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Conflation of prediction and causality in the TB literature.
Get PDFBACKGROUND: Observational data can answer both predictive and etiologic research questions; however, the model-building approach and interpretation of results differ based on the research goal (i.e., prediction versus causal inference). Conflation occurs when aspects of the methodology and/or interpretation that are unique to prediction or etiology are combined or confused, potentially leading to biased results and erroneous conclusions. METHODS: We conducted a rapid review using MEDLINE (2018-2023) of a subset of the observational TB literature: cohort studies among people with drug-resistant TB that considered HIV status an exposure of interest and reported on TB treatment outcomes. For each article, we assessed the research question, statistical approach, presentation of results, and discussion and interpretation of results. RESULTS: Among the 40 articles included, 32 (80%) had evidence of conflation. The most common specific types of conflation were recommending or proposing interventions to modify exposures in a predictive study and having a causal interpretation of predictors, with both types frequently co-occurring. CONCLUSION: Conflation between prediction and etiology was common, highlighting the importance of increasing awareness about it and its potential consequences. We propose simple steps on how TB and lung health researchers can avoid conflation, beginning with clearly defining the research question
Walking and wheeling in Low Traffic Neighbourhoods: A mixed methods study of mobility aid users’ interactions with changing public spaces
Get PDFLow Traffic Neighbourhoods (LTNs) seek to discourage car use by making vehicle journeys more circuitous, and to make active travel journeys safer and more pleasant, thus improving public health. LTNs have been adopted in urban areas across the UK, with implementation accelerated during the COVID-19 pandemic. Debates around LTNs often engage with the experiences of disabled people, and potentially varied impacts on people’s journeys and everyday lives. This paper draws ON data collected as part of a large mixed-methods study of LTN schemes in London to shed light on how the disruption of car dominance changes disabled people’s experiences of everyday walking and wheeling. Recognising that the restriction of motor traffic takes place within streetscapes already imbued with values and inequalities, we explore how disabled people using mobility aids interact with such changing infrastructures. We use quantitative analysis of video data to examine whether three new LTNs are associated with a change in the proportion of pedestrians using mobility aids. Qualitatively, we examine how such street interactions change following LTN introduction. The video findings are complemented by analysis of focus groups and interviews with disabled residents, offering diverse perspectives on the lived experiences of changing public spaces in and around LTNs
Differences in HIV-1 reservoir size, landscape characteristics, and decay dynamics in acute and chronic treated HIV-1 Clade C infection.
Get PDFPersisting HIV reservoir viruses in resting CD4 T cells and other cellular subsets are a barrier to cure efforts. Early antiretroviral therapy (ART) enables post-treatment viral control in some cases, but mechanisms remain unclear. We hypothesised that ART initiated before peak viremia impacts HIV-1 subtype C reservoirs. We studied 35 women at high risk of infection from Durban, South Africa, identified with hyperacute HIV by twice-weekly HIV-RNA testing. Participants included 11 starting ART at a median of 456 (297-1203) days post-onset of viremia (DPOV) and 24 at 1 (1-3) DPOV. Peripheral blood mononuclear cells (PBMCs) were used to measured total HIV-1 DNA by droplet digital PCR (ddPCR) and sequence viral reservoir genomes by full-length proviral sequencing (FLIP-seq). ART during hyperacute infection blunted peak viremia (p<0.0001), but contemporaneous total HIV-1 DNA did not differ (p=0.104). Over 1 year, a decline of total HIV-1 DNA was observed in early treated persons (p=0.0004), but not late treated. Among 697 viral genome sequences, the proviral genetic landscape differed between untreated, late treated, and early treated groups. Intact genomes after 1 year were higher in untreated (31%) versus late treated (14%) and early treated (0%). Treatment in both late and early infection caused more rapid decay of intact (13% and 51% per month) versus defective (2% and 35%) viral genomes. However, intact genomes persisted 1 year post chronic treatment but were undetectable with early ART. Early ART also reduced phylogenetic diversity of intact genomes and limited cytotoxic T lymphocyte immune escape variants in the reservoir. Overall, ART initiated in hyperacute HIV-1 subtype C infection did not impact reservoir seeding but was associated with rapid intact viral genome decay, reduced genetic complexity, and limited immune escape, which may accelerate reservoir clearance in combination with other interventional strategies
Towards a collaborative interdisciplinary systems approach to urban food system transformation: a case study from the Mandala research consortium.
