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Baseline sociodemographic and sexual and reproductive health characteristics of the AdSEARCH adolescent cohort study participants in rural Bangladesh: a cohort profile

Por: Alam · A. · Shiblee · S. I. · Rana · M. S. · Sheikh · S. P. · Rahman · F. N. · Sathi · S. S. · Alam · M. M. · Sharmin · I. · Arifeen · S. E. · Rahman · A. E. · Ahmed · A. · Nahar · Q.
Purpose

In Bangladesh, evidence on the long-term trajectory of adolescents' sexual and reproductive health (SRH) remains limited, largely due to the lack of longitudinal data to assess the changes over time. To address this gap, the Advancing Sexual and Reproductive Health and Rights (AdSEARCH) project of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) set up an adolescent cohort study aimed at documenting changes in SRH knowledge, attitudes and practices, and identifying the factors affecting these changes. This article presents the baseline sociodemographic and SRH characteristics of this cohort as a pathway for future analyses.

Participants

This cohort study included 2713 adolescents from the Baliakandi Health and Demographic Surveillance System run by icddr,b. The cohort covered three age groups from girls and boys, giving a total of five cohorts: girls aged 12, 14 and 16 years; and boys aged 14 and 16 years. A total of seven rounds of data had been collected at 4-month intervals over 2-years follow-up period.

Findings from the baseline

The majority of adolescents were attending school (90%), and school dropouts were higher among boys. Around 17% of the respondents were involved in income-generating activities, which were mostly boys. Among girls, the mean age of menarche was 12.2 years. Overall, 6% of adolescents had major depressive disorder, with prevalence increasing with age. Gender differences were evident regarding knowledge about conception and contraception. Egalitarian attitudes towards social norms and gender roles were found higher among girls (52%) compared to boys (11%). The majority of adolescents reported experiencing social/verbal bullying (43%), followed by physical violence (38%) and cyberbullying (4%).

Future plans

This article presents the baseline findings only. A series of papers is in the pipeline for submission to different peer-reviewed journals. The findings from this study will be used to support data-driven policy formulation for future adolescent health programmes.

Perinatal outcomes and uptake of RSV vaccine during pregnancy in South London: a cross-sectional study

Por: Razai · M. S. · Kalafat · E. · Prasad · S. · Lee-Wo · C. · Heath · P. T. · Khalil · A.
Background

Maternal respiratory syncytial virus (RSV) vaccination has been introduced to protect infants from severe respiratory infections. However, its uptake and impact on perinatal outcomes are unknown in the UK.

Objectives

To evaluate uptake of RSV vaccine during pregnancy in a UK population.

Methods and analysis

This cross-sectional study was conducted at a tertiary maternity hospital in London. The participants included pregnant women who delivered between 1 September and 17 December 2024 (n=1157). For the analysis of vaccine uptake, the cohort included women eligible for vaccination who delivered beyond 28 weeks’ gestation and were at 36 weeks or less on 1 September 2024 (n=911). The main outcome measures were RSV vaccine uptake and its association with sociodemographic factors, perinatal outcomes including preterm birth (PTB), hypertensive disorders of pregnancy and stillbirth.

Results

Of 911 eligible women, 19% (n=173) received the RSV vaccine during pregnancy. Uptake increased significantly from 4% in September to 32% in December (p

Conclusions

RSV vaccine uptake shows significant increases over time, with disparities in uptake by ethnicity and socioeconomic status. Further research is needed to increase vaccination rates, particularly in disadvantaged groups, and evaluate perinatal outcomes.

Tirzepatide for the treatment of adults living with concurrent type 1 diabetes and overweight or obesity (TZP-T1D): a double-blind, placebo-matched randomised controlled trial protocol

Por: Purcell · A. R. · Rodrigo · N. · Longfield · M. S. G. · Glastras · S. J.
Introduction

The increasing prevalence of overweight and obesity among individuals with type 1 diabetes (T1D) complicates glycaemic management and escalates insulin resistance, necessitating innovative therapeutic strategies. Tirzepatide, a dual agonist for glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide receptors, shows promise in managing weight and glycaemic control in type 2 diabetes but is unexplored in the context of T1D. This double-blind, placebo-controlled randomised trial will evaluate the efficacy of tirzepatide in adults with T1D and overweight/obesity over 32 weeks.

Methods and analysis

60 participants (aged 18–70 years) with a body mass index ≥27 kg/m2 and HbA1c≤10% will be randomised 1:1 to receive either tirzepatide or a placebo, alongside standard insulin therapy. The primary outcome is the change in body weight (%). Secondary measures include change in HbA1c (%), proportion of body weight lost (>5%, >10%, >15% and >20%), changes in insulin dosage, time in range by continuous glucose monitoring (CGM) criteria and severity of comorbidities. Compliance, adverse events and medication interactions will be closely monitored, with adjustments made for tolerability. Patient-reported outcomes and experiences will be measured to capture the benefits of glycaemic management, weight management and quality of life. To compare the means of body weight reduction (%) between the tirzepatide and control groups, an independent samples t-test will be employed under the assumption that data are normally distributed. Secondary outcome measures will be analysed by Student’s t-test. All data will be reported as group means with confidence intervals, with default statistical significance assumed at p

Ethics and dissemination

Ethical approval has been obtained from the Northern Sydney Local Health District’s Human Research Ethics Committee (approval ID #2024/ETH00180).

