Search Results for: GPG: Versione 5.7.5 (Novembre 2021)

Objective
The aim of this study is to analyse the prevalence and characteristics of alcohol consumption including the patterns of heavy episodic drinking, among the adult population of Kazakhstan (18–69 years old) and identify key socio-demographic and regional factors influencing alcohol use.

Design/methods
A cross-sectional, population-based study was conducted from October 2021 to May 2022. Data were collected via face-to-face interviews using the standardised WHO STEPwise approach.

Setting and participants
The sample included 6720 adults aged 18–69 years from all 17 regions of Kazakhstan.

Results
Among participants, 54.1% had ever consumed alcohol, 42.5% in the past 12 months and 23.7% in the past month. Men had higher adjusted odds of alcohol consumption in the past 30 days (adjusted OR 1.57; 95% CI: 1.37 to 1.81) and heavy episodic drinking (adjusted OR 1.80; 95% CI: 1.44 to 2.24) compared with women. Younger adults (18–24 years) had lower odds of alcohol consumption (adjusted OR 0.61; 95% CI: 0.45 to 0.83) and heavy episodic drinking (adjusted OR 0.59; 95% CI: 0.37 to 0.94). Russians and Ukrainians had significantly higher adjusted odds of alcohol consumption (adjusted OR 1.48; 95% CI: 1.11 to 1.98 and OR 1.85; 95% CI: 1.14 to 3.01, respectively). Significant regional differences were found, with higher alcohol use in the northern regions and major cities. Smoking was strongly associated with alcohol consumption (adjusted OR 3.08; 95% CI: 2.65 to 3.57) and heavy episodic drinking (adjusted OR 3.72; 95% CI: 3.05 to 4.54). Education, occupation and marital status were not significant determinants.

Conclusions
The findings highlight the complexity of alcohol consumption patterns in Kazakhstan and the need for targeted public health interventions tailored to gender, age, ethnicity and region.

This study evaluates the amount of out-of-pocket cost savings Medicare Part D beneficiaries would have experienced if a proposed Medicare $2 drug list model had been in place in 2021.

Background
GI cancers pose an increasing global health burden, with their impact on the working-age population (WAP) aged 15–64 years remaining largely unexplored despite the crucial role of this group in societal and economic well-being.

Objective
To assess trends and cross-country inequality in the global burden of six GI cancers from 1990 to 2021 among individuals in the WAP.

Design
The 2021 Global Burden of Disease study dataset was used to obtain estimates of GI cancer incidence and 95% uncertainty intervals, including the number of cases, crude incidence rate and age-standardised incidence rate (ASIR). WAP GI cancer epidemiology was assessed at the national, regional and global levels, evaluating trends from 1990 to 2021 from overall, local and Sociodemographic Index (SDI) perspectives and using standard health equity methods to quantify cross-country inequality.

Results
Colorectal cancer exhibited the greatest burden of GI cancer among the WAP in 2021. From 1990 to 2021, the number of GI cancer cases rose by 51.9%, although the ASIR declined by 23.4%. These rates exhibit geographic variation, with the most cases and the highest ASIR in China and Mongolia, respectively. Incidence was disproportionately concentrated in higher SDI countries, and worsening inequality was evident over time.

Conclusions
While the ASIR of GI cancer is trending downwards among the WAP, high incidence rates, regional variability and an unequal burden of disease emphasise the need for flexible, targeted medical interventions to support policymaking and medical resource allocation.

We read with great interest the study by Danpanichkul et al,1 which assessed the global burden of gastrointestinal cancers, including oesophagus, gastric, colorectal, liver, pancreas and biliary tract cancers, from 2000 to 2021. The study revealed that the burden of all types of cancers varies across geographical and socioeconomic levels. The incidence rates of some types of gastrointestinal cancer in higher sociodemographic index (SDI) countries tend to decrease or increase at a slower rate compared with the more significant rise observed in lower SDI countries. Another study on global gastrointestinal cancer also noted that the incidence tends to be concentrated in countries with higher SDI.2 In this global context, quantifying the inequalities in the burden of gastrointestinal cancers across countries is crucial for informing targeted strategies and optimising future efforts to reduce the global disparities in cancer burden. We use the SDI to represent the…

Background
Mental health disparities persist as a pressing public health concern globally. Gender disparities in mental health are evident, with women disproportionately affected by conditions such as depression and anxiety. Despite the apparent need, studies from Bangladesh indicate that women are less likely to seek mental healthcare compared with men.

