Objectives Pertussis diagnosis relies mainly on PCR tests due to their higher sensitivity and faster results than culture methods. This led to a shortage of clinical isolates for resistance testing and genomic surveillance. Data on factors affecting strain recovery and on culture medium optimization are limited. This study validated the sensitivity of a modified Regan-Lowe agar for Bordetella recovery and assessed the impact of transport medium, transport time and Ct values on culture positivity. Methods 500 PCR-positive respiratory samples from Austria and Germany were prospectively cultured on conventional Regan-Lowe agar and an in-house prepared variant supplemented with vancomycin. All plates were examined for Bordetella-suspicious colonies and confirmed by MALDI-TOF MS. Transport time, Ct values and transport media were compared between culture-positive and -negative samples. Results Bordetella spp. were isolated from 167/500 (33 %) samples. 82 isolates (16 %) were recovered from the conventional agar, whereas 160 isolates (32 %) were obtained from the plates with vancomycin. Mean transport time for culture-positive samples was 3.9 days vs. 7.9 days for culture-negative samples; mean Ct values 23.1 and Ct 29.2, respectively. Flocked swabs in Amies transport medium (eSwab®) showed the highest recovery. For short transport times, Universal Transport Medium (UTM®) was a valid alternative. Multivariable analysis confirmed Ct value, transport time and transport medium as independent predictors of culture-positivity. Conclusion The addition of vancomycin to Regan-Lowe agar doubled the probability of isolation of Bordetella from PCR-positive samples. Our findings define key parameters to optimize culture recovery for molecular epidemiology and surveillance.

Abstract Background Nature-based social prescribing (NBSP) is a form of social prescribing that can enhance mental and/or physical health by connecting participants with nature through non-medical community referrals. While evidence suggests potential benefits of NBSP in promoting well-being, its economic impact remains unclear. The purpose of our systematic literature review is to investigate the health-economic impact of NBSP programs. Methods We searched six databases in July 2024. Two reviewers independently screened publications for eligibility: (1) NBSP interventions for health improvement among adults (2), partial or complete economic analyses, and (3) peer-reviewed original studies, published in English, Spanish, or German after the year 2000. Eligible data were systematically extracted by two independent authors into an extraction form including standardized information on the publication, population and setting, compared strategies, details of the analytic framework, main results, limitations, and study conclusions. This information was further synthesized in an evidence table and analyzed using a narrative synthesis approach, with results summarized for each study. The quality of the included studies was assessed using the Consensus Health Economic Criteria list. The review followed PRISMA guideline and is registered on PROSPERO (CRD42021286176). Results Of the 2,985 hits identified, five studies met the inclusion criteria, all of which were conducted in the United Kingdom (UK) and included people with mild mental and/or physical health issues. The time horizon ranged from twelve weeks to ten years. Three studies conducted a social return on investment (SROI) analysis and reported SROI ratios between 2.6 and 5.1 British pounds (GBP) per GBP invested. One cost-benefit study identified economic returns of 6,000–14,000 GBP per person after one year, with potential returns of up to 8,600 − 24,500 GBP per person after ten years. One cost-utility analysis resulted in costs of 8,600 GBP per quality-adjusted life year gained. Conclusions Evidence on the health and economic impacts of NBSP is currently limited. The five identified studies, all based in the UK, generally reported favorable health and economic findings. However, the small number of studies, their methodological limitations, and the exclusive UK focus constrain the generalizability of these conclusions. To better inform healthcare decision-making and to implement NBSP programs worldwide, further research on NBSP interventions and their economic impact is needed. Consequently, future studies should explore international settings, incorporate additional data sources, include control groups, and assess longer follow-up periods.

To investigate whether migration background is associated with diabetes technology use at diagnosis and during follow-up in children and adolescents with type 1 diabetes. This cross-sectional study included children and adolescents aged 4–19 years with type 1 diabetes duration ≥ 1 year. Insulin pump therapy at diagnosis and diabetes technology use at follow-up (defined as insulin pump therapy or automated insulin delivery [AID]) were compared between participants with and without migration background. Multivariable logistic regression was used to assess factors associated with technology use. A total of 143 participants (mean age 13.2 ± 3.7 years) were included, of whom 24.5

