Haptoglobin, alpha-thalassaemia and glucose-6-phosphate dehydrogenase polymorphisms and risk of abnormal transcranial Doppler among patients with sickle cell anaemia in Tanzania.

Transcranial Doppler ultrasonography measures cerebral blood flow velocity (CBFv) of basal intracranial vessels and is used clinically to detect stroke risk in children with sickle cell anaemia (SCA). Co-inheritance in SCA of alpha-thalassaemia and glucose-6-phosphate dehydrogenase (G6PD) polymorphisms is reported to associate with high CBFv and/or risk of stroke. The effect of a common functional polymorphism of haptoglobin (HP) is unknown. We investigated the effect of co-inheritance of these polymorphisms on CBFv in 601 stroke-free Tanzanian SCA patients aged <24 years. Homozygosity for alpha-thalassaemia 3·7 deletion was significantly associated with reduced mean CBFv compared to wild-type (β-coefficient -16·1 cm/s, P = 0·002) adjusted for age and survey year. Inheritance of 1 or 2 alpha-thalassaemia deletions was associated with decreased risk of abnormally high CBFv, compared to published data from Kenyan healthy control children (Relative risk ratio [RRR] = 0·53 [95% confidence interval (CI):0·35-0·8] & RRR = 0·43 [95% CI:0·23-0·78]), and reduced risk of abnormally low CBFv for 1 deletion only (RRR = 0·38 [95% CI:0·17-0·83]). No effects were observed for G6PD or HP polymorphisms. This is the first report of the effects of co-inheritance of common polymorphisms, including the HP polymorphism, on CBFv in SCA patients resident in Africa and confirms the importance of alpha-thalassaemia in reducing risk of abnormal CBFv

Rates of depressive and anxiety symptoms in the perinatal period during the COVID-19 pandemic: Comparisons between countries and with pre-pandemic data

Background: The COVID-19 pandemic was a significant threat to perinatal mental health. This study examined differences in clinically significant depression, anxiety, and co-morbid symptoms among pregnant and postpartum women across several countries and compared prevalence of perinatal depression and anxiety before and during the pandemic in each participating country. Methods: Participants were 3326 pregnant and 3939 postpartum women (up to six months postpartum) living in Brazil, Chile, Cyprus, Greece, Israel, Portugal, Spain, Turkey, and the United Kingdom. An online survey was completed between June 7th and October 31st 2020, and included the Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder Screener (GAD-7). The pre-pandemic studies were identified through literature review. Results: Prevalence of clinically significant depression (EPDS≥13), anxiety (GAD-7 ≥ 10), and co-morbid (EPDS≥13 and GAD-7 ≥ 10) symptoms was 26.7 %, 20 % and 15.2 %, in pregnant women, and 32.7 %, 26.6 % and 20.3 %, in postpartum women, respectively. Significant between-country differences were found in all mental health indicators in both perinatal periods. Higher levels of symptoms were observed during (versus before) the pandemic, especially among postpartum women. Limitations: Participants were mostly highly educated and cohabiting with a partner. The online nature of the survey may have limited the participation of women from vulnerable socio-economically backgrounds. Conclusions: Our findings expand previous literature on the negative impact of the COVID-19 pandemic on perinatal mental health, by highlighting that this may be influenced by country of residence. Mental health care policies and interventions should consider the unique needs of perinatal women in different parts of the world. © 2022Funding text 1: Sara Cruz acknowledges the Centro de Investigação em Psicologia para o Desenvolvimento (CIPD) [The Psychology for Positive Development Research Center] ( UID/PSI/04375 ), Lusíada University North, Porto, supported by national funds through the Portuguese Foundation for Science and Technology , I.P., and the Portuguese Ministry of Science, Technology and Higher Education ( UID/PSI/04375/2019 ).; Funding text 2: This paper is part of the COST Action Riseup-PPD CA18138 and was supported by COST under COST Action Riseup-PPD CA18138 . ; Funding text 3: Vera Mateus received financial support from CAPES /PrInt grant no. 88887.583508/2020-00 . ; Funding text 4: Raquel Costa was supported by the FSE and FCT under the Post-Doctoral Grant SFRH/BPD/117597/2016 [RC]. EPIUnit, ITR, and HEI-lab are supported by national funds through the Portuguese Foundation for Science and Technology , I.P., under the projects UIDB/04750/2020 , LA/P/0064/2020 , and UIDB/05380/2020 , respectively. ; Funding text 5: This publication is based upon work from COST Action 18138 - Research Innovation and Sustainable Pan-European Network in Peripartum Depression Disorder (Riseup-PPD), supported by COST (European Cooperation in Science and Technology). www.cost.eu . ; Funding text 6: Ana Osório received financial support from CAPES PROEX grant no. 0426/2021 , process no. 23038.006837/2021-73, CAPES /PrInt grant no. 88887.310343/2018-00 and MackPesquisa Fund . ; Funding text 7: Rena Bina received financial support from the Bar-Ilan Dangoor Centre for Personalized Medicine , grant no. REFU/DANGO/100. ; Funding text 8: This publication is based upon work from COST Action 18138 - Research Innovation and Sustainable Pan-European Network in Peripartum Depression Disorder (Riseup-PPD), supported by COST (European Cooperation in Science and Technology). www.cost.eu.Vera Mateus received financial support from CAPES/PrInt grant no. 88887.583508/2020-00.Ana Osório received financial support from CAPES PROEX grant no. 0426/2021, process no. 23038.006837/2021-73, CAPES/PrInt grant no. 88887.310343/2018-00 and MackPesquisa Fund.Rena Bina received financial support from the Bar-Ilan Dangoor Centre for Personalized Medicine, grant no. REFU/DANGO/100.Raquel Costa was supported by the FSE and FCT under the Post-Doctoral Grant SFRH/BPD/117597/2016 [RC]. EPIUnit, ITR, and HEI-lab are supported by national funds through the Portuguese Foundation for Science and Technology, I.P., under the projects UIDB/04750/2020, LA/P/0064/2020, and UIDB/05380/2020, respectively.This paper is part of the COST Action Riseup-PPD CA18138 and was supported by COST under COST Action Riseup-PPD CA18138. The authors would like to thank all women who participated in the survey. Sara Cruz acknowledges the Centro de Investigação em Psicologia para o Desenvolvimento (CIPD) [The Psychology for Positive Development Research Center] (UID/PSI/04375), Lusíada University North, Porto, supported by national funds through the Portuguese Foundation for Science and Technology, I.P. and the Portuguese Ministry of Science, Technology and Higher Education (UID/PSI/04375/2019)

