Burden Of Disease Research Articles

Burden of mental disorders and risk factors in the Western Pacific region from 1990 to 2021

BACKGROUND The burden of mental disorders (MD) in the Western Pacific Region (WPR) remains a critical public health concern, with substantial variations across demographics and countries. AIM To analyze the burden of MD in the WPR from 1990 to 2021, along with associated risk factors, to reveal changing trends and emerging challenges. METHODS We used data from the Global Burden of Disease 2021, analyzing prevalence, incidence, and disability-adjusted life years (DALYs) of MD from 1990 to 2021. Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness. RESULTS Between 1990 and 2021, the prevalence of MD rose from 174.40 million cases [95% uncertainty interval (UI): 160.17-189.84] to 234.90 million cases (95%UI: 219.04-252.50), with corresponding DALYs increasing from 22.8 million (95%UI: 17.22-28.79) to 32.07 million (95%UI: 24.50-40.68). During this period, the burden of MD shifted towards older age groups. Depressive and anxiety disorders were predominant, with females showing higher DALYs for depressive and anxiety disorders, and males more affected by conduct disorders, attention-deficit hyperactivity disorder, and autism spectrum disorders. Australia, New Zealand, and Malaysia reported the highest burdens, whereas Vietnam, China, and Brunei Darussalam reported the lowest. Additionally, childhood sexual abuse and bullying, and intimate partner violence emerged as significant risk factors. CONCLUSION This study highlights the significant burden of MD in the WPR, with variations by age, gender, and nation. The coronavirus disease 2019 pandemic has exacerbated the situation, emphasizing the need for a coordinated response.

The global, regional, and national disease burden of colorectal cancer attributable to low physical activity from 1990 to 2021: an analysis of the Global Burden of Disease Study 2021

ObjectivesThis study aims to estimate the spatiotemporal variation in the burden of colorectal cancer (CRC) attributable to low physical activity (LPA) at global, regional, and national levels from 1990 to 2021.Study designCross-sectional study.MethodsAnnual data on deaths of CRC related to LPA, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), and the age-standardized DALYs rate (ASDR) for 204 countries and territories from 1990 to 2021 was extracted from the Global Health Data Exchange website. They were retrieved by age (5-year age groups from 25 to 94 years, and 95+ years), gender (male and female), and Socio-demographic Index (SDI). The association between age-standardized rates and SDI values was assessed by Spearman’s correlation.ResultsBetween 1990 and 2021, there was nearly a twofold increase in DALYs and mortality globally for CRC related to LPA, despite decreases in ASMR and ASDR (EAPC: −0.82% and −0.83%, respectively). However, on a national scale, ASMR and ASDR increased in more than half of the world’s countries and territories. Moreover, a greater burden of CRC related to LPA was observed in older populations, females, and those residing in regions with an SDI near 0.77.ConclusionThese findings indicate the critical need to raise awareness about the preventive role of physical activity in CRC. Policymakers should prioritize developing and implementing strategies that ensure equitable access to sports resources, enabling more people to meet the World Health Organization guidelines.

Surviving prematurity: retrospective longitudinal study of multisystem consequences in preterm-born individuals from infancy to adolescence

BackgroundPrematurity is linked to diverse and significant health outcomes, but a comprehensive understanding of its long-term multisystem impacts remains limited.MethodsRetrospective longitudinal cohort study on 417 preterm children born between 2000 and 2015 explores the incidence, dynamics, and interrelationships of health conditions from infancy to adolescence. Data on 1818 diagnoses, categorised by birth weight (BW) and gestational age (GA) and documented according to ICD-10, were analysed using non-parametric tests and negative binomial regression models.ResultsMost diagnoses occurred by age 7, with eye diseases, congenital malformations, and infections most prevalent, but the greatest disparities with the general population were in blood, nervous system, mental, and neoplastic diseases. Lower BW significantly correlated with higher mean disease counts and greater diversity of health conditions across various ICD-10 chapters, while GA showed less pronounced associations. Children in "Extremely and very low," "Low," and "Sub-optimal" BW categories exhibited 1.77, 1.50, and 1.34 times more diseases, respectively, than those in the "Normal" BW category. Unique and highly individual patterns of disease co-occurrence were observed, increasing in complexity as BW decreased.ConclusionsThe highest disease burden for preterm-born individuals occurred by age 7, with lower BW linked to greater health complexity and unique comorbidities.

