WHITE MALE SUPREMACY

Cost prevents one in five US women from using their preferred contraception

UNIVERSITY OF TEXAS AT AUSTIN

AUSTIN, Texas-- More than one in five women at risk of an unplanned pregnancy in the U.S. would use a different method of contraception if cost were not a factor, says a new study from the Texas Policy Evaluation Project (TxPEP) published in Contraception X. Uninsured women (one in three) and publicly insured women (one in four) were more likely to prefer a different method than privately insured women (one in five), indicating the importance of insurance coverage in ensuring access to the contraceptive methods women desire. The U.S. Supreme Court recently ruled in Little Sisters of the Poor v. Pennsylvania that employers can refuse to cover birth control for religious or moral reasons. Out-of-pocket costs for contraception will rise for many U.S. women, and they will be less likely to get the birth control they want.

"Whether people are able to afford the type of birth control they want to use is a strong indicator of the quality of reproductive healthcare in the U.S.," says Dr. Kari White, principal investigator of TxPEP and Associate Professor of Social Work and Sociology at The University of Texas at Austin. "The Supreme Court's ruling, along with other recent policies that have limited publicly funded services for low-income women, will likely reverse some of the gains in access and affordability we have seen in recent years."

Affordable access to contraception in the U.S. improved over the last 7 years as a result of the Affordable Care Act (ACA) contraceptive coverage mandate, which made all Food and Drug Administration-approved contraceptive methods available for no charge to women enrolled in most private insurance plans. The Court's ruling will impact an estimated 70,500 - 126,400 women of childbearing age who will now need to pay out-of-pocket for their birth control, and some of the most effective methods, such as female sterilization, IUDs and implants, are very expensive in the U.S. Some women who lose coverage may look for a new provider at a publicly funded health center that offers low-cost contraception. These facilities, which receive federal Title X family planning funds or other federal and state funding to serve low-income women, will likely not be able to meet the demand of new patients, leaving more women with cost barriers to using the birth control method they desire.

The new TxPEP study, based on data collected after the implementation of the ACA, also showed that Black and Hispanic women and those of other races/ethnicities were less likely to be using the birth control they wanted compared with white women, reflecting the structural disadvantage women of color face in the U.S. healthcare system. "Black women can face additional barriers accessing affordable contraceptive care that is free of bias, and affording contraception may be especially challenging for recent and undocumented immigrants, many of whom are Hispanic, due to limited insurance coverage options," says Kristen Burke, a doctoral student in sociology and graduate research associate at TxPEP. "The COVID-19 pandemic has highlighted incredible racial disparities in health outcomes, including access to reproductive health services, and the Court's decision will likely exacerbate these gaps in care."

The study used data from the 2015-2017 National Survey of Family Growth, focusing on sexually active women of reproductive age in the United States who were neither pregnant nor trying to become pregnant. Previous studies by TxPEP have shown that women often prefer to use more effective methods such as the IUD, implant, and sterilization, which may not be readily available at publicly funded or private health care providers.

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Dream on 

Study shows engaged workers should dare to daydream

WASHINGTON UNIVERSITY IN ST. LOUIS

IMAGE: DAYDREAMING CAN BE A SIGNIFICANT ASSET TO EMPLOYEES IN A WORKPLACE, DEPENDING UPON CERTAIN ATTRIBUTES OF THE WANDERER -- SPECIFICALLY, IF THEY IDENTIFY WITH THEIR PROFESSION OR ORGANIZATION. view more 

CREDIT: WASHINGTON UNIVERSITY IN ST. LOUIS

A wandering, daydreaming mind can spur creativity ... wait, where was I?

Oh, yes, two researchers from Washington University in St. Louis and another from Pontificia Universidad Católica in Chile found that daydreaming carries significant creative benefits, especially for those who identify with their profession and care for the work they do. When not compelled by the problems and challenges of one's profession, though, it can impair performance, the detriment historically linked to a mind meandering on the job. In other words, daydreaming can be both a liability and a significant asset, depending upon certain attributes of the wanderer.

"Daydreaming can have significant upsides for one's tendency to crack difficult challenges in new ways. This, however, presumes that people deeply care about the work they do, what attracted them to the profession in the first place," said Markus Baer, Professor of Organizational Behavior at the Olin Business School. "Daydreaming without this focus has significant downsides, which show up most directly in one's overall performance ratings."

In today's "knowledge economy," a mind is a terrible thing to waste, whatever direction it may venture. This research, published July 1 in the Academy of Management Journal, opens new windows into the power of the mind. Specifically, this project "depicts daydreaming as a critical mechanism accounting for the connection between the type of work people do and the level of creativity they exhibit on the job," wrote coauthors Baer, Erik Dane, Associate Professor of Organizational Behavior at Olin, and Hector P. Madrid of Pontificia Universidad.

Don't mistake this activity for distraction or multitasking, staples of the modern workspace. Rather, the process at the heart of this study involves thoughts disconnecting from a task and/or "stimulus environment." The coauthors found such a wandering-thought process results in work that is highly creative and not universally counterproductive, as often assumed in the business world and suggested by science that has studied daydreaming for decades.

Granted, not all daydreaming is created equally. The researchers studied two types in particular: problem-oriented daydreams, or imaginative thoughts loosely connected to one's challenges, and bizarre daydreams, or thoughts not linked to existing challenges or problems at all but rather improbable possibilities. As the coauthors explained, these bizarre thoughts usually involve scenarios that "might delight a writer of fantasy or science fiction." What they found, though, wasn't merely mental escapism.

