Riviste scientifiche

Phage therapies for superbug infections are being tested in Belgium

New Scientist - Ma, 18/01/2022 - 17:00
Bacteria-killing viruses can be used to treat antibiotic-resistant superbugs, and the approach has been tried in more than 100 people in Belgium since a 2019 change in regulations

Living with covid: How can the pandemic end and what will it be like?

New Scientist - Ma, 18/01/2022 - 16:55
For some, the phrase “living with covid” means removing all restrictions - and this could soon happen in England. But the actions countries take now will determine how many more people die of covid and whether we’re doomed to keep chasing new variants

First fully programmable quantum computer based on neutral atoms

New Scientist - Ma, 18/01/2022 - 16:15
Most quantum computers are based on superconductors or trapped ions, but an alternative approach using ordinary atoms may have advantages

Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review

PLoS Medicine - Ma, 18/01/2022 - 15:00

by Chuan De Foo, Pami Shrestha, Leiting Wang, Qianmei Du, Alberto L. García Basteiro, Abu Saleh Abdullah, Helena Legido-Quigley

Background

Low- and middle-income countries (LMICs) are facing a combined affliction from both tuberculosis (TB) and noncommunicable diseases (NCDs), which threatens population health and further strains the already stressed health systems. Integrating services for TB and NCDs is advantageous in tackling this joint burden of diseases effectively. Therefore, this systematic review explores the mechanisms for service integration for TB and NCDs and elucidates the facilitators and barriers for implementing integrated service models in LMIC settings.

Methods and findings

A systematic search was conducted in the Cochrane Library, MEDLINE, Embase, PubMed, Bibliography of Asian Studies, and the Global Index Medicus from database inception to November 4, 2021. For our search strategy, the terms “tuberculosis” AND “NCDs” (and their synonyms) AND (“delivery of healthcare, integrated” OR a range of other terms representing integration) were used. Articles were included if they were descriptions or evaluations of a management or organisational change strategy made within LMICs, which aim to increase integration between TB and NCD management at the service delivery level. We performed a comparative analysis of key themes from these studies and organised the themes based on integration of service delivery options for TB and NCD services. Subsequently, these themes were used to reconfigure and update an existing framework for integration of TB and HIV services by Legido-Quigley and colleagues, which categorises the levels of integration according to types of services and location where services were offered. Additionally, we developed themes on the facilitators and barriers facing integrated service delivery models and mapped them to the World Health Organization’s (WHO) health systems framework, which comprises the building blocks of service delivery, human resources, medical products, sustainable financing and social protection, information, and leadership and governance.A total of 22 articles published between 2011 and 2021 were used, out of which 13 were cross-sectional studies, 3 cohort studies, 1 case–control study, 1 prospective interventional study, and 4 were mixed methods studies. The studies were conducted in 15 LMICs in Asia, Africa, and the Americas. Our synthesised framework explicates the different levels of service integration of TB and NCD services. We categorised them into 3 levels with entry into the health system based on either TB or NCDs, with level 1 integration offering only testing services for either TB or NCDs, level 2 integration offering testing and referral services to linked care, and level 3 integration providing testing and treatment services at one location. Some facilitators of integrated service include improved accessibility to integrated services, motivated and engaged providers, and low to no cost for additional services for patients. A few barriers identified were poor public awareness of the diseases leading to poor uptake of services, lack of programmatic budget and resources, and additional stress on providers due to increased workload. The limitations include the dearth of data that explores the experiences of patients and providers and evaluates programme effectiveness.

Conclusions

Integration of TB and NCD services encourages the improvement of health service delivery across disease conditions and levels of care to address the combined burden of diseases in LMICs. This review not only offers recommendations for policy implementation and improvements for similar integrated programmes but also highlights the need for more high-quality TB–NCD research.

Clinical impact of vivax malaria: A collection review

PLoS Medicine - Ma, 18/01/2022 - 15:00

by Aung Pyae Phyo, Prabin Dahal, Mayfong Mayxay, Elizabeth A. Ashley

Background

Plasmodium vivax infects an estimated 7 million people every year. Previously, vivax malaria was perceived as a benign condition, particularly when compared to falciparum malaria. Reports of the severe clinical impacts of vivax malaria have been increasing over the last decade.

