170 results
Search Results
2. A Collection on the prevention, diagnosis, and treatment of sexually transmitted infections: Call for research papers
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Nathalie Broutet, Richard Turner, and Nicola Low
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Human Papillomavirus Infection ,Viral Diseases ,medicine.medical_specialty ,Infectious Disease Control ,Urology ,Sexually Transmitted Diseases ,MEDLINE ,lcsh:Medicine ,610 Medicine & health ,ComputingMilieux_LEGALASPECTSOFCOMPUTING ,030204 cardiovascular system & hematology ,Global Health ,Microbiology ,Chlamydia Infection ,03 medical and health sciences ,0302 clinical medicine ,360 Social problems & social services ,Virology ,Epidemiology ,Medicine and Health Sciences ,Global health ,medicine ,Public and Occupational Health ,030212 general & internal medicine ,Transmission risks and rates ,ComputingMilieux_MISCELLANEOUS ,Preventive healthcare ,Cervical cancer ,Genitourinary Infections ,business.industry ,lcsh:R ,Biology and Life Sciences ,HIV diagnosis and management ,General Medicine ,medicine.disease ,Diagnostic medicine ,Cancer treatment ,Editorial ,Infectious Diseases ,Family medicine ,Immunology ,Preventive Medicine ,business ,Viral Transmission and Infection - Abstract
Nicola Low and colleagues announce a call for research papers on sexually transmitted infections, to accompany a Collection on the topic.
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- 2017
3. The Future of Diabetes Prevention: A Call for Papers.
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null, null and PLOS Medicine Editors
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DIABETES prevention ,EDITORS ,MEDICAL journalism ,PEOPLE with diabetes ,DIABETES complications ,DIABETES ,DISEASES ,NEWSLETTERS ,PREVENTIVE health services ,WORLD health - Abstract
PLOS Medicine editors and guest editors announce a call for papers for submissions for a special issue on diabetes prevention. [ABSTRACT FROM AUTHOR]
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- 2016
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4. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies.
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Von Elm, Erik, Altman, Douglas G., Egger, Matthias, Pocock, Stuart J., Gøtzsche, Peter C., and Vandenbroucke, Jan P.
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SCIENTIFIC observation ,SCIENTIFIC method ,EPIDEMIOLOGY ,PUBLIC health research ,MEDICAL research - Abstract
This paper describes the recommendations of The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative on what should be included in an accurate and complete report of an observational study. [ABSTRACT FROM AUTHOR]
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- 2007
5. Child mortality estimation: a global overview of infant and child mortality age patterns in light of new empirical data.
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Guillot, Michel, Gerland, Patrick, Pelletier, François, Saabneh, Ameed, and Pelletier, François
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INFANT mortality ,ESTIMATION theory ,CHILDREN'S health ,DATABASES ,EPIDEMIOLOGY - Abstract
Background: The under-five mortality rate (the probability of dying between birth and age 5 y, also denoted in the literature as U5MR and (5)q(0)) is a key indicator of child health, but it conceals important information about how this mortality is distributed by age. One important distinction is what amount of the under-five mortality occurs below age 1 y ((1)q(0)) versus at age 1 y and above ((4)q(1)). However, in many country settings, this distinction is often difficult to establish because of various types of data errors. As a result, it is common practice to resort to model age patterns to estimate (1)q(0) and (4)q(1) on the basis of an observed value of (5)q(0). The most commonly used model age patterns for this purpose are the Coale and Demeny and the United Nations systems. Since the development of these models, many additional sources of data for under-five mortality have become available, making possible a general evaluation of age patterns of infant and child mortality. In this paper, we do a systematic comparison of empirical values of (1)q(0) and (4)q(1) against model age patterns, and discuss whether observed deviations are due to data errors, or whether they reflect true epidemiological patterns not addressed in existing model life tables.Methods and Findings: We used vital registration data from the Human Mortality Database, sample survey data from the World Fertility Survey and Demographic and Health Surveys programs, and data from Demographic Surveillance Systems. For each of these data sources, we compared empirical combinations of (1)q(0) and (4)q(1) against combinations provided by Coale and Demeny and United Nations model age patterns. We found that, on the whole, empirical values fall relatively well within the range provided by these models, but we also found important exceptions. Sub-Saharan African countries have a tendency to exhibit high values of (4)q(1) relative to (1)q(0), a pattern that appears to arise for the most part from true epidemiological causes. While this pattern is well known in the case of western Africa, we observed that it is more widespread than commonly thought. We also found that the emergence of HIV/AIDS, while perhaps contributing to high relative values of (4)q(1), does not appear to have substantially modified preexisting patterns. We also identified a small number of countries scattered in different parts of the world that exhibit unusually low values of (4)q(1) relative to (1)q(0), a pattern that is not likely to arise merely from data errors. Finally, we illustrate that it is relatively common for populations to experience changes in age patterns of infant and child mortality as they experience a decline in mortality.Conclusions: Existing models do not appear to cover the entire range of epidemiological situations and trajectories. Therefore, model life tables should be used with caution for estimating (1)q(0) and (4)q(1) on the basis of (5)q(0). Moreover, this model-based estimation procedure assumes that the input value of (5)q(0) is correct, which may not always be warranted, especially in the case of survey data. A systematic evaluation of data errors in sample surveys and their impact on age patterns of (1)q(0) and (4)q(1) is urgently needed, along with the development of model age patterns of under-five mortality that would cover a wider range of epidemiological situations and trajectories. Please see later in the article for the Editors' Summary. [ABSTRACT FROM AUTHOR]- Published
- 2012
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6. Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts.
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Stringhini, Silvia, Dugravot, Aline, Shipley, Martin, Goldberg, Marcel, Zins, Marie, Kivimäki, Mika, Marmot, Michael, Sabia, Séverine, Singh-Manoux, Archana, Kivimäki, Mika, and Sabia, Séverine
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HEALTH behavior ,SOCIAL status ,MORTALITY ,COHORT analysis ,ALCOHOL drinking ,EPIDEMIOLOGY - Abstract
Background: Differences in morbidity and mortality between socioeconomic groups constitute one of the most consistent findings of epidemiologic research. However, research on social inequalities in health has yet to provide a comprehensive understanding of the mechanisms underlying this association. In recent analysis, we showed health behaviours, assessed longitudinally over the follow-up, to explain a major proportion of the association of socioeconomic status (SES) with mortality in the British Whitehall II study. However, whether health behaviours are equally important mediators of the SES-mortality association in different cultural settings remains unknown. In the present paper, we examine this issue in Whitehall II and another prospective European cohort, the French GAZEL study.Methods and Findings: We included 9,771 participants from the Whitehall II study and 17,760 from the GAZEL study. Over the follow-up (mean 19.5 y in Whitehall II and 16.5 y in GAZEL), health behaviours (smoking, alcohol consumption, diet, and physical activity), were assessed longitudinally. Occupation (in the main analysis), education, and income (supplementary analysis) were the markers of SES. The socioeconomic gradient in smoking was greater (p<0.001) in Whitehall II (odds ratio [OR] = 3.68, 95% confidence interval [CI] 3.11-4.36) than in GAZEL (OR = 1.33, 95% CI 1.18-1.49); this was also true for unhealthy diet (OR = 7.42, 95% CI 5.19-10.60 in Whitehall II and OR = 1.31, 95% CI 1.15-1.49 in GAZEL, p<0.001). Socioeconomic differences in mortality were similar in the two cohorts, a hazard ratio of 1.62 (95% CI 1.28-2.05) in Whitehall II and 1.94 in GAZEL (95% CI 1.58-2.39) for lowest versus highest occupational position. Health behaviours attenuated the association of SES with mortality by 75% (95% CI 44%-149%) in Whitehall II but only by 19% (95% CI 13%-29%) in GAZEL. Analysis using education and income yielded similar results.Conclusions: Health behaviours were strong predictors of mortality in both cohorts but their association with SES was remarkably different. Thus, health behaviours are likely to be major contributors of socioeconomic differences in health only in contexts with a marked social characterisation of health behaviours. Please see later in the article for the Editors' Summary. [ABSTRACT FROM AUTHOR]- Published
- 2011
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7. Effectiveness of and Financial Returns to Voluntary Medical Male Circumcision for HIV Prevention in South Africa: An Incremental Cost-Effectiveness Analysis.
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Haacker, Markus, Fraser-Hurt, Nicole, and Gorgens, Marelize
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CIRCUMCISION ,HIV prevention ,EPIDEMICS ,COST effectiveness ,DISEASE incidence ,PREVENTIVE health services ,HIV infections ,ECONOMICS - Abstract
Background: Empirical studies and population-level policy simulations show the importance of voluntary medical male circumcision (VMMC) in generalized epidemics. This paper complements available scenario-based studies (projecting costs and outcomes over some policy period, typically spanning decades) by adopting an incremental approach-analyzing the expected consequences of circumcising one male individual with specific characteristics in a specific year. This approach yields more precise estimates of VMMC's cost-effectiveness and identifies the outcomes of current investments in VMMC (e.g., within a fiscal budget period) rather than of investments spread over the entire policy period.Methods/findings: The model has three components. We adapted the ASSA2008 model, a demographic and epidemiological model of the HIV epidemic in South Africa, to analyze the impact of one VMMC on HIV incidence over time and across the population. A costing module tracked the costs of VMMC and the resulting financial savings owing to reduced HIV incidence over time. Then, we used several financial indicators to assess the cost-effectiveness of and financial return on investments in VMMC. One circumcision of a young man up to age 20 prevents on average over 0.2 HIV infections, but this effect declines steeply with age, e.g., to 0.08 by age 30. Net financial savings from one VMMC at age 20 are estimated at US$617 at a discount rate of 5% and are lower for circumcisions both at younger ages (because the savings occur later and are discounted more) and at older ages (because male circumcision becomes less effective). Investments in male circumcision carry a financial rate of return of up to 14.5% (for circumcisions at age 20). The cost of a male circumcision is refinanced fastest, after 13 y, for circumcisions at ages 20 to 25. Principal limitations of the analysis arise from the long time (decades) over which the effects of VMMC unfold-the results are therefore sensitive to the discount rate applied, and more generally to the future course of the epidemic and of HIV/AIDS-related policies pursued by the government.Conclusions: VMMC in South Africa is highly effective in reducing both HIV incidence and the financial costs of the HIV response. The return on investment is highest if males are circumcised between ages 20 and 25, but this return on investment declines steeply with age. [ABSTRACT FROM AUTHOR]- Published
- 2016
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8. Mobile Phones As Surveillance Tools: Implementing and Evaluating a Large-Scale Intersectoral Surveillance System for Rabies in Tanzania.
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Mtema, Zacharia, Changalucha, Joel, Cleaveland, Sarah, Elias, Martin, Ferguson, Heather M., Halliday, Jo E. B., Haydon, Daniel T., Jaswant, Gurdeep, Kazwala, Rudovick, Killeen, Gerry F., Lembo, Tiziana, Lushasi, Kennedy, Malishee, Alpha D., Mancy, Rebecca, Maziku, Matthew, Mbunda, Eberhard M., Mchau, Geofrey J. M., Murray-Smith, Roderick, Rysava, Kristyna, and Said, Khadija
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ELECTRONIC surveillance ,MEDICAL screening ,RABIES ,MEDICAL technology ,PATIENT compliance ,PATIENTS ,MANAGEMENT - Abstract
Katie Hampson and colleagues describe their experience of developing and deploying a large-scale rabies surveillance system based on mobile phones in southern Tanzania. [ABSTRACT FROM AUTHOR]
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- 2016
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9. Projections of global mortality and burden of disease from 2002 to 2030.
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Mathers CD and Loncar D
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- Acquired Immunodeficiency Syndrome mortality, Adolescent, Adult, Aged, Cause of Death, Child, Child, Preschool, Developing Countries, HIV Infections mortality, Humans, Infant, Infant, Newborn, Middle Aged, Smoking mortality, Epidemiology trends, Global Health, Mortality trends
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Background: Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results., Methods and Findings: Relatively simple models were used to project future health trends under three scenarios-baseline, optimistic, and pessimistic-based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs reaches 80% by 2012. Under the optimistic scenario, which also assumes increased prevention activity, HIV/AIDS deaths are projected to drop to 3.7 million in 2030. Total tobacco-attributable deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 under our baseline scenario. Tobacco is projected to kill 50% more people in 2015 than HIV/AIDS, and to be responsible for 10% of all deaths globally. The three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depressive disorders, and ischaemic heart disease in the baseline and pessimistic scenarios. Road traffic accidents are the fourth leading cause in the baseline scenario, and the third leading cause ahead of ischaemic heart disease in the optimistic scenario. Under the baseline scenario, HIV/AIDS becomes the leading cause of burden of disease in middle- and low-income countries by 2015., Conclusions: These projections represent a set of three visions of the future for population health, based on certain explicit assumptions. Despite the wide uncertainty ranges around future projections, they enable us to appreciate better the implications for health and health policy of currently observed trends, and the likely impact of fairly certain future trends, such as the ageing of the population, the continued spread of HIV/AIDS in many regions, and the continuation of the epidemiological transition in developing countries. The results depend strongly on the assumption that future mortality trends in poor countries will have a relationship to economic and social development similar to those that have occurred in the higher-income countries.
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- 2006
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10. The Effect of Tobacco Control Measures during a Period of Rising Cardiovascular Disease Risk in India: A Mathematical Model of Myocardial Infarction and Stroke.
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Basu, Sanjay, Glantz, Stanton, Bitton, Asaf, and Millett, Christopher
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PREVENTION of tobacco use ,CARDIOVASCULAR disease related mortality ,MYOCARDIAL infarction ,CORONARY heart disease prevention ,CORONARY heart disease risk factors ,CIGARETTE tax ,SMOKING laws - Abstract
: In this paper from Basu and colleagues, a simulation of tobacco control and pharmacological interventions to prevent cardiovascular disease mortality in India predicted that Smokefree laws and increased tobacco taxation are likely to be the most effective measures to avert future cardiovascular deaths in India. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]
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- 2013
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11. Prevalence of Consensual Male–Male Sex and Sexual Violence, and Associations with HIV in South Africa: A Population-Based Cross-Sectional Study.
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Dunkle, Kristin L., Jewkes, Rachel K., Murdock, Daniel W., Sikweyiya, Yandisa, and Morrell, Robert
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MEN who have sex with men ,SEX crimes ,HIV infections ,SEXUALLY transmitted diseases ,MEN'S sexual behavior - Abstract
Background: In sub-Saharan Africa the population prevalence of men who have sex with men (MSM) is unknown, as is the population prevalence of male-on-male sexual violence, and whether male-on-male sexual violence may relate to HIV risk. This paper describes lifetime prevalence of consensual male-male sexual behavior and male-on-male sexual violence (victimization and perpetration) in two South African provinces, socio-demographic factors associated with these experiences, and associations with HIV serostatus. Methods and Findings: In a cross-sectional study conducted in 2008, men aged 18-49 y from randomly selected households in the Eastern Cape and KwaZulu-Natal provinces provided anonymous survey data and dried blood spots for HIV serostatus assessment. Interviews were completed in 1,737 of 2,298 (75.6%) of enumerated and eligible households. From these households, 1,705 men (97.1%) provided data on lifetime history of same-sex experiences, and 1,220 (70.2%) also provided dried blood spots for HIV testing. 5.4% (n = 92) of participants reported a lifetime history of any consensual sexual activity with another man; 9.6% (n = 164) reported any sexual victimization by a man, and 3.0% (n = 51) reported perpetrating sexual violence against another man. 85.0% (n = 79) of men with a history of consensual sex with men reported having a current female partner, and 27.7% (n = 26) reported having a current male partner. Of the latter, 80.6% (n = 21/26) also reported having a female partner. Men reporting a history of consensual male-male sexual behavior are more likely to have been a victim of male-on-male sexual violence (adjusted odds ratio [aOR] = 7.24; 95% CI 4.26-12.3), and to have perpetrated sexual violence against another man (aOR = 3.10; 95% CI 1.22-7.90). Men reporting consensual oral/anal sex with a man were more likely to be HIV+ than men with no such history (aOR = 3.11; 95% CI 1.24-7.80). Men who had raped a man were more likely to be HIV+ than non-perpetrators (aOR = 3.58; 95% CI 1.17-10.9). Conclusions: In this sample, one in 20 men (5.4%) reported lifetime consensual sexual contact with a man, while about one in ten (9.6%) reported experience of male-on-male sexual violence victimization. Men who reported having had sex with men were more likely to be HIV+, as were men who reported perpetrating sexual violence towards other men. Whilst there was no direct measure of male-female concurrency (having overlapping sexual relationships with men and women), the data suggest that this may have been common. These findings suggest that HIV prevention messages regarding male-male sex in South Africa should be mainstreamed with prevention messages for the general population, and sexual health interventions and HIV prevention interventions for South African men should explicitly address male-on-male sexual violence. [ABSTRACT FROM AUTHOR]
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- 2013
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12. Monitoring and Evaluating Progress towards Universal Health Coverage in Chile.
