18051
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Affiliation(s)
- Robert D Brook
- Division of Cardiovascular Diseases Wayne State University Detroit MI
| | - Sanjay Rajagopalan
- University Hospitals, Harrington Heart and Vascular InstituteCase Western Reserve University Cleveland OH
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18052
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Zacarías-Pons L, Vilalta-Franch J, Turró-Garriga O, Saez M, Garre-Olmo J. Multimorbidity patterns and their related characteristics in European older adults: A longitudinal perspective. Arch Gerontol Geriatr 2021; 95:104428. [PMID: 33991948 DOI: 10.1016/j.archger.2021.104428] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The concurrence of several chronic conditions is a rising concern that poses a serious burden on ageing populations. Analysing how these conditions appear together and how they change through time may provide useful information to design successful multimorbidity-management programs. OBJECTIVE To identify multimorbidity patterns and their related characteristics from a longitudinal perspective. SUBJECTS 25,931 older adults aged 50+ drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE), a population-based longitudinal European study. METHODS A sex-stratified Latent Transition Analysis was conducted to fit latent classes based on 15 self-reported chronic conditions across three time points. Health-related and socioeconomic variables were assessed as covariates of those patterns. RESULTS We identified 4 time-constant latent classes for each sex. A "severely impaired" class (with a weighted prevalence percentage of 7.24% for females and 3.30% for males at the first time point), a "metabolic" class (26.15% and 23.82%) and a "healthy" class (50.92% and 54.32%). The fourth class was named "osteoarticular" for females (15.70%) and "articular-COPD-ulcer" for males (18.56%). Age, smoke, material deprivation and a high body mass index were associated with worse health patterns, whereas education, being employed and physical activity were related to less multimorbid classes. Few class changes were detected when modelling transitions. CONCLUSIONS We reported information of multimorbidity classes and their characteristics that may help to develop targeted health strategies. Within a time window of four years, the identified latent classes were consistent between time points.
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Affiliation(s)
- Lluís Zacarías-Pons
- Research Group on Aging, Disability and Health, Girona Biomedical Research Institute (IDIBGI), Catalonia, Spain.
| | - Joan Vilalta-Franch
- Research Group on Aging, Disability and Health, Girona Biomedical Research Institute (IDIBGI), Catalonia, Spain
| | - Oriol Turró-Garriga
- Research Group on Aging, Disability and Health, Girona Biomedical Research Institute (IDIBGI), Catalonia, Spain; Institut d'Assistència Sanitària, Catalonia, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Josep Garre-Olmo
- Research Group on Aging, Disability and Health, Girona Biomedical Research Institute (IDIBGI), Catalonia, Spain; Institut d'Assistència Sanitària, Catalonia, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Catalonia, Spain
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18053
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Pengpid S, Peltzer K. Ideal Cardiovascular Health Behaviours in Nationally Representative School-Based Samples of Adolescents in the Caribbean. Vasc Health Risk Manag 2021; 17:187-194. [PMID: 33976549 PMCID: PMC8106475 DOI: 10.2147/vhrm.s302168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Ideal cardiovascular health behaviour (CVHB) measures four ideal health behaviours (non-smoking, body mass index <85th Percentile, healthy diet, and physical activity). This study aimed to determine the prevalence, distribution, and correlates of ideal CVHB among adolescents in the Caribbean. Methods Nationally representative cross-sectional data of 2016 or 2017 with complete CVHB measurements were analysed from 7556 school adolescents from four Caribbean countries. Results The prevalence of 0-1 ideal metrics CVHB was 20.4%, 2 ideal metrics 48.7%, and 3-4 ideal metrics 30.8%. Only 5.0% had all 4 ideal CVHB metrics, 41.0% intermediate CVH (≥1 metric in the intermediate category and none in the poor category), and 54.0% had poor CVH (≥1 metric in poor category). In adjusted logistic regression analysis, compared to students from Dominican Republic, students from Jamaica (Adjusted Odds Ratio-AOR: 1.36, 95% confidence interval-CI: 1.01-1.85), students from Trinidad and Tobago (AOR: 1.46, 95% CI: 1.17-1.82) and male sex (AOR: 1.35, 95% CI: 1.11-1.64) were positively associated with meeting 3-4 ideal CVHB metrics. In addition, in unadjusted analysis, rarely or sometimes experiencing hunger was negatively and high peer and parent support were positively associated with meeting 3-4 ideal CVHB metrics. Conclusion The proportion of meeting 3-4 ideal CVHB metrics was low among adolescents in four Caribbean countries. Both high-risk and school-wide intervention programmes should be implemented in aiding to improve CVHB in Caribbean countries. Several factors associated with ideal CVHB were identified, which can be targeted in school health interventions.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Nakhon Pathom, Thailand.,Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
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18054
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Synthesis and Antidepressant Activity of 4-Alkyl-5-Bromo-2,4-Dihydro-2-(Thietan-3-YL)-1,2,4-Triazol-3-Ones. Pharm Chem J 2021. [DOI: 10.1007/s11094-021-02394-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18055
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Association between knee symptoms, change in knee symptoms over 6-9 years, and SF-6D health state utility among middle-aged Australians. Qual Life Res 2021; 30:2601-2613. [PMID: 33942204 DOI: 10.1007/s11136-021-02859-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Health state utilities (HSUs) are an input metric for estimating quality-adjusted life-years (QALY) in cost-utility analyses. Currently, there is a paucity of data on association of knee symptoms with HSUs for middle-aged populations. We aimed to describe the association of knee symptoms and change in knee symptoms with SF-6D HSUs and described the distribution of HSUs against knee symptoms' severity. METHODS Participants (36-49-years) were selected from the third follow-up (completed 2019) of Australian Childhood Determinants of Adult Health study. SF-6D HSUs were generated from the participant-reported SF-12. Association between participant-reported WOMAC knee symptoms' severity, change in knee symptoms over 6-9 years, and HSUs were evaluated using linear regression models. RESULTS For the cross-sectional analysis, 1,567 participants were included; mean age 43.5 years, female 54%, BMI ± SD 27.18 ± 5.31 kg/m2. Mean ± SD HSUs for normal, moderate, and severe WOMAC scores were 0.820 ± 0.120, 0.800 ± 0.120, and 0.740 ± 0.130, respectively. A significant association was observed between worsening knee symptoms and HSUs in univariable and multivariable analyses after adjustment (age and sex). HSU decrement for normal-to-severe total-WOMAC and WOMAC-pain was - 0.080 (95% CI - 0.100 to - 0.060, p < 0.01) and - 0.067 (- 0.085 to - 0.048, p < 0.01), exceeding the mean minimal clinically important difference (0.04). Increase in knee pain over 6-9 years was associated with a significant reduction in HSU. CONCLUSION In a middle-aged population-based sample, there was an independent negative association between worse knee symptoms and SF-6D HSUs. Our findings may be used by decision-makers to define more realistic and conservative baseline and ongoing HSU values when assessing QALY changes associated with osteoarthritis interventions.
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18056
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Abstract
The current and immediate past Presidents of the World Heart Federation are pleased to publish this invited editorial to demonstrate the organization’s strong, ongoing commitment to addressing the impacts of air pollution on cardiovascular health and outline its strategy for action.
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18057
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Silva V, Martínez L, Santiago M, López A, Sánchez J, Vázquez-Garza E, Cantú F, García B, Chora D, Guerra M, Franco-Cabrera M. Interventional pain training using phantom model during COVID-19 pandemic. Pain Pract 2021; 21:984-990. [PMID: 33934501 PMCID: PMC8236913 DOI: 10.1111/papr.13026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
Background Fluoroscopic‐guided lumbar procedures have increased in daily pain practice because the lumbar spine is one of the most common sources of pain. Interventional pain fellows must develop a minimum number of skills during their training in order to achieve the competences without neglecting radiological safety. However, medical training in fluoroscopic‐guided interventions is being affected by the current coronavirus disease 2019 (COVID‐19) situation. Methods The objective of this study was to evaluate the use of a phantom model for lumbar injection as a training strategy during the COVID‐19 pandemic in fellows of interventional pain. The study was divided into theoretical and practical modules. The hands‐on practice was performed in a lumbar model phantom where fellows were evaluated in four fluoroscopically guided approaches: intra‐articular facet block (IAFB), medial branch block (MBB), transforaminal block (TFB), and interlaminar block (ILB) divided in 5 sessions. The aim was to make as many punctures as possible in every session. We measured total procedural performance (TPP), total needle hand time (TNH), and total radiation dose generated by the fluoroscopic machine (TRD) during each procedure. Additionally, a survey was applied to evaluate confidence and satisfaction before and after training. Results A total of 320 lumbar punctures were completed. The results were statistically significant in all approaches attempted (p < 0.01). The fellow’s survey for satisfaction and confidence demonstrated a significant difference between pre and post‐test (p < 0.01). Conclusions The results of this study highlight the importance of adaptations and adoption of new educational models. The use of the phantom model for simulation could be a strategy for other emerging situations, like the COVID‐19 pandemic. Including this practice in the interventional pain programs could lead to better results for the patient and operator radiology safety.
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Affiliation(s)
- Victor Silva
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Luis Martínez
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Margarita Santiago
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Anna López
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Juan Sánchez
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Eduardo Vázquez-Garza
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Fernando Cantú
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Baltazar García
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Daniel Chora
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Miguel Guerra
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - María Franco-Cabrera
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
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18058
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Moitra M, Santomauro D, Degenhardt L, Collins PY, Whiteford H, Vos T, Ferrari A. Estimating the risk of suicide associated with mental disorders: A systematic review and meta-regression analysis. J Psychiatr Res 2021; 137:242-249. [PMID: 33714076 PMCID: PMC8095367 DOI: 10.1016/j.jpsychires.2021.02.053] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mental disorders (MDs) are known risk factors for suicide. This systematic review updates the evidence base for this association and improves upon analytic approaches by incorporating study-level and methodological variables to account for measurement error in pooled suicide risk estimates. METHODS A systematic review was conducted to review studies on MDs as risk factors for suicide. Relevant studies were searched using PubMed, Embase, PsychINFO, and existing reviews from 2010 to 19. Studies were eligible if they were longitudinal/case-control studies, representative of the general population, used diagnostic instruments, and quantified suicide risk. The outcome assessed was relative risks (RRs) for suicide due to MDs. A multi-level meta-regression approach was used to obtain pooled RRs adjusted for covariates and between-study effects. FINDINGS We identified 20 eligible studies yielding 69 RRs. Disorder type, age, sex, use of psychological autopsy, study design, and adjustment for confounders were tested as predictors of pooled suicide risk. Overall, all disorders were significant predictors of suicide with predicted adjusted RRs ranging from 4·11 [2·09, 8·09] for dysthymia to 7·64 [4·3, 13·58] for major depressive disorder. INTERPRETATION Our results indicate that MDs are important risk factors for suicide. This systematic review provides pooled RRs that have been adjusted for methodological sources of bias. Findings from our paper may inform suicide prevention strategies as part of national health agendas.
