Background:Few data are available regarding the long-term case-fatality rate(CFR)among people living with HIV(PLWH)with nontuberculous mycobacteria(NTM)disease.The aim of this study is to analyze the long-term CFR in ...Background:Few data are available regarding the long-term case-fatality rate(CFR)among people living with HIV(PLWH)with nontuberculous mycobacteria(NTM)disease.The aim of this study is to analyze the long-term CFR in patients with NTM disease and to identify risk factors for their death.Methods:A retrospective cohort study of 379 cases of microbiologically confirmed NTM disease in PLWH was conducted from January 1,2012,to December 31,2020,in Shanghai,China.We used Kaplan-Meier survival analysis and the log-rank test to compare the long-term CFR in patients with disseminated NTM(DNTM)and localized NTM disease.Univariate Cox proportional hazards regression analysis and a stepwise Cox proportional hazards regression model were used to estimate the predictors of long-term CFR.Results:The cohort was followed up for a median of 26 months.The total CFR was 15.7%by one year and increased to 22.6%at 5 years after the diagnosis of NTM disease.The 5-year CFR of PLWH with DNTM was significantly higher than that of PLWH with localized NTM(26.7%vs 19.6%for DNTM and localized NTM disease,respectively).Older age[hazard ratio(HR)=1.04,95%confidence interval(CI):1.02-1.06,P<0.001],comorbidity(HR=2.05,95%CI:1.21-3.49,P<0.01),DNTM(HR=2.08,95%CI:1.17-3.68,P<0.05),and HIV viral load(HR=1.32,95%CI:1.12-1.55,P<0.001)were all independent risk factors for long-term CFR.In the subgroup analysis,time to culture positivity was negatively correlated with CFR in patients with DNTM(HR=0.90,95%CI:0.82-0.98,P<0.05).Conclusions:NTM was associated with a high long-term CFR in PLWH.Further approaches to prevent NTM disease in PLWH are urgently needed.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a common and potentially life-threatening clinical event.To date,the literature on the long-term global epidemiology of GIB has not been systematically reviewed.AIM To syste...BACKGROUND Gastrointestinal bleeding(GIB)is a common and potentially life-threatening clinical event.To date,the literature on the long-term global epidemiology of GIB has not been systematically reviewed.AIM To systematically review the published literature on the worldwide epidemiology of upper and lower GIB.METHODS EMBASE®and MEDLINE were queried from 01 January 1965 to September 17,2019 to identify population-based studies reporting incidence,mortality,or casefatality rates of upper GIB(UGIB)or lower GIB(LGIB)in the general adult population,worldwide.Relevant outcome data were extracted and summarized(including data on rebleeding following initial occurrence of GIB when available).All included studies were assessed for risk of bias based upon reporting guidelines.RESULTS Of 4203 retrieved database hits,41 studies were included,comprising a total of around 4.1 million patients with GIB worldwide from 1980–2012.Thirty-three studies reported rates for UGIB,four for LGIB,and four presented data on both.Incidence rates ranged from 15.0 to 172.0/100000 person-years for UGIB,and from 20.5 to 87.0/100000 person-years for LGIB.Thirteen studies reported on temporal trends,generally showing an overall decline in UGIB incidence over time,although a slight increase between 2003 and 2005 followed by a decline was shown in 5/13 studies.GIB-related mortality data were available from six studies for UGIB,with rates ranging from 0.9 to 9.8/100000 person-years,and from three studies for LGIB,with rates ranging from 0.8 to 3.5/100000 person-years.Casefatality rate ranged from 0.7%to 4.8%for UGIB and 0.5%to 8.0%for LGIB.Rates of rebleeding ranged from 7.3%to 32.5%for UGIB and from 6.7%to 13.5%for LGIB.Two main areas of potential bias were the differences in the operational GIB definition used and inadequate information on how missing data were handled.CONCLUSION Wide variation was seen in estimates of GIB epidemiology,likely due to high heterogeneity between studies however,UGIB showed a decreasing trend over the years.Epidemiological data were more widely available for UGIB than for LGIB.展开更多
