Clinical Epidemiology and Global Health最新文献_第4页

Descriptive epidemiology of one of the most common complications in patients living with diabetes in Mauritius: the diabetic foot 毛里求斯糖尿病患者最常见的并发症之一：糖尿病足的描述流行病学

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-12-17 DOI: 10.1016/j.cegh.2025.102265

Luqman Nisa , Thibaut Gelle , Concheta Tchibozo , Shaad Toofanee , Damien Steciuk , Andy Sadien , Parveen Pokun , Sabeena Dowlut , Farid Boumediene

Problem considered

Diabetic foot and lower-limb complications are a leading cause of disability and healthcare burden in patients with diabetes, particularly in low- and middle-income countries. Mauritius has one of the highest diabetes prevalence rates worldwide, yet data on diabetic foot and lower-limb outcomes in real-world clinical settings remain scarce. This study aimed to describe the characteristics and treatment outcomes of patients receiving diabetic foot care in a specialised center.

Methods

A retrospective observational study was conducted over 26 months (January 2021–March 2023) at a diabetic foot care center in Mauritius. Adults with diabetes requiring wound care were included. Data were extracted from clinical records. Outcomes were classified as successful or unsuccessful wound healing. Multivariable logistic regression identified factors independently associated with healing success.

Results

Among 198 patients (2407 consultations), the median age was 65.0 years (IQR 57.0–71.8) and 59.1 % were male. Arteriopathy and neuropathy were present in 38.8 % and 39.5 %, respectively. The most common wound sites were toes (30.3 %) and foot (21.1 %). Overall, 68.2 % of patients achieved successful healing. Independent predictors of success included having 3–10 visits (adjusted odds ratio [aOR] 3.1; 95 % CI 1.3–7.6; p = 0.01), while arteriopathy was associated with failure (aOR 0.3; 95 % CI 0.1–0.6; p < 0.001).

Conclusion

Moderate follow-up (3–10 visits) was associated with better wound healing, while arteriopathy impaired outcomes. These findings support the need for structured diabetic foot care pathways in Mauritius, promoting early intervention and timely referral to specialist care.

糖尿病足和下肢并发症是糖尿病患者残疾和医疗负担的主要原因，特别是在低收入和中等收入国家。毛里求斯是世界上糖尿病患病率最高的国家之一，但在现实世界的临床环境中，关于糖尿病足和下肢结局的数据仍然很少。本研究旨在描述在专门中心接受糖尿病足护理的患者的特征和治疗结果。方法在毛里求斯一家糖尿病足护理中心进行回顾性观察性研究，为期26个月（2021年1月- 2023年3月）。需要伤口护理的成人糖尿病患者也包括在内。数据从临床记录中提取。结果分为成功或不成功的伤口愈合。多变量逻辑回归确定了与治疗成功独立相关的因素。结果198例患者2407次就诊，中位年龄65.0岁（IQR 57.0 ~ 71.8），男性占59.1%。动脉病变和神经病变分别占38.8%和39.5%。最常见的伤口部位是脚趾（30.3%）和足部（21.1%）。总体而言，68.2%的患者成功治愈。成功的独立预测因子包括3-10次就诊（调整比值比[aOR] 3.1; 95% CI 1.3-7.6; p = 0.01），而动脉病变与失败相关（aOR为0.3;95% CI 0.1-0.6; p < 0.001）。结论中度随访（3-10次）患者伤口愈合较好，动脉病变患者预后较差。这些发现支持毛里求斯有必要建立结构化的糖尿病足护理途径，促进早期干预和及时转诊到专科护理。

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引用次数: 0

Effectiveness of mHealth interventions for improving diabetes management outcomes in patients with type 2 diabetes: A cluster randomized crossover trial in Western Rajasthan 移动健康干预改善2型糖尿病患者糖尿病管理结果的有效性：拉贾斯坦邦西部的一项随机交叉试验

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-12-17 DOI: 10.1016/j.cegh.2025.102264

Ramesh Kumar Huda, Jayvardhan Singh, Pankaj Kumar, Laxmikant Mandhana, Manoj Kumar, Ramesh Kumar Sangwan, Bontha V. Babu

Problem considered

Type 2 diabetes (T2DM) poses a major public health challenge in India, particularly in Western Rajasthan, where access to consistent diabetes care is limited. Despite national programs, management gaps persist. mHealth interventions offer scalable, low-cost solutions, but evidence from Indian primary care settings remains limited.

