Background: Chronic obstructive pulmonary disease (COPD) is among the leading causes of death globally, accounting for about 3 million deaths worldwide in 2011. We aimed to estimate the prevalence of COPD in Africa in the year 2010 to provide the information that could assist health policy in the region. Methods: We conducted a systematic review of Medline, EMBASE and Global Health for studies on COPD published between 1990 and 2012. We included original population based studies providing estimates of the prevalence of COPD. We considered the reported estimates in terms of the mean age of the sample, sex ratio, the year of study and the country of the study as possible covariates. Results from two different types of studies, i.e., based on spirometric and non-spirometric diagnosis of COPD, were further compared. The United Nation Population Division's population figures were used to estimate the number of COPD cases in the year 2010. Results: Our search returned 243 studies, from which only 13 met our selection criteria and only five were based on spirometry. The difference in the median prevalence of COPD in persons aged 40 years or older based on spirometry data (13.4%; IQR: 9.4%–22.1%) and non-spirometry data (4.0%; IQR: 2.1%–8.9%) was statistically significant (p = 0.001). There was no significant effect of the gender or the year of the study on the reported prevalence of COPD in either set of studies. The prevalence of COPD increased with age in spirometry-based studies (p = 0.017), which is a plausible finding suggesting internal consistency of spirometry-based estimates, while this trend was not observed in studies using other case definitions. When applied to the appropriate age group (40 years or more), which accounted for 196.4 million people in Africa in 2010, the estimated prevalence translates into 26.3 million (18.5–43.4 million) cases of COPD. Comparable figures for the year 2000 based on the same prevalence rates would amount to 20.0 million (14.1–33.1), suggesting an increase of 31.5% over a decade that is attributable to ageing of the African population alone. Conclusion: Our findings suggest that COPD is likely to already represent a very large public health problem in Africa. Moreover, rapidly ageing African population should expect a steady increase in the number of COPD cases in the next decade and beyond. The quantity and quality of available evidence does not match the size of the problem. There is a need for more research on COPD prevalence, but also incidence, mortality and risk factors in Africa. We hope this study will raise awareness of COPD in Africa and encourage further research.
Summary Background Infliximab and adalimumab have established roles in inflammatory bowel disease ( IBD ) therapy. UK regulators mandate reassessment after 12 months' anti‐ TNF therapy for IBD , with consideration of treatment withdrawal. There is a need for more data to establish the relapse rates following treatment cessation. Aim To establish outcomes following anti‐ TNF withdrawal for sustained remission using new data from a large UK cohort, and assimilation of all available literature for systematic review and meta‐analysis. Methods A retrospective observational study was performed on 166 patients with IBD (146 with Crohn's disease ( CD ) and 20 with ulcerative colitis [ UC ) and IBD unclassified ( IBDU )] withdrawn from anti‐ TNF for sustained remission. Meta‐analysis was undertaken of all published studies incorporating 11 further cohorts totalling 746 patients (624 CD , 122 UC ). Results Relapse rates in the UK cohort were 36% by 1 year and 56% by 2 years for CD , and 42% by 1 year and 47% by 2 years for UC / IBDU . Increased relapse risk in CD was associated with age at diagnosis [hazard ratio ( HR ) 2.78 for age <22 years], white cell count ( HR 3.22 for >5.25 × 10 9 /L) and faecal calprotectin ( HR 2.95 for >50 μg/g) at drug withdrawal. Neither continued immunomodulators nor endoscopic remission were predictors. In the meta‐analysis, estimated 1‐year relapse rates were 39% and 35% for CD and UC / IBDU respectively. Retreatment with anti‐ TNF was successful in 88% for CD and 76% UC / IBDU . Conclusions Assimilation of all available data reveals remarkable homogeneity. Approximately one‐third of patients with IBD flare within 12 months of withdrawal of anti‐ TNF therapy for sustained remission.
