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Community-level risk factors for temperature-related mortality in France.
No full textBACKGROUND: Vulnerability to nonoptimal temperatures varies from one geographical location to another, but the contextual factors accounting for these spatial differences are still poorly understood. We aimed to identify the community-level characteristics contributing to geographical disparities in heat-related and cold-related mortality risk in France. METHODS: We conducted a country-wide analysis using data on all-cause mortality, temperature, and contextual characteristics across 1,967 pseudo-cantons in France between 2004 and 2019. We first estimated the daily temperature-mortality association in each pseudo-canton using a time-series quasi-Poisson regression in combination with distributed lag nonlinear models, and then we fitted univariable and multivariable multivariate meta-regression models to assess the effect modification of the contextual factors on heat-related and cold-related mortality risk. FINDINGS: Over the 16-year study period, metropolitan France recorded 8,807,376 deaths out of an average population of 63·2 million inhabitants, which corresponds to an average annual mortality rate of 8.7 per 1,000 people. The country-level percent change (%CR) in mortality risk at the 1st and 99th daily temperature percentiles versus the minimum mortality temperature was, respectively, 31.2% (95% CI = 29.0, 33.5) and 11.0% (95% CI = 9.4, 15.5). The mortality risk associated with low temperatures was not modified by any of the contextual factors considered in the study, while the mortality risk associated with high temperatures was independently modified by NO2 pollution. Communities exposed to high levels of NO2 (i.e., cities or urban areas) had increased mortality risk from heat. INTERPRETATION: This study suggests that urban areas in France are more vulnerable to heat, compared to rural communities, and that this disparity is probably driven by air pollution (NO2) and urban heat island. Reducing air pollution and mitigating urban heat island should be at the forefront of adaptation strategies to prevent heat-related health impacts
Comparison of outcomes after living and deceased donor kidney transplantation: UK national cohort study.
Get PDFBACKGROUND: Most kidneys for transplantation come from deceased donors, though healthy live individuals may also donate. Living donor transplants generally show better outcomes than deceased donor transplants, but it is unclear whether this reflects inherent benefits of having a living donor kidney or differences in donor and recipient characteristics. Using data from 10 915 UK kidney-only transplants, the aim of this study was to determine the causal effect of living donors on graft survival, considering all-cause death without graft failure as a competing risk. METHODS: This study used inverse probability of treatment weighting based on propensity scores to adjust for imbalances in baseline variables between recipients of living and deceased donor kidneys implanted between 2010 and 2021. The mean treatment effect, had all patients received kidneys from living donors, was estimated from differences in survival probabilities and restricted mean survival time using weighted competing risks models. RESULTS: After adjustment for key confounders, living donor kidney transplantation (LDKT) was associated with a 6.03% (95% c.i. 4.71% to 7.35%) lower 5-year risk of graft failure compared with deceased donor kidney transplantation (DDKT). Over 7 years, living donor recipients experienced an additional 0.36 (95% c.i. 0.29 to 0.43) years of graft survival. Benefits persisted across clinically relevant LDKT subgroups. CONCLUSION: LDKT is associated with superior graft survival compared with DDKT after adjusting for confounders. Findings highlight the importance of promoting living donor programmes whilst simultaneously identifying opportunities to enhance DDKT. Future work may clarify whether factors such as reduced cold ischaemia time drive these benefits
Using the Community Perception Tracker (CPT) to inform COVID-19 response in Lebanon and Zimbabwe: a qualitative methods evaluation.