Methods

This cluster-randomized crossover trial was conducted between January and November 2024 across two urban Primary Health Centres (PHCs) in Jodhpur, Rajasthan. One PHC (n = 140) received an mHealth intervention (SMS and Android app reminders) with usual care, while the other (n = 140) received usual care alone. The primary outcome was the change in HbA1c, quality of life, and other health outcomes at 6 months, analyzed using paired and independent t-tests.

Results

Finding shows, the intervention group showed significant improvements: mean HbA1c decreased from 9.23 % to 8.33 % (p < 0.001), BMI from 27.25 to 26.74 kg/m² (p < 0.05), systolic BP from 138 to 132 mmHg (p < 0.01), diastolic BP from 86 to 84 mmHg (p < 0.05), and quality of life improved (p = 0.001). The control group demonstrated a significant reduction in mean HbA1c (8.96 %–7.70 %, p < 0.001), but no improvement in anthropometric measures, and a significant decline in quality of life (p = 0.001).

Conclusions

The study concluded that mHealth intervention significantly improved glycemic control, blood pressure, waist circumference, and quality of life, highlighting its potential as an effective tool for diabetes self-management in resource-limited settings.

2型糖尿病（T2DM）在印度构成了一个重大的公共卫生挑战，特别是在拉贾斯坦邦西部，那里获得持续的糖尿病治疗的机会有限。尽管有国家规划，管理差距依然存在。移动医疗干预措施提供了可扩展的低成本解决方案，但来自印度初级保健机构的证据仍然有限。方法本群随机交叉试验于2024年1月至11月在拉贾斯坦邦焦特布尔的两个城市初级卫生中心（PHCs）进行。一名初级保健医生（n = 140）接受移动健康干预（短信和Android应用程序提醒）和常规护理，而另一名（n = 140）单独接受常规护理。主要结局是6个月时HbA1c、生活质量和其他健康结局的变化，使用配对和独立t检验进行分析。结果干预组患者的平均HbA1c从9.23%降至8.33% (p < 0.001)， BMI从27.25降至26.74 kg/m2 (p < 0.05)，收缩压从138降至132 mmHg (p < 0.01)，舒张压从86降至84 mmHg (p < 0.05)，生活质量得到改善（p = 0.001）。对照组的平均HbA1c显著降低（8.96% - 7.70%,p < 0.001），但人体测量没有改善，生活质量显著下降（p = 0.001）。该研究得出结论，移动健康干预显著改善了血糖控制、血压、腰围和生活质量，突出了其作为资源有限环境下糖尿病自我管理的有效工具的潜力。

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引用次数: 0

Burden of reproductive cancers in India: Insights from population-based cancer registries 印度生殖癌症的负担：基于人口的癌症登记的见解

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-12-16 DOI: 10.1016/j.cegh.2025.102261

Ranjan Kumar Prusty , Varun Kumar Kashyap , Mahadev Bhise , Shahina Begum , Sharyu Mhamane , Anupama Chauhan

Problem considered

Reproductive cancers (RCs) are a major component of India's non-communicable disease burden, with significant gender and regional disparities. Despite being largely preventable, early detection and access to care remain limited, and comprehensive national-level incidence data are scarce. The present study aims to provide an overview of the epidemiology of RCs in India, including their magnitude and patterns, based on data from population-based cancer registries.

Methods

Cancer incidence data from 37 Population-Based Cancer Registries (PBCRs) in India, covering the years 2012–2017, were analysed. RC cases were identified using ICD-10 codes. Age-standardized incidence rates (ASRs), age-specific rates, and lifetime cumulative risks were computed and disaggregated by sex and region.

Results

Among 436,223 total cancer cases, 61,190 (14.0 %) were RCs—15,091 in males (6.9 %) and 46,099 in females (21.3 %). In females, cervical cancer accounted for 48.8 % of RCs, followed by ovarian (28.7 %) and endometrial (15.5 %) cancers. In males, prostate cancer comprised 78.8 % of RC cases. The burden peaked between the ages of 40 and 59 years in both sexes. In India, the lifetime cumulative risk was 1 in 34 for females and 1 in 68 for males, with higher risks observed in northern and southern regions of India.

