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Cost-free pharmacotherapy in smokers with TIA or stroke: QUIT-MED randomised controlled trial

Por: Reid · R. · Papadakis · S. · Gocan · S. · Bourgoin · A. · Laplante · M. A. · Armstrong · A. · Aitken · D. · Sahlas · D. · Stotts · G. · Cotie · L. · Mullen · K.-A. · Pipe · A. · Mir · H. · Sharma · M.
Objective

To examine whether cost-free (CF) smoking cessation medication was more effective than a prescription for cessation medication in patients after transient ischaemic attack (TIA) or stroke.

Design

Two-site randomised trial.

Setting

Stroke prevention clinics (SPCs) in Ontario, Canada.

Participants

Smokers with TIA or stroke, willing to quit smoking.

Intervention

Smoking status was assessed in SPC attendees. Smokers were advised to quit smoking and received recommendations for cessation medication and counselling. Consenting participants were randomly assigned (1:1) to either a CF medication group or a prescription-only (Rx) group. CF participants immediately received a 12-week supply of cessation medication. Rx participants were given a prescription for 12 weeks of cessation medication. Follow-up counselling was provided for 26 weeks.

Main outcome

The primary outcome was 40-week continuous abstinence verified using a carbon monoxide breath test at 52-week follow-up. Secondary outcomes included abstinence at intermediate timepoints, medication adherence and serious adverse events.

Results

Hundred and ninety-four participants were randomised and 131 (67.5%) completed the trial. The 40-week continuous abstinence rate at 52-week follow-up was 15.5% in the CF group versus 14.0% in the Rx group (OR=1.13; 95% CI 0.51 to 2.53). The 14-week continuous abstinence rate at 26-week follow-up was 18.6% in the CF group versus 16.8% in the Rx group (OR=1.20; 95% CI 0.56 to 2.55). Seven-day point-prevalence abstinence at 12 weeks was 38.1% in the CF group versus 26.9% in the Rx group (OR=1.76; 95% CI 0.94 to 3.28). Medication adherence was higher in the CF group versus the Rx group (47.4%±41.2% vs 25.5±36.8%, p

Conclusions

Our findings were inconclusive; we failed to meet our recruitment target and the effect size was smaller than anticipated. CF medication improved medication adherence.

Trial registration number

NCT00962988; ClinicalTrials.gov Identifier.

Exploring COVID-19 circuit breaker (CB) restrictions at a migrant worker dormitory in Singapore: a case study and nested mixed-method analysis of stress management and mental health

Por: Wong · M. C. P. · Tan · C. S. · Chan · A. Y. · Khaled · N. · Hasan · M. T. · Panchapakesan · C. · Tripathi · S. · Afsana · K. · Lwin · M. O. · Chen · M. I.-C. · Hildon · Z. J.-L.
Introduction

Measures to mitigate the COVID-19 outbreak in the migrant worker dormitories in Singapore included lockdown and isolation of residents for prolonged periods. In this paper, we explore efforts to ease tensions and support mental health under these conditions.

Methods

Case study of dormitory residents under lockdown from April to August 2020 comprises a nested mixed-method approach using an online questionnaire (n=175) and semistructured interviews (n=23) of migrant workers sampled from the survey (August to September 2020). Logistic regression models were used to analyse survey data. Semistructured interviews were analysed using applied thematic analysis.

Results

Survey and interview data showed that mental health was largely protected despite initial rising tensions over restrictions during lockdown. Sources of tension negatively affecting low stress responses included job related worries, OR=0.07 (95% CI 0.03 to 0.18, p

Interviewees shared how their adaptive capability played a pivotal protective role alongside social support and solidarity; aided by regular use of messaging applications, which supported mental health, OR=4.81 (95% CI 1.54 to 15.21, p

Conclusion

Tensions are mapped to protective solutions informing guidelines for future outbreak stress management response.

Cost-effectiveness of a dietary and physical activity intervention in adolescents: a prototype modelling study based on the Engaging Adolescents in Changing Behaviour (EACH-B) programme

Por: Kalita · N. · Cooper · K. · Baird · J. · Woods-Townsend · K. · Godfrey · K. · Cooper · C. · Inskip · H. · Barker · M. · Lord · J. · the EACH-B study group
Objective

To assess costs, health outcomes and cost-effectiveness of interventions that aim to improve quality of diet and level of physical activity in adolescents.

