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Removing Through-traffic on Minor Roads Reduces Road Danger at Junctions with Surrounding Major Roads
Get PDFWe tested the hypothesis that road safety improves at junctions between minor roads and major roads if the minor roads are modally filtered to remove through traffic. We did this by using police-reported casualty data (2012–2024) to examine the effects of 113 Low Traffic Neighbourhoods (LTNs) implemented in London between 2015 and 2024. Our findings supported our hypothesis: LTN implementation was associated with a 14% reduction in total numbers of casualties at junctions between newly filtered minor roads and surrounding major roads (95% CI: -21% to -8%). This effect was generally consistent across casualty injury severity, casualty travel mode, and the presence of traffic-light controlled signals
Impact of Viral Co-Detection on the Within-Host Viral Diversity of Influenza Patients.
Get PDFNumerous studies have documented the evidence of virus-virus interactions at the population, host, and cellular levels. However, the impact of these interactions on the within-host diversity of influenza viral populations remains unexplored. Our study identified 13 respiratory viral pathogens from the nasopharyngeal swab samples (NPSs) of influenza-like-illness (ILI) patients during the 2012/13 influenza season using multiplex RT-PCR. Subsequent next-generation sequencing (NGS) of RT-PCR-confirmed influenza A infections revealed all samples as subtype A/H3N2. Out of the 2305 samples tested, 538 (23.3%) were positive for the influenza A virus (IAV), while rhinovirus (RV) and adenoviruses (Adv) were detected in 264 (11.5%) and 44 (1.9%) samples, respectively. Among these, the co-detection of more than one virus was observed in ninety-six samples, and five samples showed co-detections involving more than two viruses. The most frequent viral co-detection was IAV-RV, identified in 48 out of the 96 co-detection cases. Of the total samples, 150 were processed for whole-genome sequencing (WGS), and 132 met the criteria for intra-host single-nucleotide variant (iSNV) calling. Across the genome, 397 unique iSNVs were identified, with most samples containing fewer than five iSNVs at frequencies below 10%. Seven samples had no detectable iSNVs. Notably, the majority of iSNVs (86%) were unique and rarely shared across samples. We conducted a negative binomial regression analysis to examine factors associated with the number of iSNVs detected within hosts. Two age groups-elderly individuals (>64 years old) and school-aged children (6-18 years old)-were significantly associated with higher iSNV counts, with incidence rate ratios (IRR) of 1.80 (95% confidence interval [CI]: 1.09-3.06) and 1.38 (95% CI: 1.01-1.90), respectively. Our findings suggest a minor or negligible contribution of these viral co-detections to the evolution of influenza viruses. However, the data available in this study may not be exhaustive, warranting further, more in-depth investigations to conclusively determine the impact of virus-virus interactions on influenza virus genetic diversity
Five decades of advancing global maternal and newborn health and rights: Milestones and initiatives.
Get PDFGlobal efforts have for decades aimed to reduce maternal and newborn mortality through initiatives, declarations, and high-level strategies. This article reviews the evolution of the global maternal and newborn health (MNH) agenda from the 1970s to the present, highlighting key conferences, political commitments, strategies, and advocacy movements that have shaped progress. Landmark events such as the Alma-Ata Declaration, the Safe Motherhood Initiative, the International Conference on Population and Development which reframed MNH within a rights-based approach, the Millennium Development Goals, and later the Sustainable Development Goals laid the groundwork for national and global accountability in MNH. Despite progress, the health of women and newborns remains an unfinished agenda. Evidence suggests that in 2023, approximately one woman died from maternal causes related to pregnancy and childbirth every 2 min, one newborn died every 14 s, and a stillbirth occurred every 17 s. Universal health coverage goals have stalled, with minimal gains in service coverage since 2015 emphasizing the need for urgent, united action and investments in healthcare systems, including training and empowering nurses and midwives. A global campaign was launched through World Health Day 2025 to renew commitment to ending preventable maternal and neonatal deaths. Despite the severe cuts made this year to official assistance for health and development, ongoing political will, financial investment, and societal change are needed more than ever. This moment presents an opportunity to recommit to ensuring that women and newborns not only survive but thrive well beyond 2025
Vaping and harm in young people: umbrella review.
