Journal of Epidemiology and Global Health最新文献

Background: Cor pulmonale is common in plateau areas due to chronic hypoxia and pulmonary vascular remodeling. Yet, its mortality and related factors there are under researched. We aim to explore the mortality and related factors in patients with cor pulmonale at high altitudes.

Methods: This study is a multicenter follow-up study that included all patients with cor pulmonale from four hospitals in Qinghai Province from 2012 to 2022. Under gender stratification, the characteristics of patients with cor pulmonale were described based on survival status. A line chart was further drawn to depict the changing trend of the case fatality rate of patients with pulmonary heart disease with age. The dose-response relationship between the altitude of the patient's residence and death was plotted using restricted cubic splines and presented based on ethnic stratification. Logistic regression was further used to explore the factors that affect the death of patients with cor pulmonale.

Results: The results showed that among 33,844 patients, a total of 1,451 died in the hospital, with a crude mortality rate of 4.3%. In the entire population and the Han subgroup, mortality risk initially rose with increasing altitude, then decreased, and rose again. In addition, age (odds ratio [OR]: 1.456, 95% confidence interval [CI]: 1.376-1.540), females (OR: 0.683, 95% CI: 0.609-0.764), residential altitude (OR _2000-2499 m: 1.510, 95% CI: 1.162-1.939; OR _2500-2999 m: 0.745, 95% CI: 0.562-0.988; OR_{≥ 3000 m} 0.856 95% CI: 0.615-1.192) and ethnic group were associated with death among patients with cor pulmonale.

Conclusion: The mortality risk of cor pulmonale patients in high-altitude areas is closely related to altitude, and it is necessary to strengthen the control of poor prognosis in Han, elderly, high-altitude residents, and male pulmonary heart disease patients.

Aim: The prevalence of traumatic dental injuries (TDIs) and their contributing factors among Syrian children has not been explored in any previous epidemiological studies since the onset of the crisis. This study aimed to assess the prevalence of TDIs and their associated characteristics among schoolchildren aged 9 to 12 in Damascus, Syria.

Materials and methods: We conducted this cross-sectional study from 2023 to 2024, collecting sociodemographic data and performing dental examinations, and the presence of TDIs, which were classified according to the World Health Organization's guidelines. We recorded Screen time and categorized it into two groups. We measured Overjet in millimeters, and the statistical significance was set at P < 0.05.

Results: We identified TDIs in 17.6% of children, with uncomplicated crown fractures being the most common. Falls were the leading cause, and the home was the most frequent injury location. Significant risk factors included age, gender, socioeconomic status, screen time, Body Mass Index, and overjet. Males had twice the risk of TDIs compared to females (OR = 2.104, 95% CI: 1.399-3.165), and children from lower socioeconomic backgrounds had a 2.29 times higher risk (OR = 2.299, 95% CI: 1.364-3.877).

Conclusion: This study found that a significant proportion (17.6%) of Syrian children experienced TDIs, highlighting the urgent need for preventive programs and improved dental care for Syrian children affected by TDIs.

Clinical relevance: Early identification of children at higher risk, prompt management of dental trauma, and educational initiatives for parents and educators are essential. Schools, as primary injury sites, should adopt safety measures, while dentists should engage in community outreach to enhance awareness, early diagnosis, and intervention.

Background: Schistosomiasis is one of the major neglected tropical diseases in Africa, accounting for approximately 90% of the global burden. In Zimbabwe, Schistosoma haematobium and S. mansoni infections are endemic. Although mass drug administration has been carried out among school-aged children, other interventions at the national level remain incomplete. China has established a public health cooperation mechanism with African countries targeting schistosomiasis and other infectious diseases. This study aims to conduct a pilot study to provide a methodological reference for large-scale surveys in similar settings.

Method: This pilot study served as an entry point for China-Africa cooperation in schistosomiasis control. A combination of cross-sectional studies and snail surveys was used. The survey was carried out in 14 villages of Chevakadzi ward in Zimbabwe. Households were selected through simple random sampling for the study. Fecal and urine samples were tested in the laboratory to diagnose schistosomiasis. Meanwhile, a capacity and needs assessment was conducted to understand the current situation of local disease control strategies.

Discussion: This study is expected to obtain important epidemiological information and indicators regarding the transmission of schistosomiasis at the sub-district level, providing a basis for judging the feasibility and practicality of large-scale China-Zimbabwe cooperation investments. The research results will also offer references for policy-making and the update of prevention and control strategies, contributing to schistosomiasis control in Zimbabwe. However, the study has limitations such as limited funding and difficulties in cross-border drug registration.

