Public Health Interest Research Articles

COVID-19 Vaccines and Heavy Menstrual Bleeding: The Impact of Media Attention on Reporting to EudraVigilance.

During the COVID-19 vaccination campaign, over 34,000 reports of heavy menstrual bleeding following the administration of COVID-19 vaccines originating in the Economic European Area were submitted to EudraVigilance, the European Union database of suspected adverse drug reactions. More than 90% of these reports were sent by consumers while the remaining by healthcare professionals. Public concerns regarding menstruation disorders in COVID-19 vaccinees were also covered by the media. We investigated the impact of media attention on the reporting trends of heavy menstrual bleeding to EudraVigilance. We used media outlets published in the Economic European Area on menstrual disorders and COVID-19 vaccines from the beginning of the vaccination campaign in the Economic European Area (1 January, 2021) until December 2022 (i.e., after the regulatory request to add the adverse event to the product information) and spontaneous reports from EudraVigilance. We found that the publication of safety updates from regulatory authorities and subsequent coverage in media outlets preceded increased reporting to EudraVigilance. Furthermore, the heavy menstrual bleeding reported in the cases occurred several weeks or months earlier and were not submitted to the respective date. The analysis suggests that the spikes in reporting of heavy menstrual bleeding were to some extent influenced by media coverage in some countries. Consumer reporting to the European Union spontaneous data collection system, EudraVigilance, was of high value for regulatory safety reviews, albeit the reporting behaviours were not free of the influence of the media. These sources of information can be investigated to understand the context of safety concerns of public health interest.

The Impact of Immune System Aging on Infectious Diseases.

Immune system aging is becoming a field of increasing public health interest because of prolonged life expectancy, which is not paralleled by an increase in health expectancy. As age progresses, innate and adaptive immune systems undergo changes, which are defined, respectively, as inflammaging and immune senescence. A wealth of available data demonstrates that these two conditions are closely linked, leading to a greater vulnerability of elderly subjects to viral, bacterial, and opportunistic infections as well as lower post-vaccination protection. To face this novel scenario, an in-depth assessment of the immune players involved in this changing epidemiology is demanded regarding the individual and concerted involvement of immune cells and mediators within endogenous and exogenous factors and co-morbidities. This review provides an overall updated description of the changes affecting the aging immune system, which may be of help in understanding the underlying mechanisms associated with the main age-associated infectious diseases.

Extended-spectrum beta-lactamases in clinical isolates of Escherichia coli and Klebsiella pneumoniae recovered from patients at the Tamale Teaching Hospital, Ghana.

Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae are pathogens of significant public health interest for which new antibiotics are urgently needed. To determine the prevalence of ESBLs in E. coli and K. pneumoniae isolates from patients attending the Tamale Teaching Hospital (TTH) in Ghana. The study was a cross-sectional study involving convenience sampling of E. coli and K. pneumoniae isolates from consenting patients' clinical specimens, between April and June 2015. Antimicrobial susceptibility test was performed, and ESBL-producer phenotypes were further screened for BlaTEM, BlaSHV, and BlaCTX-M genes. Patients' clinical data were additionally collected using a structured questionnaire. Of the 150 non-duplicate E. coli and K. pneumoniae isolates identified, 140 were confirmed as E. coli (84%, n = 117) and K. pneumoniae (16%, n = 23). Of these, sixty-two (44%) [E. coli (84%; n = 52); K. pneumoniae (16%; n = 10)] phenotypically expressed ESBLs. The proportion of ESBL-producing isolates was higher in adults (15-65 years) than in neonates (< 28 days) (p = 0.14). Most of the isolates showed a high percentage resistance to ampicillin (96%) and tetracycline (89%), but a relatively lower resistance to amikacin (36%). No isolate was resistant to meropenem. More ESBL producers were multidrug resistant compared to non-ESBL-producers [23% (14/62) versus 18% (14/78); p = 0.573]. Overall, 74% (n = 46) of the ESBL genotypes expressed BlaCTX-M-1 genes, followed by 63% (n = 39) BlaTEM, and 16% (n = 10) BlaSHV. The study showed a high prevalence of ESBL-positive E. coli and K. pneumoniae, mostly CTX-M-1 producers at TTH. Routine laboratory ESBL screening is warranted to inform patient management.

