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Opioid use disorder (OUD) is a chronic and severe psychiatric condition defined by a level of opioid use which significantly impairs interpersonal and social functioning. In the biopsychosocial model of addiction, research has shown that psychiatric, sociological and neurobiological factors individually affect OUD severity. However, how these factors interact in the determination of OUD severity remains poorly understood.
The Epigenetic Bonds of Opioid Use Profiles are a multidisciplinary project whose primary objective is to characterise psychiatric and social factors of OUD in a large cohort of patients. The secondary objectives are, first, to correlate psychosocial severity with blood-derived epigenetic biomarkers to provide a deeper understanding of determinants of OUD and, second, to examine over a 2 year follow-up the correlation between the evolution of OUD and psychosocial severity with epigenetic biomarkers at inclusion. An additional objective is to analyse the impact of drug consumption rooms on access to care for most severely affected patients with OUD. In total, 300 opioid users will be recruited at supervised injection sites in Strasbourg and Paris and at addiction care centres in Strasbourg and Lyon to explore four psychiatric (substance use disorders beyond opioids, depression, anxiety, post-traumatic stress disorder) and five social (social support and status, traumatic experiences, housing, imprisonment, access to care) factors. Opioid users will be followed for 24 months and reassessed for psychosocial factors at 3, 6, 12, 18 and 24 months. Opioid consumption will be measured in all subjects using questionnaires, complemented by toxicological screenings (mass spectrometry). Finally, DNA methylation and gene expression will be characterised in capillary blood using next-generation sequencing. Mixed models will be used to model the primary and secondary outcomes.
This ongoing study was approved by the French Ethics Committee ‘Sud Méditerranée III’ of University Hospital of Nîmes (approval 2023–2024, protocol IDRCB number 2022-A02477-36) and authorised by the French Data Protection Authority (authorisation decision DR-2023–277 in December 2023). Results will be presented in international and national conferences and published in peer-reviewed international journals.
Head and neck cancer (HNC) affects the mouth, throat, salivary glands, voice box, nose or sinuses. Every year, over 12 000 people in the UK are diagnosed with HNC. Neck dissection is a key, surgical component of patient care. However, many people experience postoperative restriction in shoulder and neck movements, pain, fatigue and low mood, with only half ever returning to work.
Getting Recovery Right After Neck Dissection (GRRAND) is a two-arm, multicentre, pragmatic randomised controlled trial. The trial aims to compare clinical and cost-effectiveness of a personalised physiotherapy programme (GRRAND programme) versus usual practice, National Health Service (NHS), postdischarge care.
The planned sample size is 390 participants. Participants will be recruited from across UK sites and followed up for 12 months. The primary outcome is the shoulder pain and disability index at 12 months. Economic evaluation will be conducted from a healthcare system and personal social services perspective. Secondary outcome data, including pain, function, health-related quality of life, mental well-being, health resource use and adverse events, will be collected at 6 weeks, 3, 6 and 12 months, with exercise adherence at 6 weeks. A process evaluation will determine how GRRAND is implemented, delivered and received across clinical settings, exploring what works, for whom and under what conditions. Analysis will be on an intention-to-treat basis and reported inline with the Consolidated Standards of Reporting Trials statement.
The trial was approved by the London-Brent Research Ethics Committee (ref: 24/LO/0722) on 15 October 2024. Trial results will be disseminated via peer-reviewed publications, presentations at national and international conferences, in lay summaries and social media. This protocol adheres to the recommended Standard Protocol Items: Recommendations for Interventional Trials checklist.
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.
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.
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.
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.
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)).
The study was conducted at the Faculties of Tabriz University of Medical Sciences.
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.
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 (
The Persian CPV-Q demonstrates adequate validity and reliability for assessing the prevalence and causes of CPV in Iranian society.
This systematic review examined the prevalence of postpartum family planning (PPFP) uptake and its association with spousal discussion and husband’s support.
Systematic review and meta-analysis.
A comprehensive literature search was conducted across PubMed (NLM), Scopus (Elsevier), Web of Science (Clarivate) and Cochrane Library (Wiley).
The review included primary observational studies published in English between January 2014 and March 2024. Eligible studies reported prevalence and association between spousal discussion, support, approval or contraceptive use by the husband in PPFP within 12 months of childbirth.
