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Ayer — Marzo 4th 2026Tus fuentes RSS

Hepatitis B virus infection and its determinants among pregnant women in Ethiopia: protocol for umbrella review of systematic review and meta-analysis 2025

Por: Bekele · M. · Oche · W. O. · Geltore · T. E. · Sileshi · E. · Hadaro · T. S. · Alano · B. A. · Abera · W.
Introduction

Among the five hepatitis viruses, the hepatitis B virus (HBV) is a major cause of serious acute and chronic liver infections worldwide. The major public health impact of HBV infection arises from chronic liver disease, including cirrhosis and hepatocellular carcinoma, which predominantly affects young and middle-aged adults of both sexes. Therefore, preventive interventions focusing on mothers and infants are critical due to vertical and early childhood transmission dynamics.

HBV prevalence largely varies among pregnant women in Ethiopia because of multiple interrelated factors. This umbrella review will consolidate all existing systematic reviews and create a more reliable picture of HBV infection and its determinants among pregnant women in Ethiopia.

Methods and analysis

This umbrella review will be conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting standards. The review will focus on identifying and integrating evidence from eligible systematic reviews and meta-analyses, with methodological quality appraised using the MeaSurement Tool to Assess systematic Reviews instrument. A comprehensive literature search strategy will be developed using relevant Medical Subject Headings alongside free-text keywords. Electronic searches will be conducted in PubMed/MEDLINE, African Journals Online, Web of Science, Scopus and Google Scholar. Statistical heterogeneity among the included reviews will be quantified using the I² statistic. Data management and meta-analytic procedures will be performed using STATA version 17, and effect estimates will be presented with corresponding 95% CIs to determine statistical precision.

Ethics and dissemination

This review uses only published or publicly available data, so ethics approval is not required. Findings will be disseminated via peer-reviewed publications, conference presentations and shared with policymakers, healthcare partners, clinicians and patients to inform policy, enhance education and guide future research.

PROSPERO registration number

PROSPERO (CRD420251118982).

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Mapping social determinants of health data in sub-Saharan Africa: a scoping review protocol

Por: Anyiam · F. E. · Gjonaj · J. · Osango · N. A. · Mugo · R. · Aber · P. · Shah · J. · Mangeni · J. · Vedanthan · R. · Hogan · J. W. · Mwangi · A. · Chunara · R.
Introduction

Research has increasingly underscored the impact of factors such as socioeconomic status, education, healthcare access, housing and environmental conditions in shaping population health outcomes. These factors, collectively called social determinants of health (SDOH), provide crucial context for understanding drivers of health outcomes. In sub-Saharan Africa (SSA), the study of SDOH is critical due to the region’s unique sociocultural and economic conditions. Understanding how SDOH interacts with health systems and capturing SDOH in data is crucial for informing modelling efforts and policies improving population health more effectively. This scoping review aims to map the types of data used to capture SDOH in research conducted in SSA, to identify research gaps and to summarise key findings.

Methods

This scoping review will follow the Arksey and O’Malley methodological framework, enhanced by Levac et al, providing best practices for identifying, selecting and analysing eligible studies. Key steps include (1) identifying the research question, (2) identifying relevant studies, (3) selecting eligible studies via a locally curated search, (4) extracting information, (5) collating, summarising and reporting results and (6) consultation with stakeholders.

Ethics and dissemination

Ethical approval is not required, as this review relies solely on published literature. Findings will be disseminated across academic channels (journals, conferences) and through targeted stakeholder engagement efforts, such as policy briefs and public health workshops, to reach policymakers, healthcare practitioners and community health organisations. This dissemination strategy aims to inform health policy and drive programme development in SSA.

Comparing community-based monitoring to hospital-based care of patients with quiescent age-related macular degeneration: a qualitative study of patient and practitioner perspectives on acceptability and access

Por: Vougioukalou · S. · Read · S. M. · Csontos · J. K. · Jones · A. · Jaber · A. · Sharma · A. · Balaskas · K.
Objectives

This process evaluation explores patient and healthcare professional acceptability of community-based monitoring versus hospital-based care for patients with quiescent neovascular age-related macular degeneration (QnAMD).

Design

Qualitative process evaluation was conducted as part of a randomised controlled trial.

Setting

Six hospitals and six community-based practices.

Participants

25 patients and 16 healthcare professionals (ophthalmologists and optometrists). This approach helped differentiate between common issues and those specific to community-based monitoring.

Intervention

The Quality-Assured Follow-Up of QnAMD by non-medical practitioners trial aimed to examine whether non-medical practitioners follow-up patients with QnAMD in the community in a safe and clinically and cost-effective way. The process evaluation aimed to examine whether the intervention was acceptable by patients and professionals. The process evaluation was based on interviews which contained open-ended questions focused on patient experience and confidence in community-based care, issues concerning the practicalities of the organisation and management of the clinic, and resources including IT and digital equipment. The theory of acceptability framework was used to interpret the findings.

Results

Patients reported positively on the experience of receiving QnAMD services in the community and highlighted staff professionalism and clear communication. Key themes were the proximity of care provision for patients, IT interoperability and the real-world costs of running the service. Some patients randomised to the hospital showed preference for the intervention to take place in the hospital, mediated mainly by prior experience of hospital care and travel distance. The location of the clinic and transport routes affected the experience of attending appointments, with strong preference expressed for proximity to one’s home. Inaccessibility due to non-modifiable internal building structures in the community and parking in hospital eye services was reported by a small proportion of patients. Healthcare professionals reported positively about their ability to deliver QnAMD services in community settings but raised concerns about the compatibility of technological infrastructure that facilitates the sharing of optical coherence tomography image and video files. Some optometrists were also concerned about the financial sustainability of the intervention after the end of the trial due to the costs involved in the administration of QnAMD follow-up care.