Trial registration number

NCT06180616.

Seeing Isnt measuring: ICU staffs ability to estimate patient height and weight -- A cross-sectional study from Pakistans largest cardiac centre

Por: Ahmad · B. · Islam · F. · Ansari · M. I. · Taimoor · L. · Arif · M. S. · ur Rehman Memon · A. · Umair · M. · Abubaker · J.
Objective

In critical care, intensive care unit (ICU) staff and physicians often estimate patients' height and weight visually, impacting calculations for cardiac function, ventilation, medication, nutrition and renal function. However, accurate assessment is challenging in critically ill patients. This study evaluates the accuracy of visual estimations by ICU staff.

Design

Descriptive cross-sectional study.

Setting

National Institute of Cardiovascular Diseases, Karachi, Pakistan.

Participants

We included a convenient sample of adult (≥18 years) cardiac patients admitted to the critical care unit in this study. Patients who refused to give consent, trauma/surgery of lower limbs or patients with below-knee or above-knee amputation were excluded to avoid bias.

Outcome measure

A convenient sample of cardiac ICU patients was included. Measured weight (kg) and height (cm) were compared with visual estimations by senior ICU nurse, senior non-ICU nurse, ICU consultants, fellows and residents. Correlation and agreement were analysed using Bland–Altman plots and 95% agreement limits.

Results

A total of 356 patients were evaluated, of whom 204 (57.3%) were male, with a mean age of 55.2 ± 14.3 years. The median SOFA score was 3 [2–5], and 101 patients (28.4%) were on mechanical ventilation. The mean difference between measured and estimated weight by senior non-ICU nurse was 4.7±9.2 [–13.38–22.83] kg, senior ICU nurse was 7.8±9.9 [–11.56–27.12] kg, ICU consultants was 3.0±6.6 [–9.89–15.79] kg, ICU fellow was 3.0±7.1 [–10.88–16.92] kg and ICU resident was 8.0±9.6 [–10.83–26.79] kg. Similarly, the mean difference between measured and estimated height by senior non-ICU nurse was 2.0±7.3 [-12.36–16.34] cm, senior ICU nurse was 2.4±7.5 [–12.19–17.00] cm, ICU consultants was 1.5±5.6 [–9.51–12.48] cm, ICU fellow was 1.1±5.5 [–9.68–11.95] cm and ICU resident was 2.3±8.5 [–14.40–19.01] cm.

Conclusion

The findings indicate that healthcare professionals tend to overestimate both weight and height. The accuracy of these estimations varied among professional groups, underscoring the potential clinical consequences of such errors. This emphasises the need for objective measurements in clinical decision-making.

Two years and counting: a prospective cohort study on the scope and severity of post-COVID symptoms across diverse patient groups in the Netherlands--insights from the CORFU study

Por: Klein · D. O. · Waardenburg · S. F. · Janssen · E. B. N. J. · Wintjens · M. S. J. N. · Imkamp · M. · Heemskerk · S. C. M. · Birnie · E. · Bonsel · G. J. · Warle · M. C. · Jacobs · L. M. C. · Hemmen · B. · Verbunt · J. · van Bussel · B. C. T. · van Santen · S. · Kietelaer · B. L. J.
Importance

Little research has been done on post-COVID symptoms at 24 months postinfection and on the association these may have on health-related quality of life (HRQOL).

Objective

We assessed the prevalence and severity of post-COVID symptoms and quantified EuroQol 5 Dimension 5 Level (EQ-5D-5L), self-perceived health question (EuroQol Visual Analogue Scale (EQ-VAS)) and health utility scores (HUS) up to 24 months follow-up.

Design

The longitudinal multiple cohort CORona Follow-Up (CORFU) study combines seven COVID-19 patient cohorts and a survey among the general public. The participants received questionnaires on several time points. Participants were stratified by: without a known SARS-CoV-2 infection (control group), proven SARS-CoV-2 infection but non-hospitalised, proven SARS-CoV-2 infection hospitalised to the ward, and proven SARS-CoV-2 infection hospitalised to the intensive care unit (ICU).

Setting

In this study, data of seven COVID-19 patient cohorts and a survey among the general public are included.

Participants

Former COVID-19 patients and controls participated in this cohort study.

Main outcomes and measures

Former COVID-19 patients and non-COVID-19 controls were sent questionnaires on symptoms associated with post-COVID condition. The CORFU questionnaire included 14 symptom questions on post-COVID condition using a five-level Likert-scale format. Furthermore, HRQOL was quantified using the EuroQol EQ-5D-5L questionnaire: EQ-VAS and the EQ-5D-5L utility score. The EQ-5D-5L questionnaire includes five domains that are scored on a five-point Likert scale: mobility, self-care, usual activities, pain/discomfort and anxiety/depression.

Results

A total of 901 participants (and 434 controls) responded at 24 months follow-up. In all former COVID-19 patients, the presence of post-COVID condition at 24 months was observed in 62 (42.5%, 95% CI 34.3% to 50.9%) of the non-hospitalised patients, 333 (65.0%, 95% CI 60.7% to 69.2%) of the hospitalised ward patients and 156 (63.2%, 95% CI 56.8% to 69.2%) of the ICU patients, respectively (p

Conclusions

Many former COVID-19 patients experience post-COVID symptoms at 24 months follow-up, with the highest prevalence in hospitalised participants. Also, former patients reported a lower HRQOL.

