Trauma is a major cause of morbidity and mortality across the globe accounting for significant health burden.Relevance of trauma care revolves round prevention,planning and execution of safety regulations.Acquisition ...Trauma is a major cause of morbidity and mortality across the globe accounting for significant health burden.Relevance of trauma care revolves round prevention,planning and execution of safety regulations.Acquisition of the actual data regarding the type of trauma,affected age group,timings of trauma occurrence,involved part of the body constitute the initial steps in the building of the composite overview of the epidemiology of trauma.In succession,would be the measures directed towards avoidance of trauma and capacity building of trauma center.展开更多
BACKGROUND Ampullary adenocarcinoma is a rare malignant tumor of the gastrointestinal tract.Currently,only a few cases have been reported,resulting in limited information on survival.AIM To develop a dynamic nomogram ...BACKGROUND Ampullary adenocarcinoma is a rare malignant tumor of the gastrointestinal tract.Currently,only a few cases have been reported,resulting in limited information on survival.AIM To develop a dynamic nomogram using internal and external validation to predict survival in patients with ampullary adenocarcinoma.METHODS Data were sourced from the surveillance,epidemiology,and end results stat database.The patients in the database were randomized in a 7:3 ratio into training and validation groups.Using Cox regression univariate and multivariate analyses in the training group,we identified independent risk factors for overall survival and cancer-specific survival to develop the nomogram.The nomogram was validated with a cohort of patients from the First Affiliated Hospital of the Army Medical University.RESULTS For overall and cancer-specific survival,12(sex,age,race,lymph node ratio,tumor size,chemotherapy,surgical modality,T stage,tumor differentiation,brain metastasis,lung metastasis,and extension)and 6(age;surveillance,epidemiology,and end results stage;lymph node ratio;chemotherapy;surgical modality;and tumor differentiation)independent risk factors,respectively,were incorporated into the nomogram.The area under the curve values at 1,3,and 5 years,respectively,were 0.807,0.842,and 0.826 for overall survival and 0.816,0.835,and 0.841 for cancer-specific survival.The internal and external validation cohorts indicated good consistency of the nomogram.CONCLUSION The dynamic nomogram offers robust predictive efficacy for the overall and cancer-specific survival of ampullary adenocarcinoma.展开更多
Breast cancer is the most common cancer among women worldwide. The term epidemiology generally deals with the branch of medicine and treatment that deals with a specific incident. Thus, considering the topic of breast...Breast cancer is the most common cancer among women worldwide. The term epidemiology generally deals with the branch of medicine and treatment that deals with a specific incident. Thus, considering the topic of breast cancer, this particular study deals with the distribution, determinants, and frequency of the disease. Breast cancer incidence and death data are critical to determining healthcare priorities. Women’s cancer is the most common, accounting for 25.1 percent of all malignancies. According to this specific report, more than 42,000 women die from breast cancer each year. Hence, it is apparent that it is the second leading cause of death among women, especially in the US. Family history/genetics, reproductive, hormone, benign proliferative breast disease, and mammographic density are the four main risk factors for breast cancer that can be meaningfully categorized. These elements are briefly discussed, and the risk estimators are provided. Numerous screening technologies have found breast cancer;some are linked to an increased risk of breast cancer, such as ultrasound techniques and MRI scanning. Breast cancer is more common in developed countries, while relative mortality is highest in developing countries. Women’s education is recommended for early detection and treatment in all nations. Health policymakers must prioritize plans to control and prevent this malignancy and increase awareness of risk factors and early detection in less developed countries.展开更多
Hepatocellular carcinoma(HCC)is one of the leading causes of cancer-related deaths globally,and its epidemiological characteristics and risk factors are continuously evolving.This review systematically elaborates on t...Hepatocellular carcinoma(HCC)is one of the leading causes of cancer-related deaths globally,and its epidemiological characteristics and risk factors are continuously evolving.This review systematically elaborates on the global disease burden of HCC,the main risk factors(including hepatitis B/C virus infection,non-alcoholic fatty liver disease,aflatoxin exposure,and unhealthy lifestyles),and the corresponding prevention strategies.The article provides a detailed analysis of the performance and limitations of key serological markers currently used for early diagnosis of HCC,such as alpha-fetoprotein,abnormal prothrombin,and alpha-fetoprotein variant L3.Furthermore,the review comprehensively summarizes the advancements in clinical treatment for HCC,ranging from radical approaches including surgical resection,liver transplantation,radiofrequency ablation to palliative therapies for patients with advanced disease such as transcatheter arterial chemoembolization,targeted therapy,immunotherapy,and further evaluates their efficacy,indications,and challenges.This article aims to provide a comprehensive reference for a deeper understanding of the current status of HCC prevention and control,improving early diagnostic rates,and optimizing clinical treatment strategies.展开更多
In recent years,nosocomial infections caused by Clostridium difficile(C.difficile)have risen,becoming a leading cause of hospital-acquired diarrhea.The global prevalence of C.difficile infection(CDI)varies across regi...In recent years,nosocomial infections caused by Clostridium difficile(C.difficile)have risen,becoming a leading cause of hospital-acquired diarrhea.The global prevalence of C.difficile infection(CDI)varies across regions and populations.The diagnosis relies primarily on laboratory testing,including toxin,glutamate dehy-drogenase,and nucleic acid amplification tests.Treatment strategies for CDI in-clude antimicrobial therapy(e.g.,metronidazole,vancomycin,and fidamycin),fecal transplantation,and immunotherapy(e.g.,belotozumab),depending on the patient’s specificity and severity.This paper reviews recent research on CDI’s epidemiological characteristics,risk factors,diagnosis,treatment,and prevention,aiming to support hospitals and public health initiatives in implementing effective detection,prevention,and treatment strategies.展开更多
BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world ...BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world setting and factors associated with CPF development,treatment failure,and reasons for undergoing multiple surgeries may help to inform optimal patient management strategies,reduce treatment burden,and improve outcomes in patients with CPF.AIM To describe the epidemiology,treatments,outcomes,and associated risk/protective factors for complex CPF.METHODS Electronic databases(MEDLINE,EMBASE,EBM Reviews,EconLit)were searched.Two reviewers independently used populations,interventions,comparators,outcomes,study designs,and time criteria to identify relevant studies.Observational studies published in English from January 1,2015 to February 17,2022 with>50 patients were included,even if complex CPF was not defined.Items of interest included complex CPF definitions,epidemiology,treatment patterns,morbidity,mortality,and risk factors associated with complex CPF development,treatment failure,and undergoing multiple surgeries.Data were reported using descriptive statistics.RESULTS Overall,140 studies were included.Complex CPF definitions were heterogeneous and rarely reported(24 studies).Hence,data mostly related to CPF in general.CPF prevalence was variable(range:1.5%-81.0%).Incidence was wide-ranging and mostly reported cumulatively at 1-year post-Crohn’s disease diagnosis(range:3.5%-50.1%).Overall healing and failure rates after treatment were in the range of 10.5%-80.2%and 3.6%-83.0%,respectively.Abscesses were the most frequently reported morbidity(n=18).No CPF-related deaths were reported.No consistent risk or protective factors were identified.CONCLUSION Epidemiology,treatment patterns,and risk factors for CPF vary,likely due to inconsistent CPF and clinical outcome definitions.Standardization would facilitate comparability,which may inform optimal complex CPF treatment strategies.展开更多
