Tag: nevin manimala

Eur Respir J. 2021 Aug 12:2101209. doi: 10.1183/13993003.01209-2021. Online ahead of print.

ABSTRACT

BACKGROUND: Individual case series and cohort studies have reported conflicting results on the vulnerability to and risk of mortality of people with asthma from COVID-19.

RESEARCH QUESTION: Are people with asthma at a higher risk of being infected, hospitalised or of poorer clinical outcomes from COVID-19?

METHODS: A systematic review and meta-analysis based on five main databases including the WHO COVID-19 database between December 1, 2019 to July 11, 2021 on studies with a control (non-asthma) group was conducted. Prevalence and risk ratios were pooled using Sidik-Jonkman random effects meta-analyses.

FINDINGS: Fifty-one studies with an 8.08% (95% CI 6.87-9.30) pooled prevalence of people with asthma among COVID-19 positive cases. The risk ratios were 0.83 (95% CI 0.73-0.95, p=0.01) for acquiring COVID-19; 1.18 (95% CI 0.98-1.42, p=0.08) for hospitalisation; 1.21 (95% CI 0.97-1.51, p=0.09) for ICU admission; 1.06 (95% CI 0.82-1.36, p=0.65) for ventilator use and 0.94 (95% CI 0.76-1.17; p=0.58) for mortality for people with asthma. Subgroup analyses by continent revealed a significant difference in risk of acquiring COVID-19, ICU admission, ventilator use and death between the continents.

INTERPRETATION: The risk of being infected with SARS-CoV-2 was reduced compared to the non-asthma group. No statistically significant differences in hospitalisation, ICU admission and ventilator use were found between groups. Subgroup analyses showed significant differences in outcomes from COVID-19 between America, Europe and Asia. Additional studies are required to confirm this risk profile, particularly in Africa and South America where few studies originate.

PMID:34385278 | DOI:10.1183/13993003.01209-2021

BMJ Health Care Inform. 2021 Aug;28(1):e100349. doi: 10.1136/bmjhci-2021-100349.

ABSTRACT

INTRODUCTION: The SARS-CoV-2 (COVID-19) pandemic has exposed the need to understand the risk drivers that contribute to uneven morbidity and mortality in US communities. Addressing the community-specific social determinants of health (SDOH) that correlate with spread of SARS-CoV-2 provides an opportunity for targeted public health intervention to promote greater resilience to viral respiratory infections.

METHODS: Our work combined publicly available COVID-19 statistics with county-level SDOH information. Machine learning models were trained to predict COVID-19 case growth and understand the social, physical and environmental risk factors associated with higher rates of SARS-CoV-2 infection in Tennessee and Georgia counties. Model accuracy was assessed comparing predicted case counts to actual positive case counts in each county.

RESULTS: The predictive models achieved a mean R² of 0.998 in both states with accuracy above 90% for all time points examined. Using these models, we tracked the importance of SDOH data features over time to uncover the specific racial demographic characteristics strongly associated with COVID-19 incidence in Tennessee and Georgia counties. Our results point to dynamic racial trends in both states over time and varying, localized patterns of risk among counties within the same state. For example, we find that African American and Asian racial demographics present comparable, and contrasting, patterns of risk depending on locality.

CONCLUSION: The dichotomy of demographic trends presented here emphasizes the importance of understanding the unique factors that influence COVID-19 incidence. Identifying these specific risk factors tied to COVID-19 case growth can help stakeholders target regional interventions to mitigate the burden of future outbreaks.

PMID:34385289 | DOI:10.1136/bmjhci-2021-100349

BMJ Open. 2021 Aug 12;11(8):e050108. doi: 10.1136/bmjopen-2021-050108.

ABSTRACT

OBJECTIVES: This systematic review summarises the evidence on the correlation between recurrent acute otitis media (rAOM) or chronic suppurative otitis media (CSOM) and sensorineural hearing loss (SNHL).

RESEARCH METHODS: PubMed, Embase and Cochrane Library databases were searched from inception to 15 January 2021. Two authors independently identified articles, extracted data and performed quality assessment for included studies. Studies comparing the sensorineural hearing levels of patients with a history of rAOM/CSOM for >3 months to a control group were included.

