Decline In Mortality Research Articles

Distribution and insecticide resistance profile of the major malaria vector Anopheles funestus group across the African continent.

There has been significant progress in malaria control in the last 2 decades, with a decline in mortality and morbidity. However, these gains are jeopardised by insecticide resistance, which negatively impacts the core interventions, such as insecticide-treated nets (ITN) and indoor residual spraying (IRS). While most malaria control and research efforts are still focused on Anopheles gambiae complex mosquitoes, Anopheles funestus remains an important vector in many countries and, in some cases, contributes to most of the local transmission. As countries move towards malaria elimination, it is important to ensure that all dominant vector species, including An. funestus, an important vector in some countries, are targeted. The objective of this review is to compile and discuss information related to A. funestus populations' resistance to insecticides and the mechanisms involved across Africa, emphasising the sibling species and their resistance profiles in relation to malaria elimination goals. Data on insecticide resistance in An. funestus malaria vectors in Africa were extracted from published studies. Online bibliographic databases, including Google Scholar and PubMed, were used to search for relevant studies. Articles published between 2000 and May 2023 reporting resistance of An. funestus to insecticides and associated mechanisms were included. Those reporting only bionomics were excluded. Spatial variation in species distribution and resistance to insecticides was recorded from 174 articles that met the selection criteria. It was found that An. funestus was increasingly resistant to the four classes of insecticides recommended by the World Health Organisation for malaria vector control; however, this varied by country. Insecticide resistance appears to reduce the effectiveness of vector control methods, particularly IRS and ITN. Biochemical resistance due to detoxification enzymes (P450s and glutathione-S-transferases [GSTs]) in An. funestus was widely recorded. However, An. funestus in Africa remains susceptible to other insecticide classes, such as organophosphates and neonicotinoids. This review highlights the increasing insecticide resistance of An. funestus mosquitoes, which are important malaria vectors in Africa, posing a significant challenge to malaria control efforts. While An. funestus has shown resistance to the recommended insecticide classes, notably pyrethroids and, in some cases, organochlorides and carbamates, it remains susceptible to other classes of insecticides such as organophosphates and neonicotinoids, providing potential alternative options for vector control strategies. The study underscores the need for targeted interventions that consider the population structure and geographical distribution of An. funestus, including its sibling species and their insecticide resistance profiles, to effectively achieve malaria elimination goals.

Racial disparities in genitourinary cancer mortality trends in the United States, 2000-2020: A CDC database study.

28 Background: Prostate, bladder, and kidney cancers account for substantial burden of cancer incidence and mortality in the United States. In 2020, an estimated 168,000 new cases and 32,000 deaths were attributed to these cancers. Studies examining racial disparities of mortality trends are needed. Methods: We utilized the CDC WONDER database to obtain mortality data for kidney, bladder, and prostate cancers between 2000-2020. Age-adjusted mortality rates per 100,000 persons were calculated and standardized to the Year 2000 US standard population. Rates were stratified by race, including White, Black, Asian/Pacific Islander (API), and American Indian/Alaska Native (AIAN). The National Cancer Institute Joinpoint Regression Program was utilized to calculate average annual percent changes (AAPCs). AAPCs were considered significant if the 95% confidence interval (CI) excluded zero. Results: Over the study period, 318,919 kidney cancer deaths, 150,613 bladder cancer deaths, and 516,508 prostate cancer deaths were identified. Between 2000-2020, amongst all races, mortality from prostate cancer (-1.8%; CI -2.0, -1.6), bladder cancer (-0.3%; CI -0.5, -0.2), and kidney cancer (-1.1%; CI -1.2, -0.9) all significantly declined. Considering racial disparities, prostate cancer mortality fell considerably in all race groups, most significantly among Black (-2.8%, CI -3.2%, -2.4%) and AIAN (-2.4%, CI -2.9%, -1.8%) populations, outpacing reductions in API (-1.7%, CI -2.6%, -0.8%) and White (-1.6%, CI -1.9%, -1.4%) populations. In bladder cancer, the decline in mortality was statistically significant for Black (AAPC: -0.8%, CI -1.1%, -0.6%) and for White, (-0.4%, CI -0.6%, -0.1%), but not for API individuals (-0.3%, CI -0.9%, 0.3%). For kidney cancer, mortality dropped substantially across all examined races, with the steepest decline seen in Black (-1.4%, CI -1.7%, -1.2%) and AIAN (-1.7%, CI -2.5%, -1.0%) compared to White (-1.0%, CI -1.2%, -0.9%) and API (-1.4%, CI -4.2%, 1.6%, non-significant) population. Conclusions: This study represents the most comprehensive population database analysis assessing GU cancer mortality trends. While an overall decline in GU cancer mortality was observed, which was comparatively greater for Black Americans over the past two decades, significant racial disparities continue to persist. Focused and targeted efforts are essential to address these disparities. [Table: see text]

