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Diagnostic accuracy of convolutional neural networks in classifying hepatic steatosis from B-mode ultrasound images: a systematic review with meta-analysis and novel validation in a community setting in Telangana, India 卷积神经网络从b超图像中对肝脂肪变性进行分类的诊断准确性:在印度泰伦加纳社区环境中进行的荟萃分析和新验证的系统回顾
IF 6.2 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-07-31 DOI: 10.1016/j.lansea.2025.100644
Akshay Jagadeesh , Chanchanok Aramrat , Santosh Rai , Fathima Hana Maqsood , Adarsh Kibballi Madhukeshwar , Santhi Bhogadi , Judith Lieber , Hemant Mahajan , Santosh Kumar Banjara , Alexandra Lewin , Sanjay Kinra , Poppy Mallinson

Background

Ultrasound is a widely available, inexpensive, and non-invasive modality for evaluating hepatic steatosis (HS). However, the scarcity of radiological expertise limits its utility. Convolutional Neural Networks (CNNs) have potential for automated classification of HS using B-mode ultrasound images. We aimed to assess their diagnostic accuracy and generalisability across diverse study settings and populations.

Methods

We systematically reviewed two biomedical databases up to Dec 12, 2023, to identify studies that applied CNNs in the classification of HS using B-mode ultrasound images as input (PROSPERO: CRD42024501483). We supplemented this review with a novel analysis of the community-based Andhra Pradesh Children and Parents’ Study (APCAPS) in India to address the overrepresentation of hospital samples and lack of data on South Asian populations who exhibit a distinct central adiposity phenotype that could influence CNN performance. We quantitatively synthesised diagnostic accuracy metrics for eligible studies using random-effects meta-analyses.

Findings

Our search returned 289 studies, of which 17 were eligible. All but one of the 17 studies were based in hospital or clinical outpatient settings with curated cases and controls. Studies were conducted exclusively in East Asian, European, or North American populations. Studies employed varying gold standards: seven studies (41.18%) used liver biopsy, three (17.64%) used MRI proton density fat fraction, and seven (41.18%) used clinician-evaluated ultrasound-based HS grades. The APCAPS sample included 219 participants with radiologist-assigned HS grades. Across the range of study settings and populations, CNNs demonstrated good diagnostic accuracy. Meta-analysis of studies with low risk of bias reporting on five unique datasets showed a pooled area under the receiver operating characteristic curve of 0.93 (95% CI 0.73–0.98) for detecting any severity and 0.86 (95% CI 0.77–0.92) for detecting moderate-to-severe HS severity grades, respectively.

Interpretation

CNNs have good diagnostic accuracy and generalisability for HS classification, suggesting potential for real-world application.

Funding

Medical Research Council, UK (MR/T038292/1, MR/V001221/1).
超声是一种广泛可用、廉价且无创的肝脂肪变性(HS)评估方法。然而,放射学专业知识的匮乏限制了它的实用性。卷积神经网络(cnn)具有利用b超图像自动分类HS的潜力。我们的目的是评估它们在不同研究环境和人群中的诊断准确性和普遍性。方法我们系统地回顾了截至2023年12月12日的两个生物医学数据库,以识别将cnn用于HS分类的研究,这些研究使用b超图像作为输入(PROSPERO: CRD42024501483)。我们对以社区为基础的印度安得拉邦儿童和父母研究(APCAPS)进行了一项新的分析,以补充这一综述,以解决医院样本的过度代表性和南亚人群数据的缺乏,这些人群表现出明显的中心肥胖表型,可能影响CNN的表现。我们使用随机效应荟萃分析定量地综合了符合条件的研究的诊断准确性指标。我们检索到289项研究,其中17项符合条件。17项研究中,除了一项研究外,其余研究都是在医院或临床门诊环境中进行的,有精心策划的病例和对照。研究仅在东亚、欧洲或北美人群中进行。研究采用不同的金标准:7项研究(41.18%)使用肝活检,3项研究(17.64%)使用MRI质子密度脂肪分数,7项研究(41.18%)使用临床评估的基于超声的HS分级。APCAPS样本包括219名具有放射科医生指定HS等级的参与者。在研究设置和人群的范围内,cnn表现出良好的诊断准确性。对五个独特数据集报告的低偏倚风险研究的荟萃分析显示,检测任何严重程度的受试者工作特征曲线下的合并面积为0.93 (95% CI 0.73-0.98),检测中度至重度HS严重等级的受试者工作特征曲线下的合并面积为0.86 (95% CI 0.77-0.92)。cnn对HS分类具有良好的诊断准确性和通用性,具有实际应用的潜力。资助医学研究理事会,英国(MR/T038292/1, MR/V001221/1)。
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引用次数: 0
Urgent need to integrate gender-sensitive financing in Southeast Asia's health insurance expansion 迫切需要将对性别问题有敏感认识的融资纳入东南亚医疗保险扩张
IF 6.2 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-07-29 DOI: 10.1016/j.lansea.2025.100645
Schawanya Kaewpitoon Rattanapitoon , Natnapa Heebkaew Padchasuwan , Nav La , Nathkapach Kaewpitoon Rattanapitoon
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引用次数: 0
Sample representativeness and temporal comparability in SEAR study SEAR研究的样本代表性和时间可比性
IF 6.2 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-07-29 DOI: 10.1016/j.lansea.2025.100646
Jabed Iqbal
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引用次数: 0
Clinicopathological characteristics and prognostic outcomes of young adult women (aged 18–30 years) with breast cancer in Ahmedabad, India: a single-centre, retrospective observational study 印度艾哈迈达巴德年轻成年女性(18-30岁)乳腺癌的临床病理特征和预后:一项单中心、回顾性观察性研究
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-07-28 DOI: 10.1016/j.lansea.2025.100643
Ajinkya Pawar, Poojitha Yalla, Mohit Sharma, Ketul Puj, Jebin Aaron, Vikas Warikoo, Abhijeet Salunke, Shashank Pandya