Two reviewers independently screened the articles, performed data extraction and assessed the risk of bias using the Newcastle-Ottawa Scale and Appraisal Tool for Cross-Sectional Studies. Discrepancies were resolved through consensus. Random-effects meta-analysis estimated pooled prevalence, and pooled ORs of log odds were reported for the association between spousal discussion and partner approval and PPFP uptake.
Six cross-sectional studies involving 2856 postpartum women were included. The pooled prevalence of PPFP uptake was 35% (95% CI 19% to 52%). Meta-analysis showed that spousal discussion was associated with PPFP uptake (log OR=1.39 (95% CI 0.65 to 2.13), however, partner’s approval was not associated with PPFP uptake (log OR=1.49, 95% CI –0.08 to 3.06). Two studies assessed partner support, with one reporting a significant association (log OR: 1.45); joint decision-making was assessed in two studies but showed no significant association with PPFP.
In conclusion, the overall prevalence of PPFP uptake is low. Spousal discussion plays a critical role in enhancing PPFP uptake. These findings highlight the need for policy initiatives and programmatic interventions that promote couple communication for PPFP decision-making to improve reproductive health outcomes in low–middle-income countries.
CRD42024505801.
by Chean Tat Chong, Lalitha Palaniveloo, Sulhariza Husni Zain, Muhamad Khairul Nazrin Khalil, Kishwen Kanna Yoga Ratnam
Gestational diabetes mellitus (GDM) is a growing public health concern, particularly among women with advanced maternal age. Understanding the prevalence and associated sociodemographic factors is crucial for targeted interventions. This study aimed to determine the prevalence of GDM and its association with sociodemographic factors among Malaysian women with advanced maternal age. This study utilized data from the National Health and Morbidity Survey 2022: Maternal and Child Health, a nationwide cross-sectional survey employing a two-stage stratified cluster sampling design. GDM was identified based on the result of a modified oral glucose tolerance test (MOGTT) recorded in the mother’s antenatal book. The 75-g MOGTT was performed according to the Clinical Practice Guidelines for the Management of Diabetes in Pregnancy in Malaysia. Sociodemographic variables, including ethnicity, locality, education, employment, and household income, were analysed. Multiple logistic regression was performed to identify factors associated with GDM. The prevalence of GDM among women with advanced maternal age in Malaysia was 33.7% (95% CI: 30.9%−36.5%). Ethnicity was significantly associated with GDM, with Indian women showing the highest prevalence (48.8%) and odds (AOR: 7.31, 95% CI: 2.58–20.72; PPersistent epithelial defect (PED) management can be challenging. First line of treatment includes lubrication, bandage contact lenses and punctal plugs. The second line of treatment includes autologous serum (AS). Topical insulin has been shown to be safe for topical use and improve corneal epithelial healing. Therefore, a controlled clinical trial (control group with current standard treatment, ie, AS) multicentre, randomised and with a blind third observer will be conducted to evaluate the efficacy and safety of the use of insulin eye-drops in the treatment of PED.
A preselection of patients with epithelial defect after 1 week of treatment will be made and blood tests will be obtained in order to dispense AS if necessary. After 2 weeks of standard treatment, if the PED persists and the patient meets criteria, patients will be enrolled after signing an informed consent form. Patients will be randomly allocated to receive either insulin (1 UI/mL, 4 times a day) or AS (20%, 5–6 times a day) eye-drops for 3 months. 234 patients will be included, 117 in each treatment group. The main variable (PED size) will be obtained from slit-lamp photographs, an objective and easily quantifiable variable which will be evaluated by a blinded investigator (third observer). Patients will be examined every 3–5 days until week 4 of study treatment and once a week until 6 weeks, to continue with a visit every 2 weeks until reaching 3 months of follow-up. Primary endpoints are: complete epithelialisation, epithelialisation rate (initial defect area/days until epithelialisation) and time until complete closure.
Ethical approval has been obtained from Hospital Clinico San Carlos in Madrid and Agencia Española del Medicamento y Productos Sanitarios (AEMPS). The findings will be disseminated in peer-reviewed publications and presentations at meetings.
EudraCT 2022-003589-19.
Postpartum depression (PPD) is a debilitating condition affecting over 20% of postpartum women, with disproportionately higher rates among black and Latina women compared with their white counterparts. Current recommendations for PPD prevention demand significant healthcare system resources, highlighting the need for alternative, evidence-based interventions that minimise strain on these systems. Mindfulness has been shown to effectively reduce depressive symptoms and prevent relapse across various populations. However, no studies to date have evaluated the efficacy of a digitally delivered mindfulness intervention specifically for black and Latina women at increased risk of PPD.
