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Effect of containment strategies for respiratory diseases on infections imported via international travel to the USA: a modelling study

Por: Koiso · S. · Lee · H. · Ciaranello · A. L. · Freedberg · K. A. · Ryan · E. T. · Jalali · M. S. · LaRocque · R. C. · Hyle · E. P.
Objectives

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

Design

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.

Settings

A US high-volume airport.

Participants

Simulated international travellers and airline/airport workers.

Interventions

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).

Outcome measures

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

Results

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.

Conclusions

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.

Prevalence, factors and association with academic performance of anaemia in Kandahar schoolchildren: a cross-sectional analytical study

Por: Rahimi · B. A. · Lali · W. M. · Saeed · K. M. I. · Ahmadzai · S. A. H. · Akbari · K. · Mukhlis · A. H. · Azimi · M.
Objectives

This study aimed to investigate the prevalence and associated factors of anaemia and its association with the academic performance of schoolchildren in Kandahar, Afghanistan.

Design

This was a cross-sectional analytical study.

Setting and participants

This was a school-based study conducted among 1866 schoolchildren aged 6–14 years in Kandahar city from September to December 2023. Haemoglobin concentration was measured using a portable HemoCue Hb 301 analyser, while the WHO age-adjusted cut-off for haemoglobin was used to classify anaemia. Data were analysed by using descriptive statistics, the ² test and multivariate logistic regression.

Results

In this study, the mean age of the children was 9.1 years, 61.1% (1138/1866) were boys, 83.6% (1560/1866) had illiterate mothers, and 81.3% (1517/1866) belonged to poor families. Prevalence of anaemia among schoolchildren was 64.1% (1196/1866), while 20.8% (388/1866), 41.7% (778/1866), and 1.6% (30/1866) were suffering from mild, moderate and severe anaemia, respectively. Main associated factors of anaemia were being male (adjusted OR (AOR) 1.4, 95% CI 1.1 to 1.7, p=0.003), unemployed father (AOR 1.5, 95% CI 1.1 to 2.2, p=0.020), poor family (AOR 2.3, 95% CI 1.8 to 2.9, p

Conclusions

Prevalence of anaemia was very high and is a severe public health problem in schoolchildren of Kandahar. Based on the known consequences of anaemia on academic performance, the education and health authorities of Afghanistan should take serious steps to alleviate this problem. Periodic iron supplementation and deworming, as well as daily iron-rich mid-day meal programmes, should be started for both boys and girls in schools.

Association of blood pressure control, lifestyle and socioeconomic status with self-rated health in patients with hypertension: a national cross-sectional study

Por: Behgam · N. · Karimi Ghahfarokhi · M. · Azizpour · Y. · Naderyan Feli · S. · Mozafari · S. · Lotfaliany · M. · Tohidinik · H. R. · Kompani · F. · Rezaei · N. · Djalalinia · S.
Objectives

To examine demographic, behavioural and clinical determinants of self-rated health (SRH) among Iranian adults with hypertension (HTN), with a particular focus on the association between blood pressure (BP) control and perceived health.

Design

National cross-sectional analysis of 15 predictors spanning demographic, lifestyle and clinical domains.

Setting

2021 Iranian STEPwise Approach to Non-communicable Disease Risk Factor Surveillance, a nationally representative survey.

Participants

A total of 8812 adults with HTN (mean age 56.97 years; 57% female). Controlled HTN was defined as systolic blood pressure

Primary and secondary outcome measures

The primary outcome was SRH, measured on a standard EuroQol-Visual Analogue Scale (0–100).

Results

Controlled HTN was independently associated with higher SRH scores (β=1.31, 95% CI 0.07 to 2.54). Positive predictors of SRH included male gender (β=4.34, 95% CI 3.38 to 5.31), higher wealth (richest vs poorest: β=5.52, 95% CI 4.06 to 6.97), sufficient physical activity (β=4.38, 95% CI 3.48 to 5.28), healthier diet (β=3.06, 95% CI 1.99 to 4.14) and complementary insurance coverage (β=2.50, 95% CI 0.63 to 4.37). Significant negative predictors included diabetes mellitus (β=–4.23, 95% CI –5.59 to –3.26), dyslipidaemia (β=–3.61, 95% CI –4.62 to –2.59), people who smoke (β=–4.21, 95% CI –5.64 to –2.78) and older age. Notably, antihypertensive medication use showed one of the strongest negative associations with SRH (monotherapy: β=–4.83; combination therapy: β=–5.28), likely reflecting underlying disease severity and treatment burden.

Conclusions

Better SRH among hypertensive adults was associated with controlled BP, healthier lifestyle patterns and higher socioeconomic status. Conversely, comorbidities, smoking, older age and antihypertensive treatment were linked to poorer perceived health. Integrating SRH screening into HTN management may help identify vulnerable individuals and inform targeted interventions addressing behavioural and socioeconomic determinants of health.

