BioCaster in 2021: automatic disease outbreaks detection from global news media.

SUMMARY: BioCaster was launched in 2008 to provide an ontology-based text mining system for early disease detection from open news sources. Following a 6-year break, we have re-launched the system in 2021. Our goal is to systematically upgrade the methodology using state-of-the-art neural network language models, whilst retaining the original benefits that the system provided in terms of logical reasoning and automated early detection of infectious disease outbreaks. Here, we present recent extensions such as neural machine translation in 10 languages, neural classification of disease outbreak reports and a new cloud-based visualization dashboard. Furthermore, we discuss our vision for further improvements, including combining risk assessment with event semantics and assessing the risk of outbreaks with multi-granularity. We hope that these efforts will benefit the global public health community. AVAILABILITY AND IMPLEMENTATION: BioCaster web-portal is freely accessible at http://biocaster.org.

A Conceptual Framework for Representing Events Under Public Health Surveillance.

Information integration across multiple event-based surveillance (EBS) systems has been shown to improve global disease surveillance in experimental settings. In practice, however, integration does not occur due to the lack of a common conceptual framework for encoding data within EBS systems. We aim to address this gap by proposing a candidate conceptual framework for representing events and related concepts in the domain of public health surveillance.

How global is global health research? A large-scale analysis of trends in authorship.

Many have called for greater inclusion of researchers from low- and middle-income countries (LMICs) in the conduct of global health research, yet the extent to which this occurs is unclear. Prior studies are journal-, subject-, or region-specific, largely rely on manual review, and yield varying estimates not amenable to broad evaluation of the literature. We conducted a large-scale investigation of the contribution of LMIC-affiliated researchers to published global health research and examined whether this contribution differed over time. We searched titles, abstracts, and keywords for the names of countries ever classified as low-, lower middle-, or upper middle-income by the World Bank, and limited our search to items published from 2000 to 2017 in health science-related journals. Publication metadata were obtained from Elsevier/Scopus and analysed in statistical software. We calculated proportions of publications with any, first, and last authors affiliated with any LMIC as well as the same LMIC(s) identified in the title/abstract/keywords, and stratified analyses by year, country, and countries' most common income status. We analysed 786 779 publications and found that 86.0% included at least one LMIC-affiliated author, while 77.2% and 71.2% had an LMIC-affiliated first or last author, respectively; however, analagous proportions were only 58.7%, 36.8%, and 29.1% among 100 687 publications about low-income countries. Proportions of publications with LMIC-affiliated authors increased over time, yet this observation was driven by high research activity and representation among upper middle-income countries. Between-country variation in representation was observed, even within income status categories. We invite comment regarding these findings, particularly from voices underrepresented in this field.

Declining Life Expectancy in the United States: Missing the Trees for the Forest.

In recent years, life expectancy in the United States has stagnated, followed by three consecutive years of decline. The decline is small in absolute terms but is unprecedented and has generated considerable research interest and theorizing about potential causes. Recent trends show that the decline has affected nearly all race/ethnic and gender groups, and the proximate causes of the decline are increases in opioid overdose deaths, suicide, homicide, and Alzheimer's disease. A slowdown in the long-term decline in mortality from cardiovascular diseases has also prevented life expectancy from improving further. Although a popular explanation for the decline is the cumulative decline in living standards across generations, recent trends suggest that distinct mechanisms for specific causes of death are more plausible explanations. Interventions to stem the increase in overdose deaths, reduce access to mechanisms that contribute to violent deaths, and decrease cardiovascular risk over the life course are urgently needed to improve mortality in the United States.

Harm Reduction: A Misnomer.

'Harm reduction' programs are usually justified on the utilitarian grounds that they aim to reduce the net harms of a behavior. In this paper, I contend that (1) the historical genesis of harm reduction programs, and the crucial moral imperative that distinguishes these programs from other interventions and policies, are not utilitarian; (2) the practical implementation of harm reduction programs is not, and probably cannot be, utilitarian; and (3) the continued justification of harm reduction on utilitarian grounds is untenable and may itself cause harm. Promoting harm reduction programs as utilitarian in the public arena disregards their deeper prioritarian impulses. 'Harm reduction' is a misnomer, and the name should be abandoned sooner rather than later.

