Current strategies ineffective in controlling Salmonella Dublin in Danish cattle

COMPLEXITY SCIENCE HUB

 

IMAGE: 

MAP OF (SCRAMBLED) CATTLE FARMS (NODES) ONLY WITH CATTLE MOVEMENT RECORDS IN JANUARY 2010. LINKS BETWEEN NODES REPRESENT THE TRADE MOVEMENTS AND THEIR THICKNESS REPRESENTS THE NUMBER OF CATTLE TRADED IN JANUARY 2010. COLOURS REPRESENT INFECTION CATEGORIES (RED=TEST POSITIVE) AND GREEN (TEST NEGATIVE) AND THE SIZE OF A POINT REPRESENTS THE HERD SIZE. (SOURCE: DOI: 10.3168/JDS.2023-24554)

view more 

CREDIT: COMPLEXITY SCIENCE HUB, UNIVERSITY OF COPENHAGEN, SEGES

Limited impact of current movement restrictions highlights need for enhanced strategies, says study. 

In a recent study published in the Journal of Dairy Science, researchers from the Complexity Science Hub (CSH), the University of Copenhagen, and SEGES have shown that despite stringent movement restrictions among Danish cattle farms Salmonella Dublin continues to propagate, indicating that current strategies are insufficient to curb the spread of the disease.

"We analyzed 11 years of data, including detailed information about infection outbreaks in farms and trading data between farms, and applied advanced social network and simulation modeling to study the movement patterns of cattle among farms," explain CSH Associate Faculty member Beate Conrady and CSH researcher Elma Dervic.

By mapping out these connections, the researchers aimed to assess how effectively movement restrictions were preventing the spread of Salmonella Dublin. "Surprisingly, we found that disease transmission between farms persists, with cattle movement activities in the previous month being the strongest predictor of farm infections," says Conrady, who is also an Associate Professor at the Department of Veterinary and Animal Sciences, University of Copenhagen.

Similar network trends were observed for infected and non-infected farms, indicating that the perceived strict movement restrictions had insufficient effect, likely because multi-site farm businesses are still allowed to move animals between their own farm properties. Local transmission, i.e., different transmission pathways in a short distance to neighboring farms, played a relatively minor role.

RECOMMENDATIONS

Given the limitations of current measures, the study calls for a multifaceted approach to managing Salmonella Dublin:

• Pre- and Post-Movement Measures: Implementing stricter control measures before and after movement within a one-month period can reduce the spread of Salmonella Dublin.
• Focused Control Strategies: Enhanced surveillance and targeted interventions based on cattle movement data and farm characteristics can improve the effectiveness of disease control programs. Analyzing the impact of multi-site businesses seems to be important to better understand the spread of Salmonella Dublin infections.
• Policy Recommendations: Adapt control measures to emphasize within-herd biosecurity, and improve the diagnostics and testing before and after cattle movements.

A CLOSER LOOK AT SALMONELLA DUBLIN

Salmonella Dublin is a bacterial infection that poses a threat to cattle health, causing symptoms such as fever, diarrhea, and respiratory problems. The disease is also zoonotic, meaning it can be transmitted to humans through direct contact with infected animals or consumption of contaminated dairy products, potentially leading to severe health issues, especially in immunocompromised individuals.

IMPLICATIONS FOR SOCIETY

This study has profound implications for both farmers and policymakers. For farmers, it means that despite adhering to movement restrictions, their herds remain at risk of infection, which can lead to economic losses due to decreased productivity and increased veterinary costs. For policymakers, the study highlights the urgent need to develop more effective disease management strategies. Relying solely on movement restrictions is clearly not enough to combat the spread of Salmonella Dublin.

“Our study underscores the urgent need to revise existing policies of more dynamic and targeted approaches to control the spread of Salmonella Dublin to protect animal health and safeguard public health,” concludes Conrady.

 

ABOUT THE STUDY

The study “Social network analysis reveals the failure of between-farm movement restrictions to reduce Salmonella transmission,” by B. Conrady, E.H. Dervic, P. Klimek, L. Pedersen, M. Merhi Reimert, P. Rasmussen, O.O. Apenteng and L.R. Nielsen, was published in the Journal of Dairy Science (doi: 10.3168/jds.2023-24554).

 

About CSH

The Complexity Science Hub (CSH) is Europe’s research center for the study of complex systems. We derive meaning from data from a range of disciplines – economics, medicine, ecology, and the social sciences – as a basis for actionable solutions for a better world. Established in 2016, we have grown to over 70 researchers, driven by the increasing demand to gain a genuine understanding of the networks that underlie society, from healthcare to supply chains. Through our complexity science approaches linking physics, mathematics, and computational modeling with data and network science, we develop the capacity to address today’s and tomorrow’s challenges.

---

JOURNAL

Journal of Dairy Science

DOI

10.3168/jds.2023-24554 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Social network analysis reveals the failure of between-farm movement restrictions to reduce Salmonella transmission

 

Military service's hidden health toll: servicewomen and their families endure increased chronic pain

A new study led by investigators from Brigham and Women’s Hospital reveals that military women and female family members face significantly higher risks of chronic pain

BRIGHAM AND WOMEN'S HOSPITAL

A new study led by investigators from Brigham and Women’s Hospital reveals that military women and female family members face significantly higher risks of chronic pain 

Active-duty servicewomen who served during periods of heightened combat deployments (2006-2013) face a significantly heightened risk of chronic pain compared to those serving at other times, according to a new study from researchers at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. The study also found that female dependents of military personnel serving in 2006-2013 are more likely to experience chronic pain and those of lower socioeconomic status and mental illness face an even higher risk. Results are published in JAMA Network Open. 

