High Prevalence Regions Research Articles

Hematological And Clinical Analysis of Hepatitis B Patients from Quetta, Pakistan

Background: Hepatitis B Virus (HBV) infection is still a serious worldwide health concern. The primary mechanisms of HBV transmission in Pakistan include the use of infected tools in medical and dental practices, unsafe blood transfusion, and a family history of HBV infection. Pakistan has a high HBV prevalence, with 4.55 million persons affected. The cause for this might be a lack of sufficient health facilities, a bad economic situation, and insufficient knowledge regarding the spread of infections such as HBV.
 Aim of the study: The goal of this study was to look at the possible risk factors that may lead to HBV infection and analysis of Hematological and liver function tests which are two tests that are used to determine the health of a person.
 Methods: Blood samples from 244 individuals infected with HBV infection (including both males and females) were collected and processed for complete blood count and liver function analysis. General characteristics were recorded interview and questionnaire.
 Results: A total of 244 HBV-positive patients were included in the study. Their ages were range from 17-78 years. The HBV rate was higher in males 175 (71.7%) and 69 (28.3%) in females. Out of one hundred forty-four patients, 143 (58.60%), individuals were from rural areas and 101 (41.60 %) were from urban areas. majority of the individuals 148 (60.7%) were married and 87 (35.7%) were unmarried. According to their education, most of the participants 101 (41.4%) were illiterate and only 61 (25.0%) had a higher level of education. Dental history and smoking habits were recorded in 71 (29.1%) patients respectively. Similarly, a family history of hepatitis B infection was recorded in 51 (20.9%) and only 15 (6.1%) had a blood transfusion history.
 Conclusion: In rural areas of Quetta, Balochistan, Pakistan, the current study demonstrated a significant incidence of HBV infection. The observed prevalence is gender and age-dependent, possibly because of their increased exposure to common risk factors. To prevent the spread of HBV infection, it is advised that people be made aware of the potential risk factors and that vaccination be extended in high prevalent regions.

Determinants of under-five anaemia in the high prevalence regions of Ghana

Introduction: Anaemia is a serious public health issue that mostly affects children and women throughout their lives, resulting in a high morbidity and mortality burden. It is the third most dominant cause of hospital admission among children under-five in Ghana and the fourth leading cause of under-five mortality in Ghana. This study aims to identify the determinants of under-five anaemia in the high prevalent regions of Ghana using the Ghana Malaria Indicator Survey (2019 GMIS). Methods: An analytic cross-sectional study was conducted using data from the Ghana Malaria Indicator Survey (2019 GMIS). The data was analysed using SPSS version 20. The relationship between the dependent and independent variables was established using the chi-square test and binary logistic regression model. A p-value of 0.05 was used to determine the statistical significance of the study. Results: There were 913 eligible under-five children for this study, with 50.2% males and 49.8% females. The prevalence of under-five anaemia recorded in this current study for the three northern regions was 68.0%. The region with dominant (72.9%) prevalence was the Upper East region. Children of lower age group were more likely to be diagnosed with anaemia (P < 0.05). Children with female household heads were 35% less likely to be diagnosed with anaemia (AOR=0.65, 95% C.I.= 0.421-0.995). Those who had mothers with higher educational attainment were 79% less likely to be diagnosed with anaemia (AOR=0.21, 95% C.I.=0.085–0.541). Finally, those with history of fever in the last weeks were 62% more likely (AOR=1.62, 95% C.I. = 1.155–2.282). Conclusions: The high prevalence in the three northern regions of Ghana can be corrected with women empowerment through higher formal educational achievement and improved income status.

Chromoblastomycosis-Leprosy Co-Infection in Central West Brazil. Presentation of Three Cases and Literature Review

