An Assessment of Systemic Factors and COVID-19 Mortality in Africa.

Objectives: The objective of this study was to examine the association between several country-level systemic indices and the deaths from COVID-19 across African countries. Method: Regression analyses were conducted to test the association between selected indices and deaths from COVID-19 across African countries. All tests were run at the α = 0.05 level of significance. Result: We found a statistically significant correlation between total COVID-19 deaths per million and Stringency Index (p-value <0.001) and Human Development Index (p-value <0.001). Multiple regression analysis showed that Stringency Index was the only variable that remained significant when other factors are controlled for in the model. Conclusion: Countries in Africa with poorer governance, inadequate pandemic preparedness and lower levels of development have unexpectedly fared better with respect to COVID-19 deaths mainly because of having a younger population than the countries with better indices.

Tooth retention, health, and quality of life in older adults: a scoping review.

OBJECTIVE: This scoping review describes the relationship between tooth retention, health, and quality of life in older adults. METHODS: Seven databases were searched for English language articles for subjects ≥ 65 y from 1981 to 2021. Exposure was tooth retention (≥ 20), and outcomes were general/systemic health and quality of life. Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0 tool. RESULTS: 140 articles were included, only four were randomized trials. Inter-rater agreement (κ) regarding study inclusion was 0.924. Most were assessed with low risk of bias (n = 103) and of good quality (n = 96). Most studies were conducted in Japan (n = 60) and Europe (n = 51) and only nine in the US. Tooth retention was referred to as "functional dentition" in 132 studies and "shortened dental arch" in 19 studies. Study outcomes were broadly synthesized as (1) cognitive decline/functional dependence, (2) health status/chronic diseases, (3) nutrition, and (4) quality of life. DISCUSSION: There is a positive relationship between tooth retention, overall health, and quality of life. Older adults retaining ≥ 20 teeth are less likely to experience poorer health. Having < 20 teeth increases the likelihood for functional dependence and onset of disability, and may affect successful ageing. This review supports the general finding that the more teeth older adults retain as they age, the less likely they are to have adverse health outcomes. However, significant knowledge gaps remain which can limit decision-making affecting successful ageing for many older adults. This review highlights the need to consider, as an important marker of oral health and function, the retention of a functional minimum of a natural dentition, rather than a simple numeric score of missing teeth.

Reviewing Health Security Capacities in Nigeria Using the Updated WHO Joint External Evaluation and WHO Benchmarks Tool: Experience from a Country-Led Self-Assessment Exercise.

Across the world, the level of pandemic preparedness varies and no country is fully prepared to respond to all public health events. The International Health Regulations 2005 require state parties to develop core capacities to prevent, detect, and respond to public health events of international concern. In addition to annual self-assessment, these capacities are peer reviewed once every 5 years through the voluntary Joint External Evaluation (JEE). In this article, we share Nigeria's experience of conducting a country-led midterm self-assessment using a slightly modified application of the second edition of the World Health Organization (WHO) JEE and the new WHO benchmarks tool. Despite more stringent scoring criteria in the revised JEE tool, average scoring showed modest capacity improvements in 2019 compared with 2017. Of the 19 technical areas assessed, 11 improved, 5 did not change, and 3 had lower scores. No technical area attained the highest-level scoring of 5. Understanding the level of, and gaps in, pandemic preparedness enables state parties to develop plans to improve health security; the outcome of the assessment included the development of a 12-month operational plan. Countries need to intentionally invest in preparedness by using existing frameworks (eg, JEE) to better understand the status of their preparedness. This will ensure ownership of developed plans with shared responsibilities by all key stakeholders across all levels of government.

Economic Empowerment and Tolerance of Domestic Violence Among Married Women: A Cross-Sectional Study.

We evaluated whether markers of economic empowerment are associated with a tolerant attitude toward spousal physical violence (SPV) among employed married women in Nigeria. Cross-sectional analyses of responses to the 2013 Nigeria Demographic Health Survey by a nationally representative sample of 3,999 women aged 15 to 49 years who reported being employed and married. Tolerance for SPV was defined as supporting statements with justifications for wife-beating. Logistic regression assessed the associations of reporting tolerance for SPV with educational attainment and interspousal equivalency in income, controlling for previous exposure to domestic abuse. The prevalence of tolerance for SPV among the sample was 37%. Women with tertiary education had lower odds of tolerance for SPV relative to their counterparts without formal education (adjusted odds ratio [aOR] = 0.22, 95% confidence interval [CI] = [0.12, 0.40], p < .0001). Compared with women with similar income levels as their partners, women who either earned more (aOR = 2.77, 95% CI = [1.36, 5.62], p = .005) or earned less income relative to their spouses (aOR = 1.93, 95% CI = [1.14, 3.26], p = .02) had higher odds of tolerance for SPV. Odds of tolerance for SPV were also higher among women reporting previous spousal abuse than among their counterparts without such a history (aOR = 1.55, 95% CI = [1.14, 2.12], p = .006). A history of nonspousal abuse was associated with lower odds of tolerance for SPV (aOR = 0.56, 95% CI = [0.37, 0.84], p = .005). Lower educational attainment and interspousal differences in income may contribute to tolerance of SPV. Efforts to increase economic empowerment should be combined with education to recognize cultural norms that foster SPV and build skills to exit violent relationships.

