Search Results (499)

Background/Objectives: The emergence of biologic therapies has transformed the management of severe asthma, offering targeted treatments that improve symptom control and reduce exacerbations. However, taking a biologic solely based on the initial response may not be optimal. Clinicians must regularly reassess the suitability of the selected biologic, considering evolving patient characteristics and the growing availability of treatment options. This article aims to highlight the importance of individualized decision making in the long-term management of pediatric patients receiving biologic therapy, exploring the various reasons that may justify switching biologic treatment. Methods: We present a case to illustrate this approach: a 14-year-old adolescent girl with severe allergic asthma who initially received Omalizumab, achieving clinical, laboratory, and functional improvements. Despite this positive response, the patient reported low-level satisfaction due to the frequency of injections and hospital visits, leading to poor adherence. After a comprehensive reassessment, the treatment was switched to Tezepelumab. Results: Following the switch, the patient maintained stable disease control with a slight improvement in lung function, while adherence, satisfaction, and quality of life improved significantly. The number of hospital visits was reduced from 24 to 12 per year, and the number of injections decreased from 104 to 12 annually. The patient reported high-level satisfaction with the new treatment plan, and the economic burden of therapy was also substantially reduced. We present a table summarizing the essential and secondary factors to consider when initiating or switching biologic therapy. Conclusions: This case highlights the need to go beyond the traditional criteria, such as lack of efficacy and adverse reactions, when evaluating a switch in biologic therapy for pediatric asthma. Factors such as comorbidities, injection frequency and number, route of administration, and cost should also be considered, as they can directly influence adherence and the clinical outcomes in children and adolescents. As the therapeutic options expand, regular reassessment and personalized adjustments remain essential. Full article

Background and Aims: Multiple genetic variants have been associated with disease prevalence and outcomes in middle-aged people with metabolic dysfunction-associated fatty liver disease (MAFLD). However, genetic studies in older adults have been lacking. We aimed to understand their clinical relevance in healthy older persons. Methods: A secondary analysis of the ASPREE (ASPirin in Reducing Events in the Elderly) randomized trial involving community-dwelling older adults ≥ 70 years without prior cardiovascular disease events or life-limiting illness at enrolment. The Fatty Liver Index (FLI) was used to identify MAFLD at baseline. We assessed the associations between six previously reported MAFLD-associated genetic variants with prevalent MAFLD at baseline, and the associations of these variants with cardiovascular disease events and all-cause mortality. Results: A total of 8756 participants with genetic data were stratified according to the FLI, with 3310 having MAFLD at baseline. The follow-up was for a median of 8.4 (IQR 7.3–9.5) years. Variants in two genes (GCKR and HSD17B13) were associated with prevalent MAFLD (p < 0.05); PNPLA3, TM6SF2, LYPLAL1, and MBOAT7 were not. PNPLA3, TM6SF2, HSD17B13, GCKR, and LYPLAL1 were not associated with major adverse cardiovascular events (MACEs) or mortality in the overall cohort or in participants with MAFLD during the follow-up (all p > 0.05). Within the MAFLD group, homozygosity for the rs641738 C > T variant in the MBOAT7 gene was associated with a reduced risk of MACEs (HR 0.68 [95% CI 0.48–0.97]), but not all-cause mortality (HR 1.14 [95% CI 0.89–1.47]). This protective association remained significant after adjusting for multiple key covariates (aHR 0.64 [95% CI 0.44–0.92]). The results were similar when using the metabolic dysfunction-associated steatotic liver disease definition rather than MAFLD. Conclusions: The rs641738 C > T variant in MBOAT7 may confer protection against MACEs in older adults with MAFLD, independent of other clinical risk factors. Further validation using external cohorts is needed. Full article

