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Tuberculosis impacts multiple aspects in quality of life in a Romanian cohort of drug-susceptible and drug resistant patients: A patient-reported outcome measures study. 结核病对罗马尼亚一批药物敏感和耐药患者生活质量的多方面影响:患者报告结果测量研究。
IF 2.6 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2024-05-24 DOI: 10.1111/tmi.13996
Ioana Margineanu, Teodora Butnaru, Marjolein Lam, Dragos Baiceanu, Raluca Dragomir, Adriana Sorete Arbore, Beatrice Mahler, Ioana Munteanu, Florin Mihaltan, Onno Akkerman, Jan-Willem Alffenaar, Ymkje Stienstra

Background: Tuberculosis (TB), and especially its drug resistant forms, is responsible for not only significant mortality, but also considerable morbidity, still under-quantified. This study used four Patient-Reported Outcome Measures (PROMS) to assess the status of persons affected by drug-susceptible and drug-resistant TB during their TB treatment or after treatment completion, in Romania, the highest TB burden country in the EU.

Methods: People affected by TB in two different regions in Romania were included during and after treatment, following a cross-sectional design. PROMs used were SF-36, EQ-5D-5L, WPAI and the app-based audiometry screening tool 'uHear.' Descriptive statistics and relevant statistical tests were used to compare groups between themselves and with the general Romanian population.

Results: Both patients with drug-susceptible and drug-resistant TB experience, with drug-resistant patients experiencing statistically significantly more pain and hearing loss. PROMs show some improvement in the after-treatment group; however, compared with the general Romanian population for which data were available, all groups scored lower on all outcome measures.

Conclusion: PROMs offer the possibility of obtaining a more comprehensive view of patients' status, by involving them directly in the medical process and could guide a rehabilitation strategy.

背景:结核病(TB),尤其是耐药性结核病,不仅造成了大量死亡,而且还导致了相当高的发病率,但目前对结核病的发病率仍未充分量化。本研究使用了四种患者报告结果测量方法(PROMS),以评估欧盟结核病负担最重的国家罗马尼亚的耐药性结核病患者在结核病治疗期间或治疗结束后的状况:方法:采用横断面设计,将罗马尼亚两个不同地区的结核病患者纳入治疗期间和治疗结束后的情况。使用的 PROMs 包括 SF-36、EQ-5D-5L、WPAI 和基于应用程序的听力筛查工具 "uHear"。描述性统计和相关统计检验用于比较各组之间以及与罗马尼亚一般人群之间的差异:结果:耐药性和药敏性肺结核患者都经历了疼痛和听力损失,耐药性患者的疼痛和听力损失明显高于药敏性患者。PROMs显示,治疗后组别患者的情况有所改善;然而,与有数据可查的罗马尼亚普通人群相比,所有组别的患者在所有结果指标上的得分都较低:通过让患者直接参与医疗过程,PROM 可以更全面地了解患者的状况,并为康复策略提供指导。
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引用次数: 0
Neighbourhood factors and tuberculosis incidence in Cape Town: A negative binomial regression and spatial analysis. 开普敦的邻里因素与结核病发病率:负二项式回归与空间分析。
IF 2.6 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2024-05-16 DOI: 10.1111/tmi.14001
M Molemans, L Kayaert, Q Olislagers, S Abrahams, N Berkowitz, E Mohr-Holland, D McKelly, R Wood, F van Leth, S Hermans

Objectives: Although the link between poverty and tuberculosis (TB) is widely recognised, limited studies have investigated the association between neighbourhood factors and TB incidence. Since the factors influencing different episodes of TB might be different, this study focused on the first episode of TB disease (first-episode TB).

Methods: All first episodes in previously linked and geocoded TB notification data from 2007 to 2015 in Cape Town, South Africa, were aggregated at the neighbourhood level and merged with the 2011 census data. We conducted an ecological study to assess the association between neighbourhood incidence of first-episode TB and neighbourhood factors (total TB burden [all episodes] in the previous year, socioeconomic index, mean household size, mean age, and percentage males) using a negative binomial regression. We also examined the presence of hotspots in neighbourhood TB incidence with the Global Moran's I statistic and assessed spatial dependency in the association between neighbourhood factors and TB incidence using a spatial lag model.

Results: The study included 684 neighbourhoods with a median first-episode TB incidence rate of 114 (IQR: 0-345) per 100,000 people. We found lower neighbourhood socioeconomic index (SEI), higher neighbourhood total TB burden, lower neighbourhood mean household size, and lower neighbourhood mean age were associated with increased neighbourhood first-episode TB incidence. Our findings revealed a hotspot of first-episode TB incidence in Cape Town and evidence of spatial dependency in the association between neighbourhood factors and TB incidence.

Conclusion: Neighbourhood TB burden and SEI were associated with first-episode TB incidence, and there was spatial dependency in this association. Our findings can inform targeted interventions to reduce TB in high-risk neighbourhoods, thereby reducing health disparities and promoting health equity.

