Health Policy Measures Research Articles

Red blood cell membrane trans fatty acid levels and risk of non-Hodgkin lymphoma: a prospective nested case–control study

Trans fatty acid (TFA) intake persists in much of the world, posing ongoing threats to public health that warrant further elucidation. Published evidence suggests a positive association of self-reported TFA intake with non-Hodgkin lymphoma (NHL) risk. To confirm those reports, we conducted a prospective study of prediagnosis RBC membrane TFA levels and risk of NHL and common NHL histologic subtypes. We conducted a nested case-control study in Nurses' Health Study and Health Professionals Follow-Up Study participants with archived RBC specimens and no history of cancer at blood draw (1989-1090 and 1994-1995, respectively). We confirmed 583 incident NHL cases (332 women and 251 men) and individually matched 583 controls on cohort (sex), age, race, and blood draw date/time. We analyzed RBC membrane TFA using GLC (in 2013-2014) and expressed individual TFA levels as a percentage of total fatty acids. We used unconditional logistic regression adjusted for the matching factors to estimate ORs and 95% CIs for overall NHL risk per 1 SD increase in TFA level and assessed histologic subtype-specific associations with multivariable polytomous logistic regression. Total and individual TFA levels were not associated with risk of all NHL or most subtypes. We observed a positive association of total TFA levels with diffuse large B cell lymphoma (DLBCL) risk [n=98 cases; OR (95% CI) per 1 SD increase: 1.30 (1.05, 1.61); P=0.015], driven by trans 18:1n-9(ω-9)/elaidic acid [OR (95% CI): 1.34 (1.08, 1.66); P=0.007], trans 18:1n-7/vaccenic acid [OR (95% CI): 1.28 (1.04, 1.58); P=0.023], and trans 18:2n-6t,t [OR (95% CI): 1.26 (1.01, 1.57); P=0.037]. Our findings extended evidence for TFA intake and DLBCL risk but not for other NHL subtypes. Reduced TFA consumption through dietary choices or health policy measures may support prevention of DLBCL, an aggressive NHL subtype.

Bedarfe der Langzeitpflege in der COVID-19-Pandemie

Das Virus SARS-CoV‑2 und die damit einhergehende Erkrankung COVID-19 stellen die Gesundheitssysteme weltweit vor große Herausforderungen. Besonders die vulnerable Gruppe pflegebedürftiger Menschen in der Langzeitpflege ist gefährdet, schwere Krankheitsverläufe zu erleiden oder an der Infektion zu versterben.In einer bundesweiten Querschnittsstudie wurden mittels einer Onlinebefragung die Situation und die Bedarfe stationärer und ambulanter Langzeitpflegeeinrichtungen während der SARS-CoV-2-Pandemie erfasst und analysiert.Konkret forderten Teilnehmende aus 531 Einrichtungen einheitliche Handlungsempfehlungen zu SARS-CoV‑2, ausreichende und finanzierbare Schutz- und Hygienematerialien, Reihentestungen in den Einrichtungen, fundierte Beratung bei der Umsetzung von Maßnahmen, einen konkreten Pandemieplan und unterstützende Öffentlichkeitsarbeit in den Medien. Dazu wurden eine höhere Vergütung der Pflegenden, eine bessere Personalausstattung und stärkere Wertschätzung der pflegerischen Profession gefordert.Um die vulnerable Gruppe pflegebedürftiger Menschen vor einer SARS-CoV-2-Infektion zu schützen, muss die Langzeitpflege stärker in den Fokus der gesundheitspolitischen Maßnahmen während der Pandemie gerückt werden.

COVID-19 pandemic in Finland – Preliminary analysis on health system response and economic consequences

ObjectivesThe objective of this study was to describe and analyze the impact of the coronavirus disease COVID-19 on health policy, social- and health system, and economic and financing system to prevent, treat, contain and monitor the virus in Finland. MethodsThis study provides early outcomes of health policy measures, social- and health system capacity as well as economic challenges in COVID-19 pandemic in Finland. This paper is based available documents and reports of different ministries and social, health and economic authorities collected online. This was complemented by other relevant pandemic data from Finland. ResultsThe impact of COVID-19 pandemic on the Finnish society has been unpredictable although it has not been as extensive and massive than in many other countries. As the situation evolved the Government took strict measures to stop the spread of the virus (e.g. Emergency Powers Act). Available information shows that the economic consequences will be drastic also in Finland, albeit perhaps less dramatic than in large industrial economies. ConclusionsFinland has transferred gradually to a “hybrid strategy”, referring to a move from extensive restrictive measures to enhanced management of the epidemic. However, health system must be prepared for prospective setback. It is possible, that COVID-19 pandemic has accelerated the development of digital health services and telemedicine in Finnish healthcare system.