Design

A Markov model was developed to assess four potential benefits of healthy behaviour for adolescents: better mental health (episodes of depression and generalised anxiety disorder), higher earnings and reduced incidence of type 2 diabetes and adverse pregnancy outcomes (in terms of preterm delivery). The model parameters were informed by published literature. The analysis took a societal perspective over a 20-year period. One-way and probabilistic sensitivity analyses for 10 000 simulations were conducted.

Participants

A hypothetical cohort of 100 adolescents with a mean age of 13 years.

Interventions

An exemplar school-based, multicomponent intervention that was developed by the Engaging Adolescents for Changing Behaviour programme, compared with usual schooling.

Outcome measure

Incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life-year (QALY) gained.

Results

The exemplar dietary and physical activity intervention was associated with an incremental cost of £123 per adolescent and better health outcomes with a mean QALY gain of 0.0085 compared with usual schooling, resulting in an ICER of £14 367 per QALY. The key model drivers are the intervention effect on levels of physical activity, quality-of-life gain for high levels of physical activity, the duration of the intervention effects and the period over which effects wane.

Conclusions

The results suggested that such an intervention has the potential to offer a cost-effective use of healthcare-resources for adolescents in the UK at a willingness-to-pay threshold of £20 000 per QALY. The model focused on short-term to medium-term benefits of healthy eating and physical activity exploiting the strong evidence base that exists for this age group. Other benefits in later life, such as reduced cardiovascular risk, are more sensitive to assumptions about the persistence of behavioural change and discounting.

Trail registration number

ISRCTN74109264.

Study protocol: computerised cognitive testing in a cohort of people with frontotemporal dementia

Por: Moore · K. · Convery · R. S. · Rohrer · J. D.
Introduction

The term frontotemporal dementia (FTD) refers to a heterogeneous group of neurodegenerative disorders affecting the frontal and temporal lobes. Cognitively, impairment of executive function and social cognition predominates across the FTD spectrum, although other domains can be affected. Traditionally, cognition is tested through standard ‘pen and paper’ tasks in FTD. However, recent attempts have been made across other neurodegenerative disorders such as Alzheimer’s disease to develop computerised batteries that allow more accurate and sensitive detection of cognitive impairment.

Methods and analysis

This paper describes the development of a novel battery of tests for a tablet computer, particularly focused on FTD. It consists of 12 different tasks which aim to tap into information processing speed, various aspects of executive function, social cognition, semantic knowledge, calculation and visuospatial skills. Future studies will focus on validating the battery in a healthy control cohort, comparing it against a standard ‘pen and paper’ psychometric battery, and finally testing it within an FTD cohort, including those with genetic forms of FTD where we will be able to assess its ability to detect very early cognitive deficits prior to the onset of symptoms.

Ethics and dissemination

Normative data will be produced in the initial validation study (approved by the UCL Ethics Committee, project ID 17691/002) and will be made available online.

Prevalence and correlates of self-reported cardiovascular disease in Mongolia: findings from the 2019 Mongolia STEPS cross-sectional survey

Por: Pengpid · S. · Peltzer · K.
Objective

The aim of the study was to estimate the prevalence and correlates of cardiovascular disease (ischaemic heart disease and/or stroke (IHDS)) in Mongolia.

Design

Cross-sectional study.

Setting

National community-based sample of people aged 15–69 years in Mongolia.

Participants

6654 people (15–69 years, mean 41.3) who participated in the 2019 Mongolia STEPS survey.

Primary and secondary outcome measures

Self-reported prevalence of IHDS and biological and social covariates. Determinants of IHDS were estimated with logistic regression.

Results

The prevalence of IHDS was 14.0%, 15.6% among women and 12.3% among men. Older age (45–69 years), being married or cohabiting, and urban residence were positively associated, and male sex was negatively associated, with IHDS. Additionally, experience of threats, hypertension, current tobacco use, passive smoking, sedentary behaviour and high physical activity were positively associated with IHDS.

Conclusions

Almost one in seven people aged 15–69 years had IHDS in Mongolia. Several factors amenable to public health intervention for IHDS were identified, including experience of threats, hypertension, current tobacco use, passive smoking and sedentary behaviour.

Testing the efficacy of a motor analogy designed to promote safe landing by older adults who fall accidentally: a study protocol for a randomised control study

Por: Oladi · S. · Uiga · L. · Hebert-Losier · K. · Masters · R. S. W.
Introduction

Falling is associated with adverse effects on the health of older people. The majority of research into falls among older people has focused on prevention, with less attention to ‘how to fall safely’. Previous research suggests that motor analogies can be used to promote safe landing by young adults; however, the efficacy of this technique for older people remains unknown. This study aims to determine whether a motor analogy is useful for promoting safe falling in the older adult population.