Disparities in Mortality Trends of Breast Cancer by Racial and Ethnic Status in the United States.

Breast cancer is the most commonly diagnosed malignancy for women and is a leading cause of mortality in women worldwide and in the United States. Recently, new interventions have been developed to improve its prognosis. The aim of this study was to assess the impact of new therapies on racial and ethnic groups in the United States for demographic-based disparities. We assessed the impact of these developments from 1999 to 2020 on age adjusted mortality rate (AAMR), mortality rate trend from 1999 to 2020, average annual percent change (AAPC), and temporal trends, by annual percent change (APC) in the United States for various demographic groups. We queried the CDC Wonder database to retrieve mortality rates by race and ethnic group from 1999 to 2020 with breast malignancy as a contributing cause of death. Between 1999 to 2020, all racial groups presented a significant overall decline in mortality rates: AI/AN [AAPC, -1.6% (95% CI=-2.2% to -1.0%); p<0.01], AAPI [AAPC, -0.5% (95% CI=-1.00% to -0.1%); p<0.01], Black/African American [AAPC, -1.4% (95% CI=-1.6% to -1.2%); p<0.01], and the white population [AAPC, -1.7% (95% CI=-1.8% to -1.5%); p<0.01]. The Black/African American population had a significant lower rate of decline compared to the white population (p<0.01) and Hispanic/Latinx populations had a lower rate of decline compared to those who are non-Hispanic/Latinx (p<0.01). We found that Black/African American population had a significant lower rate of decline compared to the white population and Hispanic/Latinx populations had a lower rate of decline compared to those who are non-Hispanic/Latinx. These differences in mortality trend rates in breast cancer emphasize the need for targeted interventions and resources tailored to specific demographic needs.

Incidence-Based Breast Cancer Mortality Trends in Estonia Before and After the Introduction of Organized Mammography Screening: A Register-Based Study.

Despite the relatively low breast cancer incidence in Estonia, mortality remains high, and participation in mammography screening is below the recommended 70%. The objective of this register-based study was to evaluate incidence-based (IB) breast cancer mortality before and after the introduction of organized mammography screening in 2004. Breast cancer deaths individually linked to breast cancer diagnosis were obtained from the Estonian Cancer Registry and used for calculating IB mortality. We compared age-specific IB mortality rates across 5-year birth cohorts and 5-year periods. Poisson regression was used to compare IB mortality for one age group invited to screening (50-63) and three age groups not invited to screening (30-49, 65-69, and 70+) during two periods before and after screening initiation (1993-2003 and 2004-2014). Joinpoint regression was used for age-standardized incidence and IB mortality trends. Age-standardized IB mortality has been decreasing since 1997. Age-specific IB mortality for birth cohorts never exposed to screening showed a continuous increase with age, while in cohorts exposed to organized screening the mortality curve flattened or declined after the age of first invitation. Significant decreases in mortality from 1993-2003 to 2004-2014 were seen in the 30-49 (age-adjusted rate ratio 0.51, 95% CI 90.42-0.63) and 50-63 (0.65, 95% CI 0.56-0.74) age groups, while no decline was seen in the 65-69 and 70+ age groups. The age specific IB mortality curves in birth cohorts exposed to screening and the significant mortality decline in the target age group after the initiation of the organized program suggest a beneficial effect of screening. Improved treatment without screening has not reduced mortality in older age groups. Our results support raising the upper screening age limit to 74 years.