Introduction: Influenza A (Flu A) and B (Flu B) viruses are responsible for severe acute respiratory infections (SARI) worldwide, with a morbidity of 5 million and mortality of 29,000 - 650,000 deaths per year. Influe...Introduction: Influenza A (Flu A) and B (Flu B) viruses are responsible for severe acute respiratory infections (SARI) worldwide, with a morbidity of 5 million and mortality of 29,000 - 650,000 deaths per year. Influenza B viruses are an important cause of respiratory infections in humans, but they tend to be underappreciated due to the predominance of Influenza A. No molecular study on Influenza B has been carried out in the DRC. This study was conducted to document the molecular evolution of the hemagglutinin (HA) gene in the circulating Influenza B strains over the eight consecutive epidemic seasons (from 2015 to 2022). Methods: Samples were collected from outpatient cases suspected of influenza-like illness (ILI) and in all hospitalized patients with SARI from January 2015 to December 2022. Molecular analysis was done to determine influenza type and subtype, and then segments encoding the HA gene of Influenza B viruses were performed. Results: Of 8497 samples collected and tested, 639 (7.5%) were positive for influenza viruses, including 389 (60.8%) for Influenza A viruses and 248 (38,8%) for Influenza B viruses. Of the positive Influenza B samples, 91 were sequenced, including 26 belonging to the B/Yamagata lineage and 65 to the B/Victoria lineage. The HA gene of Influenza B viruses circulating in the DRC showed deletions in the HA1 region. Molecular analysis of Influenza B viruses reflects the genetic diversity of Influenza B/Yam virus clades (Y2, Y3, Y3V1A) alternating with Influenza B/Victoria virus clades (V1A, V1A.3) depending on the year and influenza seasons. The phylogenetic analysis of these Influenza B strains shows compatibility with the corresponding vaccine strains that the WHO had validated for each influenza season. Conclusion: This study underscores the importance of continuous molecular surveillance of Influenza B viruses in the DRC to understand their epidemiology and evolutionary dynamics. Identifying mutations, such as HA deletions, is critical for assessing their impact on transmissibility vaccine efficacy and guiding effective vaccination and control strategies.展开更多
Acquired Immunodeficiency Syndrome(AIDS)caused by Human Immunodeficiency Virus(HIV)infection poses a serious threat to global public health.This article comprehensively reviews the epidemiological characteristics of H...Acquired Immunodeficiency Syndrome(AIDS)caused by Human Immunodeficiency Virus(HIV)infection poses a serious threat to global public health.This article comprehensively reviews the epidemiological characteristics of HIV infection,including the global and domestic epidemic situation,transmission routes,and characteristics of high-risk groups.It also introduces comprehensive prevention and control strategies in detail.Through analysis,it aims to provide a reference for further optimizing HIV prevention and control work.展开更多
BACKGROUND Gestational diabetes mellitus(GDM)is a growing public health concern,particularly in regions with diverse ethnic populations.Understanding the incidence and risk factors of GDM is crucial for early preventi...BACKGROUND Gestational diabetes mellitus(GDM)is a growing public health concern,particularly in regions with diverse ethnic populations.Understanding the incidence and risk factors of GDM is crucial for early prevention and management,especially in underrepresented areas like Guizhou Province,China,where geographic and ethnic diversity may influence the disease’s prevalence and risk profiles.AIM To investigate the incidence of GDM and identify its associated risk and protective factors among different ethnic groups in Guizhou Province,providing essential data for early prevention strategies.METHODS A multi-center retrospective study was conducted,dividing participants into GDM and non-GDM groups according to standardized diagnostic criteria.Data were collected from 103629 deliveries across 40 hospitals in Guizhou.Various demographic,clinical,and laboratory parameters were analyzed using logistic regression to identify risk and protective factors for GDM.RESULTS Among the 103629 deliveries,18957 cases of GDM were identified,with an incidence of approximately 18.3%.The risk of GDM was higher in the Han ethnic group compared to minority ethnic groups.The Dong ethnic group had the lowest incidence among the minorities.Key risk factors identified included older age(especially>35 years),higher pre-pregnancy body mass index(BMI),light physical activity,gravidity,family history of diabetes,hemoglobin,aspartate aminotransferase,alanine aminotransferase,and direct bilirubin.Protective factors included higher education level,total protein,and albumin.There were also differences based on blood type,with type A associated with higher risk.CONCLUSION The incidence rate in Guizhou is 18.3%.Older age(especially>35 years),Han ethnicity,lower education level,higher pre-pregnancy BMI,light physical activity,and higher gravidity are the main risk factors for GDM.Laboratory findings indicate that higher hemoglobin,higher liver function parameters(alanine aminotransferase,aspartate aminotransferase,and direct bilirubin),and lower total protein and albumin are associated with a higher risk of GDM.Blood type A has a higher risk of GDM compared to blood types AB and O.展开更多
BACKGROUND Physical inactivity is a significant yet underappreciated risk factor for cardiovascular disease(CVD),particularly among older adults.The aim of this study was to analyze the global burden of CVD attributab...BACKGROUND Physical inactivity is a significant yet underappreciated risk factor for cardiovascular disease(CVD),particularly among older adults.The aim of this study was to analyze the global burden of CVD attributable to physical inactivity in individuals aged 70 years and older from 1990 to 2021 using the Global Burden of Disease data.METHODS We assessed trends in disability-adjusted life years(DALYs)and deaths,decomposed changes into population growth,aging,and epidemiological factors,and examined health inequalities across sociodemographic index(SDI)regions.RESULTS From 1990 to 2021,a substantial rise in DALYs was observed,especially in low and middle SDI regions,with a 120.06% increase in the low SDI region,but a 23.10% decline in the high SDI region.Decomposition analysis identified population aging and growth as primary drivers for the burden,contributing 66.39% and 83.56% to the increase in middle and low SDI regions,respectively.By contrast,epidemiological improvements alleviated burden in the high SDI region(54.91%).Gender disparities persisted,with women experiencing a higher burden.Inequality analysis indicated a shift in CVD burden towards the low SDI region,with declining concentration indices for DALYs(-0.03 to-0.13)and deaths(-0.07 to-0.15).The Bayesian age-period-cohort projections suggest continued increases in DALYs and deaths through 2050,with women disproportionately affected.CONCLUSIONS These findings highlight the urgent need for targeted interventions promoting physical activity,improving healthcare access,and implementing region-specific prevention strategies.展开更多