Get PDFDespite the need to transform food systems to improve human and planetary health, the activities and actors of food systems remain largely intransigent to change. The Mandala research consortium offers a case study of how three methodological principles-interdisciplinary science, systems thinking and stakeholder collaboration-can be integrated to identify interventions with transformative potential in an urban food system. An existing conceptual framework was employed to interrogate the case study and reflect on the challenges and opportunities of its methods across two phases: (i) understanding the food system and identifying places to intervene; (ii) envisioning and prioritizing food system interventions. Ambitions to work across the breadth of the urban food system were supported by interdisciplinary science and stakeholder collaboration; tailoring the research process accommodated the epistemic, social, symbolic, spatial and temporal differences between stakeholders. A complex adaptive systems approach enabled identification of promising food system interventions. Nevertheless, challenges arose in every aspect of the work. A collaborative interdisciplinary systems approach to system transformation was articulated using a real-world example. While opportunities support the funding and design of research using a similar methodological approach, the documented challenges of adopting this approach may be overcome with practical solutions.This article is part of the theme issue 'Transforming terrestrial food systems for human and planetary health'
Effect of COVID-19 on livelihoods of people with and without disabilities: Results from a cross-sectional survey in 3 urban areas of Viet Nam.
Get PDFBackground: The COVID-19 pandemic has had widespread health, social and economic impacts worldwide. In many contexts, it has likely exacerbated existing inequalities.
Objective: This study compares the economic impacts of the COVID-19 pandemic amongst people with and without disabilities in Viet Nam.
Methods: A telephone survey was conducted in the three largest cities of Viet Nam (Da Nang, Ha Noi, and Ho Chi Minh City) between December 2021 and January 2022. Participants were recruited through convenience sampling (n = 898; 479 people with disabilities; 419 without). The survey collected data on livelihoods, employment, household economic security, and access to social protection and assistance.
Results: People with disabilities were three times more likely to have stopped working completely (PR: 2.8, 95 % CI: 2.0–4.0), 30 % more likely to report reduced earnings (PR: 1.3, 95 % CI: 1.2–1.5), twice as likely to report severe impacts on household finances (PR: 1.9, 95 % CI: 1.6–2.3) and three times more likely to report severe impacts on household food security (PR: 3.2, 95 % CI: 2.3–4.6) since the onset of the pandemic. Amongst people with disabilities, informal workers were particularly negatively affected. Households with members with disabilities were more likely to receive some types of COVID-19-related assistance (e.g. financial or food aid), but less likely to be enrolled in social insurance.
Conclusions: Urgent and inclusive responses are necessary during crises to address the unique challenges faced by people with disabilities. Implementing comprehensive social protection measures is crucial to narrowing disparities, and maintaining well-being and economic security during shocks such as COVID-19
The ratio of soluble fms-like tyrosine kinase 1 to placental growth factor predicts time to delivery and mode of birth in patients with suspected preeclampsia: a secondary analysis of the INSPIRE trial.
Get PDFBACKGROUND: The ratio of soluble fms-like tyrosine kinase 1 to placental growth factor is a useful biomarker for preeclampsia. Since it is a measure of placental dysfunction, it could also be a predictor of clinical deterioration and fetal tolerance to intrapartum stress.
OBJECTIVE: We tested the hypothesis that soluble fms-like tyrosine kinase 1 to placental growth factor ratio predicts time to delivery. Secondary objectives were to examine associations between the soluble fms-like tyrosine kinase 1 to placental growth factor ratio and mode of birth, fetal distress, need for labor induction, and birthweight z score.
STUDY DESIGN: Secondary analysis of the INSPIRE trial, a randomized interventional study on prediction of preeclampsia/eclampsia in which women with suspected preeclampsia were recruited and their blood soluble fms-like tyrosine kinase 1 to placental growth factor ratio was assessed. We stratified participants into 3 groups according to the ratio result: category 1 (soluble fms-like tyrosine kinase 1 to placental growth factor ≤38); category 2 (soluble fms-like tyrosine kinase 1 to placental growth factor >38 and <85); and category 3 (soluble fms-like tyrosine kinase 1 to placental growth factor ≥85). We modeled time from soluble fms-like tyrosine kinase 1 to placental growth factor determination to delivery using Kaplan-Meier curves and compared the 3 ratio categories adjusting for gestational age at soluble fms-like tyrosine kinase 1 to placental growth factor determination and trial arm with Cox regression. The association between ratio category and mode of delivery, induction of labor, and fetal distress was assessed using a multivariable logistic regression adjusting for gestational age at sampling and trial arm. The association between birthweight z score and soluble fms-like tyrosine kinase 1 to placental growth factor ratio was evaluated using multiple linear regression. Subgroup analysis was conducted in women with no preeclampsia and spontaneous onset of labor; women with preeclampsia; and participants in the nonreveal arm.
