Tag: After

Fides News – EnglishAFRICA/SOUTH SUDAN – One year after the disappearance, there is no news of Father Lukas and his companion​

Juba – “One year has passed, and their silence haunts us. The disappearance of Fr. Luke and Michael is not just a personal loss – it is a wound to the heart of our society,” said the Bishop of Tambura-Yambio, Hiiboro Kussala, in a statement on the disappearance of Father Luke Yugue and his driver, Michael Gbeko, who have been missing since April 27, 2024, while traveling from Nagero County to Tambura County, in the State of West Equatoria . Since then, there has been no news of the two men. Although a funeral prayer was held for the priest and his companion a month after their disappearance , the question of their fate remains unknown.
In his statement, issued last week, Bishop Hiiboro reiterated his request for further efforts to find the missing. The Bishop of Tambura-Yambio called on the government of South Sudan, the security forces, and international organizations to intensify investigations and establish responsibility. Although no public commemoration was held this year due to the period of mourning following the death of Pope Francis, Bishop Hiiboro urged the faithful to pray for the two missing people.
Father Luke and his companion were likely victims of the intercommunal violence that continues to ravage the State of Western Equatoria . This violence, unfortunately, continues to be accompanied by massacres and kidnappings that affect the population of the region.
Juba – “One year has passed, and their silence haunts us. The disappearance of Fr. Luke and Michael is not just a personal loss – it is a wound to the heart of our society,” said the Bishop of Tambura-Yambio, Hiiboro Kussala, in a statement on the disappearance of Father Luke Yugue and his driver, Michael Gbeko, who have been missing since April 27, 2024, while traveling from Nagero County to Tambura County, in the State of West Equatoria . Since then, there has been no news of the two men. Although a funeral prayer was held for the priest and his companion a month after their disappearance , the question of their fate remains unknown. In his statement, issued last week, Bishop Hiiboro reiterated his request for further efforts to find the missing. The Bishop of Tambura-Yambio called on the government of South Sudan, the security forces, and international organizations to intensify investigations and establish responsibility. Although no public commemoration was held this year due to the period of mourning following the death of Pope Francis, Bishop Hiiboro urged the faithful to pray for the two missing people. Father Luke and his companion were likely victims of the intercommunal violence that continues to ravage the State of Western Equatoria . This violence, unfortunately, continues to be accompanied by massacres and kidnappings that affect the population of the region. 

The effect of deforestation on COVID-19 transmission to Indigenous peoples in Brazil: A panel fixed-effects analysis before and after vaccination – ​Humberto Laudares

by Humberto Laudares, Carolina Batista, Pedro Henrique Gagliardi, Rudi Rocha, Nicolas Ray

Brazil had the second-largest death toll during the COVID-19 pandemic, with indigenous peoples disproportionately affected among ethnic groups. Parallel to the pandemic, Brazil has recorded the highest rate of deforestation globally, with encroachments into Indigenous territories putting climate stabilization and biodiversity at risk. However, the effects of deforestation on COVID-19 transmission to Brazil’s Indigenous peoples are unknown. This study shows that during the pre-vaccination period, deforestation partially explains COVID-19 transmission among Indigenous populations. Our main results for the pre-vaccination period indicate that a daily increase in deforestation per km2 is associated, on average, with the confirmation of 0.76 (p 

A deep-learning algorithm using real-time collected intraoperative vital sign signals for predicting acute kidney injury after major non-cardiac surgeries: A modelling study – ​Sehoon Park

by Sehoon Park, Soomin Chung, Yisak Kim, Sun-Ah Yang, Soie Kwon, Jeong Min Cho, Min Jae Lee, Eunbyeol Cho, Jiwon Ryu, Sejoong Kim, Jeonghwan Lee, Hyung Jin Yoon, Edward Choi, Kwangsoo Kim, Hajeong Lee

Background

Postoperative acute kidney injury (PO-AKI) prediction models for non-cardiac major surgeries typically rely solely on preoperative clinical characteristics.

Methods and findings

In this study, we developed and externally validated a deep-learning-based model that integrates preoperative data with minute-scale intraoperative vital signs to predict PO-AKI. Using data from three hospitals, we constructed a convolutional neural network-based EfficientNet framework to analyze intraoperative data and created an ensemble model incorporating 103 baseline variables of demographics, medication use, comorbidities, and surgery-related characteristics. Model performance was compared with the conventional SPARK model from a previous study. Among 110,696 patients, 51,345 were included in the development cohort, and 59,351 in the external validation cohorts. The median age of the cohorts was 60, 61, and 66 years, respectively, with males comprising 54.9%, 50.8%, and 42.7% of each cohort. The intraoperative vital sign-based model demonstrated comparable predictive power (AUROC (Area Under the Receiver Operating Characteristic Curve): discovery cohort 0.707, validation cohort 0.637 and 0.607) to preoperative-only models (AUROC: discovery cohort 0.724, validation cohort 0.697 and 0.745). Adding 11 key clinical variables (e.g., age, sex, estimated glomerular filtration rate (eGFR), albuminuria, hyponatremia, hypoalbuminemia, anemia, diabetes, renin-angiotensin-aldosterone inhibitors, emergency surgery, and the estimated surgery time) improved the model’s performance (AUROC: discovery cohort 0.765, validation cohort 0.716 and 0.761). The ensembled deep-learning model integrating both preoperative and intraoperative data achieved the highest predictive accuracy (AUROC: discovery cohort 0.795, validation cohort 0.762 and 0.786), outperforming the conventional SPARK model. The retrospective design in a single-nation cohort with non-inclusion of some potential AKI-associated variables is the main limitation of this study.

Conclusions

This deep-learning-based PO-AKI risk prediction model provides a comprehensive approach to evaluating PO-AKI risk prediction by combining preoperative clinical data with real-time intraoperative vital sign information, offering enhanced predictive performance for better clinical decision-making.

Fides News – EnglishASIA/INDIA – Tension between India and Pakistan after attack in Kashmir: a Catholic among the victims​

