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Changes in household purchasing of soft drinks following the UK soft drinks industry levy by household income and composition: controlled interrupted time series analysis, March 2014 to November 2019.
Get PDFBACKGROUND: The WHO recommends taxes on sugar sweetened beverages (SSBs) to improve population health. We examined changes in volume of and amount of sugar in purchases of soft drinks according to household income and composition, 19 months following the implementation of the UK soft drinks industry levy. METHODS: Data were from the Kantar Fast Moving Consumer Goods panel, a market research panel which collects data on weekly household purchases (mean weekly number of households=21 908), March 2014-November 2019. Interrupted time series analysis of volume and sugar purchases was used to estimate absolute and relative differences in the volume and amount of sugar in soft drinks, confectionery and alcohol purchased weekly by household income (£50 000) and composition (presence of children (<16 years) in the household (yes or no)), 19 months after soft drinks industry levy (SDIL) implementation, compared with the counterfactual scenario based on pre-announcement trends and using a control group (toiletries). RESULTS: By November 2019, purchased weekly sugar in soft drinks fell by 7.46 g (95% CI: 12.05, 2.87) per household but volumes of drinks purchased remained unchanged, compared with the counterfactual. In low-income households, weekly sugar purchased in soft drinks decreased by 14.0% (95% CI: 12.1, 15.9) compared with the counterfactual but in high-income households increased by 3.4% (1.07, 5.75). Among households with children, sugar purchased decreased by 13.7% (12.1, 15.3) but increased in households without children by 5.0% (3.0, 7.0). Low-income households and those with children also reduced their weekly volume of soft drinks purchased by 5.7% (3.7, 7.7) and 8.5% (6.8, 10.2) respectively. There was no evidence of substitution to confectionary or alcohol. CONCLUSION: In the second year following implementation of the SDIL, effects on sugar purchased were greatest in those with the highest pre-SDIL purchasing levels (low-income households and those with children). The SDIL may contribute to reducing dietary inequalities. TRIAL REGISTRATION NUMBER: ISRCTN18042742. Registered: August 2017
The impacts of removing pharmaceutical co-payments for chronic conditions at primary care level: a pilot study in rural China.
Get PDFThe underutilization of primary care (PC) presents a substantial challenge in enhancing the people-centeredness, quality, and efficiency of health services for patients with chronic diseases. Pharmaceutical copayments have been considered a key barrier to patient access in low- and middle-income countries. It is unclear whether the removal of pharmaceutical copayment can lead to better care and management of chronic diseases. This study sought to evaluate the impact on healthcare utilization and spending of a policy that waived fees for essential pharmaceuticals at PC facilities, piloted county-wide from 2014 in rural China. Using individual claims data from 2010 to 2017, we applied a synthetic difference-in-difference approach to estimate the policy's effects. Our sample included 9115 patients with hypertension and/or diabetes from the pilot county and 30 675 patients from the other counties in the same municipality. The policy led to a significant increase of 0.69 in the number of PC visits per patient per year (95% CI: 0.46-0.91), equivalent to a rise of 44.1%. Annual spending per person on outpatients at PC facilities increased significantly due to the policy, by 58 yuan (95% CI: 36-80), equivalent to a rise of 40.5%. As for outpatient visits at hospitals, there was a 25.8% significant reduction in the number of visits per year (-0.56; 95% CI: -0.95 to -0.16) and a nonsignificant increase in spending (45 yuan; 95% CI: -111 to 21). The annual number of admissions and spending on inpatients per person in all facilities remained stable. Using claims data, we have demonstrated that targeted removal of copayment for essential medicines successfully shifted outpatient visits and expenditure from hospitals to PC facilities but did not affect hospitalization and inpatient expenditure. Further research may be attempted to see if removing pharmaceutical copayments on people with less severe NCDs could reduce hospitalizations
Syphilis seroprevalence and risk factors among first-time blood donors in Brazil: A comprehensive repeated cross-sectional analysis spanning a decade.
Get PDFBACKGROUND: Syphilis remains a global health challenge, with rising incidence rates worldwide Prevalence surveys conducted in Brazil over extended periods of time are scarce. This study examines the secular trends and risk factors for syphilis seroprevalence among first-time blood donors in Brazil.
