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1.
PLoS One ; 19(6): e0301860, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38833461

RESUMO

OBJECTIVE: To assess the effectiveness of different machine learning models in estimating the pharmaceutical and non-pharmaceutical expenditures associated with Diabetes Mellitus type II diagnosis, based on the clinical risk index determined by the analysis of comorbidities. MATERIALS AND METHODS: In this cross-sectional study, we have used data from 11,028 anonymized records of patients admitted to a high-complexity hospital in Bogota, Colombia between 2017-2019 with a primary diagnosis of Diabetes. These cases were classified according to Charlson's comorbidity index in several risk categories. The main variables analyzed in this study are hospitalization costs (which include pharmaceutical and non-pharmaceutical expenditures), age, gender, length of stay, medicines and services consumed, and comorbidities assessed by the Charlson's index. The model's dependent variable is expenditure (composed of pharmaceutical and non-pharmaceutical expenditures). Based on these variables, different machine learning models (Multivariate linear regression, Lasso model, and Neural Networks) were used to estimate the pharmaceutical and non-pharmaceutical expenditures associated with the clinical risk classification. To evaluate the performance of these models, different metrics were used: Mean Absolute Percentage Error (MAPE), Mean Squared Error (MSE), Root Mean Squared Error (RMSE), Mean Absolute Error (MAE), and Coefficient of Determination (R2). RESULTS: The results indicate that the Neural Networks model performed better in terms of accuracy in predicting pharmaceutical and non-pharmaceutical expenditures considering the clinical risk based on Charlson's comorbidity index. A deeper understanding and experimentation with Neural Networks can improve these preliminary results, therefore we can also conclude that the main variables used and those that were proposed can be used as predictors for the medical expenditures of patients with diabetes type-II. CONCLUSIONS: With the increase of technology elements and tools, it is possible to build models that allow decision-makers in hospitals to improve the resource planning process given the accuracy obtained with the different models tested.


Assuntos
Diabetes Mellitus Tipo 2 , Gastos em Saúde , Aprendizado de Máquina , Humanos , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Colômbia/epidemiologia , Idoso , Hospitalização/economia , Comorbidade , Adulto , Fatores de Risco
2.
J Vet Sci ; 25(3): e46, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38834514

RESUMO

IMPORTANCE: Rabies is a neglected tropical viral disease most often transmitted through the bite of an infected animal. OBJECTIVE: This study assessed the level of knowledge, attitudes, and practices of the Shone Town community toward rabies. METHODS: A survey-based cross-sectional study was conducted in Shone town, Ethiopia, from November 2022 to April 2023. Woreda was selected purposefully, while Kebeles and the study populations were selected by simple random sampling. Four hundred and sixteen respondents were interviewed using a semi-structured questionnaire. RESULTS: All respondents had heard about rabies from different sources, with the majority hearing from informal sources (62%). Approximately 51.9%, 0.7%, and 47.4% of individuals were aware of saliva contact, rabid animal bites, and both as means of transmission, respectively. The survey showed that 64.4% of participants knew the 100% fatal nature of rabies once the clinical signs developed, and 35.6% did not. Approximately 51.4% of respondents agreed that killing stray dogs was an effective method for rabies prevention. In this study, 72.6% of the respondents had contact with pets, and 36.8% of the interviewees had vaccinated their dogs. Only the educational level (p = 0.03) was associated with knowledge of the transmission route. Age (p = 0.04) and educational level (p = 0.01) had a statistically significant association with knowledge of the risk of not vaccinating dogs. CONCLUSIONS AND RELEVANCE: A lack of formal education in the communities, low levels of education, and the majority of respondents acquiring their knowledge from unofficial sources are important contributors to the low levels of awareness.


Assuntos
Doenças do Cão , Conhecimentos, Atitudes e Prática em Saúde , Raiva , Raiva/veterinária , Raiva/prevenção & controle , Raiva/epidemiologia , Etiópia/epidemiologia , Adulto , Humanos , Animais , Masculino , Estudos Transversais , Feminino , Pessoa de Meia-Idade , Fatores de Risco , Cães , Inquéritos e Questionários , Doenças do Cão/prevenção & controle , Doenças do Cão/epidemiologia , Doenças do Cão/virologia , Adulto Jovem , Adolescente , Vacina Antirrábica/administração & dosagem , Idoso
3.
PeerJ ; 12: e17468, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38827287

RESUMO

The aim of this study was to evaluate the effectiveness of ChatGPT-3.5 and ChatGPT-4 in incorporating critical risk factors, namely history of depression and access to weapons, into suicide risk assessments. Both models assessed suicide risk using scenarios that featured individuals with and without a history of depression and access to weapons. The models estimated the likelihood of suicidal thoughts, suicide attempts, serious suicide attempts, and suicide-related mortality on a Likert scale. A multivariate three-way ANOVA analysis with Bonferroni post hoc tests was conducted to examine the impact of the forementioned independent factors (history of depression and access to weapons) on these outcome variables. Both models identified history of depression as a significant suicide risk factor. ChatGPT-4 demonstrated a more nuanced understanding of the relationship between depression, access to weapons, and suicide risk. In contrast, ChatGPT-3.5 displayed limited insight into this complex relationship. ChatGPT-4 consistently assigned higher severity ratings to suicide-related variables than did ChatGPT-3.5. The study highlights the potential of these two models, particularly ChatGPT-4, to enhance suicide risk assessment by considering complex risk factors.


