Nationwide Descriptive Study Research Articles

Author Response: Stroke Among SARS-CoV-2 Vaccine Recipients in Mexico: A Nationwide Descriptive Study.

We greatly appreciate the insightful comments by Dr. Taccetta on our article.1 We agree that passive epidemiologic surveillance is less likely to detect incidence, which is why we only reported the observed incidence and not a rate or ratio. This is a limitation we acknowledged in our article.1 In addition, concerning the 30-day timeframe from immunization to event detection in our study, we recognize that some neurologic events such as cerebral venous thrombosis (CVT) and Guillain-Barré syndrome (GBS) may occur up to 42 days after immunization. However, as stated in the Methods section, the World Health Organization's noted operational definition for surveillance of adverse events following immunization (AEFI) in our country only includes events occurring within the first 30 days after immunization.2,3 Hence, we were unable to detect or collect data on those cases occurring beyond the time frame specified by our legislature—a limitation that we also acknowledged as a potential selection bias. Recently, the increasing number of vaccine-induced thrombotic thrombocytopenia with CVT and GBS reports worldwide, especially with adenovirus-based vaccines,4,5 has compelled the expansion of our country's AEFI surveillance time frame to consider cases occurring within the first 42 days. We plan to consider this information in future reports.

Reader Response: Stroke Among SARS-CoV-2 Vaccine Recipients in Mexico: A Nationwide Descriptive Study.

We read with great interest the article by Lopez-Mena et al.1 We present our experience with a 28-year-old man who was admitted to our hospital with right-sided weakness on awakening. The patient was febrile for 2 days after the second dose of the BNT162b2 vaccination against SARS-CoV-2. His medical history was unremarkable. Brain magnetic resonance imaging revealed an acute ischemic stroke in the distribution of the left posterior cerebral artery.

Author Response: Stroke Among SARS-CoV-2 Vaccine Recipients in Mexico: A Nationwide Descriptive Study.

We appreciate the comment on our article.1 Dr. Stoiloudis reports the case of an otherwise healthy young male individual who developed a wake-up acute ischemic stroke after the second dose of BNT162b2. It is of interest that their patient developed a fever in close temporal association to vaccination, which may be explained by vaccination reactogenicity. Additional research on the potential pathophysiologic pathways for immunization-related strokes is needed. It would be interesting to clarify the stroke etiologic approach in this patient because the development of an acute stroke in close temporal association to the vaccine does not exclude other common stroke causes among young adults.2

Work-Related Traumatic Stress Response in Nurses Employed in COVID-19 Settings.

Nurses may be at a higher risk of experiencing work-related traumatic stress response during the COVID-19 pandemic compared to other clinicians. This study aimed to investigate the correlations between work-related trauma symptoms and demographic factors, psychosocial hazards and stress response in a census sample of nurses working in COVID-19 settings in Cyprus. In this nationwide descriptive and cross-sectional study, data were collected between April and May 2020 using a questionnaire that included sociodemographic, educational and employment and work-related variables, as well as a modified version of the Secondary Traumatic Stress Scale (STSS) for the assessment of work-related trauma symptoms during the pandemic. Overall, 233 nurses participated (with a response rate of 61.3%) and 25.7% of them reported clinical work-related trauma symptoms (STSS-M > 55; actual scale range: 17–85). The mean value for emotional exhaustion was 7.3 (SD: 2.29; visual scale range: 1–10), while the value for distress that was caused by being avoided due to work in COVID-19 units was 6.98 (SD: 2.69; visual scale range: 1–10). Positive associations were noted between trauma symptoms and both emotional exhaustion and distress from being avoided by others due to work in a COVID-19 setting and a negative association was also found between trauma symptoms and satisfaction from organizational support variables (all p < 0.002). Working in COVID-19 settings during the pandemic is a stressful experience that has been linked to psychologically traumatic symptoms Thus, supportive measures are proposed for healthcare personnel, even in countries with low COVID-19 burden.

Socioeconomic and Behavioral Disparities Among Diabetics in Saudi Arabia: A Nation-Wide Descriptive Study.

