World Health Organization Definition Research Articles

Over the Past Decade, Preoperative Anemia Has Become a Greater Predictor of Transfusions After Total Knee Arthroplasty

BackgroundWith advancements in perioperative blood management and the use of tranexamic acid, the rate of transfusions after total knee arthroplasty (TKA) has substantially decreased. As these principles are refined, other modifiable risk factors, such as preoperative anemia, may play an increasingly important role in transfusion risk for patients undergoing TKA. MethodsA multicenter, national database was utilized to identify patients undergoing TKA from 2010 to 2021. Anemia was defined by World Health Organization definitions as < 12 g/dL for women and < 13 g/dL for men. A predictive model was created using backwards elimination logistic regression to predict transfusion risk, controlling for demographic and medical covariates. The coefficient of anemia was then analyzed for each year. The trend over time was fitted with a best-fit linear regression equation. ResultsThere were 509,117 patients who underwent TKA, and had a mean age of 67 years (range, 18 to 89). There were 57,716 (11%) patients who were anemic preoperatively, and 15,426 (3%) of patients required a transfusion. Rate of transfusion decreased from 10.6% in 2010 to 0.6% in 2021. The odds ratio associated with anemia as a predictor of transfusion increased from 3.1 (95% confidence interval: 2.1 to 4.6) in 2010 to 14.0 (95% confidence interval: 8.9 to 24) in 2021. ConclusionsThe results of this study demonstrate that the importance of preoperative anemia as a predictor of transfusion has increased over the past decade as rates of transfusion have decreased. As perioperative blood management protocols improve, preoperative anemia should be considered an important focus of intervention to reduce the risk of transfusion prior to TKA. Level of EvidenceIII.

Characterization of Post-COVID-19 Definitions and Clinical Coding Practices: Longitudinal Study.

Post-COVID-19 condition (colloquially known as "long COVID-19") characterized as postacute sequelae of SARS-CoV-2 has no universal clinical case definition. Recent efforts have focused on understanding long COVID-19 symptoms, and electronic health record (EHR) data provide a unique resource for understanding this condition. The introduction of the International Classification of Diseases, Tenth Revision (ICD-10) code U09.9 for "Post COVID-19 condition, unspecified" to identify patients with long COVID-19 has provided a method of evaluating this condition in EHRs; however, the accuracy of this code is unclear. This study aimed to characterize the utility and accuracy of the U09.9 code across 3 health care systems-the Veterans Health Administration, the Beth Israel Deaconess Medical Center, and the University of Pittsburgh Medical Center-against patients identified with long COVID-19 via a chart review by operationalizing the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) definitions. Patients who were COVID-19 positive with either a U07.1 ICD-10 code or positive polymerase chain reaction test within these health care systems were identified for chart review. Among this cohort, we sampled patients based on two approaches: (1) with a U09.9 code and (2) without a U09.9 code but with a new onset long COVID-19-related ICD-10 code, which allows us to assess the sensitivity of the U09.9 code. To operationalize the long COVID-19 definition based on health agency guidelines, symptoms were grouped into a "core" cluster of 11 commonly reported symptoms among patients with long COVID-19 and an extended cluster that captured all other symptoms by disease domain. Patients having ≥2 symptoms persisting for ≥60 days that were new onset after their COVID-19 infection, with ≥1 symptom in the core cluster, were labeled as having long COVID-19 per chart review. The code's performance was compared across 3 health care systems and across different time periods of the pandemic. Overall, 900 patient charts were reviewed across 3 health care systems. The prevalence of long COVID-19 among the cohort with the U09.9 ICD-10 code based on the operationalized WHO definition was between 23.2% and 62.4% across these health care systems. We also evaluated a less stringent version of the WHO definition and the CDC definition and observed an increase in the prevalence of long COVID-19 at all 3 health care systems. This is one of the first studies to evaluate the U09.9 code against a clinical case definition for long COVID-19, as well as the first to apply this definition to EHR data using a chart review approach on a nationwide cohort across multiple health care systems. This chart review approach can be implemented at other EHR systems to further evaluate the utility and performance of the U09.9 code.

Short birth interval in the Asia-Pacific region: A systematic review and meta-analysis.