Objectives: Early diagnosis of pulmonary tuberculosis (PTB) is essential for individual case treatment and community transmission control. However, the impact of the COVID-19 pandemic on PTB diagnosis remains inadequately understood. In this study, we aimed to investigate the diagnostic delay in patients with PTB before, during and after the COVID-19 pandemic.

Methods: We conducted a longitudinal study of PTB in Yichang City from 2005 to 2023, utilizing data from the Tuberculosis Information Management System of China. The distribution of diagnostic delay (DD) was analyzed across three periods: pre-pandemic, during the pandemic, and post-pandemic. Multivariate mixed-effects logistic regression models were employed to identify factors associated with prolonged DD, defined as a delay exceeding 28 days.

Result: A total of 58,774 patients with PTB were included in this study. The average annual number of cases was 3,293 pre-pandemic, 2,319 during the pandemic, and 2,426 post-pandemic. The fitted median DD in the pre-pandemic period (31.7 days, interquartile range [IQR] = 13.8-72.8) was significantly longer than that in the pandemic period (23.8 days, IQR = 11.3-50.3) and the post-pandemic period (20.6 days, IQR = 9-47.1) (p < 0.01). Elder patients aged 65 years and older had a longer median DD (32 days, IQR = 14.2-72.0) than patients aged 18-64 years (median: 30.1 days, IQR = 13.1-68.9) and patients under 18 years (median: 19.5 days, IQR = 8.6-44.2) (p < 0.01). Patients residing in rural areas also had a longer median DD (31 days, IQR = 14.2-72.0) compared to those in urban (median: 29.4 days, IQR = 13.7-70.2) (p < 0.01). Older age (adjusted Odds Ratio [aOR] = 2.20, 95% confidence interval [95% CI] = 2.00-2.42), rural residence (aOR = 1.10, 95% CI 1.06-1.14), positive pathogen testing (aOR = 1.35, 95% CI 1.23-1.49), and retreatment status (aOR = 1.23, 95% CI 1.16-1.31) were significantly associated with prolonged DD. Diagnosed by Xpert MTB/RIF (aOR = 0.71, 95% CI 0.65-0.78) was associated with a shorter DD.

Conclusions: Compared to the pre-pandemic period, the overall interval from the onset of symptoms to the diagnosis of PTB patients shortened during and post-COVID-19 pandemic. Additional improvements in early diagnosis are needed for elderly patients and rural residents through the use of reliable diagnostic methods.

Objective: The COVID-19 lockdown impacted interactions with the health care system and societal stress levels. Previous US-based studies suggest that pandemic lockdowns may have lowered preterm birth rates although there are mixed findings from different settings. We evaluated the impact of COVID-19 on preterm birth and low birthweight rates at two San Francisco hospitals.

Methods: We compared rates of preterm birth (< 37 weeks) and low birthweight (< 2500 g) in San Francisco at a safety net hospital and an academic medical center during two time periods early in the COVID-19 pandemic compared with the same months from the prior year: from March to May 2019 and 2020 and August to December 2019 and 2020. We calculated crude rates for preterm birth and low birth weight as well as compared maternal and infant birth demographics and health characteristics during these same time periods using descriptive statistics. Secondly using a cross-sectional study design, we used logistic and linear regression models to evaluate risk for preterm birth, gestational age at birth, and low birthweight adjusting for confounders comparing the lockdown period with the pre-COVID year. All analyses were conducted using Stata 15.0.

Results: From August to December 2019 to 2020, the preterm birth rate decreased from 13.20 to 7.96% in the combined hospital data (p < 0.01), and the low birthweight rate decreased from 11.33 to 9.70% during the same time period (p = 0.13). We did not find a comparable reduction from March to May 2019 to 2020. Maternal age at delivery was significantly younger during the lockdown period, August to December, than in the prior year (36.29 ± 5.69 versus 37.15 ± 5.68 years p < 0.01) and parity was greater (0.83 ± 1.15 versus 0.74 ± 1.04, p = 0.03) but there were no other significant differences in race or ethnicity, infant sex or type of delivery (vaginal versus Cesarean section) from 2019 to 2020. In a logistic and linear regression model adjusting for maternal age and infant sex and other confounders, the lockdown period from August to December was protective against preterm birth (OR 0.65, 95%CI 0.51-0.82) and associated with overall longer gestational duration (Coeff 0.23, 95%CI 0.07-0.39). The August to December lockdown period was also associated with greater birthweight (Coeff 43.76, 95%CI 2.19-85.34).

