The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet.

OBJECTIVE: We estimated the global burden of disease attributable to low consumption of fruit and vegetables, an increasingly recognized risk factor for cardiovascular disease and cancer, and compared its impact with that of other major risk factors for disease. METHODS: The burden of disease attributable to suboptimal intake of fruit and vegetables was estimated using information on fruit and vegetable consumption in the population, and on its association with six health outcomes (ischaemic heart disease, stroke, stomach, oesophageal, colorectal and lung cancer). Data from both sources were stratified by sex, age and by 14 geographical regions. FINDINGS: The total worldwide mortality currently attributable to inadequate consumption of fruit and vegetables is estimated to be up to 2.635 million deaths per year. Increasing individual fruit and vegetable consumption to up to 600 g per day (the baseline of choice) could reduce the total worldwide burden of disease by 1.8%, and reduce the burden of ischaemic heart disease and ischaemic stroke by 31% and 19% respectively. For stomach, oesophageal, lung and colorectal cancer, the potential reductions were 19%, 20%, 12% and 2%, respectively. CONCLUSION: This study shows the potentially large impact that increasing fruit and vegetable intake could have in reducing many noncommunicable diseases. It highlights the need for much greater emphasis on dietary risk factors in public health policy in order to tackle the rise in noncommunicable diseases worldwide, and suggests that the proposed intersectoral WHO/FAO fruit and vegetable promotion initiative is a crucial component in any global diet strategy

Performance and operational characteristics of point-of-care tests for the diagnosis of urogenital gonococcal infections.

BACKGROUND: In 2012, there was an estimated 78 million new cases of gonorrhoea globally. Untreated infection may lead to reproductive and neonatal morbidity and facilitate HIV transmission. Diagnosis and treatment are a priority for control and prevention, yet use of point-of-care tests (POCTs) for Neisseria gonorrhoeae (NG) is limited. OBJECTIVES: To review the performance and operational characteristics of NG POCTs for diagnosis of urogenital gonorrhoea. METHODS: We compiled and synthesised findings from two separate systematic reviews which included evaluations published until August 2015. RESULTS: Six tests were included: five were immunochromatographic tests (ICTs) or optical immunoassay (OIAs) based on antigen detection; with 5-7 steps and results in 25-40 min, and one (GeneXpert CT/NG) was a 'near-patient test' based on nucleic acid amplification technique (NAAT); with three steps, electricity required, and results in 90 min. When compared with laboratory-based NAATs as the reference tests, sensitivities of ICT and OIA-based POCTs ranged from 12.5% to 70% when cervical/vaginal swabs were tested. Specificities ranged from 89% to 99.8%. The near-patient NAAT had sensitivities of >95% and specificities of >99.8% consistently across all specimen types (urine, cervical and vaginal swabs). CONCLUSIONS: Based on a limited number of evaluations, antigen detection POCTs for NG lacked sufficient sensitivity to be used for screening. A near-patient NAAT has acceptable performance, only involved a few steps, but needs electricity, a temperature-controlled environment and has a 90 min run time. To achieve wider scale up of NG POCTs, we need strong evidence of cost-effectiveness, which should inform guidelines and ultimately increase test development, demand and reduce costs

Point of care (POC) tests for diagnosis of sexually transmissible infections (STIs) in Australia