LSTM-Based Coherent Mortality Forecasting for Developing Countries

This paper studies a long short-term memory (LSTM)-based coherent mortality forecasting method for developing countries or regions. Many of such developing countries have experienced a rapid mortality decline over the past few decades. However, their recent mortality development trend is not necessarily driven by the same factors as their long-term behavior. Hence, we propose a time-varying mortality forecasting model based on the life expectancy and lifespan disparity gap between these developing countries and a selected benchmark group. Here, the mortality improvement trend for developing countries is expected to converge gradually to that of the benchmark group during the projection phase. More specifically, we use a unified deep neural network model with LSTM architecture to project the life expectancy and lifespan disparity difference, which further controls the rotation of the time-varying weight parameters in the model. This approach is applied to three developing countries and three developing regions. The empirical results show that this LSTM-based coherent forecasting method outperforms classical methods, especially for the long-term projections of mortality rates in developing countries.

Lung cancer statistics, 2023.

Despite decades of declining mortality rates, lung cancer remains the leading cause of cancer death in the United States. This article examines lung cancer incidence, stage at diagnosis, survival, and mortality using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Over the past 5years, declines in lung cancer mortality became considerably greater than declines in incidence among men (5.0% vs. 2.6% annually) and women (4.3% vs. 1.1% annually), reflecting absolute gains in 2-year relative survival of 1.4% annually. Improved outcomes likely reflect advances in treatment, increased access to care through the Patient Protection and Affordable Care Act, and earlier stage diagnosis; for example, compared with a 4.6% annual decrease for distant-stage disease incidence during 2013-2019, the rate for localized-stage disease rose by 3.6% annually. Localized disease incidence increased more steeply in states with the highest lung cancer screening prevalence (by 3%-5% annually) than in those with the lowest (by 1%-2% annually). Despite progress, disparities remain. For example, Native Americans have the highest incidence and the slowest decline (less than 1% annually among men and stagnant rates among women) of any group. In addition, mortality rates in Mississippi and Kentucky are two to three times higher than in most western states, largely because of elevated historic smoking prevalence that remains. Racial and geographic inequalities highlight longstanding opportunities for more concerted tobacco-control efforts targeted at high-risk populations, including improved access to smoking-cessation treatments and lung cancer screening, as well as state-of-the-art treatment.

Stagnation of maternal mortality decline in Bangladesh between 2010 and 2016 in spite of an increase in health services utilisation: Examining data from three large cross-sectional surveys.

After a 40% reduction in maternal mortality ratio (MMR) during 2001-2010 in Bangladesh, the MMR level stagnated between 2010 and 2016 despite a steady increase in maternal health services use and improvements in overall socioeconomic status. We revisited the factors that contributed to MMR decline during 2001-2010 and examined the changes in these factors between 2010 and 2016 to explain the MMR stagnation in Bangladesh. We used data from the 2001, 2010, and 2016 Bangladesh Maternal Mortality Surveys, which sampled 566 115 households in total, to estimate the changes in the risk of dying of maternal causes associated with a pregnancy or birth between 2001-2010 and 2010-2016. We carried out Poisson regression analyses with random effects at the sub-district level to explore the relationship between the change in risk of maternal death from 2001 to 2016 and a range of demographic, socioeconomic, and health care factors. Between 2001 and 2016, the proportion of high-risk pregnancies decreased, except for teenage pregnancies. Meanwhile, there were notable improvements in socioeconomic status, access to health services, and the utilisation of maternal health services. A comparison of factors affecting the risk of maternal death between 2001-2010 and 2010-2016 indicated that first pregnancies continued to offer significant protection against maternal deaths. However, subsequent pregnancies among girls under 20 years became a significant risk factor during 2010-2016, increasing the risk of maternal deaths by nearly 3-fold. Among the key maternal health services, only skilled birth attendants (SBA) were identified as a key contributor to MMR reduction during 2001-2010. However, SBA is no longer significantly associated with reducing mortality risk during 2010-2016. Despite continued improvements in the overall socioeconomic status and access to maternal health services in Bangladesh, the stagnation of MMR decline between 2010 and 2016 is associated with multiple teenage pregnancies and the lack of capacity in health facilities to provide quality delivery services, as SBA has been primarily driven by facility delivery. The findings provide a strong rationale for targeting at-risk mothers and strengthening reproductive health services, including family planning, to further reduce maternal mortality in Bangladesh.