The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.In connection with the previous section,this fifth section of the report continues the dissec...The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.In connection with the previous section,this fifth section of the report continues the dissection on the manage-ment of cardiovascular diseases(CVD).Cerebrovascular disease is the leading cause of death and loss of healthy life among Chinese residents.Based on the results of GBD 2019,from 1990 to 2019,the years of life lost due to premature death caused by stroke showed a decreasing trend,while the years lived with disability still increased continuously.At present,national mortal-ity surveillance system can provide national and provincial representative annual death data on cerebrovascular disease,but the national representative data on some other important epidemiological indicators(such as incidence,prevalence,disability rate,and case fatality rate)are scarce in China.With the construction of large cohort population and extension of follow-up time,re-search on stroke-related risk factors is increasing,providing a basis for the prevention and control of risk factors.Due to limited large-scale population-based intervention studies,there is a lack of epidemiological evidence to transform into feasible interven-tion strategies and measures.In recent years,great progress in endovascular treatment for basilar-artery occlusion has been achieved in China,but there is still much room for improvement of guideline-based anticoagulant treatment and lipid-lowering treatment,as well as standardized diagnosis and treatment among patients with ischemic stroke.展开更多
Diabetes mellitus and depression exhibit a complex bidirectional relationship that profoundly impacts patient health and quality of life.This review explores the physiological mechanisms,including inflammation,oxidati...Diabetes mellitus and depression exhibit a complex bidirectional relationship that profoundly impacts patient health and quality of life.This review explores the physiological mechanisms,including inflammation,oxidative stress,and neu-roendocrine dysregulation,that link these conditions.Psychosocial factors such as social support and lifestyle choices also contribute significantly.Epidemiological insights reveal a higher prevalence of depression among diabetics and an in-creased risk of diabetes in depressed individuals,influenced by demographic variables.Integrated management strategies combining mental health asse-ssments and personalized treatments are essential.Future research should focus on longitudinal and multi-omics studies to deepen understanding and improve therapeutic outcomes.展开更多
The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.In connection with the previous section,this ninth section of the report offers a comprehensi...The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.In connection with the previous section,this ninth section of the report offers a comprehensive analysis of valvular heart disease and cardiomyopathy.Although rheumatic valve disease is still the main cause of valvular heart disease in China,with the aging of the population and the improvement of living standards,the prevalence of degenerative valvular heart disease is on the rise.Because many patients with valvular heart disease have only mild to moderate valve stenosis or insufficiency,and no symptoms,the detection rate in the population is low and late,resulting in many patients been in the severe late stage of disease at visit,increasing the difficulty of treatment and affecting effectiveness and prognosis.Therefore,we should strengthen the examination and screening of valvular heart disease in order to find and prevent it as early as possible.In addition,compared with other diseases,the treatment of valvular heart disease needs more and higher technical support(surgery,intervention,etc).However,not all hospitals can provide relevant technologies.At present,the treatment of valvular heart disease is still mainly concentrated in the provincial hospitals.It is necessary to carry out more professional training so that more doctors and hospitals can participate in the treatment of valvular heart disease.Cardiomyopathy is a group of myocardial diseases with abnormal myocardial structure and/or function,but couldn't be explained by hypertension,coronary atherosclerosis,valvular heart disease and congenital heart disease.It includes hypertrophic cardiomyopathy(HCM),dilated cardiomyopathy(DCM),arrhythmogenic cardiomyopathy(also known as arrhythmogenic right ventricular cardiomyopathy),restrictive cardiomyopathy(RCM)and undifferentiated cardiomyopathy.展开更多
Objective:Bladder cancer(BC)is a significant public health concern in the Middle East and North Africa,but the epidemiology and clinicopathology of the disease and contributors to high mortality in this region remain ...Objective:Bladder cancer(BC)is a significant public health concern in the Middle East and North Africa,but the epidemiology and clinicopathology of the disease and contributors to high mortality in this region remain poorly understood.The aim of this systematic review was to investigate the epidemiological features of BC in the Arab world and compare them to those in Western countries in order to improve the management of this disease.Methods:An extensive electronic search of the PubMed/PMC and Cochrane Library databases was conducted to identify all articles published until May 2022,following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.A total of 95 articles were included in the final analysis after title,abstract,and full-text screening,with additional data obtained from the GLOBOCAN and WHO 2020 databases.展开更多
The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascularhealth in China.In connection with the previous section,this sixth section of the report offers a comprehensiv...The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascularhealth in China.In connection with the previous section,this sixth section of the report offers a comprehensive analysis of heart failure(HF)in China.HF is one of the most important cardiovascular disease in the 21st century.Its mortality is equivalent to that of cancer.It is an important public health problem that seriously affects the health of Chinese residents.In recent years,with the deepeningof understanding,the change of treatment principles,the innovation of treatment methods and the update of treatment guidelines,the in-hospital mortality of HF patients has declined,and the long-term prognosis is also improving.However,there are stilldifferences in the management level of HF among different hospitals in China.How to improve the standardized diagnosis andtreatment level of HF in China remains an important challenge.展开更多
