Does education influence COVID-19 vaccination? A global view

After the recent hard attempts felt on a global scale, notably in the health sector, the steady efforts of scientists have been materialized in maybe one of the most expected findings of the last decades, i.e. the launching of the COVID-19 vaccines. Although it is not our goal to plead for vaccination, as the decision in this regard is a matter of individual choice, we believe it is necessary and enlightening to analyze how one's educational status interferes with COVID-19 vaccination. There are discrepancies between world states vis-à-vis their well-being and their feedback to crises, and from the collection of features that can segregate the states in handling vaccination, in this paper, the spotlight is on education. We are referring to this topic because, generally, researches converge rather on the linkage between economic issues and COVID-19 vaccination, while education levels are less tackled in relation to this. To notice the weight of each type of education (primary, secondary, tertiary) in this process, we employ an assortment of statistical methods, for three clusters: 45 low-income countries (LICs), 72 middle-income countries (MICs) and 53 high-income countries (HICs). The estimates suggest that education counts in the COVID-19 vaccination, the tertiary one having the greatest meaning in accepting it. It is also illustrated that the imprint of education on vaccination fluctuates across the country groups scrutinized, with HICs recording the upper rates. The heterogeneity of COVID-19 vaccination-related behaviors should determine health authorities to treat this subject differently. To expand the COVID-19 vaccines uptake, they should be in an ongoing dialogue with all population categories and, remarkably, with those belonging to vulnerable communities, originated mostly in LICs. Education is imperative for vaccination, and it would ought to be on the schedule of any state, for being assimilated into health strategies and policies.

Erratum: State of the literature discussing smoke-free policies globally: A narrative review

[This corrects the article DOI: 10.18332/tid/174781.].

State of the literature discussing smoke-free policies globally: A narrative review

Despite the success of the Framework Convention on Tobacco Control (FCTC), most jurisdictions in the world do not have policies that create 100% smoke-free environments in indoor workplaces, indoor public places, public transport, or other public places. We conducted a narrative review of articles that discuss smoke-free policies and describe the state of the current literature. A search of peer-reviewed and gray literature, published between 1 January 2004 and 30 April 2022, was conducted using PubMed and EMBASE databases. We classified articles based on the location of the policy discussed (WHO region, World Bank income classification) and the environment that was being made smoke-free. Insights related to policy development and implementation, as well as compliance and enforcement, were also identified. The search identified 4469 unique citations; 134 articles met the criteria for inclusion and underwent data extraction by two independent coders. The sample included articles published in or about jurisdictions in each WHO region, in high- and low- and mediumincome countries, and articles that discussed policies regulating smoke-free indoor workplaces, indoor public places, public transport, outdoor/quasi-outdoor environments, and other (unspecified) public places. Some important insights from the literature related to smoke-free policy implementation included tobacco industry interference, the important role of civil society, and the need for effective communication, education, and leadership. Enforcement officials' awareness and training, stakeholders' attitudes and beliefs, and understanding social norms were identified as relevant determinants of effective smoke-free policies. There continue to be challenges for implementing smoke-free policies in jurisdictions throughout the globe, in high- and low- and middle-income countries. The literature includes insights to support 100% smoke-free policies in each environment that must be made smoke-free as per the FCTC.

Allocation of authorship and patient enrollment among global clinical trials in oncology

BACKGROUND

Oncology randomized controlled trials (RCTs) are increasingly global in scope. Whether authorship is equitably shared between investigators from high-income countries (HIC) and low-middle/upper-middle incomes countries (LMIC/UMIC) is not well described. The authors conducted this study to understand the allocation of authorship and patient enrollment across all oncology RCTs conducted globally.

METHODS

A cross-sectional retrospective cohort study of phase 3 RCTs (published 2014-2017) that were led by investigators in HIC and recruited patients in LMIC/UMIC.