Critical for creativity-boosting daydreaming, they found in their multi-faceted study, was professional identification -- workers who are psychologically attached to their profession, who gain a sense of self from their job. When they perform cognitively demanding work, gathering both enjoyment and fulfillment from that work, their daydreams spark imaginative thoughts around the job's tasks and problems.

The researchers tested their model via two distinct studies: (1) sampling experiences of 169 professionals in a spectrum of industries, and (2) conducting a field study of 117 professional employees and their 46 supervisors. Each study was conducted in South America, and the research participants averaged 33.9 and 35.9 years old, respectively.

"Conducting two different studies enabled us to test our hypotheses across a wide range of workers and triangulate our findings," Dane said. "The methods and measures we adopted integrated cutting-edge techniques associated with studying creativity and daydreaming alike."

In the first study, workers -- across a wide range of businesses, though mainly service (26%) and banking or commerce (22%) -- provided daily, diary-like ratings of the job challenges and their minds' tendency to engage in the two types of daydreaming. Workers also rated the extent to which they generated new ideas and solutions during the day.

The second study involved employees across three technology consulting companies, where creativity and problem-solving are rife, and where employees tend to identify strongly with their profession and its attendant values and challenges. This time, the authors also asked supervisors at those companies to rate their employees' creativity.

Workers were significantly more likely to daydream when they confronted tricky problems and new challenges in their work. And these daydreams, in turn, reliably boosted people's creativity, at least for professionally identified workers.

Interestingly, so long as employees' identification with their profession was present, the researchers discovered that both problem-oriented and bizarre daydreaming had virtually no impact on performance, neither positive nor negative. However, when professional identification was lacking, daydreaming significantly compromised performance.

"What this means is that daydreaming can boost creativity but does little to kill it; on the flip side, daydreaming does little to improve overall performance but can significantly reduce it," Madrid said.

In the end, the researchers concluded that most businesses could benefit from taking steps to remove the stigma around daydreaming at work. The mind wanders close to half of the day, previous science found, so it is unreasonable to assume that it can stay on task continuously. At the very least, perhaps we shouldn't shun workers for getting lost in their thoughts and dreams. There might just be a new idea in there.

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People with coronavirus symptoms more likely to have psychiatric disorders and loneliness

UNIVERSITY OF CAMBRIDGE

People who have or had COVID-19 symptoms are more likely to develop general psychiatric disorders and are lonelier, with women and young people more at risk, says a just-published study co-authored at Cambridge Judge Business School.

Having a job and living with a partner are significant protective factors against general psychiatric disorders and loneliness, says the study in the journal Psychiatry Research, based on 15,530 UK respondents, which is described as the first such large-scale, nationally representative survey in a developed country.

Although there has been previous research on specific coronavirus-related disorders such as anxiety, depression and insomnia, prior to this research we knew "little about the broader psychological impact of the pandemic on a wider population", says the study in the journal's September 2020 issue.

"Only focusing on specific disorders underestimates the psychiatric burdens of the pandemic in more subtle forms and overlooks the needs for psychiatric care of the people who have not been clinically diagnosed," the study says.

"Although the minor psychiatric disorders are often less urgent concerns of the public health policies, they are not negligible given the large proportion of the population that have been affected," says the study co-authored by Lambert Zixin Li of Stanford University, who holds an MPhil in Innovation, Strategy & Organisation from Cambridge Judge Business School (MPhil 2018), and Senhu Wang, a Research Fellow at the Centre for Business Research at Cambridge Judge Business School, who holds a PhD in Sociology from the University of Cambridge.

The study measures general psychiatric disorders based on the 12 items in the widely accepted General Health Questionnaire, which looks at factors ranging from depressive anxiety symptoms to confidence to overall happiness, while loneliness was assessed by a question adapted from the English Longitudinal Study on Aging about how often respondents felt lonely in the previous four weeks.

"Loneliness is linked to long-term health outcomes including all-cause mortality, so public health policies need to be aware of the (mental) health consequences of the disease control measures," the study says.

The research found that 29.2 per cent of all respondents (representing the general British population) scored '4' (the "caseness" or clinical referral threshold) or more on a five-point scale for general psychiatric disorders, while 35.86 per cent of respondents sometimes or often feel lonely; further analysis of the results showed that those who have or had coronavirus symptoms were more likely to have such disorders or feel lonely.

"People with current or past COVID-19 symptoms were perhaps more likely to develop general psychiatric disorders because they are more anxious about infection, and their greater loneliness may reflect the fact that they were isolated from family and friends," says co-author Senhu Wang of the Centre for Business Research at Cambridge Judge.

Women and young people (aged 18-30) who responded were significantly more at risk from general psychiatric disorders and loneliness, which the study says may reflect the fact that, compared to older people, these younger people's social and economic lives are more disrupted by the public health crisis.

Having a job and living with a partner are both "significant protective factors", said the study, which suggested further research into how social support from work and family buffer the psychological impacts of a pandemic.

The survey was conducted toward the end of April, at a time when there were around 23,000 coronavirus-related deaths in the UK. The study found no significant differences across different UK regions on either general psychiatric disorder or loneliness.

