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Lag Time Between Onset of First Symptom and Treatment of Retinoblastoma: Outcomes at Three Years from Recruitment.
Get PDFPURPOSE: To evaluate the effect of lag time between diagnosis of retinoblastoma (RB) and treatment in patients from 10 countries. METHODS: Prospective study of 692 treatment-naïve RB patients from 10 countries followed up for 3 years from recruitment. RESULTS: The mean lag time from the onset of the first symptom to visit to the RB treatment center was 150 days. The mean follow-up duration was 26 months (median, 32 months; range, 12 months. CONCLUSION: A lower socioeconomic status and greater AJCC stage were associated with an increased risk of enucleation. Increased lag time from the onset of the first symptom to visit the RB treatment center and AJCC T4 stage were associated with an increased risk of death from RB
A Scoping Review of Breastfeeding Interventions Conducted in the Republic of Türkiye and the Turkish Republic of Northern Cyprus
Get PDFObjective: Breastfeeding (BF) is essential for maternal and child health, yet disparities persist in initiation, exclusivity, and duration. Despite cultural and policy support in Türkiye and the Turkish Republic of Northern Cyprus, challenges such as inconsistent hospital practices, early formula supplementation, and limited workplace accommodations hinder optimal BF outcomes. Understanding the effectiveness of BF interventions in these regions is key to improving maternal and infant health. This review is aimed to identify and synthesize BF interventions and their outcomes in Türkiye and the Turkish Republic of Northern Cyprus.
Materials and Methods: A scoping review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-ScR Guidelines, searching 14 electronic databases for English-language peer-reviewed studies published between 2010 and September 2024. Studies assessing individual-, community-, institutional-, and policy-level interventions were included.
Results: Twenty-nine studies met the inclusion criteria. Interventions fell into 4 categories: educational programs, hospital-based initiatives, digital BF support, and community-driven efforts. Most interventions led to increased exclusive BF rates, BF self-efficacy, early BF initiation, and improved maternal psychosocial well-being. However, challenges persisted in Baby-Friendly Hospital Initiative (BFHI) implementation, lactation support accessibility, and workplace accommodations.
Conclusion: Multifaceted, context-specific interventions are most effective for sustaining BF practices, yet regional gaps and policy inconsistencies remain, particularly in the Turkish Republic of Northern Cyprus. Strengthening BFHI adherence, expanding digital lactation support, improving workplace policies, and addressing regional disparities can enhance BF outcomes and align with global health priorities
The transmission dynamics of Norovirus in England: A genotype-specific modelling study.
Get PDFBACKGROUND: Norovirus is the leading cause of acute gastroenteritis cases in England and worldwide, with diverse co-circulating genotypes. Vaccine candidates targeting multiple genotypes are advancing. However, most transmission models still focus on single-strain dynamics, limiting their ability to assess the role of co-circulating strains on population burden. METHODS: We developed an age structured multistrain transmission model that integrates norovirus genotype diversity, waning immunity, and cross-protection within genogroups. We calibrate to case and genotyping surveillance time-series data with community-wide age structured incidence estimates and cross-sectional seroprevalence among English children to capture the transmission dynamics of the main co-circulating norovirus strains in England. Using a calibrated model, we examine the case of an emerging GII.4 variant under different scenarios of transmissibility. RESULTS: We found that on average the current GII.4 strain has an R0 of 4.8 (CrI 4.5 - 5.01). We estimate the average number of lifetime norovirus episodes per person to be 5.2 (CrI 95 % 4.5 - 6.3) in the absence of new pandemic strains, with 66 % of children in England experiencing at least one symptomatic episode by the age of four. Our sensitivity analysis and model selection suggests that cross-protection within genogroups (between strains of the same genogroup), is very limited at conferring protection. Importantly, our modelling suggests that a potential emerging variant would cause a larger first epidemic season and return to baseline levels with an increase in relative contribution of GII.4. If such variant was more transmissible, the size of the initial peak could almost double the current average epidemic peak. CONCLUSIONS: This approach addresses key limitations of single-strain frameworks and offers a more comprehensive understanding of norovirus dynamics, improving the capacity to assess the potential population-level effects of upcoming multivalent vaccine strategies
The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 20, the hidden cost of intraocular lens choices for National Health Service funded cataract surgery in England
Get PDFBACKGROUND: Patients that have a hydrophilic intraocular lens (IOL) inserted during cataract surgery are more likely to develop posterior capsular opacification (PCO) and require YAG laser posterior capsulotomy than those with hydrophobic IOLs. This study aimed to examine the cost implications of hydrophilic and hydrophobic IOL usage in NHS-funded cataract services in England and estimate the cost saving of increased hydrophobic IOL usage.
