Global health & medicine最新文献

This study aims to identify and predict latent trajectories of depression and chronic disease among middle-aged and older adults in China using data-driven and interpretable machine learning methods, and to explore key factors that promote healthy aging. To achieve this, we analyzed longitudinal data from 13,073 middle-aged and older adults in the China Health and Retirement Longitudinal Study (CHARLS). Group-based multi-trajectory modeling (GBMTM) was applied to identify latent trajectory groups for depression and chronic disease statuses. Predictive factors included sociodemographic characteristics, health conditions, and lifestyle factors. Machine learning models and dynamic nomograms were used to predict trajectory groups, and model performance was evaluated using the area under the receiver operating characteristic curve (AUROC) and decision curve analysis (DCA). As a result, three main trajectory groups were identified: a normal healthy trajectory group (26.9%), a potential depression and disease increase trajectory group (55.6%), and a high depression and disease burden trajectory group (17.5%). Additionally, the study found that older age, disability, shorter sleep duration, and poor self-reported health status were associated with a higher likelihood of belonging to the latent depression and disease increase trajectory group or the high disease burden trajectory group, particularly among urban women. In conclusion, this study demonstrates that the GBMTM and machine learning models can effectively identify and predict depression and chronic disease trajectories. The identified predictors are crucial for developing targeted interventions to promote healthy aging among the middle-aged and older adults.

Vietnam is a lower-middle-income country where HIV drug resistance (DR) testing is not widely accessible, and antiretroviral therapy (ART) options remain limited. Since 2016, HIV services have gradually transitioned from international donor support to national Social Health Insurance (SHI). Under the decentralized policy of SHI, HIV treatment has been delivered at local neighborhood hospitals, where experience in managing ART failure is still lacking. This study evaluated a pilot model of centralized DR testing combined with decentralized treatment implementation in Northern Vietnam. Seven provincial hospitals and three healthcare facilities participated. Patients' viral loads (VL) were monitored every six months over a 48-month period (October 2019-September 2023). ART failure was defined as VL ≥ 1,000 copies/mL, which triggered DR testing at the National Hospital for Tropical Diseases in Hanoi. Based on DR results, tailored ART recommendations were provided to local hospitals and healthcare settings. The effectiveness of subsequent ART following DR testing was assessed by VL suppression at 90 days or later. Among 179 patients experiencing ART failure, DR testing was successful in 170 cases. DR mutations were detected in 126 patients (74.12%), while 44 (25.88%) showed no mutation. Patients who followed the ART recommendations had a significantly higher VL suppression rate (87.72%) than those who did not (70.37%, p = 0.026). This association was significant in district hospitals (87.50% vs. 60.00%, p = 0.032) but not in provincial hospitals (87.93% vs. 76.47%, p = 0.240). This study highlights the potential clinical benefit of our model in resource-limited situations, particularly where ART management capacity is limited.

Effective information transfer from hospitals to psychiatric home-visit nurses is essential for ensuring continuity of care. However, previous studies have suggested that discharge information is often inadequate, particularly regarding the psychosocial aspects of patient care. This study assessed home-visit nurses' subjective evaluations of the adequacy of patient information provided by hospitals in psychiatric home-visit nursing. A nationwide cross-sectional survey was distributed to 2,000 home-visit nursing agencies across Japan, yielding 482 responses. After excluding one invalid response, 481 responses were analyzed (response rate: 8.0%). The sufficiency of patient information was calculated as the logarithm of the ratio between the information received and the information requested by nurses. Wilcoxon signed-rank tests confirmed that all gaps between the information received and requested were significant (p < 0.001). The information that was least adequately provided included "psychological test results" (mean adequacy score = -0.23, SD = 0.28), "signs of worsening psychiatric symptoms" (mean adequacy score = -0.21, SD = 0.23), and "coping strategies for psychiatric symptoms" (mean adequacy score = -0.21, SD = 0.23). The information that was most adequately provided was "prescription details" (mean adequacy score = -0.07, SD = 0.16) and "diagnosis" (mean adequacy score = -0.09, SD = 0.18). To enhance information transfer, hospitals should review and revise discharge summaries to ensure the inclusion of critical items with low adequacy scores.

