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Glucose Control, Sulfonylureas, and Insulin Treatment in Older Adults With Type 2 Diabetes and Risk of Falls and Fractures: An Observational Study.
Get PDFOBJECTIVE: To estimate the association among glucose control, sulfonylureas, and insulin treatment with the risk of hospitalization for falls and fractures in older adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: This observational cohort study used U.K. Clinical Practice Research Datalink GOLD data linked to hospital and death records. Older adults (≥70 years) with T2D, identified between 2000 and 2017, were considered exposed if they had three consecutive HbA1c measurements <7% (53 mmol/mol) while receiving treatment with insulin or sulfonylureas. Each exposed individual was matched with to three nonexposed individuals. Outcomes included hospitalizations for falls and fractures. Flexible parametric survival models, adjusted for sociodemographic and clinical factors, and associated estimated relative (hazard ratio [HR]) and absolute risks. RESULTS: Among 21,365 individuals (n = 5,833 [27.3%] in the exposed group), the adjusted relative risks of hospitalization for falls and fractures were marginally higher compared with those nonexposed (HR 1.04 [95% CI 0.96-1.11] and 1.07 [95% CI 0.97-1.17], respectively). The 10-year absolute risk values of hospitalization for falls were slightly higher in the exposed (range 15.6-36.8% in those aged 70-85 years) than nonexposed (15.1-36.0%) individuals. Absolute risk differences remained minimal (0.2-0.6% at 5 years and 0.5-0.8% at 10 years). CONCLUSIONS: We found no evidence of an association between sustained HbA1c <7% while receiving insulin or sulfonylurea therapy and clinically meaningful increased risks of falls or fractures in older adults with T2D. Clinicians should continue to balance the benefits of glycemic control with the risks of complications in older adults
Prevalence and risk factors for oral human papillomavirus and Epstein-Barr virus co-infections among sexually active males and females in Ibadan, Nigeria
Get PDFBACKGROUND: Co-infection of Human papillomavirus (HPV) and Epstein-Barr virus (EBV) is associated with oral and oropharyngeal cancers. This study examined the prevalence and associated risk factors for oral HPV and EBV co-infection among sexually active individuals in Nigeria.
METHODS: This was a secondary analysis of oral samples of some selected participants in the Sexual Behaviour and HPV Infection in Nigerians in Ibadan (SHINI) study. Stored oral samples were analysed for detection of EBV DNA using real-time PCR detection and quantification kits. The socio-demographic characteristics, lifestyle and sexual behaviours, and biological characteristics, including the HPV genotype results, were retrieved from the SHINI study data. The association between oral HPV and EBV co-infection and selected participants' characteristics were examined with chi-square or Fisher exact tests. Unadjusted logistic regression and multivariable hierarchical logistic regressions were performed to identify the significant risk factors with HPV and EBV co-infection. Statistical significance was set at p < 0.05.
RESULTS: In total, 104 oral samples were analysed. The prevalence of oral HPV and EBV co-infection was 26.9%. Half (50%) of these participants were positive for EBV, and 45.2% were positive for oral HPV only. Nearly all participants with oral HPV and EBV co-infection were females (96.4%). Sex (p = 0.008), anal HPV infection (p < 0.001), genital HPV (p = 0.002), and HIV status (p = 0.004) were significantly associated with the co-infection. The odds of oral HPV and EBV co-infection was lower among males [ aOR = 0.11, 95% CI: 0.00-14.51].
CONCLUSION: There is high prevalence of oral HPV and EBV co-infection in males and females in Nigeria, with HIV status identified as a significant risk factor. Targeted public health measures, such as HPV vaccination programs especially in high-risk groups are recommended to reduce the burden of oral HPV and EBV co-infection
The relationship between leisure time physical activity patterns, Alzheimer's disease markers and cognition.
Get PDFWe assessed the association between leisure time physical activity patterns across 30 years of adulthood with a range of in vivo Alzheimer's disease-related neurodegenerative markers and cognition, and their interplay, at age 70. Participants from the 1946 British birth cohort study prospectively reported leisure time physical activity five times between ages 36 and 69 and were dichotomized into (i) not active (no participation/month) and (ii) active (participated once or more/month) and further derived into: (0) never active (not active); (1) active before 50's only (≤43 years); (2) active from 50's onwards only (≥53 years); (3) always active (active throughout). Participants underwent 18F-florbetapir Aβ and magnetic resonance imaging at age 70. Regression analyses were conducted to assess the direct and the moderating relationship between leisure time physical activity metrics, Alzheimer's disease-related neurodegeneration markers (including Aβ status, hippocampal and whole-brain volume, and cortical thickness in Alzheimer's disease signature regions) and cognition. All models were adjusted for childhood cognition, education and childhood socioeconomic position, and examined by sex. Findings drawn from 468 participants (49% female) demonstrated a direct association between being active before 50 years old (≤43 years) and throughout life (up to age 69 years), with larger hippocampal volume at age 70 (P 0.05). However, leisure time physical activity patterns modified and attenuated the association between poorer cognitive functioning at age 70 and a range of Alzheimer's disease-related neurodegenerative markers (Aβ status; hippocampal and whole-brain volume; cortical thickness in Alzheimer's disease regions) (all P < 0.05). We found suggestive evidence that women with early markers of Alzheimer's disease-related neurodegeneration were most sensitive to leisure time physical activity patterns: a lifetime of inactivity in women exacerbated the manifestation of early Alzheimer's disease markers (Aβ and cortical thickness-related cognition), yet, if women were active across life or early in life, it mostly buffered these negative relationships. Engagement in leisure time physical activity in the life course is associated with better cognitive functioning at age 70, even in those with early markers of Alzheimer's disease. If causal, this is likely via multiple pathways, potentially through the preservation of hippocampal volume, as well as via cognitive resilience pathways delaying cognitive manifestations of early markers of Alzheimer's disease, particularly in women. Our findings warrant further research to shed light on the mechanisms of physical activity as a potential disease-modifying intervention of brain health and cognitive resilience
Evaluating the effectiveness of dengue surveillance in the tropical and sub-tropical Asian nations through dengue case data from travelers returning to the five Western Pacific countries and territories.
