Improvements in prevalence trend fitting and incidence estimation in EPP 2013

OBJECTIVE: Describe modifications to the latest version of the Joint United Nations Programme on AIDS (UNAIDS) Estimation and Projection Package component of Spectrum (EPP 2013) to improve prevalence fitting and incidence trend estimation in national epidemics and global estimates of HIV burden. METHODS: Key changes made under the guidance of the UNAIDS Reference Group on Estimates, Modelling and Projections include: availability of a range of incidence calculation models and guidance for selecting a model; a shift to reporting the Bayesian median instead of the maximum likelihood estimate; procedures for comparison and validation against reported HIV and AIDS data; incorporation of national surveys as an integral part of the fitting and calibration procedure, allowing survey trends to inform the fit; improved antenatal clinic calibration procedures in countries without surveys; adjustment of national antiretroviral therapy reports used in the fitting to include only those aged 15–49 years; better estimates of mortality among people who inject drugs; and enhancements to speed fitting. RESULTS: The revised models in EPP 2013 allow closer fits to observed prevalence trend data and reflect improving understanding of HIV epidemics and associated data. CONCLUSION: Spectrum and EPP continue to adapt to make better use of the existing data sources, incorporate new sources of information in their fitting and validation procedures, and correct for quantifiable biases in inputs as they are identified and understood. These adaptations provide countries with better calibrated estimates of incidence and prevalence, which increase epidemic understanding and provide a solid base for program and policy planning

National evaluation of the neighbourhood nurseries: integrated report

Report description: The NNI was launched in 2001 to provide high quality childcare in the most disadvantaged neighbourhoods of England, to help parents into employment, reduce child poverty and boost children’s development. By 2005 45,000 new childcare places had been created in approximately 1,400 neighbourhood nurseries. This report brings together the findings of the four individual strands of the National Evaluation of Neighbourhood Nurseries Initiative as shown above and makes a number of recommendations. The report shows the rationale for the government’s strategy in targeting disadvantaged neighbourhoods and in focusing on high quality childcare to provide the link between raising parental employment and income and improving children’s life chances

A Systematic Review of Dental Disease in Patients Undergoing Cancer Therapy

Introduction: The purpose of this systematic review was to evaluate the literature and update our current understanding of the impact of present cancer therapies on the dental apparatus (teeth and periodontium) since the 1989 NIH Development Consensus Conference on the Oral Compli­cations of Cancer Therapies. Review Method: A systematic literature search was con­ducted with assistance from a research librarian in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 1990 and 31 December 2008. Each study was independently assessed by two reviewers. Taking into account predetermined quality measures, a weighted prevalence was calculated for the prevalence of dental caries, severe gingival disease, and dental infection. Data on DMFT/dmft, DMFS/dmfs, plaque, and gingival indexes were also gathered. The level of evidence, recommendation, and guideline (if possible) were given for published preventive and management strategies. Results: Sixty-four published papers between 1990 and 2008 were reviewed. The weighted overall prevalence of dental caries was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (SD, 7.98; n=457). The overall plaque index for patients who were post­antineoplastic therapy was 1.38 (SD, 0.25; n=189). The GI for patients who were post-chemotherapy was 1.02 (SD, 0.15; n=162). The weighted prevalence of dental infections/ abscess during chemotherapy was reported in three studies and was 5.8%. Conclusions: Patients who were post-radiotherapy had the highest DMFT. The use of fluoride products and chlorhex­idine rinses are beneficial in patients who are post-radiotherapy. There continues to be lack of clinical studies on the extent and severity of dental disease that are associated with infectious complications during cancer therapy

How primary care can contribute to good mental health in adults.

The need for support for good mental health is enormous. General support for good mental health is needed for 100% of the population, and at all stages of life, from early childhood to end of life. Focused support is needed for the 17.6% of adults who have a mental disorder at any time, including those who also have a mental health problem amongst the 30% who report having a long-term condition of some kind. All sectors of society and all parts of the NHS need to play their part. Primary care cannot do this on its own. This paper describes how primary care practitioners can help stimulate such a grand alliance for health, by operating at four different levels - as individual practitioners, as organisations, as geographic clusters of organisations and as policy-makers

Bioinformatic interrogation of expression array data to identify nutritionally regulated genes potentially modulated by DNA methylation

DNA methylation occurs at CpG dinucleotide sites within the genome and is recognised as one of the mechanisms involved in regulation of gene expression. CpG sites are relatively underrepresented in the mammalian genome, but occur densely in regions called CpG islands (CGIs). CGIs located in the promoters of genes inhibit transcription when methylated by impeding transcription factor binding. Due to the malleable nature of DNA methylation, environmental factors are able to influence promoter CGI methylation patterns and thus influence gene expression. Recent studies have provided evidence that nutrition (and other environmental exposures) can cause altered CGI methylation but, with a few exceptions, the genes influenced by these exposures remain largely unknown. Here we describe a novel bioinformatics approach for the analysis of gene expression microarray data designed to identify regulatory sites within promoters of differentially expressed genes that may be influenced by changes in DNA methylation

Addressing the pitfalls when designing intervention studies to discover and validate biomarkers of habitual dietary intake

