Pub Date : 2024-07-16DOI: 10.3389/fmed.2024.1411013
T. Klementi, Gunnar Piho, P. Ross
This paper addresses the dilemmas of accessibility, comprehensiveness, and ownership related to health data. To resolve these dilemmas, we propose and justify a novel, globally scalable reference architecture for a Personal Health Data Space (PHDS). This architecture leverages decentralized content-addressable storage (DCAS) networks, ensuring that the data subject retains complete control and ownership of their personal health data. In today's globalized world, where people are increasingly mobile for work and leisure, healthcare is transitioning from episodic symptom-based treatment toward continuity of care. The main aims of this are patient engagement, illness prevention, and active and healthy longevity. This shift, along with the secondary use of health data for societal benefit, has intensified the challenges associated with health data accessibility, comprehensiveness, and ownership.The study is structured around four health data use case scenarios from the Estonian National Health Information System (EHIS): primary medical use, medical emergency use, secondary use, and personal use. We analyze these use cases from the perspectives of accessibility, comprehensiveness, and ownership. Additionally, we examine the security, privacy, and interoperability aspects of health data.The proposed architectural solution allows individuals to consolidate all their health data into a unified Personal Health Record (PHR). This data can come from various healthcare institutions, mobile applications, medical devices for home use, and personal health notes.The comprehensive PHR can then be shared with healthcare providers in a semantically interoperable manner, regardless of their location or the information systems they use. Furthermore, individuals maintain the autonomy to share, sell, or donate their anonymous or pseudonymous health data for secondary use with different systems worldwide. The proposed reference architecture aligns with the principles of the European Health Data Space (EHDS) initiative, enhancing health data management by providing a secure, cost-effective, and sustainable solution.
{"title":"A reference architecture for personal health data spaces using decentralized content-addressable storage networks","authors":"T. Klementi, Gunnar Piho, P. Ross","doi":"10.3389/fmed.2024.1411013","DOIUrl":"https://doi.org/10.3389/fmed.2024.1411013","url":null,"abstract":"This paper addresses the dilemmas of accessibility, comprehensiveness, and ownership related to health data. To resolve these dilemmas, we propose and justify a novel, globally scalable reference architecture for a Personal Health Data Space (PHDS). This architecture leverages decentralized content-addressable storage (DCAS) networks, ensuring that the data subject retains complete control and ownership of their personal health data. In today's globalized world, where people are increasingly mobile for work and leisure, healthcare is transitioning from episodic symptom-based treatment toward continuity of care. The main aims of this are patient engagement, illness prevention, and active and healthy longevity. This shift, along with the secondary use of health data for societal benefit, has intensified the challenges associated with health data accessibility, comprehensiveness, and ownership.The study is structured around four health data use case scenarios from the Estonian National Health Information System (EHIS): primary medical use, medical emergency use, secondary use, and personal use. We analyze these use cases from the perspectives of accessibility, comprehensiveness, and ownership. Additionally, we examine the security, privacy, and interoperability aspects of health data.The proposed architectural solution allows individuals to consolidate all their health data into a unified Personal Health Record (PHR). This data can come from various healthcare institutions, mobile applications, medical devices for home use, and personal health notes.The comprehensive PHR can then be shared with healthcare providers in a semantically interoperable manner, regardless of their location or the information systems they use. Furthermore, individuals maintain the autonomy to share, sell, or donate their anonymous or pseudonymous health data for secondary use with different systems worldwide. The proposed reference architecture aligns with the principles of the European Health Data Space (EHDS) initiative, enhancing health data management by providing a secure, cost-effective, and sustainable solution.","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141643758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.3389/fmed.2024.1421439
Xu Chen, Xiaochen Fan, Yanda Meng, Yalin Zheng
We introduce a novel AI-driven approach to unsupervised fundus image registration utilizing our Generalized Polynomial Transformation (GPT) model. Through the GPT, we establish a foundational model capable of simulating diverse polynomial transformations, trained on a large synthetic dataset to encompass a broad range of transformation scenarios. Additionally, our hybrid pre-processing strategy aims to streamline the learning process by offering model-focused input. We evaluated our model's effectiveness on the publicly available AREDS dataset by using standard metrics such as image-level and parameter-level analyzes. Linear regression analysis reveals an average Pearson correlation coefficient (R) of 0.9876 across all quadratic transformation parameters. Image-level evaluation, comprising qualitative and quantitative analyzes, showcases significant improvements in Structural Similarity Index (SSIM) and Normalized Cross Correlation (NCC) scores, indicating its robust performance. Notably, precise matching of the optic disc and vessel locations with minimal global distortion are observed. These findings underscore the potential of GPT-based approaches in image registration methodologies, promising advancements in diagnosis, treatment planning, and disease monitoring in ophthalmology and beyond.
