Candal-Pedreira and colleagues showed that for 304 retracted papers, overall citations increased not decreased following retraction, but citations did seem to decrease for retracted papers in higher impact journals and those with higher citation rates, although that decrease might have been temporary.1 It is disturbing that retracted papers continue to be cited.
We approached the issue of changes in citations rates after retraction in a different way. We assessed citation rates of retracted and unretracted publications from individuals with more than one retracted publication in the Retraction Watch database.2 Using this approach, we found that, overall, citations for 989 retracted publications declined after the retraction and citations for 9671 unretracted papers also declined after the author’s first retraction, but the decline was greater for retracted papers. For example, for retracted publications, 671 papers had 3566 citations in the 3rd year before their retraction and 831 papers had 1575 citations in the 3rd year after their retraction. In contrast, 5311 unretracted papers had 17935 citations in the 3rd year before the author’s first retraction, and 7388 papers had 17252 citations in the 3rd year after the author’s first retraction.
Part of the difficulty in conducting and interpreting such analyses is the different lengths of time pre-and post-retraction for different papers. To try to address that issue, we calculated the slope of the citations/yea...
Candal-Pedreira and colleagues showed that for 304 retracted papers, overall citations increased not decreased following retraction, but citations did seem to decrease for retracted papers in higher impact journals and those with higher citation rates, although that decrease might have been temporary.1 It is disturbing that retracted papers continue to be cited.
We approached the issue of changes in citations rates after retraction in a different way. We assessed citation rates of retracted and unretracted publications from individuals with more than one retracted publication in the Retraction Watch database.2 Using this approach, we found that, overall, citations for 989 retracted publications declined after the retraction and citations for 9671 unretracted papers also declined after the author’s first retraction, but the decline was greater for retracted papers. For example, for retracted publications, 671 papers had 3566 citations in the 3rd year before their retraction and 831 papers had 1575 citations in the 3rd year after their retraction. In contrast, 5311 unretracted papers had 17935 citations in the 3rd year before the author’s first retraction, and 7388 papers had 17252 citations in the 3rd year after the author’s first retraction.
Part of the difficulty in conducting and interpreting such analyses is the different lengths of time pre-and post-retraction for different papers. To try to address that issue, we calculated the slope of the citations/year for individual papers for up to 5 years immediately prior to the year of the retraction (or the year of the author’s first retraction for unretracted papers) and for up to 5 years following first retraction. The median change in this slope was greater for retracted publications (−0.3, 95% CI −11.8 to 1.6) than for unretracted papers (0.0, 95% CI −6.3 to 1.7: P < 0.001).2
We agree with the Candal-Pedreira and colleagues that improvements are needed: there is no longer any excuse for citation of retracted publications. Publishers need to ensure that all retractions are clearly categorised on all commonly used bibliographic databases, and authors and journals need to ensure that papers cited have not been retracted, for example by using reference management tools such as Zotero that automatically update references when a retraction occurs.
1. Candal-Pedreira C, Ruano-Ravina A, Fernandez E, et al. Does retraction after misconduct have an impact on citations? A pre-post study. BMJ Glob Health 2020;5(11).
2. Mistry V, Grey A, Bolland MJ. Publication rates after the first retraction for biomedical researchers with multiple retracted publications. Account Res 2019;26(5):277-87.
Editor, the commentary highlights the sad situation the Levant region in the middle east has reached. The Syrian healthcare workers are most needed in Syria and not in Germany. It is their very country which is in most need for their services. Syria now has shortage of trained doctors and nurses to help fellow country men and women recover from war injuries and myriad of infectious and non-communicable diseases. Integrating in Europe is never easy for a people from Muslim countries, even if the were professionals (https://www.dailymail.co.uk/news/article-8854519/Muslim-doctor-refused-s...). I have lived in London for over 30 years and still feel an outsider in the UK. How will these refugees cope with the threat of their children losing their Arabic language or Muslim identity. Careers are not everything. It just baffles me why the Syrians who came to Europe could not seek refuge in rich Arab nations. Something terribly wrong is going on in the middle east and coming to Germany is not the answer. Syrian refugees are looking for a quick fix, but they should go back to their own country and tough it out to rebuild what was demolished before someone else comes and takes their places! Britons and Germans did not run away from their countries during the two world wars! Did millions of Britons leave to America to escape WWII? Why have did almost...
Editor, the commentary highlights the sad situation the Levant region in the middle east has reached. The Syrian healthcare workers are most needed in Syria and not in Germany. It is their very country which is in most need for their services. Syria now has shortage of trained doctors and nurses to help fellow country men and women recover from war injuries and myriad of infectious and non-communicable diseases. Integrating in Europe is never easy for a people from Muslim countries, even if the were professionals (https://www.dailymail.co.uk/news/article-8854519/Muslim-doctor-refused-s...). I have lived in London for over 30 years and still feel an outsider in the UK. How will these refugees cope with the threat of their children losing their Arabic language or Muslim identity. Careers are not everything. It just baffles me why the Syrians who came to Europe could not seek refuge in rich Arab nations. Something terribly wrong is going on in the middle east and coming to Germany is not the answer. Syrian refugees are looking for a quick fix, but they should go back to their own country and tough it out to rebuild what was demolished before someone else comes and takes their places! Britons and Germans did not run away from their countries during the two world wars! Did millions of Britons leave to America to escape WWII? Why have did almost 6 million Syrians leave their country? My parents left Palestine to Lebanon in 1948 anticipating to return to Haifa after few weeks. More than 70 years on we, their children, are still wondering whether we will ever visit Palestine.
In relation to SAM terminology. No one could argue with the logic of acute v chronic. However, SAM is well understood at a policy level. It is however understood at above six months. The work that ENN and MAMI have done on identifying wasting at birth is a narrative change which can lay the foundation for the bridging language that the paper talks about.
Narrative is a story that people can understand.
As pointed out, consistency is important, but consistency must hover across the 1000 day window. Currently, our terminology for narrating fetal undernutrition is very weak. While simplistic, if children are being born wasted, then they are also wasted in utero. To fully open the curtains, we would suggest that the SAM terminology be adapted to include fetal malnutrition. The narrative neither stops nor begins at birth regardless of the terminology we use.
In relation to the false positives and visa versa. Given current programming capacity and coverage rates well below 20% for CMAM false negatives represent only a tiny fraction of those who need treatment and do not receive it. Focus on false positives takes away from the substantive issue of low coverage rates for Essential Nutrition Actions across the 1000 day window.
On a broader theme, it would be helpful to explore how the food system and the food system summit support people in immediate need.
A conversation starter
The food system belongs to...