Background

Breast cancer in young adult women is a rapidly growing group of cancer patients in India which needs to be addressed with urgency. Despite increasing global focus on breast cancer in young women, data from India remain scarce. Considering this gap, we undertook this study to analyse the clinicopathological characteristics and prognostic outcomes of young adult women (aged 18–30 years) with breast cancer in Ahmedabad, India.

Methods

This was a retrospective observational study of a prospectively maintained database of 201 patients with breast cancer (aged 18–30 years) treated in a high-volume tertiary centre in Ahmedabad, India, from January 2015 to December 2020. Patients were followed up until June 2023. The demographic parameters, clinicopathological characteristics and survival of all patients were studied. Statistical analyses were done using SPSS and DATAtab.

Findings

In this study 49.2% of cases were early breast cancers, 26.8% locally advanced, and 23.8% were metastatic. The proportion of aggressive cancers was higher with 38.8% hormone negative, 39.3% HER2-positive, 26.8% triple-negative and 50.8% grade 3. The median overall survival for all patients was 56 months (95% CI 28–84 months) and the 5-year overall survival was 48% (95% CI 40–56%). The multivariate analysis suggested that clinical stage, grade and luminal A status, significantly affected overall survival. The 5-year overall survival and disease-free survival of patients undergoing surgery were 65% (95% CI 57–74%) and 56% (95% CI 47–65%) respectively.

Interpretation

The 5-year overall survival rate of 48% among young adult women with breast cancer included in this study is poor compared to the 77% observed in high-income countries in the western parts of the world. Adoption of appropriate and aggressive treatment strategies may enhance the outcomes in this age group of women with breast cancer.