RESULTS: Screening of 4168 articles lead to inclusion of two case-control studies (control-group: patients non-OM) and seven cohort-studies (control group: contralateral ear). Quality assessment indicated considerable risk of bias in all studies. Reported populations varied (sample size 13-607, mean age 22-41.5 years, mean duration of disease 6.1-12.4 years). The OR for SNHL in the OM-group was 3.30-7.86 (95% CI 1.16 to 9.40, p<0.05) in cohort studies (n=2), and 0.05 (95% CI 0 to 0.78, p<0.05) in a case-control study. Mean/median bone conduction thresholds were respectively 1.19-32.21/0-10 dB higher on all frequencies (0.5-4 kHz) for the OM-group in four cohort studies (p<0.05). Two other studies reported no statistical test outcomes.

CONCLUSION: Due to the high risk of bias of included studies, effect estimates heterogeneity and suboptimal research designs, no conclusion on the correlation between OM and SNHL can be made. It emphasises the need for future prognostic studies.

PMID:34385254 | DOI:10.1136/bmjopen-2021-050108

Eur Respir J. 2021 Aug 12:2101597. doi: 10.1183/13993003.01597-2021. Online ahead of print.

NO ABSTRACT

PMID:34385276 | DOI:10.1183/13993003.01597-2021

BMJ Open. 2021 Aug 12;11(8):e047995. doi: 10.1136/bmjopen-2020-047995.

ABSTRACT

OBJECTIVES: To design, deliver and evaluate a programme of training workshops for biomedical researchers aimed at building confidence and skills in actively involving patients and the public (PPI) in research.

DESIGN: A bespoke programme of training workshops in PPI aimed at researchers.

SETTING: A large National Institute for Health Research Biomedical Research Centre in London and several partner organisations.

PARTICIPANTS: 721 scientists, clinicians and research managers attending dedicated training in PPI at a major London NHS (National Health Service)-university partnership.

INTERVENTIONS: A programme of 72 training workshops, designed to build practical skills and confidence for researchers working with patients and the public in research, was delivered at a major research-active NHS:university partnership. An iterative approach was taken to the programme, with the content of the workshops continually reviewed and refreshed to respond to the needs of researchers. Surveys before, immediately following and 6 months after training investigated the impact on researchers’ confidence and skills in PPI work, and the kind of PPI they subsequently carried out.

RESULTS: Training brought about immediate marked increases in researchers’ self-reported confidence to carry out PPI activities within their research, and in their knowledge of good practice. The evaluation indicates that workshop attendees were more likely to involve patients in their research following training. Researchers tended to involve patients and the public in a range of areas, including input to study design and patient information, in particular.

CONCLUSIONS: When positioned within a broader organisational strategy for PPI in research, such training has an important role to play in progressing PPI in a major research partnership. Training appeared to provide the confidence needed to carry out PPI which enabled further development of confidence and skills. Involving researchers who have attended the training in the ongoing development of the programme and bringing in patients to the training programme are key next steps.

PMID:34385250 | DOI:10.1136/bmjopen-2020-047995

BMJ Open. 2021 Aug 12;11(8):e049000. doi: 10.1136/bmjopen-2021-049000.

ABSTRACT

OBJECTIVE: Antimicrobial resistance is a global public health challenge. Dispensing of antibiotics without prescription (DAWP), a major contributor to antibiotic resistance, is extensive in Eritrea. This study was, therefore, aimed at deeply understanding, qualitatively, the pharmacy professionals’ perspective on the factors that trigger DAWP and how this practice could be mitigated.

DESIGN: A qualitative exploratory study design was employed.

SETTING: Drug retail outlets of Asmara, capital of Eritrea, and pharmaceutical services of Eritrea.

PARTICIPANTS: Thirty pharmacy professionals who were owners and employees of the drug retail outlets stationed in Asmara and six key informants from the pharmaceutical services of all administrative regions of Eritrea, selected purposively, were the study participants.

DATA COLLECTION AND ANALYSIS: The data were collected using focus group discussions and key informant interviews between March and September 2020. The collected data were transcribed verbatim, translated to English and finally thematically analysed using an inductive approach.

