Clinical Epidemiology and Global Health最新文献_第2页

May Measurement Month (MMM) program 2021–2024: Results of a community screening program in can Tho city, Vietnam 五月测量月（MMM）计划2021-2024：越南芹苴市社区筛查计划的结果

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-22 DOI: 10.1016/j.cegh.2026.102302

Son Kim Tran , Cuong Tan Vo , Phuong Minh Nguyen , Dung The Bui , Chau Minh Tran , Toan Hoang Ngo , Minh Van Huynh

Problem considered

Hypertension (HTN) remains one of the most pressing global health challenges, straining healthcare systems. The May Measurement Month (MMM) campaign aims to raise blood pressure (BP) awareness and address screening gaps. This study screened volunteers aged ≥18 for HTN and cardiovascular risk factors to assess prevalence, awareness, and management effectiveness.

Methods

This study employed a cross-sectional, opportunistic survey design. Data were collected from adults aged ≥18 years between 2021 and 2024 as part of the MMM initiative.

Results

Among 4105 participants (mean age 53.0 ± 15.3 years), 37.2 % had HTN. Of untreated individuals, 72.5 % were hypertensive, while 53.4 % of treated cases remained uncontrolled (BP ≥ 140/90 mmHg). HTN prevalence rose from 28.9 % (2021) to 47.8 % (2024), with BP control improving to 46.5 % (p < 0.001). HTN was highest in ≥60 years (46.8 %) and lowest in <45 years (15.4 %), while BP control remained stable (33.5 %–35.1 %). Males had higher HTN prevalence, though BP control differences were not significant (p > 0.05). In univariate analyses, HTN was associated with smoking, alcohol use, overweight–obesity, pregnancy, and cardiovascular comorbidities. In the multivariate model from MMM 2021–2024, independent contributors to HTN included older age, heart attack, stroke, diabetes, and physical inactivity, whereas smoking and male sex did not retain statistical significance.

Conclusion

The MMM 2021–2024 campaign, conducted during COVID-19, highlighted the need for BP screening in Vietnam. Despite pandemic challenges, undiagnosed and uncontrolled HTN remain major concerns. Standardized screening like MMM remains crucial for detecting high BP and improving HTN management.

高血压（HTN）仍然是最紧迫的全球卫生挑战之一，给卫生保健系统带来了压力。五月测量月（MMM）活动旨在提高血压（BP）的意识并解决筛查差距。本研究筛选年龄≥18岁的志愿者进行HTN和心血管危险因素的筛查，以评估患病率、意识和管理有效性。方法本研究采用横断面、机会性调查设计。作为MMM计划的一部分，从2021年至2024年期间年龄≥18岁的成年人中收集数据。结果4105名参与者（平均年龄53.0±15.3岁）中，37.2%患有HTN。在未治疗的个体中，72.5%为高血压，而53.4%的治疗病例仍未控制（血压≥140/90 mmHg）。HTN患病率从28.9%（2021年）上升到47.8%（2024年），血压控制率提高到46.5% （p < 0.001）。≥60岁时HTN最高（46.8%），≥45岁时最低（15.4%），血压控制保持稳定（33.5% ~ 35.1%）。男性HTN患病率较高，但血压控制差异无统计学意义（p > 0.05）。在单变量分析中，HTN与吸烟、饮酒、超重肥胖、怀孕和心血管合并症有关。在MMM 2021-2024多元模型中，HTN的独立影响因素包括年龄较大、心脏病发作、中风、糖尿病和缺乏运动，而吸烟和男性性别没有统计学意义。结论在2019冠状病毒病期间开展的MMM 2021-2024运动强调了在越南进行BP筛查的必要性。尽管面临大流行的挑战，但未确诊和不受控制的HTN仍然是主要问题。像MMM这样的标准化筛查对于发现高血压和改善HTN管理仍然至关重要。

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引用次数: 0

Connotation of serum levels of vitamin D3 and LL-37 with urinary tract infection in type 2 diabetic patients 血清维生素D3和LL-37水平与2型糖尿病患者尿路感染的关系

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-21 DOI: 10.1016/j.cegh.2026.102299

Zahraa A. Hashim

Problem considered

Type 2 diabetes mellitus (T2DM) is characterized by inappropriacy of innate immunity leading to higher rates of urinary tract infection (UTI), an important risk factor for urinary tract complications. 25-hydroxy vitamin D may donate, via the production of the antimicrobial peptide cathelicidin (LL-37), to epithelial host defense against colonization of uro-pathogens. This study aimed to assess serum levels of vitamin D₃ and LL-37 in T2DM patients with and without UTI and to measure the association of these two parameters with metabolic profile and microbial distribution pattern.

Methods

Patients' characteristics were documented and included patients’ age, sex, duration of being diagnosed with T2DM, concurrent treatments, other diseases, body mass index, and smoking status. Blood sample was collected from each enrolled patient for metabolic profiling, serum vitamin D_3, and LL-37 measurement. Urine sample was collected for urinalysis and patients were grouped accordingly into with-UTI (group A) and without-UTI (group B) groups.