研究目的尽管贫困与肺结核(TB)之间的联系已得到广泛认可,但有关邻里因素与肺结核发病率之间关系的研究却十分有限。由于影响不同肺结核发病的因素可能不同,本研究重点关注肺结核病的首次发病(首次肺结核):我们将南非开普敦 2007 年至 2015 年的结核病通报数据与 2011 年的人口普查数据进行了邻里层面的汇总,并合并了这些数据。我们进行了一项生态学研究,采用负二项回归法评估了邻近地区肺结核首次发病率与邻近地区因素(前一年的肺结核总负担[所有发病]、社会经济指数、平均家庭规模、平均年龄和男性比例)之间的关联。我们还利用全球莫兰 I 统计检验了邻近地区肺结核发病率是否存在热点,并利用空间滞后模型评估了邻近地区因素与肺结核发病率之间的空间依赖性:研究共包括 684 个社区,其肺结核首次发病率中位数为每 10 万人 114 例(IQR:0-345)。我们发现,较低的居民区社会经济指数(SEI)、较高的居民区结核病总负担、较低的居民区平均家庭规模和较低的居民区平均年龄与居民区结核病首次发病率的增加有关。我们的研究结果表明,开普敦是肺结核首次发病的热点地区,也证明了邻里因素与肺结核发病率之间的空间依赖性:结论:邻里肺结核负担和 SEI 与肺结核首次发病率有关,而且这种关联存在空间依赖性。我们的研究结果可为有针对性的干预措施提供依据,以减少高风险社区的结核病发病率,从而缩小健康差距,促进健康公平。
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引用次数: 0
COVID-19 vaccination strategies in Africa: A scoping review of the use of mathematical models to inform policy. 非洲的 COVID-19 疫苗接种战略:利用数学模型为政策提供信息的范围审查。
IF 2.6 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-01 Epub Date: 2024-05-13 DOI: 10.1111/tmi.13994
Sylvia K Ofori, Emmanuelle A Dankwa, Eve Hiyori Estrada, Xinyi Hua, Teresia N Kimani, Carrie G Wade, Caroline O Buckee, Megan B Murray, Bethany L Hedt-Gauthier

Objective: Mathematical models are vital tools to understand transmission dynamics and assess the impact of interventions to mitigate COVID-19. However, historically, their use in Africa has been limited. In this scoping review, we assess how mathematical models were used to study COVID-19 vaccination to potentially inform pandemic planning and response in Africa.

Methods: We searched six electronic databases: MEDLINE, Embase, Web of Science, Global Health, MathSciNet and Africa-Wide NiPAD, using keywords to identify articles focused on the use of mathematical modelling studies of COVID-19 vaccination in Africa that were published as of October 2022. We extracted the details on the country, author affiliation, characteristics of models, policy intent and heterogeneity factors. We assessed quality using 21-point scale criteria on model characteristics and content of the studies.

Results: The literature search yielded 462 articles, of which 32 were included based on the eligibility criteria. Nineteen (59%) studies had a first author affiliated with an African country. Of the 32 included studies, 30 (94%) were compartmental models. By country, most studies were about or included South Africa (n = 12, 37%), followed by Morocco (n = 6, 19%) and Ethiopia (n = 5, 16%). Most studies (n = 19, 59%) assessed the impact of increasing vaccination coverage on COVID-19 burden. Half (n = 16, 50%) had policy intent: prioritising or selecting interventions, pandemic planning and response, vaccine distribution and optimisation strategies and understanding transmission dynamics of COVID-19. Fourteen studies (44%) were of medium quality and eight (25%) were of high quality.

Conclusions: While decision-makers could draw vital insights from the evidence generated from mathematical modelling to inform policy, we found that there was limited use of such models exploring vaccination impacts for COVID-19 in Africa. The disparity can be addressed by scaling up mathematical modelling training, increasing collaborative opportunities between modellers and policymakers, and increasing access to funding.

目的:数学模型是了解传播动态和评估减缓 COVID-19 干预措施影响的重要工具。然而,从历史上看,数学模型在非洲的应用非常有限。在这篇范围综述中,我们评估了如何使用数学模型来研究 COVID-19 疫苗接种,从而为非洲的大流行规划和应对措施提供潜在信息:我们检索了六个电子数据库:方法:我们检索了六个电子数据库:MEDLINE、Embase、Web of Science、Global Health、MathSciNet 和 Africa-Wide NiPAD,并使用关键字查找了截至 2022 年 10 月发表的有关在非洲使用数学模型研究 COVID-19 疫苗接种的文章。我们提取了有关国家、作者所属单位、模型特征、政策意图和异质性因素的详细信息。我们采用 21 分制标准对研究的模型特征和内容进行了质量评估:文献检索共获得 462 篇文章,其中 32 篇根据资格标准被纳入。19项(59%)研究的第一作者隶属于非洲国家。在纳入的 32 项研究中,30 项(94%)是分区模型。从国家来看,大多数研究涉及或包括南非(12 项,占 37%),其次是摩洛哥(6 项,占 19%)和埃塞俄比亚(5 项,占 16%)。大多数研究(n = 19,59%)评估了提高疫苗接种覆盖率对 COVID-19 负担的影响。半数研究(n = 16,50%)具有政策意图:优先考虑或选择干预措施、大流行规划和响应、疫苗分配和优化策略以及了解 COVID-19 的传播动态。14项研究(44%)质量中等,8项研究(25%)质量较高:虽然决策者可以从数学建模产生的证据中汲取重要的见解,为制定政策提供依据,但我们发现,在非洲探索 COVID-19 疫苗接种影响的此类模型使用有限。可以通过扩大数学建模培训规模、增加建模者与决策者之间的合作机会以及增加获得资金的途径来解决这一差距。
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引用次数: 0
Molecular insights into expression and silencing of resistance determinants in Staphylococcus aureus. 金黄色葡萄球菌耐药性决定因子表达和沉默的分子研究。
IF 3.3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-01 Epub Date: 2024-05-08 DOI: 10.1111/tmi.14000
Muhammad Ijaz, Muhammad Jawad Sabir, Muhammad Umar Javed, Arslan Ahmed, Hamza Rasheed, Ali Abdullah Jabir

Objective: This study aimed to investigate the status of antimicrobial-resistant strains of Staphylococcus aureus in Pakistan, their association in terms of co-occurrence with the biofilm-forming genes, resistance profiling and associated discrepancies in diagnostic methods.

