Prevalência, incidência e caracterização sociodemográfica e clínica das pessoas com estoma de eliminação em Portugal / Prevalence, incidence, and sociodemographic and clinical characterization of individuals with an intestinal or urinary stoma in Portugal / Prevalencia, incidencia y caracterización sociodemográfica y clínica de las personas con ostomía de eliminación en Portugal

Resumo Enquadramento: Dados que caracterizam as pessoas com estoma em Portugal são escassos. Estabelecer estimativas epidemiológicas pode melhorar o conhecimento sobre esta população e adaptar modelos de cuidados de saúde. Objetivos: Estimar a prevalência e incidência de pessoas com estoma de eliminação em Portugal em 2021. Metodologia: Estudo observacional, longitudinal e retrospetivo, a partir de uma base de dados de dispensa de dispositivos para ostomia. Resultados: Em 2021, o número estimado de pessoas com pelo menos um estoma foi de 22.045. Entre estes, 19.793 [IC95%:19.599;19.994] tinham um estoma de eliminação. Na sua maioria eram homens (61,4%), em média tinham 70,5 anos e residiam preferencialmente na região interior do país. O tipo de estoma de eliminação mais prevalente foi a colostomia (48,8%). A incidência estimada de novos casos foi de 6.622, sendo 5.834 [IC95%:5.680;5.984] referentes a estomas de eliminação. Conclusão: Estes resultados permitiram caracterizar o perfil das pessoas com estoma de eliminação em Portugal. Poderão ser úteis para ajustar os programas de prevenção/acompanhamento em saúde desta população e ainda alocar recursos especializados.

Abstract Background: Data characterizing individuals with a stoma in Portugal is limited. Establishing epidemiological estimates can enhance understanding of this population and facilitate the adaptation of healthcare models. Objectives: To estimate the prevalence and incidence of individuals in Portugal who have undergone intestinal or urinary ostomy in 2021. Methodology: Observational, longitudinal, and retrospective study using a stoma appliance dispensing database. Results: In 2021, an estimated 22,045 individuals had at least one stoma, with 19,793 [95%CI:19,599;19,994] having an intestinal/urinary stoma. Most of these individuals were men (61.4%) with a mean age of 70.5 years and resided in the inland region of Portugal. Colostomy was the most prevalent type of intestinal/urinary stoma (48.8%). The estimated incidence of new cases was 6,622, of which 5,834 [95%CI:5,680;5,984] were intestinal/urinary stomas. Conclusion: These results characterize the profile of individuals with intestinal and urinary stomas in Portugal. They may be useful in adjusting prevention and health monitoring programs for this population and allocating specialized resources.

Resumen Marco contextual: Los datos que caracterizan a las personas con estomas en Portugal son escasos. Establecer estimaciones epidemiológicas puede mejorar el conocimiento sobre esta población y adaptar modelos sanitarios. Objetivos: Estimar la prevalencia y la incidencia de personas con estoma de eliminación en Portugal en 2021. Metodología: Estudio observacional, longitudinal y retrospectivo, basado en una base de datos de dispensaciones de dispositivos de ostomía. Resultados: En 2021, el número estimado de personas con al menos un estoma era de 22.045, de las cuales 19.793 [IC95%:19.599;19.994] tenían un estoma de eliminación. La mayoría de ellos eran hombres (61,4%), tenían una edad media de 70,5 años y vivían principalmente en el interior del país. El tipo de estoma de eliminación más frecuente era la colostomía (48,8%). La incidencia estimada de nuevos casos fue de 6.622, de los cuales 5.834 [IC95%:5.680;5.984] eran estomas de eliminación. Conclusión: Estos resultados han permitido caracterizar el perfil de las personas con estoma de eliminación en Portugal. Podrían ser útiles para ajustar los programas de prevención/seguimiento de la salud de esta población y para asignar recursos especializados.

Technical specifications for a EU-wide baseline survey of antimicrobial resistance in bacteria from aquaculture animals.

The European Commission requested scientific and technical assistance in the preparation of a EU-wide baseline survey of antimicrobial resistance (AMR) in bacteria from aquaculture animals. It is recommended that the survey would aim at estimating the occurrence of AMR in Aeromonas spp. isolated from Atlantic Salmon (Salmo salar), European seabass (Dicentrarchus labrax) and trout (Salmo trutta, Salvelinus fontinalis, Oncorhynchus mykiss) intended to consumption, at harvesting (at farm/slaughter), at the EU level and in addition, at estimating the occurrence and diversity of AMR of Escherichia coli, Enterococcus faecium, Enterococcus faecalis, Vibrio parahaemolyticus and Vibrio alginolyticus in blue mussel (Mytilus edulis) and Mediterranean mussel (Mytilus galloprovincialis) from production areas and at dispatch centres at the EU level. These technical specifications define the target populations, the sample size for the survey, sample collection requirements, the analytical methods (for isolation, identification, phenotypic susceptibility testing and further genotypic analysis of some of the bacteria targeted) and the data reporting requirements. The data to be reported by the EU Member States to support this baseline survey are presented in three data models. The results of the survey should be reported using the EFSA reporting system.