Does bird life-history influence the prevalence of ticks? A citizen science study in North East Spain

After mosquitoes, ticks are among the most important vector of pathogens of concern for animal and public health, but unless mosquitoes ticks remain attached to their hosts for long time periods providing an opportunity to analyse their role in the dispersal and dynamics of different zoonotic pathogens. Given their interest in public health it is important to understand which factors affect their incidence in different hosts and to stablish effective surveillance programs to determine the risk of transmission and spill-over of zoonotic pathogens. Taking benefit of a large network of volunteer ornithologists, we analysed the life-history traits associated to the presence of ticks using information of 620,609 individuals of 231 avian species. Bird phylogeny, locality and year explained a large amount of variance in tick prevalence. Non-colonial species non breeding in grasslands and non-spending the non-breeding season as gregarious groups or isolated individuals (e.g. thrushes, quails and finches) had the higher prevalence of ticks and appear as good candidates for zoonosis surveillance programs based on the analyses of ticks collected from wild birds. Ringers underestimated tick prevalence but can be considered as an important source of information of ticks for public and animal health surveillance programs if properly trained for the detection and collection of the different tick development phases.

Consumption and Informal Trade of Milk in the North of Antioquia (Colombia).

The excessive and irrational use of antibiotics to control bovine mastitis and the informal trade in milk with antibiotic residues are objects of great interest for public health, due to the problems associated with the consumption of milk with antibiotic residues on human, animal, and environmental health, and antibiotic resistance. The objective of this study was to understand the attitudes of dairy farmers towards the self-consumption of milk on the farm, the use of milk with antibiotic residues, and the formal and informal milk trade that generates risks for public health. Mixed methods: cross-sectional and grounded theory. Convergent triangulation design. The study was carried out in 9 dairy municipalities in the North of Antioquia, where 216 dairy farmers participated in the quantitative component; and 17 milk producers and 9 veterinarians took part in the qualitative component. A dairy farmer characterization survey was conducted, as well as a survey on the use and marketing of milk from cows with udder health problems and/or under antibiotic treatment. Semistructured interviews were conducted on the same subject. The variable "Intention to sell milk in the village when the dairy industry does not buy it due to high BTSCC" is associated with the BTSCC variable. The variable "Type of marketing reported" is associated with the CFU variable. 5 categories: self-consumption of milk, use of milk with antibiotics, informal milk trade, control of the dairy industry, and beliefs about the elimination of antibiotics in milk, were constructed to theorize about udder health and public health. Sociocultural, political, and economic factors affect decision making in dairy farmers regarding the use and marketing of milk from cows with mastitis and antibiotic residues. These attitudes and behaviors have public health implications.

Abstract 2209: Tattooing and risk of melanoma: A population-based case-control study in Utah

Abstract Background: Carcinogens have been observed in many tattoo inks which can form new carcinogenic compounds when exposed to ultraviolet radiation and can accumulate in the lymph nodes and other organs. Tattooing can result in short- and long-term inflammatory and immune responses. At least 38 cases of melanoma have been reported in tattoos. The incidence of melanoma in Utah is the highest in the U.S., and potentially modifiable risk factors are of public health interest. In this study, we evaluated associations between tattooing and melanoma risk. Methods: We utilized a population-based case-control study of 514 incident in situ (284 men and 230 women) and 534 invasive (285 men and 249 women) melanoma cases diagnosed in Utah between 2020-2021. Controls (n=5,240) were selected from respondents to the Utah Behavioral Risk Factor Surveillance System (BRFSS) survey and frequency matched to cases in a 5:1 ratio on sex, age, race, and ethnicity. We fit logistic regression models to compute odds ratios (ORs) and 95% confidence intervals (CIs) associating ever tattooing with in situ and invasive melanoma risk, adjusting for age, education level, race, and ethnicity, separately for women and men. We then fit logistic models stratified by education level (&amp;lt; four-year college degree/four-year college degree or more) and models stratified by age (&amp;lt; 50 years/50+ years), separately for women and men. Results: Among men, the prevalence of tattooing was 7% for both in situ and invasive cases, and 11% for controls. Among women, tattooing prevalence was 20% for in situ cases, 15% for invasive cases, and 18% for controls. Ever tattooing was associated with decreased invasive melanoma risk among men (OR=0.62 [95% CI: 0.37-1.02]), particularly among those who had less than a four-year college degree (0.52 [0.28-0.99]), and among ages 50+ (0.36 [0.16-0.84]). Among men, the OR for ever tattooing and in situ melanoma was in the same direction as invasive melanoma, but the estimate was statistically imprecise (0.73 [0.45-1.19]). Among women, we did not observe an association between ever tattooing and invasive melanoma (0.83 [0.56-1.20]), while the association between ever tattooing and in situ melanoma was statistically imprecise (1.25 [0.87-1.80]). However, ever tattooing was associated with a nearly two-fold increased risk of in situ melanoma among women with a four-year college degree (1.98 [1.21-3.26]), but not for those without a college degree (0.89 [0.52-1.50]). Conclusion: These findings do not suggest that there is an association between tattooing and melanoma. Associations between tattooing and health-seeking behaviors, which may vary by sex and other demographic factors, may influence associations with melanoma diagnosis, particularly for in situ melanoma. This study is the first step in investigating whether reported cases of melanoma arising in tattoos are coincidental or whether tattoos may be associated with an increased risk of melanoma. Citation Format: Rachel D. McCarty, Britton Trabert, Morgan M. Millar, David Kriebel, Laurie Grieshober, Mollie E. Barnard, Lindsay J. Collin, Katherine A. Lawson-Michod, Jeffrey A. Gilreath, Douglas Grossman, John Hyngstrom, Paul J. Shami, Jennifer A. Doherty. Tattooing and risk of melanoma: A population-based case-control study in Utah [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2209.

