Severity of Plasmodium falciparum and Non-falciparum Malaria in Travelers and Migrants: A Nationwide Observational Study Over 2 Decades in Sweden

Abstract Background The aim was to assess factors affecting disease severity in imported P. falciparum and non-falciparum malaria. Methods We reviewed medical records from 2793/3260 (85.7%) of all episodes notified in Sweden between 1995 and 2015 and performed multivariable logistic regression. Results Severe malaria according to WHO 2015 criteria was found in P. falciparum (9.4%), P. vivax (7.7%), P. ovale (5.3%), P. malariae (3.3%), and mixed P. falciparum episodes (21.1%). Factors associated with severe P. falciparum malaria were age <5 years and >40 years, origin in nonendemic country, pregnancy, HIV, region of diagnosis, and health care delay. Moreover, oral treatment of P. falciparum episodes with parasitemia ≥2% without severe signs at presentation was associated with progress to severe malaria with selected criteria. In non-falciparum, age >60 years, health care delay and endemic origin were identified as risk factors for severe disease. Among patients originating in endemic countries, a higher risk for severe malaria, both P. falciparum and non-falciparum, was observed among newly arrived migrants. Conclusions Severe malaria was observed in P. falciparum and non-falciparum episodes. Current WHO criteria for severe malaria may need optimization to better guide the management of malaria of different species in travelers and migrants in nonendemic areas.

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Identifying the Underlying Factors Associated With Patients’ Attitudes Toward Antidepressants: Qualitative and Quantitative Analysis of Patient Drug Reviews

JMIR Mental Health ◽

10.2196/10726 ◽

2018 ◽

Vol 5 (4) ◽

pp. e10726 ◽

Cited By ~ 3

Author(s):

Maryam Zolnoori ◽

Kin Wah Fung ◽

Paul Fontelo ◽

Hadi Kharrazi ◽

Anthony Faiola ◽

...

Keyword(s):

Health Care ◽

Adverse Drug Reactions ◽

Analytical Framework ◽

Self Report ◽

Drug Reactions ◽

Factors Affecting ◽

Drug Effectiveness ◽

Qualitative And Quantitative ◽

Factors Associated ◽

Insight Into

Background Nonadherence to antidepressants is a major obstacle to deriving antidepressants’ therapeutic benefits, resulting in significant burdens on the individuals and the health care system. Several studies have shown that nonadherence is weakly associated with personal and clinical variables but strongly associated with patients’ beliefs and attitudes toward medications. Patients’ drug review posts in online health care communities might provide a significant insight into patients’ attitude toward antidepressants and could be used to address the challenges of self-report methods such as patients’ recruitment. Objective The aim of this study was to use patient-generated data to identify factors affecting the patient’s attitude toward 4 antidepressants drugs (sertraline [Zoloft], escitalopram [Lexapro], duloxetine [Cymbalta], and venlafaxine [Effexor XR]), which in turn, is a strong determinant of treatment nonadherence. We hypothesized that clinical variables (drug effectiveness; adverse drug reactions, ADRs; perceived distress from ADRs, ADR-PD; and duration of treatment) and personal variables (age, gender, and patients’ knowledge about medications) are associated with patients’ attitude toward antidepressants, and experience of ADRs and drug ineffectiveness are strongly associated with negative attitude. Methods We used both qualitative and quantitative methods to analyze the dataset. Patients’ drug reviews were randomly selected from a health care forum called askapatient. The Framework method was used to build the analytical framework containing the themes for developing structured data from the qualitative drug reviews. Then, 4 annotators coded the drug reviews at the sentence level using the analytical framework. After managing missing values, we used chi-square and ordinal logistic regression to test and model the association between variables and attitude. Results A total of 892 reviews posted between February 2001 and September 2016 were analyzed. Most of the patients were females (680/892, 76.2%) and aged less than 40 years (540/892, 60.5%). Patient attitude was significantly (P<.001) associated with experience of ADRs, ADR-PD, drug effectiveness, perceived lack of knowledge, experience of withdrawal, and duration of usage, whereas oth age (F4,874=0.72, P=.58) and gender (χ24=2.7, P=.21) were not found to be associated with patient attitudes. Moreover, modeling the relationship between variables and attitudes showed that drug effectiveness and perceived distress from adverse drug reactions were the 2 most significant factors affecting patients’ attitude toward antidepressants. Conclusions Patients’ self-report experiences of medications in online health care communities can provide a direct insight into the underlying factors associated with patients’ perceptions and attitudes toward antidepressants. However, it cannot be used as a replacement for self-report methods because of the lack of information for some of the variables, colloquial language, and the unstructured format of the reports.