In relation to SAM terminology. No one could argue with the logic of acute v chronic. However, SAM is well understood at a policy level. It is however understood at above six months. The work that ENN and MAMI have done on identifying wasting at birth is a narrative change which can lay the foundation for the bridging language that the paper talks about.
Narrative is a story that people can understand.
As pointed out, consistency is important, but consistency must hover across the 1000 day window. Currently, our terminology for narrating fetal undernutrition is very weak. While simplistic, if children are being born wasted, then they are also wasted in utero. To fully open the curtains, we would suggest that the SAM terminology be adapted to include fetal malnutrition. The narrative neither stops nor begins at birth regardless of the terminology we use.
In relation to the false positives and visa versa. Given current programming capacity and coverage rates well below 20% for CMAM false negatives represent only a tiny fraction of those who need treatment and do not receive it. Focus on false positives takes away from the substantive issue of low coverage rates for Essential Nutrition Actions across the 1000 day window.
On a broader theme, it would be helpful to explore how the food system and the food system summit support people in immediate need.
A conversation starter
The food system belongs to every one of us. The Food System and so the Food Systems Summit, at its cornerstone must aspire to meet all peoples immediate nutritional needs every day.
We have read this excellent article with interest. As physicians based in Pakistan: a low-middle income country and not having English as our first language, we could relate to the challenges mentioned in this manuscript. Authors have very rightly pointed out that the issue with most of the researchers based in the low-income (LIC) and middle-income countries (LMIC) is not of poor or low-quality science. We need data and experience sharing from all parts of the world in order to complete the bigger picture and understand the issues that we face today in health, environment, and social sciences. One of the main challenges authors based in the LIC and LMIC face is the issue of presentation of that data i a presentable form. Due to the lack of training opportunities, many authors are unable to write manuscripts that meet the high standards of global scientific journals. This deprives these authors of an opportunity to publish in journals with a global audience and the world misses out on reading a different perspective from the LIC or LMIC. In this context, the introduction of PREPSS is an excellent and welcome initiative that must be supported and promoted.
In this context, we would like to highlight the role of AuthorAID: a global platform of more than 17,000 researchers from all around the globe. We have been extensively using this platform for more than a decade to learn and now collaborate and teach other researchers based in the LIC and LMIC. AuthorAID also pr...
We have read this excellent article with interest. As physicians based in Pakistan: a low-middle income country and not having English as our first language, we could relate to the challenges mentioned in this manuscript. Authors have very rightly pointed out that the issue with most of the researchers based in the low-income (LIC) and middle-income countries (LMIC) is not of poor or low-quality science. We need data and experience sharing from all parts of the world in order to complete the bigger picture and understand the issues that we face today in health, environment, and social sciences. One of the main challenges authors based in the LIC and LMIC face is the issue of presentation of that data i a presentable form. Due to the lack of training opportunities, many authors are unable to write manuscripts that meet the high standards of global scientific journals. This deprives these authors of an opportunity to publish in journals with a global audience and the world misses out on reading a different perspective from the LIC or LMIC. In this context, the introduction of PREPSS is an excellent and welcome initiative that must be supported and promoted.
In this context, we would like to highlight the role of AuthorAID: a global platform of more than 17,000 researchers from all around the globe. We have been extensively using this platform for more than a decade to learn and now collaborate and teach other researchers based in the LIC and LMIC. AuthorAID also provides services related to the process of conducting, analyzing, and reporting research. However, the model of AuthorAID is different from the PREPSS. AuthorAID provides a platform for mutual collaboration among researchers based in different parts of the world by connecting them as mentors and mentees. The process entails free registration on the website and completing the profile including details of the collaboration and help one is seeking. The mentee has to identify the mentor from the list available and send a request for mentorship. Once the request is accepted, a formal online agreement has to be signed by both parties. The agreement clearly spells out the nature of the help requested ( formulating the research question, assistance with data analysis, help with the writing process, choosing a target journal, and responding to peer reviewers' comments) , time lines, mode, and frequency of communication planned.
We both have benefited immensely from the free services, resources and online courses offered by AuthorAID and now have progressed from mentees to mentors helping others.
The world has become a global stage open to all. It is very encouraging to see initiatives like PREPSS and AuthorAID which are primarily meant fro the authors and researchers based in the LIC and LMIC. These platforms not only foster global collaboration, create long-term professionals networks but also help researchers based in developing countries to share their rich experiences and publish in international journals with a global readership. This makes the world a better place
Introduction and Brief Overview
The Global Health Security (GHS) Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that make up the States Parties to the International Health Regulations (IHR [2005])1. The GHS Index takes into account countries’ capability to prevent, detect, and respond to public health emergencies while also assessing the robustness of the healthcare system in each country. This index is comprehensive since it has the ability to consider political and socioeconomic risks, as well as adherence to international norms, which can influence countries’ abilities to stop outbreaks1,2. The GHS Index has been the creation of Open Philanthropy Project, the Bill & Melinda Gates Foundation and the Robertson Foundation1.
The GHS Index treats biosafety and biosecurity as critical components of global health security. As such, the tool includes numerous indicators measuring country capacities and accounts for differences in priorities between high income and low/middle income countries. The GHS index is based on 6 categories, 34 indicators, and 85 sub-indicators. The six categories comprise prevention, detection and reporting, rapid response, health system, compliance with international norms, and risk environment5.
This article describes the practical value of the GHS Index and also explains how the methodology of assigning country ranks and scores is helpful in aidin...
Introduction and Brief Overview
The Global Health Security (GHS) Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that make up the States Parties to the International Health Regulations (IHR [2005])1. The GHS Index takes into account countries’ capability to prevent, detect, and respond to public health emergencies while also assessing the robustness of the healthcare system in each country. This index is comprehensive since it has the ability to consider political and socioeconomic risks, as well as adherence to international norms, which can influence countries’ abilities to stop outbreaks1,2. The GHS Index has been the creation of Open Philanthropy Project, the Bill & Melinda Gates Foundation and the Robertson Foundation1.
The GHS Index treats biosafety and biosecurity as critical components of global health security. As such, the tool includes numerous indicators measuring country capacities and accounts for differences in priorities between high income and low/middle income countries. The GHS index is based on 6 categories, 34 indicators, and 85 sub-indicators. The six categories comprise prevention, detection and reporting, rapid response, health system, compliance with international norms, and risk environment5.
This article describes the practical value of the GHS Index and also explains how the methodology of assigning country ranks and scores is helpful in aiding decision making for different countries on their health system preparedness. This concept is especially very timely in the current COVID-19 pandemic in measuring global health security capacities and pointing out areas for improvement. The main learning from the GHS index is that national health security is fundamentally weak around the world. The average GHS Index score among all 195 countries was 40.2 of a possible score of 100.