Chromoblastomycosis and leprosy are chronic diseases with high prevalence in tropical and subtropical regions. Brazil is one of the countries with the highest incidence and prevalence for both diseases, however, reports of co-infections are scarce. The aim of this study was to describe three cases of chromoblastomycosis-leprosy co-infection in patients from Mato Grosso state, Brazil. A review of chromoblastomycosis-leprosy co-infection was performed of English, Portuguese and Spanish publications in LILACS, SciELO, PubMed and Web of Science databases using the descriptors (chromoblastomycosis OR cromoblastomicose OR cromoblastomicosis) AND (leprosy OR hanseníase OR lepra), without time period delimitation. Nineteen cases were included, 16 cases were published in 11 articles, plus the three cases reported in the current study. Most reported coninfection cases came from Brazil. Majority of the patients were male with a mean age of 52.2 years. Farmer was the main occupational activity reported. In 12 patients, the clinical signs and symptoms of leprosy started first. No contacts with patients affected by leprosy, armadillos or history of injuries at the anatomical site of chromoblastomycosis lesions were reported. Five leprosy patients who received steroid treatment for leprosy reactions or neuropathies, were diagnosed with chromoblastomycosis during immunosuppressive therapy. Four cases (21.1%) were reported among the elderly patients. Co-infections in patients with chromoblastomycosis or leprosy are uncommon, but the possibility should always be considered, especially if the patient is undergoing immunosuppressive treatment or is elder.

Regional heterogeneity of malaria prevalence and associated risk factors among children under five in Togo: evidence from a national malaria indicators survey

BackgroundMalaria remains a major cause of morbidity and death among children less than 5 years of age. In Togo, despite intensification of malaria control interventions, malaria remained highly prevalent, with significant heterogeneity from one region to another. The aim of this study is to explore further such regional differences in malaria prevalence and to determine associated risk factors.MethodsData from a 2017 cross-sectional nationally representative malaria indicator survey was used. Children aged 6–59 months in selected households were tested for malaria using a rapid diagnostic test (RDT), confirmed by microscopy. Univariate and multivariate logistic regression analysis were performed using Generalized Linear Models.ResultsA total of 2131 children aged 6–59 months (1983 in rural areas, 989 in urban areas) were enrolled. Overall 28% of children tested positive for malaria, ranging from 7.0% in the Lomé Commune region to 4% 7.1 in the Plateaux region. In multivariate analysis, statistically significant differences between regions persisted. Independent risk factors identified were higher children aged (aOR = 1.46, 95% CI [1.13–1.88]) for those above 24 months compared to those below; households wealth quintile (aOR = 0.22, 95% CI [0.11–0.41]) for those richest compared to those poorest quintiles; residence in rural areas (aOR = 2.02, 95% CI [1.32–3.13]).ConclusionInterventions that target use of combined prevention measures should prioritise on older children living in poorest households in rural areas, particularly in the regions of high malaria prevalence.

Effectiveness of seasonal malaria chemoprevention in reducing under-five malaria morbidity and mortality in the Savannah Region, Ghana.

To assess the effectiveness of seasonal malaria chemoprevention (SMC) in reducing under-five malaria morbidity and mortality. Under-five malaria data for confirmed episodes, deaths, and number of children dosed per cycle of SMC campaign were extracted from the District Health Information Management System (DHIMS-2) for 2018-2019. Data verification was done to compare extracted data with the source for completeness and consistency. Association between SMC and the main outcome variables (malaria cases and mortality) was computed from 2X2 tables and reported as rate ratios at a 95% confidence level. All seven (7) districts in Savannah Region, Ghana. Children under five years. Sulphadoxine-Pyrimethamine and Amodiaquine (SPAQ) prophylaxis given monthly, four times, durng the rainy season (July to October). SMC coverage per cycle and under-five malaria morbidity and mortality ratios. Over 370,000 dose packs of SPAQ were administered with an average cycle coverage of 93%. There was approximately 17% (p<0.01) and 67% (p=0.047) reduction in malaria-related morbidity and mortality, respectively, in the implementation year compared with the baseline. This translated into nearly 9,300 episodes of all forms of malaria and nine malaria-attributable deaths averted by the intervention. SMC (combined with existing control measures) wields prospects of accelerating the regional/national malaria elimination efforts if the implementation is optimised. Expansion of the intervention to other high-prevalence regions with seasonal variation in disease burden may be worthwhile. None declared.

