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Crowdsourcing is Acceptable to Develop Pre-Exposure Prophylaxis Promotions in Alabama: A Qualitative Study with Sexual Minority Men and Sexual Health Providers.
Get PDFIntroduction:
Crowdsourcing engages the community to create and share solutions; this participatory method could be used to create effective pre-exposure prophylaxis (PrEP) promotions. We explored acceptability of using crowdsourcing to develop PrEP promotions among sexual minority men (SMM) and sexual health providers in Alabama.
Methods:
We conducted focus group discussions (FGDs) with SMM and interviews with sexual health providers with guides grounded in the Theoretical Framework of Acceptability. We employed thematic analysis through deductive and inductive coding.
Results:
Ten SMM (60% Black, 50% younger than 30 years) participated in FGDs, and six providers completed interviews. We found four themes: 1) Personal identity and background inform the participation and products of crowdsourcing, 2) SMM and providers are motivated to participate in crowdsourcing, 3) Crowdsourcing participants require resources to effectively engage, and 4) Logistic and social factors are barriers to crowdsourcing participation.
Discussion:
Crowdsourcing as a strategy to create PrEP promotions in the Southern United states would be acceptable and feasible in the correct context. These formative, yet novel, findings demonstrate that SMM and sexual health providers would be willing to participate in crowdsourcing events and also provide key insight to design crowdsourcing events
Extension Reports in Clinical Trials: A Systematic Review and Consequent Guidance.
No full textBACKGROUND: Following the primary publication of a clinical trial, questions of longer-term efficacy and safety remain unanswered. Investigators often have sequel publications based on extended follow-up; yet, no guidelines exist for such extension reports. OBJECTIVES: The purpose of this analysis was to assess the characteristics of extension reports of cardiovascular trials published in 7 high-impact medical journals METHODS: We searched MEDLINE to identify cardiovascular trial extension papers published between January 2019 and October 2023 in 7 high-impact medical journals. Extension reports were defined as those presenting additional follow-up data after publication of the primary results. Papers were screened by 2 reviewers before extracting data using a standard proforma. RESULTS: After screening 1,388 papers, 69 extension reports across 64 trials were identified. A variety of cardiovascular topics were covered, coronary heart disease (n = 20) being the most common. Interventions were medical devices, drugs, surgery, or treatment strategies. Duration of follow-up varied considerably, most common being an original 1-year report (n = 20) with extension at 2, 3, 5, or 10 years. Nearly all extension reports had a superiority hypothesis (n = 68). Most extensions (n = 53) examined the same primary outcome as the original publication. There were also 7 nonrandomized open-label extensions, which suffered from the lack of a concurrent control arm. In 18 reports, treatment crossovers were permitted during the extension, and in 16 cases, alternatives to analysis by intention to treat were utilized. One-half of the extension studies were prespecified (n = 38), and only 10 had dedicated protocols or statistical analysis plans. No study used multiplicity corrections to control type I error across the totality of evidence. Landmark analyses were common (n = 39) which, while descriptively useful, were not based on the original randomized groups. Considerable loss to follow-up (>10%) occurred in 10 of 50 extension reports with clear reporting of this issue. For some trials, the conclusions regarding treatment effects were altered by the extended follow-up. In a previous survey of cardiovascular trials published in the New England Journal of Medicine, Lancet, and Journal of the American Medical Association in 2019, we identified a total of 23 of 84 trials involving extensions in some form. CONCLUSIONS: This first systematic investigation into the reporting of extension studies found a great diversity in practice, noting several issues that need more adequate consideration. Considerations are provided on what trialists should consider when planning, conducting, and reporting extension studies
Time to fully account for cost in monitoring financial protection and universal health coverage in low- and middle-income settings.
Get PDFFinancial protection is a core pillar of universal health coverage (UHC), yet current monitoring approaches in low- and middle-income countries (LMICs) largely focus on direct medical costs, neglecting direct transport costs and indirect time costs lost when seeking care. This commentary highlights the importance of fully accounting for these often-excluded costs, which disproportionately affect poorer and rural populations and can significantly hinder access to essential health services and lead to foregone care. We outline five priority areas for action, including improved measurement of transport and time costs through household surveys, methodological advancements in valuing time, increased investment in primary health care to reduce physical access barriers, adaptation of financing schemes and social protection programs to cover non-medical costs, and a multisectoral approach to address structural determinants. Fully integrating these dimensions into financial protection metrics and policies is critical for ensuring more equitable progress toward UHC in LMICs
An outbreak of highly pathogenic avian influenza H5N1 could impact the dairy cattle sector and the broader economy in the United States.