Cash transfer programs have differential effects on health: A review of the literature from low and middle-income countries.

BACKGROUND: Cash transfer programs have grown increasingly popular and are now used as interventions to target a wide array of health outcomes across many diverse settings. However, cash transfer experiments have yielded mixed results, highlighting gaps in our understanding of how these programs work. In particular, we do not yet know whether cash transfers are more effective for certain health outcomes compared to others, or are more effective for some population subgroups compared to others. Here, we ask whether the effects of cash transfers on health outcomes differ across study subgroups. METHODS: We reviewed the literature on cash transfer experiments conducted in low and middle income countries, published in English between 1985 and 2015. We documented whether the investigators reported either i) stratum-specific estimates or ii) the interaction term between subgroups and exposure to the intervention. For studies that presented stratum-specific estimates without statistical tests for heterogeneity, we assessed heterogeneity across subgroups with a Cochran Q test. RESULTS: Of the 56 studies we reviewed, 40 reported effects on study subgroups. The majority of the cash transfer interventions had different magnitudes of effects on health across subgroups. This heterogeneity was often underreported or not formally analyzed. We find substantial heterogeneity of cash transfers on child health and on adult health yet little heterogeneity of cash transfers on sexual and reproductive health. CONCLUSIONS: Accounting for the heterogeneous impacts of cash transfers during program design and evaluation is necessary to better target cash transfer programs and generate more precise data on their effects.

The Zika epidemic and abortion in Latin America: a scoping review.

BACKGROUND: Latin America presently has the world's highest burden of Zika virus, but there are unexplained differences in national rates of congenital malformations collectively referred to as Congenital Zika Syndrome (CZS) in the region. While Zika virulence and case detection likely contribute to these differences, policy-related factors, including access to abortion, may play important roles. Our goal was to assess perspectives on, and access to, abortion in Latin America in the context of the Zika epidemic. METHODS: We conducted a scoping review of peer-reviewed and gray literature published between January 2015 and December 2016, written in English, Spanish, Portuguese, or French. We searched PubMed, Scielo, and Google Scholar for literature on Zika and/or CZS and abortion, and used automated and manual review methods to synthesize the existing information. RESULTS: 36 publications met our inclusion criteria, the majority of which were qualitative. Publications were generally in favor of increased access to safe abortion as a policy-level response for mitigating the impact of CZS, but issues with implementation were cited as the main challenge. Aside from the reform of abortion regulation in Colombia, we did not find evidence that the Zika epidemic had triggered shifts in abortion policy in other countries. CONCLUSION: Abortion policy in the region remained largely unchanged following the Zika epidemic. Further empirical research on abortion access and differential rates of CZS across Latin American countries is required.

The impact of social and psychological consequences of disease on judgments of disease severity: An experimental study.

BACKGROUND: The Global Burden of Disease (GBD) project systematically assesses mortality, healthy life expectancy, and disability across 195 countries and territories, using the disability-adjusted life year (DALY). Disability weights in the DALY are based upon surveys that ask users to rate health states based on lay descriptions. We conducted an experimental study to examine whether the inclusion or removal of psychological, social, or familial implications from a health state description might affect individual judgments about disease severity, and thus relative disability weights. METHODS: We designed a survey consisting of 36 paired descriptions in which information about plausible psychological, social, or familial implications of a health condition was either present or absent. Using a Web-based platform, we recruited 1,592 participants, who were assigned to one of two experimental groups, each of which were asked to assign a value to the health state description from 0 to 100 using a slider, with 0 as the "worst possible health" and 100 as the "best possible health." We tested five hypotheses: (1) the inclusion of psychological, social, or familial consequences in health state descriptions will reduce the average rating of a health state; (2) the effect will be stronger for diseases with lower disability weights (i.e., less severe diseases); (3) the effect will vary across the type of additional information added to the health state description; (4) the impact of adding information on familial consequences will be stronger for female than male; (5) the effect of additional consequences on ratings of health state descriptions will not differ by levels of completed education and age. RESULTS: On average, adding social, psychological, or familial consequences to the health state description lowered individual ratings of that description by 0.78 points. The impact of adding information had a stronger impact on ratings of the least severe conditions, reducing average ratings in this category by 1.67 points. Addition of information about child-rearing had the strongest impact, reducing average ratings by 2.09 points. We found little evidence that the effect of adding information on ratings of health descriptions varied by gender, education, or age. CONCLUSIONS: Including information about health states not directly related to major functional consequences or symptoms, particularly with respect to child-rearing and specifically for descriptions of less severe conditions, can lead to lower ratings of health. However, this impact was not consistent across all conditions or types of information, and was most pronounced for inclusion of information about child-rearing, and among the least severe conditions.

