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Proceedings of the National Academy of... Jul 2024Protected areas can conserve wildlife and benefit people when managed effectively. African governments increasingly delegate the management of protected areas to...
Protected areas can conserve wildlife and benefit people when managed effectively. African governments increasingly delegate the management of protected areas to private, nongovernmental organizations, hoping that private organizations' significant resources and technical capacities actualize protected areas' potential. Does private sector management improve outcomes compared to a counterfactual of government management? We leverage the transfer of management authority from governments to African Parks (AP)-the largest private manager of protected areas in Africa-to show that private management significantly improves wildlife outcomes via reduced elephant poaching and increased bird abundances. Our results also suggest that AP's management augments tourism, while the effect on rural wealth is inconclusive. However, AP's management increases the risk of armed groups targeting civilians, which could be an unintended outcome of AP's improved monitoring and enforcement systems. These findings reveal an intricate interplay between conservation, economic development, and security under privately managed protected areas in Africa.
Topics: Conservation of Natural Resources; Animals; Africa; Animals, Wild; Private Sector; Tourism; Humans; Elephants; Birds; Parks, Recreational
PubMed: 38950358
DOI: 10.1073/pnas.2401814121 -
JCO Clinical Cancer Informatics Jun 2024Randomized trials provide high-quality, internally consistent data on selected clinical questions, but lack generalizability for the aging population who are most often... (Review)
Review
Randomized trials provide high-quality, internally consistent data on selected clinical questions, but lack generalizability for the aging population who are most often diagnosed with cancer and have comorbid conditions that may affect the interpretation of treatment benefit. The need for high-quality, relevant, and timely data is greater than ever. Promising solutions lie in the collection and analysis of real-world data (RWD), which can potentially provide timely insights about the patient's course during and after initial treatment and the outcomes of important subgroups such as the elderly, rural populations, children, and patients with greater social health needs. However, to inform practice and policy, real-world evidence must be created from trustworthy and comprehensive sources of RWD; these may include pragmatic clinical trials, registries, prospective observational studies, electronic health records (EHRs), administrative claims, and digital technologies. There are unique challenges in oncology since key parameters (eg, cancer stage, biomarker status, genomic assays, imaging response, side effects, quality of life) are not recorded, siloed in inaccessible documents, or available only as free text or unstructured reports in the EHR. Advances in analytics, such as artificial intelligence, may greatly enhance the ability to obtain more granular information from EHRs and support integrated diagnostics; however, they will need to be validated purpose by purpose. We recommend a commitment to standardizing data across sources and building infrastructures that can produce fit-for-purpose RWD that will provide timely understanding of the effectiveness of individual interventions.
Topics: Humans; Medical Oncology; Neoplasms; Electronic Health Records; Registries
PubMed: 38950323
DOI: 10.1200/CCI.24.00039 -
Health Affairs (Project Hope) Jul 2024A vaccine law and policy expert reflects on the dangers of the influence of politics on public health decision making.
A vaccine law and policy expert reflects on the dangers of the influence of politics on public health decision making.
Topics: Politics; Humans; Health Policy; Vaccines; Public Health; United States; Decision Making; Vaccination; COVID-19 Vaccines; Policy Making
PubMed: 38950295
DOI: 10.1377/hlthaff.2024.00636 -
PLOS Global Public Health 2024Population knowledge of COVID-19 and adherence to prevention measures may not be equitably distributed, limiting the success of public health measures. We aimed to...
Population knowledge of COVID-19 and adherence to prevention measures may not be equitably distributed, limiting the success of public health measures. We aimed to understand whether COVID-19 knowledge differed by socio-economic status in a rural low-income setting of Jigawa State, Nigeria. We conducted a secondary analysis of the baseline cross-sectional survey of the INSPIRING cluster randomised controlled trial in Kiyawa Local Government Area, Jigawa State, from January-June 2021. Compounds were selected using simple random sampling proportional to trial cluster size. Within each compound, a representative head of compound and all women aged 16-49 years were eligible to complete a survey, which asked about socioeconomics, knowledge of COVID-19 symptoms, prevention strategies and risks for poor outcomes. We converted these into binary outcomes of "good knowledge" for symptoms, prevention and risks. Associations between woman and head of compound characteristics and good knowledge were assessed using adjusted logistic regression. We surveyed 3800 compound heads and 9564 women. Overall, <1% of respondents had been tested for COVID-19, but access to facemasks (HoC 60.0%; women 86.3%) and willingness to be vaccinated (HoC 73.9%; women 73.4%) were high. COVID-19 knowledge was low, with 33.2% of heads of compounds and 26.0% of women having good symptom knowledge, 39.5% and 30.4% having good prevention knowledge, and 17.7% and 15.4% having good risk knowledge, respectively. Those with more education, from higher wealth quintiles and access to a radio had better knowledge. Access to a mobile phone was associated with good symptom knowledge, but worse prevention and risk knowledge. We found significant differences in COVID-19 knowledge associated with socio-economic factors in rural Jigawa state, and access to communication devices was not consistently associated with better knowledge. Public health messaging in Nigeria needs to be adapted and delivered in way that ensures accessibility to all.
