Journal of Global Health最新文献

Background: Psychological distress, such as depression and anxiety, impacts cardiovascular disease (CVD) prognosis and management. Illness comprehension is essential for effective treatment, but biases can lead to suboptimal outcomes. We explored psycho-cardiovascular disease (PCD) patient characteristics, with a specific focus on comprehension biases and treatment choices from patients' perspectives in China, to improve management strategies.

Methods: We enrolled 864 PCD patients in Chinese hospitals across 11 provinces. Tools included the seven-item General Anxiety Disorder scale, the nine-item Patient Health Questionnaire, and a self-designed PCD illness comprehensibility survey. We used χ² test, univariate, and multivariate logistic regression to examine patient characteristics.

Results: Of 834 enrolled PCD patients, over 90% experienced mild to moderate anxiety and depression, yet less than 10% received treatment. 52.90% of patients had high illness comprehension. Among the high comprehension group, there were fewer labourers (19.30% vs. 26.40%; P < 0.05), fewer older individuals (39.20% vs. 46.90%; P < 0.05), and those with lower household income (15.60% vs. 30.50%; P < 0.05). A greater proportion of those in the high comprehension group lacked insurance (17.50% vs. 10.00%; P < 0.05), and they were more highly educated (42.90% vs. 32.10% with a college education). Additionally, more patients in the high comprehension group frequently received psychological consultation (24.00% vs. 5.10%; P < 0.05) and therapy (7.70% vs. 2.30%; P < 0.05). These patient groups preferred tertiary hospitals (71.66% vs. 63.33%; P < 0.05) and psycho-cardiovascular clinics (40.14% vs. 25.90%; P < 0.05). In comparison, low comprehension patients prioritised cost (32.65% vs. 46.41%; P < 0.05) and favoured a transition to community hospitals (16.55% vs. 25.38%; P < 0.05).

Conclusions: More than 90% of PCD patients in Chinese CVD departments experience mild to moderate anxiety and depression with low treatment rates. Different illness comprehension levels are associated with variations in treatment willingness, considerations, health care preferences, medication choices, and illness knowledge acquisition methods.

Background: Recreational screen time (RST) has been found to be associated with cognitive decline and neurodegenerative diseases. However, the association between RST and age-related macular degeneration (AMD), an ocular neurodegenerative disease, is still unclear. We aimed to elucidate the association between RST and AMD.

Methods: This study consisted of three parts: 1) a prospective cohort study with 482 939 UK Biobank participants and a 12.8-year median follow-up to explore the association between RST and incident AMD; 2) a two-sample Mendelian randomisation (MR) analysis using summary-level genome-wide association analysis data for RST based on 526 725 European individuals to assess causality between RST and AMD; and 3) a cross-sectional study involving 38 478 UK Biobank individuals with optical coherence tomography data to investigate the link between RST and retinal thickness.

Results: Multivariable Cox proportional-hazards models showed that an increase in total daily RST was associated with a greater risk of developing AMD (hazard ratio (HR) per standard deviation (SD) increase = 1.05; 95% confidence interval (CI) = 1.03, 1.07, P < 0.001). With further analysis, we revealed that daily high RST (>4 h/d) significantly increased the risk of AMD compared with low RST (0-3 h/d) (HR = 1.09; 95% CI = 1.04, 1.15, P = 0.001), while moderate RST (3.5-4 h/d) had no significant effect on AMD. Restricted cubic spline plots revealed a linear dose-response association between RST and AMD. With MR analysis we confirmed the potential causal association between RST and AMD (odds ratio per SD = 1.26; 95% CI = 1.01, 1.59, P = 0.042). Multivariable linear models suggested that an increase in RST was associated with thinning of the outer and inner retinal layers and total macular thickness.

Conclusions: Longer RST may be a potential causal risk factor for AMD and may lead to pathological retinal thinning. Reducing RST could be beneficial for preventing AMD, and future research should identify the most effective time points for intervening on RST.

Background: We examined COVID-19's impact on the number of small vulnerable newborns (SVN) at national and regional levels in Peru and Brazil.

Methods: Using national birth registries, we examined monthly numbers of preterm (PT), low birthweight (LBW), and small for gestational age (SGA) newborns. We analysed COVID-19's impact on SVN using two interrupted time series models. We estimated SVN's expected numbers in the absence of the pandemic using mixed-effects regressions and calculated percent changes by comparing these estimates to observed during the pandemic. Incidence rate ratios (IRR) were estimated using Poisson regression.

