Hypertension care cascades and reducing inequities in cardiovascular disease in low-and middle-income countries
Nature Medicine
Published On 2024/1/26
Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom …
Journal
Nature Medicine
Page
1-10
Authors
Deborah Carvalho Malta
Universidade Federal de Minas Gerais
H-Index
128
Research Interests
saúde coletiva
University Profile Page
Till W Bärnighausen
Heidelberg University
H-Index
118
Research Interests
population health
health systems
causal impact evaluation
randomized controlled trials
quasi-experiments
University Profile Page
Farshad Farzadfar
Tehran University of Medical Sciences
H-Index
115
Research Interests
Health metrics and evaluation
NCDs
Health system performance assessment
University Profile Page
Rifat Atun
Harvard University
H-Index
107
Research Interests
Health Systems
Global Health
Innovation
University Profile Page
Sebastian Vollmer
Georg-August-Universität Göttingen
H-Index
48
Research Interests
Development Economics
Global Health
University Profile Page
Stéphane Verguet
Harvard University
H-Index
46
Research Interests
decision science
health economics
health systems
University Profile Page
David Guwatudde
Makerere University
H-Index
40
Research Interests
Epidemiology of hypertension
Epidemiology od diabetes
Evaluation of interventions for management and control of hypertension and diabetes
University Profile Page
Other Articles from authors
Rifat Atun
Harvard University
crossroads
Ben B
In 1988, the Brazilian Constitution defined health as a universal right and a state responsibility. Progress towards universal health coverage in Brazil has been achieved through a unified health system (Sistema Único de Saúde [SUS]), created in 1990. With successes and setbacks in the implementation of health programmes and the organisation of its health system, Brazil has achieved nearly universal access to health-care services for the population. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale universal health coverage in a highly unequal country with relatively low resources allocated to health-care services by the government compared with that in middle-income and high-income countries. Analysis of the past 30 years since the inception of the SUS shows that innovations extend beyond the development of new models of care and highlights the importance of establishing political, legal, organisational, and management-related structures, with clearly defined roles for both the federal and local governments in the governance, planning, financing, and provision of health-care services. The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector–public sector collaboration. Fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental …
2030
Article DetailsTill W Bärnighausen
Heidelberg University
medRxiv
Accessibility of care and experiential quality of care for adults with hypertension in rural Burkina Faso: results from a cross-sectional household survey.
Providing quality healthcare is essential to reduce the future burden of cardiovascular disease. We assessed the quality of hypertension care in Burkina Faso using the Institute of Medicine (IOM) Quality Domains of effectiveness, timeliness of access, patient-centredness and equitability of care. We performed an analysis of cross-sectional household survey data collected from a population-representative sample of 4000 adults ≥40 years in Nouna, Burkina Faso in 2018. For people with hypertension, effectiveness was assessed through the construction of care cascades describing the proportion who were screened, diagnosed, treated, and achieved hypertension control; timeliness was defined as access to care within the last 3 months. Patient-centredness was described using experiential quality process and outcome measures (dichotomised as higher [score above the median] or lower quality [score below and including the median]; a shared understanding and decision-making variable (SUDM) was also described. Equity was assessed for effectiveness, timeliness, and patient-centredness in multivariable analyses, including socio-demographic factors. In total, 1006 participants with hypertension were included. Hypertension prevalence was 34.8%, with 62.3% having previously been screened, 42.9% diagnosed, 15.0% treated, and 6.8% having controlled disease; 26.8% had accessed care within the last three months. Overall, 61.8% of participants had a positive view of the health service. Clarity of communication and opinion of medical provider knowledge were the best-rated experiential quality process variables, with 40.1% and 39.7% of …
