Excess Mortality Research Articles

Anemia and Prognosis in Patients with Acute Venous Thromboembolism.

Studies found an association between anemia and overall mortality and major bleeding (MB) in patients with acute venous thromboembolism (VTE), but whether anemia is causally related to death, bleeding, or recurrent VTE is uncertain. To explore the association between anemia at baseline and short-/long-term clinical outcomes in a prospective cohort of 928 patients with acute VTE. We defined anemia as a hemoglobin <13 g/dL for men/< 12 g/dL for women. The primary outcome was overall mortality, secondary outcomes were MB and recurrent VTE at 3 months (short term) and over the entire follow-up (long term). An independent committee determined the cause of death. We examined the association between anemia and clinical outcomes using multivariable regression, adjusting for confounders, periods of anticoagulation, and the competing risk of death if appropriate. Overall, 42% of patients had anemia. After a median follow-up of 30 months, 21.4% died, 13.8% experienced MB, and 12.4% had recurrent VTE. Anemia was associated with long-term overall mortality (adjusted HR 1.46, 95%CI 1.06-2.02) but not with short-term mortality, MB, or recurrent VTE. Per 1 g/dL increase in hemoglobin, long-term mortality risk decreased by 8%. Anemic patients were more likely to die from left ventricular failure than non-anemic patients (9.8% versus 1.3%). Anemic patients with VTE carried a higher long-term mortality risk than those without anemia, possibly due to an excess in mortality from left ventricular failure. The lack of an independent relationship between anemia and bleeding indicated that anemia might have confounding rather than causal effects.

The temporal protection and declining health of the COVID-19 vaccinated in England: A 26-month comparison of the mortality involving and not involving COVID-19 among vaccinated vs. unvaccinated

Background Comparing non-randomized groups, such as COVID-19 vaccinated and unvaccinated, even in the presence of seemingly relevant control variables, is challenging, but in this study, using English data, I show an achievable approach. Methods First, I estimated age-standardized all-cause mortality among COVID-19 vaccinated and unvaccinated ten years and older, covering a 26-month period from Apr 21 to May 23. Then, I estimated mortality not involving COVID-19, and finally, I differentiated the calculations. Results First, I found that all-cause mortality among COVID-19 unvaccinated was higher than among vaccinated. But as the pattern was similar concerning mortality not involving COVID-19, the discrepancy is attributed mainly to unvaccinated having inferior health at the outset. There was nonetheless significant protection for vaccinated between July 21 and Jan 22. Absent of control variables as a means to compare non-randomized groups, I reached that finding by differentiating all-cause mortality from mortality not involving COVID-19. However, while mortality not involving COVID-19 decreased among unvaccinated compared to the first observation month, it was high among vaccinated, i.e., a relative increase in mortality among vaccinated. Conclusions An interpretation is that vaccination, despite temporary protection, increased mortality. Strengthening the interpretation was relatively high mortality among vaccinated not involving COVID-19 counterintuitively following periods of excess mortality. Further strengthening the interpretation was relatively high mortality not involving COVID-19 among vaccinated corresponding with the excess mortality during the same period.

Impact of the 1742–1743 Plague Epidemic on Global Excess Deaths and Social Dynamics in the City of Córdoba and Along the Camino Real Between Buenos Aires and Lima

The 1742–1743 plague epidemic profoundly impacted populations along the Camino Real, the main colonial trade route connecting Buenos Aires and Lima, with Córdoba, Argentina, as a critical focal point. This research examines the multidimensional repercussions of the epidemic, emphasizing its demographic, social, and economic consequences. Utilizing parish records as primary sources, this study quantifies the excess mortality, revealing a dramatic increase, with death rates in Córdoba peaking at 12 times the pre-epidemic average in May 1743. Marginalized groups, particularly enslaved and Indigenous populations, were disproportionately affected, which exacerbated existing social inequalities. Through a comprehensive analysis of historical data, this study contributes to understanding epidemic responses in colonial Latin America, illuminating how public health crises intersect with demographic and socio-economic structures. The findings provide insights that are relevant to contemporary public health perspectives on crisis management and resilience, highlighting how historical epidemics offer valuable understanding into the social dynamics of health emergencies.

