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PLoS Medicine
Journal Prestige (SJR): 5.914
Citation Impact (citeScore): 9
Number of Followers: 56  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1549-1277 - ISSN (Online) 1549-1676
Published by PLoS Homepage  [7 journals]
  • Evaluation of progress toward universal health coverage in Myanmar: A
           national and subnational analysis

    • Authors: Zlatko Nikoloski; Alistair McGuire, Elias Mossialos
      Abstract: by Zlatko Nikoloski, Alistair McGuire, Elias MossialosBackground Universal health coverage (UHC) encompasses 2 main components: access to essential healthcare services and protection from financial hardship when using healthcare. This study examines Myanmar’s efforts to achieve UHC on a national and subnational level. It is a primer of studying the concept of UHC on a subnational level, and it also establishes a baseline for assessing future progress toward reaching UHC in Myanmar. Methods and findings The study uses the Demographic and Health Survey (2015) and the Myanmar Living Conditions Survey (MLCS; 2017) and adapts a previously developed UHC index to provide insights into the main barriers preventing the country’s progress toward UHC. We find a negative correlation between the UHC index and the state/region poverty levels. The equity of access analysis reveals significant pro-rich inequity in access to all essential healthcare services. Socioeconomic status and limited availability of healthcare infrastructure are the main driving forces behind the unequal access to interventions that are crucial to achieving UHC by 2030. Finally, financial risk protection analysis shows that the poor are less likely to use healthcare services, and, once they do, they are at a greater risk of suffering financial catastrophe. Limitations of this study revolve around its correlational, rather than causal, nature. Conclusions We suggest a 2-pronged approach to help Myanmar achieve UHC: Government and state authorities should reduce the financial burden of seeking healthcare, and, coupled with this, significant investment in and expansion of health infrastructure and the health workforce should be made, particularly in the poorer and more remote states.
      PubDate: Fri, 15 Oct 2021 14:00:00 GMT
       
  • Correction: Immunogenicity of an oral rotavirus vaccine administered with
           prenatal nutritional support in Niger: A cluster randomized clinical trial
           

    • Authors: Sheila Isanaka; Souna Garba, Brian Plikaytis, Monica Malone McNeal, Ousmane Guindo, Céline Langendorf, Eric Adehossi, Iza Ciglenecki, Rebecca F. Grais
      Abstract: by Sheila Isanaka, Souna Garba, Brian Plikaytis, Monica Malone McNeal, Ousmane Guindo, Céline Langendorf, Eric Adehossi, Iza Ciglenecki, Rebecca F. Grais
      PubDate: Fri, 15 Oct 2021 14:00:00 GMT
       
  • HMG-CoA reductase inhibitors and COVID-19 mortality in Stockholm, Sweden:
           A registry-based cohort study

    • Authors: Rita Bergqvist; Viktor H. Ahlqvist, Michael Lundberg, Maria-Pia Hergens, Johan Sundström, Max Bell, Cecilia Magnusson
      Abstract: by Rita Bergqvist, Viktor H. Ahlqvist, Michael Lundberg, Maria-Pia Hergens, Johan Sundström, Max Bell, Cecilia MagnussonBackground The relationship between statin treatment and Coronavirus Disease 2019 (COVID-19) mortality has been discussed due to the pleiotropic effects of statins on coagulation and immune mechanisms. However, available observational studies are hampered by study design flaws, resulting in substantial heterogeneity and ambiguities. Here, we aim to determine the relationship between statin treatment and COVID-19 mortality. Methods and findings This cohort study included all Stockholm residents aged 45 or older (N = 963,876), followed up from 1 March 2020 until 11 November 2020. The exposure was statin treatment initiated before the COVID-19-pandemic, defined as recorded statin dispensation in the Swedish Prescribed Drug Register between 1 March 2019 and 29 February 2020. COVID-19-specific mortality was ascertained from the Swedish Cause of Death Registry. Hazard ratios (HRs) were calculated using multivariable Cox regression models. We further performed a target trial emulation restricted to initiators of statins.In the cohort (51.6% female), 169,642 individuals (17.6%) were statin users. Statin users were older (71.0 versus 58.0 years), more likely to be male (53.3% versus 46.7%), more often diagnosed with comorbidities (for example, ischemic heart disease 23.3% versus 1.6%), more frequently on anticoagulant and antihypertensive treatments, less likely to have a university-level education (34.5% versus 45.4%), and more likely to have a low disposable income (20.6% versus 25.2%), but less likely to reside in crowded housing (6.1% versus 10.3%).A total of 2,545 individuals died from COVID-19 during follow-up, including 765 (0.5%) of the statin users and 1,780 (0.2%) of the nonusers. Statin treatment was associated with a lowered COVID-19 mortality (adjusted HR, 0.88; 95% CI, 0.79 to 0.97, P = 0.01), and this association did not vary appreciably across age groups, sexes, or COVID-19 risk groups. The confounder adjusted HR for statin treatment initiators was 0.78 (95% CI, 0.59 to 1.05, P = 0.10) in the emulated target trial. Limitations of this study include the observational design, reliance on dispensation data, and the inability to study specific drug regimens. Conclusions Statin treatment had a modest negative association with COVID-19 mortality. While this finding needs confirmation from randomized clinical trials, it supports the continued use of statin treatment for medical prevention according to current recommendations also during the COVID-19 pandemic.
      PubDate: Thu, 14 Oct 2021 14:00:00 GMT
       
  • Correction: Accuracy of novel antigen rapid diagnostics for SARS-CoV-2: A
           living systematic review and meta-analysis

    • Authors: The PLOS Medicine Staff
      Abstract: by The PLOS Medicine Staff
      PubDate: Wed, 13 Oct 2021 14:00:00 GMT
       
  • Transmission of community- and hospital-acquired SARS-CoV-2 in hospital
           settings in the UK: A cohort study

    • Authors: Yin Mo; David W. Eyre, Sheila F. Lumley, Timothy M. Walker, Robert H. Shaw, Denise O’Donnell, Lisa Butcher, Katie Jeffery, Christl A. Donnelly, Oxford COVID infection review team , Ben S. Cooper
      Abstract: by Yin Mo, David W. Eyre, Sheila F. Lumley, Timothy M. Walker, Robert H. Shaw, Denise O’Donnell, Lisa Butcher, Katie Jeffery, Christl A. Donnelly, Oxford COVID infection review team , Ben S. CooperBackground Nosocomial spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been widely reported, but the transmission pathways among patients and healthcare workers (HCWs) are unclear. Identifying the risk factors and drivers for these nosocomial transmissions is critical for infection prevention and control interventions. The main aim of our study was to quantify the relative importance of different transmission pathways of SARS-CoV-2 in the hospital setting. Methods and findings This is an observational cohort study using data from 4 teaching hospitals in Oxfordshire, United Kingdom, from January to October 2020. Associations between infectious SARS-CoV-2 individuals and infection risk were quantified using logistic, generalised additive and linear mixed models. Cases were classified as community- or hospital-acquired using likely incubation periods of 3 to 7 days. Of 66,184 patients who were hospitalised during the study period, 920 had a positive SARS-CoV-2 PCR test within the same period (1.4%). The mean age was 67.9 (±20.7) years, 49.2% were females, and 68.5% were from the white ethnic group. Out of these, 571 patients had their first positive PCR tests while hospitalised (62.1%), and 97 of these occurred at least 7 days after admission (10.5%). Among the 5,596 HCWs, 615 (11.0%) tested positive during the study period using PCR or serological tests. The mean age was 39.5 (±11.1) years, 78.9% were females, and 49.8% were nurses. For susceptible patients, 1 day in the same ward with another patient with hospital-acquired SARS-CoV-2 was associated with an additional 7.5 infections per 1,000 susceptible patients (95% credible interval (CrI) 5.5 to 9.5/1,000 susceptible patients/day) per day. Exposure to an infectious patient with community-acquired Coronavirus Disease 2019 (COVID-19) or to an infectious HCW was associated with substantially lower infection risks (2.0/1,000 susceptible patients/day, 95% CrI 1.6 to 2.2). As for HCW infections, exposure to an infectious patient with hospital-acquired SARS-CoV-2 or to an infectious HCW were both associated with an additional 0.8 infection per 1,000 susceptible HCWs per day (95% CrI 0.3 to 1.6 and 0.6 to 1.0, respectively). Exposure to an infectious patient with community-acquired SARS-CoV-2 was associated with less than half this risk (0.2/1,000 susceptible HCWs/day, 95% CrI 0.2 to 0.2). These assumptions were tested in sensitivity analysis, which showed broadly similar results. The main limitations were that the symptom onset dates and HCW absence days were not available. Conclusions In this study, we observed that exposure to patients with hospital-acquired SARS-CoV-2 is associated with a substantial infection risk to both HCWs and other hospitalised patients. Infection control measures to limit nosocomial transmission must be optimised to protect both staff and patients from SARS-CoV-2 infection.
      PubDate: Tue, 12 Oct 2021 14:00:00 GMT
       
