Risultati per: GPG: Versione 5.7.0 (Maggio 2021)

Objective
The 2021 Pacific Northwest heat dome was Washington state’s deadliest recorded weather event and presented unprecedented response challenges to the state’s health sector. Understanding the impacts of this extreme heat event (EHE) on the sector as well as the barriers to and facilitators of implementing effective heat response is critical to preparing for future events, which are happening more frequently in the region due to climate change.

Design
Guided by an implementation science framework, we convened listening sessions and focus groups of the health sector in western Washington to reflect on regional response efforts.

Setting
Health sector organisations in 15 counties in western Washington State, USA: Clallam, Grays Harbor, Island, Jefferson, King, Kitsap, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Snohomish, Thurston and Whatcom.

Participants
A convenience sample of 109 listening group participants was recruited through the professional networks of the Northwest Healthcare Response Network, a regional healthcare coalition. 27 of the health sector professionals were recruited using purposive sampling to participate in seven focus groups organised by organisation type.

Results
The co-presence of the COVID-19 pandemic, limited staff capacity, resource acquisition challenges and inadequate regional collaboration emerged as key barriers, while advanced planning, indoor cooling capabilities, adapting strategies to local needs, robust internal relationships and strong external partnerships were reported to facilitate effective response. Establishing centralised coordination ahead of heat events, making improvements to the cooling capabilities of the built environment, developing plans and policies for EHEs that have co-benefits for other events, adopting evidence-informed response strategies, institutionalising the knowledge and relationships developed through prior events and improving evaluative processes (such as developing real-time monitoring capacity) will enable more effective response to future EHEs.

Conclusions
Western Washington’s health sector implemented EHE response activities that enabled essential service continuity, despite limited resources, unfamiliarity with EHEs and other systemic challenges. The recency of the heat dome presents an opportunity to incorporate lessons learnt into practice, policies, plans and built environment; these are necessary improvements ahead of future large-scale events the region may experience in the coming decades.

Objective
This study aimed to assess the status of infant and young child feeding (IYCF) practices and associated factors among children aged 0–23 months in the low-income regions of Dhaka City, Bangladesh.

Design
A community-based cross-sectional study.

Settings
Low-income regions of Dhaka City, Bangladesh.

Participants
530 children aged 0–23 months and their mothers.

Primary and secondary outcome measures
Prevailing IYCF practices were assessed against the 17 indicators of IYCF recommended by the WHO/UNICEF in 2021. Modified Poisson regression models were built to explore the relation between socio-demographic variables and each of the selected IYCF indicators (early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD)).

Results
More than two-thirds of the children were reported to follow appropriate breastfeeding practices (EIBF, 70.4% and EBF, 60.9%). Among the complementary feeding indicators, almost half of the children (48.8%) were reported to meet MMF; however, only about 26% of the children reportedly met the MDD with a consequent low prevalence (22.9%) of the composite indicator MAD. More than half (55%) of the children were reported to consume egg and/or flesh food consumption; still, inappropriate dietary practices were observed among 60% had unhealthy food consumption, and 56% had zero vegetable or fruit consumption). Child age was a significant determinant of IYCF practices. The children of mothers with no pregnancy complications exhibited a greater chance of having EIBF (estimate: 1.21, 95% CI: 1.04, 1.42, p=0.02), MDD (Estimate: 1.67, 95% CI: 1.09, 2.55, p=0.02), and MAD (estimate: 1.70, 95% CI: 1.04, 2.77, p=0.03) compared with the children of mothers with pregnancy complications. The children with a mother having secondary or higher education had a higher chance of having MDD (estimate: 1.93, 95% CI: 1.35, 2.76, p=0.003) and MMF (estimate: 1.27, 95% CI: 1.03, 1.56, p=0.02) than the children of mothers having primary or no education. Similarly, children from higher-income households had a higher chance of getting MDD (estimate: 1.57, 95% CI: 1.07, 2.03, p=0.02), and MAD (estimate: 1.73, 95% CI: 1.14, 2.64, p=0.01) compared with children from lower-income households.