"Future research and public health policies need to move beyond specific psychiatric disorders to attend to the general psychiatric disorders and loneliness of a larger proportion of the population," the study concludes. "They need to pay special attention to vulnerable populations including women, the younger, the unemployed, those not living with a partner, and those who have or had COVID-19 symptoms.

"A pandemic like COVID-19 could exaggerate social disparities in mental health in subtle ways, calling for research on effective interventions such as mindfulness, mediation-based stress reduction and timely provision of psychiatric services."

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The study in the journal Psychiatry Research is entitled "Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom".

More lonely deaths in hospitals and nursing homes from COVID

Patients who died from COVID-19 in 2020 are 12 times more likely to die in a hospital than patients who died from any cause in 2018

NORTHWESTERN UNIVERSITY

 

CHICAGO--- Patients who died from COVID in 2020 were almost 12 times more likely to die in a medical facility than patients who died from any cause in 2018, reports a new Northwestern Medicine study.

This the first study to look at place of death for patients with COVID-19 and how these distributions compare to previous trends in location of death for non-COVID-19 illnesses.

The paper was published July 9 in the Journal of the American Geriatrics Society.

"Where you die is important and reflects end-of-life quality for the patient and the family," said lead author Dr. Sadiya Khan, assistant professor of preventive medicine in epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. "The patients dying of COVID-19 in medical facilities may not have any family with them because of visitor restrictions.

"A loved one dying alone takes a huge mental toll on families," Khan said. "It impairs the family's ability to grieve and cope with the loss. For patients, we've all thought about how terrible it would be to have to die alone. This is the horror happening to thousands of people in medical facilities where no family member or loved one is able to be present with them during their final moments on earth."

The new study analyzed data from the Centers for Disease Control and Prevention for deaths related to COVID-19 from February 1, 2020, to May 23, 2020, and found 68.7% of patients who die of COVID-19 died in medical facilities, 22.7% in nursing homes, 5.2% at home and 1.9% in hospice facilities. When compared with 2018 deaths due to all causes over a similar time period, 35.7% of deaths took place in medical facilities, 19.1% in nursing homes, 31.1% at home, and 7.9% in hospice facilities.

There was significant variability across states, with some states having a much higher proportion of nursing home deaths (e.g. Minnesota, 60%) and home deaths (e.g. New York, 8%) deaths.

"High rates of nursing home deaths in several states reveal a highly vulnerable population and the inability to optimize resources such as PPE (personal protection equipment) to prevent infection transmission these high-risk locations," Khan said. "It's especially important as nursing homes are reopening to visitors and may be exposing residents, especially in areas where there are increasing rates of cases."

But nursing home statistics in the study only capture a glimpse of the high proportion of deaths linked to these facilities. It doesn't include people who contracted COVID-19 in a nursing home and were transferred to a hospital or staff who got it working there.

To address the heightened risk in nursing homes, Khan suggests access to adequate PPE for staff and universal testing/screening of people before they are allowed to enter the facilities, even if they don't have symptoms.

To support lonely COVID-19 patients in hospital beds and nursing homes, Khan said these facilities need a virtual infrastructure.

"We can't just rely on individual's iPhones and iPads," Khan said. "There is a land line phone in every room, why couldn't we have a virtual phone in every room or access to face-to-face communication for each patient and their families?"

"These results highlight yet another way that COVID-19 has impacted the health care system," said first author Dr. Sarah Chuzi, a Northwestern Medicine fellow in cardiovascular diseases. "While recent research shows U.S. deaths in medical facilities are decreasing and deaths at home and in hospice facilities are increasing, the burden of deaths attributed to COVID-19 may reverse these overall trends.

"End-of-life care is a hugely important but understudied aspect of medicine. We wanted to ensure this aspect of patient-centered care was acknowledged and studied in order to motivate efforts to improve our current system," Chuzi added.

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Other Northwestern authors include Dr. Sarah Chuzi, Rebecca Molsberry, Megan McCabe, Dr. Clyde Yancy, Dr. Adeboye Ogunseitan, Norrina Allen, Rebecca Molsberry and Megan McCabe.

The research was supported in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, grant KL2TR001424.

Single-dose flu drug can reduce spread within households, study finds

UNIVERSITY OF VIRGINIA HEALTH SYSTEM

 

IMAGE:  "THIS TRIAL ESTABLISHED THAT BALOXAVIR, IF TAKEN WITHIN A DAY OR SO AFTER EXPOSURE, IS HIGHLY EFFECTIVE FOR PREVENTING INFLUENZA ILLNESS IN HOUSEHOLDS, A HIGH-RISK SETTING FOR VIRUS TRANSMISSION, " SAID... view more 

CREDIT: DAN ADDISON | UVA COMMUNICATIONS

A single dose of the flu drug baloxavir marboxil can reduce the spread of the illness within households, new research concludes.

A study examining 752 household contacts of 545 patients with the flu found that flu infections were much less common in household members who received the drug than among those who received a placebo. Only 1.9% of uninfected household contacts who took a single dose of baloxavir marboxil came down with the flu, compared with 13.6% of those who received the placebo.

"This trial established that baloxavir, if taken within a day or so after exposure, is highly effective for preventing influenza illness in households, a high-risk setting for virus transmission," said researcher Frederick G. Hayden, MD, of the University of Virginia School of Medicine. "The findings indicate that baloxavir prophylaxis should prove effective for prevention in other circumstances, such as outbreaks in nursing homes and healthcare facilities, although formal studies will need to be undertaken."

