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To investigate the level of humanistic care ability of oncology nurses, its association with empathy and emotional intelligence, and the mediative role of emotional intelligence on empathy and humanistic caring ability.
This was a cross-sectional study conducted in a cancer hospital in China.
We enrolled a total of 1189 oncology nurses from several cancer hospitals from December 2023 to January 2024. All participants completed three general questionnaires: the Caring Ability Inventory, the Jefferson Scale of Empathy-Health Professionals and the Emotional Intelligence Scale.
The overall scores for the three scales were 202.35 ± 23.89, 112.38 ± 18.85 and 137.49 ± 17.81, respectively. A positive correlation was detected between caring ability, empathy and emotional intelligence (r = 0.741, p < 0.001; r = 0.577, p < 0.001). And emotional intelligence mediates the association between empathy and caring ability in oncology nurses (0.233, p < 0.001). The total and direct effect were also significant (0.825, p < 0.001; 0.592, p < 0.001).
The study findings indicated that oncology nurses exhibit a moderate level of caring ability. Emotional intelligence mediates the relationship between empathy and caring ability, at least in part. Therefore, an increase in the level of emotional intelligence in oncology nurses could improve their caring ability.
When designing training to improve humanistic care, we recommend the integration of specific training relating to empathy and emotional intelligence into the training system.
Oncology patients experience multiple forms of distress and require high-quality humanistic care. This study identified a moderate association between empathy and emotional intelligence. Our findings provide further recommendations for nurse leaders in medical institutions relating to how the humanistic care ability of oncology nurses can be improved by specific training in empathy and emotional intelligence.
This study was reported using the STROBE Checklist for cross-sectional studies.
Nurse leaders organised this survey in their own hospital.
by Priscilla Kapombe, Choolwe Jacobs, Mark W. Tenforde, Kashala Kamalonga, Diane Morof, Terrence Lo, Mweene Cheelo, Lloyd Mulenga, Sombo Fwoloshi, Cordilia M. Himwaze, Patrick Musonda, Mpundu Makasa, Jonas Z. Hines
Zambia has achieved improvements in life expectancy among persons living with HIV (PLHIV) because of high antiretroviral therapy (ART) coverage, which should improve survival due to reductions in AIDS-defining conditions. However, recent estimates of the most common causes of death are not widely available. We utilized mortality surveillance data to report on common causes of death among persons with HIV who died in community settings in Zambia. The Zambian Ministry of Health conducted sentinel mortality surveillance of community deaths in 45 hospitals in 33 of 116 districts from January 2020 through December 2023. Verbal autopsies (VA) were conducted through interviews with relatives or close associates of deceased persons using the 2016 World Health Organization tool. HIV status was reported. A probable cause of death was assigned by a validated computer algorithm (InterVA5). We describe the top assigned causes of death stratified by HIV status. Verbal autopsies were conducted for 67,079 community deaths, of which 11,475 (17.1%) were persons with HIV. The mean age at death was 45 years among persons with HIV and 48 years for persons without HIV (T-test pby Yinyin Wu, Wei Ding, Yuying Liu, Qianhong Deng, Fengqin Tao, Hanbin Chen, Chang Chen, Meng Xiao, Bilong Feng
BackgroundStandardized guidelines for optimal tunnel length in tunneled peripherally inserted central catheters (PICCs) are lacking.
ObjectivesThe objective of this study was to evaluate the real-world impact of tunnel length on clinical outcomes.
MethodsThis retrospective cohort study included 207 cancer patients who received tunneled PICCs, categorized into a control group (tunnel length > 4 cm, n = 134) and an observation group (tunnel length ≤ 4 cm, n = 73). Propensity score matching (PSM) was used to address baseline heterogeneity. Cox regression analyses were used to assess the risk of complication during a 120-day follow-up.
ResultsCompared to the control group (tunnel length > 4 cm), the observation group (tunnel length ≤ 4 cm) had a significantly higher adjusted overall complication risk (HR = 2.92, 95% CI: 1.07–7.94, P = 0.036) and unplanned catheter removal rate (4.4% vs. 0.0%, P = 0.027), confirming the safety of longer tunnels despite comparable comfort levels between groups. After PSM, Cox regression analysis showed results consistent with those from the unmatched cohort. Subgroup analyses revealed a reduced risk of complications with longer tunnels in patients with BMI ≤ 25 kg/m² (HR = 0.29, 95% CI: 0.11–0.82), without hypertension (HR = 0.36, 95% CI: 0.13–1.00), without diabetes (HR = 0.38, 95% CI: 0.15–0.97), and with solid tumors (HR = 0.31, 95% CI: 0.11–0.85).
