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Living with long COVID and its impact on family and society: a couple's view 长期慢性阻塞性肺病患者的生活及其对家庭和社会的影响:一对夫妇的观点。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52466
Karlie M Flannigan, Gerard M Flannigan
<p>My name is Karlie, and I am now 56 years old. I contracted coronavirus disease 2019 (COVID-19) in July 2020. I was working in aged and disability care as a human resources (HR) manager, mentor and trainer. I have endured long COVID symptoms for four years since my COVID-19 infection.</p><p>For a perspective of my health before the COVID-19 pandemic, my medical history can be summarised as follows. I have had severe acute asthma since the age of 14 years, treated with multiple medications including ongoing prednisolone. I have had several respiratory arrests and yearly hospital admissions due to severe asthma. I have psoriatic arthritis, which is treated with methotrexate, and was diagnosed with supraventricular tachycardia, requiring two corrective procedures. In 2017, I had a multilobal abdominal tumour from endometriosis and adenomyosis which resulted in a radical hysterectomy. About 20 years ago, I had a workplace accident that caused a Colles fracture, which required multiple reconstructive procedures for my left wrist and arm, and had multiple anterior cruciate ligament and cartilage repair surgeries.</p><p>In the early stages of the pandemic, I must admit I was extremely fearful of having COVID-19. Given my severe acute asthma, I was fully cognisant of the implications of surviving it. At the time, I was an HR manager for an aged care provider. It was the day before masks were mandated, but my office adhered to physical distancing practices. My employer had done everything possible to ensure we were in a safe working environment; however, a team member had come into work without telling anyone they were unwell.</p><p>I was in a room providing instruction to that team member and two other people. We were physically distanced from each other according to the practice at the time. The following evening, I was advised by my manager that I was a close contact to a person who tested positive to COVID-19, who was the team member who was unwell, and that I needed to have a polymerase chain reaction (PCR) test as soon as possible. I did not have a positive result on that first test, but, early the next day, I was symptomatic and began feeling very unwell. I did another PCR test and it was positive for COVID-19.</p><p>Two days after the positive test result, I was admitted to hospital and received oxygen. At that stage, I could only speak two words before being completely breathless; I relied on texting family and friends to communicate. Very quickly, I was placed on high flow oxygen, and, within a week of admission, I was transferred to the intensive care unit.</p><p>By that stage, I was unable to roll myself over in bed. I was asked if I had an advanced care directive and who to contact when I needed to be intubated. I developed secondary pneumonia and spent five weeks in hospital, with a total of 54 days in isolation (including at home).</p><p>During my whole time in hospital, my husband and youngest son also had COVID-19. They were in home iso
我叫 Karlie,现年 56 岁。我于 2020 年 7 月感染了 2019 年冠状病毒病(COVID-19)。我当时在老年和残疾护理机构担任人力资源(HR)经理、导师和培训师。自感染 COVID-19 以来,我已忍受了四年之久的 COVID 症状。要了解我在 COVID-19 大流行之前的健康状况,我的病史可概述如下。我从 14 岁起就患有严重的急性哮喘,曾接受过多种药物治疗,包括泼尼松龙。由于严重哮喘,我曾多次呼吸心跳骤停,每年都要住院治疗。我患有银屑病关节炎,接受甲氨蝶呤治疗,并被诊断患有室上性心动过速,需要进行两次矫正手术。2017 年,我因子宫内膜异位症和子宫腺肌症患上了多叶腹腔肿瘤,导致根治性子宫切除术。大约20年前,我曾因工伤事故导致科莱斯骨折,需要对左手腕和手臂进行多次整形手术,并进行了多次前十字韧带和软骨修复手术。"在大流行病的早期阶段,我必须承认我非常害怕患上COVID-19。鉴于我患有严重的急性哮喘,我充分认识到患上 COVID-19 后的后果。当时,我是一家老年护理机构的人力资源经理。那是在强制要求戴口罩的前一天,但我的办公室坚持采取物理隔离的做法。我的雇主已经尽一切可能确保我们处于一个安全的工作环境中;然而,一名团队成员没有告诉任何人他们身体不适就来上班了。根据当时的惯例,我们彼此保持着物理距离。第二天晚上,我的经理告诉我,我与一名 COVID-19 检测呈阳性的人员(也就是身体不适的团队成员)有密切接触,我需要尽快进行聚合酶链反应 (PCR) 检测。我在第一次检测中没有得到阳性结果,但第二天一早,我就出现了症状,开始感觉非常不舒服。我又做了一次 PCR 检测,结果显示 COVID-19 呈阳性。检测结果呈阳性的两天后,我被送进了医院,并接受了吸氧治疗。在那个阶段,我只能说两句话,然后就完全喘不过气来;我只能靠给家人和朋友发短信来沟通。很快,我就吸上了高流量氧气,入院不到一周,我就被转到了重症监护室。我被问及是否有预先护理指示,以及需要插管时应与谁联系。在我住院期间,我的丈夫和小儿子也患上了 COVID-19。在我整个住院期间,我的丈夫和小儿子也感染了 COVID-19,他们在家中被隔离了 26 天。只有我的两个姐姐被告知了这一情况,因为我的丈夫和儿子不想让我有负担,认为是我传染给了他们。许多症状开始出现,有些几乎是立即出现,有些则在接下来的几个月里慢慢显现出来。我开始出现慢性疲劳、肌肉疲劳、虚弱、头痛以及失眠。当我勉强入睡时,每次只能睡几个小时。我开始脱发,头发会成片脱落,我还出现了光敏感和视力衰退。医生告诉我这些症状与 COVID-19 无关,这让我的病情更加严重。我曾被转诊给一位语言治疗师,但他并不了解我的问题是由 COVID-19 引起的。后来,他们在阅读了我向他们提出的所有相同问题的研究报告后向我道歉。两年多来,我的消化系统一直有问题,包括反流、消化不良、呕吐以及只能吃流质和软食。感染后不久,我还出现了纤维肌痛,这导致我的手和腿疼痛;血压时高时低;以及无明显原因的平衡问题。我没有摔过跤,但走直线时有困难。我经常撞到门口,需要扶着家具才能站稳。我不能服用消炎药,因为我对这些药物过敏。在重症监护室期间,我还患上了广谱β-内酰胺酶。
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引用次数: 0
The economic burden of long COVID in Australia: more noise than signal? 澳大利亚长期慢性病毒性的经济负担:噪音多于信号?
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52468
Mary Rose Angeles, Thi Thu Ngan Dinh, Ting Zhao, Barbara de Graaff, Martin Hensher

Objective

To estimate the potential economic burden of long COVID in Australia.

Design

A stock-and-flow model of weekly estimated numbers of people with long COVID (January 2021 to June 2023); application of proxy cost estimates from people living with myalgic encephalomyelitis/chronic fatigue syndrome; time series analysis of labour market and social security datasets.

Setting

The working age Australian population.

