Pub Date : 2024-11-01DOI: 10.1016/s2214-109x(24)00368-1
Kapila Jayaratne,Dulani Samaranayake
{"title":"Maternal near misses: need for solid metrics and estimates.","authors":"Kapila Jayaratne,Dulani Samaranayake","doi":"10.1016/s2214-109x(24)00368-1","DOIUrl":"https://doi.org/10.1016/s2214-109x(24)00368-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"12 1","pages":"e1738-e1739"},"PeriodicalIF":34.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/s2214-109x(24)00280-8
Gyaviira Nkurunungi,Jacent Nassuuna,Agnes Natukunda,Ludoviko Zirimenya,Bridgious Walusimbi,Christopher Zziwa,Caroline Ninsiima,Joyce Kabagenyi,Prossy N Kabuubi,Govert J van Dam,Paul L A M Corstjens,John Kayiwa,Moses Kizza,Alex Mutebe,Esther Nakazibwe,Florence A Akello,Moses Sewankambo,Samuel Kiwanuka,Stephen Cose,Anne Wajja,Pontiano Kaleebu,Emily L Webb,Alison M Elliott,
BACKGROUNDVaccine responses differ between populations and are often impaired in rural and low-income settings. The reasons for this are not fully understood, but observational data suggest that the immunomodulating effects of parasitic helminths might contribute. We hypothesised that Schistosoma mansoni infection suppresses responses to unrelated vaccines, and that suppression could be reversed-at least in part-by intensive praziquantel administration.METHODSWe conducted an open-label, randomised controlled trial of intensive versus standard intervention against S mansoni among schoolchildren aged 9-17 years from eight primary schools in Koome islands, Uganda. Children were randomly allocated to either an intensive group or a standard group with a computer-generated 1:1 randomisation using permuted blocks sizes 4, 6, 8, and 10. Participants in the intensive group received three praziquantel doses (approximately 40 mg/kg) 2 weeks apart before first vaccination at week 0, and every 3 months thereafter. Participants in the standard group were given one dose of approximately 40 mg/kg praziquantel after the week 8 primary endpoint. Participants in both groups received the BCG vaccine (Serum Institute of India, Pune, India) at week 0; the yellow fever (Sanofi Pasteur, Lyon, France), oral typhoid (PaxVax, London, UK), and first human papillomavirus (HPV) vaccination (Merck, Rahway, NJ, USA) at week 4; and the HPV booster and tetanus-diphtheria vaccine (Serum Institute of India) at week 28. The primary outcome was vaccine response at week 8 (except for tetanus and diphtheria, which was assessed at week 52). The primary analysis population was participants who were infected with S mansoni at baseline, determined retrospectively using either plasma circulating anodic antigen (CAA) or stool PCR. The safety population comprised all randomly allocated participants. The trial was registered at the ISRCTN Registry (ISRCTN60517191) and is complete.FINDINGSBetween July 9 and Aug 14, 2019, we enrolled 478 participants, with 239 children per group. 276 (58%) participants were male and 202 (42%) participants were female. Among participants who were positive for S mansoni at baseline (171 [72%] in the intensive group and 164 [69%] in the standard group) intensive praziquantel administration significantly reduced pre-vaccination infection intensity (to median 30 CAA pg/mL [IQR 7-223] vs 1317 [243-8562], p<0·001) compared with standard treatment. Intensive praziquantel administration also reduced week 8 HPV-16-specific IgG response (geometric mean ratio 0·71 [95% CI 0·54-0·94], p=0·017), but had no effect on other primary outcomes. Among all participants (regardless of S mansoni status at baseline) intensive praziquantel administration significantly improved week 8 BCG-specific IFNγ ELISpot response (1·20 [1·01-1·43], p=0·038). Recognised adverse effects of praziquantel were reported more frequently in the intensive group. There were no recorded serious adverse events
