Journal of epidemiology and population health最新文献

The prognosis of acute pulmonary embolism (PE) ranges from rapid symptom resolution to cardiovascular collapse and death. The Pulmonary Embolism Severity Index (PESI) is a rigorously derived and studied clinical prediction rule for PE prognosis that stratifies patients with acute PE into 5 classes (I-V) of increasing short-term overall mortality, based on 11 objective clinical variables readily available at the time of presentation. Numerous independent validation studies across the globe have demonstrated its accuracy and generalizability in identifying low-risk (class I-II) patients with PE who are potential candidates for less costly outpatient care. To facilitate the use of the PESI by busy clinicians, a simplified 6-variable version and auto-populating e-versions integrated into electronic health records have been developed and validated. Because of their methodological rigor, prognostic accuracy, and proven effectiveness and safety in both randomized and non-randomized controlled trials for managing low-risk patients in the outpatient setting, the original and simplified PESI (sPESI) have become reference standards for risk stratification of PE. Despite explicit guideline recommendations since 2014 to use the (s)PESI as a decision aid to identify low-risk patients with PE who are suitable for home care or early discharge, both the (s)PESI as well as outpatient management of low-risk patients remain largely underutilized.

Background: Traditional medicine has been used for many years in Africa to manage various health conditions, including metabolic syndrome.

Aim: to assess the use and efficacy of African traditional medicine for metabolic syndrome in Africa while compiling a comprehensive list of the medicinal plants traditionally employed.

Methods: This systematic review was conducted, encompassing observational and interventional epidemiological studies focused on traditional medicine and the effects of medicinal plants on metabolic syndrome across all African countries. Field studies were retrieved using databases such as ScienceDirect, Medline/PubMed, and Google Scholar. PRISMA recommendations were followed.

Results: Among the 2958 articles identified, 11 studies were included (10 randomized controlled trials and 1 single-arm clinical trial). A total of 12 plant species belonging to 10 different genera and 10 families were recorded in 6 African countries. The most frequently reported species were Acacia senegal (L.) Willd. (n = 2) and Cissus quadrangularis L. (n = 2). Predominantly, whole plants (n = 4) and leaves (n = 3) were mainly used. Various methods for preparing plant-based remedies have been employed, with the use of encapsulated powder extracts (n = 4) and powder extracts dissolved in water (n = 4) being the most common techniques. Data from clinical trials provided evidence that these plants have regulatory effects on glycemia (reduction in fasting blood glucose by up to 25.3 %), lipid levels (triglycerides by 36.8 %, and increases in HDL by up to 50.5 %), and blood pressure, as well as contributing to weight reduction, all supported by significant results. Few side effects were reported, including mild hypoglycemia, intestinal flatulence and nausea.

Conclusion: This systematic review underscores the need for collaborative research between traditional healers and medical practitioners to bridge the knowledge gap regarding traditional medicine's effects on metabolic syndrome.

Introduction: Although air pollution is a leading cause of mortality in Bangladesh, epidemiological studies remain limited and largely focus on exposure rather than health outcomes. Therefore, we investigated the effects of fine particulate matter (PM_2.5) exposure on Cardiovascular Disease (CVD) mortality in Dhaka city.

Methods: We collected monthly CVD mortality records from four major government medical college hospitals in Dhaka city between 2020 and 2024. We obtained corresponding PM_2.5 concentrations from the Department of Environment and meteorological data from NASA POWER project. We applied a Generalized Additive Model (GAM) with a quasi-Poisson distribution and incorporated lag structures to estimate the percentage change in CVD mortality per 10 µg/m³ increase in PM_2.5 concentration.

Results: We found a total of 17,531 CVD deaths during the study period. A 10 µg/m³ increase in PM_2.5 concentration was associated with a 3.1 % increase in CVD mortality at lag 0 (95 % CI: 1.1 % , 5.2 %). Furthermore, an estimated 16 % of total CVD deaths during the study period were attributable to PM_2.5 exposure. Seasonal analysis showed that 28.7 % of CVD deaths in cold months were attributable to PM_2.5, compared to only 7.15 % during the hot months. The exposure-response relationship was non-linear and showed a gradual increase in CVD mortality, indicating higher health risks at high levels of PM_2.5.

Conclusion: Our study provides clear evidence that elevated PM_2.5 concentrations significantly contribute to cardiovascular mortality in Dhaka city. Therefore, reducing PM_2.5 through urgent and sustained policy action, targeted emission control, and improved monitoring could substantially lower CVD mortality and mitigate the growing health impacts of air pollution in urban Bangladesh.

