Anyone for an Evidence Summer?

By Virginia Barbour
Posted: April 17, 2013
Credit https://twitter.com/limn via https://twitter.com/mgtmccartney

Credit: @limn via @mgtmccartney

In this gloomy northern hemispheric spring, it seems there is something interesting and encouraging going on in public health.

Finally, perhaps the status quo in what is acceptable to inform clinical medicine is now changing, that it is understood that the public has the right to expect better evidence than what is now available and a growing group of health professionals, who span the spectrum from front-line GPs (including Margaret McCartney, via whom the image at the beginning of this blog comes) to systematic reviewers are rising to this challenge. In this they are supported by editors and, perhaps even most encouragingly of all, increasingly politicians and policy makers.

A couple of recent events give a real flavour of these changes. EvidenceLive, at the end of March, a conference run by the BMJ and the Centre for Evidence Based Medicine, Oxford (CEBM) was one of the most invigorating conferences I have been to for quite some time. Not only was there a real sense of a collective vision, evidenced by tremendous engagement from among the participants  (including virtually on twitter #evidencelive) – so it was almost irrelevant who was a speaker and who was the audience – but also a sense that many strands were coming together and that the argument for the need for evidence informing healthcare was over (something that might seem blindingly obvious to an outsider), it was more about how to make it happen.

Of course in one important area the argument is not over
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New Uganda case study in PLOS Medicine’s series on global mental health practice

By Jocalyn Clark
Posted: April 16, 2013

Today we publish another installment in the ongoing PLOS Medicine Series on Global Mental Health Practice, guest edited by Drs. Vikram Patel, Rachel Jenkins, and Crick Lund.

Etheldreda Nakimuli-Mpungu from the University of Makerere and colleagues describe their public-private partnership (PPP) that worked to deliver low cost, evidence-based mental health care to traumatized populations in northern Uganda. The partners—the US-based Peter C. Alderman Foundation with a mission to “heal the emotional wounds of victims of terrorism and mass violence in post-conflict countries” and several Ugandan government institutions—initiated a PPP to leverage pooled resources, raising patient care to a level that neither of the partners could provide by working alone. The partnership also employed a systems approach to mental health care, wherein clinics could deliver uniform treatment that was locally adapted to each tribal culture. The authors report that over a 6-year period (2005–2011), the partners established five psycho-trauma centers and people attending the clinics increased from 300 in 2007 to over 3,000 by June 2012.

Image Credit: Marcie Casas

Image Credit: Marcie Casas

We continue to invite submissions to this series of Health in Action articles. Details can be found in our 2012 “call for papers” editorial: Putting Evidence into Practice: The PLOS Medicine Series on Global Mental Health Practice.

The full list of case studies published thus far in the Series, which represents an extraordinary and global look at how mental health interventions are being implemented to improve the care, well-being, and human rights of individuals around the world, is here:

Stepped Care for Maternal Mental Health: A Case Study of the Perinatal Mental Health Project in South Africa

Improving Access to Mental Health Care and Psychosocial Support within a Fragile Context: A Case Study from Afghanistan

Integrating Mental Health and Development: A Case Study of the BasicNeeds Model in Nepal

Developing a National Mental Health Policy: A Case Study from Uganda

Balancing Community and Hospital Care: A Case Study of Reforming Mental Health Services in Georgia

Implementation of a Mental Health Care Package for Children in Areas of Armed Conflict: A Case Study from Burundi, Indonesia, Nepal, Sri Lanka, and Sudan

 

 

Category: Global Health, Mental Health, Mental Health Series | Leave a comment

This Week in PLOS Medicine: Preeclampsia & Diabetes, Ugandan Trauma Centers, & Sodium Bicarbonate during Open Heart Surgery

By Laura Ray
Posted: April 16, 2013

Image Credit: Flickr torbakhopper

This week PLOS Medicine featured research and discussion on Preeclampsia as a risk factor for diabetes. A case study of trauma centers in post-conflict Uganda and research on prophylactic sodium bicarbonate during open heart surgery were also published.

Denice Feig and colleagues assessed the association between gestational diabetes, gestational hypertension, and preeclampsia and the development of future diabetes in a database analysis of pregnant women in Ontario, Canada. The findings suggest that both preeclampsia and gestational hypertension without gestational diabetes are associated with a 2-fold increased incidence of diabetes in the years following pregnancy, after controlling for several important variables. Thach Tran discusses the results and whether women with a history of hypertensive disorders in pregnancy should be screened for diabetes.

In a double-blinded randomized controlled trial, Anja Haase-Fielitz and colleagues found that an infusion of sodium bicarbonate during open heart surgery did not reduce the risk for acute kidney injury, compared with saline control. The researchers stress the need for discontinuation of this prophylactic therapy.

