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Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis

August 1, 2012 Comments off

Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis (PDF)

Source: The Lancet

Background

We did a meta-analysis to assess factors associated with disparities in HIV infection in black men who have sex with men (MSM) in Canada, the UK, and the USA.

Methods

We searched Embase, Medline, Google Scholar, and online conference proceedings from Jan 1, 1981, to Dec 31, 2011, for racial comparative studies with quantitative outcomes associated with HIV risk or HIV infection. Key words and Medical Subject Headings (US National Library of Medicine) relevant to race were cross-referenced with citations pertinent to homosexuality in Canada, the UK, and the USA. Data were aggregated across studies for every outcome of interest to estimate overall effect sizes, which were converted into summary ORs for 106 148 black MSM relative to 581 577 other MSM.

Finding

We analysed seven studies from Canada, 13 from the UK, and 174 from the USA. In every country, black MSM were as likely to engage similarly in serodiscordant unprotected sex as other MSM. Black MSM in Canada and the USA were less likely than other MSM to have a history of substance use (odds ratio, OR, 0·53, 95% CI 0·38–0·75, for Canada and 0·67, 0·50–0·92, for the USA). Black MSM in the UK (1·86, 1·58–2·18) and the USA (3·00, 2·06–4·40) were more likely to be HIV positive than were other MSM, but HIV-positive black MSM in each country were less likely (22% in the UK and 60% in the USA) to initiate combination antiretroviral therapy (cART) than other HIV-positive MSM. US HIV-positive black MSM were also less likely to have health insurance, have a high CD4 count, adhere to cART, or be virally suppressed than were other US HIV-positive MSM. Notably, despite a two-fold greater odds of having any structural barrier that increases HIV risk (eg, unemployment, low income, previous incarceration, or less education) compared with other US MSM, US black MSM were more likely to report any preventive behaviour against HIV infection (1·39, 1·23–1·57). For outcomes associated with HIV infection, disparities were greatest for US black MSM versus other MSM for structural barriers, sex partner demographics (eg, age, race), and HIV care outcomes, whereas disparities were least for sexual risk outcomes.

Interpretation

Similar racial disparities in HIV and sexually transmitted infections and cART initiation are seen in MSM in the UK and the USA. Elimination of disparities in HIV infection in black MSM cannot be accomplished without addressing structural barriers or differences in HIV clinical care access and outcomes.

Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy

July 19, 2012 Comments off

Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy

Source: The Lancet

Background

Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world’s population is inactive, this link presents a major public health issue. We aimed to quantify the effect of physical inactivity on these major non-communicable diseases by estimating how much disease could be averted if inactive people were to become active and to estimate gain in life expectancy at the population level.

Methods

For our analysis of burden of disease, we calculated population attributable fractions (PAFs) associated with physical inactivity using conservative assumptions for each of the major non-communicable diseases, by country, to estimate how much disease could be averted if physical inactivity were eliminated. We used life-table analysis to estimate gains in life expectancy of the population.

Findings

Worldwide, we estimate that physical inactivity causes 6% (ranging from 3·2% in southeast Asia to 7·8% in the eastern Mediterranean region) of the burden of disease from coronary heart disease, 7% (3·9—9·6) of type 2 diabetes, 10% (5·6—14·1) of breast cancer, and 10% (5·7—13·8) of colon cancer. Inactivity causes 9% (range 5·1—12·5) of premature mortality, or more than 5·3 million of the 57 million deaths that occurred worldwide in 2008. If inactivity were not eliminated, but decreased instead by 10% or 25%, more than 533 000 and more than 1·3 million deaths, respectively, could be averted every year. We estimated that elimination of physical inactivity would increase the life expectancy of the world’s population by 0·68 (range 0·41—0·95) years.

Interpretation

Physical inactivity has a major health effect worldwide. Decrease in or removal of this unhealthy behaviour could improve health substantially.

Funding

None.