Pediatric respiratory pathogen dynamics in Southern Sichuan, China: a retrospective analysis of gender, age, and seasonal trends.

Objective: To address the research gap in the epidemiology of pediatric respiratory tract infections (RTIs) in Luzhou, Southern Sichuan, China, by analyzing respiratory pathogens in a large pediatric cohort from 2018 to 2021, covering the pre- and during-COVID-19 periods. Methods: This study conducted a retrospective analysis of children with RTIs in Luzhou from July 2018 to January 2021. Strict exclusion criteria were applied to ensure an accurate representation of the pediatric population. Pathogen detection included viruses, bacteria, and atypical agents. Results: Pathogens were identified in 52.8% of 12,546 cases. Viruses accounted for 32.2% of infections, bacteria for 29.8%, and atypical agents for 29.7%, with significant findings of Staphylococcus aureus, Moraxella catarrhalis, and Mycoplasma pneumoniae. Age-related analysis indicated a higher incidence of bacterial infections in infants and viral infections in preschool-aged children, with atypical pathogens being most prevalent in 3-5-year-olds. Gender-based analysis, adjusted for age, revealed similar overall pathogen presence; however, females were more susceptible to viral infections, while males were more prone to Streptococcus pneumoniae. Notably, there was an unusual increase in pathogen cases during spring, potentially influenced by behavioral changes and public health measures related to COVID-19. Co-infections were identified as a significant risk factor for the development of pneumonia. Conclusion: The study provides essential insights into the epidemiology of respiratory pathogens in pediatric populations, emphasizing the need for healthcare strategies tailored to age, gender, and seasonality. The findings highlight the impact of environmental and public health factors, including COVID-19 measures, on respiratory pathogen prevalence, underscoring the importance of targeted diagnostic and treatment protocols in pediatric respiratory infections.

Analysis of epidemiological characteristics of extrapulmonary tuberculosis from South-Central China.

Objectives: This study aimed to investigate the epidemiological and drug resistance (DR) characteristics of extrapulmonary tuberculosis (EPTB) in South-Central China. Methods: EPTB inpatients who were culture-positive for Mycobacterium tuberculosis were retrospectively included in a study at a provincial TB hospital in Hunan, a province in South-Central China, from January 2013 to December 2021. Demographic, clinical, and drug susceptibility data were retrieved from TB treatment records. Descriptive statistical methods and a Chi-squared test were used to analyze the epidemiological and DR characteristics of EPTB patients. A logistic regression model was used to explore the risk factors of rifampicin-resistant/multidrug-resistant (RR/MDR)-EPTB. Results: A total of 1,324 cases were included. The majority of EPTB patients were in the age range of 20-29 years, were predominantly men (male-to-female ratio: 2.03), and were farmers (65.63%). Most EPTB cases were found in 2013 and 2017 from 2013 to 2021. The most prevalent subtypes of EPTB were lymphatic TB (29.83%, 395/1,324), multiple EPTB (20.85%, 276/1,324), and musculoskeletal TB (14.65%, 194/1,324). Musculoskeletal TB and genitourinary TB predominantly presented as exclusive EPTB forms, while lymphatic TB and pharyngeal/laryngeal TB often co-occurred with pulmonary TB (PTB). Drug susceptibility testing results showed that total DR rates (resistance to any of RFP, isoniazid [INH], streptomycin [STR], and/or ethambutol [EMB]) and RR/MDR rates in EPTB were 25.23% and 12.39%, respectively. Musculoskeletal TB exhibited the highest rates of total DR (31.40%), INH resistance (28.90%), STR resistance (20.10%), EMB resistance (6.20%), MDR (13.90%), and poly-DR (6.70%). The multivariable logistic regression model showed that patients aged from 20 to 59 years (compared to those aged 10 years), workers (compared to retirees), and EPTB patients from the south and west of Hunan (compared to those from the east of Hunan) were at an increased risk of developing RR/MDR EPTB (all OR values > 1). Conclusion: Our study provided a detailed account of the epidemiological and DR characteristics of EPTB in Hunan province, China. The significant DR rates, particularly in musculoskeletal TB cases, highlight the need for timely diagnosis, effective drug susceptibility testing, and the development of more effective treatment regimens for EPTB, especially targeting musculoskeletal TB treatments.

Prevalence, risk factors, and outcomes of dysphagia after stroke: a systematic review and meta-analysis.