Conclusion

The burden of RCs in India is disproportionately higher among females, with marked regional disparities. Strengthening early detection programmes and leveraging Health and Wellness Centres under Ayushman Bharat are critical strategies. Region-specific, gender-sensitive approaches, coupled with ongoing surveillance and a multisectoral policy focus, are essential to improve outcomes and mitigate the psychosocial impacts of RCs.

生殖癌症是印度非传染性疾病负担的一个主要组成部分，存在显著的性别和地区差异。尽管这些疾病在很大程度上是可以预防的，但早期发现和获得护理的机会仍然有限，而且缺乏全面的国家级发病率数据。本研究旨在根据基于人群的癌症登记处的数据，概述印度RCs的流行病学，包括其规模和模式。方法分析印度37个基于人口的癌症登记处（pbcr） 2012-2017年的癌症发病率数据。使用ICD-10代码确定RC病例。计算年龄标准化发病率（ASRs）、年龄特异性发病率和终生累积风险，并按性别和地区分类。结果436223例肿瘤患者中，rcs 61190例（14.0%），男性15091例（6.9%），女性46099例（21.3%）。在女性中，宫颈癌占RCs的48.8%，其次是卵巢癌（28.7%）和子宫内膜癌（15.5%）。在男性中，前列腺癌占78.8%。无论男女，这种负担在40岁到59岁之间达到高峰。在印度，女性的终生累积风险为34分之一，男性为68分之一，印度北部和南部地区的风险更高。结论印度女性RCs负担高，且地区差异明显。加强早期发现方案和利用Ayushman Bharat下的保健和保健中心是关键战略。针对特定区域、对性别问题有敏感认识的方法，加上持续监测和多部门政策重点，对于改善结果和减轻rc的社会心理影响至关重要。

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引用次数: 0

Burden of anemia in inflammatory bowel disease: A systematic review and meta-analysis 炎症性肠病的贫血负担：一项系统综述和荟萃分析

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-12-15 DOI: 10.1016/j.cegh.2025.102262

Rupa Tharu , Savitesh Kushwaha , Rachana Srivastava , Vaneet Jearth , Nitin Kaushal , Anupam Kumar Singh , Shweta Khandelwal , Poonam Khanna

Problem considered

Inflammatory bowel disease (IBD) is a chronic immune-mediated condition of the gastrointestinal system. Anemia is one of the most prevalent extraintestinal manifestations of IBD. This study assessed the global prevalence of anemia in patients with IBD.

Methods

A systematic review and meta-analysis were conducted following PRISMA guidelines to estimate the prevalence of anemia in IBD across world from year 2015–2024. The literature search was conducted in PubMed, Web of Science, Scopus, and Embase. The inclusion and exclusion criteria were pre-defined. The data on prevalence of anemia were extracted and Random effect pooled prevalence with 95 % CI was estimated for overall IBD and separately for Crohn's disease and ulcerative colitis. The subgroup was also defined among types of anemia, age groups, country, study site and study designs.

Results

The Search identified 791 records and 47 publications with a sample population of 138577 unique IBD cases from 22 countries and 5 continents were included in the prevalence estimation. The prevalence of anemia among overall IBD populations was 36.9 % (95 % CI:31.1–42.9), the prevalence of iron deficiency anemia (IDA) was 32.2 % (95 % CI:25.6–39.1), and the prevalence anemia of chronic disease (ACD) was 8.1 % (95 % CI:5.8–10.7). The country wise analysis shows highest prevalence of anemia in Bulgaria, for IDA highest prevalence was in Poland and ACD was highest in India.

Conclusions

Anemia is a common and variable complication of IBD globally. Its prevalence differs significantly by anemia subtype and geographic region, highlighting a substantial and complex burden.