PurposeThis study aims to explore sociodemographic, behavioral and clinical factors in adult participants with Diabetes in Saudi Arabia.MethodsA population-based cross-sectional study of 20492 potential participants conducted in quarters 1 and 2 in 2021 from all 13 administrative regions of Saudi Arabia. A backward maximum likelihood logistic regression model, including all variables, was used to identify variables associated with participants living with Diabetes.ResultsA total of 14007 participants, aged ≥18 years, completed the interview, with a response rate of 68.3% and successful quota sampling. Fifty percent were male, the mean age was 36.7 (SD 13.7; range: 18–90). Of the total sample, 1633, 11.7% had Diabetes. Seven percent only of diabetic patients (124 participants) had an acceptable level of fruit and vegetable intake. In addition, only (274, 16.8%) had an acceptable level of physical activity, compared to (2389, 19.3%) in the non-diabetic group. Daily smokers were slightly higher in the diabetic group compared to the non-diabetic group (13.2% vs 11.7%). Hypertension was reported mostly by the diabetic group (45.1% vs 8%). Overweight and Obesity were more prevalent in patients with Diabetes (72.50% vs 51.62%). The results of the logistic regression have shown that several sociodemographic, behavioral and intermediate risk factors were significantly associated with Diabetes.ConclusionThe study found that the prevalence of Diabetes in Saudi Arabia is around 12%, which is lower than the previously reported prevalence of Diabetes in Saudi Arabia. Moreover, Diabetes was found to be associated with lower educational level, smoking, obesity and overweight, hypercholesterolemia and hypertension. These factors are essential to be identified and screened in the community at regular interval; furthermore, controlling these factors may improve their disease management and quality of life. Additionally, knowing these factors will assist policymakers to shape an effective practical approach to combat diabetes widespread.

Evaluation of neural tube defects from 2014 to 2019 in Turkey

ObjectiveThe aim of this study is to determine the frequency of neural tube defects (NTDs) and to examine the epidemiological characteristics of NTD related deaths in Turkey.MethodsThis nationwide descriptive study was included NTD related infant deaths, termination of pregnancy for fetal anomaly (ToPFA) and stillbirth cases registered in Death Notification System between 2014 and 2019, and patients diagnosed with NTD in the 2018 birth cohort.FindingsIn the 2018 birth cohort, there were 3475 cases of NTD at birth (27.5 per 10,000). The fatality rates for live-born babies with NTD in this cohort were 13.5% at first year, and 15.6% at the end of March, 2022. NTDs were associated with 11.7% of ToPFA cases, 2.5% of stillbirths and 2.8% of infant deaths in 2014–2019. NTD related stillbirth rate was 1.74 per 10,000 births, while NTD related ToPFA rate and infant mortality rate were 0.61 and 2.70 per 10,000 live births respectively. NTD-related stillbirth and infant mortality rate were highest in the Eastern region (3.64 per 10,000 births; 4.65 per 10,000 live births respectively), while ToPFA rate was highest in the North and West regions (1.17 and 0.79 per 10,000 live births respectively) (p < 0.05). Prematurity and low birth weight were the variables with the highest NTD related rates for stillbirths (11.26 and 16.80 per 10,000 birth), ToPFA (9.25 and 12.74) per 10,000 live birth), and infant deaths (13.91 and 20.11 per 10,000 live birth) (p < 0.05).ConclusionNTDs are common and have an important place among the mortality causes in Turkey. Primary prevention through mandatory folic acid fortification should be considered both to reduce the frequency of NTD and related mortality rates.

Targeting population groups with heavier burden of hepatocellular carcinoma incidence: A nationwide descriptive epidemiological study in Sweden

