Burden Of Disease Research Articles

Pre-vaccination carriage prevalence of Streptococcus pneumoniae serotypes among internally displaced people in Somaliland: a cross-sectional study

BackgroundPopulations affected by humanitarian crises likely experience high burdens of pneumococcal disease. Streptococcus pneumoniae carriage estimates are essential to understand pneumococcal transmission dynamics and the potential impact of pneumococcal conjugate vaccines (PCV). Over 100 million people are forcibly displaced worldwide, yet here we present only the second pneumococcal carriage estimates for a displaced population.MethodsIn October 2019, we conducted a cross-sectional survey among internally displaced people (IDP) living in Digaale, a permanent IDP camp in Somaliland where PCV has not been implemented. We collected nasopharyngeal swab samples from 453 residents which were assessed for presence of pneumococci and serotyped using DNA microarray.ResultsWe found that pneumococcal carriage prevalence was 36% (95%CI 31–40) in all ages, and 70% (95%CI 64–76) in children under 5. The three most common serotypes were vaccine serotypes 6B, 19F, and 23F. We estimated that the serotypes included in the 10-valent PNEUMOSIL vaccine were carried by 41% (95%CI 33–49) of all pneumococcal carriers and extrapolated that they caused 52% (95%CI 35–70) of invasive pneumococcal disease. We found some evidence that pneumococcal carriage was associated with recent respiratory symptoms, the total number of physical contacts made, and with malnutrition in children under 5. Through linking with a nested contact survey we projected that pneumococcal exposure of children under 2 was predominantly due to contact with children aged 2–5 (39%; 95%CI 31–48) and 6–14 (25%; 95%CI 17–34).ConclusionsThese findings suggest considerable potential for direct and indirect protection against pneumococcal disease in Digaale through PCV use in children and potentially adolescents.

Forecasting cardiovascular disease risk and burden in China from 2020 to 2030: a simulation study based on a nationwide cohort

BackgroundCardiovascular disease (CVD) remains a significant public health challenge in China. This study aimed to project the burden of CVD from 2020 to 2030 using a nationwide cohort and to...

Rehabilitation Patterns After Hospitalization: Results from a Danish Registry.

Conditions that could benefit from rehabilitation contribute to 310 million years of life lived with disability. Internationally rehabilitation could be part of the solution to the growing global disease burden. This register based study wanted to explore differences in patterns of rehabilitation among patients discharged from the hospital with a rehabilitation plan, explore rehabilitation initiation, and assess the activation of rehabilitation plans within legal requirements. The study was conducted at Odense University Hospital in the Region of Southern Denmark. The study investigated acute contacts by utilising rehabilitation referrals, demographic and municipal data from Odense Municipality residents from 2015 to 2020. Descriptive statistics, logistic regressions, cox regression and cumulative incidence rate were used to explore rehabilitation the activation of rehabilitation plans. The cohort consisted of 225,653 hospital contacts. Overall, 10,327 (5%) received a rehabilitation plan. Contacts were more often female or had increased co-morbidity. Prescription increased with age and for ethnical Danes. Initiation of prescribed plans increased within the first weeks, levelling from 30 to 60 days. Delayed initiation of the rehabilitation plan beyond 30 days raised the likelihood of non-initiating altogether. Although evidence acknowledges the benefits of rehabilitation, this study showed that more than 25% of all referred municipality rehabilitation plans were never initiated. If the initiation of a rehabilitation plan was delayed beyond 30 days, it significantly reduced the likelihood of initiation. Therefore, the international community need to keep focus on early rehabilitation and increase the use of rehabilitation in the future.

SURF1 Deficiency: Expanding on Disease Phenotype and Assessing Disease Burden by Describing Clinical and Biochemical Phenotype.