Trial registration number

The CORFU study was registered at clinicaltrials.gov (registration number NCT05240742).

Factors associated with generalised anxiety disorder and depression among adults living with diabetes and hypertension comorbidity in rural Bangladesh: findings from a cross-sectional study

Por: Chakravartty · M. · Shuvo · M. M. S. · Kumari · S. · Jhilik · T. C. · Sarker · T. · Akter · F. · Hossain · M. M. · Ahsan · A. · Latif · M. · Mridha · M. K.
Objective

The rising burden of non-communicable diseases (NCDs), including mental health disorders (MHDs) such as anxiety and depression, poses a significant public health challenge globally. Evidence suggests that both diabetes and hypertension, the two most prevalent NCDs, are linked to a higher prevalence of MHDs. However, there is a lack of evidence on prevalence of generalised anxiety disorder (GAD) and depression among adults living with both diabetes and hypertension in Bangladesh. We aimed to assess the prevalence of GAD and depression and explore the associated factors among adults living with diabetes and hypertension comorbidity in rural Bangladesh.

Design

We implemented a cross-sectional study.

Setting

The study was conducted in Chirirbandar, a sub-district of Dinajpur, Bangladesh.

Participants

We interviewed a total of 387 adults living with diabetes and hypertension comorbidity.

Primary outcome measures

We had two primary outcome measures: GAD and depression. Individuals scoring ≥10 on the General Anxiety Disorder-7 scale were considered as having GAD and individuals scoring ≥10 on the Patient Health Questionnaire-9 scale were considered as having depression. The outcome variables were dichotomised based on these scores.

Results

The prevalence of GAD was 7.24% (95% CI 5.04 to 10.29). Education level (grades 5–9) (adjusted OR (AOR): 3.40, 95% CI 1.26 to 9.19) and household wealth status (highest wealth tertile) (AOR: 0.12, 95% CI 0.02 to 0.62) were associated with GAD. The prevalence of depression was 17.83% (95% CI 14.32 to 21.98). Socioeconomic factors associated with depression included unemployment (AOR: 3.26, 95% CI 1.05 to 10.10) and household wealth status (highest wealth tertile) (AOR: 0.45, 95% CI 0.21 to 0.98). Higher odds of depression were also observed among participants with controlled hypertension (AOR: 3.88, 95% CI 1.81 to 8.35). Other factors, such as tobacco use, dietary diversity and physical activity, were not associated with GAD or depression.

Conclusion

A high prevalence of GAD and depression was observed among adults living with diabetes and hypertension comorbidity. The findings from the study emphasise the need for integration of mental health services into the existing non-communicable disease care. The identified factors associated with GAD or depression should be considered to develop targeted interventions for people with hypertension and diabetes comorbidity in Bangladesh.

Association between self-reported vision and mental well-being: a cross-sectional secondary analysis of Health Survey for England data

Por: Crossland · M. D. · Dekker · T. M. · Tibber · M. S.
Objectives

Eye disease and vision impairment are known to be associated with reduced mental well-being, but less is known about the well-being of people with near-normal levels of vision. Here, we examined the association between self-reported eyesight and mental well-being, controlling for eye disease, mental ill-health and demographic factors, for adults with a wide range of age and vision.

Design

Population-based cross-sectional study.

Participants

7705 adults (56% women; median age 49 years, range 16–104 years) who participated in the Health Survey for England 2013, self-reported their eyesight status and completed the Warwick-Edinburgh Mental Well-Being Scale.

Primary outcome measure

Mental well-being, controlling for self-reported mental ill health, self-reported eye disease, age, sex, socioeconomic group and ethnic origin.

Results

Poorer self-reported eyesight was strongly associated with lower mental well-being (univariate linear model, F(4,7700)=94.7, p2=0.047). Relative to reporting ‘poor’ vision, each subsequent level of vision predicted better well-being, with the exception of ‘fair’ vision, which was not significantly different from ‘poor’ reported vision. This association remained significant after controlling for self-reported mental ill health, self-reported eye disease, age, sex, socioeconomic group and ethnic origin.

Conclusions

Self-reported eyesight is strongly associated with mental well-being, irrespective of whether people have vision impairment or a diagnosed eye disease. This relationship exists in people with and without mental ill-health. Mental well-being should be considered in people with reduced eyesight, regardless of whether they have a diagnosed eye disease or mental ill-health. Interventions which improve vision may have a positive impact on mental well-being.

Psychosocial impact of the COVID-19 pandemic on children with chronic health conditions in Germany: a qualitative interview study

Por: Lukes · S. · Schäfer · T. · Dessauer · E. · Diefenbach · C. · Urschitz · M. S. · Boll · T. · Hammerle · F.
Objectives

To investigate the psychosocial impact of the COVID-19 pandemic on children with chronic health conditions (CHC) and their legal guardians (LG) living in Germany.

Design

Qualitative interview study based on the transcripts of semistructured individual telephone interviews.