The Annual Report on Cardiovascular Health and Diseases in China(2022) intricate landscape of cardiovascular health in China. This is the fourth section of the report with a specific focus on epidemiology and current ...The Annual Report on Cardiovascular Health and Diseases in China(2022) intricate landscape of cardiovascular health in China. This is the fourth section of the report with a specific focus on epidemiology and current management of cardiovascular disease(CVD) in China. This section of the report highlights the epidemiological trends of CVD in China. It reveal a concerning rise in prevalence, with approximately 330 million affected individuals, including significant numbers with stroke, coronary artery disease(CAD), heart failure, and other conditions. CVD stands as the primary cause of mortality among both urban and rural populations, accounting for nearly half of all deaths in 2020. Mortality rates are notably higher in rural areas compared to urban centers since 2009. While age-standardized mortality rates have decreased, the absolute number of CVD deaths has increased, primarily due to population aging. Ischemic heart disease, hemorrhagic and ischemic strokes are the leading causes of CVD-related deaths. Notably, the burden of atherosclerotic cardiovascular disease has risen substantially, with atherosclerotic cardiovascular disease-related deaths increasing from 1990 to 2016. The incidence of ischemic stroke and ischemic heart disease has shown similar increasing trends over the past three decades. CAD mortality, particularly acute myocardial infarction, has been on the rise, with higher mortality rates observed in rural areas since 2016. The prevalence of CAD has increased significantly, with over 11 million patients identified in 2013. Studies assessing hospital performance in managing acute coronary syndrome reveal gaps in adherence to guideline-recommended strategies, with disparities in care quality across hospitals. However, initiatives like the China Patient-centered Evaluative Assessment of Cardiac Events(PEACE)-Retrospective AMI Study and the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS) project aim to improve patient outcomes through enhanced care protocols. Moreover, advancements in medical technology, such as quantitative flow ratio-guided lesion selection during percutaneous coronary intervention, show promise in improving clinical outcomes for patients undergoing intervention.展开更多
In the United States(US),the Surveillance,Epidemiology,and End Results(SEER)program is the only comprehensive source of population-based information that includes stage of cancer at the time of diagnosis and patient s...In the United States(US),the Surveillance,Epidemiology,and End Results(SEER)program is the only comprehensive source of population-based information that includes stage of cancer at the time of diagnosis and patient survival data.This program aims to provide a database about cancer incidence and survival for studies of surveillance and the development of analytical and methodological tools in the cancer field.Currently,the SEER program covers approximately half of the total cancer patients in the US.A growing number of clinical studies have applied the SEER database in various aspects.However,the intrinsic features of the SEER database,such as the huge data volume and complexity of data types,have hindered its application.In this review,we provided a systematic overview of the commonly used methodologies and study designs for retrospective epidemiological research in order to illustrate the application of the SEER database.Therefore,the goal of this review is to assist researchers in the selection of appropriate methods and study designs for enhancing the robustness and reliability of clinical studies by mining the SEER database.展开更多
Physical activity(PA)epidemiology first emerged as a new field of study around the 1950s with publication of seminal investigations on London civil servants1 and has continued to evolve as a scientific discipline to p...Physical activity(PA)epidemiology first emerged as a new field of study around the 1950s with publication of seminal investigations on London civil servants1 and has continued to evolve as a scientific discipline to present time.This subdiscipline of epidemiology studies the frequencies,distributions,and dynamics of PA and its impact on human health,morbidity,and mortality.Research over the past 75 years has demonstrated numerous health benefits of PA.Based on these research findings,the World Health Organization recommends adults aged 18-64 years engage in at least 150-300 min of moderate-intensity aerobic PA per week,or at least 75-150 min of vigorous-intensity aerobic PA per week,or a combination of both intensities.展开更多
BACKGROUND Gastric signet ring cell carcinoma(GSRC)represents a specific subtype of gastric cancer renowned for its contentious epidemiological features,treatment principles,and prognostic factors.AIM To investigate t...BACKGROUND Gastric signet ring cell carcinoma(GSRC)represents a specific subtype of gastric cancer renowned for its contentious epidemiological features,treatment principles,and prognostic factors.AIM To investigate the epidemiology of GSRC and establish an improved model for predicting the prognosis of patients with locally advanced GSRC(LAGSRC)after surgery.METHODS The annual rates of GSRC incidence and mortality,covering the years 1975 to 2019,were extracted from the Surveillance,Epidemiology,and End Results(SEER)database to explore the temporal trends in both disease incidence and mortality rates using Joinpoint software.The clinical data of 3793 postoperative LAGSRC patients were collected from the SEER database for the analysis of survival rates.The Cox regression model was used to explore the independent prognostic factors for overall survival(OS).The risk factors extracted were used to establish a prognostic nomogram.RESULTS The overall incidence of GSRC increased dramatically between 1975 and 1998,followed by a significant downward trend in incidence after 1998.In recent years,there has been a similarly optimistic trend in GSRC mortality rates.The trend in GSRC showed discrepancies based on age and sex.Receiver operating characteristic curves,calibration curves,and decision curve analysis for 1-year,3-year,and 5-year OS demonstrated the high discriminative ability and clinical utility of this nomogram.The area under the curve indicated that the performance of the new model outperformed that of the pathological staging system.CONCLUSION The model we established can aid clinicians in the early prognostication of LAGSRC patients,resulting in improved clinical outcomes by modifying management strategies and patient health care.展开更多
Objective:To determine the temporal trend and epidemiology of animal bite cases in Gerash City,Iran.Methods:This retrospective cross-sectional study analyzed 630 cases of people with animal bites between 2011 and 2021...Objective:To determine the temporal trend and epidemiology of animal bite cases in Gerash City,Iran.Methods:This retrospective cross-sectional study analyzed 630 cases of people with animal bites between 2011 and 2021 in Gerash City.The collected data were analyzed using Chi-square test.Results:The mean age of victims was(30.9±17.5)years.80.54%Of victims were male,39.70%were self-employed,and 64.60%were adults(≥18 years).Most cases of bites occurred in 2019(91 cases),2020(74 cases)and 2021(87 cases),and most of the bites were related to the upper limbs(62.70%).Most of the wounds were superficial(78%),most of the biting animals were domestic animals(91.74%),and most of the victims had Iranian nationality(97.62%).Conclusions:Given the increasing trend of animal bites in Gerash City,health authorities should carry out basic measures such as education and awareness among the public,especially at-risk groups such as adult males.Additionally,since most cases of bites are due to dogs,it seems necessary to plan for vaccination of dogs,especially those with owners.展开更多
文摘Trauma is a major cause of morbidity and mortality across the globe accounting for significant health burden.Relevance of trauma care revolves round prevention,planning and execution of safety regulations.Acquisition of the actual data regarding the type of trauma,affected age group,timings of trauma occurrence,involved part of the body constitute the initial steps in the building of the composite overview of the epidemiology of trauma.In succession,would be the measures directed towards avoidance of trauma and capacity building of trauma center.