Short birth interval is associated with an increased risk of adverse health outcomes for mothers and children. Despite this, there is a lack of comprehensive evidence on short birth interval in the Asia-Pacific region. Thus, this study aimed to synthesise evidence related to the definition, classification, prevalence, and predictors of short birth interval in the Asia-Pacific region. Five databases (MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature, Maternity and Infant Care, and Web of Science) were searched for studies published between September 2000 and May 2023 (the last search was conducted for all databases in May 2023). We included original studies published in English that reported on short birth interval in the Asia-Pacific region. Studies that combined birth interval with birth order, used multi-country data and were published as conference abstracts and commentaries were excluded. Three independent reviewers screened the articles for relevancy, and two reviewers performed the data extraction and quality assessment. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. The findings were both qualitatively and quantitatively synthesised and presented. A total of 140 studies met the inclusion criteria for this review. About 58% (n = 82) of the studies defined short birth interval, while 42% (n = 58) did not. Out of 82 studies, nearly half (n = 39) measured a birth-to-birth interval, 37 studies measured a birth-to-pregnancy, four measured a pregnancy-to-pregnancy, and two studies measured a pregnancy loss-to-conception. Approximately 39% (n = 55) and 6% (n = 8) of studies classified short birth intervals as <24 months and <33 months, respectively. Most of the included studies were cross-sectional, and about two-thirds had either medium or high risk of bias. The pooled prevalence of short birth interval was 33.8% (95% confidence interval (CI) = 23.0-44.6, I2 = 99.9%, P < 0.01) among the studies that used the World Health Organization definition. This review's findings highlighted significant variations in the definition, measurement, classification, and reported prevalence of short birth interval across the included studies. Future research is needed to harmonise the definition and classification of short birth interval to ensure consistency and comparability across studies and facilitate the development of targeted interventions and policies. PROSPERO CRD42023426975.

Abstract PO2-17-02: Can body mass index be a complete pathological response predictor in breast cancer patients submitted to neoadjuvant chemotherapy? A real-world data trial

Abstract Background: Breast cancer is a prevalent disease, and Its incidence has increased annually worldwide. The prognosis depends on several factors, such as patient characteristics, tumor characteristics and treatment efficacy. In this scenario, neoadjuvant chemotherapy (NAC), previously used only to make surgical approach possible in advanced cases, has been increasingly used in more aggressive initial tumors such as HER 2 positive and triple negative and, in these tumors, the presence of pathological complete response is directly correlated with survival and the disease-free interval. Obesity is very common in Brazil and in the world, and its incidence grows annually. There is a direct relationship between the risk of breast cancer and obesity, especially in postmenopausal women. Justification: Many authors suggest that obese patients are less likely to achieve this pathological complete response (pCR). Real-world data is important to evaluate how patients behave in the real world, only 5% of the patients are enrolled in clinical trials. Most of the clinical trials have strict inclusion and exclusion criteria that ends up selecting a patient that almost doesn't exist in the real world. Objective: To correlate complete pathological response with Body Mass Index (BMI) and, secondarily, to evaluate the relationship between overall and disease-free survival with BMI. Methods: This was a retrospective observational study that has evaluated patients with invasive breast cancer in two Brazilian hospitals. Clinical and pathological characteristics were extracted from the database, being eligible the patients diagnosed with invasive breast cancer, stages I to III, and who underwent neoadjuvant chemotherapy (NAC). Patients were categorized using the World Health Organization (WHO) definition: BMI 18.5 to &amp;lt; 25 kg/m2: normal weight; BMI 25 to &amp;lt; 30 kg/m2: overweight; BMI ≥30kg/m2: obesity. pCR was defined as the absence of breast and axillary invasive tumor. The t test or chi-square test were used to individually analyze the association of each variable between the groups with and without RPc. Univariate and multivariate analyzes to calculate odds ratios (OR) and 95% confidence intervals (CI) of the independent variables BMI, age, clinical stage, histological type, and subtype of cancer, correlated with pCR. where p value &amp;lt; 0.05 was considered statistically significant. Results: 1,779 records were included in the analyses, with a mean age of 50 years at diagnosis and a mean BMI of 28.08 kg/m2. Most patients had stage III cancer (68.1%) at diagnosis and the invasive carcinoma nonspecial type was predominant (95.2%). Immunohistochemistry allowed us to divide the groups into Luminal A like (12.4%), Luminal B like (31.1%), HER2+ like (25.3%) and triple negative like (31.2%). After NAC, 1461 had residual disease and 390 (22.3%) had a pCR. Regarding stages, 2% of the patients were in stage I, 30% in stage II and 68% in stage III. No correlation was found between BMI categories and pCR (p=0.7607). In the multivariate analysis, the results were also not significant for the correlation between the BMI categories after adjusting for age, clinical stage, tumor histology and subtype of breast cancer. We observed, however, that the most aggressive types of cancer were predictors of pathologic complete response. The estimated average overall survival (OS) was 102 months for those of normal weight, 99 months for the overweight ones and 101 months for the obese ones. As for recurrence-free survival, the data were immature. Conclusion: This study with Brazilian real-world data found no correlation between BMI and pCR after NAC and BMI and OS in patients with breast cancer. As an additional finding, most patients were obese or overweight at diagnosis (69%) and public policies should be encouraged to act in this scenario. Trials considering stratification of patients between different regions of the country or specific subtype of cancer can elucidate this finding. Citation Format: Fernanda Grace Bauk Richter, Andre Mattar, Marcelo Antonini, Juliana Real, Luis Henrique Gebrim, Reginaldo Coelho Lopes. Can body mass index be a complete pathological response predictor in breast cancer patients submitted to neoadjuvant chemotherapy? A real-world data trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-17-02.