背景不同人群对疫苗的反应各不相同，在农村和低收入环境中，疫苗反应往往会受到影响。造成这种情况的原因尚不完全清楚，但观察数据表明，寄生蠕虫的免疫调节作用可能是原因之一。我们假设曼氏血吸虫感染会抑制对非相关疫苗的反应，而这种抑制可通过强化吡喹酮治疗得到逆转--至少是部分逆转。方法 我们在乌干达科奥米群岛 8 所小学的 9-17 岁学童中开展了一项开放标签、随机对照试验，对曼氏血吸虫进行强化干预和标准干预。孩子们被随机分配到强化组或标准组，采用计算机生成的 1:1 随机分配法，随机分配的区块大小为 4、6、8 和 10。强化组的参与者在第0周首次接种疫苗前接受三次吡喹酮治疗（约40毫克/千克），每次间隔2周，之后每3个月接种一次。标准组的参与者在第8周的主要终点之后接受一次约40毫克/千克吡喹酮的剂量。两组参与者均在第0周接种卡介苗（印度浦那血清研究所）；第4周接种黄热病疫苗（法国里昂赛诺菲巴斯德）、口服伤寒疫苗（英国伦敦PaxVax）和首次人类乳头瘤病毒（HPV）疫苗（美国新泽西州拉威默克公司）；第28周接种HPV强化疫苗和破伤风-白喉疫苗（印度血清研究所）。主要结果是第 8 周时的疫苗应答（破伤风和白喉除外，第 52 周时进行评估）。主要分析人群为基线感染曼森氏杆菌的参与者，通过血浆循环阳离子抗原 (CAA) 或粪便 PCR 进行回顾性测定。安全人群包括所有随机分配的参与者。该试验已在ISRCTN注册中心注册（ISRCTN60517191），并已完成。研究结果2019年7月9日至8月14日期间，我们共招募了478名参与者，每组239名儿童。276名（58%）参与者为男性，202名（42%）参与者为女性。在基线曼森氏杆菌检测呈阳性的参与者中（强化组171人[72%]，标准组164人[69%]），与标准治疗相比，强化吡喹酮治疗显著降低了接种前的感染强度（中位数为30 CAA pg/mL [IQR 7-223] vs 1317 [243-8562]，P<0-001）。强化吡喹酮治疗也降低了第8周的HPV-16特异性IgG反应（几何平均比为0-71 [95% CI 0-54-0-94]，p=0-017），但对其他主要结果没有影响。在所有参与者中（不考虑基线时的曼氏沙门氏菌状态），强化吡喹酮可显著改善第8周卡介苗特异性IFNγ ELISpot反应（1-20 [1-01-1-43]，p=0-038）。在强化组中，吡喹酮的公认不良反应报告更为频繁。我们发现的证据表明，服用吡喹酮可改善卡介苗特异性细胞应答，但不能改善对其他疫苗的体液应答。尽管有观察证据表明螺旋体会损害疫苗反应，但这些结果显示减少螺旋体负担的直接益处微乎其微。应研究长期螺旋体控制的效果。FUNDINGUK Medical Research Council.TRANSLATION如需摘要的卢干达文译文，请参阅补充材料部分。
{"title":"The effect of intensive praziquantel administration on vaccine-specific responses among schoolchildren in Ugandan schistosomiasis-endemic islands (POPVAC A): an open-label, randomised controlled trial.","authors":"Gyaviira Nkurunungi,Jacent Nassuuna,Agnes Natukunda,Ludoviko Zirimenya,Bridgious Walusimbi,Christopher Zziwa,Caroline Ninsiima,Joyce Kabagenyi,Prossy N Kabuubi,Govert J van Dam,Paul L A M Corstjens,John Kayiwa,Moses Kizza,Alex Mutebe,Esther Nakazibwe,Florence A Akello,Moses Sewankambo,Samuel Kiwanuka,Stephen Cose,Anne Wajja,Pontiano Kaleebu,Emily L Webb,Alison M Elliott,","doi":"10.1016/s2214-109x(24)00280-8","DOIUrl":"https://doi.org/10.1016/s2214-109x(24)00280-8","url":null,"abstract":"BACKGROUNDVaccine responses differ between populations and are often impaired in rural and low-income settings. The reasons for this are not fully understood, but observational data suggest that the immunomodulating effects of parasitic helminths might contribute. We hypothesised that Schistosoma mansoni infection suppresses responses to unrelated vaccines, and that suppression could be reversed-at least in part-by intensive praziquantel administration.METHODSWe conducted an open-label, randomised controlled trial of intensive versus standard intervention against S mansoni among schoolchildren aged 9-17 years from eight primary schools in Koome islands, Uganda. Children were randomly allocated to either an intensive group or a standard group with a computer-generated 1:1 randomisation using permuted blocks sizes 4, 6, 8, and 10. Participants in the intensive group received three praziquantel doses (approximately 40 mg/kg) 2 weeks apart before first vaccination at week 0, and every 3 months thereafter. Participants in the standard group were given one dose of approximately 40 mg/kg praziquantel after the week 8 primary endpoint. Participants in both groups received the BCG vaccine (Serum Institute of India, Pune, India) at week 0; the yellow fever (Sanofi Pasteur, Lyon, France), oral typhoid (PaxVax, London, UK), and first human papillomavirus (HPV) vaccination (Merck, Rahway, NJ, USA) at week 4; and the HPV booster and tetanus-diphtheria vaccine (Serum Institute of India) at week 28. The primary outcome was vaccine response at week 8 (except for tetanus and diphtheria, which was assessed at week 52). The primary analysis population was participants who were infected with S mansoni at baseline, determined retrospectively using either plasma circulating anodic antigen (CAA) or stool PCR. The safety population comprised all randomly allocated participants. The trial was registered at the ISRCTN Registry (ISRCTN60517191) and is complete.FINDINGSBetween July 9 and Aug 14, 2019, we enrolled 478 participants, with 239 children per group. 