Quantifying progression and regression across the spectrum of pulmonary tuberculosis: a data synthesis study

BACKGROUND: Prevalence surveys show a substantial burden of subclinical (asymptomatic but infectious) tuberculosis, from which individuals can progress, regress, or even persist in a chronic disease state. We aimed to quantify these pathways across the spectrum of tuberculosis disease. METHODS: We created a deterministic framework of untreated tuberculosis disease with progression and regression between three states of pulmonary tuberculosis disease: minimal (non-infectious), subclinical (asymptomatic but infectious), and clinical (symptomatic and infectious). We obtained data from a previous systematic review of prospective and retrospective studies that followed and recorded the disease state of individuals with tuberculosis in a cohort without treatment. These data were considered in a Bayesian framework, enabling quantitative estimation of tuberculosis disease pathways with rates of transition between states and 95% uncertainty intervals (UIs). FINDINGS: We included 22 studies with data from 5942 individuals in our analysis. Our model showed that after 5 years, 40% (95% UI 31·3-48·0) of individuals with prevalent subclinical disease at baseline recover and 18% (13·3-24·0) die from tuberculosis, with 14% (9·9-19·2) still having infectious disease, and the remainder with minimal disease at risk of re-progression. Over 5 years, 50% (40·0-59·1) of individuals with subclinical disease at baseline never develop symptoms. For those with clinical disease at baseline, 46% (38·3-52·2) die and 20% (15·2-25·8) recover from tuberculosis, with the remainder being in or transitioning between the three disease states after 5 years. We estimated the 10-year mortality of people with untreated prevalent infectious tuberculosis to be 37% (30·5-45·4). INTERPRETATION: For people with subclinical tuberculosis, classic clinical disease is neither an inevitable nor an irreversible outcome. As such, reliance on symptom-based screening means a large proportion of people with infectious disease might never be detected. FUNDING: TB Modelling and Analysis Consortium and European Research Council

Valutazione dei livelli di Health Literacy come possibile ostacolo alle vaccinazioni dell'infanzia

Introduzione. Il dibattito riguardante l'importanza delle vaccinazioni è oggi di grande attualità in Italia, portato alla ribalta dal calo delle coperture vaccinali che ha avuto come conseguenza l’estensione da parte del governo dell’obbligo vaccinale, includendo anche l’obbligo di certificazione per la frequenza delle scuole dell’infanzia. Dall’inizio del 2017 stiamo assistendo alla recrudescenza di un’epidemia di morbillo che è il primo drammatico risultato del calo delle coperture vaccinali e la prova evidente dei rischi che questa può causare. Il caso del vaccino trivalente anti-morbillo-parotite-rosolia (MPR), è quindi un paradigma della diffusione dello scetticismo nei confronti delle vaccinazioni. Questo fenomeno, definito come “Esitazione Vaccinale”, in inglese Vaccine Hesitancy (VH - termine che comprende i concetti di indecisione, incertezza, ritardo, riluttanza nei confronti delle vaccinazioni) è complesso e strettamente legato a differenti contesti sociali, psicologici e culturali, con diversi determinanti: periodo storico, aree geografiche, situazione politica. Fra le argomentazioni addotte dagli esitanti, oltre agli ipotetici rischi di gravi effetti collaterali dei vaccini, ricorrono i sospetti sui potenziali conflitti di interessi fra le autorità sanitarie e le industrie farmaceutiche che imporrebbero, per assecondare i loro profitti, i calendari vaccinali. Questo fenomeno si innesta infatti in un più complessivo senso di sfiducia verso le istituzioni diffuso nel mondo occidentale, e molto forte anche nel nostro paese. Materiali e metodi. Con il presente studio abbiamo voluto indagare attraverso un’indagine basata su di un questionario, alcuni dei fattori che influenzano l’esitazione vaccinale in un campione di genitori del territorio di Pisa con almeno un figlio di età compresa tra 0 e 16 anni. Scopo dello studio. In primo luogo abbiamo indagato l’eventualità di una relazione tra alfabetizzazione sanitaria (in inglese Health Literacy) ed esitazione vaccinale. Con il termine Health Literacy (HL) si intende la capacità individuale di ottenere, capire e trattare le informazioni di salute necessarie per prendere decisioni adatte alla propria salute, nel nostro caso valutata con il test IMETER (Italian Medical Term Recognition). L’esitazione vaccinale dei genitori è stata determinata mediante il VCI calcolato in base alla loro risposta a 6 quesiti sugli argomenti attualmente più dibattuti riguardo alle vaccinazioni. Risultati. Il campione studiato è composto in gran parte da genitori italiani con un adeguato livello di alfabetizzazione sanitaria, ma spesso scettici nei confronti dei vaccini e da genitori stranieri che hanno evidenziato invece un basso livello di HL, legato probabilmente a carenze linguistiche, ma una grande fiducia nelle vaccinazioni. Questa differenza ha fatto si che non sia emersa una significativa correlazione statistica tra i due parametri. Ci siamo quindi interrogati sulla possibile influenza delle fonti di informazioni scelte dai genitori sulla loro opinione riguardo ai vaccini. Dalla nostra indagine è emerso che coloro che utilizzano i mass media (tv o riviste o quotidiani) e i nuovi media (internet e social networks) quale fonte principale di informazione hanno meno fiducia nei vaccini e di conseguenza vaccinano meno i propri figli. Al contrario, chi si affida ai consigli del medico o dei familiari ha più fiducia e tende a vaccinare il bambino con tutte le vaccinazioni che gli vengono proposte. Si conferma così, nel nostro campione, l’opinione che, nella società di oggi, l’opposizione e l’esitazione verso i vaccini sono strettamente interconnesse con l’importanza crescente e la diffusione di internet e delle nuove tecnologie di informazione e comunicazione. Conclusioni. Quanto emerso dallo studio ci porta a confermare il bisogno di interventi di monitoraggio sulle informazioni che circolano sul web riguardo ai vaccini e deve farci riflettere sulla necessità di proporre maggiore informazione corretta tramite altri canali di comunicazione