Leigh syndrome, a severe neurological disorder is commonly caused by homozygous or bi-allelic pathogenic variants in the SURF1 gene. SURF1 deficiency leads to dysfunction of Cytochrome C Oxidase (COX) activity, which is crucial for mitochondrial oxidative phosphorylation. Understanding COX activity's correlation with disease severity is essential for developing SURF1 Leigh Syndrome biomarkers. This study assesses the disease burden in SURF1 Leigh Syndrome and evaluates COX activity as a treatment biomarker. We reviewed records and questionnaires from 17 individuals, classifying them into phenotypic and genotypic groups. We compared COX activity assays in patient fibroblasts to age-matched controls, clinical data, and neuroimaging findings. Patient COX activity was at most 50% of controls, averaging 32% (p < 0.001). Common clinical features included brainstem abnormalities (93.3%), motor regression (92.3%), bi-allelic heterozygous SURF1 variants (88.2%), and delayed growth/development (35.7%). Homozygous and heterozygous nonsense/frameshift variants showed more severe phenotypes (p = 0.008) and more MRI abnormalities (p = 0.005). Significant COX activity reduction is linked to SURF1 Leigh Syndrome, with genotype influencing disease severity. Clinical and neuroimaging correlations show potential for prognostic indicators. This study lays the groundwork for future research and clinical application of COX activity as a SURF1 Leigh Syndrome biomarker.

Global, Regional, and National Burden of Nasopharyngeal Carcinoma from 1990 to 2021.

This study analyzes nasopharyngeal carcinoma (NPC) from 1990 to 2021 across 204 countries, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs). It examines gender disparities, regional variations, age dynamics, and temporal trends to provide insights for health policy and resource allocation. We used the Global Burden of Disease (GBD) approach to assess NPC's health burden, including incidence, prevalence, mortality, and DALYs. Trends from 1990 to 2021 were illustrated using estimated annual percent change (EAPC). Subgroup analysis revealed variations by gender, age, Socio-Demographic Index (SDI), GBD classification, and country. Age-period-cohort (APC) and Bayesian age-period-cohort (BAPC) models predicted future trends. In 2021, there were 118,878 new NPC cases globally (1.38 per 100,000), with a prevalence of 525,219 cases (6.14 per 100,000), 75,359 deaths (0.87 per 100,000), and 249,019 DALYs (28.91 per 100,000). Males had higher rates across all metrics. Incidence peaked at ages 50-54, mortality at 70-74, and DALYs at 50-54. High SDI regions, especially East and Southeast Asia, showed higher burdens. Despite decreasing age-standardized incidence rates, absolute cases are rising, necessitating improved prevention and treatment strategies. NPC prevalence has increased due to better diagnosis and aging populations, despite decreasing age-adjusted incidence rates. Lower mortality rates indicate improved treatment. Males, especially in East and Southeast Asia, bear a higher NPC burden. These findings highlight the need for targeted interventions and tailored public health policies in high-risk regions. III Laryngoscope, 2024.

Short-term effects of air pollutants on hospitalization for childhood respiratory diseases in Suzhou City: a time-stratified case-crossover study

BackgroundShort-term exposure to air pollution has been demonstrated in previous studies to correlate with respiratory disease (RD) in children. Due to regional heterogeneity, our objective was to explore the correlation between short-term exposure to ambient air pollution and hospital admissions for respiratory ailments in children in Suzhou City from January 1, 2017, to December 31, 2022, alongside assessing the influence of the COVID-19 pandemic on this relationship.MethodsWe collected data on air pollutant levels and hospital admissions for childhood respiratory disease (RD) in Suzhou, China, from 2017 to 2022. We utilized a time-stratified case-crossover design along with a conditional logistic regression model to assess the short-term impacts of air pollutants on RD in children through stratified analysis and sensitivity analysis.ResultsA total of 13,408 children with respiratory diseases were included in the study. The findings revealed significant associations between hospitalization for respiratory diseases in children and exposure to PM2.5, PM10, SO2, NO2, and CO. The maximum effect values (95%CI, best lag days) for each 10 µg/m3 increase in the concentrations of PM2.5, PM10, SO2, and NO2 were as follows: 1.017 (1.003–1.031, lag0-2), 1.015 (1.004–1.026, lag0-2), 1.117 (1.001–1.247, lag0-1), and 1.036 (1.009–1.064, lag0-7). Additionally, the maximum effect value (95%CI, best lag days) for each 1 mg/m3 increase in CO concentration was found to be 1.267 1.017–1.579, lag0-7). Stratified analysis indicated that sex, season of admission, and stage of admission did not modify these correlations significantly; however, differential effects on various age groups and sexes were primarily observed among school-age and older children as well as boys.ConclusionsThe short-term exposure to PM2.5, PM10, SO2, NO2, and CO in Suzhou, China, exhibited a positive correlation with RD hospitalization. Prior to the COVID-19 pandemic, the adverse impacts of air pollutants on hospitalizations for childhood respiratory disease were mitigated compared to the period following the pandemic. Local governments should continue promoting decisions and measures for air pollution prevention and control to reduce further pollutant concentration, which is crucial for public health in reducing the burden of childhood respiratory diseases.