Objective
This study aims to investigate gender differences in mental health help-seeking behaviour in Bangladesh.

Methods
A cross-sectional online survey was conducted from 15 to 30 October 2021, targeting individuals with perceived mental health problems through the Facebook page of LifeSpring, a mental health and well-being organisation based in Bangladesh. Data (n=3031; women: 2140; men: 891) were collected using the JotForm online survey tool and analysed using descriptive statistics, bivariate analyses and multinomial logistic regression.

Results
The majority of participants were female (70.6%), aged between 18 and 34 years (87.3%), and from urban areas (85.4%). Overall, 28.4% received non-professional help, with females at 30.9% and males at 22.3%. Additionally, 22.9% received help from professionals, with females at 20.8% and males at 28.1%. Notable disparities were observed in mental health help-seeking behaviour between genders. While females exhibit higher odds of seeking non-professional support (OR 1.49, 95% CI 1.21 to 1.84, p value

Objectives
This study aims to identify factors influencing medication adherence for deep vein thrombosis (DVT) prophylaxis in post-discharge patients after joint replacement surgery using Protection Motivation Theory (PMT).

Design
This study employed qualitative semi-structured interviews with patients discharged after hip or knee replacement surgery.

Setting
Using purposive sampling to ensure a diverse representation of patient profiles, participants were recruited from patients who underwent total knee replacement surgery from April 2024 to May 2024 and were discharged 1-month prior.

Participants
12 patients who had undergone total knee replacement surgery participated in the study. The median (IQR) age of participants was 57.5 (55–67.25) years.

Analysis
Semi-structured interviews were conducted via online video calls. These interviews were audio recorded and transcribed verbatim. Data were analysed using Colaizzi’s seven-step method. Themes were identified based on the dimensions of the PMT: susceptibility, severity, internal rewards, external rewards, response efficacy, self-efficacy and response costs. Two researchers independently coded and extracted themes, with discrepancies resolved through team discussions and verification with respondents.

Results
Participants acknowledged the importance of adhering to anticoagulant medication to prevent DVT and its complications, understanding the severe consequences, such as the life-threatening nature of pulmonary embolism and the impact on daily activities. Perceived health status influenced adherence, with some participants feeling their good health negated the need for anticoagulants. External factors, including the desire to avoid side effects and financial constraints, also played significant roles in adherence decisions. Belief in the effectiveness of anticoagulants motivated adherence, but confidence in managing medication varied among participants. Practical barriers such as physical limitations and psychological burdens significantly impacted adherence.

Conclusions
Improving medication adherence requires a multifaceted approach addressing cognitive, motivational and practical barriers. Continuous education, financial assistance, support systems and tailored interventions are crucial. PMT provides a robust framework for understanding and enhancing adherence behaviours, ultimately improving health outcomes in post-discharge joint replacement patients.

Introduction
Acute circulatory failure plays a major role in the development of sepsis-related organ dysfunction. Current ‘bundles’ of the Surviving Sepsis Campaign (SSC) include the administration of a fluid loading of 30 mL/kg in the presence of hypotension within the first hour of sepsis identification. The impact of haemodynamic assessment using echocardiography at the early phase of management of septic patients in the Emergency Department (ED) on patient-centred outcomes is unknown.

Methods and analysis
This is a two-parallel arm randomised trial with blinded assessment comparing early haemodynamic assessment using transthoracic echocardiography aimed at guiding therapeutic management to standard of care according to current SSC recommendations in septic patients during initial management in 13 French EDs. Patients with suspected or documented infection and a qualifying quick Sequential Organ Failure Assessment (qSOFA) score (haemodynamic criterion required: systolic blood pressure≤100 mm Hg) will be 1:1 randomised after 500 mL of fluid loading initiation. In the intervention group, echocardiography will allow identifying the haemodynamic profile at the origin of sepsis-induced circulatory failure and monitoring the efficacy and tolerance of fluid resuscitation, or of any other therapeutic intervention according to a predefined therapeutic algorithm. The control group will receive conventional 30 mL/kg fluid resuscitation (unless pulmonary venous congestion) according to SSC recommendations. Primary outcome will be the course of organ dysfunction assessed by the crude change in the modified SOFA score between baseline and 24 hours after randomisation. Secondary outcomes will be the nature of therapeutic interventions resulting from echocardiography (fluid loading, early initiation of vasopressor support or inotrope), the prevalence of the different haemodynamic profiles, the evolution of lactatemia, the safety of the initial therapeutic, the proportion of patients who develop secondarily septic shock, the orientation of patients after ED discharge and both day 7 and in-hospital mortality. We plan to randomise 312 patients.