{"title":"AI-driven generalized polynomial transformation models for unsupervised fundus image registration","authors":"Xu Chen, Xiaochen Fan, Yanda Meng, Yalin Zheng","doi":"10.3389/fmed.2024.1421439","DOIUrl":"https://doi.org/10.3389/fmed.2024.1421439","url":null,"abstract":"We introduce a novel AI-driven approach to unsupervised fundus image registration utilizing our Generalized Polynomial Transformation (GPT) model. Through the GPT, we establish a foundational model capable of simulating diverse polynomial transformations, trained on a large synthetic dataset to encompass a broad range of transformation scenarios. Additionally, our hybrid pre-processing strategy aims to streamline the learning process by offering model-focused input. We evaluated our model's effectiveness on the publicly available AREDS dataset by using standard metrics such as image-level and parameter-level analyzes. Linear regression analysis reveals an average Pearson correlation coefficient (R) of 0.9876 across all quadratic transformation parameters. Image-level evaluation, comprising qualitative and quantitative analyzes, showcases significant improvements in Structural Similarity Index (SSIM) and Normalized Cross Correlation (NCC) scores, indicating its robust performance. Notably, precise matching of the optic disc and vessel locations with minimal global distortion are observed. These findings underscore the potential of GPT-based approaches in image registration methodologies, promising advancements in diagnosis, treatment planning, and disease monitoring in ophthalmology and beyond.","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"20 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141644199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.3389/fmed.2024.1434241
Eleftherios Chatzimichail, Nicolas Feltgen, Lorenzo Motta, Theo Empeslidis, Anastasios G. Konstas, Zisis Gatzioufas, G. Panos
Over the past decade, artificial intelligence (AI) and its subfields, deep learning and machine learning, have become integral parts of ophthalmology, particularly in the field of ophthalmic imaging. A diverse array of algorithms has emerged to facilitate the automated diagnosis of numerous medical and surgical retinal conditions. The development of these algorithms necessitates extensive training using large datasets of retinal images. This approach has demonstrated a promising impact, especially in increasing accuracy of diagnosis for unspecialized clinicians for various diseases and in the area of telemedicine, where access to ophthalmological care is restricted. In parallel, robotic technology has made significant inroads into the medical field, including ophthalmology. The vast majority of research in the field of robotic surgery has been focused on anterior segment and vitreoretinal surgery. These systems offer potential improvements in accuracy and address issues such as hand tremors. However, widespread adoption faces hurdles, including the substantial costs associated with these systems and the steep learning curve for surgeons. These challenges currently constrain the broader implementation of robotic surgical systems in ophthalmology. This mini review discusses the current research and challenges, underscoring the limited yet growing implementation of AI and robotic systems in the field of retinal conditions.
{"title":"Transforming the future of ophthalmology: artificial intelligence and robotics’ breakthrough role in surgical and medical retina advances: a mini review","authors":"Eleftherios Chatzimichail, Nicolas Feltgen, Lorenzo Motta, Theo Empeslidis, Anastasios G. Konstas, Zisis Gatzioufas, G. Panos","doi":"10.3389/fmed.2024.1434241","DOIUrl":"https://doi.org/10.3389/fmed.2024.1434241","url":null,"abstract":"Over the past decade, artificial intelligence (AI) and its subfields, deep learning and machine learning, have become integral parts of ophthalmology, particularly in the field of ophthalmic imaging. A diverse array of algorithms has emerged to facilitate the automated diagnosis of numerous medical and surgical retinal conditions. The development of these algorithms necessitates extensive training using large datasets of retinal images. This approach has demonstrated a promising impact, especially in increasing accuracy of diagnosis for unspecialized clinicians for various diseases and in the area of telemedicine, where access to ophthalmological care is restricted. In parallel, robotic technology has made significant inroads into the medical field, including ophthalmology. The vast majority of research in the field of robotic surgery has been focused on anterior segment and vitreoretinal surgery. These systems offer potential improvements in accuracy and address issues such as hand tremors. However, widespread adoption faces hurdles, including the substantial costs associated with these systems and the steep learning curve for surgeons. These challenges currently constrain the broader implementation of robotic surgical systems in ophthalmology. This mini review discusses the current research and challenges, underscoring the limited yet growing implementation of AI and robotic systems in the field of retinal conditions.","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"11 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141646125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.3389/fmed.2024.1401900
Jun Tie, Xulong Yuan, Ying Zhu, Kai Li, Xiaoyuan Gou, N. Han, Jing Niu, Jiao Xu, Wenlan Wang, Yongquan Shi
Nonselective beta blockers (NSBBs) or endoscopic therapies are currently recommended by guidelines for preventing the first variceal bleed in patients with high-risk varices. However, there is a lack of detailed treatment strategies for patients who are intolerant to both NSBBs and endoscopic approaches. Our study aimed to assess the efficacy and safety of variceal embolization as a primary prophylaxis method in cirrhosis patients who are not suitable candidates for NSBBs or endoscopic treatments.The study included 43 cirrhotic patients with high-risk varices who were candidates for primary prophylaxis against variceal bleeding. These patients underwent variceal embolization at the Xijing Hospital between January 2020 and June 2022. The primary endpoint was the occurrence of bleeding from varices, and the secondary endpoints were the recurrence of varices and the emergence of complications.The procedure of variceal embolization had a success rate of 93.0% (40 out of 43 patients). Over a 2-year follow-up period, the rate of variceal bleeding was 11.6% (5 out of 43 patients), the recurrence rate of varices was 14.0% (6 out of 43 patients), and the rate of severe complications was limited to 2.3% (1 out of 43 patients).Variceal embolization is a viable primary prophylactic intervention for cirrhotic patients who are at risk of variceal bleeding when standard treatments, such as NSBBs or endoscopic therapies, are difficult to perform.