Srinagar – The Parliament of the Indian state of Jammu and Kashmir passed a resolution today, April 28, expressing its dismay at the terrorist attack on April 22 in Pahalgam , which killed 26 people, mostly Indian tourists. The resolution pledges to resolutely combat “plans to disrupt harmony between communities and hinder progress.” Meanwhile, tensions remain high on the border between India and Pakistan following the attack by Pakistan-based terrorist groups, which India has described as an “act of war.” Violations of the ceasefire were reported for the fourth consecutive day along the Line of Control , the temporary border dividing Indian-controlled and Pakistani-controlled areas of Kashmir.
Meanwhile, the Indian government has banned 16 Pakistani YouTube channels for spreading provocative content and disinformation against India.
On the Pakistani side, the government in Islamabad banned Indian airlines from using its airspace due to escalating tensions between the two countries. Pakistani Prime Minister Shehbaz Sharif emphasized that Pakistan “seeks peace in the region”: “Pakistan condemns all forms of terrorism and has nothing to do with the recent terrorist attack in Pahalgam in the Indian-controlled region of Kashmir,” he said. He reiterated that Pakistan was ready to “cooperate in a transparent and impartial investigation into the terrorist attack.” He recalled that the Pakistani people themselves had been victims of terrorism over the past two decades, with thousands of their citizens losing their lives. Commenting on India’s decision to suspend cooperation with Pakistan under the Indus Water Treaty, he said, “Using water as a weapon is unacceptable.”
There is only one Catholic diocese in the Indian state of Kashmir, which covers the entire territory. The Bishop of Jammu-Srinagar, Ivan Pereira, expressed his deep shock and condemned the “horrific terrorist attack against innocent tourists.” “This senseless act of violence,” said Bishop Pereira, ‘casts a dark shadow on our collective conscience’ and constitutes ‘an attack on the sanctity of human life and a betrayal of the values we hold dear as a nation: peace, harmony, and the dignity of every human being.’ He assured that he would pray unceasingly for peace.
Meanwhile, in central India, the Catholic community of the Diocese of Indore paid their respects and celebrated the funeral of Sushil Nathaniel, a 57-year-old Catholic who was one of the tourists killed in Kashmir. Nathaniel, regional director of an insurance company, was on vacation in Kashmir with his wife and two children, who managed to escape. According to his wife Jennifer, the terrorists stopped Nathaniel and asked him what his faith was. Nathaniel admitted he was Catholic. They then asked him to kneel and recite the “Kalima” , and Nathaniel confessed he did not know them. So they shot him in the head in cold blood. The Bishop of Indore, Monsignor Thomas Kuttimackal, celebrating the funeral, praised Nathaniel’s “courage in not hiding his faith even under threat of arms,” calling him “a martyr.”Srinagar – The Parliament of the Indian state of Jammu and Kashmir passed a resolution today, April 28, expressing its dismay at the terrorist attack on April 22 in Pahalgam , which killed 26 people, mostly Indian tourists. The resolution pledges to resolutely combat “plans to disrupt harmony between communities and hinder progress.” Meanwhile, tensions remain high on the border between India and Pakistan following the attack by Pakistan-based terrorist groups, which India has described as an “act of war.” Violations of the ceasefire were reported for the fourth consecutive day along the Line of Control , the temporary border dividing Indian-controlled and Pakistani-controlled areas of Kashmir.Meanwhile, the Indian government has banned 16 Pakistani YouTube channels for spreading provocative content and disinformation against India.On the Pakistani side, the government in Islamabad banned Indian airlines from using its airspace due to escalating tensions between the two countries. Pakistani Prime Minister Shehbaz Sharif emphasized that Pakistan “seeks peace in the region”: “Pakistan condemns all forms of terrorism and has nothing to do with the recent terrorist attack in Pahalgam in the Indian-controlled region of Kashmir,” he said. He reiterated that Pakistan was ready to “cooperate in a transparent and impartial investigation into the terrorist attack.” He recalled that the Pakistani people themselves had been victims of terrorism over the past two decades, with thousands of their citizens losing their lives. Commenting on India’s decision to suspend cooperation with Pakistan under the Indus Water Treaty, he said, “Using water as a weapon is unacceptable.”There is only one Catholic diocese in the Indian state of Kashmir, which covers the entire territory. The Bishop of Jammu-Srinagar, Ivan Pereira, expressed his deep shock and condemned the “horrific terrorist attack against innocent tourists.” “This senseless act of violence,” said Bishop Pereira, ‘casts a dark shadow on our collective conscience’ and constitutes ‘an attack on the sanctity of human life and a betrayal of the values we hold dear as a nation: peace, harmony, and the dignity of every human being.’ He assured that he would pray unceasingly for peace.Meanwhile, in central India, the Catholic community of the Diocese of Indore paid their respects and celebrated the funeral of Sushil Nathaniel, a 57-year-old Catholic who was one of the tourists killed in Kashmir. Nathaniel, regional director of an insurance company, was on vacation in Kashmir with his wife and two children, who managed to escape. According to his wife Jennifer, the terrorists stopped Nathaniel and asked him what his faith was. Nathaniel admitted he was Catholic. They then asked him to kneel and recite the “Kalima” , and Nathaniel confessed he did not know them. So they shot him in the head in cold blood. The Bishop of Indore, Monsignor Thomas Kuttimackal, celebrating the funeral, praised Nathaniel’s “courage in not hiding his faith even under threat of arms,” calling him “a martyr.” 

Recurrence prediction using circulating tumor DNA in patients with early-stage non-small cell lung cancer after treatment with curative intent: A retrospective validation study – ​Milou M. F. Schuurbiers

by Milou M. F. Schuurbiers, Christopher G. Smith, Koen J. Hartemink, Robert C. Rintoul, Davina Gale, Kim Monkhorst, Bas L. R. Mandos, Anna L. Paterson, Dan van den Broek, Nitzan Rosenfeld, Michel M. van den Heuvel, on behalf of the LEMA Study Group and the LUCID Study Group

Background

Despite treatment with curative intent, many patients with localized non-small cell lung cancer (NSCLC) develop recurrence. The current challenge is to identify high-risk patients to guide adjuvant treatment. Identification of residual disease by detection of circulating tumor DNA (ctDNA) may allow more accurate clinical decision-making, but its reliability in NSCLC is not established. We aimed to build on previous data to validate a tissue-informed personalized ctDNA assay, to predict recurrence in patients with early-stage disease.

Methods and findings

Tumor tissue and plasma was collected from patients with stage 0–III NSCLC enrolled to LEMA (Lung cancer Early Molecular Assessment trial, NCT02894853). Serial plasma was collected before and after definitive treatment, with the latter including key timeframes of interest (1–3 days post-treatment, between 14 and 122 days after treatment end, and ≥14 days after treatment end). Somatic mutations identified by tumor exome sequencing were used to design patient-specific assays, to analyze ctDNA. Results were compared and combined with an independent dataset (LUCID; LUng Cancer CIrculating Tumour Dna study, NCT04153526). In LEMA, 130 patients (57% male; median age 66 years (range 44–82); 69% adenocarcinoma, 22% squamous cell carcinoma (SCC); 3%/49%/19%/29% with stage 0/I/II/III) were treated with curative intent. Tumor tissue originated from surgical resection or diagnostic biopsy in 118 and 12 patients respectively. LUCID included 88 patients (51% male; median age 72 years (range 44–88); 63% adenocarcinoma, 31% SCC; 49%/28%/23% with stage I/II/III). Before treatment, ctDNA was detected in 48% LEMA and 51% LUCID patients. Sensitivity, specificity, positive and negative predictive value of ctDNA detection post-treatment (≥1 positive sample ≥14 days after treatment end) to predict recurrence were 61%, 97%, 92% and 84% for LEMA and 64%, 96%, 90% and 83% for LUCID. In the combined cohort, ctDNA detection after treatment was associated with shorter recurrence-free survival (hazard ratio (HR) 11.4 (95% confidence interval (CI) [7.0,18.7]; p p  Conclusions

ctDNA detection predicted recurrence in independent retrospective cohorts with notable reproducibility, including near-identical detection rates and predictive values, confirming its ability to differentiate patients at high- versus low risk of recurrence. Our results support the potential of tissue-informed ctDNA analysis as a decision-support tool for adjuvant therapy in NSCLC.

Understanding Women’s Pregnancy Intentions, Decision-Making, and Factors Influencing Reproductive Choices After Genital Fistula Repair in Uganda: A Qualitative Study – ​Mekaleya Tilahun

by Mekaleya Tilahun, Hadija Nalubwama, Monica Getahun, Justus K. Barageine, Alison M. El Ayadi

Female genital fistula is a debilitating injury that may affect as many as two million women globally. While studies have examined women’s fertility intentions in Uganda and sub-Saharan Africa broadly, few have explored the factors influencing pregnancy decision-making among women who have undergone fistula repair. We conducted in-depth interviews with 40 women who had undergone fistula repair. Interviews were audio-recorded, transcribed into English, and coded using a group-developed collaborative coding framework. Oriented by the socio-ecological framework, we reviewed factors contributing to pregnancy desire and decision-making for women who became pregnant and those who did not following fistula repair. Factors influencing pregnancy desire included partner support, financial circumstances, number of children, and health knowledge and perspectives. Women’s own beliefs about their ability to become pregnant and their fears around surgeries and fistula recurrence also influenced pregnancy desire. Participants desiring pregnancy but experiencing infertility expressed various mental health impacts including feelings of hurt, isolation, and yearning, and described infertility stigma. Finally, societal expectations of women to assume childbearing and prioritize home responsibilities influenced participants’ decisions to pursue pregnancy. However, discordance between partners or infertility resulted in various consequences, such as women becoming pregnant to fulfill their partner’s needs, lying to their partner about their pregnancy status, or dissolution of the relationship. A nuanced understanding of pregnancy intentions and decision-making following fistula repair can help inform patient-centered post-repair pregnancy counseling to support the unique needs of women.

