Alpha-1 Deficiency: Better Detection May Improve Outcomes for COPD Patients

Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder that results in debilitating illnesses like: emphysema, COPD, liver disease, and panniculitis. AATD is highly under-diagnosed based on epidemiologic and population studies that suggest that fewer than 10% of the 60,000-100,000 individuals in the U.S. suspected to have severely deficient alleles have been identified ( Rahaghi et al., 2012). This study examines strategies aimed at improving detection of AATD. The findings indicate that utilizing flags to alert providers of the need for AATD testing initiated by RTs or automated within EMR systems are effective strategies for increasing testing rates and potentially improving detection of emphysema and COPD secondary to AATD therefore eliminating diagnostic delays and improving prognosis for those affected.https://commons.und.edu/pas-grad-posters/1052/thumbnail.jp

Die Atemnot-Ambulanz aus Sicht der Patienten – eine qualitative Interviewstudie

HINTERGRUND: Atemnot ist ein häufiges und belastendes Symptom im Krankheitsverlauf vieler chronisch fortschreitender Erkrankungen. Aufgrund der Komplexität des Symptoms ist für die erfolgreiche Behandlung oft die Kombination verschiedener Maßnahmen nötig. Nach englischem Vorbild existiert seit 2014 in München Deutschlands erste Atemnot-Ambulanz (AmbA), in der die Betroffenen in einer mehrgliedrigen und auf Selbstmanagement abzielenden Behandlung lernen, besser mit dem Symptom Atemnot umzugehen. FRAGESTELLUNG: Ermittlung der Erfahrungen und Sichtweisen von Patienten und Patientinnen sowie Angehörigen hinsichtlich der Behandlung in der Atemnot-Ambulanz. Besondere Berücksichtigung erfahren dabei das Selbstmanagement von Atem\-not und der Umgang mit einer fortgeschrittenen Erkrankung. METHODEN: In einer qualitativen semi-strukturierten Interviewstudie wurden mit Teilnehmern und Teilnehmerinnen der Atemnot-Ambulanz und deren Angehörigen leitfadengestützte Interviews geführt. Anschließend wurden diese in einem iterativen Prozess anhand der qualitativen Inhaltsanalyse nach Margrit Schreier ausgewertet. Mittels Typisierung wurden Merkmale der Ambulanz-Teilnehmer und -Teilnehmerinnen gruppiert. In einer Konzeptualisierung durch das in der Gesundheitspsychologie verbreitete Common-Sense-Modell wurden Unterschiede in der Bewertung der Ambulanz veranschaulicht. ERGEBNISSE: Es wurden insgesamt 25 Interviews geführt, davon 15 Interviews ausschließlich mit Patienten und Patientinnen, sieben sowohl mit Patienten und Patientinnen als auch mit Angehörigen und drei Interviews nur mit Angehörigen. Das Alter der Patienten und Patientinnen lag zwischen 55 und 80 