Get PDFBACKGROUND: Despite the recognized importance of community engagement during disease outbreaks, methods describing how to operationalise engagement are lacking. The Community Perception Tracker (CPT) was designed by Oxfam to systematically record real-time information on disease perceptions and outbreak response actions in order to adapt programmes. METHODS: We conducted a phased, qualitative methods, process evaluation in Zimbabwe and Lebanon to understand whether the CPT approach was a feasible way to incorporate community perceptions into COVID-19 response programming and whether this resulted in more relevant programming. We conducted 3 rounds of interviews with 15 staff using the CPT, analysed programmatic data, and conducted multiple rounds of phone-based interviews with outbreak-affected populations (41 to 50 participants per country each round). Qualitative data were thematically analysed and quantitative data descriptively summarized. RESULTS: Initially CPT implementing staff struggled to differentiate how the CPT differed from other monitoring tools that they were familiar with and felt that the training did not convey the full process and its value. However, with practise, collaboration and iterative improvements to the recommended CPT steps, staff found the process to be feasible and a significant value-add to their programming. Staff initially focused more on quantitively summarizing perceptions but eventually developed processes for maximizing the qualitative data on perceptions too. Trends emerging from the CPT led to frequent programmatic tweaks to COVID-19 messaging and product distributions. Emergent trends in perceptions also led staff to work cross-sectorally and advocate to other actors on behalf of populations. Outbreak-affected populations exposed to the programmes reported high levels of knowledge about COVID-19 and reported they practiced preventative behaviours, although this waned with time. Most population members also felt the COVID-19 programmes were relevant to their needs and said that non-government organisations were a trusted source of information. CONCLUSIONS: The CPT appears to be a promising approach for ensuring that community engagement is undertaken systematically and that community perspectives are actively incorporated to improve programming. While crisis-affected populations generally found the programmes to be useful and relevant and to have influenced their knowledge and behaviours, it is not possible to attribute this to the CPT approach due to the study design
Preterm Birth Frequency and Associated Outcomes From the MATISSE (Maternal Immunization Study for Safety and Efficacy) Maternal Trial of the Bivalent Respiratory Syncytial Virus Prefusion F Protein Vaccine.
Get PDFOBJECTIVE: To describe preterm birth frequency and newborn and infant outcomes overall and among preterm children in the MATISSE (Maternal Immunization Study for Safety and Efficacy) trial of maternal vaccination with bivalent respiratory syncytial virus (RSV) prefusion F protein-based vaccine (RSVpreF) to protect infants against severe RSV-associated illness.
METHODS: MATISSE was a global, phase 3, randomized, double-blind trial. Pregnant individuals received single injections of RSVpreF or placebo. Adverse events of special interest, including preterm birth (gestational age less than 37 weeks) and low birth weight (2,500 g or less), were collected through 6 months after delivery (pregnant participants) and from birth through age 12 or 24 months (pediatric participants).
RESULTS: Overall, 7,386 pregnant participants received RSVpreF (n=3,698) or placebo (n=3,688); 7,305 newborns and infants were included in the analysis. Most children in both groups were born full term (more than 93%) with normal birth weight (95% or higher). Newborn and infant outcomes, including rates of low birth weight and neonatal hospitalization, were favorable and comparable between groups. Preterm birth rates were 5.7% in the RSVpreF arm and 4.7% in the placebo arm (relative risk [RR] 1.20, 95% CI, 0.98-1.46); most were late preterm. Newborn and infant outcomes, including rates of low birth weight and neonatal hospitalization, were comparable between groups. Twenty-two newborn or infant deaths occurred during the study (RSVpreF n=8, placebo n=14). When stratified by income region, preterm birth rates in RSVpreF and placebo recipients were both 5.0% in high-income countries. Rates in non-high-income countries were 7.0% and 4.0% in the RSVpreF and placebo groups, respectively, and 8.3% and 4.0% in South Africa (RR 2.06, 95% CI, 1.21-3.51).
CONCLUSION: In this study of maternal RSVpreF vaccination, no clinically significant increase in adverse events of special interest, including preterm birth, low birth weight, or neonatal hospitalization, was observed among pregnant people in the overall analysis. In subgroup analysis of non-high-income countries, an elevated risk of preterm birth was observed. More research is needed to better ascertain preterm delivery risk factors, particularly aimed at minimizing disparities among geographic regions.