Viruses, microsporidia and glyphosate residues in Africanized honey bees Apis mellifera, under field conditions

Bees are affected by several factors, including pathogens and pesticides, which may cause mortality and consequent population decline. Considering the ecological and economic importance of these pollinators, this study evaluated the occurrence of the microsporidia Nosema apis and Nosema ceranae, the viruses ABVP, DWV, BQCV, KBV, IAPV and CBPV and residues of the pesticides atrazine, chlorantraniliprole, deltamethrin, fipronil and glyphosate in workers from field colonies of Africanized honey bee Apis mellifera across one year. The presence of pesticide residues was also evaluated in honey and pollen samples. All tested viruses were found in the workers, with BQCV showing the highest copy number. BQCV levels were correlated with relative humidity. Nosema ceranae was the only microsporidian with higher intensities of infection during summer and autumn; seasons with high availability of food resources, which can act as dispersers of this pathogen. Small amounts of glyphosate and its metabolite were detected in the bees tested. These data show that honey bees are contaminated with pathogens and pesticides in the field and present correlative data for these threats.

Epidemiology and age-related trends in surgical outcomes for sigmoid volvulus: a 17-year analysis.

Sigmoid volvulus, a gastrointestinal disorder characterized by twisted bowel, often requires medical intervention, either through endoscopic or surgical means, to avoid potentially severe outcomes. This study examined the challenges elderly patients face in undergoing surgical treatment, encompassing both mortality and morbidity. Furthermore, it aimed to determine how medical practices and outcomes have changed over a period of 17 years. We utilized data from the National Surgical Quality Improvement Project, which covers the period from 2005 to 2021, to identify patients who underwent left hemicolectomy for colonic volvulus. The patients were categorized into three age groups: < 60 years, 60-75 years, and > 75 years. We performed a meticulous logistic regression analysis, carefully adjusted for risk factors, to compare mortality, morbidity, and types of surgical treatment administered among the different age groups. Our study included 6775 patients. The breakdown of the patient population was as follows: 2067 patients were < 60 years of age, 2239 were between 60 and 75 years of age, and 2469 were > 75 years of age. The elderly cohort, those agedabove 75 years, were predominantly male, had lower BMIs, underwent fewer laparoscopic surgeries, required more diverting stomas and end-ostomies, and had longer hospital stays. Notably, the elderly population faced a mortality risk that was 5.67 times (95% CI 3.64, 9.20) greater than that of their youngest counterparts, with this risk increasing by 10% (95% CI 1.06, 1.14) for each additional year of age. Furthermore, the odds of mortality associated with emergency surgery were 1.63 times (95% CI 1.21, 2.22) higher than those associated with elective surgery. The postoperative morbidity odds were also elevated for emergency surgeries, 1.30 times (95% CI 1.08, 1.58) greater than that for elective cases. Over the 17-year period, we observed a decline in mortality rates, an increase in the utilization of laparoscopic procedures, and overall stability of morbidity rates. Our findings highlight the increased vulnerability of patients over 75 years of age, who are not only at an elevated risk of mortality compared to their younger counterparts, but also a continuously increasing risk with age. By focusing on elective surgeries for younger patients and minimizing emergency surgeries for the elderly, it may be possible to reduce the mortality risk associated with surgical interventions in this population.

Cumulative Update of a Systematic Overview Evaluating Interventions Addressing Polypharmacy

Polypharmacy is associated with mortality, falls, hospitalizations, and functional and cognitive decline. The study of polypharmacy-related interventions has increased substantially, prompting the need for an updated, more focused systematic overview. To systematically evaluate and summarize evidence across multiple systematic reviews (SRs) examining interventions addressing polypharmacy. A search was conducted of MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects for articles published from January 2017-October 2022, as well as those identified in a previous overview (January 2004-February 2017). Systematic reviews were included regardless of study design, setting, or outcome. The evidence was summarized by 4 categories: (1) medication-related process outcomes (eg, potentially inappropriate medication [PIM] and potential prescribing omission reductions), (2) clinical and functional outcomes, (3) health care use and economic outcomes, and (4) acceptability of the intervention. Fourteen SRs were identified (3 from the previous overview), 7 of which included meta-analyses, representing 179 unique published studies. Nine SRs examined medication-related process outcomes (low to very low evidence quality). Systematic reviews using pooled analyses found significant reductions in the number of PIMs, potential prescribing omissions, and total number of medications, and improvements in medication appropriateness. Twelve SRs examined clinical and functional outcomes (very low to moderate evidence quality). Five SRs examined mortality; all mortality meta-analyses were null, but studies with longer follow-up periods found greater reductions in mortality. Five SRs examined falls incidence; results were predominantly null save for a meta-analysis in which PIMs were discontinued. Of the 8 SRs examining quality of life, most (7) found predominantly null effects. Ten SRs examined hospitalizations and readmissions (very low to moderate evidence quality) and 4 examined emergency department visits (very low to low evidence quality). One SR found significant reductions in hospitalizations and readmissions among higher-intensity medication reviews with face-to-face patient components. Another meta-analysis found a null effect. Of the 7 SRs without meta-analyses for hospitalizations and readmissions, all had predominantly null results. Two of 4 SRs found reductions in emergency department visits. Two SRs examined acceptability (very low evidence quality), finding wide variation in the adoption of polypharmacy-related interventions. This updated systematic overview noted little evidence of an association between polypharmacy-related interventions and reduced important clinical and health care use outcomes. More evidence is needed regarding which interventions are most useful and which populations would benefit most.

