Riviste scientifiche

[Comment] Tackling COVID-19 in the Eastern Mediterranean Region

The Lancet - Ve, 20/11/2020 - 00:30
COVID-19 has substantially impacted the Eastern Mediterranean Region (EMR), home to nearly 700 million people across 22 diverse countries. Since the first reported confirmed case in January, 2020, 3 611 352 confirmed COVID-19 cases and 91 738 deaths were reported in the region as of Nov 17, 2020.1 Most countries saw fairly slow transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the early months of the pandemic but in May, as social measures, such as restrictions and partial or full lockdowns, were relaxed during the holy month of Ramadan, disease transmission accelerated.

Cesarean section and childhood infections: Causality for concern?

PLoS Medicine - Gi, 19/11/2020 - 23:00

by Gordon C. S. Smith

In this Perspective, Gordon Smith discusses the findings of Miller et al, and the balance of risks and benefits associated with different modes of delivery.

Mode of birth and risk of infection-related hospitalisation in childhood: A population cohort study of 7.17 million births from 4 high-income countries

PLoS Medicine - Gi, 19/11/2020 - 23:00

by Jessica E. Miller, Raphael Goldacre, Hannah C. Moore, Justin Zeltzer, Marian Knight, Carole Morris, Sian Nowell, Rachael Wood, Kim W. Carter, Parveen Fathima, Nicholas de Klerk, Tobias Strunk, Jiong Li, Natasha Nassar, Lars H. Pedersen, David P. Burgner

Background

The proportion of births via cesarean section (CS) varies worldwide and in many countries exceeds WHO-recommended rates. Long-term health outcomes for children born by CS are poorly understood, but limited data suggest that CS is associated with increased infection-related hospitalisation. We investigated the relationship between mode of birth and childhood infection-related hospitalisation in high-income countries with varying CS rates.

Methods and findings

We conducted a multicountry population-based cohort study of all recorded singleton live births from January 1, 1996 to December 31, 2015 using record-linked birth and hospitalisation data from Denmark, Scotland, England, and Australia (New South Wales and Western Australia). Birth years within the date range varied by site, but data were available from at least 2001 to 2010 for each site. Mode of birth was categorised as vaginal or CS (emergency/elective). Infection-related hospitalisations (overall and by clinical type) occurring after the birth-related discharge date were identified in children until 5 years of age by primary/secondary International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes. Analysis used Cox regression models, adjusting for maternal factors, birth parameters, and socioeconomic status, with results pooled using meta-analysis. In total, 7,174,787 live recorded births were included. Of these, 1,681,966 (23%, range by jurisdiction 17%–29%) were by CS, of which 727,755 (43%, range 38%–57%) were elective. A total of 1,502,537 offspring (21%) had at least 1 infection-related hospitalisation. Compared to vaginally born children, risk of infection was greater among CS-born children (hazard ratio (HR) from random effects model, HR 1.10, 95% confidence interval (CI) 1.09–1.12, p < 0.001). The risk was higher following both elective (HR 1.13, 95% CI 1.12–1.13, p < 0.001) and emergency CS (HR 1.09, 95% CI 1.06–1.12, p < 0.001). Increased risks persisted to 5 years and were highest for respiratory, gastrointestinal, and viral infections. Findings were comparable in prespecified subanalyses of children born to mothers at low obstetric risk and unchanged in sensitivity analyses. Limitations include site-specific and longitudinal variations in clinical practice and in the definition and availability of some data. Data on postnatal factors were not available.

Conclusions

In this study, we observed a consistent association between birth by CS and infection-related hospitalisation in early childhood. Notwithstanding the limitations of observational data, the associations may reflect differences in early microbial exposure by mode of birth, which should be investigated by mechanistic studies. If our findings are confirmed, they could inform efforts to reduce elective CS rates that are not clinically indicated.

The risk of <i>Plasmodium vivax</i> parasitaemia after <i>P</i>. <i>falciparum</i> malaria: An individual patient data meta-analysis from the WorldWide Antimalarial Resistance Network

PLoS Medicine - Gi, 19/11/2020 - 23:00

by Mohammad S. Hossain, Robert J. Commons, Nicholas M. Douglas, Kamala Thriemer, Bereket H. Alemayehu, Chanaki Amaratunga, Anupkumar R. Anvikar, Elizabeth A. Ashley, Puji B. S. Asih, Verena I. Carrara, Chanthap Lon, Umberto D’Alessandro, Timothy M. E. Davis, Arjen M. Dondorp, Michael D. Edstein, Rick M. Fairhurst, Marcelo U. Ferreira, Jimee Hwang, Bart Janssens, Harin Karunajeewa, Jean R. Kiechel, Simone Ladeia-Andrade, Moses Laman, Mayfong Mayxay, Rose McGready, Brioni R. Moore, Ivo Mueller, Paul N. Newton, Nguyen T. Thuy-Nhien, Harald Noedl, Francois Nosten, Aung P. Phyo, Jeanne R. Poespoprodjo, David L. Saunders, Frank Smithuis, Michele D. Spring, Kasia Stepniewska, Seila Suon, Yupin Suputtamongkol, Din Syafruddin, Hien T. Tran, Neena Valecha, Michel Van Herp, Michele Van Vugt, Nicholas J. White, Philippe J. Guerin, Julie A. Simpson, Ric N. Price