Background: Dysphagia is a common complication after stroke, which not only brings adverse outcomes but also greatly affects the quality of life of patients. At present, there is no systematic review or meta-analysis to comprehensively evaluate the epidemiological characteristics of post-stroke dysphagia (PSD). A systematic review of the prevalence, risk factors, and prognosis of PSD is essential. Methods: Through 31 December 2022, a comprehensive literature search was performed for observational studies related to PSD. Five databases were retrieved. Random-effects models were used to estimate the pooled prevalence, odds ratio (OR), and 95% CIs. Results: A total of 34 studies were included, and the results showed that the overall prevalence of PSD was 46.6% (95% CI, 0.405-0.528). The prevalence of dysphagia in ischemic stroke and hemorrhagic stroke was 43.6% (95% CI 0.370-0.501) and 58.8% (95% CI 0.519-0.654), respectively. The prevalence of PSD in Africa was 49.4% (95% CI, 0.196-0.792), in Asia was 40.1% (95% CI, 0.348-0.454), in Europe was 45.8% (95% CI, 0.327-0.590), in North America was 44.3% (95% CI, 0.370-0.517), in South America was 57.5% (95% CI, 0.441-0.708), and in Oceania was 64.1% (95%CI, 0.558, 0.724). In risk factor analysis, hypertension, previous stroke, and atrial fibrillation were significantly associated with the occurrence of PSD, pooled OR = 1.179 [(95% CI, 1.002-1.386), p < 0.05], pooled OR = 1.514 [(95% CI, 1.204-1.905), p < 0.001], and pooled OR = 1.980 [(95% CI, 1.580-2.481), p < 0.001]. In outcome studies, the prevalence of aphasia and dysarthria in PSD was 35.6% (95% CI, 0.213-0.499) and 54.5% (95% CI, 0.293-0.798), respectively. The prevalence of respiratory tract infection was 27.1% (95%CI, -0.038-0.579), and the prevalence of pneumonitis was 32.1% (95% CI, 0.224-0.418). Persistence of dysphagia at discharge and at 1 month was 74.5% (95% CI, 0.621-0.869) and 50.9% (95% CI, 0.142-0.876), respectively. Mortality rates for PSD patients during admission and discharge at 1 month, 3 months, and 1 year were 11.8% (95% CI, 0.083-0.152), 26.5% (95% CI, 0.170-0.359), 25.7% (95% CI, 0.19-0.324), and 31.3% (95% CI, 0.256-0.369), respectively. Conclusion: This study found that the overall prevalence of PSD was 46.6%. Prevalence is most influenced by the diagnosis method. Hypertension, history of stroke, atrial fibrillation, patient age, and stroke severity were risk factors significantly associated with PSD. The prevalence of aphasia, dysarthria, respiratory tract infection, and pneumonitis in PSD patients is 2-4 times that of patients without PSD.Systematic review registration: www.crd.york.ac.uk/PROSPERO, PROSPERO, CRD42021252967.

Characteristics and completeness of reporting of systematic reviews of prevalence studies in adult populations: a meta-research study.

OBJECTIVE: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, first published in 2009, has been widely endorsed and compliance is high in systematic reviews of intervention studies. Systematic reviews of prevalence studies are increasing in frequency, but their characteristics and reporting quality have not been examined in large studies. Our objectives were to describe the characteristics of systematic reviews of prevalence studies in adults, evaluate the completeness of reporting and explore study-level characteristics associated with the completeness of reporting. STUDY DESIGN AND SETTING: We did a meta-research study. We searched 5 databases from January 2010 to December 2020 to identify systematic reviews of prevalence studies in adult populations. We used the PRISMA 2009 checklist to assess completeness of reporting and recorded additional characteristics. We conducted a descriptive analysis of review characteristics and linear regression to assess the relationship between compliance with PRISMA and publication characteristics. RESULTS: We included 1172 systematic reviews of prevalence studies. The number of reviews increased from 25 in 2010 to 273 in 2020. The median PRISMA score for systematic reviews without meta-analysis was 17.5 out of a maximum of 23 and, for systematic reviews with meta-analysis, 22 out of a maximum of 25. Completeness of reporting, particularly for key items in the methods section was suboptimal. Systematic reviews that included a meta-analysis or reported using a reporting or conduct guideline were the factors most strongly associated with increased compliance with PRISMA 2009. CONCLUSION: Reporting of systematic reviews of prevalence was adequate for many PRISMA items. Nonetheless, this study highlights aspects for which special attention is needed. Development of a specific tool to assess the risk of bias in prevalence studies and an extension to the PRISMA statement could improve the conduct and reporting of systematic reviews of prevalence studies.

Prevalence of transthyretin cardiac amyloidosis in patients with heart failure with preserved ejection fraction: the PRACTICA study.