Methods and analysis

The study adopts a randomised, controlled, single-blinded study design. People 65 years and older will be randomly allocated to a control condition or a motor analogy condition. They will receive a nudge in a forward, backward or sideways direction (randomised order), which will initiate a fall. The nudge will occur at variable (randomised) time points, so participants will not be aware of when they will fall. Participants in the motor analogy condition will be instructed to ‘land like a feather’, whereas participants in the control condition will be instructed to ‘land safely’. The primary outcome parameters are maximum impact force (normalised by mass) applied to different body segments during impact and fracture risk ratio of wrists and hips. A two-way multivariate analysis of variance will be conducted to examine differences between the motor analogy and control conditions as a function of the different variables.

Ethics and dissemination

The University of Waikato Human Research Ethics Committee (Health 2021#45) has granted ethical approval. Outcomes will be disseminated through publication in peer-reviewed journals and presentations at conferences.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12621001189819. Registered on 6 September 2021.

Effect of hand versus electronic signatures on response rates in postal surveys: a randomised controlled trial among emergency physicians in Canada

Por: Patel · D. · Taljaard · M. · Yadav · K. · Hickey · M. · Perry · J. J.
Objectives

Hand signatures offer a more authentic personalisation, which carries over to a sense of trust, although are costly and time-consuming when considering large postal surveys. The objective of this study was to compare response rates when using either hand-signed or electronic-signed letters in a postal survey.

Design and setting

We embedded this randomised controlled trial within a national cross-sectional postal survey of emergency physicians in Canada. The survey aimed to describe current practice patterns with respect to primary headache disorders.

Participants

We randomly sampled 500 emergency physicians listed in the Scott’s Canadian Medical Directory, 2019 edition.

Interventions

Using computer-generated random numbers, physicians were allocated to receiving either hand-signed (n=250) or electronic signed (n=250) letters. The initial mailout contained a US$5 Tim Hortons coffee card with the invitation letter. Four reminders were sent to non-responders every 3 weeks. The same type of signature was used for the initial invitation and subsequent reminders.

Outcome

The primary outcome was the survey response rate.

Results

Among 500 physicians invited, 32 invitations were undeliverable. Among the remaining 468 physicians, 231 had been allocated to the hand-signed group and 237 to the electronic signed group. The response rate in the hand-signed group was 87 (37.7%) vs 97 (40.9%) in the electronic-signed group (absolute difference in proportions –3.3%, 95% CI –12.1% to 5.6%).

Conclusion

There was no significant difference in physician response rate between hand-signed and e-signed cover letter and reminder letters. Electronic signatures should be used in future postal surveys among physicians to save on time and labour without impacting response rates.

Quality and safety indicators for home care recipients in Australia: development and cross-sectional analyses

Por: Caughey · G. E. · Lang · C. E. · Bray · S. C. E. · Sluggett · J. K. · Whitehead · C. · Visvanathan · R. · Evans · K. · Corlis · M. · Cornell · V. · Barker · A. L. · Wesselingh · S. · Inacio · M. C.
Objectives

To develop and examine the prevalence of quality and safety indicators to monitor care of older Australians receiving home care packages (HCPs), a government-funded aged care programme to support individuals to live at home independently.

Design

Cross-sectional.

Setting

Home care recipients, Australia.

Participants

90 650 older individuals (aged ≥65 years old and ≥50 years old for people of Aboriginal or Torres Strait Islander descent) who received a HCP between 1 January 2016 and 31 December 2016 nationally were included.

Primary and secondary outcome measures

The Registry of Senior Australians developed 15 quality and safety indicators: antipsychotic use, high sedative load, chronic opioid use, antimicrobial use, premature mortality, home medicines reviews, chronic disease management plan, wait-time for HCP, falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium/dementia-related hospitalisations, emergency department (ED) presentations and pressure injuries. Risk adjusted prevalence (%, 95% CI) and geographical area (statistical level 3) variation during 2016 were examined.

