Intersectionality and public understandings of health inequity in England: learning from the views and experiences of young adults

OBJECTIVES

Attempts to reduce health inequities in England frequently prioritise some equity dimensions over others. Intersectionality highlights how different dimensions of inequity interconnect and are underpinned by historic and institutionalised power imbalances. We aimed to explore whether intersectionality could help us shed light on young adults' understanding of health inequities.

STUDY DESIGN

The study incorporatedqualitative thematic analysis of primary data.

METHODS

Online focus groups with young adults (n = 25) aged 18-30 living in three English regions (Greater London; South Yorkshire/Midlands; North-East England) between July 2020 and March 2021. Online semistructured interviews (n = 2) and text-based communication was conducted for participants unable to attend online groups.

RESULTS

Young adults described experiencing discrimination, privilege, and power imbalances driving health inequity and suggested ways to address this. Forms of inequity included cumulative, within group, interacting, and the experience of privilege alongside marginalisation. Young adults described discrimination occurring in settings relevant to social determinants of health and said it adversely affected health and well-being.

CONCLUSION

Intersectionality, with its focus on discrimination and identity, can help public health stakeholders engage with young adults on health equity. An upstream approach to improving health equity should consider multiple and intersecting forms of discrimination along with their cultural and institutional drivers.

346 Feeding Hempseed Cake Alters the Bovine gut, Respiratory and Reproductive Microbiota

A growing number of studies have investigated the viability of feeding hemp by-products as livestock feedstuffs; however, their impact on livestock microbiomes remains unexplored. Here, we evaluated the effects of feeding hempseed cake (HSC) on the gastrointestinal, respiratory, and reproductive microbiota in beef heifers. Angus-crossbred heifers [19-months old; initial body weight (BW) = 494 ± 10 kg] were fed a corn-based finishing diet (10% forage) containing either 20% HSC (n = 15) or 20% corn distillers grains (Control, n = 16) for 111 days until slaughter. Individual feed intake, feeding behavior and BW were measured throughout the study. Rumen fluid and deep nasopharyngeal swabs (days 0 7, 42, 70 and 98), and vaginal and uterine swabs (at slaughter) were collected, and the microbiota assessed using 16S rRNA gene sequencing. HSC feeding resulted in reduced average daily gain (P = 0.05) without influencing feed intake and feeding behavior (P > 0.05) (reported elsewhere). Sampling time had a significant effect on both ruminal (PERMANOVA: R2 = 0.39; P < 0.001) and nasopharyngeal (R2 = 0.18; P < 0.001) microbial community structure. There was also a significant effect of diet on the ruminal (d7– 98; 0.06 ≤ R2 ≤ 0.12; P < 0.05), nasopharyngeal (d 42; R2= 0.18; P < 0.001), and vaginal (R2 = 0.06; P < 0.01) microbiota. Although microbial richness in the rumen, nasopharynx, vagina, and uterus was not affected (P > 0.05) by HSC feeding, microbial diversity (Shannon diversity) was increased in the rumen (d42-98) but reduced in the uterus of HSC heifers (P < 0.05). The relative abundance of five ruminal genera was enriched, while five vaginal genera were reduced in HSC heifers (P < 0.05). Overall, the results of our longitudinal study suggest that feeding hemp by-products can alter the bovine gut, respiratory and reproductive microbiota.

367 Characterization of the Seminal Microbiota in Beef Bulls Subjected to Different Rate of Gains Using 16S Rrna Gene Sequencing and Culturomics

