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Abstract Despite the dramatic decline in the incidence of common opportunistic infections (OIs) after antiretroviral therapy initiation, they remain a significant cause of morbidity and mortality among children with HIV. For better interventions, information regarding the incidence and predictors of common OIs is essential for Children living with HIV. Still, there is a lack of studies in low and middle-income countries, including Ethiopia. Therefore, this study aims to assess the incidence and predictors of common OIs among Children living with HIV on anti-retroviral therapy (ART) at public health institutions in Bahir Dar City, Northwest Ethiopia. The reasons for excluding children not on ART is we want to study the effectiveness of chronic HIV care service, ART drugs and OIs prophylaxis drugs for the prevention of common OIs because it is obvious that the occurrence of OIs in children not on ART and OIs prophylaxis drugs is high. A health institution-based retrospective cohort study was done among 403 Human Immunodeficiency Virus-infected children at public health institutions in Bahir Dar City from 2010 to 2020. Data was entered using Epi-data version 4.6 and analyzed using STATA 14.0. A bivariable Cox-proportional hazards regression model was employed to appreciate the relationship between each explanatory variable with the outcome variable. In the bivariable analysis, variables with a p-value of less than 0.25 were candidates for the multivariable proportional hazard model. The Cox proportional hazards model was used to determine predictors of common opportunistic infections at a 5% significance level. The overall incidence rate of common opportunistic infections was 7.06 with a 95% confidence interval ((CI) 5.78, 9.75) per 100 person-years of observation. Statically significant predictors were World Health Organization (WHO) clinical stage III and IV (adjusted hazard ratio (AHR) = 1.90; (95% CI 1.34, 2.75), having fair/poor adherence to anti-retroviral therapy (ART) (AHR) = 1.80; (95% CI 1.25, 2.94) and hemoglobin level

Abstract Background Visceral leishmaniasis (VL) is among the world’s most serious public health threats, causing immense human suffering and death. In Ethiopia, little is known about the barriers and facilitators of visceral leishmaniasis case management. This study aimed to explore such barriers and facilitators in the Amhara Regional State, Northwest Ethiopia. Methods An exploratory qualitative study was conducted on 16 purposively selected patients and key informants from May 8 to June 2, 2023. The study participants were recruited using the maximum variation technique. The interviews were audio recorded, transcribed verbatim, and translated into English. Thematic analysis was employed using Atlas.ti 9 software with a blended approach of both deductive and inductive coding. Results The study identified a variety of issues that hinder the success of visceral leishmaniasis case management. Treatment centers face frequent interruptions of medicinal supplies, a lack of funding, and a lack of trained healthcare providers. A lack of support from health authorities, including weak supervision and feedback systems, is also a source of concern. Most patients receive treatments after significant delays, which is primarily due to low awareness, poor surveillance, and misdiagnosis by healthcare workers. The case management is further constrained by malnutrition, VL-HIV co-infection, and other comorbidities. Despite these issues, we found that effective collaboration between hospital units and VL treatment centers, acceptance by hospitals, and the caring attitude of healthcare workers play a positive role in facilitating the program’s effectiveness. Conclusions Despite the existence of certain efforts that facilitate the program’s effectiveness, VL remains largely neglected, with little government attention or intervention. Such inattention is the root cause of most of the issues. Despite limited resources, most issues could be resolved with cost-effective strategies if health authorities at all levels have the will and commitment to do so.

