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Clinical Infectious Diseases : An... Jun 2024Respiratory syncytial virus (RSV) circulation dropped markedly early in the COVID-19 pandemic, followed by a resurgence with heightened case counts. The "immunity debt"...
BACKGROUND
Respiratory syncytial virus (RSV) circulation dropped markedly early in the COVID-19 pandemic, followed by a resurgence with heightened case counts. The "immunity debt" hypothesis proposes that the RSV-naїve pediatric population increased during the period of low transmission. However, the evidence supporting this hypothesis is limited, and the role of changing testing practices in the perceived surge has not been comprehensively evaluated.
METHODS
We conducted a multicenter, retrospective analysis of 342 530 RSV encounters and 980 546 RSV diagnostic tests occurring at 32 US pediatric hospitals in 2013-2023. We used interrupted time series analysis to estimate pandemic-associated changes in RSV patient and test volume and to quantify changes in the proportions of patients requiring hospitalization, intensive care, or mechanical ventilation. We quantified the fraction of the shifts in case counts and in the age of diagnosed patients attributable to changes in testing.
RESULTS
RSV patient volume increased 2.4-fold (95% confidence interval [CI]: 1.7, 3.5) in 2021-2023 relative to the pre-pandemic phase and was accompanied by an 18.9-fold increase (95% CI: 15.0, 23.9) in RSV test volume. Shifts in patient volume and in patient age were largely attributable to increased testing. The proportions of patients with RSV that required hospitalization, intensive care, or mechanical ventilation declined significantly across all patient age groups.
CONCLUSIONS
A surge in RSV testing, rather than in viral circulation, likely underlies the increased case counts observed in 2021-2023. These findings warrant a critical assessment of the immunity debt hypothesis and highlight the importance of considering the testing denominator when surveillance strategies are dynamic.
Topics: Humans; Respiratory Syncytial Virus Infections; COVID-19; Infant; Retrospective Studies; Child, Preschool; Female; SARS-CoV-2; Male; Child; Respiratory Syncytial Virus, Human; Hospitalization; United States; Infant, Newborn; Adolescent; Respiration, Artificial; Hospitals, Pediatric; Interrupted Time Series Analysis
PubMed: 38602423
DOI: 10.1093/cid/ciae140 -
The Canadian Journal of Hospital... 2024Since 2022, it has been mandatory in Québec to report all incidents and accidents (I&As) occurring in health-care facilities. Since 2011, a summary report of these I&As...
BACKGROUND
Since 2022, it has been mandatory in Québec to report all incidents and accidents (I&As) occurring in health-care facilities. Since 2011, a summary report of these I&As has been published each year. However, it is difficult to compare health facilities given that no denominator is specified and ratios are not calculated.
OBJECTIVE
The primary objective was to calculate the ratios of total I&As and medication-related I&As per 1000 inpatient-days per type of facility for all health-care facilities in Québec.
METHODS
This retrospective descriptive study was based on data from the period of April 1, 2016, to March 31, 2021. Data were extracted from the National Register of Incidents and Accidents Occurring during the Provision of Health Care and Social Services in Québec and financial reports. The ratios of total I&As/1000 inpatient-days and medication-related I&As/1000 inpatient-days, expressed as the mean ± standard deviation and median [minimum; maximum], were calculated.
RESULTS
A total of 85 health-care facilities had usable data, specifically 33 acute-care facilities, 45 long-term care facilities, and 7 rehabilitation facilities. The mean ratio for total I&As/1000 inpatient-days varied from 33 ± 19 to 38 ± 22 in acute-care facilities, from 14 ± 5 to 16 ± 7 in long-term care facilities, and from 99 ± 39 to 147 ± 55 in rehabilitation facilities. The mean ratio for medication-related I&As/1000 inpatient-days varied from 11 ± 7 to 12 ± 7 in acute care facilities, from 3 ± 2 to 4 ± 3 in long-term care facilities, and from 24 ± 10 to 40 ± 21 in rehabilitation facilities.
