Burden Of Death Research Articles

Time trends in cardiovascular disease mortality attributable to non-optimal temperatures in China: An age-period-cohort analysis using the Global Burden of Disease Study 2019.

Associations between non-optimal temperatures and cardiovascular disease (CVD) mortality risk have been previously reported, yet the trends of CVD mortality attributable to non-optimal temperatures remain unclear in China. We analyzed trends in CVD mortality attributable to non-optimal temperatures and associations with age, period, and birth cohort. Data were obtained from the Global Burden of Disease Study (GBD) 2019. Joinpoint regression analysis was used to calculate annual percent change (APC) and average annual percent change (AAPC) from 1990 to 2019. We used the age-period-cohort model to analyze age, period, and cohort effects in CVD mortality attributable to non-optimal temperatures between 1990 and 2019. The age-standardized mortality rate (ASMR) of CVD attributable to non-optimal temperature generally declined in China from 1990 to 2019, whereas ischemic heart disease (IHD) increased slightly. Low temperatures have a greater death burden than high temperatures, but the death burden from high temperatures showed steady increases. Joinpoint regression analysis showed that CVD mortality decreased in all age groups except for IHD, and the decreases were greater in females than in males. The mortality of CVD attributable to non-optimal temperatures of males was higher than females. The mortality rate showed an upwards trend with age across all CVD categories. Period risks were generally found in unfavorable trends. The cohort effects showed a progressive downward trend during the entire period. Although there have been reductions in CVD mortality attributable to non-optimum temperatures, the mortality of IHD has increased and the burden from non-optimal temperatures remains high in China. In the context of global climate change, our results call for more attention and strategies to address climate change that protect human health from non-optimal temperatures.

Temporal Trends in Stillbirth in Greece: A Longitudinal Population-Based Study.

Stillbirths are a major public health issue and a key population health indicator. The aim of this study was to comprehensively investigate and present time trends in stillbirth in Greece. Data on all live births and stillbirths were derived from the Hellenic Statistical Authority, covering a 65-year period from 1957 to 2021 and the annual stillbirth rate (SBR) was calculated, defined as the number of stillbirths per 1,000 live births and stillbirths (total births). Trends in the SBR were assessed using joinpoint regression analysis with calculation of the annual percent change (APC) with a 95% confidence interval (95% CI) and level of statistical significance p<0.05. The SBR in Greece, after an initial increasing trend (1957-1965: APC=2.6, 95% CI: 0.5 to 4.7, p=0.016), and an all-time high of 15.8 per 1,000 births in 1966, recorded a four decades period of continuous improvement (1965-2003: APC=3.0, 95% CI: -3.2 to -2.8, p<0.001) and reached a historic low in 2008 (3.3 per 1,000 births) (a decrease by 79%). However, the SBR stagnated at an elevated level during the decade 2006-2016 and showed a steeply upward trend during the most recent period 2016-2021 (APC=7.4, 95% CI: 3.0 to 12.1, p=0.001). In 2021, the SBR was 5.3 per 1,000 births, 60% up from 2008. It was estimated that the SBR improvement for the 1967-2021 period resulted in 50,914 stillbirths averted (7.9 per 1,000 births), but the recent increase in the SBR has led to 1,200 additional fetal deaths (1.0 per 1,000 births) during 2009-2021. After an impressive decline for almost four decades the SBR gradually deteriorated during the economic crisis and finally showed an alarming rising trend after 2015, resulting in an increasing burden of fetal deaths in Greece. Further public health interventions are needed to address preventable risk factors and ensure access to optimized antenatal monitoring.