The Laboratory Diagnosis of Malaria: A Focus on the Diagnostic Assays in Non-Endemic Areas.

Even if malaria is rare in Europe, it is a medical emergency and programs for its control should ensure both an early diagnosis and a prompt treatment within 24-48 h from the onset of the symptoms. The increasing number of imported malaria cases as well as the risk of the reintroduction of autochthonous cases encouraged laboratories in non-endemic countries to adopt diagnostic methods/algorithms. Microscopy remains the gold standard, but with limitations. Rapid diagnostic tests have greatly expanded the ability to diagnose malaria for rapid results due to simplicity and low cost, but they lack sensitivity and specificity. PCR-based assays provide more relevant information but need well-trained technicians. As reported in the World Health Organization Global Technical Strategy for Malaria 2016-2030, the development of point-of-care testing is important for the improvement of diagnosis with beneficial consequences for prompt/accurate treatment and for preventing the spread of the disease. Despite their limitations, diagnostic methods contribute to the decline of malaria mortality. Recently, evidence suggested that artificial intelligence could be utilized for assisting pathologists in malaria diagnosis.

Grandmother effects over the Finnish demographic transition.

Demographic transitions are defining events for human societies, marking shifts from natural mortality and fertility rates to the low rates seen in industrialised populations. These transitions can affect trait evolution through altering the direction and strength of selection when variance in fertility and mortality decline. One key feature of human evolution is the evolution of extended post-reproductive life through indirect fitness benefits from grandmothering. Although studies in pre- and post-transition societies have documented beneficial grandmother presence, it remains unknown whether these associations changed before, during, or after the transition. Here, we use genealogical data from eighteenth- to twientieth-century Finland to show grandmother-associated changes of two measures of evolutionary fitness (grandchild survival and birth rate) over the transition. We find that grandmothers had greater opportunity to help as the transition progressed, but their effect on grandchild survival declined alongside general mortality rates, implying that selection on lifespan from grandmothering declined too. Whilst grandmother presence was still associated with reduced birth intervals and hence more grandchildren born post-transition, the nature of this relationship changed greatly. This suggests that although potential for intergenerational interactions increased over the demographic transition, the (hypothesised) evolutionary importance of these interactions declined, which reduced selection for extended post-reproductive lifespan.

Temporal trends in critical care utilization and outcomes in allogeneic hematopoietic stem cell transplant recipients.

Historically, the prognosis of allogeneic hematopoietic stem cell transplant (allo-HCT) recipients who require intensive care unit (ICU) admission has been poor. We aimed to describe the epidemiological trends of ICU utilization and outcomes in allo-HCT patients. We conducted a retrospective cohort study including adults (≥ 18) undergoing allo-HCT between 01/01/2005 and 31/12/2020 at Mayo Clinic, Rochester. Temporal trends in outcomes were assessed by robust linear regression modelling. Risk factors for hospital mortality were chosen a priori and assessed with multivariable logistic regression modelling. Of 1,249 subjects, there were 486 ICU admissions among 287 individuals. Although older patients underwent allo-HCT (1.64 [95% CI: 1.11 to 2.45] years per year; P = 0.025), there was no change in ICU utilization over time (P = 0.91). The ICU and hospital mortality rates were 19.2% (55/287) and 28.2% (81/287), respectively. There was a decline in ICU mortality (-0.38% [95% CI: -0.70 to -0.06%] per year; P = 0.035). The 1-year post-HCT mortality for those requiring ICU admission was 56.1% (161/287), with no significant difference over time, versus 15.8% (141/891, 71 missing) among those who did not. The frequency and duration of invasive mechanical ventilation (IMV) declined. In multivariable analyses, higher serum lactate, higher sequential organ failure assessment (SOFA) scores, acute respiratory distress (ARDS), and need for IMV were associated with greater odds of hospital mortality. Over time, rates of ICU utilization have remained stable, despite increasing patient age. Several trends suggest improvement in outcomes, notably lower ICU mortality and frequency of IMV. However, long-term survival remains unchanged. Further work is needed to improve long-term outcomes in this population.