Conclusions

The delivery of QnAMD services in the community by non-medical personnel was broadly accepted by both patients and practitioners. This implies that non-medical practitioners can follow up patients with QnAMD in the community in a safe way. Further research would be needed to establish whether similar results would be obtained during routine practice outside a research project and whether the long-term follow-up for QnAMD would be financially sustainable for independent as well as chain community optometry practices.

Trial registration number

NCT03893474.

Use of SGLT2 inhibitors and GLP-1 receptor agonists in patients with ischaemic heart disease and type 2 diabetes in Swedish primary care: a cross-sectional analysis of regional primary care registry data (QregPV)

Por: Andersson · T. · Bager · J.-E. · Hellgren · M. · Aberg · M. · Mourtzinis · G.
Objectives

To assess the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with coexisting ischaemic heart disease (IHD) and type 2 diabetes (T2D) in primary care, in relation to European guidelines.

Design

Cross-sectional observational study.

Setting

209 primary healthcare centres in Region Västra Götaland, Sweden (population 1.8 million in 2023).

Participants

14 414 patients with registered prevalent diagnoses of coexisting IHD and T2D, September 2023, in QregPV, the regional primary care quality of care register in Region Västra Götaland. Data on dispensed drugs were retrieved from the regional prescribed drug register, Digitalis.

Primary and secondary outcome measures

The primary outcome was the proportion of patients with dispensed SGLT2i or GLP-1 RA in relation to sex, age and primary healthcare centres (including private vs public ownership). The secondary outcome was estimated additional prescription costs.

Results

SGLT2i was dispensed to 37.2%, less often to women (adjusted OR (aOR) 0.64 (95% CI 0.59 to 0.70)). GLP-1 RA was dispensed to 10.0%, with no sex difference (aOR 1.04 (95% CI 0.92 to 1.18)). Use of SGLT2i and GLP-1 RA declined with age (p

Conclusion

SGLT2i and GLP-1 RA were underutilised in patients with coexisting IHD and T2D. The sex disparity in SGLT2i use warrants attention, as does the substantial variation between primary healthcare centres and the challenges of implementing costly cardioprotective therapies.

Factors associated with unmet healthcare needs in patients using Primary Care Access Points for unattached patients in Quebec (Canada)

by Mylaine Breton, Catherine Lamoureux-Lamarche, Véronique Deslauriers, Djamal Berbiche, Maude Laberge, Annie Talbot, Aude Motulsky, Marie-Pascale Pomey, Isabelle Gaboury

Background

Access to primary care is an important component of health systems. Given the barriers experienced by unattached patients to accessing primary care in Quebec (Canada), the Ministry of Health mandated the province-wide implementation of Primary care access points for unattached patients (Guichet d’accès première ligne; GAP), an organizational innovation designed to orient patients to the most appropriate professional or service. This study aims to 1) document the factors associated with unmet healthcare needs after receiving GAP services and 2) assess whether those factors vary by GAP orientation.

Methods

This cross-sectional study builds on data collected between April and July 2024 using an online patient questionnaire. All patients with a valid email address registered on the centralized waiting list for unattached patients in three local health territories (LHTs) received an email invitation to participate in the survey. The total sample included 20,282 participants who responded to the questionnaire and used the GAP.

Results

The findings showed that younger age, self-reporting poor/fair physical and mental health, receiving services in LHT 3 and reporting an emergency room visit were associated with increased likelihood of reporting unmet needs. Stratified analyses suggested that some characteristics (age, use of emergency room) were associated with unmet needs across orientations, while others (self-reported physical and mental health) were associated with specific orientations.

Conclusion

This study serves as a first step in deepening our understanding from a patient perspective of how to better plan primary care services and improve unattached patients’ experiences using the GAP. The findings showed that patients oriented to other professionals than a medical appointment with a family physician had the highest percentage of unmet needs. The next step involves an in-depth exploration of the reasons for patients’ unmet needs, enabling the development of more precise and effective strategies to address them.

The PROTECT trial: Effect of titrated versus conventional induction of general anaesthesia using a target-controlled infusion system on haemodynamics in patients undergoing non-cardiac surgery - protocol for a multicentre, expertise-based randomised contr

Por: Funk · S. · Lohri · M. D. · Kopp Lugli · A. · Schindler · C. · Wiencierz · A. · Mnich · K. · Schläpfer · M. · Gaberdiel · A. P. · Puhan · M. A. · Steiner · L. A. · Gomes · N. V. · Dell-Kuster · S.
Introduction

Hypotension is a frequent complication after induction of general anaesthesia leading to end-organ injury, for which elderly and multimorbid patients are particularly susceptible. The extent of hypotension depends, among other factors, on the dose and rate of propofol administration. Target-controlled infusion systems are widely used to administer short-acting anaesthetics such as propofol and remifentanil. Commonly, induction is started with a fixed effect-site concentration. Titration, an alternative method of induction using an incremental augmentation of propofol, leads to a reduced induction dose and rate of propofol. We hypothesise that the titration method improves haemodynamic stability compared with conventional induction.