Abstract 1318: Potential mechanism of re-dissemination from lung metastases to tertiary sites in breast carcinoma: Tumor microenvironment of metastasis doorways and related pro-metastatic tumor phenotypes

Abstract Background: The five-year relative survival rate of female breast cancer patients with distant metastases is only 29%, compared to 99% for localized disease. Among all subtypes, triple negative breast cancer (TNBC) has the poorest outcome due to a high risk of early relapse with visceral organ metastases, and a lack of targeted therapies. Targeting metastatic burden could improve patient survival. Recent mouse and human genomic profiling studies show that metastasis is a complex and multidirectional process. Cancer cells can re-disseminate from one metastasis to tertiary sites. But the mechanism of re-dissemination is unknown. Breast cancer cells disseminate from primary tumors via Tumor MicroEnvironment of Metastasis (TMEM) doorways, composed of three cells: a tumor cell, a perivascular macrophage, and an endothelial cell. The direct and stable interaction of these cells cause transient and local vascular opening through which metastasis-competent tumor cells co-expressing invasive, stem, and dormant phenotypes that preferentially reside around TMEM doorways disseminate to distant sites. We hypothesize that TMEM doorways also form in lung metastases, enabling cancer cell re-dissemination to tertiary sites, which increases overall cancer burden and risk of death. Methods: We used MDA-MB-231 and MDA-MB-468 human TNBC cells to generate tumors in the 4th mammary fat pad of 6-8 weeks old NOD/SCID mice. Primary tumors were resected when 5-6 mm and fixed with 10% formalin. When lung metastases were visible via micro-Computed Tomography (microCT) fluorescent dextran was injected intravascularly, and lungs collected and fixed with 10% formalin. Triple immunohistochemistry was used to visualize TMEM doorways. To test TMEM doorway-mediated vascular opening, sequential slides were stained for extravascular dextran. Cells co-expressing stem (SOX9), invasive (MenaINV), and dormant (NR2F1) markers were visualized by immunofluorescent staining. The density of TMEM doorways, CSCs, invasive, and dormant cells was determined by automated image analysis. Results: We demonstrated the presence and activity of TMEM doorways in lung metastases. Within lung metastases, we also documented the presence of cancer cells with a pro-metastatic phenotype indicated by their co-expression of invasive (MenaINV), stemness (SOX9), and dormancy (NR2F1) markers. We will report how the expression of pro-metastatic markers relates to TMEM doorway niches. Conclusion: We documented functional TMEM doorways in lung metastases of TNBC, which could explain the occurrence of an early overall metastatic burden in patients with TNBC. Thus, targeting TMEM doorways after the removal of the primary tumor in patients with TNBC could block cancer cell re-dissemination, decrease metastases, and improve survival. Citation Format: Burcu Karadal-Ferrena, Camille L. Duran, Madeline Friedman-DeLuca, Nicole Barth, Prachiben Patel, John S. Condeelis, David Entenberg, Maja H. Oktay. Potential mechanism of re-dissemination from lung metastases to tertiary sites in breast carcinoma: Tumor microenvironment of metastasis doorways and related pro-metastatic tumor phenotypes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1318.

Treating SARS-CoV-2 Omicron variant infection by molnupiravir for pandemic mitigation and living with the virus: a mathematical modeling study

Treating severe COVID-19 patients and controlling the spread of SARS-CoV-2 are concurrently important in mitigating the pandemic. Classically, antiviral drugs are primarily developed for treating hospitalized COVID-19 patients with severe diseases to reduce morbidity and/or mortality, which have limited effects on limiting pandemic spread. In this study, we simulated the expanded applications of oral antiviral drugs such as molnupiravir to mitigate the pandemic by treating nonhospitalized COVID-19 cases. We developed a compartmental mathematical model to simulate the effects of molnupiravir treatment assuming various scenarios in the Omicron variant dominated settings in Denmark, the United Kingdom and Germany. We found that treating nonhospitalized cases can limit Omicron spread. This indirectly reduces the burden of hospitalization and patient death. The effectiveness of this approach depends on the intrinsic nature of the antiviral drug and the strategies of implementation. Hypothetically, if resuming pre-pandemic social contact pattern, extensive application of molnupiravir treatment would dramatically (but not completely) mitigate the COVID-19 burden, and thus there remains lifetime cost of living with the virus.