Prevention of new infections is important for the elimination of viral hepatitis B. Assessing the impact of the Coronavirus disease 2019 (COVID-19) pandemic on hepatitis B incidence is important for future infection control measures. A recent hospital-based questionnaire survey implied that a regional assessment in each country would be useful for establishing new preventive measures. This retrospective study examined publicly reported national data of patients diagnosed with acute hepatitis B in Japan between 2015 and 2022. The transition of total numbers, incidence, sex, and age distribution in each year were analyzed. Comparisons were made between populous and non-populous prefectures before and during the COVID-19 pandemic (2015-2019 vs. 2020-2022). A median of 210.0 patients with acute hepatitis B (interquartile range [IQR], 176.5-231.2 patients) were reported in each year. The number and incidence of acute hepatitis B cases significantly decreased during the pandemic, and the impact of COVID-19 was pronounced in males, especially in non-populous prefectures. Populous prefectures had significantly higher incidence in males compared with non-populous prefectures (3.55 [3.26-4.07] vs. 2.30 [1.78-2.64] cases per 1,000,000 people per year; p = 0.004), whereas those of females did not. Regarding patient age, the proportions of patients aged in their 20s, especially females, were higher in populous prefectures. These results may reflect differences in lifestyle, including sexual behaviors, in each population with the interaction of the COVID-19 pandemic. Identifying high-risk populations in each area and establishing a tailored strategy to eliminate viral hepatitis would be useful for countries worldwide.

As an economically important insect, the silkworm (Bombyx mori) occupies a central position in the silk industry. Its unique physiological characteristics make it a potential model animal for research on disease modeling and drug screening. The aim of this review was to explore the feasibility of the silkworm as a model animal for diabetes and to evaluate the potential application of this model in new drug discovery. Through high-glucose feeding and chemical induction, researchers successfully constructed silkworm models with diabetic phenotypes, which exhibited features such as hyperglycemia and insulin resistance similar to human diabetes. Subsequently, the researchers screened a variety of natural medicines and found that certain natural medicinal components were able to significantly reduce blood glucose levels and improve insulin sensitivity in the model silkworms. This review not only provides a new model animal for the pathophysiological study of diabetes, but also provides an experimental basis for the application of natural medicines in diabetes treatment, opens up a new way for the discovery of the active sub-ingredients of natural medicines, and is expected to provide a new strategy and source of medicines for the treatment of diabetes.

China introduced universal e-cigarette regulations in 2018 to curb youth vaping, including flavor bans, online sales prohibitions, and taxation. While these policies are not explicitly age-targeted, their design disproportionately impacts adolescents due to young people's price sensitivity, preference for flavored products, and reliance on online purchases. This study examines how such regulations achieve outcomes akin to age-based bans without directly restricting moral agency or risking discrimination. We believe that universal measures like flavor restrictions and taxes amplify their impact on youth through behavioral and economic mechanisms - termed "asymmetric amplification". Results suggest these policies effectively reduce youth vaping while sidestepping ethical controversies tied to generational bans. However, challenges like informal sales channels and adolescent stigma require complementary enforcement. This paper highlights a pragmatic and ethically sound approach to youth tobacco control and offers new insights into policy design for public health practitioners and regulators worldwide.

This article proposes a framework for emergency resilience based on a review of the literature and theoretical analysis. On this basis, the Delphi method and the Analytic Hierarchy Process have been used to create an index of the emergency resilience of urban public health management. This index includes 6 primary indicators, 22 secondary indicators, and 93 tertiary indicators. An evaluation using the created index indicated that Shanghai's public health emergency management scored 82 out of 100, which is generally a good score. However, there are still problems such as the lack of specificity and implementability in emergency plans, the lack of diversification of reserves of emergency supplies, the low degree of sharing emergency information and cooperation, failure to capitalize on the advantages of traditional Chinese medicine, and the shortage of public health personnel in local communities. Overall, the index of the emergency resilience of urban public health management as was created from the perspective of preventing and controlling major infectious diseases is scientific and reliable, and it can effectively evaluate the current state of emergency management in urban public health.

