Frequency of Systemic Lupus Erythematosus Was Decreasing Among Hospitalized Patients From 2013 to 2017 in a National Database in China

Social support and audience engagement of lupus-related posts on social networking sites in China

Background

Lupus, known as a chronic multisystem autoimmune disease, has become more common in China currently. Above all, most Chinese Lupus patients haven't ample knowledge and adequate understanding of this complicated chronic disease. In recent years, social networking sites have created an interactive environment in which patients can obtain health information and also can exchange personal experiences with others having similar health concerns.

Objective

The overall aim of this study is to develop a better understanding of the social support requested and received during the routine social media use of lupus activists and their referents. In other words. This paper seeks to explore whether the lupus-related posts disseminated on the Sina microblog platform can serve and satisfy the needs of this group.

Methods

Content analysis and descriptive analysis were conducted to ascertain the core topics of lupus-related posts on the Sina microblog. Chi-square tests were performed to determine the differences in types of social support between provision and request groups, as well as engaged and non-engaged groups. Finally, negative binomial regression was undertaken to investigate which types of social support generated more audience engagement.

Results

By analyzing 9822 lupus-related posts derived from the Sina microblog, disease description was the most prominent theme. Evidence is presented which shows that information support was requested and supplied more frequently than emotional and instrumental support. Specifically, information support was provided more than requested, while the instrumental and emotional support provisions were less numerous than the requests. Analysis revealed that posts containing information support provisions attracted more engagement than those with the other five types of social support.

Conclusions

Social networking sites play a critical role on disseminating lupus-related information and provide an interactive space in which users can freely communicate their health conditions and seek peer support. However, health practitioners not only have to present more communication strategies to provide emotional and instrumental support through social media, but also have to boost audience engagement.

Genetic variants in UNC93B1 predispose to childhood-onset systemic lupus erythematosus

Rare genetic variants in toll-like receptor 7 (TLR7) are known to cause lupus in humans and mice. UNC93B1 is a transmembrane protein that regulates TLR7 localization into endosomes. In the present study, we identify two new variants in UNC93B1 (T314A, located proximally to the TLR7 transmembrane domain, and V117L) in a cohort of east Asian patients with childhood-onset systemic lupus erythematosus. The V117L variant was associated with increased expression of type I interferons and NF-κB-dependent cytokines in patient plasma and immortalized B cells. THP-1 cells expressing the variant UNC93B1 alleles exhibited exaggerated responses to stimulation of TLR7/-8, but not TLR3 or TLR9, which could be inhibited by targeting the downstream signaling molecules, IRAK1/-4. Heterozygous mice expressing the orthologous Unc93b1V117L variant developed a spontaneous lupus-like disease that was more severe in homozygotes and again hyperresponsive to TLR7 stimulation. Together, this work formally identifies genetic variants in UNC93B1 that can predispose to childhood-onset systemic lupus erythematosus.

Application of Failure Mode and Effects Analysis to Improve the Quality of the Front Page of Electronic Medical Records in China: Cross-Sectional Data Mapping Analysis

BACKGROUND

The completeness and accuracy of the front pages of electronic medical records (EMRs) are crucial for evaluating hospital performance and for health insurance payments to inpatients. However, the quality of the first page of EMRs in China's medical system is not satisfactory, which can be partly attributed to deficiencies in the EMR system. Failure mode and effects analysis (FMEA) is a proactive risk management tool that can be used to investigate the potential failure modes in an EMR system and analyze the possible consequences.

OBJECTIVE

The purpose of this study was to preemptively identify the potential failures of the EMR system in China and their causes and effects in order to prevent such failures from recurring. Further, we aimed to implement corresponding improvements to minimize system failure modes.

METHODS

From January 1, 2020, to May 31, 2022, 10 experts, including clinicians, engineers, administrators, and medical record coders, in Zhejiang People's Hospital conducted FMEA to improve the quality of the front page of the EMR. The completeness and accuracy of the front page and the risk priority numbers were compared before and after the implementation of specific improvement measures.

RESULTS

We identified 2 main processes and 6 subprocesses for improving the EMR system. We found that there were 13 potential failure modes, including data messaging errors, data completion errors, incomplete quality control, and coding errors. A questionnaire survey administered to random physicians and coders showed 7 major causes for these failure modes. Therefore, we established quality control rules for medical records and embedded them in the system. We also integrated the medical insurance system and the front page of the EMR on the same interface and established a set of intelligent front pages in the EMR management system. Further, we revamped the quality management systems such as communicating with physicians regularly and conducting special training seminars. The overall accuracy and integrity rate of the front page (P<.001) of the EMR increased significantly after implementation of the improvement measures, while the risk priority number decreased.

CONCLUSIONS

In this study, we were able to identify the potential failure modes in the front page of the EMR system by using the FMEA method and implement corresponding improvement measures in order to minimize recurring errors in the health care services in China.

