Information Strategies Research Articles

Knowledge and willingness towards malaria vaccines among caregivers in Dar es Salaam, Tanzania

BackgroundTanzania is a malaria-endemic country that relies solely on anti-malarial drugs and vector control measures, including insecticide-treated bed nets and indoor residual spraying. However, the growing resistance to these interventions threatens their effectiveness, highlighting the need for additional strategies to accelerate malaria eradication efforts. Currently, malaria vaccines have begun to roll out in endemic areas. However, hesitancy emanating from misinformation on vaccine efficacy and safety has been recorded in various parts of the world. In this context, this study investigated the knowledge and willingness of caregivers towards the malaria vaccine.MethodsThis is a health facility-based cross-sectional survey conducted from September 2022 to March 2023. In total, 293 caregivers attending Ante-Natal Clinics (ANC) in selected health facilities in Dar es Salaam were recruited. A semi-structured questionnaire was used to collect caregivers’ demographic information, knowledge of malaria, knowledge of malaria vaccines and willingness to receive malaria vaccines.ResultsThe respondents were predominantly women (97.3%) aged 18 to 52 years. Overall, 87.4% had knowledge of malaria disease, while 14% did not know how malaria is transmitted. Most respondents (86.3%) knew about malaria prevention/control methods. However, only 14.7% of the recruited caregivers were aware of the malaria vaccine. Of those exposed to vaccine messages, 67.4% were aware that the vaccine was for children under 5 years of age, while 53.5% knew that the vaccine was for pregnant women. Despite their low exposure, most respondents (92.8%) were willing to receive the malaria vaccine for their children under five years.ConclusionMalaria knowledge and willingness to vaccinate against malaria was high among Tanzanian caregivers despite the low awareness of malaria vaccines. This suggests the need for targeted information, education and communication strategies (IECs) for communities to curb misconceptions and complement their high willingness to accept the malaria vaccine in Tanzania.

Social determinants of mental health in asthma: an exploratory study

IntroductionAsthma and mental health problems co-occur at high rates. In context of a holistic approach to health, considering the extent to which social determinants relate to mental health in people with asthma helps identify health inequity and inform population-level preventative strategies. The aim of the current exploratory study was to examine how social determinants are associated with depression, anxiety and resilience in people with mild-moderate and severe asthma.MethodsA cross-sectional study of 144 adults (aged ≥18 years) with a diagnosis of asthma was conducted. Participants were classified as having mild-moderate asthma or severe asthma based on international guidelines. As part of a multidimensional assessment, participants self-reported age, sex, ethnicity, country of birth, living arrangements, employment, and postcode. They also completed validated self-report questionnaires for depression and anxiety [Hospital Anxiety and Depression Scale (HADS)], and resilience [Resilience Scale (RS-25)]. Bayesian regression analyses were conducted to examine the extent to which social determinants were associated with depression, anxiety and resilience.Results74 participants had mild-moderate asthma and 70 participants had severe asthma. Participants were on average 60 years old (SD = 14), 72% were female, 94% were Caucasian, 94% were Australian-born, 26% lived alone, 42% were working full- or part-time, and 83% lived in a major city of Australia. Anxiety and depression were relatively common (35% anxiety; 16% depression using HADS threshold of scores ≥8). Few social determinants were associated with depression, anxiety and/or resilience. Older age was associated with greater resilience. Females had higher levels of anxiety compared to males. Compared to participants currently working full- or part-time, those who were not working or studying due to their health had worse depressive symptoms and those who were not working for other reasons such as retirement had greater resilience.DiscussionAs in the general population, age, sex and employment/student status were associated with components of mental health in people with asthma. Although limited by the small sample size and sociodemographic homogeneity, the findings of this exploratory study contribute to the large body of work fostering a holistic approach to health and striving for health equity in people with asthma, particularly those who experience mental health problems.

Evaluating the Impact of Big Data Analytics in Rural-Based Hospitals.