Methodology: A total of 384 milk samples from bovine was collected by using convenient sampling technique and were initially screened for subclinical mastitis, further preceded by isolation and confirmation of S. aureus. The S. aureus isolates were subjected to evaluation of antimicrobial resistance by phenotypic identification using Kirby-Bauer disc diffusion method, while the genotypic estimation was done by polymerase chain reaction to declare isolates as methicillin, beta-lactam, vancomycin, tetracycline, and aminoglycoside resistant S. aureus (MRSA, BRSA, VRSA, TRSA, and ARSA), respectively.

Results: The current study revealed an overall prevalence of subclinical mastitis and S. aureus to be 59.11% and 46.69%, respectively. On a phenotypic basis, the prevalence of MRSA, BRSA, VRSA, TRSA, and ARSA was found to be 44.33%, 58.49%, 20.75%, 35.84%, and 30.18%, respectively. The results of PCR analysis showed that 46.80% of the tested isolates were declared as MRSA, 37.09% as BRSA, and 36.36% as VRSA, while the occurrence of TRSA and ARSA was observed in 26.31% and 18.75%, respectively. The current study also reported the existence of biofilm-producing genes (icaA and icaD) in 49.06% and 40.57% isolates, respectively. Lastly, this study also reported a high incidence of discrepancies for both genotypic and phenotypic identification methods of resistance evaluation, with the highest discrepancy ratio for the accA-aphD gene, followed by tetK, vanB, blaZ, and mecA genes.

Conclusion: The study concluded that different antibiotic resistance strains of S. aureus are prevalent in study districts with high potential to transmit between human populations. The study also determined that there are multiple resistance determinants and mechanisms that are responsible for the silencing and expression of antibiotic resistance genes.

研究目的本研究旨在调查巴基斯坦金黄色葡萄球菌的抗菌药耐药菌株状况、它们与生物膜形成基因的共存关系、耐药性分析以及诊断方法的相关差异:采用方便的取样技术收集了 384 份牛乳样本,初步筛查是否存在亚临床乳腺炎,并进一步分离和确认金黄色葡萄球菌。金黄色葡萄球菌分离物采用柯比-鲍尔盘扩散法进行表型鉴定,评估抗菌药耐药性;采用聚合酶链式反应进行基因型评估,将分离物分别列为耐甲氧西林、β-内酰胺、万古霉素、四环素和氨基糖苷类药物的金黄色葡萄球菌(MRSA、BRSA、VRSA、TRSA 和 ARSA):本次研究显示,亚临床乳腺炎和金黄色葡萄球菌的总发病率分别为 59.11% 和 46.69%。从表型上看,MRSA、BRSA、VRSA、TRSA 和 ARSA 的流行率分别为 44.33%、58.49%、20.75%、35.84% 和 30.18%。PCR 分析结果显示,46.80% 的检测分离物被宣布为 MRSA,37.09% 为 BRSA,36.36% 为 VRSA,而 TRSA 和 ARSA 的发生率分别为 26.31% 和 18.75%。本研究还报告了分别有 49.06% 和 40.57% 的分离物存在生物膜产生基因(icaA 和 icaD)。最后,本研究还报告了耐药性评估的基因型和表型鉴定方法的高差异发生率,其中 accA-aphD 基因的差异率最高,其次是 tetK、vanB、blaZ 和 mecA 基因:研究结论:研究地区普遍存在不同的金黄色葡萄球菌抗生素耐药菌株,这些菌株极有可能在人群中传播。研究还确定,有多种抗药性决定因素和机制导致抗生素抗药性基因的沉默和表达。
{"title":"Molecular insights into expression and silencing of resistance determinants in Staphylococcus aureus.","authors":"Muhammad Ijaz, Muhammad Jawad Sabir, Muhammad Umar Javed, Arslan Ahmed, Hamza Rasheed, Ali Abdullah Jabir","doi":"10.1111/tmi.14000","DOIUrl":"10.1111/tmi.14000","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the status of antimicrobial-resistant strains of Staphylococcus aureus in Pakistan, their association in terms of co-occurrence with the biofilm-forming genes, resistance profiling and associated discrepancies in diagnostic methods.</p><p><strong>Methodology: </strong>A total of 384 milk samples from bovine was collected by using convenient sampling technique and were initially screened for subclinical mastitis, further preceded by isolation and confirmation of S. aureus. The S. aureus isolates were subjected to evaluation of antimicrobial resistance by phenotypic identification using Kirby-Bauer disc diffusion method, while the genotypic estimation was done by polymerase chain reaction to declare isolates as methicillin, beta-lactam, vancomycin, tetracycline, and aminoglycoside resistant S. aureus (MRSA, BRSA, VRSA, TRSA, and ARSA), respectively.</p><p><strong>Results: </strong>The current study revealed an overall prevalence of subclinical mastitis and S. aureus to be 59.11% and 46.69%, respectively. On a phenotypic basis, the prevalence of MRSA, BRSA, VRSA, TRSA, and ARSA was found to be 44.33%, 58.49%, 20.75%, 35.84%, and 30.18%, respectively. The results of PCR analysis showed that 46.80% of the tested isolates were declared as MRSA, 37.09% as BRSA, and 36.36% as VRSA, while the occurrence of TRSA and ARSA was observed in 26.31% and 18.75%, respectively. The current study also reported the existence of biofilm-producing genes (icaA and icaD) in 49.06% and 40.57% isolates, respectively. Lastly, this study also reported a high incidence of discrepancies for both genotypic and phenotypic identification methods of resistance evaluation, with the highest discrepancy ratio for the accA-aphD gene, followed by tetK, vanB, blaZ, and mecA genes.</p><p><strong>Conclusion: </strong>The study concluded that different antibiotic resistance strains of S. aureus are prevalent in study districts with high potential to transmit between human populations. The study also determined that there are multiple resistance determinants and mechanisms that are responsible for the silencing and expression of antibiotic resistance genes.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"526-535"},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between habitual betel quid chewing and risk of adverse cardiovascular outcomes: A systematic review. 习惯性嚼槟榔与不良心血管后果风险之间的关系:系统综述。
IF 3.3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-01 Epub Date: 2024-03-31 DOI: 10.1111/tmi.13988
Rodney Itaki, Shalon Taufa

Introduction: Habitual betel quid chewing, a tobacco product, is a leading cause of oral cancer in Asia-Pacific countries where this practice is most prevalent. However, it is not well understood whether betel quid chewing is also a cause of adverse cardiovascular outcomes. To address this gap, we conducted a systematic literature review of peer-reviewed published studies evaluating the association between habitual betel quid use on the risk of adverse cardiovascular outcomes.

