scholarly journals Reduction in Short-term Outpatient Consultations After a Campaign With Measles Vaccine in Children Aged 9–59 Months: Substudy Within a Cluster-Randomized Trial

2020 ◽  
Vol 9 (5) ◽  
pp. 535-543
Author(s):  
Anshu Varma ◽  
Peter Aaby ◽  
Sanne Marie Thysen ◽  
Aksel Karl Georg Jensen ◽  
Ane Bærent Fisker

Abstract Background We assessed a measles vaccination campaign’s potential short-term adverse events. Methods In a cluster-randomized trial assessing a measles vaccination campaign’s effect on all-cause mortality and hospital admission among children aged 9–59 months in Guinea-Bissau, children received a measles vaccination (intervention) or a health check-up (control). One month to 2 months later, we visited a subgroup of children to ask mothers/guardians about outpatient consultations since enrollment. In log-binomial models, we estimated the relative risk (RR) of nonaccidental outpatient consultations. Results Among 8319 children (4437 intervention/3882 control), 652 nonaccidental outpatient consultations occurred (322 intervention/330 control). The measles vaccination campaign tended to reduce nonaccidental outpatient consultations by 16% (RR, 0.84 [95% confidence interval {CI}, .65–1.11]), especially if caused by respiratory symptoms (RR, 0.68 [95% CI, .42–1.11]). The reduction tended to be larger in children who prior to trial enrollment had a pentavalent vaccination (diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b) as the most recent vaccination (RR, 0.61 [95% CI, .42–.89]) than in children who prior to trial enrollment had a routine measles vaccination as the most recent vaccination (RR, 0.93 [95% CI, .68–1.26]) (P = .04 for interaction). Conclusions In the short term, a measles vaccination campaign seems not to increase nonaccidental outpatient consultations but may reduce them. Clinical Trials Registration NCT03460002.

2009 ◽  
Vol 49 (6) ◽  
pp. 546-552 ◽  
Author(s):  
Richard L. Berg ◽  
William Pickett ◽  
Marcy Fitz-Randolph ◽  
Steven K. Broste ◽  
Mary Jo Knobloch ◽  
...  

2020 ◽  
Vol 41 (30) ◽  
pp. 2836-2844 ◽  
Author(s):  
Carline J van den Dries ◽  
Sander van Doorn ◽  
Frans H Rutten ◽  
Ruud Oudega ◽  
Sjef J C M van de Leur ◽  
...  

Abstract Aims To evaluate whether integrated care for atrial fibrillation (AF) can be safely orchestrated in primary care. Methods and results The ALL-IN trial was a cluster randomized, open-label, pragmatic non-inferiority trial performed in primary care practices in the Netherlands. We randomized 26 practices: 15 to the integrated care intervention and 11 to usual care. The integrated care intervention consisted of (i) quarterly AF check-ups by trained nurses in primary care, also focusing on possibly interfering comorbidities, (ii) monitoring of anticoagulation therapy in primary care, and finally (iii) easy-access availability of consultations from cardiologists and anticoagulation clinics. The primary endpoint was all-cause mortality during 2 years of follow-up. In the intervention arm, 527 out of 941 eligible AF patients aged ≥65 years provided informed consent to undergo the intervention. These 527 patients were compared with 713 AF patients in the control arm receiving usual care. Median age was 77 (interquartile range 72–83) years. The all-cause mortality rate was 3.5 per 100 patient-years in the intervention arm vs. 6.7 per 100 patient-years in the control arm [adjusted hazard ratio (HR) 0.55; 95% confidence interval (CI) 0.37–0.82]. For non-cardiovascular mortality, the adjusted HR was 0.47 (95% CI 0.27–0.82). For other adverse events, no statistically significant differences were observed. Conclusion In this cluster randomized trial, integrated care for elderly AF patients in primary care showed a 45% reduction in all-cause mortality when compared with usual care.


2018 ◽  
Vol 68 (7) ◽  
pp. 1176-1183 ◽  
Author(s):  
Lucky G Ngwira ◽  
Elizabeth L Corbett ◽  
McEwen Khundi ◽  
Grace L Barnes ◽  
Austin Nkhoma ◽  
...  

Abstract Background Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV)–infected individuals globally. Screening for TB at the point of HIV diagnosis with a high-sensitivity assay presents an opportunity to reduce mortality. Methods We performed a cluster randomized trial of TB screening among adults newly diagnosed with HIV in 12 primary health clinics in rural Thyolo, Malawi. Clinics were allocated in a 1:1 ratio to perform either point-of-care Xpert MTB/RIF assay (Xpert) or point-of-care light-emitting diode fluorescence microscopy (LED-FM) for individuals screening positive for TB symptoms. Asymptomatic participants were offered isoniazid preventive therapy in both arms. Investigators, but not clinic staff or participants, were masked to allocation. Our primary outcome was the incidence rate ratio (RR) of all-cause mortality within 12 months of HIV diagnosis. Results Prevalent TB was diagnosed in 24 of 1001 (2.4%) individuals enrolled in clinics randomized to Xpert, compared with 10 of 841 (1.2%) in clinics randomized to LED-FM. All-cause mortality was 22% lower in the Xpert arm than in the LED-FM arm (6.7 vs 8.6 per 100 person-years; RR, 0.78 [95% confidence interval {CI}, .58–1.06]). A planned subgroup analysis suggested that participants with more advanced HIV (World Health Organization clinical stage 3 or 4) disease had lower mortality in clinics randomized to Xpert than to LED-FM (RR, 0.43 [95% CI, .22–.87]). Conclusions In rural Malawi, using point-of-care Xpert MTB/RIF to test symptomatic patients for TB at the time of HIV diagnosis reduced all-cause 12-month mortality among individuals with advanced HIV. Clinical Trials Registration NCT01450085.


2020 ◽  
Vol 5 (2) ◽  
pp. 230-239
Author(s):  
Shaikh I. Ahmad ◽  
Bennett L. Leventhal ◽  
Brittany N. Nielsen ◽  
Stephen P. Hinshaw

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