炎症性肠病（IBD）是一种慢性免疫介导的胃肠道疾病。贫血是IBD最常见的肠外表现之一。本研究评估了IBD患者贫血的全球患病率。方法根据PRISMA指南进行系统回顾和荟萃分析，以估计2015-2024年全球IBD患者贫血的患病率。文献检索在PubMed、Web of Science、Scopus和Embase中进行。预先定义了纳入和排除标准。提取有关贫血患病率的数据，并对总体IBD和克罗恩病和溃疡性结肠炎的随机效应汇总患病率进行95% CI估计。该亚组还根据贫血类型、年龄组、国家、研究地点和研究设计进行了定义。结果共检索到来自5大洲22个国家的138577例IBD病例样本，共791份记录和47份出版物纳入患病率估算。总体IBD人群中贫血的患病率为36.9% (95% CI: 31.1-42.9)，缺铁性贫血（IDA）患病率为32.2% (95% CI: 25.6-39.1)，慢性疾病贫血（ACD）患病率为8.1% （95% CI: 5.8-10.7）。国别分析显示，保加利亚的贫血患病率最高，国际开发协会的贫血患病率最高的是波兰，亚行的贫血患病率最高的是印度。结论贫血是全球IBD常见且多变的并发症。其患病率因贫血亚型和地理区域的不同而有显著差异，突出了一个巨大而复杂的负担。

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引用次数: 0

A qualitative analysis of climate change-related perceptions among a sample of the Egyptian population: A youth participatory action research 在埃及人口样本中对气候变化相关观念的定性分析：青年参与性行动研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-12-04 DOI: 10.1016/j.cegh.2025.102257

Samah Saleh , Ihab Abdel-Aziz Gebreel , Salah hassan AL Hanafy , Ahmed Tawfik Bayad , Sherry Medhat Ayad , Shaimaa Baher Abdel-aziz , Abdelhamid Mohamed El Shabrawy

Problem considered

Climate change-related perceptions and communication are important factors influencing people's support for climate change policies and individual behavior. The purpose of this Youth-Led PAR is to involve young people in framing the discussion about climate change, identifying knowledge, perception about CC and its effects.

Methods

This is an exploratory population-based study that was implemented in partnership with the Egyptian Ministry of Environment (MOE) and UINCEF/Egypt Country Office (ECO) during the period from June 2023 to December 2023. A qualitative investigative approach was chosen for this study's methodology including 90 focus group discussions and 180 in-depth interviews in 10 governorates including a purposive sample of 1082 respondents.

Results

The interview questions elicited responses related to five thematic areas: young people's awareness, attitudes and beliefs; lessons learned, mitigation strategies, barriers against contribution; Roles and responsibilities for the implementation strategies; Advocacy campaigns and raising awareness. The findings revealed that young people perceive climate change as a global warming phenomenon. The majority realized that the situation would be worse, children, adolescents and young people are the most affected due to spreading diseases, emerging new organisms, increasing in mental health problems.

Conclusions

Generate evidence and assessing youth's understanding related to climate change impact on health is a critical issue. The study results can provide the foundation to develop community-based awareness campaigns, draw attention to the causes, indicators, and broad hazards of CC, advocate for the urgent need to support strict governmental policies and the development of future environmental impact reducing strategies.

与气候变化相关的认知和沟通是影响人们对气候变化政策和个人行为支持的重要因素。青年领导的PAR的目的是让年轻人参与关于气候变化的讨论，确定关于气候变化及其影响的知识和看法。方法：这是一项基于人群的探索性研究，于2023年6月至2023年12月期间与埃及环境部（MOE）和联合国儿童基金会/埃及国家办事处（ECO）合作实施。本研究的方法选择了定性调查方法，包括在10个省进行90次焦点小组讨论和180次深度访谈，其中包括1082名受访者的有目的样本。结果访谈问题引出的回答涉及5个主题领域：年轻人的意识、态度和信念；经验教训、缓解战略、阻碍捐款的障碍；实施策略的角色和责任；宣传活动和提高认识。调查结果显示，年轻人认为气候变化是一种全球变暖现象。大多数人认识到情况会更糟，儿童、青少年和年轻人受疾病传播、新生物体出现和精神健康问题增加的影响最大。结论生成证据并评估青年对气候变化对健康影响的理解是一个关键问题。研究结果可为开展以社区为基础的宣传活动提供基础，引起人们对CC的原因、指标和广泛危害的关注，倡导迫切需要支持严格的政府政策和制定未来的减少环境影响战略。

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引用次数: 0

Predicting severity in spotted fever in India: A retrospective cohort study 预测印度斑疹热严重程度：一项回顾性队列研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-12-03 DOI: 10.1016/j.cegh.2025.102255

Nitin Gupta , Praveen Kumar Tirlangi , Rachana Bhat , S. Chaithra , Mohammad Arham Parvez , V. Shashidhar , Seema Shetty , Muralidhar Varma , K.E. Vandana , Prithvishree Ravindra

Problem considered

Spotted fever, a neglected rickettsial illness in India, can present with life-threatening complications, yet early predictors of severity remain poorly defined.

