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Perceptions of academic leaders in low- and middle-income countries about the role of WFME in enhancing the quality of medical education
Get PDFDespite the significant proportion of medical schools located in low- and middle-income countries (LMICs), little is known about how educational leaders in these contexts perceive various roles of the World Federation for Medical Education (WFME) and its connection with the Educational Commission for Foreign Medical Graduates (ECFMG). This article aims to explore how the role of WFME is perceived by medical educators and accrediting body members in LMICs, including WFME Standards for Basic Medical Education (SBME), the recognition programme, and the challenges and motivations in adopting SBME and seeking WFME recognition. This qualitative study employed semi-structured interviews with ten senior medical educationalists and members of national accreditation bodies from Pakistan, Sri Lanka, the Philippines, and Indonesia. Thematic analysis was conducted using an inductive approach to identify key themes regarding perceptions of WFME as an organization, its recognition programme, and its standards. Eleven themes emerged from the analysis, the most prominent of which was a considerable conceptual uncertainty about WFME’s role and authority among participants. The relationship between WFME and ECFMG was frequently misunderstood, with recognition often viewed primarily as a mechanism to facilitate graduate mobility rather than to improve educational quality. While WFME standards were perceived as sufficiently broad to allow contextual adaptation, participants identified significant challenges including resource constraints and political pressures when implementing standards and pursuing recognition. This study demonstrates that the pursuit of WFME recognition by accreditation agencies in LMICs appears to be driven more by external pressures than by conviction about its intrinsic value for quality improvement. Greater clarity about WFME’s role, improved communication about the recognition process, and more explicit attention to the needs and contexts of LMICs could enhance the relevance and impact of these global medical education initiatives
Robust mission-driven responses to infectious disease threats delivered by the Abbott pandemic defense coalition.
Get PDFOBJECTIVES: Emerging infectious disease outbreaks present a continuous threat globally, and enhanced capacity to detect and mitigate these pathogens is urgently needed.
DESIGN: The Abbott Pandemic Defense Coalition (APDC) launched in 2021 as a first of its kind global public-private partnership dedicated to early detection, characterization, and response to emerging disease threats with the mission to reduce the burden of existing epidemics and the risk of future pandemics. The APDC has the capacity to both detect emerging infectious agents and respond by rapidly developing and deploying prototype diagnostics to assist in assessing the magnitude of the threat.
RESULTS: To date, the APDC network, with sites on 5 continents, has evaluated over 39,000 specimens from enrolled patients leading to the identification and characterization of 6 outbreaks and 23 previously unknown viruses that affect humans. The network has also trained 128 scientists in epidemiology, diagnostics, sequencing, and bioinformatics. As a result, the APDC has published 113 manuscripts, which are highlighted herein.
CONCLUSIONS: As emerging pathogens present increasing challenges to public health in a closely connected global community, the APDC is uniquely positioned to continue to serve a key role in pandemic preparedness
Empirical Comparison of Exposure Set Definitions in the Prevalent New‐User Design
Get PDFABSTRACT
Purpose
Prevalent new‐user (PNU) designs aim to provide a wider assessment of treatment effects by incorporating users of a newer study drug who previously received the comparator. Similarity in terms of prior use of the comparator is accounted for via exposure sets based on time in study, prior prescription number, or a hybrid incorporating both plus calendar time. Given a current lack of consensus, we examine choice of exposure set definition using a study investigating upper gastrointestinal bleeding (UGIB) risk between users of non‐steroidal anti‐inflammatory drugs (NSAIDs) and cyclooxygenase‐2 inhibitors (COX‐2is).
Methods
We identified a cohort of individuals with osteoarthritis initiating NSAIDs or COX‐2is between 2000 and 2004 from the UK Clinical Practice Research Datalink. Considering prescription‐based, time‐based, and hybrid exposure set definitions, we estimated time‐conditional propensity scores (TCPS) using conditional logistic regression and matched COX‐2i users 1:1 to NSAID users. Analyses estimated the hazard ratio (HR) of UGIB bleed comparing COX‐2i and NSAID users overall, in the incident new‐user and prevalent new‐user subgroups.
Results
We identified 100 185 individuals who received a prescription for either COX‐2is or NSAIDs; 25 742 patients were incident new‐users of COX‐2is and 17 952 were PNUs. Prescription‐ and time‐based exposure sets resulted in the highest proportion of COX‐2i users successfully matched (86% vs. 76% using hybrid definition). We observed variability in the point estimates obtained under the different exposure set definitions; however, conclusions remained consistent.
Conclusions
Given the potential for differences in the matched cohorts and substantive results obtained under different exposure set definitions, we encourage increased use of sensitivity analyses in PNU studies to explore the robustness of results to this decision
Examining the effects of climate and environmental hazards on vector and water-borne diseases in Eastern Uganda.