Association between Urban Greenspace and Health: A Systematic Review of Literature

The current review aimed to explore the association between urban greenspaces and health indicators. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure and two selected health outcomes (objectively measured physical activity (PA) and mental health outcomes (MH)). Two electronic databases—PubMed/Medline and Excerpta Medica dataBASE (EMBASE)—were searched from 1 January 2000 to 30 September 2020. Only articles in English were considered. Out of 356 retrieved articles, a total of 34 papers were included in our review. Of those, 15 assessed the association between urban greenspace and PA and 19 dealt with MH. Almost all the included studies found a positive association between urban greenspace and both PA and MH, while a few demonstrated a non-effect or a negative effect on MH outcomes. However, only guaranteeing access is not enough. Indeed, important elements are maintenance, renovation, closeness to residential areas, planning of interactive activities, and perceived security aspects. Overall, despite some methodological limitations of the included studies, the results have shown almost univocally that urban greenspaces harbour potentially beneficial effects on physical and mental health and well-being

The spread of COVID-19 in six western metropolitan regions:a false myth on the excess of mortality in Lombardy and the defense of the city of Milan

We analyzed the spread of the COVID-19 epidemic in 6 metropolitan regions with similar demographic characteristics, daytime commuting population and business activities: the New York metropolitan area, the Île-de-France region, the Greater London county, Bruxelles-Capital, the Community of Madrid and the Lombardy region. The highest mortality rates 30-days after the onset of the epidemic were recorded in New York (81.2 x 100,000) and Madrid (77.1 x 100,000). Lombardy mortality rate is below average (41.4 per 100,000), and it is the only situation in which the capital of the region (Milan) has not been heavily impacted by the epidemic wave. Our study analyzed the role played by containment measures and the positive contribution offered by the hospital care system. (www.actabiomedica.it)

The natural history of untreated pulmonary tuberculosis in adults: a systematic review and meta-analysis