Get PDFThe outbreak of Highly Pathogenic Avian Influenza H5N1 in U.S. dairy cattle poses substantial risks to public health, economic sustainability of farming, and global food systems. Using a Computable General Equilibrium model, we simulate its short- to medium-term impacts on Gross Domestic Product and other macro-economic outcomes for the US and its main trading partners. We simulate impacts under the current situation and realistic and reasonable worst-case scenarios. We estimate domestic economic losses ranging between 0.06% and 0.9% of US GDP, with losses to the dairy sector ranging between 3.4% and 20.6%. Trading partners increase dairy production to compensate for the loss. Current government subsidies are about 1.2% (95% HDI: 1% to 1.4%) of output losses, and likely insufficient to incentivise farmers to step up surveillance and biosecurity for mitigating the possible emergence of H5N1 strains with pandemic potential into human populations
Burden of typhoid fever and antimicrobial resistance in India (2023): a modelling study.
Get PDFBACKGROUND: India is one of the countries with a high typhoid fever burden. In 2022, the National Technical Advisory Group on Immunisation recommended including the typhoid conjugate vaccine (TCV) in the Universal Immunisation Programme. In this study, we aimed to estimate the 2023 burden of typhoid fever and its antimicrobial resistance (AMR) to inform targeted vaccine introduction strategies. METHODS: We used a decision tree model to estimate typhoid cases, hospitalisations, complications, and deaths. Incidence and clinical parameters were derived from a multicentre Indian study, with state-wise AMR prevalence from a systematic review. Two co-primary and four alternative scenarios were presented to validate the robustness of the findings. FINDINGS: We estimated 4.9 million (95% UI: 4.4-5.6) typhoid cases and 7850 (4300-14,900) deaths in India in 2023. Of 730,000 (534,000-970,000) hospitalisations, 600,000 (435,000-799,000; 82%) were attributable to fluoroquinolone-resistant. Under primary scenario A, children <5 years accounted for 321,000 (235,000-427,000; 44.0%) hospitalisations and 2600 (1300-4800; 34.0%) deaths. Under primary scenario B, 5-9 years of age accounted for 265,000 (135,000-278,000; 36.0%) hospitalisations and 2900 (1500-5300; 36.0%) deaths. Delhi, Maharashtra, and Karnataka together accounted for 29% of the national burden and had the highest rates of fluoroquinolone-resistant cases and deaths among the ten highest-burden states. Deaths linked to fluoroquinolone-resistance, multidrug resistance, third-generation cephalosporins, and azithromycin resistance were 4700 (1800-10,200), 122 (45-294), 183 (69-431), and 183 (68-432), respectively. INTERPRETATION: Fluoroquinolone-resistance drives a large share of typhoid-related hospitalisations and deaths, especially in children under five and in high-burden states of India. Targeted TCV introduction, with broader age coverage among children, would maximise impact. FUNDING: WISE programme; Vaccine Impact Modelling Consortium; Japan Agency for Medical Research and Development
Social science contributions to the global action plan on antimicrobial resistance.
Get PDFSince the adoption of the Global action plan on antimicrobial resistance in 2015,1 notable progress has been made in combating antimicrobial resistance. In 2024, 178 countries had developed multisectoral national action plans, with many drawing directly on the global action plan. However, only 20 of these countries have dedicated funding for implementation, 93 have a functioning multisectoral coordinating mechanism and 121 are implementing them. Furthermore, very few national action plans address inequities in adverse health and social consequences of antimicrobial resistance, including from gender, disability and human rights perspectives.
Current efforts to curb antimicrobial resistance have stalled. Without faster implementation of effective interventions, including antimicrobial stewardship, water, sanitation and hygiene infrastructure, therapeutics and vaccines, antimicrobial resistance is estimated to reduce global life expectancy by 1.8 years by 2035
Pathways to health: Reporting on health co-benefits from urban climate mitigation action varies by sector.
Get PDFWell-designed city actions to reduce greenhouse gas emissions can also deliver substantial near-term health co-benefits. Improved understanding and reporting of the health benefits from climate mitigation can aid efforts by cities to design and deliver healthy, equitable solutions to the climate crisis. Using global data from the 2022 CDP-ICLEI Track cities questionnaire, we analysed factors that may influence the awareness and identification of health co-benefits from climate mitigation. Actions from the transport and AFOLU sector were five to eight times more likely to report health co-benefits than other sectors, regardless of which region the action was undertaken. There was no significant difference between actions in the pre-implementation stage compared to actions that were underway. The findings highlight the need to raise awareness about the potential health benefits linked to climate mitigation among urban policymakers across all sectors to help deliver an equitable transition to a healthy, net zero future
Novel plant-based alternatives support nutritional adequacy of diets and reduce their environmental impacts
Get PDFBackground: Evidence suggests dietary shifts away from animal-sourced towards plant-based foods benefit health and the environment. While the United Kingdom’s (UK) meat consumption has decreased, further efforts are required to meet national targets. Novel plant- and fungi-based foods (NPBFs) could offer a straightforward alternative to animal-sourced foods with a similar sensory experience. However, their impact on nutrition, the environment and cost remain unclear.
