Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015

Big picture thinking of global PM2.5-related COPD: Spatiotemporal trend, driving force, minimal burden and economic loss

Chronic obstructive pulmonary disease (COPD) is a leading global cause of morbidity and mortality, with increasing evidence linking long-term exposure to ambient fine particulate matter (PM2.5) to accelerated lung function decline and exacerbation of COPD symptoms. This study aimed to assess the global burden of PM2.5-related COPD from 1990 to 2021 and project future health and economic impacts. Using Mendelian randomization, the causal relationship between PM2.5 exposure and COPD was confirmed. Data from the Global Burden of Disease 2021 dataset was analyzed across 204 countries, considering age, gender, region, and socio-demographic index (SDI). A significant positive correlation between PM2.5 exposure and COPD was observed. In 2021, COPD deaths due to ambient PM2.5 exposure reached 841,466 globally, with an age-standardized mortality rate (ASR) of 10.23 per 100,000 people. DALYs were 17,683,776, with an ASR of 208.27 per 100,000. Both the number of deaths and DALYs significant increased since 1990, primarily driven by population aging and growth. Regional analysis revealed that Asia, especially China and India, bore the highest burden, high SDI regions managed to maintain relatively stable and lower rates, and there are large health inequities. Projections indicate a continued rise in COPD burden, with substantial economic implications, estimating global economic losses of approximately $1.246 trillion by 2050. These findings highlighted the urgent need for public health interventions to mitigate future health and economic impacts of PM2.5 exposure.

Global Trends and Inequalities of Liver Complications Related to Metabolic Dysfunction-Associated Steatotic Liver Disease: An Analysis From 1990 to 2021

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease is a significant driver of the increasing global burden of chronic liver disease. This study aimed to describe the temporal trends and inequalities of liver complications related to metabolic dysfunction-associated steatotic liver disease (LC-MASLD) by geographical region, age and sex during 1990-2021.

METHODS

Global Burden of Diseases Study 2021 data were analysed to assess LC-MASLD incidence, prevalence, mortality and disability-adjusted life years (DALYs). Temporal trends during 1990-2021 were measured by 'estimated annual percentage change' (EAPC). Inequalities of LC-MASLD burden across countries were evaluated by the slope index of inequality (SII) and the relative concentration index (RCI).

RESULTS

During 1990-2021, LC-MASLD rose annually by 0.73% in incidence and prevalence, 0.19% in mortality and 0.16% in DALYs. In 2021, the Middle East and North Africa had the highest incidence and prevalence and Andean and Central Latin America had the highest mortality and DALY rates. While LC-MASLD incidence was earliest in the 15-19 age group, both prevalence and DALY rates peaked at 75-79 years for both sexes. Inequalities in mortality and DALYs by countries' socioeconomic development index increased during 1990-2021, demonstrated by a decline in SII from -0.09 to -0.56 per 100 000 for mortality and from 1.41 to -7.74 per 100 000 for DALYs. RCI demonstrated similar findings.

CONCLUSION

The LC-MASLD burden is increasing globally, especially in economically disadvantaged countries, with widening disease inequalities during 1990-2021. Effective prevention and subregional interventions are crucial, with a specific focus on resource optimisation for disadvantaged populations.

Deep learning analysis for rheumatologic imaging: current trends, future directions, and the role of human

Rheumatic diseases, such as rheumatoid arthritis (RA), osteoarthritis (OA), and spondyloarthritis (SpA), present diagnostic and management challenges due to their impact on connective tissues and the musculoskeletal system. Traditional imaging techniques, including plain radiography, ultrasounds, computed tomography, and magnetic resonance imaging (MRI), play a critical role in diagnosing and monitoring these conditions, but face limitations like inter-observer variability and time-consuming assessments. Recently, deep learning (DL), a subset of artificial intelligence, has emerged as a promising tool for enhancing medical imaging analysis. Convolutional neural networks, a DL model type, have shown great potential in medical image classification, segmentation, and anomaly detection, often surpassing human performance in tasks like tumor identification and disease severity grading. In rheumatology, DL models have been applied to plain radiography, ultrasounds, and MRI for assessing joint damage, synovial inflammation, and disease progression in RA, OA, and SpA patients. Despite the promise of DL, challenges such as data bias, limited explainability, and the need for large annotated datasets remain significant barriers to its widespread adoption. Furthermore, human oversight and value judgment are essential for ensuring the ethical use and effective implementation of DL in clinical settings. This review provides a comprehensive overview of DL's applications in rheumatologic imaging and explores its future potential in enhancing diagnosis, treatment decisions, and personalized medicine.

Analysis and contrast of psoriasis disease burden trends in China and globally from 1990 to 2021

Objective

This study aimed to delineate the temporal tendency in the age and gender burden of psoriasis in China, spanning from 1990 to 2021, encompassing metrics such as incidence, prevalence, and disability-adjusted life years (DALYs). Furthermore, it sought to contrast these findings with the global disease burden. It also purposed to assess the impacts of age, time, and birth cohort, as well as to forecast the psoriasis burden in China for the upcoming 15 years.

Methods

Utilizing open-access data from the Global Burden of Disease (GBD) database spanning 1990 to 2021, this study comprehensively examined the burden of psoriasis in China and globally. In China, a detailed analysis was conducted, emphasizing dimensions such as age, gender, and temporal trends. Join-point regression models were employed to calculate the average annual percentage change (AAPC). Furthermore, age-period-cohort (APC) analyses assessed the effects of age, time, and birth cohort, while an extended autoregressive integrated moving average model (ARIMA model) was used to forecast the psoriasis burden in China from 2022 to 2036.

Results

Between 1990 and 2021, China experienced significant changes in its age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized DALY Rate (ASDR). Specifically, the ASIR rose from 48 per 100,000 in 1990 to 60 per 100,000 in 2021. Correspondingly, the ASPR increased from 362 per 100,000 in 1990 to 474 per 100,000 in 2021. Finally, the ASDR also showed an upward trend, climbing from 31 per 100,000 in 1990 to 41 per 100,000 in 2021. The AAPC of the ASIR, ASPR, and ASDR in China was 0.7434%, 0.8765%, and 0.8827%, respectively, significantly outpacing the global AAPC of 0.2204%, 0.2220%, and 0.2426%, respectively. The burden of psoriasis in China varied with age and gender, showing a trend of increasing and then decreasing ASIR, ASPR, and ASDR as age advanced. Women experienced lower incidence and prevalence rates of psoriasis than men. Over time, a delay in peak incidence was observed in both genders. The APC analyses revealed that psoriasis incidence initially increased and then declined with advancing age. Across all age groups, earlier birth cohorts had a relatively lower risk. Projections suggest that the incidence and prevalence of psoriasis in China will continue to rise over the next 15 years.

Conclusion

Psoriasis poses a substantial public health challenge in China due to the country's large and increasingly aging populace. Mitigating this burden requires a multifaceted approach, including precise epidemiological research, an enhanced understanding of its socioeconomic determinants, and the development of effective health policies.

[Quality of organizations and the system: It is not the same]

Governance and management, two terms that are barely understood, are precisely defined, and measured. They explain a very important part of the difference between countries, systems, and organizations. Also, in healthcare. The article devotes much attention to the indicators that address the quality of the rules of the game of society, its institutions, showing how the judgment about one or another form of social organization depends on more than one dimension. The good Spanish health system, with a poor prognosis due to its sclerosis of supply and flight to the private sector, needs to be depoliticized and debureaucratized so that the solvency of the health response provides the majority vote necessary for the sustainability of the welfare state. The entire text uses real examples and lands in the Spanish reality, finally distinguishing between what we can influence as citizens and what we as professionals are responsible for.

Forecasting total and cause-specific health expenditures for 116 health conditions in Norway, 2022-2050

BACKGROUND

This study forecasts total and cause-specific health expenditures in Norway to 2050 and quantifies the contribution of four key drivers-total population growth, population aging, changes in disease prevalence, and cost per case-on future health care spending.

METHODS

We forecast spending for 116 health conditions in Norway from 2022 to 2050, using historical and forecasted data of population growth, disease prevalence, gross domestic product (GDP), health spending, and residual factors. Our analysis included a reference scenario that forecasted disease-specific health spending; two alternative scenarios examining the effects of alternative unit cost developments; and a scenario examining the consequences of improved behavioral and metabolic risk factors.

RESULTS

Health spending increased from 10.6% (95% uncertainty interval, 10.2-11.1) of GDP in 2022 to 14.3% (13.0-15.7) in 2050 in the reference scenario. Among the top aggregate causes of Norwegian health spending in 2022, the spending for neurological disorders rose the most, from 1.7% (1.6-1.8) to 2.7% (2.3-3.1) of GDP, surpassing mental and substance use disorders which rose from 2.2% (2.1-2.3) to 2.4% (2.2-2.6) of GDP. Of the 116 single conditions analyzed, dementias accounted for the highest spending in 2022. This expenditure was forecasted to increase considerably from 1.1% (1.09-1.2) to 1.9% (1.6-2.2) of GDP by 2050, largely due to population aging. Spending on other old-age-related conditions like falls, stroke, and diabetes, was also forecasted to increase. Increased population, aging, and spending per case contributed to increased future spending. Reduced behavioral and metabolic risks were forecasted to increase the number of elderly persons and reduce age-specific disease prevalence but had little impact on forecasted health spending.