As one article in an ongoing series on Global Mental Health Practice, Etheldreda Nakimuli-Mpungu and colleagues describe a private-public partnership that implemented and scaled psycho-trauma centers in Northern Uganda. This case study offers valuable information on treating depression, post-traumatic stress disorder, and other mental, neurological, and substance use disorders in post-conflict low- and middle-income countries.

In light of this week’s articles on mental health, diabetes, and heart disease, PLOS Medicine reminds readers of our call for papers into research and commentary on noncommunicable diseases (NCDs) directed toward improving population health and reducing health disparities. Information on open calls can be found here.

Remember you can comment on, annotate and rate any PLOS Medicine article and see the views, citations and other indications of impact of an article on that articles metrics tab.

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How to Write a Better Systematic Review Abstract: Guidance is Here

By Emma Veitch
Posted: April 12, 2013

Given that many individuals who search the biomedical literature will only end up reading the abstract (if that!), it’s disappointing that generally biomedical research abstracts are so badly written. This problem of inaccurate and incomplete reporting of abstracts has been studied in depth for randomized trials – for example, the abstracts of such studies frequently report different figures for the numbers of individuals randomized and analysed. Abstracts can also be a factor in the “spinning” of study results in press releases and media coverage, and thus it’s even more important that these parts of a scientific paper are accurate. A previous study published in PLOS Medicine found that 40% of randomized trial abstract conclusions contained “spin” (specific reporting strategies (intentional or unintentional) emphasizing the beneficial effect of the experimental treatment), and that the only factor studied found to be associated with “spin” in press releases was “spin” in the abstract conclusion section.

However, help is now at hand. Following on from a previous effort in which the CONSORT group developed guidance for improving the writeup of randomized trial abstracts , a group involving some of the same researchers now develop similar guidance for the reporting of systematic review abstracts. The guidance, named “PRISMA for Abstracts”, is concise, and easy to use. It is designed to be used in conjunction with the previous guidance for the reporting of an entire systematic review – the PRISMA statement. The guidance for abstracts includes twelve specific recommendations which outline what key pieces of information should be included in the abstract, with the intention of avoiding accidental omission or misinterpretation, and to help readers decide whether the study is relevant to them, and whether to go on and read further. For each piece of guidance, examples from the literature are included along with justification and references. Although much of the guidance may seem simple and straight forward, it’s important to note that readers clearly find such tools useful: at the time of writing, the PRISMA guidance had received over 90,000 views and over 750 citations. Hopefully the guidance on abstract reporting will be similarly valuable: systematic reviewers should take note and use these recommendations when preparing their reports for publication.

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This Week in PLOS Pathogens and NTDs: Togo’s LF Successes; Chagas in the Gran Chaco; Neurospirochetoses in Humans and Rodent Models of Disease; Possible Role of Caveolin-1 Protein and more

By Matt Lopez
Posted: April 11, 2013
pathogens_4-11

Berthier E, Lim FY, Deng Q, Guo C-J, Kontoyiannis DP, et al. (2013) Low-Volume Toolbox for the Discovery of Immunosuppressive Fungal Secondary Metabolites. PLoS Pathog 9(4): e1003289. doi:10.1371/journal.ppat.1003289

New articles publishing in PLOS NTDs this week:

In 2000, the National Program to Eliminate Lymphatic Filariasis (NPELF) was initiated in Togo and after nine years of mass drug administration Togo has become the first sub-Saharan country to reach likely interruption of infection. Dr. Yao Kognanou Sodahlon and colleagues discuss this milestone, the steps taken to reach it and the future path towards total elimination.

The Gran Chaco – a vast region that spans parts of Paraguay, Bolivia, Argentina and Brazil – has not seen effective control of vector-borne Chagas disease. Dr. Juan Gurevitz and colleagues monitored an infestation of the major vector, Triatoma infestans, in Northern Argentina after a community-wide spraying of insecticide in an effort to understand whether or not that approach offered a sustainable and effective path to vector control.

Nutritional deficiencies such as anemia and iron deficiency are common in women in rural and disadvantaged regions. In this study, Dr. Gerard Casey and colleagues studied the effects of a 54-month program in which approximately 250,000 women in rural Vietnam were given iron-folic acid dietary supplements and regular deworming treatments. The resulting impact on anemia and iron deficiency prevalence was dramatic.

New articles publishing in PLOS Pathogens this week:

The neurotropism of spirochetes is evident in the human spirochetal diseases, such as syphilis, the human borrelioses, and leptospirosis. However, most of the current animal models for the spirochetoses either do not recreate the manifestations of the neurological spectrum or require special manipulations to establish infection. Garcia-Monco and Benach discuss this major challenge.