In dairy farming, deploying effective animal husbandry practices minimise disease infections and animal mortality. This improves animal health and welfare status, which is important in tropical smallholder dairy farmi...In dairy farming, deploying effective animal husbandry practices minimise disease infections and animal mortality. This improves animal health and welfare status, which is important in tropical smallholder dairy farming, where animals are persistently exposed to multiple environmental stresses. The hypothesis of this study was that animals managed in positive deviants and typical farms suffer different levels of disease infections and mortality, whether under low- or high-stress environments. The study adopted a two-factor nested design with farms contrasting in the level of animal husbandry (positive deviants and typical farms) nested within environments contrasting in the level of environmental stresses (low- and high-stress). A total of 1,999 animals were observed over 42 month period in the coastal lowlands and highlands of Tanzania. The disease prevalence was lower (p < 0.05) in positive deviant farms than in typical farms under low-stress (10.13 vs. 33.61 per 100 animal-years at risk) and high-stress (9.56 vs. 57.30 per 100 animal-years at risk). Cumulative disease incidence rate was also lower (p < 0.05) in positive deviant farms than in typical farms under low-stress (2.74% vs. 8.44%) and high-stress (2.58% vs. 14.34%). The probability of death for a disease infected dairy cattle was relatively lower in positive deviant farms compared to typical farms under low-stress (0.57% vs. 8.33%) and high-stress (0.60% vs. 6.99%). Per 100 animal-years at risk, the mortality density of cattle was lower (p < 0.05) in positive deviant farms compared to typical farms, 15.10 lower in low-stress and 2.60 lower in high-stress. These results show that compared to typical farms, positive deviant farms consistently attained (p < 0.05) lower animal disease infections and subsequent deaths, regardless of the level of environmental stress that the animals were exposed to. This implies that positive deviant farms deployed animal husbandry practices that more effectively minimised animal disease infections and deaths and therefore could maintain their animals in better health and welfare status.展开更多
Statistical analysis of COVID-19 mortality is challenging due to its non-stationarity and cross-sectional instability.In this paper,the authors introduce a unified method to evaluate the fatality rate of COVID-19 acro...Statistical analysis of COVID-19 mortality is challenging due to its non-stationarity and cross-sectional instability.In this paper,the authors introduce a unified method to evaluate the fatality rate of COVID-19 across countries,whose method provides more reliable information for cross-country comparison than the traditional case-fatality rate(CFR).It emerges that the new method,the blockwise case-fatality rate(BCFR),varies for different countries and in different periods.The authors also decompose the COVID-19 fatality data by three factors:1)The virus infection dynamics over population in different countries,2)pure distribution and evolution of instantaneous death rate attributed to different individual’s physical characteristics such as age and health,and 3)individual countries’variations affecting interactions between the virus infection and the instantaneous mortality due to individual’s physical characteristics.Based on the new three-factor model,the authors obtain six key findings of the COVID-19 fatality rate.Our study suggests that,on average,the estimated instantaneous fatality rate contributes about 57.0%to the global BCFR while the time-varying weight contributes about 41.5%in December 2020.The country-specific contribution of instantaneous fatality rate is significantly higher than that of the time-varying weight.Besides,the country-specific characteristics in demographical,social,and economic aspects would affect the relative severity of the disease.展开更多
Form 1980 to 1994, the number of infection of malaria imported into China was 2,603 among the personnel who had gone abroad and the infection rate was 8.38 per cent. The number of people died from malaria was 41 and t...Form 1980 to 1994, the number of infection of malaria imported into China was 2,603 among the personnel who had gone abroad and the infection rate was 8.38 per cent. The number of people died from malaria was 41 and the case fatality rate was 1.58 per cent. The army men and traffic engineering personnel were the people who had the highest infection rate,which were 78. 57 per cent and 54.97 per cent. Civil builders and agrotechnical personnel came to the second,whose infection rate were 37.15 per cent and 35.94 per cent. The constituent ratios transmitted were 97.69 per cent from Africa,2. 19 per cent from Asia,however only 0. 12 per cent from America and Europe. The malaria imported by the incoming foreign people bad been found in 148 cases,and the pernicious malarial cases were 71.62 per cent. These malarial cases,and the pernicious malarial cases were 71.62 per cent. These malarial cases were transmitted from 15 Asian and African countries. Now we would like to make a synthetically analysis on the situation of malaria death cases in this essay, and we have made a comparison between the malaria IFAT(Indiredt Fluorescence Antibody Test)and the smear of the malarial diagnosis, which can show that Ⅰ-FAT takes an important part in avoiding misjudging of malarial diagnosis. In addition, we would like to offer some useful suggestions of protection from it.展开更多
