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LSHTM Data Management Plan for Research Students
Get PDFA Data Management Plan is a planning document that describes how research data will be handled during a project and following its completion. LSHTM expects MPhil, PhD & DrPH students to prepare a Data Management Plan and include it in their Upgrading or Review report as an appendix. This template may be used as a basis for writing a Data Management Plan. Further information can be found on the LSHTM intranet and advice/feedback can be obtained from [email protected]
Associations of ambient exposure to benzene, toluene, ethylbenzene, and xylene with daily mortality: a multicountry time-series study in 757 global locations.
Get PDFBACKGROUND: The presence of benzene, toluene, ethylbenzene, and xylene isomers (BTEX) in the environment is of increasing concern due to their toxicity and ubiquity. Although the adverse health effects of BTEX exposure have been documented, robust epidemiological evidence from large-scale, multicountry studies using advanced exposure assessment methodologies remains scarce. We aimed to assess the association of short-term ambient exposure to individual BTEX components and their mixture with daily total, cardiovascular, and respiratory mortality on a global scale.
METHODS: Daily data on mortality, meteorological factors, and air pollution were collected from 757 locations across 46 countries or regions. Data on individual chemicals (ie, benzene, toluene, xylenes [summation of ethylbenzene, m-xylene, p-xylene, and o-xylene]) and the aggregate mixture (ie, BTEX) were estimated using a chemistry-climate model. We examined the short-term associations of each individual chemical as well as the BTEX mixture with daily total, cardiovascular, and respiratory mortality in a multicountry framework. Using a two-stage time-series design, we first applied generalised additive models with a quasi-Poisson distribution to obtain location-specific associations, which were subsequently pooled using random-effects meta-analysis. Two-pollutant models were used to assess the independent effects of BTEX after adjusting for co-pollutants (PM2⋅5, PM10, nitrogen dioxide, sulphur dioxide, ozone, and carbon monoxide). Additionally, we assessed the overall exposure-response curves with spline terms.
FINDINGS: An IQR increment of BTEX concentration on lag 0-2 days (3-day moving average of the present day and the previous 2 days) was associated with increases of 0⋅57% (95% CI 0⋅49-0⋅65), 0⋅42% (0⋅30-0⋅54), and 0⋅68% (0⋅50-0⋅86) in total, cardiovascular, and respiratory mortality, respectively. The corresponding effect estimates for an IQR increment in individual chemicals (benzene, toluene, and xylenes) were 0⋅38-0⋅61%, 0⋅44-0⋅70%, and 0⋅41-0⋅65%, respectively. The associations remained significant after adjusting for co-pollutants, with a general decline in magnitude, except for a slight increase after adjustment for ozone. The shape of the exposure-response curves for all pollutants and causes of death was almost linear, with steeper slopes at low concentrations and no discernible thresholds.
INTERPRETATION: This global study provides novel evidence linking short-term exposure to ambient BTEX, both individually and as a mixture, with increased daily total, cardiovascular, and respiratory mortality. Our findings underscore the need for comprehensive air pollution mitigation policies, including stringent controls on BTEX emissions, to protect public health.
FUNDING: Noncommunicable Chronic Diseases-National Science and Technology Major Project, National Natural Science Foundation of China, Shanghai Municipal Science and Technology Major Project, Shanghai B&R Joint Laboratory Project, and Shanghai International Science and Technology Partnership Project
Dynamic Landscape of Mpox Importation Risks Driven by Heavy-Tailed Sexual Contact Networks Among Men Who Have Sex With Men in 2022.
Get PDFBACKGROUND: During the 2022 global mpox outbreak, the cumulative number of countries reporting their first imported case quickly rose in the early phase, but the importation rate subsequently slowed down, leaving many countries reporting no cases by the 2022 year-end.
METHODS: We developed a mathematical model of international dissemination of mpox infections incorporating sexual networks and global mobility data. We used this model to characterize the mpox importation patterns observed in 2022 and to discuss the potential of further international spread.
