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The attribution of human health outcomes to climate change: a transdisciplinary guidance document.
Get PDFFor over 30 years, detection and attribution (D&A) studies have informed key conclusions in international and national assessments of climate science, providing compelling evidence for the reality and seriousness of the human effects on the global climate. In the early 21st century, D&A methods were adapted to assess the contribution of climate change to longer-term trends in earth system processes and extreme weather events. More recently, attribution research helped quantify the health and economic impacts of climate change. Here we provide guidance for transdisciplinary collaboration in designing, conducting, interpreting, and reporting robust and policy-relevant attribution analyses of human health outcomes. This guidance resulted from discussions among experts in health and climate science. Recommended steps include co-developing the research question across disciplines; establishing a transdisciplinary analytic team with fundamental grounding in the core disciplines; engaging meaningfully with relevant stakeholders and decision-makers to define an appropriate study design and analytic process, including defining the exposure event or trend; identifying, visualizing, and describing linkages in the causal pathway from exposure to weather/climate variables to the health outcome(s) of interest; choosing appropriate counterfactual climate data, and where applicable, to evaluate the skill of the climate and process or empirical health model(s) used in D&A research; quantifying the attributable changes in climate variables; quantifying the attributable health impacts within the context of other determinants of exposure and vulnerability; and reporting key results, including a description of how recommendations were incorporated into the analytical plan. Implementation of guidance would benefit diverse stakeholders including researchers, research funders, policymakers, and climate litigation by harmonizing methods and increasing confidence in findings
Climate change exacerbates inequalities between small-scale and large-scale farmers in South Africa’s fruit export market
No full textFood production and consumption patterns disproportionately impact climate change, biodiversity, land use, water, and soil. To reverse these impacts, a sustainable food system has been promoted and within this, a planetary health diet, which simultaneously promotes human health and ecosystem health, has been recommended. This study adapts the framework developed by the Sustainable Development Commission (SDC) to explore the sustainability challenges of fruit production for the export markets in the context of a global increase in the demand for fruits following the recommendation of the planetary health diet. The study focuses on South Africa, one of the top global exporters of fruits, and considers a set of values within the SDC sustainability framework, namely social, environmental, economic, and governance. The analysis relies on primary qualitative data collected through interviews with experts in South Africa and is complemented with quantitative secondary data. The findings show that the production of fruits for the export markets exacerbates water resource depletion due to shifts in international demand towards water-intensive fruits such as avocados. It also contributes to further increase the inequality between commercial and small-scale farmers in the country. Sustainability enablers include the economic benefits for rural communities through the provision of jobs, mainly in avocado farms
Measuring population health impact of the Trump administration's withdrawal from WHO and cuts to USAID: time to start counting.
Get PDFVideo Clips of the Dietary Approaches to Stop Hypertension Diet on YouTube: A Social Media Content Analysis.
No full textBACKGROUND: YouTube is among the most highly used internet video sharing platforms worldwide. OBJECTIVE: The aim in this study was to conduct a social media content analysis of Dietary Approaches to Stop Hypertension (DASH) diet videos on YouTube. METHODS: Specific search parameters were input into YouTube, and 101 videos were evaluated for quality and viewer exposure/engagement metrics independently by 3 content experts using the DISCERN instrument, a 16-item instrument designed to assess quality, reliability, and dependability of an online source. Scores were aggregated for analysis. RESULTS: The majority (n = 69, 68.3%) of the videos were categorized as educational and came from a nonprofit source (n = 35, 34.7%). Although multiple speakers were the most frequent speaker type (n = 30, 29.7%), influencers/actors, dietitians, and healthcare providers were relatively equally distributed across the category (25.7%, 22.8%, and 21.8% respectively). Correlation analysis evaluating video's views, comments, and likes indicates that these video metrics are not correlated with video quality. However, the length of video was moderately and positively associated (P = .01) with the 4 DISCERN parameters of quality. CONCLUSION: Study findings suggest that videos on DASH diet offered via YouTube could potentially be an inexpensive venue to promote healthful dietary practices and educate clients. Existing YouTube content on DASH diet demonstrates significant variability in quality ratings based on DISCERN. Providers should direct individuals to engage with high-quality educational DASH diet videos on YouTube that are created with qualified health professionals and are shared by reputable institutions
Tuberculosis and the climate crisis in Latin America: a predicament of poverty, migration and displacement.
Get PDFNon-communicable diseases, psychosocial wellbeing, and quality of life in Ga Mashie, Accra, Ghana: analysis from a community-based cross-sectional study.
Get PDFBACKGROUND: The burden of non-communicable diseases (NCDs), such as diabetes, hypertension, and obesity, is increasing globally, particularly in low- and middle-income countries. This has implications for physical, psychological and social aspects of health and wellbeing among individuals living with NCDs. This study sought to examine relationships between NCDs, quality of life (QoL) and psychosocial wellbeing in the urban community of Ga Mashie, Accra, Ghana. METHODS: A representative household survey was conducted among adults aged 25 years and over in Ga Mashie. Data were collected on self-reported NCD diagnoses and objectively measured random blood glucose, blood pressure and anthropometrics; sociodemographic characteristics; and health-related QoL and psychosocial wellbeing. Relationships between QoL, psychosocial wellbeing and diabetes, hypertension and obesity were examined using bivariate analyses and multivariable regressions comparing outcomes to those who did not have any of these conditions or any other self-reported NCD diagnosis. RESULTS: Data were gathered from 854 adults. Individuals with diabetes, hypertension and obesity had significantly reduced measures of QoL outcomes compared to those without these conditions or any other reported NCD. In particular, they were significantly less likely to report being satisfied or very satisfied with their health [Risk Ratios: 0.79 (95% CI: 0.63-0.98), 0.87 (95% CI: 0.79-0.95) and 0.87 (95% CI: 0.77-0.97) for diabetes, hypertension, and obesity, respectively]. They also had lower scores in the physical health domain of QoL compared to those with no known NCD [diabetes β -8.27 (95% CI: -13.55- -2.99); hypertension - 2.32 (95% CI: -4.84-0.21) and obesity - 2.74 (95% CI: -5.15- -0.32)]. Compared to the healthy comparison group, differences were more pronounced among those with a prior diagnosis of diabetes or hypertension than among those identified with raised blood glucose or raised blood pressure in our survey, but no prior diagnosis. Differences in indicators of psychosocial wellbeing such as social support, and psychological distress were not observed. CONCLUSION: Diabetes, hypertension and obesity were associated with reduced QoL in Ga Mashie, Ghana. Further studies are needed to understand factors that influence health-related QoL among adults with NCDs, how these change over time, and to identify potential coping mechanisms that may influence this association
Development of the natural history component of an early economic model for primary sclerosing cholangitis.
