Global, regional and national temporal trends in Parkinson's disease incidence, disability-adjusted life year rates in middle-aged and older adults: a cross-national inequality analysis and Bayesian age-period-cohort analysis based on the global burden of disease 2021

BACKGROUND

Parkinson's disease (PD) ranks as the second most prevalent neurodegenerative disorder; however, its epidemiological characteristics among middle-aged and older adults at global, regional, and national levels remain inadequately documented.

METHODS

This study assessed temporal trends in PD among middle-aged and older adults by extracting incidence rates, disability-adjusted life year (DALY) rates, and corresponding age-specific rates (ASRs) from the Global Burden of Disease (GBD) database spanning 1990 to 2021. Estimated annual percentage change (EAPC) was employed to analyze trends over the past 30 years. The slope index of inequality (SII) and concentration index (CI) were utilized to evaluate disparities in the burden of PD across various countries. Additionally, Bayesian age-period-cohort (BAPC) modeling was applied to project DALY figures for the next 15 years.

RESULTS

In 2021, the global incidence and DALY rates for middle-aged and older adults with PD stood at 79.68 and 477.50 cases per 100,000 population, respectively. Both incidence and DALY rates have exhibited an upward trajectory over the past 32 years, with EAPCs of 1.2 (95% UI: 1.1-1.3) and 0.6 (95% UI: 0.5-0.7), respectively. Among the five sociodemographic index (SDI) regions, the high-middle SDI region reported the highest incidence and DALY rates for PD in 2021, at 93.93 and 512.29 cases per 100,000 population, respectively. A positive correlation was observed between the SDI and age-specific incidence rate (ASIR) as well as age-specific DALY rate (ASDR). Disparities in the burden of PD among middle-aged and older adults, associated with SDI, are on the rise and are primarily concentrated in high SDI countries. It is projected that the global incidence and DALY rates for middle-aged and older adults with PD will experience significant increases over the next 15 years.

CONCLUSIONS

The global burden of PD among middle-aged and older adults has markedly escalated over the past 32 years, particularly in high-middle SDI regions. These findings underscore the necessity for the development of effective interventions and public health policies, contributing to the attainment of the sustainable development goals established by the World Health Organization (WHO).

Global, regional, and national mortality burden attributable to air pollution from landscape fires: a health impact assessment study

BACKGROUND

Landscape fire-sourced (LFS) air pollution is an increasing public health concern in the context of climate change. However, little is known about the attributable global, regional, and national mortality burden related to LFS air pollution.

METHODS

We calculated country-specific population-weighted average daily and annual LFS fine particulate matter (PM2·5) and surface ozone (O3) during 2000-19 from a validated dataset. We obtained the relative risks (RRs) for both short-term and long-term impact of LFS PM2·5 and O3 on all-cause, cardiovascular, and respiratory mortality. The short-term RRs were pooled from community-specific standard time-series regressions in 2267 communities across 59 countries or territories. The long-term RRs were obtained from published meta-analyses of cohort studies on all-source PM2·5 and O3. Annual mortality, population, and socio-demographic data for each country or territory were extracted from the Global Burden of Diseases Study 2019. These data were used to estimate country-specific annual deaths attributable to LFS air pollution using standard algorithms.

FINDINGS

Globally, 1·53 million all-cause deaths per year (95% empirical confidence interval [eCI] 1·24-1·82) were attributable to LFS air pollution during 2000-19, including 0·45 million (0·32-0·57) cardiovascular deaths and 0·22 million respiratory deaths (0·08-0·35). LFS PM2·5 and O3 contributed to 77·6% and 22·4% of the total attributable deaths, respectively. Over 90% of all attributable deaths were in low-income and middle-income countries, particularly in sub-Saharan Africa (606 769 deaths per year), southeast Asia (206 817 deaths), south Asia (170 762 deaths), and east Asia (147 291 deaths). The global cardiovascular attributable deaths saw an average 1·67% increase per year (ptrend <0·001), although the trends for all-cause and respiratory attributable deaths were not statistically significant. The five countries with the largest all-cause attributable deaths were China, the Democratic Republic of the Congo, India, Indonesia, and Nigeria, although the order changed in the second decade. The leading countries with the greatest attributable mortality rates (AMRs) were all in sub-Saharan Africa, despite decreasing trends from 2000 to 2019. North and central America, and countries surrounding the Mediterranean, showed increasing trends of all-cause, cardiovascular, and respiratory AMRs. Increasing cardiovascular AMR was also observed in southeast Asia, south Asia, and east Asia. In 2019, the AMRs in low-income countries remained four times those in high-income countries, though this had reduced from nine times in 2000. AMRs negatively correlated with a country-specific socio-demographic index (Spearman correlation coefficients r around -0·60).

INTERPRETATION

LFS air pollution induced a substantial global mortality burden, with notable geographical and socioeconomic disparities. Urgent actions are required to address such substantial health impact and the associated environmental injustice in a warming climate.

FUNDING

Australian Research Council, Australian National Health and Medical Research Council.

Cost-effectiveness analysis of subcutaneous biosimilar tocilizumab in patients with rheumatoid arthritis in Spain

INTRODUCTION

Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic disease, its management and morbidity impose a great burden to healthcare systems. Development and rollout of biological disease modifying anti-rheumatic drugs has contributed to improvements for patients, however, high costs have prevented them to be widely used. This is being addressed with biosimilars, with equal benefit-risk profile and reduced costs. The objective is to analyze the cost-effectiveness of subcutaneous biosimilar tocilizumab (bsTCZ) for patients with moderate-severe RA in Spain from a healthcare system perspective.

METHODS

A Markov model was developed with a lifetime horizon including 5 health states: remission of the disease; low, moderate, or high activity; and death. A PICO-S-T search retrieved efficacy of treatments in meta-analysis and network meta-analysis, and was further complemented with published clinical trials. Pharmacological costs were obtained from the BotPlus database, and medical resources costs from regional tariffs. Deterministic and probabilistic sensitivity analysis were performed to validate the robustness of results. Incremental cost-effectiveness ratio (ICER) for cost/percentage of remission and cost/quality-adjusted life year (QALY) gain were calculated.

RESULTS

Lifetime cost of bsTCZ was 183 741€ (lowest) versus comparative costs ranging from 184 317€ for infliximab to 201 972€ (highest) for certolizumab. QALYs were 13.74 for upadacitinib and 13.73 for sarilumab and tocilizumab with values between 13.53 and 13.72 for the comparators. ICERs as €/remission and €/QALY showed that bsTCZ was either dominant in most of the comparisons or the most cost-effective alternative. The sensitivity analysis showed that bsTCZ long term cost, and transition from low to moderate disease activity health status were the most influential factors. Moreover, bsTCZ was either dominant or cost-effective in all the comparisons.

CONCLUSIONS

bsTCZ demonstrated to be a cost-effective and cost-saving alternative for the treatment of patients with RA in Spain when compared to all the available therapeutic alternatives.

Suicide methods among Brazilian women from 1980 to 2019: Influence of age, period, and cohort

OBJECTIVE

To analyze the effect of age, period, and cohort on suicides among women by hanging, strangulation, suffocation, firearms, and autointoxication in different Brazilian regions from 1980 to 2019.

METHODS

Ecological time-trend study employing estimable functions to estimate APC models, facilitated through the Epi library of the R statistical program, version 4.2.1. Specific rates by age group per 100,00 women and relative risks by period and cohort were estimated using this method.

RESULTS

Between 1980 and 2019, 49,997 suicides among women were reported using the methods under study. Higher suicide rates per 100,000 women were observed in the South using strangulation and suffocation (2.42), while lower firearm suicide rates were observed in the Northeast (0.13). After adjusting the APC model, there was an increase in age-specific rates with advancing age across all regions for suicides by hanging, strangulation, and suffocation. In contrast, suicides by firearms and autointoxication showed a decrease in rates with advancing age. The period effect indicated an increased risk of suicides by hanging, strangulation (RR >1 and p<0.05) in the five-year intervals of the 2000s in the North, Southeast, and South regions. During the same period, there was an increased risk of suicides by autointoxication in the Southeast, South, and Northeast (RR>1, p<0.05). Suicides by firearms exhibited a statistically significant reduction in the risk of death from 2005 to 2019 in the Southeast and South regions, and from 2005 to 2014 in the Northeast and Midwest. The observed increase in the North region was not statistically significant (RR>1, p>0.05). The cohort effect demonstrated an increased risk of suicides by hanging, strangulation in younger cohorts (RR>1, p<0.05), whereas other methods showed an elevated risk in older cohorts relative to the 1950-1954 generation.

CONCLUSION

The results presented here may suggest changes in suicide method preferences between 1980 and 2019.

Association between exposure to ambient air pollutants and metabolic syndrome in the vicinity of the Taklamakan Desert

BACKGROUND

Air pollution is a recognized contributor to metabolic syndrome (MetS); but studies in developing regions, including China, remain limited, especially in severely polluted areas near the Taklamakan Desert.

METHODS

Health data from 2,689,455 individuals aged ≥ 18 years in five regions near the Taklamakan Desert were analyzed. MetS diagnosed followed the 2016 Chinese Adult Dyslipidaemias Management Guidelines. Spatio-temporal data from satellite observations were employed to estimate ambient pollution levels, encompassing particulate matter with diameters of up to 1.0 µm (PM1), 2.5 µm (PM2.5), and 10 µm (PM10), along with Ozone (O3) and Carbon monoxide (CO). To investigate the association between air pollutants and the prevalence of MetS and its components, Spatial Generalized Linear Mixed Models were applied, with adjustments made for relevant covariates. Additional stratified and sensitivity analyses were conducted to further investigate these relationships.

RESULTS

The study observed a 20.43 % prevalence of MetS. Non-linear analysis indicated a significant association between all pollutants and MetS prevalence. A 10 μg/m³ increase in concentration was associated with the following respective odds ratios: PM1 (1.341, 95 % CI: 1.331, 1.351), PM2.5 (1.036, 95 % CI: 1.034, 1.037), PM10 (1.006, 95 % CI: 1.005, 1.007), O3 (1.385, 95 % CI: 1.374, 1.396), and CO (1.015,95 %, CI: 1.0147, 1.016). The reliability of these associations was supported by further sensitivity analyses, accounting for variations in age, sex, physical activity, and smoking status. Additional analysis indicated links between pollutants and MetS components, including abdominal obesity, glucose metabolism, and lipid profiles.

CONCLUSIONS

There is an observed association between long-term exposure to air pollution and a heightened risk of MetS, particularly in men, younger individuals, those who are physically inactive, and smokers.

