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Palaniyappan N, Peach E, Pearce F, Dhaliwal A, Campos-Varela I, Cant MR, Dopazo C, Trotter J, Divani-Patel S, Hatta AAZ, Hopkins L, Testa G, Bilbao A, Kasmani Z, Faloon S, Mirza DF, Klintmalm GB, Bilbao I, Asrani SK, Rajoriya N, Aravinthan AD. Long-term outcomes (beyond 5 years) of liver transplant recipients-A transatlantic multicenter study. Liver Transpl 2024; 30:170-181. [PMID: 37589505 DOI: 10.1097/lvt.0000000000000244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/06/2023] [Indexed: 08/18/2023]
Abstract
The long-term (>5 y) outcomes following liver transplantation (LT) have not been extensively reported. The aim was to evaluate outcomes of LT recipients who have survived the first 5 years. A multicenter retrospective analysis of prospectively collected data from 3 high volume LT centers (Dallas-USA, Birmingham-UK, and Barcelona-Spain) was undertaken. All adult patients, who underwent LT since the inception of the program to December 31, 2010, and survived at least 5 years since their LT were included. Patient survival was the primary outcome. A total of 3682 patients who survived at least 5 years following LT (long-term survivors) were included. Overall, median age at LT was 52 years (IQR 44-58); 53.1% were males; and 84.6% were Caucasians. A total of 49.4% (n=1820) died during a follow-up period of 36,828 person-years (mean follow-up 10 y). A total of 80.2% (n=1460) of all deaths were premature deaths. Age-standardized all-cause mortality as compared to general population was 3 times higher for males and 5 times higher for females. On adjusted analysis, besides older recipients and older donors, predictors of long-term mortality were malignancy, cardiovascular disease, and dialysis. Implementation of strategies such as noninvasive cancer screening, minimizing immunosuppression, and intensive primary/secondary cardiovascular prevention could further improve survival.
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Affiliation(s)
- Naaventhan Palaniyappan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, UK
| | - Emily Peach
- Lifespan and Population Health, School of Medicine, University of Nottingham, UK
| | - Fiona Pearce
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, UK
| | | | - Isabel Campos-Varela
- Liver Unit, Department of Medicine, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Matthew R Cant
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Cristina Dopazo
- Department of Hepatobiliopancreatic Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - James Trotter
- Baylor University Medical Center, Dallas, Texas, USA
| | | | | | - Laurence Hopkins
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Angela Bilbao
- Department of Hepatobiliopancreatic Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Zain Kasmani
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sarah Faloon
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Darius F Mirza
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, NIHR Birmingham Biomedical Research, University of Birmingham, Birmingham, UK
| | | | - Itxarone Bilbao
- Department of Hepatobiliopancreatic Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Neil Rajoriya
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Immunology & Immunotherapy, University of Birmingham, UK
| | - Aloysious D Aravinthan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, UK
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Csákvári T, Elmer D, Németh N, Komáromy M, Kajos LF, Kovács B, Boncz I. Assessing the per Capita Food Supply Trends of 38 OECD Countries between 2000 and 2019-A Joinpoint Regression Analysis. Life (Basel) 2023; 13:life13051091. [PMID: 37240736 DOI: 10.3390/life13051091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Food supply has an impact on the prevalence of diet-related non-communicable diseases. We aimed to analyze the protein, fat (g/capita/day) and calorie (kcal/capita/day) supply from 2000 to 2019 as derived from the OECD Health Statistics database. A joinpoint regression was used to examine the number and location of breakpoints in the time series. The annual percent change (APC) was calculated using Joinpoint 4.9.0.0. The per capita daily kcal per nutrient was calculated for each country and the resulting percentage distributions were compared to the acceptable macronutrient distribution ranges. Protein, fat and calorie supplies have increased significantly between 2000 and 2019. Each started to show a much steeper, positive change between 2012 and 2014 (APCfat: 1.0; 95%CI: 0.8-1.1; APCprotein: 0.5; 95%CI: 0.3-0.6; APCkcal: 0.4; 95%CI: 0.3-0.5). In terms of the composition of the daily calorie intake per capita, the overall share of fat (+4.9%) and protein (+1.0%) increased between 2000 and 2019. We found significant differences among countries and also an increasing and optimal proportion of consumed protein per total calorie in all countries over the last two decades. We concluded that several countries have access to fat availability above the optimal level, which deserves particular attention from health policy makers in the fight against obesity and diet-related diseases.