Introduction: Long-term exposure to air pollutants worsens acute respiratory distress syndrome (ARDS) frequency, but the impact of short-term exposure remains understudied. With coronavirus disease 2019 (COVID-19) causing a surge in ARDS cases and lockdown-related air pollution changes, we explored how brief air pollutant exposure affects ventilator-free days by day 28 (VFD28) in COVID-19 ARDS patients in French metropolitan intensive care units (ICUs).

Methods: Using a high-resolution AZUR method, exposure to nitrogen dioxide (NO₂), fine particles under 2.5 or 10 µm/m³ in aerodynamic diameter (PM_2.5 and PM₁₀), and ozone (O₃) in the week before admission was determined for each patient. COVID-19 ARDS patients from seven ICUs between March 2020 and March 2022 were categorized into high or low exposure groups based on whether their exposure exceeded or fell below the population's median levels.

Results: Of 747 patients, 184 (25%) had died, and 170 (23%) remained on mechanical ventilation on day 28. The median VFD28 was 1 [0-20]. The standardized hazard ratio [IC 95%] for successful extubation by day 28 in the high short-term exposure group, compared to the low-exposure group, was 1.08 [0.91-1.3] for PM_2.5, 1.08 [0.78-1.51] for PM₁₀, 1.01 [0.84-1.2] for NO₂, and 1.08 [0.91-1.29] for O₃. After adjusting for potential confounding factors, no significant difference was observed in VFD28 or day-28 mortality between the low and high-exposure groups.

Conclusions: We found no association between short-term exposure to air pollutants and VFD28 or day 28 mortality in a population of COVID-19 related ARDS patients.

Background: The link between chronic exposure to ambient PM_2.5 and lung cancer is well established. However, there is limited evidence on the effects of acute, high-level exposure such as that resulting from the 2014 Hazelwood coal mine fire in regional Australia. We investigated the effects of PM_2.5 from this fire on cancer incidence 8.5 years later.

Methodology: We obtained Victorian Cancer Registry data linked to 2,872 Hazelwood Health Study Adult Cohort members, from August 2014 to December 2022 and analysed all cancers combined and cancer subtypes. Individual fire-related PM_2.5 exposure was estimated by blending time-location diaries with spatial and temporal air pollution modelling data. To evaluate cancer risk from fire-related PM_2.5 exposure, we used a competing risks survival model, specifically the Fine-Gray subdistribution hazard model for deaths from causes other than the cancer outcome being analysed, and to adjust for confounders including demographics, occupational exposures, and socioeconomic factors.

Results: In the post-mine fire period, 295 people (14.3/1000 person-years) were diagnosed with 332 new cancers (12.7/1000 person-years). No significant association was found between fire-related PM_2.5 exposure and the overall incidence of cancer (hazard ratio = 1.00, 95 % confidence interval: 0.90-1.11). Additionally, no associations were identified with any specific cancer subtypes, including lung cancer.

Conclusions: We found no evidence that this coal mine fire increased cancer incidence. However, it would be premature to rule out potential carcinogenic effects. Cancer has a long latency period, which means it will be necessary to analyse new data as they become available to more conclusively determine the effects of medium-duration, high-level smoke exposure.

Background: Perceived neighbourhood social cohesion is associated with better health in particular as a conveyor of social norms. Small-area demographic changes affect social structures related to health and so, could modify neighbourhood norms, lead to loneliness, or increased stress. Thus, demographic changes and perceived neighbourhood social cohesion are likely to interact in their relation to health.

Methods: We use longitudinal data from the German Socio-Economic Panel linked to demographic measures at county level to explore the association between an exposition to 5-year changes in the proportion of young and older adults with mental and physical health (MCS and PCS) and interaction effects with perceived neighbourhood social cohesion using random intercept models. Control variables include education, income, and relevant baseline measures.

Results: The analysis includes 21,239 persons up to 6 times in 399 counties. Five-year changes in the proportion of young and older adults as well as perceived neighbourhood social cohesion are associated to both PCS and MCS. Interactions between the change in older adults and perceived neighbourhood social cohesion are seen for mental health only in rural areas. In areas with larger decreases in the proportion of young individuals, the effect of perceived neighbourhood social cohesion on physical health was smaller than in areas with only small decreases (interaction term:0.87(95 % CI [0.44, 1.31]).

Conclusion: Exposition to some demographic changes modifies the relationship between Perceived neighbourhood social cohesion and health making demographic changes a potential health stressor. This work needs to be further developed by considering smaller spatial scales and further understand the underlying mechanisms.