Chronic obstructive pulmonary disease hospitalisations and mortality in Victoria: analysis of variations by socioeconomic status

Objective: This paper analysed chronic obstructive pulmonary disease (COPD) hospitalisations, unplanned readmissions and deaths in Victoria to identify associations with socioeconomic status (SES). Methods: The data was taken from the Victorian Admitted Episodes Dataset, the Victorian Health Information Surveillance System, the Victorian Burden of Disease Study and the Australian Bureau of Statistics’ Index of Relative Socioeconomic Disadvantage. Results: COPD separations have a greater variation by SES than all separations. The average age‐standardised separation rate (10.43) for the top percentile Local Government Areas (LGA) was 5.8 times that of the bottom percentile LGAs (1.80). The top percentile group was the lowest SES group (effect size = 0.93). There were significant negative correlations between the age‐standardised COPD separation rates and SES across LGAs (r = ?0.60) and Regions (r = ?0.89). Analysis of readmissions (r = ?0.49), mortality data (r = ?0.51) and the burden of disease data (r = ?0.39) also showed significant inverse associations between COPD and SES. Conclusions and implications: Victorians living in the most disadvantaged areas have a greater burden from COPD, highlighting a need to prioritise public health services interventions to improve outcomes.     

Direct and indirect costs of heart failure in relation to diabetes status - A nationwide study

Background and aimHeart failure (HF) and diabetes mellitus (DM) are burdensome chronic diseases with high lifetime risks and numerous studies indicate associations between HF and DM. The objective of this study was to investigate the direct and indirect costs of HF patients with and without DM.Methods and resultsPatients with a first-time diagnosis of HF from 1998 to 2016 were identified through nationwide Danish registries and stratified according to DM status into HF with or without DM. The economic healthcare cost analysis was based on both direct costs, including hospitalization, procedures, medication and indirect costs including social welfare and lost productivity. The economic burden was investigated prior to, at, and following diagnosis of HF. Patients with concomitant HF and DM were younger (median age 74 vs. 77), had more comorbidities and fewer were female as compared to patients with HF but without DM. The socioeconomic burden of concomitant HF and DM compared to HF alone was substantially higher; 45% in direct costs (€16,237 vs. €11,184), 35% in home care costs (€3123 vs. €2320), 8% in social transfer income (€17,257 vs. €15,994) and they had 27% lower income (€10,136 vs. €13,845). The economic burden peaked at year of diagnosis, but the difference became increasingly pronounced in the years following the HF diagnosis.ConclusionPatients with concomitant HF and DM had a significantly higher economic burden compared to patients with HF but without DM.     

T cell expression of MyD88 is required for resistance to Toxoplasma gondii

Resistance to Toxoplasma gondii depends on dendritic cells to recognize this pathogen and secrete IL-12, in turn promoting IFN-gamma production from responding T cells. The adaptor protein, myeloid differentiation primary-response gene 88 (MyD88), is important for most Toll-like receptor (TLR) signaling, as well as IL-1R/IL-18R signals. There is considerable evidence that MyD88 is required for the innate sensing of T. gondii and IL-12 responses. Although Myd88(-/-) mice challenged with T. gondii have defective IL-12 and Th1 effector responses and succumb to disease, administration of IL-12 to Myd88(-/-) mice partially restores the Th1 response and yet fails to prolong survival. This finding suggested that MyD88 may mediate signals within T cells important for resistance to this pathogen. To evaluate the role of MyD88 in T cells under noncompetitive conditions, bone marrow chimeras were generated, in which the T cells lacked MyD88, but MyD88-dependent innate immune responses were intact. Upon challenge with T. gondii, these chimeric mice were more susceptible to disease, developing severe toxoplasmic encephalitis and succumbing within 30 days. Splenocytes and brain mononuclear cells isolated from infected chimeric mice produced less IFN-gamma when cultured with a T. gondii-derived antigen. The increase in susceptibility observed was independent of signals via the IL-1R and IL-18R, suggesting a role for TLRs in MyD88-mediated T cell responses to T. gondii. These observations show that, in addition to a role for MyD88 in innate responses, T cell expression of MyD88 is necessary for prolonged resistance to a pathogen.     

