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Serhan M, Psihogios A, Kabir N, Bota AB, Mithani SS, Smith DP, Zhu DT, Greyson D, Wilson S, Fell D, Top KA, Bettinger JA, Wilson K. A scoping review of active, participant centred, digital adverse events following immunization (AEFI) surveillance of WHO approved COVID-19 vaccines: A Canadian immunization Research Network study. Hum Vaccin Immunother 2024; 20:2293550. [PMID: 38374618 PMCID: PMC10880498 DOI: 10.1080/21645515.2023.2293550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024] Open
Abstract
This scoping review examines the role of digital solutions in active, participant-centered surveillance of adverse events following initial release of COVID-19 vaccines. The goals of this paper were to examine the existing literature surrounding digital solutions and technology used for active, participant centered, AEFI surveillance of novel COVID-19 vaccines approved by WHO. This paper also aimed to identify gaps in literature surrounding digital, active, participant centered AEFI surveillance systems and to identify and describe the core components of active, participant centered, digital surveillance systems being used for post-market AEFI surveillance of WHO approved COVID-19 vaccines, with a focus on the digital solutions and technology being used, the type of AEFI detected, and the populations under surveillance. The findings highlight the need for customized surveillance systems based on local contexts and the lessons learned to improve future vaccine monitoring and pandemic preparedness.
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Affiliation(s)
- Mohamed Serhan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Athanasios Psihogios
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Nooh Kabir
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - A. Brianne Bota
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Salima S. Mithani
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - David P. Smith
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - David T. Zhu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sarah Wilson
- Health Protection, Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Populations & Public Health Research Program, ICES, Toronto, ON, Canada
| | - Deshayne Fell
- Department of Pediatrics, Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Karina A. Top
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Departments of Pediatrics and Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, Department of Pediatrics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
- O’Neill Institute for National and Global Health Law, Georgetown University
- Bruyère Research Institute, Ottawa, Canada
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Adamu AA, Jalo RI, Muhammad ID, Essoh TA, Ndwandwe D, Wiysonge CS. Sustainable financing for vaccination towards advancing universal health coverage in the WHO African region: The strategic role of national health insurance. Hum Vaccin Immunother 2024; 20:2320505. [PMID: 38414114 PMCID: PMC10903629 DOI: 10.1080/21645515.2024.2320505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
There is a growing political interest in health reforms in Africa, and many countries are choosing national health insurance as their main financing mechanism for universal health coverage. Although vaccination is an essential health service that can influence progress toward universal health coverage, it is not often prioritized by these national health insurance systems. This paper highlights the potential gains of integrating vaccination into the package of health services that is provided through national health insurance and recommends practical policy actions that can enable countries to harness these benefits at population level.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ibrahim D. Muhammad
- Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Téné-Alima Essoh
- Agence de Médecine Préventive, Regional Office for Africa, Abidjan, Cote d’Ivoire
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Tackett S, Ng CJ, Sugarman J, Daniel EGS, Gopalan N, Tivyashinee T, Kamarulzaman A, Ali J. Defining Malaysia's health research ethics system through a stakeholder driven approach. Dev World Bioeth 2024; 24:74-83. [PMID: 36861660 PMCID: PMC10474241 DOI: 10.1111/dewb.12396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/12/2023] [Indexed: 03/03/2023]
Abstract
The need to understand the systems that support ethical health research has long been recognized, but there are limited descriptions of actual health research ethics (HRE) systems. Using participatory network mapping methods, we empirically defined Malaysia's HRE system. 13 Malaysian stakeholders identified 4 overarching and 25 specific HRE system functions and 35 actors internal and 3 external to the Malaysian HRE system responsible for those functions. Functions requiring the most attention were: advising on legislation related to HRE; optimizing research value to society; and defining standards for HRE oversight. Internal actors with the greatest potential for more influence were: the national network of research ethics committees; non-institution-based research ethics committees; and research participants. The World Health Organization, an external actor, had the largest untapped potential for influence overall. In summary, this stakeholder-driven process identified HRE system functions and actors that could be targeted to increase HRE system capacity.
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Fierro V, Mazzuca C, Urbani S, Dahdah L, Calandrelli V, Valluzzi RL, Giulio D. Perspectives in precautionary allergen labelling of prepackaged foods after the FAO/WHO consultation. Curr Opin Allergy Clin Immunol 2024; 24:166-170. [PMID: 38547411 DOI: 10.1097/aci.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of the perspectives regarding precautionary allergen labelling (PAL) of prepackaged foods following the consultation conducted by the Food and Agriculture Organization (FAO) and the WHO. RECENT FINDINGS The FAO/WHO consultation provided a comprehensive assessment of the current status and practices of PAL implementation worldwide. One of the key findings highlighted by the Expert Committee was the need for improvement in existing PAL systems. It was noted that many countries lacked uniformity in PAL practices, leading to inconsistencies in labelling and potentially misleading information for consumers. Furthermore, the consultation emphasized the importance of PAL being risk-based, taking into account both the amount and frequency of unintended allergen presence (UAP) in food products. SUMMARY The FAO/WHO consultation shed light on various perspectives and challenges associated with PAL of prepackaged foods. Key findings emphasized the need for improvement in existing PAL systems, including the adoption of a risk-based approach, standardized regulations, and enhanced transparency. Moving forward, collaborative efforts between regulatory agencies, food manufacturers, and consumer advocacy groups will be essential in developing effective PAL strategies that prioritize consumer safety and well being.
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Affiliation(s)
- Vincenzo Fierro
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome
| | - Carmen Mazzuca
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome
| | - Sara Urbani
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome
| | - Lamia Dahdah
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome
| | | | | | - Dinardo Giulio
- Department of Women, Children, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
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Howard M. A market for diagnostic devices for extreme point-of-care testing: Are we ASSURED of an ethical outcome? Dev World Bioeth 2024; 24:84-96. [PMID: 36680792 DOI: 10.1111/dewb.12389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023]
Abstract
The World Health Organisation (WHO) is leading a global effort to deliver improved diagnostic testing to people living in low-resource settings. A reliance on the healthcare technologies marketplace and industry, shapes many aspects of the WHO project, and in this situation normative guidance comes by way of the ASSURED criteria - Affordable, Sensitive, Specific, User-friendly, Rapid and robust, Equipment-free, and Delivered. While generally improving access to diagnostics, I argue that the ASSURED approach to distributive justice - efficiency - and assessment of worth - productivity - may constrain efforts to deliver timely and accurate diagnosis in the developing world equitably by holding back new and innovative diagnostics and indirectly encouraging program and device design that may unfairly discriminate against certain groups. Even as we try to overcome the problem of global healthcare injustice, we may be entrenching disadvantage. I present my critique of ASSURED by 1) referencing Boltanski and Thévenot's theory of orders of worth to highlight the industrial and market foundations of the ASSURED guidelines; 2) comparing ASSURED with other normative guides that elevate the importance of civic responsibility in evaluations of distributive justice; 3) presenting a case study of the failed promise of microfluidic diagnostic devices. I conclude that a new approach to normative guidance is required to assess the value of developing world diagnostics, preferably, one that does not force global public goods into the marketplace.
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Huang YC, Hong CT, Chi WC, Yen CF, Fang Liao H, Liou TH, Chan L. Deterioration of fine motor skills and functional disability in patients with moderate-to-advanced Parkinson disease: A longitudinal follow-up study. Arch Gerontol Geriatr 2024; 121:105366. [PMID: 38341958 DOI: 10.1016/j.archger.2024.105366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Parkinson disease (PD) caused substantially disability. The impairment of fine motor skills (FMSs) is correlated with the severity of functional disability (FD) cross-sectionally in people with PD (PwP). The present study investigated the decline in FMSs and the predictive value of baseline FMSs for the progression of FD. METHODS People with moderate-to-advanced PD who received two evaluations within 1-5 years were identified from the Taiwan Data Bank of Persons with Disability database. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate FD, and FMSs including pen-holding, buttoning, and knotting were assessed. RESULTS Our study included 2,271 people with moderate-to-advanced PD. We observed annual progression of FD in each domain of the WHODAS 2.0, with no difference between the sexes. The most significant correlation between FD and FMSs was that of decline in buttoning ability and deterioration of summary WHODAS 2.0 scores. Deterioration in FD across all domains of WHODAS 2.0 was associated with at least one FMS. The extent of disability in all three types of FMS at baseline was also correlated with deterioration of motility. Additionally, baseline disability in buttoning was significantly correlated with cognitive decline, and disability in knotting was significantly associated with the progression of FD. CONCLUSION FMSs may be reliable markers for further FD, particularly in the areas of cognition, motility, and life activity. Because of the significant FD observed in people with moderate-to-advanced PD, the availability of predictors is essential for applying precautionary measures and providing appropriate treatment.
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Affiliation(s)
- Yin-Chia Huang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
| | - Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, 11031, Taiwan
| | - Wen-Chou Chi
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, 23561, Taiwan; Department of Occupational Therapy, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Chia-Feng Yen
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, 23561, Taiwan; Department of Public Health, Tzu Chi University, Hualien City, 97004, Taiwan
| | - Hua- Fang Liao
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, 23561, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, 10617, Taiwan
| | - Tsan-Hon Liou
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, 11031, Taiwan; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan.
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, 11031, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan.
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Koletzko B, Shamir R. Guidance on paediatric nutrition should follow quality standards and be evidence based: concerns regarding the recent WHO guideline on complementary feeding. Curr Opin Clin Nutr Metab Care 2024; 27:256-258. [PMID: 38573748 DOI: 10.1097/mco.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Affiliation(s)
- Berthold Koletzko
- LMU University of Munich, Department of Paediatrics, Dr von Hauner Children's Hospital, LMU Medicine, Munich, Germany
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Eduarda and Dr Moshe Ishay Institute for the Study of the Effects of Natural Food on Human Health, School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Zhou K, Gattinger G. The Evolving Regulatory Paradigm of AI in MedTech: A Review of Perspectives and Where We Are Today. Ther Innov Regul Sci 2024; 58:456-464. [PMID: 38528278 DOI: 10.1007/s43441-024-00628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/04/2024] [Indexed: 03/27/2024]
Abstract
Artificial intelligence (AI)-enabled technologies in the MedTech sector hold the promise to transform healthcare delivery by improving access, quality, and outcomes. As the regulatory contours of these technologies are being defined, there is a notable lack of literature on the key stakeholders such as the organizations and interest groups that have a significant input in shaping the regulatory framework. This article explores the perspectives and contributions of these stakeholders in shaping the regulatory paradigm of AI-enabled medical technologies. The formation of an AI regulatory framework requires the convergence of ethical, regulatory, technical, societal, and practical considerations. These multiple perspectives contribute to the various dimensions of an evolving regulatory paradigm. From the global governance guidelines set by the World Health Organization (WHO) to national regulations, the article sheds light not just on these multiple perspectives but also on their interconnectedness in shaping the regulatory landscape of AI.
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Affiliation(s)
- Karen Zhou
- Northeastern University, Toronto, ON, Canada.
