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Heavy metal contamination in unrecorded rakia from Kosovo and its public health implications.
Get PDFExcessive alcohol consumption poses a challenge to public health across Europe, but especially in the Balkan region, where alcohol from unrecorded sources, particularly home-distilled rakia, is widely consumed. Our previous research identified elevated lead and copper levels in rakia from these sources collected in Albania. However, due to its disputed political status and absence from many international health surveys, data on the composition of home-made rakia from Kosovo remains scarce. To address this knowledge gap, we report an analysis of 30 rakia samples from unrecorded sources collected in Kosovo, measuring 24 elements, including toxic metals, using inductively coupled plasma optical emission spectrometry. The ethanol concentration of the samples was determined by gas chromatography/mass spectrometry. In addition, we have applied the target hazard quotient and the margin of exposure (MOE) methods to assess the associated health risks. We find that the threshold limits of copper, iron, nickel, and lead have been exceeded in 96.7%, 3.3%, 3.3% and 26.7% of rakia samples, respectively. The health risk assessment showed that the MOE value of lead for both average and heavy drinkers was less than 100 when consuming unrecorded rakia, indicating potential for adverse health effects. Along with previous research, these findings highlight the need for targeted public health research in the Balkan region to better understand the impact of unrecorded alcohol on disease burden and mortality and how to develop policies that strengthen enforcement of trading standards
Diagnostic accuracy of the WHO clinical staging system for detection of immunologically defined advanced HIV disease: A systematic review and meta-analysis.
Get PDFINTRODUCTION: People with advanced HIV disease face high risks of severe illness and death. CD4 testing enables timely diagnosis and appropriate care, yet access remains limited in many settings. This review investigated the diagnostic accuracy of the WHO clinical staging for identifying advanced HIV disease. METHODS: We conducted a systematic review and meta-analysis of studies published between 1 January 1998 and 1 May 2024 that assessed both WHO clinical staging and CD4 counts in people living with HIV aged 5 years and older (PROSPERO: CRD42024558372). We pooled sensitivity and specificity estimates of WHO Stage 3/4 for detecting advanced HIV disease (CD4 <200 cells/μL) using bivariate random-effects meta-analysis. Risk of bias was assessed using QUADAS-2, and certainty of evidence was appraised using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). RESULTS: Of 15,194 studies screened, 335 relevant studies were identified, from which 25 were included in evidence synthesis and 21 in the meta-analysis. Most studies were from the WHO African (19/25) and South-East Asian (5/25) regions. Risk of bias was moderate to high in 88% of studies, primarily due to issues with clinical staging assessment. Pooled sensitivity and specificity of WHO Stage 3/4 were 60.7% (95% CI: 48.0%-72.1%) and 72.4% (95% CI: 61.4%-81.3%), respectively. Specificity was significantly higher outside the African region (p < 0.001). In a population of 100,000 people living with HIV with 30% advanced HIV disease prevalence, WHO staging would miss 11,700 true advanced HIV disease cases and misclassify 19,600. CONCLUSIONS: WHO clinical staging alone shows low accuracy for detecting advanced HIV disease, risking both missed diagnoses and overtreatment. CD4 testing remains essential for accurately identifying and managing advanced HIV disease
Serological assessment of pediatric parasite exposure in two Senegalese districts using multiplex serology.
Get PDFAlthough pediatric parasitic diseases cause significant morbidity and mortality in regions with high rates of co-infection, this overlap may offer opportunities for integrated control strategies. This study aimed at a serological assessment of exposure to multiple parasitic infections among children aged 1-14 years in two Senegalese districts, Saraya (Kédougou Region) and Diourbel (Diourbel Region), to inform integrated control strategies. We analysed 883 dried blood spot samples. A multiplex bead-based immunoassay quantified IgG antibody against Plasmodium falciparum, helminths (Necator americanus, Schistosoma mansoni, Strongyloides stercoralis, Taenia solium), and intestinal protozoa (Cryptosporidium parvum, Giardia duodenalis) as proxies for single- and multiple-pathogen exposure. Multivariable logistic regression identified risk factors for seropositivity. Recent malaria exposure was identified in 11% of children, while 42% showed evidence of historical exposure. Helminth seroprevalence ranged between 0.1% and 7.2%, whereas Cryptosporidium parvum and Giardia duodenalis seroprevalence values were 19.0% and 7.4%, respectively. Co-exposures to malaria and other parasites ranged from 9.4% to 18.0%. School-aged children exhibited higher seroprevalence rates for historical exposure to P. falciparum and S. stercoralis compared to pre-school children, while G. duodenalis was more seroprevalent in pre-school children. Saraya exhibited higher seroprevalence for historical P. falciparum and G. duodenalis exposure. Rare/never handwashing before meals, shorter travel time to a water source (< 10 min, likely reflecting residence near shared or surface water rather than improved household taps), and frequent contact with any waterbodies (daily/weekly) were associated with higher odds of parasite seropositivity. While seasonal malaria chemoprevention appears suitable, the low helminth seroprevalence coupled with substantial protozoan exposure suggests that current integrated interventions may require re-evaluation and enhancement
Factors associated with symptom-to-surgery time in patients undergoing surgical repair for acute type A aortic dissection: an exploratory analysis from a prospective cohort study.