Methods

Data were collected from October to December 2021 and the time frame of reference was January–June 2021 with two interviewers. Discussed aspects were, for example, socioeconomic information, daily life, thoughts and feelings of both children and LG, as well as family communication, unmet needs and possible advantages. Data were analysed using qualitative content analysis. The category system and subsequent coding schemes with anchor examples were based on interviews and the interview guide. It was tested for integrity and feasibility with one interview and finalised. To ensure classification reliability within all 11 interviews, 1 specifically trained rater (who did not participate in the interviewing to separate data collection and analysis) coded all transcripts.

Participants

11 LG of children with CHC participating in the ikidS (ich komme in die Schule) study.

Results

The three aspects that were mentioned most often in the interviews were a psychological impact on children, a psychological impact on LG and an impact on the daily routines of LG. The majority of children and LG were burdened, had changed their activities and spent more time together, while having more conflicts. Children did not worry about becoming infected with COVID-19, but were worried about the health of their relatives. It was further reported that children had become more autonomous. LG additionally reported unmet needs such as opportunities for childcare or psychotherapy.

Conclusions

While the changes brought about by the COVID-19 pandemic and their impact were often seen as negative, the LG in our study also perceived some opportunities for personal development both in their children and themselves, underlining that future research on the impact of the COVID-19 pandemic should focus not only on negative consequences but also on opportunities and positive change. Qualitative methods can be used on an exploratory basis to inform quantitative studies, as they are able to delve deeper into the area being examined and provide greater insight into which aspects interviewees focus on.

Impact of abnormal ambulatory ECG findings when screening for atrial fibrillation in primary care: a qualitative study among participants of the PATCH-AF trial

Por: Brik · T. · Niekel · M. S. · Bak · M. A. R. · Himmelreich · J. C. L. · Harskamp · R. E. · Moll van Charante · E. P.
Background and aim

European cardiovascular guidelines recommend systematic atrial fibrillation (AF) screening in community-dwelling high-risk patients. However, little is known about the impact of abnormal screening findings, including AF and non-AF incidental findings on the target population. This gap highlights the need to assess both the benefits and potential harms from patients’ perspectives to fully understand the impact of AF screening. Therefore, the aim of this study is to explore patients’ experiences with AF screening among those who received abnormal findings from ambulatory ECG monitoring.

Design

We conducted a qualitative study using semistructured interviews, analysed thematically. Participants in the PATCH-AF trial, based in Amsterdam primary care, were purposively sampled based on their screening results (AF or non-AF incidental findings), sex and socioeconomic status.

Results

We achieved data saturation after conducting 16 interviews (6 with interviewees diagnosed with AF and 10 with non-AF incidental findings). Participants had a median age of 76 (73–79) years, and 56% were male. Their experiences, whether positive or negative, fluctuated throughout the screening process and depended on their initial motivations for participation in AF screening (seeking extra health checks, finding explanations for pre-existing symptoms or contributing to medical research), expectations and perceived benefits from clarification, diagnostic workup or treatment. Influencing factors included the type of finding (AF or non-AF incidental finding), healthcare provider communication and individual characteristics such as age, socioeconomic status and medical history.

Conclusion

This qualitative study highlights both positive and negative AF screening experiences from the patients’ perspective. It underscores how patients’ motivations and expectations for participation, the type of ambulatory ECG finding and communication and follow-up by healthcare providers shape their overall experiences. Healthcare providers should be aware of these factors to optimise screening consultations. Clear guidelines on communicating abnormal ambulatory ECG findings, especially incidental findings, are warranted.

Trial registeration number

The Netherlands Trial Register (NTR) number NL9656.

Developing a screening tool and intervention strategy for elder neglect in persons with dementia in primary care: protocol to use a multistep process

Por: Rosen · T. · Shaw · A. · Elman · A. · Baek · D. · Gottesman · E. · Park · S. · Costantini · H. · Cury Hincapie · M. · Moxley · J. · Ceruso · M. · Chang · E.-S. · Hancock · D. · Jaret · A. D. · Lees Haggerty · K. · Burnes · D. · Lachs · M. S. · Pillemer · K. · Czaja · S.
Introduction

Elder neglect by both informal and formal caregivers is common, particularly among persons with dementia, and has serious health consequences but is under-recognised and under-reported. Persons with dementia are often unable to report neglect due to memory and language impairments, increasing their vulnerability. Screening for elder mistreatment and initiation of intervention in primary care clinics may be helpful, but few evidence-based tools or strategies exist. We plan to: (1) develop a novel primary care screening tool to identify elder neglect in persons with dementia, (2) develop an innovative technology-driven intervention for caregivers and (3) pilot both for feasibility and acceptability in primary care.

Methods and analysis

We will use a multistep process to develop a screening tool, including a modified Delphi approach with experts, and multivariable analysis comparing confirmed cases of neglect in patients with dementia from the existing data registry to non-neglected controls. We will develop an evidence-based, technology-driven caregiving intervention for neglect with an expert panel and iterative beta testing. Following the development of the protocol for implementation of the tool and intervention with associated training, we will pilot test both the tool and intervention in older adult patients and caregivers. We will conduct provider focus groups and interviews with patients and caregivers to assess usability and will modify the tool and intervention. These studies are in preparation for a future randomised trial.