ConclusionThe results show that tunnel lengths > 4 cm reduce overall complications and prolong catheter retention, supporting the implementation of standardized protocols while advocating for personalized adjustments based on BMI, comorbidities, and cancer type.
by Lei Guo, Jun Ge, Li Cheng, Xinyi Zhang, Zhengzheng Wu, Meili Liu, Hanmei Jiang, Wei Gong, Yi Liu
BackgroundThe incidence of ulcerative colitis (UC) remains high, with an increasing prevalence among elderly patients. Cellular senescence has been widely recognized as a contributor to UC susceptibility; however, the underlying molecular mechanisms remain incompletely understood. This study aimed to identify senescence-associated biomarkers in UC to provide new insight for diagnosis and treatment.
MethodsBy integrating transcriptomic data from UC patients with established aging-related databases, we identified aging-associated differentially expressed genes (DEGs). Using weighted gene co-expression network analysis (WGCNA) and Cytoscape, we pinpointed the core genes involved. A diagnostic model for UC was then developed based on these core genes, and their expression patterns were characterized at single-cell resolution. The roles of these genes were ultimately validated through in vitro and animal experiments.
ResultsWe identified 24 aging-related DEGs in UC, which were primarily implicated in inflammatory responses and cytokine-receptor interactions. Further analyses pinpointed three core genes (CXCL1, MMP9, and STAT1) that were predominantly expressed in macrophages. A diagnostic model constructed using these genes exhibited robust predictive performance. Experimental validation confirmed that the expression levels of all three core genes were significantly upregulated in both a UC mouse model and in macrophages compared to controls. Additionally, pathway analyses revealed elevated levels of CXCL12 and VEGFA in the enriched pathways.
DiscussionOur findings underscore the pivotal roles of CXCL1, MMP9, and STAT1 in UC-associated cellular senescence. The analysis positions these molecules as promising macrophage-mediated diagnostic biomarkers and therapeutic targets. Collectively, this work provides novel insights into UC pathogenesis and lays a foundation for developing precision medicine strategies that target senescence pathways.
by Bing-Nan Zhao, Zi-Yang Xie, Jia-Ning Liu, Xiao-Ran Chen, Xin-Xin Wang, Jia-Yi Li, Rui Zhang, Chao Si
Fermented spent coffee grounds (FSCG) serve as a valuable soil amendment to improve soil structure and fertility, while earthworms play a well-established role in enhancing soil processes and plant growth. However, their combined effects on bioactive compound accumulation in medicinal plants remain unclear. This study investigated the individual and interactive effects of FSCG (0%, 10%, and 20%, v/v) and earthworms (with and without Pheretima guillelmi) on the growth and phytochemical content of Glechoma longituba, a common medicinal herb, under greenhouse conditions. Results showed that 10% FSCG generally promoted plant growth, whereas 20% FSCG generally enhanced the accumulation of total flavonoids, chlorogenic acid, and soluble protein. Earthworms enhanced aboveground biomass and node number but significantly reduced chlorogenic acid content. These findings highlight the potential of FSCG as a sustainable soil amendment in medicinal plant cultivation and underscore the need to consider earthworm activity when optimizing both plant biomass and phytochemical quality.by Helena Tinnerholm Ljungberg, Martina Wallberg, Emmanuel Aboagye, Gunnar Bergström, Christina Björklund, Lydia Kwak, Susanna Toivanen, Irene Jensen
The prevalence of telework increased dramatically during the COVID-19 pandemic, and today it is not uncommon to refer to hybrid work as “the new normal” in work life. Leadership plays a pivotal role in hybrid work transitions, underscoring the need for research on post-pandemic managerial practices. This qualitative interview study with 15 professional service managers at a Swedish medical university, working in either central administration or a research department, provides a nuanced understanding of the experiences of implementing hybrid work in a higher education setting. The qualitative content analysis resulted in three main themes and six sub-themes: New ways of organising work (sub-themes: Hybrid work brings new opportunities and needs, and Hybrid work as an ongoing process of change); Changes for employees (sub-themes: Social interaction and sense of community, and Increased work-life balance); and Changes in leadership (sub-themes: Communication with employees and New expectations on managers). The findings of this study provide a more fine-grained understanding of how managers experienced both challenges and opportunities