Using reflective writing to enhance empathy among medical students.

Reflection is a skill which has the potential to enhance higher order thinking such as empathy and compassion. We aimed to study reflective writing as a means to nurture empathy among medical students. An interventional study was conducted among 73 final-year medical students using the Toronto Empathy Questionnaire. The questionnaire was administered anonymously before and after a clinical clerkship. Reflective writing generated strong emotional responses but did not improve Empathy Questionnaire scores. Reflective writing about patient care experiences may be useful in clinical clerkships to develop certain constructs of empathy such as perspective taking and compassion among medical students, but it may not raise empathy scores in the short term.

La réflexion est une compétence qui a le potentiel de développer la pensée de haut niveau telle que l'empathie et la compassion. Nous avons voulu étudier l'écriture réflexive comme moyen de développer l'empathie chez les étudiants en médecine. Une étude interventionnelle a été menée auprès de 73 étudiants en dernière année de médecine à l'aide du Toronto Empathy Questionnaire. Le questionnaire a été administré de manière anonyme avant et après un stage clinique. L'écriture réflexive a suscité de fortes réactions émotionnelles mais n'a pas amélioré les scores au questionnaire sur l'empathie. L'écriture réflexive sur les expériences de soins aux patients peut être utile dans les stages cliniques pour développer chez les étudiants en médecine certains concepts d'empathie tels que la compréhension du point de vue de l'autre et la compassion, sans pour autant augmenter les scores d'empathie à court terme.

Attitudes and practices toward COVID-19 precautionary measures: A comparative study of health professionals and public.

BACKGROUND: Containment of the COVID-19 pandemic has been impaired by the denial and defiance of preventive recommendations. AIMS: We aimed to study the attitudes toward COVID-19 social measures among laypersons and healthcare professionals. METHODS: We conducted a cross-sectional study in the United Arab Emirates using a self-administered online questionnaire. Both healthcare workers and laypersons were actively recruited. In addition to sociodemographic variables, the questionnaire included questions on anxiety, knowledge, and defiance related to COVID-19. RESULTS: A total of 615 individuals with a mean age of 32 years (SD, 12) participated. Females comprised 69% and healthcare workers constituted 60% of the study sample. Among laypersons, over 42% reported having social gatherings at home, and 44% admitted to visiting crowded places. More than half of the respondents felt increased anxiety. Previous COVID-19 infection did not affect attitudes or anxiety levels. Knowledge about COVID-19 was higher among those who were more educated (r = .21). Healthcare workers had lower anxiety than laypersons (p = .002). COVID-19 anxiety was higher among older persons and did not decrease with more knowledge. COVID-19 defiance was higher among younger male respondents from larger households and did not correlate with knowledge. Multivariate analysis showed more defiant attitudes at younger ages. CONCLUSIONS: Anxiety-related to the COVID-19 pandemic is more common in older individuals, whereas younger persons were more likely to deny and defy prevention recommendations despite having knowledge of viral transmission. Voluntary compliance by young individuals requires an engaging communication strategy to generate more compassionate attitudes.

Towards a better understanding between non-Muslim primary care clinicians and Muslim patients: A literature review intended to reduce health care inequities in Muslim patients.

Although Muslims are a growing population within many non-Muslim countries, there are insufficient Muslim clinicians to care for them. Studies have shown that non-Muslim clinicians have limited knowledge and understanding of Islamic practices affecting health, which may lead to disparities in the quality of healthcare delivery and outcomes when caring for Muslim patients. Muslims come from many different cultures and ethnicities and have variations in their beliefs and practices. This literature review provides some insights which may strengthen therapeutic bonds between non-Muslim clinicians and their Muslim patients resulting in improved holistic, patient-centered care in the areas of cancer screening, mental health, nutrition, and pharmacotherapy. Additionally, this review informs clinicians about the Islamic perspective on childbirth, end of life issues, travel for Islamic pilgrimage, and fasting during the month of Ramadan. Literature was sourced by a comprehensive search in PubMed, Scopus, and CINAHL along with hand screening of citations. Title and abstract screening followed by full-text screening excluded studies including less than 30% Muslim participants, protocols, or reporting results deemed irrelevant to primary care. 115 papers were selected for inclusion in the literature review. These were grouped into the themes of general spirituality, which were discussed in the Introduction, and Islam and health, Social etiquette, Cancer screening, Diet, Medications and their alternatives, Ramadan, Hajj, Mental health, Organ donation and transplants, and End of life. Summarizing the findings of the review, we conclude that health inequities affecting Muslim patients can be addressed at least in part by improved cultural competency in non-Muslim clinicians, as well as further research into this area.