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Aguilera, Ximena, Castillo-Laborde, Carla, Ferrari, Manuel Nájera-De, Delgado, Iris, and Ibañez, Ciro
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HEALTH insurance ,HEALTH services administration ,HEALTH funding ,HEALTH equity ,PUBLIC health - Abstract
This paper by Ximena Paz Aguilera and colleagues is a country case study for the Universal Health Coverage Collection, organized by WHO. It illustrates progress towards UHC and its monitoring and evaluation in Chile. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]
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- 2014
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13. Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study
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Evelien I. T. de Schepper, Robin P. Peeters, Frank J. Wolters, Silvan Licher, Brenda C.T. Kieboom, Maarten J.G. Leening, M. Kamran Ikram, Marije J. Splinter, M. Arfan Ikram, Patrick J E Bindels, Premysl Velek, Epidemiology, General Practice, Neurology, Internal Medicine, Radiology & Nuclear Medicine, and Cardiology
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Male ,Questionnaires ,Viral Diseases ,Epidemiology ,Cross-sectional study ,Social Sciences ,Anxiety ,Cardiovascular Medicine ,Medical Conditions ,Sociology ,Surveys and Questionnaires ,Health care ,Prevalence ,Medicine and Health Sciences ,Public and Occupational Health ,Netherlands ,Aged, 80 and over ,Response rate (survey) ,education.field_of_study ,Depression ,Medical record ,General Medicine ,Middle Aged ,Mental Health ,Infectious Diseases ,Research Design ,Cardiovascular Diseases ,Population study ,Medicine ,Female ,medicine.symptom ,Behavioral and Social Aspects of Health ,Research Article ,medicine.medical_specialty ,Health Personnel ,Lower Back Pain ,Population ,Cardiology ,Pain ,Research and Analysis Methods ,Education ,Signs and Symptoms ,medicine ,Humans ,education ,Pandemics ,Educational Attainment ,Aged ,Survey Research ,Primary Health Care ,SARS-CoV-2 ,business.industry ,COVID-19 ,Covid 19 ,Odds ratio ,Patient Acceptance of Health Care ,Cross-Sectional Studies ,Family medicine ,Communicable Disease Control ,Health Facilities ,Clinical Medicine ,business ,Delivery of Health Care - Abstract
Background During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance. Methods and findings On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19–specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population. Conclusions In this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences., Marije J. Splinter and colleagues assess the prevalence of healthcare avoidance during the COIVD-19 pandemic and investigate related determinants, Author summary Why was this study done? ➢ During the Coronavirus Disease 2019 (COVID-19) pandemic, consultation rates in both primary and specialist care declined compared to prepandemic levels, which can partially be attributed to the postponement or cancellation of elective and nonurgent medical care. ➢ It is unclear to what extent these declines in consultation rates could be related to healthcare avoidance by patients in the general population. ➢ To evaluate the collateral health damage of the COVID-19 pandemic, it is important to not only assess the prevalence of healthcare avoidance, but also for what symptoms healthcare was avoided and which determinants are associated with this behaviour. What did the researchers do and find? ➢ We sent out a paper questionnaire to 8,732 participants of the population-based Rotterdam Study containing several COVID-19–related subjects, such as healthcare utilisation, work status, mental and physical health, and concerns about contracting COVID-19. ➢ About 6,241 participants (73%) returned the questionnaire, of whom 5,656 participants (90.6%) were included in our analyses. We found that 1,142 of them (20.2%) avoided healthcare during the COVID-19 pandemic, often for symptoms that might have needed urgent medical evaluation, such as limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). ➢ Determinants that were most strongly associated with healthcare avoidance were female sex, poor self-appreciated health, and high levels of depression and anxiety. What do these findings mean? ➢ The results of this population-based study suggest that healthcare avoidance contributed to the decline in consultation rates during the COVID-19 pandemic. Importantly, our findings suggest that this behaviour may be associated with certain vulnerable groups within the population. ➢ These findings should be interpreted in light of the limitations of this study, which include that the actual severity of the symptoms that were reported by participants is unknown, since they were not medically evaluated when they experienced these symptoms. ➢ The findings of this study can be used to develop policy interventions targeted to vulnerable individuals who may be more likely to exhibit healthcare avoiding behaviours.
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- 2021
14. Hyperinfectivity in Cholera: A New Mechanism for an Old Epidemiological Model?
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Pascual, Mercedes, Koelle, Katia, and Dobson, Andrew P.
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CHOLERA ,VIBRIO infections ,VIBRIO cholerae ,EPIDEMIOLOGY ,MEDICAL research - Abstract
The article discusses research being done on hyperinfectivity in cholera. It references a study by D. M. Hartley et al published in the 2006 issue of "PLoS Medicine" journal. The study proposes an epidemiological model for the dynamics of cholera that explicitly incorporates a hyperinfectious stage of the pathogen Vibrio cholerae. It notes that the importance of sanitary conditions and clean water for cholera prevention and eradication has been known for a long time.
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- 2006
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15. Latitude, Birth Date, and Allergy.
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Wjst, Matthias, Dharmage, Shyamali, André, Elisabeth, Norback, Dan, Raherison, Chantal, Villani, Simona, Manfreda, Jure, Sunyer, Jordi, Jarvis, Deborah, Burney, Peter, and Svanes, Cecilie
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ALLERGIES ,DISEASE risk factors ,BIRTH date ,LATITUDE ,RHINITIS ,EPIDEMIOLOGY ,MULTIVARIATE analysis - Abstract
Background: The space and time distribution of risk factors for allergic diseases may provide insights into disease mechanisms. Allergy is believed to vary by month of birth, but multinational studies taking into account latitude have not been conducted. Methods and Findings: A questionnaire was distributed in 54 centres to a representative sample of 20- to 44-y-old men and women mainly in Europe but also including regions in North Africa, India, North America, Australia, and New Zealand. Data from 200,682 participants were analyzed. The median prevalence of allergic rhinitis was 22%, with a substantial variation across centres. Overall, allergic rhinitis decreased with geographical latitude, but there were many exceptions. No increase in prevalence during certain winters could be observed. Also, no altered risk by birth month was found, except borderline reduced risks in September and October. Effect estimates obtained by a multivariate analysis of total and specific IgE values in 18,085 individuals also excluded major birth month effects and confirmed the independent effect of language grouping. Conclusion: Neither time point of first exposure to certain allergens nor early infections during winter months seems to be a major factor for adult allergy. Although there might be effects of climate or environmental UV exposure by latitude, influences within language groups seem to be more important, reflecting so far unknown genetic or cultural risk factors. [ABSTRACT FROM AUTHOR]
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- 2005
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16. Melanoma: What Are the Gaps in Our Knowledge?
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Rees, Jonathan L
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MELANOMA ,ETIOLOGY of cancer ,ETIOLOGY of diseases ,PATHOLOGY ,EPIDEMIOLOGY - Abstract
Jonathan Rees outlines a number of puzzling gaps that remain in our knowledge of the etiology of non-acral melanomas. [ABSTRACT FROM AUTHOR]
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- 2008
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17. Reporting and methods in clinical prediction research: a systematic review
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Douglas G. Altman, Susan Mallett, Walter Bouwmeester, Mirjam I. Geerlings, Ewout W. Steyerberg, Yvonne Vergouwe, Nicolaas P.A. Zuithoff, Karel G.M. Moons, Erasmus School of Health Policy & Management, Epidemiology, and Public Health
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Research design ,Research Report ,Biomedical Research ,business.industry ,Calibration (statistics) ,Clinical Research Design ,Epidemiology ,External validation ,General Medicine ,Statistical power ,Systematic review ,Research Design ,Medicine ,Humans ,Model development ,Prospective Studies ,Periodicals as Topic ,business ,Prospective cohort study ,Reliability (statistics) ,Clinical psychology ,Research Article ,Forecasting - Abstract
Walter Bouwmeester and colleagues investigated the reporting and methods of prediction studies in 2008, in six high-impact general medical journals, and found that the majority of prediction studies do not follow current methodological recommendations., Background We investigated the reporting and methods of prediction studies, focusing on aims, designs, participant selection, outcomes, predictors, statistical power, statistical methods, and predictive performance measures. Methods and Findings We used a full hand search to identify all prediction studies published in 2008 in six high impact general medical journals. We developed a comprehensive item list to systematically score conduct and reporting of the studies, based on recent recommendations for prediction research. Two reviewers independently scored the studies. We retrieved 71 papers for full text review: 51 were predictor finding studies, 14 were prediction model development studies, three addressed an external validation of a previously developed model, and three reported on a model's impact on participant outcome. Study design was unclear in 15% of studies, and a prospective cohort was used in most studies (60%). Descriptions of the participants and definitions of predictor and outcome were generally good. Despite many recommendations against doing so, continuous predictors were often dichotomized (32% of studies). The number of events per predictor as a measure of statistical power could not be determined in 67% of the studies; of the remainder, 53% had fewer than the commonly recommended value of ten events per predictor. Methods for a priori selection of candidate predictors were described in most studies (68%). A substantial number of studies relied on a p-value cut-off of p, Editors' Summary Background There are often times in our lives when we would like to be able to predict the future. Is the stock market going to go up, for example, or will it rain tomorrow? Being able predict future health is also important, both to patients and to physicians, and there is an increasing body of published clinical “prediction research.” Diagnostic prediction research investigates the ability of variables or test results to predict the presence or absence of a specific diagnosis. So, for example, one recent study compared the ability of two imaging techniques to diagnose pulmonary embolism (a blood clot in the lungs). Prognostic prediction research investigates the ability of various markers to predict future outcomes such as the risk of a heart attack. Both types of prediction research can investigate the predictive properties of patient characteristics, single variables, tests, or markers, or combinations of variables, tests, or markers (multivariable studies). Both types of prediction research can include also studies that build multivariable prediction models to guide patient management (model development), or that test the performance of models (validation), or that quantify the effect of using a prediction model on patient and physician behaviors and outcomes (impact assessment). Why Was This Study Done? With the increase in prediction research, there is an increased interest in the methodology of this type of research because poorly done or poorly reported prediction research is likely to have limited reliability and applicability and will, therefore, be of little use in patient management. In this systematic review, the researchers investigate the reporting and methods of prediction studies by examining the aims, design, participant selection, definition and measurement of outcomes and candidate predictors, statistical power and analyses, and performance measures included in multivariable prediction research articles published in 2008 in several general medical journals. In a systematic review, researchers identify all the studies undertaken on a given topic using a predefined set of criteria and systematically analyze the reported methods and results of these studies. What Did the Researchers Do and Find? The researchers identified all the multivariable prediction studies meeting their predefined criteria that were published in 2008 in six high impact general medical journals by browsing through all the issues of the journals (a hand search). They then scored the methods and reporting of each study using a comprehensive item list based on recent recommendations for the conduct of prediction research (for example, the reporting recommendations for tumor marker prognostic studies—the REMARK guidelines). Of 71 retrieved studies, 51 were predictor finding studies, 14 were prediction model development studies, three externally validated an existing model, and three reported on a model's impact on participant outcome. Study design, participant selection, definitions of outcomes and predictors, and predictor selection were generally well reported, but other methodological and reporting aspects of the studies were suboptimal. For example, despite many recommendations, continuous predictors were often dichotomized. That is, rather than using the measured value of a variable in a prediction model (for example, blood pressure in a cardiovascular disease prediction model), measurements were frequently assigned to two broad categories. Similarly, many of the studies failed to adequately estimate the sample size needed to minimize bias in predictor effects, and few of the model development papers quantified and validated the proposed model's predictive performance. What Do These Findings Mean? These findings indicate that, in 2008, most of the prediction research published in high impact general medical journals failed to follow current guidelines for the conduct and reporting of clinical prediction studies. Because the studies examined here were published in high impact medical journals, they are likely to be representative of the higher quality studies published in 2008. However, reporting standards may have improved since 2008, and the conduct of prediction research may actually be better than this analysis suggests because the length restrictions that are often applied to journal articles may account for some of reporting omissions. Nevertheless, despite some encouraging findings, the researchers conclude that the poor reporting and poor methods they found in many published prediction studies is a cause for concern and is likely to limit the reliability and applicability of this type of clinical research. Additional Information Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001221. The EQUATOR Network is an international initiative that seeks to improve the reliability and value of medical research literature by promoting transparent and accurate reporting of research studies; its website includes information on a wide range of reporting guidelines including the REMARK recommendations (in English and Spanish) A video of a presentation by Doug Altman, one of the researchers of this study, on improving the reporting standards of the medical evidence base, is available The Cochrane Prognosis Methods Group provides additional information on the methodology of prognostic research
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- 2012
18. Valid consent for genomic epidemiology in developing countries.
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Chokshi, Dave A., Thera, Mahamadou A., Parker, Michael, Diakite, Mahamadou, Makani, Julie, Kwiatkowski, Dominic P., and Doumbo, Ogobara K.
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ETHICS ,GENOMICS ,EPIDEMIOLOGY ,RESEARCH ,INFORMED consent & ethics ,COMPARATIVE studies ,DEVELOPING countries ,EPIDEMIOLOGICAL research ,INFORMED consent (Medical law) ,INTERNATIONAL relations ,RESEARCH methodology ,MEDICAL cooperation ,WORLD health ,EVALUATION research - Abstract
Drawing on experience gained from ongoing research in Mali, this paper describes practical ethical challenges relating to the achievement of valid consent in genomic epidemiology. [ABSTRACT FROM AUTHOR]
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- 2007
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19. Risk and protective factors for child development: An observational South African birth cohort.
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Donald, Kirsten Ann, Wedderburn, Catherine J., Barnett, Whitney, Nhapi, Raymond T., Rehman, Andrea M., Stadler, Jacob A. M., Hoffman, Nadia, Koen, Nastassja, Zar, Heather J., and Stein, Dan J.
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ADULT child abuse victims ,CHILD development ,BIRTH size ,DISEASE risk factors ,INTIMATE partner violence ,CHILDBIRTH ,BIRTH weight - Abstract
Background: Approximately 250 million (43%) children under the age of 5 years in low- and middle-income countries (LMICs) are failing to meet their developmental potential. Risk factors are recognised to contribute to this loss of human potential. Expanding understanding of the risks that lead to poor outcomes and which protective factors contribute to resilience in children may be critical to improving disparities.Methods and Findings: The Drakenstein Child Health Study is a population-based birth cohort in the Western Cape, South Africa. Pregnant women were enrolled between 20 and 28 weeks' gestation from two community clinics from 2012 to 2015; sociodemographic and psychosocial data were collected antenatally. Mothers and children were followed through birth until 2 years of age. Developmental assessments were conducted by trained assessors blinded to background, using the Bayley-III Scales of Infant and Toddler Development (BSID-III), validated for use in South Africa, at 24 months of age. The study assessed all available children at 24 months; however, some children were not able to attend, because of loss to follow-up or unavailability of a caregiver or child at the correct age. Of 1,143 live births, 1,002 were in follow-up at 24 months, and a total of 734 children (73%) had developmental assessments, of which 354 (48.2%) were girls. This sample was characterised by low household employment (n = 183; 24.9%) and household income (n = 287; 39.1% earning1 domain affected, and 75 (10.2%) had delay in all domains. Bivariate and multivariable analyses revealed several factors that were associated with developmental outcomes. These included protective factors (maternal education, higher birth weight, and socioeconomic status) and risk factors (maternal anaemia in pregnancy, depression or lifetime intimate partner violence, and maternal HIV infection). Boys consistently performed worse than girls (in cognition [β = -0.74; 95% CI -1.46 to -0.03, p = 0.042], receptive language [β = -1.10; 95% CI -1.70 to -0.49, p < 0.001], expressive language [β = -1.65; 95% CI -2.46 to -0.84, p < 0.001], and fine motor [β = -0.70; 95% CI -1.20 to -0.20, p = 0.006] scales). There was evidence that child sex interacted with risk and protective factors including birth weight, maternal anaemia in pregnancy, and socioeconomic factors. Important limitations of the study include attrition of sample from birth to assessment age and missing data in some exposure areas from those assessed. Conclusions: This study provides reliable developmental data from a sub-Saharan African setting in a well-characterised sample of mother-child dyads. Our findings highlight not only the important protective effects of maternal education, birth weight, and socioeconomic status for developmental outcomes but also sex differences in developmental outcomes and key risk and protective factors for each group. [ABSTRACT FROM AUTHOR]- Published
- 2019
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20. Appraising the role of previously reported risk factors in epithelial ovarian cancer risk: A Mendelian randomization analysis.