RESULTS: Higher ratio categories were associated with a shorter latency from soluble fms-like tyrosine kinase 1 to placental growth factor determination to delivery (37 vs 13 vs 10 days for ratios categories 1-3 respectively), hazards ratio for category 3 ratio of 5.64 (95% confidence interval 4.06-7.84, P<.001). A soluble fms-like tyrosine kinase 1 to placental growth factor ratio ≥85 had specificity of 92.7% (95% confidence interval 89.0%-95.1%) and sensitivity of 54.72% (95% confidence interval, 41.3-69.5) for prediction of preeclampsia indicated delivery within 2 weeks. A ratio category 3 was also associated with decreased odds of spontaneous vaginal delivery (Odds ratio [OR] 0.47, 95% confidence interval 0.25-0.89); an almost 6-fold increased risk of emergency cesarean section (OR 5.89, 95% confidence interval 3.05-11.21); and a 2-fold increased risk for intrapartum fetal distress requiring operative delivery or cesarean section (OR 3.04, 95% confidence interval 1.53-6.05) when compared to patients with ratios ≤38. Higher ratio categories were also associated with higher odds of induction of labor when compared to ratios category 1 (category 2, OR 2.20, 95% confidence interval 1.02-4.76; category 3, OR 6.0, 95% confidence interval 2.01-17.93); and lower median birthweight z score. Within subgroups of women a) without preeclampsia and with spontaneous onset of labor and b) women with preeclampsia, the log ratio was significantly higher in patients requiring intervention for fetal distress or failure to progress compared to those who delivered vaginaly without intervention. In the subset of women with no preeclampsia and spontaneous onset of labor, those who required intervention for fetal distress or failure to progress had a significantly higher log ratio than those who delivered vaginaly without needing intervention.
CONCLUSION: The soluble fms-like tyrosine kinase 1 to placental growth factor ratio might be helpful in risk stratification of patients who present with suspected preeclampsia regarding clinical deterioration, intrapartum fetal distress, and mode of birth (including the need for intervention in labor)
Molecular detection of African swine fever virus in pork and pork products and associated risk factors in the Philippines.
Get PDFAfrican swine fever (ASF) is a contagious hemorrhagic disease affecting both domestic and wild pigs with high mortality rate and severe socio-economic losses. Due to the virus' potential ability to remain infectious in suitable conditions and environments, it is imperative to identify risk factors that may contribute to its transmission. The Philippines' current ASF surveillance relies on pig blood samples. With this very limited epidemiological data, it is imperative to include raw meat and processed pork products due to high ASF transmission risks. In this study, a total of 384 raw pork and 384 processed pork products from selected wet markets were collected and detected the ASF virus (ASFv) VP72 gene using real-time polymerase chain reaction (rt-PCR), and the overall positivity rates were 10.16% and 10.68%, respectively. Moreover, an interview with wet market vendors was conducted, and the Least Absolute Shrinkage and Selection Operator (LASSO) regression was employed to identify possible factors associated with sample positivity. Results showed that ASFv-positive samples were linked to zoning status, rainy seasons, Longganisa preparation, selling different meat types, longer pork batches, and cleaning or disinfection in market stalls. Overall, ASFv contamination in pork and processed pork products can pose a threat to the swine industry, and market practices may further lead to ASFv persistence in these commodities which may contribute to ASF spread. Therefore, there's a need to address this risk by strict surveillance and proper handling procedures throughout the food supply chain
Factors associated with the uptake of cataract surgery among adults identified with operable cataract in South Western Uganda
Get PDFObjective: To determine the factors associated with the uptake of cataract surgery among adults identified with operable cataract in South Western Uganda.Methods: In a hospital-based cross-sectional study, patients presenting with operable cataract at two largetertiary level eye hospitals in south-western Uganda were prospectively consecutively enrolled between,October 2020 to January 2021. Operable cataract was defined, as a best-corrected visual acuity equal or less than 6/60 where the principal cause is cataract. The outcome of interest was undergoing a cataract surgery within 3 months of diagnosis. In a multivariable logistic regression model, we tested for social demographic and other baseline features associated with uptake of a cataract operation.Results: During the study period, a total of 400 patients with operable cataract were enrolled out of a totaloutpatient attendance of 1692 in the two hospitals (23.6%). The median age was 71 (IQR 65-80, full-range 30-102) and 222 (55.5%) were female. Most were married 242 (60.5%), the majority with no formal education 184 (46%).The most common occupation was being a peasant 256 (64%). The majority of the patients were householdheads 285 (71.2%) and a large proportion required an escort to the hospital 384 (87%). Bilateral operable cataract was present in 146 (36.5%). Within the study period, the uptake of cataract surgery was 64% 95% CI (59- 68). Ina multivariable logistic regression model, <50 years (OR 3.0, 95% CI (1.26 – 7.23) P-value = 0.021), female gender (OR 1.5, 95% CI (1.04 – 2.34) P-value=0.032) and bilaterally affected eyes (OR 2.95, 95% CI (1.8 – 4.8) P-value 0.001) were associated with uptake of cataract surgery.Conclusion: This study showed that younger patients compared to older ones, females compared to males and bilaterally affected patients compared to unilateral were more likely to uptake cataract surgery. This provides useful background information for planning improvements in the uptake of cataract services
The Three Musketeers, The Sequel, and The Novel Malaria Vaccines RTS, S AS01E and R21 Matrix M
Get PDFWHO recommended two novel vaccines, RTS,S AS01E and R21 Matrix M, against malaria caused by Plasmodium falciparum. For both vaccines, the recommended schedule is 4 doses starting from the age of 5 months, in children living in regions with moderate to high malaria transmission, with an optional 5 dose schedule for areas with highly seasonal malaria transmission