Study of Children Aged Under 2 Years Admitted With RSV at Four Australian Hospitals [2021-2022

Primary aim was to review severe acute respiratory infections (SARI) hospitalisations caused by respiratory syncytial virus (RSV) in children aged < 2 years in paediatric hospitals in Australia. Secondary aims included RSV subtyping, assessing RSV seasonality and contributing to the World Health Organisation's RSV surveillance programme. We prospectively reviewed the medical records of children (< 2 years of age) with a confirmed SARI who were admitted to one of four major Australian paediatric hospitals and had a respiratory sample analysed by Polymerase Chain Reaction (PCR). A detailed dataset was completed for RSV positive cases. Between 1 January 2021 and 31 December 2022, 2290 RSV (laboratory-confirmed) admissions were identified (53.4% of all SARI admissions). Approximately 50% of all RSV cases were aged 0-6 months. RSV-A predominated in 2021 with peak infections observed in summer while in 2022 RSV-B predominated with peak infections in the more traditional winter months. The median total length of stay (LOS) for RSV positive admissions was 46 h (IQR: 22-82 h). 9% of these children required an ICU admission with a prolonged median LOS 68 h (IQR: 40-112 h). Respiratory support utilisation was consistent over the 2 years. 1.8% required mechanical ventilation; 4.6% continuous positive airway pressure; 23.3% high flow oxygen; and 50.8% low flow oxygen. RSV in children continues to cause a significant disease burden at Australian tertiary paediatric centres. Ongoing hospital surveillance is required to document the impact of RSV preventative therapies that have become available in 2024.

Strategies for introducing and implementing vaccines for adults into national immunization programs in Europe: Good practices and key insights of the adult immunization board meeting.

In April 2024, the Adult Immunization Board convened a technical meeting to explore the latest strategies and identify exemplary approaches regarding the implementation of vaccines for adults into Europe's National Immunization Programs (NIPs). The meeting was built around three pillars: decision making for introducing a new vaccine, implementation, monitoring, and evaluation. The increasing number of new vaccines available in a context of competing health priorities warrants transparent and evidence-based decision-making processes for vaccine introduction. In Europe, burden of disease, vaccine efficacy or effectiveness, and safety are universally used decision-making criteria. While economic evaluations and the quality of evidence are being increasingly considered, public acceptance, equity, and operational criteria remain underutilized. Vaccine implementation requires planning and coordination. Implementation activities discussed during the meeting were vaccine program goals, target population identification, communication, training of healthcare professionals, and involvement of pharmacists. Once operational, NIPs are to be monitored in terms of safety, effectiveness, and impact. Implementation science as well as behavioral and cultural insights can be used to identify tangible interventions to improve uptake. Meeting discussions allowed to identify adult vaccine implementation barriers and possible strategies to overcome them. Enhanced cooperation and coordination throughout the Europe region were recognized as critical components of progress.

Exploring the Social Determinants of Health in Nutrition Care for South Asian Communities: A Narrative Review.

The South Asian (SA) diasporic communities in Canada experience a greater burden of diabetes and cardiovascular disease (CVD) compared to white populations. Nutrition interventions often focus on individual behaviours and fail to consider that the social determinants of health (SDH) have a greater impact on chronic disease risk. A narrative review was conducted to identify the SDH in nutrition care interventions for the SA diaspora in Canada. The final analysis included fourteen articles from which SDH were identified and categorized based on the Social Ecological Model (SEM). The study analysis yielded the following needs in dietetic practice based on the SEM: (1) intrapersonal - need for language appropriate services, and representation of cultural foods and non-Western health perspectives in dietary guidelines, (2) interpersonal - understanding family and friends as social supports, (3) community - incorporating peer and community leader influences, (4) institution - importance of faith-based locations as community hubs, and client workplaces as a barrier to attending appointments, and (5) policy - advocacy for transportation and childcare access, adequate and secure income, and equitable care. These findings urge dietitians to move beyond cultural awareness, sensitivity, and competence to practicing cultural safety and humility in their practice, which is integral to providing equitable care.

Norovirus replication, host interactions and vaccine advances.