Increasing evidence supports the existence of a microbial community in bovine semen, and that this seminal microbiota may influence not only the male reproductive health, but also female and offspring health through microbial transfer. In this study, we evaluated seminal microbiota in beef bulls (BW= 503±7.2 kg) fed a common diet to achieve moderate (1.13 kg/d) or high (1.80 kg/d) rates of weight gain. Semen samples were collected at day 0 and day 112 of dietary intervention (n = 19 per group), and post-breeding (n = 6) using electroejaculation and the microbiota assessed using 16S rRNA gene sequencing, quantification of total bacteria by qPCR, and viable bacteria culturing. A complex and dynamic microbiota was detected in the semen, and the community structure changed significantly over the course of the study (R 2 = 0.126, P < 0.001) but remained unaffected by the dietary treatment (P > 0.05). Microbial richness (number of ASVs) increased from d0 (253 ± 12) to d112 (293 ± 14) while diversity (Shannon index) was reduced (P < 0.05). Twenty-seven bacterial phyla were identified across all samples, with Fusobacteriota (36.3%), Bacteroidetes (30.4%), Firmicutes (17.1%) and Actinobacteriota (14.9%) being the most predominant phyla. Total bacterial load declined over time (P < 0.05). Diet had no effect on alpha diversity metrics, microbial composition, or total bacterial concentration (P > 0.05). A total of 364 bacterial isolates were recovered under aerobic (n = 220) and anaerobic (n = 144) culturing conditions. These isolates represented 48 different genera within the Firmicutes (60%), Proteobacteria (25%), Actinobacteria (9%), Bacteroidetes (4%) and Fusobacteriota (2%) phyla. Bacillus, Staphylococcus, Escherichia, Enterococcus and Arthrobacter were the predominant genera. Overall, our results suggest that bovine semen harbors a rich and complex microbiota which changes over time but appears to be resilient to differential gains achieved via common diet.

10 Development of an Essential Oil-Based Intranasal Spray Against Bovine Respiratory Pathogens: in vitro Selection Based on Antimicrobial, Antiviral, Immunomodulatory, and Antibiofilm Activities

The objective of this study was to screen and select candidate essential oils (EOs) for the development of an intranasal EO spray against bacterial and viral pathogens associated with bovine respiratory disease (BRD) as an alternative to antibiotics. The effects of previously selected EOs (N = 6; ajowan, cinnamon leaf, citronella, grapefruit, fennel, and thyme) on bovine nasopharyngeal microbiota culture was evaluated using 16S rRNA gene sequencing. The microbiota culture was prepared by growing nasopharyngeal swabs obtained from finishing beef heifers in brain heart infusion broth with and without the presence of EOs (0.025%, vol/vol). The sequencing was performed on genomic DNA extracted from the microbiota culture harvested after 24 h incubation. These EOs were then evaluated for their immunomodulation effect on bovine turbinate (BT) cells by analyzing the concentrations of 15 cytokines and chemokines in cell culture after 24 h incubation. The EOs were further characterized by assessing their antibiofilm activity against E. coli UMN026 using a crystal violet assay. Finally, 15 EOs were screened for their antiviral activity against the bovine viral diarrhea virus 1 (BVDV1) using BT cells and a fluorescence-based method. Ajowan, fennel, and thyme resulted in a moderate reduction of overall nasopharyngeal microbiota growth, and significant alterations of both α- and β-diversity, and relative abundance of predominant bacterial families (e.g., boosting Enterobacteriaceae while suppressing Moraxellaceae) compared with control (P < 0.05). Only IL-6 and IL-8 cytokine concentrations were affected by EOs (P < 0.05). Ajowan, thyme, fennel, and cinnamon leaf exhibited antibiofilm activity at the concentration of 0.05%. Reduction of BVDV1 viral replication on BT cells was observed with thyme (strong), ajowan, and citronella (moderate; 0.0125%). Accordingly, ajowan, thyme, fennel, cinnamon leaf, and citronella EOs were selected for development as an intranasal EO spray to prevent and control BRD pathogens in feedlot cattle.

Assessment of the status and trends in abundance of a coastal pinniped, the Australian sea lion Neophoca cinerea

Australian sea lions Neophoca cinerea are endemic to Australia, with their contemporary distribution restricted to South Australia (SA) and Western Australia (WA). Monitoring of the species has proved challenging due to prolonged breeding events that occur non-annually and asynchronously across their range. The most recent available data from 80 extant breeding sites (48 in SA, 32 in WA) enabled us to estimate the species-wide pup abundance to be 2739, with 82% (2246) in SA and 18% (493) in WA, mostly based on surveys conducted between 2014 and 2019. We evaluated 1776 individual site-surveys undertaken between 1970 and 2019 and identified admissible time-series data from 30 breeding sites, which revealed that pup abundance declined on average by 2.0% yr-1 (range 9.9% decline to 1.7% growth yr-1). The overall reduction in pup abundance over 3 generations (42.3 yr) was estimated to be 64%, with over 98% of Monte Carlo simulations producing a decline >50% over a 3-generation period, providing strong evidence that the species meets IUCN ‘Endangered’ criteria (decline ≥50% and ≤80%). The population is much smaller than previously estimated and is declining. There is a strong cline in regional abundances (increasing from west to east), with marked within-region heterogeneity in breeding site pup abundances and trends. Results from this study should improve consistency in the assessment of the species and create greater certainty among stakeholders about its conservation status. To facilitate species management and recovery, we prioritise key data gaps and identify factors to improve population monitoring.

