Tracking HIV infection and networks of drugs users in China: a national series,cross-sectional study

Background

WHO reported that HIV infection transmitted through injection drug use has declined; however, some studies have indicated that HIV infection is still high in this population in many countries and these changes are uncertain. We therefore aimed to evaluate the prevalence and trend of HIV infection in opioid and synthetic users in China.

Gender inequality and associated factors from the perspective of the Palestinian youth: a cross-sectional study

Background

Women face gender inequality and marginalisation in many aspects of their lives that affect their wellbeing and role in life as important members of society. This study aimed to investigate attitudes towards gender equality in Palestinian youth, and the associated factors.

Adolescent health and Healthy China 2030: a cross-sectional study

Background

The Chinese government approved the Outline of the Healthy China 2030 (HC2030) Plan in 2016, and made public health a priority for all future economic and social development. Studies have demonstrated the importance of investment in health care throughout the 8000 days that it takes for a human to develop, on reducing the disease burden in this group. Therefore, as well as children, adolescents should be recognised as an essential target population for health-care investment, and HC2030 plans to achieve key goals in adolescent health. This study aims to explore the gaps in adolescent health care that must be bridged, and to examine experiences from previous policies for lessons that will help the goals of HC2030 in adolescent health to be realised.

Associations between soundscape experience and self-reported wellbeing in open public urban spaces: a field study

BackgroundPrevious studies, mainly conducted in laboratory experiments, showed there are associations between the perception of acoustic environments (ie, soundscapes, as per the International Organization for Standardization [ISO] 12913-1:2014 definition) and measures of individual health and wellbeing. The aim of this study was to confirm these findings in more ecologically realistic settings, by exploring associations between soundscapes and wellbeing via a questionnaire campaign.MethodsStudy design We performed a socioacoustic field survey with adult volunteers from members of the public who we approached across seven public spaces in London (UK), two in Venice (Italy), and two in Granada (Spain), including parks, urban squares, and commercial streets. Questionnaires gathered individual data about self-reported soundscape experience and wellbeing. Analysis The soundscape assessment protocol relied on the ISO/TS 12913-2:2018, whereas wellbeing measures were based on the WHO-five well-being index (WHO-5). A k-means cluster analysis was performed on the scores of the 15-item soundscape questionnaires, resulting in a two-group stratification of the sample into positive and negative soundscape experiences. The primary outcomes were WHO-5 scores and soundscape experience cluster membership.FindingsWHO-5 scores were computed for 825 (97%) of 849 surveyed participants following WHO instructions. An independent-samples t test showed statistically significant differences in WHO-5 scores between the groups who had a positive (n=445) or negative (n=380) soundscape experience; t(823)=–3·578; p<0·001. The positive group had higher WHO-5 scores (mean 63·5 [SD19·1]) than the negative group (mean 58·7 [18·9]).InterpretationTo the best of our knowledge, this is the first field study to explore associations between (perceived) soundscapes and self-reported measures of wellbeing. Although no causal effects can be established at this stage, results suggest that people with higher levels of wellbeing are more likely to report positive soundscapes, whereas people with lower levels of wellbeing might have a more negative attitude towards the acoustic environments. Self-reported data should be interpreted with caution: to contain any consequent bias, future studies might consider non-participatory methods of investigation and look at temporal effects in longitudinal designs. Overall, these findings highlight the importance of taking into account personal traits when characterising the quality of urban soundscapes and complementing conventional assessments by decibel-related metrics.FundingEuropean Research Council Advanced Grant (no 740696) on Soundscape Indices.     

Common determinants of antimicrobial resistance in sequential episodes of sexually transmitted shigellosis in men who have sex with men: a cross-sectional study

Background

In high-income nations, men who have sex with men (MSM) are at increased risk of shigellosis. A sublineage of Shigella flexneri serotype 3a was recently shown to have spread worldwide in MSM, driven by mobilisable azithromycin resistance. Since then, the serotype 2a and the species S sonnei have become epidemic in the UK. We aimed to determine whether these subsequent outbreaks were also attributable to epidemic sublineages in MSM and mobilisable antimicrobial resistance.

Workplace violence and its aftermath among health workers in Zhejiang province: a cross-sectional study

Background

In China, the reported incidence of workplace violence in hospitals has been increasing. Most research has focused on secondary and tertiary care facilities. We aimed to determine the incidence of workplace violence and its aftermath in county and township hospitals and community health centres in Zhejiang Province.

