OBJECTIVE: This study aimed to examine the diagnostic pathways and outcomes of patients with heart failure (HF), stratified by left ventricular ejection fraction (EF), and to highlight deficiencies in real-world HF diagnosis and management.
RESULTS: We conducted a retrospective cohort study in Salford, United Kingdom, utilizing linked primary and secondary care data for HF patients diagnosed between January 2010 and November 2019. We evaluated characteristics, diagnostic patterns, healthcare resource utilization, and outcomes. Patients were categorized according to baseline (the latest measure prior to or within 90 days post-diagnosis) as having HF with reduced EF (HFrEF), mildly reduced EF (HFmrEF), or preserved EF (HFpEF). The data encompassed a 2 year period before diagnosis and up to 5 years post-diagnosis. A total of 3227 patients were diagnosed with HF between January 2010 and November 2019. The mean follow-up time was 2.6 [±1.9 standard deviation (SD)] years. The mean age at diagnosis was 74.8 (±12.7 SD) years, and 1469 (45.5%) were female. HFpEF was the largest cohort (46.6%, npEF = 1505), HFmrEF constituted 16.1% (nmrEF = 520), and HFrEF 18.5% (nrEF = 596) of the population, while 18.8% (nu = 606) of patients remained unassigned due to insufficient evidence to support categorization. At baseline, measurement of natriuretic peptide (NP; brain NP and N-terminal pro-B-type NP) and echocardiographic report data were available for 592 (18.3%) and 2621 (81.2%) patients, respectively. A total of 2099 (65.0%) of the HF cohort had access to a cardiology-led outpatient clinic prior to the HF diagnosis, and 602 (18.7%) attended cardiac rehabilitation post-diagnosis. The 5 year crude survival rate was 37.8% [95% confidence interval (CI) (35.2-40.7%)], 42.3% [95% CI (38.0-47.2%)], and 45.5% [95% CI (41.0-50.4%)] for HFpEF, HFrEF, and HFmrEF, respectively.
CONCLUSIONS: Low survival rates were observed across all HF groups, along with suboptimal rates of NP testing and specialist assessments. These findings suggest missed opportunities for timely and accurate HF diagnosis, a pivotal first step in improving outcomes for HF patients. Addressing these gaps in diagnosis and management is urgently needed.

Hospitalization is a \"reachable moment\" for people who inject drugs (PWID), but preventive care including HIV testing, prevention and treatment is rarely offered within inpatient settings.
We conducted a multisite, retrospective cohort study of patients with opioid use disorder with infectious complications of injection drug use hospitalized between 1/1/2018-12/31/2018. We evaluated HIV care continuum outcomes using descriptive statistics and hypothesis tests for intergroup differences.
322 patients were included. Of 300 patients without known HIV, only 2 had a documented discussion of PrEP, while only 1 was prescribed PrEP on discharge. Among the 22 people with HIV (PWH), only 13 (59%) had a viral load collected during admission of whom all were viremic and 10 (45%) were successfully linked to care post-discharge. Rates of readmission, Medicaid or uninsured status, and unstable housing were high in both groups.
We observed poor provision of HIV testing, PrEP and other HIV services for hospitalized PWID across multiple U.S. medical centers. Future initiatives should focus on providing this group with comprehensive HIV testing and treatment services through a status neutral approach.

Reaching urban poor populations poses challenges for equitable immunization coverage. Furthermore, COVID disrupted routine immunization services. In Mumbai, India, first dose diphtheria tetanus pertussis containing vaccine (DTPCV1)coverage dropped from 88% (2019) to 76% (2021). We identified and characterized 125 zero-dose (those withoutDTPCV1)migrant children in urban Mumbai in October 2022. Almost half were born elsewhere than Mumbai; 53% resided at their present location for less than a year. More than half were 12-59 months of age, well-beyond the age for first routine childhood immunizations.Three of four zero dose children had received birth dose vaccination in the hospital; but failed to receive DTPCV1. Vaccine hesitancy, awareness gaps and operational issues were common reasons for non-vaccination. Despite frequent visits to health facilities for illness,only a third of facility staff asked or advised parents about vaccination.Missed opportunities were much more common in private than government facilities.For the vast majority (88%), residential sites were included in local routine immunization micro-plans and distances to immunization sites were short (less than 1 km for 94 % of families).However, planned session frequency was inadequate half of the time. Expanded efforts to reach migrant urban poor children are needed to ensure vaccine equity.