Methods

We conducted a retrospective cohort study of 117 adult patients with spotted fever admitted to a tertiary care centre in Karnataka, India (2017–2024). Spotted fever was diagnosed based on a positive Weil-Felix test (OX-2 and/or OX-19) with exclusion of other common tropical infections. Severe disease was defined as the presence of oxygen requirement, vasopressor use, dialysis, or altered sensorium. Clinical and laboratory variables were compared between severe and non-severe groups, and multivariable logistic regression identified independent predictors.

Results

Severe disease occurred in 31.6 % (37/117). On multivariable analysis, shorter duration of illness at presentation to the hospital was independently associated with severe disease [aOR 0.70 (95 % CI: 0.57–0.86)], while higher serum creatinine also predicted severity [aOR 1.29 (95 % CI: 1.00–1.66)]. Lower serum albumin showed a strong association with severe disease [aOR 0.16 (95 % CI: 0.07–0.37)]. Although platelet count demonstrated an inverse trend, the association did not reach statistical significance [aOR 0.92 (95 % CI: 0.83–1.03)]. The model showed good calibration (Hosmer–Lemeshow p = 0.128) and an overall accuracy of 77.7 %.

Conclusion

In spotted fever, simple and accessible markers, shorter illness duration, renal dysfunction, and hypoalbuminemia, can help predict severity and guide early referral, especially in resource-limited settings. These findings merit validation in prospective cohorts.

在印度，斑疹热是一种被忽视的立克次体疾病，可导致危及生命的并发症，但其严重程度的早期预测指标仍不明确。方法对2017-2024年印度卡纳塔克邦一家三级医疗中心收治的117例成人斑疹热患者进行回顾性队列研究。在排除其他常见热带感染的情况下，根据韦尔-费利克斯试验阳性（OX-2和/或OX-19）诊断为斑疹热。严重的疾病被定义为存在氧气需求、血管加压剂的使用、透析或感觉改变。比较重症组和非重症组的临床和实验室变量，并用多变量logistic回归确定独立预测因子。结果重症占31.6%（37/117）。在多变量分析中，入院时病程较短与疾病严重程度独立相关[aOR 0.70 (95% CI: 0.57-0.86)]，而较高的血清肌酐也预测疾病严重程度[aOR 1.29 (95% CI: 1.00-1.66)]。较低的血清白蛋白与严重疾病密切相关[aOR 0.16 (95% CI: 0.07-0.37)]。虽然血小板计数呈负相关，但相关性不具有统计学意义[aOR 0.92 (95% CI: 0.83-1.03)]。该模型具有良好的校正效果（Hosmer-Lemeshow p = 0.128），总体精度为77.7%。结论在斑疹热中，简单易行的标志物、较短的病程、肾功能不全和低白蛋白血症可帮助预测病情严重程度并指导早期转诊，特别是在资源有限的地区。这些发现值得在前瞻性队列中得到验证。

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引用次数: 0

Comparative analysis of HPV prevalence and genotype distribution in patients with base of tongue, cervical, and tonsillar squamous cell carcinomas: Indications of a shift in HPV genotype patterns 舌底、宫颈和扁桃体鳞状细胞癌患者的HPV患病率和基因型分布的比较分析：HPV基因型模式转变的指征

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-12-02 DOI: 10.1016/j.cegh.2025.102248

Reham M. Alahmad

Problem considered

Human Papillomavirus (HPV) is a significant etiological factor in several cancers, including cervical and head and neck squamous cell carcinoma (HNSCC). While HPV-16 is the most commonly reported genotype globally, emerging evidence indicates regional variations in genotype distribution. In Saudi Arabia, data on HPV genotypes in these cancers remain limited. This study investigated the prevalence and genotype distribution of high-risk HPV (HR-HPV) in base of tongue squamous cell carcinoma (BOTSCC), cervical squamous cell carcinoma (CSCC), and tonsillar squamous cell carcinoma (TSCC), and to evaluate implications for HPV vaccine coverage.

