Bulletin of the World Health Organization最新文献

Can a community-driven mental health initiative be integrated into a government health system without losing its essence? Gary Humphreys reports.

Salim 'Slim' and Quarraisha Abdool Karim talk to Gary Humphreys about their efforts to reduce the exposure of young women to infection with human immunodeficiency virus (HIV), the importance of perseverance, the opportunities presented by new long-lasting HIV therapies, and the need for unity in a challenging time.

Objective: To determine whether hepatitis B virus (HBV) vaccination of extremely preterm infants (defined in our study as < 29 weeks gestation) within 24 hours of birth (birth-dose) increases the risk of developing bronchopulmonary dysplasia.

Methods: Using data from Australia, we conducted a population data linkage study using the Victorian Vaccine Safety Health Link. This platform links state-wide immunization and health outcomes from the Victorian Perinatal Data Collection and the Victorian Admitted Episodes Dataset. Our retrospective cohort study included all extremely preterm infants born alive during 2017-2020 (excluding data outliers). We investigated the relationship between birth-dose HBV vaccination and bronchopulmonary dysplasia diagnosis at 36 weeks postmenstrual age. We identified possible confounders using a directed acyclic graph, and included these confounders in a robust Poisson regression model.

Findings: Of the 818 extremely preterm infants meeting our inclusion criteria, 306 received birth-dose HBV vaccination: 50.7% (155/306) of the vaccinated and 61.9% (317/512) of the unvaccinated infants developed bronchopulmonary dysplasia. After accounting for measured confounders, the adjusted relative risk was 0.83 (95% confidence interval, CI: 0.68-1.00), suggesting no increased risk. However, residual confounding by indication may still be present as it is not known how clinician perception of the stability of the newborn affects the decision to vaccinate or not, potentially underestimating any association between vaccination and outcome.

Conclusion: Our findings support existing World Health Organization recommendations to immunize all infants against HBV within 24 hours of birth, including those born prematurely.

Objective: To estimate the global burden of conditions requiring emergency or operative care and to investigate variations over time and between countries.

Methods: We obtained data on deaths and disability-adjusted life years (DALYs) lost from the Global Burden of Disease database for 193 countries covering 2011 to 2019. We defined emergency conditions as conditions that, if not diagnosed and treated within hours to days of onset, often lead to serious physical or mental disability or death. We defined operative conditions as conditions that may require the expertise of a surgically trained provider and these conditions were identified using a modified Delphi consensus process.

Findings: In 2019, emergency conditions accounted for 27 167 926 deaths and 1 015 000 000 DALYs globally, and operative conditions accounted for 17 648 680 deaths and 619 600 000 DALYs. Conditions classified as emergency-and-operative conditions accounted for 6 966 425 deaths and 303 344 808 DALYs. For emergency conditions, the per capita burden of deaths and DALYs was greatest for low-income countries. Between 2011 and 2019, deaths and DALYs due to emergency conditions decreased, whereas deaths due to operative conditions increased slightly. These trends may have been driven by strengthened prevention and early detection mechanisms, improved emergency care provision or epidemiological changes. However, because emergency and operative conditions were defined differently, it may not be valid to compare trends directly.

Conclusion: The high global burden of emergency and operative conditions identified underscores the importance of strengthening and scaling up integrated emergency, critical and operative care internationally.