METHODS: A retrospective analysis was conducted as part of a multicenter, repeated cross-sectional survey of blood donors from four major Brazilian blood centers, covering the period from 2007 to 2020. First-time donors who had undergone valid treponemal screening tests were included in the final dataset. Demographic characteristics and serological results were analyzed to identify risk factors for syphilis seroprevalence using multivariate Poisson models. An interaction term between age group and donation year was added to the final model. Model comparisons were performed using Likelihood Ratio Tests (LRT) and Akaike Information Criterion (AIC).
RESULTS: 1,424,850 donations from first-time donors were included during the study period. The overall syphilis seroprevalence was 2.19%, with significant heterogeneity across centers. Risk factors for increased seroprevalence included male gender, older age, lower education level, and self-reported black or mixed skin color. Notably, an increasing trend in syphilis seroprevalence was observed among younger donors and those born after 1990. Interaction analyses revealed significant effects between visit period and key demographic variables (age group, gender, education, and ethnicity), with the interaction between age group and donation year indicating higher seroprevalence among younger age groups in recent years.
CONCLUSION: The study highlights a high syphilis seroprevalence among first-time blood donors in Brazil, which has significant implications for blood safety and public health. The increasing trend among younger donors suggests a shift towards newer infections, warranting continued surveillance in this demographic
Surgical Management of Gestational Gigantomastia: A Case Report Highlighting Therapeutic Intervention.
Get PDFGigantomastia is an exceedingly rare condition characterized by extraordinary growth of breasts during pregnancy, and its underlying etiology remains elusive. Although surgical intervention is the primary treatment modality, there have been emerging prospects for utilizing adjunctive medical therapies, such as bromocriptine, to address this challenging condition. Herein, we report the case of a 26-year-old woman who experienced abrupt and asymmetric bilateral breast enlargement commencing in the second month of her pregnancy. Remarkably, this enlargement persisted for an extended duration of 3 years. Despite the absence of prior medical therapy involving bromocriptine or other interventions, the patient ultimately underwent a simple mastectomy coupled with nipple-areola complex reconstruction. Although bromocriptine treatment holds potential benefits, its availability may vary in different healthcare settings. Therefore, the consideration of surgical management as an alternative approach becomes crucial, particularly when bromocriptine is not accessible or proves ineffective. This approach ensures the appropriate management of gestational gigantomastia, with the choice of treatment tailored to the individual patient's needs and resource availability
Randomised feasibility study of an intestinal adsorbent in acute diarrhoea in The Gambia.
Get PDFBACKGROUND: Diarrhoea remains a leading cause of death in children. An intestinal adsorbent may reduce diarrhoea duration and severity.
METHODS: Randomised controlled feasibility trial with two phases: phase 1 (0-4 hours and double-blind) and phase 2 (up to 5 days and open-label). 50 children aged 6-59 months with acute diarrhoea presenting with no or some dehydration to the emergency paediatric unit and outpatient clinic at Edward Francis Small Teaching Hospital, Banjul, The Gambia were randomised to either standard treatment (oral rehydration fluid and zinc) or standard treatment with polymethylsiloxane polyhydrate for up to 5 days.
RESULTS: Recruitment was completed in 7 months. All but one child completed the study. There were no major protocol deviations although patient-held diaries did not collect reliable information. Time from randomisation to the last watery stool (primary outcome) was shorter in the intervention than control arm (mean difference -19.3 hours, 95% CI -30.9 to -7.8). Stool frequency was lower in the intervention arm on days 2 (95% CI -0.8 to -1.3 to -0.3) and 3 (95% CI -0.8; -1.3 to -0.3). One serious event (death) occurred in the control arm.
CONCLUSIONS: A randomised, controlled trial is feasible. Further clinical trials are warranted to confirm the efficacy of polymethylsiloxane polyhydrate in acute diarrhoea and inform management guidelines.
TRIAL REGISTRATION NUMBER: PACTR202302683128875
Mendelian randomization study highlights the role of hematological traits on Type-2 diabetes mellitus in African ancestry individuals.
