Archives of Public Health最新文献

Introduction: Gastrointestinal cancers encompass malignant tumors of multiple digestive system organs in humans. Each type of digestive system cancer also contains different histological types, each of which has a distinct prognosis. The survival time of cancer patients has significantly extended with the development of modern medicine, allowing for primary cancers occurring more than once in a lifetime.

Methods: The study analyzed multiple primary gastrointestinal cancers, including esophagus, stomach, liver, gallbladder, small bowel, colon, rectum, and anus, based on the Surveillance, Epidemiology, and End Results (SEER) database from 2016 to 2019 in the United States. A total of 119,760 cases were included in this study. Each gastrointestinal cancer was analyzed separately based on the International Classification of Diseases for Oncology third edition (ICD-O-3) for the common histologic type. Meanwhile, based on the sequence of cancer occurrence in the patients, they were divided into the one primary (OP) group and the multiple primaries (MP) group. The multiple primaries group was further subdivided into the first of multiple primaries (FMP) group and the non-first of multiple primaries (NFMP) group. The Kaplan-Meier method with the log-rank test was used to analyze overall survival (OS), while the Cox regression model was used for univariate and multivariate analyses.

Results: The study enrolled nine organs of the digestive system and twenty histologic types of primary gastrointestinal cancers. The characteristics of patients in different groups with various cancers, overall survival of these patients, and the risk factors for developing these cancers were comprehensively analyzed. The comprehensive analysis revealed the connection between the occurrence sequence of cancers and different outcomes for patients.

Conclusions: Different prognoses were observed in patients with different sequences of various primary gastrointestinal cancers. Patients with high mortality cancers in the FMP group may have potential factors, such as high treatment sensitivity, that could lead to improved OS. Patients with low mortality cancers in the NFMP group could benefit from positive treatment therapies.

Background: Liver cancer is a common malignant tumor of the digestive system. We aimed to estimate the trend in the burden of liver cancer in Fujian Province, China, during 2011-2020.

Methods: The population-based cancer data was collected from the cancer registry in Fujian Province during 2011-2020. Segi's world standard population was used to calculate the age-standardized incidence rates and age-standardized mortality rates. The temporal trend of liver cancer was displayed by annual percentage change and average annual percentage change (AAPC). Relative survival of liver cancer was calculated as the ratio of observed survival to expected survival. The age-standardized relative survival was calculated according to the International Cancer Survival Standards 1.

Results: There were 14,725 patients diagnosed with liver cancer and 12,698 patients died between 2011 and 2020. For males, there was a downward trend in incidence and mortality (AAPC: -3.86%, -3.44%). Similarly, the downward trend was also shown in females (AAPC: -3.96%, -2.79%). The highest age-specific incidence and mortality were in the 75-79 age group (146.59/100,000 and 137.99/100,000, respectively), and there was no downward trend in this group during the period. The overall age-standardized 5-year relative survival was 10.77% in 2011-2015 and 14.54% in 2016-2020. During the study period, the percentage improvement of survival was higher in males than in females (34.75% and 25.33%). The percentage improvement of survival in urban was higher than that in rural (38.64% and 28.75%). Except for the age group over 75, the survival of patients in other age groups all has improved.

Conclusions: Liver cancer remains a serious public health problem in Fujian Province, China, which needs to be solved, especially in some high-risk groups such as the elderly, high-risk males, and rural populations. Early detection and treatment is the key to the prevention and treatment of liver cancer.

Background: Continuous glucose monitoring (CGM) is increasingly popular for managing Type 2 Diabetes Mellitus (T2DM). Many systematic reviews have reported on CGM's effectiveness, but with heterogeneous methodologies and objectives. We aim to conduct an umbrella review (UR) to consolidate a most contemporaneous and comprehensive evidence base comparing CGM with self-monitoring of blood glucose or usual care (SMBG/UC).

