Riviste scientifiche

[Perspectives] Betty Kirkwood: trailblazer in global health epidemiology

The Lancet - Me, 13/09/2017 - 19:00
After 38 years at the London School of Hygiene & Tropical Medicine (LSHTM), Betty Kirkwood is still in love with her academic home. “It's the mission—shared by everyone from cleaners to refectory staff to academic staff—to improve health worldwide that brings a unique atmosphere to the school”, she says. Kirkwood is head of LSHTM's Maternal and Child Health Intervention Research Group, and has been Professor of Epidemiology and International Health at LSHTM since 1995.

[Perspectives] Ann Ashworth: pioneer in child nutrition

The Lancet - Me, 13/09/2017 - 19:00
Ann Ashworth may have retired in 2005, but is still closely involved with work in the sphere in which she has made such a contribution over the past half century. She currently co-convenes an international malnutrition taskforce, which aims to build capacity to prevent and treat malnutrition and to highlight malnutrition as a major cause of child death. “Sub-Saharan Africa remains a major problem, but awareness has increased since the launch of the taskforce”, she says.

Mysterious lights in the sky seen after Mexico’s huge earthquake

New Scientist - Me, 13/09/2017 - 18:40
Magnitude isn’t the only demonstration of an earthquake’s power. For centuries, mysterious lights have popped up in the wake of strong quakes

Cassini to live-stream its final moments in Saturn’s atmosphere

New Scientist - Me, 13/09/2017 - 15:02
Before the Cassini spacecraft ends its 20-year mission by disintegrating in Saturn’s atmosphere, we have one last chance for new information on the gas giant

It’s a disgrace there are no women on UK’s key science committee

New Scientist - Me, 13/09/2017 - 14:40
When the main science committee in the UK parliament turned out to be devoid of women MPs, a backlash was inevitable, says Lara Williams

The hottest place ever recorded on Earth’s surface was 2370°C

New Scientist - Me, 13/09/2017 - 14:30
When a rock from space crashed to ground 38 million years ago, it briefly heated the impact zone to 2370°C, the hottest temperature ever recorded on Earth’s crust

Why the iPhone X’s Face ID is a terrible way to secure your data

New Scientist - Me, 13/09/2017 - 13:05
Apple’s latest phone promises to unlock on seeing your face, and police forces are deploying similar tech to catch criminals – but problems dog the technology

These are the three biggest obstacles for a Brexit science deal

New Scientist - Me, 13/09/2017 - 13:01
The government says it wants to preserve EU science ties in a Brexit settlement but fails to acknowledge the major stumbling blocks ahead, says Mike Galsworthy

[Global Health Metrics] Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

The Lancet - Me, 13/09/2017 - 01:01
GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000.

Sustained effectiveness and cost-effectiveness of Counselling for Alcohol Problems, a brief psychological treatment for harmful drinking in men, delivered by lay counsellors in primary care: 12-month follow-up of a randomised controlled trial

PLoS Medicine - Ma, 12/09/2017 - 23:00

by Abhijit Nadkarni, Helen A. Weiss, Benedict Weobong, David McDaid, Daisy R. Singla, A-La Park, Bhargav Bhat, Basavaraj Katti, Jim McCambridge, Pratima Murthy, Michael King, G. Terence Wilson, Betty Kirkwood, Christopher G. Fairburn, Richard Velleman, Vikram Patel

Background

Counselling for Alcohol Problems (CAP), a brief intervention delivered by lay counsellors, enhanced remission and abstinence over 3 months among male primary care attendees with harmful drinking in a setting in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of CAP over 12 months, and the effects of the hypothesized mediator ‘readiness to change’ on clinical outcomes.