Background: Despite the worldwide increase in life expectancy, individuals aged 75 years and older with an unknown history of cardiovascular disease often receive suboptimal statin treatment for primary prevention, reflecting uncertainties regarding statin efficacy and safety in this aging group. We aimed to assess the impact of statin treatment on all-cause mortality among individuals aged 75 years and older without prior cardiovascular diagnoses. Methods: This retrospective study utilized real-world data from a large cohort of individuals aged 75 years and older who were treated as outpatients in or were admitted to the Tel Aviv Sourasky Medical Center. Extracted variables included demographic details, Charlson Comorbidity Index (CCI), chronic medication regimens, mortality outcomes and blood test results (high-density lipoprotein, low-density lipoprotein and creatinine). Patients with a prior diagnosis of angina, myocardial infarction or stroke were excluded from the study. Results: A total of 98,502 patients were included in the study, of whom 37,171 (mean age 80.67 ± 4.73 years) were treated with statins and 6804 (18.3%) of the latter patients were aged 85 years and above. The majority of the statin-treated patients (72.6%) had received high-intensity statins. The non-statin-treated group comprised 61,331 subjects with a mean age of 82.69 ± 5.77 years, of whom 19,253 (31.39%) were aged 85 years and above. The risk of all-cause mortality was significantly lower in the statin-treated group compared to the non-statin-treated group (adjusted odds ratio [aOR] 0.715, 95% confidence interval [CI] [0.671–0.761], p < 0.001). This trend persisted after stratification for age 85 years and above (aOR 0.7, 95% CI [0.606–0.809], p < 0.001), and for a low CCI (≤4) or a high CCI (>4) score (aOR 0.766, 95% CI [0.708–0.803]; aOR 0.648, 95% CI [0.585–0.717], respectively, p < 0.001). Conclusions: Provision of statin therapy contributes to a reduction in risk of all-cause mortality in individuals aged 75 years and above who have an unknown history of cardiovascular disease, regardless of the type of statin or the patient’s CCI score. Full article

Aims: To investigate the global epidemiological characteristics of lower respiratory infection (LRI) burden caused by Streptococcus pneumoniae (SP) from 1990 to 2021. Methods: Using data from the Global Burden of Disease (GBD) study 2021, we systematically analyzed Streptococcus pneumoniae-related (SP-related) LRI burden, focusing on mortality, disability-adjusted life years (DALYs), and temporal trends by age, gender, geographic region, and socio-demographic index (SDI) quintiles. Decomposition analysis assessed the influence of epidemiological shifts, population growth, and aging on age-standardized mortality rates (ASMRs), while an autoregressive integrated moving average (ARIMA) model projected future trends. Results: Between 1990 and 2021, the global SP-related LRI death number decreased from 1,028,083 (95% uncertainty interval (UI): 923,782–1,146,074) to 505,268 (95% UI: 454,335–552,539), and the ASMR dropped from 19.28 (95% UI: 17.32–21.49) to 6.40 (95% UI: 5.76–7.00) per 100,000. The age distribution consistently exhibited a clear two-tiered pattern, gradually shifting from being predominantly composed of young children to being dominated by older adults. Disparities were stark across SDI quintiles, low-SDI regions exhibited up to 100-times-higher under-five mortality than high-SDI regions. Geographic distribution showed the highest ASMRs in sub-Saharan Africa and the lowest in Canada, the United States, and Australia, with Mongolia and Finland showing the largest reductions in mortality. Epidemiological changes were the most significant factor in ASMR reduction. Conclusions: The SP-related LRI burden has decreased globally but remains a major health concern, especially in low-SDI regions. Targeted public health interventions, particularly for neonates and elderly adults, are essential to address persistent disparities and further reduce mortality. Full article

Background: Premature atherosclerosis (PreAS) is generally defined as a disease affecting those under the age of 50 and has an outsized impact on quality-adjusted life years. We sought to better understand what individuals are at the highest risk for PreAS by examining differences in demographics and comorbidities compared to traditional atherosclerosis (TradAS). Study Design: An Institutional Review Board (IRB) approved retrospective study was conducted using retrospective data from a large regional health system. Patients who received a diagnosis of cerebrovascular disease (CeVD), coronary artery disease (CAD) or peripheral arterial disease (PAD) between 2012 and 2023 were included. Results: The review identified 136,328 patients in which 17,008 or 13% presented with PreAS (diagnosed from age 18 up to, and including, age 50). Rates of comorbidities were as follows (PreAs/TradAS): hypertension 63%/86%, diabetes 29%/35%. hyperlipidemia 45%/67%, chronic kidney disease 15%/26%, tobacco use 52%/60% and substance use 25%/9%. Differences in race, ethnicity and gender were as follows (PreAS/TradAS): White 59%/80%, Black 22%/10% and Latinx 17%/6%; male 51%/55%, and female 49%/45%. Conclusions: Patients with PreAS had lower rates of diseases that typically progress with aging, including hypertension, hyperlipidemia, chronic kidney disease, and diabetes. Tobacco use was less prevalent in the PreAS group and there was a significantly higher rate of illicit substance use in the PreAS population. Race and ethnicity were notably different with Black and Hispanic patients representing a significantly larger proportion of those with PreAS relative to TradAS. Our findings suggest risk factors beyond those classically described may play key roles in causing patients to develop PreAS. Full article

