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Ebeling M, Mühlichen M, Talbäck M, Rau R, Goedel A, Klüsener S. Disease incidence and not case fatality drives the rural disadvantage in myocardial-infarction-related mortality in Germany. Prev Med 2024; 179:107833. [PMID: 38145875 DOI: 10.1016/j.ypmed.2023.107833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Demographic and infrastructural developments might compromise medical care provision in rural regions, particularly for acute health conditions. Studying the case of myocardial infarction (MI), we investigated how MI-related mortality at ages 65+ varies between rural and urban regions in Germany and to what extent differences are driven by varying case fatality and disease incidence. METHODS The study relies on data containing all hospitalizations, cause-specific deaths and population counts for the total German population between years 2012-2018 and ages 65+. MI-related mortality, MI incidence and case fatality are compared between urban and rural regions in a population-wide analysis. The impacts of changing incidence and case fatality on rural-urban MI-related mortality differences are assessed using a counterfactual approach. RESULTS Rural regions in Germany show systematically higher MI-related death rates and MI incidence at ages 65+ compared to urban regions. Higher mortality is primarily the result of higher MI incidence in rural regions, while case fatality is largely similar. The rural excess in MI-related death rates would be nullified and 1 out of 6 MI-related deaths in rural regions could be prevented if rural regions in Germany would have at least the median MI incidence of urban regions. CONCLUSIONS MI incidence and not case fatality drives the rural disadvantage in MI-related mortality in Germany. Higher MI incidence points towards potential regional variation in the effectiveness of disease prevention. The findings highlight that improving disease prevention at the patient level carries larger opportunities for reducing regional MI-related mortality inequalities in Germany.
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Affiliation(s)
- Marcus Ebeling
- Max Planck Institute for Demographic Research, Rostock, Germany; Karolinska Institute, Stockholm, Sweden; Federal Institute for Population Research (BiB), Wiesbaden, Germany.
| | | | | | - Roland Rau
- Max Planck Institute for Demographic Research, Rostock, Germany; University of Rostock, Rostock, Germany
| | - Alexander Goedel
- Karolinska Institute, Stockholm, Sweden; Technical University of Munich, Munich, Germany
| | - Sebastian Klüsener
- Federal Institute for Population Research (BiB), Wiesbaden, Germany; University of Cologne, Cologne, Germany; Vytautas Magnus University, Kaunas, Lithuania
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Dwalu E, Jetoh RW, Shobayo BI, Pewu I, Taweh F, Wilson-Sesay HW, Akpan GE, Shannon F, Joseph BO, Umeokonkwo CD, Adewuyi P, Amo-Addae M, Nagbe TK, Gilayeneh J, MaCauley JA. Trend of Lassa fever cases and factors associated with mortality in Liberia, 2016 - 2021: a secondary data analysis. Pan Afr Med J 2024; 47:22. [PMID: 38558556 PMCID: PMC10979808 DOI: 10.11604/pamj.2024.47.22.42156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 04/04/2024] Open
Abstract
Introduction Lassa fever (LF) is endemic in Liberia and is immediately reportable. Suspected cases are confirmed at the National Public Health Reference Laboratory. However, there is limited information on the trend and factors associated with mortality. We described the epidemiological characteristics of LF cases and determined factors associated with mortality in Liberia from 2016 to 2021. Methods we reviewed 867 case-based LF surveillance data from 2016 to 2021 obtained from the National Public Health Institute of Liberia (NPHIL). The cases that met the suspected LF case definition were tested with RT-PCR. Using Epi Info 7.2.5.0. We conducted univariate, bivariate, and multivariate and analysis. We calculated frequencies, proportions. Positivity rate, case fatality rate, and factors associated with LF mortality using chi-square statistics and logistics regression at 5% level of significance. Results eighty-five percent (737/867) of the suspected cases were tested and 26.0% (192/737) were confirmed LF positive. The median age of confirmed LF cases was 21(IQR: 12-34) years. Age 10-19 years accounted for 24.5% (47/192) and females 54.2% (104/192). Bong 33.9% (65/192), Grand Bassa 31.8% (61/192), and Nimba counties, 21.9% (42/192) accounted for most of the cases. The median duration from symptom onset to hospital admission was 6 (IQR: 3-9) days. A majority, 66% (126/192) of the cases were reported during the dry season (October-March) and annual incidence was highest at 12 cases per 1,000,000 population in 2019 and 2020. The overall case fatality rate was 44.8%. Non-endemic counties, Margibi, 77.8% and Montserrado, 66.7% accounted for the highest case fatality rate (CFR), while 2018, 66.7% and 2021, 60.0% recorded the highest CFR during the period. Age ≥30 years (aOR=2.1,95% CI: 1.08-4.11, p=0.027) and residing in Grand Bassa County (aOR=0.3, 95% CI: 0.13-0.73, p=0.007) were associated with LF mortality. Conclusion Lassa fever was endemic in three of the fifteen counties of Liberia, case fatality rate remained generally high and widely varied. The high fatality of LF has been reported to the NPHIL and is currently being further investigated. There is a need to continuously train healthcare workers, especially in non-endemic counties to improve the LF treatment outcome.
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Affiliation(s)
- Emmanuel Dwalu
- National Public Health Institute of Liberia, Monrovia, Liberia
- Liberia Field Epidemiology Training Program, Monrovia, Liberia
| | - Ralph Weah Jetoh
- National Public Health Institute of Liberia, Monrovia, Liberia
- Liberia Field Epidemiology Training Program, Monrovia, Liberia
| | | | - Irene Pewu
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Fahn Taweh
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Himiede Wede Wilson-Sesay
- Liberia Field Epidemiology Training Program, Monrovia, Liberia
- African Field Epidemiology Network, Monrovia, Liberia
| | - Godwin Etim Akpan
- Liberia Field Epidemiology Training Program, Monrovia, Liberia
- African Field Epidemiology Network, Monrovia, Liberia
| | - Fulton Shannon
- Liberia Field Epidemiology Training Program, Monrovia, Liberia
| | - Babalola Obafemi Joseph
- Liberia Field Epidemiology Training Program, Monrovia, Liberia
- African Field Epidemiology Network, Monrovia, Liberia
| | - Chukwuma David Umeokonkwo
- Liberia Field Epidemiology Training Program, Monrovia, Liberia
- African Field Epidemiology Network, Monrovia, Liberia
| | - Peter Adewuyi
- Liberia Field Epidemiology Training Program, Monrovia, Liberia
- African Field Epidemiology Network, Monrovia, Liberia
| | - Maame Amo-Addae
- Liberia Field Epidemiology Training Program, Monrovia, Liberia
- African Field Epidemiology Network, Monrovia, Liberia
| | - Thomas Knue Nagbe
- National Public Health Institute of Liberia, Monrovia, Liberia
- Liberia Field Epidemiology Training Program, Monrovia, Liberia
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Guzzi L, Sambade JM, Christin MD, Rodriguez Cairoli F, Rodriguez A, Vicario S, Hinojosa Del Carpio M, Molinos J, Dimitroff P. Reduction in the incidence of invasive infections caused by encapsulated bacteria after the onset of the COVID-19 pandemic. Rev Argent Microbiol 2024; 56:62-68. [PMID: 37517907 DOI: 10.1016/j.ram.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023] Open
Abstract
Interaction between severe acute respiratory coronavirus 2 (SARS-CoV-2) and IIEB remains under investigation. Objective: to compare IIEB incidence before and during COVID-19 pandemic, and assess incidence of coinfection with COVID-19 and case fatality. A cross-sectional study was performed on data from a centralized microbiology laboratory serving a network of healthcare centers comprising 713 pediatric and adult inpatient beds, expanded by 20% during the pandemic. Three periods were evaluated: (1) pre-pandemic: March 1, 2019-February 29, 2020; (2) pandemic year 1: March 1, 2020-February 28, 2021; (3) pandemic year 2: March 1, 2021-July 31, 2021. Descriptive statistical analysis was performed. 56 502 samples (96% blood cultures) from 27224 patients were analyzed. Of these, 54 samples (from 54 patients) were positive for encapsulated bacteria. IIEB incidence was: 167.4, 32.6, and 50.4 per 100000 samples for periods 1, 2, and 3, respectively. Twelve IIEB episodes occurred during the pandemic period: 10 Streptococcus pneumoniae, and 2 Haemophilus influenzae, of which 7 were SARS-CoV-2/S. pneumoniae coinfections, with an incidence of 5.68 per 10000 COVID-19-related hospitalizations (0.056%). IIEB case fatality was 31%, 29%, and 60% for each period, respectively, 3/7 patients with coinfection died (43%). Case fatality for invasive pneumococcal disease (IPD) in patients without COVID-19, was 32.5%. Significant reduction in IIEB incidence was observed during the pandemic, coinciding with implementation of containment measures. The incidence of SARS-CoV-2/S. pneumoniae coinfection was low, with higher case fatality than IPD patients without COVID-19.
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Affiliation(s)
- Leda Guzzi
- Clínica Olivos, Swiss Medical Group, Vicente López, Argentina; Sociedad Argentina de Infectología, Argentina.
| | | | | | | | - Alejandra Rodriguez
- Servicio de Microbiología Clínica, Swiss Medical Group, Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvia Vicario
- Servicio de Microbiología Clínica, Swiss Medical Group, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Juan Molinos
- Clínica Olivos, Swiss Medical Group, Vicente López, Argentina
| | - Pablo Dimitroff
- Clínica Olivos, Swiss Medical Group, Vicente López, Argentina
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Çaylan N, Yalçın SS, Tezel B, Üner O, Aydin Ş, Kara F. Evaluation of critical congenital heart disease from 2018 to 2020 in Turkey: a retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:871. [PMID: 38104075 PMCID: PMC10724899 DOI: 10.1186/s12884-023-06193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The aim of this study is to examine the features of critical congenital heart disease (CCHD). METHODS The study was planned as a retrospective cohort study. Data for the study were obtained through national data collection systems and 2018-2020 CCHD cohort was established. In this study, we divided the patients into two groups: Group 1 included seven primary target diseases of the newborn CCHD screening program and Group 2 included secondary target diseases. RESULTS There were 9884 CCHD cases, with a prevalence of 27.8 per 10,000 live births. Of the cases 44.4% were in Group 1 (12.3 per 10,000) and 54.8% were in Group 2 (15.2 per 10,000). Of all cases 55.5% were male and the female/male ratio was 1/1.2. While 21.8% of the cases were premature, 23.0% were babies with low birth weight (LBW), 4.8% were born from multiple pregnancies. The highest prevalence of CCHD was found in LBW (84.8 per 10,000), premature infants (57.8 per 10,000) (p < 0.001). The fatality rate in the cohort was 16.6% in the neonatal period, 31.6% in the first year of life respectively. The mean estimated survival time in the birth cohort was 40.0 months (95% CI: 39.5-40.6). The mean survival time for Group 1 diseases was 33.4 months (95% CI: 32.5-34.2), while it was 45.4 months (95% CI: 44.7-46.0) for Group 2 diseases (p < 0.001). Preterm birth, LBW, maternal age and region were evaluated as factors associated with mortality risk. CONCLUSION This study showed that CCHDs are common in Turkey and mortality rates are high. There are regional differences in CCHD both prevalence and survival. Improving prenatal diagnosis rates and expanding neonatal CCHD screening are of key importance.
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Affiliation(s)
- Nilgün Çaylan
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
- Department of Social Pediatrics, Hacettepe University Institute of Child Health, Ankara, Turkey
| | - Sıddika Songül Yalçın
- Department of Social Pediatrics, Hacettepe University Institute of Child Health, Ankara, Turkey.
| | - Başak Tezel
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Oben Üner
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Şirin Aydin
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Fatih Kara
- Department of Public Health, Selçuk University Faculty of Medicine, Konya, Turkey
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Lin X, Cai M, Tan K, Liu E, Wang X, Song C, Wei J, Lin H, Pan J. Ambient particulate matter and in-hospital case fatality of acute myocardial infarction: A multi-province cross-sectional study in China. Ecotoxicol Environ Saf 2023; 268:115731. [PMID: 38007949 DOI: 10.1016/j.ecoenv.2023.115731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
The acute myocardial infarction (AMI) outcomes have been extensively linked with ambient particulate matter (PM). However, whether a smaller particle has greater impact and the consequent attributable burden associated with PM of different sizes remain unclear. We conducted a multi-province cross-sectional study among AMI patients using the inpatient discharge datasets from four Chinese provinces (Shanxi, Sichuan, Guangxi, and Guangdong) from 2014 to 2019. Ambient PM exposure for each patient was assessed using the ChinaHighAirPollutants dataset. We employed the mixed-effects logistic regression models to evaluate the association of PM of different sizes (PM1, PM2.5, PM10) on in-hospital case fatality. The potential reducible fractions in in-hospital case fatality were estimated through counterfactual analyses. Of 177,749 participants, 125,501 (70.6 %) were male and the in-hospital case fatality rate was 4.9%. For short-term (7-day average) exposure, the odds ratios (ORs) for PM1, PM2.5, and PM10 (per 10 µg/m3) were 1.052 (95 % confidence interval [CI], 1.032-1.071), 1.026 (95 % CI, 1.014-1.037), and 1.016 (95% CI, 1.008-1.024), respectively. The estimated ORs for long-term exposure (annual average) were 1.303 (95 % CI, 1.252-1.356) for PM1, 1.209 (95 % CI, 1.178-1.241) for PM2.5, 1.157 (95 % CI, 1.134-1.181) for PM10. Short-term exposure to PM1 showed the highest potential reducible fraction (8.5 %, 95 % CI, 5.0-11.7 %), followed by PM2.5 and PM10, while the greatest potential reducible fraction of long-term exposure was observed in PM10 (30.9 %, 95 % CI, 27.2-34.4%), followed by PM2.5 and PM1. In summary, PM with smaller size had a more pronounced impact on in-hospital AMI case fatality, with PM1 exhibiting greater effects than PM2.5 and PM10. Substantial health benefits for AMI patients could be achieved by mitigating ambient PM exposure.
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Affiliation(s)
- Xiaojun Lin
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China
| | - Miao Cai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd road, Yuexiu District, Guangzhou, Guangdong 510080, China
| | - Kun Tan
- Health Information Center of Sichuan Province, No. 39, Wangjiaguai Street, Chengdu, Sichuan 610041, China
| | - Echu Liu
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63103, USA
| | - Xiuli Wang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China
| | - Chao Song
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD 20740, USA.
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd road, Yuexiu District, Guangzhou, Guangdong 510080, China.
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; China Center for South Asian Studies, Sichuan University, No.24 South Section I, Yihuan Road, Chengdu, Sichuan 610065, China.