Assuntos
Depressão , Suicídio , Humanos , Medição de Risco , Masculino , Feminino , Adulto , Suicídio/psicologia , Depressão/psicologia , Depressão/epidemiologia , Fatores de Risco , Ideação Suicida , Armas , Pessoa de Meia-Idade , Adulto Jovem , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Prevenção do Suicídio
4.
Sultan Qaboos Univ Med J ; 24(2): 259-267, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38828256

RESUMO

Objectives: This study aimed to determine the rate and severity patterns of bronchopulmonary dysplasia (BPD) and identify antenatal and postnatal factors associated with BPD in preterm infants <32 weeks of gestational age (GA). Methods: This retrospective observational study included preterm neonates <32 weeks of gestation admitted into the neonatal intensive care unit between January 2010 and December 2017 at Sultan Qaboos University Hospital, Muscat, Oman. A data set of antenatal and perinatal factors were collected. BPD was defined as the need for oxygen and/or respiratory support at 36 weeks post-menstrual age (PMA). Infants with and without BPD were compared in their antenatal and perinatal factors. Results: A total of 589 preterm infants <32 weeks were admitted. Among them, 505 (85.7%) survived to 36 weeks' PMA and 90 (17.8%) had BPD. The combined BPD and mortality rate was 28.4%. Grades 1, 2 and 3 BPD constituted 77.8%, 7.8% and 14.4%, respectively. BPD was associated with lower GA, lower birth weight, need for intubation at resuscitation, lower Apgar scores, longer duration of ventilation, surfactant therapy and higher rates of neonatal morbidities. On binary logistic regression analysis, predictors of BPD were longer duration of ventilation, intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC). Conclusion: In an Omani centre, 17.8% of preterm infants (<32 weeks GA) developed BPD. Various perinatal and neonatal factors were associated with BPD. However, longer duration of ventilation, IVH grades 1 and 2 and NEC stages II and III were significant predictors. Future multicentre research is necessary to provide the overall prevalence of BPD in Oman to help optimise the resources for BPD prevention and management in preterm infants.


Assuntos
Displasia Broncopulmonar , Idade Gestacional , Recém-Nascido Prematuro , Humanos , Omã/epidemiologia , Estudos Retrospectivos , Recém-Nascido , Feminino , Displasia Broncopulmonar/epidemiologia , Fatores de Risco , Prevalência , Masculino , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/organização & administração , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Índice de Gravidade de Doença , Gravidez , Lactente
5.
South Med J ; 117(6): 291-295, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38830581

RESUMO

OBJECTIVES: The purpose of this study was to examine the factors associated with vision impairment (VI), age-related eye disease (ARED), and frequency of eye examinations among older adults. METHODS: A cross-sectional study (N = 166) was designed to identify barriers in vision and eye care services among adults 50 years and older in four counties in Appalachian Tennessee. Surveys were administered in March 2023. Simple and multiple logistic regression analyses were used to determine the risk factors of VI and ARED and the frequency of eye examinations. RESULTS: In two out of the three regression models, predictors such as traveling >10 mi to an eye care provider, barriers to eye care, and a lack of exposure to eye health information emerged as significant factors. Individuals who traveled >10 mi to an eye care provider were more than twice as likely than individuals who traveled shorter distances to have VI and not maintain routine eye care (adjusted odds ratio [AOR] 2.69, 95% confidence interval [CI] 1.08-6.75; AOR 2.82, 95% CI 1.05-7.55, respectively). Reporting barriers to eye care doubled the odds of ARED (AOR 2.33, 95% CI 1.02-5.34) and substantially increased the odds of reporting a 3-year or longer interval since the last eye examination (AOR 7.45, 95% CI 1.85-29.96) compared with having no barriers to eye care. Moreover, limited exposure to eye health information tripled the odds of VI (AOR 3.26, 95% CI 1.15-9.24) and not maintaining routine eye care (AOR 3.07, 95% CI 0.97-9.70) compared with more exposure to eye health information. Other predictors also were uncovered in the analysis. CONCLUSIONS: This study contributes to the scarce literature on risk factors associated with vision health among older adults in Appalachia.


Assuntos
Transtornos da Visão , Humanos , Tennessee/epidemiologia , Masculino , Feminino , Idoso , Estudos Transversais , Pessoa de Meia-Idade , Transtornos da Visão/epidemiologia , Fatores de Risco , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Idoso de 80 Anos ou mais , Oftalmopatias/epidemiologia , Inquéritos e Questionários
6.
BMC Endocr Disord ; 24(1): 79, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38834991