Results

In 2016, a total of 102 590 HCP episodes were included for 90 650 individuals, with 66.9% (n=68 598) level 1–2 HCP episodes (ie, for basic care needs) and 33.1% (n=33 992) level 3–4 HCP (ie, higher care needs). The most prevalent indicators included: antibiotic use (52.4%, 95% CI 52.0 to 52.7), chronic disease management plans (38.1%, 95% CI 37.8 to 38.4), high sedative load (29.1%, 95% CI 28.8 to 29.4) and ED presentations (26.4%, 95% CI 25.9 to 26.9). HCP median wait time was 134 days (IQR 41–406). Geographical variation was highest in chronic disease management plans and ED presentations (20.7% of areas outside expected range).

Conclusion

A comprehensive outcome monitoring system to monitor the quality and safety of care and variation for HCP recipients was developed. It provides a pragmatic, efficient and low burden tool to support evidence-based quality and safety improvement initiatives for the aged care sector.

Using codesign focus groups to develop an online COmmunity suPporting familiEs after Sudden Cardiac Death (COPE-SCD) in the young

Por: Yeates · L. · Gardner · K. · Do · J. · van den Heuvel · L. · Fleming · G. · Semsarian · C. · McEwen · A. · Adlard · L. · Ingles · J.
Objective

To codesign an online support intervention for families after sudden cardiac death (SCD) in the young (

Design

Codesign of an SCD family intervention by stakeholder focus groups.

Setting

Families and healthcare professionals with experience in SCD in the young.

Participants

Semistructured online focus groups were held with key stakeholders, that is, family members who had experienced young SCD, healthcare professionals and researchers based in New South Wales, Australia. Guided discussions were used to develop an online support intervention. Thematic analysis of discussions and iterative feedback on draft materials guided content development.

Results

Four focus groups were held (4–6 participants per group, 12 unique participants). Stakeholder involvement facilitated development of high-level ideas and priority issues. Creative content and materials were developed based on user preference for stories, narratives and information reflecting everyday experience of families navigating the legal and medical processes surrounding SCD, normalising and supporting grief responses in the context of family relationships and fostering hope. Emphasis on accessibility led to the overarching need for digital information and online engagement. These insights allowed development of an online intervention—COPE-SCD: A COmmunity suPporting familiEs after Sudden Cardiac Death—which includes a website and online support programme.

Conclusion

Using codesign with stakeholders we have developed a support intervention that addresses the needs of SCD families and aims to fill a large gap in existing healthcare. We will evaluate COPE-SCD to determine whether this is an effective intervention for support of families following a young SCD.

Examining virtual visit use during a pandemic and perspectives of primary care providers, patients and caregivers: a mixed-methods research protocol

Por: Halas · G. · Singer · A. · Katz · A. · Labine · L. · Baldwin · A. · Wong · S. T. · Kirby · S. · Bohm · E. · Abrams · E. · MacKay · K. · Francois · J. · Talpade · S.
Introduction

COVID-19 prompted rapid shifts to virtual primary care; however, the secondary implications and ideal applications of this change require further consideration. Patient and public stakeholder input has been bypassed. To integrate virtual care (VC) in what currently appears to be a lengthier battle against COVID-19 and related sequelae, further investigation is needed to support ideal implementation and use. This study aims to describe factors associated with the use of virtual visits in primary care practices, along with more in-depth description of users’ experiences and perspectives.

Methods and analysis

This study will be conducted in three phases, using a mixed-methods approach and in consultation with community advisors. Phase 1 will analyse data from electronic medical records (EMRs) to characterise the use and users of VC in primary care during the early phase of the COVID-19 pandemic. Analysis will be primarily descriptive; regression modelling will assess associations between patient and provider factors with a virtual visit. In phase 2, we will use an EMR-facilitated process to automate the distribution of patient surveys within an estimated 10 clinics. These surveys aim to describe care experiences, transactional use and perspectives of VC. In phase 3, focus groups with patients, caregivers and primary care clinicians will seek more in-depth exploration of VC regarding accessibility of care, acceptability and perceptions of quality care. Interpretive phenomenological analysis will be used for thematic analysis. The framework method will employ a matrix structure to organise the data and to facilitate comparison, integration and further interpretation.

Ethics and dissemination

This study has been approved by the University of Manitoba’s Health Research Ethics Board (HS24197). A co-designed dissemination strategy will include reports and infographics to policymakers and the public, manuscripts and presentations to academic and clinician audiences, and contributions to a learning plan for professional development.