Disability, Ethics, and Health Care in the COVID-19 Pandemic

This article considers key ethical, legal, and medical dilemmas arising for people with disabilities in the COVID-19 pandemic. We highlight the limited application of existing frameworks of emergency planning with and for people with disabilities in the COVID-19 pandemic, explore key concerns and issues affecting the health care of people with disabilities (i.e., access to information and clinician-patient communication, nondiscrimination and reasonable accommodations, and rationing of medical goods), and indicate possible solutions. Finally, we suggest clinical and public health policy measures to ensure that people with disabilities are included in the planning of future pandemic-related efforts.The devastation evoked by the COVID-19 pandemic raises challenging dilemmas in bioethics. It also speaks to social justice issues that have plagued historically marginalized communities in the United States.Responses to the pandemic must be bound by legal standards, principles of distributive justice, and societal norms of protecting vulnerable populations-core commitments of public health-to ensure that inequities are not exacerbated, and should provide a pathway for improvements to ensure equitable access and treatment in the future.

COVID-19 Crisis Management in Luxembourg: Insights from an Epidemionomic Approach

We develop an epidemionomic model that jointly analyzes the health and economic responses to the COVID-19 crisis and to the related containment and public health policy measures implemented in Luxembourg and in the Greater Region. The model has a weekly structure and covers the whole year 2020. With a limited number of parameters, the model is calibrated to depict the pre-crisis evolution of the Luxembourg economy, and to match post-lockdown leading economic indicators and industry-specific infection curves. The nowcasting part of our analysis reveals that each week of lockdown reduces national output by about 28% (and annual GDP by 0.54%). A first peak of the infection curve was observed at the very beginning of April. If the lockdown measures had been permanent, annual GDP would have decreased by 22% in 2020, the number of COVID-19 cases would have reached zero around mid-June, and the proportion of recovered people would have reached 1.4% of the population. In an economy heavily relying on skill-intensive services, we show that the role of teleworking has been instrumental to limiting the weekly economic output loss (almost by one half) and the propagation of the virus. In the forecasting part of the analysis, we quantify the epidemiological and economic responses to gradual deconfinement measures under various public health scenarios. If the post-lockdown transmission rates could be kept constant throughout the deconfinement period, restarting all sectors would have huge effects on the economy (limiting the annual GDP loss to about 7%) and no effect on the aggregate infection curve. While it is a good time for lifting containment measures, there is also a risk that increasing the density of employees at the workplace and resuming social activities would induce a rebound in the infection curve. Preventing such a relapse is possible with PCR testing of both national and cross-border workers, and with accompanying measures such as (i) maintaining teleworking practices, (ii) reopening hotels, restaurants and cafes at half of their full capacity or with equivalent physical distancing measures and last but not least, (iii) sustaining distancing measures in social activities. Overall, in our worst-case scenario, combining bi-monthly testing with contact tracing and quarantining measures appear to be a sufficient (perhaps not necessary) policy option in the aftermath of the deconfinement plan.

Impact of Tobacco Control Policies on Smoking-Related Cancer Incidence in Germany 2020 to 2050-A Simulation Study.

Germany is known for its weak tobacco control. We aimed to provide projections of potentially avoidable cancer cases under different tobacco control policy intervention scenarios. To estimate numbers and proportions of potentially avoidable cancer cases under different policy intervention scenarios (cigarette price increases, comprehensive marketing ban, and plain packaging), we calculated cancer site-specific potential impact fractions by age, sex, and year of study period (2020-2050), considering latency periods between reduction in smoking prevalence and manifestation in declining cancer excess risks. To obtain estimates of future incident case numbers, we assumed a continuation of recent smoking trends, and combined German cancer registry data with forecasted population sizes, published effect sizes, and national daily smoking prevalence data. Over a 30-year horizon, an estimated 13.3% (men 14.0% and women 12.2%) of smoking-related cancer cases could be prevented if a combination of different tobacco control policies were to be implemented in Germany, with repeated price increases being the most effective single policy (men 8.5% and women 7.3%). Extensive sensitivity analyses indicated that the model is fairly robust. Our results suggest that the expected cancer incidence in Germany could be considerably reduced by implementing tobacco control policies as part of a primary cancer prevention strategy. Our straightforward modeling framework enables a comparison of the impact of different health policy measures. To further accelerate the currently observed tentative trend of declining smoking prevalence in Germany and thereby curtail smoking-related cancer incidence, there is a great need to urgently intensify efforts in tobacco control.