Get PDFOBJECTIVES: The primary objective of this study was to investigate perioperative factors associated with symptom-to-surgery (STS) time in patients diagnosed with hyper-acute aortic dissection (AAD). The secondary objective was to develop a causal model to understand the relationship between STS times and hospital mortality in this population. DESIGN: Prospective cohort study. SETTING: Exploratory analysis of a national audit conducted by the Association of Cardiothoracic Anaesthesia and Critical Care. PARTICIPANTS: From a total of 270 participants diagnosed with AAD with an STS time <72 hours, 218 were included in the multivariate analysis, after excluding 52 participants with missing covariates. MAIN OUTCOME MEASURES: STS time, measured in hours. Hospital mortality at 30 days. RESULTS: In the multivariate analysis, mean STS time for misdiagnosed patients was nearly twice as high when compared with patients who initially had the correct diagnosis (estimated proportion of change=1.9, 95% CI 1.5 to 2.3, p<0.001). STS time decreased when patients were accompanied by a medical doctor in the ambulance transfer, had mean arterial blood pressure below 70 mm Hg or presented to the emergency department (ED) with a Glasgow Coma Scale (GCS) <15. Estimated ED-to-surgery (ETS) times were 1.8 hours longer for women than for men (10.5 hours, 95% CI 9.0 to 12.0 hours vs 8.7 hours, 95% CI 7.8 to 9.6 hours). From a total of 334 patients, 64 (19.2%) died. Mortality was higher in older patients and when STS time was ≥6 and <24 hours, compared with STS time <6 hours. CONCLUSIONS: Potentially modifiable factors that may reduce STS times include avoidance of misdiagnosis and provision of a medical doctor for the ambulance transfer. Younger women had longer STS and ETS times, but further research is warranted to investigate the impact of age and sex on these times. The relationship between STS time and hospital mortality among these patients remains unclear
Effect of a novel house (star home) and toilet design on domestic fly densities in rural Tanzania.
Get PDFBACKGROUND: Diarrhoeal disease is the third leading cause of death in children under 5 years old with domestic flies acting as important mechanical vectors of diarrhoeal pathogens. To assess the effectiveness of a novel house design, "Star home", and improved toilets in reducing the abundance of domestic flies, potential carriers of diarrhoeal pathogens, a randomized controlled trial was carried out in rural Tanzania. METHODS: Domestic fly populations were monitored in 28 randomly selected Star homes and 28 traditional thatched roofs and mud-walled houses over 2 years from January 2022 to December 2023. Flies were sampled in kitchens and toilets using baited-fly traps from 07.00 h to 17.30 h every 7 weeks. To assess the production of flies from toilets, traps were placed over drop holes to collect emerging flies. Duration of external door openings to the kitchens was recorded with data loggers. FINDINGS: Of the 1527 flies collected, 76% were Chrysomya putoria, 16% Musca domestica and 8% Sarcophaga spp. In kitchen collections, there were 46% fewer C. putoria flies [adjusted mean rate ratio (RR) = 0.54] and 69% fewer Sarcophaga spp. (RR = 0.31) in Star homes compared to traditional houses. There was no difference in the abundance of M. domestica in the two study groups. In toilets, there was 49% fewer C. putoria (RR = 0.51), but no difference was observed for other domestic fly species. No flies emerged from Star home toilets compared with a mean of 4.2 flies/trap/day in traditional toilets. During the day, the external doors od Star homes were open for an average of 13.0 min/h less than in traditional houses. CONCLUSIONS: Star homes reduced the abundance of domestic flies, apart from houseflies, in the kitchen and there were fewer C. putoria, a putative vector of diarrhoeal diseases, in Star home toilets compared to traditional houses. Changing the design of buildings can contribute to a decline in domestic flies and may lead to a reduction in diarrhoeal diseases
Associations between cancer survivorship and subsequent respiratory disease: a systematic literature review.