Anemia in Patients After Stem Cell Transplantation and in Kidney Transplant Recipients

Hematopoietic stem cell transplant (HSCT) is the treatment of choice in various hematologic diseases, and kidney transplantation (KTx) is the best therapy for end-stage kidney disease. Chronic kidney disease (CKD) occurs relatively often after both types of transplantations. Anemia after both HSCT and KTx may be due to CKD and other reasons. This study aimed to assess the prevalence of anemia to CKD in 156 prevalent patients after HSCT and 80 after KTx. According to the World Health Organization's definition (hemoglobin <13 g/dL for men and <12 g/dL for women), the prevalence of anemia in the studied cohort after HSCT was 13% in women and 35% in men and for those after KTx, it was29% in men and 11%. Anemia in KTx was found in 46% of patients, whereas CKD was present in 53%. After HSCT, anemia was associated with CKD in 56% of women and 17% of men. In KTx, anemia and CKD was diagnosed in 21% of patients. Patients with anemia after KTx had significantly lower glomerular filtration rate (GFR), hemoglobin, and significantly higher creatinine levels. Age was related to the estimated GFR (eGFR; r = -0.39, P < .001) in patients who underwent HSCT and had anemia. In patients without anemia, age was negatively related to eGFR (r = -0.56, P < .001) and the hemoglobin-to-platelet count (r = 0.62, P < .001). In KTx, hemoglobin was related to eGFR (r = 0.35, P < .001), and age was related to eGFR (r = -0.20, P < .05). The type of induction therapy immunosuppressive regimen (anti-thymocyte globulin vs basiliximab vs no induction) did not affect the prevalence of anemia in the KTx population studied. Anemia is relatively common in CKD after HSCT. In both CKD and coexistent anemia, nephrology referral is to be considered to optimize therapy, including nephroprotection.

Analysis of Body Mass Index and Clinicopathological Factors in Patients with Papillary Thyroid Carcinoma.

To analyze the correlation between body mass index (BMI) and clinicopathological factors of papillary thyroid cancer (PTC). The clinical data of patients with PCT who were hospitalized in the Department of Thyroid Surgery of the Affiliated Hospital of Guizhou Medical University from March 2023 to September 2023 were retrospectively collected, including age, gender, height, weight, BMI, v-raf murine sarcoma viral oncogene homolog B (BRAF) gene mutation, tumor size, multifocus, Hashimoto's thyroiditis, lymph node metastasis and other clinicopathological factors. According to the World Health Organization (WHO) definition for Asian population, BMI≥25kg/m2 was obese group, 23≤BMI≤24.9kg/m2 was overweight group, 18.5≤BMI≤22.9kg/m2 was normal weight group, and BMI≤18.5kg/m2 was low weight group. The clinicopathological factors of overweight and obese patients with PTC were analyzed. A total of 164 PTC patients were included, with an average BMI of (24.44±3.57) kg/m2. Age of overweight and obese PTC patients (Z=1.978, p=0.083); Gender of overweight and obese PTC patients (χ2 value: 11.570, p=0.004); Tumor size in overweight and obese PTC patients (Z=0.894, p=0.411); BRAF gene mutation in overweight and obese PTC patients (χ2 value: 1.452, p =0.623); Multifocal lesions were found in overweight and obese patients (χ2 value: 1.653, p =0.201). Hashimoto's thyroiditis was found in overweight and obese PTC patients (χ2 value: 1.147, p=0.298). Overweight and obese patients with PTC had lymph node metastasis (χ2 value: 1.690, p =0.251). Overweight and obesity in PTC patients are correlated with male, but not with age, tumor size, BRAF mutation, multifocality, Hashimoto's thyroiditis and lymph node metastasis.

Postpartum versus postnatal period: Do the name and duration matter?

