Disease In High-income Countries Research Articles

Saved by the bell: does working too much increase the likelihood of depression?

Depression is a serious public health concern that has been predicted to be the leading cause of the burden of disease in high-income countries by 2030 [1]. In addition to human suffering, depressi...

Musculoskeletal tuberculosis: are you ready to diagnose it?

Tuberculosis (TB) is far from being eradicated from the world (1). Despite the scarcity of this disease in high-income countries, including the Nordic ones, there are 1.7 million deaths (2) and more than 9 million new cases annually in the world (3): this number is higher than at any time in history. In particular, the low-income countries in sub-Saharan Africa bear the greatest burden. For example, in South Africa about 1% of the population develops tuberculosis each year, much of it due to HIV (1). Also, the homeless people around the world are at greater risk of being infected with TB. For example, in 2009 there were 9040 cases of tuberculosis in the UK, that is 15 cases per 100,000 individuals. However, the disease is concentrated in certain demographics within certain areas. London has a rate of 44 cases per 100,000. In the country’s homeless population, the rate is 300 cases per 100,000 (4). In contrast, the Nordic countries have 3–7.7 new cases each year for 100,000 people, but the incidence in Baltic countries and, in particular, in Russia is much greater reaching close to 100 per 100,000 in the latter. But, why we should be worried about TB, since it is uncommon in people born in Nordic countries? The answer is simple. The demographics are changing at a great speed. Thus, we are faced more and more with immigration and patients born in countries with a high prevalence of TB. Moreover, people are traveling more and often to countries with high numbers of TB. For example, recent complete data show that 30% of new cases in Finland were of foreign origin (5). In 1996, Acta Radiologica included a series of five studies on different manifestations of TB (6–10). Since then, 32 papers on or related to TB have been published in this journal, of which half were published after year 2000. Most of the papers are related to pulmonary or CNS tuberculosis. This is understandable, because TB predominantly affects the lungs. However, it can cause disease in any organ, including the musculoskeletal (MSK) system, and must therefore be included within the differential diagnosis of a large range of clinical presentations (3). Also, it should be kept in mind that extrapulmonary tuberculosis in adults remains a great diagnostic challenge. Tuberculosis of the MSK system is rare, and accounts for only up to 3% of all TB infections (11), and medical awareness of these more unusual presentations of TB is often low in developed countries. Despite this, it is mandatory for the MSK radiologist to know the most common presentation and imaging features of MSK TB, since prompt diagnosis allows the start of the proper medication without any unnecessary delay. Also, it is clear that for the younger generation MSK TB is very rarely, if ever, seen in clinical practice. In a recent issue, Professor Andronikou and his colleagues shared their vast experience of imaging features of MSK TB using plain radiographs as well as modern imaging technology, i.e. CT and MRI (12). Since 1996, no paper dedicated to MSK TB has been published in this journal. Therefore, this paper is highly recommended reading for all radiologists that wish to broaden their knowledge beyond TB spondylitis, the most common form of MSK TB. Be prepared for the 21st century.

Alcoholism And Stress: A Framework For Future Treatment Strategies

Both anxiety and alcohol use disorders are among the leading causes of the burden of disease in high-income countries. They co-occur much more often than one would expect based on chance as many anxious individuals drink alcohol to reduce anxiety (Stewart & Conrod, 2008). But in the longer term, problem drinking is associated with elevations in negative affect (including anxiety). Thus, a problematic vicious cycle can develop between anxiety and alcohol misuse. Recent models of psychopathology have emphasised a role of relatively automatic cognitive processes. Both anxiety and alcohol use problems have been associated with attentional biases. Until now, little research has been conducted on the cognitive processes in anxious problem drinkers and the aim of the current study is to examine the role of attentional bias in these drinkers. It was hypothesised that anxious problem drinkers would be quick to direct their attention to alcohol stimuli especially after an anxiety-related prime stimulus. In total, 55 anxious students who frequently drank alcohol completed a primed Alcohol Stroop task. Results showed that participants were slower colour-naming alcohol words compared to neutral words. When specifically examining anxiety-alcohol trial sequences, it was shown that participants were especially slow in colour-naming alcohol words when they were preceded by an anxiety related prime compared to a neutral prime. These findings reveal an interaction between anxiety and alcohol stimuli at a relatively automatic level. In the light of new developments regarding re-training of automatic processes as attentional bias using computer programs (Cognitive Bias Modification), these findings highlight the need to take emotions and drinking motives into account when modifying attentional bias in anxious problem drinkers.

