Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study

Predicting prolonged length of in-hospital stay in patients with non-ST elevation myocardial infarction (NSTEMI) using artificial intelligence

BACKGROUND

Patients presenting with non-ST elevation myocardial infarction (NSTEMI) are typically evaluated using coronary angiography and managed through coronary revascularization. Numerous studies have demonstrated the benefits of expedited discharge following revascularization in this patient population. However, individuals with concomitant heart failure, hemodynamic instability, or arrhythmias often necessitate prolonged hospitalization. Using aortic pressure (AP) wave assessment, we aim to predict a prolonged length of stay (> 4 days, PLoS) in patients with NSTEMI treated with percutaneous coronary intervention (PCI).

METHODS

In this single-center, retrospective cohort study, we included 497 patients with NSTEMI [66.3 ± 12.9 years, 37.6 % (187) females]. We developed a predictive model for PLoS using features primarily extracted from the AP signal recorded throughout PCI. We performed feature selection using recursive feature elimination (RFE) with cross-validation and built a machine learning (ML) model using the CatBoost tree-based classifier. The decision-making process of the ML model was analyzed using SHapley Additive exPlanations (SHAP).

RESULTS

We achieved average accuracy, specificity, sensitivity, precision, and receiver operating characteristic curve area under the curve (AUC) values of 77 %, 78 %, 76 %, 67 %, and 77 %, respectively. Using SHAP, we identified the ejection systolic period, ejection systolic time, the difference between systolic blood pressure and dicrotic notch pressure (DesP), the age modified shock index (mSI_age) and mean arterial pressure (MAP) as the most characteristic features extracted from the AP signal.

CONCLUSIONS

In conclusion, this study demonstrates the potential of using ML and features extracted from the AP signal to predict PLoS in patients with NSTEMI.

Trial-based economic evaluation of a multicomponent positive psychology intervention for euthymic patients with bipolar disorder

BACKGROUND

To date, no study has evaluated the cost-effectiveness of positive psychology interventions (PPI) for people with bipolar disorder (BD). This study evaluates the cost-effectiveness of the multicomponent PPI "Living well with bipolar disorder" for people with BD in the euthymic phase, compared to treatment as usual (TAU) alone.

METHODS

96 participants were included in the study, with 53 randomized to the intervention group. Utility scores (EQ-5D-5L), well-being (MHC-SF), healthcare costs, productivity losses, and patient and family costs were assessed at baseline, 6 months and 12 months. Incremental cost-utility (quality-adjusted life-years (QALYs)) and cost-effectiveness ratios (costs per additional responder to treatment using MHC-SF scores) were estimated. Non-parametric bootstrapping (5000 repetitions) was used to assess uncertainty. Sensitivity analyses were conducted to test robustness.

RESULTS

The intervention led to an estimated incremental cost difference of €691 (95 % CI: -€2128; €3458) and 0.04 (95 % CI: -0.01; 0.08) incremental QALYs, which results in an ICUR of €19,669 per QALY gained. The probability of cost-effectiveness was ∼70 % considering a willingness-to-pay of €50,000 per QALY. Incremental treatment response was estimated at 0.12 (CI: -0.06; 0.30), resulting in an ICER of €5624 per additional responder. Sensitivity analyses indicated similar results.

CONCLUSION

Results indicate that the PPI "Living well with bipolar disorder" for patients with BD in the euthymic phase is likely to be cost-effective, introducing small but improved health outcomes against additional costs. Despite study limitations and the need for further research, results support the inclusion of this PPI in the spectrum of available treatments for BD. PRéCIS: Positive Psychology interventions in addition to treatment as usual for patients with Bipolar Disorder are more effective and more costly than treatment as usual alone.

Global Burden and Risk Factors of Stroke in Young Adults, 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study aimed to estimate the disease burden of ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and overall stroke among young adults (aged 15-49 years) in 204 countries and territories from 1990 to 2021, along with the associated risk factors.

METHODS

GBD (Global Burden of Disease Study) 2021 data were used to assess the burden and trends via age-standardized rates and their estimated annual percentage changes.

RESULTS

Although age-standardized rates generally declined from 1990 to 2021, the number of incident and prevalent stroke cases among young adults increased by 36% (95% uncertainty interval, 31%-41%) and 41% (95% uncertainty interval, 38%-43%), respectively. Notably, from 2015 to 2021, the age-standardized incidence of ischemic stroke and subarachnoid hemorrhage among young adults increased, with estimated annual percentage changes of 0.65 (95% CI, 0.39-0.92) and 0.58 (95% CI, 0.47-0.69), respectively. High systolic blood pressure was the primary risk factor for stroke-related disability-adjusted life-years among young adults. However, other risk factors varied by region, with higher proportions of smoking, high low-density lipoprotein cholesterol, and high body mass index in high sociodemographic index regions, and higher proportions of household air pollution from solid fuels and diet low in vegetable in low sociodemographic index regions. From 1990 to 2021, the total number of stroke-related disability-adjusted life-years among young adults due to risk factors increased by 12% (95% uncertainty interval, 2%-22%), driven principally by high systolic blood pressure, ambient particulate matter pollution, high body mass index, high low-density lipoprotein cholesterol, and high fasting blood glucose.

CONCLUSIONS

Since 2015, there has been a concerning rebound in the age-standardized incidence rates of ischemic stroke and subarachnoid hemorrhage among young adults globally. Given regional and sociodemographic index variations in risk factors, targeted and cost-effective policies and interventions are urgently needed to reduce stroke burden in this demographic.

Predictors of depression among caregivers of children with malnutrition in Gedeo zone public hospitals, Southern Ethiopia: case-control study

BACKGROUND

Depression is a leading cause of disability worldwide, significantly impacting global health, particularly for women. It accounts for 4.3% of the total disability-adjusted life years (DALYs), making it a major contributor to global disability. The high rate of depression in developing nations, the caregiving responsibilities of caregivers, their susceptibility to depression, and maternal mental health in these nations may significantly impact childhood development. Therefore, the study aimed to identify the predictors of depression among caregivers of children with malnutrition in Gedeo Zone public hospitals.

METHODS

A facility-based unmatched case-control study was conducted. A systematic sampling technique was used to select 226 caregivers (113 cases and 113 controls). Depression of caregivers was assessed using a patient health questionnaire (PHQ-9). Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression analysis was conducted to identify predictors, and the association was presented with an adjusted odds ratio and a 95% confidence interval.

RESULTS

In this study, not attended formal education [AOR = 2.9(95%CI: 1.0-8.1)], unemployment [AOR = 3.7, (95% CI: 1.4-9.7)], low socioeconomic status [AOR = 3.3 (95% CI: 1.2-9.4)], physical abuse [AOR = 2.3(95% CI = 1.2-3.3)], poor social support [AOR = 2.6(95% CI: 1.0-6.5)], and stunting [AOR = 2.5, 95% CI: 1.3-3.4] were a significant positive predictors of depression.

CONCLUSION AND RECOMMENDATION

Nearly half of the study participants had a significant burden of depression among caregivers of malnourished children; particularly those facing not attended formal education, unemployment, low socioeconomic status, physical abuse, poor social support, and having a stunted child. Therefore, implementing early depression screening and interventions is crucial. Additionally, enhancing caregiver education, reducing unemployment, strengthening social support systems, preventing stunted physical growth, and boosting parents' financial stability with malnourished children are essential strategies for sustainable improvement.

Joint resting state and structural networks characterize pediatric bipolar patients compared to healthy controls: a multimodal fusion approach

Pediatric bipolar disorder (PBD) is a highly debilitating condition, characterized by alternating episodes of mania and depression, with intervening periods of remission. Limited information is available about the functional and structural abnormalities in PBD, particularly when comparing type I with type II subtypes. Resting-state brain activity and structural grey matter, assessed through MRI, may provide insight into the neurobiological biomarkers of this disorder. In this study, Resting state Regional Homogeneity (ReHo) and grey matter concentration (GMC) data of 58 PBD patients, and 21 healthy controls matched for age, gender, education and IQ, were analyzed in a data fusion unsupervised machine learning approach known as transposed Independent Vector Analysis. Two networks significantly differed between BPD and HC. The first network included fronto- medial regions, such as the medial and superior frontal gyrus, the cingulate, and displayed higher ReHo and GMC values in PBD compared to HC. The second network included temporo-posterior regions, as well as the insula, the caudate and the precuneus and displayed lower ReHo and GMC values in PBD compared to HC. Additionally, two networks differ between type-I vs type-II in PBD: an occipito-cerebellar network with increased ReHo and GMC in type-I compared to type-II, and a fronto-parietal network with decreased ReHo and GMC in type-I compared to type-II. Of note, the first network positively correlated with depression scores. These findings shed new light on the functional and structural abnormalities displayed by pediatric bipolar patients.

Global, regional, and national trends in tobacco-induced cardiovascular disease burden for 1990-2021 with projections to 2045: A comprehensive analysis based on the Global Burden of Disease Study 2021

INTRODUCTION

Tobacco use is a major risk factor for cardiovascular disease (CVD), and its global disease burden trends require further clarification. This study aims to analyze trends in global CVD burden attributable to tobacco in 1990-2021 and project mortality rates and disease burden through 2045.

METHODS

Using Global Burden of Disease Study (GBD) 2021 data, we analyzed temporal trends using age-period-cohort models, evaluated change points with Joinpoint regression, and conducted forecasting using Bayesian age-period-cohort (BAPC) models.