Funding

None.
在印度,年轻成年女性乳腺癌是一个快速增长的癌症患者群体,需要紧急处理。尽管全球越来越关注年轻女性的乳腺癌,但来自印度的数据仍然很少。考虑到这一差距,我们进行了这项研究,分析了印度艾哈迈达巴德年轻成年女性(18-30岁)乳腺癌的临床病理特征和预后结果。方法:本研究是一项回顾性观察性研究,对2015年1月至2020年12月在印度艾哈迈达巴德一个大容量三级中心接受治疗的201例乳腺癌患者(18-30岁)进行前瞻性数据库维护。患者随访至2023年6月。研究了所有患者的人口学参数、临床病理特征和生存率。采用SPSS和DATAtab进行统计分析。发现49.2%的病例为早期乳腺癌,26.8%为局部晚期,23.8%为转移性乳腺癌。侵袭性肿瘤占比较高,激素阴性38.8%,her2阳性39.3%,三阴性26.8%,3级50.8%。所有患者的中位总生存期为56个月(95% CI 28-84个月),5年总生存期为48% (95% CI 40-56%)。多因素分析表明,临床分期、分级和腔内A状态对总生存率有显著影响。手术患者的5年总生存率和无病生存率分别为65% (95% CI 57-74%)和56% (95% CI 47-65%)。本研究中年轻成年女性乳腺癌患者的5年总生存率为48%,与世界西部高收入国家的77%相比很低。采用适当和积极的治疗策略可以提高这一年龄组乳腺癌妇女的预后。
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引用次数: 0
Safety and immunogenicity of booster doses of an XBB.1.5 RBD subunit COVID-19 vaccine among individuals aged 5–80 years in India: a phase 3, single-blind, randomised controlled trial 印度5-80岁人群中XBB.1.5 RBD亚单位COVID-19疫苗加强剂的安全性和免疫原性:一项3期单盲随机对照试验
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-07-24 DOI: 10.1016/j.lansea.2025.100642
Subhash Thuluva , Vikram Paradkar , SubbaReddy Gunneri , Rammohan Reddy Mogulla , Vijay Yerroju , Chirag Dhar , Siddalingaiah Ningaiah , Mallikarjuna Panchakshari , Chandrashekhar S. Gillurkar , Manish Narang , Shivnitwar Sachin Kisan , A. Venkateshwar Rao
<div><h3>Background</h3><div>The SARS-CoV-2 virus continues to evolve with recent variants such as the omicron sub-variants potentially exhibiting increased transmissibility. Of note, the XBB.1.5 variant has been associated with vaccine-breakthrough cases. We utilised the same platform previously used to develop CORBEVAX™, an ancestral Wuhan strain COVID-19 RBD subunit vaccine, to now develop an XBB.1.5 RBD subunit vaccine. We evaluated the safety and immunogenicity of the new XBB.1.5 RBD subunit vaccine compared to an ancestral Wuhan strain RBD subunit vaccine.</div></div><div><h3>Methods</h3><div>This prospective, single-blind, phase 3 randomised controlled trial was conducted in participants aged 5–80 years. Participants who had not received any other approved COVID-19 vaccine within the last 6 months were enrolled and randomised in a 2:1 ratio to receive two booster doses of either the test vaccine or the control vaccine. The vaccines were administered on Day 0 and Day 28 with immunogenicity assessments on Day 0, Day 28, and Day 42. Safety assessments included the collection of solicited and unsolicited adverse events (AEs) up to Day 56. The primary objective of the study was to demonstrate immunogenic superiority of the test vaccine booster series compared to the control vaccine series. This superiority objective was to be met if the lower limit of the two-sided 95% CI of the anti-XBB.1.5.RBD neutralising antibody (nAb) geometric mean titre (GMT) ratio of test: control was >1.0 on either Day 28 or Day 42. Given the emergence of JN.1 as the prevalent SARS-CoV-2 strain during the conduct of this study, Day 42 anti-JN.1 nAb levels were measured in a <em>post hoc</em> immunogenicity assessment. In addition, anti-XBB.1.5 RBD protein IgG concentrations were also measured by ELISA on Day 0, Day 28, and Day 42. The trial was registered at Clinical Trials Registry–India as CTRI/2024/01/061423.