BACKGROUND: Respiratory syncytial virus (RSV) is associated with substantial morbidity among infants. This study modelled the potential public health and economic impact of nirsevimab, a long-acting monoclonal antibody, as an immunoprophylactic strategy for all infants in Spain in their first RSV season.
METHODS: A static decision-analytic model of the Spanish birth cohort during its first RSV season was developed to estimate the impact of nirsevimab on RSV-related health events and costs versus the standard of practice (SoP). Spain-specific costs and epidemiological data were used as model inputs. Modelled outcomes included RSV-related outpatient visits, emerging room (ER) visits, hospitalisations - including pediatric intensive care unit (PICU) admission, mechanical ventilation, and inpatient mortality.
RESULTS: Under the current SoP, RSV caused 151,741 primary care visits, 38,798 ER visits, 12,889 hospitalisations, 1,412 PICU admissions, and 16 deaths over a single season, representing a cost of €71.8 million from a healthcare payer perspective. Universal immunisation of all infants with nirsevimab was expected to prevent 97,157 primary care visits (64.0% reduction), 24,789 ER visits (63.9%), 8,185 hospitalisations (63.5%), 869 PICU admissions (61.5%), and 9 inpatient deaths (52.6%), saving €47.8 million (62.4%) in healthcare costs.
CONCLUSIONS: These results suggest that immunisation with nirsevimab of all infants experiencing their first RSV season in Spain is likely to prevent thousands of RSV-related health events and save considerable costs versus the current SoP.

OBJECTIVE: Spontaneous subarachnoid haemorrhage (SAH) and unruptured intracranial aneurysm (UIA) epidemiology is valuable for determining neurosurgical and general healthcare effectiveness· There is an information gap regarding these conditions in middle- and low-income countries· Therefore, we aimed to investigate their hospitalisation and mortality rates in Brazil from 2011-2019· METHODS: This observational, population-based study used hospital admission and mortality data and included all SAH- and UIA-related public hospitalisations and deaths occurring from 2011-2019· Data were obtained from the Ministry of Health\'s National Hospitalisation and Mortality Information Systems· Population data were obtained from the Brazilian Institute of Geography and Statistics· Simple linear regression models with normal responses were adjusted to explain the temporal evolution of variables· Joinpoint regression models were adjusted to detect moments of significant change in variable behaviour· Graduated choropleth maps were generated using georeferencing and geospatial analyses· RESULTS: The annual SAH hospitalisation and mortality coefficients were 4·81 and 2·49/100,000 persons, respectively· The unruptured intracranial aneurysm hospitalisation and mortality coefficients were 1·21 and 0·24/100,000 persons, respectively· In addition to regional differences, we found a stable SAH hospitalisation trend and an increasing mortality rate of 0·062 cases/100,000 inhabitants annually· The UIA hospitalisation rate increased by 0·074 cases/100,000 inhabitants annually and mortality decreased by 0·07 deaths/100,000 inhabitants annually· CONCLUSION: In Brazil, the SAH hospitalisation trend is stable, while there is a worrisome increasing SAH-related mortality trend· A better scenario was observed for an UIA, with an increase in hospitalisations and decrease in mortality·.

OBJECTIVE: Motivation to change is an important predictor for treatment outcomes in individuals with anorexia nervosa (AN), however, the existence and clinical relevance of distinct motivational dimensions are understudied. This study aimed to structurally validate the AN Stage of Change Questionnaire (ANSOCQ) in the Italian adult AN population to identify separate motivational dimensions and their association with clinical variables and outcomes.
METHODS: Inpatients and outpatients with AN (N = 300) completed the ANSOCQ and measures assessing eating and depressive psychopathology. Unique Variable Analysis and Exploratory Graph Analysis were employed to identify dimensions in the network structure of ANSOCQ. Cross-sectional associations with clinical variables were assessed in the whole sample. Predictive value on weight and psychopathology was assessed in inpatients.
RESULTS: Two dimensions were identified, one comprising items relative to weight gain, and the second items regarding attitudes towards eating, body, and emotional problems. Feelings associated with eating resulted as most central in the network. Higher scores in the first dimension and ANSOCQ total predicted weight gain during hospitalisation. No significant predictors emerged for changes in eating psychopathology.
CONCLUSIONS: These findings confirm the robust psychometric properties of ANSOCQ and provide support for the use of its subdimensions in clinical practice.

