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Prostate Cancer and Dietary Sugar Intake: A Systematic Review
Get PDFBackground: Prostate cancer is a leading malignancy among men globally, with its incidence expected to rise due to aging populations and shifting lifestyles. While established risk factors include age, ethnicity, and genetics, the role of modifiable dietary factors, particularly sugar intake, remains less clear. Emerging evidence suggests that high sugar consumption may promote carcinogenesis through insulin resistance, chronic inflammation, and hormonal dysregulation. This systematic review aimed to evaluate the current evidence on the association between dietary sugar intake and prostate cancer risk.
Methods: A systematic search was conducted across six databases for observational studies published between January 2005 and April 2025. Eligible studies assessed the associations between quantitative sugar intake and prostate cancer outcomes. Screening, data extraction, and a risk of bias assessment (using ROBINS-E) were performed independently by multiple reviewers.
Results: Six studies met the inclusion criteria, comprising four prospective cohorts, one case–control study, and one cross-sectional study, with a combined sample of 11,583 men from the USA, Canada, Sweden, and France. Three studies reported a significant positive association between a high intake of dietary sugars and prostate cancer risk, two found no association, and one showed mixed findings depending on the type of sugar. Heterogeneity in the exposure assessments and confounder control limited the comparability.
Conclusions: This review suggests a possible association between high dietary sugar intake and increased prostate cancer risk, especially from added sugars and sugar-sweetened beverages. However, inconsistent findings and methodological limitations highlight the need for robust, prospective studies with standardized assessments to understand this relationship better
Universal health coverage in the context of migration and displacement: a cosmopolitan perspective.
Get PDFMigration and displacement are reshaping societies and economies with profound implications for health equity and universal health coverage (UHC). In this Viewpoint, we review the unique health challenges faced by migrants and displaced people, as well as the limitations of current UHC policies and financing arrangements. We propose a cosmopolitan approach to UHC, grounded in global solidarity and structured around four pillars: supranational financing, integrated cross-border care, harmonised legal frameworks, and long-term investment in inclusive health systems. We also explore what this approach could mean practically for regional or global financing mechanisms and sources of funding, including progressive contributions and the integration of health into climate finance. Achieving equitable and effective UHC in a world shaped by mobility and crisis requires global thinking and collective action. We call for a reimagining of UHC via a cosmopolitan approach, which offers a pathway to reframe health and wellbeing as a shared right and responsibility, transcending national borders
Identifying hotspots and risk factors for tick-borne encephalitis virus emergence at its range margins to guide interventions, Great Britain.
Get PDFBackgroundTick-borne encephalitis virus (TBEV) is expanding its range in Europe, with increasing human cases reported. Since the first detection of TBEV in ticks in the United Kingdom in 2019, one possible, two probable and two confirmed autochthonous cases in humans have been reported.AimWe aimed to understand the environmental and ecological factors limiting TBEV foci at their range edge and predict suitable areas for TBEV establishment across Great Britain (GB) by modelling patterns of exposure to TBEV in deer.MethodsWe developed spatial risk models for TBEV by integrating data between 2018 and 2021 on antibodies against tick-borne flavivirus in fallow, muntjac, red and roe deer with data on potential risk factors, including climate, land use, forest connectivity and distributions of bank voles and yellow-necked mice. We overlayed modelled suitability for TBEV exposure across GB with estimations on number of visitors to predict areas of high human exposure risk.ResultsModels for fallow, muntjac and roe deer performed well in independent validation (Boyce index > 0.92). Probable exposure to TBEV was more likely to occur in sites with a greater percentage cover of coniferous woodland, with multiple deer species, higher winter temperatures and rates of spring warming.ConclusionThe resulting TBEV suitability maps can be used by public health bodies in GB to tailor surveillance and identify probable high-risk areas for human exposure to guide awareness raising and vaccination policy. Combining animal surveillance and iterative spatial risk modelling can enhance preparedness in areas of tick-borne disease emergence
Exploring mothers' and grandmothers' perceptions of animal-source complementary foods in the diets of young children in The Gambia: A qualitative study.