This article presents the protocol for the Healthy Mama and Baby study, a randomised controlled trial (RCT). This trial evaluates whether a mobile-based (mHealth) mindfulness intervention tailored for pregnant women reduces depressive symptoms among pregnant black and Latina women at high risk for PPD.
We are conducting a fully remote RCT, recruiting 600 pregnant black and/or Latina women at risk of PPD from Kaiser Permanente Northern California (KPNC), an integrated healthcare delivery system. Participants are enrolled before 30 weeks’ gestation. They are randomised into either an mHealth mindfulness intervention arm, which receives access to a mindfulness app tailored specifically for pregnant and postpartum women, or a time-matched and attention-matched active control arm, which receives access to an online program of calming nature sounds. Both arms are instructed to engage in their assigned program for 5–20 min per day for 6 weeks. Outcome assessments are conducted online at baseline, post intervention and post partum (~7 weeks post partum) using validated questionnaires. Outcomes include depressive symptoms (primary) and anxiety, sleep and perceived stress (secondary).
All study procedures have been approved by the KPNC Institutional Review Board. The findings will be disseminated widely through peer-reviewed publications and conference presentations.
Monkeypox (Mpox) is an emerging public health concern globally as well as in Pakistan, with over 100 000 confirmed cases reported across 120 countries as of July 2024.
To assess healthcare professionals’ knowledge and preparedness regarding Mpox and examine its association with demographic factors.
Quantitative, descriptive, cross-sectional study.
Conducted in tertiary care public sector hospitals of Rawalpindi district, Pakistan, from October 2024 to February 2025.
A total of 230 healthcare professionals of either gender, aged over 18 years, currently working in the public sector tertiary care hospitals of Rawalpindi district for at least 6 months were included.
The mean age of the respondents was 29.13±6.55 years. The majority were women (147, 63.9%), post-graduate trainees (106, 46.1%), with 1–5 years of experience (184, 80%) and from medicine and allied disciplines (131, 57%). Most participants had an average level of knowledge regarding Mpox (137, 59.6%), with only a few demonstrating good knowledge (40, 17.4%). Half of the participants reported that their healthcare facilities lacked proper protocols for managing Mpox cases (97, 42.2%). Significant associations were observed between Mpox knowledge scores and participants’ field of specialty (p=0.007); notably, respondents from basic sciences had a higher proportion of good knowledge scores.
Overall, the level of knowledge and preparedness regarding Mpox among healthcare professionals was average. There is an urgent need for standardised Mpox preparedness protocols, outbreak response planning and comprehensive training programmes to enhance readiness for future outbreaks.
To explore the experience of primary healthcare (PHC) professionals in their professional role during the pandemic and to describe collective coping strategies.
We conducted a qualitative study using interviews, focus groups and photovoice techniques from February to September 2021. The qualitative data were transcribed, aggregated and analysed, from a hermeneutic perspective, using applied thematic analysis and ethnographic approaches.
Primary Care Health Madrid region (Spain).
Convenience sampling was used to select 71 multidisciplinary primary care professionals who were working in 12 PHCs representing diverse socioeconomic, social vulnerability and COVID impact levels in the Madrid region (Spain).
Findings from this study show how lack of protection in the early days, uncertainty about how the disease would evolve and the daily challenges they faced have had an impact on the participants’ perceptions of their professional role. Nuanced differences in impact were found between men and women, age groups, professional roles and territories. The questioning of the basic foundations of primary care and the lack of prospects led to a feeling of demotivation. They perceive a wide gap between their levels of involvement and commitment, the recognition they receive and the attention to resources they need to do their work to a high standard. The support of their colleagues was seen as the most valuable resource for coping with the crisis.
The practitioners’ discourses offer knowledge that could help to face new global health threats; they also identify an urgent need to restore the role and motivation of PHC professionals as part of a wider regeneration of health systems.
With growing access to the internet, online mindfulness programmes have become more commonly used to manage physical and mental health conditions. This scoping review aims to determine the nature and extent of the literature, and key characteristics, of online mindfulness-based interventions (MBIs) for adults with physical or mental health conditions.
A scoping review guided by the Joanna Briggs Institute framework.