Practices and challenges of community engagement in health research in Ethiopia: a qualitative study

Por: Solomon · K. · Jibat · N. · Bekele · A. · Abdissa · A. · Kaba · M.
Objective

The role of the community in the research process in Ethiopia has not been documented. This study aims to explore the existing practices and challenges of community engagement in health research in Ethiopia.

Design

A qualitative study with a narrative approach was conducted. Data were audio-recorded, transcribed, inductively coded and analysed thematically.

Setting

Participants were recruited from members of institutional review boards, academic and research staff of Addis Ababa and Jimma universities, research institutions and key development partners.

Participants

Thirty-six participants were involved in the study. They were purposively selected on the basis of their diverse research experiences and disciplinary profiles with clinical, biomedical and public health representation.

Data collection

Twenty-two key informant interviews were conducted with members of the institutional review board, community representatives in the institutional review board, community engagement officers, and research focal persons of the universities, research intuitions and key development partners. Fourteen participants who were senior PhD students or senior researchers in academic and research institutions were involved in the in-depth interviews.

Results

Despite differences of justification, all participants believed in the importance of the participating research community not only to own the research outcome but also contribute to the research planning, sharing of evidence, managing the research process and dissemination of findings. However, it was argued that lack of guidance, skills and experience on how to engage the community at different levels of the research process and limitation of resources affect community engagement in research.

Conclusion

As an important component of the research process, community engagement facilitates the research process and ensures community ownership of the outcome. Nevertheless, lack of experience and limitation of resources affect operationalisation of community engagement in health research. This calls for building capacity and advocacy to consider community engagement as an integral component of the research process.

How can equitable video visit access be delivered in primary care? A qualitative study among rural primary care teams and patients

Por: Goldstein · K. M. · Perry · K. R. · Lewinski · A. · Walsh · C. · Shepherd-Banigan · M. E. · Bosworth · H. B. · Weidenbacher · H. · Blalock · D. V. · Zullig · L. L.
Objective

The COVID-19 pandemic sparked exponential growth in video visit use in primary care. The rapid shift to virtual from in-person care exacerbated digital access disparities across racial groups and rural populations. Moving forward, it is critical to understand when and how to incorporate video visits equitably into primary care. We sought to develop a novel clinical algorithm to guide primary care clinics on how and when to employ video visits as part of care delivery.

Design

Qualitative data collection: one team member conducted all patient semistructured interviews and led all focus groups with four other team members taking notes during groups.

Setting

3 rural primary care clinics in the USA.

Participants

24 black veterans living in rural areas and three primary care teams caring for black veterans living in rural areas.

Primary and secondary outcome measures

Findings from semistructured interviews with patients and focus groups with primary care teams.

Results

Key issues around appropriate use of video visits for clinical teams included having adequate technical support, encouraging engagement during video visits and using video visits for appropriate clinical situations. Patients reported challenges with broadband access, inadequate equipment, concerns about the quality of video care, the importance of visit modality choice, and preferences for in-person care experience over virtual care. We developed an algorithm that requires input from both patients and their care team to assess fit for each clinical encounter.

Conclusions

Informed matching of patients and clinical situations to the right visit modality, along with individual patient technology support could reduce virtual access disparities.

Decision aids for home and community care: a systematic review

Por: Lognon · T. · Plourde · K. V. · Aubin · E. · Giguere · A. M. C. · Archambault · P. M. · Stacey · D. · Legare · F.
Objectives

Decision aids (DAs) for clients in home and community care can support shared decision-making (SDM) with patients, healthcare teams and informal caregivers. We aimed to identify DAs developed for home and community care, verify their adherence to international DA criteria and explore the involvement of interprofessional teams in their development and use.

Design

Systematic review reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources

Six electronic bibliographic databases (MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO and the Cochrane Library) from inception to November 2019, social media and grey literature websites up to January 2021.

Eligibility criteria

DAs designed for home and community care settings or including home care or community services as options.

Data extraction and synthesis

Two reviewers independently reviewed citations. Analysis consisted of a narrative synthesis of outcomes and a thematic analysis. DAs were appraised using the International Patient Decision Aid Standards (IPDAS). We collected information on the involvement of interprofessional teams, including nurses, in their development and use.

Results

After reviewing 10 337 database citations and 924 grey literature citations, we extracted characteristics of 33 included DAs. DAs addressed a variety of decision points. Nearly half (42%) were relevant to older adults. Several DAs did not meet IPDAS criteria. Involvement of nurses and interprofessional teams in the development and use of DAs was minimal (33.3% of DAs).

