1
|
Zhou S, Zhang Y, Dong X, Ma J, Li N, Shi H, Smith SC, Jin Y, Xu M, Xiang D, Zheng ZJ, Huo Y. Regional variations in management and outcomes of patients with acute coronary syndrome in China: Evidence from the National Chest Pain Center Program. Sci Bull (Beijing) 2024; 69:1302-1312. [PMID: 38519397 DOI: 10.1016/j.scib.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/25/2023] [Accepted: 12/19/2023] [Indexed: 03/24/2024]
Abstract
Regional variations in acute coronary syndrome (ACS) management and outcomes have been an enormous public health issue. However, studies have yet to explore how to reduce the variations. The National Chest Pain Center Program (NCPCP) is the first nationwide, hospital-based, comprehensive, continuous quality improvement program for improving the quality of care in patients with ACS in China. We evaluated the association of NCPCP and regional variations in ACS healthcare using generalized linear mixed models and interaction analysis. Patients in the Western region had longer onset-to-first medical contact (FMC) time and time stay in non-percutaneous coronary intervention (PCI) hospitals, lower rates of PCI for ST-elevation myocardial infarction (STEMI) patients, and higher rates of medication usage. Patients in Central regions had relatively lower in-hospital mortality and in-hospital heart failure rates. Differences in the door-to-balloon time (DtoB) and in-hospital mortality between Western and Eastern regions were less after accreditation (β = -8.82, 95% confidence interval (CI) -14.61 to -3.03; OR = 0.79, 95%CI 0.70 to 0.91). Similar results were found in differences in DtoB time, primary PCI rate for STEMI between Central and Eastern regions. The differences in PCI for higher-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients among different regions had been smaller. Additionally, the differences in medication use between Eastern and Western regions were higher after accreditation. Regional variations remained high in this large cohort of patients with ACS from hospitals participating in the NCPCP in China. More comprehensive interventions and hospital internal system optimizations are needed to further reduce regional variations in the management and outcomes of patients with ACS.
Collapse
Affiliation(s)
- Shuduo Zhou
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China
| | - Xuejie Dong
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Junxiong Ma
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Na Li
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Hong Shi
- Chinese Medical Association, Beijing 100052, China
| | - Sidney C Smith
- Division of Cardiovascular Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina 27599-3140, USA
| | - Yinzi Jin
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Ming Xu
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Dingcheng Xiang
- Department of Cardiology, General Hospital of Southern Theater Command of PLA, Guangzhou 510010, China.
| | - Zhi-Jie Zheng
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China.
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China.
| |
Collapse
|
2
|
Li X, Lu Z, Liu T, Sun Y. Impact of home quarantine on physical fitness of school-aged children in Xi'an during COVID-19 lockdown: a cross-sectional study. BMC Public Health 2024; 24:1169. [PMID: 38664808 PMCID: PMC11047002 DOI: 10.1186/s12889-024-18607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The emergence of the COVID-19 pandemic has sparked unprecedented global challenges. This study intends to investigate changes in the physical fitness of students aged 6-22 during the COVID-19 pandemic and to assess how the pandemic lockdown period affected these markers. METHODS According to the National Student Physical Health Standard, a stratified cluster sampling method was used to evaluate the body shape, body function, and physical fitness of children and adolescents (n = 8092) in Xi'an from 2019 to 2021. This study uses SPSS 26.0 (IBM, Chicago, IL, USA) for data statistics and analysis. The connection between physical fitness and years was measured using the one-variable analysis in the general linear model (GLM). Independent t-tests were used to determine the sex (male/female) and area (urban/rural) differences. RESULTS During the lockdown period, Body Mass Index (BMI) and flexibility showed an upward trend, while aerobic, strength, speed, and endurance showed a downward trend. In addition to the BMI of middle and high school students, almost all indicators show significant sex differences. There are urban-rural differences in some indicators, such as chin-ups. CONCLUSION During the pandemic of COVID-19, the physical fitness of children and adolescents in Xi'an did not change significantly, and there were slight differences among different grades. During the pandemic lockdown period, lifestyle changes and reduced outdoor activities for children and adolescents may be the reasons for the changing trend of various indicators.
