific module, accounting for 55.2% of the cumulative variance, and correlation and factor analyses confirmed good structural and criterion-related validity. Conclusions QLICD-HIV V2.0 was developed in a systematic and scientific way, and showed good reliability and validity after preliminary application, which can be further promoted and used as a new QoL scale for AIDS patients with Chinese characteristics.
Martina Gyöngy, Boglárka Sellyei, István Czeglédi
et al.
Digenean (Heterophyidae) trematodes include several zoonotic species such as the genus Metagonimus (Katsurada, 1912). Metagonimus romanicus (Ciurea, 1915) is a species widely distributed in Europe, whose metacercariae can be found on cyprinoids from the River Danube in Hungary. The aim of the study was to measure the viability of Metagonimus romanicus metacercariae by physical (freezing, heating, desiccation) and chemical (acetic acid and NaCl solutions) treatments. The methods were chosen as a model for procedures commonly used in traditional food preservation (such as freezing, salting, pickling and smoking) to measure the survival rate of metacercariae under different conditions. Most physical treatments (freezing of metacercariae at −20 °C, keeping them at 40 °C and 60 °C and desiccation) and chemical treatments (2.5%, 5%, 10% acetic acid solution and 5% and 10% NaCl solution) killed the metacercariae in a relatively short time (from 30 min to 6 days depending on the treatment) so their effects eliminated the risk of zoonotic infection. On the other hand, the metacercariae survived at room temperature and at 4 °C up to one month. Therefore, storing unprepared fish in domestic refrigerators cannot prevent infection with metacercariae in humans.
Fernanda Bruzadelli Paulino da Costa, Thaís Zamboni Berra, Jaqueline Garcia de Almeida Ballestero
et al.
Introduction: Drug-resistant tuberculosis (DR-TB) is a global threat and a challenge for public health authorities worldwide. In children, the diagnosis is even more challenging and DR-TB is poorly described in the literature, as are its treatment outcomes. In this study, we aimed to describe the treatment of drug-resistant TB in children and young adolescents in Brazil. Methods: A descriptive epidemiological study of treatment for DR-TB in children under 15 years of age in Brazil between 2013 and 2020. The primary data source was the Information System for Special Tuberculosis Treatments (SITE-TB). Categorical variables were analyzed using relative frequencies (%) and continuous variables by measures of central tendency to characterize the profile of the cases, namely: sociodemographic, clinical characteristics, procedures, tests performed and treatment success. In order to verify the distribution of cases, a spatial analysis was carried out based on the municipality where the cases resided. Results: Between 2013 and 2020, 19,757 tuberculosis (TB) cases occurred in children aged <15 years in Brazil, and 46 cases of treatment for DR-TB were reported during the same period (annual average of 6 cases). Of these, 73.9% were aged 10–14, 65.2% were male, 4.3% were HIV+ and 43.3% were underweight (BMI<18.5) at the start of treatment. 17.4% had previous contact with TB, 69.6% had primary resistance, 47.8% multidrug resistance. The median duration of treatment was 15 months. DOT and standardized treatment regimen were performed in 52.2% of cases. Bacilloscopy was performed for 97.8% (57.8% positive); culture for 89.1% (75.6% positive), rapid molecular test for 73.9% with proven resistance to rifampicin in 55.8%. Susceptibility testing revealed resistance mainly to isoniazid (87.8%) and rifampicin (60.6%). 73.9% of cases were successfully treated and one death was reported. Cases were treated in 26 Brazilian municipalities, with the majority in Rio de Janeiro (15) and São Paulo (4). Conclusion: DR-TB treatment was recorded in <1% of general TB cases in children and young adolescents, suggesting underreporting of drug-resistant cases in the country. Despite the low number of registered cases, the data reflect the situation of DR-TB in this population and describe important aspects of the problem, as the child needs comprehensive, individualized care, with support from different professionals. We recommend a strengthening of the country's referral services for the care of children with DR-TB so that surveillance and health care services can work together to identify and follow up cases.