Ethics and dissemination
Approved by the Ethics Committee CPP Ouest V on 18 January 2021 (ref: 20/075-2-20.10.16.57638). The dissemination plan includes presentations at scientific conferences and publication of results in a peer-reviewed journal.

Trial registration number
NCT04580888.

Objectives
To examine the associations between glucose levels from the antepartum 100 g oral glucose tolerance test (OGTT) and the 6-week postpartum 75 g oral glucose tolerance test (OGTT) and fatty liver disease (FLD) at 1 year postpartum in women with a history of gestational diabetes mellitus (GDM).

Design
A prospective cohort study.

Setting
A tertiary hospital centre in Bangkok, Thailand.

Participants
A total of 130 women with a history of GDM who underwent liver fat assessment at 1 year postpartum.

Outcome measures
FLD and metabolic dysfunction-associated steatotic liver disease were assessed at 1 year postpartum, with diagnosis based on transient elastography and specific cardiometabolic criteria. The associations between OGTT glucose values and FLD were evaluated using logistic regression models, adjusted for potential confounders, including age, pre-pregnancy weight, weight and waist circumference at 1 year postpartum and exclusive breastfeeding. Receiver operating characteristic analyses were also conducted to assess the predictive performance of glucose parameters from antepartum and postpartum OGTTs.

Results
A total of 44 participants (33.8%) were diagnosed with FLD, with 97.7% meeting metabolic dysfunction-associated steatotic liver disease criteria. Elevated fasting plasma glucose levels during pregnancy (adjusted odds ratio (aOR): 1.49; 95% CI: 0.93 to 3.57), in the early postpartum period (aOR: 1.77; 95% CI: 0.92 to 5.05), or across both periods combined (aOR: 2.16; 95% CI: 0.93 to 7.41) were not independently associated with FLD. In contrast, four abnormal glucose values during pregnancy (aOR: 2.53; 95% CI: 1.03 to 7.87) and two abnormal values on the 6-week postpartum 75 g OGTT (aOR: 2.95; 95% CI: 1.06 to 11.20) were independently associated with FLD. The combined presence of abnormal OGTT values from both periods showed the strongest association with FLD (aOR: 3.04; 95% CI: 1.03 to 13.99), demonstrating high specificity (95.3%) but low sensitivity (13.6%).

Conclusions
Elevated glucose levels from the antepartum 100 g OGTT and the 6 week postpartum 75 g OGTT were associated with FLD at 1 year postpartum in women with a history of GDM. Comprehensive glucose monitoring during and after pregnancy may aid early identification of individuals at higher risk.

Trial registration number
Thai Clinical Trials Registry: Registration no. TCTR20211027007. Date of registration: 27 October 2021. Date of initial participant enrolment: 1 November 2021.

Purpose
There is a need for diagnostic and prognostic biosignatures to improve long-term outcomes in inflammatory bowel disease (IBD). Here, we describe the establishment of the Swedish Inception Cohort in IBD (SIC-IBD) and demonstrate its potential for the identification of such signatures.

Participants
Patients aged ≥18 years with gastrointestinal symptoms who were referred to the gastroenterology unit due to suspected IBD at eight Swedish hospitals between November 2011 and March 2021 were eligible for inclusion.

Findings to date
In total, 367 patients with IBD (Crohn’s disease, n=142; ulcerative colitis, n=201; IBD-unclassified, n=24) and 168 symptomatic controls were included. In addition, 59 healthy controls without gastrointestinal symptoms were recruited as a second control group. Biospecimens and clinical data were collected at inclusion and in patients with IBD also during follow-up to 10 years. Levels of faecal calprotectin and high-sensitivity C-reactive protein were higher in patients with IBD compared with symptomatic controls and healthy controls. Preliminary results highlight the potential of serum protein signatures and autoantibodies, as well as results from faecal markers, to differentiate between IBD and symptomatic controls in the cohort. During the first year of follow-up, 37% (53/142) of the patients with Crohn’s disease, 24% (48/201) with ulcerative colitis and 4% (1/24) with IBD-U experienced an aggressive disease course.

Future plans
We have established an inception cohort enabling ongoing initiatives to collect and generate clinical data and multi-omics datasets. The cohort will allow analyses for translation into candidate biosignatures to support clinical decision-making in IBD. Additionally, the data will provide insights into mechanisms of disease pathogenesis.

