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Tuberculosis treatment outcome of TB/HIV co-infected patients at Adare Hospital, Hawassa City Administration, Sidama Region. 西达马大区哈瓦萨市政府阿达雷医院结核病/艾滋病毒合并感染者的治疗效果。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-11-11 DOI: 10.1186/s12879-024-10181-x
Endrias Markos Woldesemayat, Taye Gari

Background: There is lack of evidence on the TB treatment outcomes of TB/HIV co-infected patients who received anti-TB treatment in Sidama region. In this study, we aimed to assess the treatment outcome of TB/HIV co-infected patients receiving care at Adare Hospital in Hawasa City, Sidama Region.

Methods: A cross sectional study based on retrospective data among TB/HIV co-infected cases was conducted at Adare Hospital. The unit TB registry and antiretroviral therapy (ART) registry were reviewed for the period between September 1, 2016 and August 31, 2022 to measure TB treatment outcomes. Target population for this study was all TB/HIV co-infected cases aged 15 years or more treated at Adare Hospital in the Hawassa City Administration. The data sources for this study were the unit TB register at the TB clinics, patient charts, and the ART register of the facility. Data were entered and analysed using the statistical package SPSS version 26. A summary descriptive analysis was calculated. Bivariable and multivariable analyses were performed to identify associations between variables.

Results: During the study period, 298 TB/HIV co-infected cases were treated for TB in the Hospital. Thirty three (11.1%), of the cases had an unfavourable TB treatment outcome. The risk of an unfavourable treatment outcome was over three times higher among re-treated TB cases than among the new TB cases (AOR = 3.3, 95% CI (1.4, 7.9)). The risk of death was higher among stage-IV HIV cases (AOR = 8.1, 95% CI (2.3, 28.9)), and among participants who used non-communicable diseases medications during the cohort period (AOR = 7.3, 95% CI (1.6, 33.6).

Conclusion: TB treatment success rate among TB/HIV co-infected cases in the current study was comparable to many other reports. There are factors that contributed for unsuccessful TB treatment outcome. Cautious follow-up of cases and managing these factors could help in improving the TB treatment outcome.

背景:关于西达马地区接受抗结核治疗的结核病/艾滋病毒合并感染者的结核病治疗效果,目前还缺乏相关证据。本研究旨在评估在西达马地区哈瓦萨市阿达雷医院接受治疗的肺结核/艾滋病毒合并感染者的治疗效果:方法:我们在阿达雷医院对结核病/艾滋病毒合并感染病例进行了一项基于回顾性数据的横断面研究。研究回顾了2016年9月1日至2022年8月31日期间的单位结核病登记和抗逆转录病毒疗法(ART)登记,以衡量结核病治疗效果。本研究的目标人群是在哈瓦萨市政府阿达雷医院接受治疗的所有 15 岁或以上结核病/艾滋病毒合并感染病例。本研究的数据来源包括结核病诊所的结核病单位登记簿、病历以及该机构的抗逆转录病毒疗法登记簿。数据使用 SPSS 26 版统计软件包进行输入和分析。计算描述性分析摘要。为确定变量之间的关联性,还进行了二变量和多变量分析:研究期间,医院共收治了 298 例结核病/艾滋病毒合并感染者。其中 33 例(11.1%)的结核病治疗结果不理想。再次接受治疗的肺结核病例出现不良治疗结果的风险是新发肺结核病例的三倍多(AOR = 3.3,95% CI (1.4, 7.9))。在 HIV IV 期病例(AOR = 8.1,95% CI (2.3,28.9))和在队列期间使用非传染性疾病药物的参与者(AOR = 7.3,95% CI (1.6,33.6))中,死亡风险更高:结论:在本次研究中,结核病/艾滋病毒合并感染病例的结核病治疗成功率与许多其他报告不相上下。导致结核病治疗结果不成功的因素有很多。对病例进行谨慎的随访并控制这些因素有助于改善结核病的治疗效果。
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引用次数: 0
Can self-testing be enhanced to hasten safe return of healthcare workers in pandemics? Random order, open label trial using two manufacturers' SARS-CoV-2 lateral flow devices concurrently and nested viral culture study. 能否加强自我检测以加快大流行病中医护人员的安全返回?同时使用两家制造商的 SARS-CoV-2 侧流装置和巢式病毒培养研究的随机顺序、开放标签试验。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-11-11 DOI: 10.1186/s12879-024-10155-z
Xingna Zhang, Christopher P Cheyne, Christopher Jones, Michael Humann, Gary Leeming, Claire Smith, David M Hughes, Girvan Burnside, Susanna Dodd, Rebekah Penrice-Randal, Xiaofeng Dong, Malcolm G Semple, Tim Neal, Sarah Tunkel, Tom Fowler, Lance Turtle, Marta García-Fiñana, Iain E Buchan

Background: Covid-19 healthcare worker testing, isolation and quarantine policies had to balance risks to patients from the virus and from staff absence. The emergence of the Omicron variant led to dangerous levels of key-worker absence globally. We evaluated whether using two manufacturers' lateral flow tests (LFTs) concurrently improved SARS-CoV-2 Omicron detection significantly and was acceptable to hospital staff. In a nested study, to understand risks of return to work after a 5-day isolation/quarantine period, we examined virus culture 5-7 days after positive test or significant exposure.

Methods: Fully-vaccinated Liverpool (UK) University Hospitals staff participated (February-May 2022) in a random-order, open-label trial testing whether dual LFTs improved SARS-CoV-2 detection, and whether dual swabbing was acceptable to users. Participants used nose-throat swab Innova and nose-only swab Orient Gene LFTs in daily randomised order for 10 days. A user-experience questionnaire was administered on exit. Selected participants gave swabs for viral culture on days 5-7 after symptom onset or first positive test. Cultures were considered positive if cytopathic effect was apparent or SARS-CoV-2 N gene sub-genomic RNA was detected.

Results: Two hundred and twenty-six individuals reported 1466 pairs of LFT results. Tests disagreed in 127 cases (8.7%). Orient Gene was more likely (78 cf. 49; OR: 2.1, 1.1-4.1; P = 0.03) to be positive. If Innova was swabbed second, it was less likely to agree with a positive Orient Gene result (OR: 2.7, 1.3-5.2; P = 0.005); swabbing first with Innova made no significant difference (OR: 1.1, 0.5-2.3; P = 0.85). Orient Gene positive Innova negative result-pairs became more frequent over time (OR: 1.2, 1.1-1.3; P < 0.001). Of individuals completing the exit questionnaire, 90.7% reported dual swabbing was easy, 57.1% said it was no barrier to their daily routine and 65.6% preferred dual testing. Respondents had more confidence in dual versus single test results. Viral cultures from days 5-7 were positive for 6/31 (19.4%, 7.5%-37.5%) and indeterminate for 11/31 (35.5%, 19.2%-54.6%) LFT-positive participants, indicating they were likely still infectious.