基金Supported by the Appropriate Technology Promotion Program in Chongqing,No.2023jstg005.
文摘BACKGROUND Ampullary adenocarcinoma is a rare malignant tumor of the gastrointestinal tract.Currently,only a few cases have been reported,resulting in limited information on survival.AIM To develop a dynamic nomogram using internal and external validation to predict survival in patients with ampullary adenocarcinoma.METHODS Data were sourced from the surveillance,epidemiology,and end results stat database.The patients in the database were randomized in a 7:3 ratio into training and validation groups.Using Cox regression univariate and multivariate analyses in the training group,we identified independent risk factors for overall survival and cancer-specific survival to develop the nomogram.The nomogram was validated with a cohort of patients from the First Affiliated Hospital of the Army Medical University.RESULTS For overall and cancer-specific survival,12(sex,age,race,lymph node ratio,tumor size,chemotherapy,surgical modality,T stage,tumor differentiation,brain metastasis,lung metastasis,and extension)and 6(age;surveillance,epidemiology,and end results stage;lymph node ratio;chemotherapy;surgical modality;and tumor differentiation)independent risk factors,respectively,were incorporated into the nomogram.The area under the curve values at 1,3,and 5 years,respectively,were 0.807,0.842,and 0.826 for overall survival and 0.816,0.835,and 0.841 for cancer-specific survival.The internal and external validation cohorts indicated good consistency of the nomogram.CONCLUSION The dynamic nomogram offers robust predictive efficacy for the overall and cancer-specific survival of ampullary adenocarcinoma.
文摘Breast cancer is the most common cancer among women worldwide. The term epidemiology generally deals with the branch of medicine and treatment that deals with a specific incident. Thus, considering the topic of breast cancer, this particular study deals with the distribution, determinants, and frequency of the disease. Breast cancer incidence and death data are critical to determining healthcare priorities. Women’s cancer is the most common, accounting for 25.1 percent of all malignancies. According to this specific report, more than 42,000 women die from breast cancer each year. Hence, it is apparent that it is the second leading cause of death among women, especially in the US. Family history/genetics, reproductive, hormone, benign proliferative breast disease, and mammographic density are the four main risk factors for breast cancer that can be meaningfully categorized. These elements are briefly discussed, and the risk estimators are provided. Numerous screening technologies have found breast cancer;some are linked to an increased risk of breast cancer, such as ultrasound techniques and MRI scanning. Breast cancer is more common in developed countries, while relative mortality is highest in developing countries. Women’s education is recommended for early detection and treatment in all nations. Health policymakers must prioritize plans to control and prevent this malignancy and increase awareness of risk factors and early detection in less developed countries.
基金Shaanxi Provincial Department of Education Special Scientific Research Program(Project No.:24JK0634)。
文摘Hepatocellular carcinoma(HCC)is one of the leading causes of cancer-related deaths globally,and its epidemiological characteristics and risk factors are continuously evolving.This review systematically elaborates on the global disease burden of HCC,the main risk factors(including hepatitis B/C virus infection,non-alcoholic fatty liver disease,aflatoxin exposure,and unhealthy lifestyles),and the corresponding prevention strategies.The article provides a detailed analysis of the performance and limitations of key serological markers currently used for early diagnosis of HCC,such as alpha-fetoprotein,abnormal prothrombin,and alpha-fetoprotein variant L3.Furthermore,the review comprehensively summarizes the advancements in clinical treatment for HCC,ranging from radical approaches including surgical resection,liver transplantation,radiofrequency ablation to palliative therapies for patients with advanced disease such as transcatheter arterial chemoembolization,targeted therapy,immunotherapy,and further evaluates their efficacy,indications,and challenges.This article aims to provide a comprehensive reference for a deeper understanding of the current status of HCC prevention and control,improving early diagnostic rates,and optimizing clinical treatment strategies.
文摘In recent years,nosocomial infections caused by Clostridium difficile(C.difficile)have risen,becoming a leading cause of hospital-acquired diarrhea.The global prevalence of C.difficile infection(CDI)varies across regions and populations.The diagnosis relies primarily on laboratory testing,including toxin,glutamate dehy-drogenase,and nucleic acid amplification tests.Treatment strategies for CDI in-clude antimicrobial therapy(e.g.,metronidazole,vancomycin,and fidamycin),fecal transplantation,and immunotherapy(e.g.,belotozumab),depending on the patient’s specificity and severity.This paper reviews recent research on CDI’s epidemiological characteristics,risk factors,diagnosis,treatment,and prevention,aiming to support hospitals and public health initiatives in implementing effective detection,prevention,and treatment strategies.
基金Supported by Takeda Pharmaceuticals USA,Inc.Medical writing support was provided by Luke Humphreys,PhD,of Oxford PharmaGenesis,Oxford,UK and was funded by Takeda Development Center Americas,Inc.