  • Cancer Special Issue: Early detection and minimal residual disease

    • Authors: Beryne Odeny
      Abstract: by Beryne OdenyBeryne Odeny discusses PLOS Medicine’s Special Issue on early cancer detection and minimal residual disease.
      PubDate: Tue, 12 Oct 2021 14:00:00 GMT
       
  • Cesarean section: More than a maternal health issue

    • Authors: Marleen Temmerman; Abdu Mohiddin
      Abstract: by Marleen Temmerman, Abdu MohiddinA cesarean section (CS) can be a lifesaving intervention when medically indicated, but it may also lead to adverse short- and long-term health effects for women and children.
      PubDate: Tue, 12 Oct 2021 14:00:00 GMT
       
  • Associations between cesarean delivery and child mortality: A national
           record linkage longitudinal study of 17.8 million births in Brazil

    • Authors: Enny S. Paixao; Christian Bottomley, Julia M. Pescarini, Kerry L. M. Wong, Luciana L. Cardim, Rita de Cássia Ribeiro Silva, Elizabeth B. Brickley, Laura C. Rodrigues, Flavia Jôse Oliveira Alves, Maria do Carmo Leal, Maria da Conceicao N. Costa, Maria Gloria Teixeira, Maria Yury Ichihara, Liam Smeeth, Mauricio L. Barreto, Oona M. R. Campbell
      Abstract: by Enny S. Paixao, Christian Bottomley, Julia M. Pescarini, Kerry L. M. Wong, Luciana L. Cardim, Rita de Cássia Ribeiro Silva, Elizabeth B. Brickley, Laura C. Rodrigues, Flavia Jôse Oliveira Alves, Maria do Carmo Leal, Maria da Conceicao N. Costa, Maria Gloria Teixeira, Maria Yury Ichihara, Liam Smeeth, Mauricio L. Barreto, Oona M. R. CampbellBackground There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. Methods and findings We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. Conclusions In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.
      PubDate: Tue, 12 Oct 2021 14:00:00 GMT
       
  • Characterising the nationwide burden and predictors of unkept outpatient
           appointments in the National Health Service in England: A cohort study
           using a machine learning approach

    • Authors: Sion Philpott-Morgan; Dixa B. Thakrar, Joshua Symons, Daniel Ray, Hutan Ashrafian, Ara Darzi
      Abstract: by Sion Philpott-Morgan, Dixa B. Thakrar, Joshua Symons, Daniel Ray, Hutan Ashrafian, Ara DarziBackground Unkept outpatient hospital appointments cost the National Health Service £1 billion each year. Given the associated costs and morbidity of unkept appointments, this is an issue requiring urgent attention. We aimed to determine rates of unkept outpatient clinic appointments across hospital trusts in the England. In addition, we aimed to examine the predictors of unkept outpatient clinic appointments across specialties at Imperial College Healthcare NHS Trust (ICHT). Our final aim was to train machine learning models to determine the effectiveness of a potential intervention in reducing unkept appointments. Methods and findings UK Hospital Episode Statistics outpatient data from 2016 to 2018 were used for this study. Machine learning models were trained to determine predictors of unkept appointments and their relative importance. These models were gradient boosting machines. In 2017–2018 there were approximately 85 million outpatient appointments, with an unkept appointment rate of 5.7%. Within ICHT, there were almost 1 million appointments, with an unkept appointment rate of 11.2%. Hepatology had the highest rate of unkept appointments (17%), and medical oncology had the lowest (6%). The most important predictors of unkept appointments included the recency (25%) and frequency (13%) of previous unkept appointments and age at appointment (10%). A sensitivity of 0.287 was calculated overall for specialties with at least 10,000 appointments in 2016–2017 (after data cleaning). This suggests that 28.7% of patients who do miss their appointment would be successfully targeted if the top 10% least likely to attend received an intervention. As a result, an intervention targeting the top 10% of likely non-attenders, in the full population of patients, would be able to capture 28.7% of unkept appointments if successful. Study limitations include that some unkept appointments may have been missed from the analysis because recording of unkept appointments is not mandatory in England. Furthermore, results here are based on a single trust in England, hence may not be generalisable to other locations. Conclusions Unkept appointments remain an ongoing concern for healthcare systems internationally. Using machine learning, we can identify those most likely to miss their appointment and implement more targeted interventions to reduce unkept appointment rates.
      PubDate: Tue, 12 Oct 2021 14:00:00 GMT
       
  • Association of accelerometer-derived sleep measures with lifetime
           psychiatric diagnoses: A cross-sectional study of 89,205 participants from
           the UK Biobank

    • Authors: Michael Wainberg; Samuel E. Jones, Lindsay Melhuish Beaupre, Sean L. Hill, Daniel Felsky, Manuel A. Rivas, Andrew S. P. Lim, Hanna M. Ollila, Shreejoy J. Tripathy
      Abstract: by Michael Wainberg, Samuel E. Jones, Lindsay Melhuish Beaupre, Sean L. Hill, Daniel Felsky, Manuel A. Rivas, Andrew S. P. Lim, Hanna M. Ollila, Shreejoy J. TripathyBackground Sleep problems are both symptoms of and modifiable risk factors for many psychiatric disorders. Wrist-worn accelerometers enable objective measurement of sleep at scale. Here, we aimed to examine the association of accelerometer-derived sleep measures with psychiatric diagnoses and polygenic risk scores in a large community-based cohort. Methods and findings In this post hoc cross-sectional analysis of the UK Biobank cohort, 10 interpretable sleep measures—bedtime, wake-up time, sleep duration, wake after sleep onset, sleep efficiency, number of awakenings, duration of longest sleep bout, number of naps, and variability in bedtime and sleep duration—were derived from 7-day accelerometry recordings across 89,205 participants (aged 43 to 79, 56% female, 97% self-reported white) taken between 2013 and 2015. These measures were examined for association with lifetime inpatient diagnoses of major depressive disorder, anxiety disorders, bipolar disorder/mania, and schizophrenia spectrum disorders from any time before the date of accelerometry, as well as polygenic risk scores for major depression, bipolar disorder, and schizophrenia. Covariates consisted of age and season at the time of the accelerometry recording, sex, Townsend deprivation index (an indicator of socioeconomic status), and the top 10 genotype principal components. We found that sleep pattern differences were ubiquitous across diagnoses: each diagnosis was associated with a median of 8.5 of the 10 accelerometer-derived sleep measures, with measures of sleep quality (for instance, sleep efficiency) generally more affected than mere sleep duration. Effect sizes were generally small: for instance, the largest magnitude effect size across the 4 diagnoses was β = −0.11 (95% confidence interval −0.13 to −0.10, p = 3 × 10−56, FDR = 6 × 10−55) for the association between lifetime inpatient major depressive disorder diagnosis and sleep efficiency. Associations largely replicated across ancestries and sexes, and accelerometry-derived measures were concordant with self-reported sleep properties. Limitations include the use of accelerometer-based sleep measurement and the time lag between psychiatric diagnoses and accelerometry. Conclusions In this study, we observed that sleep pattern differences are a transdiagnostic feature of individuals with lifetime mental illness, suggesting that they should be considered regardless of diagnosis. Accelerometry provides a scalable way to objectively measure sleep properties in psychiatric clinical research and practice, even across tens of thousands of individuals.
      PubDate: Tue, 12 Oct 2021 14:00:00 GMT
       