Main outcome measures

The likely number of Australians severely impacted by long COVID; the economic cost of long COVID; and the impacts of long COVID, determined by analysis of labour market data.

Results

At its peak in late 2022, between 181 000 and 682 000 Australians may have experienced some long COVID symptoms, of whom 40 000–145 000 may have been severely affected. Severe cases potentially decreased to affecting 10 000–38 000 people by June 2023. The likely economic burden of long COVID in Australia during 2022 was between $1.7 billion and $6.3 billion (some 0.07% to 0.26% of gross domestic product). Labour market data suggest that between 25 000 (February 2023) and 103 000 (June 2023) more working age Australians reported being unable to work due to long term sickness than would have been predicted based on pre-COVID-19 trends. This does not appear to have translated into increased claims for Disability Support Pensions, but numbers of working age Carer Allowance recipients have grown markedly since 2022.

Conclusions

Long COVID likely imposed a small but significant aggregate toll on the Australian economy, while exposing tens of thousands of Australians to substantial personal economic hardship and contributing to labour market supply constraints. Yet while some signal from long COVID is discernible in the labour force data, Australia lacks adequate direct surveillance data to securely guide policy making.

目的估算澳大利亚长程COVID的潜在经济负担:设计:长COVID患者每周估计人数的存量与流量模型(2021年1月至2023年6月);应用肌痛性脑脊髓炎/慢性疲劳综合征患者的替代成本估算;劳动力市场和社会保障数据集的时间序列分析:主要结果测量指标:主要结果测量指标:受到长期慢性疲劳综合征严重影响的澳大利亚人的可能数量;长期慢性疲劳综合征的经济成本;以及通过劳动力市场数据分析确定的长期慢性疲劳综合征的影响:在 2022 年末的高峰期,可能有 181 000 至 682 000 名澳大利亚人出现过一些长期慢性阻塞性肺病症状,其中 40 000 至 145 000 人可能受到严重影响。到 2023 年 6 月,严重病例可能减少到 10 000-38 000 人。2022 年期间,澳大利亚可能因长期慢性阻塞性肺病造成的经济负担在 17 亿澳元至 63 亿澳元之间(约占国内生产总值的 0.07% 至 0.26%)。劳动力市场数据显示,与根据第 19 次 COVID 前的趋势预测相比,有 25000 名(2023 年 2 月)至 103000 名(2023 年 6 月)处于工作年龄的澳大利亚人因长期患病而无法工作。这似乎并没有转化为残疾支持养老金申请的增加,但自 2022 年以来,工作年龄护理津贴领取者的人数明显增加:长期的 COVID 可能会对澳大利亚经济造成微小但巨大的总体损失,同时使数以万计的澳大利亚人面临巨大的个人经济困难,并导致劳动力市场供应紧张。然而,虽然从劳动力数据中可以看出长期失业保险的一些信号,但澳大利亚缺乏足够的直接监控数据来可靠地指导政策制定。
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引用次数: 0
Factors associated with general practitioner-led diagnosis of long COVID: an observational study using electronic general practice data from Victoria and New South Wales, Australia 与全科医生主导的长期 COVID 诊断相关的因素:一项利用澳大利亚维多利亚州和新南威尔士州全科电子数据进行的观察性研究。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52458
Abbish Kamalakkannan, Mirela Prgomet, Judith Thomas, Christopher Pearce, Precious McGuire, Fiona Mackintosh, Andrew Georgiou

Objectives

To investigate associations between sociodemographic factors, pre-existing chronic comorbidities, and general practitioner-led diagnosis of long COVID.

Design, setting, patients

We conducted a retrospective observational case–control study using de-identified electronic general practice data, recorded between January 2020 and March 2023, from 869 general practice clinics across four primary health networks in Victoria and New South Wales.

Main outcome measures

Sociodemographic factors and pre-existing chronic comorbidities associated with general practitioner-led diagnosis of long COVID.

Results

A total of 1588 patients had a recorded general practitioner-led long COVID diagnosis. Females exhibited a higher likelihood of general practitioner-led long COVID diagnosis (adjusted odds ratio [aOR], 1.58; adjusted confidence interval [aCI], 1.35–1.85) compared with males. Patients aged 40–59 years had a higher likelihood of general practitioner-led long COVID diagnosis (aOR, 1.68; aCI, 1.40–2.03) compared with patients aged 20–39 years. The diagnosis was more likely in patients of high socio-economic status (aOR, 1.37; aCI, 1.05–1.79) compared with those of mid socio-economic status. Mental health conditions (aOR, 2.69; aCI, 2.25–3.21), respiratory conditions (aOR, 2.25; aCI, 1.85–2.75), cancer (aOR, 1.64; aCI, 1.15–2.33) and musculoskeletal conditions (aOR, 1.50; aCI, 1.20–1.88) were all significantly associated with general practitioner-led long COVID diagnosis.

Conclusions

Female sex, middle age, high socio-economic status and pre-existing comorbidities, including mental health conditions, respiratory conditions, cancer and musculoskeletal conditions, were associated with general practitioner-led long COVID diagnosis among general practice patients. These factors largely parallel the emerging international evidence on long COVID and highlight the patient characteristics that practitioners should be cognisant of when patients present with symptoms of long COVID.