BACKGROUND: Identifying potential factors correlated with the sustained presence of antibodies in plasma may facilitate improved retrospective diagnoses and aid in the appraisal of pertinent vaccination strategies for various demographic groups. The main objective was to describe the persistence of anti-spike IgG one year after diagnosis in children and analyse its levels in relation to epidemiological and clinical variables.
METHODS: A prospective, longitudinal, observational study was conducted in a university reference hospital in the Metropolitan Region of Barcelona (Spain) (March 2020-May 2021). This study included patients under 18 years of age with SARS-CoV-2 infection (positive PCR or antigen tests for SARS-CoV-2). Clinical and serological follow-up one year after infection was performed.
RESULTS: We included 102 patients with a median age of 8.8 years. Anti-spike IgG was positive in 98/102 (96%) 12 months after the infection. There were higher anti-spike IgG levels were noted in patients younger than 2 years (p = 0.034) and those with pneumonia (p < 0.001). A positive and significant correlation was observed between C-reactive protein at diagnosis and anti-spike IgG titre one-year after diagnosis (p = 0.027).
CONCLUSIONS: Anti-SARS-CoV-2 IgG antibodies were detected in almost all paediatric patients one year after infection. We also observed a positive correlation between virus-specific IgG antibody titres with SARS-CoV-2 clinical phenotype (pneumonia) and age (under 2 years old).

BACKGROUND: Inactivity and bedrest during hospitalisation have numerous adverse consequences, and it is especially important that older patients are mobile during hospitalisation. This study aimed to identify whether the introduction of formal education of clinical staff and a Mobilisation Initiative (MI) could increase mobilisation of patients in a geriatric and a medical ward. Furthermore, to explore patients\' and health care staffs\' view on facilitators and barriers for mobilisation during hospitalisation.
METHODS: The study was a pragmatic clinical study. Both qualitative and quantitative methods were used. The patients\' level of mobilisation was obtained through short interview-based surveys and observations. Focus group interviews and formal education of clinical staff was initiated to increase awareness of mobilisation along with the implementation of a MI.
RESULTS: 596 patient surveys were included. Of all patients, 50% in the geriatric ward and 70% in the medical ward were able to independently mobilise. The highest percentage of patients sitting in a chair for breakfast and lunch in the geriatric ward was 57% and 65%, and in the medical ward 23% and 26%, respectively. A facilitator for mobilisation was interdisciplinary collaboration, and barriers were lack of chairs and time, and the patients\' lack of help transferring.
CONCLUSIONS: This study adds new knowledge regarding the lack of in-hospital mobilisation in geriatric and medical departments. Mealtimes are obvious mobilisation opportunities, but most patients consume their meals in bed. A potential for a MI is present, however, it must be interdisciplinarily and organisationally anchored for further investigation of effectiveness.
BACKGROUND: Retrospectively registered at ClinicalTrials.gov with the trial number NCT05926908.

