Journal of Global Health最新文献

Background: This study aimed to assess the associations of two common types of preserved vegetables in China, salted and sour pickled vegetables, with the risk of gastrointestinal tract (GI) cancers, including oesophageal cancer, stomach cancer, and colorectal cancer.

Methods: The China Kadoorie Biobank collected intake frequency of preserved vegetables among 510 143 adults without self-reported cancer during 2004-2008, and followed up till 31 December 2018. The second resurvey further collected intake frequencies of salted and sour pickled vegetables, which classified the 10 study areas into three types of regions, including the regions never/rarely consuming preserved vegetables (number of participants at baseline = 201 844), mainly consuming salted vegetables (n = 202 927), and mainly consuming sour pickled vegetables (n = 105 372). Cox proportional models were respectively performed to calculate hazard ratios (HRs) for GI cancers with preserved vegetables in the latter two types of regions among baseline participants.

Results: In the regions mainly consuming salted vegetables, preserved vegetable consumption was positively associated with stomach cancer (HR = 1.17; 95% confidence interval = 1.00-1.37; P for trend = 0.039). In the regions mainly consuming sour pickled vegetables, a dose-response positive relationship was observed between preserved vegetable consumption and the risk of oesophageal cancer (P for trend = 0.013), with adjusted HR of 1.35 (95% CI 1.02-1.80) for those who daily consumed compared with never consumed.

Conclusions: Our findings suggest that different types of preserved vegetables might have different effects on GI cancers, and limiting preserved vegetable consumption might be protective against developing GI cancers.

Background: Maternal mortality remains high in sub-Saharan Africa, with little progress made in the last 20 years. The provision of emergency obstetric care has been shown to have the greatest effect in reducing maternal mortality in countries with high maternal mortality ratios, especially when paired with an emergency transport service. Integrate Health has partnered with the Togolese Ministry of Health to improve maternal and child health via the integration of a free ambulance service into a pre-existing primary care model. In this study, we aim to describe the implementation of this service and assess its effectiveness on access to emergency obstetric care by estimating its coverage of women with obstetric complications.

Methods: This is a retrospective cross-sectional study using routinely collected data from ambulance logbooks. The study was restricted to pregnant or postpartum woman in four districts of Northern Togo. For each patient transported, the variables collected included date of transport, destination, patient information, kilometres travelled, and reason for transport. Complicated obstetric cases were defined by reason for transport and included maternal haemorrhage, complicated birth, and signs of danger. Estimated coverage of major obstetric complications was calculated using population estimates per fiscal year, the birth rate (3.7%) in Togo, and the assumption that 15% of pregnant women will have a complication.

Results: Between July 2020 and June 2023, there were 2926 maternal patients transported by the ambulance service. Of these, 1030 were reported as complicated obstetric cases. Estimated coverage of obstetric complications increased over time and as the programme expanded, from 18% in 2020 to 35.7% in 2021, and 66.5% in 2022.

Conclusions: Our findings demonstrate that implementing a rural ambulance service in a region with historically high maternal mortality rates may improve maternal access to emergency obstetric care. The success of our ambulance service was likely due to the fact that it is free, available 24/7, easily accessible, operated by trained staff and community members, and integrated into a pre-existing primary care programme with well-resourced health care centres.

Background: Although numerous studies have discussed about the impact of air pollution on cognitive function, a consensus has yet to be reached, necessitating further exploration of their relationship. The aim of this study is to reveal the effects of major air pollutants on cognitive function in Chinese middle-aged and older adults, while considering the lagged effects of pollution.

Methods: Panel data were constructed by integrating the air pollutants concentration (particulate matter diameter ≤1 µm (μm) (PM₁), PM_2.5, PM₁₀, nitrogen dioxide (NO₂), and ozone (O₃)) among 28 provinces in China and the personal characteristics from China Health and Retirement Longitudinal Study participants during the period of 2011-2015. To explore the effects of single pollutants and their interactions on cognitive function, panel linear regression using ordinary least squares method was employed, and first-order lag effects (two-year interval) of air pollution were introduced into the models.

Results: Our study revealed that, after adjusting for confounding factors, higher levels of particulate matter (PM₁, coefficient (Coef.) = -0.093, P = 0.001; PM_2.5, Coef. = -0.051, P = 0.001; PM₁₀, Coef. = -0.030, P = 0.001) and NO₂ (Coef. = -0.094, P = 0.006) were associated with lower cognitive function scores among the participants. Moreover, the interaction between the five major pollutants exhibited a negative effect on cognitive function(Coef. = -2.89, P = 0.004).