While the healthcare landscape continues to evolve, rural-based hospitals face unique challenges in providing quality patient care amidst resource constraints and geographical isolation. This study evaluates the impact of big data analytics in rural-based hospitals in relation to service delivery and shaping future policies. Evaluating the impact of big data analytics in rural-based hospitals will assist in discovering the benefits and challenges pertinent to this hospital. The study employs a positivist paradigm to quantitatively analyze collected data from rural-based hospital professionals from the Information Technology (IT) departments. Through a comprehensive evaluation of big data analytics, this study seeks to provide valuable insights into the feasibility, infrastructure, policies, development, benefits and challenges associated with incorporating big data analytics into rural-based hospitals for day-to-day operations. The findings are expected to contribute to the ongoing discourse on healthcare innovation, particularly in rural-based hospitals and inform strategies for optimizing the implementation and use of big data analytics to improve patient care, decision-making, operations and healthcare sustainability in rural-based hospitals.

Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectives

IntroductionMedically tailored meals (MTMs) are home-delivered, nutritionally tailored meals for individuals living with complex or advanced diet-sensitive medical conditions. In 2020, Massachusetts Medicaid implemented the Flexible Services Program (FSP) through a Section 1115 Demonstration, which funded novel nutrition programs, including MTMs, for high-risk patients through Accountable Care Organizations (ACOs). Little is known from the practitioners’ perspective regarding the facilitators and barriers to reaching and enrolling patients in MTM programs.MethodsWe interviewed 19 staff across four ACOs that had implemented MTM interventions. Interviews were conducted from Feb to Aug 2023 and included staff who participated in patient screening, referral, or enrollment. The interview guide was informed by the Health Equity Implementation Framework. Interviews were recorded and transcribed and coded using NVivo software. We used directed qualitative content analyses. The study team identified and discussed common themes and presented them back to our ACO partners.ResultsStaff described facilitators of and barriers to reach and enrollment related to several domains of the Health Equity Implementation Framework. For program (innovation) factors, facilitators included perceived positive effects on patient health outcomes and a relative advantage over both the status quo and other nutrition assistance programs; outreach by care team members rather than other staff; the eligibility criteria, which were viewed as appropriate and evidence-based; and the simplicity of the program, which aided communication with patients. Patient-related facilitators included patients being more in need of the program due to more severe illness and being more motivated to change dietary behaviors. Patient-related barriers included lacking a working phone or stable housing and concern about meals meeting taste and cultural food preferences. Staff-related barriers included limited time and especially knowledge about the MTM program.DiscussionThis study highlights the perspectives of front-line staff during the implementation of an MTM program in a state-wide 1,115 Demonstration. Staff may require multiple trainings to gain full knowledge about the program and increase self-efficacy in describing it with sensitivity. These new findings elevate voices from front-line healthcare staff in MTM delivery and can help inform strategies for effective, equitable implementation of MTM programs.

Social network analysis of key stakeholders in Brucellosis prevention in Western Iran

BackgroundBrucellosis remains a persistent public health challenge in Iran, particularly in rural regions such as Lorestan province, due to systemic, economic, and cultural barriers. Effective disease control requires multisectoral collaboration among stakeholders. This study aimed to map the stakeholder network involved in brucellosis prevention in Lorestan province, identify gaps in coordination, and provide actionable recommendations for improving control strategies.MethodsThis cross-sectional study employed social network analysis (SNA) to explore the relationships among key stakeholders in brucellosis prevention. Data were collected through a structured questionnaire administered to 75 experts from various sectors, including health, veterinary, agriculture, and non-governmental organizations. The SNA evaluated network density, clustering coefficient, and centrality metrics to determine the levels of collaboration and influence among stakeholders.ResultsThe analysis revealed a moderately dense network (density: 0.2745; clustering coefficient: 0.2839) with central roles played by the Veterinary Organization of Lorestan Province, Lorestan University of Medical Sciences, and the Ministry of Agriculture. These organizations exhibited high levels of influence, support, and interest in brucellosis prevention. However, limited involvement of community-based organizations and environmental agencies was identified, highlighting a critical gap in grassroots engagement. Fragmented coordination was particularly evident in rural areas, where traditional livestock practices, inadequate veterinary services, and the consumption of unpasteurized dairy products perpetuate disease transmission. Economic constraints, such as the high cost of vaccines, along with limited public awareness, further hinder effective control efforts.ConclusionsBrucellosis prevention in Lorestan province requires a comprehensive, multisectoral approach. The adoption of a One Health framework can improve collaboration among stakeholders, enhance resource allocation, and address systemic barriers. Community engagement and intersectoral coordination are essential for improving public awareness and compliance with preventive measures. These findings provide a foundation for developing a National Brucellosis Control Program and inform strategies to mitigate zoonotic diseases in similar high-risk regions.