目的:研究社会人口学因素、原有慢性并发症与全科医生诊断的长期慢性并发症之间的关系:调查社会人口因素、原有慢性并发症与全科医生诊断的长期COVID之间的关联:我们利用维多利亚州和新南威尔士州四个基层医疗网络的 869 家全科诊所在 2020 年 1 月至 2023 年 3 月期间记录的去标识化全科电子数据,开展了一项回顾性观察病例对照研究:主要结果测量:与全科医生诊断的长期COVID相关的社会人口学因素和原有慢性并发症:结果:共有 1588 名患者在全科医生指导下确诊了长 COVID。与男性相比,女性在全科医生指导下确诊长COVID的可能性更高(调整后的几率比[aOR],1.58;调整后的置信区间[aCI],1.35-1.85)。与 20-39 岁的患者相比,40-59 岁的患者在全科医生指导下确诊长 COVID 的可能性更高(aOR,1.68;aCI,1.40-2.03)。与社会经济地位中等的患者相比,社会经济地位高的患者更有可能被诊断出(aOR,1.37;aCI,1.05-1.79)。精神健康状况(aOR,2.69;aCI,2.25-3.21)、呼吸系统状况(aOR,2.25;aCI,1.85-2.75)、癌症(aOR,1.64;aCI,1.15-2.33)和肌肉骨骼状况(aOR,1.50;aCI,1.20-1.88)均与全科医生主导的长期 COVID 诊断显著相关:结论:女性、中年、高社会经济地位和既往合并症(包括精神疾病、呼吸系统疾病、癌症和肌肉骨骼疾病)与全科医生主导的全科病人长期 COVID 诊断有关。这些因素在很大程度上与国际上关于长COVID的新兴证据相一致,并强调了当患者出现长COVID症状时,医生应注意的患者特征。
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引用次数: 0
Long COVID in Victoria 维多利亚州的长 COVID。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52467
David A Watters, Lance Emerson
<p>An editorial in the <i>Medical Journal of Australia</i> in early 2023 stated that “Long COVID is precisely the kind of challenge the current Australian health system finds most difficult: a non-fatal chronic condition manifested as complex combinations of symptoms, without a simple diagnostic test or definitive pharmacotherapy”.<span><sup>1</sup></span> Achieving equitable access to supportive health care is challenging because the best models of care are multidisciplinary and coordinated by primary care. These involve medical assessment and coordination, allied health interventions and psychological support, each of which often incur significant out-of-pocket expenses. Thus, long COVID represents a sustained and multiplied disadvantage, with lower socio-economic, cultural, and linguistically diverse groups experiencing the least access to care.<span><sup>2</sup></span> In this issue of the <i>MJA</i>, we publish the supplement <i>The impact of long COVID in Victoria 2020–2023</i>. This collection of seven articles investigates the health and financial burdens of long COVID in Victoria, discusses the biological mechanisms at play, and explores models of care for this complex condition.</p><p>The 2022–23 parliamentary inquiry into long COVID, <i>Sick and tired, casting a long shadow</i>, recognised the need to provide coordinated care for people with long COVID, provided largely in the community but with targeted support from specialists on a case by case basis.<span><sup>3</sup></span> The “long shadow” includes a small but significant impact for the Australian economy, with an estimated health care cost per person affected in Victoria equivalent to the average Victorian wage, as Angeles and colleagues<span><sup>4</sup></span> report in this supplement on long COVID. Another modelling study for the whole Australian population estimated that 1.2–5.4% of the population had symptoms of long COVID during 2022–2023, with 0.7–3.4% to still be affected in December 2024. The total labour loss was estimated at $9.6 billion, or 0.5% of gross domestic product, with the greatest impact in people aged 30–49 years.<span><sup>5</sup></span></p><p>The lived experience of a consumer with long COVID within this supplement reminds us that the above estimates are not just numbers, but represent the lives of many real people: “Together, my husband and I have lost contact with friends, stopped social activities, and resigned from local community groups … We struggled to maintain our previous home, but, most importantly, we struggled to care for ourselves, which has had an impact on our self-worth”.<span><sup>6</sup></span></p><p>The term long COVID was first introduced by people with the condition. It has received support from those with lived experience, and stood the test of time, despite some reluctance to accept its use by some — referring to it as “a term used commonly in the community”.<span><sup>7</sup></span> In this editorial, and throughout the supplement
11 在 COVID-19 大流行的前三年中,随着疫苗接种的引入和毒力较弱的 SARS-CoV-2 变体的出现,维多利亚州长期感染 COVID 的人数比例有所下降。然而,由于社会限制放宽,以及从 2021 年 12 月起维多利亚州人将 "与 COVID 共同生活",因此 Omicron 变体感染人数大大增加,疾病负担也随之加重。世界各地的多项全国性调查证实,PASC 或长程型 COVID 的发病率同样很高。长程型 COVID 症状加重了患者的负担,因为长程型 COVID 患者仍被告知 "这都是你的幻觉",而且正如弗兰尼根和弗兰尼根6 反映他们的长程型 COVID 经验时所说,医生不知道如何治疗他们。维多利亚州和新南威尔士州的一些全科医生也认识到了这一点,本增刊对影响全科医生诊断长COVID的因素进行了研究,12 报告了诊断方面的挑战、专家意见和建议的缺乏,以及获得多学科护理模式的机会有限。初级保健诊所仍然依赖于专科医生的建议,通常是为了排除其他必要的病症,以确诊长 COVID。尽管维多利亚州的一些长期 COVID 医院诊所已经关闭或被重新吸纳,但仍有必要开发资助模式,以提供真正的多学科诊所,并提供强有力的专职医疗投入,正如 Wrench 及其同事在本增刊中所报告的那样,13 以支持持续的康复。COVID-19 大流行已近五年,我们对长程 COVID 的病理生理学、治疗和预后的认识仍有很大差距。不过,我们已经了解到,这种病毒与肺和血管内皮 ACE2(血管紧张素转换酶 2)受体结合,因此能够在身体的各个系统诱发病毒介导的和/或炎症反应。驱动这些炎症反应的基本途径仍在阐明之中,因此目前尚无循证药物疗法。在 2020-2021 年维多利亚州 COVID-19 波期间,感染 COVID-19 的患者因心血管、神经、呼吸、肾脏和血栓性疾病的住院率显著增加。国际上有确凿证据表明,患有肥胖、糖尿病或肾脏疾病等潜在并发症的长期 COVID 患者更有可能入院治疗,而这些并发症在感染 COVID-19 后可能会恶化17 。COVID-19 后神经综合征(PCNS)很常见14 ,包括 "脑雾"、认知和记忆障碍、嗅觉和味觉丧失、平衡失调、言语和语言障碍(包括忘词)、睡眠障碍、锥体外系和运动障碍以及脑血管血栓形成。虽然我们确实知道,感染后病毒可在包括大脑在内的所有组织中发现,而且持续的炎症不利于健康和幸福,但现在要知道感染 SARS-CoV-2 对痴呆症和锥体外系疾病的发病率会产生什么长期影响还为时尚早。本增刊中的维多利亚州 COVID 长期健康调查报告11 指出,COVID-19 后的精神健康后遗症可能也有一些神经和/或炎症因素,但正如该调查所显示的,其原因可能是多因素的,可能来自各种系统紊乱,既可能是单独的,也可能是综合的。维多利亚州长期慢性阻塞性脉管炎健康调查提供了一项持久的数据资产,它将继续为研究人员和临床医生提供帮助,帮助他们了解长期慢性阻塞性脉管炎的影响,并为他们开发更好的多学科护理模式提供机会。特别是,74% 的受访者同意将他们的(去标识化的)数据与其他数据集进行链接以用于进一步研究,62% 的受访者同意在未来的调查中与他们联系。有兴趣的研究人员请联系维多利亚州卫生部维多利亚州数据链接中心。
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引用次数: 0
Persistent symptoms after COVID-19: an Australian stratified random health survey on long COVID COVID-19 后的持续症状:澳大利亚关于长期 COVID 的分层随机健康调查。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52473
Alex Holmes, Lance Emerson, Louis B Irving, Emma Tippett, Jeffrey M Pullin, Julie Young, David A Watters, Adina Hamilton
<div> <section> <h3> Objective</h3> <p>To determine the impact of persistent symptoms after coronavirus disease 2019 (COVID-19) in an Australian population.</p> </section> <section> <h3> Design, setting, participants</h3> <p>We conducted a statewide health survey of a stratified random sample of adults who had had a confirmed acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19-positive group) and their close contacts (control group). The sample was drawn from Victoria's COVID-19 database between January 2020 and October 2022. Data were collected from 12 688 survey respondents between September 2022 and April 2023 (11 174 in the COVID-19-positive group and 1514 in the control group).</p> </section> <section> <h3> Main outcome measures</h3> <p>Persistent new symptoms, recovery, and daily function using validated questionnaires for fatigue, neurocognitive symptoms, anxiety, depression and quality of life.</p> </section> <section> <h3> Results</h3> <p>At a mean of 12.6 months after infection, 4560 respondents in the COVID-19-positive group (39.1%; 95% CI, 37.9–40.3%) reported at least one persistent new symptom, compared with 216 respondents in the control group (20.8%; 95% CI, 18.5–23.1%). A total of 1656 respondents (14.2%; 95% CI, 13.4–15.0%) were classified as having clinical long COVID using the criteria of at least one persistent new symptom and less than 80% recovery three months after the infection. Of the respondents with clinical long COVID, 535 (3.2%; 95% CI, 2.6–3.8%) reported at least moderate problems with usual activities at 12 months after their infection. The proportion of respondents with clinical long COVID was lower for those with more recent infections. The risk factors for clinical long COVID were female sex, age 40–49 years, infection severity, chronic illness, and past anxiety or depression. Factors associated with a decreased risk of having clinical long COVID included infection when the Omicron strain was dominant and infection when the Delta strain was dominant, as compared with when the ancestral strain of the virus was dominant.</p> </section> <section> <h3> Conclusion</h3> <p>Persistent symptoms after COVID-19 are common, though with a lower incidence following infection from less virulent strains. Although long COVID can be largely managed in primary care, a minority of people who have persistent symptoms and impaired function may require specialist care pathways, the effectiveness of which should be
目的确定冠状病毒病2019(COVID-19)后持续症状对澳大利亚人群的影响:我们在全州范围内对确诊感染过急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)的成年人(COVID-19 阳性组)及其密切接触者(对照组)进行了分层随机抽样健康调查。样本来自维多利亚州 COVID-19 数据库,时间跨度为 2020 年 1 月至 2022 年 10 月。2022 年 9 月至 2023 年 4 月期间,从 12 688 名调查对象中收集了数据(COVID-19 阳性组 11 174 人,对照组 1514 人):主要结果指标:持续新症状、恢复情况以及日常功能,使用有效问卷调查疲劳、神经认知症状、焦虑、抑郁和生活质量:感染后平均 12.6 个月,COVID-19 阳性组中有 4560 名受访者(39.1%;95% CI,37.9-40.3%)报告了至少一种持续性新症状,而对照组中有 216 名受访者(20.8%;95% CI,18.5-23.1%)报告了至少一种持续性新症状。共有 1656 名受访者(14.2%;95% CI,13.4-15.0%)被归类为临床长期慢性阻塞性肺病患者,其标准是至少有一种持续的新症状,并且在感染三个月后痊愈率低于 80%。在患有临床长期 COVID 的受访者中,有 535 人(3.2%;95% CI,2.6-3.8%)在感染 12 个月后表示在日常活动方面至少存在中度问题。感染时间较短的受访者出现临床长期 COVID 的比例较低。女性、40-49 岁、感染严重程度、慢性疾病、既往焦虑或抑郁是临床长期 COVID 的风险因素。临床长COVID风险降低的相关因素包括:与祖先病毒株占优势时相比,奥米克龙株占优势时的感染和德尔塔株占优势时的感染:结论:COVID-19 病毒感染后出现持续症状很常见,但感染毒性较低的毒株时发病率较低。虽然长效 COVID 基本上可以在初级保健中得到控制,但少数有持续症状和功能受损的患者可能需要专科护理途径,其有效性应成为未来研究的重点。
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引用次数: 0
Hospital costs of COVID-19, post-COVID-19 condition and other viral pneumonias: a cost comparison analysis COVID-19、COVID-19 后病情和其他病毒性肺炎的住院费用:成本比较分析。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52465
Danielle Hitch, Mary Rose Angeles, Eric Lau, Kelli Nicola-Richmond, Catherine Bennett, Catherine M Said, Sara Holton, Kimberley Haines, Bodil Rasmussen, Genevieve Pepin, Kieva Richards, Martin Hensher