Methods and findings

Male primary care attendees aged 18–65 years screening with harmful drinking on the Alcohol Use Disorders Identification Test (AUDIT) were randomised to either CAP plus enhanced usual care (EUC) (n = 188) or EUC alone (n = 189), of whom 89% completed assessments at 3 months, and 84% at 12 months. Primary outcomes were remission and mean standard ethanol consumed in the past 14 days, and the proposed mediating variable was readiness to change at 3 months. CAP participants maintained the gains they showed at the end of treatment through the 12-month follow-up, with the proportion with remission (AUDIT score < 8: 54.3% versus 31.9%; adjusted prevalence ratio [aPR] 1.71 [95% CI 1.32, 2.22]; p < 0.001) and abstinence in the past 14 days (45.1% versus 26.4%; adjusted odds ratio 1.92 [95% CI 1.19, 3.10]; p = 0.008) being significantly higher in the CAP plus EUC arm than in the EUC alone arm. CAP participants also fared better on secondary outcomes including recovery (AUDIT score < 8 at 3 and 12 months: 27.4% versus 15.1%; aPR 1.90 [95% CI 1.21, 3.00]; p = 0.006) and percent of days abstinent (mean percent [SD] 71.0% [38.2] versus 55.0% [39.8]; adjusted mean difference 16.1 [95% CI 7.1, 25.0]; p = 0.001). The intervention effect for remission was higher at 12 months than at 3 months (aPR 1.50 [95% CI 1.09, 2.07]). There was no evidence of an intervention effect on Patient Health Questionnaire 9 score, suicidal behaviour, percentage of days of heavy drinking, Short Inventory of Problems score, WHO Disability Assessment Schedule 2.0 score, days unable to work, or perpetration of intimate partner violence. Economic analyses indicated that CAP plus EUC was dominant over EUC alone, with lower costs and better outcomes; uncertainty analysis showed a 99% chance of CAP being cost-effective per remission achieved from a health system perspective, using a willingness to pay threshold equivalent to 1 month’s wages for an unskilled manual worker in Goa. Readiness to change level at 3 months mediated the effect of CAP on mean standard ethanol consumption at 12 months (indirect effect −6.014 [95% CI −13.99, −0.046]). Serious adverse events were infrequent, and prevalence was similar by arm. The methodological limitations of this trial are the susceptibility of self-reported drinking to social desirability bias, the modest participation rates of eligible patients, and the examination of mediation effects of only 1 mediator and in only half of our sample.

Conclusions

CAP’s superiority over EUC at the end of treatment was largely stable over time and was mediated by readiness to change. CAP provides better outcomes at lower costs from a societal perspective.

Trial registration

ISRCTN registry ISRCTN76465238

Sustained effectiveness and cost-effectiveness of the Healthy Activity Programme, a brief psychological treatment for depression delivered by lay counsellors in primary care: 12-month follow-up of a randomised controlled trial

PLoS Medicine - Ma, 12/09/2017 - 23:00

by Benedict Weobong, Helen A. Weiss, David McDaid, Daisy R. Singla, Steven D. Hollon, Abhijit Nadkarni, A-La Park, Bhargav Bhat, Basavraj Katti, Arpita Anand, Sona Dimidjian, Ricardo Araya, Michael King, Lakshmi Vijayakumar, G. Terence Wilson, Richard Velleman, Betty R. Kirkwood, Christopher G. Fairburn, Vikram Patel

Background

The Healthy Activity Programme (HAP), a brief behavioural intervention delivered by lay counsellors, enhanced remission over 3 months among primary care attendees with depression in peri-urban and rural settings in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of HAP over 12 months, and the effects of the hypothesized mediator of activation on clinical outcomes.