Lower Prevalence of Human Papillomavirus in Head and Neck Squamous Cell Carcinoma in Middle Eastern Population: Clinical Implications for Diagnosis and Prevention.

Introduction Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide. The prevalence of human papillomavirus (HPV) in HNSCC varies across regions. Objective This study aimed to determine the prevalence of high-risk HPV (hrHPV) among patients with HNSCC in the Middle East region. Methods Samples from patients with oropharyngeal or laryngeal lesions who underwent biopsy or resection at a tertiary care hospital from 2010 to 2015 were collected. Those confirmed as squamous cell carcinoma (SCC) on histopathology were identified as cases (n = 61), whereas benign lesions were used as controls (n = 83). Immunohistochemistry (IHC) for p16, p53, Ki-67, and in situ hybridization (ISH) for hrHPV genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 66 were performed on all cases. Results A total of 154 cases were studied: 61 squamous cell cancers (cases), 83 benign lesions (control), and 10 dysplasia specimens. Among the cases, only five (8.6%) were positive for hrHPV, whereas only one control specimen tested positive. The SCC group had higher mean age, male sex, and history of cigarette smoking and alcohol usage. Among the hrHPV-positive SCC cases, 80% had a tumor in the oropharyngeal region. All hrHPV-positive cases were positive for p16 and p53 immunostains. Conclusion Among HNSCC cases, hrHPV was detected at a lower rate compared to other regions of the world. This study suggests that hrHPV plays a minor role in the pathogenesis of HNSCC in this region, compared to tobacco use and alcohol consumption.

Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases.

BACKGROUND: The literature describing clinical presentation, disease course and outcomes of SARS-CoV-2 in infants remains scarce. METHODS: We conducted a retrospective study across 2 major pediatric referral centers evaluating the demographics, clinical and laboratory characteristics, management and outcomes of COVID-19 among newborns and infants in the United Arab Emirates (UAE). Clinical and biochemical markers were evaluated for their accuracy in predicting intensive care unit (ICU) transfer and death. RESULTS: A total of 576 COVID-19-positive infants were evaluated with a mean age of 164 days. The mean duration of symptoms was 1.48 days. Fever was present in 36.5% of the cohort, while 44.3% had nasal congestion. Eight infants (of 575; 1.39%) required transfer to the ICU for impending respiratory failure and 2 required invasive ventilation. Symptomatic (fever, nasal congestion) infants were not more likely to be transferred to the ICU (Chi-squared test, P = 0.77). ICU transfer was associated with a higher chance of receiving antibiotics (70.6% vs 35.4%; Chi-squared test, P = 0.003). On multivariate analysis, none of the clinical parameters (age, symptoms, laboratory tests) predicted transfer to the ICU. No deaths were reported during the observation period. CONCLUSIONS: Infants with SARS-CoV-2 infection have a benign clinical course with favorable outcomes. Less than 2% require ICU transfer. Clinical vigilance is required as none of the admission parameters predicted ICU transfer.

Cross-Sectional Association Between Body Fat Composition and Biomarkers of Inflammation and Endothelial Dysfunction in Children with Overweight/Obesity.