Reducing Influenza Spread

The double-blind study found that baloxavir marboxil, sold under the brand name Xofluza, was effective in adults, children and those at high-risk, regardless of whether they had received the flu vaccine. The frequency of adverse events, such as headaches and nausea, was similar among those who received the drug (22.2%) and those who received placebos (20.5%). There were no deaths in either group.

Hayden, a professor emeritus in UVA's Division of Infectious Diseases and International Health, was also part of a research team that published a month ago in Lancet Infectious Diseases that baloxavir treatment shortened the duration of influenza and reduced complications in adults and adolescents at high risk of complications. A single dose of the drug was as effective as a five-day course of oseltamivir (Tamiflu), the researchers concluded.

The federal Food and Drug Administration has approved baloxavir marboxil to treat flu within 2 days of symptom onset in people 12 years and older and those at high risk of developing complications. Its approval in 2018 marked the first novel flu drug in 20 years. The FDA is reviewing baloxavir applications for both treatment in children aged 1-11 years and for prophylaxis.

Findings Published

The researchers have published their findings in the prestigious New England Journal of Medicine. The study's authors were Hideyuki Ikematsu, Hayden, Keiko Kawaguchi, Masahiro Kinoshita, Menno D. de Jong, Nelson Lee, Satoru Takashima, Takeshi Noshi, Kenji Tsuchiya and Takeki Uehara. Hayden disclosed that he has received fees for serving on a data safety and monitoring board, paid to the UVA School of Medicine, from Celltrion Healthcare, GlaxoSmithKline and Vaccitech. He has served as a consultant and received travel support from F. Hoffmann-La Roche and Shionogi, and he has served as a consultant for Cidara Therapeutics, Fujifilm Corp., Genentech, Gilead Sciences, Janssen Pharmaceuticals, MediVector, Regeneron Pharmaceuticals, resTORbio, SAB Biotherapeutics, Versatope, Vir and Visterra. A full list of disclosures is included in the paper.

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The research was funded by Shionogi, Japan Primary Registries Network No. JapicCTI-184180. Shionogi and the Roche Group are the developers of the drug.

To keep up with the latest medical research news from UVA, subscribe to the Making of Medicine blog at http://makingofmedicine.virginia.edu.

Bird droppings carry risk of antibiotic resistance

Rice engineers show feces from gulls, ducks and crows harbor abundant resistant bacteria, resistance genes

RICE UNIVERSITY

 

IMAGE: URBAN CROWS, DUCKS AND GULLS ARE A POTENTIALLY IMPORTANT RESERVOIR OF ANTIMICROBIAL RESISTANCE GENES, ACCORDING TO RICE UNIVERSITY ENGINEERS WHO STUDIED THEIR DROPPINGS. view more 

CREDIT: RICE UNIVERSITY

HOUSTON - (July 13, 2020) - Bird poop may pose more health risks than people realize, according to Rice University environmental engineers who study antibiotic resistance.

Their study found high levels of genes that encode antibiotic resistance harbored by opportunistic pathogens in the droppings of common urban ducks, crows and gulls.

The study led by postdoctoral research associate Pingfeng Yu of Rice's Brown School of Engineering appears in the Elsevier journal Environmental Pollution. Yu is a member of the lab of civil and environmental engineer and co-author Pedro Alvarez.

Previous studies determined bird-carried antibiotic resistant genes (ARGs) and bacteria (ARBs) can be transferred to humans through swimming, contact with feces or impacted soil or inhalation of aerosolized fecal particles. Studies have also analyzed bird feces found near ARG hotspots like wastewater treatment plants and drainage from poultry farms.

But the Rice study digs deeper to quantify the abundance, diversity and seasonal persistence of ARGs.

"We still do not fully understand what factors exert selective pressure for the occurrence of ARGs in the gastrointestinal system of wild urban birds," Alvarez said. "Residual antibiotics that are incidentally assimilated during foraging is likely one of these factors, but further research is needed to discern the importance of other potential etiological factors, such as bird diet, age, gut microbiome structure and other stressors."

The team that included lead authors Huiru Zhao, a student at Nankai University in China, and Rice graduate student Ruonan Sun compared "freshly deposited" samples from each species found around Houston during the winter and summer months to samples from poultry and livestock known to carry some of the same mutations.

They found that ARGs in all of the species, regardless of season, encoded significant resistance to tetracycline, beta-lactam and sulfonamide antibiotics. The researchers were surprised to see the relatively high abundance of ARGs were comparable to those found in the fresh feces of poultry occasionally fed with antibiotics.

They also found intI1, an integron that facilitates rapid bacterial acquisition of antibiotic resistance, was five times more abundant in the birds than in farm animals.

"Our results indicate that urban wild birds are an overlooked but potentially important reservoir of antimicrobial resistance genes, although their significance as vectors for direct transmission of resistant infections is possible but improbable due to low frequency of human contact," Alvarez said.

The team also looked for ARGs in soil up to 1 inch deep around bird deposits and discovered they are "moderately persistent" in the environment, with half-lives of up to 11.1 days.

Of the three species, crows showed a significantly lower level of ARGs during the summer compared to ducks and gulls, they reported.

