22 research outputs found
Clinical trial data sharing: Here's the challenge
Objective Anonymised patient-level data from clinical research are increasingly recognised as a fundamental and valuable resource. It has value beyond the original research project and can help drive scientific research and innovations and improve patient care. To support responsible data sharing, we need to develop systems that work for all stakeholders. The members of the Independent Review Panel (IRP) for the data sharing platform Clinical Study Data Request (CSDR) describe here some summary metrics from the platform and challenge the research community on why the promised demand for data has not been observed. Summary of data From 2014 to the end of January 2019, there were a total of 473 research proposals (RPs) submitted to CSDR. Of these, 364 met initial administrative and data availability checks, and the IRP approved 291. Of the 90 research teams that had completed their analyses by January 2018, 41 reported at least one resulting publication to CSDR. Less than half of the studies ever listed on CSDR have been requested. Conclusion While acknowledging there are areas for improvement in speed of access and promotion of the platform, the total number of applications for access and the resulting publications have been low and challenge the sustainability of this model. What are the barriers for data contributors and secondary analysis researchers? If this model does not work for all, what needs to be changed? One thing is clear: that data access can realise new and unforeseen contributions to knowledge and improve patient health, but this will not be achieved unless we build sustainable models together that work for all
Training the next generation of global health experts: experiences and recommendations from Pacific Rim universities
Initial findings from a novel population-based child mortality surveillance approach: a descriptive study.
--- - Label: BACKGROUND NlmCategory: BACKGROUND content:
"Sub-Saharan Africa and south Asia contributed 81% of 5\xC2\xB79
million under-5 deaths and 77% of 2\xC2\xB76 million stillbirths
worldwide in 2015. Vital registration and verbal autopsy data
are mainstays for the estimation of leading causes of death, but
both are non-specific and focus on a single underlying cause. We
aimed to provide granular data on the contributory causes of
death in stillborn fetuses and in deceased neonates and children
younger than 5 years, to inform child mortality prevention
efforts." - Label: METHODS NlmCategory: METHODS content: "The
Child Health and Mortality Prevention Surveillance (CHAMPS)
Network was established at sites in seven countries (Baliakandi,
Bangladesh; Harar and Kersa, Ethiopia; Siaya and Kisumu, Kenya;
Bamako, Mali; Manhi\xC3\xA7a, Mozambique; Bombali, Sierra Leone;
and Soweto, South Africa) to collect standardised,
population-based, longitudinal data on under-5 mortality and
stillbirths in sub-Saharan Africa and south Asia, to improve the
accuracy of determining causes of death. Here, we analysed data
obtained in the first 2 years after the implementation of CHAMPS
at the first five operational sites, during which surveillance
and post-mortem diagnostics, including minimally invasive tissue
sampling (MITS), were used. Data were abstracted from all
available clinical records of deceased children, and relevant
maternal health records were also extracted for stillbirths and
neonatal deaths, to incorporate reported pregnancy or delivery
complications. Expert panels followed standardised procedures to
characterise causal chains leading to death, including
underlying, intermediate (comorbid or antecedent causes), and
immediate causes of death for stillbirths, neonatal deaths, and
child (age 1-59 months) deaths." - Label: FINDINGS NlmCategory:
RESULTS content: Between Dec 10, 2016, and Dec 31, 2018, MITS
procedures were implemented at five sites in Mozambique, South
Africa, Kenya, Mali, and Bangladesh. We screened 2385 death
notifications for inclusion eligibility, following which 1295
families were approached for consent; consent was provided for
MITS by 963 (74%) of 1295 eligible cases approached. At least
one cause of death was identified in 912 (98%) of 933 cases (180
stillbirths, 449 neonatal deaths, and 304 child deaths); two or
more conditions were identified in the causal chain for 585
(63%) of 933 cases. The most common underlying causes of
stillbirth were perinatal asphyxia or hypoxia (130 [72%] of 180
stillbirths) and congenital infection or sepsis (27 [15%]). The
most common underlying causes of neonatal death were preterm
birth complications (187 [42%] of 449 neonatal deaths),
perinatal asphyxia or hypoxia (98 [22%]), and neonatal sepsis
(50 [11%]). The most common underlying causes of child deaths
were congenital birth defects (39 [13%] of 304 deaths), lower
respiratory infection (37 [12%]), and HIV (35 [12%]). In 503
(54%) of 933 cases, at least one contributory pathogen was
identified. Cytomegalovirus, Escherichia coli, group B
Streptococcus, and other infections contributed to 30 (17%) of
180 stillbirths. Among neonatal deaths with underlying
prematurity, 60% were precipitated by other infectious causes.