Get PDFOBJECTIVE: To appraise and synthesise the evidence on short and longer term harms of vaping in young people. DATA SOURCES: KSR Evidence (systematic reviews); Medline, Embase, and PsycInfo (umbrella reviews); and reference screening. STUDY SELECTION: Systematic and umbrella reviews evaluating any potential harms from e-cigarettes in young people. DATA SYNTHESIS: Searches identified 56 reviews for inclusion from 384 unique articles. A consistent significant association between vaping and smoking initiation was found, supporting a causal relationship, with pooled ORs of 1.50-26.01 (21 systematic reviews), most of which suggested that young people using e-cigarettes are about three times more likely than those not using them to initiate smoking. Five systematic reviews demonstrated a substantial association between e-cigarettes and substance use, with pooled ORs of 2.72-6.04 for marijuana, 4.50-6.67 for alcohol and 4.51-6.73 for binge drinking. Asthma was the most common respiratory outcome, with consistent associations (ORs: 1.20-1.36 for diagnosis and 1.44 for exacerbation). Three systematic reviews found associations between vaping and suicidal outcomes, and six included investigation of injuries, predominantly documenting explosion incidents. Significant associations between vaping and other harmful outcomes included pneumonia, bronchitis, lower total sperm counts, dizziness, headaches, migraines and oral health harms, but this evidence was largely derived from limited surveys or case series/reports. CONCLUSIONS: This study found that there were consistent associations between vaping and subsequent smoking, marijuana use, alcohol use, asthma, cough, injuries and mental health outcomes. The findings support the implementation of policy measures to restrict sales and marketing of e-cigarettes to young people. TRIAL REGISTRATION NUMBER: PROSPERO CRD42024569728
The transmission blocking activity of artemisinin-combination, non-artemisinin, and 8-aminoquinoline antimalarial therapies: A pooled analysis of individual participant data.
Get PDFBACKGROUND: Interrupting human-to-mosquito transmission is important for malaria elimination strategies as it can reduce infection burden in communities and slow the spread of drug resistance. Antimalarial medications differ in their efficacy in clearing the transmission stages of Plasmodium falciparum (gametocytes) and in preventing mosquito infection. Here, we present a retrospective combined analysis of six trials conducted at the same study site with highly consistent methodologies that allows for a direct comparison of the gametocytocidal and transmission-blocking activities of 15 different antimalarial regimens or dosing schedules. METHODS AND FINDINGS: Between January 2013 and January 2023, we conducted six clinical trials evaluating antimalarial treatments with transmission endpoints at the Clinical Research Centre of the Malaria Research and Training Centre of the University of Bamako in Mali. These trials tested Artemisinin-Combination Therapies (ACTs), non-ACT regimens and combinations with 8-aminoquinolines. Participants were males and non-pregnant females, between 5 and 50 years of age, who presented with P. falciparum mono-infection and gametocyte carriage by microscopy. We collected blood samples before and after treatment for thick film microscopy, infectivity assessments by mosquito feeding assays and molecular quantification of gametocytes. To combine direct and indirect effects of treatment groups across studies, we performed a network meta-analysis. This analysis quantified changes in mosquito infection rates and gametocyte densities within treatment groups over time and between treatments. In a pooled analysis of 422 participants, we observed substantial differences between antimalarials in gametocytocidal and transmission-blocking activities. Artemether-lumefantrine (AL) was significantly more potent at reducing mosquito infection rates within 48 h than dihydroartemisinin-piperaquine (p = 0.0164) and sulfadoxine-pyrimethamine plus amodiaquine (p = 0.0451), while this difference was near-significant for artesunate-amodiaquine (p = 0.0789) and pyronaridine-artesunate (p = 0.0519). The addition of single low-dose primaquine (SLD PQ) accelerated gametocyte clearance for any ACT and led to a substantially greater reduction in mosquito infection rate within 48 h of treatment for all ACTs except AL, while an SLD of the 8-aminoaquinoline tafenoquine showed a delayed activity, compared to SLD PQ, but was similarly effective. The main limitations of the study include the inclusion of highly infectious individuals, which may not reflect the broader malaria patient population with lower or undetectable gametocyte densities and the small sample sizes in some treatment groups, which resulted in wide confidence intervals and reduced the certainty of effect estimates. CONCLUSIONS: We found marked differences among ACTs and single low-dose 8-aminoquinoline drugs in their ability and speed to block transmission. The findings from this analysis can support treatment policy decisions for malaria elimination and be integrated into mathematical models to improve the accuracy of predictions regarding community transmission and the spread of drug resistance under varying treatment guidelines
Does life expectancy vary by disability status in LMICs?: A systematic review and meta-analysis.