Sexually transmissible infections (STIs) are responsible for a huge health, economic and social burden globally with an estimated almost 360 million new infections in 15–49 year olds annually due to curable microbial STIs. Access to accurate diagnostic testing is a key control strategy, yet in many settings laboratory infrastructure is inadequate or as is the case in remote Australia, significant physical distances and highly mobile patient populations are barriers. Point-of-care (POC) tests have the potential to provide timely testing and treatment for STIs, yet their poor accuracy or in the case of syphilis, their inability to differentiate current from past/treated infection, has limited their use. New POC tests, which overcome these limitations, need rigorous laboratory and field-based evaluations before being introduced programmatically. The research presented in this thesis provides new information from evaluations of novel POC tests for STIs. The first evaluation was a multi-site laboratory-based assessment of one new and three traditional POC test for syphilis; more than 1000 sera were tested. The new test identified >93% of active syphilis infections, whereas just over half of past infections were diagnosed as past or not syphilis, thereby avoiding unnecessary treatment compared with traditional POC tests. Its sensitivity (89.8%) was lower than traditional tests, possibly limiting its usefulness. The second evaluation was field-based in two remote Aboriginal communities and included two traditional tests and one new molecular-based POC test for chlamydia (CT) and gonorrhoea (NG); this followed a laboratory-based investigation which already confirmed test accuracy. The new test was easy-to-use and exceptionally more sensitive (CT:100%; NG:100%) than traditional tests (CT:27.3%; NG:66.7%), and was subsequently included in a large cluster-randomised controlled trial involving 12 remote Aboriginal health services to evaluate clinical benefit and accuracy in the hands of health care staff. Over 2500 POC tests were performed, demonstrating very high concordance (CT:99.4%; NG:99.9%) with laboratory results. The findings presented here contribute new knowledge to the field of STI POC testing and highlight the importance of the evaluation pathway. The research has already informed the direction of further STI POC program implementation in Australia. These findings are also likely to be applicable more broadly in similar settings globally

Metaanalysis of the Performance of a Combined Treponemal and Nontreponemal Rapid Diagnostic Test for Syphilis and Yaws

BACKGROUND: The human treponematoses are important causes of disease. Mother-to-child transmission of syphilis remains a major cause of stillbirth and neonatal death. There are also almost 100 000 cases of endemic treponemal disease reported annually, predominantly yaws. Rapid diagnostic tests (RDTs) would improve access to screening for these diseases. Most RDTs cannot distinguish current and previous infection. The Dual Path Platform (DPP) Syphilis Screen & Confirm test includes both a treponemal (T1) and nontreponemal (T2) component and may improve the accuracy of diagnosis. METHODS: We conducted a metaanalysis of published and unpublished evaluations of the DPP-RDT for the diagnosis of syphilis and yaws. We calculated the sensitivity, specificity, and overall agreement of the test compared with reference laboratory tests. RESULTS: Nine evaluations, including 7267 tests, were included. Sensitivity was higher in patients with higher titer rapid plasma reagin (>/=1:16) for both the T1 (98.2% vs 90.1%, P < .0001) and the T2 component (98.2% vs 80.6%, P < .0001). Overall agreement between the DPP test and reference serology was 85.2% (84.4%-86.1%). Agreement was highest for high-titer active infection and lowest for past infection. CONCLUSIONS: The RDT has good sensitivity and specificity of the treponemal and nontreponemal components both in cases of suspected syphilis and yaws, although the sensitivity is decreased at lower antibody titers

Point-of-Care Testing in Rural and Remote Australia: An Emerging Technology to Address Global Health Challenges, Crises and Security

Point-of-care (POC) testing enables rapid pathology results to be utilised in primary care settings for timely clinical decision-making and treatment during a patient consultation and can contribute to public health surveillance and responses. Large-scale POC testing networks (supporting 100 or more rural and remote health services) now operate for chronic, acute and infectious diseases across the length and breadth of Australia. Sound operator training, quality management and digital connectivity systems, in addition to strong clinical and cultural governance, underpin these networks, mitigate risks to patient safety, and facilitate scalability. Real-world examples from our Australian-based POC testing networks highlight how contemporary global health problems, such as diabetes, acute medical crises and the COVID-19 pandemic response can be addressed by the judicious application of POC testing in primary care settings. The recent role POC testing played in supporting First Nations communities of Australia during the pandemic serves as a template for and provides learned experiences that can be translated or adapted to other countries should or when future global security issues arise. The potential to use POC testing as an adjunctive diagnostic tool to support and enhance global health security needs to be balanced against the limitations of using this innovative technology

Dispensary level pilot implementation of rapid diagnostic tests: an evaluation of RDT acceptance and usage by providers and patients – Tanzania, 2005