Understanding excess mortality during COVID in Belgium: the influence of pre-existing health status and social factors

BackgroundThis study aims to investigate how pre-existing health status and social background contribute to excess mortality during the COVID-19 crisis in Belgium.MethodsThe study population consists of almost 1.4 million adult members of Solidaris, the second largest health insurance fund in Belgium. Pre-existing health status was identified using health care reimbursement data, including medication use. Social characteristics included a proxy for low socio-economic status, nationality of origin, and living arrangement. Excess mortality during the COVID-19 crisis was measured by computing the relative difference between all-cause mortality in 2020 or 2021 and the average yearly mortality in 2015–2019. Directly Standardised Mortality Rates (DSMRs) were calculated to investigate absolute mortality inequalities. Mortality Rate Ratios (MRRs) were computed using Poisson regression analyses to investigate relative mortality inequalities.ResultsDSMRs show that persons with no previous disease experienced significant excess mortality in 2020, like men with one, two or three diseases and women with various numbers of pre-existing diseases. Results by specific disease show heterogenous results. After adjusting for age, sex and social characteristics, persons with cancer experienced a significant mortality deficit of 17% in 2020 and of 9% in 2021. For persons with cancer and asthma or COPD, significant mortality deficits of 10% and 3% were observed in 2020 and 2021, respectively.ConclusionThe study provides insights into the complex dynamics of mortality during the COVID-19 crisis, emphasising the need to consider individual-level information on pre-existing health and social background jointly.

Colorectal Cancer Surgery at a Regional Cold Site Centre During the SARS-CoV-2 Pandemic: A Comparison With Prepandemic Practices.

Stockholm, Sweden had among the highest excess mortality rates during the first wave of the SARS-CoV-2 pandemic. In March 2020, an entire hospital implemented an infection-free cold site infrastructure and scaled up imperative mainly colorectal cancer surgery, for the Stockholm health care region. The study evaluated the efficacy of the concept. Strict preadmission screening and prophylactic interventions were implemented. The outcomes of the cold site cohort (30th March-21st June 2020) were compared to a prepandemic control. Population-based data on colorectal cancer patients were collected from the Swedish Colorectal Cancer Registry. There were 107 patients in the cold site cohort and 109 in the control cohort. None developed COVID-19 within 30 days postoperatively. The proportions of pelvic and laparoscopic surgery were similar. The cold site cohort had more potentially avoidable stomas (32/94 (34%) vs 19/91 (21%), p = 0.0442). In the region, the proportion of colorectal cancer resections at the cold site increased from prepandemic 12.9% (58 of 448) to 43.3% (94 of 217) (p < 0.001). A SARS-CoV-2-cold site can be kept infection-free by screening, allowing increased volumes of colorectal cancer surgery with outcomes comparable to prepandemic practice. The cold site model should be more widely adopted in future similar scenarios. This study reports on the implementation of an entire cold site hospital for imperative colorectal surgery, in particular colorectal cancer, during the SARS-CoV-2 pandemic. By comparing outcomes to prepandemic practices, we demonstrated that the cold site hospital was effective in preventing infection and safely increasing surgical volume many-fold.

Excess deaths from all-causes mortality in children following the discontinuation of the COVID-19 policy in Thailand

BackgroundThe emerging COVID-19 pandemic impacted excess mortality in adults. However, limited information is available about the number of children who died during and after the discontinuation of COVID-19 policies in Thailand. This study aimed to assess the excess mortality in Thai children during and after the discontinuation of COVID-19 policies in Thailand.MethodWe obtained data on all-cause mortality among children from birth until 15 years of age from the Thai Bureau of Registration Administration (BORA) between January 2015 and December 2023. Based on WHO methodology, the negative binomial distribution model was used to calculate expected mortality. The excess mortality was calculated by taking the difference between the actual all-cause and expected mortality and presented as a P-score.ResultsThere were 81,510 all-cause deaths in children during the study period. Males were more affected than females, accounting for 60.5% of all deaths. Children younger than one year of age had the highest mortality rate (37,069 deaths, 45.5%). Of these, the number of child deaths during and after the COVID-19 pandemic were 20,555 and 9,924, respectively. During the COVID-19 pandemic, the average monthly excess mortality decreased from January 2020 to September 2022 when surveillance measures were in place. However, once the national surveillance measures ended in October 2022, excess mortality experienced a significant increase, with a P-score of 13.0%. The highest monthly average P-score for children aged 3 years, particularly in October 2022.ConclusionsThe all-cause mortality of children in Thailand during the COVID-19 pandemic was significantly reduced. However, following the pandemic, mortality rates appear to have increased, particularly among children aged 2 to 3 years. It is crucial to investigate the causes of these post-pandemic excess deaths to better prepare for future pandemics.