Objectives

To compare hospital admission costs for coronavirus disease 2019 (COVID-19) cases to hospital admission costs for other viral pneumonia cases in Australia, and to describe hospital admission costs for post-COVID-19 condition.

Design, setting, participants

A cost comparison analysis of hospital admissions due to COVID-19 or other viral pneumonias between 1 January 2020 and 30 June 2021 at Victorian public health acute and subacute services.

Main outcome measures

Demographic characteristics, clinical outcomes (including diagnoses, impairment, subacute admission, intensive care unit admissions, ventilation, and length of stay) and cost data (including diagnostic-related groups, and total, direct and indirect costs).

Results

During the study period, 3197 patients were admitted to hospital due to COVID-19 and 15 761 were admitted for other viral pneumonias. Admissions for COVID-19 cost 29% more than admissions for other viral pneumonias. Admissions for COVID-19 requiring intensive care unit admission incurred significantly higher mean costs (A$120 504 or US$90 595) compared with those not requiring intensive care unit admission (A$19 634 or US$14 761). The adjusted cost of admissions related to post-COVID-19 condition was A$11 090 or US$8 337, and these admissions were significantly more likely to be elective. Direct costs accounted for most of the costs for all groups, and admissions for post-COVID-19 condition used less allied health services than other groups.

Conclusions

Given its recent emergence, cases of acute COVID-19 and post-COVID-19 condition have had a significant additional financial impact on Australian hospitals. Further studies are required to understand long term costs and identify trends over time in the context of increased vaccination rates and subsequent variants of severe acute respiratory syndrome coronavirus 2.