{"title":"Efficacy and safety of variceal embolization for primary prophylaxis in cirrhosis patients with challenges in standard treatments: preliminary results","authors":"Jun Tie, Xulong Yuan, Ying Zhu, Kai Li, Xiaoyuan Gou, N. Han, Jing Niu, Jiao Xu, Wenlan Wang, Yongquan Shi","doi":"10.3389/fmed.2024.1401900","DOIUrl":"https://doi.org/10.3389/fmed.2024.1401900","url":null,"abstract":"Nonselective beta blockers (NSBBs) or endoscopic therapies are currently recommended by guidelines for preventing the first variceal bleed in patients with high-risk varices. However, there is a lack of detailed treatment strategies for patients who are intolerant to both NSBBs and endoscopic approaches. Our study aimed to assess the efficacy and safety of variceal embolization as a primary prophylaxis method in cirrhosis patients who are not suitable candidates for NSBBs or endoscopic treatments.The study included 43 cirrhotic patients with high-risk varices who were candidates for primary prophylaxis against variceal bleeding. These patients underwent variceal embolization at the Xijing Hospital between January 2020 and June 2022. The primary endpoint was the occurrence of bleeding from varices, and the secondary endpoints were the recurrence of varices and the emergence of complications.The procedure of variceal embolization had a success rate of 93.0% (40 out of 43 patients). Over a 2-year follow-up period, the rate of variceal bleeding was 11.6% (5 out of 43 patients), the recurrence rate of varices was 14.0% (6 out of 43 patients), and the rate of severe complications was limited to 2.3% (1 out of 43 patients).Variceal embolization is a viable primary prophylactic intervention for cirrhotic patients who are at risk of variceal bleeding when standard treatments, such as NSBBs or endoscopic therapies, are difficult to perform.","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"42 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141644852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.3389/fmed.2024.1410310
A. G. Kelbore, Wendemagegn Enbiale, Jacqueline M. Van wyk, Anisa Mosam
Atopic dermatitis (AD) is a chronic relapsing, pruritic, inflammatory skin disease. Assessing the characteristics and risk factors of severe AD is central to healthcare workers’ understanding and subsequent education of patients for the most optimal outcomes. The clinical characteristics are known to vary depending on populations and regions. AD has been well-documented in the global North in mainly Caucasian populations, while very few studies have been conducted on African patients residing in Africa. This study assessed the clinical characteristics, severity, and sociodemographic factors of children with AD in Southern Ethiopia.A hospital-based cross-sectional study was conducted among 461 children and their caregivers in four randomly selected hospitals in Southern Ethiopia from October 2022 to September 2023. A systematic sampling technique was used to enroll study participants. Clinical profile and sociodemographic data were collected by trained data collectors. The Scoring Atopic Dermatitis (SCORAD) index tool was used. The descriptive analysis was performed to characterize study participants. Univariate and ordinary logistic regression were used to identify factors associated with the SCORAD index score. The OR with 95% was used to show the strength of association, and a p-value of <0.05 was used to declare the level of significance.Out of 461 AD-diagnosed children, 212 (46%) were girls and 249 (54%) were boys. In the sample of pediatric patients, 149 (32.3%) exhibited mild AD, 231 (46.2%) presented with moderate, and 99 (21.5%) showed signs and symptoms of severe AD. All patients had itching. Dryness of skin, excoriation, and erythema, followed by lichenification, were the most observed signs. In the ordinary logistic regression model, age onset of the disease [AOR 95% CI 1.95 (1.3–2.94)], sex of caregiver or family [AOR 95% CI 0.61 (0.41–0.90)], family atopy history [AOR 95% CI 0.64 (0.44–0.93)], mother education status [95% CI 2.45 (1.1–5.47)], and use of herbal medication [AOR 95% CI 0.50 (0.33–0.79)] were significantly associated with the severity of AD.In this study, 68% of children were found to have moderate-to-severe AD. Early onset, maternal education, familial atopy history, sex of caregiver, and use of herbal medication were independent predictors of severe AD in children. We recommend further investigation into these variables for their potential to serve as markers to assess the severity of AD and improve the care and management of children with AD in Ethiopia.