Results

One hundred and twelve T2DM patients (aged 51.1 ± 5.8 years) were enrolled; 50 patients with UTI and 62 without. Serum levels of vitamin D₃ were found to be significantly lower in patients with UTI (17.9 ± 4.8 ng/mL) than in patients without UTI (25.2 ± 5.7 ng/mL) (p < 0.01). In accordance, LL-37 levels were significantly reduced in group A members (27.5 ± 6.9 ng/mL) when compared to group B members (35.5 ± 8.6 ng/mL) (p-value <0.01). E. coli was the most common isolated uro-pathogen (40 %) followed by P. aeruginosa and S. aureus (14 % each), Enterobacter (10 %), Klebsiella spp (8 %) and Proteus spp (4 %). No significant difference in serum LL-37 levels was encountered between the three types of microbial isolates (p-value <0.05). A strong positive correlation was reported between LL-37 and vitamin D₃ levels in patients without UTI (r_s: 0.9855, p-value: <0.01). A weak, though non-significant, correlation was observed between LL-37 and vitamin D₃ in patients with UTI (r_s: 0.25283, p-value: >0.05).

Conclusion

Findings suggest that diminished serum levels of vitamin D₃ and LL-37 could have clinical implications and could act as a potential immunological indicator for the tendency to develop UTI in diabetic patients.

2型糖尿病（T2DM）的特点是先天免疫功能不正常，导致尿路感染（UTI）发生率增高，这是尿路并发症的重要危险因素。25-羟基维生素D可能通过抗菌肽抗菌肽（LL-37）的产生，帮助上皮宿主防御尿路病原体的定植。本研究旨在评估伴有和不伴有UTI的T2DM患者血清中维生素D3和LL-37的水平，并测量这两个参数与代谢谱和微生物分布模式的关系。方法记录患者的特征，包括患者的年龄、性别、诊断为T2DM的持续时间、同期治疗、其他疾病、体重指数和吸烟状况。收集每位入组患者的血液样本进行代谢分析、血清维生素D3和LL-37测量。采集尿样进行尿液分析，将患者分为有尿路感染组（A组）和无尿路感染组（B组）。结果纳入T2DM患者112例（年龄51.1±5.8岁）；50例尿路感染，62例无尿路感染。尿路感染患者血清维生素D3水平（17.9±4.8 ng/mL）明显低于非尿路感染患者（25.2±5.7 ng/mL）（p < 0.01）。与B组（35.5±8.6 ng/mL）相比，A组的LL-37水平显著降低（27.5±6.9 ng/mL）（p值<；0.01）。大肠杆菌是最常见的尿路病原菌（40%），其次是铜绿假单胞菌和金黄色葡萄球菌（各占14%）、肠杆菌（10%）、克雷伯氏菌（8%）和变形杆菌（4%）。三种微生物分离株血清LL-37水平无显著差异（p值<；0.05）。无UTI患者LL-37与维生素D3水平呈正相关（rs: 0.9855， p值：<；0.01）。在UTI患者中，LL-37与维生素D3之间存在微弱但不显著的相关性（rs: 0.25283， p值：0.05）。结论血清维生素D3和LL-37水平降低可能具有临床意义，可作为糖尿病患者发生尿路感染倾向的潜在免疫学指标。

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引用次数: 0

Prevalence and determinants of time to first intimate partner violence incidents among ever-married Ethiopian women 埃塞俄比亚已婚妇女中第一次亲密伴侣暴力事件的发生率和时间决定因素

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-21 DOI: 10.1016/j.cegh.2026.102300

Ashefet Agete Mengste , Denekew Bitew Belay , Haile Mekonnen Fenta , Ding-Geng Chen

Background

Intimate partner violence (IPV), including physical, emotional, and sexual abuse disproportionately affects women globally, particularly in sub-Saharan Africa.

Objective

This study examined the timing and determinants of first experiences of IPV among ever-married Ethiopian women.

Participants and setting

The study analyzed nationally representative data from 4720 ever-married women who participated in the 2016 Ethiopian Demographic and Health Survey.

Methods

Cox proportional hazards and parametric accelerated failure time (AFT) models were used to identify factors influencing time to first IPV. Women who had not experienced IPV by the survey date or who reported IPV occurring before marriage were treated as right-censored. Multiple AFT distributions were compared, and the best-fitting models were selected.

Results

Approximately 30 % of women reported experiencing at least one form IPV, most commonly emotional (22.3 %). The log-normal AFT model best fit physical and sexual violence, while the Weibull AFT model fit emotional violence. Older women (35–49 years) experienced IPV later than younger women (time ratios [TR]: 2.09 physical, 2.82 sexual, 3.00 emotional). Husband's alcohol use, controlling behavior, family violence history, and fear of the husband were associated with earlier IPV occurrence (TR < 1). More children delayed physical and emotional violence (TR > 1), while older age at marriage predicted earlier emotional violence (TR = 0.7).

Conclusions

Age, regional differences, family background, and husbands' behaviors significantly influence the timing of IPV onset among Ethiopian women. Targeted prevention programs addressing harmful partner behaviors, alcohol use, and intergenerational violence are essential to delay or prevent IPV and safeguard women's wellbeing.

伴侣暴力（IPV），包括身体、情感和性虐待，对全球妇女的影响尤为严重，尤其是在撒哈拉以南非洲地区。目的：本研究考察了埃塞俄比亚已婚妇女首次经历IPV的时间和决定因素。该研究分析了参加2016年埃塞俄比亚人口与健康调查的4720名已婚妇女的全国代表性数据。方法采用scox比例危险度和参数加速失效时间（AFT）模型确定影响首次IPV时间的因素。在调查日期之前没有经历过IPV的妇女或报告在结婚前发生过IPV的妇女被视为权利审查。比较多个AFT分布，选择最佳拟合模型。结果大约30%的女性报告至少经历过一种形式的IPV，最常见的是情绪（22.3%）。对数正态AFT模型最适合身体暴力和性暴力，而Weibull AFT模型最适合情感暴力。年龄较大的女性（35-49岁）出现IPV的时间比要晚于年轻女性（时间比[TR]：身体2.09，性2.82，情感3.00）。丈夫的酒精使用、控制行为、家庭暴力史和对丈夫的恐惧与早期IPV发生有关（TR < 1）。更多的孩子推迟了身体和情感暴力（TR > 1），而更大的结婚年龄预示着更早的情感暴力（TR = 0.7）。结论性别、地区差异、家庭背景和丈夫行为对埃塞俄比亚妇女IPV发病时间有显著影响。针对有害伴侣行为、酒精使用和代际暴力的针对性预防规划对于延迟或预防IPV和保障妇女福祉至关重要。