Guidelines and other strategic documents were collated to understand the extent of the global use of terms postpartum and postnatal along with the duration and schedule of maternal care after delivery. Postpartum care guidelines and strategies published in English, by international organisations including the World Health Organization, and countries in either the Organization for Economic Co-operation and Development or Group of 20 were included in this scoping review. All documents available online with unrestricted access and published before May 31, 2023, were included. The evolution of the World Health Organization's definition of the period after delivery for mothers and the changes in the schedule of routine maternal care following delivery over time were displayed pictorially. A summary table was then developed to present the level of similarities and differences in the latest available documents from the international organisations and countries belonging to either the Organisation for Economic Co-operation and Development or the Group of 20. Ten documents from the World Health Organization, one from the European Board, and 15 country-level guidelines from six countries met the inclusion criteria. The interchangeable use of 'postpartum' and 'postnatal' is common. While the World Health Organization mentions the definitive length (six weeks) of the postpartum/ postnatal period, it is not stated in documents from other organisations and countries. Additionally, the length and schedule of routine maternal care after delivery vary substantially between organisations/countries, spanning from six weeks to one year with two to six healthcare contacts, respectively. Through this review, we make a case for a universal harmonisation of the term postpartum when referring to mothers after delivery; add clarity to the documents on the rationale for and duration of the postpartum period; and extend the routine maternal care schedule after delivery to support women in this vulnerable period.

A retrospective cohort analysis of factors associated with the development of refeeding syndrome in children 0–59 months diagnosed with severe acute malnutrition in a South African setting

BackgroundRefeeding syndrome (RFS) is a life-threatening, underdiagnosed, and under-researched complication in treating children with severe acute malnutrition (SAM). This study aimed to determine the incidence and onset of RFS and identify biochemical abnormalities, clinical signs, and complications associated with RFS development in children, 0–59 months, treated with SAM in a South African public hospital setting. MethodsA retrospective cohort study was performed on hospital medical records of children aged 0–59 months, diagnosed with SAM at Rahima Moosa Mother and Child Hospital, Johannesburg, from 1/10/2014 to 31/12/2018. The onset of RFS among children included in the study was diagnosed based on published criteria for RFS. On admission, children who developed RFS and those who did not were compared concerning biochemistry and clinical signs and symptoms. ResultsA total of 148 medical records were retrieved from the hospital archives. The diagnosis of SAM based on the World Health Organization (WHO) definition was confirmed in 126 children who were then included in the study. The median age of the 126 children (63 % male) with confirmed SAM was 11.2 months (P25:7.0 months; P75:17.0 months). The in-hospital mortality rate was 18.2 %, of which 8.7 % were retrospectively diagnosed as having developed RFS during their recorded hospital stay, despite implementing the WHO treatment guidelines for SAM. A significantly higher percentage of the children who developed RFS presented on admission with hypophosphatemia (p = 0.015), hypokalemia (p = 0.001), hyponatremia (p = 0.001), an international normalized ratio (INR) of above 1.7 (p = 0.025), diarrhea (p = 0.042), dehydration (p = 0.029) and urinary tract infection (UTI) (p = 0.041), than those who did not. Children who developed RFS stayed in hospital significantly longer than those who did not (18 vs. 12 days with a p-value of 0.003). ConclusionIn this population of children with SAM treated in a South African public hospital setting, the presence on hospital admission of low levels of electrolytes, elevated INR, dehydration, diarrhea, and UTI was significantly associated with developing RFS. Recognizing these as possible red flags for developing RFS in children admitted with SAM might contribute to improved outcomes and needs further investigation.

Acute Hepatitis of Unknown Origin in Children: Analysis of 17 Cases Admitted to the Bambino Gesù Children's Hospital in Rome.

This study described 17 cases of children admitted to the Bambino Gesù Children's Hospital with acute hepatitis of unknown origin between mid-April and November 2022. Following the World Health Organization's working case definition of probable cases, 17 children, with a median age of 2.1 years (interquartile range: 1.0-7.1), presenting with acute hepatitis non-AE, with serum transaminase >500 IU/L, were included in the study. A pre-specified set of microbiological tests was performed on different biological specimens for all pediatric patients. All patients resulted negative for the common hepatotropic viruses. The most common pathogen detected in blood specimens was human-herpes-virus-7 (52.9%). Adenovirus was detected more frequently in stool specimens (62.5%) than in respiratory (20.0%) or blood samples (17.6%). Regarding Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, one child tested positive two days after admission, while antibodies against spike and nucleoprotein were present in 82.3% of patients. A co-pathogen detection was observed in 94.1% of children. Overall, 16 children recovered without clinical complications, while one patient required liver transplantation. In these cases of acute hepatitis of unknown origin, adenovirus was mainly detected in stool samples. A co-pathogen detection was also frequently observed, suggesting that the etiology of this acute hepatitis is most probably multifactorial.

Iron status in Dutch and Finnish blood donor and general populations: A cross-cohort comparison study.