Diagnosis of fibrotic interstitial lung diseases based on the combination of label-free quantitative multiphoton fiber histology and machine learning

Interstitial lung disease (ILD), characterized by inflammation and fibrosis, often suffers from low diagnostic accuracy and consistency. Traditional H&E staining primarily reveals cellular inflammation with limited detail on fibrosis. To address these issues, we introduce a pioneering label-free quantitative multiphoton fiber histology (MPFH) technique that delineates the intricate characteristics of collagen and elastin fibers for ILDs diagnosis. We acquired co-located multiphoton and H&E-stained images from a single tissue slice. Multiphoton imaging was performed on the deparaffinized section to obtain fibrotic tissue information, followed by H&E staining to capture cellular information. This approach was tested in a blinded diagnostic trial among 7 pathologists involving 14 relatively normal lung patients and 31 ILD patients (11 idiopathic pulmonary fibrosis (IPF) / usual interstitial pneumonia (UIP), 14 nonspecific interstitial pneumonia (NSIP), and 6 pleuroparenchymal fibroelastosis (PPFE)). A customized algorithm extracted quantitative fiber indicators from multiphoton images. These indicators, combined with clinical and radiological features, were used to develop an automatic multi-class ILDs classifier. Using MPFH, we can acquire high-quality, co-localized images of collagen fibers, elastin fibers, and cells. We found that the type, distribution, and degree of fibrotic proliferation can effectively distinguish between different subtypes. The blind study showed MPFH enhanced diagnostic consistency (kappa values from 0.56 to 0.72) and accuracy (from 73.0% to 82.5%, p=0.0090). The combination of quantitative fiber indicators effectively distinguished between different tissues, with areas under the receiver operating characteristic curves exceeding 0.92. The automatic classifier achieved 93.8% accuracy, closely paralleling the 92.2% accuracy of expert pathologists. The outcomes of our research underscore the transformative potential of MPFH in the field of f-ILD diagnostics. By integrating quantitative analysis of fiber characteristics with advanced machine learning algorithms, MPFH facilitates the automatic and accurate identification of various fibrotic disease subtypes, showcasing a significant leap forward in precision diagnostics.

Exploratory analysis of the economically justifiable price of tezepelumab for asthma severe in Colombia

INTRODUCTION

Asthma severe imposes important economic burden on health systems, especially with the incorporation of new drugs. Recently, tezepelumab has been approved to prevent exacerbations in patients. This study explores the economically justifiable price of tezepelumab for preventing exacerbations in patients with severe asthma.

MATERIALS AND METHODS

A static model was developed using the decision tree microsimulation to estimate the quality-adjusted life years of two interventions: a single intramuscular dose of tezepelumab versus not applying tezepelumab. This analysis was made during a time horizon of 50 year and from a third-payer perspective.

RESULTS

Based on thresholds of U$4828, U$ 5128, and U$19 992 per QALY evaluated in this study, we established economically justifiable drug acquisition prices of U$ 795, U$ 835, and U$ 3384 per dose of Tezepelumab. Tezepelumab not was cost-effective using a WTP of U$4828 and U$ 5128. It only was cost effective at WTP of U$19 992 per QALY.

CONCLUSION

The economically justifiable cost for tezepelumab in Colombia is between U$795 to U$3384 per dose, depending on the WTP used to decide its implementation. This result should encourage more studies in the region that optimize decision-making processes when incorporating this drug into the health plans of each country.

Interaction between walkability and fine particulate matter on ischemic heart disease: A prospective cohort study in China

BACKGROUND

Previous studies have suggested that neighborhoods characterized by higher walkability are related to a reduced risk of ischemic heart disease (IHD), whereas exposure to PM2.5 is positively associated with risk of IHD. Nevertheless, their joint impact on IHD warrants further investigation.

METHODS

This prospective cohort study was performed in Yinzhou, Ningbo, China, comprising 47,516 participants. Individual-level walkability and PM2.5 were evaluated using a commercial walkability database and a land use regression (LUR) model, respectively. Hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) were calculated using two Cox proportional hazards models: one based on two-year average PM2.5 levels prior to baseline, and the other incorporating time-varying PM2.5 assessed on a monthly scale. Dose-response relationships were explored using restricted cubic spline (RCS) functions. Interactions on both additive and multiplicative scales were assessed via relative excess risk due to interaction (RERI) and likelihood-ratio tests. Joint effects were explored and visualized using a 3D wireframe plot.

RESULTS

Over a median follow-up of 5.14 years, 1735 incident cases of IHD were identified. Adjusted HRs (95 % CIs) were 1.56 (1.34-1.81) per 10 μg/m3 increase in PM2.5 and 0.96 (0.94-0.98) per 10-unit increase in walkability, with both exposures exhibiting non-linear dose-response relationships. Walkability and PM2.5 were positively correlated (rs = 0.12, P < 0.001), and a multiplicative interaction was detected (Pinteraction = 0.019).

CONCLUSION

Walkability was inversely associated with risk of IHD, whereas exposure to PM2.5 was positively associated with IHD. Notably, the pernicious effects of PM2.5 could be attenuated in areas with higher levels of walkability. Our findings underscore the significance of walkable urban design, air quality improvement, as preventive strategies for IHD.

Piperazine ferulate impact on diabetes-induced testicular dysfunction: unveiling genetic insights, MAPK/ERK/JNK pathways, and TGF-β signaling

Diabetic testicular dysfunction (DTD) poses a significant threat to male reproductive health. This study delves into the potential of piperazine ferulate (PF), a natural phenolic compound, in alleviating DTD and sheds light on its underlying mechanisms in rats. Animals were divided into the control, PF, diabetic, and diabetic plus PF groups. Diabetes was induced in rats with a single intraperitoneal (i.p.) injection of streptozotocin (STZ) at 50 mg/kg. PF was administered at 50 mg/kg/day via i.p. injection for four weeks. Significant changes in sexual behavior were observed in diabetic rats, which additionally revealed lower serum levels of testosterone, FSH, and LH. The abnormalities in sperm count, viability, motility, and morphology occurred along with the demonstrated suppression of genes and protein expression related to spermatogenesis. Atrophy of the seminiferous tubules and extensive degeneration and necrosis of the germ and Leydig cells were highlighted by histopathological examination. The testicular function of diabetic rats was significantly improved after PF administration, evidenced by normalized testicular histology, increased testosterone levels, and enhanced sperm quality. In addition to reducing inflammatory cytokines, COX2, and NF-κB expression, pf administration elevated the antioxidant levels and Nrf2/HO-1 expression. Furthermore, key signaling pathways involved in testicular degeneration are regulated by PF. It promoted cell survival and tissue repair by activating the protective TGF-β signaling pathway and attenuating the MAPK/ERK/JNK signaling cascade, which in turn reduced inflammation and apoptosis. PF suppressed the expression of INSL3, SPHK1, CD62E, ANGPTL2, and miR-148a-5p, while increasing the expression of testicular genes like HSD17B1, DAZL, and S1P, addressing DTD. This study highlights the potential of PF to restore testicular function and fertility in diabetic males by modulating genetic and signaling pathways.

Qualitative Evaluation of mHealth Implementation for Infectious Disease Care in Low- and Middle-Income Countries: Narrative Review

Background

Mobile health (mHealth) interventions have the potential to improve health outcomes in low- and middle-income countries (LMICs) by aiding health workers to strengthen service delivery, as well as by helping patients and communities manage and prevent diseases. It is crucial to understand how best to implement mHealth within already burdened health services to maximally improve health outcomes and sustain the intervention in LMICs.

Objective

We aimed to identify key barriers to and facilitators of the implementation of mHealth interventions for infectious diseases in LMICs, drawing on a health systems analysis framework.

Methods

We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to select qualitative or mixed methods studies reporting on determinants of already implemented infectious disease mHealth interventions in LMICs. We searched MEDLINE, Embase, PubMed, CINAHL, the Social Sciences Citation Index, and Global Health. We extracted characteristics of the mHealth interventions and implementation experiences, then conducted an analysis of determinants using the Tailored Implementation for Chronic Diseases framework.

Results

We identified 10,494 titles for screening, among which 20 studies met our eligibility criteria. Of these, 9 studies examined mHealth smartphone apps and 11 examined SMS text messaging interventions. The interventions addressed HIV (n=7), malaria (n=4), tuberculosis (n=4), pneumonia (n=2), dengue (n=1), human papillomavirus (n=1), COVID-19 (n=1), and respiratory illnesses or childhood infectious diseases (n=2), with 2 studies addressing multiple diseases. Within these studies, 10 interventions were intended for use by health workers and the remainder targeted patients, at-risk individuals, or community members. Access to reliable technological resources, familiarity with technology, and training and support were key determinants of implementation. Additional themes included users forgetting to use the mHealth interventions and mHealth intervention designs affecting ease of use.

Conclusions

Acceptance of the intervention and the capacity of existing health care system infrastructure and resources are 2 key factors affecting the implementation of mHealth interventions. Understanding the interaction between mHealth interventions, their implementation, and health systems will improve their uptake in LMICs.

Worldwide prevalence of atopic dermatitis in children between 2000 and 2021: a systematic analysis

BACKGROUND

Atopic dermatitis (AD) is a prevalent allergic disease that significantly impacts pediatric health.

OBJECTIVE

To comprehensively describe the global, regional, and national AD prevalence trends among children aged 0-14 years from 2000 to 2021.

METHODS

Data from the Global Burden of Disease Study 2021 were used to analyze AD prevalence and case numbers. The Annual Average Percentage Change (AAPC) was calculated to assess prevalence trends.

RESULTS

In 2021, global pediatric AD cases reached 72.4 million (95% uncertainty interval 68.5-76.5), a 6.2% increase from 2000. Despite the rise in cases, the prevalence rate decreased averagely by 0.15% (95% CI 0.14-0.16%). Regional prevalence varied widely, with the highest rates in Central Asia, high-income Asia Pacific, and Western Europe, and the lowest in Sub-Saharan Africa. Nationally, the AD prevalence rates ranged from 1.50% in Rwanda to 10.67% in Mongolia. Between 2000 and 2021, 108 countries or territories showed a significant increase in AD prevalence, with the most notable rises in Russia, Ghana, and Latvia. In contrast, 48 countries, including the USA, Syria, and Japan, experienced a marked decrease in AD prevalence. Age and sex patterns showed the highest prevalence in children aged 5-9 years, with girls having higher rates than boys across all age groups.

CONCLUSION

This study reveals complex global patterns in pediatric AD prevalence, underscoring the necessity of regionally tailored public health strategies and further research into the diverse causes of AD to enhance prevention and management efforts.

Targeting Fibrosis: From Molecular Mechanisms to Advanced Therapies

As the final stage of disease-related tissue injury and repair, fibrosis is characterized by excessive accumulation of the extracellular matrix. Unrestricted accumulation of stromal cells and matrix during fibrosis impairs the structure and function of organs, ultimately leading to organ failure. The major etiology of fibrosis is an injury caused by genetic heterogeneity, trauma, virus infection, alcohol, mechanical stimuli, and drug. Persistent abnormal activation of "quiescent" fibroblasts that interact with or do not interact with the immune system via complicated signaling cascades, in which parenchymal cells are also triggered, is identified as the main mechanism involved in the initiation and progression of fibrosis. Although the mechanisms of fibrosis are still largely unknown, multiple therapeutic strategies targeting identified molecular mechanisms have greatly attenuated fibrotic lesions in clinical trials. In this review, the organ-specific molecular mechanisms of fibrosis is systematically summarized, including cardiac fibrosis, hepatic fibrosis, renal fibrosis, and pulmonary fibrosis. Some important signaling pathways associated with fibrosis are also introduced. Finally, the current antifibrotic strategies based on therapeutic targets and clinical trials are discussed. A comprehensive interpretation of the current mechanisms and therapeutic strategies targeting fibrosis will provide the fundamental theoretical basis not only for fibrosis but also for the development of antifibrotic therapies.