Get PDFBACKGROUND: The population of cancer survivors is growing. Some cancers and their treatments may lead to long-term adverse respiratory issues. This systematic review aims to summarise the evidence on the association between cancer survivorship and long-term respiratory health, across a range of cancer types. METHODS: We searched Cochrane, Embase and MEDLINE up until 23 February 2025 for cohort or nested case-control studies comparing incident respiratory outcomes in people with a history of cancer versus population-based cancer-free controls. We required studies to include follow-up time beyond the period of active cancer treatment. Outcomes included acute respiratory infections and chronic respiratory conditions. Study quality was assessed using The Scottish Intercollegiate Guidelines Network methodology checklists. RESULTS: We identified 34 eligible cohort studies. Cancer survivors' cohort sizes ranged from 1325 to >8 million. Only 4 out of 34 studies adjusted for smoking, leading to most studies being rated as low quality. Four of the 21 studies of acute respiratory infections were rated as acceptable/high quality, and of these, all observed raised risks, notably among survivors of haematological, head and neck, lung and oesophageal cancers. Of 19 studies of chronic respiratory conditions, 1 was rated as high quality, finding increased risks of chronic obstructive pulmonary disease (COPD) and pneumonitis in survivors of head and neck cancer. The remaining studies found increased risks of adverse outcomes from acute respiratory infections in 17 of 21 cancer types for which data were available, and of COPD in cervical, head and neck, lung, oesophageal, oral, stomach, thyroid and vulva cancers. DISCUSSION: These findings suggest increased risks of a range of respiratory conditions in survivors of some cancers. Much of the evidence is compromised by a lack of control for key potential confounders, like smoking. Future studies should address this limitation and investigate the drivers of respiratory risks in cancer survivors. Improved evidence could inform mitigation strategies and lead to better survivorship care plans. PROSPERO REGISTRATION NUMBER: CRD42022311557
The PAICE project: Integrating health and health equity into UK climate change policy
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This paper announces a new initiative - the research project
Policy and Implementation for Climate & Health Equity
(PAICE), which aims to investigate the complex systemic connections between climate change action, health and health equity, for translation of evidence into policy and practice in the UK. Using transdisciplinary approaches, PAICE will: (1) co-develop a programme theory and linked monitoring and evaluation plan, (2) work with the UK Climate Change Committee (CCC) and the Greater London Authority (GLA) using system dynamics to analyse national and local policy opportunities, (3) build an integrated model of the effects of these policies on population health, health equity and greenhouse gas emissions, (4) apply the findings to the CCC monitoring framework and GLA policy development, and (5) use the programme theory to help evaluate achievement of PAICE processes and objectives. If successful, PAICE will have helped to establish a systems capability to (i) monitor whether Government plans are on track to deliver their climate targets and associated health impacts and (ii) understand how relevant policy and implementation approaches could be enhanced.
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Trends in the shortfall of English NHS general practice doctors: repeat cross sectional study.