Methodology
The GHS tool is effectively building on the World Health Organization’s (WHO) Joint External Evaluation (JEE) which results from a collaboration that countries can volunteer to undertake to assess their compliance with the standards that have been agreed upon by the international community. The intuitive technique of scoring and ranking is used for summarizing complex health system capacities across diverse contexts3,4.
Critique/Commentary
Due to the way the tool is structured, GHS Index may be prone to misinterpretation as a forecasting tool which it clearly is not. It is in fact a snapshot in time of a country’s preparedness in tackling infectious disease outbreaks given the prevailing socio economic and political conditions. It would have been fascinating to see Andersen’s Model of Healthcare Utilization being used in the development of this index since it encompasses predisposing, enabling and need factors driving healthcare resource use. Many commonly used indicators of health security capacity like GHS Index are somewhat a rigid framework of outbreak prevention, detection and response. This framing likely fails to account for socio- cultural determinants of health and broader aspects of population health management which are parts of Andersen Model of Healthcare Utilization. The overall GHS index scores summarize country capacities across all categories. However, countries with high overall scores may still have low category-level, indicator-level and sub-indicator- level scores that more strongly influence outbreak-associated outcomes. A startling inconsistency observed was the United States (US), United Kingdom (UK), Netherlands, Australia, and Canada ranked in the top 5 countries on the GHS index. However, the top 5 countries as ranked by the GHS index are among the worst-hit countries by COVID-19, with a high number of cases and mortalities6. What would make the GHS index more comprehensive is some more focus on access to healthcare as even in the US one of the key drivers of health inequity is disparity in access. Based on the way COVID-19 has been handled in an inept manner across the world, there should be more learnings around factors affecting decision making that led to this crisis so that we can be more prepared to handle the next pandemic or global disaster. Besides the metrics in the GHS index it looks like political leadership is the most decisive factor in determining success in dealing with epidemics. Based on other background reading it appears that the GHS index expert panel did not directly engage authorities responsible for emergency preparedness in their respective countries and other key stakeholders. Instead, the panel evaluated information provided by each country which caused methodology to be biased and obscured crucial weaknesses in a country's capacity to confront outbreaks. Thus the GHS index is a good start but needs incorporation of more public health measurement factors and political leadership as a factor to make it more representative and possible a predictive tool for future pandemics.
Reference
1. Ravi SJ, Warmbrod KL, Mullen L, et al. The value proposition of the Global Health Security Index. BMJ Global Health 2020;5:e003648. doi:10.1136/ bmjgh-2020-003648
2. Cameron E, Nuzzo J, Bell J, et al. Global health security index:building collective action and accountability, 2019. Available: https://www. ghsindex. org/ wp- content/ uploads/ 2020/ 04/ 2019- Global-Health- Security- Index. Pdf
3. Peters DH, Noor AA, Singh LP, et al. A balanced scorecard for health services in Afghanistan. Bull World Health Organ 2007;85:146–51.
4. Munda G, Nardo M. On the methodological foundations of composite indicators used for ranking countries. Barcelona, Spain Universitat Autonoma de Barcelona, European Commission; 2003. https:// pdfs. semanticscholar. org/ f308/ aae4 26de ca90 aa7e 0929 9561 bcfe 10e129b0. Pdf
5. 2019 Global Health Security Index. 324.
6. COVID-19 Map. Johns Hopkins Coronavirus Resource Center. Accessed May 31, 2020. https://coronavirus.jhu.edu/map.html
We read with interest your Editorial on Global health and human rights for a postpandemic world and offering our comments on this important issue.1
COVID 19 has rampaged an unprepared world. With its high infectiousness, low virulence and asymptomatic transmission, it has crossed boundaries rapidly and affected millions. The mode of transmission of the disease, whether by large droplet (>5µm) as fomites through surface, short distance aerosol borne or long distance airborne by small particles (<5µm) is still being debated Containment and lock down strategies adopted by all affected countries to control the spread have shown mixed results but has devastated the economy and caused major societal disruptions. The policy makers aggressively contained densely populated urban areas, quarantined ships, care homes and jails but the disease has continued to spread rapidly. High fatality rates in hospitals with sophisticated infrastructures and health workers getting infected have exposed gaps in basic understanding of control of airborne diseases and their management in health care settings. The defence forces, specially the naval ships got affected all over the world. With history of pandemic diseases repeating at regular intervals, it is now amply evident that viral diseases will re-emerge in times to come, either in another novel form or as a bioweapon and effective and holistic mitigation measures will be crucial.2
We read with interest your Editorial on Global health and human rights for a postpandemic world and offering our comments on this important issue.1
COVID 19 has rampaged an unprepared world. With its high infectiousness, low virulence and asymptomatic transmission, it has crossed boundaries rapidly and affected millions. The mode of transmission of the disease, whether by large droplet (>5µm) as fomites through surface, short distance aerosol borne or long distance airborne by small particles (<5µm) is still being debated Containment and lock down strategies adopted by all affected countries to control the spread have shown mixed results but has devastated the economy and caused major societal disruptions. The policy makers aggressively contained densely populated urban areas, quarantined ships, care homes and jails but the disease has continued to spread rapidly. High fatality rates in hospitals with sophisticated infrastructures and health workers getting infected have exposed gaps in basic understanding of control of airborne diseases and their management in health care settings. The defence forces, specially the naval ships got affected all over the world. With history of pandemic diseases repeating at regular intervals, it is now amply evident that viral diseases will re-emerge in times to come, either in another novel form or as a bioweapon and effective and holistic mitigation measures will be crucial.2
Airborne or droplet borne. The infectiousness of a disease is determined by the ability of the primary case to cause secondary cases in a susceptible population. It is based on Susceptibility – Infectivity-Recovery/Death (SIR) model and is quantified by the reproductive number (R0). The R0 is dependent on the proportion of susceptible population in a given cohort and its density and reduces with decongestion.3 The initial R0 for SARS CoV 2 at Diamond Princess, a cruise ship was 14.8 and was lowered to 1.78 with disembarkation of passengers and prevented almost 2000 extra individuals from getting infected.4 The transmission onboard ships would be both airborne through ventilatory ducts and by droplet transmission because of the close environment.
