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Evaluating the burden and transmission dynamics of chikungunya virus infections in the Eastern Mediterranean Region: a systematic review and meta-analysis. 评估东地中海区域基孔肯雅病毒感染的负担和传播动态:系统回顾和荟萃分析。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 DOI: 10.1093/eurpub/ckae165
Riyaz Ahamed Shaik, Mohammad Shakil Ahmad, Mohammad Miraj, Waqas Sami, Alashjaee Ahmed Azam, Patrick Okwarah

The Chikungunya virus (CHIKV) presents substantial public health challenges in the Eastern Mediterranean Region (EMR), with its prevalence and interaction with other arboviruses (ABVs) remaining poorly understood. This systematic review and meta-analysis aimed to assess the prevalence of CHIKV and its association with other ABVs, such as dengue virus (DENV), Rift Valley fever virus (RVFV), malaria, and yellow fever virus (YFV), in the EMR. We systematically searched databases including PubMed, Embase, Web of Science, Scopus, Cochrane Library, CINAHL, PsycINFO, and ScienceDirect to identify epidemiological studies that report CHIKV prevalence and provide odds ratios (ORs) for CHIKV compared to other ABVs. Data analysis was performed using a random-effects model. Heterogeneity was evaluated using the χ2 test and I2 statistic. The GRADE approach was used to evaluate the quality of the studies while the AXIS tool, NOS tool, and AHRQ checklist assessed the risk of bias. The meta-analysis revealed a significant prevalence of CHIKV in the EMR. However, the studies exhibited heterogeneity, indicating variability in the results. A comparison of CHIKV with other ABVs did not show any statistically significant differences in prevalence. The meta-analysis found a notable prevalence of CHIKV in the EMR. The results also indicated that the prevalence of CHIKV is comparable to that of other ABVs in the region. These findings provide an overview of the burden of CHIKV in the EMR.

基孔肯雅病毒(CHIKV)在东地中海区域(EMR)构成了重大的公共卫生挑战,其流行情况及其与其他虫媒病毒(abv)的相互作用仍然知之甚少。本系统综述和荟萃分析旨在评估CHIKV在EMR中的流行情况及其与其他abv(如登革热病毒(DENV)、裂谷热病毒(RVFV)、疟疾和黄热病病毒(YFV)的关系。我们系统地检索了PubMed、Embase、Web of Science、Scopus、Cochrane Library、CINAHL、PsycINFO和ScienceDirect等数据库,以确定报告CHIKV患病率的流行病学研究,并提供CHIKV与其他abv的比值比(or)。数据分析采用随机效应模型。采用χ2检验和I2统计量评价异质性。GRADE方法用于评价研究质量,AXIS工具、NOS工具和AHRQ检查表评估偏倚风险。荟萃分析显示,CHIKV在EMR的流行率很高。然而,这些研究显示出异质性,表明结果存在差异。CHIKV与其他abv的比较没有显示出任何统计学上的显著差异。荟萃分析发现,CHIKV在EMR的流行率显著。结果还表明,该地区CHIKV的流行程度与其他abv相当。这些发现提供了EMR中CHIKV负担的概述。
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引用次数: 0
Bartonellosis in World Health Organization Eastern Mediterranean Region, a systematic review and meta-analysis. 世界卫生组织东地中海区域巴尔通体病的系统回顾和荟萃分析。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 DOI: 10.1093/eurpub/ckae123
Zahra Tahmasebi Ashtiani, Fahimeh Bagheri Amiri, Mozhgan Ahmadinezhad, Ehsan Mostafavi, Saber Esmaeili