  • Behavioural activation to prevent depression and loneliness among socially
           isolated older people with long-term conditions: The BASIL COVID-19 pilot
           randomised controlled trial

    • Authors: Simon Gilbody; Elizabeth Littlewood, Dean McMillan, Carolyn A. Chew-Graham, Della Bailey, Samantha Gascoyne, Claire Sloan, Lauren Burke, Peter Coventry, Suzanne Crosland, Caroline Fairhurst, Andrew Henry, Catherine Hewitt, Kalpita Joshi, Eloise Ryde, Leanne Shearsmith, Gemma Traviss-Turner, Rebecca Woodhouse, Andrew Clegg, Tom Gentry, Andrew J. Hill, Karina Lovell, Sarah Dexter Smith, Judith Webster, David Ekers
      Abstract: by Simon Gilbody, Elizabeth Littlewood, Dean McMillan, Carolyn A. Chew-Graham, Della Bailey, Samantha Gascoyne, Claire Sloan, Lauren Burke, Peter Coventry, Suzanne Crosland, Caroline Fairhurst, Andrew Henry, Catherine Hewitt, Kalpita Joshi, Eloise Ryde, Leanne Shearsmith, Gemma Traviss-Turner, Rebecca Woodhouse, Andrew Clegg, Tom Gentry, Andrew J. Hill, Karina Lovell, Sarah Dexter Smith, Judith Webster, David EkersBackground Older adults, including those with long-term conditions (LTCs), are vulnerable to social isolation. They are likely to have become more socially isolated during the Coronavirus Disease 2019 (COVID-19) pandemic, often due to advice to “shield” to protect them from infection. This places them at particular risk of depression and loneliness. There is a need for brief scalable psychosocial interventions to mitigate the psychological impacts of social isolation. Behavioural activation (BA) is a credible candidate intervention, but a trial is needed. Methods and findings We undertook an external pilot parallel randomised trial (ISRCTN94091479) designed to test recruitment, retention and engagement with, and the acceptability and preliminary effects of the intervention. Participants aged ≥65 years with 2 or more LTCs were recruited in primary care and randomised by computer and with concealed allocation between June and October 2020. BA was offered to intervention participants (n = 47), and control participants received usual primary care (n = 49). Assessment of outcome was made blind to treatment allocation. The primary outcome was depression severity (measured using the Patient Health Questionnaire 9 (PHQ-9)). We also measured health-related quality of life (measured by the Short Form (SF)-12v2 mental component scale (MCS) and physical component scale (PCS)), anxiety (measured by the Generalised Anxiety Disorder 7 (GAD-7)), perceived social and emotional loneliness (measured by the De Jong Gierveld Scale: 11-item loneliness scale). Outcome was measured at 1 and 3 months. The mean age of participants was aged 74 years (standard deviation (SD) 5.5) and they were mostly White (n = 92, 95.8%), and approximately two-thirds of the sample were female (n = 59, 61.5%). Remote recruitment was possible, and 45/47 (95.7%) randomised to the intervention completed 1 or more sessions (median 6 sessions) out of 8. A total of 90 (93.8%) completed the 1-month follow-up, and 86 (89.6%) completed the 3-month follow-up, with similar rates for control (1 month: 45/49 and 3 months 44/49) and intervention (1 month: 45/47and 3 months: 42/47) follow-up. Between-group comparisons were made using a confidence interval (CI) approach, and by adjusting for the covariate of interest at baseline. At 1 month (the primary clinical outcome point), the median number of completed sessions for people receiving the BA intervention was 3, and almost all participants were still receiving the BA intervention. The between-group comparison for the primary clinical outcome at 1 month was an adjusted between-group mean difference of −0.50 PHQ-9 points (95% CI −2.01 to 1.01), but only a small number of participants had completed the intervention at this point. At 3 months, the PHQ-9 adjusted mean difference (AMD) was 0.19 (95% CI −1.36 to 1.75). When we examined loneliness, the adjusted between-group difference in the De Jong Gierveld Loneliness Scale at 1 month was 0.28 (95% CI −0.51 to 1.06) and at 3 months −0.87 (95% CI −1.56 to −0.18), suggesting evidence of benefit of the intervention at this time point. For anxiety, the GAD adjusted between-group difference at 1 month was 0.20 (−1.33, 1.73) and at 3 months 0.31 (−1.08, 1.70). For the SF-12 (physical component score), the adjusted between-group difference at 1 month was 0.34 (−4.17, 4.85) and at 3 months 0.11 (−4.46, 4.67). For the SF-12 (mental component score), the adjusted between-group difference at 1 month was 1.91 (−2.64, 5.15) and at 3 months 1.26 (−2.64, 5.15). Participants who withdrew had minimal depressive symptoms at entry. There were no adverse events. The Behavioural Activation in Social Isolation (BASIL) study had 2 main limitations. First, we found that the intervention was still being delivered at the prespecified primary outcome point, and this fed into the design of the main trial where a primary outcome of 3 months is now collected. Second, this was a pilot trial and was not designed to test between-group differences with high levels of statistical power. Type 2 errors are likely to have occurred, and a larger trial is now underway to test for robust effects and replicate signals of effectiveness in important secondary outcomes such as loneliness. Conclusions In this study, we observed that BA is a credible intervention to mitigate the psychological impacts of COVID-19 isolation for older adults. We demonstrated that it is feasible to undertake a trial of BA. The intervention can be delivered remotely and at scale, but should be reserved for older adults with evidence of depressive symptoms. The significant reduction in loneliness is unlikely to be a chance finding, and replication will be explored in a fully powered randomised controlled trial (RCT). Trial registration ISRCTN94091479.
      PubDate: Tue, 12 Oct 2021 14:00:00 GMT
       
  • ctDNA: An emerging neoadjuvant biomarker in resectable solid tumors

    • Authors: Christopher Abbosh; Charles Swanton
      Abstract: by Christopher Abbosh, Charles SwantonChristopher Abbosh and Charles Swanton discuss circulating tumor DNA as a potential biomarker for neoadjuvant treatment response in solid tumors.
      PubDate: Tue, 12 Oct 2021 14:00:00 GMT
       
  • Clinical interventions for adults with comorbid alcohol use and depressive
           disorders: A systematic review and network meta-analysis

