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Consistency in self-reported age at first sex and marriage among adolescents and young adults in Northwestern Tanzania: insights from repeated responses.
Get PDFINTRODUCTION: Adolescents and young adults face unique sexual and reproductive health (SRH) challenges, with early sex and marriage linked to negative outcomes. Reported ages at first sex (AFS) and first marriage (AFM) are crucial indicators for SRH and HIV intervention programs. This study aimed to assess the consistency of AFS and AFM reports among adolescents and young adults with repeated responses across eight survey rounds (1994-2016) from the Magu Health and Demographic Surveillance System (Magu HDSS).
METHODS: A serial cross-sectional survey comprising 58,654 observations from 33,177 individuals in the Magu HDSS, conducted between 1994 and 2016, was analysed. Structured face-to-face interviews were used for data collection. A fixed-effects panel regression model was applied to assess within- and between-individual variability. Reported AFS and AFM were categorized as consistent or inconsistent across survey rounds. Variability and consistency were further analysed across different age groups, sexes, residence area, education, pregnancy and HIV status.
RESULTS: The study revealed significant within-individual variability, with nearly half of the variation due to individual-specific reporting changes over time. Among 2,637 individuals aged 15-24 who reported AFS more than once, 1,312 (49.8%) provided consistent values. For AFM, 621 out of 920 individuals (67.5%) reported same age values across multiple surveys. In other words, 49.8% of individuals provided the same AFS values each time, while 67.5% reported the same AFM values; the rest reported different values. Sub-analysis showed that age, sex, residence, HIV status, pregnancy, and education influenced variability and consistency. Females exhibited higher consistency in AFS (56.7%) and AFM (61.0%) compared to males (43.5% and 44.9%, respectively). Adolescents (15-19 years) reported more consistently with lower variability than young adults (20-24 years) and adults (25-49 years).
CONCLUSION: This study assesses the extent of consistency in reported ages among young individuals and identifies the challenge of self-reported AFS and AFM data due to inherent variability and inconsistency. It highlights the need to scrutinize the consistency of these reported events each time these indicators are used to evaluate trends and progress in SRH and HIV programs. A systematic analytical approach is essential for improving data quality and obtaining accurate estimates
Assessing community vulnerability to reduced vaccine impact in Uganda and Kenya: A spatial data analysis
Get PDFBackground Despite global efforts to improve on vaccine impact, many African countries have failed to achieve equitable vaccine benefits. Reduced vaccine impact may arise from interplay between structural, social, and biological factors, that hinder communities from achieving full benefits from vaccination programs. However, the combined influence of these factors to reduced vaccine impact and the spatial distribution of vulnerable communities remains poorly understood. In this work, we developed a Community Vaccine Impact Vulnerability Index (CVIVI) that integrates data on multiple risk factors associated with impaired vaccine impact. The index identifies communities are at risk of reduced vaccine impact, and key factors contributing to their vulnerability. Methods Vulnerability indicators were identified through literature review and grouped into structural, social, and biological domains. Using secondary data from Uganda and Kenya, we used percentile rank methodology to construct domain-specific and overall vulnerability indices. Correlation analysis was conducted to explore the relationship between indicators. Geo-spatial techniques were used to classify districts/counties from least to most vulnerable and to generate vulnerability maps. Results Our findings revealed distinct geographical distribution of community vulnerability to reduced vaccine impact. In Kenya, the most vulnerable counties were clustered in the northeast and east, including Turkana, Mandera, and West Polot. In Uganda, vulnerability was more scattered, with the most vulnerable districts concentrated in the northeast (such as Amudat, Lamo) and southwest (such as Buliisa and Kyenjojo). Key factors contributing to high vulnerability in these counties/ districts cut across different domains, including long distance to the health facilities, low maternal education, low wealth quintile, high prevalence of malnutrition, limited access to postnatal care services, and limited access to mass media. Conclusions The index is a potential tool for identifying vulnerable communities, and underlying causes of vulnerability, which guides the design of tailored strategies to improve vaccine impact among vulnerable communities.</ns3:p
Immunity against reinfection in pigs following Taenia solium infection and a quantitative dose-response model.