Urban wastewater-based epidemiology for multi-viral pathogen surveillance in the Valencian region, Spain

Wastewater-based epidemiology (WBE) has lately arised as a promising tool for monitoring and tracking viral pathogens in communities. In this study, we analysed WBE's role as a multi-pathogen surveillance strategy to detect the presence of several viral illness causative agents. Thus, an epidemiological study was conducted from October 2021 to February 2023 to estimate the weekly levels of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Respiratory Syncytial virus (RSV), and Influenza A virus (IAV) in influent wastewater samples (n = 69). In parallel, a one-year study (October 2021 to October 2022) was performed to assess the presence of pathogenic human enteric viruses. Besides, monitoring of proposed viral fecal contamination indicators crAssphage and Pepper mild mottle virus (PMMoV) was also assessed, along with plaque counting of somatic coliphages. Genetic material of rotavirus (RV), human astrovirus (HAStV), and norovirus genogroup I (GI) and GII was found in almost all samples, while hepatitis A and E viruses (HAV and HEV) only tested positive in 3.77 % and 22.64 % of the samples, respectively. No seasonal patterns were overall found for enteric viruses, although RVs had a peak prevalence in the winter months. All samples tested positive for SARS-CoV-2 RNA, with a mean concentration of 5.43 log genome copies per liter (log GC/L). The tracking of the circulating SARS-CoV-2 variants of concern (VOCs) was performed by both duplex RT-qPCR and next generation sequencing (NGS). Both techniques reliably showed how the dominant VOC transitioned from Delta to Omicron during two weeks in Spain in December 2021. RSV and IAV viruses peaked in winter months with mean concentrations 6.40 and 4.10 log GC/L, respectively. Moreover, the three selected respiratory viruses strongly correlated with reported clinical data when normalised by wastewater physico-chemical parameters and presented weaker correlations when normalising sewage concentration levels with crAssphage or somatic coliphages titers. Finally, predictive models were generated for each respiratory virus, confirming high reliability on WBE data as an early-warning system and communities illness monitoring system. Overall, this study presents WBE as an optimal tool for multi-pathogen tracking reflecting viral circulation and diseases trends within a selected area, its value as a multi-pathogen early-warning tool stands out due to its public health interest.

An NLP-based novel approach for assessing national influence in clause dissemination across bilateral investment treaties.

International investment agreements (IIAs) promote foreign investment. However, they can undermine crucial health programs, creating a dilemma for governments between corporate and public health interests. For this reason, including clauses that safeguard health has become an essential practice in IIAs. According to the current literature, some countries have played a pivotal role in leading this inclusion, while others follow the former ones. However, the existing literature needs a unique approach that can quantify the influence strength of a country in disseminating clauses that explicitly mention health provisions to others. Following an NLP (Natural Language Processing)-based text similarity analysis of Bilateral Investment Treaties (BITs), this study proposes a metric, 'Influence' (INF), which provides insights into the role of different countries or regions in the propagation of IIA texts among BITs. We demonstrate a comprehensive application of this metric using a large agreement dataset. Our findings from this application corroborate the evidence in the current literature, supporting the validity of the proposed metric. According to the INF, Germany, Canada, and Brazil emerged as the most influential players in defensive, neutral, and offensive health mentions, respectively. These countries wield substantial bargaining power in international investment law and policy, and their innovative approaches to BITs set a path for others to follow. These countries provide crucial insights into the direction and sources of influence of international investment regulations to safeguard health. The proposed metric holds substantial usage for policymakers and investors. This can help them identify vital global countries in IIA text dissemination and create new policy guidelines to safeguard health while balancing economic development and public health protection. A software tool based on the proposed INF measure can be found at https://inftool.com/.