Get PDFINTRODUCTION: Dengue, affecting over 3.9 billion people, is a significant health threat globally. Despite a tenfold increase in reported cases from 2000 to 2020, underreporting remains an issue. Our study utilized traveler data from the five Western Pacific countries and territories as sentinel sites, to examine dengue surveillance in Southeast and South Asia. METHODS: We reported dengue cases among returning travelers (2010-2018) and computed dengue incidence per 100,000 travelers for each destination country. We compared officially reported dengue incidence per 100,000 inhabitants of the destination country with estimated incidence per 100,000 travelers, using Pearson's correlation coefficient. RESULTS: Key findings revealed eight Southeast and South Asia countries as popular destinations for our sentinel sites, with Australia exhibiting the highest incidence (40.7 per 100,000 travelers). Dengue incidence variations were evident, with Malaysia showing a sharp increase over time. Correlation analysis showed strong links in Malaysia (r = 0.66-0.92) and weaker connections in India (r = -0.54-0.76) between dengue incidence among inhabitants and travelers. CONCLUSION: Systematically collected dengue surveillance data from returning travelers can serve as a proxy for dengue incidence in the destination country and can be used to assess the robustness of the country's dengue surveillance
Study protocol for an observational cohort study of heat stress impacts in pregnancy in The Gambia, West Africa [version 2; peer review: 2 approved, 1 approved with reservations]
Get PDFClimate change has resulted in an increase in heat exposure globally. There is strong evidence that this increased heat stress is associated with poor maternal and fetal outcomes, especially in vulnerable populations. However, there remains poor understanding of the biological pathways and mechanisms involved in the impact of heat in pregnancy. This observational cohort study of 764 pregnant participants based in sub-Saharan Africa, a geographical region at risk of extreme heat events, aims to evaluate the physiological and biochemical changes that occur in pregnancy due to heat stress. The key objectives of the study are to 1) map exposure to heat stress in the cohort and understand what environmental, social and community factors increase the risk of extreme heat exposure; 2) assess the impact of heat stress on maternal health, e.g. heat strain, subjective psychological well-being, sleep and activity level; 3) evaluate how heat stress impacts placenta structure and function; 4) determine how chronic heat exposure impacts birth outcomes; and 5) explore the epigenetic changes in the placenta and infant by heat stress exposure per trimester. Pregnant women will be recruited from two distinct regions in The Gambia to exploit the naturally occurring heat gradient across the country. Microclimate mapping of the area of recruitment will give detailed exposure measurements. Participants will be asked to wear a watch-style device at 28- and 35-weeks gestational age to evaluate maternal heart rate, activity and sleep. At the end of the week, an ultrasound scan will be performed to evaluate fetal size and placental blood flow. At delivery, birth outcomes will be recorded and maternal, placental and cord samples taken for epigenetic, biochemical and histological evaluation. Evaluation of neuro-behaviour and final infant samples will be taken at 1 month following birth
Healthcare payor management practices are associated with health system performance and population health.
Get PDFGood management practice has long been seen as critical to improving the performance, quality, and efficiency of healthcare systems. Better hospital management practice has been shown to correlate with improved clinical quality and performance. However, the association between the management practices of healthcare payors, the performance of the healthcare systems they oversee, and the health of their managed populations, has not been explored quantitatively. We collected data for all 152 healthcare payors and 53 million residents in England to explore the relationships between payor management practices and the performance of the healthcare system each payor managed. First, we found that better healthcare payor management practices are associated with improved health system performance in the domains of quality and value for money, and with improvements in the overall health and well-being of the managed population. Second, we found better payor management practice is associated with improvements in specific outcome metrics related to healthcare system effectiveness, safety, and value for money. Finally, we found no association between payor management practices and metrics for patient experience and access. These findings provide the first known quantitative evidence of a link between healthcare payor management practice and health system performance. They may also help both governments and payors themselves understand what healthcare system performance improvements might be possible from improving the management practices of healthcare payors
The anti-circumsporozoite antibody response to repeated, seasonal booster doses of the malaria vaccine RTS,S/AS01E.
