121 results on '"Richard Ofori-Asenso"'
Search Results
2. Association between frailty, delirium, and mortality in older critically ill patients: a binational registry study
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Berhe W. Sahle, David Pilcher, Edward Litton, Richard Ofori-Asenso, Karlheinz Peter, James McFadyen, and Tracey Bucknall
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Frailty ,Delirium ,Mortality ,Critically ill ,Intensive care unit ,Length of stay ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Frailty and delirium are prevalent among older adults admitted to the intensive care unit (ICU) and associated with adverse outcomes; however, their relationships have not been extensively explored. This study examined the association between frailty and mortality and length of hospital stay (LOS) in ICU patients, and whether the associations are mediated or modified by an episode of delirium. Methods Retrospective analysis of data from the Australian New Zealand Intensive Care Society Adult Patient Database. A total of 149,320 patients aged 65 years or older admitted to 203 participating ICUs between 1 January 2017 and 31 December 2020 who had data for frailty and delirium were included in the analysis. Results A total of 41,719 (27.9%) older ICU patients were frail on admission, and 9,179 patients (6.1%) developed delirium during ICU admission. Frail patients had significantly higher odds of in-hospital mortality (OR: 2.15, 95% CI 2.05–2.25), episodes of delirium (OR: 1.86, 95% CI 1.77–1.95), and longer LOS (log-transformed mean difference (MD): 0.24, 95% CI 0.23–0.25). Acute delirium was associated with 32% increased odds of in-hospital mortality (OR: 1.32, 95% CI 1.23–1.43) and longer LOS (MD: 0.54, 95% CI 0.50–0.54). The odds ratios (95% CI) for in-hospital mortality were 1.37 (1.23–1.52), 2.14 (2.04–2.24) and 2.77 (2.51–3.05) for non-frail who developed delirium, frail without delirium, and frail and developed delirium during ICU admission, respectively. There was very small but statistically significant effect of frailty on in-hospital mortality (b for indirect effect: 0.00037, P
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- 2022
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3. Hospitalisations related to administration errors of psychotropic drugs: a nationwide retrospective study between 1998 and 2019 in Australia
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Fatemah M. Alsaleh, Abdallah Y. Naser, Zahra K. Alsairafi, and Richard Ofori-Asenso
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admission ,Australia ,hospitalisation ,medication ,psychotropic ,poisoning ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Objectives: Medication administration error occurs when there is a discrepancy between what the patient received or was planned to receive and what the doctor originally intended. The aim of this study was to examine the trends in hospitalisation related to administration errors of psychotropic drugs in Australia.Materials and Methods: This was a secular trend analysis study that examined the hospitalisation pattern for medication administration errors of psychotropic drugs in Australia between 1998 and 2019. Data on medication administration errors of psychotropic drugs was obtained from The National Hospital Morbidity Database. We analysed the variation in hospitalisation rates using the Pearson chi-square test for independence.Results: Hospitalisation rates related to administration errors of psychotropic drugs increased by 8.3% [from 36.22 (95% CI 35.36—37.08) in 1998 to 39.21 (95% CI 38.44—39.98) in 2019 per 100,000 persons, p < 0.05]. Overnight-stay hospital admission patients accounted for 70.3% of the total number of episodes. Rates of same-day hospitalisation increased by 12.3% [from 10.35 (95% CI 9.90—10.81) in 1998 to 11.63 (95% CI 11.21—12.05) in 2019 per 100,000 persons]. Rates of overnight-stay hospital admission increased by 1.8% [from 25.86 (95% CI 25.13—26.59) in 1998 to 26.34 (95% CI 25.71—26.97) in 2019 per 100,000 persons]. Other and unspecified antidepressants (selective serotonin and norepinephrine reuptake inhibitors) were the most common reason for hospitalisation accounting for 36.6% of the total number of hospitalisation episodes. Females accounted for 111,029 hospitalisation episodes, representing 63.2% of all hospitalisation episodes. The age group 20–39 years accounted for nearly half (48.6%) of the total number of episodes.Conclusion: Psychotropic drug administration error is a regular cause of hospitalization in Australia. Hospitalizations usually required overnight stays. The majority of hospitalizations were in persons aged 20–39 years, which is concerning and warrants further investigation. Future studies should examine the risk factors for hospitalization related to psychiatric drug administration errors.
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- 2023
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4. The Diagnostic Accuracy of Syndromic Management for Genital Ulcer Disease: A Systematic Review and Meta-Analysis
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Andre J. W. Loh, Ee Lynn Ting, Teodora E. Wi, Philippe Mayaud, Eric P. F. Chow, Nancy Santesso, Jane Falconer, Richard Ofori-Asenso, and Jason J. Ong
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genital ulcer disease ,herpes ,syphilis ,syndromic algorithm ,systematic review and meta-analysis ,chancroid ,Medicine (General) ,R5-920 - Abstract
Objectives: Genital Ulcer Disease (GUD) carries a significant disease burden globally. With limited access to diagnostics, the 2001 World Health Organization (WHO) sexually transmitted illnesses (STI) guidelines proposed a syndromic management algorithm that required a clinical decision to determine the management of GUD. We assessed the diagnostic accuracy of this algorithm.Methods: We conducted a systematic review (Prospero: CRD42020153294) using eight databases for publications between 1995 and January 2021 that reported primary data on the diagnostic accuracy of clinical diagnosis to identify aetiological agents of GUD. Titles and abstracts were independently assessed for eligibility, and data were extracted from full texts for sensitivity/specificity. A hierarchical logistic regression model was used to derive pooled sensitivity and specificity. We used GRADE to evaluate the certainty of evidence.Results: Of 24,857 articles, 151 full texts were examined and 29 included in the analysis. The majority were from middle-income countries [(14/29 (48%) lower middle, 10/29 (34%) upper middle)]. We pooled studies where molecular testing was using to confirm the aetiology of GUD: 9 studies (12 estimates) for herpes, 4 studies (7 estimates) for syphilis, and 7 studies (10 estimates) for chancroid. The pooled sensitivity and specificity of GUD for the detection of herpes was 43.5% [95% confidence interval (CI): 26.2–62.4], and 88.0% (95% CI: 67.0–96.3), respectively (high certainty evidence); and for syphilis were 52.8% (95% CI: 23.0–80.7), and 72.1% (95% CI: 28.0–94.5) (moderate certainty evidence); and for chancroid were 71.9% (95% CI: 45.9–88.5) and 53.1% (95% CI: 36.6–68.9) (moderate certainty evidence), respectively.Conclusion: Algorithms requiring a clinical diagnosis to determine and treat the aetiology of GUD have poor sensitivities for syphilis and herpes simplex virus, resulting in significant numbers of missed cases. There is an urgent need to improve access to affordable and efficient diagnostics (e.g., point-of-care tests) to be incorporated into GUD algorithms to better guide appropriate management.Systematic Review Registration: PROSPERO, identifier: CRD42020153294.
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- 2022
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5. Improving Interactions Between Health Technology Assessment Bodies and Regulatory Agencies: A Systematic Review and Cross-Sectional Survey on Processes, Progress, Outcomes, and Challenges
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Richard Ofori-Asenso, Christine E. Hallgreen, and Marie Louise De Bruin
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HTA ,regulatory approval ,synergy ,harmonization ,collaboration synergy between HTA and regulatory agencies ,Medicine (General) ,R5-920 - Abstract
The need to optimize drug development and facilitate faster access for patients has ignited discussions around the importance of improving interactions between health technology assessment (HTA) bodies and regulatory agencies. In this study, we conducted a systematic review to examine processes, progress, outcomes, and challenges of harmonization/interaction initiatives between HTA bodies and regulatory agencies. MEDLINE, EMBASE, and the International Pharmaceutical Abstracts database were searched up to 21 October 2019. Searches for gray literature (working papers, commissioned reports, policy documents, etc.) were performed via Google scholar and several institutional websites. An online cross-sectional survey was also conducted among HTA (n = 22) and regulatory agencies (n = 6) across Europe to supplement the systematic review. Overall, we found that while there are areas of divergence, there has been progress over time in narrowing the gap in evidentiary requirements for HTA bodies and regulatory agencies. Most regulatory agencies (4/6; 67%) and half (11/22, 50%) of the HTA bodies reported having a formal link for “collaborating” with the other. Several mechanisms such as early tripartite dialogues, parallel submissions (reviews), adaptive licensing pathways, and postauthorization data generation have been explored as avenues for improving collaboration. A number of pilot initiatives have shown positive effects of these models to reduce the time between regulatory and HTA decisions, which may translate into faster access for patients to life-saving therapies. Thus, future approaches aimed at improving harmonization/interaction between HTA bodies and regulatory agencies should build on these existing models/mechanisms while examining their long-term impacts. Several barriers including legal, organizational, and resource-related factors were also identified, and these need to be addressed to achieve greater alignment in the current regulatory and reimbursement landscape.
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- 2020
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6. Measures of geographic accessibility to health care in the Ashanti Region of Ghana
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George Ashiagbor, Richard Ofori-Asenso, Eric K. Forkuo, and Seth Agyei-Frimpong
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Geographic information systems ,Healthcare accessibility ,Health equity ,Ashanti region ,Ghana ,Science - Abstract
Quantitative data on geographical accessibility to healthcare remain generally limited in sub-Saharan Africa. This study sought to generate quantitative evidence regarding health care access in the Ashanti region of Ghana. Dasymetric mapping technique and GIS tools were used to estimate the total population living within the World Health Organization (WHO)'s recommended 5 km distance to the nearest health facility. An estimated 81.4% of the population had access to general primary health care, 61.4% to secondary-level health care and, only 14.3% to tertiary health care. Despite the high levels of accessibility to general primary health care, accessibility remains poor in some selected districts, especially rural districts in the region. About 30% of the population are more likely to have to travel long distances to access healthcare, particularly specialist services which are available only at secondary and tertiary centres. There is the need for intensified efforts to address inequities in geographic accessibility to healthcare so as to minimise inequalities in health outcomes as well as achieve the desired improvements in population health.
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- 2020
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7. Systematic review with meta-analysis: Effects of probiotic supplementation on symptoms in functional dyspepsia
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Shahram Agah, Abolfazl Akbari, Javad Heshmati, Mahdi Sepidarkish, Mojgan Morvaridzadeh, Payman Adibi, Mohsen Mazidi, Farnaz Farsi, Richard Ofori-Asenso, Nicholas J. Talley, and Christine Feinle-Bisset
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Functional dyspepsia ,Gastrointestinal ,Probiotics ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The pathophysiology of functional dyspepsia (FD) remains poorly understood, but alterations of the small intestinal microbiome have been observed. The place of probiotics in treatment is uncertain. We performed a systematic review and meta-analysis of the currently available randomized, controlled trials (RCTs) to evaluate the potential beneficial effects and risks of probiotics in FD. Pubmed, EMBASE, Scopus, Web of Science and the Cochrane Controlled Trials Register were searched (up to May 2019) for RCTs evaluating the effects of probiotic supplementation compared to placebo in adults with FD. Two reviewers independently assessed eligibility, trial quality and extracted information from identified articles. To compare the effects of probiotics with placebo, risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random effects models. Six trials, including 422 participants were included but only three RCTs could be included in the meta-analysis. Lactobacillus strains showed potential positive effects in terms of improving upper gastrointestinal (GI) symptoms in patients with FD. Probiotic supplementation tended to improve global dyspepsia score (n = 3 RCTs, risk ratio [RR]: 1.35, 95% CI 0.99 to 1.84; P = 0.061) and bacterial composition in the GI tract. Probiotics were well tolerated without any serious adverse events. While the available data suggest that supplementation with probiotics may improve GI symptoms in patients with FD, the evidence is insufficient to draw clear conclusions regarding efficacy. Thus, high-quality RCTs are needed to establish the beneficial effects of probiotic supplementation on FD outcomes.
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- 2020
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8. Maternal and neonatal outcomes associated with COVID-19 infection: A systematic review.
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Vinayak Smith, Densearn Seo, Ritesh Warty, Olivia Payne, Mohamed Salih, Ken Lee Chin, Richard Ofori-Asenso, Sathya Krishnan, Fabricio da Silva Costa, Beverley Vollenhoven, and Euan Wallace
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Medicine ,Science - Abstract
BackgroundCOVID-19 has created an extraordinary global health crisis. However, with limited understanding of the effects of COVID-19 during pregnancy, clinicians and patients are forced to make uninformed decisions.ObjectivesTo systematically evaluate the literature and report the maternal and neonatal outcomes associated with COVID-19.Search strategyPubMed, MEDLINE, and EMBASE were searched from November 1st, 2019 and March 28th, 2020.Selection criteriaPrimary studies, reported in English, investigating COVID-19-positive pregnant women and reporting their pregnancy and neonatal outcomes.Data collection and analysisData in relation to clinical presentation, investigation were maternal and neonatal outcomes were extracted and analysed using summary statistics. Hypothesis testing was performed to examine differences in time-to-delivery. Study quality was assessed using the ICROMS tool.Main resultsOf 73 identified articles, nine were eligible for inclusion (n = 92). 67.4% (62/92) of women were symptomatic at presentation. RT-PCR was inferior to CT-based diagnosis in 31.7% (26/79) of cases. Maternal mortality rate was 0% and only one patient required intensive care and ventilation. 63.8% (30/47) had preterm births, 61.1% (11/18) fetal distress and 80% (40/50) a Caesarean section. 76.92% (11/13) of neonates required NICU admission and 42.8% (40/50) had a low birth weight. There was one indeterminate case of potential vertical transmission. Mean time-to-delivery was 4.3±3.08 days (n = 12) with no difference in outcomes (p>0.05).ConclusionsCOVID-19-positive pregnant women present with fewer symptoms than the general population and may be RT-PCR negative despite having signs of viral pneumonia. The incidence of preterm births, low birth weight, C-section, NICU admission appear higher than the general population.
