Osteoporosis is a silent disease without any evidence of disease until a fracture occurs. Approximately 200 million people in the world are affected by osteoporosis and 8.9 million fractures occur each year worldwide. Fractures of the hip are a major public health burden, by means of both social cost and health condition of the elderly because these fractures are one of the main causes of morbidity, impairment, decreased quality of life and mortality in women and men. The aim of this review is to analyze the most important factors related to the enormous impact of osteoporotic fractures on population. Among the most common risk factors, low body mass index; history of fragility fracture, environmental risk, early menopause, smoking, lack of vitamin D, endocrine disorders (for example insulin-dependent diabetes mellitus), use of glucocorticoids, excessive alcohol intake, immobility and others represented the main clinical risk factors associated with augmented risk of fragility fracture. The increasing trend of osteoporosis is accompanied by an underutilization of the available preventive strategies and only a small number of patients at high fracture risk are recognized and successively referred for therapy. This report provides analytic evidences to assess the best practices in osteoporosis management and indications for the adoption of a correct healthcare strategy to significantly reduce the osteoporosis burden. Early diagnosis is the key to resize the impact of osteoporosis on healthcare system. In this context, attention must be focused on the identification of high fracture risk among osteoporotic patients. It is necessary to increase national awareness campaigns across countries in order to reduce the osteoporotic fractures incidence.
Importance Bacterial meningitis is a worldwide health problem, with incidence rates ranging from approximately 0.9 per 100 000 individuals per year in high-income countries to 80 per 100 000 individuals per year in low-income countries. In low-income countries, bacterial meningitis has a mortality rate of up to 54%. Up to 24% of those who survive develop chronic neurological sequelae, such as hearing loss or focal neurological deficits. Observations Streptococcus pneumoniae causes about 72% and Neisseria meningitidis causes about 11% of cases of bacterial meningitis in people older than 16 years. Escherichia coli and Streptococcus agalactiae cause about 35% of cases of early-onset neonatal meningitis. In adults, risk factors for bacterial meningitis include older age and immunosuppressive conditions. The most common symptoms are headache (84%), fever (74%), stiff neck (74%), altered mental status (median [IQR] Glasgow Coma Scale score of 11 [9-14] on a scale ranging from 3-15), and nausea (62%). Brain imaging should be performed before lumbar puncture if patients present with altered mental status, focal neurological deficits, papilledema, or history of immunocompromising conditions or central nervous system disease. Bacterial meningitis should be suspected if any of the following are present on admission: serum leukocytes greater than 10.0 ×109/L, cerebrospinal fluid (CSF) leukocytes greater than 2000/μL, CSF granulocytes greater than 1180/μL, CSF protein greater than 2.2 g/L, CSF glucose less than 34.23 mg/dL, or fever. A positive Gram stain result for bacteria is diagnostic, but the sensitivity of a positive Gram stain result for bacterial meningitis ranges from 50% to 90%. In countries in which the prevalence of ceftriaxone-resistant Streptococcus pneumoniae exceeds 1%, vancomycin and ceftriaxone are the empirical antibiotics of choice, with the addition of ampicillin in neonates, older patients, and immunocompromised patients. Adjunctive dexamethasone should be used in patients with bacterial meningitis but stopped if Listeria monocytogenes is confirmed. Conclusions and Relevance Bacterial meningitis affects approximately 0.9 per 100 000 individuals to 80 per 100 000 individuals per year and has a mortality rate as high as 54%. First-line therapy is prompt empirical intravenous antibiotic therapy and adjunctive dexamethasone.