276 (58%) participants were male and 202 (42%) participants were female. Among participants who were positive for S mansoni at baseline (171 [72%] in the intensive group and 164 [69%] in the standard group) intensive praziquantel administration significantly reduced pre-vaccination infection intensity (to median 30 CAA pg/mL [IQR 7-223] vs 1317 [243-8562], p<0·001) compared with standard treatment. Intensive praziquantel administration also reduced week 8 HPV-16-specific IgG response (geometric mean ratio 0·71 [95% CI 0·54-0·94], p=0·017), but had no effect on other primary outcomes. Among all participants (regardless of S mansoni status at baseline) intensive praziquantel administration significantly improved week 8 BCG-specific IFNγ ELISpot response (1·20 [1·01-1·43], p=0·038). Recognised adverse effects of praziquantel were reported more frequently in the intensive group. There were no recorded serious adverse events","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"103 1","pages":"e1826-e1837"},"PeriodicalIF":34.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDTo meet the WHO target of eradicating yaws by 2030, highly sensitive and specific diagnostic tools are needed. A multiplex Treponema pallidum-Haemophilus ducreyi loop-mediated isothermal amplification (TPHD-LAMP) test holds promise as a near-patient diagnostic tool for yaws and H ducreyi. We conducted a prospective evaluation in Cameroon, Côte d'Ivoire, Ghana, and the Republic of the Congo to determine the diagnostic accuracy of the TPHD-LAMP test, as well as to assess its acceptability, feasibility, and cost.METHODSActive case searching within schools and communities was used to locate participants with clinically suspicious laws-like lesions. Individuals with serologically confirmed active yaws provided paired lesion swabs between March, 2021, and April, 2023. For each participant, one swab was tested with the TPHD-LAMP at a local district laboratory and the other with reference quantitative PCR (qPCR) tests conducted at national reference laboratories. The primary outcome was TPHD-LAMP test sensitivity and specificity compared with qPCR. Laboratory technicians were interviewed using a multiple-choice survey to gauge acceptability and feasibility of the TPHD-LAMP test. Costs of each test were calculated.FINDINGSOf 3085 individuals with at least one suspected yaws lesion, 531 (17%) were serologically confirmed. We enrolled 493 participants with seropositive yaws and a further 32 with negative serology. The sensitivity of the TPHD-LAMP test for detecting T pallidum was 63% (95% CI 56-70) and the specificity was 66% (95% CI 61-71). Sensitivity and specificity for T pallidum improved to 73% (63-82; p=0·0065) and 75% (68-80; p=0·0003), respectively, in H ducreyi-negative samples. Interviews highlighted challenges in user-friendliness and practicality of the TPHD-LAMP test. The cost of the test per sample was one third of that of qPCR, although the TPHD-LAMP test entailed higher costs to establish the assay.INTERPRETATIONThis was the first multi-country diagnostic evaluation of a molecular test for yaws. The TPHD-LAMP testing, in its current form, falls short of the WHO target product profile criteria for yaws diagnostics. These findings highlight the importance of assessing new diagnostics in real-world conditions to ensure their suitability for programmatic use.FUNDINGThe EDCTP2 programme supported by the EU.