Of the 275 child deaths with infectious causes, the most common
contributory pathogens were Klebsiella pneumoniae (86 [31%]),
Streptococcus pneumoniae (54 [20%]), HIV (40 [15%]), and
cytomegalovirus (34 [12%]), and multiple infections were common.
Lower respiratory tract infection contributed to 174 (57%) of
304 child deaths. - Label: INTERPRETATION NlmCategory:
CONCLUSIONS content: Cause of death determination using MITS
enabled detailed characterisation of contributing conditions.
Global estimates of child mortality aetiologies, which are
currently based on a single syndromic cause for each death, will
be strengthened by findings from CHAMPS. This approach adds
specificity and provides a more complete overview of the chain
of events leading to death, highlighting multiple potential
interventions to prevent under-5 mortality and stillbirths. -
Label: FUNDING NlmCategory: BACKGROUND content: Bill &
Melinda Gates Foundation
Activated learning; providing structure in global health education at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA)– a pilot study
Communication and marketing as tools to cultivate the public's health: a proposed "people and places" framework
<p>Abstract</p> <p>Background</p> <p>Communication and marketing are rapidly becoming recognized as core functions, or core competencies, in the field of public health. Although these disciplines have fostered considerable academic inquiry, a coherent sense of precisely how these disciplines can inform the practice of public health has been slower to emerge.</p> <p>Discussion</p> <p>In this article we propose a framework – based on contemporary ecological models of health – to explain how communication and marketing can be used to advance public health objectives. The framework identifies the attributes of people (as individuals, as social networks, and as communities or populations) and places that influence health behaviors and health. Communication, i.e., the provision of information, can be used in a variety of ways to foster beneficial change among both people (e.g., activating social support for smoking cessation among peers) and places (e.g., convincing city officials to ban smoking in public venues). Similarly, marketing, i.e., the development, distribution and promotion of products and services, can be used to foster beneficial change among both people (e.g., by making nicotine replacement therapy more accessible and affordable) and places (e.g., by providing city officials with model anti-tobacco legislation that can be adapted for use in their jurisdiction).</p> <p>Summary</p> <p>Public health agencies that use their communication and marketing resources effectively to support people in making healthful decisions and to foster health-promoting environments have considerable opportunity to advance the public's health, even within the constraints of their current resource base.</p
Initial findings from a novel population-based child mortality surveillance approach: a descriptive study.
