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Navigating Scientific Progress in Radiation Oncology: Comprehensive Analysis of Clinical Trials From the Past Two Decades Using the ClinicalTrials.gov Database.
Get PDFPURPOSE: Oncology has experienced substantial growth in clinical trial activity over the past two decades, but a comprehensive evaluation of radiation oncology research is lacking. This study analyzed trends in radiation therapy trials using data from ClinicalTrials.gov. MATERIALS AND METHODS: A comprehensive analysis was conducted on 4,253 radiation oncology trials registered in the database. Key outcomes examined included trends in trial activity over time, the geographic distribution of trials, and the phases of clinical trials conducted. RESULTS: Clinical trial activity in radiation oncology has increased significantly, with 4,253 trials registered by February 2024. Digestive, CNS, and head and neck cancers accounted for 49.7% of studies. Research on oligometastasis emerged in the past decade (2.2%), while hematology trials declined (9.7%). Phase II trials dominated (51.3%), with most originating in North America (58.2%). Europe (21.2%) and Asia (25.2%) have shown increasing contributions, reflecting a global shift. Only 6% of trials received industry funding, highlighting the financial challenges in the field. CONCLUSION: These findings underscore the dynamic nature of radiation oncology research and the need to address regional disparities, advance novel technologies and drug-radiotherapy combinations through phase I and III trials, and increase industry investment
Intestinal parasite infection in non-human primates from The Gambia, West Africa, and their relationship to human activity.
Get PDFIn many areas of The Gambia, West Africa, population crowding in a degraded environment has forced close interactions of diurnal primate species with humans. We assessed intestinal parasitic infection prevalence and diversity in 4 diurnal non-human primate (NHP) species, Chlorocebus sabaeus, Erythrocebus patas, Papio papio and Piliocolobus badius across 13 sampling sites. The effect of human activity, determined by the human activity index, and NHP group size on parasite richness was assessed using a generalized linear mixed model (GLMM). The most common protozoa identified were Entamoeba coli (30%) and Iodamoeba buetschlii (25%). The most common helminths were Strongyloides fuelleborni (11%), Oesophagostomum spp. (9%) and Trichuris trichiura (9%). Two of six (6%) Cyclospora spp. infections detected sequenced as Cyclospora cercopitheci (both in C. sabaeus). The more arboreal P. badius trended towards a lower prevalence of intestinal parasites, although this was not statistically significant (χ2P = 0.105). Human activity or group size did not have any significant effect on parasite richness for P. badius (P = 0.161 and P = 0.603) or P. papio (P = 0.817 and P = 0.607, respectively). There were insufficient observations to fit a GLMM to E. patas or C. sabaeus. Our reports present the richness and diversity of intestinal parasites in 4 diurnal NHPs in The Gambia, West Africa. Despite desertification and habitat loss, our results indicate that the prevalence and diversity of intestinal parasites in Gambian NHPs are seemingly unaffected by human activity. Further investigation with a larger dataset is required to better elucidate these findings
Infectious diseases burden and antibiotic prescribing patterns among primary care patients in Harare, Zimbabwe - a cross-sectional analysis.
Get PDFLow- and middle-income countries (LMIC) continue to experience a high burden of infectious diseases and disparities in access to and use of antimicrobials, yet data on antibiotic prescribing in outpatient settings, where the majority of global prescriptions occur, remain scarce. The objective of this study is to provide data on diagnoses and antibiotic prescriptions among primary care patients in Harare, Zimbabwe. We conducted a retrospective study of medical records from eight primary care clinics in Harare, Zimbabwe. Clinics were selected based on the population they served and the availability of records. Patient consultations conducted between January 2016 and December 2022 were included. Antibiotic prescriptions were categorised into groups according to the AWaRe (Access, Watch and Reserve) classification. During the study period, 199,880 patient consultations were recorded. The median patient age was 9 years and 52.5% (105,035/199,880) were female. The most common causes of presentation were due to infectious diseases including, in order of frequency, gastroenteritis (15.2%; 30,352/199,880), acute respiratory infections (10.9%; 21,381/199,880) and pneumonia (10.5%; 20,889/199,880). Overall, antibiotics were prescribed