CONCLUSIONS

Health spending growth was forecasted regardless of the scenario, and Norway needs to plan for this. However, policymakers can curb total spending growth, while maintaining health care quality and output, by ensuring more efficient allocation and effective use of resources. While the overall impact of behavioral and metabolic risk reductions on total healthcare spending was modest, reducing risk factors is needed if countries aim to achieve a healthier, longer-living population.

Trends, gender, and racial disparities in patients with mortality due to paroxysmal tachycardia: A nationwide analysis from 1999-2020

BACKGROUND

Paroxysmal tachycardia encompasses various heart rhythm disorders that cause rapid heart rates. Its episodic occurrence makes it difficult to identify and measure its prevalence and trends in the population. Additionally, there is limited data on disparities and trends in mortality due to paroxysmal tachycardia, which is essential for assessing current medical approaches and identifying at-risk populations.

METHODS

Our study examined death certificates from 1999 to 2020 using the CDC WONDER Database to identify deaths caused by paroxysmal tachycardia in individuals aged 25 and older, using the ICD-10 code I47. Age-adjusted mortality rates (AAMRs) and annual percent changes (APC) were calculated by year, gender, age group, race/ethnicity, geographic location, and urbanization status. Trends in AAMRs were analyzed using the Joinpoint Regression Program to identify significant changes and inflection points in mortality trends throughout the study period.

RESULTS

Between 1999 and 2020, 155,320 deaths were reported in patients with paroxysmal tachycardia. Overall, AAMR decreased from 4.8 to 3.7 per 100,000 population between 1999 and 2020, despite showing a significant increase from 2014 to 2020 (APC: 4.33; 95% CI: 3.53 to 5.56). Men had consistently higher AAMRs than women (4.7 vs. 2.2). Furthermore, we found that AAMRs were highest among Non-Hispanic (NH) Black or African Americans and lowest in NH Asian or Pacific Islanders (4 vs. 1.9). Nonmetropolitan areas had higher AAMRs than metropolitan areas (3.6 vs. 3.2).

CONCLUSIONS

Our analysis showed a significant decrease in mortality from paroxysmal tachycardia since 1999, although there has been a slight increase in recent years. However, disparities remain, with higher AAMRs among men, NH Black or African Americans, and residents of non-metropolitan areas. These findings call for immediate public health actions to curb the rising trends and reduce potential disparities.

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 invisible threat: A 30-year review of air pollution's impact on diarrhoea from the global burden of disease study 2021

BACKGROUND

Diarrhoea remains a major contributor to global morbidity and mortality among children younger than 5 years. This study aims to provide an updated assessment of diarrhoea deaths and disability-adjusted life years (DALYs) attributable to air pollution from 1990 to 2021.

METHODS

The deaths and DALYs data for diarrhoea attributable to air pollution were derived from the 2021 Global Burden of Diseases Study (GBD). Age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) were used to assess trends in deaths related to diarrhoea. In addition, Auto-Regressive Integrated Moving Average (ARIMA) and Ensemble Smoothing (ES) models were used to predict the epidemic trends of diarrhoea from 2022 to 2046, and frontier analysis was conducted to explore the potential reduction in the burden of diarrhoea in different regions.

RESULTS

Globally, from 1990 to 2021, there were 45,851 deaths from diarrhoea attributable to air pollution (95 % uncertainty interval [UI], 32,228-56,815) in 1990, and 6559 deaths (95 % UI, 4931 to 9245) in 2021. In total, diarrhoea attributable to air pollution was responsible for 4134,309 DALYs (95 % UI, 1073,440 to 1277,490) in 1990, and 593,960 DALYs (95 % UI, 446,774 to 835,347) in 2021. The decreasing trend of diarrhoea burden is uneven in different countries and regions, with higher diarrhoea deaths and DALYs in low and low-middle SDI regions, while relatively lower in high SDI regions. Predictive analysis suggests that by 2046, deaths and DALYs of air pollution-related diarrhoea, as well as their corresponding ASR, will continue to decrease.

CONCLUSION

Although the global burden of diarrhoea caused by air pollution has decreased in the past 30 years, it remains an important public health issue in low and low-middle SDI regions. The research findings emphasize the importance of public health policies and planning in reducing deaths related to diarrhoea and the disease burden, and point out the need for more targeted prevention strategies in order to reduce the disease burden.

Joint trajectories of physical activity, health, and income before and after statutory retirement: A 22-year follow-up

BACKGROUND

Health behaviors, health, and income change during aging. However, no previous studies have examined, how they develop together over the transition to statutory retirement. We aimed to examine their joint development and to identify the determinants of any distinct trajectories.

METHODS

We studied former employees of the City of Helsinki, Finland, who transitioned to full statutory retirement between 2000 and 2022 (n = 5209, 80% women). We examined five repeated questionnaire surveys to identify any joint developmental patterns in the key indicators of healthy aging and well-being-leisure-time physical activity, health measured by general health perceptions, and household income, over a follow-up of 22 years. We used joint group-based trajectory analysis to identify latent developmental groups. The social and health-related determinants of trajectory group membership are reported as average marginal effects.

RESULTS

We found four distinct joint trajectory groups. Group 1 (22.6%) had consistently poor general health perceptions, less physical activity than the recommended amount, and low income. In Group 2 (34.2%), general health perceptions were first good but then declined, and income was low but slightly increasing. Group 3 (12.3%) had good general health perceptions, a very high level of physical activity, but fluctuating income. In Group 4 (30.9%), general health perceptions were first good but then declined, physical activity was at the recommended level, and income was sharply increasing. People with obesity had a 22 percentage-point (21-24) higher predicted probability of belonging to Group 1 than people with normal weight. They were also more likely to report low education and more physician-diagnosed chronic diseases and mental disorders.

CONCLUSIONS

We identified distinct trajectories in physical activity, general health perceptions, and income over a follow-up of over 20 years. The majority of those who had transitioned to statutory retirement had good general health perceptions but varying levels of physical activity and income. As not all those with a low income had a low level of physical activity or poor general health perceptions, public health interventions should target distinct groups with the most adverse risk factor profiles, to narrow health inequalities during aging.

Reimagining Global Health: Accelerating Change for a Sustainable Future

In 2023, an interdisciplinary group of global health experts from five continents convened a plenary panel at the Consortium of Universities for Global Health (CUGH) annual conference entitled "Reimagining Global Health for the 21st Century." At the heart of this viewpoint article lies a fundamental question: How can we reimagine global health to best confront existing challenges and meet the demands of the future? To fully assess the scope of global health challenges and identify sustainable solutions, a clear definition of the aims and strategic approaches is needed. Such an assessment is also critical for progress in promoting equity, including decolonizing global health. Key issues examined are the following: equity, governance, research, education, and sustainability. To assure a sustainable global health enterprise, we propose the following three strategic imperatives as guiding principles: a holistic, unified approach grounded in mutual benefit, joint investment, long‑term collaborative commitment, and solidarity across low‑ to middle‑income countries (LMICs) and high‑income countries (HICs); joint priority setting of investments in research, education, practice, and workforce development; and collaborative governance, maximizing a multisectoral approach among local, national, regional, and global strategies. The viewpoint sets the stage for the development of an action roadmap to develop a unified concept of global health; identify strategies to ensure sustained funding for global health research, education and training, and practice; establish benchmarks and metrics to measure progress; and design a collaborative governance system to promote interconnectedness and engagement among local, regional, national, and global stakeholders.

Oral health promotion: a qualitative study to explore perspectives of kindergarten nurses at Qatar

BACKGROUND

The oral health of preschool children remains a concern globally. Kindergarten and school nurses can improve oral health by reducing the incidence of Early Childhood Caries (ECC) among children. This study aimed to explore the perceptions of kindergarten nurses about a proposed oral health promotion program to be implemented in primary health centres and kindergartens.

METHODS

The qualitative research used in-depth interviews of 12 kindergarten nurses who were audio-recorded and transcribed verbatim. Qualitative data analysis software was used (NVivo9 MANUF). Four major themes emerged and were analysed to explore contextual patterns within the data.

RESULTS

The major themes included participants acknowledged the high prevalence of caries in children and identified several causes within the local context, including parental practices, poor dietary habits, the impact of cultural lack of oral health knowledge and limitations in the healthcare system. However, the study results' themes also revealed complex barriers and enablers regarding the implementation of the program highlighting interpersonal, structural, systemic, and social elements.

CONCLUSION

Kindergarten nurses maintained an affirmative attitude towards oral health promotion programs and were enthusiastic about initiating and supporting these programs. This qualitative study brought out critical socio-biological-cultural factors that influence the oral health promotion of preschool children.

Challenges and Opportunities of Universal Health Coverage in Africa: A Scoping Review

BACKGROUND

Universal health coverage (UHC) is a global priority, with the goal of ensuring that everyone has access to high-quality healthcare without suffering financial hardship. In Africa, most governments have prioritized UHC over the last two decades. Despite this, the transition to UHC in Africa is seen to be sluggish, with certain countries facing inertia. This study sought to examine the progress of UHC-focused health reform implementation in Africa, investigating the approaches utilized, the challenges faced, and potential solutions.

METHOD

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, we scoped the literature to map out the evidence on UHC adoption, roll out, implementation, challenges, and opportunities in the African countries. Literature searches of the Cochrane database of systematic reviews, PUBMED, EBSCO, Eldis, SCOPUS, CINHAL, TRIP, and Google Scholar were conducted in 2023. Using predefined inclusion criteria, we focused on UHC adoption, rollout, implementation, and challenges and opportunities in African countries. Primary qualitative, quantitative, and mixed-methods evidence was included, as well as original analyses of secondary data. We employed thematic analysis to synthesize the evidence.