METHODS: The cost of IOLs and YAG laser posterior capsulotomy was determined using NHS Spend Comparison Service data and Payment by Results tariffs. Data from the National Ophthalmology Database (NOD) audit was used to estimate PCO rates and the proportion of cataract cases that used hydrophilic and hydrophobic IOLs in England during the 2022 NHS year.
RESULTS: The cumulative cost per case of purchasing an IOL and YAG laser posterior capsulotomy treatment over the 9-year period following cataract surgery was £148.73 (£96.83-£199.12) for hydrophilic IOLs and £107.58 (£62.99-£150.05) for hydrophobic IOLs. Of the cataract cases performed in England during the 2022 NHS year that were reported to the NOD, 52% used hydrophilic IOLs and 46% used hydrophobic IOLs. If all cases that used hydrophilic IOLs in England during the 2022 NHS year had instead used hydrophobic IOLs, the reduced need for YAG laser posterior capsulotomies could have saved around £13.0 million (£10.7 million-£15.6 million).
CONCLUSIONS: Hydrophilic IOLs remain popular amongst NHS-funded cataract services in England. Increasing hydrophobic IOL usage could be an effective strategy for lowering PCO rates while generating recurrent annual financial savings
Acute febrile illness in remote and rural communities: Perspectives of health providers and managers in Chattogram, Bangladesh.
Get PDFAcute febrile illness is a major public health issue in tropical regions, particularly in remote and rural areas where healthcare access is difficult. In these areas, patients often seek care too late or rely on self-medication, leading to increased risks of complications and death. This qualitative study examined challenges and opportunities for managing acute febrile illness in Chattogram Division, Bangladesh. The research involved interviews with 35 stakeholders across the health sector in Bangladesh, including health managers and frontline health workers, and international experts. Findings show that referral barriers, health seeking behaviour and financial considerations influence case management and outcomes in complex ways. Community health workers are vital in managing local health issues, but they have limited ability to address the evolving concerns about febrile illness. Gaps in the referral system and inadequate emergency care resources further complicate the situation. Many episodes of fever remain undifferentiated and are often managed with presumptive antibiotic treatment, which may be inappropriate and contributes to antimicrobial resistance. This study highlights the pressing need for an inte-grated approach to febrile illness management in rural Bangladesh, one that accounts for the changing epidemiology of infectious diseases, health seeking behaviour, and the limitations of the existing healthcare infrastructure. Expanding the ability of community health workers to manage patients with non-malarial febrile illnesses, stronger triage and referral systems, and addressing the financial and logistical barriers to care are critical steps toward improving health outcomes in these regions
Impact of baseline risk of death or hospitalization on effectiveness of revascularization in patients with ischaemic left ventricular dysfunction-a prespecified analysis of REVIVED-BCIS2.
No full textAIMS: Randomized trials have failed to show a consistent benefit of revascularization in patients with ischaemic cardiomyopathy. This study aimed to investigate whether a participant's baseline risk introduces heterogeneity in the treatment effect of percutaneous coronary intervention (PCI).
METHODS AND RESULTS: The REVIVED-BCIS2 trial randomised 700 participants with ischaemic cardiomyopathy to PCI plus optimal medical therapy (OMT) vs. OMT alone, 263 (37.6%) of whom experienced the primary outcome (all-cause mortality or hospitalization due to heart failure) during a median follow-up of 41 months. Pre-randomization data were used to develop a prediction model for the primary outcome, and evidence for heterogeneity of the trial intervention effect was investigated. The prediction model included 12 predictors and showed acceptable discrimination (C statistic: 0.69, 95% CI 0.66-0.72) and calibration (calibration slope: 0.79, 95% CI 0.64-0.95). Overall, there was no statistical evidence that the baseline risk score modified the trial intervention effect (pinteraction = 0.21) on the primary outcome. For the secondary outcome of cardiovascular death or hospitalization due to heart failure, weak evidence emerged that the baseline risk modified the trial intervention effect (pinteraction = 0.044). Participants with lower baseline risk trended towards a greater benefit from PCI compared with participants with higher risk scores.
CONCLUSION: Baseline risk did not influence the effect of revascularization in preventing all-cause mortality or hospitalization due to heart failure. A trend was observed that lower baseline risk might be associated with more benefit of revascularization in preventing cardiovascular death or hospitalization due to heart failure. CLINICALTRIALS.GOV IDENTIFIER: NCT01920048
There is no Flaw in Neuhaus and Jewell (1993)
Get PDFThis brief note responds to Feng, Wang, and Liu (2024), who claim that Neuhaus and Jewell (1993) contains a "flaw" and is based on an invalid argument. The opposite is true: there is no flaw in Neuhaus and Jewell (1993), and Feng, Wang, and Liu’s development is based on a misconception of what our paper describes, including their use of an incorrect assumption. This misinformation should be corrected
Mind the (widening) gap: why public health must engage with AI now
Get PDFOBJECTIVES: This commentary aims to highlight the opportunities and challenges that Artificial Intelligence (AI) presents for public health.
