Dominik Zenner

Background: Tuberculosis (TB) survivors experience high mortality and long-term morbidity, contributing substantially to the global TB burden. In the UK, where TB incidence is rising, the scale of post-TB health needs is unknown and current guidelines do not recommend follow-up. We conducted the first nationwide survey of UK TB services to assess approaches to post-TB care. Methods: We conducted a digital survey between February and May 2025 across National Health Service TB services in all four nations, targeting specialist clinicians. The questionnaire captured data on types of post-TB morbidity encountered and current practice. We analysed descriptively and stratified by caseload. Results: We received responses from 113 of 135 TB services (84%). Most respondents were lead clinicians (81%), and nearly all (96%) had encountered post-TB morbidity in their patient populations, including lung disease (82%), social vulnerabilities (79%), and financial issues (66%). High caseload services (≥30 cases/year) reported more types of morbidity (mean 4.2 vs 2.9; p95%), fewer than half of services perform assessments for broader post-TB sequelae and comorbidities, or provide direct ongoing medical care (41%). Most services cited staffing (78%), clinic capacity (70%) and funding (59%) as challenges to post-TB care. Conclusions: A high proportion of UK TB clinicians recognise post-TB morbidity among their patient groups. TB services are introducing elements of post-TB care, but provision is heterogenous and often informal, with multiple resource-related challenges. Robust UK-specific data, stakeholder engagement and clear guidance are needed to support post-TB care pathways.

There is no robust prognostic guides for patellar tendinopathy (PT), hence we do not understand who gets better, when and why. Therefore, we aimed to identify which combination of self-reported factors best predicts PT recovery. A previously validated, reliable online questionnaire battery yielded data from an international sample of professional and recreational jumping athletes with a one-year follow-up. Recovery was defined using Global Rating of Change, alongside full availability for training and competition. Data on > 100 plausible bio-psycho-social, demographic and sporting outcome predictors were collected; and a multivariable cox proportional-hazards model constructed. 128 athletes with PT (30.9 ± 8.9 years; 77 males (60%); Victorian Institute of Sport Assessment Questionnaire-Patellar Tendon = 61.5 ± 16.2) provided 25,284 days at risk for analysis. Recovery rate was 45%, peaking at 6-month. The multivariable model partially predicted PT recovery with acceptable performance (optimism-corrected C-statistic:0.77, 95%CI:0.74-0.79) and internal validation. Recovery was associated with lower severity (Hazard Ratio (HR) = 1.03, 95%CI 1.02-1.05), a shorter time off sport (HR = 0.93, 95%CI 0.87-0.99), feeling more rested after sleep (HR = 1.93, 95%CI 1.13-3.28), not having multiple concurrent tendon problems (HR = 0.23, 95%CI 0.07-0.69), higher training duration (HR = 1.05, 95%CI 1.01-1.10) and symptoms being modifiable by movement (HR = 2.71, 95%CI 1.21-6.09). To the best of our knowledge, this is the first study investigating outcome predictors for PT recovery in a large international cohort of jumping athletes. The exploratory recovery model showed that a combination of self-reported sports-specific and biomedical variables were predictive of PT recovery. These findings can be used to support clinical judgements of prognosis.

We conducted a systematic review and meta-analysis to review the association of lockdowns with adverse birth and pregnancy outcomes (ABPOs) and related inequalities, in high-income countries (HICs). Databases (EMBASE, MEDLINE/PubMed and Web of Science) were searched from 1 January 2019 to 22 June 2023 for original observational studies based in HICs that compared the rates of ABPOs, before and during lockdowns. The risk of bias was assessed using the Newcastle–Ottawa tool for cohort studies. We ran random-effects meta-analyses and subgroup analyses per region, lockdown period, ethnicity group and deprivation level and adjusted for underlying temporal trends. A total of 132 studies were meta-analysed from 28 HICs. Reduced rates of preterm birth (reported by 26 studies) were associated with the first lockdown (relative risk 0.96, 95% confidence interval 0.93–0.99), 11 studies adjusted for long-term trends and the association remained (0.97, 0.95–0.99), and subgroup analysis found that this association varied by continental region. Ten studies reported positive screening rates for possible depression antenatally, and lockdown was associated with increases in positive screening rates (1.37, 1.06–1.78). No other ABPOs were associated with lockdowns. Investigation of inequalities was limited due to data availability and heterogeneity; further research is warranted on the effect of lockdowns on health inequalities. This study was funded by the National Institute of Health Research, School of Primary Care Research and registered on PROSPERO (CRD42022327448).

Background: Optimising tuberculosis disease testing algorithms is fundamental to ensuring the effectiveness and cost-effectiveness of migrant screening programmes, including better understanding of individual and combined screening test properties. The aim of our study was to estimate pooled tuberculosis test properties from the literature and combine them in decision analytical modelling with a focus on whether tests used for the diagnosis of tuberculosis infection might add value to these algorithms. Methods: We performed a systematic review of reviews of diagnostic tests for active tuberculosis, searching PubMed, Embase, Web of Science and Cochrane library, and pooled test properties extracted from original papers included in reviews. We used these pooled results in a decision tree analysis to estimate test properties for common migrant screening algorithms. Results: We retrieved 1477 records and included 32 reviews, including data from 437 original studies for 18 tuberculosis tests, providing pooled results for 13. Our modelling showed that algorithms with interferon-γ release assays had the highest diagnostic odds ratios (dORs) (e.g. QuantiFERON/chest X-ray (for tuberculosis abnormalities)/Xpert dOR 24 670, 95% CI 11 630–52 328) and high positive predictive values. Best sensitivities were achieved for combinations with parallel cough/chest X‑ray screening followed by Xpert (0.88, 95% CI 0.86–0.90) or Ultra (0.92, 95% CI 0.90–0.94) as well as by T-Spot.TB followed by parallel symptom/chest X-ray screening and Ultra (0.81, 95% CI 0.78–0.83) or Xpert (0.77, 95% CI 0.75–0.80). Conclusions: The significant test accuracy benefit of adding interferon-γ release assays to an active tuberculosis screening pathway will help inform clinicians and policy-makers on the most effective screening algorithms.

We observed shifting trends in tuberculosis (TB) epidemiology in the EU/EEA between 2019 and 2023. In 2023, TB notifications among people of foreign origin increased by 24.6% after decreasing between 2019 and 2020. The majority originated from African and East Mediterranean regions, with a 316.4% upsurge in TB among Ukrainians in 2022–23. Rifampicin-resistant/multidrug-resistant TB increased by ≥ 60% in 2019–23, mainly among Ukrainians. Rapid response to shifting epidemiological patterns is crucial for efficient TB prevention and control within the EU/EEA.