"That's probably due to differences in their ecological niches, foraging patterns and gut microbiome," Sun said. "Crows are omnivores and feed on abundant natural food with less anthropogenic contaminations in the summer. In addition, the composition of their gut microbiome impacts ARG dissemination and enrichment in vivo, and therefore influences ARG levels in the excreted bird feces."

The researchers found that opportunistic pathogens including bacteria that cause urinary tract infections, sepsis and respiratory infections were common in the feces of all of the birds, and another associated with food poisoning was detected in samples collected during the winter.

Winter feces, they wrote, contained more of the bad bacteria that may also harbor ARGs, possibly due to lower sunlight inactivation and differences in moisture levels and temperature.

"Our study raises awareness to avoid direct contact with bird droppings in urban public areas, especially for vulnerable or sensitive populations," Yu said. "Meanwhile, regular cleaning should also help to mitigate associated health risks."

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Alvarez is the George R. Brown Professor of Civil and Environmental Engineering and a professor of chemistry and of chemical and biomolecular engineering.

The National Science Foundation and the China Scholarship Council supported the research.

Read the abstract at https://www.sciencedirect.com/science/article/pii/S0269749120322715.

This news release can be found online at https://news.rice.edu/2020/07/13/bird-droppings-carry-risk-of-antibiotic-resistance/

Follow Rice News and Media Relations via Twitter @RiceUNews.

Related materials:

Rice researchers look to 'trap and zap' coronavirus: http://news.rice.edu/2020/04/23/rice-researchers-look-to-trap-and-zap-coronavirus-2/

Alvarez Research Group: https://chemistry.rice.edu/people/pedro-alvarez

Rice Department of Civil and Environmental Engineering: https://cee.rice.edu

George R. Brown School of Engineering: https://engineering.rice.edu

Image for download:

https://news-network.rice.edu/news/files/2020/07/0713_BIRDS-1-WEB.jpg

Urban crows, ducks and gulls are a potentially important reservoir of antimicrobial resistance genes, according to Rice University engineers who studied their droppings.

Located on a 300-acre forested campus in Houston, Rice University is consistently ranked among the nation's top 20 universities by U.S. News & World Report. Rice has highly respected schools of Architecture, Business, Continuing Studies, Engineering, Humanities, Music, Natural Sciences and Social Sciences and is home to the Baker Institute for Public Policy. With 3,962 undergraduates and 3,027 graduate students, Rice's undergraduate student-to-faculty ratio is just under 6-to-1. Its residential college system builds close-knit communities and lifelong friendships, just one reason why Rice is ranked No. 1 for lots of race/class interaction and No. 4 for quality of life by the Princeton Review. Rice is also rated as a best value among private universities by Kiplinger's Personal Finance.

The Lancet Global Health: Modelling study predicts surge in HIV, TB, and malaria deaths due to COVID-19 pandemic

THE LANCET

 

-- But there is still an opportunity to substantially reduce the death toll by prioritising the most critical services, specifically antiretroviral therapy for HIV, timely TB diagnosis and treatment, and provision of long-lasting insecticide-treated nets for malaria, researchers say.

Some low- and middle-income countries (LMICs) could see HIV, tuberculosis (TB), and malaria deaths increase by as much as 10%, 20%, and 36% respectively over the next 5 years due to the disruption of health services caused by the COVID-19 pandemic and its response, according new modelling research published in The Lancet Global Health journal.

Modelling the public health impact of COVID-19 on HIV, TB, and malaria in LMICs over the next 5 years, researchers estimate that in areas heavily affected by these major infectious diseases, the impact of COVID-19 disruption on years of life lost (the number of years a person would have been expected to live had they not died of a particular cause) could, in the worst case, be of a similar scale to the direct impact of the pandemic itself.

The COVID-19 pandemic has the potential to cause substantial disruptions by overwhelming already fragile health systems, or through response measures limiting routine programme activities and care-seeking, and interrupting medical supply chains. But maintaining core services for HIV, TB, and malaria--specifically access to antiretroviral therapy (ART), timely TB diagnosis and treatment, and early resumption of the distribution of long-lasting insecticide-treated nets (LLINs) and antimalarial treatment--could largely mitigate the broader health impact of the COVID-19 pandemic, researchers say.

However, the authors caution that predicting the true impact of the ongoing COVID-19 pandemic and its response on other diseases is fraught with difficulty, especially when so much remains unknown about the virus and the extent to which other disease programmes may be disrupted, and how this might impact population health. They flag that their study aims to quantify the potential scale of the impact of COVID-19, and to guide how it could be minimised, rather than provide precise estimates.

Malaria deaths worldwide have reduced by half since 2000, but progress has stalled as mosquitoes and parasites gain resistance to treatment. Around 94% of deaths occur in sub-Saharan Africa where malaria claimed an estimated 380,000 lives in 2018. Similarly, global HIV/AIDS deaths have halved in a decade driven by the availability of ART. In 2019, around 690,000 people died from the disease worldwide, the vast majority in LMICs. An estimated 49 million lives were saved through TB diagnosis and treatment between 2000 and 2015, but the disease still claimed the lives of 1.8 million people in 2018--with over 95% of these deaths occurring in LMICs [2].