FINDINGS

During 2014-2017, 694 oncology RCTs were published; 636 (92%) were led by investigators from HIC. Among these HIC-led trials, 186 (29%) enrolled patients in LMIC/UMIC. One-third (33%, 62 of 186) of RCTs had no authors from LMIC/UMIC. Forty percent (74 of 186) of RCTs reported patient enrollment by country; in 50% (37 of 74) of these trials, LMIC/UMIC contributed <15% of patients. The relationship between enrollment and authorship proportion is very strong and is comparable between LMIC/UMIC and HIC (Spearman's ρ LMIC/UMIC 0.824, p < .001; HIC 0.823, p < .001). Among the 74 trials that report country enrollment, 34% (25 of 74) have no authors from LMIC/UMIC.

CONCLUSIONS

Among trials that enroll patients in HIC and LMIC/UMIC, authorship appears to be proportional to patient enrollment. This finding is limited by the fact that more than half of RCTs do not report enrollment by country. Moreover, there are important outliers as a significant proportion of RCTs had no authors from LMIC/UMIC despite enrolling patients in these countries. The findings in this study reflect a complex global RCT ecosystem that still underserves cancer control outside high-income settings.

Characteristics of Global Neurosurgery Sessions: A Retrospective Analysis of Major International Neurosurgical Conferences

BACKGROUND

The global burden of neurosurgical disease is substantial, particularly in low- and middle-income countries (LMICs). Medical conferences are important in connecting those from LMICs to those from high-income countries for support and serve as an educational and networking tool. In this study, we sought to quantitatively assess the incorporation of global neurosurgery topics in international conferences related to the neurosurgical specialty.

METHODS

A database of major international neurosurgical conferences, from the conference of a group of 9 major neurosurgical societies, that had global neurosurgery featured from 2015 to 2020 was created. We then did a retrospective analysis to study the characteristics of these conferences ranging from geographic location to number to different components of the conferences.

RESULTS

There was an increase in the number of conferences with global neurosurgery since 2015. This, in addition to the occurrence of 3 wholly global neurosurgery-related conferences in recent years, is promising and suggests growth in the field. However, 52.6% of conferences took place in North American or European countries, the majority of which were high-income countries. Furthermore, a majority of the presence of global neurosurgery was in the form of individual talks (54.5%) as opposed to plenaries or sessions.

CONCLUSIONS

The preponderance of conferences in North America and Europe can pose barriers for those from LMICs including travel time, expenses, and visa problems. As global neurosurgery becomes an increasing part of the global health movement, we hope that these barriers are addressed. Conferences may become an even stronger tool to promote equity in neurosurgical education and practice.

Early childhood caries and its associations with sugar consumption, overweight and exclusive breastfeeding in low, middle and high-income countries: an ecological study

Aim

This ecological study examined the associations between the prevalence of early childhood caries (ECC), overweight, country’s per capita sugar consumption and duration of exclusive breastfeeding.

Methods

Per capita consumption of sugar in kilograms, percentage of children exclusively breastfed until 6 months of age, percentage of 0–5-year-old children with overweight status, and percentage of 3–5-year-old children with ECC were compared among low-income countries (LICs), middle-income countries (MICs) and high-income countries (HICs). The association between the prevalence of ECC and the study variables, and the effect modification by income region were assessed using multivariable linear regression models. Regression coefficients, confidence intervals, partial eta squared and P-values for effect modification were calculated.