Collapse
Affiliation(s)
- Xinglu Li
- School of Physical Education, Shaanxi Normal University, Xi'an, 710119, China
| | - Zijun Lu
- School of Physical Education, Shaanxi Normal University, Xi'an, 710119, China
| | - Tao Liu
- School of Physical Education, Shaanxi Normal University, Xi'an, 710119, China
| | - Yuliang Sun
- School of Physical Education, Shaanxi Normal University, Xi'an, 710119, China.
| |
Collapse
|
3
|
Jing Q, He J, Li Y, Yang X, Peng Y, Wang H, Yu F, Wu J, Gong S, Che H, Zhang X. Analysis of the spatiotemporal changes in global land cover from 2001 to 2020. Sci Total Environ 2024; 908:168354. [PMID: 37935267 DOI: 10.1016/j.scitotenv.2023.168354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/21/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
Land cover changes have far-reaching effects on climate change and the evolution of ecological environments, making them important components of global change research. Based on MODIS land cover data (MCD12Q1), statistical parameters such as land cover dynamic degree, transition probability, and transition matrix were employed to analyse the spatiotemporal characteristics of global land cover changes from 2001 to 2020. The results indicated that land cover exhibits a latitudinal distribution in mid-latitude regions and a longitudinal distribution in high and low-latitude regions. During the study period, the areas of evergreen needleleaf forests, deciduous needleleaf forests, deciduous broadleaf forests, closed shrublands, and permanent wetlands exhibited fluctuating changes. Evergreen broadleaf forests and barren lands have decreased annually, whereas mixed forests, woody savannas, grasslands, urban and built-up areas, and cropland/natural vegetation mosaics have increased annually. In terms of the dynamic degree, the most significant changes occurred in deciduous broadleaf forests, closed shrublands, permanent wetlands, and cropland/natural vegetation mosaics. Additionally, there were significant variations in the types and regions of land cover changes and transitions. Evergreen needleleaf forests transitioned into grassland types, and the conversion between grassland types was the main transition from mid- to high- latitude regions. In tropical areas, evergreen broadleaf forests, open shrublands, and croplands have shifted towards grassland types as primary transitions. These findings provide significant implications for the in-depth exploration of land-atmosphere interactions, climate change, and numerical models.
Collapse
Affiliation(s)
- Qiaoqiao Jing
- School of Atmospheric Sciences, Chengdu University of Information Technology, Chengdu 610225, China; State Key Laboratory of Severe Weather & Key Laboratory of Atmospheric Chemistry of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - Jianjun He
- State Key Laboratory of Severe Weather & Key Laboratory of Atmospheric Chemistry of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China.
| | - Yarong Li
- State Key Laboratory of Severe Weather & Key Laboratory of Atmospheric Chemistry of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China; Key Laboratory for Semi-Arid Climate Change of the Ministry of Education, College of Atmospheric Sciences, Lanzhou University, Lanzhou 730000, China
| | - Xianyu Yang
- School of Atmospheric Sciences, Chengdu University of Information Technology, Chengdu 610225, China
| | - Yue Peng
- State Key Laboratory of Severe Weather & Key Laboratory of Atmospheric Chemistry of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - Hong Wang
- State Key Laboratory of Severe Weather & Key Laboratory of Atmospheric Chemistry of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - Fei Yu
- Center for Earth System Modeling and Prediction of CMA, Beijing 100081, China
| | - Jie Wu
- National Climate Centre, Beijing 100081, China
| | - Sunling Gong
- State Key Laboratory of Severe Weather & Key Laboratory of Atmospheric Chemistry of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - Huizheng Che
- State Key Laboratory of Severe Weather & Key Laboratory of Atmospheric Chemistry of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - Xiaoye Zhang
- State Key Laboratory of Severe Weather & Key Laboratory of Atmospheric Chemistry of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| |
Collapse
|
4
|
Axenhus M, Svedman S, Magnéli M. Trends and projection of forearm fractures including elbow fractures of the Olecranon in Sweden: an analysis of 363 968 fractures using public aggregated data. BMC Musculoskelet Disord 2024; 25:33. [PMID: 38178106 PMCID: PMC10768300 DOI: 10.1186/s12891-023-07162-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Forearm and olecranon fractures are a common orthopaedic injury. This study aimed to analyse whether the incidence of forearm injury is changing and identifying trends in the number of forearm and olecranon fractures using public aggregated data in Sweden. METHODS The number of forearm and olecranon fractures as defined by the number of registered diagnoses with the ICD-10 code of S52 were collected and normalized per 100,000 inhabitants and stratified per sex, age, and month. Age-adjusted incidence for forearm and olecranon fractures were calculated using the direct method. Poisson regression was used to analyse monthly, seasonal and yearly change in forearm and olecranon fracture incidence. Logistical regression was used to predict future trends of forearm and olecranon fractures. RESULTS The findings revealed a slight decreasing trend in forearm and olecranon fractures. The average incidence rate during the study period was 333 with women having a higher incidence rate than men. More fractures occurred in the winter months. Fluctuations in the number of forearm and olecranon fractures were observed during 2020 which may be influenced by the COVID-19 pandemic. Based on current data, forearm and olecranon fractures are expected to decrease in Sweden by 2035. CONCLUSION This study describes the trend of forearm and olecranon fractures among individuals according to sex and age in Sweden using easily obtainable data. Trends in forearm and olecranon fractures are dependent on sex and age but generally show a decreasing trend. More precise studies are needed in order to properly quantify the specific incidence of various subtypes of forearm and olecranon fractures and associated risk factors.