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Camps-Vilaró A, Subirana I, Elosua R, Palomo I, Sanchis J, Tizón-Marcos H, Cainzos-Achirica M, Sala J, Masia R, Ramos R, Dégano IR, Marrugat J. Analysis of myocardial infarction incidence and case-fatality in the last three decades in the province of Girona. Rev Esp Cardiol (Engl Ed) 2023:S1885-5857(23)00307-9. [PMID: 37981192 DOI: 10.1016/j.rec.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/28/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Myocardial infarction (MI) incidence and case fatality trends are highly informative but relatively untested at the population level. The objective of this work was to estimate MI incidence and case fatality in the Girona population aged 35-74 years, and to determine their 30-year trends (1990-2019). METHODS The REGICOR (Girona Heart Registry) monitored MI incidence and case fatality rates from 1990 to 2008. For the period 2008 to 2019, we linked discharges from Girona hospitals (n=4 974 977) and mortality registry (n=70 405) during this period. Our linkage algorithm selected key MI diagnostic codes and removed duplicates. Estimates from the linkage algorithm and the REGICOR registry were compared using chi-square tests for overlapping years (2008-2009). We estimated the annual percent change (APC) of standardized MI incidence and 28-day case fatality, and analyzed their trends using joinpoint regression. RESULTS MI incidence and case fatality estimates were similar in the linkage algorithm and the REGICOR registry. We observed significant decreasing trends in the incidence of MI. The trend was APC, -0.96% (95% confidence interval (95%CI), -1.4 to -0.53) in women from 1990 to 2019 and -4.2% (95%CI, -5.5 to -3.0) in men from 1994 to 2019. The largest decrease in case fatality was -3.8% (95%CI, -5.1 to -2.5) from 1995 to 2003 in women and -2.4% (95%CI, -2.9 to -1.9) from 1995 to 2004 in men, mainly due to prehospital case fatality declines: -1.8% (95%CI, -2.6 to -1.1) in men and -3.2% (95%CI, -4.6 to -1.8) in women. CONCLUSIONS In Girona, MI incidence and case fatality decreased between 1990 and 2019. The incidence showed a slow but continuous decrease while case fatality only stabilized in the last decade, particularly in women.
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Affiliation(s)
- Anna Camps-Vilaró
- Grup d'Estudi REGICOR, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Doctoral College, University of Vic-Central University of Catalonia (Uvic-UCC), Vic, Barcelona, Spain
| | - Isaac Subirana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Grup d'Epidemiologia i Genètica Cardiovascular, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain
| | - Roberto Elosua
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Doctoral College, University of Vic-Central University of Catalonia (Uvic-UCC), Vic, Barcelona, Spain; Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, Barcelona, Spain
| | - Iván Palomo
- Centro de Investigación en Trombosis, Departmento de Bioquímica Clínica e Inmunohematología, Escuela de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiology Department, Hospital Clínic de Valencia, Valencia, Spain
| | - Helena Tizón-Marcos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servei de Cardiologia, Hospital del Mar, Barcelona, Spain
| | | | - Joan Sala
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servei de Cardiologia, Hospital Universitari Josep Trueta, Girona, Spain
| | - Rafael Masia
- Servei de Cardiologia, Hospital Universitari Josep Trueta, Girona, Spain
| | - Rafel Ramos
- Unitat de Recerca de Medicina Familiar-de Girona, Institut de Recerca en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Irene R Dégano
- Grup d'Estudi REGICOR, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Grup d'Epidemiologia i Genètica Cardiovascular, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Vic, Barcelona, Spain.
| | - Jaume Marrugat
- Grup d'Estudi REGICOR, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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7
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Isaac WE, Jalo I, Yohanna G, Aliu R, Ebiseke K, Girbo A, Olatoke L, Raymond PM, Iliya A, Ndubusi V, Rabo Y, Daniel GE, Apollos D, Bakura B, Usman MO, Kamaludden H, Abdulshaheed B, Tukur H, Joel Z, Abdulkarim H, Abdulrahman S, Adeniran OA, Ibrahim B, Meller BT, Adamu A. IN-PATIENT PNEUMONIA BURDEN AND CASE FATALITY RATES IN CHILDREN OVER TWO DECADES IN FEDERAL TEACHING HOSPITAL, GOMBE (FTHG). West Afr J Med 2023; 40:S10. [PMID: 37971711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Introduction Pneumonia is the leading cause of death among children globally accounting for an estimated 1.2 million (18%) total deaths annually. The number of childhood-related deaths from pneumonia is approximately 2000-fold higher in developing than in developed countries. Nigeria contributes the highest of pneumonia-related deaths globally. Objectives To determine the case fatality rates (CFR) of pneumonia from 2000-2019 in paediatric ward, FTHG. Methodology All cases of pneumonia admissions and deaths in patients aged 0-18 years, using ICD-10 classification, were retrieved and analysed. The mainstay of diagnosis is clinical and/or radiographic features. Results A total of 26,716 children were admitted during this period, 1151 had pneumonia (4.3%) and 118 died. Males constituted 647 (56.2%) and females 43.8% of the total pneumonia admissions. Children aged 0-5 years had the highest pneumonia admissions, followed by 6-9 years. Admissions were highest in the wet than the dry season. Pneumonia CFR was 10.2%; 10.9% in females and 9.7% in males. Under-5 constituted 84% (969/1151) of pneumonia admission with a CFR of 9.3%. CFR were 10.3% and 21% in 6-10 years, and 11-18 years respectively. The CFR between2000-2004 was 14.1%, 2005-2009:21.1%, 2010-2014:10.2% and 2015-2019:7.2%. Kanuri had the highest CFR of 56.2%.(P <0.05) Other ethnic groups were 29.4% in Waja, 25% in Tula, 21.4% in Igbo, 16.6% in Yoruba, 12.1% in Tangale, 10.2% in Hausa, 8.8%in Bolewa and 8.3% in Fulani. The CFR was highest in February20.2%. Conclusion Pneumonia Case fatality is high.
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Affiliation(s)
- W E Isaac
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - I Jalo
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - G Yohanna
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - R Aliu
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - K Ebiseke
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - A Girbo
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - L Olatoke
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - P M Raymond
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - A Iliya
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - V Ndubusi
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - Y Rabo
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - G E Daniel
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - D Apollos
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - B Bakura
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - M O Usman
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - H Kamaludden
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - B Abdulshaheed
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - H Tukur
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - Z Joel
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - H Abdulkarim
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - S Abdulrahman
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - O A Adeniran
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - B Ibrahim
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - B T Meller
- Department of Paediatrics, Federal Teaching Hospital, Gombe
| | - A Adamu
- Department of Paediatrics, Federal Teaching Hospital, Gombe
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Adamu SA, Muhammad BF, Aishatu MZ. SEVEN-YEAR REVIEW OF PAEDIATRIC AND ADOLESCENTS HIV CARE SERVICES AT ABUBAKAR TAFAWA BALEWA UNIVERSITY TEACHING HOSPITAL BAUCHI, NIGERIA. West Afr J Med 2023; 40:S5. [PMID: 37970782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Introduction Although the global morbidity and mortality rates associated with Human Immunodeficiency Virus (HIV) are decreasing, this improvement is slow in Sub-Saharan Africa. The treatment of HIV in children and adolescents is associated with high failure and mortality. The objectives of this study are to describe HIV treatment regimens and case fatality rates for paediatric and adolescent patients. Methodology Retrospective review of data of all children aged <17 years seen for Paediatric HIV Care Clinic in Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi. Descriptive data were extracted from the electronic database of the Hospital. Results A total of 289 children and adolescents aged 3 to 16 years (mean 12 ± 3.3 yrs; female: male ratio 1.03:1) were cared for during the period under review. Most of the patients (73.7%, n-213) were adolescents. One hundred and twenty-two (42.2%) patients were active on treatment and regular with follow-up visits; 117 (40.5%) patients had an interruption in treatment (were either lost to follow-up or missed follow-up appointments for at least one month beyond their appointment date). Two patients refused to continue with their medications despite appropriate counseling. The case fatality rate was 4.2% (n=12). Conclusion There was a high rate of interruption in treatment among children and adolescents being treated for HIV at our centre. The case fatality rate was 4.2%.
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Affiliation(s)
- Sa'idu Adamu Adamu
- Department of Paediatrics, Abubakar Tafawa Balewa University and Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
| | - Bashir Faruk Muhammad
- Department of Paediatrics, Abubakar Tafawa Balewa University and Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
| | - Musa Zaidu Aishatu
- Department of Paediatrics, Abubakar Tafawa Balewa University and Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
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Mubarik S, Malik SS, Yanran Z, Hak E, Nawsherwan, Wang F, Yu C. Estimating disparities in breast cancer screening programs towards mortality, case fatality, and DALYs across BRICS-plus. BMC Med 2023; 21:299. [PMID: 37653535 PMCID: PMC10472654 DOI: 10.1186/s12916-023-03004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Numerous studies over the past four decades have revealed that breast cancer screening (BCS) significantly reduces breast cancer (BC) mortality. However, in BRICS-plus countries, the association between BCS and BC case fatality and disability are unknown. This study examines the association of different BCS approaches with age-standardized mortality, case-fatality, and disability-adjusted life years (DALYs) rates, as well as with other biological and sociodemographic risk variables, across BRICS-plus from a national and economic perspective. METHODS In this ecological study applying mixed-effect multilevel regression models, a country-specific dataset was analyzed by combining data from the Global Burden of Disease study 2019 on female age-standardized BC mortality, incidence, and DALYs rates with information on national/regional BCS availability (against no such program or only a pilot program) and BCS type (only self-breast examination (SBE) and/or clinical breast examination (CBE) [SBE/CBE] versus SBE/CBE with mammographic screening availability [MM and/or SBE/CBE] versus SBE/CBE/mammographic with digital mammography and/or ultrasound (US) [DMM/US and/or previous tests] in BRICS-plus countries. RESULTS Compared to self/clinical breast examinations (SBE/CBE) across BRICS-plus, more complex BCS program availability was the most significant predictor of decreased mortality [MM and/or SBE/CBE: - 2.64, p < 0.001; DMM/US and/or previous tests: - 1.40, p < 0.001]. In the BRICS-plus, CVD presence, high BMI, second-hand smoke, and active smoking all contributed to an increase in BC mortality and DALY rate. High-income and middle-income regions in BRICS-plus had significantly lower age-standardized BC mortality, case-fatality, and DALYs rates than low-income regions when nationwide BC screening programs were implemented. CONCLUSIONS The availability of mammography (digital or traditional) and BCS is associated with breast cancer burden in BRICS-plus countries, with regional variations. In light of high-quality evidence from previous causal studies, these findings further support the preventive role of mammography screening for BCS at the national level. Intervening on BCS related risk factors may further reduce the disease burden associated with BC.
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Affiliation(s)
- Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185 Donghu Road, Wuhan, 430071, Hubei, China
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Saima Shakil Malik
- Center for Biotechnology & Genomic Medicine (CBGM) Medical College of Georgia Augusta University, 1462 Laney Walker Blvd, Augusta, GA, 30912-4810, USA
| | - Zhang Yanran
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185 Donghu Road, Wuhan, 430071, Hubei, China
- Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Research Center for Infectious Diseases; Wuhan Research Center for Communicable Disease Diagnosis and Treatment, Chinese Academy of Medical Sciences; Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, Hubei, China
| | - Eelko Hak
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Nawsherwan
- Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, 361000, China
| | - Fang Wang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185 Donghu Road, Wuhan, 430071, Hubei, China.
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Seneviratne S, Fernando D, Chulasiri P, Gunasekera K, Thenuwara N, Aluthweera C, Wijesundara A, Fernandopulle R, Mendis K, Wickremasinghe R. A malaria death due to an imported Plasmodium falciparum infection in Sri Lanka during the prevention of re-establishment phase of malaria. Malar J 2023; 22:243. [PMID: 37620890 PMCID: PMC10463374 DOI: 10.1186/s12936-023-04681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Sri Lanka has maintained a rigorous programme to prevent the re-establishment of malaria ever since the disease was eliminated in October 2012. It includes efforts to sustain case surveillance to ensure early diagnosis and management of malaria. Yet, in April of 2023 the death occurred of an individual with imported malaria. CASE PRESENTATION The deceased was a 37-year-old Sri Lankan male who returned to Sri Lanka on the 10th of April after a business trip to several countries including Tanzania. He was febrile on arrival and consulted three Allopathic Medical Practitioners in succession in his home town in the Western Province of Sri Lanka, over a period of 5 days starting from the very day that he arrived in the country. Malaria was not tested for at any of these consultations and his clinical condition deteriorated. On the evening of 14th of April he was admitted to the medical intensive care unit of a major private hospital in the capital city of Colombo with multiple organ failure. There, on a request by the treating physician blood was tested for malaria and reported early the next morning as Plasmodium falciparum malaria with a high parasitaemia (> 10%). The patient died shortly after on the 15th of April before any anti-malarial medication was administered. The deceased had been a frequent business traveller to Africa, but with no past history of malaria. He had not taken chemoprophylaxis for malaria on this or previous travels to Africa. DISCUSSION The patient's P. falciparum infection progressed rapidly over 5 days of arriving in Sri Lanka leading to severe malaria without being diagnosed, despite him seeking healthcare from three different Medical Practitioners. Finally, a diagnosis of malaria was made on admission to an intensive care unit; the patient died before anti-malarial medicines were administered. CONCLUSIONS This first death due to severe P. falciparum malaria reported in Sri Lanka after elimination of the disease was due to the delay in diagnosing malaria.
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Affiliation(s)
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | | | | | | | | | | | - Rohini Fernandopulle
- Faculty of Medicine, General Sir John Kotelawala Defense University, Ratmalana, Sri Lanka
| | - Kamini Mendis
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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11
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Rödenbeck M, Ayobami O, Eckmanns T, Pletz MW, Bleidorn J, Markwart R. Clinical epidemiology and case fatality due to antimicrobial resistance in Germany: a systematic review and meta-analysis, 1 January 2010 to 31 December 2021. Euro Surveill 2023; 28:2200672. [PMID: 37199987 PMCID: PMC10197495 DOI: 10.2807/1560-7917.es.2023.28.20.2200672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/14/2023] [Indexed: 05/19/2023] Open
Abstract
BackgroundAntimicrobial resistance (AMR) is of public health concern worldwide.AimWe aimed to summarise the German AMR situation for clinicians and microbiologists.MethodsWe conducted a systematic review and meta-analysis of 60 published studies and data from the German Antibiotic-Resistance-Surveillance (ARS). Primary outcomes were AMR proportions in bacterial isolates from infected patients in Germany (2016-2021) and the case fatality rates (2010-2021). Random and fixed (common) effect models were used to calculate pooled proportions and pooled case fatality odds ratios, respectively.ResultsThe pooled proportion of meticillin resistance in Staphylococcus aureus infections (MRSA) was 7.9% with a declining trend between 2014 and 2020 (odds ratio (OR) = 0.89; 95% CI: 0.886-0.891; p < 0.0001), while vancomycin resistance in Enterococcus faecium (VRE) bloodstream infections increased (OR = 1.18; (95% CI: 1.16-1.21); p < 0.0001) with a pooled proportion of 34.9%. Case fatality rates for MRSA and VRE were higher than for their susceptible strains (OR = 2.29; 95% CI: 1.91-2.75 and 1.69; 95% CI: 1.22-2.33, respectively). Carbapenem resistance in Gram-negative pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Enterobacter spp. and Escherichia coli) was low to moderate (< 9%), but resistance against third-generation cephalosporins and fluoroquinolones was moderate to high (5-25%). Pseudomonas aeruginosa exhibited high resistance against carbapenems (17.0%; 95% CI: 11.9-22.8), third-generation cephalosporins (10.1%; 95% CI: 6.6-14.2) and fluoroquinolones (24.9%; 95% CI: 19.3-30.9). Statistical heterogeneity was high (I2 > 70%) across studies reporting resistance proportions.ConclusionContinuous efforts in AMR surveillance and infection prevention and control as well as antibiotic stewardship are needed to limit the spread of AMR in Germany.
