Riviste scientifiche

Mortality and major disease risk among migrants of the 1991–2001 Balkan wars to Sweden: A register-based cohort study

PLoS Medicine - Ma, 01/12/2020 - 23:00

by Edda Bjork Thordardottir, Li Yin, Arna Hauksdottir, Ellenor Mittendorfer-Rutz, Anna-Clara Hollander, Christina M. Hultman, Paul Lichtenstein, Weimin Ye, Filip K. Arnberg, Fang Fang, Emily A. Holmes, Unnur Anna Valdimarsdottir

Background

In recent decades, millions of refugees and migrants have fled wars and sought asylum in Europe. The aim of this study was to quantify the risk of mortality and major diseases among migrants during the 1991–2001 Balkan wars to Sweden in comparison to other European migrants to Sweden during the same period.

Methods and findings

We conducted a register-based cohort study of 104,770 migrants to Sweden from the former Yugoslavia during the Balkan wars and 147,430 migrants to Sweden from 24 other European countries during the same period (1991–2001). Inpatient and specialized outpatient diagnoses of cardiovascular disease (CVD), cancer, and psychiatric disorders were obtained from the Swedish National Patient Register and the Swedish Cancer Register, and mortality data from the Swedish Cause of Death Register. Adjusting for individual-level data on sociodemographic characteristics and emigration country smoking prevalence, we used Cox regressions to contrast risks of health outcomes for migrants of the Balkan wars and other European migrants. During an average of 12.26 years of follow-up, being a migrant of the Balkan wars was associated with an elevated risk of being diagnosed with CVD (HR 1.39, 95% CI 1.34–1.43, p < 0.001) and dying from CVD (HR 1.45, 95% CI 1.29–1.62, p < 0.001), as well as being diagnosed with cancer (HR 1.16, 95% CI 1.08–1.24, p < 0.001) and dying from cancer (HR 1.27, 95% CI 1.15–1.41, p < 0.001), compared to other European migrants. Being a migrant of the Balkan wars was also associated with a greater overall risk of being diagnosed with a psychiatric disorder (HR 1.19, 95% CI 1.14–1.23, p < 0.001), particularly post-traumatic stress disorder (HR 9.33, 95% CI 7.96–10.94, p < 0.001), while being associated with a reduced risk of suicide (HR 0.68, 95% CI 0.48–0.96, p = 0.030) and suicide attempt (HR 0.57, 95% CI 0.51–0.65, p < 0.001). Later time period of migration and not having any first-degree relatives in Sweden at the time of immigration were associated with greater increases in risk of CVD and psychiatric disorders. Limitations of the study included lack of individual-level information on health status and behaviors of migrants at the time of immigration.

Conclusions

Our findings indicate that migrants of the Balkan wars faced considerably elevated risks of major diseases and mortality in their first decade in Sweden compared to other European migrants. War migrants without family members in Sweden or with more recent immigration may be particularly vulnerable to adverse health outcomes. Results underscore that persons displaced by war are a vulnerable group in need of long-term health surveillance for psychiatric disorders and somatic disease.

Saving forests to fight climate change will cost $393 billion annually

New Scientist - Ma, 01/12/2020 - 17:00
Limiting warming to 1.5°C over pre-industrial levels will require $393 billion each year to incentivise forest managers to store more carbon in their forests

Rocking flies with a vibrating lullaby helps them sleep for longer

New Scientist - Ma, 01/12/2020 - 17:00
Fruit flies that are lulled by gentle vibrations while they fall sleep snooze for longer, a finding that could explain why babies like to be rocked or why people fall asleep in the car

Tiny island survived tsunami that helped separate Britain and Europe

New Scientist - Ma, 01/12/2020 - 01:01
A tsunami swept across the North Sea 8150 years ago - but the Dogger archipelago that existed in the area at the time survived the disaster

Estimated impact of RTS,S/AS01 malaria vaccine allocation strategies in sub-Saharan Africa: A modelling study

PLoS Medicine - Lu, 30/11/2020 - 23:00

by Alexandra B. Hogan, Peter Winskill, Azra C. Ghani

Background

The RTS,S/AS01 vaccine against Plasmodium falciparum malaria infection completed phase III trials in 2014 and demonstrated efficacy against clinical malaria of approximately 36% over 4 years for a 4-dose schedule in children aged 5–17 months. Pilot vaccine implementation has recently begun in 3 African countries. If the pilots demonstrate both a positive health impact and resolve remaining safety concerns, wider roll-out could be recommended from 2021 onwards. Vaccine demand may, however, outstrip initial supply. We sought to identify where vaccine introduction should be prioritised to maximise public health impact under a range of supply constraints using mathematical modelling.