Preliminary Survey of Soil Transmitted Helminths in Some Selected Primary Schools in Okitipupa Local Government Area, Ondo State, South West Nigeria

Soil transmitted helminths are nematodes commonly known as intestinal worms; characterized by high prevalence in regions exhibiting warm and moist climates, lacking adequate sanitation and proper hygiene. In this study, the prevalence and distribution of soil transmitted helminths (STHs) in five randomly selected Primary schools in Okitipupa Local Government Area, Ondo State, Nigeria was examined. The study involved soil examination for infective stages of helminth parasites. To determine the type and number of infective helminth ova, topsoil samples were collected from ecologically important sites; the playgrounds, front of classrooms, back of classrooms, around the toilet and the entrance of each selected schools. Of the 75 soil samples examined, 36 were infected showing a total prevalence of 48%. Accordingly, Ascaris lumbricoides (26 ova), Trichiuris trichuira (9 ova), Strongyloides stercoralis (6 ova/larva) and hookworm (15 ova) were the STHs parasites recorded in sampled soils. Ascaris was the most distributed parasite 26 ova (46.1%) across sites; and specifically most abundant in Ikoya 8 (30.8%), while Ayeka 9 (16.1%) reportedly had the least total parasite distribution. The total parasite prevalence in this study was 46.7%.

Prevalence and Epidemiological Characteristics of Neonates with Neural Tube Defects at Bugando Medical Center: An 8- Year Hospital Based Survey

Introduction: Neural tube defects (NTDs ) are a common health burden in the countries of the sub-Saharan region(1) and the an important concern for the public health system(2). Prevalence in Africa has been reported at 11.7 per 10,000(3) whereas the prevalence of NTDs in the lake zone region of Mwanza is yet to be known. Methods: A cross-sectional hospital based retrospective descriptive study, involved all newborns with any type of neural tube defect admitted to the neonatal ward at Bugando Medical Center between 1st November 2013 to 28th February 2022. Results: Out of the 17997 neonate admissions during the study period, the prevalence of NTDs was 44.6 :1000. Males were 438 (54.5%) more than females 366 (45.5%) with statistical significance of p=0.011. The mean age at admission 7.59 days (SD=7.12) CI 0.49(7.10-8.10). Spina Bifida in particular Myelomeningocele was the most common among the neural tube defects was found in 673 (83.7%) of the admitted neonates whereas 82 (10.2%) presented with hydranencephaly and 49(6.1%) with encephalocele and with a prevalence ratio of 37.4 : 4.5 :2.7 per 1000 cases respectively. Conclusion:The prevalence of neural tube defects in our study was 44.6:1000. Myelomeningocele is the commonest encountered NTD. The overall prevalence of neural tube defects from the lake zone region is very high compared to other regions of the world. Future work is needed to seek etiological explanations for the high regional prevalence differences and to develop improved methods for primary prevention of this public health burden.

Risk factors of concurrent malnutrition among children in Ethiopia: a bivariate spatial modeling approach

Malnutrition among children remains a challenge to public health in Africa, and it is responsible for the increased infant mortality rate in Ethiopia. This study aims to identify the joint determinant factors of malnutrition among under-age five children in Ethiopia and quantify the regional prevalence across the country. A Bayesian hierarchical linear mixed model, with a bivariate conditional autoregressive model, was adopted to account for the joint spatial prevalence pattern of malnutrition among under-age five children in Ethiopia. The data were provided by the Demography and Health Surveys program. The study revealed that gender, wealth index, mothers' education, toilet system, fever, birth order, birth interval, contraceptive use, and diarrhea, are significant risk factors of child malnutrition. The three malnutrition indicators are most prevalent in the Afar region, while stunting and underweight are most prevalent in Amhara, Beneshangul Gumuz, and Tigray, and the wasting and underweight are most prevalent in the Gambela and Somali. Findings revealed that a stunted child is more likely to be underweight than being wasted, and a wasted child is more likely to be underweight than being stunted. The findings also revealed significant changes in the prevalence of malnutrition for different mothers and children age groups. For cost-effective malnutrition intervention, programs for parents, such as awareness creation about the modern types of contraceptives, appropriate birth spacing, the benefits of antenatal and postnatal care, for example, are a propitious method to mitigate malnutrition in high prevalent regions than direct intervention to the children. Abbreviations: BICAR, Bivariate Conditional Autoregressive; DHS, Demographic and Health Survey; EDHS, Ethiopia Demographic and Health Survey; EA, Enumeration Area; GMRF, Gaussian Markov Random Field; HAZ, Height for Age Z-sscore; INLA, Integrated Nexted Laplace Approximation; MCAR, Multivariate Conditional Autoregressive; MCMC, Markov Chain Monte Carlo; SNNPR, Southern Nations, Nationalities, and People's Region; WAZ, Weight for Age Z-score; WHZ, Weight for Height Z-score; WHO, World Health Organization

To what extent do people living with HIV, people on pre-exposure prophylaxis, doctors and pharmacists endorse 90-day dispensing of antiretroviral therapy in France?