Background The burden of hypertension is high in Africa, and due to rapid population growth and ageing, the exact burden on the continent is still far from being known. We aimed to estimate the prevalence and awareness rates of hypertension in Africa based on the cut off “≥140/90 mm Hg”. Methods We conducted a systematic search of Medline, EMBASE and Global Health. Search date was set from January 1980 to December 2013. We included population-based studies on hypertension, conducted among people aged ≥15 years and providing numerical estimates on the prevalence of hypertension in Africa. Overall pooled prevalence of hypertension in mixed, rural and urban settings in Africa were estimated from reported crude prevalence rates. A meta-regression epidemiological modelling, using United Nations population demographics for the years 1990, 2000, 2010 and 2030, was applied to determine the prevalence rates and number of cases of hypertension in Africa separately for these four years. Results Our search returned 7680 publications, 92 of which met the selection criteria. The overall pooled prevalence of hypertension in Africa was 19.7% in 1990, 27.4% in 2000 and 30.8% in 2010, each with a pooled awareness rate (expressed as percentage of hypertensive cases) of 16.9%, 29.2% and 33.7%, respectively. From the modelling, over 54.6 million cases of hypertension were estimated in 1990, 92.3 million cases in 2000, 130.2 million cases in 2010, and a projected increase to 216.8 million cases of hypertension by 2030; each with an age-adjusted prevalence of 19.1% (13.9, 25.5), 24.3% (23.3, 31.6), 25.9% (23.5, 34.0), and 25.3% (24.3, 39.7), respectively. Conclusion Our findings suggest the prevalence of hypertension is increasing in Africa, and many hypertensive individuals are not aware of their condition. We hope this research will prompt appropriate policy response towards improving the awareness, control and overall management of hypertension in Africa.
Background: Cognitive frailty and the related concepts of cognitive reserve and imaging-based brain frailty are of increasing interest in older adult care. However, there is uncertainty regarding their importance within a stroke population. We aimed to establish the prevalence of cognitive frailty and reserve in stroke and determine impact on outcomes. Methods: We conducted a systematic review across multidisciplinary electronic databases using validated search syntax. The protocol for this review has been published (PROSPERO, CRD42023433385). We identified studies on cognitive frailty and cognitive reserve, including studies that used related concepts. We extracted data to inform estimates of prevalence, and associations with outcomes of physical function, cognition and quality of life, performing meta-analyses where possible. Risk of bias was assessed using Newcastle-Ottawa tools appropriate to study design. Results: Our search returned 12,095 studies, from which 14 papers met our criteria. No studies described cognitive frailty, rather studies described cognitive reserve and brain frailty. Cognitive reserve was assessed using proxy measures of education, employment, and leisure time. Four studies used the cognitive reserve index questionnaire (CRIq) with pooled estimate score of 103.25, 95%CI:96.87-109.65 (indicating moderate cognitive reserve). Cognitive reserve had varying associations with post-stroke outcomes, three studies (n=7759 participants) reporting significant negative association with cognitive measures. Brain frailty was assessed using imaging markers. Across four studies (n=3086 participants) pooled prevalence of brain frailty was 73.8%, 95%CI:72.2-75.3. Higher brain frailty was associated with poorer post stroke outcomes for majority of studies assessed. Seven studies (50%) were scored as low risk of bias. Conclusions: Attempts to synthesise these data were complicated by inconsistency in terminology and heterogeneity in methods. However, our findings suggest that brain frailty is common in stroke and associated with poorer outcomes. The epidemiology of cognitive frailty and reserve is less well described. All these measures may be useful for prognostication in stroke, but there are multiple areas where more research is needed.