Results: In Peru, the average percent changes in PT, LBW, and SGA births were -17%, -11%, and -3% in 2020, and -10%, -4%, and +2% in 2021, respectively. The IRR of PT and LBW declined throughout the pandemic, while SGA IRR increased in August 2020-November 2020 and May 2021-December 2021. The Coast region experienced the greatest drop in PT, LBW, and SGA IRR in 2020, followed by a slight increase in 2021, whereas the Highlands and Amazon regions had increased LBW and SGA IRR. In Brazil, the percent changes in PT, LBW, and SGA births were +1%, -3%, and -8% in 2020, and +1%, 0%, and -1% in 2021, respectively. Most PT, LBW, and SGA IRRs decreased during the pandemic, except in the Northeast and Southeast regions, where PT increased in 2020. All regions experienced declines in LBW and SGA in 2020, with the Central-West and South regions showing the greatest LBW declines and Central-West region the highest SGA decrease.

Conclusions: No significant worsening of neonatal outcomes were observed during the COVID-19 pandemic. In Peru, PT and LBW births declined, while SGA increased from August 2020. In Brazil, PT births slightly increased, while LBW and SGA births declined in 2020, remaining stable in 2021.

Background: The prevalence of antibiotic prescribing among total prescriptions, the percentage of combined antibiotic prescribing among prescriptions containing at least one antibiotic, and factors influencing hospital antibiotic prescribing are currently unknown. In this systematic review, we aimed to summarise antibiotic prescribing in hospitals worldwide and identify the associated factors.

Methods: We searched PubMed/MEDLINE, Ovid/Embase, and the Web of Science for articles published between 1 January 2000 and 28 February 2023 that reported antibiotic prescribing in hospitals or the associated factors. Four reviewers independently screened studies, extracted data, and assessed the risk of bias. We used meta-analysis with random-effects models to estimate the pooled effect sizes.

Results: We included 403 studies covering 93 economies. The pooled prevalence of antibiotic prescribing among total prescriptions was 34.3% (95% CI = 29.6-39.3) in outpatient settings and 47.7% (95% CI = 45.8-49.5) in inpatient settings. The pooled percentages of antibiotics in the 'access' group were 48.5% (95% CI = 34.5-62.7) in outpatient settings and 43.8% (95% CI = 39.2-48.5) in inpatient settings. Subgroup analysis showed the prevalence of antibiotic prescribing was significantly higher in low-income compared to high-income economies. Additionally, there was a rising trend of the prevalence in inpatient settings over time. The studies showed that patients' gender, education level, health status, and physicians' work experience were associated with hospital antibiotic prescribing.

Conclusions: The global prevalence of antibiotic prescribing in hospitals is high, with significant disparities across regions. Multifaceted measures with multi-sectoral cooperation are required, such as regulatory interventions, professional training for physicians, and public health education.

Registration: PROSPERO: CRD42022354076.

Background: The COVID-19 pandemic has impacted the provision and utilisation of health care services with varying magnitude across settings due to spatial temporal variation in the burden of COVID-19 cases and the roll-out of local COVID-19 response policies. This study assesses changes in the provision and utilisation of health care services for three major chronic health conditions (HIV/AIDS, hypertension, and diabetes) over the pre-COVID-19 and COVID-19 pandemic periods in a rural South African sub-district of Agincourt.

Methods: Segmented interrupted time series regression models are applied to assess changes in the number of medication collection visits and new diagnoses for HIV/AIDS, hypertension, and diabetes from 1 January 2018 to 30 September 2021 covering the pre- COVID-19 period and the first three waves of the COVID-19 pandemic.

Results: The number of medication collection visits for HIV/AIDS, hypertension, and diabetes dropped following the imposition of level 5 lockdown. Despite some improvements over the course of the pandemic, by the end of the third wave in September 2021, visits remained below the pre-COVID-19 era. The number of clinic visits for new diagnoses of HIV/AIDS and hypertension also fell after the introduction of level 5 lockdown. Although the number of new visits for HIV/AIDS bounced back to the pre-COVID-19 trends by the end of the third wave, the number of visits for new hypertension diagnoses remained significantly lower than expected. Referrals for collection of medications from the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme, as an alternative to collection from clinics, increased exponentially over the course of the pandemic.