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Affiliation(s)
- Maria Rödenbeck
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Olaniyi Ayobami
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Jutta Bleidorn
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Robby Markwart
- InfectoGnostics Research Campus Jena, Jena, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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12
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Iro MA, Goldacre MJ, Goldacre R. Central nervous system abscesses and empyemas in England: epidemiological trends over five decades. J Infect 2023; 86:309-315. [PMID: 36764391 DOI: 10.1016/j.jinf.2023.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To report on population-based epidemiological trends in central nervous system (CNS) abscesses and empyemas in England over five decades. METHODS Trend analyses of age-sex-specific hospital admission and death rates using routinely collected English national hospital discharge records, mortality records, and annual population denominators from 1968 to 2019. RESULTS Hospital admission rates for CNS abscesses and empyemas were stable in England until the late 1980s. In the last two decades of the study period (1999-2019), first-time admissions increased from 1.24 per 100,000 population in 1999 (95% confidence interval [CI] 1.14-1.35) to 2.86 in 2019 (95% CI 2.72-3.01). Admission rates were highest among infants and older adults, and were higher for males than females. There were small but significant increases in annual mortality rates for CNS abscesses and empyemas over the last two decades of the study period after accounting for population ageing, but mortality remained low at around 0.1-0.2 per 100,000 population. Mortality increased with advancing age; deaths in childhood were extremely rare. Case fatality rates where a relevant diagnosis was recorded as either the underlying or contributing cause were 4.3% and 9.7% respectively. CONCLUSIONS The increase in CNS abscesses and empyemas in England might reflect improved case ascertainment, but the likelihood of a true rise in incidence should be considered.
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Affiliation(s)
- M A Iro
- Faculty of Medicine and Institute of Life Sciences, University of Southampton, UK; Department of Paediatric Infectious Diseases, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK.
| | - M J Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Mahlamäki K, Rautalin I, Korja M. Case Fatality Rates of Subarachnoid Hemorrhage Are Decreasing with Substantial between-Country Variation: A Systematic Review of Population-Based Studies between 1980 and 2020. Neuroepidemiology 2023; 56:402-412. [PMID: 36282049 DOI: 10.1159/000526983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The declining prevalence of smoking and hypertension has been associated with the decrease of subarachnoid hemorrhage (SAH) incidence in the 21st century. Since these same risk factors are linked to SAH mortality, the case fatality rate (CFR) of SAH has potentially also decreased during recent decades. Thus, we conducted a systematic review to address SAH CFR changes over the last 40 years. METHODS We performed a systematic literature search in OVID Medline, Scopus, and Cochrane Library databases. We focused on population-based studies published between 1980 and 2020 that had included both hospitalized and nonhospitalized SAH cases, and reported 1-month CFRs for at least two individual study periods for the same population. Finally, we used a linear regression analysis to estimate the annual CFR changes in each identified population and pooled the regional changes for larger geographical and sex-specific analyses. RESULTS Of the 4,562 initial publications, we included 22 studies (three of which reached a high-quality classification) consisting of 17,593 SAH patients from 16 different populations and 10 countries. Between 1980 and 2020, SAH CFR declined in all but two populations by an average of -1.5%/year. In the continent-based pooled geographical analyses, CFR decline was the most noticeable in North America (-2.4%/year) and Oceania (-2.2%/year). The decline was more moderate in Northern Europe (-0.8%/year) and Southern Europe (-0.7%/year). Overall, CFRs declined both in women (-1.9%/year) and in men (-1.2%/year). When comparing the first and second half of the study period, CFRs declined from 41% to 31%. CONCLUSION Short-term SAH CFRs seem to have declined since 1980. Time trends of SAH CFRs can still be identified for only a few populations, and high-quality data are scarce. Whether the observed decline relates to changes in risk factors, treatment outcomes or diagnostics remains to be studied.
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Affiliation(s)
- Kasper Mahlamäki
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilari Rautalin
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Nicholson TJ, Hoddinott G, Seddon JA, Claassens MM, van der Zalm MM, Lopez E, Bock P, Caldwell J, Da Costa D, de Vaal C, Dunbar R, Du Preez K, Hesseling AC, Joseph K, Kriel E, Loveday M, Marx FM, Meehan SA, Purchase S, Naidoo K, Naidoo L, Solomon-Da Costa F, Sloot R, Osman M. A systematic review of risk factors for mortality among tuberculosis patients in South Africa. Syst Rev 2023; 12:23. [PMID: 36814335 PMCID: PMC9946877 DOI: 10.1186/s13643-023-02175-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/17/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients. METHODS We conducted a systematic review of TB research articles published between 2010 and 2018. We searched BioMed Central (BMC), PubMed®, EBSCOhost, Cochrane, and SCOPUS for publications between January 2010 and December 2018. Searches were conducted between August 2019 and October 2019. We included randomised control trials (RCTs), case control, cross sectional, retrospective, and prospective cohort studies where TB mortality was a primary endpoint and effect measure estimates were provided for risk factors for TB mortality during TB treatment. Due to heterogeneity in effect measures and risk factors evaluated, a formal meta-analysis of risk factors for TB mortality was not appropriate. A random effects meta-analysis was used to estimate case fatality ratios (CFRs) for all studies and for specific subgroups so that these could be compared. Quality assessments were performed using the Newcastle-Ottawa scale or the Cochrane Risk of Bias Tool. RESULTS We identified 1995 titles for screening, 24 publications met our inclusion criteria (one cross-sectional study, 2 RCTs, and 21 cohort studies). Twenty-two studies reported on adults (n = 12561) and two were restricted to children < 15 years of age (n = 696). The CFR estimated for all studies was 26.4% (CI 18.1-34.7, n = 13257 ); 37.5% (CI 24.8-50.3, n = 5149) for drug-resistant (DR) TB; 12.5% (CI 1.1-23.9, n = 1935) for drug-susceptible (DS) TB; 15.6% (CI 8.1-23.2, n = 6173) for studies in which drug susceptibility was mixed or not specified; 21.3% (CI 15.3-27.3, n = 7375) for people living with HIV/AIDS (PLHIV); 19.2% (CI 7.7-30.7, n = 1691) in HIV-negative TB patients; and 6.8% (CI 4.9-8.7, n = 696) in paediatric studies. The main risk factors associated with TB mortality were HIV infection, prior TB treatment, DR-TB, and lower body weight at TB diagnosis. CONCLUSIONS In South Africa, overall mortality during TB treatment remains high, people with DR-TB have an elevated risk of mortality during TB treatment and interventions to mitigate high mortality are needed. In addition, better prospective data on TB mortality are needed, especially amongst vulnerable sub-populations including young children, adolescents, pregnant women, and people with co-morbidities other than HIV. Limitations included a lack of prospective studies and RCTs and a high degree of heterogeneity in risk factors and comparator variables. SYSTEMATIC REVIEW REGISTRATION The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018108622. This study was funded by the Bill and Melinda Gates Foundation (Investment ID OPP1173131) via the South African TB Think Tank.
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Affiliation(s)
- Tamaryn J Nicholson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Mareli M Claassens
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Human, Biological and Translational Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisa Lopez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- IS Global, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universidad de Barcelona, Barcelona, Spain
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Judy Caldwell
- Community Services and Health Directorate, City of Cape Town, Cape Town, South Africa
| | - Dawood Da Costa
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Celeste de Vaal
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen Du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kay Joseph
- Community Services and Health Directorate, City of Cape Town, Cape Town, South Africa
| | - Ebrahim Kriel
- Metro Health Services, Southern and Western Substructure, Western Cape Government: Health, Cape Town, South Africa
| | - Marian Loveday
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa, CAPRISA-SA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Florian M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Sue-Ann Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan Purchase
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa, CAPRISA-SA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Lenny Naidoo
- Community Services and Health Directorate, City of Cape Town, Cape Town, South Africa
| | | | - Rosa Sloot
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom.
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Abolfotouh MA, Musattat A, Alanazi M, Alghnam S, Bosaeed M. Clinical characteristics and outcome of Covid-19 illness and predictors of in-hospital mortality in Saudi Arabia. BMC Infect Dis 2022; 22:950. [PMID: 36526994 PMCID: PMC9758036 DOI: 10.1186/s12879-022-07945-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients' race and ethnicity may play a role in mortality from Covid-19. Studies in China, the US, and Europe have been conducted on the predictors of Covid-19 mortality, yet in the EMR countries, such studies are scarce. Therefore, we aimed to describe the hospitalization rate, ICU-admission, and in-hospital mortality of Covid-19 and predictors of in-hospital mortality in Saudi Arabia. METHODS E-medical records were examined for all Covid-19 patients diagnosed in five tertiary hospitals affiliated with the Saudi-National Guard-Health Affairs during March 21, 2020, and September 12, 2021, based on a positive SARS-CoV-2 RT-PCR test, (n = 35,284). Data were collected on patients' characteristics, comorbidities, laboratory findings, hospitalization, ICU admission, and in-hospital and overall mortality. Logestic regressions were used to identify the independent predictors of in-hospital mortality. The best laboratory parameters cut-off values to predict in-hospital mortality were identified using the area under the receiver operating characteristic curve (AUC). Significance was considered at p < 0.05. RESULTS Of all 35,284 Covid-19 patients, 81.8% were adults and 21.7% were hospitalized. Compared to non-hospitalized patients, hospitalized patients were more of female gender (52.1% versus 47.3%, p < 0.001) and had higher mean age (p < 0.001), higher mean BMI (p < 0.001), and higher rates of: diabetes (p < 0.001), hypertension (p < 0.001), ischemic heart disease (p < 0.001), cancer (p < 0.001), COPD (p < 0.001) and asthma (p = 0.011). The study showed 3.1% overall case-fatality, 20.3% ICU admission rate, and 9.7% in-hospital mortality. Predictors of in-hospital mortality among adult patients were; patients' age ≥ 70 years (OR = 6.93, 95% CI 1.94-24.79), ischemic heart disease (OR = 1.80, 95% CI 1.05-3.09), ICU admission (OR = 24.38, 95% CI 15.64-38.01), abnormal C-reactive protein "CRP" (OR = 1.85, 95% CI 1.08-3.16), abnormal D-dimer (OR = 1.96, 95% CI 1.15-3.36), lymphopenia (OR = 2.76, 95% CI 2.03-3.3.76), high neutrophil count (OR = 2.10, 95% CI 1.54-2.87), and abnormal procalcitonin (OR = 3.33, 95% CI 1.88-5.90). The best laboratory parameters cut-off values to predict in-hospital mortality were CRP > 72.25 mg/L (AUC = 0.64), D-dimer > 1125 µg/L (AUC = 0.75), neutrophils count > 5,745 × 10^9/L (AUC = 0.70), lymphocytic count < 1.10 × 10^9/L (AUC = 0.72), and procalcitonin > 0.18 ng/mL (AUC = 0.76). CONCLUSIONS Rates of hospitalization, ICU-admission, in-hospital mortality and overall case fatality were nearly comparable to the rates in western countries. Early interventions are necessary for high-risk Covid-19 patients, especially elderly patients and those with cardiac diseases.
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Affiliation(s)
- Mostafa A. Abolfotouh
- grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center, Mail Code 3533, Riyadh, Saudi Arabia ,grid.412149.b0000 0004 0608 0662King Saud Bin-Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia ,grid.415254.30000 0004 1790 7311King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, POB 22490, Riyadh, 11426 Saudi Arabia
| | - Abrar Musattat
- grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center, Mail Code 3533, Riyadh, Saudi Arabia
| | - Maha Alanazi
- grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center, Mail Code 3533, Riyadh, Saudi Arabia
| | - Suliman Alghnam
- grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center, Mail Code 3533, Riyadh, Saudi Arabia ,grid.412149.b0000 0004 0608 0662King Saud Bin-Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Mohammad Bosaeed
- grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center, Mail Code 3533, Riyadh, Saudi Arabia ,grid.412149.b0000 0004 0608 0662King Saud Bin-Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia ,grid.415254.30000 0004 1790 7311King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, POB 22490, Riyadh, 11426 Saudi Arabia
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16
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Somda SM, Bado AR, Sow A, Lokossou VK, Ossei-A-Yeboah S, Ca T, Ogbureke N, Okolo S, Sombie I. The first year of the COVID-19 pandemic in the ECOWAS region. Ghana Med J 2022; 56:61-73. [PMID: 38322748 PMCID: PMC10630033 DOI: 10.4314/gmj.v56i3s.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Objective to analyse the pandemic after one year in terms of the evolution of morbidity and mortality and factors that may contribute to this evolution. Design This is a secondary analysis of data gathered to respond to the COVID-19 pandemic. The number of cases, incidence rate, cumulative incidence rate, number of deaths, case fatality rate and their trends were analysed during the first year of the pandemic. Testing and other public health measures were also described according to the information available. Settings The 15 States members of the Economic Community of West African States (ECOWAS) were considered. Results As of 31st March 2021, the ECOWAS region reported 429,760 COVID-19 cases and 5,620 deaths. In the first year, 1,110.75 persons were infected per million, while 1.31% of the confirmed patients died. The ECOWAS region represents 30% of the African population. One year after the start of COVID-19 in ECOWAS, this region reported 10% of the cases and 10% of the deaths in the continent. Cumulatively, the region has had two major epidemic waves; however, countries show different patterns. The case fatality rate presented a fast growth in the first months and then decreased to a plateau. Conclusion We learn that the context of COVID-19 is specific to each country. This analysis shows the importance of better understanding each country's response. During this first year of the pandemic, the problem of variants of concern and the vaccination were not posed. Funding The study was funded by the International Development Research Centre (IDRC) under CATALYSE project.