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Affiliation(s)
- Tímea Csákvári
- Institute of Health Insurance, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
| | - Diána Elmer
- Institute of Health Insurance, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
| | - Noémi Németh
- Institute of Health Insurance, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - Márk Komáromy
- Institute of Health Insurance, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - Luca Fanni Kajos
- Institute of Health Insurance, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
| | - Bettina Kovács
- Institute of Health Insurance, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
| | - Imre Boncz
- Institute of Health Insurance, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
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Khan SU, Yedlapati SH, Lone AN, Khan MS, Wenger NK, Watson KE, Gulati M, Hays AG, Michos ED. A comparative analysis of premature heart disease- and cancer-related mortality in women in the USA, 1999-2018. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:315-323. [PMID: 33555018 DOI: 10.1093/ehjqcco/qcaa099] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/25/2020] [Accepted: 12/30/2020] [Indexed: 12/28/2022]
Abstract
AIMS To compare premature heart disease- and cancer-related deaths in women in the USA. METHODS AND RESULTS We analysed the US national database of death certificates of women aged <65 from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database between 1999 and 2018. We measured annual percentage changes (APCs) in age-adjusted mortality rates (AAMRs) and years of potential life lost per 100 000 persons due to heart disease and cancer. Overall, cancer was a more prevalent cause of premature death compared with heart disease. Between 1999 and 2018, the AAMRs decreased for both cancer (61.9/100 000 to 45.6/100 000) and heart disease (29.2/100 000 to 22.6/100 000). However, while APC in AAMR for cancer declined consistently over time, after an initial decline, APC in AAMR for heart disease increased between 2010 and 2018 [0.53 95% confidence interval (0.18-0.89)], with a significant rise in Midwest, medium/small metros, and rural areas after 2008. Compared with cancer, APC in AAMR for heart disease increased in women aged 25-34 years [2.24 (0.30-4.22); 2013-18) and 55-64 years [0.46 (0.13-0.80); 2009-13], as well as Non-Hispanic (NH) Whites [APC, 0.79 (0.46-1.13); 2009-18] and NH American Indian/Alaskan Native [2.71 (0.59-4.87); 2011-2018]. Consequently, the mortality gap between cancer and heart disease has narrowed from an AAMR of 32.7/100 000 to 23.0/100 000. CONCLUSIONS The mortality gap between cancer and heart disease is decreasing among women <65 years. Intensive cardiovascular health interventions are required focusing on vulnerable young demographic subgroups and underserved regional areas to meet the American Heart Association's Impact Goal and Million Hearts Initiative.
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Affiliation(s)
- Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Siva H Yedlapati
- Department of Medicine, Erie County Medical Center, Buffalo, NY, USA
| | - Ahmad N Lone
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Karol E Watson
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Martha Gulati
- Department of Medicine, Division of Cardiology, University of Arizona, Phoenix, AZ, USA
| | - Allison G Hays
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Kursīte M, Stars I, Strēle I, Gobiņa I, Ķīvīte-Urtāne A, Behmane D, Dūdele A, Villeruša A. A mixed-method study on the provision of remote consultations for non-communicable disease patients during the first wave of the COVID-19 pandemic in Latvia: lessons for the future. BMC Health Serv Res 2022; 22:263. [PMID: 35219328 PMCID: PMC8881750 DOI: 10.1186/s12913-022-07634-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 02/10/2022] [Indexed: 01/31/2023] Open
Abstract
Background The COVID-19 pandemic has challenged the ability of healthcare systems to ensure the continuity of health services for patients with non-communicable diseases (NCDs). The issue of remote consultations has emerged. Before the COVID-19 pandemic, remote consultations were not routinely provided or covered by public health funding in Latvia. This study aimed to describe the dynamics of consultations and the volume of remote consultations provided for patients with particular NCD and explore clinicians’ experiences of providing remote consultations during the first wave of the COVID-19 pandemic in Latvia. Methods A mixed-method study focusing on the first wave of the COVID-19 pandemic in Latvia in Spring 2020 was conducted. Quantitative data from the National Health Services were analysed to assess the dynamics of consultations for patients with selected NCDs. Qualitative data were collected through 34 semi-structured interviews with general practitioners (GPs) and specialists and were analysed using an inductive thematic analysis. Purposive maximum variation sampling was used for participant selection. Results During the period with the strongest restrictions of scheduled on-site consultations, a decrease in the total number of consultations was observed for a variety of NCDs. A significant proportion of consultations in this period were provided remotely. GPs provided approximately one-third of cancer-related consultations and almost half of consultations for the other selected conditions remotely. Among specialists, endocrinologists had the highest proportion of remote consultations (up to 72.0%), while urologists had the lowest (16.4%). Thematic analysis of the semi-structured interviews revealed five themes: 1) Adjusting in a time of confusion and fear, 2) Remote consultations: safety versus availability, 3) Sacrifice and loss of privacy, 4) Advantages and disadvantages of communication technologies, and 5) Different form of communication and a health literacy challenge. Conclusions During the first wave of the COVID-19 pandemic in Latvia, disruptions to health care services decreased the total number of consultations for patients with NCDs provided by both GPs and specialists. In this period, remote consultations proved to be an important instrument for ensuring the continuity of health care for patients with NCDs, and the necessity to develop a well-designed system for telemedicine in Latvia was highlighted.
