Conectar
Preventing loss of autonomy has become a public health issue due to the increase in healthcare costs associated with ageing. It has become even more pressing with the arrival of the baby-boomer generation. This has given rise to several initiatives. This is the background to the VIVADOM project. The project provides a complete kit for older adults aged 60 years and over living at home. First, the kit includes a technological package (telecare, light path and digital tablet). Then, these older adults benefit from personalised human support provided by postal workers trained in gerontology. The aim of this study will be to carry out a health economic assessment (HEA) of the VIVADOM project as part of the prevention of frailty and/or dependency (by comparing beneficiaries of the complete kit with non-beneficiaries). The comparator will be the fact of not benefiting from the complete kit. In addition, the efficiency of the project in preventing falls and cognitive problems will be studied. We will calculate three incremental cost-effectiveness ratios (ICER) for these three issues.
The economic model used will be the Markov model. Transition probabilities, average costs and average quality-adjusted life year (QALY) will be calculated for the two groups being compared. The ICER will be obtained by dividing the difference in average costs by the difference in average QALYs. Finally, ICERs will be compared with willingness-to-pay (WTP) to assess the efficiency of the system. Thus, the VIVADOM project will be efficient when these ICERs are lower than the WTP. Univariate and probabilistic sensitivity analysis will be carried out to ensure the robustness of the analysis results.
The HEA of the VIVADOM project has been approved by the research unit of the University of Limoges in France. The results will be published in a peer-reviewed journal and presented at relevant national and international conferences.
by Htay-Wah Saw, Arie Kapteyn
An extensive literature studies the relation between demographic and socio-economic characteristics and attrition in longitudinal studies. In this study, we analyze the independent effects of non-demographic variables—respondent personality traits, panel tenure, and survey topics, using unique datasets from two recently completed high-frequency online longitudinal studies conducted in the U.S. We used latent class analysis to group respondents into various classes based on similarities in their nonresponse patterns across all survey waves, which revealed substantial variations in patterns of nonresponse. Our results indicate that respondent personality traits were strong predictors of nonresponse patterns. Specifically, conscientiousness is positively associated with a lower likelihood of wave nonresponses. In contrast, more open, extroverted, neurotic, and agreeable respondents are more likely to exhibit higher wave nonresponses, but with effect sizes smaller than that of conscientiousness. We found no significant demographic effects on wave nonresponse in one of the studies focused on aging and well-being. However, in the study primarily focused on COVID-19-related topics conducted during the pandemic, we found a few significant demographic effects. Collectively, our findings suggest that personality traits may play a more significant role than conventional demographic and household variables in predicting nonresponse patterns in high frequency (at least one survey per month) online surveys.Accidental hypothermia (AH) can occur in mild-to-severe cases; however, its management is crucial in severe cases as it can cause ventricular fibrillation and lead to death. Among various rewarming therapies for AH, endovascular catheter rewarming has been the focus of recent studies as a minimally invasive alternative to invasive internal rewarming, such as extracorporeal membrane oxygenation (ECMO). However, no study has demonstrated the efficacy and safety of endovascular catheter rewarming therapy. This study aimed to validate the efficacy and safety of endovascular catheter rewarming for patients with AH.
The intensive care with endovascular catheter rewarming in accidental severe hypothermia (ICE-CRASH II) study is a multicentre, randomised study of patients with AH. This study will include patients with AH (age ≥65 years, core temperature
This study was approved by the Hokkaido University Certified Review Board (approval number: 024-00013). Written informed consent will be obtained from all the participants or their legally acceptable representatives. The results will be disseminated through publications and presentations.
Japan Registry of Clinical Trials (jRCT1012240051).
Gambling is of public health importance due to the potential impacts of gambling on individuals and their communities.
This review draws on evidence to address: ‘What is known about gambling in lesbian, gay, bisexual, trans and queer+ (LGBTQ+) communities?’ including (i) the prevalence of gambling harm; (ii) the lived experience of gambling harms; (iii) the interventions and service barriers and (iv) the risk and protective factors against gambling harms.
