Conectar
by Obed Kwaku Duah Asumadu, Gilbert Abotisem Abiiro, Joyce Aputere Ndago, David Abatanie Kanligi, Martin Nyaaba Adokiya
IntroductionGlobally, the COVID-19 pandemic significantly impacted the provision of maternal health services, especially facility-based delivery. However, there is little evidence on the proportion of women who delivered at the health facility in various locations and the factors that influenced women’s decision-making in choosing a place of delivery during and amid the COVID-19 restrictions. Therefore, this study assessed the prevalence and factors associated with health facility delivery during the COVID-19 pandemic in the Tamale Metropolis of Ghana.
MethodsAn analytical cross-sectional study design was conducted. A multistage sampling technique was used in selecting the study communities. At the individual level, random sampling technique was applied, and 461 women were recruited from 21st February 2021–21st March 2021. Using a questionnaire, a face-to-face approach was used to conduct the interviews. The questionnaire included questions on socio-demographic characteristics, place of childbirth and factors that led to the choice of delivery place. Using Statistical Package for Social Sciences version 25, descriptive and binary logistic regression analysis were conducted.
ResultsThe results revealed that 64.0% of the women delivered in health facilities during the pandemic. Health facility delivery was more likely to occur among women with higher educational status (AOR: 5.2; 95% CI: 1.40–19.40), married women (AOR:6.3; 95% C.I:1.10–35.80), active National Health Insurance Scheme holders during delivery (AOR: 13.8; 95% C.I: 4.60–41.90), women who received education on birth preparedness and complication readiness (AOR: 7.6; 95% C.I:3.30–17.50) and women with underlying conditions before pregnancy (AOR:3.3; 95% C.I:1.20–9.20). There were reduced odds of health facility delivery among women with a history of home delivery (AOR:0.2; 95% C.I:0.10–0.50), when the mother-in-law decides on the place of delivery (AOR:0.1; 95% C.I:0.03–0.50), longer distance to the place of delivery (AOR:0.3; 95% C.I:0.01–1.00) and when women perceived COVID-19 as a barrier to facility delivery (AOR:0.1; 95% C.I:0.03–0.20).
ConclusionOur findings show that health facility delivery declined during COVID-19. Factors that affected health facility delivery were educational status, marriage, having an active National Health Insurance Scheme, education on birth preparedness and complication readiness, underlying conditions before pregnancy, history of home delivery, mother-in-law decision on place of delivery, distance to place of delivery and perceiving COVID-19 as a barrier to facility delivery. These contributed to low facility delivery. Thus, maternal health services need to be brought to the doorsteps of communities, including proper implementation of the Focused Antenatal Care and community-based pregnancy school programmes, especially during future pandemics.
To establish consensus definitions for non-visually impairing eye conditions (NVICs) and their methods of assessments to provide standards for use in population-based eye surveys.
A literature review of NVICs in sub-Saharan Africa, a questionnaire of inquiry based on the literature review developed by an expert panel and a modified Delphi exercise with three iterative rounds with eye health experts.
Eye health academia and community eye health in Nigeria.
Nigerian ophthalmologists, including subspecialists experienced in population-based eye health surveys.
Definitions and statements where at least 70% of the respondents agreed or strongly agreed.
Forty-two ophthalmologists practising in Nigeria with experience in conducting population-based eye health surveys were invited to take part in the Delphi exercise. There were three rounds with response rates of 39/42 (92.9%) in round 1, (94.9%) in round 2 and 100% in round 3. Consensus for NVICs to be included in population-based eye surveys, their definitions and methods for assessment was reached by the third round.