in 70.5% (117,674/166,858) of patients who were not referred to hospital. Antibiotics commonly prescribed were amoxicillin (39.4%; 65,825/166,858), ciprofloxacin (10.3%; 17,162/166,858), metronidazole (9.4%; 15,681/166,858). Among those who were prescribed antibiotics and not referred, 70.6% (83,034/117,674) were prescribed 'Access' and 29.3% (34,472/117,674) 'Watch' group antibiotics. Patients with respiratory infections, including those with upper respiratory infections, and gastroenteritis were frequently prescribed antibiotics. This study shows that infectious diseases remain a common reason for primary care presentation and antibiotics were frequently prescribed. These findings highlight the need for increasing access to diagnostics in primary care, and for antibiotic stewardship and other context-adapted interventions aimed at optimising patient management and reducing unnecessary antibiotic prescriptions
Experiences and self-care efforts among female sex workers in Nairobi, Kenya, during COVID-19
Get PDFBackground: Although the COVID-19 measures were aimed at the public good, they resulted in massive economic disruptions. We explored female sex workers’ (FSWs) experiences and self-care efforts following the deployment of COVID-19 containment measures in Nairobi, Kenya. Methods: Forty-seven women drawn from 1003 FSWs enrolled in the Maisha Fiti Longitudinal Mixed-Methods Study participated. An in-depth interview tool was used to capture FSW’ experiences and coping strategies during the COVID-19 pandemic after the Kenya government imposed containment measures that affected work, parenting, alcohol and substance use, exposure to violence, reproductive health service utilization, and mental health. All interviews were audio-recorded and transcribed verbatim. The data were thematically analysed and managed using Nvivo 12 software. Results: The findings show that FSWs suffered major economic loss following the COVID-19 containment measures that limited their movements and locked them out of sex work locations. Being mothers and daily wage earners, women reported challenges actualizing self-care goals for themselves and their children. Due to income loss, increased vulnerability to food and housing security, and mental distress were commonly reported. Specific behavioural actions to prevent contracting COVID-19 in the context of sex work were limited, due to women's inability to maintain social distance from clients. Conclusion: While the COVID-19 containment measures were intended to protect the public's health, they resulted in significant economic disruption for FSWs, which affected their ability to care for themselves and their children. Addressing the social determinants of sex work and discriminatory exclusionary practices is important for meeting the self-care needs of marginalised populations, especially FSWs and their families
Routine Cerebral Embolic Protection during Transcatheter Aortic-Valve Implantation.
Get PDFBACKGROUND: Transcatheter aortic-valve implantation (TAVI) is associated with procedure-related stroke. Cerebral embolic protection (CEP) devices may reduce embolization to the cerebral circulation and hence the incidence of stroke. METHODS: We conducted a randomized, controlled trial across 33 centers in the United Kingdom. We randomly assigned 7635 participants with aortic stenosis in a 1:1 ratio to undergo TAVI with a CEP device (CEP group) or TAVI without a CEP device (control group). The primary outcome was stroke within 72 hours after TAVI or before discharge from the hospital (if discharge occurred sooner). RESULTS: A total of 3815 participants were assigned to the CEP group and 3820 to the control group. A primary-outcome event occurred in 81 of 3795 participants (2.1%) in the CEP group and in 82 of 3799 participants (2.2%) in the control group (difference, -0.02 percentage points; 95% confidence interval, -0.68 to 0.63; P = 0.94). Disabling stroke occurred in 47 participants (1.2%) in the CEP group and in 53 (1.4%) in the control group. Death occurred in 29 participants (0.8%) in the CEP group and in 26 (0.7%) in the control group. Overall access-site complications appeared to be similar in the two groups (8.1% in the CEP group and 7.7% in the control group). A total of 24 serious adverse events occurred in 22 of 3798 participants (0.6%) in the CEP group, and 13 serious adverse events occurred in 13 of 3803 participants (0.3%) in the control group. CONCLUSIONS: Among participants undergoing TAVI, routine use of CEP did not decrease the incidence of stroke within 72 hours. (Funded by the British Heart Foundation and Boston Scientific; BHF PROTECT-TAVI ISRCTN Registry number, ISRCTN16665769.)
Measures of diabetic retinopathy treatment coverage: protocol for a methodological review.
