Global health & medicine最新文献

Recurrent spontaneous abortion (RSA) is a multifactorial disease that seriously affects womens physical and mental health. With the advent of efficient contraception, the trend for women towards later maternity until their thirties or even forties. Nevertheless, the risk of miscarriage is strongly related to maternal age. We performed a retrospective analysis to evaluate the etiology of RSA through age groups. The results demonstrated that intrauterine adhesions and ovarian dysfunction were responsible for increased miscarriages in older RSA patients. In conclusion, older women will bear a higher risk of miscarriage, mainly due to uterine adhesions or decreased ovarian function.

The visceral fat area obtained by computed tomography (CT) at the navel level is clinically used as an indicator of visceral fat obesity in Japan. Analysis of skeletal muscle mass using CT images at the navel level may potentially support concurrent assessment of sarcopenia and sarcopenic obesity. The purpose of this study was to assess the performance of deep learning models (DLMs) for skeletal muscle mass measurement using low-dose abdominal CT. The primary dataset used in this study included 11,494 low-dose abdominal CT images at navel level acquired in 7,370 subjects for metabolic syndrome screening. The publicly available Cancer Imaging Archive (TCIA) dataset, including 5,801 abdominal CT images, was used as a complementary dataset. For abdominal CT image segmentation, we used the SegU-net DLM with different filter size and hierarchical depth. The segmentation accuracy was assessed by measuring the dice similarity coefficient (DSC), cross-sectional area (CSA) error, and Bland-Altman plots. The proposed DLM achieved a DSC of 0.992 ± 0.012, a CSA error of 0.41 ± 1.89%, and a Bland-Altman percent difference of -0.1 ± 3.8%. The proposed DLM was able to automatically segment skeletal muscle mass measurements from low-dose abdominal CT with high accuracy.

The world is generally getting more prosperous and healthier, and people live longer. Japan, with the world's most advanced population ageing, has made various efforts over the past half-century to prepare for the ageing society. Globally, many countries observe today's rapid demographic changes accompanied by low birth rate and start acknowledging population shrinkage as a looming challenge beyond that of population ageing. The world will face dual challenges of population ageing and shrinkage, but these two issues have been considered in isolation. In addition, the progression differs from region to region and country to country, preventing policymakers from taking a future-back approach to address the core challenges. This issue of Global Health & Medicine carries two valuable articles on population ageing and related policies reported by staff members of the WHO Western Pacific Regional Office (WPRO) and the United Nations Population Fund (UNFPA). This paper will consider the importance of ageing and low fertility rate (declining birthrate) as global issues by placing the WHO and UNFPA articles in a broader context. Population ageing and shrinkage overlap and significantly impact society through health issues. Still, the impact on countries, regions, and the world will become obvious with a time lag. Therefore, this paper advocates analyzing and critically reviewing the experience of countries in which demographic changes are already well advanced, and sharing them with the world. This will contribute significantly to those regions and countries that will walk the same path in the future.

The "Humanization of Childbirth" Project is one of the various maternity care models that respect women and their newborn children. For more than a quarter of a century, the Japan International Cooperation Agency (JICA) has been implementing technical cooperation projects worldwide that place the humanization of childbirth at the center of the concept. By reviewing the project reports, the following 11 key processes were found for the formulation and implementation of future projects for the humanized maternity care: i) project-finding/exploration of unmet needs, ii) identification of local key persons, iii) organization of a project team and a back-up committee, iv) development of an action plan, v) sharing of concepts, vi) development of local leadership, vii) organization of infrastructure, viii) final evaluation and wrap-up seminar, ix) ensuring sustainability, x) development of younger generation experts, and xi) sustainable and autonomous action.

The treatment of HIV-1 infection and AIDS represents one of the greatest challenges in medicine. While there is no cure for HIV/AIDS, truly remarkable progress has been made for treatment of HIV/AIDS patients today. The advent of combination antiretroviral therapy (cART) in the mid-1990s dramatically improved HIV-1 related morbidity, greatly prolonged life expectancy, and delayed progression of AIDS. Due to current antiretroviral therapy, the mortality rate for HIV infected patients is closely approaching the mortality rate for the general population. The long-term success of HIV-AIDS treatment requires continued enhancement of cART with further development of novel drugs that would exhibit fewer side effects, higher genetic barrier to the development of resistance, and longer action with durable virologic suppression. This editorial article provides a quick review of four decades of intense drug development research efforts targeting various viral enzymes and cellular host factors leading to the evolution of today's treatment of patients with HIV-1 infection and AIDS. It also touches on challenges of future treatment options.

In the present study, several research methods were adopted, including literature retrieval, theoretical analysis, and qualitative research, and then the draft of the prognostic factors for the chronic post-surgical pain (CPSP) index system after video-assisted thoracoscopic surgery (VATS) for lung resection was constructed. A Delphi survey was used for the study of 24 experts in the field of pain from three different grade-A tertiary hospitals in Guangzhou, China. In the two rounds of survey, the experts rated these indicators for the importance and feasibility of measurement (round 1, n = 21 participants; round 2, n = 20). Finally, we calculated Kendall's W index as a measure of consensus. A general consensus was reached on predicting CPSP after VATS, consisting of 10 first-level domains and 64 second-level indicators, involving biological, psychological and social perspectives. This study provides a comprehensive draft of risk factors developed and identified by experts to inform research-based evidence on chronic pain. Increased clinical awareness and a full understanding of how to screen and identify people with CPSP problems may lead to earlier recognition of chronic pain and greater facilitation of professional prevention.