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- 2020
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9. Raising concerns about the Sepsis-3 definitions
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Massimo Sartelli, Yoram Kluger, Luca Ansaloni, Timothy C. Hardcastle, Jordi Rello, Richard R. Watkins, Matteo Bassetti, Eleni Giamarellou, Federico Coccolini, Fikri M. Abu-Zidan, Abdulrashid K. Adesunkanmi, Goran Augustin, Gian L. Baiocchi, Miklosh Bala, Oussema Baraket, Marcelo A. Beltran, Asri Che Jusoh, Zaza Demetrashvili, Belinda De Simone, Hamilton P. de Souza, Yunfeng Cui, R. Justin Davies, Sameer Dhingra, Jose J. Diaz, Salomone Di Saverio, Agron Dogjani, Mutasim M. Elmangory, Mushira A. Enani, Paula Ferrada, Gustavo P. Fraga, Sabrina Frattima, Wagih Ghnnam, Carlos A. Gomes, Souha S. Kanj, Aleksandar Karamarkovic, Jakub Kenig, Faryal Khamis, Vladimir Khokha, Kaoru Koike, Kenneth Y. Y. Kok, Arda Isik, Francesco M. Labricciosa, Rifat Latifi, Jae G. Lee, Andrey Litvin, Gustavo M. Machain, Ramiro Manzano-Nunez, Piotr Major, Sanjay Marwah, Michael McFarlane, Ziad A. Memish, Cristian Mesina, Ernest E. Moore, Frederick A. Moore, Noel Naidoo, Ionut Negoi, Richard Ofori-Asenso, Iyiade Olaoye, Carlos A. Ordoñez, Mouaqit Ouadii, Ciro Paolillo, Edoardo Picetti, Tadeja Pintar, Alfredo Ponce-de-Leon, Guntars Pupelis, Tarcisio Reis, Boris Sakakushev, Hossein Samadi Kafil, Norio Sato, Jay N. Shah, Boonying Siribumrungwong, Peep Talving, Cristian Tranà, Jan Ulrych, Kuo-Ching Yuan, and Fausto Catena
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Sepsis ,Septic shock ,Organ dysfunction ,Infections ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.
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- 2018
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10. Overweight and obesity epidemic in Ghana—a systematic review and meta-analysis
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Richard Ofori-Asenso, Akosua Adom Agyeman, Amos Laar, and Daniel Boateng
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Obesity ,Nutrition transition ,Non-communicable diseases ,Ghana ,Meta-analysis ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background In many low and middle income countries (LMICs), the distribution of adulthood nutritional imbalance is shifting from a predominance of undernutrition to overnutrition. This complex problem poses a huge challenge to governments, non-state actors, and individuals desirous of addressing the problem of malnutrition in LMICs. The objective of this study was to systematically review the literature towards providing an estimate of the prevalence of overweight and obesity among adult Ghanaians. Methods This study followed the recommendations outlined in the PRISMA statement. Searches were performed in PubMed, Science Direct, google scholar, Africa Journals Online (AJOL) and the WHO African Index Medicus database. This retrieved studies (published up to 31st March 2016) that reported overweight and obesity prevalence among Ghanaians. All online searches were supplemented by reference screening of retrieved papers to identify additional studies. Results Forty-three (43) studies involving a total population of 48,966 sampled across all the ten (10) regions of Ghana were selected for the review. Our analysis indicates that nearly 43% of Ghanaian adults are either overweight or obese. The national prevalence of overweight and obesity were estimated as 25.4% (95% CI 22.2–28.7%) and 17.1% (95% CI = 14.7–19.5%), respectively. Higher prevalence of overweight (27.2% vs 16.7%) and obesity (20.6% vs 8.0%) were estimated for urban than rural dwellers. Prevalence of overweight (27.8% vs 21.8%) and obesity (21.9% vs 6.0%) were also significantly higher in women than men. About 45.6% of adult diabetes patients in Ghana are either overweight or obese. At the regional level, about 43.4%, 36.9%, 32.4% and 55.2% of residents in Ashanti, Central, Northern and Greater Accra region, respectively are overweight or obese. These patterns generally mimic the levels of urbanization. Per studies’ publication years, consistent increases in overweight and obesity prevalence were observed in Ghana in the period 1998–2016. Conclusions There is a high and rising prevalence of overweight and obesity among Ghanaian adults. The possible implications on current and future population health, burden of chronic diseases, health care spending and broader economy could be enormous for a country still battling many infectious and parasitic diseases. Public health preventive measures that are appropriate for the Ghanaian context, culturally sensitive, cost-effective and sustainable are urgently needed to tackle this epidemic.
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- 2016
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11. Towards Resilient Health Systems in Sub-Saharan Africa: A Systematic Review of the English Language Literature on Health Workforce, Surveillance, and Health Governance Issues for Health Systems Strengthening
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Martin Amogre Ayanore, Norbert Amuna, Mark Aviisah, Adam Awolu, Daniel Dramani Kipo-Sunyehzi, Victor Mogre, Richard Ofori-Asenso, Jonathan Mawutor Gmanyami, Nuworza Kugbey, and Margaret Gyapong
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Meeting health security capacity in sub-Saharan Africa will require strengthening existing health systems to prevent, detect, and respond to any threats to health. The purpose of this review was to examine the literature on health workforce, surveillance, and health governance issues for health systems strengthening. Methods: We searched PubMed, Science Direct, Cochrane library, CINAHL, Web of Science, EMBASE, EBSCO, Google scholar, and the WHO depository library databases for English-language publications between January 2007 and February 2017. Electronic searches for selected articles were supplemented by manual reference screening. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: Out of 1,548 citations retrieved from the electronic searches, 31 articles were included in the review. Any country health system that trains a cadre of health professionals on the job, reduces health workforce attrition levels, and builds local capacity for health care workers to apply innovative mHealth technologies improves health sector performance. Building novel surveillance systems can improve clinical care and improve health system preparedness for health threats. Effective governance processes build strong partnerships for health and create accountability mechanisms for responding to health emergencies. Conclusions: Overall, policy shifts in African countries’ health systems that prioritize training a cadre of willing and able workforce, invest in robust and cost-effective surveillance capacity, and create financial accountability and good governance are vital in health strengthening efforts.
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- 2019
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12. Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995–2015)
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Richard Ofori-Asenso, Petra Brhlikova, and Allyson M. Pollock
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Prescribing indicators ,Drug use indicators ,Pharmacoepidemiology ,Prescribing evaluation ,Medicine utilization studies ,Systematic reviews ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Rational medicine use is essential to optimize quality of healthcare delivery and resource utilization. We aim to conduct a systematic review of changes in prescribing patterns in the WHO African region and comparison with WHO indicators in two time periods 1995–2005 and 2006–2015. Methods Systematic searches were conducted in PubMed, Scopus, Web of science, Africa-Wide Nipad, Africa Journals Online (AJOL), Google scholar and International Network for Rational Use of Drugs (INRUD) Bibliography databases to identify primary studies reporting prescribing indicators at primary healthcare centres (PHCs) in Africa. This was supplemented by a manual search of retrieved references. We assessed the quality of studies using a 14-point scoring system modified from the Downs and Black checklist with inclusions of recommendations in the WHO guidelines. Results Forty-three studies conducted in 11 African countries were included in the overall analysis. These studies presented prescribing indicators based on a total 141,323 patient encounters across 572 primary care facilities. The results of prescribing indicators were determined as follows; average number of medicines prescribed per patient encounter = 3.1 (IQR 2.3–4.8), percentage of medicines prescribed by generic name =68.0 % (IQR 55.4–80.3), Percentage of encounters with antibiotic prescribed =46.8 % (IQR 33.7–62.8), percentage of encounters with injection prescribed =25.0 % (IQR 18.7–39.5) and the percentage of medicines prescribed from essential medicines list =88.0 % (IQR 76.3–94.1). Prescribing indicators were generally worse in private compared with public facilities. Analysis of prescribing across two time points 1995–2005 and 2006–2015 showed no consistent trends. Conclusions Prescribing indicators for the African region deviate significantly from the WHO reference targets. Increased collaborative efforts are urgently needed to improve medicine prescribing practices in Africa with the aim of enhancing the optimal utilization of scarce resources and averting negative health consequences.
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- 2016
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13. Frailty Confers High Mortality Risk across Different Populations: Evidence from an Overview of Systematic Reviews and Meta-Analyses
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Richard Ofori-Asenso, Ken Lee Chin, Berhe W. Sahle, Mohsen Mazidi, Andrew R. Zullo, and Danny Liew
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frailty ,mortality ,evidence synthesis ,meta-analyses ,umbrella review ,Geriatrics ,RC952-954.6 - Abstract
We performed an overview of systematic reviews and meta-analyses to summarize available data regarding the association between frailty and all-cause mortality. Medline, Embase, CINAHL, Web of Science, PsycINFO, and AMED (Allied and Complementary Medicine) databases were searched until February 2020 for meta-analyses examining the association between frailty and all-cause mortality. The AMSTAR2 checklist was used to evaluate methodological quality. Frailty exposure and the risk of all-cause mortality (hazard ratio [HR] or relative risk [RR]) were displayed in forest plots. We included 25 meta-analyses that pooled data from between 3 and 20 studies. The number of participants included in these meta-analyses ranged between 500,000. Overall, 56%, 32%, and 12% of studies were rated as of moderate, low, and critically low quality, respectively. Frailty was associated with increased risk of all-cause mortality in 24/24 studies where the HR/RRs ranged from 1.35 [95% confidence interval (CI) 1.05−1.74] (patients with diabetes) to 7.95 [95% CI 4.88−12.96] (hospitalized patients). The median HR/RR across different meta-analyses was 1.98 (interquartile range 1.65−2.67). Pre-frailty was associated with a significantly increased risk of all-cause mortality in 7/7 studies with the HR/RR ranging from 1.09 to 3.65 (median 1.51, IQR 1.38−1.73). These data suggest that interventions to prevent frailty and pre-frailty are needed.
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- 2020
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14. Predictors of Health Care Service Quality among Women Insured Under Ghana’s National Health Insurance Scheme
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Martin Amogre Ayanore, Richard Ofori-Asenso, and Amos Laar
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Insured women in Ghana are more likely to use maternity care services than their uninsured counterparts. To improve service quality among insured women in Ghana, better understanding of the factors that predict quality standards of primary health care services is essential. Objective: To examine predictors of health care service quality among insured women under the National Health Insurance Scheme (NHIS) in Ghana. Methods: Data from the 2014 Ghana Demographic Health Survey was analysed. Cluster analysis was applied to construct a dependent variable; service care quality. Socio-demographic/background characteristics were used as independent variables. Descriptive and inferential analyses were performed followed by multiple regression to predict service quality among the insured population of women aged 15–49 years. SPSS version 21 was used during the clustering while STATA version 14 was used to perform the inferential and regression analyses. Findings: Overall, geographical region of respondents was significant to expressions of insured service quality (χ2=495.4, p ≤ 0.001). Literacy levels were significant at χ2=69.232 and p ≤ 0.001 for service quality. On place of residence, the estimation show urban residency was more positively correlated with indicating quality ratings of health services compared to rural residency (χ2=70.29, p ≤ 0.001). Highest educational level had the highest predictive influence with a coefficient of 0.15. Conclusions:A more supportive health insurance system approach that shifts towards introducing valued-based care models for patients, insurers and health care providers could be supportive in improving quality standards among insured population groups in Ghana.
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- 2018
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15. A review of injection and antibiotic use at primary health care (public and private) centers in Africa
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Richard Ofori-Asenso and Akosua Adom Agyeman
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Antibiotic ,drug use patterns ,injection ,pharmacoepidemiology ,prescribing indicators ,Pharmacy and materia medica ,RS1-441 ,Analytical chemistry ,QD71-142 - Abstract
We conducted a review to study antibiotic and injections use at primary care centers (PHCs) within the World Health Organization African region. This was part of a larger study on prescribing indicators at PHCs within the region. We analyzed antibiotic and injection use reported in studies published between 1993 and June 2013, which were identified through searches conducted in PubMed, Scopus, Web of science, Africa-Wide NiPAD, Africa Journals Online, Google Scholar, and International Network for Rational Use of Drugs bibliography databases. Sub-group analysis was carried out for private and public centers. Data were retrieved from 18 studies in 6 countries involving 21,283 patient encounters across 338 PHCs. The percentage of patient encounters with antibiotics prescribed was 51.5% (IQR 41.1-63.3%). The percentage of patient encounters which resulted in the prescription of an injection was 36.8% (IQR 20.7-57.6%). Injection use rate at private facilities was 38% (IQR 19.1-42.7) while that of the public was 32.3% (IQR 20.6-57.6). Rate of antibiotic prescribing at public centers was 49.7% (IQR 51.1-75.7) and that of private facilities 57.6 (IQR 39.0-69.5).The percentage use of injections and antibiotics is high in Africa. The excessive use of antibiotics and injections are particularly more problematic in private than public facilities. Further research is needed to understand fully the underlying factors for the observed patterns and ways of improving medicines use.
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- 2015
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16. Perspective: Does personalized medicine hold the future for medicine?
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Akosua Adom Agyeman and Richard Ofori-Asenso
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Pharmacy and materia medica ,RS1-441 ,Analytical chemistry ,QD71-142 - Published
- 2015
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17. Skipping Breakfast and the Risk of Cardiovascular Disease and Death: A Systematic Review of Prospective Cohort Studies in Primary Prevention Settings
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Richard Ofori-Asenso, Alice J. Owen, and Danny Liew
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breakfast ,meal frequency ,cardiovascular disease ,mortality ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Several studies have associated skipping (not having) breakfast with cardiometabolic risk factors such as obesity, high blood pressure, unfavorable lipid profiles, diabetes, and metabolic syndrome. We examined the available evidence regarding the effect of skipping breakfast on cardiovascular morbidity and mortality, as well as all-cause mortality. Medline, Embase, and Web of Science were searched from inception until May 2019 to identify prospective cohort studies that examined the association between skipping breakfast and the risk of cardiovascular morbidity and mortality and all-cause death. Electronic searches were supplemented by manual screening of the references of retrieved studies. Out of 456 citations identified, four studies (from Japan and the US) were included. The included studies involved a total of 199,634 adults (aged ≥40 years; 48.5% female) without known cardiovascular disease (CVD) at baseline followed over a median duration of 17.4 years. The pooled data suggested that people who regularly skipped breakfast were about 21% more likely (hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.08−1.35; I2 = 17.3%, p = 0.304) to experience incident CVD or die from it than people who regularly consumed breakfast. Also, the risk of all-cause death was 32% higher (HR 1.32, 95% CI 1.17−1.48; I2 = 7.6%, p = 0.339) in people who regularly skipped breakfast than in people who regularly consumed breakfast. However, the definition of skipping breakfast was heterogenous and adjustment for confounders varied significantly. Therefore, residual confounding could not be ruled out and caution is required in the interpretation of the findings. Hence, large prospective studies with a consistent definition of skipping breakfast, and conducted across different populations, are needed to provide more robust evidence of the health effects of skipping breakfast.