Conclusions: In San Francisco, COVID-19 lockdowns lowered the preterm birth and increased gestational duration in infants comparing 2019 with 2020 for August to December. The reduced in preterm birth rates may be related to the overall strict lockdown measures that San Francisco implemented compared with other US cities. WHAT THIS STUDY ADDS TO THE CLINICAL WORK?: This study suggests that COVID-19 lockdowns lowered the preterm birth rate in August -December 2020 compared with the same months in 2019 in two hospitals in San Francisco. San Francisco had str

Background and objectives: Telepharmacy has been increasingly used in Indonesian community pharmacies despite the absence of a policy regulating the services. In tandem with the lack of standardized pharmaceutical care, providing telepharmacy services may vary across community pharmacies. This study investigates the contemporary practice of telepharmacy in Indonesian community pharmacy.

Methods: A cross-sectional survey using a validated online questionnaire was conducted. The targeted participants were community pharmacists who claimed to have provided telepharmacy service daily. The participants were approached using purposive sampling and extended using the accidental sampling method. The questionnaire asked about several activities that pharmacists do when delivering telepharmacy services. The data were subsequently analyzed using descriptive statistics.

Results: Overall, 250 pharmacists participated in the online survey. Most respondents were female (73.6%) and less than 41 years old (78.6%). Despite respondents claiming to know telepharmacy (70%), more than half (52%) never attended any training and workshops on telepharmacy. Chat messaging apps were common platforms for telepharmacy (87.2%). Low patient uptake was evident in most pharmacies (74.4%). More than 96% of respondents ensured the accuracy of patient data before delivering the service. This includes verifying patient prescriptions and checking the prescribed medicines with patient history. However, fewer pharmacists frequently documented patient data (36%), communicated care plans to patients (22%), provided drug information (2.9%), and monitored outcomes (29.2%).

Conclusion: The lack of regulation has contributed to unstandardized telepharmacy practice. Despite the untapped potential, the growth of telepharmacy services in Indonesian community pharmacies is uncertain, with ongoing support from the regulation needed.

Background: Serum creatinine to body weight ratio (CBWR) is closely associated with non-alcoholic fatty liver disease, diabetes, and all-cause mortality. This study aimed to assess the impact of CBWR in late pregnancy on incident small and large for gestational age (SGA/LGA) deliveries.

Methods: This observational study included 11,734 pregnant women with hospital-based hepatic/renal data (2016-2017). Demographic characteristics were compared between CBWR quintiles using appropriate parametric or nonparametric tests. Relationship between CBWR and clinical/laboratory parameters was assessed using Spearman's correlation. Linear regression was employed to evaluate the association of CBWR with fetal birth length/weight, while logistic regression was used to calculate adjusted odds ratios (ORs) for SGA/LGA, with both models adjusting for maternal age, parity, blood pressure, gestational week, assisted reproduction, neonatal sex, and laboratory results. Sensitivity analyses and subgroup stratifications confirmed these associations. Non-linear trends were explored using smooth curve fitting techniques.

Results: Among these newborns, 1033 (8.80%) were classified as SGA and 1,827 (15.57%) as LGA. CBWR was associated with smaller birth length (β = -0.21 cm; 95% CI: -0.28, -0.15) and lower birth weight (β = -0.29 kg; 95% CI: -0.31, -0.27) in the highest versus lowest quintile. The multivariate-adjusted ORs of SGA in higher quintiles versus the lowest quintile of CBWR were 1.63 (95% CI: 1.21, 2.21), 2.16 (95% CI: 1.61, 2.89), 2.99 (95% CI: 2.25, 3.97), and 5.24 (95% CI: 3.97, 6.92), respectively; those for LGA were 0.60 (95% CI: 0.52, 0.70), 0.53 (95% CI: 0.46, 0.62), 0.39 (95% CI: 0.32, 0.46), and 0.23 (95% CI: 0.19, 0.29), respectively. Per standard deviation (SD) increase in CBWR was accompanied by a 1.63-fold increase in SGA risk (OR = 1.63, 95% CI: 1.52, 1.75) and a 42% decrease in LGA risk (OR = 0.58, 95% CI: 0.55, 0.63). Sensitivity analysis confirmed the consistence of these findings. Subgroup analysis demonstrated that CBWR was strongly associated with SGA risk in women with CBWR > 0.98 umol/L/kg complicated by preeclampsia or preterm birth, while in those complicated by gestational diabetes mellitus, the association was attenuated.

Conclusion: Our findings suggest that elevated CBWR in late pregnancy may be associated with decreased LGA risk and increased SGA risk. While CBWR represents an easily measurable and cost-effective potential indicator, these observational results require validation in prospective, population-based studies before considering clinical application.

Background: The study aimed to offer detailed insights into the global, regional, and national burden of IE in 2021, while also examining the temporal trends of IE from 1990 to 2021.