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Yarmolinsky, James, Relton, Caroline L., Lophatananon, Artitaya, Muir, Kenneth, Menon, Usha, Gentry-Maharaj, Aleksandra, Walther, Axel, Zheng, Jie, Fasching, Peter, Zheng, Wei, Yin Ling, Woo, Park, Sue K., Kim, Byoung-Gie, Choi, Ji-Yeob, Park, Boyoung, Davey Smith, George, Martin, Richard M., and Lewis, Sarah J.
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OVARIAN epithelial cancer ,DISEASE risk factors - Abstract
Background: Various risk factors have been associated with epithelial ovarian cancer risk in observational epidemiological studies. However, the causal nature of the risk factors reported, and thus their suitability as effective intervention targets, is unclear given the susceptibility of conventional observational designs to residual confounding and reverse causation. Mendelian randomization (MR) uses genetic variants as proxies for risk factors to strengthen causal inference in observational studies. We used MR to evaluate the association of 12 previously reported risk factors (reproductive, anthropometric, clinical, lifestyle, and molecular factors) with risk of invasive epithelial ovarian cancer, invasive epithelial ovarian cancer histotypes, and low malignant potential tumours.Methods and Findings: Genetic instruments to proxy 12 risk factors were constructed by identifying single nucleotide polymorphisms (SNPs) that were robustly (P < 5 × 10-8) and independently associated with each respective risk factor in previously reported genome-wide association studies. These risk factors included genetic liability to 3 factors (endometriosis, polycystic ovary syndrome, type 2 diabetes) scaled to reflect a 50% higher odds liability to disease. We obtained summary statistics for the association of these SNPs with risk of overall and histotype-specific invasive epithelial ovarian cancer (22,406 cases; 40,941 controls) and low malignant potential tumours (3,103 cases; 40,941 controls) from the Ovarian Cancer Association Consortium (OCAC). The OCAC dataset comprises 63 genotyping project/case-control sets with participants of European ancestry recruited from 14 countries (US, Australia, Belarus, Germany, Belgium, Denmark, Finland, Norway, Canada, Poland, UK, Spain, Netherlands, and Sweden). SNPs were combined into multi-allelic inverse-variance-weighted fixed or random effects models to generate effect estimates and 95% confidence intervals (CIs). Three complementary sensitivity analyses were performed to examine violations of MR assumptions: MR-Egger regression and weighted median and mode estimators. A Bonferroni-corrected P value threshold was used to establish strong evidence (P < 0.0042) and suggestive evidence (0.0042 < P < 0.05) for associations. In MR analyses, there was strong or suggestive evidence that 2 of the 12 risk factors were associated with invasive epithelial ovarian cancer and 8 of the 12 were associated with 1 or more invasive epithelial ovarian cancer histotypes. There was strong evidence that genetic liability to endometriosis was associated with an increased risk of invasive epithelial ovarian cancer (odds ratio [OR] per 50% higher odds liability: 1.10, 95% CI 1.06-1.15; P = 6.94 × 10-7) and suggestive evidence that lifetime smoking exposure was associated with an increased risk of invasive epithelial ovarian cancer (OR per unit increase in smoking score: 1.36, 95% CI 1.04-1.78; P = 0.02). In analyses examining histotypes and low malignant potential tumours, the strongest associations found were between height and clear cell carcinoma (OR per SD increase: 1.36, 95% CI 1.15-1.61; P = 0.0003); age at natural menopause and endometrioid carcinoma (OR per year later onset: 1.09, 95% CI 1.02-1.16; P = 0.007); and genetic liability to polycystic ovary syndrome and endometrioid carcinoma (OR per 50% higher odds liability: 0.89, 95% CI 0.82-0.96; P = 0.002). There was little evidence for an association of genetic liability to type 2 diabetes, parity, or circulating levels of 25-hydroxyvitamin D and sex hormone binding globulin with ovarian cancer or its subtypes. The primary limitations of this analysis include the modest statistical power for analyses of risk factors in relation to some less common ovarian cancer histotypes (low grade serous, mucinous, and clear cell carcinomas), the inability to directly examine the association of some ovarian cancer risk factors that did not have robust genetic variants available to serve as proxies (e.g., oral contraceptive use, hormone replacement therapy), and the assumption of linear relationships between risk factors and ovarian cancer risk.Conclusions: Our comprehensive examination of possible aetiological drivers of ovarian carcinogenesis using germline genetic variants to proxy risk factors supports a role for few of these factors in invasive epithelial ovarian cancer overall and suggests distinct aetiologies across histotypes. The identification of novel risk factors remains an important priority for the prevention of epithelial ovarian cancer. [ABSTRACT FROM AUTHOR]- Published
- 2019
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21. Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): A pragmatic multicentre randomised trial.
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H. Al Wattar, Bassel, Dodds, Julie, Placzek, Anna, Beresford, Lee, Spyreli, Eleni, Moore, Amanda, Gonzalez Carreras, Francisco J., Austin, Frances, Murugesu, Nilaani, Roseboom, Tessa J., Bes-Rastrollo, Maira, Hitman, Graham A., Hooper, Richard, Khan, Khalid S., Thangaratinam, Shakila, null, null, and ESTEEM study group
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PREGNANT women ,DIABETES in women ,HIGH-risk pregnancy ,PREGNANCY complications ,DIET ,GESTATIONAL diabetes - Abstract
Background: Pregnant women with metabolic risk factors are at high risk of complications. We aimed to assess whether a Mediterranean-style diet reduces adverse pregnancy outcomes in high-risk women.Methods and Findings: We conducted a multicentre randomised trial in 5 maternity units (4 in London and 1 in Birmingham) between 12 September 2014 and 29 February 2016. We randomised inner-city pregnant women with metabolic risk factors (obesity, chronic hypertension, or hypertriglyceridaemia) to a Mediterranean-style diet with high intake of nuts, extra virgin olive oil, fruits, vegetables, nonrefined grains, and legumes; moderate to high consumption of fish; low to moderate intake of poultry and dairy products; low intake of red and processed meat; and avoidance of sugary drinks, fast food, and food rich in animal fat versus usual care. Participants received individualised dietary advice at 18, 20, and 28 weeks' gestation. The primary endpoints were composite maternal (gestational diabetes or preeclampsia) and composite offspring (stillbirth, small for gestational age, or admission to neonatal care unit) outcomes prioritised by a Delphi survey. We used an intention-to-treat (ITT) analysis with multivariable models and identified the stratification variables and prognostic factors a priori. We screened 7,950 and randomised 1,252 women. Baseline data were available for 593 women in the intervention (93.3% follow-up, 553/593) and 612 in the control (95.6% follow-up, 585/612) groups. Over a quarter of randomised women were primigravida (330/1,205; 27%), 60% (729/1,205) were of Black or Asian ethnicity, and 69% (836/1,205) were obese. Women in the intervention arm consumed more nuts (70.1% versus 22.9%; adjusted odds ratio [aOR] 6.8, 95% confidence interval [CI] 4.3-10.6, p ≤ 0.001) and extra virgin olive oil (93.2% versus 49.0%; aOR 32.2, 95% CI 16.0-64.6, p ≤ 0.001) than controls; increased their intake of fish (p < 0.001), white meat (p < 0.001), and pulses (p = 0.05); and reduced their intake of red meat (p < 0.001), butter, margarine, and cream (p < 0.001). There was no significant reduction in the composite maternal (22.8% versus 28.6%; aOR 0.76, 95% CI 0.56-1.03, p = 0.08) or composite offspring (17.3% versus 20.9%; aOR 0.79, 95% CI 0.58-1.08, p = 0.14) outcomes. There was an apparent reduction in the odds of gestational diabetes by 35% (aOR 0.65, 95% CI 0.47-0.91, p = 0.01) but not in other individual components of the composite outcomes. Mothers gained less gestational weight (mean 6.8 versus 8.3 kg; adjusted difference -1.2 Kg, 95% CI -2.2 to -0.2, p = 0.03) with intervention versus control. There was no difference in any of the other maternal and offspring complications between both groups. When we pooled findings from the Effect of Simple, Targeted Diet in Pregnant Women With Metabolic Risk Factors on Pregnancy Outcomes (ESTEEM) trial with similar trials using random effects meta-analysis, we observed a significant reduction in gestational diabetes (odds ratio [OR] 0.67, 95% CI 0.53-0.84, I2 = 0%), with no heterogeneity (2 trials, 2,397 women). The study's limitations include the use of participant reported tools for adherence to the intervention instead of objective biomarkers.Conclusions: A simple, individualised, Mediterranean-style diet in pregnancy did not reduce the overall risk of adverse maternal and offspring complications but has the potential to reduce gestational weight gain and the risk of gestational diabetes.Trial Registration: ClinicalTrials.gov NCT02218931. [ABSTRACT FROM AUTHOR]- Published
- 2019
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22. Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis.
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Hamad, Rita, Nguyen, Thu T., Bhattacharya, Jay, Glymour, M. Maria, and Rehkopf, David H.
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EDUCATIONAL attainment ,EDUCATIONAL mobility ,HEALTH & Nutrition Examination Survey ,DISEASE progression ,CARDIOVASCULAR diseases - Abstract
Background: There is ongoing debate about whether education or socioeconomic status (SES) should be inputs into cardiovascular disease (CVD) prediction algorithms and clinical risk adjustment models. It is also unclear whether intervening on education will affect CVD, in part because there is controversy regarding whether education is a determinant of CVD or merely correlated due to confounding or reverse causation. We took advantage of a natural experiment to estimate the population-level effects of educational attainment on CVD and related risk factors.Methods and Findings: We took advantage of variation in United States state-level compulsory schooling laws (CSLs), a natural experiment that was associated with geographic and temporal differences in the minimum number of years that children were required to attend school. We linked census data on educational attainment (N = approximately 5.4 million) during childhood with outcomes in adulthood, using cohort data from the 1992-2012 waves of the Health and Retirement Study (HRS; N = 30,853) and serial cross-sectional data from 1971-2012 waves of the National Health and Nutrition Examination Survey (NHANES; N = 44,732). We examined self-reported CVD outcomes and related risk factors, as well as relevant serum biomarkers. Using instrumental variables (IV) analysis, we found that increased educational attainment was associated with reduced smoking (HRS β -0.036, 95%CI: -0.06, -0.02, p < 0.01; NHANES β -0.032, 95%CI: -0.05, -0.02, p < 0.01), depression (HRS β -0.049, 95%CI: -0.07, -0.03, p < 0.01), triglycerides (NHANES β -0.039, 95%CI: -0.06, -0.01, p < 0.01), and heart disease (HRS β -0.025, 95%CI: -0.04, -0.002, p = 0.01), and improvements in high-density lipoprotein (HDL) cholesterol (HRS β 1.50, 95%CI: 0.34, 2.49, p < 0.01; NHANES β 0.86, 95%CI: 0.32, 1.48, p < 0.01), but increased BMI (HRS β 0.20, 95%CI: 0.002, 0.40, p = 0.05; NHANES β 0.13, 95%CI: 0.01, 0.32, p = 0.05) and total cholesterol (HRS β 2.73, 95%CI: 0.09, 4.97, p = 0.03). While most findings were cross-validated across both data sets, they were not robust to the inclusion of state fixed effects. Limitations included residual confounding, use of self-reported outcomes for some analyses, and possibly limited generalizability to more recent cohorts.Conclusions: This study provides rigorous population-level estimates of the association of educational attainment with CVD. These findings may guide future implementation of interventions to address the social determinants of CVD and strengthen the argument for including educational attainment in prediction algorithms and primary prevention guidelines for CVD. [ABSTRACT FROM AUTHOR]- Published
- 2019
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23. Retention and viral suppression in a cohort of HIV patients on antiretroviral therapy in Zambia: Regionally representative estimates using a multistage-sampling-based approach.
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Sikazwe, Izukanji, Eshun-Wilson, Ingrid, Sikombe, Kombatende, Czaicki, Nancy, Somwe, Paul, Mody, Aaloke, Simbeza, Sandra, Glidden, David V., Chizema, Elizabeth, Mulenga, Lloyd B., Padian, Nancy, Duncombe, Chris J., Bolton-Moore, Carolyn, Beres, Laura K., Holmes, Charles B., and Geng, Elvin
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HIV-positive persons ,THERAPEUTICS ,ELECTRONIC health records ,RECORDS management ,TELEPHONE calls - Abstract
Background: Although the success of HIV treatment programs depends on retention and viral suppression, routine program monitoring of these outcomes may be incomplete. We used data from the national electronic medical record (EMR) system in Zambia to enumerate a large and regionally representative cohort of patients on treatment. We traced a random sample with unknown outcomes (lost to follow-up) to document true care status and HIV RNA levels.Methods and Findings: On 31 July 2015, we selected facilities from 4 provinces in 12 joint strata defined by facility type and province with probability proportional to size. In each facility, we enumerated adults with at least 1 clinical encounter after treatment initiation in the previous 24 months. From this cohort, we identified lost-to-follow-up patients (defined as 90 or more days late for their last appointment), selected a random sample, and intensively reviewed their records and traced them via phone calls and in-person visits in the community. In 1 of 4 provinces, we also collected dried blood spots (DBSs) for plasma HIV RNA testing. We used inverse probability weights to incorporate sampling outcomes into Aalen-Johansen and Cox proportional hazards regression to estimate retention and viremia. We used a bias analysis approach to correct for the known inaccuracy of plasma HIV RNA levels obtained from DBSs. From a total of 64 facilities with 165,464 adults on ART, we selected 32 facilities with 104,966 patients, of whom 17,602 (17%) were lost to follow-up: Those lost to follow-up had median age 36 years, 60% were female (N = 11,241), they had median enrollment CD4 count of 220 cells/μl, and 38% had WHO stage 1 clinical disease (N = 10,690). We traced 2,892 (16%) and found updated outcomes for 2,163 (75%): 412 (19%) had died, 836 (39%) were alive and in care at their original clinic, 457 (21%) had transferred to a new clinic, 255 (12%) were alive and out of care, and 203 (9%) were alive but we were unable to determine care status. Estimates using data from the EMR only suggested that 42.7% (95% CI 38.0%-47.1%) of new ART starters and 72.3% (95% CI 71.8%-73.0%) of all ART users were retained at 2 years. After incorporating updated data through tracing, we found that 77.3% (95% CI 70.5%-84.0%) of new initiates and 91.2% (95% CI 90.5%-91.8%) of all ART users were retained (at original clinic or transferred), indicating that routine program data underestimated retention in care markedly. In Lusaka Province, HIV RNA levels greater than or equal to 1,000 copies/ml were present in 18.1% (95% CI 14.0%-22.3%) of patients in care, 71.3% (95% CI 58.2%-84.4%) of lost patients, and 24.7% (95% CI 21.0%-29.3%). The main study limitations were imperfect response rates and the use of self-reported care status.Conclusions: In this region of Zambia, routine program data underestimated retention, and the point prevalence of unsuppressed HIV RNA was high when lost patients were accounted for. Viremia was prevalent among patients who unofficially transferred: Sustained engagement remains a challenge among HIV patients in Zambia, and targeted sampling is an effective strategy to identify such gaps in the care cascade and monitor programmatic progress. [ABSTRACT FROM AUTHOR]- Published
- 2019
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24. Plasmodium vivax morbidity after radical cure: A cohort study in Central Vietnam.