The Influence on the Suicidal Ideation of Elderly People with Sense of Loneliness : Verification of the Mediating Effect of Health Level

본 연구에서 노인의 고독감이 자살생각에 미치는 직접적 영향 및 노인의 고독감과 자살생각 영향에서 건강수준의 매개효과를 검증하여 노인의 자살생각을 줄이는 것을 목적으로 하였다. 이를 위해 노인복지관 및 종합사회복지관을 이용하는 경기도 군포시, 안양시, 의왕시에 거주하고 있는 65세 이상의 노인 200명을 대상으로 설문을 실시하였으며, 유의표집방법을 사용하였다. 최종 161부의 설문지가 분석에 사용되었다. 본 연구의 결과를 보면, 첫째, 노인의 고독감이 높을수록 자살생각은 높아지는 것을 검증하였다. 둘째, 고독감과 자살생각의 관계에서 매개변수 건강수준의 하위요인인 정신적, 기능적, 주관적 건강수준 중에서 어느 하위요인이 매개효과를 갖는지에 대해 분석하였고, 그 결과 기능적 건강수준의 하위요인이 부분매개 효과가 있음을 검증하였다. 본 연구의 결론에서는 노인의 고독감 및 자살생각을 줄이기 위해 사회복지실천에서는 기능적 건강수준에 적합한 다양한 프로그램 개발과 활성화가 요구되며 이를 실천하기 위한 재정적, 정책적 방안이 마련되어야 한다는 것을 제언하였다.The purpose of this study is to reduce the suicidal ideation in elderly people by finding out how sense of loneliness in elderly people directly affects the suicidal ideation and verifying the mediated effect of health levels in suicidal ideation. To this end, a questionnaire survey was conducted on 200 elderly people aged 65 years and over who lives in Anyang City, Gunpo City, and Uiwang City in Gyeonggi-do, and uses Seniors Welfare Agency and Comprehensive Social Welfare Agency. The final 161 questionnaire were used for this analysis using significance sampling method. The results of this study verified that, first, the higher sense of loneliness among the elderly, the more suicidal ideation are. Second, analysis of which of the mental, functional and subjective health level has mediated effect verified that sub-factor of functional health level had a partial mediated effect. In order to reduce sense of loneliness and the suicidal ideation of the elderly, social work practice require the development and activation of various programs suitable for functional health levels, and financial and policy measures should be devised to implement them.. The result of this study suggests that in order to reduce loneliness of elderly people and the suicidal ideation, social work practice needs to develop, and activate various programs in functional health level, and government should prepare financial, and political plan to practice the purpose.

Regional variations in the use of statutory skin cancer screenings in Germany: population-based spatial multisource analysis.

Due to the increasing incidence of skin cancer, programmes for the prevention of skin cancer have been developed and implemented in Germany. However, utilization of skin cancer screenings shows marked regional differences. Reasons and predictors of such variations are unclear. The objective of the study is to identify predictors for regional use of skin cancer screening variations in Germany. Analysis of the population set of ambulatory claims data (2009-2015) of the statutory health insurances (SHI) in Germany (70.2million people in 2015). Skin cancer screening utilization rate was determined on county level. Descriptive, cluster and multivariate analyses were performed to identify spatial patterns in skin cancer screening utilization. Overall, 6.5-7.9million people participated in skin cancer screenings. Utilization rates of people ≥35years of age were 9.74% (2009) and 10.96% (2015). Marked regional variations were identified between the counties. Dermatologists in Saxony and Westphalia-Lippe as well as general practitioners in Lower Saxony and North Rhine showed particularly high utilization rates. Multiple regression analyses demonstrated e.g. positive associations between the skin cancer screening utilization rates and employees with higher vocational qualifications and shorter travel time by car to the nearest major urban centre. Utilization rates of skin cancer screening vary largely in Germany with specific spatial patterns. Multivariate analyses demonstrate associations with socio-economic and geographical determinants. The results indicate the importance of health policy measures. These should be used in a more targeted manner in the regions in order to increase utilization of skin cancer screening.

