Intention to Leave and Associated Factors among Health Professionals in Jimma Zone Public Health Centers, Southwest Ethiopia

Background: Inadequate human resources are a major constraint to improving global health. The health sector is characterized by a high turnover coupled with internal as well as external brain drain but there is little information on intention to leave among health professionals in public health centers of Jimma Zone, Oromia Regional State. The aim of this study is to assess intention to leave and associated factors among health professionals in public health centers of Jimma Zone, southwest Ethiopia. Methods: A cross-sectional quantitative and qualitative study was conducted on seven randomly selected woredas (districts) which have 53 public health centers. All health professionals in sampled district public health centers were included (n = 505). Factor analysis was employed for all Likert scale instruments to extract factor(s) representing each of the scales using SPSS version 16.0. The qualitative data was analyzed by thematic analysis methods. Ethical approval was obtained from Jimma University. Results: Four hundred fifty five (90.1%) health professionals participated in the study;out of this, 290 (63.7%) had intention to leave. Among variables, job satisfaction (Beta = -0.298, (95% CI, -0.568 to -0.029), working environment (Beta = -0.612, (95% CI, -0.955 to -0.270), and organizational management (Beta = -0.552, (95% CI, 0.289 to 0.815) had statistically significant association with intention to leave among health professionals in public health centers of Jimma Zone. Conclusions: The overall intention to leave among health professionals was high. Level of job satisfaction, working environment, work pressure, and organizational management had statistically significant association with intention to leave. Thus, responsible bodies should aggressively work on the concerns identified, like, improvements in salary, promotion in terms of training/educational opportunity, improving working environment, and transfer of health professionals, and improvement of the leadership skills of managers.

Randomized controlled trial of bipolar diathermy vs ultrasonic scalpel for closed hemorrhoidectomy

AIM:To compare hemorrhoidectomy with a bipolar electrothermal device or hemorrhoidectomy using an ultrasonically activated scalpel.METHODS:Sixty patients with grade Ⅲ or Ⅳ hemorrhoids were prospectively randomized to undergo closed hemorrhoidectomy assisted by bipolar diathermy(group 1) or hemorrhoidectomy with the ultrasonic scalpel(group 2).Operative data were recorded,and patients were followed at 1,3,and 6 wk to evaluate complications.Independent assessors were assigned to obtain postoperative pain scores,oral analgesic requirement and satisfaction scores.RESULTS:Reduced intraoperative blood loss median 0.9 mL(95% CI:0.8-3.7) vs 4.6 mL(95% CI:3.8-7.0),P = 0.001 and a short operating time median 16(95% CI:14.6-18.2) min vs 31(95% CI:28.1-35.3) min,P < 0.0001 was observed in group 1 compared with group 2.There was a trend towards lower postoperative pain scores on day 1 group 1 median 2(95% CI:1.8-3.5) vs group 2 median 3(95% CI:2.6-4.2),P = 0.135.Reduced oral analgesic requirement during postoperative 24 h after operation median 1(95% CI:0.4-0.9) tablet vs 1(95% CI:0.9-1.3) tablet,P = 0.006 was observed in group 1 compared with group 2.There was no difference between the two groups in the degree of patient satisfaction or number of postoperative complications.CONCLUSION:Bipolar diathermy hemorrhoidectomy is quick and bloodless and,although as painful as closed hemorrhoidectomy with the ultrasonic scalpel,is associated with a reduced analgesic requirement immediately after operation.