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Affiliation(s)
- Modhurima Moitra
- Institute for Health Metrics and Evaluation, University of Washington, United States; Department of Global Health, University of Washington, United States.
| | - Damian Santomauro
- Institute for Health Metrics and Evaluation, University of Washington, United States; The University of Queensland, School of Public Health, Queensland, Australia; Queensland Centre for Mental Health Research, Queensland, Australia
| | - Louisa Degenhardt
- Institute for Health Metrics and Evaluation, University of Washington, United States; National Drug and Alcohol Research Center, University of New South Wales, Australia
| | - Pamela Y Collins
- Department of Global Health, University of Washington, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, United States
| | - Harvey Whiteford
- Institute for Health Metrics and Evaluation, University of Washington, United States; The University of Queensland, School of Public Health, Queensland, Australia; Queensland Centre for Mental Health Research, Queensland, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, United States
| | - Alize Ferrari
- Institute for Health Metrics and Evaluation, University of Washington, United States; The University of Queensland, School of Public Health, Queensland, Australia; Queensland Centre for Mental Health Research, Queensland, Australia
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18059
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Achievement of effective cardiopulmonary trauma surgical skills training throughout the incorporation of a low-cost and easy to implement pulsatile simulation model. Injury 2021; 52:1215-1220. [PMID: 33422290 DOI: 10.1016/j.injury.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/24/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES . In the last decade, concern regarding the preparedness of general surgery graduates to effectively manage thoracic trauma cases has been raised. However, due to limited availability and elevated costs, access to cardiopulmonary trauma simulation models is limited. This article describes our experience implementing a low-cost blended ex vivo tissue-based simulation model using animal by-products that incorporates pump perfusion and ventilation. DESIGN . Firstly, for validation purposes 8 junior residents, 8 recently graduated general surgeons, and 3 cardiothoracic surgery attendings from Pontificia Universidad Católica de Chile Clinical Hospital were recruited. Proficiency in performing a pulmonary tractotomy and a myocardial injury repair was assessed with global and specific rating scales. Secondly, to evaluate the effectiveness of the model as a learning tool, 16 general surgery residents from different programs across the country were recruited receiving intensive, personalized training on the models. Proficiency was measured before and after the training. RESULTS . For the validation phase, significant differences among groups according to the previous level of expertise were shown, and therefore construct validity was established. The results of the second phase showed a significant overall improvement in participant's performance. CONCLUSION . Effective training and assessment for advanced surgical skills in cardiothoracic trauma can be achieved using a low-cost pulsatile simulation model.
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18060
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Paton K, Gillam L, Warren H, Mulraney M, Coghill D, Efron D, Sawyer M, Hiscock H. Clinicians' perceptions of the Australian Paediatric Mental Health Service System: Problems and solutions. Aust N Z J Psychiatry 2021; 55:494-505. [PMID: 33461341 DOI: 10.1177/0004867420984242] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Despite substantial investment by governments, the prevalence of mental health disorders in developed countries remains unchanged over the past 20 years. As 50% of mental health conditions present before 14 years of age, access to high-quality mental health care for children is crucial. Barriers to access identified by parents include high costs and long wait times, difficulty navigating the health system, and a lack of recognition of the existence and/or severity of the child's mental health disorder. Often neglected, but equally important, are clinician views about the barriers to and enablers of access to high-quality mental health care. We aimed to determine perspectives of Australian clinicians including child and adolescent psychiatrists, paediatricians, psychologists and general practitioners, on barriers and enablers within the current system and components of an optimal system. METHODS A total of 143 clinicians (approximately 35 each of child and adolescent psychiatrists, paediatricians, child psychologists and general practitioners) from Victoria and South Australia participated in semi-structured phone interviews between March 2018 and February 2019. Inductive content analysis was applied to address the broad study aims. FINDINGS Clinician-identified barriers included multi-dimensional family factors, service fragmentation, long wait times and inadequate training for paediatricians and general practitioners. Rural and regional locations provided additional challenges but a greater sense of collaboration resulting from the proximity of clinicians in rural areas, creating an opportunity to develop support networks. Suggestions for an optimal system included novel ways to improve access to child psychiatry expertise, training for paediatricians and general practitioners, and co-located multidisciplinary services. CONCLUSION Within the current mental health system for children, structural, training and workforce barriers prevent optimal access to care. Clinicians identified many practical and systemic ideas to improve the system. Implementation and evaluation of effectiveness and cost effectiveness of these ideas is the next challenge for Australia's children's mental health.
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Affiliation(s)
- Kate Paton
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Lynn Gillam
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.,Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Hayley Warren
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Melissa Mulraney
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - David Coghill
- Mental Health, The Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Daryl Efron
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael Sawyer
- School of Psychology, University of Adelaide, Adelaide, SA, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Harriet Hiscock
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
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18061
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Affiliation(s)
- Martin Alda
- From the Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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18062
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18063
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Khanwilkar S, Gould CF, DeFries R, Habib B, Urpelainen J. Firewood, forests, and fringe populations: Exploring the inequitable socioeconomic dimensions of Liquified Petroleum Gas (LPG) adoption in India. ENERGY RESEARCH & SOCIAL SCIENCE 2021; 75:102012. [PMID: 33959474 PMCID: PMC8095680 DOI: 10.1016/j.erss.2021.102012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Liquified petroleum gas (LPG) is an important clean fuel alternative for households that rely on burning biomass for daily cooking needs. In India, Pradhan Mantri Ujjwala Yojana (PMUY) has provided poor households with LPG connections since 2016. We investigate cooking fuel use in households to determine the impact of the policy in the Central Indian Highlands Landscape (CIHL). The CIHL has a large population of marginalized social groups, including Indigenous, Scheduled Tribe, Schedule Caste, and Other Backward Caste people. We utilize survey data from 4,994 households within 500 villages living in forested regions collected in 2018 and a satellite-derived measure of forest availability to investigate the household and ecological determinants of LPG adoption and the timing of this adoption (pre- or post-2016). In addition, we document patterns of firewood collection and evaluate the extent to which households acquiring LPG change these activities. The probability of cooking with LPG was lowest for marginalized social groups. We observe that households recently adopting LPG, likely through PMUY, are poorer, more socially marginalized, less educated, and have more forest available nearby than their early-adopter counterparts. While 90% of LPG-using households continue to use firewood, households that have owned LPG for more years report spending less time collecting firewood, indicating a waning reliance on firewood over time. Policies targeting communities with marginalized social groups living near forests can further accelerate LPG adoption and displace firewood use. Despite overall growth in LPG use, disparities in access to clean cooking fuels remain between socioeconomic groups in India.
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Affiliation(s)
| | - Carlos F. Gould
- Columbia University Mailman School of Public Health, New York, United States
| | | | - Bilal Habib
- Wildlife Institute of India, Dehradun, India
| | - Johannes Urpelainen
- Johns Hopkins School of Advanced International Studies, Maryland, United States
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18064
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Morovatdar N, Avan A, Azarpazhooh MR, Di Napoli M, Stranges S, Kapral MK, Rezayat AA, Shariatzadeh A, Abootalebi S, Mokhber N, Spence JD, Hachinski V. Secular trends of ischaemic heart disease, stroke, and dementia in high-income countries from 1990 to 2017: the Global Burden of Disease Study 2017. Neurol Sci 2021; 43:255-264. [PMID: 33934273 DOI: 10.1007/s10072-021-05259-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We assessed secular trends in the burden of ischaemic heart disease (IHD), stroke, and dementia in the Organization for Economic Co-operation and Development (OECD) countries. METHODS Using the Global Burden of Disease (GBD) Study 2017, we compared sex-specific and age-standardized rates of disability-adjusted life years (DALY); mortality, incidence, and prevalence of IHD and stroke; and dementia per 100,000 people, in the world, OECD countries, and Canada. RESULTS From 1990 to 2017, the crude incidence number of IHD, stroke, and dementia increased 52%, 76%, and 113%, respectively. Likewise, the prevalence of IHD (75%), stroke (95%), and dementia (119%) increased worldwide. In addition during the study period, the crude global number of deaths of IHD increased 52%, stroke by 41%, and dementia by 146% (9, 6, and 3 million deaths in 2017, respectively). Despite an increase in the crude number of these diseases, the global age-standardized incidence rate of IHD, stroke, and dementia decreased by -27%, - 11%, and - 5%, respectively. Moreover, there was a decline in their age-standardized DALY rates (- 1.17%, - 1.32%, and - 0.23% per year, respectively) and death rates (- 1.29%, - 1.46%, and - 0.17% per year, respectively), with sharper downward trends in Canada and OECD countries. Almost all trends flattened during the last decade. CONCLUSIONS From 1990 to 2017, the age-standardized burden of IHD, stroke, and dementia decreased, more prominently in OECD countries than the world. However, their rising crude numbers mainly due to population growth and ageing require urgent identification of reversible risk and protective factors.
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Affiliation(s)
- Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolfazl Avan
- Department of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M Reza Azarpazhooh
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, Siebens-Drake Building, 1400 Western Rd, London, ON, N6G 2V4, Canada. .,Department of Clinical Neurological Sciences, Western University, London, ON, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
| | - Mario Di Napoli
- Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy.,Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Moira K Kapral
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Arash Akhavan Rezayat
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aidin Shariatzadeh
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, Siebens-Drake Building, 1400 Western Rd, London, ON, N6G 2V4, Canada
| | - Shahram Abootalebi
- Dr. Everett Chalmers Regional Hospital, Dalhousie University, New Brunswick, Canada
| | - Naghmeh Mokhber
- Department of Psychiatry and Behavioural Neurosciences, Western University, London, Ontario, Canada.,Department of Psychiatry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, Siebens-Drake Building, 1400 Western Rd, London, ON, N6G 2V4, Canada.,Department of Clinical Neurological Sciences, Western University, London, ON, Canada.,Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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18065
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Ru M, Brauer M, Lamarque J, Shindell D. Exploration of the Global Burden of Dementia Attributable to PM2.5: What Do We Know Based on Current Evidence? GEOHEALTH 2021; 5:e2020GH000356. [PMID: 34084981 PMCID: PMC8143277 DOI: 10.1029/2020gh000356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/15/2021] [Accepted: 03/11/2021] [Indexed: 05/17/2023]
Abstract
Exposure to ambient PM2.5 pollution has been linked to multiple adverse health effects. Additional effects have been identified in the literature and there is a need to understand its potential role in high prevalence diseases. In response to recent indications of PM2.5 as a risk factor for dementia, we examine the evidence by systematically reviewing the epidemiologic literature, in relation to exposure from ambient air pollution, household air pollution, secondhand smoke, and active smoking. We develop preliminary exposure-response functions, estimate the uncertainty, and discuss sensitivities and model selection. We estimate the likely impact to be 2.1 M (1.4 M, 2.5 M; 5%-95% confidence) global incident dementia cases and 0.6 M (0.4 M, 0.8 M) deaths attributable to ambient PM2.5 pollution in 2015. This implies a combined toll from morbidity and mortality of dementia of 7.3 M (5.0 M, 9.1 M) lost disability-adjusted life years. China, Japan, India, and the United States had the highest estimated total burden, and the per capita burden was highest in developed countries with large elderly populations. Compared to 2000, most countries in Europe, the Americas, and Southern Africa reduced the burden in 2015, while other regions had a net increase. Based on a recent systematic review of cost of illness studies for dementia, our estimates imply economic costs of US$ 26 billion worldwide in 2015. Based on this estimation, ambient PM2.5 pollution may be responsible for 15% of premature deaths and 7% of DALYs associated with dementia. Our estimates also indicate substantial uncertainty in this relationship, and future epidemiological studies at high exposure levels are especially needed.