INTRODUCTION AND OBJECTIVES: Transthyretin cardiac amyloidosis (ATTR-CA) is a frequent cause of heart failure with preserved ejection fraction (HFpEF). This study aimed to determine the prevalence of ATTR-CA in HFpEF patients in a multicenter nationwide study. METHODS: Consecutive ambulatory or hospitalized patients aged ≥ 50 years with HFpEF and left ventricle hypertrophy ≥ 12 mm were studied at 20 Spanish hospitals. Screening for CA was initiated according to the usual clinical practice at each center. Positive scintigraphs were analyzed centrally. RESULTS: A total of 422 patients were included, of whom 387 underwent further screening for CA. Sixty-five patients (16.8%) were diagnosed with ATTR-CA, and none was younger than 75 years. Prevalence increased with age. Among these patients, 60% were men, with a mean age of 85.3 ± 5.2 years, mean left ventricular ejection fraction of 60.3 ± 7.6%, and a mean maximum left ventricular wall thickness of 17.2 (range, 12-25) mm. Most of the patients were in New York Heart Association class II (48.4%) or III (46.8%). In addition to being older than patients without ATTR-CA, patients with ATTR-CA had higher median NT-proBNP levels (3801 [2266-7132] vs 2391 [1141-4796] pg/mL; P = .003). There was no statistically significant difference in the prevalence of ATTR-CA by sex (19.7% in men and 13.8% in women, P = .085). A genetic variant (ATTRv) was found in approximately 7% (4/56) of the patients. CONCLUSIONS: This multicenter nationwide study found that the prevalence of ATTR-CA was 16.8%, confirming it as a significant contributor to HFpEF in patients of both sexes with left ventricular hypertrophy older than 75 years.

Increasing trend in patients with life-limiting and complex chronic conditions.

INTRODUCTION AND OBJECTIVES: To estimate the frequency of patients with diagnoses associated with life-limiting conditions (LLCs) or complex chronic conditions (CCCs). METHODS: Retrospective mixed population-based and hospital-based cohort study. Study universe consisted of the population aged less than 18 years of an autonomous community in Spain in the 2001-2021 period; the cases were patients admitted to hospital with a diagnosis associated with LLC or CCC during this period. We estimated age-adjusted annual prevalences and analysed changes in trends using joinpoint regression. RESULTS: The prevalence of LLCs increased significantly from 20.7 per 10 000 inhabitants under 18 years in 2001 to 51.3 per 10 000 in 2019. There was also a significant increase in CCCs from 39.9 per 10 000 in 2001 to 54.4 per 10 000 in 2019. The prevalence of patients with any of these conditions rose from 45 per 10 000 in 2001 to 86.8 per 10 000 in 2019; 30.3% of these patients had conditions of both types. There was a turning point in this increasing trend between 2019 and 2020, coinciding with the COVID-19 pandemic. CONCLUSIONS: The prevalence of patients requiring specialized care has increased progressively in the last 20 years, similar to what has happened in other countries. The magnitude of the affected population must be taken into account when planning specialized paediatric palliative care and complex chronic care services.

Management of Refractory/Resistant Herpes Simplex Virus Infections in Haematopoietic Stem Cell Transplantation Recipients: A Literature Review.

Herpes simplex virus (HSV) infections in allogeneic haematopoietic stem cell transplantation (HSCT) recipients pose significant challenges, with higher incidence, severity, and risk of emergence of resistance to antivirals due to impaired T-cell mediated immunity. This literature review focuses on acyclovir-refractory/resistant HSV infections in HSCT recipients. The review addresses the efficacy of antiviral prophylaxis, the incidence of acyclovir-refractory/resistant HSV infections, and the identification of risk factors and potential prognostic impact associated with those infections. Additionally, alternative therapeutic options are discussed. While acyclovir prophylaxis demonstrates a significant benefit in reducing HSV infections in HSCT recipients and, in some cases, overall mortality, concerns arise about the emergence of drug-resistant HSV strains. Our systematic review reports a median incidence of acyclovir-resistant HSV infections of 16.1%, with an increasing trend in recent years. Despite limitations in available studies, potential risk factors of emergence of HSV resistance to acyclovir include human leucocyte antigen (HLA) mismatches, myeloid neoplasms and acute leukaemias, and graft-versus-host disease (GVHD). Limited evidences suggest a potentially poorer prognosis for allogeneic HSCT recipients with acyclovir-refractory/resistant HSV infection. Alternative therapeutic approaches, such as foscarnet, cidofovir, topical cidofovir, optimised acyclovir dosing, and helicase-primase inhibitors offer promising options but require further investigations. Overall, larger studies are needed to refine preventive and therapeutic strategies for acyclovir-refractory/resistant HSV infections in allogeneic HSCT recipients and to identify those at higher risk.

Prevalence and Classification of Pediatric Neuromuscular Disorders in the Central Region of Portugal.

