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JAMA Network Open Jul 2023The number of deaths of children younger than 5 years has been steadily decreasing worldwide, from more than 17 million annual deaths in the 1970s to an estimated 5.3...
IMPORTANCE
The number of deaths of children younger than 5 years has been steadily decreasing worldwide, from more than 17 million annual deaths in the 1970s to an estimated 5.3 million in 2019 (with 2.8 million deaths occurring in those aged 1-59 months [53% of all deaths in children aged <5 years]). More detailed characterization of childhood deaths could inform interventions to improve child survival.
OBJECTIVE
To describe causes of postneonatal child deaths across 7 mortality surveillance sentinel sites in Africa and Asia.
DESIGN, SETTING, AND PARTICIPANTS
The Child Health and Mortality Prevention Surveillance (CHAMPS) Network conducts childhood mortality surveillance in sub-Saharan Africa and South Asia using innovative postmortem minimally invasive tissue sampling (MITS). In this cross-sectional study, MITS was conducted in deceased children aged 1 to 59 months at 7 sites in sub-Saharan Africa and South Asia from December 3, 2016, to December 3, 2020. Data analysis was conducted between October and November 2021.
MAIN OUTCOMES AND MEASURES
The expert panel attributed underlying, intermediate, and immediate conditions in the chain of events leading to death, based on histopathologic analysis, microbiological diagnostics, clinical data, and verbal autopsies.
RESULTS
In this study, MITS was performed in 632 deceased children (mean [SD] age at death, 1.3 [0.3] years; 342 [54.1%] male). The 6 most common underlying causes of death were malnutrition (104 [16.5%]), HIV (75 [11.9%]), malaria (71 [11.2%]), congenital birth defects (64 [10.1%]), lower respiratory tract infections (LRTIs; 53 [8.4%]), and diarrheal diseases (46 [7.2%]). When considering immediate causes only, sepsis (191 [36.7%]) and LRTI (129 [24.8%]) were the 2 dominant causes. An infection was present in the causal chain in 549 of 632 deaths (86.9%); pathogens most frequently contributing to infectious deaths included Klebsiella pneumoniae (155 of 549 infectious deaths [28.2%]; 127 [81.9%] considered nosocomial), Plasmodium falciparum (122 of 549 [22.2%]), and Streptococcus pneumoniae (109 of 549 [19.9%]). Other organisms, such as cytomegalovirus (57 [10.4%]) and Acinetobacter baumannii (39 [7.1%]; 35 of 39 [89.7%] considered nosocomial), also played important roles. For the top underlying causes of death, the median number of conditions in the chain of events leading to death was 3 for malnutrition, 3 for HIV, 1 for malaria, 3 for congenital birth defects, and 1 for LRTI. Expert panels considered 494 of 632 deaths (78.2%) preventable and 26 of 632 deaths (4.1%) preventable under certain conditions.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study investigating causes of child mortality in the CHAMPS Network, results indicate that, in these high-mortality settings, infectious diseases continue to cause most deaths in infants and children, often in conjunction with malnutrition. These results also highlight opportunities for action to prevent deaths and reveal common interaction of various causes in the path toward death.
Topics: Infant; Child; Humans; Male; Female; Child Mortality; Cause of Death; Child Health; Cross-Sectional Studies; Africa South of the Sahara; Malnutrition; Malaria; Cross Infection; HIV Infections
PubMed: 37494044
DOI: 10.1001/jamanetworkopen.2023.22494 -
JAMA Network Open Jun 2024Obesity, especially visceral obesity, is an established risk factor associated with all-cause mortality. However, the inadequacy of conventional anthropometric measures...
IMPORTANCE
Obesity, especially visceral obesity, is an established risk factor associated with all-cause mortality. However, the inadequacy of conventional anthropometric measures in assessing fat distribution necessitates a more comprehensive indicator, body roundness index (BRI), to decipher its population-based characteristics and potential association with mortality risk.
OBJECTIVE
To evaluate the temporal trends of BRI among US noninstitutionalized civilian residents and explore its association with all-cause mortality.
DESIGN, SETTING, AND PARTICIPANTS
For this cohort study, information on a nationally representative cohort of 32 995 US adults (age ≥20 years) was extracted from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 and NHANES Linked Mortality File, with mortality ascertained through December 31, 2019. Data were analyzed between April 1 and September 30, 2023.
EXPOSURES
Biennial weighted percentage changes in BRI were calculated. Restricted cubic spline curve was used to determine optimal cutoff points for BRI.
MAIN OUTCOME AND MEASURES
The survival outcome was all-cause mortality. Mortality data were obtained from the Centers for Disease Control and Prevention website and linked to the NHANES database using the unique subject identifier. Weibull regression model was adopted to quantify the association between BRI and all-cause mortality.