The identified peer-reviewed and grey literature papers were screened against inclusion and exclusion criteria by two reviewers prior to extracting data. Eligibility for inclusion was assessed via the Critical Appraisal Skills Programme (CASP) framework and a Weight of Evidence approach.
PubMed, Web of Science, ProQuest, Google Scholar and Cochrane were searched for peer reviewed and grey literature published from June 2000 to June 2023.
Data extraction tables were developed to include the characteristics, methods, sample and key findings for each study.
19 papers were included, which showed mixed prevalence of problems with gambling among lesbian, gay and bisexual populations. There is more consistent evidence that trans and gender diverse people experience higher levels of problems with gambling compared with cisgender (not trans) people. Limited research focused on the lived experience or the wider impact of gambling harm among LGBTQ+communities. Risk factors for gambling harm included minority stress, societal stigma, discrimination and isolation. Protective factors against gambling harm included higher levels of support, positive social interaction and mainstream community connectedness. No studies were identified with gambling interventions specific to LGBTQ+people. General health service barriers included professionals’ use of pathologising language or a lack of cultural competency and education around LGBTQ+issues.
Research on LGBTQ+ gambling harm remains distinctly limited. Further, population-based surveys as well as in-depth qualitative research are needed to develop a comprehensive understanding of gambling in LGBTQ+communities. Research should be undertaken in collaboration with LGBTQ+peers. A better understanding of gambling could inform a whole systems approach with targeted interventions to protect against gambling harm and to promote greater health equity. Open Science Framework registration number (http://osf.io/jf85y/).
Rare diseases (RD) are collectively common and often genetic. Families value and can benefit from precise molecular diagnoses. Prolonged diagnostic odysseys exacerbate the burden of RD on patients, families and the healthcare system. Genome sequencing (GS) is a near-comprehensive test for genetic RD, but existing care models—where consultation with a medical geneticist is a prerequisite for testing—predate GS and may limit access or delay diagnosis. Evidence is needed to guide the optimal positioning of GS in care pathways. While initiating GS prior to geneticist consultation has been trialled in acute care settings, there are no data to inform the utility of this approach in outpatient care, where most patients with RD seek genetics services. We aim to evaluate the diagnostic yield, time to diagnosis, clinical and personal utility and incremental cost-effectiveness of GS initiated at the time of referral triage (pre-geneticist evaluation) compared with standard of care.
200 paediatric patients referred to one of two large genetics centres in Ontario, Canada, for suspected genetic RD will be randomised into a 1:1 ratio to the intervention (GS first) or standard of care (geneticist first) arm. An unblinded, permuted block randomisation design will be used, stratified within each recruitment site by phenotype and prior genetic testing. The primary outcome measure is time to genetic diagnosis or to cessation of active follow-up. Survival analysis will be used to analyse time-to-event data. Additional measures will include patient-reported and family-reported measures of satisfaction, understanding and perceived test utility, clinician-reported measures of perceived test utility and management impact, and healthcare system utilisation and costs.
This study was approved by Clinical Trials Ontario. Results will be disseminated, at minimum, via peer-reviewed journals, professional conferences and internal reports to funding bodies. Efforts will be made to share aggregated study results with participants and their families.
Atopic dermatitis (AD) is a chronic inflammatory skin condition that impairs the quality of life of affected paediatric patients and their families. Dupilumab, an antagonist of the shared alpha chain subunit of the cytokines interleukin-4 and interleukin-13, has revolutionised the management of moderate-to-severe AD by effectively targeting type 2 inflammation. However, live attenuated vaccines, including live attenuated influenza vaccines (LAIVs), are contraindicated during dupilumab therapy owing to limited safety data. This restriction poses challenges to immunisation strategies, particularly in paediatric populations. This study aims to evaluate the safety and efficacy of LAIV in paediatric patients with AD undergoing dupilumab therapy.
