Recommendations For Prevention Research Articles

Premenstrual syndrome in nurses: manifestations, risk factors, treatment and prevention

Premenstrual syndrome is observed in 20–80% of women of reproductive age and manifests itself in four clinical forms (neuropsychic, cephalgic, edematous, crisis). The article discusses the main risk factors for its occurrence in nurses, recommendations for treatment and prevention.

Improving Antibiotic Overuse in Primary Care: A Multimodal Quality Improvement Project.

Antibiotic overuse has increased over time related to provider knowledge gaps about best practices, provider perception of patient expectations on receiving an antibiotic, possible pressure to see patients in a timely fashion, and concerns about decreased patient satisfaction when an antibiotic is not prescribed. The Centers for Disease Control and Prevention estimates that up to 30% of antibiotics are inappropriately prescribed in the outpatient setting. This quality improvement project consisted of a multimodal approach to decrease inappropriate antibiotic prescribing for viral upper respiratory infections (URIs) by using provider education, passive patient education, and clinical decision support tools based on Centers for Disease Control and Prevention recommendations and the Be Antibiotic Aware tool. Following implementation, there was an 11% decrease in viral URI antibiotic prescribing, from a rate of 29.33% to 18.33% following the multimodal implementation. The use of evidence-based education and treatment guidelines was found to decrease inappropriate antibiotic prescribing for patients diagnosed with viral URIs.

Ipsilateral and contralateral coadministration of influenza and COVID-19 vaccines produce similar antibody responses

BackgroundWorld Health Organisation (WHO) and USA Centers for Disease Control and Prevention (U.S. CDC) recommendations now allow simultaneous administration of COVID-19 and other vaccines. We compared antibody responses after coadministration of influenza and bivalent COVID-19 vaccines in the same (ipsilateral) arm vs. different (contralateral) arms. MethodsPre- and post-vaccination serum samples from individuals in the Prospective Assessment of COVID-19 in a Community (PACC) cohort were used to conduct haemaglutination inhibition (HI) assays with the viruses in the 2022-23 seasonal influenza vaccine and focus reduction neutralisation tests (FRNT) using a BA.5 SARS-CoV-2 virus. The effect of ipsilateral vs. contralateral vaccination on immune responses was inferred in a model that accounted for higher variance in vaccine responses at lower pre-vaccination titers. FindingsIpsilateral vaccination did not cause higher influenza vaccine responses compared to contralateral vaccination. The response to SARS-CoV-2 was slightly increased in the ipsilateral group, but equivalence was not excluded. InterpretationCoadministration of influenza and bivalent COVID-19 vaccines in the same arm or different arms did not strongly influence the antibody response to either vaccine. FundingThis work was supported by the U.S. CDC (grant number: 75D30120C09259).

Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline.

To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer. The International Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008. A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation. Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.Additional information is available at www.asco.org/head-neck-cancer-guidelines.

Spatio-Temporal Characteristics of Land Subsidence and Driving Factors Analysis in Shenzhen

Analyzing land subsidence using Multi-temporal Interferometric Synthetic Aperture Radar (MT-InSAR) technology holds significant importance for the secure development of urban areas. Shenzhen, being a crucial component of the Pearl River Delta, faces the threat of land subsidence, similar to most deltaic cities. Numerous studies have already indicated the presence of severe land subsidence in certain localities of Shenzhen. However, due to limitations in data scope and research methodologies, the comprehensive spatial-temporal distribution of land subsidence across the entire city of Shenzhen remains unclear. This study initially employed MT-InSAR technology to process a total of 534 Sentinel-1A SAR images from three different frames (P11F71, P113F71, P11F65), covering the entire city of Shenzhen. This processing resulted in the generation of subsidence rate maps and subsidence time series. Subsequently, the temporal evolution patterns of the subsidence were analyzed while significant subsidence regions were identified. By integrating information from optical images reflecting human activities on the Earth’s surface, the study deduced the subsidence mechanisms in various significant subsidence areas. Research findings indicate that land subsidence in Shenzhen is primarily caused by construction activities, with a concentration in the western coastal areas of Shenzhen, reaching a maximum rate of 80 mm/yr, located at the estuary of Dongbao River (113.770385, 22.745305). The cumulative subsidence from March 2017 to June 2023 amounts to 500 mm. The expansion of the Qinglinjing Reservoir has led to an increased demand for water, resulting in a significant rise in formation pressure and subsequent land subsidence. InSAR land subsidence monitoring and analysis in urban areas can address the spatial and temporal resolution limitations of traditional subsidence monitoring methods, providing effective recommendations for widespread subsidence prevention and control.