Ethics and dissemination

Initial phases of this project have been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #22-06024967, with initial approval on 1 July 2022. We aim to disseminate our results in peer-reviewed journals, at national and international conferences and among interested patient groups and the public.

Uncovering gaps in workforce well-being: a national look at survey practice in Dutch university medical centres - an exploratory quantitative study

Por: Boskma · A. C. P. · Oerbekke · M. S. · Hooft · L. · Franx · A. · Schaufeli · W. · van der Laan · M. J.
Introduction

Maintaining a healthy workforce is crucial for safe, high-quality care. To enhance well-being and engagement in Dutch university medical centres (UMCs), an overview of staff well-being and job perceptions is needed first. Surveys are widely used to improve working conditions, but varying questionnaires hinder a comprehensive view. This study aimed to evaluate the content of employee surveys currently used in UMCs in the Netherlands from a well-being perspective and to analyse the survey results at a national level.

Methods

All seven UMCs were approached to participate in the study and share employee survey data. The primary outcome of interest is work experience; a secondary analysis was conducted. Items were categorised following the Job Demands-Resources model. Descriptive statistics were presented as percentages, means and medians with IQRs.

Results

Two UMCs participated and 31 862 completed surveys were included. Variation in survey items (eg, 15–18 subcategories, 21–33 question items), response options (eg, 1–5, 1–10), frequency (1–3 times per year) and timing were found. Scores on the following outcomes are presented: work overload, coworker support, job control, organisational justice, participation in decision-making, performance feedback, possibilities for learning and development, recognition, task variety, team atmosphere, team effectiveness, trust in leadership, other job resources, connecting/inspiring leadership, self-efficacy, goal-directiveness, boredom, burnout, job satisfaction, work engagement, other employee well-being, commitment organisation/team and work ability. Results should be interpreted with caution, and solely found for hospital A, for certain job control items, median scores of 2 or 3 were observed, whereas the majority of other question items revealed a median score of 4.

Conclusions

There is a significant lack of cohesion across employee surveys. As it stands, employee surveys in Dutch UMCs are not effective tools for monitoring the work experience or well-being of the healthcare workforce. While these surveys may support management decisions, this support is not reflected in interventions related to work and the work environment.

Correlation between fatigue and pulmonary involvement in the post-COVID-19 condition: a cross-sectional study 6-12 months after hospital discharge

Por: Kajiwara · M. S. · Lamas · C. A. · Luna · L. A. V. d. · Yokoyama · T. S. · de Oliveira · P. R. · Chate · R. C. · Sawamura · M. V. Y. · Imamura · M. · Carvalho · C. R. R. d. · Salge · J. M. · HCFMUSP COVID-19 task force · Araujo · Segurado · Montal · Miethke-Morais · Levin · Peron
Introduction

Post-COVID-19 conditions (PCC) may include pulmonary sequelae, fatigue and other symptoms, but its mechanisms are not fully elucidated.

Objective

This study investigated the correlation between fatigue and the presence of pulmonary abnormalities in PCC patients with respiratory involvement 6–12 months after hospitalisation.

Design

Cross-sectional study.

Setting

A tertiary hospital in Brazil.

Participants

315 patients, aged ≥18 years, were considered eligible based on SARS-CoV-2 infection confirmed by reverse transcription-PCR.

Methods

Pulmonary function tests (PFT), cardiopulmonary exercise tests (CPET), chest CT and hand grip were performed. The following scales were applied: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, Euroqol 5 Dimensions quality of life (EQ-5D) and Hospital Anxiety and Depression Scale (HADS). Participants were divided between the fatigue group (FACIT-F≤30) and the non-fatigue group (FACIT-F>30). For the statistical analysis, the primary outcome was the difference in the diffusing capacity of the lungs for carbon monoxide (DLCO) between groups. Considered secondary outcomes were differences in PFT, CPET, chest CT, hand grip, EQ-5D and HADS.

Results

The fatigue group had 81 patients (25.7%) against 234 (74.3%). PFT and CPET showed no significant difference in DLCO and oxygen consumption peak values between groups. The fatigue group had a lower workload (mean 55.3±21.3 watts vs 66.5±23.2 watts, p=0.003), higher breathing reserve (median 41.9% (33.8–52.5) vs 37.7% (28.9–47.1), p=0.028) and lower prevalence of ground glass opacity (60.8% vs 77.7%, p=0.003) and reticulation (36.7% vs 54.9%, p=0.005) in chest CT. The fatigue group had higher anxiety (57% vs 24%, p

Conclusion

Fatigue in patients with PCC 6–12 months after hospitalisation is relatively common and had weak correlation with pulmonary disorders. Our results suggested fatigue could be strongly related with peripheral disorders such as reduced musculoskeletal strength or psychosocial limitations.