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Affiliation(s)
- Muye Ru
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
- The Earth InsititueColumbia UniversityNew York CityNYUSA
| | - Michael Brauer
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
- Institute for Health Metrics and EvaluationUniversity of WashingtonSeattleWAUSA
| | | | - Drew Shindell
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
- Duke Global Health InitiativeDuke UniversityDurhamNCUSA
- Porter School of the Environment and Earth SciencesTel Aviv UniversityTel AvivIsrael
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18066
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He Y, Wang Y, Luan F, Yu Z, Feng H, Chen B, Chen W. Chinese and global burdens of gastric cancer from 1990 to 2019. Cancer Med 2021; 10:3461-3473. [PMID: 33931958 PMCID: PMC8124120 DOI: 10.1002/cam4.3892] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Gastric cancer is a common cancer in China. This project investigated the disease burden of gastric cancer from 1990 to 2019 in China and globally. METHODS The global age-standardized rates (ASRs) were extracted from the Global Burden of Disease. Moreover, the estimated annual percentage changes (eAPCs) in the ASRs of incidence (ASIR), mortality (ASMR), and disability-adjusted life-years (DALYs) were calculated to determine the trends by countries and regions. RESULTS In China, the ASIR declined from 37.56 to 30.64 per 100,000 and the ASMR declined from 37.73 to 21.72 per 100,000. The global ASIR decreased from 22.44 to 15.59 and the ASMR declined from 20.48 to 11.88 per 100,000 persons from 1990 to 2019. The ASIR was the lowest in Malawi (3.28 per 100,000) and the highest in Mongolia (43.7 per 100,000), whereas the ASMR was the lowest in the United States of America (3.40 per 100,000) and the highest in Mongolia (40.04 per 100,000) in 2019. The incidence of early-onset gastric cancer increased in China. The DALYs attributed to gastric cancer presented a slight decrease during the period. China had a higher mortality/incidence ratio (0.845) and 5-year prevalence (27.6/100,000) than most developed countries. CONCLUSION China presented a steady decline in the incidence and mortality rates for gastric cancer. The global ASIR, ASMR, and DALYs showed a slight rise decrease. Different patterns of gastric cancer rates and temporal trends have been identified in different geographical regions, indicating that specific strategies are needed to prevent the increase in some countries.
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Affiliation(s)
- Yuxin He
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Yida Wang
- Key Laboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, P. R. China
| | - Fujuan Luan
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Zhuwen Yu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Huang Feng
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Bingxin Chen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Weichang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
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18067
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Abstract
This article sets forth a solidaristic approach to global distribution of vaccines against the SARS-CoV-2 virus. Our approach draws inspiration from African ethics and from the characterization of the Covid-19 crisis as a syndemic, a convergence of biosocial forces that interact with one another to produce and exacerbate clinical disease and prognosis. The first section elaborates the twin ideas of syndemic and solidarity. The second section argues that these ideas lend support to global health alliances to distribute vaccines beyond national borders. The third section introduces ethical criteria to guide global distribution, emphasizing priority to low- and middle-income countries, which have the least ability to obtain vaccines on their own. It also justifies giving priority to people at high risk of infection and high risk of severe disease and death.
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18068
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Stoler J, Miller JD, Brewis A, Freeman MC, Harris LM, Jepson W, Pearson AL, Rosinger AY, Shah SH, Staddon C, Workman C, Wutich A, Young SL. Household water insecurity will complicate the ongoing COVID-19 response: Evidence from 29 sites in 23 low- and middle-income countries. Int J Hyg Environ Health 2021; 234:113715. [PMID: 33735823 PMCID: PMC7894133 DOI: 10.1016/j.ijheh.2021.113715] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/25/2021] [Accepted: 02/11/2021] [Indexed: 12/17/2022]
Abstract
In March 2020, the World Health Organization (WHO) issued a set of public guidelines for Coronavirus Disease 2019 (COVID-19) prevention measures that highlighted handwashing, physical distancing, and household cleaning. These health behaviors are severely compromised in parts of the world that lack secure water supplies, particularly in low- and middle-income countries (LMICs). We used empirical data gathered in 2017-2018 from 8,297 households in 29 sites across 23 LMICs to address the potential implications of water insecurity for COVID-19 prevention and response. These data demonstrate how household water insecurity presents many pathways for limiting personal and environmental hygiene, impeding physical distancing and exacerbating existing social and health vulnerabilities that can lead to more severe COVID-19 outcomes. In the four weeks prior to survey implementation, 45.9% of households in our sample either were unable to wash their hands or reported borrowing water from others, which may undermine hygiene and physical distancing. Further, 70.9% of households experienced one or more water-related problems that potentially undermine COVID-19 control strategies or disease treatment, including insufficient water for bathing, laundering, or taking medication; drinking unsafe water; going to sleep thirsty; or having little-to-no drinking water. These findings help identify where water provision is most relevant to managing COVID-19 spread and outcomes.
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Affiliation(s)
| | - Joshua D Miller
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | | | | | | | | | | | - Sameer H Shah
- University of British Columbia, Vancouver, BC, Canada.
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18069
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Liu X, Wang Z, Zhang H, Meng Q. Measuring and evaluating progress towards Universal Health Coverage in China. J Glob Health 2021; 11:08005. [PMID: 33981413 PMCID: PMC8088770 DOI: 10.7189/jogh.11.08005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This paper aims to develop a Chinese version of Universal Health Coverage (UHC) indices and to measure China's progress towards UHC. Methods Nineteen indicators were selected based on expert consultations to construct indices of accessibility and affordability to measure UHC. Data were drawn from health statistics yearbooks, nationally representative surveys, and health system reform surveillance. The index of accessibility includes absolute accessibility (to essential health services), relative accessibility (to hospital care) and people's subjective perceptions. The index of affordability includes absolute affordability (the incidence of catastrophic health expenditure, CHE), relative affordability (the composition of health expenditure), and people's subjective perceptions. Results The indices of accessibility and affordability both showed steady increases over the 17 years considered. Absolute accessibility had the most significant improvement (from 23.6 in 2002 to 73.8 in 2018), while the index of relative accessibility decreased from 81.4 in 2002 to 67.3 in 2018. The index of absolute affordability decreased significantly from 46.6 in 2002 to 30.5 in 2010 and then exhibited an increasing trend afterwards, reaching 52.1 in 2018. The index of relative affordability continuously increased during the observation period, from 35.3 to 75.4. Conclusions China has made great progress in increasing the accessibility and affordability of health services since the health system reforms in 2009. However, integrating primary health care and hospital care and containing escalating medical expenditure to further reduce patients' financial burdens are key challenges for strengthening the Chinese health system.
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Affiliation(s)
- Xiaoyun Liu
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Ziyue Wang
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Huan Zhang
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Qingyue Meng
- China Centre for Health Development Studies, Peking University, Beijing, China
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18070
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Alonso-Cotoner C, Abril-Gil M, Albert-Bayo M, Mall JPG, Expósito E, González-Castro AM, Lobo B, Santos J. The Role of Purported Mucoprotectants in Dealing with Irritable Bowel Syndrome, Functional Diarrhea, and Other Chronic Diarrheal Disorders in Adults. Adv Ther 2021; 38:2054-2076. [PMID: 33738725 PMCID: PMC7971407 DOI: 10.1007/s12325-021-01676-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
Chronic diarrhea is a frequent presenting symptom, both in primary care medicine and in specialized gastroenterology units. It is estimated that more than 5% of the global population suffers from chronic diarrhea. and that about 40% of these subjects are older than 60 years. The clinician is frequently faced with the need to decide which is the best therapeutic approach for these patients. While the origin of chronic diarrhea is diverse, impairment of intestinal barrier function, dysbiosis. and mucosal micro-inflammation are being increasingly recognized as underlying phenomena characterizing a variety of chronic diarrheal diseases. In addition to current pharmacological therapies, there is growing interest in alternative products such as mucoprotectants, which form a mucoadhesive film over the epithelium to reduce and protect against the development of altered intestinal permeability, dysbiosis, and mucosal micro-inflammation. This manuscript focuses on chronic diarrhea in adults, and we will review recent evidence on the ability of these natural compounds to improve symptoms associated with chronic diarrhea and to exert protective effects for the intestinal barrier.
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Affiliation(s)
- Carmen Alonso-Cotoner
- Servei de Aparell Digestiu, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Universitat Autònoma de Barcelona, Facultat de Medicina, Bellaterra, Barcelona, Spain
- CIBER de Enfermedades Hepaticas y Digestivas (CIBERHED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Abril-Gil
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Mercé Albert-Bayo
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - John-P Ganda Mall
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Elba Expósito
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Ana M González-Castro
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Beatriz Lobo
- Servei de Aparell Digestiu, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
- Universitat Autònoma de Barcelona, Facultat de Medicina, Bellaterra, Barcelona, Spain.
| | - Javier Santos
- Servei de Aparell Digestiu, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
- Universitat Autònoma de Barcelona, Facultat de Medicina, Bellaterra, Barcelona, Spain.
- CIBER de Enfermedades Hepaticas y Digestivas (CIBERHED), Instituto de Salud Carlos III, Madrid, Spain.
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18071
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van Meerbeeck JP, Franck C. Lung cancer screening in Europe: where are we in 2021? Transl Lung Cancer Res 2021; 10:2407-2417. [PMID: 34164288 PMCID: PMC8182708 DOI: 10.21037/tlcr-20-890] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/19/2021] [Indexed: 12/18/2022]
Abstract
This manuscript reviews the recent evidence obtained in lung cancer screening with low dose spiral CT-scan (LDSCT) and focuses on the issues associated with its implementation in Europe. After a review of the magnitude of the lung cancer toll in lives, disease and Euro's, the recently released data of the major lung cancer screening trials are reviewed and mirrored with the results of the US National Lung Screening Trial (NLST), comparing their strengths and weaknesses and areas of future research. The specific barriers and hurdles to be addressed for widely implementing this population screening in European countries are discussed, with special emphasis on the issues of inclusion of smokers, smoking cessation interventions, radiation injury and capacity planning. The pros and cons of including current smokers will be addressed together with the issue which is the better smoking cessation intervention. A medical physicist's view on radiation exposure and quality control will address concerns about radiation induced cancers. The downstream effects of a LDSCT screening program on the capacity of CT-scans, radiologists, thoracic surgeons and radiation oncologists will follow. An estimated roadmap for the future is sketched with the expected role of all key stakeholders. This roadmap reflects the opinion leader's reflections as expressed in a number of discussions with European health authorities, taking place as part of the recently released European Beating Cancer plan.