Conclusions: Although the increased adoption of the CCMDD programme can in part account for decreased medication collection visits which persisted well after lockdown measures were lifted, marked reductions in the number of newly diagnosed cases of hypertension warrant concern. A deeper assessment of the appropriateness of referrals to the CCMDD programme as well as the longer-term effects on morbidity and mortality of missed treatment and/or delayed diagnosis is needed for a more granular understanding of the true ramifications of the COVID-19 pandemic and associated lockdown policies in the Agincourt subdistrict and other rural African settings.

Background: Community-acquired pneumonia (CAP) is a frequent reason for emergency department visits and leads to increased direct medical costs, particularly due to hospitalisation. This study aims to examine the differences between emergency planned re-infusion therapy and hospitalisation in patients with CAP.

Methods: This retrospective case-control study involved 1889 CAP patients treated at the Emergency Internal Medicine Department of Class A tertiary Hospital in China from 1 January 2020 to 31 December 2022. Patients were divided into groups receiving either emergency planned re-infusion therapy or hospitalisation. Independent sample t tests and χ² tests were used to compare the clinical outcomes and economic impacts between the two groups across different pneumonia severity index (PSI) classifications.

Results: The study enrolled 1889 CAP patients. For PSI I-II patients, the improvement rates were 99.51% in the emergency planned re-infusion therapy group and 99.69% in the hospitalisation group, showing no statistically significant difference (P > 0.05). Similarly, no significant difference was observed for PSI III patients (84.16 vs. 89.82%). However, significant differences emerged for PSI IV patients, with improvement rates of 50% in the emergency planned re-infusion therapy group and 90.59% in the hospitalisation group (P < 0.001). Statistically significant differences were also noted in treatment duration (5.13 ± 1.65 days vs. 7.60 ± 3.93 days, P < 0.001) and total treatment costs (1921.57 Chinese Yuan (CNY) ± 923.16 vs. 9083.80 CNY ± 3583.55, P < 0.001) between the two groups.

Conclusions: Emergency planned re-infusion therapy for CAP is an effective and cost-efficient alternative that can reduce both treatment duration and costs, particularly for patients with PSI I-III. It is recommended that emergency physicians give priority to emergency re-infusion therapy for patients with PSI I-III. In addition, it is recommended that hospitals strengthen the classification and treatment training programmes for emergency department physicians to recognise the patients with PSI I-IV.

Registration: The hospital^'s ethics committee (XMCGIRB2024034-01).

The global aviation industry faced unprecedented challenges during the COVID-19 pandemic. As a result, the international civil aviation industry now has strong incentives to prevent and control future pandemics. It is almost unbelievable that the headquarters of the International Civil Aviation Organization (ICAO) is located right next to the headquarters of the World Anti-Doping Agency (WADA). While the vision and mission of these two organizations may seem completely different, we propose that ICAO could adopt a system similar to that of WADA to enhance its contribution to global infectious disease surveillance.

Background: Liver cancer represents a significant burden of disease globally, with variations in liver cancer status among countries. In this study, we aimed to evaluate the epidemiological burden of liver cancer in four representative countries - China, the USA, the Republic of Korea, and Mongolia - and cover the highest number of incidence cases, the highest prevalence rates and the burden in developed countries. In addition, we intended to predict the trends in liver cancer in these countries over the next six years.

Methods: We collected epidemiological data on liver cancer from the Global Burden of Disease 2019, the Global Cancer Observatory, and Cancer Incidence in Five Continents databases to conduct data source triangulation. We calculated time trends using Joinpoint regression and predicted incidence rates using an autoregressive integrated moving average model. Aetiological studies were conducted for different countries based on changes in incidence causes.

Results: Between 1990-2019, age-standardised rates (ASR) values for liver cancer declined globally. The downward trend was most pronounced in China, where the average annual percentage change of age-standardised incidence rate (ASIR) reached -3.13 (95% confidence interval (CI) = -2.90, -3.35), much higher than the world average of -1.16 (95% CI = -0.96, -1.36). The ASIR in the USA continued improving and reached 5.23 × 10⁵ in 2019. With age, the ASR for liver cancer in various countries generally shows an upward trend. Hepatitis B virus (HBV) remains the main causative agent of liver cancer in China and Korea. In Mongolia, both HBV and hepatitis C virus account for a large proportion of liver cancer. In the USA, the proportion of liver cancer cases from alcohol consumption has increased annually.

Conclusions: The ASR for liver cancer has declined over the past 30 years in most countries but has worsened in some due to ageing and unhealthy lifestyles.