Human noroviruses (HuNoVs) are the leading cause of acute gastroenteritis worldwide in all age groups and cause significant disease and economic burden globally. To date, no approved vaccines or antiviral therapies are available to treat or prevent HuNoV illness. Several candidate vaccines are in clinical trials, although potential barriers to successful development must be overcome. Recently, significant advances have been made in understanding HuNoV biology owing to breakthroughs in virus cultivation using human intestinal tissue-derived organoid (or enteroid) cultures, advances in structural biology technology combined with epitope mapping and increased metagenomic sequencing. New and unexpected strain-specific differences in pandemic versus non-pandemic virus structures, replication properties and virus-host interactions, including host factors required for susceptibility to infection and pathogenesis, are discussed.

Role of Population Based Studies in Advancing our Knowledge of Myelodysplastic Syndromes.

Myelodysplastic syndromes (MDS) are myeloid neoplasms characterized by high molecular and genomic heterogeneity. Accordingly, efforts in risk assessment and therapeutic intervention mostly target unique profiles that individualize specific MDS subtypes. In this review, we explored the contributions of population based studies accounting for MDS as a group. Large population based studies have been critical to define important details of our current knowledge of the disease. We summarized the most important population research contributions in MDS, focusing on its epidemiology, population risk factors, and relevant clinical associations. We discuss how these population data can provide vital insights to inform prevention measures, testing strategies, and treatment decisions. Population studies play an important role in guiding clinical and research efforts in MDS. Despite its complex molecular and genomic landscape, population data is integral to define the burden of disease, identify risk factors and clinical associations, and can help elucidate pathogenic mechanisms.

Cardiovascular risk profiling among South Asian adults in Hong Kong: a latent class analysis

BackgroundSouth Asians living in urbanized settings are facing disproportionate cardiovascular burden largely attributable to modifiable risk factors. Given the rapid surge in South Asian population in Hong Kong, this study aims to identify and distinguish clusters of cardiovascular risk profiles among community-dwelling South Asian adults.MethodsBetween June 2022 and December 2023, 1181 South Asian adults were recruited through territory-wide outreach health assessments on lifestyle, psychological distress, obesity, clinical cardiovascular conditions, and sociodemographic factors. Latent class analysis was performed to classify the cardiovascular profiles, followed by multinomial logistic regression to identify the sociodemographic characteristics across classes.ResultsFive latent classes were identified: low risk (19.6%), lifestyle risk plus distress (8.9%), obesity risk (33.4%), lifestyle risk plus distress with obesity (26.6%), and high clinical risk (11.4%). Apart from the higher clinical risk in older adults, women tended to cluster into classes with obesity, while men and the economically active were more likely in classes with poorer lifestyles and stress. Pakistani and Nepalese consistently exhibited higher risks compared to Indians, whereas the less educated tended to cluster into the high clinical risk class.ConclusionThis study revealed distinct cardiovascular risk patterns and sociodemographic features within the South Asian community in Hong Kong. The heavy burden on obesity especially in women, lifestyle and psychological risks especially in men, and low overall physical activity level may be translated into a tremendous cardiovascular disease burden in the forthcoming decades, in particular among Pakistani and Nepalese as well as the socioeconomically disadvantaged.

Global burden of bacterial skin diseases from 1990 to 2045: an analysis based on global burden disease data.

