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Re: Comparison of the Test-negative Design and Cohort Design With Explicit Target Trial Emulation for Evaluating COVID-19 Vaccine Effectiveness.
Get PDFHigh reliance on fortified foods when optimizing diets of adolescents in Sweden for adequate vitamin D intake and climate sustainability.
Get PDFThe global food system contributes roughly one-third of global greenhouse gas emissions (GHGEs) making shifts towards more sustainable food consumption an imperative. Such diets also need to factor in nutrient requirements and cultural acceptability. Our aim was to simulate dietary changes for adolescents in Sweden to achieve the recommended intake (RI) for vitamin D while factoring in additional nutrients, cultural acceptability and keeping the diet within planetary boundaries for climate change. A baseline diet was estimated from Sweden's national dietary survey Riksmaten Adolescents 2016-17 (n = 3099, ages 11-18 years), which provided food intake via two 24-hour recalls. Intake data were linked to the Swedish Food Agency's food composition database and GHGE estimates from the Research Institutes of Sweden's (RISE) Food Climate Database. Linear programming was used to optimize the baseline diet to meet the RI for vitamin D (10 µg/day), reduce GHGEs to ≤ 1.7 kg CO2-equivalents/person/day, and minimize dietary changes from baseline to factor in cultural acceptability. A second optimization included 25 additional nutrients requirements. Both optimized diets met their respective requirements reducing GHGEs by 54 % but relied heavily on milk and yoghurt (fortified by law), which provided > 60 % of vitamin D intake. Both diets also required major shifts toward plant-based foods and the second optimization demanded a five-fold greater change in diet from baseline compared to first optimization. Results suggest that adolescents in Sweden can achieve RIs for vitamin D and other nutrients while greatly reducing diet-related GHGEs, though cultural acceptability may be a challenge
Implementing England’s Care Act 2014: was the Act a success and when will we know?
Get PDFMany countries are reforming long-term care to deal with the social risks created by demographic and social change. However, the passage of legislation is often followed by a new set of challenges as policy is implemented. This article examines England’s Care Act 2014 through Compton and ‘t Hart’s criteria of policy endurance to demonstrate the importance of assessing effectiveness at multiple time points. Early success in ‘implementation readiness’ was followed by the abandonment or dilution of key commitments. Yet, the Act’s foundational principles – well-being, prevention and capping private spending – continue to shape care policy, much as its original supporters hoped
Making the case for an International Childhood Cancer Data Partnership.
Get PDFChildhood cancers are a heterogeneous group of rare diseases, accounting for less than 2% of all cancers diagnosed worldwide. Most countries, therefore, do not have enough cases to provide robust information on epidemiology, treatment, and late effects, especially for rarer types of cancer. Thus, only through a concerted effort to share data internationally will we be able to answer research questions that could not otherwise be answered. With this goal in mind, the US National Cancer Institute and the French National Cancer Institute co-sponsored the Paris Conference for an International Childhood Cancer Data Partnership in November 2023. This meeting convened more than 200 participants from 17 countries to address complex challenges in pediatric cancer research and data sharing. This Commentary delves into some key topics discussed during the Paris Conference and describes pilots that will help move this international effort forward. Main topics presented include: (1) the wide variation in interpreting the European Union's General Data Protection Regulation among Member States; (2) obstacles with transferring personal health data outside of the European Union; (3) standardization and harmonization, including common data models; and (4) novel approaches to data sharing such as federated querying and federated learning. We finally provide a brief description of 3 ongoing pilot projects. The International Childhood Cancer Data Partnership is the first step in developing a process to better support pediatric cancer research internationally through combining data from multiple countries
Daily iron supplementation does not impact on prevalence of exclusive breastfeeding or growth in young breastfed Gambian infants.