High vs Low Viral Load. Contact tracing data have found the contacts to be located mostly near the cases and did not spread to the rest of the population in the 2.2 square km slum area. Moreover, such transmission zones are comprised of only asymptomatic, mild or moderate cases, who have low viral load. High level of infectiousness in clusters of close quarters of susceptible hosts explains droplet and short distance aerosol transmission as has been endorsed by World Health Organisation (WHO) in their recent statement.5 Breaking the chain of transmission in a densely populated slum would have been possible because of droplet transmission from mildly symptomatic and asymptomatic cases and absence of airborne transmission from them. In the hospital setting however, high viral load in severely symptomatic patients and aerosol generating procedures may be accompanied by airborne transmission. This has been emphasised by several studies and endorsed by WHO.6
Way Ahead. Non-pharmacological Interventions of maintaining social distance, wearing of masks will have to be habit forming in the community. The hospitals have to bring in architectural modifications in their wards to include negative air pressure isolation facility alongwith HEPA filters and use of UV lights. Proper protective gears for health care workers need to be emphasised at all levels. Food habits for the general population will include known immune boosting products, also antioxidants and avoid junk; this will not only reduce the co morbidities like obesity and diabetes but will prevent mild infectious diseases. Future mitigating measures will have to emphasise on alteration of residences with proper ventilation, enough exhausts in bathrooms, multiple air exchange air conditioning system, which are essential measures for prevention and control of airborne diseases.
References
1. Khosla R, Allotey P, Gruskin S. Global health and human rights for a postpandemic world. BMJ Global Health 2020;5:e003548. doi:10.1136/ bmjgh-2020-003548
2. Prem K, Liu Y, Russell TW, et al. The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study [published correction appears in Lancet Public Health. 2020 May;5(5):e260]. Lancet Public Health. 2020;5(5):e261-e270.
3. JK Aronson, Jon Brassey, KR Nahtani. When will it be over? An introduction to viral reproduction numbers (R0 and Re). Available at https://www.cebm.net/covid-19/when-will-it-be-over-an-introduction-to-vi.... Accessed on 14 Aug 2020.
4. Zhang S, Diao M, Yu W, Pei L, Lin Z, Chen D. Estimation of the reproductive number of novel coronavirus (COVID-19) and the probable outbreak size on the Diamond Princess cruise ship: A data-driven analysis. Int J Infect Dis. 2020;93:201‐204.
5. Coronavirus: What is the Dharavi model being praised by WHO chief Tedros Adhanom. Available at https://www.indiatoday.in/india/story/what-is-the-dharavi-model-being-pr.... Accessed on 11 Aug 2020
A need for better understanding old-age mortality dynamics
Sergi Trias-Llimós* & Iñaki Permanyer
Centre d’Estudis Demogràfics, Carrer de Ca n’Altayó, Edifici E2, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
* Corresponding author. Email: strias@ced.uab.cat
Correspondence letter in response to:
Bergeron-Boucher M-P, Aburto JM, Raalte A van. Diversification in causes of death in low-mortality countries: emerging patterns and implications. BMJ Glob Health. 2020;5(7):e002414.
Word count: 492
The recent paper by Bergeron-Boucher et al. published in this journal reports an increasing diversity of cause-of-death mortality in low-mortality populations during the last 20 years [1]. Bergeron-Boucher et al. found that the preponderance of mortality from cardiovascular diseases in the countries under analysis has gradually declined in favour of a wide range of causes of death, including mental and behavioural disorders, nervous system or ill-defined causes. The increasing variability of causes of death is an important matter of potential concern because (a) fragmentation in cause of death might hinder further improvements in life expectancy, (b) preventive health policies have to cope with a more variegated set of causes, which imply more costly and less efficient health policies.
Despite their enormous interest, these findings should be interpreted with caution. As the authors...
A need for better understanding old-age mortality dynamics
Sergi Trias-Llimós* & Iñaki Permanyer
Centre d’Estudis Demogràfics, Carrer de Ca n’Altayó, Edifici E2, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
* Corresponding author. Email: strias@ced.uab.cat
Correspondence letter in response to:
Bergeron-Boucher M-P, Aburto JM, Raalte A van. Diversification in causes of death in low-mortality countries: emerging patterns and implications. BMJ Glob Health. 2020;5(7):e002414.
Word count: 492
The recent paper by Bergeron-Boucher et al. published in this journal reports an increasing diversity of cause-of-death mortality in low-mortality populations during the last 20 years [1]. Bergeron-Boucher et al. found that the preponderance of mortality from cardiovascular diseases in the countries under analysis has gradually declined in favour of a wide range of causes of death, including mental and behavioural disorders, nervous system or ill-defined causes. The increasing variability of causes of death is an important matter of potential concern because (a) fragmentation in cause of death might hinder further improvements in life expectancy, (b) preventive health policies have to cope with a more variegated set of causes, which imply more costly and less efficient health policies.
Despite their enormous interest, these findings should be interpreted with caution. As the authors themselves illustrate, most of the action takes place at advanced ages, that is: increases in the causes-of-death diversity indicators are driven by the changing distribution of causes among the elder, but not by what happens among children, youth or middle-aged adults. Remarkably, most of the deaths registered in the 15 low-mortality countries analysed in the paper increasingly occur among the elder (81% of the deaths occurs in the 65+ age group). As mortality shifts towards older ages, the surviving population becomes increasingly heterogeneous in its mortality risks [2] – a phenomenon that has led to worldwide increases in length-of-life inequality among those who survive above retirement age (e.g. around 65 years) [3]. This implies that an increasing share of population suffers comorbidities and is affected by the coexistence of well-known risk factors (e.g. diabetes) associated with several major diseases. In this context, there is mounting evidence suggesting that, as individuals age, it becomes increasingly difficult and controversial to attribute their deaths to a single underlying cause of death [4].
Taken together, the evidence suggests that it is now more complex than ever to predict the underlying causes of death [5]. Further studies examining old-age mortality could move towards different and complementary directions that attracted rather little attention so far. On the one hand, performing more post-mortem examinations comparing their results with the data reported in death certificates would contribute to validate and potentially correct some of the inaccuracies filling cause-of-death documents. On the other hand, using all cause-of-death information in the death certificates would allow grasping on risk factors and main drivers contributing to cause-specific mortality. This is particularly relevant as the number of causes of death reported in the death certificate increases with age. Unfortunately, little research has explored these interrelations; and comparability research between post-mortem examinations and cause of death data are scarce.
Mortality at old age is increasingly becoming a relevant public health challenge, and therefore requires the resources and implication of professionals from different fields, including medical doctors, demographers and public health experts. Beyond the use of underlying causes of death, further efforts should be invested in exploring the role of comorbidities in the old-age mortality dynamics.
Funding
This research has received funding from the European Research Council (ERC-2019-COG agreement No 864616 lead by Iñaki Permanyer).