CONCLUSIONS
This exploratory study demonstrated the feasibility of calculating I&A ratios from the National Register of Incidents and Accidents Occurring during the Provision of Health Care and Social Services in Québec. These ratios facilitate discussion of the reporting culture of I&As within the health-care system. It is hoped that these ratios will be added to future annual reports from the Québec I&A register.
PubMed: 38601131
DOI: 10.4212/cjhp.3497 -
Scientific Reports Apr 2024The Ecological Footprint evaluates the difference between the availability of renewable resources and the extent of human consumption of these resources. Over the past...
The Ecological Footprint evaluates the difference between the availability of renewable resources and the extent of human consumption of these resources. Over the past few decades, historical records have shown an accelerated decline in the availability of resources. Based on national footprint and biocapacity accounts, this analysis aims to advance the forecasting of the G20 countries' ecological footprints over a 30-year time frame. We employed a time series forecasting approach implemented in Python, which included-modular regression (Prophet) and Autoregressive Integrated Moving Average (ARIMA & Auto-ARIMA) methods. We evaluated and combined the performance of these three methods. The results indicated that among the largest economies of the G20, only four countries are projected to have a positive ecological footprint balance by 2050. These countries share the common denominator of large land areas and a moderate population growth projection. However, the overall trend of the indicator suggests that it will continue to decline.
PubMed: 38594329
DOI: 10.1038/s41598-024-57994-z -
Scientific Reports Apr 2024Late presentation to medical care of individuals infected with the human immunodeficiency virus (HIV) is linked to poor outcomes and increased morbidity and mortality....
Late presentation to medical care of individuals infected with the human immunodeficiency virus (HIV) is linked to poor outcomes and increased morbidity and mortality. Missed opportunities for a prompt diagnosis are frequently reported among late presenters. We aimed to estimate the proportion of late presenters and missed opportunities in diagnosis among newly diagnosed HIV-positive subjects presenting to a specialty clinic in Lebanon. This is a retrospective chart review of all newly diagnosed adult HIV-positive subjects presenting to clinic from 2012 to 2022. Demographic, laboratory, and clinical data were collected at initial HIV diagnosis or presentation to medical care. We defined late presentation as having a CD4 count < 350 or AIDS-defining event regardless of CD4 count. Advanced disease is defined as having a CD4 count below 200 cells/μL or the presence of an AIDS-defining illness, regardless of the CD4 count. A missed opportunity was defined as the presence of an indicator condition (IC) that suggests infection with HIV/AIDS during 3 years preceding the actual HIV diagnosis and not followed by a recommendation for HIV testing. The proportions for demographic, epidemiological, and clinical characteristics are calculated by excluding cases with missing information from the denominator. Our cohort included 150 subjects (92.7% males; 63.6% men who have sex with men (MSM); 33.3% heterosexuals; median age 30.5 years at diagnosis). 77 (51.3%) were late presenters and 53 (35.3% of all subjects, 68.8% of late presenters) had advanced HIV on presentation. Up to 76.5% of late presenters had a presentation with an HIV-related condition at a healthcare provider without getting HIV test within the previous 3 years. The most frequent ICs were weight loss, generalized lymphadenopathy, constitutional symptoms, and chronic idiopathic diarrhea. Overall mortality rate was 4% (6/150 individuals). All-cause mortality among those who presented with AIDS was 15.4% (6/39 subjects). In our setting, late presentations and missed opportunities for HIV diagnosis are common. In the Middle East, AIDS mortality remains high with a large gap in HIV testing. To effectively influence policies, comprehensive analyses should focus on estimating the preventable health and financial burdens of late HIV presentations. Another concern pertains to healthcare providers' attitudes and competencies.
Topics: Male; Adult; Humans; Female; HIV Infections; Homosexuality, Male; HIV; Acquired Immunodeficiency Syndrome; Retrospective Studies; Risk Factors; Lebanon; Delayed Diagnosis; Sexual and Gender Minorities; HIV Seropositivity; CD4 Lymphocyte Count
PubMed: 38594292
DOI: 10.1038/s41598-024-55277-1 -
Circulation Jun 2024Adult mammalian cardiomyocytes have limited proliferative capacity, but in specifically induced contexts they traverse through cell-cycle reentry, offering the potential...