Bartonella is a vector-borne zoonotic pathogen, which could also be transmitted directly and cause a variety of clinical illnesses. This study aimed to investigate the prevalence of Bartonella in countries in the WHO Eastern Mediterranean Region (WHO-EMR) region. We searched using the keywords Bartonella and the name of each country in the WHO-EMR in databases such as PubMed, ISI (Web of Science), Scopus, and Google Scholar, with a publication date range of 1990-2022 and limited to English articles. We evaluated the quality of the studies using the STROBE 6-item checklist and used the random effects model to integrate the findings of the included studies. A total of 45 papers out of 240 were included in the analysis. The results showed the prevalence of Bartonella infection among endocarditis patients was 3.8% (95% CI: 0.2-7.4) and the seroprevalence of Bartonella among other people was 27.5% (95% CI: 13.5-41.5). The overall prevalence of Bartonella spp. among animals, as determined by molecular, serological, and culture methods, was 11.9% (95% CI: 5.7-18.2), 38.9% (95% CI: 27.5-50.2), and 1.7% (95% CI: 0.5-2.9), respectively. Furthermore, the prevalence of Bartonella spp. in ectoparasites was 3.9% (95% CI: 3.5-5.2), with fleas (6.2%) showing a higher prevalence compared to lice (4.9%) and ticks (1.0%). The detection of Bartonella in all animal and ectoparasites species and human populations in the WHO-EMR with prevalence ranging from 0.3% to 23% is concerning, emphasizes the importance of conducting more comprehensive studies to gain a deeper understanding of the spread of Bartonella in these areas.

巴尔通体是一种媒介传播的人畜共患病原体,可直接传播,引起多种临床疾病。本研究旨在调查世卫组织东地中海区域(WHO- emr)各国巴尔通体流行情况。我们在PubMed、ISI (Web of Science)、Scopus和谷歌Scholar等数据库中使用关键字巴尔通体和WHO-EMR中每个国家的名称进行检索,出版日期范围为1990-2022年,仅限于英文文章。我们使用STROBE 6项检查表评估研究的质量,并使用随机效应模型整合纳入研究的结果。240篇论文中有45篇被纳入分析。结果显示心内膜炎患者巴尔通体感染率为3.8% (95% CI: 0.2 ~ 7.4),其他人群巴尔通体血清感染率为27.5% (95% CI: 13.5 ~ 41.5)。通过分子、血清学和培养方法确定的巴尔通体在动物中的总体流行率分别为11.9% (95% CI: 5.7-18.2)、38.9% (95% CI: 27.5-50.2)和1.7% (95% CI: 0.5-2.9)。此外,巴尔通体在体外寄生虫中的流行率为3.9% (95% CI: 3.5 ~ 5.2),蚤(6.2%)的流行率高于虱(4.9%)和蜱(1.0%)。世卫组织emr在所有动物和体外寄生虫种类以及人群中检测到巴尔通体,其流行率为0.3%至23%,这令人担忧,强调了开展更全面研究以更深入了解巴尔通体在这些地区传播的重要性。
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引用次数: 0
Correction to: Breastfeeding duration, children's diet and physical activity in immigrant children living in Lisbon. 更正:居住在里斯本的移民儿童的母乳喂养时间、儿童饮食和身体活动。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-24 DOI: 10.1093/eurpub/ckae210
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引用次数: 0
Opinion of Polish doctors on the use of futile therapy. 波兰医生对无效治疗的看法。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-20 DOI: 10.1093/eurpub/ckae202
Maria Damps, Maksymilian Gajda, Łukasz Wiktor, Elżbieta Byrska-Maciejasz, Beata Rybojad, Małgorzata Kowalska, Alicja Bartkowska-Śniatkowska, Anna Paprocka-Lipińska, Ewa Kucewicz-Czech

The discontinuation of futile therapy is increasingly discussed in Polish clinical practice. Given the need to ensure patient well-being, it is essential to consider whether all clinical options resulting from medical progress should be used for every patient and on what grounds decisions to limit therapy should be based. The aim of our study was to determine the opinions of Polish medical doctors on this topic. We anonymously surveyed physicians across various specialties. An analysis of the collected data was carried out using descriptive and analytical methods. A total of 323 physicians participated in the study; 93% of them were aware of the problem of futile therapy in adults, with intensivists being significantly more aware (P = 0.002). Additionally, 95% of respondents supported the idea of discontinuing futile therapy, and over 68% used the therapy discontinuation protocol. Among the most common reasons for undertaking futile therapy, respondents cited fear of legal liability (93.5%), as well as fear of being accused of unethical behavior (62.2%) and fear before talking to the patient/patient's family and their reactions (57.9%). Respondents also identified factors that would facilitate making decisions about limiting futile therapy, including precise qualification criteria for limiting therapy and education in this area (95.3%), the patient's declaration of will (87.5%), and a clear legal act (81.3%). The majority of study participants supported the idea of limiting futile therapy, and this issue is well known among Polish physicians.