References
1 Bergeron-Boucher M-P, Aburto JM, Raalte A van. Diversification in causes of death in low-mortality countries: emerging patterns and implications. BMJ Glob Health 2020;5:e002414. doi:10.1136/bmjgh-2020-002414
2 Engelman M, Canudas‐Romo V, Agree EM. The Implications of Increased Survivorship for Mortality Variation in Aging Populations. Popul Dev Rev 2010;36:511–39. doi:10.1111/j.1728-4457.2010.00344.x
3 Permanyer I, Scholl N. Global trends in lifespan inequality: 1950-2015. PloS One 2019;14:e0215742.
4 Tinetti ME, McAvay GJ, Murphy TE, et al. Contribution of Individual Diseases to Death in Older Adults with Multiple Diseases. J Am Geriatr Soc 2012;60:1448–56. doi:10.1111/j.1532-5415.2012.04077.x
5 Alpérovitch A, Bertrand M, Jougla E, et al. Do we really know the cause of death of the very old? Comparison between official mortality statistics and cohort study classification. Eur J Epidemiol 2009;24:669–75. doi:10.1007/s10654-009-9383-2
To the editor
We read with interest the article by Büyüm AM, Kenney C, Koris A, et al. (Decolonising
global health: if not now, when? BMJ Global Health 2020;5:e003394. doi:10.1136/
bmjgh-2020-003394) Although it is not contested that Black, Indigenous and People of Color are most disadvantaged by structural oppression, we would argue that a human rights-based approach is a more inclusive approach to global health inequity than decolonising global health.
The economic impacts of COVID mediated by the structural determinants will see recent gains in poverty reduction lost (1). Structural determinants within key service institutions such as the police service, prison system as well as those affecting gender will result in widespread suboptimal health. For example, black people are 40 times more likely to be stopped and searched in the UK under powers that allow officers to search people if serious violence is anticipated (2). In the US, a study examining all fatalities resulting from the use of lethal force by on-duty law enforcement officers between 2009 to 2012 across 17 U.S. states found that while whites were killed more frequently, the fatality rate was 2.8 times higher among blacks than whites (3). In the US, the First Step Act prison reforms have resulted in some benefits for prisoners, but ironically, highlighted the disproportionate incarceration of blacks (38%) who comprises 13% of the US population (4). There is evidence COVID disproportio...
To the editor
We read with interest the article by Büyüm AM, Kenney C, Koris A, et al. (Decolonising
global health: if not now, when? BMJ Global Health 2020;5:e003394. doi:10.1136/
bmjgh-2020-003394) Although it is not contested that Black, Indigenous and People of Color are most disadvantaged by structural oppression, we would argue that a human rights-based approach is a more inclusive approach to global health inequity than decolonising global health.
The economic impacts of COVID mediated by the structural determinants will see recent gains in poverty reduction lost (1). Structural determinants within key service institutions such as the police service, prison system as well as those affecting gender will result in widespread suboptimal health. For example, black people are 40 times more likely to be stopped and searched in the UK under powers that allow officers to search people if serious violence is anticipated (2). In the US, a study examining all fatalities resulting from the use of lethal force by on-duty law enforcement officers between 2009 to 2012 across 17 U.S. states found that while whites were killed more frequently, the fatality rate was 2.8 times higher among blacks than whites (3). In the US, the First Step Act prison reforms have resulted in some benefits for prisoners, but ironically, highlighted the disproportionate incarceration of blacks (38%) who comprises 13% of the US population (4). There is evidence COVID disproportionately affects women (who are often managing unpaid work, including caretaking responsibilities, while continuing to engage in paid work), migrant workers, asylum seekers, and other marginalized groups (5). Global health organisations are often run by leaders who came from high-income countries and it is difficult for them to accept civil society representation on their boards (6). Even if they have diverse representation, many of those appointed do not have decision-making privileges (6). These are the “discriminatory social arrangement(s) that, when encoded into laws, policies and norms, unduly privileges some social groups while harming others” to which Buyum et al refer.
However, recent observations suggest that a human rights approach is needed in order to achieve equity for all. In September 2020 in Melbourne, Australia a man experiencing an exacerbation of severe mental illness was intentionally hit by a police car and kicked in the head by a police officer as he struggled on the ground (7). The police officers involved have been suspended on full pay pending criminal investigations but this excessive use of force is symptomatic of state-sanctioned violence within the Australian police force. An Australian nationwide survey of more than 6000 international students and other temporary migrants conducted during the pandemic found systemic racism against international students in Australia (8). The study revealed the depth of Australia’s racist COVID policies (8). Although there is anti-racist rhetoric in Australia, (e.g. the National Anti-Racism Strategy) (9), there are many cases of racial discrimination against Asian students, particularly during the pandemic (9). In early June, the Chinese Ministry of Culture and Tourism warned Chinese citizens about a significant rise in racial discrimination and violence against Chinese and Asian people in Australia as an impact of the COVID-19 pandemic (10). In addition, in many countries around the world the small progress that has been made in ensuring girls receive an education is predicted to be undone by the COVID shelter at home restrictions (11). Increased “household responsibilities, child labour, early marriage and teenage pregnancy may prevent many girls from returning to school” (11). Other structural determinants include prioritisation of funding to other economic activities, instead of education, as countries emerge from the pandemic. Among those girls who do return to school post COVID, gender norms may inhibit their ambition. Education for women is consistent with part of the solution posed by Buyum et al namely a ‘knowledge shift’ which makes education widespread, bi-directional, and inclusive of new learning.
A human rights-based approach is a conceptual framework that can be applied to a broad range of program areas, including health. It is informed by international human rights law (12). The approach asserts that the integration of human rights law and principles should be visible in all activities and should contribute directly to the realization of human rights. Key elements of a human rights-based approach include participation, accountability, non-discrimination, empowerment, linkage to rights and sustainability. Applying this to the case of police brutality against people with mental illness suggests police be called on to view those with mental illness as human beings first with entitlements rather than letting the stigmatization of mental illness drive their actions. Police brutality to a marginalized group with little accountability is discriminatory, disempowering and dislocated from international human rights. It is unsustainable, and is unacceptable. In the case of maternal education a human rights-based approach would recognize the right of girls to an education. It would recognize there are no human rights, as enshrined in the Universal Declaration of Human Rights and other humanitarian instruments, without their universal application, irrespective of gender, ethnicity, occupation, country of birth. More broadly a human rights-based approach to structural determinants would re-orientate key public services and structures across multiple jurisdictions to ensure equity in participation and treatment irrespective of human characteristics.
Dismantling structural oppression is indeed key to improving global health. A human rights-based approach for addressing structural violence is a way of achieving this.
Aarya Desai MPH Student
Sundeep Manoth MPH Student
John Oldroyd MPH Co-ordinator
Australian Catholic University, Fitzroy, Australia.