Quantitative Systems Pharmacology-Based Digital Twins Approach Supplements Clinical Trial Data for Enzyme Replacement Therapies in Pompe Disease.

Pompe disease is a rare, progressive neuromuscular disease caused by deficient lysosomal glycogen degradation, and includes both late-onset (LOPD) and severe infantile-onset (IOPD) phenotypes. Due to very small patient numbers in IOPD and the high phenotypic heterogeneity observed in this population, a quantitative systems pharmacology (QSP)-based "digital twin" approach was developed to perform an in silico comparison of the efficacy of avalglucosidase alfa vs. the standard of care, in a virtual population of IOPD patients. A QSP model was developed that represents key elements of Pompe disease pathophysiology, including tissue glycogen accumulation and the elevation of the biomarker urine Hex4 in both LOPD and IOPD patients. In this approach, the QSP model was used to generate digital twins of each IOPD patient enrolled in the avalglucosidase alfa clinical program, considering their respective disease burden, demographics, and treatment history. This virtual cohort supplemented clinical observations by simulating and comparing tissue glycogen and urine Hex4 following avalglucosidase alfa treatment vs. the standard of care. The digital twin analysis supports the interpretation that the enhanced reduction in urine Hex4 observed following avalglucosidase alfa treatment is attributable to greater tissue glycogen clearance. Overall, this study provides mechanism-based insight into avalglucosidase alfa efficacy across the phenotypic spectrum of Pompe disease and demonstrates the value of applying a QSP-based digital twin analysis to support rare disease drug development.

Global, regional, and national burden of liver cancer due to alcohol use, 1990-2021: results from the Global Burden of Disease study 2021.

Liver cancer is a major global health burden, with alcohol use being a well-established risk factor. This study aims to analyze the global, regional, and national incidence, prevalence, mortality, and disability-adjusted life years (DALYs) attributable to liver cancer due to alcohol use from 1990 to 2021. Data on liver cancer due to alcohol use were collected from the 2021 Global Burden of Disease (GBD) study. The changing trend of liver cancer among alcohol users was described using the linear regression model. In addition, we employed a hierarchical cluster analysis to study the evolving patterns across diverse GBD regions and conducted a frontier analysis to explore the nexus between the burden and sociodemographic progress. In 2021, alcohol-related liver cancer globally accounted for 99 544 incidence cases, 132 033 prevalence cases, 92 228 death cases, and 2 316 027 DALYs cases. Males and middle-aged adults emerged as high-risk populations, while regions with a higher sociodemographic index (SDI) were identified as high-risk areas. From 1990 to 2021, both the number of cases and age-standardized rates (ASRs) increased. Our frontier analysis revealed unattained health gains between 1990 and 2021, highlighting disparities in disease burden among countries with varying SDI levels. This analysis further demonstrated an inverse correlation between SDI and alcohol-related liver cancer ASRs, with the ASRs stabilizing once the SDI exceeded 0.40. Alcohol use is a significant contributor to the global burden of liver cancer. Comprehensive policies and interventions targeting alcohol use are needed to reduce the burden of alcohol-related liver cancer.