Background

There is a high risk of Plasmodium vivax parasitaemia following treatment of falciparum malaria. Our study aimed to quantify this risk and the associated determinants using an individual patient data meta-analysis in order to identify populations in which a policy of universal radical cure, combining artemisinin-based combination therapy (ACT) with a hypnozoitocidal antimalarial drug, would be beneficial.

Methods and findings

A systematic review of Medline, Embase, Web of Science, and the Cochrane Database of Systematic Reviews identified efficacy studies of uncomplicated falciparum malaria treated with ACT that were undertaken in regions coendemic for P. vivax between 1 January 1960 and 5 January 2018. Data from eligible studies were pooled using standardised methodology. The risk of P. vivax parasitaemia at days 42 and 63 and associated risk factors were investigated by multivariable Cox regression analyses. Study quality was assessed using a tool developed by the Joanna Briggs Institute. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018097400). In total, 42 studies enrolling 15,341 patients were included in the analysis, including 30 randomised controlled trials and 12 cohort studies. Overall, 14,146 (92.2%) patients had P. falciparum monoinfection and 1,195 (7.8%) mixed infection with P. falciparum and P. vivax. The median age was 17.0 years (interquartile range [IQR] = 9.0–29.0 years; range = 0–80 years), with 1,584 (10.3%) patients younger than 5 years. 2,711 (17.7%) patients were treated with artemether-lumefantrine (AL, 13 studies), 651 (4.2%) with artesunate-amodiaquine (AA, 6 studies), 7,340 (47.8%) with artesunate-mefloquine (AM, 25 studies), and 4,639 (30.2%) with dihydroartemisinin-piperaquine (DP, 16 studies). 14,537 patients (94.8%) were enrolled from the Asia-Pacific region, 684 (4.5%) from the Americas, and 120 (0.8%) from Africa. At day 42, the cumulative risk of vivax parasitaemia following treatment of P. falciparum was 31.1% (95% CI 28.9–33.4) after AL, 14.1% (95% CI 10.8–18.3) after AA, 7.4% (95% CI 6.7–8.1) after AM, and 4.5% (95% CI 3.9–5.3) after DP. By day 63, the risks had risen to 39.9% (95% CI 36.6–43.3), 42.4% (95% CI 34.7–51.2), 22.8% (95% CI 21.2–24.4), and 12.8% (95% CI 11.4–14.5), respectively. In multivariable analyses, the highest rate of P. vivax parasitaemia over 42 days of follow-up was in patients residing in areas of short relapse periodicity (adjusted hazard ratio [AHR] = 6.2, 95% CI 2.0–19.5; p = 0.002); patients treated with AL (AHR = 6.2, 95% CI 4.6–8.5; p < 0.001), AA (AHR = 2.3, 95% CI 1.4–3.7; p = 0.001), or AM (AHR = 1.4, 95% CI 1.0–1.9; p = 0.028) compared with DP; and patients who did not clear their initial parasitaemia within 2 days (AHR = 1.8, 95% CI 1.4–2.3; p < 0.001). The analysis was limited by heterogeneity between study populations and lack of data from very low transmission settings. Study quality was high.

Conclusions

In this meta-analysis, we found a high risk of P. vivax parasitaemia after treatment of P. falciparum malaria that varied significantly between studies. These P. vivax infections are likely attributable to relapses that could be prevented with radical cure including a hypnozoitocidal agent; however, the benefits of such a novel strategy will vary considerably between geographical areas.

Evaluating smartphone strategies for reliability, reproducibility, and quality of VIA for cervical cancer screening in the Shiselweni region of Eswatini: A cohort study

PLoS Medicine - Gi, 19/11/2020 - 23:00

by Ramin Asgary, Nelly Staderini, Simangele Mthethwa-Hleta, Paola Andrea Lopez Saavedra, Linda Garcia Abrego, Barbara Rusch, Tombo Marie Luce, Lorraine Rusike Pasipamire, Mgcineni Ndlangamandla, Elena Beideck, Bernhard Kerschberger

Background

Cervical cancer is among the most common preventable cancers with the highest morbidity and mortality. The World Health Organization (WHO) recommends visual inspection of the cervix with acetic acid (VIA) as cervical cancer screening strategy in resource-poor settings. However, there are barriers to the sustainability of VIA programs including declining providers’ VIA competence without mentorship and quality assurances and challenges of integration into primary healthcare. This study seeks to evaluate the impact of smartphone-based strategies in improving reliability, reproducibility, and quality of VIA in humanitarian settings.