Get PDFTaenia solium is a zoonotic parasite causing significant health and economic burdens, with complex transmission dynamics that demand improved control strategies. This study examines how infection and reinfection affect cyst development in pigs and how acquired immunity constrains parasite burden. A total of 116 pigs were purchased from commercial farms in northern Peru and housed under controlled conditions. Of these, 110 pigs were allocated to 18 experimental groups to evaluate the impact of single and repeated infections with varying doses of T. solium eggs and to model the number of live cysts produced based on dose and age at infection. Gravid proglottids collected from human cases were used to prepare viable egg pools. Infections were administered orally via esophageal catheterization, and pigs were necropsied 10 weeks after the final infection to quantify cyst burden. A negative binomial regression model assessed the influence of infection dose, prior infection, age, and other factors. No significant differences in cyst counts were found between singly infected and reinfected pigs, regardless of initial or reinfection doses, highlighting that infection induces strong acquired immunity that prevents subsequent infections. A dose-response analysis indicated that cyst burden follows a power relationship with egg dose. Integrating data from both single and reinfected pigs into a unified model improved prediction precision. Furthermore, incorporating age at infection allowed us to model the combined effects of acquired and innate immunity, reflecting changes in susceptibility over time. These findings demonstrate that a single exposure to T. solium eggs can generate robust protective immunity in pigs. The resulting quantitative model, predicting viable cyst counts based on dose and age, offers valuable insights for integrating immunity dynamics into transmission models, supporting the development of more effective strategies for controlling T. solium
Resilience testing in action - piloting the health system resilience testing tool with a pandemic scenario in Finland.
Get PDFBACKGROUND: System-wide approaches to measure, prepare for and manage the next acute shock are needed. We document the application of the health system resilience testing tool to a hypothetical pandemic scenario in Finland. METHODS: The resilience testing tool promoted pre-crisis identification of resilience gaps and was built on the Health Systems Performance Assessment Framework and the Shock Cycle Framework. It included guidance on building a shock scenario, conducting a semi-structured resilience testing dialogue with health system stakeholders, and evaluating resilience. A hypothetical scenario of a pandemic affecting predominantly children was addressed in a semi-structured, mixed-methods resilience test in Finland. The resilience test brought together national experts and other stakeholders to identify the health system weaknesses exposed by the scenario. RESULTS: The resilience testing tool enabled the preparation for the high-level dialogue that identified actionable systemic weaknesses that undermine resilience. The identified weaknesses in the Finnish health system included: a lack of clarity of the process and value-basis of decision-making; sustaining trust towards and between authorities; multi-sectoral collaboration; safeguarding the health workforce; and developing a comprehensive knowledge base. CONCLUSIONS: The main benefit of the resilience testing methodology is the ability to bring key actors together to exchange different perspectives on how a health system functions during a crisis. The discussions at the high-level dialogue revealed the need for a mechanism, such as a resilience testing tool, to elucidate the range of practical challenges and how to potentially address them. The discussions also captured themes that are not routinely identified in existing performance assessment mechanisms, such as ethical considerations, values, and political determinants of the health system response. The Finnish pilot study was used to update the structure and facilitation of the resilience testing tool. Further suggested improvements for resilience testing include greater clarification for participants on the scenario, an increased emphasis on recovery and learning, and a greater representation of stakeholders from the community
Interventions to improve access to opioid agonist therapy in acute hospitals: A scoping review.
Get PDFMany people who use illicit opioids have negative experiences when admitted to hospital, which is partly due to poor availability of opioid agonist therapy (OAT). We conducted a scoping review of interventions to increase access OAT to for hospital patients, with searches of MEDLINE, EMBASE, PsychINFO, and CINAHL for evaluations published before 29 July 2024. We followed a registered protocol (identifier: CRD42022313237). We included interventions in acute inpatient or emergency department settings, and extracted intervention characteristics, location, evaluation design and quality, and evidence for effectiveness. We included 57 studies; 50 from the United States, six from Canada, and one from the UK. Fifty-one were published in 2015 or later. We identified three intervention classes: (a) pathways to initiate OAT in emergency departments, entailing screening patients or training staff to identify withdrawal, initiating buprenorphine, and supported referrals (26 studies); (b) multidisciplinary 'addiction consult teams', which provide substance-related care across hospital departments, advise primary medical teams on issues such as pain relief and withdrawal management, and support patients with discharge and onward care (18 studies); and (c) Interventions that build capacity of general clinical teams to provide OAT to inpatients, including protocols to identify patients who need OAT, multidisciplinary patient review, and training/clinical education (13 studies). Most interventions included multiple components, and the most common were clinical education and measures to improve continuity of OAT after discharge, such as bridge prescriptions and supported referrals to community prescribers. Almost all studies concluded that interventions were effective, however evaluation methods were generally weak and most used before/after or case series designs. Efforts to improve OAT in acute hospitals emerged recently in North America and focus on addiction consult teams and initiation of buprenorphine in emergency departments. Although formal evaluation is weak, these models may represent starting points for national policy and larger research programmes
Whole-genome sequencing analysis of Burkholderia pseudomallei comparing drug-resistant and pan-susceptible isolates reveals novel biomarkers for drug resistance.