Neuromuscular disorders are a group of rare heterogenous diseases with profound impact on quality of life, for which overall pediatric prevalence has rarely been reported. The purpose of this study was to determine the point prevalence of pediatric neuromuscular disorders and its subcategories in the central region of Portugal. Retrospective case identification was carried out in children with neuromuscular disorders seen between 1998 and 2020 from multiple data sources. Demographics, clinical and molecular diagnoses were registered. On January 1, 2020, the point overall prevalence in the population <18 years of age was 41.20/100 000 (95% confidence interval 34.51-49.19) for all neuromuscular disorders. The main case proportion were genetic disorders (95.7%). We found a relatively higher occurrence of limb-girdle muscular dystrophies, congenital myopathies, and spinal muscular atrophy and a slightly lower occurrence of Duchenne muscular dystrophy, hereditary spastic paraparesis, and acquired neuropathies compared to previous studies in other countries. Molecular confirmation was available in 69.5% of pediatric neuromuscular patients in our cohort.Total prevalence is high in comparison with the data reported in the only previous study on the prevalence of pediatric neuromuscular disorders in our country. Our high definitive diagnostic rate underscores the importance of advances in investigative genetic techniques, particularly new sequencing technologies, in the diagnostic workup of neuromuscular patients.

Prevalence and impact of signs and symptoms of temporomandibular disorders in dental students and faculty.

OBJECTIVES: Temporomandibular disorders (TMD) affect individuals undergoing increased stress, for example, dental professionals. No study to date has compared dental students and faculty in TMD manifestation. This cross-sectional study compared prevalence, risk factors, and impact on daily activities of self-reported TMD signs/symptoms between dental students and faculty at a predoctoral dental school, and between preclinical (first- to second-year) and clinical (third- to fourth-year) students. METHODS: A REDCap survey was sent to dental students and faculty, assessing TMD signs/symptoms (TMD Symptom Questionnaire), pain intensity (Chronic Graded Pain Scale), jaw function (Jaw Function Limitation Scale), parafunctions (Oral Behavioral Checklist), previous TMD treatments, anxiety/depression symptoms (Patient Health Questionnaire), perceived stress (Perceived Stress Scale), and sleep quality (RU-SATED Scale). Outcomes were compared between groups using chi-square and t-tests, adjusting for covariates with analyses of covariance (ANCOVA). RESULTS: Data derived from N = 145 participants (N = 108 students, N = 37 faculty). Dental students reported significantly higher prevalence (90.1% vs. 75.7%, p = 0.020) and greater number of TMD signs/symptoms (5.3 ± 3.5 vs. 3.0 ± 2.7, p < 0.001) compared to faculty. Students reported significantly more parafunctional activities (p = 0.000), jaw-strain episodes (prolonged mouth opening, p = 0.007), higher stress level (p = 0.008), and lower sleep quality (p = 0.002) than faculty. Difference in number of TMD signs/symptoms was maintained after adjusting for stress, sleep quality, and parafunctional/jaw-strain activities. Clinical students utilized significantly more often evidence-based TMD treatment compared to preclinical students. CONCLUSIONS: High prevalence of self-reported TMD was observed among dental students and faculty, with students reporting higher prevalence and impairment despite working in the same environment. Findings underscore the importance of education on preventive measures early in dental training to address contributing factors and TMD management.

Prevalence of neurocognitive impairment in patients with rheumatoid arthritis - a systematic review and meta-analysis.

ObjectiveThis study aimed to evaluate prevalence rates (PRs) of neurocognitive impairment and its potential moderators among patients with rheumatoid arthritis (RA). MethodA systematic review of the available literature and data extraction was undertaken on 6 August 2021, with the update by 14 September 2023, by two reviewers independently. Literature was screened for reported rates of prevalence of neurocognitive impairment in RA patients. The meta-analysis was performed using RStudio with the "meta" library. ResultsTwenty-two studies that fulfilled all selection criteria were carefully analyzed. The PR of neurocognitive impairment was 0.49 [0.38-0.61] across all studies included in the review; 0.75 [0.54-0.88] for the MoCA; 0.56 [0.40-0.72] for the MMSE; and 0.26 [0.16-0.38] for comprehensive batteries. The meta-regression results indicated that, depending on the measurement method, the percentage of subjects with positive rheumatoid factor, women ratio, mean age of participants, mean duration of RA, and percentage of domains that had to be impaired to diagnose neurocognitive impairment turned out to be statistically significant moderators. ConclusionsNeurocognitive impairment is a clinically relevant condition in many RA patients, and its prevalence is alarming high.

Rheumatoid arthritis (RA) is a chronic systemic disease that has a significant negative impact on functioning. Difficulties experienced by RA patients described in the literature may involve various organs and systems, including the central nervous system. The results obtained in the review indicate that cognitive impairment may affect, depending on the measurement method, up to approximately 75% of the patients. Due to potential limitations related to cognitive dysfunctions, such as reduced compliance or difficulties in everyday functioning, such a high prevalence of neurocognitive dysfunctions is an argument for screening RA patients and developing appropriate support methods.

Impact of hypertensive heart disease, risk factors, and age-period-cohort models across 204 nations and regions from 1990 to 2019: a global perspective from the 2019 global burden of disease study.