RESULTS: Our proposed model better explained the observed importation patterns than models not assuming heterogeneity in sexual contacts. Estimated importation hazards decreased in most countries, surpassing the global case count decline, suggesting a reduced per-case risk of importation. We assessed each country's potential to export mpox cases until the end of an epidemic, identifying countries capable of contributing to the future international spread.
CONCLUSIONS: The accumulation of immunity among high-risk individuals over highly heterogeneous sexual networks may have contributed to the slowdown in the rate of mpox importations. Nevertheless, the existence of countries with the potential to contribute to the global spread of mpox highlights the importance of equitable resource access to prevent the global resurgence of mpox
Development of a Health-State Classification System for the Pediatric Quality-of-Life Inventory Version 4.0 Generic Core Scales for Preference-Based Valuation in Australia.
Get PDFOBJECTIVES: Pediatric Quality-of-Life Inventory Version 4.0 Generic Core Scales (PedsQL GCS), comprising 23 items covering 4 subscales (physical, emotional, social, and school functioning), is a widely applied generic measure of childhood health-related quality of life but does not provide health utilities for cost-effectiveness-based decision making. This study aimed to develop a reduced item version of PedsQL GCS amenable to health utility derivation in Australia.
METHODS: Data sources were 2 cohorts of the Longitudinal Study of Australian Children, including proxy responses for all PedsQL GCS versions (Toddlers, Young Children, Children, and Teens), and the CheckPoint sample containing child self-report to the Children version. Three analytic samples were CheckPoint sample (n = 1874); Mallinson sample containing 1 measurement per child from one of the Young Children, Children, or Teens versions (n = 7855); and Toddlers sample (n = 7401). Exploratory and confirmatory factor analyses assessed dimensionality. Psychometric analyses used Rasch and classical criteria on 3 randomly selected subsamples (n = 500) per sample. Item selection prioritized psychometric performance in the CheckPoint sample, also considering performance in other samples and conceptual content.
RESULTS: Dimensionality assessments did not generate an alternative empirical structure for the measure, and psychometric analyses were conducted on the original 4 subscales. The selected items were: "Get aches and pains" for physical functioning; "Feel sad/blue" for emotional functioning; "Other kids not friends" for social functioning; and "Keeping up with school work" for school functioning.
CONCLUSIONS: The final 4-item set, pending further psychometric validation and valuation, can generate health utilities from the widely used PedsQL GCS to inform cost-effectiveness-based decision making
Community perspectives on drug promotion on social media during the COVID-19 pandemic in KwaZulu-Natal, South Africa.
Get PDFBackgroundDuring the COVID-19 pandemic, social media and web-based platforms were widely used to promote medicinal substances. To assess community perspectives on drug promotions on social media, we conducted qualitative research using three workshops. The workshops aimed to highlight the public understanding of drug advertising focusing on community perceptions of social media drug promotions, their risks and benefits. Discussions were conducted on the importance of adhering to national drug regulation policies and the World Health Organisation ethical criteria for promotion, advertisement, and publicity of medicines.MethodsParticipants for the workshops were purposively sampled from local community youth groups and healthcare facilities. Two workshops included ten young adults aged 18-35, while the third workshop involved three healthcare professionals and one traditional healer.ResultsThe study participants' highlighted the value of honesty and trust in the drug promotions. Gaps in the ethical conduct of advertising were observed and concerns were raised about the reliability of social media information and the omission of valuable details on the drug advertisements.ConclusionIndividuals have a right to informed choices that ensure their health safety. This study has highlighted the need for transparency and accountability in pharmaceutical and complementary medicine marketing on social media. Collaboration is needed between regulatory bodies, pharmaceutical companies, healthcare providers and community members, to make sure that drug advertising upholds ethical standards and public health
Disability Inclusive Youth (DIY) Research: an innovative and co-creative study to improve inclusion of children and youth with disabilities in health research in East Africa: a mixed-method study protocol
Get PDFYoung people with disabilities are rarely included in research, yet 75% of the East African population is under 30 years old and an estimated 15% have a disability. Without including young persons with disabilities in designing and implementing health research, we will not achieve global development goals. The aim of Disability Inclusive Youth (DIY) study is to explore barriers and facilitators to inclusion of children and youth with disabilities in health research, co-create solutions to make health research in East Africa disability inclusive, and create a disability knowledge and research centre to inform and support inclusive health research in the region. The DIY study will develop a novel participatory approach to enhance the inclusion of children and youth with disabilities in health research in East Africa. We will build capacity of 12 youth with disabilities from Uganda, Kenya, and Rwanda through a research training programme. The youth researchers will conduct interviews with 75 leading