Get PDFMelioidosis, caused by the gram-negative bacterium Burkholderia pseudomallei (Bp), poses a significant health threat due to its potential for drug resistance, which can severely limit available treatment options. To investigate this, we conducted a comparative genomic analysis of 38 drug-resistant (DR) and 300 drug-susceptible (DS) Bp isolates to identify genetic markers associated with antimicrobial resistance. Our study identified seven significant single-nucleotide polymorphisms (SNPs) linked to drug resistance: two with ceftazidime (CAZ), and five with meropenem (MEM). Pathway analysis revealed that AMC resistance was associated with alterations in fatty-acid metabolism, whereas CAZ resistance was associated with changes in membrane protein pathways. These findings highlighted how Bp develops resistance to key antibiotics through various mechanisms. In addition, we discovered 21 novel genetic variants in known drug-resistance genes, including 15 SNPs and six short insertions or deletions (indels). These previously unreported variants could contribute to resistance, highlighting the genetic diversity and adaptability to antimicrobial pressures of Bp. These findings deepen our understanding of Bp drug resistance and offer valuable insights into genetic markers with the potential to enhance diagnostic precision. By enriching the resistance database, this work provides prospective tools for early resistance prediction, facilitating prompt and effective treatment strategies. Furthermore, it emphasizes the critical role of genetic investigations in addressing the challenge of antibiotic resistance in melioidosis
The global economic burden of antibiotic-resistant infections and the potential impact of bacterial vaccines: a modelling study.
Get PDFINTRODUCTION: Antibiotic resistance (ABR) may increase hospital costs, utility loss and mortality risk per patient. Understanding these losses at national, regional and global scales is necessary for efficiently tackling ABR. Our aim is to estimate the global economic burden of antibiotic-resistant infections and the potential for bacterial vaccines to mitigate this burden. METHODS: We take healthcare system and labour productivity perspectives. Hospital cost-per-case and length-of-stay estimates were calculated through meta-analyses and reviewing published systematic reviews. Unit labour productivity losses were estimated through a human capital approach. Modelled estimates were used where secondary data were missing. Death and incidence data were combined with unit cost data to estimate the economic burden associated with ABR in 2019, and the potential costs averted (in 2019 US3000 in lower-income settings to US3000-US693 billion (IQR: US768 bn) in hospital costs globally, with US186 bn-US194 billion, with US$76 bn avertable by vaccines. CONCLUSIONS: The economic burden of ABR is associated with high levels of hospital bed-days occupied, hospital spending and labour productivity losses globally and should, therefore, remain high on national and international policy agendas. Vaccines against Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae would avert a substantial portion of the economic burden associated with ABR. More robust evidence, particularly in low-income countries, on the hospital costs, associated with and attributable to ABR, is needed
Confounding mechanisms and adjustment strategies in air pollution epidemiology: a case study assessment with the UK Biobank cohort.
