Academic literature on the topic '2004 Public health (excl. specific population health)'

Introduction:HLH is a rare, life-threatening disorder, characterized by hyperstimulation of immune system leading to systemic inflammation and multi-organ failure. It is categorized as primary and secondary HLH. Secondary HLH usually affects adolescents and adults. It results from acquired immune dysregulation secondary to a number of etiologies, including infections, malignancy, and autoimmune diseases. Owing to less epidemiological data, adult HLH is thought to be underdiagnosed, making a true assessment difficult, however, some observational data suggest 40% of HLH cases occurs in adults. Disease presentation includes fever, cytopenias, organomegaly, liver function anomalies, elevated ferritin levels, and/or demonstration of macrophage activation in hematopoietic organs. In 2014, Fardet et al proposed the H-Score, a novel diagnostic score derived from 162 adult patients with HLH.We aim to report a retrospective review of Adult HLH in an urban safety-net hospital over the course of two decades along with predictive value of H-score in our patient population. Methods:We conducted a retrospective review of patients diagnosed with HLH at Cook County Health, Chicago between January 2000 and January 2019 after approval by the Institutional Review Board. Patients were identified from electronic records using ICD-10 codes D76.1, D76.2, and ICD-9 code 288.4. Patients under 18 years were excluded. MS excel was used for data collection and further descriptive statistics were calculated with frequencies and percentage. Results:After initial review, 12 confirmed and eligible cases were included in the study. Mean age at diagnosis of adult HLH at our center was 37, with male predominance(7 males, 4 females, and 1 female transgender). 5 were African-American, 6 were Hispanic, and 1 was Asian. Most common presentation was fever, seen in 10 out of 12 cases, along with variety of symptoms like fatigue, sore throat and jaundice.4 out of 12 patients (33%) had HIV/AIDS, with CD4 counts between 79 to 180. 3 were already receiving anti-retroviral therapy at the time of HLH diagnosis, while 1 was diagnosed with HIV/AIDS at the time of HLH diagnosis. Etiologic spectrum mainly included infectious (4 HIV and 3 EBV) and autoimmune (2 systemic lupus erythematous, 1 cold immune hemolytic anemia with immune thrombocytopenic purpura) causes. 1 patient had an underlying malignancy (diffuse large B-cell lymphoma). Etiology was not established in 1patient with no familial associations found in subsequent genetic evaluation. All patients had elevated liver enzymes. The mean ferritin level in our cohort was 19,198 ng/ml. Leucopenia was seen among most cases, 11 out of 12. The 1 patient noted to have a high white cell count was actually receiving corticosteroid therapy for cold immune hemolytic anemia. Most common bone marrow findings were hemophagocytosis (9 patients) and hypocellularity (7 patients). 2 had hypercelullar marrow and 1 had normal marrow. Genetic testing was performed in 4 patients; chromosomal abnormalities were not observed in any. Specific lab parameters in our cohort as included in HLH-2004 criteria is shown in Table 1. Calculated H scores in our cohort is shown in table 2. 11 patients fall under high probability for HLH. Conclusion:The most widely used diagnostic criteria for HLH is the HLH-2004 diagnostic criteria, derived from pediatric HLH study. It is often extrapolated for use in adults. There are several limitations to the HLH-2004 diagnostic criteria. sIL2r and NK function testing is not available in all centers, and many of the manifestations of HLH in adults are not included in the criteria. When using H score, a cutoff value of 169, corresponds to sensitivity of 93% and specificity of 86% in diagnosing HLH. In our study, 11 out of 12 patients (91.66) scored higher than 169, which is highly suggestive of HLH. The remaining 1 patient with H score of only 118, however, met the diagnosis of HLH by HLH-2004 criteria (score: 5/8). Therefore, although our study population was small, results of our study were in favor of using H-score as an appropriate diagnostic tool in adult-onset HLH, which also helps mitigate the restrictions of HLH-2004 criteria in adult population. Disclosures No relevant conflicts of interest to declare.