We propose case definitions for NVICs to be assessed in population-based eye surveys through a modified Delphi approach with an expert panel of ophthalmologists from across Nigeria. These case definitions will allow for standardisation of NVICs in population-based eye surveys to assess the prevalence and magnitude of the different types of NVICs for planning purposes. Further studies are needed to validate these case definitions and inform their evolution.
by Clarisse Kagoyire, Albert Ndagijimana, Gilbert Nduwayezu, Jean Nepo Utumatwishima, Jean Pierre Mpatswenumugabo, Marie Anne Mukasafari, Diane Rinda, Vedaste Ndahindwa, Kristina Elfving, Gunilla Krantz, Torbjörn Lind, Ali Mansourian, Renée Båge, Ewa Wredle, Elias Nyandwi, Aline Umubyeyi, Jean Baptiste Ndahetuye, Petter Pilesjö
Despite national progress, stunting remains prevalent in specific regions of Rwanda, highlighting the limitations of coarse-resolution data for effective mapping and intervention planning. This study explored optimal spatial resolution and analytical approach to capture localised dynamics and the multifactorial nature of stunting. A cross-sectional, population-based study was conducted in the Northern Province of Rwanda, focusing on children aged 1–36 months. Data were collected using structured questionnaires covering socio-demographic, economic, health, childcare, livestock factors and anthropometric measurements. Environmental characteristics were obtained from national datasets, while household geographic coordinates were captured using a customized mobile geodata platform (emGeo). After data cleaning, predictors were analysed using univariable and multivariable logistic regression as well as geographically weighted logistic regression (GWLR) to account for spatial heterogeneity. Among 601 children, stunting prevalence was 27% (boys 33.8%; girls 20.9%). GWLR improved model fit, increasing adjusted deviance explained from 34% to 39%. Significant predictors included child age (adjusted OR = 2.46; 95% CI: 1.78–3.39), male sex (OR = 2.83; 95% CI: 1.65–4.86), birthweight (OR = 0.71; 95% CI: 0.54–0.94), maternal autonomy (ability to refuse sexual intercourse; OR = 0.48; 95% CI: 0.27–0.86), inconsistent maternal social support (OR = 2.30; 95% CI: 1.20–4.42), household electricity access (OR = 0.48; 95% CI: 0.27–0.84) and handwashing facilities (OR = 0.21; 95% CI: 0.07–0.67). GWLR revealed substantial spatial heterogeneity in these factors, delineating areas where each factor matters most. This household-level, spatially explicit analysis reveals localised risk patterns often masked by aggregated national data. Prioritising context-specific interventions (such as electrification, hygiene promotion, and enhanced maternal social support), can enhance effectiveness. The proposed analytical workflow provides a model for addressing persistent stunting in other resource-limited settings.by Anas Ismail, Moatasem Salah, Mads Gilbert, Yousef H. Abu Alreesh, Craig Jones
BackgroundGaza has faced numerous military attacks that resulted in mass casualty incidents (MCIs). The ongoing genocide in Gaza has destroyed much of the health system, including killing and injuring of hundreds of health care workers (HCWs). Current thinking on the health system reconstruction lacks empirical data and local HCWs’ perspectives. The study analyses locally driven innovations and lessons learned by HCWs who responded to MCIs between 2018 and 2021 to guide current and future planning of the reconstruction of the health system in Gaza.
MethodsThis was a qualitative study using online and face-to-face interviews with HCWs who responded to the Great March of Return and the 2021 Israeli military attacks. Transcripts and extensive notes from the interviews were recorded and analyzed on NVivo using thematic content analysis. We used the health system building blocks as themes for deductive analysis with a seventh place-based theme (Gaza-specific) to account for the context of Gaza and the MCIs.
ResultsProblems faced by HCWs mostly related to the nature and complexity of traumatic injuries, shortages in HCWs, particularly specialist doctors, poor coordination among actors, duplication of services, and shortages of supplies and equipment. Locally driven innovations and solutions included establishing new services centers, opening and expanding training programs, starting new coordination bodies, and task shifting of staff and facilities. Lessons learned included strengthening training and employment opportunities for staff, enhancing emergency preparedness and capacities, maintaining coordination bodies, enhancing community engagement and strengthening the governance of the Ministry of Health.
ConclusionReconstruction of Gaza’s health system needs to be grounded in its political context and in the experiences of HCWs who have worked in and managed the system. Locally driven solutions and lessons learned can ensure that reconstruction serves as a vehicle for self-determination and sovereignty, rather than entrenching dependency.
To analyse the comfort needs of patients following renal transplantation, guided by Kolcaba's Theory of Comfort.
A qualitative design was employed.
