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WHO defeating meningitis symposium, 3rd international symposium on Streptococcus agalactiae disease (ISSAD) in Rio de Janeiro, Brazil: State-of-the-art overview of S. agalactiae meningitis
No full textA World Health Organization (WHO) Defeating Meningitis Symposium took place as part of the 3rd International Symposium on Streptococcus agalactiae disease (ISSAD) conference which was held in Rio de Janeiro, Brazil, from October 16–18, 2023. The symposium highlighted WHO's Defeating meningitis by 2030 global road map focusing on Group B Streptococcus (GBS) meningitis and provided an overview of the meningitis burden and main challenges faced to tackle the disease across the Americas, Africa, and Asia
Antibody in Breastmilk Following Pertussis Vaccination in Three-time Windows in Pregnancy.
Get PDFBACKGROUND: Pertussis-containing vaccines are routinely offered in the UK at 16-32 weeks of gestation and have been shown to be safe and effective, but there remains debate about the best timing for vaccination. Most research into this has focused on serologic immunity, but breastmilk is also important in infant immunity, and the amount of IgA in breastmilk may impact mucosal immunity. It is important to understand if the timing of vaccination in pregnancy affects the concentration of IgA in breastmilk. METHODS: Participants recruited as part of the MAMA (Maternal Antibody in Milk After Vaccination) and OpTIMUM (Optimizing the Timing of Whooping Cough Immunisations in Mums) trials received a pertussis-containing vaccine during pregnancy, either before 24 weeks, between 24 and 27+6 weeks or between 28 and 31+6 weeks. Samples of colostrum within 24 hours of delivery and breastmilk at 14 days were collected. Pertussis toxin, pertactin, tetanus toxoid and diphtheria toxoid specific-IgA levels were measured using a multiplex immunoassay. RESULTS: There was no difference in specific IgA levels against pertussis toxin, pertactin, tetanus toxoid and diphtheria toxoid between the groups vaccinated within different time periods. For all antigens, there was decay in antigen-specific IgA levels between colostrum and breastmilk at 14 days. CONCLUSION: Our results suggest that the timing of administration of a pertussis-containing vaccine in pregnancy does not impact on antigen-specific IgA concentration in colostrum or breastmilk at 14 days
Cost Utility of Specialist Physiotherapy for Functional Motor Disorder (Physio4FMD)
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Functional motor disorder (FMD), a motor-dominant variant of functional neurologic disorder, is a disabling condition associated with high health and social care resource use and poor employment outcomes. Specialist physiotherapy presents a possible treatment option, but there is limited evidence for clinical effectiveness and cost-effectiveness. Physio4FMD is a multicenter randomized controlled trial of specialist physiotherapy for FMD compared with treatment as usual (TAU). The aim of the analysis was to conduct a randomized trial based on economic evaluation of specialist physiotherapy compared with TAU.
Methods
Eleven centers in England and Scotland randomized participants 1:1 to specialist physiotherapy or TAU (referral to community neurologic physiotherapy). Participants completed the EuroQoL EQ-5D-5L, Client Service Receipt Inventory, and Work Productivity and Activity Impairment Questionnaire at baseline, 6 months, and 12 months. The mean incremental cost per quality-adjusted life year (QALY) for specialist physiotherapy compared with TAU over 12 months was calculated from a health and social care and wider societal perspective. The probability of cost-effectiveness and 95% CIs were calculated using bootstrapping.
Results
The analysis included 247 participants (n = 141 for specialist physiotherapy, n = 106 for TAU). The mean cost per participant for specialist physiotherapy was £646 (SD 72) compared with £272 (SD 374) for TAU. Including the costs of treatment, the adjusted mean health and social care cost per participant at 12 months for specialist physiotherapy was £3,814 (95% CI £3,194–£4,433) compared with £3,670 (95% CI £2,931–£4,410) for TAU, with a mean incremental cost of £143 (95% CI £–825 to £1,112). There was no significant difference in QALYs over the 12-month duration of the trial (0.030, 95% CI –0.007 to 0.067). The mean incremental cost per QALY was £4,133 with an 86% probability of being cost-effective at a £20,000 threshold. When broader societal costs such as loss of productivity were taken into consideration, specialist physiotherapy was dominant (incremental cost: £−5,169, 95% CI £–15,394 to £5,056).