Jahren. Die zugrunde liegenden Erkrankungen umfassten zehn Patienten bzw. Patientinnen mit COPD, zwei mit Lungenfibrose, drei mit Pulmonalarterieller Hypertonie, zwei mit Lungenkarzinom, sechs mit Herzinsuffizienz und eine Person mit Tracheomalazie bei Zustand nach Langzeitbeatmung. In die Auswertung wurden 25 Interviews aufgenommen. Daraus ergab sich ein Kategoriensystem aus den acht Oberkategorien "Initiative zur Inanspruchnahme der Behandlung", "Leidensdruck mit Atemnot", "bisherige medizinische Versorgung", "Erwartungen an die Behandlung", "Einstellung zur Erkrankung", "Selbstmanagement-Kompetenz", "Profitieren durch die Atemnot-Ambulanz" und "Atemnot-Ambulanz als neue Versorgungskomponente". Die Ambulanz wurde besonders positiv von Patienten und Patientinnen wahrgenommen, die über einen ausreichend hohen Leidensdruck und eine mittlere oder hohe Akzeptanz der Erkrankung verfügten. Ebenso wiesen sie eine hohe Kontrollüberzeugung, zusammengesetzt aus einer ausreichend hohen Selbstwirksamkeit und einem ausreichenden Glauben an die Wirksamkeit der Behandlung, auf. Diese Patienten und Patientinnen waren ebenfalls durch äußere Faktoren, wie stabile Lebensumstände, ein Anfangsstadium der Erkrankung und noch unzureichende Kenntnisse im Umgang mit der Erkrankung gekennzeichnet. Auch wenn es nicht allen Ambulanz-Patienten und -Patientinnen gelang, ein besseres Symptommanagement zu erzielen, so konnte oft ein erweiterter Nutzen durch eine verbesserte psychische Krankheitsbewältigung aus den Ambulanz-Besuchen gezogen werden. Den Ambulanz-Patienten und -Patientinnen wurden in Abhängigkeit der Wirkung der Ambulanz die vier Typen "Profiteur", "Profiteur im erweiterten Sinn", "Experte" und "Kaum-Profiteur" zugeordnet. Unter Zuhilfenahme dieser Typisierung und des Common-Sense-Modells ließen sich Unterschiede in der Wahrnehmung und Wirksamkeit auf zugrunde liegende Coping-Strategien zurückführen. Insbesondere jene Patienten und Patientinnen, die die Ambulanz besonders positiv bewerteten, wiesen zum Zeitpunkt der Ambulanz funktionale Coping-Strategien auf. Patienten und Patientinnen hingegen, deren Umgang mit der Atemnot sich nicht verbesserte, zeigten ungünstige subjektive Krankheitstheorien und daraus resultierende dysfunktionale Coping-Strategien. FAZIT: Am Beispiel der Atemnot-Ambulanz in München ließen sich o.g. persönliche und äußere Faktoren der Teilnehmenden ableiten, deren Vorhandensein zu funktionalen Coping-Strategien und einer positiven Wahrnehmung der Intervention führte. Bei künftigen Interventionen sollten dem Behandlungserfolg entgegenwirkende Krankheitstheorien möglichst frühzeitig identifiziert und zugunsten funktionaler Coping-Strategien modifiziert werden