Blood donors are at risk of developing iron deficiency (ID) (ferritin <15 μg/L, World Health Organization definition). Blood services implement different strategies to mitigate this risk. Although in Finland risk group-based iron supplementation is in place, no iron supplementation is provided in the Netherlands. We aim to describe differences in ferritin levels and ID prevalence in donor and general populations in these countries. Six cohorts, stratified based on sex, and for women age, in the Netherlands and Finland were used to evaluate differences in ferritin levels and ID between donor populations (Donor InSight-III and FinDonor 10,000) and general populations (Prevention of Renal and Vascular End-Stage Disease [PREVEND], FinRisk 1997 and Health 2000) and newly registered Dutch donors. Multivariable logistic regression was used to quantify associations of various explanatory factors with ID. In total, 13,443 Dutch and 13,933 Finnish subjects were included. Donors, except for women aged ≤50 years old in Finland, had lower median ferritin levels compared with the general population and new donors. Dutch regular blood donors had higher or similar prevalence of ID as compared with the Dutch general population, including new donors. In contrast, Finnish donors showed similar prevalence of ID compared with the general population, except for a markedly lower prevalence in ≤50-year-old women who routinely receive iron supplements when donating. Iron status in blood donors differs from that in the general population. The Finnish blood service donor management policy, for example, iron supplementation for risk groups, seemingly protects young female blood donors from developing ID.

Post-COVID-19 syndrome, who at risk and why: an insight from Qatar 2022.

Despite the recovery from the COVID-19 pandemic, many people experience post-COVID-19 syndrome, which negatively impacts their health and function. This condition has become a significant public health problem that requires immediate attention. To study the prevalence, clinical characteristics, and predictors of post-COVID-19 Syndrome in Qatar during 2022. An analytic cross-sectional study was conducted among COVID-19 confirmed cases from January 2022 to July 2022 in Qatar. A simple random sample was employed to include (n = 588) participants from the list of cases and invited to participate in a telephone survey. The World Health Organization's standard case definition for PCS was adopted. Out of 368, the prevalence of post-COVID-19 syndrome was 43.2% (n = 159). Most PCS cases were females (67.9%; n = 108), married (73.6%; n = 117), and university and higher educational level (83.6%; n = 133). However, 78.7% (n = 125) reported poor to moderate levels of social support. Only 30.2% (n = 48) of PCS patients had a history of chronic diseases, and 5.7% (n = 9) required hospital admission during acute illness. Among PCS cases, the most commonly reported symptoms were fatigue (75.5%), followed by anxiety (49.1%), forgetfulness (46.5%), mood alteration (45.3%), and general weakness (39.6%). The logistic regression revealed that female gender (AOR: 2.58 95%CI: 1.58-4.225, p < 0.0001), university and high educational level (AOR: 2.2, 95%CI: 1.256-3.98, p < 0.006), poor level of social support (AOR: 2.45; 95%CI: 1.55-4.13; p < 0.002), were significant predictors for PCS. Post-COVID-19 syndrome may go under-recognized. More efforts are needed to raise awareness and mobilize the resources to respond to this ongoing public health problem.

Unsafe child feces disposal and childhood wasting among under five children in Myanmar

Background: Wasting is a major public health problem among under five children in developing countries, including Myanmar. The distribution of wasting and its associated factors are not well known in Myanmar. Objectives: This study aimed to examine the wasting prevalence and identify the association between child feces disposal and wasting among under-five children in Myanmar. Methods: A cross-sectional study was conducted on 1,207 under five children in Myanmar from September to December 2022. This study employed a multistage random sampling method with structured questionnaires and anthropometric measures. The World Health Organization's (WHO) definition and growth standards were used to determine the wasting. Multivariable logistic regression was performed to identify the association. An adjusted odds ratio with a 95% confidence interval and a p-value &lt;0.05 was used to define statistical significance. Results: The prevalence of childhood wasting among under five children in Myanmar was 11.10% (95% CI: 9.45 to 13.00). This study revealed that children from unsafe child feces disposing families were 94 % more likely to be wasted (AOR=1.94, 95% CI: 1.22 to 3.09; p-value 0.005). Other covariates to childhood wasting were water shortage (AOR=2.17, 95% CI: 1.13 to 4.16; p-value 0.02), less than four handwashing steps of mother (AOR=3.20, 95% CI: 1.93 to 5.32; p-value &lt;0.001), located in hilly region (AOR=2.27, 95% CI: 1.53 to 3.37; p-value &lt;0.001), boys (AOR=2.80, 95% CI: 1.86 to 4.23; p-value &lt;0.001), birth interval less than 3 years (AOR=1.84, 95% CI: 1.10 to 3.11; p-value 0.02), and eating more than 4 times per day (AOR=3.19, 95% CI: 1.93 to 5.27; p-value &lt;0.001). Conclusion: This study showed a high prevalence of wasting among under five children in Myanmar. Improving the safe child feces disposal practices of mothers would be a critical intervention to reduce under five children's wasting.