2024
Article DetailsLuisa C C Brant
Universidade Federal de Minas Gerais
Journal of the American Heart Association
Challenge of Optimizing Medical Therapy in Heart Failure: Unlocking the Potential of Digital Health and Patient Engagement
Heart failure (HF) is responsible for substantial morbidity among the estimated 6 million affected adults in the United States. 1 For HF with reduced ejection fraction (HFrEF), optimal guideline-directed medical therapy (GDMT) is estimated to reduce mortality by> 70% in addition to improving quality of life. 1 However, GDMT remains underused. 2, 3 Therefore, there is a critical need to identify strategies to improve implementation of GDMT for patients with HF. HF remote monitoring programs have traditionally focused on lifestyle management, monitoring for signs of decompensation and diuretic adjustment rather than optimization of GDMT. The impact of such programs on clinical outcomes has been inconsistent. Given the clinical benefit of GDMT, focusing digital health interventions on medication optimization may improve their overall impact. 4 In addition, interventions that have focused on improving HF medical …
2024/1/16
Article DetailsJennifer Manne-Goehler
Harvard University
medRxiv
The association between the value of a statistical life and frailty in Burkina Faso
Background To ensure resources invested into services are commensurate with benefit, economists utilise various methods to assess value of life. Understanding the performance of these methods in older populations is crucial, particularly in low-and-middle-income countries (LMICs), where the majority of older people will live by 2030. Value of Statistical Life Years (VSLY) is widely used in cost-benefit analyses but rarely been in LMICs or in older people. Objective This study aimed to investigate the hypothesis that frailty would be associated with a lower VSLY in participants in rural Burkina Faso, when controlling for factors found in other studies likely to affect VSLY, such as socio-demographics, multimorbidity, quality of life, and disability. Methods The study included 3,988 adults aged 40 years and older from a population-representative household survey done in Nouna, Burkina Faso. Data were collected on sociodemographic characteristics, chronic medical conditions, quality of life, disability, physical performance, and VSLY. Frailty status was derived using Fried's frailty phenotype. Bivariate analyses investigated the association between quintiles of VSLY and frailty. To explore modification of associations by other variables, we built sequential binary logistic regression models comparing each quintile of VSLY with the first (lowest) quintile. Models included frailty category, age, sex, marital status, educational attainment, and wealth. We sequentially added quality of life, multimorbidity, and disability. Results Of 2,761 survey participants included in this analysis, 51.4% were female. Average age was 54.5 years (with 70.0% aged 40-59 years), 24 …
2024
Article DetailsPascal Geldsetzer
Stanford University
medRxiv
Does home-based screening and health information provision improve hypertension diagnosis, treatment, and control? A regression discontinuity analysis in urban India
Background In India, several state governments are implementing or considering home-based hypertension screening programs to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programs in India. Methods Using six waves of population-representative cohort data (N = 15,573), we estimate the causal effect of a home-based hypertension screening intervention on diagnosis, treatment, and BP using a novel application of the Regression Discontinuity Design. Findings We find that screening individuals' BP in their homes and providing health information and a referral to those with elevated BP did not meaningfully improve hypertension diagnosis (0.1, p-value: 0.82), treatment (-0.2, p-value: 0.49), or BP levels (systolic: -1.8, p-value: 0.03; diastolic: 0.5, p-value: 0.39). This null effect is robust across subpopulations and alternative specifications. Interpretation Our findings suggest that a lack of knowledge of one's hypertension status might not be the primary reason for low diagnosis and treatment rates in India, where other structural and behavioral barriers may be more relevant. Adapting screening efforts to address these additional barriers will be essential for translating India's screening efforts into improved population health.