Respiratory syncytial virus (RSV) is a major cause of morbidity and mortality from lower respiratory infections (LRIs) worldwide. This study analyzes trends in age-standardized death rates (ASDRs) and disability-adjusted life years (DALYs) due to RSV-induced LRIs from 1990 to 2019, using data from the Global Burden of Disease Study 2021 (GBD 2021). The findings show a gradual decline in deaths, ASDR, and DALYs throughout this period. However, these indicators were higher in men than in women, as well as more pronounced in sub-Saharan West Africa. Developed countries exhibited higher ASDR and DALY values than developing countries, with the highest burden observed among children and the elderly in low Socio-demographic Index (SDI) regions. Globally, RSV-induced LRIs have shown a significant reduction in burden, but interventions are still urgently needed—particularly in low SDI areas—to reduce the impact on vulnerable populations. Public health policies focusing on these high-risk groups are essential for addressing the remaining disparities in RSV-related morbidity and mortality. Full article

Aim: To analyze the burden of road injuries in Colombia from 1990 to 2021, disaggregated by sex, age groups, and road injury category. Methods: Observational study based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. National data on prevalence, incidence, mortality, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life-years (DALY) were obtained. Data are reported in years and age-standardized and age-specific rates per 100,000 inhabitants. A log-linear segmented regression model was employed to analyze trends in DALY rates of road injuries from 1990 to 2021. Results: From 1990 to 2021, the age-standardized prevalence and incidence rates (per 100,000 inhabitants) due to road injury decreased by −30.6% (95% UI: −34.3; −26.4) and −27.5% (95% UI: −30.7; −24.4), respectively. The age-standardized mortality rate trend of road injuries decreased by −40.6% (95% UI: −50.0; −31.0). Meanwhile, the age-standardized DALY rate decreased by −39.7% (95% UI: −47.9; −31.3) during the study period. In all indicators, men’s rates were higher than women’s. By road injury category, the age-standardized rates increased significantly for motorcyclist road injuries, particularly among men. Conclusions: Road injuries in Colombia have declined but remain significant, especially for young men. Motorcycle injuries show alarming increases in mortality and DALY rates. Full article

Background: Endoscopic therapies for Crohn’s disease (CD) strictures, including endoscopic balloon dilation (EBD) and endoscopic stricturotomy (ESt), are less invasive interventions compared to surgery. ESt is advantageous for strictures that are longer, more fibrotic, or adjacent to anatomic structures requiring precision, and it has shown a high rate of surgery-free survival. Methods: We designed a microsimulation state-transition model comparing ESt to surgical resection for CD strictures. We calculated quality-adjusted life years (QALYs) over a 10-year time horizon; secondary outcomes included costs (in 2022 USD) and incremental cost-effectiveness ratios (ICERs). We used a societal perspective to compare our strategies at a willingness-to-pay (WTP) threshold of 100,000 USD/QALY. Sensitivity analyses, both deterministic and probabilistic, were performed. Results: The surgery strategy cost more than 2.5 times the ESt strategy, but resulted in nine more QALYs per 100 persons. The ICER for the surgery strategy was 308,787 USD/QALY; thus, the ESt strategy was determined more cost-effective. One-way sensitivity analyses showed that quality of life after ESt as compared to that after surgery, the likelihood of repeat intervention, and surgical mortality and cost were the most influential parameters shifting cost-effectiveness. Probabilistic sensitivity analyses favored ESt in most (65.5%) iterations. Conclusions: Our study finds endoscopic stricturotomy to be a cost-effective strategy to manage primary or anastomotic Crohn’s disease strictures. Post-intervention quality of life and probabilities of requiring repeated interventions exert most influence on cost-effectiveness. The decision between ESt and surgery should be made considering patient and stricture characteristics, preferences, and cost-effectiveness. Full article

The quality of life (QoL) perception has been studied in neurological diseases; however, there is limited information linking brain morphological characteristics, QoL, and cognition. Human behavior and perception are associated with specific brain areas that interact through diffuse electrochemical networking. We used magnetic resonance imaging (MRI) to analyze the brain region volume (BRV) correlation with the scores of Rand’s 36-item Short Form Survey (SF-36) and cognitive domains (memory and dementia status). We analyzed data from 420 adult participants in the Maracaibo Aging Study (MAS). Principal component analysis with oblimin axis rotation was used to gather redundant information from brain parcels and SF-36 domains. Canonical correlation was used to analyze the relationships between SF-36 domains and BRV (adjusted for intracranial cavity), as well as sex, age, education, obesity, and hypertension. The average age (±SD) of subjects was 56 ± 11.5 years; 71% were female; 39% were obese; 12% had diabetes, 52% hypertension, and 7% dementia. No sex-related differences were found in memory and orientation scores, but women had lower QoL scores. The 1st and 2nd canonical correlation roots support the association of SF-36 domains (except social functioning and role emotional) and total brain volume, frontal lobe volume, frontal pole, lateral orbital lobe, cerebellar, and entorhinal areas. Other variables, including age, dementia, memory score, and systolic blood pressure, had a significant influence. The results of this study demonstrate significant correlations between BRV and SF-36 components, adjusted for covariates. The frontal lobe and insula were associated with the mental health component; the lateral-orbital frontal lobe and entorhinal area were correlated with the physical component. Full article