Abstract Background Youth engagement refers to the collaboration between researchers and youth to produce research. Youth engagement in health research has been shown to inform effective interventions aimed at improving health outcomes. However, limited evidence has identified promising practices to meaningfully engage youth. This synthesis aims to describe youth engagement approaches, frameworks, and barriers, as well as provide both evidence-based and youth-generated recommendations for meaningful engagement. Main body This review occurred in two stages: 1) a narrative review of existing literature on youth engagement and 2) a Youth Advisory Council (YAC) to review and supplement findings with their perspectives, experiences, and recommendations. The terms ‘youth engagement’ and ‘health research’ were searched in Google Scholar, PubMed, Web of Science, Scopus, and PsycINFO. Articles and non-peer reviewed research works related to youth engagement in health research were included, reviewed, and summarized. The YAC met with research team members and in separate youth-only forums to complement the narrative review with their perspectives. Types of youth engagement include participation as research participants, advisors, partners, and co-investigators. Barriers to youth engagement were organized into youth- (e.g., time commitments), researcher- (e.g., attitudes towards youth engagement), organizational- (e.g., inadequate infrastructure to support youth engagement), and system-level (e.g., systemic discrimination and exclusion from research). To enhance youth engagement, recommendations focus on preparing and supporting youth by offering flexible communication approaches, mentorship opportunities, diverse and inclusive recruitment, and ensuring youth understand the commitment and benefits involved. Conclusions To harness the potential of youth engagement, researchers need to establish an inclusive and enabling environment that fosters collaboration, trust, and valuable contributions from youth. Future research endeavors should prioritize investigating the dynamics of power-sharing between researchers and youth, assessing the impact of youth engagement on young participants, and youth-specific evaluation frameworks.

Abstract Amidst the global pursuit of sustainable alternatives in concrete production, this study explores the viability of incorporating by-products or waste materials as aggregates to support the concrete construction industry, with a specific emphasis on steel slag. The objective of this study is to evaluate the effectiveness of steel slag as a partial replacement for fine and coarse aggregates in concrete production. The experiment involved casting 30 cubes and 10 beams, replacing fine aggregate from 0 to 60%. Flexural and compressive strength tests at 7 and 28 days followed the ACI method. Results revealed that a 30% replacement of fine aggregate with steel slag led to higher compressive strength at both 7 and 28 days, while a 45% replacement showed superior flexural strength at 28 days. Further chemical analysis and optimization are recommended for deeper insights. The study concludes with marginal improvements in compressive and flexural strength with steel slag partial replacement, identifying 30% for fine aggregate and 45% for coarse aggregate as optimal replacements. In addition, the mineral composition of steel slag exhibits significant variability, with compounds, including silicon dioxide (SiO2), iron oxide (Fe2O3), manganese oxide (MnO), aluminum oxide (Al2O3), and calcium oxide (CaO). Chemical analysis indicates high silicate content and minimal alkali content, contributing to enhanced strength during concreting. Higher steel slag replacement reduces workability, confirmed by slump tests. However, all mixes maintain a true slump, and unit weight increases with steel slag aggregate replacement. Compressive strength improves incrementally with higher steel slag content, echoing prior research. In addition, flexural strength rises with steel slag replacing both coarse and fine aggregates, suggesting enhanced performance in reinforced concrete structures. These findings highlight steel slag’s potential as a sustainable alternative in concrete production, aiming to advance its application in the construction industry, promoting environmental sustainability and economic viability.

Abstract Background Adverse birth outcomes, including preterm birth, low birth weight, and stillbirth, remain a major global health challenge, particularly in developing regions. Understanding the possible risk factors is crucial for designing effective interventions for birth outcomes. Accordingly, this study aimed to develop a predictive model for adverse birth outcomes among childbearing women in Sub-Saharan Africa using advanced machine learning techniques. Additionally, this study aimed to employ a novel data science interpretability techniques to identify the key risk factors and quantify the impact of each feature on the model prediction. Methods The study population involved women of childbearing age from 26 Sub-Saharan African countries who had given birth within five years before the data collection, totaling 139,659 participants. Our data source was a recent Demographic Health Survey (DHS). We utilized various data balancing techniques. Ten advanced machine learning algorithms were employed, with the dataset split into 80% training and 20% testing sets. Model evaluation was conducted using various performance metrics, along with hyperparameter optimization. Association rule mining and SHAP analysis were employed to enhance model interpretability. Results Based on our findings, about 28.59% (95% CI: 28.36, 28.83) of childbearing women in Sub-Saharan Africa experienced adverse birth outcomes. After repeated experimentation and evaluation, the random forest model emerged as the top-performing machine learning algorithm, with an AUC of 0.95 and an accuracy of 88.0%. The key risk factors identified were home deliveries, lack of prenatal iron supplementation, fewer than four antenatal care (ANC) visits, short and long delivery intervals, unwanted pregnancy, primiparous mothers, and geographic location in the West African region. Conclusion The region continues to face persistent adverse birth outcomes, emphasizing the urgent need for increased attention and action. Encouragingly, advanced machine learning methods, particularly the random forest algorithm, have uncovered crucial insights that can guide targeted actions. Specifically, the analysis identifies risky groups, including first-time mothers, women with short or long birth intervals, and those with unwanted pregnancies. To address the needs of these high-risk women, the researchers recommend immediately providing iron supplements, scheduling comprehensive prenatal care, and strongly encouraging facility-based deliveries or skilled birth attendance.