JustificationThe WHO 95-95-95 targets for 2030 do not imply that people living with HIV (PLHIV) achieve a good quality of life. The current 30-day dispensing interval for antiretroviral (ART) burdens the healthcare system. Lengthening dispensing intervals could alleviate this burden as well as enhance patient well-being.ObjectivesTo capture perceptions on 90-day dispensing interval (90D) for ART from the perspective of PLHIV, people on pre-exposure prophylaxis (PrEP), doctors, and pharmacists.MethodsMulti-centre observational survey led in France from 16 to 20 October 2020, among doctors agreeing to participate via regional coordinated care organisations for HIV, all PLHIV or people on PrEP consulting these outpatient-clinic doctors, and pharmacists doing ART dispensing.ResultsThe survey was completed by 220 doctors who saw 1087 people (999 PLHIV; 88 on PrEP) and 176 pharmacists from 55 centres. Among the PLHIV, 855 (85.6%, 95% CI: 83.2%–87.7%) and among the patients on PrEP, 70 (79.5%, 95% CI: 69.6%–87.4%) stated they would be interested in 90D. All in all, patients who were more likely to endorse 90D are those who opt exclusively for hospital dispensing (OR 3.22 [1.57–6.58]) and who rotate between hospital and community pharmacy dispensing (OR 3.29 [1.15–9.32]). Patients who were less likely to endorse 90-D were those who consult in a city located outside the 3 French high HIV prevalence regions (OR 0.66 [0.44–0.99]), receive 2 vs 1 pill QD regimens (OR 0.53 [0.31–0.91]), and anticipate at least one vs no limitation to 90D (OR 0.27 [0.17–0.42]). 90D was perceived as possible by 152 pharmacists (86.4%), including 8 (5%) without restriction, and 219 doctors (99.6%), including 42 (19.2%) regardless of PLHIV’s immunovirologic status or social conditions (health insurance coverage, access to housing or accommodation, access to rights, resources). Comparison of the benefits and limitations of a 90-day ART dispensing interval as perceived by PLHIV and people on PrEP, doctors and pharmacists shows that doctors anticipate a higher number of benefits than people on ART and/or pharmacists, chiefly that 90D would be more convenient and create less risk of drug shortages and that patients would gain autonomy and a better quality of life. Pharmacists were found to clearly perceive the economic benefits (90D would be less expensive) but anticipate more drawbacks than doctors and the people on ART themselves: more administrative burdens, more non-dispensing if doses get lost, harder to track adherence and more drug–drug interaction issues, and more work as they shall have to warn the patient of potential risks of shortages due to the cost of the stock.ConclusionA clear majority of PLHIV, people on PrEP, doctors, and pharmacists endorsed 90D of ART. Most patients thought that 90D would be a good option, whereas most pharmacists and doctors thought that eligibility for 90D dispensing should depend on immunovirologic factors and social condition criteria. Moreover, pharmacists thought it would be necessary to commit regulatory resources and a better follow-up on adherence and drug–drug interactions.

59P Clinical utility of plasma cell-free DNA EGFR mutation analysis in treatment-naïve stage IV non-small cell lung cancer patients

Plasma cell-free DNA epidermal growth factor receptor (EGFR) mutation tests are widely used at initial diagnosis and at progression in stage IV non-small cell lung cancer (NSCLC). We analyzed the factors associated with plasma EGFR mutation detection and the effect of plasma EGFR genotyping on the clinical outcomes of the patients with treatment-naïve stage IV NSCLC. In this retrospective cohort study, we included subjects with treatment-naïve stage IV NSCLC who underwent plasma EGFR genotyping between 2018 and 2020. The presence of plasma EGFR mutation was determined by real-time polymeric chain reaction. The prevalence of EGFR mutation in this cohort was 52.7% (164/311). Among 164 EGFR mutant subjects, 34 (20.7%) were positive for the plasma EGFR mutation assay only. The diagnostic sensitivity of the plasma EGFR mutation assay (80.5%) was similar to that of the tissue EGFR mutation assay (79.3%, p = 0.787). In multivariable analysis, the detection of plasma EGFR mutation was significantly related to higher serum carcinoembryonic antigen levels, never-smoker status, N3 stage, and brain or intrathoracic metastasis. The time to treatment initiation (TTI) of the plasma EGFR mutation-positive group (14 days) was shorter than that of the plasma EGFR mutation-negative group (21 days, p < 0.001). More patients received the 1st line EGFR-TKI in the plasma positive group compared with the tissue positive group. Smoking status and the factors reflecting tumor burden were associated with detection of plasma EGFR mutation. The plasma EGFR mutation assay can shorten the TTI, and facilitate the 1st line EGFR-TKI therapy for patients with treatment-naïve stage IV NSCLC, especially in the region of high-prevalence of EGFR mutation.