Conclusion

DAs concerned a variety of decisions, especially those related to older people. This reflects the complexity of decisions and need for better support in this sector. There is little evidence about the involvement of interprofessional teams in the development and use of DAs in home and community care settings. An interprofessional approach to designing DAs for home care could facilitate SDM with people being cared for by teams.

PROSPERO registration number

CRD42020169450.

Healthcare workers compliance with COVID-19 preventive measures, and associated factors, in Ethiopia: A systematic review and meta-analysis

Por: Zenbaba · D. · Sahiledengle · B. · Beressa · G. · Desta · F. · Atlaw · D. · Bogale · D. · Chattu · V. K.
Objective

Compliance with COVID-19 prevention measures limits infection occurrence and spread in healthcare settings. According to research conducted in Ethiopia, compliance with COVID-19 preventative strategies is inconsistent among healthcare providers. This systematic review and meta-analysis aimed to estimate the national pooled proportion of healthcare workers (HCWs) who adhere to COVID-19 preventive measures and associated factors with good compliance.

Design

A systematic review and meta-analysis of all identified studies with cross-sectional study design.

Data sources

A comprehensive search was conducted in PubMed/MEDLINE, POPLINE, HINARI, Science Direct, Cochrane Library databases and Google Scholar search engines from January 2020 to September 2021.

Data extraction and synthesis

This review included all observational studies conducted in Ethiopia that reported the proportion of compliance with COVID-19 preventive measures and associated factors among HCWs. Two independent authors assessed the methodological quality of studies using Joanna Briggs Institute’s meta-analysis of statistical assessment and review instrument. The effect estimates for pooled proportion and pooled OR (POR) were determined.

Results

From retrieved 611 original studies, 21 studies were included in the meta-analysis with a total of n=7933 HCWs. The pooled proportion of good compliance with COVID-19 preventive measures among HCWs was 49.7% (95% CI: 42.3% to 57.1%). Being male (POR=2.21, 95% CI: 1.52 to 3.21), service years (>3 years) (POR=2.65, 95% CI: 1.94 to 3.64), training (POR=2.30, 95% CI: 1.78 to 2.98), positive attitude (POR=3.14, 95% CI: 1.66 to 5.94) and good knowledge (POR=2.36, 95% CI: 1.92 to 2.89) were factors significantly associated with good compliance towards COVID-19 preventive measures.

Conclusion

Our study indicated that approximately one in every two HCWs had good compliance with COVID-19 preventive measures. There must be more emphasis on providing further training sessions for the HCWs to improve their compliance with COVID-19 preventative measures.

Estimating the health workforce requirements and costing to reach 70% COVID-19 vaccination coverage by mid-2022: a modelling study and global estimates

Por: Boniol · M. · Siyam · A. · Desai · S. · Gurung · S. · Mirelman · A. · Nair · T. S. · Diallo · K. · Campbell · J.
Objectives

The implementation of COVID-19 vaccination globally poses unprecedented stress to health systems particularly for countries with persisting health workforce shortages prior the pandemic. The present paper estimates the workforce requirement to reach 70% COVID-19 vaccination coverage in all countries by mid-2022 using service target–based estimation.

Methods

Health workforce data from National Health Workforce Accounts and vaccination coverage reported to WHO as of January 2022 were used. Workload parameters were used to estimate the number of health workers needed with a service target–based approach, the gap and the scale-up required partially accounting for countries’ challenges, as well as the associated costs in human resources.

Results

As of 1 January 2022, only 34 countries achieved 70% COVID-19 vaccination coverage and 61 countries covered less than a quarter of their population. This analysis showed that 1 831 000 health workers working full time would be needed to reach a global coverage of 70% COVID-19 vaccination by mid-2022. To avoid severe disruptions to health system, 744 000 additional health workers should be added to domestic resources mostly (77%) in low-income countries. In a sensitivity analysis, allowing for vaccination over 12 months instead of 6 months would decrease the scale-up to 476 000 health workers. The costing for the employment of these 744 000 additional health workers is estimated to be US$2.5 billion. In addition to such a massive scale-up, it is estimated that 29 countries would have needed to redeploy more than 20% of their domestic workforce, placing them at serious risk of not achieving the mid-year target.

Conclusion

Reaching 70% global coverage with COVID-19 vaccination by mid-2022 requires extraordinary efforts not before witnessed in the history of immunisation programmes. COVID-19 vaccination programmes should receive rapid and sustainable investment in health workforce.

