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PloS One 2024Data on COVID-19 vaccine effectiveness to support regional vaccine policy and practice are limited in Africa. Thus, this review aimed to evaluate the efficacy and...
BACKGROUND
Data on COVID-19 vaccine effectiveness to support regional vaccine policy and practice are limited in Africa. Thus, this review aimed to evaluate the efficacy and effectiveness of COVID-19 vaccines administered in Africa.
METHODS
We systematically searched peer-reviewed randomized controlled trials (RCTs), prospective and retrospective cohort studies, and case-control studies that reported on VE in Africa. We carried out a risk of bias assessment, and the findings of this review were synthesized and presented in a narrative form, including tables and figures. The synthesis was focused on COVID-19 VE against various levels of the disease condition and outcomes (infection, hospitalization or critical, and death), time points, and variants of concern.
RESULTS
A total of 13 studies, with a total sample size of 913,285 participants, were included in this review. The majority (8/13) of studies were from South Africa and 38.5% (5/13) were randomized clinical trials. The studies reported that a full dose of Pfizer-BioNTech vaccine had a VE of 100% against COVID-19 infection by Beta (B.1.351) and Delta variants and 96.7% against hospitalization by Delta variant. The Johnson and Johnson vaccine had VE ranging from 38.1%-62.0% against hospitalization and 51.9%- 86% against critical disease by Beta (B 1.351) variant. The Oxford-AstraZeneca vaccine had a VE of 89.4% against hospitalization by the Omicron variant but was not effective against the B.1.351 variant (10.4%). The Sinopharm vaccine had a VE of 67% against infection and 46% against hospitalization by Delta variant.
CONCLUSIONS
COVID-19 vaccines administered in Africa were effective in preventing infections, hospitalization, and death. These review findings underscore the need for concerted efforts of all stakeholders to enhance the access and availability of COVID-19 vaccines and reinforce public awareness to reach the high-risk, unvaccinated group of the African population.
Topics: Humans; COVID-19 Vaccines; COVID-19; SARS-CoV-2; Africa; Vaccine Efficacy; Hospitalization; Randomized Controlled Trials as Topic
PubMed: 38941303
DOI: 10.1371/journal.pone.0306309 -
PloS One 2024Based on 908 consumer questionnaire data from 15 urban areas in Shanghai, we use the binary logit model to empirically analyze the impact of traceability label trust on...
Based on 908 consumer questionnaire data from 15 urban areas in Shanghai, we use the binary logit model to empirically analyze the impact of traceability label trust on consumers' traceable pork purchase behavior and the moderating effect of food safety identification. After constructing the theoretical analysis framework, this paper verifies it from the two aspects of statistical analysis and econometric analysis and tests the robustness of the final results. The results show that: first, traceability label trust has a significant positive impact on consumers' traceability pork behavior. Second, food safety identification can significantly strengthen and promote this process. Third, consumers' purchasing behavior is significantly positively affected by traceable pork consumption scenarios and price labels, but the permanent elderly in the composition of family members significantly negative impact on it. Therefore, we put forward relevant policy suggestions, such as strengthening the knowledge popularization and publicity based on the advantageous commodity attributes of traceable pork, carrying out food safety knowledge popularization education, and enhancing consumers' risk perception and food safety identification ability.
Topics: Humans; Consumer Behavior; Food Safety; Male; Female; Food Labeling; Middle Aged; Adult; Trust; Surveys and Questionnaires; Animals; Swine; China; Young Adult; Aged
PubMed: 38941301
DOI: 10.1371/journal.pone.0306041 -
PLOS Global Public Health 2024Forcibly displaced populations experience an increased burden of mental illness. Scaling up mental health (MH) services places new resource demands on health systems in...
Barriers, facilitators and proposed solutions to equitable mental health financing and service delivery for the Lebanese populations and displaced Syrians in Lebanon: Findings from a qualitative study.
