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In July, we had five new articles to enter our top ten most read list. The Top 10 is compiled based on full text views, including downloads of the full article PDFs.
Risk of myocardial infarction and stroke following microbiologically confirmed urinary tract infection: a self-controlled case series study using linked electronic health data
Our most read new entry is a case-series study by Reeve et al. which investigated the risk of myocardial infarction and stroke following microbiologically confirmed urinary tract infection. This study used individually linked general practice, hospital admission and microbiology data for the population of Wales and was a self-controlled case series, with risk periods 1–7, 8–14, 15–28 and 29–90 days after UTI. The primary outcome was acute MI or stroke identified using the International Classification of Disease V.10 codes from inpatient diagnoses recorded in the Patient Episode Database for Wales. The authors found 51 660 individuals had a hospital admission for MI, of whom 2320 (4.5%) had 3900 microbiologically confirmed UTIs, and 58 150 had a hospital admission for stroke, of whom 2840 (4.9%) had 4600 microbiologically confirmed UTIs. Reeve et al concluded that UTI may be a trigger for MI or stroke. The authors note limitations of the study such as, the use of routine data meaning that outcome ascertainment relied on accurate coding and residual confounding may have been an issue. Reeve et al. state that further work is needed to understand mechanisms and test interventions to reduce the risk of cardiovascular events among people with UTIs in primary care.
Chronic health consequences of the COVID-19 pandemic on school workers: a cross-sectional post-pandemic analysis
The next new entry on the list is a cross-sectional analysis of the chronic health consequences of the COVID-19 pandemic on school workers by Watts et al. This study is a post-pandemic analysis using health questionnaires and serology testing data to determine the prevalence and the functional and mental health impact of pandemic-related chronic health symptoms among school workers towards the end of the COVID-19 pandemic. The main outcomes included self-reported, new-onset pandemic-related chronic health symptoms that started within the past year, lasting at least 3 months, after a positive viral test among those with a known infection. The authors found that 31.1% (95% CI: 28.4% to 34.0%) staff reported new-onset chronic symptoms. These symptoms appeared to be more frequently reported in staff with viral test-confirmed infections (38.0% (95% CI: 34.3% to 41.9%)) compared with those with positive serology who were unaware that they had COVID-19 (14.3% (95% CI: 7.6% to 23.6%); p<0.001) or those with a negative serology (18.1% (95% CI: 12.7% to 24.6%); p<0.001). Watts et al. concluded that many individuals reported post-COVID-19 or pandemic-related chronic health symptoms. Some limitations were noted, such as, non-random participation which may have contributed to selection bias and recall biases and the subjective nature of symptom, which may have impacted how participants responded to questions about chronic symptoms. The authors state that these findings have important public health implications mandating further research in this area, and the need to develop health programmes to address this significant disease burden and mitigate the long-term effects of the pandemic on school staff.
Development and preliminary evaluation in community mental health teams of a cervical screening informed-choice tool for women with severe mental illness in England: a mixed-method study
The next top ten entry is a mixed methods study by Lamontagne-Godwin et al., which aimed to develop and test an informed-choice tool to help women with severe mental illness (SMI) make informed decisions about screening attendance. The tool was developed using a realist review of physical health interventions and a systematic review of informed-choice tools for people with SMI. Usability and acceptability were assessed through semi-structured interviews and the think-aloud method with service users (n=18), clinicians (n=16) and key informants. A preliminary proof-of-concept (n=25) evaluated the impact on decisional conflict—the uncertainty around making value-sensitive choices. The authors found that the tool was usable and acceptable, especially for women overdue or never screened, and note that a feasibility study is underway. Lamontagne-Godwin et al. note possible limitations including that the tool was only tested as a paper leaflet in a proof-of-concept study using validated scales and that other formats of the tool may be more acceptable to some women with SMI. The authors concluded that the tool may reduce decisional conflict and increase screening uptake, potentially improving survival and suggest that future research may involve further assessments of the real-world impact of the tool and its adaptation to other health-related decisions.