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Affiliation(s)
- Jan P. van Meerbeeck
- Department of Pulmonology & Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
- Antwerp University, Antwerp, Belgium
| | - Caro Franck
- Department of Medical Imaging, Antwerp University Hospital, Edegem, Belgium
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18072
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Okely AD. 2020 WHO guidelines on physical activity and sedentary behavior. SPORTS MEDICINE AND HEALTH SCIENCE 2021; 3:115-118. [PMID: 35782159 PMCID: PMC9219310 DOI: 10.1016/j.smhs.2021.05.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 01/10/2023] Open
Abstract
The World Health Organization released new guidelines on physical activity and sedentary behaviour in November 2020. This commentary summarises these guidelines, including the new elements. An evaluation of the guidelines for each specific sub-population is provided. Finally, as the author group includes physical activity researchers from four continents, we provide recommendations on how to support the implementation of the new guidelines.
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Affiliation(s)
- Anthony D. Okely
- Corresponding author. School of Health and Society and Early Start, University of Wollongong, NSW 2522 Australia.
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18073
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Jecker N, Atuire C. Out of Africa: A Solidarity-Based Approach to Vaccine Allocation. Hastings Cent Rep 2021. [PMID: 33939182 DOI: 10.1002/hast] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
This article sets forth a solidaristic approach to global distribution of vaccines against the SARS-CoV-2 virus. Our approach draws inspiration from African ethics and from the characterization of the Covid-19 crisis as a syndemic, a convergence of biosocial forces that interact with one another to produce and exacerbate clinical disease and prognosis. The first section elaborates the twin ideas of syndemic and solidarity. The second section argues that these ideas lend support to global health alliances to distribute vaccines beyond national borders. The third section introduces ethical criteria to guide global distribution, emphasizing priority to low- and middle-income countries, which have the least ability to obtain vaccines on their own. It also justifies giving priority to people at high risk of infection and high risk of severe disease and death.
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18074
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Dhimal M, Neupane T, Lamichhane Dhimal M. Understanding linkages between environmental risk factors and noncommunicable diseases-A review. FASEB Bioadv 2021; 3:287-294. [PMID: 33977230 PMCID: PMC8103723 DOI: 10.1096/fba.2020-00119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 12/15/2022] Open
Abstract
Environmental factors such as climate change are now underway, which have substantial impacts on health and well-being of human kind, but still imprecisely quantified, implications for human health. At present, one of the most significant discussions among scientists worldwide is interdependency of escalating environmental risk factors and the increasing rates of noncommunicable diseases (NCDs), which are the leading cause of death and disability worldwide. Climate change also triggers the occurrence of NCDs through a variety of direct and indirect pathways. Therefore, it is likely that the interdependence of climate change, environmental risk factors, and NCDs as a whole poses great threat to global health. Hence, this paper aims to review the latest evidence on impacts of environmental risk factors on NCDs and methods used in establishing the cause or correlation of environmental risk factors and NCDs. The literature review leveraged online databases such as PubMed and Google Scholar with articles that matched keywords "climate change", "environmental risk factors," and "noncommunicable diseases". This review shows that the burden of NCDs is increasing globally and attribution of environmental risk factors such as climate change is significant. Understanding the nature of the relation between NCDs and the environment is complex and has relied on evidence generated from multiple study designs. This paper reviews eight types of study designs that can be used to identify and measure causal and correlational nature between environment and NCDs. Future projections suggest that increases in temperatures will continue and also increase the public health burden of NCDs.
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Affiliation(s)
- Meghnath Dhimal
- Nepal Health Research Council (NHRC)KathmanduNepal
- Global Institute for Interdisciplinary Studies (GIIS)KathmanduNepal
| | | | - Mandira Lamichhane Dhimal
- Global Institute for Interdisciplinary Studies (GIIS)KathmanduNepal
- Nepal Pollution Control and Environment Management Centre (NEPCEMAC)NayabatoLalitpurNepal
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18075
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Sacks G, Kwon J, Backholer K. Do taxes on unhealthy foods and beverages influence food purchases? Curr Nutr Rep 2021; 10:179-187. [PMID: 33929703 DOI: 10.1007/s13668-021-00358-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Interest in taxes on unhealthy foods and beverages as a public health tool has increased in recent years. This paper aimed to summarise recent evidence of the impact of taxes on unhealthy foods and beverages on food purchases, and discuss opportunities to advance knowledge and policy impact. RECENT FINDINGS Evaluations of taxes on unhealthy foods and beverages have shown reductions in purchases of targeted unhealthy products and nutrients. Similarly, data from multiple sources demonstrate that as prices of unhealthy foods and beverages increase, purchase volume decreases. However, studies indicate potential for substitution to non-taxed unhealthy foods, which needs to be factored into taxation design. Taxes on unhealthy foods and beverages are a promising strategy to improve population diets. Further research is required to understand food industry responses to tax implementation, as well as the impact of taxes on population and planetary health outcomes.
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Affiliation(s)
- Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Janelle Kwon
- Global Obesity Centre, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
| | - Kathryn Backholer
- Global Obesity Centre, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
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18076
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Stamatakis E, Ding D, Ekelund U, Bauman AE. Sliding down the risk factor rankings: reasons for and consequences of the dramatic downgrading of physical activity in the Global Burden of Disease 2019. Br J Sports Med 2021; 55:1222-1223. [PMID: 33926966 DOI: 10.1136/bjsports-2021-104064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Emmanuel Stamatakis
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ding Ding
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Adrian E Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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18077
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Cainzos-Achirica M. Polypill in Persons without Cardiovascular Disease. N Engl J Med 2021; 384:1675-1676. [PMID: 33913652 DOI: 10.1056/nejmc2102972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18078
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Boggs D, Polack S, Kuper H, Foster A. Shifting the focus to functioning: essential for achieving Sustainable Development Goal 3, inclusive Universal Health Coverage and supporting COVID-19 survivors. Glob Health Action 2021; 14:1903214. [PMID: 33904370 PMCID: PMC8081312 DOI: 10.1080/16549716.2021.1903214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
If Sustainable Developmental Goal 3 and Universal Health Coverage are to be achieved, functioning is a third health indicator which must be assessed and integrated into global health population-based metrics alongside mortality and morbidity. In this paper, we define functioning according to the International Classification of Functioning, Disability and Health (ICF) and present why functioning is important to measure, especially when considering the need for, and outcome of, rehabilitation and assistive technology. We discuss examples of tools that measure components of functioning through clinical assessment and self-report methodologies, and present the development of a comprehensive population level tool which aligns with the ICF and combines self-report and clinical measurement methods to measure functioning and the need for rehabilitation and AT. Throughout the paper a survivor of Coronavirus 2019 (COVID-19) is given as an example to illustrate functioning according to the ICF and how access to the interventions of rehabilitation and assistive technology might be of benefit to improve and optimise his/her functioning. We argue that the Global Health community must take action and ensure that the measurement of functioning is well established, accepted and integrated as the third health indicator following the COVID-19 pandemic.
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Affiliation(s)
- Dorothy Boggs
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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18079
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Vera-Zertuche JM, Mancilla-Galindo J, Tlalpa-Prisco M, Aguilar-Alonso P, Aguirre-García MM, Segura-Badilla O, Lazcano-Hernández M, Rocha-González HI, Navarro-Cruz AR, Kammar-García A, Vidal-Mayo JDJ. Obesity is a strong risk factor for short-term mortality and adverse outcomes in Mexican patients with COVID-19: a national observational study. Epidemiol Infect 2021; 149:e109. [PMID: 33913410 PMCID: PMC8134888 DOI: 10.1017/s0950268821001023] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/03/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022] Open
Abstract
Conflicting results have been obtained through meta-analyses for the role of obesity as a risk factor for adverse outcomes in patients with coronavirus disease-2019 (COVID-19), possibly due to the inclusion of predominantly multimorbid patients with severe COVID-19. Here, we aimed to study obesity alone or in combination with other comorbidities as a risk factor for short-term all-cause mortality and other adverse outcomes in Mexican patients evaluated for suspected COVID-19 in ambulatory units and hospitals in Mexico. We performed a retrospective observational analysis in a national cohort of 71 103 patients from all 32 states of Mexico from the National COVID-19 Epidemiological Surveillance Study. Two statistical models were applied through Cox regression to create survival models and logistic regression models to determine risk of death, hospitalisation, invasive mechanical ventilation, pneumonia and admission to an intensive care unit, conferred by obesity and other comorbidities (diabetes mellitus (DM), chronic obstructive pulmonary disease, asthma, immunosuppression, hypertension, cardiovascular disease and chronic kidney disease). Models were adjusted for other risk factors. From 24 February to 26 April 2020, 71 103 patients were evaluated for suspected COVID-19; 15 529 (21.8%) had a positive test for SARS-CoV-2; 46 960 (66.1%), negative and 8614 (12.1%), pending results. Obesity alone increased adjusted mortality risk in positive patients (hazard ratio (HR) = 2.7, 95% confidence interval (CI) 2.04-2.98), but not in negative and pending-result patients. Obesity combined with other comorbidities further increased risk of death (DM: HR = 2.79, 95% CI 2.04-3.80; immunosuppression: HR = 5.06, 95% CI 2.26-11.41; hypertension: HR = 2.30, 95% CI 1.77-3.01) and other adverse outcomes. In conclusion, obesity is a strong risk factor for short-term mortality and critical illness in Mexican patients with COVID-19; risk increases when obesity is present with other comorbidities.