This multicentre, prospective, single-arm, open-label trial will enrol 50 paediatric patients aged 2–18 years with AD undergoing dupilumab treatment. The participants will receive intranasal LAIV, followed by a 25-week observation period after vaccination. The primary outcome is the proportion of participants with a four-fold or greater increase in haemagglutination inhibition titres against influenza strains A(H1N1), A(H3N2) and B at 4 weeks post vaccination. The secondary outcomes include the incidence of influenza and systemic or local adverse events, such as injection site reactions, fever and other influenza-like symptoms observed within 4 weeks of vaccination. Exploratory endpoints include the evaluation of immunosuppressive markers such as neutrophil counts, lymphocyte subsets and serum immunoglobulin G levels. Safety analyses will assess the frequency of each adverse event, whereas efficacy analyses will focus on immunogenicity and influenza incidence during the 25-week follow-up period. This study aims to provide critical safety and immunogenicity data to guide immunisation strategies in biologically treated paediatric patients with AD.
This study complies with the principles of the Declaration of Helsinki and received ethics approval from the Institutional Review Board of Chiba University Hospital as a specified clinical trial. Informed consent and assent will be obtained as appropriate based on the participants’ ages. These findings will be disseminated through peer-reviewed journals and scientific conferences to inform clinical vaccination strategies for biologically treated populations.
jRCTs031240442.
by Kanyanee Promsawan, Chalurmpon Srichomthong, Monnat Pongpanich, Vorasuk Shotelersuk
DNA methylation, a key epigenetic modification, regulates gene expression and diverse cellular functions. Bisulfite sequencing (BS) remains the gold standard for methylation detection, while PacBio HiFi sequencing enables direct detection without chemical conversion. Although both technologies are increasingly used, few studies have directly compared their concordance, particularly in clinically relevant settings such as Down syndrome (DS). We performed a comparative analysis of DNA methylation profiles using whole-genome bisulfite sequencing (WGBS) and PacBio high-fidelity (HiFi) whole-genome sequencing (WGS) in a pair of monozygotic twins with DS. WGBS data were processed with two pipelines, wg-blimp and Bismark, while HiFi WGS data were analyzed using pb-CpG-tools. Our analysis focused on four key aspects: CpG site detection, genomic distribution of methylated CpGs (mCs), average methylation levels, and inter-platform concordance. HiFi WGS detected a greater number of mCs—particularly in repetitive elements and regions with low WGBS coverage—while WGBS reported higher average methylation levels than HiFi WGS. Both platforms exhibited methylation patterns consistent with known biological principles, such as low methylation in CpG islands, and the relative methylation patterns across genomic features were largely concordant. Pearson correlation coefficients indicated strong agreement between platforms (r ≈ 0.8), with higher concordance in GC-rich regions and at increased sequencing depths. Depth-matched comparisons and site-level down-sampling revealed that methylation concordance improves with increasing coverage, with stronger agreement observed beyond 20 × . Our findings support the reliability of HiFi WGS for methylation detection and highlight its advantages in regions that are challenging for bisulfite-based methods. This study demonstrates that HiFi WGS can serve as a robust alternative for genome-wide methylation profiling.This study aimed to investigate factors influencing the acceptance of smartphone applications among high-risk pregnant women in the Lao People's Democratic Republic to support continuous care.
An explanatory sequential mixed-methods design.
The quantitative phase included 167 high-risk pregnant women recruited from four tertiary hospitals in Vientiane, Lao PDR. Validated questionnaires were used to measure demographics, digital technology usage, eHealth literacy and anxiety. Data were analysed using descriptive statistics and multiple regression analysis. In the qualitative phase, in-depth interviews with 20 women were conducted to further explore experiences, perceptions and barriers related to smartphone application usage. Interviews were analysed via direct content analysis.