Get PDFBACKGROUND: People with disabilities on average experience health care barriers, poorer health and higher mortality. OBJECTIVES: This study aims to review and synthesise life expectancy (LE) and years of life lost (YLL) comparing people with disabilities to those without in low and middle-income countries (LMICs). METHOD: A systematic review was conducted across six databases. Longitudinal studies with a comparator group that measured LE in or YLL between people with and without disabilities in LMICs were eligible for inclusion. Two reviewers independently assessed study eligibility, extracted data and assessed the risk of bias. Meta-analyses were undertaken using R 4.3.3. The study assessed heterogeneity with I2 and publication bias with a funnel plot. Sub-group and meta-regression analyses were performed, and the risk of bias was evaluated. RESULTS: Twelve full-text articles were included in this meta-analysis. The pooled mean LE was lower in people with disabilities (57.98 years; 95% confidence intervals [CI]: 53.40-62.95) compared with people without disabilities (70.86 years; 95% CI: 64.06-78.38). The overall weighted years of YLL in people with disabilities was 15.84 years (95% CI: 11.1-22.61). There was no significant difference in YLL between men (16.33 years; 95% CI: 11.49-23.21) and women (13.7 years; 95% CI: 8.45-22.22). CONCLUSION: The average LE in people with disabilities was substantially lower compared to those without disabilities in LMICs. This inequity highlights that health systems and public health efforts are failing to meet the needs of people with disabilities and must be improved to become more inclusive. CONTRIBUTION: The study emphasises the need for inclusive policies and robust research in the health system to address health disparities
Internet and telephone intervention to support patients discontinuing long-term antidepressants in primary care: the REDUCE research programme including RCT
Get PDFBackground: There is significant concern about increasing long-term antidepressant use in Western countries, much of which is not evidence-based. Median duration of treatment is more than 2 years in the United Kingdom, and more than 10% of adults are taking antidepressants, risking potentially significant adverse effects, particularly for older patients.
Objectives: To develop internet- and telephone-based support for practitioners and patients, through a process of co-design, and to determine its effectiveness and cost-effectiveness in helping people discontinue antidepressants without increasing depression, in a randomised controlled trial.
Design: Two systematic reviews (one qualitative); qualitative interviews with patients; qualitative interviews and focus groups with healthcare practitioners; co-production of online interventions with patients and practitioners; feasibility randomised controlled trial; definitive non-inferiority cluster randomised controlled trial with health economic evaluation; and quantitative and qualitative process evaluations. A booklet and video version of the patient intervention was also developed in Urdu.
Setting: Primary care (131 general practices in England and Wales).
Participants: Adults on antidepressant treatment for more than 1 year for a first episode of depression, or more than 2 years for recurrent depression, who were no longer depressed or judged to be at significant risk of relapse.
Interventions: Tailored internet support (ADvisor for patients, and ADvisorHP for health professionals), plus three telephone support calls from psychological well-being practitioners.
Primary outcome: Depressive symptoms on the Patient Health Questionnaire-9 items questionnaire at 6 months.
Secondary outcomes: Depressive symptoms over 12 months, antidepressant discontinuation, anxiety, quality of life, withdrawal symptoms, adverse events, mental well-being, patient enablement, patient satisfaction, health service use and costs over 12 months.
Sample size: The original sample size calculation gave a target of 402 patients for 90% power with one-sided significance of 2.5% to determine non-inferiority of the intervention, within 2 points on the Patient Health Questionnaire-9 items. This was reduced to 360 on finding a significant correlation between baseline and follow-up values for the Patient Health Questionnaire-9 items part-way through the trial.
Randomisation: Remote cluster randomisation of practices by computerised sequence generation, with minimisation by practice size, urban/rural location and deprivation index.
Blinding: Participants and researchers could not be blinded given the pragmatic open design, but self-complete measures avoided observer rating bias, and analyses were conducted blind.
Analyses: Linear mixed modelling was used to determine differences in outcomes, adjusting for previous depression, baseline outcome values, baseline anxiety, sociodemographic characteristics, and practice as a random effect. Primary analysis was performed by intention to treat, with per-protocol and complier-average sensitivity analyses. Multiple imputation was used to account for missing values.