Background:With increasing obesity rates, community-based interventions (CBIs) have gained attention as more evidence suggests that the environment has a significant impact on individuals' behaviors. We aimed to conduct a systematic review of CBIs for preventing overweight/obesity in children and adolescents. Subject and methods:We searched PubMed (January 2011-December 2024) for studies evaluating CBIs for the prevention of overweight and obesity. We included controlled interventional studies that reported weight-related outcomes. The assessment of risks of bias of the included studies was performed using the Cochrane Collaboration tool. Results are reported in systematic evidence tables, including information on main study characteristics and effect sizes. Results:A total of 2,724 articles were retrieved, of which 37 publications representing 28 projects from seven world regions were included for review. Most of the interventions targeted children. Reported intervention effects ranged from none to small effects. A beneficial intervention effect was observed in 11 out of 16 studies that calculated the intervention effect for BMI z-score and in seven out of nine studies for the prevalence of overweight/obesity. Effect sizes ranged from -0.26 to -0.03 for the BMI z-score and up to an adjusted odds ratio of 0.65 in the intervention group compared to the control group, with respect to the prevalence of overweight/obesity. The risk of bias of the studies was moderate to high. Conclusion:Overall, our study found inconclusive evidence on the benefits of CBIs. While creating health-promoting environments can influence population-wide nutrition and physical activity behaviors by making healthy choices more accessible, methodological challenges exist to accurately capture the true effects of CBIs.

BACKGROUND AND AIMS:Identification of people living with hepatitis C virus (HCV) via readily available laboratory records could be a key strategy for macro-elimination, aligning with the WHO elimination goal. Therefore, the ELIMINATE(ELIMINation of HCV in AusTria East) project aimed to systematically re-link people with a 'last-positive' HCV-RNA PCR record to care. METHODS:In 10 major liver centres in Eastern Austria, a systematic readout of 'last-positive' HCV-RNA PCR test records obtained between 2008 and 2020 were conducted and linked to available patient contact data. Between 2020 and 2023, individuals were contacted first by phone, then by letter, to inform them about the availability of effective direct-acting antiviral (DAA) treatment and invite them for pre-treatment evaluation. RESULTS:The overall cohort of last-positive HCV+ individuals included 5695 subjects (62.5% males, mean age 57.3 ± 17.3 years); of note, 1931 (34%) of them had died and 759 (13%) individuals had no valid contact information. Of the remaining 3005 individuals, 1171 (40.0%) had already achieved sustained virological response (SVR) at the time of re-call. We successfully reached 617 (20.5%), of whom 417 (67.6%) attended their pre-treatment visit, and 397 (64.3%) commenced DAA-therapy. HCV cure has been confirmed in 326 individuals, corresponding to an SVR rate of 82.1%. CONCLUSION:The ELIMINATE project identified 5695 people living with HCV who were 'lost to care' despite documented HCV viraemia. While invalid contact data were an evident barrier to HCV elimination, premature deaths among the cohort underscored the severity of untreated HCV. The implementation of a systematic HCV-RNA PCR recorded-based re-call workflow represents an effective strategy supporting the WHO goal of HCV elimination.

BackgroundThe COVID-19 pandemic was largely driven by genetic mutations of SARS-CoV-2, leading in some instances to enhanced infectiousness of the virus or its capacity to evade the host immune system. To closely monitor SARS-CoV-2 evolution and resulting variants at genomic-level, an innovative pipeline termed SARSeq was developed in Austria.AimWe discuss technical aspects of the SARSeq pipeline, describe its performance and present noteworthy results it enabled during the pandemic in Austria.MethodsThe SARSeq pipeline was set up as a collaboration between private and public clinical diagnostic laboratories, a public health agency, and an academic institution. Representative SARS-CoV-2 positive specimens from each of the nine Austrian provinces were obtained from SARS-CoV-2 testing laboratories and processed centrally in an academic setting for S-gene sequencing and analysis.ResultsSARS-CoV-2 sequences from up to 2,880 cases weekly resulted in 222,784 characterised case samples in January 2021-March 2023. Consequently, Austria delivered the fourth densest genomic surveillance worldwide in a very resource-efficient manner. While most SARS-CoV-2 variants during the study showed comparable kinetic behaviour in all of Austria, some, like Beta, had a more focused spread. This highlighted multifaceted aspects of local population-level acquired immunity. The nationwide surveillance system enabled reliable nowcasting. Measured early growth kinetics of variants were predictive of later incidence peaks.ConclusionWith low automation, labour, and cost requirements, SARSeq is adaptable to monitor other pathogens and advantageous even for resource-limited countries. This multiplexed genomic surveillance system has potential as a rapid response tool for future emerging threats.