in implementing and managing hybrid working arrangements. Challenges included managing employee expectations and relations, while opportunities included potential improvements in work-life balance. A key conclusion of this study is that managers in hybrid work environments adjust their leadership, especially when communicating and managing relationships within teams and across the organization. Despite the identified challenges and despite managers’ wish to see their employees in person and on site, the interviewed managers are generally optimistic about hybrid work and see it as the future. To address the identified challenges, managers may benefit from networking and exchanging information with other managers in similar situations, as well as support from their organisation.by Bita Eshraghi, Jonas Hermansson, Lena Marions
IntroductionThe impact of female genital mutilation (FGM) on obstetric outcomes in high-income countries remains unclear and is an area of ongoing research. This nationwide study aimed to examine the risk of emergency cesarean section among primiparous women from countries where FGM is practiced, in comparison to Swedish-born women. Additionally, the study explored whether a confirmed diagnosis of FGM contributes to this potential risk.
Materials and methodsA Swedish nationwide cohort study including primiparous singleton term deliveries (≥37 + 0– Results
Women born in FGM-practicing countries (n = 13 246) had a significantly increased risk of emergency cesarean section (aOR 1.28, 95% CI: 1.21–1.35) compared to Swedish-born women (n = 199 914). Including FGM diagnosis as a covariate did not alter the result. When excluding women born in FGM-practicing countries outside Sub-Saharan Africa the aOR was amplified (aOR 1.58, 95% CI: 1.47–1.69). To further isolate the effect of FGM itself, we restricted the analysis to women born in FGM-practicing countries and compared those with a recorded FGM diagnosis to those without. This analysis showed no significant association between FGM diagnosis and emergency cesarean section (aOR 1.05, 95% CI: 0.90–1.23).
ConclusionsPrimiparous women from FGM-practicing countries have an increased risk of emergency CS compared to Swedish-born women, when giving birth in Sweden. The presence of FGM diagnosis did not contribute to this risk. Further research is needed to understand the underlying mechanisms for this to be able to improve obstetric care for migrant populations.
Stroke is a global health concern. A timely response to a stroke can help reduce morbidity and mortality. However, barriers to timely response include poor recognition of stroke symptoms. Stroke symptom messages are designed to increase stroke recognition and encourage individuals to seek urgent medical assistance. The Face, Arm, Speech, Time (FAST) and Balance, Eyes, Face, Arm, Speech, Time (BE FAST) are commonly used stroke symptom messages shown to improve stroke symptom recognition and response. However, cultural factors and language differences may limit the effectiveness of stroke symptom messages and their acceptability in different countries and contexts. There has not been a comprehensive examination of the stroke symptom messages used worldwide and how these messages have been adapted in various settings.
We explored what stroke response messages are being used globally, and the contextual factors that influence the adoption of a stroke response mnemonic in different settings.
A 14-item survey was disseminated by the World Stroke Organization to its networks. The survey contained open- and closed-ended questions and allowed uploading relevant stroke symptom campaign materials. The survey was analyzed using descriptive statistics and a content analysis.
All except one survey respondent used a stroke symptom message. Fifteen respondents (27%) reported they did not translate their stroke awareness messaging. Of these 15 respondents, they used the English versions of FAST (n = 8), BE FAST (n = 4), and both FAST and BE FAST (n = 3). Forty respondents (71%) reported that they/their organization used an acronym to raise public awareness of the signs/symptoms of stroke that was different from FAST or BE FAST (English), many of which were direct or indirect translations or influenced by FAST and BE FAST. Survey responses shared insights and recommendations related to the content, tailoring and dissemination of stroke symptom messages.
Study findings highlight the global use of stroke symptom messages and their contextual adaptations to fit diverse settings and contexts. The challenges in applying universal or commonly used stroke symptom messages to different contexts were highlighted.
Nurses could have a key role in raising awareness of stroke symptoms and the development of locally adapted stroke symptom messages.