Fear-evoked stimuli in social and non-social domains: comparative effects on electrophysiological processes

Fear is a vital survival mechanism across species, triggering responses to threats and aiding in navigating dangerous environments. In humans, it plays a key role in risk assessment and decision-making, contributing to adaptive behaviour and survival. Emotional well-being and inform strategies can be enhanced for managing fear-related disorders by understanding fear's neural processing through fear-evoked stimuli. This study aimed to compare the effects of social (human mutilation) and non-social (wild animals) fear-evoked stimuli on the human brain using the event-related potential (ERP) technique. Thirty-eight participants of mixed gender and ethnicity underwent ERP assessments while being exposed to images of mutilation and wild animals alongside neutral geometric images. Brain activity was measured using a 128 HydroCel Geodesic Sensor Net, focusing on the N200 component, indicative of emotional processing. The analysis revealed that social fear-evoked stimuli (human mutilation images) elicited greater electrophysiological responses in most brain areas than non-social stimuli (wild animal images). This finding suggests that stimuli related to social fears have a greater impact on the brain than non-social fears, likely due to humans' inherent empathy for one another. The gender factor may interfere with this emotional fear processing. It highlights the critical role of social context in fear response. It suggests that understanding these dynamics can guide more effective treatments for anxiety and phobias, opening avenues for further exploration into how psychological interventions influence fear reactions.

Explorative Short-Term Predictive Models for the Belgian (Energy) Renovation Market Incorporating Macroeconomic and Sector-Specific Variables

Retrofitting existing buildings is a cornerstone of Europe’s strategy for a sustainable built environment. Therefore, accurate short-term forecasts to evaluate policy impacts and inform future strategies are needed. This study investigates the short-term predictive modelling of renovation activity in Belgium, focusing on overall renovation activity (RA) and energy-specific renovation activity (EA). Using data from 2012 to 2023, linear modelling was employed to analyze the relationships between RA/EA and macroeconomic indicators, market confidence, building permits, and loan data, with model performance evaluated using Mean Absolute Percentage Error (MAPE). Monthly data and time lags of up to 24 months were considered. The three best-performing models for RA achieved MAPE values between 2.9% and 3.1%, with validated errors ranging from 0.1% to 4.1%. For EA, the best models yielded MAPE values between 4.4% and 4.6% and validated errors between 8.9% and 14%. Renovation loans and building permits emerged as strong predictors for RA, while building material prices and loans were more relevant for EA. The time lag analysis highlighted that renovation processes typically span 15–24 months following loan approval. However, the low accuracy observed for EA underscores the need for further refinement. This explorative effort forms a solid base, inviting additional research to enhance our predictive capabilities and improve short-term modelling of the (green) residential renovation market.

Escherichia coli in medicolegal autopsy causing symmetrical peripheral gangrene and psoas abscess