Quantitative findings indicated that smartphone application acceptance was significantly predicted by eHealth literacy (B = 1.53, 95% CI 1.22–1.84, p < 0.001) and pre-existing non-communicable diseases (B = 4.39, 95% CI 1.05–7.73, p = 0.010). Anxiety negatively impacted acceptance (B = −0.28, 95% CI −0.51 to −0.05, p = 0.019). The model explained 53.9% of the variance in smartphone application acceptance (R 2 = 0.539). Qualitative findings highlighted four key themes: awareness of pregnancy risks, unclear health information, perceived benefits of smartphone applications including accessibility and emotional reassurance and practical barriers such as internet costs and limited digital literacy.
Positive perceptions of smartphone applications regarding accessibility and reassurance were observed, alongside significant barriers, such as limited digital literacy and internet costs. Addressing these factors may enhance the adoption and effective utilisation of digital health technologies among high-risk pregnant populations.
No patient or public contribution.
by Giulia Bennici, Inas Al Younis, Abeer Sharfalddin, Mutaz Akkawi, Fuad Al-Rimawi, Khaled Sawalha, Abdul-Hamid Emwas, Mariusz Jaremko
Ephedra foeminea Forssk. is a medicinal plant traditionally used across various cultures and recognized for its historical significance in herbal medicine. It has been used as an herbal infusion to treat multiple respiratory diseases, headaches, and nasal congestion, as well as to prevent and manage breast cancer. In order to evaluate the validity of this ancestral knowledge, we aimed to investigate hot aqueous extracts of E. foeminea branches and fruits firstly by using untargeted metabolomic analysis, characterizing the chemical profiles of hot aqueous extracts from E. foeminea branches and fruits through the use of nuclear magnetic resonance, gas chromatography–mass spectrometry, and liquid chromatography–mass spectrometry. Subsequently, two in vitro studies were conducted to assess the anticancer and antioxidant potentials of the extracts. Antioxidant activity was evaluated using a 2,2-diphenyl-1-picrylhydrazyl assay and a total phenolic content assay. Anticancer activity was evaluated by assessing cytotoxicity using the MTT assay on MCF-7 (human breast cancer) and HeLa (cervical cancer) cell lines. Additionally, molecular docking was performed to explore the interactions between compounds identified in E. foeminea and selected cancer-related proteins, as well as the main protease of SARS-CoV-2. The results revealed that the branch extract exhibited superior antioxidant activity compared to the fruit extract, which was associated with a higher phenolic content in the branch extract (49.5 ± 0.7 mg GAE/g). The fruit extract exhibited greater cytotoxicity against MCF-7 cells, suggesting potential anticancer activity. Molecular docking analysis identified henryoside, guajavarin, and neohancoside as the most active compounds with anticancer and antiviral properties. These findings support the traditional use of E. foeminea Forssk. and highlight its potential as a source of bioactive compounds for further research into therapeutic applications.Post-COVID-19 conditions (PCC) may include pulmonary sequelae, fatigue and other symptoms, but its mechanisms are not fully elucidated.
This study investigated the correlation between fatigue and the presence of pulmonary abnormalities in PCC patients with respiratory involvement 6–12 months after hospitalisation.
Cross-sectional study.
A tertiary hospital in Brazil.
315 patients, aged ≥18 years, were considered eligible based on SARS-CoV-2 infection confirmed by reverse transcription-PCR.
Pulmonary function tests (PFT), cardiopulmonary exercise tests (CPET), chest CT and hand grip were performed. The following scales were applied: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, Euroqol 5 Dimensions quality of life (EQ-5D) and Hospital Anxiety and Depression Scale (HADS). Participants were divided between the fatigue group (FACIT-F≤30) and the non-fatigue group (FACIT-F>30). For the statistical analysis, the primary outcome was the difference in the diffusing capacity of the lungs for carbon monoxide (DLCO) between groups. Considered secondary outcomes were differences in PFT, CPET, chest CT, hand grip, EQ-5D and HADS.