health researchers, 30 key health stakeholders, and 60 children and youth with disabilities and their caregivers. Together with the youth we will design recommendations to make health research more inclusive of children and youth with disabilities through participatory workshops. At the end of the study we will have established a regional knowledge and research centre where children and youth with disabilities contribute to and health researchers consult about disability inclusive health research. Data collection methods include survey questionnaires, in-depth interviews, case studies, video and photovoice. Data will be analysed qualitatively using a thematic approach in NVIVO and quantitatively using STATA. This is a 5 year study funded by Wellcome, through the London School of Hygiene and Tropical Medicine, in partnership with the MRC/UVRI & LSHTM Uganda Research Unit, the University of Nairobi and the University of Rwanda / Lifetime Research Group
Coronary Heart Disease Attributable to Psychosocial Stressors at Work
Get PDFBackground: Psychosocial stressors at work, including job strain and effort-reward imbalance (ERI), have been associated with an increased risk of coronary heart disease (CHD). However, the proportion of CHD events attributable to these exposures has not been quantified in a prospective cohort study.
Objectives: The purpose of this study was to estimate the fraction of CHD events attributable to psychosocial stressors at work in a 20-year prospective cohort study.
Methods: This prospective cohort study included employees from public and semipublic organizations in Quebec City, Canada, followed from 2004 and 2018. A total of 6,295 participants without cardiovascular disease at baseline were included. Job strain and ERI were assessed using validated instruments. Incident CHD events were identified through universally covered health care databases. Attributable fractions were estimated using the Kaplan-Meier method. Multiple imputation and inverse probability weighting were applied to address selection and confounding. The first 5 years of follow-up were excluded to minimize reverse causation.
Results: During 15-year follow-up, 669 CHD events occurred over 112,297 person-years, yielding a CHD incidence rate of 5.96 per 1,000 person-years. The attributable fraction for job strain was 18.2% (95% CI: 1.8%-34.7%), and for ERI, it was 3.3% (95% CI: −1.6% to 8.2%). Combined exposure to both stressors resulted in an attributable fraction of 19.5% (95% CI: 0.7%-38.4%).
Conclusions: In this cohort, combined exposure to job strain and ERI accounted for approximately one-fifth of CHD events. Findings suggest that psychosocial stressors at work could be relevant targets for reducing the burden of CHD through prevention strategies
The role and functions of community-based multidisciplinary teams in two integrated care and support Pioneers: Perspectives from local system leaders.
Get PDFObjectivesCentral government has been promoting closer integration between the National Health Service (NHS) and local government social services in England for more than five decades. Improved coordination between primary, hospital, community health and social services has been advocated as a cost-effective response to growing care needs in an ageing population. This paper concentrates on one of the principal local care coordination mechanisms: community-based multidisciplinary teams (MDTs) involving NHS and social services staff. It reports local leaders' perceptions of MDTs' current and future contributions to more coordinated care and support systems in two integrated care Pioneer sites.MethodsThirty-two qualitative semi-structured interviews with 25 local system leaders and operational managers in two contrasting Integrated Care and Support Pioneer areas were conducted between October 2018 and April 2021, as part of a wider evaluation of the Integrated Care and Support Pioneer Programme. Eight of those interviews took place after the start of the COVID-19 pandemic and between lockdowns. Interviews were analysed thematically.ResultsLocal leaders in both areas broadly shared a vision of integrated care in which MDTs were essential mechanisms for coordinating improvements in health and wellbeing, especially for older people who are frail, experience falls and have long-term health conditions. Organisational differences between and within sites influenced local decisions about the purpose and structure of MDTs, but, despite such variations, interviewees identified similar challenges to implementation. Staff turnover, often linked to funding uncertainties, and the lack of shared information systems, were among the most frequent operational challenges noted. System leaders valued national policy frameworks as potential enablers of integrated care but also recognised the role of local contexts in shaping local implementation decisions. Interviewees highlighted benefits emerging from multidisciplinary working, including its potential to deliver more holistic care, fewer instances of work duplication, speedier access to care and enhanced home care provision. However, they were concerned such benefits were not always captured by commonly used performance indicators and thus the value of MDTs could be under-estimated.ConclusionsLocal contextual variables and local understandings of these variables appeared to be the main influences on variations in local responses to national expectations of improvements in care integration. Local leaders in both areas broadly shared a vision of integrated care in which MDTs provided essential mechanisms for securing interdependent improvements in both the health and wellbeing of local populations and improvements in workforce job satisfaction
Visual diagnostics for female genital schistosomiasis and the opportunity for improvement using computer vision.