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- 2019
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18. Patterns of Medication Dispensation for Multiple Comorbidities among Older Adults in Australia
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Richard Ofori-Asenso, Jenni Ilomaki, Andrea J. Curtis, Ella Zomer, Sophia Zoungas, and Danny Liew
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multimorbidity ,older adults ,disease clusters ,comorbidity ,medications ,Australia ,Pharmacy and materia medica ,RS1-441 - Abstract
Background: The increasing burden of chronic (medical) conditions (CCs) is a major issue for healthcare systems across the world. We aimed to examine the changes in the rate of medication dispensation for multiple CCs among Australians aged ≥65 years. Methods: A repeated cross-sectional study was performed using the 2013⁻2016 Pharmaceutical Benefits Scheme (PBS) data on reimbursed prescriptions for a 10% random sample of the Australian population. Twenty-two CCs were identified via the RxRisk-V tool. The yearly changes in the proportion of older adults dispensed medications for ≥2 CCs were determined through Poisson regression modelling using 2013 as the reference year. The occurrence of CC dyads and triads for which medications were dispensed within a 180-day window were characterised, and the observed and expected rate of medication dispensation for each CC dyad or triad were calculated to identify the top 15 combinations. Results: The proportion of older adults dispensed medications for ≥2 CCs remained stable from 2013 to 2016, at >79% in each year. The proportion who were dispensed medications for multiple CCs increased with age. No gender differences in the dispensation of medications for multiple CCs were observed. Over 60% had medications dispensed for ≥3 CCs. The most frequent CC dyad and triad for which medications were dispensed were dyslipidaemia + hypertension (38.6%) and dyslipidaemia + gastroesophageal reflux disease + hypertension (18.7%), respectively. For the majority of CC dyads and all triads examined, the observed rate of medication dispensation exceeded that expected by chance. Conclusions: A high proportion of older Australians are dispensed medications for multiple CCs, suggestive of multimorbidity. The results reiterate the need for increased research into understanding the causal mechanisms of multimorbidity to inform the design of cost-effective interventions.
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- 2018
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19. What is the process of obtaining informed consent in a clinical trial? Is it ever justifiable to include someone in a clinical trial without prior informed consent from the individual?
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Akosua Adom Agyeman and Richard Ofori-Asenso
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Pharmacy and materia medica ,RS1-441 ,Analytical chemistry ,QD71-142 - Published
- 2016
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20. 'When the Bug Cannot Be Killed'—The Rising Challenge of Antimicrobial Resistance
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Richard Ofori-Asenso
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antimicrobial resistance ,superbugs ,international health ,Medicine - Abstract
Antimicrobial resistance is a major global health issue that has the potential to reverse the substantial progress made against infectious diseases over the past several decades. We need strategic measures to deal with this challenge, including an intensification of public funding for research into anti-microbial agents and their alternatives, stricter mechanisms to minimize antimicrobial misuse within both clinical and non-clinical settings, and support for the development of country-level initiatives. Only with sustained, concerted, and coordinated global efforts are we likely to overcome the current and future challenges posed by these emerging “superbugs”.
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- 2017
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21. Irrational Use of Medicines—A Summary of Key Concepts
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Richard Ofori-Asenso and Akosua Adom Agyeman
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good prescribing ,rational medicine use ,rational dispensing ,Pharmacy and materia medica ,RS1-441 - Abstract
Medicines play an integral part of healthcare delivery. However, they are expensive commodities and account for a significant proportion of overall health expenditure in most countries. Irrational use of medicines is a major challenge facing many health systems across the world. Such practices are likely to lead to poor health delivery that may put patients at risk and result in wastage of scarce resources that could have been used to tackle other pressing health needs. The concept of “rational use of medicine” can at times be confusing and not easily appreciated by patients, healthcare providers, policy makers, or the public, all of whom need to collaborate effectively to address this challenge. In this article, we summarize basic concepts such as rational medicine use, good prescribing and dispensing, and explore some of the factors that contribute to irrational use of medicines as well as potential impacts of such practices. This article has been written with the intention of offering a clear, concise, and easy to understand explanation of basic medicine use concepts for health professionals, patients, policy makers, and the public.
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- 2016
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22. Adherence and Discontinuation of Disease-Specific Therapies for Pulmonary Arterial Hypertension: A Systematic Review and Meta-Analysis
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Sami Qadus, Abdallah Y. Naser, Richard Ofori-Asenso, Zanfina Ademi, Safaa Al Awawdeh, and Danny Liew
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Pharmacology (medical) ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
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23. Real World Adherence to and Persistence With Oral Oncolytics in Multiple Myeloma: A Systematic Review and Meta-analysis
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Abdallah Y. Naser, Richard Ofori-Asenso, Safaa Al Awawdeh, Sami Qadus, Hassan Alwafi, and Danny Liew
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Cancer Research ,Pharmaceutical Preparations ,Oncology ,Panobinostat ,Humans ,Hematology ,Multiple Myeloma ,Lenalidomide ,Melphalan ,Medication Adherence ,Thalidomide - Abstract
Oral oncolytic treatments (OOTs) have improved the prognosis of patients with multiple myeloma (MM). However, the effectiveness of these therapies is undermined by poor adherence. We aimed to characterize the real-world adherence to, and persistence with, OOTs for MM.MEDLINE, EMBASE, and the International Pharmaceutical abstracts databases were searched for relevant observational studies published in English up to November 21, 2021. This was supplemented by manual searches of abstracts from the annual meetings of the American Society of Hematology, the American Society for Clinical Oncology, and the European Hematology Association as well as screening the references of included articles. Random-effects meta-analysis was performed.Following screening of 11,557 articles, 19 studies involving 27,129 patients in 8 countries (France, the US, Germany, Italy, the UK, Brazil, South Korea, and Belgium) prescribed OOTs (lenalidomide, thalidomide, pomalidomide, panobinostat, ixazomib, and melphalan) for MM were included. The overall pooled proportion of adherent patients was 67.9% (95% confidence interval [CI]: 57.1%-77.8%). The pooled proportion of adherent patients was higher in self-reported questionnaire-based studies compared to those using prescription/dispensing data (81.6% vs. 61.0%; P-value for difference = .08). Across 5 studies involving 15,363 patients, a pooled proportion of 35.8% (95% CI: 22.0-50.9) discontinued treatment. Factors reported to be associated with nonadherence included increasing age, higher comorbidity, polypharmacy, and a lack of social support.In patients with MM, adherence to and persistence with OOTs remains suboptimal. To achieve desired clinical outcomes, interventions to improve adherence and minimize discontinuation may be warranted.
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- 2022
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24. <scp>Long‐term</scp> outcomes of patients with paroxysmal nocturnal hemoglobinuria treated with eculizumab in a <scp>real‐world</scp> setting
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Katharina Versmold, Ferras Alashkar, Carina Raiser, Richard Ofori‐Asenso, Tao Xu, Yutong Liu, Pablo Katz, Aijing Shang, and Alexander Röth
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Medizin ,Hematology ,General Medicine - Abstract
Objective: Describe the real-world clinical profile of eculizumab-treated patients by characterizing their short- and long-term clinical and laboratory outcomes. Methods: This retrospective study used preexisting medical records of eculizumab-treated patients with paroxysmal nocturnal hemoglobinuria (PNH) at the University Hospital Essen. Hematologic response, breakthrough hemolysis, transfusion dependence, and other outcomes were assessed. Results: Of 85 patients with PNH, 76 received eculizumab for ≥24 weeks (mean follow-up: 5.59 years; total: 425 person-years). At 24 weeks (n = 57 patients with data), 7% and 9% had complete and major hematologic response, respectively. Breakthrough hemolysis occurred in 8%, and 38% required a blood transfusion. Over long-term follow-up (25–264 weeks), 70%–82% of patients did not achieve complete or major hematologic response in any 24-week period. Breakthrough symptoms, breakthrough hemolysis, and transfusion dependence occurred in 63%, 43%, and 63% of patients, respectively, at any point during follow-up. The majority (79%–89%) of patients did not achieve normalized hemoglobin, with 76%–93% having elevated bilirubin or absolute reticulocyte count in any 24-week window. Mean percentage reduction in lactate dehydrogenase (baseline to end of follow-up) was 80.3% (95% CI, 64.0–96.6). Conclusions: A considerable proportion of patients with PNH receiving eculizumab did not achieve optimal clinical outcomes and had an ongoing disease burden.
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- 2023
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25. Impact of regulatory interventions to restrict the combined use of renin–angiotensin system blockers: A Danish nationwide drug utilisation study
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Richard Ofori-Asenso, Christine E. Hallgreen, Marie Louise De Bruin, Per Sindahl, Helga Gardarsdottir, and Kaare Kemp
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medicine.medical_specialty ,ACE inhibitors ,drug safety ,Denmark ,Population ,Combined use ,Psychological intervention ,Angiotensin-Converting Enzyme Inhibitors ,risk management ,Renin-Angiotensin System ,Danish ,Angiotensin Receptor Antagonists ,Pharmacovigilance ,medicine ,Humans ,Pharmacology (medical) ,Registries ,Medical prescription ,education ,renin–angiotensin system ,Pharmacology ,education.field_of_study ,angiotensin II receptor blockers ,business.industry ,Drug Utilization ,Confidence interval ,language.human_language ,restrict ,pharmacovigilance ,Hypertension ,Emergency medicine ,Renin angiotensin system ,drug utilisation ,language ,business - Abstract
This study aimed to evaluate the impact of the risk minimisation measures issued by the European Medicines Agency in 2014 to restrict the combined use of renin-angiotensin system (RAS) agents in Denmark. Data from the Danish National Prescription Registry covering all medications dispensed during January 2008-December 2018 was used. The outcome was monthly prevalence of patients co-dispensed RAS-acting agents. Autoregressive integrated moving average interrupted time series regression was used to evaluate dispensing trends. The prevalence of patients co-dispensed RAS-acting agents decreased from 0.01.0003intervention trend was declining and further decreased with an additional -0.45 (950.66, -0.25) co-dispensing per million population after the intervention. Overall, the intervention had minimal impact on the combined use of RAS-acting agents. However, as the combined use of RAS-acting agents is low, further interventions to restrict the combined use of RAS-acting agents may not be required in Denmark at this point. This study aimed to evaluate the impact of the risk minimisation measures issued by the European Medicines Agency in 2014 to restrict the combined use of renin-angiotensin system (RAS) agents in Denmark. Data from the Danish National Prescription Registry covering all medications dispensed during January 2008-December 2018 was used. The outcome was monthly prevalence of patients co-dispensed RAS-acting agents. Autoregressive integrated moving average interrupted time series regression was used to evaluate dispensing trends. The prevalence of patients co-dispensed RAS-acting agents decreased from 0.01% to 0.0003%. Pre-intervention trend was declining and further decreased with an additional -0.45 (95% confidence interval -0.66, -0.25) co-dispensing per million population after the intervention. Overall, the intervention had minimal impact on the combined use of RAS-acting agents. However, as the combined use of RAS-acting agents is low, further interventions to restrict the combined use of RAS-acting agents may not be required in Denmark at this point.
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- 2021
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26. Switching, Persistence and Adherence to Statin Therapy: a Retrospective Cohort Study Using the Australian National Pharmacy Data
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Marjana Petrova, Sean Lybrand, Jenni Ilomäki, Zanfina Ademi, Clara Marquina, David Thomson, Alice J. Owen, Ella Zomer, Richard Ofori-Asenso, Danny Liew, and Stella Talic
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0301 basic medicine ,medicine.medical_specialty ,Statin ,medicine.drug_class ,Population ,Pharmacy ,030204 cardiovascular system & hematology ,Medication Adherence ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Ezetimibe ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,cardiovascular diseases ,education ,Retrospective Studies ,Pharmacology ,education.field_of_study ,business.industry ,Hazard ratio ,Australia ,nutritional and metabolic diseases ,Retrospective cohort study ,General Medicine ,Confidence interval ,Discontinuation ,030104 developmental biology ,Cohort ,lipids (amino acids, peptides, and proteins) ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Statins are widely prescribed for the primary and secondary prevention of cardiovascular disease (CVD), but their effectiveness is dependent on the level of adherence and persistence. This study aimed to explore the patterns of switching, adherence and persistence among the Australian general population with newly dispensed statins. A retrospective cohort study was conducted using a random sample of data from the Australian national prescription claims data. Switching, adherence to and persistence with statins were assessed for people starting statins from 1 January 2015 to 31 December 2019. Switching was defined as either switching to another intensity of statin, to another statin or to a non-statin agent. Non-persistence to treatment was defined as discontinuation (i.e. ≥90 days with no statin) of coverage. Adherence was measured using proportion of days covered (PDC), and patients with PDC
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- 2021
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27. Association of Spicy Chilli Food Consumption With Cardiovascular and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies
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Danny Liew, Mohammad Ali Mohsenpour, Shiva Faghih, Mohsen Mazidi, Mehran Nouri, and Richard Ofori-Asenso
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medicine.medical_specialty ,Heart disease ,030309 nutrition & dietetics ,030204 cardiovascular system & hematology ,Lower risk ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Environmental health ,Epidemiology ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,0303 health sciences ,business.industry ,Hazard ratio ,medicine.disease ,Diet ,Cardiovascular Diseases ,Food ,Relative risk ,Meta-analysis ,Capsicum ,Cardiology and Cardiovascular Medicine ,business ,All cause mortality - Abstract
This systematic review and meta-analysis examined the association between spicy food (chilli pepper, chilli sauce, or chilli oil) consumption with cardiovascular and all-cause mortality. Medline and EMBASE were searched from their inception until February 2020 to identify relevant prospective cohort studies. Hazard ratios (HRs)/relative risk (RRs) were pooled via random-effect meta-analysis. Of the 4387 citations identified, 4 studies (from the United States, China, Italy, and Iran) were included in the meta-analysis. The included studies involved a total of 564 748 adults (aged ≥18 years; 51.2% female) followed over a median duration of 9.7 years. The pooled data suggested that compared with people who did not regularly consume spicy food (none/pooled 0.88, 95% CI, 0.86-0.90; I 2 = 0%) lower risk of all-cause mortality. Moreover, spicy food consumption was associated with significant reduction in the risk of death from cardiac diseases (HR/RRpooled 0.82, 0.73-0.91; I 2 = 0%), but not from cerebrovascular disorders (HR/RRpooled 0.79, 0.53-1.17; I 2 = 72.2%). In conclusion, available epidemiological studies suggest that the consumption of spicy chilli food is associated with reduced risk of all-cause as well as heart disease–related mortality. Further studies in different populations are needed to confirm this association.