Methods and analysis

This multicentre, expertise-based randomised controlled trial takes place at four Swiss hospitals. Patients ≥55 years of age undergoing non-cardiac surgery under general anaesthesia using propofol target-controlled infusion are randomised to either a conventional or a titrated anaesthesia induction method. Patients, statisticians and, if resources allow, outcome assessors will be blinded. The primary endpoint is the mean arterial pressure under the individual baseline mean arterial pressure (area under threshold) during the first 30 min after start of induction. Secondary endpoints include the maximum deviation from baseline mean arterial pressure, haemodynamic rescue methods, propofol consumption and neurocognitive recovery after regaining consciousness.

A total of 320 patients are required to have an 80% chance of observing superiority of titration for the area under the threshold as significant at the 5% level, assuming a true difference of 100 mm Hg*min. The area under threshold and the maximum deviation will be compared between arms using mixed linear regression models.

Ethics and dissemination

Ethical approval has been obtained from all responsible ethics committees (BASEC2025-01007). The results will be presented at international meetings and published in peer-reviewed journals and may contribute to a change in clinical practice for anaesthesia induction using target-controlled infusion systems with propofol.

Trial registration number

clinicaltrials.gov (NCT06980688) and www.humanforschung-schweiz.ch (HumRes67022).

Extended-spectrum β-lactamase and carbapenemase-producing <i>Enterobacterales</i> among adult patients and their family members at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

by Dessie Abera, Adane Mihret, Surafel Fentaw, Eyob Beyene, Abel Abera Negash, Woldaregay Erku Abegaz

Background

Extended-spectrum β-Lactamase and Carbapenemase-producing Enterobacterales cause severe infections and currently, they are spreading beyond hospitals and becoming a serious global health concern. They often colonize the gut silently, facilitating the transmission of resistant bacteria between patients and family members.

Objective

We sought investigate the prevalence and molecular characteristics of Extended-spectrum β-Lactamases-producing Enterobacterales (ESBL-PE), Carbapenem-resistant Enterobacterales (CRE), and factors associated there in among admitted adult patients and their family members at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Methods

A case-control study was conducted among 100 patients and their respective 100 family members from February 2023 to October 2023. Stool specimens were collected and processed using standard microbiological techniques. Antimicrobial susceptibility testing and ESBL production were determined using VITEK 2 system. Carbapenemase production was tested using modified carbapenem Inactivation method, and detection of resistance genes was performed by PCR.

Result

Intestinal colonization with ESBL-PE was higher in patients (39.0%) than their respective family members (24.0%) (P = 0.028). Among patients, ESBL production was common in E. coli, 40.3% and K. pneumoniae, 34.7% than their family members 24.2% and 22.2%, respectively. Of the ESBL-PE isolates, 84.6% from patients and 100% from family members carried at least one ESBL encoding gene, with blaCTX-M being the predominant. Colonization with CRE and Carbapenemase-Producing Carbapenem-Resistant Enterobacterales was found to be 19.0% and 10.0%, respectively. These were identified only among patients, with blaNDM and blaOXA-48 are the most prevalent genes. Older age (>53 years) (P = 0.02) and previous ICU admission (P  Conclusion

ESBL-PE colonization was more prevalent in patients compared to their family members, with blaCTX-M identified as the most common gene. Exclusive detection of carbapenemase genes among patients, and the association of previous ICU admission with ESBL-PE colonization, highlights the need for targeted screening and strengthened infection prevention.

Impact of vitamin D non-reimbursement policy on therapy discontinuation in the general and rheumatic population in the Netherlands: a cross-sectional study

Por: Singh · A. · Huiskes · V. J. B. · van den Bemt · B. J. F. · van Ameijden · H. · Nurmohamed · M. T. · Spijkers · K. M. · Vervloet · M. · Brabers · A. E. M.
Objective

To assess the impact of the non-reimbursement policy on vitamin D therapy discontinuation in patients from the general and rheumatic populations.

Design

A cross-sectional study.

Setting

Research institute specialised in health research and two outpatient pharmacies in the Netherlands.

Participants

Patients from the general and rheumatic population with an active prescription for vitamin D supplementation therapy were included.

Data collection and analysis

Data were collected between April and May 2023 through self-reported questionnaires. Descriptive statistics and logistic regression were performed using STATA V. 17. P value

Primary and secondary outcome measures

The primary outcome was the proportion of patients who discontinued vitamin D supplementation therapy following the implementation of the non-reimbursement policy. Secondary outcomes included patient-reported reasons for therapy discontinuation and the association between patient-related characteristics and the risk of therapy discontinuation. In addition, the proportion of patients who switched to an alternative supplement and whether this switch had been made in consultation with a healthcare provider was examined.

Results

Of the 4800 patients, 302 (6.4%) patients discontinued their vitamin D therapy. The three most frequently reported reasons for therapy discontinuation were the inability to afford supplements without reimbursement, not willing to pay for supplements without reimbursement and being unaware of the alternative vitamin D supplements to switch to. Younger age, financial constraints and limited health literacy were significantly associated with vitamin D therapy discontinuation (p

Conclusion

The implementation of the non-reimbursement policy resulted in a small proportion of patients discontinuing their vitamin D therapy. Elevated discontinuation rates were associated with specific patient-related characteristics including patients aged

Is practice variation determined in the needs assessments performed by Dutch home care nurses? A cross-sectional multilevel analysis

Por: van Dorst · J. I. · Schwenke · M. · Hameleers · N. · Bleijenberg · N. · Brabers · A. E. · de Jong · J. D. · de Vries · E. · van den Bulck · A. O. · Zwakhalen · S. M.
Objectives

While needs assessment is the starting point of good quality care, there is anecdotal evidence of patients receiving different care in similar circumstances. This study aims to investigate whether practice variation exists in needs assessments conducted by home care nurses and to identify the factors influencing these assessments.