Methods and findings

We implemented smartphone-based VIA that included standard VIA training, adapted refresher, and 6-month mHealth mentorship, sequentially, in the rural Shiselweni region of Eswatini. A remote expert reviewer provided diagnostic and management feedback on patients’ cervical images, which were reviewed weekly by nurses. Program’s outcomes, VIA image agreement rates, and Kappa statistic were compared before, during, and after training. From September 1, 2016 to December 31, 2018, 4,247 patients underwent screening; 247 were reviewed weekly by a VIA diagnostic expert. Of the 247, 128 (49%) were HIV–positive; mean age was 30.80 years (standard deviation [SD]: 7.74 years). Initial VIA positivity of 16% (436/2,637) after standard training gradually increased to 25.1% (293/1,168), dropped to an average of 9.7% (143/1,469) with a lowest of 7% (20/284) after refresher in 2017 (p = 0.001), increased again to an average of 9.6% (240/2,488) with a highest of 17% (17/100) before the start of mentorship, and dropped to an average of 8.3% (134/1,610) in 2018 with an average of 6.3% (37/591) after the start of mentorship (p = 0.019). Overall, 88% were eligible for and 68% received cryotherapy the same day: 10 cases were clinically suspicious for cancer; however, only 5 of those cases were confirmed using punch biopsy. Agreement rates with the expert reviewer for positive and negative cases were 100% (95% confidence interval [CI]: 79.4% to 100%) and 95.7% (95% CI: 92.2% to 97.9%), respectively, with negative predictive value (NPV) (100%), positive predictive value (PPV) (63.5%), and area under the curve of receiver operating characteristics (AUC ROC) (0.978). Kappa statistic was 0.74 (95% CI; 0.58 to 0.89); 0.64 and 0.79 at 3 and 6 months, respectively. In logistic regression, HIV and age were associated with VIA positivity (adjusted Odds Ratio [aOR]: 3.53, 95% CI: 1.10 to 11.29; p = 0.033 and aOR: 1.06, 95% CI: 1.0004 to 1.13; p = 0.048, respectively). We were unable to incorporate a control arm due to logistical constraints in routine humanitarian settings.

Conclusions

Our findings suggest that smartphone mentorship provided experiential learning to improve nurses’ competencies and VIA reliability and reproducibility, reduced false positive, and introduced peer-to-peer education and quality control services. Local collaboration; extending services to remote populations; decreasing unnecessary burden to screened women, providers, and tertiary centers; and capacity building through low-tech high-yield screening are promising strategies for scale-up of VIA programs.

Potent new antifungal discovered in the microbiome of marine animals

New Scientist - Gi, 19/11/2020 - 20:00
A new antifungal compound that is effective against multidrug-resistant fungi has been isolated from bacteria living in filter-feeding marine animals called sea squirts

Ebola outbreak in the DRC ended thanks to vaccine distribution efforts

New Scientist - Gi, 19/11/2020 - 19:46
The 11th outbreak of Ebola virus in the Democratic Republic of the Congo has ended after six months. Ultracold devices for vaccine distribution played a key role, and could help with the coronavirus pandemic

Covid-19 news: Socialising at Christmas poses ‘substantial risks’

New Scientist - Gi, 19/11/2020 - 19:02
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

Very hangry caterpillars could help reveal genetic basis of aggression

New Scientist - Gi, 19/11/2020 - 17:00
Monarch caterpillars get more aggressive when they are hungry, resulting in them headbutting and lunging at other caterpillars in an attempt to secure food

Your eyes can reveal your decisions before you've even made them

New Scientist - Gi, 19/11/2020 - 13:52
Deciding whether to complete a task that requires physical effort can trigger a change in your pupil size and brain activity, and these signals can reveal your ultimate choice

Capuchin monkeys spotted eating infant in rare act of cannibalism

New Scientist - Gi, 19/11/2020 - 13:38
Cannibalism is extremely rare among the primates living in the Americas – but some capuchin monkeys have now been spotted eating a dead infant

California's latest erosion of gig worker rights could be going global

New Scientist - Me, 18/11/2020 - 23:29
A measure passed in California removes many employment rights for gig workers. Similar rules could soon come to a place near you, writes Annalee Newitz

Plant-based diets and incident metabolic syndrome: Results from a South Korean prospective cohort study

PLoS Medicine - Me, 18/11/2020 - 23:00

by Hyunju Kim, Kyueun Lee, Casey M. Rebholz, Jihye Kim

Background

Prior studies have shown that plant-based diets are associated with lower risk of cardiovascular risk factors and incident cardiovascular disease, but risks differed by quality of plant-based diets. No prospective studies have evaluated the associations between different types of plant-based diets and incident metabolic syndrome (MetS) and components of MetS. Furthermore, limited evidence exists in Asian populations who have habitually consumed a diet rich in plant foods for a long period of time.