2024
Article DetailsDeborah Carvalho Malta
Universidade Federal de Minas Gerais
PLOS global public health
Individual characteristics associated with road traffic collisions and healthcare seeking in low-and middle-income countries and territories
Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008–2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24–65 years was 5.2% (95% CI: 4.6–5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18–64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence …
2024/1/19
Article DetailsTill W Bärnighausen
Heidelberg University
Archives of women's mental health
Socio-demographic determinants of intimate partner violence in Angola: a cross-sectional study of nationally representative survey data
Intimate Partner Violence (IPV) is a global problem of public health importance, which can be found across all social layers and cultural backgrounds worldwide. Angola is still an under-explored country in the context of domestic violence and was therefore chosen as our focus of interest. Our study’s goal was to identify the socio-demographic determinants of IPV in Angola. We used nationally representative data from female respondents of the 2015 Angolan Demographic and Health Surveys (DHS). Simple bivariate and multiple logistic regression analyses were used to assess the relationship between the experience of IPV and the women’s’ individual and contextual characteristics. Out of the 7,699 respondents, 3,070 (41.1%) reported having experienced at least one form of violence by their partners, with physical violence being more prevalent (32.5%) than emotional (27.7%) and sexual violence (7.2%). The …
2023/10/10
Article DetailsSahar Saeedi Moghaddam
Shahid Beheshti University of Medical Sciences
PLOS Global Public Health
Multiple cardiovascular risk factor care in 55 low-and middle-income countries: A cross-sectional analysis of nationally-representative, individual-level data from 280,783 adults
The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representative population-based surveys (2009–2019) with measured blood pressure (BP) and diabetes biomarker. We restricted our analysis to non-pregnant individuals aged 40–69 years and defined three mutually exclusive groups (i.e., hypertension only, diabetes only, and both hypertension-diabetes) to compare individuals living with concurrent hypertension and diabetes to individuals with each condition separately. We included 90,086 individuals who lived with hypertension only, 11,975 with diabetes only, and 16,228 with hypertension-diabetes. We estimated the percentage of individuals who were aware of their diagnosis, used pharmacological therapy, or achieved appropriate hypertension and diabetes management. A greater percentage of individuals with hypertension-diabetes were fully diagnosed (64.1% [95% CI: 61.8–66.4]) than those with hypertension only (47.4% [45.3–49.6]) or diabetes only (46.7% [44.1–49.2]). Among the hypertension-diabetes group, pharmacological treatment was higher for individual conditions (38.3% [95% CI: 34.8–41.8] using antihypertensive and 42.3% [95% CI: 39.4–45.2] using glucose-lowering medications) than for both conditions jointly (24.6% [95% CI: 22.1–27.2]).The percentage of individuals achieving appropriate management was highest in the …
2024/3/27
Article DetailsFarshad Farzadfar
Tehran University of Medical Sciences
Archives of Iranian Medicine
Assessment of Hemoglobin A1c Management and Prescription Cost Due to Polypharmacy Among Patients With Diabetes in Iran Based on the STEPS Iran 2016 Survey and a Prescription …
Background:Diabetes frequently results in the need for multiple medication therapies, known as ‘Polypharmacy’. This situation can incur significant costs and increase the likelihood of medication errors. This study evaluated the prescriptions of patients with diabetes regarding polypharmacy to assess its effect on the control of hemoglobin A1c (HbA1c) levels and prescription costs.Methods:A cross-sectional national study was conducted based on data from linking the Iranians Health Insurance Service prescriptions in 2015 and 2016 with the STEPS 2016 survey in Iran. The association of the individual and sociodemographic factors, as well as polypharmacy, as independent variables, with control of HbA1c levels and the cost of the prescriptions were assessed among diabetic patients using logistic and linear regression, respectively.Results:Among 205 patients using anti-diabetic medications, 47.8% experienced …
2024/1
Article DetailsLuisa C C Brant
Universidade Federal de Minas Gerais
The Lancet
Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the …
BackgroundRegular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.MethodsThe Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational …
2024/4/3
Article DetailsTill W Bärnighausen
Heidelberg University
Global Ageing and Health
Ageing populations pose some of the foremost global challenges of this century. Drawing on an international pool of scholars, this cutting-edge Handbook surveys the micro, macro and institutional aspects of the economics of ageing. Structured in seven parts, the volume addresses a broad range of themes, including health economics, labour economics, pensions and social security, generational accounting, wealth inequality and regional perspectives. Each chapter combines a succinct overview of the state of current research with a sketch of a promising future research agenda. This Handbook will be an essential resource for advanced students, researchers and policymakers looking at the economics of ageing across the disciplines of economics, demography, public policy, public health and beyond.
2023
Article DetailsRifat Atun
Harvard University
Correction to Lancet Glob Health 2023; 11: e1978–85
UHC+. Lancet Glob Health 2023; 11: e1978–85—In this Health Policy, figure 1 has been revised. A point corresponding to the year 2016 has been added to indicate UNGA political declaration on HIV/AIDS. The name of the existing point corresponding to the year 2021 has been changed to UNGA political declaration on HIV/AIDS. These corrections have been made as of Feb 9, 2024.