Epigenetics Changes Nothing: What a New Scientific Field Does and Does Not Mean for Ethics and Social Justice.

Recently, ethicists have posited that consideration of epigenetic mechanisms presents novel challenges to concepts of justice and equality of opportunity, such as elevating the importance of environments in bioethics and providing a counterpoint to gross genetic determinism. We argue that new findings in epigenetic sciences, including those regarding intergenerational health effects, do not necessitate reconceptualization of theories of justice or the environment. To the contrary, such claims reflect a flawed understanding of epigenetics and its relation to genetics that may unintentionally undermine appeals to social justice. We provide a brief summary of epigenetic sciences, focusing on phenomena central to the current ethical discourse. We identify three fallacious modes of reasoning arising from the emergent literature on the ethical and policy implications of epigenetics, including mischaracterization, undue extrapolation, and exceptionalism. We end by discussing how these issues may work against mobilizing health equity policies and present a more modest claim regarding the value of new epigenetic knowledge to health justice by setting this discourse within the context of known themes in biomedical ethics and health policy.

Out of Alignment? Limitations of the Global Burden of Disease in Assessing the Allocation of Global Health Aid.

The Global Burden of Disease (GBD) project quantifies the impact of different health conditions by combining information about morbidity and premature mortality within a single metric, the Disability Adjusted Life Year. One important goal for the GBD project has been to inform decisions about global health priorities. A number of recent studies have used GBD data to argue that global health funding fails to align with the GBD. We argue that these studies' shared assumption that global health resources should 'align' with the burden of disease is unfounded and has troubling implications. First, since the allocation of resources involves difficult trade-offs between different, potentially competing goals, any 'misalignment' of allocation and disease burdens need not necessarily indicate that the allocation of funds fails to meet recipient countries' needs or interests. Second, using alignment as a baseline implicitly makes controversial assumptions about how harms of different magnitudes affecting different numbers of individuals should be aggregated. We discuss two alternative ways in which GBD data could help inform decisions about resource allocation, neither of which gives more than a limited role to GBD data.

Determinants of increased opioid-related mortality in the United States and Canada, 1990-2013: a systematic review.

We review evidence of determinants contributing to increased opioid-related mortality in the United States and Canada between 1990 and 2013. We identified 17 determinants of opioid-related mortality and mortality increases that we classified into 3 categories: prescriber behavior, user behavior and characteristics, and environmental and systemic determinants. These determinants operate independently but interact in complex ways that vary according to geography and population, making generalization from single studies inadvisable. Researchers in this area face significant methodological difficulties; most of the studies in our review were ecological or observational and lacked control groups or adjustment for confounding factors; thus, causal inferences are difficult. Preventing additional opioid-related mortality will likely require interventions that address multiple determinants and are tailored to specific locations and populations.

[Implicit value judgments in the measurement of health inequalities]. / Juicios de valor implícitos en la medición de las desigualdades en salud.

CONTEXT: Quantitative estimates of the magnitude, direction, and rate of change of health inequalities play a crucial role in creating and assessing policies aimed at eliminating the disproportionate burden of disease in disadvantaged populations. It is generally assumed that the measurement of health inequalities is a value-neutral process, providing objective data that are then interpreted using normative judgments about whether a particular distribution of health is just, fair, or socially acceptable. METHODS: We discuss five examples in which normative judgments play a role in the measurement process itself, through either the selection of one measurement strategy to the exclusion of others or the selection of the type, significance, or weight assigned to the variables being measured. FINDINGS: Overall, we find that many commonly used measures of inequality are value laden and that the normative judgments implicit in these measures have important consequences for interpreting and responding to health inequalities. CONCLUSIONS: Because values implicit in the generation of health inequality measures may lead to radically different interpretations of the same underlying data,we urge researchers to explicitly consider and transparently discuss the normative judgments underlying their measures. We also urge policymakers and other consumers of health inequalities data to pay close attention to the measures on which they base their assessments of current and future health policies.

