Conectar
by Muluken Chanie Agimas, Mekuriaw Nibret Aweke, Berhanu Mengistu, Lemlem Daniel Baffa, Elsa Awoke Fentie, Ever Siyoum Shewarega, Aysheshim Kassahun Belew, Esmael Ali Muhammad
IntroductionMalaria is a global public health problem, particularly in sub-Saharan African countries. It is responsible for 90% of all deaths worldwide. To reduce the impact and complications associated with delayed treatment of malaria among children under five, comprehensive evidence about the magnitude and determinants of delayed treatment for malaria could be the solution. But there are no national-level studies in the Horn of Africa for decision-makers.
ObjectiveTo assess the prevalence and associated factors of delay in seeking malaria treatment among under-five children in the Horn of Africa.
MethodPublished and unpublished papers were searched on Google, Google Scholar, PubMed/Medline, EMBASE, SCOPUS, and the published articles’ reference list. The search mechanism was established using Medical Subject Heading (MeSH) terms by combining the key terms of the title. Joana Brigg’s Institute critical appraisal checklist was used to assess the quality of articles. A sensitivity test was conducted to evaluate the heterogeneity of the studies. The visual funnel plot test and Egger’s and Begg’s statistics in the random effect model were done to evaluate the publication bias and small study effect. The I2 statistics were also used to quantify the amount of heterogeneity between the included studies.
ResultsThe pooled prevalence of delayed treatment for malaria among under-five children in the Horn of Africa was 48% (95% CI: 34%–63%). History of child death (OR =2.5, 95% CI: 1.73–3.59), distance >3000 meters (OR = 2.59, 95% CI: 2.03–3.3), drug side effect (OR = 2.94, 95% CI: 1.86–4.67), formal education (OR = 0.69, 95% CI: 0.49–0.96), middle income (OR = 0.42, 95% CI: 0.28–0.63), expensiveness (OR = 4.39, 95% CI: 2.49–7.76), and affordable cost (OR = 2.13, 95% CI: 1.41–3.2) for transport were factors associated with malaria treatment delay among children.
Conclusion and recommendationsAbout one out of two parents in the Horn of Africa put off getting their kids treated for malaria. High transportation expenses, long travel times (greater than 3,000 meters) to medical facilities, and anxiety about drug side effects were major risk factors that contributed to this delay. On the other hand, a middle-class income was found to be protective of treatment delays. These results highlight how crucial it is to improve access to healthcare services, both financially and physically, to minimize delays in treating malaria in the area’s children.
by Susanne Jordan, Sarah Jane Böttger, Sabine Zinn
Health information about vaccinations is communicated via various sources of information and is crucial for vaccination decisions. Information sources such as interpersonal sources, traditional print and digital media as well as social media offer information about the risks and benefits of vaccination. During health crises such as the COVID-19 pandemic was, some information sources provide hanging or contradictory information, alongside with misinformation and disinformation. Little is known about the relationship between the reported persuasiveness of different sources of information for individual vaccination decisions and differences in this between the vaccinated and unvaccinated. Utilizing data from 10,284 participants in the “Corona-Monitoring Nationwide” survey in Germany from winter 2021/22, this study explored the relationship between the persuasiveness of information sources and vaccination decisions, considering socio-demographic and pandemic-related factors. For more than half of respondents, talks with family, friends, and acquaintances were the most convincing. Traditional media like television and radio were reported by 44%. Newspapers/magazines (online or print) and talks with physicians were each found the most convincing by around one third. About one fifth were persuaded by public authority’s flyers or websites. Less than a tenth each was convinced by social media/messenger services, brochures from pharmacies and health insurances, talks with pharmacy staff or online health portals. Significant differences emerged between vaccinated and unvaccinated individuals. Unvaccinated people were four times more likely to report social media and messenger services as convincing compared to vaccinated people. Reporting talks with doctors and flyers/websites from public authorities as very persuasive significantly reduced the likelihood of being unvaccinated. The findings suggest that in future health crises, information should be disseminated through diverse sources, using both traditional and digital media, as well as interpersonal communication. Proactive science communication on social media and messenger services is crucial to counteract misinformation and disinformation.by Min Wang, Yushun Yan, Wanqiu Yang, Ruini He, Lingdan Zhao, Yikai Dou, Yuanmei Tao, Xiao Yang, Qingqing Xiang, Xiaohong Ma