在波兰的临床实践中,越来越多地讨论了无效治疗的停止。考虑到需要确保病人的健康,必须考虑是否应该对每一个病人使用医学进展产生的所有临床选择,以及限制治疗的决定应该基于什么理由。我们研究的目的是确定波兰医生对这个话题的看法。我们匿名调查了不同专业的医生。使用描述性和分析性方法对收集的数据进行了分析。共有323名医生参与了这项研究;93%的受访医师意识到成人治疗无效的问题,其中强化医师的意识明显更高(P = 0.002)。此外,95%的受访者支持停止无效治疗的想法,超过68%的人使用了治疗停止方案。在接受无效治疗的最常见原因中,受访者表示害怕承担法律责任(93.5%),以及害怕被指控不道德行为(62.2%)和害怕与患者/患者家属交谈及其反应(57.9%)。受访者还确定了有助于做出限制无效治疗决定的因素,包括限制治疗的精确资格标准和该领域的教育(95.3%),患者的遗嘱声明(87.5%)和明确的法律行为(81.3%)。大多数研究参与者支持限制无效治疗的想法,这个问题在波兰医生中是众所周知的。
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引用次数: 0
Correction to: Prospective relationship between family screen time rules, obesogenic behaviours, and childhood obesity. 更正:家庭屏幕时间规则、致肥行为和儿童肥胖之间的前瞻性关系。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-15 DOI: 10.1093/eurpub/ckae207
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引用次数: 0
Screen-detected breast cancer and cancer stage by area-level deprivation: a descriptive analysis using data from the National Cancer Registry Ireland. 按地区贫困程度分列的筛查出的乳腺癌和癌症分期:利用爱尔兰国家癌症登记处的数据进行的描述性分析。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-13 DOI: 10.1093/eurpub/ckae204
Philippa White, Aline Brennan, Joe McDevitt, Deirdre Murray, Caroline Mason Mohan, Patricia Fitzpatrick, Therese Mooney, Alan Smith, Maeve Mullooly, Niamh Bambury

Breast cancer screening programmes can lead to better disease outcomes, but women from deprived backgrounds are less likely to participate and more likely to present with late-stage cancer. This study aimed to explore associations between deprivation and breast cancer screening outcomes in Ireland during 2009-2018. Data on all female breast cancer cases diagnosed in Ireland during 2009-2018 were extracted from the National Cancer Registry Ireland. Associations between area-level deprivation, using the Pobal Haase-Pratschke deprivation index, and detection of breast cancer through BreastCheck, Ireland's breast screening programme, and stage of screen-detected breast cancer were explored. Unadjusted risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. Among screening eligible women in Ireland in 2009-2018, there was no difference in risk of breast cancer detection through BreastCheck across deprivation quintiles (RR for most compared to least deprived group: 1.01, 95% CI: 0.96-1.06). In women with screen-detected breast cancer, the risk of late-stage cancer detection increased with deprivation in 2009-2013 (RR for most compared to least deprived group: 1.45, 95% CI: 1.10-1.93), but no association was observed between deprivation and cancer stage in 2014-2018. Notwithstanding its limitations, including the risk of confounding by uncontrolled variables, this study suggests screening eligible women in Ireland have had similar outcomes from breast cancer screening, regardless of deprivation level, since the national roll-out of BreastCheck. Associations between deprivation and screening outcomes should continue to be monitored to ensure Ireland's breast cancer screening programme is helping to reduce health inequities.