RESULTS

We found 9633 documents published between May 2005 and December 2023, of which 167 papers were included for analysis. A significant portion of UHC implementation in Africa has focused on establishing social health protection schemes, while others have focused on strengthening primary healthcare systems, and a few have taken integrated approaches. While progress has been made in some areas, considerable obstacles still exist. Financial constraints and supply-side challenges, such as a shortage of healthcare workers, limited infrastructure, and insufficient medical supplies, remain significant barriers to UHC implementation throughout Africa. Some of the promising solutions include boosting public funding for healthcare systems, strengthening public health systems, ensuring equity and inclusion in access to healthcare services, and strengthening governance and community engagement mechanisms.

CONCLUSION

Successful UHC implementation in Africa will require a multifaceted approach. This includes strengthening public health systems in addition to the health insurance schemes and exploring innovative financing mechanisms. Additionally, addressing the challenges of the informal sector, inequity in healthcare access, and ensuring political commitment and community engagement will be crucial in achieving sustainable and comprehensive healthcare coverage for all African citizens.

Global, regional, and national esophageal cancer deaths and DALYs attributable to diet low in vegetables and fruits, 1990-2019: analysis for the global burden of disease study

Background

This study aimed to comprehensively assess the global, regional, and national burden of esophageal cancer (EC) attributable to inadequate vegetable and fruit intake from 1990 to 2019 and explore the potential impact of existing dietary intervention programs on EC prevention.

Methods

Using the Global Burden of Disease Study 2019 (GBD 2019) database, we conducted descriptive analyses stratified by age, sex, Socio-demographic Index (SDI), and regional levels. Temporal trends were assessed using linear regression models, and cluster analysis was employed to explore burden patterns across different GBD regions. Decomposition analysis quantified the contributions of aging, population dynamics, and epidemiological changes to deaths and disability-adjusted life years (DALYs). Frontier analysis was used to evaluate the relationship between dietary risk-related disease burden and sociodemographic progress.

Results

In 2019, inadequate vegetable and fruit intake contributed to 65,919 global EC deaths, accounting for 0.12% of all deaths, with an age-standardized death rate of 0.81 per 100,000 population. The associated DALYs totaled 16,065,68, representing 0.06% of total global DALYs, with an age-standardized DALY rate of 19.24. The disease burden attributable to insufficient fruit intake (51,210 deaths, 12,497,75 DALYs) was significantly higher than that from inadequate vegetable intake (17,176 deaths, 4,203,09 DALYs). The burden was greater in males than females, peaking in middle-aged groups. Substantial regional differences were observed, with low-SDI regions bearing the highest burden. From 1990 to 2019, while the absolute numbers of deaths and DALYs followed a complex trajectory of initial increase followed by decline, age-standardized rates consistently decreased, reflecting the positive impact of epidemiological improvements. Existing dietary intervention programs, such as subsidies for fruit and vegetable production and health education initiatives, have contributed to a reduction in dietary risk-related disease burden but exhibited varying effectiveness across SDI regions.

Conclusion

Targeted dietary interventions, such as promoting fruit and vegetable consumption, are critical for the prevention and control of the EC disease burden. Future efforts should focus on optimizing the implementation of current programs, enhancing nutritional supplementation in resource-limited regions, and expanding health education initiatives to achieve broader health benefits.

Impact of early diagnosis, disease variant, and quality of care on the neurocognitive outcome in maple syrup urine disease: A meta-analysis

PURPOSE

Maple syrup urine disease (MSUD) is a rare inherited metabolic disease characterized by recurrent metabolic decompensations, neurocognitive impairment, and limited life expectancy. This meta-analysis aims to evaluate the impact of early diagnosis by newborn screening (NBS) on mortality and neurocognitive outcome in survivors, taking into account the quality of national health care systems.

METHODS

Systematic literature search was performed according to Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Effects on outcome parameters were analyzed using meta-analytical measures and reanalysis of individual participant data.

RESULTS

Thirty-three studies were included, reporting on 1141 individuals with MSUD. Participants with classic MSUD presented a more severe phenotype compared with variant MSUD as demonstrated by higher mortality rate (17.1% versus 0%), and lower median IQ (90 versus 104; P < .001, linear mixed model). NBS was associated with improved cognition (mean IQ: 95 versus 82; P = .014, random effects model) and decreased mortality (3% versus 14.6%; P = .028, Kaplan-Meier estimates) compared with individuals identified after onset of symptoms, in trend even after the exclusion of individuals with variant MSUD. Quality of national health care systems correlated with survival (P = .025, meta-regression) and permanent neurological symptoms (P = .031, meta-regression).

CONCLUSION

NBS is a prerequisite to improved outcome in individuals with MSUD; however, health benefit critically depends on the quality of the national health care systems.

Barriers to Healthcare Access for Indigenous Communities: Insights from Healthcare Professionals

BACKGROUND

The indigenous people or 'Orang Asli' (OA) in Malaysia is a vulnerable group who lags behind in terms of socioeconomic, education and health. Despite numerous developments, health disparities still exist among the OA, resulting in varying health outcomes. This study aimed to identify barriers to providing healthcare to OA by healthcare professionals (HCPs) in Malaysia.

METHODS

Semi-structure interview was conducted with 20 HCPs who have experience working with OA communities. Data were analysed thematically using the Health Care Access Barriers model as a framework.

RESULTS

Our study identified three themes which improve or hinder access to health care among OA communities. The main perceived barriers were (1) structural barriers, (2) cognitive barriers and (3) financial barriers.

CONCLUSION

Our study illuminates how financial, structural and cognitive factors intersect to affect healthcare access among OA communities. To narrow the health outcome disparities, future research must engage with OA communities to ensure culturally appropriate and sustainable healthcare delivery.

Global burden of subarachnoid hemorrhage among adolescents and young adults aged 15-39 years: A trend analysis study from 1990 to 2021

OBJECTIVE

This study aims to analyze the global burden of subarachnoid hemorrhage (SAH) among adolescents and young adults (AYAs) aged 15-39 years from 1990 to 2021, highlighting spatial and temporal trends and providing insights for future public health strategies.

METHODS

Data were collected from the Global Burden of Disease Study 2021 (GBD 2021), which includes comprehensive evaluations of health conditions and associated risk factors across 204 countries and territories. The focus was on SAH incidence, prevalence, mortality, and disability-adjusted life years (DALYs) among AYAs. The data were segmented by age groups (15-19, 20-24, 25-29, 30-34, 35-39 years) and socio-demographic index (SDI) quintiles. Statistical analyses, including Joinpoint regression and decomposition analysis, were employed to assess temporal trends and the impact of population growth, aging, and epidemiological changes.

RESULTS

From 1990 to 2021, the global number of SAH incident cases among AYAs increased by 12.6%, from 109,120 cases in 1990 to 122,822 cases in 2021. Prevalent cases rose by 17.1%, from 1,212,170 cases in 1990 to 1,419,127 cases in 2021. Conversely, the number of deaths decreased by approximately 26.6%, from 30,348 cases in 1990 to 22,266 cases in 2021. Similarly, DALYs decreased by 23.7%, from 1,996,041 cases in 1990 to 1,523,328 cases in 2021. Notably, over these thirty years, the age-standardized rates (ASR) of incidence, prevalence, mortality, and DALYs for the AYA population showed an overall decreasing trend, despite fluctuations in specific periods. The age-standardized mortality rate (ASMR) and age-standardized DALYs (ASR for DALYs) decreased continuously with an average annual percentage change (AAPC) of -2.2% (95% CI: -2.36, -2.04) and -2.02% (95% CI: -2.17, -1.88), respectively. The age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) had an AAPC of -0.8% (95% CI: -0.85, -0.75) and -0.65% (95% CI: -0.66, -0.64), respectively. Particularly, the ASIR showed a continuous decline from 1990 to 2015, followed by a slight increase from 2014 to 2019 (APC: 0.14%, 95% CI: 0.03, 0.25), and accelerated growth from 2019 to 2021 (APC: 1.23%, 95% CI: 0.88, 1.57). The ASPR declined from 1990 to 2019, followed by an increase from 2019 to 2021 (APC: 0.15%, 95% CI: 0.05, 0.25). Regional analysis revealed substantial burdens in the Middle-SDI and Low-Middle-SDI regions, with the Middle-SDI region having the highest incidence, prevalence, mortality, and DALYs. Decomposition analysis indicated that population growth was the primary driver of increased SAH cases, while epidemiological changes contributed significantly to the decline in deaths and DALYs.

CONCLUSION

The findings underscore the need for targeted public health interventions, particularly in low and low-middle-SDI regions, to reduce the burden of SAH among AYAs. Improved healthcare resources, enhanced health education, and preventive strategies are crucial. This study provides valuable data to inform future public health policies and resource allocation, emphasizing the importance of addressing the unique challenges faced by AYAs.

Minimally Invasive Surgery for Colorectal Cancer: Benchmarking Uptake for a Regional Improvement Programme

BACKGROUND

The uptake of minimally invasive surgery (MIS) for patients with colorectal cancer has progressed at differing rates, both across countries, and within countries. This study aimed to investigate uptake for a regional colorectal cancer improvement programme in England.

METHOD

We calculated the proportion of patients receiving elective laparoscopic and robot-assisted surgery amongst those diagnosed with colorectal cancer over 3 time periods (2007-2011, 2012-2016 and 2017-2021) in hospitals participating in the Yorkshire Cancer Research Bowel Cancer Improvement Programme (YCR BCIP). These were benchmarked against national rates. Regression analysis and funnel plots were used to develop a data driven approach for analysing trends in the use of MIS at hospitals in the programme.