RESUMO

BACKGROUND: Research on Metabolic Associated Fatty Liver Disease (MAFLD) is still in its early stages, with few studies available to identify and predict effective indicators of this disease. On the other hand, early diagnosis and intervention are crucial to reduce the burden of MAFLD. Therefore, the aim of this research was to investigate the effectiveness of eleven anthropometric indices and their appropriate cut-off values as a non-invasive method to predict and diagnose MAFLD in the Iranian population. METHODS: In this cross-sectional study, we analyzed baseline data from the Hoveyzeh Cohort Study, a prospective population-based study conducted in Iran that enrolled a total of 7836 subjects aged 35 to 70 years from May 2016 through August 2018. RESULTS: The optimal cut-off values of anthropometric indices for predicting MAFLD risk were determined for waist circumference(WC) (102.25 cm for males and 101.45 cm for females), body mass index (BMI) (27.80 kg/m2 for males and 28.75 kg/m2 for females), waist-to-hip ratio (WHR) (0.96 for both males and females), waist-to-height ratio (WHtR) (0.56 for males and 0.63 for females), body adiposity index (BAI) (23.24 for males and 32.97 for females), visceral adiposity index (VAI) (1.64 for males and 1.88 for females), weight-adjusted waist index (WWI) (10.63 for males and 11.71 for females), conicity index (CI) (1.29 for males and 1.36 for females), body roundness index (BRI) (4.52 for males and 6.45 for females), relative fat mass (RFM) (28.18 for males and 44.91 for females) and abdominal volume index (AVI) (18.85 for males and for 21.37 females). VAI in males (sensitivity: 77%, specificity: 60%, Youden's Index: 0.37) and RFM in females (sensitivity: 76%, specificity: 59%, Youden's Index: 0.35) were found to have higher sensitivity and specificity compared to other anthropometric indices. Furthermore, anthropometric indices demonstrated statistically significant correlations with various hepatic and cardiometabolic indices. Among these, the strongest positive correlations were observed between WC, BMI, BAI, BRI, and AVI with the Hepatic Steatosis Index (HSI), TyG-BMI, and TyG-WC, as well as between VAI and the Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP), Cardiometabolic Index (CMI), and the Triglyceride and Glucose (TyG) Index. CONCLUSION: Anthropometric indices are effective in predicting MAFLD risk among Iranian adults, with WWI, VAI, and RFM identified as the strongest predictors. The proposed cutoff values could serve as a straightforward and non-invasive methods for the early diagnosis of MAFLD.


Assuntos
Antropometria , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Estudos Transversais , Antropometria/métodos , Irã (Geográfico)/epidemiologia , Idoso , Estudos Prospectivos , Índice de Massa Corporal , Relação Cintura-Quadril , Circunferência da Cintura , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Fatores de Risco , Prognóstico , Adiposidade , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Seguimentos
7.
J Clin Psychiatry ; 85(2)2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38836860

RESUMO

Objective: Shorter sleep duration has been linked to increased suicidal ideation (SI). However, limited research has examined the relationship between nightly sleep duration and short-term fluctuations in suicide risk, as well as the potential clinical utility of leveraging indices of recent (ie, past 3 days) patterns of sleep duration as a marker of acute suicide risk. This study examined associations between nightly and cumulative sleep duration and suicidal desire and intent utilizing ecological momentary assessment (EMA) in a high risk sample of community-based adults.Methods: A sample of 237 community based adults with severe SI provided daily indices of self-reported sleep duration and ratings of suicidal desire and intent 6 times per day for 14 consecutive days of EMA monitoring. Data collection took place between February and May 2019.Results: Between-person nightly sleep duration and cumulative sleep duration were negatively associated with suicidal desire (Bs = -3.48 and -4.78) and intent (Bs = -1.96 and -2.46). At the within person level, nightly sleep duration was negatively related to suicidal desire (Bs = -0.51 and -0.47) and intent. Within person cumulative sleep duration, on the other hand, was unrelated to both suicidal desire and intent (Bs = -0.26 and -0.09).Conclusion: Our findings highlight the clinical utility of examining individual differences in sleep duration as a marker for suicide-related outcomes, as well as deviations from one's typical nightly sleep as a potential acute predictor of suicide-related outcomes, in addition to information about recent duration over one or more nights of sleep. Limitations and future directions are discussed.


Assuntos
Avaliação Momentânea Ecológica , Ideação Suicida , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Sono/fisiologia , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Intenção , Fatores de Tempo , Adulto Jovem , Autorrelato , Fatores de Risco , Duração do Sono
8.
Glob Public Health ; 19(1): 2361782, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38837785

RESUMO

A growing body of evidence has shown the effects of poor preconception health on adverse pregnancy outcomes and, subsequently, maternal and child morbidity and mortality. However, the cost of poor preconception health remains relatively unexplored. Using the case of Nigeria, this study provides the first estimate of the disease and economic burden of poor preconception health at a country level. Using data from international databases and the scientific literature, the study used a cost-of-illness approach to quantify the foregone productivity and direct healthcare costs resulting from six preconception risk factors (adolescent pregnancy, short birth interval, overweight and obesity, intimate partner violence, female genital mutilation, folate deficiency). The results indicate that 6.7% of maternal deaths, 10.9% of perinatal deaths, and 10.5% of late neonatal deaths were attributable to the selected preconception risk factors in 2020. The economic burden of poor preconception health in Nigeria was estimated at US$ 3.3 billion in 2020, of which over 90% was generated by premature mortality. If prevalence rates remain constant, total economic losses could amount to US$ 46.2 billion by 2035. This analysis paves the way for further studies investigating the economic costs and benefits of preconception interventions and policies in low and middle-income countries.


