Editorial: Building Back Progress Towards Meeting Sustainable Development Goal 3 by 2030: Applications of AI and Digital Solutions.

The COVID-19 pandemic has exposed the vulnerability of many health systems across the world, including some of the highest income countries, when they were overwhelmed by rapid surges of demand for health services and disruptions to the global healthcare supply chain. The suspension or even closure of some life-saving healthcare facilities and provisions, such as childhood immunization programmes, coupled with the fear of disease exposure, have made access to healthcare challenging. These factors may have led to a rise in preventable deaths due to delayed diagnosis of cancers and other diseases, and poor management of existing chronic conditions such as diabetes

A cluster-randomized trial to reduce caesarean delivery rates in Quebec: cost-effectiveness analysis.

BACKGROUND: Widespread increases in caesarean section (CS) rates have sparked concerns about risks to mothers and infants and rising healthcare costs. A multicentre, two-arm, cluster-randomized trial in Quebec, Canada assessed whether an audit and feedback intervention targeting health professionals would reduce CS rates for pregnant women compared to usual care, and concluded that it reduced CS rates without adverse effects on maternal or neonatal health. The effect was statistically significant but clinically small. We assessed cost-effectiveness to inform scale-up decisions. METHODS: A prospective economic evaluation was undertaken using individual patient data from the Quality of Care, Obstetrics Risk Management, and Mode of Delivery (QUARISMA) trial (April 2008 to October 2011). Analyses took a healthcare payer perspective. The time horizon captured hospital-based costs and clinical events for mothers and neonates from labour onset to 3 months postpartum. Resource use was identified and measured from patient charts and valued using standardized government sources. We estimated the changes in CS rates and costs for the intervention group (versus controls) between the baseline and post-intervention periods. We examined heterogeneity between clinical subgroups of high-risk versus low-risk pregnancies and estimated the joint uncertainty in cost-effectiveness over 20,000 trial simulations. We decomposed costs to identify drivers of change. RESULTS: The intervention group experienced per-patient reductions of 0.005 CS (95% confidence interval (CI): -0.015 to 0.004, P = 0.09) and $180 (95$277 to - $83, P < 0.001). Women with low-risk pregnancies experienced statistically significant reductions in CS rates and costs; changes for the high-risk subgroup were not significant. The intervention was "dominant" (effective in reducing CS and less costly than usual care) in 86.08$190, 95% CI: -$255 to -$125, P < 0.001). Given 88,000 annual provincial births, a similar intervention could save $15.8 million (range:$7.3 to $24.4 million) in Quebec annually. CONCLUSIONS: From a healthcare payer perspective, a multifaceted intervention involving audits and feedback resulted in a small reduction in caesarean deliveries and important cost savings. Cost reductions are consistent with improved quality of care in intervention group hospitals. TRIAL REGISTRATION: International Clinical Trials Registry Platform, ISRCTN95086407 . Registered on 23 October 2007

A prospective, population-based study of the role of visual impairment in motor vehicle crashes among older drivers: the SEE study.

PURPOSE: To determine the role of vision and visual attention factors in automobile crash involvement. METHODS: Drivers aged 65 to 84 years were identified during the baseline interview (1993-1995) of the Salisbury Eye Evaluation (SEE) Study. Crash involvement through December 1997 was determined from Maryland State motor vehicle records. Vision tests at baseline included distance acuity at normal and low luminance, contrast sensitivity, glare sensitivity, stereoacuity, and visual fields. Visual attention was evaluated with the Useful Field of View Test (UFOV; Visual Awareness, Chicago, IL). Survival analysis was used to determine the relative risk of a crash as a function of demographic variables, miles driven, vision, and visual attention. RESULTS: One hundred twenty (6.7%) of the 1801 drivers were involved in a crash during the observation interval. Glare sensitivity and binocular field loss were significant predictors of crash involvement (P < 0.05). For those with moderate or better vision (<3 letters for glare sensitivity and <20 points missed for binocular visual fields) increased glare sensitivity or reduced visual fields were, paradoxically, associated with a reduction in crash risk, whereas for those with poorer levels of vision, increased glare sensitivity or reduced visual fields were associated with increased crash risk. Worse UFOV score was associated with increased crash risk. CONCLUSIONS: Glare sensitivity, visual field loss, and UFOV were significant predictors of crash involvement. Acuity, contrast sensitivity, and stereoacuity were not associated with crashes. These results suggest that current vision screening for drivers' licensure, based primarily on visual acuity, may miss important aspects of visual impairment

Effects of zero-dose vaccination status in early childhood and level of community socioeconomic development on learning attainment in preadolescence in India: a population-based cohort study