A nomogram topredict the risk of acute ischemic stroke inpatients with maintenancehemodialysis: aretrospective cohort study.

Acute ischemic stroke (AIS) stands as a leading cause of death and disability globally. This study aimed to investigate the risk factors linked with AIS in patients undergoing maintenance hemodialysis (MHD) and to create and validate nomogram models. We examined the medical records of 314 patients with stage 5 chronic kidney disease (CKD5) undergoing MHD, who sought neurology outpatient department consultation for suspected AIS symptoms between January 2018 and December 2023. These 314 patients were randomly divided into the training cohort (n=222) and validation cohort (n=92). The Least Absolute Shrinkage Selection Operator (LASSO) regression model was employed for optimal feature selection in the AIS risk model. Subsequently, multivariable logistic regression analysis was used to construct a predictive model incorporating the features selected through LASSO. This predictive model's performance was assessed using the C-index and the area under the receiver operating characteristic curve (AUC). Additionally, calibration and clinical utility were evaluated through calibration plots and decision curve analysis (DCA). The model's internal validation was conducted using the validation cohort. Resaults: Predictors integrated into the prediction nomogram encompassed cardiovascular disease (CVD) (Odds Ratio [OR] 7.95, 95% confidence interval [CI] 2.400-29.979), smoking (OR 5.7, 95% CI 1.661-21.955), dialysis time (OR 5.91, 95% CI 5.866-29.979), low-density lipoprotein (LDL) (OR 2.99, 95% CI 0.751-13.007), and fibrin degradation products (FDP) (OR 5.47, 95% CI 1.563-23.162). The model exhibited robust discrimination, with a C-index of 0.877 and 0.915 in the internal training and validation cohorts, respectively. The AUC for the training set was 0.857, and a similar AUC of 0.905 was achieved in the validation cohort. Decision curve analysis (DCA) demonstrated a positive net benefit within a threshold risk range of 2 to 96%. The proposed nomogram effectively identifies MHD patients at high risk of AIS at an early stage. This model holds the potential to aid clinicians in making preventive recommendations.

Tackle Risk Factors for Head Injury Assessments (HIAs) in Sub-Elite Rugby League and Recommendations for Prevention: Head Contacts from Upright Tackles Increase the HIA Risk to Both Ball Carrier and Tackler

BackgroundThe rugby league tackle has been identified as the game event with the greatest propensity for a clinically diagnosed concussion. This study aims to replicate the work conducted in professional rugby league and rugby union by examining Head Injury Assessment (HIA) events to determine the associated tackle characteristics that increase concussion risk in sub-elite rugby league players. This comparison between competition levels is important due to the less developed physiological and tackle proficiency characteristics of sub-elite rugby league players and the fewer resources available for an on-field diagnosis, compared to the elite level of the sport.ResultsTackles resulting in Head Injury Assessments (HIAs, n = 131) and 2,088 tackles that did not result in a head injury were identified and coded from one season of the 2019 Queensland Cup. The body position of both ball carrier and tackler, tackle height, and body contact areas were evaluated. The propensity for tacklers to undergo a head injury assessment was 1.49 HIAs per 1,000 tackles, equating to a 2.5-fold higher risk than that of the ball carrier (0.59 HIAs per 1,000 tackles). The risk for an HIA was 2.75-fold greater when the tackler was upright (2.89 HIAs per 1,000 tackles) compared to a bent-at-the-waist tackler (1.05 HIAs per 1,000 tackles). The greatest risk for the tackler and ball carrier sustaining an HIA occurred when the tackle height was high, with head-to-head contact having the greatest propensity for an HIA (44.37 HIAs per 1,000 tackles). HIA risk was also greater for both players when the ball carrier did not employ an evasion strategy (3.73 HIAs per 1,000 tackles).ConclusionsThe study replicates results from research in elite rugby league and rugby union. A combination of higher head contact/proximity and upright body position significantly increase an HIA risk. Tackler head position and ball carrier evasion behaviours also affect risk, suggesting that injury prevention strategies designed to reduce tackle height and improve tackle technique by focusing on head position, body position, and in a novel finding, ball carrier evasion, may reduce head injury risk in sub-elite rugby league players.