Get PDFBACKGROUND: In The Gambia, many children consume diets that are lacking in nutrients that are essential for their growth and development. This study aims to explore Gambian mothers' and grandmothers' perceptions around animal source foods (meat, eggs, milk etc.) in order to inform future interventions focused on improving child feeding practices. METHODS: In July and August 2023, nine semi - structured focus group discussions were conducted with mothers and grandmothers in two settings in The Gambia. A purposeful sample of participants were recruited with the support of each local Medical Research Council clinic. Data were analysed using the framework method and thematic analysis. Participants included 19 mothers and 12 grandmothers in a semi-rural area and 12 mothers and 12 grandmothers in a rural area, caring for children 6-24 and grandmothers were in separate groups. RESULTS: Knowledge gaps were identified in both settings regarding aspects of complementary feeding, such as the appropriate timing and methods for introducing animal source foods to children's diets. Differences were noted in the availability and dissemination of infant and young child feeding information in the two settings, emphasising the crucial role of contextual factors in shaping future programmes. The accessibility and affordability of animal source foods, was found to be a key determinant of their inclusion into children's diets. A reliance on commercially available complementary foods was common in both settings. CONCLUSION: This study reveals disparities between current complementary feeding practices and guidelines in this setting. It also underscores context-specific barriers caregivers encounter in offering diverse complementary foods, including animal source foods. A high reliance on commercially available complementary foods was also uncovered, particularly in Keneba. Further research is recommended to aid the development of context- specific interventions
Executive Dysfunction and Disability in SPMS: Predictive Value of the Frontal Assessment Battery in the UCLH MS-STAT2 Cohort.
Get PDFINTRODUCTION: Cognitive impairment is common in secondary progressive multiple sclerosis (SPMS), with executive dysfunction disproportionately so. The frontal assessment battery (FAB) is a bedside test assessing executive function. This study explores the distribution of FAB scores in a large SPMS cohort and their associations with disability. METHODS: Data were analysed from 294 participants in a cognitive substudy of the MS-STAT2 trial (NCT03387670). Associations between baseline FAB scores, ambulation status (Expanded Disability Status Scale [EDSS] < 6.0 vs. ≥ 6.0) and other disability measures were assessed using generalised linear models, adjusting for age, education, gender and disease duration. FAB performance was also compared against other cognitive tests (SDMT, CVLT-II, BVMT-R). RESULTS: 23.8% of participants scored the FAB maximum of 18; 29.9% scored below the clinical threshold of 16. FAB scores showed moderate correlations with SDMT (ρ = 0.46), CVLT-II (ρ = 0.36) and BVMT-R (ρ = 0.43), and participants scoring < 16 were significantly more likely to be impaired across these cognitive domains (p < 0.001). Lower baseline FAB scores were significantly associated with higher EDSS, slower T25FW and reduced manual dexterity (9HPT) (all p < 0.005) at baseline and longitudinally, with performance comparable to other validated cognitive tests. CONCLUSIONS: We present a large cohort of FAB scores in the SPMS population. Lower FAB scores are associated with both concurrent and future disability and may offer a scalable tool for identifying individuals at greater risk of progression and a robust trial outcome measure
Performance of 2 Finger-Stick Blood Tests to Triage Adults With Symptoms of Pulmonary Tuberculosis: A Prospective Multisite Diagnostic Accuracy Study.
Get PDFBACKGROUND: Non-sputum-based, point-of-care triage tests for pulmonary tuberculosis could enhance tuberculosis diagnostic programs. We assessed the diagnostic accuracy of 2 finger-stick blood tests: the Cepheid 3 gene host-response cartridge (Xpert-HR), which measures 3 host messenger RNA transcripts, and the 3-host protein multibiomarker test (MBT). METHODS: We performed a prospective diagnostic accuracy study of consecutive participants with symptoms compatible with pulmonary tuberculosis in The Gambia, South Africa, Uganda, and Vietnam. A composite reference standard for active pulmonary tuberculosis incorporated chest radiography, symptom resolution, and sputum microbiological test results. A training-test set approach was used to evaluate test cutoff specificities at 90% sensitivity. RESULTS: Between 1 November 2020 and 1 May 2023, we screened 1262 participants aged 12-70 years with cough lasting >2 weeks and another symptom suggestive of tuberculosis. Of those who were classifiable by reference tests, 1154 participants had evaluable Xpert-HR results and 961 had evaluable MBT results. Xpert-HR had an area under the receiver operating characteristic (AUROC) curve of 0.92 at a cutoff of -1.275 or below, with a sensitivity of 92.8%, specificity of 62.5%, positive predictive value of 47.9%, and negative predictive value of 95.9%. The MBT had an AUROC of 0.91 at a cutoff of ≥0.42, with a sensitivity of 91.4%, specificity of 73.2%, positive predictive value of 52.0%, and negative predictive value of 96.4%. CONCLUSIONS: Our results show that both Xpert-HR and the MBT are promising non-sputum-based point-of-care tests. The MBT met the World Health Organization target product profile for a triage test, which suggests it should be further developed
Non-invasive breath testing to detect colorectal cancer: protocol for a multicentre, case-control development and validation study (COBRA2 study).