Effects of a novel three-step sous-vide cooking and subsequent chilled storage on the microbiota of beef steaks

This study aimed to evaluate a novel three-step sous-vide (SV) method on bacterial growth and diversity, and its relationship to product storage life. Vacuum-packed naturally contaminated steaks were sequentially cooked at 39 °C (1 h), 49 °C (1 h), and 59 °C (4 h), then stored at -1.5 and 2 °C for 28 d, with a single-step SV at 59 °C for 4 h for comparison. None of the seven indicator bacteria tested proliferated (P > .05) after incubation at 39 or 49 °C; microbial diversity was also unaffected. Bacterial load was reduced (P < .05) by up to 5 log units with both (P > .05) SV methods. The odour of all steaks remained acceptable on d 28. Unexpectedly, during storage, Pseudomonas, not lactic acid bacteria, dominated the microbiota on steaks cooked by either SV method, likely due to the temperature shift-induced lag phase and/or heat sensitivity of psychrotrophic bacteria. In conclusion, the three-step SV did not lead to bacterial proliferation or compromise the storage life of cooked products.

Impact of peer support on inpatient and outpatient payments among people with Type 2 diabetes: a prospective cohort study

AIM

To investigate the impact of a low-cost diabetes peer-support intervention, aimed at reducing inpatient and outpatient care utilization and healthcare payments, by conducting a cohort study that followed up a randomized controlled trial.

METHODS

A total of 1121 adults with Type 2 diabetes were recruited through general practices in Cambridgeshire and Hertfordshire, UK, and were followed up for 3.25 financial years after 8-12 months of one-to-one, group or combined diabetes peer support and usual care. Use of, and payments for inpatient and outpatient services were fully recorded in the follow-up. Adjusted mean inpatient and outpatient payments per person were estimated using a two-part model after adjusting for baseline characteristics.

RESULTS

The mean age of the recruited adults was 65.6±11.4 years, 60.4% were male, and 16.8% were insulin-treated. Compared with the control group, less healthcare utilization (especially non-elective inpatient care and outpatient consultations) was observed in each of the intervention groups, particularly the combined intervention group. Over the course of 3.25 financial years, significant reductions of 41% (£909.20 per head) were observed for overall inpatient payments (P<0.0001), 51% (£514.67 per head) for non-elective inpatient payments (P=0.005) in the combined intervention group, and 34% (£413.30 per head) and 32% (£388.99 per head) for elective inpatient payments in the one-to-one (P=0.029) and combined intervention (P=0.048) groups, respectively.

CONCLUSIONS

Type 2 diabetes peer support, whether delivered using a one-to-one, group or combined approach was associated with reduced inpatient care utilization (particularly non-elective admissions) and payments over 3.25 years.

Combined therapeutic use of AdGFPFasL and small molecule inhibitors of ceramide metabolism in prostate and head and neck cancers: a status report

As of January 2005, there were 1020 gene therapy clinical trials ongoing worldwide with 675 or 66.2% devoted to cancer gene therapy. The majority are occurring in the US and Europe (http://www.wiley.co.uk/genetherapy/clinical/). At the present time, to our knowledge there are no trials that employ gene delivery of Fas Ligand (FasL). As an important note, and in contrast to somatic cell therapy trials, there are no reported deaths due to therapeutic vector administration in any cancer gene therapy trial. That said, from our studies and from the published literature, the issue of gene delivery remains the major obstacle to successfully employing gene therapy for cancer treatment. Numerous laboratories are studying this with many different approaches. My co-workers and I have focused on the delivery issue by using various approaches that address tumor targeting and transgene expression. In addition, we are focusing on enhancing tumor cell killing via the bystander effect and through use of small molecules to enhance bystander activity.