乳腺癌筛查项目可以带来更好的疾病结果,但是来自贫困背景的妇女参与的可能性较小,而且更有可能出现晚期癌症。本研究旨在探讨2009-2018年爱尔兰贫困与乳腺癌筛查结果之间的关系。2009-2018年期间爱尔兰诊断出的所有女性乳腺癌病例的数据来自爱尔兰国家癌症登记处。使用Pobal Haase-Pratschke剥夺指数的地区剥夺与通过BreastCheck(爱尔兰的乳房筛查计划)检测乳腺癌以及筛查发现的乳腺癌阶段之间的联系进行了探讨。计算未调整风险比(RRs)和95%置信区间(ci)。在2009-2018年爱尔兰符合筛查条件的女性中,通过乳房检查发现乳腺癌的风险在剥夺五分位数之间没有差异(大多数与最不剥夺组的RR: 1.01, 95% CI: 0.96-1.06)。在筛查出乳腺癌的女性中,在2009-2013年,随着剥夺剥夺,晚期癌症检测的风险增加(与最剥夺组相比,剥夺剥夺组的RR: 1.45, 95% CI: 1.10-1.93),但在2014-2018年,剥夺剥夺与癌症分期之间没有观察到关联。尽管有其局限性,包括不受控制的变量混淆的风险,但该研究表明,自全国推广乳房检查以来,爱尔兰筛查符合条件的妇女从乳腺癌筛查中获得了相似的结果,无论剥夺程度如何。应继续监测贫困与筛查结果之间的关系,以确保爱尔兰的乳腺癌筛查方案有助于减少保健不平等现象。
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引用次数: 0
The different definitions of multimorbidity and their implications for research, surveillance, and policy. 多病症的不同定义及其对研究、监测和政策的影响。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-02 DOI: 10.1093/eurpub/ckae193
Sarah Cuschieri, Saverio Stranges, Tatjana T Makovski
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引用次数: 0
HPV-associated cancers among people living with HIV: nationwide population-based retrospective cohort study 2004-21 in Estonia. 艾滋病病毒感染者中与人乳头瘤病毒相关的癌症:爱沙尼亚 2004-21 年全国范围内基于人群的回顾性队列研究。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-01 DOI: 10.1093/eurpub/ckae152
Anna Tisler, Karolin Toompere, Marc Bardou, Jose Diaz, Madleen Orumaa, Anneli Uusküla

Cancers represent the primary cause of mortality among people living with HIV (PLWH). However, comprehensive nationwide data regarding cancer incidence remains limited. Our objective was to evaluate the incidence rates of cancers, particularly those associated with human papillomavirus (HPV), within a nationwide study cohort. Using data from the Estonian Health Insurance Fund and the National Cancer Registry from 2004 to 2021, we calculated standardized incidence ratios (SIRs) for various cancer types among PLWH to compare to the general population with special emphases on HPV-associated cancers. A total of 7011 individuals (65.7% men) diagnosed with HIV were identified. HPV-associated cancers accounted for 21.4% of all incident cancer cases among PLWH. SIRs for HPV-associated cancers were 3.7 [95% confidence interval (CI) 2.2-6.2] among men living with HIV (MLWH) and 5.7 (95% CI 4.0-7.9) among women living with HIV (WLWH). In MLWH, the highest SIRs were for penile 12.5 (95% CI 4.0-38.7), followed by oropharyngeal 3.6 (95% CI 1.7-7.6) and anal-rectal cancers 2.7 (95% CI 1.1-6.4) in comparison to the general population. In WLWH, an increased incidence of cervical (SIR = 5.8, 95% CI 3.9-8.5), oropharyngeal (SIR = 6.1, 95% CI 1.5-24.3), and anal-rectal (SIR = 3.6, 95% CI 1.2-11.2) cancers was observed. A significantly increased risk of AIDS-defining and non-AIDS-defining cancers is reported. We demonstrate a substantially heightened risk of HPV-associated cancers among PLWH compared to the general population, underscoring the imperative for intensified screening and scaled-up vaccination along with improvement in adherence to antiretroviral therapy.