Forcibly displaced populations experience an increased burden of mental illness. Scaling up mental health (MH) services places new resource demands on health systems in crises-affected settings and raises questions about how to provide equitable MH services for refugee and host populations. Our study investigates barriers, facilitators, and proposed solutions to MH financing and access for Lebanese populations and Syrian refugees in Lebanon, a protracted crisis setting. We collected qualitative data via 73 interviews and 3 focus group discussions. Participants were purposively selected from: (i) national, United Nations and NGO stakeholders; (ii) frontline MH service providers; (iii) insurance company representatives; (iv) Lebanese and Syrian adults and parents of children aged 12-17 years using MH services. Data were analysed using inductive and deductive approaches. Our results highlight challenges facing Lebanon's system of financing MH care in the face of ongoing multiple crises, including inequitable coverage, dependence on external humanitarian funds, and risks associated with short-term funding and their impact on sustainability of services. The built environment presents additional challenges to individuals trying to navigate, access and use existing MH services, and the social environment and service provider factors enable or hinder individuals accessing MH care. Registered Syrian refugees have better financial coverage to secondary MH care than Lebanese populations. However, given the economic crisis, both populations are facing similar challenges in paying for and accessing MH care at primary health care (PHC) level. Multiple crises in Lebanon have exacerbated challenges in financing MH care, dependence on external humanitarian funds, and risks and sustainability issues associated with short-term funding. Urgent reforms are needed to Lebanon's health financing system, working with government and external donors to equitably and efficiently finance and scale up MH care with a focus on PHC, and to reduce inequities in MH service coverage between Lebanese and Syrian refugee populations.
PubMed: 38941293
DOI: 10.1371/journal.pgph.0003318 -
Age and Ageing Jun 2024Incontinence is a common, distressing condition, most prevalent in older people. There is an unmet need for effective interventions to support continence. This review...
Effectiveness of non-pharmacological interventions delivered at home for urinary and faecal incontinence with homebound older people: systematic review of randomised controlled trials.
INTRODUCTION
Incontinence is a common, distressing condition, most prevalent in older people. There is an unmet need for effective interventions to support continence. This review focuses on non-pharmacological interventions to reduce incontinence among homebound older people. Aim: to identify interventions with potential to be delivered by care workers, nurses or family members in a person's home.
METHODS
Multiple databases were searched until 15 September 2023 for randomised controlled trials reporting home-based interventions for incontinence for older people (≥65 years) living at home. Two reviewers independently screened titles, abstracts and papers against inclusion criteria, then assessed for the Risk of Bias (RoB2). A third reviewer resolved the discrepancies. Primary data were extracted and synthesised.
RESULTS
A full-text review of 81 papers identified seven eligible papers (1996-2022, all USA), including n = 636 participants (561 women and 75 men). Two studies focusing on multicomponent behavioural interventions showed benefit, as did one study of transcutaneous tibial nerve stimulation self-administered through electrode-embedded socks. Three, which included cognitively impaired people, reported improvement with toileting assistance programmes, but the effects were not all significant. Results were inconclusive from a study examining the effects of fluid intake adjustments. Interventions were delivered by nurses, three in collaboration with family caregivers. No faecal incontinence interventions met the criteria.
CONCLUSION
There is scant evidence for continence supporting interventions delivered in older people's own homes. With an ageing population often reliant on family or social care workers well-placed to support continence promotion and policy drives for services to support older people remaining at home, this evidence gap needs addressing.
Topics: Humans; Fecal Incontinence; Aged; Randomized Controlled Trials as Topic; Urinary Incontinence; Homebound Persons; Home Care Services; Female; Male; Treatment Outcome; Aged, 80 and over
PubMed: 38941119
DOI: 10.1093/ageing/afae126 -
JAMA Network Open Jun 2024
Topics: Humans; Opioid-Related Disorders; Primary Health Care; Health Knowledge, Attitudes, Practice; Female; Male; Adult; Middle Aged; Analgesics, Opioid; Cross-Sectional Studies; Surveys and Questionnaires
PubMed: 38941101
DOI: 10.1001/jamanetworkopen.2024.19094 -
JAMA Network Open Jun 2024Understanding the cost of drug development can help inform the development of policies to reduce costs, encourage innovation, and improve patient access to drugs.
IMPORTANCE
Understanding the cost of drug development can help inform the development of policies to reduce costs, encourage innovation, and improve patient access to drugs.