BackgroundAs the worldwide population has aged, the number of surgical procedures performed on older patients has increased. It is not known whether this increase has been proportional to growth in the elderly population. The aim of this study was to assess the population-adjusted incidence of acute and elective general and orthopaedic surgery in older patients at a tertiary hospital in New Zealand.MethodsThis was a retrospective study using routinely collected electronic data from Auckland District Health Board (DHB) and New Zealand Ministry of Health databases. Population estimates and numbers of general surgical and orthopaedic procedures from 2004 to 2016 were obtained. Annual age-specific incidence rates of surgical procedures were calculated and trends analysed using negative binomial regression.ResultsThe incidence of elective surgery increased by 5.35% annually from 2004 to 2016. The rate of increase is lower in the Māori population (2.14%) compared with other ethnic groups (4.22%–5.62%). The incidence of acute surgery in those aged 70 years and above decreased from 2004 to 2016. The European and other ethnic group had the highest rate of acute surgery, and higher rates of elective surgery than Pacific and Asian peoples.ConclusionThe increasing number of elective general surgical and orthopaedic procedures performed on older patients in Auckland DHB is beyond what is expected for population growth alone. This has significant implication for clinicians, healthcare providers and governmental institutions. Ethnic differences are evident and warrants further attention as these may reflect disparities in access to surgery.

In the article there is presented an analysis of the own parasitological studies, as well as indices of the prevalence of parasitic diseases according to the official statistical reports of medical institutions, Service for Supervision of Consumer Rights Protection and Human Welfare in the Nenets Autonomous District (NAD) over the periodfrom 2002 to 2013. The survey on parasitoses was performed in the indigenous population - the Nenets reindeer herders and their families, as well as in the alien population residing in the territory of the NAD settlements: Varnek, Krasnoe, Karatayka, Nes, Haruta, Norey-Ver, Iskateley, village Oma, and city of Naryan-Mar. During this period, by means of the method of the native smear there were surveyed 5891 cases, method of Kato - 217,417 persons, by perianal scraping - 3054 persons, by ELISA for the presence of specific antibodies to the antigens of various parasites - 11556 cases. The statistical analysis was performed with the use of Statistical Software Package - Excel 2010. There were revealed both downward trends in the prevalence of the county's population for giardiasis, enterobiasis, diphyllobothriasis and the gain in indices of prevalence of ascariasis in the population of the District, also there were detected and found new types ofparasitoses for county - opisthorchiasis, toxocariasis in all age groups of the population of NAD.

Objectives. Orofacial clefts are common birth defects that often require multiple surgeries and medical treatments during childhood. We used healthcare insurance claims data to estimate health-care expenditures for infants and children ≤10 years of age with an orofacial cleft. Methods. The data were derived from the 2000–2004 MarketScan® Commercial Claims and Encounters databases, which include person-specific information on health-care use, expenditures, and enrollment for approximately 50 large employers, health plans, and government and public organizations. Health insurance claims data from 821,619 children ≤10 years of age enrolled in employer-sponsored plans during 2004 were analyzed. Expenditures for inpatient admissions, outpatient services, and prescription drug claims were calculated for children with and those without an orofacial cleft. Results. The difference in annual mean costs (i.e., incremental costs) between children aged 0 through 10 years with an orofacial cleft and those without an orofacial cleft was $13,405. The mean and median costs for children ≤10 years of age with an orofacial cleft were eight times higher than for children of the same age without an orofacial cleft. Mean costs for infants with a cleft and another major, unrelated defect were 25 times higher than those for an infant without a cleft, and five times higher than for infants with an isolated cleft. Conclusion. These findings document substantially elevated medical care costs for privately insured children with an orofacial cleft. Additional study of the economic burden associated with this condition should include a broader range of economic costs.