海南省农村儿童肠道寄生虫感染的调查

本文报道全省抽查的５个县、市１５个点的１－６岁农村儿童肠道寄生虫感染概况，按全国人体寄生虫分布调查实施细则的方法，共调查１－６岁儿童１３８７人，查见寄生虫感染者１２３７例，寄生虫总感染率为８９．２％。共查见寄生虫２３种，其中线虫１０种、原虫８种、吸虫４种、绦虫１种。以蛔虫、鞭虫、钩虫和蛲虫感染率较高，依次为６７．１％、５８．７％、２９．１％和３３．４％。其次为贾第虫和粪类圆线虫、其感染率分别为８．２％和２．６％。多虫感染者达７４．２％，１人同时感染３种寄生虫以上者占感染人数３７．１％，表明海南１－６岁农村儿童肠道寄生虫感染的普遍性和严重性。     

Epidemiology of Cardiovascular Disease in China and Opportunities for Improvement: JACC International

The burden of cardiovascular (CV) disease is very high in China, due to highly prevalent and poorly controlled risk factors resulting from changing sociodemographic structure and lifestyles in its large population. Rapid economic development and urbanization have been accompanied by changing patterns, expression, and management of CV disease. However, the health care system in China lacks a hierarchical structure, with a focus on treating acute diseases in hospital while ignoring long-term management, and primary health care is too weak to effectively control CV risk factors. To address these challenges, the Chinese central government has ensured health is a national priority and has introduced reforms that include implementing policies for a healthy environment, strengthening primary care, and improving affordability and accessibility within the health system. Turning the inverted pyramid of the health care system is essential in the ongoing battle against CV disease.     

云南省人体寄生虫分布调查

应用分层整群随机抽样方法,于1987～1990年进行了云南省人体寄生虫分布调查。共查28个县103个点,53061人,寄生虫感染率为76.3%。查到肠道寄生虫25种,包括线虫9种,绦虫5种,吸虫1种和原虫10种。感染1、2、3、4、5种寄生虫者分别占总感染人数的47.0%、33.7%、14.4%、3.7%和0.8%。主要致病虫种的感染率为:钩虫19.3%、蛔虫59.6%、鞭虫27.6%、蛲虫12.9%(儿童)、旋毛虫13.5%(血清免疫学试验阳性458/3392)、带绦虫0.93%、猪囊虫3.26%(106/3252,血清学阳性)、溶组织内阿米巴2.54%、蓝氏贾第鞭毛虫2.49%、芽囊原虫(人体酵母菌)6.98%。总感染率和钩虫、蛔虫、鞭虫的感染率在不同地区和不同性别、年龄、职业和民族之间均有显著性差异。     

Assessment of Multivessel Coronary Artery Disease Using Cardiovascular Magnetic Resonance Pixelwise Quantitative Perfusion Mapping

ObjectivesThe authors sought to compare the diagnostic accuracy of quantitative perfusion maps to visual assessment (VA) of first-pass perfusion images for the detection of multivessel coronary artery disease (MVCAD).BackgroundVA of first-pass stress perfusion cardiac magnetic resonance (CMR) may underestimate ischemia in MVCAD. Pixelwise perfusion mapping allows quantitative measurement of regional myocardial blood flow, which may improve ischemia detection in MVCAD.MethodsOne hundred fifty-one subjects recruited at 2 centers underwent stress perfusion CMR with myocardial perfusion mapping, and invasive coronary angiography with coronary physiology assessment. Ischemic burden was assessed by VA of first-pass images and by quantitative measurement of stress myocardial blood flow using perfusion maps.ResultsIn patients with MVCAD (2-vessel [2VD] or 3-vessel disease [3VD]; n = 95), perfusion mapping identified significantly more segments with perfusion defects (median segments per patient 12 [interquartile range (IQR): 9 to 16] by mapping vs. 8 [IQR: 5 to 9.5] by VA; p < 0.001). Ischemic burden (IB) measured using mapping was higher in MVCAD compared with IB measured using VA (3VD mapping 100 % (75% to 100%) vs. first-pass 56% (38% to 81%) ; 2VD mapping 63% (50% to 75%) vs. first-pass 41% (31% to 50%); both p < 0.001), but there was no difference in single-vessel disease (mapping 25% (13% to 44%) vs. 25% (13% to 31%). Perfusion mapping was superior to VA for the correct identification of extent of coronary disease (78% vs. 58%; p < 0.001) due to better identification of 3VD (87% vs. 40%) and 2VD (71% vs. 48%).ConclusionsVA of first-pass stress perfusion underestimates ischemic burden in MVCAD. Pixelwise quantitative perfusion mapping increases the accuracy of CMR in correctly identifying extent of coronary disease. This has important implications for assessment of ischemia and therapeutic decision-making.