Conclusion
IYCF practices among a considerable proportion of children aged 0–23 months in the low-income regions of Dhaka City were found to be suboptimal and predicted by children’s age, maternal education and pregnancy complications, and household income.

Objectives
Using the Korea Health Panel 2021 survey data, we identify factors associated with health literacy (HL) among older adults aged 65 years and older.

Design
A secondary data analysis of the 2021 Korea Health Panel survey.

Setting
Korea Health Panel survey.

Participants
Data were from 3410 older adults greater double equals65 years of age, drawn from the 2016 registration census of the Korea Health Panel 2021 survey, with a stratified selection approach for participants.

Outcome measure
To explore the factors associated with HL within the framework of the Andersen behavioural model, considering predisposing factors (age, gender, region and spouse), enabling factors (National Basic Livelihood Security recipient, education level, economic activity, usual source of care) and need factors (subjective health status, usual activities, depression/anxiety and chronic disease).

Analysis
Stepwise multiple regression analysis was employed to examine the factors associated with HL among the study participants within the framework of the Andersen behavioural model.

Results
Statistically significant associations with HL were found for predisposition factors (age, gender and residential area), enabling factors (National Basic Livelihood Security recipient, educational background and usual source of care) and need factors (subjective health status, usual activities and the presence of chronic diseases). While the National Basic Livelihood Security recipient was significant in model 2 (p=0.011), it became nonsignificant in model 3 after adding need factors (p=0.093). Adding enabling factors to model 1 significantly increased the explanatory power (R2=0.084, p

Objectives
Using the Korea Health Panel 2021 survey data, we identify factors associated with health literacy (HL) among older adults aged 65 years and older.

Design
A secondary data analysis of the 2021 Korea Health Panel survey.

Setting
Korea Health Panel survey.

Participants
Data were from 3410 older adults greater double equals65 years of age, drawn from the 2016 registration census of the Korea Health Panel 2021 survey, with a stratified selection approach for participants.

Outcome measure
To explore the factors associated with HL within the framework of the Andersen behavioural model, considering predisposing factors (age, gender, region and spouse), enabling factors (National Basic Livelihood Security recipient, education level, economic activity, usual source of care) and need factors (subjective health status, usual activities, depression/anxiety and chronic disease).

Analysis
Stepwise multiple regression analysis was employed to examine the factors associated with HL among the study participants within the framework of the Andersen behavioural model.

Results
Statistically significant associations with HL were found for predisposition factors (age, gender and residential area), enabling factors (National Basic Livelihood Security recipient, educational background and usual source of care) and need factors (subjective health status, usual activities and the presence of chronic diseases). While the National Basic Livelihood Security recipient was significant in model 2 (p=0.011), it became nonsignificant in model 3 after adding need factors (p=0.093). Adding enabling factors to model 1 significantly increased the explanatory power (R2=0.084, p

This study elucidates a significant non-linear relationship between BMI and asthma risk in populations aged 45 years and older, providing insights for tailored asthma prevention strategies, although the cross-sectional design limits causal inference. Future studies should focus on collecting and stratifying longitudinal data and adjusting for asthma diagnosis timing to obtain more accurate results.

Objectives
Subarachnoid haemorrhage (SAH) is the third most prevalent subtype of stroke, representing a critical and potentially life-threatening cerebrovascular emergency. Given their large populations and diverse healthcare infrastructures, the BRICS (Brazil, Russian Federation, India, China and South Africa) nations play a pivotal role in the global SAH landscape. This investigation assesses the mortality trends of SAH in BRICS countries from 1982 to 2021.

Design and participants
This study uses data from the Global Burden of Disease (GBD) 2021 public dataset to investigate the temporal trends in SAH mortality over four decades globally and within BRICS countries. The age-period-cohort (APC) model was employed to estimate net drift, local drift, age-specific curves and period (cohort) relative risks.

Primary outcome measures
Mortality.