MEDLINE, CINAHL, Embase, PsycINFO, Allied and Complementary Medicine and the Cochrane Central Register of Controlled Trials.
Studies focusing on online MBIs, online mindfulness-based stress reduction and online mindfulness-based cognitive therapy (MBCT) in adults with a physical or mental health condition were included.
Study and participant characteristics, key intervention characteristics, outcome measures and results were abstracted.
84 studies were included. Online MBIs have been studied in many different physical and mental health conditions; however, 63 of the included studies were for physical health conditions. MBCT was the most common intervention type assessed, with 33 of the included studies assessing it. Regarding intervention characteristics, intervention duration was similar across intervention type at 8 weeks, with sessions led by therapists, clinicians or mindfulness instructors. Web-based and videoconferencing were the most common delivery formats. Intervention content generally remained similar to standardised MBIs, with the addition of psychoeducation and disease management. Many studies did not report on tailoring the intervention to the participant population. There was a lack of consistency in reporting intervention characteristics.
This review highlights some evidence for online mindfulness programmes for both physical and mental health conditions. However, intervention componentry remains somewhat obscure, and reporting on tailoring appears relatively sparse. Greater consistency in reporting intervention componentry will improve knowledge and study in this area and enhance the translation of these interventions to clinical settings.
by Ebenezer Assoah, Denis Dekugmen Yar, Papa Kofi Amissah-Reynolds, Gadafi Iddrisu Balali, Rockson Addy, Joshua Kpieonuma Zineyele
This study assessed the prevalence of co-infections (human immunodeficiency virus, hepatitis B, and syphilis) and associated risk factors for Toxoplasma gondii infection among pregnant women in Mampong Municipality, Ghana. A cross-sectional design was used to recruit 201 pregnant women from six health facilities conveniently. Participants’ socio-demographics, clinical and environmental data were collected using a structured questionnaire. Using 2 ml of blood, T. gondii seroprevalence was determined by the TOXO IgG/IgM Rapid Test Cassette. Data was analyzed using descriptive and logistic regression analysis with SPSS version 27 to determine the prevalence and associations of T. gondii infection with other variables, respectively. The seroprevalence of T. gondii was 49.75%, of which 40.30%, 2.49%, and 6.97% tested positive for IgG, IgM, and IgG/IgM, respectively. Co-infection of toxoplasmosis with viral hepatitis B, human immunodeficiency virus (HIV), and syphilis rates were 15%, 1%, and 4%, respectively and were not risk factors for T. gondii transmission. Educational level and residential status were associated with toxoplasmosis [p T. gondii infections compared to a lower level of education [AOR = 0.39 (0.13, 0.99) p = 0.049]. Similarly, the risk of T. gondii infection was significantly lower among individuals residing in peri-urban [AOR = 0.13 (0.02–0.70), p = 0.02] and urban areas [AOR = 0.10 (0.02–0.78), p = 0.03] compared to those in rural areas. Backyard animals with extensive and semi-intensive systems, without veterinary care, and contact with animal droppings and water sources were significant risk factors for T. gondii infection [p T. gondii infection [p T. gondii infection was high among the study population, posing a risk of mother-to-child transmission. Key risk factors included low education, rural residence, backyard animal exposure, poor hygiene, and unsafe water sources. Toxoplasmosis was associated with miscarriage; thus, integrating it into routine antenatal screening could improve pregnancy outcomes. Health promotion interventions such as education on zoonotic risks, improved sanitation, safe water practices, and veterinary care for domestic animals are recommended to reduce infection risk among pregnant women.by Mohammed O. Khabour, Owais Omar Tarabsheh, Bilal M. Al-zu’bi, Omar F. Khabour, Rami Saadeh
Studies have reported a strong relationship between climate change and human health. Medical students’ knowledge and attitudes toward the impact of climate change on health are crucial to fostering their environmental stewardship. Therefore, the aim of this study was to examine the awareness and attitudes of medical students in Jordan toward climate change and human health. The study was cross-sectional in design, anonymous, self-reported, and used a closed-ended questionnaire. The study included 837 students from various medical specialties, including medicine, dentistry, applied medical sciences, pharmacy, and nursing. Statistical analysis involved cross-tabulations and regression analysis. About 46.3% of students reported good awareness of the health impacts of climate change, while 44.8% reported somewhat awareness. This awareness was found to be associated with female gender (P = 0.003) and university level (Pby José C. Langa, Mohsin Sidat, Jahit Sacarlal, Troy D. Moon