Background: Childhood obesity is most prevalent nutritional disorder worldwide. Studies on clinical correlations between body fat (BF) composition, lipid profile, inflammatory biomarkers, and endothelial dysfunction (ED) parameters in children from United Arab Emirates (UAE) are limited. Therefore, we aimed to study obesity pattern in children and determine clinical correlations with biomarkers. Methods: Children (6-13 years) from different schools were divided into obese, overweight, and normal groups based upon Centers for Disease Control and Prevention weight-for-age centiles study (n=166). Anthropometric, BF composition, lipid profile, inflammatory, and ED biomarkers were determined and analyzed using SPSS software. Results: The mean age and weight ± SD of participants were 10.6 ± 2.6 years and 48.2 ± 19.5 kg with 65% as overweight or obese. In normal, overweight, and obese group male were 40 (70.2%), 35 (67.3%), and 40 (70.2%) and female were 17 (29.8%), 17 (32.7%) and 17 (29.8%). There was significant difference in age (p<0.01), height (p< 0.01), weight (p< 0.01) among groups. Obesity markers (MCP-1, leptin, adiponectin) showed positive correlation with age, height, weight, WC, BF%, body fat mass (BFM), body muscle mass (BMM). A significant correlation (all p<0.01) of BMM with SBP (r=0.412), DBP (r=0.255), MCP-1 (r=0.558), adiponectin (r=0.635), hs-CRP (r=0.263), IL-6 (r=0.348), TNF-alpha (r=0.370), ICAM-1 (r=0.237), and VCAM-1 (r=0.343). The inflammatory markers (ICAM-1, VCAM-1) showed significant correlations with age, height, weight, WC, BF%, BFM, BMM. Leptin significantly (all p<0.01) correlated with age (r=0.470), height (r=0.423), weight (r=0.677), WC (r=0.606), BF (r=0.700), BFM (r=0.752), and BMM (r=0.524) and negatively correlated with TBW (r=-0.701). Adiponectin also showed a significant (all p<0.01) positive correlation with age, height, weight, WC, BF, BFM, and BMM. Conclusion: A strong association between BF composition, lipid profile, and inflammatory and ED biomarkers was observed in the study. Thus, immediate measures should be implemented to reduce risk of obesity and associated diseases.

LecturePlus: a learner-centered teaching method to promote deep learning.

A new teaching format, the LecturePlus, was formulated as a lecture followed by small-group learning activities. This study assessed the effectiveness of LecturePlus in medical education. An interventional study was conducted among final-year medical students, with 74 students in the experimental group and 96 students in the control group. Each LecturePlus lasted ∼1 h and was conducted with 12-18 students. A LecturePlus session comprised of a lecture followed by small-group problem-solving exercises. The exercises were clinical cases with open-ended short-answer questions. Students were divided into groups of three (triads) for these exercises. A faculty tutor assisted the small groups as needed. Closure was achieved through a discussion moderated by the tutor. Learning outcomes were assessed via the National Board of Medical Examiners (NBME) subject scores and compared with those of the preceding academic year. An additional multiple-choice question (MCQ) test was administered before and after the clerkship. The MCQ test showed improvement in knowledge application (P < 0.001, partial eta squared = 0.42). There was a statistically significant improvement in adjusted NBME scores among female students (74.8 vs. 71.8; P = 0.017) but not among male students. An anonymous written questionnaire survey showed high ratings for LecturePlus (95% selecting yes or partly yes to overall satisfaction). LecturePlus is an instructional strategy that integrates a lecture with learning activities. It can be scaled to large class sizes facilitated by one teacher. By combining didactic teaching with problem-solving, this new instructional strategy may foster application of knowledge.NEW & NOTEWORTHY We developed a new structured teaching format, the LecturePlus, to promote deep learning. A LecturePlus session consists of a brief lecture, followed by small-group problem-solving exercises, ending with a closing discussion moderated by the teacher. During the small-group exercises, students were divided into groups of three (triads) and given case-based problems. One faculty tutor supervised the entire session. LecturePlus resulted in improved learning outcomes and was rated highly by medical students.

The art of diabetes care: guidelines for a holistic approach to human and social factors.