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Pham, Thanh Vinh, Nguyen, Hong Van, Aguirre, Angel Rosas, Nguyen, Van Van, A. Cleves, Mario, Nguyen, Xa Xuan, Nguyen, Thao Thanh, Tran, Duong Thanh, Le, Hung Xuan, Hens, Niel, Rosanas-Urgell, Anna, D’Alessandro, Umberto, Speybroeck, Niko, Erhart, Annette, and D'Alessandro, Umberto
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PLASMODIUM vivax ,COHORT analysis ,DISEASES ,POLYMERASE chain reaction ,THERAPEUTICS - Abstract
Background: In Vietnam, the importance of vivax malaria relative to falciparum during the past decade has steadily increased to 50%. This, together with the spread of multidrug-resistant Plasmodium falciparum, is a major challenge for malaria elimination. A 2-year prospective cohort study to assess P. vivax morbidity after radical cure treatment and related risk factors was conducted in Central Vietnam.Methods and Findings: The study was implemented between April 2009 and December 2011 in four neighboring villages in a remote forested area of Quang Nam province. P. vivax-infected patients were treated radically with chloroquine (CQ; 25 mg/kg over 3 days) and primaquine (PQ; 0.5 mg/kg/day for 10 days) and visited monthly (malaria symptoms and blood sampling) for up to 2 years. Time to first vivax recurrence was estimated by Kaplan-Meier survival analysis, and risk factors for first and recurrent infections were identified by Cox regression models. Among the 260 P. vivax patients (61% males [159/260]; age range 3-60) recruited, 240 completed the 10-day treatment, 223 entered the second month of follow-up, and 219 were followed for at least 12 months. Most individuals (76.78%, 171/223) had recurrent vivax infections identified by molecular methods (polymerase chain reaction [PCR]); in about half of them (55.61%, 124/223), infection was detected by microscopy, and 84 individuals (37.67%) had symptomatic recurrences. Median time to first recurrence by PCR was 118 days (IQR 59-208). The estimated probability of remaining free of recurrence by month 24 was 20.40% (95% CI [14.42; 27.13]) by PCR, 42.52% (95% CI [35.41; 49.44]) by microscopy, and 60.69% (95% CI [53.51; 67.11]) for symptomatic recurrences. The main risk factor for recurrence (first or recurrent) was prior P. falciparum infection. The main limitations of this study are the age of the results and the absence of a comparator arm, which does not allow estimating the proportion of vivax relapses among recurrent infections.Conclusion: A substantial number of P. vivax recurrences, mainly submicroscopic (SM) and asymptomatic, were observed after high-dose PQ treatment (5.0 mg/kg). Prior P. falciparum infection was an important risk factor for all types of vivax recurrences. Malaria elimination efforts need to address this largely undetected P. vivax transmission by simultaneously tackling the reservoir of P. falciparum and P. vivax infections. [ABSTRACT FROM AUTHOR]- Published
- 2019
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25. COSMOS-E: Guidance on conducting systematic reviews and meta-analyses of observational studies of etiology.
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Dekkers, Olaf M., Vandenbroucke, Jan P., Cevallos, Myriam, Renehan, Andrew G., Altman, Douglas G., and Egger, Matthias
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Background: To our knowledge, no publication providing overarching guidance on the conduct of systematic reviews of observational studies of etiology exists.Methods and Findings: Conducting Systematic Reviews and Meta-Analyses of Observational Studies of Etiology (COSMOS-E) provides guidance on all steps in systematic reviews of observational studies of etiology, from shaping the research question, defining exposure and outcomes, to assessing the risk of bias and statistical analysis. The writing group included researchers experienced in meta-analyses and observational studies of etiology. Standard peer-review was performed. While the structure of systematic reviews of observational studies on etiology may be similar to that for systematic reviews of randomised controlled trials, there are specific tasks within each component that differ. Examples include assessment for confounding, selection bias, and information bias. In systematic reviews of observational studies of etiology, combining studies in meta-analysis may lead to more precise estimates, but such greater precision does not automatically remedy potential bias. Thorough exploration of sources of heterogeneity is key when assessing the validity of estimates and causality.Conclusion: As many reviews of observational studies on etiology are being performed, this document may provide researchers with guidance on how to conduct and analyse such reviews. [ABSTRACT FROM AUTHOR]- Published
- 2019
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26. Setting targets for HIV/AIDS-What lessons can be learned from other disease control programmes?
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Bhatia, Tazeem, Heymann, David, Dar, Osman, Enoch, Jamie, Khan, Mishal, Hayes, Richard, and Mathewson, Sophie
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AIDS diagnosis ,AIDS prevention ,PREVENTION of epidemics ,DIAGNOSIS of HIV infections ,HIV prevention ,HANSEN'S disease diagnosis ,MALARIA diagnosis ,MALARIA prevention ,HIV infection epidemiology ,AIDS ,COMPARATIVE studies ,HANSEN'S disease ,MALARIA ,RESEARCH methodology ,MEDICAL care ,MEDICAL cooperation ,RESEARCH ,EVALUATION research ,DISEASE eradication - Abstract
In a Collection Review, Richard Hayes and colleagues discuss metrics for assessing progress in control of the HIV/AIDS epidemic in the context of prior disease control programmes. [ABSTRACT FROM AUTHOR]
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- 2019
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27. Progress in the HIV epidemic: Identifying goals and measuring success.
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Jones, Jeb, Sullivan, Patrick S., and Curran, James W.
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HIV prevention ,AIDS prevention ,HIV infections ,AIDS ,AIDS treatment ,HIV infection transmission - Abstract
Substantial progress has been made towards the goal of ending the HIV/AIDS epidemic due to advancements in both prevention and treatment of HIV. However, major challenges still remain. We describe basic principles of epidemic control in the context of HIV and identify a number of attainable goals in terms of control and elimination of HIV in specific populations and risk groups, given currently available HIV prevention and treatment methods. Currently available HIV prevention methods make it a feasible goal to eliminate HIV transmission attributable to mother-to-child transmission and blood transfusions. Reductions in transmission attributable to sexual behavior and injection drug use are feasible, but elimination of these modes of transmission will require further advancements in behavioral and biomedical HIV prevention. With regard to HIV-related mortality, we argue that elimination of death due to HIV-related causes is a feasible goal. HIV-related deaths should be treated as sentinel events triggering epidemiological investigation into the breakdowns in the HIV care continuum that led to them. We briefly discuss additional considerations that will affect the success of HIV prevention programs. [ABSTRACT FROM AUTHOR]
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- 2019
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28. Association between severe drought and HIV prevention and care behaviors in Lesotho: A population-based survey 2016-2017.
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Low, Andrea J., Frederix, Koen, McCracken, Stephen, Manyau, Salome, Gummerson, Elizabeth, Radin, Elizabeth, Davia, Stefania, Longwe, Herbert, Ahmed, Nahima, Parekh, Bharat, Findley, Sally, and Schwitters, Amee
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DROUGHTS ,DIAGNOSIS of HIV infections ,DISEASE prevalence ,SEXUAL assault ,SEX customs ,PUBLIC health - Abstract
Background: A previous analysis of the impact of drought in Africa on HIV demonstrated an 11% greater prevalence in HIV-endemic rural areas attributable to local rainfall shocks. The Lesotho Population-Based HIV Impact Assessment (LePHIA) was conducted after the severe drought of 2014-2016, allowing for reevaluation of this relationship in a setting of expanded antiretroviral coverage.Methods and Findings: LePHIA selected a nationally representative sample between November 2016 and May 2017. All adults aged 15-59 years in randomly selected households were invited to complete an interview and HIV testing, with one woman per household eligible to answer questions on their experience of sexual violence. Deviations in rainfall for May 2014-June 2016 were estimated using precipitation data from Climate Hazards Group InfraRed Precipitation with Station Data (CHIRPS), with drought defined as <15% of the average rainfall from 1981 to 2016. The association between drought and risk behaviors as well as HIV-related outcomes was assessed using logistic regression, incorporating complex survey weights. Analyses were stratified by age, sex, and geography (urban versus rural). All of Lesotho suffered from reduced rainfall, with regions receiving 1%-36% of their historical rainfall. Of the 12,887 interviewed participants, 93.5% (12,052) lived in areas that experienced drought, with the majority in rural areas (7,281 versus 4,771 in urban areas). Of the 835 adults living in areas without drought, 520 were in rural areas and 315 in urban. Among females 15-19 years old, living in a rural drought area was associated with early sexual debut (odds ratio [OR] 3.11, 95% confidence interval [CI] 1.43-6.74, p = 0.004), and higher HIV prevalence (OR 2.77, 95% CI 1.19-6.47, p = 0.02). It was also associated with lower educational attainment in rural females ages 15-24 years (OR 0.44, 95% CI 0.25-0.78, p = 0.005). Multivariable analysis adjusting for household wealth and sexual behavior showed that experiencing drought increased the odds of HIV infection among females 15-24 years old (adjusted OR [aOR] 1.80, 95% CI 0.96-3.39, p = 0.07), although this was not statistically significant. Migration was associated with 2-fold higher odds of HIV infection in young people (aOR 2.06, 95% CI 1.25-3.40, p = 0.006). The study was limited by the extensiveness of the drought and the small number of participants in the comparison group.Conclusions: Drought in Lesotho was associated with higher HIV prevalence in girls 15-19 years old in rural areas and with lower educational attainment and riskier sexual behavior in rural females 15-24 years old. Policy-makers may consider adopting potential mechanisms to mitigate the impact of income shock from natural disasters on populations vulnerable to HIV transmission. [ABSTRACT FROM AUTHOR]- Published
- 2019
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29. Health system costs for individual and comorbid noncommunicable diseases: An analysis of publicly funded health events from New Zealand.
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Blakely, Tony, Kvizhinadze, Giorgi, Atkinson, June, Dieleman, Joseph, and Clarke, Philip
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MEDICAL care costs ,MEDICAL economics ,NON-communicable diseases ,COMORBIDITY ,EPIDEMIOLOGY - Abstract
Background: There is little systematic assessment of how total health expenditure is distributed across diseases and comorbidities. The objective of this study was to use statistical methods to disaggregate all publicly funded health expenditure by disease and comorbidities in order to answer three research questions: (1) What is health expenditure by disease phase for noncommunicable diseases (NCDs) in New Zealand? (2) Is the cost of having two NCDs more or less than that expected given the independent costs of each NCD? (3) How is total health spending disaggregated by NCDs across age and by sex?Methods and Findings: We used linked data for all adult New Zealanders for publicly funded events, including hospitalisation, outpatient, pharmaceutical, laboratory testing, and primary care from 1 July 2007 to 30 June 2014. These data include 18.9 million person-years and $26.4 billion in spending (US$ 2016). We used case definition algorithms to identify if a person had any of six NCDs (cancer, cardiovascular disease [CVD], diabetes, musculoskeletal, neurological, and a chronic lung/liver/kidney [LLK] disease). Indicator variables were used to identify the presence of any of the 15 possible comorbidity pairings of these six NCDs. Regression was used to estimate excess annual health expenditure per person. Cause deletion methods were used to estimate total population expenditure by disease. A majority (59%) of health expenditure was attributable to NCDs. Expenditure due to diseases was generally highest in the year of diagnosis and year of death. A person having two diseases simultaneously generally had greater health expenditure than the expected sum of having the diseases separately, for all 15 comorbidity pairs except the CVD-cancer pair. For example, a 60-64-year-old female with none of the six NCDs had $633 per annum expenditure. If she had both CVD and chronic LLK, additional expenditure for CVD separately was $6,443/$839/$9,225 for the first year of diagnosis/prevalent years/last year of life if dying of CVD; additional expenditure for chronic LLK separately was $6,443/$1,291/$9,051; and the additional comorbidity expenditure of having both CVD and LLK was $2,456 (95% confidence interval [CI] $2,238-$2,674). The pattern was similar for males (e.g., additional comorbidity expenditure for a 60-64-year-old male with CVD and chronic LLK was $2,498 [95% CI $2,264-$2,632]). In addition to this, the excess comorbidity costs for a person with two diseases was greater at younger ages, e.g., excess expenditure for 45-49-year-old males with CVD and chronic LLK was 10 times higher than for 75-79-year-old males and six times higher for females. At the population level, 23.8% of total health expenditure was attributable to higher costs of having one of the 15 comorbidity pairs over and above the six NCDs separately; of the remaining expenditure, CVD accounted for 18.7%, followed by musculoskeletal (16.2%), neurological (14.4%), cancer (14.1%), chronic LLK disease (7.4%), and diabetes (5.5%). Major limitations included incomplete linkage to all costed events (although these were largely non-NCD events) and missing private expenditure.Conclusions: The costs of having two NCDs simultaneously is typically superadditive, and more so for younger adults. Neurological and musculoskeletal diseases contributed the largest health system costs, in accord with burden of disease studies finding that they contribute large morbidity. Just as burden of disease methodology has advanced the understanding of disease burden, there is a need to create disease-based costing studies that facilitate the disaggregation of health budgets at a national level. [ABSTRACT FROM AUTHOR]- Published
- 2019
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30. A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study.
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Liu, Zuyun, Kuo, Pei-Lun, Horvath, Steve, Crimmins, Eileen, Ferrucci, Luigi, and Levine, Morgan
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GERONTOLOGY ,MORTALITY ,SOCIOECONOMIC factors ,HEALTH behavior ,EPIDEMIOLOGY ,HEALTH outcome assessment - Abstract
Background: A person's rate of aging has important implications for his/her risk of death and disease; thus, quantifying aging using observable characteristics has important applications for clinical, basic, and observational research. Based on routine clinical chemistry biomarkers, we previously developed a novel aging measure, Phenotypic Age, representing the expected age within the population that corresponds to a person's estimated mortality risk. The aim of this study was to assess its applicability for differentiating risk for a variety of health outcomes within diverse subpopulations that include healthy and unhealthy groups, distinct age groups, and persons with various race/ethnic, socioeconomic, and health behavior characteristics.Methods and Findings: Phenotypic Age was calculated based on a linear combination of chronological age and 9 multi-system clinical chemistry biomarkers in accordance with our previously established method. We also estimated Phenotypic Age Acceleration (PhenoAgeAccel), which represents Phenotypic Age after accounting for chronological age (i.e., whether a person appears older [positive value] or younger [negative value] than expected, physiologically). All analyses were conducted using NHANES IV (1999-2010, an independent sample from that originally used to develop the measure). Our analytic sample consisted of 11,432 adults aged 20-84 years and 185 oldest-old adults top-coded at age 85 years. We observed a total of 1,012 deaths, ascertained over 12.6 years of follow-up (based on National Death Index data through December 31, 2011). Proportional hazard models and receiver operating characteristic curves were used to evaluate all-cause and cause-specific mortality predictions. Overall, participants with more diseases had older Phenotypic Age. For instance, among young adults, those with 1 disease were 0.2 years older phenotypically than disease-free persons, and those with 2 or 3 diseases were about 0.6 years older phenotypically. After adjusting for chronological age and sex, Phenotypic Age was significantly associated with all-cause mortality and cause-specific mortality (with the exception of cerebrovascular disease mortality). Results for all-cause mortality were robust to stratifications by age, race/ethnicity, education, disease count, and health behaviors. Further, Phenotypic Age was associated with mortality among seemingly healthy participants-defined as those who reported being disease-free and who had normal BMI-as well as among oldest-old adults, even after adjustment for disease prevalence. The main limitation of this study was the lack of longitudinal data on Phenotypic Age and disease incidence.Conclusions: In a nationally representative US adult population, Phenotypic Age was associated with mortality even after adjusting for chronological age. Overall, this association was robust across different stratifications, particularly by age, disease count, health behaviors, and cause of death. We also observed a strong association between Phenotypic Age and the disease count an individual had. These findings suggest that this new aging measure may serve as a useful tool to facilitate identification of at-risk individuals and evaluation of the efficacy of interventions, and may also facilitate investigation into potential biological mechanisms of aging. Nevertheless, further evaluation in other cohorts is needed. [ABSTRACT FROM AUTHOR]- Published
- 2018
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31. Defining rights-based indicators for HIV epidemic transition.
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Amon, Joseph J., Eba, Patrick, Sprague, Laurel, Edwards, Olive, and Beyrer, Chris
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HUMAN rights ,HIV infections ,EPIDEMIOLOGY ,PUBLIC health ,VIRUS diseases - Abstract
In a Policy Forum, Joseph Amon and colleagues discuss human rights indicators for tracking progress toward ending the HIV epidemic. [ABSTRACT FROM AUTHOR]
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- 2018
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32. Epidemiological metrics and benchmarks for a transition in the HIV epidemic.