Transformation of animal agriculture should be evidence-driven and respectful of livestock’s benefits and contextual aspects

Response to a Letter to the Edito

Roads to interdisciplinarity - working at the nexus among food systems, nutrition and health: 1st annual Agriculture, Nutrition and Health (ANH) Academy Week, Addis Ababa (Ethiopia), 20-24 June 2016

The development agenda over the next 15 years will be framed by the Sustainable Development Goals (SDGs), of which more than half relate either directly or indirectly to the agricultural sector, highlighting its importance in economic growth and development of low- and middle-income countries (LMICs) (FAO 2015). It is therefore imperative that agricultural systems are better understood, so that they may be strengthened and optimised to deliver outcomes in line with the SDGs. The interface between agriculture, nutrition and health is particularly multifaceted and complex, and the development of successful strategies will require an integrated and multi-sectoral approach (Dorward and Dangour 2012; Jones and Ejeta 2016). ‘Agri-health’ is an evolving paradigm seeking to unify research approaches and methodologies between agriculture and health. Research within the field encapsulates a broad range of disciplines, locations and actors, and aligns these into a common research agenda. In doing so, agri-health aims to transcend barriers imposed by the longstanding institutional and disciplinary silos. Much progress has been made in recent years in this regard (Harris et al. 2013; Kanter et al. 2014; Picchioni et al. 2015). However, more coordinated efforts are required to generate consensus and target strategic priorities amongst the many existing information gaps (Webb and Kennedy 2014). Understanding the linkages between complex issues such as globalisation, climate change, food systems, and evolving burdens of malnutrition is central to agri-health research. The Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH) was created in 2010 with a key focus on agri-health interdisciplinary research. LCIRAH includes experts from across the member colleges of the University of London: the London School of Hygiene and Tropical Medicine (LSHTM), the School of Oriental and African Studies (SOAS), and the Royal Veterinary College (RVC). The Agriculture, Nutrition and Health Academy (ANH Academy), was established in 2015 as a platform to facilitate learning, knowledge sharing, capacity building and collaborative partnerships among the growing global community of researchers, practitioners and policy makers working within agri-health. It was developed with support from the Innovative Metrics and Methods for Agriculture and Nutrition Actions (IMMANA) research programme,Footnote1 led by LCIRAH and Tufts University, in partnership with the CGIAR Programme on Agriculture for Nutrition and Health (A4NH). Within this scope, the ANH Academy hosts an annual ANH Academy Week, building on the legacy of five agri-health research conferences organised by LCIRAH; as well as events and activities coordinated under the CGIAR A4NH. The inaugural ANH Academy Week took place in Addis Ababa, Ethiopia, in June 2016 and included two days of interactive ‘learning labs’ (training sessions on skills and methods across a broad range of disciplines in agri-health), followed by a three-day research conference. The conference included a mix of abstract-driven sessions, round table discussions, and keynote speeches from across the spectrum of agriculture, nutrition and health disciplines, and a wide range of countries. Hawkes et al. (2012) developed a conceptual framework (Fig. 2, hereafter referred to as the Framework), outlining the key pathways through which agriculture may affect nutritional status in Low and Middle Income Countries (LMICs), as well as broader drivers of these pathways. Drawing on this Framework, this paper aims to provide an analytical synthesis of the ANH Academy week by mapping the research and debates presented during the conference

Changes to women's childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study

A considerable number of women giving birth during COVID-19 pandemic reported being concerned about changes to their childbirth plans and experiences due to imposed restrictions. Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans. Therefore, this study aimed to examine if the mismatch between women’s planned birth and actual birth experiences during COVID-19 was associated with women’s postpartum PTSS. Women in the postpartum period (up to 6 months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors, and PTSS (PTSD checklist DSM-5 version) using self-report questionnaires (ClinicalTrials.gov: NCT04595123). More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans. All changes were significantly associated with PTSS scores. Participants with one and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes (Exp(β) = 1.12; 95% CI [1.06–1.19]; p < 0.001 and Exp(β) = 1.38; 95% CI [1.29–1.48]; p < 0.001). In addition, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida (Exp(β) = 0.86; 95% CI [0.77–0.97]; p = 0.014). Changes to women’s childbirth plans during the COVID-19 pandemic were common and associated with women’s postpartum PTSS score. Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health

Reverse thinking: taking a healthy diet perspective towards food systems transformations

Food systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries

Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project

Purpose: To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). Methods: A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. Results: Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS &gt;5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. Conclusion: Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice

Support for UNRWA's survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy. Its social services include rebuilding infrastructure and homes that have been destroyed by conflict and providing cash assistance and micro-finance loans for Palestinians whose rights are curtailed and who are denied the right of return to their homeland