Abstract Background Infection is the most common complication of pediatric patients with nephrotic syndrome. The factors associated with infection in nephrotic syndrome are lacking. The objective of the study was to identify the prevalence and associated factors among children with nephrotic syndrome aged 2 to 18 years. Methods We conducted a hospital-based retrospective cross-sectional study. The data collector installed an Epi5 collector electronic data-collecting tool from Google Play. Then, we exported the data to Stata version 15.1 for analysis. The mean, standard deviation, frequency, and percentage were used for descriptive statistics. The logistic regression model was used to identify the factors associated with infection. Results In this study, the prevalence of infection among nephrotic syndrome children is 39.8% (95%CI: 30.7, 49.7). The types of infection identified were pneumonia, urinary tract infection, diarrheal disease, cutaneous fungal infection, intestinal parasitic infection, and sepsis. The presence of hematuria increased the odds of infection by 5-times. On the other hand, low level of serum albumin increased the odds of infection by 7%. Being a rural resident increased the odds of infection by 3.3-times as compared to urban. Conclusions Serum albumin level, presence of hematuria, and rural residence were significantly associated with infection. We recommended a longitudinal incidence study on large sample size at multicenter to strengthen this finding.

Correct estimation of tree biomass is important when calculating uptake or emission of CO2 in relation to land-use and land-use change. The objectives of this study were (1) to estimate the root/shoot ratio for the estimation of root biomass based on the above-ground biomass (AGB) of Acacia mearnsii, and (2) to develop allometric equations for the estimation of the above-and below-ground biomass (BGB) of Acacia mearnsii. To estimate the AGB and BGB, twenty-four trees of varying ages (3, 4, 5, and 6 years) were harvested, with six trees per age group. We measured the dry biomass for different tree parts and developed allometric models using tree height (H) and diameter at breast height (DBH) as independent variables. The results showed that the biomass of the stem accounted for 69% of the total biomass, followed by branches (14%), roots (8.1%), and leaves (7.3%). The recorded mean root/shoot ratio was 0.11. The biomass of the stem and coarse roots increased with increasing tree age, while a contrary trend was observed for the other tree components. Each component has its unique allometric model.

The objective of this study was to evaluate the best performed bias correction methods to simulate the regional climate models for future climate change projections in Muger Subbasin. Delta change methods perform very well with a coefficient of correlation of 0.99 and a percent of bias –3. When we compare its corrected simulation result with observed data, the delta change method seems to have with no biases for maximum temperature, but increases by 1.67 °C from the mean for minimum temperature of 0.39 and 38.41 mm for monthly and annual precipitation, respectively. Delta change methods underestimate the model result for both temperature and precipitation. Linear scaling and variance scaling methods overestimate the maximum temperature of the simulation by 0.002 and 0.004 °C from the mean of the observed data, but it underestimates 1.59 and 1.56 °C the minimum temperature, respectively. The long-term temperature projection values (2060–2090) are higher than the near-term projections (2030–2060) for both RCP2.6 and RCP8.5 scenarios. Similarly, the change in annual precipitation for the long-term is higher than the near-term projections. As a conclusion, the results draw attention to the fact that bias-adjusted regional climate models data are crucial for the provision of local climate change impact studies in the Muger Subbasin. HIGHLIGHTS It evaluates the method of bias correction methods.; Assess changes in precipitation and temperature in the future.; Select the best bias correction methods.;

