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Infrastructure, policy and regulatory interventions to increase physical activity to prevent cardiovascular diseases and diabetes: a systematic review

Durão, S.; Burns, J.; Schmidt, B. et al. BMC Public Health (2023) CC

Background Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physical activity occurs may promote physical activity a...t a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity. Methods We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction. Results We included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence). Conclusions Evidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings. more

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Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Smith, E.E.; Saposnik, G.; Biessels. G.J. et al. American Heart Association (2016) CC

Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to ... more

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Therapeutics and COVID-19 (Living Guideline, 10 November 2023)

World Health Organization WHO (2023) C_WHO

WHO has updated its guidelines for COVID-19 therapeutics, with revised recommendations for patients with non-severe COVID-19. This is the 13th update to these guidelines. Updated risk rates for hospital admission in patients with non-severe COVID-19 The guidance includes updated risk rates for... hospital admission in patients with non-severe COVID-19. The current COVID-19 virus variants tend to cause less severe disease while immunity levels are higher due to vaccination, leading to lower risks of severe illness and death for most patients. This update includes new baseline risk estimates for hospital admission in patients with non-severe COVID-19. The new ‘moderate risk’ category now includes people previously considered to be high risk including older people and/or those with chronic conditions, disabilities, and comorbidities of chronic disease. The updated risk estimates will assist healthcare professionals to identify individuals at high, moderate or low risk of hospital admission, and to tailor treatment according to WHO guidelines: **High: **People who are immunosuppressed remain at higher risk if they contract COVID-19, with an estimated hospitalization rate of 6%. **Moderate: **People over 65 years old, those with conditions like obesity, diabetes and/or chronic conditions including chronic obstructive pulmonary disease, kidney or liver disease, cancer, people with disabilities and those with comorbidities of chronic disease are at moderate risk, with an estimated hospitalization rate of 3%. Low: Those who are not in the high or moderate risk categories are at low risk of hospitalization (0.5%). Most people are low risk. Review of COVID-19 treatments for people with non-severe COVID-19 WHO continues to strongly recommend nirmatrelvir-ritonavir (also known by its brand name ‘Paxlovid’) for people at high-risk and moderate risk of hospitalization. The recommendations state that nirmatrelvir-ritonavir is considered the best choice for most eligible patients, given its therapeutic benefits, ease of administration and fewer concerns about potential harms. Nirmatrelvir-ritonavir was first recommended by WHO in April 2022. If nirmatrelvir-ritonavir is not available to patients at high-risk of hospitalization, WHO suggests the use of molnupiravir or remdesivir instead. WHO suggests against the use of molnupiravir and remdesivir for patients at moderate risk, judging the potential harms to outweigh the limited benefits in patients at moderate risk of hospital admission. For people at low risk of hospitalization, WHO does not recommend any antiviral therapy. Symptoms like fever and pain can continue to be managed with analgesics like paracetamol. WHO also recommends against use of a new antiviral (VV116) for patients, except in clinical trials. The update also includes a strong recommendation against the use of ivermectin for patients with non-severe COVID-19. WHO continues to advise that in patients with severe or critical COVID-19, ivermectin should only be used in clinical trials. more

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Human African trypanosomiasis - General Information

Büscher P., Cecchi G., Jamonneau V. et al World Health Organisation (WHO) (2017) C2

Human African trypanosomiasis (HAT), also called sleeping sickness, is a parasitic infection that almost invariably progresses to death, unless treatment is provided. HAT caused devastating epidemics during the 20th century. Thanks to sustained and coordinated efforts during the past 15 years the nu... more

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Ethical considerations in HIV prevention trials

World Health Organization WHO; UNAIDS (2021) C_WHO

UNAIDS and the World Health Organization have published this updated guidance on ethical considerations in HIV prevention trials. The new guidance is the result of a year-long process that saw more than 80 experts and members of the public give inputs and is published 21 years after the first editio... more

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Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies

Alipanah N, Jarlsberg L et al. (2018) CC

We systematically reviewed Medline as well as the references of published review articles for relevant studies of adherence to multidrug treatment of both drug-susceptible and drug-resistant TB through February 3, 2018. We included randomized controlled trials (RCTs) as well as prospective and retro... more

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Nigeria: Good Clinical Practice Guidelines

National Agency for Food and Drugs Administration and Control (NAFDAC) (2016) C2

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Nota Conceitual para o Consórcio do África CDC para Ensaios Clínicos para Vacina da COVID-19 (CONCVACT)

African Union; Africa CDC Centres for Disease Control and Prevention (2020) C1

A Estratégia Conjunta Continental Africana para a COVID-19 é sustentada pela necessidade de limitar a transmissão, prevenir mortes e reduzir os danos associados. A participação das nações africanas em ensaios clínicos é um passo essencial para garantir que sejam gerados dados suficientes so... more

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Consortium du Centre Africain pour le Contrôle et la Prévention des Maladies (CACM) pour les essais cliniques sur le vaccin contre la COVID-19 (CONCVACT)

African Union; Africa CDC Centres for Disease Control and Prevention (2020) C1

La stratégie continentale commune africaine pour COVID-19 est sous-tendue par la nécessité de limiter la transmission, de prévenir les décès et de réduire les dommages associés. La participation des nations africaines aux essais cliniques est une étape essentielle pour garantir la productio... more

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Effects of BCG on COVID-19 — based on information as of 25 December 2020

World Health Organization WHO (2020) C_WHO

WHO Regional Office for Africa

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Effets de la vaccination par le BCG sur la COVID-19 — sur la base des informations disponibles au 25 décembre 2020

Organisation Mondiale de la Santé, Bureau régional de l'OMS pour l'Afrique (2020) C_WHO

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Efeitos da vacina BCG na COVID-19 — com base na informação disponível a 25 de Dezembro de 2020

Organização Mundial da Saúde. Escritório Regional para a África (2020) C_WHO

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The Top COVID-19 Vaccine Myths Spreading Online

Gregory, J. NewsGuard (2021) CC

Scientists and researchers managed to produce vaccines to protect against COVID-19. Vaccine candidates have recently been approved in some countries and are in the approval process in others, yet misinformation about the safety and effects of any future vaccine is already threatening its rollout. In... more

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Male Circumcision and HIV in Lesotho: Is the Relationship Real or Spurious? Analysis of the 2009 Demographic and Health Survey

Makatjane, T. J., T. Hlabana, and E. M. Letete Rockville, Maryland, USA: ICF International (2016) C2

DHS Working Papers No. 125

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Ghana: GUIDELINES FOR REPORTING ADVERSE REACTION

Food and Drugs Authority (FDA), Ghana (2016) C2

Document No. : FDA/SMC/SMD/GL-RAR/2013/01

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Ghana: Public Health Act

Government of Ghana (2012) C1

Act 851 | AN ACT to revise and consolidate the law relating to public health to prevent disease, promote, safeguard, maintain and protect the health of humans and animals and to provide for related matters.

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Ten Clinical Tips on COVID-19 for Healthcare Providers Involved in Patient Care

Centers for Disease Control and Prevention CDC (2020) C_CDC

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Clinical Guidelines: Antiretroviral drugs for HIV prevention - Chapter 3

World Health Organization (2019) C_WHO

Accessed: 27.11.2019

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Comprehensive COVID-19 Slideset: Symptoms and Clinical Manifestations

Clinical Care Options (2021) CC

26 March 2021 Slideset updated regularly to include the latest data on the evolution and duration of COVID-19 symptoms and prevalence and duration of natural immunity.

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Money & Microbes: Strengthening clinical research capacity to prevent epidemics

International Vaccines Task Force (IVTF) (2018) C1

Robust clinical research capacity in low- and middle-income countries is key to stemming the spread of epidemics, according to a new report from the International Vaccines Task Force (IVTF). The report lays out how to develop the political support, financing and coordination required to build this c... more