European, multicentre, prospective observational phase IV clinical study to assess the impact of lebrikizumab on health-related well-being and control of skin manifestations in patients with moderate-to-severe atopic dermatitis (ADTrust): study protocol

Por: Augustin · M. · Bewley · A. · Brüggen · M.-C. · de Bruin-Weller · M. S. · Ezzedine · K. · Ferrucci · S. M. · Gkalpakiotis · S. · Herranz · P. · Johansson · E. K. · Kampe · T. · Lapeere · H. · Legat · F. J. · Rehbinder · E. M. · Szepietowski · J. C. · Torres · T. · Vestergaard · C.
Introduction

Atopic dermatitis (AD) is a chronic, relapsing, heterogeneous skin disease affecting 2%–7% of adults, with roughly 30% having moderate-to-severe disease. AD symptoms, like intense itching and skin pain, carry a substantial disease burden that negatively impacts patients’ quality of life (QoL) and psychosocial well-being. Lebrikizumab is a novel, high-affinity monoclonal antibody that selectively binds to and neutralises interleukin-13 with high potency. Three clinical trials with lebrikizumab (ADvocate 1 and 2; ADhere) demonstrated significant clinical benefit in patients with AD, while the 3-year long-term extension study of lebrikizumab (ADjoin) further demonstrated long-term efficacy and safety in patients with AD. The ADTrust study will evaluate patient well-being, their relationship with their skin, long-term effectiveness, and safety of lebrikizumab, treatment satisfaction, and long-term effect of lebrikizumab treatment on different aspects of patients’ lives, including itch, pain, sleep, fatigue, work impairment and overall QoL among adult patients with moderate-to-severe AD in a real-world setting.

Methods and analysis

This non-interventional, prospective, observational, real-world evidence study will involve approximately 150 sites across Europe and approximately 1200 adults with moderate-to-severe AD treated with lebrikizumab for 2 years. The primary endpoint is patient well-being assessed by the 5-item WHO Well-Being Index (WHO-5) questionnaire. Key secondary endpoints include clinical effectiveness (Eczema Area and Severity Index and Investigator’s Global Assessment Scale), disease symptomatology and control (Patient-Oriented Eczema Measure, 24-hour peak pruritus, skin pain, fatigue and sleep quality Numerical Rating Scale, and safety and tolerability. Other validated endpoints will evaluate physician-reported and patient-reported QoL and treatment satisfaction (Dermatology Life Quality Index, Treatment Satisfaction Questionnaire-9), patients’ work productivity and impairment (Work Productivity and Activity Impairment (WPAI)-AD) and disease control (AD Control Tool). Novel experimental endpoints will also be evaluated with the aim to assess patients’ relationship with their skin (SkinLove questionnaire), disease control (intensity and frequency of flares) and an Effectiveness Diary (a brief monthly survey on a voluntary basis with the aim to assess the long-term impact of lebrikizumab on three fundamental aspects of the patients’ life: the well-being (WHO-5), the itch intensity (24 hours peak pruritus) and the frequency and intensity of flares). Statistical analyses will be descriptive and explorative and based on observed cases. Missing data imputation may be used to handle missing data for primary endpoints and secondary effectiveness endpoints.

Ethics and dissemination

This study will be conducted according to the protocol, which has ethics committee approval (Hamburg Ethic Committee in Germany: 2024-101358-BO-ff), and all applicable laws and regulatory requirements for each participating country. The results will be disseminated through scientific publications and congress presentations.

Trial registration number

NCT06815380 (Pre-results).

Impact of left ventricular end-diastolic pressure on clinical outcomes in patients with ST-elevation myocardial infarction (Hunter LVEDP Study): a prospective, single-centre study

Por: Khan · A. A. · Williams · T. · Ray · M. · Al-Omary · M. S. · Taylor · J. · Collins · N. · Attia · J. · Boyle · A. J.
Objectives

Elevated left ventricular end-diastolic pressure (LVEDP) in ST-segment elevation myocardial infarction (STEMI) has been studied in patients who received thrombolysis or who were treated early in the primary percutaneous coronary intervention (PCI) era; LVEDP was found to be a predictor of adverse outcomes in these retrospective post hoc analyses. The aim of the current analysis is to assess the prognostic value of the elevated LVEDP in STEMI patients undergoing primary PCI in current contemporary practice.

Design

Prospective, single-centre study.

Participants

Our study enrolled STEMI patients with elevated LVEDP undergoing primary PCI at John Hunter Hospital, Newcastle, Australia.

Primary outcome measure

The primary endpoint was the combination of 12-month all-cause mortality and heart failure admissions, comparing different quartiles of LVEDP.

Results

A total of 997 patients underwent primary PCI at our hospital during the 5-year study period (age: 64±13 years, males: 73%; n=728) from 1 January 2015 to 31 December 2019. The median LVEDP for the whole cohort was 27 mm Hg (IQR: 22–31 mm Hg). The median LVEDP was 17 mm Hg (IQR: 13–18 mm Hg) and 33 mm Hg (IQR: 30–36 mm Hg) for 1st and 4th quartiles respectively (p

Conclusions

LVEDP is an independent predictor of adverse outcomes in STEMI patients, despite a relatively normal LVEF. Further prospective studies are needed to assess the effects of early reduction in LVEDP on the prognosis.