Is time running out? The urgent need for appropriate global health curricula in Germany

Recently, representatives of politics, health officials and academia in Germany have advocated a greater role for Germany in matters concerning global health. However, health professionals in Germany are rarely taught about global health topics and accordingly real expertise in this field is lacking. To advance knowledge and competencies at German universities and adequately equip health professionals to achieve Germany’s political goals, global health curricula must be developed at medical schools and other institutions. Such ambitions raise questions about the required content and dimensions of global health curricula as the field is currently highly heterogeneous and ill defined. To systematically identify strengths and shortcomings of current curricula, we scrutinised the global health curriculum at our institution, Charité—Universitätsmedizin Berlin, using an analytical framework that integrates the various approaches of global health. Our analysis identified that four (technical, social justice, security and humanitarian) of five approaches are present in our core global health curriculum. Local and global aspects of the field are equally represented. We propose that the use of such a structured analytical framework can support the development of GH curricula for all health professionals—in Germany and elsewhere. But it can also help to evaluate existing curricula like ours at Charité. This framework has the potential to support the design of comprehensive GH trainings, serving German aspirations in politics and academia to promote health worldwide

Determinants of COVID-19 vaccine acceptance and access among people experiencing homelessness in Germany: A qualitative interview study

Introduction: People experiencing homelessness face lower life expectancy, higher prevalence of somatic and mental diseases and a more difficult access to healthcare compared to people in secure living. During the COVID-19 pandemic transmission rates were higher among people experiencing homelessness and preventive public health measures were not properly adapted to the specific needs of people experiencing homelessness. Thus, goal of our study was understanding the determinants of acceptability and access of the COVID-19 vaccine. Materials and methods: We conducted a qualitative interview study with twenty guideline interviews with adult people currently experiencing homelessness in Berlin, Germany (August 2021 - April 2022). Participants were approached in a purposive sampling strategy. The interviews were analyzed with qualitative content analysis according to Mayring. Results: Acceptance and attitude toward the COVID-19 vaccine is influenced by confidence in the vaccine as well as in the political and healthcare system, the individual COVID-19 risk perception and sense of collective responsibility. Overall, the acceptance of the vaccine was high among our participants. Facilities offering low threshold COVID-19 vaccines for people experiencing homelessness were perceived as helpful. Language barriers and the need for identity documents were major barriers to access the COVID 19 vaccine. Discussion: People experiencing homelessness are a marginalized and vulnerable group often underrepresented in the public and scientific discourse. During the COVID-19 pandemic, preventive public health measures, including the COVID-19 vaccine, failed to consider specific needs of people experiencing homelessness. Multidimensional strategy to enhance inclusive healthcare are needed to improve access and to reduce discrimination and stigmatization

Knowledge, experiences, and practices of women affected by female genital schistosomiasis in rural Madagascar:A qualitative study on disease perception, health impairment and social impact

BACKGROUND: Female genital schistosomiasis (FGS) is a neglected manifestation of urogenital schistosomiasis caused by S. haematobium. The disease presents with symptoms such as pelvic pain, vaginal discharge and bleeding and menstruation disorders, and might lead to infertility and pregnancy complications. The perspectives of women with FGS have not been studied systematically. The aim of the study was to understand knowledge, experiences, and practices of women with FGS. METHODS: We performed a qualitative study with seventy-six women diagnosed of having FGS, in the Ambanja district in Northwest Madagascar. Data collection was either through focus group discussion (N = 60) or in an individual semi-structured interview (N = 16). FGS was diagnosed by colposcopy. The data was analysed using Mayring´s qualitative content analysis. RESULTS: Knowledge on how the disease is acquired varied and ideas on prevention remained vague. Patients suffered from vaginal discharge and pelvic complaints. Some women expressed unbearable pain during sexual intercourse and compared their pain to an open wound being touched. FGS considerably impaired women´s daily activities and their quality of life. Infertility led to resignation and despair, conflicts with the partner and to social exclusion from the community. Women fearing to sexually transmit FGS refrained from partnership and sexual relations. Many women with FGS reported stigmatisation. A coping strategy was to share strain with other women having similar complaints. However, concealing FGS was a common behaviour which led to social isolation and delayed health care seeking. CONCLUSIONS: Our study underlines that FGS has an important impact on the sexual health of women and on their social life in the community. Our results highlight the importance of providing adequate health education and structural interventions, such as the supply of water and the provision of sanitation measures. Further, correct diagnosis and treatment of FGS in adolescent girls and women should be available in all S. haematobium-endemic areas. TRIAL REGISTRATION: The qualitative study was embedded in a randomised controlled trial (RCT) in which two doses of praziquantel were compared (https://clinicaltrials.gov/ct2/show/NCT04115072)

Infections in hematopoietic cell transplant recipients: Results from the Organ Transplant Infection Project, a multicenter, prospective, cohort study