Cost-utility of molecular adsorbent recirculating system treatment in acute liver failure

AIM:To determine the short-term cost-utility of mo-lecular adsorbent recirculating system(MARS) treatment in acute liver failure(ALF).METHODS:A controlled retrospective study was conducted with 90 ALF patients treated with MARS from 2001 to 2005.Comparisons were made with a historical control group of 17 ALF patients treated from 2000 to 2001 in the same intensive care unit(ICU) specializing in liver diseases.The 3-year outcomes and number of liver transplantations were recorded.All direct liver disease-related medical expenses from 6 mo before to 3 years after ICU treatment were determined for 31 MARS patients and 16 control patients.The health-related quality of life(HRQoL) before MARS treatment was estimated by a panel of ICU doctors and after MARS using a mailed 15D(15-dimensional generic healthrelated quality of life instrument) questionnaire.The HRQoL,cost,and survival data were combined and the incremental cost/quality-adjusted life years(QALYs) was calculated.RESULTS:In surviving ALF patients,the health-related quality of life after treatmeant was generally high and comparable to the age-and gender-matched general Finnish population.Compared to the controls,the average cost per QALY was considerably lower in the MARS group(64 732€ vs 133 858€) within a timeframe of 3.5 years.The incremental cost of standard medical treatment alone compared to MARS was 10 928€,and the incremental number of QALYs gained by MARS was 0.66.CONCLUSION:MARS treatment combined with standard medical treatment for ALF in an ICU setting is more cost-effective than standard medical treatment alone.

Economic evaluation of the hepatitis C elimination strategy in Greece in the era of affordable direct-acting antivirals

BACKGROUND Hepatitis C virus(HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims to estimate the required interventions to achieve elimination using updated information for direct-acting antiviral(DAA) treatment coverage, to compute the total costs(including indirect/societal costs) of the strategy and to identify whether the elimination strategy is cost-effective/cost-saving in Greece.AIM To estimate the required interventions and subsequent costs to achieve HCV elimination in Greece.METHODS A previously validated mathematical model was adapted to the Greek HCVinfected population to compare the outcomes of DAA treatment without the additional implementation of awareness or screening campaigns versus an HCV elimination strategy, which includes a sufficient number of treated patients. We estimated the total costs(direct and indirect costs), the disability-adjusted life years and the incremental cost-effectiveness ratio using two different price scenarios.RESULTS Without the implementation of awareness or screening campaigns,approximately 20000 patients would be diagnosed and treated with DAAs by2030. This strategy would result in a 19.6% increase in HCV-related mortality in2030 compared to 2015. To achieve the elimination goal, 90000 patients need to be treated by 2030. Under the elimination scenario, viremic cases would decrease by78.8% in 2030 compared to 2015. The cumulative direct costs to eliminate the disease would range from 2.1-2.3 billion euros(€) by 2030, while the indirect costs would be €1.1 billion. The total elimination cost in Greece would range from €3.2-3.4 billion by 2030. The cost per averted disability-adjusted life year is estimated between €10100 and €13380, indicating that the elimination strategy is very costeffective. Furthermore, HCV elimination strategy would save €560-895 million by2035.CONCLUSION Without large screening programs, elimination of HCV cannot be achieved. The HCV elimination strategy is feasible and cost-saving despite the uncertainty of the future cost of DAAs in Greece.

Expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China:a hospital.based,multicenter,cross-sectional survey

Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods: We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan(CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup(hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results: A total of 2356 patients with a mean age of 57.4 years were included, 57.1 % of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3%of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups(P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less(all P < 0.05).Conclusions: For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.

Cost-Minimization and Budget Impact Analysis of Rituximab SC VS Rituximab IV for Non-Hodgkin’s Lymphoma (NHLs) in Greece