Clinical Utility of Peak Flow Meter in Asthma Diagnosis and Monitoring in Low- and Middle-Income Countries

Low- and middle-income countries (LMICs) suffer a disproportionate burden of asthma-related deaths. This may be attributed to the underdiagnosis and undertreatment. It remains unclear the extent to which the access to utility of peak flow meters (PFMs) affect the mortality rates recorded across LMICs. The purpose of this narrative review was to offer a comprehensive overview of PFMs’ clinical value for diagnosing and monitoring asthma in low- and middle-income nations. Using the standards for conducting a narrative review, this paper carried out a literature search on three major databases: Google Scholar, ResearchGate, and PubMed. Search terms were created from the variables present in the topic and strung together to find relevant literature. Exclusion criteria were used to ensure that the chosen articles were relevant after a trickle of articles was collected from various databases on the internet. There is limited knowledge about the clinical utility of PFM in LMICs despite the evidence that it can be used to demonstrate large airway obstruction. There is also limited access to the device in most health facilities and patients for self-monitoring. There is a need for more awareness on the usefulness of peak flow among doctors on the utility of the device for asthma diagnosis and monitoring. There is also a need for more research to assess the impact of the poor use of the device on asthma diagnosis, management, and overall outcome.

Recent Trends in Occupational Therapy Specific to Motor Intervention for Adults with Traumatic Brain Injury: A Scoping Review

Abstract Background: According to the National Crime Records Bureau (2014), traumatic brain injury (TBI) is increasingly being recognized as a public health problem of immense proportions with the substantial burden of disability and death occurring in low- and middle-income countries. Many people with TBI experience various degrees of motor function impairment which can have a significant impact on participation in all the areas of occupation. There is a dearth of evidence-based occupational therapy (OT)-specific motor intervention. Moreover, it is necessary to be aware of the current literature available on OT interventions to support recovery of patients with TBI. Objective: To describe the recent trends in OT-specific motor interventions for adults with TBI. Study Design: A scoping review was employed for this study. Methods: Arksey and O’Malley’s six-stage framework for scoping reviews guided our study. A search was conducted in various databases, including PubMed, Cochrane Database of Systematic Reviews, National Institute for Health and Care Excellence, and the Cumulative Index to Nursing and Allied Health Literature–CINAHL for papers published between 2016 and 2021. The search strategy was developed based on the concepts and keywords used in the Population, Intervention, Comparison, Outcomes, and Study design framework. Numerical and thematic analyses were employed. Results: Of the 35 articles identified in the review process, 13 papers were included in the scoping review. On performing analyses, 6 major themes were identified which were as follows: (1) The centrality of occupation (top-down approach), (2) Should bottom-up approach be used? When? (3) Contemporary approaches to intervention, (4) Traditional approaches to intervention, (5) Outcome measures for motor intervention, and (6) Futuristic intervention concepts and opportunities. Conclusion: Several recent trends in OT-specific to motor intervention have emerged in the yesteryears which may be considered for integration into practice with TBI survivors. Whilst there have been some advancements in TBI literature including “occupation” in the limelight, multidisciplinary or interdisciplinary collaboration and several contemporary approaches with unique and new concepts, there are still undeniable challenges to the practicing occupational therapists with regard to understanding its implementation, limited evidence, and equivocacy of its effectiveness.

Addressing disparities in cancer care and incorporating precision medicine for minority populations