Status of inpatients with pediatric epilepsy in children's hospitals in China (2016-2021).

Pediatric epilepsy is the most common disease of pediatric neurological diseases in China. Current demographic characteristics and economic burdens are needed to guide public health policy. In this study, we provide the demographic characteristics and economic burden of pediatric epilepsy patients in China from 2016 to 2021, and describe the change trend and correlation of demographic characteristics and economic burden by province. Using data from the Futang Research Center of Pediatric Development, we conducted a demographic-based cross-sectional study of pediatric epilepsy patients in 29 children's hospitals in China to assess changes in the distribution and economic burden over 6 years and related factors. We obtained per capita disposable income information from the Economic Statistical Bulletin of the National Bureau of Statistics of China and the statistical bureaus of provincial administrative regions. Demographic, diagnostic classification proportion and distribution trends, and economic burden from 2016 to 2021 were verified for pediatric patients with epilepsy. From 2016 to 2021, there were 149,375 patients diagnosed with epilepsy. The proportion of patients younger than 3 years decreased significantly from 51.13% to 29.43% (P=0.00853, R2=0.9803). The root-mean-square-error between the Inter-Provincial Visits Indexes decreased from 1.70 to 0.90, decreasing significantly (R2=0.8306). The disease burden decreased from 17.26% to 12.11% with a significant upward trend (P=0.02417, R2=0.8817). A negative correlation between disease burden and the Inter-Provincial Visits Index (P=0.0383) was observed, along with a positive correlation with the proportion of patients younger than 3 years old (P<0.0001). From 2016 to 2021, the proportion of young patients, population mobility and economic burden on patients decreased, and healthcare level of pediatric epilepsy improved. In addition, based on the current observations, the healthcare level of pediatric epilepsy in Western and Central China is lower than in other regions, and the economic burden on patients is higher than in other regions. In the future, these areas require higher priority concerning policy and financial support.

Real-World Evaluation of Dupilumab in the Long-Term Management of Eosinophilic Chronic Rhinosinusitis with Nasal Polyps: A Focus on IL-4 and IL-13 Receptor Blockade

Background and Objectives: Chronic rhinosinusitis (CRS) is a complex inflammatory condition of the nasal passages that severely impairs quality of life. Type 2 CRS is characterized by eosinophilic inflammation, driven by cytokines like IL-4, IL-5, and IL-13. These cytokines are key to CRS pathogenesis and contribute to a heavy disease burden, especially with comorbidities. This study assessed dupilumab, a monoclonal antibody targeting IL-4 and IL-13 signaling, to evaluate its efficacy in reducing the disease burden in patients with CRS with nasal polyps (CRSwNP). Materials and Methods: The patients received subcutaneous dupilumab for 42 weeks. The outcomes included Nasal Polyp Score (NPS); Sino-Nasal Outcome Test (SNOT-22), Numeric Rating Scale (NRS), and Visual Analog Scale (VAS) scores; total IgE; and olfactory function. Results: Significant improvements were observed across the NPS and SNOT-22, NRS, and VAS scores after 42 weeks. Their total IgE levels were reduced, though a transient increase in peripheral eosinophilia appeared at 16 weeks. The patients also reported substantial improvements in olfactory function and high satisfaction with the treatment, supporting dupilumab’s potential in reducing both symptom severity and inflammation in CRSwNP. Conclusions: These results indicate that dupilumab may be an effective treatment for CRSwNP, offering significant symptom relief, improved olfactory function, and enhanced quality of life. High satisfaction levels suggest that dupilumab may provide therapeutic advantages over the conventional CRS treatments, though further studies are warranted to confirm its long-term benefits.

A Prospective Multicenter Analysis of Mobile Stroke Unit Cost-Effectiveness.