Conclusions: Dual brand testing increased LFT detection of SARS-CoV-2 antigen by a small but meaningful margin and was acceptable to hospital workers. Viral cultures demonstrated that policies recommending safe return to work ~ 5 days after Omicron infection/exposure were flawed. Key-workers should be prepared for dynamic self-testing protocols in future pandemics.

Trial registration: https://www.isrctn.com/ISRCTN47058442 (26 January 2022).

背景:Covid-19 医护人员检测、隔离和检疫政策必须平衡病毒对患者造成的风险和工作人员缺勤造成的风险。Omicron 变体的出现导致全球关键员工缺勤达到危险水平。我们评估了同时使用两家制造商的侧流试验(LFT)是否能显著提高 SARS-CoV-2 Omicron 的检测率,以及医院员工是否能接受。在一项嵌套研究中,为了了解 5 天隔离/检疫期后重返工作岗位的风险,我们在检测结果呈阳性或明显暴露后 5-7 天对病毒培养进行了检查:完全接种疫苗的英国利物浦大学医院员工(2022 年 2 月至 5 月)参加了一项随机排序、开放标签试验,测试双 LFT 是否能提高 SARS-CoV-2 的检测率,以及使用者是否能接受双拭子检测。参与者每天随机使用鼻咽拭子Innova和鼻咽拭子Orient Gene LFTs,为期10天。离开时进行用户体验问卷调查。被选中的参与者在症状出现或首次检测呈阳性后的第 5-7 天提供拭子进行病毒培养。如果细胞病理效应明显或检测到 SARS-CoV-2 N 基因亚基因组 RNA,则认为培养结果呈阳性:226 人报告了 1466 对 LFT 结果。检测结果不一致的有 127 例(8.7%)。东方基因更有可能呈阳性(78 对 49;OR:2.1,1.1-4.1;P = 0.03)。如果先拭子再拭Innova,则与Orient Gene阳性结果一致的可能性较低(OR:2.7,1.3-5.2;P = 0.005);先拭子再拭Innova没有显著差异(OR:1.1,0.5-2.3;P = 0.85)。随着时间的推移,Orient Gene 阳性 Innova 阴性结果对的出现频率越来越高(OR:1.2,1.1-1.3;P 结论:双品牌检测提高了SARS-CoV-2抗原的LFT检测率,虽然幅度很小,但意义重大,医院工作人员可以接受。病毒培养结果表明,建议在感染/接触 Omicron 后 ~5 天安全返回工作岗位的政策是错误的。在未来的大流行中,主要工作人员应做好动态自我检测方案的准备。试验注册:https://www.isrctn.com/ISRCTN47058442(2022年1月26日)。
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引用次数: 0
Securing long-term immunity: The possible necessity of supplementary measles vaccination. 确保长期免疫:补充接种麻疹疫苗的必要性。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-11-11 DOI: 10.1186/s12879-024-10149-x
Furkan Kalayci, Metin Yigit, Belgin Gulhan, Saliha Kanik Yuksek, Enes Kaan Kilic, Yunus Emre Ince, Betul Demircioglu Kalayci, Hasan Salih Yuzdemir, Aslinur Ozkaya Parlakay

Background: The global initiative to eliminate measles, spearheaded by the World Health Organization, has yet to achieve its intended goals. In Turkey, despite robust vaccination strategies, recent increases in measles cases have been attributed to vaccine hesitancy and irregular migration. This study evaluates measles serology within a pediatric population to determine the impact of vaccination regimens on immunity.

Methods: A retrospective study at Ankara Bilkent City Hospital analyzed serum measles IgG levels in children aged 1-18 years from January 2020 to August 2023. Exclusions were applied for individuals with positive IgM results, incomplete vaccinations, and immunocompromised conditions. Patients were categorized based on their M-M-R®II vaccine status into those having received either one or two doses. Seropositivity was assessed using the ELISA method.

Results: Of the 686 children, 30.2% received a single dose, and 69.8% received two doses of the MMR vaccine. Overall, 70.7% exhibited positive IgG levels. No significant differences were found in IgG levels between those who received one dose and those who received two doses. However, a decline in IgG levels was observed with age, particularly notable in adolescents aged 14-18 years.

Conclusion: The study reveals seropositivity rates lower than expected, highlighting challenges in achieving WHO targets. This suggests a potential need for booster doses during adolescence to maintain protective antibody levels. The findings emphasize the importance of continued surveillance and research to adapt vaccination strategies effectively and prevent measles outbreaks, particularly considering the decline in antibody levels and diverse vaccination histories across populations.

背景:由世界卫生组织牵头发起的全球消除麻疹倡议尚未实现预期目标。在土耳其,尽管采取了强有力的疫苗接种策略,但最近麻疹病例的增加被归咎于疫苗接种犹豫不决和非正常移民。本研究对儿科人群的麻疹血清学进行了评估,以确定疫苗接种方案对免疫力的影响:安卡拉比尔肯特市医院的一项回顾性研究分析了 2020 年 1 月至 2023 年 8 月期间 1-18 岁儿童的血清麻疹 IgG 水平。研究排除了 IgM 阳性、疫苗接种不全和免疫功能低下的患者。根据患者的 M-M-R®II 疫苗接种情况,将其分为接种过一剂或两剂疫苗的患者。血清阳性反应采用 ELISA 方法进行评估:结果:在 686 名儿童中,30.2% 的儿童接种了一剂麻风腮疫苗,69.8% 的儿童接种了两剂麻风腮疫苗。总体而言,70.7%的儿童IgG水平呈阳性。接种一剂疫苗和接种两剂疫苗的儿童的 IgG 水平没有明显差异。然而,随着年龄的增长,IgG水平有所下降,这在14-18岁的青少年中尤为明显:研究显示,血清阳性率低于预期,凸显了实现世界卫生组织目标所面临的挑战。这表明在青少年时期可能需要加强剂量以维持保护性抗体水平。研究结果强调了持续监测和研究对于有效调整疫苗接种策略和预防麻疹暴发的重要性,特别是考虑到抗体水平的下降和不同人群不同的疫苗接种史。
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引用次数: 0
SARS-CoV-2 seroprevalence and associated factors among outpatient attendees at health facilities in different provinces in Chad. 乍得各省医疗机构门诊患者的 SARS-CoV-2 血清流行率及相关因素。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-11-11 DOI: 10.1186/s12879-024-10099-4
Koutaya Dezoumbe, Oumaima Djarma, Andrillene Laure Deutou Wondeu, Fatima Abdelrazak Zakaria, Sabrina Atturo, Nathan Naïbeï, Franck J D Mennechet, Denise Campagna, Abdoulaye Boukar, Choroma Ahmat Moussa, Issa Mahamat, Nontegyol Armand, Mahamat Idriss Hamad, Netalar Honorine, Kayanlengar Frederic, Adam Adami Moustapha, Yanda Mberkissam Daniel, Adam Moussa Alim, Mahamat Grene, Noubaramadji Yamti Suitombaye, Amine Akouya, Ouchemi Choua, Hota Mathieu, Djallaye Djimtoïbaye, Vittorio Colizzi, Giulia Cappelli, Takoudjou Dzomo Guy Rodrigue, Mahamat Fayiz Abakar, Ali Mahamat Moussa

