Risultati per: La nevralgia post-erpetica

Da 4 anni rifiuta intervento e vaccini ma scatena una polemica

Da 4 anni rifiuta intervento e vaccini ma scatena una polemica

Background
Following the COVID-19 pandemic, there was an increase in teenage pregnancies nationally, however, limited data exists regarding the same among girls living in refugee settlements.

Objectives
We evaluated the prevalence of teenage pregnancy and associated factors in Palorinya and Bidi Bidi refugee settlements in Obongi and Yumbe districts of northern Uganda, in the post-COVID-19 era.

Design
We conducted a cross-sectional study.

Setting
Refugee settlements in northern Uganda.

Participants
We included 385 teenage girls aged 15–19 years.

Methods
We used convenience sampling techniques between March and May 2023. Prevalence of teenage pregnancy was assessed by self-reported pregnancies between January 2020 and May 2023 among participants. We conducted Pearson’s 2 and Fisher’s exact tests for bivariate analysis. All variables with a p value

Stroke, Ahead of Print. BACKGROUND:Previous trials have failed to demonstrate the benefits of extracranial-intracranial (EC-IC) bypass surgery for patients with carotid or middle cerebral artery occlusion. However, little evidence has focused on the effect of age on prognosis. This study aimed to explore whether EC-IC bypass surgery can provide greater benefits than medical therapy alone in specific age groups.METHODS:A post hoc analysis was performed of the CMOSS (Carotid or Middle Cerebral Artery Occlusion Surgery Study), which was a randomized, open-label, outcome assessor-blinded trial conducted at 13 centers in China between June 2013 and March 2018. A total of 324 patients with internal carotid artery or middle cerebral artery occlusion with transient ischemic attack or nondisabling ischemic stroke attributed to hemodynamic insufficiency were randomized into a surgical group (n=161) that underwent EC-IC bypass surgery with medical therapy, and a medical group (n=163) that received antiplatelet therapy and stroke risk factor control alone. The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days up to 2 years after randomization. Receiver operating characteristic curves were drawn to explore the optimal age boundary, and survival analyses were used to explore differences between groups.RESULTS:Among the 324 patients (median age, 52.7 years; 79.3% men), an age cutoff of 55.5 years predicted the primary outcome in the surgical group (area under the curve, 0.649 [95% CI, 0.530–0.769]). Patients were further divided into an older group ( >55.5 years) and a younger group (≤55.5 years). Younger patients who underwent bypass surgery showed a lower risk of the primary outcome (log-rankP=0.001) than older patients. Patients who underwent EC-IC bypass surgery had a lower risk than patients with medical therapy alone in the younger group (3.2% versus 11.6%; hazard ratio, 0.255 [95% CI, 0.071–0.916];P=0.036), but not in the older group (17.5% versus 13.3%; adjusted hazard ratio, 0.597 [95% CI, 0.225–1.580];P=0.298).CONCLUSIONS:In patients aged 55.5 years or younger with symptomatic atherosclerotic occlusion of the internal carotid artery or middle cerebral artery and hemodynamic insufficiency, the addition of EC-IC bypass surgery to medical therapy significantly improved prognosis. These findings suggest that the clinical application of EC-IC bypass surgery needs more research to explore refined patient selection criteria incorporating more clinical features.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT01758614.

Introduction
Ischaemic heart disease (IHD) is a pathological process characterised by a blockage or non-obstructive accumulation of atherosclerotic plaques in the epicardial arteries. Percutaneous coronary intervention (PCI) is widely used in clinical practice to treat IHD. However, angina post PCI (APPCI) impairs quality of life and portends a worse prognosis. Hence, an effective and safe treatment option remains an urgent need for patients with APPCI. In recent years, there has been an increasing body of clinical trials regarding the use of acupuncture for the prevention and treatment of APPCI, and the results have indicated it might be a promising therapeutic intervention. However, to our knowledge, the potential benefits of acupuncture for the prevention and treatment of APPCI to justify either their recommendation or their clinical role have not been evaluated.

Methods and analysis
PubMed, Embase, Cochrane Library, Web of Science Core Collection, Chinese Biomedical Database, Chinese National Knowledge Infrastructure, Wanfang Database and VIP Database will be searched from inception to 8 June 2024 without language restrictions. Two investigators will independently screen studies, extract data, assess the risk of bias from randomised controlled trials (RCTs) and assess the risk of bias. The third reviewer will arbitrate any disagreements. Data synthesis and analysis will be conducted using the RevMan V.5.4 software. Subgroup analyses, sensitivity analysis, meta-regression and bias reporting assessments will be performed if necessary and appropriate. Finally, the quality of evidence from RCTs will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation System tool.

