Prevalence of hypertension and diabetes among Ethiopian adults

ObjectiveTo determine the prevalence of hypertension and diabetes among members of an Ethiopian occupational cohort; and to examine the proportion of adults who were aware of their conditions.MethodsA total of 2153 of subjects were included in this cross-sectional study. The World Health Organization STEPwise approach for non-communicable diseases was used to collect socio-demographic data, blood pressure measures and blood samples from participants. Prevalence estimates for hypertension and diabetes were determined separately. The 95% confidence intervals for prevalence estimates were also determined.ResultsThe overall prevalence of hypertension was 19.1% (95%CI: 17.1–20.8) and 22% (95%CI: 20.2–23.8) and 14.9% (95%CI: 13.4–16.4) among men and women respectively. The overall prevalence of diabetes was 6.5% (95%CI: 5.4–7.6) and 6.4% (95%CI: 5.0–7.8) and 6.6% (95%CI: 4.8–8.4) among men and women correspondingly. Notably, 15% of hypertensives reported never having had their blood pressure checked prior to the present study examination. Approximately 45% of participants who had their blood pressure checked were never diagnosed with hypertension, but were found to be hypertensive in our study. Approximately 27% of newly diagnosed diabetics (during this study) reported never having a previous blood glucose test. Among those who had their blood glucose assessed prior to this study, 17.4% were found to have diabetes but were never diagnosed.ConclusionThe high prevalence of hypertension and diabetes reported in our study confirms findings from other Sub-Saharan Africa countries, and extends the literature to urban dwelling Ethiopians where non-communicable diseases are emerging as a major public health concern.     

Urbanization and Daily Exposure to Biomass Fuel Smoke Both Contribute to Chronic Bronchitis Risk in a Population with Low Prevalence of Daily Tobacco Smoking

Objective: Risk factors beyond tobacco smoking associated with chronic bronchitis are not well understood. We sought to describe the prevalence and risk factors of chronic bronchitis across four distinct settings in Peru with overall low prevalence of tobacco smoking yet varying degrees of urbanization, daily exposure to biomass fuel smoke and living at high altitude. Methods: We analyzed data of 2,947 participants from rural and urban Puno, Lima and Tumbes including spirometry, blood samples, anthropometry and administered questionnaires about respiratory symptoms. We used multivariable Poisson regression to assess biologic, socioeconomic and environmental risk factors associated with chronic bronchitis. Results: Overall prevalence of chronic bronchitis was 5.9% (95%CI 5.1%–6.9%) with variation by setting: prevalence was lower in semi-urban Tumbes (1.3%) vs. highly urbanized Lima (8.9%), urban Puno (7.0%) and rural Puno (7.8%; p < 0.001). Chronic bronchitis was more common among participants with vs. without COPD based on FEV₁/FVC< LLN (12.1% vs 5.6%, p < 0.01) and it was associated with increased reporting of dyspnea on exertion (p < 0.001), hospitalization (p = 0.003) and workdays missed due to respiratory symptoms (p < 0.001). Older age (Prevalence ratio [PR] = 1.23 for each 10-years of age, 95%CI 1.09–1.40) past history of asthma (PR = 2.87, 95%CI 1.80–4.56), urbanization (PR = 3.34, 95%CI 2.18–5.11) and daily exposure to biomass fuel smoke (PR = 2.00, 95%CI 1.30–3.07) were all associated with chronic bronchitis. Conclusions: We found important variations in the prevalence of chronic bronchitis across settings. Prevalence increased with both urbanization and with daily exposure to biomass fuel smoke. Having chronic bronchitis was also associated with worse patient-centered outcomes including dyspnea, hospitalization and missed workdays.     

The prevalence of depression and anxiety in Iranian patients with diabetes mellitus: A systematic review and meta-analysis