Methods: Data on the absolute numbers and age-standardized rates (ASR) of incidence, deaths, and disability-adjusted life years (DALYs) related to IE were sourced from the Global Burden of Disease Study (GBD) 2021. The estimated annual percentage changes (EAPC) of ASR were calculated to quantify the temporal trends. Furthermore, joinpoint regression models were used to identify the temporal trends and the primary joinpoint year of ASR.

Results: Globally, the age-standardized incidence rate (ASIR) for IE increased with an EAPC of 1.00 (95%CI: 0.93-1.08) from 9.35 per 100 000 population in 1990 to 12.61 per 100 000 population in 2021. Despite a rise in the absolute number of death cases and DALYs related to IE, the age-standardized mortality rate (ASMR) has remained stable (EAPC 0.06, 95%CI: -0.10-0.22), and the age-standardized DALYs rate (ASDR) has exhibited a decline (EAPC - 0.34, 95%CI: -0.45-0.24) between 1990 and 2021. Males bore a higher burden of IE compared to females, with the peak burden gradually shifting towards older individuals. In 2021, the ASIR for IE exhibited an increase with the rise in socio-demographic index (SDI) quintiles, with the highest ASIR observed in the high SDI region (15.77 per 100 000 population). Moreover, the highest growth rates of ASIR, ASMR, and ASDR were also noted in the high SDI region. On the other hand, the ASMR (1.34 per 100 000 population) and ASDR (40.71 per 100 000 population) for IE were relatively high in the low SDI region. Joinpoint analysis demonstrated that the ASIR, ASMR, and ASDR did not experience any sudden surges either globally or across different SDI regions after 2007.

Conclusions: The burden of IE remained relatively high, characterized by a rising ASIR and a stable ASMR on a global scale. This burden was notably prominent among males, the elderly, and in the high and low SDI regions. Region-specific prevention and management strategies might be warranted to reduce the burden of IE.

Background: Cholera, an acute diarrheal infection caused by Vibrio cholerae, remains a significant public health concern globally, with 1.4-4.0 million cases and 21,000-143,000 deaths annually. While the disease is endemic in 47 less-developed countries across Africa and Asia, the African continent has been particularly affected, with 19 of 29 countries reporting cases in 2023 being from Africa.

Aim: To explore the trend of cholera outbreaks in Africa and analyze how climate change has contributed to the spread of the disease in the continent.

Methods: A review of current cholera outbreaks in Africa, with particular focus on Sudan and Ethiopia as case studies, examining the relationship between climatic factors and cholera transmission.

Results: Recent outbreaks in Sudan (declared September 26, 2023) resulted in 5,414 suspected cases and 170 deaths (case fatality rate 3.1%) across nine states as of December 5, 2023. In Ethiopia's Somali region, 772 confirmed cases and 23 deaths were reported within two weeks, with approximately 80% of cases affecting children. Climate factors significantly influence cholera transmission: a 1 °C temperature rise doubled cholera cases in Zanzibar. Both drought conditions, which increase Vibrio cholerae concentration in groundwater, and heavy rainfall periods, which lead to flooding and breakdown of sanitary conditions, contribute to outbreak risks.

Conclusions: Climate change impacts cholera transmission through rainfall patterns, temperature variations, and extreme weather events. Management recommendations include implementing accurate weather surveillance systems, strategic vaccination programs, flood-proof water supply infrastructure, and community engagement protocols. These interventions should be integrated while considering the growing influence of climate change on disease patterns.

Clinical trial number: Not applicable.

HEV, primarily known for its waterborne transmission, is increasingly recognized for its zoonotic potential, raising public health concerns for individuals in close contact with animals or animal products. This study aims to evaluate the seroprevalence of Hepatitis E Virus (HEV) among slaughterhouse workers in Saudi Arabia and compare it to a control group of blood donors, emphasizing potential occupational risks and associated factors.This comparative cross-sectional study included 239 slaughterhouse workers (study group) and 250 blood donors (control group). HEV IgG antibodies were detected using an in-house ELISA. Sociodemographic data, occupational exposure duration, and animal contact details were analyzed.The HEV seroprevalence was significantly higher in slaughterhouse workers (49.7%) compared to blood donors (22.1%) (p < 0.0001). Age and duration of occupational exposure were strongly predictive of HEV infection, with workers exposed for over one year showing higher odds of seropositivity. Geographic region and type of animal contact showed no significant associations.The findings suggest that prolonged occupational exposure to animals demonstrated increased the risk of HEV infection among slaughterhouse workers. Public health interventions, including improved hygiene measures, health screenings, and potential vaccination, could mitigate the risk of HEV transmission in high-exposure occupations.