Collapse
Affiliation(s)
- Michael Axenhus
- Department of Orthopaedic Surgery, Danderyd Hospital, Stockholm, Sweden.
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Simon Svedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Magnéli
- Department of Orthopaedic Surgery, Danderyd Hospital, Stockholm, Sweden
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
5
|
Wang Y, Li J, Men Y, Wei W. Intrinsic Cortical Property Analysis of the Medial Column of Proximal Humerus. Orthop Surg 2023; 15:793-800. [PMID: 36716195 PMCID: PMC9977591 DOI: 10.1111/os.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Adequate mechanical support of the medial column is paramount to maintain fracture reduction in locking plating of proximal humerus fractures. However, intrinsic cortical properties of the medial column are rarely discussed. The purpose of the study is to describe regional variation of cortex in the medial column. METHODS A total of 147 healthy participants were eligible for enrollment between December 2016 and December 2018. Subjects were divided into three groups: group A (20-39 years), group B (40-59 years), and group C (>60 years). For each individual, a color 3D thickness map for proximal humerus was created by cortical bone mapping (CBM) technique after bilateral shoulders were imaged by computed tomography. Measurement Indices including the cortical thickness (CTh), cortical mass surface density (CM) and the endocortical trabecular density (ECTD) were determined, after six regions of interest (ROI) were defined in metaphyseal region. Regional parameter variations were analyzed by one-way ANOVA. RESULTS The CTh, CM and ECTD values were approximately equivalent between genders in the proximal part of the medial column across all ages (P > 0.05).The greatest difference between sexes was found in CTh and CM values of middle and distal part (P < 0.05). The CTh and CM within medial column were negatively associated with age (P < 0.05). The proximal cortical bone of the medial column was thicker and more dense, compared to the lateral column (P < 0.05). Significant regional variation was found in all measured parameters in group A, but not in groups B and C. CONCLUSION Our finding proved that regional differences in the distribution of cortical bone in the medial column The attenuation of cortical bone heterogeneity in the medial column was found after the age of 40 years.
Collapse
Affiliation(s)
- Yeming Wang
- Department of OrthopaedicsTianjin Hospital, Tianjin UniversityTianjinChina
| | - Jian Li
- Department of RadiologyTianjin Hospital, Tianjin UniversityTianjinChina
| | - Yutao Men
- Tianjin Key Laboratory of the Design and Intelligent Control of the Advanced Mechanical SystemTianjin University of TechnologyTianjinChina,National Demonstration Center for Experimental Mechanical and Electrical Engineering EducationTianjin University of TechnologyTianjinChina
| | - Wanfu Wei
- Department of OrthopaedicsTianjin Hospital, Tianjin UniversityTianjinChina
| |
Collapse
|
6
|
Draganic D, Wangen KR. The effect of physician density on colorectal cancer stage at diagnosis: causal inference methods for spatial data applied on regional-level data. Int J Health Geogr 2023; 22:1. [PMID: 36658603 PMCID: PMC9850813 DOI: 10.1186/s12942-023-00323-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The early detection of colorectal cancer (CRC) through regular screening decreases its incidence and mortality rates and improves survival rates. Norway has an extremely high percentage of CRC cases diagnosed at late stages, with large variations across municipalities and hospital catchment areas. This study examined whether the availability of physicians related to CRC primary diagnosis and preoperative investigations, or physician density, contributes to the observed geographical differences in late-stage incidence rates. METHOD Municipality-level data on CRC stage at diagnosis were obtained from the Cancer Registry of Norway for the period 2012-2020. Physician density was calculated as the number of physicians related to CRC investigations, general practitioners (GPs) and specialists per 10,000 people, using physician counts per municipality and hospital areas from Statistics Norway. The relationship was examined using a novel causal inference method for spatial data-neighbourhood adjustment method via spatial smoothing (NA approach)-which allowed for studying the region-level effect of physician supply on CRC outcome by using spatially referenced data and still providing causal relationships. RESULTS According to the NA approach, an increase in one general practitioner per 10,000 people will result in a 3.6% (CI -0.064 to -0.008) decrease in late-stage CRC rates. For specialists, there was no evidence of a significant correlation with late-stage CRC distribution, while for both groups, GPs and specialists combined, an increase of 1 physician per 10,000 people would be equal to an average decrease in late-stage incidence rates by 2.79% (CI -0.055 to -0.001). CONCLUSION The study confirmed previous findings that an increase in GP supply will significantly improve CRC outcomes. In contrast to previous research, this study identified the importance of accessibility to both groups of physicians-GPs and specialists. If GPs encounter insufficient workforces in hospitals and long delays in colonoscopy scheduling, they will less often recommend colonoscopy examinations to patients. This study also highlighted the efficiency of the novel methodology for spatially referenced data, which allowed us to study the effect of physician density on cancer outcomes within a causal inference framework.