Tendência temporal da mortalidade por desnutrição proteico-calórica em pessoas idosas no Brasil, no período de 2000 – 2021

Abstract Objective To analyze the temporal trend in mortality from protein-calorie malnutrition among older adults in Brazil from 2000 to 2021. Method An epidemiological study with an ecological, descriptive analytical design was conducted. Annual data were obtained from the Brazilian Mortality Information System (SIM) for the specified period. Crude and age-adjusted mortality rates were calculated using the direct method and the world population as a reference. The Prais-Winsten model and Annual Percentage Change (APC) were used to observe the mortality trend. Results From 2000 to 2021, the general mortality rate from protein-calorie malnutrition in older adults fluctuated, reaching a maximum in 2006 (28.74) and minimum in 2021 (10.64), with a decreasing trend (β=- 0.015; p=0.005; APC=-3.454%). Analysis of standardized mortality rates by sex revealed a decreasing trend for both genders, and higher rates among men throughout the historical series. Regarding age group, a decline in mortality among individuals aged 60-79 years and a stable trend in subjects aged ≥ 80 years was observed. Conclusion The study results showed a drop in the rate of mortality from protein-calorie malnutrition among older adults. However, mortality rates from this modifiable cause remain high, underscoring the need to improve health care for this specific population.

Understanding Knowledge, Practices, and Barriers in Metered Dose Inhaler Use Among Sri Lankan Patients with Bronchial Asthma and Chronic Obstructive Pulmonary Disease

Background and Aims: Despite declining mortality rates, asthma and chronic obstructive pulmonary disease (COPD) continue to pose significant public health challenges with persistently high morbidity rates. One prominent con¬tributing factor is the inadequate use of prescription metered dose inhalers (MDIs) by patients, leading to insufficient dosing and suboptimal disease control. Thus, it is crucial to assess patients’ knowledge, practices, and barriers concerning MDI usage. Methods: This descriptive convenience sampling, conducted at Polonnaruwa District General Hospital in Sri Lanka, enrolled 250 participants to investigate MDI-related behaviors. Questionnaire was used as data collection tool and sampling technique is conveniet sampling. Microsoft Excel spreadsheet and SPSS version 20 (IBM Corporation, New York, USA) software were used for statistical analysis. Results: The majority of participants were aged over 40, with a higher proportion of females (59%) than males (39%). Over half of them had been managing bronchial asthma and COPD for more than five years. Notably, all participants were MDI users, but 59% reported disease exacerbations occurring more than four weeks ago, with dust being the primary trigger (45%). Healthcare professionals, especially nurses and doctors, were common sources of MDI education. However, none of the participants demonstrated correct inhalation technique both before and after receiving education, raising significant concerns. Conclusions: This study highlights the inadequacies in MDI utilization among participants, emphasizing the urgent need for improved patient education by healthcare professionals. Addressing these knowledge and skills gaps related to MDI usage is essential for enhancing asthma and COPD management, ultimately leading to improved patient outcomes and a reduced disease burden.

ANTENATAL CARE OF A WOMAN WITH PREECLAMPSIA

Between 2018 and 2020, eight women in the UK died from complications associated with pre-eclampsia. Despite a decline in maternal mortality rates, the numbers are still higher than the previous triennial review report, 2012 to 2014. Many women and babies will experience substantial morbidities impacting their long-term physical and mental health. To ensure optimal care, it is critical midwives are competent in the detection and management of women at risk of pre-eclampsia. This article will review best practice in relation to the antenatal clinical management of a woman with pre-eclampsia.