Introduction Dietary exposure monitoring within populations is reliant on self-reported measures such as Food Frequency Questionnaires and diet diaries. These methods often contain inaccurate information due to participant misreporting, non-compliance and bias. Urinary metabolites derived from individual foods could provide additional objective indicators of dietary exposure. For biomarker approaches to have utility it is essential that they cover a wide-range of commonly consumed foods and the methodology works in a real-world environment. Objectives To test that the methodology works in a real-world environment and to consider the impact of the major sources of likely variance; particularly complex meals, different food formulations, processing and cooking methods, as well as the dynamics of biomarker duration in the body. Methods We designed and tested a dietary exposure biomarker discovery and validation strategy based on a food intervention study involving free-living individuals preparing meals and collecting urine samples at home. Two experimental periods were built around three consecutive day menu plans where all foods and drinks were provided (n = 15 and n = 36). Results The experimental design was validated by confirming known consumption biomarkers in urinary samples after the first menu plan. We tested biomarker performance with different food formulations and processing methods involving meat, wholegrain, fruits and vegetables. Conclusion It was demonstrated that spot urine samples, together with robust dietary biomarkers, despite major sources of variance, could be used successfully for dietary exposure monitoring in large epidemiological studies

Selenium supplementation to improve bone health in postmenopausal women: the SeMS three-armRCT

Background Observational and pre-clinical studies have reported an association between selenium status, bone density, bone turnover and fracture risk. Selenium is an anti-oxidant, so we hypothesised that selenium could reduce the pro-resorptive action of reactive oxygen species on osteoclasts. Population mortality data suggest that the optimum range for serum selenium is 120–150 µg/l. Most adults in Europe are relatively selenium insufficient compared with adults in the USA and other geographical areas. Objectives The objectives of the study were to determine if selenium supplementation in postmenopausal women with osteopenia decreased bone turnover, improved physical function or decreased markers of oxidative stress and inflammation. Design We conducted a 6-month double-blind, randomised, placebo-controlled trial. Setting This was a single-centre study in Sheffield, UK. Participants We recruited 120 postmenopausal women with osteopenia or osteoporosis. One hundred and fifteen women completed follow-up and were included in the intention-to-treat analysis. Interventions The interventions were sodium selenite as Selenase 200 µg/day, Selenase 50 µg/day (biosyn, Germany) and placebo. Main outcome measures The primary end point was urine N–terminal cross-linking telopeptide of type I collagen/Cr (NTX/Cr) at 26 weeks. Groups were compared with an analysis of covariance, through the use of Hochberg testing. Secondary end points were other biochemical markers of bone turnover, bone mineral density by dual-energy X-ray absorptiometry and physical function scores (short physical performance battery and grip strength). The mechanistic end points were markers of inflammation and anti-oxidant activity (glutathione peroxidase, highly sensitive C-reactive protein and interleukin 6). Results In the 200 µg/day group, mean serum selenium increased from 78.8 µg/l (95% confidence interval 73.5 to 84.2 µg/l) to 105.7 µg/l (95% confidence interval 99.5 to 111.9 µg/l) at 26 weeks. Urine NTX/Cr did not differ between treatment groups at 26 weeks. None of the secondary or mechanistic end-point measurements differed between the treatment groups at 26 weeks. Conclusions We conclude that selenium supplementation at these doses does not affect bone turnover (assessed by NTX/Cr) and is not beneficial for musculoskeletal health in postmenopausal women. Trial registration IRAS 200308, EudraCT 2016-002964-15 and ClinicalTrials.gov NCT02832648. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 6. See the NIHR Journals Library website for further project information

Long-term and recent changes in sea level in the Falkland Islands

Mean sea level measurements made at Port Louis in the Falkland Islands in 1981-2, 1984 and 2009, together with values from the nearby permanent tide gauge at Port Stanley, have been compared to measurements made at Port Louis in 1842 by James Clark Ross. The long-term rate of change of sea level is estimated to have been +0.75 ± 0.35 mm/year between 1842 and the early 1980s, after correction for air pressure effects and for vertical land movement due to Glacial Isostatic Adjustment (GIA). The 2009 Port Louis data set is of particular importance due to the availability of simultaneous information from Port Stanley. The data set has been employed in two ways, by providing a short recent estimate of mean sea level itself, and by enabling the effective combination of measurements at the two sites. The rate of sea level rise observed since 1992, when the modern Stanley gauge was installed, has been larger at 2.51 ± 0.58 mm/year, after correction for air pressure and GIA. This rate compares to a value of 2.79 ± 0.42 mm/year obtained from satellite altimetry in the region over the same period. Such a relatively recent acceleration in the rate of sea level rise is consistent with findings from other locations in the southern hemisphere and globall

Burden of disease in Thailand: changes in health gap between 1999 and 2004

<p>Abstract</p> <p>Background</p> <p>Continuing comprehensive assessment of population health gap is essential for effective health planning. This paper assessed changes in the magnitude and pattern of disease burden in Thailand between 1999 and 2004. It further drew lessons learned from applying the global burden of disease (GBD) methods to the Thai context for other developing country settings.</p> <p>Methods</p> <p>Multiple sources of mortality and morbidity data for both years were assessed and used to estimate Disability-Adjusted Life Years (DALYs) loss for 110 specific diseases and conditions relevant to the country's health problems. Causes of death from national vital registration were adjusted for misclassification from a verbal autopsy study.</p> <p>Results</p> <p>Between 1999 and 2004, DALYs loss per 1,000 population in 2004 slightly decreased in men but a minor increase in women was observed. HIV/AIDS maintained the highest burden for men in both 1999 and 2004 while in 2004, stroke took over the 1999 first rank of HIV/AIDS in women. Among the top twenty diseases, there was a slight increase of the proportion of non-communicable diseases and two out of three infectious diseases revealed a decrease burden except for lower respiratory tract infections.</p> <p>Conclusion</p> <p>The study highlights unique pattern of disease burden in Thailand whereby epidemiological transition have occurred as non-communicable diseases were on the rise but burden from HIV/AIDS resulting from the epidemic in the 1990s remains high and injuries show negligent change. Lessons point that assessing DALY over time critically requires continuing improvement in data sources particularly on cause of death statistics, institutional capacity and long term commitments.</p