“We aimed to investigate the impact of frequent exposure to intense combat deployments on women in the military and their civilian spouses,” said first author Andrew Schoenfeld, MD, MSc, an orthopaedic surgeon in the Department of Orthopaedic Surgery and Center for Surgery and Public Health at BWH. “My previous military service provided insight into the stress of repeated deployments on service members and their families. However, I was surprised by the magnitude of the effect we observed here, particularly among female civilian spouses. This underscores an overlooked aspect of deployment schedules that the Military Health System must recognize.” 

Chronic pain—a distressing condition that persists for months to years—can significantly reduce one’s quality of life. According to the Centers for Disease Control and Prevention (CDC), as of 2021, 20.9 percent of U.S. adults experienced chronic pain. This condition is also costly, both to individuals and the healthcare system, due to ongoing treatment needs and immense productivity losses. 

Researchers conducted a cohort study using data from the Military Health System Data Repository, focusing on active-duty servicewomen and female dependents of active-duty servicemembers across all branches of the Department of Defense (Army, Air Force, Navy and Marine Corps).  The study included health records of 3,473,401 individuals ages 18 to 64, spanning 2006 to 2020.  

Among these records, 324,499 individuals (9.3 percent) had a diagnosis of chronic pain. The study divided the cohort into two groups: one from 2006 to 2013, characterized by more intense combat exposure, and another from 2014 to 2020 with significantly less combat exposure. Individuals with pre-existing chronic pain diagnoses before military service were excluded. 

Comparing these cohorts revealed that those serving from 2006 to 2013 had significantly higher rates of chronic pain (14.8 percent among active duty and 11.3 percent among dependents) compared to those serving from 2014 to 2020 (7.1 percent among active duty and 3.7 percent among dependents). 

Specifically, servicewomen from 2006 to 2013 had a 53 percent higher likelihood of chronic pain than those from 2014 to 2020. 

The study also found associations between chronic pain, and factors like mental health and socioeconomic status, among those serving in the Army or Marine Corps. 

“Populations from disadvantaged economic backgrounds and those with preexisting mental health conditions often encounter more barriers to accessing medical and behavioral health services, which can worsen and prolong their suffering,” noted Schoenfeld.  

One limitation of these findings is that they are based on claims data, which prevented investigators from directly interviewing patients to fully understand the circumstances and symptoms that culminated in their chronic pain diagnoses. 

Looking ahead, Schoenfeld and colleagues aim to evaluate how sustained use of prescription opioids differs among active-duty service women and civilian dependents living with chronic pain. They further hope to conduct a prospective observational study to better understand the long-term ramifications of military deployments on health.  

Authorship: In addition to Andrew Schoenfeld, BWH authors include Jonathan Gong, and Joel Weissman. Additional authors include Madison N. Cirillo, Amanda Banaag, Matthew Bryan and Tracey P. Koehlmoos. 

Disclosures: Andrew Schoenfeld reported receiving grants from National Institutes of Health National Institute of Arthritis and Musculoskeletal and Skin Diseases (paid to institution) and Orthopaedic Research and Education Foundation (paid to institution), personal fees from Wolters Kluwer and Springer, serving as a consultant for Vertex Pharmaceuticals, serving as editor in chief for Spine, serving on the editorial board for Journal of Bone and Joint Surgery, and serving on the board of directors for North American Spine Society outside the submitted work.  
 
Funding: This study was funded through a grant from the US Department of Defense, Defense Health Agency (award No. HU00012320021). 

Paper cited: Schoenfeld A. et al. “Development of Chronic Pain Conditions Among Women in the Military Health System.” JAMA Network Open DOI: 10.1001/jamanetworkopen.2024.20393  

---

JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2024.20393 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Development of Chronic Pain Conditions Among Women in the Military Health System

ARTICLE PUBLICATION DATE

5-Jul-2024

COI STATEMENT

Andrew Schoenfeld reported receiving grants from National Institutes of Health National Institute of Arthritis and Musculoskeletal and Skin Diseases (paid to institution) and Orthopaedic Research and Education Foundation (paid to institution), personal fees from Wolters Kluwer and Springer, serving as a consultant for Vertex Pharmaceuticals, serving as editor in chief for Spine, serving on the editorial board for Journal of Bone and Joint Surgery, and serving on the board of directors for North American Spine Society outside the submitted work

CAPITALI$M APPROVES

 FTSE Turns Bullish as UK Voters Reject Right-Wing Conservative Rule

ByAdam Harris
Market Overview
Published 05/07/2024
Articles(46)|My Homepage

The United Kingdom has witnessed a seismic shift in its political landscape, with the Labour Party securing a historic landslide victory over the Conservative Party in the recent general election.

Election Results and Political Landscape
In a stunning turn of events, Labour, led by Sir Keir Starmer, is on course for a 170-seat majority in the House of Commons - the party's biggest win since Tony Blair's famous victory in 1997. The Conservative Party, under outgoing Prime Minister Rishi Sunak, has suffered a crushing defeat, projected to secure just 144 MPs - their lowest total in the party's history.

Market Reaction to Labour's Victory
The FTSE has responded with enthusiasm to the clear election outcome, demonstrating a strong bullish trend. Investors typically favor political stability and clear policy direction, both of which are expected under the new Labour government. The market's positive reaction underscores confidence in the incoming administration's ability to steer the economy towards growth and prosperity.

Labour's Economic Vision
Labour's economic agenda, which resonated strongly with voters, includes increased public spending on infrastructure, education, and healthcare. These policies are aimed at stimulating economic growth, creating jobs, and boosting consumer spending. Additionally, Labour's commitment to green energy initiatives and technology innovation has particularly excited investors, with renewable energy and tech stocks seeing significant gains.