Design

A cross-sectional, quantitative retrospective study.

Setting

Primary care; home care nursing in the Netherlands in 2023.

Participants

Sampling was based on criterion sampling. Home care organisations were approached based on the following inclusion criteria: organisations providing home care nursing in the Netherlands, organisations from various regions of the country and organisations offering different types of home care nursing (eg, paediatric or palliative care), funded under the Dutch Health Insurance Act (Zvw). Organisations were excluded if they provided home care nursing funded by sources other than the Dutch Health Insurance Act. Home care nurses were recruited from participating organisations, each of whom had recently assessed the care needs of at least five patients. In total, 28 organisations and 258 home care nurses participated in this study, thereby yielding data from 1615 patients.

Primary and secondary outcome measures

Assessed and delivered minutes of home care per patient per week.

Results

Variation was primarily associated with patient-related factors. After accounting for these factors, 83% (assessed minutes) and 88% (delivered minutes) of the total variation was attributed to the patient level, 8% (assessed minutes) and 10% (delivered minutes) to the home care nurses’ level and 9% (assessed minutes) and 2% (delivered minutes) to the organisational level. Due to inadequate documentation in electronic health records, many missing values were identified.

Conclusions

The lack of nursing documentation suggests that missing factors may have contributed to variations in needs assessments. Thus, further research should comprehensively explore the patient-related factors currently absent from nursing documentation.

Effectiveness of an anti-inflammatory diet before in vitro fertilisation in women with endometriosis: protocol for a randomised controlled trial

Por: Vigano · P. · Abodi · M. · Benaglia · L. · Bolis · I. · Casalechi · M. · Ferraro · C. · Li Piani · L. · Reschini · M. · Ruggiero · F. · Salmeri · N. · Somigliana · E. · Horne · A. W. · Nap · A. W. · Dolmans · M.-M. · EUmetriosis Working Group · Beaussart · Jaber · Cox · Candiracci · Dep
Introduction

Endometriosis is a common, benign, chronic inflammatory disease with multiple consequences, from chronic pain to systemic comorbidities and poor quality of life. As it usually affects people of reproductive age, one of the most distressing consequences is infertility, which can be only partly overcome by medically assisted reproduction. Poor outcomes are, in fact, frequent adverse events. As no definitive therapy exists for endometriosis-related infertility, affected women often tend to try either complementary and alternative medicine or self-management strategies to improve their quality of life, with the hope of also enhancing their fertility. Among available options, dietary interventions are commonly explored, even if no robust evidence is available on the optimal type of diet and its effects on reproductive outcomes. This trial will investigate whether an anti-inflammatory dietary intervention can improve fertility outcomes in women affected by endometriosis undergoing in vitro fertilisation (IVF).

Methods and analysis

The DietAry interveNtion in ameliorating fertiliTy parameters in women with Endometriosis undergoing IVF (DANTE) study is a single-centre, randomised, controlled, non-pharmacological interventional trial in patients living with endometriosis who are infertile and require IVF. Participants will be allocated to either a 12-week intervention based on an anti-inflammatory diet or no diet before the beginning of controlled ovarian stimulation. Following baseline assessment, 438 participants aged

Ethics and dissemination

The study has received ethics approval from Comitato Etico Territoriale Lombardia 3 (#5587_18.12.2024). Results will be presented in peer-reviewed journals and at international conferences.

Trial registration number

NCT06885125.

Development and validation of a postoperative risk calculator (POP-score) for patients undergoing cardiac surgery: a retrospective cohort study

Por: Pölzl · L. · Sutter · C. · Lohmann · R. · Eder · J. · Ioannou-Nikolaidou · M. · Engler · C. · Graber · M. · Naegele · F. · Hirsch · J. · Maier · S. · Ulmer · H. · Mathis · S. · Reinstadler · S. J. · Grimm · M. · Bonaros · N. · Holfeld · J. · Gollmann-Tepeköylü · C.
Objectives

This study aimed to identify intraoperative and perioperative factors influencing 30-day mortality after cardiac surgery and to develop a risk score (POP-score) for its prediction.

Design

Retrospective cohort study with multivariable regression analysis.

Setting

A tertiary care cardiac surgery centre in Austria; data from consecutive patients undergoing cardiac surgery between 2010 and 2020 were analysed.

Participants

A total of 8072 patients were included. The cohort was randomly divided into a derivation cohort (75%) and a validation cohort (25%).

Outcome measures

The primary outcome measure was 30-day mortality. We analysed associations between intraoperative and perioperative variables and 30-day mortality, assessed via multivariable regression analysis.