基金Shanghai Commission of Science and Technology(20MC1920100 and 21Y11901200)Shanghai key Infectious Disease Project(shslczdzk01102)+2 种基金Shanghai Municipal Health Commission(GWV-10.1-XK02)development fund for Shanghai talents(2020089)Shanghai "Rising stars of Medical Talent" Youth Development Program(No. 2019-72)。
文摘Background:Few data are available regarding the long-term case-fatality rate(CFR)among people living with HIV(PLWH)with nontuberculous mycobacteria(NTM)disease.The aim of this study is to analyze the long-term CFR in patients with NTM disease and to identify risk factors for their death.Methods:A retrospective cohort study of 379 cases of microbiologically confirmed NTM disease in PLWH was conducted from January 1,2012,to December 31,2020,in Shanghai,China.We used Kaplan-Meier survival analysis and the log-rank test to compare the long-term CFR in patients with disseminated NTM(DNTM)and localized NTM disease.Univariate Cox proportional hazards regression analysis and a stepwise Cox proportional hazards regression model were used to estimate the predictors of long-term CFR.Results:The cohort was followed up for a median of 26 months.The total CFR was 15.7%by one year and increased to 22.6%at 5 years after the diagnosis of NTM disease.The 5-year CFR of PLWH with DNTM was significantly higher than that of PLWH with localized NTM(26.7%vs 19.6%for DNTM and localized NTM disease,respectively).Older age[hazard ratio(HR)=1.04,95%confidence interval(CI):1.02-1.06,P<0.001],comorbidity(HR=2.05,95%CI:1.21-3.49,P<0.01),DNTM(HR=2.08,95%CI:1.17-3.68,P<0.05),and HIV viral load(HR=1.32,95%CI:1.12-1.55,P<0.001)were all independent risk factors for long-term CFR.In the subgroup analysis,time to culture positivity was negatively correlated with CFR in patients with DNTM(HR=0.90,95%CI:0.82-0.98,P<0.05).Conclusions:NTM was associated with a high long-term CFR in PLWH.Further approaches to prevent NTM disease in PLWH are urgently needed.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a common and potentially life-threatening clinical event.To date,the literature on the long-term global epidemiology of GIB has not been systematically reviewed.AIM To systematically review the published literature on the worldwide epidemiology of upper and lower GIB.METHODS EMBASE®and MEDLINE were queried from 01 January 1965 to September 17,2019 to identify population-based studies reporting incidence,mortality,or casefatality rates of upper GIB(UGIB)or lower GIB(LGIB)in the general adult population,worldwide.Relevant outcome data were extracted and summarized(including data on rebleeding following initial occurrence of GIB when available).All included studies were assessed for risk of bias based upon reporting guidelines.RESULTS Of 4203 retrieved database hits,41 studies were included,comprising a total of around 4.1 million patients with GIB worldwide from 1980–2012.Thirty-three studies reported rates for UGIB,four for LGIB,and four presented data on both.Incidence rates ranged from 15.0 to 172.0/100000 person-years for UGIB,and from 20.5 to 87.0/100000 person-years for LGIB.Thirteen studies reported on temporal trends,generally showing an overall decline in UGIB incidence over time,although a slight increase between 2003 and 2005 followed by a decline was shown in 5/13 studies.GIB-related mortality data were available from six studies for UGIB,with rates ranging from 0.9 to 9.8/100000 person-years,and from three studies for LGIB,with rates ranging from 0.8 to 3.5/100000 person-years.Casefatality rate ranged from 0.7%to 4.8%for UGIB and 0.5%to 8.0%for LGIB.Rates of rebleeding ranged from 7.3%to 32.5%for UGIB and from 6.7%to 13.5%for LGIB.Two main areas of potential bias were the differences in the operational GIB definition used and inadequate information on how missing data were handled.CONCLUSION Wide variation was seen in estimates of GIB epidemiology,likely due to high heterogeneity between studies however,UGIB showed a decreasing trend over the years.Epidemiological data were more widely available for UGIB than for LGIB.