Diseases of the respiratory system, Infectious and parasitic diseases
Background: In the face of a sudden influx of several million migrants and war refugees from Ukraine to other European countries, knowledge about the health of Ukrainian citizens becomes increasingly important. The aim of the study is to identify the main health problems of hospitalized Ukrainian citizens residing in Poland in the period from 2014 to June 2022. Methods: This study is based on hospitalization data of Ukrainian patients in Poland taken from the Nationwide General Hospital Morbidity Study. Results: The study group covered 8591 hospitalization records. We observed two hospitalization peaks, one in patients aged 0–5 and the other one in those aged 20–35. After the official outbreak of the war, 2231 Ukrainian citizens were hospitalized in Poland. At this time, the most often reported principal reasons for the hospitalizations of adult women were diseases related to pregnancy, childbirth and the puerperium, whereas in groups of adult men diseases were related to injury, poisoning and certain other consequences of external causes, and in children and adolescents diseases were infectious and parasitic diseases. Conclusions: Our findings may have implications for healthcare policies and service provision to newly arrived migrants and war refugees in target European countries.
B. Joshi, Sujogya Kumar Panda, Ramin Saleh Jouneghani
et al.
Background Infections by microbes (viruses, bacteria, and fungi) and parasites can cause serious diseases in both humans and animals. Heavy use of antimicrobials has created selective pressure and caused resistance to currently available antibiotics, hence the need for finding new and better antibiotics. Natural products, especially from plants, are known for their medicinal properties, including antimicrobial and anthelmintic activities. Geoclimatic variation, together with diversity in ethnomedicinal traditions, has made the Himalayas of Nepal an invaluable repository of traditional medicinal plants. We studied antiviral, antibacterial, antifungal, and anthelmintic activities of medicinal plants, selected based upon ethnobotanical evidence. Methods Ethanolic and methanolic extracts were tested (1) on a panel of microbes: two Gram-positive bacteria (Staphylococcus aureus and Listeria innocua), four Gram-negative bacteria (Escherichia coli, Pseudomonas aeruginosa, Salmonella enterica, and Shigella sonnei), and one fungal species: Candida albicans; (2) against three different viruses: yellow fever, chikungunya, and enterovirus; and (3) on the nematode Caenorhabditis elegans. Also, cytotoxicity was assessed on human hepatoma (Huh), rhabdosarcoma (RD), and Vero (VC) cell lines. Results Of 18 plants studied, Ampelocissus tomentosa and Aleuritopteris anceps inhibited S. aureus (MIC 35 μg/mL and 649 μg/mL, respectively) and Pseudomonas aeruginosa (MIC 15 μg/mL and 38 μg/mL, respectively). Rhododendron arboreum and Adhatoda vasica inhibited S. enterica (MIC 285 μg/mL and 326 μg/mL, respectively). Kalanchoe pinnata, Ampelocissus tomentosa, and Paris polyphylla were active against chikungunya virus, and Clerodendrum serratum was active against yellow fever virus (EC50 15.9 μg/mL); Terminalia chebula was active against enterovirus (EC50 10.6 μg/mL). Ampelocissus tomentosa, Boenninghausenia albiflora, Dichrocephala integrifolia, and Kalanchoe pinnata significantly reduced C. elegans motility, comparable to levamisole. Conclusions In countries like Nepal, with a high burden of infectious and parasitic diseases, and a current health system unable to combat the burden of diseases, evaluation of local plants as a treatment or potential source of drugs can help expand treatment options. Screening plants against a broad range of pathogens (bacteria, viruses, fungi, and parasites) will support bioprospecting in Nepal, which may eventually lead to new drug development.
Alfonso de Miguel-Arribas, Alberto Aleta, Yamir Moreno
Abstract Background The COVID-19 outbreak has become the worst pandemic in at least a century. To fight this disease, a global effort led to the development of several vaccines at an unprecedented rate. There have been, however, several logistic issues with its deployment, from their production and transport, to the hesitancy of the population to be vaccinated. For different reasons, an important amount of individuals is reluctant to get the vaccine, something that hinders our ability to control and—eventually—eradicate the disease. Materials and methods Our aim is to explore the impact of vaccine hesitancy when highly transmissible SARS-CoV-2 variants of concern spread through a partially vaccinated population. To do so, we use age-stratified data from surveys on vaccination acceptance, together with age-contact matrices to inform an age-structured SIR model set in the US. Results Our results show that per every one percent decrease in vaccine hesitancy up to 45 deaths per million inhabitants could be averted. A closer inspection of the stratified infection rates also reveals the important role played by the youngest groups. The model captures the general trends of the Delta wave spreading in the US (July-October 2021) with a correlation coefficient of $$\rho =0.79$$ ρ = 0.79 . Conclusions Our results shed light on the role that hesitancy plays on COVID-19 mortality and highlight the importance of increasing vaccine uptake in the population, specially among the eldest age groups.