IntroductionThis study aims to estimate the prevalence of depression and anxiety among Iranian patients with diabetes mellitus (DM) through meta-analysis.MethodsThis is a systematic review article based on MOOSE and PRISMA guidelines. Review of the literature was done using databases including Magiran, Barakat Knowledge Network System, SID, RICST, IranDoc, PubMed/Medline, Science Direct, Embase, Scopus, Cochrane Library, Web of Science and the Google Scholar search engine without time limit until December, 2018. Heterogeneity between studies was assessed using Cochran's Q test and I² index. Data were analyzed using Comprehensive Meta-Analysis (CMA) software version 2 according to a random-effects model. P-values less than 0.05 were considered as the significance level.ResultsThe analysis consisted of 44 studies including 10,349 Iranian patients with DM. The prevalence of depression was estimated to be 61.8% (95% confidence interval [CI]: 56.6–66.7). The lowest and highest prevalence of depression based on regions was in the North (56.7% [95%CI: 44.9–67.8]) and the East (64.2% [95%CI: 30.7–87.9]), respectively. The depression prevalence in females and males was 63.9% (95%CI: 54.0–72.8) and 46.3% (95%CI: 36.4–56.4), respectively, The prevalence of mild, moderate, severe and highly severe depression was estimated to be 24.4% (95%CI: 21.0–28.2), 19.1% (95%CI: 15.2–23.9), 11.4% (95%CI: 8.6–14.9), and 4.6% (95%CI: 3.4–6.1), respectively. In eight studies, the prevalence of anxiety in Iranian patients with DM was estimated to be 64.5% (95%CI: 42.0–82.1).ConclusionsDepression and anxiety are more prevalent among Iranian patients with DM compared with developed countries. Therefore, regular psychiatric consultation is required for the early diagnosis and treatment of depression and anxiety in these patients.     

A Multiethnic Study of Pre-Diabetes and Diabetes in LMIC

BackgroundDiabetes mellitus is one of the leading causes of death and disability worldwide. Approximately three-quarters of people with diabetes live in low- and middle-income countries, and these countries are projected to experience the greatest increase in diabetes burden.ObjectivesWe sought to compare the prevalence, awareness, treatment, and control of diabetes in 3 urban and periurban regions: the Southern Cone of Latin America and Peru, South Asia, and South Africa. In addition, we examined the relationship between diabetes and pre-diabetes with known cardiovascular and metabolic risk factors.MethodsA total of 26,680 participants (mean age, 47.7 ± 14.0 years; 45.9% male) were enrolled in 4 sites (Southern Cone of Latin America = 7,524; Peru = 3,601; South Asia = 11,907; South Africa = 1,099). Detailed demographic, anthropometric, and biochemical data were collected. Diabetes and pre-diabetes were defined as a fasting plasma glucose ≥126 mg/dl and 100 to 125 mg/dl, respectively. Diabetes control was defined as fasting plasma glucose <130 mg/dl.ResultsThe prevalence of diabetes and pre-diabetes was 14.0% (95% confidence interval [CI]: 13.2% to 14.8%) and 17.8% (95% CI: 17.0% to 18.7%) in the Southern Cone of Latin America, 9.8% (95% CI: 8.8% to 10.9%) and 17.1% (95% CI: 15.9% to 18.5%) in Peru, 19.0% (95% CI: 18.4% to 19.8%) and 24.0% (95% CI: 23.2% to 24.7%) in South Asia, and 13.8% (95% CI: 11.9% to 16.0%) and 9.9% (95% CI: 8.3% to 11.8%) in South Africa. The age- and sex-specific prevalence of diabetes and pre-diabetes for all countries increased with age (p < 0.001). In the Southern Cone of Latin America, Peru, and South Africa the prevalence of pre-diabetes rose sharply at 35 to 44 years. In South Asia, the sharpest rise in pre-diabetes prevalence occurred younger at 25 to 34 years. The prevalence of diabetes rose sharply at 45 to 54 years in the Southern Cone of Latin America, Peru, and South Africa, and at 35 to 44 years in South Asia. Diabetes and pre-diabetes prevalence increased with body mass index. South Asians had the highest prevalence of diabetes and pre-diabetes for any body mass index and normal-weight South Asians had a higher prevalence of diabetes and pre-diabetes than overweight and obese individuals from other regions. Across all regions, only 79.8% of persons with diabetes were aware of their diagnosis, of these only 78.2% were receiving treatment, and only 36.6% were able to attain glycemic control.ConclusionsThe prevalence of diabetes and pre-diabetes is alarmingly high among urban and periurban populations in Latin America, South Asia, and South Africa. Even more alarming is the propensity for South Asians to develop diabetes and pre-diabetes at a younger age and lower body mass index compared with individuals from other low and middle income countries. It is concerning that one-fifth of all people with diabetes were unaware of their diagnosis and that only two-thirds of those under treatment were able to attain glycemic control. Health systems and policy makers must make concerted efforts to improve diabetes prevention, detection, and control to prevent long-term consequences.     