Commentary on: Taylor SP, Kowalkowski MA, Skewes S, Chou SH. Real-world implications of updated surviving sepsis campaign antibiotic timing recommendations. Crit Care Med. 2024 doi: 10.1097/CCM.0000000000006240.
Implications for practice and research Antibiotic delivery in suspected sepsis must be prioritised within the clinical context emphasising the need to individualise antibiotic timing according to patient profiles. In the absence of shock, a more lenient approach to antibiotic timing could support the rational use of antibiotics.
Sepsis is a life-threatening response to infection and remains a critical challenge with high morbidity and mortality rates. The Surviving Sepsis Campaign (SSC) guidelines serve as a cornerstone for sepsis management and are pivotal in standardising care. Taylor et al’s article
Commentary on: Velthuijs ELM, Jacod BC, Videler-Sinke L, et al. Outcome of induction of labour at 41 weeks with Foley catheter in midwifery-led care. Midwifery 2024 Aug;135:104026. doi: 10.1016/j.midw.2024.104026. Epub 9 May 2024. PMID: 38781793.
Implications for practice and research Performing induction of labour with a Foley catheter and subsequent amniotomy in midwife-led care is associated with worse neonatal outcomes and equivalent maternal outcomes compared with consultant-led care. Future research should further explore the cost-effectiveness, feasibility and neonatal outcomes associated with midwife-led care in different patient populations.
Although care for low-risk births in the Netherlands is primarily conducted by midwives, the use of consultant-led care has been increasing for a variety of indications, leading to a high patient burden for consultants. The induction of labour (IOL) of late-term pregnancies has historically been an indication for consultant-led care. This study by Velthuijs et...
Commentary on: Hunt K, Davies A, Fraser A, Burden C, Howell A, Buckley K, Harding S, Bakhbakhi D. Exposure to microplastics and human reproductive outcomes: A systematic review. BJOG. 2024 Apr;131(5):675-683. doi: 10.1111/1471-0528.17756. Epub 2024 Jan 29. PMID: 38287142.
Implications for practice and research Plastic exposure may be associated with increased deposition of microplastics in reproductive tissues, and the quantity of microplastics in these tissues may lead to adverse clinical outcomes. Future research should aim to provide high-quality, generalisable evidence to further demonstrate the impact of plastic exposure and microplastics on reproductive outcomes in humans.
As a result of the mass scale of production of plastics since the 1950s, microplastics, defined as particles 1 Microplastics have been linked to reproductive toxicity in both cell culture...
Commentary on: Kosola S, Mproa S, Holoapaine E. Smartphone use and well-being of adolescent girls: a population-based study. Arch Dis Child, 2024; 109: 576–581
Implications for practice and research Smartphone addiction may contribute to the increase in anxiety disorders in adolescent girls; peer engagement activities and tech-free zones may help reduce smartphone use. Providing support and advice relating to smartphone use for young people is everyone’s responsibility; solely relying on mental health services to address smartphone addiction is not realistic.
The prevalence of anxiety disorders, particularly in adolescent girls, is increasing; smartphone addiction is a potential causal factor. Kosola et al
This population-based study recruited over a thousand adolescent girls from 21 socially diverse schools who completed online...
Self-treatment of benign symptoms using hot water bottles, steam inhalation or hot tea is common in households and poses risks of severe scald injuries. This study aims to investigate associated hazards and identify high-risk patient groups to facilitate targeted prevention. A retrospective, single-center descriptive study was conducted on adult burn patients with scald injuries from hot water bottles, steam inhalation or hot tea. Demographic information, injury mechanism and outcomes were analysed. A total of 43 patients (mean age: 37.5 years; female:male ratio 23:20) were included. Injuries were caused by hot water/tea (37.2%), steam (34.9%) and hot water bottles (27.9%). The average burned total body surface area (TBSA) was 4%, with 79.1% of injuries being superficial partial-thickness burns. Surgical intervention was required in 13.9% of cases. Hot water bottle injuries predominantly affected young females (75%, mean age 32.6 years), with a high incidence of genital burns (58.3%). Hot tea-related injuries were more frequent in older males (62.5%, mean age 41.6 years), involving greater TBSA (6.5%) and a higher necessity for skin grafting (18.8%). Common self-treatment strategies can cause serious scalds, particularly in specific demographic groups, thereby burdening healthcare systems. Awareness of these risks is pivotal for effective education and prevention.
