International Health最新文献

Background: This study evaluates changes in the burden of high body mass index (BMI) and its impact on atrial fibrillation and flutter (AF/AFL) using the 2021 Global Burden of Disease database.

Methods: Mortality and disability-adjusted life years rates were analysed globally, considering age, sex, geography and the Socio-demographic Index (SDI). Decomposition and frontier analyses assessed the impact of epidemiological drivers and SDI on the burden. The nordpred model validated the predictions.

Results: The burden of high BMI is now 2.5 times greater than 30 y ago and will continue to increase over the next 20 y, heavily impacting cardiovascular and metabolic diseases. High BMI-related AF/AFL also poses a significant burden, especially in developed regions. Men's burden grows faster than women's. Decomposition analysis shows epidemiological changes mainly drive burden increases, while in women, population growth is more significant. Frontier analysis indicates that the gap between actual burden and theoretical optimal value has widened with increasing SDI, except in countries such as Bulgaria and the Czech Republic.

Conclusions: Over the past 30 y, the overall burden of high BMI and its impact on AF/AFL have increased significantly, highlighting the need for targeted public health strategies.

Background: Antimicrobial resistance (AMR) has emerged as a priority for both public health and the global economy. Moreover, information on AMR is scarce, particularly in low/middle-income countries. We evaluated the direct economic cost of microorganisms and AMR.

Methods: We performed a cross-sectional study to assess the economic costs of neonatal cases diagnosed with bacteremia at the Instituto Nacional Materno Perinatal in Lima, Peru, from January 2017 to June 2018. We used cost invoices calculated by the micro-costing bottom-up approach, as well as the strain identification and antimicrobial susceptibility data, to estimate the direct costs.

Results: The average costs of bacteremia were US$349 (SD 403) for multidrug-resistant (MDR) strains and US$276 (SD 349) for non-MDR strains. Costs were higher for microorganisms associated with late-onset sepsis (LOS). We found that LOS, multidrug resistance and age were significantly associated with bloodstream infection (BSI) costs. Also, all microorganism groups were associated with increased costs, with the highest average costs for Acinetobacter, followed by Pseudomonas.

Conclusions: In Peru, BSI costs are strongly associated with AMR. Furthermore, costs increase significantly with LOS, multidrug resistance and the patient's age. We urge health authorities to strengthen measures and strategies against the pressing threat of AMR.

Background: To reduce the spread and transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), schools implemented a series of non-pharmacological interventions such as handwashing stations and cleaning protocols. A baseline assessment of the available interventions and readiness scores for SARS-CoV-2 prevention was conducted in primary schools in Maputo City, Mozambique.

Methods: A cross-sectional study was conducted between August and October 2023. Data were collected using a semi-structured questionnaire that assessed the availability of preventive measures. Readiness scores were calculated, based on the relative frequency of available preventive measures against SARS-CoV-2, recommended by the government. Schools with readiness scores of 100% were considered ready.

Results: Of the enrolled schools, 60.6% (66/109) were from the public sector. The median readiness score for preventive measures against SARS-CoV-2 implemented in schools was 70%. Water was the most frequent available measure, with 98.2% (107/109). Ash/soap for handwashing (47.7% [52/109]) and functioning thermometers (31.2% [34/109]) were the least available measures. Private schools showed significantly higher readiness scores compared with public schools (p<0.001).

Conclusions: Private compared with public schools had higher readiness scores for preventive measures against SARS-CoV-2 in Maputo City, Mozambique. These findings suggest a need for targeted interventions to improve readiness in public schools.

It is an awkward fact that effective public health control of schistosomiasis in Africa has yet to deliver a fully comprehensive intervention for appropriate anthelmintic treatment of those preschool-age children and infants with active infection(s) and/or insidious disease. Over the last decade, despite the steady progress of the Pediatric Praziquantel Consortium in developing a monoenantiomeric oral dispersible tablet, future challenges remain in securing its deployment and implementation at scale. This commentary provides a forward-looking critique for the international community, reminding us of this unfortunate treatment gap, and seeks to encourage commensurate action on ameliorating this overlooked medical inequity.