A holistic approach to diabetes considers patient preferences, emotional health, living conditions, and other contextual factors, in addition to medication selection. Human and social factors influence treatment adherence and clinical outcomes. Social issues, cost of care, out-of-pocket expenses, pill burden (number and frequency), and injectable drugs such as insulin, can affect adherence. Clinicians can ask about these contextual factors when discussing treatment options with patients. Patients' emotional health can also affect diabetes self-care. Social stressors such as family issues may impair self-care behaviors. Diabetes can also lead to emotional stress. Diabetes distress correlates with worse glycemic control and lower overall well-being. Patient-centered communication can build the foundation of a trusting relationship with the clinician. Respect for patient preferences and fears can build trust. Relevant communication skills include asking open-ended questions, expressing empathy, active listening, and exploring the patient's perspective. Glycemic goals must be personalized based on frailty, the risk of hypoglycemia, and healthy life expectancy. Lifestyle counseling requires a nonjudgmental approach and tactfulness. The art of diabetes care rests on clinicians perceiving a patient's emotional state. Tailoring the level of advice and diabetes targets based on a patient's personal and contextual factors requires mindfulness by clinicians.

Effectiveness of containment strategies in preventing SARS-CoV-2 transmission.

BACKGROUND: Despite substantial resources deployed to curb SARS-CoV-2 transmission, controlling the COVID-19 pandemic has been a major challenge. New variants of the virus are frequently emerging leading to new waves of infection and re-introduction of control measures. In this study, we assessed the effectiveness of containment strategies implemented in the early phase of the pandemic. METHODS: Real-world data for COVID-19 cases was retrieved for the period Jan 1 to May 1, 2020 from a number of different sources, including PubMed, MEDLINE, Facebook, Epidemic Forecasting and Google Mobility Reports. We analyzed data for 18 countries/regions that deployed containment strategies such as travel restrictions, lockdowns, stay-at-home requests, school/public events closure, social distancing, and exposure history information management (digital contact tracing, DCT). Primary outcome measure was the change in the number of new cases over 30 days before and after deployment of a control measure. We also compared the effectiveness of centralized versus decentralized DCT. Time series data for COVID-19 were analyzed using Mann-Kendall (M-K) trend tests to investigate the impact of these measures on changes in the number of new cases. The rate of change in the number of new cases was compared using M-K z-values and Sen's slope. RESULTS: In spite of the widespread implementation of conventional strategies such as lockdowns, travel restrictions, social distancing, school closures, and stay-at-home requests, analysis revealed that these measures could not prevent the spread of the virus. However, countries which adopted DCT with centralized data storage were more likely to contain the spread. CONCLUSIONS: Centralized DCT was more effective in containing the spread of COVID-19. Early implementation of centralized DCT should be considered in future outbreaks. However, challenges such as public acceptance, data security and privacy concerns will need to be addressed.

Teaching Family Medicine and General Practice.

The teaching of family medicine and general practice should aim to develop an appreciation of the unique nature and role of the specialty. Teachers should relate patient cases to the principles of family medicine. These principles include (1) compassionate care; (2) a generalist/holistic approach focusing on the whole person, family, and community; (3) continuity of relationship, i.e., building a patient-physician bond of trust; (4) reflective mindfulness; and (5) lifelong learning. The curriculum, instructional strategy, and assessment should be carefully aligned. Core competencies include patient-centered communication, physical examination skills, clinical procedures, palliative care, humanities in medicine, holistic care, shared decision-making, family therapy, home and community visits, chronic disease care, problem-based documentation, team-based care, data-driven improvement, information mastery, ethics and professionalism, and work-life balance. Family medicine/general practice is defined as the medical specialty that manages common and long-term illnesses, focusing on overall health and well-being. Hence, clerkship schedules should maximize clinical exposure and opportunities for self-reflection. A learner-centered approach should begin with a self-identified inventory of learning needs based on the curriculum; next, these needs should be chosen as topics for student presentations. Teaching methods should include mini-workshops: a combination of didactic lectures and small-group exercises. Individual face-to-face formative feedback should occur at midcourse and culminate in a group reflection on the learning experience. Clinical supervision should gradually decrease as each resident demonstrates safe patient care. Procedure skills training should be closely supervised, formally documented, and constitute about one-fourth of learning sessions.

Global Epidemiology of HIV/AIDS: A Resurgence in North America and Europe.