Global Ranking of COVID-19-Related Mortality by Country using a Novel Pandemic Efficiency Index (PEI).

The world is currently witnessing a dramatic disruption of everyday life owing to the rapid progression of the coronavirus disease 2019 (COVID-19) pandemic. As the pandemic evolves, there is an urgent need to better understand its epidemiology, characterize its potential impact, and identify mitigatory strategies to avert pandemic-related mortality. There is a need for a tool or algorithm to evaluate the extent to which public health policy and/or economic preparedness measures are effectively averting COVID-19 related mortality. We present a simple and yet practical epidemiological tool, the Pandemic Efficiency Index (PEI), that can be utilized globally to test the relative efficiency of measures put in place to avert death resulting from COVID-19 infection. Using the PEI and current COVID-19-related mortality, we determined that so far Germany demonstrates the highest PEI (5.1) among countries with more than 5,000 recorded cases of the infection, indicating high quality measures instituted by the country to avert death during the pandemic. Italy and France currently have the lowest COVID-19-related PEIs. Epidemics and pandemics come and go, but local, national, and global abilities to determine the efficiency of their efforts in averting deaths is critical.

The determinants of out-of-pocket health-care expenses for diabetes mellitus patients in India: An examination of a tertiary care government hospital in Delhi.

Objective:To assess the determinants of out-of-pocket (OOP) expenses on diabetes-related treatment incurred in patients attending outpatient clinics in a tertiary care hospital in Delhi, India.Study Design:A cross-sectional analysis of baseline data from a quasi-experimental study was conducted over 8 months in 2016 in a major tertiary care hospital in Delhi.Methods:The study included 375 diabetes patients up to 65 years of age on treatment for at least a year without significant complications. Data were collected through a patient interview schedule.Results:Of the previous six scheduled appointments, at least two missed appointments were seen in 267 (71.2%) patients. The average patient's OOP expenditure on diabetes-related medicines was ₹63.5 a month, a similar amount was spent on traveling to and from health facilities. Sixty-four (17.1%) patients took antidiabetic medication for <85% of the days in the previous 3 months.Conclusion:There exists a high burden of missed clinic appointments among diabetes patients in tertiary care government health settings in India. This appears to be related to the high cost in terms of both time and money involved in attending appointments for the modest benefit of a dispensation of a 15-day drug refill. Health policy measures focused on strengthening medication coverage need to explore the balance of costs and benefits when determining the frequency of clinical appointments in these settings.

A Statistical Model to Monitor COVID-19 Contagion Growth

We present a statistical model which can be employed to monitor the time evolution of the COVID-19 contagion curve, and of the associated reproduction rate R0. The model is a Poisson autoregression of the daily new observed cases and can, differently from classical exponential growth models, dynamically adapt its estimates to explain the evolution of contagion in different time periods and locations, allowing for the comparative evaluation of health policy measures. We have applied the model to the first two months of data from the countries most hit by the virus. Our empirical findings show that the proposed model is able to identify where a country lies on the contagion curve, at each point in time: behind a peak, on a peak, and after a peak. Based on this positioning, we draw three main health policy conclusions that can be useful for all countries in the world. First, countries that are still behind the peak (e.g. France and the United Kingdom) should maintain strong containment measures, such as diffuse testing and lockdown. Second, countries that are on the peak and have experienced a steep contagion growth (e.g. Italy, Spain and the United States), could partially relax containment measures but must couple them with continuous monitoring of the growth curve. Third, in countries that have experienced a less steep contagion growth (e.g. Germany) the approach to restrictive measures could be more cautious since there is a risk that social costs outweigh the benefits. Last, countries that have passed the peak (e.g. China) should relax containment measures, but continue statistical monitoring.