OBJECTIVE
To estimate the cost of drug development by therapeutic class and trends in pharmaceutical research and development (R&D) intensity over time.
DESIGN, SETTING, AND PARTICIPANTS
In this economic evaluation study, an analytical model of drug development constructed using public and proprietary sources that collectively cover data from 2000 to 2018 was used to estimate the cost of bringing a drug to market, overall and for specific therapeutic classes. The analysis for the study was completed in October 2020.
MAIN OUTCOMES AND MEASURES
Three measures of development cost from nonclinical through postmarketing stages were estimated: mean out-of-pocket cost or cash outlay, mean expected cost, and mean expected capitalized cost. Pharmaceutical R&D intensity, defined as the ratio of R&D spending to total sales, from 2008 to 2019, based on the time frame for available data, was also analyzed.
RESULTS
The estimated mean cost of developing a new drug was approximately $172.7 million (2018 dollars) (range, $72.5 million for genitourinary to $297.2 million for pain and anesthesia), inclusive of postmarketing studies. The cost increased to $515.8 million when cost of failures was included. When the costs of failures and capital were included, the mean expected capitalized cost of drug development increased to $879.3 million (range, $378.7 million for anti-infectives to $1756.2 million for pain and anesthesia); results varied widely by therapeutic class. The pharmaceutical industry as a whole experienced a decline of 15.6% in sales but increased R&D intensity from 11.9% to 17.7% from 2008 to 2019. By contrast, R&D intensity of large pharmaceutical companies increased from 16.6% to 19.3%, whereas sales increased by 10.0% (from $380.0 to $418.0 billion) over the same 2008 to 2019 period, even though the cost of drug development remained relatively stable or may have even decreased.
CONCLUSIONS AND RELEVANCE
In this economic evaluation of new drug development costs, even though the cost of drug development appears to have remained stable, R&D intensity of large pharmaceutical companies remained relatively unchanged, despite substantial growth in revenues during this period. These findings can inform the design of drug-related policies and their potential impacts on innovation and competition.
Topics: Drug Development; United States; Humans; Drug Costs; Drug Industry; Pharmaceutical Research
PubMed: 38941099
DOI: 10.1001/jamanetworkopen.2024.15445 -
JAMA Network Open Jun 2024Air pollution is a recognized risk factor associated with chronic diseases, including respiratory and cardiovascular conditions, which can lead to physical and cognitive...
IMPORTANCE
Air pollution is a recognized risk factor associated with chronic diseases, including respiratory and cardiovascular conditions, which can lead to physical and cognitive impairments in later life. Although these losses of function, individually or in combination, reduce individuals' likelihood of living independently, little is known about the association of air pollution with this critical outcome.
OBJECTIVE
To investigate associations between air pollution and loss of independence in later life.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study was conducted as part of the Environmental Predictors Of Cognitive Health and Aging study and used 1998 to 2016 data from the Health and Retirement Study. Participants included respondents from this nationally representative, population-based cohort who were older than 50 years and had not previously reported a loss of independence. Analyses were performed from August 31 to October 15, 2023.
EXPOSURES
Mean 10-year pollutant concentrations (particulate matter less than 2.5 μm in diameter [PM2.5] or ranging from 2.5 μm to 10 μm in diameter [PM10-2.5], nitrogen dioxide [NO2], and ozone [O3]) were estimated at respondent addresses using spatiotemporal models along with PM2.5 levels from 9 emission sources.
MAIN OUTCOMES AND MEASURES
Loss of independence was defined as newly receiving care for at least 1 activity of daily living or instrumental activity of daily living due to health and memory problems or moving to a nursing home. Associations were estimated with generalized estimating equation regression adjusting for potential confounders.