We aimed to assess global trends in Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and evaluate progress toward eradication since the inception of the pandemic. Data were extracted from the Global Burden of Disease 2019 update and the UNAIDS Data 2019. The datasets included annual figures from 1990 to 2019 for HIV/AIDS in 204 countries and all world regions. We analyzed rates and trends for prevalence, incidence, mortality and disability adjusted life years. Analysis of age and gender distribution in different regions was used to assess demographic changes. Forecasting was used to estimate disease burden up to 2040. Although many countries have witnessed a decrease in the incidence, for Russia, Ukraine, Portugal, Brazil, Spain and the United States, the rates of new cases are rising since 2010. This trend is present even in age-standardized analysis, indicating a rise in excess of population growth. Over 0.5% of the world's population is infected. About 5000 new infections occur daily, of which 500 are children. Mortality rates are falling globally; currently at 11 deaths per 100,000 population, forecasted to decrease to 8.5 deaths by 2040. Prevalence continues to increase, with South Africa, Nigeria, Mozambique, India, Kenya and the United States having the highest burden. The total number as well as the rates of new HIV infections are rising every year in Europe, South America, North America and other regions over the last decade. Maternal-to-child transmission continues at high rates despite effective preventive regimens. There is an urgent need to develop programs to curb the rising incidence of HIV.

Population risk factors for COVID-19 deaths in Nigeria at sub-national level.

INTRODUCTION: Nigeria is the most populous country in the African continent. The aim of this study was to analyze risk factors for COVID-19 prevalence and deaths in all 6 geopolitical regions and 37 States in Nigeria. METHODS: we analyzed the data retrieved from various sources, including Nigeria CDC, Nigeria National Bureau of Statistics, Unicef-Nigeria multiple indicator cluster survey and the Institute of Health Metrics and Evaluation, University of Washington. We examined 4 clinical risk factors (prevalence of TB, HIV, smoking and BCG vaccination coverage) and 5 sociodemographic factors (age ≥65, population density, literacy rate, unemployment and GDP per capita). Multivariate modeling was conducted using generalized linear model. RESULTS: our analysis showed that the incidence of confirmed COVID-19 cases differed widely across the 37 States, from 0.09 per 100,000 in Kogi to 83.7 in Lagos. However, more than 70% of confirmed cases were concentrated in just 7 States: Lagos, Abuja, Oyo, Kano, Edo, Rivers and Delta. Case mortality rate (CMR) also varied considerably, with Lagos, Abuja and Edo having CMR above 9 per million population. On bivariate analysis, higher CMR correlated positively with GDP (r=0.53) and to a lesser extent with TB (r=0.36) and population density (r=0.38). On multivariate analysis, which is more definitive, States with higher HIV prevalence and BCG coverage had lower CMR, while high GDP States had a greater CMR. CONCLUSION: this study indicates that COVID-19 has disproportionately affected certain States in Nigeria. Population susceptibility factors include higher economic development but not literacy or unemployment. Death rates were mildly lower in States with higher HIV prevalence and BCG vaccination coverage.

Population Risk Factors for COVID-19 Mortality in 93 Countries.

Death rates due to COVID-19 pandemic vary considerably across regions and countries. Case Mortality Rates (CMR) per 100,000 population are more reliable than case-fatality rates per 100 test-positive cases, which are heavily dependent on the extent of viral case testing carried out in a country. We aimed to study the variations in CMR against population risk factors such as aging, underlying chronic diseases and social determinants such as poverty and overcrowding. Data on COVID-19 CMR in 93 countries was analyzed for associations with preexisting prevalence rates of eight diseases [asthma, lung cancer, Chronic Obstructive Pulmonary Disease (COPD), Alzheimer's Disease (AD), hypertension, ischemic heart disease, depression and diabetes], and six socio-demographic factors [Gross Domestic Product (GDP) per capita, unemployment, age over 65 years, urbanization, population density, and socio-demographic index]. These data were analyzed in three steps: correlation analysis, bivariate comparison of countries, and multivariate modelling. Bivariate analysis revealed that COVID-19 CMR were higher in countries that had high prevalence of population risk factors such as AD, lung cancer, asthma and COPD. On multivariate modeling however, AD, COPD, depression and higher GDP predicted increased death rates. Comorbid illnesses such as AD and lung diseases may be more influential than aging alone.

Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study.

Background Ischemic heart disease (IHD) is a leading cause of death worldwide. Also referred to as coronary artery disease (CAD) and atherosclerotic cardiovascular disease (ACD), it manifests clinically as myocardial infarction and ischemic cardiomyopathy. This study aims to evaluate the epidemiological trends of IHD globally. Methods The most up-to-date epidemiological data from the Global Burden of Disease (GBD) dataset were analyzed. GBD collates data from a large number of sources, including research studies, hospital registries, and government reports. This dataset includes annual figures from 1990 to 2017 for IHD in all countries and regions. We analyzed the incidence, prevalence, and disability-adjusted life years (DALY) for IHD. Forecasting for the next two decades was conducted using the Statistical Package for the Social Sciences (SPSS) Time Series Modeler (IBM Corp., Armonk, NY). Results Our study estimated that globally, IHD affects around 126 million individuals (1,655 per 100,000), which is approximately 1.72% of the world's population. Nine million deaths were caused by IHD globally. Men were more commonly affected than women, and incidence typically started in the fourth decade and increased with age. The global prevalence of IHD is rising. We estimated that the current prevalence rate of 1,655 per 100,000 population is expected to exceed 1,845 by the year 2030. Eastern European countries are sustaining the highest prevalence. Age-standardized rates, which remove the effect of population changes over time, have decreased in many regions. Conclusions IHD is the number one cause of death, disability, and human suffering globally. Age-adjusted rates show a promising decrease. However, health systems have to manage an increasing number of cases due to population aging.

Global burden of psoriasis - comparison of regional and global epidemiology, 1990 to 2017.

BACKGROUND: Psoriasis is a common disease that has not only cutaneous manifestations but also causes significant systemic illness and disability. Most epidemiological studies on the burden of psoriasis that are available in literature are regional, and thus a detailed description of the worldwide burden of psoriasis is warranted. METHODS: We analyzed the prevalence, incidence, disability adjusted life years (DALY), and years lived with disability (YLD) related to psoriasis for the period 1990 to 2017, from the Global Burden of Disease dataset (developed by the Institute of Health Metrics, University of Washington). We also searched the PubMed MEDLINE for quality of life and economic burden of psoriasis for a comprehensive evaluation of the burden of psoriasis. RESULTS: In 2017, the global age-standardized prevalence rate of psoriasis was 811 per 100,000 population, approximating to 0.84% of world population or about 64.6 million individuals. The incidence of new cases increased from 92 per 100,000 in 1990 to 99 in 2017. The highest rates were recorded in North America and Western Europe, while the lowest rates were found in Asia and Western Pacific regions. The age distribution shows a rising rate of incidence from the second decade, peaking at 55-60 years. Women are slightly more likely to be affected. CONCLUSIONS: The global incidence of psoriasis has been rising over the last three decades. The burden of the economic and psychosocial suffering caused by psoriasis calls for resource allocation and a multidisciplinary approach to address this common medical condition. KEY MESSAGE: The prevalence, incidence, and the burden of suffering caused by psoriasis have been rising over the past 17 years, despite efforts at improving diagnosis and treatment.

Global Trends and Forecast of the Burden of Adverse Effects of Medical Treatment: Epidemiological Analysis Based on the Global Burden of Disease Study.