    • Authors: Sean Grant; Gulrez Azhar, Eugeniu Han, Marika Booth, Aneesa Motala, Jody Larkin, Susanne Hempel
      Abstract: by Sean Grant, Gulrez Azhar, Eugeniu Han, Marika Booth, Aneesa Motala, Jody Larkin, Susanne HempelBackground Uncertainty remains regarding the effectiveness of treatments for patients diagnosed with both an alcohol use disorder (AUD) and depressive disorder. This study aimed to compare the effectiveness of clinical interventions for improving symptoms of adults with co-occurring AUDs and depressive disorders. Methods and findings We searched CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Excerpta Medica Database, International Clinical Trials Registry Platform (ICTRP), PubMed, PsycINFO, and Web of Science from inception to December 2020. We included randomized controlled trials (RCTs) evaluating clinical interventions for adults with co-occurring AUDs and depressive disorders. Two independent reviewers extracted study-level information and outcome data. We assessed risk of bias using the Cochrane Risk of Bias tool, used frequentist random effects models for network meta-analyses, and rated our confidence in effect estimates using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Primary outcomes were remission from depression and alcohol use. Secondary outcomes were depressive symptoms, alcohol use, heavy drinking, health-related quality of life, functional status, and adverse events. We used standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes to estimate intervention effects. Overall, 36 RCTs with 2,729 participants evaluated 14 pharmacological and 4 psychological interventions adjunctive to treatment as usual (TAU). Studies were published from 1971 to 2019, conducted in 13 countries, and had a median sample size of 50 participants (range: 14 to 350 participants). We have very low confidence in all estimates of intervention effects on our primary outcomes (i.e., remission from depression and remission from alcohol use). We have moderate confidence that cognitive behavioral therapies (CBTs) demonstrated greater benefit than no additional treatment (SMD = −0.84; 95% confidence interval [CI], −1.05 to −0.63; p < 0.001) for depressive symptoms and low confidence (SMD = −0.25; 95% CI, −0.47 to −0.04; p = 0.021) for alcohol use. We have low confidence that tricyclic antidepressants (TCAs) demonstrated greater benefit than placebo (SMD = −0.37; 95% CI, −0.72 to −0.02, p = 0.038) for depressive symptoms. Compared with placebo, we have moderate confidence that selective serotonin reuptake inhibitors (SSRIs) demonstrated greater benefit for functional status (SMD = −0.92; 95% CI, −1.36 to −0.47, p < 0.001) and low confidence for alcohol use (SMD = −0.30; 95% CI, −0.59 to −0.02, p = 0.039). However, we have moderate confidence that patients receiving SSRIs also were more likely to experience an adverse event (OR = 2.20; 95% CI, 0.94 to 5.16, p = 0.07). We have very low confidence in all other effect estimates, and we did not have high confidence in any effect estimates. Limitations include the sparsity of evidence on intervention effects over the long term, risks of attrition bias, and heterogeneous definitions of adverse events in the evidence base. Conclusions We are very uncertain about the existence (or not) of any non-null effects for our primary outcomes of remission from depression and remission from alcohol use. The available evidence does suggest that CBTs likely reduced, and TCAs may have resulted in a slight reduction of depressive symptoms. SSRIs likely increased functional status, and SSRIs and CBTs may have resulted in a slight reduction of alcohol use. However, patients receiving SSRIs also likely had an increased risk of experiencing an adverse event. In addition, these conclusions only apply to postintervention and are not against active comparators, limiting the understanding of the efficacy of interventions in the long term as well as the comparative effectiveness of active treatments. As we did not have high confidence in any outcomes, additional studies are warranted to provide more conclusive evidence.
      PubDate: Fri, 08 Oct 2021 14:00:00 GMT
       
  • The global burden of Plasmodium vivax malaria is obscure and
           insidious

    • Authors: Katherine E. Battle; J. Kevin Baird
      Abstract: by Katherine E. Battle, J. Kevin BairdJ. Kevin Baird and colleagues, examine and discuss the estimated global burden of vivax malaria and it’s biological, clinical, and public health complexity.
      PubDate: Thu, 07 Oct 2021 14:00:00 GMT
       
  • Impact of color-coded and warning nutrition labelling schemes: A
           systematic review and network meta-analysis

    • Authors: Jing Song; Mhairi K. Brown, Monique Tan, Graham A. MacGregor, Jacqui Webster, Norm R. C. Campbell, Kathy Trieu, Cliona Ni Mhurchu, Laura K. Cobb, Feng J. He
      Abstract: by Jing Song, Mhairi K. Brown, Monique Tan, Graham A. MacGregor, Jacqui Webster, Norm R. C. Campbell, Kathy Trieu, Cliona Ni Mhurchu, Laura K. Cobb, Feng J. HeBackground Suboptimal diets are a leading risk factor for death and disability. Nutrition labelling is a potential method to encourage consumers to improve dietary behaviour. This systematic review and network meta-analysis (NMA) summarises evidence on the impact of colour-coded interpretive labels and warning labels on changing consumers’ purchasing behaviour. Methods and findings We conducted a literature review of peer-reviewed articles published between 1 January 1990 and 24 May 2021 in PubMed, Embase via Ovid, Cochrane Central Register of Controlled Trials, and SCOPUS. Randomised controlled trials (RCTs) and quasi-experimental studies were included for the primary outcomes (measures of changes in consumers’ purchasing and consuming behaviour). A frequentist NMA method was applied to pool the results. A total of 156 studies (including 101 RCTs and 55 non-RCTs) nested in 138 articles were incorporated into the systematic review, of which 134 studies in 120 articles were eligible for meta-analysis. We found that the traffic light labelling system (TLS), nutrient warning (NW), and health warning (HW) were associated with an increased probability of selecting more healthful products (odds ratios [ORs] and 95% confidence intervals [CIs]: TLS, 1.5 [1.2, 1.87]; NW, 3.61 [2.82, 4.63]; HW, 1.65 [1.32, 2.06]). Nutri-Score (NS) and warning labels appeared effective in reducing consumers’ probability of selecting less healthful products (NS, 0.66 [0.53, 0.82]; NW,0.65 [0.54, 0.77]; HW,0.64 [0.53, 0.76]). NS and NW were associated with an increased overall healthfulness (healthfulness ratings of products purchased using models such as FSAm-NPS/HCSP) by 7.9% and 26%, respectively. TLS, NS, and NW were associated with a reduced energy (total energy: TLS, −6.5%; NS, −6%; NW, −12.9%; energy per 100 g/ml: TLS, −3%; NS, −3.5%; NW, −3.8%), sodium (total sodium/salt: TLS, −6.4%; sodium/salt per 100 g/ml: NS: −7.8%), fat (total fat: NS, −15.7%; fat per 100 g/ml: TLS: −2.6%; NS: −3.2%), and total saturated fat (TLS, −12.9%; NS: −17.1%; NW: −16.3%) content of purchases. The impact of TLS, NS, and NW on purchasing behaviour could be explained by improved understanding of the nutrition information, which further elicits negative perception towards unhealthful products or positive attitudes towards healthful foods. Comparisons across label types suggested that colour-coded labels performed better in nudging consumers towards the purchase of more healthful products (NS versus NW: 1.51 [1.08, 2.11]), while warning labels have the advantage in discouraging unhealthful purchasing behaviour (NW versus TLS: 0.81 [0.67, 0.98]; HW versus TLS: 0.8 [0.63, 1]). Study limitations included high heterogeneity and inconsistency in the comparisons across different label types, limited number of real-world studies (95% were laboratory studies), and lack of long-term impact assessments. Conclusions Our systematic review provided comprehensive evidence for the impact of colour-coded labels and warnings in nudging consumers’ purchasing behaviour towards more healthful products and the underlying psychological mechanism of behavioural change. Each type of label had different attributes, which should be taken into consideration when making front-of-package nutrition labelling (FOPL) policies according to local contexts. Our study supported mandatory front-of-pack labelling policies in directing consumers’ choice and encouraging the food industry to reformulate their products. Protocol registry PROSPERO (CRD42020161877).
      PubDate: Tue, 05 Oct 2021 14:00:00 GMT
       
  • Fatal opioid overdoses during and shortly after hospital admissions in
           England: A case-crossover study