Chemical cartography of experimental gastrointestinal Chagas disease identifies previously-unknown mechanisms of disease tolerance. Chagas disease (CD) is a parasitic disease caused by Trypanosoma cruzi protozoa, presenting with cardiomyopathy, megaesophagus, and/or megacolon. To determine the mechanisms of gastrointestinal (GI) CD tissue tropism, we systematically characterized the spatial localization of infection-induced metabolic and microbiome alterations, in a mouse model of CD. Notably, the impact of the transition between acute and persistent infection differed between tissue sites, with sustained large-scale effects of infection in the esophagus and large intestine, providing a potential mechanism for the tropism of CD within the GI tract. Infection affected acylcarnitine metabolism; carnitine supplementation prevented acute-stage CD mortality without affecting parasite burden by mitigating infection-induced metabolic disturbances and reducing cardiac strain. Overall, results identified a previously-unknown mechanism of disease tolerance in CD, with potential for new therapeutic regimen development. More broadly, results highlight the potential of spatially resolved metabolomics to provide insight into disease pathogenesis and infectious disease drug development.
George F. Jones, Valeria Fabre, Jeremiah Hinson
et al.
Abstract
Objective:
To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED).
Design:
A controlled before-and-after study.
Setting:
The study was conducted in 5 adult EDs at teaching and community hospitals in a health system.
Patients:
Adults presenting to the ED with a respiratory condition diagnosis code. Hospitalized patients and those with a diagnosis code for a non-respiratory condition for which antibiotics are or may be warranted were excluded.
Interventions:
After a baseline period from January 2016 to March 2018, 3 EDs implemented a feedback intervention with peer comparison between April 2018 and December 2019 for attending physicians. Also, 2 EDs in the health system served as controls. Using interrupted time series analysis, the inappropriate ARI prescribing rate was calculated as the proportion of antibiotic-inappropriate ARI encounters with a prescription. Prescribing rates were also evaluated for all ARIs. Attending physicians at intervention sites received biannual e-mails with their inappropriate prescribing rate and had access to a dashboard that was updated daily showing their performance relative to their peers.
Results:
Among 28,544 ARI encounters, the inappropriate prescribing rate remained stable at the control EDs between the 2 periods (23.0% and 23.8%). At the intervention sites, the inappropriate prescribing rate decreased significantly from 22.0% to 15.2%. Between periods, the overall ARI prescribing rate was 38.1% and 40.6% in the control group and 35.9% and 30.6% in the intervention group.
Conclusions:
Behavioral feedback with peer comparison can be implemented effectively in the ED to reduce inappropriate prescribing for ARIs.
Infectious and parasitic diseases, Public aspects of medicine
Majid Sorouri, Amir Kasaeian, Helia Mojtabavi
et al.
Abstract Background COVID-19 has caused great concern for patients with underlying medical conditions. We aimed to determine the prognosis of patients with current or previous cancer with either a PCR-confirmed COVID-19 infection or a probable diagnosis according to chest CT scan. Methods We conducted a case control study in a referral hospital on confirmed COVID-19 adult patients with and without a history of cancer from February25th to April21st, 2020. Patients were matched according to age, gender, and underlying diseases including ischemic heart disease (IHD), diabetes mellitus (DM), and hypertension (HTN). Demographic features, clinical data, comorbidities, symptoms, vital signs, laboratory findings, and chest computed tomography (CT) images have been extracted from patients’ medical records. Multivariable logistic regression was used to estimate odd ratios and 95% confidence intervals of each factor of interest with outcomes. Results Fifty-three confirmed COVID-19 patients with history of cancer were recruited and compared with 106 non-cancerous COVID-19 patients as controls. Male to female ratio was 1.33 and 45% were older than 65. Dyspnea and fever were the most common presenting symptoms in our population with 57.86 and 52.83% respectively. Moreover, dyspnea was significantly associated with an increased rate of mortality in the cancer subgroup (p = 0.013). Twenty-six patients (49%) survived among the cancer group while 89 patients (84%) survived in control (p = 0.000). in cancer group, patients with hematologic cancer had 63% mortality while patients with solid tumors had 37%. multivariate analysis model for survival prediction showed that history of cancer, impaired consciousness level, tachypnea, tachycardia, leukocytosis and thrombocytopenia were associated with an increased risk of death. Conclusion In our study, cancer increased the mortality rate and hospital stay of COVID-19 patients and this effect remains significant after adjustment of confounders. Compared to solid tumors, hematologic malignancies have been associated with worse consequences and higher mortality rate. Clinical and para-clinical indicators were not appropriate to predict death in these patients.