RESULTS

In 2021, tobacco-attributable CVD deaths reached 2.147 million globally (71.3% increase from 1990), although age-standardized mortality rates decreased to 25.36 per 100000 (83.3% reduction). Mortality rates were lowest in high SDI regions (326.71 per 100000) and highest in low-middle sociodemographic index (SDI) regions (788.05 per 100000). The proportion of deaths among those aged ≥80 years increased from 19.2% to 26.2%. Global mortality rates decreased by 1.8% annually, with a greater decline in females (-2.6%) than males (-1.6%). Projections suggest that by 2045, global CVD deaths may reach approximately 3.267 million (52.1% potential increase), although age-standardized mortality rates are expected to decrease to around 38.6 per 100000 (15.9% estimated reduction). Disability-adjusted life years (DALYs) are projected to potentially increase to 75.755 million (39.9% estimated increase), while age-standardized DALY rates could decline to approximately 1008.02 per 100000.

CONCLUSIONS

Between 1990 and 2021, global tobacco-attributable CVD mortality rates showed a declining trend, with notable regional, sex, and age disparities. Projections indicate that while age-standardized rates will continue to decrease, absolute numbers of deaths and disease burden will increase. The findings emphasize the need to strengthen tobacco control and CVD prevention in low-middle SDI regions.

The Challenge in Burden of Pulmonary Arterial Hypertension: A Perspective From the Global Burden of Disease Study

Pulmonary arterial hypertension (PAH) poses significant clinical management challenges due to gaps in understanding its global epidemiology. We analyzed PAH-related disability-adjusted life years (DALYs), deaths, and prevalence from 1990 to 2021. Age-period-cohort models and regression analyses assessed temporal trends and projected burdens to 2050. Globally, PAH-related DALYs declined by 6.6%, but increased by 13.9% in high socio-demographic index (SDI) countries. Middle SDI regions reported the highest DALYs in 1990 and 2021. Deaths rose by 48.5% worldwide, with high SDI nations experiencing a 76.6% surge. Age-standardized rates (ASRs) of DALYs and deaths decreased across SDI countries, with high-middle SDI regions showing the steepest declines. Younger age groups, especially males, had a higher proportion of global DALYs in earlier years, but the burden shifted toward older populations over time, with this trend more pronounced in high-SDI countries. Age-period-cohort analysis revealed declining DALYs in younger ages but rising rates in older cohorts. By 2050, deaths and prevalence are projected to rise, disproportionately affecting females. Significant regional disparities in PAH burden persist, necessitating targeted policies, improved healthcare access, and early detection strategies, especially in underserved areas. Addressing these disparities is critical for mitigating PAH' s global impact.

Age-period-cohort analysis of autism spectrum disorders-related prevalence and DALYs: based on the Global Burden Of Disease Study 2021

Background

The Sustainable Development Goals (SDGs) call for systematic monitoring to optimize child development outcomes. As a developmental disorder affecting children and adults, Autism Spectrum Disorder (ASD) not only impacts individual social functioning but also places a burden on families and society. A detailed analysis of the latest global burden data on ASD can assist stakeholders in formulating support policies and interventions, thereby helping to meet the health needs of ASD.

Methods

We used data from the Global Burden of Disease Study 2021 (GBD 2021), compiled by the Institute for Health Metrics and Evaluation (IHME). Data were obtained through the Global Health Data Exchange (GHDx) and covered 204 countries and territories from 1990 to 2019. Variables included ASD-related prevalence, mortality, disability-adjusted life years (DALYs), age-standardized rates, and the sociodemographic index (SDI).

Results

Exposure to autism spectrum disorders contributed to 61823540 prevalence and 11544038 DALYs globally in 2021. Males and younger adults were high-risk populations. Higher socio-demographic index (SDI) regions were high-risk areas. The disease burden varied considerably across the GBD regions and the countries. From 1990 to 2021, the number of cases increased. The predicted results showed that the disease burden for both genders would still increase from 2022 to 2046. Countries or regions with a higher SDI have greater burden improvement potential.

Conclusion

The global burden of ASD has shown a continuous upward trend, with some differences observed across gender, age groups, and SDI regions. In terms of gender, the burden of ASD among females may be underestimated. Regarding age groups, the aging process has highlighted the urgent need to address ASD in the elderly population. High-SDI regions should place greater emphasis on improving diagnostic methods and implementing precise interventions, while middle- and low-SDI regions should focus on raising public awareness and enhancing screening capabilities.

Global burden and future trends of head and neck cancer: a deep learning-based analysis (1980-2030)

BACKGROUND

Head and neck cancer (HNC) becomes a vital global health burden. Accurate assessment of the disease burden plays an essential role in setting health priorities and guiding decision-making.

METHODS

This study explores data from the Global Burden of Disease (GBD) 2021 study, involving totally 204 countries during the period from 1980 to 2021. The analysis focuses on age-standardized incidence, mortality, and disability-adjusted life years (DALYs) for HNC. A Transformer-based model, HNCP-T, is used for the prediction of future trends from 2022 to 2030, quantified based on the estimated annual percentage change (EAPC).

RESULTS

The global age-standardized incidence rate (ASIR) for HNC has escalated between 1980 and 2021, with men bearing a higher burden than women. In addition, the burden rises with age and exhibits regional disparities, with the greatest impact on low-to-middle sociodemographic index (SDI) regions. Additionally, the model predicts a continued rise in ASIR (EAPC = 0.22), while the age-standardized death rate (ASDR) is shown to decrease more sharply for women (EAPC = -0.92) than men (EAPC = -0.54). The most rapid increase in ASIR is projected for low-to-middle SDI countries, while ASDR and DALY rates are found to decrease in different degrees across regions.

CONCLUSIONS

The current work offers a detailed analysis of the global burden of HNC based on the GBD 2021 dataset and demonstrates the accuracy of the HNCP-T model in predicting future trends. Significant regional and gender-based differences are found, with incidence rates rising, especially among women and in low-middle SDI regions. Furthermore, the results underscore the value of deep learning models in disease burden prediction, which can outperform traditional methods.

Organochlorine pesticide residues and urinary arsenic and fluoride levels in mothers and their newborns who are residents of rural areas in Durango State, Mexico

Maternal and prenatal exposure to organochlorine pesticides (OCP), arsenic (As), and fluoride (F-) is a critical public health concern. The present study assessed serum OCP residues and urinary As and F- levels in mother and newborn pairs who are residents of rural areas of Durango State, Mexico, from August 2018 to February 2019. Levels of OCP, As, and F- were measured in serum and urine samples by Gas chromatography - Tandem mass spectrometry (GC - MS/MS), Hydride generation - Atomic fluorescent spectrometry (HG-AFS, and ion-selective electron analysis (ISE), respectively, in 60 binomial mothers - newborns. Dieldrin, endrin aldehyde, and endosulfan-II were significantly higher in newborns than in mothers (p ˂0.05). Meanwhile, no significant differences were observed for As and F- concentrations between mother - newborn pairs. Differences were observed in ∑Dienes and ∑DDTs comparing newborns with normal and low birth weights and a positive relationship in ƩDienes, ƩChlordanes, and ƩDDTs between mother and newborn pairs (p ˂ 0.05). These findings highlight the importance of extensive research regarding the influence of pollution.

Rising Obesity-Associated Mortality in Men: Exploration of Gender Disparity from the Global Burden of Disease Study, 1990-2019

OBJECTIVES

The global rise in overweight, obesity, and related diseases is undeniable; however, the pathogenesis of obesity and obesity-associated diseases is heterogeneous, with varied complications and a discordant response to treatment. Intriguingly, men have a shorter lifespan than women, despite being half as likely to be obese. This paradox suggests a potential gender disparity in the impact of obesity on mortality, with men potentially being more vulnerable to obesity-associated health risks.

METHODS

This retrospective study utilized Global Burden of Diseases data from 204 countries/territories to bridge the knowledge gap in understanding gender disparities in obesity-related mortality. Outcomes were obesity-associated mortality, years of life lost, years lived with disability, and disability-adjusted life years (DALYs).

RESULTS

In 2019, the global overweight/obesity-related disease burden reached 160.2 million DALYs, with 5.02 million associated deaths. From 1990 to 2019, the age-standardized death rates increased in males (from 58.19 to 66.55 per 100,000 person-years, APC = 0.36%, 95% CI: 0.30 to 0.42%, P < 0.001), while females experienced a decrease in age-standardized death rates (from 59.31 to 58.14 per 100,000 person-years, APC = -0.22%, 95% CI: -0.29% to -0.14%, P < 0.001). Age-standardized DALYs increased more in males (1632.5 to 2070.34 per 100,000 years, APC = 0.74%, 95% CI: 0.70% to 0.78%, P < .001) compared to females (1618.26 to 1789.67 per 100,000 years, APC = 0.24%, 95% CI: 0.19% to 0.29%, P < 0.001). Disparities were more pronounced in countries with a higher socioeconomic status and predominantly affected younger populations.

CONCLUSIONS

Overweight/obesity-related morbidity and mortality are higher among male sex. Identifying differences in pathogenesis, complications and treatment response is crucial to develop targeted interventions and equitable public health policies to combat this global burden.

The correlation between plasma cortisol levels and scores of psychological scales among patients with recurrent depressive disorder in Vietnam

OBJECTIVES

We aimed to examine levels of plasma cortisol in the morning and evening before and after standardised treatment, and analyze the correlation between these levels and scores of psychological assessment scales among patients with recurrent depressive disorder (PRDD) in Vietnam.

METHODS

From January 2020 to December 2021, a cross-sectional study was carried out at the National Institute of Mental Health in Bach Mai Hospital. After using a convenience sampling method, 109 consecutive patients met our criteria were recruited. We measured and analysed plasma cortisol levels in all participants at baseline (T0), two weeks after treatment (T1) and four weeks after treatment (T2). Spearman correlation was applied to assess the correlations between plasma cortisol at six different time and scores of six psychological assessment scales including HAM-D, HAM-A, BDI, SAS, DASS, and MMSE.