Methods and findings

Using a mathematical model of P. falciparum malaria transmission and RTS,S vaccine impact, we estimated the clinical cases and deaths averted in children aged 0–5 years in sub-Saharan Africa under 2 scenarios for vaccine coverage (100% and realistic) and 2 scenarios for other interventions (current coverage and World Health Organization [WHO] Global Technical Strategy targets). We used a prioritisation algorithm to identify potential allocative efficiency gains from prioritising vaccine allocation among countries or administrative units to maximise cases or deaths averted. If malaria burden at introduction is similar to current levels—assuming realistic vaccine coverage and country-level prioritisation in areas with parasite prevalence >10%—we estimate that 4.3 million malaria cases (95% credible interval [CrI] 2.8–6.8 million) and 22,000 deaths (95% CrI 11,000–35,000) in children younger than 5 years could be averted annually at a dose constraint of 30 million. This decreases to 3.0 million cases (95% CrI 2.0–4.7 million) and 14,000 deaths (95% CrI 7,000–23,000) at a dose constraint of 20 million, and increases to 6.6 million cases (95% CrI 4.2–10.8 million) and 38,000 deaths (95% CrI 18,000–61,000) at a dose constraint of 60 million. At 100% vaccine coverage, these impact estimates increase to 5.2 million cases (95% CrI 3.5–8.2 million) and 27,000 deaths (95% CrI 14,000–43,000), 3.9 million cases (95% CrI 2.7–6.0 million) and 19,000 deaths (95% CrI 10,000–30,000), and 10.0 million cases (95% CrI 6.7–15.7 million) and 51,000 deaths (95% CrI 25,000–82,000), respectively. Under realistic vaccine coverage, if the vaccine is prioritised sub-nationally, 5.3 million cases (95% CrI 3.5–8.2 million) and 24,000 deaths (95% CrI 12,000–38,000) could be averted at a dose constraint of 30 million. Furthermore, sub-national prioritisation would allow introduction in almost double the number of countries compared to national prioritisation (21 versus 11). If vaccine introduction is prioritised in the 3 pilot countries (Ghana, Kenya, and Malawi), health impact would be reduced, but this effect becomes less substantial (change of <5%) if 50 million or more doses are available. We did not account for within-country variation in vaccine coverage, and the optimisation was based on a single outcome measure, therefore this study should be used to understand overall trends rather than guide country-specific allocation.

Conclusions

These results suggest that the impact of constraints in vaccine supply on the public health impact of the RTS,S malaria vaccine could be reduced by introducing the vaccine at the sub-national level and prioritising countries with the highest malaria incidence.

Covid-19 news: Infections in England fell 30 per cent during lockdown

New Scientist - Lu, 30/11/2020 - 18:23
The latest coronavirus news updated every day including coronavirus cases, the latest news, features and interviews from New Scientist and essential information about the covid-19 pandemic

DeepMind's AI biologist can decipher secrets of the machinery of life

New Scientist - Lu, 30/11/2020 - 16:30
AI firm DeepMind's latest creation, AlphaFold, can predict the shape of proteins from their sequence alone. This fiendish problem normally requires time-consuming experiments, but is key to understanding the machinery of life

Ivy is multiplying across Europe’s forests as the climate warms

New Scientist - Lu, 30/11/2020 - 11:00
Ivy is multiplying across European forests, riding a perfect storm of warmer conditions and forest management practices

Armoured liquid marbles connected together in a chain 1.7 metres long

New Scientist - Lu, 30/11/2020 - 09:00
Liquid marbles that can be picked up and handled have now been linked together in a 1.7-metre-long chain – and could be used as chemical microreactors

[Perspectives] People versus politics at the 2020 Global Health Film Festival

The Lancet - Sa, 28/11/2020 - 00:30
A dusty ranch road parts a cattle herd and stretches to a distant horizon under a vast Texan sky. Vultures swirling overhead provide the only scraps of shade. A pick-up truck full of water bottles destined for undocumented migrants bumps to a halt, and a lone figure emerges and waves his way through the bush with the help of a couple of broken sticks. The camera tracks his progress: there, spread-eagle in a clearing, lies a recently young man, now mummifying in the unforgiving sun. The scene, from Missing in Brooks County, encapsulates the David-and-Goliath theme that runs through much of the 2020 Global Health Film Festival.

[Editorial] Maintaining the HIV response in a world shaped by COVID-19

The Lancet - Sa, 28/11/2020 - 00:00
Although global attention is dominated by COVID-19, the HIV/AIDS pandemic, as it enters its fifth decade, is far from over. Since the early 1980s, 75·7 million people have become infected with HIV. 32·7 million people have died from AIDS-related illnesses. HIV/AIDS remains a major public health crisis and only a few countries will meet the 90–90–90 treatment target for 2020. Much has been made of how information systems and service models in the HIV response have helped the COVID-19 response, but the COVID-19 pandemic could have knock-on effects on the HIV response and be devastating for communities.