Ethics and dissemination
Ethical approval is unnecessary since no private or confidential patient data will be included. The systematic review will be published in peer-reviewed journals.

PROSPERO registration number
CRD42024562116.

Introduction
Diagnostic errors in ear, nose and throat (ENT) diseases are prevalent among healthcare workers (HCWs) in resource-limited settings, yet comprehensive data that describe HCW knowledge, attitudes and practices (KAP) regarding ENT disease management remains scarce. Further, the impact of basic ENT training on HCW KAP in such settings is largely undetermined.

Objective
We assessed HCW KAP before and after basic training in ENT disease management.

Methods
This questionnaire-based pre-post-test cross-sectional survey employed HCW training in public hospitals in a resource-limited setting. We conducted a 2-day training, preceded by a pretraining survey, followed by immediate and 5-month post-training assessments using a prevalidated questionnaire. 416 HCWs participated and were selected through probability-proportionate-to-size random sampling. Wilcoxon matched-pairs signed-rank and Kruskal-Wallis tests were used to assess pre-post training KAP variations.

Results
At baseline, the median (IQR) percentage knowledge scores for HCWs in general ENT, ear, sinonasal and head and neck disease management were 60 (40), 55 (18), 58.3 (25) and 56 (22.6), respectively. Only 33.8% (133/394) of HCWs had access to an otoscope, 25.5% (101/396) to a headlight and 12.1% (48/397) to a nasal speculum. While 99.2% (390/393) of HCWs considered ENT important, 57.8% (226/391) of them lacked the confidence to correctly diagnose and manage most ENT conditions. At the immediate post-training assessment, HCWs’ median knowledge scores increased by 20%, 18%, 25% and 33% for general ENT, ear, sinonasal and head and neck disease management, respectively (p

Objectives
Post-stroke emotionalism (PSE) is a common, under-researched neurologic symptom of stroke, characterised by frequent crying episodes not under usual social control. Currently, there are no data on carer strain in the context of emotionalism after stroke. We aimed to explore the degree of carer strain in carers of individuals with diagnosed PSE compared with carers of individuals with stroke but no PSE to examine whether carer strain varies with particular characteristics of the cared for individual (patient age, sex, social deprivation, stroke type, functional status, mood status) and to quantify the impact of PSE on carer strain, after accounting for other factors.

Design
Cross-sectional observation study.

Setting
Nine secondary care stroke units in Scotland, UK.

Participants
102 informants of people with stroke.

Primary and secondary outcome measures
The Modified Carer Strain Index was completed at 6 months post-stroke as part of the Testing Emotionalism After Recent Stroke (TEARS) longitudinal cohort study between 1 October 2015 and 30 September 2018. Stroke survivor diagnostic status was determined using TEARS-Diagnostic Interview based on published, widely accepted diagnostic criteria of emotionalism.

Results
There was little evidence of association between carer strain and sex, age, deprivation level or stroke type of the cared for individual. There was strong evidence that carer strain was associated with both increased functional dependence post-stroke (–0.30 to –0.02, p=0.026) and presence of PSE (0.16 to 1.73, p=0.019).

Conclusions
Even after accounting for increased functional dependence, our study data indicates that caring in a PSE context may significantly increase carer strain, comparable to a six-point reduction on the Barthel Index.

Trial registration number
NRS Stroke Research Network ID 18980.

Objectives
Post-COVID-19 condition (PCC), also referred to as Long COVID, has become an emerging public health issue requiring adequate prevention, treatment and management strategies. Evaluating these strategies from the patients’ perspective using patient-reported outcome measures (PROMs) is critical. In this systematic review, we aimed to critically appraise and summarise the quality of existing PROMs for PCC, and to identify PROMs that can be recommended for use in future research.

Design
Systematic review using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

Data sources
PubMed and Web of Science were searched on 16 January 2023 and again on 23 July 2024.

Eligibility criteria
We included studies reporting on the development and/or validation of any disease-specific PROMs for PCC.

Data extraction and synthesis
Two independent reviewers screened the results for eligibility. The methodological quality of each included study was assessed using the COSMIN Risk of Bias Checklist. We further evaluated the quality of measurement properties per PROM and study according to the criteria for good measurement properties as outlined in the COSMIN manual, and graded the evidence of the synthesised results. Based on the overall evidence, we derived recommendations for the use of the identified instruments.