RESULTS

Among 109 PRDD, the percentage of subjects had high cortisol levels decreased during hospital treatment. At admission (T0), these figures were 4.76% in the morning and 8% in the evening. After 4-week treatment (T2), these figures declined to 1.32% and 3.09%, respectively. At T0, the morning cortisol concentrations had a positive correlation with the mean scores of HAM-A (r = 0.257), BDI (r = 0.251), and SAS (r = 0.276) (p ≤ 0.05), whereas the evening cortisol concentrations in the evening had a positive correlation with the mean scores of BDI (r = 0.197), SAS (r = 0.206), and Depression subscale of DASS (r = 0.252) (p ≤ 0.05). At T2, we did not detect any correlation between morning or evening cortisol levels and six test scores.

CONCLUSION

The utilization of psychological measures for monitoring purposes can facilitate the assessment of alterations in cortisol levels among individuals experiencing recurrent depression, hence aiding in the treatment of depression in this population. Additional investigation using a more extensive sample size is required to furnish additional substantiation on this matter in Vietnam.

The burden of cardiovascular disease in children in Asian countries (1990-2021): Systematic analysis and projection of the burden of disease

Background

Cardiovascular disease (CVD) is the leading global cause of death and health loss. The epidemiology and factors influencing CVD in children are unique, making it essential to first evaluate current and future trends to guide interventions and reduce the disease burden.

Objective

To analyze the incidence, mortality, and disability-adjusted life years (DALY) of CVD in children aged 0-14 from 1990 to 2021, and explore global disease burden, risk factors, and trends over the next 30 years. The study focuses on China, Japan, South Korea, India, and Singapore to aid in developing targeted prevention and treatment strategies.

Methods

Using data from the Global Burden of Disease Study (GBD) 1990-2021, we assessed age- and sex-specific morbidity, mortality, and DALY of CVD in Asian children aged 0-14 and computed the EAPC. We analyzed risk factors, specific causes, and projected prevalence trends through 2050 using the Bayesian Age-Period-Cohort (BAPC) model.

Results

From 1990 to 2021, CVD incidence among Asian children aged 0-14 decreased by 8.03 % (95 % UI:13.63 to -4.02). Mortality saw a significant drop of 67.98 % (95 % UI:73.73 to -62.23), with the greatest decline in children aged 2-4, and the highest death rate in those under 1 year. Disability and mortality patterns were similar across gender, age, etiology, and overall trends. In 2021, South Asia had the highest rates of morbidity, mortality, and disability. Rates varied significantly, with Mongolia exhibiting the highest rate and Cyprus the lowest, showing a sixfold difference. Rheumatic heart disease (RHD) and intracerebral hemorrhage were the most critical diseases needed attention. Abnormal temperatures were identified as a risk factor associated with CVD outcomes in children. The burden of CVD is projected to increase in various regions and countries across Asia.

Conclusion

The burden of CVD continues to challenge children aged 0-14 in Asia. Enhancing our understanding of pediatric CVD epidemiology, addressing risk factors, and reinforcing prevention and control measures are essential for reducing this burden.

Examining the association between service coverage of UHC and global disease burden: A cross-country panel analysis

Over the past two decades, numerous countries have enhanced their Universal Health Coverage (UHC), as indicated by the UHC Service Coverage Index (SCI), alongside a global reduction in the disease burden measured by Disability-Adjusted Life Years (DALYs). This paper uses a cross-country panel of 190 countries from 2000 to 2019 to identify the association between UHC SCI and DALYs gain. We find that a one-unit increase in the UHC SCI was associated with a significant decrease in total DALYs. Furthermore, UHC SCI was mostly associated with lowering DALYs from communicable, maternal, neonatal, and nutritional diseases but showed little to no significant association with non-communicable diseases or injuries. These results are robust to various robustness tests. Notable reasons include governments spending more on communicable, maternal, neonatal, and nutritional diseases than on non-communicable diseases and injuries, which is also the case for external aid. Our results also suggest that moving towards UHC helps lower-income countries more than higher-income countries, as developed nation-states have already established a well-functioning health system. Addressing non-communicable diseases and injuries will be essential to improve health outcomes and achieve SDGs in future.

Importance of hospital food intake for early discharge after total hip arthroplasty for osteoarthritis: a propensity score matching analysis

BACKGROUND

Total hip arthroplasty (THA) is widely used to treat hip osteoarthritis (HOA), particularly in elderly patients. However, the associated costs and complications highlight the need for strategies to shorten hospital stays and optimise postoperative outcomes. This study aimed to investigate the effect of preoperative nutritional status and postoperative dietary intake on the discharge outcomes of patients with unilateral HOA who underwent THA.

METHODS

A retrospective analysis of 57 patients without significant comorbidities out of 172 THA procedures performed by the same surgeon was conducted. Propensity score matching was used to compare the early discharge group (n = 14), discharged within 2 weeks, with the delayed discharge group (n = 14), hospitalised for longer. The assessed factors included preoperative Controlling Nutritional Status (CONUT) scores, postoperative dietary intake (staple foods and side dishes), and complications.

RESULTS

Preoperative malnutrition, as assessed using the CONUT score, showed no significant difference between the groups. The early discharge group exhibited a higher intake of staple foods (rich in carbohydrates) in the early postoperative phase than the delayed discharge group, potentially influencing earlier discharge. No significant difference was observed in side dish intake between the two groups. The incidence of complications did not differ between the two groups.

CONCLUSION

Higher intake of staple foods in the early postoperative period may positively impact metabolic demands and wound healing, suggesting the importance of dietary strategies in postoperative rehabilitation. Ensuring adequate hospital meal consumption and implementing effective dietary guidance and education are crucial for optimising recovery and reducing hospital stay. This study highlights that postoperative feeding strategies, especially staple food intake, may have a positive impact on early discharge in THA patients. Future studies should explore the benefits of long-term nutritional interventions and the role of continuous dietary education in enhancing postoperative recovery.

Breast cancer burden among young women from 1990 to 2021: a global, regional, and national perspective

BACKGROUND

Breast cancer, the most prevalent tumor in women globally, significantly impacts young women, compromising their daily lives and overall well-being. Breast cancer represents a significant public health concern due to its extensive physical and psychological consequences.

MATERIAL AND METHODS

Data from the Global Burden of Disease (GBD) were used to assess the global, regional, and national burden of breast cancer in young women aged 20-39 from 1990 to 2021. This analysis focused on trends measured by the estimated annual percentage change (EAPC) and explored the socioeconomic impacts via the sociodemographic index (SDI).

RESULTS

During 1990-2021, the incidence and prevalence of breast cancer among young women increased globally, with annual rates of 0.82 and 0.87%, respectively. The mortality rate and disability-adjusted life years (DALYs) also rose annually by -0.12% and -0.05, respectively. A significant burden shift was observed towards regions with lower SDI, with diet high in red meat, alcohol use, and high fasting plasma glucose identified as prominent risk factors, particularly in lower SDI regions.

CONCLUSION

Our findings underscore breast cancer in young women as an escalating global health challenge, with the burden increasingly shifting towards lower socioeconomic areas. This underscores the necessity for targeted prevention and control strategies for breast cancer, focusing on reducing the identified risk factors and ensuring equitable health resource distribution.

Global burden of viral skin diseases from 1990 to 2021: a systematic analysis for the global burden of disease study 2021

Background

The scarcity of knowledge regarding the epidemiology and temporal patterns of viral skin diseases worldwide poses significant challenges to their control and management.

Methods

We analyzed the global incidence, prevalence, and age-standardized rates (ASR) of disability-adjusted life years (DALYs) for viral skin diseases in 2021. To examine temporal trends from 1990 to 2021, we employed the EPAC model, assessing changes by country, gender, age, Socio-demographic Index (SDI), and GBD regions. Additionally, we utilized the age-period-cohort (APC) model and the Bayesian age-period-cohort (BAPC) model to forecast the burden of viral skin diseases for the next 25 years.

Results

In 2021, the global burden of viral skin diseases was estimated at 84.7 million incident cases, with a prevalence of over 130 million cases and 4.2 million DALYs. Males experienced a slightly higher ASR burden than females. The highest burden was observed among individuals aged 10 to 19, with significant geographical variations in cases and ASR, particularly in high SDI regions. Unexpected rises in incidence were noted in East Asia and Sub-Saharan Africa in the detected period. Despite modest declines in ASPR and ASDR, the global ASIR displayed a significant upward trend.

Conclusion

Our study provides detailed data on the global impact of viral skin diseases from 1990 to 2021, highlighting the need for continuous surveillance and tailored interventions to manage and reduce the effects of these diseases. Targeted public health measures are essential to address and mitigate the global health burden of viral skin diseases.

Global, regional and national burdens of cardiovascular disease attributable to secondhand smoke from 1990-2019: an age-period-cohort analysis

BACKGROUND

Over the past three decades, significant disparities in the global burden of cardiovascular disease (CVD) have been observed, particularly CVD attributed to secondhand smoke. However, a comprehensive understanding of global trends and their interaction with secondhand smoke remains inadequate.

METHODS

Using Global Burden of Disease data (1990-2019), an age-period-cohort analysis examined temporal trends in CVD mortality among secondhand smoke-exposed populations, considering age, period and cohort interactions.

