Right to Care

Klebsiella pneumoniae is a leading cause of neonatal sepsis in low- and middle-income countries, with antimicrobial resistance (AMR) significantly contributing to mortality. We used whole genome sequencing to explore the impact of an infection prevention and control (IPC) intervention on K. pneumoniae strains and transmission dynamics responsible for sepsis in a Zambian neonatal unit. Blood culture isolates were collected during the Sepsis Prevention in Neonates in Zambia (SPINZ) study, including a 7-month baseline period and 12 months following implementation of a low-cost IPC bundle. K. pneumoniae genomes associated with 411 neonatal infections were characterised, comprising 24 unique sequence types (STs) and dominated by ST307 (69.3%, n = 285). Nearly all isolates (99.0%) carried extended spectrum beta-lactamases, but few carried carbapenemases (2.7%). Most infections (95.6%) were associated with probable transmission clusters, ranging in size from 2-202 patients and spanning durations of 2-232 days. Most K. pneumoniae (n = 228, 70%) were isolated during the 7-month baseline period and formed six clusters, including one cluster of >200 neonates infected with ST307. Transmission of all strains was periodically suppressed by an IPC bundle; however not all strains were eliminated, and some were able to re-emerge later to re-establish infection and transmission, alongside newly introduced strains that formed additional transmission clusters. Some clusters were associated with rapid onset of disease (within 2 days of admission) and others with delayed onset, suggesting different sources of contamination (e.g., reagent vs environmental). These findings reinforce the need for sustained IPC efforts, and better understanding of environmental reservoirs of opportunistic pathogens in neonatal units to inform such efforts.

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Patients with cancer have high utilization of health care services, and many have high financial burdens from care. High-deductible health plans (HDHPs), which offer lower premiums at the expense of higher deductibles and possibly higher out-of-pocket costs, are associated with decreased care utilization among survivors of cancer. However, it is unclear whether HDHPs are associated with cancer outcomes. To determine whether HDHP status is associated with survival among cancer survivors and individuals without history of cancer and whether financial barriers to care mediate associations between HDHP status and survival. This cross-sectional study included US adults ages 18 to 84 years who participated in the National Health Interview Survey from 2011 to 2018. Data were analyzed from December 14, 2023, to December 1, 2025. HDHP status. Outcomes of interest were overall survival (OS) and cancer-specific survival (CSS). Analyses were adjusted for insurance status, marital status, sex, comorbidities, education, household income, geographic region, and cancer site and time since cancer diagnosis (if applicable). A total of 147 254 respondents (mean [SD] age, 45.7 [16.4] years; 79 261 [50.9%] female) were identified, including 9799 (5.9%) with history of cancer. A total of 2331 cancer survivors (25.6%) and 37 473 individuals without history of cancer (28.5%) reported an HDHP at the time of NHIS participation. HDHP status was associated with worse OS (hazard ratio [HR], 1.46; 95% CI, 1.19-1.79) and CSS (HR, 1.34; 95% CI, 1.01-1.77) among cancer survivors. In contrast, among adults without history of cancer, HDHP status was not significantly associated with OS (HR, 1.08; 95% CI, 0.96-1.21; P for interaction = .001). In mediation analyses, HDHP status among cancer survivors was associated with increased financial barriers to care, which mediated approximately 30% to 70% of the total association of HDHP with survival. In this cross-sectional study of nationwide population-based data, HDHPs were associated with worse OS and CSS among cancer survivors. However, HDHPs were not associated with mortality in adults without history of cancer. These data suggest that insurance coverage that financially discourages medical care may financially discourage necessary care and ultimately worsen cancer outcomes.

ABSTRACT The concept of creative destruction emphasizes how the turnover of businesses and workers drives innovation, productivity gains and aggregate economic growth, even as individual firms and employees experience disruption. This article leverages administrative tax data for South Africa that measures flows rather than stocks, enabling a dynamic analysis of labour and firm adjustments. Our findings reveal unexpectedly high levels of churn in both jobs and business establishments, suggesting fluid rather than rigid markets. However, job and business creation mirror destruction, resulting in low net growth. Moreover, sectoral shifts over time have not increased the share of tradables, implying that structural transformation has stalled.