Juicios de valor implícitos en la medición de las desigualdades en salud / Implicit value judgments in the measurement of health inequalities

CONTEXTO: Los estimados cuantitativos de magnitud, dirección e índice de cambio de las desigualdades en salud juegan un papel crucial en la creación y evaluación de las políticas destinadas a eliminar la desproporcionada carga de enfermedad en las poblaciones carenciadas. En general se asume que la medición de las desigualdades en salud es un proceso con un valor neutral que brinda datos objetivos que luego se interpretan usando juicios normativos sobre si una particular distribución de la salud es justa, ecuánime o socialmente aceptable. MÉTODOS: Se discuten cinco ejemplos en los cuales los juicios normativos juegan un papel en la medición del proceso en sí, sea mediante la selección de una estrategia de medición sobre la exclusión de otras como mediante la selección del tipo, importancia o peso asignados a las variables que se están midiendo. HALLAZGOS: En términos generales, encontramos que muchas medidas de desigualdad comúnmente usadas son subjetivas y que los juicios normativos implícitos en estas medidas tienen importantes consecuencias de interpretación y respuesta a las desigualdades en salud. CONCLUSIONES: Debido a que los valores implícitos en la generación de las medidas de desigualdad en salud pueden llevar a interpretaciones radicalmente diferentes de los mismos datos subyacentes, instamos a los investigadores a considerar en forma explícita y discutir con transparencia los juicios normativos subyacentes en sus medidas. También instamos a los responsables de las políticas y a otros consumidores de datos sobre desigualdades en salud a prestar mucha atención a las medidas sobre las cuales basan su evaluación sobre las políticas de salud actuales y futuras.

CONTEXT: Quantitative estimates of the magnitude, direction, and rate of change of health inequalities play a crucial role in creating and assessing policies aimed at eliminating the disproportionate burden of disease in disadvantaged populations. It is generally assumed that the measurement of health inequalities is a value-neutral process, providing objective data that are then interpreted using normative judgments about whether a particular distribution of health is just, fair, or socially acceptable. METHODS: We discuss five examples in which normative judgments play a role in the measurement process itself, through either the selection of one measurement strategy to the exclusion of others or the selection of the type, significance, or weight assigned to the variables being measured. FINDINGS: Overall, we find that many commonly used measures of inequality are value laden and that the normative judgments implicit in these measures have important consequences for interpreting and responding to health inequalities. CONCLUSIONS: Because values implicit in the generation of health inequality measures may lead to radically different interpretations of the same underlying data,we urge researchers to explicitly consider and transparently discuss the normative judgments underlying their measures. We also urge policymakers and other consumers of health inequalities data to pay close attention to the measures on which they base their assessments of current and future health policies.

Impact of selective evidence presentation on judgments of health inequality trends: an experimental study.

Reducing health inequalities is a key objective for many governments and public health organizations. Whether inequalities are measured on the absolute (difference) or relative (ratio) scale can have a significant impact on judgments about whether health inequalities are increasing or decreasing, but both of these measures are not often presented in empirical studies. In this study we investigated the impact of selective presentation of health inequality measures on judgments of health inequality trends among 40 university undergraduates. We randomized participants to see either a difference or ratio measure of health inequality alongside raw mortality rates in 5 different scenarios. At baseline there were no differences between treatment groups in assessments of inequality trends, but selective exposure to the same raw data augmented with ratio versus difference inequality graphs altered participants' assessments of inequality change. When absolute inequality decreased and relative inequality increased, exposure to ratio measures increased the probability of concluding that inequality had increased from 32.5% to 70%, but exposure to difference measures did not (35% vs. 25%). Selective exposure to ratio versus difference inequality graphs thus increased the difference between groups in concluding that inequality had increased from 2.5% (95% CI -9.5% to 14.5%) to 45% (95% CI 29.4 to 60.6). A similar pattern was evident for other scenarios where absolute and relative inequality trends gave conflicting results. In cases where measures of absolute and relative inequality both increased or both decreased, we did not find any evidence that assignment to ratio vs. difference graphs had an impact on assessments of inequality change. Selective reporting of measures of health inequality has the potential to create biased judgments of progress in ameliorating health inequalities.