by Thomas C. Scheier, Richard Whitlock, Mark Loeb, Philip James Devereaux, Andre Lamy, Michael McGillion, MacKenzie Quantz, Ingrid Copland, Shun-Fu Lee, Dominik Mertz
Sternal surgical site infections after cardiac surgery can lead to significant morbidity, mortality, and cost. The effects of negative pressure wound management and adding vancomycin as perioperative antimicrobial prophylaxis are unknown. The PICS-PREVENA pilot/vanguard trial, a 2x2 factorial, open label, cluster-randomized crossover trial with 4 periods, was conducted at two major cardiac surgery hospitals in Ontario, Canada. Sites were randomized to one of eight sequences of the four study arms (Cefazolin or Cefazolin + Vancomycin (not analyzed) and standard wound dressing or a negative pressure 3M Prevena incision management system (Prevena). Only diabetic or obese patients were eligible for the latter comparison. This trial investigated feasability including adherence to protocol of each intervention (goal: > 90% each) and loss to follow-up (goal:by Mi Lv, Hui Che, Jiayan Hu, Wenxi Yu, Zhaoxia Liu, Xiaolin Zhou, Binduo Zhou, Jinyi Xie, Fengyun Wang
BackgroundThe overlap between non-erosive reflux disease (NERD) and epigastric pain syndrome (EPS, a subtype of functional dyspepsia) is common, yet its associated factors remain poorly defined. We aimed to identify factors associated with symptom severity in NERD-EPS overlap, focusing on psychosocial and somatic factors.
MethodsIn this multicenter cross-sectional study, 800 patients meeting Rome IV criteria for NERD-EPS overlap were enrolled. Standardized questionnaires assessed gastrointestinal symptoms (GSRS), somatic symptoms (PHQ-15), anxiety/depression (PHQ-4), and sleep quality (SRSS). Multivariable regression models identified factors independently associated with GSRS scores, adjusted for demographics and clinical covariates. Interaction terms were tested to assess whether the association between one factor and GSRS scores varied across different levels of another factor.
ResultsOf the 800 patients, 67% were female, and the mean age was (44.50 ± 14.43) years. 67% had mild or more sleep problems, and 47% had anxiety or depression. Somatic symptoms (PHQ-15) showed the strongest association with GSRS scores (β = 0.617, P P P = 0.026). Urban residence (β = 0.071) and mixed labor type (β = −0.066) were also independently associated with symptom burden.
ConclusionSomatic symptoms, psychological distress, and sleep disturbances were the factors most strongly associated with symptom severity in NERD-EPS overlap, with additional contributions from younger age, male sex, and urban residence. Our findings advocate for integrated biopsychosocial interventions to alleviate symptom burden in this population.
by Hellen W. Kinyi, Charles Kato Drago, Lucy Ochola, Gertrude N. Kiwanuka
Macronutrients serve as principal sources of energy, structural components, and regulators of physiological processes. However, the optimal macronutrient combination for health remains unclear. While previous studies indicate that dietary macronutrient composition influences immune function, many have examined individual nutrients in isolation, failing to reflect the interactive effects of macronutrients. This study addresses this gap by examining how varying ratios of dietary carbohydrates, proteins, and lipids modulate serum cytokine responses to lipopolysaccharide challenge in Swiss albino mice. Male and female Swiss albino mice (n = 6 per group), aged 6–8 weeks, were randomly assigned to six purified isocaloric diets with differing macronutrient ratios for 15 weeks. Body weights were monitored to assess nutritional status. Serum levels of TNF-α, IL-6, IL-1β, and IL-10 were measured in unchallenged mice and after three hours of intraperitoneal LPS administration. Mice fed high-carbohydrate, low-protein diets had the highest weight (33.1 g ± 1.1), while those on high-lipid, low-protein diets had the lowest (28.3 g ± 0.6). Plasma levels of TNF-α and IL-10 varied significantly (pby Ying Li, Jing Jia, Runze Lu, Liyan Dong, Lizhu Fang, Litao Sun, Zongyi Zhang, Qing Duan, Lijie Zhang, Kunzheng Lv, Huilai Ma
BackgroundQingdao, a historically high-risk area for hemorrhagic fever with renal syndrome (HFRS) in China, is undergoing agricultural mechanization and urbanization. However, the specific risk factors for HFRS in this context remain unclear. This study sought to determine the risk factors for HFRS in Qingdao.