Background: Chad with 7,698 confirmed cases of infection and 194 deaths since the beginning of the COVID-19 pandemic, is one of the African countries with the lowest reported case numbers. However, this figure likely underestimates the true spread of the virus due to the low rate of diagnosis. The high rate of asymptomatic infections reflects the reality of SARS-CoV-2 transmission in Chad. In this study, we estimated the seroprevalence and identified factors associated with SARS-CoV-2 infection.

Methods: A cross-sectional study was conducted between September 2022 and February 2023. A total of 1,290 plasma samples were collected from outpatient attendees at Health Facilities located in 11 provinces of Chad and tested by ELISA method, for the presence of IgG antibodies to SARS-CoV2 nucleocapsid (N) protein. KoboToolbox was used to gather data from the participants and data were analyzed using STATA 16.

Results: The overall seroprevalence was 83.0% [95% CI = 81.6%-85.5%], with variations between provinces, ranging from 99.2% [95% CI = 94.0%-100%] in Moundou (Southern Chad) to 46.8% [95% CI = 36.0% -57.1%] in Biltine (Eastern Chad). Factors associated with the seroprevalence included military occupation (OR = 0.37 CI [0.80-1.77] p = 0.025) and age group between 55-64 years (OR = 0.33 CI [0.15-0.72] p = 0.005). While, other factors, such as gender and age were not significantly associated with seroprevalence.

Conclusion: Our results indicated that, the seroprevalence of COVID-19 in Chad is among the highest in Sub-Saharan Africa. These estimates could guide the response and public health policy decisions, enhancing the management of future outbreaks involving respiratory pathogens.

背景:自 COVID-19 大流行以来,乍得确诊感染病例 7698 例,死亡 194 例,是报告病例数最少的非洲国家之一。然而,由于诊断率低,这一数字很可能低估了病毒的真实传播情况。无症状感染率高反映了 SARS-CoV-2 在乍得传播的实际情况。在这项研究中,我们估算了血清流行率,并确定了与 SARS-CoV-2 感染相关的因素:方法:我们在 2022 年 9 月至 2023 年 2 月期间进行了一项横断面研究。我们从乍得 11 个省医疗机构的门诊病人中收集了 1,290 份血浆样本,采用 ELISA 方法检测 SARS-CoV2 核头壳(N)蛋白 IgG 抗体。使用 KoboToolbox 收集参与者的数据,并使用 STATA 16 对数据进行分析:总血清阳性率为 83.0% [95% CI = 81.6% -85.5%],各省之间存在差异,蒙杜(乍得南部)为 99.2% [95% CI = 94.0% -100%],比尔廷(乍得东部)为 46.8% [95% CI = 36.0% -57.1%]。与血清阳性率相关的因素包括军人职业(OR = 0.37 CI [0.80-1.77] p = 0.025)和 55-64 岁年龄组(OR = 0.33 CI [0.15-0.72] p = 0.005)。而性别和年龄等其他因素与血清阳性率无明显关系:我们的研究结果表明,乍得的 COVID-19 血清流行率在撒哈拉以南非洲地区是最高的。这些估计值可为应对措施和公共卫生政策决策提供指导,从而加强对未来涉及呼吸道病原体的疫情的管理。
{"title":"SARS-CoV-2 seroprevalence and associated factors among outpatient attendees at health facilities in different provinces in Chad.","authors":"Koutaya Dezoumbe, Oumaima Djarma, Andrillene Laure Deutou Wondeu, Fatima Abdelrazak Zakaria, Sabrina Atturo, Nathan Naïbeï, Franck J D Mennechet, Denise Campagna, Abdoulaye Boukar, Choroma Ahmat Moussa, Issa Mahamat, Nontegyol Armand, Mahamat Idriss Hamad, Netalar Honorine, Kayanlengar Frederic, Adam Adami Moustapha, Yanda Mberkissam Daniel, Adam Moussa Alim, Mahamat Grene, Noubaramadji Yamti Suitombaye, Amine Akouya, Ouchemi Choua, Hota Mathieu, Djallaye Djimtoïbaye, Vittorio Colizzi, Giulia Cappelli, Takoudjou Dzomo Guy Rodrigue, Mahamat Fayiz Abakar, Ali Mahamat Moussa","doi":"10.1186/s12879-024-10099-4","DOIUrl":"10.1186/s12879-024-10099-4","url":null,"abstract":"<p><strong>Background: </strong>Chad with 7,698 confirmed cases of infection and 194 deaths since the beginning of the COVID-19 pandemic, is one of the African countries with the lowest reported case numbers. However, this figure likely underestimates the true spread of the virus due to the low rate of diagnosis. The high rate of asymptomatic infections reflects the reality of SARS-CoV-2 transmission in Chad. In this study, we estimated the seroprevalence and identified factors associated with SARS-CoV-2 infection.</p><p><strong>Methods: </strong>A cross-sectional study was conducted between September 2022 and February 2023. A total of 1,290 plasma samples were collected from outpatient attendees at Health Facilities located in 11 provinces of Chad and tested by ELISA method, for the presence of IgG antibodies to SARS-CoV2 nucleocapsid (N) protein. KoboToolbox was used to gather data from the participants and data were analyzed using STATA 16.</p><p><strong>Results: </strong>The overall seroprevalence was 83.0% [95% CI = 81.6%-85.5%], with variations between provinces, ranging from 99.2% [95% CI = 94.0%-100%] in Moundou (Southern Chad) to 46.8% [95% CI = 36.0% -57.1%] in Biltine (Eastern Chad). Factors associated with the seroprevalence included military occupation (OR = 0.37 CI [0.80-1.77] p = 0.025) and age group between 55-64 years (OR = 0.33 CI [0.15-0.72] p = 0.005). While, other factors, such as gender and age were not significantly associated with seroprevalence.</p><p><strong>Conclusion: </strong>Our results indicated that, the seroprevalence of COVID-19 in Chad is among the highest in Sub-Saharan Africa. These estimates could guide the response and public health policy decisions, enhancing the management of future outbreaks involving respiratory pathogens.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"24 1","pages":"1271"},"PeriodicalIF":3.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Social integration and risky sexual behaviors among international migrants in China: a cross-sectional study. 中国国际移民的社会融合与危险性行为:一项横断面研究。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-11-11 DOI: 10.1186/s12879-024-10167-9
Yuyin Zhou, Junfang Xu