Acceptability and implementation of a comprehensive digital diabetes self-management platform (MyWay Diabetes): a qualitative protocol

Por: Hawkes · R. E. · Ashpole · D. · Baxter · M. S. · Bickerton · A. · Osei-Kwasi · H. · Rutter · M. K. · Taylor · D. · Wake · D. J. · Willis · T. · Brooks · J.
Introduction

Diabetes is one of the most common long-term health conditions worldwide, placing a huge economic burden on health services. Diabetes self-management education and support programmes can support people with diabetes to manage their condition; however, uptake of face-to-face services remains low. Digital self-management tools are becoming increasingly available. MyWay Diabetes is a digital platform that offers a comprehensive self-management and education programme accessible through a mobile app and website and allows patients to access their personal healthcare records. Following successful implementation in Scotland, MyWay Diabetes is now being rolled out in three geographical areas in England. We plan to undertake three qualitative studies, as part of a larger mixed-methods research programme, to assess whether MyWay Diabetes is acceptable across diverse patient groups and healthcare professionals and gather views of patients who do not currently use the digital service.

Methods and analysis

We will conduct three online focus group studies. (1) One focus group with healthcare professionals (n=6–10) to understand their perceptions of implementing MyWay Diabetes in their local regions. (2) Up to four focus groups with existing users of MyWay Diabetes (n=24–40) across the three geographical areas in England to explore their acceptability of the platform. (3) Up to three focus groups with people living with diabetes who do not currently use MyWay Diabetes (n=18–30). Data will be collected using online videoconferencing and analysed thematically using template analysis.

Ethics and dissemination

Ethical approval was granted by South Central – Berkshire Research Ethics Committee (ref: 25/SC/0125) and The University of Manchester Proportionate Research Ethics Committee (ref: 2025-23064-42006). Study results will be disseminated through peer-reviewed journals, conference presentations, MyWay Digital Health platforms and national bodies. The evidence from this broader mixed-methods evaluation will inform decisions for platform improvement and regional and national commissioning across the National Health Service in England.

Mortality risk associated with clinical signs of possible serious bacterial infection (PSBI) in young infants in Africa and Asia: protocol for a secondary pooled analysis

Por: Darmstadt · G. L. · Bhamidi · V. · Adhikari · K. · Maric · I. · Islam · M. S. · Qazi · S. A. · Ahmed · S. · Tshefu Kitoto · A. · Esamai · F. · Ayede · A. I. · Adejuyigbe · E. A. · Wammanda · R. D. · Saha · S. K. · Nisar · Y. B.
Introduction

The WHO’s Integrated Management of Childhood Illness (IMCI) in young infants

Methods and analysis

We will create a dataset that integrates data from population-based studies globally with similar designs that have examined the presence of signs of PSBI identified by frontline health workers throughout the young infant period (days 0 to

Ethics and dissemination

All prior studies incorporated into our pooled analysis were approved by the independent local ethics committee/institutional review board (IRB) at each study site in each country, and all study participants provided informed consent. This project was approved by the Stanford University School of Medicine IRB protocol 74456. Study findings will be disseminated through publications in peer-reviewed journals, WHO documents, and presentations at maternal and child health meetings.

Leishmaniases in Ethiopia: a scoping review

Por: OBrien · K. · Grifferty · G. · Totten · A. · Asres · M. S. · Ayele · E. · Coombs · P. · Orriols · A. M. · Mosurkal · S. · Krulwich · E. · Oruko · L. · Roman · I. C. · Shah · P. · Fanning-Hughes · R. · Williams · A. L. · Wallace · F. · Wong · M. G. · Roe · S. · Gandhi · K. · Matari · L. · Sha
Objectives

With recent efforts to eliminate visceral leishmaniasis in East Africa, we aimed to map the breadth of research on leishmaniases in Ethiopia, one of the high-endemic countries in the region, to help understand the current literature landscape and highlight priority areas for future research.

Design

The scoping review was conducted in accordance with the JBI Scoping Review Methodology Group’s guidance and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Reviews guidelines.

Data sources

We searched the following databases and sources: PubMed, Embase, Web of Science, Cochrane Library, Global Medicus Index, PROSPERO, ClinicalTrials.gov and the Pan African Clinical Trials Registry and known local journals.

Eligibility criteria

We included studies addressing the issue of leishmaniasis in Ethiopia that were published in English language.

Data extraction and synthesis

Two reviewers independently extracted data from each study, with conflicts resolved by a third reviewer. The identified studies were analysed using an extensive codebook, which was previously developed by this team and adapted to the Ethiopian context to classify the research into different categories.

Results

A total of 8698 articles were identified. A stepwise review was conducted, and 639 papers were selected for inclusion. The research spans different themes and designs and has steadily increased over the past 14 years. Research on prevention and control, health systems/policies and post-kala-azar dermal leishmaniasis, as well as randomised controlled trials, was lacking. Studies on coinfections with other diseases accounted for 14% of research.

Conclusions

The findings underscore the growing amount of research on leishmaniasis in Ethiopia, addressing several themes and emphasising the need for more research in prevention, control, health systems/policy and high-quality studies for evidence-based treatment.

Bidirectional relationship between caregiver mastery and anxiety in individuals with cognitive impairment

Por: Ontan · M. S. · Isik · A. T.

Commentary on: Yeji Hwang, Miranda V. McPhillips, Liming Huang, G. Adriana Perez and Nancy A. Hodgson, Better caregiver mastery is associated with less anxiety in individuals with cognitive impairment, BMC Nursing. 2023; 22:307.

Implications for practice and research

  • Anxiety is one of the common neuropsychiatric symptoms (NPs) in individuals with cognitive impairment. Considering the fluctuating and variable course of NPs in dementia, studies with longer follow-up periods are required to understand the relationship between caregiver mastery and anxiety in patients with dementia.

