Local understandings of zoonotic disease should be built into epidemic preparedness and response

People in many global regions can make complex trade-offs between the risk of contracting disease and the need to support their livelihoods, particularly in situations of poverty. Interventions to promote epidemic preparedness should therefore be sensitive to local contexts. These should incorporate knowledge within communities to ensure more effective zoonotic disease surveillance and control, while appreciating broader local priorities for health and well-being

Are Retail Outlets Complying with National Legislation to Protect Children from Exposure to Tobacco Displays at Point of Sale? Results from the First Compliance Study in the UK

Background   From April 6th2015, all small shops in the UK were required to cover up tobacco products at point of sale (POS) to protect children from exposure. As part of a larger 5-year study to measure the impact of the legislation in Scotland, an audit was conducted to assess level and nature of compliance with the ban immediately following its introduction.  Materials and Methods   A discreet observational audit was conducted 7–14 days post implementation which took measures of physical changes made to cover products, server/assistant practices, tobacco signage and advertising, and communication of price information. The audit was conducted in all small retail outlets (n = 83) selling tobacco in four communities in Scotland selected to represent different levels of urbanisation and social deprivation. Data were analysed descriptively.  Results   Compliance with the legislation was high, with 98% of shops removing tobacco from permanent display and non-compliance was restricted almost entirely to minor contraventions. The refurbishment of shops with new or adapted tobacco storage units resulted in the removal of nearly all commercial brand messages and images from POS, dropping from 51% to 4%. The majority of shops stored their tobacco in public-facing storage units (81%). Most shops also displayed at least one generic tobacco message (88%).  Conclusions  Compliance with Scottish prohibitions on display of tobacco products in small retail outlets was high immediately after the legislation implementation date. However, although tobacco branding is no longer visible in retail outlets, tobacco storage units with generic tobacco messages are still prominent. This points towards a need to monitor how the space vacated by tobacco products is utilised and to better understand how the continuing presence of tobacco storage units influences people’s awareness and understanding of tobacco and smoking. Countries with existing POS bans and who are considering such bans should pay particular attention to regulations regarding the use of generic signage and where within the retail setting tobacco stocks can be stored

Isolated proteinuria due to CUBN homozygous mutation – challenging the investigative paradigm

Background: Proteinuria is a common clinical presentation, the diagnostic workup for which involves many noninvasive and invasive investigations. We report on two siblings that highlight the clinically relevant functional role of cubulin for albumin resorption in the proximal tubule and supports the use of genomic sequencing early in the diagnostic work up of patients who present with proteinuria. Case presentation: An 8-year-old boy was referred with an incidental finding of proteinuria. All preliminary investigations were unremarkable. Further assessment revealed consanguineous family history and a brother with isolated proteinuria. Renal biopsy demonstrated normal light microscopy and global glomerular basement membrane thinning on electron microscopy. Chromosomal microarray revealed long continuous stretches of homozygosity (LCSH) representing ~ 4.5% of the genome. Shared regions of LCSH between the brothers were identified and their further research genomic analysis implicated a homozygous stop-gain variant in CUBN (10p12.31). Conclusions: CUBN mutations have been implicated as a hereditary cause of megaloblastic anaemia and variable proteinuria. This is the second reported family with isolated proteinuria due to biallelic CUBN variants in the absence of megaloblastic anaemia, demonstrating the ability of genomic testing to identify genetic causes of nephropathy within expanding associated phenotypic spectra. Genomic sequencing, undertaken earlier in the diagnostic trajectory, may reduce the need for invasive investigations and the time to definitive diagnosis for patients and families

Changes in physical activity following total hip or knee arthroplasty: a matched case-control study from the EPIC-Norfolk cohort