Contemporary European studies examining associations between socioeconomic status and hepatocellular carcinoma (HCC) incidence are scarce. We aimed to target population groups with a heavier burden of HCC by assessing associations of individual‐level sociodemographic variables and neighbourhood deprivation with all‐stage and stage‐specific HCC incidence rates (IR). Patient and population data stratified by calendar year (2012‐2018), sex, age (5‐year groups), household income (low, medium and high), country of birth (Nordic, non‐Nordic) and neighbourhood deprivation (national quintiles Q1‐Q5) were retrieved from Swedish registers. HCC stages were defined by Barcelona Clinic Liver Cancer stages 0 to A (early‐stage) and B to D (late‐stage). IR (per 100 000 person‐years) were estimated by Poisson regression models. Men had four times higher IR than women. IRs increased markedly with lower household income as well as with neighbourhood deprivation. Seven times higher IR was observed among people with a low household income living in the most deprived neighbourhoods (IR 3.90, 95% confidence interval [CI] 3.28‐4.64) compared to people with a high household income living in the least deprived neighbourhoods (IR 0.58, 95% CI 0.46‐0.74). The gradient across income categories was more pronounced for late‐stage than early‐stage HCC. IR reached 30 (per 100 000 person‐years) for people in the age span 60 to 79 years with low income and 20 for 60 to 79 year old people living in the most deprived neighbourhoods (regardless of income). Men with low household income and/or living in the most deprived neighbourhoods might be considered as primary targets in studies evaluating the cost‐effectiveness of screening for early‐stage HCC detection.

Agrobacterium species bacteraemia, Switzerland, 2008 to 2019: a molecular epidemiological study

BackgroundAgrobacterium spp. are infrequent agents of bloodstream infections linked to healthcare-associated outbreaks. However, it is unclear if outbreaks also occur across larger geographic areas. Triggered by two local clusters from putative point sources, our aim was to detect potential additional clusters in Switzerland.MethodsWe performed a nationwide descriptive study of cases in Switzerland based on a prospective surveillance system (Swiss Centre for Antibiotic Resistance, anresis.ch), from 2008 to 2019. We identified patients with Agrobacterium spp. isolated from blood cultures and used a survey to collect clinical-epidemiological information and susceptibility testing results. We performed whole genome sequencing (WGS) of available clinical isolates and determined their relatedness by single nucleotide polymorphism (SNP) variant calling analysis.ResultsWe identified a total of 36 cases of Agrobacterium spp. from blood samples over 10 years. Beyond previously known local clusters, no new ones were identified. WGS-based typing was performed on 22 available isolates and showed no clonal relationships between newly identified isolates or to those from the known clusters, with all isolates outside these clusters being at least 50 SNPs apart.Conclusion and relevanceAgrobacterium spp. bacteraemia is infrequently detected and, given that it may be healthcare-associated and stem from a point source, occurrence of multiple episodes should entail an outbreak investigation. With the help of the national antimicrobial resistance surveillance system we identified multiple clinical cases of this rare pathogen but found no evidence by WGS that suggested a nation-wide outbreak.Graphical abstract

Healthcare resource consumption prior to asthma-related death: a nationwide descriptive study.

Background:Although asthma mortality declined sharply until the mid-2000s, a stagnation in mortality has been observed over the past decade in different countries.Objective:The objective of this study is to describe healthcare resource consumption for patients who died from asthma in France.Method:This study was conducted using data from the French National Health Data System. Patients who died from asthma between 2013 and 2017 were identified by the ICD10 codes J45 and J46. Health care consumption data were collected. Patients were categorized into four categories according to age: ⩾75, (18–75), (12–18), (0–12). Daily doses of ICS were categorized according to GINA guidelines.Results:A total of 3829 patients were included. No ICS or an inadequate ICS dose was observed in 43.8%, 50.6%, 48.1%, and 54.0% of patients aged ⩾75, (18–74), (12–18), and (0–12) years, respectively. Dispensation of six or more SABA canisters was observed in 37.2%, 49.0%, and 70.3% of patients aged of ⩾75, (18–75), and (12–18) years, respectively. Omalizumab dispensation rate was very low [1.1% and 2.8% in patients aged ⩾75 and (18–75) years)]. The proportion of patients with a pulmonologist office visit was 13.8% and 14.6% in patients ⩾75 and (18–75) years, respectively. A lung function test was noted in only 18.6%, 28.3%, and 25.9% of patients ⩾75, (18–75) and (12–18) years, respectively.Conclusion:Half of the patients who died from asthma received inadequate ICS doses and only a small proportion had access to biological therapies. Less than 15% were referred to a specialist.

