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Sustaining success through strategies for post-elimination management of neglected tropical diseases in African Union Member States
Get PDFThe elimination of Neglected Tropical Diseases (NTDs) has seen significant progress, with 22 African Union Member States having successfully eliminated at least one NTD. However, post-elimination management of NTDs remains a challenge. This article provides important insights into the challenges faced by African Union Member States after eliminating NTDs, including potential financial support withdrawal and risk of disease reemergence. We also discuss comprehensive strategies for post-elimination management, emphasising the importance of robust surveillance systems, capacity building, community engagement, and the integration of mental health services. We also advocate for a multisectoral approach to sustain elimination gains, aligning with global and regional health strategies. Our analysis underscores the necessity of continuous innovation in surveillance, the critical role of community health workers, the integration of NTD post-elimination management into broader health and development frameworks such as Universal Healthcare Coverage, and the need for innovative financing and partnerships to ensure the long-term success of NTD elimination efforts
Shift and night work in the fourth decade is associated with reduced brain volume in late life independent of amyloidogenic pathways: an Insight 46 study
Get PDFBackground: Sleep and circadian disruption are associated with increased dementia risk, yet the mechanism remains poorly understood. We examined the relationship between night/shift working in the fourth decade and late‐life brain health. We explored whether significant relationships were mediated by life course factors including cardiovascular risk.
Methods: Night/shift working (yes/no) was recorded prospectively at age 31. Smoking, alcohol intake, body mass index, exercise, blood pressure, and Framingham risk scores (FRS) were determined at 3‐6 timepoints across the life course (age 20, 36, 43, 53, 60‐64, 68‐70). Whole‐brain and hippocampal volumes, white matter hyperintensity volume (WMHV), and β‐amyloid PET SUVr were derived from T1, fluid‐attenuated inversion recovery, and 18F‐Florbetapir PET, respectively, at age ∼73.
Associations between night/shift working, life course cardiovascular risk factors, and imaging metrics were examined with linear regression. Causal mediation analysis (gformula approach in R), examined whether significant relationships between night/shift working and imaging metrics were mediated by life course cardiovascular risk factors. Analyses were adjusted for gender, adult socioeconomic status, educational attainment, age at imaging, and intracranial volume for volumetric measures.
Results: 432 participants had available data, of whom 74 (17.1%) were night/shift workers. Night/shift workers had lower whole brain volume (‐26.2 ml, 95% CI ‐39.3, ‐13.0, P < 0.001, Figure 1), without evidence of a significant difference in hippocampal volume, WMHV, or amyloid‐β SUVr. Night/shift workers had 0.6% higher FRS (95% CI; 0.23%, 0.91%; P = 0.001) and higher alcohol consumption age 36 (5.7 g/day, 95% CI, 0.3, 11.2, P = 0.04); higher alcohol consumption age 60‐64 (10.7 g/day, 95% CI, 4.5, 16.9; P < 0.001); and smoked an additional 5.7 pack‐years by age 60‐64 (95% CI 1.9, 9.4; P = 0.003, Figure 2). 35% of the brain volume reduction in shift workers was mediated by cardiovascular risk factors (Figure 3).
Conclusion: Shift working in the early 30s is associated with lower brain volume in late‐life independent of amyloidogenic pathways. While partially mediated by increased cardiovascular risk factors in night/shift workers, the majority of the effect is unexplained and may be a direct effect of night/shift working on brain health
Reemergence of Clade IIb-Associated Mpox, Germany, July-December 2023.
Get PDFIn July 2023, clade IIb-associated mpox reemerged in Germany at low levels, mainly affecting men who have sex with men. We report a representative case and phylogeny of available genome sequences. Our findings underscore the need for standardized surveillance and indication-based vaccination to limit transmission and help prevent endemicity
Developing a conceptual framework for the practical ethics of prescribing in medical school curricula.
Get PDFPrescribing medications has traditionally been conceptualised as a technical process and skill in medical education, failing to acknowledge broader social, political, and economic dimensions. Consequently it's ethical component is often overlooked. Existing educational approaches in medicine have predominantly covered ethics in abstract terms, which fail to equip students with an understanding of the complexity of ethical decision-making in real-world medical practice. This essay seeks to address this gap by proposing a conceptual framework to understand the practical ethics of prescribing in terms of its broader determinants. The authors emphasise the contextual factors that determine how ethical prescribing, and its coverage in medical curricula, can be defined. They propose that the framework outlined in this article can be the basis for cross-cultural dialogue. It can help tailor educational approaches and support future physicians in understanding and navigating the complex landscape that shapes their prescribing decisions
Prognostic significance of troponin in patients with malignancy (NIHR Health Informatics Collaborative TROP-MALIGNANCY study)
Get PDFBackground: Cardiac troponin is commonly raised in patients presenting with malignancy. The prognostic significance of raised troponin in these patients is unclear.