RESULTS
Among 25 314 respondents older than 50 years (mean [SD] baseline age, 61.1 [9.4] years; 11 208 male [44.3%]), 9985 individuals (39.4%) experienced lost independence during a mean (SD) follow-up of 10.2 (5.5) years. Higher exposure levels of mean concentration were associated with increased risks of lost independence for total PM2.5 levels (risk ratio [RR] per 1-IQR of 10-year mean, 1.05; 95% CI, 1.01-1.10), PM2.5 levels from road traffic (RR per 1-IQR of 10-year mean, 1.09; 95% CI, 1.03-1.16) and nonroad traffic (RR per 1-IQR of 10-year mean, 1.13; 95% CI, 1.03-1.24), and NO2 levels (RR per 1-IQR of 10-year mean, 1.05; 95% CI, 1.01-1.08). Compared with other sources, traffic-generated pollutants were most consistently and robustly associated with loss of independence; only road traffic-related PM2.5 levels remained associated with increased risk after adjustment for PM2.5 from other sources (RR per 1-IQR increase in 10-year mean concentration, 1.10; 95% CI, 1.00-1.21). Other pollutant-outcome associations were null, except for O3 levels, which were associated with lower risks of lost independence (RR per 1-IQR increase in 10-year mean concentration, 0.94; 95% CI, 0.92-0.97).
CONCLUSIONS AND RELEVANCE
This study found that long-term exposure to air pollution was associated with the need for help for lost independence in later life, with especially large and consistent increases in risk for pollution generated by traffic-related sources. These findings suggest that controlling air pollution could be associated with diversion or delay of the need for care and prolonged ability to live independently.
Topics: Humans; Male; Aged; Female; Air Pollution; Middle Aged; United States; Particulate Matter; Environmental Exposure; Air Pollutants; Cohort Studies; Ozone; Independent Living; Nitrogen Dioxide; Aged, 80 and over; Risk Factors
PubMed: 38941096
DOI: 10.1001/jamanetworkopen.2024.18460 -
JAMA Network Open Jun 2024While adults aged 80 years and older account for 70% of hip fractures in the US, performance of fracture risk assessment tools in this population is uncertain.
IMPORTANCE
While adults aged 80 years and older account for 70% of hip fractures in the US, performance of fracture risk assessment tools in this population is uncertain.
OBJECTIVE
To compare performance of the Fracture Risk Assessment Tool (FRAX), Garvan Fracture Risk Calculator, and femoral neck bone mineral density (FNBMD) alone in 5-year hip fracture prediction.
DESIGN, SETTING AND PARTICIPANTS
Prognostic analysis of 3 prospective cohort studies including participants attending an index examination (1997 to 2016) at age 80 years or older. Data were analyzed from March 2023 to April 2024.
MAIN OUTCOMES AND MEASURES
Participants contacted every 4 or 6 months after index examination to ascertain incident hip fractures and vital status. Predicted 5-year hip fracture probabilities calculated using FRAX and Garvan models incorporating FNBMD and FNBMD alone. Model discrimination assessed by area under receiver operating characteristic curve (AUC). Model calibration assessed by comparing observed vs predicted hip fracture probabilities within predicted risk quintiles.
RESULTS
A total of 8890 participants were included, with a mean (SD) age at index examination of 82.6 (2.7) years; 4906 participants (55.2%) were women, 866 (9.7%) were Black, 7836 (88.1%) were White, and 188 (2.1%) were other races and ethnicities. During 5-year follow-up, 321 women (6.5%) and 123 men (3.1%) experienced a hip fracture; 818 women (16.7%) and 921 men (23.1%) died before hip fracture. Among women, AUC was 0.69 (95% CI, 0.67-0.72) for FRAX, 0.69 (95% CI, 0.66-0.72) for Garvan, and 0.72 (95% CI, 0.69-0.75) for FNBMD alone (FNBMD superior to FRAX, P = .01; and Garvan, P = .01). Among men, AUC was 0.71 (95% CI, 0.66-0.75) for FRAX, 0.76 (95% CI, 0.72-0.81) for Garvan, and 0.77 (95% CI, 0.72-0.81) for FNBMD alone (P < .001 Garvan and FNBMD alone superior to FRAX). Among both sexes, Garvan greatly overestimated hip fracture risk among individuals in upper quintiles of predicted risk, while FRAX modestly underestimated risk among those in intermediate quintiles of predicted risk.