Bacterial skin diseases are a category of inflammatory skin conditions caused by bacterial infections, which impose a significant global disease burden. However, they have not been well assessed or predicted on a global scale. It is necessary to update the estimates and forecast future trends of the global burden of bacterial skin diseases to evaluate the impact of past healthcare policies and to provide guidance and information for new national and international healthcare strategies. We aimed to describe the burden and trend of bacterial skin diseases and to predict the burden up to 2045. To achieve this, we employed a cross-sectional analysis based on Global Burden of Disease (GBD) data, utilizing advanced statistical models to quantify trends and forecast future burdens. Data on incidence and disability-adjusted life years (DALYs) of bacterial skin diseases were obtained from Global Burden of Disease 2021. We used average annual percent change (AAPC) by Joinpoint Regression to quantify the temporal trends. We conducted decomposition analysis to understand the contribution of aging, epidemiological changes, and population growth. Bayesian Age-Period-Cohort model was used to predict burden up to 2045. Global incidence rate of bacterial skin diseases increased from 8,988.74 per 100,000 in 1990 to 10,823.88 per 100,000, with AAPC of 0.62% (0.61 ~ 0.63%). The highest incidence rate was in low Socio-demographic Index (SDI) region and population aged < 35. The DALYs rate increased from 20.82 per 100,000 in 1990 to 25.45 per 100,000 in 2021, with AAPC of -0.11% (-0.34 ~ 0.13%). The highest increase of DALYs was in high SDI region and population aged > 85. Among the three evaluated factors of decomposition analysis, the major drivers of incident case rise were population growth, followed by epidemiological changes; the major drivers of DALYs case rise were population growth, followed by aging. The number of incidence cases has increased since 1990, reaching nearly 90million in 2021 and expected to hit 1.2billion in 2045. The incidence rate has also risen. Meanwhile, DALYs showed an upward trend from 1990 to 2005, peaking at 32/100,000, then a downward trend. Our findings align with our initial objectives, demonstrating a significant increase in the global incidence of bacterial skin diseases and highlighting the need for targeted prevention and treatment strategies. The variation in burden across different regions and age groups underscores the importance of tailored public health interventions. Predictive models suggest a continued rise in incidence rates and incident cases through 2045, emphasizing the urgency for action. This study provides a foundation for future research and policy development aimed at reducing the burden of bacterial skin diseases worldwide.

Burden of disease attributable to high body mass index in Belgium: a comparative risk assessment analysis

Background and methodsHigh body mass index (BMI) is a major risk factor for several non-communicable diseases. The increasing concern about the health and economic burden of BMI makes it essential...

Utility of Diaphragm Dome Height as a Marker of Operational Lung Volume Changes, Disease Burden and Exacerbations in Patients with Mild-to-Moderate COPD: An Observational Study Within the CanCOLD Cohort

BackgroundDynamic hyperinflation is central to dyspnoea, exercise limitation, and exacerbations in chronic obstructive pulmonary disease (COPD). While studied previously in moderate-severe COPD, the relevance of diaphragm dome height on clinically important outcomes has been under-investigated in mild-to-moderate COPD.MethodsCanadian Cohort Obstructive Lung Disease participants with spirometry-confirmed COPD, symptom-limited incremental cardiopulmonary exercise testing, and computed tomography image data were included. Base-to-apex left and right diaphragm dome height (DDH) was automatically segmented, with increased height implying less flattening and thus less hyperinflation. Dynamic hyperinflation was defined as ≥150 mL reduction in inspiratory capacity (IC) from rest to peak-exercise. Cross-sectional linear regression models were fitted between left and right DDH (predictor variables) with peak IC (ICpeak), peak workload (Wpeak), FEV1, and CAT score (outcome variables), and in longitudinal (Anderson-Gill) models with “symptom-based” and “event-based” exacerbations. Results are reported as parameter estimates or hazard ratios with 95%CIs per interquartile range dome height increment.ResultsAmong 304 participants (mean age 64.7±10.3, 41.8% female, 44.4% with mild COPD), each left and right DDH increment, respectively, was associated with ICpeak(0.21[0.13,0.29]L, 0.13[0.07,0.19]L), Wpeak(9.54[5.03,14.04]W, 6.04[2.45,9.62]W), FEV1(0.17[0.10,0.25]L, 0.08[0.02,0.14]L), and CAT score (−1.36[−2.39,−0.33], −0.82[−1.63,0.00]). Left DDH alone was associated with both symptom-based (HR: 0.82[0.74,0.91]) and event-based (0.83[0.73,0.95]) exacerbations. Of 167/304 participants with confirmed dynamic hyperinflation (ΔIC=−0.47±0.25 L), left DDH alone was associated with all outcomes (ICpeak, Wpeak, FEV1, CAT, and symptom-based/event-based exacerbations).ConclusionsLeft DDH appears to be a clinically important marker for operational lung volume changes, lung function, exercise performance, disease burden, and exacerbations in mild-to-moderate COPD.