Missed opportunity (MO) for IPTp SP remains high in Nigeria even among pregnant women with four or more ANC visits. We assessed the current MO rate and its predictors, using data from the 2021 MIS.
We carried out a secondary analysis of data of women who had at least one live birth and at least 4 ANC visits. Bivariate analyses assessed the relationship between socio-demographic characteristics, type of ANC facility, type of ANC provider, knowledge of malaria prevention, awareness about IPT, and missed opportunity using the Chi-square test. Multivariate analyses were presented as odd ratios at 95% CI, (P value <0.05).
Nearly half (47%) had only primary education or none at all. About 30% were poor. Most had their 1st visit ANC in the 2nd trimester (58%). The missed opportunity rate was 55%. Predictors included age 20 to 34 years [aOR 1.3(1.1-1.67)], being very poor [aOR 1.6(1.1-2.4)], late ANC (in 2nd or 3rd trimester) [aOR 0.57(0.4-0.89)], ignorance about malaria prevention [aOR 1.8(1.4-2.4)], ignorance about IPT [aOR 1.3(1.3-2.5)] and residence in the South South and North East [aOR 0.46(0.31-0.68)] regions.
The missed opportunity was high. Place of residence, poor knowledge of malaria prevention and IPT use, late commencement of ANC, poverty, and young age (20 to 34 years) contributed to the burden. Recommendations include stressing the importance of IPT during health talks. Provision of cups and drinking water for the IPT DOT policy by the Government and partners. There is a need for further research to unravel the reasons for the higher MO rates in some regions.
Les opportunités manquées (OM) pour le TPIp SP restent élevées au Nigéria, même parmi les femmes enceintes ayant effectué quatre visites ou plus aux soins prénatals. Nous avons évalué le taux actuel d\'OM et ses prédicteurs en utilisant les données de l\'Enquête sur les Indicateurs du Paludisme de 2021.
Nous avons réalisé une analyse secondaire des données des femmes ayant eu au moins une naissance en vie et au moins quatre visites de soins prénatals. Les analyses bivariées ont évalué la relation entre les caractéristiques sociodémographiques, le type d\'installation de soins prénatals, le type de prestataire de soins prénatals, la connaissance de la prévention du paludisme, la sensibilisation à propos du TPIp, et les opportunités manquées en utilisant le test du chi-carré. Les analyses multivariées ont été présentées sous forme de cotes ajustées avec un intervalle de confiance de 95 % (valeur de p<0,05).
Près de la moitié (47 %) avaient seulement une éducation primaire ou n\'en avaient pas du tout. Environ 30 % étaient pauvres. La plupart ont effectué leur 1ère visite prénatale au cours du 2ème trimestre (58 %). Le taux d\'opportunités manquées était de 55 %. Les prédicteurs comprenaient l\'âge de 20 à 34 ans [aOR 1,3 (1,1-1,67)], être très pauvre [aOR 1,6 (1,1-2,4)], début tardif des soins prénatals (au 2ème ou 3ème trimestre) [aOR 0,57 (0,4-0,89)], ignorance de la prévention du paludisme [aOR 1,8 (1,4-2,4)], ignorance du TPIp [aOR 1,3 (1,3-2,5)] et résider dans les régions du Sud-Sud et du Nord-Est [aOR 0,46 (0,31-0,68)].
Les opportunités manquées étaient élevées. Le lieu de résidence, la méconnaissance de la prévention du paludisme et de l\'utilisation du TPIp, le début tardif des soins prénatals, la pauvreté et l\'âge jeune (20 à 34 ans) ont contribué à cette charge. Les recommandations incluent de souligner l\'importance du TPIp lors des entretiens de santé. La fourniture de gobelets et d\'eau potable pour la politique de l\'administration directe du TPI par le gouvernement et les partenaires. Il est nécessaire de poursuivre la recherche pour découvrir les raisons des taux plus élevés d\'OM dans certaines régions.
Paludisme pendant la grossesse, traitement préventif intermittent, sulfadoxine-pyriméthamine, opportunité manquée, soins prénatals.

We aimed to estimate the diagnostic latency of patients with visceral leishmaniasis (VL). A monocentric retrospective observational study was conducted including all confirmed cases of VL diagnosed from January 2005 to March 2022. Epidemiological and clinical characteristics of patients with VL were collected. The diagnostic latency was defined as the number of days between the first contact with a health-care provider for signs and/or symptoms referable to VL and the laboratory diagnosis of leishmaniasis. Twenty-four cases of VL were included in the study, mostly male (75%) and Italians (79.2%), with a median age of 40 years [Inter Quartile Range (IQR 30-48)]. Fourteen (58.3%) VL cases were people living with HIV (PLWH) and 4 (16.6%) subjects were on immunosuppressive therapy. For VL the median diagnostic latency was 54 days (IQR 28-162). The shorter diagnostic latency was observed in PLWH [31 days (IQR 20-47)] followed by immunocompetent patients [160 days (IQR 133-247)] and those on immunosuppressive therapy [329 days (IQR 200-678)]. Twelve patients (50%) reported at least one medical encounter before the diagnosis of VL and 6 patients received a wrong therapy. Diagnostic delay in VL was significant in patients under immune suppressive treatment.