This chapter explores the transformative role of smart healthcare systems and predictive medicine in modern healthcare. By incorporating advanced technologies such as the Internet of Things (IoT), artificial intelligence (AI), and big data analytics, these systems enable a proactive and personalized approach to patient care. The chapter examines the evolution of healthcare systems, highlights key components of smart healthcare, and explores their benefits, challenges, and future directions, supported by real-world case studies. It emphasizes the potential to enhance patient outcomes, improve efficiency, and reduce costs in healthcare delivery. Despite significant challenges, the benefits present a promising future for advancing patient care.

People who inject drugs (PWID) are disproportionately burdened with hepatitis C virus (HCV) infection in South Africa (SA). Transmission dynamics can be inferred using phylogenetic clustering to inform prevention interventions. We utilized Core-E2 sequences and demographic data to investigate factors associated with HCV phylogenetic clustering among PWID and men who have sex with men (MSM) who inject drugs in SA. Previously genotyped samples (n = 285) that met the selection criteria were extracted, amplified, and Sanger sequenced. Phylogenetic trees were inferred using maximum likelihood implemented in RAxML (Cipres Gateway). Transmission clusters were determined in Clusterpicker using a 90% bootstrap threshold and a genetic distance cut-off on genetic similarity of ≤3.5%. Factors associated with clustering were assessed using logistic regression. Phylogenetic clustering of Core-E2 sequences was observed for 55% (78 of 141) of participant samples that were successfully sequenced, including 50 (64.1%) with genotype 1a and 28 (35.9%) with genotype 3a. Twelve clusters were identified, including six clusters each for genotypes 1a and 3a. Among genotype 1a, the cluster size ranged from 3 to 15 participants. Among genotype 3a, the cluster size ranged from 3 to 9 participants. Clustering among the mixed ancestry group in Cape Town was noted for ages 18-55. Factors independently associated with phylogenetic clustering included sharing a needle (adjusted odds ratio [aOR] 4.02, 95% confidence interval [CI] 1.08-14.87, p = 0.037), age ≥ 29 years (aOR 3.00, 95% CI 1.22-7.37, p = 0.016), and mixed ancestry race (aOR 6.11, 95% CI 1.87-19.95, p = 0.003). These data highlight the urgent need to reduce transmission by providing sufficient sterile needles and syringes and tailored education to prevent HCV transmission among older, experienced PWID.

The 3rd African Microbiome Symposium was held in Cape Town, South Africa, from 20 to 22 November 2024. The symposium featured a diverse range of local and international microbiome research and provided a platform for 79 researchers, students, and industry members to engage in discussions on the microbiome within an African context and focusing on translational research. This meeting review shares highlights, findings, and recommendations derived from the event. Insights from two panel discussions revealed key barriers to microbiome research in Africa, including limited funding, infrastructure gaps, and a shortage of trained local scientists. Recommendations centered on increased investment, institutional training, adherence to ethical guidelines, and the fostering of equitable global partnerships.

This study responds to the growing need for practical and implementable nursing home care models that prioritise resident dignity, autonomy, and inclusion.Aim: The study aimed to develop evidence-based guidance to support the implementation of a Human Rights-Based Approach (HRBA) in nursing home care in Ireland.The study was initiated and commissioned by Nursing Homes Ireland and led by the Faculty of Nursing and Midwifery at Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences.Methods: The research study comprised a three-phase methodology: 1) a rapid review of international literature; 2) stakeholder consultations through focus groups; and 3) development of guidance information for nursing homes in Ireland.This paper reports on the third stage of the project, focusing on using a co-design process and best-practice approaches to develop and implement evidence-based guidance tailored for practical use in the Irish nursing home care context.Findings: Findings revealed that while legal and regulatory frameworks exist to protect resident rights, there are significant barriers to their practical implementation.These barriers include institutional routines, staff shortages, inadequate training, and limited resident voice in decision-making.Stakeholders emphasised the importance of moving beyond technocratic compliance with care quality requirements to foster a 'homeliness culture' of respect, fairness, and person-led care.Guidance information in the form of accessible information, methods, tools and resources, as well as signposting resources, training and support, was developed drawing on best practice in implementation to facilitate a HRBA in nursing home care settings.Implications for practice: Overall, the guidance information that has been developed aligns with legal and statutory requirements and offers a roadmap for transforming care environments into spaces where human rights are actively protected and promoted.The paper concludes with a call for further research and systemic change to ensure that nursing home care in Ireland fully reflects the values and standards of a human rights-based model.