Given the high disease and cost burden of ischemic stroke, evaluating the clinical efficacy and cost-effectiveness of new approaches to prevent and treat ischemic stroke is critical. Effective ischemic stroke management depends on timely administration of thrombolytics after stroke onset. This study evaluates the cost-effectiveness associated with the use of mobile stroke units (MSUs) to expedite tissue plasminogen activator (tPA) administration, as compared with standard management through emergency medical services (EMS). This study is a prospective, multicenter, alternating-week, cluster-controlled trial of MSU versus EMS. One-year and life-time cost-effectiveness analyses, using the incremental cost-effectiveness ratio (ICER) method, were performed from the perspective of CMS's Medicare. Quality-adjusted life years (QALYs) estimated using patient-reported EQ-5D-5L data were used as the effectiveness measure. Health care utilizations were converted to costs using average national Medicare reimbursements. ICERs excluding patients with pre-existing disability, and limited to stroke-related costs were also calculated. The first-year ICER for all tPA-eligible patients using total cost differences between MSU and EMS groups was $238,873/QALY; for patients without pre-existing disability was $61,199/QALY. The lifetime ICERs for all tPA-eligible patients and for those without pre-existing disability were $94,710 and $31,259/QALY, respectively. All ICERs were lower when restricted to stroke-related costs and were highly dependent on the number of patients treated per year in an MSU. MSUs' cost-effectiveness is borderline if we consider total first-year costs and outcomes in all tPA-eligible patients. MSUs are cost-effective to highly cost-effective when calculations are based on patients without pre-existing disability, patients' lifetime horizon, stroke-related costs, and more patients treated per year in an MSU. ANN NEUROL 2024.

Design Principles of an Engineered Metastatic Niche for Monitoring of Cancer Progression.

Across many types of cancer, metastatic disease is associated with a substantial decrease in 5-year survival rates relative to only a localized primary tumor. Many patients self-report metastatic disease due to disruption of normal organ or tissue function, and earlier detection could enable treatment with a lower burden of disease. We have previously reported a subcutaneous biomaterial implant for early detection by serving as an engineered metastatic niche, which has been reported to recruit tumor cells before colonization of solid organs. In this report, we investigated the design principles of the scaffold and defined the conditions for use in disease detection. Using the metastatic 4T1 triple-negative breast cancer model, we identified that a porous structure was essential to capture tumor and immune cells. Scaffolds of multiple diameters were investigated for their ability to serve as a metastatic niche, with a porous scaffold with a diameter as small as 2 mm identifying disease accurately. Additionally, scaffolds that had been in vivo for 1-5 weeks were able to identify disease accurately. Finally, the sensitivity of the scaffold relative to liquid biopsies was analyzed, with scaffolds accurately detecting disease at earlier time points than liquid biopsy. Collectively, these studies inform the design principles and use conditions for porous scaffolds to detect metastatic disease.

Unmet needs in patients with COPD in Germany: a retrospective, cross-sectional study

BackgroundEarlier diagnosis and treatment of chronic obstructive pulmonary disease (COPD), particularly preventing exacerbations, are key to slowing disease progression and reducing mortality. This study focused on the identification of patients in Germany with unstable COPD due to suboptimal treatments.MethodsThe IQVIA™ LRx database, capturing 80% of Statutory Health Insurance prescriptions was used to identify patients with COPD using a machine learning (ML) model. Patients with unstable COPD were identified through high prescriptions of oral corticosteroid (OCS) and/or rescue inhalers during the period from April 2022 to March 2023.ResultsThe ML model identified around 2.6 million treated patients with COPD, with 77% precision. The mean age was 71 years, 48% were female and 86% were aged ≥60 years. About 14% patients (n=363k) exhibited unstable COPD due to high OCS prescriptions, while 10% patients (n=256k) had high rescue inhaler prescriptions. Among those with high OCS and high rescue inhaler prescriptions, respectively, 43% and 38% were on dual therapy, 17% and 21% were on single inhaler triple therapy, 14% and 16% were on multiple inhaler triple therapy, 11% and 9% were on monotherapy and 15% and 17% had no maintenance therapy.ConclusionsA substantial portion of unstable COPD patients were either on suboptimal maintenance therapy (monotherapy or inhaled corticosteroid-based dual therapy) or not receiving any maintenance therapy. The study highlights a substantial need in Germany for improved maintenance therapy, which could reduce disease burden, improve disease stability and reduce reliance on OCS and rescue therapies, thereby minimising side effects.