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Affiliation(s)
- J. M. Vera-Zertuche
- Endocrinology Department, Obesity Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - J. Mancilla-Galindo
- Unidad de Investigación UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - M. Tlalpa-Prisco
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - P. Aguilar-Alonso
- Facultad de Ciencias Químicas, Departamento de Bioquímica y Alimentos, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - M. M. Aguirre-García
- Unidad de Investigación UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - O. Segura-Badilla
- Facultad de Ciencias de la Salud y de los Alimentos, Departamento de Nutrición y Salud Pública, Programa UBB Saludable, Universidad del Bío-Bío, Bío-Bío, Chile
| | - M. Lazcano-Hernández
- Facultad de Ciencias Químicas, Departamento de Bioquímica y Alimentos, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - H. I. Rocha-González
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - A. R. Navarro-Cruz
- Facultad de Ciencias Químicas, Departamento de Bioquímica y Alimentos, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - A. Kammar-García
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - J. de J. Vidal-Mayo
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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18080
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von Stackelberg K, Williams PR, Sánchez-Triana E. A Systematic Framework for Collecting Site-Specific Sampling and Survey Data to Support Analyses of Health Impacts from Land-Based Pollution in Low- and Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094676. [PMID: 33924797 PMCID: PMC8125743 DOI: 10.3390/ijerph18094676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 10/28/2022]
Abstract
The rise of small-scale and localized economic activities in low- and middle-income countries (LMICs) has led to increased exposures to contaminants associated with these processes and the potential for resulting adverse health effects in exposed communities. Risk assessment is the process of building models to predict the probability of adverse outcomes based on concentration-response functions and exposure scenarios for individual contaminants, while epidemiology uses statistical methods to explore associations between potential exposures and observed health outcomes. Neither approach by itself is practical or sufficient for evaluating the magnitude of exposures and health impacts associated with land-based pollution in LMICs. Here we propose a more pragmatic framework for designing representative studies, including uniform sampling guidelines and household surveys, that draws from both methodologies to better support community health impact analyses associated with land-based pollution sources in LMICs. Our primary goal is to explicitly link environmental contamination from land-based pollution associated with specific localized economic activities to community exposures and health outcomes at the household level. The proposed framework was applied to the following three types of industries that are now widespread in many LMICs: artisanal scale gold mining (ASGM), used lead-acid battery recycling (ULAB), and small tanning facilities. For each activity, we develop a generalized conceptual site model (CSM) that describes qualitative linkages from chemical releases or discharges, environmental fate and transport mechanisms, exposure pathways and routes, populations at risk, and health outcomes. This upfront information, which is often overlooked, is essential for delineating the contaminant zone of influence in a community and identifying relevant households for study. We also recommend cost-effective methods for use in LMICs related to environmental sampling, biological monitoring, survey questionnaires, and health outcome measurements at contaminated and unexposed reference sites. Future study designs based on this framework will facilitate consistent, comparable, and standardized community exposure, risk, and health impact assessments for land-based pollution in LMICs. The results of these studies can also support economic burden analyses and risk management decision-making around site cleanup, risk mitigation, and public health education.
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18081
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Inequalities in the Global Burden of Chronic Kidney Disease Due to Type 2 Diabetes Mellitus: An Analysis of Trends from 1990 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094723. [PMID: 33925259 PMCID: PMC8124442 DOI: 10.3390/ijerph18094723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/11/2022]
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) and the burden of complications are increasing worldwide. Chronic kidney disease (CKD) is one serious complication. Our aim was to investigate the trends and inequalities of the burden of CKD due to T2DM between 1990 and 2019. Data were obtained from the Global Health Data Exchange database. Age-standardized incidence, mortality, and DALYs rates of CKD were used to estimate the disease burden across the Human Development Index (HDI). Joinpoint regression was performed to assess changes in trend, and the Gini coefficient was used to assess health inequality. A higher incidence was observed in more developed countries (p < 0.001), while higher mortality and DALYs rates were experienced in low and middle HDI countries in 2019 (p < 0.001). The trend of incidence has increased since 1990 (AAPC: 0.9–1.5%), while slight decrease was observed in low HDI countries in mortality (APC: −0.1%) and DALYs (APC: −0.2%). The Gini coefficients of CKD incidence decreased from 0.25 in 2006 to 0.23 in 2019. The socioeconomic development was associated with disease burden. Our findings indicate that awareness of complications should be improved in countries with high incidence, and cost-effective preventive, diagnostic, and therapeutic tools are necessary to implement in less developed regions.
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18082
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Han L, Liu J, Yin P, Cai T, Zhou M. Burden of maternal disorders in China from 1990 to 2019: Analysis of the Global Burden of Disease Study 2019. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 11:100141. [PMID: 34327355 PMCID: PMC8315359 DOI: 10.1016/j.lanwpc.2021.100141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
Background Efforts to quantify the burden of maternal disorders at the national and provincial levels are valuable for resource allocation and for development and adoption of public health policies. Methods Following the methods of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, the prevalence of maternal disorders and the resulting disability-adjusted life years (DALYs), years lived with disability(YLD), deaths, and years of life lost (YLL) at the national and provincial levels in China were examined for the 1990–2019 period. Estimated annual percentage changes (EAPCs) were calculated to estimate the trends of age-standardized rate (ASR) of prevalence, DALYs, death, and YLD due to maternal disorders and its main subcategories from 1990 to 2019. Findings In 2019, China had an estimated 0.85 million cases of maternal disorders (95% uncertainty interval: 0.65–1.08 million), with a 73% decline in absolute numbers from 1990 to 2019. The ASR of prevalence, DALYs and death for overall maternal disorders showed decreasing trends in China from 1990 to 2019 with the EAPCs being −3.25(95% confidence interval [CI] = −3.86 to −2.64), −8.07 (95% CI= −9.14 to −6.98), and −7.04 (95% CI= −7.99 to −6.07), respectively. The most pronounced decreases in trends in ASR of prevalence, DALYs and death were observed for maternal hemorrhage. Shandong, Hong Kong, Macao showed no significant trends in ASR of prevalence. Notably, the trends in ASR of prevalence due to maternal hypertensive disorders had been stable in China and most provinces. The trends in ASR of DALYs and death decreased the most in Jiangxi province. Interpretation The disease burden of prevalence, DALYs and death for overall maternal disorders decreased significantly in China from 1990 to 2019, however, the trends in ASR of prevalence due to maternal hypertensive disorders had been stable in China and most provinces. Funding The study is supported by grants from the Innovative Talent Support Plan of the Medical and Health Technology Project in Zhejiang Province (2021422878), Ningbo Science and Technology Project (202002N3152), Ningbo Health Branding Subject Fund (PPXK2018–02), Sanming Project of Medicine in Shen-zhen (SZSM201803080).
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Affiliation(s)
- Liyuan Han
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China.,Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China
| | - Jingjing Liu
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, Heilongjiang Province, PR China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27# Nanwei Rd, Xicheng District, 100050 Beijing, PR China
| | - Ting Cai
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China.,Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27# Nanwei Rd, Xicheng District, 100050 Beijing, PR China
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18083
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Vedanthan R, Kamano JH, Chrysanthopoulou SA, Mugo R, Andama B, Bloomfield GS, Chesoli CW, DeLong AK, Edelman D, Finkelstein EA, Horowitz CR, Manyara S, Menya D, Naanyu V, Orango V, Pastakia SD, Valente TW, Hogan JW, Fuster V. Group Medical Visit and Microfinance Intervention for Patients With Diabetes or Hypertension in Kenya. J Am Coll Cardiol 2021; 77:2007-2018. [PMID: 33888251 PMCID: PMC8065205 DOI: 10.1016/j.jacc.2021.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incorporating social determinants of health into care delivery for chronic diseases is a priority. OBJECTIVES The goal of this study was to evaluate the impact of group medical visits and/or microfinance on blood pressure reduction. METHODS The authors conducted a cluster randomized trial with 4 arms and 24 clusters: 1) usual care (UC); 2) usual care plus microfinance (MF); 3) group medical visits (GMVs); and 4) GMV integrated into MF (GMV-MF). The primary outcome was 1-year change in systolic blood pressure (SBP). Mixed-effects intention-to-treat models were used to evaluate the outcomes. RESULTS A total of 2,890 individuals (69.9% women) were enrolled (708 UC, 709 MF, 740 GMV, and 733 GMV-MF). Average baseline SBP was 157.5 mm Hg. Mean SBP declined -11.4, -14.8, -14.7, and -16.4 mm Hg in UC, MF, GMV, and GMV-MF, respectively. Adjusted estimates and multiplicity-adjusted 98.3% confidence intervals showed that, relative to UC, SBP reduction was 3.9 mm Hg (-8.5 to 0.7), 3.3 mm Hg (-7.8 to 1.2), and 2.3 mm Hg (-7.0 to 2.4) greater in GMV-MF, GMV, and MF, respectively. GMV and GMV-MF tended to benefit women, and MF and GMV-MF tended to benefit poorer individuals. Active participation in GMV-MF was associated with greater benefit. CONCLUSIONS A strategy combining GMV and MF for individuals with diabetes or hypertension in Kenya led to clinically meaningful SBP reductions associated with cardiovascular benefit. Although the significance threshold was not met in pairwise comparison hypothesis testing, confidence intervals for GMV-MF were consistent with impacts ranging from substantive benefit to neutral effect relative to UC. Incorporating social determinants of health into care delivery for chronic diseases has potential to improve outcomes. (Bridging Income Generation With Group Integrated Care [BIGPIC]; NCT02501746).
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Affiliation(s)
- Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, New York, USA.
| | - Jemima H Kamano
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Richard Mugo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Benjamin Andama
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | | | - Eric A Finkelstein
- Duke University, Durham, North Carolina, USA; Duke-National University of Singapore Medical School, Singapore
| | - Carol R Horowitz
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Simon Manyara
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Diana Menya
- School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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18084
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Manthey J, Hassan SA, Carr S, Kilian C, Kuitunen-Paul S, Rehm J. Estimating the economic consequences of substance use and substance use disorders. Expert Rev Pharmacoecon Outcomes Res 2021; 21:869-876. [PMID: 33899647 DOI: 10.1080/14737167.2021.1916470] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This contribution gives an overview on estimating the economic impact of substance use (SU) and substance use disorders (SUDs) from a societal perspective. AREAS COVERED In this Expert Review, we first discuss the scope of the economic costs of SU to society and the methods used to estimate them. In general, cost studies should not be limited to SUDs, but should also include costs related to the consequences of any type of SU to achieve a comprehensive picture of the societal burden. Further, estimating potentially avoidable costs will increase the value of cost studies. Importantly, methodologically sound cost studies shed light on the magnitude of societal problems related to SU and can be used as a reference point to evaluate regulatory policies and other preventive measures. The area of estimating potential economic benefits of SU is understudied and lacks a theoretical and methodological framework. EXPERT OPINION Overall, economic studies on the impact of SU and SUDs can strongly contribute to better-informed decision-making in the creation of regulatory and control policies. The least developed area of research refers to a consensus methodology that could be used in studies which compare economic costs to potential economic benefits.