Sectoral Impact and Investment Opportunities
Key sectors expected to benefit under the new government include:
1. Renewable energy and clean technology
2. Infrastructure and construction
3. Healthcare and education
4. Financial services

Investors are already positioning themselves to capitalise on these anticipated growth areas, leading to notable surges in relevant stocks.

What the charts are saying this week
Technical Analysis of FTSE daily chart.

Price is currently going sideways within a tight range. However, it has also produced a clean double-bottom bullish pattern within a larger uptrend.
Price has also moved above both its weekly and monthly pivots, and appears to be setting up for a push to achieve new highs.
The general global markets (including the U.S.) are very stable and bullish, which obviously helps. Globally, the sentiments in the markets are optimistic.




Long-term Economic Outlook
Analysts are predicting sustained growth driven by Labour's proposed policies. While challenges such as managing national debt and navigating post-Brexit trade relations remain, the overall sentiment is decidedly optimistic. The clear mandate given to Labour is seen as a catalyst for decisive action on key economic issues.

State of UK Debt and Its Relevance
While the FTSE 100 shows bullish momentum in anticipation of a Labour landslide, it's important to consider the state of UK debt. As of mid-2024, the UK's national debt remains a significant concern, hovering around 100% of GDP. This high debt level could pose challenges for the incoming government, particularly in implementing expansive fiscal policies. Investors should be aware that while short-term market sentiment is positive, long-term economic stability might be influenced by how effectively the new government manages this debt. Sustainable debt management will be crucial in maintaining investor confidence and supporting continued growth in the FTSE 100.

International Perspective
The UK's decisive shift towards a centre-left government bucks the trend seen in some other Western democracies. This unique position could potentially influence global investor sentiment towards the UK, presenting both opportunities and challenges in international markets.


International Context and the U.S. Influence
The UK's decisive shift towards a centre-left government occurs against a backdrop of global political trends, notably the perceived slide towards authoritarianism in the United States. Some analysts suggest that British voters may have been influenced by concerns over the rightward drift in American politics, viewing Labour's victory as a pre-emptive protective measure against similar trends in the UK.

The recent turbulence in U.S. politics, characterised by challenges to democratic norms and institutions, appears to have resonated across the Atlantic. British voters, mindful of the close historical ties between the two nations, may have chosen to chart a distinctly different course. This 'transatlantic caution' could have contributed to the strong support for Labour's more progressive platform, seen as a bulwark against potential authoritarian leanings.

However, it's important to note that domestic issues, including economic concerns and dissatisfaction with the incumbent government, likely played a more direct role in shaping the election outcome. Nonetheless, the global context, particularly developments in the U.S., may have reinforced British voters' desire for a change in political direction, contributing to the market's optimistic response to Labour's victory.

As Keir Starmer prepares to become the next Prime Minister, the FTSE's bullish reaction reflects a market that is embracing change and looking forward to a new era of economic policy. While the political landscape has shifted dramatically, the financial markets appear confident in the UK's economic future.

The historic nature of this election victory, coupled with the positive market response, suggests a period of renewed optimism and potential economic resurgence for the United Kingdom. As always, investors should remain informed and agile, ready to adapt to the evolving economic landscape under the new Labour government.

Wales' 13 new MPs after General Election 2024

Labour has won 27 of Wales' 32 seats and wiped out all the Conservatives in Wales

NEWS
By Ruth Mosalski

Political Editor

5 JUL 2024

Nine of Wales' 13 new MPs at this election

Labour has won the general election although its vote share did go down in Wales. Labour wiped out the Conservatives in Wales and 27 of the total 32 constituencies are represented by Labour.

Plaid Cymru had what the party's leader called a "stunning" night taking four seats, double the number expected at the beginning of the campaign. They now have MPs representing Dwyfor Meirionnydd, Ceredigion Preseli, Ynys Mon and Caerfyrddin.

The Conservatives had a disastrous night with five secretaries of state for Wales losing their seats, four who were standing in Wales.

READ MORE: General Election 2024 results live in Wales as Labour wins landslide but Plaid take key seats

Bangor Aberconwy

Claire Hughes - Labour

Claire Hughes (Image: Mike Plunkett)

The 45-year-old was born in Bangor, grew up in Penmaenmawr and live in Llanfairfechan with her family and two teenage kids. She has spent her career before politics working in the digital sector, mostly with start-ups in the technology and innovation space. Ms Hughes previously started and run a training business helping hundreds of people start a small business. Also a published author, she says she loves spending time outdoors, walking while listening to a podcast, or a power-walk with friends.

You can see the full results from the constituency here.

Brecon, Radnor and Cwm Tawe:

David Chadwick - Liberal Democrat

David Chadwick (Image: Welsh Liberal Democrats)

David lives in Brecon with his wife Gemma and young son William. He is a consultant in cybersecurity and became interested in politics when his grandfather took him to see the steelworks in Port Talbot to see what it was like to work in a blast furnace saying it showed him the link between industry and politics.

The full results are here.

Cardiff West

Alex Barros-Curtis - Labour

Alex Barros-Curtis (Image: Labour Party)

The first time MP for this constituency is Labour's Alex Barros-Curtis. Born and brought up in north Wales, he went to Gronant Primary School and Prestatyn High School, with some time spent in St. Asaph as a member of its Cathedral Male Voice Choir.

His mum was a teacher and my and dad a police officer.

He moved to London to study law at the London School of Economics and qualified at one of the world’s largest law firms and has worked for charities and organisations, as well as the Labour Party as its principal legal adviser.