{"title":"A loop-mediated isothermal amplification test for yaws: a multi-country diagnostic accuracy evaluation.","authors":"Becca L Handley,Camila González-Beiras,Serges Tchatchouang,Kouadio Aboh Hugues,Laud Antony Basing,Aboubacar Sylla,Mireille S Kouamé-Sina,Ivy Amanor,Philippe Ndzomo,Axel Aloumba,Mohammed Bakheit,Claudia Müller,Nadine Borst,Emelie Landmann,Helena Gmoser,Tamara Härpfer,Lisa Becherer,Simone Lüert,Sieghard Frischmann,Sarah Burl,Earnest Njih Tabah,Tania Crucitti,Adingra Tano Kouadio,Daniel Kojo Arhinful,Patrick Awondo,Solange Ngazoa Kakou,Sara Eyangoh,Kennedy Kwasi Addo,Sascha Knauf,Oriol Mitjà,Emma Michèle Harding-Esch,Michael Marks","doi":"10.1016/s2214-109x(24)00324-3","DOIUrl":"https://doi.org/10.1016/s2214-109x(24)00324-3","url":null,"abstract":"BACKGROUNDTo meet the WHO target of eradicating yaws by 2030, highly sensitive and specific diagnostic tools are needed. A multiplex Treponema pallidum-Haemophilus ducreyi loop-mediated isothermal amplification (TPHD-LAMP) test holds promise as a near-patient diagnostic tool for yaws and H ducreyi. We conducted a prospective evaluation in Cameroon, Côte d'Ivoire, Ghana, and the Republic of the Congo to determine the diagnostic accuracy of the TPHD-LAMP test, as well as to assess its acceptability, feasibility, and cost.METHODSActive case searching within schools and communities was used to locate participants with clinically suspicious laws-like lesions. Individuals with serologically confirmed active yaws provided paired lesion swabs between March, 2021, and April, 2023. For each participant, one swab was tested with the TPHD-LAMP at a local district laboratory and the other with reference quantitative PCR (qPCR) tests conducted at national reference laboratories. The primary outcome was TPHD-LAMP test sensitivity and specificity compared with qPCR. Laboratory technicians were interviewed using a multiple-choice survey to gauge acceptability and feasibility of the TPHD-LAMP test. Costs of each test were calculated.FINDINGSOf 3085 individuals with at least one suspected yaws lesion, 531 (17%) were serologically confirmed. We enrolled 493 participants with seropositive yaws and a further 32 with negative serology. The sensitivity of the TPHD-LAMP test for detecting T pallidum was 63% (95% CI 56-70) and the specificity was 66% (95% CI 61-71). Sensitivity and specificity for T pallidum improved to 73% (63-82; p=0·0065) and 75% (68-80; p=0·0003), respectively, in H ducreyi-negative samples. Interviews highlighted challenges in user-friendliness and practicality of the TPHD-LAMP test. The cost of the test per sample was one third of that of qPCR, although the TPHD-LAMP test entailed higher costs to establish the assay.INTERPRETATIONThis was the first multi-country diagnostic evaluation of a molecular test for yaws. The TPHD-LAMP testing, in its current form, falls short of the WHO target product profile criteria for yaws diagnostics. These findings highlight the importance of assessing new diagnostics in real-world conditions to ensure their suitability for programmatic use.FUNDINGThe EDCTP2 programme supported by the EU.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"6 1","pages":"e1891-e1898"},"PeriodicalIF":34.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-27DOI: 10.1016/S2214-109X(24)00337-1
Amanda Alderton
{"title":"Accelerating the evidence for built environment health interventions.","authors":"Amanda Alderton","doi":"10.1016/S2214-109X(24)00337-1","DOIUrl":"10.1016/S2214-109X(24)00337-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1742-e1743"},"PeriodicalIF":19.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-16DOI: 10.1016/S2214-109X(24)00360-7
Alain Braillon, Adam Edward Lang
{"title":"Optimism in the tobacco endgame.","authors":"Alain Braillon, Adam Edward Lang","doi":"10.1016/S2214-109X(24)00360-7","DOIUrl":"10.1016/S2214-109X(24)00360-7","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1761"},"PeriodicalIF":19.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/s2214-109x(24)00426-1