Analysis the Burden of Breast Cancer Among Adolescents and Young Adults Using the Global Burden of Disease 2021

BACKGROUND

Unique features and worse outcomes have been reported for breast cancers among adolescents and young adults (AYAs; age 15-39 years). However, there are few up-to-date and comprehensive data to analyze the disease burden of AYA breast cancer.

PATIENTS AND METHODS

The data of incidence, deaths, and disability-adjusted life years (DALYs) owing to breast cancer was obtained from the Global Burden of Disease (GBD) 2021. We computed estimated annual percentage changes (EAPCs) of each indicator to capture the secular trend in breast cancer and conducted a decomposition analysis to examine factors behind DALYs changes. We also predicted the incident cases, deaths and DALYs to 2044.

RESULTS

From 1990 to 2021, the age-standardized incidence rate (ASIR) experienced an increasing trend globally [EAPC: 0.87, 95% confidence interval (CI) 0.77-0.97]. The age-standardized rates (ASRs) of male AYAs breast cancer were all on the rise. The most significant increase trends in ASRs among female AYAs occurred in North Africa and Middle East, while male AYAs showed the highest increases in East Asia. Population growth contributed the most to the growth of DALYs in East Asia. Frontier analysis showed that despite limited resources, some underdeveloped countries still exhibit superior performance, while other countries with higher sociodemographic index have great room for improvement.

CONCLUSIONS

The global burden of AYAs breast cancer is grim, especially in North Africa and Middle East. The significant increase in male AYAs breast cancer burden, targeted prevention strategies may need to be developed for AYAs breast cancer by sex and countries.

Research Trends and Hotspots on Asthma and Depression: A Bibliometric Analysis

Purpose

Asthma and depression are prevalent conditions with significant comorbidity, impacting patients' quality of life. This bibliometric study aims to analyze research trends and hotspots in the field from 2000 to 2023, identifying key contributions and predicting future directions.

Methods

We conducted a systematic search in the Web of Science Core Collection (WoSCC) for articles on asthma and depression, published between 2000 and 2023. Bibliometrics, which involves the application of mathematical and statistical methods to analyze scholarly literature, was employed in this study to systematically assess the research trends and hotspots in the field of asthma and depression. VOSviewer and CiteSpace software were utilized for visual analysis and data visualization, enabling us to map collaboration networks and identify research hotspots and trends within the asthma and depression literature.

Results

Our analysis retrieved 3067 papers from 937 journals, involving 14,631 authors and 4006 institutions across 106 countries. The United States, Columbia University, the Journal of Asthma, and Christer Janson were the most prolific contributors. Six primary research themes emerged: quality of life, childhood asthma, primary care, substance P, intervention, and emotion. Additionally, Burst detection analysis identified emerging topics, including severe asthma, other respiratory diseases, and oxidative stress.

Conclusion

This bibliometric analysis has revealed significant insights into the research trends and hotspots in the field of asthma and depression. The primary findings indicate a growing body of research highlighting the impact of depression on asthma control and patients' quality of life, the need for psychological interventions in treating comorbid asthma and depression, and the emerging focus on severe asthma and oxidative stress mechanisms. These findings underscore the importance of continued research in these areas to advance our understanding and improve clinical outcomes for patients with these comorbid conditions.

A gut commensal protozoan determines respiratory disease outcomes by shaping pulmonary immunity

The underlying mechanisms used by the intestinal microbiota to shape disease outcomes of the host are poorly understood. Here, we show that the gut commensal protozoan, Tritrichomonas musculis (T.mu), remotely shapes the lung immune landscape to facilitate perivascular shielding of the airways by eosinophils. Lung-specific eosinophilia requires a tripartite immune network between gut-derived inflammatory group 2 innate lymphoid cells and lung-resident T cells and B cells. This network exacerbates the severity of allergic airway inflammation while hindering the systemic dissemination of pulmonary Mycobacterium tuberculosis. The identification of protozoan DNA sequences in the sputum of patients with severe allergic asthma further emphasizes the relevance of commensal protozoa in human disease. Collectively, these findings demonstrate that a commensal protozoan tunes pulmonary immunity via a gut-operated lung immune network, promoting both beneficial and detrimental disease outcomes in response to environmental airway allergens and pulmonary infections.

Economic evaluation of a community dental care model for people experiencing homelessness

Aim The study aims to conduct economic evaluation of the Peninsula Dental Social Enterprise (PDSE) programme for people experiencing homelessness over an 18-month period, when compared to a hypothetical base-case scenario ('status quo').Methods A decision tree model was generated in TreeAge Pro Healthcare 2024. Benefit-cost analysis and cost-effectiveness analysis were performed using data informed by the literature and probabilistic sensitivity analysis (Monte Carlo simulation with 1,000 cycles). The pre-determined willingness-to-pay threshold was estimated to be £59,502 per disability-adjusted life year (DALY) averted. Costs (£) and benefits were valued in 2020 prices. Health benefits in DALYs included dental treatment for dental caries, periodontitis and severe tooth loss.Results The hypothetical cohort of 89 patients costs £11,502 (SD: 488) and £57,118 (SD: 2,784) for the base-scenario and the PDSE programme, respectively. The health outcomes generated 0.9 (SD: 0.2) DALYs averted for the base-case scenario, and 5.4 (SD: 0.9) DALYs averted for the PDSE programme. The DALYs averted generated £26,648 (SD: 4,805) and £163,910 (SD: 28,542) in benefits for the base-scenario and the PDSE programme, respectively. The calculated incremental benefit-cost ratio was 3.02 (SD: 0.5) and incremental cost-effectiveness ratio was £10,472 (SD: 2,073) per DALY averted. Uncertainty analysis demonstrated that the PDSE programme was 100% cost-effective.Conclusions Funding a targeted dental programme from the UK healthcare perspective that provides timely and affordable access to dental services for people experiencing homelessness is cost-effective.

Changing trends in lung cancer disease burden between China and Australia from 1990 to 2019 and its predictions

PURPOSE

Lung cancer (LC) is a leading cause of death and presents a substantial societal burden. This article compares its disease burden and risk factors between China and Australia to support health policymakers for LC prevention and treatment.

MATERIALS AND METHODS

The data from the 2019 Global Burden of Disease Study were used to analyze disease temporal trends using Joinpoint regression model. The Bayesian age-period-cohort model was used for prediction. The population-attributable fraction (PAF) was used to analyze LC risk factors.

RESULTS

In 2019, the age-standardized rates (ASR) of incidence and of mortality of LC in China were 41.71/100 000 and 38.70/100 000, while Australia's rates were 30.45/100 000 and 23.46/100 000. It showed an increasing trend in China but a decreasing trend in Australia. By 2030, the ASR of incidence and mortality are predicted to be 47.21/100 000 and 41.54/100 000 in China, while Australia's rates will reach 30.09/100 000 and 23.3/100 000, respectively. Smoking is the most common risk factor for LC, followed by particulate matter and occupational carcinogenesis. The PAF of smoking dropped in Australia (from 68.38% to 53.75% in females; 77.41% to 58.47% in males) but increased in China (from 19.56% to 26.58% in females; 80.45% to 82.03% in males) from 1990 to 2019.

CONCLUSIONS

The disease burden of LC in China is rising, whereas in Australia, it is declining. China still faces a heavy LC burden. Risk factor analysis supported for further improving the compliance and enforcement of polices on tobacco control and environmental management to reduce this disease burden.

Association of metabolomic aging acceleration and body mass index phenotypes with mortality and obesity-related morbidities

This study aims to investigate the association between metabolomic aging acceleration and body mass index (BMI) phenotypes with mortality and obesity-related morbidities (ORMs). 85,458 participants were included from the UK Biobank. Metabolomic age was determined using 168 metabolites. The Chronological Age-Adjusted Gap was used to define metabolomically younger (MY) or older (MO) status. BMI categories were defined as normal weight, overweight, and obese. Participants were categorized into MY normal weight (MY-NW, reference), MY overweight (MY-OW), MY obesity (MY-OB), MO normal weight (MO-NW), MO overweight (MO-OW), and MO obesity (MO-OB). Mortality and 43 ORMs were identified through death registries and hospitalization records. Compared with MY-NW phenotype, MO-OB phenotype yielded increased risk of mortality and 32 ORMs, followed by MO-OW with mortality and 27 ORMs, MY-OB with mortality and 26 ORMs, MY-OW with 21 ORMs, and MO-NW with mortality and 14 ORMs. Consistently, MO-OB phenotype showed the highest risk of developing obesity-related multimorbidities, followed by MY-OB phenotype, MO-OW phenotype, MY-OW phenotype, and MO-NW phenotype. Additive interactions were found between metabolomic aging acceleration and obesity on CVD-specific mortality and 10 ORMs. Additionally, individuals with metabolomic aging acceleration had higher mortality and cardiovascular risk, even within the same BMI category. These findings suggest that metabolomic aging acceleration could help stratify mortality and ORMs risk across different BMI categories. Weight management should also be extended to individuals with overweight or obesity even in the absence of accelerated metabolomic aging, as they face increased healthy risk compared with MY-NW individuals. Additionally, delaying metabolic aging acceleration is needed for all metabolomically older groups, including those with normal weight.

Lack of Association Between Sodium Intake and Cytokine Levels

Purpose

The complex pathogenesis of hypertension, potentially involving inflammatory pathways, remains elusive. This study aimed to evaluate the relationship between 24-hour urinary sodium excretion and inflammatory cytokines alongside C-reactive protein (CRP) in a nationwide Finnish sample.

Materials and methods

265 participants from the FINRISK 2002 study were included in the analyses. Multivariable-adjusted associations of 24-hour urinary sodium with circulating CRP and 26 cytokines were examined.

Results

24-hour urinary sodium was not significantly associated with any of the cytokines or CRP (p ≥ 0.02 for all, significance at <0.001). Adjustments for age, sex, serum creatinine concentration, and alcohol intake did not alter these results.

Conclusion

This cross-sectional study revealed no associations between 24-hour urinary sodium and cytokine or CRP levels. This does not suggest reducing salt intake would be unbeneficial in hypertension. Additional research is required to clarify the mechanisms through which salt may induce hypertension. Assessing sodium intake in epidemiological studies is also challenging.

Is there a link between per capita alcohol consumption and cancer mortality?

INTRODUCTION

A growing body of evidence has established alcohol consumption as a causative factor in an increasing array of cancer types, thereby positioning it as a leading global risk factor for cancer. Surprisingly, there is a scarcity of studies examining the extent to which shifts in population drinking affect cancer mortality, despite the substantial public health implications. This paper aims to: (i) estimate the impact of changes in per capita alcohol consumption on both overall cancer mortality rates and specific types of alcohol-related cancer; and (ii) assess whether the association between cancer and population alcohol consumption is influenced by a country's drinking patterns.