Sex-influenced association of metabolic syndrome with lower extremity arterial disease in type 2 diabetes

AimThe present study is undertaken to investigate the relationship between metabolic syndrome (MS) and lower extremity arterial disease (LEAD) in type 2 diabetes mellitus (T2DM) patients.MethodsA multi-center cross-sectional study was conducted on 8374 T2DM patients (4521 males and 3853 females) from 30 hospitals across China from June 2016 to January 2017. The odds ratios (ORs) and 95% confidence intervals (CIs) were presented to show the association between MS and LEAD. The univariate and multiple logistic analyses were performed to examine the association between MS and the prevalence of LEAD. Furthermore, the relationship was analyzed in different sex groups. Subgroup analysis was performed based on the number and individual of MS components.ResultsFinally, 1809(21.60%) T2DM patients meet the diagnostic criteria of LEAD. Of the 3853 female subjects, 841(21.83%) patients were in the LEAD group and of the 4521 male subjects, 968(21.41%) patients were in the LEAD group. When adjusting for confounding variables, MS was significantly associated with the prevalence of LEAD in all enrolled T2DM patients (OR = 1.22, 95%CI: 1.09–1.37, P = 0.001). However, upon analyzing LEAD in different sex groups, the significant association remained in females (OR = 1.33, 95%CI: 1.12–1.58, P < 0.001), but not in males (OR = 1.11, 95%CI: 0.95–1.29, P = 0.202).ConclusionsOur results suggest that MS is specifically associated with an increased risk of LEAD in female T2DM patients. However, MS may not be a significant factor in the prevalence of LEAD in male T2DM patients.     

Prevalence of nephropathy in patients with type 2 diabetes in Iran: A systematic review and meta-analysis based on geographic information system (GIS)

Background and aimsDiabetic nephropathy are one of the most important causes of renal failure and dysfunction in diabetic patients and imposes high costs for the healthcare system. Studies conducted in Iran show different prevalence. This study aims to determine the overall prevalence of nephropathy in patients with type 2 diabetes in Iran with a systematic review and meta-analysis.MethodsThe present study was carried out by meta-analysis from January 2000 to May 2020. Related articles were obtained through searching in Scopus, Cochrane, Library, ScienceDirect, Embase, SID, Magiran, Barakatkns, Medline (PubMed), and Google Scholar. Heterogeneity of studies was studied using I² index and data were analyzed using Comprehensive Meta-Analysis and Arc map (ArcGIS 10.6) software.ResultsIn a review of 18 articles and 6190 subjects aged 20–83 years, the overall prevalence of nephropathy in patients with type 2 diabetes in Iran was 30.6% (95%CI: 24.3–37.7) based on a meta-analysis. The highest prevalence of nephropathy in patients with type 2 diabetes was obtained in Tehran province with 57.3% (95%CI: 51.5–62.9) in 2008 and the lowest prevalence of nephropathy in patients with type 2 diabetes was obtained in Hamedan province with 14.4% (95%CI: 11.3–18.8) in 2016. An increase in sample size and research year reduces the prevalence of nephropathy in patients with type 2 diabetes in Iran, and differences were statistically significant (P < 0.05).ConclusionConsidering the high prevalence of nephropathy in patients with type 2 diabetes in Iran, it is essential that health policymakers take effective measures to reduce this disease in diabetic patients.     

A systematic review and meta-analysis of the prevalence of Helicobacter pylori in patients with diabetes

Background and aimsPrior studies have shown that Helicobacter pylori (H. Pylori) has the important role in the development of gastrointestinal diseases and diabetes in patients with diabetes. Due to the contradictory results on the prevalence of H. pylori in patients, we carried out a systematic review and meta-analysis to discover the pooled prevalence of H. Pylori in patients with diabetes.MethodsA systematic literature search was performed utilizing international databases including Medline (PubMed), Web of sciences, Scopus, EMBASE, Cochrane, Ovid and CINHAL to retrieve all cross-sectional studies which had reported H. pylori prevalence in patients with diabetes between January 1990 and March 2019. The random effects models were applied to calculate the pooled prevalence with 95% confidence interval.ResultsA total of 13 articles were selected for meta-analysis according to PRISMA guideline. The pooled prevalence of H. Pylori was obtained 54% (95% CI: 44%–64%) in patients with diabetes. The highest and least prevalence of H. pylori were associated to Africa (66%; 95%CI: 49%–73%) and USA (15%; 95%CI: 8%−26%). In addition, the rapid urease test and biopsy/histology had the most strength in detecting of the H. pylori infection. The meta-regression analysis demonstrated that H. pylori prevalence is not affected by patients’ age, publication year, study duration, and HbA1C.ConclusionGiven that the high prevalence of H. pylori in patients with diabetes and its important role in the development of gastrointestinal diseases and diabetes, treatment and eradication of this bacterium should be considered in patients with diabetes.     