Get PDFINTRODUCTION: Observational studies have identified associations between hematological traits and type-2 diabetes mellitus (T2D). However, it is difficult to infer causal effects due to the potential of confounding. Our study utilizes the Mendelian randomization (MR) approach to address the above limitation and investigate the causal effect of hematological traits such as white blood cell (WBC), platelets (PLT), and red blood cell (RBC) on T2D in individuals of African ancestry. METHODS: The participating cohorts included participants of African ancestry in the Blood Cell consortium and the Million Veteran Program dataset. Using GWAS summary statistics, we applied a univariable and multivariable Two-sample MR to estimate the causal relationship between hematological traits and T2D. RESULTS: In the main IVW MR estimates, genetically predicted levels of mean corpuscular hemoglobin concentration (MCHC), mean corpuscular hemoglobin (MCH), and mean corpuscular volume (MCV) were associated with decreased risk of T2D. We also observed a decreased risk of T2D with genetically predicted total WBC count and neutrophil count (NEU), for the WBC traits. The multivariable analysis further supported the direct associations of genetically predicted MCH, MCHC, and MCV levels with a decreased risk of T2D. For the European ancestry, a similar pattern of association was observed for MCH and MCV. DISCUSSION: These findings indicate that hematological traits may differentially play a role in the development of T2D and be affected by T2D. However, further research is needed to validate and explore the biological pathways and mechanisms involved in these associations
Mapping the cancer research landscape across Zambia: evidence to support national cancer control planning.
Get PDFBACKGROUND: Zambia faces the double burden of rising cancer incidence and a disproportionate volume of mortality from delayed presentations. The Ministry of Health Zambia acknowledged cancer research as a key pillar of cancer control in the National Cancer Control Strategic Plan 2022-2026, but there remains a paucity of country-specific evidence to inform strategies, implementation, monitoring and evaluation of research activities. Our study aimed to map and critically analyse the existing cancer research landscape to inform national planning. METHODS: We adopted a two-stage mixed-method research. First, we conducted a systematic review, including 76 Zambian cancer studies published between 2012 and 2022, adhering to PRISMA guidance. Second, we conducted an in-person modified consensus meeting in Ndola, Zambia attended by 31 domestic and international stakeholders, to co-develop priorities and strategies based on gaps and facilitators identified through the systematic review. RESULTS: The year-on-year cancer research output in Zambia had risen and diversified beyond cervical cancer but prevention, palliative care and health economic studies were lacking. Delay in deciding to seek care was most studied (n = 17, 63.0%), especially in cervical cancer. Research activities were mostly retrospective (n = 47/76, 61.8%) with only one randomised controlled trial identified. Greater than 90% (n = 10/11, 90.9%) of the most prolific research funders were international, predominantly from the United States and the United Kingdom, and Zambian researchers were under-represented as first and last authors at 43% (n = 33/76) and 45% (n = 34/76), respectively. The existing national cervical cancer registry, active global collaboration and adoption of technology were facilitators to be leveraged to build research capacity through multi-level, stakeholder-specific strategies. CONCLUSION: To strengthen research capacity, sustained commitment to priorities through the implementation of co-developed strategies is required at individual, organisational and institutional levels. This paradigm shift is necessary to deliver evidence-based cancer care tailored to the needs of Zambians with emphasis on value and quality
Long-Term Immune Consequences of Initial SARS-CoV-2 A.23.1 Exposure: A Longitudinal Study of Antibody Responses and Cross-Neutralization in a Ugandan Cohort.
Get PDFBackground: This study assessed the long-term dynamics of neutralizing antibodies in a Ugandan cohort primarily exposed to the A.23.1 SARS-CoV-2 variant, examining how this shaped immune breadth and potency against diverse strains following infection and prototype-based vaccination.
Methods: We conducted a 427-day retrospective analysis of 41 participants across multiple SARS-CoV-2 waves, assessing binding and neutralizing antibody responses using in-house ELISA and pseudotyped virus neutralization assays. We quantified immune responses to key SARS-CoV-2 variants, A.23.1, D614G, Delta, and BA.4, capturing evolving immunity across the pandemic.
Results: Neutralizing antibody titers against A.23.1 remained significantly higher than those against D614G, Delta, and BA.4, highlighting the solid immune memory following A.23.1 infection. Consistently lower titers were observed for BA.4 across all time points, aligning with its strong immune-evasion capability. Correlations between neutralizing titers and spike-directed IgG (S-IgG) concentrations were significantly stronger for A.23.1 than for D614G, with no correlation for BA.4. ChAdOx1-S vaccination substantially elevated the neutralizing titers across all variants, most notably BA.4, highlighting the essential role of vaccination in boosting immunity, even in individuals with initially low titers.