METHODS

We used time-series data for 19 high-income countries spanning the period 1960-2018. Cigarette sales and GDP per capita were included as control variables. The data were analysed using first-difference modelling. The World Health Organization drinking patterns score was used to evaluate a country's drinking pattern.

RESULTS

Our findings revealed that a 1 L per capita increase in alcohol consumption was associated with a 0.9% rise in total cancer mortality among women and a 1.1% increase among men. Notably, among men, the association was more pronounced for cancers with strong evidence of alcohol's effect and for prostate cancer. For women, the alcohol effect was statistically significant for breast cancer. Generally, the estimated alcohol effects were elevated in the country group with more harmful drinking patterns.

DISCUSSION AND CONCLUSIONS

Our results indicate that lowering per capita alcohol consumption is likely to reduce cancer mortality.

Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use

BACKGROUND

A range of school-based interventions are effective in improving student diet and physical activity (e.g. school food policy interventions and classroom physical activity interventions), and reducing obesity, tobacco use and/or alcohol use (e.g. tobacco control programmes and alcohol education programmes). However, schools are frequently unsuccessful in implementing such evidence-based interventions.

OBJECTIVES

The primary review objective is to evaluate the effectiveness of strategies aiming to improve school implementation of interventions to address students' (aged 5 to 18 years) diet, physical activity, obesity, tobacco use and/or alcohol use. The secondary objectives are to: 1. determine whether the effects are different based on the characteristics of the intervention including school type and the health behaviour or risk factor targeted by the intervention; 2. describe any unintended consequences and adverse effects of strategies on schools, school staff or students; and 3. describe the cost or cost-effectiveness of strategies.

SEARCH METHODS

We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), five additional databases, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and the US National Institutes of Health registry (clinicaltrials.gov). The latest search was between 1 May 2021 and 30 June 2023 to identify any relevant trials published since the last published review.

SELECTION CRITERIA

We defined 'implementation' as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any randomised controlled trial (RCT) or cluster-RCT conducted on any scale, in a school setting, with a parallel control group that compared a strategy to improve the implementation of policies or practices to address diet, physical activity, obesity, tobacco use and/or alcohol use by students (aged 5 to 18 years) to no active implementation strategy (i.e. no intervention, inclusive of usual practice, minimal support) or a different implementation strategy.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Given the large number of outcomes reported, we selected and included the effects of a single outcome measure for each trial for the primary outcome using a decision hierarchy (i.e. continuous over dichotomous, most valid, total score over subscore). Where possible, we calculated standardised mean differences (SMDs) to account for variable outcome measures with 95% confidence intervals (CI). We conducted meta-analyses using a random-effects model. Where we could not combine data in meta-analysis, we followed recommended Cochrane methods and reported results in accordance with 'Synthesis without meta-analysis' (SWiM) guidelines. We conducted assessments of risk of bias and evaluated the certainty of evidence (GRADE approach) using Cochrane procedures.

MAIN RESULTS

We included an additional 14 trials in this update, bringing the total number of included trials in the review to 39 trials with 83 trial arms and 6489 participants. Of these, the majority were conducted in Australia and the USA (n = 15 each). Nine were RCTs and 30 were cluster-RCTs. Twelve trials tested strategies to implement healthy eating practices; 17 physical activity, two tobacco, one alcohol, and seven a combination of risk factors. All trials used multiple implementation strategies, the most common being educational materials, educational meetings, and education outreach visits, or academic detailing. Of the 39 included trials, we judged 26 as having high risks of bias, 11 as having some concerns, and two as having low risk of bias across all domains. Pooled analyses found, relative to a control (no active implementation strategy), the use of implementation strategies probably results in a large increase in the implementation of interventions in schools (SMD 0.95, 95% CI 0.71, 1.19; I2 = 78%; 30 trials, 4912 participants; moderate-certainty evidence). This is equivalent to a 0.76 increase in the implementation of seven physical activity intervention components when the SMD is re-expressed using an implementation measure from a selected included trial. Subgroup analyses by school type and targeted health behaviour or risk factor did not identify any differential effects, and only one study was included that was implemented at scale. Compared to a control (no active implementation strategy), no unintended consequences or adverse effects of interventions were identified in the 11 trials that reported assessing them (1595 participants; moderate-certainty evidence). Nine trials compared costs between groups with and without an implementation strategy and the results of these comparisons were mixed (2136 participants; low-certainty evidence). A lack of consistent terminology describing implementation strategies was an important limitation of the review.

AUTHORS' CONCLUSIONS

We found the use of implementation strategies probably results in large increases in implementation of interventions targeting healthy eating, physical activity, tobacco and/or alcohol use. While the effectiveness of individual implementation strategies could not be determined, such examination will likely be possible in future updates as data from new trials can be synthesised. Such research will further guide efforts to facilitate the translation of evidence into practice in this setting. The review will be maintained as a living systematic review.

Association of Low Muscle Strength With Incident Pneumonia in Older Patients With Heart Failure

BACKGROUND

Patients with heart failure (HF) are at an increased risk of developing pneumonia, leading to a high mortality. A decrease in muscle strength due to aging or concomitant disease may contribute to the development of pneumonia in older adults. We sought to investigate the relationship between low muscle strength and pneumonia incidence in older patients hospitalized for worsening HF.

METHODS

We carried out a subanalysis of the FRAGILE-HF, a prospective multicenter observational study, including 1 266 consecutive older (≥65 years) patients hospitalized with HF (mean age 80.2 ± 7.8 years; 57.4% male; left ventricular ejection fraction 46% ± 17%) and information of incident pneumonia observed after discharge. Patients were followed up for 2 years post-discharge.

RESULTS

A total of 88 patients (7.0%) developed pneumonia after discharge, with an incidence of 42.7 per 1 000 person-years. A total of 893 patients with low muscle strength, defined as handgrip strength <28 kg for men and <18 kg for women according to international criteria, were more likely to develop pneumonia than those with normal muscle strength (p < .001; log-rank test). Low muscle strength was a significant predictor of incident pneumonia (adjusted hazard ratio with 95% confidence interval: 2.65 [1.31-5.35], p = .007). Furthermore, the mortality rates were 43.2% in patients who developed pneumonia and 19.3% in those who did not, indicating a heightened risk of death following the onset of pneumonia (adjusted hazard ratio: 4.25 [2.91-6.19], p < .001).

CONCLUSIONS

In older patients hospitalized for HF, low muscle strength was associated with incident pneumonia after discharge.

Prevalence and attributable health burdens of vector-borne parasitic infectious diseases of poverty, 1990-2021: findings from the Global Burden of Disease Study 2021

BACKGROUND

Vector-borne parasitic infectious diseases associated with poverty (referred to as vb-pIDP), such as malaria, leishmaniasis, lymphatic filariasis, African trypanosomiasis, Chagas disease, and onchocerciasis, are highly prevalent in many regions around the world. This study aims to characterize the recent burdens of and changes in these vb-pIDP globally and provide a comprehensive and up-to-date analysis of geographical and temporal trends.

METHODS

Data on the prevalence and disability-adjusted life years (DALYs) of the vb-pIDP were retrieved from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021 for 21 geographical regions and 204 countries worldwide, from 1990-2021. The age-standardized prevalence rate and DALYs rate by age, sex, and sociodemographic index (SDI) were calculated to quantify temporal trends. Correlation analysis was performed to examine the relationship between the age-standardized rate and the SDI.

RESULTS

Over the past 30 years, the age-standardized prevalence rate and DALYs rate of these vb-pIDP have generally decreased, with some fluctuations. The distribution of vb-pIDP globally is highly distinctive. Except for Chagas disease, the age-standardized prevalence rate and DALYs rate of other vb-pIDP were highest in low-SDI regions by 2021. Malaria had the highest age-standardized prevalence rate (2336.8 per 100,000 population, 95% UI: 2122.9, 2612.2 per 100,000 population) and age-standardized DALYs rate (806.0 per 100,000 population, 95% UI: 318.9, 1570.2 per 100,000 population) among these six vb-pIDP globally. Moreover, significant declines in the age-standardized prevalence rate and DALYs rate have been observed in association with an increase in the SDI . Globally, 0.14% of DALYs related to malaria are attributed to child underweight, and 0.08% of DALYs related to malaria are attributed to child stunting.

CONCLUSIONS

The age-standardized prevalence rate and DALY rates for the vb-pIDP showed pronounced decreasing trends from 1990-2021. However, the vb-pIDP burden remains a substantial challenge for vector-borne infectious disease control globally and requires effective control strategies and healthcare systems. The findings provide scientific evidence for designing targeted health interventions and contribute to improving the prevention and control of infectious diseases.

A bibliometric analysis of inflammatory bowel disease research in the Arab world

BACKGROUND

The prevalence of inflammatory bowel disease (IBD) continues to increase worldwide, including in the Arab world. This study investigates IBD research output in Arab countries from 2009 to 2023, alongside prevalence and incidence trends.

METHODS

We utilized bibliometric analysis with data from Clarivate Analytics, the Institute for Health Metrics and Evaluation, and the World Bank. We compared the research output, citation impact, and funding across 22 Arab countries with global averages. Spearman's correlation examined relationships between IBD publications and prevalence, incidence rates, gross domestic product (GDP), and population size.

RESULTS

Between 2009 and 2023, Arab countries produced 1004 IBD-related publications (2.9% of global output), with Saudi Arabia (37.7%) and Egypt (27.5%) being the leading countries. The median IBD incidence rose from 2.42 to 3.06 per 100,000, with the prevalence increasing from 28.93 to 33.95 per 100,000 from 2009 to 2019. Arab IBD research had a citation impact of 14.49 compared to the global average of 23.98. Funded research constituted 18.7% of Arab publications, lower than the global rate of 32.4%. We found positive correlations between IBD publication counts and prevalence (r s = 0.753), incidence rates (r s = 0.734), and GDP (r s = 0.782), all with P < 0.001. Population size showed a nonsignificant correlation (r s = 0.371, P = 0.090) with IBD publication counts.

CONCLUSIONS

Arab nations contribute 2.9% of global IBD research, with lower citation impact and funding than the global average. Enhanced local support is crucial to improving research impact and addressing the rising prevalence of IBD in the Arab world.

Indian Shot (Canna Indica L). Leaves Provide Valuable Insights into the Management of Inflammation and Other Associated Disorders Offering Health Benefits

Background

Throughout history, plants have played a crucial role in advancing medicinal treatments by providing a diverse range of compounds for the development of innovative therapies. Canna indica L. a tropical herb of the Cannaceae family, also known as Indian shot, has a rich history of traditional use in treating ailments like inflammation, malaria, dysentery, fever, dropsy, and diarrhea.

Objective

This comprehensive research invesigates the extract preparation of C. indica leaves using multidisciplinary analytical approaches for this extract in order to shed light on its therapeutic potentials.