Introduction ‘Zero-dose’ children (infants who fail to receive the first dose of diphtheria-tetanus-pertussis-containing vaccine) face substantial adversity in early childhood and may be at risk of failure to thrive. To inform a new global policy, we studied the relationship between zero-dose vaccination status in early childhood and learning attainment in preadolescence, and considered whether community socioeconomic development moderated these relationships. Methods We constructed a population cohort from the 2019 India Human Development Survey panel dataset to study the comparative performance of zero-dose versus vaccinated children identified in wave I (2004–2005) on basic learning tests at ages 8–11 in wave II (2011–2012). The outcome was a sum of reading, writing and math scores ranging from 0 (no knowledge) to 8. We fit three linear regression models examining whether child zero-dose status predicts learning attainment: a crude model, a main effects model including all prespecified covariates, and a model including an interaction between child zero-dose status and community development level. Results The analytic sample included 3781 children from 3781 households in 1699 communities, representing 18.2 million children. Predicted learning attainment scores for zero-dose children were lower than those for vaccinated children by −1.698 (95% CI −2.02 to −1.37; p&lt;0.001) points (crude model) and −0.477 (95% CI −0.78 to −0.18; p&lt;0.001) points (adjusted for all prespecified covariates). We found strong evidence of effect modification. The model including all prespecified correlates and an interaction predicted no effect of child zero-dose status in urban areas (p=0.830) or more developed rural villages (p=0.279), but an important effect in the least developed rural villages, where zero-dose children were expected to have test scores −0.750 (95% CI −1.15 to −0.344; p&lt;0.001) points lower than vaccinated children. Conclusion Zero-dose children living in contexts of very low socioeconomic development are at elevated risk of poor learning attainment in preadolescence

Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses.

BACKGROUND: Although rare, cardiac arrest during pregnancy is the leading cause of maternal death. Recently, its incidence has been increasing worldwide because more pregnant women have risk factors. The provision of early, high-quality cardiopulmonary resuscitation (CPR) plays a major role in the increased likelihood of survival; therefore, it is important for clinicians to know how to manage it. Due to the aortocaval compression caused by the gravid uterus, clinical guidelines often emphasise the importance of maternal positioning during CPR, but there has been little evidence regarding which position is most effective. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and OpenGrey (updated on April 3, 2021). We included clinical trials and observational studies with reported outcomes related to successful resuscitations. RESULTS: We included eight studies from the 1,490 screened. The eight studies were simulation-based, crossover trials that examine the quality of chest compressions. No data were available about the survival rates of mothers or foetuses/neonates. The meta-analyses showed that resuscitation of pregnant women in the 27°-30° left-lateral tilt position resulted in lower quality chest compressions. The difference is an 19% and 9% reduction in correct compression depth rate and correct hand position rate, respectively, compared with resuscitations in the supine position. Inexperienced clinicians find it difficult to perform chest compressions in the left-lateral tilt position. CONCLUSIONS: Given that manual left uterine displacement allows the patient to remain supine, the resuscitation of women in the supine position using manual left uterine displacement should continue to be supported. Further research is needed to fill knowledge gaps regarding the effects of maternal positioning on clinical outcomes, such as survival rates following maternal cardiac arrest

Ir-LBP, an Ixodes ricinus Tick Salivary LTB4-Binding Lipocalin, Interferes with Host Neutrophil Function

BACKGROUND: During their blood meal, ticks secrete a wide variety of proteins that can interfere with their host's defense mechanisms. Among these proteins, lipocalins play a major role in the modulation of the inflammatory response. METHODOLOGY/PRINCIPAL FINDINGS: We previously identified 14 new lipocalin genes in the tick Ixodes ricinus. One of them codes for a protein that specifically binds leukotriene B4 with a very high affinity (Kd: +/-1 nM), similar to that of the neutrophil transmembrane receptor BLT1. By in silico approaches, we modeled the 3D structure of the protein and the binding of LTB4 into the ligand pocket. This protein, called Ir-LBP, inhibits neutrophil chemotaxis in vitro and delays LTB4-induced apoptosis. Ir-LBP also inhibits the host inflammatory response in vivo by decreasing the number and activation of neutrophils located at the tick bite site. Thus, Ir-LBP participates in the tick's ability to interfere with proper neutrophil function in inflammation. CONCLUSIONS/SIGNIFICANCE: These elements suggest that Ir-LBP is a "scavenger" of LTB4, which, in combination with other factors, such as histamine-binding proteins or proteins inhibiting the classical or alternative complement pathways, permits the tick to properly manage its blood meal. Moreover, with regard to its properties, Ir-LBP could possibly be used as a therapeutic tool for illnesses associated with an increased LTB4 production.Journal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Burden of infectious disease studies in Europe and the United Kingdom: a review of methodological design choices.