Fides News – EnglishASIA/MYANMAR – Four years after the coup: prayer and charity in the face of violence, hunger and displacement​

Yangon – “Catholics hope that the state of emergency will not be extended and pray for justice and peace,” Joseph Kung, a Catholic from Yangon who works in the National Human Rights Commission, told Fides. In the country, February 1 marks the fourth anniversary of the coup in which the military junta overthrew the democratic government and dissolved parliament. According to observers, General Min Aung Hlaing, the head of the junta, is about to extend the state of emergency, while reiterating his intention to hold elections by 2025.
The civil war, which has left more than 50,000 dead and 3.5 million internally displaced, has led to a food emergency and the situation will worsen in 2025, according to estimates by the United Nations World Food Programme, while more than 15 million people will suffer from hunger and 20 million inhabitants will need humanitarian aid for food and disease.
The number of displaced people will also rise to 4.5 million. The civilian population is also threatened by landmines, which, according to the ‘Landmine Monitor 2024’, are causing victims in all 14 states and regions of Myanmar and in about 60 percent of cities . As observers tell Fides, the army is placing landmines in villages,
farms, rice and corn fields and near military camps. When farmers go to the fields to harvest food, they risk their lives. Catholic communities and religious orders, meanwhile, report on the plight of children: on the one hand, there is a growing phenomenon of child labor, where children are employed in sectors such as clothing, agriculture, catering, domestic work, construction and street vending, which is a blatant violation of children’s rights. On the other hand, the closure of schools and educational institutions denies children and young people the fundamental right to education, with serious implications for the future of the nation. Many religious orders and Catholic parishes are therefore setting up small informal schools where they try to provide children with an education. Father Terence Anthony, parish priest of the parish of Our Lady of Lourdes in the southern part of the Archdiocese of Yangon, told Fides: “We entrust ourselves to the Lord in prayer and do our best with concrete actions. In many areas of the country, where there is fighting or where there is no violence, priests, religious and catechists dedicate themselves tirelessly to the service of wounded and tried humanity. We comfort the afflicted and give bread to the hungry. We place ourselves at the service of the poor, the displaced and the weakest, trying to give a concrete witness of the love of God.”

Yangon – “Catholics hope that the state of emergency will not be extended and pray for justice and peace,” Joseph Kung, a Catholic from Yangon who works in the National Human Rights Commission, told Fides. In the country, February 1 marks the fourth anniversary of the coup in which the military junta overthrew the democratic government and dissolved parliament. According to observers, General Min Aung Hlaing, the head of the junta, is about to extend the state of emergency, while reiterating his intention to hold elections by 2025. The civil war, which has left more than 50,000 dead and 3.5 million internally displaced, has led to a food emergency and the situation will worsen in 2025, according to estimates by the United Nations World Food Programme, while more than 15 million people will suffer from hunger and 20 million inhabitants will need humanitarian aid for food and disease. The number of displaced people will also rise to 4.5 million. The civilian population is also threatened by landmines, which, according to the ‘Landmine Monitor 2024’, are causing victims in all 14 states and regions of Myanmar and in about 60 percent of cities . As observers tell Fides, the army is placing landmines in villages, farms, rice and corn fields and near military camps. When farmers go to the fields to harvest food, they risk their lives. Catholic communities and religious orders, meanwhile, report on the plight of children: on the one hand, there is a growing phenomenon of child labor, where children are employed in sectors such as clothing, agriculture, catering, domestic work, construction and street vending, which is a blatant violation of children’s rights. On the other hand, the closure of schools and educational institutions denies children and young people the fundamental right to education, with serious implications for the future of the nation. Many religious orders and Catholic parishes are therefore setting up small informal schools where they try to provide children with an education. Father Terence Anthony, parish priest of the parish of Our Lady of Lourdes in the southern part of the Archdiocese of Yangon, told Fides: “We entrust ourselves to the Lord in prayer and do our best with concrete actions. In many areas of the country, where there is fighting or where there is no violence, priests, religious and catechists dedicate themselves tirelessly to the service of wounded and tried humanity. We comfort the afflicted and give bread to the hungry. We place ourselves at the service of the poor, the displaced and the weakest, trying to give a concrete witness of the love of God.” 

Child mortality in England after national lockdowns for COVID-19: An analysis of childhood deaths, 2019–2023 – ​David Odd

by David Odd, Sylvia Stoianova, Tom Williams, Peter Fleming, Karen Luyt

Background

During the COVID-19 pandemic children and young people (CYP) mortality in England reduced to the lowest on record, but it is unclear if the mechanisms which facilitated a reduction in mortality had a longer lasting impact, and what impact the pandemic, and its social restrictions, have had on deaths with longer latencies (e.g., malignancies). The aim of this analysis was to quantify the relative rate, and causes, of childhood deaths in England, before, during, and after national lockdowns for COVID-19 and its social changes.

Methods and findings

Deaths of all children (occurring before their 18th birthday) occurring from April 2019 until March 2023 in England were identified. Data were collated by the National Child Mortality Database. Study population size and the underlying population profile was derived from 2021 Office of National Statistics census data Mortality for each analysis year was calculated per 1,000,000 person years. Poisson regression was used to test for an overall trend across the time period and tested if trends differed between April 2019 to March 2021 (Period 1)) and April 2021 to March 2023 (Period 2: after lockdown restrictions). This was then repeated for each category of death and demographic group. Twelve thousand eight hundred twenty-eight deaths were included in the analysis. Around 59.4% of deaths occurred under 1 year of age, 57.0% were male, and 63.9% were of white ethnicity. Mortality rate (per 1,000,000 CYP per year) dropped from 274.2 (95% CI 264.8–283.8) in 2019−2020, to 242.2 (95% CI 233.4–251.2) in 2020−2021, increasing to 296.1 (95% CI 286.3–306.1) in 2022−2023. Overall, death rate reduced across Period 1 (Incidence rate ratio (IRR) 0.96 (95% CI 0.92–0.99)) and then increased across Period 2 (IRR 1.12 (95% CI 1.08–1.16)), and this pattern was also seen for death by Infection and Underlying Disease. In contrast, rate of death after Intrapartum events increased across the first period, followed by a decrease in rate in the second (Period 1 IRR 1.15 (95% CI 1.00–1.34)) versus Period 2 (IRR 0.78 (95% CI 0.68–0.91), pdifference = 0.004). Rates of death from preterm birth, trauma and sudden unexpected deaths in infancy and childhood (SUDIC), increased across the entire 4-year-study period (preterm birth, IRR 1.03 (95% CI 1.00–1.07); trauma IRR 1.12 (95% CI 1.06–1.20); SUDIC IRR 1.09 (95% CI 1.04–1.13)), and there was no change in the rate of death from Malignancy (IRR 1.01 (95% CI 0.95–1.06)). Repeating the analysis, split by child characteristics, suggested that mortality initially dropped and subsequently rose for children between 1 and 4 years old (Period 1 RR 0.85 (95% CI 0.76–0.94) versus Period 2 IRR 1.31 (95% CI 1.19–1.43), pdifference pdifference pdifference = 0.012); Other (Period 1 IRR 0.84 (95% CI 0.68–1.04) versus Period 2 IRR 1.45 (95% CI 1.20–1.75), pdifference = 0.003). Similar results were observed in CYP in the most deprived areas (Period 1 IRR 0.95 (95% CI 0.89–1.01) versus Period 2 IRR 1.18 (95% CI 1.12–1.25), pdifference p = 0.601) or mixed (p = 0.823) ethnic backgrounds, or those in the least deprived areas (p = 0.832), between Periods 1 and 2; with evidence of a rise across the whole study period for children from white backgrounds (IRR 1.05 (95% CI 1.03–1.07), p p  Conclusions

In this study, overall child mortality in England after the national lockdowns was higher than before them. We observed different temporal profiles across the different causes of death, with reassuring trends in deaths from Intrapartum deaths after lockdowns were lifted. However, for all other causes of death, rates are either static, or increasing. In addition, the relative rate of dying for children from non-white backgrounds, compared to white children, is now higher than before or during the lockdowns.

