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A man taking no regular medications had 1 month of small painless facial papules progressing over 1 week to vesicles and pustules. He reported unprotected sex with multiple partners and recent exposure to a person with active tuberculosis; rapid plasma reagin titer was normal; results of HIV and fluorescent treponemal antibody absorption tests were positive. What is the diagnosis and what would you do next?
Objective
This study aimed to examine the trends and inequalities in women’s use of quality antenatal care (ANC), quality intrapartum care and immediate postnatal care (PNC) services, and the determinants that contributed to changes in receiving these services from 2001 to 2019 in Ethiopia using the Ethiopia Demographic and Health Surveys (EDHSs) data.
Design, outcomes, setting and analysis
Secondary data analyses of four waves of nationally representative EDHSs from 2005 to 2019 were conducted. We defined quality ANC as having blood pressure measurement, blood and urine tests, iron supplementation and being informed of pregnancy-related complications during ANC visits; quality intrapartum care as having health facility birth, birth assisted by skilled personnel and newborn put to the breast within 1 hour of birth and immediate PNC as having maternal and newborn PNC within 24 hours of birth. We used control charts, multivariate logistic regression decomposition analyses and equiplots to measure and analyse trends and inequalities over two decades using data from EDHSs 2005–2019.
Results
Over the period 2001–2019, there were increases in the percentage of quality ANC (3.7%–39.6%), intrapartum care (3.9%–43.3%) and immediate PNC (2.6%22.1%) services received. However, there were widening inequalities between these services received by women, favouring those from advantageous socioeconomic backgrounds. From 2001–2019, the largest significant increases in the percentage of women receiving quality ANC and immediate PNC services were due to changes in the distribution of sociodemographic and maternal care characteristics, while the largest significant increase in the percentage of women receiving quality intrapartum care was due to changes in the effects of these characteristics.
Conclusions
The healthcare system in Ethiopia should expand access to all the recommended maternal healthcare interventions to disadvantaged population subgroups. Universal coverage of quality maternal and newborn healthcare across the continuum is needed. There is also a need to promote ≥4 ANC, early initiation of ANC, girls’ and women’s education and enabling women’s economic empowerment.
Psicogeriatri, ‘impatto paragonabile a tabagismo e obesità’
Objectives
This study aimed to evaluate the global, regional and national disparities in the quality of care for leukaemia and brain and central nervous system (CNS) tumours among children and adolescents aged 0–19 years. We also assessed temporal trends in the quality of care index (QCI) and explored associations with sociodemographic development levels, gender and age.
Setting
The study used data from the Global Burden of Disease (GBD) 2019 database, covering 204 countries and territories. The analysis included global, regional and national levels of care, stratified by sociodemographic index (SDI), gender and age groups.
Participants
The study included children and adolescents aged 0–19 years diagnosed with leukaemia or CNS tumours. Data on incidence, prevalence, mortality and disability-adjusted life years (DALYs) were extracted from the GBD 2019 database.
Primary and secondary outcome measures
The primary outcome was the QCI, constructed using principal component analysis from four secondary indicators: years of life lost to years lived with disability ratio, DALYs to prevalence ratio, mortality to incidence ratio and prevalence to incidence ratio. Secondary outcomes included temporal trends in QCI, gender disparity ratios (GDRs) and correlations between QCI and SDI levels.
Results
In 2019, leukaemia and CNS tumours accounted for 132 194 deaths globally. The QCI for leukaemia was 74.71, while for CNS tumours, it was 56.59. From 1990 to 2019, the QCI for CNS tumours increased significantly (estimated annual percentage change (EAPC)=1.45, 95% CI: 1.41 to 1.50), whereas the QCI for leukaemia showed a declining trend in middle and low-middle SDI regions (EAPC=–0.13, 95% CI: –0.16 to –0.09). Western Europe had the highest QCI for leukaemia (94.50), while South Asia had the lowest (57.64). Boys had lower QCI scores than girls, and the gender disparity in CNS tumours widened over time (GDR increased from 1.147 in 1990 to 1.160 in 2019). QCI was positively correlated with SDI levels (leukaemia: r=0.591, p
Si abbassa l’età media, casi sempre più severi tra i più giovani
Fnomceo, ‘le pari opportunità sono la priorità del nuovo Comitato centrale’
Objective
People living with HIV (PLWH) are disproportionately affected by substance use disorder (SUD) and mood/anxiety disorders, which are barriers to sustained viral suppression and can contribute to increased healthcare utilisations. This study examined the impact of SUD and mood/anxiety disorders on healthcare utilisation of PLWH with sustained and unsustained viral suppression.