Swedish guidelines for type 1 diabetes and pregnancy outcomes: A nationwide descriptive study of consensus and adherence

AimsType 1 diabetes (DM1) during pregnancy and labor is associated with an increased risk of maternal and fetal complications. Evidence-based care is therefore provided in accordance with guidelines.In this study, we aimed to compare all the Swedish guidelines for DM1 during pregnancy and labor in terms of the variables emphasized in the national guidelines from the US and from England and Wales. The second aim was to measure adherence to local guidelines at the four hospitals in Stockholm that cared for pregnant women with DM1 during 2016 and to describe the pregnancy and labor outcomes. MethodsAll the Swedish guidelines for DM1 during pregnancy and labor were reviewed on 31 variables. The medical records of 114 women were reviewed according to whether ≥70% of 22 variables in the guidelines were followed. ResultsNo consensus was found in the Swedish guidelines for any of the 31 variables. Some guidelines were contradictory. The pregnancy guidelines were followed in 17.5% of the medical records, 18.4% followed the labor guidelines, and 5.3% followed both guidelines. The onset of labor, mode of delivery and HbA1c in the third trimester varied significantly, depending on the adherence to guidelines. ConclusionsThe Swedish guidelines for DM1 during pregnancy and labor lack both consensus and adherence. A national guideline on DM1 during pregnancy and childbirth with high adherence could improve care for pregnant Swedish women with DM1 and their fetuses.

Age, Sex, Population Density and COVID-19 Pandemic in Thailand: A Nationwide Descriptive Correlational Study

Objective: It is reported that age and sex have been identified as potential risk factors for severe outcomes and the distribution of coronavirus disease (COVID-19), although the specifics of these relationships are unclear. Furthermore, little is known about the relationship between age, sex, COVID-19, and population density in Thailand. This study proposed to examine the relationships among age, sex, population density, and the number of COVID-19 patients in Thailand.Material and Methods: In this nationwide descriptive correlational study, the dataset of daily COVID-19 cases in Thailand between January 12, 2020, and November 30, 2020, and population density (people/km2 ) in each province of Thailand was retrieved from the Open Government Data of Thailand, the Registration Office Department of the Interior, the Ministry of the Interior, and the National Statistical Office of Thailand. Chi-square and Pearson product-moment correlation were used to determine the difference and relationships among studied variables. Simple linear regression was used to predict the number of COVID-19 cases based on population density.Results: The findings illustrated a significant difference between male and female patients, in which the number of male patients was higher than female patients across age groups 31-45 years, 40-60 years, and &gt;60 years (p-value&lt;0.010). Further, population density was significantly associated with the number of COVID-19 cases.Conclusion: This investigation would provide intervention planning implications during potential future pandemics, especially in groups at higher risk (males, age 17-46 years old, and people living in high-density population areas).

Neurologic adverse events among 704,003 first-dose recipients of the BNT162b2 mRNA COVID-19 vaccine in Mexico: A nationwide descriptive study

mRNA vaccines against SARS-CoV-2 are remarkably effective. Limited information exists about the incidence of adverse events following immunization (AEFI) with their use. We conducted a prospective observational study including data from 704,003 first-doses recipients; 6536 AEFI were reported, of whom 65.1% had at least one neurologic AEFI (non-serious 99.6%). Thirty-three serious events were reported; 17 (51.5%) were neurologic (observed frequency, 2.4/100,000 doses). At the time of writing this report, 16/17 cases had been discharged without deaths. Our data suggest that the BNT162b2 mRNA COVID-19 vaccine is safe; its individual and societal benefits outweigh the low percentage of serious neurologic AEFI. This information should help to dissipate hesitancy towards this new vaccine platform.

Uncovering Modern Clinical Applications of Fuzi and Fuzi-Based Formulas: A Nationwide Descriptive Study With Market Basket Analysis.