Cancer incidence and outcomes vary considerably between racial and ethnic groups. Non-Hispanic (NH) Blacks are disproportionately burdened with the most common cancer types, having the highest death rate of any group. Racial health disparities are complex and have been identified at each step of the cancer care continuum, encompassing patient and provider factors and health care system processes. The higher cancer mortality among NH Blacks may reflect underuse of prevention strategies such as vaccination and screening, resulting in later stage of disease at diagnosis and underuse of cancer-directed therapy. Inequalities in the quality of care, including access to health care and receipt of recommended diagnostic and therapeutic interventions as well as supportive care also contribute to the excess burden of cancer-related deaths among NH Blacks. Non-clinical factors such as structural racism and lower socioeconomic status are associated with unequal access to resources such as housing, healthy foods, employment, and education, which have been demonstrated to drive racial disparities in cancer. Concerted efforts to understand and target the causes of the observed differences in access, screening, and treatment utilization will be critical for achieving more equitable treatment delivery and outcomes for all patients with cancer. Moreover, ongoing efforts to enhance diversity in clinical trials enrollment and access to novel precision medicine initiatives are processes warranted to reduce healthcare inequalities.

Maternal and Perinatal Death Surveillance and Response System: An Intervention to Reduce Maternal and Perinatal Deaths in Africa; Using Nigeria as a Case Study

Zero maternal and early neonatal deaths from preventable causes have been a global target for many years. There has been observed improvement as the trends have reduced for the past 20 years globally. While this can be seen as a considerable global reduction, it is, however, not uniform to continents, regions, and Nations. Of note, Sub-Saharan African countries remain the worst affected. Healthcare solutions to manage or prevent complications in pregnancy and childbirth are well known. While access to quality skilled care has been accepted globally as a major solution to the reduction of maternal and perinatal deaths and it is the greatest need of every woman, the majority of countries in Sub-Saharan Africa lack an accountability framework to ensure every woman in childbirth receive the right care, every time. For this reason, the sustainable development goals called for a renewed focus, and the healthcare system is held accountable for quality service provision. This article appreciates the efforts and approaches African Countries have put to close the gap. However, after several years of implementation, the goal remains far from being achieved. This article, therefore, provides the significance of adopting maternal and perinatal death surveillance and response (MPDSR) as a quality improvement methodology, using Nigeria as a case study. This will definitely contribute to the realization of global targets among countries in sub-Saharan Africa with a high burden of maternal deaths. It further explains why and how the MPDSR system works and outlines the structural and operational requirements for the implementation of the methodology.

Assessing the Burden of Suicide Death Associated With Nonoptimum Temperature in a Changing Climate

Few studies have projected future suicide burden associated with daily temperatures in a warming climate. To assess the burden of suicide death associated with daily nonoptimal temperature and to project the change of suicide burden associated with nonoptimal temperature in different regions and seasons under various climate change scenarios. Between January 1, 2013, and December 31, 2019, we conducted a time-stratified, case-control study among more than 430 000 individual suicide decedents from all counties in mainland China. Daily meteorological data were obtained from the European Centre for Medium-Range Weather Forecasts Reanalysis Fifth Generation (ERA5) reanalysis product. Historical and future temperature series were projected under 3 scenarios of greenhouse-gas emissions from 1980 to 2099, with 10 general circulation models. The relative risk (RR) and burden of suicide death associated with nonoptimal temperature (ie, temperatures greater than or less than minimum-mortality temperature); the change of suicide burden associated with future climate warming in different regions and seasons under various climate change scenarios. Of 432 008 individuals (mean [SD] age; 57.6 [19.0] years; 253 093 male [58.6%]) who died by suicide, 85.8% (370 577) had a middle school education or less. The temperature-suicide associations were approximately linear, with increasing death risks at higher temperatures. The excess risk was more prominent among older adults (ie, ≥75 years; RR, 1.71; 95% CI, 1.46-1.99) and those with low education level (ie, middle school education or less; RR, 1.46; 95% CI, 1.36-1.57). There were 15.2% suicide deaths (95% estimated CI [eCI], 14.6%-15.6%) associated with nonoptimal temperature nationally. Consistent and drastic increases in excess suicide deaths over this century were predicted under the high-emission scenario, whereas a leveling-off trend after the mid-21st century was predicted under the medium- and low-emission scenarios. Nationally, compared with the historical period (1980-2009), excess suicide deaths were predicted to increase by 8.3% to 11.4% in the 2050s and 8.5% to 21.7% in the 2090s under the 3 scenarios. The projected percentage increments of excess suicide deaths were predicted to be greater in the South (55.0%; 95% eCI, 30.5%-85.6%) and in winter (54.5%; 95% eCI, 30.4%-77.0%) in the 2090s under the high-emission scenario. Findings of this nationwide case-control study suggest that higher temperature may be associated with the risk and burden of suicide death in China. These findings highlight the importance of implementing effective climate policies to reduce greenhouse gas emissions and tailoring public health policies to adapt to global warming.