BACKGROUND\ud \ud Malaria rapid diagnostic tests (RDTs) may assist in diagnosis, improve prescribing practices and reduce potential drug resistance development. Without understanding operational issues or acceptance and usage by providers and patients, the costs of these tests may not be justified.\ud \ud OBJECTIVES\ud \ud To evaluate the impact of RDTs on prescribing behaviours, assess prescribers' and patients' perceptions, and identify operational issues during implementation.\ud \ud METHODS\ud \ud Baseline data were collected at six Tanzanian public dispensaries. RDTs were implemented for eight weeks and data collected on frequency of RDT use, results, malaria diagnoses and the prescription of antimalarials. Patients referred for RDTs completed a standardised exit interview. Qualitative methods assessed attitudes toward and satisfaction with RDTs, perceptions about the test and operational issues related to implementation.\ud \ud RESULTS\ud \ud Of 595 patients at baseline, 200 (33%) were diagnosed clinically with malaria but had a negative RDT. Among the 2519 RDTs performed during implementation, 289 (11.5%) had a negative result and antimalarials prescribed. The proportion of "over-prescriptions" at baseline was 54.8% (198/365). At weeks four and eight this decreased to 16.1% (27/168) and 16.4% (42/256) respectively.A total of 355 patient or parent/caregiver and 21 prescriber individual interviews and 12 focus group discussions (FGDs) were conducted. Patients, caregivers and providers trusted RDT results, agreed that use of RDTs was feasible at dispensary level, and perceived that RDTs improved clinical diagnosis. Negative concerns included community suspicion and fear that RDTs were HIV tests, the need for additional supervision in interpreting the results, and increased work loads without added compensation.\ud \ud CONCLUSION\ud \ud Overprescriptions decreased over the study period. There was a high degree of patient/caregiver and provider acceptance of and satisfaction with RDTs. Implementation should include community education, sufficient levels of training and supervision and consideration of the need for additional staff

Understanding the role of patient communication protocols in sexually transmissible infections point-of-care testing among Aboriginal and Torres Strait Islander peoples in remote communities: a qualitative study

Background: Untreated sexually transmissible infections (STIs) such as Chlamydia trachomatis and Neisseria gonorrhoeae can lead to serious health issues, including pelvic inflammatory disease, infertility in women, increased HIV risk, and emotional distress. Timely testing and treatment are crucial for reducing transmission. Australia's STI Management Guidelines recommend regular STI testing every 6-12 months for sexually active individuals aged 15-35 years in high-prevalence, remote areas. However, testing uptake remains low among young Aboriginal and Torres Strait Islander peoples. This analysis explores how healthcare providers engage Aboriginal and Torres Strait Islander peoples in STI testing using point-of-care (POC) diagnostics. Methods: Semi-structured interviews were conducted with trained STI POC testing operators within the Test Treat ANd GO (TTANGO2) project. Seven clinics involved in TTANGO2 were selected for their 'high' and 'low' implementation of STI POC testing. Purposive sampling was used to recruit similar personnel from each of the selected clinics. Coding was informed by a patient communication protocol lens. Results: Twenty healthcare personnel, including Aboriginal Health Workers/Practitioners (n = 8), Registered Nurses (n = 7), Coordinators (n = 2), and Clinical/Practice Managers (n = 3) participated. Key themes related to implementing STI POC testing focused on different stages of identified patient communication protocols, such as offering tests, providing follow-up results, and contact tracing. Concerns about shame and confidentiality were significant factors affecting patient communication protocols throughout the process. Conclusions: Normalising sexual health discussions in healthcare settings helps reduce feelings of shame and stigma, further encouraging patient participation in sexual health services. Ensuring patient safety and offering culturally appropriate explanations of STI POC testing are essential to reduce barriers, such as shame and stigma. Culturally safe practices can increase patient engagement and provide opportunities for health education. Integrating STI POC testing into routine health care can help normalise testing and boost uptake. However, same-day results may still require patient follow-up to maintain confidentiality. Addressing external factors, such as accessibility, confidentiality, stigma reduction, and community engagement, is crucial for improving STI testing services