Results

Several factors were significantly associated with 30-day mortality, including intraoperative RBC transfusion (OR 3.407 (95% CI 2.124–5.464)), postoperative high-sensitive cardiac troponin T cut-off levels (OR 2.856 (95% CI 1.958 to 4.165)), need for dialysis/haemofiltration (OR 2.958 (95% CI 2.013 to 4.348)) and temporary extracorporeal membrane oxygenation support (OR 5.218 (95% CI 3.329 to 8.179)) (p

Conclusions

The validated POP-score provides an improved tool for predicting 30-day mortality after cardiac surgery by incorporating intraoperative and perioperative factors alongside the EuroSCORE II. Although model performance was evaluated using 7-day peak troponin data, the score can be calculated within the first 72 hours postoperatively in most patients, supporting its clinical applicability for early decision-making, resource allocation and patient counselling. Further research is warranted to assess its clinical utility in diverse populations.

Sugar-sweetened beverage/snack consumption and its determinants among infant and young children aged 6–23 months in twelve Sub-Saharan African countries: Evidence from 2019–2023 Demographic Health Survey data

by Birtukan Gizachew Ayal, Abebe Kassa Geto, Sefineh Fenta Feleke, Ali Yimer, Atitegeb Abera Kidie, Natnael Amare Tesfa, Esuyawkal Mislu, Molla Hailu, Hassen Ahmed Yesuf

Background

Sugar-sweetened beverages or snacks are limited in nutritional value. Excess consumption of sugar-sweetened beverages or snacks in early childhood is associated with inadequate micronutrient intake, being overweight or obese, and developing chronic diseases later in life. There is scarcity of information specific to sugar-sweetened beverages or snacks consumption prevalence and its determinants in Sub-Saharan Africa Countries. This study aimed to determine the pooled prevalence of sugar-sweetened beverage or snack consumption and its determinants among infants and young children aged 6–23 months.

Methods

A cross-sectional study design was conducted using demographic and health survey data conducted from 2019 to 2023 from twelve Sub-Saharan African countries. A weighted sample of 23,145 children aged 6–23 months was included in the study. Multilevel mixed-effects logistic regression analysis was used to determine the factors associated with the dependent variable. The level of statistical significance was declared with a p-value  Results

The pooled prevalence of Sugar-sweetened beverage or snack consumption was 25.40% (95% CI: 24.84% − 25.96%). In multilevel multivariable logistic regression analysis, children aged between 9−11(AOR = 1.95 95% CI: 1.62, 2.35), 12–17(AOR = 2.83; 95% CI: 2.26, 3.54), and 18−23 months (AOR = 3.77;95% CI: 3.07, 4.63), media exposure (AOR = 1.59; 95% CI:1.28, 1.98), children from households with middle (AOR = 1.39; 95% CI: 1.11, 1.73) and rich (AOR = 2.31; 95% CI: 1.87, 2.85) wealth status, post natal checkup (AOR = 1.18; 95%CI:1.05,1.33), maternal ANC visit (AOR = 1.60; 95% CI: 1.15, 2.22), and high community media exposure ((AOR = 2.22;95%CI:1.65,5.81) were positively associated significant factors whereas currently breast feeding children (AOR = 0.70; 95% CI: 0.59,0.82), older age at first birth (AOR = 0.88,95% CI: 0.81, 0.96), presences of more than one under-5 children in the household (AOR = 0.89, 95% CI: 0.80, 0.99), mothers don’t perceive distance to health facility as big problem (AOR = 0.86; 95% CI:0.76, 0.98), and children reside in rural (AOR = 0.83;95%CI:0.68,0.95) were negatively associated with sugar sweetened beverage or snack consumption.

Conclusion

In this study, one out of four children consumed sugar-sweetened beverages or snacks. Current age of child, current breastfeeding status of child, media exposure, wealth index, maternal age at first birth, post natal checkup, maternal ANC visit, number of under-five children in the household, distance to health facility, place of residence, and community level media exposure were significant factors with sugar-sweetened beverage or snack consumption. Therefore, it is recommended to raise awareness about the health risks of sugar-sweetened beverage and snack consumption, enforce restrictions on their advertisement, strengthen nutrition-focused counseling within maternal and child health services with special attention for older age children, promote breastfeeding, and give special attention to challenges related to health facility accessibility, and support for young mothers.

Annual U.S. healthcare expenditures attributable to cigar smoking between 2001 and 2018, overall and by payer

by Xin Xu, Ghada Homsi, Sherry T. Liu, Jennifer M. Gaber, Naa A. Inyang, Brian L. Rostron, Caryn F. Nagler, James Nonnemaker

Background

In 2022, 3.7% of U.S. adults currently smoked cigars. This study assesses cigar-smoking-attributable fractions in U.S. healthcare expenditures and associated annual healthcare expenditures overall and by payer, including publicly funded healthcare programs.

Methods

Data were obtained from the 2000, 2005, 2010, and 2015–2017 National Health Interview Survey linked with corresponding panels from the Medical Expenditure Panel Survey data through 2018. The final sample (n = 53,733) was restricted to adults aged 25 + . Estimates from four-part models and data from the Personal Health Care component of the 2001–2018 National Health Expenditures Accounts were combined to estimate fractions of and annual healthcare expenditures attributable to cigar smoking. All models controlled for sociodemographic characteristics and health-related behaviors.

Results

During 2001–2018, an estimated 1.8% (95% CI = 0.9%–3.4%) or $29.7 billion annually of U.S. healthcare expenditures could be attributed to cigar smoking. Most of this was funded by other third-party health insurance programs, a mix of private and public payers (e.g., Department of Veterans Affairs).