Background: International migrants are vulnerable to sexually transmitted infections, and their flow may accelerate the related virus (e.g., HIV, HCV, and syphilis) transmission. When international migrants enter a new environment, there will be a process of adaptation in all areas of life, and social integration plays an important role in international migrants' daily life.

Objective: This study aimed to explore the influence of social integration on the risky sexual behaviors of international migrants in China and provided evidence both for healthcare intervention and global health development.

Methods: A cross-sectional survey was conducted between January and September 2021 among international migrants who lived in China by snowball sampling method. Descriptive statistics were used to analyze the basic characteristics and risky sexual behaviors of international migrants. Multivariable logistic regression analyses were used to identify the influencing factors of risky sexual behaviors.

Results: In total, 1433 international migrants were incorporated into the study. There were 23.10% (331) participants who considered their Chinese fluent, and 34.40% (493) considered it hard. The average number of Chinese friends they frequently interact with was (5.45 ± 2.16), and 77.60% (1112) of international migrants often attend activities held by Chinese people with 84.86% (1216) having a Chinese name. The probability of engaging in risky sexual behaviors was higher among people with lower Chinese or English level. Moreover, participants with fewer Chinese friends frequently interacted with had more unprotected sexual behaviors. People who did not often attend activities held by Chinese people had more multiple sexual partners (AOR 1.441; 95%CI 1.019,2.039) and unprotected sexual behaviors (AOR 1.523; 95%CI 1.006,2.306).

Conclusions: Social integration was related to the prevalence of risky sexual behaviors among international migrants. Improving Chinese level, increasing social interaction with locals as well as maintaining a healthy lifestyle may help decrease risky sexual behaviors. Therefore, more attention should be paid to social integration among international migrants, helping them integrate into local society, and promote their health condition to effectively address the health challenges faced by them in a globalized world.