FUNDING SOURCE: This study was sponsored by Pfizer. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT04424316
A novel post-mortem pathogen discovery program detects an outbreak of Echovirus E7: Uganda, 2022-2023.
Get PDFOBJECTIVES: Utilizing post-mortem examination for routine monitoring of infectious diseases and pandemic preparedness is a common-sense, yet uncommon, public health measure. Here, we established a novel mortuary surveillance program in Uganda that leverages the unbiased nature of metagenomic next-generation sequencing (mNGS) to detect pathogens in recently deceased individuals. METHODS: Between October 2022 and December 2023, specimens and patient metadata were collected from 2,607 individuals across five mortuary sites around Kampala. Specimens were pre-screened for hemorrhagic fever viruses by RT-qPCR and a subset (n = 134) of RT-qPCR negatives were sequenced by mNGS. RESULTS: A variety of DNA (herpes, parvovirus, bufavirus) and RNA (Saffold, Salivirus, HAV) viruses, vectored (Bartonella, Rickettsia) and nosocomial (Enterobacter, Klebsiella) bacterial infections, and potentially lethal respiratory pathogens (e.g., Cryptococcus neoformans, Corynebacterium diphtheria) were detected. A localized outbreak of Enterovirus B (EV-B), specifically a recombinant Echovirus E7, was observed in Kampala. An epidemiologic assessment indicated that most identified pathogens were acquired via direct and/or indirect contact (e.g., fecal-oral, fomites) and that other modes of transmission (e.g., food-borne, insect-vectored) played a less significant role. CONCLUSION: Integration of mortuary surveillance, coupled with mNGS, into public health systems represents a powerful strategy for identifying unrecognized outbreaks and monitoring the (re-) emergence of infectious diseases
The EpiFusion Analysis Framework for joint phylodynamic and epidemiological analysis of outbreak characteristics.
Get PDFThe fields of epidemiology and viral phylodynamics share the ultimate goal of disease control, but concepts, methodologies and data employed by each differ in ways that confer complementary strengths and different areas of weakness. We recently introduced EpiFusion, a model for joint inference of outbreak characteristics using phylogenetic and case incidence data via particle filtering and demonstrated its usage to infer the effective reproduction number of simulated and real outbreaks. Here we provide a series of vignettes demonstrating data analysis using the EpiFusion Analysis Framework, consisting of the R package EpiFusionUtilities and the Java program in which the model is implemented, including an example using a new feature incorporated since EpiFusion's last description: the option to provide a phylogenetic tree posterior as the phylogenetic data input to the program. By outlining these examples, we aim to improve the usability of our model, and promote workflow reproducibility and open research
Prevalence and characteristics of dengue virus co-infection in patients and mosquitoes collected from patients' houses.
Get PDFCo-infection with multiple DENV serotypes can affect human immune status and complicate the clinical presentation and management of dengue patients, so understanding the prevalence and dynamics of co-infection is important for effective dengue control. We aimed to identify and characterize DENV co-infection patterns in field-caught mosquitoes and dengue patients. This study was conducted in northeastern Thailand between June 2016 to August 2019. Female Aedes mosquitos collected from and around dengue patient's houses were analyzed for DENV infection and presence of serotypes using RT-PCR. DENV serotyping was successful in 154 (39.49%) of human and 165 (14.26%) of mosquito samples. Prevalence of DENV co-infection in patients and mosquitoes was 22.73% (35 cases) and 28.48% (47 samples), respectively. Co-infection with multiple serotypes were double (human 88.57%, mosquito 89.36%), triple (human 5.72%, mosquito 10.64%) and quadruple (human 5.72%, mosquito 0%) infections. Concurrent infection was different between hosts and concurrence patterns of DENV serotype in each host mostly composed of the predominant serotype of the detected year. This is the first report that show DENV co-infection patterns in field-caught mosquito and in dengue fever patients with combinations of triple and quadruple serotypes in Thailand. These finding are potentially useful for understanding shifts in serotypes, concurrent DENV infection patterns, vaccine development, and further research on the ability of vectors to transmit multiple serotypes
Co-creating inclusive sexual health services for middle-aged and older adults, including disabled people, in England: an innovative participatory approach within the field of sexual health.