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Global physical activity levels: surveillance progress, pitfalls, and prospects

July 19, 2012 Comments off

Global physical activity levels: surveillance progress, pitfalls, and prospects

Source: The Lancet

To implement effective non-communicable disease prevention programmes, policy makers need data for physical activity levels and trends. In this report, we describe physical activity levels worldwide with data for adults (15 years or older) from 122 countries and for adolescents (13—15-years-old) from 105 countries. Worldwide, 31·1% (95% CI 30·9—31·2) of adults are physically inactive, with proportions ranging from 17·0% (16·8—17·2) in southeast Asia to about 43% in the Americas and the eastern Mediterranean. Inactivity rises with age, is higher in women than in men, and is increased in high-income countries. The proportion of 13—15-year-olds doing fewer than 60 min of physical activity of moderate to vigorous intensity per day is 80·3% (80·1—80·5); boys are more active than are girls. Continued improvement in monitoring of physical activity would help to guide development of policies and programmes to increase activity levels and to reduce the burden of non-communicable diseases.

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Global cancer transitions according to the Human Development Index (2008—2030): a population-based study

June 1, 2012 Comments off

Global cancer transitions according to the Human Development Index (2008—2030): a population-based study

Source: The Lancet

Background

Cancer is set to become a major cause of morbidity and mortality in the coming decades in every region of the world. We aimed to assess the changing patterns of cancer according to varying levels of human development.

Methods

We used four levels (low, medium, high, and very high) of the Human Development Index (HDI), a composite indicator of life expectancy, education, and gross domestic product per head, to highlight cancer-specific patterns in 2008 (on the basis of GLOBOCAN estimates) and trends 1988—2002 (on the basis of the series in Cancer Incidence in Five Continents), and to produce future burden scenario for 2030 according to projected demographic changes alone and trends-based changes for selected cancer sites.

Findings

In the highest HDI regions in 2008, cancers of the female breast, lung, colorectum, and prostate accounted for half the overall cancer burden, whereas in medium HDI regions, cancers of the oesophagus, stomach, and liver were also common, and together these seven cancers comprised 62% of the total cancer burden in medium to very high HDI areas. In low HDI regions, cervical cancer was more common than both breast cancer and liver cancer. Nine different cancers were the most commonly diagnosed in men across 184 countries, with cancers of the prostate, lung, and liver being the most common. Breast and cervical cancers were the most common in women. In medium HDI and high HDI settings, decreases in cervical and stomach cancer incidence seem to be offset by increases in the incidence of cancers of the female breast, prostate, and colorectum. If the cancer-specific and sex-specific trends estimated in this study continue, we predict an increase in the incidence of all-cancer cases from 12·7 million new cases in 2008 to 22·2 million by 2030.

Interpretation

Our findings suggest that rapid societal and economic transition in many countries means that any reductions in infection-related cancers are offset by an increasing number of new cases that are more associated with reproductive, dietary, and hormonal factors. Targeted interventions can lead to a decrease in the projected increases in cancer burden through effective primary prevention strategies, alongside the implementation of vaccination, early detection, and effective treatment programmes.

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Shaping cities for health: complexity and the planning of urban environments in the 21st century

June 1, 2012 Comments off

Shaping cities for health: complexity and the planning of urban environments in the 21st century
Source: The Lancet

With almost 30 years’ experience from the Healthy Cities movement, we are increasingly aware of the features needed to transform a city into a healthy city. However, how to deliver the potential health benefits and how to ensure that they reach all citizens in urban contexts worldwide is less well understood. This task is becoming increasingly important, given that most of the world’s population live in cities, and the current high rates of urbanisation.

This report argues against the assumption that urban health outcomes will improve with economic growth and demographic change, and instead highlights the need for urban planning for health needs. A linear or cyclical planning approach is insufficient in conditions of complexity. Progress towards effective action on urban health will be best achieved through local experimentation in a range of projects, for example case studies of sanitation and wastewater management (Mumbai), urban mobility (Bogotá), building standards (London), the urban heat island effect (London), and urban agriculture (Havana and Accra). Evaluation and assessment of practices and decision-making processes through dialogue between stakeholders and communities and mutual learning is essential.

