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Diagnostic testing is an important tool to combat the COVID-19 pandemic, yet access to and uptake of testing vary widely 3 years into the pandemic. The WHO recommends the use of COVID-19 self-testing as an option to help expand testing access. We aimed to calculate the cost of providing COVID-19 self-testing across countries and distribution modalities.
We estimated economic costs from the provider perspective to calculate the total cost and the cost per self-test kit distributed for three scenarios that differed by costing period (pilot, annual), the number of tests distributed (actual, planned, scaled assuming an epidemic peak) and self-test kit costs (pilot purchase price, 50% reduction).
We used data collected between August and December 2022 in Brazil, Georgia, Malaysia, Ethiopia and the Philippines from pilot implementation studies designed to provide COVID-19 self-tests in a variety of settings—namely, workplace and healthcare facilities.
Across all five countries, 173 000 kits were distributed during pilot implementation with the cost/test distributed ranging from $2.44 to $12.78. The cost/self-test kit distributed was lowest in the scenario that assumed implementation over a longer period (year), with higher test demand (peak) and a test kit price reduction of 50% ($1.04–3.07). Across all countries and scenarios, test procurement occupied the greatest proportion of costs: 58–87% for countries with off-site self-testing (outside the workplace, for example, home) and 15–50% for countries with on-site self-testing (at the workplace). Staffing was the next key cost driver, particularly for distribution modalities that had on-site self-testing (29–35%) versus off-site self-testing (7–27%).
Our results indicate that it is likely to cost between $2.44 and $12.78 per test to distribute COVID-19 self-tests across common settings in five heterogeneous countries. Cost-effectiveness analyses using these results will allow policymakers to make informed decisions on optimally scaling up COVID-19 self-test distribution programmes across diverse settings and evolving needs.
Introducción. El objetivo de la siguiente revisión fue determinar los factores de riesgo asociados a las conductas suicidas (intento de suicidio, ideación suicida y suicidio consumado) en adolescentes. Metodología. La presente revisión de la evidencia se llevó a cabo utilizando varios estudios que se hayan publicado en los últimos 10 años en cualquier país a nivel mundial; la búsqueda de la información se realizó con el uso del término de texto libre “conducta suicida” en las bases de datos PubMed, Epistemonikos, Scielo y Dialnet, identificando un total de 424 artículos y de ellos, 12 estudios se incluyeron en esta investigación. Resultados. Se determinó que los principales factores de riesgo que están asociados con la conducta suicida a partir del análisis de la evidencia científica disponible son: ser mujer, antecedentes de suicidios en la familia, violencia familiar, ausencia de padres y grupo familiar, conflictos con los padres, trauma infantil, rechazo, acoso escolar, conflictos con los compañeros, dificultades académicas, influencia de los amigos o conocidos cibernéticos, bullying, problemas para regular las emociones, depresión, desesperación, tristeza, soledad, enfermedad física y mental, eventos estresantes, impotencia, abuso de sustancias psicoactivas y violencia física o psicológica. Discusión. La conducta suicida en los adolescentes continúa siendo una problemática multicausal frecuente de salud pública, los factores de riesgo para desarrollar el comportamiento suicida incluyen aspectos personales, familiares, académicos y sociales, con base a estos hallazgos se pueden construir planes de cuidado enfermero individualizados, ajustados a las necesidades de cada persona.
ABSTRACT
Introduction. The objective of the following review was to determine the risk factors associated with suicidal behaviors (suicide attempt, suicidal ideation, and completed suicide) in adolescents. Methodology. The present evidence review was carried out using several studies that have been published in the last 10 years in any country worldwide; the search for information was carried out using the free text term "suicidal behavior" in the databases PubMed, Epistemonikos, Scielo and Dialnet, identifying a total of 424 articles and of these, 12 studies were included in this research. Results. It was determined that the main risk factors associated with suicidal behavior from the analysis of the available scientific evidence are: being female, history of suicide in the family, family violence, absence of parents and family group, conflicts with parents, childhood trauma, rejection, school bullying, conflicts with peers, academic difficulties, influence of cyber friends or acquaintances, bullying, problems regulating emotions, depression, despair, sadness, loneliness, physical and mental illness, stressful events, helplessness, abuse of psychoactive substances, and physical or psychological violence. Discussion. Suicidal behavior in adolescents continues to be a frequent multicausal public health problem. The risk factors for developing suicidal behavior include personal, family, academic and social aspects; based on these findings, individualized nursing care plans can be constructed, adjusted to the needs of each person.
Commentary on: Suh M, Kim DH, Cho I, Ham OK. Age and gender differences in fall-related factors affecting community-dwelling older adults. J Nurs Res. 2023 Apr 1;31(2):e270. doi: 10.1097/jnr.0000000000000545.