RESULTS

Over the 30-year period, the global number of CVD deaths attributed to secondhand smoke increased substantially, from 432.6 thousand in 1990 (95% UI: 357.4-508.3) to 598.5 thousand in 2019 (95% UI: 489.7-713.5), representing a 38.4% increase (95% UI: 26.8%-49.5%). In 2019, CVD accounted for 45.9% of all deaths attributable to secondhand smoke among both sexes globally. Among these CVD deaths, ischaemic heart disease predominated, accounting for 66.4% of cases, compared with stroke. The distribution by sex revealed a slightly lower percentage of males (46.5%) than females (53.5%). Age-period-cohort models show overall global decline in CVD mortality due to secondhand smoke over 30 years, with regional, sex and subtype variations. Notably, a higher Sociodemographic Index (SDI) correlated with a greater reduction in mortality, exhibiting a significant 39.1% decrease in high SDI areas (95% UI: 35.6%-42.3%), in stark contrast to the minimal change observed in low SDI areas (0.1%, 95% UI: -52.4%-62.2%).

CONCLUSIONS

This study highlights the importance of considering secondhand smoke as a modifiable CVD risk. Further research is needed to understand disparities in CVD burden across development levels, sexes and subtypes.

Distributions and trends in the global burden of young-onset tracheal, bronchus, and lung cancer by region, age, and sex from 1990 to 2021: An age-period-cohort analysis

BACKGROUND

The young onset Tracheal, Bronchus, and Lung Cancer (TBLC) exhibits distinct gene mutations and clinical characteristics. With worsening air pollution, the incidence of young onset TBLC is increasing, resulting in significant economic burdens. The specific epidemiology of the disease burden remains elusive.

METHODS

The updated Global Burden of Disease (GBD) 2021 study was employed. This study reports on the disease burden trends of young TBLC (≤54 years) and its risk factors. Data is presented as counts and age-standardized rates (ASRs) per 100,000 people across different age groups, years, sexes, sociodemographic levels (SDI), and geographic locations (global, regional, and national). An age-period-cohort (APC) model was used to analyze longitudinal curves on age, period, and cohort effects for young TBLC. Decomposition analysis broke down temporal changes into three factors: population aging, population growth, and epidemiological change, to quantify the changes and identify their causes. An inequality index was applied to examine the inequality of disease burden of young TBLC by sex across different SDI levels between 1990 and 2021.

RESULTS

From 1990-2021, the global number of individuals under 55 diagnosed with TBLC increased from 320,715 to 489,080, representing a 52 % rise. However, the age-standardized rates of prevalence (Average annual percentage changes (AAPC) -0.05 %), incidence (AAPC -0.59 %), mortality (AAPC -0.88 %), and disability-adjusted life-years (DALYs) (AAPC -0.92 %) all showed a notable decline tendency. In 2021, there were 258,360 new diagnoses and 207,000 deaths from young TBLC, with ASRs of incidence and mortality at 6.43 and 5.49 per 100,000, respectively. Regionally, East Asia bore the highest burden, with about 117,730 new young TBLC cases and an ASR of 12.01 per 100,000 people. Decomposition analysis indicated that population growth was the primary driver for the increased prevalence of young TBLC. While tobacco-related DALYs for young TBLC decreased globally, tobacco remains the leading risk factor. In contrast, air pollution-related DALYs have significantly increased in middle and lower SDI regions. Over the past two decades, the burden of young TBLC among females has grown substantially, with increased inequality observed in 2021. Tobacco was the largest contributor to the PAF of young female DALYs in high SDI regions, whereas air pollution was the leading contributor in other SDI regions.

CONCLUSION

While the total number of young TBLC cases has been on the rise trend, primarily due to population changes, the ASRs of young TBLC burdens have decreased over the past two decades. In 2021, East Asia recorded the highest ASRs for young TBLC in terms of prevalence, incidence, and mortality. Tobacco remains the primary risk factor for young TBLC, and the DALYs burden from tobacco use has significantly decreased. However, the incidence of TBLC among non-smoking young females has grown rapidly over the past two decades, mainly due to air pollution, leading to increased inequality.

Symptoms Profile and Psychopathological Correlates of (Hypo)Manic and Depressive Symptoms in Saudis With Bipolar Disorder: Preliminary Evidence

ABSTRACT

Although scientific knowledge about bipolar disorder (BD) is readily available and accumulating, there is still a particular need to inform this inquiry with evidence generated in understudied cultures. This study was set up to fulfill this need, focusing on two objectives: ascertaining the levels of hypo(manic) and depressive symptoms ( i.e. , symptom profile) in Saudis with BD and looking at the psychopathological correlates of bipolarity. These objectives were addressed using data from 87 individuals with BD (M age = 30.95, ±9.58 years) and 86 nonclinical persons (M age = 22.20, ±1.29 years). Racing thoughts was the most common hypo(manic) symptom, whereas depressed mood was the most depressive symptom reported. Somatization and hostility psychopathological dimensions appeared to constitute significant independent predictors of bipolarity, independent of depression and hypo(mania). Findings partially replicate previous ones, indicating a cross-cultural resemblance for BD.

Global, regional and national burden of pancreatic cancer and its attributable risk factors from 2019 to 2021, with projection to 2044

Background

To estimate the global burden of pancreatic cancer in 2019 and 2021 including incidence, mortality, and disability-adjusted-life-years (DALYs).

Methods

Data on pancreatic cancer incidence, mortality and DALYs were downloaded from the Global Health Data Exchange. The 95% uncertainty intervals (UIs) were reported for annual numbers and rates (per 100,000 populations).

Results

In 2021, there were 508,532 (95% UI: 462,09 to 547,208) incident cases of pancreatic cancer globally, of which 273,617 (250,808 to 299,347; 53.8%) were in males. The age-standardized incidence rate was 6.0 (5.5 to 6.5) per 100,000 people in 2019 and decreased to 5.9 (5.4 to 6.4) per 100,000 people in 2021. There was a 3.9% increase in the number of deaths from pancreatic cancer from 486,869 (446,272 to 517,185) in 2019 to 505,752 (461,224 to 543,899) in 2021. There was a 3.5% increase in DALYs due to pancreatic cancer, increasing from 10.9 million (10.1 to 11.7) in 2019 to 11.3 million (10.5 to 12.2) in 2021. In 2021, the highest age-standardized death rates were observed in Greenland and Monaco, and the highest age-standardized DALY rates were observed in Greenland and Uruguay. The numbers of incident cases and deaths peaked at the ages of 70 to 74 years. The pancreatic cancer burden increased as the socio-demographic index increased. To 2044, the number of incident cases and deaths will be more than 875 thousand and 879 thousand, respectively.

Conclusion

The disease burden of pancreatic cancer remains high, especially in high-income regions. More cancer prevention measures are needed in the future to reduce the burden of pancreatic cancer.

Relationship Between Depression and Epigallocatechin Gallate from the Perspective of Gut Microbiota: A Systematic Review

Depression, a serious mental illness, is characterized by high risk, high incidence, persistence, and tendency to relapse, posing a significant burden on global health. The connection between depression and gut microbiota is an emerging field of study in psychiatry and neuroscience. Understanding the gut-brain axis is pivotal for understanding the pathogenesis and treatment of depression. Gut microbes influence depression-like behaviors by impacting the hypothalamic-pituitary-adrenal axis (HPA), monoamine neurotransmitters, immune responses, cell signaling, and metabolic pathways. Tea, widely used in clinical practice to improve neuropsychiatric disorders, contains Epigallocatechin gallate (EGCG), a major ingredient of green tea, which effectively regulates intestinal flora. This review examined the risks and causes of depression, the complications associated with intestinal flora, their role in the development and treatment of depression, and how EGCG may alleviate depression through interactions with gut microbiota and other mechanisms.

Global, regional, and national burden of ovarian cancer among young women during 1990-2019

BACKGROUND

Ovarian cancer, the most devastating tumor in women globally, significantly impacts young women, compromising their daily lives and overall well-being. Ovarian cancer represents a significant public health concern due to its extensive physical and psychological consequences.

MATERIAL AND METHODS

Data from the Global Burden of Disease were used to assess the global, regional, and national burden of ovarian cancer in young women aged 20-39 from 1990 to 2019. This analysis focused on trends measured by the estimated annual percentage change and explored the socioeconomic impacts via the socio-demographic index (SDI).

RESULTS

During 1990-2019, the incidence and prevalence of ovarian cancer among young women increased globally, with annual rates of 0.74% and 0.89%, respectively. The mortality rate and disability-adjusted life years also rose annually by 0.20% and 0.23%, respectively. A significant burden shift was observed toward regions with lower SDI, with high fasting plasma glucose, BMI, and asbestos exposure identified as prominent risk factors, particularly in lower SDI regions.

CONCLUSION

Our findings underscore ovarian cancer in young women as an escalating global health challenge, with the burden increasingly shifting toward lower socioeconomic areas. This underscores the necessity for targeted prevention and control strategies for ovarian cancer, focusing on reducing the identified risk factors and ensuring equitable health resource distribution.

Merits of the social return on investment methodology for assessing the value of palliative care programmes

Despite the widely accepted benefits of palliative care for individuals with serious illnesses and their families, the utilisation of this approach remains low. Although an increased use of palliative care services can increase the value of health-care spending by providing comprehensive wraparound services to support care, the economic evidence required to implement, promote, and engage in palliative care models on a wide scale eludes the affected individuals, health-care providers, payers, and policy makers. This gap in evidence is partly owing to the methodological limitations of standard value-assessment frameworks, which do not capture important societal dimensions of the value generated by palliative care. This Personal View proposes the adoption of value-assessment frameworks that incorporate broader dimensions of social value into the evaluation of palliative care programmes. We focus on the social return on investment methodology as an example of a value-assessment framework that can complement standard frameworks to better capture the social impact and all-around benefits of palliative care.