Health Impacts of Long-Term NO2 Exposure and Inequalities among the Chinese Population from 2013 to 2020.

Nitrogen dioxide (NO2) is associated with mortality and many other adverse health outcomes. In 2021, the World Health Organization established a new NO2 air quality guideline (AQG) (annual average <10 μg/m3). However, the burden of diseases attributable to long-term NO2 exposure above the AQG is unknown in China. Nitrogen oxide is a major air pollutant in populous cities, which are disproportionately impacted by NO2; this represents a form of environmental inequality. We conducted a nationwide risk assessment of premature deaths attributable to long-term NO2 exposure from 2013 to 2020 based on the exposure-response relationship, high-resolution annual NO2 concentrations, and gridded population data (considering sex, age, and residence [urban vs rural]). We calculated health metrics including attributable deaths, years of life lost (YLL), and loss of life expectancy (LLE). Inequality in the distribution of attributable deaths and YLLs was evaluated by the Lorenz curve and Gini index. According to the health impact assessments, in 2013, long-term NO2 exposure contributed to 315,847 (95% confidence interval [CI]: 306,709-319,269) premature deaths, 7.90 (7.68-7.99) million YLLs, and an LLE of 0.51 (0.50-0.52) years. The high-risk subgroup (top 20%) accounted for 85.7% of all NO2-related deaths and 85.2% of YLLs, resulting in Gini index values of 0.81 and 0.67, respectively. From 2013 to 2020, the estimated health impact from NO2 exposure was significantly reduced, but inequality displayed a slightly increasing trend. Our study revealed a considerable burden of NO2-related deaths in China, which were disproportionally frequent in a small high-risk subgroup. Future clean air initiatives should focus not only on reducing the average level of NO2 exposure but also minimizing inequality.

Strategies to inTerrupt RAbies Transmission for the Elimination Goal by 2030 In China (STRATEGIC): a modelling study

BackgroundA global plan has been set to end human deaths from dog-mediated rabies by 2030 ("Zero-by-30"), but whether it could be achieved in some countries, such as China, remains unclear. Although elimination strategies through post-exposure prophylaxis (PEP) use, dog vaccination, and patient risk assessments with integrated bite case management (IBCM) were proposed to be cost-effective, evidence is still lacking in China. We aim to evaluate the future burdens of dog-mediated human rabies deaths in the next decade and provide quantitative evidence on the cost-effectiveness of different rabies-control strategies in China.MethodsBased on data from China's national human rabies surveillance system, we used decision-analytic modelling to estimate dog-mediated human rabies death trends in China till 2035. We simulated and compared the expected consequences and costs of different combination strategies of the status quo, improved access to PEP, mass dog vaccination, and use of IBCM.ResultsThe predicted human rabies deaths in 2030 in China will be 308 (95%UI: 214–411) and remain stable in the next decade under the status quo. The strategy of improved PEP access alone could only decrease deaths to 212 (95%UI: 147–284) in 2028, remaining unchanged till 2035. In contrast, scaling up dog vaccination to coverage of 70% could eliminate rabies deaths by 2033 and prevent approximately 3,265 (95%UI: 2,477–3,687) extra deaths compared to the status quo during 2024–2035. Moreover, with the addition of IBCM, the "One Health" approach through mass dog vaccination could avoid unnecessary PEP use and substantially reduce total cost from 12.53 (95%UI: 11.71–13.34) to 8.73 (95%UI: 8.09–9.85) billion US dollars. Even if increasing the total costs of IBCM from 100 thousand to 652.10 million US dollars during 2024–2035, the combined strategy of mass dog vaccination and use of IBCM will still dominate, suggesting the robustness of our results.ConclusionsThe combined strategy of mass dog vaccination and IBCM requires collaboration between health and livestock/veterinary sectors, and it could eliminate Chinese rabies deaths as early as 2033, with more deaths averted and less cost, indicating that adding IBCM could reduce unnecessary use of PEP and make the "One Health" rabies-control strategy most cost-effective.