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Masta R, Kukupe E, Marcus R, Duke T. The identification of WHO emergency signs in children by nurses at triage in an emergency department. Paediatr Int Child Health 2024; 44:8-12. [PMID: 38482930 DOI: 10.1080/20469047.2024.2328903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/01/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The World Health Organization recommends the use of a three-tier triage system to recognise a sick child in low- and middle-income countries. The three tiers are based on standardised emergency and priority signs. No studies have evaluated the prevalence or reliable detection of these emergency signs. AIMS To determine the prevalence of WHO emergency signs and the underlying causes, and to determine whether nurses could reliably detect these signs in children presenting to the emergency department at Port Moresby General Hospital in Papua New Guinea. METHODS A prospective study measured inter-rater agreement between nurses at triage and a blinded second assessor trained in paediatrics. RESULTS The prevalence of emergency signs was 16.7%: 32 of 192 children had these signs at presentation; 18 (9.4%) had severe respiratory distress; 10 (5.2%) had severe dehydration; and 3 (1.6%) had convulsions. There was an acceptable inter-rater agreement between nurses and doctors (Cohen's Kappa score >0.4) for some signs: subcostal recession, intercostal recession, nasal flaring, lethargy, weak volume pulses, convulsions, sunken eyes and a poor conscious state. Obstructed breathing, cyanosis, tracheal tug and cold hands and feet were less commonly detected and had poor inter-rater agreement (Kappa score <0.4). CONCLUSIONS Effective screening at triage can enable prompt emergency treatment by nurses and can help focus doctors' attention on children who require it most. There is a need for additional training in the identification of some emergency signs. ABBREVIATIONS CED: children's emergency department; ETAT: emergency triage assessment and treatment; HCC: Hospital Care for Children; PMGH: Port Moresby General Hospital; PNG: Papua New Guinea; WHO: World Health Organization.
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Affiliation(s)
- Rachel Masta
- Children's Emergency Department, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Everlyn Kukupe
- Children's Emergency Department, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Rupert Marcus
- Children's Emergency Department, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Trevor Duke
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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Lazarus JV, Pujol-Martinez C, Kopka CJ, Batista C, El-Sadr WM, Saenz R, El-Mohandes A. Implications from COVID-19 for future pandemic global health governance. Clin Microbiol Infect 2024; 30:576-581. [PMID: 37011809 PMCID: PMC10065870 DOI: 10.1016/j.cmi.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Limitations of current global health governance revealed during the COVID-19 pandemic can inform the ongoing deliberations of an international treaty on pandemics. OBJECTIVES To report on WHO definitions for governance and the enforcement of treaties in the context of a proposed international treaty on pandemics. SOURCES This narrative review was based on keyword searches related to public health, global health governance, and enforcement in PubMed/Medline and Google Scholar. Snowballing for additional articles followed the keyword search review. CONTENT WHO lacks a consistent definition of global health governance. Moreover, in its current state, the proposed international treaty on pandemics lacks articulated compliance, accountability, or enforcement mechanisms. Findings reveal that humanitarian treaties often fail to achieve their aims absent clear enforcement mechanisms. The proposed international treaty on public health is garnering a range of perspectives. Decision-makers should evaluate whether a globally aligned definition of global health governance is needed. Decision-makers should also consider whether the proposed international treaty on pandemics should be opposed if it lacks sufficiently clear compliance, accountability, and enforcement mechanisms. IMPLICATIONS To our knowledge, this narrative review is believed to be the first of its kind to search scientific-oriented databases regarding governance and international pandemic treaties. The review includes several findings that advance the literature. These findings, in turn, reveal two key implications for decision-makers. First, whether an aligned definition for governance addressing compliance, accountability, and enforcement mechanisms is needed. Second, whether a draft treaty lacking enforcement mechanisms should be approved.
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Affiliation(s)
- Jeffrey V Lazarus
- Health Systems Research Group, Barcelona Institute for Global Health, Barcelona, Spain; City University of New York Graduate School of Public Health and Health Policy, New York City, NY, USA; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| | - Cristina Pujol-Martinez
- Health Systems Research Group, Barcelona Institute for Global Health, Barcelona, Spain; Department of Political Science, Faculty of Law, University of Barcelona, Barcelona, Spain
| | | | - Carolina Batista
- Department of Global Health Affairs, Baraka Impact Finance, Geneva, Switzerland
| | - Wafaa M El-Sadr
- International Center for AIDS Care and Treatment Programs at Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Rocio Saenz
- School of Public Health, University of Costa Rica, San José, Costa Rica
| | - Ayman El-Mohandes
- City University of New York Graduate School of Public Health and Health Policy, New York City, NY, USA
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El-Anwar N, El-Shabrawi M, Shahin OO, Abdel Kareem R, Salama AM, Baroudy S. Health-related quality of life and cognitive function in children with Crigler-Najjar syndrome type 1. Paediatr Int Child Health 2024; 44:18-23. [PMID: 38334259 DOI: 10.1080/20469047.2024.2309727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND The aim of the study was to assess the health-related quality of life (HRQOL) and cognitive function in patients with Crigler-Najjar syndrome (CNS) type I and its impact on their lives. METHODS Twenty-one patients diagnosed with CNS type I aged 1 month to 18 years in the Paediatric Hepatology Unit of Cairo University Children's Hospital were enrolled in this cross-sectional observational study. The patients' health-related quality of life (HRQOL) was assessed using the World Health Organization Quality Of Life BREF questionnaire (WHOQOL-BREF) and the Short Form 36 Health Survey Questionnaire (SF-36). Cognitive function was assessed using the Stanford-Binet Intelligence Scale: Fifth Edition (SB5). RESULTS All patients had a history of admission to a neonatal intensive care unit, 17 were managed by phototherapy only and 5 also underwent exchange transfusion. According to the WHOQOL questionnaire, 11 cases (52.4%) had a low QOL score, and 7 of 13 patients had an average score for their total IQ test. Cases with poor compliance to phototherapy had statistically significantly lower QOL scores (p=0.001), while, according to the SF36 survey, cases who received exchange transfusion had statistically significantly higher cognitive function (p=0.03). There was a positive correlation between the neurological effect as a complication of the disease and poor physical QOL. CONCLUSION Paediatric patients with CNS have significantly lower HRQOL, especially physically, psychologically and environmentally. It is recommended that assessment of HRQOL should be a routine part of follow-up in CNS patients. Patients whose HRQOL is affected receive regular psychiatric counselling, social support and rehabilitation.Abbreviations: CNS: Crigler-Najjar syndrome; HRQOL: health-related quality of life; IQ: intelligence quotient; NICU: neonatal intensive care unit; QOL: quality of life; SB5: Stanford-Binet intelligence scale: 5th edition; SF-36: Short Form 36 Health Survey Questionnaire; UDGT: uridine diphosphate glucuronosyl transferase; UGT1A1: uridine 5'-diphosphate glucuronosyltransferase; WHOQOL-BREF: World Health Organization Quality of Life Brief Version.
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Affiliation(s)
- Noha El-Anwar
- Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mortada El-Shabrawi
- Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ola Omar Shahin
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reem Abdel Kareem
- Paediatrics department, Ministry of Health and Population, Cairo, Egypt
| | | | - Sherif Baroudy
- Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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Shamieh O, Alarjeh G, Hammad R, Payne S, Harding R, Sullivan R, Mansour A. National Palliative Care Strategy in a Conflict Affected Country: A Jordanian Demonstration Project. J Pain Symptom Manage 2024; 67:e473-e485. [PMID: 38159658 DOI: 10.1016/j.jpainsymman.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
CONTEXT Palliative care (PC) integration is vital, as endorsed by the World Health Organization. Yet, Jordan, a Middle Eastern country with limited resources, faces ongoing challenges despite efforts to improve palliative and home care. Establishing a national PC strategic framework, with government and stakeholder consensus, is essential for ensuring universal access to high-quality palliative care. However, processes for achieving this, particularly in the Middle East, are underreported. OBJECTIVES This study delineates the process of developing Jordan's National Palliative and Home Care Strategic Framework, reflecting on its five-year impact. Additionally, it identifies barriers to PC progress in Jordan and offers recommendations to stakeholders. METHODS We conducted a rapid review and analyzed reports, minutes, meetings, and publications. The sequential framework development involved content and situational analysis, expert review, transparent expert consultation, multistage consensus procedures, and high-level advocacy meetings. RESULTS The National Palliative and Home Care Strategic Framework encompasses six domains: 1) policy, 2) finance, 3) service delivery, 4) opioid access, 5) capacity building, and 6) information, research, monitoring, and evaluation. Government endorsement in April 2018 ignited national engagement, driving policy, service delivery, workforce development, education, training, and research progress. Nonetheless, workforce shortages, limited opioid access, and inadequate funding persist as barriers. CONCLUSION Jordan's collaborative development of the inaugural National Palliative and Home Care Strategic Framework, endorsed by the government and stakeholders, provides a comprehensive roadmap for PC advancement. While it promises improved services, effective solutions to workforce and opioid access issues are crucial for successful implementation.
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Affiliation(s)
- Omar Shamieh
- Department of Palliative Care (O.S.), King Hussein Cancer Center, Amman, Jordan; Center for Palliative and Cancer Care in Conflict (O.S., G.A., A.M.), King Hussein Cancer Center, Amman, Jordan; College of Medicine, Faculty of medicine (O.S.), The University of Jordan, Amman, Jordan.
| | - Ghadeer Alarjeh
- Center for Palliative and Cancer Care in Conflict (O.S., G.A., A.M.), King Hussein Cancer Center, Amman, Jordan.
| | - Rana Hammad
- Center for Palliative and Cancer Care in Conflict (O.S., G.A., A.M.), King Hussein Cancer Center, Amman, Jordan
| | - Sheila Payne
- International Observatory on End of Life Care (S.P.), Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation (R.H.), Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Richard Sullivan
- Institute of Cancer Policy & Conflict & Health Research Group (R.S.), King's College London, London, United Kingdom
| | - Asem Mansour
- Center for Palliative and Cancer Care in Conflict (O.S., G.A., A.M.), King Hussein Cancer Center, Amman, Jordan; Department of Radiology, King Hussein Cancer Centre (KHCC), Amman, Jordan
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Pietrzykowski MO, Vranceanu AM, Macklin EA, Mace RA. Minimal clinically important difference in the World Health Organization Quality of Life Brief (WHOQOL-BREF) for adults with neurofibromatosis. Qual Life Res 2024; 33:1233-1240. [PMID: 38214851 DOI: 10.1007/s11136-023-03596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE This study aimed to estimate minimal clinically important difference (MCID) values for the World Health Organization Quality of Life Brief version (WHOQOL-BREF) among adults with neurofibromatosis (NF). An MCID is needed to demonstrate clinical meaningfulness of interventions for NF. METHODS We estimated MCID for the WHOQOL-BREF: the quality of life (QoL) measure recommended by the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration. We used data from 228 clinical trial participants with NF type 1, NF type 2-related schwannomatosis, or schwannomatosis (SCHWN) who completed 10 weeks of a virtual group mind-body program targeting resiliency or a time- and attention-matched control. Following established guidelines, we estimated MCIDs using both anchor-based and distribution-based methods for physical, psychological, social relationships, and environmental domains of the WHOQOL-BREF. RESULTS MCID results varied across method and QoL domain. Three anchor-based methods, average change (AC), change difference (CD), and regression (REG), yielded the most consistent and comparable MCID across QoL domains. Based on these methods, we recommend ranges for each QoL domain: Physical QoL (3.9-7.3), Psychological QoL (4.7-8.1), Social QoL (2.6-5.9), and Environmental QoL (4.1-6.6). CONCLUSION Establishing a rigorous MCID for QoL in NF is a critical step toward evaluating meaningful change in response to psychosocial interventions.
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Affiliation(s)
- Malvina O Pietrzykowski
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, USA.
