A Study on the Global Scenario of COVID-19 Related Case Fatality Rate, Recovery Rate and Prevalence Rate and Its Implications for India—A Record Based Retrospective Cohort Study

Importance: Corona virus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pandemic claiming millions of lives since the first outbreak was reported in Wuhan, China during December 2019. It is thus important to make cross-country comparison of the relevant rates and understand the socio-demographic risk factors. Methods: This is a record based retrospective cohort study. Table 1 was extracted from https://www.worldometers.info/coronavirus/ and from the Corona virus resource center (Table 2, Figures 1-3), Johns Hopkins University. Data for Table 1 includes all countries which reported >1000 cases and Table 2 includes 20 countries reporting the largest number of deaths. The estimation of CFR, RR and PR of the infection, and disease pattern across geographical clusters in the world is presented. Results: From Table 1, we could infer that as on 4th May 2020, COVID-19 has rapidly spread world-wide with total infections of 3,566,423 and mortality of 248,291. The maximum morbidity is in USA with 1,188,122 cases and 68,598 deaths (CFR 5.77%, RR 15% and PR 16.51%), while Spain is at the second position with 247,122 cases and 25,264 deaths (CFR 13.71%, RR 38.75%, PR 9.78%). Table 2 depicts the scenario as on 8th October 2020, where-in the highest number of confirmed cases occurred in US followed by India and Brazil (cases per million population: 23,080, 5007 & 23,872 respectively). For deaths per million population: US recorded 647, while India and Brazil recorded 77 and 708 respectively. Conclusion: Studying the distribution of relevant rates across different geographical clusters plays a major role for measuring the disease burden, which in-turn enables implementation of appropriate public healthcare measures.

Effect of low-dose glucocorticoid on corticosteroid insufficient patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND: This study aimed to investigate the prevalence rate of critical illness-related corticosteroid insuffi ciency(CIRCI) and the effect of low-dose glucocorticoid on prognosis of CIRCI in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).METHODS: Since January 2010 to December 2012, 385 patients, who met the criteria of AECOPD, were enrolled in the Intensive Care Unit(ICU) of the First People's Hospital and Municipal Central Hospital of Xiangtan City. The AECOPD patients complicated with CIRCI screened by an adrenalcorticotrophic hormone test within 12 hours after admission to ICU were divided into a treatment group(n=32) and a control group(n=31) for a prospective, randomized and controlled clinical trial. Hydrocortisone(150 mg/d) or normal saline was injected intravenously for 7 days. The patients were followed up for 28 days after injection. The endpoint included 28-day survival time, non-shock time, ICU stay and the period of non-mechanical ventilation. The markers ofinfl ammation C-reactive protein, tumor necrosis factor-α, interleukin 6 and procalcitonin were measured at baseline and 7 days after treatment. The variables were analyzed by Student's t test, the non-parametric statistical test, the Chi-square test or the Kaplan-Meier method with SPSS18.0 statistic software. A P value <0.05 was considered statistically signifi cant.RESULTS: Totally 63 patients were diagnosed with CIRCI by an adrenalcorticotrophic hormone test and the prevalence rate was 16.4%. The shock rate of the AECOPD patients complicated with CIRCI was higher than that of the AECOPD patients without CIRCI(23.8% vs. 8.7%, P<0.01). KaplanMeier analysis revealed that the 28-day survival time of the treatment group was obviously longer than that of the control group(P<0.05). Compared with the control group, shock-free days within 28 days was longer in the treatment group(18.2±9.5 vs. 25.8±4.1, P<0.05). Treatment with low-dose glucocorticoid obviously decreased the markers ofinfection and inflammation(P<0.01), such as C-reactive protein(13.2±5.5 mg/L vs. 8.3±3.1 mg/L for the control group; 13.5±5.9 mg/L vs. 5.1±2.3 mg/L for the treatment group), tumor necrosis factor-α(26.1±16.2 g/L vs. 17.5±11.7 g/L for the control group; 25.0±14.8 g/L vs. 10.4±7.8 g/L for the treatment group) and procalcitonin(3.88 g/L vs. 2.03 g/L for the control group; 3.77 g/L vs. 1.26 g/L for the treatment group). Furthermore, the markers in the treatment group decreased more obviously than those in the control group(P<0.01).CONCLUSION: The prevalence rate of CIRCI was higher in the patients with AECOPD in the department of critical medicine, and low-dose glucocorticoid treatment for one week reduced the 28-day mortality, shock time and markers ofinfection and infl ammation.

