Risultati per: Focus su febbre gialla, tifo e epatite A, Meningite

Objectives
To generate qualitative data on the views of Occupational Therapists and Physiotherapists about why people do not receive the Royal College of Physicians’ recommended minimum of 45 minutes (min) of daily therapy after stroke, in order to inform a Delphi study.

Design
Focus group study.

Setting
Stroke services in the South of England.

Participants
A total of nine participants, in two groups, including therapists covering inpatient and Early Supported Discharge (ESD) services with awareness of the 45 min guideline.

Results
Thematic analysis of focus group data identified five factors that influence the amount of therapy a person receives: The Person (with stroke), Individual Therapist, Stroke Multidisciplinary Team, the Organisation and the Guideline. Study findings suggest that the reasons why a person does not receive the therapy recommendation in inpatient and ESD services relate to either the suitability of the guideline for the person with stroke, or the ability of the service to deliver the guideline.

Conclusion
This study provides evidence for possible reasons why some people do not receive a minimum of 45 minutes of therapy, 5 days per week, related to (1) the suitability of the guideline for people with stroke and (2) services’ ability to deliver this amount of intervention. These two factors are related; therapists decide who should receive therapy and how much in the context of (a) resource availability and (b) people’s need and the benefit they will experience. The study findings, combined with the findings from other studies, will be used to initiate a Delphi study, which will establish consensus among therapists regarding the reasons why some people do not receive the guideline amount of therapy.

A new committee focused on digital health technologies, including artificial intelligence, machine learning, and virtual reality, will advise the US Food and Drug Administration (FDA) on the risks, benefits, and clinical outcomes linked with these tools, the agency announced.

Circulation, Volume 148, Issue Suppl_1, Page A18190-A18190, November 6, 2023. Introduction:Guideline-directed medical therapy (GDMT) has proven to significantly reduce morbidity and mortality in Heart Failure. We highlighted the differences in renal function among HF patients managed on GDMT, comparing those within a dedicated HF unit (HFU) to those under General Medical (GM) and Geriatrics (GER).Aim:The purpose of this single-centre cohort study is to highlight differences in renal function outcome between these groups.Methods:Our database consists of 540 patients with AHF admitted to HFU or GM/GER from 01/08/2021 to 31/07/2022. We divided this group as follows:Group A: 267 patients from GM/GER.Group B: 273 patients in HFU.Groups were classified by ejection fraction(HFrEF/HFmrEF/HFpEF). We analyzed eGFR, K+ and Creatinine(Cr) on admission(adm) and discharge(dc).Results:Group A(GM/GER): HFrEF patients had average eGFR of 45.70(mL/min) on adm and 43.58 on dc. HFmrEF subgroups had eGFR of 48.60 on adm and 46.54 on dc. HFpEF subgroups had eGFR of 50.16 on adm and 47.75 on dc.Group B(HFU):Patients with HFrEF had eGFR of 53.50 on adm and 50.74 on dc. HFmrEF subgroup had adm eGFR of 49.48 and 47.01 on dc. HFpEF subgroups had eGFR of 45.95 on adm and 41.72 on dc.Group A and B comparison: We have previously demonstrated (Fig.1) that among patients with AHF managed in HFU, there is better optimisation of GDMT. Within the HFrEF cohort, eGFR decreased -2.76 in Group B, with reduction of -2.12 in Group A. Group B HFmrEF showed reduced eGFR of -2.47; Group A decreased -2.06. In HFpEF, eGFR reduced -4.23 in Group B. In Group A, eGFR decreased -2.41. An inpatient mortality of 15.73% was calculated in Group A, contrasting significantly with 6.23% among the HFU cohort.Conclusion:This study highlights differences in renal function outcome between these two groups. It demonstrates that despite optimisation and initiation of GDMT in Group B – which may lead to concern for its impact on renal function – eGFR, Cr and K+ levels were not markedly different between both cohorts.