文摘In dairy farming, deploying effective animal husbandry practices minimise disease infections and animal mortality. This improves animal health and welfare status, which is important in tropical smallholder dairy farming, where animals are persistently exposed to multiple environmental stresses. The hypothesis of this study was that animals managed in positive deviants and typical farms suffer different levels of disease infections and mortality, whether under low- or high-stress environments. The study adopted a two-factor nested design with farms contrasting in the level of animal husbandry (positive deviants and typical farms) nested within environments contrasting in the level of environmental stresses (low- and high-stress). A total of 1,999 animals were observed over 42 month period in the coastal lowlands and highlands of Tanzania. The disease prevalence was lower (p < 0.05) in positive deviant farms than in typical farms under low-stress (10.13 vs. 33.61 per 100 animal-years at risk) and high-stress (9.56 vs. 57.30 per 100 animal-years at risk). Cumulative disease incidence rate was also lower (p < 0.05) in positive deviant farms than in typical farms under low-stress (2.74% vs. 8.44%) and high-stress (2.58% vs. 14.34%). The probability of death for a disease infected dairy cattle was relatively lower in positive deviant farms compared to typical farms under low-stress (0.57% vs. 8.33%) and high-stress (0.60% vs. 6.99%). Per 100 animal-years at risk, the mortality density of cattle was lower (p < 0.05) in positive deviant farms compared to typical farms, 15.10 lower in low-stress and 2.60 lower in high-stress. These results show that compared to typical farms, positive deviant farms consistently attained (p < 0.05) lower animal disease infections and subsequent deaths, regardless of the level of environmental stress that the animals were exposed to. This implies that positive deviant farms deployed animal husbandry practices that more effectively minimised animal disease infections and deaths and therefore could maintain their animals in better health and welfare status.
基金This study was supported by the National Key R&D Program of China under Grant No.2021ZD0111204the National Natural Science Foundation of China under Grant Nos.72073127 and 71988101.
文摘Statistical analysis of COVID-19 mortality is challenging due to its non-stationarity and cross-sectional instability.In this paper,the authors introduce a unified method to evaluate the fatality rate of COVID-19 across countries,whose method provides more reliable information for cross-country comparison than the traditional case-fatality rate(CFR).It emerges that the new method,the blockwise case-fatality rate(BCFR),varies for different countries and in different periods.The authors also decompose the COVID-19 fatality data by three factors:1)The virus infection dynamics over population in different countries,2)pure distribution and evolution of instantaneous death rate attributed to different individual’s physical characteristics such as age and health,and 3)individual countries’variations affecting interactions between the virus infection and the instantaneous mortality due to individual’s physical characteristics.Based on the new three-factor model,the authors obtain six key findings of the COVID-19 fatality rate.Our study suggests that,on average,the estimated instantaneous fatality rate contributes about 57.0%to the global BCFR while the time-varying weight contributes about 41.5%in December 2020.The country-specific contribution of instantaneous fatality rate is significantly higher than that of the time-varying weight.Besides,the country-specific characteristics in demographical,social,and economic aspects would affect the relative severity of the disease.
文摘Form 1980 to 1994, the number of infection of malaria imported into China was 2,603 among the personnel who had gone abroad and the infection rate was 8.38 per cent. The number of people died from malaria was 41 and the case fatality rate was 1.58 per cent. The army men and traffic engineering personnel were the people who had the highest infection rate,which were 78. 57 per cent and 54.97 per cent. Civil builders and agrotechnical personnel came to the second,whose infection rate were 37.15 per cent and 35.94 per cent. The constituent ratios transmitted were 97.69 per cent from Africa,2. 19 per cent from Asia,however only 0. 12 per cent from America and Europe. The malaria imported by the incoming foreign people bad been found in 148 cases,and the pernicious malarial cases were 71.62 per cent. These malarial cases,and the pernicious malarial cases were 71.62 per cent. These malarial cases were transmitted from 15 Asian and African countries. Now we would like to make a synthetically analysis on the situation of malaria death cases in this essay, and we have made a comparison between the malaria IFAT(Indiredt Fluorescence Antibody Test)and the smear of the malarial diagnosis, which can show that Ⅰ-FAT takes an important part in avoiding misjudging of malarial diagnosis. In addition, we would like to offer some useful suggestions of protection from it.