He is a Liverpool FC and music fan and loves music. He very nearly trained to become a professional pianist instead of a lawyer. The full results are here.

Caerfyrddin

Ann Davies - Plaid Cymru

Ann Davies (Image: PA)

Born and bred in Carmarthenshire, she farms in Llanarthne with husband Gareth. She's been county councillor for Llanddarog Ward since 2017 and cabinet member since 2021.

A former lecturer in early years learning at the University of Wales Trinity Saint David, she's also been a peripatetic music teacher and is now the joint owner of a local children’s nursery.

In her spare time, she volunteers at the local village hall, and is county chair for a farming union.

Clwyd East

Becky Gittins - Labour

Becky Gittins (Image: Mike Plunkett)

Born at Glan Clwyd and raised in Bagillt, the 29-year-old was educated at Flint High and the Alun School, Mold, and now lives in Pentre Halkyn with her husband and dog.

After university, she trained as an accountant and worked in finance and has also served as a councillor. Her job before election was as a trade union negotiator.

You can see all the details of the result here.

Clwyd North

Gill German - Labour

Gill German (Image: Mike Plunkett)

Brought up locally and with two children, she was a local teacher for over 20 years. She says she entered politics because she says she saw life getting more and more difficult for families.

She is the current deputy leader of Denbighshire County Council and cabinet member for education, children and families.

The full results are here.

Monmouthshire

Catherine Fookes - Labour

Catherine Fookes (Image: Nathan Roach)

A mum to two boys she says she's been involved in her local community for decades, most recently as a councillor and school governor. A former chief executive of charity Women's Equality Network. She served as a board member on the Food and Drink Wales Industry Board, helping to grow and promote the industry in Wales. Before that, she advised the UK Government on organic food and farming as well as working as a campaigner for an environmental charity.

She set up the Children's Food Academy at Abergavenny Food Festival, providing children with free cookery sessions. She enjoys going to her sons' gigs, popping into her local pub and walking Beanie, the family dog.

All the result detail is here.

Montgomeryshire and Glyndwr

Stephen Witherden - Labour

Steve Witherden (Image: Nathan Roach)

Born in Wrexham and brought up in Llantysilio and Llangollen, he lives in Acrefair. He studied at Lampeter and Aberystwyth University. He married his wife, an NHS worker, 14 years ago. They have two children. He has been a teacher in Wrexham for 18 years and has a number of union roles.

Pembrokeshire Mid and South

Henry Tufnell - Labour

Henry Tufnell (Image: Nathan Roach)

Henry Tufnell, 30, lives in St Davids and grew up in a farming family. He trained and practised as a barrister, specialising in healthcare, public and employment law, before leaving to work as an organiser for a grassroots trade union.

You can see the results page here.

Swansea West

Torsten Bell - Labour

Torsten Bell (Image: Labour Party)


Aged 41, Torsten Bell is married with two children. He is a fellow of the Academy of Social Sciences, school governor, and an honorary professor at UCL. He also has a weekly column in The Observer. His dad formerly taught at Swansea University, before spending decades working at Save the Children. He has been an economist in the Treasury during the financial crisis and trustee of the Child Poverty Action Group.

For the decade before standing for election, he led the Resolution Foundation, a national economic research charity dedicated to improving the lives of working people through better jobs, affordable housing and a more equal country

Vale of Glamorgan
Kanishka Narayan - Labour

Kanishka Narayan (Image: Labour Party)

Growing up in Cardiff, the 34-year-old's parents worked in hospitality and then as lawyers, he now lives in Barry. He trained as an economist and advised ministers on economics as senior adviser at the Cabinet Office and then as expert adviser to Britain’s environment secretary. He then worked in the private sector, advising FTSE boards, government finance ministries, and climatetech entrepreneurs on managing their balance sheets.

He volunteers for Citizens Advice, Trussell Trust, a mentoring scheme to help children into academia and job opportunities. He says he likes reading history and philosophy and walking.

The full detail of results is here.

Wrexham
Andrew Ranger - Labour

Andrew Ranger (Image: Mike Plunkett)

The 53-year-old moved to Wrexham 25 years ago. Following a 27-year career in the hospitality industry, starting as a kitchen porter, and finishing as a hotel general Manager, he then became an accountant.

A community councillor he says he enjoys travelling as well as going to music concerts, the theatre, and is an avid reader – especially of science fiction and fantasy novels.

Ynys Mon

Llinos Medi - Plaid Cymru

Llinos Medi (Image: Plaid Cymru)

The first ever female leader of Ynys Mon council, Llinos Medi was first elected as a councillor in 2013 and re-elected in 2017, becoming leader aged 35. She is divorced and has two children.

You can read the full results here.

Ben Lake wins Ceredigion Preseli for Plaid Cymru


Published  July 5, 2024
By Tom Sinclair



BEN LAKE has been re-elected as the Member of Parliament for Ceredigion Preseli, securing Plaid Cymru’s hold on the seat in tonight’s election.

Ben retained his seat with a total of 21,738 votes, outperforming the Liberal Democrats and Labour. This marks the third consecutive election victory for Lake, who first claimed the seat from Liberal Democrat Mark Williams in 2017 and successfully defended it against Conservative Aled Thomas in 2019.

In his victory speech, Ben expressed his gratitude, stating: “I would like to thank everybody including my competitors who have been part of a great campaign.”