Methods

The research, an international collaboration involving researchers from Bangladesh and China, utilized GC-MS/MS analysis to identify bioactive compounds across different C. indica extracts. Biological assays were conducted to assess antimicrobial activity using the disc diffusion method (in vitro), cytotoxicity through the brine shrimp lethality assay (in vitro), analgesic effects via the acetic acid-induced writhing test (in vivo), and antidiarrheal activity with the castor oil-induced diarrhea model (in vivo). Molecular docking studies were performed to determine binding affinities with Epidermal Growth Factor Receptor (EGFR), Dihydrofolate Reductase (DHFR), Delta Opioid Receptor (DOR), Tumor Necrosis Factor-alpha (TNF-α), and Cyclooxygenase-2 (COX-2) receptors.

Results

The GC-MS/MS analysis identified 35, 43, 27, and 20 compounds in dichloromethane, aqueous, petroleum ether, and ethyl acetate extracts, respectively. The aqueous (AQSF) and dichloromethane (DCMSF) extracts showed notable antimicrobial activity, particularly against gram-negative bacteria. Cytotoxicity tests indicated that ethyl acetate (EASF) and dichloromethane (DCMSF) fractions were potent. Analgesic activity was highest in DCMSF, and antidiarrheal effects were dose-dependent, with DCMSF showing the greatest efficacy. Molecular docking revealed strong affinities of Ergostane-3,5,6,12,25-pentol, 25-acetate, (3.beta.,5.alpha.,6.beta.,12.beta).- for EGFR and Norgestrel for COX-2.

Conclusion

This research provides valuable insights into the bioactivity evaluation of C. indica, bridging the gap between its chemical composition and diverse biological effects. The findings contribute to the growing body of knowledge in natural product-based drug discovery and underscore the significance of C. indica as a potential source of novel therapeutic agents to treat inflammation and other disease states.

Global burden of neonatal preterm birth: A systematic analysis for the global burden of disease study 2019

OBJECTIVES

Addressing the research gap on neonatal preterm birth's global impact, this study aims to present a detailed analysis of its incidence and mortality rates from 1990 to 2019, capturing the disease burden's evolution during this timeframe.

METHODS

We analyzed Global Burden of Disease Study 2019 data across 204 countries to assess age-standardized incidence, prevalence, mortality, and DALYs for neonatal preterm birth from 1990 to 2019, along with EPAC and risk factors.

RESULTS

From 1990 to 2019, EPAC for neonatal death at 0-6 days was -1.75 %, and DALYs was -1.75 %. For deaths under 5 years, EPAC was -2.23 %, and DALYs was -2.19 %. Key risk factors for neonatal preterm birth DALYs included low birth weight, gestational age, ambient air pollution, and household pollution from solid fuels.

CONCLUSIONS

Preterm birth notably increases neonatal risks at 0-6 days and under 5 years. Our study shows diseased disease burdens in these periods. Preventive strategies, such as reducing household and ambient air pollution, are crucial for preterm birth reduction. Tailored regional interventions are essential.

Seroconversion following PPSV23 vaccination in children with type 1 diabetes mellitus

OBJECTIVE

To evaluate whether children with type 1 diabetes mellitus (T1DM) have optimal humoral immune response to pneumococcal polysaccharide vaccination (PPSV23) and to study factors affecting that response.

METHODS

In this prospective pilot study, we recruited 29 children with T1DM who were vaccine naïve to PPSV23 and assessed serum-serotype specific IgG at baseline and 4-6 weeks post-immunization. We tested association between independent variables (age, gender, body mass index (BMI), hemoglobin A1c (HbA1c), glucose variability, and time in range assessed by continuous glucose monitors (CGM), insulin dose and outcome (log-2-fold change of immunoassay response between pre- and post-immunization testing) using linear regression.

RESULTS

Eighty-eight percent of children (22/25) who completed the study had overall appropriate response with a median 4.2-fold change following immunization. When assessing PPSV23-exclusive serotypes, there was a statistically significant correlation between increasing age and greater response (0.16 log2-fold change per year, 95 % CI (0.014 to 0.3), p = 0.033). Higher BMI for age (p = 0.085) and a lower coefficient of glucose variation from CGM following immunization (p = 0.067) also coincided with greater vaccine response, with correlation statistically significant for certain pneumococcal serotypes for both.

CONCLUSIONS

Response to pneumococcal vaccination has not previously been assessed in children with T1DM, and our study demonstrates robust humoral immune response to PPSV23 vaccination in these children. Larger studies with a diverse representation and longer follow up to assess how humoral seroconversion correlates with clinical response to PPSV23 in this vulnerable population are warranted.

Elucidating the bidirectional association between autoimmune diseases and depression: a systematic review and meta-analysis

QUESTION

Collective evidence for the bidirectional association between depression and autoimmune diseases (ADs) is scarce, especially for subgroups of patients with specific ADs. We conducted a meta-analysis to determine the incidence rates and relative risks (RRs) of depression among patients with ADs, and vice versa.

STUDY SELECTION AND ANALYSIS

PubMed, Embase, Web of Science, Ovid, PsycNet and Cochrane were searched up to 10 September 2024. Cohort studies evaluating longitudinal risks between ADs and depression were included. Incidence rates and RRs of depression among patients with ADs and vice versa were pooled.

FINDINGS

The analysis included 47 studies, involving over 40.77 million participants. The pooled incidence rate of depression among patients with ADs was 6.71% (95% CI 5.10% to 8.77%), with an RR of 1.85 (95% CI 1.57 to 2.19), higher in patients aged over 45 (2.30; 95% CI 1.62 to 3.26) and females (1.88; 95% CI 1.61 to 2.20). Conversely, the pooled incidence rate of ADs among depression was 0.54% (95% CI 0.24% to 1.19%), with an RR of 1.84 (95% CI 1.10 to 3.09). The incidence rate and RRs also varied across subgroups with the highest incidence rate in the musculoskeletal system and connective tissue (1.36; 95% CI 0.50 to 3.63) and RR in the genitourinary system (2.23; 95% CI 1.98 to 2.51).

CONCLUSIONS

This study identified a bidirectional association between depression and ADs, with higher RRs among patients aged over 45 and females. Especially higher risks were also found for specific types of ADs including endocrine, nutritional, and metabolic diseases, genitourinary system, and skin and subcutaneous tissue.

PROSPERO REGISTRATION NUMBER

CRD42024541053.

Efficacy and Safety of One Shot of Hyaluronic Acid in Hip Osteoarthritis: Postmarketing Clinical Follow-Up for Real-World Evidence

Purpose

This study aims to evaluate the real-world efficacy and safety of intra-articular (IA) hyaluronic acid (HA) injections in patients with hip osteoarthritis (OA). Given the increasing burden of hip osteoarthritis and limited evidence supporting viscosupplementation in this context, this research aims to provide valuable insights under real clinical practice conditions.

Patients and Methods

An observational, cross-sectional and retrospective study was conducted in a cohort of patients with hip OA treated with a single injection of HA (Adant One, Meiji Pharma Spain, Spain) from January 2021 to December 2022. Data on patient demographics, clinical characteristics, and treatment outcomes were collected. Efficacy regarding pain relief and/or function improvement was assessed at 6 months using the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were pseudonymized. The study was approved by the Research Ethics Committee of the Autonomous Community of Aragon (CEICA).

Results

The study included 40 patients with a mean age of 62.8 years, with 72.5% being female. Significant improvement was observed six-months post-treatment: 25% and 18.5% reduction in pain (VAS and WOMAC, respectively), 11.6% improvement in function (WOMAC), 7.4% improvement in stiffness (WOMAC), and 13.6% improvement in total WOMAC. No adverse events were reported.

Conclusion

A single injection of IA HA significantly improved pain and function in patients with hip OA. These findings support the use of viscosupplementation for hip OA management and underscore the need for further studies to confirm these results and assess the long-term benefits of IA HA in hip OA.

Epidemiology of gastrointestinal cancers: a systematic analysis from the Global Burden of Disease Study 2021

BACKGROUND

Gastrointestinal cancers comprise nearly one-third of global mortality from cancer, yet the comprehensive global burden of these cancers remains uninvestigated.

OBJECTIVE

We aimed to assess the global, regional and national burden of gastrointestinal cancers.

DESIGNS

Data on oesophagus, gastric, colorectal, liver, pancreas and biliary tract cancers were extracted from the Global Burden of Disease 2021 database. Age-standardised incidence rate (ASIR) and age-standardised death rate (ASDR) were calculated by sex, region and Sociodemographic Index (SDI).

RESULTS

In 2021, there were 5.26 million incidences and 3.70 million deaths from gastrointestinal cancer. The greatest burden is from colorectal, followed by gastric, oesophageal, pancreatic, liver and biliary tract cancer. We noted geographical and socioeconomic differences in ASIR and ASDR across all types of cancers. From 2000 to 2021, ASIR increased for colorectal cancer (annual percent change (APC): 0.10%, 95% CI 0.05% to 0.14%), pancreatic cancer (APC: 0.27%, 95% CI 0.14% to 0.41%), and liver cancer from metabolic dysfunction-associated steatotic liver disease (APC: 0.62%, 95% CI 0.58% to 0.67%) and alcohol-related liver disease (APC: 0.26%, 95% CI 0.22% to 0.30%). ASDR increased for pancreatic cancer (APC: 0.18%, 95% CI 0.02% to 0.34%). Higher SDI countries had higher incidence rates for most types of gastrointestinal cancer.

CONCLUSIONS

Although the ASIR of oesophageal, gastric and biliary tract cancer has decreased, the ASIR still increased in colorectal, pancreatic and liver cancer from steatotic liver disease. Public policies are important for controlling gastrointestinal cancers-most importantly, reducing alcohol consumption, hepatitis B immunisation and tackling the burden of metabolic diseases.

Aged and Obscured Wildfire Smoke Associated with Downwind Health Risks

Fine-mode particulate matter (PM2.5) is a highly detrimental air pollutant, regulated without regard for chemical composition and a chief component of wildfire smoke. As wildfire activity increases with climate change, its growing continental influence necessitates multidisciplinary research to examine smoke's evolving chemical composition far downwind and connect chemical composition-based source apportionment to potential health effects. Leveraging advanced real-time speciated PM2.5 measurements, including an aerosol chemical speciation monitor in conjunction with source apportionment and health risk assessments, we quantified the stark pollution enhancements during peak Canadian wildfire smoke transport to New York City over June 6-9, 2023. Interestingly, we also observed lower-intensity, but frequent, multiday wildfire smoke episodes during May-June 2023, which risk exposure misclassification as generic aged organic PM2.5 via aerosol mass spectrometry given its extensive chemical transformations during 1 to 6+ days of transport. Total smoke-related organic PM2.5 showed significant associations with asthma exacerbations, and estimates of in-lung oxidative stress were enhanced with chemical aging, collectively demonstrating elevated health risks with increasingly frequent smoke episodes. These results show that avoiding underestimated aged biomass burning PM2.5 contributions, especially outside of peak episodes, necessitates real-time chemically resolved PM2.5 monitoring to enable next-generation health studies, models, and policy under far-reaching wildfire impacts in the 21st century.

