The London School of Hygiene & Tropical Medicine (LSHTM) is a public research university in Bloomsbury, central London, and a member institution of the University of London that specialises in public health and tropical medicine.The institution was founded in 1899 by Sir Patrick Manson, after a donation from the Indian Parsi philanthropist B. D. Petit. Since its foundation it has become one of the most highly placed institutions in global rankings in the fields of public health and infectious diseases.The annual income of the institution for 2020–21 was £244.2 million, of which £167.6 million was from research grants and contracts, with expenditures totalling £235.2 million during the same period.
Abstract Background Low 5-minute Apgar scores remain an important indicator of compromised neonatal status and may assist in identifying high-risk newborns in resource-constrained or high-volume labour ward settings. Accurate prediction of newborns at risk could guide timely intrapartum and immediate postpartum interventions. Because risk factors vary by maternal parity, prediction models may benefit from a parity-specific approach. This study aimed to develop and internally validate two prognostic models for predicting low 5-minute Apgar scores, stratified by parity. Methods The analysis used data from 124,376 singleton births at or beyond 28 weeks of gestation, recorded between July 2021 and December 2023 across 16 hospitals in Benin, Malawi, Tanzania and Uganda. Model predictors were selected using a knowledge-based approach, and multivariable logistic regression was performed. Model performance was assessed through calibration and discrimination with internal validation conducted using bootstrapping. The predicted outcome was the 5-minute Apgar score, categorised as low (< 7) or normal (≥ 7). Results In the overall study population, 6.3% of newborns received a low Apgar score. The final nulliparous and parous models included 14 and 19 predictor parameters, respectively, with country included as an additional fixed effect. The models demonstrated moderate optimism-adjusted performance, with C-statistics of 0.663 for the nulliparous model (95% CI: 0.654–0.675) and 0.732 for the multiparous model (95% CI: 0.724–0.740). Calibration was excellent in both models, with calibration-in-the-large (CITL) values of 0.000–0.001 and calibration slopes of 0.989–0.995. Antepartum haemorrhage and severe anaemia were the strongest contributors in both models. Conclusions Two prediction models for low 5-minute Apgar scores, one for nulliparous and one for parous women, demonstrated moderate predictive ability. External validation and further testing are necessary to assess the generalisability and clinical utility of these models.
We sought to describe current perceptions and attitudes to management of of brain abscess (BA) or sub-/extra-dural empyema (SDE/EDE) in the United Kingdom (UK) to compare this to the 2024 European Society of Clinical Microbiology and Infectious Diseases BA guidelines. We conducted a web-based survey of infection specialists (IS) and neurosurgeons (NS) at neurosurgical centres across the UK. IS from 27/39 (69
QUESTIONS:In the case of a road traffic crash, do sports utility vehicles (SUVs) and light truck vehicles (LTVs) cause more severe injuries to pedestrians and cyclists than passenger cars? Does any effect differ between adults and children? DESIGN:Systematic review and meta-analysis. DATA SOURCES:MEDLINE, TRID and Global Index Medicus were searched up to September 2024, with no restrictions by setting or language. INCLUSION CRITERIA:Eligible studies had to compare injury severity between pedestrians and/or cyclists hit by an SUV or LTV versus a passenger car. Only sources using real-world crash data were included. MAIN OUTCOME MEASURE:Injury severity, defined either as 'fatal versus non-fatal injury' or as 'killed or seriously injured (KSI) versus slight injury'. RESULTS:24 studies were included in the meta-analysis. The results were similar between pedestrians and cyclists. When combining pedestrians and cyclists, the pooled odds of KSI versus slight injury if hit by an SUV/LTV versus a passenger car were higher among adults/all-age samples by 1.24 (95% CI 1.15, 1.34) and higher among children by 1.28 (95% CI 1.19, 1.37). The odds of fatal versus non-fatal injury if hit by an SUV/LTV versus a passenger car increased among adults/all-age samples by 1.44 (95% CI 1.33, 1.56) and among children by 1.82 (95% CI 1.57, 2.11; p=0.006 for heterogeneity by age). CONCLUSION:In the case of a crash, SUVs and LTVs cause more severe injuries to pedestrians and cyclists than passenger cars. This effect is larger for fatalities than for KSIs, and the fatality effect is particularly large for children. PROSPERO registration number CRD42024597283.
Oropouche fever is an increasingly significant health concern in tropical and subtropical areas of South and Central America, and is primarily spread by midge vectors. The Oropouche virus (OROV) was first identified in 1955 and has been responsible for numerous outbreaks, particularly in urban environments. Despite its prevalence, the disease is often under-reported, making it difficult to fully understand its impact. OROV typically causes febrile illness characterized by symptoms such as headaches, muscle pain, and, occasionally, neurological issues such as meningitis. The ability of the virus to thrive in both forested and urban areas has raised concerns regarding its potential spread to new regions, particularly in the context of climate change. This paper delves into the epidemiology, clinical features, and transmission patterns of OROV, shedding light on the difficulties in diagnosing and managing the disease. The absence of specific treatments and vaccines highlights the urgent need for continued research and development of targeted public health strategies. Advancements in molecular diagnostics and vector control strategies can mitigate Oropouche fever’s impact. However, a comprehensive public health approach involving increased surveillance, public education, and cross-border collaboration is needed, especially as the global climate crisis may expand vector habitats, posing risks to previously unaffected regions.
BACKGROUND:Relationships and sex education (RSE) impacts some sexual behaviours but could be strengthened by incorporating whole-school approaches (eg, building engagement, providing contraception). These can prevent pregnancies and sexually-transmitted infections but are unevaluated in UK schools. METHODS:A cluster-randomised trial of 'Positive Choices' compared it with usual practice in English secondary schools. Intervention comprised: RSE, school-health-promotion councils involving students, student-needs data to tailor provision; student-led campaigns; review of sexual-health services; and parent information. The primary outcome was prevention of non-competent sexual debut (lacking decision autonomy, judging timing as right, partners' equal willingness or contraception). RESULTS:Of 2845 schools invited, 50 (1.76%) consented, 1 leaving post-allocation. Of 25 control and 24 intervention schools, 4 withdrew pre-endline. 6970 (77.3%) students participated at baseline and 6268 (77.9%) at 33-month endline. Fidelity of whole-school components was suboptimal. No schools achieved 'good' fidelity; two achieved 'adequate' fidelity across components. 11 achieved 'adequate fidelity on selected components' (student-needs report, school-health-promotion council meetings, lessons, parent information). Control schools delivered similar activities to intervention schools. Among 780 (12.44%) students sexually debuting between baseline and endline, non-competent debut was reported by 268 (64.42%) in the control and 240 (65.93%) in the intervention group (risk difference=0.020 (95% CI -0.05 to 0.09)). There were no effects on secondary outcomes. Incremental costs were £1337 per school (£10 per student). CONCLUSION:Positive Choices did not prevent non-competent sexual debut (primary outcome) or impact secondary outcomes compared with usual RSE, possibly explained by weak fidelity of whole-school elements and/or comprehensive RSE in control schools. TRIAL REGISTRATION NUMBER:ISRCTN16723909.