Methods: Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, CINAHL, Epistemonikos, SCOPUS, Web of Science and PubMed were searched from their dates of inception to 28th June 2024. Systematic reviews (SR) with or without meta-analyses comparing the use of CGM with SMBG or usual care (UC) for T2DM management in patients treated with or without insulin were included. Narrative synthesis of HbA1c, glycemic variability metrics and other physical measurements were done. Corrected covered area (CCA) was calculated to assess suitability of meta-meta-analysis.

Results: 31 SRs were included in this UR. There was high overlap within meta-analyses of HbA1c, time-in-range (TIR), time-above-range (TAR) and time-below-range (TBR). A primary study-level meta-analysis demonstrated that compared to SMBG/UC, CGM was associated with significantly greater HbA1c decrease (n = 11,494, MD = -0.40% [95% CI: -0.54 to -0.25]), TIR increase (n = 1452, MD = 6.00% [95%CI: 3.13 to 8.88]) and TAR decrease (n = 1113, MD = -4.33% [95%CI: -8.37 to -0.28]).These findings were invariant with CGM modality, study funding, pre-existing insulin treatment and risk-of-bias. Meta-analysis of patient reported outcome measures (PROMs) demonstrated insignificant differences in PROMs with CGM use compared to SMBG/UC.

Conclusion: CGM could lead to better clinical outcomes than SMBG/UC and was of moderate evidence certainty (GRADE), while its effect on PROMs remains inconclusive. We recommend the introduction of CGM into standard care alongside SMBG for T2DM and further research exploring patient experience and acceptability of CGM use.

Background: Cognitive frailty, intimately tied to adverse outcomes such as falls, early mortality, and hospitalization, represents a dynamic, reversible process. Multicomponent exercise has emerged as one of the most potent means of mitigating cognitive frailty.

Aims: This research seeks to quantitively amalgamate the effects of multicomponent exercise on various domains: cognitive function, frailty status, and other health-related outcomes in cognitively frail older adults.

Methods: Our methodology entailed a comprehensive review of literature in databases including PubMed, EMbase, CINAHL, Cochrane Library, Web of Science, Wanfang, Sinomed, VIP, and CNKI from the inception of these databases to December 10, 2023. For our statistical analysis, we utilized RevMan 5.3, Stata 17.0 and R 4.3.2 software. Adherence was maintained to the PRISMA checklist, with the study being registered with PROSPERO (CRD42024499808).

Results: Our review encapsulated a total of 2,222 participants and 11 trials. The findings intimate that multicomponent exercise enhances cognitive function [MD = 2.52, p = 0.03]), grip strength[SMD = 0.39, p = 0.008] and lower limb muscle strength[MD = 4.30, p < 0.001], while alleviating frailty[MD = -2.21, p < 0.001] and depression [MD = -1.20, p = 0.001]. However, cogent evidence is still lacking to endorse the positive effects of multicomponent exercises on both ADL(p = 0.19) and quality of life(p = 0.16). Subgroup analyses revealed beneficial effects on cognitive frailty for multicomponent exercise whose type of exercise consisted of aerobic, the duration of which exceeded 120 min per week, and whose form of exercise was group exercise.

Conclusion: Multicomponent exercises offer significant improvements in cognitive function, muscle strength, and have the added benefit of reducing frailty and depression in older adults. However, these exercises do not appear to influence activities of daily living and quality of life positively.

Background: It is important to identify and evaluate cardiovascular risk factors at an early stage to address them accordingly. Among the younger population, the metabolic syndrome is less common than in older ages. However, each separate metabolic risk factor still has an additive effect on cardiovascular risk factor burden. Non-metabolic risk factors that occur in the younger population include family history, smoking, psychological distress and socioeconomic vulnerability. In 2021 a voluntary health intervention program was introduced in an urban area in Sweden where a cohort of 40-year-olds was invited for cardiovascular risk identification. The aim of this study was to identify how cardiovascular risk factors tend to aggregate in individuals participating in a voluntary health screening program and how the metabolic risk factors associate with non-metabolic cardiovascular risk factors.