The number of foreign residents in Japan continues to increase, and many are of reproductive age. Foreign residents report many difficulties when receiving nursing care. Midwives and nurses also experience negative feelings about nursing care for foreigners. This study clarified the factors related to feelings toward nursing practices for foreign pregnant and postpartum residents among midwives and nurses at perinatal medical centers in Osaka, Japan. A web-based survey was conducted from 1 October to 31 December 2023. A research request form was distributed to 309 midwives and nurses working at nine perinatal medical centers in Osaka. Data for 82 participants were analyzed (response rate: 26.5%). The mean age was 35.7 ± 10.6 years; 76 participants (92.7%) were midwives. Logistic regression analysis was conducted to examine associations between several factors and the proportion of participants scoring above the median on each feeling. Participants with poor English-language skills reported significantly more frustration (multivariable-adjusted odds ratios [ORs] and 95% confidence intervals [CIs] for above-median scoring: 3.16 [1.03-9.66]). Participants who had not attended workshops on nursing care for foreign residents experienced more difficulty (OR: 4.60; 95% CI: 1.32-16.01), helplessness (OR: 4.39; 95% CI: 1.28-15.04), and uncertainty (OR: 5.29; 95% CI: 1.52-18.43). To reduce feelings of difficulty and increase positivity in providing nursing care to foreign residents with different languages, cultures, and customs, it is important to improve cross-cultural competency. Education programs, especially web-based interventions and individualized education programs that include workshops on cross-cultural competence, could be effective.

This study aimed to determine whether procedure volume is associated with 30-day mortality following endovascular thrombectomy (EVT) or intravenous recombinant tissue plasminogen activator (IV rt-PA) for stroke during the introduction period of EVT in Japan. Using nationwide claims records, we investigated data from 8,227 patients undergoing EVT and 13,406 and 6,035 patients undergoing rt-PA monotherapy in hospitals with and without EVT capability, respectively, between April 2014 and February 2016 in Japan. Procedure volume was categorized into three groups according to tertiles of the annual number of EVTs or IV rt-PA injections performed in the hospitals. Hierarchical logistic regression demonstrated that the odds ratio (95% confidence interval) of 30-day mortality following EVT was significantly lower in middle- (0.77 [0.62-0.96]) and high- (0.69 [0.53-0.89]) volume hospitals than that in low-volume hospitals even after adjusting for potential confounding factors. The generalized additive mixed models revealed no obvious threshold volume of EVT to reduce the mortality risk. By contrast, mortality risk following IV rt-PA monotherapy did not decrease in hospitals without EVT capability but did with increasing IV rt-PA volume in hospitals with EVT capability (P for heterogeneity 0.003). The risk of 30-day mortality after EVT for acute ischemic stroke decreased linearly according to EVT procedure volume in each hospital. However, the association between IV rt- PA volume and mortality risk was modified by the hospital's EVT capability. Further research is warranted to determine whether the volume-outcome relationship we observed is a temporary phenomenon following EVT or a consistent trend over time.

Pancreatitis is a rapidly expanding global non-communicable disease, marked by substantial disparities across populations. However, comprehensive long-term assessments of global health inequalities remain scarce. This study examined inequality in the pancreatitis burden from 1990 to 2021, identified principal determinants, and forecasted future trends across countries with varying Socio-demographic Index (SDI) levels. Using data from the Global Burden of Disease 2021, we assessed inequalities in the prevalence, incidence, and disability-adjusted life years of pancreatitis via the Slope Index of Inequality (SII) and Concentration Index (CI). Decomposition analysis was used to identify drivers of change, and a Bayesian age-period-cohort model projected trends to 2030. Between 1990 and 2019, the SII decreased from 13.83 to 8.61, signaling a reduction in absolute health inequality. Nevertheless, beginning in 2020, the SII turned negative, reaching -10.79 in 2021, indicating a structural reversal in disease burden distribution from high- to low-SDI countries. Concurrently, the CI declined from -0.04 to -0.10, suggesting worsening relative inequality. Decomposition revealed population growth and aging as primary drivers of the rising burden, while epidemiological improvements contributed minimally, particularly in low-SDI regions. Projections suggest that while global age-standardized rates may continue to decrease through 2030, the proportional burden in low-SDI countries is expected to rise steadily. The global socioeconomic distribution of pancreatitis burden is experiencing a profound shift, with inequalities increasingly concentrated in low-SDI areas. Driven by demographic trends, this shift underscores the necessity for targeted global strategies to mitigate disparities and bolster health system resilience.