National burden of rheumatoid arthritis in Canada, 1990–2019: findings from the Global Burden of Disease Study 2019 – a GBD collaborator-led study

ObjectiveThe objectives of this study were: (1) to describe burden of rheumatoid arthritis (RA) and trends from 1990 to 2019 using the Global Burden of Diseases, Injuries and Risk Factors...

Advancements in the Regulatory Role of microRNAs in Childhood Acute Lymphoblastic Leukemia: Mechanisms and Clinical Implications.

microRNAs (miRNAs), tiny, non-coding RNA molecules, fine-tune the expression of target genes through interacting with mRNAs. These miRNAs are involved in a wide range of biological processes, encompassing cell division, death, blood cell production, and tumor development. When these miRNAs become dysfunctional, they can promote the invasion and spread of cancer cells in various human malignancies, including leukemia. Acute lymphoblastic leukemia (ALL), the preeminent malignancy affecting children, is a blood cancer marked by the uncontrollable growth of immature lymphoid cells that displace healthy blood precursors in the bone marrow. Despite a decline in ALL mortality rates over the past two decades, a significant proportion of deaths still results from a lack of effective diagnostic and prognostic markers that can guide treatment decisions and overcome drug resistance. The analysis of miRNA expression patterns in ALL could lead to more precise disease classification, earlier diagnosis, and better prognostic outcomes in the near future. The connection between miRNA dysfunction and the biology of ALL suggests that these molecules could represent promising therapeutic targets. Therefore, this review delves into the regulatory mechanisms of miRNAs in pediatric ALL, exploring how miRNA-based diagnostic, prognostic, and therapeutic strategies offer unique advantages and hold promise for clinical applications.

Prostate cancer mortality temporal trend in Brazil

Prostate cancer (CaP) is the second most common malignant tumor among men in Brazil and represents a significant factor in mortality when diagnosed late. Studies on mortality are relevant sources for understanding the epidemiological profile and measuring the importance of PCa as a public health problem. The objective was to describe the distribution and temporal trends of the mortality rate in different age groups (30 to 80 years or more) in Brazil between the years 2011 - 2020. The research has a quantitative and analytical character, through the collection of mortality data in the Mortality Information System (SIM) of the Ministry of Health (SIM/MS/DATASUS). The mortality rate due to malignant prostate neoplasia was calculated annually, considering age range, and then arranged in simple dispersion data. According to the analyses, it was observed that the incidence of prostate cancer was 95.17% in individuals over 60 years of age, highlighting the age group of 80 years or more in which it was 44%. Furthermore, the mortality rate prevailed in white ethnic groups, with low education and married people. Among the years analyzed, the period with the peak in mortality was in 2017, representing 29.25%. Furthermore, a linear decline in PCa mortality rates was evidenced in all age groups between 2011 and 2020. However, there was a higher prevalence of deaths from the sixth decade of life onwards, with emphasis on the population over 80 years. And, it was possible to observe a lower number of deaths among individuals aged 30 to 59 years.

Long-term trends in cancer incidence and mortality among U.S. children and adolescents: a SEER database analysis from 1975 to 2018.

Childhood and adolescent cancer represent a significant health burden in the United States. Current and precise epidemiological data are crucial to develop effective cancer control plans and ultimately reduce the burden of childhood and adolescent cancer. We analyzed data obtained from cancer registries in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Age-standardized incidence and death rates, assessed using joinpoint analysis, were quantified as annual percentage changes (APC) and average percentage changes (AAPC). The overall cancer incidence rate in 2008-2018 was 187.9 per 1,000,000 persons. Cancer incidence rates demonstrated a sustained upward trend, with an APC of 0.8 from 1975 to 2018. Incidence rates during 2008-2018 remained stable among non-Hispanic Black children but increased among other racial and ethnic groups. Leukemias, central nervous system tumors, and lymphomas were the most common cancer groups for patients aged 0-19 years. Cancer death rates decreased among children [AAPC, -1.3 (95% CI, -1.5 to -1.1)] during 2009-2019, while were stable among adolescents during that period. In this study, we analyzed cancer incidence and mortality rates and trends in children aged 0-19 years in the United States. Our findings revealed an overall increase in cancer incidence rates among children and adolescents, accompanied by a decline in cancer mortality rates over time. These rates and trends varied by age, sex, and particularly race and ethnicity, highlighting the significance of comprehending and addressing disparities and ultimately reducing the disease burden of childhood and adolescent cancer.