Collapse
Affiliation(s)
- Dajana Draganic
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Knut Reidar Wangen
- grid.5510.10000 0004 1936 8921Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
7
|
Shoji S, Yamaji K, Sandhu AT, Ikemura N, Shiraishi Y, Inohara T, Heidenreich PA, Amano T, Ikari Y, Kohsaka S. Regional variations in the process of care for patients undergoing percutaneous coronary intervention in Japan. Lancet Reg Health West Pac 2022; 22:100425. [PMID: 35308578 PMCID: PMC8928076 DOI: 10.1016/j.lanwpc.2022.100425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Measuring the quality of care has been central for improving the outcomes of patients undergoing percutaneous coronary intervention (PCI). This study described the performance rates and regional variations in quality metrics for PCI using a representative national Japanese registry. Methods Overall, 760,854 patients across 714 institutions (2016-2018) were analysed. Quality metrics included preprocedural antiplatelet therapy use, door-to-balloon time ≤90 min for ST-elevation myocardial infarction, transradial approach, and preprocedural noninvasive stress testing for elective cases in 47 Japanese prefectures. Coronary computed tomography angiography (CCTA) and fractional flow reserve (FFR) were also evaluated. Factors associated with preprocedural testing rates were evaluated using multivariable linear regression. Findings Rates of preprocedural antiplatelet therapy use were high with low variations (96·4% [94·7-97·2%]), but there was still substantial room for improvement in the rates of door-to-balloon time (74·7% [71·2-78·9%]) and transradial approach use (70·9% [65·1-73·4%]). Rates of preprocedural noninvasive stress testing were low with substantial variation (36·6% [27·1-49·7%]). Additionally, we found substantial variations in CCTA (50·0% [39·5-55·1%]) and FFR measurement (15·7% [113·-18·3%]) rates. The number of scintigraphy scanners/ prefecture was associated with the performance of noninvasive stress testing (13·4% [95% CI, 2·45-24·4%] increase for every 1/100,000 population increase in scanners). Interpretations We observed substantial regional variation in the use of preprocedural testing, and its performance was directly related to nuclear-scanner availability. These findings suggest the need for targeted efforts in improving testing rates, whether by optimising resource allocation or additional education or feedback mechanisms. Funding This study was funded by the Japan Society for the Promotion of Science (Grant Nos. 20H03915, 16H05215, 16KK0186, and 20K22883) and by the Ministry of Health, Labor and Welfare Grants-in-Aid for Scientific Research Program (Grant No. 21FA1015). The J-PCI registry is led and supported by the Japanese Association of Cardiovascular Intervention and Therapeutics.
Collapse
Affiliation(s)
- Satoshi Shoji
- Department of Cardiology, Hino Municipal Hospital, Tokyo, Japan
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Alexander T. Sandhu
- Department of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Paul A. Heidenreich
- Department of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA
- Medical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Corresponding author.