Background: As time evolved, traditional Chinese medicine (TCM) became integrated into the global medical system as complementary treatments. Some essential TCM herbs started to play a limited role in clinical practices because of Western medication development. For example, Fuzi (Aconiti Lateralis Radix Praeparata) is a toxic but indispensable TCM herb. Fuzi was mainly used in poor circulation and life-threatening conditions by history records. However, with various Western medication options for treating critical conditions currently, how is Fuzi used clinically and its indications in modern TCM are unclear. This study aimed to evaluate Fuzi and Fuzi-based formulas in modern clinical practices using artificial intelligence and data mining methods. Methods: This nationwide descriptive study with market basket analysis used a cohort selected from the Taiwan National Health Insurance database that contained one million national representatives between 2003 and 2010 used for our analysis. Descriptive statistics were performed to demonstrate the modern clinical indications of Fuzi. Market basket analysis was calculated by the Apriori algorithm to discover the association rules between Fuzi and other TCM herbs. Results: A total of 104,281 patients using 405,837 prescriptions of Fuzi and Fuzi-based formulas were identified. TCM doctors were found to use Fuzi in pulmonary (21.5%), gastrointestinal (17.3%), and rheumatologic (11.0%) diseases, but not commonly in cardiovascular diseases (7.4%). Long-term users of Fuzi and Fuzi-based formulas often had the following comorbidities diagnosed by Western doctors: osteoarthritis (31.0%), peptic ulcers (29.5%), hypertension (19.9%), and COPD (19.7%). Patients also used concurrent medications such as H2-receptor antagonists, nonsteroidal anti-inflammatory drugs, β-blockers, calcium channel blockers, and aspirin. Through market basket analysis, for the first time, we noticed many practical Fuzi-related herbal pairs such as Fuzi–Hsihsin (Asari Radix et Rhizoma)–Dahuang (Rhei Radix et Rhizoma) for neurologic diseases and headache. Conclusion: For the first time, big data analysis was applied to uncover the modern clinical indications of Fuzi in addition to traditional use. We provided necessary evidence on the scientific use of Fuzi in current TCM practices, and the Fuzi-related herbal pairs discovered in this study are helpful to the development of new botanical drugs.

Electroconvulsive therapy use in psychiatric hospitalizations - a nationwide descriptive study

IntroductionDespite being one of the oldest treatments in the field of Psychiatry, Electroconvulsive therapy (ECT) is used worldwide for various severe and treatment-resistant psychiatric disorders, establishing itself as one of the fastest and most effective treatments.ObjectivesThe primary aim of this study was to describe a nationwide epidemiological perspective of the use of ECT in hospitalized psychiatric patients. The secondary aims were to characterize clinical and sociodemographic trends of hospitalized patients who needed ECT.MethodsA retrospective-observational study was conducted using an administrative database which gathered all hospitalizations registered in Portuguese public hospitals from 2008 to 2015. We selected all hospitalizations with a procedure code 94.27 - Other electroshock therapy defined by the International Classification of Diseases version-9, Clinical Modification.The variables included in the study were birth date, sex, residence address, primary and secondary diagnoses, admission date, discharge date, length of stay (LoS), discharge status from each single hospitalization episode.ResultsThere were a total of 879 hospitalizations with ECT during the 8-year period of the study. Most of the hospitalizations occurred in female patients (53.4 vs 46.6%), belonging to the age group of 51-70 years old, with a mean age of 50.5 years old. The median LoS was 43.0 days with an IQR of 27.0-68.0 days. The specific primary diagnosis most frequent in all hospitalizations was Major depressive disorder, recurrent episode representing 19.6% of all ECT related hospitalizations.ConclusionsIn Portugal most of the patients who received ECT were women above middle age, and depressive disorders were the most common indication.

Infective endocarditis in patients with solid organ transplantation. A nationwide descriptive study

BackgroundSolid organ transplantation (SOT) implies immunosuppression and frequent health care contact. Our aim was to compare the characteristics of patients with infective endocarditis (IE) and SOT against those without SOT. MethodsWe used data from the Spanish Collaboration on Endocarditis during the period 2008-2018. ResultsWe identified 4794 cases of IE, 85 (1.8%) in SOT (56 kidney, 18 liver, 8 heart, 3 lung). Thirteen patients with other transplantation types (bone marrow, hematopoietic precursors, and cornea) were excluded from the analysis. Compared with patients without SOT, patients with SOT had lower median age (61 vs. 69 years, p<0.001), more comorbidities (mean age-adjusted Charlson index 5.7±2.9 vs. 4.9±2.9, p=0.004), a lower prevalence of native valvular heart disease (29.4 vs. 45.4%, p=0.003), more in-hospital and healthcare-related IE (70.5% vs. 36.3%, p<0.001) and staphylococcal etiology (57.7% vs. 39.7%, p=0.001). Patients with SOT had more frequent kidney function worsening (47.1% vs. 34.6%, p=0.02), septic shock (25.9% vs. 12.1 %, p<0.001), sepsis (27.1% vs. 17.2%, p=0.02), and less surgery indication (54.1% vs 66.3%, p=0.02) and surgery (32.9% vs. 46.3%, p=0.01) than patients without SOT. There were no significant differences in mortality: inhospital (30.6% SOT vs. 25.6% without SOT, p=0.31), 1-year (38.8% SOT vs. 31.9% without SOT, p=0.18). ConclusionsMost IE in SOT recipients are nosocomial and over 70% are health care-related. Half have previously normal heart valves and almost 60% are due to Staphylococcus spp. infections. Mortality seems to be similar to non-SOT counterparts.