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Ghys, Peter D., Williams, Brian G., Over, Mead, Hallett, Timothy B., and Godfrey-Faussett, Peter
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DIAGNOSIS of HIV infections ,HIV prevention ,EPIDEMIOLOGY ,EPIDEMICS ,PUBLIC health - Abstract
Peter Godfrey-Faussett and colleagues present six epidemiological metrics for tracking progress in reducing the public health threat of HIV. [ABSTRACT FROM AUTHOR]
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- 2018
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33. Using routinely collected laboratory data to identify high rifampicin-resistant tuberculosis burden communities in the Western Cape Province, South Africa: A retrospective spatiotemporal analysis.
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McIntosh, Avery I., Jenkins, Helen E., White, Laura F., Barnard, Marinus, Thomson, Dana R., Dolby, Tania, Simpson, John, Streicher, Elizabeth M., Kleinman, Mary B., Ragan, Elizabeth J., van Helden, Paul D., Murray, Megan B., Warren, Robin M., and Jacobson, Karen R.
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TUBERCULOSIS ,RIFAMPIN ,MICROBIOLOGY ,DRUG resistance ,PHARMACOLOGY - Abstract
Background: South Africa has the highest tuberculosis incidence globally (781/100,000), with an estimated 4.3% of cases being rifampicin resistant (RR). Control and elimination strategies will require detailed spatial information to understand where drug-resistant tuberculosis exists and why it persists in those communities. We demonstrate a method to enable drug-resistant tuberculosis monitoring by identifying high-burden communities in the Western Cape Province using routinely collected laboratory data.Methods and Findings: We retrospectively identified cases of microbiologically confirmed tuberculosis and RR-tuberculosis from all biological samples submitted for tuberculosis testing (n = 2,219,891) to the Western Cape National Health Laboratory Services (NHLS) between January 1, 2008, and June 30, 2013. Because the NHLS database lacks unique patient identifiers, we performed a series of record-linking processes to match specimen records to individual patients. We counted an individual as having a single disease episode if their positive samples came from within two years of each other. Cases were aggregated by clinic location (n = 302) to estimate the percentage of tuberculosis cases with rifampicin resistance per clinic. We used inverse distance weighting (IDW) to produce heatmaps of the RR-tuberculosis percentage across the province. Regression was used to estimate annual changes in the RR-tuberculosis percentage by clinic, and estimated average size and direction of change was mapped. We identified 799,779 individuals who had specimens submitted from mappable clinics for testing, of whom 222,735 (27.8%) had microbiologically confirmed tuberculosis. The study population was 43% female, the median age was 36 years (IQR 27-44), and 10,255 (4.6%, 95% CI: 4.6-4.7) cases had documented rifampicin resistance. Among individuals with microbiologically confirmed tuberculosis, 8,947 (4.0%) had more than one disease episode during the study period. The percentage of tuberculosis cases with rifampicin resistance documented among these individuals was 11.4% (95% CI: 10.7-12.0). Overall, the percentage of tuberculosis cases that were RR-tuberculosis was spatially heterogeneous, ranging from 0% to 25% across the province. Our maps reveal significant yearly fluctuations in RR-tuberculosis percentages at several locations. Additionally, the directions of change over time in RR-tuberculosis percentage were not uniform. The main limitation of this study is the lack of unique patient identifiers in the NHLS database, rendering findings to be estimates reliant on the accuracy of the person-matching algorithm.Conclusions: Our maps reveal striking spatial and temporal heterogeneity in RR-tuberculosis percentages across this province. We demonstrate the potential to monitor RR-tuberculosis spatially and temporally with routinely collected laboratory data, enabling improved resource targeting and more rapid locally appropriate interventions. [ABSTRACT FROM AUTHOR]- Published
- 2018
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34. Choices in vaccine trial design in epidemics of emerging infections.
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Kahn, Rebecca, Rid, Annette, Smith, Peter G., Eyal, Nir, and Lipsitch, Marc
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EPIDEMICS ,COMMUNICABLE diseases ,VACCINES ,INFECTION ,PANDEMICS ,PREVENTION of communicable diseases ,EBOLA virus disease prevention ,VIRAL vaccines ,INVESTIGATIONAL drugs ,COMMUNICABLE disease epidemiology ,EBOLA virus disease ,THERAPEUTICS - Abstract
In a Policy Forum, Marc Lipsitch and colleagues discuss trial design issues in infectious disease outbreaks. [ABSTRACT FROM AUTHOR]
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- 2018
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35. Sexual transmission of Zika virus and other flaviviruses: A living systematic review.
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Counotte, Michel Jacques, Kim, Caron Rahn, Wang, Jingying, Bernstein, Kyle, Deal, Carolyn D., Broutet, Nathalie Jeanne Nicole, and Low, Nicola
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INFECTIOUS disease transmission ,ZIKA virus ,SEXUALLY transmitted diseases ,EPIDEMICS ,EPIDEMIOLOGY ,VIRAL transmission - Abstract
Background: Health authorities in the United States and Europe reported an increasing number of travel-associated episodes of sexual transmission of Zika virus (ZIKV) following the 2015-2017 ZIKV outbreak. This, and other scientific evidence, suggests that ZIKV is sexually transmissible in addition to having its primary mosquito-borne route. The objective of this systematic review and evidence synthesis was to clarify the epidemiology of sexually transmitted ZIKV.Methods and Findings: We performed a living (i.e., continually updated) systematic review of evidence published up to 15 April 2018 about sexual transmission of ZIKV and other arthropod-borne flaviviruses in humans and other animals. We defined 7 key elements of ZIKV sexual transmission for which we extracted data: (1) rectal and vaginal susceptibility to infection, (2) incubation period following sexual transmission, (3) serial interval between the onset of symptoms in a primary and secondary infected individuals, (4) duration of infectiousness, (5) reproduction number, (6) probability of transmission per sex act, and (7) transmission rate. We identified 1,227 unique publications and included 128, of which 77 presented data on humans and 51 presented data on animals. Laboratory experiments confirm that rectal and vaginal mucosae are susceptible to infection with ZIKV and that the testis serves as a reservoir for the virus in animal models. Sexual transmission was reported in 36 human couples: 34/36 of these involved male-to-female sexual transmission. The median serial symptom onset interval in 15 couples was 12 days (interquartile range: 10-14.5); the maximum was 44 days. We found evidence from 2 prospective cohorts that ZIKV RNA is present in human semen with a median duration of 34 days (95% CI: 28-41 days) and 35 days (no CI given) (low certainty of evidence, according to GRADE). Aggregated data about detection of ZIKV RNA from 37 case reports and case series indicate a median duration of detection of ZIKV of 40 days (95% CI: 30-49 days) and maximum duration of 370 days in semen. In human vaginal fluid, median duration was 14 days (95% CI: 7-20 days) and maximum duration was 37 days (very low certainty). Infectious virus in human semen was detected for a median duration of 12 days (95% CI: 1-21 days) and maximum of 69 days. Modelling studies indicate that the reproduction number is below 1 (very low certainty). Evidence was lacking to estimate the incubation period or the transmission rate. Evidence on sexual transmission of other flaviviruses was scarce. The certainty of the evidence is limited because of uncontrolled residual bias.Conclusions: The living systematic review and sexual transmission framework allowed us to assess evidence about the risk of sexual transmission of ZIKV. ZIKV is more likely transmitted from men to women than from women to men. For other flaviviruses, evidence of sexual transmissibility is still absent. Taking into account all available data about the duration of detection of ZIKV in culture and from the serial interval, our findings suggest that the infectious period for sexual transmission of ZIKV is shorter than estimates from the earliest post-outbreak studies, which were based on reverse transcription PCR alone. [ABSTRACT FROM AUTHOR]- Published
- 2018
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36. Estimating the costs of air pollution to the National Health Service and social care: An assessment and forecast up to 2035.
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Pimpin, Laura, Retat, Lise, Fecht, Daniela, de Preux, Laure, Sassi, Franco, Gulliver, John, Belloni, Annalisa, Ferguson, Brian, Corbould, Emily, Jaccard, Abbygail, and Webber, Laura
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AIR pollution ,HEALTH ,NON-communicable diseases ,MEDICAL care costs ,PARTICULATE matter ,NITROGEN dioxide ,PUBLIC health ,AIR pollution prevention ,COMPARATIVE studies ,COMPUTER simulation ,ENVIRONMENTAL monitoring ,FORECASTING ,RESEARCH methodology ,MEDICAL cooperation ,NATIONAL health services ,NITRIC oxide ,RESEARCH ,RISK assessment ,SOCIAL case work ,TIME ,EVALUATION research ,DISEASE incidence ,STATISTICAL models ,INHALATION injuries ,ECONOMICS - Abstract
Background: Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England.Method and Findings: Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data.Conclusions: Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status. [ABSTRACT FROM AUTHOR]- Published
- 2018
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37. Cardiovascular disease: The rise of the genetic risk score.
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Knowles, Joshua W. and Ashley, Euan A.
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CARDIOVASCULAR diseases ,MEDICAL genetics ,CARDIOVASCULAR diseases risk factors ,CARDIOVASCULAR disease diagnosis ,CLINICAL trials ,MEDICAL care - Abstract
In a Perspective, Joshua Knowles and Euan Ashley discuss the potential for use of genetic risk scores in clinical practice. [ABSTRACT FROM AUTHOR]
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- 2018
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38. Mortality, ethnicity, and country of birth on a national scale, 2001-2013: A retrospective cohort (Scottish Health and Ethnicity Linkage Study).
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Bhopal, Raj S., Gruer, Laurence, Cezard, Genevieve, Douglas, Anne, Steiner, Markus F. C., Millard, Andrew, Buchanan, Duncan, Katikireddi, S. Vittal, and Sheikh, Aziz
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HEALTH equity ,PUBLIC health ,LIFE expectancy ,HEALTH services accessibility ,PUBLIC health surveillance ,CHRONIC diseases ,COMPARATIVE studies ,DIABETES ,EPIDEMIOLOGY ,ETHNIC groups ,IMMIGRANTS ,RESEARCH methodology ,MEDICAL cooperation ,MORTALITY ,CULTURAL pluralism ,RESEARCH ,RESEARCH funding ,SEX distribution ,SMOKING ,RESIDENTIAL patterns ,SOCIOECONOMIC factors ,EVALUATION research - Abstract
Background: Migrant and ethnic minority groups are often assumed to have poor health relative to the majority population. Few countries have the capacity to study a key indicator, mortality, by ethnicity and country of birth. We hypothesized at least 10% differences in mortality by ethnic group in Scotland that would not be wholly attenuated by adjustment for socio-economic factors or country of birth.Methods and Findings: We linked the Scottish 2001 Census to mortality data (2001-2013) in 4.62 million people (91% of estimated population), calculating age-adjusted mortality rate ratios (RRs; multiplied by 100 as percentages) with 95% confidence intervals (CIs) for 13 ethnic groups, with the White Scottish group as reference (ethnic group classification follows the Scottish 2001 Census). The Scottish Index of Multiple Deprivation, education status, and household tenure were socio-economic status (SES) confounding variables and born in the UK or Republic of Ireland (UK/RoI) an interacting and confounding variable. Smoking and diabetes data were from a primary care sub-sample (about 53,000 people). Males and females in most minority groups had lower age-adjusted mortality RRs than the White Scottish group. The 95% CIs provided good evidence that the RR was more than 10% lower in the following ethnic groups: Other White British (72.3 [95% CI 64.2, 81.3] in males and 75.2 [68.0, 83.2] in females); Other White (80.8 [72.8, 89.8] in males and 76.2 [68.6, 84.7] in females); Indian (62.6 [51.6, 76.0] in males and 60.7 [50.4, 73.1] in females); Pakistani (66.1 [57.4, 76.2] in males and 73.8 [63.7, 85.5] in females); Bangladeshi males (50.7 [32.5, 79.1]); Caribbean females (57.5 [38.5, 85.9]); and Chinese (52.2 [43.7, 62.5] in males and 65.8 [55.3, 78.2] in females). The differences were diminished but not eliminated after adjusting for UK/RoI birth and SES variables. A mortality advantage was evident in all 12 minority groups for those born abroad, but in only 6/12 male groups and 5/12 female groups of those born in the UK/RoI. In the primary care sub-sample, after adjustment for age, UK/RoI born, SES, smoking, and diabetes, the RR was not lower in Indian males (114.7 [95% CI 78.3, 167.9]) and Pakistani females (103.9 [73.9, 145.9]) than in White Scottish males and females, respectively. The main limitations were the inability to include deaths abroad and the small number of deaths in some ethnic minority groups, especially for people born in the UK/RoI.Conclusions: There was relatively low mortality for many ethnic minority groups compared to the White Scottish majority. The mortality advantage was less clear in UK/RoI-born minority group offspring than in immigrants. These differences need explaining, and health-related behaviours seem important. Similar analyses are required internationally to fulfil agreed goals for monitoring, understanding, and improving health in ethnically diverse societies and to apply to health policy, especially on health inequalities and inequities. [ABSTRACT FROM AUTHOR]- Published
- 2018
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39. The potential impact of case-area targeted interventions in response to cholera outbreaks: A modeling study.
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Finger, Flavio, Bertuzzo, Enrico, Luquero, Francisco J., Naibei, Nathan, Touré, Brahima, Allan, Maya, Porten, Klaudia, Lessler, Justin, Rinaldo, Andrea, and Azman, Andrew S.
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PREVENTION of cholera ,CHOLERA vaccines ,SANITATION ,ANTIBIOTICS ,VIBRIO cholerae ,CHOLERA treatment ,WATER supply ,CHOLERA ,COMPARATIVE studies ,COMPUTER simulation ,DISEASE outbreaks ,HEALTH planning ,MATHEMATICAL models ,RESEARCH methodology ,MEDICAL needs assessment ,MEDICAL cooperation ,POPULATION geography ,RESEARCH ,THEORY ,EVALUATION research ,SOCIAL services case management ,THERAPEUTICS ,STANDARDS - Abstract
Background: Cholera prevention and control interventions targeted to neighbors of cholera cases (case-area targeted interventions [CATIs]), including improved water, sanitation, and hygiene, oral cholera vaccine (OCV), and prophylactic antibiotics, may be able to efficiently avert cholera cases and deaths while saving scarce resources during epidemics. Efforts to quickly target interventions to neighbors of cases have been made in recent outbreaks, but little empirical evidence related to the effectiveness, efficiency, or ideal design of this approach exists. Here, we aim to provide practical guidance on how CATIs might be used by exploring key determinants of intervention impact, including the mix of interventions, "ring" size, and timing, in simulated cholera epidemics fit to data from an urban cholera epidemic in Africa.Methods and Findings: We developed a micro-simulation model and calibrated it to both the epidemic curve and the small-scale spatiotemporal clustering pattern of case households from a large 2011 cholera outbreak in N'Djamena, Chad (4,352 reported cases over 232 days), and explored the potential impact of CATIs in simulated epidemics. CATIs were implemented with realistic logistical delays after cases presented for care using different combinations of prophylactic antibiotics, OCV, and/or point-of-use water treatment (POUWT) starting at different points during the epidemics and targeting rings of various radii around incident case households. Our findings suggest that CATIs shorten the duration of epidemics and are more resource-efficient than mass campaigns. OCV was predicted to be the most effective single intervention, followed by POUWT and antibiotics. CATIs with OCV started early in an epidemic focusing on a 100-m radius around case households were estimated to shorten epidemics by 68% (IQR 62% to 72%), with an 81% (IQR 69% to 87%) reduction in cases compared to uncontrolled epidemics. These same targeted interventions with OCV led to a 44-fold (IQR 27 to 78) reduction in the number of people needed to target to avert a single case of cholera, compared to mass campaigns in high-cholera-risk neighborhoods. The optimal radius to target around incident case households differed by intervention type, with antibiotics having an optimal radius of 30 m to 45 m compared to 70 m to 100 m for OCV and POUWT. Adding POUWT or antibiotics to OCV provided only marginal impact and efficiency improvements. Starting CATIs early in an epidemic with OCV and POUWT targeting those within 100 m of an incident case household reduced epidemic durations by 70% (IQR 65% to 75%) and the number of cases by 82% (IQR 71% to 88%) compared to uncontrolled epidemics. CATIs used late in epidemics, even after the peak, were estimated to avert relatively few cases but substantially reduced the number of epidemic days (e.g., by 28% [IQR 15% to 45%] for OCV in a 100-m radius). While this study is based on a rigorous, data-driven approach, the relatively high uncertainty about the ways in which POUWT and antibiotic interventions reduce cholera risk, as well as the heterogeneity in outbreak dynamics from place to place, limits the precision and generalizability of our quantitative estimates.Conclusions: In this study, we found that CATIs using OCV, antibiotics, and water treatment interventions at an appropriate radius around cases could be an effective and efficient way to fight cholera epidemics. They can provide a complementary and efficient approach to mass intervention campaigns and may prove particularly useful during the initial phase of an outbreak, when there are few cases and few available resources, or in order to shorten the often protracted tails of cholera epidemics. [ABSTRACT FROM AUTHOR]- Published
- 2018
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40. Prevalence of sexually transmitted infections among young people in South Africa: A nested survey in a health and demographic surveillance site.