The full election results for Ceredigion Preseli are as follows:

Ceredigion Preseli results

Plaid Cymru,Ben LakeVotes 21,738
Share 46.9%
Share change +15.8
Liberal Democrat,Mark WilliamsVotes 6,949
Share 15.0%
Share change +0.4
Labour,Jackie JonesVotes 5,386
Share 11.6%
Share change -9.2
Reform UK,Karl PollardVotes 5,374
Share 11.6%
Share change +7.6
Conservative,Aled ThomasVotes 4,763
Share 10.3%
Share change -18.0
Green,Tomos BarlowVotes 1,864
Share 4.0%
Share change +2.7
Workers Party of Britain,Taghrid Al-MawedVotes 228
Share 0.5%
Share change +0.5

Mark Williams, who came second for the Liberal Democrats, commented: “It’s better than coming third. Second this time. It was a positive campaign and I’m very grateful for all the votes. Clearly Ben won an emphatic victory and deserves praise.

“Many issues are unresolved, however, and me and my party will continue to campaign on them.”

Could Labour use public-private projects to fix England’s hospitals?

Denis Campbell Health policy editor

THE GUARDIAN
Wed, 3 July 2024 a


Patients were evacuated from Stepping Hill hospital in Stockport when some ceilings fell down.Photograph: Manchester Evening News Syndication


Scores of hospitals in England are so old and decrepit that some are falling down. The Conservative government recognised that the NHS needed a massive modernisation of its estate in 2019 when Boris Johnson promised 40 new hospitals by 2030.

But, with public spending due to be tight for the next few years, where would a new government find the money to enable these other projects to go ahead? NHS Providers, which represents trusts, has put forward a new wave of NHS/private-sector partnerships as a potential answer.
Why are so many hospitals in England in such a bad state?

That is partly because so many NHS premises are old, and also because the NHS’s capital budget – which it uses to pay for repairs, build new facilities and buy new equipment such as scanners – has been held down for many years. The cost of all the maintenance repairs needed across the NHS has soared from £4.7bn in 2011-12 to £11.6bn in 2022-23.
But are 40 new hospitals not due to be built by 2030?


Boris Johnson promised in 2019 to do just that, but the new hospitals programme has been beset by cost overruns, confusion over when promised new facilities would finally arrive and a growing number of trusts saying their schemes would not be ready until after 2030.

Plus, while 100 health trusts applied to join, 88 were refused entry, even though parts of some of them – such as Stepping Hill hospital in Stockport – are literally falling down.
So what is NHS Providers proposing?

That the Treasury overhauls the Department of Health and Social Care’s capital departmental expenditure limit (CDEL) rules, which restrict how much money the NHS can spend on building projects, even if some of that money comes from external sources.

Julian Hartley, the head of NHS Providers, wants the new government to apply “fresh thinking” and “imagination” to how the health service can access potentially billions of pounds to build new facilities – by collaborating with property developers, private healthcare companies, pension funds, drug companies, universities and local councils.
Critics claim this would just be a rerun of PFI. What is the concern?

The private finance initiative was used to build an array of new hospitals in the 1990s and 2000s. It was a way of keeping finance used to fund public infrastructure such as schools and hospitals off the Treasury’s balance sheet for reporting public debt.

But under it, developers made profits which, in some cases, were considered obscene. In 2019, the IPPR thinktank calculated that the NHS would end up paying £80bn for £13bn worth of new hospital buildings, so extortionate were the terms their private partners obtained. Trusts spend more than £2bn a year on PFI repayments.

The Commons public accounts committee found in a 2018 report that the “ongoing costs to the institutions at the frontline have been high and the contracts inflexible”. The committee concluded that the “deal is not working for the taxpayer”.

Keep Our NHS Public fears that new joint NHS/private arrangements would again lead to a “need to siphon off taxpayer money to private companies and their shareholders”.
Could Labour act on Hartley’s suggestion?

Wes Streeting, the shadow health secretary, has made clear that he expects the NHS to use the private sector to clear as much of the care backlog as possible. It is unclear, though, if he would see NHS/private sector collaborations as a viable way for health trusts to unlock much-needed funding to enable them to press ahead with building much-needed new facilities.

On Monday, the Health Service Journal asked him if he would relax the Treasury’s CDEL rules, so that trusts could more easily partner with property developers and pension funds on construction projects. He acknowledged trusts faced obstacles accessing capital spending which caused “immense frustration”, and that the shadow chancellor, Rachel Reeves, understood “the scale of the capital challenge in the NHS”.

But, he added, “Treasury rules exist for a reason” and there are “lots of competing demands” for capital, which Labour would have to consider.

However, it is not inconceivable that Labour, which mentioned “partnership” with business 18 times in its manifesto, may be persuaded to explore Hartley’s idea as a way of using private money to rebuild the NHS’s aged, crumbling infrastructure, given the financial position it will inherit.

NHS leader calls for partnership with private sector to build new hospitals

Denis Campbell Health policy editor

THE GUARDIAN
Wed, 3 July 2024


An artist’s impression of Birmingham’s private Harborne hospital, where the local NHS trust has leased 72 beds over two floors.Illustration: Harborne hospital

The NHS must be given the green light to partner with private health firms and property developers to build new hospitals to slash the care backlog, a health service boss has said.

The last Labour government was widely criticised over controversial private finance initiative (PFI) deals to erect scores of new NHS facilities that led to vast profits for major corporations.

But in a major intervention the head of NHS Providers, Julian Hartley, has urged the next administration to relax Treasury rules that limit health service trusts in England from entering into such collaborations and insisted that the NHS has “nothing to fear” from them.

He said: “We need to think outside the box when it comes to solving this double whammy of under-strain public finances and an NHS estate in desperate need of renewal.

“Collaboration with public and private partners such as ethical pension funds, property developers, universities, private healthcare providers and local councils could unlock opportunities for NHS trusts keen to build new hospitals or redevelop existing sites which have been stymied by rigid Treasury rules.”