Methods and findings

We describe the main clinical impacts of vivax malaria, incorporating a rapid systematic review of severe disease with meta-analysis of data from studies with clearly defined denominators, stratified by hospitalization status. Severe anemia is a serious consequence of relapsing infections in children in endemic areas, in whom vivax malaria causes increased morbidity and mortality and impaired school performance. P. vivax infection in pregnancy is associated with maternal anemia, prematurity, fetal loss, and low birth weight. More than 11,658 patients with severe vivax malaria have been reported since 1929, with 15,954 manifestations of severe malaria, of which only 7,157 (45%) conformed to the World Health Organization (WHO) diagnostic criteria. Out of 423 articles, 311 (74%) were published since 2010. In a random-effects meta-analysis of 85 studies, 68 of which were in hospitalized patients with vivax malaria, we estimated the proportion of patients with WHO-defined severe disease as 0.7% [95% confidence interval (CI) 0.19% to 2.57%] in all patients with vivax malaria and 7.11% [95% CI 4.30% to 11.55%] in hospitalized patients. We estimated the mortality from vivax malaria as 0.01% [95% CI 0.00% to 0.07%] in all patients and 0.56% [95% CI 0.35% to 0.92%] in hospital settings. WHO-defined cerebral, respiratory, and renal severe complications were generally estimated to occur in fewer than 0.5% patients in all included studies. Limitations of this review include the observational nature and small size of most of the studies of severe vivax malaria, high heterogeneity of included studies which were predominantly in hospitalized patients (who were therefore more likely to be severely unwell), and high risk of bias including small study effects.

Conclusions

Young children and pregnant women are particularly vulnerable to adverse clinical impacts of vivax malaria, and preventing infections and relapse in this groups is a priority. Substantial evidence of severe presentations of vivax malaria has accrued over the last 10 years, but reporting is inconsistent. There are major knowledge gaps, for example, limited understanding of the underlying pathophysiology and the reason for the heterogenous geographical distribution of reported complications. An adapted case definition of severe vivax malaria would facilitate surveillance and future research to better understand this condition.

Effects of preconception lifestyle intervention in infertile women with obesity: The FIT-PLESE randomized controlled trial

PLoS Medicine - Ma, 18/01/2022 - 15:00

by Richard S. Legro, Karl R. Hansen, Michael P. Diamond, Anne Z. Steiner, Christos Coutifaris, Marcelle I. Cedars, Kathleen M. Hoeger, Rebecca Usadi, Erica B. Johnstone, Daniel J. Haisenleder, Robert A. Wild, Kurt T. Barnhart, Jennifer Mersereau, J. C. Trussell, Stephen A. Krawetz, Penny M. Kris-Etherton, David B. Sarwer, Nanette Santoro, Esther Eisenberg, Hao Huang, Heping Zhang, for the Reproductive Medicine Network

Background

Women with obesity and infertility are counseled to lose weight prior to conception and infertility treatment to improve pregnancy rates and birth outcomes, although confirmatory evidence from randomized trials is lacking. We assessed whether a preconception intensive lifestyle intervention with acute weight loss is superior to a weight neutral intervention at achieving a healthy live birth.