Comparison of Trials Using Ivermectin for COVID-19 Between Regions With High and Low Prevalence of Strongyloidiasis

A widely cited meta-analysis of randomized clinical trials has claimed ivermectin as an effective treatment for prevention of mortality in COVID-19. However, an unrecognized interaction variable with the relative risk (RR) of mortality may substantially change the appropriate interpretation of this analysis. To evaluate the association between regional prevalence of strongyloidiasis and ivermectin trial results for the outcome of mortality by testing the hypothesis that strongyloidiasis prevalence interacts with the RR of mortality. Original meta-analysis as well as a manual review of all references in a dedicated ivermectin trial database (c19ivermectin) from January 1, 2019, to November 6, 2021. Randomized clinical trials using ivermectin as a treatment for COVID-19 and reporting the outcome of mortality. Studies were excluded in the event of publications revealing suspected trial fraud and/or randomization failure. Study characteristics and RR estimates were extracted from each source. Estimates were pooled using random-effects meta-analysis. Differences by strongyloidiasis prevalence were estimated using subgroup meta-analysis and meta-regression. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Relative risk of mortality in ivermectin trials in regions of high vs low strongyloidiasis prevalence and correlation coefficient of meta-regression analysis between RR of mortality and regional prevalence of strongyloidiasis. A total of 12 trials comprising 3901 patients were included in the analysis. Four trials (33%) took place in regions of high strongyloidiasis prevalence and 8 (67%) trials took place in regions of low strongyloidiasis prevalence. Ivermectin trials that took place in areas of low regional strongyloidiasis prevalence were not associated with a statistically significant decreased risk of mortality (RR, 0.84 [95% CI, 0.60-1.18]; P = .31). By contrast, ivermectin trials that took place in areas of high regional strongyloidiasis prevalence were associated with a significantly decreased risk of mortality (RR, 0.25 [95% CI, 0.09-0.70]; P = .008). Testing for subgroup differences revealed a significant difference between the results of groups with low and high strongyloidiasis prevalence (χ21 = 4.79; P = .03). The estimate for τ2 (the variance of the study effect sizes) was 0 (95% CI, 0.0000-0.2786), and the estimate for I2 (percentage of variability that is explained by between-study heterogeneity) was 0 (95% CI, 0-43.7%). The meta-regression analysis revealed an RR decrease of 38.83% (95% CI, 0.87%-62.25%) for each 5% increase in strongyloidiasis prevalence. In this meta-analysis of 12 trials including 3901 patients, strongyloidiasis prevalence was found to interact with the RR of mortality for ivermectin as a treatment for COVID-19. No evidence was found to suggest ivermectin has any role in preventing mortality among patients with COVID-19 in regions where strongyloidiasis was not endemic.

Clinical and Public Health Implications of Human T-Lymphotropic Virus Type 1 Infection.

Human T-lymphotropic virus type 1 (HTLV-1) is estimated to affect 5 to 10 million people globally and can cause severe and potentially fatal disease, including adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The burden of HTLV-1 infection appears to be geographically concentrated, with high prevalence in discrete regions and populations. While most high-income countries have introduced HTLV-1 screening of blood donations, few other public health measures have been implemented to prevent infection or its consequences. Recent advocacy from concerned researchers, clinicians, and community members has emphasized the potential for improved prevention and management of HTLV-1 infection. Despite all that has been learned in the 4 decades following the discovery of HTLV-1, gaps in knowledge across clinical and public health aspects persist, impeding optimal control and prevention, as well as the development of policies and guidelines. Awareness of HTLV-1 among health care providers, communities, and affected individuals remains limited, even in countries of endemicity. This review provides a comprehensive overview on HTLV-1 epidemiology and on clinical and public health and highlights key areas for further research and collaboration to advance the health of people with and at risk of HTLV-1 infection.