Senility-Related Mortality in the United States During the COVID-19 Pandemic.

Senility has been shown to negatively impact health outcomes. While national stressors have altered death trajectories for numerous diseases, little is known about the impact of the COVID-19 pandemic on senility-related outcomes. To evaluate the impact of the COVID-19 pandemic on senility-related mortality in the United States. This is a retrospective analysis of US decedents with documented senility-related death using the CDC WONDER database. We estimated annual trends in senility-related age-adjusted mortality rates (AAMR) from 1999 to 2020 using log-linear regression models. Calculation of excess deaths attributable to the COVID-19 pandemic was completed by comparison of actual 2020 mortality rates and estimated 2020 mortality using average annual percentage changes. A total of 510819 senility-related deaths were identified. AAMR declined by 9.76%, from 7.48 in 1999 to 6.75 deaths per 100000 in 2020. Year 2020 showed a marked increase in mortality, with 1.13 excess deaths per 100000 population attributable to the COVID-19 pandemic. The COVID-19 pandemic contributed to an additional burden of mortality across both sexes, resulting in an estimated 1.18 and 0.99 per 100000 excess deaths among females and males, respectively. The excess death rates per 100000 for Black, White, Asian/Pacific Islander, and American Indian/Alaska Native populations were 1.84, 1.05, 0.99, and 1.16, respectively. The impact on US census regions was reflected in excess death rates, with the Northeastern, Midwestern, Southern, and Western regions seeing 1.27, 1.27, 1.39, and 0.31 excess deaths per 100000, respectively. These findings suggest that the pandemic had an association with excess senility-related mortality. Further investigation is warranted to identify factors that impact senility-related outcomes.

Productivity Losses due to Health Problems Arising from COVID-19 Pandemic: A Systematic Review of Population-Level Studies Worldwide.

To systematically review the evidence on productivity losses due to health problems arising from the COVID-19 pandemic based on evidence from population-level studies. Following PRISMA statement, we conducted a systematic review using Medline, Embase, Scopus, Web of Science, EconLit, WHO COVID-19 Research and EuropePMC databases and a grey literature search. We included population-level studies using secondary data and qualitatively assessed eligible studies. For a quantitative cross-study comparison, we calculated losses in 2020 international dollars and as a share of gross domestic product. PROSPERO registration number: CRD42023478059. Thirty-eight studies were eligible for review, most of which reported losses in high-income countries and the European region. COVID-19 was a focus of 33 studies while 3 studies investigated losses from both long COVID and excess mortality. The Human Capital Approach dominated (30 studies) and no study used the Friction Cost Approach. Most studies (84%) reported on premature mortality losses and a quarter provided estimates of losses due to absenteeism. Of the 33 studies eligible for quantitative comparison, we found that the productivity losses ranged from 0 to 2.1% of gross domestic product; the greatest losses were in the high-income countries and for those aged 40-59years; and losses among men contributed to around 3/4 of the total burden. The available evidence on the topic is limited, particularly considering the methodological approaches used. Thus, more research is needed to reach a more comprehensive understanding of economy-level productivity losses resulting from the recent COVID-19 pandemic.

Excess mortality and associated community risk factors related to hurricane Maria in Puerto Rico

Excess mortality and associated community risk factors related to hurricane Maria in Puerto Rico

Kidney failure-related excess mortality during the first three years of the COVID-19 pandemic in the United States: a nation-wide, population-based analysis