Methods and findings

Primary care attendees aged 18–65 years screened with moderately severe to severe depression on the Patient Health Questionnaire 9 (PHQ-9) were randomised to either HAP plus enhanced usual care (EUC) (n = 247) or EUC alone (n = 248), of whom 95% completed assessments at 3 months, and 91% at 12 months. Primary outcomes were severity on the Beck Depression Inventory–II (BDI-II) and remission on the PHQ-9. HAP participants maintained the gains they showed at the end of treatment through the 12-month follow-up (difference in mean BDI-II score between 3 and 12 months = −0.34; 95% CI −2.37, 1.69; p = 0.74), with lower symptom severity scores than participants who received EUC alone (adjusted mean difference in BDI-II score = −4.45; 95% CI −7.26, −1.63; p = 0.002) and higher rates of remission (adjusted prevalence ratio [aPR] = 1.36; 95% CI 1.15, 1.61; p < 0.009). They also fared better on most secondary outcomes, including recovery (aPR = 1.98; 95% CI 1.29, 3.03; p = 0.002), any response over time (aPR = 1.45; 95% CI 1.27, 1.66; p < 0.001), higher likelihood of reporting a minimal clinically important difference (aPR = 1.42; 95% CI 1.17, 1.71; p < 0.001), and lower likelihood of reporting suicidal behaviour (aPR = 0.71; 95% CI 0.51, 1.01; p = 0.06). HAP plus EUC also had a marginal effect on WHO Disability Assessment Schedule score at 12 months (aPR = −1.58; 95% CI −3.33, 0.17; p = 0.08); other outcomes (days unable to work, intimate partner violence toward females) did not statistically significantly differ between the two arms. Economic analyses indicated that HAP plus EUC was dominant over EUC alone, with lower costs and better outcomes; uncertainty analysis showed that from this health system perspective there was a 95% chance of HAP being cost-effective, given a willingness to pay threshold of Intl$16,060—equivalent to GDP per capita in Goa—per quality-adjusted life year gained. Patient-reported behavioural activation level at 3 months mediated the effect of the HAP intervention on the 12-month depression score (β = −2.62; 95% CI −3.28, −1.97; p < 0.001). Serious adverse events were infrequent, and prevalence was similar by arm. We were unable to assess possible episodes of remission and relapse that may have occurred between our outcome assessment time points of 3 and 12 months after randomisation. We did not account for or evaluate the effect of mediators other than behavioural activation.

Conclusions

HAP’s superiority over EUC at the end of treatment was largely stable over time and was mediated by patient activation. HAP provides better outcomes at lower costs from a perspective covering publicly funded healthcare services and productivity impacts on patients and their families.

Trial registration

ISRCTN registry ISRCTN95149997

HbA1c for type 2 diabetes diagnosis in Africans and African Americans: Personalized medicine NOW!

PLoS Medicine - Ma, 12/09/2017 - 23:00

by Andrew D. Paterson

Andrew Paterson discusses findings from a new study that shows HbA1c screening for diabetes will leave 2% of African Americans undiagnosed and how personalised medicine is needed.

Impact of common genetic determinants of Hemoglobin A1c on type 2 diabetes risk and diagnosis in ancestrally diverse populations: A transethnic genome-wide meta-analysis