Purpose – The purpose of this paper is to investigate the claim by the Chief Medical Officer for England that “There is virtually no robust, peer-reviewed evidence to support a ‘well-being’ approach to mental health”. Design/methodology/approach – Secondary research using research literature from two widely available databases, Scopus and Applied Social Sciences Index and Abstracts. Randomised controlled trials were sought that focused on “well-being” (including well-being or wellness), from 2004 to the present. Findings – With both clinical samples and non-clinical populations, a variety of experimental trials were found. Studies were identified with both positive benefits and no benefits from intervention. The most numerous type of paper reported positive benefits for clinical patients. Research limitations/implications – Only a single reader classified the studies in this investigation, so the inter-rater reliability may be limited. Only two databases were searched. However, future work (such as that in progress by the What Works Centre for Wellbeing) may find an abundance of evidence on mental well-being. Practical implications – In many settings, well-being can improve after intervention. Social implications – What is measured as “well-being” may need to take into account the perspective of the specific population being studied. Originality/value – This small-scale study was undertaken to inform policy in the new Public Mental Health Network.

Background: While broad-based societal efforts to improve public health have targeted disorders such as cardiovascular disease and cancer for several decades, efforts devoted to kidney disease have developed only more recently. The Peer Kidney Care Initiative, a novel effort designed to address knowledge gaps in the care of patients with kidney disease, examines key disease processes, the roles of geography and seasonality on outcomes, and longitudinal trends in outcomes over time. Summary: Admissions for gastrointestinal bleeds increased approximately 28% between 2004 and 2011 in prevalent patients. Infection with Clostridium difficile increased nearly 70% between 2003 and 2010 in patients within a year of initiation. Admissions for heart failure in prevalent patients decreased approximately 25% between 2004 and 2012, but admissions for volume overload increased a nearly equal amount. Incidence rates varied substantially by geographic region, such that unadjusted rates in the highest region were nearly double than those in the lowest. There was seasonal variation in all-cause mortality of approximately 15-20% in both incident and prevalent patients, suggesting a link between cardiovascular events and seasonally related environmental conditions. New cases of end-stage renal disease fell from 385 per million population in 2003 to 344 in 2012, a decline of approximately 10%. Key Messages: Peer complements existing kidney disease epidemiologic efforts by examining specific actionable disease entities, exploring geographic variation in care, highlighting the role of seasonality on outcomes, and emphasizing the importance of trending outcomes over time as overall societal progress is being made.

Objectives: To determine by systematic review the prevalence of genital chlamydial infection in Australia between 1997 and 2004. Methods: Electronic literature databases, reference lists, and conference proceedings were searched and health agencies and jurisdictions were contacted for published and unpublished reports. Studies were eligible if they offered a diagnostic nucleic acid amplification test to consecutive individuals presenting during the study period. As a summary measure of the available data, mean prevalence rates, weighted by sample size and irrespective of participant age, were calculated for the population sub-groups. Results: 40 studies of 50 populations and 40587 individuals met the inclusion criteria, but only one of these was population-based. The use of non-systematic methodologies prevented an assessment of time trends and a statistical comparison of population sub-groups. The mean overall prevalence of genital chlamydial infection was 4.6% (95% CI 4.4–4.8%), reflecting over-sampling of high-risk groups. The mean community-based rates were 7.5% (95% CI 6.4–8.6%) and 8.7% (95% CI 7.9–9.7%) for Indigenous men and women, and 1.5% (95% CI 1.1–1.9%) and 1.4% (95% CI 0.9–2.0%) for non-Indigenous men and women. The overall mean estimates for other groups were 3.3% (95% CI 3.0–3.7%) for female attendees of sexual health and related clinics, 5.6% (95% CI 4.9–6.4%) for adolescents and young adults, 3.3% (95% CI 2.8–3.9%) for sex workers, and 1.6% (95% CI 1.2–2.0%) for urethral infection in men who have sex with men. Clinic-based estimates were generally, although not consistently, higher than community-based estimates. There is no serial population-based data for sexually active young men and women, but the available age-specific rates suggest under-ascertainment by the routine surveillance systems. Conclusions: The prevalence of genital chlamydial infection in Indigenous Australians and young adults is unacceptably high and quality epidemiological studies are urgently required to supplement the routinely collected national notification data.