Nature‐based social prescribing (NBSP) is an evolving subject aiming to reduce loneliness and to foster social connections, health, and well‐being. To evaluate the short‐term and long‐term consequences of different health technologies, decision‐analytic modeling can be applied. Decision‐analytic modeling studies systematically integrate current short‐ and long‐term evidence to weigh benefits, harms, and costs of different strategies. Our systematic literature review identified and assessed decision‐analytic modeling studies addressing specifically NBSP or other interventions aiming to reduce loneliness. Predefined inclusion/exclusion criteria guided our systematic literature search in five databases. Title/abstract screening and full‐text screening were conducted by two independent reviewers. An a priori defined extraction table included country, intervention, and model type. The Philips framework was used to evaluate the quality of the studies. Overall, 3273 studies were identified, and 16 studies were eligible for full‐text screening. None of these studies applied a decision‐analytic model specifically to NBSP. However, two studies compared interventions for reducing loneliness. One study was conducted in Australia and performed a cost‐utility analysis, resulting in cost‐saving results and a positive return on investment. The second study was conducted in England and applied a cost‐effectiveness analysis resulting in 768 British pounds per loneliness‐free year gained. Overall, the evaluated interventions can be regarded as cost‐effective, and in some instances, they have the potential to save costs. Further research on the connection of loneliness, overall health, social well‐being, and quality of life and their integration into decision‐analytic studies is needed.

Here, we report the complete genome of Bordetella parapertussis strain 400431-b isolated from a nasopharyngeal swab from a 4-year-old patient presenting with a protracted course of whooping cough, vaccinated with three doses of diphtheria-tetanus-acellular pertussis-hepatitis B-poliomyelitis-Haemophilus influenzae type b vaccine.

OBJECTIVES:To summarise the prevalence of Mycoplasma genitalium (MG) and antibiotic-resistant MG infection among HIV pre-exposure prophylaxis (PrEP) users.METHODS:We searched MEDLINE, Embase, Web of Science and Global Index Medicus up to 30 September 2022. We included studies reporting the prevalence of MG and/or antibiotic-resistant MG infection among PrEP users. Two reviewers independently searched for studies and extracted data. A systematic review with random-effects meta-analysis was performed to quantitatively summarise the results of included studies. The critical appraisal of included studies was conducted with the Joanna Briggs Institute checklist for prevalence studies and the quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE).RESULTS:A total of 15 studies were included in the systematic review, with 2341 individuals taking PrEP. Studies were conducted in high-income level countries between 2014 and 2019. Median age of participants varied from 23.5 to 40 years. The majority were men (85%) and among them, 93% were men who have sex with men. To identify MG, urine samples were analysed in 14 studies, rectal or anal swabs in 12 studies, oral or pharyngeal swabs in 9 studies, and urethral or vaginal in 3 studies. The pooled point prevalence of MG among PrEP users was 16.7% (95% CI 13.6% to 20.3%; 95% prediction interval (95% PI) 8.2% to 31.1%). The pooled point prevalence of macrolide-resistant infections was 82.6% (95% CI 70.1% to 90.6%; 95% PI 4.7% to 99.8%) and the prevalence of fluoroquinolone-resistant infections was 14.3% (95% CI 1.8% to 42.8%). Individuals taking PrEP have a higher chance of being infected with MG compared with those not taking PrEP (OR 2.30; 95% CI 1.6 to 3.4). The quality of evidence was very low to moderate.CONCLUSION:We observed a high prevalence of MG and its macrolide resistance among PrEP users, highlighting the need to reinforce prevention strategies against sexually transmitted infections in this population.PROSPERO REGISTRATION NUMBER:CRD42022310597.