    • Authors: Dan Lewer; Brian Eastwood, Martin White, Thomas D. Brothers, Martin McCusker, Caroline Copeland, Michael Farrell, Irene Petersen
      Abstract: by Dan Lewer, Brian Eastwood, Martin White, Thomas D. Brothers, Martin McCusker, Caroline Copeland, Michael Farrell, Irene PetersenBackground Hospital patients who use illicit opioids such as heroin may use drugs during an admission or leave the hospital in order to use drugs. There have been reports of patients found dead from drug poisoning on the hospital premises or shortly after leaving the hospital. This study examines whether hospital admission and discharge are associated with increased risk of opioid-related death. Methods and findings We conducted a case-crossover study of opioid-related deaths in England. Our study included 13,609 deaths between January 1, 2010 and December 31, 2019 among individuals aged 18 to 64. For each death, we sampled 5 control days from the period 730 to 28 days before death. We used data from the national Hospital Episode Statistics database to determine the time proximity of deaths and control days to hospital admissions. We estimated the association between hospital admission and opioid-related death using conditional logistic regression, with a reference category of time neither admitted to the hospital nor within 14 days of discharge. A total of 236/13,609 deaths (1.7%) occurred following drug use while admitted to the hospital. The risk during hospital admissions was similar or lower than periods neither admitted to the hospital nor recently discharged, with odds ratios 1.03 (95% CI 0.87 to 1.21; p = 0.75) for the first 14 days of an admission and 0.41 (95% CI 0.30 to 0.56; p < 0.001) for days 15 onwards. 1,088/13,609 deaths (8.0%) occurred in the 14 days after discharge. The risk of opioid-related death increased in this period, with odds ratios of 4.39 (95% CI 3.75 to 5.14; p < 0.001) on days 1 to 2 after discharge and 2.09 (95% CI 1.92 to 2.28; p < 0.001) on days 3 to 14. 11,629/13,609 deaths (85.5%) did not occur close to a hospital admission, and the remaining 656/13,609 deaths (4.8%) occurred in hospital following admission due to drug poisoning. Risk was greater for patients discharged from psychiatric admissions, those who left the hospital against medical advice, and those leaving the hospital after admissions of 7 days or more. The main limitation of the method is that it does not control for time-varying health or drug use within individuals; therefore, hospital admissions coinciding with high-risk periods may in part explain the results. Conclusions Discharge from the hospital is associated with an acute increase in the risk of opioid-related death, and 1 in 14 opioid-related deaths in England happens in the 2 weeks after the hospital discharge. This supports interventions that prevent early discharge and improve linkage with community drug treatment and harm reduction services.
      PubDate: Tue, 05 Oct 2021 14:00:00 GMT
       
  • COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of
           health impact and cost-effectiveness

    • Authors: Carl A. B. Pearson; Fiammetta Bozzani, Simon R. Procter, Nicholas G. Davies, Maryam Huda, Henning Tarp Jensen, Marcus Keogh-Brown, Muhammad Khalid, Sedona Sweeney, Sergio Torres-Rueda, CHiL COVID-19 Working Group , CMMID COVID-19 Working Group , Rosalind M. Eggo, Anna Vassall, Mark Jit
      Abstract: by Carl A. B. Pearson, Fiammetta Bozzani, Simon R. Procter, Nicholas G. Davies, Maryam Huda, Henning Tarp Jensen, Marcus Keogh-Brown, Muhammad Khalid, Sedona Sweeney, Sergio Torres-Rueda, CHiL COVID-19 Working Group , CMMID COVID-19 Working Group , Rosalind M. Eggo, Anna Vassall, Mark JitBackground Multiple Coronavirus Disease 2019 (COVID-19) vaccines appear to be safe and efficacious, but only high-income countries have the resources to procure sufficient vaccine doses for most of their eligible populations. The World Health Organization has published guidelines for vaccine prioritisation, but most vaccine impact projections have focused on high-income countries, and few incorporate economic considerations. To address this evidence gap, we projected the health and economic impact of different vaccination scenarios in Sindh Province, Pakistan (population: 48 million). Methods and findings We fitted a compartmental transmission model to COVID-19 cases and deaths in Sindh from 30 April to 15 September 2020. We then projected cases, deaths, and hospitalisation outcomes over 10 years under different vaccine scenarios. Finally, we combined these projections with a detailed economic model to estimate incremental costs (from healthcare and partial societal perspectives), disability-adjusted life years (DALYs), and incremental cost-effectiveness ratio (ICER) for each scenario.We project that 1 year of vaccine distribution, at delivery rates consistent with COVAX projections, using an infection-blocking vaccine at $3/dose with 70% efficacy and 2.5-year duration of protection is likely to avert around 0.9 (95% credible interval (CrI): 0.9, 1.0) million cases, 10.1 (95% CrI: 10.1, 10.3) thousand deaths, and 70.1 (95% CrI: 69.9, 70.6) thousand DALYs, with an ICER of $27.9 per DALY averted from the health system perspective. Under a broad range of alternative scenarios, we find that initially prioritising the older (65+) population generally prevents more deaths. However, unprioritised distribution has almost the same cost-effectiveness when considering all outcomes, and both prioritised and unprioritised programmes can be cost-effective for low per-dose costs. High vaccine prices ($10/dose), however, may not be cost-effective, depending on the specifics of vaccine performance, distribution programme, and future pandemic trends.The principal drivers of the health outcomes are the fitted values for the overall transmission scaling parameter and disease natural history parameters from other studies, particularly age-specific probabilities of infection and symptomatic disease, as well as social contact rates. Other parameters are investigated in sensitivity analyses.This study is limited by model approximations, available data, and future uncertainty. Because the model is a single-population compartmental model, detailed impacts of nonpharmaceutical interventions (NPIs) such as household isolation cannot be practically represented or evaluated in combination with vaccine programmes. Similarly, the model cannot consider prioritising groups like healthcare or other essential workers. The model is only fitted to the reported case and death data, which are incomplete and not disaggregated by, e.g., age. Finally, because the future impact and implementation cost of NPIs are uncertain, how these would interact with vaccination remains an open question. Conclusions COVID-19 vaccination can have a considerable health impact and is likely to be cost-effective if more optimistic vaccine scenarios apply. Preventing severe disease is an important contributor to this impact. However, the advantage of prioritising older, high-risk populations is smaller in generally younger populations. This reduction is especially true in populations with more past transmission, and if the vaccine is likely to further impede transmission rather than just disease. Those conditions are typical of many low- and middle-income countries.
      PubDate: Mon, 04 Oct 2021 14:00:00 GMT
       
  • The EmpaTeach intervention for reducing physical violence from teachers to
           

    • Authors: Camilla Fabbri; Katherine Rodrigues, Baptiste Leurent, Elizabeth Allen, Mary Qiu, Martin Zuakulu, Dennis Nombo, Michael Kaemingk, Alexandra De Filippo, Gerard Torrats-Espinosa, Elizabeth Shayo, Vivien Barongo, Giulia Greco, Wietse Tol, Karen M. Devries
      Abstract: by Camilla Fabbri, Katherine Rodrigues, Baptiste Leurent, Elizabeth Allen, Mary Qiu, Martin Zuakulu, Dennis Nombo, Michael Kaemingk, Alexandra De Filippo, Gerard Torrats-Espinosa, Elizabeth Shayo, Vivien Barongo, Giulia Greco, Wietse Tol, Karen M. DevriesBackground School-based violence prevention interventions offer enormous potential to reduce children’s experience of violence perpetrated by teachers, but few have been rigorously evaluated globally and, to the best of our knowledge, none in humanitarian settings. We tested whether the EmpaTeach intervention could reduce physical violence from teachers to students in Nyarugusu Refugee Camp, Tanzania. Methods and findings We conducted a 2-arm cluster-randomised controlled trial with parallel assignment. A complete sample of all 27 primary and secondary schools in Nyarugusu Refugee Camp were approached and agreed to participate in the study. Eligible students and teachers participated in cross-sectional baseline, midline, and endline surveys in November/December 2018, May/June 2019, and January/February 2020, respectively. Fourteen schools were randomly assigned to receive a violence prevention intervention targeted at teachers implemented in January–March 2019; 13 formed a wait-list control group. The EmpaTeach intervention used empathy-building exercises and group work to equip teachers with self-regulation, alternative discipline techniques, and classroom management strategies. Allocation was not concealed due to the nature of the intervention. The primary outcome was students’ self-reported experience of physical violence from teachers, assessed at midline using a modified version of the ISPCAN Child Abuse Screening Tool–Child Institutional. Secondary outcomes included student reports of emotional violence, depressive symptoms, and school attendance. Analyses were by intention to treat, using generalised estimating equations adjusted for stratification factors. No schools left the study. In total, 1,493 of the 1,866 (80%) randomly sampled students approached for participation took part in the baseline survey; at baseline 54.1% of students reported past-week physical violence from school staff. In total, 1,619 of 1,978 students (81.9%) took part in the midline survey, and 1,617 of 2,032 students (79.6%) participated at endline. Prevalence of past-week violence at midline was not statistically different in intervention (408 of 839 students, 48.6%) and control schools (412 of 777 students, 53.0%; risk ratio = 0.91, 95% CI 0.80 to 1.02, p = 0.106). No effect was detected on secondary outcomes. A camp-wide educational policy change during intervention implementation resulted in 14.7% of teachers in the intervention arm receiving a compressed version of the intervention, but exploratory analyses showed no difference in our primary outcome by school-level adherence to the intervention. Main study limitations included the small number of schools in the camp, which limited statistical power to detect small differences between intervention and control groups. We also did not assess the test–retest reliability of our outcome measures, and interviewers were unmasked to intervention allocation. Conclusions There was no evidence that the EmpaTeach intervention effectively reduced physical violence from teachers towards primary or secondary school students in Nyarugusu Refugee Camp. Further research is needed to develop and test interventions to prevent teacher violence in humanitarian settings. Trial registration clinicaltrials.gov (NCT03745573)
      PubDate: Mon, 04 Oct 2021 14:00:00 GMT
       