| |
Collapse
|
8
|
Leeser L, Neukirch B, Drösler SE. [Regional and gender variations in appendicectomy : Nationwide small-area development of operation rates in the time series]. Chirurg 2022; 93:884-891. [PMID: 35391554 PMCID: PMC9399065 DOI: 10.1007/s00104-022-01628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/08/2022]
Abstract
Hintergrund Frühere Analysen kleinräumiger Appendektomieraten zeigen erheblich höhere regionale Unterschiede der Operationshäufigkeiten bei Frauen als bei Männern. Ziel Die Arbeit identifiziert valide Messgrößen zur Darstellung regionaler Unterschiede und analysiert geschlechtsspezifische Veränderungen der Appendektomieraten auf Landkreisebene in der Zeitreihe. Material und Methoden Datengrundlage sind die der DRG-Statistik entnommenen Appendektomiehäufigkeiten für 2014, 2016 sowie 2018 nach Geschlecht auf Landkreisebene. Die regionalen Unterschiede werden mittels der „systematic component of variation“ (SCV) berechnet und beurteilt. Die SCV ist im Vergleich zu Extrem-Ratio und Variationskoeffizient robuster gegenüber stark schwankender Nennerpopulationen. SCV-Werte über 5 geben einen Hinweis auf hohe Variationen und größer 10 auf sehr hohe Variationen. Ergebnisse Bei der männlichen Population lassen sich nur geringe regionale Unterschiede der Operationsraten feststellen, die im Zeitverlauf stabil bleiben (SCV2014 = 2,1, SCV2016 = 1,8 und SCV2018 = 2,0). Bei Frauen hingegen liegt die SCV in den Jahren 2014 sowie 2016 (SCV2014 = 6,1, SCV2016 = 5,3) über 5 und sinkt 2018 auf 4,5 ab. Darstellungen als Funnel-Plot berücksichtigen höhere Streuungen der Operationsraten in Landkreisen mit niedrigen Einwohnerzahlen. Diskussion Bei Frauen ist ein rückläufiger Trend in den Appendektomiehäufigkeiten zu erkennen. Unklar ist, ob dieser Trend auf einer Veränderung der Indikationsstellung oder auf einem geänderten allgemeinen Behandlungsmanagement bei einem Appendizitisverdacht beruht. Durch robuste Variationsmaße und der graphischen Aufbereitung als Funnel-Plots ist es möglich, systematisch bedingte regionale Versorgungsunterschiede von Zufallseffekten zu unterscheiden.
Collapse
Affiliation(s)
- Lea Leeser
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstraße 49, 47805, Krefeld, Deutschland.
| | - Benno Neukirch
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstraße 49, 47805, Krefeld, Deutschland
| | - Saskia E Drösler
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstraße 49, 47805, Krefeld, Deutschland
| |
Collapse
|
9
|
Akmatov MK, Holstiege J, Bätzing J. Secular trends and regional variations in pharmacotherapy of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. BMC Psychiatry 2021; 21:405. [PMID: 34391396 PMCID: PMC8364007 DOI: 10.1186/s12888-021-03409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/05/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The study aim was to examine the secular trends and regional variations in pharmacotherapy of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) in Germany. METHODS We used nationwide drug prescription data of outpatient care (2009 to 2016). The study population comprised patients aged between 5 and 14 years with the diagnoses "hyperkinetic disorders" (ICD-10 code F90) (e.g. n = 262,766 in 2016). The examined drugs were methylphenidate, amphetamines, atomoxetine and guanfacine. RESULTS Overall, the proportion of patients received any prescription showed a decreasing trend over years (2010, 51%; 2016, 44%). The proportion of methylphenidate prescription was higher in Western than Eastern federal states. However, atomoxetine was more often prescribed in Eastern than Western federal states. The proportion of methylphenidate prescriptions issued by pediatric psychiatrists increased from 28% (2009) to 41% (2016). CONCLUSION A decreasing trend in use of pharmacotherapy may be explained by prescription restrictions issued by the Federal Joint Committee in recent years.
Collapse
Affiliation(s)
- Manas K. Akmatov
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care in Germany, Salzufer 8, 10587 Berlin, Germany
| | - Jakob Holstiege
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care in Germany, Salzufer 8, 10587 Berlin, Germany
| | - Jörg Bätzing
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care in Germany, Salzufer 8, 10587 Berlin, Germany
| |
Collapse
|
10
|
Abstract
BACKGROUND Distribution of physicians is a key component of access to health care. Although there is extensive research on urban-rural disparities in physician distribution, limited attention has been directed to the heterogeneity across urban areas. This research depicts variations in physician density across over 600 cities in the context of China's rapid urbanization. METHODS Data came from National Census Surveys and China statistical yearbooks, 2000-2003, and 2010-2013. Cities were characterized in terms of not only administrative level but also geographic regions and urban agglomerations. We analyzed variations in physician supply by applying generalized estimating equations with an ordinal logistic linking function. RESULTS Although overall physician density increased between 2003 and 2013, with population and socioeconomic attributes adjusted, physician density declined in urban China. On average, urban districts had a higher physician density than county-level cities, but there were regional variations. Cities in urban agglomerations and those outsides did not differ in physician density. CONCLUSION Despite the reduced inequality between 2003 and 2013, the growth in physician density did not appear to be commensurate with the changes in population health demand. Assessment in physician distribution needs to take into account heterogeneity in population and socioeconomic characteristics.