Exploration of the impact of gene therapy on the lives of people with haemophilia and their families: a protocol for the mixed-methods exigency study

Por: Fletcher · S. · Pembroke · L. · Holland · M. · Khair · K.
Introduction

Gene therapy has the potential to change the life experience of people with haemophilia and their families. A growing number of studies have examined the experience for those who have had gene therapy. A few studies have examined the process with other gene therapy among a wider cross-section of the haemophilia community.

Exigency is a nested group of studies investigating the experience and understanding of the haemophilia community to identify what place gene therapy is likely to have in haemophilia care.

Five groups have been identified: those who have already undergone gene therapy, those who do not want it, those who wanted to have it but withdrew or were withdrawn before dosing, those who have not yet been offered it and parents of children with haemophilia.

Methods

A qualitative, mixed-methods process will identify what each group understands about gene therapy and what it might mean for the haemophilia community in the future.

Analysis

All of the transcripts will be analysed by the lead and coinvestigator using a grounded theory approach. The texts will be coded into themes for further analysis. The data will be summarised and synthesised, and the views expressed will be represented descriptively.

Ethics and dissemination

Written consent will be required, and participants will be anonymised. All elements of the study will be reviewed by UK statutory bodies.

The study findings will be submitted for publication in peer-reviewed journals, and at haemophilia conferences and symposia.

The study results will also be disseminated directly to study participants. Each participant will receive a copy of any publication and a summary report at the end of the study.

Trial registration number

NCT04723680

Evaluating the Management of chronic Pelvic girdle Pain following pregnancy (EMaPP): study protocol for a randomised controlled feasibility trial to compare a customised pelvic orthosis with standard care

Por: Halliday · B. J. · Chatfield · S. · Cameron · L. · Hosking · J. · Shawe · J. · Hawton · A. · Hayward · C. · Carter · K. · Freeman · J. A.
Introduction

An estimated 10% of women experience severe, chronic pelvic girdle pain post partum. This has significant physical, psychological and socioeconomic consequences. Typically, such pain is recalcitrant to conservative management; hence the need to identify effective management strategies. Customised Dynamic Elastomeric Fabric Orthoses may be an option to address this gap; designed to improve pain by providing support while optimising movement and function. Currently, no studies have evaluated the clinical and cost-effectiveness, or acceptability of these customised orthoses in postpartum women.

Methods and analysis

EMaPP is a pragmatic, multicentre randomised controlled feasibility trial with an embedded qualitative study and economic evaluation. Sixty participants with pregnancy-related severe pelvic girdle pain >3 months post partum will be recruited. Participants will be randomly allocated in a 1:1 ratio (stratified by centre and presence/absence of lumbo-pelvic pain pre pregnancy) to receive either standard care (standardised information and exercise) or intervention (orthosis plus standard care). All participants will be asked to complete a battery of self-report questionnaires (including pain, function, health-related quality of life and health and social care resource use), via a web-based application at baseline, 12 weeks and 24 weeks. Pain levels and medication usage will be reported fortnightly. Feasibility and acceptability of the trial procedures will be determined in terms of recruitment and retention rates, data completion rates and intervention adherence. Five clinicians and 10 participants will be interviewed to explore their experiences of the trial procedures and receiving the intervention.

Ethics and dissemination

This study was approved by: National Research Ethics Scheme (NRES Committee Health and Care Research Wales Research Ethics Committee (21/WM/0155) and University of Plymouth Faculty of Health Research Ethics and Integrity Committee (ref:2966). Results will be made available to participants, the funders, staff, general public and other researchers through a range of mechanisms.

Trial status

Currently recruiting.

Trial registration number

ISRCTN67232113.

Evaluation of the effectiveness of a South African laboratory cryptococcal antigen screening programme using a retrospective cohort and a cluster-randomised trial design

Por: DeSanto · D. J. · Bangdiwala · A. S. · Van Schalkwyk · E. · Skipper · C. P. · Greene · G. · Paxton · J. · Huppler Hullsiek · K. · Mashau · R. · Rajasingham · R. · Boulware · D. R. · Govender · N. P.
Introduction

Cryptococcal meningitis is a common fungal opportunistic infection and a leading cause of death among people with advanced HIV disease in sub-Saharan Africa. The WHO recommends cryptococcal antigen (CrAg) screening followed by pre-emptive therapy to prevent cryptococcal meningitis and death in this population. In 2016, South Africa was the first country to implement reflexive laboratory CrAg screening nationally. The Cryptococcal Antigen Screen-and-Treat National Evaluation Team (CAST-NET) aims to evaluate the effectiveness of this national screening programme to optimise health outcomes.