Results
We identified 23 studies reporting on 11 PROMs measuring functional status (COVID-19 Yorkshire Rehabilitation Scale, C19-YRS; Modified COVID-19 Yorkshire Rehabilitation Scale, C19-YRSm; Functional Impairment Checklist, FIC; Post-COVID-19 Functional Status Scale, PCFS), symptom burden and impact (Long COVID Symptom and Severity Score, LC-SSS; Long COVID Symptom Tool, LCST; Long COVID Impact Tool, LCIT; Symptom Burden Questionnaire Long COVID, SBQ-LC), quality of life (Post-acute COVID-19 Quality of Life instrument, PAC-19QoL) and stigma (Long COVID Stigma Scale, LCSS; Post-COVID-19 Condition Stigma Questionnaire, PCCSQ). Sample sizes of the included studies ranged from 29 to 1969 participants. Overall, 95 single studies on measurement properties were evaluated. Among the identified instruments, the Long Covid Stigma Scale (LCSS) showed sufficient content validity and internal consistency and can be recommended for use according to COSMIN criteria. Our assessment of measurement properties revealed significant evidence gaps for all PROMs, indicating the need for further validation studies to make an adequate decision on the recommendation for their use. Content validity is a major shortcoming of all included instruments.

Conclusion
The LCSS measuring stigma can be recommended for use in future research. For the assessment of PCC symptoms and impact, no instrument with sufficient measurement properties is currently available. Further validation of all identified PROMs is indicated, in particular comprehensive assessments of content validity involving experts and patients.

PROSPERO registration number
CRD42023391238.

Stroke, Volume 56, Issue 1, Page 46-55, January 1, 2025. BACKGROUND:Risk profile of recurrence may influence the effect of antiplatelet therapy. This study aimed to evaluate the efficacy and safety of clopidogrel-aspirin initiated within 72 hours after symptom onset for acute mild stroke or high-risk transient ischemic attack stratified by risk profile.METHODS:This is a secondary post hoc analysis of the INSPIRES (Intensive Statin and Antiplatelet Therapy for Acute High-risk Intracranial or Extracranial Atherosclerosis) randomized clinical trial that enrolled patients 35 to 80 years old with acute mild ischemic stroke or high-risk transient ischemic attack between 2018 and 2022. Patients were stratified into different groups based on the Essen Stroke Risk Score (ESRS) and modified ESRS. The primary efficacy outcome was any new stroke within 90 days. The primary safety outcome was moderate-to-severe bleeding within 90 days.RESULTS:Among 6100 patients (3050 each in the clopidogrel-aspirin group and aspirin group), the median age was 65 years (interquartile range, 57–71 years), and 3915 (64.2%) were male. Clopidogrel-aspirin was associated with a reduced risk of new stroke in patients with an ESRS of

Introduction
Patients with pulmonary embolism (PE) experience impaired functional ability and reduced quality of life long after discharge from the hospital. However, there are no structured follow-up programmes in Denmark for these patients, and there is considerable variation in practice patterns of post-PE management. No studies have investigated the effectiveness of structured follow-up care models in patients with PE. This study aims to investigate the effect and cost-effectiveness of a structured integrated post-pulmonary embolism follow-up care model (Attend-PE) compared with usual care. The Attend-PE model outlines a structured approach for in-hospital follow-up, involving group-based patient education, individual consultations and systematic use of patient-reported outcome measures to assess the patient’s physical and psychological well-being.

Methods and analysis
The study is conducted in Denmark, where the healthcare system is tax-funded and services are freely available for all citizens, with an expected inclusion of 2000 patients in total. A pre-post-intervention study design is used to compare outcomes in the post-implementation cohort with the pre-implementation cohort. The co-primary outcomes are (1) health-related quality of life (patient-reported outcome, PRO) and (2) adherence to medical treatment (register-based data). Secondary outcomes include PROs on disability, treatment satisfaction, self-management, anxiety, depression and work productivity, and register-based outcomes, including recurrent PE, bleeding, mortality and healthcare use. Register-based data will be assessed at baseline (date of PE event), 6 and 12 months, while PRO-data will be assessed at 6 and 12 months after the PE event. The health economic evaluation of the Attend-PE model will include a cost-effectiveness analysis and a cost-utility analysis.