COVID-19 outbreak impact on health professionals: A survey on the Italian radiographer experience

AimTo evaluate the impact of the Phase 1 COVID-19 (C19) outbreak on Italian Radiographers. Material and methodsCOVID-19 has spread rapidly worldwide. Many patients underwent radiological examinations, leading to a high risk of infection within the radiology department's staff. Italy was the first-hit European country to face the COVID-19 outbreak and the impact on radiographers was huge. An online survey was disseminated to investigate the involvement and working environment of Italian radiographers during the first outbreak of COVID-19. ResultsOf the 840 responders, 65% were men. The majority of the responding Health-care Workers (HCW) was represented by radiographers (96%), from high-prevalence regions (82%; p<.05). Forty-five percent were involved in the activation of the protocol for the management of COVID-19 positive patients, without exhaustive indication for Plain Radiography and Computed Tomography (CT). Only 17% of hospitals counted on available guidelines for serious infections (p<0.05). Diagnostic examinations were mainly performed by a single radiographer (62%). Many professionals (69%) confirmed wearing all indispensable PPE in case of COVID-19 positive patients. ConclusionThe primary objective of management strategies should be to redact standardized policies for the safeguarding of patient's health and operator's safety. All front-line workers, including radiographers working in diagnostic services, should be involved in the decision-making process to generate wellness and awareness.

Clinical Utility of Plasma Cell-Free DNA EGFR Mutation Analysis in Treatment-Naïve Stage IV Non-Small Cell Lung Cancer Patients.

Background: Plasma cell-free Deoxyribo nucleic acid epidermal growth factor receptor (EGFR) mutation tests are widely used at initial diagnosis and at progression in stage IV non-small cell lung cancer (NSCLC). We analyzed the factors associated with plasma EGFR mutation detection and the effect of plasma EGFR genotyping on the clinical outcomes of the patients with treatment-naïve stage IV NSCLC. Methods: In this retrospective cohort study, we included subjects with treatment-naïve stage IV NSCLC who underwent plasma EGFR genotyping between 2018 and 2020. The presence of plasma EGFR mutation was determined by real-time polymeric chain reaction. Results: The prevalence of EGFR mutation in this cohort was 52.7% (164/311). Among 164 EGFR mutant subjects, 34 (20.7%) were positive for the plasma EGFR mutation assay only. In multivariable analysis, the detection of plasma EGFR mutation was significantly related to higher serum carcinoembryonic antigen levels, never-smoker status, N3 stage, and brain or intrathoracic metastasis. The time to treatment initiation (TTI) of the plasma EGFR mutation-positive group (14 days) was shorter than that of the plasma EGFR mutation-negative group (21 days, p < 0.001). More patients received the 1st line EGFR-TKI in the plasma positive group compared with the tissue positive group. Conclusion: Smoking status and the factors reflecting tumor burden were associated with the detection of plasma EGFR mutation. The plasma EGFR mutation assay can shorten the TTI, and facilitate the 1st line EGFR-TKI therapy for patients with treatment-naïve stage IV NSCLC, especially in the region of high-prevalence of EGFR mutation.

Disparities in state-mandated third-trimester testing for syphilis

Since 1999, Illinois has had a legal statute mandating both first-visit and third-trimester syphilis testing in all pregnancies. However, the incidence of syphilis infection is increasing at the national and state level, including among individuals of reproductive age, conferring risk of congenital syphilis. Although state-mandated infectious disease screening is purported to be a strategy to improve equity and quality of care, adherence to such mandates and disparities in adherence are unknown. We sought to evaluate compliance with state-mandated third-trimester syphilis testing at a single tertiary hospital in Illinois and to identify disparities in testing. This is a retrospective cohort study of all pregnant individuals who delivered between January 1, 2015 and February 28, 2018 at a large-volume academic center. Patients who delivered after 28 weeks of gestation were included. Frequency of state-mandated first-visit (<28 weeks) and third-trimester (≥28 weeks) syphilis screening was evaluated over the study period. The primary outcome was completion of any third-trimester screening (ie, performed as an initial or repeat test in the third trimester) in accordance with state law. Demographic and clinical factors associated with the primary outcome and with completion of both first-visit and third-trimester screening were evaluated with multivariable logistic regression. Of the 9048 eligible deliveries, 96.9% (N=8766) of patients had first-visit syphilis screening, whereas only 27.3% (N=2469) had third-trimester screening. Performance of third-trimester syphilis testing increased over time from an average of 5.8% of deliveries during the first 6 months of the study period to 59.8% over the last 6 months of the study period. Non-Hispanic Black or Hispanic race or ethnicity, non-English primary language, public insurance, age <25, multiparity, and greater body mass index were independently associated with increased odds of third-trimester screening. Despite a decades-old state mandate for third-trimester syphilis screening in this high-prevalence region, third-trimester screening performance was suboptimal. Several demographic characteristics were associated with adherence to screening, suggesting inequity and bias exist in testing practices. It is important to acknowledge that legal statutes do not fully eliminate bias and health disparities.