Summary: Background: Post-tuberculosis (TB) sequelae present a significant challenge in the management of TB survivors, often leading to persistent health issues even after successful treatment. Identifying risk factors associated with post-TB sequelae is important for improving outcomes and quality of life of TB survivors. This systematic review and meta-analysis aims to identify risk factors associated with long-term physical sequelae among TB survivors. Methods: We systematically searched Medline, Embase, PROQUEST, and Scopus for studies on long-term physical sequelae among TB survivors up to December 12, 2023. The primary outcome of interest was to quantify risk factors of long-term physical sequelae (i.e., respiratory, hepatic, hearing, neurological, visual, renal, and musculoskeletal sequelae). We included all forms of TB patients who experienced long-term physical sequelae. We used narrative synthesis for risk factors reported once and random-effect meta-analysis for primary outcomes with two or more studies. Findings were presented with odds ratios (OR) and 95% confidence intervals (CI). Publication bias was assessed using funnel plots and Egger regression, and heterogeneity was examined with a Galbraith radial plot. The protocol was registered on Prospero (CRD42021250909). Findings: A total of 73 articles from 28 countries representing 31,553 TB-treated patients were included in the narrative synthesis, with 64 of these studies included in the meta-analysis. Risk factors associated with post-TB lung sequelae include older age (OR = 1.62, 95% CI: 1.07–2.47), previous TB treatment history (OR = 3.43, 95% CI: 2.37–4.97), smoking (OR = 1.41, 95% CI: 1.09–1.83), alcohol consumption (OR = 1.84, 95% CI: 1.04–3.25), smear-positive pulmonary TB diagnosis (OR = 3.11, 95% CI: 1.77–6.44), and the presence of radiographic evidence of pulmonary lesions at the commencement of treatment (OR = 2.04, 95% CI: 1.07–3.87). Risk factors associated with post-TB liver injury included pre-existing hepatitis (OR = 2.41, 95% CI: 1.16–6.08), previous TB treatment (OR = 2.64, 95% CI: 1.22–6.67), hypo-albuminemia (OR = 2.10, 95% CI: 1.53–2.88), HIV co-infection (OR = 2.72, 95% CI: 1.66–4.46), and CD4 count

Background Mental health (MH) conditions are prevalent in adolescents with childhood-onset SLE (cSLE). Early identification is crucial in preventing poor patient outcomes; however, MH screening rates remain low.Local problem From July 2021–January 2022, only 15% of adolescents in a paediatric tertiary care cSLE clinic were being screened for depression and anxiety. By November 2023, we aimed to increase the percentage of patients with cSLE (≥12–18 years) screened for depression (Patient Health Questionnaire: PHQ-9) and anxiety (Generalised Anxiety Disorder-7: GAD-7) from 15% to 80%.Methods This quality improvement project employed the Model for Improvement framework. Stakeholders included the clinic team, patients and families, and MH providers. Statistical process control charts were used to analyse the outcome measure for percentage of screened patients with cSLE. Patient and caregiver satisfaction surveys were conducted at baseline and after screening as a balancing measure.Interventions MH screening workflow with a referral algorithm was developed with stakeholders. Additional interventions included two MH training workshops for healthcare providers and a preclinic reminder of eligible patients for screening.Results Over 21 months, 146 patients with cSLE completed 270 MH screens, increasing the screening rate from 15%, peaking at 100%, to a median of 56%. Sixty-six individuals (45%) reported symptoms of depression and/or anxiety on their initial screen. Of 270 screens, 44 individuals (17%) reported moderate to severe symptoms meeting the screening workflow criteria for referral to a MH service; 10% of patients screened were referred and seen by the MH service within 2–12 weeks. Patients and caregivers reported satisfaction with the MH screening process and quality of MH follow-up.Conclusion Despite not sustainably meeting the target, MH screening rates increased in the cSLE clinic by nearly fourfold, demonstrating feasibility and acceptability. Patients expressed satisfaction with their mental health follow-up, emphasising its importance in their care.

