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Center For Disease Dynamics, Economics & Policy

Soil pollution and birth weight; AMR and cell phones

A gloved hand pouring chemical fertilizer against a green background

Mentorship is needed to improve global health leadership equity.

The majority of global health governing board seats analyzed in the Global Health 50/50 report were held by high-income countries (HICs); 51% were from the U.S. and UK, while people from low-income countries held only 2.5%. While it is vital to mentor early-career and mid-career global health professionals from low- and middle-income countries (LMICs) to improve the diversity of boards at the global level, existing inequities represent considerable barriers. To address this challenge, mentorship and co-authorship should be incentivized in governing boards’ professional agendas and contract agreements, and the development of research staff should be seen as a shared responsibility between HIC and LMIC institutions. [The Lancet Global Health]

Self-medication with antibiotics (SMA) is impacted by distance to healthcare facilities compared with pharmacies.

Face-to-face interviews using structured questionnaires were conducted in selected rural and urban communities of the Dodoma region, Central Tanzania, from August to November 2019 to assess the prevalence and predictors of SMA. Of 430 respondents, 161 and 269 were from rural and urban areas, respectively. The prevalence of SMA was similar between rural and urban residents (23.6% vs. 23.4%). Rural participants who reported a shorter perceived distance to a health care facility than to a pharmacy were 58.9% less likely to practice SMA, while SMA decreased by 16.3% among urban participants who reported a shorter perceived distance to a health care facility. [Antimicrobial Resistance and Infection Control]

The probable monkeypox case definition should broaden.

While monkeypox is unlikely to spread as rapidly and amply as COVID-19, lessons learned from SARS-CoV-2 are still applicable to Monkeypox outbreaks. The early spread of the virus could have been mitigated if initial case definitions had been less stringent and extensive community testing implemented sooner. Probable case definitions of monkeypox should broaden to include anyone with an unexplained vesiculo-pustular rash on any part of their body associated with fever, malaise, and lymphadenopathy so that fewer cases go undetected. While this may increase the initial public health workload, the probable case definition can be refined over time, once scientists have a better understanding of factors like the cause of infections, locations where exposures are likely to occur, and the viral incubation period. [The Lancet]

Food support programs were used to address food insecurity (FI) during the COVID-19 pandemic.

Researchers conducted a web-based survey of clinicians and staff from 43 practices providing primary care or prenatal care in northern New England to understand how practices experienced changes in FI during the COVID-19 pandemic. About 60% of practices surveyed reported at least one new food program at the practice or community level since the pandemic began. Practices reporting new food programs were more likely to be rural, federally qualified health centers, and have greater confidence in practice and community capacity to address FI. [Journal of Primary Care & Community Health]

A decision tree (DT) algorithm is a possible tool to help identify COVID-19 patients at high risk of mortality.

A machine learning DT algorithm was used to describe the association of specific variables with 28-day ICU outcomes in adult COVID-19 patients admitted to 14 ICUs in Saudia Arabia from March to October 2020 and assess the value of utilizing a machine learning DT algorithm to identify patients at high risk of mortality. Of 1,468 critically ill COVID-19 patients, the 28-day ICU mortality was 36.8%, and the 90-day mortality was 40.9%. The DT algorithm identified a need for intubation, need for vasopressors, age, gender, and PaO2/FiO2 ratio as variables to be integrated into the algorithm to predict 28-day ICU outcomes. [Journal of Infection and Public Health]

In the absence of infectious disease physician support, pharmacists can lead antimicrobial stewardship programs (ASPs).

To evaluate the effectiveness of a pharmacist-led ASP in a hospital without an infectious disease physician, a prospective quasi-experimental study was executed, implementing an ASP in a 194-bed hospital in Spain. Researchers evaluated changes in antimicrobial use between pre- and post- intervention periods. A total of 847 antimicrobial pharmacist interventions (PIs) were proposed, of which 88.3% accepted, and direct expenditure on antibiotics decreased significantly. Discontinuation due to excessive duration was the most frequently performed PI (23.4%) with most PIs classified as having major or moderate clinical impact. [Nature]

How can pharma improve access to medicines in the poorest countries?

In its latest report, the Access to Medicine Foundation explores the lack of access to antibiotics and antifungals as a driving force of antimicrobial resistance in countries carrying a high infectious disease burden and large gaps in access to the right treatment. Acknowledging the role that pharmaceutical companies can play to reduce this gap, the report uses case studies and provides recommendations on ways by which barriers can be addressed at a local level. [Access to Medicine Foundation]

Agricultural pollutants cause adverse pregnancy outcomes, especially in disadvantaged socio-economic populations.

To explore the interactive effects of maternal exposure to chemical fertilizer during pregnancy and low socioeconomic status (SES) on the risk of term low birth weight (tLBW), researchers executed a population-based case-control study involving 179 tLBW cases (birthweight < 2500 g and gestational age ≥ 37 weeks) and 204 controls (birthweight ≥ 2500 g and gestational age ≥ 37 weeks) from the Perinatal Health Care Surveillance System of Pingding County in China between 2007 and 2012. The combination of low SES and high exposure to village-level and household-level chemical fertilizer consumption was associated with an increased risk of tLBW with more than two-fold. [BMC Public Health]

Mobile phones are vectors for antimicrobial-resistant genes.

Twenty-six mobile phones of healthcare staff were swabbed and metagenomic microbial profiling was performed to identify the presence and diversity of microbial genetic signatures. 11,163 organisms (5,714 bacteria, 675 fungi, 93 protists, 228 viruses, 4,453 bacteriophages) and 2,096 genes coding for antibiotic resistance and virulent factors were isolated from all phones in the study, with phones from the General Pediatric Department carrying a larger microbial burden than those from the Pediatric Intensive Care Unit. Additionally, survey questionnaires on mobile phone usage and behaviors from staff revealed that 46% of participants reported using their mobile phones in the bathroom. [Nature]

A framework for monitoring antimicrobial resistance (AMR) in water environments.

Researchers sought to establish a framework to standardize and evaluate the state of the science and practice of AMR monitoring of wastewater, recycled water, and surface water, through a literature review, survey, and a workshop with academic, governmental, consulting, and water utility professionals. They identified culture-based methods, qPCR-based methods, and metagenomic-based methods, as well as critical research needs, and the type of local and global collaboration required to standardize monitoring. The framework could be applied to reach broader global AMR surveillance goals, including tracking and mitigating the spread of AMR through water environments and informing epidemiological studies and human health risk assessments. [Environmental Science & Technology]