Methods: We searched PubMed for studies assessing the correlation between betel quid chewing and cardiovascular health. We included studies if (i) they included human subjects; (ii) were peer-reviewed articles in indexed journals; and (iii) were in English. We extracted data from eligible studies and stratified them by geographical location, study designs and cardiovascular outcomes. Finally, we did a narrative synthesis of the data to identify adverse cardiovascular outcomes associated with chronic betel quid use.

Findings: We reviewed data from 19 studies that met the inclusion criteria. Habitual betel quid chewing was associated with hypertension, atherosclerosis, inflammation and ischaemic heart disease. In addition, betel quid use was a risk factor for arrhythmias. Interestingly, betel quid use was an independent risk factor for cardiovascular disease in women. Long-term betel quid consumption was associated with higher risks for all-cause mortality and increased overall cardiovascular risk.

Conclusions: Habitual betel quid chewing is an important cardiovascular risk factor in populations where the practice is prevalent.

导言:习惯性咀嚼槟榔(一种烟草制品)是导致口腔癌的一个主要原因,而在亚太地区国家,这种习惯最为普遍。然而,咀嚼槟榔是否也是导致不良心血管后果的一个原因,目前还不十分清楚。为了填补这一空白,我们对经同行评审的已发表研究进行了系统的文献综述,评估了习惯性使用槟榔与不良心血管后果风险之间的关联:我们在 PubMed 上搜索了评估咀嚼槟榔与心血管健康之间相关性的研究。我们纳入了符合以下条件的研究:(i) 包括人类受试者;(ii) 在索引期刊上发表的同行评审文章;(iii) 英语。我们从符合条件的研究中提取数据,并按照地理位置、研究设计和心血管结果对其进行分层。最后,我们对数据进行了叙述性综合,以确定与长期服用槟榔有关的不良心血管结果:我们审查了 19 项符合纳入标准的研究数据。习惯性咀嚼槟榔与高血压、动脉粥样硬化、炎症和缺血性心脏病有关。此外,使用槟榔是心律失常的一个危险因素。有趣的是,咀嚼槟榔是女性罹患心血管疾病的独立风险因素。长期食用槟榔与较高的全因死亡风险和总体心血管风险有关:结论:在嚼槟榔习惯盛行的人群中,嚼槟榔是一个重要的心血管风险因素。
{"title":"Association between habitual betel quid chewing and risk of adverse cardiovascular outcomes: A systematic review.","authors":"Rodney Itaki, Shalon Taufa","doi":"10.1111/tmi.13988","DOIUrl":"10.1111/tmi.13988","url":null,"abstract":"<p><strong>Introduction: </strong>Habitual betel quid chewing, a tobacco product, is a leading cause of oral cancer in Asia-Pacific countries where this practice is most prevalent. However, it is not well understood whether betel quid chewing is also a cause of adverse cardiovascular outcomes. To address this gap, we conducted a systematic literature review of peer-reviewed published studies evaluating the association between habitual betel quid use on the risk of adverse cardiovascular outcomes.</p><p><strong>Methods: </strong>We searched PubMed for studies assessing the correlation between betel quid chewing and cardiovascular health. We included studies if (i) they included human subjects; (ii) were peer-reviewed articles in indexed journals; and (iii) were in English. We extracted data from eligible studies and stratified them by geographical location, study designs and cardiovascular outcomes. Finally, we did a narrative synthesis of the data to identify adverse cardiovascular outcomes associated with chronic betel quid use.</p><p><strong>Findings: </strong>We reviewed data from 19 studies that met the inclusion criteria. Habitual betel quid chewing was associated with hypertension, atherosclerosis, inflammation and ischaemic heart disease. In addition, betel quid use was a risk factor for arrhythmias. Interestingly, betel quid use was an independent risk factor for cardiovascular disease in women. Long-term betel quid consumption was associated with higher risks for all-cause mortality and increased overall cardiovascular risk.</p><p><strong>Conclusions: </strong>Habitual betel quid chewing is an important cardiovascular risk factor in populations where the practice is prevalent.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"447-453"},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transfers between health facilities of people living with diabetes attending primary health care services in the Western Cape Province of South Africa: A retrospective cohort study. 南非西开普省接受初级医疗服务的糖尿病患者在医疗机构之间的转院情况:一项回顾性队列研究。
IF 3.3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-01 Epub Date: 2024-03-21 DOI: 10.1111/tmi.13990
Jasantha Odayar, Jody Rusch, Joel A Dave, Diederick J Van Der Westhuizen, Elton Mukonda, Maia Lesosky, Landon Myer

Objectives: Transfers between health facilities of people living with HIV attending primary health care (PHC) including hospital to PHC facility, PHC facility to hospital and PHC facility to PHC facility transfers occur frequently, affect health service planning, and are associated with disengagement from care and viraemia. Data on transfers among people living with diabetes attending PHC, particularly transfers between PHC facilities, are few. We assessed the transfer incidence rate of people living with diabetes attending PHC, and the association between transfers between PHC facilities and subsequent HbA1c values.