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引用次数: 0

The prognostic value of frailty in hospitalized older adults with chronic heart failure: A short-term follow-up study in Vietnam 衰弱对住院的老年慢性心力衰竭患者的预后价值：越南的一项短期随访研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-21 DOI: 10.1016/j.cegh.2026.102298

Tri Van Nguyen , Tran To Tran Nguyen , Yen Thi Bao Nguyen , Tai Huy Kien Pham

Problem considered

To evaluate the impact of frailty on adverse outcomes, including hospital readmissions and mortality among older patients with chronic heart failure (CHF) in Vietnam.

Methods

This prospective, observational study was conducted in the cardiology departments of two general hospitals in Ho Chi Minh City between July 2023 and March 2024. Frailty was assessed using the Clinical Frailty Scale (CFS). Baseline evaluations included frailty status, demographic characteristics, comorbidities, and laboratory results. Patients were followed for three months post-discharge to monitor hospital readmissions, mortality, and composite outcomes (readmission and/or death).

Results

A total of 214 older Vietnamese patients with CHF participated in the study. Frailty was very common, affecting 74.3 % of the group. Within three months after hospital discharge, the rates of readmission, death, and combined adverse events were 44.9 %, 2.3 %, and 46.3 %, respectively. After adjusting for potential confounders, frailty was independently associated with a significantly increased risk of both hospital readmission (adjusted hazard ratio [aHR]: 2.42; 95 % CI: 1.13–5.25; p = .026) and composite events (aHR: 2.67; 95 % CI: 1.22–5.82; p = .014). Subgroup analysis revealed that no statistically significant association was observed between frailty and adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF).

Conclusion

Pre-discharge frailty was independently associated with short-term adverse outcomes in older adults hospitalized with chronic heart failure. Given the three-month follow-up period, these findings underscore the potential value of routine frailty assessment in identifying individuals at high risk.

评估虚弱对不良结局的影响，包括越南老年慢性心力衰竭（CHF）患者的再入院率和死亡率。方法本前瞻性观察性研究于2023年7月至2024年3月在胡志明市两家综合医院的心内科进行。使用临床虚弱量表（CFS）评估虚弱程度。基线评估包括虚弱状态、人口学特征、合并症和实验室结果。患者出院后随访3个月，监测再入院率、死亡率和复合结局（再入院和/或死亡）。结果共有214例越南老年CHF患者参与了本研究。虚弱是非常普遍的，影响74.3%的组。出院后3个月内，再入院率、死亡率和联合不良事件发生率分别为44.9%、2.3%和46.3%。在对潜在混杂因素进行校正后，虚弱与再入院风险的显著增加（校正危险比[aHR]: 2.42; 95% CI: 1.13-5.25; p = 0.026）和复合事件（aHR: 2.67; 95% CI: 1.22-5.82; p = 0.014）独立相关。亚组分析显示，在保留射血分数（HFpEF）的心力衰竭患者中，虚弱和不良结局之间没有统计学上显著的关联。结论老年慢性心力衰竭住院患者出院前虚弱与短期不良结局独立相关。考虑到三个月的随访期，这些发现强调了常规虚弱评估在识别高风险个体方面的潜在价值。

{"title":"The prognostic value of frailty in hospitalized older adults with chronic heart failure: A short-term follow-up study in Vietnam","authors":"Tri Van Nguyen , Tran To Tran Nguyen , Yen Thi Bao Nguyen , Tai Huy Kien Pham","doi":"10.1016/j.cegh.2026.102298","DOIUrl":"10.1016/j.cegh.2026.102298","url":null,"abstract":"<div><h3>Problem considered</h3><div>To evaluate the impact of frailty on adverse outcomes, including hospital readmissions and mortality among older patients with chronic heart failure (CHF) in Vietnam.</div></div><div><h3>Methods</h3><div>This prospective, observational study was conducted in the cardiology departments of two general hospitals in Ho Chi Minh City between July 2023 and March 2024. Frailty was assessed using the Clinical Frailty Scale (CFS). Baseline evaluations included frailty status, demographic characteristics, comorbidities, and laboratory results. Patients were followed for three months post-discharge to monitor hospital readmissions, mortality, and composite outcomes (readmission and/or death).</div></div><div><h3>Results</h3><div>A total of 214 older Vietnamese patients with CHF participated in the study. Frailty was very common, affecting 74.3 % of the group. Within three months after hospital discharge, the rates of readmission, death, and combined adverse events were 44.9 %, 2.3 %, and 46.3 %, respectively. After adjusting for potential confounders, frailty was independently associated with a significantly increased risk of both hospital readmission (adjusted hazard ratio [aHR]: 2.42; 95 % CI: 1.13–5.25; p = .026) and composite events (aHR: 2.67; 95 % CI: 1.22–5.82; p = .014). Subgroup analysis revealed that no statistically significant association was observed between frailty and adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF).</div></div><div><h3>Conclusion</h3><div>Pre-discharge frailty was independently associated with short-term adverse outcomes in older adults hospitalized with chronic heart failure. Given the three-month follow-up period, these findings underscore the potential value of routine frailty assessment in identifying individuals at high risk.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102298"},"PeriodicalIF":1.7,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors influencing the childbirth experience of mothers underwent labour induction in Northwest Ethiopia: A Mixed-methods Study 影响埃塞俄比亚西北部引产母亲分娩经验的因素：一项混合方法研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-19 DOI: 10.1016/j.cegh.2026.102296

