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Health SA = SA Gesondheid 2022Following the rollout of several effective vaccines against coronavirus disease 2019 (COVID-19), many countries have introduced vaccination passports or certificates as...
BACKGROUND
Following the rollout of several effective vaccines against coronavirus disease 2019 (COVID-19), many countries have introduced vaccination passports or certificates as a means of certifying that an individual has been vaccinated against, is immune to, or is presently uninfected with COVID-19. An extensive ethical debate has ensued.
AIM
To determine the perspectives of South African healthcare workers (HCWs) on the implementation of COVID-19 vaccination passports (C19VPs) in South Africa (SA).
SETTING
Healthcare workers working in various fields and practice settings throughout SA were invited to complete an online questionnaire.
METHODS
An online questionnaire was distributed using convenience sampling via social media platforms to HCWs over a 1-month period, collecting demographic details and responses to 8 Likert-type items regarding agreement with C19VPs, ethical issues and feasibility. Each item was graded from 1 (strongly disagree) to 5 (strongly agree), with grouping of 4 of the 8 items exploring a common theme of C19VPs being a good idea, constituting a score out of 20. Non-parametric tests were performed to determine differences in responses between groups.
RESULTS
One thousand HCWs responded to the survey and fulfilled inclusion criteria. The majority (83.2%) of respondents were medical practitioners (MPs). Overall, most (73.5%) respondents agreed that C19VPs are a good idea. Older respondents agreed more strongly than younger respondents (medians 18 and 17, respectively, = 0.001), and respondents in private practice agreed more strongly than those in state practice (medians 18 and 16, respectively, = 0.042). The median response was neutral (3) in response to the ethics of C19VPs considering variations in vaccine access and tending towards disagreement (2.5) in disadvantaging poorer people. Most respondents disagreed that vaccine hesitancy would make C19VPs unethical, and responses from provinces with the highest vaccination proportions disagreed more than others with lower vaccination proportion (median 2 compared with 3, < 0.001). There was uncertainty about the feasibility of C19VPs in SA, with older HCWs, non-students, senior MPs and those who thought C19VPs are a good idea being more likely to consider them feasible.
CONCLUSION
The perspectives of HCWs, mainly MPs, about C19VPs in SA were obtained. Further research should focus on vaccine hesitancy and its factors in HCWs and the effect of C19VPs on restrictions, reduction in transmission and benefits on economies and mental health.
CONTRIBUTION
To the authors' knowledge, this is the first survey data published on the perspectives of South African HCWs on C19VPs in the country. Healthcare workers are trusted influencers of vaccination decisions, and their opinion on vaccination certificates may also influence the South African public's perception and acceptance thereof.
PubMed: 35548060
DOI: 10.4102/hsag.v27i0.1823 -
Blood Cells, Molecules & Diseases Jan 2011To investigate the relationship between chemokines and cytokines and osteonecrosis in Gaucher disease, we conducted multiplex assays in a cohort of 100 adult patients.
BACKGROUND
To investigate the relationship between chemokines and cytokines and osteonecrosis in Gaucher disease, we conducted multiplex assays in a cohort of 100 adult patients.
METHODS
Mean age was 45 years (18-86); 92 Gaucher patients received imiglucerase (median duration 8 years (2-18)). Forty-three had experienced osteonecrosis (ON), and eight had ON despite enzyme therapy. Serum cytokines/chemokines were determined by fluorimetric bead arrays in samples from Gaucher patients and healthy volunteers (10 males and 10 females). Intra-assay and inter-assay coefficients of variation were 2%-9.8% and 5.6%-15%, respectively.
RESULTS
VEGF and CCL5/RANTES did not differ between Gaucher and control samples. Concentrations of CCL3/MIP-1α, CCL4/MIP-1β, CCL2/MCP-1, CXCL8/IL-8, IL-1ra and CCL18/PARC were elevated in Gaucher patients (p<0.05 for each). Median CCL4/MIP-1β, CXCL8/IL-8, CCL5/RANTES and CCL18/PARC concentrations were greater in the 43 osteonecrosis patients (88.6 pg/mL, 30.5 pg/mL, 89.6 ng/mL and 434 ng/mL, respectively) compared with the 57 patients who had no evidence of osteonecrosis (medians of 59.4, 13.3, 62.7 and 283, respectively, p<0.05). Moreover, the eight patients with ON despite imiglucerase had median concentrations of CCL3/MIP-1α, CCL4/MIP-1β, CXCL8/IL-8, CCL5/RANTES and CCL18/PARC (73.2, 120.9, 36.3 pg/mL, 105 and 767 ng/mL, respectively), which significantly exceeded the values in 84 patients now free of ON (52.3, 71.2, 16.5 pg/mL, 69.5 and 315 ng/mL, respectively, p<0.05). Treatment exposures were similar.
