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Background: Informal caregivers contribute substantially to the self-care of people with heart failure (HF) by helping with concrete and interpersonal tasks. Time perception and management are essential issues among caregivers. However, investigators have not explored this topic in caregivers of people with HF., Objectives: The aim of this study was to describe the perceptions and challenges of the time management experience among caregivers who support the self-care efforts of their relatives with HF., Methods: Adult informal caregivers of patients with HF, taking care of the patient for at least 3 months and without cognitive limitations, were recruited from Spain, Italy, and the Netherlands. Data were collected using semistructured interviews. Maryring's qualitative content analysis strategy with both a deductive and an inductive approach was used for analysis., Results: We enrolled 50 participants (20 Italians, 19 Spanish, and 11 Dutch). Caregivers had a mean (SD) age of 62.8 (12.8) years and were mostly female (84%). They dedicated 31.2 (SD, 21.7) hours per week to providing caring activities for their patients. After extracting 33 codes from their qualitative interview data, we summarized them into 8 categories and identified 4 main themes: (1) time for yourself, (2) house management, (3) time for the patient (dedicated to directing care), and (4) time for own socialization., Conclusion: Caregivers navigate the complexity of time management by balancing dedicated time for supporting patients with HF and their own personal time., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To estimate HIV incidence among female sex workers (FSW) in Zimbabwe: using HIV prevalence by age and number of years since started selling sex (YSSS)., Design: We pooled data from FSW aged 18-39 participating in respondent-driven sampling surveys conducted in Zimbabwe between 2011 and 2017., Methods: For each year of age, we estimated: HIV prevalence ( Pt ) and the change in HIV prevalence from the previous age ( Pt - Pt -1 ). We then estimated the rate of new HIV infections during that year of age: It  =  Pt - Pt -1 /(1 - Pt -1 ), and calculated HIV incidence for 18-24 and 25-39 year-olds separately as the weighted average of It . We estimated HIV incidence for FSW 1-5 years and 6-15 years since first selling sex using the same approach, and compared HIV prevalence among FSW first selling sex at their current age with the general population., Results: Among 9906 women, 50.2% were HIV positive. Based on HIV prevalence increases by age, we estimated an HIV incidence of 6.3/100 person-years at risk (pyar) (95% confidence interval [CI] 5.3, 7.6) among 18-24 year-olds, and 3.3/100 pyar (95% CI 1.3, 4.2) among 25-39 year-olds. Based on prevalence increases by YSSS, HIV incidence was 5.3/100 pyar (95% CI 4.3, 8.5) between 1 and 5 years since first selling sex, and 2.1/100 pyar (95% CI -1.3, 7.2) between 6 and 15 years., Conclusions: Our analysis is consistent with very high HIV incidence among FSW in Zimbabwe, especially among those who are young and recently started selling sex. There is a critical need to engage young entrants into sex work in interventions that reduce their HIV risk., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The main objectives of this study were to determine the effect of concurrent malnutrition on disease condition and the primary outcome of mortality in children younger than 5 years hospitalized after presenting to a rural emergency department (ED) in Uganda and to identify a high-risk patient population who may benefit from acute ED intervention., Methods: A retrospective, observational study was performed to examine the effect of any form of malnutrition on the primary disease conditions of lower-respiratory tract infection (LRTI), malaria, and diarrheal illness. This study was conducted via review of a quality assurance database between January 2010 and July 2014., Results: Of 3428 hospitalized children, the mean age (SD) was 19.8 months (13.9 months) and 56% were boys. Children diagnosed with malaria, an LRTI, or diarrheal illness all had a higher rate of mortality with concurrent malnutrition versus those without malnutrition (malaria, 6.2% [3.6-8.8%] vs 2.8% [2.0-3.7%]; P < 0.01; LRTI, 8.7% [5.0-12.4%] vs. 3.7% [2.6-4.9%], P < 0.01; and diarrheal