Perfluoroalkyl and polyfluoroalkyl substances and Cancer risk: results from a dose-response Meta-analysis

Background

Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are persistent organic pollutants in the environment. While some studies suggest that PFASs may contribute to cancer development, the link between PFAS exposure and cancer risk remains debated.

Methods

This dose-response meta-analysis explores the relationship between PFASs and cancer. It employs odds ratio (OR) and standardized mean difference (SMD), along with their 95% confidence interval (CI), to assess the effects of PFASs on cancer risk. Relevant studies were sourced from Web of Science, PubMed, Embase, Medline, and CNKI databases. The dose-response relationship was assessed by the fixed-effects model and least-squares regression.

Results

Forty studies, involving a total of 748,188 participants, were included in this meta-analysis. Out of these, 13 studies were specifically analyzed for the dose-response relationship. Findings revealed that exposure to PFASs, especially PFDA, significantly raises the risk of genitourinary cancers, and PFDA exposure shows a dose-dependent increase in overall and breast cancer risk. Additionally, PFOS exposure is associated with an increased cancer risk, and elevated PFOA levels were significantly observed in breast cancer patients.

Conclusions

The findings suggest that PFAS exposure is a potential cancer risk factor, with the carcinogenic potential of PFDA being dose-dependent.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40201-024-00899-w.

The burden of type 2 diabetes attributable to dietary risks in China: Insights from the global burden of disease study 2021

OBJECTIVES

This study aims to comprehensively assess how dietary risk factors have influenced the prevalence of Type 2 Diabetes Mellitus (T2DM) in China from 1990 to 2021. The study seeks to provide robust data and scientific evidence essential for formulating effective preventive and control strategies to combat T2DM in China.

STUDY DESIGN

This cross-sectional study conducted secondary analyses using data from the Global Burden of Disease 2021 (GBD 2021) to assess the burden of T2DM in China attributable to dietary risks.

METHODS

The study analyzed age-adjusted metrics related to T2DM, including death counts, Disability-Adjusted Life Years (DALYs), and Age-Standardized Rates (ASRs), using GBD 2021 data, stratified by age and sex. Additionally, Estimated Annual Percentage Changes (EAPCs) were employed to track trends over time.

RESULTS

In 2021, the results show that 21.43 % of T2DM-related deaths and 23.51 % of DALYs were attributable to dietary risk factors, notably a diet low in whole grains and high in red and processed meats. Over the period from 1990 to 2021, there has been an increasing trend in the EAPCs of death rates and DALYs associated with dietary risks in China, suggesting a substantial impact of dietary factors on the burden of T2DM in the country.

CONCLUSION

This study highlights the urgent need for targeted public health interventions to promote dietary changes and reduce the burden of T2DM in China.

Chartering Patient Flights for Surgery in a Road Inaccessible Nation: The Samaritan's Purse Cleft Lip Missions Model in South Sudan

INTRODUCTION

Few patients in South Sudan have access to cleft lip repair due to limitations in health care facilities, personnel and road infrastructure. Samaritan's Purse is a non-governmental organization that provides chartered flights from road inaccessible regions to a single central hospital in this nation's capital. This study's purpose was to describe the chartered flight model for conducting nationwide cleft lip mission trips.

METHODS

The authors performed a retrospective chart review of all patients who received cleft lip surgery at Juba Teaching Hospital during mission trips from 2011 to 2023. Patient sex, age, cleft characteristics, and home location were retrieved. Disability-adjusted life years (DALYs) were calculated and compared with the GDP/capita to assess cost-effectiveness using World Health Organization (WHO) standards.

RESULTS

Chart review identified 1085 patients who received cleft lip surgery. The average age of patients decreased from a high of 14.0 years in 2013 to a low of 8.2 years in 2023 (P<0.001). Patients were flown to Juba from all 10 states of South Sudan. The number of patients treated correlated with the state population (P<0.001). Each mission utilized an average of 14 flight paths. The cost of intervention per DALY averted was less than the GDP/capita of South Sudan, indicating the procedure was very cost-effective by WHO standards.

CONCLUSIONS

Flight chartered mission trips in South Sudan have significantly decreased the backlog of patients with cleft lip in that country and are very cost-effective according to WHO standards. Investigating this model's utility for other surgical missions while continuing to build local surgical capacity is warranted.

Spatial and temporal modeling of the global burden of Cutaneous Leishmaniasis in Brazil: A 21-year ecological study

BACKGROUND

Cutaneous Leishmaniasis (CL) is a neglected tropical disease endemic in Brazil. Morbidity and disabilities caused by CL lesions require an analysis of a Global Burden of Disease (GBD), which would help discern the impact on the Brazilian population. Herein, we assess the burden of CL and its spatial and temporal patterns in Brazil between 2001 and 2021.

METHODOLOGY/PRINCIPAL FINDINGS

We estimated rates per 100,000 population for years lived with disabilities (YLD), years of life lost prematurely (YLL) and disability-adjusted life years (DALY) for each year of the study, sex assigned at birth, age group, and for each municipality in Brazil. In addition, the relative changes in these metrics over time for each region and sex were determined, as well as temporal trends using segmented joinpoint regression models. Using spatiotemporal analysis tools, we created choropleth maps representing DALY, YLD and YLL for three distinct periods (P1 = 2001 to 2007; P2 = 2008 to 2014; P3 = 2015 to 2021). These maps were constructed to visualize the inferences from Bayesian spatial statistics and Moran's autocorrelation using the Poisson model. The data were obtained from the DATASUS database. Although the global burden of CL has reduced over two decades, with the continual high impact among adults aged 20 to 39 years. In turn, YLL increased over time in 40-year-old populations, while among the elderly (>60 years old) this rate almost doubled from 2010 to 2021. Regarding the region of residence, we observed an average increase of 28% in YLL in Southeast, South and Central-West. Furthermore, the global burden of CL does not have a random spatial distribution, since there was a high-risk clustering of YLD in the north of the country. Interestingly, the YLL showed a vast geographic expansion through Brazilian territory.

CONCLUSIONS

This study provides a comprehensive analysis of the burden of CL in Brazil, pointing out areas of highest disease burden, where control and surveillance efforts should be undertaken.

Linking acculturation stress, parenting stress and depression of Asian expatriates' wives in the USA with their distress disclosure intention: The moderating role of husband's support

The present circumstances of Asian expatriates' wives residing in the United States and the effects of acculturation stress, parenthood stress, and depression on the distress disclosure intention have been examined this study. The nature of this investigation is exploratory. 611 married women with children who reside in the United States provided data, which was then processed with a measurement model, structural analysis, mediating analysis, moderating analysis, and regression analysis. Structural analysis showed that acculturation stress influenced parenting stress and depression. In addition, it is viewed that there is the positive link between parenting stress, and depression; distress disclosure intention was caused by parenting stress and depression. Finally, it is observed from the regression analysis that supportive husband interactions had not moderated the link between depression and distress disclosure intention. The data gathered from Asian women who live overseas and have children makes the empirical proof possible. The developed conceptual framework can be used in other geographical areas.

The cardiovascular disease burden attributable to kidney dysfunction from 1990 to 2021: an age-period-cohort analysis of the Global Burden of Disease study

BACKGROUND

Kidney dysfunction (KD) poses a severe threat to human health. The aim of this study is to gain a comprehensive understanding of the trends in cardiovascular disease (CVD) burden attributable to KD, thereby providing a theoretical basis for relevant public health policies.

METHODS

This study analyzed trends in the burden of CVD attributable to KD using the 2021 Global Burden of Disease data. It also examined the differences in mortality rates across various age groups, genders, and subtypes of CVD. Additionally, the age-period-cohort model combined with joinpoint regression analysis was employed to gain further insights into the changing trends and inflection points of CVD-related mortality.

RESULTS

In 2021, the global number of deaths from CVD attributable to KD significantly increased compared to 1990. However, the global age-standardized mortality rate (ASMR) decreased in 2021. The burden of CVD due to KD was particularly heavy among the elderly. Analysis using the age-period-cohort model revealed a decline in CVD-related mortality rates, with similar trends observed for both men and women.

CONCLUSIONS

This study reveals that although the ASMR for CVD due to KD is on a declining trend globally, the absolute number of deaths has significantly increased. This trend is especially pronounced among individuals aged 80 and older, males, and regions with a middle socio-demographic index (SDI). In the context of global aging, the burden of CVD related to KD is becoming increasingly substantial.

Estimating the economic impact of gender-based violence on women survivors: A comparative study of support program interventions in Makueni and Naivasha, Kenya

OBJECTIVE

To estimate the economic cost of GBV from the perspective of a women survivor who sought help from two identified programs (Makueni GBVRC and Life Bloom Services International [LBSI]).

DESIGN

A mixed method research design combining qualitative and quantitative approaches. SITE: Makueni GBVRC in Makueni County, overseen by the Makueni County government, and LBSI in Naivasha, Nakuru County, a non-profit organization devoted to serving local communities.

PARTICIPANTS

Study participants include women survivors of GBV, aged 18 and above, actively seeking services at Makueni GBVRC and LBSI.

INTERVENTIONS

The study adopts a qualitative approach to delve into the intricate economic costs of GBV on survivors. Additionally, quantitative data analysis employs an accounting model to ascertain the financial implications.

MAIN MEASUREMENTS

The costs analyses were done from the perspective of the women survivors. An accounting model was utilized to evaluate the cost of GBV on selected survivors. Furthermore, the research explores the enduring consequences for survivors, including psychological trauma and susceptibility to stress-related diseases.

RESULTS

The findings reveal substantial economic costs linked to GBV, adversely affecting survivors, their children, and society at large. These costs encompass direct expenditures on medical care, legal representation, and counseling, as well as indirect costs, such as lost productivity.