STUDY DESIGN: Narrative commentary and conceptual analysis.
METHODS: The commentary draws on material developed for a forthcoming book by the European Observatory on Health Systems and Policies. Sources were selected to highlight both the potential and the limitations of AI integration at population levels, with a focus on equity, governance, and implementation. The analysis is informed by established public health principles: prevention, systems thinking, and the social determinants of health.
RESULTS: AI applications in public health go beyond process automation and operational efficiency. By integrating and processing diverse, multi-modal data sources, its implementation presents opportunities to understand the wider determinants of health at a more nuanced level and identify populations at risk with greater precision. Additionally, AI has the potential to help understand and support behaviour change in sophisticated ways, enhance disease surveillance and modelling, and enable more targeted and responsive public communication and engagement strategies. However, there are several barriers to realise AI's potential in public health, including system fragmentation, data access limitations, resource constraints, implementation challenges, workforce readiness gaps, and technological limitations such as bias and generative AI "hallucinations".
CONCLUSION: Without deliberate engagement, AI risks reinforcing existing inequities. Practical steps for action include embedding AI training in public health education, building multidisciplinary teams, investing in data infrastructure, and ensuring participatory approaches. AI will continue to shape public health systems, whether or not public health professionals engage. We argue that the public health community is both uniquely positioned and ethically obligated to engage proactively with AI
Sex differences in the prevalence of high-risk oral and anal human papillomavirus infections among heterosexually active populations in Ibadan, Nigeria
Get PDFPURPOSE: To determine sex differences in the prevalence of oral and anal high-risk HPV infections among heterosexually active males and females in Ibadan.
METHODS: This was a secondary analysis from the Sexual Behavior and HPV Infections in Nigerians in Ibadan (SHINI) study that involved sexually active males and females aged 18-45 years. After a face-to-face interview, samples were collected from the mouth, cervix, vulva, and anus by a sex-matched trained nurse. High-risk HPV (hrHPV) in oral or/and anal sites were primary outcome variables, profiled by AnyplexTM II HPV28 assay. The participants' demographic characteristics, sexual behaviors, and social lifestyle were included as explanatory variables. The chi-square or Fisher exact test was used to investigate the association between the presence of hrHPV and the participants' characteristics. Multivariable logistic regression was conducted to test the association between the sex of participants and each of the primary outcome after adjusting for potential confounders. Statistical significance was set at p < 0.05.
RESULTS: A total of 625 females including 310 females in general population (FGP) and 315 female sex workers (FSWs) and 316 males were recruited. Oral hrHPV prevalence was higher among FGP and FSWs than among males (10.5% vs. 14.9% vs. 3.6%, p < 0.001), as was anal hrHPV prevalence (39.3% vs. 60.8% vs. 6.7%, p < 0.001). More FGP (7.5%) and FSWs (13.0%) than males (0.9%) had hrHPV at both oral and anal sites (p < 0.001). Males had significantly lower odds of oral hrHPV [adjusted odds ratio (aOR) = 0.43, 95% CI: 0.15-1.24] than FSWs and FGP [aOR = 1.70, 95% CI: 0.62-4.63]. The odds of anal hrHPV was significantly lower among males [aOR = 0.05, 95% CI: 0.03-0.08] compared to FSWs and FGP [aOR = 0.42, 95% CI: 0.30-0.58].
CONCLUSION: Oral hrHPV, anal hrHPV, and hrHPV at both sites were more prevalent in females than in males in the heterosexually active population. These findings highlight the importance of developing targeted HPV prevention strategies that account for sex-specific risk factors and the potential biological underpinnings contributing to these disparities
From the 100 Day Mission to 100 lines of software development: how to improve early outbreak analytics.
Get PDFSince the COVID-19 pandemic, considerable advances have been made to improve epidemic preparedness by accelerating diagnostics, therapeutics, and vaccine development. However, we argue that it is crucial to make equivalent efforts in the field of outbreak analytics to help ensure reliable, evidence-based decision making. To explore the challenges and key priorities in the field of outbreak analytics, the Epiverse-TRACE initiative brought together a multidisciplinary group of experts, including field epidemiologists, data scientists, academics, and software engineers from public health institutions across multiple countries. During a 3-day workshop, 40 participants discussed what the first 100 lines of code written during an outbreak should look like. The main findings from this workshop are summarised in this Viewpoint. We provide an overview of the current outbreak analytic landscape by highlighting current key challenges that should be addressed to improve the response to future public health crises. Furthermore, we propose actionable solutions to these challenges that are achievable in the short term, and longer-term strategic recommendations. This Viewpoint constitutes a call to action for experts involved in epidemic response to develop modern and robust data analytic approaches at the heart of epidemic preparedness and response