BACKGROUND
Adult mammalian cardiomyocytes have limited proliferative capacity, but in specifically induced contexts they traverse through cell-cycle reentry, offering the potential for heart regeneration. Endogenous cardiomyocyte proliferation is preceded by cardiomyocyte dedifferentiation (CMDD), wherein adult cardiomyocytes revert to a less matured state that is distinct from the classical myocardial fetal stress gene response associated with heart failure. However, very little is known about CMDD as a defined cardiomyocyte cell state in transition.
METHODS
Here, we leveraged 2 models of in vitro cultured adult mouse cardiomyocytes and in vivo adeno-associated virus serotype 9 cardiomyocyte-targeted delivery of reprogramming factors (, , , and ) in adult mice to study CMDD. We profiled their transcriptomes using RNA sequencing, in combination with multiple published data sets, with the aim of identifying a common denominator for tracking CMDD.
RESULTS
RNA sequencing and integrated analysis identified () as a unique molecular marker gene well correlated with CMDD, required for increased asparagine and also for distinct fluxes in other amino acids. Although overexpression in , , , and cardiomyocytes augmented hallmarks of CMDD, deficiency led to defective regeneration in the neonatal mouse myocardial infarction model, increased cell death of cultured adult cardiomyocytes, and reduced cell cycle in , , , and cardiomyocytes, at least in part through disrupting the mammalian target of rapamycin complex 1 pathway.
CONCLUSIONS
We discovered a novel gene as both a molecular marker and an essential mediator, marking a distinct threshold that appears in common for at least 4 models of CMDD, and revealing an /mammalian target of rapamycin complex 1 axis dependency for dedifferentiating cardiomyocytes. Further study will be needed to extrapolate and assess its relevance to other cell state transitions as well as in heart regeneration.
Topics: Animals; Mice; Aspartate-Ammonia Ligase; Cell Dedifferentiation; Cells, Cultured; Kruppel-Like Factor 4; Myocytes, Cardiac; Carbon-Nitrogen Ligases with Glutamine as Amide-N-Donor
PubMed: 38586957
DOI: 10.1161/CIRCULATIONAHA.123.063965 -
The Lancet Regional Health. Europe May 2024Ethnic disparities in maternal mortality are consistently reported. This study aimed to investigate the contribution of known risk factors including age, socioeconomic...
BACKGROUND
Ethnic disparities in maternal mortality are consistently reported. This study aimed to investigate the contribution of known risk factors including age, socioeconomic status, and medical comorbidities to observed ethnic disparities in the United Kingdom (UK).
METHODS
A cohort of all women who died during or up to six weeks after pregnancy in the UK 2009-2019 were identified through national surveillance. No single denominator population included data on all risk factors, therefore we used logistic regression modelling to compare to 1) routine population birth and demographic data (2015-19) (routine data comparator) and 2) combined control groups of four UK Obstetric Surveillance System studies (UKOSS) control comparator)).
FINDINGS
There were 801 maternal deaths in the UK between 2009 and 2019 (White: 70%, Asian: 13%, Black: 12%, Chinese/Other: 3%, Mixed: 2%). Using the routine data comparator (n = 3,519,931 maternities) to adjust for demographics, including social deprivation, women of Black ethnicity remained at significantly increased risk of maternal death compared with women of white ethnicity (adjusted OR 2.43 (95% Confidence Interval 1.92-3.08)). The risk was greatest in women of Caribbean ethnicity (aOR 3.55 (2.30-5.48)). Among women of White ethnicity, risk of mortality increased as deprivation increased, but women of Black ethnicity had greater risk irrespective of deprivation. Using the UKOSS control comparator (n = 2210), after multiple adjustments including smoking, body mass index, and comorbidities, women of Black and Asian ethnicity remained at increased risk (aOR 3.13 (2.21-4.43) and 1.57 (1.16-2.12) respectively).
INTERPRETATION
Known risk factors do not fully explain ethnic disparities in maternal mortality. The impact of socioeconomic deprivation appears to differ between ethnic groups.
FUNDING
This research is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-127-21202.
