Risultati per: Linee Guida GOLD (2019) sulla BPCO

Objective
To determine wealth-based inequality and the dropout rate in the completion of the maternal continuum of care (CoC) in Ethiopia.

Setting
Ethiopian Demographic and Health Survey-2019.

Participants
Reproductive-age women (15–49 years) in Ethiopia.

Primary outcome
Completion of the maternal CoC services is the primary outcome. Maternal CoC is defined as a situation where women have at least four antenatal care (ANC) visits, deliver their babies at a health facility and receive at least one postnatal care service for both mother and newborn baby.

Methods
We analysed the 2019 Mini demographic and health survey data using STATA V.17. Multilevel logistic regression analysis was employed for the factors associated with the maternal CoC. The concentration index was used to measure equity.

Result
Overall, 24% (95% CI: 21.6 to 26.5) of women completed the maternal CoC. There was wealth-based inequality in the completion of maternal CoC in Ethiopia (concentration index: 0.25 (95% CI: 0.18 to 0.31, p≤0.001)), rural residents (concentration index: 0.15 (95% CI: 0.09 to 0.21, p≤0.001)) and urban residents (concentration index: 0.15 (95% CI: 0.05 to 0.26, p≤0.01)). Being an urban resident (adjusted OR (AOR)=1.59, 95% CI: 1.09 to 2.33), attaining secondary (AOR=1.67, 95% CI: 1.19 to 2.33) or higher education (AOR=1.93, 95% CI: 1.30 to 2.87) and early initiation of ANC (AOR=1.97, 95% CI: 1.61 to 2.41) were positively associated with the completion of maternal CoC. However, belonging to a pastoral region (Afar or Somali) (AOR=0.46, 95% CI: 0.28 to 0.77), belonging to the poorest (AOR=0.58, 95% CI: 0.37 to 0.92) or middle (AOR=0.62, 95% CI: 0.40 to 0.96) wealth quintile, not being informed about obstetric danger signs (AOR=0.54, 95% CI: 0.43 to 0.66) and blood pressure not being measured (AOR=0.53, 95% CI: 0.32 to 0.85) were negatively associated with maternal CoC.

Conclusion
We concluded that completion of the maternal CoC was low in Ethiopia. There was significant inequality in the completion of maternal CoC across wealth status, place of residence and educational status. Strategies and interventions that target the disadvantaged group of women are needed to improve the utilisation of maternal healthcare services. Tailored and multisectoral intervention considering women with poor or middle wealth, women in pastoralist regions and women with no information on obstetric danger signs improves the CoC practice in the country.

Objectives
The influence of short-term variations in blood pressure (BP) in acute stroke on clinical outcomes remains uncertain. Our study explores the relationship between BP variability (BPV) from stroke admission up to 72 hours and in-hospital and 1-year mortality.

Design
Retrospective observational cohort study.

Setting
Hamad General Hospital (HGH) a tertiary care stroke centre in Qatar.

Participants
2820 participants were initially included. After the exclusion of ineligible subjects, 2554 patients (82.5% male, median age 53±9 years) were included. 893 (34.96%) were from the Middle East and North Africa, 1302 (50.98%) were from South Asia, 258 (10.10%) from Southeast Asia, 9 (0.35%) were from East Asia and 92 (3.60%) were from other regions. Eligible participants were adult patients above 18 years of age who presented with acute ischaemic or haemorrhagic stroke. Excluded individuals were those younger than 18 years, had incomplete data, had transient ischaemic attack (TIA), had severe hypoglycaemia on admission (

Neglet e l’afasia tra principali problemi lungo termine malattia

Objective
To analyse the trend of the disease burden of common malignancies of the female reproductive system and the influence of age, period and birth cohort in China from 1990 to 2019.

Design
We used the joinpoint model based on the global burden of disease (GBD 2019) database to explore the trend of the burden of common malignancies of the female reproductive system in China from 1990 to 2019, and further analyzed the impact of age, period, and birth cohort using the age-period-cohort model.

Setting
GBD data from 1990 to 2019.

Participants
Data were publicly available and individuals were not involved.

Main outcomes
Outcomes included age standardised incidence rate, standardised mortality, standardised disability-adjusted life year (DALY), annual percentage change, average annual percentage change, age (period, cohort) effect coefficient, relative coefficient and SE. Akchi information criterion and Bayesian information criterion were used to estimate model goodness of fit.

Results
From 1990 to 2019, the standardised incidence and prevalence of cervical cancer and endometrial cancer increased, while the standardised mortality and DALY rate decreased. The standardised incidence, prevalence, mortality and DALY rates of ovarian cancer increased. The risk of cervical cancer, ovarian cancer and endometrial cancer increased first and then decreased with age, reaching its peak at ages 55, 70 and 55, respectively, while the risk of death increased with age. The risk of the onset and death of cervical cancer and ovarian cancer increased with the period, while those of endometrial cancer increased first and then decreased. The cohort with later female reproductive system malignancies had a lower risk of morbidity and mortality than the previous cohort.

Conclusion
From 1990 to 2019, the disease burden of malignant tumours in the female reproductive system in China was high. Relevant departments should pay attention to the prevention and treatment of malignant tumours in the reproductive system. Middle-aged and elderly women are the key target group for prevention and control.