{"title":"Atopic dermatitis in Ethiopian children: a multicenter study of clinical severity, characteristics, and sociodemographic factors","authors":"A. G. Kelbore, Wendemagegn Enbiale, Jacqueline M. Van wyk, Anisa Mosam","doi":"10.3389/fmed.2024.1410310","DOIUrl":"https://doi.org/10.3389/fmed.2024.1410310","url":null,"abstract":"Atopic dermatitis (AD) is a chronic relapsing, pruritic, inflammatory skin disease. Assessing the characteristics and risk factors of severe AD is central to healthcare workers’ understanding and subsequent education of patients for the most optimal outcomes. The clinical characteristics are known to vary depending on populations and regions. AD has been well-documented in the global North in mainly Caucasian populations, while very few studies have been conducted on African patients residing in Africa. This study assessed the clinical characteristics, severity, and sociodemographic factors of children with AD in Southern Ethiopia.A hospital-based cross-sectional study was conducted among 461 children and their caregivers in four randomly selected hospitals in Southern Ethiopia from October 2022 to September 2023. A systematic sampling technique was used to enroll study participants. Clinical profile and sociodemographic data were collected by trained data collectors. The Scoring Atopic Dermatitis (SCORAD) index tool was used. The descriptive analysis was performed to characterize study participants. Univariate and ordinary logistic regression were used to identify factors associated with the SCORAD index score. The OR with 95% was used to show the strength of association, and a p-value of <0.05 was used to declare the level of significance.Out of 461 AD-diagnosed children, 212 (46%) were girls and 249 (54%) were boys. In the sample of pediatric patients, 149 (32.3%) exhibited mild AD, 231 (46.2%) presented with moderate, and 99 (21.5%) showed signs and symptoms of severe AD. All patients had itching. Dryness of skin, excoriation, and erythema, followed by lichenification, were the most observed signs. In the ordinary logistic regression model, age onset of the disease [AOR 95% CI 1.95 (1.3–2.94)], sex of caregiver or family [AOR 95% CI 0.61 (0.41–0.90)], family atopy history [AOR 95% CI 0.64 (0.44–0.93)], mother education status [95% CI 2.45 (1.1–5.47)], and use of herbal medication [AOR 95% CI 0.50 (0.33–0.79)] were significantly associated with the severity of AD.In this study, 68% of children were found to have moderate-to-severe AD. Early onset, maternal education, familial atopy history, sex of caregiver, and use of herbal medication were independent predictors of severe AD in children. We recommend further investigation into these variables for their potential to serve as markers to assess the severity of AD and improve the care and management of children with AD in Ethiopia.","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141647756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.3389/fmed.2024.1453497
Christian Waydhas, Frank Hildebrand, Liping Liu
{"title":"Editorial: Emergency and critical care of severely injured patients","authors":"Christian Waydhas, Frank Hildebrand, Liping Liu","doi":"10.3389/fmed.2024.1453497","DOIUrl":"https://doi.org/10.3389/fmed.2024.1453497","url":null,"abstract":"","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"10 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141648386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.3389/fmed.2024.1278449
Harish Kamalanathan, Lewis Hains, Stephen Bacchi, Wrivu N. Martin, A. Zaka, Flynn Slattery, J. Kovoor, Aashray K. Gupta, Peter Psaltis, P. Kovoor
Podcasts are an increasingly popular medium for medical education in the field of cardiology. However, evidence suggests that the quality of the information presented can be variable. The aim of our study was to assess the quality of the most popular cardiology podcasts on existing podcast streaming services, using tools designed to grade online medical education.We analyzed the five most recent episodes from 28 different popular cardiology podcasts as of 20th of September, 2022 using the validated rMETRIQ and JAMA scoring tools. The median podcast length was 20 min and most episodes were hosted by professors, subspecialty discussants or consultant physicians (87.14%). Although most episodes had only essential content (85%), only a small proportion of episodes provided detailed references (12.9%), explicitly identified conflicts of interest (30.7%), described a review process (13.6%), or provided a robust discussion of the podcast's content (13.6%). We observed no consistent relationship between episode length, seniority of host or seniority of guest speaker with rMETRIQ or JAMA scores.Cardiology podcasts are a valuable remote learning tool for clinicians. However, the reliability, relevance, and transparency of information provided on cardiology podcasts varies widely. Streamlined standards for evaluation are needed to improve podcast quality.