Laboratory diagnosis for cryptococcal disease among HIV-infected patients remains a challenge in most low- and middle-income countries (LMIC). Difficulties with sustained access to cryptococcal rapid tests is cited as a major barrier to the routine screening for cryptococcus in many LMIC. Thus, clinicians in these countries often resort to empirical treatment based solely on clinical suspicion of cryptococcosis. To address this challenge, we aim to evaluate the re-introduction of India ink testing for diagnosis of cryptococcosis among HIV-infected patients in southern Mozambique. India ink testing was historically a common first choice, low-cost, laboratory diagnostic tool for cryptococcal infection. This study uses implementation science methods framed by the Dynamic Adaption Process (DAP) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) conceptual frameworks to develop a multi-phase, stepped-wedged trial using mixed-methods approaches. The study will be conducted in six hospitals from southern Mozambique over a period of 15 months and will include the following phases: pre-implementation (baseline assessment), Adaptation-implementation (gradual introduction of the intervention), and post-implementation (post-intervention assessment). This study aims to promote the use of India Ink staining as a cheap and readily available tool for cryptococcosis diagnosis in southern Mozambique. Lessons learned in this study may be important to inform approaches to overcome the existing challenges in diagnosis of cryptococcosis in many LMICs due unavailability of readily diagnostic tools. Trial registration: ISRCTN11882960, Registered 06 August 2024.by Abdallah Tageldein Mansour, Safaa I. Khater, Hemmat M. Eissa, Helal F. Al-Harthi, Areej A. Eskandrani, Mohammed Ageeli Hakami, Wafa S. Alansari, Amirah Albaqami, Hanan M. Alharbi, Tarek Khamis, Doaa Ibrahim
The medicinal application of pomegranate peel extract enriched with polyphenols (PPE) as a therapeutic strategy for managing inflammatory bowel diseases (IBD) is still limited. Integrating pomegranate peel extract (PPE) into an effective nanocarrier system could enhance its mechanistic actions, potentially aiding in the remission of colitis. Therefore, this approach aimed to enhance PPE’s stability and bioavailability and investigate mitigating impact of pomegranate peel extract-loaded nanoparticles (PPE-NPs) in a colitis model. Colonic injury was induced by 5% dextran sulfate sodium (DSS) and efficacy of disease progression after oral administration of PPE-NPs for 14 days was assessed by evaluating clinical signs severity, antioxidant and inflammatory markers, expressions of endoplasmic reticulum associated genes and histopathological and immunostaining analysis in colonic tissues. Clinical signs and disease activity index were effectively reduced, and the levels of fecal calprotectin were decreased in groups treated with PPE-NPs compared to DSS group. The colitic group showed a significant increase (P IL-17, TNF-α, and IL-1β (increased up to 2.99, 4.36 and 4.90 respectively unlike PPE-NPsIII that recorded reduced levels of CRP, MPO and NO (8,96, 78.30 and 123 nmol/g tissue respectively) and much lower (P CHOP, JUNK, ATF6, BIP, and Elf-2) and immunostaining expression regulation of key markers regulating autophagy (Beclin-2) in this group. The histopathological changes in the colon were less severe in the PPE-NPs received groups (especially at the level of 150 mg/kg) compared to DSS group. Collectively, these findings suggest that the nanoencapsulation of PPE enhances its effectiveness in promoting recovery of colonic tissue damage and achieving remission of colitis.by Biniyam Tedla Mamo, Zelalem Tazu Bonger, Feyissa Regassa Senbato, Tadesse Eguale, Kibrewossen Kiflu Akililu, Samuel Muluye Welelaw, Eden Dagnachew Zeleke, Asrat Demtse, Turegne Assefa, Ruth Woldeyohannes Yirgu, Zelalem Mekuria, Joan-Miquel Balada-Llasat, Shu-Hua Wang
BackgroundNeonatal sepsis is a leading cause of mortality and morbidity. To improve the clinical outcomes of neonates with sepsis, treatment should be based on bacteriological identification and antibiotic susceptibility. This study aims to assess the proportion of culture-positive gram-negative bacteria (GNB), the antibiotic susceptibility patterns, and treatment outcomes of neonatal sepsis at two neonatal intensive care units (NICUs) in Addis Ababa.