Results
From 1982 to 2021, there was a 3.85% increase in global SAH deaths and a 59.46% decrease in age-standardised mortality rates. SAH mortality rates are increasing across various age groups in BRICS countries, except in China and the Russian Federation, where most age groups show increasing trends. The annual net drift in SAH mortality varied from a decrease of 5.62% in China to an increase of 0.31% in the Russian Federation. Countries demonstrated similar age-effect patterns, with risk decreasing as age increased. However, period and cohort effects varied, suggesting different control measures and temporal mortality trends.

Conclusions
Changing patterns of mortality from SAH in the BRICS countries over the last four decades vary. We suggest using local resources to step up SAH prevention. Healthcare for all ages, especially the vulnerable, should improve to prevent and treat SAH better.

Objective
This study aimed to assess the global, regional and national burden of pulmonary arterial hypertension (PAH) from 1990 to 2021 using data from the Global Burden of Disease Study 2021. The focus was on evaluating trends in incidence, prevalence, mortality and disability-adjusted life-years (DALYs) associated with PAH and examining these trends by age, gender and sociodemographic index (SDI).

Design
This is a systematic analysis leveraging data from the Global Burden of Disease Study 2021. The analysis focused on both crude and age-standardised rates to track temporal trends in PAH burden, with data stratified by region and SDI.

Setting
The study used global, regiona, and national data from 204 countries and regions, spanning from 1990 to 2021.

Participants
The participants in this study include individuals diagnosed with PAH, with data representing populations globally, categorised by age, gender and SDI.

Primary and secondary outcome measures
Primary outcome measures included global, regional and national incidence, prevalence, mortality and DALYs related to PAH. Secondary outcomes consisted of age-standardised rates (age-standardised incidence rate (ASIR), age-standardised mortality rate (ASMR)) and trends over the study period. A key strength of this study is the detailed stratification by SDI, revealing how PAH burden varies across different socio-economic settings. This extended temporal analysis offers new insights into long-term trends, highlighting the rising burden in lower-SDI regions and significant regional disparities in disease management and outcomes.

Results
From 1990 to 2021, global PAH cases showed substantial increases in both incidence (85.62%) and prevalence (81.46%), while age-standardised rates remained stable. Across SDI levels, high-SDI regions maintained stable ASIRs (0.37 per 100 000) with a slight decline (estimated average percentage change (EAPC) –0.06%), while low-SDI regions demonstrated the most significant reduction (EAPC –0.30%). Deaths increased by 48.36% globally, though the ASMR decreased from 0.35 to 0.27 per 100 000. The disease burden measured by DALYs decreased by 6.59%, with high-SDI regions showing better improvements in age-standardised DALY rates (–1.39% EAPC) compared with other SDI levels. Gender analysis revealed persistent female predominance (female-to-male ratio 1.62:1), particularly pronounced in populations over 50 years across all SDI quintiles.

Conclusions
While global age-standardised rates have declined, PAH remains a significant global health burden, particularly in low-SDI regions. These findings underscore the need for targeted prevention and intervention strategies, especially for high-risk populations, such as females and the elderly, to reduce the global health impact of PAH.

Stroke, Ahead of Print. BACKGROUND:The purpose of this study is to examine the association between race and ethnicity and ischemic stroke severity in the United States.METHODS:We performed an analysis of adult hospital discharges in the National Inpatient Sample from 2018 to 2021 with a primary discharge diagnosis of ischemic stroke. We stratified our cohort based on self-reported race and ethnicity and evaluated stroke severity using the National Institutes of Health Stroke Scale. Age- and sex-adjusted estimates of the National Institutes of Health Stroke Scale were derived from linear regression models.RESULTS:We included 231 396 stroke discharges with a mean National Institutes of Health Stroke Scale of 6.5±7.2. The cohort was 68.1% White, 17.4% Black, 8.2% Hispanic, and 6.3% other. The age- and sex-adjusted National Institutes of Health Stroke Scale for White patients was 6.25 (95% CI, 6.22–6.29), for Black patients was 7.12 (95% CI, 7.05–7.19), for Hispanic patients was 6.86 (95% CI, 6.76–6.97), and for patients of other races and ethnicities was 7.29 (95% CI, 7.18–7.41). Further adjustment for the Charlson Comorbidity Index, socioeconomic factors, and poorly controlled hypertension or diabetes did not significantly alter these findings.CONCLUSIONS:In a large, contemporary, and nationally representative sample of patients with acute ischemic stroke, we show an association between non-White race and ethnicity and higher stroke severity. These results are concerning for an underappreciated health disparity in acute ischemic stroke.