{"title":"Listen to your heart: a critical analysis of popular cardiology podcasts","authors":"Harish Kamalanathan, Lewis Hains, Stephen Bacchi, Wrivu N. Martin, A. Zaka, Flynn Slattery, J. Kovoor, Aashray K. Gupta, Peter Psaltis, P. Kovoor","doi":"10.3389/fmed.2024.1278449","DOIUrl":"https://doi.org/10.3389/fmed.2024.1278449","url":null,"abstract":"Podcasts are an increasingly popular medium for medical education in the field of cardiology. However, evidence suggests that the quality of the information presented can be variable. The aim of our study was to assess the quality of the most popular cardiology podcasts on existing podcast streaming services, using tools designed to grade online medical education.We analyzed the five most recent episodes from 28 different popular cardiology podcasts as of 20th of September, 2022 using the validated rMETRIQ and JAMA scoring tools. The median podcast length was 20 min and most episodes were hosted by professors, subspecialty discussants or consultant physicians (87.14%). Although most episodes had only essential content (85%), only a small proportion of episodes provided detailed references (12.9%), explicitly identified conflicts of interest (30.7%), described a review process (13.6%), or provided a robust discussion of the podcast's content (13.6%). We observed no consistent relationship between episode length, seniority of host or seniority of guest speaker with rMETRIQ or JAMA scores.Cardiology podcasts are a valuable remote learning tool for clinicians. However, the reliability, relevance, and transparency of information provided on cardiology podcasts varies widely. Streamlined standards for evaluation are needed to improve podcast quality.","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"105 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141647589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.3389/fmed.2024.1403548
C. Cassani, M. Dominoni, Marianna Francesca Pasquali, Barbara Gardella, A. Spinillo
This study aimed to evaluate the prevalence of multiple high-risk (HR) human papillomavirus (HPV) infections in women with human immunodeficiency virus (HIV) compared to negative controls. This study also aimed to assess the impact of multiple HR-HPVs on the risk of high-grade squamous cervical lesions (HSILs) among women with HIV.We performed a systematic search of PubMed/Medline, Scopus, Cochrane databases, and ClinicalTrials.gov from 1 January 2004 to 30 June 2023, including screenings and clinical studies evaluating the rates and role of multiple HPV infections in squamous intraepithelial lesions (SILs). Three reviewers independently screened the abstracts of the selected studies and extracted data from full-text articles. The data were subsequently tabulated and compared for consistency. The bias associated with each included study was evaluated according to the OSQE method.Forty-seven studies meet definitive inclusion criteria. The quality of the observations was considered low in 26 of the included studies and moderate in 21 of the included studies. In comparative screening studies, the pooled prevalence of multiple HR-HPV was 39.1% (95% CI = 33.7–44.7) among women with (n = 1734) and 21.6% (95% CI = 17.3–26.1) in those without HIV infection (n = 912) (OR = 2.33, 95% CI = 1.83–2.97, I2 = 2.8%). The pooled ORs of HR-HPV multiple infections were similar in African (OR = 2.72, 95% CI = 1.89–3.9) and non-African countries (OR = 2.1, 95% CI = 1.46–3, p for difference = 0.96). Among women with HIV, the risk of HSIL diagnosed either by cytology or histology was higher among those with overall (OR = 2.62, 95% CI = 1.62–4.23) and HR multiple infections than those with single HPV infection (OR = 1.93, 95% CI = 1.51–2.46). Among women with HIV, the excess rates of multiple HPV infections and the excess risk of associated HSIL were consistent across studies including both HIV-naïve subjects and those on antiretroviral therapy, as well as in studies with different rates of immunocompromised women. When study quality (low vs. moderate) was used as a moderator, the results were unchanged.Multiple HR-HPV infections are common among women living with HIV and are associated with an increased prevalence of HSIL. These associations were also confirmed in studies with high rates of antiretroviral therapy and low rates of immunocompromise.Systematic Review Registration: PROSPERO [registration number: CRD42023433022].