MethodsA retrospective observational study was conducted among gram-negative sepsis suspected neonates admitted at Zewditu Memorial Hospital and Tikur Anbessa Specialized Hospital NICUs from January to December 2023. All neonates who were suspected of having sepsis were included in this study. Standard microbiological culture and biochemical tests were used to identify bacterial species and the Kirby-Bauer disc diffusion assay using Mueller-Hinton agar was employed to test the antimicrobial susceptibility of bacterial isolates as per Clinical Laboratory Standard Institute guidelines. Descriptive statistics were used to describe the study variables. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with the treatment outcomes of neonatal sepsis. A p-value Results
A total of 933 neonates were diagnosed with sepsis during the study period, of which 166 neonates were enrolled in the study for gram-negative sepsis: 84 (51%) were female and 97 (58%) had early onset sepsis. The median length of hospital stay was nine days with interquartile range of 16 days. The predominant GNB identified was Klebsiella spp. (n = 89; 49%), followed by Acinetobacter spp. (n = 38; 21%) and Escherichia coli (n = 19; 11%). In both hospitals, Klebsiella spp. was resistant to most of the routinely prescribed antibiotics: (n = 68; 89%) were resistant to ceftriaxone, (n = 56, 89%) cefepime and (n = 60; 75%) to gentamicin. Lower rates of resistance were recorded for other antibiotics such as ciprofloxacin (n = 12; 18%), ertapenem (n = 11; 16%), meropenem (n = 9; 13%), and amikacin (n = 3; 4%). A total of 92 (55%) neonates with the GNB isolated in the current study had multidrug-resistant (MDR) organisms. The study found that newborns with MDR infections were five times more likely to experience poor treatment outcomes compared to those with non-resistant strains (AOR, 5.23 95% CI [2.59, 11.11]). In addition, newborns who stayed less than seven days, compared to those who spent seven or more days in the hospital was four times (AOR: 4.16, 95% CI (2.0–9.01) more likely to experience poor health outcomes.
ConclusionKlebsiella spp. was the most common GNB isolated from the NICUs. More than half neonatal sepsis was caused by MDR organisms and associated with significant poor treatment outcomes. high prevalence of MDR-gram-negative bacteremia is alarming and highlights the need for the implementation of routine surveillance and infection control measures to decrease morbidity and mortality and to combat the development of antimicrobial resistance.
Preventing pressure injuries is a primary objective for care and treatment teams in intensive care units (ICUs). Therefore, the current study aimed to compare the efficacy of Zinc Oxide and Vaseline prophylactic dressings in preventing sacral pressure injuries in patients admitted to the ICU. This clinical trial was conducted in the ICU in 2023. The study population included patients at moderate to high risk for pressure injuries based on the Braden scale criteria. Eligible patients were randomly assigned to one of five groups using random allocation software: (1) the intervention group receiving Zinc Oxide as a prophylactic dressing, (2) the intervention group using Zinc Oxide as a topical application, (3) the intervention group with Vaseline as a prophylactic dressing, (4) the intervention group using Vaseline as a topical application and (5) the control group. Participants were homogenous regarding demographic information in all five groups. The frequency distribution of pressure injuries across the five groups was analysed using the Chi-square test. The results revealed no pressure injuries were observed in the Zinc Oxide and Vaseline with dressing groups. In contrast, the Zinc Oxide without dressing group had five cases, the Vaseline without dressing group had six cases and the Control group had 14 cases of pressure injuries. These differences were statistically significant (p < 0.05). The results of this study showed that Zinc Oxide and Vaseline as preventive dressings in the sacral area of patients admitted to ICUs can be considered an effective and affordable strategy for healthcare providers.