Srawork Tesfaye , Endeshaw Admasu , Eden Bishaw Taye , Mengstu Melkamu Asaye

Background

Induction of labor is an obstetric intervention. It can be a significant biomedical and psychosocial event, resulting in a range of positive or negative childbirth experiences. Gaining in-depth knowledge in these areas may help improve the quality of care and the utilization of maternity services. However, in Ethiopia, no studies have been conducted to date.

Objective

To assess mothers’ childbirth experiences and influencing factors among those who underwent induction of labor.

Methods

A facility-based mixed-methods study was conducted from 5 May to August 20, 2025 among 422 mothers. Data were collected using contextualized tools. Audio transcription and translation were performed for the qualitative data. Logistic regression analysis was used, with a P-value of less than 0.05 considered significant. Thematic analysis was applied to the qualitative data.

Results

The proportion of positive childbirth experiences was 236 (55.9 %) (95 % CI: 51.2–60.7). Being multiparous (AOR = 8.63, 95 % CI: 5.21–14.27), having a vaginal delivery (AOR = 2.11, 95 % CI: 1.31–3.41), age under 20 (AOR = 4.65, 95 % CI: 1.53–14.13), and age 21–30 (AOR = 2.35, 95 % CI: 1.22–4.51) were associated factors. The identified facilitators were trust building at admission, clear communication, and labour pain coping strategies. In contrast, feeling disturbed and lack of involvement were barriers that negatively affected mothers' childbirth experiences.

Conclusion

The proportion of positive childbirth experiences was moderate. Building trust, clear communication with healthcare providers, and strategies to manage labour pain were facilitators. Emotional disturbances and lack of involvement were barriers to a positive childbirth experience.

背景引产是一种产科干预措施。它可能是一个重大的生物医学和社会心理事件，导致一系列积极或消极的分娩经历。在这些领域获得深入的知识可能有助于提高护理质量和产妇服务的利用。然而，在埃塞俄比亚，迄今尚未进行任何研究。目的了解引产产妇分娩经历及其影响因素。方法于2025年5月5日至8月20日对422名产妇进行综合调查。使用情境化工具收集数据。对定性数据进行音频转录和翻译。采用Logistic回归分析，p值小于0.05为显著性。对定性数据进行专题分析。结果阳性分娩比例为236例（55.9%）（95% CI: 51.2 ~ 60.7）。多产（AOR = 8.63, 95% CI: 5.21 ~ 14.27）、阴道分娩（AOR = 2.11, 95% CI: 1.31 ~ 3.41）、年龄在20岁以下（AOR = 4.65, 95% CI: 1.53 ~ 14.13）、年龄在21 ~ 30岁（AOR = 2.35, 95% CI: 1.22 ~ 4.51）为相关因素。确定的促进因素是入院时建立信任，明确沟通和分娩疼痛应对策略。相比之下，感到不安和缺乏参与是对母亲分娩经历产生负面影响的障碍。结论阳性分娩经历比例适中。建立信任、与医疗保健提供者明确沟通以及管理分娩疼痛的策略是促进因素。情绪紊乱和缺乏参与是积极分娩经历的障碍。

{"title":"Factors influencing the childbirth experience of mothers underwent labour induction in Northwest Ethiopia: A Mixed-methods Study","authors":"Srawork Tesfaye , Endeshaw Admasu , Eden Bishaw Taye , Mengstu Melkamu Asaye","doi":"10.1016/j.cegh.2026.102296","DOIUrl":"10.1016/j.cegh.2026.102296","url":null,"abstract":"<div><h3>Background</h3><div>Induction of labor is an obstetric intervention. It can be a significant biomedical and psychosocial event, resulting in a range of positive or negative childbirth experiences. Gaining in-depth knowledge in these areas may help improve the quality of care and the utilization of maternity services. However, in Ethiopia, no studies have been conducted to date.</div></div><div><h3>Objective</h3><div>To assess mothers’ childbirth experiences and influencing factors among those who underwent induction of labor.</div></div><div><h3>Methods</h3><div>A facility-based mixed-methods study was conducted from 5 May to August 20, 2025 among 422 mothers. Data were collected using contextualized tools. Audio transcription and translation were performed for the qualitative data. Logistic regression analysis was used, with a P-value of less than 0.05 considered significant. Thematic analysis was applied to the qualitative data.</div></div><div><h3>Results</h3><div>The proportion of positive childbirth experiences was 236 (55.9 %) (95 % CI: 51.2–60.7). Being multiparous (AOR = 8.63, 95 % CI: 5.21–14.27), having a vaginal delivery (AOR = 2.11, 95 % CI: 1.31–3.41), age under 20 (AOR = 4.65, 95 % CI: 1.53–14.13), and age 21–30 (AOR = 2.35, 95 % CI: 1.22–4.51) were associated factors. The identified facilitators were trust building at admission, clear communication, and labour pain coping strategies. In contrast, feeling disturbed and lack of involvement were barriers that negatively affected mothers' childbirth experiences.</div></div><div><h3>Conclusion</h3><div>The proportion of positive childbirth experiences was moderate. Building trust, clear communication with healthcare providers, and strategies to manage labour pain were facilitators. Emotional disturbances and lack of involvement were barriers to a positive childbirth experience.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102296"},"PeriodicalIF":1.7,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Biologic treatment outcomes in rheumatoid arthritis: Biomarker response and cost-effectiveness analysis in an Albanian cohort 类风湿关节炎的生物治疗结果：阿尔巴尼亚队列的生物标志物反应和成本-效果分析