</div></div><div><h3>Findings</h3><div>A total of 360 participants (32.8% female) were enrolled and randomised across seven sites in India. The nAb GMT ratio of test: control participants was 2.08 (95% CI 1.64–2.63) on Day 28 and 2.91 (95% CI 2.38–3.56) on Day 42. The geometric mean fold rise (GMFR) of neutralising antibodies (nAb) was 7.637 (95% CI 6.090–9.578) on Day 28 and 17.02 (95% CI 13.79–21.01) on Day 42 in the test booster series arm. The nAb GMFRs in the control booster series arm at the same time points were 3.033 (95% CI 2.340–3.932) and 4.824 (95% CI 3.731–6.236), respectively. <em>Post hoc</em> analyses revealed an nAb GMT ratio of 1.90 (95% CI 1.56–2.31) for test: control against the JN.1 SARS-CoV-2 strain. The safety profile of the new XBB.1.5 RBD subunit vaccine was found to be very similar to that of the ancestral strain vaccine with 59 AEs (about 1 AE for every 8 doses administered) and 27 AEs (a little less than 1 AE for every 8 doses administered) respectively during the study. No serious AEs or AEs of special interest were reported in ei
SARS-CoV-2病毒继续进化,最近的变体,如组粒亚变体,可能表现出更高的传播性。值得注意的是,XBB.1.5变异与疫苗突破病例有关。我们利用先前用于开发祖先武汉株COVID-19 RBD亚单位疫苗CORBEVAX™的相同平台,现在开发了XBB.1.5 RBD亚单位疫苗。我们对新型XBB.1.5 RBD亚单位疫苗的安全性和免疫原性进行了比较。方法本研究为前瞻性、单盲、3期随机对照试验,受试者年龄为5-80岁。在过去6个月内未接种任何其他批准的COVID-19疫苗的参与者被纳入研究,并按2:1的比例随机分配,接受两剂强化疫苗,一剂是试验疫苗,一剂是对照疫苗。在第0天和第28天接种疫苗,并在第0天、第28天和第42天进行免疫原性评估。安全性评估包括收集截至第56天的主动和非主动不良事件(ae)。该研究的主要目的是证明与对照疫苗系列相比,试验疫苗增强系列具有免疫原性优势。如果抗xbb的双侧95% CI下限为1.5,则可以满足这一优势目标。在第28天和第42天,RBD中和抗体(nAb)几何平均滴度(GMT)比为1.0。鉴于在本研究期间出现了流行的SARS-CoV-2毒株JN.1,第42天抗jn。在事后免疫原性评估中测量nAb水平。另外,在第0天、第28天、第42天用ELISA法检测抗xbb .1.5 RBD蛋白IgG浓度。该试验已在印度临床试验注册中心注册为CTRI/ 20124/01/061423。在印度的7个地点,共有360名参与者(32.8%为女性)被随机招募。试验与对照受试者的nAb / GMT比值在第28天为2.08 (95% CI 1.64-2.63),在第42天为2.91 (95% CI 2.38-3.56)。中和抗体(nAb)的几何平均倍数上升(GMFR)在第28天为7.637 (95% CI 6.090-9.578),在第42天为17.02 (95% CI 13.79-21.01)。在同一时间点,对照组增强组的nAb gmfr分别为3.033 (95% CI 2.340-3.932)和4.824 (95% CI 3.731-6.236)。事后分析显示,nAb - GMT比值为1.90 (95% CI为1.56-2.31),用于测试:对照jn1 SARS-CoV-2菌株。研究发现,新的XBB.1.5 RBD亚单位疫苗的安全性与祖先株疫苗非常相似,分别有59个AE(每8次给药约1个AE)和27个AE(每8次给药略低于1个AE)。在研究的试验组和对照组中均未报告严重的不良反应或特殊的不良反应。两例发热需要就医,每只手臂各一例。新的XBB.1.5 RBD亚单位疫苗被发现在5-80岁的个体中作为两剂加强系列接种时既安全又具有强大的免疫原性。特别是,该疫苗诱导了针对XBB.1.5菌株的中和抗体以及针对JN.1 SARS-CoV-2菌株的交叉保护性中和抗体的显著增加。这些数据与对其他XBB.1.5单价疫苗的研究一致,并支持积极的风险-收益概况。现实世界的研究可能为这种新的更新疫苗的有效性提供额外的证据。FundingBiological Limited,印度。
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引用次数: 0
Nutrients of concern for older infants and young children in packaged food products available in Nepali retail stores 尼泊尔零售商店提供的包装食品中对年龄较大的婴儿和幼儿的营养素
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-07-23 DOI: 10.1016/j.lansea.2025.100637
Nisha Sharma , Prabhat Lamichhane , Penelope Love , Pradeep Kaji Poudel , Cherie Russell , Colin Bell