PubMed: 38950079
DOI: 10.1371/journal.pgph.0003386 -
PLoS Pathogens Jul 2024The regulation of inflammatory responses and pulmonary disease during SARS-CoV-2 infection is incompletely understood. Here we examine the roles of the prototypic pro-...
The regulation of inflammatory responses and pulmonary disease during SARS-CoV-2 infection is incompletely understood. Here we examine the roles of the prototypic pro- and anti-inflammatory cytokines IFNγ and IL-10 using the rhesus macaque model of mild COVID-19. We find that IFNγ drives the development of 18fluorodeoxyglucose (FDG)-avid lesions in the lungs as measured by PET/CT imaging but is not required for suppression of viral replication. In contrast, IL-10 limits the duration of acute pulmonary lesions, serum markers of inflammation and the magnitude of virus-specific T cell expansion but does not impair viral clearance. We also show that IL-10 induces the subsequent differentiation of virus-specific effector T cells into CD69+CD103+ tissue resident memory cells (Trm) in the airways and maintains Trm cells in nasal mucosal surfaces, highlighting an unexpected role for IL-10 in promoting airway memory T cells during SARS-CoV-2 infection of macaques.
PubMed: 38950078
DOI: 10.1371/journal.ppat.1012339 -
PLOS Digital Health Jul 2024The integration of Artificial Intelligence (AI) into public health has the potential to transform the field, influencing healthcare at the population level. AI can aid...
The integration of Artificial Intelligence (AI) into public health has the potential to transform the field, influencing healthcare at the population level. AI can aid in disease surveillance, diagnosis, and treatment decisions, impacting how healthcare professionals deliver care. However, it raises critical questions about inputs, values, and biases that must be addressed to ensure its effectiveness. This article investigates the factors influencing the values guiding AI technology and the potential consequences for public health. It outlines four key considerations that should shape discussions regarding the role of AI in the future of public health. These include the potential omission of vital factors due to incomplete data inputs, the challenge of balancing trade-offs in public health decisions, managing conflicting inputs between public health objectives and community preferences, and the importance of acknowledging the values and biases embedded in AI systems, which could influence public health policy-making.
PubMed: 38950051
DOI: 10.1371/journal.pdig.0000540 -
PLOS Global Public Health 2024Monoclonal antibodies (mAbs) are revolutionizing management of non-communicable diseases in high-income countries and are increasingly being advanced for a range of... (Review)
Review
Monoclonal antibodies (mAbs) are revolutionizing management of non-communicable diseases in high-income countries and are increasingly being advanced for a range of infectious diseases (IDs). However, access to existing mAbs is limited in low- and middle-income countries (LMICs), and investment in developing fit-for-purpose mAbs for IDs that disproportionately affect LMICs has been limited. Underlying these access barriers are systemic challenges, including a lack of commercial incentives to target LMIC markets and complexity in manufacturing and regulatory processes. Novel strategies are needed to overcome systemic access barriers for mAbs. We outline key areas where new approaches could address these barriers, based on a multistakeholder consultation in March 2023. Three disease-market archetypes are identified to guide thinking about business models tailored to different contexts. New business models are needed to incentivize development and manufacturing of ID mAbs and to ensure mAbs are optimized with a target product profile and cost of goods that enable use in diverse LMIC settings. Lessons can be applied from voluntary licensing strategies and product development partnerships that have shown success in catalysing development and affordable supply for a range of infectious diseases. Technology transfer will be key to expand LMIC research and manufacturing capacity and to enable sustainable and diversified supply. Improved market intelligence, demand aggregation mechanisms, and portfolio-based manufacturing models could be used to de-risk commercial investment and establish a sustainable manufacturing ecosystem for affordable mAbs. Novel regulatory approaches and robust technology transfer may reduce data requirements and timelines for biosimilar approvals. Trailblazer products, with coordinated "end-to-end" support from funders, can demonstrate proof of concept for pathways to accessible mAbs across a broader range of LMICs. Research funders; local, regional, global health agencies; and, private sector partners should commit to implementing innovative partnerships and end-to-end strategies that enable equitable access to mAbs for infectious diseases in LMICs.