Persistent symptoms and clinical findings in adults with post-acute sequelae of COVID-19/post-COVID-19 syndrome in the second year after acute infection: A population-based, nested case-control study – ​Raphael S. Peter

by Raphael S. Peter, Alexandra Nieters, Siri Göpel, Uta Merle, Jürgen M. Steinacker, Peter Deibert, Birgit Friedmann-Bette, Andreas Nieß, Barbara Müller, Claudia Schilling, Gunnar Erz, Roland Giesen, Veronika Götz, Karsten Keller, Philipp Maier, Lynn Matits, Sylvia Parthé, Martin Rehm, Jana Schellenberg, Ulrike Schempf, Mengyu Zhu, Hans-Georg Kräusslich, Dietrich Rothenbacher, Winfried V. Kern, on behalf of the EPILOC Phase 2 Study Group

Background

Self-reported health problems following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are common and often include relatively non-specific complaints such as fatigue, exertional dyspnoea, concentration or memory disturbance and sleep problems. The long-term prognosis of such post-acute sequelae of COVID-19/post-COVID-19 syndrome (PCS) is unknown, and data finding and correlating organ dysfunction and pathology with self-reported symptoms in patients with non-recovery from PCS is scarce. We wanted to describe clinical characteristics and diagnostic findings among patients with PCS persisting for >1 year and assessed risk factors for PCS persistence versus improvement.

Methods and findings

This nested population-based case-control study included subjects with PCS aged 18–65 years with (n = 982) and age- and sex-matched control subjects without PCS (n = 576) according to an earlier population-based questionnaire study (6–12 months after acute infection, phase 1) consenting to provide follow-up information and to undergo comprehensive outpatient assessment, including neurocognitive, cardiopulmonary exercise, and laboratory testing in four university health centres in southwestern Germany (phase 2, another 8.5 months [median, range 3–14 months] after phase 1). The mean age of the participants was 48 years, and 65% were female. At phase 2, 67.6% of the patients with PCS at phase 1 developed persistent PCS, whereas 78.5% of the recovered participants remained free of health problems related to PCS. Improvement among patients with earlier PCS was associated with mild acute index infection, previous full-time employment, educational status, and no specialist consultation and not attending a rehabilitation programme. The development of new symptoms related to PCS among participants initially recovered was associated with an intercurrent secondary SARS-CoV-2 infection and educational status. Patients with persistent PCS were less frequently never smokers (61.2% versus 75.7%), more often obese (30.2% versus 12.4%) with higher mean values for body mass index (BMI) and body fat, and had lower educational status (university entrance qualification 38.7% versus 61.5%) than participants with continued recovery. Fatigue/exhaustion, neurocognitive disturbance, chest symptoms/breathlessness and anxiety/depression/sleep problems remained the predominant symptom clusters. Exercise intolerance with post-exertional malaise (PEM) for >14 h and symptoms compatible with myalgic encephalomyelitis/chronic fatigue syndrome were reported by 35.6% and 11.6% of participants with persistent PCS patients, respectively. In analyses adjusted for sex-age class combinations, study centre and university entrance qualification, significant differences between participants with persistent PCS versus those with continued recovery were observed for performance in three different neurocognitive tests, scores for perceived stress, subjective cognitive disturbances, dysautonomia, depression and anxiety, sleep quality, fatigue and quality of life. In persistent PCS, handgrip strength (40.2 [95% confidence interval (CI) [39.4, 41.1]] versus 42.5 [95% CI [41.5, 43.6]] kg), maximal oxygen consumption (27.9 [95% CI [27.3, 28.4]] versus 31.0 [95% CI [30.3, 31.6]] ml/min/kg body weight) and ventilatory efficiency (minute ventilation/carbon dioxide production slope, 28.8 [95% CI [28.3, 29.2]] versus 27.1 [95% CI [26.6, 27.7]]) were significantly reduced relative to the control group of participants with continued recovery after adjustment for sex-age class combinations, study centre, education, BMI, smoking status and use of beta blocking agents. There were no differences in measures of systolic and diastolic cardiac function at rest, in the level of N-terminal brain natriuretic peptide blood levels or other laboratory measurements (including complement activity, markers of Epstein–Barr virus [EBV] reactivation, inflammatory and coagulation markers, serum levels of cortisol, adrenocorticotropic hormone and dehydroepiandrosterone sulfate). Screening for viral persistence (PCR in stool samples and SARS-CoV-2 spike antigen levels in plasma) in a subgroup of the patients with persistent PCS was negative. Sensitivity analyses (pre-existing illness/comorbidity, obesity, medical care of the index acute infection) revealed similar findings. Patients with persistent PCS and PEM reported more pain symptoms and had worse results in almost all tests. A limitation was that we had no objective information on exercise capacity and cognition before acute infection. In addition, we did not include patients unable to attend the outpatient clinic for whatever reason including severe illness, immobility or social deprivation or exclusion.

Conclusions

In this study, we observed that the majority of working age patients with PCS did not recover in the second year of their illness. Patterns of reported symptoms remained essentially similar, non-specific and dominated by fatigue, exercise intolerance and cognitive complaints. Despite objective signs of cognitive deficits and reduced exercise capacity, there was no major pathology in laboratory investigations, and our findings do not support viral persistence, EBV reactivation, adrenal insufficiency or increased complement turnover as pathophysiologically relevant for persistent PCS. A history of PEM was associated with more severe symptoms and more objective signs of disease and might help stratify cases for disease severity.

Respiratory symptoms after coalmine fire and pandemic: A longitudinal analysis of the Hazelwood Health Study adult cohort – ​Tyler J. Lane

by Tyler J. Lane, Matthew Carroll, Brigitte M. Borg, Tracy A. McCaffrey, Catherine L. Smith, Caroline X. Gao, David Brown, Amanda Johnson, David Poland, Shantelle Allgood, Jillian Ikin, Michael J. Abramson

The aim of this study was to determine whether the effects of extreme but discrete PM2.5 exposure from a coal mine fire on respiratory symptoms abated, persisted, or worsened over time, and whether they were exacerbated by COVID-19. We analysed longitudinal survey data from a cohort residing near a 2014 coalmine fire in regional Australia. A 2016/2017 survey included 4,056 participants, of whom 612 were followed-up in 2022. Items included respiratory symptoms, history of COVID-19, and time-location diaries from the mine fire period, which were combined with geospatial and temporal models of fire-related PM2.5. Longitudinal effects of fire-related PM2.5 were examined using a mixed-effects logistic regression model. Exacerbation due to COVID-19 was examined using a logistic regression model. PM2.5 exposure was associated with chronic cough and possibly current wheeze, chest tightness, and current nasal symptoms 2–3 years post-fire, and chronic cough and current wheeze 8.5–9 years post-fire. Further, the association between PM2.5 and chronic cough and possibly current wheeze appeared to increase between the survey periods. While there were no detectable interactions between PM2.5 and COVID-19, PM2.5 exposure was associated with additional respiratory symptoms among participants who reported a history of COVID-19. In summary, medium-duration exposure to extreme levels of fire-related PM2.5 may have increased the long-term risk of chronic cough and current wheeze. While the COVID-19 pandemic started several years after the mine fire, contracting this illness may have exacerbated the effect of fire-related PM2.5 through development of additional respiratory symptoms.