Introduction: Foodborne diseases pose a significant global public health threat, often originating from improper food handling practices. Given the crucial role of food handlers in preventing transmission of foodborne diseases, this study assessed the food safety knowledge, attitudes, and hygiene practices related to foodborne diseases among food handlers in food service establishments in Yeka Sub-city, Addis Ababa, Ethiopia. Method: A descriptive cross-sectional study was conducted among 373 randomly selected food handlers. Data collection involved observing the kitchen hygiene practices and food handling practices through an observational checklist, and administering structured/standardized questionnaires. Statistical analysis was performed using SPSS version 20, with associations examined using the linear by linear association test. Spearman’s correlation assessed relationships between knowledge, attitude, and practice cut points. Pre-testing and Cronbach’s alpha were used to ensure the reproducibility, and reliability of the questionnaire. Results: Majority of food handlers (50.1%) were aged less than 25 years, with 78.8% being female, and attended secondary school (46.4%). The overall knowledge (65%), positive attitude (92.2%), and hygiene practices (44%) of the food handlers toward food safety were good. Regarding the knowledge perspective, gaps existed in understanding disease transmission, notably Hepatitis A and tuberculosis. Although positive attitudes toward food safety were reported, observed practices were inconsistent, with a significant proportion admitting to working while ill. Compliance with uniform and protective gear was lacking. Marital status, Experience in food safety, and Work satisfaction has been shown to affect the knowledge, attitude, and hygiene practices of food handlers in this study. Conclusion: This study highlights critical gaps in understanding disease transmission, and hygiene practices of food handlers in Yeka sub-city. Addressing these gaps will necessitate targeted interventions, including continuous education and training programs. Enhanced regulatory oversight is also needed to ensure compliance with food safety standards in public food establishments.

Objective: To develop and validate a social capital assessment tool that considers the cultural and social realities of north-western Ethiopia. Methods: A mixed-methods approach was applied through rigorous phases. Existing measurement approaches for social capital are reviewed. Additionally, a qualitative study was conducted for domain and item identification. The domains and their items were given to panel experts and rated for content validity. Cognitive interviews were conducted with mothers who gave birth in the previous year. For psychometric validation of the tool, 400 mothers who lived in South Gondar zone participated from January 2 to 27, 2023. Results: Five factors of structural social capital were extracted. These include group participation, emotional, social, financial, and informational support. The content validity index of the scale was 0.88, indicating that 88% of the experts rated the items of the scale as relevant. The loading of the items ranged from 0.505 to 0.858, exceeding the threshold of 0.50. For cognitive social capital, factor analysis grouped 43 items into four subscales: trust in social networks, trust in institutions, trust in the health care system, and social cohesion. The loadings of the items ranged from 0.507 to 0.913. The internal consistency reliability of the scale was excellent, with a Cronbach’s alpha of 0.901. Conclusion: The Maternal Social Capital Assessment Tool is a valid and reliable instrument for measuring social capital during pregnancy, childbirth, and the postpartum period. The application of such a tool could allow us to decipher the influence of social capital on maternal health.

BackgroundFertility rates are key indicators of population health and demographic change, influencing economic development, healthcare planning, and social policies. Understanding subnational variation in fertility rate is important for effective geographical targeting and policy prioritization. This study aimed to identify geographic variation, trends, and determinants of fertility rates in Ethiopia over the past two decades.MethodsWe estimated total fertility rates (TFRs) and age-specific fertility rates (ASFRs) using five nationally representative cross-sectional Demographic and Health Surveys collected in Ethiopia between 2000 and 2019. ASFRs represent the number of live births per 1,000 women aged 15 to 49 during the 3 years before each survey, while TFRs indicate the average number of children a woman would have by the end of her reproductive years, calculated as the sum of ASFRs over five-year intervals. We developed model-based geostatistics by incorporating demographic and healthcare access data with spatial random fields to produce high-resolution fertility rate maps. These results were then aggregated to produce fertility rate estimates at local, sub-national, and national levels in Ethiopia.ResultsThe national TFR gradually declined from 4.8 live births in 2000 to 4.2 live births in 2019, but it is still above the replacement level of 2.1 children per woman. There were sub-national and local variations in TFR, ranging from 5.7 live births in Somalia and 5.3 Oromia regions to 2.7 live births in Addis Ababa and 3.6 live births Dire Dawa cities. Geographical areas with high TFR were mostly associated with a high proportion of Muslim women and low access to health facilities.ConclusionDespite a decline in fertility rates among women of reproductive age over the past two decades, marked spatial variation persists at sub-national and local levels in Ethiopia, with demographic factors determining the spatial distribution and rate of decline, highlighting the need for tailored programs and strategies in high-fertility areas to increase access to family planning.

