Abstract
In the Kpone-Katamanso Municipality (Greater Accra, Ghana), as part of the coronavirus disease 2019 (COVID-19) pandemic response, public health teams implemented and carried out enhanced ...contact tracing and surveillance from March 2020 to March 2021. There were 725 confirmed COVID-19 cases during this time period, most of which were detected as part of the enhanced surveillance. This is resource intensive, but beneficial in the early detection of cases, thus reducing further community transmission and, in effect, stopping larger outbreaks at the source. A proactive approach to case detection can be successful in reducing community transmission and supporting the pandemic response.
Africa has the slowest COVID-19 vaccination rate of any continent in the world, with only 29.8% of the population receiving at least one dose of the vaccine. This includes Ghana, where only 37.8% of ...the country have received at least one dose as of October, 2022. The key aims of this research were to determine levels of hesitancy in COVID-19 vaccines among unvaccinated individuals in Ghana and observe their trends across time, and to identify independent predictors associated with vaccine hesitancy among unvaccinated individuals.
four online cross-sectional surveys of Ghanaian citizens were conducted in August, 2020 (N = 3048), March, 2021 (N = 1558), June, 2021 (N = 1295), and February, 2022 (N = 424).
overall hesitancy decreased from 36.8% (95% CI: 35.1%-38.5%) in August, 2020 to 17.2% (95% CI: 15.3%-19.1%) in March, 2021. However, hesitancy increased to 23.8% (95% CI: 21.5%-26.1%) in June, 2021, and then again to 52.2% (95% CI: 47.4%-57.0%) in February, 2022. Key reasons included not having enough vaccine-related information (50.6%) and concerns over vaccine safety (32.0%). Hesitant groups included Christians, urban dwellers, opposition political party voters, females, individuals who completed higher education, individuals who reported receiving COVID-19 information from internet sources, and individuals who expressed uncertainty about commonly-circulated COVID-19 misinformation beliefs.
hesitancy rates among unvaccinated individuals in Ghana continues to rise. However, vaccine awareness strategies are sensitive to subpopulation characteristics. Many are reachable through targeted communication strategies, to which campaigns must focus on resolving vaccine-related concerns to ensure high vaccine uptake across Ghana.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
ObjectivesProvide insights into the experiences and perspectives of healthcare staff who treated scabies or managed outbreaks in formal and informal refugee/migrant camps in Europe ...2014–2017.DesignRetrospective qualitative study using semistructured telephone interviews and framework analysis. Recruitment was done primarily through online networks of healthcare staff involved in medical care in refugee/migrant settings.SettingFormal and informal refugee/migrant camps in Europe 2014–2017.ParticipantsTwelve participants (four doctors, four nurses, three allied health workers, one medical student) who had worked in camps (six in informal camps, nine in formal ones) across 15 locations within seven European countries (Greece, Serbia, Macedonia, Turkey, France, the Netherlands, Belgium).ResultsParticipants reported that in camps they had worked, scabies diagnosis was primarily clinical (without dermatoscopy), and treatment and outbreak management varied highly. Seven stated scabicides were provided, while five reported that only symptomatic management was offered. They described camps as difficult places to work, with poor living standards for residents. Key perceived barriers to scabies control were (1) lack of water, sanitation and hygiene, specifically: absent/limited showers (difficult to wash off topical scabicides), and inability to wash clothes and bedding (may have increased transmission/reinfestation); (2) social factors: language, stigma, treatment non-compliance and mobility (interfering with contact tracing and follow-up treatments); (3) healthcare factors: scabicide shortages and diversity, lack of examination privacy and staff inexperience; (4) organisational factors: overcrowding, ineffective interorganisational coordination, and lack of support and maltreatment by state authorities (eg, not providing basic facilities, obstruction of self-care by camp residents and non-governmental organisation (NGO) aid).ConclusionsWe recommend development of accessible scabies guidelines for camps, use of consensus diagnostic criteria and oral ivermectin mass treatments. In addition, as much of the work described was by small, volunteer-staffed NGOs, we in the wider healthcare community should reflect how to better support such initiatives and those they serve.
Cancer is a leading cause of disease burden globally, with more than 19·3 million cases and 10 million deaths recorded in 2020. Research is crucial to understanding the determinants of cancer and the ...effects of interventions, and to improving outcomes. We aimed to analyse global patterns of public and philanthropic investment in cancer research.
In this content analysis, we searched the UberResearch Dimensions database and Cancer Research UK data for human cancer research funding awards from public and philanthropic funders between Jan 1, 2016, and Dec 31, 2020. Included award types were project and programme grants, fellowships, pump priming, and pilot projects. Awards focused on operational delivery of cancer care were excluded. Awards were categorised by cancer type, cross-cutting research theme, and research phase. Funding amount was compared with global burden of specific cancers, measured by disability-adjusted life-years, years lived with disability, and mortality using data from the Global Burden of Disease study.