Results

The per capita sugar consumption in LICs was significantly lower than in MICs (P = 0.001) and HICs (P < 0.001). The percentage of infants who exclusively breastfed up to 6 months was significantly lower in HICs than in LICs (P < 0.001) and MICs (P = 0.003). The prevalence of overweight was significantly lower in LICs than in MICs (P < 0.001) and HICs (P = 0.021). The prevalence of ECC was significantly lower in HICs than in MICs (P < 0.001). Income was a significant modifier of the associations between the prevalence of ECC, per capita sugar consumption (P = 0.005), and exclusive breastfeeding up to 6 months (P = 0.03). The associations between the prevalence of ECC and per capita sugar consumption at the global level and for MICs were stronger (partial eta squared = 0.05 and 0.13 respectively) than for LICs and HICs (partial eta squared <0.0001 and 0.003 respectively). Only in MICs was there a significant association between the prevalence of ECC and per capita sugar consumption (P = 0.002), and between the prevalence of ECC and the percentage of children exclusively breastfed up to 6 months (P = 0.02).

Conclusion

Though the quantity of sugar consumption and exclusive breastfeeding may be a significant risk indicator for ECC in MICs, sugar consumption may be more of a risk indicator for ECC in HICs than in LICs, and vice versa for exclusive breastfeeding. Although ECC and overweight are both sugar-related diseases, we found no significant relationship between them.

Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies

BACKGROUND

With ageing world populations, multimorbidity (presence of two or more chronic diseases in the same individual) becomes a major concern in public health. Although multimorbidity is associated with age, its prevalence varies. This systematic review aimed to summarise and meta-analyse the prevalence of multimorbidity in high, low- and middle-income countries (HICs and LMICs).

METHODS

Studies were identified by searching electronic databases (Medline, Embase, PsycINFO, Global Health, Web of Science and Cochrane Library). The term 'multimorbidity' and its various spellings were used, alongside 'prevalence' or 'epidemiology'. Quality assessment employed the Newcastle-Ottawa scale. Overall and stratified analyses according to multimorbidity operational definitions, HICs/LMICs status, gender and age were performed. A random-effects model for meta-analysis was used.

RESULTS

Seventy community-based studies (conducted in 18 HICs and 31 LMICs) were included in the final sample. Sample sizes ranged from 264 to 162,464. The overall pooled prevalence of multimorbidity was 33.1% (95% confidence interval (CI): 30.0-36.3%). There was a considerable difference in the pooled estimates between HICs and LMICs, with prevalence being 37.9% (95% CI: 32.5-43.4%) and 29.7% (26.4-33.0%), respectively. Heterogeneity across studies was high for both overall and stratified analyses (I 2 > 99%). A sensitivity analysis showed that none of the reviewed studies skewed the overall pooled estimates.

CONCLUSION

A large proportion of the global population, especially those aged 65+, is affected by multimorbidity. To allow accurate estimations of disease burden, and effective disease management and resources distribution, a standardised operationalisation of multimorbidity is needed.

Mpdz expression in the caudolateral substantia nigra pars reticulata is crucially involved in alcohol withdrawal

Association studies implicate the multiple PDZ domain protein (MUPP1/MPDZ) gene in risk for alcoholism in humans and alcohol withdrawal in mice. Although manipulation of the Mpdz gene by homologous recombination and bacterial artificial chromosome transgenesis has suggested that its expression affects alcohol withdrawal risk, the potential confounding effects of linked genes and developmental compensation currently limit interpretation. Here, using RNA interference (RNAi), we directly test the impact of Mpdz expression on alcohol withdrawal severity and provide brain regional mechanistic information. Lentiviral-mediated delivery of Mpdz short hairpin RNA (shRNA) to the caudolateral substantia nigra pars reticulata (clSNr) significantly reduces Mpdz expression and exacerbates alcohol withdrawal convulsions compared with control mice that delivered a scrambled shRNA. Neither baseline nor pentylenetetrazol-enhanced convulsions differed between Mpdz shRNA and control animals, indicating Mpdz expression in the clSNr does not generally affect seizure susceptibility. To our knowledge, these represent the first in vivo Mpdz RNAi analyses, and provide the first direct evidence that Mpdz expression impacts behavior. Our results confirm that Mpdz is a quantitative trait gene for alcohol withdrawal and demonstrate that its expression in the clSNr is crucially involved in risk for alcohol withdrawal.