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Patient Satisfaction Determinants of Inpatient Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111337. [PMID: 34769856 PMCID: PMC8582779 DOI: 10.3390/ijerph182111337] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/26/2021] [Accepted: 10/12/2021] [Indexed: 12/19/2022]
Abstract
The aim of the study was to analyse and evaluate the determinants influencing the overall satisfaction of patients with inpatient healthcare in the conditions of the Czech Republic. A total of the 1425 patients, who experienced hospitalisation and agreed to participate, were questioned in the study. A research questionnaire was used to obtain data on satisfaction with hospitalisation. The subject of the research consisted of the indicators related to the following factors: (i) satisfaction with the hospital, clinic, room and meals; (ii) satisfaction with medical staff-nurses, physician expertise and other staff; (iii) the quality of the treatment provided; (iv) satisfaction with leaving the hospital. The formulated statistical hypotheses were evaluated through structural equation modelling. The results of the analyses brought interesting findings. Satisfaction with medical staff is the most significant factor which has a positive effect on satisfaction with hospitalisation. Physician expertise (with trust and good communication skills) is more important for patients than satisfaction with nurses or other staff. The results obtained from the study represent valuable information for policymakers, regional healthcare plans, as well as for managers of hospitals.
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Mazzuco SS, Suhrcke MM, Zanotto LL. How to measure premature mortality? A proposal combining "relative" and "absolute" approaches. Popul Health Metr 2021; 19:41. [PMID: 34702295 PMCID: PMC8547117 DOI: 10.1186/s12963-021-00267-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 09/22/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The concept of "premature mortality" is at the heart of many national and global health measurement and benchmarking efforts. However, despite the intuitive appeal of its underlying concept, it is far from obvious how to best operationalise it. The previous work offers at least two basic approaches: an absolute and a relative one. The former-and far more widely used- approach sets a unique age threshold (e.g. 65 years), below which deaths are defined as premature. The relative approach derives the share of premature deaths from the country-specific age distribution of deaths in the country of interest. The biggest disadvantage of the absolute approach is that of using a unique, arbitrary threshold for different mortality patterns, while the main disadvantage of the relative approach is that its estimate of premature mortality strongly depends on how the senescent deaths distribution is defined in each country. METHOD We propose to overcome some of the downsides of the existing approaches, by combining features of both, using a hierarchical model, in which senescent deaths distribution is held constant for each country as a pivotal quantity and the premature mortality distribution is allowed to vary across countries. In this way, premature mortality estimates become more comparable across countries with similar characteristics. RESULTS The proposed hierarchical models provide results, which appear to align with related evidence from specific countries. In particular, we find a relatively high premature mortality for the United States and Denmark. CONCLUSIONS While our hybrid approach overcomes some of the problems of previous measures, some issues require further research, in particular the choice of the group of countries that a given country is assigned to and the choice of the benchmarks within the groups. Hence, our proposed method, combined with further study addressing these issues, could provide a valid alternative way to measure and compare premature mortality across countries.