RESULTS
Among 32 995 US adults, the mean (SD) age was 46.74 (16.92) years, and 16 529 (50.10%) were women. Mean BRI increased gradually from 4.80 (95% CI, 4.62-4.97) to 5.62 (95% CI, 5.37-5.86) from 1999 through 2018, with a biennial change of 0.95% (95% CI, 0.80%-1.09%; P < .001), and this increasing trend was more obvious among women, elderly individuals, and individuals who identified as Mexican American. After a median (IQR) follow-up of 9.98 (5.33-14.33) years, 3452 deaths (10.46% of participants) from all causes occurred. There was a U-shaped association between BRI and all-cause mortality, with the risk increased by 25% (hazard ratio, 1.25; 95% CI, 1.05-1.47) for adults with BRI less than 3.4 and by 49% (hazard ratio, 1.49; 95% CI, 1.31-1.70) for those with BRI of 6.9 or greater compared with the middle quintile of BRI of 4.5 to 5.5 after full adjustment.
CONCLUSIONS AND RELEVANCE
This national cohort study found an increasing trend of BRI during nearly 20-year period among US adults, and importantly, a U-shaped association between BRI and all-cause mortality. These findings provide evidence for proposing BRI as a noninvasive screening tool for mortality risk estimation, an innovative concept that could be incorporated into public health practice pending consistent validation in other independent cohorts.
Topics: Humans; Female; Male; Adult; United States; Middle Aged; Nutrition Surveys; Mortality; Cohort Studies; Aged; Cause of Death; Risk Factors; Body Mass Index; Obesity; Young Adult
PubMed: 38837158
DOI: 10.1001/jamanetworkopen.2024.15051 -
JAMA Surgery Dec 2023Morbidity and mortality conferences (MMCs) are thought to advance trainee education, quality improvement (QI), and faculty development. However, there is considerable...
IMPORTANCE
Morbidity and mortality conferences (MMCs) are thought to advance trainee education, quality improvement (QI), and faculty development. However, there is considerable variability with regard to their completion.
OBJECTIVE
To compile and analyze the literature describing the format, design, and other attributes of MMCs that appear to best advance their stated objectives related to QI and practitioner education.
EVIDENCE REVIEW
For this systematic review, a literature search with terms combining conference and QI or morbidity and mortality was performed in January 2022, using the PubMed, Embase, and ERIC (Education Resources Information Center) databases with no date restrictions. Included studies were published in English and described surgical or nonsurgical MMCs with explicit reference to quality or system improvement, education, professional development, or patient outcomes; these studies were classified by design as survey based, intervention based, or other methodologies. For survey-based studies, positively and negatively regarded attributes of conference design, format, and completion were extracted. For intervention-based studies, details of the intervention and their impact on stated MMC objectives were abstracted. Principal study findings were summarized for the other group. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Abstract screening, full-text review, and data extraction and analysis were completed between January 2022 and December 2022.
FINDINGS
A total of 59 studies met appropriateness for study inclusion. The mean MERSQI score for the included studies was 6.7 (range, 5.0-9.5) of a maximum possible 18, which implied that the studies were of average quality. The evidence suggested that preparation and postconference follow-up regarding QI initiatives are equally as important as both (1) succinctly presenting case details, opportunities for improvement, and educational topics and (2) creating a constructive space for accountability, engagement, and multistakeholder discussion.
CONCLUSIONS AND RELEVANCE
These findings suggest that the published literature on MMCs provides substantial insight into the optimal format, design, and related attributes of an effective MMC. This systematic review provides a road map for surgical departments to improve MMCs in order to align their format and design with their principal objectives related to practitioner and trainee education, error prevention, and QI.