Psychiatric nurses represent a high-stress occupational group that experiences elevated levels of suicidal ideation (SI), emphasizing the need for focused mental health interventions. The main purpose of this study was to examine the prevalence of SI among psychiatric nurses and to identify the psychological and occupational factors associated with SI. A total of 1,835 psychiatric nurses completed questionnaires on depressive symptoms (PHQ-9), SI, quality of work-related life (QWL), and burnout. Multivariate logistic regression and phenotypic network analyses were conducted to identify factors associated with SI and the potential pathways linking depressive symptoms, burnout, and QWL to SI. The results indicated that 11.33% of the participants had SI in the past two weeks. Multivariate logistic regression revealed that emotional exhaustion, depersonalization, personal accomplishment, stress at work, general well-being, and the home-work interface were significant predictors of SI. Network analysis further revealed that psychomotor changes, guilt, sad mood, low energy, and appetite changes were the symptoms most directly associated with SI. In addition, sad mood, general well-being, and work-home interface were linked to job and career satisfaction, whereas sad mood and low energy were associated with emotional exhaustion and SI. These findings contribute valuable large-scale evidence on the mental health challenges faced by psychiatric nurses and highlight the importance of addressing mood disturbances, energy loss, and work-related stress in SI prevention efforts for this vulnerable group.by Jordan Salomon, Haydee Montemayor, Cassandra Durden, Dorcas Abiara, Rachel E. Busselman, Gabriel L. Hamer, Sarah A. Hamer
Management of tick-borne disease necessitates an understanding of tick phenology, tick-host associations, and pathogen dynamics. In a recreational hotspot outside of one of the largest cities in the United States, we conducted a year of monthly standardized tick drag sampling and wildlife trapping in Sam Houston National Forest, a high use recreation site near Houston in east Texas, US. By sampling 150 wildlife hosts of 18 species, including rodents, meso-mammals, deer, reptiles, and amphibians, we collected 87 blood samples, 90 ear biopsies, and 861 ticks representing four species (Amblyomma americanum, Dermacentor variabilis, Ixodes scapularis and Ixodes texanus). Drag sampling yielded 1,651 questing ticks of three species: A. americanum (921), D. variabilis (10), and I. scapularis (720). Off-host larval A. americanum abundance peaked in July, followed by peak infestations of wildlife, predominantly raccoons, in August. Off-host I. scapularis larvae abundance peaked in spring (March-May), while very few were removed from hosts and only a single I. scapularis nymph was found throughout the study via dragging in June. In contrast, both off-host and on-host adult I. scapularis occurred most frequently in the winter. Overall, tick infections included 25.3% (183/725) with Rickettsia buchneri, 15.5% (112/725) Rickettsia amblyommatis, 8.0% (58/725) Rickettsia tillamookensis, 0.8% (6/725) Rickettsia spp., and a single tick with a hard tick relapsing fever Borrelia spp.; no tick tested positive for Borrelia burgdorferi. Characterizing tick phenology, tick-host associations, and tick-borne bacteria fills important knowledge gaps for the risk of tick-borne diseases in pine-dominated forests of this region.by Ana Paula Cândido Oliveira, Daniela Alencar Vieira, Cristiane Wanderley Cardoso, Tereza Magalhães, Rosangela Oliveira Anjos, Eduardo José Farias Borges Reis, Kionna Oliveira Bernardes Santos, Guilherme Sousa Ribeiro
Work ability is a subjective concept that reflects the balance between an individual’s perception of the physical, mental, and social demands of work and their competence and resources to meet those demands. The COVID-19 crisis significantly impacted health, work, and socioeconomic conditions worldwide. However, few studies have examined work ability in disadvantaged urban communities during this period. To analyze factors associated with work ability within the context of social vulnerability during the COVID-19 pandemic, we conducted a cross-sectional study in a low-income neighborhood in Salvador, Brazil, between February and June 2022. Sociodemographic, health, and labor data were collected, and work ability was assessed using the Work Ability Index (WAI), a widely used tool for evaluating work ability. Multivariable analyses based on a hierarchical model were run to investigate factors associated with low WAI