Altered kynurenine pathway metabolism and association with disease activity in patients with systemic lupus

Systemic lupus erythematosus (SLE) is an autoimmune disease accompanied by increased release of proinflammatory cytokines that are known to activate the indoleamine 2,3-dioxygenase (IDO-1) enzyme, which catalyzes the rate-limiting step of the kynurenine pathway (KP). This study aimed to measure KP metabolite levels in patients with SLE and investigate the relationship between disease activity, clinical findings, and KP. The study included 100 patients with SLE and 100 healthy controls. Serum tryptophan (TRP), kynurenine (KYN), kynurenic acid (KYNA), 3-hydroxyanthranilic acid (3HAA), 3-hydroxykynurenine (3HK), quinolinic acid (QA) concentrations were measured with tandem mass spectrometry. Serum KYN, KYNA, 3HAA, 3HK, and QA levels of the patients with SLE were significantly higher than the control group. Serum QA levels were elevated in patients with neurological involvement (four patients with peripheral neuropathy and two patients with mononeuropathy), serum KYN levels and KYN/TRP ratio increased in patients with joint involvement, and serum KYN, 3HK, and 3HAA levels and the KYN/TRP ratio were increased in patients with renal involvement. Moreover, KYN and KYN/TRP ratios were positively correlated with the disease activity score. These findings indicated that imbalances in KP metabolites may be associated with the pathogenesis, activation, and clinical manifestations of SLE.

Clustering of systemic lupus erythematosus mortality in southwestern Spain

OBJECTIVE

To analyse time trends in systemic lupus erythematosus (SLE) mortality and explore possible provincial clustering of SLE mortality in Spain (2001-2020).

METHODS

We conducted an ecological study using deaths registered in SLE at the Spanish National Institute of Statistics between 2001 and 2020. Jointpoint regression models have been used to evaluate temporal trends. To analyse the spatial pattern of SLE mortality in men and women in Spain, crude rates, age-standardised mortality rates (ASMRs), smooth relative risk (RR) and posterior probabilities (PP) for RR greater than one for the period 2001-2020 were calculated. The Global Moran I index was used to assess the existence of global spatial autocorrelation. Local indicators of spatial association (LISA) and Kulldorff's spatial scan statistic were used to identify clusters.

RESULTS

Over the 20 years analyzed in this study, the SLE average ASMR for the period was 2.7 for women and 0.7 for men, with a sex ratio (female/male) of 3.8. In men, no province showed a RR>1. Conversely, in women, eight provinces showed values of RR> 1 with a PP greater than 0.8 (Seville, Cadiz, Huelva and Murcia in the south, Barcelona, Zaragoza, Huesca and Leon in the north). In men, neither of the two methods detected a clustering of provinces. However, in women, both methods identified a cluster of provinces located in the southwest of the country (Huelva, Cádiz, Seville and Malaga) as a cluster with significant excess mortality. In the second cluster (centred on the province of Huelva) obtained with the Kulldorff method, two more provinces were added (Badajoz and Cordoba, also located in the southwest).

CONCLUSIONS

We detected a cluster of provinces with an excess risk of female SLE mortality in the southwest of Spain.

Global epidemiology of systemic lupus erythematosus: a comprehensive systematic analysis and modelling study

OBJECTIVES

To quantify global, regional and country-specific estimates of epidemiology of systemic lupus erythematosus (SLE).

METHODS

Four databases were systematically searched, and a Bayesian hierarchical linear mixed model was constructed to estimate the global, regional, and country-specific incidence and prevalence of SLE.

RESULTS

112 studies met the inclusion criteria. The global SLE incidence and newly diagnosed population were estimated to be 5.14 (1.4 to 15.13) per 100 000 person-years and 0.40 million people annually, respectively. In women, the values were 8.82 (2.4 to 25.99) per 100 000 person-years and 0.34 million people annually, while in men, the estimates were 1.53 (0.41 to 4.46) per 100 000 person-years and 0.06 million people annually, respectively. Poland, the USA and Barbados had the highest estimates of SLE incidence. Regarding prevalence, the global SLE prevalence and affected population were estimated to be 43.7 (15.87 to 108.92) per 100 000 persons and 3.41 million people, respectively. In women, the values were 78.73 (28.61 to 196.33) per 100 000 persons and 3.04 million people, while in men the estimates were 9.26 (3.36 to 22.97) per 100 000 persons and 0.36 million people, respectively. The United Arab Emirates, Barbados and Brazil had the highest SLE prevalence. In addition to regional and sex differences, age and prevalence estimation method (period or point prevalence) differences could also lead to variations in epidemiological SLE findings.

CONCLUSIONS

Epidemiological data on SLE are lacking for 79.8% of countries worldwide. The epidemiology of SLE varies substantially between different sex and age groups and is distributed unequally among geographical regions; specifically, SLE occurs more frequently in high-income countries.

Increase in direct costs for health systems due to lupus nephritis: the case of Colombia

Objective

Lupus nephritis is one of the most severe complications of systemic lupus erythematosus and it has been estimated that can occur in up to 60% of patients. Direct costs of lupus nephritis have not been studied in developing countries. This study aimed to describe lupus nephritis direct costs in Colombia.

Methods

Administrative data from two Colombian health maintenance organizations for 2014 and 2015 was obtained. An algorithm based on the International Statistical Classification of Diseases and Related Health Problems 10^th revision codes was developed to identify patients with lupus nephritis and lupus nephritis under study.

Results

The average annual per-patient, all-claims, all-cause direct cost for lupus nephritis was US$ 12,624, 7.5 times higher than the average lupus patient without lupus nephritis. For lupus nephritis cases under study, estimated direct cost was US$ 3,664, 2 times higher than average lupus patient in Colombia. Difference in lupus nephritis patients is mainly accounted for the cost and frequency of procedures, exceeding by a factor of 5 the cost for durable medical equipment and the cost for drugs, respectively.

Conclusion

Lupus patients who progress to lupus nephritis stage increased seven-fold the average annual per-patient, all-claims, and all-cause direct cost for the Colombian health system.