RESULTS

In England, resections performed by MIS increased from 34.9% to 72.9% for colon cancer and from 28.8% to 72.5% for rectal cancer. Robot-assisted surgery increased from 0.1% to 2.7% for colon cancer and from 0.2% to 7.9% for rectal cancer. Wide variation in the uptake of MIS was observed at a hospital level. Detailed analysis of the YCR BCIP region identified a decreasing number of surgical departments, since the start of the programme, as potential outliers for MIS when compared to the English national average.

CONCLUSION

Wide variation in use of MIS for colorectal cancer exists within the English National Health Service and a data-driven approach can help identify outlying hospitals. Addressing some of the challenges behind the uptake of MIS, such as ensuring adequate provision of surgical training and equipment, could help increase its use.

Epidemiological analysis of chronic kidney disease from 1990 to 2019 and predictions to 2030 by Bayesian age-period-cohort analysis

BACKGROUND

Chronic Kidney Disease (CKD) has emerged as a significant global health issue. This study aimed to reveal and predict the epidemiological characteristics of CKD.

METHODS

Data from the Global Burden of Disease Study spanning the years 1990 to 2019 were employed to analyze the incidence, prevalence, death, and disability-adjusted life year (DALY) of CKD. Joinpoint analysis assessed epidemiological trends of CKD from 1990 to 2019. An age-period-cohort model evaluated risk variations. Risk factor analysis uncovered their influences on DALYs and deaths of CKD. Decomposition analysis explored the drivers to CKD. Frontier analysis evaluated the correlations between CKD burden and the sociodemographic index (SDI). A Bayesian Age-Period-Cohort model was employed to predict future incidence and death of CKD.

RESULTS

In 2019, there were 18,986,903 incident cases, 697,294,307 prevalent cases, 1,427,232 deaths, and 41,538,592 DALYs of CKD globally. Joinpoint analysis showed increasing age-standardized rates of CKD incidence, prevalence, mortality, and DALY from 1990 to 2019. High systolic blood pressure significantly contributed to CKD-related deaths and DALYs, particularly in the high SDI region. Decomposition analysis identified population growth as the primary driver of CKD incident cases and DALYs globally. Countries like Nicaragua showed the highest effective differences, indicating room for improvement in CKD management. By 2030, while incident cases of CKD were predicted to rise, the global deaths might decrease.

CONCLUSIONS

The study revealed a concerning upward trend in the global burden of CKD, emphasizing the need for targeted management strategies across different causes, regions, age groups, and genders.

Unraveling the enigma: chronic kidney disease of unknown etiology and its causative factors with a specific focus on dissolved organic compounds in groundwater-reviews and future prospects

Chronic kidney disease is globally recognized as a highly impactful non-communicable disease. The inability of early identification contributes to its high mortality rate and financial burden on affected individuals. Chronic kidney disease of uncertain etiology (CKDu) constitutes a significant global public health concern. This condition does not arise from traditional risk factors such as diabetes, hypertension, or glomerulonephritis. More than 150 articles were analysed to understand risk factors of CKDu. This study aimed to investigate the potential association between dissolved organic compounds, such as Polycyclic Aromatic Hydrocarbons and Humic Acid, and the incidence of CKDu. Through a comprehensive literature review, we identified CKDu clusters worldwide, including notable nephropathies, and explored their potential links with organic compounds. Our analysis revealed that organic compounds can leach from sediments and low-rank lignite deposits into groundwater, subsequently contaminating water supplies and food. These compounds have been implicated in the development of diabetes and increased heavy metal mobility, both of which are risk factors for kidney disease. Our findings suggest that exposure to organic compounds may contribute to the etiology of CKDu, underscoring the need for regular monitoring and establishment of baseline and threshold values in water and soil. We also emphasize the importance of analyzing organic compounds in groundwater in CKDu hotspots and establishing distinct registries for CKD and CKDu implementation.

Periodontal diseases in Africa

Periodontal diseases, a group of complex conditions marked by an excessive immune response and periodontal tissue destruction, are a global health concern. Since 1990, the incidence of these diseases has doubled, with Western sub-Saharan Africa experiencing the highest burden. Accurate diagnosis and case identification are crucial for understanding the etiology, features of disease, research, treatment and prevention. Modern perspectives on periodontal disease classification are based on commonality among those affected. However, current literature is often plagued by methodological inconsistencies and focused on disease mechanisms in European populations. Health inequalities in low- and middle-income countries (LMICs) are exacerbated by these challenges, with sub-Saharan Africa, and Nigeria specifically, facing unique difficulties such as clinical personnel shortages and limited research infrastructure. This review explored disparities in periodontal disease research, care and outcomes in African populations. We highlighted these disparities and identified the factors contributing to inequities in periodontal health outcomes. We further demonstrated the critical need for inclusive and equitable healthcare and research practices tailored to the unique challenges faced by diverse populations and regions with limited resources. Addressing these disparities is essential for ensuring that advancements in healthcare are accessible to all, thereby improving global oral health and general health.

Performance evaluation of Mexico's health system at the national and subnational level, 1990-2019: an analysis of the Health Access and Quality Index

OBJECTIVES

This study aimed to comprehensively evaluate Mexico's health system performance from 1990 to 2019 utilising the Health Access and Quality Index (HAQI) as a primary indicator.

STUDY DESIGN

A retrospective ecological analysis was performed using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) study and the National Population Council (CONAPO).

METHODS

HAQI values for 1990, 2000, 2010, 2015, and 2019 were examined for each state in Mexico and three age groups (young, working, and post-working). Additionally, the marginalisation index was employed to assess inequalities in the HAQI distribution across states. The concentration index of the HAQI for each year was estimated, and the efficiency of states in producing the HAQI was evaluated using a data envelopment approach.

RESULTS

Through the analysis of national and subnational data, results indicated an overall improvement in healthcare access and quality during the study period. Although differences in the HAQI value related to state marginalisation decreased from 1990 to 2015, by 2019, the inequality had returned to a level comparable to 2000. Efficiency in producing health (HAQI values) exhibited substantial heterogeneity and fluctuations in the ranking order over time. States such as Nuevo León consistently performed well, while others, such as Guerrero, Chihuahua, Mexico City, and Puebla, consistently underperformed.

CONCLUSIONS

The findings from this study emphasise the necessity for nuanced strategies to address healthcare disparities and enhance the overall system performance. The study provides valuable insights for ongoing discussions about the future of Mexico's healthcare system, aiming to inform evidence-based policy decisions and improve the nationwide delivery of healthcare services.

The contribution of avoidable mortality to life expectancy differences and lifespan disparities in the European Union: a population-based study

Background

Twenty years after the 2004 European Union (EU) enlargement, life expectancy differences between established (EMS) and new member states (NMS) remain large. Contributing to this gap are deaths that can be avoided through preventive services or adequate medical treatment. We estimate the impact of reducing avoidable mortality on life expectancy and lifespan disparities in the enlarged EU.

Methods

Using World Health Organization mortality database data, we analysed the potential of reducing avoidable mortality, as defined by Eurostat and the Organisation for Economic Cooperation and Development, to close the mortality gap between NMS and EMS. We decomposed the changes in life expectancy and lifespan disparity by age and cause using linear integral decomposition.

Findings

Averting all avoidable deaths across the EU from 2005 to 2019 would decrease the average life expectancy gap from 5.8 to 2.4 years in men and 3.3-2 years in women and eliminate the lifespan disparity gap. Had NMS achieved the average EMS avoidable mortality rates during the same period, the average life expectancy gap would have been reduced to 1.8 years in men and 1.6 years in women, and the lifespan disparities gap would have been reversed. Avoidable circulatory and injury-related deaths in middle and older age drove the observed mortality changes.

Interpretation

Our results suggest that the gap in life expectancy and lifespan disparity across the EU could be reduced by strengthening health systems and investing in averting circulatory and injury-related deaths in middle and older age in NMS.

Funding

None.

Global, regional, and national burden of bladder cancer, 1990-2019: an age-period-cohort analysis based on the Global Burden of Disease 2019 study

OBJECTIVES

Bladder cancer is a common malignancy worldwide, with substantial morbidity and mortality. This study aimed to assess the global, regional, and national burden of bladder cancer from 1990 to 2019 using data from the Global Burden of Disease (GBD) 2019 study and to analyze the trends using an age-period-cohort (APC) model.

STUDY DESIGN

In this cross-sectional study, secondary analyses were conducted to assess the burden of bladder cancer using data from GBD 2019.

METHODS

Bladder cancer prevalence, incidence, mortality, disability-adjusted life years (DALYs), and their age-standardized rates (ASRs) were obtained from the GBD 2019 study. The estimated annual percentage changes (EAPCs) were calculated to quantify the trends in ASRs. An APC analysis was performed to distinguish the effects of age, period, and cohort on the observed temporal trends.

RESULTS

The global prevalence of bladder cancer increased substantially from 1990 to 2019, reaching 2,869,046.4 cases (95% UI: 2,614,200.3-3,114,474.4) in 2019. The age-standardized prevalence rate rose from 20.9 per 100,000 population in 1990 to 37.1 per 100,000 population in 2019, with an EAPC of 1.97 (95% CI: 1.93-2.01). The global burden of bladder cancer, as measured by DALYs, increased from 48.0 per 100,000 population in 1990 to 56.8 per 100,000 population in 2019, with an EAPC of 0.47 (95% CI: 0.4-0.53), demonstrating the growing impact of this disease on population health.