Background: Hypertension is a leading cause of morbidity and mortality in Africa, and Nigeria, the most populous country in the continent, hugely contributes to this burden. Objective: To provide an improved estimate of the prevalence and number of cases of hypertension in Nigeria based on the cut-off ‘at least 140/90 mmHg’, towards ensuring better awareness, control and policy response in the country. Methods: We conducted a systematic search of Medline, EMBASE and Global Health from January 1980 to December 2013 for population-based studies providing estimates on the prevalence of hypertension in Nigeria. From the extracted crude prevalence rates, we conducted a random-effects meta-analysis, and further estimated the overall awareness rate of hypertension in Nigeria, expressed as percentage of all hypertension cases. We applied a meta-regression epidemiological modelling, using United Nations population demographics for the years 2010 and 2030, to determine the prevalence and number of cases of hypertension in Nigeria for the 2 years. Results: Our search returned 2260 publications, 27 of which met our selection criteria. From the random-effects meta-analysis, we estimated an overall hypertension prevalence of 28.9% (25.1, 32.8), with a prevalence of 29.5% (24.8, 34.3) among men and 25.0% (20.2, 29.7) among women. We estimated a prevalence of 30.6% (24.5, 36.6) and 26.4% (19.4, 33.4) among urban and rural dwellers, respectively. The pooled awareness rate of hypertension was 17.4% (11.4, 23.3). The overall mean SBP was 128.6 (125.5, 130.8) mmHg, and the DBP was 80.6 (78.5, 82.7) mmHg. From our modelling, we estimated about 20.8 million cases of hypertension in Nigeria among people aged at least 20 years in 2010, with a prevalence of 28.0% (24.6, 31.9) in both sexes – 30.7% (24.9, 33.7) among men and 25.2% (22.7, 31.9) among women. By 2030, we projected an increase to 39.1 million cases of hypertension among people aged at least 20 years with a prevalence of 30.8% (24.5, 33.7) in both sexes – 32.6% (27.3, 38.2) among men and 29.0% (21.9–32.2) among women. Conclusions: Our findings suggest the prevalence of hypertension is high in Nigeria, and the overall awareness of raised blood pressure among hypertension cases is low in the country. We hope this study will inform appropriate public health response towards reducing this burden.
Background The burden of chronic obstructive pulmonary disease
(COPD) across many world regions is high. We aim to estimate COPD
prevalence and number of disease cases for the years 1990 and 2010
across world regions based on the best available evidence in publicly
accessible scientific databases.
Methods We conducted a systematic search of Medline, EMBASE and
Global Health for original, population–based studies providing spirometry–
based prevalence rates of COPD across the world from January
1990 to December 2014. Random effects meta–analysis was conducted
on extracted crude prevalence rates of COPD, with overall summaries
of the meta–estimates (and confidence intervals) reported separately for
World Health Organization (WHO) regions, the World Bank's income
categories and settings (urban and rural). We developed a meta–regression
epidemiological model that we used to estimate the prevalence of
COPD in people aged 30 years or more.
Findings Our search returned 37 472 publications. A total of 123 studies
based on a spirometry–defined prevalence were retained for the review.
From the meta–regression epidemiological model, we estimated
about 227.3 million COPD cases in the year 1990 among people aged
30 years or more, corresponding to a global prevalence of 10.7% (95%
confidence interval (CI) 7.3%–14.0%) in this age group. The number
of COPD cases increased to 384 million in 2010, with a global prevalence
of 11.7% (8.4%–15.0%). This increase of 68.9% was mainly driven
by global demographic changes. Across WHO regions, the highest
prevalence was estimated in the Americas (13.3% in 1990 and 15.2%
in 2010), and the lowest in South East Asia (7.9% in 1990 and 9.7% in
2010). The percentage increase in COPD cases between 1990 and 2010
was the highest in the Eastern Mediterranean region (118.7%), followed
by the African region (102.1%), while the European region recorded the
lowest increase (22.5%). In 1990, we estimated about 120.9 million
COPD cases among urban dwellers (prevalence of 13.2%) and 106.3
million cases among rural dwellers (prevalence of 8.8%). In 2010, there
were more than 230 million COPD cases among urban dwellers (prevalence
of 13.6%) and 153.7 million among rural dwellers (prevalence
of 9.7%). The overall prevalence in men aged 30 years or more was
14.3% (95% CI 13.3%–15.3%) compared to 7.6% (95% CI 7.0%–
8.2%) in women.
Conclusions Our findings suggest a high and growing prevalence of
COPD, both globally and regionally. There is a paucity of studies in Africa,
South East Asia and the Eastern Mediterranean region. There is a
need for governments, policy makers and international organizations to
consider strengthening collaborations to address COPD globally
Infliximab and adalimumab have established roles in IBD therapy. NICE and SMC guidelines mandate reassessment of disease activity after 12 months. Therapy should ordinarily be discontinued where clinical remission and mucosal healing has been achieved. However, there are presently few data about outcomes of anti-TNF withdrawal.
