Development of the simulation-based German albuminuria screening model (S-GASM) for estimating the cost-effectiveness of albuminuria screening in Germany

Background Chronic kidney disease is often asymptomatic in its early stages but constitutes a severe burden for patients and causes major healthcare systems costs worldwide. While models for assessing the cost-effectiveness of screening were proposed in the past, they often presented only a limited view. This study aimed to develop a simulation-based German Albuminuria Screening Model (S-GASM) and present some initial applications. Methods The model consists of an individual-based simulation of disease progression, considering age, gender, body mass index, systolic blood pressure, diabetes, albuminuria, glomerular filtration rate, and quality of life, furthermore, costs of testing, therapy, and renal replacement therapy with parameters based on published evidence. Selected screening scenarios were compared in a cost-effectiveness analysis. Results Compared to no testing, a simulation of 10 million individuals with a current age distribution of the adult German population and a follow-up until death or the age of 90 shows that a testing of all individuals with diabetes every two years leads to a reduction of the lifetime prevalence of renal replacement therapy from 2.5% to 2.3%. The undiscounted costs of this intervention would be 1164.10 € / QALY (quality-adjusted life year). Considering saved costs for renal replacement therapy, the overall undiscounted costs would be—12581.95 € / QALY. Testing all individuals with diabetes or hypertension and screening the general population reduced the lifetime prevalence even further (to 2.2% and 1.8%, respectively). Both scenarios were cost-saving (undiscounted, - 7127.10 €/QALY and—5439.23 €/QALY). Conclusions The S-GASM can be used for the comparison of various albuminuria testing strategies. The exemplary analysis demonstrates cost savings through albuminuria testing for individuals with diabetes, diabetes or hypertension, and for population-wide screening.

Healthcare Professionals’ Own Experiences of Domestic Violence and Abuse: A Meta-Analysis of Prevalence and Systematic Review of Risk Markers and Consequences

Background: Globally, healthcare professionals (HCPs) are increasingly asked to identify and respond to domestic violence and abuse (DVA) among patients. However, their own experiences of DVA have been largely ignored. Aim: To determine the prevalence of current and lifetime DVA victimisation among HCPs globally, and identify risk markers, consequences and support-seeking for DVA. Method: PubMed, EMBASE, PsycINFO, CINAHL ASSIA and ProQuest were searched. Studies about HCPs’ personal experience of any type of DVA from any health service/country were included. Meta-analysis and narrative synthesis were adopted. Results: Fifty-one reports were included. Pooled lifetime prevalence was 31.3% (95% CI [24.7%, 38.7%] p < .001)) and past-year prevalence was 10.4% (95% CI [5.8%, 17.9%] p <.001). Pooled lifetime prevalence significantly differed (Qb=6.96, p < .01) between men (14.8%) and women (41.8%), and between HCPs in low-middle income (64.0%) and high-income countries (20.7%) (Qb = 31.41, p <.001). Risk markers were similar to those in the general population, but aspects of the HCP role posed additional and unique risks/vulnerabilities. Direct and indirect consequences of DVA meant HCP-survivors were less able to work to their best ability. While HCP-survivors were more likely than other HCPs to identify and respond to DVA among patients, doing so could be distressing. HCP-survivors faced unique barriers to seeking support. Being unable to access support – which is crucial for leaving or ending relationships with abusive people – leaves HCP-survivors entrapped. Conclusion: Specialised DVA interventions for HCPs are urgently needed, with adaptations for different groups and country settings. Future research should focus on developing interventions with HCP-survivors.

Lifetime Prevalence of Sexual Violence and Its Associated Factors among High School Female Students in Jarso District, Oromia Region, Eastern Ethiopia

Background. Sexual violence is a serious public health problem affecting millions of young girls and women across the world. Recently, the issue of sexual violence against schoolgirls has garnered global and national attention with implications for health and education outcomes. Sexual violence is driven by a multitude of risk factors that occur at different levels. Understanding the magnitude, risk factors, and conceptuality of sexual violence is crucial for setting priorities and elimination efforts at different levels. Therefore, the objective of this study was to determine the lifetime prevalence of sexual violence and associated factors among high school female students in Jarso district, Oromia region, eastern Ethiopia. Methods. A school-based cross-sectional study was conducted in public high schools of Jarso district, eastern Ethiopia, from 1st March to 5th April 2019. A multistage sampling technique was used to select 559 eligible study participants. Data were collected by a structured self-administered questionnaire. The outcome measure of interest was lifetime sexual violence. Bivariate and multivariable logistic regression analyses were done. Statistically significant association of variables had been declared based on the adjusted odds ratio (AOR) with its 95% CI and p value < 0.05. Results. The overall magnitude of sexual violence among female students was 28.6% (95% CI: 25%-32.2%) in the study area. Forty (7.2%) participants have experienced coercive sex against their consent. Participant’s level of education (( AOR = 1.5 , 95% CI (1.03–2.30)), being unmarried (( AOR = 2.80 , 95% CI (1.40–5.81)), consumption of alcohol (( AOR = 3.41 , 95% CI (1.11–10.40)), using substances (hashish and/or shisha) (( AOR = 2.6 , 95% CI (1.02–6.50)), and ever initiated sexual intercourse (( AOR = 5.9 , 95% CI (3.3–10.7)) were positively and statistically associated with sexual violence at p value < 0.05. Conclusion. The overall magnitude of sexual violence was relatively high (28.6%). Thus, any intervention aimed to address sexual violence should consider the identified associated risk factors in the study area.