Conclusions: PM₁, PM_2.5, PM₁₀ have detrimental effects on the cognitive function of middle-aged and elderly adults in China, where increasing particle diameter correlates with a less negative impacts, providing theoretical underpinnings for the formulation of environmental protection policies.

Background: The full-scale invasion disrupted health care in Ukraine, leading to the displacement of physicians and affecting their access to subspecialist consultations. HealUA, a mobile application, was designed to provide secure and timely remote physician-to-physician consultations. We aimed to assess the implementation of the HealUA mobile application for peer-to-peer physician consultations in Ukraine during the Russian invasion.

Methods: HealUA was developed in May 2022. Security measures included user verification, privacy policies, and legal disclaimers. The application allowed physicians to submit cases and receive remote consultations from physicians in Ukraine and worldwide. We assessed the implementation of the HealUA application using Proctor's implementation outcomes framework, specifically adoption and feasibility. Adoption was measured by user downloads, characteristics of registered physicians, and case submissions. Feasibility was evaluated through clinical case response times, translation services, and technical issues.

Results: From May 2022 to May 2024, 3861 physicians registered. The majority were from Ukraine (95%). Of 474 submitted cases, 97.3% received timely responses from other physicians. The application demonstrated prompt response times (84.6% within the first day), successful translation services, and effective resolution of technical issues.

Conclusions: The HealUA application achieved broad adoption across medical specialties, fostering robust clinical information exchange during the ongoing conflict. Security standards were upheld and routine technical issues were satisfactorily addressed. Future efforts will focus on broader dissemination and assessing additional implementation outcomes.

Background: Dementia and cognitive impairment rates in Asia have significant policy implications. Contrary to the existing literature, which primarily focused on the Western region, in this study, we provide novel insights into previously unexplored geographical contexts. We aimed to evaluate the prevalence of cognitive impairment and dementia in Asia.

Methods: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched six bibliographic databases: Web of Science, Medline, Science Direct, Ovid, Google Scholar, and PubMed. We targeted cross-sectional studies on dementia and cognitive impairment in Asia, published between 2019-23.

Results: Our extensive search yielded 2593 original articles, of which 39 met eligibility criteria. This selection unveiled a significant rise in dementia and cognitive impairment prevalence in Asia, aligning now with trends observed in Western countries - a novel finding that challenges previous assumptions about regional prevalence disparities. The studies predominantly conducted in East Asia (n = 29), along with limited research from Southeast (n = 2), South (n = 7), and Central Asia (n = 1), underscore the geographical gaps in current research. This shift in prevalence patterns is potentially linked to demographic changes, urbanisation, environmental factors, ethnic diversity, and neuroimaging advancements. Identifying modifiable risk factors associated with dementia in these regions presents new avenues for prevention and intervention strategies.

Conclusions: Current dementia research in Asia is concentrated in East Asia, with limited data from Southeast, South, and Central Asia. Comprehensive studies across all parts of Asia are crucial to establishing robust data collection methods and identifying modifiable risk factors. This can help manage and mitigate the growing burden of dementia in these societies.

Background: Air pollution exposure poses significant health risks for the general population, but particularly for women with acute and chronic respiratory conditions. Given the increasing global burden of air pollution-related illnesses, understanding these biomarkers is crucial for developing targeted interventions and improving respiratory health outcomes in vulnerable populations. In this systematic review, we aimed to determine potential dysregulated respiratory inflammatory blood biomarker candidates in adult female patients who experience varying levels and sources of inhaled pollutant exposure.

Methods: We searched the Cochrane Library, PubMed, and Web of Science with nuanced search terms to retrieve articles published in English between 1 January 2000 and 12 June 2023, to ensure relevancy. We filtered our findings to generate a focussed narrative analysis and used the Risk of Bias In Non-randomized Studies-of Exposures (ROBINS-E) and Risk-of-bias VISualization (robVIS) tools to ensure the validity of the data and the quality of the conclusions being made.