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Francis, Suzanna C., Mthiyane, T. Nondumiso, Baisley, Kathy, Mchunu, S. Lerato, Ferguson, Jane B., Smit, Theresa, Crucitti, Tania, Gareta, Dickman, Dlamini, Siphephelo, Mutevedzi, Tinofa, Seeley, Janet, Pillay, Deenan, McGrath, Nuala, and Shahmanesh, Maryam
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SEXUALLY transmitted diseases ,BACTERIAL vaginitis ,DISEASE prevalence ,HIV infection transmission ,SYPHILIS ,EPIDEMIOLOGY of sexually transmitted diseases ,COMPARATIVE studies ,RESEARCH methodology ,MEDICAL cooperation ,PUBLIC health surveillance ,RESEARCH ,RESEARCH funding ,EVALUATION research ,CROSS-sectional method - Abstract
Background: Sexually transmitted infections (STIs) and bacterial vaginosis (BV) are associated with increased transmission of HIV, and poor reproductive and sexual health. The burden of STIs/BV among young people is unknown in many high HIV prevalence settings. We conducted an acceptability, feasibility, and prevalence study of home-based sampling for STIs/BV among young men and women aged 15-24 years old in a health and demographic surveillance site (HDSS) in rural KwaZulu-Natal, South Africa.Methods and Findings: A total of 1,342 young people, stratified by age (15-19 and 20-24 years) and sex were selected from the HDSS sampling frame; 1,171/1,342 (87%) individuals had ≥1 attempted home visit between 4 October 2016 and 31 January 2017, of whom 790 (67%) were successfully contacted. Among the 645 who were contacted and eligible, 447 (69%) enrolled. Consenting/assenting participants were interviewed, and blood, self-collected urine (men), and vaginal swabs (women) were tested for herpes simplex virus type 2 (HSV-2), chlamydia, gonorrhoea, syphilis, trichomoniasis, and BV. Both men and women reported that sample collection was easy. Participants disagreed that sampling was painful; more than half of the participants disagreed that they felt anxious or embarrassed. The weighted prevalence of STIs/BV among men and women, respectively, was 5.3% and 11.2% for chlamydia, 1.5% and 1.8% for gonorrhoea, 0% and 0.4% for active syphilis, 0.6% and 4.6% for trichomoniasis, 16.8% and 28.7% for HSV-2, and 42.1% for BV (women only). Of the women with ≥1 curable STI, 75% reported no symptoms. Factors associated with STIs/BV included having older age, being female, and not being in school or working. Among those who participated in the 2016 HIV serosurvey, the prevalence of HIV was 5.6% among men and 19% among women. Feasibility was impacted by the short study duration and the difficulty finding men at home.Conclusions: A high prevalence of STIs/BV was found in this rural setting with high HIV prevalence in South Africa. Most STIs and HIV infections were asymptomatic and would not have been identified or treated under national syndromic management guidelines. A nested STI/BV survey within a HDSS proved acceptable and feasible. This is a proof of concept for population-based STI surveillance in low- and middle-income countries that could be utilised in the evaluation of STI/HIV prevention and control programmes. [ABSTRACT FROM AUTHOR]- Published
- 2018
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41. The 2014-2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010-2016.
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Wagenaar, Bradley H., Augusto, Orvalho, Beste, Jason, Toomay, Stephen J., Wickett, Eugene, Dunbar, Nelson, Bawo, Luke, and Wesseh, Chea Sanford
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TREATMENT of Ebola virus diseases ,DISEASE outbreaks ,MEDICAL care ,TIME series analysis ,MEDICAL informatics - Abstract
Background: The aim of this study is to estimate the immediate and lasting effects of the 2014-2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery in Liberia using 7 years of comprehensive routine health information system data.Methods and Findings: We analyzed 10 key primary healthcare indicators before, during, and after the EVD outbreak using 31,836 facility-month service outputs from 1 January 2010 to 31 December 2016 across a census of 379 public-sector health facilities in Liberia (excluding Montserrado County). All indicators had statistically significant decreases during the first 4 months of the EVD outbreak, with all indicators having their lowest raw mean outputs in August 2014. Decreases in outputs comparing the end of the initial EVD period (September 2014) to May 2014 (pre-EVD) ranged in magnitude from a 67.3% decrease in measles vaccinations (95% CI: -77.9%, -56.8%, p < 0.001) and a 61.4% decrease in artemisinin-based combination therapy (ACT) treatments for malaria (95% CI: -69.0%, -53.8%, p < 0.001) to a 35.2% decrease in first antenatal care (ANC) visits (95% CI: -45.8%, -24.7%, p < 0.001) and a 38.5% decrease in medroxyprogesterone acetate doses (95% CI: -47.6%, -29.5%, p < 0.001). Following the nadir of system outputs in August 2014, all indicators showed statistically significant increases from October 2014 to December 2014. All indicators had significant positive trends during the post-EVD period, with every system output exceeding pre-Ebola forecasted trends for 3 consecutive months by November 2016. Health system outputs lost during and after the EVD outbreak were large and sustained for most indicators. Prior to exceeding pre-EVD forecasted trends for 3 months, we estimate statistically significant cumulative losses of -776,110 clinic visits (95% CI: -1,480,896, -101,357, p = 0.030); -24,449 bacille Calmette-Guérin vaccinations (95% CI: -45,947, -2,020, p = 0.032); -9,129 measles vaccinations (95% CI: -12,312, -5,659, p < 0.001); -17,191 postnatal care (PNC) visits within 6 weeks of birth (95% CI: -28,344, -5,775, p = 0.002); and -101,857 ACT malaria treatments (95% CI: -205,839, -2,139, p = 0.044) due to the EVD outbreak. Other outputs showed statistically significant cumulative losses only through December 2014, including losses of -12,941 first pentavalent vaccinations (95% CI: -20,309, -5,527, p = 0.002); -5,122 institutional births (95% CI: -8,767, -1,234, p = 0.003); and -45,024 acute respiratory infections treated (95% CI: -66,185, -24,019, p < 0.001). Compared to pre-EVD forecasted trends, medroxyprogesterone acetate doses and first ANC visits did not show statistically significant net losses. ACT treatment for malaria was the only indicator with an estimated net increase in system outputs through December 2016, showing an excess of +78,583 outputs (95% CI: -309,417, +450,661, p = 0.634) compared to pre-EVD forecasted trends, although this increase was not statistically significant. However, comparing December 2013 to December 2017, ACT malaria cases have increased 49.2% (95% CI: 33.9%, 64.5%, p < 0.001). Compared to pre-EVD forecasted trends, there remains a statistically significant loss of -15,144 PNC visits within 6 weeks (95% CI: -29,453, -787, p = 0.040) through December 2016.Conclusions: The Liberian public-sector primary healthcare system has made strides towards recovery from the 2014-2015 EVD outbreak. All primary healthcare indicators tracked have recovered to pre-EVD levels as of November 2016. Yet, for most indicators, it took more than 1 year to recover to pre-EVD levels. During this time, large losses of essential primary healthcare services occurred compared to what would have been expected had the EVD outbreak not occurred. The disruption of malaria case management during the EVD outbreak may have resulted in increased malaria cases. Large and sustained investments in public-sector primary care health system strengthening are urgently needed for EVD-affected countries. [ABSTRACT FROM AUTHOR]- Published
- 2018
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42. Estimated mortality on HIV treatment among active patients and patients lost to follow-up in 4 provinces of Zambia: Findings from a multistage sampling-based survey.
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Holmes, Charles B., Sikazwe, Izukanji, Sikombe, Kombatende, Eshun-Wilson, Ingrid, Czaicki, Nancy, Beres, Laura K., Mukamba, Njekwa, Simbeza, Sandra, Bolton Moore, Carolyn, Hantuba, Cardinal, Mwaba, Peter, Phiri, Caroline, Padian, Nancy, Glidden, David V., and Geng, Elvin
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THERAPEUTICS ,HIV-positive persons ,MORTALITY ,HIV infections ,PUBLIC health - Abstract
Background: Survival represents the single most important indicator of successful HIV treatment. Routine monitoring fails to capture most deaths. As a result, both regional assessments of the impact of HIV services and identification of hotspots for improvement efforts are limited. We sought to assess true mortality on treatment, characterize the extent under-reporting of mortality in routine health information systems in Zambia, and identify drivers of mortality across sites and over time using a multistage, regionally representative sampling approach.Methods and Findings: We enumerated all HIV infected adults on antiretroviral therapy (ART) who visited any one of 64 facilities across 4 provinces in Zambia during the 24-month period from 1 August 2013 to 31 July 2015. We identified a probability sample of patients who were lost to follow-up through selecting facilities probability proportional to size and then a simple random sample of lost patients. Outcomes among patients lost to follow-up were incorporated into survival analysis and multivariate regression through probability weights. Of 165,464 individuals (64% female, median age 39 years (IQR 33-46), median CD4 201 cells/mm3 (IQR 111-312), the 2-year cumulative incidence of mortality increased from 1.9% (95% CI 1.7%-2.0%) to a corrected rate of 7.0% (95% CI 5.7%-8.4%) (all ART users) and from 2.1% (95% CI 1.8%-2.4%) to 8.3% (95% CI 6.1%-10.7%) (new ART users). Revised provincial mortality rates ranged from 3-9 times higher than naïve rates for new ART users and were lowest in Lusaka Province (4.6 per 100 person-years) and highest in Western Province (8.7 per 100 person-years) after correction. Corrected mortality rates varied markedly by clinic, with an IQR of 3.5 to 7.5 deaths per 100 person-years and a high of 13.4 deaths per 100 person-years among new ART users, even after adjustment for clinical (e.g., pretherapy CD4) and contextual (e.g., province and clinic size) factors. Mortality rates (all ART users) were highest year 1 after treatment at 4.6/100 person-years (95% CI 3.9-5.5), 2.9/100 person-years (95% CI 2.1-3.9) in year 2, and approximately 1.6% per year through 8 years on treatment. In multivariate analysis, patient-level factors including male sex and pretherapy CD4 levels and WHO stage were associated with higher mortality among new ART users, while male sex and HIV disclosure were associated with mortality among all ART users. In both cases, being late (>14 days late for appointment) or lost (>90 days late for an appointment) was associated with deaths. We were unable to ascertain the vital status of about one-quarter of those lost and selected for tracing and did not adjudicate causes of death.Conclusions: HIV treatment in Zambia is not optimally effective. The high and sustained mortality rates and marked under-reporting of mortality at the provincial-level and unexplained heterogeneity between regions and sites suggest opportunities for the use of corrected mortality rates for quality improvement. A regionally representative sampling-based approach can bring gaps and opportunities for programs into clear epidemiological focus for local and global decision makers. [ABSTRACT FROM AUTHOR]- Published
- 2018
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43. Respondent-driven sampling for identification of HIV- and HCV-infected people who inject drugs and men who have sex with men in India: A cross-sectional, community-based analysis.
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Solomon, Sunil S., McFall, Allison M., Lucas, Gregory M., Srikrishnan, Aylur K., Kumar, Muniratnam S., Anand, Santhanam, Quinn, Thomas C., Celentano, David D., and Mehta, Shruti H.
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DIAGNOSIS of HIV infections ,HEPATITIS C diagnosis ,INTRAVENOUS drug abusers ,MEN who have sex with men ,EPIDEMIOLOGY ,DISEASES ,HIV infection epidemiology ,INTRAVENOUS drug abuse ,HEPATITIS C ,HEPATITIS viruses ,HIV infections ,HOMOSEXUALITY ,MEDICAL care research ,PUBLIC relations ,RESEARCH funding ,DISEASE prevalence ,CROSS-sectional method ,SEXUAL partners ,DISEASE complications - Abstract
Background: A major barrier to achieving ambitious targets for global control of HIV and hepatitis C virus (HCV) is low levels of awareness of infection among key populations such as men who have sex with men (MSM) and people who inject drugs (PWID). We explored the potential of a strategy routinely used for surveillance in these groups, respondent-driven sampling (RDS), to be used as an intervention to identify HIV- and HCV-infected PWID and MSM who are unaware of their status and those who are viremic across 26 Indian cities at various epidemic stages.Methods and Findings: Data were collected as part of the baseline assessment of an ongoing cluster-randomized trial. RDS was used to accrue participants at 27 sites (15 PWID sites and 12 MSM sites) selected to reflect varying stages of the HIV epidemic among MSM and PWID in India. A total of 56 seeds recruited a sample of 26,447 persons (approximately 1,000 participants per site) between October 1, 2012, and December 19, 2013. Across MSM sites (n = 11,997), the median age was 25 years and the median number of lifetime male partners was 8. Across PWID sites (n = 14,450), 92.4% were male, the median age was 30 years, and 87.5% reported injection in the prior 6 months. RDS identified 4,051 HIV-infected persons, of whom 2,325 (57.4%) were unaware of their HIV infection and 2,816 (69.5%) were HIV viremic. It also identified 5,777 HCV-infected persons, of whom 5,337 (92.4%) were unaware that they were infected with HCV and 4,728 (81.8%) were viremic. In the overall sample (both MSM and PWID), the prevalence of HIV-infected persons who were unaware of their status increased with sampling depth, from 7.9% in participants recruited in waves 1 through 5 to 12.8% among those recruited in waves 26 and above (p-value for trend < 0.001). The overall detection rate of people unaware of their HIV infection was 0.5 persons per day, and the detection rate of HIV-infected persons with viremia (regardless of their awareness status) was 0.7 per day. The detection rate of HIV viremic individuals was positively associated with underlying HIV prevalence and the prevalence of HIV viremia (linear regression coefficient per 1-percentage-point increase in prevalence: 0.05 and 0.07, respectively). The median detection rate of PWID who were unaware of their HCV infection was 2.5 per day. The cost of identifying 1 unaware HIV-infected individual ranged from US$51 to US$2,072 across PWID sites and from US$189 to US$5,367 across MSM sites. The mean additional cost of identifying 1 unaware HCV-infected PWID was US$13 (site range: US$7-US$140). Limitations of the study include the exclusivity of study sites to India, lack of prior HIV/HCV diagnosis confirmation with clinic records, and lack of cost data from other case-finding approaches commonly used in India.Conclusions: In this study, RDS was able to rapidly identify at nominal cost a substantial number of unaware and viremic HIV-infected and HCV-infected individuals who were currently not being reached by existing programs and who were at high risk for transmission. Combining RDS (or other network-driven recruitment approaches) with strategies focused on linkage to care, particularly in high-burden settings, may be a viable option for achieving the 90-90-90 targets in key populations in resource-limited settings. [ABSTRACT FROM AUTHOR]- Published
- 2017
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44. A combination intervention strategy to improve linkage to and retention in HIV care following diagnosis in Mozambique: A cluster-randomized study.