{"title":"Correction to Lancet Glob Health 2024; 12: e1794-806.","authors":"","doi":"10.1016/s2214-109x(24)00426-1","DOIUrl":"https://doi.org/10.1016/s2214-109x(24)00426-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"26 1","pages":"e1763"},"PeriodicalIF":34.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-07-17DOI: 10.1016/S2214-109X(24)00290-0
Melanie Marti, Kristine Macartney, Rebecca F Grais, Rakesh Aggarwal
{"title":"Hepatitis E vaccination: continued benefit for pregnant women in vulnerable settings.","authors":"Melanie Marti, Kristine Macartney, Rebecca F Grais, Rakesh Aggarwal","doi":"10.1016/S2214-109X(24)00290-0","DOIUrl":"10.1016/S2214-109X(24)00290-0","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1758"},"PeriodicalIF":19.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-25DOI: 10.1016/S2214-109X(24)00365-6
Arthur W D Edridge, Michael Boele van Hensbroek
{"title":"The cause of nodding syndrome remains unknown.","authors":"Arthur W D Edridge, Michael Boele van Hensbroek","doi":"10.1016/S2214-109X(24)00365-6","DOIUrl":"10.1016/S2214-109X(24)00365-6","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1756"},"PeriodicalIF":19.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-27DOI: 10.1016/S2214-109X(24)00287-0
Daniel J Corsi, Simone Marschner, Scott Lear, Perry Hystad, Annika Rosengren, Rosnah Ismail, Karen Yeates, Sumathi Swaminathan, Thandi Puoane, Chuangshi Wang, Yang Li, Sumathy Rangarajan, Iolanthé M Kruger, Jephat Chifamba, K Vidhu Kumar, Indu Mohan, Kairat Davletov, Galina Artamonov, Lia M Palileo-Villanueva, Nafiza Mat-Nasir, Katarzyna Zatonska, Aytekin Oguz, Ahmad Bahonar, Khalid F Alhabib, Afzalhussein Yusufali, Patricio Lopez-Jaramillo, Fernando Lanas, Agustina Galatte, Álvaro Avezum, Martin Mckee, Salim Yusuf, Clara K Chow
<p><strong>Background: </strong>The built environment can influence human health, but the available evidence is modest and almost entirely from urban communities in high-income countries. Here we aimed to analyse built environment characteristics and their associations with obesity in urban and rural communities in 21 countries at different development levels participating in the Prospective Urban and Rural Epidemiology (PURE) Study.</p><p><strong>Methods: </strong>Photographs were acquired with a standardised approach. We used the previously validated Environmental Profile of a Community's Health photo instrument to evaluate photos for safety, walkability, neighbourhood beautification, and community disorder. An integrated built environment score (ie, a minimum of 0 and a maximum of 20) was used to summarise this evaluation across built environment domains. Associations between built environment characteristics, separately and combined in the integrated built environment score, and obesity (ie, a BMI >30kg/m<sup>2</sup>) were assessed using multilevel regression models, adjusting for individual, household, and community confounding factors. Attenuation in the associations due to walking was examined.</p><p><strong>Findings: </strong>Analyses include 143 338 participants from 530 communities. The mean integrated built environment score was higher in high-income countries (13·3, SD 2·8) compared with other regions (10·1, 2·5) and urban communities (11·2, 3·0). More than 60% of high-income country communities had pedestrian safety features (eg, crosswalks, sidewalks, and traffic signals). Urban communities outside high-income countries had higher rates of sidewalks (176 [84%] of 209) than rural communities (59 [28%] of 209). 15 (5%) of 290 urban communities had bike lanes. Litter and graffiti were present in 372 (70%) of 530 communities, and poorly maintained buildings were present in 103 (19%) of 530. The integrated built environment score was significantly associated with reduced obesity overall (relative risk [RR] 0·58, 95% CI 0·35-0·93; p=0·025) for high compared with low scores and for increasing trend (0·85, 0·78-0·91; p<0·0001). The trends were statistically significant in urban (0·85, 0·77-0·93; p=0·0007) and rural (0·87, 0·78-0·97; p=0·015) communities. Some built environment features were associated with a lower prevalence of obesity: community beautification RR 0·75 (95% CI 0·61-0·92; p=0·0066); bike lanes RR 0·58 (0·45-0·73; p<0·0001); pedestrian safety RR 0·75 (0·62-0·90; p=0·0018); and traffic signals RR 0·68 (0·52-0·89; p=0·0055). Community disorder was associated with a higher prevalence of obesity (RR 1·48, 95% CI 1·17-1·86; p=0·0010).</p><p><strong>Interpretation: </strong>Community built environment features recorded in photographs, including bike lanes, pedestrian safety measures, beautification, traffic density, and disorder, were related to obesity after adjusting for confounders, and stronger associations were found in urban