[Comment] First-line treatment for type 2 diabetes: is it too early to abandon metformin?

The Lancet - Sa, 28/11/2020 - 00:00
With the sulfonylurea gliclazide and insulin, metformin is part of the triad of antihyperglycaemic agents on the 2019 WHO list of essential medications. In most international guidelines on the management of hyperglycaemia, metformin is the recommended first-line glucose-lowering agent in patients with type 2 diabetes. The evidence that underpins these recommendations is partly based on the efficacy results in a small subgroup of the UK Prospective Diabetes Study participants, which showed a reduction in macrovascular and microvascular complications in overweight people with newly diagnosed type 2 diabetes randomised to metformin or non-pharmacological (diet) intervention.

[Comment] Offline: Europe and COVID-19—struggling with tragedy

The Lancet - Sa, 28/11/2020 - 00:00
The Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, USA, publishes weekly reports on progress to control the COVID-19 pandemic in Europe. They make grim reading. The latest iteration, dated Nov 19, predicts that daily deaths from COVID-19 will continue to rise in the coming weeks, reaching a peak of over 7000 deaths per day around mid-January. Hospitals will be stretched to breaking point from December through to the end of February. COVID-19 is currently the second leading cause of death in the region—29 858 weekly deaths (ischaemic heart disease killed 44 253 people across Europe during the same period).

[World Report] Funding crisis threatens Palestinian refugee agency

The Lancet - Sa, 28/11/2020 - 00:00
UN Relief and Works Agency for Palestine Refugees in the Near East says that a $300 million shortfall is threatening health services. Sharmila Devi reports.

[World Report] New international group on antimicrobial resistance

The Lancet - Sa, 28/11/2020 - 00:00
The One Health Global Leaders Group on Antimicrobial Resistance aims to raise awareness and political advocacy on antimicrobial resistance. John Zarocostas reports from Geneva.

[World Report] Afghanistan braced for second wave of COVID-19

The Lancet - Sa, 28/11/2020 - 00:00
Afghan health workers predict a second wave of COVID-19 infections, but is the health system ready? Sophie Cousins reports from Afghanistan.

[Perspectives] Applying for residency in the time of COVID-19

The Lancet - Sa, 28/11/2020 - 00:00
This year has been one of tremendous uncertainty for medical students, especially those entering their final year. The dynamics of selecting a specialty, preparing to apply for it, and entering the application process have been disrupted. Many rotations were cancelled or changed so the opportunities to fully explore a specialty were curtailed. Other research and extracurricular activities in support of such training were also constrained. Students entered application season with only the small comfort of knowing that everyone was pretty much in the same boat.

[Perspectives] Steven Laureys: a clinical focus on consciousness research

The Lancet - Sa, 28/11/2020 - 00:00
“It is curious how awareness of consciousness science is so low in the medical and scientific arenas. We need to inspire more neurologists and doctors to be interested in consciousness—and what it means for the thousands of people who experience traumatic brain injury and disorders of consciousness every year”, Steven Laureys says. He's spent much of his career trying to do just that. As Research Director for the Belgian National Fund for Scientific Research, Laureys founded the GIGA Consciousness and Coma Science Group at the University of Liège, Belgium, comprising around 60 staff focused on contrasting areas of consciousness research, ranging from anaesthesia to dreaming, and the important clinical question of consciousness in patients after traumatic brain injury.

[Obituary] A tribute to some of the doctors who died from COVID-19

The Lancet - Sa, 28/11/2020 - 00:00
The global COVID-19 death toll stands at more than 1·3 million. Among the lives lost have been those of health-care workers, who have had crucial roles throughout the response and continue to serve at the front lines. At the outset of the pandemic, doctors warned of the potential implications of the virus. As the virus spread, many doctors provided treatment for a disease they little understood, while others contributed to accelerated research on potential treatments and vaccines. And as the COVID-19 pandemic worsened worldwide, health professionals worked tirelessly to provide care for patients—some even emerged from retirement to provide assistance.

[Correspondence] Harmful marketing to children

The Lancet - Sa, 28/11/2020 - 00:00
The WHO–UNICEF–Lancet Commission1 identified an important threat to children's health and futures by stating that children across the globe are exposed to exploitative advertising and marketing by the private sector. Fast food and sugar-sweetened beverages, alcohol, tobacco, e-cigarettes, breastmilk substitutes, and gambling, were positioned as the key products that children are increasingly exposed to and harmed by. However, by focusing on the marketing of particular so-called unhealthy products, the Commission has made a critical oversight.
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