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Elul, Batya, Lamb, Matthew R., Lahuerta, Maria, Abacassamo, Fatima, Ahoua, Laurence, Kujawski, Stephanie A., Tomo, Maria, and Jani, Ilesh
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HIV infections ,HOSPITAL care ,PRIMARY health care ,HEALTH facilities ,HEALTH counseling ,DIAGNOSIS of HIV infections ,THERAPEUTICS ,HIV infection epidemiology ,CLINICAL medicine ,CLUSTER analysis (Statistics) ,COMBINED modality therapy ,COMPARATIVE studies ,HEALTH behavior ,HIV ,INFORMATION storage & retrieval systems ,MEDICAL databases ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,MOTIVATION (Psychology) ,PATIENT compliance ,RESEARCH ,RESEARCH funding ,EVALUATION research ,RANDOMIZED controlled trials ,EARLY medical intervention ,ANTI-HIV agents - Abstract
Background: Concerning gaps in the HIV care continuum compromise individual and population health. We evaluated a combination intervention strategy (CIS) targeting prevalent barriers to timely linkage and sustained retention in HIV care in Mozambique.Methods and Findings: In this cluster-randomized trial, 10 primary health facilities in the city of Maputo and Inhambane Province were randomly assigned to provide the CIS or the standard of care (SOC). The CIS included point-of-care CD4 testing at the time of diagnosis, accelerated ART initiation, and short message service (SMS) health messages and appointment reminders. A pre-post intervention 2-sample design was nested within the CIS arm to assess the effectiveness of CIS+, an enhanced version of the CIS that additionally included conditional non-cash financial incentives for linkage and retention. The primary outcome was a combined outcome of linkage to care within 1 month and retention at 12 months after diagnosis. From April 22, 2013, to June 30, 2015, we enrolled 2,004 out of 5,327 adults ≥18 years of age diagnosed with HIV in the voluntary counseling and testing clinics of participating health facilities: 744 (37%) in the CIS group, 493 (25%) in the CIS+ group, and 767 (38%) in the SOC group. Fifty-seven percent of the CIS group achieved the primary outcome versus 35% in the SOC group (relative risk [RR]CIS vs SOC = 1.58, 95% CI 1.05-2.39). Eighty-nine percent of the CIS group linked to care on the day of diagnosis versus 16% of the SOC group (RRCIS vs SOC = 9.13, 95% CI 1.65-50.40). There was no significant benefit of adding financial incentives to the CIS in terms of the combined outcome (55% of the CIS+ group achieved the primary outcome, RRCIS+ vs CIS = 0.96, 95% CI 0.81-1.16). Key limitations include the use of existing medical records to assess outcomes, the inability to isolate the effect of each component of the CIS, non-concurrent enrollment of the CIS+ group, and exclusion of many patients newly diagnosed with HIV.Conclusions: The CIS showed promise for making much needed gains in the HIV care continuum in our study, particularly in the critical first step of timely linkage to care following diagnosis.Trial Registration: ClinicalTrials.gov NCT01930084. [ABSTRACT FROM AUTHOR]- Published
- 2017
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45. Child mortality estimation: a global overview of infant and child mortality age patterns in light of new empirical data
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François Pelletier, Patrick Gerland, Ameed Saabneh, and Michel Guillot
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Gerontology ,Internationality ,Epidemiology ,Population ,Statistics as Topic ,Survey sampling ,HIV Infections ,CHILD_MORTALITY ,VITAL_STATISTICS ,Empirical Research ,Global Health ,Social and Behavioral Sciences ,MODEL_LIFE_TABLES ,QUALITY_OF_DATA ,Sociology ,DEMOGRAPHIC_SURVEILLANCE_SYSTEM ,Death Rate ,Prevalence ,Humans ,education ,Child ,INFANT_MORTALITY_RATE ,Epidemiological Methods ,Demography ,Retrospective Studies ,Estimation ,education.field_of_study ,DEMOGRAPHIC_MODELS ,Mortality rate ,WORLD_FERTILITY_SURVEY ,Infant ,AGE_DISTRIBUTION ,General Medicine ,Health Surveys ,Infant mortality ,Demographic analysis ,Child mortality ,INFANT_MORTALITY ,LIFE_TABLES ,Geography ,Databases as Topic ,ESTIMATE ,Child Mortality ,Survey data collection ,Medicine ,Research Article - Abstract
Michel Guillot and colleagues did a systematic evaluation to assess what proportion of under-five mortality occurs below age one compared with at age one and above, to determine how much observed values deviate from so called “model age patterns” of under-five mortality, Background The under-five mortality rate (the probability of dying between birth and age 5 y, also denoted in the literature as U5MR and 5 q 0) is a key indicator of child health, but it conceals important information about how this mortality is distributed by age. One important distinction is what amount of the under-five mortality occurs below age 1 y (1 q 0) versus at age 1 y and above (4 q 1). However, in many country settings, this distinction is often difficult to establish because of various types of data errors. As a result, it is common practice to resort to model age patterns to estimate 1 q 0 and 4 q 1 on the basis of an observed value of 5 q 0. The most commonly used model age patterns for this purpose are the Coale and Demeny and the United Nations systems. Since the development of these models, many additional sources of data for under-five mortality have become available, making possible a general evaluation of age patterns of infant and child mortality. In this paper, we do a systematic comparison of empirical values of 1 q 0 and 4 q 1 against model age patterns, and discuss whether observed deviations are due to data errors, or whether they reflect true epidemiological patterns not addressed in existing model life tables. Methods and Findings We used vital registration data from the Human Mortality Database, sample survey data from the World Fertility Survey and Demographic and Health Surveys programs, and data from Demographic Surveillance Systems. For each of these data sources, we compared empirical combinations of 1 q 0 and 4 q 1 against combinations provided by Coale and Demeny and United Nations model age patterns. We found that, on the whole, empirical values fall relatively well within the range provided by these models, but we also found important exceptions. Sub-Saharan African countries have a tendency to exhibit high values of 4 q 1 relative to 1 q 0, a pattern that appears to arise for the most part from true epidemiological causes. While this pattern is well known in the case of western Africa, we observed that it is more widespread than commonly thought. We also found that the emergence of HIV/AIDS, while perhaps contributing to high relative values of 4 q 1, does not appear to have substantially modified preexisting patterns. We also identified a small number of countries scattered in different parts of the world that exhibit unusually low values of 4 q 1 relative to 1 q 0, a pattern that is not likely to arise merely from data errors. Finally, we illustrate that it is relatively common for populations to experience changes in age patterns of infant and child mortality as they experience a decline in mortality. Conclusions Existing models do not appear to cover the entire range of epidemiological situations and trajectories. Therefore, model life tables should be used with caution for estimating 1 q 0 and 4 q 1 on the basis of 5 q 0. Moreover, this model-based estimation procedure assumes that the input value of 5 q 0 is correct, which may not always be warranted, especially in the case of survey data. A systematic evaluation of data errors in sample surveys and their impact on age patterns of 1 q 0 and 4 q 1 is urgently needed, along with the development of model age patterns of under-five mortality that would cover a wider range of epidemiological situations and trajectories. Please see later in the article for the Editors' Summary., Editors' Summary Background In 2000, world leaders agreed on eight Millennium Development Goals designed to end extreme poverty by 2015. The fourth of these goals—MDG 4—aims to reduce under-five mortality (the number of children who die before their fifth birthday) to a third of its 1990 level by 2015. A key indicator used to monitor progress towards this target is the under-five mortality rate (the probability of a child dying before his/her fifth birthday, also denoted as U5MR or 5 q 0). In developed countries, data collected through vital registration systems (which record all births and deaths) are used to calculate 5 q 0. However, developing countries, which are where most under-five deaths occur, rarely have vital registration systems, and 5 q 0 is estimated using data collected by programs such as the World Fertility Survey (WFS) and Demographic and Health Surveys (DHS), which conduct nationally representative surveys that ask a sample of women about their living and dead children. Why Was This Study Done? Although 5 q 0 is a key indicator of child health, it conceals important information about the age distribution of child deaths. Public health experts need to know the distribution of 5 q 0 with respect to 1 q 0 (the probability that an infant will die before age one) and 4 q 1 (the probability that a child reaching age one will die below age five) to help them reduce child mortality. At a given level of 5 q 0, high values of 1 q 0 indicate high levels of death from congenital (inherited) anomalies and conditions that occur around the time of birth; these deaths can be reduced by improving the care of women during pregnancy and childbirth and the care of newborn babies. By contrast, at a given level of 5 q 0, high values of 4 q 1 indicate high levels of death from infectious diseases; these deaths can be reduced by, for example, introducing immunization programs. 1 q 0 and 4 q 1 are usually estimated from observed (empirical) values of 5 q 0 using the Coale and Demeny or United Nations (UN) “model life tables” (mathematical models of the variation of mortality with age), which were constructed in 1966 and 1982, respectively, using the best data available. Since their construction, additional sources of data about under-five mortality have become available; in this study, the researchers systematically compare global empirical values of 1 q 0 and 4 q 1 with values obtained using model life tables. What Did the Researchers Do and Find? The researchers compared empirical combinations of 1 q 0 and 4 q 1 (estimated using vital registration data, WFS and DHS data, and data from Demographic Surveillance Sites in sub-Saharan Africa) with the combinations derived from 5 q 0 using the Coale and Demeny and UN model life tables. The empirical values mainly fell within the range provided by these tables, but there were important exceptions. For example, empirical values of 4 q 1 relative to 1 q 0 tended to be above the range provided by the model life tables for sub-Saharan African countries. This pattern was mainly because of epidemiological reasons (epidemiology is the study of disease patterns in populations), such as the occurrence of diseases such as malaria, measles, and diarrhea that generate excess mortality among children older than one year. Interestingly, the emergence of HIV does not seem to have substantially modified preexisting patterns of 1 q 0 versus 4 q 1. Importantly, the researchers also show that populations often experience changes in the age patterns of infant and child mortality as they experience an overall decline in mortality. What Do These Findings Mean? These findings suggest that the existing model life tables do not cover the entire global range of epidemiological situations and trajectories and must, therefore, be used with caution for estimating 1 q 0 and 4 q 1 on the basis of 5 q 0. The development of new model age patterns of under-five mortality that cover a wider range of epidemiological situations should improve this situation, but a systematic analysis of data errors in sample surveys and the impact of such errors on estimates of 1 q 0 and 4 q 1 is also urgently needed to ensure that public health experts have access to accurate information on child mortality. Importantly, this overview shows that a wide range of 1 q 0 and 4 q 1 combinations can occur at a given level of 5 q 0. Because the level of 4 q 1 relative to 1 q 0 provides important information about the disease processes occurring in a population, this finding highlights the importance of determining 1 q 0 and 4 q 1 as well as 5 q 0 whenever possible. Additional Information Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001299. This paper is part of a collection of papers on Child Mortality Estimation Methods published in PLOS Medicine The United Nations Childrens Fund (UNICEF) works for children's rights, survival, development, and protection around the world; it provides information on Millennium Development Goal 4, and its Childinfo website provides detailed statistics about child survival and health, including a description of the United Nations Inter-agency Group for Child Mortality Estimation; the 2011 UN IGME report Levels & Trends in Child Mortality is available The World Health Organization also has information about Millennium Development Goal 4 and provides estimates of child mortality rates (some information in several languages) Further information about the Millennium Development Goals is available Information is also available about the Human Mortality Database, which holds vital registration data; the World Fertility Survey program; the Demographic and Health Surveys program; and model life tables
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- 2012
46. Selection in Reported Epidemiological Risks: An Empirical Assessment
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John P. A. Ioannidis, George Liberopoulos, and Fotini K. Kavvoura
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Risk ,medicine.medical_specialty ,PubMed ,Epidemiology ,Public Health and Epidemiology ,03 medical and health sciences ,0302 clinical medicine ,Bias ,Interquartile range ,Risk Factors ,Statistics ,Epidemiology of cancer ,Research Methods ,medicine ,030212 general & internal medicine ,Risk factor ,030304 developmental biology ,0303 health sciences ,business.industry ,General Medicine ,Publication bias ,3. Good health ,Quartile ,Relative risk ,Meta-analysis ,Medicine ,Public Health ,business ,Epidemiologic Methods ,Publication Bias ,Mathematics ,Demography ,Research Article - Abstract
Background Epidemiological studies may be subject to selective reporting, but empirical evidence thereof is limited. We empirically evaluated the extent of selection of significant results and large effect sizes in a large sample of recent articles. Methods and Findings We evaluated 389 articles of epidemiological studies that reported, in their respective abstracts, at least one relative risk for a continuous risk factor in contrasts based on median, tertile, quartile, or quintile categorizations. We examined the proportion and correlates of reporting statistically significant and nonsignificant results in the abstract and whether the magnitude of the relative risks presented (coined to be consistently ≥1.00) differs depending on the type of contrast used for the risk factor. In 342 articles (87.9%), ≥1 statistically significant relative risk was reported in the abstract, while only 169 articles (43.4%) reported ≥1 statistically nonsignificant relative risk in the abstract. Reporting of statistically significant results was more common with structured abstracts, and was less common in US-based studies and in cancer outcomes. Among 50 randomly selected articles in which the full text was examined, a median of nine (interquartile range 5–16) statistically significant and six (interquartile range 3–16) statistically nonsignificant relative risks were presented (p = 0.25). Paradoxically, the smallest presented relative risks were based on the contrasts of extreme quintiles; on average, the relative risk magnitude was 1.41-, 1.42-, and 1.36-fold larger in contrasts of extreme quartiles, extreme tertiles, and above-versus-below median values, respectively (p < 0.001). Conclusions Published epidemiological investigations almost universally highlight significant associations between risk factors and outcomes. For continuous risk factors, investigators selectively present contrasts between more extreme groups, when relative risks are inherently lower., An evaluation of published articles reporting epidemiological studies found that they almost universally highlight significant associations between risk factors and outcomes., Editors' Summary Background. Medical and scientific researchers use statistical tests to try to work out whether their observations—for example, seeing a difference in some characteristic between two groups of people—might have occurred as a result of chance alone. Statistical tests cannot determine this for sure, rather they can only give a probability that the observations would have arisen by chance. When researchers have many different hypotheses, and carry out many statistical tests on the same set of data, they run the risk of concluding that there are real differences where in fact there are none. At the same time, it has long been known that scientific and medical researchers tend to pick out the findings on which to report in their papers. Findings that are more interesting, impressive, or statistically significant are more likely to be published. This is termed “publication bias” or “selective reporting bias.” Therefore, some people are concerned that the published scientific literature might contain many false-positive findings, i.e., findings that are not true but are simply the result of chance variation in the data. This would have a serious impact on the accuracy of the published scientific literature and would tend to overestimate the strength and direction of relationships being studied. Why Was This Study Done? Selective reporting bias has already been studied in detail in the area of randomized trials (studies where participants are randomly allocated to receive an intervention, e.g., a new drug, versus an alternative intervention or “comparator,” in order to understand the benefits or safety of the new intervention). These studies have shown that very many of the findings of trials are never published, and that statistically significant findings are more likely to be included in published papers than nonsignificant findings. However, much medical research is carried out that does not use randomized trial methods, either because that method is not useful to answer the question at hand or is unethical. Epidemiological research is often concerned with looking at links between risk factors and the development of disease, and this type of research would generally use observation rather than experiment to uncover connections. The researchers here were concerned that selective reporting bias might be just as much of a problem in epidemiological research as in randomized trials research, and wanted to study this specifically. What Did the Researchers Do and Find? In this investigation, searches were carried out of PubMed, a database of biomedical research studies, to extract epidemiological studies that were published between January 2004 and October 2005. The researchers wanted to specifically look at studies reporting the effect of continuous risk factors and their effect on health or disease outcomes (a continuous risk factor is something like age or glucose concentration in the blood, is a number, and can have any value on a sliding scale). Three hundred and eighty-nine original research studies were found, and the researchers pulled out from the abstracts and full text of these papers the relative risks that were reported along with the results of statistical tests for them. (Relative risk is the chance of getting an outcome, say disease, in one group as compared to another group.) The researchers found that nearly 90% of these studies had one or more statistically significant risks reported in the abstract, but only 43% reported one or more risks that were not statistically significant. When looking at all of the findings reported anywhere in the full text for 50 of these studies, the researchers saw that papers overall reported more statistically significant risks than nonsignificant risks. Finally, it seemed that in the set of papers studied here, the way in which statistical analyses were done produced a bias towards more extreme findings: for datasets showing small relative risks, papers were more likely to report a comparison between extreme subsets of the data so as to report larger relative risks. What Do These Findings Mean? These findings suggest that there is a tendency among epidemiology researchers to highlight statistically significant findings and to avoid highlighting nonsignificant findings in their research papers. This behavior may be a problem, because many of these significant findings could in future turn out to be “false positives.” At present, registers exist for researchers to describe ongoing clinical trials, and to set out the outcomes that they plan to analyze for those trials. These registers will go some way towards addressing some of the problems described here, but only for clinical trials research. Registers do not yet exist for epidemiological studies, and therefore it is important that researchers and readers are aware of and cautious about the problem of selective reporting in epidemiological research. Additional Information. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040079. Wikipedia entry on publication bias (note: Wikipedia is an internet encyclopedia that anyone can edit) The International Committee of Medical Journal Editors gives guidelines for submitting manuscripts to its member journals, and includes comments about registration of ongoing studies and the obligation to publish negative studies ClinicalTrials.gov and the ISRCTN register are two registries of ongoing clinical trials