Topics: Humans; Morbidity; Quality Improvement; Congresses as Topic; Mortality
PubMed: 37851458
DOI: 10.1001/jamasurg.2023.4672 -
Revue Medicale Suisse Jul 2023
Topics: Humans; Blood Pressure; Mortality
PubMed: 37403958
DOI: 10.53738/REVMED.2023.19.834.1338 -
Critical Care Medicine Oct 2023
Topics: Respiration; Humans; Mortality
PubMed: 37707384
DOI: 10.1097/CCM.0000000000005965 -
Deutsche Medizinische Wochenschrift... Apr 2024Over the past few decades, substantial advancements have been achieved in the early detection and treatment of gastrointestinal oncological diseases. The survival rates... (Review)
Review
Over the past few decades, substantial advancements have been achieved in the early detection and treatment of gastrointestinal oncological diseases. The survival rates of patients have significantly improved due to the expansion and enhancement of therapeutic and diagnostic options, leading to modifications in (neo-)adjuvant, perioperative, and palliative strategies, as well as the advent of personalized molecular therapy. Noteworthy progress has also been observed in primary, secondary, and tertiary prevention domains.Despite these advancements, gastrointestinal tumours continue to be a global health burden, with approximately 4 million new cases diagnosed annually. These constitute over a quarter of all tumour cases, with nearly one-third of all global tumour-related mortalities attributed to gastrointestinal tumours.Emerging evidence implicates aberrant differentiation of stem or progenitor cells in the pathogenesis of gastrointestinal tumour diseases. A confluence of clinically recognized risk factors, including high-fat diet, bile acid, microbiome alterations, and host factors, can instigate chronic inflammation. This disrupts stem cell homeostasis and precipitates malignant transformation. Consequently, environmental inflammation emerges as a critical risk factor warranting consideration in clinical cancer prevention and surveillance strategies.This review encapsulates the current understanding and recommendations in the prevention of selected gastrointestinal tumours, aiming to facilitate their integration into clinical practice. It underscores the need for continued research to further refine diagnostic and therapeutic strategies and improve patient outcomes.
Topics: Humans; Gastrointestinal Neoplasms; Medical Oncology; Survival Rate; Inflammation
PubMed: 38565115
DOI: 10.1055/a-2060-2225 -
Social Science & Medicine (1982) Sep 2023While recent research suggests that remittances affect child mortality, little is known about how remittances influence this outcome and what conditions may moderate its...
While recent research suggests that remittances affect child mortality, little is known about how remittances influence this outcome and what conditions may moderate its effectiveness. This article investigates whether and how remittances affect child mortality in developing countries. We examine the impact of remittances on the three leading causes of child mortality, explore potential channels through which this may occur and examine whether socioeconomic or political factors affect the remittances-mortality relationship. Using data for 122 developing countries over the period 2003-2018 and a dynamic panel estimator, with both internal instruments and a shift-share external instrument, we find that remittances reduce child mortality from diarrheal diseases. Our findings suggest that sanitation usage is a possible channel through which remittances affect diarrheal mortality. We also find that the mortality-reducing effect of remittances does not appear to be contingent on the level of governance or health infrastructure. However, it remains unclear whether the effect is influenced by other forms of health funding. These findings suggest that remittances serve an important role in improving child health, and the effectiveness of these inflows is not reliant on onerous preconditions being met. Thus, remittances may be important to public health dialogue, especially in developing countries where diarrheal diseases are prevalent.
Topics: Child; Humans; Child Mortality; Child Health; Diarrhea; Healthcare Financing; Public Health
PubMed: 37595420
DOI: 10.1016/j.socscimed.2023.116178 -
Scientific Reports Jan 2024The role of inflammation in disease promotion is significant, yet the precise association between a newly identified inflammatory biomarker and insulin resistance (IR)...
The role of inflammation in disease promotion is significant, yet the precise association between a newly identified inflammatory biomarker and insulin resistance (IR) and mortality remains uncertain. We aim to explore the potential correlation between systemic immune-inflammation index (SII) and these factors. We used data from 2011 to 2016 of National Health and Nutrition Examination Survey, and multivariate logistic regression and restricted cubic spline were employed. Subgroup and interaction analysis were conducted to recognize the consistency of the results. The association between SII and mortality was described by survival analysis. 6734 participants were enrolled, of whom 49.3% (3318) exhibited IR and 7.02% experienced mortality. Multivariate logistic regression revealed that individuals in the highest quartile (Q4) of SII had a significantly increased risk of IR compared to those in the lowest quartile (Q1). We then identified a linear association between SII and IR with an inflection point of 407, but may be influenced by gender. Similarly, compared to Q1, people whose SII at Q4 showed a higher all-cause and cardiovascular mortality. It showed a significant association between SII and both all-cause and cardiovascular mortality, but the results need to be interpreted with caution.
Topics: Humans; Cardiovascular Diseases; Data Interpretation, Statistical; Inflammation; Insulin Resistance; Nutrition Surveys; Mortality
PubMed: 38263234
DOI: 10.1038/s41598-024-51878-y -
Journal of the American College of... Feb 2024
Topics: Male; Female; Humans; Exercise; Cardiovascular Diseases; Mortality
PubMed: 38383093
DOI: 10.1016/j.jacc.2024.01.003 -
BMJ (Clinical Research Ed.) May 2024
Topics: Humans; Fast Foods; Food Handling; Mortality; Food, Processed
PubMed: 38719491
DOI: 10.1136/bmj.q793