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Global malaria mortality between 1980 and 2010: a systematic analysis

February 6, 2012 Comments off
Source:  The Lancet
Background
During the past decade, renewed global and national efforts to combat malaria have led to ambitious goals. We aimed to provide an accurate assessment of the levels and time trends in malaria mortality to aid assessment of progress towards these goals and the focusing of future efforts.
Methods
We systematically collected all available data for malaria mortality for the period 1980—2010, correcting for misclassification bias. We developed a range of predictive models, including ensemble models, to estimate malaria mortality with uncertainty by age, sex, country, and year. We used key predictors of malaria mortality such as Plasmodium falciparum parasite prevalence, first-line antimalarial drug resistance, and vector control. We used out-of-sample predictive validity to select the final model.
Findings
Global malaria deaths increased from 995 000 (95% uncertainty interval 711 000—1 412 000) in 1980 to a peak of 1 817 000 (1 430 000—2 366 000) in 2004, decreasing to 1 238 000 (929 000—1 685 000) in 2010. In Africa, malaria deaths increased from 493 000 (290 000—747 000) in 1980 to 1 613 000 (1 243 000—2 145 000) in 2004, decreasing by about 30% to 1 133 000 (848 000—1 591 000) in 2010. Outside of Africa, malaria deaths have steadily decreased from 502 000 (322 000—833 000) in 1980 to 104 000 (45 000—191 000) in 2010. We estimated more deaths in individuals aged 5 years or older than has been estimated in previous studies: 435 000 (307 000—658 000) deaths in Africa and 89 000 (33 000—177 000) deaths outside of Africa in 2010.
Interpretation
Our findings show that the malaria mortality burden is larger than previously estimated, especially in adults. There has been a rapid decrease in malaria mortality in Africa because of the scaling up of control activities supported by international donors. Donor support, however, needs to be increased if malaria elimination and eradication and broader health and development goals are to be met.
Funding
The Bill & Melinda Gates Foundation.
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The Lancet: Addiction Series

January 12, 2012 Comments off
Source: The Lancet
A three-part Series assesses the global public-health toll and policy implications of drug addiction. The first paper summarises data for the prevalence and consequences of problem use of amphetamines, cannabis, cocaine, and opioids. In high-income countries, illicit drug use contributes less to the burden of disease than tobacco, but a substantial proportion of that burden is due to alcohol. Intelligent policy responses to drug problems need better prevalence data for different types of illicit drug use and the harms that their use causes globally. This need is especially urgent in high-income countries with substantial rates of illicit drug use and in low-income and middle-income countries close to illicit drug production areas. The second paper reviews existing drug policies and highlights the need for greater reliance on scientific evidence-based policy making. The final paper examines the value of international drug conventions in protecting public health.

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Obesity (Series)

August 31, 2011 Comments off

Obesity
Source: The Lancet

This four-part Series critically examines what we know about the global obesity pandemic: its drivers, its economic and health burden, the physiology behind weight control and maintenance, and what science tells us about the kind of actions that are needed to change our obesogenic environment and reverse the current tsunami of risk factors for chronic diseases in future generations.

The first paper looks at the global drivers of the epidemic; the second paper analyses obesity trends in the USA and UK, and their impact on prevalence of diseases and healthcare spending. The third paper introduces a new web-based bodyweight simulation model, that incorporates metabolic adaptations that occur with decreasing bodyweight; and the final paper assesses the interventions needed to halt and reverse the epidemic. Its authors conclude that the changes needed are likely to require many sustained interventions at several levels, but that national governments should take the lead.

Health and economic burden of the projected obesity trends in the USA and the UK

August 29, 2011 Comments off

Health and economic burden of the projected obesity trends in the USA and the UK
Source: The Lancet

Rising prevalence of obesity is a worldwide health concern because excess weight gain within populations forecasts an increased burden from several diseases, most notably cardiovascular diseases, diabetes, and cancers. In this report, we used a simulation model to project the probable health and economic consequences in the next two decades from a continued rise in obesity in two ageing populations—the USA and the UK. These trends project 65 million more obese adults in the USA and 11 million more obese adults in the UK by 2030, consequently accruing an additional 6—8·5 million cases of diabetes, 5·7—7·3 million cases of heart disease and stroke, 492 000—669 000 additional cases of cancer, and 26—55 million quality-adjusted life years forgone for USA and UK combined. The combined medical costs associated with treatment of these preventable diseases are estimated to increase by $48—66 billion/year in the USA and by £1·9—2 billion/year in the UK by 2030. Hence, effective policies to promote healthier weight also have economic benefits.

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