Conclusions

Cigar smoking creates a preventable financial burden on the U.S. healthcare system. Health consequences associated with cigar smoking may remain after successful quitting. The findings underscore the importance of preventing initiation of cigar smoking and providing evidence-based cessation methods to reduce the health and economic burden of cigar smoking.

Clinical and behavioural correlates of early diabetic foot ulcer risk at Jimma Medical Center, Ethiopia: application of Inlows 60-Second Screening Tool in a resource-constrained setting

Por: Kifle · T. · Abera · E. G. · Tesfaye · K. · Gebremichael · E. H. · Gudina · E. K.
Objectives

To assess the early risk of diabetic foot ulcer (DFU) among adult patients with diabetes and to identify clinical and behavioural correlates associated with DFU risk using Inlow’s 60-Second Screening Tool.

Design

A cross-sectional analytical study.

Setting

Conducted at a tertiary-level referral hospital in Southwest Ethiopia.

Participants

The study included 164 adult patients with diabetes (aged ≥18 years) who attended routine follow-up visits at the diabetic clinic between February and March 2025. Patients who were critically ill, unable to communicate during data collection or pregnant were excluded. The median age of participants was 55 years (IQR 46–60), and 54.9% were male.

Primary and secondary outcome measures

The primary outcome was early DFU risk, categorised as ‘at risk’ or ‘not at risk’ using Inlow’s 60-Second Screening Tool. Secondary outcomes included factors associated with DFU risk, such as glycaemic control, lipid profile and foot care practices.

Results

Of the 164 participants, 32.3% (n=53) were found to be at risk for DFU. Participants who performed foot self-checks infrequently had more than threefold higher odds of DFU risk compared with those who practiced daily foot care (adjusted OR (AOR)=3.35; 95% CI 1.48 to 7.58; p=0.004). Poor glycaemic control (AOR=2.39; 95% CI 1.03 to 5.55; p=0.042) and dyslipidaemia (AOR=2.63; 95% CI 1.18 to 5.85; p=0.018) were also significantly associated with increased DFU risk.

Conclusions

Nearly one-third of patients with diabetes in this Ethiopian hospital setting were at early risk for DFU. Factors such as inadequate foot care, poor glycaemic control and dyslipidaemia were associated with increased risk. Incorporating rapid foot screening tools like Inlow’s 60-Second assessment into routine diabetes care, together with strengthened patient education and metabolic management, may help reduce the risk of DFU in resource-limited settings.

Study protocol for a randomised controlled trial to determine the efficacy of lisdexamfetamine for the treatment of acute methamphetamine withdrawal in inpatient settings

Por: Acheson · L. S. · Siefried · K. J. · Lintzeris · N. · Dunlop · A. J. · Haber · P. S. · Arunogiri · S. · Christmass · M. · Doyle · M. · Donoghoe · M. · Nagle · J. · Clifford · B. · McKetin · R. · Lubman · D. I. · Brett · J. · Taylor · N. · Carr · A. · Levin · F. R. · Shoptaw · S. · Ezard · N
Introduction

Harms due to methamphetamine use disorder (MAUD) are rising globally. Untreated withdrawal symptoms perpetuate the cycle of dependence and are a barrier to treatment. There is no pharmacotherapy approved for methamphetamine withdrawal. Lisdexamfetamine (LDX) dimesylate has potential as an agonist therapy to ameliorate symptom severity during acute methamphetamine withdrawal and increase duration of initial abstinence and retention in treatment.

Methods and analysis

We will conduct a double-blind, randomised, controlled trial to evaluate the efficacy of LDX in reducing symptom severity during acute methamphetamine (MA) withdrawal. One hundred eighty-four adults with moderate to severe MAUD presenting to a health service requesting MA withdrawal treatment who report use of MA within the last 72 hours will be recruited. Participants will be randomised 1:1 to receive a tapering dose of lisdexamfetamine (250 mg on day 1, reducing by 50 mg per day to 50 mg on day 5, followed by 2 days of placebo washout on days 6 and 7), or placebo for 7 days. The study will be conducted over 7 days in an inpatient unit, and all participants will also receive standard inpatient withdrawal care. Participants will be followed up in the community to day 84. The primary outcome is efficacy, defined as the between-group difference in average withdrawal severity measured over the 7-day admission by the Amphetamine Withdrawal Questionnaire. Secondary outcomes are retention in treatment, treatment satisfaction, sleep and concomitant medication use (symptomatic medications and medications for other indications to day 7); safety, craving for MA, post-treatment withdrawal symptoms, depression, anxiety and stress, insomnia and cost effectiveness (to day 28) and MA use, mental, physical and social health and post-withdrawal treatment utilisation (to day 84). A First Nations qualitative substudy will assess the experiences of Aboriginal and Torres Strait Islander participants, ensuring the treatment meets the needs of First Nations people.

Ethics and dissemination

This protocol was first approved by the St Vincent’s Hospital Human Research Ethics Committee on 15/05/2024 (2024/ETH00788). All participants will be provided with a participant information sheet and consent form, be fully informed about the study and given ample time to consider participation. Results will be published in peer-reviewed journals and presented at national and international conferences. Findings will be presented such that individual participants will not be identifiable.

Trial registration number

ACTRN12624001061527.