Circulation, Volume 148, Issue Suppl_1, Page A18492-A18492, November 6, 2023. Background:Icosapent ethyl was approved in Dec 2019 to reduce CV event risk in statin-treated adults with elevated TG (≥150 mg/dL) and established CVD or diabetes with other risk factors of CVD.Hypothesis:Patients who take icosapent ethyl have demographic/clinical characteristics consistent with its indication.Aims:This study describes demographic/clinical characteristics of US patients taking icosapent ethyl, focusing on those with diabetes.Methods:A database of >89 million US electronic medical records identified patients taking icosapent ethyl (ie, ≥2 prescriptions on 2 separate days). Patient demographic/clinical baseline data were retrieved.Results:As of Jan 19, 2023, 40,408 patients taking icosapent ethyl were identified, with a mean (SD) age of 60.3 (12.9) y, BMI of 31.9 (6.07) kg/m2, HbA1c of 7.24% (1.88), and glucose level of 143 (67.8) mg/dL. Most were men (60.5%), White (75.2%), and taking statins (71.8%). Mean (SD; median) TG in the 3 mo before icosapent ethyl initiation was 422 (506; 300) mg/dL; 8.1% of patients had TG ≥500 mg/dL. In line with the indication of icosapent ethyl, 65.3% had prior atherosclerotic CVD or diabetes and ≥1 risk factor. Among 16,564 patients with diabetes (Figure), 13.0% had a history of myocardial infarction, 12.5% had stroke, and 10.4% had revascularization. Overall, 14.2% had chronic kidney disease and 5.5% had type 2 diabetes mellitus with diabetic kidney disease. Common risk factors for CVD were hypertension (68.4%), obesity (40.9%), and history of cigarette smoking (21.6%). Common antidiabetic medications were metformin (37.4%), insulin (27.9%), and sulfonylurea (15.1%).Conclusions:Patients using icosapent ethyl often had diabetes and/or CVD, took statins, and had elevated TG, meeting indications for its use. However, the high median TG before therapy suggests that many physicians reserve icosapent ethyl for more severe TG; thus many patients with more moderate levels ( >150 mg/dL) could potentially benefit.

Objectives
Vaccination averts an estimated 2–3 million deaths annually. Although vaccine coverage improvements across Africa and South Asia have remained below global targets, several countries have outperformed their peers with significant increases in coverage. The objective of this study was to examine these countries’ vaccination programmes and to identify and describe critical success factors that may have supported these improvements.

Design
Multiple case study design using qualitative research methods.

Setting
Three countries with high routine immunisation rates: Nepal, Senegal, and Zambia.

Participants
We conducted 207 key informant interviews and 71 focus group discussions with a total of 678 participants. Participants were recruited from all levels, including government officials, health facility staff, frontline workers, community health workers, and parents. Participants were recruited from both urban and rural districts in Nepal, Senegal, and Zambia.

Results
Our data revealed that the critical success factors for vaccination programmes relied on the cultural, historical, and statutory context in which the interventions were delivered. In Nepal, Senegal, and Zambia, high immunisation coverage was driven by (1) strong governance structures and healthy policy environments; (2) adjacent successes in health system strengthening; (3) government-led community engagement initiatives, and (4) adaptation considering contextual factors at all levels of the health system.

Conclusions
Throughout this project, our analysis returned to the importance of defining and understanding the context, governance, financing, and health systems within a country, rather than focusing on any one intervention. This paper augments findings from existing literature by highlighting how contextual factors impact implementation decisions that have led to improvements in childhood vaccine delivery. Findings from this research may help identify transferable lessons and support actionable recommendations to improve national immunisation coverage in other settings.

Asl, rafforzate misure di contrasto diffusione della malattia

Objective
The paper aimed to study the association between household access to water, sanitation and hygiene (WASH) services and the occurrence of diarrhoea and acute respiratory infection among children under 5 years in Benin.

Design
We performed secondary analyses using Benin’s Fifth Demographic and Health Survey datasets. The dependent variables were diarrhoea and acute respiratory infection (yes=1, no=0). Among the independent variables were the household access to individual WASH services, grouped as follows: ‘basic’, ‘limited’, ‘unimproved’ and ‘no service’. Multivariate logistic regression was used to determine the association between household access to WASH services and the occurrence of diarrhoea and acute respiratory infection. Results from the multivariate logistic regression were presented using adjusted Odds Ratios (aORs) with 95% Confidence Intervals (95% CIs).

Setting
Benin.

Participants
Children under 5 years successfully surveyed during Benin’s Fifth Demographic and Health Survey.

Outcome measures
Diarrhoea and acute respiratory infection.