Nationwide descriptive study of COVID-19 in children below the age of 14 years in Sri Lanka

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Electroconvulsive Therapy Use in Psychiatric Hospitalizations in Portugal: A Nationwide Descriptive Study.

The primary aim of this study was to describe a Portuguese nationwide epidemiological perspective on the use of electroconvulsive therapy (ECT) in hospitalized psychiatric patients. The secondary aims of the study were to characterize clinical and sociodemographic trends of hospitalized patients treated with ECT. A retrospective-observational study was conducted using an administrative database gathering every registered Portuguese public hospital hospitalizations from 2008 to 2015. We selected all hospitalizations with a procedure code 94.27 (Other electroshock therapy) defined by the International Classification of Diseases version 9, Clinical Modification. Variables included birth date, sex, address, primary and secondary diagnoses, admission/discharge date, length of stay, and discharge status from each single hospitalization episode. We also calculated Portugal's inpatient ECT prevalence rate (iP%). There were a total of 879 registered hospitalizations with ECT within the 8-year period of this study. Most occurred in female patients (53.4%), belonging to the age group of 51 to 70 years old, with a mean age of 50.5 years. The median length of stay was 43.0 days with an interquartile range of 27.0 to 68.0. The most frequent primary diagnosis was major depressive disorder, recurrent episode, representing 19.6% of all hospitalizations. The iP% for the study period was 0.71%. In Portugal, most of the patients who received ECT were women above middle age, and depressive disorders were the most common indication. Portugal's iP% represents a low rate when compared with other European countries, which might indicate an underutilization of ECT in Portuguese psychiatric hospitals.

Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study

Inappropriate antibiotic use greatly accelerates antimicrobial resistance. The appropriateness of antibiotic prescriptions is well evaluated, using big observational data, in some high-income countries, whereas the evidence of this appropriateness is scarce in China. We aimed to assess the appropriateness of antibiotic prescriptions in ambulatory care settings in China to inform future antimicrobial stewardship. We used data from the Beijing Data Center for Rational Use of Drugs, which was a national database designed for monitoring rationality of drug use. 139 hospitals that uploaded diagnosis and prescription information were included from 28 provincial-level regions of mainland China. Outpatient prescriptions were classified as appropriate, potentially appropriate, inappropriate, or not linked to any diagnosis for antibiotic use by following a published classification scheme. Antibiotic prescription rates for various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Antibiotic prescribing patterns and proportions of individual antibiotics prescribed for different diagnosis categories were analysed and reported. Between Oct 1, 2014, and April 30, 2018, 18 848 864 (10·9%) of 172 704 117 outpatient visits ended with antibiotic prescriptions. For conditions for which antibiotic use was appropriate, potentially appropriate, and inappropriate, 42·2%, 30·6%, and 7·6% of visits were associated with antibiotic prescriptions, respectively. Of all 18 848 864 antibiotic prescriptions, 9 689 937 (51·4%) were inappropriate, 5 354 224 (28·4%) were potentially appropriate, 2 893 102 (15·3%) were appropriate, and 911 601 (4·8%) could not be linked to any diagnosis. A total of 23 266 494 individual antibiotics were prescribed, of which 18 620 086 (80·0%) were broad-spectrum and the top four most prescribed antibiotics were third-generation cephalosporins (5 056 058 [21·7%]), second-generation cephalosporins (3 823 410 [16·4%]), macrolides (3 554 348 [15·3%]), and fluoroquinolones (3 285 765 [14·1%]). Inappropriate antibiotic prescribing was highly prevalent nationwide in China. Over half of the antibiotic prescriptions were inappropriate in secondary-level and tertiary-level hospitals, suggesting an urgent need for outpatient antibiotic stewardship aimed at optimising antibiotic prescribing to achieve the goals set in China's 2016 national action plan to contain antimicrobial resistance. The National Natural Science Foundation of China.