Background: Cancer survivors may continue to experience health issues that affect their quality of life and raise the risk of other chronic diseases. Methods: This study aimed to assess adherence to general health check-ups, cancer-specific screenings, and chronic disease management among five-year cancer survivors using nationally representative data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted between 2013 and 2021. A total of 2597 cancer survivors and 2458 matched non-cancer controls were selected via 1:1 propensity score matching based on demographic and lifestyle characteristics. We analyzed health behaviors (smoking and alcohol use), participation in general and cancer-specific screenings, and medication adherence for hypertension, diabetes, and dyslipidemia. Results: Compared to controls, cancer survivors, especially those diagnosed more than five years ago, were significantly less likely to participate in recommended cancer screenings (adjusted OR: 0.82, p = 0.014) and had lower adherence to treatment for hypertension (adjusted OR: 1.84, p = 0.004) and dyslipidemia (adjusted OR: 1.42, p = 0.026). However, cancer survivors were less likely to smoke or consume alcohol. Conclusions: These findings underscore the need for comprehensive survivorship care policies that integrate both cancer surveillance and chronic disease management. Full article

Objective: This study aimed to explore the burden attributable to different groups of risk factors (environmental/occupational, behavioral, and metabolic) in Saudi Arabia that were stratified by gender and year and measured by summary exposure values (SEVs) and disability-adjusted life years (DALYs) per 100,000. Design: This study was structured as a systematic analysis. Methods: Using the GBD 2021 data, we extracted information on different risk factors attributed to the disease burden in Saudi Arabia to quantify the differences in exposure value (SEV) and disability-adjusted life year (DALY) rates (per 100,000) between females and males across different years. Results: Over the years, sustained progress in reducing the number of DALYs attributable to specific environmental and occupational risks has been observed, as well as a slight decrease in some behavioral risks. The highest disease burden was attributed to metabolic and behavioral risk factors, with body mass index being the leading risk factor for both genders. Between 1990 and 2021, the age-standardized DALY rate in those with high body mass indices increased by 168.4% and reached 3436.23 (95% UI 1878.7–5031.5) in males and increased by 125.2% to reach 2952.6 (95% UI 1456.9–4.407) in females. The age-standardized SEVs were the highest in females with a high body mass index, reaching an SEV of 57.98 (95% UI: 64.1–49.2), and in males, an SEV of 50.75 (95% UI: 57.1–42.3) was achieved. Regarding their attributable deaths in 2021, metabolic risk factors were identified as the primary contributors to NCD mortality in 2021. Conclusions: These results reveal persistent health disparities between males and females, underscoring the urgent need for gender-specific research, policies, and interventions. Strategies aimed at promoting health and reducing disease burden should acknowledge the unique health challenges encountered by males and females. Full article

Background: Development Assistance for Health (DAH) plays a vital role in health financing across Sub-Saharan Africa, particularly in tackling communicable diseases such as HIV/AIDS, malaria, and tuberculosis. Despite its importance, the efficiency and equity of DAH allocation remain contested. Objectives: The study aims to evaluate the cost-effectiveness of DAH in Sub-Saharan Africa from 1995 to 2018, as well as to explore differences in efficiency across diseases and country contexts. Methods: Data were drawn from the Institute for Health Metrics and Evaluation and applied Generalized Cost-Effectiveness Analysis in conjunction with the Gross Domestic Product-based thresholds. Averted Disability-Adjusted Life Years were analyzed across countries and diseases, and countries were categorized by the Human Development Index (HDI) level to assess differential DAH performance. Results: DAH cost-effectiveness showed similar patterns across HDI groups, with roughly equal proportions of cost-effective and dominated outcomes in both low- and middle-HDI countries. Thirteen countries were identified as very cost-effective, nine as cost-effective, and two as non-cost-effective. Twenty-one countries were dominated, reflecting persistent inefficiencies in aid impact that transcends the various levels of development. Conclusions: Tailoring DAH allocation to specific disease burdens and development levels enhances its impact. The study underscores the need for targeted investment and a strategic shift toward integrated health system strengthening. Additionally, microinsurance is highlighted as a key mechanism for improving healthcare access and financial protection in low-income settings. Full article