Background. Infection is a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Our object was to better define the epidemiology and outcomes of infections after HCT. Methods. This was a prospective, multicenter cohort study of HCT recipients and conducted from 2006 to 2011. The study included 4 US transplant centers and 444 HCT recipients. Data were prospectively collected for up to 30 months after HCT using a standardized data collection tool. Results. The median age was 53 years, and median follow up was 413 (range, 5-980) days. The most common reason for HCT was hematologic malignancy (87%). The overall crude mortality was 52%. Death was due to underlying disease in 44% cases and infection in 21%. Bacteremia occurred in 231 (52%) cases and occurred early posttransplant (median day 48). Gram-negative bloodstream infections were less frequent than Gram-positive, but it was associated with higher mortality (45% vs 13%, P = .02). Clostridium difficile infection developed in 148 patients (33%) at a median of 27 days post-HCT. There were 53 invasive fungal infections (IFIs) among 48 patients (11%). The median time to IFI was 142 days. Of 155 patients with cytomegalovirus (CMV) infection, 4% had CMV organ involvement. Varicella zoster infection (VZV) occurred in 13 (4%) cases and was disseminated in 2. Infection with respiratory viruses was seen in 49 patients. Pneumocystis jirovecii pneumonia was rare (1%), and there were no documented cases of nocardiosis, toxoplasmosis, endemic mycoses, or mycobacterial infection. This study lacked standardized antifungal and antiviral prophylactic strategies. Conclusions. Infection remains a significant cause of morbidity and mortality after HCT. Bacteremias and C difficile infection are frequent, particularly in the early posttransplant period. The rate of IFI is approximately 10%. Organ involvement with CMV is infrequent, as are serious infections with VZV and herpes simplex virus, likely reflecting improved prevention strategies

Patient and provider experiences with virtual care during the COVID-19 pandemic: A mixed methods study

The COVID-19 pandemic prompted the rapid uptake of Virtual Care (VC). Positive patient outcomes with VC are previously reported but little is known about the experiences of patients and providers using VC during the pandemic. We aimed to describe patient and primary care provider experiences, satisfaction, perceptions, and attitudes to VC during the COVID-19 pandemic that might explain adoption of VC across the continuum of care and inform sustained uptake. We conducted a sequential explanatory mixed methods study using online surveys and virtual interviews with a convenience sample of primary care providers and patients in a Canadian province (July – December 2020). Eligible participants included patients and primary care providers using VC during the COVID-19 pandemic. Survey responses and interviews were analyzed using descriptive statistics and thematic analysis, respectively. Overall satisfaction was compared using the Mann-Whitney U test. Eighty-five patients and 94 primary care providers responded to the surveys. Patients reported higher overall satisfaction with VC than primary care providers (median [interquartile range]: 4.4 [4.0-4.7] and 3.7 [3.4-3.9] p \u3c 0.001). Ten patients and 11 primary care providers were interviewed. Both groups strongly appreciated VC’s increased access and convenience, identified the lack of compensation as a pre-pandemic barrier to providing VC, and reported willingness to continue VC post-COVID-19 pandemic. The COVID-19 pandemic provided an opportunity for patients and primary care providers to rapidly adopt VC with high satisfaction. Patients and primary care providers viewed VC positively due to its convenience and accessibility; both intend to continue using VC post-pandemic. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

The type IIn supernova 1994W: evidence for the explosive ejection of a circumstellar envelope

We present and analyse spectra of the Type IIn supernova 1994W obtained between 18 and 203 days after explosion. During the luminous phase (first 100 d) the line profiles are composed of three major components: (i) narrow P-Cygni lines with the absorption minima at -700 km/s; (ii) broad emission lines with BVZI ~4000 km/s; and (iii) broad, smooth wings, most apparent in H-alpha. These components are identified with an expanding circumstellar (CS) envelope, shocked cool gas in the forward post-shock region, and multiple Thomson scattering in the CS envelope, respectively. The absence of broad P-Cygni lines from the supernova is the result of the formation of an optically thick, cool, dense shell at the interface of the ejecta and the CS envelope. We model the supernova deceleration and Thomson scattering wings to recover the density, radial extent and Thomson optical depth of the CS envelope during the first month. We reproduce the light curve with a hydrodynamical model and find it to be powered by a combination of internal energy leakage after the explosion of an extended pre-supernova (~10^15 cm) and luminosity from circumstellar interaction. We recover the pre-explosion kinematics of the CS envelope: it is close to homologous expansion with outer velocity ~1100 km/s and a kinematic age of ~1.5 yr. The CS envelope's high mass and kinetic energy, combined with its small age, strongly suggest that the CS envelope was explosively ejected about 1.5 yr before the supernova explosion.Comment: 22 pages, 21 figures. Accepted for publication in Monthly Notices of the Royal Astronomical Societ