Postmortem microbiology (PMM) plays a crucial role in identifying infectious causes of death, which have significant legal and clinical implications. Not only determining the cause of death, PMM is vital in identifying infectious pathogens providing valuable medical insights. This case series presents two medicolegal autopsy cases where Escherichia coli infections led to rare and severe complications: Symmetrical peripheral gangrene (SPG) and psoas abscess. The first case involves a 28-year-old female hospitalized for 35 days after allegedly consuming sedatives. Postmortem findings included gangrene in her hands and feet and extensive lung consolidation with pus nodules. Blood cultures identified E. coli, while lung swabs revealed Klebsiella pneumoniae and Candida spp. The second case involves a 32-year-old female experiencing abdominal pain and breathing difficulties who died en route to the hospital. The autopsy revealed congested lungs and a psoas abscess, with blood cultures confirming E. coli infection. E. coli, typically associated with urinary tract infections, can cause severe complications such as SPG and psoas abscess. SPG involves ischemic damage to extremities without central vessel occlusion, often linked to septicemia and disseminated intravascular coagulation. Psoas abscesses result from hematogenous spread or direct extension from adjacent structures. These cases highlight the need to consider atypical pathogen presentations in critically ill patients. Recognizing E. coli’s potential for rare, fatal complications emphasizes the importance of thorough microbiological analysis during autopsies to improve diagnostic accuracy, guide clinical management, and inform public health strategies. Integrating PMM into routine autopsy protocol is essential for advancing medical and forensic knowledge.

Elevated Lp(a) and its association with cardiac fibrosis in group II pulmonary hypertension patients.

Group II Pulmonary Hypertension (PH) secondary to Heart Failure with preserved Ejection Fraction (HFpEF) is associated with significant morbidity and mortality. Lipoprotein(a) [Lp(a)] is a novel biomarker implicated in cardiovascular pathology, yet its role in myocardial fibrosis within this population remains underexplored. This study investigates the association between elevated Lp(a) levels and cardiac fibrosis to improve understanding of its prognostic and diagnostic utility. This retrospective cohort study included 100 patients with Group II PH secondary to HFpEF. Serum Lp(a) levels were quantified using enzymatic assays, and myocardial fibrosis was assessed using Cardiac Magnetic Resonance Imaging (CMR) techniques, including T1 mapping and late gadolinium enhancement (LGE). Statistical models adjusted for confounding factors. Elevated Lp(a) levels were significantly associated with increased myocardial extracellular volume (31% vs. 27%, p < 0.01), prolonged native T1 times, and increased odds of myocardial scar formation. Structural cardiac changes correlated with Lp(a) concentrations. Elevated Lp(a) is a key marker of myocardial fibrosis and structural remodeling in Group II PH secondary to HFpEF. Routine Lp(a) measurement may enhance risk stratification and inform therapeutic strategies.

Changes in Decisional Conflict and Decisional Regret Among Living Kidney Donors From Pre-Donation to 1-Year Post-Donation.

Previous research indicates that most living kidney donors (LKDs) are content with their decision to donate and seldom experience regret. Nevertheless, a small percentage of donors report adverse experiences, such as psychological distress and reduced vitality. Therefore, it is essential to explore the experiences of LKDs, particularly within the context of their decision-making process both before and following kidney donation. This study aimed to examine the decisional conflict and decisional regret experienced by LKDs from the evaluation stage to 12 months post-donation and to identify the associated factors. A longitudinal study design was implemented, and the initial data collection took place when potential LKDs visited the hospital for evaluation (n = 50). Subsequent data collection was conducted at 3 (n = 49), 6, and 12 (n = 46) months post-donation. Variables, including basic demographics, decisional conflict, decisional regret, perceived control, psychological distress, and healthcare orientation, were collected. Generalized estimating equations were used to obtain inferential statistics. Results showed that perceived control characterized by personal control orientation, lower psychological distress, and better healthcare orientation were associated with reduced decisional conflict among LKDs. Meanwhile, lower decisional regret was associated with better self-perceived health status, perceived control inclined toward interpersonal control, and less psychological distress among LKDs. Nurses should assess the decisional conflict and mental health of potential LKDs, and provide clear information to support their decision regarding kidney donation. They should also offer self-care information and stress-coping strategies related to living donor nephrectomy to aid in reducing decisional conflict and regret.