Antimicrobial resistance in hospital wastewater in Scotland: a cross-sectional metagenomics study

BackgroundAntimicrobial resistance (AMR) is a global health crisis. It is well established that hospital wastewater can contain organisms that are on the WHO priority list of antibiotic-resistant organisms. We aimed to use metagenomics to study whether the abundances of resistance genes in hospital wastewater reflects clinical activity within the hospital.MethodsHospital wastewater was collected over a 24-h period in June, 2017 from multiple collection points representing different specialties within a tertiary hospital site in Scotland, UK and simultaneously from community sewage works. High throughput shotgun sequencing was done using Illumina HiSeq4000. Sequence reads were assigned taxonomically and to the AMR genes in the ResFinder database. The measured AMR gene abundances were correlated to hospital antimicrobial usage in defined daily doses per 100 occupied bed-days, mean patient length of stay in hospital, mean patient age per hospital collection point, and resistance levels in clinical isolates.Findings1047 bacterial genera and 174 different AMR genes were detected across all samples. Microbiota composition and AMR gene abundance and diversity varied between each collection point and AMR gene abundance was higher in hospital wastewater than in community influent. The composition of AMR genes correlated with microbiota composition (Procrustes analysis, p=0·002). Increased antimicrobial consumption at a class level was associated with higher AMR gene abundance within that class in hospital wastewater (incidence rate ratio 2·80, 95% CI 1·2–6·5, p=0·016). Prolonged mean patient length of stay was associated with higher total AMR gene abundance in hospital wastewater (2·05, 1·39–3·01, p=0·0003). No overall association was found between resistance in clinical isolates at an antimicrobial class level and AMR gene abundance in hospital wastewater.InterpretationAntimicrobial usage is a major driver of AMR gene outflow from hospitals into the sewage environment. The positive relationship between length of stay and AMR gene abundance is consistent with prolonged admission being a risk factor for carriage and infection with resistant microorganisms. Our findings show that hospital wastewater does reflect inpatient activity. With further evaluation this method might represent a useful surveillance tool to monitor hospital AMR gene outflow and guide environmental policy on AMR.FundingAcademy of Medical Sciences.     

Antibiotic misuse among university students in western and eastern China: a cross-sectional survey

Background

Antimicrobial resistance (AMR) is one of the greatest threats to public health in China. The primary cause of AMR is antibiotic misuse, especially used for self-limiting illnesses. Little is known about regional differences of antibiotic-misuse behaviors in China. We aimed to explore such behaviors among university students in western and eastern China.

Association between the arrested decline in cardiovascular disease and health and social-care costs: a modelling study

BackgroundDementia and cardiovascular disease generate enormous health and social-care costs and have shared risk factors. Following decades of cardiovascular disease mortality declines in England, improvements slowed after 2011. We investigated the potential economic implications of this slowdown.MethodsWe used the IMPACT better aging model—an open-cohort, stochastic Markov model. We synthesised trends in cardiovascular disease incidence and mortality, dementia, and disability (defined as reported diagnosis, functional impairment, or measured cognitive impairment) from the English Longitudinal Study of Ageing (ELSA) and Office for National Statistics data. We projected trends for adults aged 35–100 years in England and Wales from 2019–29. We modelled undiscounted health and social-care costs (primary outcome), and quality-adjusted life-years (QALYs) under the following two scenarios: age-specific cardiovascular disease incidence continues to decline, recommencing previous downward trends (scenario one); or age-specific cardiovascular disease incidence plateaus after 2006, continuing recent trends, assuming changes in mortality reflect incidence 5 years before (scenario two). We linked 85% of ELSA participants to their Hospital Episode Statistics (HES) data, which were costed and calibrated to national estimates. Age-related social-care costs were estimated by use of reported contact hours from ELSA combined with standard reference costs. Standard catalogues were used for QALY weights.FindingsIn scenario one, changes in population size and health were projected to increase health-care costs by around 12% between 2019 and 2029, from £93·0 billion to £104·6 billion per year (in 2019 prices). Social-care costs were projected to increase by around 27%, from £8·0 billion to £10·2 billion per year. In scenario two, health-care costs were projected to increase by around 15%, from £95·3 billion to £109·6 billion, and social-care costs by around 30%, from £8·2 billion to £10·7 billion, between 2019 and 2029. The overall net monetary cost of this slowdown in cardiovascular disease decline was £17·5 billion per year (made up of 200 000 QALYs and £5·5 billion in health and social-care costs).InterpretationWe predict social-care costs will grow twice as fast as health-care costs over the next decade, even if cardiovascular disease occurrence continues to decline. Understanding the scale of the future health and social-care funding challenge might support proactive policy making. This study represents the first time ELSA data have been linked with HES data. However, we did not assess changes in health and social-care efficiency over time or the effect of spending on improving health.FundingBritish Heart Foundation     

Tuberculosis detection and the cost of integrated care in rural China: a cross-sectional standardised patient study

Background

Future progress against tuberculosis in China will likely rely on improved detection, particularly in rural areas where prevalence remains high. The ability of rural providers to correctly diagnose Tuberculosis is largely unknown, as are the potential effects on tuberculosis patients of health-system reforms promoting initial contact with grassroots providers.