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Affiliation(s)
- Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Syed Ahmed Hassan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
| | - Sinclair Carr
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Sören Kuitunen-Paul
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.,WHO Collaborating Centre for Addiction and Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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18085
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Abualait TS, Alzahrani MA, Ibrahim AI, Bashir S, Abuoliat ZA. Determinants of life satisfaction among stroke survivors 1 year post stroke. Medicine (Baltimore) 2021; 100:e25550. [PMID: 33879705 PMCID: PMC8078317 DOI: 10.1097/md.0000000000025550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/08/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Stroke is the major leading cause of death and severe long-term disability worldwide. The consequences of stroke, aside from diminished survival, have a significant impact on an individual's capability in maintaining self-autonomy and life satisfaction (LS). Thus, this study aimed to assess LS and other specific domains of LS in stroke survivors following their first-ever stroke, and to describe the relationship using socio-demographic and stroke-related variables.This study recruited 376 stroke survivors (244 men and 132 women, mean age: 57 years) 1 year following stroke. Data on participants' LS (measured using the Life Satisfaction Questionnaire [LiSat-11]), socio-demographics, and stroke-related variables were collected.Univariate analysis showed that LS and the 10 specific domains were not associated with the patients' gender or stroke type; however, age at onset, marital status, and vocational situation were significantly associated with some domains in LiSat-11 (Spearman's rho = 0.42-0.87; all P < 0.05). Logistic regression revealed that verbal and cognitive dysfunction were the most negative predictors of LS (odds ratio 4.1 and 3.7, respectively).LS is negatively affected in stroke survivors 1 year post onset. The results indicate that recovering social engagement is a positive predictor of higher LS in stroke survivors. More importantly, the findings revealed that cognitive and verbal dysfunctions were the most prominent negative predictors of the overall gross level of LS. Multidisciplinary rehabilitation for stroke survivors is therefore critical.
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Affiliation(s)
- Turki S. Abualait
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University
| | - Matar A. Alzahrani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University
| | - Alaa I. Ibrahim
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital, Dammam
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18086
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Bulaj G, Clark J, Ebrahimi M, Bald E. From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies. Front Pharmacol 2021; 12:612602. [PMID: 33972825 PMCID: PMC8105510 DOI: 10.3389/fphar.2021.612602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering “medicinal” self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.
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Affiliation(s)
- Grzegorz Bulaj
- Department of Medicinal Chemistry, Skaggs Pharmacy Institute, University of Utah, Salt Lake City, UT, United States
| | - Jacqueline Clark
- College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Maryam Ebrahimi
- College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Elizabeth Bald
- Department of Pharmacotherapy, Skaggs Pharmacy Institute, University of Utah, Salt Lake City, UT, United States
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18087
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Zhai X, Zhang S, Li C, Liu F, Huo Q. Complementary and alternative therapies for tension-type headache: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e25544. [PMID: 33879702 PMCID: PMC8078286 DOI: 10.1097/md.0000000000025544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Tension-type headache (TTH) is the most common form of primary headache with high prevalence, which affects the quantity of life seriously. The pharmacological treatment of TTH is not the most effective. Meanwhile, complementary therapies and alternative therapies play an essential role in the treatment of TTH, and there is an absence of comparison between various interventions. Therefore, we propose the network meta-analysis protocol to compare the efficacy and safety of various complementary therapies and alternative therapies for TTH. METHODS From the beginning to February 2021, we will search the database to collect randomized controlled trials of complementary and alternative therapies for TTH. Two researchers will be responsible for screening retrieve documents, extracting data. The risk of bias will be assessed based on the Cochrane bias risk tool. We will use STATA16.0 and WinBUGS1.4.3 for paired meta-analysis and Bayesian network meta-analysis. The quality of evidence will be assessed using the grading of recommendations assessment development and evaluation. RESULTS This study will compare and rank the efficacy and safety of various complementary and alternative treatments for TTH. CONCLUSIONS This study will provide more extensive evidence for the complementary and alternative therapies of TTH. We expect to assist clinicians and patients in choosing the optimum treatment. PROTOCOL REGISTRATION NUMBER INPLASY202130088.
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Affiliation(s)
- Xixi Zhai
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Sishuo Zhang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine
| | - Chuancheng Li
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Fei Liu
- Zhangqiu Hospital of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Qing Huo
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine
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18088
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Borghi C, Cicero AFG. Improving adherence with treatment-resistant hypertension. Expert Opin Pharmacother 2021; 22:1373-1375. [PMID: 33888035 DOI: 10.1080/14656566.2021.1915290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Claudio Borghi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Arrigo F G Cicero
- Department of Medical and Surgical Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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18089
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Ezezika O, Ragunathan A, El-Bakri Y, Barrett K. Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review. PLoS One 2021; 16:e0249638. [PMID: 33886584 PMCID: PMC8062013 DOI: 10.1371/journal.pone.0249638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries. METHODS A comprehensive search strategy comprised of relevant subject headings and keywords was executed in 5 databases including OVID Medline, OVID Embase, OVID HealthStar, Web of Science and Scopus. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. RESULTS The search identified 1570 citations and following removal of duplicates as well as screening according to our inclusion/exclusion criteria, 55 articles were eligible for inclusion in the review. Twenty-three countries were represented in this review, with India, Bangladesh, Egypt, Nigeria, and South Africa having the most representation of available studies. Study dates ranged from 1981 to 2020. Overarching thematic areas spanning the barriers and facilitators that were identified included: availability and accessibility, knowledge, partnership engagement, and design and acceptability. CONCLUSION A systematic review of studies on implementation of ORT in low- and middle-income countries (LMICs) highlights key activities that facilitate the development of successful implementation that include: (1) availability and accessibility of ORT, (2) awareness and education among communities, (3) strong partnership engagement strategies, and (4) adaptable design to enhance acceptability. The barriers and facilitators identified under the CIFR domains can be used to build knowledge on how to adapt ORT to national and local settings and contribute to a better understanding on the implementation and use of ORT in LMICs. The prospects for scaling and sustaining ORT (after years of low use) will increase if implementation research informs local applications, and implementers engage appropriate stakeholders and test assumptions around localized theories of change from interventions to expected outcomes. REGISTRATION A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD420201695).
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Affiliation(s)
- Obidimma Ezezika
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- African Centre for Innovation and Leadership Development, Abuja, Nigeria
| | - Apira Ragunathan
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Yasmine El-Bakri
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
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18090
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Luan T, Zhuang Y, Nie W, Yang S, Wu Y, Wang R, Dai Y, Zhang H. The death risk factors of patients undergoing re-exploration for bleeding or tamponade after isolated off-pump coronary artery bypass grafting: a case-control study. BMC Cardiovasc Disord 2021; 21:204. [PMID: 33888070 PMCID: PMC8063367 DOI: 10.1186/s12872-021-02017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/14/2021] [Indexed: 11/12/2022] Open
Abstract
Background The purpose of the study is to identify off-pump patients who are at higher risk of mortality after re-exploration for bleeding or tamponade. Methods We analyzed the data of 3256 consecutive patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG) in our heart center from 2013 through 2020. Fifty-eight patients underwent re-exploration after OPCABG. The 58 patients were divided into death group and survival group according to their discharge status. Propensity score matching (PSM) was performed to analysis the risk factors of death. 15 pairs of cases of two groups were matched well. Results The mortality rate of patients underwent re-exploration after OPCABG for bleeding or tamponade was 27.59% (16/58). In the raw data, we found the patients in death group had higher body mass index (BMI) (P = 0.030), higher cardiac troponin T (cTnT) (P = 0.028) and higher incidence of heart failure before OPCABG (P = 0.003). After PSM, the levels of lactic acid before and after re-exploration (P = 0.028 and P < 0.001) were higher in death group. And the levels of creatinine (P = 0.002) and cTnT (P = 0.017) were higher in the death group after re-exploration. The death group had longer reoperation time (P = 0.010). In addition, the perioperative utilization rate of intra-aortic ballon pump (IABP) (P = 0.027), continuous renal replacement therapy (CRRT) (P < 0.001) and platelet transfusion (P = 0.017) were higher than survival group. Conclusions The mortality rate of patients undergoing re-exploration for bleeding or tamponade after isolated OPCABG is high. More attention should be paid to patients with above risk factors and appropriate measures should be taken in time.
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Affiliation(s)
- Tongxiao Luan
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong Province, China.,Qingdao University, 308 Ningxia Road, Qingdao, 266071, Shandong Province, China
| | - Yingzhu Zhuang
- Qingdao Fuwai Cardiovascular Hospital, 201 Nanjing Road, Qingdao, 266034, Shandong Province, China
| | - Weihong Nie
- Qingdao University, 308 Ningxia Road, Qingdao, 266071, Shandong Province, China
| | - Sumin Yang
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong Province, China
| | - Yuhui Wu
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong Province, China
| | - Rongmei Wang
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong Province, China
| | - Yunyan Dai
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong Province, China
| | - Hong Zhang
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong Province, China. .,Qingdao University, 308 Ningxia Road, Qingdao, 266071, Shandong Province, China.
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18091
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Slapø H, Schjøll A, Strømgren B, Sandaker I, Lekhal S. Efficiency of In-Store Interventions to Impact Customers to Purchase Healthier Food and Beverage Products in Real-Life Grocery Stores: A Systematic Review and Meta-Analysis. Foods 2021; 10:922. [PMID: 33922185 PMCID: PMC8146080 DOI: 10.3390/foods10050922] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Grocery stores are important settings to promote healthier food and beverage choices. The present paper aims at reviewing the effectiveness of different types of in-store interventions and how they impact sales of different product category in real grocery stores. Systematic search was conducted in six databases. In-store interventions were categorized according to the framework by Kraak et al. (2017) into one or more of eight interventions (e.g., place, profile, portion, pricing, promotion, healthy default picks, prompting and proximity). This systematic theme-based review follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) data screening and selection. Thirty-six studies were included in the qualitative synthesis and 30 studies were included in the meta-analysis, representing 72 combinations of in-store interventions. The analysis demonstrates that interventions overall had small significant effect size (ES) using Cohen's d on food purchase behavior (d = 0.17, 95% CI [0.04, 0.09]), with largest ES for pricing (d = 0.21) and targeting fruits and vegetables (d = 0.28). Analysis of ES of in-store interventions show that pricing, and pricing combined with promotion and prompting, effectively impacted purchase behavior. Interventions significantly impacted both sales of healthy and unhealthy products and significantly increased sales of fruits and vegetables, healthy beverage and total volume of healthy products. Results should however be interpreted with some caution, given the relatively low quality of overall evidence and low number of studies and observations for some types of intervention. Further research exploring impact on different in-store interventions and targeting especially unhealthy products are needed.
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Affiliation(s)
- Helena Slapø
- Department of Behavioral Sciences, Oslo Metropolitan University, P.O. BOX 4 St., Olavs plass, N-0130 Oslo, Norway; (B.S.); (I.S.)