Design and participants
This retrospective population-based cohort study used administrative data from 9757 antiretroviral-treated PLWH (83% men, median age 40 years). Eligible PLWH were≥19 years of age, followed during 2001–2019, and achieved viral suppression at least once during follow-up.
Setting
This study was conducted in British Columbia, Canada.
Measurements
The exposure variable consisted of eight levels and included (1) sustained suppression, (2) SUD and mood/anxiety disorder diagnoses and the interaction between (1) and (2). Outcome variables included annual counts of primary care and specialist physician visits, laboratory visits, acute care hospitalisation, day surgery episodes and hospital length of stay (LOS). Statistical count models were used to determine the effect of exposure variables on each healthcare utilisation outcome while adjusting for socioeconomic confounders.
Results
In the presence of sustained suppression, having both disorders was significantly associated with over four times more acute-care hospitalisations (0.28 vs 0.05), three times longer LOS (9.1 vs 3.0 days) and almost double primary care physician (13.1 vs 6.9) and specialist (7.9 vs 4.0) visits. Overall, SUD alone was associated with increased use of all healthcare services (except day surgery). Regardless of disorder diagnoses, unsustained suppression was associated with higher healthcare utilisation (except day surgery).
Conclusion
In this study, SUD, mood/anxiety disorders and unsustained suppression, when combined, resulted in the highest healthcare utilisation among PLWH. The results suggest that providing comprehensive mental health and substance use services to PLWH and addressing barriers to sustained suppression could reduce the healthcare burden within this population.
Objective
To describe demographics, causative pathogens, hospitalisation, mortality and antimicrobial resistance (AMR) of bacterial bloodstream infections (BSIs) among beneficiaries in the global US Military Health System (MHS), a single-provider healthcare system with 10-year longitudinal follow-up.
Design
Retrospective cohort study.
Setting
Clinical and demographic data collected from the MHS Data Repository and collated with microbiological data obtained from the Defense Centers for Public Health-Portsmouth.
Participants: 12 748 MHS beneficiaries diagnosed with 15 357 bacterial BSIs (2010–2019).
Main outcome(s) and measure(s)
Demographic data and diagnosis codes preceding BSI episodes and during hospitalisations were collected. Inpatient admission data identified acute clinical diagnoses, intensive care unit (ICU) admission and mortality. BSI pathogens were evaluated for AMR, including difficult-to-treat resistance (DTR). Crude mortality trends were assessed.
Results
The decade analysed included 15 357 BSI episodes in 12 748 patients; 6216 patients (48.8%) were≥65 years and 83.7% of episodes had≥1 comorbidity (12 856 of 15 357). Approximately 29% of episodes with hospitalisation required ICU admission and~34% had concurrent urinary tract infections. Pathogen distribution was 53% and 47% for Gram-positive bacteria and Gram-negative bacilli (GNB), respectively. Inpatient mortality was 4.4%, and at 1 year was 23.4%; 0.5% (16 of 2977) of deaths were associated with DTR GNB. Among an average 8 145 778 individuals receiving care annually in the MHS, annual rates of overall BSI, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp and DTR GNB BSI were 18.9, 1.30, 0.25 and 0.05 per 100 000 beneficiaries, respectively. Over the decade, annual mortality did not significantly increase for any pathogen and decreased by~2% for overall BSI (p=0.024) and~3% for lactose-fermenting GNB BSI (p=0.048).
Conclusions
In the global US MHS, the mortality burden associated with BSI was substantial (approximately one in four dying at 1 year), relatively unchanged over a decade, and associated with older age and comorbidities. First-line treatment options remained available for 99.7% of BSIs. Population-level improvements in BSI survival might be maximally influenced by focusing on prevention, early detection, prompt antibiotics and other novel therapies not contingent on in vitro activity.