Increased psychological distress after the lifting of COVID-19 lockdown in the Saudi population: a cross-sectional study

BackgroundAmid the ongoing COVID-19 pandemic and its global health and socioeconomic aftereffects, the enduring state of crisis is increasingly impacting the coping capacity of the populations. In this study, we aimed to characterize the levels of psychological distress after the lifting of COVID-19 lockdown.ResultsThe Impact of Event Scale (IES-R) and Depression, Anxiety, and Stress Scales-21 items (DASS-21) were used to screen for post-traumatic stress syndrome (PTSD), depression, anxiety, and stress. The prevalence of PTSD was 41.6% and was associated with severe or extremely severe stress (27.8%), anxiety (31.4%), and depression (39.0%). All disorders were strongly correlated with one another. The risk of developing PTSD was independently associated with residence in high COVID-19 prevalence region (OR = 2.25, p = 0.004), poor (OR = 3.98, p = 0.002), or moderate (OR = 1.63, p = 0.048) self-assessed overall physical health, psychiatric comorbidity (OR = 1.87, p = 0.036), number of COVID-19-like symptoms (OR = 1.94, p = 0.039), and severe COVID-19 morbidity in the acquaintances (OR = 1.54, p = 0.026). Four theories were proposed to explain these high figures, with a discussion of their practical implications.ConclusionsThe lifting of lockdown measures was associated with a substantial increase in psychological distress among the Saudi population, referring to figures reported during the lockdown. This may indicate a decline in the overall population’s coping capacity with the enduring crisis.

Post tuberculosis chronic lung disease in tuberculosis HIV coinfected and non-HIV individuals in Sub-Saharan Africa: A systematic review and meta-analysis.

Post tuberculosis (TB) sequelae are faced by many individuals who survive TB. The most common of all is post-TB chronic lung disease (CLD) and pulmonary impairment. We reviewed studies that estimated the prevalence of post-TB CLD in patients with TB only and those with TB-HIV coinfection. Searched Google scholar, PubMed, African journals online, Embase, and Cochrane Central Register of Clinical Trials from the year 2000 to 01 March 2022 for all designs of studies that examined the impact of post on lung impairment or damage. The protocol was registered in PROSPERO, ID: chronic respiratory disease 42022304628. Three hundred and thirty-six studies were identified and five studies were identified through other sources, four were finally in the meta-analysis with a total of 4382 enrolled participants. All the studies had a low risk of bias; The prevalence of CLD between the TB HIV coinfection and those with TB only was of no statistical significance between the three of the four studies - new statement: the prevalence of CLD in the TB-HIV coinfected group when compared to the group of participants with TB only was not statistically significant in the study. This was seen in three of the four studies. One study was in favor of the high prevalence of CLD in HIV coinfection participants (relative risk [RR] = 0.75 [0.61-0.89] with 95% confidence interval [0.61-0.89]). Post-TB lung disease is still a burden that needs advocation and an increase of awareness is necessary from the health-care level to the communities and societies, especially in regions of high prevalence. Development of guidelines for health-care workers to aid the management of individuals, multi-disciplinary advocacy is necessary for those whom prevention is not too late.

"PrEP Gives the Woman the Control": Healthcare Worker Perspectives on Using pre-Exposure Prophylaxis (PrEP) During Pregnancy and Postpartum in Kenya.