We identified 66 388 awards with total investment of about US$24·5 billion in 2016–20. Investment decreased year-on-year, with the largest drop observed between 2019 and 2020. Pre-clinical research received 73·5% of the funding across the 5 years ($18 billion), phase 1–4 clinical trials received 7·4% ($1·8 billion), public health research received 9·4% ($2·3 billion), and cross-disciplinary research received 5·0% ($1·2 billion). General cancer research received the largest investment ($7·1 billion, 29·2% of the total funding). The most highly funded cancer types were breast cancer ($2·7 billion 11·2%), haematological cancer ($2·3 billion 9·4%), and brain cancer ($1·3 billion 5·5%). Analysis by cross-cutting theme revealed that 41·2% of investment ($9·6 billion) went to cancer biology research, 19·6% ($4·6 billion) to drug treatment research, and 12·1% ($2·8 billion) to immuno-oncology. 1·4% of the total funding ($0·3 billion) was spent on surgery research, 2·8% ($0·7 billion) was spent on radiotherapy research, and 0·5% ($0·1 billion) was spent on global health studies.
Cancer research funding must be aligned with the global burden of cancer with more equitable funding for cancer research in low-income and middle-income countries (which account for 80% of cancer burden), both to support research relevant to these settings, and build research capacity within these countries. There is an urgent need to prioritise investment in surgery and radiotherapy research given their primacy in the treatment of many solid tumours.
None.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Recently, AI tools have been deployed with increasing speed in educational and clinical settings. However, the use of AI by trainees across different levels of experience has not been well studied. ...This study investigates the impact of AI assistance on diagnostic accuracy for intracranial hemorrhage (ICH) and large vessel occlusion (LVO) by medical students (MS) and resident trainees (RT).BACKGROUND AND PURPOSERecently, AI tools have been deployed with increasing speed in educational and clinical settings. However, the use of AI by trainees across different levels of experience has not been well studied. This study investigates the impact of AI assistance on diagnostic accuracy for intracranial hemorrhage (ICH) and large vessel occlusion (LVO) by medical students (MS) and resident trainees (RT).This prospective study was conducted between March 2023 and October 2023. MS and RT were asked to identify ICH and LVO in 100 non-contrast head CTs and 100 head CTAs, respectively. One group received diagnostic aid simulating AI for ICH only (n = 26), the other for LVO only (n = 28). Primary outcomes included accuracy, sensitivity, and specificity for ICH / LVO detection without and with aid. Study interpretation time was a secondary outcome. Individual responses were pooled and analyzed with chi-square; differences in continuous variables were assessed with ANOVA.MATERIALS AND METHODSThis prospective study was conducted between March 2023 and October 2023. MS and RT were asked to identify ICH and LVO in 100 non-contrast head CTs and 100 head CTAs, respectively. One group received diagnostic aid simulating AI for ICH only (n = 26), the other for LVO only (n = 28). Primary outcomes included accuracy, sensitivity, and specificity for ICH / LVO detection without and with aid. Study interpretation time was a secondary outcome. Individual responses were pooled and analyzed with chi-square; differences in continuous variables were assessed with ANOVA.48 participants completed the study, generating 10,779 ICH or LVO interpretations. With diagnostic aid, MS accuracy improved 11.0 points (P < .001) and RT accuracy showed no significant change. ICH interpretation time increased with diagnostic aid for both groups (P < .001) while LVO interpretation time decreased for MS (P < .001). Despite worse performance in detection of the smallest vs. the largest hemorrhages at baseline, MS were not more likely to accept a true positive AI result for these more difficult tasks. Both groups were considerably less accurate when disagreeing with the AI or when supplied with an incorrect AI result.RESULTS48 participants completed the study, generating 10,779 ICH or LVO interpretations. With diagnostic aid, MS accuracy improved 11.0 points (P < .001) and RT accuracy showed no significant change. ICH interpretation time increased with diagnostic aid for both groups (P < .001) while LVO interpretation time decreased for MS (P < .001). Despite worse performance in detection of the smallest vs. the largest hemorrhages at baseline, MS were not more likely to accept a true positive AI result for these more difficult tasks. Both groups were considerably less accurate when disagreeing with the AI or when supplied with an incorrect AI result.This study demonstrated greater improvement in diagnostic accuracy with AI for MS compared to RT. However, MS were less likely than RT to overrule incorrect AI interpretations and were less accurate, even with diagnostic aid, than the AI was by itself.CONCLUSIONSThis study demonstrated greater improvement in diagnostic accuracy with AI for MS compared to RT. However, MS were less likely than RT to overrule incorrect AI interpretations and were less accurate, even with diagnostic aid, than the AI was by itself.ICH = intracranial hemorrhage; LVO = large vessel occlusion; MS = medical students; RT = resident trainees.ABBREVIATIONSICH = intracranial hemorrhage; LVO = large vessel occlusion; MS = medical students; RT = resident trainees.