Williams et al. examined the cost-effectiveness of tranexamic acid treatment for traumatic brain injury (TBI) (1). Tranexamic acid was highly cost-effective for patients with mild TBI and intracranial bleeding or patients with moderate TBI. In addition, tranexamic acid was even more cost-effective with earlier treatment administration. In contrast, the cost-effectiveness for those with severe TBI could not be clarified. I feel that cost-effectiveness viewpoint is very important for distributing medial resources effectively, and I present recent inconsistent results for the safety and effectiveness of tranexamic acid in TBI patients with special reference to disease severity.
Rowell et al. conducted a double-blinded, randomized clinical trial to determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI (2). They concluded that tranexamic acid administration did not improve 6-month neurologic outcome as measured by the Glasgow Outcome Scale-Extended. A large effectiveness trial with optimized dosing protocols, a mortality end point, and specific focus on the TBI severity cohorts might be needed to verify the existence of benefits (3).
There have been some meta-analyses on the efficacy of tranexamic acid for TBI, and I recently presented a comment regarding inconsistent results of the association (4). Based on the report by Williams et al., the...
Williams et al. examined the cost-effectiveness of tranexamic acid treatment for traumatic brain injury (TBI) (1). Tranexamic acid was highly cost-effective for patients with mild TBI and intracranial bleeding or patients with moderate TBI. In addition, tranexamic acid was even more cost-effective with earlier treatment administration. In contrast, the cost-effectiveness for those with severe TBI could not be clarified. I feel that cost-effectiveness viewpoint is very important for distributing medial resources effectively, and I present recent inconsistent results for the safety and effectiveness of tranexamic acid in TBI patients with special reference to disease severity.
Rowell et al. conducted a double-blinded, randomized clinical trial to determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI (2). They concluded that tranexamic acid administration did not improve 6-month neurologic outcome as measured by the Glasgow Outcome Scale-Extended. A large effectiveness trial with optimized dosing protocols, a mortality end point, and specific focus on the TBI severity cohorts might be needed to verify the existence of benefits (3).
There have been some meta-analyses on the efficacy of tranexamic acid for TBI, and I recently presented a comment regarding inconsistent results of the association (4). Based on the report by Williams et al., the cost-effectiveness/cost-benefit analysis of tranexamic acid for the treatment of TBI by including variables of disease severity should also be conducted.
References
1. Williams J, Roberts I, Shakur-Still H, et al. Cost-effectiveness analysis of tranexamic acid for the treatment of traumatic brain injury, based on the results of the CRASH-3 randomised trial: a decision modelling approach. BMJ Glob Health. 2020;5(9):e002716.
2. Rowell SE, Meier EN, McKnight B, et al. Effect of out-of-hospital tranexamic acid vs placebo on 6-month functional neurologic outcomes in patients with moderate or severe traumatic brain injury. JAMA. 2020;324(10):961-974.
3. Cone DC, Spaite DW, Coats TJ. Out-of-Hospital Tranexamic Acid for Traumatic Brain Injury. JAMA. 2020;324(10):946-947.
4. Kawada T. The efficacy of tranexamic acid for brain injury. Am J Emerg Med. 2020 doi:10.1016/j.ajem.2020.07.048
Arnab and colleagues reported the findings from their research study in India, UK, and the USA that politicians are unlikely to be punished or rewarded for their failures or successes in managing COVID-19 in the next election. (1) By early September, India came only next to the US in terms of COVID 19 burden. Officially, India collects and reports data in terms of geographical variations, disaggregated by age and sex. India also reports the count of deaths among patients with and without comorbidities. However, none of the States report COVID 19 data disaggregated by social determinants, primarily castes and wealth quintiles, which are the most important determinants from an Indian perspective.
The caste system in India is a ‘disabling myth’ which contributes to preventable and inequitable mortality in women and children.(2) Globally, COVID 19 has once again exposed the vulnerability of disadvantaged groups due to ongoing social discrimination and economic deprivation.(3) Emerging data shows that the racial minorities in the US are disproportionately affected by the pandemic. Data shows that Non-Hispanic Blacks have five times the risk of hospitalization compared to non-Hispanic Whites (age-adjusted) and Hispanic and Latinos have 4 times the risk compared to non-Hispanic Whites.(4,5) However, realizing the importance of having more accurate data to understand the impact of COVID 19, foundations and agencies came forward to support and set-up mechanisms to track rac...
Arnab and colleagues reported the findings from their research study in India, UK, and the USA that politicians are unlikely to be punished or rewarded for their failures or successes in managing COVID-19 in the next election. (1) By early September, India came only next to the US in terms of COVID 19 burden. Officially, India collects and reports data in terms of geographical variations, disaggregated by age and sex. India also reports the count of deaths among patients with and without comorbidities. However, none of the States report COVID 19 data disaggregated by social determinants, primarily castes and wealth quintiles, which are the most important determinants from an Indian perspective.
The caste system in India is a ‘disabling myth’ which contributes to preventable and inequitable mortality in women and children.(2) Globally, COVID 19 has once again exposed the vulnerability of disadvantaged groups due to ongoing social discrimination and economic deprivation.(3) Emerging data shows that the racial minorities in the US are disproportionately affected by the pandemic. Data shows that Non-Hispanic Blacks have five times the risk of hospitalization compared to non-Hispanic Whites (age-adjusted) and Hispanic and Latinos have 4 times the risk compared to non-Hispanic Whites.(4,5) However, realizing the importance of having more accurate data to understand the impact of COVID 19, foundations and agencies came forward to support and set-up mechanisms to track racial disparity in COVID in the US. (6,7) Ongoing data collection shows that COVID-19 is affecting minorities the most and that Black people are dying at 2.3 times the rate of white people. (8) The same is the case with minorities in other countries including the UK.
The last round of India’s Demographic and Health Survey (National Family Health Survey, 2015-16), gives some indication of the differences in the risk between castes and wealth quintiles. (9) Hand washing is one of the most recognized and irrefutable preventive measures to avoid COVID. NFHS data shows that the upper castes have the luxury of soap and water in close to three-fourth of their households, while more than 60% of the scheduled tribes (most backward castes) and half of the scheduled castes (backward castes) do not have soap and water facilities. Every one-in-five households of schedules tribes didn’t even have water, soap, or other cleansing agents. This is almost four times more than the proportion among higher castes.
Ninety-three percent of households in the wealthiest quintile had soap and water, while not even a quarter of households in the lowest quintile had them. One in every five households in the lowest wealth quintile lacked water, soap, and other cleansing agents. The upper castes are predominantly rich (57% of the upper castes are in the richest two quintiles) while 70% scheduled tribes and 50% of scheduled castes belong to the lowest two quintiles.12
The startling disparity in having access to such simple preventive measures as soap and water for handwashing will have a differential impact on the burden of COVID among people in the lower castes and or wealth groups. Previous studies have shown that the difference persists in terms of access to care as well. (10) It is in this context that the lack of disaggregated data for COVID 19 in India, the second-largest population in the world becomes important. It’s high time that research agencies and philanthropies invest in and collect, analyze, and disseminate data on the caste and wealth differentials on COVID 19 including mortality rates. Bringing in such evidence also helps to increase the political relevance of public health issues.