Objective: To assess self-reported physical activity changes pre- compared to post-operatively in patients undergoing total hip or knee arthroplasty, and to compare this to an age- and gender-matched cohort of people who have not undergone arthroplasty.  Design: Population-based prospective cohort study.  Setting: Norfolk, UK  Subjects: People who had undergone hip or knee arthroplasty, compared to an age- and gender-matched non-arthroplasty cohort.  Intervention: Primary total hip or knee arthroplasty.  Main measures: Physical activity, measured using the EPIC Physical Activity Questionnaire (EPAQ2).  Results: 400 people from the EPIC-Norfolk community cohort were identified who had undergone hip or knee arthroplasty. 767 people were identified to form an age- and gender-matched non-arthroplasty cohort. Mean post-operative follow-up was 43 months post-total hip and 41 months post-total knee arthroplasty. There was a statistically significant reduction from pre- to post-arthroplasty in the number of flights of stairs climbed weekly (hip: mean difference (MD): 6.8; p<0.01; knee: MD: 10.2; p<0.01); duration of walking (hip: MD: 1.4 hours/week; p=0.02; knee: MD: 2.2 hours/week; p<0.01) and duration of total recreational activity (hip: MD: 1.1 hours/week; p=0.02). Compared to the non-arthroplasty cohort, duration of physical activity was lower post-total hip arthroplasty (MD: 1.8 hours/week; p=0.01). The number of flights of stairs climbed weekly (MD: 12.0; p<0.01), total recreational activity (MD: 1.7 hours/week; p=0.04) and physical activity energy expenditure (MD: 5.7 Mets-hours/week; p=0.05) was lower for people post-total knee arthroplasty compared to the matched controls.  Conclusions: Physical activity did not increase, and in instances decreased, following total hip or knee arthroplasty

The publics of public health in Africa

How do we understand the public character of public health in contemporary Africa? What are the parameters of community engagement in health care delivery, medical research and disease control programmes? To what extent is public health in Africa a project led by African Governments? Through what political processes and deliberative practices can African publics influence the priorities of research in health sciences and interventions which aim in broad terms to improve the health of such publics? Drawing insight from empirical research conducted with African scientists, nurses, community members, clinical trialists and policy-makers, this special section examines the multiple ways in which the public comes into being around public health provisioning and investigation in sub-Saharan Africa, its role and political reach. Collectively, these papers show how contestation and negotiation around different ideas about who the public is and what being public means can lead to the emergence of conflicting understandings, with implications for who and what is seen to represent the public interest, and for the acceptance of research and other interventions

Assessing Change in Tobacco Visibility at Point-of-sale Following a Display Ban

Objectives:  In this paper, we describe a point-of-sale (POS) tobacco visibility tool and examine its utility for assessing changes in visibility following legislation banning tobacco displays.  Methods:  An observational tool was developed as part of DISPLAY, a multimodal, longitudinal study evaluating the impact of the tobacco POS display ban in Scotland. Measures were taken of product and storage unit visibility, over 5 years, pre- and post-implementation in all retail outlets selling tobacco in 4 contrasting study areas (N = 103).  Results:  Data generated by the visibility tool illustrated that whereas the display ban had reduced product visibility, it had little impact on reducing visibility of tobacco storage units. However, it did narrow the inequality gap in storage visibility. It also found some shop types reduced product visibility before legally required to do so.  Conclusions:  The DISPLAY visibility tool provides a reliable method for measuring visibility of tobacco displays before and after implementation of POS legislation. Tobacco product visibility reduced as expected following implementation of the legislation, but storage unit visibility persisted, providing residual cues of tobacco availability which may confound the effects of the legislation. The DISPLAY tool has the potential to be utilized in countries planning POS display bans

The impact of the point-of-sale tobacco display ban on young people in Scotland: before-and-after study

Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme.Background Tobacco displays at point of sale have been shown to increase young people’s pro-smoking attitudes, susceptibility to smoking and smoking initiation. In Scotland, legislation that prohibited tobacco point-of-sale displays was implemented in large stores (i.e. those > 280 m2) in April 2013 and in small retailers in April 2015. Objective To assess the impact of the point-of-sale tobacco display ban on young people’s exposure to tobacco advertising, their attitudes to smoking and smoking susceptibility, and their risk of smoking initiation. Design Multimodal before-and-after study design using mixed methods to collect data at baseline (2013) and then longitudinally for 4 years. Setting Four main study communities in the central belt of mainland Scotland, UK, purposively selected to reflect two levels of urbanity (urban vs. small town) and two levels of deprivation (high vs. medium/low). Four matched communities. Participants In the main study communities, 94 tobacco retail outlets. All Secondary 2 (aged 13 years) and Secondary 4 (aged 15 years) pupils in 2013 and 2014 together with all Secondary 1 to Secondary 6 (aged 12–17 years) pupils in 2015–17. This included 6612 pupils who completed 14,344 questionnaires over 5 years. Three hundred and eighty-two participants in 80 focus groups who were recruited from Secondary 2 and Secondary 4 in 2013–17. In matched communities, 24 retail panel members in 2013–17. Main outcome measures Tobacco product and tobacco storage visibility, density of retail outlets (the number of retailers in a pre-defined area such as a residential neighbourhood), tobacco product exposure, brand awareness, perceived accessibility of tobacco, pro-smoking attitudes, pro-smoking norms, smoking susceptibility and smoking initiation. Data platform and methods The study had four components – a mapping and spatial analysis of retail outlets; a tobacco marketing audit, including retail panel interviews in matched communities; school surveys; and focus group discussions with secondary school pupils. Limitations The study was based on a small number of communities and did not include communities in remote areas. Results Compliance with the point-of-sale legislation in Scotland was high. This led to a large reduction in the visibility of tobacco products in retail outlets. However, when the results were stratified by socioeconomic status, declines in retailer density, weighted by total product visibility, were restricted to the least disadvantaged tertile of participants. Nevertheless, the implementation of the legislation was associated with a reduction in risk of both smoking susceptibility and smoking initiation in young people, as well as a reduction in the perceived accessibility of tobacco and in pro-smoking attitudes after both the partial and the comprehensive bans were introduced. Conclusions The Scottish point-of-sale legislation has been successful in reducing the overall visibility of tobacco products and is associated with improvements in attitudinal and behavioural outcomes in young people. However, cues that tobacco is for sale are still highly visible, particularly in retail outlets in areas of deprivation. In addition, the increase in retailer density that was observed after 2015 increased inequalities in product visibility. There was also evidence that the emergence of e-cigarettes may have disrupted the full impact of the legislation. Future work Our research indicates that further research is needed to examine the longitudinal relationships between tobacco outlet availability and product visibility inequalities; and the impact of e-cigarettes and standardised packaging on smoking initiation and prevalence.Publisher PDFPeer reviewe

Tobacco point-of-sale displays, brand awareness, and smoking and vaping among young people in Scotland Insights for policymakers from the DISPLAY project In

In 2013, the Scottish Government set an ambitious target to create a tobacco-free generation in Scotland by 2034, with cigarettes out of sight and out of mind for generations born in 2013 and after. Since 2013, important reforms aimed at reducing the visibility and availability of tobacco and nicotine products to young people have been introduced as part of Scotland’s tobacco control policy. These include: banning tobacco displays and promotions at point-of-sale; prohibiting the sale of vaping products to under-18s; and banning the sale of vaping products through vending machines. In addition, smoking in cars carrying passengers under 18 years of age has also been banned. However, further action is needed to embed the cultural change necessary to raise a tobacco-free generation. A consultation is also planned in Scotland on what further regulation of e-cigarettes is required, such as the restriction of domestic advertising and promotion of e-cigarettes. In a rapidly changing environment, where smoking rates among young people are falling but experimentation with e-cigarettes has increased, understanding the influence of tobacco branding and the display of tobacco and nicotine products is essential in order to develop effective policy interventions that protect young people. This briefing draws on research led by the University of Stirling’s Faculty of Health Sciences and Sport, and provides insights into the relationship between tobacco branding, point of sale marketing and e-cigarette uptake among young people in Scotland. The paper will be of use to policymakers in Scotland, and further afield, when considering the next steps necessary to combat the uptake of smoking and vaping among young people.Briefing based on: Haw S, Currie D, Eadie D, Pearce J, MacGregor A, Stead M, et al. The impact of the point-of-sale tobacco display ban on young people in Scotland: before-and-after study. Public Health Research 2020;8(1). https://doi.org/10.3310/phr0801

Ecological drivers of global gradients in avian dispersal inferred from wing morphology

An organism’s ability to disperse influences many fundamental processes, from speciation and geographical range expansion to community assembly. However, the patterns and underlying drivers of variation in dispersal across species remain unclear, partly because standardised estimates of dispersal ability are rarely available. Here we present a global dataset of avian hand-wing index (HWI), an estimate of wing shape widely adopted as a proxy for dispersal ability in birds. We show that HWI is correlated with geography and ecology across 10,338 (&gt;99%) species, increasing at higher latitudes and with migration, and decreasing with territoriality. After controlling for these effects, the strongest predictor of HWI is temperature variability (seasonality), with secondary effects of diet and habitat type. Finally, we also show that HWI is a strong predictor of geographical range size. Our analyses reveal a prominent latitudinal gradient in HWI shaped by a combination of environmental and behavioural factors, and also provide a global index of avian dispersal ability for use in community ecology, macroecology, and macroevolution

Building on the past, shaping the future: The environmental mutagenesis and genomics society

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97167/1/em21765.pd