Household water treatment (HWT) is being widely promoted as an appropriate intervention for reducing the burden of waterborne disease in poor communities in developing countries. A recent study has ...raised concerns about the effectiveness of HWT, in part because of concerns over the lack of blinding and in part because of considerable heterogeneity in the reported effectiveness of randomized controlled trials. This study set out to attempt to investigate the causes of this heterogeneity and so identify factors associated with good health gains. Studies identified in an earlier systematic review and meta-analysis were supplemented with more recently published randomized controlled trials. A total of 28 separate studies of randomized controlled trials of HWT with 39 intervention arms were included in the analysis. Heterogeneity was studied using the “metareg” command in Stata. Initial analyses with single candidate predictors were undertaken and all variables significant at the P < 0.2 level were included in a final regression model. Further analyses were done to estimate the effect of the interventions over time by MonteCarlo modeling using @Risk and the parameter estimates from the final regression model. The overall effect size of all unblinded studies was relative risk = 0.56 (95% confidence intervals 0.51−0.63), but after adjusting for bias due to lack of blinding the effect size was much lower (RR = 0.85, 95% CI = 0.76−0.97). Four main variables were significant predictors of effectiveness of intervention in a multipredictor meta regression model: Log duration of study follow-up (regression coefficient of log effect size = 0.186, standard error (SE) = 0.072), whether or not the study was blinded (coefficient 0.251, SE 0.066) and being conducted in an emergency setting (coefficient −0.351, SE 0.076) were all significant predictors of effect size in the final model. Compared to the ceramic filter all other interventions were much less effective (Biosand 0.247, 0.073; chlorine and safe waste storage 0.295, 0.061; combined coagulant-chlorine 0.2349, 0.067; SODIS 0.302, 0.068). A Monte Carlo model predicted that over 12 months ceramic filters were likely to be still effective at reducing disease, whereas SODIS, chlorination, and coagulation−chlorination had little if any benefit. Indeed these three interventions are predicted to have the same or less effect than what may be expected due purely to reporting bias in unblinded studies With the currently available evidence ceramic filters are the most effective form of HWT in the longterm, disinfection-only interventions including SODIS appear to have poor if any longterm public health benefit.
One of the few studies to estimate infection risk with SARS-CoV-2 in the general population was the UK Office of National Statistics Infection Survey. This survey provided data that allowed us to ...describe and interpret apparent risk factors for testing positive for SARS-CoV-2 in a period when variants and COVID-19 controls experienced large changes.
The ONS published estimates of likelihood of individuals testing positive in two week monitoring periods between 21st November 2021 and 7th May 2022, relating this positivity to social and behavioural factors. We applied meta-regression to these estimates of likelihood of testing positive to determine whether the monitored potential risk factors remained constant during the pandemic.
Some risk factors had consistent relationship with risk of infection (always protective or always linked to higher risk, throughout monitoring period). Other risk factors had variable relationship with risk of infection, with changes seeming to especially correlate with the emergence of Omicron BA.2 dominance. These variable factors were mask-wearing habits, history of foreign travel, household size, working status (retired or not) and contact with children or persons age over 70.
Relevance of some risk factors to likelihood of testing positive for SARS-CoV-2 may relate to reinfection risk, variant infectiousness and status of social distancing regulations.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Transthoracic Doppler echocardiography is recommended for screening for the presence of pulmonary hypertension (PH). However, some recent studies have suggested that Doppler echocardiographic ...pulmonary artery pressure estimates may frequently be inaccurate.
Evaluate the accuracy of Doppler echocardiography for estimating pulmonary artery pressure and cardiac output.
We conducted a prospective study on patients with various forms of PH who underwent comprehensive Doppler echocardiography within 1 hour of a clinically indicated right-heart catheterization to compare noninvasive hemodynamic estimates with invasively measured values.
A total of 65 patients completed the study protocol. Using Bland-Altman analytic methods, the bias for the echocardiographic estimates of the pulmonary artery systolic pressure was -0.6 mm Hg with 95% limits of agreement ranging from +38.8 to -40.0 mm Hg. Doppler echocardiography was inaccurate (defined as being greater than +/-10 mm Hg of the invasive measurement) in 48% of cases. Overestimation and underestimation of pulmonary artery systolic pressure by Doppler echocardiography occurred with a similar frequency (16 vs. 15 instances, respectively). The magnitude of pressure underestimation was greater than overestimation (-30 +/- 16 vs. +19 +/- 11 mm Hg; P = 0.03); underestimates by Doppler also led more often to misclassification of the severity of the PH. For cardiac output measurement, the bias was -0.1 L/min with 95% limits of agreement ranging from +2.2 to -2.4 L/min.
Doppler echocardiography may frequently be inaccurate in estimating pulmonary artery pressure and cardiac output in patients being evaluated for PH.
Cryptosporidium infection causes gastrointestinal disease and has a worldwide distribution. The highest burden is in developing countries.
We sought to conduct a systematic review and meta-analysis ...to identify Cryptosporidium risk factors in Low and Middle Income countries (LMICs).