Background

Nepali older infants and young children (IYC) are increasingly consuming packaged foods. However, energy and nutrients of concern in these products (total sugar, added sugar, total fat, saturated fat, sodium, and non-sugar sweeteners) have not been assessed. This cross-sectional study aimed to assess energy and nutrients of concern in packaged foods available to older IYC in retail stores in Nepal using thresholds from the WHO Southeast Asia Region Nutrient Profile Model (SEAR NPM).

Methods

Nutrition labels on packaged food products for sale in a cross-section of 4 large stores (2 supermarkets, 2 departmental stores) and 22 small (corner) stores were photographed by three trained researchers. Ingredients, energy and nutrients of concern were extracted from the labels. Products were categorised into 14 food groups using the SEAR NPM with the primary outcome being the proportion of products exceeding thresholds for one or more nutrients of concern.

Findings

We found 2001 unique packaged food products, of which 1525 (76.0%) contained all requisite and readable nutrition information on the labels. Of 1525 products, 1323 products (86.8%) exceeded one or more SEAR NPM thresholds for energy and nutrients of concern and/or contained NSS. Most products exceeded the threshold for total energy (94.9%), followed by 79.7%, 72.5%, 71.4%, 55.3%, and 55.1% of products exceeding the threshold for total sugar, total fat, saturated fat, added sugar, and sodium respectively. By food category, almost all bakery products (99.7%), confectionery (99.6%), savoury snacks (99.2%), and water-based flavoured drinks (98.3%), most frozen dairy based desserts and edible ices (88.4%), approximately three-quarters of instant noodles and soups (75.6%), half of the cereals (54.0%), juices (50.0%), and milk and dairy-based drinks (46.0%) exceeded one or more of the SEAR NPM thresholds for energy and nutrients of concern and/or contained NSS.

Interpretation

Our findings suggest that regulatory measures are needed to limit exposure to and consumption of packaged foods by older IYC given the number of products exceeding thresholds for energy and one or more of the nutrients of concern.

Funding

NS was supported by Deakin University Postgraduate Research Scholarship and CR was supported by a Deakin University Post-Doctoral Fellowship.
尼泊尔较大的婴儿和幼儿(IYC)越来越多地消费包装食品。然而,这些产品中所涉及的能量和营养素(总糖、添加糖、总脂肪、饱和脂肪、钠和非糖甜味剂)尚未得到评估。本横断面研究旨在使用世卫组织东南亚区域营养概况模型(SEAR NPM)的阈值,评估尼泊尔零售商店中面向老年IYC提供的包装食品中令人担忧的能量和营养素。方法由3名训练有素的研究人员对4家大型商店(2家超市、2家百货公司)和22家小型商店(街角)销售的包装食品的营养标签进行拍摄。所关注的成分、能量和营养成分从标签中提取出来。使用SEAR NPM将产品分为14个食品组,主要结果是产品超过一种或多种关注营养素阈值的比例。我们发现2001种独特的包装食品,其中1525种(76.0%)在标签上包含所有必需的和可读的营养信息。在1525种产品中,1323种产品(86.8%)超过了SEAR NPM的一个或多个能量和营养素关注和/或含有NSS的阈值。总能量超过阈值的产品最多(94.9%),其次是总糖、总脂肪、饱和脂肪、添加糖和钠分别超过阈值的产品分别为79.7%、72.5%、71.4%、55.3%和55.1%。按食品类别划分,几乎所有的烘焙产品(99.7%)、糖果(99.6%)、咸味小吃(99.2%)和水基风味饮料(98.3%)、大多数冷冻乳制品甜点和可食用冰(88.4%)、大约四分之三的方便面和汤(75.6%)、一半的谷物(54.0%)、果汁(50.0%)、牛奶和乳制品饮料(46.0%)超过了SEAR NPM中一个或多个有关能量和营养素和/或含有NSS的阈值。我们的研究结果表明,鉴于产品的数量超过了能量和一种或多种相关营养素的阈值,需要采取监管措施来限制老年人接触和消费包装食品。研究经费由迪肯大学研究生奖学金资助,研究报告由迪肯大学博士后奖学金资助。
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引用次数: 0
Financial vulnerability of the elderly population undergoing cataract surgery within a distributed eye care delivery system in India (2011–2022): a multicentre, retrospective cohort study 2011-2022年印度分散式眼科护理系统中接受白内障手术的老年人口的经济脆弱性:一项多中心回顾性队列研究
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-07-23 DOI: 10.1016/j.lansea.2025.100640
Brijesh Takkar , Ragukumar Venugopal , Mehul Mehta , Anthony Vipin Das , Varsha Rathi , Rohit Khanna , Gudlavalleti V.S. Murthy , Hemendra Kumar Vaishnav , Brijesh Kashyap , Chirantan Chatterjee , Raja Narayanan

Background

The health burden of geriatric eye care is expected to rise, yet medical insurance uptake among the elderly population remains low. There is minimal evidence regarding insurance uptake for eye care among the elderly population in the Southeast Asia region. We explored insurance uptake and its impact on visual outcomes among the elderly population who visited an eye care system distributed across four Indian states.