Background: Hypertensive heart disease (HHD) is a major global public health issue resulting from hypertension-induced end-organ damage. The aim of this study was to examine the global impact, risk factors, and age-period-cohort (APC) model of HHD from 1990 to 2019. Methods: Data from the 2019 Global Burden of Disease were used to assess age-adjusted HHD prevalence, disability-adjusted life years (DALYs), mortality rates, and contributions of HHD risk factors with 95% uncertainty intervals (UIs). APC models were used to analyze global age, period, and cohort mortality trends for HHD. Results: In 2019, 18.6 million prevalent HHD cases led to 1.16 million fatalities and 21.51 million DALYs. Age-adjusted rates were 233.8 (95%UI = 170.5-312.9) per 100,000 individuals for prevalence, 15.2 (11.2-16.7) for mortality, and 268.2 (204.6-298.1) for DALYs. Regionally, the Cook Islands (703.1), Jordan (561.6), and Kuwait (514.9) had the highest age-standardized incidence of HHD in 2019. There were significant increases in HHD prevalence in Andean Latin America (16.7%), western sub-Saharan Africa (5.6%), and eastern sub-Saharan Africa (4.6%). Mortality rate varied widely among countries. Risk factors like elevated systolic blood pressure and high body mass index significant influenced DALY rates, especially in females. The APC model revealed an association between mortality rates and age, with a decreasing mortality risk over time and improved survival rates for a later birth cohort. Conclusions: Despite the reduction in prevalence, HHD remains a significant public health issue, particularly in nations with low sociodemographic indices. To alleviate the impact of HHD, prevention efforts should concentrate on the management of hypertension, weight loss, and lifestyle improvement.

Prevalence of tick-borne bacterial pathogens in Germany-has the situation changed after a decade?

Introduction: Tick-borne pathogens, such as Borreliella spp., Rickettsia spp., and Anaplasma spp., are frequently detected in Germany. They circulate between animals and tick vectors and can cause mild to severe diseases in humans. Knowledge about distribution and prevalence of these pathogens over time is important for risk assessment of human and animal health. Methods: Ixodes ricinus nymphs were collected at different locations in 2009/2010 and 2019 in Germany and analyzed for tick-borne pathogens by real-time PCR and sequencing. Results: Borreliella spp. were detected with a prevalence of 11.96% in 2009/2010 and 13.10% in 2019 with B. afzelii and B. garinii as dominant species. Borrelia miyamotoi was detected in seven ticks and in coinfection with B. afzelii or B. garinii. Rickettsia spp. showed a prevalence of 8.82% in 2009/2010 and 1.68% in 2019 with the exclusive detection of R. helvetica. The prevalence of Anaplasma spp. was 1.00% in 2009/2010 and 7.01% in 2019. A. phagocytophilum was detected in seven tick samples. None of the nymphs were positive for C. burnetii. Discussion: Here, observed changes in prevalence were not significant after a decade but require longitudinal observations including parameters like host species and density, climatic factors to improve our understanding of tick-borne diseases.

Screening and assessment of malnutrition in patients with liver cirrhosis.

The development and advancement of malnutrition is associated not only with the progression of hepatic dysfunction, but also with cirrhosis-related complications. However, the prevalence of malnutrition reported in different studies varies widely due to differences in diagnostic methods and patient investigation settings. Therefore, we need to identify malnourished patients promptly and accurately. The purpose of this review was to compare the validity and reliability of nutritional screening tools and to select the most appropriate nutritional risk screening for patients with cirrhosis. We compared nutritional risk screening tools such as the Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is more feasible to screen cirrhotic patients for nutritional risk, and is highly reproducible, considering the impact of sodium and water retention; so it is practical to screen cirrhotic patients via RFH-NPT for nutritional risk, subsequently, to evaluate the nutritional status of patients with nutritional risk via the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria. L3-SMI (third lumbar-skeletal muscle index) can accurately define sarcopenia in cirrhotic patients and also be used for clinical nutritional status assessment.

Prevalence and Characteristics by Age and Sex in Pediatric Trigger Digits: Nationwide Analysis Using Korea Health Insurance Dataset.