Methods: This was a cross-sectional study with 1831 participants. Data from questionnaires and baseline measurements were used to calculate the prevalence of metabolic- (blood pressure, lipids, fasting plasma glucose, BMI, waist-hip ratio) and non-metabolic risk factors (family history of CVD, smoking, psychological distress, socioeconomic vulnerability) for CVD. SCORE2 was calculated according to the algorithm provided by the SCORE2 working group and ESC (European Society of Cardiology) Cardiovascular Risk Collaboration. Associations among each of the metabolic risk factors and non-metabolic risk factors were estimated using logistic regression and presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: More than half of the study population had at least one metabolic risk factor, and more than 1/3 was considered to be suffering from psychological distress. Furthermore, obesity or central obesity demonstrated individual associations with all of the non-metabolic risk factors in the study; smoking (1.49; 1.32-2.63), family history of CVD (1.41; 1.14-1.73), socioeconomic vulnerability (1.60; 1.24-2.07), and psychological distress (1.40; 1.14-1.72). According to SCORE2 25% of the men were at moderate risk (2.5-7.5%) of developing a cardiovascular event within 5-10 years, but only 2% of the women.

Conclusions: Obesity/central obesity should be a prioritized target in health screening programs. The non-metabolic risk factors, socioeconomic vulnerability, and psychological distress should not be ignored and addressed with adequate guidance to create health equity.

Introduction: Despite the significant contribution of postnatal care (PNC) to maternal and newborn survival, few studies have explored the concept of the quality of PNC received by mothers in Kenya. Therefore, this study aimed to determine the prevalence and factors associated with the quality of PNC in Kenya.

Methods: Secondary data from the Kenya Demographic and Health Survey (KDHS) of 2022 were analyzed, comprising 11,863 women who were aged 15 to 49 years. The quality of PNC was indicated as receiving all components of PNC in the first two days after childbirth. Multivariable logistic regression was conducted to determine the factors associated with the quality of PNC, using SPSS, version 20.

Results: Out of the 11,863 women, 39% (95% CI: 37.0-40.9) had received all components of PNC in the first two days after childbirth. Additionally, older women aged 35-49 years (AOR 1.88, 95%CI: 1.07-3.29), those who made decisions to seek health care jointly (AOR 1.48, 95%CI: 1.18-1.85), those who owned a telephone (AOR 1.36, 95%CI: 1.05-1.76), women who received quality antenatal care (AOR 4.62, 95%CI: 3.69-5.76), older women aged 30-34 years at the time of their first childbirth (AOR 2.25, 95%CI: 1.11-4.55), those who gave birth through cesarean section birth (AOR 1.93, 95%CI: 1.49-2.49), those who gave birth at public health facilities (AOR 1.69, 95%CI: 1.01-2.82) and those who received quality intrapartum care (AOR 1.87, 95%CI: 1.43-2.43) when compared with their counterparts were more likely to receive quality PNC. On the other hand, women from other provinces of Kenya i.e., Western (AOR 0.51, 95%CI: 0.33-0.80), and Rift Valley (AOR 0.57, 95%CI: 0.39-0.81), those who gave birth to female children (AOR 0.75, 95%CI: 0.61-0.91) and those who reported to have not been respected at all times during their hospital stay (AOR 0.49, 95%CI: 0.29-0.82) when compared with their counterparts were less likely to receive quality PNC.

Conclusion: The proportion of mothers receiving quality PNC was found to be low. The study also highlights the need to continue encouraging mothers to attend numerous ANC visits. Moreover, emphasis should be placed on providing quality ANC, intrapartum care, and respectful maternity care by health workers. Targeted interventions to increase access to quality PNC may need to focus on young mothers, mothers living in certain regions of Kenya, and those giving birth to female babies, most especially at private health facilities, and through vaginal birth.