Assuntos
Cuidado Pré-Concepcional , Humanos , Feminino , Nigéria , Gravidez , Cuidado Pré-Concepcional/economia , Efeitos Psicossociais da Doença , Fatores de Risco , Adulto , Custos de Cuidados de Saúde , Recém-Nascido , Adolescente , Adulto Jovem
9.
Trials ; 25(1): 353, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38822392

RESUMO

BACKGROUND: The SAVVY project aims to improve the analyses of adverse events (AEs) in clinical trials through the use of survival techniques appropriately dealing with varying follow-up times and competing events (CEs). This paper summarizes key features and conclusions from the various SAVVY papers. METHODS: Summarizing several papers reporting theoretical investigations using simulations and an empirical study including randomized clinical trials from several sponsor organizations, biases from ignoring varying follow-up times or CEs are investigated. The bias of commonly used estimators of the absolute (incidence proportion and one minus Kaplan-Meier) and relative (risk and hazard ratio) AE risk is quantified. Furthermore, we provide a cursory assessment of how pertinent guidelines for the analysis of safety data deal with the features of varying follow-up time and CEs. RESULTS: SAVVY finds that for both, avoiding bias and categorization of evidence with respect to treatment effect on AE risk into categories, the choice of the estimator is key and more important than features of the underlying data such as percentage of censoring, CEs, amount of follow-up, or value of the gold-standard. CONCLUSIONS: The choice of the estimator of the cumulative AE probability and the definition of CEs are crucial. Whenever varying follow-up times and/or CEs are present in the assessment of AEs, SAVVY recommends using the Aalen-Johansen estimator (AJE) with an appropriate definition of CEs to quantify AE risk. There is an urgent need to improve pertinent clinical trial reporting guidelines for reporting AEs so that incidence proportions or one minus Kaplan-Meier estimators are finally replaced by the AJE with appropriate definition of CEs.


Assuntos
Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Fatores de Tempo , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Guias de Prática Clínica como Assunto , Interpretação Estatística de Dados , Medição de Risco , Projetos de Pesquisa/normas , Fatores de Risco , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Viés , Análise de Sobrevida , Seguimentos , Resultado do Tratamento , Simulação por Computador , Estimativa de Kaplan-Meier
10.
Niger Postgrad Med J ; 31(2): 118-129, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38826015

RESUMO

BACKGROUND: Children develop dynamically, and when a child fails to reach age-appropriate developmental milestones compared to their peers, it is considered a developmental delay. In developing nations like Nigeria, several demographics, socioeconomic, childcare and external factors may influence the highly individualised process. This study assessed the prevalence and pattern of developmental delay, across Nigeria's geopolitical zones including identified factors associated with developmental delay, providing insight for appropriate interventions to prevent disability in affected children. METHODS: This was a secondary analysis of data from the Multiple Indicator Cluster Survey (MICS), which was carried out in rounds 4 (2011) and 5 (2016/2017). Every 5 years, the UNICEF-supported MICS cross-sectional household survey is carried out using the cluster sampling method. A semi-structured, questionnaire administered by the interviewer was used to obtain individual and household-level data. This study comprised a weighted sample of 17,373 under-5 children who had complete data from both survey rounds on characteristics deemed significant for the study. Data were analysed using SPSS version 23. Using the Chi-square test and multivariate binomial logistic regression, factors linked to developmental delay were identified, with 95% confidence intervals (CIs) provided and the significance level set at 5%. RESULTS: The mean age and sex distribution of the children surveyed in both rounds was comparable, with a male preponderance of 51.2% in round 4 and 50.4% in round 5. In both round 4 (51.2%) and round 5 (49.0%), the Northeast zone had the highest prevalence of overall developmental delay while the least prevalence was seen in the Southwest zone (20.3%) and the Southeast zone (14.7%) in round 4 and round 5, respectively. Across all the zones, delay in the literacy-numeracy domain of development was the most prevalent, with the highest (91.3% and 86.7%, respectively) in the Northeast zone during both rounds of the survey. Delay in the physical domain was, however, the least prevalent form of developmental delay across the zones, with the least in South South (20.6%) and Southeast (5.4%) in rounds 4 and 5. The odds of developmental delay were 1.5 and 1.7 times higher amongst children 4 years old than 3 years old in both rounds of the survey. The likelihood of having developmental delay was found to increase with the severity of stunting amongst the children during both rounds of the survey (odds ratio [OR] =1.5; 95% CI = 1.20-1.78 in round 4 and OR = 1.4; 95% CI = 1.16-1.58 in round 5). Children from the poorest wealth index had higher odds of developmental delay (OR = 5.8; 95% CI = 4.92-6.82 in round 4 and OR = 2.5; 95% CI = 1.99-3.10 in round 5). CONCLUSION: The prevalence of developmental delay is high across all zones; however, the burden varies amongst them. The age of the child, nutritional status and wealth index were indicators of developmental delay in Nigerian under-5 children. This underscores the need for surveillance and interventions focussed on improving child literacy, nutritional status and household standard of living across the zones.