CONCLUSIONS

This study demonstrates a significant increase in prevalence, incidence, mortality, and DALYs, with substantial variations across sociodemographic index (SDI) quintiles and GBD regions. The findings emphasize the need for concerted efforts at the global, regional, and national levels to reduce the burden of bladder cancer through primary prevention, early detection, and improved access to treatment services.

Experiences in healthcare for weight management - a qualitative interview study of retired individuals with obesity and low or high education

BACKGROUND

Overweight and obesity are global health concerns, especially significant for older adults at higher risk for chronic diseases. The transition to retirement, altering daily routines, highlights the need for adequate weight management support. Since obesity is a challenging topic in healthcare and socioeconomic inequalities exist in access and utilization, we examined how retired individuals with obesity and low or high education describe their experiences of unmet needs, mismatches, and successes within the healthcare service system for weight management.

METHODS

This qualitative interview study is part of the Helsinki Health Study. The participants (N = 20, with a body mass index of at least 30 kg/m2) were selected from a cohort of retired former employees of the City of Helsinki. Half of the interviewees had low education, and the other half had high education. Women and men were equally represented. The interviews were conducted in 2023 and the data were analyzed using inductive thematic analysis.

RESULTS

Three main themes were formed: Deficiencies in engaged care, Services are mismatched with needs, and Facilitating conditions for individual successes. The first main theme had two sub-themes: Condescending attitude and Ignoring weight during the appointment. The second main theme had one sub-theme: Inadequate personnel resources. The third main theme had one sub-theme: Individual opportunities to acquire information and treatment. Educational differences were most clearly reflected in the sub-themes. Participants with low education more often described experiencing a condescending attitude towards them when seeking care and had had difficulties in obtaining time for appointments due to inadequate resources. Participants with high education described broader experiences related to individual opportunities to acquire information and treatment within the healthcare service system than participants with low education.

CONCLUSIONS

The participants in this study highlighted the importance of respectful engagement with the subject of their weight and felt that these kinds of interaction skills should still be developed in healthcare personnel. The participants articulated a need for approaches that are tailored to their unique circumstances. According to the participants, long-term group intervention, provided with peer support and supported by a multidisciplinary team, could sustain their weight management.

Engineering Principles and Bioengineering in Global Health

Medical technology plays a significant role in the reduction of disability and mortality due to the global burden of disease. The lack of diagnostic technology has been identified as the largest gap in the global health care pathway, and the cost of this technology is a driving factor for its lack of proliferation. Technology developed in high-income countries is often focused on producing high-quality, patient-specific data at a cost high-income markets can pay. While machine learning plays an important role in this process, great care must be taken to ensure appropriate translation to clinical practice.

Diminishing marginal returns and sufficiency in health-care resource use: an exploratory analysis of outcomes, expenditure, and emissions

BACKGROUND

Increasing health expenditure in low-income countries is associated with rapid gains in health status. Less attention has been paid to the possibility of diminishing marginal returns to health expenditure at high levels of spending, or to the relationship between health-care greenhouse gas emissions and outcomes. Our study aimed to investigate the existence, scale, and implications of diminishing marginal returns to health-care expenditure and emissions.

METHODS

Segmented (piecewise) regression analysis was used to explore the relationship between two measures of health outcome from the Global Burden of Disease project (mortality amenable to health care [MAH] and health-adjusted life expectancy [HALE]), four aggregates of health expenditure per capita from the WHO Global Health Expenditure Database, and health-care sector greenhouse gas emissions per capita derived from a 2020 study by Lenzen and colleagues. Turning point knots-points at which the elasticity or velocity of increasing returns to expenditure and emissions changed substantially-were estimated and countries in the vicinity of these knots identified.

FINDINGS

Rapidly increasing returns (improvements in population health as measured by MAH and HALE) to health expenditure were estimated in low-income and lower-middle-income countries; at levels of spending above approximately US$500 per capita, these returns start to slow. At levels of spending above those seen in high-income countries such as Italy (approximately US$3400), there is little or no evidence of further health returns to additional spending or to increasing health-care greenhouse gas emissions.

INTERPRETATION

Dramatic improvements in population health outcomes could be achieved by additional investment in health expenditure in low-income countries. Conversely, continuing growth in health expenditure in high-income countries will, by itself, be unlikely to yield rapid improvements in health outcomes. Our findings inform the emerging debate on the importance of sufficiency within planetary boundaries-low-income countries need rapid growth in health expenditure, whereas high-income countries could potentially achieve better health outcomes at substantially lower levels of resource use.

FUNDING

None.

Breast cancer in Switzerland: a comparison between organized-screening versus opportunistic-screening cantons

BACKGROUND

Switzerland is one of the few remaining European countries without a uniform national breast cancer screening program. Most Swiss cantons have initiated mammography screening programs, with the notable exceptions of the cantons of central Switzerland. The aim of this study is to compare the TNM (tumor-node-metastasis) status in woman diagnosed with screen- and non-screen-detected breast cancers. We compare TNM of breast cancers of cantonal screening cantons (Or-SC) with organized mammographic screening and opportunistic-screening cantons (Op-SC) without organized mammographic screening.

MATERIALS AND METHODS

We compared the TNM documented in cantons with organized screening (Or-SC) in the national cancer registry with those in the cantons of central Switzerland without organized screening (Op-SC) between 2014 and 2020. Since 2014, a total of 19 236 patients from Or-SC and 2282 from Op-SC with breast cancer were compared. Age groups were defined as younger than 50 years, between 50 and 69 years, and older than 70 years.

RESULTS

By comparison, women aged 50-69 years in the cantons of the Op-SC group exhibited significantly larger tumors T1-3 [point estimate of the difference with 95% confidence interval (CI) for T1: -7.7% (95% CI -11.0% to -4.4%); T2: 5.3% (95% CI 2.2% to 8.5%); T3: 2.5% (95% CI 0.8% to 4.2%)] and significantly fewer proportion of N0 [-5.7% (95% CI -9.0% to -2.5%)] without significant difference in the M status (P = 0.97).

CONCLUSION

Our study shows that patients aged 50-69 years from Op-SC have significantly larger tumors and higher incidence of lymph node metastases than women in the corresponding Or-SC group. This globally unique case within one single small country with very high living standards, but with different screening strategies, indicates the benefits of organized breast screening programs.

Healthcare as a driver, reservoir and amplifier of antimicrobial resistance: opportunities for interventions

Antimicrobial resistance (AMR) is a global health challenge that threatens humans, animals and the environment. Evidence is emerging for a role of healthcare infrastructure, environments and patient pathways in promoting and maintaining AMR via direct and indirect mechanisms. Advances in vaccination and monoclonal antibody therapies together with integrated surveillance, rapid diagnostics, targeted antimicrobial therapy and infection control measures offer opportunities to address healthcare-associated AMR risks more effectively. Additionally, innovations in artificial intelligence, data linkage and intelligent systems can be used to better predict and reduce AMR and improve healthcare resilience. In this Review, we examine the mechanisms by which healthcare functions as a driver, reservoir and amplifier of AMR, contextualized within a One Health framework. We also explore the opportunities and innovative solutions that can be used to combat AMR throughout the patient journey. We provide a perspective on the current evidence for the effectiveness of interventions designed to mitigate healthcare-associated AMR and promote healthcare resilience within high-income and resource-limited settings, as well as the challenges associated with their implementation.

Healthcare can't stop evolving: innovation as the catalyst for unleashing the managerial potential of value-based healthcare by stimulating intangible assets and enhancing organizational resilience

Background

With increasing healthcare service utilization and the introduction of costly therapies, healthcare organizations are pressured to deliver cost-effective services within constrained budgets. Rising costs and the need for efficient healthcare delivery are major concerns for governments, insurers, and health plans.

Objectives

It aims to understand the impact of these intangible assets on creating value and organizational resilience in healthcare, informing better practices and strategies for VBHC implementation.

Methods

An applied research approach using the Work Breakdown Structure (WBS) methodology was adopted. The research was divided into seven interconnected Work Packages (WPs), each designed to investigate different aspects of the integration between VBHC and intangible assets, with a focus on enhancing organizational resilience through innovative health processes. Key methodologies included literature reviews and qualitative analyses, employing Open Innovation and Design Thinking.

Results

The study revealed a dynamic interplay between VBHC, organizational resilience, and intangible assets. It showed that managerial effectiveness is influenced by direct patient outcomes and elements like intellectual capital and organizational reputation. Data integration from various Work Packages provided new insights into how intangible assets underpin VBHC strategies, proposing novel management approaches. Findings highlight the essential role of intangible assets in enhancing service delivery and fostering sustainable healthcare practices.

Discussion

The study highlights a significant oversight in the integration of intangible assets within healthcare organizations, despite their crucial role in optimizing VBHC. It supports literature emphasizing the importance of intellectual capital and organizational culture in enhancing healthcare management efficiency and resilience. A paradigm shift in VBHC to include these assets is needed for building a more adaptable and sustainable healthcare system. This integration can lead to better clinical outcomes, patient satisfaction, and overall healthcare efficiency, aligning more closely with VBHC goals.

Conclusion

Recognizing and effectively managing intangible assets are paramount for the successful implementation of VBHC and enhanced organizational resilience. Strategic integration of these assets into healthcare management practices can significantly improve patient outcomes and create a more sustainable, patient-centered, and resilient healthcare system. Future studies should develop methodologies for robust measurement and integration of these assets to fully realize the potential of VBHC.