"The COVID-19 pandemic and actions taken in response to it could undo the some of the advances made against major diseases such as HIV, TB, and malaria over the past two decades, compounding the burden caused by the pandemic directly", says Professor Timothy Hallett from Imperial College London, UK, who co-led the research. "In countries with a high malaria burden and large HIV and TB epidemics, even short-term disruptions could have devastating consequences for the millions of people who depend on programmes to control and treat these diseases. However, the knock-on impact of the pandemic could be largely avoided by maintaining core services and continuing preventative measures." [1]

He continues, "Our findings underscore the extraordinarily difficult decisions facing policy makers. Well managed, long-term suppression measures could avert the most COVID-19 deaths. But if these interventions are not well managed, they could cause people to stay away from hospitals and clinics and force public health programmes to be cancelled, leading to a large spike in deaths from other major infectious diseases that had been coming under control." [1]

Discussing the implications of the findings in a linked Comment, Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland (who was not involved in the study) says, "The knock-on impact on HIV, tuberculosis, and malaria could potentially be even worse than this study suggests, and in some countries, it could be even worse than the direct impact of COVID-19. The Global Fund conducts a biweekly qualitative survey across the more than 100 countries in which it invests; the latest published results suggest that 85% of HIV, 78% of tuberculosis, and 73% of malaria programmes are being disrupted. 18% of HIV programmes, 17% of tuberculosis programmes, and 19% of malaria programmes are experiencing high or very high disruption."

He adds, "In countries heavily affected by HIV, tuberculosis, and malaria, COVID-19 could result in many years of hard-won gains being reversed. We cannot let this happen. We need more resources and decisive action, and we must measure success not just in terms of minimising the direct impact of COVID-19, but in terms of minimising its total impact, including the knock-on impact on HIV, tuberculosis, and malaria."

In this study, the researchers assumed a basic reproductive number (R0; the average number of people each individual with the virus is likely to infect) of 3 to develop four different policy response scenarios to the COVID-19 pandemic--no action, mitigation (which represents a 45% reduction in R0 for 6 months using interventions such as physical distancing), suppression-lift (a 75% reduction in R0 for 2 months), or suppression a 75% reduction in R0 for 1 year; see table 1). Then they used transmission models of HIV, TB, and malaria to estimate the additional impact on health that could be caused in different settings, either by COVID-19 interventions limiting routine programme activities, or due to COVID-19 cases overburdening the health system (table 2, figure 2).

Overall, the findings suggest that the impact of the pandemic varies according to the extent to which interventions against COVID-19 cause long disruptions to activities, and how successfully those measures reduce transmission of SARS-CoV-2, and avoid the health system being overwhelmed.

The greatest impact on HIV is projected to be from interruption to the supply and administering of ART, which may occur during times of high health system demand. In the worst case scenario, assuming no action or suppression-lift, countries with high rates of HIV typical in parts of southern Africa (20% prevalence among 15-49 year olds in 2018), could see up to 10% more deaths due to HIV over the next 5 years than would occur without COVID disruptions--equivalent to 612 additional HIV deaths per million population in 2020-2024. The researchers suggest that offering individuals receiving ART multi-month prescriptions or home delivery could ensure they can access treatment even in periods of highest health system demand.

For TB, the greatest impact is predicted to be from reductions in timely diagnosis and treatment of new cases, which could result from long periods of COVID-19 containment measures limiting access to services. In the worst case scenario, assuming suppression in countries with a very high burden typical in southern Africa (520 new cases per 100,000 population in 2018), TB deaths could rise by as much as 20% over the next 5 years (equivalent to 987 additional TB deaths per million population in 2020-2024) compared with when services are functioning normally.

The model predicts that the greatest impact on malaria burden could result from interruption of planned net campaigns, which usually take place every 3 years. In the worst case, with COVID-19 disruptions coinciding with the malaria transmission season and planned LLIN distribution, malaria deaths could increase by 36% over the next 5 years--equivalent to 474 additional malaria deaths per million population in 2020-2024.

"Many of the gains made in malaria control over the past decade have been due to distribution of long-lasting insecticide-treated nets in sub-Saharan Africa where the vast majority of malaria deaths occur. However, the COVID-19 pandemic will likely disrupt these distributions in 2020, resulting in more malaria deaths", says co-lead author Dr Alexandra Hogan from Imperial College London, UK. "Routine preventative measures must be prioritised, ensuring mosquito net distribution campaigns and prophylactic treatments, such as mass drug distribution and seasonal malaria chemoprevention, are maintained." [1]

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Peer-reviewed / Modelling study / People

The authors note several limitations, including that the scenarios modelled are not exhaustive but reflect the trade-offs between disruption due to COVID-19 interventions and periods of high health system demand. They also note that did not consider how long-term global changes such as a global recession might affect disease programmes.

NOTES TO EDITORS

This study was funded by Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council. It was conducted by researchers from Imperial College London, UK.

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com

[1] Quotes direct from authors and cannot be found in text of Article.

[2] https://www.who.int/news-room/feature-stories/detail/world-malaria-report-2019; https://ourworldindata.org/hiv-aids; https://www.afro.who.int/news/tuberculosis

Examine narratives to end policy deadlock, boost agricultural development in Africa, economists say

Impasse over dominant and counter approaches -- state-led or market-led policy -- to promote agricultural development in Africa could be solved by analyzing the one-sided narratives that shape this dichotomy.