Summary Background and aims Micro-elimination projects targeted to specific hepatitis C virus (HCV) risk populations have been successful. Systematic identification of persons with HCV viremia, regardless of risk group, based on already available laboratory records may represent an effective macroelimination approach to achieve global HCV elimination. Methods Persons with a last positive HCV-RNA PCR result between 2008–2020 in the reference virology laboratories in eastern Austria were identified. First, (i) we described their demographic characteristics, (ii) we systematically recalled persons to the respective centers and (iii) started antiviral treatment if HCV-RNA viremia was confirmed, and (iv) recorded sustained virologic response (SVR). This interim report includes the preliminary results from 8 participating centers. Results During the study period 22,682 persons underwent HCV-RNA PCR testing, 11,216 (49.4%) were positive at any point in time, and 6006 (26.5%) showed detectable HCV-RNA at the last PCR test, suggesting ongoing HCV viremia. At the time of this interim report, 2546/6006 HCV-RNA PCR(+) persons were evaluated: 443/2546 (17.4%) had died, 852/2546 (33.5%) had invalid contact data, and 547/2546 (21.5%) had achieved SVR between data retrieval and recall. Contact could be established in 236/704 (33.5%) of the remaining target population with 97/236 (41.1%) presenting at the clinic for treatment evaluation. Ultimately, 71/236 (30.1%) started antiviral treatment and SVR was documented in 47/71 (66.2%). Conclusion This ELIMINATE project based on systematic assessment of HCV-RNA PCR-records, identified 6006 persons with potential persisting HCV viremia. Invalid contact data and missed visits for treatment evaluation were the main barriers towards HCV elimination within this project. Importantly, many subjects with HCV viremia lost to follow-up were successfully linked to care and started antiviral treatment.

Background European-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening. Aim We aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening. Methods The Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin. Results Data on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta (both > 1,000/100,000) and lowest among Ukrainian patients in Poland (3.6/100,000). They were mainly lower in countries of residence than countries of origin. However, IRs among Eritreans and Somalis in Greece and Malta were five times higher than in Eritrea and Somalia. Similarly, IRs among Eritreans in Germany, the Netherlands and the UK were four times higher than in Eritrea. Conclusions Country of origin TB IR is an insufficient indicator when targeting foreign-born populations for active case finding or TB prevention policies in the countries covered here. Elimination strategies should be informed by regularly collected country-specific data to address rapidly changing epidemiology and associated risks.

Patients with myelodysplastic syndromes (MDS) frequently experience a significant symptom burden, which reduces health-related quality of life (HRQoL). We aimed to identify determinants of low HRQoL in patients recently diagnosed with MDS, for guiding early intervention strategies. We evaluated longitudinal data in 2205 patients with MDS during their first year after diagnosis. Median values of EQ-5D 3-level (EQ-5D-3L) index (0.78) and visual analog scale (VAS) score (0.70) were used as thresholds for low HRQoL. In addition, the 5 dimensions of EQ-5D-3L were analyzed for impairments (any level vs “no problem” category). After multiple imputation of missing values, we used generalized estimating equations (GEE) to estimate odds ratios (OR) for univariable determinant screening (P < .15), and to subsequently derive multivariable models for low HRQoL with 95% confidence intervals (CI). Multivariable GEE analysis showed the following independent determinants (OR, 95% CI) for low EQ-5D index: increased age (60-75 years: 1.33, 1.01-1.75; >75: 1.84, 1.39-2.45), female sex (1.70, 1.43-2.03), high serum ferritin level (≥1000 vs ≤300 μg/L: 1.41, 1.06-1.87), comorbidity burden (per unit: 1.11, 1.02-1.20), and reduced Karnofsky performance status (KPS, per 10 units: 0.62, 0.58-0.67). For low VAS score, additional determinants were transfusion dependence (1.53, 1.03-2.29), low hemoglobin <10 g/dL (1.34, 1.12-1.61), and high body mass index (≥30 vs 23-29.9 kg/m2: 1.26, 1.02-1.57). Sex, KPS, comorbidity burden, hemoglobin count, and transfusion burden were determinants for all EQ-5D dimensions. Low HRQoL is determined by multiple factors, which should be considered in the management and shared decision making of patients with MDS. This trial was registered at www.clinicaltrials.gov as #NCT00600860.

Hintergrund und Zielsetzung Bekannte Hepatitis-C-Virus (HCV)-Risikogruppen werden von spezifischen Mikro-Eliminationsprojekten erfasst. Die systematische Identifikation von Personen mit HCV-Virämie - unabhängig von der Risikogruppe - basierend auf bereits vorhandenen Laboraufzeichnungen, könnte einen effektiven Makro-Eliminationsansatz darstellen, um die globalen HCV-Eliminationsziele zu erreichen.