Methods

A total of 97 patients (11 BOTSCC, 70 CSCC, and 16 TSCC) were tested for the presence and genotypes of HR-HPV using molecular methods. The distribution of HR-HPV genotypes, single and multiple infections, was assessed, and genotypes were compared to the coverage provided by the nine-valent HPV vaccine.

Results

In patients with base of tongue squamous cell carcinoma (BOTSCC), HPV DNA was detected in all cases, with HPV-35 being the most prevalent genotype (90 %), followed by HPV-16 (63 %) and HPV-45 (9 %). Notably, 81.8 % of BOTSCC patients exhibited multiple HPV infections, predominantly dual infections. Among cervical squamous cell carcinoma (CSCC) cases, HPV-35 was again the most frequently detected genotype (84 %), followed by HPV-16 (68 %) and HPV-18 (54 %), while HPV-33 was not observed. In tonsillar squamous cell carcinoma (TSCC), 81.3 % of patients tested positive for.

Conclusion

The predominance of HPV-35 over HPV-16 in CSCC and HNSCC highlights a unique regional pattern and a gap in current vaccine coverage. The detection of non-vaccine genotypes supports the need for regional surveillance and potential expansion of vaccine targets to improve protection against HPV-related cancers in Saudi Arabia.

人乳头瘤病毒（HPV）是几种癌症的重要病因，包括宫颈癌和头颈部鳞状细胞癌（HNSCC）。虽然HPV-16是全球最常见的基因型，但新出现的证据表明基因型分布存在区域差异。在沙特阿拉伯，这些癌症中HPV基因型的数据仍然有限。本研究调查了高危型HPV （HR-HPV）在舌鳞癌（BOTSCC）、宫颈鳞癌（CSCC）和扁桃体鳞癌（TSCC）基底的患病率和基因型分布，并评估HPV疫苗覆盖率的影响。方法采用分子方法对97例患者（11例BOTSCC、70例CSCC、16例TSCC）进行HR-HPV基因型检测。评估了单次和多次感染的HR-HPV基因型分布，并将基因型与九价HPV疫苗提供的覆盖率进行了比较。结果舌底鳞状细胞癌（BOTSCC）患者均检出HPV DNA，其中HPV-35基因型最多（90%），其次是HPV-16（63%）和HPV-45（9%）。值得注意的是，81.8%的BOTSCC患者表现为多发HPV感染，主要是双重感染。在宫颈鳞状细胞癌（CSCC）病例中，HPV-35再次是最常检测到的基因型（84%），其次是HPV-16（68%）和HPV-18(54%)，而HPV-33未被观察到。在扁桃体鳞状细胞癌（TSCC）中，81.3%的患者检测呈阳性。结论HPV-35比HPV-16在CSCC和HNSCC中的优势突出了一种独特的区域模式和目前疫苗覆盖率的差距。非疫苗基因型的检测支持了区域监测的必要性和扩大疫苗靶点的潜力，以改善对沙特阿拉伯人乳头瘤病毒相关癌症的保护。

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引用次数: 0

Unveiling the hidden burden of malnutrition in tuberculosis: A multifaceted evaluation using malnutrition universal screening tool and patient-generated subjective global assessment 揭示结核病中营养不良的隐性负担：利用营养不良普遍筛查工具和患者主观全球评估进行多方面评估

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-12-02 DOI: 10.1016/j.cegh.2025.102253

Priyanka Guha , Meenakshi Abbagouni , Maturu Ashok , Rajat Kumar Mishra , Tukaram Kendre , Gulshan Singh Rana , Abhik Sen , Krishna Pandey , Sameer Dhingra

Problem considered

Tuberculosis (TB) remains a significant public health burden, especially in resource-limited countries. Malnutrition is a significant concern among TB patients, exacerbating symptoms and impeding recovery. Despite this, standardised nutritional screening remains underutilised in TB care programs. Accurate and routine nutritional assessment is essential to guide timely interventions and improve treatment outcomes among TB patients. This study aimed to assess malnutrition risk in TB patients using MUST and PG-SGA, evaluate disagreement between screening tools, and determine the limitations of Body Mass Index (BMI) based assessments.

Methods

A cross-sectional study was conducted among 194 adult TB patients receiving anti-TB therapy in Bihar, India. Nutritional risk was evaluated using MUST and PG-SGA, along with demographic, clinical, and anthropometric data. Statistical analyses included ANOVA, Bonferroni post hoc tests, chi-square tests, and Cohen's kappa to assess agreement between tools.