Get PDFBackground Middle-aged and older adults, including disabled people, are rarely engaged in helping to develop sexual health services to meet their needs. We used co-creation as a promising participatory strategy to develop ideas to inform more inclusive sexual health services for middle-aged and older adults in England. Methods During April and May 2023, we recruited participants to take part in our co-creation workshops and interviews. The research team partnered with active community leaders with lived experience to co-design and co-organise sessions. Discussion topics were developed iteratively, centred on participant input, to ensure the sessions were accessible and appropriate for the focus population. Implementation of the co-creation workshops and one-to-one interviews was evaluated by gathering community facilitators' reflections on how they felt about their experience as facilitators and the success of the workshops. Reflections Overall, co-creation activities are well-accepted and highly valuable means to engage middle-aged and older adults. We are identifying three strengths and four challenges worth noting. As for strengths, they entail: (1) shared informed decision-making; (2) co-leadership for conducting the research activities; and (3) importance of co-facilitation; and for challenges: (1) ensuring the venue/information is accessible to all; (2) recruitment of middle-aged and older adults for a stigmatised research topic; (3) need more time for co-creation sessions to make sure equal opportunity to contribute; and (4) integrating co-creation into existing community activities. Conclusion Co-creation is crucial for inclusive health services, but underexplored in sexual health research involving middle-aged, older and disabled individuals. This study emphasises shared ownership, which enables the offering of practical guidance for researchers and healthcare professionals
Increasing Rigor in Online Health Surveys Through the Reduction of Fraudulent Data.
Get PDFOnline surveys have become a key tool of modern health research, offering a fast, cost-effective, and convenient means of data collection. It enables researchers to access diverse populations, such as those underrepresented in traditional studies, and facilitates the collection of stigmatized or sensitive behaviors through greater anonymity. However, the ease of participation also introduces significant challenges, particularly around data integrity and rigor. As fraudulent responses-whether from bots, repeat responders, or individuals misrepresenting themselves-become more sophisticated and pervasive, ensuring the rigor of online surveys has never been more crucial. This article provides a comprehensive synthesis of practical strategies that help to increase the rigor of online surveys through the detection and removal of fraudulent data. Drawing on recent literature and case studies, we outline several options that address the full research cycle from predata collection strategies to validation post data collection. We emphasize the integration of automated screening techniques (eg, CAPTCHAs and honeypot questions) and attention checks (eg, trap questions) for purposeful survey design. Robust recruitment procedures (eg, concealed eligibility criteria and 2-stage screening) and a proper incentive or compensation structure can also help to deter fraudulent participation. We examine the merits and limitations of different sampling methodologies, including river sampling, online panels, and crowdsourcing platforms, offering guidance on how to select samples based on specific research objectives. Post data collection, we discuss metadata-based techniques to detect fraudulent data (eg, duplicate email or IP addresses, response time analysis), alongside methods to better screen for low-quality responses (eg, inconsistent response patterns and improbable qualitative responses). The escalating sophistication of fraud tactics, particularly with the growth of artificial intelligence (AI), demands that researchers continuously adapt and stay vigilant. We propose the use of dynamic protocols, combining multiple strategies into a multipronged approach that can better filter for fraudulent data and evolve depending on the type of responses received across the data collection process. However, there is still significant room for strategies to develop, and it should be a key focus for upcoming research. As online surveys become increasingly integral to health research, investing in robust strategies to screen for fraudulent data and increasing the rigor of studies is key to upholding scientific integrity