Associations of Low Vitamin D and Elevated Parathyroid Hormone Concentrations With Bone Mineral Density in Perinatally HIV-Infected Children

BACKGROUND: Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual. METHODS: PHIV and PHEU children in the Pediatric HIV/AIDS Cohort Study had total body (TB) and lumbar spine (LS) BMD and bone mineral content (BMC) measured by dual-energy x-ray absorptiometry; BMD z-scores (BMDz) were calculated for age and sex. Low 25(OH)D was defined as ≤20 ng/mL and high PTH as >65 pg/mL. We fit linear regression models to estimate the average adjusted differences in BMD/BMC by 25(OH)D and PTH status and log binomial models to determine adjusted prevalence ratios of low 25(OH)D and high PTH in PHIV relative to PHEU children. RESULTS: PHIV children (n = 412) were older (13.0 vs. 10.8 years) and more often black (76% vs. 64%) than PHEU (n = 207). Among PHIV, children with low 25(OH)D had lower TB-BMDz [SD, -0.38; 95% confidence interval (CI), -0.60 to -0.16] and TB-BMC (SD, -59.1 g; 95% CI, -108.3 to -9.8); high PTH accompanied by low 25(OH)D was associated with lower TB-BMDz. Among PHEU, children with low 25(OH)D had lower TB-BMDz (SD, -0.34; 95% CI, -0.64 to -0.03). Prevalence of low 25(OH)D was similar by HIV status (adjusted prevalence ratio, 1.00; 95% CI, 0.81 to 1.24). High PTH was 3.17 (95% CI, 1.25 to 8.06) times more likely in PHIV children. CONCLUSIONS: PHIV and PHEU children with low 25(OH)D may have lower BMD. Vitamin D supplementation trials during critical periods of bone accrual are needed

Prevalence and risk factors for long COVID and post-COVID-19 condition in Africa: a systematic review

Summary Background An improved estimation of the clinical sequelae of SARS-CoV-2 infection is crucial in African countries, where the subject has received little attention despite more than 12 million reported cases and evidence that many more people were infected. We reviewed the evidence on prevalence, associated risk factors for long COVID, and systemic or sociocultural determinants of reporting long COVID. Methods We conducted a systematic review, searching PubMed, the Living OVerview of Evidence platform, and grey literature sources for publications from Dec 1, 2019, to Nov 23, 2022. We included articles published in English, French, Spanish, or Portuguese that reported on any study type in Africa with participants of any age who had symptoms for 4 weeks or more after an acute SARS-CoV-2 infection. We excluded secondary research, comments, and correspondence. Screening and data extraction were performed by two reviewers. Summary estimates were extracted, including sociodemographic factors, medical history, prevalence of persistent symptoms, and symptoms and associated factors. Results were analysed descriptively. The study was registered on the Open Science Framework platform. Findings Our search yielded 294 articles, of which 24 peer-reviewed manuscripts were included, reporting on 9712 patients from eight African countries. Only one study exclusively recruited children, and one other study included children as part of their study population. Studies indicated moderate to low risk of bias. Prevalence of long COVID varied widely, from 2% in Ghana to 86% in Egypt. Long COVID was positively associated with female sex, older age, non-Black ethnicity, low level of education, and the severity of acute infection and underlying comorbidity. HIV and tuberculosis were not identified as risk factors. Factors influencing reporting included absence of awareness, inadequate clinical data and diagnostics, and little access to health-care services. Interpretation In Africa, research on long COVID is scarce, particularly among children, who represent the majority of the population. However, existing studies show a substantial prevalence across settings, emphasising the importance of vaccination and other prevention strategies to avert the effects of long COVID on individual wellbeing, the increased strain on health systems, and the potential negative effects on economically vulnerable populations. At a global level, including African countries, tools for research on long COVID need to be harmonised to maximise the usefulness of the data collected. Funding NonePeer Reviewe