This study was conducted at a Brazilian university hospital's renal transplant outpatient clinic. Forty-six post-transplant patients were purposively sampled by age, transplant time and clinic attendance. Face-to-face interviews were audio-recorded, transcribed and conducted using a semi-structured script. Data were analysed through thematic content analysis, guided by Kolcaba's Comfort Theory and relevant literature.
Participant narratives were categorised according to the contexts outlined by Kolcaba's Theory of Comfort: Physical, Environmental, Sociocultural and Psychospiritual. In the physical context, pain was identified as a major factor diminishing comfort after renal transplantation. In the environmental context, elements such as light, odour, sound, temperature and uncomfortable furnishings contributed to discomfort. In the sociocultural context, family support was highlighted as essential. In the psychospiritual context, religiosity played a key role in enhancing the comfort of transplant recipients.
Spirituality, strengthened social support networks and non-pharmacological comfort measures are essential for promoting comfort among patients following renal transplantation. These findings underscore the importance of integrated care approaches that address physical, emotional and social aspects to improve quality of life for this population.
Conceptual models in nursing provide a critical perspective for care and support the delivery of effective, evidence-based interventions. By identifying the multidimensional comfort needs of post-renal transplant patients, this study informs the development of targeted, holistic strategies for nursing and multidisciplinary practice in outpatient settings.
This study examined the multidimensional comfort needs of post-renal transplant patients and found that comfort is shaped by physical, environmental, sociocultural and psychospiritual factors. The results may guide global nursing and multidisciplinary outpatient care by informing integrated approaches that enhance the quality of life of transplant recipients.
This study was reported according to the COREQ framework.
No patient or public contribution.
An abnormal composition of gut bacteria along with alterations in microbial metabolites and reduced gut barrier integrity has been associated with the pathogenesis of chronic autoimmune and inflammatory rheumatic diseases (AIRDs). The aim of the systematic review, for which this protocol is presented, is to evaluate the clinical benefits and potential harms of therapies targeting the intestinal microbiota and/or gut barrier function in AIRDs to inform clinical practice and future research.
This protocol used the reporting guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol. We will search Embase (Ovid), Medline (Ovid) and the Cochrane Library (Central) for reports of randomised controlled trials of patients diagnosed with an AIRD. Eligible interventions are therapies targeting the intestinal microbiota and/or gut barrier function including probiotics, synbiotics, faecal microbiota transplantation, live biotherapeutic products and antibiotics with the intent to modify disease activity in AIRDs. The primary outcome of the evidence synthesis will be based on the primary endpoint of each trial. Secondary efficacy outcomes will be evaluated and selected from the existing core domain sets of the individual diseases and include the following domains: disease control, patient global assessment, physician global assessment, health-related quality of life, fatigue, pain and inflammation. Harms will include the total number of withdrawals, withdrawals due to adverse events, number of patients with serious adverse events, disease flares and deaths. A meta-analysis will be performed for each outcome domain separately. Depending on the type of outcome, the quantitative synthesis will encompass both ORs and standardised mean differences with corresponding 95% CIs.
No ethics approval will be needed for this systematic review. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to disseminate the study results through a peer-reviewed publication.
CRD42025644244.
Low back pain (LBP) is the leading contributor to disability globally. It has a substantial impact on the lives of those who experience it, and places considerable economic burden on healthcare systems. Despite these impacts, and the consistency of guideline recommendations, many individuals do not receive recommended LBP management. Structural barriers to accessing timely, evidence-based care, as well as public uncertainty about where to seek appropriate management, can influence the care individuals receive. Telephone and digitally based helplines assist to overcome many traditional barriers to accessing care and offer a scalable platform to improve the delivery of guideline recommended management for LBP. However, uptake of such services can be limited without targeted promotion and patient-centred design. This project aims to codesign, implement and evaluate an upgraded component of an existing Australian helpline service, tailored for people with back pain and supported by a media awareness campaign. This protocol outlines the codesign process, implementation and planned evaluation of the helpline.