Prevalence of white coat and masked hypertension in Africa: A systematic review and meta‐analysis

Data on masked hypertension (MH) and white‐coat hypertension (WCH) in African populations are needed to estimate the true prevalence of hypertension in these populations because they have the highest burden of the disease. We conducted the first systematic review and meta‐analysis that summarized available data on the prevalence of WCH and MH in Africa. We searched PubMed and Scopus to identify all the articles published on MH and WCH in populations living in Africa from inception to November 30, 2017. We reviewed each study for methodological quality. A random‐effects model was used to estimate the prevalence of WCH and MH across studies. Eleven studies were included, all having a low‐risk of bias. The prevalence of masked hypertension was 11% (95% CI: 4.7‐19.3; 10 studies) in a pooled sample of 7789 individuals. The prevalence of WCH was 14.8% (95% CI: 9.4‐21.1; 8 studies) in a pooled sample of 4451 individuals. There was no difference on the prevalence of WCH and MH between studies in which participants were recruited from the community and the hospital. The prevalence of MH was higher in urban areas compared to rural ones; there was no difference for WCH. WHC and MH seem to be frequent in African populations, suggesting the importance of out‐of‐clinic BP measurement in the diagnosis and management of patients with hypertension in Africa, especially in urban areas for MH.     

Contribution of diabetes to amputations in sub-Sahara Africa: A systematic review and meta-analysis

Diabetes related amputations remain a major global problem, with devastating complications. We critically appraised relevant literature to quantify the prevalence of diabetes related amputations in sub-Saharan Africa (SSA). An electronic search was performed using the EMBASE and PubMed databases until 2020. Twenty-four out of 834 studies retrieved were included. The pooled prevalence of diabetic-related amputations was 36.9% (95%CI: 32.9%–40.8%). Complications of diabetes related amputations included infection, anaemia, foot deformity and mortality. The study revealed a substantial contribution of diabetes to the burden of amputations in SSA and suggests the need for further studies to assess how to reduce the incidence of diabetes, reduce the incidence of and or delay the progression of macro and microvascular complications of diabetes in SSA.     

Efficiency of the EmERGE Pathway to provide continuity of care for Spanish people living with medically stable HIV

ObjectiveCalculate the efficiency of the EmERGE Pathway of Care for medically stable people living with HIV at the Hospital Clínic-IDIBAPS, Barcelona, Spain.Methods546 study participants were followed between 1st July 2016 and 30th October 2019 across three HIV outpatient clinics, but the virtual clinic was closed during the second year. Unit costs were calculated, linked to mean use outpatient services per patient year, one-year before and after the implementation of EmERGE. Costs were combined with primary and secondary outcomes.ResultsAnnual costs across HIV-outpatient services increased by 8%: €1073 (95%CI €999–€1157) to €1158 (95%CI €1084–€1238). Annual cost of ARVs was €7,557; total annual costs increased by 1% from €8430 (95%CI €8356–8514) to €8515 (95%CI €8441–8595).Annual cost for 433 participants managed in face-to-face (F2F) clinics decreased by 5% from €958 (95%CI 905–1018) to €904 (95%CI 863–945); participants transferred from virtual to F2F outpatient clinics (V2F) increased their annual cost by a factor of 2.2, from €115 (95%CI 94–139) to €251 (95%CI 219–290). No substantive changes were observed in primary and secondary outcomes.ConclusionEmERGE Pathway is an efficient and acceptable intervention. Increases in costs were caused by internal structural changes. The cost reduction observed in F2F clinics were off-set by the transfer of participants from the virtual to the F2F clinics due to the closure of the virtual clinic during the second year of the Study. Greater efficiencies are likely to be achieved by extending the use of the Pathway to other PLHIV.     