Get PDFINTRODUCTION: Diabetic retinopathy is one of the leading causes of vision impairment globally. Alongside the systemic control of diabetes and timely detection of diabetic retinopathy, the prompt initiation and completion of treatment is essential to prevent vision loss. Routine monitoring of access to retinal screening services for the detection of diabetic retinopathy is common, while monitoring of coverage of subsequent treatment services is far less common. When diabetic retinopathy treatment coverage is assessed, there is great variability in how it is defined and reported. If a definition of treatment coverage could be standardised, the monitoring of the quality of diabetes eye care could more readily be compared between settings and over time. The aim of this review is to summarise how diabetic retinopathy treatment coverage has been measured in published studies and the extent to which these have been disaggregated by population groups. METHODS AND ANALYSIS: A search will be conducted on Medline and Embase without any language restrictions, for cohort and cross-sectional studies published from 1 January 2015 that report diabetic retinopathy treatment coverage for adults with diabetic retinopathy and/or macular oedema. We will include studies from any world region reporting diabetic retinopathy treatment coverage for one or more of: (1) laser photocoagulation; (2) intravitreal injections of antivascular endothelial growth factor agents; (3) intravitreal injections of corticosteroids; (4) vitrectomy. The PROGRESS framework (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status and social capital) will be used to assess disaggregation by population groups. Two investigators will independently screen studies and extract relevant data. Data will be synthesised descriptively to outline the full range of definitions of diabetic retinopathy treatment coverage in the literature and identify the common sources of data used. ETHICS AND DISSEMINATION: This review will only include published data; thus, no ethical approval will be sought. The findings of this review will be published in a peer-reviewed journal and presented at relevant conferences. The findings will also be considered in conjunction with an ongoing review on retinal screening for diabetic retinopathy to develop indicators for monitoring of services along the diabetes eye care pathway, which may include an indicator of effective service coverage. REGISTRATION: Open Science Framework registration 6/08/2024: https://osf.io/5b93m
Responsive population-based cohorts as platforms for characterising pathogen- and population-level infection dynamics for epidemic prevention, preparedness and response.
Get PDFEstablishing population-based cohorts is indispensable for effective epidemic prevention, preparedness and response. Existing passive surveillance systems face limitations in their capacity to promptly provide representative data for estimating disease burden and modelling disease transmission. This perspective paper introduces a framework for establishing a dynamic and responsive nationally representative population-based cohort, with Germany as an example country. We emphasise the need for comprehensive demographic representation, innovative strategies to address participant attrition, efficient data collection and testing using digital tools, as well as novel data integration and analysis methods. Financial considerations and cost estimates for cohort establishment are discussed, highlighting potential cost savings through integration with existing research infrastructures and digital approaches. The framework outlined for creating, operating and integrating the cohort within the broader epidemiological landscape illustrates the potential of a population-based cohort to offer timely, evidence-based insights for robust public health interventions during both epidemics and pandemics, as well as during inter-epidemic periods
Migration, Urbanism and Health: Moving Toward Systems-Informed Policy and Practice.
Get PDFMigration and displacement are pivotal determinants of urban health, influencing both direct and indirect health outcomes. Migrants may face unique health risks, often exacerbated by economic, social, and environmental factors encountered during transit or upon resettlement. As migration patterns shift due to geopolitical, climatic, and economic pressures, they reshape the global and urban policy landscapes in unpredictable ways, presenting challenges that will continue to evolve in the coming decades. Many current legal frameworks do not adequately account for migrant populations, hindering effective policy responses. Therefore, effective urban health interventions must be inclusive of migrant populations and expand beyond healthcare services. A systems-thinking approach that recognizes the broader determinants of health-including housing, employment, social services, and urban infrastructure-is essential to address the intersecting challenges migrants face. Despite these challenges, migration remains crucial to the functioning of urban environments. Migrant workers consistently contribute to the healthy operation of cities, underpinning key infrastructure and services. However, to optimize policy responses and improve urban health outcomes, more robust data and evidence on the health risks and outcomes of migrants, as well as the structural drivers of migration, are needed. Moreover, macro factors such as climate change, future pandemics, and geopolitical shifts are likely to influence both migration dynamics and migrant health. This paper explores links between migration and urban health and identifies implications for policy and practice. It draws from a qualitative review of policy documents, academic literature, and illustrative examples from selected urban contexts. The paper calls for integrated, equity-oriented strategies that consider the structural and social determinants shaping migrant health. A systems-informed and holistic vision of urban health is required to integrate migration into the broader urban policy and planning frameworks to foster healthier, more resilient cities
Associations of educational level with ECG-derived cardiovascular ageing in a population-based cohort: a mediation analysis from the Tromsø Study.