Cancer is currently a major public health issue faced by countries around the world. With the progress of medical science and technology, the survival rate of cancer patients has increased significantly and the survival time has been effectively prolonged. How to provide quality and efficient care for the increasingly large group of cancer survivors with limited medical resources will be a key concern in the field of global public health in the future. Compared to developed countries, China's theoretical research and practical experience in care for cancer survivors are relatively limited and cannot meet the multi-faceted and diverse care needs of cancer patients. Based on the existing models of care worldwide, the current work reviews care for cancer survivors in China, it proposes considerations and suggestions for the creation of models of cancer care with Chinese characteristics in terms of optimizing top-level system design, enhancing institutional mechanisms, accelerating human resource development, and enhancing self-management and social support for patients.

Controlling avoidable causes of cancer may save cancer-related healthcare costs and indirect costs of premature deaths and productivity loss. This study aimed to estimate the economic burden of cancer attributable to major lifestyle and environmental risk factors in Japan in 2015. We evaluated the economic cost of cancer attributable to modifiable risk factors from a societal perspective. We obtained the direct medical costs for 2015 from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, and estimated the indirect costs of premature mortality and of morbidity due to cancer using the relevant national surveys in Japan. Finally, we estimated the economic cost of cancer associated with lifestyle and environmental risk factors. The estimated cost of cancer attributable to lifestyle and environmental factors was 1,024,006 million Japanese yen (¥) (8,460 million US dollars [$]) for both sexes, and ¥673,780 million ($5,566 million) in men and ¥350,226 million ($2,893 million) in women, using the average exchange rate in 2015 ($1 = ¥121.044). A total of ¥285,150 million ($2,356 million) was lost due to premature death in Japan in 2015. Indirect morbidity costs that could have been prevented were estimated to be ¥200,602 million ($1,657 million). Productivity loss was highest for stomach cancer in men (¥28,735 million/$237 million) and cervical cancer in women (¥24,448 million/$202 million). Preventing and controlling cancers caused by infections including Helicobacter pylori, human papillomavirus and tobacco smoking will not only be life-saving but may also be cost-saving in the long run.

For patients suspected of sepsis, early recognition of the need for initial resuscitation is key in management. This study evaluated the ability of a modified shock index - the reverse shock index multiplied by the Glasgow Coma Scale score (rSIG) - to predict the need for initial resuscitation in patients with sepsis. This retrospective study involved adults with infection who were admitted to a Japanese tertiary care hospital from an emergency department between January and November 2020. The rSIG, modified Early Warning Score (MEWS), quick Sequential Organ Failure Assessment (qSOFA), and original shock index (SI) values were recorded using initial vital signs. The primary outcome was the area under the receiver-operating characteristic curve (AUROC) for the composite outcome consisting of vasopressor use, mechanical ventilation, and 72-h mortality. Secondary outcomes were the AUROCs for each component of the primary outcome and 28-day mortality. As a result, the primary outcome was met by 67 of the 724 patients (9%). The AUROC was significantly higher for the rSIG than for the other tools (rSIG 0.84 [0.78 - 0.88]; MEWS 0.78 [0.71 - 0.84]; qSOFA 0.72 [0.65 - 0.79]; SI 0.80 [0.74 - 0.85]). Compared with MEWS and qSOFA, the rSIG also had a higher AUROC for vasopressor use and mechanical ventilation, but not for 72-h mortality or in-hospital mortality. The rSIG could be a simple and reliable predictor of the need for initial resuscitation in patients suspected of sepsis.

Hepatitis B virus (HBV) is a hepadnavirus, a small DNA virus that infects liver tissue, with some unusual replication steps that share similarities to retroviruses. HBV infection can lead to chronic hepatitis B (CHB), a life-long infection associated with significant risks of liver disease, especially if untreated. HBV is a significant global health problem, with hundreds of millions currently living with CHB. Currently approved strategies to prevent or inhibit HBV are highly effective, however, a cure for CHB has remained elusive. To achieve a cure, elimination of the functionally integrated HBV covalently closed chromosomal DNA (cccDNA) genome is required. The capsid core is an essential component of HBV replication, serving roles when establishing infection and in creating new virions. Over the last two and a half decades, significant efforts have been made to find and characterize antivirals that target the capsid, specifically the HBV core protein (Cp). The antivirals that interfere with the kinetics and morphology of the capsid, termed capsid assembly modulators (CAMs), are extremely potent, and clinical investigations indicate they are well tolerated and highly effective. Several CAMs offer the potential to cure CHB by decreasing the cccDNA pools. Here, we review the biology of the HBV capsid, focused on Cp, and the development of inhibitors that target it.