Methods
We conducted a retrospective clinical audit of outcomes following withdrawal of anti-TNF therapy. Inclusion criteria were confirmed diagnosis of IBD; ≥12 m continuous anti-TNF therapy; primary withdrawal reason sustained clinical remission (no corticosteroids for 6 m); ≥12 m follow-up post-withdrawal. Relapse was defined as moderate (oral steroids, immunomodulators, recommencement of anti-TNF agent) or severe (hospitalisation, iv steroids, surgical resection). All UK centres were invited to participate. Demographic and phenotypic data plus clinical, laboratory and endoscopic parameters were recorded.
Results
80 cases (62 infliximab; 18 adalimumab) with a median follow-up time of 26 m post drug withdrawal were included in this analysis (59% female; median age at drug withdrawal 32y). All were in clinical remission at withdrawal; 47/80 had normal laboratory parameters (Hb, WCC, plts, Albumin, CRP, FC) prior to withdrawal. 49/80 had endoscopic re-evaluation with mild disease noted on 9/50 and moderate on 1. 23/70 (33%; 2/23 severe) of patients with Crohn’s disease relapsed by 12 months and 49% relapse (3/35 severe) by 24 months (Fig 1, median time to relapse 10.4 m). Younger age at diagnosis (p = 0.017) and elevated WCC (p = 0.025), but not CRP or faecal calprotectin, were predictive of relapse. 4/10 (none severe) with UC/IBDU had relapsed by 12 and 24 months. Anti-TNF therapy was re-introduced in 30 patients following relapse and was successful in 93%.
Conclusion
Planned withdrawal of anti-TNF therapy for sustained clinical remission is associated with a moderate relapse of Crohn’s disease in up to half of patients by 2 years. Data collection of an expanded cohort is ongoing around the UK to improve power to dissect predictive factors at time of drug withdrawal.
Self-expanding metallic stents (SEMS) have a well-recognised palliative role in the management of patients with oesophageal cancer. Such stents are inserted endoscopically, under direct vision or under fluoroscopic radiological guidance. There is little evidence to compare these approaches. The objective of this study was to assess the outcomes, using various performance indicators, in patients who underwent endoscopically inserted SEMS for palliation in oesophageal cancer at the Royal Infirmary of Edinburgh (RIE).
Method
A retrospective observational study was conducted at the RIE from January 2010 to August 2011, and compared with outcomes between May 2014 to April 2016. A total of 72 SEMS were inserted in 57 patients (2010–2011) and 73 SEMS in 64 patients (2014–2016). The outcome measures included: adequate SEMS position, short term complications, 1 month dysphagia, additional intervention rates and 30 day mortality post insertion.
Results
Between 2010–2011, 72 stents were inserted in 57 patients (median age 73) and 73 stents between 2014–2016 in 64 patients (median age 74). Most SEMS were inserted as primary or adjunctive therapy alongside chemo- or radiotherapy. Stent positioning was adequate in the majority (99% 2010–11; 98% 2014–16). Where data was available, short term complication rates remained similar across both groups (12% in 2010–11; 11% in 2014–16). Repeat endoscopy with no additional therapy rates reduced by 4% (24% 2010–11; 20% 2014–16). However, those requiring intervention including argon plasma coagulation, clips and laser therapy increased by 18%. There was a 6% reduction in re-stent rates. Overall, 30 day mortality reduced from 21% (2010–2011) to 8% (2014–2016).
Conclusion
The majority of SEMS had satisfactory endoscopic positioning with low post-procedure complication rates. When assessing key performance indicators relating to endoscopically sited SEMS across the two time points, we observed positive and improved outcomes - notably a 13% reduction in 30 day mortality with low post-procedure complication rates; lower compared with published data from other UK centres (18%1). This may be explained by SEMS insertion at earlier stages of disease, frequent and timely intervention and increased operator experience over time, among others. Further studies would be required to corroborate our findings.
Reference
NHS Information Centre. 2010. "National Oesophago-Gastric Cancer Audit 2010"
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