Background: Non-Hodgkin’s lymphoma (NHLs) is a prevalent type of cancer for which Intravenous (IV) Rituximab is a widely used treatment option. Nevertheless, IV infusions can lead to intense resource use and, subsequently, costs. Given that a subcutaneous (SC) therapeutically equivalent formulation of the drug is currently available, this study aimed to examine the potential clinical and economic value of the introduction of the SC formulation for the Greek healthcare setting. Methods: A cost-minimization and budget-impact analysis contributed to comparing staff, patient time and resource utilization and estimating the clinical effects and associated costs in the IV and SC administration. A questionnaire-based survey was used to provide data regarding the local treatment patterns and the resource use associated with each treatment in the Greek NHS. The analysis followed the third-party payer perspective, and cost data relevant to personnel salaries, pharmaceuticals and resource utilization were obtained from official government sources. Results: SC administration was associated with time savings in activities such as pre-medication administration (3 minutes saved with the SC use), monitoring during infusion (12 minutes for physicians and 3 minutes for nurses) as well as time-savings in the preparation of the drugs, the actual dispensing process and the post-injecting monitoring processes. A significant decrease was observed in the nursing and chair time (57% and 90% per case, respectively) and a higher level of services could be secured in terms of hospital capacity with the SC use. SC administration was found to generate budget savings of 618,708€ per 1000 patients/3 years over the full course of treatment. Conclusions: Switching IV to SC administration, as demonstrated in the case of Rituximab for NHLs in Greece, can reduce staff time and administration costs, improve the capacity of the system and, possibly, improve resource allocation in the healthcare system.

Dietary fat intake of Japanese male children and its associated factors: Results of the 1995 National Nutrition Survey in Japan

Aim: To clarify the factors associated with reported dietary fat intake by Japanese male children. Methods: This study is based on the data of a nationally representative cross-sectional study in Japan. Three hundred and seventy-seven male children (age, 6 - 11 years) whose households were sampled in the 1995 Comprehensive Survey of Living Conditions of the People on Health and Welfare, and the 1995 National Nutrition Survey and whose parents were identified through record linkage between the 2 survey data sets were enrolled. Results: The final dataset in this study consisted of 377 boys with 329 of their parents. Fifty-two boys were found to be overweight (13.8%). The reported dietary fat intake was higher among the overweight boys than among the non-overweight boys. Maternal obesity was significantly associated with obesity in male children. Boys who frequently consumed foods from the “fats and lipids” group and the “meat” groups, and children from nuclear families rather than 3- generation families reported high dietary fat intake. In addition, parental fat intake was also significantly associated with fat intake of male children. Conclusions: Child and parental dietary habits along with the household status should be considered when implementing nutritional education programmes to control dietary fat intake and reduce the obesity risks of male children.

Direct Costs of Diabetes Care in Pediatric Patients with Type 1 Diabetes in Greece

Background: Type 1 diabetes (T1D) is a chronic disease with increasing incidence and major impact on the health care costs. Aim: To estimate the direct cost of pediatric T1D in the Greek National Health System (NHS) and its distribution by service category. Methods: This is a retrospective cost-of-illness study, focusing on the direct costs from the healthcare system’s point of view. All patients aged 0 - 16 years, diagnosed with T1D, who were followed in the Diabetes Outpatients’ Clinic of the University Pediatric Department of one of the two main Pediatric Hospitals in Athens, for a two-year period (1st?January 2011 to 31st December 2012) were included. Results: Total diabetes-related direct costs per person-year were estimated at €2,712 (95% CI 2468 - 2956). Diabetes healthcare provider and education visits including laboratory tests, accounted for only 7.6% of total costs. Cost for hospitalizations was only 1.7%. Medication costs were 17% of total costs and were the highest for multi-injection therapy. Supply costs accounted for 73.7% of the total costs and were the highest for insulin pump therapy (p = 0.000). 12.4% of patients were admitted yearly for diabetes related cause and the mean length of hospitalization was 0.18 days per person-year (95%CI: 0.05 - 0.3). Conclusion: This is a preliminary study based on a single institution’s data, which however constitutes a major referral center, thus dealing with a balanced sample of the Greek pediatric diabetic population. Considering that standards of diabetes care are common throughout the NHS, the management of patients in our hospital represents the common practice for pediatric diabetes in Greece. Data are suggesting that cost for hospitalization and outpatients’ care for T1D patients followed in the public sector was rather low compared to other countries, the medication cost was at similar or lower levels and the cost of supplies was generally higher.