2024/2/9
Article DetailsSebastian Vollmer
Georg-August-Universität Göttingen
PLOS Global Public Health
Multiple cardiovascular risk factor care in 55 low-and middle-income countries: A cross-sectional analysis of nationally-representative, individual-level data from 280,783 adults
The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representative population-based surveys (2009–2019) with measured blood pressure (BP) and diabetes biomarker. We restricted our analysis to non-pregnant individuals aged 40–69 years and defined three mutually exclusive groups (i.e., hypertension only, diabetes only, and both hypertension-diabetes) to compare individuals living with concurrent hypertension and diabetes to individuals with each condition separately. We included 90,086 individuals who lived with hypertension only, 11,975 with diabetes only, and 16,228 with hypertension-diabetes. We estimated the percentage of individuals who were aware of their diagnosis, used pharmacological therapy, or achieved appropriate hypertension and diabetes management. A greater percentage of individuals with hypertension-diabetes were fully diagnosed (64.1% [95% CI: 61.8–66.4]) than those with hypertension only (47.4% [45.3–49.6]) or diabetes only (46.7% [44.1–49.2]). Among the hypertension-diabetes group, pharmacological treatment was higher for individual conditions (38.3% [95% CI: 34.8–41.8] using antihypertensive and 42.3% [95% CI: 39.4–45.2] using glucose-lowering medications) than for both conditions jointly (24.6% [95% CI: 22.1–27.2]).The percentage of individuals achieving appropriate management was highest in the …
2024/3/27
Article DetailsTill W Bärnighausen
Heidelberg University
JMIR Research Protocols
Effectiveness of Sensitization Campaigns in Reducing Leprosy-Related Stigma in Rural Togo: Protocol for a Mixed Methods Cluster Randomized Controlled Trial
Background: In the global strategy to eliminate leprosy, there remains a need for early case detection to successfully interrupt transmissions. Poor knowledge about leprosy and leprosy-related stigma are key drivers of delayed diagnosis and treatment. Sensitization campaigns to inform and increase awareness among the general population are an integral part of many national neglected tropical disease programs. Despite their importance, the effectiveness of such campaigns has not been rigorously studied in the West African context. A multilingual rural setting with low health literacy in this region presents challenges to the potential impact of sensitization campaigns.Objective: The primary objective of this study is to assess the causal effect of common practice community sensitization campaigns on leprosy-related knowledge and stigma at the community level and among community health volunteers. Additionally, we will test the potential of novel educational audio tools in the 15 most prominent local languages to overcome literacy and language barriers and amplify sensitization campaigns.Methods: We will conduct a cluster randomized controlled trial using a sequential mixed methods approach in 60 rural communities across all regions of Togo, West Africa. The study features 2 intervention arms and 1 control arm, with intervention and control assignments made at the community level through randomization. Communities in intervention arm 1 will receive a sensitization campaign in line with the current Togolese national neglected tropical disease program. Communities in intervention arm 2 will receive the same sensitization campaign …
2024/4/18
Article DetailsDeborah Carvalho Malta
Universidade Federal de Minas Gerais
Revista Brasileira de Saúde Ocupacional
Laryngeal cancer mortality and burden attributable to occupational risks in Brazil: 2019 Global Burden of Disease
Objective to describe mortality and disability-adjusted life years (DALYs) due to laryngeal cancer attributable to occupational and behavioral risk factors in Brazil. Methods this is an ecological study with data from the 2019 Global Burden of Disease. Mortality and DALY rates for laryngeal cancer attributable to occupational (sulfuric acid and asbestos) and behavioral (tobacco and alcohol) risks were obtained from 1990 and 2019. Results in 2019, the mortality rate from laryngeal cancer attributable to occupational hazards (sulfuric acid and asbestos) totaled 0.28 (95% UI: 0.17; 0.43) and 0.03 (95% UI: 0.02; 0.04), whereas and DALY rates, 7.33 (95% UI: 4.28; 11.44) and 0.64 (95% UI: 0.35; 0.03) in men and women in Brazil, respectively. Sulfuric acid configured the main occupational risk for the disease. The rates attributable to tobacco (mortality:− 45.83%; DALYs:− 47.36%) and occupational hazards (mortality:− 23.20%; DALYs:− 26.31%) decreased in Brazil but increased in some Northern and Northeastern states. Conclusion laryngeal cancer mortality and burden attributable to occupational factors decreased in the period (although less than that for smoking), reinforcing the importance of actions to reduce the impact of occupational risks, such as the regulatory measures applied to tobacco.