The reported incidence of eclampsia is 1.6-10 per 10,000 deliveries in developed countries, where as it is 50-151 per 10,000 deliveries in developing countries. In addition, low resource countries have substantially higher rates of maternal and perinatal mortalities and morbidities. This disparity in incidence and pregnancy outcomes maybe related to universal access to prenatal care, early detection of preeclampsia, timely delivery, and availability of health care resources in developed as compared to developing countries. Because of its infrequency in developed countries, many obstetric providers and maternity units have minimal to no experience in acute management of eclampsia and its complications. Therefore, clear protocols for prevention of eclampsia in those with severe preeclampsia and acute treatment of eclamptic seizures at all levels of health care are required for better maternal and neonatal outcomes. Eclamptic seizure will occur in 2% of women with preeclampsia with severe features who are not receiving magnesium sulfate, and in less than 0.6% in those receiving magnesium. The pathogenesis of an eclamptic seizure is not well understood, however blood brain barrier (BBB) disruption with passage of fluid, ions and plasma protein into the brain parenchyma remains the leading theory. New data suggest that BBB permeability may increase by circulating factors found in preeclamptic women plasma such as vascular endothelial growth factor and placental growth factor. The management of an eclamptic seizure will include supportive care to prevent serious maternal injury, magnesium sulfate for prevention of recurrent seizures and promoting delivery. While routine imagining following eclamptic seizure is not recommended, the classic finding is referred to as posterior reversible encephalopathy syndrome (PRES). The majority of patients with PRES will show complete resolution of the imaging finding within 1-2 weeks, but routine imaging follow up is unnecessary unless there are findings of intracranial hemorrhage, infraction or ongoing neurologic deficit. Eclampsia is associated with increased risk for maternal mortality and morbidity such as placental abruption, disseminated intravascular coagulation, pulmonary edema, aspiration pneumonia, cardiopulmonary arrest and acute renal failure. Furthermore, a history of eclamptic seizure is may be related to long-term cardiovascular risk and cognitive difficulties related to memory and concentration years after the index pregnancy. Finally, limited data suggest that placental growth factor levels in preeclamptic women are superior to clinical markers in prediction of adverse pregnancy outcomes. This data may be extrapolated to prediction of eclampsia in future studies. This summary of available evidence provides data and expert opinion on possible pathogenesis of eclampsia, imagining findings, differential diagnosis, and stepwise approach regarding management of eclampsia prior to delivery and during the postpartum, as well as current recommendations for prevention of eclamptic seizure in women with preeclampsia.
Objective: To estimate the global and regional prevalence and cases of abdominal aortic aneurysms (AAAs) in 2019 and to evaluate major associated factors. Background: Understanding the global prevalence of AAA is essential for optimizing health services and reducing mortality from reputed AAA. Methods: PubMed, MEDLINE, and Embase were searched for articles published until October 11, 2021. Population-based studies that reported AAA prevalence in the general population, defined AAA as an aortic diameter of 30 mm or greater with ultrasonography or computed tomography. A multilevel mixed-effects meta-regression approach was used to establish the relation between age and AAA prevalence for high-demographic sociodemographic index and low-and middle-sociodemographic index countries. Odds ratios of AAA associated factors were pooled using a random-effects method. Results: We retained 54 articles across 19 countries. The global prevalence of AAA among persons aged 30 to 79 years was 0.92% (95% CI, 0.65–1.30), translating to a total of 35.12 million (95% CI, 24.94–49.80) AAA cases in 2019. Smoking, male sex, family history of AAA, advanced age, hypertension, hypercholesterolemia, obesity, cardiovascular disease, cerebrovascular disease, claudication, peripheral artery disease, pulmonary disease, and renal disease were associated with AAA. In 2019, the Western Pacific region had the highest AAA prevalence at 1.31% (95% CI, 0.94–1.85), whereas the African region had the lowest prevalence at 0.33% (95% CI, 0.23–0.48). Conclusions: A substantial proportion of people are affected by AAA. There is a need to optimize epidemiological studies to promptly respond to at-risk and identified cases to improve outcomes.
Hundreds of (semi-)religious women, so-called kloppen and Beguines, lived in early modern Amsterdam, many of them in a community at the Begijnhof in the city centre. This case study analyses, via an emblematically painted devotional print with a calligraphed poem on the verso, how they collectively visualised and experienced their communion with the bridegroom Christ. A significant proportion of the Dutch population remained Catholic throughout the seventeenth century. As monasteries were forbidden, many Catholic women turned to a religious life ‘in the world’, an act which was tolerated by the Reformed authorities. Such a life offered women the chance to develop independently, self-willed, and intellectually outside marriage, a path that was cut off for Protestant women after the Reformation. For their spiritual life, these Catholic women made intensive use of devotional prints, which they sometimes augmented with friendly poems or prayers on the reverse. Prayers were also exchanged for the salvation of deceased fellow sisters. Sometimes, texts and notes on the prints and drawings were inspired by songs that were included in their prayer books. These devotionalia thus provide an interesting, as yet unknown source for research into the daily life, practised spirituality, and agency of semi-religious women in the Low Countries.
