Global, regional and national burden of rheumatoid arthritis, and attributable risk factors from 1990 to 2019: update from the Global Burden of Disease 2019 study.

OBJECTIVES: Statistical data on the incidence, disability-adjusted life years (DALYs) and burden of rheumatoid arthritis (RA), and associated risk factors are essential for the development of effective treatment options. The Global Burden of Disease (GBD) study provides a unique opportunity to evaluate the aforementioned parameters. METHODS: The RA incidence rate, age-standardised incidence rate (ASR), DALYs and estimated annual percentage change (EAPC) between 1990 and 2019 were evaluated, using data from 204 territories and countries from the GBD 2019. Risk factors associated with DALYs in patients with RA were estimated using the comparative risk assessment framework of the GBD study. RESULTS: The results of the present study demonstrated that the incidence of RA increased from 567,462.89 to 1,074,390.80 cases, with an ASR of 13/100,000 patients between 1990 and 2019. The number of RA cases and DALYs were increased in all socio-demographic index quintiles during the study period. A significant negative association was found between EAPCs and age-standardised DALYs per 100,000 (ρ= -0.60; p<0.001). Notably, females exhibited an increased ASRs and DALYs than males, at both global and regional levels during the study period. Globally, age-standardised DALYs increased in an age-dependent manner, with the highest rate in the 60-69 years age group. Moreover, smoking was the predominant contributor to RA-associated DALYs for males worldwide, and this trend decreased from 1990 to 2019. CONCLUSIONS: The incidence rate of RA and associated DALYs are increasing worldwide, particularly among female patients. This trend is expected to increase, due an ageing population. Notably, smoking remained the predominant risk factor for RA-associated DALYs in males. Therefore, further investigations into the impact of smoking, and improvements in early diagnosis and treatment strategies for RA are required to reduce the global burden of RA.

Immunotherapy and delivery systems for melanoma.

Melanoma is a highly malignant tumor of melanocyte origin that is prone to early metastasis and has a very poor prognosis. Early melanoma treatment modalities are mainly surgical, and treatment strategies for advanced or metastatic melanoma contain chemotherapy, radiotherapy, targeted therapy and immunotherapy. The efficacy of chemotherapy and radiotherapy has been unsatisfactory due to low sensitivity and strong toxic side effects. And targeted therapy is prone to drug resistance, so its clinical application is limited. Melanoma has always been the leader of immunotherapy for solid tumors, and how to maximize the role of immunotherapy and how to implement immunotherapy more accurately are still urgent to be explored. This review summarizes the common immunotherapies and applications for melanoma, illustrates the current research status of melanoma immunotherapy delivery systems, and discusses the advantages and disadvantages of each delivery system and its prospects for clinical application.

Tumor vaccines: Toward multidimensional anti-tumor therapies.

For decades, immunotherapies have offered hope for patients with advanced cancer. However, they show distinct benefits and limited clinical effects. Tumor vaccines have the potential to prime tumor-antigen-specific T cells and induce broad subsets of immune responses, ultimately eradicating tumor cells. Here, we classify tumor vaccines by their anti-tumor mechanisms, which include boosting the immune system, overcoming tumor immunosuppression, and modulating tumor angiogenesis. We focus on multidimensional tumor vaccine strategies using combinations of two or three of the above mechanisms, as these are superior to single-dimensional treatments. This review offers a perspective on tumor vaccine strategies and the future role of vaccine therapies in cancer treatment.

Can information infrastructure development improve the health care environment? Evidence from China.

Existing studies ignore the importance of information infrastructure development in improving regional health care environment. This paper adopts a spatial difference-in-difference (DID) model to assess the impact of information infrastructure development on urban health care environment based on a quasi-natural experiment of the "Broadband China" city pilots (BCCP). A balanced panel of 259 cities from 2010 to 2019 is selected for empirical analysis in this paper. Our findings show that the implementation of BCCP resulted in a 4.1 and 2.9% improvement in local medical workforce and medical infrastructure. In addition, there is significant spatial spillover effects of the implementation of BCCP, with 7.2 and 12.5% improvement in medical workforce and medical infrastructure in the surrounding areas. Our findings also suggest that information infrastructure development enhances the health care environment by driving industrial upgrading and education levels. Further analysis shows that BCCP has the strongest improvement on medical workforce in the eastern region and non-ordinary prefecture-level cities. For medical infrastructure, BCCP has stronger improvement in central region, western region, and non-ordinary prefecture-level cities. Finally, the paper conducts a series of robustness tests to ensure the reliability of the analysis results, including parallel trend tests, placebo tests, and re-estimation with different methods. Policies to improve the health care environment through information infrastructure development are proposed.

Regional integration and public healthcare environment: Evidence from China.

Introduction: Existing studies have focused on the impact of economic development and urban expansion on public healthcare environment but has ignored the importance of regional integration. Regional integration reflects the spatial distribution of the labor force, which significantly affects healthcare workforce and healthcare infrastructure development. Methods: Based on panel nested data for 137 cities in 16 major city clusters in China from 2001 to 2019, this paper assesses the impact of regional integration on the public healthcare environment through a hierarchical linear model (HLM). Results: Our findings indicate that a 1% increase in regional integration leads to a 6.6 and 1.9% improvement in healthcare workforce and healthcare infrastructure. The results of the mechanism analysis indicate that regional integration affects the public healthcare environment through improving transportation infrastructure and industrial upgrading. In addition, regional integration has a stronger effect on cities with lower levels of economic development and healthcare environments. Finally, the endogeneity test based on the difference-in-difference (DID) model and the robustness test based on high-dimensional fixed effects model conduct the consistent conclusions. Discussion: Policies to improve the public healthcare environment through promoting regional integration are proposed. Government should develop a more comprehensive regional cooperation plan to improve the public healthcare environment. Also, financial spending on improving the healthcare environment in peripheral cities should be increased. In addition, regional integration policy development needs to consider differences across regions.