Objectives: We sought to investigate the relation between troponin and mortality in a large, well characterised cohort of patients with a routinely measured troponin and a primary diagnosis of malignancy.
Methods: We used the National Institute for Health Research (NIHR) Health Informatics Collaborative data of 5571 patients, who had troponin levels measured at 5 UK cardiac centres between 2010 and 2017 and had a primary diagnosis of malignancy. Patients were classified into solid tumour or haematological malignancy subgroups. Peak troponin levels were standardised as a multiple of each laboratory’s 99th -percentile upper limit of normal (xULN).
Results: 4649 patients were diagnosed with solid tumours and 922 patients with haematological malignancies. Raised troponin was an independent predictor of mortality in all patients (Troponin > 10 vs. <1 adjusted HR 2.01, 95% CI 1.73 to 2.34), in solid tumours (HR 1.84, 95% CI 1.55 to 2.19), and in haematological malignancy (HR 2.72, 95% CI 1.99 to 3.72). There was a significant trend in increasing mortality risk across troponin categories in all three subgroups (p < 0.001).
Conclusion: Raised troponin level is associated with increased mortality in patients with a primary diagnosis of malignancy regardless of cancer subtype. Mortality risk is stable for patients with a troponin level below the ULN but increases as troponin level increases above the ULN in the absence of acute coronary syndrome
Evaluation of a FlpA Glycoconjugate Vaccine with Ten N-Heptasaccharide Glycan Moieties to reduce Campylobacter jejuni Colonisation in Chickens.
Get PDFCampylobacter is a major cause of acute gastroenteritis in humans, and infections can be followed by inflammatory neuropathies and other sequelae. Handling or consumption of poultry meat is the primary risk factor for human campylobacteriosis, and C. jejuni remains highly prevalent in retail chicken in many countries. Control of Campylobacter in the avian reservoir is expected to limit the incidence of human disease. Toward this aim, we evaluated a glycoconjugate vaccine comprising the fibronectin-binding adhesin FlpA conjugated to up to ten moieties of the conserved N-linked heptasaccharide glycan of C. jejuni or with FlpA alone. The glycan dose significantly exceeded previous trials using FlpA with two N-glycan moieties. Vaccinated birds were challenged with C. jejuni orally or by exposure to seeder-birds colonised by C. jejuni to mimic natural transmission. No protection against caecal colonisation was observed with FlpA or the FlpA glycoconjugate vaccine. FlpA-specific antibody responses were significantly induced in vaccinated birds at the point of challenge relative to mock-vaccinated birds. A slight but significant antibody response to the N-glycan was detected after vaccination with FlpA-10×GT and challenge. As other laboratories have reported protection against Campylobacter with FlpA and glycoconjugate vaccines in chickens, our data indicate that vaccine-mediated immunity may be sensitive to host- or study-specific variables
The double burden of malnutrition in individuals: Identifying key challenges and re-thinking research focus.
Get PDFThe 'double burden of malnutrition' is a global health challenge that increasingly affects populations in both low- and middle-income countries (LMICs). This phenomenon refers to the coexistence of undernutrition and overweight or obesity, as well as other diet-related non-communicable diseases, in the same population, household or even individual. While noteworthy progress has been made in reducing undernutrition in some parts of the world, in many of these areas, the prevalence of overweight and obesity is increasing, particularly in urban areas, resulting in greater numbers of people who were undernourished in childhood and have overweight or obesity in adulthood. This creates a complex and challenging situation for research experts and policymakers who must simultaneously address the public health burdens of undernutrition and overweight/obesity. This review identifies key challenges and limitations in the current research on the double burden of malnutrition in individuals, including the need for a more comprehensive and nuanced understanding of the drivers of malnutrition, the importance of context-specific interventions and the need for greater attention to the food environment and food systems. We advocate for the re-evaluation of research strategies and focus, with a greater emphasis on multidisciplinary and systems approaches and greater attention to the synergistic relationship between the biological, environmental, commercial and socio-economic determinants of malnutrition. Addressing these key challenges can enable us to better comprehend and tackle the multifaceted and dynamic issues of the double burden of malnutrition, particularly in individuals and work towards more effective and sustainable solutions
The impact of informant-related characteristics including sex/gender on assessment of Alzheimer's disease symptoms and severity.