Assuntos
Deficiências do Desenvolvimento , Humanos , Deficiências do Desenvolvimento/epidemiologia , Nigéria/epidemiologia , Pré-Escolar , Masculino , Feminino , Prevalência , Estudos Transversais , Lactente , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
11.
Iran J Allergy Asthma Immunol ; 23(2): 168-181, 2024 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-38822512

RESUMO

The life expectancy and the risk of developing cardiovascular diseases in patients with inborn errors of immunity are systematically increasing. The aim of the study was to assess cardiovascular risk factors and to evaluate the heart in echocardiography in patients with primary antibody deficiency (PAD). Cardiac echography and selected cardiovascular risk factors, including body mass index, sedentary lifestyle, nicotine, glucose, C-reactive protein, lipid profile, uric acid level, certain chronic diseases, and glucocorticoid use, were analyzed in 94 patients >18 years of age with PAD. Of the patients,25.5% had a cardiovascular disease (mostly hypertension, 18%), 10.5% smoked, 17% were overweight, 14% were obese, and 15% were underweight. Abnormal blood pressure was found in 6.5% of the patients. Lipid metabolism disorders were found in 72.5% of in the studied cohort, increased total cholesterol (45.5%), non-high-density lipoprotein (HDL) (51%), low-density lipoprotein (LDL) (47%), and triglycerides (32%) were observed. Furthermore, 28.5% had a decrease in HDL and 9.5% had a history of hyperuricemia. The average number of risk factors was 5 ± 3 for the entire population and 4 ± 2 for those under 40 years of age. Elevated uric acid levels were found de novo in 4% of participants. In particular, 74.5% of the patients had never undergone an echocardiogram with a successful completion rate of 87% among those tested. Among them, 30% showed parameters within normal limits, primarily regurgitation (92.5%). New pathologies were identified in 28% of patients. Prevention in patients with PAD, aimed at reducing cardiovascular risk, should be a priority.


Assuntos
Doenças Cardiovasculares , Ecocardiografia , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Feminino , Adulto , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/diagnóstico por imagem , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem , Medição de Risco
12.
Epidemiol Psychiatr Sci ; 33: e28, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38764153

RESUMO

AIMS: Caused by multiple risk factors, heavy burden of major depressive disorder (MDD) poses serious challenges to public health worldwide over the past 30 years. Yet the burden and attributable risk factors of MDD were not systematically known. We aimed to reveal the long-term spatio-temporal trends in the burden and attributable risk factors of MDD at global, regional and national levels during 1990-2019. METHODS: We obtained MDD and attributable risk factors data from Global Burden of Disease Study 2019. We used joinpoint regression model to assess the temporal trend in MDD burden, and age-period-cohort model to measure the effects of age, period and birth cohort on MDD incidence rate. We utilized population attributable fractions (PAFs) to estimate the specific proportions of MDD burden attributed to given risk factors. RESULTS: During 1990-2019, the global number of MDD incident cases, prevalent cases and disability-adjusted life years (DALYs) increased by 59.10%, 59.57% and 58.57%, respectively. Whereas the global age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR) and age-standardized DALYs rate (ASDR) of MDD decreased during 1990-2019. The ASIR, ASPR and ASDR in women were 1.62, 1.62 and 1.60 times as that in men in 2019, respectively. The highest age-specific incidence, prevalence and DALYs rate occurred at the age of 60-64 in women, and at the age of 75-84 in men, but the maximum increasing trends in these age-specific rates occurred at the age of 5-9. Population living during 2000-2004 had higher risk of MDD. MDD burden varied by socio-demographic index (SDI), regions and nations. In 2019, low-SDI region, Central sub-Saharan Africa and Uganda had the highest ASIR, ASPR and ASDR. The global PAFs of intimate partner violence (IPV), childhood sexual abuse (CSA) and bullying victimization (BV) were 8.43%, 5.46% and 4.86% in 2019, respectively. CONCLUSIONS: Over the past 30 years, the global ASIR, ASPR and ASDR of MDD had decreased trends, while the burden of MDD was still serious, and multiple disparities in MDD burden remarkably existed. Women, elderly and populations living during 2000-2004 and in low-SDI regions, had more severe burden of MDD. Children were more susceptible to MDD. Up to 18.75% of global MDD burden would be eliminated through early preventing against IPV, CSA and BV. Tailored strategies-and-measures in different regions and demographic groups based on findings in this studywould be urgently needed to eliminate the impacts of modifiable risk factors on MDD, and then mitigate the burden of MDD.


Assuntos
Transtorno Depressivo Maior , Carga Global da Doença , Saúde Global , Humanos , Transtorno Depressivo Maior/epidemiologia , Fatores de Risco , Carga Global da Doença/tendências , Feminino , Masculino , Incidência , Saúde Global/estatística & dados numéricos , Adulto , Prevalência , Pessoa de Meia-Idade , Análise Espaço-Temporal , Idoso , Anos de Vida Ajustados por Deficiência/tendências , Adulto Jovem , Efeitos Psicossociais da Doença , Adolescente
13.
Aggress Behav ; 50(3): e22150, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38764372

RESUMO

Structured clinical risk assessments represent a preferred means of assessing levels of aggression risk at different times and in different individuals. Increasing attention has been given to capturing protective factors, with sound risk assessment critical to high-secure forensic mental health care. The aim was to assess the predictive value of the HCR-20v3 for aggression risk and the long-term care pilot version of the SAPROF (the SAPROF-LC-pilot) in a high-secure forensic mental health inpatient population and to determine the incremental value of protective over risk factors. Participants were adult males detained in a high secure forensic mental health service, with a primary diagnosis of schizophrenia and/or personality disorder. The focus was on examining hospital based aggression (self- and other-directed) at two time points; up to 6 months (T1) and between 7 and 12 months (T2). The HCR-20V3 and SAPROF-LC-pilot demonstrated good predictive validity but with variability across subscales and aggression types/periods. Historical factors of the HCR-20V3 and External factors of the SAPROF-LC-pilot failed to predict, aside from a medium effect at T1 for verbal aggression and self-harm, for Historical factors. There was evidence for protective factors adding to prediction over risk factors alone, with the integration of protective and risk factors into a risk judgement particularly helpful in improving prediction accuracy. Protective factors contributed to risk estimates and particularly if integrated with risk factors. Combining risk and protective factors has clear predictive advantages, ensuring that protective factors are not supplementary but important to the aggression assessment process.