目的比较澳大利亚2019年冠状病毒病(COVID-19)病例的住院费用与其他病毒性肺炎病例的住院费用,并描述COVID-19后的住院费用:2020年1月1日至2021年6月30日期间维多利亚州公共卫生急症和亚急性服务机构因COVID-19或其他病毒性肺炎入院的成本比较分析:人口统计学特征、临床结果(包括诊断、损伤、亚急性入院、重症监护室入院、通气和住院时间)和成本数据(包括诊断相关组别以及总成本、直接成本和间接成本):研究期间,3197 名患者因 COVID-19 入院,15761 名患者因其他病毒性肺炎入院。COVID-19 的住院费用比其他病毒性肺炎的住院费用高出 29%。因 COVID-19 入院需要入住重症监护室的平均费用(120 504 澳元或 90 595 美元)明显高于不需要入住重症监护室的平均费用(19 634 澳元或 14 761 美元)。与 COVID-19 后病情相关的入院调整成本为 11 090 澳元或 8 337 美元,而且这些入院明显更可能是选择性的。直接成本占所有组别成本的大部分,COVID-19 后病情入院患者使用的专职医疗服务少于其他组别:结论:急性 COVID-19 和 COVID-19 后遗症病例最近才出现,对澳大利亚医院造成了重大的额外经济影响。随着疫苗接种率的提高和严重急性呼吸系统综合症冠状病毒 2 的后续变种的出现,还需要进一步的研究来了解长期成本并确定长期趋势。
{"title":"Hospital costs of COVID-19, post-COVID-19 condition and other viral pneumonias: a cost comparison analysis","authors":"Danielle Hitch,&nbsp;Mary Rose Angeles,&nbsp;Eric Lau,&nbsp;Kelli Nicola-Richmond,&nbsp;Catherine Bennett,&nbsp;Catherine M Said,&nbsp;Sara Holton,&nbsp;Kimberley Haines,&nbsp;Bodil Rasmussen,&nbsp;Genevieve Pepin,&nbsp;Kieva Richards,&nbsp;Martin Hensher","doi":"10.5694/mja2.52465","DOIUrl":"10.5694/mja2.52465","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare hospital admission costs for coronavirus disease 2019 (COVID-19) cases to hospital admission costs for other viral pneumonia cases in Australia, and to describe hospital admission costs for post-COVID-19 condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting, participants</h3>\u0000 \u0000 <p>A cost comparison analysis of hospital admissions due to COVID-19 or other viral pneumonias between 1 January 2020 and 30 June 2021 at Victorian public health acute and subacute services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Demographic characteristics, clinical outcomes (including diagnoses, impairment, subacute admission, intensive care unit admissions, ventilation, and length of stay) and cost data (including diagnostic-related groups, and total, direct and indirect costs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study period, 3197 patients were admitted to hospital due to COVID-19 and 15 761 were admitted for other viral pneumonias. Admissions for COVID-19 cost 29% more than admissions for other viral pneumonias. Admissions for COVID-19 requiring intensive care unit admission incurred significantly higher mean costs (A$120 504 or US$90 595) compared with those not requiring intensive care unit admission (A$19 634 or US$14 761). The adjusted cost of admissions related to post-COVID-19 condition was A$11 090 or US$8 337, and these admissions were significantly more likely to be elective. Direct costs accounted for most of the costs for all groups, and admissions for post-COVID-19 condition used less allied health services than other groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Given its recent emergence, cases of acute COVID-19 and post-COVID-19 condition have had a significant additional financial impact on Australian hospitals. Further studies are required to understand long term costs and identify trends over time in the context of increased vaccination rates and subsequent variants of severe acute respiratory syndrome coronavirus 2.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S9","pages":"S23-S30"},"PeriodicalIF":6.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52465","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Five decades of debate on burnout 五十年来关于职业倦怠的争论
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-03 DOI: 10.5694/mja2.52512
Renzo Bianchi, James F Sowden
<p>First described in the mid-1970s, “burnout” has elicited continued interest among occupational health specialists.<span><sup>1, 2</sup></span> The World Health Organization<span><sup>3</sup></span> defines burnout as a triadic syndrome that comprises: (i) feelings of energy depletion or exhaustion; (ii) increased mental distance from one's job, or feelings of negativism or cynicism towards one's job; and (iii) a sense of ineffectiveness and lack of accomplishment. This definition closely aligns with the conceptualisation of burnout in the Maslach Burnout Inventory, the most prominent measure of the entity.<span><sup>2, 4</sup></span> Although burnout has become a popular indicator of job-related distress, persistent controversies surround the construct. As burnout reaches its half-century of existence, this article offers an overview of key research developments that have prompted investigators to revamp their views of the syndrome.</p><p>The conventional wisdom among researchers is that burnout arises from unresolvable job stress.<span><sup>2, 5</sup></span> The “job-relatedness” of burnout has been considered a signature feature of the syndrome.<span><sup>2</sup></span> These views have been incorporated by the World Health Organization, which characterises burnout as a syndrome “resulting from chronic workplace stress that has not been successfully managed”.<span><sup>3</sup></span> Although widely shared, the idea that work-related stress is the force driving the development of burnout has proven difficult to support. Substantial associations between work-related stress and burnout have been documented in a wealth of cross-sectional studies. However, longitudinal studies have showed a more subtle pattern of results. In a meta-analysis of 74 follow-up studies, Lesener and colleagues found that job demands and job resources predicted burnout only modestly.