Medline Ovid and Scopus databases were searched with no restriction on year or language of publication. All references were screened independently in duplicate and were included if they presented data on at least 3 risk factors. Meta-analyses using random effects models were used to calculate overall estimates for each exposure.
The most frequently reported risk factors in the 15 included studies were overcrowding, household diarrhoea, poor quality drinking water, animal contact, open defecation/ lack of toilet and breastfeeding. The combined odds ratio for animal contact was 1.98 (95%CI: 1.11-3.54) based on 11 studies and for diarrhoea in the household 1.98 (95%CI: 1.13-3.49) based on 4 studies. Open defecation was associated with a pooled odds ratio of 1.82 (95%CI: 1.19-2.8) based on 5 studies. Poor drinking water quality was not associated with a significant Cryptosporidium risk, odds ratio 1.06 (95%CI: 0.77-1.47). Breastfeeding was protective with pooled odds ratio 0.4 (95%CI: 0.13-1.22), which was not statistically significant.
Based on the included studies, crowded living conditions, animal contact and open defecation are responsible for the majority of Cryptosporidium cases in LMICs. Future studies investigating Cryptosporidium risk factors should have a good study design and duration, include appropriate number of cases, select suitable controls, investigate multiple relevant risk factors, fully report data and perform multivariate analysis.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
There is much uncertainty about the future impact of climate change on vector-borne diseases. Such uncertainty reflects the difficulties in modelling the complex interactions between disease, ...climatic and socioeconomic determinants. We used a comprehensive panel dataset from Mexico covering 23 years of province-specific dengue reports across nine climatic regions to estimate the impact of weather on dengue, accounting for the effects of non-climatic factors.
Using a Generalized Additive Model, we estimated statistically significant effects of weather and access to piped water on dengue. The effects of weather were highly nonlinear. Minimum temperature (Tmin) had almost no effect on dengue incidence below 5 °C, but Tmin values above 18 °C showed a rapidly increasing effect. Maximum temperature above 20 °C also showed an increasing effect on dengue incidence with a peak around 32 °C, after which the effect declined. There is also an increasing effect of precipitation as it rose to about 550 mm, beyond which such effect declines. Rising access to piped water was related to increasing dengue incidence. We used our model estimations to project the potential impact of climate change on dengue incidence under three emission scenarios by 2030, 2050, and 2080. An increase of up to 40% in dengue incidence by 2080 was estimated under climate change while holding the other driving factors constant.
Our results indicate that weather significantly influences dengue incidence in Mexico and that such relationships are highly nonlinear. These findings highlight the importance of using flexible model specifications when analysing weather-health interactions. Climate change may contribute to an increase in dengue incidence. Rising access to piped water may aggravate dengue incidence if it leads to increased domestic water storage. Climate change may therefore influence the success or failure of future efforts against dengue.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
How features of the visual scene are encoded in the population activity of retinal ganglion cells (RGCs) targeting specific regions of the brain is not well understood. To address this, we have used ...a genetically encoded reporter of presynaptic function (SyGCaMP3) to record visually evoked activity in the population of RGC axons innervating the zebrafish tectum. Using unbiased voxel-wise analysis of SyGCaMP3 signals, we identify three subtypes of direction-selective and two subtypes of orientation-selective retinal input. Composite parametric functional maps generated across many larvae show laminar segregation of direction- and orientation-selective responses and unexpected retinotopic biases in the distribution of functional subtypes. These findings provide a systematic description of the form, organization, and dimensionality of visual inputs to the brain and will serve as a platform for understanding emergent properties in tectal circuits associated with visually driven behavior.
► Fine-scale functional imaging of retinotectal inputs at the population level ► Voxel-wise analysis reveals direction- and orientation-selective retinotectal inputs ► Direction- and orientation-selective inputs segregate into distinct laminae ► Composite maps show retinotopic biases in directional and orientational inputs
The functional organization of sensory terminals within the brain is insufficiently characterized. Nikolaou et al. provide maps of retinal inputs to the zebrafish tectum that reveal segregation according to functional class. Their approach illustrates the strength of examining inputs en masse.
Health misinformation can exacerbate infectious disease outbreaks. Especially pernicious advice could be classified as “fake news”: manufactured with no respect for accuracy and often integrated with ...emotive or conspiracy-framed narratives. We built an agent-based model that simulated separate but linked circulating contagious disease and sharing of health advice (classified as useful or harmful). Such advice has potential to influence human risk-taking behavior and therefore the risk of acquiring infection, especially as people are more likely in observed social networks to share bad advice. We test strategies proposed in the recent literature for countering misinformation. Reducing harmful advice from 50% to 40% of circulating information, or making at least 20% of the population unable to share or believe harmful advice, mitigated the influence of bad advice in the disease outbreak outcomes. How feasible it is to try to make people “immune” to misinformation or control spread of harmful advice should be explored.
Water supply and health Hunter, Paul R; MacDonald, Alan M; Carter, Richard C
PLoS medicine,
11/2010, Letnik:
7, Številka:
11
Journal Article
Recenzirano
Odprti dostop
As one article in a four-part PLoS Medicine series on water and sanitation, Paul Hunter and colleagues argue that much more effort is needed to improve access to safe and sustainable water supplies.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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