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Eric A Macklin
- Department of Medicine, Biostatistics Center, Massachusetts General Hospital, Boston, USA
- Department of Neurology, Harvard Medical School, Boston, USA
| | - Ryan A Mace
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
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14
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Obidike P, Chang A, Calisi O, Lee JJ, Ssentongo P, Ssentongo AE, Oh JS. COVID-19 and Mortality in the Global Surgical Population: A Systematic Review and Meta-Analysis. J Surg Res 2024; 297:88-100. [PMID: 38460454 DOI: 10.1016/j.jss.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION To date, no systematic review or meta-analysis has comprehensively estimated the risk of mortality by surgery type on an international scale. We aim to delineate the risk of mortality in patients with COVID-19 who undergo surgery. METHODS PubMed (MEDLINE), Scopus, OVID, the World Health Organization Global Literature on Coronavirus Disease, and Corona-Central databases were searched from December 2019 through January 2022. Studies providing data on mortality in patients undergoing surgery were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for abstracting data were followed and performed independently by two reviewers. The main outcome was mortality in patients with COVID-19. RESULTS Of a total of 4023 studies identified, 46 studies with 80,015 patients met our inclusion criteria. The mean age was 67 y; 57% were male. Surgery types included general (14.9%), orthopedic (23.4%), vascular (6.4%), thoracic (10.6%), and urologic (8.5%). Patients undergoing surgery with COVID-19 elicited a nine-fold increased risk of mortality (relative risk [RR] 8.99, 95% confidence interval [CI] 4.96-16.32) over those without COVID-19. In low-income and middle-income countries (RR: 16.04, 95% CI: 4.59-56.12), the mortality risk was twice as high compared to high-income countries (RR: 7.50, 95% CI: 4.30-13.09). CONCLUSIONS Mortality risk in surgical patients with COVID-19 compared to those without is increased almost 10-fold. The risk was highest in low-income and middle-income countries compared to high-income countries, suggesting a disproportionate effect of the pandemic on resource-constrained regions.
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Affiliation(s)
- Prisca Obidike
- Department of General Surgery, University of Virginia, Charlottesville, Virginia; Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Allison Chang
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Olivia Calisi
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jungeun J Lee
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Paddy Ssentongo
- Department of Medicine, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Anna E Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania; Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - John S Oh
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania.
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Chen X, Yuan L, Zhang Y, Wang F, Ma X, Fang J, Cao P, Liu Y, Liu Z, Liu M, Chen J, Zhou X, Liu M, Jin D, Wang T, Lu P, Liu H. Advances towards genome-based acute myeloid leukemia classification: A comparative analysis of WHO-HAEM4R, WHO-HAEM5, and International Consensus Classification. Am J Hematol 2024; 99:824-835. [PMID: 38321864 DOI: 10.1002/ajh.27249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Abstract
Two recent guidelines, the 5th edition of the World Health Organization Classification of Haematolymphoid Tumours (WHO-HAEM5) and the International Consensus Classification (ICC), were published to refine the diagnostic criteria of acute myeloid leukemia (AML). They both consider genomic features more extensively and expand molecularly defined AML subtypes. In this study, we compared the classifications of 1135 AML cases under both criteria. According to WHO-HAEM5 and ICC, the integration of whole transcriptome sequencing, targeted gene mutation screening, and conventional cytogenetic analysis identified defining genetic abnormalities in 89% and 90% of AML patients, respectively. The classifications displayed discrepancies in 16% of AML cases after being classified using the two guidelines, respectively. Both new criteria significantly reduce the number of cases defined by morphology and differentiation. However, their clinical implementation heavily relies on comprehensive and sophisticated genomic analysis, including genome and transcriptome levels, alongside the assessment of pathogenetic somatic and germline variations. Discrepancies between WHO-HAEM5 and ICC, such as the assignment of RUNX1 mutations, the rationality of designating AML with mutated TP53 as a unique entity, and the scope of rare genetic fusions, along with the priority of concurrent AML-defining genetic abnormalities, are still pending questions requiring further research for more elucidated insights.
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Affiliation(s)
- Xue Chen
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Lili Yuan
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Yang Zhang
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Fang Wang
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Xiaoli Ma
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Jiancheng Fang
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Panxiang Cao
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Yijun Liu
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Zhixiu Liu
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Ming Liu
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Jiaqi Chen
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Xiaosu Zhou
- Molecular Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
| | - Mingyue Liu
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - David Jin
- Molecular Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
| | - Tong Wang
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Peihua Lu
- Molecular Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
- Department of Hematology, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Hongxing Liu
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
- Molecular Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
- Division of Pathology and Laboratory Medicine, Beijing Lu Daopei Hospital, Beijing, China
- Department of Oncology, Capital Medical University, Beijing, China
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Wagatsuma K, Ikemoto K, Inaji M, Kamitaka Y, Hara S, Tamura K, Miwa K, Tsuzura K, Tsuruki T, Miyaji N, Ishibashi K, Ishii K. Impact of [ 11C]methionine PET with Bayesian penalized likelihood reconstruction on glioma grades based on new WHO 2021 classification. Ann Nucl Med 2024; 38:400-407. [PMID: 38466549 DOI: 10.1007/s12149-024-01911-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/02/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The uptake of [11C]methionine in positron emission tomography (PET) imaging overlapped in earlier images of tumors. Bayesian penalized likelihood (BPL) reconstruction increases the quantitative values of tumors compared with conventional ordered subset-expectation maximization (OSEM). The present study aimed to grade glioma malignancy based on the new WHO 2021 classification using [11C]methionine PET images reconstructed using BPL. METHODS We categorized 32 gliomas in 28 patients as grades 2/3 (n = 15) and 4 (n = 17) based on the WHO 2021 classification. All [11C]methionine images were reconstructed using OSEM + time-of-flight (TOF) and BPL + TOF (β = 200). Maximum standardized uptake value (SUVmax) and tumor-to-normal tissue ratio (T/Nmax) were measured at each lesion. RESULTS The mean SUVmax was 4.65 and 4.93 in grade 2/3 and 6.38 and 7.11 in grade 4, and the mean T/Nmax was 7.08 and 7.22 in grade 2/3 and 9.30 and 10.19 in grade 4 for OSEM and BPL, respectively. The BPL significantly increased these values in grade 4 gliomas. The area under the receiver operator characteristic (ROC) curve (AUC) for SUVmax was the highest (0.792) using BPL. CONCLUSIONS The BPL increased mean SUVmax and mean T/Nmax in lesions with higher contrast such as grade 4 glioma. The discrimination power between grades 2/3 and 4 in SUVmax was also increased using [11C]methionine PET images reconstructed with BPL.
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Affiliation(s)
- Kei Wagatsuma
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitazato, Minami-Ku, Sagamihara, Kanagawa, 252-0373, Japan.
- Research Team for Neuroimaging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan.
| | - Kensuke Ikemoto
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitazato, Minami-Ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Motoki Inaji
- Research Team for Neuroimaging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yuto Kamitaka
- Research Team for Neuroimaging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan
| | - Shoko Hara
- Research Team for Neuroimaging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Kaoru Tamura
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Kenta Miwa
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, 10-6 Sakaemachi, Fukushima-Shi, Fukushima, 960-8516, Japan
| | - Kaede Tsuzura
- Department of Medical Technology, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Taisei Tsuruki
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitazato, Minami-Ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Noriaki Miyaji
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, 10-6 Sakaemachi, Fukushima-Shi, Fukushima, 960-8516, Japan
| | - Kenji Ishibashi
- Research Team for Neuroimaging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan
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Shomali W, Gotlib J. World Health Organization and International Consensus Classification of eosinophilic disorders: 2024 update on diagnosis, risk stratification, and management. Am J Hematol 2024; 99:946-968. [PMID: 38551368 DOI: 10.1002/ajh.27287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 04/09/2024]
Abstract
DISEASE OVERVIEW The eosinophilias encompass a broad range of non-hematologic (secondary or reactive) and hematologic (primary or clonal) disorders with the potential for end-organ damage. DIAGNOSIS Hypereosinophilia (HE) has generally been defined as a peripheral blood eosinophil count greater than 1.5 × 109/L, and may be associated with tissue damage. After the exclusion of secondary causes of eosinophilia, diagnostic evaluation of primary eosinophilias relies on a combination of various tests. They include morphologic review of the blood and marrow, standard cytogenetics, fluorescence in situ hybridization, molecular testing and flow immunophenotyping to detect histopathologic or clonal evidence for an acute or chronic hematolymphoid neoplasm. RISK STRATIFICATION Disease prognosis relies on identifying the subtype of eosinophilia. After evaluation of secondary causes of eosinophilia, the 2022 World Health Organization and International Consensus Classification endorse a semi-molecular classification scheme of disease subtypes. This includes the major category "myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase gene fusions" (MLN-eo-TK), and the MPN subtype, "chronic eosinophilic leukemia" (CEL). Lymphocyte-variant HE is an aberrant T-cell clone-driven reactive eosinophila, and idiopathic hypereosinophilic syndrome (HES) is a diagnosis of exclusion. RISK-ADAPTED THERAPY The goal of therapy is to mitigate eosinophil-mediated organ damage. For patients with milder forms of eosinophilia (e.g., <1.5 × 109/L) without symptoms or signs of organ involvement, a watch and wait approach with close follow-up may be undertaken. Identification of rearranged PDGFRA or PDGFRB is critical because of the exquisite responsiveness of these diseases to imatinib. Pemigatinib was recently approved for patients with relapsed or refractory FGFR1-rearranged neoplasms. Corticosteroids are first-line therapy for patients with lymphocyte-variant HE and HES. Hydroxyurea and interferon-α have demonstrated efficacy as initial treatment and in steroid-refractory cases of HES. Mepolizumab, an interleukin-5 (IL-5) antagonist monoclonal antibody, is approved by the U.S Food and Drug Administration for patients with idiopathic HES. Cytotoxic chemotherapy agents, and hematopoietic stem cell transplantation have been used for aggressive forms of HES and CEL, with outcomes reported for limited numbers of patients. Targeted therapies such as the IL-5 receptor antibody benralizumab, IL-5 monoclonal antibody depemokimab, and various tyrosine kinase inhibitors for MLN-eo-TK, are under active investigation.
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Affiliation(s)
- William Shomali
- Division of Hematology, Stanford Cancer Institute/Stanford University School of Medicine, Stanford, California, USA
| | - Jason Gotlib
- Division of Hematology, Stanford Cancer Institute/Stanford University School of Medicine, Stanford, California, USA
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18
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Rademaker D, de Groot ECM, van den Akker ES, Franx A, van Rijn BB, DeVries JH, Siegelaar SE, Painter RC. The WHO 2013 oral glucose tolerance test: The utility of isolated glucose measurements - A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 296:371-375. [PMID: 38552506 DOI: 10.1016/j.ejogrb.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE The WHO 2013 guidelines recommend screening for gestational diabetes mellitus (GDM) by 3-point oral glucose tolerance test (OGTT). The objective of this retrospective cohort study was to evaluate GDM diagnosed by an isolated high glucose. STUDY DESIGN We included pregnant women deemed at risk for GDM were offered GDM screening. We examined the records of 1939 consecutively screened pregnancies at two teaching hospitals in Amsterdam during 2016-2020. Using the WHO 2013 diagnostic criteria, we calculated the proportion of GDM cases diagnosed by isolated abnormal glucose values. RESULTS Among those screened in our high risk cohort, GDM incidence was 31.5%. Of the GDM diagnoses, 57.0% were based on an isolated fasting glucose value, 30.9% based on multiple raised glucose measurements, 7.4% on an isolated raised 2-hour glucose and 4.7% on an isolated raised 1-hour glucose. For 1-hour glucose, the number needed to screen was 67 persons for one additional GDM case. CONCLUSION The 1-hour glucose in the 3 point OGTT, as suggested by the WHO 2013 guidelines for GDM, contributes only small numbers of GDM cases and a high number needed to screen (67 for 1 additional case in a selective high risk GDM screening strategy), and is likely even less effective in universally screened populations.