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Affiliation(s)
- Serge Ma Somda
- Department of Planning and Health Information, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
| | - Aristide R Bado
- Department of Planning and Health Information, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
| | - Abdourahmane Sow
- Department Public Health and Research, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
| | - Virgil K Lokossou
- Regional Centre for Disease Surveillance and Control, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
| | - Sybil Ossei-A-Yeboah
- Department Public Health and Research, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
| | - Tome Ca
- Department of Planning and Health Information, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
| | - Nanlop Ogbureke
- General Directorate, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
| | - Stanley Okolo
- General Directorate, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
| | - Issiaka Sombie
- Department Public Health and Research, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
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17
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Adams C, Wortley P, Chamberlain A, Lopman BA. Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic? Ann Epidemiol 2022; 72:57-64. [PMID: 35649472 PMCID: PMC9148435 DOI: 10.1016/j.annepidem.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To examine whether declines in the crude U.S. COVID-19 case fatality ratio is due to improved clinical care and/or other factors. METHODS We used multivariable logistic regression, adjusted for age and other individual-level characteristics, to examine associations between report month and mortality among confirmed and probable COVID-19 cases and hospitalized cases in Georgia reported March 2, 2020 to March 31, 2021. RESULTS Compared to August 2020, mortality risk among cases was lowest in November 2020 (OR = 0.84; 95% CI: 0.78-0.91) and remained lower until March 2021 (OR = 0.86; 95% CI: 0.77-0.95). Among hospitalized cases, mortality risk increased in December 2020 (OR = 1.16, 95% CI: 1.07-1.27) and January 2021 (OR = 1.25; 95% CI: 1.14-1.36), before declining until March 2021 (OR = 0.90, 95% CI: 0.78-1.04). CONCLUSIONS After adjusting for other factors, including the shift to a younger age distribution of cases, we observed lower mortality risk from November 2020 to March 2021 compared to August 2020 among cases. This suggests that improved clinical management may have contributed to lower mortality risk. Among hospitalized cases, mortality risk increased again in December 2020 and January 2021, but then decreased to a risk similar to that among all cases by March 2021.
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Affiliation(s)
- Carly Adams
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Pascale Wortley
- HIV Epidemiology Section, Georgia Department of Public Health, State of Georgia Building, Atlanta, GA
| | - Allison Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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18
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Cai Z, Junus A, Chang Q, Yip PSF. The lethality of suicide methods: A systematic review and meta-analysis. J Affect Disord 2022; 300:121-129. [PMID: 34953923 DOI: 10.1016/j.jad.2021.12.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The use of suicide methods largely determines the outcome of suicide acts. However, no existing meta-analysis has assessed the case fatality rates (CFRs) by different suicide methods. The current study aimed to fill this gap. METHODS We searched Scopus, Web of Science, PubMed, ProQuest and Embase for studies reporting method-specific CFRs in suicide, published from inception to 31 December 2020. A random-effect model meta-analysis was applied to compute pooled estimates. RESULTS Of 10,708 studies screened, 34 studies were included in the meta-analysis. Based on the suicide acts that resulted in death or hospitalization, firearms were found to be the most lethal method (CFR:89.7%), followed by hanging/suffocation (84.5%), drowning (80.4%), gas poisoning (56.6%), jumping (46.7%), drug/liquid poisoning (8.0%) and cutting (4.0%). The rank of the lethality for different methods remained relatively stable across study setting, sex and age group. Method-specific CFRs for males and females were similar for most suicide methods, while method-CFRs were specifically higher in older adults. CONCLUSIONS This study is the first meta-analysis that provides significant evidence for the wide variation of the lethality of suicide methods. Restricting highly lethal methods based on local context is vital in suicide prevention.
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Affiliation(s)
- Ziyi Cai
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Alvin Junus
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Qingsong Chang
- School of Sociology and Anthropology, Xiamen University, Xiamen, China.
| | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China; Hong Kong Jockey Club Center for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China.
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19
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Ebinger JE, Lan R, Driver M, Sun N, Botting P, Park E, Davis T, Minissian MB, Coleman B, Riggs R, Roberts P, Cheng S. Seasonal COVID-19 surge related hospital volumes and case fatality rates. BMC Infect Dis 2022; 22:178. [PMID: 35197000 PMCID: PMC8864601 DOI: 10.1186/s12879-022-07139-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/09/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Seasonal and regional surges in COVID-19 have imposed substantial strain on healthcare systems. Whereas sharp inclines in hospital volume were accompanied by overt increases in case fatality rates during the very early phases of the pandemic, the relative impact during later phases of the pandemic are less clear. We sought to characterize how the 2020 winter surge in COVID-19 volumes impacted case fatality in an adequately-resourced health system. METHODS We performed a retrospective cohort study of all adult diagnosed with COVID-19 in a large academic healthcare system between August 25, 2020 to May 8, 2021, using multivariable logistic regression to examine case fatality rates across 3 sequential time periods around the 2020 winter surge: pre-surge, surge, and post-surge. Subgroup analyses of patients admitted to the hospital and those receiving ICU-level care were also performed. Additionally, we used multivariable logistic regression to examine risk factors for mortality during the surge period. RESULTS We studied 7388 patients (aged 52.8 ± 19.6 years, 48% male) who received outpatient or inpatient care for COVID-19 during the study period. Patients treated during surge (N = 6372) compared to the pre-surge (N = 536) period had 2.64 greater odds (95% CI 1.46-5.27) of mortality after adjusting for sociodemographic and clinical factors. Adjusted mortality risk returned to pre-surge levels during the post-surge period. Notably, first-encounter patient-level measures of illness severity appeared higher during surge compared to non-surge periods. CONCLUSIONS We observed excess mortality risk during a recent winter COVID-19 surge that was not explained by conventional risk factors or easily measurable variables, although recovered rapidly in the setting of targeted facility resources. These findings point to how complex interrelations of population- and patient-level pandemic factors can profoundly augment health system strain and drive dynamic, if short-lived, changes in outcomes.
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Affiliation(s)
- Joseph E. Ebinger
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA USA ,grid.50956.3f0000 0001 2152 9905Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Roy Lan
- grid.267301.10000 0004 0386 9246College of Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | - Matthew Driver
- grid.50956.3f0000 0001 2152 9905Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Nancy Sun
- grid.50956.3f0000 0001 2152 9905Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Patrick Botting
- grid.50956.3f0000 0001 2152 9905Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Eunice Park
- grid.50956.3f0000 0001 2152 9905Enterprise Data Intelligence, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tod Davis
- grid.50956.3f0000 0001 2152 9905Enterprise Data Intelligence, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Margo B. Minissian
- grid.50956.3f0000 0001 2152 9905Brawerman Nursing Institute and Nursing Research Department, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Bernice Coleman
- grid.50956.3f0000 0001 2152 9905Brawerman Nursing Institute and Nursing Research Department, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Richard Riggs
- grid.50956.3f0000 0001 2152 9905Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Pamela Roberts
- grid.50956.3f0000 0001 2152 9905Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA USA ,grid.50956.3f0000 0001 2152 9905Department of Biomedical Sciences, Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Susan Cheng
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA USA ,grid.50956.3f0000 0001 2152 9905Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
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20
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Leepattarakit T, Tulyaprawat O, Vongseenin C, Rujirachun P, Wattanachayakul P, Phichinitikorn P, Phoompoung P, Ngamskulrungroj P. EQUAL Candida score, an effective tool for predicting the outcomes of Candida tropicalis candidaemia: a retrospective cohort study. Mycoses 2022; 65:473-480. [PMID: 35138673 DOI: 10.1111/myc.13429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Candida tropicalis is the most common non-albicans Candida species found in Asia-Pacific countries, including Thailand. The pathogen is known for its great virulence, which causes a high case-fatality rate. Associations between case fatality and patient characteristics, infectious disease unit consultation, and EQUAL Candida score were investigated. METHODS This retrospective cohort study was conducted with 160 cases of C. tropicalis bloodstream infection between 2015 and 2019 at a single, large, tertiary centre in Thailand. Clinical characteristics, clinical presentations, patient outcomes (30-day case-fatality rate) and independent predictive factors were analysed. RESULTS The 30-day case-fatality rate was 68.1%. The median of the EQUAL Candida score was 8. Independent factors for the prediction of case fatality were septic shock (hazard ratio, 1.84), the use of mechanical ventilation (hazard ratio, 2.03) and the EQUAL Candida score (hazard ratio, 0.75). CONCLUSIONS The predictive factors for 30-day case fatality were septic shock, mechanical ventilation use and the EQUAL Candida score. It is recommended that the EQUAL score be considered for patients infected with C. tropicalis candidaemia to reduce the case-fatality rate.
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Affiliation(s)
- Teera Leepattarakit
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Orawan Tulyaprawat
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chyanis Vongseenin
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pongprueth Rujirachun
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Prawut Phichinitikorn
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pakpoom Phoompoung
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Popchai Ngamskulrungroj
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Laupland KB, Ramanan M, Shekar K, Kirrane M, Clement P, Young P, Edwards F, Bushell R, Tabah A. Is intensive care unit mortality a valid survival outcome measure related to critical illness? Anaesth Crit Care Pain Med 2021; 41:100996. [PMID: 34902631 DOI: 10.1016/j.accpm.2021.100996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/01/2021] [Accepted: 10/12/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE Use of death as an outcome of intensive care unit (ICU) admission may be biased by differential discharge decisions. OBJECTIVE To determine the validity of ICU survival status as an outcome measure of all cause case-fatality. METHODS A retrospective cohort of first admissions among adults to four ICUs in North Brisbane, Australia was assembled. Death in ICU (censored at discharge or 30 days) was compared with 30-day overall case-fatality. RESULTS The 30-day overall case-fatality was 8.1% (2436/29,939). One thousand six hundred and thirty-one deaths occurred within the ICU stay and 576 subsequent during hospital post-ICU discharge within 30-days; ICU and hospital case-fatality rates were 5.4% and 7.4%, respectively. An additional 229 patients died after hospital separation within 30 days of ICU admission of which 110 (48.0%) were transferred to another acute care hospital, 80 (34.9%) discharged home, and 39 (17.0%) transferred to an aged care/chronic care/rehabilitation facility. Patients who died after ICU discharge were older, had higher APACHE III scores, were more likely to be elective surgical patients, and were less likely to be out of state residents or managed in a tertiary referral hospital. Limiting determination of case-fatality to ICU information alone would correctly detect 95% (780/821) of all-cause mortality at day 3, 90% (1093/1213) at day 5, 75% (1524/2019) at day 15, 72% (1592/2244) at day 21, and 67% (1631/2436) at day 30 of follow-up. CONCLUSIONS Use of ICU case-fatality significantly underestimates the true burden and biases assessment of determinants of critical illness-related mortality in our region.
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Affiliation(s)
- Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
| | - Mahesh Ramanan
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Intensive Care Unit, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Kiran Shekar
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Intensive Care Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Marianne Kirrane
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Pierre Clement
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Patrick Young
- Intensive Care Unit, Caboolture Hospital, Caboolture, Queensland, Australia; Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Felicity Edwards
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Rachel Bushell
- Intensive Care Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Alexis Tabah
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
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22
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Jayaraj VJ, Rampal S, Ng CW, Chong DWQ. The Epidemiology of COVID-19 in Malaysia. Lancet Reg Health West Pac 2021; 17:100295. [PMID: 34704083 PMCID: PMC8529946 DOI: 10.1016/j.lanwpc.2021.100295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND COVID-19 has rapidly spread across the globe. Critical to the control of COVID-19 is the characterisation of its epidemiology. Despite this, there has been a paucity of evidence from many parts of the world, including Malaysia. We aim to describe the epidemiology of COVID-19 in Malaysia to inform prevention and control policies better. METHODS Malaysian COVID-19 data was extracted from 16 March 2020 up to 31 May 2021. We estimated the following epidemiological indicators: 7-day incidence rates, 7-day mortality rates, case fatality rates, test positive ratios, testing rates and the time-varying reproduction number (Rt). FINDINGS Between 16 March 2020 and 31 May 2021, Malaysia has reported 571,901 cases and 2,796 deaths. Malaysia's average 7-day incidence rate was 26•6 reported infections per 100,000 population (95% CI: 17•8, 38•1). The average test positive ratio and testing rate were 4•3% (95% CI: 1•6, 10•2) and 0•8 tests per 1,000 population (95% CI: <0•1, 3•7), respectively. The case fatality rates (CFR) was 0•6% (95% CI: <0•1, 3•7). Among the 2,796 cases who died, 87•3% were ≥ 50 years. INTERPRETATION The public health response was successful in the suppression of COVID-19 transmission or the first half of 2020. However, a state election and outbreaks in institutionalised populations have been the catalyst for more significant community propagation. This rising community transmission has continued in 2021, leading to increased incidence and strained healthcare systems. Calibrating NPI based on epidemiological indicators remain critical for us to live with the virus. (243 words). FUNDING This study is part of the COVID-19 Epidemiological Analysis and Strategies (CEASe) Project with funding from the Ministry of Science, Technology and Innovation (UM.0000245/HGA.GV).
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Affiliation(s)
- Vivek Jason Jayaraj
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive, Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Sanjay Rampal
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive, Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chiu-Wan Ng
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive, Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Diane Woei Quan Chong
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive, Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Ministry of Health Malaysia, Putrajaya, Malaysia
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Abstract
Rural-urban health disparities in life expectancy are large and increasing, with the rural-urban disparity stroke mortality serving as a potential contributor. Data from Vital Statistics shows an unexplained temporal pattern in the rural-urban disparity in stroke-specific mortality, with the magnitude of the disparity increasing from 15% to 25% between 1999 and 2010, but subsequently decreasing to 8% by 2019. This recent decrease in the magnitude of the rural-urban disparity in stroke mortality appears to be driven by a previously unreported plateauing of stroke mortality in urban areas and a continued decline of stroke mortality in rural areas. There is a need to better understand the contributors to these temporal changes; however, a general lack of temporal data on potential contributors prevents this investigation. However considering contributors to the rural-urban differences pooled across time, an overall a higher stroke incidence in rural areas appears to be a contributor to the higher rural stroke mortality, with this higher incidence potentially associated with a higher prevalence of stroke risk factors in rural areas. Conversely, studies assessing rural-urban disparities in stroke case fatality show smaller and inconsistent associations. To the extent that disparities in case fatality do exist, there are many studies showing rural-urban disparities in stroke care could be contributing. While these data offer insights to the overall rural-urban disparities in stroke mortality, additional data are needed to help understand temporal changes in the magnitude of the rural-urban stroke mortality disparity.
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Affiliation(s)
- George Howard
- Department of Biostatistics, UAB School of Public Health, 1665 University Drive, University of Alabama at Birmingham, Birmingham, AL 35294-0022, United States of America.
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Telisinghe L, Ruperez M, Amofa-Sekyi M, Mwenge L, Mainga T, Kumar R, Hassan M, Chaisson L, Naufal F, Shapiro A, Golub J, Miller C, Corbett E, Burke R, MacPherson P, Hayes R, Bond V, Daneshvar C, Klinkenberg E, Ayles H. Does tuberculosis screening improve individual outcomes? A systematic review. EClinicalMedicine 2021; 40:101127. [PMID: 34604724 PMCID: PMC8473670 DOI: 10.1016/j.eclinm.2021.101127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To determine if tuberculosis (TB) screening improves patient outcomes, we conducted two systematic reviews to investigate the effect of TB screening on diagnosis, treatment outcomes, deaths (clinical review assessing 23 outcome indicators); and patient costs (economic review). METHODS Pubmed, EMBASE, Scopus and the Cochrane Library were searched between 1/1/1980-13/4/2020 (clinical review) and 1/1/2010-14/8/2020 (economic review). As studies were heterogeneous, data synthesis was narrative. FINDINGS Clinical review: of 27,270 articles, 18 (n=3 trials) were eligible. Nine involved general populations. Compared to passive case finding (PCF), studies showed lower smear grade (n=2/3) and time to diagnosis (n=2/3); higher pre-treatment losses to follow-up (screened 23% and 29% vs PCF 15% and 14%; n=2/2); and similar treatment success (range 68-81%; n=4) and case fatality (range 3-11%; n=5) in the screened group. Nine reported on risk groups. Compared to PCF, studies showed lower smear positivity among those culture-confirmed (n=3/4) and time to diagnosis (n=2/2); and similar (range 80-90%; n=2/2) treatment success in the screened group. Case fatality was lower in n=2/3 observational studies; both reported on established screening programmes. A neonatal trial and post-hoc analysis of a household contacts trial found screening was associated with lower all-cause mortality. Economic review: From 2841 articles, six observational studies were eligible. Total costs (n=6) and catastrophic cost prevalence (n=4; range screened 9-45% vs PCF 12-61%) was lower among those screened. INTERPRETATION We found very limited patient outcome data. Collecting and reporting this data must be prioritised to inform policy and practice. FUNDING WHO and EDCTP.