Osteogenic potential of five different recombinant human bone morphogenetic protein adenoviral vectors in the rat

Bone morphogenetic protein (BMP) adenoviral vectors for the induction of osteogenesis are being developed for the treatment of bone pathology. However, it is still unknown which BMP adenoviral vector has the highest potential to stimulate bone formation in vivo. In this study, the osteogenic activities of recombinant human BMP-2, BMP-4, BMP-6, BMP-7, and BMP-9 adenoviruses were compared in vitro, in athymic nude rats, and in Sprague-Dawley rats. In vitro osteogenic activity was assessed by measuring the alkaline phosphatase activity in C2C12 cells transduced by the various BMP vectors. The alkaline phosphatase activity induced by 2 x 10(5) PFU/well of BMP viral vector was 4890 x 10(-12) U/well for ADCMVBMP-9, 302 x 10(-12) U/well for ADCMVBMP-4, 220 x 10(-12) U/well for ADCMVBMP-6, 45 x 10(-12) U/well for ADCMVBMP-2, and 0.43 x 10(-12) U/well for ADCMVBMP-7. The average volume of new bone induced by 10(7) PFU of BMP vector in athymic nude rats was 0.37+/-0.03 cm(3) for ADCMVBMP-2, 0.89+/-0.07 cm(3) for ADCMVBMP-4, 1.02+/-0.07 cm(3) for ADCMVBMP-6, 0.24+/-0.05 cm(3) for ADCMVBMP-7, and 0.63+/-0.07 cm(3) for ADCMVBMP-9. In immunocompetent Sprague-Dawley rats, no bone formation was demonstrated in the ADCMVBMP-2, ADCMVBMP-4, and ADCMVBMP-7 groups. ADCMVBMP-6 at a viral dose of 10(8) PFU induced 0.10+/-0.03 cm(3) of new bone, whereas ADCMVBMP-9 at a lower viral dose of 10(7) PFU induced more bone, with an average volume of 0.29+/-0.01 cm(3).

Long-term safety analysis of preventive HIV-1 vaccines evaluated in AIDS vaccine evaluation group NIAID-sponsored Phase I and II clinical trials

This report evaluates long-term safety data from 3189 human immunodeficiency virus type 1 (HIV-1) uninfected, healthy volunteers who were enrolled into 51 National Institute of Allergy and Infectious Diseases (NIAID)-sponsored Phase I and II multicentred, randomized, double-blind trials of recombinant HIV-1 subunit vaccines (23 studies), synthetic peptide vaccines (7 studies), live vaccinia-vector recombinant envelope vaccines (7 studies), canarypox vector recombinant vaccines (13 studies), a DNA vaccine (1 study), and a Salmonella-vector vaccine (1 study). During the 12,340 person-years of follow-up, participants were monitored for adverse events including immune dysfunction/autoimmunity, anaphylaxis, cancer, death, and vaccine allergy. The analysis provides evidence that a preparation of a C4-V3 polypeptide vaccine emulsified in incomplete Freund's caused serious toxicity, but otherwise no safety problems considered serious were identified for any of the vaccines and adjuvants studied. These data serve to solidify the growing safety base of current vaccine technologies utilized in candidate vaccines for HIV-1 infection.

A new rat model to study the correlation of cardiac and skeletal muscle allograft rejection

As a first step to study the correlation of cardiac and skeletal muscle allograft rejection, we describe a new experimental rat model of simultaneous heterotopic heart and cutaneous maximus muscle flap allotransplant. Brown Norway rats were used as donors and Lewis rats as recipients. No immunosuppression was given. The grafts were revascularized with sequential end-to-side anastomosis of each vascular pedicle to the infrarenal aorta and vena cava. Syngeneic heart and cutaneous maximus muscle grafts remained functional and showed no sign of rejection at 7 days after the transplant. In contrast, both allografts developed severe rejection and functional compromise at 7 days after the transplant. Our experimental model is technically feasible and reproducible and may provide important information about the pattern of rejection of cardiac and skeletal muscle allografts.