The fatigue group had 81 patients (25.7%) against 234 (74.3%). PFT and CPET showed no significant difference in DLCO and oxygen consumption peak values between groups. The fatigue group had a lower workload (mean 55.3±21.3 watts vs 66.5±23.2 watts, p=0.003), higher breathing reserve (median 41.9% (33.8–52.5) vs 37.7% (28.9–47.1), p=0.028) and lower prevalence of ground glass opacity (60.8% vs 77.7%, p=0.003) and reticulation (36.7% vs 54.9%, p=0.005) in chest CT. The fatigue group had higher anxiety (57% vs 24%, p
Fatigue in patients with PCC 6–12 months after hospitalisation is relatively common and had weak correlation with pulmonary disorders. Our results suggested fatigue could be strongly related with peripheral disorders such as reduced musculoskeletal strength or psychosocial limitations.
Nearly 40% of adults receiving life-saving dialysis for kidney failure report depressive symptoms. With more than 40 000 Canadians on dialysis, this is a significant health burden. Cognitive behavioural therapy (CBT) has been shown to be effective for treating depressive symptoms; however, it is rarely considered or used for people receiving dialysis. The aim of this realist study is to evaluate and explain how, why, for whom and in what circumstances therapist-guided and remotely delivered CBT works in order to provide equitable mental healthcare to individuals with depressive symptoms receiving dialysis.
The project will include a realist synthesis, a quantitative cohort study and a realist evaluation. Realist methodology is a theory-driven approach that seeks to explain how generative mechanisms are shaped by contextual features, giving rise to outcome patterns. We will begin by developing an initial programme theory (IPT) from the literature and interviews with CBT therapists to understand how CBT is intended to work and for whom. We will use data from the quantitative cohort study to identify contexts that may shape outcome patterns in CBT for people receiving dialysis. This includes previously collected survey data and data from a longitudinal cohort study, both sourced from people across Canada undergoing dialysis. We will test and refine the IPT using data from a realist evaluation and existing literature. The realist evaluation will involve participants from the quantitative cohort study who received therapist-guided, remotely delivered CBT.
Ethical approvals have been granted. We have planned a wide range of dissemination strategies: journal manuscripts and conference presentations, executive memos for administrators of renal programmes in Canada, an online inventory of resources for depressive symptoms and presentations of findings together with patient partners at all participating sites.
CRD42023476184.
Epilepsy is a prevalent chronic neurological disorder, with approximately one-third of patients experiencing intractable epilepsy, often necessitating surgical intervention. Deep brain stimulation (DBS) of the thalamus has been introduced as a palliative surgical option for seizure control; however, its precise mechanisms remain largely unclear. The thalamus plays a crucial role in coordinating neural networks, both in normal brain function and the propagation of epileptic activity. This study aims to investigate the involvement of the thalamus in epilepsy networks using stereoelectroencephalography (SEEG) to monitor thalamic activity during epileptic seizures in patients with drug-resistant epilepsy.
This single-arm, non-randomised, prospective, exploratory study will be conducted at Nagoya University Hospital, involving 10 patients undergoing SEEG for presurgical evaluation of drug-resistant epilepsy. Participants must be 18 years or older, have normal cognitive function and provide informed consent. Between 7 and 14 SEEG electrodes, including 2 in the bilateral thalamus, will be implanted in key thalamic nuclei (anterior, dorsomedial, centromedian and pulvinar) using a robotic system. The primary outcome focuses on electroencephalographic findings from the thalamus, emphasising waveform and frequency changes around seizures. Secondary outcomes include postoperative seizure frequency, changes in cognitive function and neuroimaging results. SEEG data will be recorded continuously for 1–2 weeks to capture both ictal and interictal activity. Data analysis will employ t-tests to compare ictal and interictal periods, with p values
This study was approved by the ethics committee of the Nagoya University Graduate School of Medicine (Approval No. 2024-0044). All participants will provide written informed consent prior to enrolment. The results of this study will be disseminated through publication in a peer-reviewed journal and presentations at academic conferences.
jRCT1042240024.
This study aimed to explore the barriers to the implementation of the improved Community Health Fund (iCHF) electronic-claim (e-claim) process in primary healthcare services in Tanzania.