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Affiliation(s)
- L Telisinghe
- London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - M Ruperez
- London School of Hygiene and Tropical Medicine, London, UK
| | - M Amofa-Sekyi
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - L Mwenge
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - T Mainga
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - R Kumar
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - M Hassan
- University Hospitals Plymouth NHS Trust, UK
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Egypt
| | - L.H Chaisson
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, USA
| | - F Naufal
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, USA
| | - A.E Shapiro
- Departments of Global Health and Medicine, University of Washington, Seattle, USA
| | - J.E Golub
- Johns Hopkins University School of Medicine, Center for Tuberculosis Research, Baltimore, USA
| | - C Miller
- Global TB programme, World Health Organization, Geneva, Switzerland
| | - E.L Corbett
- London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - R.M Burke
- London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - P MacPherson
- London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - R.J Hayes
- London School of Hygiene and Tropical Medicine, London, UK
| | - V Bond
- London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | | | - E Klinkenberg
- London School of Hygiene and Tropical Medicine, London, UK
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - H.M Ayles
- London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
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Laupland KB, Edwards F, Ramanan M, Shekar K, Tabah A. Reconciling the obesity paradox: Obese patients suffer the highest critical illness associated mortality rates. J Crit Care 2021; 66:75-7. [PMID: 34461379 DOI: 10.1016/j.jcrc.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023]
Abstract
The obesity paradox refers to the observation that obese patients admitted to intensive care units (ICU) have lower case fatality as compared to healthy weight patients. However, selection bias could explain the apparent paradox. Our objective was to assess whether obese people have a different overall burden of critical illness associated mortality. A retrospective population-based cohort study was conducted in North Brisbane ICUs during 2017-2019. Patients were classified as underweight, healthy weight, overweight, and obese according to BMIs <18.5, 18.5-24.9, 25-29.9, and ≥ 30 kg/m2, respectively. ICU admission incidence rates were 245.6, 138.2, 178.9, and 421.9 per 100,000 population; 90-day all cause case fatalities were 24.0%, 17.0%, 18.1%, and 16.0%; and critical illness associated mortality rates were 58.8, 23.4, 32.4, and 67.7 per 100,000 population among underweight, healthy weight, overweight, and obese patients, respectively. As compared to patients of healthy weight, those who were underweight (relative risk; RR 2.51; 95% CI, 1.79-3.44), overweight (RR 1.38; 95% CI, 1.16-1.65), and obese (RR 2.89; 2.43-3.43) were each at significantly higher risk for critical illness associated mortality. While obese patients have lower case fatality they are at much higher risk for ICU admission and as result suffer the highest burden of critical illness associated mortality in our region.
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MacKinnon MC, McEwen SA, Pearl DL, Lyytikäinen O, Jacobsson G, Collignon P, Gregson DB, Valiquette L, Laupland KB. Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study. BMC Infect Dis 2021; 21:606. [PMID: 34172003 PMCID: PMC8229717 DOI: 10.1186/s12879-021-06326-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. Methods During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion. Results From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female. Conclusions In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06326-x.
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Affiliation(s)
- Melissa C MacKinnon
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada.
| | - Scott A McEwen
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - David L Pearl
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Outi Lyytikäinen
- Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - Gunnar Jacobsson
- Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden.,CARe - Center for Antibiotic Resistance Research, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Peter Collignon
- Department of Infectious Disease and Microbiology, The Canberra Hospital, Garran, Australian Capital Territory, Australia.,Medical School, Australian National University, Acton, Australian Capital Territory, Australia
| | - Daniel B Gregson
- Departments of Medicine, and Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
| | - Louis Valiquette
- Department of Microbiology-Infectious Diseases, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Kevin B Laupland
- Department of Medicine, Royal Inland Hospital, Kamloops, British Columbia, Canada.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Marschner IC. Estimating age-specific COVID-19 fatality risk and time to death by comparing population diagnosis and death patterns: Australian data. BMC Med Res Methodol 2021; 21:126. [PMID: 34154563 PMCID: PMC8215490 DOI: 10.1186/s12874-021-01314-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022] Open
Abstract
Background Mortality is a key component of the natural history of COVID-19 infection. Surveillance data on COVID-19 deaths and case diagnoses are widely available in the public domain, but they are not used to model time to death because they typically do not link diagnosis and death at an individual level. This paper demonstrates that by comparing the unlinked patterns of new diagnoses and deaths over age and time, age-specific mortality and time to death may be estimated using a statistical method called deconvolution. Methods Age-specific data were analysed on 816 deaths among 6235 cases over age 50 years in Victoria, Australia, from the period January through December 2020. Deconvolution was applied assuming logistic dependence of case fatality risk (CFR) on age and a gamma time to death distribution. Non-parametric deconvolution analyses stratified into separate age groups were used to assess the model assumptions. Results It was found that age-specific CFR rose from 2.9% at age 65 years (95% CI:2.2 – 3.5) to 40.0% at age 95 years (CI: 36.6 – 43.6). The estimated mean time between diagnosis and death was 18.1 days (CI: 16.9 – 19.3) and showed no evidence of varying by age (heterogeneity P = 0.97). The estimated 90% percentile of time to death was 33.3 days (CI: 30.4 – 36.3; heterogeneity P = 0.85). The final age-specific model provided a good fit to the observed age-stratified mortality patterns. Conclusions Deconvolution was demonstrated to be a powerful analysis method that could be applied to extensive data sources worldwide. Such analyses can inform transmission dynamics models and CFR assessment in emerging outbreaks. Based on these Australian data it is concluded that death from COVID-19 occurs within three weeks of diagnosis on average but takes five weeks in 10% of fatal cases. Fatality risk is negligible in the young but rises above 40% in the elderly, while time to death does not seem to vary by age. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01314-w.
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Affiliation(s)
- Ian C Marschner
- Trials Centre, National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW, 2006, Australia.
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28
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Ben Abid F, El-Maki N, Alsoub H, Al Masalmani M, Al-Khal A, Valentine Coyle P, Ben Hadj Kacem MA, AlGazwani H, Al-Thani M, Eid Al-Romaihi H, Al-Hajri M, Elmoubashar F. Middle East respiratory syndrome coronavirus infection profile in Qatar: An 8-year experience. IDCases 2021; 24:e01161. [PMID: 34026547 DOI: 10.1016/j.idcr.2021.e01161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/29/2022] Open
Abstract
The Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012. The objective of the study was to describe the epidemiology, risk factors, clinical characteristics, and outcome of MERS-CoV in Qatar. A total of 28 cases of MERS-CoV were identified, corresponding to an incidence of 1.7 per 1,000,000 population. Most patients had a history of contact with camels 15, travel to Kingdom of Saudi Arabia 7 or known contact with individuals with confirmed MERS-CoV infection 7. Majority of patients had acute kidney injury (AKI) 17 and 9 needed renal replacement therapy. All patients were hospitalized, 14 required critical care support. Overall, total of 10 died. The immediate cause of death was multiorgan failure with acute respiratory syndrome (ARDS) 9. MERS-CoV is a rare infection in the State of Qatar. There was no hospital outbreaks or healthcare worker reported infection. The infection causes severe respiratory failure and acute renal failure. Patients with AKI and on ventilator support carry higher risk of mortality.
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29
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Orji ML, Ajayi NA, Onyire NB, Unigwe US, Ojide CK. Positivity Rate, Predictors, and Outcome of Paediatric Lassa Fever Disease (LFD) in a Lassa Fever Endemic State, South-East Nigeria. Niger Med J 2021; 62:133-138. [PMID: 38505199 PMCID: PMC10937061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Background The pattern and case fatality rate of Paediatric Lassa fever disease (LFD) is not well documented even in Lassa fever endemic communities. Aim and Objective This prospective observational study was aimed at determining the pattern and outcome of Paediatric LFD. Methodology A total of 183 children that met the criteria for LFD suspects were subjected to the Lassa virus PCR test. The suspects that tested positive were recruited into the study and a structured questionnaire was used to collect information on socio-demographics. Results Of the 183 LFD suspects that were tested, 24 of them were positive to Lassa virus PCR, giving a positivity rate of 13.1%. The mean duration of illness before hospital presentation was 8.54 ± 3.83 days. All the subjects had a history of fever. Abdominal pain and vomiting were the two highest presenting complaints after fever. Seven out of 24 children died during the study period, giving a case fatality rate (CFR) of 29.2%. Subjects who presented with convulsions and unconsciousness (OR =10.00, 95% CI= 1.2, 81.81, p=0.020), bleeding (OR =40.00, 95% CI= 12.96, 539.67, p=0.020), poor urine output (OR =40.00, 95% CI= 12.96, 539.67, p=0.020) were more likely to die of LFD compared to their colleagues without such symptoms. Conclusion The positivity rate and case fatality rate of LFD in children were high. Public enlightenment on the common features of Lassa fever disease and the need to seek health care early for children with febrile illness is advocated.
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Affiliation(s)
- Maria-Lauretta Orji
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State
| | - Nnennaya Anthony Ajayi
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State
| | - Nnamdi Benson Onyire
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State
| | - Uche Sonny Unigwe
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State
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Kaur H, Thakur JS, Paika R, Advani SM. Impact of Underlying Comorbidities on Mortality in SARS-COV-2 Infected Cancer Patients: A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev 2021; 22:1333-1349. [PMID: 34048161 PMCID: PMC8408376 DOI: 10.31557/apjcp.2021.22.5.1333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The evidence has shown that SARS CoV-2 infected patients with comorbidities are more likely to have severe disease sequel and mortality. In SARS-CoV-2 infected cancer patients risks associated with other underlying comorbidities might vary from those in non-cancer SARS CoV-2 infected patients. The relative impact of different underlying health conditions among patients with cancer and SARS CoV-2 infection remains yet to be explored. This systematic review aims to explore the prevalence of comorbidities among cancer patients with SARS CoV-2 infection and their impact on mortality. METHODS Online databases PubMed, Embase, Scopus and Web of science were searched for articles published between 9th July 2019 to July 8th 2020.Studies of cancer patients (>18 years) with diagnosis of SARS CoV-2 infection, published in English were included. A random-effects modelling for the meta-analyses was applied to assess the pooled prevalence and odds ratio for mortality due to comorbidities in SARS CoV-2 infected cancer patients. RESULTS Total 31studies with 4086 SARS-CoV-2 infectedcancer patientsmet the inclusion criteria. Most prevalent co-morbidities in cancer patients with SARS CoV-2 infection were hypertension [42.3% (95%CI:37.5- 47.0)], diabetes [17.8% (95% CI: 15.3-20.4)] and cardiovascular diseases [16.7% (95%CI:12.9-20.4)].The risk of mortality (pOR) was significantly higher in individuals with hypertension[1.6(95%CI 1.24-2.00)], cardiovascular diseases [2.2 (95%CI 1.49- 3.27)], chronic obstructive pulmonary diseases [1.4(95% CI 1.05-2.00)] and diabetes [1.35(95%CI 1.06-1.73)]. CONCLUSION Our results indicates that the mortality in SARS-CoV-2 infected cancer patients is affected by preexisting non-cancer comorbidities. By identifying the comorbidities predictive for mortality, clinicians can better stratify the risk of cancer patients presenting with SARS-COV-2, on their initial contact with health services. .
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Affiliation(s)
- Harmanjeet Kaur
- Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India.
| | - JS Thakur
- Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India.
| | - Ronika Paika
- Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India.
| | - Shailesh M Advani
- Cancer Prevention and Control Program, Georgetown University School of Medicine, Georgetown University, Washington DC, USA.
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Liu Y, Lan Z, Yin Y, Liu NH, Tong Y. Trends in suicide rates and the case-fatality of pesticide self-poisoning in an agricultural county in china, 2009 to 2014. J Affect Disord 2021; 283:52-9. [PMID: 33517228 DOI: 10.1016/j.jad.2021.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/30/2020] [Accepted: 01/10/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Suicide rates in China have declined substantially in the last two decades, however, the correlates of the decreases are still unclear. METHODS Using hospital-based suicidal acts registry system in Meixian county, we reviewed all episodes of suicidal behaviors presented at hospitals from 2009 to 2014. The data was combined with the suicides reported in the same period by the county's Center for Disease Prevention and Control. Stratified by gender and method, age-standardized incidences of suicide death, suicide attempts, suicidal acts, as well as the case-fatalities of suicidal acts, were calculated. Joinpoint regression analysis was applied to test the time trends changes of the annual incidences and case-fatalities. Correlation coefficients between suicide rates and case-fatality were estimated. RESULTS Age-standardized suicide rates among females declined by 20.4% per year, meanwhile, overall suicide rates were characterized by downward trend without statistical significance. The annual proportions of suicide deaths by pesticide self-poisoning ranged from 57.1% to 82.6%. There were positive or marginally positive correlations between suicide rates and case-fatalities of suicidal acts in gender- and method-specific groups (r values range from 0.77 to 0.89). LIMITATIONS Underreporting in the hospital-based registry system and misclassification in the death reporting system. Changes in other related factors are not yet accessible. CONCLUSION Suicide rates in females declined prominently in Meixian from 2009 to 2014, even though overall suicide rates remained steady. Pesticide ingestion were most common suicide method. Restriction of pesticide and reduction in the case-fatality are critical targets of suicide prevention in rural China.