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- 2007
47. The 'Ultimate Prize' for Big Tobacco: Opening the Chinese Cigarette Market by Cigarette Smuggling
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Thomas E. Novotny
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Male ,Epidemiology ,International Cooperation ,lcsh:Medicine ,Smoking Prevention ,Medical Law ,Global Health ,Tobacco industry ,Sex factors ,Global health ,Substance use (including alcohol) ,Child ,health care economics and organizations ,Marketing ,Data Collection ,Health Policy ,Tobacco control ,Smoking ,Commerce ,General Medicine ,Taxes ,Middle Aged ,International health ,Chinese people ,Socioeconomic determinants of health ,Costs and Cost Analysis ,Hong Kong ,Female ,Crime ,Public Health ,Perspectives ,Research Article ,Adult ,China ,Adolescent ,Tobacco Industry ,World health ,Health Economics ,Sex Factors ,Environmental health ,Political science ,Humans ,Aged ,Health economics ,lcsh:R ,Toxicology/Environmental Health ,International Agencies ,United Kingdom ,United States ,Epidemiology/Public Health ,Other - Abstract
Background Cigarette smuggling is a major public health issue, stimulating increased tobacco consumption and undermining tobacco control measures. China is the ultimate prize among tobacco's emerging markets, and is also believed to have the world's largest cigarette smuggling problem. Previous work has demonstrated the complicity of British American Tobacco (BAT) in this illicit trade within Asia and the former Soviet Union. Methods and Findings This paper analyses internal documents of BAT available on site from the Guildford Depository and online from the BAT Document Archive. Documents dating from the early 1900s to 2003 were searched and indexed on a specially designed project database to enable the construction of an historical narrative. Document analysis incorporated several validation techniques within a hermeneutic process. This paper describes the huge scale of this illicit trade in China, amounting to billions of (United States) dollars in sales, and the key supply routes by which it has been conducted. It examines BAT's efforts to optimise earnings by restructuring operations, and controlling the supply chain and pricing of smuggled cigarettes. Conclusions Our research shows that smuggling has been strategically critical to BAT's ongoing efforts to penetrate the Chinese market, and to its overall goal to become the leading company within an increasingly global industry. These findings support the need for concerted efforts to strengthen global collaboration to combat cigarette smuggling., Editors' Summary Background. Smoking tobacco kills about 5 million people around the world every year, and according to the World Health Organization, half of the people who smoke will eventually die as a result. The habit is in decline in most of the world's richer nations, but it is growing in developing countries. Governments can control consumption, and raise substantial tax revenues, by levying high taxes on tobacco. However, this is undermined when tobacco is smuggled into the country and sold illegally. Smuggling makes cigarettes more affordable, thus stimulating consumption, and undermines efforts to reduce smoking rates. British American Tobacco (BAT) is one of the largest international tobacco companies. Following a legal case in the United States, millions of pages of BAT internal documents (dating back to the early 1900s) have been made public. They are held in a depository in the United Kingdom, and most can now be seen online. Researchers have already undertaken wide-ranging studies of these documents and have drawn conclusions about the way BAT has sought to enter emerging markets throughout the world. Why Was This Study Done? Previously published studies have concluded that BAT has been “complicit” in large-scale cigarette smuggling, described in documents by the euphemisms “transit,” “general trade” (“GT”), “duty not paid” (“DNP”), and “free market.” This study focuses on such activities in China, which is believed to have the world's biggest tobacco smuggling problem. China is a key market for BAT and other tobacco companies because of the size of its population, high smoking prevalence, and rapidly growing economy. The development of effective tobacco control policy in China constitutes one of the greatest opportunities to advance global health. The State Tobacco Monopoly Administration is the only agency legally allowed to trade in tobacco in China. What Did the Researchers Do and Find? The authors have put together an account of the company's trading in China in the period from 1986 to 1999. They begin by describing the scale on which tobacco was smuggled into China and the main supply routes through which tobacco entered the country. They found evidence that smuggling increased considerably during the period. The researchers found that BAT's own documents describe the company's efforts to improve its earnings from China by restructuring operations and controlling the supply chain—that is, how cigarettes are manufactured and legally exported, are handled by various “agents” or middlemen, and then are sold illicitly as contraband. The title of this article is taken from one BAT document that states that exports from Hong Kong to China are the “key to the future” of the company's planned growth. The researchers say that this can be taken to mean smuggling, and that BAT's documents indicate that the company benefited from, encouraged, and attempted to control the smuggling of tobacco into China. What Do These Findings Mean? BAT has stated publicly that it does not approve of smuggling. However, from the researchers' analysis of the information in the internal papers, they conclude that “the documents demonstrate that contraband has been a hugely profitable and integral part of BAT operations in China over the past two decades.” They estimate that the value of the illicit trade amounts to billions of (United States) dollars and go on to say that “for the Chinese government, this illicit trade undermined restrictions on imports, represented an enormous loss of tax revenue, and stimulated demand for premium brand cigarettes.” The researchers argue that action should be taken internationally to reduce tobacco smuggling. Additional Information. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030228. • Most of the documents used in this paper can be found at the British American Tobacco Documents Archive created by public health researchers (the Web site also contains useful information on tobacco document research) • The Tobacco Free Initiative, based at the World Health Organization, provides information on the global scale of the tobacco problem, and about efforts to combat the situation • Many countries have national anti-smoking organizations; the United Kingdom charity Action on Smoking and Health has a useful list of these • Information about the dangers of smoking to personal health and advice on giving up the habit are available from the Web sites of the American Academy of Family Physicians and NHS Direct (United Kingdom National Health Service), Internal documents from British American Tobacco demonstrate the scale of tobacco smuggling into China and show that this illicit trade has been a critical factor in BAT's expansion in this market.
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48. Harmonization of community health worker programs for HIV: A four-country qualitative study in Southern Africa.
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De Neve, Jan-Walter, Garrison-Desany, Henri, Andrews, Kathryn G., Sharara, Nour, Boudreaux, Chantelle, Gill, Roopan, Geldsetzer, Pascal, Vaikath, Maria, Bärnighausen, Till, and Bossert, Thomas J.
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MEDICAL personnel training ,COMMUNITY health services ,HIV infections ,NONGOVERNMENTAL organizations ,ORGANIZATIONAL structure ,LABOR incentives ,HIV prevention ,COMMUNITY health workers ,COMMUNITY health services administration - Abstract
Background: Community health worker (CHW) programs are believed to be poorly coordinated, poorly integrated into national health systems, and lacking long-term support. Duplication of services, fragmentation, and resource limitations may have impeded the potential impact of CHWs for achieving HIV goals. This study assesses mediators of a more harmonized approach to implementing large-scale CHW programs for HIV in the context of complex health systems and multiple donors.Methods and Findings: We undertook four country case studies in Lesotho, Mozambique, South Africa, and Swaziland between August 2015 and May 2016. We conducted 60 semistructured interviews with donors, government officials, and expert observers involved in CHW programs delivering HIV services. Interviews were triangulated with published literature, country reports, national health plans, and policies. Data were analyzed based on 3 priority areas of harmonization (coordination, integration, and sustainability) and 5 components of a conceptual framework (the health issue, intervention, stakeholders, health system, and context) to assess facilitators and barriers to harmonization of CHW programs. CHWs supporting HIV programs were found to be highly fragmented and poorly integrated into national health systems. Stakeholders generally supported increasing harmonization, although they recognized several challenges and disadvantages to harmonization. Key facilitators to harmonization included (i) a large existing national CHW program and recognition of nongovernmental CHW programs, (ii) use of common incentives and training processes for CHWs, (iii) existence of an organizational structure dedicated to community health initiatives, and (iv) involvement of community leaders in decision-making. Key barriers included a wide range of stakeholders and lack of ownership and accountability of non-governmental CHW programs. Limitations of our study include subjectively selected case studies, our focus on decision-makers, and limited generalizability beyond the countries analyzed.Conclusion: CHW programs for HIV in Southern Africa are fragmented, poorly integrated, and lack long-term support. We provide 5 policy recommendations to harmonize CHW programs in order to strengthen and sustain the role of CHWs in HIV service delivery. [ABSTRACT FROM AUTHOR]- Published
- 2017
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49. Years of life lost due to traumatic brain injury in Europe: A cross-sectional analysis of 16 countries.
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Majdan, Marek, Plancikova, Dominika, Maas, Andrew, Polinder, Suzanne, Feigin, Valery, Theadom, Alice, Rusnak, Martin, Brazinova, Alexandra, and Haagsma, Juanita
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BRAIN injuries ,BRAIN injury treatment ,CAUSES of death ,NERVOUS system injuries ,TRAUMATOLOGY ,DIAGNOSIS ,LIFE expectancy ,DISEASE incidence ,CROSS-sectional method - Abstract
Introduction: Traumatic brain injuries (TBIs) are a major public health, medical, and societal challenge globally. They present a substantial burden to victims, their families, and the society as a whole. Although indicators such as incidence or death rates provide insight into the occurrence and outcome of TBIs in various populations, they fail to quantify the full extent of their public health and societal impact. Measures such as years of life lost (YLLs), which quantifies the number of years of life lost because the person dies prematurely due to a disease or injury, should be employed to better quantify the population impact. The aim of this study was to provide an in-depth analysis of the burden of deaths due to TBI by calculating TBI-specific YLLs in 16 European countries, analyzing their main causes and demographic patterns, using data extracted from death certificates under unified guidelines and collected in a standardized manner.Methods and Findings: A population-wide, cross-sectional epidemiological study was conducted in 16 European countries to estimate TBI YLLs for the year 2013. The data used for all analyses in this study were acquired from the statistical office of the European Union (Eurostat). A specifically tailored dataset of micro-level data was provided that listed the external cause of death (International Classification of Diseases-10th Revision [ICD-10] codes V01-Y98), the specific nature of injury (ICD-10 codes S00-T98), the age at death, and sex for each death. Overall number of TBI YLLs, crude and age-standardized TBI YLL rates, and TBI YLLs per case were calculated stratified for country, sex, and age. Pooled analyses were performed in order to estimate summary age-standardized rates of TBI YLLs. In order to evaluate the relative importance of TBI in the context of all injuries, proportions of TBI YLLs out of overall injury YLLs were calculated. The total number of TBI YLLs was estimated by extrapolating the pooled crude rate of TBI YLLs in the 16 analyzed countries to the total population of the 28 member states of the EU (EU-28). We found that a total of 17,049 TBI deaths occurred in 2013 in the 16 analyzed countries. These translated into a total of 374,636 YLLs. The pooled age-standardized rate of YLLs per 100,000 people per year was 259.1 (95% CI: 205.8 to 312.3) overall, 427.5 (95% CI: 290.0 to 564.9) in males, and 105.4 (95% CI: 89.1 to 121.6) in females. Males contributed substantially more to TBI YLLs than females (282,870 YLLs, 76% of all TBI YLLs), which translated into a rate ratio of 3.24 (95% CI: 3.22 to 3.27). Each TBI death was on average associated with 24.3 (95% CI: 22.0 to 26.6) YLLs overall, 25.6 (95% CI: 23.4 to 27.8) in males and 20.9 (17.9 to 24.0) in females. Falls and traffic crashes were the most common external causes of TBI YLLs. TBI contributed on average 41% (44% in males and 34% in females) to overall injury YLLs. Extrapolating our findings, about 1.3 million YLLs were attributable to TBI in the EU-28 in 2013 overall, 1.1 million in males and 271,000 in females. This study is based on administratively collected data from 16 countries, and despite the efforts to harmonize them to the greatest possible extent, there may be differences in coding practices or reporting between countries. If present, these would be inherited into our findings without our ability to control for them. The extrapolation of the pooled rates from the 16 countries to the EU-28 should be interpreted with caution.Conclusions: Our study showed that TBI-related deaths and YLLs have a substantial impact at the individual and population level in Europe and present an important societal and economic burden that must not be overlooked. We provide information valuable for policy-makers, enabling them to evaluate and plan preventive activities and resource allocation, and to formulate and implement strategic decisions. In addition, our results can serve as a basis for analyzing the overall burden of TBI in the population. [ABSTRACT FROM AUTHOR]- Published
- 2017
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50. A universal testing and treatment intervention to improve HIV control: One-year results from intervention communities in Zambia in the HPTN 071 (PopART) cluster-randomised trial.
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Hayes, Richard, Floyd, Sian, Schaap, Ab, Shanaube, Kwame, Bock, Peter, Sabapathy, Kalpana, Griffith, Sam, Donnell, Deborah, Piwowar-Manning, Estelle, El-Sadr, Wafaa, Beyers, Nulda, Ayles, Helen, Fidler, Sarah, null, null, and HPTN 071 (PopART) Study Team
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HIGHLY active antiretroviral therapy ,MEDICAL screening ,DIAGNOSIS of HIV infections ,HIV prevention ,ANTIRETROVIRAL agents ,HIV infection epidemiology ,PSYCHOLOGICAL adaptation ,COMPARATIVE studies ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,PSYCHOLOGICAL tests ,RESEARCH ,RESEARCH funding ,EVALUATION research ,RANDOMIZED controlled trials ,DISEASE incidence ,ANTI-HIV agents - Abstract
Background: The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets require that, by 2020, 90% of those living with HIV know their status, 90% of known HIV-positive individuals receive sustained antiretroviral therapy (ART), and 90% of individuals on ART have durable viral suppression. The HPTN 071 (PopART) trial is measuring the impact of a universal testing and treatment intervention on population-level HIV incidence in 21 urban communities in Zambia and South Africa. We report observational data from four communities in Zambia to assess progress towards the UNAIDS targets after 1 y of the PopART intervention.Methods and Findings: The PopART intervention comprises annual rounds of home-based HIV testing delivered by community HIV-care providers (CHiPs) who also support linkage to care, ART retention, and other services. Data from four communities in Zambia receiving the full intervention (including immediate ART for all individuals with HIV) were used to determine proportions of participants who knew their HIV status after the CHiP visit; proportions linking to care and initiating ART following referral; and overall proportions of HIV-infected individuals who knew their status (first 90 target) and the proportion of these on ART (second 90 target), pre- and post-intervention. We are not able to assess progress towards the third 90 target at this stage of the study. Overall, 121,130 adults (59,283 men and 61,847 women) were enumerated in 46,714 households during the first annual round (December 2013 to June 2015). Of the 45,399 (77%) men and 55,703 (90%) women consenting to the intervention, 80% of men and 85% of women knew their HIV status after the CHiP visit. Of 6,197 HIV-positive adults referred by CHiPs, 42% (95% CI: 40%-43%) initiated ART within 6 mo and 53% (95% CI: 52%-55%) within 12 mo. In the entire population, the estimated proportion of HIV-positive adults who knew their status increased from 52% to 78% for men and from 56% to 87% for women. The estimated proportion of known HIV-positive individuals on ART increased overall from 54% after the CHiP visit to 74% by the end of the round for men and from 53% to 73% for women. The estimated overall proportion of HIV-positive adults on ART, irrespective of whether they knew their status, increased from 44% to 61%, compared with the 81% target (the product of the first two 90 targets). Coverage was lower among young men and women than in older age groups. The main limitation of the study was the need for assumptions concerning knowledge of HIV status and ART coverage among adults not consenting to the intervention or HIV testing, although our conclusions were robust in sensitivity analyses.Conclusions: In this analysis, acceptance of HIV testing among those consenting to the intervention was high, although linkage to care and ART initiation took longer than expected. Knowledge of HIV-positive status increased steeply after 1 y, almost attaining the first 90 target in women and approaching it in men. The second 90 target was more challenging, with approximately three-quarters of known HIV-positive individuals on ART by the end of the annual round. Achieving higher test uptake in men and more rapid linkage to care will be key objectives during the second annual round of the intervention.Trial Registration: ClinicalTrials.gov NCT01900977. [ABSTRACT FROM AUTHOR]- Published
- 2017
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