Objectives
To analyse the past 30-year trends in mortality and morbidity of interpersonal violence against children, its demographic distribution and correlation with specific risk factors.

Design
Ecological study at the country and regional level.

Setting
46 countries and 4 subregions of sub-Saharan Africa (SSA): Central, Eastern, Southern and Western.

Participants
Children aged 0–19 years old.

Primary and secondary outcome measures
Trends in mortality rates and disability-adjusted life-years (DALYs) attributed to interpersonal violence injuries in children; correlation between socio-demographic index (SDI)/alcohol consumption per capita and child interpersonal violence.

Results
Deaths and DALYs per 100 000 population from child violence-related injuries in SSA declined from 4.0 (95% uncertainty interval (UI): 3.3–4.9) to 3.1 (95% UI: 2.3 to 3.9) and 334.9 (95% UI: 276.4 to 407.7) to 260.3 (95% UI: 197.9 to 321.9) respectively from 1990 to 2019 (reductions of 22.5% and 22.3%). Southern SSA had the highest deaths/DALYs rates for each type of physical violence (sharp object/firearm/other) and Central SSA for sexual violence. Alcohol consumption correlated significantly with deaths and DALYs, but SDI showed a non-significant correlation.

Conclusions
Rates of child interpersonal violence deaths and DALYs decreased from 2009 to 2019 in SSA, driven by remarkable decreases in the Southern subregion. Understanding the determinants of these downward trends and implementation of policies targeting known risk factors like alcohol consumption may pave the way for enhanced child safety protection. Further curbing the disparities between countries and subregions necessitates long-term commitment to evidence-based action plans.

Objectives
Informal gold mining represents a major source of mercury pollution worldwide. People involved in informal gold mining in French Guiana are mainly migrants from Brazil and represent an exposed, mobile and hard-to-reach population. This study assessed mercury poisoning in this particular population.

Design
This multicentre, cross-sectional survey, conducted in 2022, included participants using snowball sampling.

Setting
Inclusions took place in the logistical rare bases of gold mining at the border between French Guiana and Brazil and French Guiana and Suriname.

Participants
Between September and December 2022, 539 participants were included in the study. Inclusion criteria were being over 18 years, working in gold mines in French Guiana and having left the mine for less than 7 days. Among them, 526 had a usable blood sample, and 439 had a usable hair sample.

Intervention
After giving informed consent, the participants received a questionnaire, a medical examination and provided a dried blood spot and a hair sample.

Results
The median concentration of mercury in hair was 4.5 µg/g (IQR=1.3–9.4), and 46.7% of the study population (205/439) had a concentration above 5 µg/g and 23.7% (104/439) above 10 µg/g. This population is highly exposed to mercury inhalation, with 59.0% performing or witnessing the gold amalgamation process, using minimal protective measures. Piscivorous fish consumption is another potential source of contamination, with 82.0% reporting consumption in the previous month. This digestive source of exposure seems to be associated with mercury hair concentration. We observed a geographical heterogeneity of mercury exposure, with lower levels of poisoning in the eastern part of the region. Higher hair mercury concentrations were found in individuals with a history of malaria attacks and with systolic blood pressure above 160 mm Hg.

Conclusion
Mercury intoxication in this population is concerning and comparable to levels observed in other Amazonian communities. Physicians treating women working in gold mines should assess mercury concentrations in their hair and provide appropriate guidance. Comprehensive clinical investigations are needed in future studies to accurately assess neuropsychological impacts.

Objective
Though vaccination coverage in Ethiopia has shown steady progress over the years, there are districts with below targeted vaccination coverage. This study assessed the magnitude and determinants of recently introduced vaccines uptake among children aged 12–23 months in Ethiopia.

Design
National cross-sectional study.

Setting
Ethiopia.

Participants
Mothers with children aged between 12 and 23 months.

Outcome measures
The outcome variable was the uptake of recently introduced vaccines (rotavirus vaccine (RV) and pneumococcal conjugate vaccine (PCV)) among children aged 12–23.

Results
Our analysis revealed that 45.7%, 53.4% and 43.5% of the children completed vaccination with PCV, RV and both PCV and RV, respectively. Being in the age group of 20–34 (adjusted OR (AOR)=2.03, 95% CI: 1.37 to 3.02) and 35–49 (AOR=2.44, 95% CI: 1.52 to 3.91), having at least four antenatal care contacts (AOR=2.73, 95% CI: 2.06 to 3.62), having postnatal care (AOR=1.84, 95% CI: 1.42 to 2.37), delivery in the health facility (AOR=1.45, 95% CI: 1.17 to 1.79) and having exposure to media (AOR=1.24, 95% CI: 1.09 to 1.56) and any of the wealth quintile categories higher than poorest category were positively associated with the uptake of newly introduced vaccines. Rural residency was found to be negatively associated with the uptake of newly introduced vaccines.

Conclusion
The overall full uptakes of newly introduced vaccines among children aged 12–23 months were significantly lower. Hence, this study emphasises the need to strengthen maternal and child healthcare services, particularly to the younger age mother and those with lower socioeconomic status.