illness, 10.9% [1.9-19.9%] vs 1.7% [0.1-3.4%], P < 0.01). In children with an LRTI or malaria with concurrent malnutrition, they were statistically significantly less likely to have abnormal temperature and heart rate during the ED encounter than those without concurrent malnutrition., Conclusions: Based on these results, children with malnutrition and concurrent diseases with known high morbidity may not present with abnormal vital signs. This may have clinical relevance in patient management to the acute care provider in identifying and triaging children with malnutrition and acute disease conditions., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Sepsis is a leading cause of mortality in noncoronary ICUs. Although immediate start of antibiotics reduces sepsis-related mortality, antibiotics are often administered for too long, leading to suboptimal treatment and, importantly, contributes to antimicrobial resistance. Prior literature suggests that procalcitonin correlates with infection and thus may help to guide the decision on when to stop antibiotic treatment. This study was conducted as part of a regulatory submission to the U.S. Food and Drug Administration and aimed to summarize the evidence of procalcitonin guidance on efficacy and safety outcomes in adult patients with sepsis., Data Sources: PubMed and the Cochrane Database of Systematic Reviews., Study Selection: English-language randomized controlled trials evaluating procalcitonin use among adult patients with suspected or confirmed sepsis published between January 2004 and May 2016., Data Extraction: Inverse-variance weighting fixed and random effects meta-analyses were performed on the following efficacy and safety endpoints: antibiotic duration, all-cause mortality, and length of ICU stay. Two reviewers independently extracted data elements from identified studies and measured risk of bias with the Cochrane Risk of Bias Tool., Data Synthesis: From a total of 369 potentially eligible articles, 10 randomized controlled trials containing 3,489 patients were used for analysis. Procalcitonin-guided patients had shorter antibiotics duration compared with controls (7.35 vs. 8.85 d; weighted mean difference, -1.49 d; 95% CI, -2.27 to -0.71; p < 0.001). Procalcitonin use had no adverse impact on mortality (risk ratio, 0.90; 95% CI, 0.79-1.03; p = 0.114) and length of ICU stay (11.09 d vs. 11.91 d; weighted mean difference, -0.84 d; 95% CI, -2.52 to 0.84; p = 0.329)., Conclusions: In adult patients with suspected or confirmed sepsis, procalcitonin guidance reduces antibiotics duration with no observed adverse effects on patient outcomes.

Objective: To investigate whether HIV-infected individuals diagnosed with tuberculosis (HIV-TB) around the time of starting antiretroviral therapy (ART) have impaired CD4 cell responses to treatment., Design: Analysis of a national cohort of HIV-infected adults, linked to the national TB surveillance system for England, Wales and Northern Ireland, including individuals starting ART from 2005 to 2009., Methods: We compared CD4 cell responses in HIV-infected individuals starting ART with a TB diagnosis ('HIV-TB cohort') with those not known to have TB ('TB-free cohort'). The TB-free cohort was frequency-matched to the HIV-TB cases for sex, age strata, baseline CD4 strata and ethnicity. Median change in CD4 cell count from baseline (ΔCD4) was calculated at 6-monthly intervals until 36 months., Results: There were 593 and 1779 individuals in the HIV-TB and TB-free cohorts, respectively (median follow-up 3.8 years). In both cohorts, median age was 36 years, 49.2% were women and 74.9% were black-African. Median baseline CD4 at the start of treatment was similar in the HIV-TB and TB-free cohorts (74 vs. 80 cells/μl). Median ΔCD4 was similar in HIV-TB and TB-free cohorts at all time points [294 (inter-quartile range 198-424) cells/μl in HIV-TB cohort; 296 (inter-quartile range 196-431) cells/μl in TB-free cohort after 3 years of ART]. A higher proportion of the HIV-TB cohort than the TB-free cohort died during follow-up (4.2 vs. 2.2%; P = 0.01); 78.5% of all individuals who died had a baseline CD4 cell count below 100 cells/μl., Conclusions: Long-term CD4 cell recovery during ART appears similar in HIV-TB and TB-free patients. Significant mortality in both cohorts highlights the need for earlier HIV diagnosis and ART initiation.