Assuntos
Agressão , Pacientes Internados , Humanos , Masculino , Agressão/psicologia , Adulto , Medição de Risco , Pacientes Internados/psicologia , Pessoa de Meia-Idade , Fatores de Proteção , Fatores de Risco , Psiquiatria Legal/métodos , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/psicologia , Adulto Jovem , Esquizofrenia
14.
Clin Rheumatol ; 43(6): 2061-2077, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38696115

RESUMO

OBJECTIVE: This study aimed to estimate and predict the burden of osteoarthritis (OA) and site-specific OA (hip, knee, hand, and others) from 1990 to 2030 and their attributable risk factors in China. METHOD: Data were obtained from the Global Burden of Diseases 2019. The burden was estimated by analyzing the trends of prevalence, incidence, and disability-adjusted life years (DALY). Population attributable risk (PAR) was calculated to assess the impact of high body mass index (BMI). The prediction from 2020 to 2030 was implemented by Bayesian age-period-cohort analysis. RESULTS: In China, prevalent cases, DALY, and incident cases of OA increased to 132.81 million, 4.72 million, and 10.68 million, respectively. Age-standardized rates (ASRs) of prevalence, DALYs, and incidence increased for OA and site-specific OA, especially for hip OA. Site-specific OA showed different susceptible peaking ages, and the burden for those over 50 years old became serious. Female preference existed in the trends for knee OA but not in those for hip, hand, and other OA. PARs of high BMI continued to increase, impacting knee OA more than hip OA and showing female preference. In the next decade, incident cases for OA and site-specific OA will continue to increase, despite that the ASR of OA incidence will decrease. CONCLUSIONS: OA and site-specific OA remain huge public health challenges in China. The burden of OA and site-specific OA is increasing, especially among people over 50 years old. Health education, exercise, and removing modifiable risk factors contribute to alleviate the growing burden. Key Points • In China, the burden of osteoarthritis and site-specific osteoarthritis (hip, knee, hand, and others) as well as the Risk Factor (high body mass index) increased greatly from 1990 to 2019. • It is estimated that incident cases for OA and site-specific OA will continue to increase, despite that the ASR of OA incidence will decrease.


Assuntos
Osteoartrite , Humanos , China/epidemiologia , Feminino , Fatores de Risco , Pessoa de Meia-Idade , Masculino , Prevalência , Idoso , Osteoartrite/epidemiologia , Incidência , Adulto , Índice de Massa Corporal , Osteoartrite do Joelho/epidemiologia , Efeitos Psicossociais da Doença , Anos de Vida Ajustados por Deficiência , Adulto Jovem , Carga Global da Doença/tendências , Anos de Vida Ajustados por Qualidade de Vida , Adolescente , Osteoartrite do Quadril/epidemiologia , Idoso de 80 Anos ou mais , Teorema de Bayes
15.
J Health Popul Nutr ; 43(1): 73, 2024 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-38802965

RESUMO

Depression is a major cause of disability and, if left untreated, can increase the risk of suicide. Evidence on the determinants of depression is incomplete, making it challenging to interpret results across studies. This study aims to identify the social, economic, environmental, political, and technological factors influencing the great recession in Iran. The study was conducted in two parts. The first step involved a literature review to identify the factors, using PubMed, Scopus, and Web of Science for the search. The reference lists of all identified articles were reviewed to find relevant studies, and the extracted information was summarized and reported descriptively. The second steps involved compiling and consulting 14 experts from different fields, using a framework analysis method. Twenty-four articles were used as primary sources of information, and a total of 28 factors were found to exist. After removing duplicates and related factors, 19 of these were subsequently declared as factors, resulting in a total of 36 determinants being identified. Most of these factors belong to the social category. The health policies implemented have a significant impact on disease risk factors and ultimately their occurrence. Political decisions and policy-making processes play a crucial role in all areas, particularly in addressing disease risk factors. Severe depression can disrupt all aspects of the healthcare system, underscoring the importance of access to care. Policies concerning physical education, transportation, nutrition, employment, green spaces, recreational facilities, and tobacco are vital in this context. The influence of health policies on disease risk factors and disease occurrence is profound. Severe depression can have far-reaching effects on the healthcare system, emphasizing the critical need for access to care. The formulation of policies to combat depression must be thoroughly evaluated in terms of economic, political, social, technological, and environmental factors. The findings suggest that addressing social inequalities and emphasizing the role of political action, as highlighted by the social determinants of health, should be top priorities in addressing depression. Efforts to prevent depression should incorporate ecological approaches that consider the impact of the socioeconomic environment on depressive symptoms.