Single catheter strategy for transradial angiography and primary percutaneous coronary intervention enhances procedural efficiency, microvascular outcomes, and cost-effectiveness: Implications for STEMI healthcare in resource-limited settings

by Mohajit Arneja, Swetharajan Gunasekar, Dharaneswari Hari Narayanan, Joshma Joseph, Harilalith Kovvuri, Sharath Shanmugam, Pavitraa Saravana Kumar, Asuwin Anandaram, Vinod Kumar Balakrishnan, Jayanty Venkata Balasubramaniyan, Sadhanandham Shanmugasundaram, Sankaran Ramesh, Nagendra Boopathy Senguttuvan

Background

Faster time to reperfusion can be achieved by minimizing various patient and system-level delays that contribute to total ischemic time. Procedural delays within the catheterization laboratory represent a non-negligible and modifiable component in the chain of reperfusion, but remain unquantified by conventional metrics such as door-to-ballon (D2B) time. Universal catheter approaches have rapidly gained traction as an alternative to the traditional two catheter approach for transradial coronary interventions. However, their utility for both diagnostic angiography and subsequent angioplasty is limited, and the impact of this strategy on reperfusion outcomes has remained unexplored. We utilized a procedural metric termed fluoroscopy-to-device (FluTD) time to quantify the efficiency of a single catheter strategy, and assessed its impact on epicardial and myocardial perfusion.

Methods and results

In this retrospective study, consecutive STEMI patients undergoing transradial primary PCI (pPCI) at a tertiary care center in India between May 2022 to October 2024 were analyzed. Patients were divided into two groups: 51 underwent PCI using a single universal guiding catheter (UGC), and 51 underwent the conventional two-catheter (CTC) approach. The primary outcome of the study was a comparison of the FluTD time between the two procedural strategies. Secondary outcomes included myocardial blush grade (MBG), Thrombolysis in Myocardial Infarction (TIMI) flow grade, total fluoroscopy time, radiation dose, device safety and efficacy, and procedural success.The median FluTD time was significantly shorter in the UGC compared to the CTC group (3 minutes [IQR 3–4] vs. 10 minutes [IQR 8–17], p  Conclusion

A single catheter strategy for both angiography and pPCI in STEMI patients was associated with a significant reduction in FluTD time and improved microvascular perfusion, without compromising device safety or efficacy. In low- and middle-income countries (LMICs), where intra- and extra-procedural delays are often more pronounced, inclusion of the single catheter strategy can optimize catheterization workflows and yield substantial cost-savings.

Strategies employed by Iranian nurses for managing workplace bullying: a qualitative descriptive study

Por: Piri · S. · Jalali · R. · Khatony · A.
Objectives

This study aimed to explore the strategies employed by nurses to manage workplace bullying.

Design

Qualitative descriptive study.

Setting

The study was conducted in a hospital located in western Iran between 21 March and 22 September 2023.

Participants

A purposive sample of 14 nurses was selected.

Methods

Data collection was conducted through semistructured in-depth interviews. The collected data were analysed using a conventional content analysis approach. Lincoln and Guba’s (2004) criteria were employed to ensure data validity. The data management process was facilitated using MAXQDA software (2020 version).

Results

Nurses’ experiences of workplace bullying were categorised into two themes: ‘constructive strategies’ and ‘non-constructive strategies’. These themes were further divided into categories: ‘seeking support’, ‘individual empowerment’, ‘avoidance’, ‘confrontation’ and ‘no reaction’. The subcategories encompassed specific strategies employed by nurses to manage workplace bullying.

Conclusions

The findings demonstrate that nurses use both constructive and non-constructive strategies to manage workplace bullying. Understanding nurses’ strategies for managing workplace bullying can assist managers in developing comprehensive intervention programmes to address these issues. It is crucial to provide nurses with training on using constructive strategies and avoiding non-constructive ones. Creating a healthy and supportive work environment and addressing the psychological and social aspects of bullying phenomena also play a vital role in reducing and managing bullying behaviours.

Quadrivalent HPV Vaccine Evaluation Study with Addition of the Nonavalent Vaccine (QUEST-ADVANCE): protocol of an observational cohort study

Por: Middeldorp · M. · Donken · R. · Nirmal · A. · Smith · B. · Citlali Marquez · A. · Bettinger · J. A. · Brisson · M. · Burchell · A. N. · Dobson · S. R. · Dawar · M. · Franco · E. L. · Grennan · T. · Krajden · M. · Mayrand · M.-H. · McNeil · S. · Naus · M. · Sauvageau · C. · Singer · J. · Sm
Introduction

The Quadrivalent human papillomavirus (HPV) Vaccine Evaluation Study with Addition of the Nonavalent Vaccine Study (QUEST-ADVANCE) aims to provide insight into the long-term immunogenicity and effectiveness of one, two and three HPV vaccine doses. Here, we describe the protocol for QUEST-ADVANCE.