CONCLUSIONS

Beyond immediate and indirect costs, the study underscores the existence of opportunity costs-what survivors and affected children could attain in the absence of GBV.

A Systematic Review of EEG and MRI Features for Predicting Long-Term Neurological Outcomes in Cooled Neonates With Hypoxic-Ischemic Encephalopathy (HIE)

Neonatal hypoxic-ischemic encephalopathy (HIE) represents a significant global disease burden, but more importantly, it leaves a lasting impact of disability on individual children and their families. HIE outcome prognostication is important for guiding clinical interventions and counseling families. The objective of this study was to systematically review early electroencephalogram (EEG) and magnetic resonance imaging (MRI) features associated with long-term neurological outcomes in infants after perinatal HIE. Articles were extracted from PubMed, CINAHL, and Scopus. Twenty studies were included that assessed EEG and/or MRI patterns in neonates who underwent therapeutic hypothermia and were followed to determine long-term outcomes. Articles that did not meet the inclusion criteria were excluded. Covidence review manager (Melbourne, Australia: Covidence) was used to extract, evaluate, and synthesize review results. Of the articles included, eight focused on EEG features, eight on MRI features, and four on assessments using both EEG and MRI. Abnormal EEG background and burst suppression severity were associated with poor outcomes. Higher MRI injury scores in the basal ganglia and thalamus were also correlated with poor outcomes. Finally, studies also revealed restricted diffusion and greater lesion size in the subcortical gray matter correlated with poor outcomes. We also identified limitations in the included studies which primarily involved sample size, potential for MRI pseudonormalization, and the potential tradeoff between retention of infants able to receive long-term follow-up and attrition of those lost to follow-up. We conclude that EEG background patterns, MRI scoring, subcortical lesion burden, and MRI diffusivity are sensitive metrics for predicting outcomes. Both early EEG and MRI features may serve as high-fidelity biomarkers for secondary energy failure and for counseling families of neonates at high risk for devastating neurologic outcomes. Additionally, there is a paucity of information on the impact of HIE on brain areas outside of the standard clinical basal-ganglia and watershed patterns, especially in locations like the corpus callosum. Finally, MRI pseudonormalization may underestimate the extent of injury in these studies.

Prevalence and Characteristics of Tuberculosis in the Korean Homeless Population Based on Nationwide Tuberculosis Screening

BACKGROUND

The government of Korea implemented a strategy of prevention and early diagnosis in high-risk groups to reduce the tuberculosis (TB) burden. This study aims to investigate the TB epidemiology and gap in understanding of TB prevalence among homeless individuals by analyzing active TB chest X-ray (CXR) screening results in Korea.

METHODS

The Korean National Tuberculosis Association conducted active TB screening with CXR for homeless groups from January 1 to December 31, 2021. Sputum acid-fast bacilli smear and culture were performed for the subjects suggestive of TB on CXR. We performed a cross-sectional analysis of the data in comparison with the national health screening results from the general population.

RESULTS

Among 17,713 homeless persons, 40 (0.23%), 3,077 (17.37%), and 79 (0.45%) were categorized as suggested TB, inactive TB, and observation required, respectively. Prevalence of suggested TB in the homeless was significantly higher (3-5 fold) than in Univerthe national general health screening based on age category (p<0.005). Twenty-nine cases were confirmed as TB, yielding a prevalence of 164 cases per 100,000 individuals; 19 of these 29 cases showed inactive TB on CXR. Body mass index (p=0.0478) and CXR result (p<0.001) significantly correlated with confirmed TB based on multivariable analysis.

CONCLUSION

Nutrition status and CXR results, especially that of inactive TB, should be considered in active TB screening of the homeless population, where TB prevalence is higher than the general population.

Fixed-Dose Antiplatelet Dual Combination in Patients with Coronary Artery Disease in Turkish Population: DAPT-TR

BACKGROUND

Dual antiplatelet therapy (DAPT) is the treatment of choice for patients with acute and chronic coronary syndromes as it reduces mortality and prevents recurrent thrombotic complications. The assessment of both ischaemic burden and bleeding risk is crucial in deciding which DAPT to choose and how long it should be continued.

OBJECTIVES

The aim of our study was to perform prospective clinical follow-up of patients receiving fixed-dose combination therapy (ASA 75 mg + clopidogrel 75 mg). Our study is a multicentric, cross-sectional, observational, cohort study.

METHODS

A total of 1500 patients who were started on fixed-dose combination DAPT for acute or chronic coronary syndrome were included in the study. Primary endpoints were hospitalization for any reason, hospitalization for cardiovascular cause, acute myocardial infarction, stent thrombosis, target vessel revascularization and bleeding; the secondary endpoints were death for any reason or cardiovascular cause and stroke. The significance level adopted in the statistical analysis was 5%.

RESULTS

Median age was 63 years; 78.5% of the patients were receiving DAPT treatment for acute coronary syndrome. The rates of hospitalization for cardiovascular reasons, acute myocardial infartion, stent thrombosis and target-vessel revascularization were 7.9%, 2.3%, 1.3% and 4.2%, respectively. While the rate of BARC type 1 bleeding was 3.3%, the rate of BARC type 5, 3, or 2 bleeding was 0.6%. The secondary endpoints which were death from any cause, cardiovascular death and stroke were 0.5%, 0.3% and 0.3%, respectively. Conclusion: Our study shows that fixed-dose combination therapy is effective and safe in appropriately selected patients with acute or chronic coronary syndromes.

Resective epilepsy surgery and its impact on depression in adults: a systematic review, meta-analysis, and implications for future research

BACKGROUND

How epilepsy surgery influences the bidirectional relationship of epilepsy and depression remains poorly defined.

METHOD

For a better understanding of this question, we conducted a systematic review and meta-analysis of risk ratio on depression prevalence before and after epilepsy surgery, using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Three databases were comprehensively screened for all studies assessing depression before and after resective surgery in adult epileptic patients until 8 October 2022. Studies were included if depression was assessed before and after epilepsy surgery regardless of the time of follow-up. A total of 1917 studies were screened for eligibility and 91 full-texts up for inclusion; 35 studies were finally included, 25 studies and 2563 patients were included in main meta-analysis and 10 for exploratory analysis. Risk of bias was assessed using Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) from Cochrane. To derive the pooled depression rates before and after surgery, a meta-analysis with inversed-variance was performed using random-effects logistic models with Peto's correction and a 95% CI. Heterogeneity was assessed with Cochran's Q-test along with its derived measure of inconsistency I2.

RESULTS

Overall, the depression rates before and after resective epilepsy surgery were 0.70 (0.53 to 0.91) 95% CI, suggesting that the rate of depression at last follow-up evaluation tends to decrease after Resective Epilepsy Surgery (RES). Subgroup analysis suggest a positive long-term effect appears with a significant lower rates of depression already 6 months (0.61 (0.38 to 0.98)), after surgery which is maintained over time after 1 year (0.53 (0.31 to 0.90)), and after 2 years (0.62 (0.42 to 0.92)).

CONCLUSION

This important finding should be taken in consideration before resective surgery for drug-resistant epilepsies. However, prospective studies should be conducted to characterise which patient, at the individual level, might be at risk of de novo or worsening of depression.

PROSPERO REGISTRATION NUMBER

CRD42022355386.

Discontinuation of Antidepressants and the Risk of Medication Resumption among Community-Dwelling Older Adults with Depression in the US

Antidepressants are among the most prescribed drugs in the US, but the current treatment patterns and modalities among older adults are unclear. This study assessed the patterns of discontinuation of antidepressants and the risk of medication resumption among community-dwelling older adults with depression. Using Medicare Current Beneficiary Survey (MCBS) data from 2015-2019, we identified 1084 beneficiaries with depression who newly initiated serotonergic antidepressants. The risk of medication resumption was explored using survival analysis. The median duration of continuous medication was 90 days. However, about 30% of patients had a treatment duration of 30 days or shorter, 26% for 31-90 days, 15% for 91-180 days, and 30% for 181 days or more. After adjusting for all covariates, patients with less than 30 days of continuous medication were half as likely to resume the medications compared to those with 91-180 days (HR: 0.49 (95% CI: 0.37, 0.65)). Nearly one-third of older adults used an antidepressant medication for a short duration with a lower risk of medication resumption. A shorter treatment duration without resumption might suggest over-prescription of antidepressants among community-dwelling older adults.

A systematic review of studies that estimated the burden of chronic non-communicable rare diseases using disability-adjusted life years

BACKGROUND

Initiatives aiming to assess the impact of rare diseases on population health might be hampered due to the complexity of disability-adjusted life years (DALYs) estimation. This study aimed to give insight into the epidemiological data sources and methodological approaches used in studies that estimated DALYs for chronic non-communicable rare diseases (CNCRD), and compare its results.

METHODS

A literature strategy was developed for peer-review search in Embase and Medline, and also performed on grey literature databases and population health and/or rare disease-focused websites. We included studies that determined the burden of CNCRD listed on the Orphanet's and/or the Genetic and Rare Diseases information center (GARD) websites. We excluded communicable and occupational diseases, rare cancers, and cost-effectiveness/benefit studies. Two researchers independently screened the identified records and extracted data from the final included studies. We used the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) statement to assess the quality of reporting of the included studies. The data synthesis depicted the studies' characteristics, their distribution by geographic coverage and the group of disease(s) they focused on, the methods and data input sources used and estimated DALY per case.

RESULTS

In total, 533 titles were screened, and 18 studies were included. These studies covered 19 different CNCRDs, of which most fell in the disease category "Diseases of the nervous system". Diverse methodological approaches and data input sources were observed among burden of CNCRD studies. A wide range of DALY per case was observed across the different studies and diseases included.