CONCLUSION
Numerous serum cytokines are elevated in Gaucher disease. CCL18/PARC, CCL3/MIP-1α, CCL4/MIP-1β, CCL5/RANTES and CXCL8/IL-8 are potential biomarkers of osteonecrosis and may allow prediction of this disabling complication.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Case-Control Studies; Chemokines, CC; Cytokines; Enzyme Replacement Therapy; Female; Gaucher Disease; Hexosaminidases; Humans; Male; Middle Aged; Osteonecrosis; Up-Regulation; Young Adult
PubMed: 21075651
DOI: 10.1016/j.bcmd.2010.10.010 -
Acta Neurochirurgica. Supplement 2018The aim of this analysis was to investigate to what extent median cerebral perfusion pressure (CPP) differs between severe traumatic brain injury (TBI) patients and...
INTRODUCTION
The aim of this analysis was to investigate to what extent median cerebral perfusion pressure (CPP) differs between severe traumatic brain injury (TBI) patients and between centres, and whether the 2007 change in CPP threshold in the Brain Trauma Foundation guidelines is reflected in patient data collected at several centres over different time periods.
METHODS
Data were collected from the Brain-IT database, a multi-centre project between 2003 and 2005, and from a recent project in four centres between 2009 and 2013. For patients nursed with their head up at 30° and with the blood pressure transducer at atrium level, CPP was corrected by 10 mmHg. Median CPP, interquartile ranges and total CPP ranges over the monitoring time were calculated per patient and per centre.
RESULTS
Per-centre medians pre-2007 were situated between 50 and 70 mmHg in 6 out of 16 centres, while 10 centres had medians above 70 mmHg and 4 above 80 mmHg. Post-2007, three out of four centres had medians between 60 and 70 mmHg and one above 80 mmHg. One out of two centres with data pre- and post-2007 shifted from a median CPP of 76 mmHg to 60 mmHg, while the other remained at 68-67 mmHg.
CONCLUSIONS
CPP data are characterised by a high inter-individual variability, but the data also suggest differences in CPP policies between centres. The 2007 guideline change may have affected policies towards lower CPP in some centres. Deviations from the guidelines occur in the direction of CPP > 70 mmHg.
Topics: Adult; Blood Pressure; Brain; Brain Injuries, Traumatic; Cerebrovascular Circulation; Cohort Studies; Databases, Factual; Female; Hospitals; Humans; Individuality; Male; Patient Care Planning; Practice Guidelines as Topic; Trauma Severity Indices
PubMed: 29492521
DOI: 10.1007/978-3-319-65798-1_1 -
Annals of Human Biology May 1976The median ages at menarche were obtained from a sample of 2029 urban and 328 rural Nigerian girls by the status quo method, and calculated by probits. The median age at...
The median ages at menarche were obtained from a sample of 2029 urban and 328 rural Nigerian girls by the status quo method, and calculated by probits. The median age at menarche for the urban girls was 13-70 +/- 0-03 years whilst it was 14-50 +/- 0-09 years for the rural girls. There were significant differences in the median menarcheal ages of the girls according to the level of education and the occupation of the parents, and their geographical residence. The number of siblings and the birth rank of the girls did not influence the age of onset of menstruation. A secular trend towards earlier menarcheal age at a rate of 5 to 6 months per decade was observed amongst children of the professionally privileged group. The earliest menarche occurred amongst girls with university-educated fathers or mothers; in this group the median was 13-26 +/- 0-06 years, a value comparable with current European medians.
Topics: Adolescent; Age Factors; Birth Order; Child; Educational Status; Environment; Female; Humans; Menarche; Nigeria; Occupations; Parity; Time Factors
PubMed: 962305
DOI: 10.1080/03014467600001431 -
Anesthesia and Analgesia Feb 2020Continuous data that are not normally distributed are typically presented in terms of median and interquartile range (IQR) for each group. High-quality anesthesia... (Comparative Study)
Comparative Study
Continuous data that are not normally distributed are typically presented in terms of median and interquartile range (IQR) for each group. High-quality anesthesia journals often require that confidence intervals are calculated and presented for all estimated associations of interest reported within a manuscript submission, and therefore, methods for calculating confidence intervals for differences in medians are vital. It is informative to present the difference in medians along with a confidence interval to provide insight about the magnitude of variability for the estimated difference. In a clinical research example using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric database, we demonstrate how to estimate confidence intervals for the difference in medians using 3 different statistical methods: the Hodges-Lehmann estimator, bootstrap resampling with replacement, and quantile regression modeling on the median (median regression). We discuss specific recommendations regarding the methods according to the objectives of the study as well as the distribution of the data as it pertains to the assumptions of the respective methods. Quantile regression allows for covariate adjustment, which may be an advantage in situations where differences in medians between groups may be due to confounding.