BackgroundThe onset of the COVID-19 pandemic has had a detrimental impact on the healthcare system. Patients with kidney failure and related kidney disease are notably vulnerable to the COVID-19 pandemic. However, it remains unclear how mortality trends associated with kidney failure have evolved over the past three years. In this study, we investigated temporal trends in excess kidney failure-related mortality during the first three years of the pandemic in the United States.MethodsWe aim to estimate time-varying excess kidney failure-related mortality, which is defined as the difference between observed mortality and expected mortality predicted by a Poisson log-linear regression model, in the United States (March 2020—March 2023).ResultsOur findings revealed two distinct peaks in excess kidney failure-related mortality during the first year (March 2020—February 2021) and the second year (February 2021—March 2022), whereas a notable decline in excess mortality was observed in the third year (March 2022—March 2023). Additionally, disparities in mortality were evident among various demographic groups, including age, sex, racial/ethnic subgroups, and geographic regions. Across all age subgroups, an increase in kidney failure-related mortalities was observed, with individuals aged 85 years and above experiencing the most substantial relative increase, reaching 9595.8 per million persons (95% CI: 9438.8, 9752.9). Moreover, excess kidney failure-related mortalities were recorded at 510.3 per million persons (95% CI: 502.6, 517.9) and 721.8 per million persons (95% CI: 713.4, 730.1) for women and men, respectively. Notably, non-Hispanic Blacks exhibited the highest excess mortality within the racial/ethnic group, registering at 772.6 per million persons (95% CI: 756.3, 788.9).ConclusionsOur study observed high levels of excess kidney failure-related mortality during the first two years of the pandemic, followed by a notable decline in the third year. This highlights the effectiveness of current policies and prevention measures implemented to mitigate the impact of the pandemic.

Nearby armed conflict affects girls' education in Africa.

Female education is a crucial input to women's agency and empowerment, and has wide-ranging impacts, from improved labor market outcomes to reducing child mortality. Existing gender-specific evidence on the effect of armed conflict on education is conflict-specific and mixed. We link granular data on conflict events to georeferenced survey data on educational attainment from 28 countries in Africa, and use a regression-based approach to estimate the local effect of conflict exposure on female years of schooling. We find that conflict events occurring within 25 kilometers during a female child's primary school years reduces years of schooling by 0.4 years by adolescence. We do not find the same effect for males. Exposure to only low intensity conflict events with at most two casualties has persistent negative and significant effects. Consecutive years of conflict, however, can have positive effects in later years, which offset earlier negative effects, suggesting a habituation to violence. In the past two decades, we estimate excess child mortality in Africa associated with the indirect channel of women's education to be similar in magnitude to the number of direct child casualties due to conflict.

Microfilaremic Loiasis and Mansonella perstans Infection Prevalence and Sociodemographic Risk Factors in Urban and Rural Provinces of Gabon, Central Africa

Introduction: Loiasis and blood mansonellosis are parasitic vector borne diseases, the most widespread in Gabon after malaria. Loiasis presents all characteristics of a Neglected Tropical Diseases with recent implication on excess mortality among hypermicrofilaremia patients and Mansonella perstans seems to interact with other pathogens. The present study aimed to determine the prevalence and sociodemographic risk factors associated with loiasis and blood mansonellosis in three provinces of Gabon with different levels of urbanization. Methods: Participants were recruited in the province of Woleu-Ntem (rural area), Ngounié (rural area) and Estuaire (urban area). This cross-sectional study was conducted from December 2020 to April 2022. Sociodemographic data were collected and venous blood was collected in an EDTA tube for detection of Loa loa and Mansonella perstans microfilariae by direct microscopic examination and leukoconcentration techniques. Results: A total of 2,132 participants were included: 1,342 in the Woleu-Ntem, 492 in the Estuaire and 298 in the Ngounié. Loiasis prevalence was 23.6% (n=503/2,132), 8.7% (n= 185/2,132) for Mansonella perstans infection and 2.4% (n=51/2,131) for co-infection in the study population. Loa loa was found more frequently in Woleu-Ntem compared to Ngounié (OR: 1.9 [CI 95%: 1.4-2.8]; p&lt; 0.01) and Estuaire (OR: 2.9 [CI 95%: 2.1-4.1]; p&lt; 0.01). Regarding Mansonella perstans, the risk of having microfilaremia was 14 and 7 times higher in Ngounié compared to Estuaire (OR: 14.7 [CI 95%: 7.9-29.8]) (p&lt; 0.01) and Woleu-Ntem (OR: 7.3 [CI 95%: 5.2-10.3]) (p&lt; 0.01). The microfilaremia geometric mean was significantly higher in the group of infected inhabitants from Ngounié sites (p&lt; 0.01). No risk factors were found in Estuaire province for both filariasis. In Ngounié, participants older than 29 years old were less frequently infected by Loa loa and Mansonella perstans (p&lt; 0.01). In Woleu-Ntem, men and the older people were more infected than their counterparts (p&lt; 0.01). Conclusions: Loiasis and blood mansonellosis burden are higher in rural settings, although also present in the Estuaire. Age and gender were differently associated with these blood filariasis carriage in the three provinces.