Methods and analysis

The CAST-NET study consists of two integrated parts: a retrospective cohort study and a cluster-randomised trial (CRT). The retrospective cohort study will determine 6-month cryptococcal meningitis-free survival among CrAg-positive patients. Secondary outcomes include the proportion of CrAg-positive results noted for action in the CrAg-positive patient chart, the proportion of CrAg-positive patients offered and accept/decline a lumbar puncture, the proportion of CrAg-positive patients prescribed antifungal therapy and the proportion of CrAg-positive patients who have antiretroviral therapy initiated or reinitiated at an appropriate time according to South African national guidelines. Cohort data will be analysed by the type of facility (ie, hospital vs primary health clinic) at which the patient was diagnosed with antigenaemia. The CRT will determine if the appointment and mentoring of a healthcare worker, or ‘crypto champion’, at intervention facilities is associated with a higher proportion of CrAg-positive persons initiating pre-emptive fluconazole therapy. Secondary outcomes will include 6-month cryptococcal meningitis-free survival and the proportion prescribed fluconazole maintenance treatment.

Ethics and dissemination

Ethics approvals were received from the University of the Witwatersrand Human Research Ethics Committee (Medical), the University of KwaZulu-Natal Biomedical Research Ethics Committee and the University of Pretoria Faculty of Health Sciences Research Ethics Committee. Study results will be disseminated to the South African Department of Health and participating facilities through peer-reviewed publications and reports.

Clinical performance of the Roche Cobas 4800 HPV test for primary cervical cancer screening in a Chinese population

by Stephanie S. Liu, Karen K. L. Chan, Tina N. Wei, Ka Yu Tse, Siew F. Ngu, Mandy M. Y. Chu, Lesley S. K. Lau, Annie N. Y. Cheung, Hextan Y. S. Ngan

High-risk human papillomavirus (HR-HPV) testing has become an increasing important strategy in primary cervical cancer screening in recent years. It warrants the evaluation of molecular-based HPV tests for accuracy and efficacy of screening. The performance of Roche Cobas 4800 HPV test was validated and compared with Digene Hybrid Capture 2 (HC2) high-risk HPV DNA test for primary screening in a large Chinese screening cohort. Of 6345 women screened, overall agreement between Cobas and HC2 was 92.23% (95% CI: 91.57–92.89). The inter-assay agreement was correlated with the severity of underlying biology, with an increasing concordance found in samples with more severe abnormalities. Most of the discordant samples had the test signal strength closer to the test limits of the detection than concordant samples, reflecting a low viral load and infection of a cluster of low-risk HPV in these samples. The Cobas test demonstrated significantly higher specificity in identifying CIN2+/CIN3+ cases than HC2 test (66.46% vs 43.67% and 65.42% vs 42.86%, p

Scoping review to evaluate the effects of peer support on the mental health of young adults

Por: Richard · J. · Rebinsky · R. · Suresh · R. · Kubic · S. · Carter · A. · Cunningham · J. E. A. · Ker · A. · Williams · K. · Sorin · M.
Objectives

Young adults report disproportionality greater mental health problems compared with the rest of the population with numerous barriers preventing them from seeking help. Peer support, defined as a form of social-emotional support offered by an individual with a shared lived experience, has been reported as being effective in improving a variety of mental health outcomes in differing populations. The objective of this scoping review is to provide an overview of the literature investigating the impact of peer support on the mental health of young adults.

Design

A scoping review methodology was used to identify relevant peer-reviewed articles in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across six databases and Google/Google Scholar. Overall, 17 eligible studies met the inclusion criteria and were included in the review.

Results

Overall, studies suggest that peer support is associated with improvements in mental health including greater happiness, self-esteem and effective coping, and reductions in depression, loneliness and anxiety. This effect appears to be present among university students, non-student young adults and ethnic/sexual minorities. Both individual and group peer support appear to be beneficial for mental health with positive effects also being present for those providing the support.

Conclusions

Peer support appears to be a promising avenue towards improving the mental health of young adults, with lower barriers to accessing these services when compared with traditional mental health services. The importance of training peer supporters and the differential impact of peer support based on the method of delivery should be investigated in future research.

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