Qualitative interviews: Semistructured topic guides were used for interviews and focus groups, informed by normalisation process theory, which were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis.
Results: Systematic reviews, qualitative interviews and focus groups indicated that barriers to discontinuing treatment include a fear of relapse of depression and withdrawal symptoms. If practitioners do not broach possible discontinuation, patients will usually continue treatment without questioning it. Patients wanted information on antidepressant mechanisms and effects, withdrawal symptoms and coping strategies. Practitioners wanted guidance on initiating discontinuation, antidepressant tapering regimens, and distinguishing withdrawal from relapse.
The definitive trial randomised 330 patients (5% of those approached; 178 in intervention practices and 152 in controls), of whom 275 (83%) were followed up at 6 months, and 240 (73%) at 12 months. Mean Patient Health Questionnaire-9 items scores were slightly higher among controls at 6 months [5.0 vs. 4.0; adjusted difference 1.07 (95% confidence interval 0.09 to 2.06; p = 0.033)]. Antidepressant discontinuation rates at 6 months were slightly higher in the intervention arm, but not significantly (45.5% vs. 41.9% in the control arm). Antidepressant withdrawal symptoms and mental well-being were significantly better in the intervention arm. There were no significant differences in anxiety, quality of life, adverse events, patient enablement, or satisfaction with care.
The adjusted mean cost of services used was lower in the intervention arm by −£69 (95% confidence interval −£77 to £207). The incremental cost-effectiveness ratio was a mean saving of −£2839 per quality-adjusted life-year gained (95% confidence interval −£30,024 to £22,227). The probability of the intervention being cost-effective compared to review alone, at the National Institute for Health and Care Excellence thresholds of societal willingness to pay of £20,000 and £30,000 per quality-adjusted life-year, was > 89% for both.
Qualitative interviews suggested advice to taper slowly, and information on the difference between relapse and withdrawal symptoms, contributed significantly to the success of the interventions.
Participants were well and willing to attempt antidepressant discontinuation, and general practitioners excluded people considered at high risk of relapse of depression. This may explain why more than 40% of participants in each arm discontinued. The results may not generalise to an unselected sample of people on long-term antidepressants, including people at greater risk of relapse.
Conclusions: Comparatively high rates of discontinuation of long-term antidepressants are achievable through enabling patients, who are ready to consider stopping them, to get tapering advice and support from their general practitioners. Tailored internet and psychologist telephone support may help protect patients coming off long-term antidepressants against depressive and withdrawal symptoms, and conserve mental well-being. The interventions appear highly cost-effective at thresholds for societal willingness to pay used by the National Institute for Health and Care Excellence.
Trial registration: Workstream 4 (feasibility trial) is registered as International Standardised Randomised Controlled Trial Number ISRCTN15036829 and Workstream 5 (definitive trial of effectiveness and cost-effectiveness) is registered as ISRCTN12417565.
Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-1214-20004) and is published in full in Programme Grants for Applied Research; Vol. 13, No. 7. See the NIHR Funding and Awards website for further award information
Navigating norms: a qualitative exploration of factors shaping contraceptive use in Senegal.
Get PDFINTRODUCTION: Despite the increasing contraceptive, women in Senegal are facing both material and social obstacles to access family planning (FP) services. Decisions regarding contraceptive use involve an interplay of influencers, including the woman, her partner, family members, healthcare providers, and the social norms in place. This study employs social norms theory to explore how these dynamics shape women's contraceptive choices, examining the societal expectations, influential relationships, and strategies women use.
METHODS: This qualitative study involved 256 participants (130 men and 126 women) from four regions of Senegal (Dakar, Tambacounda, Ziguinchor, and Matam). We employed semi-structured interviews (116) and focus group discussions (16 FGDs with 8-10 participants each) to explore experiences related to family planning access and services. Participants were recruited through purposive sampling. Thematic analysis was performed using NVivo 12 Pro.
RESULTS: Participants highlighted how social norms on marriage, infertility, and childbearing heavily influence women's contraceptive use decisions. Participants also mentioned social norms that directly discouraged contraception use, labeling women who used it as disloyal or unloving. The failure to fulfill normative expectations resulted in various forms of sanctions. Given the normative system, numerous women opted to make decisions regarding childbearing in secrecy. Finally, a system of beliefs that participants held about religion and healthcare providers intersected with contraceptive utilization.