scores. The study included 292 workers aged ≥16 years (59.6% women; median age 41 years). Most workers (84.6%) were classified as having adequate work ability based on their WAI scores. Multivariable analyses found that inadequate work ability was more frequent among women (prevalence ratio [PR]: 1.89, 95% confidence interval [CI]: 1.02-3.48), individuals who self-rated their health as moderate/good (PR: 5.91; 95% CI: 1.45-24.05) or poor/very poor (PR: 21.62; 95% CI: 5.14-90.91) compared to those with excellent/very good health, and those reporting diabetes (PR: 2.1; 95% CI: 1.13-3.9). Working >40 hours per week (PR: 0.47; 95% CI: 0.28-0.96) was negatively associated with inadequate work ability, suggesting that individuals with adequate work ability may be selected for longer working hours. A history of COVID-19 was not associated with inadequate work ability. These findings suggest that targeted interventions to improve work ability in low-income communities should prioritize women and workers with chronic health conditions, such as diabetes.by Dima Alhomsi, Mhd Khaled Tello, Dania Abdalsalam, Majd Barmo, Hamzeh Al Asadi, Hasan Najjar, Bayan Alsaid
IntroductionBasic medical sciences form the cornerstone of any medical knowledge and are essential for understanding various diseases. This study aims to shed light on students’ viewpoints toward those sciences while delving into their motivations and hindrances and investigating individual subjects.
MethodsThis cross-sectional study was carried out at Damascus University in Syria, targeting final-year medical students. Data collection occurred on a designated clerkship day, during which students were invited to complete an anonymous, self-administered questionnaire. The questionnaire evaluated students’ overall perception and academic interest in studying basic medical sciences in pre-clinical years and their willingness to pursue these sciences as a prospective career.
ResultsThe study surveyed 350 medical students, with 40% rating their interest as good/very good. The extensive content was perceived as a major hindrance by 76.9%. Anatomy was perceived as the easiest subject while pharmacology and biochemistry were considered the hardest. The majority acknowledged the value of basic sciences for further medical education (75.1%) and good physician (77.4%), but only 20.9% indicated their relevance for practical training. Furthermore, 68.6% of students were not interested in pursuing these sciences as a career, primarily due to their preference for clinical fields (55.8%) and concerns about low-income potential (41.3%).
ConclusionThis study highlighted students’ positive views on Basic Medical Sciences, emphasizing their essential role in understanding disease pathophysiology for medical education and practice. Nonetheless, it pointed out a lack of practical training. The findings underscore the importance of decreasing content intensity and enhancing retention through practical approaches aligned with clinical practice.
by Marija Cerjak, Marcin Adam Antoniak, Daniela Šálková, Benedykt Pepliński, Sylwester Białowąs, Željka Mesić
Food intolerances, allergies, and celiac disease cause hypersensitive reactions to certain foods, collectively termed adverse reactions to food. This study aims to identify predictors of purchasing intentions and behaviors among individuals with such reactions, using three behavioral models: the Theory of Planned Behavior, the Health Belief Model, and Protection Motivation Theory. The authors created a new, comprehensive model by integrating these theories, combining their strengths to provide a more robust framework. The survey, conducted via the Forthright platform using the Computer-Assisted Web Interview (CAWI) method, involved 1,088 respondents. This article is the first to explore predictors of consumer intentions and behaviors regarding food products suitable for individuals with intolerances or allergies, offering new insights into consumer decision-making models.by Braeden A. Terpou, Lauren Lapointe-Shaw, Ruoxi Wang, Danielle Martin, Mina Tadrous, Sacha Bhatia, Jennifer Shuldiner, Simon Berthelot, Niels Thakkar, Kerry McBrien, Bahram Rahman, Aisha Lofters, J. Michael Paterson, Rita McCracken, Christine Salahub, Tara Kiran, Noah M Ivers, Laura Desveaux