Temporal Decomposition Analysis of Noncommunicable Disease Burden: The Interplay of Population Aging, Population Growth, and Low Physical Activity, 2010-2019

BACKGROUND

To analyze global trends in the noncommunicable diseases (NCDs) burden attributable to low physical activity, considering the impacts of population aging and growth.

METHOD

Based on the Global Burden Disease 2019 Study, the NCDs-related death and disability-adjusted life years attributable to low physical activity (defined as <3000 metabolic equivalent-min/wk) were obtained from 2010 to 2019. The average annual percent change was calculated using the joinpoint analysis. Decomposition analysis was applied to assess the separated contributions of 3 components (population aging, population growth, and death change due to all other factors) on the overall change in NCDs death attributed to low physical activity.

RESULTS

From 2010 to 2019, the average annual percent change of age-standardized rates of NCDs due to low physical activity was -0.09% for death and -0.06% for disability-adjusted life years. However, the global absolute number of deaths from NCDs attributable to low physical activity increased from 672,215 to 831,502, and disability-adjusted life years rose from 12,813,793 to 15,747,938. This rise was largely driven by population aging and growth, contributing to a 13.0% and 14.7% increase, respectively. The most significant impact of population aging on NCD deaths was observed in high-middle socio-demographic index countries (17.6%), whereas population growth had the greatest effect in low socio-demographic index countries (24.3%).

CONCLUSIONS

The reduction in NCDs death rates attributed to low physical activity is insufficient to counteract the effects of population aging and growth. Targeted interventions for physical activity promotion should focus on the older population with special attention to diseases most sensitive to physical inactivity.

Real-Time Digitized Visual Feedback in Exercise Therapy for Lower Extremity Functional Deficits: Qualitative Study of Usability Factors During Prototype Testing

BACKGROUND

Osteoarthritis is one of the most common degenerative diseases of the musculoskeletal system and can ultimately lead to the need for surgery, such as total knee or hip arthroplasty. Functional movement deficits can be a prognostic factor for osteoarthritis in the lower extremities. Thus, training physiological movement patterns may help in the treatment of such functional deficits. Motivation to exercise frequently is of utmost importance and can be promoted by using digital real-time feedback.

OBJECTIVE

This qualitative study aims to gather user recommendations for prototype feedback visualizations in a real-time exercise-feedback system called homeSETT for the treatment of functional deficits. The system provides real-time feedback to participants while performing exercises that focus on functional deficits, such as lateral trunk lean, pelvic drop, and valgus thrust. The findings of this study should help to optimize the prototype feedback visualizations. Thus, the main research questions were how patients, physiotherapists, and physicians evaluate the presented, current state of prototype feedback visualizations for selected functional exercises, and what improvements and variations would be recommended.

METHODS

Testing of the prototype feedback visualizations took place at a movement laboratory using a 3D optoelectronic movement analysis system. Data on usability factors were acquired using the thinking aloud method during and semistructured interviews after prototype testing. Transcribed audio recordings of semistructured interviews as well as scribing logs of the thinking aloud method were examined using qualitative content analysis.

RESULTS

Data were analyzed from 9 participants, comprising 2 (22%) patients, 2 (22%) physicians, and 5 (56%) physiotherapists. The mean age of the participants was 45 (SD 9) years and the mean work experience among the participating physiotherapists and physicians was 22 (SD 5) years. Each participant tested 11 different exercise-feedback combinations. Overall, results indicated that participants enjoyed the prototype feedback visualizations and believed that they could be used in therapeutic settings. Participants appreciated the simplicity, clarity, and self-explanatory nature of the feedback visualizations. While most participants quickly familiarized themselves, some struggled to recognize the feedback goals and connect the visualizations to their movements. Recommendations for improvement included optimizing color schemes, sensitivity, and difficulty adjustments. Adding instructional information and game design elements, such as repetition counting and reward systems, was deemed useful. The main study limitations were the small sample size and the use of feedback on performance as the sole feedback modality.

CONCLUSIONS

The prototype feedback visualizations were positively perceived by the participants and were considered applicable in therapy settings. Insights were gathered on improving the color scheme, sensitivity, and recognizability of the feedback visualizations. The implementation of additional gamification and instructional elements was emphasized. Future work will optimize the prototype feedback visualizations based on study results and evaluate the homeSETT system's efficacy in eligible patient populations.

Global, Regional and National Burden of Maternal Obstructed Labour and Uterine Rupture, 1990-2021: Global Burden of Disease Study 2021

BACKGROUND

Maternal obstructed labour and uterine rupture (MOLUR) are among the major maternal labour complications that threaten maternal and child health.

OBJECTIVE

The objective of this study was to systematically analyse the global burden of MOLUR using the Global Burden of Disease 2021 (GBD 2021) database to inform further improvements in maternal-related public health policies.

METHODS

Incidence and disability-adjusted life-year (DALY) data on MOLUR from 1990 to 2021 were collected in the GBD 2021. The joinpoint and Bayesian age-period-cohort models were used to analyse and predict time burden trends. The slope index and concentration index were used to evaluate health inequality. Frontier analysis was used to visualise the potential for burden reduction in individual countries or territories.

RESULTS

In 2021, 13,471,093 (95% uncertainty interval [UI] 8,938,373, 19,008,282) incident cases of MOLUR were reported worldwide, which caused 1,067,270 (95% UI 896,161, 1,275,042) DALYs. Over the past three decades, there has been an overall downward trend in the age-standardised incidence rate (ASIR) and age-standardised DALY rate (ASDR) of MOLUR globally, with the ASIR decreasing from 554.0 (95% UI 355.6, 786.3) per 100,000 in 1990 to 347.0 (95% UI 228.8, 489.4) in 2021. The ASDR decreased from 65.4 (95% UI 56.0, 75.7) per 100,000 in 1990 to 27.0 (95% UI 22.7, 32.2) in 2021. By 2040, the global ASIRs and ASDRs projections for MOLUR will likely continue to decline. Socioeconomic-related inequalities are narrowing, but the burden remains concentrated in low socioeconomically developed countries. Israel and Afghanistan showed the largest differences from the frontier boundaries of ASIR and ASDR.

CONCLUSIONS

Although the global burden of MOLUR has declined in the last three decades, it remains high and is still concentrated in economically underdeveloped countries. The reduction in DALYs attributable to MOLUR globally reflects significant progress in improving maternal health and reducing complications of childbirth.

The potential role of n-3 fatty acids and their lipid mediators on asthmatic airway inflammation

Asthma, is a common, significant and diverse condition marked by persistent airway inflammation, with a major impact on human health worldwide. The predisposing factors for asthma are complex and widespread. The beneficial effects of omega-3 (n-3) polyunsaturated fatty acids (PUFAs) in asthma have increasingly attracted attention recently. In asthma therapy, n-3 PUFAs may reduce asthma risk by controlling on levels of inflammatory cytokines and regulating recruitment of inflammatory cells in asthma. The specialized pro-resolving mediators (SPMs) derived from n-3 PUFAs, including the E- and D-series resolvins, protectins, and maresins, were discovered in inflammatory exudates and their biosynthesis by lipoxygenase mediated pathways elucidated., SPMs alleviated T-helper (Th)1/Th17 and type 2 cytokine immune imbalance, and regulated macrophage polarization and recruitment of inflammatory cells in asthma via specific receptors such as formyl peptide receptor 2 (ALX/FPR2) and G protein-coupled receptor 32. In conclusion, the further study of n-3 PUFAs and their derived SPMs may lead to novel anti-inflammatory asthma treatments.

Prevalence of overweight and obesity and their impact on academic performance and psychological well-being among university students in 2024 in Bangladesh

BACKGROUND

The prevalence and impact of obesity and overweight is one of the main concerns among researchers worldwide. There are several consequences of overweight and obesity among students in developing countries like Bangladesh. Therefore, this study aims to explore the prevalence and impact of overweight or obesity on individuals' self-esteem and academic performance among university students in Bangladesh.

METHODS AND MATERIALS

This study is based on primary data that was collected from 600 students of Jahangirnagar University using a well-structured questionnaire. The questionnaire included demographic information, the Rosenberg Self-Esteem Scale (RSES), and the International Physical Activity Questionnaire (IPAQ-7). The summary statistics, the Fisher exact test, the Chi-square test, and the Pearson correlation matrix were computed. A logistic regression model assessed the relationship between low self-esteem and other variables such as demographic characteristics, BMI status, and physical activities.

RESULTS

The findings indicate that 38.2% of the students are overweight or obese, and the prevalence rate is high among males. The lowest academic performance across all disciplines is observed among obese students. A negative correlation is observed between BMI and self-esteem (r = -0.41) and academic performance is negatively linked with overweight or obese (r = -0.26) Results depict that overweight/obese students are 7.11 times more likely to have low self-esteem (AOR: 7.11, 95% CI: 4.59-11.02) compared to normal students.

CONCLUSIONS

Overweight and obese students are more prone to lower academic performance and low self-esteem, considering physical inactivity and irregular dietary patterns. Therefore, university authorities ought to encourage students to engage in physical activities and should create awareness among students about the beneficial effects of nutritious foods and the importance of physical exercise.

Wearable equipment-based telemedical management via multiparameter monitoring on cardiovascular outcomes in elderly patients with chronic coronary heart disease: an open-labelled, randomised, controlled trial

BACKGROUND

The prevalence of chronic coronary heart diseases (CHDs) increases with age in the elderly, which represents one of the top-ranked causes of death and disease burden.

METHODS

This study aimed to investigate the management efficiency of telemedicine based on the remote multiparameter monitoring in elderly patients with CHD. A total of 1248 elderly patients diagnosed with CHD were enrolled. The subjects were randomly divided into two groups, wearable equipment-based telemedical management (WTM) group and traditional follow-up management (TFM) group. Face-to-face clinical interview at least once every 2 months was required in TFM group to collect the medical records. Patients in WTM group were provided with wearable equipment to complete remote monitoring, real-time alerts and health intervention via virtual consultations and remote medication recommendations.

RESULTS

The mean age of patients in WTM group and TFM group was 71.1 (68.0-82.0) years and 71.0 (68.0-81.0) years, respectively‏. After a 12-month management, patients in WTM group presented a lower occurrence of hospitalisation (HR 0.59, 95% CI=0.47 to 0.73, p<0.0001) and major adverse cardiac events (HR 0.60, 95% CI=0.44 to 0.82, p=0.0012) compared with patients in TFM group.

CONCLUSION

The multiparameter telemedical management could help with the out-of-hospital management and reduce the incidence of rehospitalisation in elderly patients with CHD.

Trends and levels of the global, regional, and national burden of pulmonary arterial hypertension from 1990 to 2021: findings from the global burden of disease study 2021

Background

Pulmonary arterial hypertension (PAH) is a severe and progressive lung disease that significantly impairs patients' health and imposes heavy clinical and economic burdens. Currently, there is a lack of comprehensive epidemiological analysis on the global burden and trends of PAH.