A phenomenological study design using a qualitative approach.
In-depth interviews were conducted to collect data from 19 participants from Mkalama and Iramba districts.
The data were collected from the regional health managers, district health managers, information technology officers, facility in-charges and iCHF focal persons from dispensaries, health centres and hospitals. Thematic analysis was employed to analyse the data in this study.
This study identified several key barriers to the implementation of the iCHF e-claim process. The barriers include financial governance and oversight, institutional capacity for the iCHF e-claim process, staff negligence in complying with iCHF guidelines, resource availability, and logistical shortcomings for handling iCHF e-claim processes.
The iCHF e-claim process is inadequately implemented and does not attract healthcare workers due to the observed challenges. There is a need for joint efforts to improve the implementation of the iCHF e-claim process involving stakeholders at all levels.
Homelessness across the early life course poses a grave and largely preventable challenge. Those who experience homelessness early are at increased risk of a range of health, education and social inequities that can extend across the life course. Better understanding of the modifiable factors on the pathway to homelessness is needed to inform prevention at the earliest possible point in the life course and reduce the rate of child and adolescent homelessness at the population level. Here we address this gap in real-time knowledge by establishing a living systematic review of population studies of social determinants of homelessness from childhood to adolescence.
We will search MEDLINE, Embase, PubMed and PsycINFO for population-based prospective cohort studies reporting on social determinants of child and adolescent homelessness from 0 to 24 years. No study eligibility restrictions will be placed on the date, country of origin or language of publications. Study quality will be assessed using the Methodological Standards for Epidemiological Research scale. Associations between social determinants and homelessness will be reported using pooled relative risk ratios with 95% CI. If sufficient data are available, the influence of subgroup and methodological factors will be examined using meta-regression.
The study will synthesise published studies that have previously been granted ethics approval, meaning that it is exempt from ethics review or approval. Study findings will be disseminated through a peer-reviewed journal article, conference and seminar presentations. The authors will distribute a plain language summary through their academic and professional networks.
CRD42024577716.
This study aims to synthesise evidence on the pooled level of exit knowledge among outpatients served in public hospital pharmacies and private pharmacies in Ethiopia and to identify the associated factors associated with medication knowledge by conducting a systematic review and meta-analysis of primary articles focused on this area.
This systematic review and meta-analysis study employed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.
Three electronic databases—MEDLINE, Scopus and Google Scholar—were searched for all English-language articles published from 2010 until 18 December 2024.
The review exclusively included studies that reported original data, were freely accessible in full text and were written in English, as well as those investigating the level of knowledge among outpatients and associated factors, irrespective of study design. Studies lacking abstracts and full texts, reports, qualitative research, and conference summaries were excluded from the analysis.
Data from selected studies were extracted by three independent reviewers using a standardised data extraction format created using Microsoft Excel. Their results were cross-checked by two additional reviewers for consistency.
Of the 521 identified studies, 9 met the inclusion criteria. The overall pooled knowledge level was 45%. Factors associated with knowledge included residence (OR=0.67, 95% CI: 0.27 to 0.71), adequacy of information provided (OR=0.87, 95% CI: 0.24 to 0.90), education level (OR=0.70 CI: 0.39 to 0.89), clarity of instructions (OR=0.80 CI: 0.14 to 0.99) and pharmacist politeness (OR=0.72 CI: 0.46 to 0.77).
The systematic review and meta-analysis showed that pooled patient knowledge regarding their dispensed medications in Ethiopia is about 45%. Key determinant factors of knowledge included education level, quality of pharmacist communication, urban versus rural residence and pharmacist politeness. Recommendations for improvement include enhancing pharmacist training, developing educational materials in local languages, outreach programmes for rural areas and implementing patient-centred care policies.
PROSPERO number: CRD42024560816
Non-adherence to antidiabetic medication remains a major barrier to achieve optimal health outcomes among individuals with diabetes, particularly in developing countries. This issue exacerbates poor health outcomes and leads to the wastage of limited healthcare resources.