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-19 DOI: 10.1016/j.cegh.2026.102301

Dorela Hasankolli , Mirela Miraci , Silvi Bozo , Teuta Backa , Marsida Mulaj , Entela Haloci , Fatjola Ferrollari

Background

Rheumatoid arthritis (RA) is a chronic autoimmune disease causing progressive joint damage, disability, and high healthcare costs. Biologic DMARDs have improved outcomes, but responses vary. Identifying predictive biomarkers and evaluating cost-effectiveness are essential, particularly in resource-limited settings like Albania.

Methods

A retrospective cohort study at Mother Teresa University Hospital Center, Tirana, included 162 RA patients treated with bDMARDs (2021–2024). All met ACR/EULAR criteria and had biomarker data at baseline and six months. ESR, CRP, fibrinogen, RF, and anti-CCP were analyzed using paired t-tests (p < 0.05). Cost-effectiveness analysis compared direct drug costs with biomarker improvement across adalimumab and tocilizumab using ICERs.

Results

Tocilizumab (46.8 %), adalimumab (37.1 %), and etanercept (16.1 %) were the main bDMARDs used. ESR, CRP, and fibrinogen significantly decreased (p < 0.01). Six-month direct costs were 1136.20 USD for adalimumab, 2233.40 USD for etanercept, and 4069.00 USD for tocilizumab. Adalimumab demonstrated the best cost-effectiveness, with the lowest cost per unit biomarker reduction (ESR 87.40 USD/mm/h; CRP 59.80 USD/mg/L; fibrinogen 1456.66 USD/g/L). Tocilizumab achieved the greatest biomarker reductions but had the highest price (156.60 USD/unit) and incremental costs, with ICERs of 2932.80 USD vs. adalimumab, below Albania's 3 × GDP threshold (∼21,000 USD) for ESR and CRP, but near/exceeding it for fibrinogen.

Conclusions

Among available biologics, adalimumab shows the most favorable cost-effectiveness, while tocilizumab may be justified in non-responders to TNF inhibitors. Etanercept was considered economically dominated and was not included in the incremental cost-effectiveness analysis. Biomarker-guided assessment supports cost-effective and evidence-based management of RA in Albania.

类风湿性关节炎（RA）是一种慢性自身免疫性疾病，可导致进行性关节损伤、残疾和高昂的医疗费用。生物dmard改善了结果，但反应各不相同。识别预测性生物标志物和评估成本效益至关重要，特别是在阿尔巴尼亚等资源有限的环境中。方法在地拉那特蕾莎修女大学医院中心进行回顾性队列研究，纳入了162例接受bDMARDs治疗的RA患者（2021-2024）。所有患者均符合ACR/EULAR标准，并在基线和6个月时具有生物标志物数据。采用配对t检验分析ESR、CRP、纤维蛋白原、RF和anti-CCP （p < 0.05）。成本-效果分析比较了使用ICERs的阿达木单抗和托珠单抗生物标志物改善的直接药物成本。结果单抗（46.8%）、阿达木单抗（37.1%）和依那西普（16.1%）是主要使用的bdmard。ESR、CRP、纤维蛋白原显著降低（p < 0.01）。6个月直接成本为阿达木单抗1136.20美元，依那西普2233.40美元，托珠单抗4069.00美元。阿达木单抗表现出最佳的成本效益，单位生物标志物降低成本最低（ESR 87.40美元/mm/h； CRP 59.80美元/mg/L；纤维蛋白原1456.66美元/g/L）。托珠单抗实现了最大的生物标志物降低，但价格最高（156.60美元/单位）和增量成本最高，与阿达木单抗相比，ICERs为2932.80美元，低于阿尔巴尼亚ESR和CRP的3倍GDP阈值（~ 21,000美元），但接近/超过纤维蛋白原。结论在现有的生物制剂中，阿达木单抗显示出最有利的成本效益，而托珠单抗可能在对TNF抑制剂无反应的情况下是合理的。依那西普被认为在经济上占主导地位，未被纳入增量成本-效果分析。在阿尔巴尼亚，生物标志物引导的评估支持具有成本效益和循证的类风湿性关节炎管理。

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引用次数: 0

Cow's milk protein-induced FPIES: Clinical outcomes in severe cases 牛奶蛋白诱导的FPIES：重症病例的临床结果

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-17 DOI: 10.1016/j.cegh.2025.102235

Príscila da Silva Pereira Vasconcelos, Tassiana dos Anjos, Juliana Bellote, Elizete Aparecida Lomazi, Maria Ângela Bellomo-Brandão

Problem considered

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a rare and poorly understood condition that primarily affects infants and young children. This study aimed to evaluate the clinical characteristics and outcomes of patients diagnosed with severe cow's milk protein-induced FPIES.

Methods

A case series was conducted involving pediatric patients who underwent oral food challenges OFCs for FPIES exclusively triggered by cow's milk protein, followed at the pediatric gastroenterology outpatient clinic of a quaternary hospital between January 16, 2018, and June 20, 2024.