Should We Wait to Brush Our Teeth?: A Scoping Review Regarding Dental Caries and Erosive Tooth Wear.

Tooth brushing is a universal recommendation. However, the recommendations related to the time of its execution are conflicting, especially when dealing with patients at risk of erosive tooth wear (ETW) or dental caries. Our objective was to summarize the evidence on the timing of brushing with fluoridated toothpaste in relation to ETW and cariogenic dietary challenges. We conducted a scoping review following the PRISMA-ScR checklist, using three databases searching for in-vivo, in-situ, or in-vitro studies involving human teeth exposed to either a cariogenic or an erosive challenge. Only models including human saliva and fluoride were assessed. Data selection, extraction, and risk of bias analysis were done in duplicate and independently. From 1,545 identified studies, 17 (16 related to ETW and 1 to dental caries) were included. Most evidence (n=10) supported that brushing with a fluoride-containing product does not increase ETW, independent of the moment of brushing. Delaying tooth brushing up to 1 hour (n=4) or individualized recommendations based on the patient's problem (n=2) were less frequent. Only one study reported that brushing pre- or post-meal does not affect Streptococcus mutans counts. Most data was in-situ (n=13), and the overall study quality was judged as sufficient/low risk of bias. Although the available evidence lacked robust clinical studies, tooth brushing using fluoridated products immediately after an erosive challenge does not increase the risk of ETW and can be recommended, which is in line with recommendations for dental caries prevention. Furthermore, we suggest updating the international guidelines to promote individualized recommendations based on risk factors to prevent either ETW or dental caries.

Evaluation of a Pilot Program to Prevent the Misuse of Prescribed Opioids Among Health Care Workers: Repeated Measures Survey Study.

Overprescription of opioids has led to increased misuse of opioids, resulting in higher rates of overdose. The workplace can play a vital role in an individual's intentions to misuse prescription opioids with injured workers being prescribed opioids, at a rate 3 times the national average. For example, health care workers are at risk for injuries, opioid dispensing, and diversion. Intervening within a context that may contribute to risks for opioid misuse while targeting individual psychosocial factors may be a useful complement to interventions at policy and prescribing levels. This pilot study assessed the effects of a mobile-friendly opioid misuse intervention prototype tailored for health care workers using the preparation phase of a multiphase optimization strategy design. A total of 33 health care practitioners participated in the pilot intervention, which included 10 brief web-based lessons aimed at impacting psychosocial measures that underlie opioid misuse. The lesson topics included: addiction beliefs, addiction control, Centers for Disease Control and Prevention guidelines and recommendations, beliefs about patient-provider relationships and communication, control in communicating with providers, beliefs about self-monitoring pain and side effects, control in self-monitoring pain and side effects, diversion and disposal beliefs, diversion and disposal control, and a conclusion lesson. Using a treatment-only design, pretest and posttest surveys were collected. A general linear repeated measures ANOVA was used to assess mean differences from pretest to posttest. Descriptive statistics were used to assess participant feedback about the intervention. After completing the intervention, participants showed significant mean changes with increases in knowledge of opioids (+0.459; P<.001), less favorable attitudes toward opioids (-1.081; P=.001), more positive beliefs about communication with providers (+0.205; P=.01), more positive beliefs about pain management control (+0.969; P<.001), and increased intentions to avoid opioid use (+0.212; P=.03). Of the 33 practitioners who completed the program, most felt positive about the information presented, and almost 70% (23/33) agreed or strongly agreed that other workers in the industry should complete a program like this. While attempts to address the opioid crisis have been made through public health policies and prescribing initiatives, opioid misuse continues to rise. Certain industries place workers at greater risk for injury and opioid dispensing, making interventions that target workers in these industries of particular importance. Results from this pilot study show positive impacts on knowledge, attitudes, and beliefs about communicating with providers and pain management control, as well as intentions to avoid opioid misuse. However, the dropout rate and small sample size are severe limitations, and the results lack generalizability. Results will be used to inform program revisions and future optimization trials, with the intention of providing insight for future intervention development and evaluation of mobile-friendly eHealth interventions for employees.