Reducing Burnout, Suicide &amp; Wellbeing among Healthcare Professionals:

Recently the lack of well-being, higher rates of burnout and reports of suicide in healthcare professionals have become an area of concern for organisations. Physician and nurse suicides are a worry and subject of increasing ‘professional and public health interest. Despite good resources to help others, healthcare workers are sacrificing their well-being. Moreover, systemic barriers by organisational culture and policy are often preventing self-care or help-seeking actions.

Cyanopeptolins and Anabaenopeptins Are the Dominant Cyanopeptides from Planktothrix Strains Collected in Canadian Lakes.

Common bloom-forming cyanobacteria produce complex strain-specific mixtures of secondary metabolites. The beneficial and toxic properties of these metabolite mixtures have attracted both research and public health interest. The advancement of mass spectrometry-based platforms and metabolomics data processing has accelerated the identification of new metabolites and feature dereplication from microbial sources. The objective of this study was to use metabolomics data processing to decipher the intracellular cyanopeptide diversity of six Planktothrix strains collected from Canadian lakes. Data-dependent acquisition experiments were used to collect a non-targeted high-resolution mass spectrometry dataset. Principal component analysis and factor loadings were used to visualize cyanopeptide variation between strains and identified features contributing to the observed variation. GNPS molecular networking was subsequently used to show the diversity of cyanopeptides produced by the Planktothrix strains. Each strain produced a unique mixture of cyanopeptides, and a total of 225 cyanopeptides were detected. Planktothrix sp. CPCC 735 produced the most (n = 68) cyanopeptides, and P. rubescens CPCC 732 produced the fewest (n = 27). Microcystins and anabaenopeptins were detected from all strains. Cyanopeptolins, microviridins and aeruginosins were detected from five, four and two strains, respectively. Cyanopeptolin (n = 80) and anabaenopeptin (n = 61) diversity was the greatest, whereas microcystins (n = 21) were the least diverse. Interestingly, three of the P. rubescens strains had different cyanopeptide profiles, despite being collected from the same lake at the same time. This study highlights the diversity of cyanopeptides produced by Planktothrix and further hints at the underestimated cyanopeptide diversity from subpopulations of chemotypic cyanobacteria in freshwater lakes.

Current and future potential distribution of Culex (Melanoconion) (Diptera: Culicidae) of public health interest in the Neotropics.

Anthropogenic activities are altering ecosystem stability and climate worldwide, which is disturbing and shifting arbovirus vector distributions. Although the overall geographic range of some epidemiologically important species is recognized, the spatiotemporal variation for other species in the context of climate change remains poorly understood. Here we predict the current potential distribution of 9 species of Culex (Melanoconion) based on an ecological niche modeling (ENM) approach and assess spatiotemporal variation in future climate change in the Neotropics. The most important environmental predictors were the mean temperature of the warmest season (27 °C), precipitation during the driest month (50 mm), and precipitation during the warmest season (>200 mm). The best current model for each species was transferred to the future general circulation model IPSL-CM6A-LR, using 2 shared socioeconomic pathway scenarios (ssp1-2.6, ssp5-8.5). Under both scenarios of climatic change, an expansion of suitable areas can be observed followed by a strong reduction for the medium-long future under the worst scenario. The multivariate environmental similarity surface analysis indicated future novel climates outside the current range. However, none of the species would occur in those areas. Even if many challenges remain in improving methods for forecasting species responses to global climate change and arbovirus transmission, ENM has strong potential to be applied to the geographic characterization of these systems. Our study can be used for the monitoring of Culex (Melanoconion) species populations and their associated arboviruses, contributing to develop region-specific public health surveillance programs.