Get PDFBACKGROUND: Cohort studies are instrumental in examining long-term risks associated with environmental exposures but require appropriate control for various confounding effects. In this contribution, we assessed this issue by investigating the relationship between fine particulate matter (PM2.5) exposure and mortality in a UK-based cohort. METHODS: We analysed data from half a million adults in the UK Biobank linked with time-varying individual-level exposure data and followed up during the period 2006-21. The assessment focused on confounding related to spatial and temporal patterns as well as due to measurable variables, including both contextual and individual-level factors. We performed an evaluation consisting of descriptive analyses, specification and interpretation of direct acyclic graphs (DAGs), and comparison of results from survival models. RESULTS: We found correlations between PM2.5 exposure and mortality rates across time, geographical areas, and categories of measurable variables. The DAG indicated complex causal pathways and the need to adjust for a wide set of potential confounders. The regression analysis confirmed these patterns: the fully adjusted model estimated a hazard ratio (HR) of 1.25 (95% CI: 1.06-1.49) per 10 μg/m3 increments in PM2.5, but the association reversed to 0.82 (0.76-0.87) when excluding control for recruitment centre, suggesting strong spatial confounding. Calendar time showed stronger confounding effects compared to age. Area-level socio-economic indicators were more important than individual-level counterparts, while lack of control for lifestyle factors led to a noticeable overestimation. CONCLUSIONS: This case-study illustration elucidates various confounding mechanisms in cohort studies on environmental risks and offers a critical evaluation of alternative adjustment strategies
Ethnic differences in the comparative effectiveness of second-line type 2 diabetes medications in preventing cardiovascular disease.
Get PDFAIM: To investigate ethnic differences in the comparative effectiveness of sulfonylureas (SU), dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) on cardiovascular outcomes. MATERIALS AND METHODS: We identified adults with type 2 diabetes in UK electronic health records initiating SU, DPP4i or SGLT2i (2015-2022). The outcomes were major adverse cardiovascular events (MACE: myocardial infarction, stroke, heart failure hospitalisation, cardiovascular death). Cox models estimated hazard ratios for DPP4i versus SU, SGLT2i versus SU and SGLT2i versus DPP4i. Wald tests assessed interaction by ethnicity. RESULTS: Among 91 116 included individuals (72.3% White, 14.2% South Asian, 6.0% Black), 34.2% initiated an SU, 42.0% DPP4i and 23.8% SGLT2i. There was weak evidence of interaction by ethnicity for DPP4i versus SU on MACE (p = 0.12), with stronger effects observed for DPP4i in the Black group (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.46-0.89) than White (HR: 0.91, 95% CI: 0.84-0.98) or South Asian (HR: 0.93, 95% CI: 0.75-1.16) groups. There was evidence of interaction by ethnicity for DPP4i versus SU on heart failure hospitalisation (p = 0.05), with a stronger effect observed for DPP4i in the Black group (HR: 0.50, 95% CI: 0.30-0.84). There was no clear evidence of ethnic differences for other treatment comparators or cardiovascular outcomes. CONCLUSIONS: We found weak evidence suggesting a greater effect of DPP4i than SUs against MACE in Black people, particularly for heart failure hospitalisation, but no evidence of other ethnic differences in treatment effects
Sublobar resection or lobectomy for stage Ia non-small cell lung cancer: a systematic review and meta-analysis.
Get PDFBACKGROUND: This systematic review and meta-analysis synthesises evidence from both randomised trials and observational studies to determine whether lobectomy or sublobar resection offers improved outcomes for patients with stage Ia non-small cell lung cancer (NSCLC). METHODS: Studies (up to June 2025) comparing lobectomy and sublobar resection (segmentectomy or wedge) for clinical stage Ia NSCLC (<2 cm) were included in the random-effects meta-analyses. Risk of bias was assessed using Risk of Bias 2 for randomised trials or Risk of Bias in Non-randomised Studies of Interventions-I for observational studies. RESULTS: 19 studies, including four randomised trials, were included. Overall survival at 5 years was comparable between lobectomy and sublobar resection (HR=1.00; 95% CI 0.84 to 1.19; I²=26%), as was disease-free survival (HR=1.05; 95% CI 0.90 to 1.23; I²=0%). Sublobar resection was associated with significantly higher local recurrence (OR=1.86; 95% CI 1.07 to 3.25; I²=73%). No differences were observed in 10-year survival (OR=0.99; 95% CI 0.27 to 3.59; I²=86%) or postoperative change in forced expiratory volume in 1 s (mean difference=-4.70; 95% CI -11.15 to 1.76; I²=99%). In 10 studies that mandated systematic hilar and mediastinal lymph node sampling, sublobar resection was associated with improved overall survival compared with lobectomy (HR=0.81; 95% CI 0.69 to 0.965; I²=0%). CONCLUSION: Lobectomy and sublobar resection offer comparable long-term survival for patients with stage Ia NSCLC. While sublobar resection is associated with higher local recurrence rates, subgroup analysis suggests that when intraoperative systematic hilar and mediastinal lymph node sampling is performed, sublobar resection may offer a survival advantage