Results

The study revealed a high prevalence of malnutrition risk, with MUST detecting 74.2 % and PG-SGA detecting 88.1 % of the overall population. Underweight patients were disproportionately affected, with MUST identifying 96.5 % and PG-SGA identifying 88.3 % as high-risk. This study emphasises the limitations of BMI alone in assessing malnutrition risk and reveals near-random agreement (κ = 0.010, p < 0.001), suggesting BMI alone inadequately captures malnutrition risk in TB patients.

Conclusion

This study highlights a critical gap in malnutrition screening for TB patients, with MUST and PG-SGA detecting high but discordant risk levels. Given PG-SGA's higher sensitivity, policymakers in resource-limited settings should consider integrating it into TB programs for early nutritional intervention, while further research validates optimal screening approaches.

结核病仍然是一个重大的公共卫生负担，特别是在资源有限的国家。营养不良是结核病患者的一个重大问题，它会加剧症状并阻碍康复。尽管如此，标准化营养筛查在结核病治疗规划中仍未得到充分利用。准确和常规的营养评估对于指导及时干预和改善结核病患者的治疗结果至关重要。本研究旨在利用MUST和PG-SGA评估结核病患者的营养不良风险，评估筛查工具之间的差异，并确定基于体重指数（BMI）评估的局限性。方法对印度比哈尔邦194例接受抗结核治疗的成年结核病患者进行横断面研究。营养风险评估使用MUST和PG-SGA，以及人口统计学、临床和人体测量数据。统计分析包括方差分析、Bonferroni事后检验、卡方检验和Cohen kappa来评估工具之间的一致性。结果该研究显示营养不良风险的患病率较高，MUST检出率为74.2%，PG-SGA检出率为88.1%。体重过轻的患者受到不成比例的影响，其中必须确定96.5%，PG-SGA确定88.3%为高危患者。这项研究强调了单独使用BMI来评估营养不良风险的局限性，并揭示了近乎随机的一致性（κ = 0.010, p < 0.001），表明单独使用BMI不能充分反映结核病患者的营养不良风险。结论本研究突出了结核病患者营养不良筛查的关键差距，MUST和PG-SGA检测出高但不一致的风险水平。鉴于PG-SGA具有更高的敏感性，资源有限国家的政策制定者应考虑将其纳入结核病规划，用于早期营养干预，同时进一步研究验证最佳筛查方法。

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引用次数: 0

Vitamin D normative values by age, sex, and supplement use 维生素D按年龄、性别和补充剂使用的标准值

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-12-02 DOI: 10.1016/j.cegh.2025.102251

Man Hung , Eric S. Hon , Amir Mohajeri , Sharon Vu , Samantha Lee , Martin S. Lipsky

Problem considered

Vitamin D levels vary by age, sex, lifestyle, and supplement use. Establishing normative values for Vitamin D within these populations is crucial to advancing global health and reducing the disease burden. This study aimed to establish age-, sex-, and supplementation-specific normative values for serum 25-hydroxyvitamin D2 [25(OH)D2], 25-hydroxyvitamin D3 [25(OH)D3], and total Vitamin D using nationally representative United States data from the NHANES 2017–2018 cycle.

Methods

A cross-sectional analysis was conducted using data from 3668 NHANES participants aged 1 year and older. Serum 25(OH)D2, 25(OH)D3, and total Vitamin D levels were measured. Participants were stratified by age, sex, and supplement use. Percentile distributions were calculated to provide reference values for subgroups.

Results

25(OH)D3 was the primary contributor to total Vitamin D levels across all demographics. Adults 51 years and older displayed higher upper percentiles for 25(OH)D3 and total Vitamin D. Males exhibited higher levels than females, especially in younger age groups. Among non-supplement users, Vitamin D levels at the 5th percentile were above 20 nmol/L across all ages, suggesting adequate levels from natural sources, such as sunlight and diet.

Conclusion

This study established normative values for Vitamin D across demographic groups, emphasizing the importance of age- and sex-specific values in clinical evaluations. These findings highlight that many individuals obtain Vitamin D naturally, reinforcing the global relevance of environmental and nutritional health strategies. These normative values can inform clinical and public health assessments and help to refine Vitamin D guidelines and support worldwide efforts toward optimal population health.