Association between waist circumference and waist-to-height ratio with insulin resistance biomarkers in normal-weight adults working in a private educational institution

AimTo assess the association between elevated waist circumference (WC) and high waist-to-height ratio (WHtR) with insulin resistance biomarkers.MethodsWe conducted an analytical cross-sectional study in normal-weight adults. Participants were divided in two groups according to WC or WHtR levels. We considered values of WC ≥ 90 in male participants and WC ≥ 80 in adult women as elevated, and values of WHtR≥0.50 as high, for both genders. Our outcomes were high triglycerides to HDL-cholesterol (TG/HDL-C) ratio and elevated triglycerides and glucose index (TGI). We considered values of TG/HDL-C ratio ≥ 3 as high and TGI values ≥ 8.37 as elevated. We elaborated crude and adjusted Poisson generalized linear models to evaluate the proposed associations and explored the gender interaction using stratified models. We reported the prevalence ratio (PR) with their respective 95% confidence intervals (95%CI).ResultsWe analyzed 355 participants. The prevalence of elevated WC and high WHtR was 17.2% (n = 61) and 33.2% (n = 118), respectively, while the prevalence of high TG/HDL-C ratio and elevated TGI was 24.8% (n = 88) and 12.7% (n = 45), respectively. In the adjusted regression model, elevated WC was associated with high TG/HDL-C ratio only in female participants (aPR = 3.61; 95%CI: 1.59–8.20). Similarly, high WHtR was associated with high TG/HDL-C ratio in women (aPR = 2.54; 95%CI:1.08–5.97). We found an association with statistically marginal significance between elevated WC and elevated TGI in women (aPR = 1.54; 95%CI: 0.95–2.50); as well as for the association between high WHtR and elevated TGI in male participants (aPR = 1.87; 95%CI: 1.00–3.50).ConclusionElevated WC and high WHtR were associated with a high TG/HDL-C ratio in women. It is necessary to perform prospective follow-up studies in the Peruvian population in order to corroborate our results.     

Prevalence and risk factors of bronchiectasis in rheumatoid arthritis: A systematic review and meta-analysis

ObjectivesWe performed a systematic review and meta-analysis for the prevalence and risk factors of rheumatoid arthritis-related bronchiectasis (RA-BR).MethodsWe queried PubMed and EMBASE databases to identify published literature related to prevalence and risk factors for RA-BR among patients with RA. Data extraction included study design, country, year, method of RA-BR detection, RA characteristics, numerator of RA-BR cases and denominator of patients with RA, and associations with RA-BR presence. We performed a meta-analysis using random or fixed effects models to estimate the prevalence of RA-BR among RA.ResultsOut of a total of 253 studies, we identified 41 total studies that reported on prevalence (n = 34), risk factors (n = 5), or both (n = 2). The included studies had heterogeneous methods to identify RA-BR. Among the 36 studies reporting prevalence, 608 RA-BR cases were identified from a total of 8569 patients with RA. In the meta-analysis, the pooled overall prevalence of RA-BR among RA was 18.7% (95%CI 13.7–24.3%) using random effects and 3.8% (95%CI 3.3–4.2%) using fixed effects. Among studies that used high-resolution chest computed tomography (HRCT) imaging, the prevalence of RA-BR was 22.6% (95%CI 16.8–29.0%) using random effects. When only considering retrospective studies (n = 12), the pooled prevalence of RA-BR among RA was 15.5% (95%CI 7.5–25.5%); among prospective studies (n = 24), the pooled prevalence was 20.7% (95% CI 14.7–27.4%). Risk factors for RA-BR included older age, longer RA duration, genetics (CFTR and HLA), and undetectable circulating mannose binding lectin (MBL) as a biomarker.ConclusionIn this systematic review and meta-analysis, the prevalence of RA-BR was nearly 20% among studies with HRCT imaging, suggesting that bronchiectasis may be a common extra-articular feature of RA. Relatively few factors have been associated with RA-BR. Future studies should standardize methods to identify RA-BR cases and investigate the natural history and clinical course given the relatively high prevalence among RA.     