Use of a state data bank to measure incidence and prevalence of a chronic disease: end-stage renal failure

The Western Australian Health Services Research Linked Database was used to examine trends in the incidence rate and prevalence of end-stage renal failure and to describe treatment patterns in these patients. Linked hospital morbidity and mortality records from 1980 to 1994 were selected if a record had a principal diagnosis or procedure of chronic renal failure, dialysis, or renal transplantation. Patient records were grouped according to the stage of care (predialysis, dialysis, transplant, or death). A total of 1, 046 patients with a principal diagnosis or procedure that met our criteria for end-stage renal failure was admitted to the hospital from 1985 to 1994. Trends in the incidence rate and prevalence of end-stage renal failure by sex and race, patterns of care, indices of comorbidity, and waiting time to transplantation were calculated. Results showed that both the incidence rate and prevalence of end-stage renal failure increased from 1986 to 1994, most noticeably in the aboriginal population. Rates of renal failure in 1994 were 15 times greater in aborigines than in nonaborigines. Of the hospital patients, 73.5% received dialysis three times a week. Complications associated with dialysis treatment were the most common cause of comorbid hospitalization. The mean waiting time to transplantation was 503 days for those who had a transplant and 6.3 years for all patients. The escalating numbers of patients undergoing renal dialysis, the high cost of maintaining them on dialysis, and the additional use of hospital services for comorbid conditions highlight the need to develop programs to prevent the occurrence of renal failure, particularly in the aboriginal population.

A survey of contraceptive use and unplanned pregnancy in Perth, Western Australia

Contraceptive use and unplanned pregnancy were studied in a stratified cluster sample of 1,511 couples with women aged 16 to 44 years resident in metropolitan Perth in 1988. Twenty-one couples were excluded from analysis owing to missing data. The proportion of couples using contraception was 76.8 per cent (1,144 of 1,490), and all but three of the remaining couples gave a reason for nonuse. Among users, surgical sterilisation made up 42.3 per cent (484 of 1,144) of all methods, with a slight predominance of tubal ligation over vasectomy. Oral contraceptives accounted for just over half of nonsurgical methods. Comparisons with a Victorian survey performed in 1978 suggested that surgical methods and condom use may have increased, whereas use of oral contraceptives and intrauterine devices may have fallen. Unplanned pregnancies conceived during the 12 months before the interview affected 3.4 per cent (51 of 1,490) of respondents. The incidence of unplanned pregnancy was four times higher in couples with inconsistent usage patterns of contraception.

A survey of infertility, surgical sterility and associated reproductive disability in Perth, Western Australia

Infertility, surgical sterility and associated reproductive disability were studied in a stratified cluster sample of 1,511 couples with women aged 16 to 44 years resident in metropolitan Perth in 1988. Sixteen couples were omitted from analysis because of missing data. The proportion of couples affected by current infertility was 3.5 per cent (53 of 1,495), and 67.9 per cent of these (36 of 53) had a reproductive disability, meaning that they were unable to achieve their desired level of reproductive function. Those affected by surgical sterility accounted for 37.1 per cent (555 of 1,495), and of these couples 2.0 per cent (11 of 555) had a reproductive disability. Empirically, the prevalence of both infertility and reproductive disability peaked at ages 30 to 34 years in the female partner. Of the factors studied, infertility was associated with surgery for a ruptured appendix, a history of pelvic inflammatory disease and number of sexual partners. In 10 of the 47 couples with reproductive disability, contraceptive sterilisation had been a cause of later regret. Most other cases were due to infertility. Almost one half of couples with reproductive disability had sought treatment. The affected couples had at least one child from the current union in 23 of the 47 cases of reproductive disability. The results support the need for development of a strategy to prevent infertility and other causes of reproductive disability.

The effect of spine fusion on respiratory function in Duchenne muscular dystrophy

Serial measures of respiratory function were made in 17 patients with Duchenne muscular dystrophy who underwent segmental spine fusion and in 22 patients who did not. No significant differences were observed between the 2 groups (operated vs. nonoperated) in terms of declining respiratory function. Nonetheless, all operated patients reported either improved sitting comfort, appearance, or both. Thus, our results suggest that there are distinct benefits from segmental spine fusion; however, there was no salutary effect upon respiratory function either in the short term or after up to 5 years follow-up.

Increasing mortality from cancer of the cervix in young Australian women

Mortality from uterine cancer in Australia has fallen progressively since 1908, as has mortality from cancer of the cervix specifically since it was distinguished, in statistics, from other uterine cancer in 1950. However, in women aged under 40 years, this trend has reversed recently, and cervical cancer mortality has risen since about 1970. This rise has also been shown by incidence data collected by the New South Wales Central Cancer Registry. Similar increases have been observed in New Zealand, Britain at least, appear to parallel increases in promiscuous sexual activity. Increases in the frequency of cervical cancer in older women can be expected when the cohorts affected (those born after 1935) reach older age groups.