<span><sup>6</sup></span> Similar results were obtained by Guthier and colleagues in a meta-analysis of 48 follow-up studies focusing on job stressors and burnout.<span><sup>7</sup></span> Guthier and colleagues found that the association between job stressors and burnout was not only small but also likely overestimated.<span><sup>7</sup></span> In both meta-analyses, burnout was predictive of, rather than predicted by, work-related stress. In summary, there is no clear evidence that burnout is primarily caused by work, or that work contributes more to burnout than it does to other stress-related conditions — such as anxiety and depression. Recently, an increased focus on non-work factors (eg, negative life events, lifestyle factors), personality traits (eg, neuroticism), and physical disorders (eg, sleep–wake disorders and thyroid disorders) has been encouraged.<span><sup>7, 8</sup></span> Studies capitalising on intensive longitudinal methods, objective (health) measures, and long term follow-ups may be helpful in this endeavour. Without a deeper understanding of the determinants of burno
“职业倦怠”在20世纪70年代中期首次被描述,引起了职业健康专家的持续关注。1,2世界卫生组织3将倦怠定义为一种三重综合征,包括:(i)感觉精力耗尽或疲惫;(ii)与工作的心理距离增加,或对工作产生消极或愤世嫉俗的情绪;(三)无效能感和缺乏成就感。这一定义与马斯拉克职业倦怠量表(Maslach burnout Inventory)中职业倦怠的概念密切相关,后者是衡量企业最重要的指标。尽管职业倦怠已成为一个流行的工作相关压力指标,但围绕这一概念的争议一直存在。随着职业倦怠已经存在了半个世纪,这篇文章提供了一个关键研究进展的概述,这些研究进展促使研究人员改变了他们对这种综合症的看法。研究人员的传统观点是,职业倦怠源于无法解决的工作压力。2,5职业倦怠的“工作相关性”被认为是该综合征的一个标志性特征这些观点已被世界卫生组织纳入其中,该组织将职业倦怠定性为“由于长期工作压力而未得到成功管理”的一种综合症尽管工作压力是导致职业倦怠的原因这一观点得到了广泛认同,但事实证明,这一观点很难得到支持。大量的横断面研究已经证明了工作压力和职业倦怠之间的实质性联系。然而,纵向研究显示了一种更为微妙的结果模式。在对74项后续研究的荟萃分析中,Lesener及其同事发现,工作需求和工作资源对职业倦怠的预测作用不大Guthier和他的同事对48项关注工作压力源和倦怠的后续研究进行了荟萃分析,得出了类似的结果Guthier和他的同事们发现,工作压力源和倦怠之间的联系不仅很小,而且很可能被高估了在这两项荟萃分析中,职业倦怠是工作压力的预测因素,而不是工作压力的预测因素。总而言之,没有明确的证据表明职业倦怠主要是由工作引起的,或者工作对职业倦怠的影响比对其他与压力相关的情况(如焦虑和抑郁)的影响更大。最近,越来越多的关注非工作因素(如负面生活事件、生活方式因素)、人格特征(如神经质)和身体疾病(如睡眠-觉醒障碍和甲状腺疾病)。7,8利用密集的纵向方法、客观(健康)测量和长期随访的研究可能有助于这一努力。如果对职业倦怠的决定因素没有更深入的了解,设计有效的干预措施可能仍然具有挑战性。近几十年来,职业倦怠流行病的说法越来越多。科学和一般新闻界都流传着极高的流行率估计。然而,这些数字的有效性和合理性令人担忧。研究人员强调,由于无法准确诊断,因此无法估计倦怠的患病率。在实践中,职业倦怠患病率的衡量标准不仅在临床上和理论上是任意的,而且是松散和异构的这种标准的使用受到了严厉的批评,有人呼吁在建立健全的诊断标准之前停止进行(和发表)患病率研究。在制定职业倦怠的诊断标准时,研究人员应注意诊断潜行,以避免将压力、疲劳或动机方面的普通变化病态化。尽管许多研究人员将倦怠和抑郁视为两种不同的动物,但要确定两者之间的明显差异仍是一项挑战检查倦怠的临床表现,很难不注意到倦怠的症状学在很大程度上借鉴了抑郁症的症状。马斯拉奇和他的同事们自己也指出,职业倦怠的特点是“焦虑的症状占主导地位”。一个特别令人困惑的发现是,倦怠症状之间的相关性不如抑郁症状之间的相关性强基于这些结果,研究者认为,倦怠症状可以被视为抑郁症状的一部分,而不是一个独立症状的组成部分在病因学上,无法解决的压力似乎是一个共同点。8、12森指出,倦怠和抑郁基本上是由相同的因素预测的对认知功能的研究,主要关注人们在环境中如何处理任务和处理刺激,发现倦怠与抑郁症的典型变化有关在神经生物学方面,对倦怠的研究尚无定论。 许多伴随倦怠结构引入的叙述已经被揭穿。一些误解已经达到了都市传说的地位,尽管缺乏有效性,但仍然困扰着这个领域。有些令人不安的是,对于职业倦怠研究人员来说,最紧迫的问题可能是就他们感兴趣的实体的基本性质达成一致。随着研究人员进一步阐明倦怠之谜,倦怠是否反映了一种“真实现象”,即不能归结为痛苦的经典表现(即焦虑和抑郁症状),这一问题可能需要特别关注。无相关披露。不是委托;外部同行评审。
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引用次数: 0
A Northern Territory-trained health workforce is required to meet its context-specific disease burden and health care needs 北部地区需要一支经过培训的医疗卫生队伍,以满足其特定的疾病负担和医疗保健需求。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-31 DOI: 10.5694/mja2.52513
Dominic Upton, Varunika Ruwanpura
<p>The beauty and diversity of the Northern Territory often mask major health, economic, and social challenges for the people living in this vast Australian region. The geography of the NT adds to this complexity: some 1 347 791 km<sup>2</sup> with a sparse population of about 250 000 people, of whom about 26% are First Nations Australians.<span><sup>1</sup></span></p><p>The pronounced health problems for people in the NT have been documented in numerous reports detailing high levels of morbidity and mortality. Most strikingly, albeit most simplistically, life expectancy at birth in the NT is the lowest in Australia: in 2020–2022 it was 76.2 years for males, five years lower than the national figure (81.2 years), and 80.7 years for females, 4.6 years lower than the national figure (85.3 years).<span><sup>2</sup></span> Unsurprisingly, these health inequalities are the result of several factors that have frequently been articulated, including geographic isolation and remoteness, inadequate infrastructure and resources, the complex needs of the large proportion of Indigenous Australians, and the difficulty of recruiting and retaining health care workers.<span><sup>3</sup></span></p><p>A key contributor to health inequalities may be the lack of an adequate and appropriate health care workforce that suits the specific needs of the NT population; the recruitment and retention of health care professionals is a lamented tale nationwide.<span><sup>4</sup></span> The shortage and often high turnover of health workers in the NT exacerbates these challenges and has far reaching consequences for regional public health and wellbeing. Some reports highlight regional deficiencies in specific health professions; for example, the Australian Institute of Health and Welfare and other national peak bodies have reported that the numbers of allied health professionals, pharmacists, speech pathologists, and dentists are among the lowest in the country.<span><sup>5, 6</sup></span> However, some areas of apparent adequate supply have also been identified; for example, a surplus of optometrists is expected nationally, and their numbers are also reasonable in the NT.<span><sup>7</sup></span> The pattern regarding medical practitioners is similar: the number in the NT (505 full-time equivalents per 100 000 population) was the highest in the country in 2022, as reported by the Australian Institute of Health and Welfare (the lowest was for Western Australia, 423 full-time equivalents per 100 000 population).<span><sup>5</sup></span> Despite the apparent adequate supply of these health care professionals, the health demands of people in the NT remain high and their outcomes poor.</p><p>In this issue of the <i>MJA</i>, Zhao and colleagues<span><sup>8</sup></span> present a different perspective on the problem, assessing the health workforce in relation to the burden of disease and injury in the NT. In their analysis of administrative data for 2009–2018, the authors found that t