Disease Burden and Costs Associated with Multiple Sclerosis in China:A Cross-sectional Analysis of Nationwide Survey Data

DearEditors,Multiple sclerosis(MS)is a chronic,autoimmune neurological disorder characterized by inflammatory demyelination of the central nervous system;it is associated with reduced mobility,cognitive impairment,and numerous comorbidities[1].Global MS incidence(2.1 per 100,000 person-years)and prevalence(30.1 per 100,000)have increased in recent years,and its prevalence is notably higher in Western countries,ranging from~30 to 200 cases per 100,000[2].In China,recent epidemiological research has shown that the crude prevalence was 2.44 per 100,000 in 2016[3],and the age-and sex-adjusted incidence was 0.235 per 100,000 person-years[4].Despite the relatively low prevalence compared with the global average,China has extensively addressed the well-being of over 30,000 MS patients,enrolling MS in China's First National List of Rare Diseases in 2018.

Biological therapy in inflammatory bowel diseases:Access in Central and Eastern Europe

Biological drugs opened up new horizons in the management of inflammatory bowel diseases(IBD).This study focuses on access to biological therapy in IBD patients across 9 selected Central and Eastern European(CEE)countries,namely Bulgaria,the Czech Republic,Estonia,Hungary,Latvia,Lithuania,Poland,Romania and Slovakia.Literature data on the epidemiology and disease burden of IBD in CEE countries was systematically reviewed.Moreover,we provide an estimation on prevalence of IBD as well as biological treatment rates.In all countries with the exception of Romania,lower biological treatment rates were observed in ulcerative colitis(UC)compared to Crohn’s disease despite the higher prevalence of UC.Great heterogeneity(up to 96-fold)was found in access to biologicals across the CEE countries.Poland,Bulgaria,Romania and the Baltic States are lagging behind Hungary,Slovakia and the Czech Republic in their access to biologicals.Variations of reimbursement policy may be one of the factors explaining the differences to a certain extent in Bulgaria,Latvia,Lithuania,and Poland,but association with other possible determinants(differences in prevalence and incidence,price of biologicals,total expenditure on health,geographical access,and cost-effectiveness results)was not proven.We assume,nevertheless,that healthdeterioration linked to IBD might be valued differently against other systemic inflammatory conditions in distinct countries and which may contribute to the immense diversity in the utilization of biological drugs for IBD.In conclusion,access to biologicals varies widely among CEE countries and this difference cannot be explained by epidemiological factors,drug prices or total health expenditure.Changes in reimbursement policy could contribute to better access to biologicals in some countries.

Medical expenditures for colorectal cancer diagnosis and treatment: A 10-year high-level-hospital-based multicenter retrospective survey in China, 2002-2011

Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 values.Results: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.

Access to biologicals in Crohn's disease in ten European countries

AIM To analyze access(availability, affordability and acceptability) to biologicals for Crohn's disease(CD) in ten European countries and to explore the associations between these dimensions, the uptake of biologicals and economic development.METHODS A questionnaire-based survey combined with desk research was carried out in May 2016. Gastroenterologists from the Czech Republic, France, Germany, Hungary, Latvia, Poland, Romania, Slovakia, Spain and Sweden were invited to participate and provide data on the availability of biologicals/biosimilars, reimbursement criteria, clinical practice and prices, and use of biologicals. An availability score was developed to evaluate the restrictiveness of eligibility and administrative criteria applied in the countries. Affordability was defined as the annual cost of treatment as a share of gross domestic product(GDP) per capita. Correlations with the uptake of biologicals, dimensions of access and GDP per capita were calculated.RESULTS At the time of the survey, infliximab and adalimumab were reimbursed in all ten countries, and vedolizumab was reimbursed in five countries(France, Germany, Latvia, Slovakia, Sweden). Reimbursement criteria were the least strict in Sweden and Germany, and the strictest in Hungary, Poland and Slovakia. Between countries, the annual cost of different biological treatments differed 1.6-3.3-fold. Treatments were the most affordable in Sweden(13%-37% of the GDP per capita) and the least affordable in the Central and Eastern European countries, especially in Hungary(87%-124%) and Romania(141%-277%). Biosimilars made treatments more affordable by driving down the annual costs. The number of patients with CD on biologicals per 100000 population was strongly correlated with GDP per capita(0.91), although substantial differences were found in the uptake among countries with similar economic development. Correlation between the number of patients with CD on biologicals per 100000 population and the availability and affordability was also strong(-0.75,-0.69 respectively). CONCLUSION Substantial inequalities in access to biologicals were largely associated with GDP. To explain differences in access among countries with similar development needs further research on acceptance.