by Patrice Whitehorne-Smith, Kunal Lalwani, Robyn Martin, Gabrielle Mitchell, Ben Milbourn, Wendel Abel, Sharyn Burns
Chronic physical illnesses (CPI) are highly prevalent among people with serious mental illnesses (PWSMI) yet people in this population experience significant challenges accessing healthcare. This study utilised a constructivist grounded theory approach to collect and analyse data related to the enablers and barriers to public healthcare access for PWSMI & CPI. Data were collected through semi-structured interviews conducted with fifty-seven participants comprising PWSMI &CPI and their caregivers, health policymakers, primary care physicians, psychiatrists, and mental health nurses. Enablers and barriers to healthcare access were represented using a socio-ecological model consisting of five levels: wider society, health system, clinician, family and community, and individual. Jamaica’s free public healthcare system was the most pronounced enabler of healthcare access, while poverty, stigma, and discrimination were the most pronounced barriers. Factors such as social support, time, clinician beliefs, attitudes and training, and individual characteristics were identified as consisting of dimensions that were both enablers and barriers to healthcare access. These findings indicated that factors that influenced healthcare access for PWSMI & CPI were aligned with the social determinants of health. Improved healthcare access for PWSMI & CPI necessitates strategies that incorporate a multi-sectoral approach to address social and environmental factors influencing healthcare access across all levels of the socio-ecological model.by Molalign Gualu Gobena, Maru Zewdu Kassie
IntroductionModern contraceptive methods are a scientifically effective method to control the fertility of reproductive-aged groups of people. The women’s use of contraceptive methods creates a birth gap and limits the number of their children. The main objective of this study is to identify the significant determinant of modern contraceptive use of reproductive-aged women in Ethiopia.
MethodsWe used data from 2019 Ethiopian Mini Demographic and Health Survey. This data was multi-level, taking into account factors at the individual and community levels. In order to capture the multi-level structure of this data and make more reliable and broadly applicable conclusions about the variables influencing the use of modern contraceptives at the individual and community levels, we employed a two-level mixed-effects logistic regression model. In addition, we used cross-tabulation analysis to know the percentage of modern contraception users (reproductive-aged women) across their socio-economic, demographic, and health characteristics. A total of 8196 reproductive aged (15–49) women were included in this study.
ResultsFrom a total of 8196 reproductive-aged women, 2495(30.4%) were using modern contraceptive method and the rest 5701(69.6%) did not use any modern contraceptive methods. Among 2495 contraceptive users, 1657 (67.3%) used injections and 533 (21.7%) used implants/Norplant. At a 5% level of significance, the result from the two-level binary logistic regression model revealed that the predictors; Age of women, education level, religion, wealth index, knowledge of modern contraception method, number of died children, number of living children, family size, total children ever born and contextual region have significant effect on the use of modern contraception method.
ConclusionReproductive-aged women in Ethiopia with more living children, residing in urban/agrarian region, younger, wealthier, married, and more educated, were more likely to be modern contraceptive users. The concerned bodies in Ethiopia should bring forward the intervention strategy and should expand the existed programs to improve the use of modern contraception methods among reproductive-aged women in Ethiopia. Especially, they should give special attention to reproductive-aged women of less income, resident in pastoralist region, less educated, unmarried, and haven’t living child.
by Najam ul Hasan Abbasi, Ahmad Bilal, Khair Muhammad, Saba Riaz, Shakeela Altaf
The previous studies have found an association between Big Five personality traits and postpartum depression in women. The present study aimed to find out an association between Big Five personality traits and postpartum depression in a sample of Pakistani fathers. A total of 400 Pakistani fathers who had birth of a child in the past 1 month to 1 year period and had been living with their married partners were recruited purposively by using Google Form based survey from the major cities of Pakistan. The Urdu translated versions of Big Five Personality Inventory (BFI) and Edinburgh Postnatal Depression Scale (EPDS) were used as the main outcome measures to assess the relationship between personality traits and postpartum depression. The results found a significant negative and moderate association between Big Five personality traits and paternal postpartum depression except openness which had a weak association and neuroticism which had a positive and moderate association with PPPD (r(398) = .45). The multiple linear regression analysis found that Big Five personality traits significantly predicted paternal postpartum depression (F(5, 394) = 53.33, p = .001) except openness (B = .007, p = .98). The analysis of variance (ANOVA) found significant differences in paternal postpartum depression for age of father (F(2, 397) = 6.65, p = .001, ηp2 = .03), spouse age (F(2, 393) = 5.97, p = .003, ηp2 = .02), employment type (F(2, 395) = 9.69, p = .001, ηp2 = .04) and time spent at home (F(2, 397) = 6.23, p = .002, ηp2 = .03) while there were found no significant differences for education (F(2, 397) = 1.29, p = .27, ηp2 = .006), marital duration (F(2, 397) = 2.17, p = .11, ηp2 = .01), and birth number of recent child (F(2, 397) = 1.48, p = .22, ηp2 = .007). The study concluded that Big Five personality traits are significantly correlated with and predict paternal postpartum depression except openness which did not predict paternal postpartum depression. The occurrence of paternal postpartum depression varied significantly for age of father, age of spouse, type of employment and time spent at home.
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