- GreeNudge, Tordenskioldsgate 2, N-0160 Oslo, Norway;
| | - Alexander Schjøll
- Consumption Research Norway, Oslo Metropolitan University, P.O. BOX 4 St., Olavs plass, N-0130 Oslo, Norway;
| | - Børge Strømgren
- Department of Behavioral Sciences, Oslo Metropolitan University, P.O. BOX 4 St., Olavs plass, N-0130 Oslo, Norway; (B.S.); (I.S.)
| | - Ingunn Sandaker
- Department of Behavioral Sciences, Oslo Metropolitan University, P.O. BOX 4 St., Olavs plass, N-0130 Oslo, Norway; (B.S.); (I.S.)
| | - Samira Lekhal
- GreeNudge, Tordenskioldsgate 2, N-0160 Oslo, Norway;
- Morbid Obesity Centre, Vestfold Hospital Trust, Halfdan Wilhelmsens allé 17, 3116 Tønsberg, Norway
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18092
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Feng L, Han F, Zhou L, Wu S, Du Y, Zhang D, Zhang C, Gao Y. Efficacy and Safety of Panax Notoginseng Saponins (Xueshuantong) in Patients With Acute Ischemic Stroke (EXPECT) Trial: Rationale and Design. Front Pharmacol 2021; 12:648921. [PMID: 33967788 PMCID: PMC8101545 DOI: 10.3389/fphar.2021.648921] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Although revascularization treatment is recommended as the first-line therapy for patients with non-minor acute ischemic stroke (AIS), it only benefits a minority of patients. Previous studies have reported the positive effects of Panax notoginseng saponins (PNS) (Xueshuantong lyophilized powder) on AIS, however, there have been no rigorous trials. This study aims to assess the efficacy and safety of PNS therapy for patients with AIS. Methods: The Evaluation of Xueshuantong in Patients with acutE ischemiC sTroke (EXPECT) trial is a multicenter, randomized, placebo-controlled, double-blind study aiming to enroll 480 patients in China. Eligible patients with AIS within 72 h of symptom onset will randomly receive either PNS or PNS placebo for 10 days and subsequently be followed up to 90 days. The primary outcome will be a change in the National Institute of Health Stroke Scale (NIHSS) score from baseline to 10 post-randomization days. The secondary outcomes include early neurological improvement (proportion of patients with NIHSS score 0–1), and Patient-Reported Outcomes Scale for Stroke score at 10 post-randomization days, the proportion of patients with life independence (modified Rankin Scale score of 0–1), the proportion of patients with a favorable outcome (Barthel Index ≥90), and Stroke-Specific Quality of Life score at 90 days. Adverse events or clinically significant changes in vital signs and laboratory parameters, regardless of the severity, will be recorded during the trial to assess the safety of PNS. Conclusions: To our knowledge, this study is the first double-blind trial to assess the efficacy and safety of PNS in patients with AIS. Findings of the EXPECT trial will be valuable in improving evidence regarding the clinical application of PNS therapy in patients with AIS ineligible for revascularization treatment in the reperfusion era.
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Affiliation(s)
- Luda Feng
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China.,Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Fang Han
- Office of Academic Research, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Li Zhou
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shengxian Wu
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Office of State Drug Clinical Trial Institution, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yawei Du
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Dandan Zhang
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Chi Zhang
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China.,Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China.,Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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18093
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Schiess N, Groce NE, Dua T. The Impact and Burden of Neurological Sequelae Following Bacterial Meningitis: A Narrative Review. Microorganisms 2021; 9:microorganisms9050900. [PMID: 33922381 PMCID: PMC8145552 DOI: 10.3390/microorganisms9050900] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 01/17/2023] Open
Abstract
The burden, impact, and social and economic costs of neurological sequelae following meningitis can be devastating to patients, families and communities. An acute inflammation of the brain and spinal cord, meningitis results in high mortality rates, with over 2.5 million new cases of bacterial meningitis and over 236,000 deaths worldwide in 2019 alone. Up to 30% of survivors have some type of neurological or neuro-behavioural sequelae. These include seizures, hearing and vision loss, cognitive impairment, neuromotor disability and memory or behaviour changes. Few studies have documented the long-term (greater than five years) consequences or have parsed out whether the age at time of meningitis contributes to poor outcome. Knowledge of the socioeconomic impact and demand for medical follow-up services among these patients and their caregivers is also lacking, especially in low- and middle-income countries (LMICs). Within resource-limited settings, the costs incurred by patients and their families can be very high. This review summarises the available evidence to better understand the impact and burden of the neurological sequelae and disabling consequences of bacterial meningitis, with particular focus on identifying existing gaps in LMICs.
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Affiliation(s)
- Nicoline Schiess
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization (WHO), 1202 Geneva, Switzerland;
- Correspondence:
| | - Nora E. Groce
- UCL International Disability Research Centre, Department of Epidemiology and Health Care, University College London, London WC1E 7HB, UK;
| | - Tarun Dua
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization (WHO), 1202 Geneva, Switzerland;
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18094
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Mayer F, Remoli G, Bacigalupo I, Palazzesi I, Piscopo P, Bellomo G, Canevelli M, Corbo M, Vanacore N, Lacorte E. Decreasing trend in the incidence and prevalence of dementia: a systematic review. Minerva Med 2021; 112:430-440. [PMID: 33881282 DOI: 10.23736/s0026-4806.21.07454-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The progressive ageing of the population is one of the main socio-demographic phenomena, taking place at a global level. Several recent population-based studies conducted worldwide suggest that the age-specific risk of dementia may be changing in some countries and areas. EVIDENCE ACQUISITION This systematic review was performed using the methodology proposed by the Cochrane handbook for systematic reviews and reported following the PRISMA statement. A structured bibliographic search was performed on the databases PubMed, ISI Web of Science and the Cochrane Database of Systematic Reviews. All included studies were qualitatively assessed using the Methodological Evaluation of Observational REsearch (MORE). EVIDENCE SYNTHESIS The bibliographic search yielded 2394 records. Three more articles were retrieved from other sources. A total of ten studies were included, five reported data on a possible reduction in the prevalence of dementia, and five reported data on a possible reduction in its incidence. CONCLUSIONS The present systematic review focused on the recent observations of a possible decrease in the frequency of dementia and cognitive impairment in some Western countries (USA, UK, Sweden, the Netherlands, France, Iceland) between 1977 and 2014. The included studies have a high heterogeneity in terms of the clinical criteria used to diagnose dementia, and of the criteria used to define the clinical condition preceding dementia, such as isolated cognitive impairment. Moreover, the methodological quality with which they were conducted was also heterogeneous, with scores ranging from 1 to 7 using the MORE tool.
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Affiliation(s)
- Flavia Mayer
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Giulia Remoli
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Ilaria Bacigalupo
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Ilaria Palazzesi
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Paola Piscopo
- Department of Neurosciences, Italian National Institute of Health, Rome, Italy
| | - Guido Bellomo
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Marco Canevelli
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.,Sapienza University, Rome, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Privata del Policlinico, Milan, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Eleonora Lacorte
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy -
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18095
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Qi F, Zhou H, Gu P, Tang ZH, Zhu BF, Chen JR, Zhang JS, Li F. Endothelial glycocalyx degradation is associated with early organ impairment in polytrauma patients. BMC Emerg Med 2021; 21:52. [PMID: 33879092 PMCID: PMC8056622 DOI: 10.1186/s12873-021-00446-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/08/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Endothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in polytrauma patients. METHODS A prospective observational study was conducted to enroll health participants (control group) and polytrauma patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 h and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 h, and 28-day mortality in trauma group. RESULTS There were 45 polytrauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18-130.80] vs. 24.15 [13.89-32.36], 38.92 [30.47-67.96] vs. 15.55 [11.89-23.24], P < 0.001, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. The area under the receiver operator characteristic curves (AUC) of SDC1 to predict AKI, TIC occurrence within 48 h and 28-day mortality were 0.838 (95%CI: 0.720-0.957), 0.700 (95%CI: 0.514-0.885) and 0.764 (95%CI: 0.543-0.984), respectively. CONCLUSIONS EG degradation was elevated significantly in polytrauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems in early stage. Serum SDC1 is a valuable predictive indicator of early onset of AKI, TIC, and 28-day mortality in polytrauma patients.
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Affiliation(s)
- Feng Qi
- Emergency Intensive Care Unit, The Second Affiliated Hospital of Nantong University, Nantong First People's Hospital, 6 Haier Xiang North Road, Nantong, 226001, Jiangsu, China
| | - Hao Zhou
- Emergency Intensive Care Unit, The Second Affiliated Hospital of Nantong University, Nantong First People's Hospital, 6 Haier Xiang North Road, Nantong, 226001, Jiangsu, China
| | - Peng Gu
- Emergency Intensive Care Unit, The Second Affiliated Hospital of Nantong University, Nantong First People's Hospital, 6 Haier Xiang North Road, Nantong, 226001, Jiangsu, China
| | - Zhi-He Tang
- Emergency Intensive Care Unit, The Second Affiliated Hospital of Nantong University, Nantong First People's Hospital, 6 Haier Xiang North Road, Nantong, 226001, Jiangsu, China
| | - Bao-Feng Zhu
- Emergency Intensive Care Unit, The Second Affiliated Hospital of Nantong University, Nantong First People's Hospital, 6 Haier Xiang North Road, Nantong, 226001, Jiangsu, China
| | - Jian-Rong Chen
- Emergency Intensive Care Unit, The Second Affiliated Hospital of Nantong University, Nantong First People's Hospital, 6 Haier Xiang North Road, Nantong, 226001, Jiangsu, China
| | - Jin-Song Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Feng Li
- Emergency Intensive Care Unit, The Second Affiliated Hospital of Nantong University, Nantong First People's Hospital, 6 Haier Xiang North Road, Nantong, 226001, Jiangsu, China.