However, Dr John Puntis of Keep Our NHS Public said most people would find his suggestion “appalling” and that it constituted “a shocking attack on the founding principles of the NHS” as it prepares to mark the 76th birthday of its creation on Friday.

Hartley cited recent partnerships between NHS trusts in Birmingham and Surrey and private health providers to run newly built facilities, which treat NHS and fee-paying patients, as “successful examples of NHS and private sector collaboration. We can draw positive lessons that this is doable, that the NHS and the private sector can work together, and that it supports the interests of NHS services”.

“This doesn’t have to be PFI Two. This is not about privatisation of the NHS; this is about strengthening and supporting the NHS through investment that creates better facilities for patient,” Hartley added.

University Hospitals Birmingham (UHB) trust has been given operational control of 72 of the 122 beds in the Harborne private hospital on its site, which opened in January in a partnership between it and HCA, a large American healthcare firm which operates a network of private hospitals in the UK. UHB did not contribute towards the £100m cost of building the hospital, which provides cancer, cardiac and orthopaedic care, but has taken a lease on two of its eight floors for its own patients.

The extra beds will let people in Birmingham and Solihull get quicker treatment “in world-class facilities, delivered by leading NHS specialists” by cutting its waiting list, it has said.

In a similar move the Royal Surrey NHS trust and Genesis Cancer Care have entered into an arrangement to run a new dedicated cancer centre, which opened in Guildford, Surrey in March. The £30m facility is providing oncology and radiotherapy to NHS and private patients.

Hartley urged whoever are the chancellor and health secretary after the UK general election to “have an open mind” on NHS tie-ups involving major injections of capital from drug companies, pension funds and universities. The new government should see the new wave of hospitals that would ensue as a boost to the economy and a way of the public sector leveraging private sources of funding at a time when government spending is likely to remain tight, he said.

He wants the Treasury to review the Department of Health and Social Care’s capital departmental expenditure limit (CDEL), which restricts how much health trusts and the NHS overall can spend on capital projects, even if some of the money has come from external sources. The backlog of repairs needed across the NHS in England has ballooned in recent years to £11.6bn.

Keir Starmer and the shadow health secretary, Wes Streeting, have said that under a Labour government the NHS will use the private sector as much as it can to cut a backlog that has spiralled to 7.6m procedures. Acting on Hartley’s idea would risk angering those anxious about NHS privatisation.

Hartley highlighted that scores of NHS trusts were left unable to rebuild or replace sometimes dangerously decrepit facilities when, of the 100 that applied to join the New Hospitals Programme, the scheme to implement the pledge of the then prime minister, Boris Johnson, to build “40 new hospitals” by 2030, only 40 were given entry because numbers were capped.

David Hare, chief executive of the Independent Healthcare Providers Network, which represents private health providers, said: “There is huge appetite in the independent sector to partner with the NHS and bring much-needed new capital, capacity and capability to support better access to NHS services for patients free at the point of use.”

But David Rowland, director of the Centre for Health and the Public Interest thinktank, warned that NHS/private partnerships would “hasten a two-tier health system”. He accused Hartley of displaying “astonishing naivete” in his attitude to “the for-profit sector, particularly those with private equity backers”. Such firms are only interested in the NHS so they can “use the highly trained NHS workforce to treat those patients who can afford to pay privately and jump the queue.

“The last Labour government thought that getting into bed with the private sector to finance, build and operate NHS hospitals under the PFI programme would bring in investment and expertise. In reality it has led to huge amounts of money leaking out of the NHS in the form of profits and has saddled NHS Trusts with massive, crippling debt repayments.

“The mistakes from this fiasco should not be repeated.”

Midwife on the frontline of climate change on Pakistan’s islands


By AFP
Published July 1, 2024

Each week Neha Mankani comes by boat ambulance to Baba, an old fishing settlement and reportedly one of the world's most crowded islands - Copyright AFP Rizwan TABASSUM
Sabina QAZI

On a densely populated island off Pakistan’s megacity of Karachi, a group of pregnant women wait in a punishing heatwave for the only midwife to arrive from the mainland.

Each week Neha Mankani comes by boat ambulance to Baba, an old fishing settlement and reportedly one of the world’s most crowded islands with around 6,500 people crammed into 0.15 square kilometres (0.06 miles).

Climate change is swelling the surrounding seas and baking the land with rising temperatures. Until Mankani’s ambulance launched last year, expectant mothers were marooned at the mercy of the elements.

At the gate of her island clinic waits 26-year-old Zainab Bibi, pregnant again after a second-trimester miscarriage last summer.

“It was a very hot day, I was not feeling well,” she recalled. It took her husband hours of haggling with boat owners before one agreed to ferry them to the mainland — but it was too late.

“By the time I delivered my baby in the hospital, she was already dead,” she said.



– Summer heat hits pregnancies –



Heatwaves are becoming hotter, longer and more frequent in Pakistan, one of the countries most vulnerable to extreme weather conditions resulting from climate change.

In May and June, a string of heatwaves have seen temperatures top 52 degrees Celcius (126 degrees Fahrenheit) for days.

“Climate change doesn’t affect everyone equally,” 38-year-old Mankani told AFP during the 20-minute boat journey.

“Pregnant women and newborns, postpartum women are definitely more affected,” she said.

“In the summer months, we see a real increase in low-birth weights, preterm births, and in pregnancy losses.”

Women are at higher risk of stillbirth when exposed to temperatures above 90 percent of the normal range for their location, according to experts published in the British Journal of Obstetrics and Gynaecology last year.