Association between dietary selenium and zinc intake and risk of dilated cardiomyopathy in children: a case-control study

BackgroundDilated cardiomyopathy (DCMP) is characterized by the enlargement and weakening of the heart and is a major cause of heart failure in children. Infection and nutritional deficiencies are culprits for DCMP. Zinc is an important nutrient for human health due to its anti-oxidant effect that protects cell against oxidative damage. This case-control study aimed to investigate the relationship between dietary intake of zinc and selenium and the risk of DCMP in pediatric patients.MethodsA total of 36 DCMP patients and 72 matched controls were recruited, and their dietary intakes were assessed via a validated food frequency questionnaire. We used chi-square and sample T-test for qualitative and quantitative variables, respectively. Logistic regression analysis was applied to assess the relationship between selenium and zinc intake with the risk of DCMP.ResultsAfter fully adjusting for confounding factors, analyses showed that selenium (OR = 0.19, CI = 0.057–0.069, P trend < 0.011) and zinc (OR = 0.12, CI = 0.035–0.046, P trend < 0.002) intake were strongly associated with 81% and 88% lower risk of pediatric DCMP, respectively.ConclusionsThis study highlights the protective role of adequate dietary intake of selenium and zinc in decreasing the risk of DCMP in children. Malnutrition may exacerbate the condition and addressing these micronutrient deficiencies may improve the cardiac function. Further studies are recommended to detect the underlying mechanisms and dietary recommendations for DCMP prevention.

[Interpretation of global lung cancer statistics].

Lung cancer remains one of the leading cause of global cancer-related mortality, posing a significant burden of disease. Tobacco exposure stands as the foremost risk factor for lung cancer. Since the 1960, global efforts have gradually been implemented to control tobacco exposure, consequently reducing tobacco exposure levels within populations. This shift in exposure levels may have altered the epidemiological characteristics of lung cancer globally. This study aims to describe global lung cancer incidence data across five dimensions: age, gender, region, stage at diagnosis, and survival status, using global cancer registry data and relevant research findings. The objective is to elucidate the current epidemiological features of lung cancer worldwide, providing a scientific basis for lung cancer prevention and control. Furthermore, this study offers corresponding measures and recommendations for lung cancer prevention and control, aligning with the three-tiered cancer prevention strategy. Findings indicate that the incidence and mortality burden of lung cancer is significantly higher among the elderly population (aged 65 years and above) compared to the working-age population (aged 15-64 years). The aged-standardized incidence rate of lung cancer remains higher in males than in females, but the overall aged-standardized incidence rate of lung cancer in males shows a declining trend, while that in females shows an increasing trend. Regions with high and very high human development index (HDI) exhibit a substantially higher incidence and mortality burden of lung cancer compared to regions with low and very low HDI. Japan ranks highest in the diagnosis of stage Ⅰ lung cancer, with a diagnosis rate of 38.6%. Its age-standardized 5-year net survival rate is relatively high at 32.9%. Despite improvements in the survival status of lung cancer in certain countries like China and Japan, the overall prognosis for lung cancer remains pessimistic. Given the current epidemiological characteristics of lung cancer, reinforcing tobacco control measures and reducing female-specific lung cancer risk factors stand as significant goals for primary prevention. Promoting low-dose computed tomography screening for high-risk population, minimizing false-positive rates in lung cancer screening, and promoting medical system reforms and standardized treatment constitute principal measures for secondary and tertiary lung cancer prevention, respectively.