文摘BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world setting and factors associated with CPF development,treatment failure,and reasons for undergoing multiple surgeries may help to inform optimal patient management strategies,reduce treatment burden,and improve outcomes in patients with CPF.AIM To describe the epidemiology,treatments,outcomes,and associated risk/protective factors for complex CPF.METHODS Electronic databases(MEDLINE,EMBASE,EBM Reviews,EconLit)were searched.Two reviewers independently used populations,interventions,comparators,outcomes,study designs,and time criteria to identify relevant studies.Observational studies published in English from January 1,2015 to February 17,2022 with>50 patients were included,even if complex CPF was not defined.Items of interest included complex CPF definitions,epidemiology,treatment patterns,morbidity,mortality,and risk factors associated with complex CPF development,treatment failure,and undergoing multiple surgeries.Data were reported using descriptive statistics.RESULTS Overall,140 studies were included.Complex CPF definitions were heterogeneous and rarely reported(24 studies).Hence,data mostly related to CPF in general.CPF prevalence was variable(range:1.5%-81.0%).Incidence was wide-ranging and mostly reported cumulatively at 1-year post-Crohn’s disease diagnosis(range:3.5%-50.1%).Overall healing and failure rates after treatment were in the range of 10.5%-80.2%and 3.6%-83.0%,respectively.Abscesses were the most frequently reported morbidity(n=18).No CPF-related deaths were reported.No consistent risk or protective factors were identified.CONCLUSION Epidemiology,treatment patterns,and risk factors for CPF vary,likely due to inconsistent CPF and clinical outcome definitions.Standardization would facilitate comparability,which may inform optimal complex CPF treatment strategies.
文摘Introduction: Influenza A (Flu A) and B (Flu B) viruses are responsible for severe acute respiratory infections (SARI) worldwide, with a morbidity of 5 million and mortality of 29,000 - 650,000 deaths per year. Influenza B viruses are an important cause of respiratory infections in humans, but they tend to be underappreciated due to the predominance of Influenza A. No molecular study on Influenza B has been carried out in the DRC. This study was conducted to document the molecular evolution of the hemagglutinin (HA) gene in the circulating Influenza B strains over the eight consecutive epidemic seasons (from 2015 to 2022). Methods: Samples were collected from outpatient cases suspected of influenza-like illness (ILI) and in all hospitalized patients with SARI from January 2015 to December 2022. Molecular analysis was done to determine influenza type and subtype, and then segments encoding the HA gene of Influenza B viruses were performed. Results: Of 8497 samples collected and tested, 639 (7.5%) were positive for influenza viruses, including 389 (60.8%) for Influenza A viruses and 248 (38,8%) for Influenza B viruses. Of the positive Influenza B samples, 91 were sequenced, including 26 belonging to the B/Yamagata lineage and 65 to the B/Victoria lineage. The HA gene of Influenza B viruses circulating in the DRC showed deletions in the HA1 region. Molecular analysis of Influenza B viruses reflects the genetic diversity of Influenza B/Yam virus clades (Y2, Y3, Y3V1A) alternating with Influenza B/Victoria virus clades (V1A, V1A.3) depending on the year and influenza seasons. The phylogenetic analysis of these Influenza B strains shows compatibility with the corresponding vaccine strains that the WHO had validated for each influenza season. Conclusion: This study underscores the importance of continuous molecular surveillance of Influenza B viruses in the DRC to understand their epidemiology and evolutionary dynamics. Identifying mutations, such as HA deletions, is critical for assessing their impact on transmissibility vaccine efficacy and guiding effective vaccination and control strategies.
文摘Acquired Immunodeficiency Syndrome(AIDS)caused by Human Immunodeficiency Virus(HIV)infection poses a serious threat to global public health.This article comprehensively reviews the epidemiological characteristics of HIV infection,including the global and domestic epidemic situation,transmission routes,and characteristics of high-risk groups.It also introduces comprehensive prevention and control strategies in detail.Through analysis,it aims to provide a reference for further optimizing HIV prevention and control work.
基金National Natural Science Foundation of China,No.81960284Science and Technology Support Program of Science and Technology Department of Guizhou Province,No.Qian Ke He Zhi Cheng[2022]Yi Ban 183.
文摘BACKGROUND Gestational diabetes mellitus(GDM)is a growing public health concern,particularly in regions with diverse ethnic populations.Understanding the incidence and risk factors of GDM is crucial for early prevention and management,especially in underrepresented areas like Guizhou Province,China,where geographic and ethnic diversity may influence the disease’s prevalence and risk profiles.AIM To investigate the incidence of GDM and identify its associated risk and protective factors among different ethnic groups in Guizhou Province,providing essential data for early prevention strategies.METHODS A multi-center retrospective study was conducted,dividing participants into GDM and non-GDM groups according to standardized diagnostic criteria.Data were collected from 103629 deliveries across 40 hospitals in Guizhou.Various demographic,clinical,and laboratory parameters were analyzed using logistic regression to identify risk and protective factors for GDM.RESULTS Among the 103629 deliveries,18957 cases of GDM were identified,with an incidence of approximately 18.3%.The risk of GDM was higher in the Han ethnic group compared to minority ethnic groups.The Dong ethnic group had the lowest incidence among the minorities.Key risk factors identified included older age(especially>35 years),higher pre-pregnancy body mass index(BMI),light physical activity,gravidity,family history of diabetes,hemoglobin,aspartate aminotransferase,alanine aminotransferase,and direct bilirubin.Protective factors included higher education level,total protein,and albumin.There were also differences based on blood type,with type A associated with higher risk.CONCLUSION The incidence rate in Guizhou is 18.3%.Older age(especially>35 years),Han ethnicity,lower education level,higher pre-pregnancy BMI,light physical activity,and higher gravidity are the main risk factors for GDM.Laboratory findings indicate that higher hemoglobin,higher liver function parameters(alanine aminotransferase,aspartate aminotransferase,and direct bilirubin),and lower total protein and albumin are associated with a higher risk of GDM.Blood type A has a higher risk of GDM compared to blood types AB and O.
基金supported by the Jiangsu Commission of Health(LR2022004&LKZ2023005)the Project of Zhongda Hospital Affiliated to Southeast University for Cultivating Academic Talent(CZXM-GSPRC22)+2 种基金the Zhongda Hospital Affiliated to Southeast University,Jiangsu Province High-Level Hospital Pairing Assistance Construction Funds(ZDLYG10)the Zhongda Hospital Affiliated to Southeast University,Jiangsu Province High-Level Hospital Construction Funds(GSP-LCYJFH17)the Nanjing Commission of Health(YKK24257).