Proposal of a mosquito control plan of Smir-Restinga region (north-west of Morocco)

BackgroundThe present study conducted on mosquitoes in the region of Restinga Smir, located in the north-west of Morocco, attempts to provide a scientific platform for an appropriate mosquito control plan for this tourism spot. The aim of this plan is to perfect the methods of the means of mosquito control for an effective fight against mosquitoes in this area, known for their strong nuisance (bites) and their ability to transmit several deadly diseases.ResultsMonitoring of mosquito species in the Smir marshes, especially those of public health interest, shows that they are distributed differently in the permanent and temporary environments. The establishment and analysis of their development cycles shows that their periods of activity in the different stations of the study area overlap in several cases, especially in the permanent stations. The study of the resistance of these species to the organophosphate insecticides commonly used for mosquito control in the region allowed to conclude the doses of insecticides (LC 90) that could be used for this mosquito control programme.ConclusionsThe proposed mosquito control programme gives an estimate of the timing of larval treatments and the insecticides that may be used. This plan was concluded based on the results obtained from the study of life cycles, spatial and temporal distribution of mosquitoes in the Smir area and their resistance to the organophosphate insecticides most used by public health services.

The Effects of Dairy Consumption on Vaccine Immune Response and Immunoglobulins: A Systematic Literature Review

Public health interest in vaccinations and immune protection has increased with the COVID-19 pandemic. Dairy products are an important source of protein and other nutrients, and there are unresolved research questions regarding the potential health impact of dairy products on the enhancement of immune response. A systematic literature review was conducted to synthesize the published literature reporting the effects of dairy interventions on: 1) the vaccine-specific immune response and 2) immunoglobulins in the absence of vaccination. To assess study validity and quality, we used the Academy of Nutrition and Dietetics Quality Criteria Checklist. Sixty-one studies (59 clinical trials, 1 cohort, 1 cross-sectional survey) were included, spanning 1983-2017. Ten trials evaluated the effect of dairy intervention on vaccine-specific IgG, IgA, IgM, vaccine-specific antibody titers, seroprotection rates, or seroconversion rates. Of these, 7 reported significant increases with dairy interventions for post-vaccine tetanus antibodies, mean change in tetanus antibody level, total antibody titers to flagellin from Salmonella Adelaide, mean antibody titers to influenza B, influenza-specific IgA and IgG levels, and seroconversion or seroprotection rates for influenza A and B. Fifty-six studies evaluated dairy’s effects on immunoglobulins without vaccinations. The results were heterogenous, with some studies reporting significant enhancement of immunoglobulins (IgA, IgE, or IgG), while others observed no differences between groups. Clinical relevance of the immunoglobulin changes was not investigated in these studies. Dairy products and their components could enhance the efficacy of vaccines. This review highlights the evidence gaps and provides a potential roadmap for additional research.

Public health engagement in alcohol licensing in England and Scotland: the ExILEnS mixed-method, natural experiment evaluation.