Methods and findings

Analyses were based on a community-based cohort of 5,646 men and women (40–69 years of age at baseline) living in Ansan and Ansung, South Korea (2001–2016) without MetS and related chronic diseases at baseline. Dietary intake was assessed using a validated food frequency questionnaire. Using the responses in the questionnaire, we calculated 4 plant-based diet indices (overall plant-based diet index [PDI], healthful plant-based diet index [hPDI], unhealthful plant-based diet index [uPDI], and pro-vegetarian diet index). Higher PDI score represented greater consumption of all types of plant foods regardless of healthiness. Higher hPDI score represented greater consumption of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, tea and coffee) and lower consumption of less-healthy plant foods (refined grains, potatoes, sugar-sweetened beverages, sweets, salty foods). Higher uPDI represented lower consumption of healthy plant foods and greater consumption of less-healthy plant foods. Similar to PDI, higher pro-vegetarian diet score represented greater consumption of plant foods but included only selected plant foods (grains, fruits, vegetables, nuts, legumes, potatoes). Higher scores in all plant-based diet indices represented lower consumption of animal foods (animal fat, dairy, eggs, fish/seafood, meat). Over a median follow-up of 8 years, 2,583 participants developed incident MetS. Individuals in the highest versus lowest quintile of uPDI had 50% higher risk of developing incident MetS, adjusting for demographic characteristics and lifestyle factors (hazard ratio [HR]: 1.50, 95% CI 1.31–1.71, P-trend < 0.001). When we further adjusted for body mass index (BMI), those in the highest quintile of uPDI had 24%–46% higher risk of 4 out of 5 individual components of MetS (abdominal obesity, hypertriglyceridemia, low high-density lipoprotein [HDL], and elevated blood pressure) (P-trend for all tests ≤ 0.001). Greater adherence to PDI was associated with lower risk of elevated fasting glucose (HR: 0.80, 95% CI 0.70–0.92, P-trend = 0.003). No consistent associations were observed for other plant-based diet indices and MetS. Limitations of the study may include potential measurement error in self-reported dietary intake, inability to classify a few plant foods as healthy and less-healthy, lack of data on vegetable oil intake, and possibility of residual confounding.

Conclusions

In this study, we observed that greater adherence to diets consisting of a high intake of refined carbohydrates, sugars, and salty foods in the framework of plant-based diets was associated with an elevated risk of MetS. These results suggest that considering the quality of plant foods is important for prevention of MetS in a population that habitually consumes plant foods.

Our supposed earliest human relative may have walked on four legs

New Scientist - Me, 18/11/2020 - 22:38
The femur of Sahelanthropus tchadensis, generally regarded as the oldest known hominin, has finally been scientifically examined. The results suggest it walked on four legs, so may not actually be a close human relative at all

Magnetic spray turns objects into mini robots that can deliver drugs

New Scientist - Me, 18/11/2020 - 20:00
A glue-like magnetic spray can turn objects, such as pills, into mini robots that can be controlled by magnets and navigated through the body

AI that can diagnose tinnitus from brain scans may improve treatment

New Scientist - Me, 18/11/2020 - 20:00
Tinnitus is usually diagnosed by a hearing test, by self-reporting or based on a subjective questionnaire, but now an AI can make a more objective assessment from brain scans

Warehouse robots upgraded to make packing decisions 350 times faster

New Scientist - Me, 18/11/2020 - 20:00
Robotic arms for packing boxes in warehouses work out which path to take more than 350 times faster when using a neural network that predicts how quickly they can safely transport items

Systemic racism: What research reveals about the extent of its impact

New Scientist - Me, 18/11/2020 - 19:50
We spoke to five researchers working to demonstrate the various ways that racial discrimination is embedded in the structures and procedures that underpin US society

Vaccine results show we can end the pandemic, but hurdles lie ahead

New Scientist - Me, 18/11/2020 - 19:06
Promising early results from vaccine trials offer hope of defeating covid-19, but vaccines may be less effective in the real world and people's safety concerns could hamper take-up

Away review: An exquisite animated film created entirely by one person

New Scientist - Me, 18/11/2020 - 19:00
Feature-length animation Away was created solely by film-maker Gints Zilbalodis. The writing, animation and soundtrack are all uncomplicated, and the storytelling is all the better for it, says Simon Ings
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