Collapse
Affiliation(s)
- Xuexin Yu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610040, Sichuan, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610040, Sichuan, China.
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| |
Collapse
|
11
|
Chen J, Wang S, Zhou C, Li M. Does the path of technological progress matter in mitigating China's PM 2.5 concentrations? Evidence from three urban agglomerations in China. Environ Pollut 2019; 254:113012. [PMID: 31419663 DOI: 10.1016/j.envpol.2019.113012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/10/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
Technological progress is widely considered to play an important role in reducing air pollution. While growing literature has explored the effects of technological progress on environmental quality, fewer studies have considered the varied effects exerted by different technological progress paths on PM2.5 concentrations. This paper explored the relationship between two different kinds of technological progress (indigenous innovation and technology diffusion) and PM2.5 concentrations. Indigenous innovation was in this study considered to be composed by research and development investment (R&D) and import technology (IM); technology diffusion was represented by foreign direction investment (FDI) and export learning effect represent (EX). A panel data model was employed in order to explore the varied impact of these different technological progress paths on PM2.5 concentrations, using data for 48 cities located in China's three most developed urban agglomerations (Beijing-Tianjin-Hebei, the Yangtze River Delta, and the Pearl River Delta), for the period 2000-2015. The results reveal that without control variables, FDI had a significant negative impact on PM2.5 levels in Beijing-Tianjin-Hebei, and EX a significant positive impact. FDI, R&D, and EX were found to positively correlate with PM2.5 levels in the Yangtze River Delta. In Pearl River Delta, R&D presented a significant negative relationship. The findings of this study provide decision makers and industry managers with a scientific basis from which to approach the task of mitigating PM2.5 concentrations through technological progress.
Collapse
Affiliation(s)
- Jing Chen
- School of Geographical Sciences, Fujian Normal University, Fuzhou, 350007, China; Guangdong Provincial Key Laboratory of Urbanization and Geo-simulation, School of Geography and Planning, Sun Yat-sen University, Guangzhou, 510275, China
| | - Shaojian Wang
- Guangdong Provincial Key Laboratory of Urbanization and Geo-simulation, School of Geography and Planning, Sun Yat-sen University, Guangzhou, 510275, China; Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, 02138, USA.
| | - Chunshan Zhou
- College of Tourism, Xinjiang University, Urumqi, 830001, China; Guangdong Provincial Key Laboratory of Urbanization and Geo-simulation, School of Geography and Planning, Sun Yat-sen University, Guangzhou, 510275, China
| | - Ming Li
- Guangdong Provincial Key Laboratory of Urbanization and Geo-simulation, School of Geography and Planning, Sun Yat-sen University, Guangzhou, 510275, China
| |
Collapse
|
12
|
Nayyar A, Strassle PD, Reddy KG, Jameison DI, Moses CG, Roughton MC, McGuire KP, Gallagher KK. Variations in the utilization of immediate post-mastectomy breast reconstruction. Am J Surg 2019; 218:712-5. [PMID: 31542150 DOI: 10.1016/j.amjsurg.2019.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/13/2019] [Accepted: 07/17/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND For female breast cancer (BC) patients undergoing mastectomy, post-mastectomy breast reconstruction (PMBR) confers significant psychosocial benefits and improved cosmetic outcomes. The objective of this study is to explore whether the utilization of PMBR varies by race, marital status, and geographical location of the patient. METHODS Women ≥18 years old who underwent mastectomy for breast cancer diagnosed between 2000 and 2014 were eligible. Women with inflammatory BC, Stage IV BC diagnoses, and bilateral BC were excluded. Multivariable logistic regression, adjusting for patient and cancer characteristics, were used to assess the association between of race, marital status, and region on immediate PMBR utilization. RESULTS 321,206 women were included and 24% underwent immediate PMBR (<4 months after mastectomy). Compared to white women, black and other non-white women (OR 0.67, 95% CI 0.65, 0.70 and OR 0.52, 95% CI 0.50, 0.53, respectively) were significantly less likely to receive PMBR. Additionally, women who were single (OR 0.72, 95% CI 0.70, 0.75) or no longer married (OR 0.84, 95% CI 0.82, 0.86) were significantly less likely to undergo breast reconstruction, compared to married women. Regional differences were also seen, with women in the Northeast (OR 2.11, 95% CI 2.05,2.17), Midwest (OR 1.53, 95% CI 1.48, 1.58) and South (OR 1.20, 95%CI 1.17, 1.23) all being more likely to undergo breast reconstruction compared to the West. DISCUSSION Significant variations exist in the utilization of post-mastectomy breast reconstruction across race, marital status or geographical location of the patient. Further research is needed to elucidate these differences and identify areas for intervention to increase awareness, and access to reconstruction for all breast cancer patients.