Objective: This study aimed to elucidate the microbiological and clinical characteristics of patients affected by infection caused by S.maltophilia in a tertiary hospital in the north-east of Brazil. Methodology: The study consisted of a retrospective analysis of microbiological samples from January 2022 to September 2023 from the microbiology department of the Walter Cantídio University Hospital, Fortaleza, Ceará. The prevalence of these infections was determined, along with the epidemiology and antimicrobial sensitivity profile to sulphamethoxazole/trimethoprim (SMX-TMP) and levofloxacin. Clinical characteristics of the affected patients were identified, such as the use of mechanical ventilation (MV), hemodialysis (HD), previous use of antimicrobials and the outcome of these patients. Results: The prevalence of S.maltophilia infections was 1.79% in the period (35 positive samples and 26 affected patients). Of the positive clinical isolates, there was a predominance from the respiratory tract, with 23 samples (61.43%) from tracheal aspirates and 5 samples from bronchoalveolar lavage (14.57%). The highest number of positive samples was identified in the clinical ICU (23 isolates). About SMX-TMP, 65.71% of the strains were sensitive to increased exposure, 5.71% were fully sensitive and 28.57% were resistant. A profile of strains predominantly sensitive to levofloxacin was observed (91.49%), with 5.71% of the isolates proving sensitive by increasing exposure and 2.85% proving resistant. Women were more affected (57.69%). The average age was 54.33 years. Patients undergoing HD during the infection accounted for 53.84% of the profile obtained, while the use of MV occurred in around 69.23% of those infected. All patients had previously used antimicrobials. 19 patients (69.23%) died and only 7 were discharged from hospital (30.76%). Conclusion: With the findings, it was possible to determine a predominant profile of critically ill patients, with greater involvement of the respiratory tract. We also identified considerable rates of resistance to SMX-TMP, as well as an association between S. maltophilia infection and death.

This study investigates how effectively Intergovernmental Authority on Development (IGAD) has addressed the crisis in Somalia since 1991, using realism theory as its analytical framework. It employs a qualitative case study approach to delve into IGAD's interventions and their implications, conducting an in-depth analysis of IGAD's official documents, resolutions, and crisis-related reports concerning Somalia. By applying realism theory, the study scrutinizes IGAD's actions and motivations from a perspective centered on power politics, highlighting the significance of state interests and regional stability. It suggests that IGAD member states may resist to cooperate when they perceive IGAD's engagement in Somalia is regarded as a threat to their security interests. Despite IGAD's numerous peace initiatives, achieving sustainable peace in Somalia remains elusive. The paper asserts that while IGAD has made substantial efforts to resolve the Somalia conflict, its effectiveness has been constrained by the complexity of the conflict, external influences, and divergent interests among member states. To enhance IGAD's effectiveness, the study recommends various actions, including promoting regional economic integration, mobilizing external resources, improving transparency and accountability, fostering regional identity and solidarity, and maintaining a balanced power dynamic to prevent dominance by any single entity. Applying these measures could significantly improve IGAD's capacity to support peace and stability in Somalia and the entire East Africa region.