CONCLUSIONS

A low number of burden of CNCRD studies was observed and most estimates resulted from multi-country studies, underlining the importance of international cooperation to further CNCRD research. This study revealed a lack of epidemiological data and harmonization of methods which hampers comparisons across burden of CNCRD studies.

Heritability of carotid intima-media thickness and inflammatory factors of atherosclerosis in a Chinese population

Carotid intima-media thickness (cIMT), a marker of subclinical atherosclerosis, has been found to be associated with incident stroke. High-sensitivity C-reactive protein (CRP) and fibrinogen have been demonstrated to be associated with atherosclerosis. Previous studies on heritability estimates of IMT, CRP, and fibrinogen among Chinese populations are limited. This study aims to estimate the heritability of these risk factors in residents who participated in the Taichung Community Health Study (TCHS) and their family members. A total of 2671 study subjects from 805 families were enrolled in the study, selected from a random sample of TCHS participants and their family members. CRP, and fibrinogen were obtained from each participant, and a questionnaire interview was conducted. cIMT was measured by high-resolution B-mode ultrasound and expressed as the mean of the maximum. Heritability estimates and the familial correlation of cIMT, CRP, and fibrinogen among family pairs were determined with SAGE software. With multivariate adjustments, significant heritability was found for cIMT (h2 = 0.26, P < 0.001), CRP (h2 = 0.34, P < 0.001), and fibrinogen (h2 = 0.48, P < 0.001). The intrafamilial correlation coefficients for the three indexes in the parent-offspring pairs were significant (P < 0.001) and ranged from 0.17 to 0.41. The full sibship correlations were also significant (P < 0.001) for the three indexes and ranged from 0.19 to 0.47. This study indicates that a moderate proportion of the variability in CRP, fibrinogen, and cIMT can be attributed to genetic factors in Chinese populations. The findings suggest that CRP is associated with cIMT, whereas no significant association exists between fibrinogen and cIMT.

Participatory asset mapping and photovoice interviews to scope cultural and community resources to reduce alcohol harm in Chitwan, Nepal

AIMS

To scope the breadth of existing cultural and community assets and how alcohol drinkers and community health workers perceived them in relation to reducing alcohol-related harm.

METHODS

The study was conducted in Chitwan, south-central Nepal, which has considerable alcohol problems. Participatory asset mapping was conducted using field notes, photography, and through engaging with communities to explore how community assets affect alcohol consumption. Semi-structured photovoice interviews were conducted with harmful/hazardous drinkers (AUDIT score 8 to 19) and community health workers. Purposive and snowball sampling were used to recruit participants. During interviews, participants used their photographs to reflect on how community assets influenced alcohol use. Thematic framework analysis was used to analyse the data.

RESULTS

We recruited 12 harmful/hazardous drinkers (3 females) and 6 health workers (2 females). The mean AUDIT score of the former was 12.17 (SD ±2.86). Thematic analysis of the photovoice interviews produced three themes: 'influences and impact of families and communities'; 'culture and spirituality'; and 'nature and the environment'. The community mapping produced five assets that promoted alcohol consumption: (1) availability; (2) advertising; (3) negative attitudes towards users; (4) festivals/gatherings; and (5) illiteracy/poverty. Six assets that discouraged consumption were: (1) legislation restricting use; (2) community organisations; (3) cultural/spiritual sites; (4) healthcare facilities; (5) family and communities; and (6) women's community groups. Those from certain ethnic groups consumed more alcohol, experienced more family discord, or felt stigmatised due to their drinking. Assets 'festivals/gatherings' and 'negative attitudes toward users' and the theme 'family and communities' concerned with relationships and community activities were perceived to both promote and reduce alcohol use.

CONCLUSIONS

This study provides new insight into a variety of cultural and community assets that promote and reduce alcohol use. The study identifies new possibilities to build on visual participatory and arts-based methods that have potential to be effectively implemented at scale.

The Pathology of the Brain Eating Amoeba Naegleria fowleri

The genus Naegleria is a taxonomic subfamily consisting of 47 free-living amoebae. The genus can be found in warm aqueous or soil habitats worldwide. The species Naegleria fowleri is probably the best-known species of this genus. As a facultative parasite, the protist is not dependent on hosts to complete its life cycle. However, it can infect humans by entering the nose during water contact, such as swimming, and travel along the olfactory nerve to the brain. There it causes a purulent meningitis (primary amoebic meningoencephalitis or PAME). Symptoms are severe and death usually occurs within the first week. PAME is a frightening infectious disease for which there is neither a proven cure nor a vaccine. In order to contain the disease and give patients any chance to survival, action must be taken quickly. A rapid diagnosis is therefore crucial. PAME is diagnosed by the detection of amoebae in the liquor and later in the cerebrospinal fluid. For this purpose, CSF samples are cultured and stained and finally examined microscopically. Molecular techniques such as PCR or ELISA support the microscopic analysis and secure the diagnosis.

Does women's decision-making autonomy matter in utilization of antenatal care services in India? An analysis from nationally representative survey

The primary goal is to examine the association between women's decision-making autonomy and utilization of antenatal care services among ever-married women in India. The entire study has been accomplished with the help of secondary data composed from the latest round of the National Family Health Survey (NFHS-5) conducted during 2019-21. A total of 34,618 ever-married women aged 15-49 with at least one live birth preceding five years of the survey have been taken into consideration in this study. Bivariate and multivariate analyses were conducted for proper illustration of the outcome. A sizable proportion of women did not fulfill the WHO-recommended criterion of obtaining ANC services. Utilization of full ANC services is found in some regions of southern, eastern, northern, and northeastern states, and in some districts of Gujarat. After adjusting the other explanatory variables, the result of multivariate analysis indicates that women's autonomy is significantly and positively associated with the utilization of full antenatal care services. Women who participate actively in decision-making are more likely to use full ANC services (AOR: 1.316, 95% CI: 1.197-1.446, p<0.05). Additionally, likelihood of utilization of full ANC services is high among women aged 25-34 years, are educated, have access to the media, come from richest wealth quintile, and are from southern, western, and eastern regions. Therefore, appropriate measures should be adopted to eliminate gender bias and promote women's empowerment for the overall improvement of maternal health as well as societal health.

Exploring the factors behind socioeconomic inequalities in Antenatal Care (ANC) utilization across five South Asian natiaons: A decomposition approach

Maternal and child mortality rates remain a significant concern in South Asian countries, primarily due to limited access to maternal care services and socioeconomic disparities. While previous studies have examined the factors influencing the utilization of antenatal care (ANC) services in individual countries, there is a lack of comparative analysis across South Asian nations. This study aims to investigate the factors affecting ANC utilization among women aged 15-49 in Bangladesh, India, Nepal, Maldives, and Pakistan using the latest Demographic and Health Survey data. The study utilized a total weighted sample size of 262,531 women. Simple bivariate statistics and binary logistic regression were employed to identify potential factors influencing ANC utilization. Decomposition analysis and concentration curve (Lorenz curve) were used to assess inequality in ANC service utilization. The prevalence of ANC utilization varied across the countries, with Maldives having the highest (96.83%) and Bangladesh the lowest (47.01%). Women's and husbands' education, household wealth status, BMI, and urban residence were found to significantly influence maternal healthcare services utilization. Higher education levels, affluent wealth quintiles, and urban living were identified as significant contributors to socioeconomic disparities in accessing ANC services. This study highlights the crucial role of socioeconomic factors in the utilization of maternal healthcare services in South Asian countries. Governments should focus on improving healthcare infrastructure, addressing cultural barriers, and promoting education to address these disparities. Identifying context-specific causes of maternal healthcare utilization is essential to inform targeted interventions and policies aimed at improving access to ANC services and reducing maternal mortality rates.

Impact of twelve immunization-preventable infectious diseases on population health using disability-adjusted life years (DALYs) in Spain

BACKGROUND

The objective of this study is to estimate the burden of selected immunization-preventable infectious diseases in Spain using the Burden of Communicable Diseases in Europe (BCoDE) methodology, as well as focusing on the national immunization programme and potential new inclusions.

METHODS

The BCoDE methodology relies on an incidence and pathogen-based approach to calculate disease burden via disability-adjusted life year (DALY) estimates. It considers short and long-term sequelae associated to an infection via outcome trees. The BCoDE toolkit was used to populate those trees with Spanish-specific incidence estimates, and de novo outcome trees were developed for four infections (herpes zoster, rotavirus, respiratory syncytial virus [RSV], and varicella) not covered by the toolkit. Age/sex specific incidences were estimated based on data from the Spanish Network of Epidemiological Surveillance; hospitalisation and mortality rates were collected from the Minimum Basic Data Set. A literature review was performed to design the de novo models and obtain the rest of the parameters. The methodology, assumptions, data inputs and results were validated by a group of experts in epidemiology and disease modelling, immunization and public health policy.

RESULTS

The total burden of disease amounted to 163.54 annual DALYs/100,000 population. Among the selected twelve diseases, respiratory infections represented around 90% of the total burden. Influenza exhibited the highest burden, with 110.00 DALYs/100,000 population, followed by invasive pneumococcal disease and RSV, with 25.20 and 10.57 DALYs/100,000 population, respectively. Herpes zoster, invasive meningococcal disease, invasive Haemophilus influenza infection and hepatitis B virus infection ranked lower with fewer than 10 DALYs/100,000 population each, while the rest of the infections had a limited burden (< 1 DALY/100,000 population). A higher burden of disease was observed in the elderly (≥ 60 years) and children < 5 years, with influenza being the main cause. In infants < 1 year, RSV represented the greatest burden.