Patterns and trends in burden of asthma and its attributable risk factors from 1990 to 2021 among south Asian countries: a systematic analysis for the Global Burden of Disease Study 2021

Objective Asthma poses a significant health burden in South Asia, with increasing incidence and mortality despite a global decline in age-standardized prevalence rates. This study aims to analyze asthma trends from 1990 to 2021, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs) across South Asia. The study also assesses the impact of risk factors like high body mass index (BMI), smoking, and occupational exposures on asthma outcomes. Method We extracted asthma data from the Global Burden of Disease (GBD) database for South Asia (1990–2021). Joinpoint regression analysis was used to assess temporal trends in asthma burden. Annual percentage changes in age-standardized rates (ASR) of incidence, mortality, and DALYs were calculated. Data were stratified by gender, and the contribution of risk factors was evaluated. Results Asthma-related mortality in South Asia decreased by 37%, from 27.78 per 100,000 (1990) to 17.54 per 100,000 (2021). The Maldives showed the most significant reduction in mortality (78.31%), while Bangladesh recorded a 47.44% reduction in prevalence and a 62.64% decrease in DALYs. High BMI, smoking, and environmental risks contributed significantly to DALYs, with environmental factors playing a major role in countries like Afghanistan (20.73%) and Bhutan (18.58%). Females, particularly those over 20, experienced higher asthma-related DALYs than males. Conclusion Asthma burden in South Asia has reduced over the past three decades, yet the absolute number of cases continues to rise, driven by population growth and environmental risk factors. Targeted interventions addressing risk factors and healthcare disparities are essential for further reducing asthma burden.

A systematic epidemiological trends analysis study in global burden of multiple myeloma and 29 years forecast

Multiple myeloma is a prevalent hematologic cancer. This investigation analyzes the latest global, regional, and national data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Data on the incidence, prevalence, disability-adjusted life years, and mortality rates of multiple myeloma, including estimates and 95% uncertainty intervals, were sourced from the 2021 Global Burden of Diseases Study. Furthermore, we explored the trends affecting the multiple myeloma burden from 1990 to 2021, breaking it down by demographic, age, and epidemiological factors. By 2021, the global incidence of multiple myeloma involved 148,754.63 reported cases, with confidence intervals ranging from 131,780.43 to 162,049.23. Worldwide, the number of mortality attributed to multiple myeloma reached 116,359.63, with the confidence interval lying between 103,078.62 and 128,470.57, and an age-standardized mortality rate of 1.37 per 100,000 individuals, the confidence interval for which was 1.22 to 1.52. There was a consistent increase in the incidence, prevalence, and disability-adjusted life years associated with multiple myeloma. Most of the disease burdens were seen in high income countries though its incidence is on the rise in low-income countries. Forecast for the years 2022–2050 showed the further increase in the incidence, prevalence, disability-adjusted life years, and age-standardized death rates of multiple myeloma.

The long-term effects of cardiometabolic risk factors on mortality and life expectancy: evidence from a health check-up cohort study

ObjectiveCardiometabolic risk factors significantly contribute to disease burden. This study explored the effects of hypertension (HTN), diabetes mellitus (DM), and hyperlipidemia (HLP) on mortality. It stratified findings by age group and comorbidity severity using the Charlson Comorbidity Index (CCI) score. Additionally, it assessed the compounded effects of comorbid conditions to estimate life expectancy (LE) and years of life lost (YLL) in individuals with various cardiometabolic risk factor combinations.MethodsUsing data from the MJ Health Check-up Database (2002–2017), linked with the National Health Insurance Research Database (2000–2017) and the Death Registry (2002–2019), this study employed Cox proportional hazards models to determine mortality risk associated with various cardiometabolic risk factors. Adjusted Kaplan–Meier curves were constructed to evaluate survival rates across different risk factors and CCI scores. Survival rates were extrapolated to estimate confounder-adjusted LE and YLL for age-comorbidity combinations.ResultsAmong the three age groups (20–39, 40–59, 60–79), HLP was the most common single risk factor, followed by HTN. In participants with dual risk factors, HTN and HLP were the most frequent pair, with diabetes and HLP second. An increased number of cardiometabolic risk factors elevated mortality risk, particularly in the 20–39 age group. LE, adjusted for confounders, declined with age, higher CCI scores, and more risk factors. YLL decreased with age but increased with higher CCI scores and more risk factors.ConclusionsPromoting health awareness, early disease detection, and timely medical access can reduce cardiometabolic risk factors and associated comorbidities, thereby alleviating disease burden.