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Wang G, Luo FM, Liu D, Liu JS, Wang Y, Chen H, Tian PW, Fan T, Tang L, Yu H, Wang L, Feng M, Ni Z, Wang B, Song ZF, Wu XL, Wang HJ, Tong X, Xue M, Lei XY, Long B, Jia C, Xiao J, Shang J, Xiong N, Luo JF, Liang ZA, Li WM. Differences in the clinical characteristics and outcomes of COVID-19 patients in the epicenter and peripheral areas of the pandemic from China: a retrospective, large-sample, comparative analysis. BMC Infect Dis 2021; 21:206. [PMID: 33627072 PMCID: PMC7903397 DOI: 10.1186/s12879-020-05728-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is limited information on the difference in epidemiology, clinical characteristics and outcomes of the initial outbreak of the coronavirus disease (COVID-19) in Wuhan (the epicenter) and Sichuan (the peripheral area) in the early phase of the COVID-19 pandemic. This study was conducted to investigate the differences in the epidemiological and clinical characteristics of patients with COVID-19 between the epicenter and peripheral areas of pandemic and thereby generate information that would be potentially helpful in formulating clinical practice recommendations to tackle the COVID-19 pandemic. METHODS The Sichuan & Wuhan Collaboration Research Group for COVID-19 established two retrospective cohorts that separately reflect the epicenter and peripheral area during the early pandemic. The epidemiology, clinical characteristics and outcomes of patients in the two groups were compared. Multivariate regression analyses were used to estimate the adjusted odds ratios (aOR) with regard to the outcomes. RESULTS The Wuhan (epicenter) cohort included 710 randomly selected patients, and the peripheral (Sichuan) cohort included 474 consecutive patients. A higher proportion of patients from the periphery had upper airway symptoms, whereas a lower proportion of patients in the epicenter had lower airway symptoms and comorbidities. Patients in the epicenter had a higher risk of death (aOR=7.64), intensive care unit (ICU) admission (aOR=1.66), delayed time from illness onset to hospital and ICU admission (aOR=6.29 and aOR=8.03, respectively), and prolonged duration of viral shedding (aOR=1.64). CONCLUSIONS The worse outcomes in the epicenter could be explained by the prolonged time from illness onset to hospital and ICU admission. This could potentially have been associated with elevated systemic inflammation secondary to organ dysfunction and prolonged duration of virus shedding independent of age and comorbidities. Thus, early supportive care could achieve better clinical outcomes.
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Affiliation(s)
- Gang Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Feng Ming Luo
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jia Sheng Liu
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Ye Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hong Chen
- Department of Critical Care Medicine, Public Health Clinical Center of Chengdu, Chengdu, 610061, Sichuan, China
| | - Pan Wen Tian
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tao Fan
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Li Tang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - He Yu
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lan Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Mei Feng
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhong Ni
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Bo Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhi Fang Song
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiao Ling Wu
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hong Jun Wang
- Department of Respiratory Medicine, Dazhou Central Hospital, Dazhou, 635000, Sichuan, China
| | - Xiang Tong
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Miao Xue
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xian Ying Lei
- Department of Critical Care Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Bo Long
- Mianyang 404 Hospital, Mianyang, 621000, Sichuan, China
| | - Chao Jia
- Department of Critical Care Medicine, Mianyang Central Hospital, Mianyang, 621000, Sichuan, China
| | - Jun Xiao
- Department of Respiratory and Critical Care Medicine, People's Hospital of Ganzi Prefecture, Ganzi, 626700, Sichuan, China
| | - Juan Shang
- Department of Critical Care Medicine, Nanchong Central Hospital, Nanchong, 637000, Sichuan, China
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Wuhan Red Cross Hospital, Wuhan, 430015, Hubei, China.
| | - Jian Fei Luo
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China.
| | - Zong An Liang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Wei Min Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Yaro CA, Kogi E, Opara KN, Batiha GES, Baty RS, Albrakati A, Altalbawy FMA, Etuh IU, Oni JP. Infection pattern, case fatality rate and spread of Lassa virus in Nigeria. BMC Infect Dis 2021; 21:149. [PMID: 33546623 PMCID: PMC7863503 DOI: 10.1186/s12879-021-05837-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Lassa fever (LF) is a zoonotic infectious disease of public concern in Nigeria. The infection dynamics of the disease is not well elucidated in Nigeria. This study was carried out to describe the pattern of infection, case fatality rate and spread of lassa virus (LASV) from 2017 to 2020. METHODS Weekly epidemiological data on LF from December, 2016 to September, 2020 were obtained from Nigeria Centre for Disease Control. The number of confirmed cases and deaths were computed according to months and states. Descriptive statistics was performed and case fatality rate was calculated. Distribution and spread maps of LF over the four years period was performed on ArcMap 10.7. RESULTS A total of 2787 confirmed cases and 516 deaths were reported in Nigeria from December, 2016 to September, 2020. Increase in number of cases and deaths were observed with 298, 528, 796 and 1165 confirmed cases and 79, 125, 158 and 158 deaths in 2017, 2018, 2019 and 2020 respectively. Over 60% of the cases were reported in two states, Edo and Ondo states. The LF cases spread from 19 states in 2017 to 32 states and Federal Capital Territory (FCT) in 2020. Ondo state (25.39%) had the highest of deaths rate from LF over the four years. Case fatality rate (CFR) of LF was highest in 2017 (26.5%) with CFR of 23.7, 19.6 and 13.4% in 2018, 2019 and 2020 respectively. The peak of infection was in the month of February for the four years. Infections increases at the onset of dry season in November and decline till April when the wet season sets-in. CONCLUSION There is an annual increase in the number of LASV infection across the states in Nigeria. There is need to heighten control strategies through the use of integrated approach, ranging from vector control, health education and early diagnosis.
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Affiliation(s)
- Clement Ameh Yaro
- Department of Animal and Environmental Biology, University of Uyo, Uyo, Akwa Ibom Nigeria
- Department of Zoology, Ahmadu Bello University, Zaria, Nigeria
| | - Ezekiel Kogi
- Department of Zoology, Ahmadu Bello University, Zaria, Nigeria
| | - Kenneth Nnamdi Opara
- Department of Animal and Environmental Biology, University of Uyo, Uyo, Akwa Ibom Nigeria
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, AlBeheira 22511 Egypt
| | - Roua S. Baty
- Department of Biotechnology, College of Science, Taif University, P.O. Box 11099, Taif, 21944 Saudi Arabia
| | - Ashraf Albrakati
- Department of Human Anatomy, College of Medicine, Taif University, P.O. Box 11099, Taif, 21944 Saudi Arabia
| | - Farag M. A. Altalbawy
- National Institute of Laser Enhanced Sciences (NILES), Cairo University, Giza, 12613 Egypt
| | | | - James Paul Oni
- Department of Animal and Environmental Biology, Kogi State University, Anyigba, Nigeria
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Reyes-Bueno JA, Mena-Vázquez N, Ojea-Ortega T, Gonzalez-Sotomayor MM, Cabezudo-Garcia P, Ciano-Petersen NL, Pons-Pons G, Castro-Sánchez MV, Serrano-Castro PJ. [ Case fatality of COVID-19 in patients with neurodegenerative dementia]. Neurologia 2020; 35:639-645. [PMID: 38620303 PMCID: PMC7386259 DOI: 10.1016/j.nrl.2020.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/12/2020] [Accepted: 07/19/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction The elderly population is the group most threatened by COVID-19, with the highest mortality rates. This study aims to analyse the case fatality of COVID-19 in a cohort of patients with degenerative dementia. Methods We conducted a descriptive case-control study of a sample of patients diagnosed with primary neurodegenerative dementia. Results Twenty-four of the 88 patients with COVID-19 included in the study died: 10/23 (43.4%) patients diagnosed with dementia and 14/65 (21.5%) controls; this difference was statistically significant. Discussion Our results suggest that case fatality of COVID-19 is significantly higher among patients with primary degenerative dementia than in other patients with similar mean ages and comorbidities.
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Affiliation(s)
- J A Reyes-Bueno
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - N Mena-Vázquez
- Unidad de Gestión Clínica de Reumatología, Hospital Regional Universitario de Málaga, Málaga, España
| | - T Ojea-Ortega
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - M M Gonzalez-Sotomayor
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - P Cabezudo-Garcia
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - N L Ciano-Petersen
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - G Pons-Pons
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - M V Castro-Sánchez
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - P J Serrano-Castro
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
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Rochemont DR, Lemenager P, Franck Y, Farhasmane A, Sabbah N, Nacher M. The epidemiology of acute coronary syndromes in French Guiana. Ann Cardiol Angeiol (Paris) 2020; 70:7-12. [PMID: 33067006 DOI: 10.1016/j.ancard.2020.09.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND French Guiana is an overseas territory of France with marked specificities in terms of populations, socioeconomic factors, risk factors, and an access to care. In this context, the objective of the present study was to describe the epidemiology of acute coronary syndromes in French Guiana and to make comparisons with mainland France and neighbouring country. METHODS The data were obtained from a retrospective descriptive hospital-based cohort conceived to describe the incidence of acute coronary syndromes and their epidemiologic and clinical characteristics. It included patients aged 18 or more hospitalised for a first coronary syndrome in the reference centre for coronary syndromes in Cayenne French Guiana between Jan 1st 2012 and Dec 31st 2014. Overall, 266 patients were analysed. RESULTS The mean age was 64 years (SD=12.54). A majority of patients were men (sex ratio=1.83). The proportion of patients born in an overseas French territory (44.36%) was similar to that of those born in a foreign country (43.98%), and 11.65% were born in mainland France. Only 59% of patients had regular health insurance. Moreover, 33.21% had universal medical insurance (CMU for those below a minimal income), 4.91% had state insurance (for illegal foreign patients) and 2.64% had no insurance at all. The main risk factors were high blood pressure (73.68%), diabetes (39.85%), hypercholesterolemia (40.23%), and smoking (37.97%). Overall, 82/266 patients developed an ST elevation coronary syndrome (STEMI) and 184/266 had a non-ST elevation coronary syndrome NSTEMI or unstable angina pectoris. Thrombolysis was only performed in 20.73% of patients with STEMI. Mortality at 1 month was 8/82 (9.76%) for STEMI and 2/184 (1.09%) for NSTEMI. CONCLUSIONS The epidemiologic profile of acute coronary syndromes in French Guiana is different from that of mainland France and Europe to the neighbouring country Brazil. Mortality of STEMI also seems higher than in mainland France, but similar to Brazil. In a context of frequent health inequalities, interventions targeting the major risk factors, notably high blood pressure, obesity and diabetes, have the potential to significantly impact cardiovascular morbidity and mortality.
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Affiliation(s)
- D R Rochemont
- CIC INSERM 1424, centre hospitalier de Cayenne « Andrée-Rosemon », rue des flamboyants, BP 6006, poste 5669, 97306 Cayenne cedex, French Guiana.
| | - P Lemenager
- CIC INSERM 1424, centre hospitalier de Cayenne « Andrée-Rosemon », rue des flamboyants, BP 6006, poste 5669, 97306 Cayenne cedex, French Guiana
| | - Y Franck
- Service de cardiologie, centre hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - A Farhasmane
- CIC INSERM 1424, centre hospitalier de Cayenne « Andrée-Rosemon », rue des flamboyants, BP 6006, poste 5669, 97306 Cayenne cedex, French Guiana
| | - N Sabbah
- Service de diabétologie endocrinologie, centre hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - M Nacher
- CIC INSERM 1424, centre hospitalier de Cayenne « Andrée-Rosemon », rue des flamboyants, BP 6006, poste 5669, 97306 Cayenne cedex, French Guiana; DFR Santé, université de Guyane, 97300 Cayenne, French Guiana
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Øie LR, Solheim O, Majewska P, Nordseth T, Müller TB, Carlsen SM, Jensberg H, Salvesen Ø, Gulati S. Incidence and case fatality of aneurysmal subarachnoid hemorrhage admitted to hospital between 2008 and 2014 in Norway. Acta Neurochir (Wien) 2020; 162:2251-2259. [PMID: 32601806 PMCID: PMC7415018 DOI: 10.1007/s00701-020-04463-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/13/2020] [Indexed: 01/23/2023]
Abstract
Background To provide age- and sex-specific incidence and case fatality rates for non-traumatic aneurysmal subarachnoid hemorrhage (aSAH) in Norway. We also studied time trends in incidence and case fatality, as well as predictors of death following aSAH. Methods A nationwide study using discharge data for patients admitted with aSAH between 2008 and 2014. Results A total of 1732 patients with aSAH were included. The mean age was 60 years (SD 14) and 63% were females. Crude annual incidence was 5.7 per 100,000 person-years (95% CI 5.4–6.0) and was higher in females (6.3 per 100,000, 95% CI 5.9–6.7) compared with males (4.9 per 100,000, 95% CI 4.5–5.3). The annual decline in aSAH incidence was 3.2% per year (p = 0.007). The cumulative proportions of fatalities at days 30, 90, and 1 year were 22%, 25%, and 37%, respectively. The 30-day mortality rate did not change during the study period. Age (HR 0.7–2.2) and aneurysms in the posterior circulation (HR 1.7, 95% CI 1.3–2.3, p = 0.001) were associated with higher 30-day case fatality following aSAH, while aneurysm repair (HR 0.2, 95% CI 0.2–0.3, p < 0.001) was associated with lower risk. Conclusions The incidence of aSAH declined in Norway between 2008 and 2014. Case fatality following aSAH continues to be high, and the 30-day mortality during the study period was unchanged. Increasing age and aneurysms in the posterior circulation were associated with increased risk of death within 30 days following aSAH.
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Affiliation(s)
- Lise R. Øie
- Department of Neurology, St. Olavs hospital, Trondheim University Hospital, 7006 Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ole Solheim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Neurosurgery, St.Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Paulina Majewska
- Department of Neurosurgery, St.Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trond Nordseth
- Department of Anesthesiology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tomm B. Müller
- Department of Neurosurgery, St.Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sven M. Carlsen
- Department of Endocrinology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Heidi Jensberg
- Department of Health Registries, Directorate of Health, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sasha Gulati
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Neurosurgery, St.Olavs hospital, Trondheim University Hospital, Trondheim, Norway
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Muloiwa R, Kagina BM, Engel ME, Hussey GD. The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis. BMC Med 2020; 18:233. [PMID: 32854714 PMCID: PMC7453720 DOI: 10.1186/s12916-020-01699-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An effective vaccine against Bordetella pertussis was introduced into the Expanded Programme on Immunisation (EPI) by WHO in 1974, leading to a substantial global reduction in pertussis morbidity and mortality. In low- and middle-income countries (LMICs), however, the epidemiology of pertussis remains largely unknown. This impacts negatively on pertussis control strategies in these countries. This study aimed to systematically and comprehensively review published literature on the burden of laboratory-confirmed pertussis in LMICs over the 45 years of EPI. METHODS Electronic databases were searched for relevant literature (1974 to December 2018) using common and MeSH terms for pertussis. Studies using PCR, culture or paired serology to confirm Bordetella pertussis and parapertussis in symptomatic individuals were included if they had clearly defined numerators and denominators to determine prevalence and mortality rates. RESULTS Eighty-two studies (49,167 participants) made the inclusion criteria. All six WHO regions were represented with most of the studies published after 2010 and involving mainly upper middle-income countries (n = 63; 77%). PCR was the main diagnostic test after the year 2000. The overall median point prevalence of PCR-confirmed Bordetella pertussis was 11% (interquartile range (IQR), 5-27%), while culture-confirmed was 3% (IQR 1-9%) and paired serology a median of 17% (IQR 3-23%) over the period. On average, culture underestimated prevalence by 85% (RR = 0.15, 95% CI, 0.10-0.22) compared to PCR in the same studies. Risk of pertussis increased with HIV exposure [RR, 1.4 (95% CI, 1.0-2.0)] and infection [RR, 2.4 (95% CI, 1.1-5.1)]. HIV infection and exposure were also related to higher pertussis incidences, higher rates of hospitalisation and pertussis-related deaths. Pertussis mortality and case fatality rates were 0.8% (95% CI, 0.4-1.4%) and 6.5% (95% CI, 4.0-9.5%), respectively. Most deaths occurred in infants less than 6 months of age. CONCLUSIONS Despite the widespread use of pertussis vaccines, the prevalence of pertussis remains high in LMIC over the last three decades. There is a need to increase access to PCR-based diagnostic confirmation in order to improve surveillance. Disease control measures in LMICs must take into account the persistent significant infant mortality and increased disease burden associated with HIV infection and exposure.