Stages of tuberculosis disease can be delineated by radiology, microbiology, and symptoms, but transitions between these stages remain unclear. In a systematic review and meta-analysis of studies of individuals with untreated tuberculosis who underwent follow-up (34 cohorts from 24 studies, with a combined sample of 139 063), we aimed to quantify progression and regression across the tuberculosis disease spectrum by extracting summary estimates to align with disease transitions in a conceptual framework of the natural history of tuberculosis. Progression from microbiologically negative to positive disease (based on smear or culture tests) in participants with baseline radiographic evidence of tuberculosis occurred at an annualised rate of 10% (95% CI 6·2–13·3) in those with chest x-rays suggestive of active tuberculosis, and at a rate of 1% (0·3–1·8) in those with chest x-ray changes suggestive of inactive tuberculosis. Reversion from microbiologically positive to undetectable disease in prospective cohorts occurred at an annualised rate of 12% (6·8–18·0). A better understanding of the natural history of pulmonary tuberculosis, including the risk of progression in relation to radiological findings, could improve estimates of the global disease burden and inform the development of clinical guidelines and policies for treatment and prevention

Assessing vaccine hesitancy and health literacy using a new Italian vaccine confidence index and a modified Italian medical term recognition test: A cross-sectional survey on Italian parents

ABSTRACTThe decline in children’s vaccination coverage and the resurgence of preventable infectious diseases draw attention to parents’ vaccine hesitancy. Our study introduces two validated tools to independently assess vaccine hesitancy and health literacy among parents with school-age children. We developed a Vaccine Confidence Index (VCI) from 10 Likert items, exploring their relationships through exploratory and confirmatory factor analyses. We modified the IMETER (Italian medical term recognition test) to measure health literacy. We assessed the internal consistency of the modified IMETER and the 10 Likert items using Cronbach’s alpha test (α) and McDonald’s omega total coefficient (ω) with good results (ω = 0.92, α = 0.90; ω = 0.87, α = 0.82 respectively). We used these tools within a questionnaire conducted on 743 parents recruited from pediatric clinic waiting rooms in Italy, collecting demographic data, information sources on vaccines and vaccine-preventable diseases knowledge. The VCI resulting from factor analyses consisted of six items on a ten-point Likert scale, reflecting the ratio of positive to negative items. The survey revealed significant variations in the VCI according to individual features such as education, use of social networks, or Health institutions as sources of information. Multivariate logistic regression identified an association between vaccine intention and the VCI. Health literacy was functional for 91.2% of participants, but knowledge about vaccine-preventable diseases was generally low. The VCI showed no significant association with health literacy and vaccine-preventable diseases knowledge. The VCI and the modified IMETER effectively assess vaccination attitude and health literacy, offering valuable public health tools for tailoring vaccination campaigns to hesitant population subgroups

Quantifying progression and regression across the spectrum of pulmonary tuberculosis: a data synthesis study

Background Prevalence surveys show a substantial burden of subclinical (asymptomatic but infectious) tuberculosis, from which individuals can progress, regress, or even persist in a chronic disease state. We aimed to quantify these pathways across the spectrum of tuberculosis disease.Methods We created a deterministic framework of untreated tuberculosis disease with progression and regression between three states of pulmonary tuberculosis disease: minimal (non-infectious), subclinical (asymptomatic but infectious), and clinical (symptomatic and infectious). We obtained data from a previous systematic review of prospective and retrospective studies that followed and recorded the disease state of individuals with tuberculosis in a cohort without treatment. These data were considered in a Bayesian framework, enabling quantitative estimation of tuberculosis disease pathways with rates of transition between states and 95% uncertainty intervals (UIs).Findings We included 22 studies with data from 5942 individuals in our analysis. Our model showed that after 5 years, 40% (95% UI 31 center dot 3-48 center dot 0) of individuals with prevalent subclinical disease at baseline recover and 18% (13 center dot 3-24 center dot 0) die from tuberculosis, with 14% (9 center dot 9-19 center dot 2) still having infectious disease, and the remainder with minimal disease at risk of re-progression. Over 5 years, 50% (40 center dot 0-59 center dot 1) of individuals with subclinical disease at baseline never develop symptoms. For those with clinical disease at baseline, 46% (38 center dot 3-52 center dot 2) die and 20% (15 center dot 2-25 center dot 8) recover from tuberculosis, with the remainder being in or transitioning between the three disease states after 5 years. We estimated the 10-year mortality of people with untreated prevalent infectious tuberculosis to be 37% (30 center dot 5-45 center dot 4).Interpretation For people with subclinical tuberculosis, classic clinical disease is neither an inevitable nor an irreversible outcome. As such, reliance on symptom-based screening means a large proportion of people with infectious disease might never be detected.Funding TB Modelling and Analysis Consortium and European Research Council.Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license