Laryngeal features in Lipoid proteinosis: a systematic review and meta-analysis of individual participant data

PURPOSE

Lipoid proteinosis (LP) or Urbach-Wiethe disease (OMIM 247100) is a rare syndrome characterised by early vocal folds infiltration and subsequent multi-organ involvement. LP is often unrecognised and its associated hoarseness is overlooked. The main objective of the study was to investigate hoarseness in LP and implement a diagnosis among otolaryngologists.

METHODS

PubMed/MEDLINE and OMIM databases were systematically searched. Authors concentrated the search on published articles starting from the discovery of the pathogenesis of LP by Hamada et al. in 2002. Only cases in which a diagnosis was reported both clinically and through biopsy and/or genetic molecular testing were included. Characteristics of the LP cases were extracted from each included study. Results were obtained through Generalized Estimating Equations.

RESULTS

The search strategy yielded 217 articles, of which 74 (34.1%) met the selection criteria. A total of 154 cases were included. Hoarseness was described in all LP cases and clearly stated as the onset symptom in 68.8%. The onset was on average at 19 months of age (CI: 3.00-20.00), while the mean age at diagnosis was 15 years (CI: 10.00-30.00). Therefore, the diagnostic delay amounted to 13.42 years (CI: 8.00-23.83). Hoarseness alone was responsible for an LP diagnosis in only 14.3% of cases. In 43.5% of cases, genetic analysis of the ECM1 gene was performed and exon 6 was the most frequently altered portion.

CONCLUSION

Analysing the largest number of published cases, the study underlined that hoarseness is the key symptom for diagnosing LP since early childhood, though frequently overlooked.

The Burden of Occupational Noise-Induced Hearing Loss From 1990 to 2019: An Analysis of Global Burden of Disease Data

OBJECTIVES

The relationship between long-term exposure to occupational noise and hearing loss has been extensively documented. We aimed to assess spatial and temporal changes in the burden of occupational noise-induced hearing loss (ONIHL) in 204 countries and territories with varying socio-demographic indexes (SDI) from 1990 to 2019.

DESIGN

Temporal and spatial trends in age-standardized disability-adjusted life year rates (ASDR) for ONIHL were estimated by sex, age, SDI level, country, and geographic region from 1990 to 2019. We used the Joinpoint model to calculate annual average percentage changes to assess such trends and projected trends in ASDR for ONIHL globally and across different income regions from 2020 to 2044 using an age-period-cohort model. We fitted the relationship between ASDR and SDI, ASDR and healthcare access and quality index, respectively.

RESULTS

Overall, the global burden of ONIHL has decreased since 1990, especially in middle and lower SDI regions. In 2019, the global ASDR for ONIHL was 84.23 (95% confidence interval: 57.46 to 120.52) per 100,000 population. From 1990 to 2019, the global ASDR for ONIHL decreased by 1.72% (annual average percentage change = -0.05, 95% confidence interval: -0.07 to -0.03). Our projections showed a decreasing trend in the global ONIHL burden until 2044. ASDR and SDI ( R = -0.8, p < 0.05), ASDR and healthcare access and quality index ( R = -0.75, p < 0.05) showed significant negative correlations.

CONCLUSIONS

The global ONIHL burden has decreased over the past three decades, especially in regions with middle and lower SDI levels. However, the global ONIHL burden still remained severe in 2019, notably among males, the middle-aged and elderly, and regions with lower SDI levels.

Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021

BACKGROUND

Appendicitis is a common surgical emergency that poses a large clinical and economic burden. Understanding the global burden of appendicitis is crucial for evaluating unmet needs and implementing and scaling up intervention services to reduce adverse health outcomes. This study aims to provide a comprehensive assessment of the global, regional, and national burden of appendicitis, by age and sex, from 1990 to 2021.

METHODS

Vital registration and verbal autopsy data, the Cause of Death Ensemble model (CODEm), and demographic estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) were used to estimate cause-specific mortality rates (CSMRs) for appendicitis. Incidence data were extracted from insurance claims and inpatient discharge sources and analysed with disease modelling meta-regression, version 2.1 (DisMod-MR 2.1). Years of life lost (YLLs) were estimated by combining death counts with standard life expectancy at the age of death. Years lived with disability (YLDs) were estimated by multiplying incidence estimates by an average disease duration of 2 weeks and a disability weight for abdominal pain. YLLs and YLDs were summed to estimate disability-adjusted life-years (DALYs).

FINDINGS

In 2021, the global age-standardised mortality rate of appendicitis was 0·358 (95% uncertainty interval [UI] 0·311-0·414) per 100 000. Mortality rates ranged from 1·01 (0·895-1·13) per 100 000 in central Latin America to 0·054 (0·0464-0·0617) per 100 000 in high-income Asia Pacific. The global age-standardised incidence rate of appendicitis in 2021 was 214 (174-274) per 100 000, corresponding to 17 million (13·8-21·6) new cases. The incidence rate was the highest in high-income Asia Pacific, at 364 (286-475) per 100 000 and the lowest in western sub-Saharan Africa, at 81·4 (63·9-109) per 100 000. The global age-standardised rates of mortality, incidence, YLLs, YLDs, and DALYs due to appendicitis decreased steadily between 1990 and 2021, with the largest reduction in mortality and YLL rates. The global annualised rate of decline in the DALY rate was greatest in children younger than the age of 10 years. Although mortality rates due to appendicitis decreased in all regions, there were large regional variations in the temporal trend in incidence. Although the global age-standardised incidence rate of appendicitis has steadily decreased between 1990 and 2021, almost half of GBD regions saw an increase of greater than 10% in their age-standardised incidence rates.

INTERPRETATION

Slow but promising progress has been observed in reducing the overall burden of appendicitis in all regions. However, there are important geographical variations in appendicitis incidence and mortality, and the relationship between these measures suggests that many people still do not have access to quality health care. As the incidence of appendicitis is rising in many parts of the world, countries should prepare their health-care infrastructure for timely, high-quality diagnosis and treatment. Given the risk that improved diagnosis may counterintuitively drive apparent rising trends in incidence, these efforts should be coupled with improved data collection, which will also be crucial for understanding trends and developing targeted interventions.

FUNDING

Bill and Melinda Gates Foundation.

Global prevalence and disability-adjusted life years of hypertensive heart disease: A trend analysis from the Global Burden of Disease Study 2019

Background

As hypertensive heart disease (HHD) presents a significant public health challenge globally, we analysed its global, regional, and national burdens and trends from 1990 to 2019.

Methods

We used data from the Global Burden of Disease (GBD) 2019 study, focussing on the age-standardised prevalence rates (ASPRs) of HHD prevalence, age-standardised disability-adjusted life year (DALY) rates, average annual percentage change (AAPC), and risk factor attributions. We compared the HHD burden across sociodemographic index (SDI) strata, gender, age groups, and 204 countries and territories.

Results

In 2019, the global prevalence of HHD was estimated at 18 598 thousand cases, with DALYs reaching 21 508 thousand. From 1990 to 2019, the ASPRs increased (AAPC = 0.21; 95% confidence interval (CI) = 0.17, 0.24), while the age-standardised DALY rates decreased (AAPC = -0.45; 95% CI = -1.23, -0.93). We observed the highest increase in ASPRs in high-middle SDI quantile countries, and an overall negative correlation between age-standardised DALY rates and SDI. Individuals above 70 years of age were the most affected, particularly elderly women. There has been a significant increase in HHD burden attributed to high body mass index (BMI) since 1990. The burden of HHD is concentrated in the middle SDI quintile, with population ageing and growth being major drivers for the increase in DALYs. We identified opportunities for reducing age-standardised DALY rates in the middle SDI quintile or lower.

Conclusion

Despite a declining trend in the age-standardised DALY rates, the ASPRs of HHD continue to rise, especially in high-middle SDI regions. Meanwhile, countries in middle and lower SDI quintiles face a higher burden of age-standardised DALY rates. Targeted attention towards elderly women and controlling high BMI, alongside enhancing hypertension and HHD management awareness, is crucial for reducing the global burden of HHD.

Global burden, risk factor analysis, and prediction study of leukaemia from 1990 to 2030

Background

Leukaemia is a devastating disease with an incidence that progressively increases with advancing age. The World Health Organization has designated 2021-30 as the decade of healthy ageing, highlighting the need to address age-related diseases. We estimated the disease burden of leukaemia and forecasted it by 2030.

Methods

Based on the Global Burden of Disease 2019 database, we systematically analysed the geographical distribution of leukaemia and its subtypes. We used Joinpoint regression and Bayesian age-period-cohort models to evaluate incidence and mortality trends from 1990 to 2019 and projections through 2030. We analysed five leukaemia subtypes and the impact of age, gender, and social development. Decomposition analysis revealed the effects of disease burden on ageing and population growth. We used frontier analysis to illustrate the potential of each country to reduce its burden based on its development levels.

Results

Globally, the absolute numbers of leukaemia incidence and mortality have increased, while the age-standardised rates (ASRs) have shown a decreasing trend. The disease burden was more pronounced in men, the elderly, and regions with a high socio-demographic index (SDI), where ageing and population growth played varying roles across subtypes. From 2000 to 2006, disease burdens were most effectively controlled. Global ASRs of incidence might stabilise, while ASRs of death are expected to decrease until 2030. Frontier analysis showed that middle and high-middle SDI countries have the most improvement potential. Smoking and high body mass index were the main risk factors for leukaemia-related mortality and disability-adjusted life years.