Walk-in clinics (WICs), appreciated for their accessibility and convenience, have become an increasingly popular healthcare option in Ontario for patients with and without primary care enrolment. Despite their utility, WICs face criticism for delivering lower-quality care compared to comprehensive, enrolment-based primary care models. Critics argue that WICs contribute to system inefficiencies and encourage practice patterns misaligned with population health goals. This study explored physician perspectives on two key outcomes often associated with low-quality care in WICs: repeat primary care visits and potentially inappropriate antibiotic prescribing. Using a qualitative descriptive approach, semi-structured interviews were conducted with Ontario-based family physicians (N = 19) who had experience practicing in both WICs and enrolment-based primary care. The findings highlight systemic challenges, including limited access to enrolment-based primary care and increasing healthcare demands, which have pushed WICs beyond their intended role. This misalignment has created tensions between their structure and purpose, resulting in visits that participants described as more transactional than those in primary care. These constraints—rooted in a lack of informational and relational continuity—often limited participants’ ability to provide in-depth engagement or follow-up care. Repeat visits were frequently linked to efforts to ensure continuity for complex or chronic conditions. Similarly, participants acknowledged the reality of potentially inappropriate antibiotic prescribing, attributing it to the high patient volume, desire to satisfy patient expectations, and a tendency to “err on the side of caution” when the nature of the illness is in question. The findings underscore how health system pressures and well-intended policies, such as Ontario’s primary care access bonus, can produce unintended consequences, including inequities in access and difficulties with care coordination across settings. Addressing these challenges requires reforms to better integrate WICs with the primary care system, alongside tailored training to support physician decision-making in episodic care contexts.by Vincent Q. Pham, Hannah M. Miller, Elise O. Fernandez, Daniel de Marchi, Elizabeth Budi, Hongtu Zhu, David Fleischman
PurposeThe objective of this investigation is to evaluate the 5-year mortality of geriatric patients who have sustained eye injuries.
DesignThis retrospective cohort study included patients aged 65 years or older who had histories of either ocular trauma or age-related nuclear cataracts.Subjects and controls: Patients with ocular trauma constituted the study group, while those with a history of cataracts served as controls.
MethodsData from the I2B2 Carolina Data Warehouse were analyzed. Patient demographics were collected, and the outcomes of interest were the overall mortality rate and annual mortality rates over a 5-year period. Chi-squared tests were utilized for the comparison of mortality data.
Main outcomes and measuresThe primary outcomes were overall mortality rates and annual mortality rates expressed as percentages.
ResultsThe study group consisted of 602 patients who had suffered ocular trauma. The control group included 1066 patients of similar age who had been diagnosed with age-related nuclear cataracts at some point in their lives. Among the study group, 74 patients died within 5 years, while 69 patients in the control group died within the same timeframe, resulting in a study group mortality rate of 11.30% and a control group mortality rate of 6.47%. For patients with ocular trauma, the annual mortality rates were 4.15%, 2.60%, 1.96%, 2.54%, and 0.56%, respectively. For the control group, the annual mortality rates were 1.03%, 1.70%, 1.64%, 0.88%, and 1.38% respectively.
ConclusionThe study suggests that geriatric patients who have experienced ocular trauma are at a higher risk of mortality compared to age-matched controls without such injuries. These findings highlight the necessity of identifying the causes of geriatric periorbital trauma and underscore the importance of close patient follow-up to improve outcomes.
by Jeff Ondocsin, Lissa Moran, Daniel Ciccarone, Simon Outram, Dan Werb, Nicole Holm, Emily A. Arnold
BackgroundOverdose deaths have continued to rise in the US despite heightened public attention and resources. Drug checking shows promise for integration into existing services for people who use drugs (PWUD) across North America. Amidst the backdrop of rising overdose deaths and emerging funds for harm reduction initiatives, this manuscript explores the landscape of drug checking services in North America and perspectives on improved integration with a diverse set of PWUD based in San Francisco and North American drug checking experts.
MethodsTwo separate samples of drug checking stakeholders, ‘providers’ and ‘clients’ were recruited. Providers participated in in-depth semi-structured qualitative interviews over Zoom on their experiences advocating for and operating drug checking services in the US and Canada. Clients were people who used drugs and lived in or commuted to the San Francisco Bay Area and participated in semi-structured interviews in November 2022. Interviews were transcribed fully and analyzed using thematic analysis methods.