Results: We identified 916 articles from the databases used in our search, 16 of which met the criteria of our focussed narrative analysis. Among blood biomarkers, platelet-activating factor and eosinophilia could be used to assess the severity of asthma conditions, as a lack or reduction thereof indicates specific conditions. Pro-inflammatory cytokines require further validation, as some studies with a high risk of bias have reported conflicting results compared to more recent research on whether these markers are up-regulated or down-regulated. We found one study to be at a very high risk of bias, two had a high risk of bias, one had some concerns of confounding factors which may not have affected their results, and 12 studies had a low risk of bias.

Conclusions: There were narrowed-down blood biomarker candidates that could be used in future research and avenues of research like generating specific microRNA sequences to test for prognostic/diagnostic tests.

Registration: PROSPERO: 42023435721.

Background: High body mass index (BMI) has gradually become an increased risk factor for the global burden of diseases (GBD). As the disease burden and the number of elders globally increase, it is crucial for policymakers to realise the associations between high BMI and disease burden worldwide in a timely manner and to develop effective interventions for different countries and ages.

Methods: We used the GBD 2019 database to analyse the deaths and disability-adjusted life-years (DALYs) in the disease burden associated with high BMI and indicated the health inequality at the global, regional, and national levels. We applied the slope index of inequality and concentration index, two standard metrics of absolute and relative gradient inequality recommended by the World Health Organization (WHO), to quantify the distributive inequalities in the burden of diseases associated with high BMI. These rates were reported per 100 000 population as crude incidence rates, death rates, and DALYs rates. All the estimates were generated with a 95% uncertainty interval (UIs).

Results: Globally, we revealed that an estimated age-standardised mortality rate associated with high BMI is 6.26 million (95% UIs = 3.99, 8.91). The age-standardised DALYs rate is 19.32 million (95% UIs = 12.77, 26.40), and the global population attributable fraction was 9% (95% UIs = 5, 12) in 2019. The largest number of high-BMI-related deaths in women mainly concentrated in the age group of 65-79 years, whereas the largest number in men was in the age group of 60-69 years. The age-standardised DALYs rate of diseases associated with high BMI was larger in the high-middle and middle socio-demographic index (SDI) (population attributable fraction (PAF) = 11 and PAF = 9) regions than those with high SDI (PAF = 1) and low SDI (PAF = 5) regions.

Conclusions: In this study, our results showed that the disease burden of global deaths and DALYs associated with high BMI has substantially increased between 1990-2019. Furthermore, we demonstrated that countries with higher SDI development levels shoulders higher burden of diseases associated with high BMI. Future policies to prevent and reduce the burden should be developed and implemented based on country-specific development status.

Background: Women in India are often responsible for unpaid household work, family caregiving, and paid work, which can contribute to poorer mental health. The provision of childcare has the potential to improve women's mental health, but evidence on the effects of providing access to daycare is limited.

Methods: We designed a cluster-randomised trial and used data from a sample of 2858 mothers with age-eligible children from 160 village hamlets in rural Rajasthan, India, to evaluate the impact of providing access to a community-based daycare programme on social and emotional aspects of women's mental health. We conducted a baseline survey in early 2016, randomised hamlets to intervention or control groups approximately six months later, and delivered the final post-intervention survey approximately two years thereafter.

Results: Treatment assignment increased the probability that a respondent used a daycare over the two-year follow-up by 40.9 percentage points. Providing randomised access to a daycare resulted in 0.2 (95% confidence interval (CI) = -0.1, 0.4) fewer symptoms of mental distress, representing a 9.5% decline compared to the baseline mean of 2.1 symptoms, as well as a 3.7 (95% CI = -0.8, 8.3) percentage point increase in the proportion of women who reported feeling very happy, equivalent to an 11.0% increase relative to the baseline mean of 33.6%. Among social indicators, treatment assignment was associated with a 5.6 (95% CI = -1.2, 12.4) percentage point increase in membership in an association, a relative increase of 43.4% compared to the baseline mean of 12.9%. The intervention did not have an appreciable impact on measures of life satisfaction or trust in institutions. Two-stage least squares instrumental variable analyses showed that daycare use decreased mental distress by 0.4 (95% CI = -0.1, 0.8) symptoms, increased the proportion of women who were very happy by 9.4 (95% CI = 0.0, 17.6) percentage points, and increased membership in an organisation by 15.9 (95% CI = 8.4, 23.7) percentage points.