Diabetes in Mozambique: prevalence, management and healthcare challenges

AimThe growing trend towards and deficient management of diabetes in Africa are important public-health challenges requiring surveillance. For this reason, this study aimed to assess the prevalence and awareness of diabetes in urban and rural Mozambique, and to describe its management.MethodsIn 2005, a representative sample of the national Mozambican adult population (n = 2343) was evaluated, according to the STEPwise approach to chronic disease risk factor surveillance (STEPS). Twelve-hour fasting blood glucose (FBG) was measured, using fingertip capillary whole blood, to estimate the prevalence of impaired fasting glucose (IFG; FBG ≥ 5.6 mmol/L and less than 6.1 mmol/L) and diabetes (FBG ≥ 6.1 mmol/L, or treatment with insulin and/or oral blood glucose-lowering drugs). Patients’ awareness and management of diabetes were assessed by questionnaire.ResultsThe prevalence of diabetes and IFG was 2.9% [95% confidence interval (95%CI): 1.8–4.0] and 2.5% (95%CI: 1.3–3.7), respectively. Diabetes was more frequent among urban dwellers (OR = 2.92, 95%CI: 1.45–5.86), mostly due to urban–rural differences in age, education, body mass index (BMI) and waist circumference (adjusted OR = 2.27, 95%CI: 0.83–6.26). In all, 13% of those with diabetes were aware of their condition, 10.9% had undergone glycaemia determination during the previous year, and 9% were being treated with oral blood glucose-lowering drugs and 3% with insulin.ConclusionDiabetes prevalence is low in Mozambique, but most diabetic patients were neither aware of their condition nor being treated pharmacologically, thus posing serious challenges to the provision of adequate care in an already disadvantageous context.     

Hepatitis E in solid organ transplant recipients: A systematic review and meta-analysis

BACKGROUNDHepatitis E virus (HEV) infection is underdiagnosed due to the use of serological assays with low sensitivity. Although most patients with HEV recover completely, HEV infection among patients with pre-existing chronic liver disease and organ-transplant recipients on immunosuppressive therapy can result in decompensated liver disease and death.AIMTo demonstrate the prevalence of HEV infection in solid organ transplant (SOT) recipients. METHODSWe searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through October 2020. The inclusion criteria consisted of adult patients with history of SOT. HEV infection is confirmed by either HEV-immunoglobulin G, HEV-immunoglobulin M, or HEV RNA assay.RESULTSOf 563 citations, a total of 22 studies (n = 4557) were included in this meta-analysis. The pooled estimated prevalence of HEV infection in SOT patients was 20.2% [95% confidence interval (CI): 14.9-26.8]. The pooled estimated prevalence of HEV infection for each organ transplant was as follows: liver (27.2%; 95%CI: 20.0-35.8), kidney (12.8%; 95%CI: 9.3-17.3), heart (12.8%; 95%CI: 9.3-17.3), and lung (5.6%; 95%CI: 1.6-17.9). Comparison across organ transplants demonstrated statistical significance (Q = 16.721, P = 0.002). The subgroup analyses showed that the prevalence of HEV infection among SOT recipients was significantly higher in middle-income countries compared to high-income countries. The pooled estimated prevalence of de novo HEV infection was 5.1% (95%CI: 2.6-9.6) and the pooled estimated prevalence of acute HEV infection was 4.3% (95%CI: 1.9-9.4).CONCLUSIONHEV infection is common in SOT recipients, particularly in middle-income countries. The prevalence of HEV infection in lung transplant recipients is considerably less common than other organ transplants. More studies examining the clinical impacts of HEV infection in SOT recipients, such as graft failure, rejection, and mortality are warranted.     

Cancer and obstructive sleep apnea: An updated meta-analysis

Objective:The relationship between cancers and obstructive sleep apnea (OSA) has been discussed for decades. However, the previous meta-analysis led to opposite conclusions. To further investigate this controversial issue, we performed this systematic review and meta-analysis update.Methods:PubMed, Embase, and the Cochrane Library were systematically searched and studies on “cancer and OSA” were all included. Two reviewers independently searched articles, extracted data, and assessed the quality of included studies. Moreover, the overall incidence of cancer and OSA in corresponding populations was calculated.Results:Of the 1434 titles identified, 22 articles involving more than 32.1 million patients were included in this meta-analysis. An overall incidence of OSA positive individuals in cancer was 46 (95%CI, 27–67)%, and the prevalence of cancers in OSA patients reached 1.53 (95%CI, 1.01–2.31) times higher than non-OSA individuals.Conclusion:This meta-analysis indicated that there was a high prevalence of OSA in cancer patients, and individuals with OSA were more likely to develop tumors, and the incidence was related to the severity of OSA.     