Get PDFBACKGROUND: Colorectal cancer (CRC) is the fourth most common cancer in the United Kingdom. The five-year survival rate from CRC is only 10% when discovered at a late stage, but can exceed 90% if diagnosed early. Symptoms related to CRC can be non-specific, and therefore the decision to refer for a colonoscopy can be challenging. Breath analysis potentially offers a simple and quick method to detect CRC specific volatile organic compounds (VOCs) in breath. This protocol describes the COBRA2 study which aims to develop and validate the clinical prediction model (CPM) in the detection of CRC based on the breath test. An exploratory comparison between the breath test and faecal immunochemical test (FIT) will also be carried out to assess whether combining both tests improves diagnostic performance. METHODS: The COBRA2 study is a multicentre, case-control development and validation study. Breath samples will be collected from participants attending hospital for a planned colonoscopy (control group) or from participants with histologically confirmed colorectal adenocarcinoma (CRC group). A total of 720 participants (470 controls, 250 CRC) will be recruited. All participants will maintain a clear fluid diet for a minimum of 4-6 h prior to sampling, which will take place at outpatient clinics to avoid bowel preparation. The FIT result will be recorded where available. Breath samples will be analysed using gas chromatography-mass spectrometry to identify the VOCs present. Relationships between VOCs of interest and presence of CRC will be explored, and the CPM will be developed using statistical and machine learning methods. We will also assess whether incorporating FIT into the CPM improves diagnostic performance. The CPM will be subsequently validated in an independent sample of up to 250 participants (125 controls, 125 CRC) using the same case-control design and the potential clinical utility of decision rules for triaging will be assessed. If successful, broad validation in an unselected target population of symptomatic patients is required. DISCUSSION: The non-invasive breath test may provide direct patient benefit through earlier and accurate detection of CRC, and higher patient acceptability. It can help ensure timely secondary care referral, potentially translating to improved curative treatment and survival for patients. TRIAL REGISTRATION: The study is registered with ClinicalTrials.gov (NCT05844514)
Translational framework for implementation evaluation and research: implementation strategies derived from normalization process theory.
Get PDFBACKGROUND: Implementation strategies are deliberate systematic actions used to support the uptake of innovations in health and social care. While widely used taxonomies such as ERIC and EPOC have emerged from consensus exercises, few implementation strategies are explicitly derived from theory and tested against empirical data. This study develops a taxonomy of implementation strategies grounded in Normalization Process Theory (NPT), an implementation theory that explains how new practices become embedded and sustained. METHODS: We conducted a qualitative evidence synthesis of studies that reported implementation projects informed by NPT. Studies were identified through citation tracking and database searches, screened using pre-specified criteria, and appraised for methodological quality. Using the NPT coding manual, we identified implementation mechanisms described in each study and translated these into candidate implementation strategies. These were then tested against all included studies through iterative qualitative content analysis. RESULT: Searches led to 9,147 references, and we then eliminated 5,708 duplicates. After title and abstract screening a further 1,443 were eliminated. Full text screening was undertaken with 1,996 papers, and 1,411 of these were eliminated. This left 585 papers subjected to quality assessment, of which 522 were eliminated. Finally, 63 papers were included in the review. Qualitative analysis of included papers yielded 24 general strategies linked to NPT's theoretical constructs and 96 micro-strategies representing four domains of implementation activity: leadership, information, empowerment, and service user involvement. Each strategy was explicitly linked to an NPT construct. CONCLUSIONS: This study provides a theory-based and empirically grounded set of actionable implementation strategies. These are grounded in qualitative descriptions of implementation work. These strategies support practical decision-making across the planning, delivery, and sustainment phases of implementation, and offer context-sensitive guidance for adapting interventions to diverse settings. Unlike consensus-based taxonomies, these strategies are tied to observable mechanisms of action, enabling users to better understand and respond to the dynamic and socially organised nature of implementation. The NPT taxonomy of implementation strategies can support the design, tailoring, and operationalisation of implementation efforts across varied health and social care contexts
Relative Contribution of Pharmacokinetics and Immune Signatures to Clinical Outcomes in Patients With HIV-associated Cryptococcal Meningitis.
Get PDFBACKGROUND: Host immune responses to HIV-associated cryptococcal meningitis are critical in disease outcome. Their interaction with antifungal drug exposure is poorly understood. This study explored associations between immune biomarkers, antifungal drug exposure, and clinical outcomes in HIV-associated cryptococcal meningitis. METHODS: We analyzed serial plasma and cerebrospinal fluid immune biomarkers from 64 participants recruited from the AMBITION-cm trial. We estimated individual-level exposure to amphotericin B, flucytosine, and fluconazole. Associations between immune biomarkers, pharmacokinetic parameters, and clinical outcomes were evaluated. RESULTS: An inflammatory cerebrospinal fluid response, characterized by coordination between tumor necrosis factor-α, granulocyte colony-stimulating factor, and interleukin-7 signaling, was linked to low fungal burden, low intracranial pressure, and survival. However, the value of specific immune biomarkers did not predict EFA or mortality. Exposure to amphotericin B was significantly associated with EFA. CONCLUSIONS: Favorable clinical outcomes from HIV-associated cryptococcal meningitis are associated with coordinated inflammatory and cytotoxic responses in the central nervous system. Antifungal drug exposure was the dominant predictor of EFA