Tra i motivi, ricerca di partner stabile e social freezing
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Usata soprattutto per dolore cronico, 28 mila pazienti trattati
Objective
To examine trends in the prevalence of depression and anxiety during the COVID-19 pandemic among US adult cancer patients and survivors (CPS) in comparison to those of non-CPS (NCPS).
Methods and analysis
National Health Interview Survey 2019–2022 data were analysed using spline logistic regression.
Results
A total of 115 664 participants completed the survey (mean age (SD), 52.8 (18.4) years; 54.3% female; 12.6% CPS). The age-adjusted prevalence of depression significantly increased from 26.53% in 2019 to 29.78% in 2022 among CPS, while that of anxiety increased from 24.02% in 2019 to 28.08% in 2022. Throughout the pandemic, there were consistently significant annual increases in the prevalence of both depression and anxiety with CPS experiencing significantly faster rates of increase compared with NCPS (average annual absolute increase 0.72% in NCPS vs 1.08% in CPS, p
Objectives
This study aimed to assess the global burden of oesophageal cancer (EC) attributable to alcohol consumption across 204 countries and territories from 1990 to 2019. Alcohol use is a major modifiable risk factor for EC, with unique biological and epidemiological effects compared with other contributors such as smoking, necessitating a focused analysis of its global impact.
Design
We analysed trends in EC attributable to alcohol consumption from 1990 to 2019 using data from the Global Burden of Disease (GBD) 2019 study.
Setting
Data were obtained from the GBD Results Tool, covering 204 countries and territories across 21 GBD regions.
Participants
Patients with EC attributable to alcohol consumption.
Main outcomes and measures
The number and age-standardised rates of deaths and disability-adjusted life-years (DALYs) due to EC attributable to alcohol consumption are presented by region for 1990 and 2019, along with the number of deaths, age-standardised mortality rates (ASMR) and age-standardised DALY rates (ASDR) in 204 countries and territories in 2019. Geographical variations were visualised using maps, and linear regression analyses were performed to assess the association between the Socio-Demographic Index (SDI) and EC mortality and DALY rates.
Results
In 2019, there were 113 600.3 deaths (95% uncertainty intervals (UIs): 84 062.5–144 685.6), contributing to 2818.2×103 DALYs (95% UI: 2109.6–3573.6). From 1990 to 2019, total deaths and DALYs associated with EC increased, while age-standardised rates decreased. ASMR and ASDR decreased in high SDI populations but plateaued in low-middle or low SDI populations for both genders. China recorded the highest death toll (61 887.7, 95% UI: 42 882.6–84 201.3), while Uganda had the highest ASMR (4.48, 95% UI: 3.06–6.26) and ASDR (119.21, 95% UI: 80.72–167.22). Males accounted predominantly for EC attributed to alcohol use.
Conclusions
Globally, there was a decline in ASMR and ASDR but an increase in overall deaths and DALYs related to EC from 1990 to 2019. The burden of EC varied across regions and countries, with Uganda exhibiting the highest ASMR, and China having the highest fatalities. The association between alcohol and EC was more pronounced in males than females.
In this age group, cervical cancer mortality has decreased dramatically in recent years.
Objective
Our study aims to evaluate the spatial and temporal changes of breast-conserving surgery (BCS) rates and influential factors of BCS in Guangdong Province, China.
Design, setting and participants
This registry-based cohort study analysed the data of patients of all age groups, from the medical record cover page, which was mandatorily collected for inpatients by the Health Administrative Department of Guangdong Province, China. Patients with non-metastatic breast cancer, who underwent breast surgery between 2013 and 2019, were included.
Main outcomes and measures
We analysed the BCS rate in Guangdong Province between 2013 and 2019. Logistic regression was applied to investigate the association between patient-level influential factors and BCS, respectively. We used restricted cubic spline regression to model the non-linear association between hospital volume rank with BCS rate. Linear regression was used to evaluate the association between city-level parameters with BCS rate of each city.
Results
A total of 93 521 patients with non-metastatic breast cancer, who underwent breast surgery, were included in the analyses. Among them, 10 949 (11.7%) had BCS, with the BCS rates increasing from 0.8% in 2013 to 19.2% in 2019. Patients who were older (vs