维生素D水平因年龄、性别、生活方式和补充剂的使用而异。在这些人群中确立维生素D的标准价值对于促进全球健康和减轻疾病负担至关重要。本研究旨在利用美国NHANES 2017-2018周期具有全国代表性的数据，建立血清25-羟维生素D2 [25(OH)D2]、25-羟维生素D3 [25(OH)D3]和总维生素D的年龄、性别和补充剂特异性规范值。方法对3668名年龄在1岁及以上的NHANES参与者的数据进行横断面分析。测定血清25(OH)D2、25(OH)D3和总维生素D水平。参与者按年龄、性别和补充剂使用情况分层。计算百分位数分布，为亚组提供参考值。结果25(OH)D3是所有人口统计数据中总维生素D水平的主要贡献者。51岁及以上的成年人25(OH)D3和总维生素d的百分位数较高，男性的水平高于女性，尤其是在年轻年龄组。在未服用补充剂的人群中，所有年龄段的第5百分位数的维生素D水平都高于20毫摩尔/升，这表明自然来源（如阳光和饮食）的维生素D水平足够。结论：本研究建立了不同人群维生素D的标准值，强调了临床评估中年龄和性别特异性值的重要性。这些发现突出表明，许多人可以自然获取维生素D，从而加强了环境和营养健康战略的全球相关性。这些标准值可以为临床和公共卫生评估提供信息，有助于完善维生素D指南，并支持全世界为实现最佳人口健康所做的努力。

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引用次数: 0

Perception of Human Papilloma Virus infection and acceptance of its testing among women of reproductive age in a low-resource setting, Ghana 加纳，资源匮乏地区育龄妇女对人乳头瘤病毒感染的认识和接受检测

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-12-01 DOI: 10.1016/j.cegh.2025.102254

Rejoice Fletcher, Evelyn Asamoah Ampofo, Caroline Dinam Badzi, Janet Aba Saah

Problem considered

Human Papillomavirus (HPV) infection is a significant public health concern globally, particularly among young women. Globally, 662, 000 cervical cancer cases were reported. In Ghana, the prevalence of HPV infection among females was 2, 797. Yet there is limited understanding of the perception of HPV infection and acceptance of its testing among women of reproductive age especially those in New Takoradi as evidenced by poor uptake of the test. This study aimed to investigate the perception of HPV infection and its testing among women of reproductive age in New Takoradi, Western Region of Ghana.

Methods

Using a quantitative cross-sectional design, 323 women aged 18–49 years were surveyed. Descriptive statistics was used to analyse the data.

Results

Majority of the respondents (70.6 %) were aged 18–30 years, had completed senior high school (SHS) (43.3 %) and single (61 %). A third of participants (30 %) perceived HPV to affect only promiscuous women, curable (53.6 %) and causes infertility (81.7 %). Whereas two-thirds (66.3 %) of participants were willing to undergo HPV testing in the next 6 months, majority (80.5 %) were willing to do so out of fear of contracting the disease.

Conclusion

The study's findings highlighted the importance of education and awareness campaigns to promote HPV testing among women of reproductive age in Ghana and similar contexts.

人乳头瘤病毒（HPV）感染是全球范围内一个重要的公共卫生问题，尤其是在年轻女性中。全球共有662,000宗子宫颈癌个案。在加纳，女性感染HPV的流行率为2797。然而，育龄妇女，特别是新塔科拉迪的育龄妇女，对HPV感染的认知和对其检测的接受程度的了解有限，这一点从检测的接受程度较低可见一斑。本研究旨在调查加纳西部地区新塔科拉迪育龄妇女对HPV感染的认识及其检测。方法采用定量横断面设计，对323名年龄在18 ~ 49岁的女性进行调查。采用描述性统计方法对数据进行分析。结果调查对象的年龄以18-30岁为主（70.6%），高中毕业（43.3%），单身（61%）。三分之一的参与者（30%）认为HPV只影响滥交妇女，可治愈（53.6%）并导致不孕（81.7%）。尽管三分之二（66.3%）的参与者愿意在未来6个月内接受HPV检测，但大多数（80.5%）的参与者愿意这样做是因为害怕感染这种疾病。该研究的发现强调了教育和宣传运动在加纳和类似环境中促进育龄妇女进行HPV检测的重要性。

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引用次数: 0