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- 2021
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28. Use of quality‐of‐life instruments for people living with HIV: a global systematic review and meta‐analysis
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Jason J. Ong, Emily S.G. Hulse, Tessa Peasgood, Christopher K. Fairley, Christine He, Graham Brown, Richard Ofori-Asenso, and Ying Zhang
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Gerontology ,History ,Acquired Immunodeficiency Syndrome ,Polymers and Plastics ,Human immunodeficiency virus (HIV) ,Public Health, Environmental and Occupational Health ,HIV Infections ,medicine.disease_cause ,Industrial and Manufacturing Engineering ,Quality of life (healthcare) ,Infectious Diseases ,Anti-Retroviral Agents ,Meta-analysis ,Surveys and Questionnaires ,medicine ,Quality of Life ,Humans ,Business and International Management ,Psychology - Abstract
Due to the effectiveness of combined antiretroviral therapy and its growing availability worldwide, most people living with HIV (PLHIV) have a near-normal life expectancy. However, PLHIV continue to face various health and social challenges that severely impact their health-related quality-of-life (HRQoL). The UNAIDS Global AIDS Strategy discusses the need to optimize quality-of-life, but no guidance was given regarding which instruments were appropriate measures of HRQoL. This study aimed to review and assess the use of HRQoL instruments for PLHIV.We conducted a global systematic review and meta-analysis, searching five databases for studies published between January 2010 and February 2021 that assessed HRQoL among PLHIV aged 16 years and over. Multivariable regression analyses were performed to identify factors associated with the choice of HRQoL instruments. We examined the domains covered by each instrument. Random-effects meta-analysis was conducted to explore the average completion rates of HRQoL instruments.From 714 publications, we identified 65 different HRQoL instruments. The most commonly used instruments were the World Health Organization Quality-of-Life- HIV Bref (WHOQOL-HIV BREF)-19%, Medical Outcome Survey-HIV (MOS-HIV)-17%, Short Form-36 (SF-36)-12%, European Quality-of-Life Instrument-5 Dimension (EQ-5D)-10%, World Health Organization Quality-of-Life Bref (WHOQOL BREF)-8%, Short Form-12 (SF-12)-7% and HIV/AIDS Targeted Quality-of-Life (HAT-QOL)-6%. There were greater odds of using HIV-specific instruments for middle- and low-income countries (than high-income countries), studies in the Americas and Europe (than Africa) and target population of PLHIV only (than both PLHIV and people without HIV). Domains unique to the HIV-specific instruments were worries about death, stigma and HIV disclosure. There were no significant differences in completion rates between different HRQoL instruments. The overall pooled completion rate was 95.9% (95% CI: 94.7-97.0, IA wide range of instruments have been used to assess HRQoL in PLHIV, and the choice of instrument might be based on their different characteristics and reason for application. Although completion rates were high, future studies should explore the feasibility of implementing these instruments and the appropriateness of domains covered by each instrument.
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- 2022
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29. Rationing health and social goods during pandemics: Guidance for Ghanaian decision makers
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Richard Ofori-Asenso, Amos Laar, Debra A. DeBruin, Arthur L. Caplan, Barbara K. Redman, and Matilda E. Laar
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Coronavirus disease 2019 (COVID-19) ,business.industry ,Rationing ,Medicine (miscellaneous) ,06 humanities and the arts ,Bioethics ,0603 philosophy, ethics and religion ,03 medical and health sciences ,Philosophy ,Issues, ethics and legal aspects ,0302 clinical medicine ,Health care ,Development economics ,Pandemic ,Economics ,060301 applied ethics ,030212 general & internal medicine ,business ,High income countries - Abstract
Healthcare rationing during pandemics has been widely discussed in global bioethics literature. However, existing scenarios and analyses have focused on high income countries, except for very few disease areas such as HIV treatment where some analyses related to African countries exist. We argue that the lack of scholastic discourse, and by extension, professional and democratic engagement on the subject constitute an unacceptable ethical omission. Not only have African governments failed to develop robust ethical plans for pandemics, ethicists in this region have been unable to ignite public discourse on rationing. Therefore, we aim to initiate a debate on how rationing health and social goods could be done ethically in Ghana during the current and future pandemics. The paper discusses and critiques some moral considerations (utilitarian, equity, equal worth, urgent need, and the prioritarian principles) for rationing and their relevance in the Ghanaian context. This contribution may facilitate ethical decision-making during the current (COVID-19) pandemic - in Ghana and other African settings where hardly any rationing guidelines exist
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- 2020
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30. Real-world adherence, persistence, and in-class switching during use of dipeptidyl peptidase-4 inhibitors: a systematic review and meta-analysis involving 594,138 patients with type 2 diabetes
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Bernard Appiah, Mohsen Mazidi, Danny Liew, Maarit Jaana Korhonen, Berhe W. Sahle, Oyepeju Ogundipe, Andrew McGovern, Deval Gor, György Jermendy, Zanfina Ademi, Richard Ofori-Asenso, Marie L. De Bruin, and Ken Lee Chin
- Subjects
medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Discontinuation ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Saxagliptin ,Cochrane Library ,Persistence ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Endocrinology ,Hypoglycemic agents ,Dipeptidyl peptidase-4 inhibitors ,Internal medicine ,Taverne ,Internal Medicine ,medicine ,business.industry ,General Medicine ,medicine.disease ,Confidence interval ,Diabetes and Metabolism ,chemistry ,Adherence ,Meta-analysis ,Switching ,Gliptins ,business ,DPP4 inhibitors ,Alogliptin ,Cohort study - Abstract
Aims: Medication adherence and persistence are important determinants of treatment success in type 2 diabetes mellitus (T2DM). This systematic review and meta-analysis evaluated the real-world adherence, persistence, and in-class switching among patients with T2DM prescribed dipeptidyl peptidase-4 (DPP4) inhibitors. Methods: MEDLINE, EMBASE, Cochrane Library, PsychINFO, and CINAHL were searched for relevant observational studies published in the English language up to 20 December 2019. This was supplemented by manual screening of the references of included papers. Random-effects meta-analysis was performed. Results: Thirty-four cohort studies involving 594,138 patients with T2DM prescribed DPP4 inhibitors from ten countries were included. The pooled proportion adherent (proportion of days covered (PDC) or medication possession ratio (MPR) ≥ 0.80) was 56.9% (95% confidence interval [CI] 49.3–64.4) at one year and 44.2% (95% CI 36.4–52.1) at two years. The proportion persistent with treatment decreased from 75.6% (95% CI 71.5–79.5) at six months to 52.8% (95% CI 51.6–59.8) at two years. No significant differences in adherence and persistence were observed between individual DPP4 inhibitors. At one year, just 3.2% (95% CI 3.1–3.3) of patients switched from one DPP4 inhibitor to another. Switching from saxagliptin and alogliptin to others was commonest. Conclusions: Adherence to and persistence with DPP4 inhibitors is suboptimal but similar across all medications within the class. While in-class switching is uncommon, saxagliptin and alogliptin are the DPP4 inhibitors most commonly switched. Interventions to improve treatment adherence and persistence among patients with T2DM prescribed DPP4 inhibitors may be warranted.
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- 2020
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31. Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness
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Zanfina Ademi, Sandra Vargas-Torres, Sophia Zoungas, Clara Marquina, Danny Liew, Ella Zomer, and Richard Ofori-Asenso
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medicine.medical_specialty ,STATIN THERAPY ,Cost effectiveness ,EZETIMIBE ,MEDLINE ,ECONOMIC-EVALUATION ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Ezetimibe ,Health care ,medicine ,CORONARY-HEART-DISEASE ,030212 general & internal medicine ,COMBINATION ,Intensive care medicine ,Polypill ,PCSK9 INHIBITORS ,METAANALYSIS ,health care economics and organizations ,Pharmacology ,Health economics ,business.industry ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,HIGH-RISK ,Economic evaluation ,LDL CHOLESTEROL ,0305 other medical science ,business ,INTERVENTIONS ,medicine.drug - Abstract
Background New pharmacological therapies for the treatment of cardiovascular disease (CVD) have emerged in recent years. The high rates of CVD and the need for long-term treatment to decrease risk factors makes cost-effectiveness crucial for their successful long-term implementation. Objective This study assessed cost-effectiveness studies of novel pharmacological treatments (ezetimibe, proprotein convertase subtilisin/kexin type 9 [PCSK9] inhibitors, omega-3 polyunsaturated fatty acids [n-3 PUFAs], and the cardiovascular polypill) compared with standard care for the secondary prevention of CVD. Methods We searched seven databases and the reference list of selected literature reviews for eligible cost-effective analyses (CEA) published between January 2009 and January 2020 that evaluated the above novel treatments versus standard care. Two independent reviewers performed the screening and evaluation in accordance with the Consolidated Health Economic Evaluation Reporting Standards statement. Cost results were adapted to 2018 US dollars (US$) to facilitate comparisons between studies. Consideration of cost-effectiveness was based on the original study criteria. Results Thirty-two studies were included in this review, most of them adopting a healthcare perspective. Studies evaluating ezetimibe, PCSK9 inhibitors and n-3 PUFAs assessed their addition to standard care compared with standard care alone, while studies analysing the polypill evaluated the replacement of multiple monotherapies for a fixed-dose combination. Ten studies reported on ezetimibe, fifteen evaluated PCSK9 inhibitors, five focused on n-3 PUFAs and seven on the polypill. From a healthcare perspective, ezetimibe was cost effective in 62.5% of the studies (incremental cost-effectiveness ratios [ICERs] ranged from US$27,195 to US$204,140), n-3 PUFAs in 60% (ICERs from US$57,128 to US$139,082) and the cardiovascular polypill in 100% (ICERs from dominant to US$30,731) compared with standard care. Conversely, only 10% of the studies considered PCSK9 inhibitors cost effective compared with standard care from a healthcare perspective (ICERs ranged from US$231,119 to US$1,223,831). Additionally, ezetimibe was cost effective in 50% of the studies, PCSK9 inhibitors in 33% and the polypill in 50% of the studies adopting a societal perspective. The key model-related parameters predicting cost-effectiveness included drug cost, time horizon, and the baseline risk of cardiovascular events. Conclusions Based on current pricing and willingness-to-pay thresholds, most CEA studies considered ezetimibe, n-3 PUFAs and the polypill to be cost effective compared with standard care but not PCSK9 inhibitors for secondary prevention of CVD.
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- 2020
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32. Dietary patterns are associated with likelihood of hepatic steatosis among US adults
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Mohsen Mazidi, Richard Ofori-Asenso, and Andre Pascal Kengne
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Adult ,Dietary Fiber ,Male ,Adolescent ,National Health and Nutrition Examination Survey ,Physiology ,Blood Pressure ,Logistic regression ,Eating ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Diabetes Mellitus ,Prevalence ,medicine ,Humans ,Nutritional Physiological Phenomena ,chemistry.chemical_classification ,Minerals ,Hepatology ,medicine.diagnostic_test ,business.industry ,Fatty liver ,Gastroenterology ,Feeding Behavior ,Vitamins ,Odds ratio ,Middle Aged ,medicine.disease ,United States ,Fatty Liver ,Cross-Sectional Studies ,Logistic Models ,chemistry ,030220 oncology & carcinogenesis ,Fatty Acids, Unsaturated ,Female ,030211 gastroenterology & hepatology ,Diet, Healthy ,Steatosis ,business ,Liver function tests ,Polyunsaturated fatty acid - Abstract
Background and aim Non-alcoholic fatty liver disease is a rapidly growing public health problem. In this study, we explored the association between dietary patterns (DPs) and fatty liver and liver function tests. Methods This was a cross-sectional study using data from the US community-based National Health and Nutrition Examination Survey. Participants with data on dietary intake, blood pressure, and status for diabetes mellitus were analyzed. DPs were determined by principal components analysis. Analysis of covariance and logistic regression models accounted for the survey design and sample weights. Results Of the 20 643 eligible participants, 45.7% had prevalent fatty liver. Three DPs collectively explained 50.8% of variance in dietary nutrients consumption. The first DP was representative of a diet containing high levels of saturated and mono-unsaturated fatty acids, total fat and carbohydrate; the second DP comprised vitamins, minerals and dietary fibre; and the third DP was mainly representative of polyunsaturated fatty acids. In adjusted multivariable regression models, participants in the top quarter of the second DP had 34% lower odds of prevalent fatty liver (odds ratio 0.66 [95% confidence interval [CI]: 0.43-0.71]), while those in the top quarter of the first DP had 86% higher odds (1.86 [95% CI: 1.42-2.95]) of prevalent fatty liver, relative to participants in the bottom quarter of each of the DPs. Conclusion Our findings suggest that a diet with high load of vitamins, minerals, and fiber content is associated with a lower prevalence of non-alcoholic fatty liver disease.
