Building Resilient African Food Systems after COVID-19: ReSAKSS 2021 Annual Trends and Outlook Report

The report assesses the impacts of COVID-19 on African economies and food systems, examines African governments' responses to the pandemic, including the expansion of social protection, discusses measurement and methodological issues related to gauging countries' vulnerability and resilience to crises, and makes recommendations to ensure the recovery and resilience of African food systems. The report also reviews progress in CAADP implementation and examines the likely impacts of COVID-19 on the CAADP Results Framework indicators.

Reanalysis-driven simulations may overestimate persistent contrail formation by 100-250%

Model-based estimates of aviation’s climate impacts have found that contrails contribute 36 – 81% of aviation’s instantaneous radiative forcing. These estimates depend on the accuracy of meteorological data provided by reanalyses like ERA5 and MERRA-2. Using data from 793,044 radiosondes, we find persistent contrails forming at cruise altitudes in 30N – 60S are overestimated by factors of 2.0 and 3.5 for ERA5 and MERRA-2 respectively. Seasonal and inter-annual trends are well-reproduced by both models (R2 = 0.79 and 0.74). We also find a contrail lifetime metric is overestimated by 17% in ERA5 and 45% in MERRA-2. Finally, the reanalyses incorrectly identify individual regions that could form persistent contrails 87% and 52% of the time respectively. These results suggest that contrail models currently overestimate the number and lifetime of persistent contrails. Additional observations are needed for future models to provide locally accurate estimates of contrails or support mitigation strategies.

Changes in hyperglycaemia-related testing for prediabetes and type 2 diabetes mellitus management: a prospective, cross-sectional survey of 16 years of general practice data from Australia

BackgroundThe rising prevalence of prediabetes increases the population risk of type 2 diabetes mellitus (T2DM), metabolic syndrome and cardiovascular disease. Early identification by General Practitioners (GPs) provides opportunities for lifestyle modifications that can lower these risks.MethodsThis study examined 16 years of annual trends (2000/01-20015/16) in hyperglycaemia-related testing for patients in Australia aged 13 years or older with, or at risk of a diagnosis of T2DM. The Bettering the Evaluation and Care of Health (BEACH) study is a national cross-sectional survey, with a single-stage, cluster sampling design. Approximately 1,000 GPs were randomly selected annually (2000/01-20015/16) from across Australia, who each recorded details of 100 consecutive clinical encounters with consenting patients. Means and 95% confidence intervals were adjusted for intracluster correlation and GP characteristics.Results15,679 GPs recorded details of 1,387,190 clinical encounters with patients aged 13+ years. Prediabetes and T2DM were managed at 0.25% (95% CI: 0.24-0.27%) and 3.68% (95% CI: 3.62-3.73%) of encounters respectively. By the end of the study, annual management rates were 2.3 times higher for prediabetes and 1.5 times for T2DM management. The likelihood of ordering at least one hyperglycaemia-related test during prediabetes management occasion was twice the likelihood in management of T2DM. For prediabetes, glucose tolerance tests were most common but from 2014/15, requests for HbA1c tests began to increase. For T2DM, HbA1c tests were most common, and requests for one or more glucose tests gradually declined.ConclusionThe observed 16-year annual trends align with the rising incidence of prediabetes and T2DM. GPs appeared to be strongly influenced by changes to the national insurance scheme and clinical guidelines for hyperglycaemia-related pathology testing. However, some GPs may have been pre-empting policy changes as there was also evidence of ‘unendorsed’ testing, notably for prediabetes that warrants further investigation. The increasing management rates for prediabetes, coupled with higher rates of pathology requesting have substantial resource implication. Calls to lower the risk threshold for prediabetes screening therefore warrant an economic analysis. Ongoing, reliable, up-to-date data is needed to inform clinical practice guidelines and policy in Australia.