Discussion
FMD was associated with high health and social care costs. There is a high probability that specialist physiotherapy is cost-effective compared with TAU particularly when wider societal costs are taken into account.
Trial Registration Information
International Standard Randomised Controlled Trial registry, ISRCTN56136713
Cost-Effectiveness of Introducing Nuvaxovid to COVID-19 Vaccination in the United Kingdom: A Dynamic Transmission Model
Get PDFBackground/Objectives: Vaccination against SARS-CoV-2 remains a key measure to control COVID-19. Nuvaxovid, a recombinant Matrix-M–adjuvanted protein-based vaccine, showed similar efficacy to mRNA vaccines in clinical trials and real-world studies, with lower rates of reactogenicity. Methods: To support decision making on UK vaccine selection, a population-based compartmental dynamic transmission model with a cost-utility component was developed to evaluate the cost-effectiveness of Nuvaxovid compared with mRNA vaccines from a UK National Health Service perspective. The model was calibrated to official epidemiology statistics for mortality, incidence, and hospitalisation. Scenario and sensitivity analyses were conducted. Results: In the probabilistic base case, a Nuvaxovid-only strategy provided total incremental cost savings of GBP 1,338,323 and 1558 additional quality-adjusted life years (QALYs) compared with an mRNA-only vaccination strategy. Cost savings were driven by reduced cold chain-related operational costs and vaccine wastage, while QALY gains were driven by potential differences in vaccine tolerability. Probabilistic sensitivity analysis indicated an approximately 70% probability of cost-effectiveness with Nuvaxovid-only versus mRNA-only vaccination across most cost-effectiveness thresholds (up to GBP 300,000/QALY gained). Conclusions: Nuvaxovid remained dominant over mRNA vaccines in scenario analyses assessing vaccine efficacy waning, Nuvaxovid market shares, and the vaccinated population
Effect of ethnicity and other sociodemographic factors on attendance at ophthalmology appointments following referral from a Diabetic Eye Screening Programme: a retrospective cohort study.
Get PDFBACKGROUND/AIMS: To examine the association between sociodemographic characteristics and attendance at Hospital Eye Service (HES) referrals from the Diabetic Eye Screening Programme (DESP), in a large, ethnically diverse urban population. METHODS: Retrospective cohort study (4 January 2016-12 August 2019) of people with diabetic retinopathy (DR) referred from an English DESP to a tertiary referral eye hospital. We conducted a multivariable logistic regression with attendance as the primary outcome, controlling for age, sex, ethnicity, Index of Multiple Deprivation, best eye visual acuity and baseline DR grade. RESULTS: Of 7793 people referred (mean age 64 years, 62.6% male, 13.9% white, 12.5% black, 25.3% South Asian, 6.5% any other Asian background, 19.3% no recorded ethnicity and 20.9% of 'Other' ethnic origin), 69% attended. Compared with white individuals, people of black ethnic origin were similarly likely to attend. South Asians and those of other Asian backgrounds were more likely, and people with 'Other' or missing ethnicity were less likely to attend. Those with higher levels of deprivation, younger (aged 18-45 years) and older (76-90 years) age groups and worse visual acuity were less likely to attend, whereas people identified as having proliferative DR in both eyes were more likely to attend. CONCLUSION: Sociodemographic patterns in attendance after referral from the DESP to the HES exist, and these do not appear to explain ethnic differences in more severe sight-threatening DR, suggesting other explanations. More work is needed to understand and reduce inequalities in HES attendance
Pitfalls and practical suggestions for using local field potential recordings in DBS clinical practice and research.
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Local field potential (LFP) recordings using chronically implanted sensing-enabled stimulators are a powerful tool for indexing symptom presence and severity in neurological and neuropsychiatric disorders, and for enhancing our neurophysiological understanding of brain processes. LFPs have gained interest as input signals for closed-loop deep brain stimulation (DBS) and can be used to inform DBS parameter selection. LFP recordings using chronically implanted sensing-enabled stimulators have various implementational challenges.