Dually Crosslinked Copper-Poly(tannic acid) Nanoparticles with Microenvironment-Responsiveness for Infected Wound Treatment.

Reducing the burden of death due to wound infection is an urgent global public health priority. Metal-phenolic networks (MPNs) have received widespread attention in antimicrobial infections due to their facile synthesis process, excellent biocompatibility, and antimicrobial properties brought about by polyphenols and metal ions. However, typical therapeutic MPNs show rapid release of metal ions due to their poor solution stability, impeding long-acting efficacy in multiple wound healing stages. To address these issues, copper-poly (tannic acid) nanoparticles (Cu-PTA NPs): robust (dually crosslinked), microenvironment-responsive, antibacterial, antioxidative, and anti-inflammatory are prepared, which hierarchically modulate the infected wound healing process. Covalently polymerized via phenol-formaldehyde condensation and crosslinked with bioactive Cu2+ , reactive polyphenols are preserved, and Cu2+ is efficiently entrapped in the PTA scaffold. The proposed strategy relieves the systemic toxicity, and only high reactive oxygen species (ROS)level as stimuli can "turn on" the catalytic activity of Cu2+ to implement antibacterial therapy specifically in an infected wound. Systematic tissue regeneration assessment on the infected full-thickness skin wounds of rats demonstrates enhanced wound healing rate. Cu-PTA NPs enables the direct application in infected wound and exertion of long-acting healing efficacy. This synergetic therapy strategy will pave the way for more complicated infections and inflammatory diseases.

Loss of life expectancy due to stroke and its subtypes in urban and rural areas in China, 2005–2020

Stroke is characterised by high mortality and disability rate in China. This study aimed to explore the temporal trends in years of life lost (YLL) and loss of life expectancy...

Secular trends of epidemiologic patterns of chronic kidney disease over three decades: an updated analysis of the Global Burden of Disease Study 2019

ObjectivesTo assess the characteristics of the global death burden imposed by chronic kidney disease (CKD) and the attributable risk factors from 1990 to 2019 to help inform a framework for...

A protocol for modelled evaluations to maximise the long-term health and economic gains of lung cancer interventions in Australia: The Lung cancer Evaluation And Policy program (LEAPp)

Background: Tobacco control interventions in Australia have had success in recent decades, international screening trials have yielded significant mortality benefits, and therapeutic innovation in disease management is burgeoning; however, lung cancer remains the leading cause of cancer death and disease burden in Australia and the most appropriate combination of interventions to address this is unclear. Underpinned by modelling infrastructure, The Daffodil Centre’s Lung cancer Evaluation And Policy program (LEAPp) combines large-scale linked data analysis, clinical trial data, statistical projections, evidence review, and stakeholder engagement to quantify and optimise the long-term health and economic impacts of lung cancer interventions for Australia, both alone and in combination.