PNS146 WHAT APPROACH SHOULD BE TAKEN IN ORDER TO EFFECTIVELY MANAGE BEHAVIORAL HEALTH RISK FACTORS? A CONSENSUS PANEL ANALYSIS FOR GREECE

To assess which modifiable health risk factors should be the priorities of health policy and which management approaches would be most feasible and effective in the Greek environment. A digital delphi panel was conducted, consisting of experts in healthcare and health policy, seeking convergence with the use of a close-end questionnaire. The risk factors prioritized in the study were: road safety, physical activity, dietary risks, smoking, alcohol consumption, unsafe sexual behavior, obesity and substance use. Additionally, various health policy measures were assessed on terms of effectiveness and importance for each risk factor. Overall, 23 health professionals participated in the panel. Regarding prioritization, smoking ranked first (9.45/10), followed by obesity (8.35/10) and dietary risks (8.00/10), while unsafe sexual behavior ranked last (5.16/10). Current health policy for the selected risk factors was assessed ineffective, since road safety policy ranked first with 2.48/5, while health policy on obesity ranked last at 1.37/5. Sin taxes on products related to the selected risk factors were assessed quite effective by the panel, as higher taxation on sugary beverages gathered the highest score of 3.95/5, while VAT increase in red meat gathered the lowest score of 2.86/5. Regarding individual measures for each risk factor, prohibition of use in public spaces ranked as the most important measure for the management of smoking (9.22/10), expansion of sport facilities for the promotion of physical activity (8.65/10), while health promotion ranked as the most important approach for the management of alcohol consumption (9.18/10), dietary risks (9.09/10), obesity (8.70/10), substance use (8.64/10) and road safety (8.86/10). Based on the results, effective health policy for the management of the main behavioral risk factors is yet to be achieved. Health promotion and sin taxes are considered the most efficient approach to be utilized in health policies for the management of behavioral risk factors.

Physical activity and colorectal cancer risk: a two-sample Mendelian randomisation study

BackgroundEvidence from observational studies suggests a protective role for physical activity against colorectal cancer risk. However, whether the observed association is causal or not is not clear. We did a two sample Mendelian randomisation study to examine the causal relationship between physical activity and colorectal cancer risk. MethodsThis Mendelian randomisation study used common genetic variants associated with self-reported physical activity and accelerometer-based physical activity as instrumental variables. These variables were derived from the largest available genome-wide association study of physical activity, namely, UK Biobank. The effect of the instrumental variables for physical activity was analysed in a large colorectal cancer risk genome-wide association study using summary level data that included 31 197 cases and 61 770 controls. We applied inverse variance-weighted method as the main analysis method, with Mendelian randomisation-Egger, Mendelian randomisation–pleiotropy residual sum and outlier, Mendelian randomisation-robust, leave-one-out method, mode-based estimate, and the median-based method as sensitivity analyses. FindingsOur results show a significant protective effect between accelerometer-based physical activity and colorectal cancer risk (the outlier-adjusted odds ratios [OR] of inverse variance-weighted Mendelian randomisation was 0·92 per one standard deviation increase of accelerometer-base physical activity (95% CI 0·87–0·98, p=0·0137). The effect between self-reported physical activity and colorectal cancer risk was not statistically significant but was supportive of an inverse association (the outlier-adjusted OR of inverse variance-weighted Mendelian randomisation was 0·61 per 1 SD increase of moderate-to-vigorous physical activity [95% CI 0·36–1·06, p=0·0783]). InterpretationThe findings of this large Mendelian randomisation study show, for the first time to our knowledge, that objectively measured physical activity is causally implicated in reducing colorectal cancer risk. It suggests that physical activity is not merely a biomarker of good health. The limitations of the study are that it is based on only two genetic instruments and that it has limited power, despite the study size. Nonetheless, at a population level, these findings provide strong reinforcing evidence to support public health policy measures that encourage exercise, even in obese individuals. FundingThis work was supported by cancer research UK programme grant C348/A18927 (MD). ET is supported by a cancer research UK Career Development Fellowship (C31250/A22804). XZ has a PhD studentship from The Darwin Trust of Edinburgh.

Ethics, health policy-making and the economic crisis: a qualitative interview study with European policy-makers

BackgroundThe economic crisis posed various challenges to policy-makers who had to decide on which health policy measures to focus on and on which to refrain from. The aim of this research was to assess the relevance of ethics and to highlight ethical dimensions in decision-taking by policy-makers with regard to policy and priority-setting in health systems posed by the economic crisis.MethodsSemi-structured qualitative interviews were conducted with eight European policy-makers from six countries.ResultsAll interviewees recalled difficult and strenuous situations where they had to prioritise between distinct areas to focus on and invest in, for example around choices between prioritising medications, health professional staffing, care specific equipment, or urgent infrastructure issues. Values could be identified which they deemed as important within the policy-making process, such as trust and responsibility. They explicitly expressed the need for ethical tools and assistance in terms of policy advice for reaching morally sustainable decisions in health policy matters.ConclusionsThe study showed that ethical concepts and values frequently come into play in health policy-making, and that ethics is highly relevant in policy-makers’ daily decision-taking, yet that they lack ethical guidance on what to base their decisions. The study is of relevance since it can provide future decisions on austerity-related issues with an ethical underpinning and could identify areas of moral concern.