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Affiliation(s)
- D Rademaker
- Amsterdam UMC Location University of Amsterdam, Department of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands.
| | - E C M de Groot
- Amsterdam UMC Location University of Amsterdam, Department of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands
| | - E S van den Akker
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands
| | - A Franx
- Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - B B van Rijn
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - J H DeVries
- Department of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - S E Siegelaar
- Department of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, the Netherlands
| | - R C Painter
- Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynecology, Boelelaan 1117, Amsterdam, the Netherlands
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De la Cerna-Luna R, Reebye R. Spasticity Management Model for Low- and Middle-Income Countries Based on World Health Organization Rehabilitation Initiatives. Am J Phys Med Rehabil 2024; 103:e62-e64. [PMID: 38063328 DOI: 10.1097/phm.0000000000002390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
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20
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Harris E. WHO Documents Rising Resistance to First-Line HIV Drug. JAMA 2024; 331:1355. [PMID: 38578630 DOI: 10.1001/jama.2024.4497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
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Yang SL, Togawa K, Gilmour S, Leon ME, Soerjomataram I, Katanoda K. Projecting the impact of implementation of WHO MPOWER measures on smoking prevalence and mortality in Japan. Tob Control 2024; 33:295-301. [PMID: 36100264 DOI: 10.1136/tc-2022-057262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/23/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aimed to quantify the long-term impact of implementing the WHO Framework Convention on Tobacco Control (FCTC) compliant tobacco control measures, MPOWER, on smoking prevalence and mortality in men and women aged ≥20 years in Japan. DESIGN A Stock-and-Flow simulation model was used to project smoking prevalence and mortality from 2018 to 2050 under eight different scenarios: (1) maintaining the 2018 status quo, (2) implementation of smoke-free policies, (3) tobacco use cessation programmes, (4-5) health warning about the dangers of tobacco (labels, mass media), (6) enforcement of tobacco advertising bans or (7) tobacco taxation at the highest recommended level and (8) all these interventions combined. RESULTS Under the status quo, the smoking prevalence in Japan will decrease from 29.6% to 15.5% in men and 8.3% to 4.7% in women by 2050. Full implementation of MPOWER will accelerate this trend, dropping the prevalence to 10.6% in men and 3.2% in women, and save nearly a quarter million deaths by 2050. This reduction implies that Japan will only attain the current national target of 12% overall smoking prevalence in 2033, 8 years earlier than it would with the status quo (in 2041), a significant delay from the national government's 2022 deadline. CONCLUSIONS To bring forward the elimination of tobacco smoking and substantially reduce smoking-related deaths, the government of Japan should fulfil its commitment to the FCTC and adopt stringent tobacco control measures delineated by MPOWER and beyond.
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Affiliation(s)
- Su Lan Yang
- Institute for Clinical Research, Centre for Clinical Epidemiology, National Institute of Health Malaysia, Selangor, Malaysia
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Kayo Togawa
- Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Stuart Gilmour
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Maria E Leon
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Kota Katanoda
- Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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22
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Tawiah P, Mensah PB, Gyabaah S, Adebanji AO, Konadu E, Amoah I. Gait speed and its associated factors among older black adults in Sub-Saharan Africa: Evidence from the WHO study on Global AGEing in older adults (SAGE). PLoS One 2024; 19:e0295520. [PMID: 38635683 PMCID: PMC11025960 DOI: 10.1371/journal.pone.0295520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/22/2023] [Indexed: 04/20/2024] Open
Abstract
Gait speed is an essential predictor of functional and cognitive decline in older adults. The study aimed to investigate the gait speed of older adults in Ghana and South Africa and to determine its associated factors, as the Sub-Saharan representatives in the World Health Organization's Study on Global AGEing in Older Adults (SAGE). A secondary analysis of data from the SAGE study which consists of nationally representative data involving participants aged ≥50+ years with smaller samples of younger adults aged 18-49 years in Ghana and South Africa was conducted. SAGE study employed a multistage, stratified clustered sample design and involved the use of a standardised questionnaire to obtain participants' (n = 5808) demographic, anthropometric and gait speed information. The standard 4 metre-gait speed was used. Median gait speed for the study group, which comprised African/Black participants aged ≥50+ years was 0.769(Q1 = 0.571, Q3 = 0.952)m/s for males and 0.667 (Q1 = 0.500,Q3 = 0.833)m/s for females. For every unit increase in age, the odds of being in a higher-ranked gait speed category was 0.96(95%CI 0·96, 0·97, p<0.001) times that of the previous age. Females had odds of 0.55 (95%CI 0.50, 0.61, p<0.001) of recording higher gait speed, as compared to males. Rural dwellers had odds of 1.43 (95%CI 1.29, 1.58, p < 0.001) of being in a higher-ranked category of gait speed compared to urban dwellers. Underweight (OR = 0.85, 95%C1 = 0.73-1.00, p<0.05) and obesity (OR = 0.53, 95%CI = 0.46-0.61, p<0.001) were associated with slower gait speed. Amongst functional indices, the World Health Organization Disability Assessment Schedule (WHODAS) score was the biggest determinant of gait speed. Having a "Severe/Extreme" WHODAS score had the strongest association with gait speed (OR = 0.18, 95%CI = 0.14-0.23, p<0.001). These gait speed results provide an essential reference for older adults' care in Ghana and South Africa.
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Affiliation(s)
- Phyllis Tawiah
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Atinuke Olusola Adebanji
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Konadu
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Amoah
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Kyung S, Woo S, Kim M, Lee H, Kang J, Rahmati M, Yon DK. Global burden of vaccine-associated alopecia, 1979-2023: a comprehensive analysis of the international pharmacovigilance database. Br J Dermatol 2024; 190:764-767. [PMID: 38332614 DOI: 10.1093/bjd/ljae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024]
Abstract
While global concern over vaccine-associated alopecia has been gradually increasing, it has also been reported that alopecia, classified as an autoimmune disease, can manifest as an immune-related side-effect caused by vaccinations. However, comprehensive research on vaccine-associated alopecia has been limited. Therefore, we carried out a comprehensive analysis using information from VigiBase (1979–2023) from more than 156 countries, managed by the WHO and the Uppsala Monitoring Centre. Thus, this global pharmacovigilance study of vaccine-associated alopecia, encompassing all age and sex groups, provides international and comprehensive evidence that substantiates the overall real-world impact of vaccines.
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Affiliation(s)
- Seoyeon Kyung
- Center for Digital Health, Medical Science Research Institute
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Selin Woo
- Center for Digital Health, Medical Science Research Institute
| | - Minji Kim
- Center for Digital Health, Medical Science Research Institute
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute
| | - Jiseung Kang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-e-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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24
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Wirtz VJ, Gray AL, Sharma S, Sun J, Hogerzeil HV. Refocusing the World Health Organization's Model List of Essential Medicines on the needs of low and middle income countries. BMJ 2024; 385:e077776. [PMID: 38626944 DOI: 10.1136/bmj-2023-077776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Andrew L Gray
- Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sangeeta Sharma
- Department of Neuropsychopharmacology, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Jing Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hans V Hogerzeil
- University Medical Centre Groningen, University of Groningen, Netherlands
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25
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Hirsch-Moverman Y, Hsu A, Abrams EJ, Killam WP, Moore B, Howard AA. Guidelines for tuberculosis screening and preventive treatment among pregnant and breastfeeding women living with HIV in PEPFAR-supported countries. PLoS One 2024; 19:e0296993. [PMID: 38625930 PMCID: PMC11021021 DOI: 10.1371/journal.pone.0296993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/21/2023] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) preventive treatment (TPT) is recommended by the World Health Organization (WHO) for persons living with HIV, including pregnant and breastfeeding women. Given the President's Emergency Plan for AIDS Relief (PEPFAR)'s investment in TPT services for persons living with HIV as a strategy to prevent TB as well as uncertainty in guidelines and policy regarding use of TPT during pregnancy and the postpartum period, we conducted a review of current relevant national guidelines among PEPFAR-supported countries. METHODS Our review included 44/49 PEPFAR-supported countries to determine if TB screening and TPT are recommended specifically for pregnant and breastfeeding women living with HIV (WLHIV). National guidelines reviewed and abstracted included TB, HIV, prevention of vertical HIV transmission, TPT, and any other relevant guidelines. We abstracted information regarding TB screening, including screening tools and frequency; and TPT, including timing, regimen, frequency, and laboratory monitoring. RESULTS Of 44 PEPFAR-supported countries for which guidelines were reviewed, 66% were high TB incidence countries; 41% were classified by WHO as high TB burden countries, and 43% as high HIV-associated TB burden countries. We found that 64% (n = 28) of countries included TB screening recommendations for pregnant WLHIV in their national guidelines, and most (n = 35, 80%) countries recommend TPT for pregnant WLHIV. Fewer countries included recommendations for breastfeeding as compared to pregnant WLHIV, with only 32% (n = 14) mentioning TB screening and 45% (n = 20) specifically recommending TPT for this population; most of these recommend isoniazid-based TPT regimens for pregnant and breastfeeding WLHIV. However, several countries also recommend isoniazid combined with rifampicin (3RH) or rifapentine (3HP). CONCLUSIONS Despite progress in the number of PEPFAR-supported countries that specifically include TB screening and TPT recommendations for pregnant and breastfeeding WLHIV in their national guidelines, many PEPFAR-supported countries still do not include specific screening and TPT recommendations for pregnant and breastfeeding WLHIV.
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Affiliation(s)
- Yael Hirsch-Moverman
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health Columbia University, New York, New York, United States of America
| | - Allison Hsu
- ICAP at Columbia University, New York, New York, United States of America
| | - Elaine J. Abrams
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health Columbia University, New York, New York, United States of America
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, United States of America
| | - William P. Killam
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brittany Moore
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea A. Howard
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health Columbia University, New York, New York, United States of America
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Petkevičienė J, Voeller A, Čiupkevičienė E, Razavi-Shearer D, Liakina V, Jančorienė L, Kazėnaitė E, Zaksas V, Urbonas G, Kupčinskas L. Hepatitis C screening in Lithuania: first-year results and scenarios for achieving WHO elimination targets. BMC Public Health 2024; 24:1055. [PMID: 38622549 PMCID: PMC11020450 DOI: 10.1186/s12889-024-18470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) has outlined a set of targets to achieve eliminating hepatitis C by 2030. In May 2022, Lithuanian health authorities initiated a hepatitis C virus (HCV) screening program to start working towards elimination. In the program, bonus was given to general practitioners (GPs) to promote and conduct anti-HCV tests for two situations: (1) one time testing for individuals born in 1945-1994 and (2) annual HCV testing for persons who inject drugs or are living with human immunodeficiency virus (HIV) regardless of age. This study aimed to model the current viral hepatitis C epidemiological status in Lithuania and to outline the requirements for WHO elimination targets using the first-year HCV screening results. METHODS Individuals were invited to participate in the anti-HCV screening by GPs during routine visits. Patients who tested positive were then referred to a gastroenterologist or infectious disease doctor for further confirmatory testing. If a patient received a positive RNA test and a fibrosis staging result of ≥ F2, the doctor prescribed direct-acting antivirals. Information on the patients screened, diagnosed, and treated was obtained from the National Health Insurance Fund. The Markov disease progression model, developed by the CDA Foundation, was used to evaluate the screening program results and HCV elimination progress in Lithuania. RESULTS Between May 2022 and April 2023, 790,070 individuals underwent anti-HCV testing, with 11,943 individuals (1.5%) receiving positive results. Anti-HCV seroprevalence was found to be higher among males than females, 1.9% and 1.2%, respectively. Within the risk population tested, 2087 (31.1%) seropositive individuals were identified. When comparing the screening program results to WHO elimination targets through modelling, 2180 patients still need to be treated annually until 2030, along with expanding fibrosis restrictions. If an elimination approach was implemented, 1000 new infections would be prevented, while saving 150 lives and averting 90 decompensated cirrhosis cases and 110 hepatocellular carcinoma cases. CONCLUSIONS During the first year of the Lithuanian screening program, GPs were able to screen 44% of the target population. However, the country will not meet elimination targets as it currently stands without increasing treatment levels and lifting fibrosis restrictions.