Get PDFOBJECTIVE: To assess the association between educational level and cardiovascular age acceleration metric derived from ECG, and to determine whether this association is mediated by established cardiovascular disease (CVD) risk factors. DESIGN: Prospective population-based cohort study (the Tromsø Study). SETTING: General population of the Tromsø municipality, Norway. PARTICIPANTS: The study sample consisted of 4367 participants of the Tromsø Study, who took part in both Tromsø6 (2007-2008) and Tromsø7 (2015-2016), had a 12-lead ECG obtained at Tromsø7 and did not report a history of heart attack, stroke or atrial fibrillation. PRIMARY OUTCOME MEASURES: δ-age, a biomarker of cardiovascular ageing, is defined as the difference (in years) between an individual's ECG-predicted heart age and their chronological age. ECG-predicted heart age was estimated using a previously validated deep neural network. RESULTS: Our findings indicate an inverse association between education and δ-age, with a regression coefficient per increment increase in education of -0.24 (95% CI -0.41 to -0.07) in the overall sample, -0.38 (95% CI -0.59 to -0.16) for women and -0.04 (95% CI -0.31 to 0.23) for men. Participants with the highest level of education (university/college for 4 or more years) had the lowest estimated δ-age with a regression coefficient of -0.69 years (95% CI -1.23 to -0.16) compared with the group with primary education for the overall sample, -1.05 years (95% CI -1.73 to -0.37) for women and -0.15 years (95% CI -1.03 to 0.73) for men. CVD risk factors mediated up to 75% of the association between overall education and δ-age, and 80% of the association among those with the highest education level (university/college for 4 or more years). Among women, 50% of the effect of overall education on δ-age was mediated by CVD risk factors, rising to 53% in the category with the highest level of education. However, in the subsample of men, there was no significant association between education and δ-age, and the mediation analysis produced natural direct and indirect effects pointing in opposite directions. CONCLUSIONS: Cardiovascular ageing is inversely associated with educational level, an effect that appears to be largely mediated through established risk factors
How lived experiences of illness trajectories, burdens of treatment, and social inequalities shape service user and caregiver participation in health and social care: a theory-informed qualitative evidence synthesis.
Get PDFBACKGROUND: The workload service users and caregivers take on, and their capacity to do this work, when they engage with and participate in different kinds of care is important. It is reflected in policy and practice interventions that identify service users and caregivers as part of a team that consists of informal networks beyond provider organisations and the professionals within them in health and social care. AIMS AND OBJECTIVES: To synthesise qualitative studies of the lived experience of the work of service user and caregiver engagement in three kinds of conditions: long-term conditions associated with significant disability (Parkinson's disease, schizophrenia); serious relapsing-remitting disease (inflammatory bowel disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early-onset dementia). DESIGN: Theory-informed qualitative evidence synthesis of primary qualitative studies, qualitative systematic reviews and meta-syntheses. Papers analysed using qualitative attribution analysis, and Event-State Modelling. DATA SOURCES: Cumulative Index to Nursing and Allied Health Literature, EMBASE, MEDLINE, PsycInfo, Scopus and Social Care Online were searched from January 2010 to April 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Qualitative primary studies, systematic reviews and meta-syntheses where the participants were service users, or caregivers, aged ≥ 18, with one of six index conditions, and which described their lived experiences of care. METHODS: Qualitative evidence synthesis to model core components of service user and caregiver work, and to identify common factors across index conditions, disease trajectories and service contexts. RESULTS: Searches identified 34,787 records. Following deduplication, 13,234 records were assessed for relevance, and after first-stage screening, 7782 records were excluded at this stage, leaving 5452 for further screening, and 279 of these met inclusion criteria and were included in the evidence synthesis. These showed that patients' and caregivers' lived experiences of illness trajectories were shaped by mechanisms of enabling agency (personal capacity, social capital, affective contributions of others), and their degree of existential threat, competence in managing processes of care, and caregiver responses to new responsibilities. Their degree of structural disadvantage was framed in terms of loss of income, employment and housing, and by the presence of stigma, rather than by intersectional position and socioeconomic status. CONCLUSIONS: This evidence synthesis maps intervention points to support service users and caregivers, and the trajectories of work that frame their effective participation in their care. We identify potential targets for interventions that could support their outward-facing work as they seek to mobilise agency, sustain personal capacity, maintain their social capital and draw on the affective contributions of others. LIMITATIONS: Our pragmatic search strategies led to a maximum variation sample of studies of lived experiences of index conditions but may have missed relevant studies. No papers with an explicit social care focus were discovered for brain cancer, bipolar disorder and inflammatory bowel disease. Most studies were descriptive, and samples and methods were often poorly described. FUTURE WORK: Future research should explore interactions between personal capacity, social capital and affective contributions, in lived experiences of service users and caregivers. STUDY REGISTRATION: This study is registered as PROSPERO CRD42020224787. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130407) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 24. See the NIHR Funding and Awards website for further award information