Methods

In this retrospective cohort study, we used a browser-based proprietary, Hospital Information Management System (HIMSS) stage six, electronic medical record (EMR) system. Datasets were collected from new patients who visited the four tertiary centres with linked primary and secondary centres of our pyramidal health system (L V Prasad Eye Institute [India]) distributed in four Indian states, Andhra Pradesh, Odisha, Telangana, and Karnataka, between August 2011 and December 2022. The electronic medical records of 38,387 patients aged >70 years who underwent cataract surgery were included (45.5% were females [17,471]). Individuals treated with fully subsidised care were excluded. Data on age, health insurance uptake, type of health insurance (government or private), and mode of payment for cataract surgery were collected. Factors impacting insurance uptake and visual outcomes were studied using logistic regression analysis.

Findings

Insurance uptake declined from 17.5% among people aged 70 years to less than 10% among those aged >85 years. Private insurance uptake declined from 13.3% among people aged 70 years to 4.7% among those aged 90 years, while publicly funded insurance remained between 3.3% and 4.2%. Insurance uptake increased during 2018–2022 compared to 2011–2017 (20.61% vs. 10.65%; p < 0.001). A higher proportion of males had insurance uptake compared to females. Median waiting times for surgery among patients with government versus private insurance were 18 and 11 days, respectively. Among patients aged >80 years, surgical outcomes for those without insurance were worse than for those with insurance.

Interpretation

Insurance uptake declined dramatically in patients aged above 80 years and was associated with poorer visual outcomes following cataract surgery, as the insurance uptake may impact the quality of eye care received. Policy changes are needed to increase insurance uptake for eye care in this population.