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18096
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Ideal Cardiovascular Health in a Nationally Representative Population-Based Sample of Adults in Malawi. Glob Heart 2021; 16:24. [PMID: 34040937 PMCID: PMC8064282 DOI: 10.5334/gh.986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Ideal cardiovascular health (ICH) measures four ideal health behaviours (non-smoking, body mass index <25 kg/m2, healthy diet, and physical activity) and three health factors (total cholesterol <200 mg/dL, blood pressure <120/<80 mmHg, and fasting blood glucose <100 mg/dL). Objective: This study aimed to determine the prevalence, distribution, and correlates of ICH among adults in Malawi. Methods: National cross-sectional survey data of 3,441 persons aged 18–69 years with complete ICH measurements in Malawi in 2017 were analysed. Results: Almost one in ten (7.4%) of respondents had 0–2 ICH metric), 21.2% 3–4 ICH metrics, and 71.5% 5–7 ICH metrics). Only 3.3% had all seven ICH metrics, 15.3% had intermediate ICH (≥1 metric in the intermediate category and none in the poor category), and 81.5% poor ICH (≥1 metric in poor category). In adjusted logistic regression analysis, older age (50–69 years) (Adjusted Odds Ratio-AOR: 0.25, 95% Confidence Interval-CI: 0.17–0.36) and urban residence (AOR: 0.56, 95% CI: 0.40–0.78) were negatively associated with meeting 5–7 ICH metrics. In addition, in unadjusted analysis, higher education was positively associated with meeting 5–7 ICH metrics. Conclusion: The proportion of meeting 5–7 ICH metrics was high in Malawian adults. Both high-risk and population-wide intervention programmes targeting older adults and urban residents should be implemented in aiding to improve cardiovascular health in Malawi. Highlights
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18097
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United States burden of melanoma and non-melanoma skin cancer from 1990 to 2019. J Am Acad Dermatol 2021; 85:388-395. [PMID: 33852922 DOI: 10.1016/j.jaad.2021.03.109] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/16/2021] [Accepted: 03/31/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Skin cancer is the most common cancer worldwide. OBJECTIVE To evaluate the burden of skin cancer in the US from 1990 to 2019. METHODS Age-standardized incidence, prevalence, disability-adjusted life years (DALY), and mortality rates from skin cancer in the US were evaluated from the Global Burden of Disease 2019. RESULTS Incidence, prevalence, DALY, and mortality rates for melanoma per 100,000 persons in 2019 were 17.0, 138, 64.8, and 2.2, respectively; for squamous cell carcinoma, rates were 262, 314, 26.6, and 0.8, respectively; and for basal cell carcinoma, rates were 525, 51.2, 0.2, and zero, respectively. Incidence and prevalence rates of melanoma and non-melanoma skin cancer (NMSC) have increased since 1990, while mortality rates have remained fairly stable. Males have had higher incidence, prevalence, DALY, and mortality rates from melanoma and NMSC every year since 1990. Incidence and prevalence of melanoma was relatively higher in the northern half of the US than in the southern half. LIMITATIONS Global Burden of Disease is derived from estimation and mathematical modeling. CONCLUSIONS Health care professionals can utilize differences and trends noted in this study to guide allocation of resources to reduce incidence and morbidity from skin cancer.
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18098
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DeLang MN, Becker JS, Chang KL, Serre ML, Cooper OR, Schultz MG, Schröder S, Lu X, Zhang L, Deushi M, Josse B, Keller CA, Lamarque JF, Lin M, Liu J, Marécal V, Strode SA, Sudo K, Tilmes S, Zhang L, Cleland SE, Collins EL, Brauer M, West JJ. Mapping Yearly Fine Resolution Global Surface Ozone through the Bayesian Maximum Entropy Data Fusion of Observations and Model Output for 1990-2017. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:4389-4398. [PMID: 33682412 DOI: 10.1021/acs.est.0c07742] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Estimates of ground-level ozone concentrations are necessary to determine the human health burden of ozone. To support the Global Burden of Disease Study, we produce yearly fine resolution global surface ozone estimates from 1990 to 2017 through a data fusion of observations and models. As ozone observations are sparse in many populated regions, we use a novel combination of the M3Fusion and Bayesian Maximum Entropy (BME) methods. With M3Fusion, we create a multimodel composite by bias-correcting and weighting nine global atmospheric chemistry models based on their ability to predict observations (8834 sites globally) in each region and year. BME is then used to integrate observations, such that estimates match observations at each monitoring site with the observational influence decreasing smoothly across space and time until the output matches the multimodel composite. After estimating at 0.5° resolution using BME, we add fine spatial detail from an additional model, yielding estimates at 0.1° resolution. Observed ozone is predicted more accurately (R2 = 0.81 at the test point, 0.63 at 0.1°, and 0.62 at 0.5°) than the multimodel mean (R2 = 0.28 at 0.5°). Global ozone exposure is estimated to be increasing, driven by highly populated regions of Asia and Africa, despite decreases in the United States and Russia.
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Affiliation(s)
- Marissa N DeLang
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Jacob S Becker
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Kai-Lan Chang
- Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, Colorado 80309-0401, United States
- NOAA Chemical Sciences Laboratory, Boulder, Colorado 80305, United States
| | - Marc L Serre
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Owen R Cooper
- Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, Colorado 80309-0401, United States
- NOAA Chemical Sciences Laboratory, Boulder, Colorado 80305, United States
| | - Martin G Schultz
- Jülich Supercomputing Centre (JSC), Forschungszentrum Jülich, Jülich D-5242, Germany
| | - Sabine Schröder
- Jülich Supercomputing Centre (JSC), Forschungszentrum Jülich, Jülich D-5242, Germany
| | - Xiao Lu
- Laboratory for Climate and Ocean-Atmosphere Studies, Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, Beijing 100871, China
| | - Lin Zhang
- Laboratory for Climate and Ocean-Atmosphere Studies, Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, Beijing 100871, China
| | - Makoto Deushi
- Meteorological Research Institute (MRI), Tsukuba 305-0052, Japan
| | - Beatrice Josse
- Centre National de Recherches Météorologiques, Université de Toulouse, Météo-France, CNRS, Toulouse 31057, France
| | - Christoph A Keller
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771-0003, United States
- Universities Space Research Association, Columbia, Maryland 21046, United States
| | | | - Meiyun Lin
- NOAA Geophysical Fluid Dynamics Laboratory, Princeton, New Jersey 08540, United States
- Program in Atmospheric and Oceanic Sciences, Princeton University, Princeton, New Jersey 08544, United States
| | - Junhua Liu
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771-0003, United States
- Universities Space Research Association, Columbia, Maryland 21046, United States
| | - Virginie Marécal
- Centre National de Recherches Météorologiques, Université de Toulouse, Météo-France, CNRS, Toulouse 31057, France
| | - Sarah A Strode
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771-0003, United States
- Universities Space Research Association, Columbia, Maryland 21046, United States
| | - Kengo Sudo
- Graduate School of Environmental Studies, Nagoya University, Nagoya 464-8601, Japan
- Japan Agency for Marine-Earth Science and Technology (JAMSTEC), Yokosuka 237-0061, Japan
| | - Simone Tilmes
- National Center for Atmospheric Research, Boulder, Colorado 80305, United States
| | - Li Zhang
- NOAA Geophysical Fluid Dynamics Laboratory, Princeton, New Jersey 08540, United States
- Program in Atmospheric and Oceanic Sciences, Princeton University, Princeton, New Jersey 08544, United States
- Department of Meteorology and Atmospheric Science, Pennsylvania State University, University Park, Pennsylvania 16802-1503, United States
| | - Stephanie E Cleland
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Elyssa L Collins
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Michael Brauer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington 98195, United States
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - J Jason West
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
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18099
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Yuan S, Shi Y, Li M, Hu X, Bai R. Trends in Incidence of Urinary Tract Infection in Mainland China from 1990 to 2019. Int J Gen Med 2021; 14:1413-1420. [PMID: 33907445 PMCID: PMC8068484 DOI: 10.2147/ijgm.s305358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose Urinary tract infection (UTI) is the second-most-common type of infection in China. This study aimed to determine the long-term trends in the incidence of UTI in Mainland China between 1990 and 2019. Materials and Methods Data were extracted from the Global Burden of Disease Study 2019 and were analyzed with the age–period–cohort framework. Results The net drift in the incidence of UTI was –0.37% (95% CI: –0.40%, –0.35%) in males and –0.25% (95% CI: –0.29%, –0.20%) in females. For males, the local drift was lower than 0 (P<0.05) among those younger than 90 years. For females, the local drift was lower than 0 (P<0.05) among those younger than 60 years and higher than 0 (P<0.05) in those aged 65–79 years. In the same birth cohort, the incidence of UTI was higher in females than in males in all age groups (P<0.05). The period relative risk (RR) showed a decreasing pattern after 2005 in both sexes. The cohort RR showed a downward trend of the birth cohort after 1905 for males and 1960 for females. Conclusion The incidence has increased significantly among older females over the past 30 years. It is necessary to develop a comprehensive intervention plan for reproductive health services covering females and males of all ages.
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Affiliation(s)
- Sheng Yuan
- Department of New Medicine and Needle Pricking, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China.,Department of Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ying Shi
- School of Public Health, Shaanxi University of Chinese Medicine, Xi'an, Shaanxi, People's Republic of China
| | - Minmin Li
- Department of Infection Disease Control and Prevention, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, People's Republic of China
| | - Xiaojun Hu
- Department of Hepatobiliary Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Ruhai Bai
- School of Public Affair, Nanjing University of Science and Technology, Nanjing, Jiangsu, People's Republic of China
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18100
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Wu J, Ning Y, Gao Y, Shan R, Wang B, Lv J, Li L. Association between Ambient Air Pollution and MRI-Defined Brain Infarcts in Health Examinations in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084325. [PMID: 33921763 PMCID: PMC8072670 DOI: 10.3390/ijerph18084325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
The study aimed to evaluate the relationships between air pollutants and risk of magnetic resonance imaging (MRI)-defined brain infarcts (BI). We used data from routine health examinations of 1,400,503 participants aged ≥18 years who underwent brain MRI scans in 174 cities in 30 provinces in China in 2018. We assessed exposures to particulate matter (PM)2.5, PM10, nitrogen dioxide (NO2), and carbon monoxide (CO) from 2015 to 2017. MRI-defined BI was defined as lesions ≥3 mm in diameter. Air pollutants were associated with a higher risk of MRI-defined BI. The odds ratio (OR) (95% CI) for MRI-defined BI comparing the highest with the lowest tertiles of air pollutant concentrations was 2.00 (1.96–2.03) for PM2.5, 1.68 (1.65–1.71) for PM10, 1.58 (1.55–1.61) for NO2, and 1.57 (1.54–1.60) for CO. Each SD increase in air pollutants was associated with 16–42% increases in the risk of MRI-defined BI. The associations were stronger in the elderly subgroup. This is the largest survey to evaluate the association between air pollution and MRI-defined BI. Our findings indicate that ambient air pollution was significantly associated with a higher risk of MRI-defined BI.
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Affiliation(s)
- Jing Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (J.W.); (R.S.); (J.L.)
| | - Yi Ning
- Meinian Public Health Institute, Peking University Health Science Center, Beijing 100191, China;
- Meinian Institute of Health, Beijing 100191, China;
- Correspondence: (Y.N.); (L.L.); Tel.: +86-0089-3791 (Y.N.); +86-10-828-01528 (ext. 321) (L.L.)
| | | | - Ruiqi Shan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (J.W.); (R.S.); (J.L.)
| | - Bo Wang
- Meinian Public Health Institute, Peking University Health Science Center, Beijing 100191, China;
- Meinian Institute of Health, Beijing 100191, China;
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (J.W.); (R.S.); (J.L.)
- Meinian Public Health Institute, Peking University Health Science Center, Beijing 100191, China;
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (J.W.); (R.S.); (J.L.)
- Meinian Public Health Institute, Peking University Health Science Center, Beijing 100191, China;
- Correspondence: (Y.N.); (L.L.); Tel.: +86-0089-3791 (Y.N.); +86-10-828-01528 (ext. 321) (L.L.)
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