Get PDFThe recently deployed RTS,S/AS01E malaria vaccine induces a strong antibody response to the circumsporozoite protein (CSP) on the surface of the Plasmodium falciparum sporozoite which is associated with protection. The anti-CSP antibody titre falls rapidly after primary vaccination, associated with a decline in efficacy, but the antibody titre and the protective response can be partially restored by a booster dose of vaccine, but this response is also transitory. In many malaria- endemic areas of Africa, children are at risk of malaria, including severe malaria, until they are five years of age or older and to sustain protection from malaria for this period by vaccination with RTS,S/AS01E, repeated booster doses of vaccine may be required. However, there is little information about the immune response to repeated booster doses of RTS,S/AS01E. In many malaria-endemic areas of Africa, the burden of malaria is largely restricted to the rainy season and, therefore, a recent trial conducted in Burkina Faso and Mali explored the impact of repeated annual booster doses of RTS,S/AS01E given immediately prior to the malaria transmission season until children reached the age of five years. Anti-CSP antibody titres were measured in sera obtained from a randomly selected subset of children enrolled in this trial collected before and one month after three priming and four annual booster doses of vaccine using the GSK ELISA developed at the University of Ghent and, in a subset of these samples, by a multiplex assay developed at the University of Oxford. Three priming doses of RTS,S/AS01E induced a strong anti-CSP antibody response (GMT 368.9 IU/mL). Subsequent annual, seasonal booster doses induced a strong, but lower, antibody response; the GMT after the fourth booster was 128.5 IU/mL. Children whose antibody response was in the upper and middle terciles post vaccination had a lower incidence of malaria during the following year than children in the lowest tercile. Results obtained with GSK ELISA and the Oxford Multiplex assay were strongly correlated (Pearson's correlation coefficient, r = 0.94; 95% CI, 0.93-0.95). Although anti-CSP antibody titres declined after repeated booster doses of RTS,S/AS01E a high, although declining, level of efficacy was sustained suggesting that there may have been changes in the characteristics of the anti-CSP antibody following repeated booster doses.Clinical Trials Registration. NCT03143218
Towards a net-zero healthcare system in Kenya: Stakeholder perspectives on opportunities, challenges and priorities.
Get PDFINTRODUCTION: Kenya's healthcare system committed to achieving net-zero greenhouse gas emissions by 2030 as part of the UNFCCC COP26 Health Program. To turn these ambitious commitments into outcomes and share learnings with other nations, a comprehensive assessment of the perspectives of key stakeholders likely to be involved in implementing the transition of the healthcare system is needed. METHODS: This study employs qualitative methods, including 21 semi-structured interviews with key stakeholders and a Delphi consensus process, to explore stakeholder perspectives on Kenya's journey to a net-zero healthcare system. RESULTS: Stakeholders identified and validated 14 process components crucial for this transformation, ranging from leadership and financing to behavioral change and monitoring. Critical barriers, such as infrastructure limitations, competing health priorities, financial constraints, and gaps in strategy coordination, were highlighted. Stakeholders ranked three interventions as the highest priority: implementing clean energy solutions in healthcare facilities, developing national sustainable healthcare policies that are informed by existing evidence on climate benefits, and generating localized data to guide actionable policies. Ranking interventions based on feasibility, however, produced different results that favored simpler, more immediately actionable measures like hospital vegetable gardens and the creation of guidelines for health facilities. CONCLUSION: While the transition to net-zero poses challenges, stakeholders expressed optimism about the potential of current strong leadership, strategic partnerships, and the growing momentum for action on climate change and health. This research provides actionable insights and recommendations to guide Kenya's transition to a sustainable, resilient healthcare system, while offering valuable lessons for other countries facing similar challenges
Inclusive policy development from the ground up: Insights from the household water-energy-food nexus
Get PDFDespite substantial contemporary research and a growing trend in exploring the water-energy-food (WEF) nexus, most research efforts have been invested in macro-level supply-side infrastructure and policies. However, prioritizing demand-side management policies can provide new opportunities and untapped potential for addressing interconnected resource challenges. Demand management inherently encompasses users’ consumption patterns, behaviors, socio-economic conditions, and choices, thereby necessitating active engagement and participation. Understanding household-level demands is fundamental to assess the demand for and consumption of water, energy, and food, as well as to inform policy decisions. In this context, our study investigated household consumption patterns within the interconnected WEF nexus, including daily practices such as cooking and washing, conservation measures, household governance, and their cross-cutting relationships with climate change. As a case study, we conducted our research in the Jabal Al Natheef neighborhood of Amman City, Jordan. Our findings reveal that households can propose and enact climate-friendly decisions. Significant gender-related differences were also observed in decisions made across WEF household practices. Additionally, households’ perspectives highlighted governance issues and revealed gaps in policy implementation along with the need for more inclusive decision-making processes. Our results underscore the importance of understanding household-level WEF nexus dynamics and daily practices in informing environmental policies, particularly those related to climate action. Such policies are best developed from the bottom-up by incorporating household insights, rather than relying solely on top-down, one-size-fits-all solutions