Reference:
1. Arnab Acharya, Gerring J, Reeves A. Is health politically irrelevant? Experimental evidence during a global pandemic. BMJ Global Health. 2020;5(10):e004222. doi:10.1136/bmjgh-2020-004222
2. The Lancet. The health of India: a future that must be devoid of caste. Lancet 2014; 384: 1901. doi: https://doi.org/10.1016/S0140-6736(14)62261-3
3. Kirby T. Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities. Lancet Respir Med. 2020;8(6):547-548. doi:10.1016/S2213-2600(20)30228-9
4. Dorn AV, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. Lancet. 2020;395(10232):1243-1244. doi:10.1016/S0140-6736(20)30893-X
5. CDC. Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. Published February 11, 2020. Accessed July 6, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-...
6. Marguerite Casey Foundation Announces $3.5 Million in COVID-19 Grant Funding to Tackle Racial Disparities Resulting from Pandemic | Marguerite Casey Foundation. Marguerite Casey Foundation. Published April 23, 2020. Accessed October 24, 2020. https://caseygrants.org/who-we-are/inside-mcf/marguerite-casey-foundatio...
7. The Rockefeller Foundation Commits $1.5 Million to Support the Boston University Center for Antiracist Research - The Rockefeller Foundation. The Rockefeller Foundation. Published September 30, 2020. Accessed October 24, 2020. https://www.rockefellerfoundation.org/news/the-rockefeller-foundation-co...
8. The COVID Racial Data Tracker. The COVID Tracking Project. Published 2018. Accessed October 24, 2020. https://covidtracking.com/race
9. International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS.
10. Shaikh M, Miraldo M, Renner A-T. Waiting time at health facilities and social class: Evidence from the Indian caste system. Kamolz L-P, ed. PLOS ONE. 2018;13(10):e0205641. doi:10.1371/journal.pone.0205641
Candal-Pedreira and colleagues showed that for 304 retracted papers, overall citations increased not decreased following retraction, but citations did seem to decrease for retracted papers in higher impact journals and those with higher citation rates, although that decrease might have been temporary.1 It is disturbing that retracted papers continue to be cited.
We approached the issue of changes in citations rates after retraction in a different way. We assessed citation rates of retracted and unretracted publications from individuals with more than one retracted publication in the Retraction Watch database.2 Using this approach, we found that, overall, citations for 989 retracted publications declined after the retraction and citations for 9671 unretracted papers also declined after the author’s first retraction, but the decline was greater for retracted papers. For example, for retracted publications, 671 papers had 3566 citations in the 3rd year before their retraction and 831 papers had 1575 citations in the 3rd year after their retraction. In contrast, 5311 unretracted papers had 17935 citations in the 3rd year before the author’s first retraction, and 7388 papers had 17252 citations in the 3rd year after the author’s first retraction.
Part of the difficulty in conducting and interpreting such analyses is the different lengths of time pre-and post-retraction for different papers. To try to address that issue, we calculated the slope of the citations/yea...
Show MoreEditor, the commentary highlights the sad situation the Levant region in the middle east has reached. The Syrian healthcare workers are most needed in Syria and not in Germany. It is their very country which is in most need for their services. Syria now has shortage of trained doctors and nurses to help fellow country men and women recover from war injuries and myriad of infectious and non-communicable diseases. Integrating in Europe is never easy for a people from Muslim countries, even if the were professionals (https://www.dailymail.co.uk/news/article-8854519/Muslim-doctor-refused-s...). I have lived in London for over 30 years and still feel an outsider in the UK. How will these refugees cope with the threat of their children losing their Arabic language or Muslim identity. Careers are not everything. It just baffles me why the Syrians who came to Europe could not seek refuge in rich Arab nations. Something terribly wrong is going on in the middle east and coming to Germany is not the answer. Syrian refugees are looking for a quick fix, but they should go back to their own country and tough it out to rebuild what was demolished before someone else comes and takes their places! Britons and Germans did not run away from their countries during the two world wars! Did millions of Britons leave to America to escape WWII? Why have did almost...
Show MoreA few thoughts on the paper.
In relation to SAM terminology. No one could argue with the logic of acute v chronic. However, SAM is well understood at a policy level. It is however understood at above six months. The work that ENN and MAMI have done on identifying wasting at birth is a narrative change which can lay the foundation for the bridging language that the paper talks about.
Narrative is a story that people can understand.
As pointed out, consistency is important, but consistency must hover across the 1000 day window. Currently, our terminology for narrating fetal undernutrition is very weak. While simplistic, if children are being born wasted, then they are also wasted in utero. To fully open the curtains, we would suggest that the SAM terminology be adapted to include fetal malnutrition. The narrative neither stops nor begins at birth regardless of the terminology we use.
In relation to the false positives and visa versa. Given current programming capacity and coverage rates well below 20% for CMAM false negatives represent only a tiny fraction of those who need treatment and do not receive it. Focus on false positives takes away from the substantive issue of low coverage rates for Essential Nutrition Actions across the 1000 day window.
On a broader theme, it would be helpful to explore how the food system and the food system summit support people in immediate need.
A conversation starter
Show MoreThe food system belongs to...
We have read this excellent article with interest. As physicians based in Pakistan: a low-middle income country and not having English as our first language, we could relate to the challenges mentioned in this manuscript. Authors have very rightly pointed out that the issue with most of the researchers based in the low-income (LIC) and middle-income countries (LMIC) is not of poor or low-quality science. We need data and experience sharing from all parts of the world in order to complete the bigger picture and understand the issues that we face today in health, environment, and social sciences. One of the main challenges authors based in the LIC and LMIC face is the issue of presentation of that data i a presentable form. Due to the lack of training opportunities, many authors are unable to write manuscripts that meet the high standards of global scientific journals. This deprives these authors of an opportunity to publish in journals with a global audience and the world misses out on reading a different perspective from the LIC or LMIC. In this context, the introduction of PREPSS is an excellent and welcome initiative that must be supported and promoted.
Show MoreIn this context, we would like to highlight the role of AuthorAID: a global platform of more than 17,000 researchers from all around the globe. We have been extensively using this platform for more than a decade to learn and now collaborate and teach other researchers based in the LIC and LMIC. AuthorAID also pr...