Results

A total of six patients were included, and 24 OFCs were assessed. The median age at symptom onset was 44 days (range: 3–99 days). Before the first OFC, the median duration of the elimination diet was 11.2 months (Q1: 8.7 – Q3: 27 months; IQR: 18.3 months); for patients requiring additional OFCs, the median duration was 35.17 months (Q1: 27.27 – Q3: 72.2 months, IQR: 44.93). All patients required admission to the intensive care unit. Two patients were formula-fed, three received mixed feeding, and one received whole cow's milk. Three patients had a family history of atopy, and one had a personal history of atopy. One patient had Down syndrome (DS), one was otherwise healthy, one had a genetic disorder (3p deletion/16q duplication), and three patients had cytomegalovirus infection. All patients developed tolerance to cow's milk protein, with a median time of 33 months (range: 17–103 months).

Conclusions

While the overall prognosis of FPIES was favorable, managing cases with severe initial symptoms necessitating ICU admission is complex and frequently involves multiple OFC before achieving tolerance.

食物蛋白性小肠结肠炎综合征（FPIES）是一种罕见且知之甚少的疾病，主要影响婴儿和幼儿。本研究旨在评估诊断为严重牛奶蛋白诱导的FPIES患者的临床特征和预后。方法对2018年1月16日至2024年6月20日在某第四医院儿科胃肠病学门诊接受口服食物挑战OFCs的FPIES儿科患者进行病例系列研究。结果共纳入6例患者，共评估了24例OFCs。出现症状的中位年龄为44天（范围：3-99天）。在第一次OFC之前，消除饮食的中位持续时间为11.2个月（Q1: 8.7 - Q3: 27个月；IQR: 18.3个月）；对于需要额外OFCs的患者，中位持续时间为35.17个月（Q1: 27.27 - Q3: 72.2个月，IQR: 44.93）。所有病人都需要住进重症监护室。两名患者采用配方奶喂养，三名患者采用混合喂养，一名患者采用全脂牛奶喂养。3例患者有特应性家族史，1例患者有个人特应性病史。1例患者患有唐氏综合征（DS）， 1例其他健康，1例患有遗传性疾病（3p缺失/16q重复），3例患者患有巨细胞病毒感染。所有患者均对牛奶蛋白产生耐受性，中位时间为33个月（范围：17-103个月）。结论：虽然FPIES的总体预后良好，但治疗有严重初始症状需要住院的病例是复杂的，并且在达到耐受性之前经常涉及多次OFC。

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引用次数: 0

Relationship between postpartum depression and exclusive breastfeeding practices among urban mothers, Bhubaneswar, Odisha 奥里萨邦布巴内斯瓦尔城市母亲产后抑郁症与纯母乳喂养的关系

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-14 DOI: 10.1016/j.cegh.2025.102259

Deepanjali Behera , Manasmruti Sahu , Manas Ranjan Behera , Magnus Micchael Sichalwe , Manatee Jitanan , Janmejaya Samal , Ranjit Kumar Dehury , Damodar Jena

Problem considered

Postpartum depression (PPD) involves persistent sadness, fatigue, and bonding difficulties, while exclusive breastfeeding (EBF) means feeding infants only breast milk for six months. Both are vital for maternal and child health, yet their relationship is understudied. This study examined the prevalence of PPD among mothers in urban Bhubaneswar, Odisha, and its association with EBF.

Methods

An analytical cross-sectional study was conducted among 107 postpartum mothers in urban Bhubaneswar from February to April 2024. A pre-designed questionnaire captured socio-demographic characteristics and breastfeeding practices. Data were analyzed using SPSS version 27. Univariate analysis described variables, bivariate analysis assessed associations between categorical variables, and multivariate analysis identified predictors of postpartum depression at a significance level of p ≤ 0.05.

Results

Among the mothers surveyed, 12.1 % reported postpartum depression, while 94.4 % practiced exclusive breastfeeding. Cesarean delivery was associated with over fourfold higher odds of depression compared to vaginal delivery (AOR = 4.41, 95 % CI: 2.19–16.27, p = 0.001). Mothers who planned to breastfeed for ≤12 months (AOR = 5.34, 95 % CI: 1.07–26.61, p = 0.04) and those intending 12–24 months (AOR = 10.28, 95 % CI: 1.14–93.14, p = 0.03) also had significantly greater odds of postpartum depression compared to those planning >24 months.

Conclusion

Postpartum depression is linked to normal vaginal delivery and shorter planned breastfeeding durations. Early screening and breastfeeding support are essential to improve maternal mental health and infant care.

产后抑郁症（PPD）包括持续的悲伤、疲劳和联系困难，而纯母乳喂养（EBF）意味着只给婴儿喂母乳六个月。两者对孕产妇和儿童健康都至关重要，但它们之间的关系尚未得到充分研究。本研究调查了奥里萨邦布巴内斯瓦尔城市母亲PPD的患病率及其与EBF的关系。方法对2024年2月至4月布巴内斯瓦尔市107名产后母亲进行分析性横断面研究。预先设计的调查问卷包含了社会人口特征和母乳喂养做法。数据分析采用SPSS 27版。单因素分析描述变量，双因素分析评估分类变量之间的相关性，多因素分析确定产后抑郁的预测因素，p≤0.05。结果12.1%的母亲报告产后抑郁，94.4%的母亲实行纯母乳喂养。与阴道分娩相比，剖宫产患抑郁症的几率高出4倍以上（AOR = 4.41, 95% CI: 2.19-16.27, p = 0.001）。计划母乳喂养≤12个月的母亲（AOR = 5.34, 95% CI: 1.07-26.61, p = 0.04）和计划母乳喂养12 - 24个月的母亲（AOR = 10.28, 95% CI: 1.14-93.14, p = 0.03）患产后抑郁症的几率也明显高于计划母乳喂养24个月的母亲。结论产后抑郁与正常阴道分娩和较短的计划母乳喂养时间有关。早期筛查和母乳喂养支持对于改善孕产妇心理健康和婴儿护理至关重要。