Assuntos
Transtorno Depressivo Maior , Humanos , Irã (Geográfico)/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Fatores de Risco , Política de Saúde , Fatores Socioeconômicos , Recessão Econômica , Política , Feminino , Masculino
16.
JAMA Netw Open ; 7(5): e2413309, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38805226

RESUMO

Importance: More than 70 000 Medicare beneficiaries receive care in long-term acute care hospitals (LTCHs) annually for prolonged acute illness. However, little is known about long-term functional and cognitive outcomes of middle-aged and older adults after hospitalization in an LTCH. Objective: To describe survival, functional, and cognitive status after LTCH hospitalization and to identify factors associated with an adverse outcome. Design, Setting, and Participants: This retrospective cohort study included middle-aged and older adults enrolled in the Health and Retirement Study (HRS) with linked fee-for-service Medicare claims. Included participants were aged 50 years or older with an LTCH admission between January 1, 2003, and December 31, 2016, with HRS interviews available before admission. Data were analyzed between November 1, 2021, and June 30, 2023. Main Outcomes and Measures: Function and cognition were ascertained from HRS interviews conducted every 2 years. The primary outcome was death or severe impairment in the 2.5 years after LTCH hospitalization, defined as dependencies in 2 or more activities of daily living (ADLs) or dementia. Multivariable logistic regression was performed to evaluate associations with a priori selected risk factors including pre-LTCH survival prognosis (Lee index score), pre-LTCH impairment status, and illness severity characterized by receipt of mechanical ventilation and prolonged intensive care unit stay of 3 days or longer. Results: This study included 396 participants, with a median age of 75 (IQR, 68-82) years. Of the participants, 201 (51%) were women, 125 (28%) had severe impairment, and 318 (80%) died or survived with severe impairment (functional, cognitive, or both) within 2.5 years of LTCH hospitalization. After accounting for acute illness characteristics, prehospitalization survival prognosis as determined by the Lee index score and severe baseline impairment (functional, cognitive, or both) were associated with an increased likelihood of death or severe impairment in the 2.5 years after LTCH hospitalization (adjusted odds ratio [AOR], 3.2 [95% CI, 1.7 to 6.0] for a 5-point increase in Lee index score; and AOR, 4.5 [95% CI, 1.3 to 15.4] for severe vs no impairment). Conclusions and Relevance: In this cohort study, 4 of 5 middle-aged and older adults died or survived with severe impairment within 2.5 years of LTCH hospitalization. Better preadmission survival prognosis and functional and cognitive status were associated with lower risk of an adverse outcome, and these findings should inform decision-making for older adults with prolonged acute illness.


Assuntos
Cognição , Hospitalização , Humanos , Feminino , Masculino , Idoso , Estudos Retrospectivos , Hospitalização/estatística & dados numéricos , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Atividades Cotidianas , Assistência de Longa Duração/estatística & dados numéricos , Medicare/estatística & dados numéricos , Fatores de Risco
17.
BMC Vet Res ; 20(1): 229, 2024 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-38796437

RESUMO

BACKGROUND: A thorough understanding of lameness prevalence is essential for evaluating the impact of this condition on the dairy industry and assessing the effectiveness of preventive strategies designed to minimize its occurrence. Therefore, this cross-sectional study aimed to ascertain the prevalence of lameness and identify potential risk factors associated with lameness in Holstein Friesian crossbred cows across both commercial and smallholder dairy production systems in Bengaluru Rural District of Karnataka, India. METHODS: The research encompassed six commercial dairy farms and 139 smallholder dairy farms, involving a total of 617 Holstein Friesian crossbred cattle. On-site surveys were conducted at the farms, employing a meticulously designed questionnaire. Lameness in dairy cattle was assessed subjectively using a locomotion scoring system. Both bivariate and binary logistic regression models were employed for risk assessment, while principal components analysis (PCA) was conducted to address the high dimensionality of the data and capture the underlying structure of the explanatory variables. RESULTS: The overall lameness prevalence of 21.9% in commercial dairy farms and 4.6% in smallholder dairy farms. Various factors such as age, body weight, parity, body condition score (BCS), floor type, hock and knee injuries, animal hygiene, provision of hoof trimming, and the presence of hoof lesions were found to be significantly associated with lameness. Binary logistic regression analysis indicated that the odds of lameness in crossbred cows increased with higher parity, decreased BCS, presence of hard flooring, poor animal hygiene, and the existence of hoof lesions. These factors were identified as potential risk factors for lameness in dairy cows. Principal component analysis unveiled five components explaining 71.32% of the total variance in commercial farms and 61.21% in smallholder dairy farms. The extracted components demonstrated higher loadings of housing and management factors (such as hoof trimming and provision of footbath) and animal-level factors (including parity, age, and BCS) in relation to lameness in dairy cows. CONCLUSIONS: The findings suggest that principal component analysis effectively reduces the dimensionality of risk factors. Addressing these identified risk factors for lameness is crucial for the strategic management of lameness in dairy cows. Future research in India should investigate the effectiveness of management interventions targeted at the identified risk factors in preventing lameness in dairy cattle across diverse environments.