Get PDFFemale genital schistosomiasis (FGS) is a chronically disabling gynaecological condition, impacting up to 56 million women and girls, mostly in sub-Saharan Africa. In lieu of a gold standard laboratory test, it is possible to diagnose FGS visually. Visual diagnosis is performed through inspection of the cervix and surrounding tissue to identify signs of Schistosoma egg deposition, associated inflammation and granuloma formation. The change related to egg deposition can be very subtle and heterogeneous and is often seen in the context of other altered cervical morphology. Visual diagnostics for FGS are therefore currently highly subjective and lack specificity, with low consistency of grading between trained expert reviewers. Computer vision, driven by artificial intelligence, is an enticing prospect to overcome these issues due to the potential to accurately detect and classify the subtle changes and patterns that are indiscernible to human graders. Computer vision also offers the opportunity to support resource-constrained regions with few staff trained on visual diagnostics. However, several challenges stand in the way of progressing and successfully implementing computer vision tools for FGS. These challenges are particularly related to the variation in the appearance of the cervix (with or without disease) and FGS lesions, as well as the difficulty with accurately labelling cervical images. Exploring alternative annotation methods and model architectures is likely to improve the performance of FGS computer vision tools. This paper will explore the challenges of FGS computer vision and provide suggestions on how to overcome these barriers to enhance visual diagnostics for FGS
Diagnostic Performance of Unattended Automated Office Blood Pressure Measurement for Hypertension Screening Among People With and Without HIV.
Get PDFBACKGROUND: The diagnostic performance of automated office blood pressure (AOBP) in screening for hypertension in people with HIV (PWH) is not known. METHODS: We conducted a cross-sectional analysis of baseline data from PWH and people without HIV (PWoH) from the Mwanza HIV&CVD cohort study. We conducted unattended AOBP and 24-hour ambulatory BP monitoring as recommended by international guidelines. Using average 24-hour BP as the reference standard, we estimated the prevalence of hypertensive diagnostic phenotypes and calculated measures of diagnostic performance at different diagnostic cutoffs in participants. RESULTS: We included 959 participants (50.4% PWH and 49.6% PWoH). Characteristics were similar across participant groups. The median age was 44 years (interquartile range, 38-50 years), and 69.8% were women. Overall prevalence of hypertension, based on average 24-hour ambulatory BP monitoring, was 35.3% using European Society of Hypertension cutoffs and did not differ by HIV infection status. Masked hypertension was present in 25.7% (95% CI, 22.0%-29.8%) of PWH and 26.7% (95% CI, 22.9%-30.8%) of PWoH. The sensitivity of unattended AOBP was 25.7% for PWH (95% CI, 19.3%-33.1%) and 25.7% for PWoH (95% CI, 19.4%-33.0%) with little difference in the area under the receiver-operating curve by HIV infection status. Based on 24-hour BP averages, 24.2% of PWH and 21.6% of PWoH had isolated nocturnal hypertension. CONCLUSIONS: More than half of individuals with hypertension on ambulatory BP monitoring, irrespective of their HIV infection status, may be misdiagnosed if unattended AOBP alone is used to screen for hypertension in sub-Saharan Africa