Get PDFBACKGROUND: Primary sclerosing cholangitis (PSC) is a rare, chronic cholestatic disease that can progress to cirrhosis and liver failure. The natural history of PSC is variable as liver enzymes and liver symptoms fluctuate over time. Several drugs for PSC are under investigation, but there are currently no economic models to evaluate the cost-effectiveness and value of new treatments. The objective of this study was to develop an early economic model for PSC and validate the natural history component. METHODS: A lifetime horizon Markov cohort model was developed to track the progression of adults with PSC with or without inflammatory bowel disease. Based on relevant literature and clinical expert advice, fibrosis staging was used to model disease progression. Evidence on disease progression, mortality, PSC-related complications, and secondary cancers was identified by literature searches and validated by interviews with clinical and cost-effectiveness modelling experts. Model outcomes were overall survival and transplant-free survival years, and the proportions of patients receiving liver transplants, 2nd liver transplants after recurrent PSC (rPSC), and developing rPSC after liver transplantation during their lifetime. Cumulative incidence of secondary cancers and quality-adjusted life-years (QALYs) were also tracked. RESULTS: Model outcomes are in line with estimates reported in literature recommended by clinical experts. Overall survival (95% uncertainty interval [UI]) was estimated to be 25.0 (23.2-26.3) years and transplant-free survival was estimated to be 22.0 (20.2-23.6) years. The estimated proportion (95% UI) of patients receiving first liver transplants was 14.5% (11.6-17.1%), while the proportion of patients developing rPSC and receiving 2nd liver transplants after rPSC was 24.2% (20.4-28.0%) and 21.6% (12.9-29.7%), respectively. The cumulative incidence (95% UI) of cholangiocarcinoma, colorectal cancer, and gallbladder cancer were estimated at 5.2% (2.1-10.0%), 3.6% (1.4-5.4%), and 3.3% (1.2-7.6%), respectively. Discounted lifetime QALYs per patient (95% UI) were estimated at 16.4 (15.6-17.1). CONCLUSIONS: We have developed a model framework to simulate the progression of PSC with estimates of overall and transplant-free survival. This model, which calibrates well with existing estimates of disease progression, may be useful to evaluate the clinical and economic benefits of future treatments
Long-term risk of psychiatric disorders in childhood and adolescence following neonatal invasive group B Streptococcus disease-A Danish cohort study.
Get PDFOBJECTIVES: The long-term risk of child and adolescent psychiatric disorders (PDs) after neonatal invasive group B Streptococcus disease (iGBS) and the modifying factors are poorly understood. METHODS: A population-based matched cohort study, including 1548 infants with iGBS diagnosed during the first 3 months of life from 1997 through 2020 and follow-up until 2022, based on data from Danish national health and administrative registers. A general population comparison cohort of infants without iGBS was randomly sampled and matched 1:10 by sex, the child's birth year and month, and gestational age (n= 15,345). RESULTS: The cumulative incidence proportion (CIP) with 95% confidence intervals (CIs) of any PD was 21.1% (95% CI 18.7-23.7) in infants exposed to iGBS (88% sepsis, 12% meningitis) and 16.2% (95% CI 15.5-17.0) in the comparison cohort. The 18-year CIP of PD was higher for infants exposed to iGBS meningitis compared to iGBS sepsis. The adjusted hazard ratio for PD in infants with iGBS was 1.41 (95% CI 1.23-1.62). CONCLUSIONS: iGBS in early infancy is a risk factor for PDs, especially iGBS meningitis. Premature birth, gestational diabetes, and low maternal education increased the risk of any PD further. SUMMARY: Group B Streptococcus (Streptococcus agalactiae) remains the leading cause of neonatal, invasive disease and is associated with high mortality and risk of neurodevelopmental impairments. Scarce data exist regarding the long-term risk of psychiatric disorders following invasive group B Streptococcus disease in early infancy (iGBS), especially following sepsis. In this Danish national cohort study, we investigated the association of iGBS and the risk of psychiatric disorders until adolescence and early adulthood. We investigated to which extent premature birth, sex (at birth), maternal socioeconomic position or gestational diabetes were modifying the association between iGBS and psychiatric disorders. Our study found an increased risk of psychiatric disorders persisting into adolescence following iGBS, including both meningitis and sepsis. Specific psychiatric disorders with elevated risk included anxiety, obsessive-compulsive disorder, autism, and attention deficit hyperactivity disorder. Premature birth, maternal gestational diabetes, and low maternal education further increased the risk of any psychiatric disorders, whereas the child's sex did not