PLoS Medicine - Ma, 12/09/2017 - 23:00

by Eleanor Wheeler, Aaron Leong, Ching-Ti Liu, Marie-France Hivert, Rona J. Strawbridge, Clara Podmore, Man Li, Jie Yao, Xueling Sim, Jaeyoung Hong, Audrey Y. Chu, Weihua Zhang, Xu Wang, Peng Chen, Nisa M. Maruthur, Bianca C. Porneala, Stephen J. Sharp, Yucheng Jia, Edmond K. Kabagambe, Li-Ching Chang, Wei-Min Chen, Cathy E. Elks, Daniel S. Evans, Qiao Fan, Franco Giulianini, Min Jin Go, Jouke-Jan Hottenga, Yao Hu, Anne U. Jackson, Stavroula Kanoni, Young Jin Kim, Marcus E. Kleber, Claes Ladenvall, Cecile Lecoeur, Sing-Hui Lim, Yingchang Lu, Anubha Mahajan, Carola Marzi, Mike A. Nalls, Pau Navarro, Ilja M. Nolte, Lynda M. Rose, Denis V. Rybin, Serena Sanna, Yuan Shi, Daniel O. Stram, Fumihiko Takeuchi, Shu Pei Tan, Peter J. van der Most, Jana V. Van Vliet-Ostaptchouk, Andrew Wong, Loic Yengo, Wanting Zhao, Anuj Goel, Maria Teresa Martinez Larrad, Dörte Radke, Perttu Salo, Toshiko Tanaka, Erik P. A. van Iperen, Goncalo Abecasis, Saima Afaq, Behrooz Z. Alizadeh, Alain G. Bertoni, Amelie Bonnefond, Yvonne Böttcher, Erwin P. Bottinger, Harry Campbell, Olga D. Carlson, Chien-Hsiun Chen, Yoon Shin Cho, W. Timothy Garvey, Christian Gieger, Mark O. Goodarzi, Harald Grallert, Anders Hamsten, Catharina A. Hartman, Christian Herder, Chao Agnes Hsiung, Jie Huang, Michiya Igase, Masato Isono, Tomohiro Katsuya, Chiea-Chuen Khor, Wieland Kiess, Katsuhiko Kohara, Peter Kovacs, Juyoung Lee, Wen-Jane Lee, Benjamin Lehne, Huaixing Li, Jianjun Liu, Stephane Lobbens, Jian'an Luan, Valeriya Lyssenko, Thomas Meitinger, Tetsuro Miki, Iva Miljkovic, Sanghoon Moon, Antonella Mulas, Gabriele Müller, Martina Müller-Nurasyid, Ramaiah Nagaraja, Matthias Nauck, James S. Pankow, Ozren Polasek, Inga Prokopenko, Paula S. Ramos, Laura Rasmussen-Torvik, Wolfgang Rathmann, Stephen S. Rich, Neil R. Robertson, Michael Roden, Ronan Roussel, Igor Rudan, Robert A. Scott, William R. Scott, Bengt Sennblad, David S. Siscovick, Konstantin Strauch, Liang Sun, Morris Swertz, Salman M. Tajuddin, Kent D. Taylor, Yik-Ying Teo, Yih Chung Tham, Anke Tönjes, Nicholas J. Wareham, Gonneke Willemsen, Tom Wilsgaard, Aroon D. Hingorani, EPIC-CVD Consortium , EPIC-InterAct Consortium , Lifelines Cohort Study , Josephine Egan, Luigi Ferrucci, G. Kees Hovingh, Antti Jula, Mika Kivimaki, Meena Kumari, Inger Njølstad, Colin N. A. Palmer, Manuel Serrano Ríos, Michael Stumvoll, Hugh Watkins, Tin Aung, Matthias Blüher, Michael Boehnke, Dorret I. Boomsma, Stefan R. Bornstein, John C. Chambers, Daniel I. Chasman, Yii-Der Ida Chen, Yduan-Tsong Chen, Ching-Yu Cheng, Francesco Cucca, Eco J. C. de Geus, Panos Deloukas, Michele K. Evans, Myriam Fornage, Yechiel Friedlander, Philippe Froguel, Leif Groop, Myron D. Gross, Tamara B. Harris, Caroline Hayward, Chew-Kiat Heng, Erik Ingelsson, Norihiro Kato, Bong-Jo Kim, Woon-Puay Koh, Jaspal S. Kooner, Antje Körner, Diana Kuh, Johanna Kuusisto, Markku Laakso, Xu Lin, Yongmei Liu, Ruth J. F. Loos, Patrik K. E. Magnusson, Winfried März, Mark I. McCarthy, Albertine J. Oldehinkel, Ken K. Ong, Nancy L. Pedersen, Mark A. Pereira, Annette Peters, Paul M. Ridker, Charumathi Sabanayagam, Michele Sale, Danish Saleheen, Juha Saltevo, Peter EH. Schwarz, Wayne H. H. Sheu, Harold Snieder, Timothy D. Spector, Yasuharu Tabara, Jaakko Tuomilehto, Rob M. van Dam, James G. Wilson, James F. Wilson, Bruce H. R. Wolffenbuttel, Tien Yin Wong, Jer-Yuarn Wu, Jian-Min Yuan, Alan B. Zonderman, Nicole Soranzo, Xiuqing Guo, David J. Roberts, Jose C. Florez, Robert Sladek, Josée Dupuis, Andrew P. Morris, E-Shyong Tai, Elizabeth Selvin, Jerome I. Rotter, Claudia Langenberg, Inês Barroso, James B. Meigs