Ethics and dissemination
The project will be conducted by the Declaration of Helsinki. In accordance with the Danish Act on Health Research Ethics §14, the study is exempt from approval. The use of survey responses in research (in anonymous form) is, however, contingent on participants’ consent, and the invitation letter therefore included information about the purpose of the study and participants’ rights to withdraw consent at any time, and that completion of the questionnaire is considered as consent to their survey data to be included in research.
Study findings will be disseminated in scientific peer-reviewed journals, at national and international conferences, and for staff and decision-makers at participating hospitals and patients and relatives via the Danish Heart Association.

Trial registration number
Clinicaltrials.gov NCT06037096.

Objectives
The study aimed to assess the predictors of upper limb motor recovery in stroke survivors.

Design
Pre–post test study design.

Setting
Conducted in two centres (First Level Hospital and University Teaching Hospital in Lusaka).

Participants
Patients living with stroke accessing physiotherapy services at the two public hospitals. A total of 52 patients were recruited at the start of the study, 6 were lost to follow-up and 46 completed the study.

Intervention
Conventional physiotherapy for 8 weeks (5 September 2022–28 October 2022).

Primary outcome
Motor function measured using a Fugl-Meyer assessment of the upper extremity.

Results
Analysis was conducted on 46 participants. A significant difference was observed between the level of motor function at baseline and after 8 weeks of treatment (p=0.0183). At baseline, 50% of participants had mild motor function, which improved after 8 weeks, with 69.6% having mild motor function. Stroke patients with severe motor function impairment at baseline were associated with 0.01 times likelihood of having mild motor function impairment after 8 weeks of physiotherapy treatment (AOR 0.01; 95 % CI 0.00 to 0.16; p=0.002).

Conclusion
The motor function of stroke patients continues to improve over time. This study demonstrated that initial upper limb motor function impairment could be used as a predictor for upper limb motor function.

Objectives
Little prior research investigated how to promote physical activity (PA), which can reduce cancer risk, to immigrant women. The overall aim of the current study was to pilot test education session feasibility. The objectives were to assess participation in, satisfaction with and potential impact of the education session, knowledge needed to refine the education session prior to a future trial.

Design
Pre–post multiple-methods comparative cohort,

Setting
Canadian immigrant settlement agencies recruited intervention and control women.

Participants
Intervention: 60 baseline, 53 education (49 virtual group, 4 video only), 1 month (43 virtual, 4 video), 6 months (38 virtual, 4 video), 37% African black; control: 41, 32% African black.

Results
Among intervention women, PA knowledge increased significantly from baseline at 1 (p

Objectives
We conducted an implementation science mental health treatment study in western Kenya, testing strategies for scale up of evidence-based mental health services for common adult disorders using a non-specialist workforce, integrated with existing primary care (Sequential Multiple, Assignment Randomized Trial of non-specialist-delivered psychotherapy (Interpersonal Psychotherapy) and/or medication (fluoxetine) for major depression and post-traumatic stress disorder (PTSD) (SMART DAPPER)). Because study launch coincided with the COVID-19 pandemic, participants were allowed to attend treatment visits via mHealth (audio-only mobile phone) or in-person. We conducted a secondary data analysis of the parent study to evaluate preference for mHealth or in-person treatment among our study participants, including rationale for choosing in-person or mHealth treatment modality, and comparison of baseline demographic and clinical characteristics.

Design, setting, participants and interventions
Participants were public sector primary care patients at Kisumu County Hospital in western Kenya with major depression and/or PTSD and were individually randomised to non-specialist delivery of evidence-based psychotherapy or medication (n=2162).

Outcomes
Treatment modality preference and rationale were ascertained before randomised assignment to treatment arm (psychotherapy or medication). The parent SMART DAPPER study baseline assessment included core demographic (age, gender, relationship status, income, clinic transport time and cost) and clinical data (eg, depression and PTSD symptoms, trauma exposures, medical comorbidities and history of mental healthcare). Given that this evaluation of mHealth treatment preference sought to identify the demographic and clinical characteristics of participants who chose in-person or mHealth treatment modality, we included most SMART DAPPER core measurement domains (not all subcategories).

Results
649 (30.3%) SMART DAPPER participants preferred treatment via mHealth, rather than in person. The most cited rationales for choosing mHealth were affordability (18.5%) (eg, no transportation cost) and convenience (12.9%). On multivariate analysis, compared with those who preferred in-person treatment, participants who chose mHealth were younger and had higher constraints on receiving in-person treatment, including transport time 1.004 (1.00, 1.007) and finances 0.757 (0.612, 0.936). Higher PTSD symptoms 0.527 (0.395, 0.702) and higher disability 0.741 (0.559, 0.982) were associated with preference for in-person treatment.