Dietary patterns as compared with physical activity in relation to metabolic syndrome among Chinese adults

AimsTo examine the nationally-representative dietary patterns and their joint effects with physical activity on the likelihood of metabolic syndrome (MS) among 20,827 Chinese adults.Methods and resultsCNNHS was a nationally representative cross-sectional observational study. Metabolic syndrome was defined according to the Joint Interim Statement definition. The “Green Water” dietary pattern, characterized by high intakes of rice and vegetables and moderate intakes in animal foods was related to the lowest prevalence of MS (15.9%). Compared to the “Green Water” dietary pattern, the “Yellow Earth” dietary pattern, characterized by high intakes of refined cereal products, tubers, cooking salt and salted vegetable was associated with a significantly elevated odds of MS (odds ratio 1.66, 95%CI: 1.40–1.96), after adjustment of age, sex, socioeconomic status and lifestyle factors. The “Western/new affluence” dietary pattern characterized by higher consumption of beef/lamb, fruit, eggs, poultry and seafood also significantly associated with MS (odds ratio: 1.37, 95%CI: 1.13–1.67). Physical activity showed significant interactions with the dietary patterns in relation to MS risk (P for interaction = 0.008). In the joint analysis, participants with the combination of sedentary activity with the “Yellow Earth” dietary pattern or the “Western/new affluence” dietary pattern both had more than three times (95%CI: 2.8–6.1) higher odds of MS than those with active activity and the “Green Water” dietary pattern.ConclusionsOur findings from the large Chinese national representative data indicate that dietary patterns affect the likelihood of MS. Combining healthy dietary pattern with active lifestyle may benefit more in prevention of MS.     

Global prevalence of hepatitis B virus serological markers among healthcare workers: A systematic review and meta-analysis

BACKGROUNDThe hepatitis B virus (HBV) infection is a global public health concern that affects about 2 billion people and causes 1 million people deaths yearly. HBV is a blood-borne disease and healthcare workers (HCWs) are a high-risk group because of occupational hazard to patients’ blood. Different regions of the world show a highly variable proportion of HCWs infected and/or immunized against HBV. Global data on serologic markers of HBV infection and immunization in HCWs are very important to improve strategies for HBV control.AIMTo determine the worldwide prevalence of HBV serological markers among HCWs.METHODSIn this systematic review and meta–analyses, we searched PubMed and Excerpta Medica Database (Embase) to identify studies published between 1970 and 2019 on the prevalence of HBV serological markers in HCWs worldwide. We also manually searched for references of relevant articles. Four independent investigators selected studies and included those on the prevalence of each of the HBV serological markers including hepatitis B surface antigen (HBsAg), hepatitis e antigen (HBeAg), immunoglobulin M anti-HBc, and anti-HBs. Methodological quality of eligible studies was assessed and random-effect model meta-analysis resulted in the pooled prevalence of HBV serological markers HBV infection in HCWs. Heterogeneity (I²) was assessed using the χ² test on Cochran’s Q statistic and H parameters. Heterogeneity’ sources were explored through subgroup and metaregression analyses. This study is registered with PROSPERO, number CRD42019137144.RESULTSWe reviewed 14059 references, out of which 227 studies corresponding to 448 prevalence data among HCWs (224936 HCWs recruited from 1964 to 2019 in 71 countries) were included in this meta-analysis. The pooled seroprevalences of current HBsAg, current HBeAg, and acute HBV infection among HCWs were 2.3% [95% confidence interval (CI): 1.9-2.7], 0.2% (95%CI: 0.0-1.7), and 5.3% (95%CI: 1.4-11.2), respectively. The pooled seroprevalences of total immunity against HBV and immunity acquired by natural HBV infection in HCWs were 56.6% (95%CI: 48.7-63.4) and 9.2% (95%CI: 6.8-11.8), respectively. HBV infection was more prevalent in HCWs in low-income countries, particularly in Africa. The highest immunization rates against HBV in HCWs were recorded in urban areas and in high-income countries including Europe, the Eastern Mediterranean and the Western Pacific.CONCLUSIONNew strategies are needed to improve awareness, training, screening, vaccination, post-exposure management and treatment of HBV infection in HCWs, and particularly in low-income regions.     