文摘BACKGROUND Physical inactivity is a significant yet underappreciated risk factor for cardiovascular disease(CVD),particularly among older adults.The aim of this study was to analyze the global burden of CVD attributable to physical inactivity in individuals aged 70 years and older from 1990 to 2021 using the Global Burden of Disease data.METHODS We assessed trends in disability-adjusted life years(DALYs)and deaths,decomposed changes into population growth,aging,and epidemiological factors,and examined health inequalities across sociodemographic index(SDI)regions.RESULTS From 1990 to 2021,a substantial rise in DALYs was observed,especially in low and middle SDI regions,with a 120.06% increase in the low SDI region,but a 23.10% decline in the high SDI region.Decomposition analysis identified population aging and growth as primary drivers for the burden,contributing 66.39% and 83.56% to the increase in middle and low SDI regions,respectively.By contrast,epidemiological improvements alleviated burden in the high SDI region(54.91%).Gender disparities persisted,with women experiencing a higher burden.Inequality analysis indicated a shift in CVD burden towards the low SDI region,with declining concentration indices for DALYs(-0.03 to-0.13)and deaths(-0.07 to-0.15).The Bayesian age-period-cohort projections suggest continued increases in DALYs and deaths through 2050,with women disproportionately affected.CONCLUSIONS These findings highlight the urgent need for targeted interventions promoting physical activity,improving healthcare access,and implementing region-specific prevention strategies.
文摘The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.In connection with the previous section,this fifth section of the report continues the dissection on the manage-ment of cardiovascular diseases(CVD).Cerebrovascular disease is the leading cause of death and loss of healthy life among Chinese residents.Based on the results of GBD 2019,from 1990 to 2019,the years of life lost due to premature death caused by stroke showed a decreasing trend,while the years lived with disability still increased continuously.At present,national mortal-ity surveillance system can provide national and provincial representative annual death data on cerebrovascular disease,but the national representative data on some other important epidemiological indicators(such as incidence,prevalence,disability rate,and case fatality rate)are scarce in China.With the construction of large cohort population and extension of follow-up time,re-search on stroke-related risk factors is increasing,providing a basis for the prevention and control of risk factors.Due to limited large-scale population-based intervention studies,there is a lack of epidemiological evidence to transform into feasible interven-tion strategies and measures.In recent years,great progress in endovascular treatment for basilar-artery occlusion has been achieved in China,but there is still much room for improvement of guideline-based anticoagulant treatment and lipid-lowering treatment,as well as standardized diagnosis and treatment among patients with ischemic stroke.
文摘Diabetes mellitus and depression exhibit a complex bidirectional relationship that profoundly impacts patient health and quality of life.This review explores the physiological mechanisms,including inflammation,oxidative stress,and neu-roendocrine dysregulation,that link these conditions.Psychosocial factors such as social support and lifestyle choices also contribute significantly.Epidemiological insights reveal a higher prevalence of depression among diabetics and an in-creased risk of diabetes in depressed individuals,influenced by demographic variables.Integrated management strategies combining mental health asse-ssments and personalized treatments are essential.Future research should focus on longitudinal and multi-omics studies to deepen understanding and improve therapeutic outcomes.
文摘The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.In connection with the previous section,this ninth section of the report offers a comprehensive analysis of valvular heart disease and cardiomyopathy.Although rheumatic valve disease is still the main cause of valvular heart disease in China,with the aging of the population and the improvement of living standards,the prevalence of degenerative valvular heart disease is on the rise.Because many patients with valvular heart disease have only mild to moderate valve stenosis or insufficiency,and no symptoms,the detection rate in the population is low and late,resulting in many patients been in the severe late stage of disease at visit,increasing the difficulty of treatment and affecting effectiveness and prognosis.Therefore,we should strengthen the examination and screening of valvular heart disease in order to find and prevent it as early as possible.In addition,compared with other diseases,the treatment of valvular heart disease needs more and higher technical support(surgery,intervention,etc).However,not all hospitals can provide relevant technologies.At present,the treatment of valvular heart disease is still mainly concentrated in the provincial hospitals.It is necessary to carry out more professional training so that more doctors and hospitals can participate in the treatment of valvular heart disease.Cardiomyopathy is a group of myocardial diseases with abnormal myocardial structure and/or function,but couldn't be explained by hypertension,coronary atherosclerosis,valvular heart disease and congenital heart disease.It includes hypertrophic cardiomyopathy(HCM),dilated cardiomyopathy(DCM),arrhythmogenic cardiomyopathy(also known as arrhythmogenic right ventricular cardiomyopathy),restrictive cardiomyopathy(RCM)and undifferentiated cardiomyopathy.
文摘Objective:Bladder cancer(BC)is a significant public health concern in the Middle East and North Africa,but the epidemiology and clinicopathology of the disease and contributors to high mortality in this region remain poorly understood.The aim of this systematic review was to investigate the epidemiological features of BC in the Arab world and compare them to those in Western countries in order to improve the management of this disease.Methods:An extensive electronic search of the PubMed/PMC and Cochrane Library databases was conducted to identify all articles published until May 2022,following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.A total of 95 articles were included in the final analysis after title,abstract,and full-text screening,with additional data obtained from the GLOBOCAN and WHO 2020 databases.
文摘The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascularhealth in China.In connection with the previous section,this sixth section of the report offers a comprehensive analysis of heart failure(HF)in China.HF is one of the most important cardiovascular disease in the 21st century.Its mortality is equivalent to that of cancer.It is an important public health problem that seriously affects the health of Chinese residents.In recent years,with the deepeningof understanding,the change of treatment principles,the innovation of treatment methods and the update of treatment guidelines,the in-hospital mortality of HF patients has declined,and the long-term prognosis is also improving.However,there are stilldifferences in the management level of HF among different hospitals in China.How to improve the standardized diagnosis andtreatment level of HF in China remains an important challenge.