Methods: We analysed data on HbA1c tests at public sector facilities in the Western Cape Province (2016-March 2020). Individuals with an HbA1c in 2016-2017 were followed-up for 27 months and included in the analysis if ≥18 years at first included HbA1c, ≥2 HbA1cs during follow-up and ≥1 HbA1c at a PHC facility. A visit interval was the duration between two consecutive HbA1cs. Successive HbA1cs at different facilities of any type indicated any transfer, and HbA1cs at different PHC facilities indicated a transfer between PHC facilities. Mixed effects logistic regression adjusted for sex, age, rural/urban facility attended at the start of the visit interval, disengagement (visit interval >14 months) and a hospital visit during follow-up assessed the association between transfers between PHC facilities and HbA1c >8%.

Results: Among 102,813 participants, 22.6% had ≥1 transfer of any type. Including repeat transfers, there were 29,994 transfers (14.4 transfers per 100 person-years, 95% confidence interval [CI] 14.3-14.6). A total of 6996 (30.1%) of those who transferred had a transfer between PHC facilities. Visit intervals with a transfer between PHC facilities were longer (349 days, interquartile range [IQR] 211-503) than those without any transfer (330 days, IQR 182-422). The adjusted relative odds of an HbA1c ≥8% after a transfer between PHC facilities versus no transfer were 1.20 (95% CI 1.05-1.37).

Conclusion: The volume of transfers involving PHC facilities requires consideration when planning services. Individuals who transfer between PHC facilities require additional monitoring and support.