The Need to Widen the Concept of Health and to Include the Spiritual Dimension.

For many, the World Health Organization's (WHO) definition of health does not reflect their own understanding of health, because it lacks aspects such as spiritual wellbeing. Responding to these concerns, the WHO called in 2023 for a vision of health that integrates physical, mental, psychological, emotional, spiritual, and social wellbeing. To date, medical practitioners are often reluctant to consider spiritual aspects, because of a perceived lack of statistical evidence about the strength of relations. Research on this topic is emerging. A recent study among 800 young people living with HIV in Zimbabwe showed how study participants navigated three parallel, at times contradicting health systems (religious, traditional, medical). Conflicting approaches led to multifaceted dilemmas (= spiritual struggles), which were significantly related to poorer mental and physical health. This illustrates the need for inclusion of spiritual aspects for health and wellbeing in research, and of increased collaboration between all stakeholders in healthcare.

Death after cure: Mortality among pulmonary tuberculosis survivors in rural Uganda

ObjectivesTo determine the incidence of mortality and its predictors among pulmonary tuberculosis (PTB) survivors treated at a rural Ugandan tertiary hospital. MethodsWe conducted a retrospective chart review of data between 2013 and 2023. We included all people that met the World Health Organisation's definition of tuberculosis cure and traced them or their next of kin to determine vital status (alive/deceased). We estimated the cumulative incidence of mortality per 1000 population, crude all-cause mortality rate per 1000 person-years, and median years of potential life lost for deceased individuals. Using Cox proportional hazard models, we investigated predictors of mortality. ResultsOf 334 PTB survivors enrolled, 38 (11.4%) had died. The cumulative incidence of all-cause mortality was 113.7 per 1000 population, and the crude all-cause mortality rate was 28.5 per 1000 person-years. The median years of potential life lost for deceased individuals was 23.8 years (IQR: 9.6-32.8). Hospitalization (adjusted hazard ratio (aHR): 4.3, 95% CI: 1.1-16.6) and unemployment (aHR: 7.04, 95% CI: 1.5-31.6) at TB treatment initiation predicted mortality. ConclusionPTB survivors experience post high mortality rates after TB cure. Survivors who were hospitalized and unemployed at treatment initiation were more likely to die after cure. Social protection measures and long-term follow-up of previously hospitalized patients could improve the long-term survival of TB survivors.

The Effects of Gluten-free Diet on Body Mass Indexes in Adults with Celiac Disease: A Systematic Review and Meta-analysis of Observational Studies.

Gluten-free diet (GFD) includes a higher intake of sugars and fats. Previous studies have investigated its effect on body mass index (BMI) in celiac disease (CD) patients but had contradictive conclusions. Thus, we conducted a systematic review and meta-analysis examining the effect of GFD on BMI in CD patients. Systematically, we conducted literature research using Medline, Scopus, and Embase, and we identified 1565 potential studies/abstracts. Only studies of patients with CD under a GFD with recorded BMI before and after dietary intervention were included. Subgroup analyses based on study design and BMI categories were performed. We calculated the pooled odds ratios (ORs) and 95% confidence intervals (Cls) for the number of patients in each BMI group according to the World Health Organization (WHO) definitions after GFD using fixed and random effect meta-analysis. The analysis included 10 studies and 38 sub-studies/data sets, which encompassed 2450 patients from 5 countries. We found nonsignificant odds for changing the BMI group (pooled OR 0.972, 95% CI: 0.858-1.101, P=0.65) after GFD. However, looking specifically at BMI subgroups, we found higher odds for BMI category change after GFD in underweight patients (OR 0.588, 95% CI: 0.479-0.723, P <0.001), and overweight patients,25<BMI<30, (OR 1.332, 95% CI: 1.167-1.521, P<0.001). No publication bias was demonstrated, and the amount of heterogeneity between studies was moderate (I2=54.13). Although crucial in patients with CD, GFD is associated with increased BMI in some CD patient populations. Accordingly, special considerations and follow-up should be maintained in overweight patients with CD after GFD.