Prevalence, Etiology and Outcomes of Native Pulmonary Regurgitation in the General Adult Population.

Pulmonary regurgitation (PR) after reparative intervention for congenital heart disease has been studied extensively. However, the burden, distribution of causes, and outcome of PR in adults is unknown. The study aimed to evaluate the prevalence, types, and outcomes of moderate/severe PR in adults in the community setting. A total of 398 adult residents of Olmsted County who had clinically indicated echocardiography 2004-2023 at Mayo Clinic, Rochester and had moderate or severe PR were identified retrospectively. Median age was 77 years, 48% were females, and 61 (51%) had severe PR. The age and sex-adjusted U.S. prevalence was 0.11% (vs 0.67% for ≥moderate tricuspid regurgitation). Moderate/severe PR was due to pulmonary hypertension in 77%, congenital/iatrogenic in 11%, primary pulmonary valve disease in 2% (88% due to carcinoid), and idiopathic isolated in 10%. In contrast, severe PR was due to congenital/iatrogenic disease in 52%, pulmonary hypertension in 39%, primary PR in 5% and isolated idiopathic in 3%. All-cause mortality rate per 100-person-year was 73 in primary (mostly carcinoid) PR, 16 in pulmonary hypertension-related PR (not different vs propensity matched patients without PR), and 6 in isolated idiopathic PR (not different vs matched patients without PR). Moderate or severe PR had a lower prevalence vs TR. The most frequent cause was pulmonary hypertension for ≥moderate PR and congenital/iatrogenic for severe PR. Mortality in patients with acquired ≥moderate PR appeared to be related to the underlying cause, with no excess mortality compared to matched patients without PR. Whether specifically severe PR confers excess mortality requires future investigation.

Patriarchy, Fertility and Excess Female Child Mortality in India

Research investigating association between patriarchy and demographic behavior is limited in India. The only study on this subject utilized 1981 Indian Census data to examine associations between patriarchy and fertility. We examined the association of patriarchy, measured using India Patriarchy Index (IPI), with total fertility rate (TFR) and excess female child mortality in India. Additionally, we examined independent associations of the 5 dimensions included in the IPI with the two outcomes. We used univariate and bivariate Local Indicators of Spatial Autocorrelation, multivariable ordinary least squares and spatial error- regressions to examine the associations. Spatial heterogeneity beyond the north–south divide was evident in the spatial association of IPI with TFR and excess female child mortality. Results show positive association of IPI with TFR and excess female child mortality. While son preference and socio-economic domination were positively associated with TFR, domination of men over women and son preference were positively associated with excess female child mortality. This study is the first of its kind to examine the association of a novel measure of patriarchy with TFR and excess female child mortality. As patriarchy is deep-rooted in Indian society, a great deal of effort is needed to shift these traditionally held social norms and practices.

Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture-recapture analysis.

Accurate mortality estimates help quantify and memorialise the impact of war. We used multiple data sources to estimate deaths due to traumatic injury in the Gaza Strip between Oct 7, 2023, and June 30, 2024. We used a three-list capture-recapture analysis using data from Palestinian Ministry of Health (MoH) hospital lists, an MoH online survey, and social media obituaries. After imputing missing values, we fitted alternative generalised linear models to the three lists' overlap structure, with each model representing different possible dependencies among lists and including covariates predictive of the probability of being listed; we averaged the models to estimate the true number of deaths in the analysis period (Oct 7, 2023, to June 30, 2024). Resulting annualised age-specific and sex-specific mortality rates were compared with mortality in 2022. We estimated 64 260 deaths (95% CI 55 298-78 525) due to traumatic injury during the study period, suggesting the Palestinian MoH under-reported mortality by 41%. The annualised crude death rate was 39·3 per 1000 people (95% CI 35·7-49·4), representing a rate ratio of 14·0 (95% CI 12·8-17·6) compared with all-cause mortality in 2022, even when ignoring non-injury excess mortality. Women, children (aged <18 years), and older people (aged ≥65 years) accounted for 16 699 (59·1%) of the 28 257 deaths for which age and sex data were available. Our findings show an exceptionally high mortality rate in the Gaza Strip during the period studied. These results underscore the urgent need for interventions to prevent further loss of life and illuminate important patterns in the conduct of the war. None.