Fides News – EnglishAFRICA/SOUTH SUDAN – Tensions between Juba and Khartoum after the massacres of South Sudanese in Wad Madani​

Juba – Yesterday, January 16, riots broke out in Juba, the capital of South Sudan, where demonstrators took to the streets to protest against the massacre of South Sudanese in neighboring Sudan.
Some criminals took advantage of the chaos to loot shops belonging to Sudanese citizens and attack the Sudanese embassy, where a diplomat was killed. The police fired into the air to disperse the crowd. The news of the massacre of civilians, including South Sudanese citizens, after the capture of Wad Madani by the Sudanese Armed Forces has caused unrest. Wad Madani, the capital of Jazira State , was recaptured by the SAF on 11 January from Rapid Support Forces paramilitaries who had taken it in December 2023. South Sudanese anger has been fuelled by videos circulating on the internet showing atrocities committed by SAF soldiers against South Sudanese and Sudanese from Western Sudan. The South Sudanese Ministry of Foreign Affairs had summoned the Sudanese ambassador to protest the “loss of lives of innocent citizens”. The government in Khartoum has stated that it has set up a commission of inquiry into the massacres committed in Wad Madani. According to the Sudanese ambassador in Juba, the human rights violations were not committed by regular soldiers, but by a militia affiliated with the army. A SAF spokesman admits that there have been “violations committed by some individuals.” At the time of its capture by the SAF in December 2023, Wad Madani, located south of the capital Khartoum, was considered a relatively safe area, so thousands of people fleeing fighting in other parts of Sudan had found refuge there, and had thus been trapped in the city for more than a year. Its recapture by the SAF marked a major step in the Sudanese conflict, marked by persistent human rights violations by all factions on the ground. The US government has imposed sanctions on both the head of the RSF, Mohammad Hamdan Dagalo Mousa, and the commander of the SAF, General Abdel Fattah Al-Burhan, for crimes committed against civilians. Ahmad Abdalla, a Sudanese-Ukrainian citizen and official of the Defence Industries System , and of Portex Trade Limited, a Hong Kong-based company controlled by Abdalla, has also been sanctioned for violating the UN arms embargo on Sudanese factions.
Juba – Yesterday, January 16, riots broke out in Juba, the capital of South Sudan, where demonstrators took to the streets to protest against the massacre of South Sudanese in neighboring Sudan. Some criminals took advantage of the chaos to loot shops belonging to Sudanese citizens and attack the Sudanese embassy, where a diplomat was killed. The police fired into the air to disperse the crowd. The news of the massacre of civilians, including South Sudanese citizens, after the capture of Wad Madani by the Sudanese Armed Forces has caused unrest. Wad Madani, the capital of Jazira State , was recaptured by the SAF on 11 January from Rapid Support Forces paramilitaries who had taken it in December 2023. South Sudanese anger has been fuelled by videos circulating on the internet showing atrocities committed by SAF soldiers against South Sudanese and Sudanese from Western Sudan. The South Sudanese Ministry of Foreign Affairs had summoned the Sudanese ambassador to protest the “loss of lives of innocent citizens”. The government in Khartoum has stated that it has set up a commission of inquiry into the massacres committed in Wad Madani. According to the Sudanese ambassador in Juba, the human rights violations were not committed by regular soldiers, but by a militia affiliated with the army. A SAF spokesman admits that there have been “violations committed by some individuals.” At the time of its capture by the SAF in December 2023, Wad Madani, located south of the capital Khartoum, was considered a relatively safe area, so thousands of people fleeing fighting in other parts of Sudan had found refuge there, and had thus been trapped in the city for more than a year. Its recapture by the SAF marked a major step in the Sudanese conflict, marked by persistent human rights violations by all factions on the ground. The US government has imposed sanctions on both the head of the RSF, Mohammad Hamdan Dagalo Mousa, and the commander of the SAF, General Abdel Fattah Al-Burhan, for crimes committed against civilians. Ahmad Abdalla, a Sudanese-Ukrainian citizen and official of the Defence Industries System , and of Portex Trade Limited, a Hong Kong-based company controlled by Abdalla, has also been sanctioned for violating the UN arms embargo on Sudanese factions. 

Maternal and perinatal outcomes after implementation of a more active management in late- and postterm pregnancies in Sweden: A population-based cohort study – ​Karin Källén

by Karin Källén, Mikael Norman, Charlotte Elvander, Christina Bergh, Verena Sengpiel, Henrik Hagberg, Teresia Svanvik, Ulla-Britt Wennerholm

Background

The risk of perinatal death and severe neonatal morbidity increases gradually after 41 weeks of pregnancy. We evaluated maternal and perinatal outcomes after a national shift from expectancy and induction at 42+0 weeks to a more active management of late-term pregnancies in Sweden offering induction from 41+0 weeks or an individual plan aiming at birth or active labour no later than 42+0 weeks.

Methods and findings

Women with a singleton pregnancy lasting 41+0 weeks or more with a fetus in cephalic presentation (N = 150,370) were included in a nationwide, register-based cohort study. Elective cesarean sections were excluded. Outcomes during period 1, January 2017 to December 2019 (before the shift) versus outcomes during period 2, January 2020 to October 1, 2023 (after the shift) were analysed. For comparison, outcomes of pregnancies lasting 39+0 to 40+6 weeks (N = 358,548) were also studied.Primary outcomes were: First, peri/neonatal death (stillbirth or neonatal death before 28 days); second, composite adverse peri/neonatal outcome (peri/neonatal death, Apgar score +0 weeks or more increased from 33.7% in period 1 to 52.4% in period 2. Mean (standard deviation) gestational age at birth decreased from 290.7 (2.9) days to 289.6 (2.3) days. Infants born during period 2 were at lower risk of peri/neonatal death compared to infants born during period 1; 0.9/1,000 versus 1.7/1,000 born infants (adjusted RR 0.52; 95% CI [0.38, 0.69]; p p p p Conclusions

A more active management of pregnancies lasting 41+0 weeks or more was associated with a decrease in peri/neonatal deaths, and a decrease in composite adverse peri/neonatal outcomes. Increased rate of emergency cesarean sections was observed. Women with pregnancies advancing towards 41 gestational weeks should be given balanced information on the benefits and risks of induction of labour at 41 weeks compared to expectant management until 42 weeks and be offered induction of labour at 41 weeks or active surveillance of pregnancies from 41 weeks in order to decrease peri/neonatal mortality.

Fides News – EnglishAFRICA/CHAD – Doubts and many questions after the mysterious attack on the presidential palace​

