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Τρίτη 29 Νοεμβρίου 2022

Trends and disparities in 44 national notifiable infectious diseases in China: an analysis of national surveillance data from 2010 to 2019

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Abstract

Background

Research assessing the changing epidemiology of infectious diseases in China after the implementation of new health-care reform in 2009 was scarce. We aimed to get the latest trends and disparities of national notifiable infectious diseases by age, sex, province and seasons in China from 2010 to 2019.

Methods

The number of incident cases and deaths, incidence rate and mortality of 44 national notifiable infectious diseases by sex, age groups, and provincial regions from 2010 to 2019 was extracted from the China Information System for Disease Control and Prevention and official reports, and divided into six kinds of infectious diseases by transmission routes and three classes (A, B and C) in this descriptive study. Estimated annual percentage changes (EAPCs) were calculated to quantify the temporal trends of incidence and mortality rate. We calculated concentration index to measure economic-related inequality. Segmented interrupted time-series analy sis was used to estimate the impact of the COVID-19 pandemic on the epidemic of notifiable infectious disease.

Results

The trend of incidence rate on six kinds of infectious diseases by transmission routes was stable, while only mortality of sexual, blood-borne, and mother-to-child-borne infectious diseases increased from 0.6466 per 100 000 population in 2010 to 1.5499 per 100 000 population in 2019 by 8.76% per year (95%CI: 6.88-10.68). There was a decreasing trend of incidence rate on Class-A infectious diseases (EAPC=-16.30%; 95%CI: -27.93 - -2.79) and Class-B infectious diseases (EAPC=-1.05%; 95%CI: -1.56 - -0.54), while an increasing trend on Class-C infectious diseases (EAPC=6.22%; 95%CI: 2.13~10.48). For mortality, there was a decreasing trend on Class-C infectious diseases (EAPC=-14.76%; 95%CI: -23.46 - -5.07), and an increasing trend on Class-B infectious diseases (EAPC=4.56%; 95%CI: 2.44-6.72). In 2019, the infectious diseases with highest incidence rate and mortality were respiratory diseases (340.95 per 100 000 population), and sexual, blood-borne, and mother-to-child-borne infectious diseases (1.5459 per 100 000 population), respectively. The greatest increasing trend of incidence rate was observed in seasonal influenza, from 4.83 per 100 000 population in 2010 to 253.36 per 100 000 population in 2019 by 45.16% per year (95%CI: 29.81-62.33), especially among female and children aged 0 – 4 years old. The top disease with highest mortality was still AIDs which had the highest average yearly mortality in 24 provinces from 2010 to 2019, and its incidence rate (EAPC=14.99%; 95%CI: 8.75-21.59) and mortality (EAPC=9.65; 95%CI: 7.71-11.63) both increased from 2010 to 2019, especially among people aged 44 – 59 years old and 60 or older. Male incidence rate and mortality were higher than females each year from 2010 to 2018 on 29 and 10 infectious diseases, respectively. Additionally, sex differences of incidence and mortality of AIDS were becoming larger. The curve lay above the equality line, with the negative value of the concentration index, which indicated that economic-related health disparities exist in the distribution of incidence rate and mortality of respiratory diseases (incidence rate: the concentration index = -0.063, P<0.0001; mortality: the concentration index = -0.131, P<0.001), sexual, blood-borne, and mother-to-child-borne infectious diseases (incidence rate: the concentration index = -0.039, P=0.0192; mortality: the concentration index = -0.207, P<0.0001), and the inequality disadvantageous to the poor (pro-rich). Respiratory diseases (Dec, Jan), intestinal diseases (May, Jun, July), zoonotic infectious diseases (Mar-Jul) and vector-borne infectious diseases (Sep-Oct) had distinct seasonal epidemic patterns. In addition, segmented interrupted time-series analyses showed that, after adjusted for potential seasonality, autocorrelation, GDP per capita, number of primary medical institutions a nd other factors, there was no significant impact of COVID-19 epidemic on the monthly incidence rate of six kinds of infectious diseases by transmission routes from 2018 to 2020 (all P>0.05).

Conclusions

The incidence rates of six kinds of infectious diseases were stable in the past decade, and incidence rates of Class-A and Class-B infectious diseases were deceasing, because of comprehensive prevention and control measures and strengthened health system after the implementation of the new health-care reform in China since 2009. However, age, gender, regional and economic disparities were still observed. Concerted efforts are needed to reduce the impact of seasonal influenza (especially among children aged 0 – 4 years old) and the mortality of AIDs (especially among people aged 44 – 59 years old and 60 or older). More attention should be paid to the disparities on the burden of infectious diseases.

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Concomitant administration of warfarin and toremifene: A case report

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Concomitant administration of warfarin and toremifene: A case report

We reported a 50-year-old woman who was treated with warfarin after prosthetic valve replacement and had a fluctuating international normalized ratio (INR) following the concomitant administration of toremifene. The results suggested when concomitant administration of warfarin and to remifene, the interaction between them is not serious, but the dose of warfarin needs to be reduced.


Abstract

What Is Known and Objective

Antiestrogen agents have been reported to enhance the anticoagulant activity of warfarin. The use of tamoxifen with warfarin has been contraindicated. However, warfarin in combination with toremifene has not been reported. We report a case in which warfarin was combined with toremifene and applied warfarin dose prediction models to predict the dose of warfarin.

Case Summary

We report the case of a 50-year-old woman with a history of breast cancer, who underwent long-term toremifene therapy after mastectomy. The patient was treated with warfarin after prosthetic valve replacement and had a fluctuating international normalized ratio (INR) following the concomitant administration of toremifene. We applied the warfarin dose prediction model to adjust the warfarin dose during treatment. Finally, her INR stabilized with a lower dose of warfarin, and there was no serious bleeding during the 1-year follow-up.

What Is New and Conclusion

Warfarin does not have a serious interaction with toremifene in this case, but it needed about 37.5% dose reduction which was comparable to the interaction of some common antibiotics with warfarin.

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Differential Associations of Rheumatoid Arthritis and Periodontitis or Tooth Loss: A Cross‐Sectional Study

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Abstract

Aims

To study the association between periodontitis, tooth loss, and rheumatoid arthritis by using a large national dataset.

Materials and Methods

An observational cross-sectional study was performed using the National Health and Nutrition Examination Survey (NHANES) cycles (2009-2014). Rheumatoid arthritis status was detected by a questionnaire. Periodontal status was assigned based on clinical attachment level and periodontal pocket depth. Dentition status was assessed by the number of permanent teeth observed. We examined the association between rheumatoid arthritis as exposure and moderate/severe periodontitis and non-functional dentition as outcomes. We progressively adjusted our models for different sets of potential confounders.

Results

Moderate/severe periodontitis was more prevalent in participants reporting rheumatoid arthritis (53% vs. 41.5%, p= 0.0003). Non-functional dentition was more prevalent in participants with rheumatoid arthritis (41% vs. 15.5%, p= 0.0001). The fully adjusted model showed participants with rheumatoid arthritis had higher odds of having a non-functional dentition (Odds Ratio 1.8, 95% CI 1.3-2.3, p= 0.0001), but no association with moderate/severe periodontitis (Prevalence Ratio 1.01, 95% CI 0.9-1.1, p= 0.9).

Conclusion

Rheumatoid arthritis was associated with a higher likelihood of having non-functional dentition but did not show an association with periodontitis after adjustments of the risk factors to control their confounding effect.

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