ObjectivesAsbestos is the main risk factor for peritoneal mesothelioma (PeM). However, due to its rarity, PeM has rarely been investigated in community-based studies. We examined the association between asbestos exposure and PeM risk in a general population in Lombardy, Italy.MethodsFrom the regional mesothelioma registry, we selected PeM cases diagnosed in 2000–2015. Population controls (matched by area, gender and age) came from two case–control studies in Lombardy on lung cancer (2002–2004) and pleural mesothelioma (2014). Assessment of exposure to asbestos was performed through a quantitative job-exposure matrix (SYN-JEM) and expert evaluation based on a standardised questionnaire. We calculated period-specific and gender-specific OR and 90% CI using conditional logistic regression adjusted for age, province of residence and education.ResultsWe selected 68 cases and 2116 controls (2000–2007) and 159 cases and 205 controls (2008–2015). The ORs for ever asbestos exposure (expert-based, 2008–2015 only) were 5.78 (90% CI 3.03 to 11.0) in men and 8.00 (2.56 to 25.0) in women; the ORs for definite occupational exposure were 12.3 (5.62 to 26.7) in men and 14.3 (3.16 to 65.0) in women. The ORs for ever versus never occupational asbestos exposure based on SYN-JEM (both periods) were 2.05 (90% CI 1.39 to 3.01) in men and 1.62 (0.79 to 3.27) in women. In men, clear positive associations were found for duration, cumulative exposure (OR 1.33 (1.19 to 1.48) per fibres/mL-years) and latency.ConclusionsUsing two different methods of exposure assessment we provided evidence of a clear association between asbestos exposure and PeM risk in the general population.

Objective To investigate the impact of population mammography screening on breast cancer incidence trends in New Zealand. Methods Trends in age-specific rates of invasive breast cancer incidence (1994–2014) were assessed in relation to screening in women aged 50–64 from 1999 and 45–69 following the programme age extension in mid-2004. Results Breast cancer incidence increased significantly by 18% in women aged 50–64 compared with 1994–98 (p<0.0001), coinciding with the 1999 introduction of mammography screening, and remained elevated for four years, before declining to pre-screening levels. Increases over 1994–99 incidence occurred in the 45–49 (21%) and 65–69 (19%) age groups following the 2004 age extension (p<0.0001). Following establishment of screening (2006–10), elevated incidence in the screening target age groups was compensated for by lower incidence in the post-screening ⩾70 age groups than in 1994–98. Incidence in women aged ⩾45 was not significantly higher (+5%) after 2006 than in 1994–98. The cumulated risk of breast cancer in women aged 45–84 for 1994–98 was 10.7% compared with 10.8% in 2006–10. Conclusions Increases in breast cancer incidence following introduction of mammography screening in women aged 50–64 did not persist. Incidence inflation also occurred after introduction of screening for age groups 45–49 and 65–69. The cumulated incidence for women aged 45–84 over 2006–10 after screening was well established, compared with 1994–98 prior to screening, shows no increase in diagnosis. Over-diagnosis is not inevitable in population mammography screening programmes.

There has been a growing concern among researchers and media commentators that men in the United States may be increasingly less sexually active, creating a form of a “sex recession.” Using 14 years of survey data from men in the National Survey of Family Growth (2006–2019), this study assesses whether such concerns are warranted. Cross-classified mixed-effects models are estimated to ascertain whether there is evidence of a population-wide sex recession among men due to secular conditions specific to different time periods, or if birth cohorts that comprise the male population at any given point in time are exhibiting distinct patterns of sexual behavior. The analysis finds no evidence of a population-wide sex recession among men. Rates of sexual inactivity among men have been constant across the time series, but those born between 2000 and 2004 had significantly higher rates of sexual inactivity than previous birth cohorts did at the same age. Additionally, men who are unemployed and/or living at home with their parents are more likely to refrain from sexual intercourse than their peers who are employed and/or living independently of their parents.