Get PDFOBJECTIVES: To compare the numbers and characteristics of English general practitioner doctors (GPs) across publicly available data sources, and to examine trends in GP numbers relative to population growth and the specialist medical workforce in England. DESIGN: Repeat cross sectional study. SETTING: Three national data sources, England, 2012-24: General Medical Council (GMC) GP and specialist registers; NHS England GP Performers List; and NHS England's General Practice Workforce and NHS Workforce Statistics datasets. PARTICIPANTS: All GMC licensed, fully qualified GPs in England. MAIN OUTCOME MEASURES: Differences over time in total numbers and GP characteristics. Changes in the difference between GMC and NHS general practice GP numbers and characteristics, and analysis of trends relative to population size and equivalent data on specialist doctors. RESULTS: As of 31 December 2024, 58 548 GPs were listed on the GMC GP register, 55 958 on the Performers List, but only 38 626 by headcount and 28 197 by full time equivalent GPs in NHS general practice. Between 2015 and 2024, on average, for every five additional GPs licensed by the GMC, NHS general practice lost one full time equivalent GP each year. As a result, the proportion of GMC licensed GPs not working in NHS general practice increased from 27% (13 492) in 2015 to 34% (19 922) in 2024 by headcount and from 41% (20 210) to 52% (30 351) by full time equivalent GPs. Differences were greatest among female GPs, younger GPs, UK qualified GPs, and GPs in London and the South East of England. In contrast, between 2015 and 2024, for every five additional GMC licensed specialist doctors, the NHS gained 4.3 full time equivalent consultants. Taking population growth into account, the number of NHS patients for each full time equivalent GP in NHS general practice increased by15%, whereas the number of patients for each full time equivalent NHS consultant fell by 18%. By the end of 2024, there were twice as many NHS patients for each full time equivalent NHS general practice GP (2260) than for each full time equivalent NHS consultant (1092). CONCLUSION: The growing difference between GMC licensed GPs and those working in NHS general practice is in contrast with trends among specialists. This shift is occurring despite rising patient demand and policy commitments to strengthen primary care. Addressing the underlying reasons for workforce attrition in NHS general practice is critical to achieving the government's stated goals of strengthening community based care and shifting the focus of care from treatment to prevention
A Delphi process to build consensus on revised Emergency Obstetric and Newborn Care (EmONC) signal functions and levels of care.
Get PDFThe emergency obstetric care (EmOC) monitoring framework has been used for decades to monitor the availability and use of EmOC services in low- and middle-income countries (LMICs). EmOC monitoring is based around eight signal functions, a shortlist of key clinical interventions capable of averting deaths from the main direct causes of maternal mortality, categorised between two levels of care: basic and comprehensive, with a newborn resuscitation signal function added in 2009. The Re-Visioning Emergency Obstetric and Newborn Care (EmONC) Project (2020-2024) aimed to update the EmOC approach to reflect new knowledge in maternal and newborn health (MNH), and to expand the scope of the original EmOC monitoring framework. The project used technical workstreams and workshops to arrive at new proposals. This paper reports on the approach used to build consensus on a revised set of EmONC signal functions and levels of care. Using a three-round online Delphi approach, consensus (≥85%) was sought from a diverse panel of global MNH experts on EmONC signal functions and their placement at different levels of care, based on existing evidence-based guidelines. The process was iterative, each round building on the previous, and embedded in the wider Re-Visioning EmONC project; the output from each round involved coordination of inputs from multiple tiers of technical experts, including UN agencies, via technical expert groups, workstreams and workshops. The Delphi study recruited 113 experts in MNH from a range of geographic and economic settings, specialities and professions, including clinical, academic and programme expertise. The output from the three rounds included substantial convergence, resulting in set of 25 signal functions (11 obstetric, 13 neonatal and 1 referral) that reflect the spectrum of EmONC required for women and newborns. The revised EmONC signal functions are intended as a simple approach to allow health system managers to visualise their EmONC services, and as a means to hold health systems accountable to provide the main interventions to avert preventable maternal and newborn morbidity and mortality, and stillbirths
Digital-based physical activity interventions implemented across the League of Arab States: a scoping review.
Get PDFThis scoping review investigates the use and impact of digital-based physical activity (PA) interventions in Arabic-speaking countries. These technologies have dramatically transformed healthcare management and offer a valuable tool for managing non-communicable diseases. Despite challenges such as limited healthcare access and cultural norms, these tools enable health promotion, preventive care, and personalized health plans. The aim of this scoping review is to evaluate the effectiveness of digital-based PA interventions, such as mobile apps, used across the League of Arab States. PRISMA-ScR guidelines were applied to conduct this scoping review across 10 databases using pertinent search terms for relevant studies published between 2010 and December 2024 to identify publications conducted across Arab countries. Sixteen studies on digital-based PA interventions in four Arab countries were analyzed. The most effective interventions blended various digital and educational strategies, leading to significant increases in PA levels and associated anthropometric outcomes. Despite promising results, there was no evidence that the interventions' effects were sustained over the long term, and the studies' geographical coverage was limited, emphasizing the need for larger-scale, diverse studies to assess long-term effectiveness of digital-based PA interventions