UNASSIGNED: The final year of life is often associated with increasing health complexities and use of health services. This frequently includes admission to an acute hospital which may or may not convey overall benefit. This uncertainty makes decisions regarding admission complex for clinicians. There is evidence of much variation in approaches to admission.
UNASSIGNED: To explore how Primary Care clinicians approach hospitalisation decisions for people in the final year of life.
UNASSIGNED: Systematic literature review and narrative synthesis.
UNASSIGNED: We searched the following databases from inception to April 2023: CINAHL, Cochrane Library, Embase, MedLine, PsychInfo and Web of Science followed by reference and forward citation reviews of included records.
UNASSIGNED: A total of 18 studies were included: 14 qualitative, 3 quantitative and 1 mixed methods study. As most of the results were qualitative, we performed a thematic analysis with narrative synthesis. Six key themes were identified: navigating the views of other stakeholders; clinician attributes; clinician interpretation of events; the perceived adequacy of the current setting and the alternatives; system factors and continuity of care.
UNASSIGNED: This review shows that a breadth of factors influence hospitalisation decisions. The views of other stakeholders take great importance but it is not clear how these views are, or should be, should be balanced. Clinician factors, such as experience with palliative care and clinical judgement, are also important. Future research should focus on how different aspects of the decision are balanced and to consider if, and how, this could be improved to optimise patient-centred outcomes and use of health resources.

OBJECTIVE: To determine demographic and clinical characteristics associated with uptake of COVID-19 vaccines among pregnant women, and quantify the relationship between vaccine uptake and admission to hospital for COVID-19.
BACKGROUND: Pregnant women are at increased risk of severe adverse outcomes from COVID-19. Since April 2021, COVID-19 vaccines were recommended for pregnant women in the UK. Despite this, evidence shows vaccine uptake is low. However, this evidence has been based only on women admitted to hospital, or on qualitative or survey-based studies.
METHODS: Retrospective cohort study including all pregnancies ending between 18 June 2021 and 22 August 2022, among adult women registered with a Northwest London general practice. Statistical analyses were mixed-effects multiple logistic regression models. We conducted a nested case-control analysis to quantify the relationship between vaccine uptake by end of pregnancy and hospitalisation for COVID-19 during pregnancy.
RESULTS: Our study included 47,046 pregnancies among 39,213 women. In 26,724 (57%) pregnancies, women had at least one dose of vaccine by the end of pregnancy. Uptake was lowest in pregnant women aged 18-24 (33%; reference group), Black women compared with White (37%; OR 0.55, 95% CI: 0.51 to 0.60), and women in more deprived areas (50%; reference group). Women with chronic conditions were more likely to receive the vaccine than women without (Asthma OR 1.21, 95% CI: 1.13 to 1.29). Patterns were similar for the second dose. Women admitted to hospital were much less likely to be vaccinated (22%) than those not admitted (57%, OR 0.22, 95% CI: 0.15 to 0.31).
CONCLUSIONS: Women who received the COVID-19 vaccine were less likely to be hospitalised for COVID-19 during pregnancy. COVID-19 vaccine uptake among pregnant women is suboptimal, particularly in younger women, Black women, and women in more deprived areas. Interventions should focus on increasing uptake in these groups to improve health outcomes and reduce health inequalities.