Conclusions: Initial exposure to the A.23.1 variant triggered potent immune responses, shaping neutralizing antibody dynamics during subsequent exposures. These findings highlight the importance of accounting for early viral exposures in vaccine development and public health planning. The distinctly lower immune response to BA.4 highlights the need for continuous antigenic monitoring and timely vaccine updates for protection against emerging variants. Vaccination remains essential for reinforcing and sustaining immunity against evolving variants
Longitudinal Assessment of Sexual Behavior and Relationship Quality During the First Year of the COVID-19 Pandemic in Britain: Findings from a Longitudinal Population Survey (Natsal-COVID).
Get PDFWhile the impact of social restrictions on sexual and romantic life early in the COVID-19 pandemic has been widely studied, little is known about impacts beyond the initial months. We analyzed responses from 2,098 British adults (aged 18-59) taking part in the Natsal-COVID study (Waves 1 and 2). Participants were recruited via a web panel and surveyed twice: four months and one year after the start of the UK's first national lockdown (July 2020 and March 2021). Changes in the prevalence and frequency of participants' physical and virtual sexual behaviors between the two surveys were analyzed using multinomial logistic regression. Changes in the quality of intimate relationships were modeled using logistic regression for the 1,407 participants in steady relationships, adjusting for age, gender, and relationship status. The reported prevalence of any sexual activity amongst the full sample increased over the study period (from 88.1% to 91.5%, aOR = 1.50, 95% CI 1.23-1.84). Increases were observed for physical (aOR = 1.41, 95% CI 1.15-1.74) and virtual (aOR = 1.20, 95% CI 1.07-1.34) activities, particularly masturbation (aOR 1.53, 95% CI 1.37-1.72). Increases were larger for men than women. The proportion of participants in steady relationships whose relationship scored as "lower quality" increased (from 23.9% to 26.9%, aOR = 1.28, 95% CI 1.10-1.49). These findings have implications for understanding sexual health needs during disasters and planning sexual health service priorities following the pandemic
One Health conceptualization of sustainable diets looking at low- and middle-income settings: a systematic literature review
Get PDFUnhealthy diets are proven risks for non-communicable diseases and mortality globally. Low- and Middle-Income Countries (LMICs) are equally faced with food/nutrition insecurity, poor health outcomes, and the need for sustainable food systems transformation to cater for the growing population within safe planetary boundaries. Despite significant progress globally, persistent challenges necessitate a more holistic and systemic approach to healthy sustainable diets, particularly in LMICs which are often underrepresented in global studies. This review conceptualizes sustainable diets looking at LMICs by assessing sustainability through the One Health approach which considers the interdependencies among humans, animals, plants, and the environment. Using the preferred reporting items of systematic reviews and meta-analyses (PRISMA) guidelines and the checklist for One Health epidemiological reporting of evidence (COHERE) standards, four databases were searched (Embase, Global Health, Web of Science, and Scopus) between 1947 and June 2023. Dietary sustainability was assessed in LMICs by evaluating coverage across the four One Health pillars (human, animal, plant, and environmental health) and five dietary sustainability dimensions (diet/nutrition, health, environment, economic, and social). Extracted data were analyzed qualitatively. The database searches yielded 3,122 studies. After removing duplicates and screening for eligibility, 35 studies were selected for inclusion. Most studies were from upper (77%) and lower (20%) middle-income countries. While 20 studies (57%) assessed human and environmental health, none assessed plant or animal health, nor all four One Health pillars combined. No study assessed all five dietary sustainability dimensions. Most studies assessed two (54%) or three (34%) dimensions, and the most frequently assessed dimension was the environment (71%). Thus, highlighting the non-comprehensive nature and the dearth of research on sustainable diets conducted in LMICs, particularly, low-income countries, and that the research so far mainly focuses on environmental impacts. Overall, studies found that LMICs’ diets, particularly middle-income countries, are unsustainable due to low quality, low diversity, and high environmental effects, with associated inequities. The underrepresentation of LMICs, particularly low-income countries, in this review is a wake-up call urging the generation of more country-specific data incorporating more dietary sustainability dimensions and One Health pillars (especially plant and animal health) for progress and monitoring toward attaining global dietary sustainability