Background: Polytrauma was defined as a severe traumatic injury and believed that it was a sudden and unpredictable incident. Is polytrauma really just a simple accident? In order to comprehensively answer this question, the study sought to determine the frequency and specific risk factors associated with polytrauma recidivism, while also comparing the initial and subsequent injury events among recidivists.

Methods: A multicenter, retrospective cohort study was conducted at four Advanced Trauma Centers' emergency surgery or traumatic intensive care units (TICUs) between August 2020 and July 2023. A total of 2490 consecutive trauma patients who met the criteria consecutively were recruited and analyzed in the study. Risk factors for recurrent polytrauma were identified through the use of logistic regression analysis. A nomogram was created using the results from a multivariate logistic regression analysis and the rms package in R.

Results: In polytrauma, the rate of recidivism was 44.6% (672/1507), then recidivists were predominantly male (80.4%) and frequently within the 45 to 54 year-old age range (51.3%). Recidivists in polytrauma patients overall had a median time to reinjury of 27 months, as measured by the interquartile range (IQR). The polytrauma patients in the recent traumatic event were often more severe than that in the initial event, as patients had higher ISS scores and lower GCS scores (P < 0.01). Moreover, polytrauma recidivism were associated with poorer prognosis and increased healthcare costs. Polytrauma patients with the specific characteristics were found to have a higher likelihood of experiencing a subsequent recurrence, including being male (OR = 3.82,95% CI: 2.21-6.83), aged 45-54 years old (OR = 2.62,95% CI: 2.13-6.32),experiencing sleep deprivation (OR = 2.38,95% CI: 1.32-4.25), working in construction (OR = 2.72,95% CI: 1.44-5.42), working as delivery staff (OR = 3.65,95% CI: 1.51-7.96) and being involved in an electric bicycle collision (OR = 2.85,95% CI: 1.31-5.64).

Conclusion: Polytrauma recidivism is associated with a high recurrence rate, poorer clinical outcomes, and elevated healthcare costs. Key predictive markers for recidivism include being male, aged 45-54 years, experiencing sleep deprivation, employment in construction or delivery roles, and involvement in electric bicycle collisions. These findings highlight polytrauma recidivists as a critical target for primary prevention efforts. Public health strategies should prioritize tailored interventions to reduce recidivism, aiming to mitigate morbidity, mortality, and associated healthcare burdens in this high-risk population.

Background: Under the background of similar geography and culture in Lancang-Mekong countries and rapid changes in the regional economy and lifestyle, this study aimed to describe and compare the prevalence, awareness, treatment, and control of hypertension and assess the hypertension care cascade in three provinces of China, Laos, and Cambodia.

Methods: A cross-sectional study was conducted between 2021 and 2023 in the three provinces of Lancang-Mekong River countries using consistent investigative procedures. We included 11,005 participants aged ≥ 18 years from three provinces, and data were collected through questionnaires, physical examinations, and biochemical tests. We analyzed the cascade of hypertension care and compared the prevalence, awareness, treatment, and control of hypertension.

Results: The hypertension care cascade indicated that 46.3%, 51.6%, and 63.1% of patients in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia), respectively, were not diagnosed, and 10.7%, 12.8% and 21.1% of patients, respectively, did not receive treatment. After sex-age standardization, the prevalence rates of hypertension in the three provinces were 33.4%, 34.5%, and 23.6%, respectively. Higher awareness rate in Yunnan Province (53.4%) and Oudomxay Province (46.5%) than in Ratanakiri Province of Cambodia (39.7%). The treatment rate of hypertension in Yunnan Province (42.4%) was higher than that in Oudomxay Province (34.5%), and Ratanakiri Province (16.9%). In addition, less than 20% of the patients in the three provinces had their blood pressure under control. The factors associated with hypertension differed across the three provinces.

Conclusions: In the three provinces of the Lancang-Mekong River Basin countries, there is a high burden of hypertension and a significant unmet need for hypertension care. Targeted and precise intervention strategies are urgently needed to improve the awareness, treatment, and control of hypertension in low- and middle-income regions.