Exposure to air pollution and the risk of type II diabetes mellitus: a time-series study

BackgroundEnvironmental factors have been identified as primary risk factors for type 2 diabetes mellitus (T2DM). However, studies on the association between environmental factors and T2DM have mainly focused on morbidity and mortality, which do not fully reflect the disease burden stemming from air pollution. Therefore, we aimed to evaluate the correlation between air pollution and T2DM, including hospital length of stay (LOS) and costs.MethodsWe collected data on patients with T2DM from three healthcare institutions in Xinxiang from 2016–2021. Data on particulate and gaseous pollutants in Xinxiang and daily meteorological data were collected from national databases. The distribution lag nonlinear model was used to evaluate the correlation between air pollution and the number of inpatients with T2DM, LOS, and hospital costs. Subgroup analyses were conducted to identify potential modifying factors.ResultsOverall, 13,797 patients with T2DM were included in our analysis. Within the cumulative lag of 7 days, with every increase of 1 mg/m3 of carbon monoxide (CO) and 10 μg/m3 of 2.5 microns particulate matter, nitrogen dioxide and ozone exhibited significant associations with an increase in diabetes hospitalization risk. CO exhibited adverse effects on LOS on most lag days. Moreover, hospital costs were significantly associated with the attributable fraction of LOS and hospital costs attributed to diabetes.ConclusionsExposure to air pollutants increased T2DM risk, imposing significant economic and social burdens in Xinxiang, China. Implementing policies to reduce air pollutant exposure may decrease T2DM admissions, costs, and LOS.

Persistent symptoms, exacerbations and drug side effects despite treatment in myasthenia gravis.

Generalized myasthenia gravis (gMG) is characterized by fluctuating muscle weakness. Exacerbation frequency, adverse events (AEs) related to immunosuppressant therapy and healthcare resource utilization (HCRU) are not well understood. Our study aimed to describe long-term clinical outcomes, drug-related AEs and estimated HCRU in gMG patients. This was a retrospective cohort analysis of clinical data from patients with gMG followed-up over eight consecutive years in a Spanish referral unit. Myasthenia Gravis Foundation of America (MGFA) clinical classification, MGFA post-interventional status (MGFA-PIS), Myasthenia Gravis Activities of Daily Living (MG-ADL) score, exacerbations, MG crises, therapies, AEs reported, specialist consultations and emergency room visits were studied biannually. An estimation of HRCU was made based on these data. Some 220 patients newly diagnosed with gMG were included. Ninety percent were seropositive (84.5% anti-acetylcholine receptor [AChR], 5.9% anti-muscle-specific kinase [MuSK]). Baseline mean MG-ADL score was 5.04 points (SD 3.17), improving to 0.7 points (SD 1.40) after 8 years. Exacerbations were more frequent in years 1-2 (30.1%) but still occurred in years 7-8 (20.2%). Myasthenic crisis frequency remained 1% in years 7-8. Eighty-nine percent achieved MGFA-PIS minimal manifestations or better at 8 years. Fifty-one percent of patients reported at least one AE during the study period, leading to drug withdrawal in approximately 20% of cases. HCRU decreased between years 1-2 to years 7-8 with an estimated cost of MG from 8074.19 € per patient/year to 1679.46 €, respectively. There is a group of MG patients that suffers from persistent symptoms and exacerbations (11%-20%) or MG crises, and drug AEs, which may increase disease burden and impact on the healthcare system.

Cohort profile of a prospective cohort study among middle-aged community-dwellers in rural Vietnam: The Khánh Hòa cardiovascular study.