Background

Glycated hemoglobin (HbA1c) is used to diagnose type 2 diabetes (T2D) and assess glycemic control in patients with diabetes. Previous genome-wide association studies (GWAS) have identified 18 HbA1c-associated genetic variants. These variants proved to be classifiable by their likely biological action as erythrocytic (also associated with erythrocyte traits) or glycemic (associated with other glucose-related traits). In this study, we tested the hypotheses that, in a very large scale GWAS, we would identify more genetic variants associated with HbA1c and that HbA1c variants implicated in erythrocytic biology would affect the diagnostic accuracy of HbA1c. We therefore expanded the number of HbA1c-associated loci and tested the effect of genetic risk-scores comprised of erythrocytic or glycemic variants on incident diabetes prediction and on prevalent diabetes screening performance. Throughout this multiancestry study, we kept a focus on interancestry differences in HbA1c genetics performance that might influence race-ancestry differences in health outcomes.

Methods & findings

Using genome-wide association meta-analyses in up to 159,940 individuals from 82 cohorts of European, African, East Asian, and South Asian ancestry, we identified 60 common genetic variants associated with HbA1c. We classified variants as implicated in glycemic, erythrocytic, or unclassified biology and tested whether additive genetic scores of erythrocytic variants (GS-E) or glycemic variants (GS-G) were associated with higher T2D incidence in multiethnic longitudinal cohorts (N = 33,241). Nineteen glycemic and 22 erythrocytic variants were associated with HbA1c at genome-wide significance. GS-G was associated with higher T2D risk (incidence OR = 1.05, 95% CI 1.04–1.06, per HbA1c-raising allele, p = 3 × 10−29); whereas GS-E was not (OR = 1.00, 95% CI 0.99–1.01, p = 0.60). In Europeans and Asians, erythrocytic variants in aggregate had only modest effects on the diagnostic accuracy of HbA1c. Yet, in African Americans, the X-linked G6PD G202A variant (T-allele frequency 11%) was associated with an absolute decrease in HbA1c of 0.81%-units (95% CI 0.66–0.96) per allele in hemizygous men, and 0.68%-units (95% CI 0.38–0.97) in homozygous women. The G6PD variant may cause approximately 2% (N = 0.65 million, 95% CI 0.55–0.74) of African American adults with T2D to remain undiagnosed when screened with HbA1c. Limitations include the smaller sample sizes for non-European ancestries and the inability to classify approximately one-third of the variants. Further studies in large multiethnic cohorts with HbA1c, glycemic, and erythrocytic traits are required to better determine the biological action of the unclassified variants.

Conclusions

As G6PD deficiency can be clinically silent until illness strikes, we recommend investigation of the possible benefits of screening for the G6PD genotype along with using HbA1c to diagnose T2D in populations of African ancestry or groups where G6PD deficiency is common. Screening with direct glucose measurements, or genetically-informed HbA1c diagnostic thresholds in people with G6PD deficiency, may be required to avoid missed or delayed diagnoses.

Air pollution changes what bugs colonise our airways

New Scientist - Ma, 12/09/2017 - 18:24
Higher levels of pollutants in the air correlate with reduced diversity of bacteria in our nose, hinting at a possible mechanism for why pollution causes disease

Meet the vampire ant from hell with huge jaws and a metal horn

New Scientist - Ma, 12/09/2017 - 17:00
Linguamyrmex vladi had ferocious snapping jaws and a horn reinforced with metal, which it may have used to puncture prey and drain their blood

Extreme wildfires in the US could lead to long-term lung damage

New Scientist - Ma, 12/09/2017 - 14:30
This year’s exceptional wildfire season could drag on until December, and the resulting air pollution poses a serious risk to people’s health

The Caribbean will be recovering from Hurricane Irma for years

New Scientist - Ma, 12/09/2017 - 13:41
Florida escaped the worst of hurricane Irma, but islands like Puerto Rico and Cuba were hit hard – and they face a hard road back to prosperity

