Linear pathway analysis of European botulism poisoning response guidelines

Abstract Background Botulism is a rare illness caused by Clostridium botulinum toxin with a naïve case fatality ratio of 40-50%. There is no coordinated collective worldwide reporting on cases and comparatively few recommendations on case management. This study examined 14 European botulism treatment guidelines. Methods A ten-language search was conducted to examine European botulism guidelines. The guidelines were classified by differential diagnosis advice; expert advice access; mention of causalities; contract tracing; biological sampling method; and treatment access rapidity. The guidelines were linearly represented on a probability pathway. Quantified probabilities were entered into the algorithm. Probabilities for algorithmic delay or deviance were estimated or mathematically modeled against Hamiltonian, Ford- Fulkerson and Kruskal pathways. Case recognition was deemed proportional to the availability of information at point of care and produced a hazard function related to a Bayes’ probability model. Results Two guidelines did not display all diagnostic information in one place, and six European nations had incomplete descriptions of the chain of causality linking botulism cases: factorially reducing the Borel algorithmic likelihood of diagnosis through contact tracing and decreasing the affectable survival chance. Another limitation was specialist advice and treatment availability in a 48-hour window. Survival probability models to the quoted naïve minimum constraint of a 60% survival factor were depicted, with pharmacokinetic tendential to an exponential decay model. This highlighted the importance of well-constructed case management and logistical stockpiling methods. Conclusions In botulism poisoning the 48-hour window is cited as crucial to patient survival chances, to this extent, the availability of clear diagnostic criteria including causation considerations, expert advice access and logistically considered therapeutic stockpiles could improve survival probability. Key messages • An international standard for botulism guidance may further improve botulism case identification and survival rates. • National botulism guidelines with direct contact method to an expert and with strategic positioning of therapeutic stockpiles may reduce time to treatment and improve survival chances.


Background:
Botulism is a rare illness caused by Clostridium botulinum toxin with a naïve case fatality ratio of 40-50%. There is no coordinated collective worldwide reporting on cases and comparatively few recommendations on case management. This study examined 14 European botulism treatment guidelines. Methods: A ten-language search was conducted to examine European botulism guidelines. The guidelines were classified by differential diagnosis advice; expert advice access; mention of causalities; contract tracing; biological sampling method; and treatment access rapidity. The guidelines were linearly represented on a probability pathway. Quantified probabilities were entered into the algorithm. Probabilities for algorithmic delay or deviance were estimated or mathematically modeled against Hamiltonian, Ford-Fulkerson and Kruskal pathways. Case recognition was deemed proportional to the availability of information at point of care and produced a hazard function related to a Bayes' probability model.

Results:
Two guidelines did not display all diagnostic information in one place, and six European nations had incomplete descriptions of the chain of causality linking botulism cases: factorially reducing the Borel algorithmic likelihood of diagnosis through contact tracing and decreasing the affectable survival chance. Another limitation was specialist advice and treatment availability in a 48-hour window. Survival probability models to the quoted naïve minimum constraint of a 60% survival factor were depicted, with pharmacokinetic tendential to an exponential decay model. This highlighted the importance of well-constructed case management and logistical stockpiling methods.

Conclusions:
In botulism poisoning the 48-hour window is cited as crucial to patient survival chances, to this extent, the availability of clear diagnostic criteria including causation considerations, expert advice access and logistically considered therapeutic stockpiles could improve survival probability. Key messages: An international standard for botulism guidance may further improve botulism case identification and survival rates. National botulism guidelines with direct contact method to an expert and with strategic positioning of therapeutic stockpiles may reduce time to treatment and improve survival chances.

Background:
Research shows that vaccine-related beliefs (i.e., about efficacy, safety, purpose) may reflect a host of within-person and contextual factors yielding homogeneous subgroups of individuals. This study aims to characterize distinct subgroups of people and identify ideal targets for tailored public health interventions to increase vaccine adherence.

Methods:
Latent class analysis was used to derive subgroups based on unique response profiles using the 2019 Gallup survey of 140 countries (>140,000 individuals). We modeled a composite of vaccine beliefs as a distal outcome examining differences for the obtained classes, with and without covariates in the model.

Results:
A 5-class model fit best with classes distinguished primarily on whether individuals possessed or sought personal knowledge about science, medicine, and health, whether they trusted science, scientists and have confidence in the healthcare system. The lowest levels of vaccine beliefs were reported by a class not endorsing any of these indicators and the highest levels by a class endorsing all the indicators (p < 0.001). Age class showed a U-shaped relation with vaccine beliefs, while higher educational level (p = 0.025), higher subjective income (p = 0.006) and employment (p < 0.001) were related to higher vaccine beliefs. Country-level income was moderately related to class membership and vaccine beliefs were higher in lower-income countries (p < 0.001).

Conclusions:
Our findings suggest that more work is needed to improve trust in science and medical providers. Tailored interventions grounded in a community-based and empowering approach with the collaboration of multiple stakeholders seems to be needed to improve vaccination rates. This can only be achieved when individuals trust science, scientists and healthcare providers and accrue the necessary wisdom to make good healthcare decisions that affect not only themselves but their fellow citizens. Key messages: Efforts to alter vaccine beliefs should touch on where people access information on science and health, the processes that build trust, and their belief whether science improves wellbeing.
Public health interventions should focus on reassuring individuals that science and health workers are benevolent. An essential first step in the health worker-patient relations is building trust.