BackgroundInjuries rank among the top 5 leading causes of death worldwide with 90% of all injury-related deaths occurring in low- and middle-income countries. Up to 70% of injuries are potentially preventable. One approach to inform strategies to reduce post-injury mortality is expert-led trauma death reviews. The objective of this study is to present the results of an expert review of decedent cases and the associated recommendations for health system improvement.MethodsA cohort of trauma decedents from 2023 was identified from an ongoing study in the Western Cape Province of South Africa. Demographics, injury details, time and location of death, and postmortem findings were collected. In April 2024, a multi-disciplinary expert panel determined preventability for each death and made actionable recommendations for improvements. Analysis of preventable and non-preventable cases was performed using Chi-square, Fisher’s exact, and Wilcoxon signed rank tests. A rapid qualitative analysis of recommendations was completed and descriptively summarized.Results210 deaths were reviewed by 30 expert panelists. The largest proportion of deaths were from assaults (39%), followed by gunshot injuries (29%). Overall, 33% of deaths were classified as preventable or potentially preventable. Of the 161 in-hospital and ambulance deaths, 64 (39%) were preventable or potentially preventable. The largest proportion of preventable deaths were from haemorrhage (27, 39%) and multi-organ failure or sepsis (25, 36%). The majority (100, 62.1%) of deaths occurred in an emergency centre. Top recommendations from the panel were: development of protocols for diagnosis and management of severe head injuries, context appropriate and accessible trauma training for all frontline providers particularly junior physicians, improved access to diagnostic CT imaging and operating theatres at non-tertiary facilities, and community initiatives to reduce interpersonal violence.ConclusionOne-third of deaths were preventable or potentially preventable, demonstrating a decrease from a review of 2021 trauma deaths in the same system which found 45% to be preventable. Findings highlight a continued need to increase training and strategic utilization of limited existing resources, such as CT and operating theatres, to improve the quality of trauma care. Preventable trauma death reviews are a powerful methodology to inform actionable change.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-25139-0.

The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool was developed to inform nurse staffing decisions and projections. We propose a novel use of the CAMEO data, ie, CAMEO Acuity Curves, to identify high-acuity periods after congenital heart surgery. The aims of this study were to describe CAMEO acuity scores for selected congenital heart surgeries and examine acuity trends during the cardiac intensive care unit (CICU) admissions. We performed a retrospective review of 3 common congenital heart procedures between January 2017 and January 2020: stage I palliation for single ventricle (stage I), Arterial Switch Operation (ASO) for dextro transposition of great arteries with or without ventricular septal defect repair (ASO), and tetralogy of Fallot repair. Postoperative acuity was assessed using CAMEO Acuity Curves stratified by severity of residual lesions in anatomic area of repair as assessed by the Residual Lesion Score (RLS). Among 205 cases (stage I, n = 45; ASO, n = 60; tetralogy of Fallot repair, n = 100), the overall mean CAMEO scores varied in acuity by procedure, with the highest acuity during cardiac intensive care unit stay noted for stage I (76%), followed by ASO (69%) and tetralogy of Fallot repair (62%). When stratified by RLS, acuity increased for each procedure, with RLS 3 having a higher acuity than RLS 1 and 2. The CAMEO Acuity Curves enabled construction of postoperative acuity timeline in cardiac intensive care unit, allowing description and comparison of acuity across various case complexities, which may guide clinical decision-making and optimize staffing to meet patient care resource needs.