Failed electric buses remind us that roads not taken do matter

New Scientist - Ma, 12/09/2017 - 11:00
Human actions rather than technology undermined London's electric buses 100 years ago, showing there's plenty to be learned by revisiting the past

Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso

PLoS Medicine - Lu, 11/09/2017 - 23:00

by Christian Fabiansen, Charles W. Yaméogo, Ann-Sophie Iuel-Brockdorf, Bernardette Cichon, Maren J. H. Rytter, Anura Kurpad, Jonathan C. Wells, Christian Ritz, Per Ashorn, Suzanne Filteau, André Briend, Susan Shepherd, Vibeke B. Christensen, Kim F. Michaelsen, Henrik Friis

Background

Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplement (LNS) or corn-soy blend (CSB). We assessed the effectiveness of (a) matrix, i.e., LNS or CSB, (b) soy quality, i.e., soy isolate (SI) or dehulled soy (DS), and (c) percentage of total protein from dry skimmed milk, i.e., 0%, 20%, or 50%, in increasing fat-free tissue accretion.

Methods and findings

Between September 9, 2013, and August 29, 2014, a randomised 2 × 2 × 3 factorial trial recruited 6- to 23-month-old children with MAM in Burkina Faso. The intervention comprised 12 weeks of food supplementation providing 500 kcal/day as LNS or CSB, each containing SI or DS, and 0%, 20%, or 50% of protein from milk. Fat-free mass (FFM) was assessed by deuterium dilution technique. By dividing FFM by length squared, the primary outcome was expressed independent of length as FFM index (FFMI) accretion over 12 weeks. Other outcomes comprised recovery rate and additional anthropometric measures. Of 1,609 children, 4 died, 61 were lost to follow-up, and 119 were transferred out due to supplementation being switched to non-experimental products. No children developed allergic reaction. At inclusion, 95% were breastfed, mean (SD) weight was 6.91 kg (0.93), with 83.5% (5.5) FFM. In the whole cohort, weight increased 0.90 kg (95% CI 0.88, 0.93; p < 0.01) comprising 93.5% (95% CI 89.5, 97.3) FFM. As compared to children who received CSB, FFMI accretion was increased by 0.083 kg/m2 (95% CI 0.003, 0.163; p = 0.042) in those who received LNS. In contrast, SI did not increase FFMI compared to DS (mean difference 0.038 kg/m2; 95% CI −0.041, 0.118; p = 0.35), irrespective of matrix. Having 20% milk protein was associated with 0.097 kg/m2 (95% CI −0.002, 0.196) greater FFMI accretion than having 0% milk protein, although this difference was not significant (p = 0.055), and there was no effect of 50% milk protein (0.049 kg/m2; 95% CI −0.047, 0.146; p = 0.32). There was no effect modification by season, admission criteria, or baseline FFMI, stunting, inflammation, or breastfeeding (p > 0.05). LNS compared to CSB resulted in 128 g (95% CI 67, 190; p < 0.01) greater weight gain if both contained SI, but there was no difference between LNS and CSB if both contained DS (mean difference 22 g; 95% CI −40, 84; p = 0.49) (interaction p = 0.017). Accordingly, SI compared to DS increased weight by 89 g (95% CI 27, 150; p = 0.005) when combined with LNS, but not when combined with CSB. A limitation of this and other food supplementation trials is that it is not possible to collect reliable data on individual adherence.

Conclusions

Based on this study, children with MAM mainly gain fat-free tissue when rehabilitated. Nevertheless, LNS yields more fat-free tissue and higher recovery rates than CSB. Moreover, current LNSs with DS may be improved by shifting to SI. The role of milk relative to soy merits further research.

Trial registration

ISRCTN registry ISRCTN42569496

Eating more salt might save your life? Not so much

New Scientist - Lu, 11/09/2017 - 19:34
The Salt Fix is the latest book attempting to overturn well-established dietary advice, but it leaves a bad taste, says Anthony Warner
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