This study aimed to assess the prevalence of non-adherence to antidiabetic medications and identify associated factors among adult type 2 diabetes mellitus (DM) patients in the North Wollo zone.
An institutional-based cross-sectional study.
The study was conducted in three randomly selected public hospitals in the North Wollo zone: Woldia Comprehensive Specialized Hospital, Lalibela General Hospital and Mersa Primary Hospital.
A total of 327 adult type 2 DM patients receiving follow-up care were included. Participants were selected proportionally from each hospital using consecutive sampling. Inclusion criteria included individuals aged ≥18 years, on antidiabetic treatment for at least 6 months and actively on follow-up care during the study period. Patients with hearing impairment, severe illness or incomplete medical records were excluded.
Adherence was assessed using the Morisky Medication Adherence Scale-8, a validated eight-item, self-reported questionnaire. Scores ranged from 0 to 8, with adherence levels classified as high (≥8), medium (6–7.75) and low (
Data were analysed using SPSS V.27. Descriptive statistics were used to summarise the data, and multivariable logistic regression analysis was performed to identify factors associated with non-adherence. A p value ≤0.05 was considered statistically significant.
The overall prevalence of medication non-adherence was 24.5%. Factors significantly associated with non-adherence included living with diabetes for less than 3 years (adjusted OR (AOR) 3.37, 95% CI 1.91 to 5.95), residing in rural areas (AOR 2.67, 95% CI 1.49 to 4.79), having comorbidities (AOR 2.99, 95% CI 1.67 to 5.34) and having no formal education (AOR 3.26, 95% CI 1.49 to 7.00).
The prevalence of non-adherence to antidiabetic medications (24.5%) exceeded the widely accepted benchmark of ≤20%. Key factors such as rural residence, comorbidities, lower education levels and shorter duration since diagnosis were significantly associated with non-adherence. These findings underscore the need for targeted interventions, including patient education, improved rural healthcare access and integrated care models, to enhance adherence and diabetes management outcomes.
Selection of antiseizure medications (ASMs) for newly diagnosed epilepsy remains largely a trial-and-error process. We have developed a machine learning (ML) model using retrospective data collected from five international cohorts that predicts response to different ASMs as the initial treatment for individual adults with new-onset epilepsy. This study aims to prospectively evaluate this model in Australia using a randomised controlled trial design.
At least 234 adult patients with newly diagnosed epilepsy will be recruited from 14 centres in Australia. Patients will be randomised 1:1 to the ML group or usual care group. The ML group will receive the ASM recommended by the model unless it is considered contraindicated by the neurologist. The usual care group will receive the ASM selected by the neurologist alone. Both the patient and neurologists conducting the follow-up will be blinded to the group assignment. Both groups will be followed up for 52 weeks to assess treatment outcomes. Additional information on adverse events, quality of life, mood and use of healthcare services and productivity will be collected using validated questionnaires. Acceptability of the model will also be assessed.
The primary outcome will be the proportion of participants who achieve seizure-freedom (defined as no seizures during the 12-month follow-up period) while taking the initially prescribed ASM. Secondary outcomes include time to treatment failure, time to first seizure after randomisation, changes in mood assessment score and quality of life score, direct healthcare costs, and loss of productivity during the treatment period.
This trial will provide class I evidence for the effectiveness of a ML model as a decision support tool for neurologists to select the first ASM for adults with newly diagnosed epilepsy.
This study is approved by the Alfred Health Human Research Ethics Committee (Project 130/23). Findings will be presented in academic conferences and submitted to peer-reviewed journals for publication.
ACTRN12623000209695.