Conclusions

The absolute number of leukaemia cases has increased worldwide, but there has been a sharp decline in ASRs over the past decade, primarily driven by population growth and ageing. Countries with middle and high-middle SDI urgently need to take action to address this challenge.

Global, regional, and national burden and trends of migraine among youths and young adults aged 15-39 years from 1990 to 2021: findings from the global burden of disease study 2021

BACKGROUND

Migraine, a widespread neurological condition, substantially affects the quality of life, particularly for adolescents and young adults. While its impact is significant, there remains a paucity of comprehensive global research on the burden of migraine in younger demographics. Our study sought to elucidate the global prevalence, incidence, and disability-adjusted life-years (DALYs) associated with migraine in the 15-39 age group from 1990 to 2021, utilizing data from the Global Burden of Disease (GBD) 2021 study.

METHODS

Our comprehensive study analyzed migraine data from the GBD 2021 report, examining the prevalence, incidence, and DALYs across 204 countries and territories over a 32-year span. We stratified the information by age, sex, year, geographical region, and Socio-demographic Index (SDI). To evaluate temporal trends in these metrics, we employed the estimated annual percentage change (EAPC) calculation.

RESULTS

Between 1990 and 2021, the worldwide prevalence of migraine among 15-39 year-olds increased substantially. By 2021, an estimated 593.8 million cases were reported, representing a 39.52% rise from 425.6 million cases in 1990. Global trends showed increases in age-standardized prevalence rate, incidence rate, and DALY rate for migraine during this period. The EAPC were positive for all three metrics: 0.09 for ASPR, 0.03 for ASIR, and 0.09 for DALY rate. Regions with medium SDI reported the highest absolute numbers of prevalent cases, incident cases, and DALYs in 2021. However, high SDI regions demonstrated the most elevated rates overall. Across the globe, migraine prevalence peaked in the 35-39 age group. Notably, female rates consistently exceeded male rates across all age categories.

CONCLUSION

The global impact of migraine on youths and young adults has grown considerably from 1990 to 2021, revealing notable variations across SDI regions, countries, age groups, and sexes. This escalating burden necessitates targeted interventions and public health initiatives, especially in areas and populations disproportionately affected by migraine.

Money matters: The association between blood donation rates and healthcare system quality across 171 countries

BACKGROUND

Worldwide, insufficient blood donations cause blood shortages that jeopardize vital medical treatments for patients. Blood donation rates vary widely across countries, yet the determinants of this variation remain poorly understood. This study aims to illuminate the role of the institutional context in which blood donation is embedded by examining the link between country-level blood donation rates and healthcare system quality.

STUDY DESIGN AND METHODS

The study employed a cross-sectional design using data on blood donation rates from 171 countries from the 2021 WHO Global Status Report on Blood Safety and Availability and three healthcare quality indicators (i.e., Healthcare Access and Quality [HAQ] Index, life expectancy, and health expenditures). The pre-registered hypotheses are tested using multiple linear regression. Robustness checks control for confounding factors.

RESULTS

HAQ Index and health expenditures are positively associated with blood donation rates, whereas life expectancy is not related to blood donation when controlling for confounds. Health expenditures display the most robust association with blood donations, even when controlling for confounding factors, and when comparing countries within the same continent.

CONCLUSION

Higher healthcare system quality in terms of HAQ Index and higher healthcare expenditures are related to higher blood donation rates. The finding that healthcare expenditures are most consistently related to blood donation rates indicates that policymakers should consider prioritizing financial support for the healthcare system, including blood-collecting institutions. More broadly, a better understanding of the role of contextual factors for blood donation may be needed to increase blood availability worldwide.

Urban-rural health disparity among patients with chronic kidney disease: a cross-sectional community-based study from 2012 to 2019

OBJECTIVES

The incidence of chronic kidney disease (CKD) is increasing owing to the ageing population, resulting in an increased demand for dialysis and kidney transplantation, which can be costly. Current research lacks clarity regarding the relationship between residence setting and CKD prevalence or its related risk factors. This study explored the urban-rural disparities in CKD prevalence and risk factors in Taiwan. Our findings will aid the understanding of the distribution of CKD and the design of more effective prevention programmes.

DESIGN

This cross-sectional community-based study used the Renal Value Evaluation Awareness and Lift programme, which involves early screening and health education for CKD diagnosis and treatment. CKD prevalence and risk factors including alcohol consumption, smoking and betel nut chewing were compared between urban and rural areas.

SETTING

Urbanisation levels were determined based on population density, education, age, agricultural population and medical resources.

PARTICIPANTS

A total of 7786 participants from 26 urban and 15 rural townships were included.

RESULTS

The prevalence of CKD was significantly higher in rural (29.2%) than urban (10.8%) areas, representing a 2.7-fold difference (p<0.0001). Risk factors including diabetes (rural vs urban: 21.7% and 11.0%), hypertension (59.0% vs 39.9%), hyperuricaemia (36.7% vs 18.6%), alcohol consumption (29.0% vs 19.5%), smoking (15.9% vs 12.0%), betel nut chewing (12.6% vs 2.8%) and obesity (33.6% vs 19.4%) were significantly higher (p<0.0001) in rural areas.

CONCLUSIONS

The prevalence of CKD is three times higher in rural versus urban areas. Despite >99% National Health Insurance coverage, disparities in CKD prevalence persist between residential areas. Targeted interventions and further studies are crucial for addressing these disparities and enhancing CKD management across different settings.

Efficiency evaluation of 28 health systems by MCDA and DEA

BACKGROUND

Policymakers, who are constantly discussing growing health expenditures, should know whether the health system is efficient. We can provide them with such information through international health system efficiency evaluations. The main objectives of this study are: (a) to evaluate the efficiency of health systems in 28 developed countries by multiple-criteria decision analysis (MCDA) and data envelopment analysis (DEA) and (b) to identify reasonable benchmark countries for the Czech Republic, for which we collect information on the relative importance of health system inputs and outputs.

METHODS

We used MCDA and DEA to evaluate the efficiency of the health systems of 28 developed countries. The models included four health system inputs (health expenditure as a relative share of GDP, the number of physicians, nurses, and hospital beds) and three health system outputs (life expectancy at birth, healthy life expectancy, and infant mortality rate). The sample covers 27 OECD countries and Russia, which is also included in the OECD database. To determine the input and output weights, we used a questionnaire sent to health policy experts in the Czech Republic.

RESULTS

We obtained subjective information on the relative importance of the health system inputs and outputs from 27 Czech health policy experts. We evaluated health system efficiency using four MCDA and two DEA models. According to the MCDA models, Turkey, Poland, and Israel were found to have efficient health systems. The Czech Republic ranked 16th, 19th, 15th, and 17th. The benchmark countries for the Czech Republic's health system were Israel, Estonia, Luxembourg, Italy, the UK, Spain, Slovenia, and Canada. The DEA model with the constant returns to scale identified four technically efficient health systems: Turkey, the UK, Canada, and Sweden. The Czech Republic was found to be one of the worst-performing health systems. The DEA model with the variable returns to scale identified 15 technically efficient health systems. We found that efficiency results are quite robust. With two exceptions, the Spearman rank correlations between each pair of models were statistically significant at the 0.05 level.

CONCLUSIONS

During the model formulation, we investigated the pitfalls of efficiency measurement in health care and used several practical solutions. We consider MCDA and DEA, above all, as exploratory methods, not methods providing definitive answers.

Health disparities in cervical cancer: Estimating geographic variations of disease burden and association with key socioeconomic and demographic factors in the US

BACKGROUND

Despite advances in cervical cancer (CC) prevention, detection, and treatment in the US, health disparities persist, disproportionately affecting underserved populations or regions. This study analyzes the geographical distribution of both CC and recurrent/metastatic CC (r/mCC) in the US and explores potential risk factors of higher disease burden to inform potential strategies to address disparities in CC and r/mCC.

METHODS

We estimated CC screening rates, as well as CC burden (number of patients with CC diagnosis per 100,000 eligible enrollees) and r/mCC burden (proportion of CC patients receiving systemic therapy not in conjunction with surgery or radiation), at the geographic level between 2017-2022 using administrative claims. Data on income and race/ethnicity were obtained from US Census Bureau's American Community Survey. Brachytherapy centers were proxies for guideline-conforming care for locally advanced CC. Associations among demographic, socioeconomic, and healthcare resource variables, with CC and r/mCC disease burden were assessed.

RESULTS

Between 2017-2022, approximately 48,000 CC-diagnosed patients were identified, and approximately 10,000 initiated systemic therapy treatment. Both CC and r/mCC burden varied considerably across the US. Higher screening was significantly associated with lower CC burden only in the South. Lower income level was significantly associated with lower screening rates, higher CC and r/mCC burden. Higher proportion of Hispanic population was also associated with higher CC burden. The presence of ≥1 brachytherapy center in a region was significantly associated with a reduction in r/mCC burden (2.7%).

CONCLUSION

CC and r/mCC disparities are an interplay of certain social determinants of health, behavior, and race/ethnicity. Our findings may inform targeted interventions for a geographic area, and further highlight the importance of guideline-conforming care to reduce disease burden.