Objective
While continuous glucose monitoring (CGM) utilisation has been increasing among patients with type 1 diabetes (T1D), few studies have examined patterns of use across age, race/ethnicity and insurance status together. In this study, we examine CGM utilisation among patients with T1D from a regional academic medical centre across all insurance types.

Design and setting
This is a retrospective cohort study including both paediatric and adult patients with T1D who visited a regional academic medical centre between 1 January 2018 and 31 December 2021.

Methods
Patients were followed from the date of their first T1D encounter during the study period until the first of the following: CGM use was documented, ≥730 days with no encounters at this centre or the end of the study period. We compared CGM use across demographic and clinical characteristics and used logistic regression models to assess the association between demographic variables and CGM utilisation.

Results
Among 3311 eligible patients with T1D, CGM utilisation was 51.22%. The highest utilisation rates were among patients

Stroke, Ahead of Print. BACKGROUND:Subarachnoid hemorrhage (SAH) is a critical condition that has far-reaching implications for public health systems globally due to its severe consequences and long-term disabilities. This study aims to provide a comprehensive analysis of SAH trends from 1990 to 2021 and project future trends up to 2041, aiding in better understanding and management of its global burden.METHODS:We utilized data from the GBD (Global Burden of Disease) 2021 database, using joinpoint regression, frontier, and decomposition analyses to assess changes in SAH burden. Bayesian Age-Period-Cohort modeling was implemented to predict future trends. Our study included populations from 204 countries and territories.RESULTS:From 1990 to 2021, SAH incidence decreased by −1.03% for men and −1.16% for women, while mortality rates declined by −2.56% for men and −2.69% for women. Middle sociodemographic index locations and East Asia experienced substantial declines, particularly among women. However, countries like the Philippines and Turkmenistan showed increasing trends. Population aging and growth significantly contributed to these trends, while epidemiological changes led to reductions in SAH burden. The prediction model forecasts continued decreases in SAH mortality and disability-adjusted life years over the next 20 years, although incidence rates may slightly increase.CONCLUSIONS:The global burden of SAH has significantly diminished from 1990 to 2021, with considerable variations across regions, sexes, and countries. Ongoing and future research should prioritize high-risk populations and develop innovative interventions to further decrease SAH incidence and enhance outcomes.

Objectives
To examine the prevalence and days of long-term sickness absence (LTSA) by occupational class and by most important diagnostic groups in Finland during 2011–2021.

Design
Population-based cross-sectional study.

Setting and participants
National comprehensive register data were linked for all employed persons and entrepreneurs in Finland aged 25–64 for years 2011–2021 (yearly number of individuals in the study population around 2 million persons).

Main outcome measures
LTSA was measured by sickness allowance that covers over 10-day long absences. Yearly age-standardised LTSA prevalences and average number of LTSA days were calculated for women and men in four occupational classes, separately for all-cause LTSA and LTSA due to mental disorders, musculoskeletal diseases and injuries. Modified Poisson regression and negative binomial regression models were run to assess relative differences between occupational classes, adjusted for age, marital status, education and region of residence.

Results
All-cause LTSA slightly decreased between years 2011 and 2021, but the trends varied by occupational class and diagnostic group. LTSA due to mental disorders increased in all occupational classes after 2016 among both sexes, while LTSA due to musculoskeletal diseases and injuries continued to decrease in all occupational classes. The increase in LTSA due to mental disorders was largest among lower non-manual employees, especially among women, whereby all-cause LTSA prevalence among female lower non-manual employees reached the level of female manual workers. Men showed broadly similar trends, but manual workers still had the highest all-cause LTSA prevalence at the end of the study period. The main results were similar adjusted for covariates.