{"title":"Relationship between postpartum depression and exclusive breastfeeding practices among urban mothers, Bhubaneswar, Odisha","authors":"Deepanjali Behera , Manasmruti Sahu , Manas Ranjan Behera , Magnus Micchael Sichalwe , Manatee Jitanan , Janmejaya Samal , Ranjit Kumar Dehury , Damodar Jena","doi":"10.1016/j.cegh.2025.102259","DOIUrl":"10.1016/j.cegh.2025.102259","url":null,"abstract":"<div><h3>Problem considered</h3><div>Postpartum depression (PPD) involves persistent sadness, fatigue, and bonding difficulties, while exclusive breastfeeding (EBF) means feeding infants only breast milk for six months. Both are vital for maternal and child health, yet their relationship is understudied. This study examined the prevalence of PPD among mothers in urban Bhubaneswar, Odisha, and its association with EBF.</div></div><div><h3>Methods</h3><div>An analytical cross-sectional study was conducted among 107 postpartum mothers in urban Bhubaneswar from February to April 2024. A pre-designed questionnaire captured socio-demographic characteristics and breastfeeding practices. Data were analyzed using SPSS version 27. Univariate analysis described variables, bivariate analysis assessed associations between categorical variables, and multivariate analysis identified predictors of postpartum depression at a significance level of p ≤ 0.05.</div></div><div><h3>Results</h3><div>Among the mothers surveyed, 12.1 % reported postpartum depression, while 94.4 % practiced exclusive breastfeeding. Cesarean delivery was associated with over fourfold higher odds of depression compared to vaginal delivery (AOR = 4.41, 95 % CI: 2.19–16.27, p = 0.001). Mothers who planned to breastfeed for ≤12 months (AOR = 5.34, 95 % CI: 1.07–26.61, p = 0.04) and those intending 12–24 months (AOR = 10.28, 95 % CI: 1.14–93.14, p = 0.03) also had significantly greater odds of postpartum depression compared to those planning >24 months.</div></div><div><h3>Conclusion</h3><div>Postpartum depression is linked to normal vaginal delivery and shorter planned breastfeeding durations. Early screening and breastfeeding support are essential to improve maternal mental health and infant care.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102259"},"PeriodicalIF":1.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reasons for medication non-adherence among diabetes mellitus patients in Kelantan: A cross-sectional study 吉兰丹州糖尿病患者服药不依从的原因：一项横断面研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-14 DOI: 10.1016/j.cegh.2026.102297

Thamron Keowmani , Erwan Ershad Ahmad Khan , Siti Farhain Amir , Suzita Mukhtar , Raja Nurul Fatin Raja Kamaruzaman , Kok Han Lim , Mohd Azri Mohd Khatib , Nurul Ezzati Arifin , Siti Nur Sarah Saharudin

Objectives

The main objective of this study was to investigate self-reported reasons for medication non-adherence among type 2 diabetes mellitus (T2DM) patients in Kelantan.

Methods

A cross-sectional study was conducted among a representative sample of the Kelantanese population of T2DM patients who refilled their medications at government health clinics between April 15th and May 31st, 2025 (n = 458). Medication adherence was measured using the Simplified Medication Adherence Scale (SMAQ). Reasons for medication non-adherence were obtained via a structured interview. Associations between baseline characteristics and low adherence were estimated using the chi-squared test.

Results

The survey response rate was 83.2 % (472/566). Three percent (14/472) of respondents were excluded from the analysis due to missing data. The top five reasons for non-adherence were ‘I forgot’ 92.3 % (385/417), ‘I was late for/missed the medication refill appointment at the pharmacy counter’ 31.2 % (130/417), ‘Nobody reminds me to take the medications’ 24.7 % (103/417), ‘There are too many medications to take’ 22.1 % (92/417) and ‘I feel healthy’ 21.6 % (90/417). The prevalence of low adherence was 18.8 % (86/417). Distance from home to clinic >5 km (p = 0.045) and the need for assistance in medication taking (p = 0.035) were significantly associated with low adherence.

Conclusions

Our study identified several key reasons for medication non-adherence among patients with T2DM in Kelantan, including forgetfulness, missed refill appointments, lack of reminders, polypharmacy, and the perception of being healthy. Distance to the clinic and reliance on others for medication administration were significantly associated with low adherence. These findings highlight the need for patient-centred interventions that address both behavioural and structural barriers to adherence.

目的本研究的主要目的是调查吉兰丹2型糖尿病（T2DM）患者自我报告的药物不依从性原因。方法对2025年4月15日至5月31日期间在政府卫生诊所补药的吉兰丹岛T2DM患者的代表性样本（n = 458）进行横断面研究。采用简化药物依从性量表（SMAQ）测量药物依从性。不坚持服药的原因通过结构化访谈获得。使用卡方检验估计基线特征与低依从性之间的关联。结果调查回复率为83.2%（472/566）。3%（14/472）的受访者因数据缺失而被排除在分析之外。不遵守规定的前五大原因是“我忘记了”92.3%(385/417)，“我迟到/错过了药房柜台的药物补充预约”31.2%(130/417)，“没有人提醒我吃药”24.7%(103/417)，“药物太多”22.1%（92/417）和“我觉得自己很健康”21.6%（90/417）。低依从性患病率为18.8%（86/417）。从家到诊所的距离>；5 km （p = 0.045）和在服药方面需要帮助（p = 0.035）与低依从性显著相关。结论我们的研究确定了吉兰丹州T2DM患者药物不依从性的几个关键原因，包括健忘、错过补药预约、缺乏提醒、多药和健康的感觉。与诊所的距离和对他人用药的依赖与低依从性显著相关。这些发现强调需要以患者为中心的干预措施，解决行为和结构障碍。