Disease burden associated with cardiovascular diseases (CVDs) in low- and middle-income countries has been on an increasing trend in the past decades. Despite the worldwide genetic, cultural, and environmental variations in determinants of CVDs, few studies have attempted the identification of risk factors of CVDs in low- and middle-income countries. This article aims to introduce the Khánh Hòa Cardiovascular Study, a prospective cohort study among middle-aged community dwellers in rural Khánh Hòa, Vietnam. A total of 3000 individuals, aged 40-60 years at baseline, participated in the baseline survey conducted from June 2019 to June 2020 and will be followed up for the subsequent 10 years. The baseline survey collected information on sociodemographic variables, disease history, lifestyle, social environment, and mental health via questionnaires, physical examinations, and biochemical measurements. Information on the incidence of severe health outcomes (i.e., mortality, CVDs, and cancer) has been and will be collected using a study-specific disease registry. Results showed that the prevalences of excess body weight (body mass index ≥25 kg/m2), hypertension, diabetes mellitus, and dyslipidemia were 25.9%, 39.6%, 10.2%, and 45.1%, respectively. Furthermore, by March 2023, 21 participants had died, including 5 CVD deaths and 12 cancer deaths. Moreover, we recorded 22 and 31 cases of nonfatal CVDs and cancer, respectively. These results suggest that many rural residents in Vietnam have high cardiometabolic risk, and underscore the importance of advancing research to identify risk factors and prevent the onset of serious health events.

Childhood obesity and sugar-sweetened beverages in Río Negro: Burden of disease and expected impact of Law no. 27642 on the Promotion of Healthy Eating.

Introduction. The highest levels of childhood overweight and obesity in Latin America correspond to Argentina; this condition increases the risk of obesity, type 2 diabetes, cardiovascular and cerebrovascular diseases, and other conditions in adulthood. More than 25% of childhood and adolescent obesity are attributable to the consumption of sugar-sweetened beverages (SSBs). Our objective was to assess the disease and financial burden of SSB consumption among children and adolescents in Río Negro, the morbidity and mortality in adulthood, and the impact of reducing sugar consumption via the implementation of Law no. 27642 on the Promotion of Healthy Eating. Population and methods. We used a mathematical simulation model with a comparative risk assessment approach in the Río Negro population aged 0 to 17 years. The burden of obesity attributable to SSB consumption in the short and long term and direct medical costs were assessed. Results. The average consumption of SSBs was 348 mL/day; the prevalence of overweight and obesity was 16.6% and 11.6%, respectively. There were over 6600 cases of overweight in children and adolescents; while in adulthood, there were over 17 500 cases of overweight, 34 deaths attributable to SSBs, 3200 cases of diabetes, and over 4230 other health events. Direct medical costs were estimated at ARS 250 000 000 attributable to SSB consumption. Conclusion. The implementation of a comprehensive policy as established by Law no. 27642 on the Promotion of Healthy Eating in Río Negro would decrease 24% of overweight cases, morbidity, mortality, and associated medical costs.

Inequalities in the prevalence recording of 205 chronic conditions recorded in primary and secondary care for 12 million patients in the English National Health Service