Lifetime Prevalence and Risk Factors for Perinatal Depression in a Large Cohort of Women with Depression

ObjectivesAmongst women with a history of depression, this study sought to identify risk factors associated with reporting perinatal depression (PND)). Lifetime prevalence, length and severity of PND were evaluated, as well as the effect of PND onset either after previous depression episodes, or as the first episode of depression.SettingThe Australian Genetics of Depression Study (AGDS), an online case cohort study of the etiology of depression.ParticipantsIn a large sample of parous women who met DSM criteria for major depressive disorder (MDD) (n=7,182), we identified two subgroups of PND cases (Edinburgh Postnatal Depression Scale score >= 13) with and without prior depression history (n=2,261; n=878 respectively). For a range of risk factors, both subgroups were compared to women with MDD who did not report depressive symptoms in the perinatal period (non-perinatal depression (NPD) cases). PND cases with prior depression history were compared to NPD cases with depression onset before their first pregnancy (n=672). PND cases without prior depression history were compared to all NPD cases (n=2,124).Primary and secondary outcome measuresDescriptive measures reported lifetime prevalence, length, and severity of PND. Logistic regression compared a range of characteristics of PND cases to those of the comparison group of NPD cases.ResultsOf women who experienced depression prior to first pregnancy, PND cases were significantly more likely to report more episodes of depression (OR=1.1 per additional depression episode, CI=[1.1-1.1], P=1.9e-13), non-European ancestry (OR=1.5, CI=[1.0-2.1], P=3.4e-02), severe nausea during pregnancy (OR=1.3, CI=[1.1-1.6], P=6.6e-03) and emotional abuse (OR=1.4, CI=[1.1-1.7], P=5.3e-03). Women without any depression before their first perinatal episode were significantly more likely to report emotional abuse (OR=1.3, CI=[1.1-1.6], P=1.0e-02) than women with NPD.ConclusionsThe majority of parous women in this study experienced PND, associated with more complex, severe depression. Results highlight the importance of perinatal assessments of depressive symptoms, particularly for women with a history of depression or childhood adverse experiences.

Prevalence of Low Back Pain among School-Aged Children between 10 and 12 Years

Low back pain (LBP) is one of the biggest health problems worldwide that often begins during childhood. The existence of a previous episode of LBP is a premonitory sign of future back pain problems, therefore, prevention among youth will be essential. The main objective of the study was to determine the lifetime, point, and 7-day prevalence of LBP in children. This cross-sectional study evaluated 849 participants (47.1 boys and 52.9% girls) aged 10–12 from 10 primary schools using a self-administered questionnaire. The results demonstrated a lifetime prevalence of LBP of 73.6%, a last 7-days prevalence of 21.2%, and a point prevalence of 9.66%. LBP intensity reported in a Visual Analogue Scale (VAS) was 3.37 (SD 2.02). Chi-square analysis identified a significant difference between boys and girls in LBP lifetime prevalence (p < 0.001), 7-day prevalence (p = 0.035), and point prevalence (p = 0.014). The Student’s t-test in pain intensity showed the same differences (p = 0.007). Studies on LBP prevalence in young primary school students are scarce. Therefore, future studies investigating the prevention of LBP should focus on school interventions since schools are the most suitable institutions to participate in back pain prevention and health promotion.

Worldwide prevalence of suicidal ideation and suicide plan among people with schizophrenia: a meta-analysis and systematic review of epidemiological surveys

Schizophrenia is a severe psychiatric disorder with high premature mortality rates. This is a meta-analysis and systematic review of the prevalence of suicidal ideation (SI) and suicide plan (SP) among people with schizophrenia. PubMed, Web of Science, Embase, and PsycINFO were systematically searched from their respective inception to October 10, 2020. Data on prevalence of SI and/or SP were synthesized using the random effects model. Twenty-six studies covering 5079 people with schizophrenia were included for meta-analysis. The lifetime and point prevalence of SI were 34.5% (95% CI: 28.2−40.9%), and 29.9% (95% CI: 24.2−35.6%), respectively. The lifetime prevalence of SP was 44.3% and the point prevalence of SP ranged between 6.4 and 13%. Subgroup and meta-regression analyses revealed that source of patients, survey countries, and sample size were significantly associated with the point prevalence of SI, while male proportion and quality assessment scores were significantly associated with the lifetime and point prevalence of SI. Survey time and mean age were significantly associated with lifetime prevalence of SI. Both SI and SP are common in people living with schizophrenia, especially in males and inpatients. Routine screening and effective interventions for SI and SP should be implemented in this population.