背景:国际移民是性传播感染的易感人群,他们的流动可能会加速相关病毒(如艾滋病毒、丙肝病毒和梅毒)的传播。国际移民进入一个新的环境,在生活的各个领域都会有一个适应的过程,而社会融合在国际移民的日常生活中扮演着重要的角色:本研究旨在探讨社会融合对中国国际移民危险性行为的影响,为医疗干预和全球健康发展提供证据:方法:在 2021 年 1 月至 9 月期间,采用滚雪球抽样方法对在中国居住的国际移民进行了横断面调查。采用描述性统计分析了国际移民的基本特征和危险性行为。采用多变量逻辑回归分析确定危险性行为的影响因素:研究共纳入了 1433 名国际移民。有 23.10%(331 人)的受访者认为自己的中文流利,34.40%(493 人)的受访者认为自己的中文较难。他们经常交往的中国朋友的平均人数为(5.45 ± 2.16),77.60%(1112 人)的国际移民经常参加中国人举办的活动,84.86%(1216 人)有中文名字。中文或英文水平较低的人发生危险性行为的概率较高。此外,经常交往的中国朋友较少的参与者有更多的无保护性行为。不经常参加华人举办的活动的人有更多的多个性伴侣(AOR 1.441; 95%CI 1.019,2.039)和无保护的性行为(AOR 1.523; 95%CI 1.006,2.306):结论:社会融合与国际移民中危险性行为的发生率有关。提高中文水平、增加与当地人的社会交往以及保持健康的生活方式可能有助于减少危险性行为。因此,应更加关注国际移民的社会融合,帮助他们融入当地社会,促进他们的健康状况,以有效应对他们在全球化世界中所面临的健康挑战。
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引用次数: 0
Inequalities in measles immunization coverage among two-year-olds in Sierra Leone, 2008-2019. 2008-2019 年塞拉利昂两岁儿童麻疹免疫覆盖率的不平等。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-11-11 DOI: 10.1186/s12879-024-10088-7
Augustus Osborne, Alpha Umaru Bai-Sesay, Umaru Sesay, Alieu Tommy, Camilla Bangura, Bright Opoku Ahinkorah
<p><strong>Background: </strong>Measles, a highly contagious and potentially fatal disease, remains a significant public health concern, particularly in low- and middle-income countries. Vaccination is the most effective way to prevent measles and achieving high immunization coverage is crucial for protecting children and communities. This study investigated the trends and inequalities in measles immunization coverage among two-year-olds in Sierra Leone between 2008 and 2019.</p><p><strong>Methods: </strong>The study utilized data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. The World Health Organisation Health Equity Assessment Toolkit was used to calculate various inequality measures, including Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAF). An inequality assessment was conducted for six stratifiers: age, economic status, level of education, place of residence, sex of the child, and sub-national province.</p><p><strong>Results: </strong>In Sierra Leone, measles immunization coverage increased between 2008 and 2013 and decreased slightly in 2019. In 2008, 66.2% of two-year-olds were immunized, which increased to 86.2% in 2013 and then fell slightly to 82.2% in 2019. There was a decrease in inequality for age from 4.2 percentage points in 2008 to 3.0 percentage points in 2019 (D = 4.2 in 2008 and 3.0 in 2019). Economic-related inequality decreased from 8.1 percentage points in 2008 to 7.5 percentage points in 2019 (D = 8.1 in 2008 and 7.5 in 2019). Inequality in education decreased from 10.3 percentage points in 2008 to 7.4 percentage points in 2019 based on results from the inequality measure D. For place of residence, inequality decreased from 6.0 percentage points in 2008 to 4.0 percentage points in 2019. For the child's sex, the inequality increased from 1.9 percentage points in 2008 to 4.5 percentage points in 2019. The PAF revealed that the setting average could have been 1.4% higher in 2008 and 2.7% higher in 2019 without the child's sex inequality. Provincial inequality decreased from 19.4 percentage points in 2008 to 16.9 percentage points in 2019 (D = 19.4 in 2008 and 16.9 in 2019).</p><p><strong>Conclusion: </strong>The observed fluctuations in national measles immunization coverage for children under two underscore the need for sustained efforts in vaccination programs. While improvements in access based on age, socioeconomic status, education level, and place of residence suggest progress in reducing inequalities, the persistent provincial disparities, with a significant gap in 2019, highlight ongoing challenges that must be addressed to ensure equitable health outcomes. Additionally, the increase in inequalities based on the child's sex during the study period raises concerns about targeted interventions that may inadvertently neglect specific groups. These findings imply that policymakers must prioritize strategies that maintain high v
背景:麻疹是一种传染性极强、可能致命的疾病,仍然是一个重大的公共卫生问题,尤其是在中低收入国家。接种疫苗是预防麻疹的最有效方法,实现高免疫覆盖率对于保护儿童和社区至关重要。本研究调查了 2008 年至 2019 年期间塞拉利昂两岁儿童麻疹免疫接种覆盖率的趋势和不平等现象:研究利用了 2008 年、2013 年和 2019 年进行的塞拉利昂人口健康调查的数据。世界卫生组织健康公平评估工具包用于计算各种不平等度量,包括差值 (D)、比率 (R)、人口可归因风险 (PAR) 和人口可归因分数 (PAF)。对六个分层因素进行了不平等评估:年龄、经济状况、教育水平、居住地、儿童性别和次国家级省份:在塞拉利昂,麻疹免疫接种覆盖率在 2008 年至 2013 年间有所上升,但在 2019 年略有下降。2008年,66.2%的两岁儿童接受了免疫接种,2013年增至86.2%,2019年略微降至82.2%。年龄不平等从 2008 年的 4.2 个百分点降至 2019 年的 3.0 个百分点(2008 年的 D = 4.2,2019 年的 D = 3.0)。与经济有关的不平等从 2008 年的 8.1 个百分点降至 2019 年的 7.5 个百分点(2008 年的 D = 8.1,2019 年的 D = 7.5)。根据不平等度量 D 的结果,教育方面的不平等从 2008 年的 10.3 个百分点降至 2019 年的 7.4 个百分点。在儿童性别方面,不平等从 2008 年的 1.9 个百分点增加到 2019 年的 4.5 个百分点。PAF 显示,如果没有儿童性别的不平等,2008 年和 2019 年的设定平均值分别可以提高 1.4%和 2.7%。省级不平等从 2008 年的 19.4 个百分点降至 2019 年的 16.9 个百分点(D=2008 年的 19.4 和 2019 年的 16.9):观察到的全国两岁以下儿童麻疹免疫覆盖率的波动突出表明,需要在疫苗接种计划中持续努力。虽然基于年龄、社会经济地位、教育水平和居住地的接种情况有所改善,表明在减少不平等方面取得了进展,但各省之间持续存在的差距,以及 2019 年的巨大差距,凸显了为确保公平的健康结果而必须应对的持续挑战。此外,在研究期间,基于儿童性别的不平等现象有所增加,这引发了人们对有针对性的干预措施的担忧,因为这些干预措施可能会无意中忽视特定群体。这些研究结果表明,政策制定者必须优先考虑维持高疫苗接种率的战略,并重点缩小地域和性别差距,尤其是在服务不足的省份和弱势群体中。
{"title":"Inequalities in measles immunization coverage among two-year-olds in Sierra Leone, 2008-2019.","authors":"Augustus Osborne, Alpha Umaru Bai-Sesay, Umaru Sesay, Alieu Tommy, Camilla Bangura, Bright Opoku Ahinkorah","doi":"10.1186/s12879-024-10088-7","DOIUrl":"10.1186/s12879-024-10088-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Measles, a highly contagious and potentially fatal disease, remains a significant public health concern, particularly in low- and middle-income countries. Vaccination is the most effective way to prevent measles and achieving high immunization coverage is crucial for protecting children and communities. This study investigated the trends and inequalities in measles immunization coverage among two-year-olds in Sierra Leone between 2008 and 2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study utilized data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. The World Health Organisation Health Equity Assessment Toolkit was used to calculate various inequality measures, including Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAF). An inequality assessment was conducted for six stratifiers: age, economic status, level of education, place of residence, sex of the child, and sub-national province.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In Sierra Leone, measles immunization coverage increased between 2008 and 2013 and decreased slightly in 2019. In 2008, 66.2% of two-year-olds were immunized, which increased to 86.2% in 2013 and then fell slightly to 82.2% in 2019. There was a decrease in inequality for age from 4.2 percentage points in 2008 to 3.0 percentage points in 2019 (D = 4.2 in 2008 and 3.0 in 2019). Economic-related inequality decreased from 8.1 percentage points in 2008 to 7.5 percentage points in 2019 (D = 8.1 in 2008 and 7.5 in 2019). Inequality in education decreased from 10.3 percentage points in 2008 to 7.4 percentage points in 2019 based on results from the inequality measure D. For place of residence, inequality decreased from 6.0 percentage points in 2008 to 4.0 percentage points in 2019. For the child's sex, the inequality increased from 1.9 percentage points in 2008 to 4.5 percentage points in 2019. The PAF revealed that the setting average could have been 1.4% higher in 2008 and 2.7% higher in 2019 without the child's sex inequality. Provincial inequality decreased from 19.4 percentage points in 2008 to 16.9 percentage points in 2019 (D = 19.4 in 2008 and 16.9 in 2019).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The observed fluctuations in national measles immunization coverage for children under two underscore the need for sustained efforts in vaccination programs. While improvements in access based on age, socioeconomic status, education level, and place of residence suggest progress in reducing inequalities, the persistent provincial disparities, with a significant gap in 2019, highlight ongoing challenges that must be addressed to ensure equitable health outcomes. Additionally, the increase in inequalities based on the child's sex during the study period raises concerns about targeted interventions that may inadvertently neglect specific groups. These findings imply that policymakers must prioritize strategies that maintain high v","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"24 1","pages":"1280"},"PeriodicalIF":3.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Hospital-based cross-sectional study on the clinical characteristics of children with severe acute respiratory infections in Hungary. 关于匈牙利严重急性呼吸道感染患儿临床特征的医院横断面研究。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-11-09 DOI: 10.1186/s12879-024-10186-6
Nikolett Orosz, Gabriella Gömöri, Ulambayar Battamir, Attila Csaba Nagy

Background: Severe acute respiratory infection (SARI) is a major cause for hospital admission and associated with high mortality among children worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses and respiratory syncytial virus (RSV) are the most frequently identified pathogens in children with SARI. The duration of care can be affected by the type of infection and patient characteristics. Therefore, the objective of this study was to identify factors affecting the length of hospitalization in children infected with SARS-CoV-2, influenza A and RSV.