Schistosomiasis is a serious public health problem in many African countries and beyond. Preventive chemotherapy with praziquantel is a successful public health intervention that is recommended for all communities at risk, commonly reached through large-scale mass drug administration campaigns. However, preschool-age children are currently not routinely targeted for treatment due to operational challenges related to dosing and administration with the standard drug formulation. In response to the need for a suitable, child-friendly treatment, the multistakeholder Pediatric Praziquantel Consortium has developed a novel dispersible tablet with improved taste and smaller size. To prepare the introduction and inform future uptake of the novel paediatric formulation in endemic countries, we conducted a landscape analysis to explore perspectives, opinions and experiences of key stakeholders on operational and practical issues in relation to drug dosing and administration. Our findings confirm that child-friendly drug formulations mitigate several operational constraints related to the dosing and administration in young children. The introduction of this novel child health intervention into routine platforms and programs requires solid training and careful communication by engaging with communities, caregivers, healthcare workers and decision-makers to ensure acceptance and future uptake of treatment.

Background: Aflatoxin M1 (AFM1) is a derivative of aflatoxin B1 and a significant contaminant of milk and dairy products. In this study, we implemented an umbrella review of all existing systematic reviews and meta-analyzing studies to apprise and summarize the worldwide prevalence and level of AFM1 in milk and dairy products.

Methods: We conducted a systematic review of structured review and meta-analysis articles published in English until January 2024, with no time limit. Articles were sourced from reputable databases, including PubMed/MEDLINE, EMBASE, Scopus, Web of Science, CINAHL and the Cochrane Database of Systematic Reviews. Relevant studies from Google Scholar were also included.

Results: The overall prevalence of AFM1 in all dairy products was 66.2% (95% CI 60.6 to 71.9%), with high heterogeneity (I²=99.7%, Q statistic=2221.03, p<0.0001). The prevalence for specific dairy products was as follows: raw milk, 64.8% (95% CI 60.9 to 68.7%); pasteurized milk, 88.7% (95% CI 81.6 to 95.7%); sterilized milk, 71.0% (95% CI 67.2 to 74.8%); ultra-high temperature processing (UHT) milk, 67.9% (95% CI 64.9 to 70.9%); yogurt, 58.8% (95% CI 42.5 to 75.1%); doogh, 17.2% (95% CI 13.9 to 20.5%); and cheese 49.8% (95% CI 47.8 to 51.9%). The overall mean concentration of AFM1 across all dairy products was 57.22 ng/kg (95% CI 46.95 to 67.49), with significant heterogeneity (I²=99.7%, Q statistic=2221.03, p<0.0001). Mean AFM1 levels (ng/kg) for each dairy product were as follows: raw milk, 52.51 (95% CI 40.96 to 64.05); pasteurized milk, 71.14 (95% CI 48.81 to 93.47); sterilized milk, 60.10 (95% CI 30.90 to 89.30); UHT milk, 82.57 (95% CI 35.30 to 129.85); yogurt, 46.74 (95% CI 24.27 to 69.21); and doogh, 41.60 (95% CI 32.60 to 50.60).

Conclusions: In total, these results highlight the importance of increasing the regulation of animal feed, reducing aflatoxin B1 (AFB1) in animal feed, and monitoring AFM1 in dairy products, particularly raw and heated milk.

Background: The life expectancy (LE) index reflects health changes in society, highlighting trends in health quality and quantity. This study focused on analysing the impact of the top 10 causes of death on the global increase in LE in 2019.

Methods: Data on the top 10 causes of death in 2019 were obtained from the Global Burden of Disease website and a period life table was used to assess how eliminating these causes would impact LE.

Results: At the global level, eliminating deaths from ischaemic heart disease, stroke, chronic obstructive pulmonary disease, lower respiratory infections, neonatal conditions, lung cancers, Alzheimer's disease, diarrheal diseases, diabetes mellitus and kidney diseases resulted in an increase in LE at birth of 2.44, 1.64, 0.75, 0.80, 4.06, 0.48, 0.36, 0.52, 0.36 and 0.35 y, respectively.

Conclusions: The analysis reveals a gender gap in LE influenced by specific causes of death and regional differences. Therefore, public health policies should be customized for each area to target reductions in deaths that significantly improve LE.

Large multimodal models, a type of generative artificial intelligence (AI), could contribute to wider government efforts to achieve universal health coverage if ethical challenges are proactively addressed during the design and deployment of these AI technologies. The World Health Organization has published new guidance to highlight the risks and benefits of large multimodal models and recommendations to effectively govern this technology.