ResultsProviders and clients identified ongoing instability in the North American drug supply that is exacerbating overdose risk while also identifying groups that would benefit from greater access to drug checking services. Both groups believed the paradoxical impacts of the fentanyl crisis at the core of drug checking services created barriers to the implementation and expansion of these services, hurting PWUD and their providers. Additionally, clients and providers reflected on the social and policy challenges to expansion and improvement of drug checking in their communities.
ConclusionDrug checking remains underleveraged, particularly with respect to the most vulnerable PWUD. Clients and providers contended that these services must become more responsive to an ever changing and dangerous drug supply in North America.
by Rhonda M. Merwin, Patrick J. Smith, J.A. Riley, Jordan Infield, Christine O’Connell, Dorothy Mayo, Ashley A. Moskovich, Lauren Hill, Hilary Winthrop, Amy Bush, Ernaya Johnson, Francesca Scheiber, Anthony D. Sung
Introduction: Allogeneic hematopoietic stem cell transplant (HCT) has the potential to cure patients with hematologic malignancies, but treatment-related morbidity and mortality is high. Transplant outcomes are optimized by patients maintaining physical activity. The aim of the current study was to examine whether a brief Acceptance and Commitment Therapy (ACT) intervention is acceptable to HCT patients and caregivers and helps patients engage in healthy behavior despite physical and emotional discomfort. Methods: Patients ≥ 18 years of age who were undergoing allogenic HCT for any cancer or non-cancer illness and their caregivers were invited to complete six ACT sessions between transplant day − 30 and day + 90. Multiple small cohorts of n = 3 dyads were enrolled, and the protocol content was iterated after each cohort to reflect the experiences and breadth of concerns of individuals undergoing HCT. Acceptability was indexed by session completion rates and acceptability surveys. Pre-post 6-minute walk distance was collected as an index of physical function as part of standard care. Results: Sixteen HCT dyads enrolled in the study; 12 continued to treatment. Most participants completed all assigned sessions. Participants perceived ACT to be helpful and 70% (5 of 7) of the patients with pre-post 6-minute walk test data showed improvement. Conclusion: ACT is an acceptable and potentially useful intervention for individuals undergoing HCT. Additional controlled studies are warranted.by Quynh Nga Duong, Nguyen Thuy Khue Tran, Thi Phuong Thao Dang
Our research employed Bayesian linear regression utilizing an adaptive Metropolis-Hastings method with Gibbs sampling to assess the influence of bank income diversification on the liquidity risk of five ASEAN banks. The results indicate a positive relationship between bank liquidity risk and income diversification, as well as loan interest rates. This implies that banks with greater income diversification tend to have higher liquidity ratios and reduce the bank risk and conversely. Therefore, the study suggests that banks should enhance their diversification efforts to mitigate their liquidity riskby Ĺubomír Skladaný, Daniela Žilinčanová, Michal Žilinčan, Stanislav Okapec, Filip Danček, Svetlana Adamcová-Selčanová, Michal Kukla, Tomáš Koller
Background and aimsHepatic venous pressure gradient (HVPG) is a strong surrogate of severity and outcome but its relative prognostic value in metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD) is yet to be clarified. We compared HVPG in MASLD with ALD and other etiologies according to cirrhosis complications.
Patients and methodsIn our cirrhosis registry RH7, we identified patients with data on HVPG and scrutinized them against the etiology of advanced chronic liver disease (ACLD) (MASLD, ALD, Other) and specific complications of ACLD such as variceal bleeding or ascites. We excluded patients with advanced malignancies and less than 6 months of follow-up.
ResultsWe enrolled 220 patients with ALD, MASLD, and Other etiology in 128, 52, and 40 cases, respectively; te median age was 57, 60, and 52 years (P = 0.09); the proportion of females was 31, 67, and 55%, respectively (P 10 mmHg).
ConclusionIn our cirrhosis registry study of hospitalized patients with ACLD, baseline HVPG measured for accepted indications differed according to the etiology of dACLD: patients with ALD had the highest values followed by MASLD and Other etiologies. Importantly, when looked at from the point of view of complications, the treshold for clinically significant portal hypertension remained fixed at the level recommended by BAVENO Consensus - 10 mm Hg irrespective of etiology.
by Rafael C. Schick, Henriette Bast, Manuela Frank, Theresa Urban, Thomas Koehler, Florian T. Gassert, Andreas P. Sauter, Bernhard Renger, Alexander A. Fingerle, Alexandra Karrer, Marcus R. Makowski, Daniela Pfeiffer, Franz Pfeiffer
BackgroundDark-field radiography has been proven to be a promising tool for the assessment of various lung diseases.