  • Dementia, an umbrella condition, encompasses various neurogenerative diseases that can cause behavioural problems, movement problems, autonomic dysfunction, gait and balance problems, as well as cognitive impairment. Hence, it is important to develop caregiver skills with different strategies for each type of dementia.

  • Context

    As the population ages, the prevalence of dementia has increased.1 Due to interruption in activities of...

    Validation of urinary biomarkers for accurate diagnosis of urinary tract infections in older adults across primary care, hospitals and long-term care facilities in the Netherlands and UK (UTI-GOLD): a multicentre observational study protocol

    Por: El Moussaoui · N. · van Andel · E. · van der Beek · M. T. · Vlot · J. A. · Bilsen · M. P. · van Nieuwkoop · C. · Lauw · F. N. · Delfos · N. M. · Stalenhoef · J. E. · Sijbom · M. · Akintola · A. A. · Achterberg · W. P. · Goeman · J. J. · Leyten · E. M. S. · van Uhm · J. I. M. · Corstj
    Introduction

    Urinary tract infections (UTIs) are highly prevalent and pose a significant burden among older adults. Accurate diagnosis in this population is challenging due to the high prevalence of pre-existing lower urinary tract symptoms, inability to express symptoms and asymptomatic bacteriuria. Current diagnostic tests are unreliable, often resulting in over- and underdiagnosis. A previous pilot study proposed a higher cut-off for pyuria and identified five promising biomarkers for the diagnosis of UTIs in older adults. The UTI-GOLD study aims to validate these five new biomarkers and the higher leucocyte cut-off as a diagnostic tool for UTIs in older people in a real-world setting.

    Methods and analysis

    Between August 2024 and December 2027, an observational multicentre diagnostic accuracy study is being conducted across primary, secondary and tertiary healthcare facilities in the Netherlands and the UK. Adults ≥65 years with a suspected UTI will be considered eligible. Patients with pre-existing decision-making incapacity or an indwelling catheter will be excluded. UTI will be defined according to an international consensus-based reference standard. Biomarkers will be measured by liquid chromatography-mass spectrometry (neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinase 2 and CXC motif chemokine ligand 9) and enzyme-linked immunosorbent assay (interleukin 6 and azurocidin). Pyuria will be quantified by automated microscopy and/or flow cytometry. Diagnostic accuracy measures will be calculated using the receiver operating characteristic curves, and sensitivity, specificity, likelihood ratios and predictive values will be reported for optimal cut-offs.

    Ethics and dissemination

    The protocol was reviewed by the local Leiden University Medical Center research committee, who declared on 15 April 2024 that the medical research involving human subject act (Dutch abbreviation: WMO) does not apply to the current study (reference number nWMODIV2_2024025). The study also received approval from the NHS Research Ethics Committee in the UK (reference number 24/LO/0649).

    The study findings will be published in a peer-reviewed journal, presented at academic congresses and shared with healthcare providers.

    Trial registration number

    The study was registered at clinicaltrial.gov on the 24 September 2024 with registration number: NCT06610721.

    Incidence and predictors of mortality among children with severe acute malnutrition admitted to therapeutic feeding units in Ethiopia: a systematic review and meta-analysis

    Por: Adugna · A. · Abebe · G. F. · Alie · M. S. · Girma · D.
    Objective

    To estimate the mortality rate and identify predictors of mortality among under-five children with severe acute malnutrition (SAM) admitted to therapeutic feeding units (TFUs) in Ethiopia.

    Methods

    We searched PubMed, HINARI, Science Direct, Google Scholar and African Journals Online from 1 March to 30 May 2024. The Joanna Briggs Institute checklist was used to appraise the included studies. Heterogeneity was identified using I2 statistics. Funnel plots and Egger’s tests were used to determine publication bias.

    Results

    Out of 1085 studies, 15 were included in this analysis. The pooled mortality rate among under-five children with SAM admitted to TFUs in Ethiopia was 8.32 per 1000 person-days of observation (95% CI: 6.25 to 11.06). The mortality rate has not changed over time. HIV infection (HR: 2.84; 95% CI: 1.25 to 6.42), tuberculosis (HR: 1.86; 95% CI: 1.35 to 2.56), intravenous fluid use (HR: 3.37; 95% CI: 2.39 to 4.75), altered body temperature (HR: 4.47; 95% CI: 1.90 to 10.51), impaired consciousness (HR: 2.91; 95% CI: 1.94 to 4.37), not receiving F-100 supplementation (HR: 4.51; 95% CI: 3.25 to 6.26), shock (HR: 4.20; 95% CI: 2.92 to 6.04), and nasogastric tube feeding (HR: 2.02; 95% CI: 1.67 to 2.44) were predictors of mortality.

    Conclusion

    The pooled mortality rate in Ethiopia was 8.32 per 1000 person-days, and it has not decreased over time. Most of the identified factors are related to comorbidities and complications of SAM, as well as nutritional therapy. Thus, it is essential to strengthen nutrition policies, programme implementation and healthcare services, which focus on the timely management of SAM complications, integrated care for comorbidities and improved F-100 supplementation.

    PROSPERO registration number

    CRD42024555014.

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