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- 2020
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33. Estimating global injuries morbidity and mortality
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Zohreh Arefi, Rasmus Havmoeller, Pietro Ferrara, Vijay Kumar Chattu, Payman Salamati, Agegnehu Bante Getenet, Seyedeh Zahra Masoumi, Alexander C. Tsai, Andrew T Olagunju, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Tim Driscoll, Reza Rawassizadeh, Vishnu Renjith, Taras Kavetskyy, Ejaz Ahmad Khan, Gebreamlak Gebremedhn Gebremeskel, Richard C. Franklin, Naznin Hossain, Bhaskaran Unnikrishnan, Fariborz Mansour-Ghanaei, Arash Tehrani-Banihashemi, Morteza Naserbakht, Sangram Kishor Patel, Vera Marisa Costa, Suzanne Polinder, Ziad El-Khatib, Ashish Pathak, Mika Shigematsu, Bryan L. Sykes, David M. Pigott, Zeleke Aschalew Melketsedik, Hadi Hassankhani, Nuworza Kugbey, Lal B. Rawal, Masoud Foroutan, Dejana Braithwaite, Muluken Bekele Sorrie, Grant M. A. Wyper, Joht Singh Chandan, Akbar Barzegar, Hamid Safarpour, Kate E. LeGrand, Giulio Castelpietra, Dina Nur Anggraini Ningrum, Seth Christopher Yaw Appiah, Amin Soheili, Azeem Majeed, Akshaya Srikanth Bhagavathula, Nikolay Ivanovich Briko, Vahid Yazdi-Feyzabadi, Walter Mendoza, Ghulam Mustafa, Cuong Tat Nguyen, Pengpeng Ye, Mahesh P A, Carlos Miguel Rios González, Ahmad Daryani, Ibrahim Abdollahpour, Masoud Moradi, Haileab Fekadu Wolde, Mohammad Rabiee, Jaya Prasad Tripathy, Jack T Fox, Diep Ngoc Nguyen, Pallab K. Maulik, Ai-Min Wu, Félix Carvalho, Yun Jin Kim, Fatemeh Rajati, Nathaniel J Henry, David C. Schwebel, Ali H. Mokdad, Akine Eshete Abosetugn, Leonardo Roever, Ketema Bizuwork Gebremedhin, Khalid A Altirkawi, Hayimro Edemealem Merie, Farhad Ghamari, Ramesh Holla, Arash Sarveazad, Devasahayam J. Christopher, Kedir Hussein Abegaz, Suresh Jungari, Rohan Borschmann, Irfan Ullah, Nitin Joseph, Catalina Liliana Andrei, Abdallah M. 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Male ,Populations/contexts ,1106 Human Movement and Sports Sciences ,Global injuries ,population ,030204 cardiovascular system & hematology ,Global Health ,contexts ,context ,Global Burden of Disease ,0302 clinical medicine ,Quality-Adjusted Life Year ,Global health ,030212 general & internal medicine ,Original Research ,Data ,populations/contexts ,Incidence (epidemiology) ,Incidence ,methodology ,3142 Public health care science, environmental and occupational health ,Female ,Public Health ,TERRITORIES ,Quality-Adjusted Life Years ,descriptive epidemiology ,Human ,Disabilities ,195 COUNTRIES ,statistical issue ,1117 Public Health and Health Services ,03 medical and health sciences ,AGE ,Life Expectancy ,Environmental health ,Injury prevention ,SYSTEMATIC ANALYSIS ,statistical issues ,Humans ,Mortality ,Estimation ,SEX-SPECIFIC MORTALITY ,DISABILITY ,Public Health, Environmental and Occupational Health ,populations ,Morbidity ,Wounds and Injuries ,1106 Human Movement and Sports Sciences, 1117 Public Health and Health Services, 1701 Psychology ,Quality-adjusted life year ,Years of potential life lost ,1701 Psychology ,Life expectancy ,Estimates ,Human medicine ,populations/context - Abstract
Background. While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods. In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results. GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions. GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future. Seyed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Alaa Badawi acknowledges support by the Public Health Agency of Canada. Till Bärnighausen acknowledges support by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Traolach Brugha received support from NatCen Social Research (http://natcen.ac.uk/) via NHS Digital and Department of Health and Social Care London, for the Adult Psychiatric Morbidity Survey (APMS) programme. Felix Carvalho received support from UID/MULTI/04378/2019 with funding from FCT/MCTES through national funds. Vera M Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. Kebede Deribe is supported by a grant from the Wellcome Trust [grant number 201900] as part of his International Intermediate Fellowship. Tim Driscoll acknowledges that work on occupational risk factors was partially supported by funds from the World Health Organization. Eduarda Fernandes acknowledges support from UID/QUI/50006/2019 with funding from FCT/MCTES through national funds. Yuming Guo acknowledges support from Career Development Fellowships of the Australian National Health and Medical Research Council (numbers APP1107107 and APP1163693). Sheikh Mohammed Shariful Islam is funded by a Fellowship from National Heart Foundation of Australia and Institute for Physical Activity and Nutrition, Deakin University. Mihajlo Jakovljevic acknowledges support by the Ministry of Education Science and Technological Development of the Republic of Serbia through the Grant number OI175014; publication of results was not contingent upon Ministry's censorship or approval. Sudha Jayaraman acknowledges support from: NIH R21: 1R21TW010439-01A1 (PI); Rotary Foundation Global Grant #GG1749568 (PI); NIH P20: 1P20CA210284-01A1 (Co-PI) and DOD grant W81XWH-16-2-0040 (Co-I), during the period of this study. Yun Jin Kim acknowledges support from a grant from the Research Management Centre, Xiamen University Malaysia [grant number: XMUMRF/2018-C2/ITCM/0001]. Kewal Krishan is supported by UGC Centre of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Mansai Kumar acknowledges support from FIC/ NIH K43 1K43MH114320-01. Amanda Mason-Jones acknowledges support by the University of York. Mariam Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’s National Health Service Foundation Trust and King’s College London. Ilais Moreno Velasquez is supported by the Sistema Nacional de Investigación (SNI, Senacyt, Panama). Mukhammad David Naimzada acknowledges support from Government of the Russian Federation (Agreement No – 075-02-2019-967). Duduzile Ndwandwe acknowledges support from Cochrane South Africa, South African Medical Research Council. Stanislav S. Otstavnov acknowledges the support from the Government of the Russian Federation (Agreement No – 075-02-2019-967). Ashish Pathak acknowledges support from Indian Council of Medical Research (ICMR), New Delhi, India (Grant number 2013-1253). Michael R Phillips acknowledges support in part by a grant from the National Natural Science Foundation of China (No.81761128031). Abdallah M. Samy received a fellowship from the Egyptian Fulbright Mission Program. Milena Santric Milicevic acknowledges the support from the Ministry of Education, Science and Technological Development, Republic of Serbia (Contract No. 175087). Seyedmojtaba Seyedmousavi was supported by the Intramural Research Program of the National Institutes of Health, Clinical Center, Department of Laboratory Medicine, Bethesda, MD, USA. Rafael Tabarés-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. Sojib Bin Zaman acknowledges support from an "Australian Government Research Training Program (RTP) Scholarship.
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- 2020
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34. Attainment of low-density lipoprotein cholesterol goals in statin treated patients: Real-world evidence from Australia
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Dina Abushana, Sandra Vargas-Torres, Danny Liew, Zanfina Ademi, Richard Ofori Asenso, Giles Stratton, Clara Marquina, Sean Lybrand, David Thomson, Rory Wolfe, Ella Zomer, Stella Talic, and Marjana Petrova
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Male ,medicine.medical_specialty ,Statin ,medicine.drug_class ,Disease ,Type 2 diabetes ,Logistic regression ,Internal medicine ,medicine ,Humans ,Stroke ,Aged ,Retrospective Studies ,business.industry ,Medical record ,Australia ,Retrospective cohort study ,General Medicine ,Cholesterol, LDL ,medicine.disease ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Population study ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,business ,Goals - Abstract
OBJECTIVE Little is known about the attainment of low-density lipoprotein cholesterol (LDL-C) targets in patients treated with statins in Australian primary healthcare setting that are at increased risk of cardiovascular disease. METHODS A retrospective cohort study was conducted using data from electronic medical records of patients treated by general practitioners across Australia. LDL-C target attainment was defined as LDL-C levels ≤ 2 mmol/L for all risk groups, in line with Australian guidelines. Multivariable logistic regression was used to identify the factors associated with LDL-C target attainment. RESULTS Overall, 61,407 patients were included in the analysis. The mean age was 65 years (± standard deviation [SD] 12.1); 52.0% were males.. Overall, the median LDL-C level was 2.3 mmol/L (IQR = 1.8 - 2.8) and 36.0% of the study population met therapeutic targets. Increased likelihood to achieve LDL-C targets was observed in patients diagnosed with type 2 diabetes (OR 2.07, 95% CI 1.92 - 2.24), stroke (OR = 1.58, 95% CI 1.39 - 1.79, p< 0.001) or chronic heart disease (OR = 1.67, 95% CI 1.55 - 1.81, p
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- 2021
35. Attainment of low-density lipoprotein cholesterol goals in patients treated with combination therapy: A retrospective cohort study in primary care
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Clara Marquina, Stella Talic, Ella Zomer, Sandra Vargas-Torres, Marjana Petrova, Rory Wolfe, Dina Abushanab, Sean Lybrand, David Thomson, Giles Stratton, Richard Ofori-Asenso, Danny Liew, and Zanfina Ademi
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Male ,Nutrition and Dietetics ,Primary Health Care ,Endocrinology, Diabetes and Metabolism ,Australia ,Cholesterol, LDL ,Middle Aged ,Cohort Studies ,Treatment Outcome ,Internal Medicine ,Humans ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,Aged ,Retrospective Studies - Abstract
The attainment of low-density lipoprotein cholesterol (LDL-C) therapeutic goals in real-world settings among patients receiving combination lipid-lowering therapy (LLT, statins plus non-statins) is not well characterised.To evaluate LDL-C levels and LDL-C goal attainment in patients treated with combination LLT in real-world primary care settings.A retrospective cohort study of patients treated with combination LLT. Data were drawn from general practitioner electronic medical records across Australia from 2013 to 2019. The on-treatment goal for LDL-C was2 mmol/L (77 mg/dL), as per Australian guidelines.The cohort analysed included 9,173 individuals treated with combination LLT. The mean age was 65.8 years (standard deviation [SD] 11.5), 60.1% were males, and 56.7% had at least one cardiovascular risk factor. The median on-treatment LDL-C was 2.1 mmol/L (IQR 1.6-2.8), and overall 45.4% of the cohort met LDL-C goals, with individuals on fixed-dose combination of statins plus ezetimibe having the highest rates of achievement (49.8%). In multivariable logistic regression analyses, factors associated with LDL-C goal achievement were male sex (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.6, p0.001), aged80 years (OR 4.2, 95% CI 1.5 - 6.6, p = 0.006), and a history of T2DM (OR 1.7; 95% CI 1.5-1.9, p0.001) or coronary heart disease (OR 1.4, 95% CI 1.2 - 1.6, p0.001).More than half of Australians on combination LLT did not achieve LDL-C goals. Urgent measures are needed to address this gap in clinical practice to minimise negative health outcomes.