Stroke Prevention in Hispanic Children with Sickle Cell Anemia: the SACRED trial.

Sickle cell anemia (SCA) is recognized globally, but little is known about affected Hispanic populations. In partnership with Dominican Republic, a Hispanic Caribbean Island with a large SCA population, a TCD screening program provided hydroxyurea to children with conditional velocities. Building local capacity, ten Dominican medical graduates were certified in TCD examinations and trained in hydroxyurea management. Stroke Avoidance for Children in REpública Dominicana trial (SACRED, NCT02769845) enrolled 283 children with average age 8.7±3.4 years and 130 (46%) females. At initial screening, treatment-naïve children with conditional velocities (170-199 cm/sec) were younger (6.6±2.7 versus 8.9±3.4 years, p=.0002) and more anemic (hemoglobin 7.4±0.8 versus 8.0±1.2 g/dL, p=.0046) than children with normal screening velocities (<170 cm/sec). Among 57 treatment-naïve children receiving six months of fixed-dose hydroxyurea at 20 mg/kg/day, average TCD velocities decreased 20 cm/sec and 61% became normal. Compared to fixed-dose hydroxyurea, dose escalation to maximum tolerated dose (MTD) led to fewer sickle-related events with incidence rate ratio 0.59, 95% Confidence Intervals 0.36-0.98, p=0.0420. At MTD, TCD benefits were sustained over 5 years, with 81% reverting to normal and average TCD velocity decrease of 27 cm/sec. Brain MRI documented substantial baseline parenchymal disease; during hydroxyurea treatment 10% developed new vasculopathy, plus one stroke and one death. SACRED documents a high burden of cerebrovascular disease among Hispanic children with SCA, but also demonstrates the feasibility of partnership to establish TCD screening programs, the utility of hydroxyurea to reduce TCD velocities and reduce stroke risk, and the sustained benefits of hydroxyurea dose escalation.

Burden of Valvular Heart Diseases in a Racially and Ethnically Diverse Population: The Bronx-Valve Registry.

Valvular heart disease (VHD) is a major focus of cardiovascular medicine, but limited data are available for racial and ethnic minorities. The aim was to assess the burden and clinical correlates of VHD in a highly diverse area of the United States. Individuals with echocardiographic diagnosis of native VHD between January 2010 and December 2019 at a quaternary care health system of the Bronx (New York, USA) were included. Prevalence and correlates of VHD were assessed per each racial and ethnic group. From a total of 330 570 adult echocardiograms, 80 584 individuals were diagnosed with VHD and included in the final study population. Stratified by race and ethnicity, 38.0%, 23.2%, 2.1%, and 36.7% were non-Hispanic Black, non-Hispanic White, Asian, and Hispanic, respectively. The mean age was 67.7±16.3 years, with non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals being younger and having a higher burden of comorbidities. The prevalence of VHD increased with age, irrespective of race or ethnicity. In people aged ≥75 years, tricuspid and mitral regurgitation were the most prevalent VHD (21.1% and 16.1%, respectively). Non-Hispanic White individualsmore frequently had tricuspid regurgitation, mitral regurgitation, and multiple VHDs, but among those aged <65 years, these were more frequent in non-Hispanic Black individuals. Our Bronx-Valve Registry illustrates that the burden of VHD is high, increases with age, and varies among racial and ethnic groups. When diagnosed with VHD, non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals are younger and with a higher burden of comorbidities. Appropriate resources and strategies need to be implemented to minimize racial and ethnic disparities and promote equity in VHD diagnosis and cardiovascular risk factor management. URL: https://clinicaltrials.gov. Unique Identifier: NCT05453526.