Services availability and readiness assessment of adolescent sexual and reproductive health in primary healthcare facilities: evidence from selected districts in Ghana

BackgroundGlobally, adolescent health remains a public health priority given that adolescents often face unique vulnerabilities to health issues like mental disorders, substance abuse, and sexual health risks. In developing countries like Ghana, primary healthcare facilities (PHCs) are often the first point of contact for addressing these issues. However, there is a lack of literature examining the capacity of PHCs to address adolescent sexual and reproductive health (ASRH) issues. This study aims to fill this gap in the literature by assessing the availability and readiness of ASRH services within Ghana’s PHCs.MethodsThe study utilized a multi-stage sampling approach to select 67 PHCs across four districts in the Greater Accra region, reflecting Ghana's broad demographic diversity. We employed the WHO's Services Availability and Readiness Assessment (SARA) tool to measure the availability and readiness of ASRH services. This framework focused on key domains including service availability and readiness, assessing aspects such as HIV testing, family planning, and availability of contraceptives and necessary staff training. Data analysis was conducted using Stata version 17.0, analysing frequencies and percentages to capture the extent of service provision across the selected facilities.ResultsThe study highlighted significant disparities in the availability and readiness of essential ASRH services (HIV services, family planning, contraceptive pills, IUCD provisions, and male condoms) across selected districts and facility types. In Shai Osudoku, 65% of facilities offered a full range of selected ASRH services, the highest among the districts, whereas Ningo Prampram had the lowest at just 16%. In terms of facility types, 57% of CHPS facilities, 59% of health centres, and 44% of clinics provided all the selected ASRH services. Urban areas reported a 51% provision rate of these services, slightly less than the 54% observed in rural areas. Additionally, readiness disparities were evident: only 21% of urban facilities had adequate service guidelines compared to 29% in rural areas, and a higher percentage of rural facilities (46%) had trained staff, compared to 23% in urban areas.ConclusionThis study examined the availability and readiness of ASRH services in PHCs across the Greater Accra region, revealing significant disparities by location and facility type. Particularly, rural and public facilities demonstrated a higher availability of ASRH services compared to urban and private facilities. These findings suggest an uneven distribution of resources and highlight a potential urban underutilization of public health services. Moreover, the study identified a critical lack of service guidelines and trained staff across many facilities, emphasizing the need for enhanced training and resource allocation to improve service readiness. Targeted interventions are necessary to elevate the quality and accessibility of ASRH services, ensuring equitable health care delivery across all regions. Future research should expand to other regions to validate these findings and inform nationwide health strategies.

The effect of fruits and vegetables on children's mental and cognitive health: A systematic review of intervention studies and perspective for future research.

ObjectiveTo synthesize evidence from fruit and vegetable intervention studies investigating mental and/or cognitive health outcomes in children ≤10 years. Our aim was to understand the efficacy of such interventions in improving measures of cognitive performance or mental health, and to identify successful intervention elements to inform future research. Research MethodsWe conducted a systematic search of Cochrane, Embase, PubMed, and CINAHL databases for articles published before August 2022 (PROSPERO registration: CRD42022356571). A narrative synthesis was conducted according to SWiM (Synthesis without Meta-Analysis) guidelines. ResultsFrom 4686 articles identified, only 7 of the 17 full texts screened were included in the final review. No studies investigated the efficacy of interventions using ‘whole’ fruits or vegetables. Six studies examined the effects of blueberries using drinks made from fresh (1 cup) or freeze-dried (30g) blueberries, and one study evaluated a mulberry powder-based drink. Sample sizes ranged from 14-54, and most studies were acute interventions with outcomes measured in a 2–3-hour window (n=6). Through a narrative synthesis of direction of responses, measures of executive function appeared sensitive to intervention effects in both acute and longer-term settings. Some concerns with risk of bias were evident according to the ROB2 tool, related to incomplete reporting of methodological aspects. ConclusionsThe studies identified through this systematic review could not directly address the planned research question, resulting in a poor certainty of evidence. Future research with whole fruit and vegetable interventions could better inform population health strategies for improved mental and cognitive health outcomes in children.

Safety and efficacy of combining PD-L1 and CTLA-4 blockade with transarterial chemoembolization in intermediate-stage hepatocellular carcinoma: A phase II study.