Results
In the current study, 12 034 children under 5 years met the selection criteria and were included in the analyses. The prevalence of diarrhoea and acute respiratory infection was 10.5% (95% CI=9.8% to 11.3%) and 2.9% (95% CI=2.5% to 3.4%), respectively. Children living in households without sanitation service, that is, practising open defecation (aOR=1.9, 95% CI=1.4 to 2.6), and with unimproved (aOR=1.9, 95% CI=1.3 to 2.7) and limited (aOR=1.5, 95% CI=1.1 to 2.2) services were more likely to have diarrhoea compared with children with basic sanitation services. Household access to WASH services was not associated with acute respiratory infection.

Conclusion
We suggest reinforcing household access to basic sanitation services to combat diarrhoea in children under 5 years. Further research is needed on the effects of WASH interventions on diarrhoea and acute respiratory infection in children under 5 years.

Andreoni: “La tropicalizzazione del Paese porta malattie nuove”

Da maggio a oggi, coinvolte 9 regioni e 49 province

La malattia nella maggior parte dei casi è asintomatica, in altri può causare febbre e sintomi influenzali, nausea, vomito, irritazioni della pelle, e nei casi più gravi anche emorragie potenzialmente fatali (in meno dell’1% delle persone)

Objectives
To adapt the content and functionalities of Brain Health PRO, a web-based multidomain program designed to increase dementia literacy, to the context and needs of users, providers and community organisations across Québec, Canada.

Design
Five consecutive qualitative co-creation focus group sessions 30–90 min in duration each, exploring potential barriers and facilitators to usability, accessibility, comprehensibility, participant recruitment and retention.

Setting
Virtual meetings.

Participants
A 15-member team based in Québec and Ontario, Canada, consisting of 9 researchers (including a graduate student and the project coordinator), representing occupational therapy, sensory rehabilitation, neuropsychology, psychology, health science and research methods, 3 informal caregivers of older adults living with cognitive decline and 3 members of the Federation of Quebec Alzheimer Societies.

Data analysis
Session recordings were summarised through both qualitative description and thematic analysis.

Results
The synthesised recommendations included adjustments around diversity, the complexity and presentation styles of the materials, suggestions on refining the web interface and the measurement approaches; it influenced aspects of participant recruitment, retention efforts and engagement with the content of Brain Health PRO.

Conclusions
Co-creation in dementia prevention research is important because it involves collaboration between researchers, community support and service providers, and persons with lived experience as care providers, in the design and implementation of clinical studies. This approach helps to ensure that the content and presentation of educational material is relevant and meaningful to the target population and those involved in its delivery, and it leads to a greater understanding of their needs and perspectives.

Signorelli, “fra i primi segni il mal di testa e la rigidità”

Salgono a 46 le Province con circolazione, 9 Regioni interessate

Objective
Improving synergy among regulation, health technology assessment (HTA) and clinical guideline development is relevant as these independent processes are building on shared evidence-based grounds. The two objectives were first to assess how convergence of evidentiary needs among stakeholders may be achieved, and second, to determine to what extent convergence can be achieved.

Design
Qualitative study using eight online dual-moderator focus groups.

Setting
Discussions had a European focus and were contextualised in four case studies on head and neck cancer, diabetes mellitus, multiple sclerosis and myelodysplastic syndromes.

Participants
Forty-two experienced (over 10 years) European regulators, HTA representatives and clinicians participated in the discussion.

Interventions
Participants received information on the case study and research topic in advance. An introductory background presentation and interview guide for the moderators were used to steer the discussion.

Results
Convergence may be achieved through improved communication institutionalised in multistakeholder early dialogues, shared definitions and shared methods. Required data sets should be inclusive rather than aligned. Deliberation and decision-making should remain independent. Alignment could be sought for pragmatic clinical trial designs and patient registries. Smaller and lower-income countries should be included in these efforts.

Conclusion
Actors in the field expressed that improving synergy among stakeholders always involves trade-offs. A balance needs to be found between the convergence of processes and the institutional remits or geographical independence. A similar tension exists between the involvement of more actors, for example, patients or additional countries, and the level of collaboration that may be achieved. Communication is key to establishing this balance.

Circulation, Volume 148, Issue 9, Page 800-802, August 29, 2023.

Stroke, Volume 54, Issue 9, Page 2449-2452, September 1, 2023.