Methods: We collected data on 713 children with SARI from the medical databases of a university hospital in Hungary. To examine whether there is a difference in the length of hospitalization in children with the SARI Kruskal-Wallis test was performed. To determine the factors that may have an impact on the duration of care a multiple logistic regression analysis was executed.

Results: Our results showed that among RSV infected patients the proportions of children requiring intensive care (8.94%), mechanical ventilation (8.94%) and oxygen therapy (13.01%) and suffering from pneumonia (29.27%) were larger than among cases with SARS-CoV-2 and influenza A infection. Considering the age distribution and the duration of care in children with SARI, cases with RSV were significantly younger (p < 0.001) and stayed longer in the hospital (median: 5 days, IQR: 4-7 days, p < 0.001) than those with SARS-CoV-2 and influenza A virus. Multiple logistic regression analysis showed that RSV infection (adjusted odds ratio (aOR): 3.25, 95% confidence interval (CI): 1.43-7.38; p = 0.005), pneumonia (aOR: 3.65, 95% CI: 2.14-6.24; p < 0.001), mechanical ventilation or oxygen therapy (aOR: 3.23, 95% CI: 1.29-8.11; p = 0.012) and underlying illnesses (aOR: 2.39, 95% CI: 1.35-4.23; p = 0.003) significantly increased the odds of hospitalization for more than 4 days.

Conclusions: Our research showed that of the viruses causing SARI, RSV had the greatest clinical relevance, contributing to hospital stays of more than 4 days in a large share of paediatric patients below 1 year of age. Our results supply new information on children with SARI, and provide evidence for health policy makers to allocate additional resources to hospitals during SARI epidemics.

背景:严重急性呼吸道感染(SARI)是全球儿童入院治疗的主要原因,死亡率也很高。严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)、流感病毒和呼吸道合胞病毒(RSV)是 SARI 患儿中最常见的病原体。护理时间的长短会受到感染类型和患者特征的影响。因此,本研究旨在确定影响感染 SARS-CoV-2、甲型流感和 RSV 儿童住院时间的因素:我们从匈牙利一所大学医院的医疗数据库中收集了 713 名感染 SARI 儿童的数据。为了研究 SARI 患儿的住院时间是否存在差异,我们进行了 Kruskal-Wallis 检验。为了确定可能对护理时间产生影响的因素,我们进行了多元逻辑回归分析:结果表明,在 RSV 感染者中,需要重症监护(8.94%)、机械通气(8.94%)和氧疗(13.01%)以及肺炎(29.27%)的儿童比例高于 SARS-CoV-2 和甲型流感感染者。考虑到 SARI 患儿的年龄分布和护理时间,RSV 患儿的年龄明显更小(p 结论):我们的研究表明,在导致 SARI 的病毒中,RSV 的临床意义最大,导致大量 1 岁以下儿童患者的住院时间超过 4 天。我们的研究结果提供了有关 SARI 儿童的新信息,并为卫生决策者在 SARI 流行期间向医院分配额外资源提供了证据。
{"title":"Hospital-based cross-sectional study on the clinical characteristics of children with severe acute respiratory infections in Hungary.","authors":"Nikolett Orosz, Gabriella Gömöri, Ulambayar Battamir, Attila Csaba Nagy","doi":"10.1186/s12879-024-10186-6","DOIUrl":"10.1186/s12879-024-10186-6","url":null,"abstract":"<p><strong>Background: </strong>Severe acute respiratory infection (SARI) is a major cause for hospital admission and associated with high mortality among children worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses and respiratory syncytial virus (RSV) are the most frequently identified pathogens in children with SARI. The duration of care can be affected by the type of infection and patient characteristics. Therefore, the objective of this study was to identify factors affecting the length of hospitalization in children infected with SARS-CoV-2, influenza A and RSV.</p><p><strong>Methods: </strong>We collected data on 713 children with SARI from the medical databases of a university hospital in Hungary. To examine whether there is a difference in the length of hospitalization in children with the SARI Kruskal-Wallis test was performed. To determine the factors that may have an impact on the duration of care a multiple logistic regression analysis was executed.</p><p><strong>Results: </strong>Our results showed that among RSV infected patients the proportions of children requiring intensive care (8.94%), mechanical ventilation (8.94%) and oxygen therapy (13.01%) and suffering from pneumonia (29.27%) were larger than among cases with SARS-CoV-2 and influenza A infection. Considering the age distribution and the duration of care in children with SARI, cases with RSV were significantly younger (p < 0.001) and stayed longer in the hospital (median: 5 days, IQR: 4-7 days, p < 0.001) than those with SARS-CoV-2 and influenza A virus. Multiple logistic regression analysis showed that RSV infection (adjusted odds ratio (aOR): 3.25, 95% confidence interval (CI): 1.43-7.38; p = 0.005), pneumonia (aOR: 3.65, 95% CI: 2.14-6.24; p < 0.001), mechanical ventilation or oxygen therapy (aOR: 3.23, 95% CI: 1.29-8.11; p = 0.012) and underlying illnesses (aOR: 2.39, 95% CI: 1.35-4.23; p = 0.003) significantly increased the odds of hospitalization for more than 4 days.</p><p><strong>Conclusions: </strong>Our research showed that of the viruses causing SARI, RSV had the greatest clinical relevance, contributing to hospital stays of more than 4 days in a large share of paediatric patients below 1 year of age. Our results supply new information on children with SARI, and provide evidence for health policy makers to allocate additional resources to hospitals during SARI epidemics.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"24 1","pages":"1268"},"PeriodicalIF":3.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Malaria treatment for prevention: a modelling study of the impact of routine case management on malaria prevalence and burden. 疟疾治疗预防:常规病例管理对疟疾流行和负担影响的模型研究。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-11-08 DOI: 10.1186/s12879-024-09912-x
Flavia Camponovo, Aurélie Jeandron, Laura A Skrip, Monica Golumbeanu, Clara Champagne, Tasmin L Symons, Mark Connell, Peter W Gething, Theodoor Visser, Arnaud Le Menach, Justin M Cohen, Emilie Pothin

Background: Testing and treating symptomatic malaria cases is crucial for case management, but it may also prevent future illness by reducing mean infection duration. Measuring the impact of effective treatment on burden and transmission via field studies or routine surveillance systems is difficult and potentially unethical. This project uses mathematical modeling to explore how increasing treatment of symptomatic cases impacts malaria prevalence and incidence.