Association between consultation length and patient experience of ambulatory care in China: a cross-sectional study

Background

A longer time in consultation with doctors in ambulatory care has been associated with better quality of care. Patient experience is of great concern to policy makers and is linked with health-care quality. However, the relationship between consultation length and patient experience remains unclear. We aimed to investigate the effect of consultation length on patient experience, based on analysis of a cross-sectional nationwide patient survey data in China.

Validity of using UK primary care electronic health records to study migration and health: a population-based cohort study

BackgroundDespite international migrants comprising 15·6% of the English population, there are no large-scale studies of migrant health in UK primary care electronic health records (EHRs). Developing and validating a migration phenotype (a transparent reproducible algorithm based on EHRs to identify migrants) is necessary to determine the feasibility of using EHRs for migration health research. This study aims to develop and validate a migrant phenotype in Clinical Practice Research Datalink (CPRD), the largest UK primary care EHR.MethodsThis is a population-based cohort study of individuals of any age in CPRD between Jan 1, 2007, and Feb 29, 2016, with a diagnostic Read term indicating international migration. We describe completeness of recording of migration: percentage of individuals recorded as migrants over time. We also describe representativeness of the cohort (age, sex, and geographical origin) compared with data from the Office of National Statistics (ONS; country of birth and the 2011 English Census).Findings325 391 (3·4%) of 9,448,898 individuals in CPRD had at least one of 440 terms indicating international migration. The cohort was mostly female (53·7% [174 883/325 391] overall; 52·4% [55 734/106 462] in 2011), which is similar to ONS 2011 census data (51·7 [3 791 375/7 337 139]). The percentage of migrants per year increased from 1·2% (69 046/5 716 075) in 2007 to 2·8 (154 525/5 427 745) in 2013, following a similar trend to ONS migration data (11·7% [5 927 000/50 714 000] in 2007; 13·7% [7 285 000/53 164 000] in 2013). Proportions were significantly lower in CPRD (χ² test; p<0·0001). The highest percentages of migrants were in the 25–34-year-old band (4·6% [30 549/668 864] in CPRD; 25·9% [1 851 952/7 160 102] in ONS). Migrants were mostly born in Europe (35·4% [10 316/29 113] in CPRD; 36·5% [2 675 003/7 337 042] in ONS) or the Middle East and Asia (34·5% [10 037/29 113] in CPRD; 34·5% [2 529 137/7 337 042] in ONS).InterpretationWe created a cohort of international migrants in England that is broadly representative in terms of age, sex, and geographical region of origin. Future validation work should explore representativeness by ethnicity and deprivation. Potential reasons for undersampling compared with ONS data include insufficient recording and poor health-care access. Nonetheless, the large cohort size provides sufficient power to study a range of health-care analyses in this potentially underserved population.FundingWellcome Trust (approvals [CPRD ISAC 19_062R]; REC 09/H0810/16).     

Equity as a consideration in evaluations of health taxes: a systematic review

BackgroundTaxing harmful products—such as tobacco, sugar, or alcohol—is a valuable way to improve population health. However, it is argued that excise duties on goods are regressive, because the payment burden falls on the poorest people. The extent to which distributional equity is incorporated into evaluations of the (potential or observed) effect of such taxes is unclear. The primary outcome of this systematic review of evaluations investigating taxation on tobacco, sugar-sweetened-beverages (SSBs), or alcohol was the proportion of evaluations that have considered distributional equity. Secondary aims included identifying methods used to incorporate equity, and summarising the reported distributional effects, for both costs and health benefits.MethodsA literature search was done using three databases: Medline, NHS Economic Evaluation Database, and EconLit. The full list of search terms is included in the appendix. We included studies published in English, from Jan 1, 1946, to May 20, 2019. Studies that did not explicitly quantify both costs and benefits in terms of health were excluded. Two authors independently reviewed each study to determine inclusion. Citation tracking was used to identify remaining studies, and appraisal for risk of bias in included evaluations was done against validated tools. This systematic review was prospectively registered on PROSPERO (CRD42019137409).FindingsOf 4656 search results, 69 studies were included. 45 combined economic methods with epidemiological modelling. Tobacco was most commonly investigated, with 35 evaluations. Of these 35, 14 (40%) considered distributional equity, with six (27%) of 22 included SSB evaluations doing the same, and none for alcohol. A tobacco tax favoured lower-income groups in the distribution of costs in all 14 evaluations, and for health benefits in eight evaluations. For SSBs, four evaluations found costs to favour low-income groups, with three finding the same distribution for health benefits.InterpretationDespite recommendations, evaluations of health taxes do not routinely consider distributional equity. Evaluations for alcohol taxation are particularly weak. Where investigated, the majority of evidence found tobacco taxation to favour low-income groups, but the little evidence for SSBs is mixed. Future evaluations of health taxes must incorporate distributional equity, if they are to be useful to policy makers.FundingNone.