Background: Pediatric trigger digit (TD) does not appear at birth but is diagnosed after birth by finding a flexion contracture of the thumb or other fingers. The reported incidence of pediatric TDs varies from 0.5 to 5 cases per 1,000 live births without sex-specific predominance. We performed a nationwide large-scale study to determine the prevalence and incidence of pediatric TDs and analyzed operative treatment for pediatric TDs using the National Health Insurance data of South Korea. Methods: Patients with pediatric TDs, aged 0-10 years between 2011 and 2020, were included in this study. Children born between 2011 and 2015 were set as the reference population and followed up until 2020. We calculated the prevalence and incidence rates of pediatric TDs according to age and sex and analyzed the operation rate, age at surgery, time interval from initial diagnosis to surgery, and follow-up period. Patient selection and treatment were based on International Classification of Diseases, 10th Revision (ICD-10). Results: The prevalence rates of pediatric TDs ranged from 0.063% to 0.084%. Girls had a higher prevalence rate (0.066%-0.094%) than boys (0.060%-0.075%). The total incidence rate was 77.6/100,000 person-years, and the incidence rate was higher in girls (84.8) than in boys (70.7). Among 2,181,814 children born between 2011 and 2015, 12,729 were diagnosed with pediatric TDs, of which 1,128 (8.9%) underwent operative management. The means of age at initial diagnosis, age at surgery, and the time interval between diagnosis and operation were 2.76 ± 1.91 years, 3.79 ± 2.19 years, and 1.15 ± 1.71 years, respectively. Conclusions: High prevalence and incidence rates of pediatric TDs were found in 2- to 3-year-old patients. Among pediatric patients, 8.9% underwent operative management that was most frequently conducted between 2 and 3 years of age (within 1 year of initial diagnosis).

The Prevalence and Associated Factors of Post-COVID-19 Fatigue: A Systematic Review and Meta-Analysis.

After the coronavirus disease 2019 (COVID-19) pandemic, numerous individuals experienced the enduring consequences of infection. One of the psychological symptoms that patients report most frequently is persistent fatigue, which is also called post-COVID-19 fatigue. This persistent fatigue can prolong recovery time for hospitalized patients and reduce exercise motivation for residents, affecting their health and working conditions. To determine the prevalence and associated factors, we conducted searches in PubMed, Embase, Web of Science, and Cochrane Library, from inception to 27 March 2023, and a total of 38 studies and 17,738 patients were included in this analysis. We analyzed data and estimated publication bias by Egger's test and funnel plot by STATA 14. We summarized the prevalence of post-COVID-19 fatigue and calculated the pooled OR to determine associated factors. This study revealed that the prevalence of fatigue in post-COVID-19 syndrome was 46.6% (95% CI: 38.5%-54.7%). Being female (OR: 0.40, 95% CI: 0.24-0.56), older age (OR: 0.04, 95% CI: 0.01-0.07), clinical severity (OR: 0.66, 95% CI: 0.24-1.09), the number of acute COVID symptoms (OR: 3.23, 95% CI: 1.83-5.69), preexisting hypertension (OR: 1.24, 95% CI: 1.08-1.42), lung disease (OR: 2.71, 95% CI: 1.07-6.89), and depression (OR: 1.55, 95% CI: 1.01-2.39) were risk factors for post-COVID-19 fatigue. By revealing the association of these factors with fatigue, it can help us to identify and treat post-COVID-19 fatigue early.

Pneumonitis Incidence in Patients With Metastatic Non-small Cell Lung Cancer on Immunotherapy: A Systematic Review and Meta-Analysis.

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, often diagnosed at the advanced stage (metastatic). Treatment options for metastatic NSCLC include radiotherapy, chemotherapy, target drug therapy, and immunotherapy. Immunotherapy (utilization of checkpoint inhibitors) boosts the immune system to recognize and destroy cancer cells. However, it is often associated with immune-related complications such as pneumonitis. This review aims to determine the incidence of pneumonitis in metastatic NSCLC patients treated with different immunotherapy drugs. PubMed, Cochrane Library, and Embase databases were scoured for randomized controlled trials (RCTs) until October 2023. Published RCTs with similar research objectives were included, while non-English articles, reviews, case reports, ongoing trials, non-randomized studies, conference abstracts, and studies on small cell lung cancer (SCLC) were excluded. The Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess the risk of bias among the included studies. The statistical analyses were performed with the Comprehensive Meta-Analysis software. The subgroup analysis of the 16 included RCTs showed that metastatic NSCLC patients treated with nivolumab and pembrolizumab had a higher incidence of any grade pneumonitis than those treated with atezolizumab (4.5% and 5.1% vs. 1.6%, respectively). Similarly, the incidence of grade ≥3 pneumonitis was higher among patients receiving nivolumab (1.3%) and pembrolizumab (2.4%) than those receiving atezolizumab (0.7%). Furthermore, the subgroup analysis showed that patients with naive-treated NSCLC on immunotherapy had a higher incidence of any grade pneumonitis than those with previously treated NSCLC (6.5% vs. 3.9%). Treatment-naive patients recorded higher grade ≥3 pneumonitis incidences than those previously treated (3.1% vs. 1.3%). Programmed death 1 (PD-1) inhibitors (i.e., pembrolizumab and nivolumab) have higher incidences of pneumonitis than programmed death-ligand 1 inhibitors (atezolizumab).