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- 2021
36. Prevalence and impact of non-cardiovascular comorbidities among older adults hospitalized for non-ST segment elevation acute coronary syndrome
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Sophia Zoungas, Ella Zomer, Richard Ofori-Asenso, Zanfina Ademi, Andrea J. Curtis, Ken Lee Chin, Danny Liew, Si Si, and Peter Markey
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Acute coronary syndrome ,medicine.medical_specialty ,Anemia ,business.industry ,Hazard ratio ,Disease ,030204 cardiovascular system & hematology ,medicine.disease ,Rate ratio ,Comorbidity ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,medicine ,Original Article ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND: There is a paucity of information on the prognostic importance of non-cardiovascular comorbidities (NCCs) among patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). This study examined the prevalence and impact of NCCs on the length of stay (LOS) and mortality among older adults hospitalized for NSTE-ACS. METHODS: Among 1,488 older adults (mean age 79.4±8.4 years; 62.0% male) hospitalized for NSTE-ACS at a tertiary hospital in Melbourne, Australia, during 2013–2015, we collected data on comorbidities, LOS, and discharge outcomes. Thirteen NCCs were studied. Negative binomial and Cox proportional regression models were applied to examine the association between NCCs and LOS and in-hospital death, respectively. RESULTS: Approximately 53% of the patients had ≥1 NCCs. Diabetes and renal disease as well as anemia and renal disease co-existed more frequently than expected. Compared to having no NCCs, having one NCC was not associated with a significant increase in the likelihood of longer LOS [incidence rate ratio (IRR) 1.07; 95% CI: 0.99–1.15; P=0.085] or in-hospital death [hazard ratio (HR) 1.11; 95% CI: 0.65–1.90; P=0.707]. However, having ≥2 NCCs was associated with 22% and 79% increased likelihood of longer LOS (IRR 1.22, 95% CI: 1.11–1.33; P
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- 2019
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37. Clinical Profile and Long-Term Outcomes of Patients with Paroxysmal Nocturnal Hemoglobinuria Treated with Eculizumab in a Real-World Setting : High Frequency of Anemia Despite Decreased Intravascular Hemolysis
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Pablo Katz, Carina Raiser, Alexander Roeth, Richard Ofori-Asenso, Katharina Versmold, Yutong Liu, Aijing Shang, Tao Xu, and Ferras Alashkar
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medicine.medical_specialty ,business.industry ,Anemia ,Immunology ,Medizin ,Cell Biology ,Hematology ,Eculizumab ,medicine.disease ,Biochemistry ,Intravascular hemolysis ,Internal medicine ,Paroxysmal nocturnal hemoglobinuria ,medicine ,Cardiology ,Long term outcomes ,business ,medicine.drug - Abstract
Background: Eculizumab, an anti-C5 antibody, was approved for the treatment of patients (pts) with symptomatic paroxysmal nocturnal hemoglobinuria (PNH) in 2007 and has been the standard of care for over a decade. However, published data on real-world outcomes of eculizumab-treated pts with PNH are limited. The aim of this study was to describe the clinical profile of pts with PNH treated with eculizumab by characterizing their short- and long-term laboratory and clinical outcomes. Methods: This retrospective study (Versmold et al, Blood 2020) used preexisting medical records of eculizumab-treated pts with PNH (treatment duration ≥24 weeks [wks]) treated at the University Hospital Essen, Germany prior to April 2018. Anonymized data were collected via electronic case report forms. Laboratory data were extracted from the hospital computer system. Lactate dehydrogenase (LDH), hemoglobin, absolute reticulocyte count (ARC), and bilirubin profiles were assessed at baseline (12 months before treatment) and during the treatment phase (up to 13.2 years [yrs] follow-up). Breakthrough hemolysis (BTH) was defined as ≥1 new symptom or sign of intravascular hemolysis (including fatigue, hemoglobinuria, abdominal pain, dyspnea, anemia [hemoglobin 100 × 10 9/L with bilirubin >1 × ULN and positive direct Coombs test or reticulocytes >100 × 10 9/L with bilirubin >1 × ULN and ≥1 positive C3c or C3d test. Complete hematologic response was zero blood transfusions with hemoglobin ≥12 g/dL and LDH ≤1.5 × ULN and major hematologic response was zero blood transfusions with hemoglobin ≥12 g/dL and LDH >1.5 × ULN within any 24-wk window (Risitano et al, Front Immunol 2019). Transfusion-dependence was ≥2 blood transfusions within any 24-wk period. Pts transferred from other centers or within 24 wks of treatment were excluded due to missing baseline data. Results: The study included 56 pts with PNH (mean age: 42.9 yrs [± 17.6]; 46.4% female) treated with eculizumab for ≥24 wks (mean follow-up: 5.24 yrs [± 3.25]) during the study period. The median duration from diagnosis to starting eculizumab was 1.57 yrs. Overall, 18 pts (32.1%) had aplastic anemia at diagnosis, 10 (17.9%) had symptoms of high disease activity, and 34 (60.7%) had a blood transfusion in the prior 12 months. The most reported disease-related symptoms at baseline were anemia (28.6%), fatigue (26.8%), thrombosis (21.4%), dyspnea (17.9%), dysphagia (10.7%), erectile dysfunction (10.0%), kidney complications (8.9%), abdominal pain (8.9%), and hemoglobinuria (7.1%). Mean hemoglobin (n=44) was 9.67 g/dL [± 2.06] and LDH in the past 12 months (n=47) was 1480 U/L [± 1010]. During the first 24-wk treatment phase, 37% (20/54) of pts had LDH >1.5 × ULN, 31% (14/45) had ARC >1.5 × ULN, and 17% (8/47) had hemoglobin ≥12 g/dL (Figure). Among pts with response data, 15% (7/47) had complete hematologic response and 2% (1/47) had major hematologic response within 24 wks. Documented BTH with symptoms occurred in 11% (6/56). Moreover, 23% (13/56) of pts were transfusion-dependent, increasing to 39% (22/56) when including pts who had ≥1 transfusion during the first 24 wks of treatment. Six pts (11%) received a higher-than-labeled dose (600 mg intravenous [IV] weekly for 4 wks, 900 mg IV 1 wk later, then 900 mg IV every 2 wks thereafter) of eculizumab. Over the long term (ie, between 25 and 246 wks), 11.1-34.7% of pts received blood transfusions and 7.0-21.7% had LDH >1.5 × ULN in any 24-wk window; whereas 36.1-72.7% had ARC >1.5 × ULN (Figure). Moreover, 65.8-77.3% of pts had hemoglobin Conclusions: In this long-term real-world study, a considerable proportion of pts with PNH treated with eculizumab did not achieve optimal clinical outcomes with an ongoing burden of disease (ie, low hemoglobin level with high reticulocyte count due to extravascular hemolysis, BTH, etc.). Future exploration of other therapies that improve pt outcomes could help to address remaining unmet medical needs. Figure 1 Figure 1. Disclosures Alashkar: Alexion: Honoraria; Novartis: Honoraria; BMS/Celgene: Honoraria; Bluebird Bio: Honoraria. Ofori-Asenso: F. Hoffmann-La Roche Ltd: Current Employment. Xu: F. Hoffmann-La Roche AG: Current Employment. Liu: Genesis Research: Current Employment. Katz: F. Hoffman-La Roche Ltd: Current Employment. Shang: F. Hoffman-La Roche Ltd: Current Employment, Current equity holder in publicly-traded company. Roeth: Apellis Pharmaceuticals: Consultancy, Honoraria; Alexion Pharmaceuticals Inc.: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Research Funding; Bioverativ, a Sanofi company: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Kira: Consultancy, Honoraria.
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- 2021
38. The Diagnostic Accuracy of Syndromic Management for Genital Ulcer Disease: A Systematic Review and Meta-Analysis
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Nancy Santesso, Andre Jin Wei Loh, Teodora Wi, Jason J. Ong, Richard Ofori-Asenso, Ee Lynn Ting, Philippe Mayaud, Jane Falconer, and Eric P F Chow
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medicine.medical_specialty ,business.industry ,Disease ,Logistic regression ,medicine.disease ,Confidence interval ,Genital ulcer ,Internal medicine ,Meta-analysis ,medicine ,Etiology ,Syphilis ,medicine.symptom ,business ,Disease burden - Abstract
Background: Genital Ulcer Disease (GUD) carries a significant disease burden globally. With limited access to diagnostics, the 2001 World Health Organisation (WHO) sexually transmitted illnesses (STI) guidelines proposed a syndromic management algorithm that required a clinical decision to determine the management of GUD. We assessed the diagnostic accuracy of this algorithm. Methods: We conducted a systematic review (Prospero: CRD42020153294) using eight databases for publications between 1995 and January 2021 that reported primary data on the diagnostic accuracy of clinical diagnosis to identify aetiological agents of GUD. Titles and abstracts were independently assessed for eligibility, and data were extracted from full texts for sensitivity/specificity. A hierarchical logistic regression model was used to derive pooled sensitivity and specificity. We used GRADE to evaluate the quality of evidence. Findings: Of 24,857 articles, 151 full texts were examined and 29 included in the analysis. The majority were from middle-income countries [(14/29 (48%) lower middle, 10/29 (34%) upper middle)]. The pooled sensitivity and specificity of GUD for the detection of herpes was 40·4% (95% confidence interval [CI]: 23·0-60·6), and 88·0% (95% CI: 75·3-94·6), respectively (high certainty evidence); and for syphilis were 64·4% (95% CI: 44·8-80·2), and 83·7% (95% CI: 67·0-92·9), respectively (moderate certainty evidence). Interpretation: Algorithms requiring a clinical diagnosis to determine and treat the aetiology of GUD have poor sensitivities for syphilis and herpes simplex virus, resulting in significant numbers of missed cases. There is an urgent need to improve access to affordable and efficient diagnostics (e.g., point-of-care tests) to be incorporated into GUD algorithms to better guide appropriate management. Funding: World Health Organization Declaration of Interest: None to declare.
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- 2021
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39. Angiotensin converting enzyme genotypes and mortality from COVID-19: An ecological study
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Tess Aitken, Christiaan Yu, Bing Mei Teh, Ar Kar Aung, Richard Ofori-Asenso, Danny Liew, and Ken Lee Chin
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0301 basic medicine ,Male ,Microbiology (medical) ,Genotype ,Epidemiology ,Viral pneumonia ,030106 microbiology ,Population ,Peptidyl-Dipeptidase A ,Rate ratio ,Article ,03 medical and health sciences ,0302 clinical medicine ,Gene Frequency ,Medicine ,Humans ,Genetic Predisposition to Disease ,030212 general & internal medicine ,Mortality ,education ,Letter to the Editor ,education.field_of_study ,Polymorphism, Genetic ,biology ,business.industry ,SARS-CoV-2 ,Mortality rate ,Ecological study ,COVID-19 ,Angiotensin-converting enzyme ,Confidence interval ,Genotype frequency ,Infectious Diseases ,Case-Control Studies ,biology.protein ,Female ,Angiotensin-Converting Enzyme 2 ,business ,Demography - Abstract
Highlights • Angiotensin converting enzyme (ACE) genotypes may influence COVID-19 mortality. • II genotype frequency was significantly associated with decreased mortality. • Association between increased mortality and DD genotype frequency was not detected., Background Angiotensin converting enzyme (ACE) genotypes are known to be associated with development of acute respiratory distress syndrome (ARDS) and resultant mortality. In the present study, we examined the association between distribution frequency of ACE genotypes and COVID-19 mortality. Methods We undertook an ecological study to examine the association between ACE genotypes and COVID-19 mortality across 25 countries to represent different geographical regions of the world. The population frequencies of ACE genotypes were drawn from previously published reports and data on COVID-19-related mortality were extracted from ‘Worldometer’. Multivariable analyses were also undertaken adjusting for age (median age), sex (percentage of females) and the number of COVID-19 tests undertaken. Associations between genotypes deletion/deletion (DD) and insertion/insertion (II) prevalence and COVID-19-related mortality (per million people per day since the first diagnosed case) were evaluated. Results The frequency of II genotype is highest in east Asian countries and lower among the European and African countries. An inverse geographical distribution frequency was noted for DD genotype. Increasing II genotype frequency was significantly associated with decreased COVID-19 mortality rates (adjusted incident rate ratio [IRR] 0.3, 95% confidence interval [CI]: 0.002–0.7, p = 0.03). However, no association was found between DD genotype frequency and COVID-19 mortality rates (adjusted IRR 4.3, 95% CI: 0.5–41.2, p = 0.2). Conclusions Distribution frequency of ACE insertion/insertion (II) genotype may have a significant influence on COVID-19 mortality. This information has potential utility for resource planning at a systemic level, as well as for clinical management.
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- 2020
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40. Redundancy in meta‐analyses publications—Time to pull the plug
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Danny Liew and Richard Ofori-Asenso
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Computer science ,law ,Redundancy (engineering) ,Hematology ,Spark plug ,Reliability engineering ,law.invention - Published
- 2021
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41. The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia
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Richard Ofori-Asenso, Daryl A Jones, Danny Liew, and Johan Mårtensson
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bed utilization ,medicine.medical_specialty ,SURGERY ,Hospital bed ,MODIFIED-CHARLSON-INDEX ,Specialty ,lcsh:Medicine ,Bed days ,030204 cardiovascular system & hematology ,Logistic regression ,PATIENT ,Article ,RISK STRATIFICATION ,03 medical and health sciences ,AGE ,0302 clinical medicine ,length of stay ,Epidemiology ,medicine ,EPIDEMIOLOGY ,030212 general & internal medicine ,PREDICTORS ,FRAILTY ,OUTCOMES ,business.industry ,Mortality rate ,lcsh:R ,LENGTH-OF-STAY ,Discharge disposition ,Retrospective cohort study ,General Medicine ,mortality ,Emergency medicine ,business ,hospitalization - Abstract
Background: Limited available evidence suggests that a small proportion of inpatients undergo prolonged hospitalization and use a disproportionate number of bed days. Understanding the factors contributing to prolonged hospitalization may improve patient care and reduce the length of stay in such patients. Methods: We undertook a retrospective cohort study of adult (&ge, 20 years) patients admitted for at least 24 h between 14 November 2016 and 14 November 2018 to hospitals in Victoria, Australia. Data including baseline demographics, admitting specialty, survival status and discharge disposition were obtained from the Victorian Admission Episode Dataset. Multivariable logistic regression analysis was used to identify factors independently associated with prolonged hospitalization (&ge, 14 days). Cox proportional hazard regression model was used to examine the association between various factors and in-hospital mortality. Results: There were almost 5 million hospital admissions over two years. After exclusions, 1,696,112 admissions lasting at least 24 h were included. Admissions with prolonged hospitalization comprised only 9.7% of admissions but utilized 44.2% of all hospital bed days. Factors independently associated with prolonged hospitalization included age, female gender, not being in a relationship, being a current smoker, level of co-morbidity, admission from another hospital, admission on the weekend, and the number of admissions in the prior 12 months. The in-hospital mortality rate was 5.0% for those with prolonged hospitalization compared with 1.8% in those without (p <, 0.001). Prolonged hospitalization was also independently associated with a decreased likelihood of being discharged to home (OR 0.53, 95% CI 0.52&ndash, 0.54). Conclusions: Patients experiencing prolonged hospitalization utilize a disproportionate proportion of bed days and are at higher risk of in-hospital death and discharge to destinations other than home. Further studies are required to identify modifiable factors contributing to prolonged hospitalization as well as the quality of end-of-life care in such admissions.
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- 2020
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42. Early signs that COVID-19 is being contained in Australia
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Ken Lee Chin, Daryl A Jones, Danny Liew, Kaylee A Jordan, and Richard Ofori-Asenso
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Microbiology (medical) ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Early signs ,Pneumonia, Viral ,Article ,Betacoronavirus ,Pandemic ,medicine ,Humans ,Infection control ,Pandemics ,Infection Control ,biology ,SARS-CoV-2 ,Australia ,COVID-19 ,medicine.disease ,biology.organism_classification ,Virology ,Pneumonia ,Geography ,Infectious Diseases ,Coronavirus Infections - Abstract
Highlights • The COVID-19 pandemic is overwhelming many national healthcare networks. • Case fatality from COVID-19 infection in Australia is between 0.4% to 3.0%. • Strict public health measures were enforced to control this outbreak in Australia. • Australia is on its way joining China and South Korea in ‘flattening the curve’.