  • Testing approaches to sharing trial results with participants: The Show
           RESPECT cluster randomised, factorial, mixed methods trial

    • Authors: Annabelle South; Nalinie Joharatnam-Hogan, Cara Purvis, Elizabeth C. James, Carlos Diaz-Montana, William J. Cragg, Conor Tweed, Archie Macnair, Matthew R. Sydes, Claire Snowdon, Katie Gillies, Talia Isaacs, Barbara E. Bierer, Andrew J. Copas
      Abstract: by Annabelle South, Nalinie Joharatnam-Hogan, Cara Purvis, Elizabeth C. James, Carlos Diaz-Montana, William J. Cragg, Conor Tweed, Archie Macnair, Matthew R. Sydes, Claire Snowdon, Katie Gillies, Talia Isaacs, Barbara E. Bierer, Andrew J. CopasBackground Sharing trial results with participants is an ethical imperative but often does not happen. We tested an Enhanced Webpage versus a Basic Webpage, Mailed Printed Summary versus no Mailed Printed Summary, and Email List Invitation versus no Email List Invitation to see which approach resulted in the highest patient satisfaction with how the results were communicated. Methods and findings We carried out a cluster randomised, 2 by 2 by 2 factorial, nonblinded study within a trial, with semistructured qualitative interviews with some patients (ISRCTN96189403). Each cluster was a UK hospital participating in the ICON8 ovarian cancer trial. Interventions were shared with 384 ICON8 participants who were alive and considered well enough to be contacted, at 43 hospitals. Hospitals were allocated to share results with participants through one of the 8 intervention combinations based on random permutation within blocks of 8, stratified by number of participants. All interventions contained a written plain English summary of the results. The Enhanced Webpage also contained a short video. Both the Enhanced Webpage and Email contained links to further information and support. The Mailed Printed Summary was opt-out.Follow-up questionnaires were sent 1 month after patients had been offered the interventions. Patients’ reported satisfaction was measured using a 5-point scale, analysed by ordinal logistic regression estimating main effects for all 3 interventions, with random effects for site, restricted to those who reported receiving the results and assuming no interaction. Data collection took place in 2018 to 2019.Questionnaires were sent to 275/384 randomly selected participants and returned by 180: 90/142 allocated Basic Webpage, 90/133 Enhanced Webpage; 91/141 no Mailed Printed Summary, 89/134 Mailed Printed Summary; 82/129 no Email List Invitation, 98/146 Email List Invitation. About 3 patients opted out of receiving the Mailed Printed Summary; no patients signed up to the email list. Patients’ satisfaction was greater at sites allocated the Mailed Printed Summary, where 65/81 (80%) were quite or very satisfied compared to sites with no Mailed Printed Summary 39/64(61%), ordinal odds ratio (OR) = 3.15 (1.66 to 5.98, p < 0.001). We found no effect on patient satisfaction from the Enhanced Webpage, OR = 1.47 (0.78 to 2.76, p = 0.235) or Email List Invitation, OR = 1.38 (0.72 to 2.63, p = 0.327). Interviewees described the results as interesting, important, and disappointing (the ICON8 trial found no benefit). Finding out the results made some feel their trial participation had been more worthwhile. Regardless of allocated group, patients who received results generally reported that the information was easy to understand and find, were glad and did not regret finding out the results. The main limitation of our study is the 65% response rate. Conclusions Nearly all respondents wanted to know the results and were glad to receive them. Adding an opt-out Mailed Printed Summary alongside a webpage yielded the highest reported satisfaction. This study provides evidence on how to share results with other similar trial populations. Further research is needed to look at different results scenarios and patient populations. Trial registration ISRCTN: ISRCTN96189403.
      PubDate: Mon, 04 Oct 2021 14:00:00 GMT
       
  • The effects of an evidence- and theory-informed feedback intervention on
           opioid prescribing for non-cancer pain in primary care: A controlled
           interrupted time series analysis

    • Authors: Sarah L. Alderson; Tracey M. Farragher, Thomas A. Willis, Paul Carder, Stella Johnson, Robbie Foy
      Abstract: by Sarah L. Alderson, Tracey M. Farragher, Thomas A. Willis, Paul Carder, Stella Johnson, Robbie FoyBackground The rise in opioid prescribing in primary care represents a significant international public health challenge, associated with increased psychosocial problems, hospitalisations, and mortality. We evaluated the effects of a comparative feedback intervention with persuasive messaging and action planning on opioid prescribing in primary care. Methods and findings A quasi-experimental controlled interrupted time series analysis used anonymised, aggregated practice data from electronic health records and prescribing data from publicly available sources. The study included 316 intervention and 130 control primary care practices in the Yorkshire and Humber region, UK, serving 2.2 million and 1 million residents, respectively. We observed the number of adult patients prescribed opioid medication by practice between July 2013 and December 2017. We excluded adults with coded cancer or drug dependency. The intervention, the Campaign to Reduce Opioid Prescribing (CROP), entailed bimonthly, comparative, and practice-individualised feedback reports to practices, with persuasive messaging and suggested actions over 1 year. Outcomes comprised the number of adults per 1,000 adults per month prescribed any opioid (main outcome), prescribed strong opioids, prescribed opioids in high-risk groups, prescribed other analgesics, and referred to musculoskeletal services. The number of adults prescribed any opioid rose pre-intervention in both intervention and control practices, by 0.18 (95% CI 0.11, 0.25) and 0.36 (95% CI 0.27, 0.46) per 1,000 adults per month, respectively. During the intervention period, prescribing per 1,000 adults fell in intervention practices (change −0.11; 95% CI −0.30, −0.08) and continued rising in control practices (change 0.54; 95% CI 0.29, 0.78), with a difference of −0.65 per 1,000 patients (95% CI −0.96, −0.34), corresponding to 15,000 fewer patients prescribed opioids. These trends continued post-intervention, although at slower rates. Prescribing of strong opioids, total opioid prescriptions, and prescribing in high-risk patient groups also generally fell. Prescribing of other analgesics fell whilst musculoskeletal referrals did not rise. Effects were attenuated after feedback ceased. Study limitations include being limited to 1 region in the UK, possible coding errors in routine data, being unable to fully account for concurrent interventions, and uncertainties over how general practices actually used the feedback reports and whether reductions in prescribing were always clinically appropriate. Conclusions Repeated comparative feedback offers a promising and relatively efficient population-level approach to reduce opioid prescribing in primary care, including prescribing of strong opioids and prescribing in high-risk patient groups. Such feedback may also prompt clinicians to reconsider prescribing other medicines associated with chronic pain, without causing a rise in referrals to musculoskeletal clinics. Feedback may need to be sustained for maximum effect.
      PubDate: Mon, 04 Oct 2021 14:00:00 GMT
       
  • COVID-19 and global equity for health: The good, the bad, and the wicked

    • Authors: Elvin H. Geng; Michael J. A. Reid, Eric Goosby, Quarraisha Abdool-Karim
      Abstract: by Elvin H. Geng, Michael J. A. Reid, Eric Goosby, Quarraisha Abdool-KarimElvin Geng and co-authors discuss monitoring and achieving equity in provision of vaccines for COVID-19.
      PubDate: Fri, 01 Oct 2021 14:00:00 GMT
       