609 Background: Transarterial chemoembolization (TACE) is the standard treatment for intermediate-stage hepatocellular carcinoma (HCC) defined as Barcelona Clinic Liver Cancer (BCLC) B, but the benefit of adding systemic therapy remains unclear. While durvalumab and tremelimumab are approved for advanced HCC, the safety and efficacy in combination with TACE for intermediate-stage disease is undefined. Combining these PDL1 and CTLA4 inhibitors with TACE may enhance anti-tumor activity by leveraging TACE’s proinflammatory effects while blocking immune evasion and reducing immune suppression. This phase IIb study evaluates the safety and efficacy of this combination in BCLC-B HCC. Methods: We enrolled patients with intermediate-stage HCC that are also unresectable and ineligible for transplant. All patients received drug-eluting bead TACE (DEB-TACE) followed by durvalumab (1500 mg Q4W) and tremelimumab (300 mg once). Durvalumab monotherapy was continued until disease progression or unacceptable toxicity, for a maximum of 13 cycles. Primary endpoints include objective response rate (ORR) based on mRECIST. Secondary endpoints were overall survival (OS), and safety/adverse events (AEs). The trial is designed to rule out ORR of 30%. We obtained 3 serial biopsies and plasma for participating patients prior and one week after TACE and after the administration of immunotherapy for correlative studies. Results: 21 patients were enrolled. Of these, 20 patients were considered evaluable after receiving at least one dose of TACE and immunotherapy. ORR was 55% (95% CI: 32%-77%, CR 10% (n=2), PR 45% (n=9), meeting the primary endpoint. Five patients had PD (25%) per mRECIST, of which two were unconfirmed on repeat imaging and continued treatment beyond progression. Three patients received curative intent treatment as the result of treatment: surgical resection (n=1) and transplant (n=2). At a median follow-up of 18.4 months, median OS was 28.8 mo (95% CI: 15.1, NA) and mPFS was 6.1mo (95% CI: 3.3, NA). Grade 3 or higher immune related adverse events were rash (n=2), diarrhea, myalgia, nausea, elevated AST/ALT. One patient developed multiple irAEs after first dose (myocarditis, myositis, pericarditis) and was taken off study. Conclusions: The combination of DEB-TACE with PD-L1/CTLA-4 blockade is safe and shows promising activity in patients with BCLC-B HCC. The ongoing immune analysis and biomarker studies on serial blood and tissue biopsies will provide further insights into the mechanistic effects of this combination approach and inform future therapeutic strategies. Clinical trial information: NCT03638141 .

Influence of information strategies on behavioral intention to adopt driverless vehicles: Based on a survey experiment

Influence of information strategies on behavioral intention to adopt driverless vehicles: Based on a survey experiment

A scoping review and expert consensus on digital determinants of health.

To map how social, commercial, political and digital determinants of health have changed or emerged during the recent digital transformation of society and to identify priority areas for policy action. We systematically searched MEDLINE, Embase and Web of Science on 24 September 2023, to identify eligible reviews published in 2018 and later. To ensure we included the most recent literature, we supplemented our review with non-systematic searches in PubMed® and Google Scholar, along with records identified by subject matter experts. Using thematic analysis, we clustered the extracted data into five societal domains affected by digitalization. The clustering also informed a novel framework, which the authors and contributors reviewed for comprehensiveness and accuracy. Using a two-round consensus process, we rated the identified determinants into high, moderate and low urgency for policy actions. We identified 13 804 records, of which 204 met the inclusion criteria. A total of 127 health determinants were found to have emerged or changed during the digital transformation of society (37 digital, 33 social, 33 commercial and economic and 24 political determinants). Of these, 30 determinants (23.6%) were considered particularly urgent for policy action. This review offers a comprehensive overview of health determinants across digital, social, commercial and economic, and political domains, highlighting how policy decisions, individual behaviours and broader factors influence health by digitalization. The findings deepen our understanding of how health outcomes manifest within a digital ecosystem and inform strategies for addressing the complex and evolving networks of health determinants.