Methods: Leveraging the OpenMalaria stochastic agent-based transmission model, we first simulated an array of transmission intensities with baseline effective treatment coverages of 28%, 44%, and 54% incorporated to reflect the 2023 coverage distribution across Africa, as estimated by the Malaria Atlas Project. We assessed the impact of increasing coverage to as high as 60%, the highest 2023 estimate on the continent. Subsequently, we performed simulations resembling the specific subnational endemicities of Kenya, Mozambique, and Benin, using the Malaria Atlas Project estimates of intervention coverages to reproduce historical subnational prevalence. We estimated the impact of increasing effective treatment coverage in these example settings in terms of prevalence reduction and clinical cases averted in children under 5 years old and the total population.

Results: The most significant prevalence reduction - up to 50% - was observed in young children from lower transmission settings (prevalence below 0.2), alongside a 35% reduction in incidence, when increasing effective treatment from 28% to 60%. A nonlinear relationship between baseline transmission intensity and the impact of treatment was observed. Increasing effective treatment coverage to 60% reduced the risk in high-risk areas (prevalence in children under 5 years old > 0.3), affecting 39% of young children in Benin and 20% in Mozambique previously living in those areas. In Kenya where most of the population lives in areas with prevalence below 0.15, and case management is fairly high (53.9%), 0.39% of children were estimated to transition to lower-risk areas.

Conclusions: Improving case management directly reduces the burden of illness, but these results suggest it also reduces transmission, especially for young children. With vector control interventions, enhancing case management can be an important tool for reducing transmission intensity over time.

背景:对有症状的疟疾病例进行检测和治疗对于病例管理至关重要,而且还可以通过缩短平均感染时间来预防未来的疾病。通过实地研究或常规监测系统来衡量有效治疗对负担和传播的影响十分困难,而且有可能不道德。本项目采用数学建模的方法来探讨增加对无症状病例的治疗如何影响疟疾流行率和发病率:利用 OpenMalaria 基于随机代理的传播模型,我们首先模拟了一系列传播强度,并纳入了 28%、44% 和 54% 的基线有效治疗覆盖率,以反映疟疾图集项目估计的 2023 年整个非洲的覆盖率分布。我们评估了将覆盖率提高到 60% 的影响,这是 2023 年非洲大陆的最高估计值。随后,我们利用疟疾地图集项目估计的干预覆盖率,进行了与肯尼亚、莫桑比克和贝宁特定次国家流行率相似的模拟,以再现历史次国家流行率。我们估算了在这些示例环境中提高有效治疗覆盖率在降低流行率和避免 5 岁以下儿童及总人口临床病例方面的影响:当有效治疗率从 28% 提高到 60% 时,在传播率较低地区(传播率低于 0.2)的幼儿中观察到了最明显的流行率降低(高达 50%),同时发病率降低了 35%。基线传播强度与治疗效果之间存在非线性关系。将有效治疗覆盖率提高到 60%,可降低高风险地区的风险(5 岁以下儿童发病率大于 0.3),贝宁 39% 的幼儿和莫桑比克 20% 的幼儿以前生活在这些地区。在肯尼亚,大多数人口生活在发病率低于 0.15 的地区,而且病例管理水平相当高(53.9%),估计有 0.39% 的儿童转到了低风险地区:结论:改善病例管理可直接减轻疾病负担,但这些结果表明,它还能减少传播,尤其是对幼儿而言。通过病媒控制干预措施,加强病例管理可以成为长期降低传播强度的重要工具。
{"title":"Malaria treatment for prevention: a modelling study of the impact of routine case management on malaria prevalence and burden.","authors":"Flavia Camponovo, Aurélie Jeandron, Laura A Skrip, Monica Golumbeanu, Clara Champagne, Tasmin L Symons, Mark Connell, Peter W Gething, Theodoor Visser, Arnaud Le Menach, Justin M Cohen, Emilie Pothin","doi":"10.1186/s12879-024-09912-x","DOIUrl":"10.1186/s12879-024-09912-x","url":null,"abstract":"<p><strong>Background: </strong>Testing and treating symptomatic malaria cases is crucial for case management, but it may also prevent future illness by reducing mean infection duration. Measuring the impact of effective treatment on burden and transmission via field studies or routine surveillance systems is difficult and potentially unethical. This project uses mathematical modeling to explore how increasing treatment of symptomatic cases impacts malaria prevalence and incidence.</p><p><strong>Methods: </strong>Leveraging the OpenMalaria stochastic agent-based transmission model, we first simulated an array of transmission intensities with baseline effective treatment coverages of 28%, 44%, and 54% incorporated to reflect the 2023 coverage distribution across Africa, as estimated by the Malaria Atlas Project. We assessed the impact of increasing coverage to as high as 60%, the highest 2023 estimate on the continent. Subsequently, we performed simulations resembling the specific subnational endemicities of Kenya, Mozambique, and Benin, using the Malaria Atlas Project estimates of intervention coverages to reproduce historical subnational prevalence. We estimated the impact of increasing effective treatment coverage in these example settings in terms of prevalence reduction and clinical cases averted in children under 5 years old and the total population.</p><p><strong>Results: </strong>The most significant prevalence reduction - up to 50% - was observed in young children from lower transmission settings (prevalence below 0.2), alongside a 35% reduction in incidence, when increasing effective treatment from 28% to 60%. A nonlinear relationship between baseline transmission intensity and the impact of treatment was observed. Increasing effective treatment coverage to 60% reduced the risk in high-risk areas (prevalence in children under 5 years old > 0.3), affecting 39% of young children in Benin and 20% in Mozambique previously living in those areas. In Kenya where most of the population lives in areas with prevalence below 0.15, and case management is fairly high (53.9%), 0.39% of children were estimated to transition to lower-risk areas.</p><p><strong>Conclusions: </strong>Improving case management directly reduces the burden of illness, but these results suggest it also reduces transmission, especially for young children. With vector control interventions, enhancing case management can be an important tool for reducing transmission intensity over time.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"24 1","pages":"1267"},"PeriodicalIF":3.4,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
The association between stress hyperglycemia ratio and clinical outcomes in patients with sepsis-associated acute kidney injury: a secondary analysis of the MIMIC-IV database. 脓毒症相关急性肾损伤患者的应激性高血糖比率与临床结局之间的关系:对 MIMIC-IV 数据库的二次分析。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-11-08 DOI: 10.1186/s12879-024-10179-5
Yuanjun Zhou, Liping Zhong, Yuting Zhong, Yilin Liao

Background: The stress hyperglycemia ratio (SHR) is associated with poor outcomes in critically ill patients. However, the relationship between SHR and mortality in patients with sepsis-associated acute kidney injury (SA-AKI) remains unclear.