Aim To quantify and update the years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALY) due to the adverse effects of medical treatment (AEMT) between 1990 and 2017. Subject and methods We analyzed the latest dataset from the Global Burden of Disease (GBD) 2017 study. We described the burden of AEMT based on the number of DALY. We additionally evaluated the global age and sex-specific DALY and compared the age-standardized rates of DALY across the World Health Organization (WHO) regions from 1990 to 2017. Results Worldwide, the total DALYs due to AEMT were 84.93 [95% uncertainty interval (UI), 62.52 to 102.21] in 1990 and 62.79 (52.09 to 75.45) in 2017 per 100,000 population. The global percentage of change in DALY showed a negative trend of -26.06 % (-41.52 to -10.59) across all WHO regions between 1990 and 2017. The YLD has increased during the period from 1997 to 2017 by 29.47% (17.87 to 41.06). In 2017, men were affected more than women with a DALY of 66.78 in comparison to 58.91 DALY in women. DALY rates per 100,000 were highest across all the WHO regions in the first years of life. The predicted DALY rates were 59.92 (57.52 to 62.32) in the year 2020, 50.36 (32.03 to 68.70) in 2030, and 40.8 (-1.33 to 82.93) in 2040. Conclusion Using the GBD 2017 study data, we found a decrease in the DALY rate due to AEMT between 1990 and 2017 with a varying range of DALY between different WHO regions. DALY also differed by age and sex. The forecasting analyses showed a decrease in DALY due to AEMTs with a significant drop in the European region when compared to the African and American regions. However, the increasing trend for YLD signifies an increasing burden of people living with poor health due to AEMT. Our study proposes to identify disability due to AEMT as a significant public health crisis and calls for policymakers to create a robust revised policy.

Global Incidence and Mortality Trends due to Adverse Effects of Medical Treatment, 1990-2017: A Systematic Analysis from the Global Burden of Diseases, Injuries and Risk Factors Study.

Aim To quantify the global incidence and mortality of adverse effects of medical treatment (AEMT) and forecast the possible emerging trends of AEMT. Materials and methods We analyzed the latest data from the Global Burden of Disease (GBD) 2017 study. We describe the burden of AEMT based on age- and region-specific incidence and mortality rates between 1990 and 2017. Additionally, we evaluated the change of burden due to AEMT by different periods between 1990 and 2017, and compared the age-standardized incidence and mortality rates among different World Health Organization (WHO) regions. Results Globally, AEMT incidence rates varied across WHO regions and countries. The estimated age-standardized average incidence rates of AEMT were 309 [95% uncertainty interval (UI), 270 to 351], 340 (298 to 384), 401 (348 to 458), and 439 (376 to 505) per 100,000 population across the world in 1990, 2000, 2010, and 2017, respectively, showing an increasing trend in the new occurrence of adverse events. The incidence rate among women (469/100,000) was higher compared to men (409/100,000) in 2017. Between 1990 and 2017, we observed an upward trend in the incidence rates of AEMT across global regions, with a substantial increase in the incidence by 42% (27 to 57) between the years 1990 and 2017, translated to an annualized rate of incline of 1.5%. In the age group of 60-64 years, the incidence rates increased by 96% in 2017 compared to 1990. The global incidence rate due to AEMT is forecasted to increase to 446.94 (433.65 to 460.22) by 2020, 478.49 (376.88 to 580.09) in 2030, and to reach 510.03 (276.58 to 743.49) per 100,000 by 2040. We observed a decline in mortality rates due to AEMT across global regions, and the annualized rate of mortality change was -0.90 percentage points between 1990 and 2017. Overall, the AEMT mortality rate was higher in men (1.73/100,000) than in women (1.48/100,000), and age-specific mortality rates showed a bimodal increase between the age group of birth to one year, and an increase in the age group of 65 years and above. The global mortality rate due to AEMT is expected to be 1.55 (1.48 to 1.61) in 2020, 1.37 (0.88 to 1.86 ) in 2030 and 1.2 deaths per 100,000 (0.08 to 2.32) by 2040. Conclusion Using the GBD 2017 study data, we found an increase in the incidence of AEMT, and an overall decrease in the mortality rate between 1990 and 2017, with varying estimates between different countries and regions, gender and age groups. The forecast analysis displayed the same trends - an increase in AEMT incidence and a decline in mortality between 2020 and 2040. The high burden of AEMT warrants the implementation of robust policies in the healthcare system including appropriate patient safety training for the healthcare professionals, and safe culture of feedback with the implementation of electronic medical records to achieve WHO patient safety strategy goals.

Global Incidence and Mortality Patterns of Pedestrian Road Traffic Injuries by Sociodemographic Index, with Forecasting: Findings from the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study.