An in-depth investigation of the widespread effects of child abuse on development and wellbeing

The problem of child abuse is an everywhere phenomenon throughout the world that leads to the most detrimental effects on the children in the question of their development and general health. This article makes an effort to convey the complexity of child abuse by focusing on its physical-emotional-sexual-neglect dimensions. The World Health Organization's exhaustive definition of the concept furnishes the basis for the acknowledgement of the injuries that one person can suffer from the relationships based on care, authority, or dependency. Approximately 40 million children around the world were abused last year regardless of whether they were wealthier, belonged to a particular culture or were badly educated. The UN Convention on the Rights of the Child features childhood its age from the moment of birth until 18 years recognizing the fact that individuals at this age have specific vulnerabilities which are inherently tied to their dependence on others. The session next proceeds into addressing child abuse, with its different dynamics and levels of complexity. Brief description of different kinds of mistreatment including violence, sexual, emotional, and neglect specifying the urgent necessity to eliminate sexual abuse – especially the already existing one-in-ten girls globally. The consequences of child maltreatment on behavioral development throughout the various periods, including infant period through adolescence are considered. Stages of the syndicated approach will shed the light on the particular difficulties and bad results, promoting the application of the relevant measures. Issues concerning common behavioral signals include but are not limited to difficulty in identifying the signs and the importance of being able to sign them, which pays a big role in fighting the issue of abuse. Finally, the paper states that the world's dedication should never fail if our intentions are to end abuse among children. The main reason why every child ought to be ensured of a safe environment so that they can all flourish is that the diverse types of child abuse and the long-lasting impacts on the development of behavior need to be addressed in their entirety. Keywords: Child Abuse, Behavioral Development, World Health Organization, UN Convention on the Rights of the Child, Sexual Abuse, and Responsibility.

Quality of life, disease burden and healthcare need of patients with vitiligo

With aprevalence of 0.5-2%, vitiligo is one of the most common skin disorders worldwide with loss of pigment. The skin disease has adisfiguring, often stigmatising character and is often associated with psychosocial distress. To provide an overview of the psychosocial impairment, disease burden and resulting health care needs of patients with vitiligo. Narrative review based on aliterature search in PubMed for the years 1996-2022 on disease burden, quality of life and stigmatization is provided. The search yielded 175 relevant original papers including clinical studies, meta-analyses and systematic reviews (n = 65) for the search period. Alarge number of studies document that vitiligo is associated with considerable psychosocial stress and relevant losses in quality of life. Problem areas particularly concern stigmatisation, sexual dysfunction, anxiety, reduced self-esteem and problems at work. The observed increased levels of anxiety and depression correlate with the severity and activity of vitiligo. Often, comorbidity also contributes to reduced self-esteem and social isolation. These factors determine ahigh need for care in arelevant proportion of those affected. Vitiligo is not primarily acosmetic problem, but adisease requiring treatment according to the World Health Organisation's definition of health as physical, mental and social well-being. The benefits of treatment options are to be measured by their effects on patient-reported outcomes.

The Effect of Sex on the Risk of Long-COVID and Cardiovascular Complications in Healthy Patients without Comorbidities: Data from a Polish Long-COVID Cardiovascular (PoLoCOV-CVD) Study.

Background: The prevalence of long-COVID (LC) presents a significant challenge to healthcare systems globally. There are still some discrepancies on the role of sex as an independent risk factor of LC complications. Thus, we aimed to determine the differences in clinical and cardiovascular complications between males and females without comorbidities after COVID-19. Methods: Clinical data on the course of the disease with the accompanying symptoms and post-COVID-19 symptoms were compiled from both male and female subjects with a minimum 12-week interval after COVID-19 recovery. Next, the patients were followed for 12 months. ECG, echocardiography, 24 h ECG monitoring, 24 h ambulatory blood pressure monitoring (ABPM), and selected biochemical tests were performed. LC was diagnosed based on the World Health Organization (WHO) definition. To reduce the impact of confounders, i.e., body mass index (BMI) and age, on the results of the study, the nearest neighbour (NN) propensity score matching (PSM) method with a 1:1 ratio was used. Results: The results were obtained following the removal of cases with comorbidities from the database consisting of 1237 males and 2192 females, and PSM of the new database included 886 cases (443 males and 443 females). At both the 3-month and 1-year post-recovery marks, females consistently reported a higher frequency of LC symptoms compared to males (p < 0.001 for both comparisons). Moreover, after 1 year of follow-up, females exhibited a higher prevalence of LC compared to males, with rates of 14% versus 8.3%, respectively (p = 0.013). The symptoms that significantly differed between females and males in the 12-month follow-up were hair loss (5.4 vs. 0.7%, p < 0.001), memory and concentration disturbances (8.4 vs. 4.3%, p = 0.013), and headaches (4.3 vs. 1.4%, p = 0.008). Females presented lower mean arterial pressure (MAP) [89 (83-95) mmHg versus (vs.) 94 (89-100); p < 0.001] and lower pulse pressure (PP) [46 (42-52) mmHg vs. 51 (48-57); p < 0.001] in 24 h ABPM and more elevated heart rates (HRs) in 24 h ECG monitoring as well as arrhythmia (p < 0.001 and p = 0.018, respectively). Males had a higher occurrence of ECG abnormalities such as QRS >= 120 ms, ST-T changes, T inversion, arrhythmia, and QRS fragmentation (27.3% vs. 19.2%; p = 0.004). No significant differences were observed between males and females concerning physical activity levels, stress, fatigue, alcohol consumption, and smoking habits. Conclusions: One year post-COVID-19 recovery, regardless of age and BMI, healthy females more often suffered from LC symptoms than males. They had lower MAP and PP in 24 h ABPM, more often had higher HRs and arrhythmia in 24 h ECG monitoring, and fewer ECG abnormalities than males.