癌症是艾滋病病毒感染者(PLWH)死亡的主要原因。然而,有关癌症发病率的全国性综合数据仍然有限。我们的目标是评估全国性研究队列中的癌症发病率,尤其是与人类乳头瘤病毒(HPV)相关的癌症。利用爱沙尼亚健康保险基金和国家癌症登记处 2004 年至 2021 年的数据,我们计算了 PLWH 中各种癌症类型的标准化发病率(SIR),以便与普通人群进行比较,重点是与 HPV 相关的癌症。共确定了 7011 名艾滋病毒感染者(65.7% 为男性)。HPV相关癌症占 PLWH 所有癌症病例的 21.4%。在男性艾滋病病毒感染者(MLWH)和女性艾滋病病毒感染者(WLWH)中,HPV 相关癌症的 SIR 分别为 3.7 [95% 置信区间 (CI) 2.2-6.2] 和 5.7 (95% CI 4.0-7.9)。与普通人群相比,阴茎癌的 SIR 值最高,为 12.5 (95% CI 4.0-38.7),其次是口咽癌 3.6 (95% CI 1.7-7.6)和肛门直肠癌 2.7 (95% CI 1.1-6.4)。在 WLWH 中,观察到宫颈癌(SIR = 5.8,95% CI 3.9-8.5)、口咽癌(SIR = 6.1,95% CI 1.5-24.3)和肛门直肠癌(SIR = 3.6,95% CI 1.2-11.2)的发病率增加。报告显示,罹患艾滋病定义癌症和非艾滋病定义癌症的风险明显增加。我们的研究表明,与普通人群相比,PLWH 感染 HPV 相关癌症的风险大大增加,这就强调了在加强抗逆转录病毒治疗的同时,加强筛查和扩大疫苗接种的必要性。
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引用次数: 0
Disease management program in patients with type 2 diabetes. 2 型糖尿病患者的疾病管理计划。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-01 DOI: 10.1093/eurpub/ckae155
Mette Bender, Charlotte Glümer, Henrik Brønnum-Hansen, Ingelise Andersen, Karsten Vrangbæk

The aim of this paper was to study ethnic and socioeconomic (SEP) factors' association with provision and participation in a type 2 diabetes disease-management program. In 2016-21, 3464 persons were referred to type 2 diabetes management in Copenhagen municipality. Personalized plans included a mix of activities; program consultations, dietary education, telephone conversations, patient education, and physical training. We estimated the association between education, income, civic status, employment, and country of origin with the number of booked and participated activities using Poisson regression models. A total of 55 394 program sessions were scheduled. Small differences in booked dietary education, program consultations, telephone conversations, and patient education were seen between SEP groupings. In situations where groups with lower SEP had booked more sessions (e.g. unemployed bookings of dietary education), these were predominantly translated into equal or more participated sessions among persons with high SEP. Regarding physical training, considerably more booked and participated sessions were delivered to women with lower SEP and ethnic minorities. This study is unique, in the sense that it is the first of its kind to analyze data on diabetes-management programs, systematically collected by primary healthcare workers. Our results suggest that specific elements of the program together with a higher number of booked sessions promoted vulnerable women to participate in more physical training sessions. In closing, these findings have the potential to provide motivation and ideas for policymakers and health professionals in how to design equitable type 2 diabetes management activities.