目的:在初级医疗保健机构(PHC)就诊的艾滋病病毒感染者在医疗机构之间的转院,包括医院到初级医疗保健机构、初级医疗保健机构到医院以及初级医疗保健机构到初级医疗保健机构之间的转院频繁发生,影响了医疗服务规划,并与脱离医疗服务和病毒血症有关。有关在初级保健中心就诊的糖尿病患者转院,尤其是在初级保健中心之间转院的数据很少。我们评估了就诊于初级保健中心的糖尿病患者的转院发生率,以及初级保健中心之间的转院与随后的 HbA1c 值之间的关联:我们分析了西开普省公共部门机构的 HbA1c 检测数据(2016 年至 2020 年 3 月)。对2016-2017年进行过一次HbA1c检测的个体进行了为期27个月的随访,如果首次纳入HbA1c检测时年龄≥18岁,随访期间HbA1c检测次数≥2次,且在公共卫生机构进行的HbA1c检测次数≥1次,则将其纳入分析。就诊间隔是指两次连续 HbA1c 之间的时间间隔。在任何类型的不同医疗机构连续测得 HbA1c 均表示转院,而在不同的初级保健医疗机构测得 HbA1c 则表示在初级保健医疗机构之间转院。混合效应逻辑回归对性别、年龄、就诊间隔开始时就诊的农村/城市机构、脱离(就诊间隔大于 14 个月)和随访期间的医院就诊进行了调整,以评估初级保健机构之间的转院与 HbA1c >8% 之间的关系:在 102 813 名参与者中,22.6% 的人进行过≥1 次任何类型的转院。包括重复转院在内,共有 29994 次转院(每百人年转院 14.4 次,95% 置信区间 [CI] 14.3-14.6)。在转院患者中,共有 6996 人(30.1%)在初级保健机构之间转院。在初级保健机构之间转院的就诊间隔时间(349 天,四分位数间距 [IQR] 211-503)长于未转院的就诊间隔时间(330 天,四分位数间距 [IQR] 182-422)。在初级保健机构之间转院后 HbA1c ≥8% 的调整相对几率为 1.20(95% CI 1.05-1.37):结论:在规划服务时,需要考虑涉及初级保健机构的转院量。在初级保健机构之间转院的患者需要额外的监测和支持。
{"title":"Transfers between health facilities of people living with diabetes attending primary health care services in the Western Cape Province of South Africa: A retrospective cohort study.","authors":"Jasantha Odayar, Jody Rusch, Joel A Dave, Diederick J Van Der Westhuizen, Elton Mukonda, Maia Lesosky, Landon Myer","doi":"10.1111/tmi.13990","DOIUrl":"10.1111/tmi.13990","url":null,"abstract":"<p><strong>Objectives: </strong>Transfers between health facilities of people living with HIV attending primary health care (PHC) including hospital to PHC facility, PHC facility to hospital and PHC facility to PHC facility transfers occur frequently, affect health service planning, and are associated with disengagement from care and viraemia. Data on transfers among people living with diabetes attending PHC, particularly transfers between PHC facilities, are few. We assessed the transfer incidence rate of people living with diabetes attending PHC, and the association between transfers between PHC facilities and subsequent HbA1c values.</p><p><strong>Methods: </strong>We analysed data on HbA1c tests at public sector facilities in the Western Cape Province (2016-March 2020). Individuals with an HbA1c in 2016-2017 were followed-up for 27 months and included in the analysis if ≥18 years at first included HbA1c, ≥2 HbA1cs during follow-up and ≥1 HbA1c at a PHC facility. A visit interval was the duration between two consecutive HbA1cs. Successive HbA1cs at different facilities of any type indicated any transfer, and HbA1cs at different PHC facilities indicated a transfer between PHC facilities. Mixed effects logistic regression adjusted for sex, age, rural/urban facility attended at the start of the visit interval, disengagement (visit interval >14 months) and a hospital visit during follow-up assessed the association between transfers between PHC facilities and HbA1c >8%.</p><p><strong>Results: </strong>Among 102,813 participants, 22.6% had ≥1 transfer of any type. Including repeat transfers, there were 29,994 transfers (14.4 transfers per 100 person-years, 95% confidence interval [CI] 14.3-14.6). A total of 6996 (30.1%) of those who transferred had a transfer between PHC facilities. Visit intervals with a transfer between PHC facilities were longer (349 days, interquartile range [IQR] 211-503) than those without any transfer (330 days, IQR 182-422). The adjusted relative odds of an HbA1c ≥8% after a transfer between PHC facilities versus no transfer were 1.20 (95% CI 1.05-1.37).</p><p><strong>Conclusion: </strong>The volume of transfers involving PHC facilities requires consideration when planning services. Individuals who transfer between PHC facilities require additional monitoring and support.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"489-498"},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11147718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reasons for mosquito net non‐use in malaria‐endemic countries: A review of qualitative research published between 2011 and 2021 疟疾流行国家不使用蚊帐的原因:2011 年至 2021 年间发表的定性研究综述
IF 3.3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-26 DOI: 10.1111/tmi.14006
Hadiza Isa Ladu, Umar Shuaibu, Justin Pulford
Mosquito nets, particularly insecticide‐treated nets, are the most recommended method of malaria control in endemic countries. However, individuals do not always have access to insecticide‐treated nets or use them as recommended. The current paper expands on a previous review published in 2011 which highlighted a need for more qualitative research on the reasons for mosquito net non‐use. We present a systematic review of qualitative research published in the past decade to assess the growth and quality of qualitative papers about net non‐use and examine and update the current understanding. A comprehensive literature search was carried out in MEDLINE, CINAHL, and Global Health, in addition to a citation search of the initial review. Relevant papers were screened and discussed. The critical appraisal assessment tool was used to ensure quality. Thematic synthesis was used to extract, synthesise, and analyse study findings. Compared with the initial review, the results showed a 10‐fold increase in qualitative research on the reasons for mosquito net non‐use between 2011 and 2021. In addition, the quality of the research has improved, with more than 90% of the papers receiving high scores, using the critical appraisal assessment tool. The reported reasons for non‐use were categorised into four themes: human factors, net factors, housing structure, and net access. More than two thirds of the studies (25/39) were led by authors affiliated with institutions in malaria‐endemic countries. Despite the distribution of free mosquito nets in malaria‐endemic countries, earlier reported challenges remain pertinent. The most common reasons for net non‐use across all regions of Malaria endemic countries pertained to human‐ and net‐related factors. The research focus should shift towards intervention studies to address these issues.
蚊帐,尤其是驱虫蚊帐,是疟疾流行国家最推荐的疟疾控制方法。然而,人们并不总能获得驱虫蚊帐或按照建议使用蚊帐。2011 年发表的一篇综述强调,有必要对不使用蚊帐的原因进行更多定性研究,本论文是对该综述的进一步阐述。我们对过去十年间发表的定性研究进行了系统回顾,以评估不使用蚊帐定性论文的增长情况和质量,并检查和更新当前的认识。除了对初步综述进行引文检索外,我们还在 MEDLINE、CINAHL 和 Global Health 中进行了全面的文献检索。对相关论文进行了筛选和讨论。为确保质量,使用了批判性评价评估工具。专题综合法用于提取、综合和分析研究结果。与最初的综述相比,结果显示,2011 年至 2021 年间,有关不使用蚊帐原因的定性研究增加了 10 倍。此外,研究质量也有所提高,90% 以上的论文都获得了批判性评价评估工具的高分。所报告的不使用蚊帐的原因分为四个主题:人为因素、蚊帐因素、住房结构和蚊帐获取。超过三分之二的研究(25/39)是由疟疾流行国家机构的作者领导的。尽管疟疾流行国家发放了免费蚊帐,但之前报告的挑战依然存在。在疟疾流行国家的所有地区,不使用蚊帐的最常见原因与人和蚊帐有关。研究重点应转向干预研究,以解决这些问题。
{"title":"Reasons for mosquito net non‐use in malaria‐endemic countries: A review of qualitative research published between 2011 and 2021","authors":"Hadiza Isa Ladu, Umar Shuaibu, Justin Pulford","doi":"10.1111/tmi.14006","DOIUrl":"https://doi.org/10.1111/tmi.14006","url":null,"abstract":"Mosquito nets, particularly insecticide‐treated nets, are the most recommended method of malaria control in endemic countries. However, individuals do not always have access to insecticide‐treated nets or use them as recommended. The current paper expands on a previous review published in 2011 which highlighted a need for more qualitative research on the reasons for mosquito net non‐use. We present a systematic review of qualitative research published in the past decade to assess the growth and quality of qualitative papers about net non‐use and examine and update the current understanding. A comprehensive literature search was carried out in MEDLINE, CINAHL, and Global Health, in addition to a citation search of the initial review. Relevant papers were screened and discussed. The critical appraisal assessment tool was used to ensure quality. Thematic synthesis was used to extract, synthesise, and analyse study findings. Compared with the initial review, the results showed a 10‐fold increase in qualitative research on the reasons for mosquito net non‐use between 2011 and 2021. In addition, the quality of the research has improved, with more than 90% of the papers receiving high scores, using the critical appraisal assessment tool. The reported reasons for non‐use were categorised into four themes: human factors, net factors, housing structure, and net access. More than two thirds of the studies (25/39) were led by authors affiliated with institutions in malaria‐endemic countries. Despite the distribution of free mosquito nets in malaria‐endemic countries, earlier reported challenges remain pertinent. The most common reasons for net non‐use across all regions of Malaria endemic countries pertained to human‐ and net‐related factors. The research focus should shift towards intervention studies to address these issues.","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":"37 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141150981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Spread and persistence of antimicrobial resistance genes in wastewater from human and animal sources in São Paulo, Brazil. 巴西圣保罗人类和动物废水中抗菌药耐药性基因的传播和持久性。
IF 3.3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-03-28 DOI: 10.1111/tmi.13986
Milena Dropa, Jéssica Santiago Bispo da Silva, André Furugen César Andrade, Denis Hideki Nakasone, Marcos Paulo Vieira Cunha, Gesiane Ribeiro, Ronalda Silva de Araújo, Carlos Jesus Brandão, Barbara Ghiglione, Nilton Lincopan, Maria Inês Zanoli Sato, Terezinha Knöbl