Conclusions: The provision of affordable, community-based daycare was associated with substantial uptake and showed potential for improving mothers' mental health in a rural context where most women were not employed in the formal labour force.

Registration: ISRCTN clinical trial registry (ISRCTN45369145), registered on 16 May 2016; American Economic Association's registry for randomised controlled trials (AEARCTR-0000774), registered on 15 July 2015.

Background: While diarrhoeal disease remains a leading cause of death in children aged <5 years in low- and middle-income countries (LMICs), it also poses significant health risks for older children, underscoring the importance of our study focusing on children aged <10 years. In this systematic review, we assessed common diarrhoea aetiologies in children aged <10 years in LMICs.

Methods: We identified relevant articles in PubMed, Embase, and Web of Science using pre-defined search criteria. We included case series and case-control studies of children aged <10 years with non-bloody, bloody, acute, persistent, and chronic diarrhoea. Articles that evaluated two or more diarrhoea pathogens in LMICs conducted between 1 January 1990 and 31 July 2020 were eligible for inclusion. We stratified combined data from case series and case-control studies by age and World Health Organization (WHO) regions.

Results: 76 studies published between 1990-2020 were eligible for inclusion. Among these, eight were case-control studies. 56 papers focused only on children aged <5 years, while 20 also included children aged ≥5 years. The most common viral pathogens among <5 years old children were rotavirus, norovirus, adenovirus, and astrovirus. Bacterial pathogens included Escherichia coli, Salmonella enterica, Shigella species, and Campylobacter species, while parasitic pathogens included Cryptosporidium, Giardia, and Entamoeba species. Rotavirus was the most common viral pathogen among children across all age groups and every WHO region. Escherichia coli was prevalent in all age groups and was responsible for most diarrhoea cases in the African Region. Among parasitic pathogens, Entamoeba species and Giardia were prevalent in children aged three to five years, with the former a major cause of diarrhoea in the Eastern Mediterranean Region. Similarly, in children aged six to 10 years, bacterial pathogens, including Escherichia coli, Salmonella, and Shigella, suggest a continued significance of these pathogens beyond the age of five. Common viral pathogens for this group were rotavirus, norovirus, and sapovirus, although the number of studies for this age group is limited.

Conclusions: Escherichia coli, rotavirus, and Entamoeba species were the most common pathogens responsible for diarrhoea in children aged <5 years in LMICs. Future research should focus on characterising the pathogens responsible for causing diarrhoea in children aged six to 10 years stratified by geographic area of residence, i.e. WHO region and urban vs rural. Case-control or cohort studies covering a full 12-month period to account for seasonality are needed for a more accurate picture of diarrhoea aetiology among children.

Registration: PROSPERO (CRD42020204005).

Background: Despite the significant impact of blindness on the affected individuals' quality of life, its burden has not been assessed according to temporal cause-specific changes in severity, impeding our ability to evaluate the impact of blindness on population health accurately. Therefore, we aimed to comprehensively quantify the changes in cause-specific blindness burden according to changes in disease severity for 18 causes of blindness.

Methods: For this cross-sectional population-based study, we derived data on prevalence, disability-adjusted life-years (DALYs), and population size between 1990 and 2019 from the Global Burden of Disease 2019 study. Using the decomposition method, we attributed changes in total DALYs to population growth, population ageing, and changes in prevalence rate and disease severity between 1990 and each subsequent year globally, regionally, nationally, and by sex, cause, and sociodemographic index (SDI). The absolute and relative contributions to the variation in blindness-related DALYs between 1990 and each year from 1991 to 2019 then served as a measure of changes in disease severity.

Results: Changes in disease severity from 1990 to 2019 were associated with 15 165.11 DALYs in men and 20 639.32 DALYs in women. We observed disease severity increases in most countries/territories, with attributable DALY proportions ranging from -0.07% to 1.30% in men and from -0.06% to 1.73% in women. Notably, both attributable proportions and DALYs were greater in women than men. The largest increases in attributable DALYs were observed for cataracts, refraction disorders, and glaucoma globally; age-related macular degeneration in high-SDI countries; and trachoma and retinopathy of prematurity in lower-SDI countries.

Conclusions: Growth in the burden of cause-specific blindness due to increased disease severity reflects the lag of healthy vision life behind increasing life expectancy, necessitating the implementation of preventive and long-term therapeutic measures focussed on improving visual outcomes.