Knowledge, Attitudes, and Barriers to the Utilization of Optional Vaccines among Mothers of Children under Five Years of Age in Kheda District, Gujarat

Introduction: Vaccination is an effective and a reliable method to safeguard oneself from dangerous diseases before encountering them. Vaccination remains one of the most effective public health interventions in human history, significantly reducing the burden of infectious diseases and saving countless lives worldwide. Aim: To determine knowledge and attitude regarding optional vaccines and barriers to use among mothers of under five children in Kheda district. Methodology: The non-experimental Descriptive Survey Research design used for this study. The study was conducted on 384 mothers of under five children from selected areas of Kheda district by non-probability purposive sampling technique. For the data collection researcher has prepared and used knowledge questionnaire, Attitude scale and to assess the barrier checklist questionnaire. Result: 240 (63%) of mothers have low knowledge, 123 (32%) have moderate knowledge, and 21 (5%) have good knowledge regarding optional vaccination. When 1 (0.3%) mother have Unfavourable attitude, 275 (71.6%) have moderate attitude, and 108 (28.1%) have favourable attitude towards optional vaccination. The mean score of attitude is 8.7083. The Correlation-Coefficient (r) of knowledge and attitude is 0.76. Conclusion: The study highlights the disparity between knowledge and attitude regarding optional vaccination among mothers of under five children. Although the majority lack adequate knowledge, a considerable number still maintain a moderate attitude. This emphasizes the need for targeted interventions to improve understanding and promote positive attitudes toward optional vaccination.

Are we disadvantaging smokers by excluding them from kidney transplantation? A single-centre experience and survey of kidney transplantation units.

Smoking has been shown to have detrimental effects on KT outcomes and survival. Most units and guidelines advocate for the cessation of smoking prior to a kidney transplant and consider it a general contraindication to listing. Smoking prevalence is higher in disadvantaged groups. Smoking cessation is complex and often takes many years. For those suffering from the burden of chronic kidney disease, a delay in transplantation with a longer dialysis time may result in worse outcomes and accentuate the difficulty of cessation. The objective of this study was to describe the cohort of excluded smokers for kidney transplantation (KT) and further examine the current practices regarding smoking and KT waitlisting. We undertook a retrospective observational study of dialysis patients in Hunter New England Local Health District 2013-2023 <65 years old and assessed but not listed for KT. We examined the reasons for non-transplant listing and divided them into two categories, smoking versus others (comorbidities, patient preference and cancer). We compared the categories in terms of demography, comorbidities and dialysis modality. We also conducted a survey of KT units across Australia and New Zealand regarding their policies towards smoking. We reviewed the records of 333 patients (142 female), 89 of whom were smokers. Patients not listed due to smoking were less comorbid than those rejected for another reason (83% vs 40% having ≤1 comorbid condition, P < 0.001). Patients rejected due to smoking were younger than those rejected for other reasons (47.8 vs 52.1, P = 0.007). There was no difference between the two groups in terms of sex or dialysis modality. All the acute KT units were surveyed (response rate 100%); 72% of units do not list current smokers for KT. Patients not listed for KT due to smoking are generally younger and less comorbid than those not listed for other reasons. Our survey shows variation in practice between units. As smoking is more prevalent in marginalised communities, not listing these patients for KT may be an equity-of-access-to-treatment issue.

Cancer statistics, 2025.

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries (through 2021) and mortality data collected by the National Center for Health Statistics (through 2022). In 2025, 2,041,910 new cancer cases and 618,120 cancer deaths are projected to occur in the United States. The cancer mortality rate continued to decline through 2022, averting nearly 4.5 million deaths since 1991 because of smoking reductions, earlier detection for some cancers, and improved treatment. Yetalarming disparities persist; Native American people bear the highest cancer mortality, including rates that are two to three times those in White people for kidney, liver, stomach, and cervical cancers. Similarly, Black people have two-fold higher mortality than White people for prostate, stomach, and uterine corpus cancers. Overall cancer incidence has generally declined in men but has risen in women, narrowing the male-to-female rate ratio (RR) from a peak of 1.6 (95% confidence interval, 1.57-1.61) in 1992 to 1.1 (95% confidence interval, 1.12-1.12) in 2021. However, rates in women aged 50-64 years have already surpassed those in men (832.5 vs. 830.6 per 100,000), and younger women (younger than 50 years) have an 82% higher incidence rate than their male counterparts (141.1 vs. 77.4 per 100,000), up from 51% in 2002. Notably, lung cancer incidence in women surpassed that in men among people younger than 65 years in 2021 (15.7 vs. 15.4 per 100,000; RR, 0.98, p = 0.03). In summary, cancer mortality continues to decline, but future gains are threatened by rampant racial inequalities and a growing burden of disease in middle-aged and young adults, especially women. Continued progress will require investment in cancer prevention and access to equitable treatment, especially for Native American and Black individuals.