Get PDFBACKGROUND: Environmental hazards like floods, droughts and landslides pose serious public health and wellbeing consequences for populations, especially vulnerable communities in countries with low adaptive capacity. Empirical evidence from peer-reviewed literature and official climate change assessments indicates that, alongside high interannual climate variability, Uganda has experienced observable climate change over the past 50 years. This changing and increasingly variable climate poses challenges to population health in diverse ways, including through the transmission of infectious diseases. This study explored local perceptions of the impact of climate variability and change on the prevalence of infectious diseases like typhoid fever, malaria, and diarrhoeal diseases in three districts: Amudat, Bududa, and Katakwi in Eastern Uganda. Relatively few integrated and empirical studies have been conducted in Uganda to assess the specific climate-related health risks faced by local communities.
METHODS: A cross-sectional survey of 341 respondents was conducted to collect data from households. Data were collected using Kobo software, exported, cleaned and analysed with SPSS 28.0.
RESULTS: Populations in the three study districts perceived drought, floods, and landslides as significant hazards, though with varying levels of exposure, frequency, and severity. Strong associations were found between environmental hazards and occurrences of infectious diseases. Floods, significantly increased the reported prevalence of malaria (Chi-Square = 12.901, p 0.242) or typhoid fever (Chi-Square = 4.739, p > 0.192). Landslides were significantly associated with diarrheal diseases (Chi-Square = 7.846, p 0.457) or typhoid fever (Chi-Square = 3.277, p > 0.351). Most respondents experienced the negative interactive effects of multiple environmental hazards on their health status. The increased prevalence of diarrhea was attributable to floods, drought, and landslides; cases of typhoid fever were increased by floods rather than by drought or landslides. Malaria was more influenced by floods.
CONCLUSION: Environmental hazards affected population health in the three districts by increasing the risk of waterborne diseases, such as diarrhea, during severe droughts and landslides. Floods exacerbated waterborne and vector-borne diseases by creating ideal conditions for mosquito breeding and water contamination. There is an urgent need for multihazard-targeted interventions, including improved access to water, sanitation, and hygiene (e.g., regular handwashing with soap, safe water access and use, boiling water, proper sanitation, community WASH sensitization supported by local public health outreach), as well as disaster preparedness strategies, to reduce the health burdens of environmental hazards and enhance community resilience in these regions
Designing causal evaluations of analytics-prompted interventions in higher education: three case studies of interventions designed to improve wellbeing
Get PDFLearning analytics systems are increasingly used in higher education to monitor student engagement and identify those at risk of poor wellbeing. However, there is limited causal evidence on the effectiveness of student support interventions prompted by analytics. Drawing on three case studies from universities in England, this paper documents how randomised controlled trials can be feasibly designed and implemented within university settings to rigorously assess analytics-prompted interventions. It highlights some key considerations that should be reflected in the design of causal evaluations of interventions prompted by analytics, such as developing theories of change to practically inform the selection of outcomes. It also discusses the suitability of different trial designs, depending on whether new or existing interventions are being evaluated, evaluation pre-registration, and the value of complementing statistical studies of intervention’s effects with implementation and process evaluations
Serotype-specific pneumococcal invasiveness: a global meta-analysis of paired estimates of disease incidence and carriage prevalence.
Get PDFBACKGROUND: Serotype-specific estimates of pneumococcal invasiveness used in pneumococcal carriage transmission models to predict changes in disease incidence post-vaccination are largely derived from high-income settings. We conducted a systematic review of carriage prevalence and invasive pneumococcal disease (IPD) incidence to calculate case-carrier ratios (CCRs) in different income settings. METHODS: We conducted a systematic search of MEDLINE, Embase, and Global Health databases on March 14, 2022, to identify publications on pneumococcal carriage prevalence or IPD incidence; we requested individual-level data from authors of relevant texts. Serotype-specific CCRs, calculated as IPD incidence divided by carriage prevalence, were pooled across settings using random effects meta-analyses, stratified by before versus after pneumococcal conjugate vaccine (PCV) introduction, country income group, age group, sex, and HIV status. FINDINGS: We identified 80 publications from 18 countries (13 upper-middle-income countries [UMICS] or high-income countries [HICs], five low-income countries [LICs] or lower-middle-income countries [LMICs]) reporting carriage prevalence or IPD incidence in overlapping geographical areas, time periods, and age groups. We calculated CCRs for more than 70 serotypes, stratified by age group, income setting, and pre-PCV versus post-PCV introduction. In children younger than 5 years, pre-PCV CCRs for non-vaccine serotypes not included in the 13-valent PCV were higher in LICs and LMICs than in UMICs and HICs (177 [95% CI 124-251] vs 103 [60-176], respectively). Post-PCV CCRs for non-PCV13 serotypes dropped in UMICs and HICs (26 [22-30]) but not in LICs and LMICs (173 [139-216]). Pre-PCV versus post-PCV changes varied by serotype and age group. CCRs were lowest in 5-14-year-olds and were higher in HIV-positive than HIV-negative individuals. There were no differences in CCRs by sex. INTERPRETATION: Pneumococcal invasiveness varies by serotype, age group, country income group, HIV status, and over time; however, substantial variation remains unexplained. Our CCRs represent the most representative estimates of invasiveness currently available for use in statistical or mathematical prediction models of disease incidence, where only carriage prevalence data are available. FUNDING: Wellcome Trust
Incremental Carbon Footprint Effectiveness Ratio in Ophthalmology.