Get PDFBACKGROUND: In a randomised placebo-controlled trial among exclusively breastfed rural Gambian infants aged 6-10 weeks at randomisation, daily iron supplementation for 14 weeks improved iron status. This secondary analysis explores the impact of iron supplementation on duration of exclusive breastfeeding and growth. METHODS: Breastfed 6-10 week-old infants were supplemented for 14 weeks with either daily iron or placebo (n=101). Infant feeding practices were assessed weekly through questionnaires. Survival analysis was used to measure the effect of iron supplementation on age at and time to cessation of exclusive breastfeeding. Groups were also compared regarding the change in anthropometric z-scores between baseline and endline. RESULTS: At endline, 31% (n=31/101) of infants were exclusively breastfed. There was no evidence that iron supplementation reduced the time to cessation of exclusive breastfeeding (median: 70 days (range: 7-105 days), iron: 67 days; placebo 71 days; Kaplan-Meier, log-rank test: p=0.15; Cox regression, crude HR: 1.42, 95% CI: 0.86 to 2.34, p=0.17; HR adjusting for infant age and sex: 1.40, 95% CI: 0.85 to 2.31, p=0.19) or age at cessation of exclusive breastfeeding (median time: 18 weeks (range:1-24 weeks), iron: 16 weeks; placebo 18 weeks; Kaplan-Meier, log-rank test: p=0.13; crude HR=1.47, 95% CI: 0.89, 2.43; p=0.13; HR adjusting for infant age and sex=1.44, 95% CI: 0.87, 2.39 p=0.16) There was no evidence that iron supplementation affected infant weight (p=0.79) or length (p=0.64) at endline or change in z-scores during the intervention period for weight-for-age (p=0.99), length-for-age (p=0.70) and weight-for-length (p=0.89). There was no evidence that duration of exclusive breastfeeding impacted endline anthropometric outcomes. CONCLUSION: Although requiring replication in larger trials, these findings do not raise concerns about iron supplementations' effect on feeding or growth in exclusively breastfed infants
High Prevalence of Sexually Transmitted Infections and Poor Sensitivity and Specificity of Screening Algorithms for Chlamydia and Gonorrhea Among Female Sex Workers in Zimbabwe: Analysis of Respondent-Driven Sampling Surveys in 3 Communities.
Get PDFBACKGROUND: Effective strategies to reduce sexually transmitted infection burden and transmission among female sex workers (FSWs) and their networks are needed. We report sexually transmitted infection prevalence among FSWs in Zimbabwe and investigate the performance of screening algorithms. METHODS: Respondent-driven sampling (RDS) surveys, including blood sampling for syphilis serology, were conducted among FSWs in 3 communities in Zimbabwe in 2017. In addition, a random sample of one-third of participants were offered genital examination and sexually transmitted infection (STI) testing. Data on symptoms and clinical signs were analyzed to determine the proportion of asymptomatic and clinically inapparent STIs by HIV status, and the sensitivity, specificity, and predictive values of syndromic, clinical, and hybrid screening algorithms for chlamydia and gonorrhea. Analyses were RDS-II weighted. RESULTS: Overall, 2507 women were included in the RDS surveys, and 661 of 836 (79.1%) of those randomly offered genital examination and STI testing accepted. The prevalence of STI by site ranged from 15.7% to 20.0% for syphilis (rapid plasma reagin + Treponema pallidum hemagglutination assay), 6.8% to 14.3% for gonorrhea, 8.4% to 10.1% for chlamydia, 26.6% to 35.5% for trichomonas, and 37.0% to 47.6% for any high-risk human papilloma virus. A high proportion of infections were both asymptomatic and clinically undetectable (gonorrhea: 41.2%, chlamydia: 51.7%, trichomonas: 62.8%). Screening algorithms performed poorly whether based on symptoms only (sensitivity: 53.3% gonorrhea, 43.3% chlamydia) or either symptoms or clinical signs (sensitivity: 58.7% gonorrhea, 48.3% chlamydia). CONCLUSIONS: Sexually transmitted infection burden is high among FSWs in Zimbabwe. The low sensitivity and specificity of screening algorithms used to guide syndromic management mean that more effective approaches are required to strengthen STI control. As access to HIV-specific prevention methods like preexposure prophylaxis increases, support for consistent condom use needs to be strengthened
Socio-economic inequalities in second primary cancer incidence: A competing risks analysis of women with breast cancer in England between 2000 and 2018.