A longitudinal analysis of pneumococcal vaccine serotypes in pneumonia patients in Germany

Recently, a 15-valent (PCV15) and a 20-valent pneumococcal conjugate vaccine (PCV20) have been licensed by the US Food and Drug Administration and are under evaluation by the European Medicines Agency.PCV15 contains all serotypes of the 13-valent conjugate vaccine (PCV13) plus serotype 22F and 33F and PCV20 includes PCV13 serotypes plus serotype 8, 10A, 11A, 12F, 15B, 22F and 33F. We investigated pneumococcal serotype distribution, secular trends and proportion of pneumonia caused by serotypes included in PCV13, PCV15, PCV20, and the 23-valent pneumococcal polysaccharide vaccine (PPV23) among adult patients with all-cause community-acquired pneumonia (CAP) between 2013 and 2019. We applied logistic mixed regression modelling to assess annual trends. Urine samples from adult patients with CAP treated in the community or hospital in Germany and included in the CAPNETZ study, a prospective multi-centre cohort study, were analysed by two serotype-specific multiplex urinary antigen detection assays (UAD1/UAD2) at Pfizer's Vaccines Research and Development Laboratory. UAD1 detects serotypes in PCV13, UAD2 detects additional serotypes in PCV20 plus serotypes 2, 9N, 17F and 20. Out of 1,831 patients screened, urine samples with a valid UAD test result were available for 1,343 patients (73.3%). Among those patients, 829 patients (61.7%) were male, 792 patients (59,0%) were aged 60 years and above, 1038 patients (77.3%) had at least one comorbidity and 1,204 patients (89.7%) were treated in the hospital. The overall proportion of vaccine-type pneumonia among all-cause CAP for PCV13, PCV15, PCV20 and PPV23 was 7.7% (n=103), 9.1% (n=122), 12.3% (n=165) and 13.3% (n=178). Over the entire observation period, we did not observe evidence for significant annual trends in pneumococcal vaccine serotype coverage against pneumonia in adults (PCV13: OR 0.94, 95% CI 0.83-1.05; PCV15: OR 0.93, 95% CI 0.84-1.03; PCV20: OR 0.95, 95% CI 0.86-1.04; PPV23: OR 0.99, 95% CI 0.90-1.08). In conclusion, our data show that i) the infant vaccination program of PCV13, which started in Germany 2010 did not result in a relevant and sustained decrease of PCV13 serotypes in pneumonia in adults and ii) that the gap in the coverage between PCV20 and PPV23 was small and did not increase over the entire observation time.

Nationwide trends in in-patient chemotherapy hospitalizations, cost, and mortality for patients with testicular carcinoma.

e17012 Background: Salvage therapy for advanced Testicular Carcinoma involves patients receiving ifosfamide are treated in hospital for risk of neuro-toxicities. We evaluated annual trends to assess the health care burden of testicular patients admitted for chemotherapy, as well as co-morbidities and complications associated with mortality. Methods: The National Inpatient Sample is a nationwide sample of all US hospital discharges. We collected data from the years of 2002 to 2017 on patients with Testicular Carcinoma who were receiving chemotherapy, to capture patients recieving ifosfamide and cisplatin in an in-patient setting. Patients undergoing an autologous stem cell transplant were excluded. Annual trends for inpatient mortality, length of stay, and total costs of admission were assessed. A univariate logistic regression analysis was used to calculate odds ratios (OR) for the effect of comorbid conditions and acute inpatient complications on in-patient mortality. Results: Hospitalizations for ifosfamide and cisplatin based treatment among patients with Testicular Carcinoma remained stable from a weighted national estimate of 2,261 in 2002 to 2,160 in 2017. Length of stay increased from 4.6 days to 5.5 days (p=0.01). Cost of stay increased from $26,140 to $53,193 (p <0.001) when adjusted for inflation. The average age of patients was 32.6 years. In-patient mortality was low at 0.2% in 2002 to <0.1% in 2017. Among comorbid conditions, heart failure was associated with increased mortality (OR 21.9). Among acute complications – acute kidney injury (OR 32.6), infection (OR 15.3), neurotoxicity (OR 12.3) were associated with significantly higher mortality. Conclusions: The increase in cost of stay is out of proportion to increases in length of stay. Indicating a disproportionate increase in financial toxicity for these patients. Patients with underlying heart disease are at increased risk of complications. Care needs to be taken to specifically identify patients at risk for renal failure and infectious complications.[Table: see text]