Future research could explore and test the efficacy of gender-specific fall prevention protocols. In practice, understanding that there are gender-based risk factors for falls would assist and prompt nurses and health professionals to perform assessments or interventions to specifically mitigate those risks
Falls are an incredibly common issue among older adults, with potentially serious downstream consequences. Suh et al (2023) aimed to explore not only the prevalence of falls but also the factors relating to age, gender and falls. It is well established that there are gender differences in the prevalence of falls, however, the reasoning is not fully understood. This study was conducted to address the paucity in...
by Michala Sliefert, May Maloba, Catherine Wexler, Frederick Were, Yvonne Mbithi, George Mugendi, Edward Maliski, Zachary Nicolay, Gregory Thomas, Shadrack Kale, Nicodemus Maosa, Sarah Finocchario-Kessler
BackgroundCurrent formulations of pediatric antiretroviral therapy (ART) for children with HIV present significant barriers to adherence, leading to drug resistance, ART ineffectiveness, and preventable child morbidity and mortality. Understanding these challenges and how they contribute to suboptimal adherence is an important step in improving outcomes. This qualitative study describes how regimen-related challenges create barriers to adherence and impact families.
MethodsWe conducted key informant interviews (KIIs) with 30 healthcare providers and 9 focus group discussions (FGDs) with a total of 72 caregivers, across three public hospitals in Siaya and Mombasa Kenya. The KIIs and FGDs were audio recorded, translated, and transcribed verbatim. The transcripts were hand coded based on emergent and a-priori themes.
ResultsCaregivers discussed major regimen-related challenges to adherence included poor palatability of current formulations, complex preparation, and administration (including measuring, crushing, dissolving, mixing), complex drug storage, and frequent refill appointments and how these regimen-related challenges contributed to individual and intrapersonal barriers to adherence. Caregivers discussed how poor taste led to child anxiety, refusal of medications, and the need for caregivers to use bribes or threats during administration. Complex preparation led to concerns and challenges about maintaining privacy and confidentiality, especially during times of travel. Providers corroborated this patient experience and described how these challenges with administration led to poor infant outcomes, including high viral load and preventable morbidity. Providers discussed how the frequency of refills could range from every 2 weeks to every 3 months, depending on the patient. Caregivers discussed how these refill frequencies interrupted work and school schedules, risked unwanted disclosure to peers, required use of financial resources for travel, and ultimately were a challenge to adherence.
ConclusionThese findings highlight the need for improved formulations for pediatric ART to ease the daily burden on caregivers and children to increase adherence, improve child health, and overall quality of life of families.
Attention deficit hyperactivity disorder (ADHD) affects 5%–10% of paediatric population and is reportedly more common in children with type 1 diabetes (T1D), exacerbating its clinical course. Proper treatment of ADHD in such patients may thus provide neurological and metabolic benefits. To test this, we designed a non-commercial second phase clinical trial comparing the impact of different pharmacological interventions for ADHD in children with T1D.
This is a multicentre, randomised, open-label, cross-over clinical trial in children and adolescents with ADHD and T1D. The trial will be conducted in four reference paediatric diabetes centres in Poland. Over 36 months, eligible patients with both T1D and ADHD (aged 8–16.5 years, T1D duration >1 year) will be offered participation. Patients’ guardians will undergo online once-weekly training sessions behaviour management for 10 weeks. Afterward, children will be randomised to methylphenidate (long-release capsule, doses 18-36-54 mg) versus lisdexamphetamine (LDX, 30-50-70 mg). Pharmacotherapy will continue for 6 months before switching to alternative medication. Throughout the trial, the participants will be evaluated every 3 months by their diabetologist and online psychological assessments. The primary endpoint (ADHD symptom severity, Conners 3.0 questionnaire) will be assessed by a blinded investigator. Secondary endpoints will include HbA1c, continuous glucose monitoring indices and quality-of-life (PedsQL).
The trial is approved by Bioethical Committee at Medical University of Lodz and Polish regulatory agency (RNN/142/22/KE, UR/DBL/D/263/2022). The results will be communicated to the research and clinical community, and Polish agencies responsible for healthcare policy. Patient organisations focused on paediatric T1D will be notified by a consortium member. We hope to use the trial’s results to promote collaboration between mental health professionals and diabetes teams, evaluate the economic feasibility of using LDX in patients with both diseases and the long run improve ADHD treatment in children with T1D.
EU Clinical Trials Register (EU-CTR, 2022-001906-24) and NCT05957055.
by Chalachew Kassaw, Valeriia Demareva
BackgroundAcademic success is a measure of students’ ability to attain their educational objectives, often assessed through regular evaluations or examinations. To establish effective policies and programs that align with academic accomplishments, conducting comprehensive data analysis is pivotal. Hence, this systematic review aimed to synthesize the factors impeding the academic achievements of Ethiopian students in higher education.
MethodsA comprehensive review was conducted on studies involving Ethiopian university students from 2013 to 2022. The review encompassed 24 papers that were gathered from different databases like PubMed, Google Scholar, African Journals Online, Scopus, and Web of Science.
ResultsThe findings of this research revealed that inadequate classroom environments, experiencing dysmenorrhea, and engaging in excessive social media usage were all linked to a decline in academic performance. Conversely, adopting healthy sleep habits, achieving high scores in entrance exams, and avoiding recent substance abuse were all factors positively influencing academic success. In addition, there was a positive correlation between academic excellence and being a health science college student and age range of 20 to 24 years old.
ConclusionTo enhance academic performance, it is crucial to address the negative factors identified, such as inadequate classroom environments, dysmenorrhea, and excessive social media usage, while promoting positive factors like healthy sleep habits, high scores in exams, and avoiding substance abuse. Additionally, being a health science college student and belonging to the age range of 20 to 24 were found to be associated with academic excellence.
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