Commercial interests, agenda setting, and the epistemic trustworthiness of nutrition science

The trustworthiness of nutrition science has been questioned recently. According to the critics, the food industry has corrupted scientists in the field. I argue that the worries that commercialization threatens the epistemic trustworthiness of nutrition science are indeed well-founded. However, it is problematic that the discussion has revolved around how funding can threaten the integrity of researchers and the methodological quality of the studies. By extending Wilholt’s (Br J Philos Sci 64(2):233–253, 2013) account of epistemic trustworthiness, I argue that when assessing the epistemic trustworthiness of research that forms the basis for different health policy measures, it is necessary to evaluate research at the macro-level and whether agenda setting advances the goals that are assigned to the field. The prevalence of commercial funding becomes problematic if it leads to a situation where the body of available evidence that is used for making health policy decisions does not reflect the shared sense of what epistemic and non-epistemic goals of the inquiry are important.

Do Europeans consider sustainability when making food choices? A survey of Polish city-dwellers.

To obtain a better insight into the conceptualization of sustainable consumption among consumers with special focus on food choice determinants. Previous studies show that people present positive attitude towards sustainable diet while their everyday food choices do not follow sustainable diet rules. A structured questionnaire was designed and data were collected via computer-assisted telephone interview among a random group (n 600) of city-dwellers. Quota sampling was used in proportion to the city population. Cluster analysis (k-means method) was applied to identify consumer segments according to the determinants of food choices. Consumer segments were identified using one-way ANOVA with post hoc Duncan comparison of mean scores and cross-tabulation with χ 2. The Friedman test was applied to identify enablers and barriers of sustainable food choices. Cities in Mazovia, the best developed, central region of Poland.ParticipantsAdults (21-70 years old). Consumers are not familiar with the concept of sustainability and are not able to define it adequately. Only 6 % of the studied population indicated that sustainable consumption is connected with nutrition which has possibly less impact on the environment. Three segments of consumers were distinguished regarding their attitude to food choice determinants adequate to sustainable diet: Non-Adopters (17 %), Emergents (32 %), Adopters (51 %). Desire to improve health by decreasing body weight was the main driver for sustainable food choices, while prices were the main limitation. Knowledge dissemination on sustainability issues is needed to empower consumers to make more sustainable food choices and to make public health and food policy measures more effective.

Elimination of hepatitis C. Positioning document of the Spanish Association for the Study of the Liver (AEEH).

The Spanish Association for the Study of the Liver (AEEH) is convinced that the elimination of hepatitis C virus (HCV) in Spain is possible as long as we are able to use the resources and tools necessary for it. This document reflects the position of the AEEH regarding the elimination of HCV, establishing a wide range of recommendations that can be grouped into five categories: 1) Screening of HCV according to age, of the existence of classic acquisition risk factors of infection, active search of previously diagnosed patients and development of microelimination strategies in vulnerable populations; 2) Simplification of HCV diagnosis (one-step diagnosis and diagnosis at the point of patient care); 3) Simplification of patient treatment and improvement of care circuits; 4) Health policy measures, and, finally, 5) Establishment of HCV elimination indicators.