Introduction and Brief Overview
Show MoreThe Global Health Security (GHS) Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that make up the States Parties to the International Health Regulations (IHR [2005])1. The GHS Index takes into account countries’ capability to prevent, detect, and respond to public health emergencies while also assessing the robustness of the healthcare system in each country. This index is comprehensive since it has the ability to consider political and socioeconomic risks, as well as adherence to international norms, which can influence countries’ abilities to stop outbreaks1,2. The GHS Index has been the creation of Open Philanthropy Project, the Bill & Melinda Gates Foundation and the Robertson Foundation1.
The GHS Index treats biosafety and biosecurity as critical components of global health security. As such, the tool includes numerous indicators measuring country capacities and accounts for differences in priorities between high income and low/middle income countries. The GHS index is based on 6 categories, 34 indicators, and 85 sub-indicators. The six categories comprise prevention, detection and reporting, rapid response, health system, compliance with international norms, and risk environment5.
This article describes the practical value of the GHS Index and also explains how the methodology of assigning country ranks and scores is helpful in aidin...
We read with interest your Editorial on Global health and human rights for a postpandemic world and offering our comments on this important issue.1
COVID 19 has rampaged an unprepared world. With its high infectiousness, low virulence and asymptomatic transmission, it has crossed boundaries rapidly and affected millions. The mode of transmission of the disease, whether by large droplet (>5µm) as fomites through surface, short distance aerosol borne or long distance airborne by small particles (<5µm) is still being debated Containment and lock down strategies adopted by all affected countries to control the spread have shown mixed results but has devastated the economy and caused major societal disruptions. The policy makers aggressively contained densely populated urban areas, quarantined ships, care homes and jails but the disease has continued to spread rapidly. High fatality rates in hospitals with sophisticated infrastructures and health workers getting infected have exposed gaps in basic understanding of control of airborne diseases and their management in health care settings. The defence forces, specially the naval ships got affected all over the world. With history of pandemic diseases repeating at regular intervals, it is now amply evident that viral diseases will re-emerge in times to come, either in another novel form or as a bioweapon and effective and holistic mitigation measures will be crucial.2
Airborne or droplet borne. The infectious...
Show MoreA need for better understanding old-age mortality dynamics
Sergi Trias-Llimós* & Iñaki Permanyer
Centre d’Estudis Demogràfics, Carrer de Ca n’Altayó, Edifici E2, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
* Corresponding author. Email: strias@ced.uab.cat
Correspondence letter in response to:
Bergeron-Boucher M-P, Aburto JM, Raalte A van. Diversification in causes of death in low-mortality countries: emerging patterns and implications. BMJ Glob Health. 2020;5(7):e002414.
Word count: 492
The recent paper by Bergeron-Boucher et al. published in this journal reports an increasing diversity of cause-of-death mortality in low-mortality populations during the last 20 years [1]. Bergeron-Boucher et al. found that the preponderance of mortality from cardiovascular diseases in the countries under analysis has gradually declined in favour of a wide range of causes of death, including mental and behavioural disorders, nervous system or ill-defined causes. The increasing variability of causes of death is an important matter of potential concern because (a) fragmentation in cause of death might hinder further improvements in life expectancy, (b) preventive health policies have to cope with a more variegated set of causes, which imply more costly and less efficient health policies.
Show MoreDespite their enormous interest, these findings should be interpreted with caution. As the authors...
To the editor
We read with interest the article by Büyüm AM, Kenney C, Koris A, et al. (Decolonising
global health: if not now, when? BMJ Global Health 2020;5:e003394. doi:10.1136/
bmjgh-2020-003394) Although it is not contested that Black, Indigenous and People of Color are most disadvantaged by structural oppression, we would argue that a human rights-based approach is a more inclusive approach to global health inequity than decolonising global health.
The economic impacts of COVID mediated by the structural determinants will see recent gains in poverty reduction lost (1). Structural determinants within key service institutions such as the police service, prison system as well as those affecting gender will result in widespread suboptimal health. For example, black people are 40 times more likely to be stopped and searched in the UK under powers that allow officers to search people if serious violence is anticipated (2). In the US, a study examining all fatalities resulting from the use of lethal force by on-duty law enforcement officers between 2009 to 2012 across 17 U.S. states found that while whites were killed more frequently, the fatality rate was 2.8 times higher among blacks than whites (3). In the US, the First Step Act prison reforms have resulted in some benefits for prisoners, but ironically, highlighted the disproportionate incarceration of blacks (38%) who comprises 13% of the US population (4). There is evidence COVID disproportio...
Show MoreWilliams et al. examined the cost-effectiveness of tranexamic acid treatment for traumatic brain injury (TBI) (1). Tranexamic acid was highly cost-effective for patients with mild TBI and intracranial bleeding or patients with moderate TBI. In addition, tranexamic acid was even more cost-effective with earlier treatment administration. In contrast, the cost-effectiveness for those with severe TBI could not be clarified. I feel that cost-effectiveness viewpoint is very important for distributing medial resources effectively, and I present recent inconsistent results for the safety and effectiveness of tranexamic acid in TBI patients with special reference to disease severity.
Rowell et al. conducted a double-blinded, randomized clinical trial to determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI (2). They concluded that tranexamic acid administration did not improve 6-month neurologic outcome as measured by the Glasgow Outcome Scale-Extended. A large effectiveness trial with optimized dosing protocols, a mortality end point, and specific focus on the TBI severity cohorts might be needed to verify the existence of benefits (3).
There have been some meta-analyses on the efficacy of tranexamic acid for TBI, and I recently presented a comment regarding inconsistent results of the association (4). Based on the report by Williams et al., the...
Show MoreArnab and colleagues reported the findings from their research study in India, UK, and the USA that politicians are unlikely to be punished or rewarded for their failures or successes in managing COVID-19 in the next election. (1) By early September, India came only next to the US in terms of COVID 19 burden. Officially, India collects and reports data in terms of geographical variations, disaggregated by age and sex. India also reports the count of deaths among patients with and without comorbidities. However, none of the States report COVID 19 data disaggregated by social determinants, primarily castes and wealth quintiles, which are the most important determinants from an Indian perspective.
The caste system in India is a ‘disabling myth’ which contributes to preventable and inequitable mortality in women and children.(2) Globally, COVID 19 has once again exposed the vulnerability of disadvantaged groups due to ongoing social discrimination and economic deprivation.(3) Emerging data shows that the racial minorities in the US are disproportionately affected by the pandemic. Data shows that Non-Hispanic Blacks have five times the risk of hospitalization compared to non-Hispanic Whites (age-adjusted) and Hispanic and Latinos have 4 times the risk compared to non-Hispanic Whites.(4,5) However, realizing the importance of having more accurate data to understand the impact of COVID 19, foundations and agencies came forward to support and set-up mechanisms to track rac...
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