Get PDFThis Viewpoint describes the incremental carbon footprint effectiveness ratio (ICFER) as a measure to assess the environmental impact of interventions in terms of carbon footprint per quality-adjusted life-year
Addressing the balance between fairness and performance in glioma grade prediction using bias mitigation techniques.
Get PDFThis research paper investigates the impact of demographic biases, specifically race and gender, on machine learning-based glioma grading, using the TCGA data set compiled from The Cancer Genome Atlas. The study applies three common classifiers (logistic regression, random forests, and extreme gradient boosting) and explores pre-processing (reweighting) and post-processing (equalized odds) strategies for bias mitigation. It evaluates prediction performance metrics (Matthews correlation coefficient, recall, specificity) and fairness metrics (disparate impact, equal opportunity difference, error rate difference), highlighting the trade-offs between fairness and accuracy across different demographic groups. For the most severe bias (race), the pre-trained logistic regression model using the reweighting algorithm shows some deterioration in prediction outcomes for the under-represented group and even an increase in unfairness, while the post-processing approach improves results for the under-represented group and provides significant improvements in fairness. These results are interesting because they could be taken into account in real-world clinical decision-making or in outcomes for under-represented patient groups
Associations of common infections with frailty and mortality in two UK cohort studies.
Get PDFBACKGROUND: Some common infections are associated with poorer age-related health outcomes; however, findings are limited to a small number of pathogens and frequently inconclusive. This study aimed to expand the range of pathogens investigated in relation to frailty and mortality in older age.
METHODS: We investigated relationships between seropositivity for 18 viruses, bacteria and protozoa with concurrent frailty and prospective mortality in middle-aged and older adults within two UK population-based cohorts: UK Biobank (N = 9,427; aged 40-70 years) and MRC NSHD (N = 1,791; aged 60-65 years). Multiplex serological assays were used to identify seropositivity for each pathogen and frailty was assessed using a frailty index measuring the accumulation of age-related health deficits. Mortality was determined from linked administrative records.
RESULTS: Adjusting for sex, age, income and education, previous infection with Toxoplasma gondii ((β = 0.77%; 95% CI: 0.42, 1.11) and Helicobacter pylori (0.63%; 95% CI: 0.28, 0.97) were associated with higher frailty equivalent to 3.8 or 3.1 years of aging, as was inflammation-weighted pathogen burden (0.41%/SD, 95% CI: 0.25, 0.57; 0.42%/SD, 95% CI: 0.26, 0.58). Previous infection with Chlamydia trachomatis, human herpes simplex virus 1 and cytomegalovirus were associated with increased frailty after adjustment for sex and age, although relationships were confounded by socioeconomic circumstances. No common infections were robustly associated with mortality.
CONCLUSIONS: Our results indicate that infection with H. pylori and T. gondii, and the combined burden of infection may detrimentally impact ageing health. These pathogens may warrant targeting beyond current clinical measures to mitigate the development of frailty
Determinants and outcomes of ovarian cancer diagnosis following an emergency presentation: a systematic review.
Get PDFOBJECTIVE: This study aimed to identify the clinical and sociodemographic risk factors and compare cancer stage, treatment, and survival outcomes associated with ovarian cancer diagnosed following an emergency presentation versus other routes. METHODS: A systematic search of Embase and MEDLINE was conducted from January 2000 to August 2025, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (PROSPERO: CRD420251111636). Studies were included if they examined risk factors associated with ovarian cancer diagnosis following an emergency presentation. Studies were also included if they compared treatment or survival outcomes between those diagnosed after an emergency presentation and those diagnosed via other routes. The quality of the studies was assessed using the Newcastle-Ottawa scale. RESULTS: Of the 3499 studies identified, 12 met the inclusion criteria and included a total of 127,395 women. All of the studies were conducted in high-income countries. Older age and socioeconomic deprivation were the most common determinants of an ovarian cancer diagnosis following an emergency presentation, although most studies did not adjust for key confounders. This diagnostic route was associated with advanced tumor stage, lower rates of treatment, shorter intervals between diagnosis and treatment initiation, and poorer survival outcomes. While the included studies were at low risk of bias, substantial heterogeneity made cross-study comparison challenging, especially as contradictory findings between larger population-based studies and single-center studies were noted. CONCLUSIONS: Women diagnosed with ovarian cancer following an emergency admission have a poor prognosis in many high-income countries. Urgent concerted action is needed to both decrease the number of women diagnosed through this diagnostic pathway and increase their treatment rates to improve survival outcomes