UNLABELLED Indoor air is a dominant exposure for humans. More that half of the body's intake during a lifetime is air inhaled in the home. Thus, most illnesses related to environmental exposures stem from indoor air exposure. Indoor air was believed to be a major environmental factor for more than a hundred years, from the start of the hygienic revolution, around 1850, until outdoor environmental issues entered the scene, and became dominant around 1960. Main environmental issues today are outdoor air quality, energy use, and sustainable buildings, but not indoor air quality (IAQ). But, there is mounting evidence that exposure to IAQ is the cause of excessive morbidity and mortality. In developing regions indoor unvented burning of biomass for cooking is the cause of at least 2,000,000 deaths a year (mainly women and children), and in the developed world IAQ is a main cause of allergies, other hypersensitivity reactions, airway infections, and cancers. Cancer of the lungs is related to indoor radon and ETS exposure. Allergies, airway infections and sick building syndrome are associated with, e.g., "dampness", a low ventilation rate, and plasticizers. In the future more emphasis must be given to IAQ and health issues. PRACTICAL IMPLICATIONS Indoor air quality plays a major role with regard to public health. The main problems are in the developing countries with the indoor burning of biomass for cooking and heating. The solution is a stove with a chimney. In developed regions, good ventilation, getting rid of "dampness" problems, and adequate testing of new building materials would reduce morbidity and mortality.
Low-dose computer tomographic (LDCT) lung cancer screening reduces lung cancer-specific and all-cause mortality among high-risk individuals, but implementation has been challenging. Despite health insurance coverage for lung cancer screening in the United States since 2015, fewer than 10% of eligible persons have participated; striking geographic, racial, and socioeconomic disparities were already evident, especially in the populations at greatest risk of lung cancer and, therefore, most likely to benefit from screening; and adherence to subsequent testing is significantly lower than that reported in clinical trials, potentially reducing the realized benefit. Lung cancer screening is a covered health care benefit in very few countries. Obtaining the full population-level benefit of lung cancer screening will require improved participation of already eligible persons (the grasp of screening) and improved eligibility criteria that more closely match up with the full spectrum of persons at risk (the reach of screening), irrespective of smoking history. We used the socioecological framework of health care to systematically review implementation barriers to lung cancer screening and discuss multilevel solutions. We also discussed guideline-concordant management of incidentally detected lung nodules as a complementary approach to early lung cancer detection that can extend the reach and strengthen the grasp of screening. Furthermore, we discussed ongoing efforts in Asia to explore the possibility of LDCT screening in populations in whom lung cancer risk is relatively independent of smoking. Finally, we summarized innovative technological solutions, including biomarker selection and artificial intelligence strategies, to improve the safety, effectiveness, and cost-effectiveness of lung cancer screening in diverse populations.
Preterm births (PTB) are the leading cause of neonatal deaths, the majority of which occur in low- and middle-income countries, particularly those in Sub-Saharan Africa (SSA). Understanding the epidemiology of prematurity is an essential step towards tackling the challenge of PTB in the sub-continent. We performed a scoping review of the burden, predictors and outcomes of PTB in SSA. We searched PubMed, Embase, and three other databases for articles published from the database inception to 10 July 2021. Studies reporting the prevalence of PTB, the associated risk factors, and/or its outcomes were eligible for inclusion in this review. Our literature search identified 4441 publications, but only 181 met the inclusion criteria. Last menstrual period (LMP) was the most commonly used method of estimating gestational age. The prevalence of PTB in SSA ranged from 3.4% to 49.4%. Several risk factors of PTB were identified in this review. The most frequently reported risk factors (i.e., reported in ≥10 studies) were previous history of PTB, underutilization of antenatal care (<4 visits), premature rupture of membrane, maternal age (≤20 or ≥35 years), inter-pregnancy interval, malaria, HIV and hypertension in pregnancy. Premature babies had high rates of hospital admissions, were at risk of poor growth and development, and were also at a high risk of morbidity and mortality. There is a high burden of PTB in SSA. The true burden of PTB is underestimated due to the widespread use of LMP, an unreliable and often inaccurate method for estimating gestational age. The associated risk factors for PTB are mostly modifiable and require an all-inclusive intervention to reduce the burden and improve outcomes in SSA.
Muluken Dessalegn Muluneh, L. Francis, K. Agho
et al.