Objective: We aimed to identify trade-offs and co-benefits of substituting specific animal-sourced foods with NPBFs in a UK minimally accepted “basic basket” (baseline) stratified by gender.
Methods: Nine new baskets were created to assess the nutritional, environmental and cost outcomes by substituting either all processed meats, milk or yogurt with NPBFs (most popular, nutritionally balanced, inexpensive). Foods from the “basic basket” were matched with the UK food composition table. NPBF nutritional data were collected from UK supermarkets using Open Food Facts. All foods were matched with dietary environmental footprints (greenhouse gas emissions, water and land use) from Clark et al. 2022. Prices were manually collected from UK supermarkets.
Results: Dietary environmental footprints decreased in all new baskets (-0.39 to -6.94%). Nutritional outcomes varied across new baskets, with most substitutions aligned with recommended weekly averages. Baskets with the most nutritionally balanced NPBFs showed minimal nutritional differences compared to the baselline. Notable micronutrient reductions occurred when replacing milk with the most inexpensive alternative. Nearly all dairy alternative substitutions lowered food basket costs, except for the most popular plant-based drink. All plant-based meats increased the cost.
Conclusions: When nutritional quality of individual NPBFs is considered, single targeted replacements of specific animal-sourced foods by NPBFs presents a powerful opportunity for health and environmental benefits, especially over processed meats. Without policies to improve NPBFs affordability, such shift at population level is unlikely, missing an opportunity to drive progress towards net zero and health targets
Performance evaluation of an operational dengue forecasting system (D-MOSS) in Vietnam.
Get PDFD-MOSS (Dengue forecasting Model Satellite-based System) was launched operationally in Vietnam in June 2019, providing near-real time dengue forecasts across all 63 provinces. Very few dengue forecasting systems have prospectively evaluated the performance of dengue forecasting under real-world operational conditions. This study comprehensively assesses D-MOSS dengue forecasting performance since operationalisation through both statistical accuracy (absolute dengue incidence, trajectory of incidence, timing of peaks), and operational utility (predictions for specific decision-making scenarios). The D-MOSS dengue forecasts in Vietnam outperformed null model baselines across almost all performance metrics.. While lead times of one month reported the highest accuracy, there was no steep linear decline in accuracy as lead times increased up to six months, and the greatest value-added over seasonal average baseline models was found for later lead times at four to six months. Higher value-added differences were observed for the second half of the year, but the unusually-early June dengue outbreak in 2022 provided a notable challenge. Spatially, larger errors were found in central and southern provinces, that report higher dengue incidence, alongside contrastingly greater value-added over null baseline models, particularly at shorter lead times. Four contextualised operational utility scenarios were tested through probabilistic classification of outbreak threshold exceedance, with accuracy ranging across probability cut-offs but peaking at 0.83 - 0.94 across scenarios.The value of waiting for the next month's forecast and utilising different outbreak thresholds was assessed, with heterogeneous results and the distribution of false alarms or missed outbreaks clustering spatially. The results of both the global performance analysis and utility assessments continue to highlight the strong predictive ability of D-MOSS in an operational setting. Lessons should be taken from the higher-than-expected performance over long-term horizons to improve our ability to forecast further into the future, amidst the key insights these results provide into the improvement of operational dengue forecasting for key decision-making situations in Vietnam and beyond
Abortion Ban and the Next Generation's Family Formation Decisions: Evidence from Romania.
Get PDFThis study examines how the introduction of an abortion ban can shape the next generation’s family formation trajectories, and whether the influence of the ban varies by gender and parental socioeconomic status (SES). Focusing on Romania’s abortion ban period under the Ceaușescu regime, we investigate changes in the probability of being married, the age at leaving the parental home and at first marriage, and spousal age characteristics. Using two complementary datasets, the 2011 Romanian census and the 2005 Generations and Gender Survey, and employing a regression discontinuity design, we find that compared to their counterparts born before the abortion ban, women born under the ban regime left their parental home later, formed their first marriage later, and had a lower probability of being married. This postponement effect was mainly driven by women with lower parental SES. Conversely, we do not observe significant changes in men’s family formation outcomes, except for a higher likelihood of marriage among men with higher parental SES who were born after the ban. The spousal age difference was smaller for both women and men born during the abortion ban. Findings show that abortion restrictions can have lasting effects not only on the individuals who are directly affected by them, but also on the next generation’s family formation trajectories