The spread of antimicrobial resistance (AMR) through multiple reservoirs is a global concern. Wastewater is a critical AMR dissemination source, so this study aimed to assess the persistence of resistance genetic markers in wastewater using a culture-independent approach. Raw and treated wastewater samples (n = 121) from a wastewater treatment plant (WWTP), a human hospital, a veterinary hospital, and a pig farm were monthly collected and concentrated by filtration. DNA was extracted directly from filter membranes, and PCR was used in the qualitative search of 32 antimicrobial resistance genes (ARGs). Selected genes (blaCTX-M, blaKPC, qnrB, and mcr-1) were enumerated by quantitative real-time PCR (qPCR). Twenty-six ARGs were detected in the qualitative ARGs search, while quantitative data showed a low variation of the ARG's relative abundance (RA) throughout the months, especially at the human hospital and the WWTP. At the WWTP, despite significantly reducing the absolute number of gene copies/L after each treatment stage (p < 0.05), slight increases (p > 0.05) in the RAs of genes blaCTX-M, qnrB, and mcr-1 were observed in reused water (tertiary treatment) when compared with secondary effluent. Although the increase is not statistically significant, it is worth noting that there was some level of ARGs concentration after the disinfection process. No significant absolute or relative after-treatment quantification reductions were observed for any ARGs at the veterinary hospital or the pig farm. The spread of ARGs through sewage needs to be continuously addressed, because their release into natural environments may pose potential risks of exposure to resistant bacteria and impact local ecosystems.

抗菌药耐药性(AMR)通过多个蓄水池传播是一个全球关注的问题。废水是一个重要的 AMR 传播源,因此本研究旨在采用独立于培养的方法评估废水中耐药性遗传标记的持久性。每月从一家污水处理厂(WWTP)、一家人类医院、一家兽医院和一家养猪场收集未经处理的废水样本(n = 121),并通过过滤进行浓缩。直接从滤膜中提取 DNA,并利用 PCR 对 32 个抗菌素耐药性基因(ARGs)进行定性搜索。对部分基因(blaCTX-M、blaKPC、qnrB 和 mcr-1)进行了实时定量 PCR(qPCR)检测。在定性 ARGs 搜索中发现了 26 个 ARGs,而定量数据显示,ARGs 的相对丰度(RA)在各月中变化较小,尤其是在人类医院和污水处理厂。在污水处理厂,尽管在每个处理阶段后基因拷贝/L 的绝对数量都明显减少(p 0.05),但与二级出水相比,在回用水(三级处理)中观察到 blaCTX-M、qnrB 和 mcr-1 基因的相对丰度有所提高。虽然增加的幅度在统计学上并不显著,但值得注意的是,在消毒过程后,ARGs 浓度有一定程度的增加。在兽医院和养猪场,没有观察到任何 ARGs 在处理后的绝对或相对定量减少。需要持续解决 ARGs 通过污水传播的问题,因为它们释放到自然环境中可能会带来接触抗性细菌的潜在风险,并影响当地生态系统。
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引用次数: 0
Optimising the surveillance of Aedes aegypti in Brazil by selecting smaller representative areas within an endemic city. 通过在流行城市内选择较小的代表性区域,优化对巴西埃及伊蚊的监测。
IF 3.3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-03-12 DOI: 10.1111/tmi.13985
André de Souza Leandro, Lara Helena Pires-Vieira, Renata Defante Lopes, Açucena Veleh Rivas, Caroline Amaral, Isaac Silva, Rafael Maciel-de-Freitas, Wagner A Chiba de Castro

Objectives: Arboviruses, such as dengue (DENV), zika (ZIKV), and chikungunya (CHIKV), constitute a growing urban public health threat. Focusing on Aedes aegypti mosquitoes, their primary vectors, is crucial for mitigation. While traditional immature-stage mosquito surveillance has limitations, capturing adult mosquitoes through traps yields more accurate data on disease transmission. However, deploying traps presents logistical and financial challenges, demonstrating effective temporal predictions but lacking spatial accuracy. Our goal is to identify smaller representative areas within cities to enhance the early warning system for DENV outbreaks.

Methods: We created Sentinel Geographic Units (SGUs), smaller areas of 1 km2 within each stratum, larger areas, with the aim of aligning the Trap Positivity Index (TPI) and Adult Density Index (ADI) with their respective strata. We conducted a two-step evaluation of SGUs. First, we examined the equivalence of TPI and ADI between SGUs and strata from January 2017 to July 2022. Second, we assessed the ability of SGU's TPI and ADI to predict DENV outbreaks in comparison to Foz do Iguaçu's Early-Warning System, which forecasts outbreaks up to 4 weeks ahead. Spatial and temporal analyses were carried out, including data interpolation and model selection based on Akaike information criteria (AIC).

Results: Entomological indicators produced in small SGUs can effectively replace larger sentinel areas to access dengue outbreaks. Based on historical data, the best predictive capability is achieved 2 weeks after infestation verification. Implementing the SGU strategy with more frequent sampling can provide more precise space-time estimates and enhance dengue control.

Conclusions: The implementation of SGUs offers an efficient way to monitor mosquito populations, reducing the need for extensive resources. This approach has the potential to improve dengue transmission management and enhance the public health response in endemic cities.