A systematic review and meta-analysis were employed to address the associated factors of gender-based violence (GBV) in sub-Saharan African (SSA) countries. The Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. Ovid Medline, CINAHL, Cochrane Central, Embase, Scopus and Web of Science were used to source articles with stringent eligibility criteria. A total of 4931 studies were found and 50 studies met the inclusion criteria. Pooled meta-analyses revealed that low educational attainment, higher alcohol consumption, substance use, history of child and family abuse, limited decision-making skills, experiencing depression, males having multiple sexual partners, and younger age were found to be individual- and family-associated factors that increase the experiences of GBV. Community tolerant attitudes to violence, women’s unemployment, being Muslim, lower socioeconomic class, food and social insecurity were found to be community- and societal-associated factors of GBV. Alcohol consumption, low educational attainment, experiencing depression, being younger, a history of child and family abuse, tolerant attitudes to violence, and low socioeconomic status were poignant factors associated with GBV amongst women in SSA countries. The need to develop a multipronged approach of intervention is a top priority in SSA to reach the Sustainable Development Goals’ (SDGs) target of 2030 to eliminate all forms of violence. Socio-behavioural change communication interventions at individual and community levels need to be introduced, and interventions need to address the prevention of child and family abuse and increase women’s feelings of empowerment in order to prevent GBV in SSA.
We propose a simple measure of de facto financial market integration based on a factor model of monthly equity returns, which can be computed back to the first era of financial globalization for 17 countries. Global financial market integration follows a “swoosh” shape – i.e. high pre-1913, still higher post-1990, low in the interwar period – rather than the other shapes hypothesized in earlier literature. We find no evidence of financial globalization reversing since the Great Recession as claimed in other recent studies. De jure capital account openness and global growth uncertainty are the two main determinants of long-run global financial market integration. We use our measure to revisit the debate on the trilemma between financial openness, the exchange rate regime, and monetary policy autonomy, and on whether the trilemma has recently morphed into a dilemma due to global financial cycles. We find evidence consistent with the trilemma and inconsistent with the dilemma hypothesis, both throughout history and for the recent decades; non-US central banks still exert more control over domestic interest rates when exchange rates are flexible in economies open to global finance.
Kurniati Puji Lestari, Firdha Rahma Nurbadlina, Wagiyo Wagiyo
et al.
Background The low birth weight (LBW) problem is found in various developing countries with an increasing trend of cases every year. This is caused by nutritional status and a history of maternal health. The impact of LBW in children is they are more likely to experience delayed growth and development. This study aims to identify the effect of baby massage on infants’ body weight. Design and Methods The research design used was quasiexperimental pre and post-test type with control group. There were 16 infants for each group selected by purposive sampling. Baby massage was given to the infants twice a week within four weeks, 10 to 15 mins per session. Data analysis was used paired ttest and independent t-test. Results The mean age of infants was 3.69 months for both group, the mean age at birth was 37.8 weeks (intervention) and 38 weeks (control), the mean birth weight of infants was 2,295 grams (intervention) and 2,288 grams (control). Most of the infants was male for both group. There was an effect of baby massage on the increase in infants’ weight gain with a history of low birth weight significantly with a p-value <0.05. Conclusions Baby massage can increase infants’ weight with a history of low birth weight aged 1-6 months. The role of health workers is to provide education and practice baby massage for mothers in order to stimulate the growth and development of infants. This intervention can be integrated with maternal and child health programs in primary health care facilities.
C. Coll, Mariângela Freitas da Silveira, Diego G Bassani
et al.
Background Antenatal depression (AD) is a major public health issue but evidence regarding its prevalence and associated factors in low and middle-income countries (LMICs) is limited. The aim of the study was to estimate the prevalence and identify risk factors for AD among Brazilian pregnant women. Methods All women living in the urban area of the city of Pelotas, Southern Brazil, with confirmed pregnancy and estimated delivery date in the year 2015, were invited to take part. Eligible pregnant women were recruited from health services. Symptoms of antenatal depression were assessed using the Edinburgh Postnatal Depression Scale (EPDS) by face-to-face interviews. A cutoff-point of 13 or more was used to define probable AD. Results EPDS scores were available for 4130 women. The prevalence of AD was 16% (95%CI 14·9–17·1). After adjustment for potential confounders, the factors most strongly associated with higher EPDS scores were a previous history of depression (PR 2·81; 95%CI 2·44-3·25), high parity (PR 1·72; 95%CI 1·38-2·15 - ≥2 children vs. 1 child) and maternal education (PR 5·47; 95%CI 4·22-7·09 - 0–4 vs. ≥12 years of formal education). Limitations EPDS was administered through face-to-face interviews rather than questionnaires and some women may have felt uncomfortable reporting their symptoms leading to underreporting and consequently underestimation of the prevalence found. Conclusion AD prevalence is substantially higher in Brazil than in high-income countries (HICs) but similar to other LMICs. Our study identified relevant risk factors that may be potential targets to plan interventions, particularly a history of depression.