Methods

We estimated the prevalence, mortality, disability-adjusted life years (DALYs) of PAH from 1990 to 2021 using the results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). The average annual percentage changes were used to estimate the trends of PAH across 21 regions and 204 countries and territories.

Results

From 1990 to 2021, the number of prevalent cases and deaths associated with PAH worldwide increased by 81.5 and 48.4%. However, the age-standardized prevalence rate of PAH remained relatively stable, while the age-standardized mortality rate and DALYs declined. In 2021, the global age-standardized prevalence rate of PAH was 2.28 per 100,000, with 1.78 per 100,000 in males and 2.75 per 100,000 in females. The age-standardized mortality rate of PAH globally was 0.27 per 100,000, and the age-standardized DALYs was 8.24 per 100,000. Among the 21 regions, Western Europe had the highest age-standardized prevalence rate (3.56 per 100,000), while North Africa and the Middle East had the highest age-standardized mortality rate (0.44 per 100,000) and DALYs (14.81 per 100,000). Additionally, older individuals and females are at higher risk of PAH. The age-standardized mortality rate and DALYs associated with PAH increase with age, peaking in the 95+ age group. As the sociodemographic index increased, the age-standardized prevalence rates showed an upward trend, while both the age-standardized mortality rates and DALYs exhibited a downward trend.

Conclusion

From 1990 to 2021, the overall trend of PAH burden presents regional and national variations and differs by age, sex, and sociodemographic index. These findings emphasize the importance of implementing targeted interventions to alleviate the burden of PAH.

Early Restrictive vs Liberal Oxygen for Trauma Patients: The TRAUMOX2 Randomized Clinical Trial

Importance

Early administration of supplemental oxygen for all severely injured trauma patients is recommended, but liberal oxygen treatment has been associated with increased risk of death and respiratory complications.

Objective

To determine whether an early 8-hour restrictive oxygen strategy compared with a liberal oxygen strategy in adult trauma patients would reduce death and/or major respiratory complications.

Design, Setting, and Participants

This randomized controlled trial enrolled adult trauma patients transferred directly to hospitals, triggering a full trauma team activation with an anticipated hospital stay of a minimum of 24 hours from December 7, 2021, to September 12, 2023. This multicenter trial was conducted at 15 prehospital bases and 5 major trauma centers in Denmark, the Netherlands, and Switzerland. The 30-day follow-up period ended on October 12, 2023. The primary outcome was assessed by medical specialists in anesthesia and intensive care medicine blinded to the randomization.

Interventions

In the prehospital setting or on trauma center admission, patients were randomly assigned 1:1 to a restrictive oxygen strategy (arterial oxygen saturation target of 94%) (n = 733) or liberal oxygen strategy (12-15 L of oxygen per minute or fraction of inspired oxygen of 0.6-1.0) (n = 724) for 8 hours.

Main Outcomes and Measures

The primary outcome was a composite of death and/or major respiratory complications within 30 days. The 2 key secondary outcomes, death and major respiratory complications within 30 days, were assessed individually.

Results

Among 1979 randomized patients, 1508 completed the trial (median [IQR] age, 50 [31-65] years; 73% male; and median Injury Severity Score was 14 [9-22]). Death and/or major respiratory complications within 30 days occurred in 118 of 733 patients (16.1%) in the restrictive oxygen group and 121 of 724 patients (16.7%) in the liberal oxygen group (odds ratio, 1.01 [95% CI, 0.75 to 1.37]; P = .94; absolute difference, 0.56 percentage points [95% CI, -2.70 to 3.82]). No significant differences were found between groups for each component of the composite outcome. Adverse and serious adverse events were similar across groups, with the exception of atelectasis, which was less common in the restrictive oxygen group compared with the liberal oxygen group (27.6% vs 34.7%, respectively).

Conclusions and Relevance

In adult trauma patients, an early restrictive oxygen strategy compared with a liberal oxygen strategy initiated in the prehospital setting or on trauma center admission for 8 hours did not significantly reduce death and/or major respiratory complications within 30 days.

Trial Registration

ClinicalTrials.gov Identifier: NCT05146700.

Non-communicable disease mortality and economic costs attributable to high body mass index in Argentina

OBJECTIVES

Non-communicable diseases (NCDs) such as cardiovascular diseases, respiratory diseases, and cancer represent a significant public health challenge in Argentina. This study aimed to estimate the burden of NCD mortality attributable to a high body mass index (BMI) in Argentina in 2018 and assess the associated economic costs.

STUDY DESIGN

Comparative risk assessment modeling study.

METHODS

Potential impact fractions and preventable deaths were calculated under three counterfactual scenarios. Theoretical Minimum Risk Exposure Level (TMREL; mean BMI of 22.0 kg/m2), 1.0 kg/m2 reduction in BMI, and returned to 2005 BMI levels. The years of life lost (YLLs) and economic costs in terms of productivity loss were also estimated.

RESULTS

In 2018, nearly two-thirds of Argentina's adult population were overweight or obese. In the TMREL scenario, 24 % of major NCD deaths and 20 % of all-cause deaths could have been prevented if the population had a mean BMI of 22 kg/m2. If a 1.0 kg/m2 reduction in BMI was achieved, 1.92 % of major NCD deaths and 3.48 % of all-cause deaths could have been avoided. Reducing the average BMI to the 2005 levels (25.8 kg/m2) could have prevented 6 % of major NCD deaths and 8.8 % of all-cause deaths. The economic costs associated with high BMI-related mortality were estimated to be 0.37 % and 0.62 % of Argentina's GDP for major NCDs and all-cause mortality, respectively.

CONCLUSION

The burden of NCD mortality and associated economic costs attributable to high BMI in Argentina are substantial, highlighting the urgent need for multi-sectoral interventions to address the increasing prevalence of overweight and obesity.

miRNA-199b-5p suppresses of oral squamous cell carcinoma by targeting apical-basolateral polarity via Scribble/Lgl

In epithelial cells, Scribble forms cell-cell junctions and contributes to cell morphology and homeostasis by regulating apical-basolateral polarity in mammals and functions as a tumor suppressor in many carcinomas. The initial diagnosis of oral squamous cell carcinoma is important, and its prognosis is poor when accompanied by metastasis. However, research on the mechanisms of oral squamous cell carcinoma metastasis is insufficient. Herein, we showed that Scribble regulates the apical-basolateral polarity of oral squamous cell carcinoma by regulating lethal giant larvae 1, Scribble module and E-cadherin, the adhesion junction. The expression of lethal giant larvae 1 and E-cadherin decreased when the expression of Scribble was knocked down and their localization was completely disrupted in both the oral squamous cell carcinoma cell line and in vivo model. In particular, the Scribble was involved in oral squamous cell carcinoma metastasis via hsa-miR-199b-5p, which is a microenvironmental factor of hypoxia. The disruption of Scribble localization under hypoxic conditions, but its localization was maintained in miR-199b-5p oral squamous cell carcinoma cell lines and in vivo. These results suggest that Scribble functions as a tumor suppressor marker mediated by miR-199b-5p in oral squamous cell carcinoma.

Advancing Prognostic Prediction in Pediatric Trauma: The Role of Inflammatory Markers

BACKGROUND

This study aimed to evaluate the prognostic value of various inflammatory markers and indices derived from complete blood counts in predicting mortality among pediatric trauma patients admitted to the Pediatric Intensive Care Unit (PICU).

PATIENTS AND METHODS

We designed a single-center retrospective study that included 165 pediatric trauma patients in the PICU between January 2020 and June 2024.

RESULTS

Of 165 patients, 108 (69.2%) were male and the mean age of all patients was 75.16±57.14 months. The mortality rate was found to be 5.45% (9 patients). The Lactate-to-Albumin Ratio (LAR) and Procalcitonin (PCT) demonstrated strong prognostic performance with area under the curve (AUCs) of 0.807 and 0.745, respectively. Notably, LAR and PCT correlated well with mortality and the duration of invasive mechanical ventilation and PICU stay. The Systemic Immune-Inflammation Index (SIRI), Neutrophil-to-Lymphocyte Ratio (NLR), CRP-to-Albumin Ratio (CAR), and Pan-Immune-Inflammation Value (PIV) were less effective individually but showed potential when combined with other indices.

CONCLUSION

LAR, PCT, SIRI, NLR, CAR, and PIV were associated with mortality in pediatric trauma patients, with LAR and PCT demonstrating superior predictive value. Therefore, LAR and PCT may serve as reliable standalone markers for identifying critically ill pediatric trauma patients at risk of mortality.

Sex differences in the intention and decision to use emergency medical services for acute coronary syndrome in Australia: a retrospective study

BACKGROUND

Sex-based disparities in acute coronary syndrome (ACS) presentations exist and women often have worse outcomes after an ACS event. Calling the emergency medical services (EMS) initiates prehospital diagnosis and treatment and reduces in-hospital time to treatment. This study aims to identify factors affecting the intention to call EMS and EMS usage in Australian women and men.

METHODS

A retrospective cross-sectional analysis was conducted to identify sex differences and associated characteristics in the (1) intention to call EMS and (2) EMS use in the setting of ACS. Data sources included national survey data (2018-2020) and the Victorian Emergency Minimum Dataset (2016-2021). Multivariable analysis identified factors associated with intention and EMS use by sex.

RESULTS

Of 34 328 survey participants, fewer men expressed an intention to call EMS if experiencing ACS symptoms than women (62.7% vs 70.4%, p<0.001). Associated factors in men included being of Aboriginal or Torres Strait Islander origin, living in Western Australia, having diabetes or having a lower education level. In both sexes, preferring a non-English language, having cardiovascular risk factors, poor symptom knowledge, living in the Northern territory or no/unclear EMS insurance status were associated with lower intentions to call EMS. Finally, women were less comfortable with calling EMS and more likely to hesitate (69.1 vs 76.7%, p<0.001).Among 51 165 ACS presentations (33.6% women) to Victorian public hospitals, fewer men presented by EMS (62.5% vs 67.7%, p<0.001), however, no associated male-specific characteristics were identified. Women preferring a non-English language or living in outer regional/remote Victoria were less likely to use EMS. Being born overseas or being referral by a healthcare provider was associated with lower EMS use in both sexes.

CONCLUSION

Sex differences were identified in the intention and use of EMS during an ACS event based on cultural background, preferred language and residential regionality. These subgroups' characteristics can be targeted with education to improve EMS use.

Global, regional, and national burden of HIV and tuberculosis and predictions by Bayesian age-period-cohort analysis: a systematic analysis for the global burden of disease study 2021

Objective

To assess sex, age, regional differences, and the changing trend in human immunodeficiency virus and tuberculosis (HIV-TB) in different regions from 1990 to 2021, and project future trends.

Methods

Global Burden of Disease Study 2021 data were analyzed to assess HIV-TB incidence, death, prevalence, and DALY rates from 1990 to 2021, including different types of TB co-infections (drug-susceptible, multidrug-resistant, and extensively drug-resistant). Bayesian age-period-cohort models were used to forecast age-standardized DALY rates through 2035.