INTERNATIONAL CENTER FOR TROPICAL AGRICULTURE (CIAT)

 

IMAGE: ECONOMISTS ARGUE THAT A DICHOTOMY BETWEEN EITHER STATE-LED OR MARKET-LED APPROACHES TO BOOST FOOD PRODUCTION LEADS TO POLITICAL DEADLOCK THAT HINDERS ALTERNATIVE SOLUTIONS. view more 

CREDIT: CIAT/G.SMITH

The COVID-19 pandemic presents an opportunity to transform food systems and achieve sustainable development. But the lively policy debate on which policy approach will promote agricultural development in Africa still prevents progress.

Debates include: Do small-scale farms have development potential or does supporting them promote 'romantic populism'? Are input subsidy programs an effective strategy to increase agricultural productivity? What role should the government play?

In new research published in World Development, economists argue that a dichotomy between either state-led or market-led approaches to boost food production leads to political deadlock that hinders alternative solutions.

State-led or market-led policy to boost agriculture?

State-led oriented approaches tend to favor incentives, such as fertilizer subsidy programs for increasing agricultural productivity. Market-led approaches favor competitive approaches led by the private sector.

Using policy-making in Senegal as a case study, authors say empirical analysis of economic incentives like subsidy programs for fertilizer, and critiques of such incentives, must be complemented by an analysis of narratives that unravel the policy ideas of decision-makers.

Both sides must be more open to alternative solutions not only based on already-existing evidence, but also through analysis of one-sided 'stories' that reveal why specific policies are favored, say the authors.

"To really bring change, we need new frameworks and additional methods," said Jonathan Mockshell, an Agricultural Economist at the Alliance of Bioversity International and the International Center for Tropical Agriculture (CIAT).

Forging a way forward

"We shouldn't look at numbers only. We need to understand underlying narratives behind the numbers, to study how the use of language influences policy-making. When decision-makers speak, they use persuasive narratives to convey policy positions. Missing such narratives in the policy process and program design is like missing gold in the soil."

"Amid persistent low agricultural productivity across Africa, cracks in our food systems, locust outbreaks and the global COVID-19 pandemic, it's not really about who is right or wrong," said Mockshell.

"It is about finding a better narrative for what works where. The time for achieving the Sustainable Development Goals (SDGs) is too short for this continued dichotomy. We need to bridge the two narratives now to achieve sustained agricultural development."

Market-smart solutions

Regina Birner, Professor at the University of Hohenheim, said: "The actors in favor of state-led agricultural support do have 'a better story' as far as the structure of their narrative is concerned. This does, however, not imply that their story is better in a normative sense.

"Or that their prescribed policies are indeed better suited to reach their intended goals than the policies suggested by the authors who favor market-led agricultural support. The actors who favor state-led support have a dominant narrative influenced by what they think is needed to transform the agricultural sector."

"The counter narrative is that input-subsidies won't work and crowd out private sector investment. Alternative narratives offer a way forward. An existing example, though not well developed, is "market-smart subsidies". They are defined as temporary subsidies designed to promote rather than undermine the development of fertilizer markets, for example, by using fertilizer vouchers.

A combination of such state-led initiatives, combined with donor-funded or market-led approaches and input subsidy programs can work, if there is evidence-based policy learning between both camps to better-align policy with reality, say the authors.

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UK  

Study calls for action to protect BAME and migrant groups from economic impact of COVID-19

The COVID-19 lockdown has had a disproportionate economic impact on Black, Asian and Minority Ethnic (BAME) migrants in the UK

LANCASTER UNIVERSITY

 

The COVID-19 lockdown has had a disproportionate economic impact on Black, Asian and Minority Ethnic (BAME) migrants in the UK, new research, which also calls for racial justice, reveals today (13 July 2020).

BAME migrants are 3.1 times more likely than white British to lose their jobs during the pandemic, while BAME British are 40% less likely to benefit from employee protection such as furloughing.

As a result, white British in work before the pandemic were 5.7 times more likely to experience furlough than job loss (18.9% vs. 3.3%), the rate was as low as 1.4 times for BAME migrants (16.3% vs. 11.4%).

'Intersecting ethnic and native-migrant inequalities in the economic impact of the COVID-19 pandemic in the UK' by Dr Yang Hu, of Lancaster University, is published open access in 'Research on Social Stratification and Mobility' - an official journal of the International Sociological Association.

The report also highlights:

• While BAME migrants are 35% less likely to reduce their work hours than white British, they are 1.3 times more likely to experience income loss due to COVID-19.
• Compared with white British, BAME migrants are 2.2 times more likely to experience an increase in financial strain, such as keeping up to date with bills (e.g. utility, credit card, etc.), during the COVID-19 lockdown.
• White British (28.8%) are 1.4 times more likely than BAME migrants (20.9%) to report leading a financially comfortable life during the pandemic. In contrast, BAME migrants (11.1%) are 1.5 times more likely than white British (7.2%) to report experiencing financial difficulty during the pandemic.
• BAME migrants (26.6%) are 1.3 times more likely than white British (20.2%) to experience an increase in their perceived level of financial hardship during the lockdown.

Dr Hu, a Senior Lecturer in Sociology and Data Science, presents nationwide evidence based on the analysis of data from the Understanding Society COVID-19 survey--an initiative funded by the UK Research and Innovation.

The initiative collected data from a national sample of more than 10,000 people from both before the pandemic and in April, the 'prime time' of the COVID lockdown in the UK.