Global prevalence of nonalcoholic fatty liver disease: an updated meta-analysis on 78 million population over 38 countries.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a global health challenge, with a rising rate in line with other metabolic diseases. We aimed to assess the global prevalence of NAFLD in adult and pediatric populations. METHODS: PubMed, Scopus and Web of Science databases were systematically searched up to May 2023. Heterogeneity was assessed using Cochran's Q test and I2 statistics, and random-effects model was used for meta-analysis. Analyses were performed using STATA version 18. RESULTS: A total of 479 studies with 78,001,755 participants from 38 countries were finally included. The global prevalence of NAFLD was estimated to be 30.2% (95% CI: 28.7-31.7%). Regionally, the prevalence of NAFLD was as follows: Asia 30.9% (95% CI: 29.2-32.6%), Australia 16.1% (95% CI: 9.0-24.8%), Europe 30.2% (95% CI: 25.6-35.0%), North America 29% (95% CI: 25.8-32.3%), and South America 34% (95% CI: 16.9-53.5%). Countries with a higher human development index (HDI) had significantly lower prevalence of NAFLD (coefficient = -0.523, p = 0.005). Globally, the prevalence of NAFLD in men and women was 36.6% (95% CI: 34.7-38.4%) and 25.5% (95% CI: 23.9-27.1%), respectively. The prevalence of NAFLD in adults, adults with obesity, children, and children with obesity was 30.2% (95% CI: 28.8-31.7%), 57.5% (95% CI: 43.6-70.9%), 14.3% (95% CI: 10.3-18.8%), and 38.0% (95% CI: 31.5-44.7%), respectively. CONCLUSION: The prevalence of NAFLD is remarkably high, particularly in countries with lower HDI. This substantial prevalence in both adults and children underscores the need for disease management protocols to reduce the burden.

Ecological approach to the characteristics and determinants of sexual violence against adolescents in Perú / Aproximación ecológica a las características y factores determinantes de la violencia sexual contra adolescentes en Perú.

Introduction. Sexual violence against adolescents is a global problem that affects young people around the world. The ecological model examines its forms and determinants through interconnected levels. Objective. To determine the frequency, characteristics, and predictors of sexual violence in adolescents attending school in Perú. Materials and methods. This was a cross-sectional study that secondarily analyzed data from the Encuesta Nacional de Relaciones Sociales (2019). A stratified probabilistic sample involved 1,579 youth aged 12-17 from 93 schools. The questionnaire evaluated physical, psychological, and sexual violence in the family and at school. Models were estimated using logistic regression analysis, calculating odds ratio (OR). Results. Eighteen point sixty eight per cent (95% CI: 16.80-20.60) suffered some type of sexual assault. In addition, 9.75% (95% CI: 8.28-11.21) reported having been touched in some part of the body and 1.84% (95% CI: 1.17-2.50) reported that was a victim of rape. Age was identified as a risk factor in the microsystem (OR = 1.48) (95% CI: 1.26-1.74), while the age of the first experienced sexual violence acted as a protective factor (OR = 0.61) (95% CI: 0.54-0.69). In addition, in the macrosystem, the perception that violence occurs mainly outside the home increased the risk (OR = 2.06) (95% CI: 1.01-4.19). Conclusions. Approximately two out of ten respondents reported having experienced some type of sexual violence, with verbal harassment and invasive personal contact being the most common. No single level or factor can fully explain adolescent sexual violence without considering its ecological interconnectedness.

Introducción. La violencia sexual contra los adolescentes es un problema global que afecta a jóvenes de todo el mundo. El modelo ecológico examina sus formas y factores determinantes a través de niveles interconectados. Objetivo. Determinar la frecuencia, las características y los predictores de la violencia sexual contra adolescentes escolarizados en Perú. Materiales y métodos. Se llevó a cabo un estudio transversal en el cual se analizaron de manera secundaria los datos de la Encuesta Nacional de Relaciones Sociales (2019). Una muestra probabilística estratificada incluyó a 1.579 jóvenes de 12 a 17 años de 93 escuelas. Con el cuestionario se evaluó la violencia sexual en la familia y en la escuela. Se estimaron modelos mediante análisis de regresión logística, calculando la razón de momios (odds ratio, OR). Resultados. El 18,68 % (IC95%: 16,80-20,60) sufrió algún tipo de agresión sexual. Además, el 9,75 % (IC95%: 8,28-11,21) informó haber sido tocado en alguna parte del cuerpo y el 1,84 % (IC95%: 1,17-2,50) informó que fue víctima de violación. La edad se identificó como factor de riesgo en el microsistema (OR=1,48) (IC95%: 1,26-1,74), mientras que la edad de la primera violencia sexual actuó como factor protector (OR=0,61) (IC95%: 0,54-0,69). Además, en el macrosistema, la percepción de que la violencia ocurre principalmente fuera del hogar incrementó el riesgo (OR=2,06) (IC95%: 1,01-4,19). Conclusión. Aproximadamente, dos de cada diez encuestados informaron haber experimentado algún tipo de violencia sexual, siendo el acoso verbal y el contacto personal invasivo los más comunes. Ningún nivel del modelo ecológico o factor único puede explicar completamente la violencia sexual contra los adolescentes sin considerar su interconexión ecológica.