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Possible relationship between esophageal dilatation and severity of M. abscessus pulmonary disease

PLoS ONE ◽

10.1371/journal.pone.0261866 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261866

Author(s):

Hiromichi Hara ◽

Keitaro Okuda ◽

Jun Araya ◽

Hirofumi Utsumi ◽

Daisuke Takekoshi ◽

...

Keyword(s):

Pulmonary Disease ◽

Medical Records ◽

Severe Disease ◽

Laboratory Data ◽

Mycobacterium Abscessus ◽

Chest Ct ◽

Maximum Diameter ◽

Esophageal Dilatation ◽

Lung Lesions ◽

Factors Associated

Objectives Recently, incidence of Mycobacterium abscessus (Mab) pulmonary disease (Mab-PD) is increasing worldwide. We aimed to identify factors associated with severity of Mycobacterium abscessus (Mab) pulmonary disease (Mab-PD). Methods All patients diagnosed as Mab-PD based on the official ATS/IDSA statement between 2017 January 1 and 2021 July 31 were included (n = 13). We reviewed medical records, bacteriological and laboratory data of the patients. Severity of lung lesions and esophageal diameters in chest CT were quantitatively evaluated. Gaffky score in the sputum was used as airway mycobacterial burden. We explored the factors associated with high CT score and high Gaffky score. Results Maximum diameter of esophagus (MDE) in severe disease (CT score≧10) was greater than that in milder disease (CT score<10) (18.0±7.9mm, 9.3±3.1mm, respectively, p = 0.01), and MDE was well correlated with CT score (R = 0.69, p = 0.007). MDE in high mycobacterial burden group (Gaffky score ≧5) tended to be greater than that in low mycobacterial burden group (Gaffky score <5) (16.1±6.8mm, 10.1±5.5mm, respectively, p = 0.12), and MDE was well correlated with Gaffky score (R = 0.68, p = 0.009). Lung lesions were bilateral and predominant in middle or lower lobes. Conclusions Esophageal dilatation was correlated with severity of Mab-PD and airway mycobacterial burden. Gastroesophageal reflux might be associated with Mab disease progression.

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Factors affecting the documentation of spoken safety-netting advice in routine GP consultations

British Journal of General Practice ◽

10.3399/bjgp.2021.0195 ◽

2021 ◽

pp. BJGP.2021.0195

Author(s):

Peter Jonathan Edwards ◽

Ian Bennett-Britton ◽

Matthew Ridd ◽

Matthew Booker ◽

Rebecca Kate Barnes

Keyword(s):

Logistic Regression ◽

Medical Record ◽

Medical Records ◽

Secondary Analysis ◽

Observational Coding ◽

Factors Affecting ◽

Factors Associated ◽

Legal Implications ◽

Safety Netting

Background: Previous studies have reported how often safety-netting is documented in medical records, but it is not known how this compares to what is verbalised and what factors might influence the consistency of documentation. Aim: To compare spoken and documented safety-netting advice (SNA) and explore factors associated with documentation. Design and setting: Secondary analysis of GP consultations archive. Method: Observational coding involving classifying and quantifying medical record entries and comparison with spoken SNA in 295 video / audio recorded consultations. Associations were tested using logistic regression. Results: Two-thirds of consultations (192/295) contained spoken SNA which applied to less than half of problems assessed (242/516). Only one-third of consultations (94/295) had documented SNA which covered 20% of problems (105/516). The practice of GPs varied widely from those that did not document their SNA, to those that nearly always did so (86.7%). GPs were more likely to document their SNA for new problems (p=0.030), when only a single problem was discussed in a consultation (p=0.040) and when they gave specific, rather than generic SNA (p=0.007). In consultations where multiple problems were assessed (n=139), the frequency of spoken and documented SNA decreased the later a problem was assessed. Conclusion: GPs frequently do not document safety-netting advice they have given to patients which may have medico-legal implications in the event of an untoward incident. GPs should consider how safely they can assess and document more than one problem in a single consultation and this risk should be shared with patients to help manage expectations.