Collapse
|
13
|
Ross EG, Mell MW. Evaluation of regional variations in length of stay after elective, uncomplicated carotid endarterectomy in North America. J Vasc Surg 2019; 71:536-544.e7. [PMID: 31280981 DOI: 10.1016/j.jvs.2019.02.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 02/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate factors affecting regional variation in length of stay (LOS) after elective, uncomplicated carotid endarterectomy (CEA). METHODS Data were obtained from the Vascular Quality Initiative database and included patients with complete data who received elective CEA without complications between 2012 and 2017 across 18 regions in North America and 294 centers. The main outcome measure was LOS >1 day after surgery (LOS >1 postoperative day [POD]). Using least absolute shrinkage and selection operator regression, multivariable modeling, and mixed-effects general linear modeling, we evaluated whether regional variations in LOS were independent of demographic, clinical, or center-related factors and to what extent these factors accounted for postoperative variation in LOS. RESULTS A total of 36,004 patients were included. Mean postprocedure LOS was 1.6 ± 6.6 days. Overall, 24% of patients had an LOS >1 POD. After adjustment for important demographic, clinical, and center-related factors, the region in which a patient was treated independently and significantly affected LOS after elective, uncomplicated CEA. Region and center of treatment accounted for 18% of LOS variation. Demographic, clinical, and surgical factors accounted for another 32% of variation in LOS. Of these factors, postoperative discharge to a facility other than home (odds ratio [OR], 6.3; confidence interval [CI], 5.2-7.6), use of intravenous (IV) vasoactive agents (OR, 3.2; CI, 3-3.4), intraoperative drain placement (OR, 1.4; CI, 1.3-1.55), and female sex (OR, 1.4; CI, 1.3-1.5) were associated with longer LOS. Factors associated with LOS ≤1 POD included preoperative aspirin (OR, 0.88; CI, 0.8-0.96) and statin use (OR, 0.9; CI, 0.83-0.98), high surgeon volume (highest quartile: OR, 0.68; CI, 0.5-0.87), and completion evaluation after CEA (eg, Doppler, ultrasound; OR, 0.87; CI, 0.8-0.95). We also found that use of IV vasoactive medications varied significantly across regions, independent of demographic and clinical factors. CONCLUSIONS Significant regional variation in LOS exists after elective, uncomplicated CEA even after controlling for a wide range of important factors, indicating that there remain unmeasured causes of longer LOS in some regions. Even so, modification of certain clinical practices may reduce overall LOS. Regional differences in use of IV vasoactive medications not driven by clinical factors warrant further analysis, given the strong association with longer LOS.
Collapse
Affiliation(s)
- Elsie Gyang Ross
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Matthew W Mell
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif.
| |
Collapse
|
14
|
Villaseñor-Derbez JC, Fitzgerald S. Spatial variation in allometric growth of invasive lionfish has management implications. PeerJ 2019; 7:e6667. [PMID: 30972253 PMCID: PMC6450370 DOI: 10.7717/peerj.6667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/21/2019] [Indexed: 11/20/2022] Open
Abstract
Lionfish (Pterois volitans/miles) are an invasive species in the Western Atlantic and the Caribbean. Improving management of invasive lionfish populations requires accurate total biomass estimates, which depend on accurate estimates of allometric growth; sedentary species like lionfish often exhibit high levels of spatial variation in life history characteristics. We reviewed 17 published length-weight relationships for lionfish taken throughout their invasive range and found regional differences that led to significant misestimates when calculating weight from length observations. The spatial pattern we observed is consistent with findings from other studies focused on genetics or length-at-age. Here, the use of ex situ parameter values resulted in total biomass estimates between 76.2% and 140% of true observed biomass, and up to a threefold under- or overestimation of total weight for an individual organism. These findings can have implications for management in terms of predicting effects on local ecosystems, evaluating the effectiveness of removal programs, or estimating biomass available for harvest.