本研究旨在评估与阴性对照组相比，感染人类免疫缺陷病毒（HIV）的女性中多重高危（HR）人类乳头瘤病毒（HPV）感染的流行率。我们对 2004 年 1 月 1 日至 2023 年 6 月 30 日期间的 PubMed/Medline、Scopus、Cochrane 数据库和 ClinicalTrials.gov 进行了系统检索，包括评估鳞状上皮内病变（SIL）中多种 HPV 感染率和作用的筛查和临床研究。三位审稿人独立筛选了所选研究的摘要，并从全文中提取了数据。随后将数据制成表格并进行比较，以确保数据的一致性。根据 OSQE 方法对每项纳入研究的相关偏倚进行了评估。其中 26 项研究的观察质量被认为较低，21 项研究的观察质量被认为中等。在对比筛查研究中，感染 HIV 的女性（n = 1734）和未感染 HIV 的女性（n = 912）中，多重 HR-HPV 的汇总患病率分别为 39.1%（95% CI = 33.7-44.7）和 21.6%（95% CI = 17.3-26.1）（OR = 2.33，95% CI = 1.83-2.97，I2 = 2.8%）。在非洲国家（OR = 2.72，95% CI = 1.89-3.9）和非非洲国家（OR = 2.1，95% CI = 1.46-3，差异 p = 0.96），HR-HPV 多重感染的汇总 ORs 相似。在感染艾滋病毒的妇女中，经细胞学或组织学诊断为HSIL的妇女中，整体感染（OR = 2.62，95% CI = 1.62-4.23）和HR多重感染的风险高于单一HPV感染的妇女（OR = 1.93，95% CI = 1.51-2.46）。在感染艾滋病病毒的妇女中，多项HPV感染的超常率和相关HSIL的超常风险在包括艾滋病病毒感染者和接受抗逆转录病毒治疗者在内的各项研究中以及在免疫力低下妇女比例不同的研究中都是一致的。多重HR-HPV感染在感染HIV的女性中很常见，并且与HSIL患病率的增加有关。这些关联在抗逆转录病毒治疗率高、免疫力低下率低的研究中也得到了证实：PROSPERO[注册号：CRD42023433022]。
{"title":"Multiple human papillomavirus infection and high-grade cervical squamous intraepithelial lesions among women with human immunodeficiency virus: a systematic review and a meta-analysis","authors":"C. Cassani, M. Dominoni, Marianna Francesca Pasquali, Barbara Gardella, A. Spinillo","doi":"10.3389/fmed.2024.1403548","DOIUrl":"https://doi.org/10.3389/fmed.2024.1403548","url":null,"abstract":"This study aimed to evaluate the prevalence of multiple high-risk (HR) human papillomavirus (HPV) infections in women with human immunodeficiency virus (HIV) compared to negative controls. This study also aimed to assess the impact of multiple HR-HPVs on the risk of high-grade squamous cervical lesions (HSILs) among women with HIV.We performed a systematic search of PubMed/Medline, Scopus, Cochrane databases, and ClinicalTrials.gov from 1 January 2004 to 30 June 2023, including screenings and clinical studies evaluating the rates and role of multiple HPV infections in squamous intraepithelial lesions (SILs). Three reviewers independently screened the abstracts of the selected studies and extracted data from full-text articles. The data were subsequently tabulated and compared for consistency. The bias associated with each included study was evaluated according to the OSQE method.Forty-seven studies meet definitive inclusion criteria. The quality of the observations was considered low in 26 of the included studies and moderate in 21 of the included studies. In comparative screening studies, the pooled prevalence of multiple HR-HPV was 39.1% (95% CI = 33.7–44.7) among women with (n = 1734) and 21.6% (95% CI = 17.3–26.1) in those without HIV infection (n = 912) (OR = 2.33, 95% CI = 1.83–2.97, I2 = 2.8%). The pooled ORs of HR-HPV multiple infections were similar in African (OR = 2.72, 95% CI = 1.89–3.9) and non-African countries (OR = 2.1, 95% CI = 1.46–3, p for difference = 0.96). Among women with HIV, the risk of HSIL diagnosed either by cytology or histology was higher among those with overall (OR = 2.62, 95% CI = 1.62–4.23) and HR multiple infections than those with single HPV infection (OR = 1.93, 95% CI = 1.51–2.46). Among women with HIV, the excess rates of multiple HPV infections and the excess risk of associated HSIL were consistent across studies including both HIV-naïve subjects and those on antiretroviral therapy, as well as in studies with different rates of immunocompromised women. When study quality (low vs. moderate) was used as a moderator, the results were unchanged.Multiple HR-HPV infections are common among women living with HIV and are associated with an increased prevalence of HSIL. These associations were also confirmed in studies with high rates of antiretroviral therapy and low rates of immunocompromise.Systematic Review Registration: PROSPERO [registration number: CRD42023433022].","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141648296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.3389/fmed.2024.1391219
R. Alsouri, Yousef Khader, Haitham Bashier, Mirwais Amiri, Sara Abdelkarim Morsy, Zainab Naseer Abbas, Zeina Elias Farah, M. Al Nsour