N’Djamena – “It is difficult to know exactly what happened last night,” local sources in N’Djamena tell Fides. In the capital of Chad, an armed group attacked the presidential palace yesterday evening, January 8. The attack was repelled and Abderaman Koulamallah, Foreign Minister and government spokesman, published a video on social media in which he can be seen with a gun on his belt in the courtyard of the presidential palace, surrounded by soldiers, declaring that the attack had been repelled and the situation was calm.
The government had initially claimed that the attack had been carried out by members of the jihadist militia “Boko Haram”, but later downgraded it to a simple criminal act committed by some bandits armed only with machetes and knives. “Among the 24 attackers in the commando, there were 18 dead and six injured,” the spokesman later clarified.
“The versions presented by the government are not confirmed by independent sources,” our sources say. “What we can report is that the area of the capital where we were was calm last night; there were no troop movements or special checkpoints of the security forces. Even this morning, everything seems calm in N’Djamena: there are no special movements of the military or police, while people go to work normally.”
The attack on the presidential palace took place during the visit of the Chinese Foreign Minister and less than a month before the completion of the withdrawal of French troops from Chad. “The decision announced at the end of November by President Mahamat Idriss Déby Itno to end the defense agreement with France and withdraw the French military was completely unexpected ,” the observers say. “It is not known what prompted the Chadian president to end more than ten years of military relations with the former colonial power. There are unconfirmed rumors linking the decision to the visit of the French Foreign Minister a few hours earlier, who is said to have urged the Chadian authorities to respect human rights.”
“Among other things, the withdrawal of the French military, which was originally scheduled to take place in about six months, has been accelerated under pressure from Chad. The soldiers from France are to complete the repatriation operations by the end of January,” they say.
“What is certain,” our sources continue, “is that the Chadian army must act alone to ensure the stability of the country, which is threatened by internal rebellions, Boko Haram in the Lake Chad region and the consequences of the civil war in neighboring Sudan.” “In addition, a food crisis is expected this year as a result of the drought of the last few months, which has led to a sharp drop in harvests,” they warn. “So far, French troops have always intervened to support the ruling regime, as they did in 2008 and 2019. Now, in the event of a new attack on the capital, the Chadian army will be on its own,” the sources said. The other three neighboring countries in the Sahel governed by military juntas, Burkina Faso, Mali and Niger, have imposed the withdrawal of French troops from their territory. After Chad, the two West African countries of Senegal and Côte d’Ivoire have now also asked France to withdraw its troops from military bases on their soil.
N’Djamena – “It is difficult to know exactly what happened last night,” local sources in N’Djamena tell Fides. In the capital of Chad, an armed group attacked the presidential palace yesterday evening, January 8. The attack was repelled and Abderaman Koulamallah, Foreign Minister and government spokesman, published a video on social media in which he can be seen with a gun on his belt in the courtyard of the presidential palace, surrounded by soldiers, declaring that the attack had been repelled and the situation was calm. The government had initially claimed that the attack had been carried out by members of the jihadist militia “Boko Haram”, but later downgraded it to a simple criminal act committed by some bandits armed only with machetes and knives. “Among the 24 attackers in the commando, there were 18 dead and six injured,” the spokesman later clarified. “The versions presented by the government are not confirmed by independent sources,” our sources say. “What we can report is that the area of the capital where we were was calm last night; there were no troop movements or special checkpoints of the security forces. Even this morning, everything seems calm in N’Djamena: there are no special movements of the military or police, while people go to work normally.” The attack on the presidential palace took place during the visit of the Chinese Foreign Minister and less than a month before the completion of the withdrawal of French troops from Chad. “The decision announced at the end of November by President Mahamat Idriss Déby Itno to end the defense agreement with France and withdraw the French military was completely unexpected ,” the observers say. “It is not known what prompted the Chadian president to end more than ten years of military relations with the former colonial power. There are unconfirmed rumors linking the decision to the visit of the French Foreign Minister a few hours earlier, who is said to have urged the Chadian authorities to respect human rights.” “Among other things, the withdrawal of the French military, which was originally scheduled to take place in about six months, has been accelerated under pressure from Chad. The soldiers from France are to complete the repatriation operations by the end of January,” they say. “What is certain,” our sources continue, “is that the Chadian army must act alone to ensure the stability of the country, which is threatened by internal rebellions, Boko Haram in the Lake Chad region and the consequences of the civil war in neighboring Sudan.” “In addition, a food crisis is expected this year as a result of the drought of the last few months, which has led to a sharp drop in harvests,” they warn. “So far, French troops have always intervened to support the ruling regime, as they did in 2008 and 2019. Now, in the event of a new attack on the capital, the Chadian army will be on its own,” the sources said. The other three neighboring countries in the Sahel governed by military juntas, Burkina Faso, Mali and Niger, have imposed the withdrawal of French troops from their territory. After Chad, the two West African countries of Senegal and Côte d’Ivoire have now also asked France to withdraw its troops from military bases on their soil. 

Fides News – EnglishAFRICA/NIGERIA – Pain and dismay in the Archdiocese of Owerri after the shooting in a church that caused the death of a young man​

Abuja – The Catholic Archdiocese of Owerri highly regrets the shooting incident that took place on the eve of the New Year at the premises of St. Columba’s Catholic Church Amaimo, leading to the death of a young man and the wounding of another.
In an official message issued on January 2, Archbishop Lucius I. Ugorji said: “The Archdiocese of Owerri condoles with the bereaved family, and prays for the happy repose of the dead, and the speedy recovery of the injured.”Meanwhile, the message continues, “the Police is investigating the incident and the circumstances surrounding it. We, therefore, call for calm at St. Columba’s Parish, Amaimo,” the message concludes.

According to press sources, the Imo State Police have arrested the parish priest of the church, Father Joseph Enyinaya, in connection with the death of the young man.
The young man was reportedly killed on December 31, after setting off fireworks inside the St. Columbus Catholic Church, in the Amaimo Ikeduru Local Government Area, in Imo State .
The Imo State Police announced that the suspect was arrested yesterday, January 2, and that an investigation has been opened into the shooting. According to a witness, the priest, in an attempt to disperse a group of boys who were setting off fireworks inside the church, fired a few shots into the air, but then lost control of the weapon and ended up hitting the boys.
Abuja – The Catholic Archdiocese of Owerri highly regrets the shooting incident that took place on the eve of the New Year at the premises of St. Columba’s Catholic Church Amaimo, leading to the death of a young man and the wounding of another.In an official message issued on January 2, Archbishop Lucius I. Ugorji said: “The Archdiocese of Owerri condoles with the bereaved family, and prays for the happy repose of the dead, and the speedy recovery of the injured.”Meanwhile, the message continues, “the Police is investigating the incident and the circumstances surrounding it. We, therefore, call for calm at St. Columba’s Parish, Amaimo,” the message concludes.According to press sources, the Imo State Police have arrested the parish priest of the church, Father Joseph Enyinaya, in connection with the death of the young man.The young man was reportedly killed on December 31, after setting off fireworks inside the St. Columbus Catholic Church, in the Amaimo Ikeduru Local Government Area, in Imo State .The Imo State Police announced that the suspect was arrested yesterday, January 2, and that an investigation has been opened into the shooting. According to a witness, the priest, in an attempt to disperse a group of boys who were setting off fireworks inside the church, fired a few shots into the air, but then lost control of the weapon and ended up hitting the boys. 

Fides News – EnglishAFRICA/LIBERIA – Fire in the Parliament after weeks of tension​

Monrovia – Yesterday, December 18, a fire broke out in the Parliament building in Monrovia. The flames, whose origin is currently unclear, were only extinguished with difficulty by the firefighters. The Parliament is burning while the country is shaken by protests against the attempt by the presidential majority to depose the Speaker of the House of Representatives.
The mysterious incident occurred after clashes between the police and demonstrators of the opposition alliance “Coalition for Democratic Change” led by former President George Weah, who were protesting against the attempt by the presidential majority to oust the current Speaker of Parliament, Jonathan Fonati Koffa . During the clashes, Weah’s former assistant Sekou Kalasco Damaro was arrested, among others. The drive to remove the Speaker of the House of Representatives began on October 17, when 47 MPs signed a resolution to remove Koffa, who was accused of corruption. This led to a brawl with Koffa supporters. Tensions were then fueled by news circulating on social media that Deputy Speaker of Parliament Thomas Fallah and Deputy Speaker of Parliament Jeremiah Kpan Koung had bribed MPs to remove Koffa, while those directly involved denied this claim. The legally required two-thirds majority to remove the Speaker of the House of Representatives was not achieved, which resulted in the delay in the passage of the national budget.
This then led to rallies in the streets of the capital, where CDC protesters called on President Joseph Nyumah Boakai and Vice President Koung to stop interfering in the work of the legislature and to abandon the unconstitutional attempt to remove Koffa. Yesterday’s fire is already the second fire in the Parliament building within a week.
Monrovia – Yesterday, December 18, a fire broke out in the Parliament building in Monrovia. The flames, whose origin is currently unclear, were only extinguished with difficulty by the firefighters. The Parliament is burning while the country is shaken by protests against the attempt by the presidential majority to depose the Speaker of the House of Representatives. The mysterious incident occurred after clashes between the police and demonstrators of the opposition alliance “Coalition for Democratic Change” led by former President George Weah, who were protesting against the attempt by the presidential majority to oust the current Speaker of Parliament, Jonathan Fonati Koffa . During the clashes, Weah’s former assistant Sekou Kalasco Damaro was arrested, among others. The drive to remove the Speaker of the House of Representatives began on October 17, when 47 MPs signed a resolution to remove Koffa, who was accused of corruption. This led to a brawl with Koffa supporters. Tensions were then fueled by news circulating on social media that Deputy Speaker of Parliament Thomas Fallah and Deputy Speaker of Parliament Jeremiah Kpan Koung had bribed MPs to remove Koffa, while those directly involved denied this claim. The legally required two-thirds majority to remove the Speaker of the House of Representatives was not achieved, which resulted in the delay in the passage of the national budget. This then led to rallies in the streets of the capital, where CDC protesters called on President Joseph Nyumah Boakai and Vice President Koung to stop interfering in the work of the legislature and to abandon the unconstitutional attempt to remove Koffa. Yesterday’s fire is already the second fire in the Parliament building within a week. 