PubMed: 38585675
DOI: 10.1016/j.lanepe.2024.100893 -
American Journal of Epidemiology Apr 2024Hysterectomy protects against cervical cancer when the cervix is removed. However, measures of cervical cancer incidence often fail to exclude women with a hysterectomy...
Hysterectomy protects against cervical cancer when the cervix is removed. However, measures of cervical cancer incidence often fail to exclude women with a hysterectomy from the population at risk denominator, underestimating and distorting disease burden. In this study, we estimated hysterectomy prevalence from the Behavioral Risk Factor Surveillance System surveys to remove the women who were not at risk of cervical cancer from the denominator and combined these estimates with the United States Cancer Statistics data. From these data, we calculated age-specific and age-standardized incidence rates for women aged >30 years from 2001-2019, adjusted for hysterectomy prevalence. We calculated the difference between unadjusted and adjusted incidence rates and examined trends by histology, age, race and ethnicity, and geographic region using Joinpoint regression. The hysterectomy-adjusted cervical cancer incidence rate from 2001-2019 was 16.7 per 100,000 women-34.6% higher than the unadjusted rate. After adjustment, incidence rates were higher by approximately 55% among Black women, 56% among those living in the East South Central division, and 90% among women aged 70-79 and >80 years. These findings underscore the importance of adjusting for hysterectomy prevalence to avoid underestimating cervical cancer incidence rates and masking disparities by age, race, and geographic region.
PubMed: 38583940
DOI: 10.1093/aje/kwae041 -
Indian Heart Journal 2024Left atrial (LA) volume indexing for body surface area (BSA) is the common practice. Since LA volume index is of cardiovascular pathophysiologic significance, it is...
BACKGROUND
Left atrial (LA) volume indexing for body surface area (BSA) is the common practice. Since LA volume index is of cardiovascular pathophysiologic significance, it is suggested that indexing for other body size parameters be explored to evaluate a more appropriate alternative method. The aims of this study were to find normal and the best cutoff values for LA volume indexed for multiple body size parameters in normal Indian subjects.
METHODS
Data from the multicentric prospective INDEA study conducted through 2018 to 2020 was reviewed and subjects without known cardiac disease and completely normal echocardiograms that had the left atrial volume (LAV) measured by biplane Simpson's method were included. LAV was indexed by BSA (ml/m), by height (LAV/m), by height raised to exponent 1.72 (mL/m and 2.7 (ml/m), by body weight, by ideal body weight (IBW), by ideal body surface area (IBSA) and by height squared (ml/h).
RESULTS
A total of 1046 healthy volunteers (382 female, 38%), mean age 38 ± 10.4 years (range 30-48 years) and body mass index 23.6 kg/m (22-25 kg/m) were analyzed. Mean and normal values were: LAV/BSA 18.7 + 3.15 ml/m (range 15-21 ml/m), LAV/ht 26.0 ± 4.5 ml/m, (range 17-35 ml/m), LAV/ht 16 ± 2.8 ml/m (range 10.4-21.6 ml/m) and LAV/ht 8.71 ± 2.2 ml/m (range 6.98-13.58 ml/m). Using ROC curve analysis, LAV/h had the highest AUC and the best predictive value to identify LA enlargement but not very different from LAV/BSA. Ideal BSA and ideal body weight as a denominator did not provide any incremental value.
CONCLUSION
Normal values for LAV indexed for height, weight, body surface area by three different methods of height as an allometric parameter are described in normal Indian individuals. We reinforce that LA volume indexation for BSA is an acceptable and robust method in non-obese Indian subjects. Indexing for height is probably slightly superior method to evaluate LAV.
Topics: Humans; Female; Heart Atria; Male; India; Prospective Studies; Adult; Middle Aged; Echocardiography; Body Size; Body Mass Index; Healthy Volunteers; Reference Values; Body Surface Area; Organ Size
PubMed: 38574812
DOI: 10.1016/j.ihj.2024.04.001 -
Ecancermedicalscience 2024Gastric cancer (GC) is the third leading cause of global cancer-related mortality. Despite the shifting burden of GC to low-and middle-income countries, the data... (Review)
Review
INTRODUCTION
Gastric cancer (GC) is the third leading cause of global cancer-related mortality. Despite the shifting burden of GC to low-and middle-income countries, the data regarding incidence, treatment, and outcomes in these settings are sparse. The primary aim of this systematic review was to aggregate all available data on GC in sub-Saharan Africa (SSA) to describe the variability in incidence across the region.