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Injury to the Human Median and Ulnar Nerves in the Forearm – Analysis of Costs for Treatment and Rehabilitation of 69 Patients in Southern Sweden

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.09.003 ◽

2005 ◽

Vol 30 (1) ◽

pp. 35-39 ◽

Cited By ~ 89

Author(s):

H. E. ROSBERG ◽

K. S. CARLSSON ◽

S. HÖJGÅRD ◽

B. LINDGREN ◽

G. LUNDBORG ◽

...

Keyword(s):

Health Care ◽

Nerve Injury ◽

Ulnar Nerve ◽

Tendon Injuries ◽

Health Care Sector ◽

Nerve Injuries ◽

Southern Sweden ◽

Factors Affecting ◽

Factors Associated ◽

Ulnar Nerve Injury

This study analysed the costs of median and ulnar nerve injuries in the forearm in humans and factors affecting such costs. The costs within the health-care sector and costs of lost production were calculated in 69 patients with an injury to the median and/or ulnar nerve in the forearm, usually caused by glass, a knife, or a razorblade. Factors associated with the variation in costs and outcome were analysed. The total median costs for an employed person with a median and an ulnar nerve injury were EUR 51,238 and EUR 31,186, respectively, and 87% of the total costs were due to loss of production. All costs were higher for patients with concomitant tendon injuries (≥4 tendons). The costs within the health-care sector were also higher for patients who changed work after the injury and if both nerves were injured. Outcome was dependent on age and repair method.

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PO 8594 VALIDATION OF A VERBAL AUTOPSY QUESTIONNAIRE APPLIED TO A CASE-CONTROL STUDY OF CEREBRAL MALARIA IN BANDIAGARA AND BAMAKO, MALI

BMJ Global Health ◽

10.1136/bmjgh-2019-edc.158 ◽

2019 ◽

Vol 4 (Suppl 3) ◽

pp. A60.2-A60

Author(s):

Karim Traore ◽

Drissy Coulibaly ◽

Abdoulaye K Kone ◽

Ali Thera ◽

Boureima Guindo ◽

...

Keyword(s):

Health Care ◽

Cerebral Malaria ◽

Severe Malaria ◽

Verbal Autopsy ◽

Medical Records ◽

Case Control Study ◽

Case Control ◽

History Of ◽

Sensitivity Specificity ◽

Control Study

BackgroundMalaria remains a leading cause of child mortality in sub-Saharan Africa. Severe malaria is the main pathway to death caused by malaria. A study of factors associated with protection against severe malaria is best achieved using a case-control design. However, these studies are affected by the quality and appropriateness of the choice of controls that may introduce important bias in study design and definitively alter the conclusions from the studies. It is of paramount importance that the presence or absence of an episode of severe malaria in the history of the controls is ascertained. In settings with reliable medical data this is easily tracked back from hospital records. In settings like Bandiagara, with weak health care systems, a dedicated approach is needed to track history of severe malaria. We used an adapted verbal autopsy questionnaire to identify presence of cerebral malaria in the history of controls in a case-control study of severe malaria in Bandiagara.We have assessed the sensitivity, specificity and predictive positive and negative values of the questionnaire.MethodsFrom January through August 2018 we enrolled 450 children with or without known confirmed cerebral malaria selected at health care centers in Bandiagara and Bamako, with archived medical records. Parents of enrolled children were identified, located and interviewed using the adapted verbal autopsy questionnaire. Interviewers were not aware of children’s diagnosis. We compared the diagnosis derived from the verbal autopsy questionnaire to the confirmed biological diagnosis from the medical records.ResultsWe will present full results on the sensitivity, specificity, the predictive positive and negative values of the verbal questionnaire, and the Kappa coefficient of agreement.ConclusionA good verbal questionnaire will enhance the quality of the choice of controls in case-control studies of severe malaria and overall will improve the quality and relevance of inferences from such studies.