Medication fill duration in pediatric hypertension: adherence, blood pressure control, and disparities.

Medication nonadherence is a barrier to hypertension control. The Centers for Disease Control and Prevention recommends prescribing 90-day fills for maintenance medications yet antihypertensives are often dispensed as 30-day fills. Our objectives were to examine how often patients receive 30-day supplies of medication despite prescriptions for longer duration and to examine the effect of medication fill duration on adherence and hypertension control. We conducted a retrospective cohort study of pediatric patients with hypertension over a 3-year period. For each patient, days prescribed per fill were compared to days dispensed per fill using pharmacy reports and insurance claim data. Proportion of Days Covered (PDC) was calculated to estimate adherence. Hypertension control was determined by provider assessment of control and blood pressure measurement at the final visit. Final cohort included 449 patients. A total of 70% had at least one prescription for ≥ 90days but only 37% had at least one dispense for ≥ 90days. There was no difference in the likelihood of being prescribed a 90-day fill by insurance type (public vs. private); however, patients with public insurance were less likely to be dispensed a 90-day fill (OR = 0.068, p < 0.001). Patients who received 90-day fills had better adherence (median PDC 77.5% vs. 58.1%, p < 0.001) and were more likely to have hypertension control based on provider assessment. Longer fill duration is associated with improved adherence and hypertension control. Patients with public insurance are markedly less likely to be dispensed 90-day fills, a modifiable barrier to improving adherence.

Developing and implementing survivor-centred approaches for college student-athletes: perspectives from athletic department, Title IX, and campus advocacy personnel

ABSTRACT Background: Sexual violence (SV) is a persistent issue on US college campuses, particularly among college student-athletes. Strategies to address SV are urgently needed. Yet, prior research shows that many university practices can be more harmful than helpful to SV survivors and necessitates a reimagination of how institutions support SV survivors. Survivor-centred approaches may be one way to effectively address SV for students, including student-athletes, across college campuses. Objective: This qualitative study explored campus personnel experiences with and perceptions of survivor-centred SV prevention and intervention policies and practices on college campuses and examined how these approaches serve SV survivors, including college student-athletes. Methods: As part of a larger study on campus SV and student-athletes across four institutions, semi-structured interviews with 22 representatives from athletic departments, campus advocacy, and Title IX were conducted. Guided by phenomenology, a thematic analysis approach was used to identify key patterns in survivor-centred SV prevention and intervention policies and practices. Participant demographic data were analysed descriptively. Results: Most participants identified as white (72.2%), heterosexual (63.6%), women (68.2%), and were an average of 41.8 years old (SD = 10.2). The majority were in positions associated with athletic departments (63.6%), and they had been in their role for an average of 5.6 years (SD = 6.6). Through thematic analysis, three main themes were identified: (1) education & accessibility; (2) interpersonal relationships & individual well-being; and (3) campus and societal norms. Conclusions: The findings from this study highlight clear policy and practice recommendations for survivor-centred SV prevention and intervention on college campuses, such as accessible, applicable SV training and the implementation of survivor-centred approaches. Further research is needed to understand existing survivor-centred practices and the facilitators and barriers to their implementation across institutions and within athletic departments.

Changes in cardiovascular-related health behaviors after the end of social distancing: the 2023 Cardiovascular Disease Prevention Awareness Survey