Epidemiological and clinical characteristics of cancer patients with COVID-19: A systematic review and meta-analysis of global data.

There are minimal data regarding the prevalence of cancer in patients with coronavirus disease 2019 (COVID-19), as well as the incidence of severe illness and rate of mortality in COVID-19 patients with cancer. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched, from database inception to July 15, 2020, for studies of patients with COVID-19 that included information regarding comorbid cancer. In total, 109 eligible global studies were included in this systematic review. Ninety studies with 94,845 COVID-19 patients, among which 4106 exhibited comorbid cancer, were included in the meta-analysis regarding prevalence of comorbid cancer. Twenty-three studies with 71,969 COVID-19 patients, among which 4351 with comorbid cancer had severe illness or death, were included in the meta-analysis. The overall prevalence of cancer among COVID-19 patients was 0.07 (95% CI 0.05-0.09). The cancer prevalence in COVID-19 patients was higher in Europe (0.22, 95% CI 0.17-0.28) than in the Asia-Pacific region (0.04, 95% CI 0.03-0.06) or North America (0.05, 95% CI 0.04-0.06). The cancer prevalence in COVID-19 patients aged >60 years was 0.10 (95% CI 0.07-0.14), while the prevalence among patients aged ≤60 years was 0.05 (95% CI 0.03-0.06). The pooled prevalence of severe illness among COVID-19 patients with cancer was 0.34 (95% CI 0.26-0.42) and the pooled mortality rate of COVID-19 patients with cancer was 0.20 (95% CI 0.16-0.25). Pooled incidences of severe illness among COVID-19 patients with cancer from Asia Pacific, Europe, and North America were 0.38 (95% CI 0.24-0.52), 0.39 (95% CI 0.25-0.53), and 0.26 (95% CI 0.20-0.31), respectively; pooled mortality rates from the Asia-Pacific region, Europe, and North America were 0.17 (95% CI 0.10-0.24), 0.26 (95% CI 0.18-0.35), and 0.19 (95% CI 0.13-0.25), respectively.

Association between blood circulating vitamin D and colorectal cancer risk in Asian countries: a systematic review and dose-response meta-analysis.

OBJECTIVES: To assess the association between blood circulating vitamin D levels and colorectal cancer risk in the Asian population. DESIGN: This is a systematic review and dose-response meta-analysis of observational studies that investigated the relationship between blood circulating vitamin D levels and colorectal cancer risk in the Asian population. DATA SOURCES: Relevant studies were identified through a literature search in Medline, Embase and Web of Science from 1st January 1980 to 31st January 2019. Eligibility criteria: original studies published in peer-reviewed journals investigating the association between blood circulating vitamin D levels and the risk of colorectal cancer and/or adenoma in Asian countries. DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted data and assessed the quality of included studies. Study-specific ORs were pooled using a random-effects model. A dose-response meta-analysis was performed with generalised least squares regression. We applied the Newcastle-Ottawa Scale quality assessment to evaluate the quality of the selected studies. RESULTS: The eight included studies encompassed a total of 2916 cases and 6678 controls. The pooled ORs of colorectal cancer for the highest versus lowest categories of blood circulating vitamin D levels was 0.75 (95% CI 0.58 to 0.97) up to 36.5 ng/mL in the Asian population. There was heterogeneity among the studies (I2=53.9%, Pheterogeneity=0.034). The dose-response meta-analysis indicated a significant linear relationship (Pnon-linearity=0.11). An increment of 16 ng/mL in blood circulating vitamin D level corresponded to an OR of 0.79 (95% CI 0.64 to 0.97). CONCLUSIONS: The results of this meta-analysis indicate that blood circulating vitamin D level is associated with decreased risk of colorectal cancer in Asian countries. The dose-response meta-analysis shows that the strength of this association among the Asian population is similar to that among the Western population. Our study suggests that the Asian population should improve nutritional status and maintain a higher level of blood circulating vitamin D.