  • Different dose regimens of a SARS-CoV-2 recombinant spike protein vaccine
           (NVX-CoV2373) in younger and older adults: A phase 2 randomized
           placebo-controlled trial

    • Authors: Neil Formica; Raburn Mallory, Gary Albert, Michelle Robinson, Joyce S. Plested, Iksung Cho, Andreana Robertson, Filip Dubovsky, Gregory M. Glenn, for the 2019nCoV-101 Study Group
      Abstract: by Neil Formica, Raburn Mallory, Gary Albert, Michelle Robinson, Joyce S. Plested, Iksung Cho, Andreana Robertson, Filip Dubovsky, Gregory M. Glenn, for the 2019nCoV-101 Study Group Background NVX-CoV2373 is a recombinant severe acute respiratory coronavirus 2 (rSARS-CoV-2) nanoparticle vaccine composed of trimeric full-length SARS-CoV-2 spike glycoproteins and Matrix-M1 adjuvant. Methods and findings The phase 2 component of our randomized, placebo-controlled, phase 1 to 2 trial was designed to identify which dosing regimen of NVX-CoV2373 should move forward into late-phase studies and was based on immunogenicity and safety data through Day 35 (14 days after the second dose). The trial was conducted at 9 sites in Australia and 8 sites in the United States. Participants in 2 age groups (aged 18 to 59 and 60 to 84 years) were randomly assigned to receive either 1 or 2 intramuscular doses of 5-μg or 25-μg NVX-CoV2373 or placebo, 21 days apart. Primary endpoints were immunoglobulin G (IgG) anti-spike protein response, 7-day solicited reactogenicity, and unsolicited adverse events. A key secondary endpoint was wild-type virus neutralizing antibody response. After enrollment, 1,288 participants were randomly assigned to 1 of 4 vaccine groups or placebo, with 1,283 participants administered at least 1 study treatment. Of these, 45% were older participants 60 to 84 years. Reactogenicity was predominantly mild to moderate in severity and of short duration (median
      PubDate: Fri, 01 Oct 2021 14:00:00 GMT
       
  • Postmortem investigations and identification of multiple causes of child
           deaths: An analysis of findings from the Child Health and Mortality
           Prevention Surveillance (CHAMPS) network

    • Authors: Robert F. Breiman; Dianna M. Blau, Portia Mutevedzi, Victor Akelo, Inacio Mandomando, Ikechukwu U. Ogbuanu, Samba O. Sow, Lola Madrid, Shams El Arifeen, Mischka Garel, Nana Bukiwe Thwala, Dickens Onyango, Antonio Sitoe, Ima-Abasi Bassey, Adama Mamby Keita, Addisu Alemu, Muntasir Alam, Sana Mahtab, Dickson Gethi, Rosauro Varo, Julius Ojulong, Solomon Samura, Ashka Mehta, Alexander M. Ibrahim, Afruna Rahman, Pio Vitorino, Vicky L. Baillie, Janet Agaya, Milagritos D. Tapia, Nega Assefa, Atique Iqbal Chowdhury, J. Anthony G. Scott, Emily S. Gurley, Karen L. Kotloff, Amara Jambai, Quique Bassat, Beth A. Tippett-Barr, Shabir A. Madhi, Cynthia G. Whitney, the CHAMPS Consortium
      Abstract: by Robert F. Breiman, Dianna M. Blau, Portia Mutevedzi, Victor Akelo, Inacio Mandomando, Ikechukwu U. Ogbuanu, Samba O. Sow, Lola Madrid, Shams El Arifeen, Mischka Garel, Nana Bukiwe Thwala, Dickens Onyango, Antonio Sitoe, Ima-Abasi Bassey, Adama Mamby Keita, Addisu Alemu, Muntasir Alam, Sana Mahtab, Dickson Gethi, Rosauro Varo, Julius Ojulong, Solomon Samura, Ashka Mehta, Alexander M. Ibrahim, Afruna Rahman, Pio Vitorino, Vicky L. Baillie, Janet Agaya, Milagritos D. Tapia, Nega Assefa, Atique Iqbal Chowdhury, J. Anthony G. Scott, Emily S. Gurley, Karen L. Kotloff, Amara Jambai, Quique Bassat, Beth A. Tippett-Barr, Shabir A. Madhi, Cynthia G. Whitney, the CHAMPS Consortium Background The current burden of>5 million deaths yearly is the focus of the Sustainable Development Goal (SDG) to end preventable deaths of newborns and children under 5 years old by 2030. To accelerate progression toward this goal, data are needed that accurately quantify the leading causes of death, so that interventions can target the common causes. By adding postmortem pathology and microbiology studies to other available data, the Child Health and Mortality Prevention Surveillance (CHAMPS) network provides comprehensive evaluations of conditions leading to death, in contrast to standard methods that rely on data from medical records and verbal autopsy and report only a single underlying condition. We analyzed CHAMPS data to characterize the value of considering multiple causes of death. Methods and findings We examined deaths identified from December 2016 through November 2020 from 7 CHAMPS sites (in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa), including 741 neonatal, 278 infant, and 241 child
      PubDate: Thu, 30 Sep 2021 14:00:00 GMT
       
  • Evaluation of portable devices for medicine quality screening: Lessons
           learnt, recommendations for implementation, and future priorities

    • Authors: Céline Caillet; Serena Vickers, Vayouly Vidhamaly, Kem Boutsamay, Phonepasith Boupha, Stephen Zambrzycki, Nantasit Luangasanatip, Yoel Lubell, Facundo M. Fernández, Paul N. Newton
      Abstract: by Céline Caillet, Serena Vickers, Vayouly Vidhamaly, Kem Boutsamay, Phonepasith Boupha, Stephen Zambrzycki, Nantasit Luangasanatip, Yoel Lubell, Facundo M. Fernández, Paul N. NewtonCéline Caillet and co-authors discuss a Collection on use of portable devices for the evaluation of medicine quality and legitimacy.
      PubDate: Thu, 30 Sep 2021 14:00:00 GMT
       
  • Correction: Accelerometer measured physical activity and the incidence of
           cardiovascular disease: Evidence from the UK Biobank cohort study

    • Authors: Rema Ramakrishnan; Aiden Doherty, Karl Smith-Byrne, Kazem Rahimi, Derrick Bennett, Mark Woodward, Rosemary Walmsley, Terence Dwyer
      Abstract: by Rema Ramakrishnan, Aiden Doherty, Karl Smith-Byrne, Kazem Rahimi, Derrick Bennett, Mark Woodward, Rosemary Walmsley, Terence Dwyer
      PubDate: Wed, 29 Sep 2021 14:00:00 GMT
       
  • Death of an offspring and parental risk of ischemic heart diseases: A
           population-based cohort study

    • Authors: Dang Wei; Imre Janszky, Fang Fang, Hua Chen, Rickard Ljung, Jiangwei Sun, Jiong Li, Krisztina D. László
      Abstract: by Dang Wei, Imre Janszky, Fang Fang, Hua Chen, Rickard Ljung, Jiangwei Sun, Jiong Li, Krisztina D. LászlóBackground The death of a child is an extreme life event with potentially long-term health consequences. Knowledge about its association with ischemic heart diseases (IHDs) and acute myocardial infarction (AMI), however, is very limited. We investigated whether the death of an offspring is associated with the risk of IHD and AMI. Methods and findings We studied parents of live-born children recorded in the Danish (1973 to 2016) and the Swedish (1973 to 2014) Medical Birth Registers (n = 6,711,952; mean age at baseline 31 years, 53% women). We retrieved information on exposure, outcomes, and covariates by linking individual-level information from several nationwide registers. We analyzed the abovementioned associations using Poisson regression. A total of 126,522 (1.9%) parents lost at least 1 child during the study period. Bereaved parents had a higher risk of IHD and AMI than the nonbereaved [incidence rate ratios (IRRs) (95% confidence intervals (CIs)): 1.20 (1.18 to 1.23), P < 0.001 and 1.21 (1.17 to 1.25), P < 0.001, respectively]. The association was present not only in case of losses due to CVD or other natural causes, but also in case of unnatural deaths. The AMI risk was highest in the first week after the loss [IRR (95% CI): 3.67 (2.08 to 6.46), P < 0.001], but a 20% to 40% increased risk was observed throughout the whole follow-up period. Study limitations include the possibility of residual confounding by socioeconomic, lifestyle, or health-related factors and the potentially limited generalizability of our findings outside Scandinavia. Conclusions The death of an offspring was associated with an increased risk of IHD and AMI. The finding that the association was present also in case of losses due to unnatural causes, which are less likely to be confounded by cardiovascular risk factors clustering in families, suggests that stress-related mechanisms may also contribute to the observed associations.
      PubDate: Wed, 29 Sep 2021 14:00:00 GMT
       
