To examine outcomes from respiratory pathogens containment strategies focused on international travellers.

We developed a compartmental model generalisable to respiratory infectious diseases, in which international travellers interact with each other and airline/airport workers during transit. We used SARS-CoV-2 Omicron surge data (basic reproduction number (R₀): 9.5) as a case example and performed sensitivity and scenario analyses, including varying the R₀ for different respiratory pathogens.

A US high-volume airport.

Simulated international travellers and airline/airport workers.

Projection of new and imported SARS-CoV-2 infections without intervention (No Intervention); pre-travel screening for travellers who intend to travel (intended travellers) with PCR (Pre-travel PCR); or antigen testing (Pre-travel Ag); mask-wearing guidance for travellers and workers (Mask-wearing); and a Combined strategy (Pre-travel PCR & Mask-wearing).

The number of new and imported respiratory disease infections over the 90-day simulation period.

Over the 90-day simulation, the number of infected travellers entering the USA would be: 1 155 580 (27.2% of 4.2 million (M) intended travellers) with No Intervention; 709 560/4.2M (16.7%) with Pre-travel PCR; 862 330/4.2M (20.3%) with Pre-travel Ag; 1033 820/4.2M (24.4%) with Mask-wearing; and 650 480/4.2M (15.3%) with Combined. The number of new infections among airline/airport workers would be: 25 670 (73.3% of 35 000 workers) with No Intervention; 25 260 (72.2%) in Pre-travel PCR; 25 590 (73.1%) in Pre-travel Ag; 24 630 (70.4%) in Mask-wearing; and 18 770 (53.6%) in Combined. In scenario analyses, the most impactful parameters were R₀ of the respiratory pathogen and population immunity level.

A Combined strategy of pre-travel PCR testing and mask-wearing would most effectively reduce respiratory infection among international travellers and airline/airport workers, but would still allow a substantial number of infections to enter the USA, especially when the pathogen is highly transmissible.

To explore differences in health-related benefit status over 3 years, focusing on patterns of sick leave, work assessment allowance and disability benefits, between people who underwent rehabilitation and a matched control group.

Prospective longitudinal multicentre cohort study using registry data over three consecutive years.

Secondary specialist rehabilitation services at 17 institutions across Norway.

Patients (n=2710), 42% with rheumatic and musculoskeletal diseases, aged 18–65 years referred for multidisciplinary rehabilitation at one of the participating institutions. They were propensity score matched with 37 760 controls from the national sick leave registry, based on sociodemographic factors and health-related benefit status.

Multidisciplinary rehabilitation programmes, commonly lasting 3 weeks (range: 1 week to 6 months), tailored to individual needs.

Days on health-related benefits (sick leave, work assessment allowance (WAA) and disability benefits) were quantified as lost workdays per month. Differences between groups were analysed using Generalised Estimating Equations across three consecutive years: the year before rehabilitation, the rehabilitation year and the year after rehabilitation.

The rehabilitation group had more days on health-related benefits per month than controls throughout the observation period. During the rehabilitation year, they had on average 1.7 more days on sick leave (95 % CI 1.3 to 1.9), 2.3 more WAA days (95% CI 1.9 to 2.7) and 0.2 more days on disability benefits (95% CI 0.1 to 0.3). In the year after rehabilitation, they had 0.6 fewer days on sick leave (95% CI –0.8 to –0.3), but 3.7 more days on WAA (95% CI 3.1 to 4.2) and 0.6 more days on disability benefits (95% CI 0.4 to 0.8). Patterns were similar for the subgroup with rheumatic and musculoskeletal diseases.

People undergoing rehabilitation had more days on health-related benefits and a greater increase in long-term benefits, even after matching, indicating a higher disease and support burden than controls. Tailoring interventions and health-related benefits is an essential aspect of rehabilitation for people with complex work participation needs. Future research should include longer observation periods to explore long-term outcomes of rehabilitation.

NCT03764982

To describe the prevalence and characteristics of traditional, complementary and integrative medicine (TCIM) practice and product use by the population of the UK providing up-to-date data on the landscape of TCIM use in the UK.

A cross-sectional online survey, administered using the Qualtrics platform, among adults (aged 18 years and over) residing in the UK (England, Wales, Scotland or Northern Ireland). Data were collected between May and October 2024. The 40-item instrument covered four domains: demographics, health status, use of health products and practices, and use of health services. Descriptive statistics were used to summarise survey responses, and ² tests were applied to assess associations between participant characteristics and TCIM use. Backwards stepwise logistic regression was conducted to identify predictors of TCIM use across four outcome categories (p≤0.05).

The sample (n=1559) was broadly representative of the UK population. Prevalence of any TCIM use over a 12-month period was 65.9% with 19.1% consulting a TCIM practitioner and 63.3% using any TCIM product or practice. Bodywork therapists (massage therapists 9.4%, chiropractors 7.9%, yoga teachers 5.0%) and homeopaths (4.1%) were the most commonly consulted TCIM practitioners and Anthroposophic doctors were the least commonly consulted (2.1%). Among TCIM products, vitamin and mineral supplements were the most commonly used (37.3%) and relaxation or meditation practices were reported by 19.4% of respondents. TCIM users were more likely to be female, identify as Asian or Black, have a chronic disease diagnosis, report good health, possess private health insurance, have a higher education level, be employed (or seeking employment) and sometimes experience financial management difficulties.

There is substantial use of TCIM across the UK adult population and there is a need for more research on integrating TCIM into mainstream healthcare and the National Health Service. Clear strategies are necessary to enhance communication between TCIM and conventional healthcare providers, ensure patient safety and promote person-centred, coordinated models of care.

This study aimed to describe the epidemiology, outcomes and costs of four immune-mediated inflammatory rheumatic diseases (IMIRDs)—systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS)—in Brazil’s public and private healthcare systems from 2018 to 2022.

Retrospective observational study.

The study was conducted across hospital and outpatient levels of care in Brazil, based on nationwide data representing the public (Department of Informatics of the Unified Health System—DATASUS) and private (National Supplementary Health Agency—ANS) healthcare sectors.

The study analysed data from four distinct systems: 609 427 patients from the public Outpatient Information System (SIA), 32 119 patients from the public Hospital Information System (SIH), 19 083 deaths from the public Mortality Information System (SIM) and 11 846 hospitalisations from the private healthcare system (ANS).

RA had the highest incidence, ranging from 19.9 to 24.9 per 100 000, while SLE remained stable (6.3–6.7 per 100 000). Prevalence increased for all diseases: RA rose from 95.7 to 136.8, SLE from 23.4 to 38.9, AS from 15.0 to 23.6 and PsA from 10.8 to 17.4 per 100 000. SLE had the highest hospitalisation (7.2%) and lethality rates (8.7%), along with the highest average outpatient cost (US$440.9 per patient). In the private system, RA and SLE accounted for the most hospitalisations (36.3% each). SLE had the highest proportion of emergency hospitalisations (70.5%), while PsA had the highest proportion of elective hospitalisations (61.8%).

RA had the highest prevalence and incidence rates among the studied IMIRDs, while SLE was associated with the highest lethality, outpatient costs and emergency hospitalisations. The rising prevalence of these diseases highlights their growing burden on Brazil’s healthcare systems.

NCT06698900.