“Before we didn’t have the evidence, a lot of it was anecdotal,” said Mankani. “But we’ve been seeing the impact of climate change for a while.”

In Pakistan, 154 women die for every 100,000 live births -— a high maternal mortality rate shaped by socioeconomic status, barriers to healthcare access and limited decision-making powers, especially among young women, according to the United Nations.

Mankani began her 16-year career as a midwife in a Karachi hospital, where she worked at a high-risk ward, often treating women from the five islands dotted off the coast.

She founded the Mama Baby Fund in 2015 and set up the first clinics on the islands for expectant and new mothers. “Everyone opened their homes to us,” she said.

The free 24/7 boat ambulance followed last year, crucially equipped to navigate rough seas in a region increasingly prone to flooding.

Sabira Rashid, 26, gave birth to a girl she named Eesha two months ago, following one stillbirth and a miscarriage at seven months — painful losses she blames on not reaching the hospital in time.

“At the dock, they make us wait because they don’t want to ferry only two or three people. They told us to wait for more passengers, no matter what the emergency,” she said.



– Rising, dirty waters –



Girls on the impoverished islands are often wed as young as 16, with marriage considered the source of security for women in an area where polluted water is killing off the fishing trade.

“Most of these girls don’t know how to take care of themselves, they get severe infections from the dirty water they are constantly exposed to,” said Shahida Sumaar, an assistant at the clinic, wiping the sweat from her face.

The 45-year-old said basic advice is offered to young mothers during heatwaves, such as using dry, clean towels to wrap their newborns in, washing their breasts before feeding and staying hydrated.

But with no access to running water and little electricity, warding off heat stress is a challenge for all the islanders.

Women are at particular risk, typically responsible for cooking over open flames in small rooms with no fans or proper ventilation.

Ayesha Mansoor, 30, has four children and lives on the fringes of Baba, with just four to five hours of electricity a day.

The path to her home is covered by a carpet of discarded plastic bags which disappear underwater when the tide is high.

“Only those who have solar can deal better with the heat. We can’t afford it,” she said, swatting away flies that settled on her baby.

Mariam Abubakr, an 18-year-old assistant at the clinic who has grown up on the island, hopes to become its first full-time midwife.

“I used to wonder why we women didn’t have any facilities here, a clinic that could just cater to us,” she said.

“When Neha opened her clinic, I saw a way that I could help the women of my community.”

Using data and clinical research to improve patient care across national borders

Charité intensifies cooperation with CLALIT Health Services

CHARITÉ - UNIVERSITÄTSMEDIZIN BERLIN

During the COVID-19 pandemic, Israel impressively demonstrated how efficient patient data collection can be used to advance research into the prevention of infections and development of therapies. One of Israel's largest healthcare organizations, Clalit Health Services, has since been cooperating with Charité – Universitätsmedizin Berlin with the aim of combining Israeli expertise in the use of "big data" with innovative biomedical research approaches by Charité scientists. As part of the cooperation, one of the first joint projects has now received EU funding. 

Charité – Universitätsmedizin Berlin and Clalit Health Services began working together in a strategic scientific partnership two years ago. "At first glance, both Charité, one of the largest university hospitals in Europe, and Clalit, a health management organization, may appear very different. However, this is precisely what makes this partnership so appealing and holds so much potential," explains Prof. Dr. Heyo Kroemer, CEO of Charité. "Clalit's particular strength lies in its outstanding digital infrastructure and its ability to put innovations such as AI-driven care platforms into practice on a large scale." Clalit Health Services, the largest public healthcare organization in Israel, operates a network of 14 hospitals, over 1,300 primary care clinics, pharmacies, and dental clinics, and serves approximately 5 million members. Through its innovation hub, Clalit Innovation, it promotes advanced research and development.

In June 2022, two Charité scientists – Prof. Friedemann Paul, director of the Experimental and Clinical Research Center and Prof. Leif Erik Sander, director of the Department for Infectious Diseases and Critical Care Medicine – officially initiated the collaboration at a first scientific workshop. At this meeting, ten German-Israeli interdisciplinary research group tandems were established in the fields of AI and health data, immunology and infectious diseases, imaging, oncology, and cardiology. In June of this year, a second follow-up meeting took place at the Charité, where scientists from Tel Aviv and Berlin presented results and plans for ongoing joint projects in more than 40 lectures, and formed new project groups in the fields of women's health and mental health in workshops.  Prof. Dr. Joachim Spranger, Dean of Charité, expressed his enthusiasm at the opening of the event: "The collaboration with Clalit offers unique opportunities to improve data analysis and AI solutions. The processing and use of such high-quality health data makes it possible to better predict disease progression and treatment outcomes,  identify previously unknown disease patterns, and ultimately offer patients suitable diagnostic and therapeutic measures at an early stage.”

EU funds German-Israeli research project
One example of this future-oriented collaboration is the joint Charité and Clalit project EXPLORE – NB, led by PD Dr. Hedwig Deubzer, senior physician at the Charité Department of Pediatrics. It has recently been accepted in the HORIZON 2020 program ERA-NET and received funding of about 939.000 Euro. 

Together with her Israeli colleagues Dr. Esther Berko, Dr. Assaf Grunwald, Dr. Nurit Gal Mark, and other European partners, they will be working intensively over the next three years on the question of whether molecular markers of solid tumors in children, such as neuroblastoma, can also be identified in the so-called biofluids and thus less invasively. Biofluids include blood, bone marrow, urine, and cerebrospinal fluid. The liquid biopsies can be obtained minimally to non-invasively, with low risk, and can therefore be performed serially. Dr. Deubzer emphasizes: " Our hypothesis is that we can monitor therapy response with liquid biopsies and detect and understand the emergence of therapy resistance at an early stage. In EXPLORE-NB, we will focus on epigenetic changes. Our cooperation is based on the research goal of increasing the chances of recovery and improving health monitoring after childhood cancer. Together, we would therefore like to examine the significance of the EXPLORE-NB research data in a clinical study in the future."