北领地的美丽和多样性往往掩盖了生活在这片广阔的澳大利亚地区的人们面临的重大健康、经济和社会挑战。北领地的地理位置增加了这种复杂性:面积约为1 347 791平方公里,人口稀少,约25万人,其中约26%是第一民族澳大利亚人。1许多报告详细记录了北领地人民明显的健康问题,详细说明了高发病率和高死亡率。最引人注目的是,尽管最简单,北领地出生时的预期寿命是澳大利亚最低的:2020-2022年,男性的预期寿命为76.2岁,比全国数字(81.2岁)低5岁,女性为80.7岁,比全国数字(85.3岁)低4.6岁毫不奇怪,这些保健不平等现象是经常提到的几个因素造成的,包括地理上的孤立和偏远、基础设施和资源不足、大部分澳大利亚土著居民的复杂需求以及征聘和留住保健工作者的困难。3A保健不平等的主要原因可能是缺乏足够和适当的保健工作人员,以适应北领地人口的具体需要;卫生保健专业人员的招聘和保留在全国范围内是一个令人遗憾的故事北领地卫生工作者的短缺和经常的高流动率加剧了这些挑战,并对区域公共卫生和福祉产生了深远的影响。一些报告强调了区域在特定卫生专业方面的不足;例如,澳大利亚健康与福利研究所和其他国家高峰机构报告说,专职卫生专业人员、药剂师、语言病理学家和牙医的数量是全国最低的。5,6不过,也查明了一些显然供应充足的地区;例如,预计全国的验光师将出现过剩,其数量在北领地也是合理的。7关于医生的模式也类似:根据澳大利亚卫生和福利研究所的报告,北领地的人数(每10万人中有505名全职等效人员)在2022年是全国最高的(最低的是西澳大利亚州,每10万人中有423名全职等效人员)尽管这些保健专业人员显然供应充足,但北领地人民的保健需求仍然很高,结果很差。在这一期的MJA中,赵和他的同事8提出了一个不同的观点,评估了与北领地疾病和伤害负担相关的卫生人力资源。在对2009-2018年行政数据的分析中,作者发现北领地卫生人力资源在调整疾病负担后比全国水平低22%左右,需要更多的卫生保健专业人员来满足其需求。最急需的卫生保健专业人员是464名护士和助产士、196名物理治疗师、189名心理学家、152名药剂师和144名牙医。简而言之,赵和他的同事们发现,北部地区卫生保健专业人员的服务不足,在许多专业方面存在重大差距由于北领地难以招聘和留住现有水平的保健工作人员,它在保健标准方面将继续落后于澳大利亚其他地区。维持现状不是一种选择。北领地偏远地区的护士在向澳大利亚一些最孤立和服务不足的社区提供保健服务方面发挥着关键和多方面的作用。他们在小型诊所或保健中心工作,通常在偏远或非常偏远的地方,提供广泛的保健服务,适应这些地区的独特需求和挑战。不幸的是,许多接受北部地区职位的护士都有短期合同,导致高流动率和护理连续性差。在资源有限的情况下工作,照顾有复杂卫生保健问题的人,以及偏远地区的隔离,这些压力都可能导致倦怠。专业人员的短缺也意味着,那些留下来的人往往要承受巨大的工作量,进一步增加了精疲力竭的风险。恶性循环的结果是,在偏远地区护士中发现高职业压力不足为奇。这种专业经验不仅限于护士:许多在偏远地区工作的卫生保健专业人员都有这种经验。Zhao及其同事强调了改善北部地区土著居民健康结果的具体劳动力要求。由于北部地区26%的人是澳大利亚土著居民,因此显然需要更多的土著卫生从业人员;他们的人数必须反映北部地区土著人民的人数及其保健需求。 总之,Zhao和他的同事们对北北省卫生人力提供了令人大开眼界的见解,这些见解共同表明,根据北北省的疾病负担,人数短缺22%。解决方案之一是在当地教育、招聘和保留适合该地区独特需求的卫生人力。采用这种方法,北部地区的保健工作人员更有可能包括更多的土著人民,了解北部地区独特的保健问题,并留在北部地区,确保工作人员的安全和人数适当,以满足这一广大地区的需要通过系统地应对这些挑战,北部地区可以努力实现其人民理应拥有的更稳定的卫生人力。无相关披露。外部同行评审。
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引用次数: 0
Cerebral palsy in Australia: optimism and challenges 澳大利亚的大脑性麻痹:乐观与挑战。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-31 DOI: 10.5694/mja2.52492
Rod W Hunt
<p>In this issue of the <i>MJA</i>, Smithers-Sheedy and colleagues<span><sup>1</sup></span> report that rates of cerebral palsy in Australia are declining in a sustained and significant manner, and are among the lowest in the world. During 1995–2016, the overall cerebral palsy incidence rate declined by about 40%.<span><sup>1</sup></span> This change was accompanied by a reduction in the severity of the condition; the incidence of children who required assistive mobility equipment declined from 0.8 per 1000 live births in 1997–1998 to 0.5 per 1000 live births in 2015–2016.<span><sup>2</sup></span> Not only is this incredibly exciting, but the major improvements in the rates and severity of cerebral palsy will have a substantial economic benefit: in 2018, the financial costs of cerebral palsy in Australia were $3.03 billion, not including $2.15 billion in lost wellbeing.<span><sup>3</sup></span></p><p>The strength of the study by Smithers-Sheedy and colleagues stems from its basis in data from population-based cerebral palsy registers with near complete case ascertainment. The power of such registers to capture the current status of the condition cannot be overstated. Epidemiologists and clinician scientists rely on registry data to inform effective research, stimulating questions about interventions for optimising outcomes for those at greatest risk of specific medical conditions. The researchers who manage registers spend vast amounts of time seeking funding for the ongoing employment of qualified staff to enter, manage, and analyse the data. The potential of registers to improve patient outcomes is enormous. For example, guidelines for hip screening and early interventions to reduce hip displacement in children with cerebral palsy were developed because register data identified risk factors and the natural history of this painful and debilitating condition.<span><sup>4</sup></span> Funding for these valuable registers must be secure and sustained so that those managing them can undertake the research that will further improve treatment and patient outcomes.</p><p>Smithers-Sheedy and colleagues note that a major limitation of their study was that their birth prevalence analysis included data from only three state registers; data from New South Wales were excluded from the birth prevalence analyses, but will be included in future analyses as complete case ascertainment data become available.<span><sup>1</sup></span> That said, it is unlikely that the situation in South Australia, Victoria, or Western Australia (the included registers) differ significantly from that in NSW or the Australian Capital Territory. State-based cerebral palsy registers often operate ethically with an opt-out arrangement, whereby families are automatically included but are offered the choice of opting out. When families do opt out, ethics may still allow for a small minimum dataset to be collected from which prevalence can be estimated. Smithers-Sheedy and colleagues did