RESULTS: The main triggering factors were related to the drug retail outlet owners, dispensers, healthcare system and patients. Knowledge and attitude-based motivation, economic interest, inadequate services in health facilities, weak regulatory enforcement, inadequate training, trust and satisfaction of patients, previous successful experience, seriousness of a condition and saving time and money were reported among others as determinants of DAWP.

CONCLUSIONS: The triggering factors to DAWP were found to be very complex and some of them were important that might require immediate attention from policymakers. Ensuring readily available and accessible healthcare services, empowering medicines regulation and continuing sensitisation of dispensers are highly recommended to minimise DAWP.

PMID:34385252 | DOI:10.1136/bmjopen-2021-049000

BMJ Open. 2021 Aug 12;11(8):e046707. doi: 10.1136/bmjopen-2020-046707.

ABSTRACT

INTRODUCTION: Chimeric antigen receptor T-cell (CAR-T) therapy is a class of immunotherapy. An economic evaluation conducted at an early stage of development of CAR-T therapy for treatment of adult relapsed or refractory acute lymphoblastic leukaemia could provide insight into factors contributing to the cost of treatment, the potential clinical benefits, and what the health system can afford. Traditionally, stakeholders are engaged in certain parts of health technology assessment processes, such as in the identification and selection of technologies, formulation of recommendations, and implementation of recommendations; however, little is known about processes for stakeholder engagement during the conduct of the assessment. This is especially the case for economic evaluations. Stakeholders, such as clinicians, policy-makers, patients, and their support networks, have insight into factors that can enhance the validity of an economic evaluation model. This research outlines a specific methodology for stakeholder engagement and represents an avenue to enhance health economic evaluations and support the use of these models to inform decision making for resource allocation. This protocol may inform a tailored framework for stakeholder engagement processes in future economic evaluation model development.

METHODS AND ANALYSIS: We will involve clinicians, healthcare researchers, payers, and policy-makers, as well as patients and their support networks in the conduct and verification of an early economic evaluation of a novel health technology to incorporate stakeholder-generated knowledge. Three stakeholder-specific focus groups will be conducted using an online adaptation of the nominal group technique to elicit considerations from each. This study will use CAR-T therapy for adults with relapsed or refractory B-cell acute lymphoblastic leukaemia as a basis for investigating broader stakeholder engagement processes.

ETHICS AND DISSEMINATION: This study received ethics approval from the Ottawa Hospital Research Institute Research Ethics Board (REB 20200320-01HT) and the results will be shared via conference presentations, peer-reviewed publications, and ongoing stakeholder engagement.

PMID:34385243 | DOI:10.1136/bmjopen-2020-046707

BMJ Open. 2021 Aug 12;11(8):e046957. doi: 10.1136/bmjopen-2020-046957.

ABSTRACT

OBJECTIVES: People who inject drugs (PWID) play an integral role in facilitating the entry of others into injection drug use (IDU). We sought to assess factors influencing PWID in providing IDU initiation assistance across three distinct North American settings and to generate pooled measures of risk.

DESIGN: We employed data from three PWID cohort studies participating in PReventing Injecting by Modifying Existing Responses (PRIMER), for this cross-sectional analysis.

SETTING: Tijuana, Mexico; San Diego, USA; Vancouver, Canada.

PARTICIPANTS: A total of 2944 participants were included in this study (Tijuana: n=766, San Diego: n=353, Vancouver: n=1825).

MEASUREMENTS: The outcome was defined as recently (ie, past 6 months) assisting in an IDU initiation event. Independent variables of interest were identified from previous PRIMER analyses. Site-specific multiple modified Poisson regressions were fit. Pooled relative risks (pRR) were calculated and heterogeneity across sites was assessed via linear random effects models.

RESULTS: Evidence across all three sites indicated that having a history of providing IDU initiation assistance (pRR: 4.83, 95% CI: 3.49 to 6.66) and recently being stopped by law enforcement (pRR: 1.49, 95% CI: 1.07 to 2.07) were associated with a higher risk of providing assistance with IDU initiation; while recent opioid agonist treatment (OAT) enrolment (pRR: 0.64, 95% CI: 0.43 to 0.96) and no recent IDU (pRR: 0.21, 95% CI: 0.07 to 0.64) were associated with a lower risk. We identified substantial differences across site in the association of age (I²: 52%), recent housing insecurity (I²: 39%) and recent non-injection heroin use (I²: 78%).