Background: The COVID-19 pandemic and the implementation of social distancing have been reported to negatively impact cardiovascular-related health behaviors. However, the effects of lifting social distancing restrictions on these health behaviors remain unclear. This study investigated public awareness and behavioral changes related to cardiovascular disease prevention after the end of social distancing.Methods: Between June 5 and June 12, 2023, 2,000 adults participated in the 2023 Cardiovascular Disease Prevention Awareness Survey in Korea. The survey comprehensively addressed sociodemographic factors, cardiometabolic disease history, cardiovascular disease concern, prevention awareness, and behavioral changes after the end of social distancing. Logistic regression analyses were performed to assess the associations between behavioral changes and sociodemographic factors.Results: Cardiovascular disease ranked as the second most feared disease (most feared, 18.0%; second most feared, 26.3%) after cancer (most feared, 42.3%; second most feared, 21.7%). Among nine cardiovascular disease prevention recommendations, stress management, being physically active, and maintaining a healthy diet were perceived as the most challenging recommendations. After the end of social distancing, there were more positive changes than negative changes in smoking, alcohol consumption, dietary habits, physical activity, and healthcare service use, whereas stress management more frequently changed negatively (40.0%) than it changed positively (19.5%).Conclusions: Positive changes in cardiovascular-related health behaviors, except for stress management, were observed after the end of social distancing. Further research is necessary to fully comprehend the impact of discontinuing social distancing practices.

Describing adverse events in an animal-assisted intervention organization: Recommendations for prevention and management

Abstract Little is known about adverse events surrounding animal-assisted interventions (AAIs) since they are reluctantly reported and uncommonly discussed in the literature. Voluntarily reported adverse events occurring within an AAI program in the south-east United States over a 5-year period (2015–2019) were retrospectively reviewed. Thirteen adverse events were reported with four events resulting in injury to a human while engaged in AAI. Nine of the 13 animals involved in adverse events were reported in their first year of service. Outcomes of adverse events were based on severity of the event and likelihood of recurrence. All animal-handler teams involved in adverse events that occurred outside of the AAI setting (3/13) were retired and of the remaining 10 adverse events that occurred while engaged in AAI, three animal-handler teams returned to work, three returned to modified work, and four were retired. These findings indicate that adverse events do occur in AAI, although they are typically not severe in nature. When they do occur, retirement of the animal-handler team is not compulsory. Based on the findings of this study, recommendations are offered for potentially preventing, managing, and determining outcomes of adverse events.

Students who witness critical events in the clinical setting: Recommendations for prevention of psychological trauma

BackgroundStudent nurses often do not receive adequate preparation, support, and debriefing related to witnessing or experiencing critical events in the clinical setting. PurposeThe purpose of this analysis was to describe the experiences of student nurses who have witnessed critical events in the clinical setting, the support and preparation they received, and staff and faculty actions they perceived as facilitating or hindering their processing of the event. MethodsThis is a sub-analysis of a Straussian Grounded Theory qualitative study. ResultsStaff and faculty actions that helped and hindered the processing of the critical event were identified at four time points: pre-event, during the critical event, immediately post-event, and in the days and weeks following. ConclusionsStudents exposed to critical events during their clinical rotations can experience psychological trauma. If unresolved, this can result in new nurses entering the profession already in distress. Preparation and support for witnessing critical patient events should start at the beginning of nursing school. During critical patient events, students need faculty or staff to be actively present to explain the event and support the student throughout the event. Immediate debrief and follow-up is recommended and should continue weeks or months after the event.

Human Papillomavirus Vaccination Rates in Patients Living With Human Immunodeficiency Virus (HIV).

Human immunodeficiency virus (HIV) and human papillomavirus (HPV) have a strong association with one another, including the development of HPV-related neoplasms. The Centers for Disease Control and Prevention (CDC) recommends routine HPV vaccination in persons aged 9-26, and consideration can be made to vaccinate up to age 45 based on provider discretion. This study aimed to look at the rate of HPV vaccination in adult HIV-positive patients. This was a retrospective study looking at 71 current patients of an HIV clinic at Hackensack University Health. The entire clinic patient list was included. Exclusion criteria were anyone under age 18. Chart review and calls to the patient's pharmacy were done to record the patient's HPV vaccination history. From there, the number of patients eligible to receive the HPV vaccine was calculated based on routine schedule as well as increasing the eligible age up to 44. Only three patients had a history of receiving the HPV vaccine (4.23%).Using the routine vaccination schedule, there were five patients eligible to receive the HPV vaccine (7%). When using the extended vaccination schedule up to age 44, there were a total of 35 patients eligible to receive the HPV vaccine (49.30%). There are a substantial number of HIV-positive patients who would benefit from HPV vaccination. This is especially true if the provider chooses to use the extended vaccination schedule. Providers working with HIV-positive patients should probe about vaccination history and intervene as appropriate.