Smithers-Sheedy 及其同事1 在本期《澳大利亚医学杂志》(MJA)上报告称,澳大利亚的脑瘫发病率正在持续大幅下降,是世界上发病率最低的国家之一。1995-2016 年间,大脑性麻痹的总体发病率下降了约 40%。1 这一变化伴随着病情严重程度的降低;需要辅助移动设备的儿童发病率从 1997-1998 年的每千名活产儿 0.8 例降至 2015 年的每千名活产儿 0.5 例。2 这不仅令人振奋,而且脑瘫发病率和严重程度的显著改善将带来巨大的经济效益:2018 年,澳大利亚脑瘫的经济成本为 30.3 亿澳元,这还不包括 21.5 亿澳元的福利损失。Smithers-Sheedy 及其同事所做研究的优势在于其数据来源于以人口为基础的脑瘫登记册,这些登记册对病例的确认几近完整。此类登记册在掌握病情现状方面的作用怎么强调都不为过。流行病学家和临床科学家依靠登记册数据为有效研究提供信息,激发有关干预措施的问题,以优化特定病症高危人群的治疗效果。管理登记册的研究人员花费大量时间寻求资金,以持续聘用合格的工作人员来输入、管理和分析数据。登记册在改善患者治疗效果方面潜力巨大。例如,制定髋关节筛查和早期干预指南以减少脑瘫儿童的髋关节移位,就是因为登记册数据确定了风险因素以及这种令人痛苦和衰弱的疾病的自然病史。Smithers-Sheedy 及其同事指出,他们的研究存在一个主要局限性,即他们的出生流行率分析仅包括来自三个州登记册的数据;新南威尔士州的数据被排除在出生流行率分析之外,但随着完整的病例确诊数据的获得,这些数据将被纳入未来的分析中。尽管如此,南澳大利亚州、维多利亚州或西澳大利亚州(包括登记册)的情况与新南威尔士州或澳大利亚首都直辖区的情况不太可能有显著差异。以州为基础的大脑性瘫痪登记册通常采用选择退出的伦理安排,即家庭自动被纳入登记册,但可选择退出。当家庭选择退出时,伦理道德仍允许收集最低限度的少量数据集,并据此估算患病率。Smithers-Sheedy 及其同事没有报告选择退出的比例,但登记保管人向我们保证,选择退出的比例非常低。尽管如此,澳大利亚并不能保证完全确定脑瘫病例,这可能会使分析产生偏差,特别是如果偏远地区的家庭比大城市的家庭更频繁地选择退出的话。围产期的脆弱性是导致脑瘫风险的最主要因素。它主要与早产相关的脑损伤有关,而出生窒息和其他新生儿脑病原因(如中风和围产期中枢神经系统感染)的影响较小。只有约 5%的脑瘫病例是由产后原因造成的,如脑部感染、缺氧性损伤(窒息或溺水)和非意外伤害。极早产儿(早于妊娠 28 周出生)的病例数量最少,他们最容易受到脑损伤和发育不良的影响;由于现在的存活极限低至 22 周,5 他们的数量正在增加。新生儿重症监护正在不断改进,但由于积极治疗妊娠 22-23 周出生的婴儿而增加的风险,抵消了预期改善的结果。在新生儿学取得进步的同时,脑瘫的发病率也有所下降,例如使用产前皮质类固醇来预防早产儿肺部疾病6 ,以及将硫酸镁作为早产儿溶血剂7。最常见的早产儿脑损伤是由炎症引起的弥漫性脑白质损伤;目前正在研究有针对性的抗炎疗法,看它们是否也能降低脑瘫的发病率。
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引用次数: 0
Cerebral palsy in Australia: birth prevalence, 1995–2016, and differences by residential remoteness: a population-based register study 澳大利亚的大脑性麻痹:1995-2016 年的出生率以及居住地偏远程度的差异:一项基于人口的登记研究。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-30 DOI: 10.5694/mja2.52487
Hayley Smithers-Sheedy, Emma Waight, Shona Goldsmith, Sue Reid, Catherine Gibson, Heather Scott, Linda Watson, Megan Auld, Fiona Kay, Clare Wiltshire, Gina Hinwood, Annabel Webb, Tanya Martin, Nadia Badawi, Sarah McIntyre, the ACPR Group
<div> <section> <h3> Objective</h3> <p>To examine recent changes in the birth prevalence of cerebral palsy in Australia; to examine the functional mobility of children with cerebral palsy by residential remoteness.</p> </section> <section> <h3> Study design</h3> <p>Population-based register study; analysis of Australian Cerebral Palsy Register (ACPR) data.</p> </section> <section> <h3> Setting, participants</h3> <p>Children with cerebral palsy born in Australia, 1995–2016, and included in the ACPR at the time of the most recent state/territory data provision (31 July 2022).</p> </section> <section> <h3> Main outcome measures</h3> <p>Change in birth prevalence of cerebral palsy, of cerebral palsy acquired pre- or perinatally (<i>in utero</i> to day 28 after birth), both overall and by gestational age group (less than 28, 28–31, 32–36, 37 or more weeks), and of cerebral palsy acquired post-neonatally (day 29 to two years of age); gross motor function classification by residential remoteness.</p> </section> <section> <h3> Results</h3> <p>Data for 10 855 children with cerebral palsy born during 1995–2016 were available, 6258 of whom were boys (57.7%). The birth prevalence of cerebral palsy in the three states with complete case ascertainment (South Australia, Victoria, Western Australia) declined from 2.1 (95% confidence interval [CI], 1.9–2.4) cases per 1000 live births in 1995–1996 to 1.5 (95% CI, 1.3–1.7) cases per 1000 live births in 2015–2016. The birth prevalence of pre- or perinatally acquired cerebral palsy declined from 2.0 (95% CI, 1.7–2.3) to 1.4 (95% CI, 1.2–1.6) cases per 1000 live births; statistically significant declines were noted for all gestational ages except 32–36 weeks. The decline in birth prevalence of post-neonatally acquired cerebral palsy, from 0.15 (95% CI, 0.11–0.21) to 0.08 (95% CI, 0.05–0.12) cases per 1000 live births, was not statistically significant. Overall, 3.4% of children with cerebral palsy (307 children) lived in remote or very remote areas, a larger proportion than for all Australians (2.0%); the proportion of children in these areas who required wheelchairs for mobility was larger (31.3%) than that of children with cerebral palsy in major cities or regional areas (each 26.1%).</p> </section> <section> <h3> Conclusions</h3> <p>The birth prevalence of cerebral palsy declined markedly in Australia during 1995–201
研究目的考察澳大利亚脑瘫出生率的最新变化;根据居住地的偏远程度考察脑瘫儿童的功能活动能力:基于人口的登记研究;澳大利亚脑瘫登记(ACPR)数据分析:主要结果测量指标:出生时脑瘫患病率的变化:主要结果测量指标:出生时脑瘫患病率的变化,出生前或围产期(子宫内至出生后第28天)脑瘫患病率的变化,包括总体患病率和按胎龄组(小于28周、28-31周、32-36周、37周或以上)划分的患病率,以及新生儿出生后(第29天至两岁)脑瘫患病率的变化;按居住地偏远程度划分的粗大运动功能分类:1995-2016年期间出生的10 855名脑瘫患儿的数据,其中6258名为男孩(57.7%)。在有完整病例确认的三个州(南澳大利亚州、维多利亚州和西澳大利亚州),脑瘫的出生流行率从1995-1996年的每千名活产婴儿2.1例(95%置信区间[CI],1.9-2.4)下降到2015-2016年的每千名活产婴儿1.5例(95%置信区间,1.3-1.7)。出生前或围产期获得性脑瘫的出生流行率从每1000例活产中2.0例(95% CI,1.7-2.3)下降到1.4例(95% CI,1.2-1.6);除32-36周外,所有孕周的出生流行率均出现了统计学意义上的显著下降。新生儿出生后获得性脑瘫的发病率从每 1000 例活产中 0.15 例(95% CI,0.11-0.21 例)下降到 0.08 例(95% CI,0.05-0.12 例),但没有统计学意义。总体而言,3.4%的脑瘫儿童(307名儿童)生活在偏远或非常偏远的地区,这一比例高于所有澳大利亚人(2.0%);这些地区需要轮椅代步的儿童比例(31.3%)高于大城市或地区的脑瘫儿童比例(各为26.1%):结论:1995-2016年间,澳大利亚的脑瘫出生率明显下降,这反映了孕产妇和围产期护理进步所带来的影响。我们的研究结果突出表明,有必要在澳大利亚全国范围内为妇女提供公平、文化安全的产前服务,并为脑瘫患者提供健康和残疾服务。
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Medical Journal of Australia
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