Approach: Here we describe our collective experience using BrainSense (Medtronic®) for clinical and research work. We aim to provide insightful tips and practical advice to empower readers with the knowledge needed to navigate the intricacies of the device and make the most out of its features.
Main results:
The central issues that apply to several BrainSense features encompass restricted compatibility of stimulation configuration with sensing, differences in electrophysiological signal properties between 'stimulation OFF' and 'stimulation ON at 0.0 mA', and challenges associated with the internal clock of the neurostimulator. In addition, since recordings are obtained from bipolar and not monopolar channels, spatial certainty regarding the distribution of LFPs around the DBS electrode is limited. Several options exist to synchronize LFP time series with external data streams, but standardization and generalization are lacking. The use of at-home chronic LFP recording is limited by a low temporal and spectral resolution. Regarding at-home LFP snapshots, LFP time series are not stored, parts of the power spectrum are censored when stimulating at high or low frequencies, and the stimulation amplitude is not readily available.
Significance: We discussed practical applications, implementation, system limitations, and pitfalls with the aim that sensing can be better applied for clinical practice and research.
Six-Month Survivorship Prediction in Spinal Metastatic Patients by Oncologists Shows Reliable Prognostication.
Get PDFSTUDY DESIGN: A retrospective analysis of oncologist-provided prognoses vs actual survival outcomes of patients referred with Metastatic spinal cord compression (MSCC) to a supra-regional multidisciplinary team (MDT). OBJECTIVES: Prognostic scoring systems, such as the revised Tokuhashi, are commonly used to help guide the treatment of MSCC. However, scoring systems do not accommodate for the improved outcomes of contemporary cancer therapy. Oncologist-provided prognoses play an important role in real world rapid decision making. There is a paucity of evidence assessing the accuracy of the oncologist-provided prognosis. We conducted a retrospective study to evaluate this. METHODS: Data was captured between January 2015 and December 2018. Patients were split into 2 groups: Group 1 (prognosis estimated 6 months). Median overall survival (mOS) and hazard ratio for death (HR) was assessed. Receiver operating characteristic (ROC) analysis was performed to assess the accuracy of the oncologist's prognosis. RESULTS: 829 patients were included. mOS in Group 1 was 5.8 months (95% CI 4.2-7.4 m), and in Group 2 mOS was not reached. Log rank test gave a Chi2 of 131 (P < .001). Cox regression analysis revealed a HR of .30 (P < .001). Area under the ROC curve was 78%. CONCLUSIONS: Oncologist-provided prognosis is accurate in this cohort of unselected, consecutive MSCC patients. It reduced reliance on scoring systems that can become outdated. Given the rapid progress in cancer treatment, the oncologist's prognostic prediction is integral in efficient and effective MSCC management to help rapidly determine surgical candidacy
Gait Rehabilitation for Early rheumatoid Arthritis Trial (GREAT): lessons learnt from a mixed-methods feasibility study and internal pilot trial
Get PDFBackground: People with rheumatoid arthritis experience foot and lower limb pain due to active synovitis, resulting in impaired lower limb function. Earlier intervention may help with prevention of functional decline. The aims of this research were to develop and evaluate a new gait rehabilitation intervention for people with early rheumatoid arthritis, evaluate its feasibility, and to test whether or not gait rehabilitation plus usual care is more clinically and cost-effective than usual care alone.
Design and methods: We undertook a single-arm, repeated measures, pre- and post-intervention, mixed methods feasibility study with embedded qualitative components. We planned to undertake a pragmatic, two-arm, multi-centre, superiority randomised controlled trial, with health economic evaluation, process evaluation, and internal pilot.
Setting and participants: Participants with early rheumatoid arthritis (<2 years post-diagnosis) were identified from early arthritis and rheumatology outpatient clinics and referred for intervention in either podiatry or physiotherapy clinics.