Get PDFAlzheimer's disease (AD) is a debilitating neurological disorder affecting millions of people worldwide. Early and accurate diagnosis of AD is crucial for accessing treatments (including clinical trials), planning for the future, and obtaining necessary services. Unfortunately, AD and other neurodegenerative diseases associated with cognitive impairment or behavioral changes, are frequently misdiagnosed or diagnosed at later stages. Experts recommend a multifaceted approach that integrates performance, informant, and self-report data to properly assess patients with neurodegenerative diseases (1). This approach allows clinicians to assess the presence and severity of cognitive disorders, establish a differential diagnosis, and formulate an effective treatment plan. Caregivers play a pivotal role in recognizing early signs of the disease, such as memory loss and behavioral changes. They provide valuable insights to healthcare providers, assisting in diagnosis and treatment (2). In contrast to conditions where self-reporting is standard, caregiver input is instrumental in AD assessments, especially in clinical trials where disease severity is a critical criterion and endpoint
Reaching the unreached through building trust: a mixed-method study on COVID-19 vaccination in rural Lao PDR.
Get PDFINTRODUCTION: The global COVID-19 vaccine rollout has been impacted by socioeconomic disparities and vaccine hesitancy, but few studies examine reasons for changed attitudes. In Lao People's Democratic Republic (Lao PDR), a nationwide government-led initiative was developed in response to COVID-19, focused on community health ownership and trust in primary healthcare. The intervention team including health and governance sectors conducted capacity-building workshops with local staff and community representatives and visited villages for vaccination outreach. This study investigates the impact of this intervention on COVID-19 vaccine acceptance in rural communities.
METHODS: Conducted in Xiengkhuang province, Lao PDR, from December 2022 to February 2023, the study employed a sequential mixed-methods research design. Data on vaccinated individuals from 25 villages were collected from 11 primary healthcare units; pre-post analysis was applied. Qualitative data, gathered through interviews and focus group discussions with villagers, village authorities, health staff and local government (n=102) in six villages, underwent inductive thematic analysis.
RESULTS: First-dose vaccine uptake after the intervention increased significantly (6.9 times). Qualitative analysis identified key reasons for vaccination hesitancy: (1) mistrust due to rumours and past experiences; (2) poor communication and inconsistent messaging and (3) challenges in access for priority groups. Influencing factors during the intervention included (1) effective local-context communication; (2) leveraging existing community structures and influential individuals in a multisectoral approach and (3) increased community motivation through improved satisfaction, ownership and relationships.
CONCLUSION: This study highlights the impact and methods of building trust with unreached populations in health interventions, emphasising locally led solutions. Successful reversal of vaccine hesitancy was achieved by addressing root causes and fostering ownership at community and local government levels through a 'positive approach'. This diverges from conventional supplemental immunisation activities and holds potential for systematically building trust between unreached populations and health systems. Further research could explore the impacts of routine vaccination for sustained improvements in health equity
Body mass index and cardiorenal outcomes in the EMPEROR-Preserved trial: Principal findings and meta-analysis with the DELIVER trial.
Get PDFAims: Both low and high body mass index (BMI) are associated with poor heart failure outcomes. Whether BMI modifies benefits of sodium–glucose cotransporter 2 inhibitors (SGLT2i) in heart failure with preserved ejection fraction (HFpEF) requires further investigation.
Methods and results: Using EMPEROR-Preserved data, the effects of empagliflozin versus placebo on the risks for the primary outcome (hospitalization for heart failure [HHF] or cardiovascular [CV] death), change in estimated glomerular filtration rate (eGFR) slopes, change in Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS), and secondary outcomes across baseline BMI categories (<25 kg/m2, 25 to <30 kg/m2, 30 to <35 kg/m2, 35 to <40 kg/m2 and ≥40 kg/m2) were examined, and a meta-analysis conducted with DELIVER. Forty-five percent had a BMI of ≥30 kg/m2. For the primary outcome, there was a consistent treatment effect of empagliflozin versus placebo across the BMI categories with no formal interaction (p trend = 0.19) by BMI categories. There was also no difference in the effects on secondary outcomes including total HHF (p trend = 0.19), CV death (p trend = 0.20), or eGFR slope with slower declines with empagliflozin regardless of BMI (range 1.12–1.71 ml/min/1.73 m2 relative to placebo, p trend = 0.85 for interaction), though there was no overall impact on the composite renal endpoint. The difference in weight change between empagliflozin and placebo was −0.59, −1.48, −1.54, −0.87, and − 2.67 kg in the lowest to highest BMI categories (p trend = 0.016 for interaction). A meta-analysis of data from EMPEROR-Preserved and DELIVER showed a consistent effect of SGLT2i versus placebo across BMI categories for the outcome of HHF or CV death. There was a trend toward greater absolute KCCQ-CSS benefit at 32 weeks with empagliflozin at higher BMIs (p = 0.08).
Conclusions: Empagliflozin treatment resulted in broadly consistent cardiac effects across the range of BMI in patients with HFpEF. SGLT2i treatment yields benefit in patients with HFpEF regardless of baseline BMI