Methods and findings

In this open-label, randomized controlled study (FIT-PLESE), 379 women with obesity (BMI ≥ 30 kg/m2) and unexplained infertility were randomly assigned in a 1:1 ratio to 2 preconception lifestyle modification groups lasting 16 weeks, between July 2015 and July 2018 (final follow-up September 2019) followed by infertility therapy. The primary outcome was the healthy live birth (term infant of normal weight without major anomalies) incidence. This was conducted at 9 academic health centers across the United States. The intensive group underwent increased physical activity and weight loss (target 7%) through meal replacements and medication (Orlistat) compared to a standard group with increased physical activity alone without weight loss. This was followed by standardized empiric infertility treatment consisting of 3 cycles of ovarian stimulation/intrauterine insemination. Outcomes of any resulting pregnancy were tracked. Among 191 women randomized to standard lifestyle group, 40 dropped out of the study before conception; among 188 women randomized to intensive lifestyle group, 31 dropped out of the study before conception. All the randomized women were included in the intent-to-treat analysis for primary outcome of a healthy live birth. There were no significant differences in the incidence of healthy live births [standard 29/191(15.2%), intensive 23/188(12.2%), rate ratio 0.81 (0.48 to 1.34), P = 0.40]. Intensive had significant weight loss compared to standard (−6.6 ± 5.4% versus −0.3 ± 3.2%, P < 0.001). There were improvements in metabolic health, including a marked decrease in incidence of the metabolic syndrome (baseline to 16 weeks: standard: 53.6% to 49.4%, intensive 52.8% to 32.2%, P = 0.003). Gastrointestinal side effects were significantly more common in intensive. There was a higher, but nonsignificant, first trimester pregnancy loss in the intensive group (33.3% versus 23.7% in standard, 95% rate ratio 1.40, 95% confidence interval [CI]: 0.79 to 2.50). The main limitations of the study are the limited power of the study to detect rare complications and the design difficulty in finding an adequate time matched control intervention, as the standard exercise intervention may have potentially been helpful or harmful.

Conclusions

A preconception intensive lifestyle intervention for weight loss did not improve fertility or birth outcomes compared to an exercise intervention without targeted weight loss. Improvement in metabolic health may not translate into improved female fecundity.

Trial registration

ClinicalTrials.gov NCT02432209.

A nationwide school fruit and vegetable policy and childhood and adolescent overweight: A quasi-natural experimental study

PLoS Medicine - Ma, 18/01/2022 - 15:00

by Bente Øvrebø, Tonje H. Stea, Ingunn H. Bergh, Elling Bere, Pål Surén, Per Magnus, Petur B. Juliusson, Andrew K. Wills

Background

School free fruit and vegetable (FFV) policies are used to promote healthy dietary habits and tackle obesity; however, our understanding of their effects on weight outcomes is limited. We assess the effect of a nationwide FFV policy on childhood and adolescent weight status and explore heterogeneity by sex and socioeconomic position.

Methods and findings

This study used a quasi-natural experimental design. Between 2007 and 2014, Norwegian combined schools (grades 1–10, age 6 to 16 years) were obligated to provide FFVs while elementary schools (grades 1–7) were not. We used 4 nationwide studies (n = 11,215 children) from the Norwegian Growth Cohort with longitudinal or cross-sectional anthropometric data up to age 8.5 and 13 years to capture variation in FFV exposure. Outcomes were body mass index standard deviation score (BMISDS), overweight and obesity (OW/OB), waist circumference (WC), and weight to height ratio (WtHR) at age 8.5 years, and BMISDS and OW/OB at age 13 years. Analyses included longitudinal models of the pre- and post-exposure trajectories to estimate the policy effect. The participation rate in each cohort was >80%, and in most analyses <4% were excluded due to missing data. Estimates were adjusted for region, population density, and parental education. In pooled models additionally adjusted for pre-exposure BMISDS, there was little evidence of any benefit or unintended consequence from 1–2.5 years of exposure to the FFV policy on BMISDS, OW/OB, WC, or WtHR in either sex. For example, boys exposed to the FFV policy had a 0.05 higher BMISDS (95% CI: −0.04, 0.14), a 1.20-fold higher odds of OW/OB (95% CI: 0.86, 1.66) and a 0.3 cm bigger WC (95% CI: −0.3, 0.8); while exposed girls had a 0.04 higher BMISDS (95% CI: −0.04, 0.13), a 1.03 fold higher odds of OW/OB (95% CI: 0.75, 1.39), and a 0-cm difference in WC (95% CI: −0.6, 0.6). There was evidence of heterogeneity in the policy effect estimates at 8.5 years across cohorts and socioeconomic position; however, these results were inconsistent with other comparisons. Analysis at age 13 years, after 4 years of policy exposure, also showed little evidence of an effect on BMISDS or OW/OB. The main limitations of this study are the potential for residual confounding and exposure misclassification, despite efforts to minimize their impact on conclusions.

Conclusions

In this study we observed little evidence that the Norwegian nationwide FFV policy had any notable beneficial effect or unintended consequence on weight status among Norwegian children and adolescents.