Introduction
Persistent acute kidney injury (AKI) is associated with an increased morbidity and mortality. In patients with an already established AKI, the new urinary biomarker C-C motif chemokine ligand 14 (CCL14) can predict a persistent AKI. However, it is still unknown whether the implementation of nephroprotective measures in patients with an already established moderate/severe AKI can positively influence the trajectory of AKI and patients’ outcome.

Methods and analysis
The PrevProgAKI trial is a randomised, controlled, single-centre trial designed to evaluate the effectiveness of nephroprotective measures in patients with established moderate/severe AKI. We aim to enrol 480 patients with moderate or severe AKI (Kidney Disease: Imroving Global Outcomes, KDIGO, stage 2 or 3) within 72 hours of major surgery. Eligible patients will be randomised to receive either standard of care (control group) or an extended therapeutic strategy that consists of different supportive measures (intervention group). The randomisation will be stratified by urinary CCL14 results (CCL14

This study examines post–COVID-19 pandemic cancer screening rates in 2023 relative to previously documented declines through 2021.

Objective
To describe primary care providers’ (PCPs) experience and satisfaction with receiving risk communication documents on their patient’s breast cancer (BC) risk assessment and proposed screening action plan.

Design
Descriptive cross-sectional study.

Setting
A survey was distributed to all 763 PCPs linked to 1642 women participating in the Personalized Risk Assessment for Prevention and Early Detection of Breast Cancer: Integration and Implementation (PERSPECTIVE I&I) research project in Quebec, approximately 1–4 months after the delivery of the risk communication documents. The recruitment phase took place from July 2021 to July 2022.

Participants
PCPs.

Main outcome measures
Descriptive analyses were conducted to report participants’ experiences and satisfaction with receiving risk communication. Responses to two open-ended questions were subjected to content analysis.

Results
A total of 168 PCPs answered the survey, from which 73% reported being women and 74% having more than 15 years of practice. Only 38% were familiar with the risk-based BC screening approach prior to receiving their patient risk category. A majority (86%) agreed with the screening approach and would recommend it to their patients if implemented at the population level. A majority of PCPs also reported understanding the information provided (92%) and expressed agreement with the proposed BC screening action plan (89%). Some PCPs recommended simplifying the materials, acknowledging the potential increase in workload and emphasising the need for careful planning of professional training efforts.

Conclusion
PCPs expressed positive attitudes towards a risk-based BC screening approach and were generally satisfied with the information provided. This study suggests that, if introduced in Canada in a manner similar to the PERSPECTIVE I&I project, risk-based BC screening would likely be supported by most PCPs. However, they emphasised the importance of addressing concerns such as professional training and the potential impact on workload if the approach were to be implemented at the population level. Future qualitative studies are needed to further explore the training needs of PCPs and to develop strategies for integrating this approach with the high workloads faced by PCPs.

Objectives
To monitor the safety and utilisation of AZD1222 under real-world use in the UK.

Design
A non-interventional post-authorisation active surveillance study.

Setting
Vaccination sites in the UK.

Participants
A total of 17 945 participants were eligible and provided consent to participate in the study between 1 March 2021 and 6 April 2023. Participants were followed up at weeks 1, 4 and 14 and at months 6, 9, 12 and 18 after the first dose of AZD1222 vaccination and prompted to complete electronic data capture forms. A total of 11 219 participants submitted a Follow-Up 1 form and 5189 participants submitted a Follow-Up 7 form (at 18 months).

Primary and secondary outcome measures
The safety of AZD1222, including the identification, assessment and quantification of serious adverse events (SAEs) and adverse events of special interest (AESI), was examined. The utilisation of AZD1222 was described and characterised, including populations with missing information.

Results
The majority of participants were women (n=10 845; 60.4%) and the median age (IQR) was 50 (43, 62) years. Most participants were from white ethnic groups (n=13 112; 73.1%). Headache and fatigue had the highest reported incidence rate (421.28 cases per 1000 person years and 386.00 cases per 1000 person years, respectively). The most frequently reported AESI was anosmia (6.25 cases per 1000 person years). An increased Observed versus Expected (O:E) ratio was seen for anaphylaxis (O:E 7.38 (95% CI 2.80 to 11.95); based on 10 observed cases (expected cases: 1.36)) and anosmia and/or ageusia (O:E 39.23 (95% CI 29.13 to 49.32), based on 58 observed cases (expected cases: 1.48)).