PurposeTo evaluate the potential of dose reduction in dark-field chest radiography for the detection of the Coronavirus SARS-CoV-2 (COVID-19) pneumonia.
Materials and methodsPatients aged at least 18 years with a medically indicated chest computed tomography scan (CT scan) were screened for participation in a prospective study between October 2018 and December 2020. Patients were included if they had a CO-RADS (COVID-19 Reporting and Data System) score ≥ 4 (COVID-19 group) or if they had no pathologic lung changes (controls). A total of 89 participants with a median age of 60 years (interquartile range 48 to 68 yrs.) were included in this study. Dark-field and attenuation-based radiographs were simultaneously obtained by using a prototype system for dark-field radiography. By modifying the image reconstruction algorithm, low-dose radiographs were simulated based on real participant images. The simulated radiographs corresponded to 50%, 25%, and 13% of the full dose (41.9 μSv, median value). Four experienced radiologists served as blinded readers assessing both image modalities, displayed side by side in random order. The presence of COVID-19-associated lung changes was rated on a scale from 1 to 6. The readers’ diagnostic performance was evaluated by analyzing the area under the receiver operating characteristic curves (AUC) using Obuchowski’s method. Also, the dark-field images were analyzed quantitatively by comparing the dark-field coefficients within and between the COVID-19 and the control group.
ResultsThe readers’ diagnostic performance in the image evaluation, as described by the AUC value (where a value of 1 corresponds to perfect diagnostic accuracy), did not differ significantly between the full dose images (AUC = 0.86) and the simulated images at 50% (AUC = 0.86) and 25% of the full dose(AUC = 0.84) (p>0.050), but was slightly lower at 13% dose (AUC = 0.82) (p = 0.038). For all four radiation dose levels, the median dark-field coefficients within groups were identical but different significantly by 15% between the controls and the COVID-19 pneumonia group (p Conclusion
Dark-field imaging can be used to diagnose the Coronavirus SARS-CoV-2 (COVID-19) pneumonia with a median dose of 10.5 μSv, which corresponds to 25% of the original dose used for dark-field chest imaging.
by Jaeyoung Choi, Esther Park, Hyejeong Park, Danbee Kang, Jeong Hoon Yang, Hyunsoo Kim, Juhee Cho, Joongbum Cho
BackgroundHigh-flow nasal cannula (HFNC) therapy has gained popularity in the pediatric intensive care unit (PICU). However, the nationwide effect of HFNC on mechanical ventilation duration has not been studied.
MethodsWe retrospectively analyzed pediatric patients (28 days to 17 years old) admitted to tertiary ICUs for respiratory support from 2012 to 2019 using the Korean National Health Insurance database. Pre-/post-HFNC periods were defined as the 12 months before and after the application of HFNC in any hospital, respectively, allowing a 6-month transition period. Mechanical ventilation duration and ventilator-free days during these two periods were compared using a multivariable regression model.
ResultsUsing data from 46 hospitals, 4,705 and 4,864 respective pre-/post-HFNC period patients were evaluated. During the post-HFNC period, 14.8% of patients were treated by HFNC, and 67.1% were treated using invasive mechanical ventilation. In adjusted analysis, mechanical ventilation duration was reduced by 0.99 days (confidence interval [CI]: -1.86, -0.12). The duration was significantly reduced by 17.81 days (CI: -35.46, -0.16) among patients whose ventilation duration was longer than 28 days. In subgroup analysis, mechanical ventilation duration was reduced by 1.49 days (CI: -2.78, -0.19) in the overall surgical group and 6.71 days (CI: -11.71, - 1.71) in the neurologic subgroup. Ventilator-free days were increased only in the overall surgical group, by 0.31 days (CI: 0.01, 0.61).