Introdução: O transplante renal constitui o tipo de transplante mais realizado no Brasil. O tacrolimo é um dos principais fármacos utilizados na terapia imunossupressora pós-transplante e possui como um de seus principais efeitos adversos a nefrotoxicidade. Os exames laboratoriais de avaliação da função renal possuem grande importância no acompanhamento de pacientes pós-transplante renal, auxiliando no diagnóstico de eventos indicativos de disfunção do enxerto. Objetivo: O presente estudo objetivou avaliar a associação entre alterações laboratoriais de função renal e os níveis sanguíneos de tacrolimo em pacientes pós-transplante renal. Métodos: Estudo observacional, analítico e transversal. Foram analisados os resultados dos níveis sanguíneos de tacrolimo e das dosagens de ureia, creatinina e estimativa da Taxa de Filtração Glomerular (eTFG), bem como os dados sociodemográficos de receptores de transplante renal acompanhados em um hospital universitário, que realizaram exames laboratoriais entre os meses de janeiro de 2021 e julho de 2022 no período próximo a 1 ano após a realização do transplante. As variáveis analisadas na pesquisa foram colhidas a partir dos registros dos prontuários dos pacientes e posteriormente analisadas, as análises estatísticas consideraram p < 0,05. O projeto foi aprovado pelo Comitê de Ética do Hospital Universitário Walter Cantídio sob o parecer número 5.436.434 e CAAE número 57396622.1.0000.5045. Resultados: A amostra foi composta, majoritariamente, pelo sexo masculino, cor parda, idade média de 51,5 anos (DP ± 12,5) e de cidades do interior do Ceará. Quanto ao percentual de pacientes com alterações laboratoriais, 50,62% (n = 45) deles apresentaram alterações dos níveis sanguíneos de tacrolimo; ainda, 56,79% (n = 46) apresentaram alterações na dosagem de creatinina sérica, 49,38% (n = 40) apresentaram alterações na dosagem de ureia sérica e 59,26% (n = 48) apresentaram uma eTFG alterada. As análises de correlação realizadas sugeriram uma baixa significância entre variações das variáveis estudadas. Conclusão: Os resultados obtidos sugerem não existir relação entre variações das concentrações sanguíneas de tacrolimo e o surgimento de alterações nos resultados de biomarcadores renais clássicos ao final do primeiro ano pós-transplante. Entretanto, faz-se necessária a realização de novos estudos para uma maior compreensão do impacto causado por alterações dos níveis sanguíneos de tacrolimo na função renal de receptores de aloenxerto renal.

Objectives Our understanding of the contribution of new presentations versus pre-existing eating disorders during the COVID-19 pandemic is limited. This study aims to evaluate rates of emergency department (ED) visits and hospitalizations for eating disorders among adolescents and young adults (YA) new to care and those with pre-existing eating disorders during the pandemic. Approach We conducted a population-based cross-sectional study using linked health administrative data for Ontario residents aged 10-26 during the pre-pandemic (Jan. 1, 2017-Feb. 29, 2020) and pandemic periods (Mar. 1, 2020-Jun. 30, 2022). We used Poisson generalized estimating equations models to predict expected overall and monthly rates of eating disorder-related ED visits and hospitalizations among those with a new and pre-existing eating disorder. Results Compared with expected rates, ED visits increased during the pandemic among only adolescents with new eating disorders (adolescent RR 2.12, 95% CI [1.84,2.45]). Additionally, both adolescents and YA with pre-existing eating disorders experienced an increase in ED visits (RR 2.78, 95% CI [2.28, 3.38] and RR 1.52, 95% CI [1.25, 1.85], respectively). Similarly, hospitalizations for new presentations increased solely for adolescents (RR 1.48, 95% CI [1.34,1.64]), while hospitalizations for pre-existing eating disorders increased for both adolescents (RR 1.82, 95% CI [1.43,2.32]) and YA (RR 1.12, 95% CI [1.01,1.23]). Conclusions There was an increase in acute care visits for eating disorders during the pandemic, especially among adolescents and YA with pre-existing conditions. This differentiation is important in advancing our understanding of the pandemic's effects on adolescents and YA and the healthcare system receiving them.