METHODS
Studies reporting population-based primary data on GC in SSA were considered. The inclusion was limited to primary studies published between January 1995 and March 2022 which comprised of adult patients in SSA with GC. Studies without accessible full text in either French or English language were excluded. Unadjusted GC incidence rates with their standard errors for each study were recalculated from the crude numerators and denominators provided in individual studies.
RESULTS
A total of 5,626 articles were identified in the initial search, of which, 69 studies were retained. Reported incidence rates ranged from a high of 5.56 GC cases per 100,000 in Greater Meru Kenya to a low of 0.04 GC cases per 100,000 people in Benin City Nigeria. The overall crude pooled incidence was 1.20 GC cases per 100, 000 (95%CI 1.15-1.26) with a variability of 99.83% ( < 0.001). From the 29 high-quality population-based registry studies the crude pooled incidence was 1.71 GC cases per 100,000 people (95%CI 1.56-21.88) with a variability of 99.60%.
CONCLUSION
This systemic review demonstrates that GC incidence is highly variable across SSA. The limited data on GC treatment, mortality, and survival presents a significant challenge to providing a complete epidemiologic description of the burden of GC in SSA. There is a need for further robust data collection, exploration, and research studies on cancer care in SSA, with continued assessment of primary data availability.
PubMed: 38566758
DOI: 10.3332/ecancer.2024.1680 -
BMC Medical Research Methodology Apr 2024Epidemiological studies in refugee settings are often challenged by the denominator problem, i.e. lack of population at risk data. We develop an empirical approach to...
BACKGROUND
Epidemiological studies in refugee settings are often challenged by the denominator problem, i.e. lack of population at risk data. We develop an empirical approach to address this problem by assessing relationships between occupancy data in refugee centres, number of refugee patients in walk-in clinics, and diseases of the digestive system.
METHODS
Individual-level patient data from a primary care surveillance system (PriCarenet) was matched with occupancy data retrieved from immigration authorities. The three relationships were analysed using regression models, considering age, sex, and type of centre. Then predictions for the respective data category not available in each of the relationships were made. Twenty-one German on-site health care facilities in state-level registration and reception centres participated in the study, covering the time period from November 2017 to July 2021.
RESULTS
445 observations ("centre-months") for patient data from electronic health records (EHR, 230 mean walk-in clinics visiting refugee patients per month and centre; standard deviation sd: 202) of a total of 47.617 refugee patients were available, 215 for occupancy data (OCC, mean occupancy of 348 residents, sd: 287), 147 for both (matched), leaving 270 observations without occupancy (EHR-unmatched) and 40 without patient data (OCC-unmatched). The incidence of diseases of the digestive system, using patients as denominators in the different sub-data sets were 9.2% (sd: 5.9) in EHR, 8.8% (sd: 5.1) when matched, 9.6% (sd: 6.4) in EHR- and 12% (sd 2.9) in OCC-unmatched. Using the available or predicted occupancy as denominator yielded average incidence estimates (per centre and month) of 4.7% (sd: 3.2) in matched data, 4.8% (sd: 3.3) in EHR- and 7.4% (sd: 2.7) in OCC-unmatched.
CONCLUSIONS
By modelling the ratio between patient and occupancy numbers in refugee centres depending on sex and age, as well as on the total number of patients or occupancy, the denominator problem in health monitoring systems could be mitigated. The approach helped to estimate the missing component of the denominator, and to compare disease frequency across time and refugee centres more accurately using an empirically grounded prediction of disease frequency based on demographic and centre typology. This avoided over-estimation of disease frequency as opposed to the use of patients as denominators.
Topics: Humans; Refugees; Electronic Health Records; Emigration and Immigration; Risk Factors; Electronics
PubMed: 38561661
DOI: 10.1186/s12874-024-02204-7