Conclusions
The magnitude and order of the occupational-class differences in LTSA changed between 2011 and 2021, along with increasing LTSA due to mental disorders, especially among employees, and decreasing LTSA due to somatic diagnoses, especially among manual workers. Occupational-class differences should be taken into account when aiming to prevent LTSA and especially further increases in LTSA due to mental disorders.

Background
The introduction of immune checkpoint inhibitors (ICIs) has modified treatment modalities for patients with lung cancer, offering new alternatives for treatment. Despite improved survival benefits, ICIs may cause side effects impacting patients’ quality of life (QoL). We aim to study the changes in global QoL (gQoL) of patients with advanced-stage lung cancer up to 18 months after treatment with ICIs between 2015 and 2021.

Methods and analysis
A longitudinal cohort study was conducted using the Oncological Life Study: Living well as a cancer survivor data-biobank from the University Medical Center Groningen. Participants completed the European Organisation for Research and Treatment of Cancer QoL 30-item questionnaire, at the beginning of their ICI treatment (baseline) and then at 6, 12 and 18 months. Using joint modelling, changes in predicted mean gQoL were studied by treatment regimens from baseline to 18 months, while accounting for the competing risk of death and adjusting for prespecified covariates.

Results
Of the 418 participants with median age of 66 years, 39% were women. Patients receiving first-line immuno-monotherapy with palliative intent had a small improvement in their gQoL within 6 months and no clinically significant change thereafter. Patients receiving first-line immune-chemotherapy with palliative intent had a small improvement in their gQoL within 12 months and no clinically significant change thereafter. Patients with second/further line immunotherapy with palliative intent or first-line chemoradiotherapy followed by durvalumab with curative intent had no clinically significant change in their gQoL over 18 months.

Conclusion
The changes in gQoL over time among patients with advanced-stage lung cancer may vary by treatment regimens based on drug intensity, line and intent of treatment, which will help clinicians and patients understand the potential dynamic of treatments on QoL. It may further influence treatment decisions and patient management strategies, reflecting the practical implications of different treatment regimens.

Objectives
To estimate the levels and trends of maternal and child healthcare (MCH) service utilisation in India across subsidised and unsubsidised health sectors and to explore total market approach to identify geographies where the private sector has potential to improve MCH services in India.

Design and setting
This study used three recent rounds of the National Family Health Survey (NFHS), a cross-sectional survey in India, conducted in 2005–2006, 2015–2016 and 2019–2021. Bivariate analysis and multinomial logistic regression were used to estimate the utilisation of key MCH indicators from subsidised and unsubsidised health sectors. Market sustainability of key MCH indicators was assessed by level of MCH services and subsidisation.

Participants
36 850, 190 898 and 176 843 ever-married women aged 15–49 years, 4440, 22 500 and 15 334 children under 5 years of age with diarrhoea before the survey, and 2552, 6960 and 6117 children with symptoms of acute respiratory infections (ARI) in NFHS 2005–2006, 2015–2016 and 2019–2021, respectively.

Outcome measures
The study used three maternal healthcare indicators: women had four or more antenatal care (ANC) visits, had institutional delivery, and received postnatal care (PNC); and two child healthcare indicators: care seeking for ARI and diarrhoea.

Results
In India, utilisation of maternal healthcare services increased over the last 15 years: four or more ANC visits increased from 37% to 58% and PNC of mothers increased from 33% to 78% between 2005–2006 and 2019–2021. The results of the multivariate analysis showed that utilisation of ANC (67% from public vs 18% from private health facilities), institutional delivery (64% from public vs 25% from private health facilities) and PNC (73% from public vs 27% from private health facilities) was significantly higher (p

Objectives
This study aims to systematically assess the global, regional, and national burden of asthma attributable to nitrogen dioxide (NO2) pollution.

Design and setting
Analysis of population-level data from 1990 to 2021 obtained from the Global Burden of Disease Study 2021, covering 204 countries and territories.

Participants
Participants included patients with asthma attributable to NO2 pollution.

Main outcomes and measures
Asthma-related disability-adjusted life-years (DALYs) and age-standardised DALY rates (ASDR) attributable to NO2 pollution across 204 countries and territories. The estimated annual percentage change (EAPC) was used to assess temporal trends to identify regions with increasing or decreasing asthma burdens.