Breast cancer is a condition characterized by the uncontrolled growth of breast cancer cells. The treatment for the disease, such as surgery, chemotherapy, radiotherapy, and systemic therapy, can significantly impact patients’ body image and overall quality of life. This study aimed to evaluate body image perceptions and cancer-related quality of life in women who underwent surgical treatment for breast cancer at a reference hospital in southern Brazil. One hundred six women with breast cancer, aged 21 to 93 years (M = 55.3; SD = 12.9), participated in this cross-sectional study. They responded to the Body Image and Relationships Scale (BIRS), Functional Assessment of Cancer Therapy for Breast Cancer scale (FACT-B), and a questionnaire on clinical and sociodemographic variables. Multiple linear regression analyses revealed that general perceived body image, as measured by BIRS, was significantly predicted by younger age and chemotherapy (F(2, 99) = 7.376, p = 0.003). These predictors accounted for 11.2% of the variance in BIRS (adjusted R² = 0.112). Hierarchical multiple regression analysis indicated that cancer-related quality of life was significantly predicted by younger age, use of psychiatric medication, and body image domains, including strength and health, social barriers, and appearance and sexuality. The complete model, encompassing all predictors, was significant (F(5, 96) = 15.970, p < 0.001) and explained 42.6% of the variance in FACT-B (adjusted R² = 0.426). Clinicians should be aware that younger patients who have undergone chemotherapy for breast cancer may experience changes in body image perception following surgery. Contributing factors such as younger age, use of psychiatric medications, and negative postoperative body image may be associated with a diminished quality of life related to cancer. Full article

Background/Objectives: Climate change is a major factor exacerbating non-communicable diseases (NCDs) such as cardiovascular diseases, neoplasms, respiratory diseases, and diabetes, especially in vulnerable Latin American regions. This study analyzes the impact of environmental exposures related to climate change on the NCD burden in eight Latin American countries by quantifying the disability-adjusted life years (DALYs) attributable to these factors. Using Global Burden of Disease (GBD) data (1990–2021), we performed multiple linear regression to assess associations between DALYs and environmental risk factors—air pollution (particulate matter, nitrogen dioxide), radon, lead, and extreme temperatures—in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, and Uruguay. The study included major NCDs, and the population was stratified by age and sex. Results: Ischemic heart disease was the leading cause of DALYs in most countries. Particulate matter pollution was the main environmental risk factor contributing to the NCD burden, mainly affecting cardiovascular and respiratory diseases. Mexico showed the highest DALYs from particulate and ozone pollution; temperature and lead exposure also contributed in some countries. Nitrogen dioxide was the primary risk factor for asthma. Statistically significant relationships between environmental factors and DALYs were confirmed. Conclusions: Climate change-related exposures significantly increase the burden of NCDs in Latin America. Targeted interventions in industry, transportation, and energy, along with sustainable urban policies, are essential to mitigate health impacts and reduce disparities. Integrating environmental health into public policies can improve health outcomes amid ongoing climate challenges. Full article

Background/Objectives: The role of maternal diet in atopic dermatitis (AD) requires better understanding, as AD often manifests early in life and precedes other allergic diseases. We evaluated the association between maternal diet and AD up to 2 years of age. Methods: A total of 116 mother–child dyads from the CARE birth cohort study were included. Maternal diet during pregnancy was assessed with a validated self-administered 97-item food frequency questionnaire, and dietary scores were calculated. AD was evaluated at ages 4 months, 1 year, and 2 years. The associations between maternal dietary patterns and AD were examined by logistic regression analysis adjusting for total energy intake, gender of the child, maternal antibiotic therapy during pregnancy, and history of atopic disease among both parents. Results: Of the 116 children, 27 (23.3%) developed AD by 2 years, 11 of whom (40.7%) had persistent AD within the first 2 years. AD risk was reduced with a higher Mediterranean diet score during pregnancy (upper median > 3 points versus lower median: adjusted OR 0.24, 95% CI 0.08–0.69, p = 0.009) and with greater dietary diversity, as measured by the number of items consumed (upper median > 53 items versus lower median: OR 0.19, 95% CI 0.06–0.58, p = 0.005). No association was found with macronutrients and micronutrients. Red meat consumption showed a positive association with the persistent AD phenotype (adjusted OR 5.04, 95% CI 1.47 to 31.36, p = 0.034). Conclusions: Adherence to a Mediterranean diet and a diverse diet during pregnancy may decrease the risk of developing early childhood AD. This highlights the synergistic role of nutrients in dietary patterns as they modulate immune development and disease susceptibility. Full article