Results

In 2021, there were approximately 1.76 million HIV-TB infections and 200,895 deaths globally. The highest burden of HIV-DS-TB and HIV-MDR-TB was found in Southern Sub-Saharan Africa, while HIV-XDR-TB was most prevalent in Eastern Europe. The co-infection burden was highest among individuals aged 30-49. Key risk factors were unsafe sex, drug use, and intimate partner violence, with regional variations. The global burden of HIV-TB remains high, and age-standardized DALY rates are expected to increase in the coming years, especially in regions with low socio-demographic indices (SDI).

Conclusion

The burden of HIV-TB co-infection correlates with the socio-demographic index (SDI): countries with a low SDI have a higher burden. Therefore, clinical diagnosis and treatment in such areas are more challenging and may warrant more attention. High death rates underscore the importance of early management.

Association between atherogenic index of plasma and post-stroke depression: a cross-sectional study

Background: Few studies have established a link between the atherogenic index of plasma (AIP) and post-stroke depression (PSD). This study aims to further investigate the potential relationship between the AIP and PSD, and to provide references for the prevention and prognosis management of patients with PSD.Methods: A cross-sectional study was conducted using data from participants in the National Health and Nutrition Examination Survey from 2005 to 2018. Inclusion criteria required complete data on the AIP, stroke history, and depression status. Weighted logistic regression models and restricted cubic splines (RCS) were employed to examine the association between the AIP and PSD. By subgroup and interaction analyses, the stability associated with AIP and PSD was assessed between different subgroups.Results: Among the 32,364 participants ultimately enrolled in the study, 482 were diagnosed with PSD. In the weighted multivariate logistic regression adjustment model 3, AIP, as a continuous variable, was positively associated with the risk of PSD [odds ratio (OR) = 1.85, 95% confidence interval (CI): 1.18, 2.91; P = 0.007]. After the quartile classification of AIP, the adjusted model 3 showed that the risk of PSD in group Q4 was significantly higher than that in group Q1 (OR = 1.61, 95%CI:1.10, 2.34; P = 0.006). In the RCS linearity test, AIP was positively associated with the risk of PSD (Pnon-linear = 0.357). The interaction test demonstrated that AIP only had an interaction with gender (Pinteraction = 0.031) and not with other variables (Pinteraction > 0.05).Conclusion: AIP was positively associated with the prevalence of PSD, suggesting that AIP may be a promising predictor of the risk of developing PSD. In addition, the interaction of AIP and gender differences combined to influence the incidence of PSD.

Are 8 years dietary changes in the prospective NutriNet-Santé Cohort consistent with the EAT-Lancet reference diet?

BACKGROUND

The transition towards sustainable dietary patterns, such as the planetary diet proposed by the EAT-Lancet Commission, is warranted to optimize health and achieve environmental sustainability.

OBJECTIVE

To examine the extent to which the evolution of dietary changes over an 8-year period in the French NutriNet-Santé cohort aligned with the EAT-Lancet diet.

METHODS

A sample of 17,187 participants of the prospective NutriNet-Santé study was used. Dietary intakes were evaluated in 2014, 2018, and 2022 using a food frequency questionnaire. The alignment of dietary patterns with the EAT-Lancet diet was assessed using the EAT-Lancet Dietary Index (ELD-I). Changes over time in the ELD-I score and component sub-scores were evaluated using linear mixed regression models.

RESULTS

The mean ELD-I score in 2014 (35.1 ± 0.4 points) increased by an average of 5.5 points (95%CI, 5.0 to 5.9) in 2018, with no further increase in 2022 (+4.2 points compared with 2014, 95%CI, 3.6 to 4.9). The increase in the ELD-I observed in 2018 was mostly explained by increases in the sub-scores of these components: Beef, lamb and pork (+3.4 points, 95%CI, 3.1 to 3.6, i.e. lower consumption), Fruits (+1.6 points, 95%CI, 1.3 to 1.9, i.e. greater consumption), and Nuts (+1.1 points, 95%CI, 1.0 to 1.2, i.e. greater consumption). Changes of similar magnitudes were observed between 2014 and 2022, except for the Fruits component which showed a decrease (-1.3 points, 95%CI, -1.7 to -0.9). Greater changes in the ELD-I scores over time were observed for females, younger adults, and adults with high education levels.

CONCLUSIONS

Results suggest that the slight shift towards more sustainable dietary patterns within the NutriNet-Santé cohort between 2014 and 2018 plateaued in 2022. This suggests the need for strong efforts from various actor in the field of nutrition and public health that may facilitate the transition towards sustainable dietary patterns.

Patterns and Correlates of Multiple tobacco Product use Among people With HIV in India

Introduction: Multiple tobacco product (MTP) use may intensify nicotine dependence and reduce the chances of quitting success. Characterizing MTP use in people with HIV (PWH) in low- and middle-income countries (LMICs) is needed to guide cessation approaches in this group. This study aimed to identify patterns and correlates of MTP use among PWH in a single clinic. Methods: This study was conducted among PWH at a clinic in Chennai, India. Participants completed an in-person survey providing information on tobacco use, demographics, and cessation-related factors. This analysis focused on PWH who reported current tobacco use. We used Fisher's exact test (categorical variables) and the Wilcoxon rank-sum test (continuous variables) to assess statistical differences in demographics and cessation-related factors between PWH who used single vs multiple tobacco products. Results: Of 154 PWH adults surveyed, 58 (37.7%) reported current tobacco use. Most PWH currently using tobacco were male (n = 49/58, 84%), with a median age of 21 years (IQR: 10). Forty-six percent (n = 27/58; 95% CI: 33% - 60%) reported MTP use, combining three products (IQR: 3) on average. Those who used multiple products were more likely to have a higher education level (n = 12/27, 44%; 95% CI: 25% - 65%) compared to those who used a single product (n = 2/16, 12%; 95% CI: 1% - 38%) (P-value = 0.03). A lower proportion of participants who reported MTP use were unemployed (n = 1/27, 97%; 95% CI: 0% - 19%) compared to those who used a single product (n = 5/16, 31%; 95% CI: 11% - 59%) (P-value = 0.04). All other factors, including gender, primary language, marital status, and cessation-related factors, were comparable between PWH who used a single tobacco product and those who used multiple products. Conclusion: Among PWH who currently smoke, almost half use tobacco combined multiple products. MTP use in PWH was linked to higher education levels and employment in this single clinical setting.

Socioeconomic Position and Oral Health in Chinese Older Adults: A Life Course Approach

OBJECTIVES

We investigated associations between socioeconomic position (SEP) across childhood, adulthood, and older age and number of teeth among Chinese older adults.

METHODS

Data came from 15,136 participants aged 65 to 105 y in the Chinese Longitudinal Healthy Longevity Survey (2018 wave). The outcome was number of teeth. Pathways and sensitive period models were tested simultaneously via structural equation modeling. Ordinal logistic regression assessed the accumulation of risk and social mobility models. Differences were examined across 4 birth cohorts.

RESULTS

Adult and older age SEP had direct effects on number of teeth in older age (adulthood, direct β = 0.182, P < 0.001; older age, direct β = 0.093, P = 0.005), supporting the sensitive period model. Childhood SEP had an indirect effect on number of teeth (indirect β = 0.130, P < 0.001) through adult and older age SEP, supporting the pathway/accumulation of risk and social mobility models. Effects of SEP on number of teeth were more pronounced in younger cohorts. Graded associations in the expected directions were found between the number of periods in which participants experienced disadvantaged SEP and number of teeth, as well as social mobility trajectories and number of teeth.

CONCLUSION

Among Chinese older adults, the number of remaining teeth is subject to marked social inequalities. Our findings document the simultaneous applicability of life course models and a widening of oral health inequalities in China across generations. Interventions earlier in child and adult life are needed to address this problem and reduce oral health inequalities.

KNOWLEDGE TRANSFER STATEMENT

The findings of this study suggest marked socioeconomic inequalities in oral health among Chinese older adults. These inequalities are generated throughout the life course and appear to have widened across cohorts. This study emphasizes that interventions are needed to address the social determinants of oral health at all life stages.

Indian perspective on childhood malnutrition: Prevalence, pathophysiology, risk factors, and prevention

BACKGROUND

Childhood malnutrition contributes over half of the childhood mortality around the world, predominantly in South-Asian and sub-Saharan countries.

AIM

To summarize the childhood malnutrition epidemiology along with the comorbid factors associated with it and its management within the community.

METHODS

The data collection process involved conducting a comprehensive search using specific keywords such as child nutrition disorders and India with Boolean operators. The search was conducted in the Scopus and PubMed electronic databases.

RESULTS

Inadequate energy consumption initiates pathological alterations in the form of growth retardation, fat, visceral, and muscle loss, a reduction in basal metabolic rate, and a significant reduction in total energy expenditure. It has become evident that malnutrition shows an increased prevalence and incidence rate, despite available guidelines for the management of malnutrition.

CONCLUSION

Malnutrition can be a major player in the establishment of severe infections that result in significant post discharge mortalities in children. Future trials are required to fill the prime gaps in knowledge regarding the identification of other contributory factors in the pathogenesis of malnutrition and post-discharge infection. New biomarkers for early detection of malnutrition should be the priority of the scientific community for the early management of malnutrition.

Barriers and facilitators to integration of screening for hypertension, diabetes mellitus and dyslipidaemia, among adult people living with HIV at district hospital ART clinics in Southern Malawi

Background Atherosclerotic cardiovascular diseases (ASCDs) are a significant health concern globally and in Sub-Saharan Africa (SSA), particularly for people living with HIV (PLWH). Hypertension, diabetes mellitus (DM), and dyslipidaemia significantly increase the risk of ASCDs, and integrating screening for these conditions in public health facilities remains challenging in Malawi. This study aimed to explore the barriers and facilitators to integrating screening for hypertension, DM and dyslipidaemia among adult PLWH at district hospital ART clinics in Southern Malawi. Methods This was mixed-methods study conducted between November 2021 and April 2022. Quantitative data was collected from retrospective ART clinic records from between 2016 and 2020 (n = 875) from five district hospital ART clinics and informed the subsequent qualitative data collection, guided by the Consolidated Framework for Implementation Research (CFIR) in three purposively selected district hospital ART clinics. The qualitative aspect included in-depth interviews, focus group discussions, and key informant interviews. Non-participant observations were also conducted to assess the availability of functional screening equipment. Descriptive statistics were used to analyse the quantitative data while the qualitative data was analysed using thematic analysis. Results One district hospital ART clinic facility only performed the screening for hypertension and DM (40% and 9.84% at the commencement of ART and 39.4% and 5.14% in 2021). Facilitators for integration included time efficiency, patient information integration, existing infrastructure utilization, organisational incentives and training. Barriers included clinic flow delays, additional strain on a limited workforce, lack of prioritization and resources, increased workload and inadequate knowledge. PLWH expressed fear of screening and diagnosis without available medication. Conclusion The study found poor integration of hypertension, DM and dyslipidaemia screening among PLWH in Southern Malawi, but highlighted opportunities for successful implementation. Our study emphasizes the feasibility of the intervention and the importance of coordination between HIV and NCD care services in low-income settings such as Malawi.