{"title":"Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study.","authors":"Daniel J Corsi, Simone Marschner, Scott Lear, Perry Hystad, Annika Rosengren, Rosnah Ismail, Karen Yeates, Sumathi Swaminathan, Thandi Puoane, Chuangshi Wang, Yang Li, Sumathy Rangarajan, Iolanthé M Kruger, Jephat Chifamba, K Vidhu Kumar, Indu Mohan, Kairat Davletov, Galina Artamonov, Lia M Palileo-Villanueva, Nafiza Mat-Nasir, Katarzyna Zatonska, Aytekin Oguz, Ahmad Bahonar, Khalid F Alhabib, Afzalhussein Yusufali, Patricio Lopez-Jaramillo, Fernando Lanas, Agustina Galatte, Álvaro Avezum, Martin Mckee, Salim Yusuf, Clara K Chow","doi":"10.1016/S2214-109X(24)00287-0","DOIUrl":"10.1016/S2214-109X(24)00287-0","url":null,"abstract":"<p><strong>Background: </strong>The built environment can influence human health, but the available evidence is modest and almost entirely from urban communities in high-income countries. Here we aimed to analyse built environment characteristics and their associations with obesity in urban and rural communities in 21 countries at different development levels participating in the Prospective Urban and Rural Epidemiology (PURE) Study.</p><p><strong>Methods: </strong>Photographs were acquired with a standardised approach. We used the previously validated Environmental Profile of a Community's Health photo instrument to evaluate photos for safety, walkability, neighbourhood beautification, and community disorder. An integrated built environment score (ie, a minimum of 0 and a maximum of 20) was used to summarise this evaluation across built environment domains. Associations between built environment characteristics, separately and combined in the integrated built environment score, and obesity (ie, a BMI >30kg/m<sup>2</sup>) were assessed using multilevel regression models, adjusting for individual, household, and community confounding factors. Attenuation in the associations due to walking was examined.</p><p><strong>Findings: </strong>Analyses include 143 338 participants from 530 communities. The mean integrated built environment score was higher in high-income countries (13·3, SD 2·8) compared with other regions (10·1, 2·5) and urban communities (11·2, 3·0). More than 60% of high-income country communities had pedestrian safety features (eg, crosswalks, sidewalks, and traffic signals). Urban communities outside high-income countries had higher rates of sidewalks (176 [84%] of 209) than rural communities (59 [28%] of 209). 15 (5%) of 290 urban communities had bike lanes. Litter and graffiti were present in 372 (70%) of 530 communities, and poorly maintained buildings were present in 103 (19%) of 530. The integrated built environment score was significantly associated with reduced obesity overall (relative risk [RR] 0·58, 95% CI 0·35-0·93; p=0·025) for high compared with low scores and for increasing trend (0·85, 0·78-0·91; p<0·0001). The trends were statistically significant in urban (0·85, 0·77-0·93; p=0·0007) and rural (0·87, 0·78-0·97; p=0·015) communities. Some built environment features were associated with a lower prevalence of obesity: community beautification RR 0·75 (95% CI 0·61-0·92; p=0·0066); bike lanes RR 0·58 (0·45-0·73; p<0·0001); pedestrian safety RR 0·75 (0·62-0·90; p=0·0018); and traffic signals RR 0·68 (0·52-0·89; p=0·0055). Community disorder was associated with a higher prevalence of obesity (RR 1·48, 95% CI 1·17-1·86; p=0·0010).</p><p><strong>Interpretation: </strong>Community built environment features recorded in photographs, including bike lanes, pedestrian safety measures, beautification, traffic density, and disorder, were related to obesity after adjusting for confounders, and stronger associations were found in urban ","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1794-e1806"},"PeriodicalIF":19.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/s2214-109x(24)00294-8