Reported rates of clostridium difficile following radical cystectomy in national datasets compared to individual institutions

BackgroundClostridium difficile infection (CDI) is an important cause of hospital acquired morbidity with implications for quality of care. Radical cystectomy is a surgical procedure associated with high rates of morbidity one of which is a high rate of CDI. The rate of CDI among patients undergoing radical cystectomy may be estimated based on the reports from single institutions or by querying national databases. This study aims to compare rates of CDI reported in single institution series with rates obtained from national datasets. MethodsA search was conducted on PubMed and Google Scholar using the terms “cystectomy+difficile” and “cystectomy+complication.” Three hundred fifty articles were screened and 46 met criteria for inclusion based on the presence of specific rates of C. difficile following radical cystectomy. In the case of articles reporting on the same database, only the article with a larger sample size was included in the pooled analysis. One study reviewing a single institution was excluded from pooled analysis because it did not relate the rate of CDI specifically with cystectomy. Multi-institutional studies were not included in pooled analysis. ResultsAfter exclusion of repeated data and multi-institutional studies, the pooled analysis consisted of 39 studies. Thirty five articles reported rates of CDI in single institutions and 4 articles reported rates found in national databases. Studies focusing on a single institution reported an average 5.02% (standard deviation = 4.88) incidence of CDI, compared to an average of 1.92% (standard deviation = 0.22) in databases. The rate of CDI found by totaling patients and incidence of infection found that databases show a rate of 1.95%, while institutions show a rate of 4.11% (P < 0.0000001). ConclusionThe rate of CDI following radical cystectomy may be underestimated in national databases. This has implications for the development of health policy and quality measures based on the rate of CDI.

Best practice assessment of disease modelling for infectious disease outbreaks.

During emerging disease outbreaks, public health, emergency management officials and decision-makers increasingly rely on epidemiological models to forecast outbreak progression and determine the best response to health crisis needs. Outbreak response strategies derived from such modelling may include pharmaceutical distribution, immunisation campaigns, social distancing, prophylactic pharmaceuticals, medical care, bed surge, security and other requirements. Infectious disease modelling estimates are unavoidably subject to multiple interpretations, and full understanding of a model's limitations may be lost when provided from the disease modeller to public health practitioner to government policymaker. We review epidemiological models created for diseases which are of greatest concern for public health protection. Such diseases, whether transmitted from person-to-person (Ebola, influenza, smallpox), via direct exposure (anthrax), or food and waterborne exposure (cholera, typhoid) may cause severe illness and death in a large population. We examine disease-specific models to determine best practices characterising infectious disease outbreaks and facilitating emergency response and implementation of public health policy and disease control measures.

Dietary Fiber Intake and Metabolic Syndrome Risk Factors among Young South African Adults.

This study attempts to bridge the research gap regarding the importance of dietary fiber in reducing metabolic syndrome (MetS) risk factors in young rural South Africans. A total of 627 individuals (309 males and 318 females) aged 18–30 years participated in the study. Dietary intake was measured using a validated 24-h recall method. The consumption of different types of dietary fiber (total, soluble, and insoluble) was calculated and presented as grams. Anthropometrics, blood pressure, fasting blood glucose, and lipid profiles were measured according to standard protocols. According to the definition of the International Diabetes Federation (IDF), the prevalence of MetS was 23.1%. Overall, the total median [interquartile range (IQR)] values for total, insoluble, and soluble fiber consumed were 4.6 g [0.0–48.9], 0.0 g [0.0–18.0], and 0.0 g [0.0–15.0], respectively. Females had a higher median [IQR] intake of total (5.1 g [0.0–48.9] vs. 4.3 g [0.0–43.9]), insoluble (0.0 g [0.0–18.0] vs. 0.0 g [0.0–12.0]), and soluble fiber (0.0 g [0.0–14.9] vs. 0.0 g [0.0–7.3]) than males, respectively. The mean values for waist circumference, fasting blood glucose, and total cholesterol were higher in females than males (82.20 cm vs. 75.07 cm; 5.59 mmol/L vs. 5.44 mmol/L; and 4.26 mmol/L vs. 4.03 mmol/L, respectively), with significant differences observed for waist circumference and total cholesterol (p < 0.001 and p = 0.005, respectively). More than 97% of participants had fiber intakes below the recommended levels. After adjusting for all potential confounders (age, gender, and energy), log total fiber was inversely associated with fasting blood glucose (β = −0.019, 95% CI [−0.042 to 0.003], p < 0.05), systolic blood pressure (β = −0.002, 95% CI [−0.050 to 0.002], p < 0.05) and high-density lipoprotein cholesterol (β = −0.085, 95% CI [−0.173 to 0.002], p = 0.051) This study may be of public health relevance, providing a potential link between less dietary fiber intake and fasting blood glucose (FBG) and both systolic and diastolic blood pressure. Therefore, this observational data encourages public health policy measures to increase the consumption of dietary fiber in rural communities in order to lower the burden of MetS and its associated risk factors.