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Affiliation(s)
- S. Stefano Mazzuco
- Department of Statistical Sciences, University of Padova, Via Cesare Battisti 241, 35121 Padua, Italy
| | - M. Marc Suhrcke
- Luxembourg Institute of Socio-Economic Research, Maison des Sciences Humaines 11, 4366 Esch-sur-Alzette, Belval, Luxembourg
- Centre for Health Economics, University of York, York, UK
| | - L. Lucia Zanotto
- Department of Economics, University of Venice, Fondamenta San Giobbe 873, 30100 Venice, Italy
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Gavurova B, Khouri S, Kovac V, Ferkova M. Exploration of Influence of Socioeconomic Determinants on Mortality in the European Union. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4699. [PMID: 32629913 PMCID: PMC7369843 DOI: 10.3390/ijerph17134699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 12/03/2022]
Abstract
Economic performance measured through the gross domestic product indicator and the poverty rate varies across the whole European Union, together with the considerable income inequalities in the long-term. Economic growth may not bring a reduction in the health inequalities in the individual countries themselves. In order to eliminate health inequalities, the different types of policies implemented in the health, social and economic systems need to be explored in more detail. Mortality is explored through an indicator of the standardised mortality rate for both sexes explained by the several socioeconomic determinants, among which variables such as the variations of the gross domestic product per capita, the healthcare expenditures, the unemployment rate, and the healthcare system financing. Almost in all the described cases, these dimensions have negative impact. All the influences are expressed in a relative way in order to be suitably interpretable. The analysis is not comprehensive; nevertheless, it contains 18 regression models to cover as many aspects as it is possible. The Discussion section offers an evaluation of the obtained results according to the outcome of the other studies.
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Affiliation(s)
- Beata Gavurova
- Faculty of Mining, Ecology, Process Control and Geotechnologies, Technical University of Košice, 04001 Košice, Slovakia;
| | - Samer Khouri
- Faculty of Mining, Ecology, Process Control and Geotechnologies, Technical University of Košice, 04001 Košice, Slovakia;
| | - Viliam Kovac
- Faculty of Economics, Technical University of Košice, 04001 Košice, Slovakia; (V.K.); (M.F.)
| | - Michaela Ferkova
- Faculty of Economics, Technical University of Košice, 04001 Košice, Slovakia; (V.K.); (M.F.)
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Gavurova B, Khouri S, Korony S. Exploration of Disparities in Regions and Specialized Fields of Day Surgery System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030936. [PMID: 32028666 PMCID: PMC7038371 DOI: 10.3390/ijerph17030936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/23/2020] [Accepted: 02/01/2020] [Indexed: 01/03/2023]
Abstract
The main objective of this paper was to find similarities among eight Slovak regions from the viewpoint of five specialized day surgery fields and among specialized day surgery fields from the viewpoint of Slovak regions on the basis of day surgery operated and hospitalized patient counts. Day surgery data of paediatric patients and of adult patients from the National Health Information Centre during the years 2009-2017 were used. Correspondence analysis in two dimensions of the Slovak regions and of specialized day surgery fields was applied in order to achieve the paper's objective. The Košice Region differs most from the overall national average in both groups of paediatric day surgery. This is caused by its largest proportions in the fields of Gynaecology (29.7%) and Urology (48.0%) (operated patients), and in the fields of Gynaecology (60.5%) and Surgery (21.6%) (hospitalized patients). The most different specialized day surgery fields from overall average are: Urology (operated paediatric patients), Gynaecology (hospitalized paediatric patients), Otorhinolaryngology (operated adult patients) and Ophthalmology (hospitalized adult patients). Urogenital system day surgery procedures (Gynaecology, Urology) are separated from other three fields (i.e., Surgery, Ophthalmology, Otorhinolaryngology) either in the first or in the second dimension of the singular value matrix decomposition.
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Affiliation(s)
- Beata Gavurova
- Faculty of Mining, Ecology, Process Control and Geotechnologies of the Technical University of Košice, 040 01 Košice, Slovakia;
- Correspondence: ; Tel.: +421-944420654
| | - Samer Khouri
- Faculty of Mining, Ecology, Process Control and Geotechnologies of the Technical University of Košice, 040 01 Košice, Slovakia;
| | - Samuel Korony
- Faculty of Economics, Matej Bel University, 974 01 Banska Bystrica, Slovakia;
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