BackgroundUnderstanding the prevalence of diseases and where it is detected and recorded in healthcare settings is important for planning effective prevention and care provision. We examined inequalities in the prevalence of 205 chronic conditions and in the care setting where the related diagnoses were recorded in the English National Health Service.MethodsWe used data from the Clinical Practice Research Datalink Aurum linked with Hospital Episode Statistics for 12.8 million patients registered with 1406 general practices in 2018. We mapped diagnoses recorded in primary and secondary care in the previous 12 years. We used linear regressions to assess associations of ethnicity, deprivation, and general practice with a diagnosis being recorded in primary care only, secondary care only, or both settings.Results72.65% of patients had at least one diagnosis recorded in any care setting. Most diagnoses were reported only in primary care (62.56%) and a minority only in secondary care (15.24%) or in both settings (22.18%). Black (− 0.08 percentage points (pp)), Asian (− 0.08 pp), mixed (− 0.13 pp), and other ethnicity patients (− 0.31 pp) were less likely than White patients to have a condition recorded. Patients in most deprived areas were 0.27 pp more likely to have a condition recorded (+ 0.07 pp in secondary care only, + 0.10 pp in both primary and secondary care, and + 0.10 pp in primary care only). Differences in prevalence by ethnicity were driven by diagnostic recording in primary care. Higher recording of diagnoses in more deprived areas was consistent across care settings. There were large differences in prevalence and diagnostic recording between general practices after adjusting for patient characteristics.ConclusionsLinked primary and secondary care records support the identification of disease prevalence more comprehensively. There are inequalities in the prevalence and setting of diagnostic recording by ethnicity, deprivation, and providers on average across conditions. Further research should examine inequalities for each specific condition and whether they reflect also differences in access or recording as well as disease burden. Improving recording where needed and making national linked records accessible for research are key to understanding and reducing inequalities in disease prevention and management.

Salivary testosterone is associated with feelings of senselessness and self-dislike in women with borderline personality disorder

ABSTRACT Background: Women with borderline personality disorder (BPD) show increased basal levels of testosterone. We investigated whether salivary testosterone levels in women with BPD were indicative of specific symptoms associated with BPD. Based on the assumed link between testosterone and interpersonal dominance, we hypothesized a positive association between testosterone and externalising, i.e. aggressive or impulsive behaviour, potentially contributing to higher burden of interpersonal reactivity and conflict. Methods: Saliva was collected from 98 women with BPD (average age in years: 28, range 18–46) between 1 and 2 pm. Self-rating scales were administered to assess severity of BPD (Borderline Symptom Checklist, BSL-23) and depressive symptoms (Beck’s Depression Inventory, BDI-II). Regression analyses targeted associations between individual testosterone levels and BSL-23 and BDI-II total and by-item scores. Results: Higher testosterone levels were associated with higher overall disease burden indicated by BSL-23 and BDI-II total scores. When analysed by item, higher testosterone levels were significantly associated with increased feelings of self-dislike, senselessness and pessimism, and the feeling of being a failure. Conclusion: Our findings show that in women with BPD testosterone levels are positively associated with increased borderline and depressive symptomatology. Contrary to our expectations, rather than predicting externalising symptoms, higher testosterone is associated with a well-defined cluster of internalising symptoms characterized by a pessimistic and derogatory view towards oneself.

Estimating the Economic Burden of COVID-19: Findings from Southern Iran

Background and Objective COVID-19 is an acute respiratory disease that poses a significant threat to public health. Recognizing the impact and costs associated with this disease can assist policymakers in making informed decisions about the allocation of resources. Therefore, this study estimated the economic burden of COVID-19 from a societal perspective, focusing on patients admitted to the referral hospital for this disease in southern Iran in 2022. Methods This descriptive and analytical study employed a random sampling method to select patients admitted to hospitals affiliated with Jiroft University of Medical Sciences in southern Kerman, Iran. The sampling period spanned from March 2020 to February 2021. In total, 450 patients were included in this study. A researcher-made checklist was used as the data collection tool. The data were then analyzed using a t-test, ANOVA, and Pearson correlation coefficient. The analysis was performed using SPSS23, with the significance level set at 0.05. Results The study estimated the total direct cost, total indirect cost, total cost of the studied patients, and the economic burden of COVID-19 disease as 600,211.89, 193,667.28, 793,879.17, and 4,186,389.48 dollars, respectively. A statistically significant correlation was found between length of stay (r=0.858, p&lt;0.001), type of insurance (F=2.853, P=0.023), and total direct cost. Conclusion Based on these results, it is evident that COVID-19 has imposed a substantial economic burden. The study findings emphasize the need for decision-makers to take measures and implement effective interventions to address COVID-19. This can be achieved by controlling risk factors, drawing upon successful experiences from other countries, and following recommendations provided by international organizations. By reducing the number of infections, the economic burden associated with the disease can be alleviated.