Conclusions
The most frequent vaccinee-reported adverse events (AEs) were headache and fatigue. An increased O:E ratio was seen for the AEs of anaphylaxis and anosmia and/or ageusia. No safety signals were identified throughout the course of this study.

Trial registration number
This study is registered with the HMA-EMA Catalogue of RWD studies (EUPAS44035).

Stroke, Ahead of Print. BACKGROUND:There is a paucity of evidence on whether gestational diabetes (GDM) is a risk factor for cerebral vascular disease for Black women and lack of data on incident stroke as end point.METHODS:We conducted a large prospective cohort study of Black women across the United States and assessed the association between self-reported history of GDM and incident stroke. The study began when participants became parous or enrolled in 1995. We followed up 41 143 parous Black women who were free of cerebral vascular disease or cancer and followed up until incident stroke, death, or the end of 2021. Our exposure was self-reported history of GDM, and outcome was incident stroke. Multivariable Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% CIs, adjusting for major known risk factors for stroke.RESULTS:A total of 1495 incident stroke cases were identified among 41 143 Black women from 1995 until 2021 (881 505 person-years of follow-up). Black women with a history of GDM had a consistent 1.4-fold increased risk of stroke compared with those with a healthy pregnancy (age-adjusted HR, 1.44 [95% CI, 1.14–1.82]; multivariable HR, 1.41 [95% CI, 1.11–1.79]). Compared with healthy parous women with neither GDM nor type 2 diabetes, women with a history of both had a 2.6-fold increased stroke risk (multivariable HR, 2.59 [95% CI, 1.88–3.57]); women with only type 2 diabetes have 2-fold increased stroke risk (multivariable HR, 2.04 [95% CI, 1.79–2.32]); women with a history of GDM but no progression to type 2 diabetes do not have an increased risk of stroke (multivariable HR, 1.22 [95% CI, 0.86–1.73]).CONCLUSIONS:In this large prospective study of Black women, a vulnerable population at high risk for stroke, a history of GDM increased stroke incidence by 41%. There was no elevated risk of stroke for Black women with a history of GDM and no progression to type 2 diabetes, while the stroke risk increased by 2.6-fold for Black women with GDM and progression to type 2 diabetes. Our results highlight the importance of consideration of history of GDM for stroke early prevention, especially Black women with progression to T2DM after GDM.

Objective
Missed hospital appointments are common among outpatients and have significant clinical and economic consequences. The purpose of this study is to develop a predictive model of missed hospital appointments and to evaluate different overbooking strategies.

Study design
Retrospective cross-sectional analysis.

Setting
Outpatient clinics of the Royal Hospital in Muscat, Oman.

Participants
All outpatient clinic appointments scheduled between January 2014 and February 2021 (n=947 364).

Primary and secondary outcome measures
Predictive models were created using logistic regression for the entire cohort and individual practices to predict missed hospital appointments. The performance of the models was evaluated using a holdout set. Simulations were performed to compare the effectiveness of predictive model-based overbooking and organisational overbooking in optimising appointment utilisation.

Results
Of the 947 364 outpatient appointments booked, 201 877 (21.3%) were missed. The proportion of missed appointments varied by clinic, ranging from 13.8% in oncology to 28.3% in urology. The area under the receiver operating characteristic curve (AUC) for the overall predictive model was 0.771 (95% CI: 0.768 to 0.775), while the AUC for the clinic-specific predictive model was 0.845 (95% CI: 0.836 to 0.855) for oncology and 0.738 (95% CI: 0.732 to 0.744) for paediatrics. The overbooking strategy based on the predictive model outperformed systematic overbooking, with shortages of available appointments at 10.4% in oncology and 25.0% in gastroenterology.

Conclusions
Predictive models can effectively estimate the probability of missing a hospital appointment with high accuracy. Using these models to guide overbooking strategies can enable better appointment scheduling without burdening clinics and reduce the impact of missed appointments.

US physicians’ elevated risk for depression has been well established in the past decade—however, the risk of physician suicide relative to the general public remains unclear. In this issue of JAMA Psychiatry, Makhija and colleagues use data from 97 915 US suicides from 2017 to 2021, drawn from the US National Violent Death Reporting System, to estimate sex-specific suicide incidence rates among physicians and the general population. The authors’ findings indicate that rates of suicide are higher among female physicians and lower among male physicians compared to sex-matched nonphysicians in the general population.