目标:登革热 (DENV)、寨卡病毒 (ZIKV) 和基孔肯雅病毒 (CHIKV) 等虫媒病毒对城市公共卫生的威胁日益严重。重点关注其主要传播媒介埃及伊蚊对于减轻威胁至关重要。虽然传统的未成熟期蚊虫监测有其局限性,但通过诱捕器捕捉成蚊可以获得更准确的疾病传播数据。然而,部署诱捕器面临着后勤和资金方面的挑战,虽然能有效地进行时间预测,但缺乏空间准确性。我们的目标是在城市中确定较小的代表性区域,以加强 DENV 爆发的早期预警系统:我们创建了哨点地理单元(Sentinel Geographic Units,SGUs),即每个层内 1 平方公里的较小区域(较大区域),目的是使捕获阳性指数(TPI)和成虫密度指数(ADI)与各自的层相一致。我们分两步对 SGU 进行了评估。首先,我们检查了 2017 年 1 月至 2022 年 7 月期间 SGU 与各层之间的 TPI 和 ADI 的等效性。其次,我们将SGU的TPI和ADI与福斯-杜伊瓜苏的预警系统(可提前4周预测疫情)进行了比较,评估了SGU的TPI和ADI预测DENV疫情的能力。进行了空间和时间分析,包括数据插值和基于阿凯克信息标准(AIC)的模型选择:结果:小型哨点单位产生的昆虫学指标可有效取代较大的哨点地区,以获取登革热疫情。根据历史数据,登革热疫情核实两周后即可达到最佳预测能力。实施 SGU 策略,增加采样频率,可以提供更精确的时空估计,加强登革热控制:实施 SGU 为监测蚊子数量提供了一种有效的方法,减少了对大量资源的需求。这种方法有可能改善登革热的传播管理,加强流行城市的公共卫生应对措施。
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引用次数: 0
Current progress towards prevention of Nipah and Hendra disease in humans: A scoping review of vaccine and monoclonal antibody candidates being evaluated in clinical trials. 目前在预防人类尼帕病和亨德拉病方面取得的进展:对临床试验中正在评估的候选疫苗和单克隆抗体进行范围审查。
IF 2.6 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2024-02-28 DOI: 10.1111/tmi.13979
Valerie Rodrigue, Katie Gravagna, Jacqueline Yao, Vaidehi Nafade, Nicole E Basta

Objectives: Nipah and Hendra are deadly zoonotic diseases with pandemic potential. To date, no human vaccine or monoclonal antibody (mAb) has been licensed to prevent disease caused by these pathogens. The aim of this scoping review was to identify and describe all Phase I, II, and III clinical trials of vaccine candidates or mAbs candidates designed to prevent Nipah and Hendra in humans and to compare the characteristics of the vaccine candidates to characteristics outlined in the Target Product Profile drafted by the World Health Organisation as part of the WHO Research & Development Blueprint for Action to Prevent Epidemics.

Methods: We searched 23 clinical trial registries, the Cochrane Central Register of Clinical Trials, and grey literature up to June 2023 to identify vaccine and mAb candidates being evaluated in registered clinical trials. Vaccine candidate and trial characteristics were double-extracted for evaluation and the vaccine candidate characteristics were compared with the preferred and critical criteria of the World Health Organisation's Target Product Profile for Nipah virus vaccine.

Results: Three vaccine candidates (Hendra Virus Soluble Glycoprotein Vaccine [HeV-sG-V], PHV02, and mRNA-1215) and one mAb (m102.4) had a registered human clinical trial by June 2023. All trials were phase 1, dose-ranging trials taking place in the United States of America or Australia and enrolling healthy adults. Although all vaccine candidates meet the dose regimen and route of administration criteria of the Target Product Profile, other criteria such as measures of efficacy and reactogenicity will need to be evaluated in the future as evidence becomes available.

Conclusion: Multiple vaccine candidates and one mAb candidate have reached the stage of human clinical trials and are reviewed here. Monitoring progress during evaluation of these candidates and candidates entering clinical trials in the future can help highlight many of the challenges that remain.

目标:尼帕(Nipah)和亨德拉(Hendra)是致命的人畜共患病,具有大流行的潜力。迄今为止,还没有任何人类疫苗或单克隆抗体 (mAb) 获准用于预防由这些病原体引起的疾病。此次范围界定审查的目的是确定并描述所有旨在预防人类尼帕病和亨德拉病的候选疫苗或 mAb 的 I、II 和 III 期临床试验,并将候选疫苗的特征与世界卫生组织起草的目标产品简介中概述的特征进行比较,该目标产品简介是世界卫生组织预防流行病研发行动蓝图的一部分:我们检索了 23 个临床试验登记处、Cochrane 临床试验中央登记处以及截至 2023 年 6 月的灰色文献,以确定在已登记的临床试验中接受评估的候选疫苗和 mAb。对候选疫苗和试验特征进行双重提取评估,并将候选疫苗特征与世界卫生组织尼帕病毒疫苗目标产品简介中的首选标准和关键标准进行比较:结果:到2023年6月,三种候选疫苗(亨德拉病毒可溶性糖蛋白疫苗[HeV-sG-V]、PHV02和mRNA-1215)和一种mAb(m102.4)已注册人类临床试验。所有试验都是在美国或澳大利亚进行的第一阶段剂量范围试验,并招募了健康成年人。尽管所有候选疫苗都符合《目标产品简介》中的剂量方案和给药途径标准,但其他标准,如疗效和致反应性的衡量标准,还需要在未来获得证据后进行评估:多种候选疫苗和一种候选 mAb 已进入人体临床试验阶段,本文将对其进行回顾。在对这些候选疫苗和未来进入临床试验的候选疫苗进行评估的过程中,对进展情况进行监测有助于突出仍然存在的许多挑战。
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引用次数: 0
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Tropical Medicine & International Health
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