Close cooperation despite challenges
Just how close the cooperation is after only two years and despite the pandemic and Middle East conflict is also demonstrated by the visiting professorship for Prof. Ran Balicer, funded by Stiftung Charité. The Israeli physician and public health expert Prof. Balicer will set up a working group at Charité over the next three years as part of Stiftung Charité's Visiting Fellowship Program and continue to promote cooperation between the two institutions. "We find this ongoing collaboration between Charité and Clalit to be of the highest scientific merit and potential clinical impact. The ability of top-notch clinicians and researchers on both sides to use the unparalleled data resources of Clalit has a strong synergistic effect that allows for groundbreaking research on multiple scientific domains," says Prof. Ran Balicer, Chief Innovation Officer of Clalit. He adds: "We are pleased to see the launch of a new cohort of collaborative efforts this week, and are sure these will further increase the beneficial impact this research has on patients' lives and wellbeing – in Germany, in Israel, and worldwide."

About Clalit Health Services 
Clalit is part of Israel's integrated healthcare system, of which around 52 percent of the approximately 10 million residents are members. It is a non-profit organization that integrates primary, specialist, and hospital care. With 14 hospitals, Clalit provides around 30 percent of inpatient beds in Israel. Of the 48,000 employees, 11,000 are doctors and 15,000 are nurses. The annual budget is 13.5 billion dollars.

Clalit Innovation 
Charité International Affairs 
EXPLORE – NB Project 

 

American Indian/Alaska Native patients less likely to undergo breast reconstruction

Disparity in reconstruction persists for AI/AN women, reports Plastic and Reconstructive Surgery®

Peer-Reviewed Publication

WOLTERS KLUWER HEALTH

Waltham — July 2, 2024 — American Indian/Alaska Native (AI/AN) women with breast cancer have consistently lower rates of breast reconstruction after mastectomy compared to non-Hispanic White women, reports a paper in the July issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer. 

"Despite an upward trend in reconstruction, AI/AN women continue to be less likely to undergo breast reconstruction," comments Jane Hui, MD, MS, of University of Minnesota, Minneapolis. "While our findings point to some possible approaches to reducing this disparity, it will be essential to also determine Native women's opinions related to breast reconstruction." 

Focus on factors affecting breast reconstruction in AI/AN women 

Using data from the National Cancer Database, the researchers identified 1,980 AI/AN women and 414,036 non-Hispanic White women who underwent mastectomy for breast cancer between 2004 and 2017. Annual breast reconstruction rates were compared between groups, along with factors associated with decisions about reconstruction. 

The two groups differed in some important characteristics. American Indian/Alaska Native women had higher rates of other medical diagnoses (comorbidity), 20% versus 12%; were more likely to have public health insurance, 49% versus 20%; and more likely to undergo single-breast (unilateral) mastectomy. 

Over the 13-year study period, breast reconstruction increased in both groups: from 13% to 47% for AI/AN women and from 29% to 62% from non-Hispanic White women. After adjustment for other factors, AI/AN women remained nearly one-half less likely to undergo reconstruction.  

Other factors associated with lower reconstruction rates included older age, earlier year of diagnosis, more advanced cancer, unilateral mastectomy, public insurance, and living in an area of lower educational attainment. Within the AI/AN group, reconstruction was more likely for younger women; those with more recent diagnosis, less-advanced cancer, and less comorbidity; and those living in urban areas or areas with a higher level of educational attainment. 

Insights for addressing breast reconstruction disparity in Native women 

Breast reconstruction after mastectomy has known benefits for some, including improved quality of life and body image. However, breast reconstruction is a personal decision – there is "no optimal proportion" of patients who should opt for reconstruction, Dr. Hui and colleagues note. 

American Indian/Alaska Native women face a wide range of health disparities and barriers to medical care, including elevated rates of chronic health conditions, later diagnosis and higher mortality from breast cancer. "Complicating the healthcare environment in which AI/AN receive medical care is chronic underfunding of the Indian Health Service (IHS), implicit bias against AI/AN, and fraught relationships between physicians and AI/AN patients," the researchers write. 

Their study offers insights into factors associated with the lower rate of breast reconstruction for AI/AN women with breast cancer. "Multidisciplinary efforts to improve care delivery to AI/AN women may continue to minimize disparities through earlier diagnosis and treatment," Dr. Hui and coauthors conclude. "Simultaneously, qualitative research into AI/AN perspectives on breast cancer care could improve shared decision-making between physicians and AI/AN patients, empowering AI/AN women to choose post-mastectomy reconstruction if they so desire." 

Read Article: Disparities in post-mastectomy reconstruction use among American Indian and Alaska Native women 

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health. 

### 

About Wolters Kluwer 

Wolters Kluwer (EURONEXT: WKL) is a global leader in information, software solutions and services for professionals in healthcare; tax and accounting; financial and corporate compliance; legal and regulatory; corporate performance and ESG. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with technology and services. 

Wolters Kluwer reported 2023 annual revenues of €5.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 21,400 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.  

For more information, visit www.wolterskluwer.com, follow us on LinkedIn, Facebook, YouTube and Instagram. 

---

JOURNAL

Plastic & Reconstructive Surgery

ARTICLE TITLE

Disparities in post-mastectomy reconstruction use among American Indian and Alaska Native women