This protocol uses three complementary frameworks—an iterative codesign process, the Practical Robust Implementation Sustainability Model, and the Reach, Effectiveness, Adoption, Implementation and Maintenance framework—to guide the codesign and development, implementation and evaluation of an upgraded helpline for people with LBP. The codesign process involves key stakeholders, including consumers and clinicians, to inform the development and implementation of both the upgraded helpline service and the media campaign to raise awareness and uptake of the helpline. Data sources will include a pre–post cohort of helpline service users, routinely collected service data (eg, monthly call rate) and health system data to evaluate the broader population level impact (eg, rates of emergency department presentations for LBP in the Australian region targeted by the media campaign). Implementation evaluation will include Reach, Effectiveness, Adoption, Implementation and Maintenance as well as internal and external environmental factors that influence the success of these outcome measures.
The project was approved by the University of Sydney’s Human Research Ethics Committee (HE001081). This project involves collaboration with consumers, clinicians and other stakeholders to interpret, translate and disseminate research findings to relevant audiences.
Peripheral arterial disease (PAD) commonly coexists with chronic kidney disease (CKD). Patients with symptomatic PAD often require endovascular revascularisation to relieve pain or salvage limbs. However, the iodinated intra-arterial contrast routinely used in these procedures is nephrotoxic, placing patients with CKD at increased risk of acute kidney injury (AKI) and long-term renal decline. Carbon dioxide (CO2) delivered via automated injection is a potential alternative imaging contrast medium. This trial will evaluate whether using CO2 instead of iodinated contrast reduces the risk of AKI and short-term renal function decline in this high-risk group.
This is a multicentre, open-label, prospective randomised controlled trial across six secondary-care National Health Service (NHS) vascular surgery centres. A total of 174 patients with PAD and CKD undergoing endovascular intervention will be randomised 1:1 to receive iodinated contrast (standard of care) or CO2 via automated injector (Angiodroid). All perioperative care will follow local NHS protocols.
The primary outcome is log serum creatinine at 2, 30 and 90 days postprocedure. Key secondary outcomes include: incidence and severity of AKI within 48 hours postprocedure, major adverse kidney events (death, dialysis or >25% estimated glomerular filtration rate decline) by 90 days, inpatient length of stay, procedural pain, quality of life, procedural success, reinterventions, acceptability and feasibility (patient/practitioner questionnaires) of using CO2, and cost-effectiveness (healthcare resource use analysis). A mixed-methods process evaluation will be undertaken with patients and clinicians.
The trial has been approved by an NHS ethical review committee (24/WA/0332) and patients have been involved in trial design. Findings will be disseminated to participants, clinicians and the wider public through patient groups, lay summaries, social media, conferences, peer-reviewed journals and NHS policy channels.
The incidence of anal carcinoma is increasing, with the current gold standard treatment being chemoradiotherapy. There is currently a wide range in the radiotherapy dose used internationally which may lead to overtreatment of early-stage disease and potential undertreatment of locally advanced disease.
PLATO is an integrated umbrella trial protocol which consists of three trials focused on assessing risk-adapted use of adjuvant low-dose chemoradiotherapy in anal margin tumours (ACT3), reduced-dose chemoradiotherapy in early anal carcinoma (ACT4) and dose-escalated chemoradiotherapy in locally advanced anal carcinoma (ACT5), given with standard concurrent chemotherapy.
The primary endpoints of PLATO are locoregional failure (LRF)-free rate for ACT3 and ACT4 and LRF-free survival for ACT5. Secondary objectives include acute and late toxicities, colostomy-free survival and patient-reported outcome measures. ACT3 will recruit 90 participants: participants with removed anal tumours with margins ≤1 mm will receive lower dose chemoradiotherapy, while participants with anal tumours with margins >1 mm will be observed. ACT4 will recruit 162 participants, randomised on a 1:2 basis to receive either standard-dose intensity modulated radiotherapy (IMRT) in combination with chemotherapy or reduced-dose IMRT in combination with chemotherapy. ACT5 will recruit 459 participants, randomised on a 1:1:1 basis to receive either standard-dose IMRT in combination with chemotherapy, or one of two increased-dose experimental arms of IMRT with synchronous integrated boost in combination with chemotherapy.
This study has been approved by Yorkshire & The Humber – Bradford Leeds Research Ethics Committee (ref: 16/YH/0157, IRAS: 204585), July 2016. Results will be disseminated via national and international conferences, peer-reviewed journal articles and social media. A plain English report will be shared with the study participants, patients’ organisations and media.
FreshRSS 