MethodsCommunity-based, 1:2 case-control study. Each case was matched with two healthy neighborhood controls based on biological sex, age, and the same neighborhood or village. Univariate and multivariate conditional logistic regression analyses were performed. Furthermore, stratified analyses were performed to explore risk factor heterogeneity between the peak season for Hantaan virus (HTNV) type HFRS (October-January) and other months.
Results93 cases (73.2%, 93/127) reported from January 2022 to September 2023 and 186 controls completed this questionnaire. Farmers accounted for the highest proportion (68.8%, 64/93). In multivariate logistic regression analysis, there were three significant risk factors for HFRS: piles of firewood and/or grain in residential yards (odds ratio [OR]=3.75, 95% CI: 2.14–6.55), mite and/or flea bites (OR=1.83, 95% CI: 1.06–3.18) and contacting with rats and/or their excreta (OR=1.73, 95% CI: 1.09–2.74); three variables represented significant protective factors for HFRS: frequency of sun exposure for quilts and bedding (OR=0.41, 95% CI: 0.19–0.90), rodent control measures at home (OR=0.50, 95% CI: 0.30–0.81) and knowing the main sources of HFRS transmission (OR=0.58, 95% CI: 0.36–0.90). Stratified analysis revealed that the influence of these factors varied by season, with rodent contact and control measures being particularly salient during the HTNV peak season.
ConclusionThis study provides the first comprehensive evidence of risk and protective factors for HFRS in Qingdao, highlighting the role of rodent control, promoting comprehensive health education, environmental management, and personal protection. However, the results should be interpreted considering the study’s limitations, including a 73.2% response rate and the potential for recall bias.
by Qian Yue Tan, Kinda Ibrahim, Helen C. Roberts, Khaled Amar, Simon D.S. Fraser
BackgroundPeople with Parkinson’s (PwP) and their caregivers have to manage multiple daily healthcare tasks (treatment burden). This can be challenging and may lead to poor health outcomes.
ObjectiveTo assess the extent of treatment burden in Parkinson’s disease(PD), identify key modifiable factors, and develop recommendations to improve treatment burden.
MethodsA mixed-methods study was conducted consisting of: 1) a UK-wide cross-sectional survey for PwP and caregivers using the Multimorbidity Treatment Burden Questionnaire (MTBQ) to measure treatment burden levels and associated factors and 2) focus groups with key stakeholders to discuss survey findings and develop recommendations.
Results160 PwP (mean age = 68 years) and 30 caregivers (mean age = 69 years) completed the surveys. High treatment burden was reported by 21% (N = 34) of PwP and 50% (N = 15) of caregivers using the MTBQ. Amongst PwP, higher treatment burden was significantly associated with advancing PD severity, frailty, a higher number of non-motor symptoms, and more frequent medication timings (>3 times/day). Caregivers reporting higher treatment burden were more likely to care for someone with memory issues, had lower mental well-being scores and higher caregiver burden. Three online focus groups involved 11 participants (3 PwP, 1 caregiver and 7 healthcare professionals) recruited from the South of England. Recommendations to reduce treatment burden that were discussed in the focus groups include improving communication. clear expectation setting, and better signposting from healthcare professionals, increasing education and awareness of PD complexity, flexibility of appointment structures, increasing access to healthcare professionals, and embracing the supportive role of technology.
ConclusionsTreatment burden is common amongst PwP and caregivers and could be identified in clinical practice using the MTBQ. There is a need for change at individual provider and system levels to recognise and minimise treatment burden to improve health outcomes in PD.
by Anne-Fleur Griffon, Loeïza Rault, Clément Tanvet, Etienne Simon-Lorière, Myrielle Dupont-Rouzeyrol, Catherine Inizan
BackgroundComparing the in vitro fitness of dengue virus (DENV) isolates is a pivotal approach to assess the contribution of DENV strains’ replicative fitness to epidemiological contexts, including serotype replacements. Competition assays are the gold standard to compare the in vitro replicative fitness of viral strains. Implementing competition assays between DENV serotypes requires an experimental setup and an appropriate read-out to quantify the viral progeny of strains belonging to different serotypes.