Assuntos
Doenças dos Bovinos , Indústria de Laticínios , Coxeadura Animal , Animais , Coxeadura Animal/epidemiologia , Bovinos , Fatores de Risco , Feminino , Doenças dos Bovinos/epidemiologia , Índia/epidemiologia , Prevalência , Estudos Transversais , Criação de Animais Domésticos/métodos
18.
Artigo em Inglês | MEDLINE | ID: mdl-38791795

RESUMO

The rising global prevalence of diabetes mellitus, a chronic metabolic disorder, poses significant challenges to healthcare systems worldwide. This study examined in-hospital mortality among patients diagnosed with non-insulin-dependent diabetes mellitus (NIDDM) of ICD-10, or Type 2 Diabetes Mellitus (T2DM), in Indonesia, utilizing hospital claims data spanning from 2017 to 2022 obtained from the Indonesia Health Social Security Agency or Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan. The analysis, which included 610,809 hospitalized T2DM patients, revealed an in-hospital mortality rate of 6.6%. Factors contributing to an elevated risk of mortality included advanced age, the presence of comorbidities, and severe complications. Additionally, patients receiving health subsidies and those treated in government hospitals were found to have higher mortality risks. Geographic disparities were observed, highlighting variations in healthcare outcomes across different regions. Notably, the complication of ketoacidosis emerged as the most significant risk factor for in-hospital mortality, with an odds ratio (OR) of 10.86, underscoring the critical need for prompt intervention and thorough management of complications to improve patient outcomes.


Assuntos
Diabetes Mellitus Tipo 2 , Mortalidade Hospitalar , Humanos , Diabetes Mellitus Tipo 2/mortalidade , Indonésia/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Fatores de Risco , Programas Nacionais de Saúde/estatística & dados numéricos , Idoso de 80 Anos ou mais , Hospitalização/estatística & dados numéricos , Adulto Jovem
19.
BMC Public Health ; 24(1): 1326, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38755548

RESUMO

BACKGROUND: Hypertension prevalence among the overall US adult population has been relatively stable during the last two decades. However, whether this stabilization has occurred across rural-urban communities and across different geographic regions is unknown, particularly among older adults with diabetes who are likely to have concomitant cardiovascular risk factors. METHODS: This serial cross-sectional analysis used the 5% national sample of Medicare administrative claims data (n = 3,516,541) to examine temporal trends (2005-2017) in diagnosed hypertension among older adults with diabetes, across urban-rural communities and US census regions (Northeast, Midwest, South, and West). Joinpoint regression was used to obtain annual percent change (APC) in hypertension prevalence across rural-urban communities and geographic regions, and multivariable adjusted regression was used to assess associations between rural-urban communities and hypertension prevalence. RESULTS: The APC in the prevalence of hypertension was higher during 2005-2010, and there was a slowdown in the increase during 2011-2017 across all regions, with significant variations across rural-urban communities within each of the regions. In the regression analysis, in the adjusted model, older adults living in non-core (most rural) areas in the Midwest (PR = 0.988, 95% CI: 0.981-0.995) and West (PR = 0.935, 95% CI: 0.923-0.946) had lower hypertension prevalence than their regional counterparts living in large central metro areas. CONCLUSIONS: Although the magnitudes of these associations are small, differences in hypertension prevalence across rural-urban areas and geographic regions may have implications for targeted interventions to improve chronic disease prevention and management.


Assuntos
Diabetes Mellitus , Hipertensão , População Rural , População Urbana , Humanos , Hipertensão/epidemiologia , Idoso , Masculino , Feminino , Prevalência , Estudos Transversais , Estados Unidos/epidemiologia , Diabetes Mellitus/epidemiologia , População Rural/estatística & dados numéricos , Idoso de 80 Anos ou mais , População Urbana/estatística & dados numéricos , Medicare/estatística & dados numéricos , Fatores de Risco
20.
Rev Saude Publica ; 58: 18, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38747866

RESUMO

INTRODUCTION: Lung cancer (LC) is a relevant public health problem in Brazil and worldwide, given its high incidence and mortality. Thus, the objective of this study is to analyze the distribution of smoking and smoking status according to sociodemographic characteristics and disparities in access, treatment, and mortality due to LC in Brazil in 2013 and 2019. METHOD: Retrospective study of triangulation of national data sources: a) analysis of the distribution of smoking, based on the National Survey of Health (PNS); b) investigation of LC records via Hospital-based Cancer Registry (HCR); and c) distribution of mortality due to LC in the Mortality Information System (SIM). RESULTS: There was a decrease in the percentage of people who had never smoked from 2013 (68.5%) to 2019 (60.2%) and in smoking history (pack-years). This was observed to be greater in men, people of older age groups, and those with less education. Concerning patients registered in the HCR, entry into the healthcare service occurs at the age of 50, and only 19% have never smoked. While smokers in the population are mainly Mixed-race, patients in the HCR are primarily White. As for the initial stage (I and II), it is more common in White people and people who have never smoked. The mortality rate varied from 1.00 for people with higher education to 3.36 for people without education. Furthermore, White people have a mortality rate three times higher than that of Black and mixed-race people. CONCLUSION: This article highlighted relevant sociodemographic disparities in access to LC diagnosis, treatment, and mortality. Therefore, the recommendation is to strengthen the Population-Based Cancer Registry and develop and implement a nationwide LC screening strategy in Brazil since combined prevention and early diagnosis strategies work better in controlling mortality from the disease and continued investment in tobacco prevention and control policies.


Assuntos
Acessibilidade aos Serviços de Saúde , Neoplasias Pulmonares , Fumar , Fatores Socioeconômicos , Humanos , Brasil/epidemiologia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Fumar/epidemiologia , Fumar/efeitos adversos , Adulto , Idoso , Fatores Sociodemográficos , Distribuição por Sexo , Adulto Jovem , Fatores de Risco , Distribuição por Idade , Disparidades em Assistência à Saúde/estatística & dados numéricos , Sistema de Registros
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