(1) Background: Pedestrian injuries (PIs) represent a significant proportion of road traffic injuries. Our aim was to investigate the incidence and mortality of PIs in different age groups and sociodemographic index (SDI) categories between 1990 and 2017. (2) Method: Estimates of age-standardized incidence and mortality along with trends of PIs by SDI levels were obtained from the Global Burden of Disease from 1990 to 2017. We also forecasted the trends across all the SDI categories until 2040 using the Statistical Package for the Social Sciences (SPSS Statistics for Windows, version 23.0, Chicago, IL, USA) time series expert modeler. (3) Results: Globally, the incidence of PIs increased by 3.31% (-9.94 to 16.56) in 2017 compared to 1990. Men have higher incidence of PIs than women. Forecasted incidence was 132.02 (127.37 to 136.66) per 100,000 population in 2020, 101.52 (65.99 to 137.05) in 2030, and reduced further to 71.02 (10.62 to 152.65) by 2040. Globally across all SDI categories, there was a decreasing trend in mortality due to PIs with the global estimated percentage reduction of 37.12% (-45.19 to -29.04). (4) Conclusions: The results show that PIs are still a burden for all SDI categories despite some variation. Although incidence and mortality are expected to decrease globally, some SDI categories and specific vulnerable age groups may require particular attention. Further studies addressing incidence and mortality patterns in vulnerable SDI categories are needed.

Provision of primary care by specialist physicians: a systematic review.

Patients with stable chronic diseases such as diabetes and hypertension can be safely managed at the primary care level. Yet many such patients continue to follow-up with specialists at a higher expense with no added benefit. We introduce a new term to describe this phenomenon: scope inversion, defined as the provision of primary care by specialist physicians. We aimed to quantify the extent of scope inversion by conducting a systematic review. MEDLINE and five other databases were searched using the keywords 'specialist AND (routine OR primary) AND provi*' as well as other variations. The search was limited to human research without restrictions on language or date of publication. The inclusion criterion was studies on rates of the provision of routine primary care by specialist physicians. Thirteen observational studies met the inclusion criteria. A wide range of primary care involvement was observed among specialists, from 2.6% to 65% of clinic visits. Among children, 41.3% of visits with specialists were routine follow-ups for conditions such as allergic rhinitis and seborrhoeic dermatitis which could be managed in primary care. Data quality was moderate to low across the studies due to limitations of source data and varying definitions of primary care. Specialist physicians provide primary care to patients in a substantial proportion of clinic visits. Scope inversion is wasteful as it diverts patients to more expensive care without improving outcomes. A systems approach is needed to mitigate scope inversion and its harmful effects on healthcare service delivery.

Epidemiology of Type 2 Diabetes - Global Burden of Disease and Forecasted Trends.

The rising burden of type 2 diabetes is a major concern in healthcare worldwide. This research aimed to analyze the global epidemiology of type 2 diabetes. We analyzed the incidence, prevalence, and burden of suffering of diabetes mellitus based on epidemiological data from the Global Burden of Disease (GBD) current dataset from the Institute of Health Metrics, Seattle. Global and regional trends from 1990 to 2017 of type 2 diabetes for all ages were compiled. Forecast estimates were obtained using the SPSS Time Series Modeler. In 2017, approximately 462 million individuals were affected by type 2 diabetes corresponding to 6.28% of the world's population (4.4% of those aged 15-49 years, 15% of those aged 50-69, and 22% of those aged 70+), or a prevalence rate of 6059 cases per 100,000. Over 1 million deaths per year can be attributed to diabetes alone, making it the ninth leading cause of mortality. The burden of diabetes mellitus is rising globally, and at a much faster rate in developed regions, such as Western Europe. The gender distribution is equal, and the incidence peaks at around 55 years of age. Global prevalence of type 2 diabetes is projected to increase to 7079 individuals per 100,000 by 2030, reflecting a continued rise across all regions of the world. There are concerning trends of rising prevalence in lower-income countries. Urgent public health and clinical preventive measures are warranted.