"As the information was collected from the same people, it provides a very clear and effective comparison of the impact of COVID-19," said Dr Hu, an expert in the study of how socio-economic, political and institutional developments and cultural changes impact on everyday family and intimate lives.

"The findings show that as the pandemic hits BAME migrants particularly hard, it widens entrenched racial disparities in people's labour market participation and economic well-being. They urge policy makers to place racial justice at the centre of the government's immediate and long-term response to the pandemic.

"As we enter the third decade of the 21st century, the COVID-19 pandemic and the global rise of racism and anti-racism movements are two of the most prominent developments to define people's lives in many countries."

As many countries start to ease and lift lockdown measures, Dr Hu said it would also be crucial to examine and tackle inequalities in people's long-term economic recovery from the pandemic.

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Most 50+ adults say they've experienced ageism; most still hold positive aging attitudes

IMAGE: KEY FINDINGS FROM THE NATIONAL POLL ON HEALTHY AGING'S POLL ON EXPERIENCES OF AGEISM AND ATTITUDES TOWARD AGING AMONG PEOPLE AGED 50 TO 80 view more 

CREDIT: UNIVERSITY OF MICHIGAN

Ageism plays out in day-to-day interactions and messaging, and those experiencing it are more likely to have worse physical and mental health

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

 An offhand remark by an acquaintance about using a smartphone. A joke about someone losing their memory or hearing. An ad in a magazine focused on erasing wrinkles or gray hair. An inner worry that getting older means growing lonely.

All of these kinds of everyday ageism, and many more, are common in the lives of Americans over 50, a new poll finds. In fact, more than 80% of those polled say they commonly experience at least one form of ageism in their day-to-day lives.

The poll even shows relationships between experiencing multiple forms of everyday ageism and health. In all, 40% of all poll respondents said they routinely experience three or more forms of ageism - and these older adults were much more likely to have poor mental and physical health.

But despite all this, the poll also suggests that most older adults hold positive attitudes toward aging - including 88% who say that they have become more comfortable being themselves, and 80% who have a strong sense of purpose. Two-thirds said life over 50 is better than they thought it would be.

The new results come from the National Poll on Healthy Aging, carried out by the University of Michigan Institute for Healthcare Policy and Innovation with support from AARP and Michigan Medicine, U-M's academic medical center. It involved a national sample of more than 2,000 adults aged 50 to 80.

The poll was taken in December, before the COVID-19 pandemic arrived and introduced new health risks for older adults. But the researchers hope the findings will inform efforts to address assumptions about older adults' thoughts and experiences, and any age-based discrimination and negative consequences on health and well-being that may arise because of of the pandemic.

"Everyday ageism is part of American culture and one of the most common and socially condoned forms of prejudice and discrimination. There is no doubt that it harms the health and wellbeing of older adults, yet we don't have enough data on how older adults experience it and how harmful it is," says Julie Ober Allen, Ph.D., a research fellow at the U-M Institute for Social Research who partnered with the poll team to develop the questions and analyze the results.

"In addition to addressing everyday ageism in general, we as a society should be especially careful about how ageist prejudices and stereotypes affect our response to the massive public health challenges of the ongoing pandemic."

Confronting stereotypes

The new poll asked older adults about nine forms of everyday ageism, and analyzed the results based on respondents' age, income, media consumption habits, residence, work status and self-reported health and appearance.

In all, 65% said they're commonly exposed to ageist messages in materials they watch or read, and 45% said they sometimes or often experience ageism in interactions with other people. More than one-third of older adults have internalized stereotypes to the extent that they agreed or strongly agreed that feeling lonely or depressed were inherent parts of growing older.

Older and lower income older adults were more likely to report that they commonly experienced three or more forms of everyday ageism. Women, those who had retired and those who lived in rural areas were also more likely than men to experience it, as well as those still working and those living in suburban or urban areas.

Those who spent more time watching television, browsing the internet or reading magazines were also more likely to report that they'd been exposed to more different forms of ageism than those who spent less time consuming media.

The relationship between ageism experiences in older adults' day-to-day lives and health especially interested poll director Preeti Malani, M.D., a professor at Michigan Medicine with a background in caring for older adults.

"The fact that our poll respondents who said they'd felt the most forms of ageism were also more likely to say their physical or mental health was fair or poor, or to have a chronic condition such as diabetes or heart disease, is something that needs more examination," she says. "On the other hand, the fact that half of our respondents agreed with all four of the positive views on aging that we asked them about is encouraging."

Dispelling ageism

AARP has focused attention on the effects of ageism in the workplace, and worked to dispel outdated perceptions of aging.

"As Americans continue living longer, society must redefine what it means to get older,"says Alison Bryant, Ph.D., senior vice president of research for AARP. "We are encouraged these findings show most older adults feel positive about their lives, reaffirming that we can be active and happy in older age, but we have more work to do to disrupt damaging negative associations around aging."

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The National Poll on Healthy Aging results are based on responses from a nationally representative sample of 2,048 adults aged 50 to 80 who answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have them.

Allen is a member of the U-M Population Studies Center, the Michigan Center for Urban African American Aging Research, the Program for Research on Black Americans, and the Group for Research on the Epidemiology of Mobility, Aging and Psychiatry. She will be joining the faculty in the Department of Health and Exercise Science at the Universty of Oklahoma in the fall.

A full report of the findings and methodology is available at http://www.healthyagingpoll.org, along with past National Poll on Healthy Aging reports.