Associated risk factors of type 2 Diabetes mellitus developments in the next 10 years using the FINDRISC among residents aged 25 and over in some wards of Hue city

Background: Diabetes is a common disease, with a rapidly increasing trend in Vietnam and worldwide, and is also the leading cause of death, morbidity, and health burden. Therefore, it is important to predict increasing levels of type 2 Diabetes mellitus (T2DM) risk and its associated risk factors to improve prevention strategies. The purpose of our study is to predict the risk of T2DM development and explore its associated factors among individuals aged 25 and above in Hue City. Materials and method: A cross-sectional study was carried out on 732 residents, aged 25 and above, living in some wards of Hue City. Results: In Tay Loc ward and Thuan Hoa ward of Hue City, the estimated incidence of T2DM development using the ModAsian FINDRISC scale was 5.18%. According to the ModAsian FINDRISC scale, occupational, history of hypertension, and dyslipidemia were significant factors associated with the risk of developing T2DM in the next ten years. Conclusion: The intervention strategy of addressing associated risk factors would be essential to reducing the risk of T2DM in the community. Key words: Diabetes mellitus, FINDRISC, Hue city.

Abstract P6-05-18: Reasons for Delay in Indian Women Presenting with Primary Stage III or IV Breast Cancer: An Observational Study

Abstract Background: Developing countries like India share higher burden of deaths due to breast cancer, despite having lower incidence than the west. Greater proportion of patients presenting with advanced stages of cancer is one of the reasons for this disparity. Since the factors leading to such delay have not been well studied in Indian patients, we decided to perform this study. Methodology: This was an observational study conducted from Jan 2021 to July 2022. Purposive Non-Random sampling was used and patients who had stage 3 or 4 breast cancer and were between 18-80 years of age were recruited. Interview was done on a one-to-one basis in a secluded area. Descriptive statistics were used, and chi-square was used to study the association of socio-demographic and clinical variables with the delay status of the breast cancer. Results: A total of 75 participants were enrolled in the study with mean age of 52.5 years and SD of 12.5 years. Out of these, 74 had lump as their first symptom. Only 14 of these 74 presented early i.e., within 3 months of onset of symptoms. Rest 60 participants presented late (more than 3 months after onset of symptoms). Between these two groups, difference in incidences of pregnancy associated lumps (0% in &amp;lt; 3 months vs 13.1% in ≥ 3 months, p=0.002), patients being afraid of treatment related complications (0% in &amp;lt; 3months vs 6.6% in ≥ 3 months, p=0.039) and their inability to decide because of lack of knowledge (0% in &amp;lt; 3months vs 6.6% in ≥ 3 months, p=0.039) were statistically significant. To our surprise, the thought that the lump was harmless and painless, embarrassment, limited access to healthcare and distance from the nearest healthcare facility, financial limitations, educational status, socio-economic status, family history of breast cancer, fear of mutilating surgeries and use of traditional medicine or spiritual care didn’t have significant effect on whether the patients presented within or after 3 months of onset of symptoms. On the question of COVID pandemic related delay, only 16% of all patients cited this as an additional reason for delay and this was again, not different between the patients who presented within or after 3 months of onset of symptoms. Conclusions: Health promotion in terms of proper evaluation of pregnancy related lumps and awareness about the management options of breast cancer may help patients to present earlier to healthcare facilities and may help in improving breast cancer related outcomes in developing countries like India. Citation Format: SIDDHANT KHARE, Vidushi Doda, R N NAGA SANTOSH IRRINKI. Reasons for Delay in Indian Women Presenting with Primary Stage III or IV Breast Cancer: An Observational Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-18.

Predictors of Hospital Readmission After Motor Vehicle Crash: Prospective Cohort Study.

Motor vehicle crash (MVC) is a major public health problem worldwide and contributes to a large burden of death, disability, and economic loss. To identify the predictors of hospital readmission in victims of MVC within 1 year after discharge. A prospective cohort study conducted with individuals who suffered MVC admitted to a regional hospital and who were followed up for 12 months after discharge. Predictors of hospital readmission were verified by means of Poisson regression models with robust variance, using a hierarchical conceptual model. Of the 241 patients followed up, 200 were contacted and comprised the population of this study. Of these, 50 (25.0%) reported hospital readmission during the 12-month period after discharge. It was evidenced that being male (relative risk [RR] = 0.58; 95% CI [0.36, 0.95], p = .033) was a protective factor, whereas occurrences of greater severity (RR = 1.77; 95% CI [1.03, 3.02], p = .036), not receiving pre-hospital care (RR = 2.14; 95% CI [1.24, 3.69], p = .006), the occurrence of postdischarge infection (RR = 2.14; 95% CI [1.37, 3.36], p = .001), and having access to rehabilitation treatment (RR = 1.64; 95% CI [1.03, 2.62], p≤ .001) are configured as risk factors for hospital readmission in individuals who have suffered these events. It was found that gender, trauma severity, pre-hospital care, postdischarge infection, and rehabilitation treatment variables predict hospital readmission in MVC victims within 1 year after discharge.