Overcoming Barriers to Contraceptive Uptake among Adolescents: The Case of Kiambu County, Kenya

Despite high sexual activity among adolescent girls in Kenya, contraceptive uptake is very low with only about 26 percent sexually active adolescent girls currently using a contraceptive method. This exposes them to HIV infections and unplanned pregnancies which consequently lead to school dropouts, unsafe abortions, and lack of employment opportunities. This cross-sectional study aimed at assessing the utilization of contraceptives among secondary school adolescent girls in Karuri Town Council, Kiambu County. Overall, 421 girls aged between 13.0 to 19.0 years took part in the study. Findings showed that despite majority (77.5%) of the adolescent girls having had sexual debut by the age of 15 years, contraceptive utilization was very low at 43%. The results revealed that age of the adolescent, knowledge of contraceptives options, perception and accessibility of the contraceptives had positive significant effect on contraceptive utilization. Adolescents aged 18 years and above were more likely to utilize contraceptives as compared to those of a lesser age (p ≤ 0.001;OR: 9.870 (95% CI: 3.781 - 25.763)). Those with knowledge on contraceptives were OR 3.2 times more likely to use contraceptives (p = 0.025), similarly, accessibility was significantly associated with increased contraceptive utilization (p = 0.34, 95% CI: 1.054 - 4.187). Adolescents who perceived use of contraceptives as wise were more likely to use a contraceptive than those of a divergent opinion (OR: 2.053 (95% CI: 1.024 - 4.115), p = 0.041). This revealed that high level of knowledge on contraceptives did not always amount to practice. There is therefore a need to develop age specific reproductive health messages to guide school education curriculum as well as parent or guardian-child communication.

Factors Relevant to Knee Pain among Independent Community-Dwelling Older Adults: A Complete Cross-Sectional Study

Objective: Knee pain is commonly observed among older adults. Therefore, the prevention of knee pain in older adults is a major public health issue. This study aimed to clarify factors relevant to knee pain among older adults. Methods: This study targeted all independent older adults (N = 6661) living in a local municipality in Japan. Participants’ health status and lifestyle habits were surveyed using a questionnaire. The survey was conducted from 15 January to 14 February 2016. Relationships between knee pain and physical activity, sitting time, nutrition, drinking, smoking, or body mass index (BMI) were examined using logistic regression analysis. Odds ratios (OR) and 95% confidence intervals (CI) adjusted for several confounding factors were calculated. Results: Older adults of 5311 responded to the questionnaire and 1843 reported knee pain. The prevalence of knee pain was 34.8%. Knee pain was significantly associated with BMI (OR: 0.60, 95% CI: 0.51 - 0.69, P < 0.001 in the group of normal range, OR: 0.38, 95% CI: 0.29 - 0.51, P < 0.001 in the group of <18.0), nutrition status (OR: 0.63, 95% CI: 0.54 - 0.75, P < 0.001), and physical activity (OR: 0.81, 95% CI: 0.71 - 0.92, P = 0.001). Conclusions: This study suggests that one in three independently-living older adults experiences chronic knee pain and that physical activity, BMI, and nutritional status are associated with knee pain.

The health status of China’s elderly and their demand for healthcare services

This paper,based on data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey(CLHLS),reports on the health status of China’s elderly,and their needs for care and use of medical services.The proportion of the elderly in 2018 who reported being satisfied with their current lives was 67.1%,a proportion signifi-cantly higher than that reported by CLHLS 2002.Some 73.1%of the elderly self-rated their health as good or fair.There were ten types of chronic diseases with prev-alence rates higher than 5%,among which hypertension was the most common,with 46.2%of survey respondents self-reporting suffering from it.The daily lives of some people suffering from chronic diseases were seriously affected.Most elderly people(93.2%)were able to complete without assistance all of the ADL items surveyed by CLHLS 2018,while 63.6%were able to do so with IADL items.Only 19.1%of the elderly reported that they were unable to perform at least one IADL item.Family members were still the main source of primary care.The satisfaction of the elderly with primary caregiver and helps they received was quite high.The data shows that the average weekly cost of care was RMB 651.1 yuan,with a median of RMB 180.0 yuan.The median hours children or grandchildren helped their elderly parents(grandparents)in the week prior to being interviewed was 0,and the mean value was 10.3 h.Because 86.5%of elderly survey respondents were covered by some type of medical insurance,more than half of the elderly had their medical expenses covered by insurance,and most elderly people had access to adequate medical services.