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Affiliation(s)
- Janina Petkevičienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės str. 18, LT47181, Kaunas, Lithuania.
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės str. 18, LT47181, Kaunas, Lithuania.
| | - Alexis Voeller
- Center for Disease Analysis Foundation, 1120 W South Boulder Rd, Suite 102, Lafayette, CO, USA
| | - Eglė Čiupkevičienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės str. 18, LT47181, Kaunas, Lithuania
| | - Devin Razavi-Shearer
- Center for Disease Analysis Foundation, 1120 W South Boulder Rd, Suite 102, Lafayette, CO, USA
| | - Valentina Liakina
- Faculty of Medicine, Vilnius University, Universiteto str. 3, LT01513, Vilnius, Lithuania
- Faculty of Fundamental Sciences, Vilnius Tech, Saulėtekio av. 11, LT10223, Vilnius, Lithuania
| | - Ligita Jančorienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Santariškių str. 14, 08406, Vilnius, Lithuania
| | - Edita Kazėnaitė
- Faculty of Medicine, Vilnius University, Universiteto str. 3, LT01513, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Santariškių str. 2, LT08661, Vilnius, Lithuania
| | - Viačeslavas Zaksas
- National Health Insurance Fund under the Ministry of Health, Europos Sq. 1, LT03505, Vilnius, Lithuania
| | - Gediminas Urbonas
- Department of Family Medicine, Lithuanian University of Health Sciences, Eivenių str. 2, LT50161, Kaunas, Lithuania
| | - Limas Kupčinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Eivenių str. 2, LT50161, Kaunas, Lithuania
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Ahmat A, Okoroafor SC, Asamani JA, Jean M, Mourtala AI, Nyoni J, Mwinga K. Health workforce strategies during COVID-19 response: insights from 15 countries in the WHO Africa Region. BMC Health Serv Res 2024; 24:470. [PMID: 38622621 PMCID: PMC11017512 DOI: 10.1186/s12913-024-10942-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic unveiled huge challenges in health workforce governance in the context of public health emergencies in Africa. Several countries applied several measures to ensure access to qualified and skilled health workers to respond to the pandemic and provide essential health services. However, there has been limited documentation of these measures. This study was undertaken to examine the health workforce governance strategies applied by 15 countries in the World Health Organization (WHO) Africa Region in responding to the COVID-19 pandemic. METHODS We extracted data from country case studies developed from national policy documents, reports and grey literature obtained from the Ministries of Health and other service delivery agencies. This study was conducted from October 2020 to January 2021 in 15 countries - Angola, Burkina Faso, Chad, Eswatini, Ghana, Guinea, Guinea Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal and Togo. RESULTS All 15 countries had national multi-sectoral bodies to manage the COVID-19 response and a costed national COVID-19 response plan. All the countries also reflected human resources for health (HRH) activities along the different response pillars. These activities included training for health workers, and budget for the recruitment or mobilization of additional health workers to support the response, and for provision of financial and non-financial incentives for health workers. Nine countries recruited additional 35,812 health workers either on a permanent or temporary basis to respond to the COVID-19 with an abridged process of recruitment implemented to ensure needed health workers are in place on time. Six countries redeployed 3671 health workers to respond to the COVID-19. The redeployment of existing health workers was reported to have impacted negatively on essential health service provision. CONCLUSION Strengthening multi-sector engagement in the development of public health emergency plans is critical as this promotes the development of holistic interventions needed to improve health workforce availability, retention, incentivization, and coordination. It also ensures optimized utilization based on competencies, especially for the existing health workers.
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Affiliation(s)
- Adam Ahmat
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Sunny C Okoroafor
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo.
| | - James Avoka Asamani
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
- Centre for Health Professions Education, North-West University, Potchefstroom, South Africa
| | - Millogo Jean
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Abdou Illou Mourtala
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Jennifer Nyoni
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Kasonde Mwinga
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Wenham C, Stout L. A legal mapping of 48 WHO member states' inclusion of public health emergency of international concern, pandemic, and health emergency terminology within national emergency legislation in responding to health emergencies. Lancet 2024; 403:1504-1512. [PMID: 38527480 DOI: 10.1016/s0140-6736(24)00156-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 03/27/2024]
Abstract
WHO has determined a public health emergency of international concern (PHEIC) seven times, and beyond this nomenclature declared COVID-19 to be a pandemic. Under the International Health Regulations (IHR), and through their operationalisation in the joint external evaluation (JEE), governments are urged to create suitable legislation to be able to enact a response to a public health emergency. Whether the pandemic declaration had a greater effect than a PHEIC in encouraging goverments to act, however, remains conjecture, as there is no systemic analysis of what each term means in practice and whether either has meaningful legal implications at the national level. We undertook a legal scoping review to assess the utilisation of PHEIC and pandemic language within national legislation in 28 WHO member states. Data were collected from national websites, JEE reviews, COVID Analysis and Mapping of Policies Tool, Natlex, and Oxford Compendium of National Legal Responses to COVID-19. We found that only 16% of countries have any reference to the PHEIC in national legislation and 37·5% of countries reference the term pandemic. This finding paints a weakened picture of the IHR and PHEIC mechanisms. Having such legalese enshrined in legislation might enhance the interaction between WHO determining a PHEIC or declaring a pandemic and resulting action to mitigate transnational spread of disease and enhance health security. Given the ongoing negotiations at WHO in relation to the amendments to the IHR and creation of the pandemic accord, both of which deal with this declaratory power of the PHEIC and pandemic language, negotiators should understand the possible implications of any changes to these proclamations at the national level and for global health security.
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Affiliation(s)
- Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Liam Stout
- Department of Health Policy, London School of Economics and Political Science, London, UK
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29
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Kilpatrick C, Tartari E, Deeves M, Pittet D, Allegranzi B. World Health Organization World Hand Hygiene Day, 5 May 2024. SAVE LIVES: clean your hands campaign: promoting knowledge and capacity building on infection prevention and control, including hand hygiene, among health and care workers. Antimicrob Resist Infect Control 2024; 13:41. [PMID: 38610050 PMCID: PMC11015592 DOI: 10.1186/s13756-024-01391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
The World Health Organization's (WHO) World Hand Hygiene Day continues to "bring people together and accelerate hand hygiene action at the point of care in health care to contribute to a reduction in health care-associated infections and the achievement of safer, quality health care for all".
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Affiliation(s)
- Claire Kilpatrick
- Infection Prevention and Control Unit and Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - Ermira Tartari
- Infection Prevention and Control Unit and Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - Miranda Deeves
- Infection Prevention and Control Unit and Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Unit and Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland.
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Lamberti-Castronuovo A, Lamine H, Valente M, Hubloue I, Barone-Adesi F, Ragazzoni L. Assessing primary healthcare disaster preparedness: a study in Northern Italy. Prim Health Care Res Dev 2024; 25:e16. [PMID: 38605659 PMCID: PMC11022512 DOI: 10.1017/s1463423624000124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/05/2024] [Accepted: 02/24/2024] [Indexed: 04/13/2024] Open
Abstract
AIM The aim of this paper is to outline the steps taken to develop an operational checklist to assess primary healthcare (PHC) all-hazards disaster preparedness. It then describes a study testing the applicability of the checklist. BACKGROUND A PHC approach is an essential foundation for health emergency and disaster risk management (H-EDRM) because it can prevent and mitigate risks prior to disasters and support an effective response and recovery, thereby contributing to communities' and countries' resilience across the continuum of the disaster cycle. This approach is in line with the H-EDRM framework, published by the World Health Organization (WHO) in 2019, which emphasizes a whole-of-health system approach in disaster management and highlights the importance of integrating PHC into countries' H-EDRM. Nevertheless, literature focusing on how to practically integrate PHC into disaster management, both at the facility and at the policy level, is in its infancy. As of yet, there is no standardized, validated way to assess the specific characteristics that render PHC prepared for disasters nor a method to evaluate its role in H-EDRM. METHODS The checklist was developed through an iterative process that leveraged academic literature and expert consultations at different stages of the elaboration process. It was then used to assess primary care facilities in a province in Italy. FINDINGS The checklist offers a practical instrument for assessing and enhancing PHC disaster preparedness and for improving planning, coordination, and funding allocation. The study identified three critical areas for improvement in the province's PHC disaster preparedness. First, primary care teams should be more interdisciplinary. Second, primary care services should be more thoroughly integrated into the broader health system. Third, there is a notable lack of awareness of H-EDRM principles among PHC professionals. In the future, the checklist can be elaborated into a weighted tool to be more broadly applicable.
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Affiliation(s)
- Alessandro Lamberti-Castronuovo
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Hamdi Lamine
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Martina Valente
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Ives Hubloue
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - Francesco Barone-Adesi
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
| | - Luca Ragazzoni
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
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Özlü C, Yalçin C. Effects of methane emissions on multiple myeloma-related mortality rates: A World Health Organization perspective. Medicine (Baltimore) 2024; 103:e37580. [PMID: 38608057 PMCID: PMC11018147 DOI: 10.1097/md.0000000000037580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/21/2024] [Indexed: 04/14/2024] Open
Abstract
In this research, it was aimed to evaluate effects of methane emissions on multiple myeloma related mortality rates. Two countries in Europe (Germany and Netherlands) and 1 country for each region (Turkey, USA, Brazil, Egypt, and Australia) were selected within The World Health Organization Database. Multiple myeloma mortality rates of countries between 2009 and 2019 were used as dependent variable of the research. Methane emission level and agriculture methane levels of countries were used as independent variables from The World Bank Database. Current health expenditure and healthy life expectancy were used as controlling variables. Multiple myeloma-related mortality rate was the highest in the USA, followed by Germany, Brazil, Turkey, Australia, Netherlands, and Egypt. Difference analysis results were significant (P < .05). Methane and agriculture methane emissions were the highest in the USA. Multiple myeloma mortality was positively correlated with methane emissions (R = 0.504; P < .01), agricultural methane emissions (R = 0.705; P < .01), and current health expenditure (R = 0.528; P < .01). According to year and country controlled correlation analysis results, multiple myeloma mortality (MMM) was positively correlated with methane emissions (R = 0.889; P < .01), agricultural methane emissions (R = 0.495; P < .01), and current health expenditure (R = 0.704; P < .01). Methane emission (B = 0.01; P < .05), Germany (B = 9010.81; P < .01), the USA (B = 26516.77; P < .01), and Brazil (B = 4886.14; P < .01) had significant effect on MMM. Nonagricultural methane production has an increasing effect on MMM. Therefore, by looking at the differences between agricultural methane emissions and general methane emissions, studies can be conducted that allow for more effective global comparisons.