Objective:The authors examined whether timely treatment for serious mental illness and substance use disorder reduces overall health care costs in a 3-year period.Methods:Claims data from the IBM ...MarketScan Research Databases (2010–2017) were analyzed. The population studied included 2,997 Medicaid enrollees and 35,805 commercial insurance enrollees ages 18–64 years with an index event for a serious mental illness and 2,315 Medicaid enrollees and 28,419 commercial insurance enrollees with an index event for a substance use disorder. Health care costs in the 3 years after an index event were calculated for enrollees who received care that met a minimum threshold for treatment and for those who did not receive such care. The Toolkit for Weighting and Analysis of Nonequivalent Groups was used to control for statistically significant differences in pretreatment characteristics between the groups.Results:All health care spending for enrollees who were engaged in behavioral health treatment for substance use disorder or a serious mental illness increased from year 0 to year 1 but decreased faster than the spending of enrollees who were not engaged in treatment, with larger trends for those engaged in substance use disorder treatment. Expenses for inpatient and emergency department care decreased over the 3 follow-up years; however, spending on outpatient services was significantly higher in all 3 follow-up years for those engaged in treatment.Conclusions:Health care delivery and payment models that improve access to behavioral health treatment may reduce emergency department, inpatient, and overall health care costs for particular subpopulations.
Long-term consequences of the misuse of ivermectin data Alvarez-Moreno, Carlos; Cassell, Jackie A; Donkor, Claudia M ...
Lancet. Infectious diseases/The Lancet. Infectious diseases,
December 2021, 2021-12-00, 20211201, Volume:
21, Issue:
12
Journal Article
Peer reviewed
Open access
On March 31, 2021, WHO advised that ivermectin should only be used within clinical trials and not as part of routine clinical practice.4 This advice was followed by the manufacturer, Merck, that ...stated on Feb 4, 2021, that there is “no meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease”.5 Despite this, ivermectin is being routinely used in some Latin American settings amid recommendations from some governments and health professionals.6 In July, 2021, a number of scientists reviewed and reported detailed clinical trial data for use of ivermectin for COVID-19.7 Their commentaries, which were not peer-reviewed, highlighted extensive inconsistencies within the trial data. Ivermectin itself has been the subject of a widely reproduced but unsubstantiated link to mortality in older people in care homes that still deters clinical use in some settings (including the UK).10 Sustained misinformation can lead to diversion of limited health-care and government resources to addressing rumours rather than making genuine public heath progress. Proactive health promotion and education is needed right now to ensure that locally trusted actors and communicators (including, but not limited to, health-care workers) are aware of the uncertainty around the ivermectin evidence base for managing COVID-19, and that it remains a vital medicine for managing neglected tropical disease.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Togo is a low-income country in West Africa. Estimates from Our World in Data suggest that only 25% of the Togolese population have received at least one dose of any COVID-19 vaccine by June 2023. ...Whilst the early phase of the pandemic vaccine rollout across 2021 was dominated by higher-income countries taking much of the available supply, there have long been sufficient supplies for all nations. Thus, there remains a need to understand reasons for low uptake in countries such as Togo, here focusing on population confidence and trust, essentially characteristics that could potentially be addressed within health promotion strategies. Two cross-sectional telephone surveys of Togo residents were conducted in December 2020 and January 2022. These surveys asked questions around perceptions of COVID-19, trust in public health messaging, belief in conspiracy theories, and hesitancy around COVID-19 vaccination. Analyses here focus on unvaccinated respondents. Across Survey 1 (N = 1430) and Survey 2 (N = 212), 65% of respondents were men, and 47% lived in Lomé (capital city of Togo). Between Surveys 1 and 2, overall hesitancy (33.0% to 58.0% respectively) and beliefs in conspiracy theories (29% to 65%) significantly increased. Using logistics regression, governmental mistrust was the strongest significant predictor of hesitancy (OR: 2.90). Participants who indicated agreement or uncertainty with at least one conspiracy belief also predicted greater vaccine hesitancy (OR: 1.36). Proactive approaches to public health messaging, that better understand reasons for hesitancy across different demographics, can support uptake of COVID-19 vaccinations within Togo. This includes health promotion campaigns that use locally and nationally trusted knowledge providers (e.g. the health service or religious leaders) for greatest effectiveness at reducing impact of misinformation. Key future research should focus around knowledge gaps and areas of mistrust created by the pandemic, such as the impact of misinformation upon routine immunisation uptake.
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