Results
In 2021, NO2 pollution contributed to approximately 176.73 thousand DALYs globally, with an ASDR of 2.48 per 100 000 population (95% uncertainty interval (UI) –2.26 to 10.30). The global ASDR declined significantly from 1990 to 2021, with an EAPC of –1.93% (95% CI –2.14% to –1.72%). High-income North America had the highest ASDR (10.74 per 100 000; 95% UI 10.12 to 46.56), while Australasia experienced the most significant reduction in ASDR over the study period (EAPC –3.92%; 95% CI –4.46% to –3.37%). In contrast, Oceania and Southeast Asia showed increasing trends in asthma burden, with EAPCs of 2.33% (95% CI 1.57% to 3.10%) and 1.14% (95% CI 0.81% to 1.47%), respectively. The 5–9 age group carried the highest asthma burden, reflecting the vulnerability of younger children to NO2 exposure. A positive correlation between ASDR and sociodemographic index (SDI) was observed (R=0.637, p

Objective
To examine longitudinal trends in infertility management in women attending general practice.

Design
Cohort study using the national general practice dataset, MedicineInsight.

Setting
Australian general practice.

Intervention(s)
Not applicable.

Participants
The cohort included 2 552 339 women aged 18–49 years with one or more general practice clinical encounters between January 2011 and December 2021.

Primary and secondary outcome measures(s)
The primary outcome assessed was the proportion of women who had a clinical encounter related to infertility, stratified by year and age group. Second, the proportions of women receiving relevant clinical management actions, including selected pathology tests, imaging ordered and selected medications, were calculated. Univariable logistic regression analyses compared the likelihood of women having a documented clinical encounter related to infertility and receiving selected management actions based on individual characteristics. We also examined practice-level variation in the proportion receiving selected management for infertility by stratifying proportions based on practice site.

Results
A total of 2 552 339 women had one or more clinical encounters with their general practitioner (GP) between January 2011 and December 2021, of which 27 671 (1.1%) had a clinical encounter related to infertility management. The rate of infertility encounters increased from 3.4 per 1000 in 2011 to 5.7 per 1000 in 2021. Over episodes of care, half (50.9%) of women presenting for an infertility encounter had at least one specified pathology test, and almost a quarter (23.1%) had a specified imaging test. A relatively small proportion of infertility encounters (5.4%) resulted in prescribing of a selected infertility medication by the GP.
Large variation in clinical management (pathology, imaging and medication prescribing) was evident according to both individual characteristics and also at the clinical-practice level. Factors associated with increased likelihood of being provided infertility medications included younger age, holding a Commonwealth concession card (indicating low income), lower socioeconomic status and living outside a major city.

Conclusions
Clinical encounters related to infertility are increasing in primary care, with large variation evident in corresponding clinical management. These findings support the development of clinical practice guidelines to enhance standardised and equitable approaches towards the management of infertility in primary care.

Stroke, Volume 56, Issue Suppl_1, Page ATP309-ATP309, February 1, 2025. Introduction:A nation-wide stroke surveillance system is not available in the US, limiting analyses to identify subgroups at disproportionate risk for ischemic stroke (IS). These data are needed to help inform targeted interventions to improve primary stroke prevention in high-risk populations. We assessed trends in IS hospitalizations and risk factor prevalence by age, sex, and racial/ethnic subgroups using data from GWTG-Stroke.Methods:The sample included patients discharged from GWTG-Stroke participating hospitals in 2010-2021 with a final diagnosis of IS. We conducted a stratified analysis to determine the proportionate composition and temporal trends in IS hospitalizations by race/ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic, or Other), sex (women, men), and age (18-44, 45-64, 65+ y). We then used logistic regression to calculate the unadjusted prevalence odds for 10 stroke risk factors for the different race/ethnic, sex, and age groups.Results:There were 4,229,981 IS hospitalizations (mean age 70.1±14.4 y, 49.8% women) from 2,771 hospitals. The Hispanic and Other groups comprised an increasingly greater proportion of total IS hospitalizations over the study period in both women and men and in all age groups (P for trend