International systematic reviews suggest an association between alcohol availability and increased alcohol-related harms. Alcohol availability is regulated through separate locally administered licensing systems in England and Scotland, in which local public health teams have a statutory role. The system in Scotland includes a public health objective for licensing. Public health teams engage to varying degrees in licensing matters but no previous study has sought to objectively characterise and measure their activity, examine their effectiveness, or compare practices between Scotland and England. To critically assess the impact and mechanisms of impact of public health team engagement in alcohol premises licensing on alcohol-related harms in England and Scotland. We recruited 39 diverse public health teams in England (n = 27) and Scotland (n = 12). Public health teams more active in licensing were recruited first and then matched to lower-activity public health teams. Using structured interviews (n = 66), documentation analysis, and expert consultation, we developed and applied the Public Health Engagement In Alcohol Licensing (PHIAL) measure to quantify six-monthly activity levels from 2012 to 2019. Time series of PHIAL scores, and health and crime outcomes for each area, were analysed using multivariable negative binomial mixed-effects models to assess correlations between outcome and exposure, with 18-month average PHIAL score as the primary exposure metric. In-depth interviews (n = 53) and a workshop (n = 10) explored public health team approaches and potential mechanisms of impact of alcohol availability interventions with public health team members and licensing stakeholders (local authority licensing officers, managers and lawyers/clerks, police staff with a licensing remit, local elected representatives). Nineteen public health team activity types were assessed in six categories: (1) staffing; (2) reviewing and (3) responding to licence applications; (4) data usage; (5) influencing licensing stakeholders/policy; and (6) public involvement. Usage and intensity of activities and overall approaches varied within and between areas over time, including between Scotland and England. The latter variation could be explained by legal, structural and philosophical differences, including Scotland's public health objective. This objective was felt to legitimise public health considerations and the use of public health data within licensing. Quantitative analysis showed no clear evidence of association between level of public health team activity and the health or crime outcomes examined, using the primary exposure or other metrics (neither change in, nor cumulative, PHIAL scores). Qualitative data suggested that public health team input was valued by many licensing stakeholders, and that alcohol availability may lead to harms by affecting the accessibility, visibility and norms of alcohol consumption, but that the licensing systems have limited power to act in the interests of public health. This study provides no evidence that public health team engagement in local licensing matters was associated with measurable downstream reductions in crime or health harms, in the short term, or over a 7-year follow-up period. The extensive qualitative data suggest that public health team engagement is valued and appears to be slowly reorienting the licensing system to better address health (and other) harms, especially in Scotland, but this will take time. A rise in home drinking, alcohol deliveries, and the inherent inability of the licensing system to reduce - or in the case of online sales, to contain - availability, may explain the null findings and will continue to limit the potential of these licensing systems to address alcohol-related harms. Further analysis could consider the relative success of different public health team approaches in terms of changing alcohol availability and retailing. A key gap relates to the nature and impact of online availability on alcohol consumption, harms and inequalities, alongside development and study of relevant policy options. A national approach to licensing data and oversight would greatly facilitate future studies and public health input to licensing. Our interview data and therefore PHIAL scores may be limited by recall bias where documentary evidence of public health activity was not available, and by possible variability in grading of such activity, though steps were taken to minimise both. The analyses would have benefited from additional data on licensing policies and environmental changes that might have affected availability or harms in the study areas. The study was registered with the Research Registry (researchregistry6162) on 26 October 2020. The study protocol was published in BMC Medical Research Methodology on 6 November 2018. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/129/11.

Study and analysis of the structural-biochemical characteristics in Mollicutes biofilms formation

Biofilms have a wide distribution in various environments and even in devices used in medical practice, for this reason its relevance to study these structures and consider strategies to prevent their development and the effects they imply. Due to the medical importance that mycoplasmas represent, the objective of the present work was to analyze the capacity of Mycoplasma fermentans P140 to form a biofilm on an inert surface and to document the characteristics of the process in the formation of biofilm in Mollicutes. The interaction of the culture of Mycoplasma fermentans P140 with intrauterine devices for 72 hours showed by macroscopic analysis the crystal violet staining of the technique to evaluate biofilm formation, stereoscopic microscopy showed the formation of cell aggregates and by scanning electron microscopy the characteristic formation of biofilm. The search for reports referring to studies of biofilm formation in Mollicutes showed that there is recent evidence of biofilm formation in this group of microorganisms, both of veterinary medical interest and of interest in public health. Through metabolomics studies, it will be possible to demonstrate the metabolic products during the formation of biofilms in the different genera and species of these bacteria. Representing these investigations relevance to the field of public health and other ecosystems where health-disease processes are related.

Clinical trials and their impact on policy during COVID-19: a review.

Of over 8,000 recorded randomised trials addressing COVID-19, around 80% were of treatments, and 17% have reported results. Approximately 1% were adaptive or platform trials, with 25 having results available, across 29 journal articles and 10 preprint articles. We conducted an extensive literature review to address four questions about COVID-19 trials, particularly the role and impact of platform/adaptive trials and lessons learned. The key findings were: Q1. Social value in conducting trials and uptake into policy? COVID-19 drug treatments varied substantially and changed considerably, with drugs found effective in definitive clinical trials replacing unproven drugs. Dexamethasone has likely saved ½-2 million lives, and was cost effective across a range of countries and populations, whereas the cost effectiveness of remdesivir is uncertain. Published economic and health system impacts of COVID-19 treatments were infrequent. Q2. Issues with adaptive trial designs. Of the 77 platform trials registered, 6 major platform trials, with approximately 50 treatment arms, recruited ~135,000 participants with funding over $100 million. Q3. Models of good practice. Streamlined set-up processes such as flexible and fast-track funding, ethics, and governance approvals are vital. To facilitate recruitment, simple and streamlined research processes, and pre-existing research networks to coordinate trial planning, design, conduct and practice change are crucial to success. Q4. Potential conflicts to avoid? When treating patients through trials, balancing individual and collective rights and allocating scarce resources between healthcare and research are challenging. Tensions occur between commercial and non-commercial sectors, and academic and public health interests, such as publication and funding driven indicators and the public good. There is a need to (i) reduce small, repetitive, single centre trials, (ii) increase coordination to ensure robust research conducted for treatments, and (iii) a wider adoption of adaptive/platform trial designs to respond to fast-evolving evidence landscape.