2024/1/8
Article DetailsFarshad Farzadfar
Tehran University of Medical Sciences
Journal of the American Heart Association
Burden of Ischemic Heart Disease and Its Attributable Risk Factors in North Africa and the Middle East, 1990 to 2019: Results From the GBD Study 2019
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2024/1/16
Article DetailsTill W Bärnighausen
Heidelberg University
PLOS Global Public Health
Multiple cardiovascular risk factor care in 55 low-and middle-income countries: A cross-sectional analysis of nationally-representative, individual-level data from 280,783 adults
The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representative population-based surveys (2009–2019) with measured blood pressure (BP) and diabetes biomarker. We restricted our analysis to non-pregnant individuals aged 40–69 years and defined three mutually exclusive groups (i.e., hypertension only, diabetes only, and both hypertension-diabetes) to compare individuals living with concurrent hypertension and diabetes to individuals with each condition separately. We included 90,086 individuals who lived with hypertension only, 11,975 with diabetes only, and 16,228 with hypertension-diabetes. We estimated the percentage of individuals who were aware of their diagnosis, used pharmacological therapy, or achieved appropriate hypertension and diabetes management. A greater percentage of individuals with hypertension-diabetes were fully diagnosed (64.1% [95% CI: 61.8–66.4]) than those with hypertension only (47.4% [45.3–49.6]) or diabetes only (46.7% [44.1–49.2]). Among the hypertension-diabetes group, pharmacological treatment was higher for individual conditions (38.3% [95% CI: 34.8–41.8] using antihypertensive and 42.3% [95% CI: 39.4–45.2] using glucose-lowering medications) than for both conditions jointly (24.6% [95% CI: 22.1–27.2]).The percentage of individuals achieving appropriate management was highest in the …
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University of South Australia
Nature Medicine
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This paper was originally published under a standard Springer Nature license (© Crown, under exclusive licence to Springer Nature America, Inc.). It is now available as an open-access paper under a Creative Commons Attribution 4.0 International license,© Crown. The error has been corrected in the HTML and PDF versions of the article.
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Nature medicine
Association between pathologic response and survival after neoadjuvant therapy in lung cancer
Neoadjuvant immunotherapy plus chemotherapy improves event-free survival (EFS) and pathologic complete response (0% residual viable tumor (RVT) in primary tumor (PT) and lymph nodes (LNs)), and is approved for treatment of resectable lung cancer. Pathologic response assessment after neoadjuvant therapy is the potential analog to radiographic response for advanced disease. However, %RVT thresholds beyond pathologic complete response and major pathologic response (≤10% RVT) have not been explored. Pathologic response was prospectively assessed in the randomized, phase 3 CheckMate 816 trial (NCT02998528), which evaluated neoadjuvant nivolumab (anti-programmed death protein 1) plus chemotherapy in patients with resectable lung cancer. RVT, regression and necrosis were quantified (0–100%) in PT and LNs using a pan-tumor scoring system and tested for association with EFS in …
2024/1
Article DetailsDavid M. Dorfman, M.D., Ph.D.
Harvard University
Nature medicine
Author Correction: The Cyclophilin A-CD147 complex promotes the proliferation and homing of multiple myeloma cells
Author Correction: The Cyclophilin A-CD147 complex promotes the proliferation and homing of multiple myeloma cells Author Correction: The Cyclophilin A-CD147 complex promotes the proliferation and homing of multiple myeloma cells Nat Med. 2024 Jan 25. doi: 10.1038/s41591-024-02820-2. Online ahead of print. Authors Di Zhu 1 , Zhongqiu Wang 1 2 , Jian-Jun Zhao 1 , Teresa Calimeri 3 , Jiang Meng 1 4 , Teru Hideshima 1 5 , Mariateresa Fulciniti 1 5 , Yue Kang 1 6 , Scott B Ficarro 7 8 , Yu-Tzu Tai 1 5 , Zachary Hunter 1 , Douglas McMilin 1 5 , Haoxuan Tong 7 , Constantine S Mitsiades 1 , Catherine J Wu 1 , Steven P Treon 1 , David M Dorfman 9 , Geraldine Pinkus 9 , Nikhil C Munshi 1 5 , Pierfrancesco Tassone 3 , Jarrod A Marto 7 8 , Kenneth C Anderson 1 5 , Ruben D Carrasco 10 11 Affiliations 1 Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, …
2024/1/25
Article DetailsSafiyyah Okoye
Johns Hopkins University
Nature medicine
Tackling heat-related mortality in aging populations
A large study of older adults in China points to physical and cognitive function — not age — as key predictors of heat-related mortality, highlighting the need for climate adaptation policies to prioritize accessibility across all age groups.