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Affiliation(s)
- Can Özlü
- Internal Diseases, Hematology, Medicine Faculty, Kutahya Health Sciences University, Kütahya, Turkey
| | - Cumali Yalçin
- Internal Diseases, Hematology, Medicine Faculty, Kutahya Health Sciences University, Kütahya, Turkey
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Doshi RH, Nsasiirwe S, Dahlke M, Atagbaza A, Aluta OE, Tatsinkou AB, Dauda E, Vilajeliu A, Gurung S, Tusiime J, Braka F, Bwaka A, Wanyoike S, Brooks DJ, Blanc DC, Alexander JP, Dahl BA, Lindstrand A, Wiysonge CS. COVID-19 Vaccination Coverage - World Health Organization African Region, 2021-2023. MMWR Morb Mortal Wkly Rep 2024; 73:307-311. [PMID: 38602879 PMCID: PMC11008790 DOI: 10.15585/mmwr.mm7314a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
With the availability of authorized COVID-19 vaccines in early 2021, vaccination became an effective tool to reduce COVID-19-associated morbidity and mortality. Initially, the World Health Organization (WHO) set an ambitious target to vaccinate 70% of the global population by mid-2022. However, in July 2022, WHO recommended that all countries, including those in the African Region, prioritize COVID-19 vaccination of high-risk groups, including older adults and health care workers, to have the greatest impact on morbidity and mortality. As of December 31, 2023, approximately 860 million doses of COVID-19 vaccine had been delivered to countries in the African Region, and 646 million doses had been administered. Cumulatively, 38% of the African Region's population had received ≥1 dose, 32% had completed a primary series, and 21% had received ≥1 booster dose. Cumulative total population coverage with ≥1 dose ranged by country from 0.3% to 89%. Coverage with the primary series among older age groups was 52% (range among countries = 15%-96%); primary series coverage among health care workers was 48% (range = 13%-99%). Although the COVID-19 public health emergency of international concern was declared over in May 2023, current WHO recommendations reinforce the need to vaccinate priority populations at highest risk for severe COVID-19 disease and death and build more sustainable programs by integrating COVID-19 vaccination into primary health care, strengthening immunization across the life course, and improving pandemic preparedness.
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Zewde HK. Using the WHO individual near miss case review (NMCR) cycle to improve quality of emergency obstetric care and maternal outcome in Keren hospital, Eritrea: an interrupted time series analysis. BMC Pregnancy Childbirth 2024; 24:266. [PMID: 38605302 PMCID: PMC11010365 DOI: 10.1186/s12884-024-06482-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND In 2016, the WHO regional office for Europe prepared a manual for conducting routine facility based individual near miss case review cycle. This study evaluates the effectiveness of the individual near miss case review (NMCR) cycle in improving quality of emergency obstetric care and maternal outcome in Keren hospital. METHODS An interrupted time series design was used to achieve the objectives of this study. Monthly data on women with potentially life-threatening conditions (PLTCs) admitted between April 2018 and October 2022 (i.e. 33 months pre-implementation and 22 months post-implementation) were collected from medical records. Segmented regression analysis was used to assess the intervention's effect on three process and outcome measures, namely, SMO, delayed care, and substandard care. The intervention was expected a priori to show immediate improvements without time-lag followed by gradual increment in slope. Segmented regression analyses were performed using the "itsa' command in STATA. RESULTS During the entire study period, 4365 women with potentially life threatening conditions were identified. There was a significant reduction in the post-implementation period in the proportion of mothers with PLTC who experienced SMO (- 8.86; p < 0.001), delayed care (- 8.76; p < 0.001) and substandard care (- 5.58; p < 0.001) compared to pre-implementation period. Results from the segmented regression analysis revealed that the percentage of women with SMO showed a significant 4.75% (95% CI: - 6.95 to - 2.54, p < 0.001) reduction in level followed by 0.28 percentage points monthly (95% CI: - 0.37 to - 0.14, p < 0.001) drop in trend. Similarly, a significant drop of 3.50% (95% CI: - 4.74 to - 2.26, p < 0.001) in the level of substandard care along with a significant decrease of 0.21 percentage points (95% CI: - 0.28 to - 0.14, p < 0.001) in the slope of the regression line was observed. The proportion of women who received delayed care also showed a significant 7% (95% CI: - 9.28 to - 4.68, p < 0.001) reduction in post-implementation level without significant change in slope. CONCLUSIONS Our findings suggest that the WHO individual NMCR cycle was associated with substantial improvements in quality of emergency obstetric care and maternal outcome. The intervention also bears a great potential for scaling-up following the guidance provided in the WHO NMCR manual.
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Affiliation(s)
- Henos Kiflom Zewde
- Department of Family and Community Health, Ministry of Health Anseba Region Branch, Keren, Anseba, Eritrea.
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Lee WH, Lin CC, Tsai CH, Tien FM, Lo MY, Tseng MH, Kuo YY, Yu SC, Liu MC, Yuan CT, Yang YT, Chuang MK, Ko BS, Tang JL, Sun HI, Chuang YK, Tien HF, Hou HA, Chou WC. Comparison of the 2022 world health organization classification and international consensus classification in myelodysplastic syndromes/neoplasms. Blood Cancer J 2024; 14:57. [PMID: 38594285 PMCID: PMC11004131 DOI: 10.1038/s41408-024-01031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
In 2022, two novel classification systems for myelodysplastic syndromes/neoplasms (MDS) have been proposed: the International Consensus Classification (ICC) and the 2022 World Health Organization (WHO-2022) classification. These two contemporary systems exhibit numerous shared features but also diverge significantly in terminology and the definition of new entities. Thus, we retrospectively validated the ICC and WHO-2022 classification and found that both systems promoted efficient segregation of this heterogeneous disease. After examining the distinction between the two systems, we showed that a peripheral blood blast percentage ≥ 5% indicates adverse survival. Identifying MDS/acute myeloid leukemia with MDS-related gene mutations or cytogenetic abnormalities helps differentiate survival outcomes. In MDS, not otherwise specified patients, those diagnosed with hypoplastic MDS and single lineage dysplasia displayed a trend of superior survival compared to other low-risk MDS patients. Furthermore, the impact of bone marrow fibrosis on survival was less pronounced within the ICC framework. Allogeneic transplantation appears to improve outcomes for patients diagnosed with MDS with excess blasts in the ICC. Therefore, we proposed an integrated system that may lead to the accurate diagnosis and advancement of future research for MDS. Prospective studies are warranted to validate this refined classification.
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Affiliation(s)
- Wan-Hsuan Lee
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Chin Lin
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Hong Tsai
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Education and Research, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Feng-Ming Tien
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Yen Lo
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Mei-Hsuan Tseng
- Tai-Chen Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Yuan-Yeh Kuo
- Tai-Chen Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Shan-Chi Yu
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chih Liu
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Tsu Yuan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Pathology, National Taiwan University Hospital Cancer Center Branch, Taipei, Taiwan
| | - Yi-Tsung Yang
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Kai Chuang
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Bor-Sheng Ko
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Tai-Chen Cell Therapy Center, National Taiwan University, Taipei, Taiwan.
- Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.
| | - Jih-Luh Tang
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Hsun-I Sun
- Tai-Chen Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Yi-Kuang Chuang
- Tai-Chen Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Hwei-Fang Tien
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei, Taiwan
| | - Hsin-An Hou
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- General Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wen-Chien Chou
- Divisions of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Zhou Q, Zhao D, Zarif M, Davidson MB, Minden MD, Tierens A, Yeung YWT, Wei C, Chang H. A real-world analysis of clinical outcomes in AML with myelodysplasia-related changes: a comparison of ICC and WHO-HAEM5 criteria. Blood Adv 2024; 8:1760-1771. [PMID: 38286462 PMCID: PMC10985805 DOI: 10.1182/bloodadvances.2023011869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/31/2024] Open
Abstract
ABSTRACT The proposed fifth edition of the World Health Organization classification of hematolymphoid tumors (WHO-HAEM5) and International Consensus Classification (ICC) provide different definitions of acute myeloid leukemia with myelodysplasia-related genetics (AML-MR). We conducted a retrospective study which included a cohort of 432 patients, with 354 patients fulfilling WHO-HAEM5 criteria for WHO-AML-MR or 276 patients fulfilling ICC criteria for ICC-AML-MR by gene mutation or cytogenetics (ICC-AML-MR-M/CG). The clinicopathological features were largely similar, irrespective of the classification used, except for higher rates of complex karyotype, monosomy 17, TP53 mutations, and fewer RUNX1 mutations in the WHO-AML-MR group. TP53 mutations were associated with distinct clinicopathological features and dismal outcomes (hazard ratio [HR], 2.98; P < .001). ICC-AML-MR-M/CG group had superior outcome compared with the WHO-AML-MR group (HR, 0.80, P = .032), largely in part due to defining TP53 mutated AML as a standalone entity. In the intensively-treated group, WHO-AML-MR had significantly worse outcomes than AML by differentiation (HR, 1.97; P = .024). Based on ICC criteria, ICC-AML-MR-M/CG had more inferior outcomes compared to AML not otherwise specified (HR, 2.11; P = .048 and HR, 2.55; P = .028; respectively). Furthermore, changing the order of genetic abnormalities defining AML-MR (ie, by gene mutations or cytogenetics) did not significantly affect clinical outcomes. ICC-AML-MR-M/CG showed similar outcomes regardless of the order of assignment. We propose to harmonize the 2 classifications by excluding TP53 mutations from WHO-HAEM5 defined AML-MR group and combining AML-MR defined by gene mutations and cytogenetics to form a unified group.
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Affiliation(s)
- Qianghua Zhou
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Hematology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Davidson Zhao
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mojgan Zarif
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marta B. Davidson
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mark D. Minden
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Anne Tierens
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Hematology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Yu Wing Tony Yeung
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Cuihong Wei
- Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Hong Chang
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Hematology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
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36
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Iacobucci G. Hepatitis: WHO publishes warning over rise in global deaths. BMJ 2024; 385:q833. [PMID: 38594034 DOI: 10.1136/bmj.q833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
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37
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Sun Q, Wang Z. [Interpretation of myeloid neoplasms in the 5th WHO classification of haematolymphoid tumors]. Zhonghua Bing Li Xue Za Zhi 2024; 53:323-330. [PMID: 38556814 DOI: 10.3760/cma.j.cn112151-20230823-00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The 5th edition of the WHO classification of haematolymphoid tumors β version had been released online, in which the section of myeloid neoplasms had undergone significant changes in the classification framework,standards of diagnosis and classification criteria. The principle of comprehensive diagnosis based on clinicopathologic multi-parameter was maintained, especially strengthening the priority importance of biological features in diagnosis and classification, and highlighting the biological characteristics of the disease and thus providing the basis for targeted treatment and prognostic evaluation. This article introduces the main updates and changes in the myeloid neoplasms of the 5th edition of the WHO haematolymphoid tumor classification, in order to better understand and guide clinical diagnosis and therapeutic treatment in the future.
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Affiliation(s)
- Q Sun
- Department of Pathology, Institute of Hematology, Blood Diseases Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Tianjin Institutes of Health Science, Tianjin 300020, China
| | - Z Wang
- Department of Pathology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China
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38
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Yach D. WHO should embrace tobacco harm reduction to save lives. Lancet 2024; 403:1334-1335. [PMID: 38582554 DOI: 10.1016/s0140-6736(24)00245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 02/06/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Derek Yach
- Global Health Strategies, Southport, CT 06890-3033, USA.