CONCLUSION: We identified common and site-specific factors related to PWID’s risk of assisting in IDU initiation events. Individuals reporting a history of assisting IDU initiations, being recently stopped by law enforcement, and recently injecting methamphetamine/speedball were more likely to have recently assisted an IDU initiation. Whereas those who reported not recently engaging in IDU and those recently enrolled in OAT were less likely to have done so. Interventions and harm reduction strategies aimed at reducing the harms of IDU should incorporate context-specific approaches to reduce the initiation of IDU.

PMID:34385244 | DOI:10.1136/bmjopen-2020-046957

BMJ Open. 2021 Aug 12;11(8):e045506. doi: 10.1136/bmjopen-2020-045506.

ABSTRACT

OBJECTIVE: The main objective of this study is to investigate how the direction and strength of the association between infant mortality and its predictors are changing over time in Bangladesh using a nationally representative sample for the period 2011-2014.

DESIGN, SETTING AND PARTICIPANTS: Data from two repeatedly cross-sectional Bangladesh Demographic and Health Surveys (BDHSs) for the years 2011 and 2014 were used. A total of 7664 (with 312 infant death) and 7048 (with 264 infant death) complete cases, respectively, from BDHS 2011 and 2014 datasets were included in the study.

METHODS: Cox’s proportional hazard model with robust standard error (SE) that adjusts for the complex survey design characteristics was implemented to assess how the risk factors associated with infant mortality change their paths.

RESULTS: Results reflected that administrative division remained as a potential risk factor of infant death for both periods. Household’s socioeconomic status, father’s employment status, age difference between parents turned out to be potential risk factors in 2014, though they did not show any significant association with infant death in the year 2011. In contrast to 2011, mothers’ individual-level characteristics such as age at childbirth, education, media exposure, employment status did not remain as significant risk factors for infant death in 2014. Younger fathers increased the burden of death among infants of adolescent mothers. At higher order births, the burden of infant death significantly shifted from rural to urban areas. From the year 2011 to 2014, urban areas achieved socioeconomic equity in infant survival, while the extent of inequity was increased in rural areas.

CONCLUSION: Community-based programmes should be designed for urban mothers who are expecting higher order births. To eradicate the socioeconomic inequity in infant survival, the government should design strong and sustainable maternal and child healthcare facilities, especially for rural areas.

PMID:34385233 | DOI:10.1136/bmjopen-2020-045506

BMJ Open. 2021 Aug 12;11(8):e046206. doi: 10.1136/bmjopen-2020-046206.

ABSTRACT

INTRODUCTION: The increase in international travel brought about by globalisation has enabled the rapid spread of emerging pathogens with epidemic and pandemic potential. While travel connectivity-based assessments may help understand patterns of travel network-mediated epidemics, such approaches are rarely carried out in sufficient detail for Oceania where air travel is the dominant method of transportation between countries.

DESIGN: Travel data from the Australian Bureau of Statistics, Stats NZ and the United Nations World Tourism Organization websites were used to calculate travel volumes in 2018 within Oceania and between Oceania and the rest of the world. The Infectious Disease Vulnerability Index (IDVI) was incorporated into the analysis as an indicator of each country’s capacity to contain an outbreak. Travel networks were developed to assess the spread of infectious diseases (1) into and from Oceania, (2) within Oceania and (3) between each of the Pacific Island Countries and Territories (PICTs) and their most connected countries.

RESULTS: Oceania was highly connected to countries in Asia, Europe and North America. Australia, New Zealand and several PICTs were highly connected to the USA and the UK (least vulnerable countries for outbreaks based on the IDVI), and to China (intermediate low vulnerable country). High variability was also observed between the PICTs in the geographical distribution of their international connections. The PICTs with the highest number of international connections were Fiji, French Polynesia, Guam and Papua New Guinea.

CONCLUSION: Travel connectivity assessments may help to accurately stratify the risk of infectious disease importation and outbreaks in countries depending on disease transmission in other parts of the world. This information is essential to track future requirements for scaling up and targeting outbreak surveillance and control strategies in Oceania.

PMID:34385235 | DOI:10.1136/bmjopen-2020-046206