HIV-1 interactions with myeloid dendritic cells (DCs) can result in virus dissemination to CD4+ T cells via a trans-infection pathway dependent on virion incorporation of the host cell derived glycosphingolipid, GM3, yet it’s the underlying mechanism remains unclear. Puryear et al. define a novel host-encoded receptor-ligand interaction that drives HIV-1 dissemination and can be used for development of novel anti-viral therapeutics.

Chronic infection of gastric epithelial cells by Helicobacter pylori is a major risk factor for human gastric cancer (GC) where Caveolin-1 (Cav1), a scaffold protein and pathogen receptor, is frequently down-regulated. However the function of Cav1 remains unknown. The results of Hitkova et al. suggest a protective role of this protein against H. pylori-induced inflammation and tissue damage.

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With Unpredictable Federal R&D Backing Can Crowdfunding Fill the Gaps?

By Matt Lopez
Posted: April 10, 2013
Credit: Tax Credits, via Flickr

Credit: Tax Credits, via Flickr

The White House released its $3.78 trillion fiscal year 2014 budget plan this week after much political wrangling in Washington DC. Among the winners and losers science looks like it’s emerged victorious, with government-funded R&D showing 9% gains over 2012 levels. This news comes closely on the heels of the Rally for Medical Research that was held in front of the Carnegie Library in the capital where around 10,000 researchers, medical professionals and protesters gathered to protest budget cuts that would hurt basic research due to the sequestration. Under the sequestration, cuts to the National Institute of Health topped $1.6 billion on March 1, with more cuts being only a matter of time.

Although it’s looking like these cuts to important medical R&D may be rectified in this budget, we live in a time of worrying national budget volatility, where the shifting political and economic sands put long-term science funding in politicians’ cross-hairs. To combat this seemingly new normal, some researchers are turning to innovative crowdfunding models to keep experiments financed. One such researcher is Ethan Perlstein, an evolutionary pharmacologist who launched a very different kind of experiment than is dictated by his academic work when he set out to raise $25,000 on the crowdfunding facilitator RocketHub. Yesterday, ASTMH Executive Director Karen Goraleski discussed this model and the future of crowdfunding science with Perlstein and PLOS NTDs Editor-in-Chief, Peter Hotez via Google Hangouts.

View the full video here.

 

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What Justifies the Environmental Impact of 1000 Medical Students Flying to Baltimore? The IFMSA General Assembly

By Medsin
Posted: April 10, 2013

David Carroll describes the ups and downs of the recent International Federation of Medical Students Associations General Assembly.

Last month, I was privileged to represent Medsin-UK at the International Federation of Medical Students Associations (IFMSA) General Assembly (GA). The theme of the general assembly is advocacy and the physician in training; advocacy is something that Medsin-UK personifies through our work in the UK.

As I arrived after 12 hours travel from Dublin to Baltimore, I was greeted by 1000 students speaking 100 languages cramped into 1 hotel lobby, you can imagine the scene, absolute pandemonium. What followed in the week after this first encounter was nothing short of wonderful; it was a week of students, all empowered to create tangible social change to help their future patients and the wider society.

My two personal highlights both happened on the Tuesday of the General Assembly. Firstly, the national member associations of Serbia and Lebanon proposed the removal of a by-law regarding pharmaceutical funding. The by-law stated, “Pharmaceutical sponsoring of General Assemblies and Regional Meetings in the IFMSA should be avoided. If found necessary, explanation and consultation with National Member Organizations should be conducted prior to accepting funding”.

The removal of this by-law would have removed the only binding policy we currently have regarding securing funding from the pharmaceutical industry. Not having this bylaw would open the door to unethical funding within our federation and show a worrying disregard for this important matter.


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This Week in PLOS Medicine: ART in South Africa, Herpes Zoster Vaccine, & PRISMA

By Laura Ray
Posted: April 9, 2013
Image Credit: Flickr Horia Varlan

Image Credit: Flickr Horia Varlan

PLOS Medicine published three articles this week, spanning research topics from life expectancy on ART in South Africa to the shingles vaccine for US seniors.

Leigh Johnson and colleagues estimated the life expectancies of HIV positive South African adults who are taking antiretroviral therapy by using information from 6 programmes between 2001 and 2010. Their findings suggest that in South Africa, patients starting ART have life expectancies around 80% of normal life expectancy, provided that they start treatment before their CD4 count drops below 200 cells/µl.

Sinead Marie Langan and colleagues studied a cohort of more than 750,000 individuals aged 65 years or more to assess whether herpes zoster vaccine is effective against incident zoster and post-herpetic neuralgia in an older population. Their findings highlight the need to increase shingles vaccination among elderly individuals in the US and could inform policy makers in countries that are currently considering the introduction of routine shingles vaccination.