Fides News – EnglishAFRICA/MOZAMBIQUE – After Cyclone Chido: opposition suspends protests​

Maputo – “If we know the truth about the election, we will move towards peace. If it is an electoral lie, we will plunge the country into the abyss, chaos and disorder,” warned Venancio Mondlane, candidate of the opposition party PODEMOS, who came second in the presidential elections on October 9 . Mondlane contested the result of the election, which saw the victory of candidate Daniel Chapo of the ruling party FRELIMO .
Protest demonstrations began in the country on October 21. The Electoral Commission, meanwhile, announced that the ruling party candidate Daniel Chapo won with almost 71% of the vote. Mondlane claims he received 53% of the vote and accuses the authorities of falsifying the results. Clashes with police have so far left about 100 people dead .
Mondlane, who is abroad and claims to have escaped two attacks, one of which is said to have taken place in South Africa , appealed in a video broadcast live on social media to “paralyze” the country, but offered to suspend demonstrations for a week to commemorate the victims of Cyclone “Chido”, which hit the northern provinces of Cabo Delgado and Nampula last weekend. According to local authorities, the damage caused by the cyclone currently amounts to at least 15 dead, more than 5,000 houses destroyed or seriously damaged and more than 100,000 people affected. The protests will be suspended until Sunday, December 22, but will resume the next day, when the Constitutional Council is expected to announce the final results of the parliamentary elections.
According to Mondlane, the decision to be announced by the President of the Constitutional Council, Lúcia Ribeiro, will determine the future of the protests. The political crisis in Mozambique is also affecting the economies of neighboring countries that use Mozambican ports for their foreign trade. South Africa, in particular, exports a large part of its mineral production through Mozambique. A mineral that is strategic for the world industry, such as South African chromium, is exported 50 percent through the port of Maputo.
The complete suspension of exports through Mozambique risks a rise in the price of this mineral, of which South Africa is the leading producer with 70% of the world’s reserves.
Maputo – “If we know the truth about the election, we will move towards peace. If it is an electoral lie, we will plunge the country into the abyss, chaos and disorder,” warned Venancio Mondlane, candidate of the opposition party PODEMOS, who came second in the presidential elections on October 9 . Mondlane contested the result of the election, which saw the victory of candidate Daniel Chapo of the ruling party FRELIMO . Protest demonstrations began in the country on October 21. The Electoral Commission, meanwhile, announced that the ruling party candidate Daniel Chapo won with almost 71% of the vote. Mondlane claims he received 53% of the vote and accuses the authorities of falsifying the results. Clashes with police have so far left about 100 people dead . Mondlane, who is abroad and claims to have escaped two attacks, one of which is said to have taken place in South Africa , appealed in a video broadcast live on social media to “paralyze” the country, but offered to suspend demonstrations for a week to commemorate the victims of Cyclone “Chido”, which hit the northern provinces of Cabo Delgado and Nampula last weekend. According to local authorities, the damage caused by the cyclone currently amounts to at least 15 dead, more than 5,000 houses destroyed or seriously damaged and more than 100,000 people affected. The protests will be suspended until Sunday, December 22, but will resume the next day, when the Constitutional Council is expected to announce the final results of the parliamentary elections. According to Mondlane, the decision to be announced by the President of the Constitutional Council, Lúcia Ribeiro, will determine the future of the protests. The political crisis in Mozambique is also affecting the economies of neighboring countries that use Mozambican ports for their foreign trade. South Africa, in particular, exports a large part of its mineral production through Mozambique. A mineral that is strategic for the world industry, such as South African chromium, is exported 50 percent through the port of Maputo. The complete suspension of exports through Mozambique risks a rise in the price of this mineral, of which South Africa is the leading producer with 70% of the world’s reserves. 

Cost-effectiveness of a patient-reported outcome-based remote monitoring and alert intervention for early detection of critical recovery after joint replacement: A randomised controlled trial

by Lukas Schöner, David Kuklinski, Laura Wittich, Viktoria Steinbeck, Benedikt Langenberger, Thorben Breitkreuz, Felix Compes, Mathias Kretzler, Ursula Marschall, Wolfgang Klauser, Mustafa Citak, Georg Matziolis, Daniel Schrednitzki, Kim Grasböck, Justus Vogel, Christoph Pross, Reinhard Busse, Alexander Geissler

Background

While the effectiveness of patient-reported outcome measures (PROMs) as an intervention to impact patient pathways has been established for cancer care, it is unknown for other indications. We assessed the cost-effectiveness of a PROM-based monitoring and alert intervention for early detection of critical recovery paths following hip and knee replacement.

Methods and findings

The cost-effectiveness analysis (CEA) is based on a multicentre randomised controlled trial encompassing 3,697 patients with hip replacement and 3,110 patients with knee replacement enrolled from 2019 to 2020 in 9 German hospitals. The analysis was conducted with a subset of 546 hip and 492 knee replacement cases with longitudinal cost data from 24 statutory health insurances. Patients were randomised 1:1 to a PROM-based remote monitoring and alert intervention or to a standard care group. All patients were assessed at 12-months post-surgery via digitally collected PROMs. Patients within the intervention group were additionally assessed at 1-, 3-, and 6-months post-surgery to be contacted in case of critical recovery paths. For the effect evaluation, a PROM-based composite measure (PRO-CM) was developed, combining changes across various PROMs in a single index ranging from 0 to 100. The PRO-CM included 6 PROMs focused on quality of life and various aspects of physical and mental health. The primary outcome was the incremental cost-effectiveness ratio (ICER). The intervention group showed incremental outcomes of 2.54 units PRO-CM (95% confidence interval (CI) [0.93, 4.14]; p = 0.002) for patients with hip and 0.87 (95% CI [−0.94, 2.67]; p = 0.347) for patients with knee replacement. Within the 12-months post-surgery period the intervention group had less costs of 376.43€ (95% CI [−639.74, −113.12]; p = 0.005) in patients with hip, and 375.50€ (95% CI [−767.40, 16.39]; p = 0.060) in patients with knee replacement, revealing a dominant ICER for both procedures. However, it remains unclear which step of the multistage intervention contributes most to the positive effect.

Conclusions

The intervention significantly improved patient outcomes at lower costs in patients with hip replacements when compared with standard care. Further it showed a nonsignificant cost reduction in knee replacement patients. This reinforces the notion that PROMs can be utilised as a cost-effective instrument for remote monitoring in standard care settings.

Trial registration

Registration: German Register for Clinical Studies (DRKS) under DRKS00019916.