The COVID-19 pandemic encouraged the shift toward technology-based learning globally, impacting education systems profoundly. In response to this emerging need, the Eastern Mediterranean Public Health Network (EMPHNET) adapted its Public Health Empowerment Program-Basic Field Epidemiology (PHEP-BFE) to a Blended Learning Model. This study evaluates the Blended PHEP-BFE program in Iraq, Egypt, and Lebanon, focusing on participant reactions and learning outcomes.A descriptive evaluation was conducted, aligned with the first two levels of Kirkpatrick's model. Online questionnaires were administered to participants and facilitators through EMPHNET's Learning Management System (LMS). Qualitative and quantitative data were analyzed to assess program effectiveness, satisfaction, and challenges.A total of 138 PHEP-BFE participants (119 (86.2%) males and 19 (13.8%) females) from Iraq (n = 61), Egypt (n = 66), and Lebanon (n = 11) responded to the questionnaire. The majority of the participants (96.4%) reported that they were satisfied with PHEP-BFE. Notably, 77.5% of participants rated the blended learning program as very good or excellent, 18.1% rated it good, and 3.6% found it average, with a minimal 0.7% expressing dissatisfaction. The majority of participants agreed that the blended PHEP-BFE enhanced their capacity to conduct, review and monitor surveillance data (95.7%), perform descriptive data analysis (94.2%), effectively communicate information with agency staff and the local community (95.7%), write summaries of surveillance findings or outbreak investigations (95.7%), use MS Excel to enter, analyze, and display public health surveillance data (91.3%), prepare and administer an oral presentation for fieldwork (94.9%), and increase their knowledge of fundamental field epidemiology (94.9%). The participants responded positively to the program's content, training duration, learning platform, facilitators and mentors, and fieldwork.The study showcases the success of the blended PHEP-BFE in diverse contexts, emphasizing positive participant reactions and improved competencies. The evaluation underscores the program's success in advancing public health training in the EMR. Blended learning models prove promising for future FETP initiatives, contributing valuable insights to public health workforce development. Positive outcomes and identified challenges, provide a roadmap for continuous improvement.
{"title":"Evaluation of the blended public health empowerment program-basic field epidemiology in the Eastern Mediterranean Region","authors":"R. Alsouri, Yousef Khader, Haitham Bashier, Mirwais Amiri, Sara Abdelkarim Morsy, Zainab Naseer Abbas, Zeina Elias Farah, M. Al Nsour","doi":"10.3389/fmed.2024.1391219","DOIUrl":"https://doi.org/10.3389/fmed.2024.1391219","url":null,"abstract":"The COVID-19 pandemic encouraged the shift toward technology-based learning globally, impacting education systems profoundly. In response to this emerging need, the Eastern Mediterranean Public Health Network (EMPHNET) adapted its Public Health Empowerment Program-Basic Field Epidemiology (PHEP-BFE) to a Blended Learning Model. This study evaluates the Blended PHEP-BFE program in Iraq, Egypt, and Lebanon, focusing on participant reactions and learning outcomes.A descriptive evaluation was conducted, aligned with the first two levels of Kirkpatrick's model. Online questionnaires were administered to participants and facilitators through EMPHNET's Learning Management System (LMS). Qualitative and quantitative data were analyzed to assess program effectiveness, satisfaction, and challenges.A total of 138 PHEP-BFE participants (119 (86.2%) males and 19 (13.8%) females) from Iraq (n = 61), Egypt (n = 66), and Lebanon (n = 11) responded to the questionnaire. The majority of the participants (96.4%) reported that they were satisfied with PHEP-BFE. Notably, 77.5% of participants rated the blended learning program as very good or excellent, 18.1% rated it good, and 3.6% found it average, with a minimal 0.7% expressing dissatisfaction. The majority of participants agreed that the blended PHEP-BFE enhanced their capacity to conduct, review and monitor surveillance data (95.7%), perform descriptive data analysis (94.2%), effectively communicate information with agency staff and the local community (95.7%), write summaries of surveillance findings or outbreak investigations (95.7%), use MS Excel to enter, analyze, and display public health surveillance data (91.3%), prepare and administer an oral presentation for fieldwork (94.9%), and increase their knowledge of fundamental field epidemiology (94.9%). The participants