文摘The Annual Report on Cardiovascular Health and Diseases in China(2022) intricate landscape of cardiovascular health in China. This is the fourth section of the report with a specific focus on epidemiology and current management of cardiovascular disease(CVD) in China. This section of the report highlights the epidemiological trends of CVD in China. It reveal a concerning rise in prevalence, with approximately 330 million affected individuals, including significant numbers with stroke, coronary artery disease(CAD), heart failure, and other conditions. CVD stands as the primary cause of mortality among both urban and rural populations, accounting for nearly half of all deaths in 2020. Mortality rates are notably higher in rural areas compared to urban centers since 2009. While age-standardized mortality rates have decreased, the absolute number of CVD deaths has increased, primarily due to population aging. Ischemic heart disease, hemorrhagic and ischemic strokes are the leading causes of CVD-related deaths. Notably, the burden of atherosclerotic cardiovascular disease has risen substantially, with atherosclerotic cardiovascular disease-related deaths increasing from 1990 to 2016. The incidence of ischemic stroke and ischemic heart disease has shown similar increasing trends over the past three decades. CAD mortality, particularly acute myocardial infarction, has been on the rise, with higher mortality rates observed in rural areas since 2016. The prevalence of CAD has increased significantly, with over 11 million patients identified in 2013. Studies assessing hospital performance in managing acute coronary syndrome reveal gaps in adherence to guideline-recommended strategies, with disparities in care quality across hospitals. However, initiatives like the China Patient-centered Evaluative Assessment of Cardiac Events(PEACE)-Retrospective AMI Study and the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS) project aim to improve patient outcomes through enhanced care protocols. Moreover, advancements in medical technology, such as quantitative flow ratio-guided lesion selection during percutaneous coronary intervention, show promise in improving clinical outcomes for patients undergoing intervention.
基金Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization(2021B1212040007)Clinical Frontier Technology Program of the First Affiliated Hospital of Jinan University,China(JNU1AF-CFTP-2022-a01235)Science and Technology Projects in Guangzhou,China(202201020054,2023A03J1032).
文摘In the United States(US),the Surveillance,Epidemiology,and End Results(SEER)program is the only comprehensive source of population-based information that includes stage of cancer at the time of diagnosis and patient survival data.This program aims to provide a database about cancer incidence and survival for studies of surveillance and the development of analytical and methodological tools in the cancer field.Currently,the SEER program covers approximately half of the total cancer patients in the US.A growing number of clinical studies have applied the SEER database in various aspects.However,the intrinsic features of the SEER database,such as the huge data volume and complexity of data types,have hindered its application.In this review,we provided a systematic overview of the commonly used methodologies and study designs for retrospective epidemiological research in order to illustrate the application of the SEER database.Therefore,the goal of this review is to assist researchers in the selection of appropriate methods and study designs for enhancing the robustness and reliability of clinical studies by mining the SEER database.
文摘Physical activity(PA)epidemiology first emerged as a new field of study around the 1950s with publication of seminal investigations on London civil servants1 and has continued to evolve as a scientific discipline to present time.This subdiscipline of epidemiology studies the frequencies,distributions,and dynamics of PA and its impact on human health,morbidity,and mortality.Research over the past 75 years has demonstrated numerous health benefits of PA.Based on these research findings,the World Health Organization recommends adults aged 18-64 years engage in at least 150-300 min of moderate-intensity aerobic PA per week,or at least 75-150 min of vigorous-intensity aerobic PA per week,or a combination of both intensities.
基金Supported by the TCM Science and Technology Plan Project of Zhejiang Province,No.2022ZB323the Medical and Health Science and Technology Plan Project of Zhejiang Province,No.2022KY1114the Basic Research Program of Ningbo,No.2023Z210.
文摘BACKGROUND Gastric signet ring cell carcinoma(GSRC)represents a specific subtype of gastric cancer renowned for its contentious epidemiological features,treatment principles,and prognostic factors.AIM To investigate the epidemiology of GSRC and establish an improved model for predicting the prognosis of patients with locally advanced GSRC(LAGSRC)after surgery.METHODS The annual rates of GSRC incidence and mortality,covering the years 1975 to 2019,were extracted from the Surveillance,Epidemiology,and End Results(SEER)database to explore the temporal trends in both disease incidence and mortality rates using Joinpoint software.The clinical data of 3793 postoperative LAGSRC patients were collected from the SEER database for the analysis of survival rates.The Cox regression model was used to explore the independent prognostic factors for overall survival(OS).The risk factors extracted were used to establish a prognostic nomogram.RESULTS The overall incidence of GSRC increased dramatically between 1975 and 1998,followed by a significant downward trend in incidence after 1998.In recent years,there has been a similarly optimistic trend in GSRC mortality rates.The trend in GSRC showed discrepancies based on age and sex.Receiver operating characteristic curves,calibration curves,and decision curve analysis for 1-year,3-year,and 5-year OS demonstrated the high discriminative ability and clinical utility of this nomogram.The area under the curve indicated that the performance of the new model outperformed that of the pathological staging system.CONCLUSION The model we established can aid clinicians in the early prognostication of LAGSRC patients,resulting in improved clinical outcomes by modifying management strategies and patient health care.
基金This study was financially supported by the vice-chancellery for research affairs at Gerash University of Medical Sciences,Gerash,Iran(Grant number:99000071).
文摘Objective:To determine the temporal trend and epidemiology of animal bite cases in Gerash City,Iran.Methods:This retrospective cross-sectional study analyzed 630 cases of people with animal bites between 2011 and 2021 in Gerash City.The collected data were analyzed using Chi-square test.Results:The mean age of victims was(30.9±17.5)years.80.54%Of victims were male,39.70%were self-employed,and 64.60%were adults(≥18 years).Most cases of bites occurred in 2019(91 cases),2020(74 cases)and 2021(87 cases),and most of the bites were related to the upper limbs(62.70%).Most of the wounds were superficial(78%),most of the biting animals were domestic animals(91.74%),and most of the victims had Iranian nationality(97.62%).Conclusions:Given the increasing trend of animal bites in Gerash City,health authorities should carry out basic measures such as education and awareness among the public,especially at-risk groups such as adult males.Additionally,since most cases of bites are due to dogs,it seems necessary to plan for vaccination of dogs,especially those with owners.
