[EQ] Reassessing HIV Prevention

Reassessing HIV Prevention

Malcolm Potts,1* Daniel T. Halperin,2*†  Douglas Kirby,3   Ann Swidler,4 Elliot Marseille,5 Jeffrey D. Klausner6

Norman Hearst, 7 Richard G. Wamai,2  James G. Kahn,5  Julia Walsh1

Science - 9 May 2008: Vol. 320. no. 5877, pp. 749 – 750 - DOI: 10.1126/science.1153843

 

The largest investments in AIDS prevention targeted to the general population are being made in interventions where the evidence for large-scale impact is uncertain.

 

1 School of Public Health, University of California at Berkeley, Berkeley,  USA.

2 Harvard University School of Public Health, Boston,  USA.

3 ETR Associates, Scotts Valley, CA , USA.

4 Department of Sociology, University of California at Berkeley, Berkeley,  USA.

5 Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA USA.

6 San Francisco Department of Public Health, San Francisco, CA , USA.

7 Department of Family and Community Medicine, University of California at San Francisco, San Francisco, CA, USA.

 

Available online at: http://www.sciencemag.org/cgi/content/full/320/5877/749

 

"……Several decades into the AIDS pandemic, HIV transmission in most of the world remains firmly concentrated among sex workers, men who have sex with men (MSM), injecting drug users (IDUs), and their sex partners (1). In some parts of Africa, where over two-thirds of infections occur globally, HIV has expanded outside these high-risk groups, creating generalized, predominantly heterosexual epidemics. In nine southern African countries, more than 12% of adults are infected with HIV. Such devastating epidemics have frequently been attributed to poverty, limited health services, illiteracy, war, and gender inequity. Although these grave problems demand an effective response in their own right, they do not appear to be the immediate causes of generalized epidemics (2)…."

 

The Independent: http://www.independent.co.uk/news/science/circumcision-is-the-best-weapon-in-fight-against-aids-824587.html

 

 

 

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[EQ] Delivery of Genomic Medicine for Common Chronic Adult Diseases - A Systematic Review

Delivery of Genomic Medicine for Common Chronic Adult Diseases

A Systematic Review

Maren T. Scheuner, Pauline Sieverding, Paul G. Shekelle

JAMA, March 19, 2008—Vol 299, No. 11  American Medical Association

PDF file at: http://jama.ama-assn.org/cgi/reprint/299/11/1320.pdf

Context  The greatest public health benefit of advances in understanding the human genome may be realized for common chronic diseases such as cardiovascular disease, diabetes mellitus, and cancer. Attempts to integrate such knowledge into clinical practice are still in the early stages, and as a result, many questions surround the current state of this translation.

Objective  To synthesize current information on genetic health services for common adult-onset conditions by examining studies that have addressed the outcomes, consumer information needs, delivery, and challenges in integrating these services.

Data Sources  MEDLINE articles published between January 2000 and February 2008.

Study Selection  Original research articles and systematic reviews dealing with common chronic adult-onset conditions were reviewed. A total of 3371 citations were reviewed, 170 articles retrieved, and 68 articles included in the analysis.

Data Extraction  Data were independently extracted by one reviewer and checked by another with disagreement resolved by consensus. Variables assessed included study design and 4 key areas: outcomes of genomic medicine, consumer information needs, delivery of genomic medicine, and challenges and barriers to integration of genomic medicine.

Data Synthesis  Sixty-eight articles contributed data to the synthesis: 5 systematic reviews, 8 experimental studies, 35 surveys, 7 pre/post studies, 3 observational studies, and 10 qualitative reports. Three systematic reviews, 4 experimental studies, and 9 additional studies reported on outcomes of genetic services. Generally there were modest positive effects on psychological outcomes such as worry and anxiety, behavioral outcomes have shown mixed results, and clinical outcomes were less well studied. One systematic review, 1 randomized controlled trial, and 14 other studies assessed consumer information needs and found in general that genetics knowledge was reported to be low but that attitudes were generally positive. Three randomized controlled trials and 13 other studies assessed how genomic medicine is delivered and newer models of delivery. One systematic review and 19 other studies assessed barriers; the most consistent finding was the self-assessed inadequacy of the primary care workforce to deliver genetic services. Additional identified barriers included lack of oversight of genetic testing and concerns about privacy and discrimination.

Conclusion  Many gaps in knowledge about organization, clinician, and patient needs must be filled to translate basic and clinical science advances in genomics of common chronic diseases into practice……”.

Delivery of Genomic Medicine for Common Chronic Adult Diseases

RAND Corporation, May 2008

http://rand.org/pubs/research_briefs/RB9338/index1.html

“…..The greatest public health benefit from increased understanding of the human genome will probably come from translating advances in basic and clinical science into effective care for common chronic diseases, such as cardiovascular disease, diabetes, and cancer. Is the U.S. health care system ready for the translation? To answer this question, RAND Corporation researchers reviewed the relevant scientific literature published between January 2000 and February 2008. Three themes emerged from the review:

The health care workforce is not adequately prepared to help integrate genomics into routine clinical practice. There are too few genetic specialists for common chronic diseases. Other health professionals, such as primary care clinicians and nurses, lack the knowledge and confidence to provide genetic services, including recognition of familial patterns of disease and ordering and interpreting genetic tests.