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Infectious and parasitic diseases
Abstract Background eIF2α is a regulatory node that controls protein synthesis initiation by its phosphorylation or dephosphorylation. General control nonderepressible-2 (GCN2), protein kinase R-like endoplasmic reticulum kinase (PERK), double-stranded RNA (dsRNA)-dependent protein kinase (PKR) and heme-regulated inhibitor (HRI) are four kinases that regulate eIF2α phosphorylation. Main body In the viral infection process, dsRNA or viral proteins produced by viral proliferation activate different eIF2α kinases, resulting in eIF2α phosphorylation, which hinders ternary tRNAMet-GTP-eIF2 complex formation and inhibits host or viral protein synthesis. The stalled messenger ribonucleoprotein (mRNP) complex aggregates under viral infection stress to form stress granules (SGs), which encapsulate viral RNA and transcription- and translation-related proteins, thereby limiting virus proliferation. However, many viruses have evolved a corresponding escape mechanism to synthesize their own proteins in the event of host protein synthesis shutdown and SG formation caused by eIF2α phosphorylation, and viruses can block the cell replication cycle through the PERK-eIF2α pathway, providing a favorable environment for their own replication. Subsequently, viruses can induce host cell autophagy or apoptosis through the eIF2α-ATF4-CHOP pathway. Conclusions This review summarizes the role of eIF2α in viral infection to provide a reference for studying the interactions between viruses and hosts.
Susanne F. Awad, Julia A. Critchley, Laith J. Abu-Raddad
Introduction: Diabetes mellitus (DM) is a leading driver of tuberculosis (TB) disease in TB-DM burdened countries. We aimed to assess the impact on TB disease of several intervention strategies targeting people with DM in India. Methods: A previously validated TB-DM mathematical model was extended to include interventions targeting DM individuals. The model stratified the population by age, DM status, TB infection status and stage, TB disease form, treatment, recovery, and intervention status. Results: By 2050, different TB vaccination strategies (coverage of 50 % and vaccine efficacies ranging between 50 %–60 %) reduced TB incidence and mortality rates by 4.5 %–20.8 % and 4.1 %–22.1 %, respectively, and averted 3.1 %–12.8 % of TB disease cases in the total population. Number of vaccinations needed to avert one TB case (effectiveness) was 14–105. Varying the coverage levels of latent TB treatment (coverage of 50 %–80 % and drug effectiveness of 90 %) reduced TB incidence and mortality rates by 7.1 %–11.3 % and 8.2 %–13.0 %, respectively, averting 4.2 %–6.7 % of TB cases, with effectiveness of 38–40. Different scenarios for dual and concurrent treatment of those with TB and DM, reduced TB incidence and mortality rates by 0.1 %–0.4 % and 1.3 %–4.8 %, respectively, averting 0.1 %–0.2 % of TB cases, with effectiveness of 28–107. Different scenarios for managing and controlling DM (regardless of TB status) reduced TB incidence and mortality rates by 4.5 %–16.5 % and 6.5 %–22.2 %, respectively, averting 2.9 %–10.8 % of TB cases, with effectiveness of 6–24. Conclusion: Gains can be attained by targeting DM individuals with interventions to reduce TB burden. Most strategies were effective with <50 intervention doses needed to avert one TB disease case, informing key updates of current treatment guidelines. Keywords: Tuberculosis, Diabetes mellitus, Interventions, Vaccine, Latent tuberculosis infection, Diabetes mellitus management, Mathematical modelling