暂无摘要。

According to UNAIDS, the 90-90-90 strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on anti-retroviral therapy (ART) and 90% of whom will achieve sustained virologic suppression. HIV counselling and testing (HCT) is an important entry point for effective prevention of mother-to-child transmission of HIV. However, evidence abounds that HCT is often missed by pregnant women during antenatal care in Nigeria. We used secondary data from the 2018 Nigerian National Nutrition and Health Survey (NNHS) to determine the pattern of missed opportunities within the HCT algorithm and the factors associated with the missed opportunities. Of the 8,329 eligible women, 2,327 (27.9%) missed HCT because of lack of antenatal care; 1,493 (24.9%) missed HIV pre-test counselling; 180 (4.0%) missed HIV testing after participating in pre-test counselling, while 793 (18.2%) missed collection of HIV result and post-test counselling. Generally, most of the women that missed HCT were from the North West (43.3%) and had their antenatal care with traditional birth attendants. The odds of missing ANC were higher in women in the Northern and Southern regions. Concerning pre-test HIV counselling, the odds of missing it were higher among women in the Northwest and Southeast while the odds of missing post-test counselling of HIV test were higher among women in the Northeast and Southeast relative to other regions. Using TBA as a care provider was associated with higher odds of women missing pre-test and post-test counselling of HIV during ANC compared to those that used doctors or midwives or CHEWs. Missed opportunities are common in different stages of HIV counselling and testing pathway in Nigeria, particularly in the Northern regions. Future studies would need to identify the specific reasons for these missed opportunities, enabling the targeting of more specific policy reform and interventions.

BACKGROUND: Despite the proven effectiveness of immunization against vaccine preventable diseases, vaccination coverage among children remains low in many developing countries including Nigeria. A significant contributor is missed opportunity for vaccination (MOV). This study compared the prevalence and determinants of MOV among under-five children in an urban and a rural community in Edo State, Southern Nigeria.
METHODS: This comparative cross-sectional community-based study was carried out among 644 mothers of under-five children selected using a multistage sampling technique from an urban and a rural community. Data was collected using a modified structured WHO protocol for evaluation of MOV and analyzed with IBM SPSS version 22.0. Descriptive and inferential statistics were done with p<0.05 considered statistically significant.
RESULTS: The prevalence of MOV was 21.7% and 22.1% in urban and rural communities, respectively (p=0.924). The measles vaccine was the most frequently missed in the urban 40 (57.1%) and rural 45 (63.4%) communities. The major reason for MOV in both communities was limited hours of vaccination (urban-58.6% and rural-62.0%). Poor knowledge of vaccination was a determinant of MOV in both urban (aOR=0.923; 95%CI=0.098-0.453) and rural (aOR=0.231; 95%CI=0.029-0.270) communities. Other determinants in the community included older maternal age (aOR=0.452; 95%CI=0.243-0.841) while in the rural community, they included older child (aOR=0.467; 95%CI=0.220-0.990) and ANC attendance (aOR=2.827; 95%CI=1.583-5.046).
CONCLUSIONS: MOV was common in both urban and rural communities in Edo State. Regular public awareness campaigns and capacity building workshops for health care workers to address the individual and health system factors are recommended.
BACKGROUND: Malgré l’efficacité prouvée de l’immunisation contre les maladies évitables par la vaccination, la couverture vaccinale des enfants reste faible dans de nombreux pays en développement, y compris le Nigéria. Les occasions manquées de vaccination (OMV) y contribuent de manière significative. Cette étude a comparé la prévalence et les déterminants des occasions manquées de vaccination chez les enfants de moins de cinq ans dans une communauté urbaine et rurale de l’État d’Edo, au sud du Nigéria.
UNASSIGNED: Cette étude transversale comparative a été menée auprès de 644 mères d’enfants de moins de cinq ans sélectionnées à l’aide d’une technique d’échantillonnage à plusieurs degrés dans une communauté urbaine et une communauté rurale. Les données ont été collectées à l’aide d’un protocole structuré modifié de l’OMS pour l’évaluation du MOV et analysées à l’aide d’IBM SPSS version 22.0. Des statistiques descriptives et inférentielles ont été réalisées, p<0,05 étant considéré comme statistiquement significatif.
UNASSIGNED: La prévalence du vaccin antirougeoleux était de 21,7% et de 22,1 % dans les communautés urbaines et rurales, respectivement (p=0,924). Le vaccin contre la rougeole était le plus souvent omis dans les communautés urbaines 40 (57,1 %) et rurales 45 (63,4 %). La principale raison de l’omission dans les deuxcommunautés était le nombre limité d’heures de vaccination (58,6 % en milieu urbain et 62,0 % en milieu rural). Une mauvaise connaissance de la vaccination était un facteur déterminant de l’OMV dans les communautés urbaines (aOR=0,923 ; 95%CI=0,098-0,453) et rurales (aOR=0,231 ; 95%CI=0,029-0,270). Les autres déterminants en milieu urbain comprenaient l’âge maternel plus élevé (aOR=0,452 ; 95%CI=0,243-0,841) tandis qu’en milieu rural, ils comprenaient l’enfant plus âgé (aOR=0,467 ; 95%CI=0,220-0,990) et la fréquentation de la CPN (aOR=2,827 ; 95%CI=1,583-5,046).
CONCLUSIONS: La MVO est fréquente dans les communautés urbaines et rurales de l’État d’Edo. Il est recommandé d’organiser régulièrement des campagnes de sensibilisation du public et des ateliers de renforcement des capacités pour les travailleurs de la santé afin de s’attaquer aux facteurs individuels et aux facteurs liés au système de santé.
UNASSIGNED: Occasion manquée; Vaccination; Enfants de moins de cinqans; Communautés; Rurales; Urbaines.