Magnetic sphincter augmentation: Optimal patient selection and referral care pathways

Outcomes associated with magnetic sphincter augmentation (MSA) in patients with gastroesophageal reflux disease (GERD) have been reported,however the optimal population for MSA and the related patient care pathways have not been summarized.This Minireview presents evidence that describes the optimal patient population for MSA,delineates diagnostics to identify these patients,and outlines opportunities for improving GERD patient care pathways.Relevant publications from MEDLINE/EMBASE and guidelines were identified from 2000-2018.Clinical experts contextualized the evidence based on clinical experience.The optimal MSA population may be the 2.2-2.4% of GERD patients who,despite optimal medical management,continue experiencing symptoms of heartburn and/or uncontrolled regurgitation,have abnormal pH,and have intact esophageal function as determined by high resolution manometry.Diagnostic work-ups include ambulatory pH monitoring,high-resolution manometry,barium swallow,and esophagogastroduodenoscopy.GERD patients may present with a range of typical or atypical symptoms.In addition to primary care providers (PCPs) and gastroenterologists (GIs),other specialties involved may include otolaryngologists,allergists,pulmonologists,among others.Objective diagnostic testing is required to ascertain surgical necessity for GERD.Current referral pathways for GERD management are suboptimal.Opportunities exist for enabling patients,PCPs,GIs,and surgeons to act as a team in developing evidence-based optimal care plans.

Resection of high-grade glioma involving language areas assisted by multimodal techniques under general anesthesia:a retrospective study

Background Multimodal techniques-assisted resection of glioma under general anesthesia(GA)has been shown to achieve similar clinical outcomes as awake craniotomy(AC)in some studies.In this study,we aim to validate the use of multimodal techniques can achieve the maximal safe resection of high-grade glioma involving language areas(HGILAs)under GA.Methods HGILAs cases were reviewed and collected between January 2009 and December 2020 in our center.Patients were separated into multimodal group(using neuronavigation,intraoperative MRI combined with direct electrical stimulation[DES]and neuromonitoring[IONM])and conventional group(neuronavigation alone)and clinical outcomes were compared between groups.Studies of HGILAs were reviewed systematically and the meta-analysis results of previous(GA or AC)studies were compared with our results.Results Finally,there were 263 patients in multimodal group and 137 patients in conventional group.Compared to the conventional group,the multimodal group achieved the higher median EOR(100%versus 94.32%,P<0.001)and rate of gross total resection(GTR)(73.8%versus 36.5%,P<0.001)and the lower incidence of permanent language deficit(PLD)(9.5%versus 19.7%,P=0.004).The multimodal group achieved the longer median PFS(16.8 versus 10.3 months,P<0.001)and OS(23.7 versus 15.7 months,P<0.001)than the conventional group.The multimodal group achieved a higher rate of GTR than the cohorts in previous multimodal studies under GA and AC(73.8%versus 55.7%[95%CI 32.0-79.3%]versus 53.4%[35.5-71.2%]).The multimodal group had a lower incidence of PLD than the cohorts in previous multimodal studies under GA(9.5%versus 14.0%[5.8-22.1%])and our incidence of PLD was a little higher than that of previous multimodal studies under AC(9.5%versus 7.5%[3.7-11.2%]).Our multimodal group also achieved a relative longer survival than previous studies.Conclusions Surgery assisted by multimodal techniques can achieve maximal safe resection for HGILAs under GA.Further prospective studies are needed to compare GA with AC for HGILAs.