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Management of malaria with acute renal failure

African Journal of Nephrology ◽

10.21804/3-2-864 ◽

1999 ◽

Vol 3 (2) ◽

Author(s):

Polrat Wilairatana ◽

Sornchai Looareesuwan ◽

Guy H. Neild

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Vietnam War ◽

Severe Malaria ◽

Falciparum Malaria ◽

Severe Disease ◽

Severe Anaemia ◽

Common Complication ◽

Risk Of Infection ◽

Severe Falciparum Malaria

In parts of the world, such as Africa, where Plasmodium falciparum is endemic and its transmission is stable, severe malaria affects mainly children. Cerebral malaria and severe anaemia are common but multi-organ failure involving the kidneys or liver is very rare. Surviving children develop immunity and thus as adults rarely develop severe disease III. In contrast, in other tropical countries where transmission of P. falciparum is unstable and the risk of infection low, severe malaria can occur at any age. Severe malaria is defined as parasitaemia greater than 5% or vital organ dysfunction. Acute renal failure (ARF) is a common complication of severe falciparum malaria in non-immune individuals. At the Bangkok hospital for Tropical Disease, 5,210 patients with falciparum malaria were admitted during the period 1991-1997 of whom 112 patients (2.12%) had ARF. In a recent study of 560 cases of severe adult malaria in Vietnam, 28% of patients had renal failure on admission and 41% at some stage, with 14% overall requiring dialysis [2]. Overall, however, ARF is not a common complication of malaria. During the Vietnam war, the reported incidence was 19 cases in 3,000 malarial admissions in 1965/6 and 8 of 2003 admissions n 1966 [3,4].

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Circulating Neutrophil Extracellular Traps and Neutrophil Activation Are Increased in Proportion to Disease Severity in Human Malaria

The Journal of Infectious Diseases ◽

10.1093/infdis/jiy661 ◽

2018 ◽

Vol 219 (12) ◽

pp. 1994-2004 ◽

Cited By ~ 13

Author(s):

Steven Kho ◽

Gabriela Minigo ◽

Benediktus Andries ◽

Leo Leonardo ◽

Pak Prayoga ◽

...

Keyword(s):

Severe Malaria ◽

Falciparum Malaria ◽

Disease Severity ◽

Severe Disease ◽

Plasmodium Species ◽

Neutrophil Extracellular Traps ◽

Falciparum Infection ◽

Neutrophil Activation ◽

Extracellular Traps

AbstractBackgroundNeutrophil activation results in Plasmodium parasite killing in vitro, but neutrophil products including neutrophil extracellular traps (NETs) mediate host organ damage and may contribute to severe malaria. The role of NETs in the pathogenesis of severe malaria has not been examined.MethodsIn Papua, Indonesia, we enrolled adults with symptomatic Plasmodium falciparum (n = 47 uncomplicated, n = 8 severe), Plasmodium vivax (n = 37), or Plasmodium malariae (n = 14) malaria; asymptomatic P falciparum (n = 19) or P vivax (n = 21) parasitemia; and healthy adults (n = 23) without parasitemia. Neutrophil activation and NETs were quantified by immunoassays and microscopy and correlated with parasite biomass and disease severity.ResultsIn patients with symptomatic malaria, neutrophil activation and NET counts were increased in all 3 Plasmodium species. In falciparum malaria, neutrophil activation and NET counts positively correlated with parasite biomass (Spearman rho = 0.41, P = .005 and r2 = 0.26, P = .002, respectively) and were significantly increased in severe disease. In contrast, NETs were inversely associated with parasitemia in adults with asymptomatic P falciparum infection (r2 = 0.24, P = .031) but not asymptomatic P vivax infection.ConclusionsAlthough NETs may inhibit parasite growth in asymptomatic P falciparum infection, neutrophil activation and NET release may contribute to pathogenesis in severe falciparum malaria. Agents with potential to attenuate these processes should be evaluated.

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