The Most Relevant Socio-Economic Aspects of Medicinal and Aromatic Plants through a Literature Review

Around the world, medicinal and aromatic plants (MAPs) play a fundamental role in the economic, social, cultural, and ecological ambits of local communities. Today, the most important uses of MAPs are their applications in the pharmaceutical, perfume, cosmetics, toothpaste, soap, beverage, and food industries. At the same time, the expression MAPs is often used with a plurality of meanings that are not always clear and well-defined. Thus, the paper aims to answer two research questions: (1) to understand how the expression MAPs has been meant over time by scholars, and (2) to realize the weight that socio-economic research regarding MAPs has assumed in this context. To these ends, a literature review was conducted using the scientific database Scopus. The results highlight that researchers started talking explicitly about MAPs in the 1950s, and the geographical focus of the literature on this theme is in India, followed by China. Researchers have published studies concerning the agronomic aspects, cultivation, characterization, and germination techniques of MAPs, but the most cited articles concern the health and beneficial properties of their essential oils. At the same time, nobody has ever wondered what MAPs are, and since 1977, the World Health Organization definition has been taken for granted, and any species with medicinal or aromatic functions is considered to be a MAP. Regarding the socio-economic weight of the research conducted on MAPs, they represent only 1% of the total academic publications, but from them, it has emerged that, especially in rural areas, MAPs depict important sources of income for several local communities. At the same time, there is a need to increase the estimation of the ecosystem services that MAPs offer, the analyses of consumer preferences in the search for new business opportunities, and the environmental impact assessment of the entire supply chain.

Comparison of metabolic syndrome prevalence and characteristics using five different definitions in China: a population-based retrospective study.

Metabolic syndrome (MetS) is on the rise in developing countries and is characterized by a series of indications of metabolic disturbance. However, the prevalence of MetS varies under different definitions. The study aimed to compare five definitions of MetS in the China adult population, to explore their prevalence, characteristics and agreement. The data for the retrospective study came from the China Health and Retirement Longitudinal Study (CHARLS), consisting of 9,588 participants (≥45). MetS definitions from International Diabetes Federation (IDF) (2006), National Cholesterol Education Program Adult Treatment Panel III (ATPIII) (2005), National Cholesterol Education Program Adult Treatment Panel III (ATPIII) (2001), Chinese Diabetes society (CDS) (2004) and the World Health Organization (WHO) (1999). We used binary and multivariable logistic analysis to explore factors connected with MetS. The five definitions of MetS led to different prevalence of MetS:34.52% by IDF (2006), 38.63% by ATP (2005), 25.94% by ATP (2001), 26.31% by CDS (2004), 21.57% by WHO (1999). According to the definition of IDF (2006) (22.32% vs. 45.06%), ATPIII (2005) definition (27.99% vs. 47.82%), ATPIII (2001) definition (15.37% vs. 35.07%), CDS (2004) definition (19.96% vs. 31.80%), and WHO (1999) definition (17.44% vs. 25.14%), the prevalence of MetS in men was low but in women was high. The agreement between the five definitions for men was good except for the IDF (2006) definition and ATPIII (2001) definition (kappa = 0.51), with kappa values from 0.64 to 0.85. For women, the agreement between the five definitions was good ranging from 0.67 to 0.95, however, except for the definition of CDS (2004) and the definition of IDF (2006) (kappa = 0.44), the definition of WHO (1999) and the definition of IDF (2006) (kappa = 0.55), and the definition of WHO (1999) and the definition of ATPIII (2005) (kappa = 0.54). Binary logistic analysis indicated that although the impact and relevance varied by sex and definition, age, education, marital status, current residence, current smoking, alcohol using, taking activities and number of chronic diseases were factors connected to MetS. the prevalence and characteristics of the five definitions of MetS are different in the Chinese population. Therefore, it is vital to use the same definition for a country to diagnose MetS. On the other side, a lower prevalence in men than in women and the consistency of five MetS definitions are good in men but relatively poor in women.