The cross-regional settlement methods in hospitals and the treatment-seeking behavior of patients with malignant tumors in China: an evolutionary game model

Background

Cross-regional settlement management is a key indicator of national health insurance system maturity. Given the significant demand for cross-regional medical treatment among Chinese patients with malignant tumors and the territorially managed health insurance system, further research is necessary to explore the relationship between hospital settlement methods and treatment-seeking behaviors among these patients. This study introduces and validates an evolutionary game model that provides a theoretical foundation for direct settlement policies in cross-regional treatment.

Methods

An evolutionary game model was constructed with patients and hospitals serving as strategic players within a dynamic system. This model integrates the patients' treatment utility, medical and nonmedical costs, and hospitals' financial and technological advancement benefits.

Results

The evolutionary stability analysis revealed seven-game outcomes between hospitals and patients with malignant tumors. The numerical simulations suggest an evolutionary convergence toward strategy (1, 0), indicating a trend where patients with malignant tumors opt for cross-regional treatment, yet hospitals choose not to implement a direct settlement policy. Parameter sensitivity analysis showed that the parameters set in this study affected player behavioral choices and game equilibria.

Conclusion

A strong demand for cross-regional medical treatment among Chinese patients with malignant tumors, and some hospitals require more incentives to implement cross-regional settlements. The key factors influencing the willingness of some patients with malignant tumors to resettle include the costs of in-area medical care, costs of cross-regional treatment without direct settlement, and the utility of cross-regional treatment. Technological advancement benefits and input costs influence some hospitals' motivation to adopt cross-regional settlements. Policy adjustments that effectively implement direct settlement policies can facilitate equilibrium, enhance the initiatives of some local health insurance management departments, improve the accessibility and efficiency of medical services, and reduce nonmedical expenses for patients.

Impact of the Covid-19 pandemic on inpatient health care in Switzerland 2020-2021-A descriptive retrospective study using admission data of all Swiss hospitals

BACKGROUND

As part of the Covid-19-restrictions in Switzerland, a federal ban on non-urgent examinations and treatments was applied to all hospitals during six weeks in spring 2020 ("spring lockdown"). The aim of this study was to comprehensively investigate the consequences of the Covid-19 pandemic on Swiss inpatient admissions based on data of all hospitals, focusing on selected procedures of different medical urgency.

METHODS

The study includes all acute care inpatient cases (including Covid-19 cases, excluding cases in psychiatry and rehabilitation) according to the Swiss Medical Statistics of Hospitals. Besides the total number of admissions, subdivided by regions, hospital types and age groups, we focused on selected procedures representing different medical urgency: elective surgeries, cancer surgeries, and emergencies. Procedures were selected based on expert interviews. We compared the number of admissions during spring lockdown and for the whole years 2020 and 2021 in absolute numbers and in percentage changes to the corresponding periods in 2019 (baseline year).

RESULTS

During spring lockdown, the number of admissions decreased by 47,156 (32.2%) without catch-up effect by the end of 2020 (-72,817 admissions/-5.8%). With procedure-specific decreases of up to 86%, the decline in admissions was largest for elective surgery, a decline that was only fully reversed in the case of a few procedures, such as joint arthroplasty. Strikingly, admissions due to emergencies also substantially decreased during spring lockdown (stroke -14%; acute myocardial infarction STEMI: -9%, NSTEMI: -26%). Results for the selected procedures in cancer surgery showed no consistent pattern. In 2021, admission numbers for most procedures reached or even exceeded those in 2019.

CONCLUSIONS

The substantial reduction in admissions, particularly in elective procedures, may reflect the impact of the triage in favor of anticipated Covid-19-cases during spring lockdown. By the end of 2020, admissions were still at lower levels relative to the previous, pre-pandemic year. The numbers in 2021 reached the same levels as those in 2019, which suggests that the Covid-19 pandemic only temporarily impacted inpatient health care in Switzerland. Long-term consequences of the observed reduction in admissions for emergencies and cancer surgery need to be investigated at the individual level.

Population assessment of health system performance in 16 countries

Objective

To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income.

Methods

We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment. We examined correlation with per capita health spending by calculating Pearson coefficients, and within-country income-based inequities using the slope index of inequality.

Findings

In the domain of care effectiveness, we found major gaps in health screenings and endorsement of public primary care. Only one in three respondents reported very good user experience during health visits, with lower proportions in low-income countries. Access to health care was rated highest of all domains; however, only half of the populations felt secure that they could access and afford high-quality care if they became ill. Populations rated the quality of private health systems higher than that of public health systems in most countries. Only half of respondents felt involved in decision-making (less in high-income countries). Within countries, we found statistically significant pro-rich inequalities across many indicators.

Conclusion

Populations can provide vital information about the real-world function of health systems, complementing other system performance metrics. Population-wide surveys such as the People's Voice Survey should become part of regular health system performance assessments.

Priapism as an initial manifestation in an adult patient with chronic myeloid leukemia in Japan: case report and review of the literature

We report the first documented Japanese case in the English literature of chronic myeloid leukemia (CML) in which priapism was the presenting symptom. Priapism, a rare manifestation in CML patients, is particularly uncommon in Japan. This can be attributed to the high quality of medical services and proactive health strategies implemented by the Japanese government. These strategies include recommending regular blood tests for company employees aged 35 and above, thereby facilitating early detection of CML. Hence, it is crucial to consider CML when examining any patient presenting with priapism, particularly among those who have not undergone regular medical check-ups.

"What's in a name?": Using mpox as a case study to understand the importance of communication, advocacy, and information accuracy in disease nomenclature

Historically, many diseases have been named after the species or location of discovery, the discovering scientists, or the most impacted population. However, species-specific disease names often misrepresent the true reservoir; location-based disease names are frequently targeted with xenophobia; some of the discovering scientists have darker histories; and impacted populations have been stigmatized for this association. Acknowledging these concerns, the World Health Organization now proposes naming diseases after their causative pathogen or symptomatology. Recently, this guidance has been retrospectively applied to a disease at the center of an outbreak rife with stigmatization and misinformation: mpox (f.k.a. 'monkeypox'). This disease, historically endemic to west and central Africa, has prompted racist remarks as it spread globally in 2022 in an epidemic ongoing today. Moreover, its elevated prevalence among men who have sex with men has yielded increased stigma against the LGBTQ+ community. To address these prejudicial associations, 'monkeypox' was renamed 'mpox' in November 2022. We used publicly available data from Google Search Trends to determine which countries were quicker to adopt this name change-and understand factors that limit or facilitate its use. Specifically, we built regression models to quantify the relationship between 'mpox' search intensity in a given country and the country's type of political regime, robustness of sociopolitical and health systems, level of pandemic preparedness, extent of gender and educational inequalities, and temporal evolution of mpox cases through December 2023. Our results suggest that, when compared to 'monkeypox' search intensity, 'mpox' search intensity was significantly higher in countries with any history of mpox outbreaks or higher levels of LGBTQ+ acceptance; meanwhile, 'mpox' search intensity was significantly lower in countries governed by leaders who had recently propagated infectious disease misinformation. Among infectious diseases with stigmatizing names, mpox is among the first to be revised retrospectively. While the adoption of a given disease name will be context-specific-depending in part on its origins and the affected subpopulations-our study provides generalizable insights, applicable to future changes in disease nomenclature.

Advancing Global Health Equity: The Role of the Liberal Arts in Health Professional Education

Much innovation has taken place in the development of medical schools and licensure exam processes across the African continent. Still, little attention has been paid to education that enables the multidisciplinary, critical thinking needed to understand and help shape the larger social systems in which health care is delivered. Although more than half of medical schools in Canada, the United Kingdom, and the United States offer at least one medical humanities course, this is less common in Africa. We report on the "liberal arts approach" to medical curricula undertaken by the University of Global Health Equity beginning in 2019. The first six-month semester of the curriculum, called Foundations in Social Medicine, includes courses in critical thinking and communication, African history and global political economy, medical anthropology and social medicine, psychology and health, gender and social justice, information technology and health, and community-based training. Additionally, an inquiry-based pedagogy with relatively small classes is featured within an overall institutional culture that emphasizes health equity. We identify key competencies for physicians interested in pursuing global health equity and how such competencies relate to liberal arts integration into the African medical school curriculum and pedagogical approach. We conclude with a call for a research agenda that can better evaluate the impact of such innovations on physicians' education and subsequent practices.

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.

METHODS

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.

FINDINGS

The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.

INTERPRETATION

Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere.

FUNDING

Bill & Melinda Gates Foundation.

[Human resource management in health. Consensual paths forward. SESPAS Report 2024]

Healthcare professionals deserve good management, and Spain, stagnant in its productivity, needs it. Good management is possible, as evidenced during the states of alarm in 2020. None of the lessons learned have been consolidated. Dismissing the term "public management" as an oxymoron is extreme, as there has never been a greater need for a well-functioning state, along with a better market, for reasons beyond the consolidation of the welfare state. The opposite extreme of thinking that salvation lies only within the civil service is also unhelpful. Bureaucratic sclerosis, a sign of deterioration, focused on legality or its appearance, cannot continue to ignore the need for effectiveness. The quality of management, both in general and in the healthcare sector, can be measured, and there is knowledge on how to improve it. More flexible models of labor relations -for selection, recruitment, and retention based on improved criteria of "equality, merit, and capability"- require modifications in institutional architecture, as proposed in this article: competitor benchmarking among autonomous centers and responsible entities that share standardized rules. The healthcare system, the jewel of the country, thanks in large part to the quality of its human resources, not only deserves to have its potential unleashed but can also lead the necessary increase in its resolution capacity, ensuring its impact on social well-being. It can also document its research and innovative capabilities in intellectual property, thereby contributing to the gross domestic product.