Photobiomodulation for postoperative pain relief following conventional periapical surgery: a randomised controlled study protocol

Por: Cirisola · R. W. C. · Moya · L. E. P. · Olazabal · M. V. G. · Wagmann · D. A. A. · Suarez · G. P. · Wince · C. · Bruno · M. L. H. · Salaberry · D. R. · Sobral · A. P. T. · Longo · P. L. · Motta · L. J. · Bussadori · S. K. · Duran · C. C. G. · Fernandes · K. P. S. · Mesquita-Ferrari
Introduction

Photobiomodulation (PBM) has shown promising effects in managing postoperative pain following conventional periapical surgery, although current evidence remains limited. This study aims to assess the effect of PBM on postoperative pain 24 hours after periapical surgery.

Methods and analysis

A randomised, controlled, double-blind trial will include 34 patients undergoing periapical surgery in the maxillary region, randomly assigned to an experimental group (n=17) or control group (n=17). The experimental group will receive PBM (GaAlAs diode laser, 808 nm, 100 mW, 4 J/cm², applied at five vestibular points) and placebo ibuprofen immediately and 24 hours postoperatively. The control group will receive simulated PBM and active ibuprofen. The primary outcome is postoperative pain assessed by the visual analogue scale at 24 hours. Secondary outcomes include pain at the seventh day, paracetamol intake, oedema, ecchymosis, soft tissue status and temperature at 24 hours and 7 days. Radiographic evaluation of healing will be performed at 1 and 3 months. Statistical analysis will be conducted based on data distribution, using repeated measures ANOVA (Analysis of Variance) or non-parametric equivalents for longitudinal outcomes, and appropriate tests for categorical variables. Significance will be set at p

Ethics and dissemination

The study was approved by the Human Research Ethics Committee of Universidad Católica del Uruguay (process no. 220914). Results will be disseminated to participants, healthcare professionals, the public and scientific communities.

Trial registration number

NCT05935306.

Validation and selection of criteria for evaluating apps for managing depression: a Delphi study

Por: Robles · N. · Fuster-Casanovas · A. · Moreto · S. · Duarte-Diaz · A. · Gelabert · E. · Padilla-Ruiz · M. · Gomez · C. · Perez-Navarro · A. · Vidal-Alaball · J. · Subira · S. · Davins · M. · Saigi-Rubio · F. · Carrion · C.
Background

Despite a lack of evidence relating to effectiveness and safety, the use of apps in the field of mental health is increasing due to their ease of use and accessibility. The aim of the EvalDepApps project is to develop and validate an assessment tool for evaluating depression management apps based on scientific evidence, expert judgement and end-user needs.

Objective

The purpose of this study was to determine the most relevant criteria for evaluating apps intended to manage depression through consensus-based assessment.

Methods

A total of 43 individuals were invited to participate in an online modified Delphi study of 51 criteria identified from the literature. In Round 1, participants rated criteria according to relevance and three levels of consensus were defined: high level when ≥80% of respondents scored the criterion at 5 or 6; medium when 60%–79% of respondents scored the criterion at 5 or 6 and low when

Findings

The response rate was 59.0% (26/43) in Round 1 and 53.4% (23/43) in Round 2. In Round 1, 24 criteria (47.1%) attained the maximum level of consensus, 20 (39.2%) the medium level and 7 (13.7%) the lowest level. In Round 2, 4 out of 20 criteria (20.0%) attained the maximum consensus. Participant comments reinforced the relevance of the selected criteria. The final list consisted of 28 criteria, the majority relating to Safety and Privacy and Clinical Effectiveness (25.0% each), followed by Usability and Functionality (17.9%).

Conclusions

By prioritising criteria relating to data safety and clinical effectiveness, participants in this study emphasised that the assessment of apps for depression management must take both these aspects into full consideration. Despite some limitations of the study (eg, lack of participant sociodemographic data and its implications for generalisation, not face-to-face inter-round), the results of this study will enable the EvalDepApps project to develop an assessment tool for depression management apps that incorporates the most relevant criteria.

Clinical implications

EvalDepApps will support healthcare professionals and users in identifying safe, effective and user-friendly depression management apps.

Wearables Integrated Technology to support healthy behaviours in general practice patients with type 2 diabetes (WEAR-IT): study protocol for a cluster randomised controlled trial

Por: Hobden · B. · Fakes · K. · Halcomb · E. J. · Wallis · K. · Maberly · G. · Seng-Lim · K. · Doran · C. · Oldmeadow · C. · Meyerowitz-Katz · G. · Soenen · S. · Zwar · N.
Introduction

Type 2 diabetes is a prevalent chronic disease, associated with health complications, premature morbidity and significant healthcare costs. Optimal lifestyle behaviour control and patient self-management are crucial for improving diabetes control; however, they are difficult to achieve in primary care. There is limited research on the use of information from wearable devices to encourage behaviour change. This study will examine the effectiveness and cost-effectiveness of a multi-component health behaviour intervention in achieving clinically significant reductions in haemoglobin A1c (HbA1c) among general practice patients with type 2 diabetes.

Methods and analysis

The study uses a cluster-randomised controlled design, with general practices randomly assigned to either the Wearables Integrated Technology (WEAR-IT) intervention (n=15) or usual care (n=15). To achieve a sample size of 375 participants, 12–13 patients per practice will be recruited. Patients diagnosed with type 2 diabetes will be eligible to participate if they are aged 18–75 years; have had poorly controlled diabetes (HbA1c≥7.5%), with the cognitive capacity and ability to access the intervention application via an iOS or Android smart device. The WEAR-IT self-management intervention combines information from wearable devices (physical activity, blood glucose and blood pressure) and the electronic medical record, with goal setting and coaching support. The intervention will be primarily delivered by the general practice nurse, with review and confirmation of goals by the general practitioner. Participants attending the usual care practices will receive standard care. Outcome measures, including HbA1c, lipids, blood pressure, quality of life, dietary and exercise behaviours and cost-effectiveness, will be collected at baseline, 6-month (primary endpoint) and 12-month post-randomisation. The primary analysis will compare the change in HbA1c between the intervention and control groups at 6-month follow-up, with long-term outcomes assessed at 12-month post-randomisation.