Barriers to implementing National Action Plans on antimicrobial resistance using a One Health Approach: policymakers’ perspectives from South Africa and Eswatini

ObjectivesAntimicrobial resistance poses a global public health concern that threatens human, animal, and environmental health. If it is not addressed, it is estimated to cost the global economy between USD 90 trillion and USD 210 trillion, and the death burden could balloon to 10 million lives per year by 2050. This study aimed to explore policymakers experiences on barriers to implementing National Action Plans on antimicrobial resistance using a One Health approach in South Africa and Eswatini. MethodsThirty-six policy makers were recruited using purposive and snowballing sampling in South Africa and Eswatini. Data were collected between November 2018 and January 2019 in South Africa, and February to March 2019 in Eswatini. Data was then analysed based on Creswell methods. ResultsThree themes and five subthemes emerged from our findings. The themes were resource barriers, political barriers, and regulation barriers to the implementation of National Action Plans on antimicrobial resistance in South Africa and Eswatini. ConclusionSouth African and Eswatini governments should commit funds to their One Health sector budgets to enable the implementation of National Action Plans on antimicrobial resistance. Specialized human resources issues need to be prioritized to unlock barriers of implementation. A renewed political commitment is needed to combat antimicrobial resistance in a One Health approach, as it plays a significant role in resource mobilization from regional and international organizations to support the resource-constrained countries to successfully implement policies.

Pediatric post-discharge mortality in resource-poor countries: A protocol for an updated systematic review and meta-analysis.

More than 50 countries, mainly in Sub-Saharan Africa and South Asia, are not on course to meet the neonatal and under-five mortality target set by the Sustainable Development Goals (SDGs) for the year 2030. One important, yet neglected, aspect of child mortality rates is deaths occurring during the post-discharge period. For children living in resource-poor countries, the rate of post-discharge mortality within the first several months after discharge is often as high as the rates observed during the initial admission period. This has generally been observed within the context of acute illness and has been closely linked to underlying conditions such as malnutrition, HIV, and anemia. These post-discharge mortality rates tend to be underreported and present a major oversight in the efforts to reduce overall child mortality. This review will explore recurrent illness following discharge through determination of rates of, and risk factors for, pediatric post-discharge mortality in resource-poor settings. Eligible studies will be retrieved using MEDLINE, EMBASE, and CINAHL databases. Only studies with a post-discharge observation period of more than 7 days following discharge will be eligible for inclusion. Secondary outcomes will include post-discharge mortality relative to in-hospital mortality, overall readmission rates, pooled estimates of risk factors (e.g. admission details vs discharge factors, clinical vs social factors), pooled post-discharge mortality Kaplan-Meier survival curves, and outcomes by disease subgroups (e.g. malnutrition, anemia, general admissions). A narrative description of the included studies will be synthesized to categorize commonly affected patient population categories and a random-effects meta-analysis will be conducted to quantify overall post-discharge mortality rates at the 6-month time point. Post-discharge mortality contributes to global child mortality rates with a greater burden of deaths occurring in resource-poor settings. Literature concentrated on child mortality published over the last decade has expanded to focus on the fatal outcomes of children post-discharge and associated risk factors. The results from this systematic review will inform current policy and interventions on the epidemiological burden of post-discharge mortality and morbidity following acute illness among children living in resource-poor settings. PROSPERO Registration ID: CRD42022350975.