Funding

DBT Wellcome Trust India Alliance, Clinical Research Centre Grant IA/CRC/19/1/610010; Hyderabad Eye Research Foundation (HERF).
背景:老年人眼科保健的健康负担预计会增加,但老年人的医疗保险覆盖率仍然很低。关于东南亚地区老年人口的眼科保健保险吸收的证据很少。我们探讨了保险的吸收及其对老年人视力结果的影响,这些老年人访问了分布在印度四个邦的眼科保健系统。方法在回顾性队列研究中,我们使用基于浏览器的专有医院信息管理系统(HIMSS)第六阶段电子病历(EMR)系统。数据集是从2011年8月至2022年12月期间访问我们金字塔卫生系统(L V Prasad眼科研究所[印度])四个三级中心的新患者中收集的,这些三级中心与我们金字塔卫生系统的初级和二级中心有联系,这些中心分布在印度四个州,安得拉邦、奥里萨邦、特伦甘纳邦和卡纳塔克邦。纳入了38387例70岁白内障手术患者的电子病历,其中45.5%为女性[17471]。接受全额补贴治疗的个人被排除在外。收集了年龄、健康保险使用情况、健康保险类型(政府或私人)以及白内障手术支付方式的数据。采用logistic回归分析研究影响保险摄取和视力结果的因素。研究发现,70岁人群的保险覆盖率从17.5%下降到85岁人群的不到10%。70岁老人的私人保险使用率从13.3%下降到90岁老人的4.7%,而公共资助的保险仍然在3.3%至4.2%之间。与2011-2017年相比,2018-2022年的保险吸收率有所增加(20.61%对10.65%;p & lt;0.001)。男性参保比例高于女性。政府保险和私人保险患者的手术等待时间中位数分别为18天和11天。在80岁的患者中,没有保险的患者手术效果比有保险的患者差。在80岁以上的患者中,保险的使用急剧下降,并且与白内障手术后较差的视力结果相关,因为保险的使用可能会影响所接受的眼科护理的质量。需要改变政策以增加这一人群的眼科保健保险。资助:dbt威康信托印度联盟,临床研究中心IA基金/CRC/19/1/610010;海德拉巴眼科研究基金会。
{"title":"Financial vulnerability of the elderly population undergoing cataract surgery within a distributed eye care delivery system in India (2011–2022): a multicentre, retrospective cohort study","authors":"Brijesh Takkar ,&nbsp;Ragukumar Venugopal ,&nbsp;Mehul Mehta ,&nbsp;Anthony Vipin Das ,&nbsp;Varsha Rathi ,&nbsp;Rohit Khanna ,&nbsp;Gudlavalleti V.S. Murthy ,&nbsp;Hemendra Kumar Vaishnav ,&nbsp;Brijesh Kashyap ,&nbsp;Chirantan Chatterjee ,&nbsp;Raja Narayanan","doi":"10.1016/j.lansea.2025.100640","DOIUrl":"10.1016/j.lansea.2025.100640","url":null,"abstract":"<div><h3>Background</h3><div>The health burden of geriatric eye care is expected to rise, yet medical insurance uptake among the elderly population remains low. There is minimal evidence regarding insurance uptake for eye care among the elderly population in the Southeast Asia region. We explored insurance uptake and its impact on visual outcomes among the elderly population who visited an eye care system distributed across four Indian states.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we used a browser-based proprietary, Hospital Information Management System (HIMSS) stage six, electronic medical record (EMR) system. Datasets were collected from new patients who visited the four tertiary centres with linked primary and secondary centres of our pyramidal health system (L V Prasad Eye Institute [India]) distributed in four Indian states, Andhra Pradesh, Odisha, Telangana, and Karnataka, between August 2011 and December 2022. The electronic medical records of 38,387 patients aged &gt;70 years who underwent cataract surgery were included (45.5% were females [17,471]). Individuals treated with fully subsidised care were excluded. Data on age, health insurance uptake, type of health insurance (government or private), and mode of payment for cataract surgery were collected. Factors impacting insurance uptake and visual outcomes were studied using logistic regression analysis.</div></div><div><h3>Findings</h3><div>Insurance uptake declined from 17.5% among people aged 70 years to less than 10% among those aged &gt;85 years. Private insurance uptake declined from 13.3% among people aged 70 years to 4.7% among those aged 90 years, while publicly funded insurance remained between 3.3% and 4.2%. Insurance uptake increased during 2018–2022 compared to 2011–2017 (20.61% vs. 10.65%; p &lt; 0.001). A higher proportion of males had insurance uptake compared to females. Median waiting times for surgery among patients with government versus private insurance were 18 and 11 days, respectively. Among patients aged &gt;80 years, surgical outcomes for those without insurance were worse than for those with insurance.</div></div><div><h3>Interpretation</h3><div>Insurance uptake declined dramatically in patients aged above 80 years and was associated with poorer visual outcomes following cataract surgery, as the insurance uptake may impact the quality of eye care received. Policy changes are needed to increase insurance uptake for eye care in this population.</div></div><div><h3>Funding</h3><div><span>DBT Wellcome Trust India Alliance</span>, <span>Clinical Research Centre</span> Grant IA/CRC/19/1/610010; <span>Hyderabad Eye Research Foundation</span> (HERF).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100640"},"PeriodicalIF":5.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144685473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transfusion-transmitted Plasmodium spp. infections and safety challenges for malaria in the Indian subcontinent: a systematic review 印度次大陆输血传播疟原虫感染和疟疾安全挑战:系统综述
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-07-22 DOI: 10.1016/j.lansea.2025.100641
Loick P. Kojom Foko , Shweta Sharma , Amit Sharma