Ethics and dissemination

The study was approved by Bond University (BH00137). Results will be disseminated through peer-reviewed journal publications, conference presentations and summaries to participating sites and patients.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12624000957594).

Implementing a Scalable, personalised, behaviour Change digitAL hEalth programme in primary care for type 2 diabetes treatment: the SCALE cluster-randomised study protocol

Por: Shahidi · M. · deCourten · B. · Glennan · J. · Assange · J. · Seng-Lim · K. · Maberly · G. · Brinkworth · G. · Meyerowitz-Katz · G.
Introduction

Type 2 diabetes mellitus (T2DM) is a fast-growing chronic disease, with at least 1.3 million people diagnosed in Australia. In the Western Sydney Local Health District (WSLHD), an estimated 13.1% of all adults have T2DM. The condition significantly contributes to cardiovascular, heart and kidney diseases and causes a large disease burden. Lifestyle modifications, such as improved nutrition, increased physical activity and stress reduction, are recommended as first-line treatments for T2DM management. However, the current primary care system cannot meet the growing demands for diabetes care, necessitating the development of innovative, scalable, cost-effective solutions. Digital health technologies present a promising approach for promoting self-management in individuals with T2DM.

Methods and analysis

This cluster-randomised controlled trial aims to evaluate the feasibility and effectiveness of Gro-AUS, a localised version of the Gro Health app in Australia, to support T2DM management in Australian primary care settings. The trial will be conducted across multiple general practice clinics within the WSLHD, an area with a high prevalence of T2DM and significant cultural diversity in patient populations. Participants will be randomly assigned by clinic to either the intervention group (digital health programme) or control group (standard care). Primary outcomes include improvements in glycaemic control, cardiovascular risk factors and diabetes remission, with secondary outcomes such as weight loss, physical activity and mental well-being. Data will be collected using electronic and paper methods, with secure storage and de-identification ensuring participant privacy. The study’s mixed-method approach ensures inclusivity for patients with varying levels of digital literacy. Data will be securely stored, de-identified and used to assess the effectiveness of the intervention. Findings are expected to inform future models of diabetes care in Australia, providing evidence for the scalability of digital health technologies in chronic disease management.

Strengths and limitations

This trial is by nature unblinded. The recruitment style for a stepped-wedge trial may also bias participant engagement. However, it has direct implications for clinical practice as an effectiveness implementation trial. The design also allows for a much larger sample and more statistical power to examine outcomes.

Ethics and dissemination

This trial has been prospectively registered with the Australian New Zealand Clinical Trials Registry. Ethical approval has been granted by the WSLHD Human Research Ethics Committee prior to data collection. Results will be disseminated through publication in a peer-reviewed medical journal and shared via the Agency for Clinical Innovation, the Primary Care Health Network and through community engagement initiatives.

Trial registration

ANZCTR388639.

Low back pain among academic staff at a university in Ethiopia: a cross-sectional study

Por: Hailu Tesfaye · A. · Abere · G. · Demoze · L. · Yitageasu · G. · Mekonnen · T. H.
Objective

Low back pain (LBP) is a common occupational health problem among academic staff, often associated with prolonged sitting, poor ergonomics and psychosocial stress. This study aimed to assess the prevalence of LBP and its associated factors among academic staff at a university in Ethiopia.

Design and setting

A cross-sectional survey was conducted among academic staff at the University of Gondar (Gondar, Ethiopia) using simple random sampling from March to April 2021.

Participants

A total of 607 workers participated in the study.

Outcome measures

A self-administered, structured Nordic Musculoskeletal Questionnaire was used to assess the occurrences of LBP over the past 12 months. Data were analysed using Stata (V.14), and associations between variables were examined using binary logistic regression. Results are presented as adjusted ORs (AOR) with 95% CIs, with statistical significance set at p

Results

The prevalence of LBP in the last 7 days was 44.8% (95% CI 40.8% to 48.86%), and over the past 12 months it was 55.68% (95% CI 51.63% to 59.68%). A significant difference in 7-day prevalence was observed between female and male participants (39.86% vs 15.81%, respectively; ² = 0.887; p=0.02). In the multivariable logistic regression analysis, being female was associated with higher odds of LBP (AOR=1.72; 95% CI 1.15 to 2.57; p=0.009), as was working more than 8 hours per day (AOR=1.45; 95% CI 1.02 to 2.10; p=0.038), physical inactivity (AOR=1.88; 95% CI 1.30 to 2.72; p=0.001) and prolonged standing during work hours (AOR=1.63; 95% CI 1.03 to 2.59; p=0.036).

Conclusion

The prevalence of LBP among academic staff is high. Targeted interventions are recommended to address LBP, focusing on gender-sensitive strategies to mitigate the additional burden on female staff, time management to reduce long working hours and workplace programmes to limit sedentary behaviour, encourage physical activity and improve ergonomic awareness.

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