Methods and analysis

QUEST-ADVANCE is an observational cohort study including males and females who are unvaccinated or vaccinated with the quadrivalent or nonavalent HPV vaccine in British Columbia, Canada. Female participants who are unvaccinated or vaccinated with 1–3 doses of the quadrivalent or nonavalent HPV vaccine at 9–14 years of age will be recruited approximately 5 or 12 years postvaccination eligibility. Male participants who are unvaccinated or vaccinated with 1 or 2 doses of the nonavalent HPV vaccine at 9–14 years of age will be recruited at approximately 5 years postvaccination eligibility. The study involves a maximum of four visits over a period of 4–5 years for female participants, and two visits over a 12-month period for male participants. At each visit, self-collected swabs (cervico-vaginal or penile) and questionnaire data will be collected. In each study group, a subset of participants will be invited to participate in a substudy evaluating the long-term humoral immunogenicity of the HPV vaccine. Additional blood samples will be collected from participants who are part of the immunogenicity substudy. The total required sample size is 7180 individuals. The primary objectives are (1) to examine vaccine effectiveness in males and females against prevalent genital HPV infections for one, two and three doses of the HPV vaccine compared with unvaccinated participants and (2) to evaluate if there is non-inferior immunogenicity as indicated by type-specific antibody response of one dose of the HPV vaccine in 20–27-year-old females vaccinated at 9–14 years of age compared with historical data of three doses of the HPV vaccine females vaccinated at 16–26 years of age up to 12 years postvaccination.

Ethics and dissemination

QUEST-ADVANCE was approved by the Research Ethics Board of the University of British Columbia/Children’s and Women’s Health Centre of British Columbia (H20-02111). Individual electronic informed consent or assent will be obtained from each participant before any study-specific procedures are undertaken. Results will be published in an international peer-reviewed journal and on the study website.

Translation and measurement properties of Persian version of Child-to-Parent Violence Questionnaire

Por: Abdolalipour · S. · Hosseinzadeh · M. · Khalili · M. · Asghari Jafarabadi · M. · Mirghafourvand · M.
Objective

Child-to-parent violence (CPV) has received limited attention in scientific literature, but due to a recent increase in reported cases, it has become a subject of investigation. The reliability and validity of the Child-to-Parent Violence Questionnaire (CPV-Q), in separate mother and father versions, have not yet been studied in Iran. This study aimed to assess the psychometric properties of the Persian CPV-Q.

Design

This research employed a cross-sectional design to evaluate the Persian CPV-Q’s psychometric properties. The process included translation (using backward-forward method), face validity (via impact score calculation), content validity (using content validity ratio (CVR) and content validity index (CVI)), construct validity (through exploratory and confirmatory factor analyses (CFA)) and reliability assessment (via test–retest, coefficient α, coefficient and intraclass correlation coefficient (ICC)).

Setting

The study was conducted at the Faculties of Tabriz University of Medical Sciences.

Participants

A total of 500 qualified students from Tabriz University of Medical Sciences were recruited using cluster random sampling. These participants completed the Persian CPV-Q.

Results

Face validity was confirmed, with impact scores exceeding 1.5 for all items. Content validity was strong, with CVR=0.92 and CVI=0.89. Exploratory factor analysis revealed four factors related to violence frequency and two factors regarding reasons for violence, consistent with the original questionnaire, covering 19 and 8 items, respectively. Total variance explained was 0.30 and 0.39 for the mother’s version and 0.33 and 0.43 for the father’s version in frequency and reason sections. The Kaiser-Meyer-Olkin test confirmed sample adequacy (

Conclusions

The Persian CPV-Q demonstrates adequate validity and reliability for assessing the prevalence and causes of CPV in Iranian society.

Family Communication to Enhance Adolescent Depression Recovery—Intervention Development Protocol

ABSTRACT

Aim

To develop a structured intervention aimed at enhancing family communication to reduce relapse in adolescents with depression.

Design

This study follows a multi-stage process guided by the Intervention Mapping procedure with the Medical Research Council framework, assessing the layers of complexity. Its design comprises four interrelated stages to construct a family communication intervention, culminating in a pilot randomised controlled trial.

Methods

The program has four stages: (1) Identifying family interaction gaps through literature review and expert input; (2) Investigating communication needs of depressed adolescents and their families via a mixed methods study to develop a model intervention; (3) Refining the intervention with focus groups and expert e-Delphi; and (4) Finalising the intervention based on pilot randomised controlled trial outcomes. The research will be conducted in Greater Accra, Ghana.

Results

The process will result in a family communication intervention tailored to the needs of adolescents with depression and their families. It will be pilot tested, and the results will inform a nationwide efficacy trial.

Conclusion

This research integrates qualitative and quantitative data to inform the development of an evidence-based family communication intervention. The program will carefully examine data integration and contextual challenges encountered during its implementation.

Implications for the Profession and/or Patient Care

The intervention has the potential to enhance family communication, thus playing a crucial role in adolescent depression recovery by reducing relapse rates. Healthcare professionals will benefit from a structured, evidence-based communication tool that can be used in clinical settings.

Impact

The study focuses on improving communication between families of adolescents with depression, aiming to develop a family communication package for clinical and community use. This intervention may enhance recovery outcomes and reduce relapse risk for adolescents.

Reporting Method

This study adhered to the GUIDED guideline for reporting intervention development studies.

Patient or Public Contribution

No Patient or Public Contribution.

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