Blood transfusion is a globally life-saving intervention, but blood-borne pathogens can threaten its effectiveness. While blood bags are systematically screened for viral and bacterial pathogens, parasite infections are generally overlooked. In this review, we analysed the current literature on transfusion-transmitted malaria (TTM) in India over the past five decades. This analysis is based on 122 studies involving more than 6.5 million individuals. The prevalence of Plasmodium parasitaemia in donors ranged from ∼0% to 0.87% by light microscopy and ∼0% to 2.3% by rapid diagnostic tests. The proportion of post-transfusion malaria (PTM) cases ranged from 0.8% to 6.8% across the studies. The risk of PTM is both time- and diagnosis method-dependent and relatively high in some regions of India. The clinical impacts of PTM range from mild to severe and even fatal outcomes. It is also crucial to address TTM given the often-neglected Plasmodium malariae, in addition to the prevalence of Plasmodium vivax and Plasmodium falciparum. The spread of drug-resistant and/or pfhrp2 gene-deleted P. falciparum parasites is another threat in PTM. Blood screening could be achieved through point-of-care nucleic acid amplification techniques to guarantee safer transfusion. If neglected, TTM can become an obstacle to malaria elimination in the coming years.
输血是一项全球性的拯救生命的干预措施,但血源性病原体可能威胁其有效性。虽然血袋系统地筛查病毒和细菌病原体,但寄生虫感染通常被忽视。在这篇综述中,我们分析了过去50年来印度输血传播疟疾(TTM)的现有文献。这项分析基于122项研究,涉及650多万人。通过光镜检查,供体中疟原虫的流行率为~ 0% ~ 0.87%,通过快速诊断试验为~ 0% ~ 2.3%。在所有研究中,输血后疟疾病例的比例从0.8%到6.8%不等。在印度的一些地区,PTM的风险与时间和诊断方法有关,并且相对较高。PTM的临床影响从轻微到严重,甚至致命。除了间日疟原虫和恶性疟原虫的流行之外,考虑到经常被忽视的疟疾,解决TTM问题也至关重要。耐药和/或pfhrp2基因缺失的恶性疟原虫的传播是PTM的另一个威胁。血液筛查可以通过即时核酸扩增技术来实现,以保证更安全的输血。如果被忽视,TTM可能成为未来几年消除疟疾的障碍。
{"title":"Transfusion-transmitted Plasmodium spp. infections and safety challenges for malaria in the Indian subcontinent: a systematic review","authors":"Loick P. Kojom Foko ,&nbsp;Shweta Sharma ,&nbsp;Amit Sharma","doi":"10.1016/j.lansea.2025.100641","DOIUrl":"10.1016/j.lansea.2025.100641","url":null,"abstract":"<div><div>Blood transfusion is a globally life-saving intervention, but blood-borne pathogens can threaten its effectiveness. While blood bags are systematically screened for viral and bacterial pathogens, parasite infections are generally overlooked. In this review, we analysed the current literature on transfusion-transmitted malaria (TTM) in India over the past five decades. This analysis is based on 122 studies involving more than 6.5 million individuals. The prevalence of <em>Plasmodium</em> parasitaemia in donors ranged from ∼0% to 0.87% by light microscopy and ∼0% to 2.3% by rapid diagnostic tests. The proportion of post-transfusion malaria (PTM) cases ranged from 0.8% to 6.8% across the studies. The risk of PTM is both time- and diagnosis method-dependent and relatively high in some regions of India. The clinical impacts of PTM range from mild to severe and even fatal outcomes. It is also crucial to address TTM given the often-neglected <em>Plasmodium malariae</em>, in addition to the prevalence of <em>Plasmodium vivax</em> and <em>Plasmodium falciparum</em>. The spread of drug-resistant and/or <em>pfhrp2</em> gene-deleted <em>P. falciparum</em> parasites is another threat in PTM. Blood screening could be achieved through point-of-care nucleic acid amplification techniques to guarantee safer transfusion. If neglected, TTM can become an obstacle to malaria elimination in the coming years.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"40 ","pages":"Article 100641"},"PeriodicalIF":5.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exome sequencing facilitates personalized treatment in developmental and epileptic encephalopathy patients: transforming current clinical practice in Indonesia 外显子组测序促进了发展性和癫痫性脑病患者的个性化治疗:改变印度尼西亚目前的临床实践
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-07-19 DOI: 10.1016/j.lansea.2025.100638
Agung Triono , Kristy Iskandar , Auliya S.B. Sumpono , Tyas I. Hikmawan , Gunadi , Elisabeth S. Herini
{"title":"Exome sequencing facilitates personalized treatment in developmental and epileptic encephalopathy patients: transforming current clinical practice in Indonesia","authors":"Agung Triono ,&nbsp;Kristy Iskandar ,&nbsp;Auliya S.B. Sumpono ,&nbsp;Tyas I. Hikmawan ,&nbsp;Gunadi ,&nbsp;Elisabeth S. Herini","doi":"10.1016/j.lansea.2025.100638","DOIUrl":"10.1016/j.lansea.2025.100638","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100638"},"PeriodicalIF":5.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Testing the Geoffrey Rose's assumption of uniform population change for body mass index distribution in India 检验杰弗里·罗斯关于印度人口体重指数分布均匀变化的假设
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-07-19 DOI: 10.1016/j.lansea.2025.100639
Janny Liao , Meekang Sung , Rockli Kim , S.V. Subramanian
{"title":"Testing the Geoffrey Rose's assumption of uniform population change for body mass index distribution in India","authors":"Janny Liao ,&nbsp;Meekang Sung ,&nbsp;Rockli Kim ,&nbsp;S.V. Subramanian","doi":"10.1016/j.lansea.2025.100639","DOIUrl":"10.1016/j.lansea.2025.100639","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100639"},"PeriodicalIF":5.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
The Lancet regional health. Southeast Asia
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