2024/4/8
Article DetailsDeborah Carvalho Malta
Universidade Federal de Minas Gerais
Nature Medicine
Hypertension care cascades and reducing inequities in cardiovascular disease in low-and middle-income countries
Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom …
2024/1/26
Article Detailslaura esserman
University of California, San Francisco
Nature Medicine
Reproductive rights in the United States: acquiescence is not a strategy
Scientific and medical conferences should not be held in states that ban abortion, as such bans put the lives of women at risk.
2024/4/25
Article DetailsAlyssa Parker
Brigham Young University
Nature Medicine
Clonal hematopoiesis of indeterminate potential is associated with acute kidney injury
Age is a predominant risk factor for acute kidney injury (AKI), yet the biological mechanisms underlying this risk are largely unknown. Clonal hematopoiesis of indeterminate potential (CHIP) confers increased risk for several chronic diseases associated with aging. Here we sought to test whether CHIP increases the risk of AKI. In three population-based epidemiology cohorts, we found that CHIP was associated with a greater risk of incident AKI, which was more pronounced in patients with AKI requiring dialysis and in individuals with somatic mutations in genes other than DNMT3A, including mutations in TET2 and JAK2. Mendelian randomization analyses supported a causal role for CHIP in promoting AKI. Non-DNMT3A-CHIP was also associated with a nonresolving pattern of injury in patients with AKI. To gain mechanistic insight, we evaluated the role of Tet2-CHIP and Jak2V617F-CHIP in two mouse models of …
2024/3/7
Article DetailsWilliam Cross
University College London
Nature Medicine
Insights for precision oncology from the integration of genomic and clinical data of 13,880 tumors from the 100,000 Genomes Cancer Programme
The Cancer Programme of the 100,000 Genomes Project was an initiative to provide whole-genome sequencing (WGS) for patients with cancer, evaluating opportunities for precision cancer care within the UK National Healthcare System (NHS). Genomics England, alongside NHS England, analyzed WGS data from 13,880 solid tumors spanning 33 cancer types, integrating genomic data with real-world treatment and outcome data, within a secure Research Environment. Incidence of somatic mutations in genes recommended for standard-of-care testing varied across cancer types. For instance, in glioblastoma multiforme, small variants were present in 94% of cases and copy number aberrations in at least one gene in 58% of cases, while sarcoma demonstrated the highest occurrence of actionable structural variants (13%). Homologous recombination deficiency was identified in 40% of high-grade serous ovarian …
2024/1/11
Article DetailsSergio López-Estévez
Universidad Autónoma de Barcelona
Nature Medicine
MYC targeting by OMO-103 in solid tumors: a phase 1 trial
Among the ‘most wanted’ targets in cancer therapy is the oncogene MYC, which coordinates key transcriptional programs in tumor development and maintenance. It has, however, long been considered undruggable. OMO-103 is a MYC inhibitor consisting of a 91-amino acid miniprotein. Here we present results from a phase 1 study of OMO-103 in advanced solid tumors, established to examine safety and tolerability as primary outcomes and pharmacokinetics, recommended phase 2 dose and preliminary signs of activity as secondary ones. A classical 3 + 3 design was used for dose escalation of weekly intravenous, single-agent OMO-103 administration in 21-day cycles, encompassing six dose levels (DLs). A total of 22 patients were enrolled, with treatment maintained until disease progression. The most common adverse events were grade 1 infusion-related reactions, occurring in ten patients. One dose …
2024/2/6
Article Details