responded positively to the program's content, training duration, learning platform, facilitators and mentors, and fieldwork.The study showcases the success of the blended PHEP-BFE in diverse contexts, emphasizing positive participant reactions and improved competencies. The evaluation underscores the program's success in advancing public health training in the EMR. Blended learning models prove promising for future FETP initiatives, contributing valuable insights to public health workforce development. Positive outcomes and identified challenges, provide a roadmap for continuous improvement.","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"29 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141645335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Postoperative urinary tract infections (UTIs) worsen the prognosis of elderly patients with hip fractures. This study aimed to assess the predictive ability of blood-based biomarkers, specifically the glucose-albumin ratio (GAR), in predicting postoperative UTIs.A retrospective observational study of 1,231 patients from a Level I trauma center was conducted. We evaluated the prognostic and predictive value of 15 biomarkers, including the glucose-albumin ratio, in elderly patients with hip fractures. The primary outcome measure was the incidence of postoperative UTIs.The glucose to albumin ratio transformed into GAR was superior to any other biomarker in predicting postoperative UTIs in elderly hip fracture patients (AUC = 0.756, p < 0.001). Elevated GAR (using the best cut-off value of 0.18) was independently associated with postoperative UTIs (OR 3.20, 95% CI 2.23–4.58). Further analysis dividing GAR levels into four groups according to quartiles showed that compared to patients with GAR levels of Q1 (< 0.14), GAR levels of Q2 (0.14–0.17; OR 2.11, 95% CI 1.07–4.15), Q3 (0.17–0.21; OR 3.36, 95% CI 1.74–6.52) and Q4 (> 0.21; OR 7.55, 95% CI 3.84–14.83) patients had significantly higher odds of UTIs.GAR holds potential as a novel biomarker for predicting postoperative UTIs in elderly patients with hip fractures.
术后尿路感染（UTI）会恶化髋部骨折老年患者的预后。本研究旨在评估基于血液的生物标志物（尤其是葡萄糖-白蛋白比值（GAR））在预测术后UTI方面的预测能力。我们评估了包括葡萄糖-白蛋白比值在内的 15 种生物标志物对老年髋部骨折患者的预后和预测价值。在预测老年髋部骨折患者术后尿毒症方面，转化为 GAR 的葡萄糖与白蛋白比值优于其他任何生物标志物（AUC = 0.756，p < 0.001）。GAR 升高（使用最佳临界值 0.18）与术后 UTIs 独立相关（OR 3.20，95% CI 2.23-4.58）。根据四分位数将 GAR 水平分为四组的进一步分析显示，与 GAR 水平为 Q1（< 0.14）的患者相比，GAR 水平为 Q2（0.14-0.17；OR 2.11，95% CI 1.07-4.15）、Q3（0.17-0.21；OR 3.GAR有望成为预测老年髋部骨折患者术后UTI的新型生物标志物。
{"title":"Glucose-albumin ratio (GAR) as a novel biomarker of postoperative urinary tract infection in elderly hip fracture patients","authors":"Wei Wang, Wanyun Tang, Wei Yao, Qiaomei Lv, Wenbo Ding","doi":"10.3389/fmed.2024.1366012","DOIUrl":"https://doi.org/10.3389/fmed.2024.1366012","url":null,"abstract":"Postoperative urinary tract infections (UTIs) worsen the prognosis of elderly patients with hip fractures. This study aimed to assess the predictive ability of blood-based biomarkers, specifically the glucose-albumin ratio (GAR), in predicting postoperative UTIs.A retrospective observational study of 1,231 patients from a Level I trauma center was conducted. We evaluated the prognostic and predictive value of 15 biomarkers, including the glucose-albumin ratio, in elderly patients with hip fractures. The primary outcome measure was the incidence of postoperative UTIs.The glucose to albumin ratio transformed into GAR was superior to any other biomarker in predicting postoperative UTIs in elderly hip fracture patients (AUC = 0.756, p < 0.001). Elevated GAR (using the best cut-off value of 0.18) was independently associated with postoperative UTIs (OR 3.20, 95% CI 2.23–4.58). Further analysis dividing GAR levels into four groups according to quartiles showed that compared to patients with GAR levels of Q1 (< 0.14), GAR levels of Q2 (0.14–0.17; OR 2.11, 95% CI 1.07–4.15), Q3 (0.17–0.21; OR 3.36, 95% CI 1.74–6.52) and Q4 (> 0.21; OR 7.55, 95% CI 3.84–14.83) patients had significantly higher odds of UTIs.GAR holds potential as a novel biomarker for predicting postoperative UTIs in elderly patients with hip fractures.","PeriodicalId":502302,"journal":{"name":"Frontiers in Medicine","volume":"16 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141645759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：