Routine measurement of cardiometabolic disease risk factors in primary care in England before, during, and after the COVID-19 pandemic: A population-based cohort study

by Frederick K. Ho, Caroline Dale, Mehrdad A. Mizani, Thomas Bolton, Ewan R. Pearson, Jonathan Valabhji, Christian Delles, Paul Welsh, Shinya Nakada, Daniel Mackay, Jill P. Pell, Chris Tomlinson, Steffen E. Petersen, Benjamin Bray, Mark Ashworth, Kazem Rahimi, Mamas Mamas, Julian Halcox, Cathie Sudlow, Reecha Sofat, Naveed Sattar, CVD-COVID-UK/COVID-IMPACT Consortium

Background

This study estimated to what extent the number of measurements of cardiometabolic risk factors (e.g., blood pressure, cholesterol, glycated haemoglobin) were impacted by the COVID-19 pandemic and whether these have recovered to expected levels.

Methods and findings

A cohort of individuals aged ≥18 years in England with records in the primary care—COVID-19 General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) were identified. Their records of 12 risk factor measurements were extracted between November 2018 and March 2024. Number of measurements per 1,000 individuals were calculated by age group, sex, ethnicity, and area deprivation quintile. The observed number of measurements were compared to a composite expectation band, derived as the union of the 95% confidence intervals of 2 estimates: (1) a projected trend based on data prior to the COVID-19 pandemic; and (2) an assumed stable trend from before pandemic. Point estimates were calculated as the mid-point of the expectation band.A cohort of 49,303,410 individuals aged ≥18 years were included. There was sharp drop in all measurements in March 2020 to February 2022, but overall recovered to the expected levels during March 2022 to February 2023 except for blood pressure, which had prolonged recovery. In March 2023 to March 2024, blood pressure measurements were below expectation by 16% (−19 per 1,000) overall, in people aged 18 to 39 (−23%; −18 per 1,000), 60 to 79 (−17%; −27 per 1,000), and ≥80 (−31%; −57 per 1,000). There was suggestion that recovery in blood pressure measurements was socioeconomically patterned. The second most deprived quintile had the highest deviation (−20%; −23 per 1,000) from expectation compared to least deprived quintile (−13%; −15 per 1,000).

Conclusions

There was a substantial reduction in routine measurements of cardiometabolic risk factors following the COVID-19 pandemic, with variable recovery. The implications for missed diagnoses, worse prognosis, and health inequality are a concern.

Rare but elevated incidence of hematological malignancy after clozapine use in schizophrenia: A population cohort study

by Yuqi Hu, Le Gao, Lingyue Zhou, Wenlong Liu, Cuiling Wei, Boyan Liu, Qi Sun, Wenxin Tian, Rachel Yui Ki Chu, Song Song, Franco Wing Tak Cheng, Joe Kwun Nam Chan, Amy Pui Pui Ng, Heidi Ka Ying Lo, Krystal Chi Kei Lee, Wing Chung Chang, William Chi Wai Wong, Esther Wai Yin Chan, Ian Chi Kei Wong, Yi Chai, Francisco Tsz Tsun Lai

Background

Clozapine is widely regarded as a highly efficacious psychotropic drug that is largely underused worldwide. Recent disproportionality analyses and nationwide case-control studies suggested a potential association between clozapine use and hematological malignancy (HM). Nevertheless, the absolute rate difference is not well-established due to the absence of analytic cohort studies. The clinical significance of such a potential risk remains unclear.

Methods and findings

We extracted data from a territory-wide public healthcare database from January 2001 to August 2022 in Hong Kong to conduct a retrospective cohort study of anonymized patients aged 18+ years with a diagnosis of schizophrenia who used clozapine or olanzapine (drug comparator with highly similar chemical structure and pharmacological mechanisms) for 90+ days, with at least 2 prior other antipsychotic use records within both groups. Weighted by inverse probability of treatment (IPTW) based on propensity scores, Poisson regression was used to estimate the incidence rate ratio (IRR) of HM between clozapine and olanzapine users. The absolute rate difference was also estimated. In total, 9,965 patients with a median follow-up period of 6.99 years (25th to 75th percentile: 4.45 to 10.32 years) were included, among which 834 were clozapine users. After IPTW, the demographic and clinical characteristics of clozapine users were comparable to those of olanzapine users. Clozapine users had a significant weighted IRR of 2.22 (95% confidence interval (CI) [1.52, 3.34]; p Conclusions

Absolute rate difference in HM incidence associated with clozapine is small despite a 2-fold elevated rate. Given the rarity of HM and existing blood monitoring requirements, more restrictive indication for clozapine or special warnings may not be necessary.

Alma Nova – After Hours

Alma Nova – After Hours

01-Bosna Nova-AlmaNova.mp3 4.180.699 18/12/2012 17:35
02-Kafana-AlmaNova.mp3 4.246.235 18/12/2012 17:35
03-Zajdi Zajdi-AlmaNova.mp3 5.944.961 18/12/2012 17:35
04-Jovano Jovanke-AlmaNova.mp3 5.241.563 18/12/2012 17:35
05-Love-AlmaNova.mp3 4.762.547 18/12/2012 17:35
06-After Hours-AlmaNova.mp3 5.216.987 18/12/2012 17:35
07-Massimo Dancing-AlmaNova.mp3 3.599.067 18/12/2012 17:35
08-Ikindija-AlmaNova.mp3 4.221.712 18/12/2012 17:35
09-Rain-AlmaNova.mp3 5.651.163 18/12/2012 17:35

Love:

Risk of long COVID and associated symptoms after acute SARS-COV-2 infection in ethnic minorities: A nationwide register-linked cohort study in Denmark

by George Frederick Mkoma, Charles Agyemang, Thomas Benfield, Mikael Rostila, Agneta Cederström, Jørgen Holm Petersen, Marie Norredam

Background

Ethnic minorities living in high-income countries have been disproportionately affected by Coronavirus Disease 2019 (COVID-19) in terms of infection rates, hospitalisations, and deaths; however, less is known about long COVID in these populations. Our aim was to examine the risk of long COVID and associated symptoms among ethnic minorities.

Methods and findings

We used nationwide register-based cohort data on individuals diagnosed with COVID-19 aged ≥18 years (n = 2,286,955) between January 2020 and August 2022 in Denmark. We calculated the risk of long COVID diagnosis and long COVID symptoms among ethnic minorities compared with native Danes using multivariable Cox proportional hazard regression and logistic regression, respectively.Among individuals who were first time diagnosed with COVID-19 during the study period, 39,876 (1.7%) were hospitalised and 2,247,079 (98.3%) were nonhospitalised individuals. Of the diagnosed COVID-19 cases, 1,952,021 (85.3%) were native Danes and 334,934 (14.7%) were ethnic minorities. After adjustment for age, sex, civil status, education, family income, and Charlson comorbidity index, ethnic minorities from North Africa (adjusted hazard ratio [aHR] 1.41, 95% confidence interval [CI] [1.12,1.79], p = 0.003), Middle East (aHR 1.38, 95% CI [1.24,1.55], p p p = 0.001) had significantly greater risk of long COVID diagnosis than native Danes. In the analysis by largest countries of origin, the greater risks of long COVID diagnosis were found in people of Iraqi origin (aHR 1.56, 95% CI [1.30,1.88], p p p = 0.016). A significant factor associated with an increased risk of long COVID diagnosis was COVID-19 hospitalisation. The risk of long COVID diagnosis among ethnic minorities was more pronounced between January 2020 and June 2021. Furthermore, the odds of reporting cardiopulmonary symptoms (including dyspnoea, cough, and chest pain) and any long COVID symptoms were higher among people of North African, Middle Eastern, Eastern European, and Asian origins than among native Danes in both unadjusted and adjusted models. Despite including the nationwide sample of individuals diagnosed with COVID-19, the precision of our estimates on long COVID was limited to the sample of patients with symptoms who had contacted the hospital.

Conclusions

Belonging to an ethnic minority group was significantly associated with an increased risk of long COVID, indicating the need to better understand long COVID drivers and address care and treatment strategies in these populations.