Antibiotic stewardship challenges in an evolving health-care market in China

Overuse of antibiotics has attracted increasing concerns globally. Excessive use of antibiotics is believed to be associated with the development of antimicrobial resistance, which can seriously jeopardise health-care services and patient outcomes. 1 Zhang X Cui Y Liu C Zuo K Tang Y Antibiotic sales in primary care in Hubei province, China: An Analysis of 2012–2017 Procurement Records. Int J Environ Res Public Health. 2019; 163376 Crossref Scopus (12) Google Scholar An Article by Houyu Zhao and colleagues 2 Zhao H Wei L Li H et al. Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study. Lancet Infect Dis. 2021; (published online Jan 27.)https://doi.org/10.1016/S1473-3099(20)30596-X Summary Full Text Full Text PDF Scopus (12) Google Scholar —one of the largest studies ever conducted in China—published by The Lancet Infectious Diseases, revealed a concerningly high proportion of inappropriate prescriptions of antibiotics. More than 51% of antibiotic prescriptions (almost 2 million per year) from 139 public hospitals for outpatient visits were found to be inappropriate, compared with 15·3% that were deemed appropriate. China has 12 436 secondary and tertiary hospitals. 3 National Health Commission of the People's Repubic of China2019 health development report. http://www.nhc.gov.cn/wjw/nianb/list.shtmlDate: 2020 Date accessed: July 15, 2020 Google Scholar The total volume of inappropriate antibiotic prescriptions from secondary and tertiary hospitals could have exceeded 173 millions per year on the basis of these data. Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database studyInappropriate antibiotic prescribing was highly prevalent nationwide in China. Over half of the antibiotic prescriptions were inappropriate in secondary-level and tertiary-level hospitals, suggesting an urgent need for outpatient antibiotic stewardship aimed at optimising antibiotic prescribing to achieve the goals set in China's 2016 national action plan to contain antimicrobial resistance. Full-Text PDF

Effectiveness and safety of delamanid- or bedaquiline-containing regimens among children and adolescents with multidrug resistant or extensively drug resistant tuberculosis: A nationwide study from Belarus, 2015-19.

There is limited evidence describing the safety and effectiveness of bedaquiline and delamanid containing regimens in children and adolescents with Multidrug-Resistant Tuberculosis (MDR-TB) and Extensively Drug-Resistant Tuberculosis (XDR-TB) globally. In this nationwide descriptive cohort study from Belarus, we examined adverse drug events, time to culture conversion, treatment outcomes including post-treatment recurrence among children and adolescents (<18 years of age) treated with bedaquiline and/or delamanid containing regimens from 2015 to 2019. Of the 40 participants included (55% females; age range 10-17 years), 20 (50%) had XDR-TB and 15 (38%) had resistance to either fluoroquinolone or second-line injectable. Half of the patients received delamanid and another half received bedaquiline with one patient receiving both drugs. AEs were reported in all the patients. A total of 224 AEs were reported, most of which (76%) were mild in nature. Only 10 (5%) AEs were graded severe and one AE was graded life-threatening. A total of 7 AEs (3%) were classified as 'serious' and only one patient required permanent discontinuation of the suspected drug (linezolid). Most of the AEs (94%) were resolved before the end of treatment. All patients culture-positive at baseline (n=34) became culture-negative within three months of treatment. Median time to culture conversion was 1.1 months (interquartile range: 0.9-1.6). Two patients were still receiving treatment at the time of analysis. The remaining 38 patients successfully completed treatment. Among those eligible and assessed at 6 (n=32) and 12 months (n=27) post-treatment, no recurrences were detected. In conclusion, treatment of children and adolescents with MDR-TB and XDR-TB using bedaquiline and/or delamanid containing regimens was effective and had favourable safety profile. Achieving such excellent outcomes under programmatic settings is encouraging for other national tuberculosis programmes, which are in the process of introducing or scaling-up the use of these new drugs in their countries.