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- 2020
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43. Rationing health and social goods during pandemics: guidance for Ghanaian decision makers
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Arthur Caplan, Barbara Redman, Matilda Essandoh Laar, Richard Ofori-Asenso, Debra DeBruin, and Amos Laar
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Healthcare rationing during pandemics has been widely discussed in global bioethics literature. However, existing scenarios and analyses have focused on high income countries, except for very few disease areas such as HIV treatment where some analyses related to African countries exist. We argue that the lack of scholastic discourse, and by extension, professional and democratic engagement on the subject constitute an unacceptable ethical omission. Not only have African governments failed to develop robust ethical plans for pandemics, ethicists in this region have been unable to ignite public discourse on rationing. Therefore, we aim to initiate a debate on how rationing health and social goods could be done ethically in Ghana during the current and future pandemics. The paper discusses and critiques some moral considerations (utilitarian, equity, equal worth, urgent need, and the prioritarian principles) for rationing and their relevance in the Ghanaian context. This contribution may facilitate ethical decision-making during COVID-19 in Ghana and other African settings where hardly any rationing guidelines exist
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- 2020
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44. Improving Interactions Between Health Technology Assessment Bodies and Regulatory Agencies: A Systematic Review and Cross-Sectional Survey on Processes, Progress, Outcomes, and Challenges
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Marie L. De Bruin, Christine E. Hallgreen, Richard Ofori-Asenso, Afd Pharmacoepi & Clinical Pharmacology, and Pharmacoepidemiology and Clinical Pharmacology
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Cross-sectional study ,education ,MEDLINE ,synergy ,Harmonization ,Review ,COLLABORATION ,RELATIVE EFFICACY ,REIMBURSEMENT ,DRUGS ,Reimbursement ,collaboration synergy between HTA and regulatory agencies ,lcsh:R5-920 ,business.industry ,Health technology ,HTA ,General Medicine ,Grey literature ,Public relations ,COVERAGE ,SCIENTIFIC ADVICE ,Drug development ,collaboration synergy between HTA and regulatoryagencies ,regulatory approval ,MEDICINES ,harmonization ,Medicine ,Business ,ADAPTIVE PATHWAYS ,lcsh:Medicine (General) ,REQUIREMENTS - Abstract
The need to optimize drug development and facilitate faster access for patients has ignited discussions around the importance of improving interactions between health technology assessment (HTA) bodies and regulatory agencies. In this study, we conducted a systematic review to examine processes, progress, outcomes, and challenges of harmonization/interaction initiatives between HTA bodies and regulatory agencies. MEDLINE, EMBASE, and the International Pharmaceutical Abstracts database were searched up to 21 October 2019. Searches for gray literature (working papers, commissioned reports, policy documents, etc.) were performed via Google scholar and several institutional websites. An online cross-sectional survey was also conducted among HTA (n = 22) and regulatory agencies (n = 6) across Europe to supplement the systematic review. Overall, we found that while there are areas of divergence, there has been progress over time in narrowing the gap in evidentiary requirements for HTA bodies and regulatory agencies. Most regulatory agencies (4/6; 67%) and half (11/22, 50%) of the HTA bodies reported having a formal link for "collaborating" with the other. Several mechanisms such as early tripartite dialogues, parallel submissions (reviews), adaptive licensing pathways, and postauthorization data generation have been explored as avenues for improving collaboration. A number of pilot initiatives have shown positive effects of these models to reduce the time between regulatory and HTA decisions, which may translate into faster access for patients to life-saving therapies. Thus, future approaches aimed at improving harmonization/interaction between HTA bodies and regulatory agencies should build on these existing models/mechanisms while examining their long-term impacts. Several barriers including legal, organizational, and resource-related factors were also identified, and these need to be addressed to achieve greater alignment in the current regulatory and reimbursement landscape.
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- 2020
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45. Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness
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Clara, Marquina, Ella, Zomer, Sandra, Vargas-Torres, Sophia, Zoungas, Richard, Ofori-Asenso, Danny, Liew, and Zanfina, Ademi
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Cardiovascular Diseases ,Anticholesteremic Agents ,Cost-Benefit Analysis ,Secondary Prevention ,Humans ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Proprotein Convertase 9 - Abstract
New pharmacological therapies for the treatment of cardiovascular disease (CVD) have emerged in recent years. The high rates of CVD and the need for long-term treatment to decrease risk factors makes cost-effectiveness crucial for their successful long-term implementation.This study assessed cost-effectiveness studies of novel pharmacological treatments (ezetimibe, proprotein convertase subtilisin/kexin type 9 [PCSK9] inhibitors, omega-3 polyunsaturated fatty acids [n-3 PUFAs], and the cardiovascular polypill) compared with standard care for the secondary prevention of CVD.We searched seven databases and the reference list of selected literature reviews for eligible cost-effective analyses (CEA) published between January 2009 and January 2020 that evaluated the above novel treatments versus standard care. Two independent reviewers performed the screening and evaluation in accordance with the Consolidated Health Economic Evaluation Reporting Standards statement. Cost results were adapted to 2018 US dollars (US$) to facilitate comparisons between studies. Consideration of cost-effectiveness was based on the original study criteria.Thirty-two studies were included in this review, most of them adopting a healthcare perspective. Studies evaluating ezetimibe, PCSK9 inhibitors and n-3 PUFAs assessed their addition to standard care compared with standard care alone, while studies analysing the polypill evaluated the replacement of multiple monotherapies for a fixed-dose combination. Ten studies reported on ezetimibe, fifteen evaluated PCSK9 inhibitors, five focused on n-3 PUFAs and seven on the polypill. From a healthcare perspective, ezetimibe was cost effective in 62.5% of the studies (incremental cost-effectiveness ratios [ICERs] ranged from US$27,195 to US$204,140), n-3 PUFAs in 60% (ICERs from US$57,128 to US$139,082) and the cardiovascular polypill in 100% (ICERs from dominant to US$30,731) compared with standard care. Conversely, only 10% of the studies considered PCSK9 inhibitors cost effective compared with standard care from a healthcare perspective (ICERs ranged from US$231,119 to US$1,223,831). Additionally, ezetimibe was cost effective in 50% of the studies, PCSK9 inhibitors in 33% and the polypill in 50% of the studies adopting a societal perspective. The key model-related parameters predicting cost-effectiveness included drug cost, time horizon, and the baseline risk of cardiovascular events.Based on current pricing and willingness-to-pay thresholds, most CEA studies considered ezetimibe, n-3 PUFAs and the polypill to be cost effective compared with standard care but not PCSK9 inhibitors for secondary prevention of CVD.
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- 2020
46. Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
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Mohsen Naghavi, Maarten J. Postma, Mahesh P A, Milena Santric-Milicevic, Barbora de Courten, Parvaiz A Koul, Elias Merdassa Roro, Marek Majdan, Ali H. Mokdad, Mihaela Hostiuc, Félix Carvalho, Rufus A. Adedoyin, Miriam Levi, Ejaz Ahmad Khan, Rakhi Dandona, Mohamad-Hani Temsah, Catalina Liliana Andrei, Benn Sartorius, Gebre Teklemariam Demoz, Derrick A Bennett, Ahmad Daryani, Paulo A. Lotufo, Fereshteh Ansari, Elissa M. Abrams, Luke D. Knibbs, Seyyed Meysam Mousavi, Azeem Majeed, Tomislav Mestrovic, Rajeev Gupta, Irina Filip, Leonardo Roever, G.K. Mini, Lorainne Tudor Car, Ghulam Mustafa, Josip Car, Lalit Dandona, Masoud Moradi, Molly R Nixon, Mohammad Zamani, Babak Moazen, Devasahayam J. Christopher, Chi Linh Hoang, Aaron J Cohen, Hossein Poustchi, Luca Ronfani, Sheikh Mohammed Shariful Islam, Nefsu Awoke, Miguel Tortajada-Girbés, Khalid A Altirkawi, Justin R. Ortiz, Adane Teshome Kefale, Shailesh Advani, Alireza Rafiei, Kristina E. Rudd, Tim Driscoll, Yousef Khader, Heather J. Zar, Josep M. Antó, Milena Ilic, Fakher Rahim, Jost B. Jonas, Trang Huyen Nguyen, Yonatal Mesfin Tefera, Simon I. Hay, Aloke Gopal Ghoshal, Adnan Kisa, Ranjani Somayaji, Gholamreza Roshandel, Smita Pakhale, Francesco Saverio Violante, Monika Sawhney, Eyal Oren, Ali Bijani, Gebrekiros Gebremichael Meles, Hajer Elkout, Shanshan Li, Michael Soljak, Masoud Foroutan, Narayan Bahadur Mahotra, Mina Anjomshoa, Jasvinder A. Singh, Mika Shigematsu, Abdel Douiri, Naohiro Yonemoto, Amir Kasaeian, Lorenzo Monasta, Hagazi Gebre Meles, Rupak Desai, Hai Quang Pham, Feleke Mekonnen Demeke, Marissa B Reitsma, Samath D Dharmaratne, Amr Jamal, Miguel Ángel García-Gordillo, Seyed Sina Naghibi Irvani, Michael K. Hole, Aman Yesuf Endries, Vinay Gupta, Mehdi Naderi, Tham Thi Le, Houman Goudarzi, Hamid Yimam Hassen, Siamak Sabour, Theo Vos, Anurag Agrawal, Ireneous N. Soyiri, Kathleen S Sachiko Berfield, Charles D.A. Wolfe, Jobert Richie Nansseu, Robert C. Reiner, Carlo La Vecchia, Michael Brauer, Jagdish Khubchandani, Alaa Badawi, Sezer Kisa, Basema Saddik, Amir Hasanzadeh, H. Dean Hosgood, Berhe Etsay Tesfay, Ibtihal Fadhil, Ketema Bizuwork Gebremedhin, Ai Koyanagi, Maheswar Satpathy, James Leigh, Si Si, Gregory R. Wagner, Eduarda Fernandes, Huong Lan Thi Nguyen, Isabela M. Benseñor, Tommi Vasankari, Gebreamlak Gebremedhn Gebremeskel, Andrew T Olagunju, Moslem Soofi, Jalal Arabloo, Muhammad Aziz Rahman, Mowafa Househ, Amir Radfar, Gebremicheal Gebreslassie Kasahun, Tara Ballav Adhikari, Songhomitra Panda-Jonas, Gessessew Bugssa Hailu, Komal Saleem, Bach Xuan Tran, Lal B. Rawal, Jee-Young Jasmine Choi, Hadi Pourjafar, Robert S. Bernstein, Ghobad Moradi, Farnam Mohebi, Mariam Molokhia, Kamarul Imran Musa, Elham Ahmadian, Pascual R. Valdez, Irfan Ullah, Ritesh G. Menezes, Dawit Zewdu Wondafrash, Olayinka Stephen Ilesanmi, Masood Ali Shaikh, Richard F. Gillum, Aziz Sheikh, Eun-Kee Park, Virendra Singh, Aziz Eftekhari, Yogesh Sabde, Florian Fischer, Krittika Bhattacharyya, Syed Mohamed Aljunid, Alemayehu Toma, Ruxandra Irina Negoi, Kebede Embaye Gezae, Abadi Kahsu Gebre, Abdullah Al Mamun, Junaid Khan, Yuming Guo, Parkes J Kendrick, Reza Malekzadeh, Bruno Piassi Sao Jose, Mohammad Hifz Ur Rahman, Lidia Morawska, Soraya Siabani, Tinuke O Olagunju, Zahid A Butt, Ronny Westerman, Eyasu Ejeta Duken, Khanh Bao Tran, Yousef Veisani, Getachew Mullu Kassa, Erkin M. Mirrakhimov, Miloje Savic, Anh Kim Dang, Vinay Nangia, Job F M van Boven, Adam Belay Wondmieneh, Alan D. Lopez, G Anil Kumar, Navid Manafi, Andre Pascal Kengne, Joan B. Soriano, Luis Camera, Seok Jun Yoon, Paramjit Gill, Yun Jin Kim, Seyyede Masoume Athari, Gurudatta Naik, Sadaf G. Sepanlou, Sanjeev Nair, Jarnail Singh Thakur, André Faro, Javad Nazari, Gene Bukhman, Nelson Alvis-Guzman, Mayowa O. Owolabi, Lorenzo G. Mantovani, Nobuyuki Horita, Zubair Kabir, Felix Akpojene Ogbo, Birhanu Geta Meharie, Daniel Diaz, Adrian Pana, Salman Rawaf, Mihajlo Jakovljevic, Ted R. Miller, Savita Lasrado, Joseph Adel Mattar Banoub, Fares Alahdab, Jan-Walter De Neve, Carlos A Castañeda-Orjuela, Saeed Safari, Farzad Manafi, Marco Vacante, Katherine R. Paulson, Hamidreza Komaki, Reza Shirkoohi, Young Eun Kim, Duduzile Ndwandwe, Nahla Anber, Ravi Prakash Jha, Farshad Farzadfar, Abdallah M. Samy, Richard Ofori-Asenso, Shafiu Mohammed, Paolo Lauriola, Fabiana Madotto, Yunquan Zhang, Qing Lan, David Laith Rawaf, Zoubida Zaidi, Karzan Abdulmuhsin Mohammad, Juan Jesus Carrero, Morteza Abdullatif Khafaie, Seyyed Shamsadin Athari, Cuong Tat Nguyen, UAM. Departamento de Medicina, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP), Soriano, J, Kendrick, P, Paulson, K, Gupta, V, Abrams, E, Adedoyin, R, Adhikari, T, Advani, S, Agrawal, A, Ahmadian, E, Alahdab, F, Aljunid, S, Altirkawi, K, Alvis-Guzman, N, Anber, N, Andrei, C, Anjomshoa, M, Ansari, F, Anto, J, Arabloo, J, Athari, S, Awoke, N, Badawi, A, Banoub, J, Bennett, D, Bensenor, I, Berfield, K, Bernstein, R, Bhattacharyya, K, Bijani, A, Brauer, M, Bukhman, G, Butt, Z, Camera, L, Car, J, Carrero, J, Carvalho, F, Castaneda-Orjuela, C, Choi, J, Christopher, D, Cohen, A, Dandona, L, Dandona, R, Dang, A, Daryani, A, de Courten, B, Demeke, F, Demoz, G, De