Early-life famine exposure and subsequent risk of chronic diseases in later adulthood: a population-based retrospective cohort study.

Over the past few decades, China has experienced significant demographic and epidemiological changes. The sharp decline in fertility and mortality rates has accelerated population aging, contributing to an increase in the prevalence of chronic diseases. The nutritional condition during early life is associated with the onset of chronic illnesses later in adulthood. However, it remains unclear whether this association also increases the risk of multimorbidity in later adulthood. This study aimed to systematically evaluate the association between early-life famine exposure and the subsequent development of 14 chronic diseases, as well as multimorbidity, and whether there exists a discrepancy in gender, residence, and famine severity. Data are from the 2018 Wave 4 CHARLS database, a national survey covering 19,816 participants aged 45 years or older. Drawing from our past research on famine in China, we incorporated 3,867 participants, categorizing them into three groups based on their birth years. Considering that climate conditions and population density can influence the intensity of famine, we characterize its severity by establishing a threshold of 50% excess death rate. The 14 chronic diseases assessed by CHARLS were used as the main outcome indicator, with multimorbidity as a secondary outcome indicator. We conducted a stepwise logistic regression analysis to investigate the impact of exposure to famine in early life affects the development of chronic diseases in adulthood, presenting the findings as ORs and 95% CIs. Additionally, we assess multiple moderating factors such as gender, residence, and famine severity to evaluate the outcomes. Of the 3,867 participants included, the prevalence of each chronic disease ranged from 1.1% (Psychiatric disease) to 10.7% (Hypertension). Overall, 27.0% of participants reported being affected by at least one chronic disease, while 9.6% indicated they had suffered from two or more chronic conditions. Early-life exposure to famine makes it more likely to develop diabetes in later adulthood OR (95% CI) of 1.85 (1.26 to2.72), stroke OR (95% CI) of 1.96 (1.17 to 3.29), kidney disease OR (95% CI) of 1.91 (1.07 to 3.40), and multimorbidity OR (95% CI) of 1.39 (1.08 to 1.80), compared to those who did not face such conditions. The moderating effects analysis revealed that less severe famine exposure during toddlerhood was associated with an increased risk of multimorbidity in adulthood OR (95% CI) of 1.43 (1.01 to 2.03). Males exposed to famine during toddlerhood had a higher risk of multimorbidity in adulthood OR (95% CI) of 2.26 (1.29 to 3.98). Compared to the unexposed group, rural residents who experienced famine exposure in their early life are at a higher risk of developing multimorbidity by about 1.5 times in adulthood. Experiencing famine in early childhood increases susceptibility to developing chronic diseases in later adulthood, with the risk of diabetes, stroke, and kidney disease nearly doubling. The association of multimorbidity in later adulthood varies according to the severity of the famine, gender, and residential area.

IMPACT MONITORING OF LOW AND HIGH DEXAMETHASONE DOSES ON COVID-19 OUTCOMES IN HODEIDAH, YEMEN: A PHARMACOEPIDEMIOLOGICAL STUDY

Objectives: The study aimed to describe the pharmacoepidemiological properties of high and low dexamethasone doses on patients from COVID-19 in Hodeidah, Yemen. Methodology: A randomized clinical trial included 192/323 patients with COVID-19 (28/49 cases in the first wave 2020 and 164/274 cases in the second wave 2021), aged from 3 to 80 years old, confirmed by real time-polymerase chain reaction. All patients were admitted in the isolation department, Center of Tropical Medicine and Infectious Diseases, AL Thawara Public Hospital Authority, Hodeidah, Yemen. 28 patients received high dose of dexamethasone (20–10 mg daily for 10 days) with standard care in the first wave and 164 patients received low dose of dexamethasone (6–8 mg daily for 10 days) in the second wave with standard care. Results: The results showed non-significant differences between the impact of dexamethasone in both waves with different doses of dexamethasone (X2: 1.70; p=0.91). On the other mean, the case fatality rate (CFR) in the first wave with high dose was 10.71% and CFR of the second wave with low dose was 22.29%. While the results showed significant differences between high dose and low dose group with mechanical ventilator “mechanical ventilation (MV)” (X2: 7.10; p=0.0076), the CFR of patients with MV and high dose was 37% and CFR of the second wave with low dose was 77% In addition, all admitted cases had acute respiratory distress syndrome and the onset date of symptom was 2 weeks before hospitalization. Old age, chronic diseases, and co-infection may be contributing factors to effect on dexamethasone efficacy and excess mortality among COVID-19 patients. Conclusion: The study assessed the effectiveness of dexamethasone in high and low dose in treating patients hospitalized with COVID-19 in Hodeidah, Yemen and found difference between mortality and recovery outcomes with high and low dose where the high doses of dexamethasone had good outcome for critical cases with MV.