Background: Pregnant and postpartum women in high HIV prevalent regions are at increased HIV risk. Oral pre-exposure prophylaxis (PrEP) can decrease HIV incidence reducing infant HIV infections. Understanding healthcare worker (HCW) beliefs about PrEP prior to national roll-out is critical to supporting PrEP scale-up. Methods: We conducted 45 semi-structured interviews among a range of HCW cadres with and without PrEP provision experience purposively recruited from four clinics in Kenya to compare their views on prescribing PrEP during pregnancy and postpartum. Interviews were analysed using a conventional content analysis approach to identify key influences on PrEP acceptability and feasibility. Results: All HCWs perceived PrEP as an acceptable and feasible HIV prevention strategy for pregnant and postpartum women. They believed PrEP meets women’s needs as an on-demand, female-controlled prevention strategy that empowers women to take control of their HIV risk. HCWs highlighted their role in PrEP delivery success while acknowledging how their knowledge gaps, concerns and perceived PrEP implementation challenges may hinder optimal PrEP delivery. Conclusion: HCWs supported PrEP provision to pregnant and postpartum women. However, counseling tools to address risk perceptions in this population and strategies to reduce HCW knowledge gaps, concerns and perceived implementation barriers are required.

Eradicating slave labour by 2030: the challenge of worker health surveillance.

Eradicating modern slavery is a relevant scientific, social, and institutional challenge issue. Indeed, efforts are being made globally to understand, map, and eradicate contemporary slavery as a target of the United Nations Sustainable Development Goals by 2030. However, little attention has been given to the Occupational Health Surveillance (VISAT) in the strategies and struggle against exploiting relationships. In order to fill this gap, the paper discusses contemporary slave labor (CSL) and its specificities in Brazil from an occupational health surveillance perspective. We initially highlight the link between CSL, occupational health, and occupational health surveillance (VISAT). We then present three VISAT challenges to addressing CSL: the challenging task of characterizing economic sectors and populations most affected; identifying determinants, risks, and effects on health; and strengthening occupational health practices and services to trigger specific actions regarding formation, information, and intervention in regions of high CSL prevalence. We conclude that Occupational Health Surveillance can play an essential role in the emancipation of workers engaged in slavery relationships.

Towards a better characterization of dementia in northeast Brazil: Numbers from a reference center in Recife

AbstractBackgrounddementia numbers are increasing rapidly with a substantial contribution from low and middle‐income countries. There’s a limited number of reports in Brazil, mostly modest initiatives from south‐eastern, more developed areas, such as the Tremembe study which reported a 17,5% prevalence of dementia in 630 elderly subjects. With a population of approx. million individuals, the metropolitan region of Recife is among the largest cities of Northeast Brazil, a region of profound social disparities and high prevalence of low‐literacy.Methodthis is a single‐center, descriptive and health records‐based analysis of patients evaluated in the Dementia outpatient clinic of the Neurology and Neurosurgery Unit at the Federal University of Pernambuco in the timeframe between 2018 ‐ 2019.Result60 patients had their data available and were included for descriptive analysis. Mean age was 69 years old (+ 7.6 SD) with 62% of women and 6 years of formal education. 46% of all cases were referred for evaluation from neighboring cities and states. The mean Mini‐mental state examination in the first consultation was 15/30 and patients had a significant burden of functional impairment with a mean Pfeffer score of 21/30 (+ 9.8 SD). Hypertension (40%), Diabetes (71%) and Anxiety (85%) were frequent comorbidities. Regarding access to neuroimaging methods, 75% subjects had access to either CT (16/60) or MRI (39/60) and 12 individuals were further evaluated with molecular neuroimaging (SPECT and/or FDG‐PET). Formal neuropsychological evaluation, CSF biomarkers and advanced amyloid/tau imaging were not available. Alzheimer’s dementia was diagnosed in 45% individuals and another 45% had criteria for mixed vascular and degenerative conditions. 18% presented with other neurodegenerative syndromes such as FTD and Lewy bodies dementia. The mean follow up time in our service was of 19.8 months.Conclusionpatients referred for evaluation were mostly in moderate to advanced stages of dementia, with a significant prevalence of mixed‐type and non‐Alzheimer’s pathologies. This data could suggest a referral bias and poor access to specialized clinics. Despite a modest sample size and heterogeneous data, the present study may contribute towards a better characterization of dementia numbers in Northeast Brazil.