The ability to make suitable risky decision is necessary for individuals\' survival and development. However, individuals vary in risk preference. The current study, adopting a decision task, aimed to explore the emotional sensitivity to missed opportunity and grey matter volume (GMV) of thalamus in high risk-takers by using voxel-based morphology analysis. In the task, eight boxes should be opened successively. Seven boxes contained coins and one box contained the devil to zero coins. Once stopped, collected and missed (missed opportunity) coins were presented. Participants were divided into high- and low risk-takers according to their risk-taking behaviour in the decision task. We found that high risk-takers showed stronger emotional sensitivity to missed opportunity and smaller GMV of thalamus than low risk-takers. In addition, the GMV of thalamus partially mediated the effect of emotional sensitivity to missed opportunity on risk-taking behaviour among all participants. Overall, the current study highlights the role of emotional sensitivity to missed opportunity and the GMV of thalamus in risk-taking behaviour, which helps us understand the possible reason for the variation among individuals in risk preference.

UNASSIGNED: Tuberculosis meningitis (TBM) has high mortality and morbidity. Diagnostic delays can impact TBM outcomes. We aimed to estimate the number of potentially missed opportunities (MOs) to diagnose TBM and determine its impact on 90-day mortality.
UNASSIGNED: This is a retrospective cohort of adult patients with a central nervous system (CNS) TB International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) diagnosis code (013*, A17*) identified in the Healthcare Cost and Utilization Project, State Inpatient and State Emergency Department (ED) Databases from 8 states. Missed opportunity was defined as composite of ICD-9/10 diagnosis/procedure codes that included CNS signs/symptoms, systemic illness, or non-CNS TB diagnosis during a hospital/ED visit 180 days before the index TBM admission. Demographics, comorbidities, admission characteristics, mortality, and admission costs were compared between those with and without a MO, and 90-day in-hospital mortality, using univariate and multivariable analyses.
UNASSIGNED: Of 893 patients with TBM, median age at diagnosis was 50 years (interquartile range, 37-64), 61.3% were male, and 35.2% had Medicaid as primary payer. Overall, 407 (45.6%) had a prior hospital or ED visit with an MO code. In-hospital 90-day mortality was not different between those with and without an MO, regardless of the MO coded during an ED visit (13.7% vs 15.2%, P = .73) or a hospitalization (28.2% vs 30.9%, P = .74). Independent risk of 90-day in-hospital mortality was associated with older age, hyponatremia (relative risk [RR], 1.62; 95% confidence interval [CI], 1.1-2.4; P = .01), septicemia (RR, 1.6; 95% CI, 1.03-2.45; P = .03), and mechanical ventilation (RR, 3.4; 95% CI, 2.25-5.3; P < .001) during the index admission.
UNASSIGNED: Approximately half the patients coded for TBM had a hospital or ED visit in the previous 6 months meeting the MO definition. We found no association between having an MO for TBM and 90-day in-hospital mortality.