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Affiliation(s)
- Rudzani Muloiwa
- Department of Paediatrics & Child Health, Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, 7925, Cape Town, Republic of South Africa.
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, Republic of South Africa
| | - Mark E Engel
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, 7925, Cape Town, Republic of South Africa
| | - Gregory D Hussey
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, Republic of South Africa.,Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, Republic of South Africa
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Kamorudeen RT, Adedokun KA, Olarinmoye AO. Ebola outbreak in West Africa, 2014 - 2016: Epidemic timeline, differential diagnoses, determining factors, and lessons for future response. J Infect Public Health 2020; 13:956-962. [PMID: 32475805 DOI: 10.1016/j.jiph.2020.03.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 01/02/2023] Open
Abstract
The outbreak of Ebola virus disease (EVD) that raged between 2014 and 2016 in the West African sub-region was one of the global epidemics that spiked international public health concern in the last decade. Since the discovery of ebolavirus in 1976, the 2014-2016 epidemics have been the worst with significant case fatality rates and socioeconomic impact in the affected countries. This review looks at important health determinants that directly accounted for the spatial events of rapid spread and severity of EVD in West Africa, with consequent high fatality rates. It also brings up a time-point health determinant model to conceptualize understanding of this important outbreak with a view to enlightening the public andproviding valuable recommendations that may be crucial to preventing or curtailing any future outbreak of the disease.
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Affiliation(s)
- Ramat Toyin Kamorudeen
- Public Health Department, University of South Wales, Pontypridd, United Kingdom; Children Welfare Unit, Osun State Hospital Management Board, Asubiaro, Osogbo, Osun State, Nigeria
| | - Kamoru Ademola Adedokun
- Department of Oral Pathology, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Ayodeji Oluwadare Olarinmoye
- Engineer Abdullah Bugshan Research Chair for Dental and Oral Rehabilitation (DOR), King Saud University, Riyadh, Kingdom of Saudi Arabia; Centre for Control and Prevention of Zoonoses (CCPZ), University of Ibadan, Ibadan, Nigeria
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Darney BG, Fuentes-Rivera E, Polo G, Saavedra-Avendaño B, Alexander LT, Schiavon R. Con la ley y sin la ley/With and without the law: Utilization of abortion services and case fatality in Mexico, 2000-2016. Int J Gynaecol Obstet 2019; 148:369-374. [PMID: 31821537 PMCID: PMC7027437 DOI: 10.1002/ijgo.13077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/17/2019] [Accepted: 12/06/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe utilization of health services for, and case fatality from, abortion in Mexico. METHOD A historical cohort study using a census of state-level aggregate hospital discharge and primary care clinic data across Mexico's 32 states from January 2000 to December 2016. Abortive events and changes over time in utilization per 1000 women aged 15-44 years, and case fatality per 100 000 abortion-related events were described by year, health sector, and state. Associations of location (Mexico City vs 31 other states) and time (Mexico City implemented legal abortion services in 2007) with outcomes were tested by linear regression, controlling for secular trends. RESULTS The national abortion utilization rate was 6.7 per 1000 women in 2000, peaked at 7.9 in 2011, and plateaued to 7.0 in 2016. In Mexico City, utilization peaked at 16.7 in 2014 and then plateaued. Nationwide, the case-fatality rate declined over time from 53.7 deaths per 100 000 events in 2000 to 33.0 in 2016. Case fatality declined more rapidly in Mexico City than in the other 31 states to 12.3 in 2015. CONCLUSION Case fatality from abortive events has decreased across Mexico. Where abortion became legal, utilization increased sharply but plateaued afterward.
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Affiliation(s)
- Blair G Darney
- Department of Obstetrics and Gynecology and School of Public Health, Oregon Health & Science University, Portland, OR, USA.,Instituto Nacional de Salud Publica, Center for Population Health Research, Cuernavaca, Mexico
| | - Evelyn Fuentes-Rivera
- Instituto Nacional de Salud Publica, Center for Population Health Research, Cuernavaca, Mexico
| | | | | | - Lily T Alexander
- Department of Global Health, University of Washington, Seattle, WA, USA
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Gabet A, Danchin N, Puymirat E, Tuppin P, Olié V. Early and late case fatality after hospitalization for acute coronary syndrome in France, 2010-2015. Arch Cardiovasc Dis 2019; 112:754-764. [PMID: 31718932 DOI: 10.1016/j.acvd.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/08/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Case-fatality data for acute coronary syndromes (ACS) are scarce in unselected French patients. AIMS To analyse early and late case-fatality rates in patients with ACS in France, case fatality determinants and time trends between 2010 and 2015. METHODS For each year from 2010 to 2015, all patients hospitalized for ACS in France and aged>18 years were selected. Multivariable Cox models were used to assess determinants of case fatality at 3 days, 4-30 days and 31-365 days after hospital admission. RESULTS In 2015, cumulative 3-day, 30-day and 1-year case-fatality rates were, respectively, 2.0%, 5.1% and 11.1% for all patients with ACS, and 3.9%, 8.5% and 13.8% for those with ST-segment elevation myocardial infarction (STEMI). Admission through the emergency department was associated with a higher risk of death, particularly at 3 days. Female sex was associated with higher case-fatality rates at 3 days, but with lower case-fatality rates at 31-365 days. Social deprivation was associated with higher case-fatality rates for all periods for all patients with ACS. A significant decrease was found between 2010 and 2015 in case-fatality rates at 31-365 days, particularly for patients with STEMI; this time trend was no longer significant after additional adjustment for hospital management. CONCLUSIONS Case fatality up to 1 year after hospitalization for ACS was non-negligible, highlighting the need to ensure better follow-up after the acute stage, particularly in the most deprived patients. As hospital admission through the emergency department still occurs frequently, health policy should promote a national campaign to increase the awareness and preparedness of the general population regarding ACS. Finally, our results suggest that women need specific attention early after the index event.
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Affiliation(s)
- Amélie Gabet
- French Public Health Agency, 94410 Saint-Maurice, France.
| | - Nicolas Danchin
- Department of cardiology, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Etienne Puymirat
- Department of cardiology, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Philippe Tuppin
- General Health Insurance Scheme (Caisse nationale d'assurance maladie), 75020 Paris, France
| | - Valérie Olié
- French Public Health Agency, 94410 Saint-Maurice, France
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Barra M, Labberton AS, Faiz KW, Lindstrøm JC, Rønning OM, Viana J, Dahl FA, Rand K. Stroke incidence in the young: evidence from a Norwegian register study. J Neurol 2019; 266:68-84. [PMID: 30377817 DOI: 10.1007/s00415-018-9102-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 02/03/2023]
Abstract
Introduction While there is a general agreement that stroke incidence among the elderly is declining in the developed world, there is a concern that it may be increasing among the young. The present study investigates this issue for the Norwegian population for the years 2010–2015. Cerebrovascular accidents (CVAs) for patients younger than 55 years were identified through the Norwegian Patient Registry and the Norwegian Cause-of-death Registry. Methods Negative binomial regression modelling was used to estimate temporal trends in the CVA incidence rates for the young, aged 15–54, with 10-year sub-intervals, and for children below the age of 18. The main outcomes were CVA incidence per 100,000 person-years at risk (PY), 30-day stroke mortality per 100,000 PY, and 30-day case-fatality rates. Results The analysis showed a negative and non-significant temporal trend in the CVA incidence (\documentclass[12pt]{minimal}
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\begin{document}$$p = 0.052$$\end{document}p=0.052) as well as for 30-day mortality (\documentclass[12pt]{minimal}
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\begin{document}$$p = 0.074$$\end{document}p=0.074) for the age group 15–54. Overall, the inclusion of an interaction for age in the bracket 45–54 suggested that any temporal decline is restricted to this age bracket. The analyses of the 10-year age brackets 15–24, 25–34, and 34–45, provided evidence neither for an increase, nor for a decrease, in incidence. Among the children, the estimated temporal coefficients were positive, but non-significant, consistent with a stationary trend. Conclusion Weak statistical evidence was found for a decline in CVA incidence and for overall stroke 30-day case fatality for 15–54 year olds, but the decline was significant only for the 45–54 age band. All results considered, the study suggests a stationary or decreasing temporal trend in CVA incidence and stroke fatality for children (0–18) and young (15–54) in Norway. Even larger data sets are needed to estimate these temporal trends accurately.
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Ross JM, Henry NJ, Dwyer-Lindgren LA, de Paula Lobo A, Marinho de Souza F, Biehl MH, Ray SE, Reiner RC, Stubbs RW, Wiens KE, Earl L, Kutz MJ, Bhattacharjee NV, Kyu HH, Naghavi M, Hay SI. Progress toward eliminating TB and HIV deaths in Brazil, 2001-2015: a spatial assessment. BMC Med 2018; 16:144. [PMID: 30185204 PMCID: PMC6125942 DOI: 10.1186/s12916-018-1131-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/17/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Brazil has high burdens of tuberculosis (TB) and HIV, as previously estimated for the 26 states and the Federal District, as well as high levels of inequality in social and health indicators. We improved the geographic detail of burden estimation by modelling deaths due to TB and HIV and TB case fatality ratios for the more than 5400 municipalities in Brazil. METHODS This ecological study used vital registration data from the national mortality information system and TB case notifications from the national communicable disease notification system from 2001 to 2015. Mortality due to TB and HIV was modelled separately by cause and sex using a Bayesian spatially explicit mixed effects regression model. TB incidence was modelled using the same approach. Results were calibrated to the Global Burden of Disease Study 2016. Case fatality ratios were calculated for TB. RESULTS There was substantial inequality in TB and HIV mortality rates within the nation and within states. National-level TB mortality in people without HIV infection declined by nearly 50% during 2001 to 2015, but HIV mortality declined by just over 20% for males and 10% for females. TB and HIV mortality rates for municipalities in the 90th percentile nationally were more than three times rates in the 10th percentile, with nearly 70% of the worst-performing municipalities for male TB mortality and more than 75% for female mortality in 2001 also in the worst decile in 2015. The same municipality ranking metric for HIV was observed to be between 55% and 61%. Within states, the TB mortality rate ratios by sex for municipalities in the worst decile versus the best decile varied from 1.4 to 2.9, and HIV varied from 1.4 to 4.2. The World Health Organization target case fatality rate for TB of less than 10% was achieved in 9.6% of municipalities for males versus 38.4% for females in 2001 and improved to 38.4% and 56.6% of municipalities for males versus females, respectively, by 2014. CONCLUSIONS Mortality rates in municipalities within the same state exhibited nearly as much relative variation as within the nation as a whole. Monitoring the mortality burden at this level of geographic detail is critical for guiding precision public health responses.
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Affiliation(s)
- Jennifer M Ross
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.,Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Laura A Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Andrea de Paula Lobo
- Department of Public Health, University of Brasilia, Distrito Federal, Brazil.,Department of Health Surveillance, Ministry of Health, Brasilia, Brazil
| | | | - Molly H Biehl
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Sarah E Ray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Rebecca W Stubbs
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Kirsten E Wiens
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Michael J Kutz
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Natalia V Bhattacharjee
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Hmwe H Kyu
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA.
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Parikh SR, Campbell H, Gray SJ, Beebeejaun K, Ribeiro S, Borrow R, Ramsay ME, Ladhani SN. Epidemiology, clinical presentation, risk factors, intensive care admission and outcomes of invasive meningococcal disease in England, 2010-2015. Vaccine 2018; 36:3876-3881. [PMID: 29699791 DOI: 10.1016/j.vaccine.2018.02.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 01/08/2023]
Abstract
The epidemiology of invasive meningococcal disease (IMD) is constantly changing as new strains are introduced into a population and older strains are removed through vaccination, population immunity or natural trends. Consequently, the clinical disease associated with circulating strains may also change over time. In England, IMD incidence has declined from 1.8/100,000 in 2010/2011 to 1.1/100,000 in 2013/2014, with a small increase in 2014/2015 to 1.3/100,000. Between 01 January 2011 and 30 June 2015, MenB was responsible for 73.0% (n = 2489) of 3411 laboratory-confirmed IMD cases, followed by MenW (n = 371, 10.9%), MenY (n = 373, 10.9%) and MenC (n = 129, 3.8%); other capsular groups were rare (n = 49, 1.4%). Detailed questionnaires were completed for all 3411 laboratory-confirmed cases. Clinical presentation varied by capsular group and age. Atypical presentations were uncommon (244/3411; 7.2%), increasing from 1.2% (41/3411) in children to 3.5% (120/3411) in older adults. Known IMD risk factors were rare (18/3411; 0.5%) and included complement deficiency (n = 11), asplenia (n = 6) or both (n = 1). Nearly a third of cases required intensive care (1069/3411; 31.3%), with rates highest in adults. The 28-day CFR was 6.9% (n = 237), with the lowest rates in 0-14 year-olds (85/1885, 4.5%) and highest among 85+ year-olds (30/94, 31.9%). These observations provide a useful baseline for the current burden of IMD in a European country with enhanced national surveillance.
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Affiliation(s)
- Sydel R Parikh
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom.
| | - Helen Campbell
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
| | - Stephen J Gray
- Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom
| | - Kazim Beebeejaun
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
| | - Sonia Ribeiro
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
| | - Ray Borrow
- St. George's University of London, United Kingdom
| | - Mary E Ramsay
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
| | - Shamez N Ladhani
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom; St. George's University of London, United Kingdom
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Gierlotka M, Labuz-Roszak B, Wojtyniak B, Lasek-Bal A, Zdrojewski T, Adamczyk-Sowa M, Chwojnicki K, Skrzypek M, Ciesla D, Gasior M. Early and One-Year Outcomes of Acute Stroke in the Industrial Region of Poland During the Decade 2006-2015: The Silesian Stroke Registry. Neuroepidemiology 2018; 50:183-194. [PMID: 29587253 DOI: 10.1159/000487324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Poland, classified as a high-income country, is still considered to have a high cardiovascular risk population. During the last decade, the standards of care in acute stroke (AS) had markedly improved; thus, we aimed to assess whether and how it translated into early and late outcomes. METHODS Silesian Stroke Registry was created from the administrative database of the public, obligatory, health -insurer in Poland. The AS cases were selected based on primary diagnosis coded in ICD-10 as I60-I64 for years 2006-2015 (n = 120,844). Index hospitalization together with data on re-hospitalizations, procedures, ambulatory visits, rehabilitation and all-cause deaths in a 1-year follow-up were analyzed. RESULTS The rates of admissions per 100,000 adult population varied between 41-47 for haemorrhagic and 257-275 for ischaemic stroke with substantial decrease in almost all age groups except for the oldest patients. In ischaemic stroke, thrombolytic therapy raised from 0 to 8.8% in 2015, along with significant trends of decreasing 30-day (from 20 to 16%) and 12-month (from 35 to 31%) case fatality. In haemorrhagic stroke, case fatality had not changed. After ischaemic stroke, 12-month readmissions due to AS declined from 11-12% in 2006-2009 to 9% in 2010-2014. The percentage of patients benefiting from rehabilitation increased from 24 to 32%. CONCLUSIONS In a large population of industrial province, we showed recent, positive trends in AS admissions, treatment and 1-year outcomes. Development of stroke unit networks and increase in thrombolytic treatment were at least in part responsible for survival improvement and reduction of recurrence of AS. However, case-fatality and stroke recurrence remain high compared to those of other developed countries.
