The Association between the Burden of PM2.5-Related Neonatal Preterm Birth and Socio-Demographic Index from 1990 to 2019: A Global Burden Study

Global cross-sectional survey on neonatal pharmacologic sedation and analgesia practices and pain assessment tools: impact of the sociodemographic index (SDI)

BACKGROUND

There is variability in the use of sedatives and analgesics in neonatal intensive care units (NICUs). We aimed to investigate the use of analgesics and sedatives and the management of neonatal pain and distress.

METHODS

This was a global, prospective, cross-sectional study. A survey was distributed May-November 2022. The primary outcome of this research was to compare results between countries depending on their socio-sanitary level using the sociodemographic index (SDI). We organized results based on geographical location.

RESULTS

The survey collected 1304 responses, but we analyzed 924 responses after database cleaning. Responses from 98 different countries were analyzed. More than 60% of NICUs reported having an analgosedation guideline, and one-third of respondents used neonatal pain scales in more than 80% of neonates. We found differences in the management of sedation and analgesia between NICUs on different continents, but especially between countries with different SDIs. Countries with a higher SDI had greater availability of and adherence to analgosedation guidelines, as well as higher rates of analgosedation for painful or distressing procedures. Countries with different SDIs reported differences in analgosedation for neonatal intubation, invasive ventilation, and therapeutic hypothermia, among others.

CONCLUSIONS

Socio-economic status of countries impacts on neonatal analgosedation management.

IMPACT

There is significant variability in the pain management practices in neonates. There is a lack of knowledge related to how neonatal pain management practices differ between regions. Sociodemographic index is a key factor associated with differences in neonatal pain management practices across global regions.

Global, regional, and national thyroid cancer age-period-cohort modeling and Bayesian predictive modeling studies: A systematic analysis of the global burden of disease study 2019

Objective

To analyze the changing trend of the global burden of thyroid cancer (TC) and its associated risk factors using data from the Global Burden of Disease study 2019 (GBD 2019).

Methods

This study utilized the GBD 2019 database to analyze the burden trend of TC in various regions and countries from 1990 to 2019, while also examining the age-period-cohort (APC) effect. Additionally, the study used Bayesian age-period-cohort (BAPC) and predictive models to forecast TC incidence up until 2030.

Results

According to data from 2019, there were 233,846.64 (95 % UI 211,636.89-252,806.55) cases of TC worldwide. The burden of TC varies among regions and countries, with higher incidence rates observed in moderate and above SDI regions. Age and gender also play a role, with incidence rates peaking in the >95 age group for men and the 70-74 age group for women. Additionally, women have a higher incidence than men. The APC model revealed that the impact of age was most significant among individuals aged 95 years and older, while it was lowest among those aged 0-14 years. Additionally, the period effect showed a relatively low risk of morbidity with a Period RR < 0 during 1990-2004 and a high relative risk of morbidity with a Period RR > 0 during 2005-2019. Furthermore, the cohort effect demonstrated that the relative risk of developing the disease was lower before 1950 and higher after 1950. Predicted values show an increasing trend in thyroid incidence over the next 30 years.

Conclusions

The findings of this study highlight the continued significance of thyroid cancer as a global public health issue. It is crucial to develop targeted interventions that address the specific risk factors associated with thyroid cancer. Furthermore, health policies should be customized and adapted to the unique needs of different regions and populations.

Global, regional, and national burden of ambient and household PM2.5-related neonatal disorders, 1990-2019

Previous studies have shown a relationship between fine particulate matter (PM_2.5) exposure and an increased risk of neonatal disorders. Considering the huge burden of neonatal disorders, we assessed spatiotemporal trends of neonatal disorders burden caused by ambient and household PM_2.5 at the global, regional, and national levels from 1990 to 2019. The number, rate, and population attributable fraction (PAF) of ambient and household PM_2.5-related neonatal disorders disability-adjusted life years (DALYs) in 204 countries and territories from 1990 to 2019 were obtained from the Global Burden of Disease Study 2019 to measure the related neonatal disorders burden by age, sex, subtype, and region. Estimated annual percentage change (EAPC) was estimated to quantify temporal trends. In 2019, approximately a fifth of the global neonatal disorders burden was attributable to PM_2.5 exposure, with 7.54% for ambient PM_2.5 and 13.23% for household PM_2.5. Although the global neonatal disorders burden attributable to household PM_2.5 has decreased substantially in the past 30 years, that attributable to ambient PM_2.5 has increased, especially in lower sociodemographic index (SDI) regions. The highest rate and PAF of ambient PM_2.5-related neonatal disorders DALYs in 2019 were in South Asia and East Asia, respectively, and the fastest increases were in Eastern Sub-Saharan Africa (for rate: EAPC = 2.55, 95% CI: 2.37-2.73) and South Asia (for PAF: EAPC = 3.88, 95% CI: 3.68-4.08). In addition, we found an inverted V-shaped between rates and PAFs of ambient PM_2.5-related neonatal disorders DALYs in 2019, as well as corresponding EAPCs, and SDI, while rates and PAFs of household PM_2.5-related neonatal disorders DALYs in 2019 were highly negatively correlated with SDI. In the past three decades, the global ambient PM_2.5-related neonatal disorders burden largely increased, especially in lower SDI regions. Comparatively, the household PM_2.5-related neonatal disorders burden decreased but still accounted for about two-thirds of the PM_2.5-related neonatal disease burden.