Prevalence and determinants of undiagnosed diabetes in an urban sub-Saharan African population

AimsTo report the prevalence of undiagnosed diabetes and its determinants among adults Cameroonian urban dwellers.MethodsOn May 17th 2011, a community-based combined screening for diabetes and hypertension was conducted simultaneously in four major Cameroonian cities. Adult participants were invited through mass media. Fasting blood glucose was measured in capillary blood.ResultsOf the 2120 respondents, 1591 (52% being men) received a fasting glucose test. The median age was 43.7 years, and 64.2% were overweight or obese. The sex-specific age adjusted prevalence (for men and women) were 10.1% (95% confidence interval [CI]: 8.1–12.1%) and 11.2% (95%CI: 9.1–13.3%) for any diabetes, and 4.6% (95%CI: 2.6–6.6%) and 5.1% (95%CI: 3.0–7.2%) for screened-detected diabetes, respectively. The prevalence of diabetes increased with increasing age in men and women (all p ≤ 0.001 for linear trend). Older age (p < 0.001), region of residence (p < 0.001), excessive alcohol intake (p = 0.02) were significantly associated with screened-detected diabetes, while physical inactivity, body mass index, and high waist girth were not significantly associated with the same outcome.ConclusionsPrevalence of undiagnosed diabetes is very high among Cameroonian urban dwellers, indicating a potentially huge impact of screening for diabetes, thus the need for more proactive policies of early detection of the disease.     

Disparities in type 2 diabetes prevalence among ethnic minority groups resident in Europe: a systematic review and meta-analysis

Many ethnic minorities in Europe have a higher type 2 diabetes (T2D) prevalence than their host European populations. The risk size differs between ethnic groups, but the extent of the differences in the various ethnic minority groups has not yet been systematically quantified. We conducted a meta-analysis of published data on T2D in various ethnic minority populations resident in Europe compared to their host European populations. We systematically searched MEDLINE (using PUBMED) and EMBASE for papers on T2D prevalence in ethnic minorities in Europe published between 1994 and 2014. The ethnic minority groups were classified into five population groups by geographical origin: South Asian (SA), Sub-Saharan African (SSA), Middle Eastern and North African (MENA), South and Central American (SCA), and Western Pacific (WP). Pooled odds ratios with corresponding 95 % confidence interval (CI) were calculated using Review Manager 5.3. Twenty articles were included in the analysis. Compared with the host populations, SA origin populations had the highest odds for T2D (3.7, 95 % CI 2.7–5.1), followed by MENA (2.7, 95 % CI 1.8–3.9), SSA (2.6, 95 % CI 2.0–3.5), WP (2.3, 95 % CI 1.2–4.1), and lastly SCA (1.3, 95 % CI 1.1–1.6). Odds ratios were in all ethnic minority populations higher for women than for men except for SCA. Among SA subgroups, compared with Europeans, Bangladeshi had the highest odds ratio of 6.2 (95 % CI 3.9–9.8), followed by Pakistani (5.4, 95 % CI 3.2–9.3) and Indians (4.1, 95 % CI 3.0–5.7). The risk of T2D among ethnic minority groups living in Europe compared to Europeans varies by geographical origin of the group: three to five times higher among SA, two to four times higher among MENA, and two to three times higher among SSA origin. Future research and policy initiatives on T2D among ethnic minority groups should take the interethnic differences into account.     

Rate of post-bariatric hypoglycemia using continuous glucose monitoring: A meta-analysis of literature studies

AimsHypoglycemia is a serious complication of bariatric surgery. The aim of the present meta-analysis was to evaluate the rate and the timing of post-bariatric hypoglycemia (PBH) with different bariatric procedures using reliable data from continuous glucose monitoring (CGM).Data synthesisStudies were systematically searched in the Web of Science, Scopus and PubMed databases according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The prevalence of PBH was expressed as weighted mean prevalence (WMP) with pertinent 95% confidence intervals (95%CI). A total of 8 studies (16 datasets) enrolling 280 bariatric subjects were identified. The total WMP of PBH was 54.3% (95%CI: 44.5%–63.8%) while the WMP of nocturnal PBH was 16.4% (95%CI: 7.0%–34%). We found a comparable rate of PBH after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) (OR 1.62, 95%CI: 0.71–3.7; P = 0.248); likewise, the percent time spent in hypoglycemia was similar with the two procedures (mean difference 5.3%, 95%CI: ?1.4%–12.0%; P = 0.122); however, RYGB was characterized by a higher glycemic variability than SG. Regression models showed that the time elapsed from surgical intervention was positively associated with a higher rate of both total PBH (Z-value: 3.32, P < 0.001) and nocturnal PBH (Z-value: 2.15, P = 0.013).ConclusionsPBH, both post-prandial and nocturnal, is more prevalent than currently believed. The rate of PBH increases at increasing time from surgery and is comparable after RYGB and SG with a higher glucose variability after RYGB.