Topics: Confidence Intervals; Databases, Factual; Female; Humans; Infant, Newborn; Length of Stay; Male; Neurosurgical Procedures; Quality Improvement
PubMed: 31725019
DOI: 10.1213/ANE.0000000000004535 -
MedEdPORTAL : the Journal of Teaching... 2023Despite increasing awareness of media exposure to children and adolescents and the known value of media education for physicians, residency programs lack formal media...
INTRODUCTION
Despite increasing awareness of media exposure to children and adolescents and the known value of media education for physicians, residency programs lack formal media education.
METHODS
We designed an interactive curriculum for pediatric residents to teach health effects of media as well as screening and counseling strategies. Instructional methods were based on constructivism, experiential learning, and situated learning theories. Participants independently reflected on a media viewing, then participated in two facilitator-led 1-hour workshops of two to three residents. Facilitators received speaker notes based on American Academy of Pediatrics media guidelines. Changes in knowledge, reported skills, and attitudes were assessed by pre- and posttests.
RESULTS
Twenty-one residents completed the curriculum from September 2021 through April 2022. Knowledge improved after the curriculum as the median score increased from 3 to 5 out of 6, although 4 months later it was insignificant. Reported skills in screening did not significantly change. Residents strongly agreed that media use was an important health issue, with medians of 9 or 10 out of 10 on all tests. Attitudes regarding residency preparedness and confidence in screening and counseling significantly improved from pretest medians of 6 and 6 out of 10, respectively, to posttest medians of 8 and 9 to 4-month posttest medians of 6 and 8.
DISCUSSION
A media curriculum for pediatric residents resulted in improved knowledge and attitudes. Enhanced attitudes demonstrated sustainability. All participants found the curriculum relevant and engaging and felt it should be continued.
Topics: Adolescent; Humans; Child; Curriculum; Internship and Residency; Problem-Based Learning; Knowledge; Physicians
PubMed: 38144390
DOI: 10.15766/mep_2374-8265.11372 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2022The aim: To investigate the relationship between serum bilirubin level and the presence of the APS in women with a history of spontaneous miscarriages.
OBJECTIVE
The aim: To investigate the relationship between serum bilirubin level and the presence of the APS in women with a history of spontaneous miscarriages.
PATIENTS AND METHODS
Materials and methods: Fifty six women aged 22-38 (median 27) years with a history of spontaneous miscarriages were divided into two groups: 33 women with the APS and 23 without. Patients were tested for the presence of lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein 1, antiphospholipid antibodies and genetic thrombophilic defects.
RESULTS
Results: Groups were comparable by age, blood pressure, BMI, co-morbidity (anemia, heart abnormality, thyroid disease, overweight). Median serum total bilirubin levels were 7,2 μmol/L (interquartile range [5,8-9,7]) in women with the APS and 10,5 μmol/L (interquartile range [7,5-15,1]) in control group, p=0.005. The chance of detecting a total bilirubin level of less than 8 μmol/L is 4.1 times higher in the APS patients than in the control group (OR 4,1; 95% CI 1,274-13,213). Logistic regression analysis found a statistically significant association between total bilirubin and the presence of the APS (odds ratio, 0.856; 95% CI, 0.734-0.997, p =0.046). Patients with the APS had elevated serum C-reactive protein (medians 2,3 vs 1,1 mg/L, p=0.01) and fibrinogen (medians 2,8 vs 2,5 g/L, p=0.006) levels compared with controls. Correlation analysis revealed a significant correlation between all types of bilirubin and inflammatory markers.
CONCLUSION
Conclusions: All types of serum bilirubin (total, direct and indirect) are significantly reduced in women with APS, associated with higher inflammatory markers and lower levels of 25-hydroxyvitamin D, which may be the result of oxidative stress.