Chikungunya: From Hypothesis to Evidence of Increased Severe Disease and Fatalities.

Chikungunya virus infection often manifests as an acute, self-limiting febrile illness, with arthralgia and musculoskeletal symptoms being the most commonly reported. Arthralgia can persist for months or even years, and approximately 50% of cases progress to chronic conditions. However, recent outbreaks have revealed a rising number of severe cases and fatalities. This review examines evidence from the past decade that suggests a higher incidence of severe chikungunya virus (CHIKV) infections and increased mortality rates, challenging official reports and guidelines from many countries. The literature review includes case reports, series, and studies with comparison groups to assess whether CHIKV-related mortality is underreported. Evaluating excess mortality involves analyzing consistent findings across different regions, biological plausibility, and systemic manifestations that contribute to severe outcomes. These findings aim to expand disease classifications in international guidelines and raise awareness among healthcare professionals to better identify severe CHIKV cases and related deaths. Studies were identified through PubMed using the search terms "chikungunya", "death", "severe", "pathogenesis", and "pathophysiology".

Relating mental health, health-related quality of life and well-being in the aftermath of the COVID-19 pandemic: A cross-sectional comparison in 14 European countries in early 2023.

To understand country-level differences in the population's health and well-being in Europe in the aftermath of the COVID-19 pandemic, while also investigating the internal relationships among health and well-being outcomes. Cross-sectional study. We collected representative panel-based samples of 1000 adult respondents per country across 14 Western European countries in early 2023. The survey used standardised instruments to assess health and well-being, including EQ-5D-5L, GHQ-12, PHQ-9, general satisfaction, the Brief Resilience Scale and the ULS-6 (Loneliness) Scale. Summary statistics of the aggregate scores for each country were calculated and ranked. Multidimensional unfolding was used to visualize the rank relationships across countries and the indices, whereby a closer distance between a country and an index indicated a higher/better rank. Additionally, two key objective country-level indices (GDP growth rate and excess mortality rates) were integrated into the analysis. Austria was found to report better status on most of the indices, while Sweden and the UK ranked consistently worse than the other countries. The loneliness, EQ-VAS and satisfaction scores were plotted further from the mental well-being scores and EQ-5D utility scores. Countries that did well in controlling excess mortality and maintaining economic growth tended to exhibit lower performance in self-reported well-being. This study presents the variability in health and well-being across 14 West-European countries. Discrepancies between countries in self-reported outcomes reveal the complex interrelationship among different aspects of well-being. The study also highlights the complexities and challenges in optimising policies to maximize the overall well-being of society.

Effects of combined exposure to PM2.5, O3, and NO2 on health risks of different disease populations in the Beijing-Tianjin-Hebei region.

Air pollution adversely affects people's health. Under the current background of compound air pollution in China, the emission reduction potential of air pollution control has significantly decreased, and there are few studies on multi-pollutant emission reduction and synergistic effects. PM2.5, O3, and NO2 have caused the enormous disease burden and health risks. This study evaluated the single and combined health effects of pollutants in the Beijing-Tianjin-Hebei region, and discussed the differences in susceptibility among disease populations. Identified the interactions of multiple pollutants and evaluated current environmental policies. This study provided evidence of the interactive effect of combined PM2.5, O3, and NO2 exposure on the health risks of different disease populations. Among them, the interaction between PM2.5 and O3 posed the most significant health risks (Odds Ratio of 3.026) and had the greatest impact on the health of people with cardiovascular diseases (Odds Ratio of 3.136). The excess deaths affected by combined exposure exceeded 40% of the total excess deaths. The assessment of environmental policies indicated that compliance with the AQG 2021 guideline values would reduce ambient air pollution-related deaths in the Beijing-Tianjin-Hebei region alone by about 30,000 per year. Our national standards were still far from the benchmarks given by the World Health Organization, especially for NO2. In the future, attentions should also be paid to the control of NO2 and other reaction precursors while coordinating the control of PM2.5 and O3.