CONCLUSIONS

Aligned with the BCoDE study, the results of this analysis show a persisting high burden of immunization-preventable respiratory infections in Spain and, for the first time, highlight a high number of DALYs due to RSV. These estimates provide a basis to guide prevention strategies and make public health decisions to prioritise interventions and allocate healthcare resources in Spain.

Global incidence and prevalence of gastritis and duodenitis from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND AND AIM

Gastritis and duodenitis, prevalent diseases of the digestive system, impose a significant global burden. This study aimed to examine their incidence and prevalence patterns worldwide, including changes over the past 30 years.

METHODS

The age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of gastritis and duodenitis, stratified by age, sex, geographical region, and sociodemographic index (SDI), were obtained from the Global Burden of Disease 2019. The dynamic trends were captured by calculating the average annual percentage changes (AAPC).

RESULTS

In 2019, the global ASIR and ASPR of gastritis and duodenitis were 379.88/100 000 (95% uncertainty interval [UI]: 312.42/100 000-448.12/100 000) and 518.11/100 000 (95% UI: 420.62/100 000-631.66/100 000), respectively. The highest rates were observed among the 50-69 age group (ASIR: 856.48/100 000; ASPR: 1158.04/100 000) and in low SDI regions (ASIR: 443.33/100 000; ASPR: 631.22/100 000). From 1990 to 2019, there was a significant decrease in global ASIR (AAPC = -0.34%, 95% confidence interval [CI]: -0.36% to -0.31%) and ASPR (AAPC = -0.34%, 95% CI: -0.37% to -0.31%) of gastritis and duodenitis. However, ASIR (AAPC = 0.47%, 95% CI: 0.42%-0.52%) and ASPR (AAPC = 0.51%, 95% CI: 0.47%-0.52%) of gastritis and duodenitis experienced a significant increase in low SDI regions.

CONCLUSIONS

Despite a significant decrease in the global incidence and prevalence of gastritis and duodenitis, these conditions continue to impose a burden on individuals aged 50-69 years and low SDI regions. Targeted interventions for those specific populations and regions are necessary.

Etiology-specific incidence and mortality of diarrheal diseases in the African region: a systematic review and meta-analysis

BACKGROUND

Diarrheal diseases substantially affect public health impact in low- and middle-income countries (LMIC), particularly in Africa, where previous studies have indicated a lack of comprehensive data. With a growing number of primary studies on enteric infections in Africa, this study aimed to estimate the incidence and mortality of diarrheal pathogens across all ages in Africa in the year 2020. We also explored different methodological assumptions to allow comparison with other approaches.

METHODS

Through a systematic review and meta-analysis of data from African LMICs, we estimated the etiology proportions for diarrheal diseases and deaths. We combined the etiology proportions with incidence data collected from a population survey in Africa from 2020 and mortality data from the Global Health Observatory of WHO.

RESULTS

We estimated 1,008 billion diarrhea cases (95% UI 447 million-1,4 billion) and 515,031 diarrhea deaths (95% UI 248,983-1,007,641) in the African region in 2020. In children under five, enteroaggregative E. coli (EAEC) (44,073 cases per 100,000 people, 95% UI 18,818 - 60,922) and G. lamblia (36,116 cases per 100,000 people, 95% UI 15,245 - 49,961) were the leading causes of illness. Enteroinvasive E. coli (EIEC) (155 deaths per 100,000 people, 95% UI 106.5-252.9) and rotavirus (61.5 deaths per 100,000 people, 95% UI 42.3-100.3) were the primary causes of deaths. For children over five and adults, Salmonella spp. caused the largest number of diarrheal cases in the population of children ≥ 5 and adults (122,090 cases per 100,000 people, 95% UI 51,833 - 168,822), while rotavirus (16.4 deaths per 100,000 people, 95% UI 4.2-36.7) and enteroaggregative E. coli (EAEC) (14.6 deaths per 100,000 people, 95% UI 3.9-32.9) causing the most deaths. Geographically, the highest incidence of diarrhea was in Eastern Africa for children under five (114,389 cases per 100,000 people, 95% UI 34,771 - 172,884) and Central Africa for children over five and adults (117,820 cases per 100,000 people, 95% UI 75,111-157,584). Diarrheal mortality was highest in Western Africa for both children below five and above (children < 5: 194.5 deaths per 100,000 people, 95% UI 120-325.4; children ≥ 5 and above: 33.5 deaths per 100,000 people, 95% UI 12.9-75.1).

CONCLUSION

These findings provide new information on the incidence and mortality of sixteen pathogens and highlight the need for surveillance and control of diarrheal infectious diseases in Africa. The cause-specific estimates are crucial for prioritizing diarrheal disease prevention in the region.

Factors influencing the overall satisfaction of teachers participating in a nationwide school-based smoking prevention program in Korea

INTRODUCTION

Numerous studies of school-based smoking prevention programs (SSPPs) exist; however, most have been conducted from the students' perspective, and insufficient research has explored teachers' perceptions. Our study aimed to identify factors affecting overall satisfaction and operational status from the perspective of teachers participating in the SSPP.

METHODS

This is a cross-sectional study analyzing data from a survey regarding the operation of an SSPP conducted by the Korea Health Promotion Institute in 2022. The study sample comprised 669 teachers involved in the SSPP: 215 from elementary schools, 212 from middle schools, and 242 from high schools. To identify factors influencing teachers' overall satisfaction, independent variables were categorized into three types of factors: personal, school, and teacher perceptions. Multiple linear regression analysis was performed for each factor to test the independent association.

RESULTS

For elementary school teachers, as the necessity of smoking prevention and cessation education (β=0.292; 95% CI: 0.182-0.382) increased, the overall satisfaction with the operation of the SSPP significantly improved. Similarly, for middle school teachers, as the necessity of smoking prevention and cessation education (β=0.231; 95% CI: 0.104-0.336) increased, the overall satisfaction significantly improved. Conversely, for high school teachers, the effectiveness (β=0.347; 95% CI: 0.184-0.520) was the variable that significantly improved overall satisfaction with the SSPP operation. The variables affecting teacher satisfaction across all school levels were the necessity of smoking prevention and cessation education, the effectiveness of the SSPP, and its impact on smoking cessation among smoking students, all of which belonged to the teacher perceptions factor.

CONCLUSIONS

Smoking education in schools requires teachers to play a crucial role. Among participating teachers, overall satisfaction with SSPP operations and the influencing factors differed according to school level, highlighting the importance of careful consideration to establish a more effective operational environment tailored to each school level.

Preventable Deaths Attributable to Second-Hand Smoke in Southeast Asia-Analysis of the Global Burden of Disease Study 2019

Objectives

In addition to harms caused to individuals who smoke, second-hand smoke (SHS or passive smoke) is an important public health issue. We aim to estimate the extent of preventable deaths due to tobacco and SHS exposure in Southeast Asia.

Methods

Data were from the Global Burden of Disease Study 2019. We analysed data from Southeast Asia, including Cambodia, Indonesia, Laos, Malaysia, Maldives, Mauritius, Myanmar, Philippines, Seychelles, Sri Lanka, Thailand, Timor-Leste, and Vietnam.

Results

In 2019, there were 728,500 deaths attributable to tobacco in Southeast Asia, with 128,200 deaths attributed to SHS exposure. The leading causes of preventable deaths were ischemic heart disease, stroke, diabetes mellitus, lower respiratory infections, chronic obstructive pulmonary disease, tracheal, bronchus, and lung cancer. Among deaths attributable to tobacco, females had higher proportions of deaths attributable to SHS exposure than males in Southeast Asia.

Conclusion

The burden of preventable deaths in a year due to SHS exposure in Southeast Asia is substantial. The implementation and enforcement of smoke-free policies should be prioritized to reduce the disease burden attributed to passive smoking in Southeast Asia.

Prevalence and associated factors of maternal depression among mothers of children with undernutrition at comprehensive specialized hospitals in Northwest Ethiopia in 2023: a cross-sectional study

Background

Malnutrition is one of the most significant child health problems in developing countries, accounting for an estimated 53% of child deaths per year. Depression is the leading cause of disease-related disability in women and adversely affects the health and well-being of mothers and their children. Studies have shown that maternal depression has an impact on infant growth and nutritional status. However, evidence is scarce regarding the relationship between maternal depression and child malnutrition.

Objectives

The general objective of this study was to assess the prevalence and associated factors of maternal depression among mothers of undernourished children at comprehensive specialized hospitals in Northwest Ethiopia in 2023.

Methods

An institution-based cross-sectional study was conducted among 465 participants. Outcome variables were assessed using a Patient Health Questionnaire-9 (PHQ-9). Data were analyzed using SPSS-25. Bivariate and multivariable logistic regression analyses were conducted. Variables with a p-value less than 0.05 were considered statistically significant with a corresponding 95% confidence interval (CI).

Results

The prevalence of maternal depression among mothers of children with undernutrition was 36.4% (95% CI = 32%-41%). According to a multivariate analysis, lack of maternal education (adjusted odds ratio [AOR] = 2.872, 95% CI = 1.502-5.492), unemployment (AOR = 2.581, 95% CI = 1.497-4.451), poor social support (AOR = 2.209, 95% CI = 1.314-3.713), perceived stigma (AOR = 2.243, 95% CI = 1.414-3.560), and stunting (AOR = 1.913, 95% CI = 1.129-3.241) were factors significantly associated with maternal depression.

Conclusion

The overall prevalence of maternal depression was higher among mothers of children with undernutrition. This higher prevalence was associated with several factors, including lack of education, unemployment, poor social support, high perceived stigma, and stunted physical growth in the children themselves. To decrease maternal depression, we can address these factors by increasing the level of maternal education and employment opportunities, strengthening social support systems, reducing stigma, and providing interventions to reduce stunting.