PubMed: 38950021
DOI: 10.1371/journal.pgph.0003418 -
PLoS Neglected Tropical Diseases Jul 2024Hand, foot, and mouth disease (HFMD) is a major public health issue in China while temperature and humidity are well-documented predictors. However, evidence on the...
BACKGROUND
Hand, foot, and mouth disease (HFMD) is a major public health issue in China while temperature and humidity are well-documented predictors. However, evidence on the combined effect of temperature and humidity is still limited. It also remains unclear whether such an effect could be modified by the enterovirus 71 (EV71) vaccination.
METHODS
Based on 320,042 reported HFMD cases during the summer months between 2012 and 2019, we conducted a study utilizing Distributed Lag Non-Linear Models (DLNM) and time-varying DLNM to examine how China's HFMD EV71 vaccine strategy would affect the correlation between meteorological conditions and HFMD risk.
RESULTS
The incidence of HFMD changed with the Discomfort Index in an arm-shaped form. The 14-day cumulative risk of HFMD exhibited a statistically significant increase during the period of 2017-2019 (following the implementation of the EV71 vaccine policy) compared to 2012-2016 (prior to the vaccine implementation). For the total population, the range of relative risk (RR) values for HFMD at the 75th, 90th, and 99th percentiles increased from 1.082-1.303 in 2012-2016 to 1.836-2.022 in 2017-2019. In the stratified analyses, Han Chinese areas show stronger relative growth, with RR values at the 75th, 90th, and 99th percentiles increased by 14.3%, 39.1%, and 134.4% post-vaccination, compared to increases of 22.7%, 41.6%, and 38.8% in minority areas. Similarly, boys showed greater increases (24.4%, 47.7%, 121.5%) compared to girls (8.1%, 28.1%, 58.3%). Additionally, the central Guizhou urban agglomeration displayed a tendency for stronger relative growth compared to other counties.
CONCLUSIONS
Although the EV71 vaccine policy has been implemented, it hasn't effectively controlled the overall risk of HFMD. There's been a shift in the main viral subtypes, potentially altering population susceptibility and influencing HFMD occurrences. The modulating effects of vaccine intervention may also be influenced by factors such as race, sex, and economic level.
Topics: Hand, Foot and Mouth Disease; Humans; China; Male; Female; Vaccination; Infant; Child, Preschool; Enterovirus A, Human; Incidence; Viral Vaccines; Humidity; Temperature; Child
PubMed: 38949988
DOI: 10.1371/journal.pntd.0012008 -
The Journal of the Association of...The COVID-19 pandemic drastically affected health care delivery for vulnerable populations. Many facilities shifted services to telemedicine, and people with HIV or at...
The COVID-19 pandemic drastically affected health care delivery for vulnerable populations. Many facilities shifted services to telemedicine, and people with HIV or at risk of acquiring HIV experienced interruptions in care. Simultaneously, traditional training approaches to help providers adapt were disrupted. Using a mixed method approach to examine changes over time, we integrated data on trainee needs collected by the Mountain West AIDS Education and Training Center (AETC): a 10-state needs assessment survey in 2020; feedback from a 2020 community of practice; aggregate training data from 2000 to 2022; and a second survey in 2022. HIV care providers' training needs evolved from wanting support on telemedicine and COVID-19 patient care issues, to a later focus on mental health and substance use, social determinants of health, and care coordination. This integrative analysis demonstrates the vital role that AETCs can play in addressing evolving and emergent public health challenges for the HIV workforce.
Topics: Humans; COVID-19; HIV Infections; Needs Assessment; Health Personnel; SARS-CoV-2; Telemedicine; Health Workforce; United States; Pandemics; Delivery of Health Care; Health Services Needs and Demand; Surveys and Questionnaires; Female; Male
PubMed: 38949905
DOI: 10.1097/JNC.0000000000000448 -
JAMA Jul 2024
PubMed: 38949836
DOI: 10.1001/jama.2024.11126