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39
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Schwalbe N, Hannon E, Gilby L, Lehtimaki S. Governance provisions in the WHO Pandemic Agreement draft. Lancet 2024; 403:1333-1334. [PMID: 38527479 DOI: 10.1016/s0140-6736(24)00585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Nina Schwalbe
- Spark Street Advisors, New York, NY 10013, USA; Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY USA; United Nations University, International Institute for Global Health, Kuala Lumpur, Malaysia.
| | | | - Lynda Gilby
- Spark Street Advisors, New York, NY 10013, USA
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Teske N, Teske NC, Greve T, Karschnia P, Kirchleitner SV, Harter PN, Forbrig R, Tonn JC, Schichor C, Biczok A. Perifocal edema is a risk factor for preoperative seizures in patients with meningioma WHO grade 2 and 3. Acta Neurochir (Wien) 2024; 166:170. [PMID: 38581569 PMCID: PMC10998776 DOI: 10.1007/s00701-024-06057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Patients with intracranial meningiomas frequently suffer from tumor-related seizures prior to resection, impacting patients' quality of life. We aimed to elaborate on incidence and predictors for seizures in a patient cohort with meningiomas WHO grade 2 and 3. METHODS We retrospectively searched for patients with meningioma WHO grade 2 and 3 according to the 2021 WHO classification undergoing tumor resection. Clinical, histopathological and imaging findings were collected and correlated with preoperative seizure development. Tumor and edema volumes were quantified. RESULTS Ninety-five patients with a mean age of 59.5 ± 16.0 years were included. Most tumors (86/95, 90.5%) were classified as atypical meningioma WHO grade 2. Nine of 95 tumors (9.5%) corresponded to anaplastic meningiomas WHO grade 3, including six patients harboring TERT promoter mutations. Meningiomas were most frequently located at the convexity in 38/95 patients (40.0%). Twenty-eight of 95 patients (29.5%) experienced preoperative seizures. Peritumoral edema was detected in 62/95 patients (65.3%) with a median volume of 9 cm3 (IR: 0-54 cm3). Presence of peritumoral edema but not age, tumor localization, TERT promoter mutation, brain invasion or WHO grading was associated with incidence of preoperative seizures, as confirmed in multivariate analysis (OR: 6.61, 95% CI: 1.18, 58.12, p = *0.049). Postoperative freedom of seizures was achieved in 91/95 patients (95.8%). CONCLUSIONS Preoperative seizures were frequently encountered in about every third patient with meningioma WHO grade 2 or 3. Patients presenting with peritumoral edema on preoperative imaging are at particular risk for developing tumor-related seizures. Tumor resection was highly effective in achieving seizure freedom.
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Affiliation(s)
- Nico Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Nina C Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Tobias Greve
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Philipp Karschnia
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Sabrina V Kirchleitner
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Patrick N Harter
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Center for Neuropathology and Prion Research, LMU University Hospital, LMU Munich, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Annamaria Biczok
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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Clift S, Bathke A, Daffern H, Davies C, Grebosz-Haring K, Kaasgaard M, McCrary JM, Musgrave G, Thun-Hohenstein L. WHO-Lancet Global Series on health and the arts. Lancet 2024; 403:1335. [PMID: 38582556 DOI: 10.1016/s0140-6736(24)00246-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/06/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Stephen Clift
- Canterbury Christ Church University, Canterbury CT1 1QU, UK.
| | - Arne Bathke
- Paris Lodron University of Salzburg, Salzburg, Austria
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Raleigh DR. Radiotherapy dose escalation for high-risk meningiomas after subtotal resection. Neuro Oncol 2024; 26:713-714. [PMID: 38153397 PMCID: PMC10995498 DOI: 10.1093/neuonc/noad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- David R Raleigh
- Departments of Radiation Oncology, Neurological Surgery, and Pathology, University of California San Francisco, San Francisco, CA, USA
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Affiliation(s)
- Carlos Javier Regazzoni
- Institute of Global Health, Faculty of Health Sciences, Kennedy University, Buenos Aires, Argentina
- Committee on Global Health and Human Security, Argentine Council on Foreign Relations, Buenos Aires, Argentina
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Deng MY, Maas SLN, Hinz F, Karger CP, Sievers P, Eichkorn T, Meixner E, Hoegen-Sassmannshausen P, Hörner-Rieber J, Lischalk JW, Seidensaal K, Bernhardt D, Jungk C, Unterberg A, Wick A, Wick W, von Deimling A, Sahm F, Combs S, Herfarth K, Debus J, König L. Efficacy and toxicity of bimodal radiotherapy in WHO grade 2 meningiomas following subtotal resection with carbon ion boost: Prospective phase 2 MARCIE trial. Neuro Oncol 2024; 26:701-712. [PMID: 38079455 PMCID: PMC10995516 DOI: 10.1093/neuonc/noad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Novel radiotherapeutic modalities using carbon ions provide an increased relative biological effectiveness (RBE) compared to photons, delivering a higher biological dose while reducing radiation exposure for adjacent organs. This prospective phase 2 trial investigated bimodal radiotherapy using photons with carbon-ion (C12)-boost in patients with WHO grade 2 meningiomas following subtotal resection (Simpson grade 4 or 5). METHODS A total of 33 patients were enrolled from July 2012 until July 2020. The study treatment comprised a C12-boost (18 Gy [RBE] in 6 fractions) applied to the macroscopic tumor in combination with photon radiotherapy (50 Gy in 25 fractions). The primary endpoint was the 3-year progression-free survival (PFS), and the secondary endpoints included overall survival, safety and treatment toxicities. RESULTS With a median follow-up of 42 months, the 3-year estimates of PFS, local PFS and overall survival were 80.3%, 86.7%, and 89.8%, respectively. Radiation-induced contrast enhancement (RICE) was encountered in 45%, particularly in patients with periventricularly located meningiomas. Patients exhibiting RICE were mostly either asymptomatic (40%) or presented immediate neurological and radiological improvement (47%) after the administration of corticosteroids or bevacizumab in case of radiation necrosis (3/33). Treatment-associated complications occurred in 1 patient with radiation necrosis who died due to postoperative complications after resection of radiation necrosis. The study was prematurely terminated after recruiting 33 of the planned 40 patients. CONCLUSIONS Our study demonstrates a bimodal approach utilizing photons with C12-boost may achieve a superior local PFS to conventional photon RT, but must be balanced against the potential risks of toxicities.
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Affiliation(s)
- Maximilian Y Deng
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sybren L N Maas
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Felix Hinz
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian P Karger
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Philipp Sievers
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tanja Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Philipp Hoegen-Sassmannshausen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Jonathan W Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Health at Long Island, New York, New York, USA
| | - Katharina Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Christine Jungk
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Antje Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Wolfgang Wick
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stephanie Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
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Ayenew B, Belay DM, Gashaw Y, Gimja W, Gardie Y. WHO's end of TB targets: unachievable by 2035 without addressing under nutrition, forced displacement, and homelessness: trend analysis from 2015 to 2022. BMC Public Health 2024; 24:961. [PMID: 38575958 PMCID: PMC10996214 DOI: 10.1186/s12889-024-18400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
Tuberculosis (TB) remains a significant global health challenge, despite the World Health Organization (WHO) actively working towards its eradication through various initiatives and programs. Undernutrition, forced displacement, and homelessness worsen TB's burden and challenge control efforts; however, there is still no adequate research that shows the trend of these underlying factors to attain the WHO's ambitious TB targets. So, this study aims to analyze the trend analysis of these underlying factors worldwide from 2015 to 2022 and their impact on the feasibility and implications of reaching the End TB targets by 2035. We utilized international databases, including UNHCR, FAO, and WHO reports, as secondary data sources. Data were extracted chronologically from 2015 to 2022 to illustrate trends in undernutrition, forced displacement, and homelessness on a global level.This trend analysis reveals that undernutrition, forced displacement, and homelessness have worsened over time. Undernutrition rose from 8.4 to 9.8% globally between 2015 and 2021, affecting 22.7 million additional individuals each year. In 2022, undernutrition affected 735 million people globally. Africa (21.9%) and Asia (10.6%) had the highest rates, while Western Europe and North America had lower rates than the global average: 3.4% and 2.5%, respectively.Similarly, the global rate of forced displacement increased from 65.1 million people in 2015 to 108.4 million in 2022, a 21% increase from 2021. This means that an extra 19 million people were displaced in 2021. Globally, homelessness, affecting 1.6 billion people, has worsened over time. Despite being a highly vulnerable group to TB, homeless individuals are often neglected in TB control efforts. Our findings underscore the critical importance of addressing undernutrition, forced displacement, and homelessness in achieving the World Health Organization's ambitious End TB targets by 2035, as highlighted through trend analysis from 2015 to 2022. Implementing policies focusing on nutrition, stable housing, and the challenges faced by displaced populations is imperative for progress toward a TB-free world.
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Affiliation(s)
- Birhanu Ayenew
- Department of Adult Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia.
| | - Dawit Misganaw Belay
- Department of Midwifery, College of Health Sciences, Assosa University, Assosa, Ethiopia
| | - Yegoraw Gashaw
- Department of Pediatric and Child Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Wondimu Gimja
- Department of Adult Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Yimenu Gardie
- Department of Pediatric and Child Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
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Ikejezie J, Miglietta A, Hammermeister Nezu I, Adele S, Higdon MM, Feikin D, Lata H, Mesfin S, Idoko F, Shimizu K, Acma A, Moro S, Attar Cohen H, Sinnathamby MA, Otieno JR, Temre Y, Ajong BN, Mirembe BB, Guinko TN, Sodagar V, Schultz C, Muianga J, De Barros S, Escobar Corado Waeber AR, Jin Y, Rico Chinchilla A, Izawa Y, Khare S, Poole M, Alexander N, Ciobanu S, Dorji T, Hassan M, Kato M, Matsui T, Ogundiran O, Pebody RG, Phengxay M, Riviere-Cinnamond A, Greene-Cramer BJ, Peron E, Archer BN, Subissi L, Kassamali ZA, Awofisayo-Okuyelu A, le Polain de Waroux O, Hamblion E, Pavlin BI, Morgan O, Fall IS, Van Kerkhove MD, Mahamud A. Informing the pandemic response: the role of the WHO's COVID-19 Weekly Epidemiological Update. BMJ Glob Health 2024; 9:e014466. [PMID: 38580376 PMCID: PMC11002403 DOI: 10.1136/bmjgh-2023-014466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/19/2024] [Indexed: 04/07/2024] Open
Abstract
On 31 December 2019, the Municipal Health Commission of Wuhan, China, reported a cluster of atypical pneumonia cases. On 5 January 2020, the WHO publicly released a Disease Outbreak News (DON) report, providing information about the pneumonia cases, implemented response interventions, and WHO's risk assessment and advice on public health and social measures. Following 9 additional DON reports and 209 daily situation reports, on 17 August 2020, WHO published the first edition of the COVID-19 Weekly Epidemiological Update (WEU). On 1 September 2023, the 158th edition of the WEU was published on WHO's website, marking its final issue. Since then, the WEU has been replaced by comprehensive global epidemiological updates on COVID-19 released every 4 weeks. During the span of its publication, the webpage that hosts the WEU and the COVID-19 Operational Updates was accessed annually over 1.4 million times on average, with visits originating from more than 100 countries. This article provides an in-depth analysis of the WEU process, from data collection to publication, focusing on the scope, technical details, main features, underlying methods, impact and limitations. We also discuss WHO's experience in disseminating epidemiological information on the COVID-19 pandemic at the global level and provide recommendations for enhancing collaboration and information sharing to support future health emergency responses.