Topics: Adult; Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Bilirubin; Female; Humans; Lupus Coagulation Inhibitor; Young Adult; beta 2-Glycoprotein I
PubMed: 35182123
DOI: No ID Found -
Sexually Transmitted Infections Jul 2007This study aimed to systematically review and describe the evidence on chlamydia and gonorrhoea reinfection among men, and to evaluate the need for retesting... (Review)
Review
This study aimed to systematically review and describe the evidence on chlamydia and gonorrhoea reinfection among men, and to evaluate the need for retesting recommendations in men. PubMed and STI conference abstract books from January 1995 to October 2006 were searched to identify studies on chlamydia and gonorrhoea reinfection among men using chlamydia and gonorrhoea nucleic acid amplification tests or gonorrhoea culture. Studies were categorised as using either active or passive follow-up methods. The proportions of chlamydial and gonococcal reinfection among men were calculated for each study and summary medians were reported. Repeat chlamydia infection among men had a median reinfection probability of 11.3%. Repeat gonorrhoea infection among men had a median reinfection probability of 7.0%. Studies with active follow-up had moderate rates of chlamydia and gonorrhoea reinfection among men, with respective medians of 10.9% and 7.0%. Studies with passive follow-up had higher proportions of both chlamydia and gonorrhoea reinfections among men, with respective medians of 17.4% and 8.5%. Proportions of chlamydia and gonorrhoea reinfection among men were comparable with those among women. Reinfection among men was strongly associated with previous history of sexually transmitted diseases and younger age, and inconsistently associated with risky sexual behaviour. Substantial repeat chlamydia and gonorrhoea infection rates were found in men comparable with those in women. Retesting recommendations in men are appropriate, given the high rate of reinfection. To optimise retesting guidelines, further research to determine effective retesting methods and establish factors associated with reinfection among men is suggested.
Topics: Chlamydia Infections; Gonorrhea; Humans; Incidence; Male; Mass Screening; Practice Guidelines as Topic; Prevalence; Recurrence; Retreatment; Unsafe Sex
PubMed: 17166889
DOI: 10.1136/sti.2006.024059 -
American Journal of Perinatology Nov 2018The objective of this study was to investigate frequency and trends of skin punctures in preterm infants.
OBJECTIVE
The objective of this study was to investigate frequency and trends of skin punctures in preterm infants.
STUDY DESIGN
A prospective audit of preterm infants less than 35 weeks admitted over a 6-month period to a tertiary neonatal intensive care unit. Each skin puncture performed in the first 2 weeks of life was documented in a specifically designed audit sheet.
RESULTS
Ninety-nine preterm infants were enrolled. Infants born at < 32 weeks' gestation had significantly more skin punctures than infants > 32 weeks (median skin punctures 26.5 vs. 17, -value < 0.05). The highest frequency of skin punctures occurred during the first week of life for infants > 28 weeks' gestation (medians 17.5 in 28-31 + 6 weeks' gestation, and 15 in > 32 weeks), and during the second week of life for those born at < 28 weeks (median 17.5). Infants with sepsis had more skin punctures (-value < 0.001), but this was not significant on multivariate analysis. Median skin punctures in the second week of life were statistically higher in the sepsis group on multivariate analysis (odds ratio: 1.07, 95% confidence interval: 1.00-1.14, = 0.041).
CONCLUSION
Frequency of skin punctures is influenced by gestational age and postnatal age. Skin punctures were not an independent risk factor for sepsis.
Topics: Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Ireland; Male; Medical Audit; Punctures; Risk Assessment; Sepsis
PubMed: 29791952
DOI: 10.1055/s-0038-1654711 -
Annals of Vascular Surgery Feb 2017Medical care in the United States has evolved into a more cost-conscious value-based health care system that necessitates a comparison of costs when there are... (Comparative Study)
Comparative Study
BACKGROUND
Medical care in the United States has evolved into a more cost-conscious value-based health care system that necessitates a comparison of costs when there are alternative interventions considered to be acceptable in the treatment of a disease. This study compares the cost differences between regional anesthesia (RA) and general anesthesia (GA) for carotid endarterectomy (CEA).
METHODS
Data from 346 consecutive patients who underwent CEA between January 2012 and September 2014 were retrospectively reviewed for the type of anesthesia used, outcomes data, and cost variables. Overall hospital day costs were compared between RA and GA. Medians and interquartile ranges were compared using Wilcoxon-Mann-Whitney test. A P < 0.05 was considered statistically significant using 2-sided tests.
RESULTS
Median overall costs for GA were significantly higher than median costs for RA (medians [with interquartile ranges], $10,140 [$7,158-$12,658] versus $7,122 [$5,072-$8,511], P < 0.001). Median total operative time for GA was significantly longer than median time for RA (168 [144-188] versus 134 [115-147] min, P < 0.001). Median in-hospital length of stay (LOS) for GA was significantly longer compared with RA (2.0 vs 1.2 days, P < 0.001). Patients who received GA were also more likely to be admitted to the intensive care unit.
CONCLUSIONS
Decreased cost, operating room expenses, postoperative resources, and overall LOS were observed for individuals who underwent RA for CEA as compared with GA. In summary, RA is more cost-effective and should be the optimal choice when clinically appropriate.
Topics: Anesthesia, Conduction; Anesthesia, General; Carotid Stenosis; Cost-Benefit Analysis; Decision Support Techniques; Endarterectomy, Carotid; Female; Hospital Costs; Humans; Length of Stay; Male; Models, Economic; Operating Rooms; Operative Time; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 27554700
DOI: 10.1016/j.avsg.2016.05.124