BACKGROUND: TB is a leading infectious cause of death worldwide. The COVID-19 pandemic raised concerns that the burden of TB disease and death would increase due to the synergy between the two conditions.
METHODS: We used individual-level data submitted to the WHO Global Clinical Platform for COVID-19 on hospitalised patients to explore associations of TB with mortality using multivariable logistic regression.
RESULTS: Data were available from 453,233 persons with COVID-19 and known TB status and mortality outcomes from 62 countries (96% SARS-CoV-2 test-positive). Of these, 48% were male, and the median age was 53 years (IQR 38-67). There were 8,214 cases with current TB reported by 46 countries, mainly from Africa. Of people with current TB, 31.4% were admitted with severe illness, and 24.5% died. Current TB was independently associated with higher mortality when adjusted for age, sex, HIV status, illness severity at hospital admission, and underlying conditions (adjusted RR 1.47, 95% CI 1.35-1.61).
CONCLUSIONS: Current or past TB were independent risk factors for in-hospital mortality regardless of illness severity at admission. Caveats for interpretation include changes during the data collection period (viral variation, vaccination coverage) and opportunistic sampling. However, the platform exemplifies how timely, coordinated global reporting can inform our understanding of health emergencies and the vulnerable populations affected.
BACKGROUND: La TB est l\'une des principales causes infectieuses de décès dans le monde. La pandémie de COVID-19 a fait craindre que le fardeau de la TB et des décès n\'augmente en raison de la synergie entre les deux maladies.
UNASSIGNED: Nous avons utilisé les données individuelles soumises à la Plateforme clinique mondiale de l\'OMS pour la COVID-19 sur les patients hospitalisés pour explorer les associations entre la TB et la mortalité à l\'aide d\'une régression logistique multivariée.
UNASSIGNED: Des données étaient disponibles sur 453 233 personnes atteintes de COVID-19 et connues pour le statut de TB et les résultats de mortalité dans 62 pays (96% de tests positifs au SRAS-CoV-2). Parmi eux, 48% étaient des hommes et l\'âge médian était de 53 ans (IQR 38–67). Un total de 8 214 cas de TB ont été signalés par 46 pays, principalement en Afrique. Parmi les personnes atteintes de TB actuelle, 31,4% ont été admises avec une maladie grave et 24,5% sont décédées. La TB actuelle était indépendamment associée à une mortalité plus élevée lorsqu\'elle était ajustée en fonction de l\'âge, du sexe, du statut VIH, de la gravité de la maladie à l\'admission à l\'hôpital et des affections sous-jacentes (RR ajusté 1,47 ; IC à 95% 1,35–1,61).
CONCLUSIONS: La TB actuelle ou passée était un facteur de risque indépendant de mortalité à l\'hôpital, quelle que soit la gravité de la maladie à l\'admission. Les mises en garde concernant l\'interprétation comprennent les changements au cours de la période de collecte des données (variation virale, couverture vaccinale) et l\'échantillonnage opportuniste. Cependant, la plateforme illustre comment des rapports mondiaux opportuns et coordonnés peuvent éclairer notre compréhension des urgences sanitaires et des populations vulnérables touchées.

OBJECTIVE: To describe the trends of hospitalisation for infections in people with diabetes and in the general population.
METHODS: People with diabetes were identified from the Australian National Diabetes Services Scheme linked to hospitalisation datasets from 2010/11 to 2018/19. Data on hospitalisations in the general population were obtained from the Australian Institute of Health and Welfare. Joinpoint regression software was used to calculate the annual percentage change (APC) of rates.
RESULTS: The rate of hospitalisation for total infections increased with an APC of 2.6% (95% CI: 1.5, 3.7) among people with type 1 diabetes, 3.6% (2.6, 4.6) among people with type 2 diabetes, and 2.5% (1.3, 3.9) in the general population. Increasing rates were observed for sepsis, influenza, kidney infections, osteomyelitis, cellulitis, and foot infections in all groups. The rate of hospitalisation for urinary tract infection declined among people with type 2 diabetes though it was stable in other groups. The rate of hospitalisation for respiratory tract infections was stable among people with type 1 diabetes but increased in other groups. The rate of hospitalisation for gastrointestinal infection was stable in all cohorts.
CONCLUSIONS: Hospitalisation rates for infection have increased more rapidly over time in people with diabetes than in the general population.

BACKGROUND: The use of seclusion in Adolescent Inpatient Psychiatric Units is being heavily scrutinised due to its forceful nature and potential to cause harm. This study aimed to understand staff perspectives on reasons for seclusion in an Adolescent Inpatient Psychiatric Unit.
METHODS: A mixed methods approach that included the Attitudes to Seclusion Survey followed by a semi-structured interview on the reasons for seclusion was used. We recruited 31 participants who worked on the unit of which 27 were involved in seclusion.
RESULTS: The findings showed that the majority of staff view seclusion as undesirable and believe it should only be used out of necessity. However, there was disagreement among staff about the reasons why adolescents were secluded and whether those reasons were justified. Staff identified factors that contributed to increases in seclusion but also provided several ways in which seclusion could be reduced.
CONCLUSIONS: These findings highlight a need for precision on what constitutes justifiable use of seclusion to reduce the potential for misuse. It also shows opportunities exist for further reduction in seclusion through teamwork and communication.