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引用次数: 0

Seroprevalence of Toxoplasma gondii and associated factors among pregnant women consulted in Buhodle Healthcare Centers, Somalia 索马里Buhodle医疗保健中心孕妇弓形虫血清阳性率及相关因素

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-13 DOI: 10.1016/j.cegh.2026.102293

Mohamed Osman , Abdullahi Adan , Abdulahi Abdiwali Mahamed , Md Al-Mamun , Marufa Alam

Problem considered

Toxoplasma gondii infection is a globally prevalent parasitic disease with serious health consequences, especially for pregnant women due to the risk of congenital transmission. Despite its importance, limited data exist on its prevalence in Somalia. This study aimed to determine the seroprevalence of T. gondii infection and identify associated risk factors among pregnant women attending healthcare centers in Buhodle District, Somalia.

Methods

A cross-sectional study was conducted from March to May 2024 among 384 randomly selected pregnant women. Serum samples were analyzed using competitive ELISA (cELISA) to detect T. gondii antibodies. Data were processed using EpiData and SPSS. Descriptive statistics summarized participant characteristics, while bivariate and multivariate logistic regression analyses identified associations between potential risk factors and seropositivity. A p-value <0.05 and a 95 % confidence interval were considered statistically significant.

Results

The overall seroprevalence of T. gondii was 36.4 % (140/384). Among these, 28.1 % (108/140) were positive for anti-T. gondii IgG antibodies, indicating prior exposure, while 8.3 % (32/140) were positive for IgM, reflecting recent infection. Multivariable logistic regression revealed significant associations between T. gondii seropositivity and lower educational attainment, as well as frequent contact with soil (p < 0.05).

Conclusion

The high prevalence of T. gondii infection among pregnant women in Buhodle District indicates a substantial public health concern. Targeted community awareness programs, enhanced antenatal screening, and further epidemiological and molecular studies are essential to reduce maternal and fetal health risks.

考虑的问题刚地弓形虫感染是一种全球流行的寄生虫病，具有严重的健康后果，特别是对孕妇，因为有先天性传播的风险。尽管它很重要，但关于它在索马里的流行情况的数据有限。本研究旨在确定在索马里Buhodle区保健中心就诊的孕妇中弓形虫感染的血清流行率，并确定相关的危险因素。方法于2024年3月~ 5月对384例随机抽取的孕妇进行横断面研究。采用竞争ELISA （cELISA）检测血清中弓形虫抗体。数据采用EpiData和SPSS进行处理。描述性统计总结了参与者的特征，而双变量和多变量逻辑回归分析确定了潜在危险因素与血清阳性之间的关联。p值<；0.05和95%置信区间被认为具有统计学意义。结果弓形虫血清总阳性率为36.4%（140/384）。其中，28.1%（108/140）抗体阳性。弓形虫IgG抗体，提示有接触史，而IgM抗体阳性的有8.3%(32/140)，提示近期感染。多变量logistic回归结果显示，弓形虫血清阳性与受教育程度低、频繁接触土壤有显著相关性（p < 0.05）。结论Buhodle地区孕妇弓形虫感染率较高，存在严重的公共卫生问题。有针对性的社区宣传计划、加强产前筛查以及进一步的流行病学和分子研究对于降低孕产妇和胎儿健康风险至关重要。

{"title":"Seroprevalence of Toxoplasma gondii and associated factors among pregnant women consulted in Buhodle Healthcare Centers, Somalia","authors":"Mohamed Osman , Abdullahi Adan , Abdulahi Abdiwali Mahamed , Md Al-Mamun , Marufa Alam","doi":"10.1016/j.cegh.2026.102293","DOIUrl":"10.1016/j.cegh.2026.102293","url":null,"abstract":"<div><h3>Problem considered</h3><div>Toxoplasma gondii infection is a globally prevalent parasitic disease with serious health consequences, especially for pregnant women due to the risk of congenital transmission. Despite its importance, limited data exist on its prevalence in Somalia. This study aimed to determine the seroprevalence of T. gondii infection and identify associated risk factors among pregnant women attending healthcare centers in Buhodle District, Somalia.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted from March to May 2024 among 384 randomly selected pregnant women. Serum samples were analyzed using competitive ELISA (cELISA) to detect T. gondii antibodies. Data were processed using EpiData and SPSS. Descriptive statistics summarized participant characteristics, while bivariate and multivariate logistic regression analyses identified associations between potential risk factors and seropositivity. A p-value <0.05 and a 95 % confidence interval were considered statistically significant.</div></div><div><h3>Results</h3><div>The overall seroprevalence of T. gondii was 36.4 % (140/384). Among these, 28.1 % (108/140) were positive for anti-T. gondii IgG antibodies, indicating prior exposure, while 8.3 % (32/140) were positive for IgM, reflecting recent infection. Multivariable logistic regression revealed significant associations between T. gondii seropositivity and lower educational attainment, as well as frequent contact with soil (p < 0.05).</div></div><div><h3>Conclusion</h3><div>The high prevalence of T. gondii infection among pregnant women in Buhodle District indicates a substantial public health concern. Targeted community awareness programs, enhanced antenatal screening, and further epidemiological and molecular studies are essential to reduce maternal and fetal health risks.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102293"},"PeriodicalIF":1.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0