Intervention(s): Participants were randomised to a gait rehabilitation programme (GREAT Strides) involving a 6-task gait circuit. Sessions were underpinned by motivational interviewing to facilitate behaviour change, supported by trained physiotherapists or podiatrists for a minimum of two sessions. Both groups received their normal usual care from the rheumatology multidisciplinary team.
Main outcome measures: Outcome measures for the feasibility study were intervention acceptability, adherence using the Exercise Adherence Rating Scale (EARS) and fidelity using the Motivational Interviewing Treatment Integrity Scale (MITI). The main outcome measure for the internal pilot/RCT was the Foot Function Index disability subscale. Outcomes were measured at baseline, 3-months, 6-months and 12-months. Other outcomes: intervention acceptability questionnaire (IAQ), EARS, exercise treatment beliefs via the Theory of Planned Behaviour Questionnaire, intervention fidelity (MITI), health-related quality of life (EQ5D-5L).
Results: Thirty-five participants were recruited for feasibility and 23 (65.7%) completed 12-week follow-up. Intervention acceptability was excellent; 21/23 were confident that it could help and would recommend it; 22/23 indicated it made sense to them. Adherence was good, with a median [IQR] EARS score of 17/24 [12.5–22.5]. Twelve participants’ and 9 therapists’ interviews confirmed intervention acceptability, identified perceptions of benefit, but highlighted some barriers to completion. MITI scores demonstrated good fidelity. The trial did not progress from internal pilot to full main trial as a result of low recruitment and high attrition, after fifty-three participants were recruited from nine sites over 12-months. Process evaluation confirmed good intervention acceptability and adherence, and fair fidelity. Evaluation of clinical and cost-effectiveness was not possible.
Limitations: Significant delays were experienced with the impact of COVID-19, regulatory approvals, contracts, and site readiness, resulting in few sites opening in time and low recruitment capacity. Foot and/or ankle pain prevalence was lower than anticipated, resulting in a low potential participant pool and a low conversion rate from screening to enrolment.
Conclusions: The GREAT Strides intervention was acceptable to people with early RA and intervention clinicians, safe, with good levels of adherence by participants, and fair intervention fidelity. The RCT stopped early following failure to meet recruitment targets. GREAT Strides is a promising intervention that could be adapted for future evaluations. A definitive trial of the GREAT Strides gait rehabilitation intervention still needs to be done.
Study registration: ISRCTN (International Standard Randomised Controlled Trial Number) registry as ISRCTN14277030.
Funding details: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme (15/165/04)
Knowledge, Attitudes, and Practices of Iraqi Parents Regarding Antibiotic Use in Children and the Implications
Get PDFBackground: Antibiotic misuse is a major global health issue, particularly in low- and middle-income countries (LMICs), where inappropriate use contributes to antimicrobial resistance (AMR). Inappropriate antibiotic use is exacerbated in LMICs by pressure from parents on physicians and pharmacists to prescribe and dispense antibiotics for their children, often for viral infections. There is currently limited knowledge of key issues in Iraq to improve future antibiotic use. Consequently, we explored knowledge, attitudes, and practices (KAPs) of Iraqi parents regarding antibiotic use in their children to provide future direction. Methods: A cross-sectional survey was conducted between November 2023 and September 2024 among 1878 parents in four districts of Iraq. A structured questionnaire assessed parents’ KAPs towards antibiotic-related uses and practices. Data were analyzed using descriptive statistics and Chi-square tests to examine the associations between demographic variables and KAP indicators. Results: Among the participants, 83% were aware that antibiotics are ineffective for viral infections, and 75% recognized potential side effects from antibiotics. Despite this knowledge, 63% of parents admitted to administering antibiotics to their children without a prescription, with 42% discontinuing treatment once symptoms improved. Factors including cost, dosage, and taste influenced antibiotic selection. Parents with higher education and income levels were more likely to engage in self-medication. Pharmacists were the primary source of antibiotic information for 52% of respondents. Conclusions: Despite adequate knowledge, inappropriate practices such as self-medication and discontinuing treatment early were prevalent. Targeted educational campaigns, particularly among parents with higher education levels and incomes, are necessary to mitigate AMR in Iraq