  • Implications of armed conflict for maternal and child health: A regression
           analysis of data from 181 countries for 2000–2019

    • Authors: Mohammed Jawad; Thomas Hone, Eszter P. Vamos, Valeria Cetorelli, Christopher Millett
      Abstract: by Mohammed Jawad, Thomas Hone, Eszter P. Vamos, Valeria Cetorelli, Christopher MillettBackground Armed conflicts have major indirect health impacts in addition to the direct harms from violence. They create enduring political instability, destabilise health systems, and foster negative socioeconomic and environmental conditions—all of which constrain efforts to reduce maternal and child mortality. The detrimental impacts of conflict on global maternal and child health are not robustly quantified. This study assesses the association between conflict and maternal and child health globally. Methods and findings Data for 181 countries (2000–2019) from the Uppsala Conflict Data Program and World Bank were analysed using panel regression models. Primary outcomes were maternal, under-5, infant, and neonatal mortality rates. Secondary outcomes were delivery by a skilled birth attendant and diphtheria, pertussis, and tetanus (DPT) and measles vaccination coverage. Models were adjusted for 10 confounders, country and year fixed effects, and conflict lagged by 1 year. Further lagged associations up to 10 years post-conflict were tested. The number of excess deaths due to conflict was estimated. Out of 3,718 country–year observations, 522 (14.0%) had minor conflicts and 148 (4.0%) had wars. In adjusted models, conflicts classified as wars were associated with an increase in maternal mortality of 36.9 maternal deaths per 100,000 live births (95% CI 1.9–72.0; 0.3 million excess deaths [95% CI 0.2 million–0.4 million] over the study period), an increase in infant mortality of 2.8 per 1,000 live births (95% CI 0.1–5.5; 2.0 million excess deaths [95% CI 1.6 million–2.5 million]), a decrease in DPT vaccination coverage of 4.9% (95% CI 1.5%–8.3%), and a decrease in measles vaccination coverage of 7.3% (95% CI 2.7%–11.8%). The long-term impacts of war were demonstrated by associated increases in maternal mortality observed for up to 7 years, in under-5 mortality for 3–5 years, in infant mortality for up to 8 years, in DPT vaccination coverage for up to 3 years, and in measles vaccination coverage for up to 2 years. No evidence of association between armed conflict and neonatal mortality or delivery by a skilled birth attendant was found. Study limitations include the ecological study design, which may mask sub-national variation in conflict intensity, and the quality of the underlying data. Conclusions Our analysis indicates that armed conflict is associated with substantial and persistent excess maternal and child deaths globally, and with reductions in key measures that indicate reduced availability of organised healthcare. These findings highlight the importance of protecting women and children from the indirect harms of conflict, including those relating to health system deterioration and worsening socioeconomic conditions.
      PubDate: Tue, 28 Sep 2021 14:00:00 GMT
       
  • Maternal hypertensive disorder of pregnancy and offspring early-onset
           cardiovascular disease in childhood, adolescence, and young adulthood: A
           national population-based cohort study

    • Authors: Chen Huang; Jiong Li, Guoyou Qin, Zeyan Liew, Jing Hu, Krisztina D. László, Fangbiao Tao, Carsten Obel, Jørn Olsen, Yongfu Yu
      Abstract: by Chen Huang, Jiong Li, Guoyou Qin, Zeyan Liew, Jing Hu, Krisztina D. László, Fangbiao Tao, Carsten Obel, Jørn Olsen, Yongfu YuBackground The prevalence of cardiovascular disease (CVD) has been increasing in children, adolescents, and young adults in recent decades. Exposure to adverse intrauterine environment in fetal life may contribute to the elevated risk of early-onset CVD. Many studies have shown that maternal hypertensive disorders of pregnancy (HDP) are associated with increased risks of congenital heart disease, high blood pressure, increased BMI, and systemic vascular dysfunction in offspring. However, empirical evidence on the association between prenatal exposure to maternal HDP and early-onset CVD in childhood and adolescence remains limited. Methods and findings We conducted a population-based cohort study using Danish national health registers, including 2,491,340 individuals born in Denmark from 1977 to 2018. Follow-up started at birth and ended at the first diagnosis of CVD, emigration, death, or 31 December 2018, whichever came first. Exposure of maternal HDP was categorized as preeclampsia or eclampsia (n = 68,387), gestational hypertension (n = 18,603), and pregestational hypertension (n = 15,062). Outcome was the diagnosis of early-onset CVD from birth to young adulthood (up to 40 years old). We performed Cox proportional hazards regression to evaluate the associations and whether the association differed by maternal history of CVD or diabetes before childbirth. We further assessed the association by timing of onset and severity of preeclampsia. The median follow-up time was 18.37 years, and 51.3% of the participants were males. A total of 4,532 offspring in the exposed group (2.47 per 1,000 person-years) and 94,457 in the unexposed group (2.03 per 1,000 person-years) were diagnosed with CVD. We found that exposure to maternal HDP was associated with an increased risk of early-onset CVD (hazard ratio [HR]: 1.23; 95% CI = 1.19 to 1.26; P < 0.001). The HRs for preeclampsia or eclampsia, gestational hypertension, and pregestational hypertension were 1.22 (95% CI, 1.18 to 1.26; P < 0.001), 1.25 (95% CI, 1.17 to 1.34; P < 0.001), and 1.28 (95% CI, 1.15 to 1.42; P < 0.001), respectively. We also observed increased risks for type-specific CVDs, in particular for hypertensive disease (HR, 2.11; 95% CI, 1.96 to 2.27; P < 0.001) and myocardial infarction (HR, 1.49; 95% CI, 1.12 to 1.98; P = 0.007). Strong associations were found among offspring of mothers with CVD history (HR, 1.67; 95% CI, 1.41 to 1.98; P < 0.001) or comorbid diabetes (HR, 1.56; 95% CI, 1.34 to 1.83; P < 0.001). When considering timing of onset and severity of preeclampsia on offspring CVD, the strongest association was observed for early-onset and severe preeclampsia (HR, 1.48, 95% CI, 1.30 to 1.67; P < 0.001). Study limitations include the lack of information on certain potential confounders (including smoking, physical activity, and alcohol consumption) and limited generalizability in other countries with varying disparities in healthcare. Conclusions Offspring born to mothers with HDP, especially mothers with CVD or diabetes history, were at increased risks of overall and certain type-specific early-onset CVDs in their first decades of life. Further research is warranted to better understand the mechanisms underlying the relationship between maternal HDP and early-onset CVD in offspring.
      PubDate: Tue, 28 Sep 2021 14:00:00 GMT
       
  • Sustainable Developmental Goals interrupted: Overcoming challenges to
           global child and adolescent health

    • Authors: Zulfiqar A. Bhutta; Kathryn M. Yount, Quique Bassat, Caitlin E. Moyer
      Abstract: by Zulfiqar A. Bhutta, Kathryn M. Yount, Quique Bassat, Caitlin E. Moyer
      PubDate: Tue, 28 Sep 2021 14:00:00 GMT
       
  • Special Issue Editor’s choice: Global child health from birth to
           adolescence and beyond

    • Authors: Caitlin Moyer
      Abstract: by Caitlin MoyerCaitlin Moyer discusses PLOS Medicine’s Special Issue on Global Child and Adolescent Health.
      PubDate: Tue, 28 Sep 2021 14:00:00 GMT
       
 
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