Pollen analysis as a tool to advance avian research and inform conservation strategies

Pollen analysis as a tool to advance avian research and inform conservation strategies

Multi-functional code for hydrogen isotopes transport analyses: verification & validation against fusion-relevant applications

Abstract The management of hydrogen isotopes within a fusion reactor remains a key design issue, with many constraints concerning tritium. The fusion power plant should be self-sufficient with respect to its fuel, while the contamination of components and the releases outside the primary system should be limited. There is a need for versatile numerical tools to assess tritium inventories and losses, which will support the design of components relevant to tritium management and inform mitigation strategies. This work presents the development, verification and validation of the System-level Application for Engineering Tritium Transport Analysis (SAETTA). SAETTA is a modular, system-level code designed with flexibility in mind. It is capable of simulating thin membranes as well as large systems with several components and connections. The program is built using Python, with a one-dimensional approach to simulate the transport of hydrogen isotopes in fluid and solid systems. Various factors influencing the transport of hydrogen isotopes are addressed, such as chemical reactions, mass transfer in the fluid, surface effects, permeation, trapping, leakage and decay. SAETTA methodology and implementation strategy are thoroughly outlined. In addition, a comprehensive verification and validation campaign has been specifically designed and performed to demonstrate the code capabilities in a wide range of fusion-related applications.

Surgical versus conservative management of spinal cord cavernous malformations: a systematic review and comparative meta-analysis.

Spinal cord cavernous malformations (SCCMs) are rare vascular malformations with a capricious prognosis. Given the eloquent nature of the spinal cord, considerable surgical morbidity may be encountered. Therefore, conservative management has emerged as a valid alternative, especially for incidental lesions diagnosed on ubiquitous imaging. The aim of this systematic review and meta-analysis was to evaluate the safety and efficacy of surgical versus conservative management of SCCMs. Following PRISMA guidelines, this study included articles published in full-text form comparing the outcomes following conservative and surgical management of SCCMs. Collected variables included the total number of patients, spine level, resection, myelotomy, follow-up duration, bleeding, motor weakness, pain, bladder and/or bowel dysfunction, and neurological improvement or deterioration after discharge. The primary outcome of interest was long-term functional outcome. Eleven articles comprising 515 patients were included, of whom 343 (66.6%) underwent resection and 172 (33.4%) were managed conservatively. Patients who underwent surgery were more likely to have preoperative motor deficits, hemorrhagic episodes, and bladder and/or bowel dysfunction, indicating increased disease severity. Resection was associated with significantly improved long-term functional outcomes (OR 3.27, 95% CI 1.72-6.24) compared with conservative management. There was no significant difference between the two groups regarding odds of long-term clinical deterioration (OR 1.03, 95% CI 0.35-3.03). However, the risk of hemorrhagic episodes during follow-up was higher in the conservative group (17.3%) compared with the surgical group (1.69%). The odds of hemorrhage during follow-up were lower in the surgical group, although not statistically significant (OR 0.24, 95% CI 0.05-1.05). This study highlights that while surgical management of SCCMs is associated with better long-term functional outcomes and reduced risk of recurrent hemorrhage, treatment decisions must be carefully tailored to the individual patient, particularly given the potential risks associated with surgery. Conservative management, although less invasive, carries a nonnegligible risk of hemorrhage during follow-up, warranting close monitoring. These findings parallel management strategies used for brainstem cavernomas, for which surgery is reserved for cases with low surgical risk and worsening neurological symptoms. However, the limitations of current data, including selection bias and heterogeneity in reporting, emphasize the need for a multi-institutional registry to better define the natural history of SCCMs and inform future management strategies.