This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results

Estimation in generalised linear mixed models with binary outcomes by simulated maximum likelihood

Fitting multilevel models to discrete outcome data is problematic because the discrete distribution of the response variable implies an analytically intractable log-likelihood function. Among a number of approximate methods proposed, second-order penalised quasi-likelihood (PQL) is commonly used and is one of the most accurate. Unfortunately, even the second-order PQL approximation has been shown to produce estimates biased toward zero in certain circumstances. This bias can be marked especially when the data are sparse. One option to reduce this bias is to use Monte-Carlo simulation. A bootstrap bias correction method proposed by Kuk has been implemented in MLwiN. However, a similar technique based on the Robbins-Monro (RM) algorithm is potentially more efficient. An alternative is to use simulated maximum likelihood (SML), either alone or to refine estimates identified by other methods. In this article, we first compare bias correction using the RM algorithm, Kuk’s method and SML. We find that SML performs as efficiently as the other two methods and also yields standard errors of the bias-corrected parameter estimates and an estimate of the log-likelihood at the maximum, with which nested models can be compared. Secondly, using simulated and real data examples, we compare SML, second-order Laplace approximation (as implemented in HLM), Markov Chain Monte-Carlo (MCMC) (in MLwiN) and numerical integration using adaptive quadrature methods (in Stata’s GLLAMM and in SAS’s proc NLMIXED). We find that when the data are sparse, the second-order Laplace approximation produces markedly lower parameter estimates, whereas the MCMC method produces estimates that are noticeably higher than those from the SML and quadrature methods. Although proc NLMIXED is much faster than GLLAMM, it is not designed to fit models of more than two levels. SML produces parameter estimates and log-likelihoods very similar to those from quadrature methods. Further our SML approach extends to handle other link functions, discrete data distributions, non-normal random effects and higher-level models. </jats:p

Inequalities in influenza vaccine uptake among people aged over 74 years in Britain.

BACKGROUND: In the UK, payments to providers (General Practitioners) for vaccinating all people aged over 64 years old against influenza commenced in 2000. Little information exists on the relationship between uptake and need. We assessed factors influencing uptake and equity in uptake in over 74 year olds. METHODS: We analysed cohort data from 5572 subjects in a community-based trial. Analyses took into account clustering and location of general practices in terms of Underprivileged Area (UPA) Score and area Standardised Mortality Ratio (SMR). RESULTS: Vaccine uptake in practices in the most deprived tertile was 0.88 (95% CI 0.80-0.96) that of the least deprived and mid tertile, adjusted for confounding. Within each deprivation tertile, uptake in the mid and highest SMR tertile was 0.86 (95% CI 0.79, 0.94) and 0.87 (95% CI 0.81, 0.95) that of the lowest respectively. Uptake was 10% lower at the most in individuals with poorer quality housing. Higher uptake if married or with respiratory conditions and lower uptake if smoked had cognitive impairment or depression did not explain the socioeconomic differentials. CONCLUSIONS: Lower uptake in practices in deprived areas supports targeting of resources. At the individual level, those who are more isolated require support to access influenza vaccination

A cluster-randomized trial to reduce caesarean delivery rates in Quebec: cost-effectiveness analysis.

BackgroundWidespread increases in caesarean section (CS) rates have sparked concerns about risks to mothers and infants and rising healthcare costs. A multicentre, two-arm, cluster-randomized trial in Quebec, Canada assessed whether an audit and feedback intervention targeting health professionals would reduce CS rates for pregnant women compared to usual care, and concluded that it reduced CS rates without adverse effects on maternal or neonatal health. The effect was statistically significant but clinically small. We assessed cost-effectiveness to inform scale-up decisions.MethodsA prospective economic evaluation was undertaken using individual patient data from the Quality of Care, Obstetrics Risk Management, and Mode of Delivery (QUARISMA) trial (April 2008 to October 2011). Analyses took a healthcare payer perspective. The time horizon captured hospital-based costs and clinical events for mothers and neonates from labour onset to 3&nbsp;months postpartum. Resource use was identified and measured from patient charts and valued using standardized government sources. We estimated the changes in CS rates and costs for the intervention group (versus controls) between the baseline and post-intervention periods. We examined heterogeneity between clinical subgroups of high-risk versus low-risk pregnancies and estimated the joint uncertainty in cost-effectiveness over 20,000 trial simulations. We decomposed costs to identify drivers of change.ResultsThe intervention group experienced per-patient reductions of 0.005 CS (95% confidence interval (CI): -0.015 to 0.004, P = 0.09) and $180 (95$277 to - 83, P < 0.001). Women with low-risk pregnancies experienced statistically significant reductions in CS rates and costs; changes for the high-risk subgroup were not significant. The intervention was "dominant" (effective in reducing CS and less costly than usual care) in 86.08% of simulations. It reduced costs in 99.99% of simulations. Cost reductions were driven by lower rates of neonatal complications in the intervention group (-190, 95% CI: -$255 to -$125, P &lt; 0.001). Given 88,000 annual provincial births, a similar intervention could save $15.8 million (range:$7.3 to $24.4 million) in Quebec annually.ConclusionsFrom a healthcare payer perspective, a multifaceted intervention involving audits and feedback resulted in a small reduction in caesarean deliveries and important cost savings. Cost reductions are consistent with improved quality of care in intervention group hospitals.Trial registrationInternational Clinical Trials Registry Platform, ISRCTN95086407 . Registered on 23 October 2007