Tolulope Kehinde,Jesse Biwott,Gregory Sund,J Matthew Kynes
As the global burden of disease shifts from communicable to non-communicable diseases and trauma-related debility, the global health-care community has increasingly advocated for equitable access to surgical services. Much of this attention has focused on bolstering clinical and research expertise through the expansion of clinical training programmes and research resources. However, despite the crucial role of equipment, including medical devices, in safe clinical care, comparatively little attention has been paid to sustainably bridging the biomedical and technical gaps that exist in global health. Although closing these gaps with locally driven solutions is the goal, the reality in many settings is that partnerships between institutions in high-income countries and low-income and middle-income countries currently remain necessary. Thus, this Viewpoint provides guidelines conscious to biomedical engineering for institutions looking to expand or begin global health initiatives with the Partners In Health Five S's-staff, stuff, space, systems, and social support-framework for health systems strengthening as a guide. We focus first on initiatives involving staff, stuff, and space, encouraging institutions to ask, listen, and enable, through a set of questions and actionable recommendations. Then, we urge institutions to strengthen systems and social support, underscoring the need for wider societal scaffolding to support and sustain initiatives beyond initial efforts.
随着全球疾病负担从传染性疾病转向非传染性疾病和与创伤有关的衰弱，全球医疗保健界越来越多地倡导公平获得外科服务。这些关注主要集中在通过扩大临床培训计划和研究资源来加强临床和研究方面的专业知识。然而，尽管包括医疗器械在内的设备在安全的临床护理中发挥着至关重要的作用，但人们对可持续地弥合全球卫生领域存在的生物医学和技术差距的关注却相对较少。尽管缩小这些差距的目标是采用本地驱动的解决方案，但在许多情况下，高收入国家的机构与低收入和中等收入国家的机构之间目前仍然需要建立合作伙伴关系。因此，本视点以 "健康伙伴"（Partners In Health）的 "五S"（人员、物资、空间、系统和社会支持）框架为指导，为希望扩大或开始全球健康计划的机构提供生物医学工程方面的指导。我们首先关注涉及人员、物资和空间的倡议，通过一系列问题和可操作的建议，鼓励机构询问、倾听和支持。然后，我们敦促各机构加强系统和社会支持，强调需要更广泛的社会支架来支持和维持超越最初努力的举措。
{"title":"Machines matter too: including biomedical engineering partnerships in global health initiatives.","authors":"Tolulope Kehinde,Jesse Biwott,Gregory Sund,J Matthew Kynes","doi":"10.1016/s2214-109x(24)00294-8","DOIUrl":"https://doi.org/10.1016/s2214-109x(24)00294-8","url":null,"abstract":"As the global burden of disease shifts from communicable to non-communicable diseases and trauma-related debility, the global health-care community has increasingly advocated for equitable access to surgical services. Much of this attention has focused on bolstering clinical and research expertise through the expansion of clinical training programmes and research resources. However, despite the crucial role of equipment, including medical devices, in safe clinical care, comparatively little attention has been paid to sustainably bridging the biomedical and technical gaps that exist in global health. Although closing these gaps with locally driven solutions is the goal, the reality in many settings is that partnerships between institutions in high-income countries and low-income and middle-income countries currently remain necessary. Thus, this Viewpoint provides guidelines conscious to biomedical engineering for institutions looking to expand or begin global health initiatives with the Partners In Health Five S's-staff, stuff, space, systems, and social support-framework for health systems strengthening as a guide. We focus first on initiatives involving staff, stuff, and space, encouraging institutions to ask, listen, and enable, through a set of questions and actionable recommendations. Then, we urge institutions to strengthen systems and social support, underscoring the need for wider societal scaffolding to support and sustain initiatives beyond initial efforts.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"64 1","pages":"e1905-e1909"},"PeriodicalIF":34.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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