Methods: The data of patients with SA-AKI, identified based on the KDIGO criteria, were retrospectively collected from the Beth Israel Deaconess Medical Center between 2008 and 2019. SHR was calculated as follows: (glycemia [mmol/L]) / (1.59 × HbA1c [%] - 2.59). Primary outcomes were 30-day and 1-year mortality. The cumulative incidence of all-cause mortality was assessed using Kaplan-Meier survival analysis. Multivariable-adjusted logistic and Cox models and restricted cubic spline curves were used to analyze the correlation between SHR and all-cause mortality. Post-hoc subgroup analysis was performed to compare the effects of SHR across different subgroups.

Results: 1161 patients with SA-AKI were identified and categorized into four SHR quartiles as follows: Q1 (0.26, 0.90), Q2 (0.91, 1.08), Q3 (1.09, 1.30), and Q4 (1.31, 5.42). The median age of patients was 69 years, with 42.7% of the patients being women and 20.2% of the patients having chronic kidney disease. The 30-day and 1-year mortality were 22.1% and 35.0% respectively. Kaplan-Meier survival analysis indicated a gradual decrease in survival probability with increasing SHR quartiles. An increased SHR exhibited a strong correlation with 30-day mortality (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.18-1.90; P < 0.001) and 1-year mortality (HR, 1.32; 95% CI, 1.06-1.65; P = 0.014). SHR has a nonlinear relationship with 1-year mortality but not with 30-day mortality (P-nonlinear = 0.048 and 0.114, respectively). The results of subgroup analysis were mostly consistent with these findings.

Conclusion: An increased SHR is independently associated with 30-day and 1-year mortality in patients with SA-AKI. Therefore, SHR may serve as an effective tool for risk stratification in patients with SA-AKI.

背景:应激性高血糖比率(SHR)与危重病人的不良预后有关。然而,脓毒症相关急性肾损伤(SA-AKI)患者的 SHR 与死亡率之间的关系仍不清楚:方法:根据 KDIGO 标准从贝斯以色列女执事医疗中心回顾性收集了 2008 年至 2019 年期间 SA-AKI 患者的数据。SHR的计算方法如下:(血糖[mmol/L])/(1.59 × HbA1c [%] - 2.59)。主要结果为 30 天和 1 年死亡率。全因死亡率的累积发生率采用 Kaplan-Meier 生存分析法进行评估。采用多变量调整逻辑模型和 Cox 模型以及限制性三次样条曲线分析 SHR 与全因死亡率之间的相关性。进行了事后亚组分析,以比较SHR对不同亚组的影响:确定了1161名SA-AKI患者,并将其分为以下四个SHR四分位数:Q1(0.26,0.90)、Q2(0.91,1.08)、Q3(1.09,1.30)和Q4(1.31,5.42)。患者的中位年龄为 69 岁,42.7% 的患者为女性,20.2% 的患者患有慢性肾病。30天和1年的死亡率分别为22.1%和35.0%。Kaplan-Meier生存分析表明,随着SHR四分位数的增加,生存概率逐渐下降。SHR 增加与 30 天死亡率密切相关(危险比 [HR],1.50;95% 置信区间 [CI],1.18-1.90;P 结论:SHR升高与SA-AKI患者的30天和1年死亡率密切相关。因此,SHR 可作为对 SA-AKI 患者进行风险分层的有效工具。
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引用次数: 0
Genomic characteristics, disease outcome and heterologous vaccine effectiveness among cases with SARS CoV-2 infection. SARS CoV-2 感染病例的基因组特征、疾病结果和异源疫苗效果。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-11-08 DOI: 10.1186/s12879-024-10124-6
Rowan Abuyadek, Mira Mousa, Jumana AlAzazi, Ahmed Al Romaithi, Francis Selvaraj, Habiba Alsafar, Nawal Al Kaabi, Farida Al Hosani

Background: In the pursuit of global health security, continuous monitoring of vaccine effectiveness across various viral strains emerges as a crucial imperative. The emergence of SARS-CoV-2 major variants of concern (VOCs), including Alpha, Beta, Delta, and Omicron, has added complexity to the COVID-19 vaccination landscape.

Objectives: To assess illness severity, evaluate vaccine efficacy across varying doses and types, and determine effectiveness against major VOCs within the population.

Methods: This retrospective cohort study, conducted in Abu Dhabi, United Arab Emirates, focuses on a cohort of 44,073 SARS-CoV-2 positive cases from February 2021 to May 2022, dominated by the Delta and Omicron variants. The study employed a nested case-control design, analyzing hospital admissions for confirmed SARS-CoV-2 infection.

Results: Vaccine effectiveness was higher among heterologus-boosted individuals at 87% (95% CI:79%-93%) compared to homologus-boosted individuals at 59% (95% CI: 48%-68%) and fully vaccinated, non-boosted adults at 53% (95% CI: 46%-59%). These findings highlight the importance of heterologous boosting, particularly against rapidly evolving viral variants, offering valuable insights for refining pandemic response strategies.

Conclusion: The study underscores the critical need for ongoing assessment and adaptation of vaccination strategies to the evolving viral landscape.

背景:为了确保全球健康安全,必须持续监测不同病毒株的疫苗效果。包括 Alpha、Beta、Delta 和 Omicron 在内的 SARS-CoV-2 主要变种(VOCs)的出现增加了 COVID-19 疫苗接种的复杂性:评估疾病严重程度,评估不同剂量和类型疫苗的效力,并确定对人群中主要 VOCs 的效力:这项回顾性队列研究在阿联酋阿布扎比进行,重点研究了 2021 年 2 月至 2022 年 5 月期间 44,073 例 SARS-CoV-2 阳性病例,其中以 Delta 和 Omicron 变体为主。研究采用了巢式病例对照设计,分析了确诊感染 SARS-CoV-2 的入院病例:结果:接种过异源疫苗的人接种疫苗的有效率为 87%(95% CI:79%-93%),而接种过同源疫苗的人接种疫苗的有效率为 59%(95% CI:48%-68%),未接种过疫苗的成年人接种疫苗的有效率为 53%(95% CI:46%-59%)。这些发现强调了异源强化的重要性,尤其是针对快速发展的病毒变种,为完善大流行应对策略提供了宝贵的见解:这项研究强调了持续评估和调整疫苗接种策略以适应不断变化的病毒环境的迫切需要。
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BMC Infectious Diseases
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