CONCLUSIONS AND RELEVANCE
In this prognostic study of adults aged 80 years and older, FRAX and Garvan tools incorporating FNBMD compared with FNBMD alone did not improve 5-year hip fracture discrimination. FRAX modestly underpredicted observed hip fracture probability in intermediate-risk individuals. Garvan markedly overpredicted observed hip fracture probability in high-risk individuals. Until better prediction tools are available, clinicians should prioritize consideration of hip BMD, life expectancy, and patient preferences in decision-making regarding drug treatment initiation for hip fracture prevention in late-life adults.
Topics: Humans; Hip Fractures; Male; Female; Risk Assessment; Aged, 80 and over; Prospective Studies; Bone Density; Risk Factors; Femur Neck
PubMed: 38941095
DOI: 10.1001/jamanetworkopen.2024.18612 -
Global Public Health Jan 2024Urban inequalities are exacerbated due to rapid urbanisation. This is also evident within slums in low- and middle-income countries, where high levels of heterogeneity... (Review)
Review
Urban inequalities are exacerbated due to rapid urbanisation. This is also evident within slums in low- and middle-income countries, where high levels of heterogeneity amongst the slum population lead to differential experiences in Water, Sanitation, and Hygiene (WASH) and housing access. This scoping review provides evidence of the interconnection of WASH and housing and presents barriers to access and the consequences thereof for slum dwellers. It does so while considering the social stratification amongst urban slum dwellers and their lived experiences. A systematic search of journal articles was conducted in November 2022 in PubMed, Scopus, and Web of Science. A total of 33 papers were identified which were full text reviewed and data extracted. Infrastructure, social and cultural, socio-economic, governance and policy and environmental barriers emerged as general themes. Barriers to WASH and housing were more frequently described concerning women and girls due to gender norms within WASH and the home. Barriers to WASH lead to compromised health, socio-economic burdens, and adverse social impacts, thus causing residents of slums to navigate their WASH mobility spatially and over time. Insights from this review underscore the need for an intersectional approach to understanding access inequalities to WASH and housing.
Topics: Humans; Poverty Areas; Housing; Sanitation; Developing Countries; Hygiene; Socioeconomic Factors
PubMed: 38940272
DOI: 10.1080/17441692.2024.2369099 -
Annals of Agricultural and... Jun 2024Smoking-free policies protect non-smokers from the negative effects of smoking, but many young adults still use products containing nicotine. The aim of this article is...
INTRODUCTION AND OBJECTIVE
Smoking-free policies protect non-smokers from the negative effects of smoking, but many young adults still use products containing nicotine. The aim of this article is to analyze the factors that influence young people's attitudes towards the ban on smoking in public places.
MATERIAL AND METHODS
Data were obtained from a representative sample of young adults aged 13-15 from the Global Youth Tobacco Survey (GYTS) conducted in the Czech Republic, Lithuania, Romania, Slovakia and Slovenia. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS
At least a quarter of the adolescents were exposed to cigarette smoking, about 40% have parents who smoke and over 50% declared that they have peers who smoke. A higher proportion of adolescents have knowledge about the harmful effects of second-hand smoking (62.6-71.9%), but at least one-fifth of young people are still exposed to the marketing of tobacco products. Compared with current smoking, those with never smoked were significantly associated with positive attitude toward to restricting smoking in all five analyzed countries, with an AOR= 4.74 (95% CI: 3.61-6.23), AOR=4.33 (95% CI: 2.32-8.07), AOR=2.85 (95% CI: 2.19-3.70) and AOR=2.45 (95% CI: 1.65-3.64), respectively. Gender, age, smoking, exposure to second-hand smoke, knowledge about the harmful effects of smoking, anti-smoking education, seeing people using tobacco and exposure to tobacco marketing, were significantly associated with the attitudes of young people towards restricting smoking in public places.
CONCLUSIONS
The study provides useful information on factors that should be taken into account when planning anti-smoking strategies so that young people are able to resist the pressure to use tobacco products.
Topics: Humans; Adolescent; Male; Female; Lithuania; Slovakia; Smoke-Free Policy; Czech Republic; Surveys and Questionnaires; Tobacco Smoke Pollution; Romania; Slovenia; Smoking; Health Knowledge, Attitudes, Practice
PubMed: 38940106
DOI: 10.26444/aaem/173531