Conclusions
To our knowledge, this is the first study of public sector mental healthcare delivered by non-specialists via mHealth for major depression and/or PTSD in Sub-Saharan Africa. Our finding that mHealth treatment is preferred by approximately one-third of participants, particularly younger individuals with barriers to in-person care, may inform future mHealth research to (1) address knowledge gaps in mental health service implementation and (2) improve mental healthcare access to evidence-based treatment.

Trial registration number
NCT03466346.

Objectives
To investigate how post-traumatic growth (PTG) and moral sensitivity influence service behaviour among healthcare workers (HCWs) in mainland China post-COVID-19, with a focus on the mediating role of moral sensitivity.

Design
Cross- sectional survey design.

Setting
This study was conducted in 27 provinces across mainland China, from 16 March to 2 April 2023.

Participants
1,193 HCWs, including 378 physicians and 815 nurses, were selected using convenience and snowball sampling methods.

Methods
The survey included the Post-traumatic Growth Inventory-Chinese version (PTGI-C), the Moral Sensitivity Questionnaire-Revised Chinese Version (MSQ-R-CV) and a service behaviour scale. Structural equation modelling was employed to analyse the data, focusing on the associations between PTG, moral sensitivity, and service behaviours.

Results
The study found significant associations between PTG and moral sensitivity (r=0.49, p

Introduction
Healthcare workers (HCWs) have been of particular relevance for overcoming the SARS-CoV-2 pandemic. At the same time they have been affected by SARS-CoV-2 infections with above average probability. Around 6.5% of the overall infected persons are likely to develop persistent symptoms resulting from the infection, known as long-COVID or post-COVID syndrome (PCS). The aim of this study is (1) to investigate the prevalence, course and characteristics of PCS in German HCWs, (2) to examine its effects on psychosocial variables, (3) to identify rehabilitation and healthcare needs and (4) to analyse treatment experiences.

Methods and analysis
In a cohort study with a randomised selection of participants (N=20 000) from the Employer’s Liability Insurance Association for Health and Welfare Care, the health status of HCWs, who had COVID-19 in their professional context will be examined. There will be two measurement points: baseline (T1) and a 12-month follow-up (T2). The outcome measures are the health status with a particular focus on persistent or newly occurring symptoms after a SARS-CoV-2 infection, health-related quality of life, functional capacity, the subjective need for and utilisation of healthcare services. Pre-existing conditions, the course of the acute infection and sociodemographic factors are considered as predictors. An advisory board made up of affected HCWs supports the study by contributing to the surveys’ contents.

Ethics and dissemination
The study has been approved by the Local Ethics Committee of the Center for Psychosocial Medicine at the University Hospital Hamburg-Eppendorf (LPEK-0518). For dissemination, the results will be published in peer-reviewed journals, presented at conferences and communicated to relevant stakeholders in general and rehabilitation medicine.

Trail registration number
https://drks.de/search/de/trial/DRKS00029314

Purpose
The Management of Post-transplant Infections in Collaborating Hospitals (MATCH) programme, initiated in 2011 and still ongoing, was created to 1) optimise the implementation of existing preventive strategies against viral infections in solid organ transplant (SOT) recipients and allogenic haematopoietic stem-cell transplant (HSCT) recipients and 2) advance research in the field of transplantation by collecting data from a multitude of sources.

Participants
All SOT and HSCT recipients at Copenhagen University Hospital, Rigshospitalet, are followed in MATCH. By February 2021, a total of 1192 HSCT recipients and 2039 SOT recipients have been included. Participants are followed life long. An automated electronic data capture system retrieves prospective data from nationwide registries. Data from the years prior to transplantation are also collected.

Findings to date
Data entries before and after transplantation include the following: biochemistry: 13 995 222 and 26 127 817; microbiology, cultures: 242 023 and 410 558; other microbiological analyses: 265 007 and 566 402; and pathology: 170 884 and 200 394. There are genomic data on 2431 transplant recipients, whole blood biobank samples from 1003 transplant recipients and faeces biobank samples from 207 HSCT recipients. Clinical data collected in MATCH have contributed to 50 scientific papers published in peer-reviewed journals and have demonstrated success in reducing cytomegalovirus disease in SOT recipients. The programme has established international collaborations with the Swiss Transplant Cohort Study and the lung transplant cohort at Toronto General Hospital.

Future plans
Enrolment into MATCH is ongoing with no planned end date for enrolment or follow-up. MATCH will continue to provide high-quality data on transplant recipients and expand and strengthen international collaborations.