P-2157. Genomic Characterization of Group A Streptococcus Isolates Circulating among Children in Greece during 2023

Abstract Background An increase in invasive Group A Streptococcus (iGAS) and non-invasive GAS cases has been reported worldwide, especially among children, since 2022. The aim of this study was the genetic characterization of GAS isolates in the pediatric population of Greece. Methods GAS isolates from children with iGAS reported to National Public Health Organization (NPHO) and a representative number of GAS from non-invasive infections were prospectively collected during 01-12/2023. Isolates were examined for antimicrobial susceptibility with Etest and the emm types were determined by Sanger Sequencing. Whole-genome Sequencing (WGS) was performed to selected GAS isolates to detect the toxin profile regarding 47 virulence factors, among them 11 superantigens. Results GAS isolates from 511 children [266/467 (57%) males, median (IQR) age: 5.6 (3.8-8.0) years] were tested. iGAS represented 66/511 (12.9%) of isolates and among them 9/66 (13.6%) deaths were recorded. The most common GAS isolation sites were the following: throat (294/511, 57.5%), ear infusion (84/511, 16.4%) and skin lesions (60/511, 11.7%). All isolates were sensitive to penicillin. The resistance rates in erythromycin, clindamycin and tetracycline were 25/511 (4.9%), 18/511 (3.5%), and 61/511 (11.9%), respectively. We detected 29 different emm types, with the most prevalent being emm12 (232/511, 45.4%) and emm1 (135/511, 26.4%). Among the deceased children with iGAS, the emm1 (7/9, 77.8%) and emm12 (2/9, 22.2%) types were detected. Toxins profiles were examined with WGS in 6 non-invasive GAS isolates, 11 iGAS isolates and 7 iGAS isolates from deceased children. All isolates contained the speB gene (24/24, 100%). The speA, speC, ssa genes were detected: in 3/6 (50%), 3/6 (50%), 1/6 (16.6%) non-invasive GAS isolates, in 4/11 (36.4%), 4/11 (36.4%) and 0/11 (0%) iGAS isolates and in 5/7 (71.4%), 2/7 (28.6%) and 1/7 (14.3%) isolates from deceased children. Conclusion During 2023, although several emm types caused infections in Greek children, the most prominent types were emm12 and emm1. Continuous clinical and genomic surveillance of GAS is needed to comprehend the GAS disease trends and inform prevention strategies. Disclosures All Authors: No reported disclosures

P-624. Changes in Pneumoccocal serotypes in adults and children after 2 years of introduction of PCV13 in National Inmunization Plan in Colombia

Abstract Background Pneumococcal disease remains a significant public health concern globally, particularly affecting vulnerable populations such as children and adults. The introduction of pneumococcal conjugate vaccine 13 (PCV13) into national immunization plans has aimed to reduce the burden of pneumococcal disease by targeting specific serotypes. However, monitoring changes in pneumococcal serotypes following vaccine introduction is crucial for understanding vaccine effectiveness and potential serotype replacement. Distribution of Streptococcus pneumoniae serotype isolates by age in Colombia 2023 Distribution of Streptococcus pneumoniae serotype isolates by age in Colombia by age group, INS data as of December 2023. Methods In this study, data were extracted from the National Institute of Health for the Surveillance of Pneumococcus in Colombia. We conducted a comparison of proportions to analyze changes in pneumococcal serotypes among both adults and children after two years of PCV13 introduction. Serotype distribution was examined pre- and post-vaccine introduction to identify shifts in prevalence. Distribution of Streptococcus pneumoniae serotype isolates in children under 5 years of age, Colombia 2023 Distribution of Streptococcus pneumoniae serotype isolates in children under 5 years of age in Colombia by age group, INS data as of December 2023. Results Our analysis revealed a notable decrease in vaccine serotypes among both adults and children following the introduction of PCV13. However, an increase in non-vaccine serotypes was observed during the same period. Of particular significance, isolates of serotypes 19A, 3, and 6C continued to predominate, suggesting a persistent challenge in combating these serotypes despite vaccination efforts. Distribution of Streptococcus pneumoniae serotype isolates in persons over 60 years old, Colombia 2023 Conclusion The findings of this study underscore the complex dynamics of pneumococcal serotype distribution following the introduction of PCV13. While the vaccine has led to a reduction in vaccine-targeted serotypes, the emergence of non-vaccine serotypes presents a new challenge for pneumococcal disease prevention and control efforts. Continued surveillance and research are essential to monitor serotype trends and inform vaccine strategies to effectively combat pneumococcal disease in both children and adults. Disclosures Omar Huang Escobar Franco, MD, MSc, PhD., Pfizer: Honoraria