Medical students’ career preferences in Bangladesh

AimThis study aimed to investigate the career preferences among Bangladeshi medical students, identify the factors that influence their present choices, and additionally report the role of gender and academic year behind their decisions.MethodsThis cross-sectional study conducted in Bangladesh from August 2022 to April 2023 included 801 medical students conveniently selected from medical colleges in eight divisions. Data were collected using a web-based survey and analysed using STATA version 16.0. Statistical tests included the Kolmogorov-Smirnov test, arithmetic mean, standard deviation, frequency, and Kruskal-Wallis H test. The response rate was 94.6%, and the CHERRIES guideline was followed for reporting the results.ResultThe majority of the participants were female (64.42%) and under the age of 23 years (58.8%). The study revealed that medicine was the preferred career choice for the majority of students (65%), with surgery being the most popular first choice (30.21%) among them. Female medical students showed a significantly higher preference for gynaecology & obstetrics (p < 0.001), while male students had a significantly higher tendency to choose general practice (p = 0.002). There is a significant gender difference (p < 0.05) in the career preference factors, including professional prestige, role model influence, easy money, family time, promotion opportunities, income for lifestyle, and research opportunities. Academic year differences were also observed, with increasing interest in medicine and public health (p < 0.001), a decrease in interest in surgery (p < 0.001), and a decline in preference for non-medical careers as students progressed through their MBBS life (p < 0.05).ConclusionOverall, medicine was the most popular speciality choice, however, male students preferred general practice and female students preferred gynaecology and obstetrics more. Personal passion, opportunities for contribution to society, professional prestige, having a direct dealing with patients, and income will allow an enjoyable lifestyle were the most important factors in the choice of their career.

Conflicts of Interest in Public Health and Nutrition: A Content Analysis of a Ghanaian Newspaper and Policy Documents

Conflicts of Interest in Public Health and Nutrition: A Content Analysis of a Ghanaian Newspaper and Policy Documents

The Legal Framework for Public-Private Partnerships in Drug R&D.

Public-private partnerships in drug R&D have great potential for driving innovation. They can bridge between excellent fundamental research and development and commercialization of innovative medicines to address unmet needs for the therapy of severe diseases in the interest of public health and human welfare. Therefore, public-private partnerships in drug R&D are promoted and publicly funded by governments and the European Commission. Nonetheless, they need to comply with legal requirements, particularly stemming from State aid law and competition law. Those requirements do not only protect a fair competition, but rather also further open information exchange as well as fair sharing of risks and fair participation in gains and results with the goal of having a successful collaboration and increasing the chance of successful commercialization of pharmaceutical innovations.

The Perils of Partnership: Interactions Between Public Health England, Drinkaware, and the Portman Group Surrounding the Drink Free Days Campaign.

There is growing evidence that the alcohol industry seeks to obstruct public health policies that might affect future alcohol sales. In parallel, the alcohol industry funds organisations that engage in "responsible drinking" campaigns. Evidence is growing that the content and delivery of such campaigns serves industry, rather than public health interests, yet these organizations continue to be the subject of partnerships with government health departments. This study aimed to examine the nature and potential impacts of such partnerships by analysing the practices of the alcohol industry-funded charity Drinkaware during the establishment of the Drink Free Days campaign. A case study based on an inductive analysis of documents revealed by freedom of information (FoI) request regarding communications between Drinkaware, Public Health England (PHE), and the Portman Group, in the years running up to, and during, the Drink Free Days campaign, a partnership between alcohol industry-funded charity Drinkware, and PHE. This study reveals a range of less visible, system-level effects of such partnerships for government departments and civil society. The tensions observed, as exhibited by discrepancies between internal and external communications, the emphasis on managing and mitigating the perception of negative consequences, and the links to wider alcohol industry initiatives and bodies, suggest the need for wider considerations of organizational conflicts of interest, and of possible indirect, harmful consequences to policy-making. These include the marginalization of other civil society voices, the displacing of more effective policy options, and strategic alignment with other industry lobbying activities. The findings have implications for how public health practitioners and health organisations might better weigh the potential trade-offs of partnership in the context of health promotion campaigns.