Immune reconstitution disease: recent developments and implications for antiretroviral treatment in resource-limited settings

We review literature published over the past 2 years regarding the immunopathogenesis, epidemiology, clinical spectrum and outcomes of immune reconstitution disease in patients receiving antiretroviral treatment. Particular attention is drawn to data relevant to resource-limited settings. In high-income countries, immune reconstitution disease occurs in association with a largely predictable spectrum of pathogens, including the herpesviruses, Mycobacterium tuberculosis and Mycobacterium avium complex, Cryptococcus neoformans and hepatitis viruses. Dermatological manifestations are most frequent. In resource-limited settings, patients accessing antiretroviral treatment programmes typically have advanced immunodeficiency, which increases risk of immune reconstitution disease. M. tuberculosis and C. neoformans have emerged as the key causes of morbidity and mortality associated with immune reconstitution disease. An increasing number of 'tropical' infections, including leprosy, schistosomiasis, strongyloidiasis, leishmaniasis, histoplasmosis and many nontuberculous mycobacteria, are also now recognised to provoke immune reconstitution disease but the overall spectrum and relative importance of these organisms remain to be defined. Better characterisation of immune reconstitution disease in these settings is needed to enable development of guidelines regarding prevention, diagnosis and management. While immune reconstitution disease in high-income countries has been clinically and epidemiologically well described, much remains to be learned in resource-limited settings in which immune reconstitution disease is emerging as a significant cause of morbidity and mortality.

Treating children in underdeveloped countries

<h3>Abstract</h3> <h3>Importance</h3> The most socioeconomically deprived individuals remain at the greatest risk of cardiovascular disease. Differences in risk adjusted use of statins between educational groups may contribute to these inequalities. <h3>Objective</h3> To identify whether people with lower levels of educational attainment are less likely to take statins for a given level of cardiovascular risk. <h3>Design</h3> Cross-sectional analysis of a population-based cohort study and linked longitudinal primary care records. <h3>Setting</h3> UK Biobank data from baseline assessment centres, linked primary care data and hospital episode statistics <h3>Participants</h3> UK Biobank participants (N = 489 679, mean age = 56, 54% female) with complete data on educational attainment and self-reported medication use. Secondary analyses were carried out on a subsample of participants with linked primary care data (N = 217 675). <h3>Main outcome measures</h3> Statin use self-reported to clinic nurses at baseline assessment centres, validated with linked prescription data in a subsample of participants in secondary analyses. <h3>Results</h3> Greater education was associated with lower statin use, whilst higher cardiovascular risk (assessed by QRISK3 score) was associated with higher statin use in both females and males. There was evidence of an interaction between QRISK3 and education, such that for the same QRISK3 score, people with more education were more likely to report taking statins. For example, in women with 7 years of schooling, equivalent to leaving school with no formal qualifications, a one unit increase in QRISK3 score was associated with a 6% higher odds of statin use (odds ratio (OR) 1.06, 95% CI 1.05, 1.06). In contrast, in women with 20 years of schooling, equivalent to obtaining a degree, a one unit increase in QRISK3 score was associated with an 11% higher odds of statin use (OR 1.11, 95% CI 1.10, 1.11). Comparable ORs in men were 1.04 (95% CI 1.04, 1.05) for men with 7 years of schooling and (95% CI 1.07, 1.07) for men with 20 years of schooling. <h3>Conclusions</h3> For the same level of cardiovascular risk, individuals with lower educational attainment are less likely to receive statins, likely contributing to health inequalities. <h3>Summary</h3> What is already known on this topic? Despite reductions in the rates of cardiovascular disease in high income countries, individuals who are the most socioeconomically deprived remain at the highest risk. Although intermediate lifestyle and behavioural risk factors explain some of this, much of the effect remains unexplained. <h3>What does this study add?</h3> For the same increase in QRISK3 score, the likelihood of statin use increased more in individuals with high educational attainment compared with individuals with lower educational attainment. These results were similar when using UK Biobank to derive QRISK3 scores and when using QRISK scores recorded in primary care records, and when using self-reported statin prescription data or prescription data from linked primary care records. The mechanisms leading to these differences are unknown, but both health seeking behaviours and clinical factors may contribute.