Consumers are optimistic yet cautious about genomic medicine. Consumers know little about genetics/genomics, but they are optimistic that genomic medicine will help identify and manage common chronic diseases for which they and their families are at risk. But consumers are also concerned that genetic information could be used to discriminate against them in health insurance or employment.

 There is limited evidence about the health outcomes of genomic medicine for common chronic diseases. Most studies assessed the psychological well-being associated with genomic medicine; few focused on clinical outcomes. Among studies that focused on outcomes, there is no evidence that genetic counseling and testing cause psychological harm. Some studies identified health benefits from genetic information, such as preventive surgery for women with BRCA mutations (inherited alterations in specific genes that are involved in many cases of hereditary breast and ovarian cancer) and greater weight loss when diet recommendations are informed by genetic tests….”

 

Editorial: Genetics and Genomics for Clinicians

Phil B. Fontanarosa, Boris Pasche, Catherine D. DeAngelis

JAMA, March 19, 2008—Vol 299, No. 11 - American Medical Association

http://jama.ama-assn.org/cgi/content/full/299/11/1364?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Scheuner&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
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[EQ] Politics and public health-some conceptual considerations concerning welfare state characteristics

Commentary:
Politics and public health—some conceptual considerations concerning welfare state characteristics and public health outcomes

Olle Lundberg, Professor of Health Equity Studies and Assistant Director, Centre for Health Equity Studies
Stockholm University/Karolinska Institutet,  Stockholm, Sweden.
International Journal of Epidemiology – May 8, 2008

 

Available online at: http://ije.oxfordjournals.org/cgi/content/full/dyn078v1?etoc

 “…..Espelt et al. have published a paper¹ on differences between European welfare states and how these differences are linked to health inequalities among the older part of the population. Although many comparative studies of international variations in health inequalities have drawn conclusions about the pros and cons of different welfare state set-ups, the issue has not been properly studied. Partly, this could be due to the conceptual and methodological problems involved when one attempts to relate international variations in complex welfare state structures on the one hand with mortality, ill health or health inequalities on the other. And because of the complexity of the task, the analytical choices made when designing a study become even more crucial than in regular individual-level epidemiological studies.

Examples of such choices include what kind of welfare state characteristics we believe to be of importance for public health outcomes; how data on these characteristics are handled and what kinds of public health outcomes are likely to be affected. I believe that the choices made by Espelt et al. need to be examined, since they have important consequences for our understanding of the links between welfare state characteristics and public health outcomes.

A fundamental question is of course what it is about welfare states that affect the health and longevity among their populations and that also vary systematically across different types of welfare state. Ultimately, I would argue, it is the resources available to people that will be of importance for the levels of and inequalities in health in a country.² …….”

 

 

Inequalities in health by social class dimensions in European countries of different political traditions

 

Albert Espelt1,2, Carme Borrell 1,3,4,*, Maica Rodríguez-Sanz 1,3, Carles Muntaner 5, M Isabel Pasarín 1,3,4, Joan Benach 3,7,
Maartje Schaap 6, Anton E Kunst 6 and Vicente Navarro 4,8

1 Agència de Salut Pública de Barcelona, Barcelona, Spain.

2 Consorci de Serveis Socials de Barcelona, Barcelona, Spain.

3 CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.

4 Universitat Pompeu Fabra, Barcelona, Spain.

5 Social Equity and Health Section, Center for Addictions and Mental Health and Faculty of Nursing, University of Toronto, Toronto, Canada.

6 Department of Public Health, University Medical Centre, Rotterdam, The Netherlands.

7 Health Inequalities Research Group, Occupational Health Research Unit, Universitat Pompeu Fabra, Barcelona, Spain.

8 Department of Health Policy and Management, Johns Hopkins University, USA.

 

International Journal of Epidemiology - March 13, 2008

 

Website:

http://ije.oxfordjournals.org/cgi/content/full/dyn051v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=borrell&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=1/1/2008&resourcetype=HWCIT

 

Objective To compare inequalities in self-perceived health in the population older than 50 years, in 2004, using Wright's social class dimensions, in nine European countries grouped in three political traditions (Social democracy, Christian democracy and Late democracies).

 

Methods Cross-sectional design, including data of the Survey of Health, Ageing and Retirement in Europe (Sweden, Denmark, Austria, France, Germany, The Netherlands, Spain, Italy and Greece). The population aged from 50 to 74 years was included. Absolute and relative social class dimension inequalities in poor self-reported health and long-term illness were determined for each sex and political tradition. Relative inequalities were assessed by fitting Poisson regression models with robust variance estimators.

 

Results Absolute and relative health inequalities by social class dimensions are found in the three political traditions, but these differences are more marked in Late democracies and mainly among women. For example the prevalence ratio of poor self-perceived health comparing poorly educated women with highly educated women, was 1.75 (95% CI: 1.39–2.21) in Late democracies and 1.36 (95% CI: 1.21–1.52) in Social democracies. The prevalence differences were 24.2 and 13.7%, respectively.

 

Conclusion This study is one of the first to show the impact of different political traditions on social class inequalities in health. These results emphasize the need to evaluate the impact of the implementation of public policies.

 

Abstract

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
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