本文旨在研究种族和社会经济(SEP)因素与提供和参与 2 型糖尿病疾病管理计划的关系。2016-21年间,哥本哈根市共有3464人转诊接受2型糖尿病管理。个性化计划包括各种活动;项目咨询、饮食教育、电话交谈、患者教育和体育训练。我们使用泊松回归模型估算了教育、收入、公民身份、就业和原籍国与预约和参与活动次数之间的关系。共安排了 55 394 次活动。不同 SEP 组别在预约饮食教育、项目咨询、电话交谈和患者教育方面存在微小差异。在 SEP 值较低的组别中,预订的课程较多(如失业者预订的饮食教育课程),而在 SEP 值较高的组别中,这些课程主要转化为相同或更多的参与课程。在体能训练方面,SEP 值较低的妇女和少数族裔预订和参与的课程都要多得多。这项研究是独一无二的,因为它是第一项对基层医疗工作者系统收集的糖尿病管理计划数据进行分析的研究。我们的研究结果表明,项目中的特定元素以及更多的预约课程促进了弱势妇女参加更多的体能训练课程。最后,这些研究结果有望为政策制定者和医疗专业人员提供如何设计公平的 2 型糖尿病管理活动的动力和思路。
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引用次数: 0
Association of unemployment and increased depressive symptoms with all-cause mortality: follow-up study of a cardiovascular prevention programme. 失业和抑郁症状加重与全因死亡率的关系:一项心血管预防计划的跟踪研究。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-01 DOI: 10.1093/eurpub/ckae175
Päivi E Korhonen, Hannu Kautiainen, Ansa T Rantanen

Unemployment has been associated with increased risk of cardiovascular disease (CVD) and all-cause mortality. However, factors behind this association remain unsettled. A primary care CVD prevention programme was conducted in two Finnish towns in 2005-07. Of the participants (n = 4450), a cohort of apparently healthy CVD risk subjects belonging to the labour force (n = 1487) was identified. Baseline depressive symptoms were assessed by Beck's Depression Inventory. Data on employment status and mortality were obtained from official statistics. The effect of employment status and depressive symptoms on all-cause mortality after a median follow-up of 15 years was estimated in models adjusted for age, sex, body mass index, non-high-density lipoprotein cholesterol, physical activity, alcohol use, current smoking, glucose metabolism, and hypertension. In comparison to employed non-depressive subjects, fully adjusted hazard ratio (HR) for all-cause mortality was 3.53 (1.90-6.57) in unemployed subjects with increased depressive symptoms, 1.26 (0.68-2.34) in unemployed non-depressive subjects, and 1.09 (0.63-1.90) in employed depressive subjects. Factors independently associated with mortality were unemployment with increased depressive symptoms [HR 3.56 (95% CI 1.92-6.61)], screen-detected diabetes [HR 2.71 (95% CI 1.59-4.63)], current smoking [HR 1.77 (95% CI 1.19-2.65)], and higher age [HR 1.10 (95% CI 1.05-1.15)]. Unemployment in itself was not associated with all-cause mortality. If unemployment was accompanied with increased depressive symptoms, risk of death was significantly elevated.

失业与心血管疾病(CVD)和全因死亡率风险增加有关。然而,这种关联背后的因素仍未确定。2005-2007年,芬兰在两个城镇开展了一项初级保健心血管疾病预防计划。在参与者(n = 4450)中,发现了一批属于劳动力的明显健康的心血管疾病高危人群(n = 1487)。基线抑郁症状由贝克抑郁量表进行评估。有关就业状况和死亡率的数据来自官方统计数据。在对年龄、性别、体重指数、非高密度脂蛋白胆固醇、体力活动、饮酒、目前吸烟、糖代谢和高血压进行调整后的模型中,估计了就业状况和抑郁症状对中位随访 15 年后全因死亡率的影响。与非抑郁症就业受试者相比,抑郁症状加重的失业受试者全因死亡率的完全调整危险比(HR)为 3.53(1.90-6.57),非抑郁症失业受试者为 1.26(0.68-2.34),抑郁症就业受试者为 1.09(0.63-1.90)。与死亡率独立相关的因素包括:失业导致抑郁症状加重[HR 3.56 (95% CI 1.92-6.61)]、筛查出糖尿病[HR 2.71 (95% CI 1.59-4.63)]、目前吸烟[HR 1.77 (95% CI 1.19-2.65)]和年龄较大[HR 1.10 (95% CI 1.05-1.15)]。失业本身与全因死亡率无关。如果失业同时伴有抑郁症状加重,则死亡风险会显著升高。
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引用次数: 0
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European Journal of Public Health
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