ConclusionsApplication of HFNC to PICU patients could reduce mechanical ventilation duration, especially in patients requiring prolonged mechanical ventilator support or in post-operative patients.
by Daniel Felipe Mendivelso-González, Daniel Clavijo Cabezas, Luisa Montoya, Merideidy Plazas Vargas, Patricia López-Correa, Eugenia Colón, Rafael Parra-Medina
PurposeHER2-low has garnered significant attention for the treatment of HER2-negative breast cancer. We aimed to determine the prevalence of HER2-low expression in Hispanic/Latino women with breast cancer (BC).
MethodsWe searched in Embase, LILACS, and Medline databases for articles reporting the expression of HER2 immunohistochemistry with scores reported as 0, 1+, 2+, or 3+, with equivocal cases (2+) confirmed through in situ hybridization (ISH).
ResultsA total of 12 articles were finally included, comprising 73,467 individuals. The prevalence of HER2-zero, HER2-low and HER2 positive cases among all BC (0, 1+, 2+/ISH-, 2+/ISH+ and 3+), was 45.0%, 32.0%, and 23.0%, respectively. The prevalence of HER2-zero and HER2-low expression among negative cases (0, 1+ and 2+/ISH-), was 53.0% and 47.0%, respectively.
ConclusionThere is an important percentage of Hispanic/Latino individuals who would benefit from HER2-targeted therapies, even in HER2 negative cases. Additional research on the prevalence of HER2-low tumors across a wider range of Latin American countries is required to better understand the molecular epidemiology of this biomarker within the Hispanic/Latino population.
by Christina Lange Ferreira, Sara Donetto, Hellena Habte-Asres, Jyothish Govindan, Angus Forbes, Kirsty Winkley
AimsTo present a study protocol for the development of an intervention to enhance safe insulin use for older or frail adults undergoing a surgical admission to hospital.
DesignFollowing the United Kingdom’s Medical Research Council and National Institute for Health and Care Research Frameworks for development and evaluation of complex interventions; this qualitative study will use a co-design approach using design thinking, to develop a theoretical model for the intervention.
MethodsNon-participatory observations, interviews and co-design workshops will be conducted with older or frail individuals with diabetes, their caregivers and healthcare staff responsible for their care during surgical admissions at a single National Health Service hospital in England. We will utilise their experiences and perspectives to establish priorities and generate ideas for the development of a conceptual model aimed at supporting the insulin safety review process in hospitals. Data will be analysed using framework analysis. People with diabetes were involved in the design of this study. The protocol was approved by the East-Midlands-Derby Research Ethics Committee (24/EM/0022). Study registered on Open Science Framework: https://osf.io/4wvu5.
ResultsResults of this study will be shared with study participants and disseminated through presentations at conferences/meetings and peer-reviewed publications.
ConclusionThis article outlines the methodology for the planned study which will employ a novel methodology to tackle the problem of hospital insulin safety. Its findings will contribute to a better understanding of the multiple interacting components implicated in hospital insulin use (patient, staff, context) and support further work around system-based strategies to enhance insulin safety resilience in hospital.
by Ruth Nanjekho Wafubwa, Erica Soler-Hampejsek, Eva Muluve, Daniel Osuka, Karen Austrian
This mixed methods study investigated factors associated with school retention among marginalized adolescents in four different settings in Kenya, following COVID-19 school closures. Logistic regressions were used to examine factors associated with school retention in 2022 among 1798 adolescent students aged 10–19 in 2020. Qualitative data from 89 in-depth interviews (64 adolescents aged 11–19 and 25 parents), and 21 key informants were thematically analysed. Among female adolescents, age (aOR = 0.76, 95% CI: 0.67, 0.87) and internet access (aOR = 0.55, 95% CI: 0.35, 0.87) were negatively associated with school retention. Engaging in income-generating activities was similarly linked to reduced school retention (aOR = 0.27, 95% CI: 0.16, 0.46). For male adolescents, household loss of income (aOR = 0.40, 95% CI: 0.21, 0.76) and engaging in income-generating activities (aOR = 0.07, 95% CI: 0.02, 0.19) were associated with lower school retention. The qualitative findings highlighted the gendered nature of barriers to school retention. Specifically, pregnancy, child marriage, and related childcare responsibilities emerged as important constraints for girls, whereas engaging in income-generating activities and drug and alcohol use were more dominant factors for boys. Across both genders, financial constraints were a key barrier to school retention. This study underscores the multifaceted nature of factors influencing school retention among marginalized adolescents in times of crisis such as the COVID-19 pandemic. The findings provide useful information for designing targeted policies and programmes for adolescent school retention in times of crisis.by Ada Aita, Paola Galozzi, Filippo Zemin, Giulia Principi, Nicole Contran, Giulia Musso, Chiara Cosma, Antonio Ragusa, Donato D’Antona, Daniela Basso
ObjectiveSalivary alpha-amylase (sAA) has been recently proposed as biomarker of stress responsiveness within the sympathetic nervous system, preferable to cortisol, since limitations related to cortisol measurement (e.g. diurnal and seasonal rhythms, drugs interferences). Several factors, as age, collection device and analytical methods, also influence sAA levels and interpretation. This study aims to assess whether sAA could be useful to evaluate the stress response, also verifying some sources of variability.