Trends and Patterns of Respiratory Tuberculosis Mortality in Rural and Urban——China,1987-2021

Summary What is already known about this topic?In China,an estimated 780,000 individuals contract tuberculosis(TB)every year.With TB ranked as the second most prevalent disease in terms of the morbidity and mortality rates for legally infectious diseases,it imparts a substantial disease burden on families and society.What is added by this report?This study identifies specific periods and cohort effects related to trends in respiratory TB mortality in both rural and urban regions of China.The mortality rates have been found to decrease at an annual rate of 5.5%in urban regions and 6.6%in rural ones,with a more marked decline evident in rural areas.These findings represent a significant milestone in the prevention and treatment of respiratory TB in China,especially in its rural locales.

Changing Patterns of Mortality in Viral Hepatitis——China,1987–2021

Summary What is already known about this topic?Viral hepatitis continues to present a major global public health challenge,with China shouldering the heaviest burden of this disease worldwide.What is added by this report?This study examined evolving trends and assessed the impacts of age,period,and cohort on viral hepatitis mortality from 1987 to 2021 in both urban and rural settings across China.What are the implications for public health practice?This research provides critical insights,enabling policymakers to develop precise and effective intervention strategies that are specifically tailored to address the needs of high-risk older adults.

Changing Patterns of Mortality in Diabetes Mellitus Among Older Adults—China,1987-2021

What is already known about this topic?Diabetes mellitus poses a significant public health concern for older adults in China,resulting in increased mortality rates.What is added by this report?This study investigates the evolving pattern of mortality associated with diabetes mellitus and analyzes the contributions of age,period,and cohort effects from 1987 to 2021.The results demonstrate a consistent rise in diabetes mellitus mortality over the last 30 years,notably in rural regions.What are the implications for public health practice?This research offers valuable insights to aid policymakers in developing targeted intervention strategies that address the specific needs of higher-risk populations,such as women,older adults,and individuals in rural areas.

Changing Patterns of Injury Mortality Among the Elderly Population in Urban and Rural Areas—China,1987–2021

What is already known about this topic?Injury is a significant public health issue,particularly among the elderly population.However,the extent of this problem varies significantly based on age,gender,and geographic location.What is added by this report?This study aims to examine the changing patterns of injury mortality rates in China over a 35-year period and assess the age-period-cohort effects on mortality trends.What are the implications for public health practice?This study examines the evolving patterns of injury mortality in the elderly population and identifies potential high-risk groups.The findings offer valuable insights for informing injury prevention policies.

Time of sunrise and hours with daylight may have an effect on the seasonality and diurnal variation of heart attack

Background The time of onset of myocardial infarction shows seasonal and daily variation. We aimed to investigate whether the number of hours with daylight has an effect on the seasonal variation of heart attack, and whether the time of sunrise has an effect on the diurnal rhythm of myocardial infarction. Methods We carried out a retrospective database study covering all patients admitted to any acute care hospital with the diagnosis of myocardial infarction in Hungary between January 2004 and December 2005 （n=32 329）. Data were collected from the National Health Insurance Fund Administration （OEP） according to the International Classification of Diseases （ICD 121, 122） and National Meteorology Service （OMSZ）. In case of patients who occurred in the database several times the events have been considered as a separate case. Results With consideration to seasonal variation, the peak period of heart attack was found in the spring, with the lowest number of events in the summer. The number of hours with daylight showed a weak negative correlation with the occurrence of myocardial infarction （r=-0.108, P 〈0.05）. With respect to diurnal variation, the peak period of daily events was between 6-12 in the morning （35.57%）. We have found a positive correlation between the time of sunrise and sunset and the occurrence of myocardial infarction （P 〈0.01）. Conclusion Based on our findings, the number of hours with daylight and the time of sunrise may be connected with the chances of having heart attack; however other factors, such as high blood pressure, diabetes or smoking may also have an influence.