BACKGROUND: Sub-Saharan Africa and south Asia contributed 81% of 5·9 million under-5 deaths and 77% of 2·6 million stillbirths worldwide in 2015. Vital registration and verbal autopsy data are mainstays for the estimation of leading causes of death, but both are non-specific and focus on a single underlying cause. We aimed to provide granular data on the contributory causes of death in stillborn fetuses and in deceased neonates and children younger than 5 years, to inform child mortality prevention efforts. METHODS: The Child Health and Mortality Prevention Surveillance (CHAMPS) Network was established at sites in seven countries (Baliakandi, Bangladesh; Harar and Kersa, Ethiopia; Siaya and Kisumu, Kenya; Bamako, Mali; Manhiça, Mozambique; Bombali, Sierra Leone; and Soweto, South Africa) to collect standardised, population-based, longitudinal data on under-5 mortality and stillbirths in sub-Saharan Africa and south Asia, to improve the accuracy of determining causes of death. Here, we analysed data obtained in the first 2 years after the implementation of CHAMPS at the first five operational sites, during which surveillance and post-mortem diagnostics, including minimally invasive tissue sampling (MITS), were used. Data were abstracted from all available clinical records of deceased children, and relevant maternal health records were also extracted for stillbirths and neonatal deaths, to incorporate reported pregnancy or delivery complications. Expert panels followed standardised procedures to characterise causal chains leading to death, including underlying, intermediate (comorbid or antecedent causes), and immediate causes of death for stillbirths, neonatal deaths, and child (age 1-59 months) deaths. FINDINGS: Between Dec 10, 2016, and Dec 31, 2018, MITS procedures were implemented at five sites in Mozambique, South Africa, Kenya, Mali, and Bangladesh. We screened 2385 death notifications for inclusion eligibility, following which 1295 families were approached for consent; consent was provided for MITS by 963 (74%) of 1295 eligible cases approached. At least one cause of death was identified in 912 (98%) of 933 cases (180 stillbirths, 449 neonatal deaths, and 304 child deaths); two or more conditions were identified in the causal chain for 585 (63%) of 933 cases. The most common underlying causes of stillbirth were perinatal asphyxia or hypoxia (130 [72%] of 180 stillbirths) and congenital infection or sepsis (27 [15%]). The most common underlying causes of neonatal death were preterm birth complications (187 [42%] of 449 neonatal deaths), perinatal asphyxia or hypoxia (98 [22%]), and neonatal sepsis (50 [11%]). The most common underlying causes of child deaths were congenital birth defects (39 [13%] of 304 deaths), lower respiratory infection (37 [12%]), and HIV (35 [12%]). In 503 (54%) of 933 cases, at least one contributory pathogen was identified. Cytomegalovirus, Escherichia coli, group B Streptococcus, and other infections contributed to 30 (17%) of 180 stillbirths. Among neonatal deaths with underlying prematurity, 60% were precipitated by other infectious causes. Of the 275 child deaths with infectious causes, the most common contributory pathogens were Klebsiella pneumoniae (86 [31%]), Streptococcus pneumoniae (54 [20%]), HIV (40 [15%]), and cytomegalovirus (34 [12%]), and multiple infections were common. Lower respiratory tract infection contributed to 174 (57%) of 304 child deaths. INTERPRETATION: Cause of death determination using MITS enabled detailed characterisation of contributing conditions. Global estimates of child mortality aetiologies, which are currently based on a single syndromic cause for each death, will be strengthened by findings from CHAMPS. This approach adds specificity and provides a more complete overview of the chain of events leading to death, highlighting multiple potential interventions to prevent under-5 mortality and stillbirths. FUNDING: Bill & Melinda Gates Foundation
Mortality Surveillance Methods to Identify and Characterize Deaths in Child Health and Mortality Prevention Surveillance Network Sites
Despite reductions over the past 2 decades, childhood
mortality remains high in low- and middle-income countries in
sub-Saharan Africa and South Asia. In these settings, children
often die at home, without contact with the health system, and
are neither accounted for, nor attributed with a cause of death.
In addition, when cause of death determinations occur, they
often use nonspecific methods. Consequently, findings from
models currently utilized to build national and global estimates
of causes of death are associated with substantial uncertainty.
Higher-quality data would enable stakeholders to effectively
target interventions for the leading causes of childhood
mortality, a critical component to achieving the Sustainable
Development Goals by eliminating preventable perinatal and
childhood deaths. The Child Health and Mortality Prevention
Surveillance (CHAMPS) Network tracks the causes of under-5
mortality and stillbirths at sites in sub-Saharan Africa and
South Asia through comprehensive mortality surveillance,
utilizing minimally invasive tissue sampling (MITS), postmortem
laboratory and pathology testing, verbal autopsy, and clinical
and demographic data. CHAMPS sites have established facility-
and community-based mortality notification systems, which aim to
report potentially eligible deaths, defined as under-5 deaths
and stillbirths within a defined catchment area, within 24-36
hours so that MITS can be conducted quickly after death. Where
MITS has been conducted, a final cause of death is determined by
an expert review panel. Data on cause of death will be provided
to local, national, and global stakeholders to inform strategies
to reduce perinatal and childhood mortality in sub-Saharan
Africa and South Asia