Covid-19 news: Joint flu and covid-19 vaccine could be offered in 2023

New Scientist - Ma, 18/01/2022 - 13:35
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

AI learns to create images from text descriptions by destroying data

New Scientist - Ma, 18/01/2022 - 13:00
A fresh approach to generating images based on text descriptions with AI, called a diffusion model, effectively un-destroys new images into existence

Ancient Mars may have had a liquid ocean despite freezing temperatures

New Scientist - Lu, 17/01/2022 - 21:00
A model based on Earth’s oceans and atmosphere explains how Mars could have been cold and wet 3 billion years ago

Unknown voices spark more brain activity in sleep than familiar ones

New Scientist - Lu, 17/01/2022 - 19:00
Unfamiliar voices seem to put the sleeping brain on alert in a way that familiar voices don’t

Ozone pollution causes $63 billion damage per year to East Asian crops

New Scientist - Lu, 17/01/2022 - 17:00
Rising levels of ground-level ozone in China and nearby countries are having a big effect on the yields of staple crops such as wheat, rice and maize

Edible straws made by bacteria are better than paper or plastic ones

New Scientist - Lu, 17/01/2022 - 13:33
Plastic straws are increasingly being avoided for both health and environmental reasons, but the alternatives all have their downsides – until now

Covid-19 news: Falling cases in UK suggests omicron wave has peaked

New Scientist - Lu, 17/01/2022 - 13:15
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

Volcano eruption in Tonga was a once-in-a-millennium event

New Scientist - Lu, 17/01/2022 - 12:01
The underwater Hunga Tonga-Hunga Ha'apai eruption has already triggered a tsunami, a sonic boom and thousands of lightning bolts, and could now lead to acid rain

[Editorial] Theranos and the scientific community: at the bleeding edge

The Lancet - Sa, 15/01/2022 - 00:00
The Theranos story is reaching its conclusion. Elizabeth Holmes, the company's founder and former CEO, once the world's youngest self-made female billionaire, was last week found guilty of four of 11 charges of fraud related to her actions at the now defunct blood testing company. COO Ramesh Balwani will face similar charges in a trial later this year. The sensational rise and fall of Theranos has spawned books, documentaries, and podcasts. Yet, for all the attention, questions remain: where was the scientific community in exposing the absence of evidence backing the claims of Theranos? Why did it take the Wall Street Journal to uncover the scandal, and not the supposedly self-correcting culture of science?

[Comment] Offline: The incontestable moral value of health

The Lancet - Sa, 15/01/2022 - 00:00
In March, 2020, chief science advisers from 12 countries, including the US, the UK, and Germany, issued a call to scholarly publishers “to voluntarily agree to make their COVID-19 and coronavirus-related publications, and the available data supporting them, immediately accessible in PubMed Central and other appropriate public repositories.” That same month, over 30 publishers, including The Lancet, signed up to this request. The call reflected the urgency of the pandemic and “the associated global health crisis.” We have made all of our coronavirus-related content freely available through a COVID-19 Resource Centre.

[World Report] Holmes verdicts prompt questions over justice for patients

The Lancet - Sa, 15/01/2022 - 00:00
The founder of Theranos was found guilty of defrauding some investors, but cleared of charges that she misled patients. Susan Jaffe reports.

[World Report] Disrupted care in Papua New Guinea: the harms of COVID-19

The Lancet - Sa, 15/01/2022 - 00:00
The COVID-19 pandemic in Papua New Guinea shows no sign of ending, and its worst legacy might be its effect on other diseases, such as tuberculosis, HIV/AIDS, and malaria. Chris McCall reports.

[Perspectives] From herbs and humours to anatomy

The Lancet - Sa, 15/01/2022 - 00:00
What if you had a second chance? If you could throw off suffocating circumstances, rewrite your narrative, and pursue your drive towards modern advances in understanding? In Ophelia Swam: An Oxford Novel, this chance unfolds for a young woman in mid-16th-century England, drawn towards the huge transformations taking place in medicine. This delicate exploration of trauma, grief, and friendship, deftly navigates the changes in thought and practice in this fascinating period of the history of medicine.
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