MethodsTo identify any sources of sAA variability, saliva samples were collected from eight healthy subjects at five different times (8:00, 10:00, 12:00, 14:00 and 16:00) over five consecutive days using two different collection devices. Saliva was then collected from 35 obstetric residents before and after a simulated shoulder dystocia scenario, one of the most traumatic birth events in the professional life of gynecologists, to assess the stress levels. Samples were analysed throughout two different assays. Heart rate (HR) of residents was also measured before and after simulation scenario. Residents self-collected two saliva samples 10 min apart on a typical day.
ResultsOverall, sAA levels increased significantly from morning to afternoon. Levels varied between subjects, but no differences were found between days or sampling devices. sAA activity levels in samples from 35 residents were significantly higher than those obtained before the scenario took place (about ten minutes later). These results were confirmed by two different assays. Moreover, a similar trend was observed when HR was considered. No differences were observed between samples collected 10 minutes apart on a typical day.
ConclusionsSalivary alpha-amylase activity is a reliable, quick, and efficient marker for stress response, then its measurement will be of potential interest in the field of stress-related disorders. However, it is important to consider the timing of sample collection before introducing sAA in a clinical setting.
by Aklilu Habte Hailegebireal, Habtamu Mellie Bizuayehu, Yordanos Sisay Asgedom, Jira Wakoya Feyisa
BackgroundQuality Antenatal Care (ANC) is considered if pregnant women have access to essential services that align with the best evidence-based practice. Although several studies have been conducted on ANC uptake in Ethiopia, they have focused on the timing and number of visits and the level of complete uptake of care contents according to the WHO recommendation remains scarce. Hence, this study aimed to assess the magnitude of missing care content during ANC visits, its spatial variations, and individual- and community-level determinants in Ethiopia.
MethodsThe study was conducted using the 2016 Ethiopian Demographic and Health Survey and included a total weighted sample of 4,771 women who gave birth within five years before the survey. Spatial analysis was carried out using Arc-GIS version 10.7 and SaTScan version 9.6 statistical software. Spatial autocorrelation (Moran’s I) was checked to determine the non-randomness of the spatial variation in the missing contents of care. Multilevel multivariable logistic regression analysis was performed using STATA version 16. The adjusted odds ratio (aOR) with its corresponding 95% CI was used as a measure of association.
ResultsThe prevalence of missing full contents of ANC in Ethiopia was 88.2% (95% CI: 87.2, 89.0), with significant spatial variations observed across regions. Missing essential contents of care was higher among women who live in rural areas (aOR = 1.68, 95% CI: 1.47, 2.71), not completed formal education (aOR = 1.94, 95% CI:1.24, 3.02), late initiation of ANC (aOR = 3.05, 95% CI:1.59, 6.54), attended only one ANC (aOR = 4.13, 95% CI: 1.95, 8.74), and not having a mobile phone (aOR = 1.44, 95% CI: 1.07, 1.95).
ConclusionThe level of missing care content during prenatal visits was high in Ethiopia, with significant spatial variation across regions. Health systems and policymakers should promote early initiation and encourage multiple visits to provide optimal care to pregnant women. In addition, it is vital to focus on enhancing education and healthcare infrastructure in rural parts of the country.
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