Get PDFWe aimed to investigate socio-economic inequalities in second primary cancer (SPC) incidence among breast cancer survivors. Using Data from cancer registries in England, we included all women diagnosed with a first primary breast cancer (PBC) between 2000 and 2018 and aged between 18 and 99 years and followed them up from 6 months after the PBC diagnosis until a SPC event, death, or right censoring, whichever came first. We used flexible parametric survival models adjusting for age and year of PBC diagnosis, ethnicity, PBC tumour stage, comorbidity, and PBC treatments to model the cause-specific hazards of SPC incidence and death according to income deprivation, and then estimated standardised cumulative incidences of SPC by deprivation, taking death as the competing event. Multiple imputation was performed to account for missing data. Among 649,905 included women, 47,399 SPCs and 171,223 deaths occurred during 4,269,042 person-years of follow-up. Income deprivation was consistently associated with an increased rate of SPC incidence (cause-specific hazard ratio for the most vs. least deprived quintile: 1.29; 95% CI: 1.25, 1.33) and of death (1.36; 1.34, 1.38), translating into an absolute risk difference (the most vs. least deprived quintile) of 1.3% (95% CI: 1.0, 1.5) for SPC incidence and 4.9% (95% CI: 4.6, 5.1) for death at 10 years. Women with PBC from deprived areas in England faced a substantially higher risk of SPC than their counterparts. Future research is warranted to understand mechanisms for observed inequalities to inform strategies to monitor, prevent, and identify SPC in women with PBC
Trends in life expectancy, age and cause-specific mortality in the UK, 1970–2022, in comparison with a set of high-income countries: An analysis of vital statistics data
Get PDFIn 2019 the authors of this report published a paper in Lancet Public Health
(https://pubmed.ncbi.nlm.nih.gov/31677776/) comparing life expectancy and mortality
trends in England and Wales from 1970 to 2016 to a group of other high-income countries.
In 2023 our group started a new project commissioned and funded by UK The Health
Foundation that aimed to extend our analyses from our Lancet Public Health paper to
consider mortality up to 2022 for the UK and all its constituent parts compared to a set of 21
peer countries. Moreover it aimed tp look at the contribution of specific causes of death to
these overall trends. This report, written at the end of 2024, is the final output of this
project for The Health Foundation.
In summary, we found that over the past 50 years up to 2022, judged against the central
tendency of our set of other high-income peer countries, the UK’s mortality record has been
average for males and very poor for females. Of even more concern is the fact that over the
past 30 years the relative international standing of the UK has deteriorated. This
deterioration is seen in nearly all age groups and across a diverse range of causes of death.
A key long-term influence is that for both sexes the UK was in the international vanguard of
the smoking epidemic, which continues to affect the UK mortality disadvantage among
women. At younger adult ages (25-49 years) a historical advantage in external cause
mortality, with the UK having lower rates than many other peer countries, has progressively
eroded since 2001 and was reversed by 2013. UK drug-related death rates stand out as
having shown very steep increases in the period after 2010. However, this has not gone
along with the same pattern of increases in alcohol-related deaths and suicide, casting some
doubt on the relevance of the “deaths of despair” narrative. What is striking however is that
despite the wide range of changes in mortality rates seen since 1990, a persistent north
south geographic gradient persists, with only southern areas of the UK having a persistent
mortality advantage compared to the peer country median, although even this has
diminished over time
Long term monitoring and adaptive strategies: lessons from Hainan's malaria elimination and prevention efforts.
Get PDFHuaiyu Tian and colleagues argue that to improve sustainable malaria control and reduce the risk of disease resurgence, targeted interventions can be optimised for eliminating malaria in areas co-endemic for multiple Plasmodium specie
Impact of COVID-19 on healthcare programs in Zimbabwe: a mixed methods study.
Get PDFBACKGROUND: The COVID-19 pandemic disrupted healthcare services. Understanding similar epidemic-related disruptions on a broader scope in our local setting is critical for the effective planning of essential services. The study determined the impact of Coronavirus disease(COVID-19) on healthcare programs in Zimbabwe. METHODS: A mixed-methods study compared healthcare service delivery trends from the Ministry of Health and Child Care before, during and post the pandemic. It employed two methods of data collection: Key informant interviews (KII) and secondary data analysis from the Zimbabwe District Health Information Systems 2 (DHIS2). Purposive sampling obtained key informants for interviews whilst 18 healthcare service indicators were identified from the national database. Statistical analysis consisted of an interrupted time series analysis of those indicators preceded by visualization to appreciate trend change. An inductive approach was used to code and identify basic themes which were then triangulated against DHIS2 findings. RESULTS: The study revealed that COVID-19 had a negative impact on health service delivery; increasing disruptions of critical healthcare services, maternal and child health, reproductive health issues, and other specialist services were prominent. The rise in maternal and child mortality cases and caesarean sections could be directly linked to the decline in service delivery during the pandemic. Mitigation strategies that were introduced during the pandemic included the use of community-based services, outreach services, capacity building, and de-congestion of public services. CONCLUSIONS: The pandemic disrupted healthcare delivery, causing service usage to decline due to lockdowns. Response strategies included community services, capacity building, and stakeholder engagement. Future readiness requires epidemic plans, enhanced resources, a multisectoral approach, workforce training, and public education