Background Psychiatric conditions are common amongst hospitalized children. Co-occurring psychiatric conditions for medical hospitalizations contribute to length of stay, costs, and readmissions. We sought to measure trends over 20 years in pediatric hospitalizations for co-occurring medical and psychiatric conditions and compare with those without psychiatric comorbidity, overall and in free-standing children’s hospitals. Methods We identified all 3- to 17-year-olds hospitalized in Ontario, Canada between April 1, 2003 and March 31, 2022. Using health record discharge diagnoses, hospitalizations were assigned to 1 of 4 groups: 1) medical-diagnosis-only, 2) psychiatric-diagnosis-only, 3) primary medical diagnosis with psychiatric comorbidity, and 4) primary psychiatric diagnosis with medical comorbidity. Hospitalization trends for 1) all hospitals, and 2) free-standing children’s hospitals were described and compared. Results From 2003 to 2022, medical-diagnosis-only hospitalizations declined 39% (41,909 to 25,486 hospitalizations), psychiatric-diagnosis-only hospitalizations increased 96% (3227 to 6337), medical hospitalizations with psychiatric comorbidity increased 127% (977 to 2221) and psychiatric hospitalizations with medical comorbidity increased 100% (2051 to 4096). Among pediatric hospitals, medical-diagnosis-only hospitalizations increased 23% (12,430 to 15,318), psychiatric-diagnosis-only hospitalizations increased 420% (271 to 1408), psychiatric hospitalizations with medical comorbidity increased 172% (539 to 1468) and medical hospitalizations with psychiatric comorbidity increased 235% (478 to 1599). Conclusions Hospitals have experienced large absolute and relative increases in volumes for psychiatric conditions both with and without co-occurring medical conditions, particularly among free-standing children’s hospitals. Healthcare provider training, hospital resourcing, and health system planning must consider how best to accommodate the increasing acute psychiatric care needs of hospitalized children and adolescents.

BackgroundThe transition from pediatric to adult care poses a significant health system–level challenge impeding the delivery of quality health services for youth with chronic health conditions. In Canada and globally, the transition to adult care is regarded as a top priority in adolescent health in need of readily applicable, adaptable, and relevant national metrics to evaluate and benchmark transition success across disease populations and clinical care settings. Unfortunately, existing literature fails to account for the lack of engagement from youth and caregivers in developing indicators, and its applicability across chronic conditions, primary care involvement, and health equity considerations. ObjectiveOur proposed study aims to establish a consensus-driven set of quality indicators for the transition to adult care that are universally applicable across physical, developmental, and mental health conditions, clinical care settings, and health jurisdictions. MethodsUsing an integrated knowledge translation (iKT) approach, a panel comprising youth, caregivers, interdisciplinary health care providers, and health system leaders will be established to collaborate with our research team to ensure that the study methodology, materials, and knowledge dissemination are suitable and reflect the perspectives of youth and their families. We will then conduct an iterative 3-round Online Modified Delphi (OMD) study (n=160) to (1) compare and contrast the perspectives of youth, caregivers, health care providers, and health system leaders on quality indicators for transition; and (2) prioritize a key set of quality indicators for transition applicable across disease populations that are the most important, useful, and feasible in the Canadian context. Using the RAND/UCLA Appropriateness Method (RAM) multistage analytic approach, data from each panel and stakeholder group will be examined separately and compared to establish a key set of indicators endorsed by both panels. ResultsThe study is funded by the Canadian Institutes of Health Research and Physicians Services Incorporated. ConclusionsThis study will produce quality indicators to evaluate and inform action equitably to improve transition from pediatric to adult care for youth and their families in Canada. International Registered Report Identifier (IRRID)PRR1-10.2196/60860

Anthropogenic climate change is increasing the frequency and severity of extreme heat events, leading to increased morbidity and mortality. Many of the populations at greatest risk from the health threats of extreme heat are also more likely to receive health insurance coverage from the Medicaid program. While Medicaid has not historically covered air conditioners, an increasing number of states are offering coverage. Of the Medicaid programs administered by the 50 states and Washington DC, 13 currently offer an air conditioner coverage benefit and 2 have applied to offer coverage to the federal government. Most of these states have obtained various types of waivers under the Social Security Act to cover air conditioners. Section 1115 waivers tend to offer more flexible and holistic coverage. The states offering coverage vary in the types of air conditioners covered, the approximate frequency with which air conditioners have been furnished, and the billing codes utilized. The lack of a specific billing code or procedure modifier code for air conditioners is a barrier to tracking the effectiveness, reach, and implementation of air conditioner coverage policies within and across states.