DISCUSSION: Our findings provide evidence of the importance of integrating social interventions into FP interventions to help reframe social relations. Three policy implications arise: (1) Addressing broader social needs and support mechanisms. (2) Integrating insights from violence against women research and theories on the dynamics of abuse into FP programs. (3) Integrating men further into FP programming to address misconceptions.
CONCLUSION: Drawing on data from 256 young people, men, and women of reproductive age, we uncovered how women navigate the terrain of social norms within their networks, shaping their choices concerning contraceptive utilization
Assessing the quality of antimalarial drugs in Equatorial Guinea: a follow-up study.
Get PDFINTRODUCTION: Poor-quality antimalarial medications, including falsified and substandard formulations, pose significant public health risks, contributing to ineffective treatment and potential drug resistance. Our research conducted in 2013 on Bioko Island, Equatorial Guinea (EG), found 9.6% (n=61) of the artemisinin-containing antimalarials (ACAs) purchased were of poor quality. This study aimed to update the quality of all sold antimalarials and extend to include regions on the mainland. METHODS: A total of 637 samples, 564 ACAs and 73 non-ACAs, were purchased from 424 outlets on Bioko Island and mainland EG using a mystery client sampling approach. Samples were analysed for content using high-performance liquid chromatography with diode-array detection and classified as acceptable, substandard or falsified based on pharmacopoeia tolerance limits. Additionally, bioavailability was assessed through dissolution testing for a select number of samples. RESULTS: Overall, 40.5% of the samples were of acceptable quality, 31.2% were substandard and 28.3% were falsified. Regional differences showed a higher prevalence of falsified samples in Bata, Mangomo, Evinayong and Ebebiyín cities on the mainland (30.9%) compared with Bioko Island (25.6%). Artemether/lumefantrine, the first-line treatment for malaria in EG, showed 25.7% were of acceptable quality, 48.2% substandard and 26.1% falsified. Artemisinin monotherapy tablets had the highest rate of falsification (56.8%). For non-ACAs, 13.3% of sulfadoxine/pyrimethamine tablets were of acceptable quality, 48.9% substandard and 37.8% falsified. All quinine syrups were falsified, and most quinine tablets (87.5%) and injections (75.0%) were substandard. CONCLUSION: The prevalence of substandard and falsified antimalarials in EG has alarmingly increased from 9% in 2013 to 59.5% in 2018, highlighting the urgent need for enhanced regulatory measures. Immediate actions should include strengthening drug quality surveillance, particularly in private sector pharmacies, and implementing low-cost medicine screening methods for early detection of poor-quality medications. Ensuring the quality of antimalarials is critical to maintaining the efficacy of malaria control programmes and preventing the development of drug resistance
Barriers to HPV vaccination and cervical cancer screening in developing countries
Get PDFHuman papillomavirus (HPV) infection, a leading cause of cervical cancer in women, is a significant public health concern, especially in low-and middle-income countries (LMICs) where access to healthcare is limited. High HPV vaccination coverage is crucial for herd immunity against cervical cancer in LMICs. While developed countries have introduced a considerable amount of HPV vaccines (80%), the introduction in LMICs is low (41%) due to significant barriers that limit access to these essential health services in the region. This review identifies key obstacles and proposes targeted interventions to improve HPV vaccination uptake and cervical cancer screening in LMICs. This narrative review was carried out by searching various databases, such as PubMed, Scopus, Google Scholar, and Web of Science, as well as resources from health organizations like the World Health Organization (WHO), for articles on HPV vaccination and cervical cancer screening in LMICs, published between October 2005 and December 2024, using specific keywords. The review included English-language publications that met predefined criteria, facilitating secondary data analysis. Several barriers to HPV vaccination and cervical cancer screening services exist in LMICs, including limited healthcare infrastructure, insufficient health education, cultural and social norms, vaccine hesitancy, and inadequate governmental support. To address these challenges, recommended strategies include implementing sustainable financing, government subsidies, price negotiations with pharmaceutical companies, increasing healthcare facilities, fostering public-private partnerships, launching targeted awareness campaigns, engaging men in health education, and ensuring community involvement in decision-making processes. To achieve the WHO’s goal of eradicating cervical cancer by 2030, addressing barriers to cervical cancer screening and HPV vaccination in LMICs is crucial for lowering the cervical cancer burden and enhancing women’s health. Moreover, prioritizing equitable access to these essential services, especially for individuals in rural areas and those facing financial barriers, is necessary