Development of Systematic Reviews to Inform WHO's Recommendations for Elimination and Prevention of Re-Establishment of Malaria: Methodology.

The basis for an evidence-based recommendation is a well-conducted systematic review that synthesizes the primary literature relevant to the policy or program question of interest. In 2020, the WHO commissioned 10 systematic reviews of potential interventions in elimination or post-elimination settings to summarize their impact on malaria transmission. This paper describes the general methods used to conduct this series of systematic reviews and notes where individual reviews diverged from the common methodology. The paper also presents lessons learned from conducting the systematic reviews to make similar future efforts more efficient, standardized, and streamlined.

Adequacy of prostate cancer prevention and screening recommendations provided by an artificial intelligence-powered large language model.

We aimed to assess the appropriateness of ChatGPT in providing answers related to prostate cancer (PCa) screening, comparing GPT-3.5 and GPT-4. A committee of five reviewers designed 30 questions related to PCa screening, categorized into three difficulty levels. The questions were formulated identically for both GPTs three times, varying the prompts. Each reviewer assigned a score for accuracy, clarity, and conciseness. The readability was assessed by the Flesch Kincaid Grade (FKG) and Flesch Reading Ease (FRE). The mean scores were extracted and compared using the Wilcoxon test. We compared the readability across the three different prompts by ANOVA. In GPT-3.5 the mean score (SD) for accuracy, clarity, and conciseness was 1.5 (0.59), 1.7 (0.45), 1.7 (0.49), respectively for easy questions; 1.3 (0.67), 1.6 (0.69), 1.3 (0.65) for medium; 1.3 (0.62), 1.6 (0.56), 1.4 (0.56) for hard. In GPT-4 was 2.0 (0), 2.0 (0), 2.0 (0.14), respectively for easy questions; 1.7 (0.66), 1.8 (0.61), 1.7 (0.64) for medium; 2.0 (0.24), 1.8 (0.37), 1.9 (0.27) for hard. GPT-4 performed better for all three qualities and difficulty levels than GPT-3.5. The FKG mean for GPT-3.5 and GPT-4 answers were 12.8 (1.75) and 10.8 (1.72), respectively; the FRE for GPT-3.5 and GPT-4 was 37.3 (9.65) and 47.6 (9.88), respectively. The 2nd prompt has achieved better results in terms of clarity (all p < 0.05). GPT-4 displayed superior accuracy, clarity, conciseness, and readability than GPT-3.5. Though prompts influenced the quality response in both GPTs, their impact was significant only for clarity.

EAACI guidelines on environmental science for allergy and asthma: The impact of short-term exposure to outdoor air pollutants on asthma-related outcomes and recommendations for mitigation measures.

The EAACI Guidelines on the impact of short-term exposure to outdoor pollutants on asthma-related outcomes provide recommendations for prevention, patient care and mitigation in a framework supporting rational decisions for healthcare professionals and patients to individualize and improve asthma management and for policymakers and regulators as an evidence-informed reference to help setting legally binding standards and goals for outdoor air quality at international, national and local levels. The Guideline was developed using the GRADE approach and evaluated outdoor pollutants referenced in the current Air Quality Guideline of the World Health Organization as single or mixed pollutants and outdoor pesticides. Short-term exposure to all pollutants evaluated increases the risk of asthma-related adverse outcomes, especially hospital admissions and emergency department visits (moderate certainty of evidence at specific lag days). There is limited evidence for the impact of traffic-related air pollution and outdoor pesticides exposure as well as for the interventions to reduce emissions. Due to the quality of evidence, conditional recommendations were formulated for all pollutants and for the interventions reducing outdoor air pollution. Asthma management counselled by the current EAACI guidelines can improve asthma-related outcomes but global measures for clean air are needed to achieve significant impact.