This study set forth to investigate the efficacy of Quality and Quantity mononuclear cells (QQMNCs) for promoting wound healing and limb salvage in a severe ischemic wound model using diabetic mice. Female BALB/c nude mice induced with diabetes were used to create ischemic limb models in a controlled experimental design. Intramuscular injections of human QQMNCs were compared to phosphate-buffered saline (PBS) and peripheral blood mononuclear cells (PBMNCs) relative to their effects on wound healing and limb salvage. In vitro analysis demonstrated that the QQMNC group had significantly higher median percentages of CD34+ cells, CD34+CD133+ cells, CD206+ cells, and FOXP3+ cells compared to the PBMNC group (all p < 0.05), which suggests an enhanced regenerative and immunomodulatory profile. Kaplan–Meier survival analysis showed a significantly higher number of completely healed wounds in the QQMNC group than in the PBMNC group (p = 0.044). The histological evaluation showed that the QQMNC group had a significantly thinner epithelial thickness than the PBMNC (p = 0.032) and PBS groups (p = 0.002), and a significantly greater T cell density than the PBS group (p = 0.033), which suggests more efficient tissue repair. Moreover, the QQMNC group exhibited the highest percentage of minor tissue loss (57% for forefoot and toe gangrene), and the lowest incidence of severe limb loss (0% for lower leg gangrene). The findings of this study highlight the effectiveness of QQMNCs for promoting wound healing and limb salvage in diabetic ischemic animal model; however, clinical trials are needed to further assess their efficacy in this clinical context.
by Kazuo Teramoto, Yuji Ueda, Ryosuke Murai, Kazumasa Ogasawara, Misako Nakayama, Hirohito Ishigaki, Yasushi Itoh
Reducing the number of immunosuppressive cells in blood is a potential strategy for activating anti-tumor immunity, which provides a promising approach to cancer treatment. In this study, we developed an adsorbent designed to selectively target and adsorb lymphocytes expressing latency-associated peptide (LAP), which is abundantly expressed on the surface of CD4+ regulatory T cells (Tregs) and CD14+ monocytes. We investigated whether diethylenetriamine-conjugated polysulfone adsorbent-based direct hemoperfusion (DHP) enhances anti-tumor immunity in a rat cancer model with KDH-V liver cells. Our findings revealed that DHP significantly reduced LAP+ Tregs in both peripheral blood and tumor tissues in treated mice. Consequently, cytotoxic T-lymphocytes increased in tumor-bearing rats. The anti-tumor effect was negated by the addition of cells detached from the absorbent, indicating that these cells play a crucial role in inhibiting the observed therapeutic effect. The results suggest that depleting LAP+ immunosuppressive cells in blood can enhance anti-tumor immunity and improve survival of patients.by Khomsan Ruangrit, Kittiya Phinyo, Sahassawat Chailungka, Kritsana Duangjan, Apitchaya Naree, Jearanai Thasana, Wassana Kamopas, Senoch Seanpong, Jeeraporn Pekkoh, Nuttapol Noirungsee
This study investigates the effectiveness of biochar immobilized with algicidal Bacillus sp. AK3 and denitrifying Alcaligenes sp. M3 in mitigating harmful algal blooms (HABs) and reducing nitrate pollution in aquatic environments. Over a six-day period, we analyzed changes in algal bloom-forming Microcystis density, chlorophyll-a levels (indicative of algal biomass), nitrate concentration, and microbial community composition in water treated with biochar and Bacillus sp. AK3 and Alcaligenes sp. M3-immobilized biochar. In water treatment using the AK3 and M3-immobilized biochar, Microcystis density decreased from 600,000 cells/mL to 80,000 cells/mL, and chlorophyll-a concentrations also substantially reduced, from 85.7 µg/L initially to 42.8 µg/L. Nitrate concentrations in the AK3 and M3-immobilized biochar treatment significantly decreased from approximately 23 mg/L to around 14 mg/L by Day 6, demonstrating the enhanced denitrification capabilities of the immobilized Alcaligenes sp. M3 and associated bacterial communities. The results also showed significant shifts in bacterial communities, with a decrease in Microcystis, highlighting the specific algicidal activity of Bacillus sp. AK3. The study underscores the potential of biochar-based treatments as a sustainable and effective approach for improving water quality and mitigating the environmental impacts of nutrient pollution and HABs.
FreshRSS 