Neve, J, Desai, R, Dharmaratne, S, Diaz, D, Douiri, A, Driscoll, T, Duken, E, Eftekhari, A, Elkout, H, Endries, A, Fadhil, I, Faro, A, Farzadfar, F, Fernandes, E, Filip, I, Fischer, F, Foroutan, M, Garcia-Gordillo, M, Gebre, A, Gebremedhin, K, Gebremeskel, G, Gezae, K, Ghoshal, A, Gill, P, Gillum, R, Goudarzi, H, Guo, Y, Gupta, R, Hailu, G, Hasanzadeh, A, Hassen, H, Hay, S, Hoang, C, Hole, M, Horita, N, Hosgood, H, Hostiuc, M, Househ, M, Ilesanmi, O, Ilic, M, Irvani, S, Islam, S, Jakovljevic, M, Jamal, A, Jha, R, Jonas, J, Kabir, Z, Kasaeian, A, Kasahun, G, Kassa, G, Kefale, A, Kengne, A, Khader, Y, Khafaie, M, Khan, E, Khan, J, Khubchandani, J, Kim, Y, Kisa, S, Kisa, A, Knibbs, L, Komaki, H, Koul, P, Koyanagi, A, Kumar, G, Lan, Q, Lasrado, S, Lauriola, P, La Vecchia, C, Le, T, Leigh, J, Levi, M, Li, S, Lopez, A, Lotufo, P, Madotto, F, Mahotra, N, Majdan, M, Majeed, A, Malekzadeh, R, Mamun, A, Manafi, N, Manafi, F, Mantovani, L, Meharie, B, Meles, H, Meles, G, Menezes, R, Mestrovic, T, Miller, T, Mini, G, Mirrakhimov, E, Moazen, B, Mohammad, K, Mohammed, S, Mohebi, F, Mokdad, A, Molokhia, M, Monasta, L, Moradi, M, Moradi, G, Morawska, L, Mousavi, S, Musa, K, Mustafa, G, Naderi, M, Naghavi, M, Naik, G, Nair, S, Nangia, V, Nansseu, J, Nazari, J, Ndwandwe, D, Negoi, R, Nguyen, T, Nguyen, C, Nguyen, H, Nixon, M, Ofori-Asenso, R, Ogbo, F, Olagunju, A, Olagunju, T, Oren, E, Ortiz, J, Owolabi, M, P A, M, Pakhale, S, Pana, A, Panda-Jonas, S, Park, E, Pham, H, Postma, M, Pourjafar, H, Poustchi, H, Radfar, A, Rafiei, A, Rahim, F, Rahman, M, Rawaf, S, Rawaf, D, Rawal, L, Reiner, R, Reitsma, M, Roever, L, Ronfani, L, Roro, E, Roshandel, G, Rudd, K, Sabde, Y, Sabour, S, Saddik, B, Safari, S, Saleem, K, Samy, A, Santric-Milicevic, M, Sao Jose, B, Sartorius, B, Satpathy, M, Savic, M, Sawhney, M, Sepanlou, S, Shaikh, M, Sheikh, A, Shigematsu, M, Shirkoohi, R, Si, S, Siabani, S, Singh, V, Singh, J, Soljak, M, Somayaji, R, Soofi, M, Soyiri, I, Tefera, Y, Temsah, M, Tesfay, B, Thakur, J, Toma, A, Tortajada-Girbes, M, Tran, K, Tran, B, Tudor Car, L, Ullah, I, Vacante, M, Valdez, P, van Boven, J, Vasankari, T, Veisani, Y, Violante, F, Wagner, G, Westerman, R, Wolfe, C, Wondafrash, D, Wondmieneh, A, Yonemoto, N, Yoon, S, Zaidi, Z, Zamani, M, Zar, H, Zhang, Y, Vos, T, GBD Chronic Respiratory Disease Collaborator, Violante FS, GBD Chronic Respiratory Disease Collaborators, Collaborators, GBD Chronic Respiratory Disease, Groningen Research Institute for Asthma and COPD (GRIAC), Value, Affordability and Sustainability (VALUE), and Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET)
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Male ,Respiratory diseases ,Respiratory Tract Diseases ,Disease ,Chronic respiratory diseases ,Global Burden of Disease ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Cost of Illness ,11. Sustainability ,METABOLIC RISKS ,EPIDEMIOLOGY ,030212 general & internal medicine ,Child ,Cause of death ,Aged, 80 and over ,COPD ,DALY ,Chronic obstructive pulmonary disease ,Mortality rate ,Respiratory disease ,1. No poverty ,Age Factors ,Middle Aged ,Death causes ,3. Good health ,PREVALENCE ,Health risks ,Child, Preschool ,COMPARATIVE RISK-ASSESSMENT ,Female ,death and disability worldwide ,Quality-Adjusted Life Years ,TERRITORIES ,BURDEN ,growth in absolute numbers ,Pulmonary and Respiratory Medicine ,Adult ,ADJUSTED LIFE-YEARS ,Health burdens ,Adolescent ,Medicina ,195 COUNTRIES ,chronic respiratory diseases ,Article ,1117 Public Health and Health Services ,03 medical and health sciences ,Young Adult ,Life Expectancy ,Sex Factors ,Burden of Disease, Respiratory disease ,Sarcoidosis, Pulmonary ,Environmental health ,medicine ,Disability-adjusted life year ,Humans ,EXPOSURE ,Risk factor ,Mortality ,Aged ,per-capita basis ,business.industry ,DISABILITY ,Infant, Newborn ,Infant ,1103 Clinical Sciences ,asthma ,medicine.disease ,Asthma ,Years of potential life lost ,030228 respiratory system ,Risk factors ,13. Climate action ,Systematic analyses ,Chronic Disease ,INJURIES ,Human medicine ,Pneumoconiosis ,Morbidity ,business ,Lung Diseases, Interstitial ,1199 Other Medical and Health Sciences - Abstract
Artículo con numerosos autores. Sólo se hace referencia al primero que coincide con el de la UAM y al colectivo, Background Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings In 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–4 044 819) in 2017, an increase of 18·0% since 1990, while total DALYs increased by 13·3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14·3% decrease), agestandardised death rates (42·6%), and age-standardised DALY rates (38·2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis, Bill & Melinda Gates Foundation.
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47. Smell and Taste Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis
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Danny Liew, Akosua Adom Agyeman, Ken Lee Chin, Richard Ofori-Asenso, and Cornelia B. Landersdorfer
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medicine.medical_specialty ,Pneumonia, Viral ,Anosmia ,Olfaction ,030204 cardiovascular system & hematology ,Global Health ,Article ,US, United States ,Betacoronavirus ,Olfaction Disorders ,Taste Disorders ,03 medical and health sciences ,COVID-19 Testing ,0302 clinical medicine ,Hyposmia ,Internal medicine ,Prevalence ,medicine ,Humans ,AAO-HNS, American Academy of Otolaryngology-Head and Neck Surgery ,COVID-19, novel coronavirus disease 2019 ,030212 general & internal medicine ,gustatory ,Pandemics ,Clinical Laboratory Techniques ,business.industry ,SARS-CoV-2 ,OGD, olfactory and gustatory dysfunction ,Hypogeusia ,hyposmia ,COVID-19 ,General Medicine ,Ageusia ,Dysosmia ,olfactory ,Dysgeusia ,CI, confidence interval ,Taste disorder ,UK, United Kingdom ,dysgeusia ,medicine.symptom ,Coronavirus Infections ,business ,anosmia - Abstract
Objective To estimate the prevalence of olfactory and gustatory dysfunctions (OGDs) among patients infected with novel coronavirus disease 2019 (COVID-19). Patients and Methods A systematic review was conducted by searching MEDLINE, EMBASE, and the preprint server MedRxiv until 11 May 2020 using the terms ‘anosmia’ or ‘hyposmia’ or ‘dysosmia’ or ‘olfactory dysfunction’ or ‘olfaction disorder’ or ‘smell dysfunction’ or ‘ageusia’ or ‘hypogeusia’ or ‘dysgeusia’ or ‘taste dysfunction’ or ‘gustatory dysfunction’ or ‘neurological’ and ‘COVID-19’ or ‘2019 novel coronavirus’ or ‘2019-nCoV’ or ‘SARS-CoV-2’. References of included studies were also manually screened. Only studies involving diagnostic-confirmed patients with COVID-19 were included. Random-effects meta-analysis was performed. Results A total of twenty-four studies with data from 8438 test-confirmed COVID-19 patients from thirteen countries were included. The pooled proportion of patients presenting with olfactory and gustatory dysfunctions was 41.0% (95% confidence interval [CI] 28.5% to 53.9) and 38.2% (95% CI 24.0 to 53.6%), respectively. Increasing mean age correlated with lower prevalence of olfactory (coefficient = -0.076; p=.02) and gustatory (coefficient = -0.073; p=.03) dysfunctions. There was a higher prevalence of olfactory dysfunctions with the use of objective measurements compared to self-reports (coefficient = 2.33; p=.01). No significant moderation of the prevalence of OGDs by gender was observed. Conclusion There is a high prevalence of OGDs among patients infected with COVID-19. Routine screening for these conditions could contribute to improved case detection in the ongoing COVID-19 pandemic. However, to better inform population screening measures, further studies are needed to establish causality.
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- 2020
48. Trends in the Dispensing and Costs of Glucose-Lowering Medications Among Older Australians: Findings from National Claims Data
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Sophia Zoungas, Danny Liew, Ken Lee Chin, Jenni Ilomäki, Richard Ofori-Asenso, J. Simon Bell, and Frisky Maulida Hidayat
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Blood Glucose ,Male ,Databases, Factual ,Pharmaceutical Benefits Scheme ,Rate ratio ,Drug Costs ,03 medical and health sciences ,Insurance Claim Review ,0302 clinical medicine ,Pharmacotherapy ,Drug Utilization Review ,Diabetes mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Pharmacology (medical) ,030212 general & internal medicine ,Aged ,Glucose lowering ,business.industry ,Incidence (epidemiology) ,Australia ,medicine.disease ,Confidence interval ,Metformin ,Diabetes Mellitus, Type 2 ,Female ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery ,medicine.drug ,Demography - Abstract
Temporal changes in the dispensing of glucose-lowering drugs (GLD) and their associated costs among elderly populations is unclear. This information is especially relevant to countries in which medications are partly or fully government subsidized. Our objective was to estimate the trends in prevalence, incidence and costs associated with GLD dispensed to older Australians. We analysed Pharmaceutical Benefits Scheme data for 76,906 people aged ≥ 65 years dispensed diabetes medications over the period 2013–2016. Older males were dispensed more GLD than were older females, with the marginal difference increasing from 3.2% in 2013 (age-sex adjusted incidence rate ratio [aIRR] 1.032; 95% confidence interval [CI] 1.024–1.041; p
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- 2020
49. Effects of Statins for Secondary Prevention on Functioning and Other Outcomes Among Nursing Home Residents
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Marci Wood, Wen-Chih Wu, Michael A. Steinman, James L. Rudolph, Richard Ofori-Asenso, Yoojin Lee, Danny Liew, Andrew R. Zullo, and Allison Zuern
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Male ,Aging ,Activities of daily living ,nursing homes ,Hydroxymethylglutaryl-CoA reductase inhibitors ,Cardiovascular ,0302 clinical medicine ,inhibitors ,80 and over ,Secondary Prevention ,030212 general & internal medicine ,General Nursing ,Aged, 80 and over ,Minimum Data Set ,Health Policy ,Hazard ratio ,Rehabilitation ,General Medicine ,Health Services ,6.1 Pharmaceuticals ,Cohort ,Public Health and Health Services ,Female ,activities of daily living ,medicine.medical_specialty ,Statin ,medicine.drug_class ,Clinical Sciences ,frailty ,Nursing ,Medicare ,Article ,03 medical and health sciences ,Clinical Research ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,Aged ,business.industry ,Prevention ,Evaluation of treatments and therapeutic interventions ,Retrospective cohort study ,Hydroxymethylglutaryl-CoA reductase ,Confidence interval ,United States ,Nursing Homes ,Good Health and Well Being ,Geriatrics ,Life expectancy ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery - Abstract
Objectives Studies examining the effects of statins after acute myocardial infarction (AMI) excluded frail older adults, especially nursing home (NH) residents, and few examined functional outcomes. Older NH residents may benefit less from statins and be particularly susceptible to adverse drug events like myopathy-related functional decline. We evaluated the effects of statins on 1-year functional decline, rehospitalization, and death in NH residents. Design We conducted a retrospective cohort study using 2007-2010 linked national data from Minimum Data Set (MDS) assessments, Medicare claims, and Online Survey Certification and Reporting System records. Setting and Participants We included US NH residents 65 years and older who were statin nonusers, were hospitalized for AMI between May 2007 and March 2010, and returned to the NH. Measures Outcomes were functional decline, death, and rehospitalization in the first year after post-AMI NH admission. New statin users were 1:1 propensity-score matched to nonusers to adjust for 92 characteristics. We estimated hazard ratios (HRs) and restricted mean survival time differences with 95% confidence intervals (CIs) comparing individuals who did vs did not initiate statin therapy after AMI hospitalization. Results Propensity-score matching yielded a cohort of 5440 residents. Mean age was 83 years and 69% were female. Statin use was associated with a reduction in mortality (HR 0.80, 95% CI 0.73-0.87), corresponding to a mean of 15.9 (95% CI 9.9-22.0) days of extended life expectancy. No overall differences in rehospitalization (HR 1.06, 95% CI 0.98-1.14) or functional decline (HR 1.00, 95% CI 0.88-1.14) were observed. Conclusions and Implications Statins may reduce 1-year mortality by 20% without affecting function among older NH residents who wish to live longer after AMI. During shared decision making with these patients or their representatives, clinicians should consider communicating that the average benefit of statins is 16 days of additional survival over 1 year.
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- 2020
50. Will COVID‐19 be a litmus test for post‐Ebola sub‐Saharan Africa?
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Amos Laar, Richard Ofori-Asenso, and Akosua Adom Agyeman
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2019-20 coronavirus outbreak ,disease control ,Sub saharan ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,coronavirus ,medicine.disease_cause ,Ebola virus ,Political science ,Virology ,medicine ,Humans ,virus classification ,Virus classification ,Africa South of the Sahara ,Coronavirus ,COVID-19 ,Hemorrhagic Fever, Ebola ,Litmus ,Hospitalization ,Infectious Diseases ,Government ,Communicable Disease Control ,Commentary ,Delivery of Health Care - Published
- 2020
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