MethodsIn the current study, we optimized an existing serotyping qRT-PCR by adapting primer/probe design and multiplexing the serotype-specific qRT-PCR reactions, allowing to accurately detect and quantify all four DENV serotypes. We next developed an in vitro competition assay to compare the replicative fitness of two DENV serotypes in the human hepatic cell line HuH7.
FindingsThe qRT-PCR was specific, and had a limit of detection below 7.52, 1.19, 3.48 and 1.36 genome copies/µL, an efficiency of 1.993, 1.975, 1.902, 1.898 and a linearity (R²) of 0.99975, 0.99975, 0.99850, 0.99965 for DENV-1, −2, −3 and −4, respectively. Challenge of this multiplex serotype-specific qRT-PCR on mixes of viral supernatants containing known concentrations of strains from two serotypes evidenced an accurate quantification of the amount of genome copies of each serotype. Quantification of the viral progeny of each serotype in the inoculum and the supernatant of competition assays using the serotype-specific multiplex qRT-PCR unveiled an enrichment of the supernatant in DENV-1 genome copies, uncovering the enhanced replicative fitness of this DENV-1 isolate.
ConclusionsThis optimized qRT-PCR combined with a relevant cellular model allowed to accurately quantify the viral progeny of two DENV strains belonging to two different serotypes in a competition assay, allowing to determine which strain had a replicative advantage. This reliable experimental setup is adaptable to the comparative study of the replicative fitness of any DENV serotypes.
by Melissa M. Baker, Lyonel Nerolin Doffou Assalé, David Doledec, Romance Dissieka, Ahmenan Claude Liliane Konan, Agnes Helen Epse Assagou Mobio, Koffi Landry Kouadio, Oka René Kouamé, Ama Emilienne Yao, Hubert Zirimwabagabo
BackgroundWhile recent data on vitamin A deficiency (VAD) prevalence is lacking, the 2004 Côte d’Ivoire Nutrition and Mortality Survey reported that 26.7% of children aged 6–59 months were affected by VAD, and approximately 60% were at risk. Since 2016, the government has transitioned from mass campaigns to routine vitamin A supplementation (VAS) delivery integrated into health services. However, evidence on the cost-effectiveness of the routine distribution approaches is limited. This study evaluated the cost, coverage, and cost-effectiveness of three routine VAS delivery strategies across two health districts in northern Côte d’Ivoire.
MethodsA mixed-methods study evaluated three routine VAS delivery strategies – routine-fixed, advanced community-based, and catch-up – across two health districts, Ferkessédougou and Niakaramadougou, in northern Côte d’Ivoire. The quantitative cost data were collected via a structured tool covering six cost categories: planning, procurement, training, social mobilization, distribution, and supervision. VAS coverage was assessed through a post-event coverage survey (PECS) via a two-stage cluster sampling methodology. A cost-effectiveness analysis determined the cost per child supplemented, the cost per DALY averted, and a sensitivity analysis tested the robustness of the findings under different cost scenarios.
ResultsThe total program cost for July-December 2023 was 25.5 million FCFA, with personnel costs comprising over 70% of expenditures. In Ferkessédougou, the routine advanced community-based strategy was the most cost-effective, at 458 FCFA per child in rural areas (versus 596 FCFA for the routine-fixed facility-based approach in the same area). In Niakaramadougou, the December catch-up was more cost-effective in rural areas (606 FCFA per child) than the routine-fixed approach (714 FCFA). Across both districts combined, the routine-fixed strategy averaged roughly 651 FCFA per child supplemented, and the cost per DALY averted ranged from 30,093 FCFA (advanced strategy in Ferkessédougou) to 89,550 FCFA (catch-up Jul 2023 in Niakaramadougou) – all below Côte d’Ivoire’s cost-effectiveness threshold (0.5 x GDP per capita; approximately USD 1,265).
ConclusionAll three strategies were cost-effective, though the advanced community-based strategy achieved the best balance of reach and efficiency. Scaling advanced strategies within health system constraints may enhance sustainability and coverage in low-resource settings.
FreshRSS 