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Affiliation(s)
- Marek Gierlotka
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Beata Labuz-Roszak
- Department of Basic Medical Sciences, Faculty of Public Health, Medical University of Silesia, Katowice, Poland
| | - Bogdan Wojtyniak
- Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Medical Centre of Upper Silesia, Katowice, Poland
| | - Tomasz Zdrojewski
- Department of Arterial Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Monika Adamczyk-Sowa
- Department of Neurology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Kamil Chwojnicki
- Department of Neurology, Medical University of Gdansk, Gdansk, Poland
| | - Michal Skrzypek
- Department of Biostatistics, Faculty of Public Health, Medical University of Silesia, Katowice, Poland
| | - Daniel Ciesla
- Department of Science, Training and New Medical Technologies, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Mariusz Gasior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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Kontula KSK, Skogberg K, Ollgren J, Järvinen A, Lyytikäinen O. The outcome and timing of death of 17,767 nosocomial bloodstream infections in acute care hospitals in Finland during 1999-2014. Eur J Clin Microbiol Infect Dis 2018; 37:945-52. [PMID: 29455272 DOI: 10.1007/s10096-018-3211-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/02/2018] [Indexed: 01/23/2023]
Abstract
Few studies covering all patient groups and specialties are available regarding the outcome of nosocomial bloodstream infections (BSI). We analyzed the role of patient characteristics and causative pathogens of nosocomial BSIs reported by the hospitals participating in national surveillance in Finland during 1999-2014, in terms of outcome, with particular interest in those leading to death within 2 days (i.e. early death). National nosocomial BSI surveillance was laboratory-based and hospital-wide. Data on nosocomial BSIs was collected by infection control nurses, and dates of death were obtained from the national population registry with linkage to national identity codes. A total of 17,767 nosocomial BSIs were identified; 557 BSIs (3%) were fatal within 2 days and 1150 (6%) within 1 week. The 1-month case fatality was 14% (2460 BSIs), and 23% of the deaths occurred within 2 days and 47% within 1 week. The patients who died early were older than those who survived > 28 days, and their BSIs were more often related to intensive care. Gram-positive bacteria caused over half of the BSIs of patients who survived, whereas gram-negative bacteria, especially Pseudomonas aeruginosa, caused more often BSIs of patients who died early, and fungi BSIs of patients who died within 1 week. A significant portion of patients with nosocomial BSIs died early, which underlines the importance of rapid recognition of BSI. Hospital-wide surveillance data of causative pathogens can be utilized when composing recommendations for empiric antimicrobial treatment in collaboration with clinicians, as well as when promoting infection prevention.
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Val F, Avalos S, Gomes AA, Zerpa JEA, Fontecha G, Siqueira AM, Bassat Q, Alecrim MGC, Monteiro WM, Lacerda MVG. Are respiratory complications of Plasmodium vivax malaria an underestimated problem? Malar J 2017; 16:495. [PMID: 29273053 PMCID: PMC5741897 DOI: 10.1186/s12936-017-2143-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/18/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Respiratory complications are uncommon, but often life-threatening features of Plasmodium vivax malaria. This study aimed to estimate the prevalence and lethality associated with such complications among P. vivax malaria patients in a tertiary hospital in the Western Brazilian Amazon, and to identify variables associated with severe respiratory complications, intensive care need and death. Medical records from 2009 to 2016 were reviewed aiming to identify all patients diagnosed with P. vivax malaria and respiratory complications. Prevalence, lethality and risk factors associated with WHO defined respiratory complications, intensive care need and death were assessed. RESULTS A total of 587 vivax malaria patients were hospitalized during the study period. Thirty (5.1%) developed respiratory complications. Thirteen (43.3%) developed severe respiratory complications, intensive care was required for 12 (40%) patients and 5 (16.6%) died. On admission, anaemia and thrombocytopaenia were common findings, whereas fever was unusual. Patients presented different classes of parasitaemia and six were aparasitaemic on admission. Time to respiratory complications occurred after anti-malarials administration in 18 (60%) patients and progressed very rapidly. Seventeen patients (56.7%) had comorbidities and/or concomitant conditions, which were significantly associated to higher odds of developing severe respiratory complications, need for intensive care and death (p < 0.05). CONCLUSION Respiratory complications were shown to be associated with significant mortality in this population. Patients with comorbidities and/or concomitant conditions require special attention to avoid this potential life-threatening complication.
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Affiliation(s)
- Fernando Val
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil. .,Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil.
| | - Sara Avalos
- Microbiology Research Institute, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - André Alexandre Gomes
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - José Evelio Albornoz Zerpa
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Gustavo Fontecha
- Microbiology Research Institute, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - André Machado Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Quique Bassat
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Universidad Europea de Madrid, Madrid, Spain
| | - Maria Graças Costa Alecrim
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil. .,Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil.
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil.,Instituto de Pesquisas Leônidas and Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
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Mehl A, Åsvold BO, Lydersen S, Paulsen J, Solligård E, Damås JK, Harthug S, Edna TH. Burden of bloodstream infection in an area of Mid-Norway 2002-2013: a prospective population-based observational study. BMC Infect Dis 2017; 17:205. [PMID: 28284196 PMCID: PMC5346205 DOI: 10.1186/s12879-017-2291-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/24/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Studies from several countries indicate that the incidence and mortality of bloodstream infection (BSI) have been increasing over time. METHODS We studied the burden of disease and death related to BSI in a defined geographical area of Mid-Norway, where BSI episodes were prospectively recorded by the same microbiological department during 12 consecutive years. Death from BSI was defined as death within 30 days of BSI detection. Age and sex standardized incidence and mortality rates and case fatality rates were calculated. RESULTS Between 2002 and 2013, 1995 episodes of BSI in 1719 patients aged 16 to 99 years were included. The overall incidence of BSI was 215 per 100,000 person-years. The incidence increased exponentially with age, particularly in males. The incidence increased from 205 to 223 per 100,000 person-years from 2002-07 to 2008-13. Escherichia coli was the most frequently isolated infective agent, followed by Streptococcus pneumoniae and Staphylococcus aureus. The rate of S. pneumoniae BSI decreased over time in males (on average by 9.2% annually), but not in females. The total rate of BSI microbes with acquired resistance increased slightly over time, but did not exceed 2 episodes per 100,000 person-years. The mortality of BSI was 32 per 100,000 person-years, higher in males than in females (36 vs. 28 per 100,000 person-years) and was significantly higher in old age, particularly in males. The total BSI mortality was similar in the first and second halves of the study period, but the mortality of S. pneumoniae BSI decreased in males (15.0% annually). The crude case fatality decreased from the first to the second half of the study period (17.2% to 13.1%; p = 0.014). The rate of blood culture sampling increased more than twofold during the study period. CONCLUSIONS The mortality of BSI remained stable during 2002-2013. At the same time, BSI incidence increased and case fatality rate decreased, perhaps because an increased rate of blood culture sampling may have led to improved detection of milder BSI episodes. Very low, yet slightly increasing rates of microbes with acquired resistance were observed.
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Affiliation(s)
- Arne Mehl
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, post box 333, Levanger, N-7601, Norway. .,Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. .,Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Trondheim, Norway.
| | - Bjørn Olav Åsvold
- Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Trondheim, Norway.,Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Julie Paulsen
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, post box 333, Levanger, N-7601, Norway.,Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Trondheim, Norway.,Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik Solligård
- Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Trondheim, Norway.,Clinic of Anaesthesia and Intensive Care, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Kristian Damås
- Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Trondheim, Norway.,Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Infectious Diseases, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Tom-Harald Edna
- Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Levira F, Thurman DJ, Sander JW, Hauser WA, Hesdorffer DC, Masanja H, Odermatt P, Logroscino G, Newton CR. Premature mortality of epilepsy in low- and middle-income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy. Epilepsia 2016; 58:6-16. [PMID: 27988968 PMCID: PMC7012644 DOI: 10.1111/epi.13603] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/29/2022]
Abstract
To determine the magnitude of risk factors and causes of premature mortality associated with epilepsy in low- and middle-income countries (LMICs). We conducted a systematic search of the literature reporting mortality and epilepsy in the World Bank-defined LMICs. We assessed the quality of the studies based on representativeness; ascertainment of cases, diagnosis, and mortality; and extracted data on standardized mortality ratios (SMRs) and mortality rates in people with epilepsy. We examined risk factors and causes of death. The annual mortality rate was estimated at 19.8 (range 9.7-45.1) deaths per 1,000 people with epilepsy with a weighted median SMR of 2.6 (range 1.3-7.2) among higher-quality population-based studies. Clinical cohort studies yielded 7.1 (range 1.6-25.1) deaths per 1,000 people. The weighted median SMRs were 5.0 in male and 4.5 in female patients; relatively higher SMRs within studies were measured in children and adolescents, those with symptomatic epilepsies, and those reporting less adherence to treatment. The main causes of death in people with epilepsy living in LMICs include those directly attributable to epilepsy, which yield a mean proportional mortality ratio (PMR) of 27.3% (range 5-75.5%) derived from population-based studies. These direct causes comprise status epilepticus, with reported PMRs ranging from 5 to 56.6%, and sudden unexpected death in epilepsy (SUDEP), with reported PMRs ranging from 1 to 18.9%. Important causes of mortality indirectly related to epilepsy include drowning, head injury, and burns. Epilepsy in LMICs has a significantly greater premature mortality, as in high-income countries, but in LMICs the excess mortality is more likely to be associated with causes attributable to lack of access to medical facilities such as status epilepticus, and preventable causes such as drowning, head injuries, and burns. This excess premature mortality could be substantially reduced with education about the risk of death and improved access to treatments, including AEDs.
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Affiliation(s)
- Francis Levira
- Ifakara Health Institute, Dar-es-Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - David J Thurman
- Department of Neurology, Emory University, Atlanta, Georgia, U.S.A
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, United Kingdom.,Epilepsy Institute in The Netherlands (SEIN), Heemstede, The Netherlands
| | - W Allen Hauser
- Sergievsky Center, Columbia University Medical Center, New York, New York, U.S.A
| | - Dale C Hesdorffer
- Sergievsky Center, Columbia University Medical Center, New York, New York, U.S.A
| | | | - Peter Odermatt
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Charles R Newton
- Department of Neurosciences, Institute of Child Health, University College London, London, United Kingdom.,Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Tuomikoski P, Salomaa V, Havulinna A, Airaksinen J, Ketonen M, Koukkunen H, Ukkola O, Kesäniemi YA, Lyytinen H, Ylikorkala O, Mikkola TS. Decreased mortality risk due to first acute coronary syndrome in women with postmenopausal hormone therapy use. Maturitas 2016; 94:106-109. [PMID: 27823727 DOI: 10.1016/j.maturitas.2016.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The role of postmenopausal hormone therapy (HT) in the incidence of acute coronary syndrome (ACS) has been studied extensively, but less is known of the impact of HT on the mortality risk due to an ACS. STUDY DESIGN AND MAIN OUTCOME MEASURES We extracted from a population-based ACS register, FINAMI, 7258 postmenopausal women with the first ACS. These data were combined with HT use data from the National Drug Reimbursement Register; 625 patients (9%) had used various HT regimens. The death risks due to ACS before admission to hospital, 2-28, or 29-365days after the incident ACS were compared between HT users and non-users with logistic regression analyses. RESULTS In all follow-up time points, the ACS death risks in HT ever-users were smaller compared to non-users. Of women with HT ever use, 42% died within one year as compared with 52% of non-users (OR 0.62, p<0.001). Most deaths (84%) occurred within 28days after the ACS, and in this group 36% of women with ever use of HT (OR 0.73, p=0.002) and 30% of women with ≥5year HT use (OR 0.54, p<0.001) died as compared to 43% of the non-users. Age ≤60 or >60 years at the HT initiation was accompanied with similar reductions in ACS mortality risk. CONCLUSIONS Postmenopausal HT use is accompanied with reduced mortality risk after primary ACS.
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Affiliation(s)
- Pauliina Tuomikoski
- University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland
| | - Veikko Salomaa
- THL-National Institute for Health and Welfare, PO BOX 30, 00271 Helsinki, Finland
| | - Aki Havulinna
- THL-National Institute for Health and Welfare, PO BOX 30, 00271 Helsinki, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital and Department of Clinical Medicine, University of Turku, Turku, Finland
| | | | | | - Olavi Ukkola
- Research Institute of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Y Antero Kesäniemi
- Research Institute of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heli Lyytinen
- University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland
| | - Olavi Ylikorkala
- University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland
| | - Tomi S Mikkola
- University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland; Folkhälsan Research Center, Biomedicum, 00029 Helsinki, Finland.
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Hadeler KP, Dietz K, Safan M. Case fatality models for epidemics in growing populations. Math Biosci 2016; 281:120-127. [PMID: 27668847 DOI: 10.1016/j.mbs.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 08/31/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
Abstract
The asymptotically homogeneous SIR model of Thieme (1992) for growing populations, with incidence depending in a general way on total population size, is reconsidered with respect to other parameterizations that give clear insight into epidemiological relevant relations and thresholds. One important feature of the present approach is case fatality as opposed to differential mortality. Although case fatality models and differential mortality models are equivalent via a transformation in parameter space, the underlying ideas and the dynamic behaviors are different, e.g. the basic reproduction number depends on differential mortality but not on case fatality. The persistent distributions and exponents of growth of infected solutions are computed and discussed in terms of the parameters. The notion of asymptotically exponentially growing state (as opposed to stationary state or exponential solution) coined by Thieme is interpreted in terms of stability theory. Of some interest are limiting cases of models without recovery where two infected solutions exist.
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Affiliation(s)
| | - Klaus Dietz
- Medical Biometry, University of Tübingen, 72076 Tübingen, Germany.
| | - Muntaser Safan
- Biomathematics, University of Tübingen, 72076 Tübingen, Germany; Medical Biometry, University of Tübingen, 72076 Tübingen, Germany; Department of Mathematical Sciences, Faculty of Applied Science, Umm Al-Qura University, Makkah 21955, Saudi Arabia; Mathematics Department, Faculty of Science, Mansoura University, Mansoura 35516, Egypt.
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