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Affiliation(s)
| | | | | | - Sandra Adele
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Melissa M Higdon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel Feikin
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Harsh Lata
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Samuel Mesfin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Friday Idoko
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Kazuki Shimizu
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Ayse Acma
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Samuel Moro
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Homa Attar Cohen
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Yosef Temre
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Tondri Noe Guinko
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Vaishali Sodagar
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Craig Schultz
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Joao Muianga
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Stéphane De Barros
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Yeowon Jin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Yurie Izawa
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Shagun Khare
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Marcia Poole
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Nyka Alexander
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Silviu Ciobanu
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Tshewang Dorji
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Mahmoud Hassan
- World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Masaya Kato
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Tamano Matsui
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Opeayo Ogundiran
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Richard G Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Manilay Phengxay
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | | | - Emilie Peron
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Lorenzo Subissi
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | - Esther Hamblion
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Boris Igor Pavlin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Oliver Morgan
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Ibrahima Socé Fall
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Abdi Mahamud
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
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Taylor M, Garner P, Oliver S, Desmond N. Use of qualitative research in World Health Organisation guidelines: a document analysis. Health Res Policy Syst 2024; 22:44. [PMID: 38576035 PMCID: PMC10996230 DOI: 10.1186/s12961-024-01120-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/10/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Guidelines depend on effect estimates, usually derived from randomised controlled trials, to inform their decisions. Qualitative research evidence may improve decisions made but where in the process and the methods to do this have not been so clearly established. We sought to describe and appraise how qualitative research has been used to inform World Heath Organization guidance since 2020. METHODS We conducted a document analysis of WHO guidelines from 2020 to 2022. We purposely sampled guidelines on the topics of maternal and newborn health (MANH) and infectious diseases, as most of the qualitative synthesis to date has been conducted on these topics, likely representing the 'best case' scenario. We searched the in-built repository feature of the WHO website and used standardised search terms to identify qualitative reporting. Using deductive frameworks, we described how qualitative evidence was used to inform guidelines and appraised the standards of this use. RESULTS Of the 29 guidelines, over half used qualitative research to help guide decisions (18/29). A total of 8 of these used qualitative research to inform the guideline scope, all 18 to inform recommendations, and 1 to inform implementation considerations. All guidelines drew on qualitative evidence syntheses (QES), and five further supplemented this with primary qualitative research. Qualitative findings reported in guidelines were typically descriptive, identifying people's perception of the benefits and harms of interventions or logistical barriers and facilitators to programme success. No guideline provided transparent reporting of how qualitative research was interpreted and weighed used alongside other evidence when informing decisions, and only one guideline reported the inclusion of qualitative methods experts on the panel. Only a few guidelines contextualised their recommendations by indicating which populations and settings qualitative findings could be applied. CONCLUSIONS Qualitative research frequently informed WHO guideline decisions particularly in the field of MANH. However, the process often lacked transparency. We identified unmet potential in informing implementation considerations and contextualisation of the recommendations. Use in these areas needs further methods development.
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Affiliation(s)
- Melissa Taylor
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Paul Garner
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
- Africa Centre for Evidence, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Nicola Desmond
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Gu X, Watson C, Agrawal U, Whitaker H, Elson WH, Anand S, Borrow R, Buckingham A, Button E, Curtis L, Dunn D, Elliot AJ, Ferreira F, Goudie R, Hoang U, Hoschler K, Jamie G, Kar D, Kele B, Leston M, Linley E, Macartney J, Marsden GL, Okusi C, Parvizi O, Quinot C, Sebastianpillai P, Sexton V, Smith G, Suli T, Thomas NPB, Thompson C, Todkill D, Wimalaratna R, Inada-Kim M, Andrews N, Tzortziou-Brown V, Byford R, Zambon M, Lopez-Bernal J, de Lusignan S. Postpandemic Sentinel Surveillance of Respiratory Diseases in the Context of the World Health Organization Mosaic Framework: Protocol for a Development and Evaluation Study Involving the English Primary Care Network 2023-2024. JMIR Public Health Surveill 2024; 10:e52047. [PMID: 38569175 PMCID: PMC11024753 DOI: 10.2196/52047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Prepandemic sentinel surveillance focused on improved management of winter pressures, with influenza-like illness (ILI) being the key clinical indicator. The World Health Organization (WHO) global standards for influenza surveillance include monitoring acute respiratory infection (ARI) and ILI. The WHO's mosaic framework recommends that the surveillance strategies of countries include the virological monitoring of respiratory viruses with pandemic potential such as influenza. The Oxford-Royal College of General Practitioner Research and Surveillance Centre (RSC) in collaboration with the UK Health Security Agency (UKHSA) has provided sentinel surveillance since 1967, including virology since 1993. OBJECTIVE We aim to describe the RSC's plans for sentinel surveillance in the 2023-2024 season and evaluate these plans against the WHO mosaic framework. METHODS Our approach, which includes patient and public involvement, contributes to surveillance objectives across all 3 domains of the mosaic framework. We will generate an ARI phenotype to enable reporting of this indicator in addition to ILI. These data will support UKHSA's sentinel surveillance, including vaccine effectiveness and burden of disease studies. The panel of virology tests analyzed in UKHSA's reference laboratory will remain unchanged, with additional plans for point-of-care testing, pneumococcus testing, and asymptomatic screening. Our sampling framework for serological surveillance will provide greater representativeness and more samples from younger people. We will create a biomedical resource that enables linkage between clinical data held in the RSC and virology data, including sequencing data, held by the UKHSA. We describe the governance framework for the RSC. RESULTS We are co-designing our communication about data sharing and sampling, contextualized by the mosaic framework, with national and general practice patient and public involvement groups. We present our ARI digital phenotype and the key data RSC network members are requested to include in computerized medical records. We will share data with the UKHSA to report vaccine effectiveness for COVID-19 and influenza, assess the disease burden of respiratory syncytial virus, and perform syndromic surveillance. Virological surveillance will include COVID-19, influenza, respiratory syncytial virus, and other common respiratory viruses. We plan to pilot point-of-care testing for group A streptococcus, urine tests for pneumococcus, and asymptomatic testing. We will integrate test requests and results with the laboratory-computerized medical record system. A biomedical resource will enable research linking clinical data to virology data. The legal basis for the RSC's pseudonymized data extract is The Health Service (Control of Patient Information) Regulations 2002, and all nonsurveillance uses require research ethics approval. CONCLUSIONS The RSC extended its surveillance activities to meet more but not all of the mosaic framework's objectives. We have introduced an ARI indicator. We seek to expand our surveillance scope and could do more around transmissibility and the benefits and risks of nonvaccine therapies.
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Affiliation(s)
- Xinchun Gu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Conall Watson
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Utkarsh Agrawal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Heather Whitaker
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, United Kingdom
| | - William H Elson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sneha Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester, United Kingdom
| | | | - Elizabeth Button
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lottie Curtis
- Royal College of General Practitioners, London, United Kingdom
| | - Dominic Dunn
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, UK Health Security Agency, Birmingham, United Kingdom
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rosalind Goudie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Uy Hoang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Katja Hoschler
- Respiratory Virus Unit, UK Health Security Agency, London, United Kingdom
| | - Gavin Jamie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Beatrix Kele
- Respiratory Virus Unit, UK Health Security Agency, London, United Kingdom
| | - Meredith Leston
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ezra Linley
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester, United Kingdom
| | - Jack Macartney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma L Marsden
- Royal College of General Practitioners, London, United Kingdom
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Omid Parvizi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Respiratory Virus Unit, UK Health Security Agency, London, United Kingdom
| | - Catherine Quinot
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | | | - Vanashree Sexton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gillian Smith
- Real-time Syndromic Surveillance Team, UK Health Security Agency, Birmingham, United Kingdom
| | - Timea Suli
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Catherine Thompson
- Respiratory Virus Unit, UK Health Security Agency, London, United Kingdom
| | - Daniel Todkill
- Real-time Syndromic Surveillance Team, UK Health Security Agency, Birmingham, United Kingdom
| | - Rashmi Wimalaratna
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Nick Andrews
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | | | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Maria Zambon
- Virus Reference Department, UK Health Security Agency, London, United Kingdom
| | - Jamie Lopez-Bernal
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Freeland C, Adjei C, Wallace J, Wang S, Hicks J, Adda D, James C, Cohen C. Survey of lived experiences and challenges in hepatitis B management and treatment. BMC Public Health 2024; 24:944. [PMID: 38566070 PMCID: PMC10986103 DOI: 10.1186/s12889-024-18425-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Almost 300 million people are living with chronic hepatitis B infection worldwide and most remain undiagnosed and at risk for liver cancer. In 2015 the World Health Organization (WHO) developed guidelines for the prevention, care, and treatment of persons with chronic hepatitis B and in early 2023 began to work on updating these guidelines. In March 2023, a self-administered, anonymous online survey was launched, aiming to identify patient preferences related to the clinical management of hepatitis B including current management, treatment, and care experiences, preferences regarding engagement with providers, and preferences related to simplifying hepatitis B care access. A sample of 560 individuals living with hepatitis B (self-identified as HBsAg positive) from 76 countries completed the survey. Key findings demonstrated that less than half (49%, N = 268) of participants regularly visited a doctor to check the health of their liver (every 6-12 months), with 37% of participants prescribed antiviral medication by a specialist (82%, N = 167) or general practitioner (13%, N = 26). Participants reported not being actively involved in care decision making with their providers (42%, N = 217), with an overwhelming majority wanting to participate in hepatitis B management and treatment choices (85%, N = 435). Participants provided qualitative and quantitative details using open-ended responses within the survey about challenges with medication affordability and receiving care from a knowledgeable provider. Overall findings demonstrated key gaps in care, management, and treatment access related to hepatitis B: identifying these gaps can be used to identify areas for improvement along the care continuum for viral hepatitis. The survey found a need for the comprehensive simplification of clinical management and health care services related to hepatitis B. A thematic analysis of the open-ended survey responses highlighted major overarching themes including the cost and access burdens associated with hepatitis B management and treatment, and challenges in finding knowledgeable providers. Results from this mixed methods survey were used to inform the WHO hepatitis B guidelines update. Efforts should continue to explore public health approaches to address barriers and facilitators to testing, care, and treatment for people with hepatitis B to improve awareness of hepatitis B and access, care, and treatment among patients and providers.
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Affiliation(s)
| | | | - Jack Wallace
- Burnet Institute, Melbourne, Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Su Wang
- Saint Barnabas Medical Center, Livingston, NJ, USA
| | | | - Danjuma Adda
- World Hepatitis Alliance, London, UK
- CFID Taraba, Taraba, Nigeria
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Tusell M, Steinhardt LC, Gutman J, Schneider ZD, Bhamani B, Shah MP, Martí Coma-Cros E, Gimnig JE, Allen KC, Akl EA, Lindblade KA. Development of Systematic Reviews to Inform WHO's Recommendations for Elimination and Prevention of Re-Establishment of Malaria: Methodology. Am J Trop Med Hyg 2024; 110:11-16. [PMID: 38118164 PMCID: PMC10993789 DOI: 10.4269/ajtmh.22-0740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 10/09/2023] [Indexed: 12/22/2023] Open
Abstract
The basis for an evidence-based recommendation is a well-conducted systematic review that synthesizes the primary literature relevant to the policy or program question of interest. In 2020, the WHO commissioned 10 systematic reviews of potential interventions in elimination or post-elimination settings to summarize their impact on malaria transmission. This paper describes the general methods used to conduct this series of systematic reviews and notes where individual reviews diverged from the common methodology. The paper also presents lessons learned from conducting the systematic reviews to make similar future efforts more efficient, standardized, and streamlined.
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Affiliation(s)
- Maria Tusell
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Laura C. Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zachary D. Schneider
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beena Bhamani
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Monica P. Shah
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elisabet Martí Coma-Cros
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - John E. Gimnig
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Koya C. Allen
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Kim A. Lindblade
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
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