Elaine Beller and colleagues from the PRISMA for Abstracts group provided reporting guidelines for abstracts of systematic reviews in journals and at conferences. Other PLOS Medicine articles on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) are also highlighted on the Medicine homepage.

Remember you can comment on, annotate and rate any PLOS Medicine article and see the views, citations and other indications of impact of an article on that articles metrics tab.

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This Week in PLOS Pathogens and NTDs: Spatio-temporal Dynamics of Cholera in Haiti, Rabies Epidemiology in the Philippines, FeS Cluster Biogenesis Pathways, HIV Envelope Incorporation and More

By Matt Lopez
Posted: April 4, 2013
journal.pntd.0002144.g003

Saito M, Oshitani H, Orbina JRC, Tohma K, de Guzman AS, et al. (2013) Genetic Diversity and Geographic Distribution of Genetically Distinct Rabies
Viruses in the Philippines. PLoS Negl Trop Dis 7(4): e2144. doi:10.1371/journal.pntd.0002144

New articles publishing in PLOS NTDs this week:

Dr. Jean Gaudart and colleagues describe and analyze the spatio-temporal dynamics and underlying factors associated with the first year of the 2010 cholera epidemic in Haiti. Environmental factors, such as rivers and rice fields, appeared to play a role in disease dynamics exclusively during the beginning of the epidemic, but varied from place to place as time passed, suggesting the need for rapid and exhaustive case tracking.

The elimination of rabies by 2020 is a national goal of the Philippines and understanding the phylogeography of this virus is important for establishing a more effective and feasible control strategy. Dr. Mariko Saito and colleagues conducted a molecular epidemiological study to locate three major rabies clades and two distinct genogroups around the country.

Dr. Bonnie Webster and colleagues report on the hybridization between a human (S.
haematobium) and two ruminant schistosomes (S. bovis and S. curassoni). Hybridization can lead to phenotypic characteristics that can influence disease epidemiology and control success, highlighting the importance of monitoring these evolving hybrid zones.

New articles publishing in PLOS Pathogens this week:

Iron-sulfur (FeS) clusters are among the most ancient and versatile protein cofactors. FeS cluster biogenesis pathways are extremely well conserved, and are invariably essential for viability. In this Pearl Dr. Teegan Dellibovi-Ragheb and colleagues compare the subcellular organization of FeS cluster biogenesis pathways in the diverse organelles of eukaryotic pathogens.

Cryptococcus is the leading cause of fungal meningitis in immunosuppressed patients, but why it frequently infects the central nervous system to cause fatal meningitis is not known.  This study by Dr. Tong-Bao Liu and colleagues lays an important foundation for understanding how fungi respond to available host inositol and indicates the impact of host inositol acquisition on the development of cryptococcal meningitis.

The HIV envelope glycoprotein is specifically incorporated onto assembling virions in relevant cells such as T lymphocytes in a manner that requires its long cytoplasmic tail, yet the mechanism underlying this specific incorporation has remained unknown. Dr. Mingli Qi and colleagues identify a trafficking complex required for HIV envelope incorporation and for the formation of infectious HIV particles.

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Famine in Somalia and the Failure of Data-Driven Humanitarianism

By PLOS Guest Blogger
Posted: April 4, 2013

Andrew Seal and Rob Bailey discuss the limitations of data-driven humanitarian efforts, and the lessons learned from the 2011 Somalia famine.

In May 2012, the UN Secretary General published a report on ‘Strengthening of the coordination of emergency humanitarian assistance of the United Nations.’ The report identified the need to ‘…build systems to support data-driven humanitarian decision making,’ noting that ‘…the current humanitarian system often struggles to furnish timely and consistently reliable information and analysis in order to provide an appropriate response.’

Perhaps there was a certain irony that the UN report was published just 3 months after the end of the famine in Southern Somalia. One year on from its officially declared end, we reflect on what has been learnt from the various evaluations of the response to the famine, and what that says about the limits to data-driven humanitarian decision making.

The 2011 famine in Somalia was the most recent to afflict humankind and one of the best documented. It affected extensive parts of Southern Somalia and is thought to have cost the lives of tens of thousands of people, while hundreds of thousands more fled across the border into Kenya and Ethiopia.

Did, in fact, the famine occur because data from this conflict-affected country were just not available and the famine was impossible to predict? Would more data have driven a better decision making process that could have averted disaster? Unfortunately, this does not appear to be the case. There had, in fact, been eleven months of escalating warnings emanating from the famine early warning systems that monitor Somalia. Somalia was, at the time, one of the most frequently surveyed countries in the world, with detailed data available on malnutrition prevalence, mortality rates, and many other indicators. The evolution of the famine was reported in almost real time, yet there was no adequate scaling up of humanitarian intervention until too late.
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