Collapse
Affiliation(s)
- Juan Carlos Villaseñor-Derbez
- Bren School of Environmental Science and Management, University of California, Santa Barbara, Santa Barbara, CA, United States of America
| | - Sean Fitzgerald
- Bren School of Environmental Science and Management, University of California, Santa Barbara, Santa Barbara, CA, United States of America
| |
Collapse
|
15
|
Jiao K, Gao J, Wu S. Climatic determinants impacting the distribution of greenness in China: regional differentiation and spatial variability. Int J Biometeorol 2019; 63:523-533. [PMID: 30729305 DOI: 10.1007/s00484-019-01683-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 06/09/2023]
Abstract
This study investigated climatic determinants for regional greenness in China and spatially variable correlations between climatic determinants and vegetation in specific regions using the geographical detector and geographically weighted regression (GWR) methodologies. The analyses were based on normalized difference vegetation index (NDVI) and interpolations of climatic determinants from 652 Chinese meteorological stations. The study period (1982-2013) was divided into two stages (T1-T2) before and after the inflection year identified by the accumulative anomaly of NDVI. Three typical regions (R1-R3) were then selected according to the same NDVI variation trend as China in the two periods. Precipitation was the dominant climatic factor of NDVI in China, and the effect of temperature on greenness increased with warming from T1 to T2. In a relatively arid region (R1), the effect of precipitation in T2 was further strengthened compared to T1. Meanwhile, the effect of minimum temperature in T2 also increased compared with T1 in a relatively humid region (R2), becoming the major climatic determinant. In addition to the regional differentiation, spatial variability was investigated by comparing normalized coefficients of GWR for climatic determinants; this showed significant spatial heterogeneity within each region. Temperature impact areas also existed within precipitation-dominated regions (R1 and R3), where areas of precipitation impact expanded from T1 to T2. Furthermore, regression coefficients between NDVI dynamics and climate variability revealed relationships between regional differentiation and spatial variability. For example, the increasing precipitation rate could mediate the adverse impacts on greenness caused by the higher warming rate in relatively arid regions (R1).
Collapse
Affiliation(s)
- Kewei Jiao
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, 11A Datun Road, Chaoyang District, Beijing, 100101, China
- Key Laboratory of Forest Ecology and Management, Institute of Applied Ecology, Chinese Academy of Sciences, 72 Wenhua Road, Shenhe District, Shenyang, 110016, China
| | - Jiangbo Gao
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, 11A Datun Road, Chaoyang District, Beijing, 100101, China.
| | - Shaohong Wu
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, 11A Datun Road, Chaoyang District, Beijing, 100101, China
- College of Resources and Environment, University of Chinese Academy of Sciences, 19A Yuquan Road, Shijingshan District, Beijing, 100049, China
| |
Collapse
|
16
|
Wang Y, Li J, Yang J, Dong J. Regional characteristics of cortical bone quality in the proximal humerus of postmenopausal women: a preliminary study. J Shoulder Elbow Surg 2019; 28:685-691. [PMID: 30527884 DOI: 10.1016/j.jse.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal humeral fractures represent the third most common fragility fracture treated in osteoporotic populations, after hip and distal radial fractures. The purpose of this study was to characterize the spatial variability in cortical geometry in the proximal humerus in postmenopausal women. METHODS The proximal humeri in 43 healthy postmenopausal women were imaged by computed tomography. Cortical bone mapping was applied to create color 3-dimensional thickness maps for each proximal humerus. Cortical parameters, including the cortical thickness (CTh), cortical mass surface density (CM), and endocortical trabecular density, were measured over the humeral head and metaphyseal region after 15 regions of interest (ROIs) were defined. RESULTS In the humeral head region, significant differences in CTh and CM values were detected between the anterior, lateral, and posterior walls (P < .05). The highest CTh and CM were found in the anterior wall in each plane (P < .05). Regarding the endocortical trabecular density, no significant findings were noted in the 3 planes (P > .05). In the metaphyseal region, the cortical structure in the medial column had higher CTh and CM values in ROI 10 compared with the lateral column (P < .05). The highest CTh and CM values of compact bone were seen in ROI 10 of the medial column (ROIs 10-12) (P < .05). CONCLUSION Our results showed significant regional variation of cortical bone in the humeral head region in postmenopausal women. Similar conditions were seen in the medial column in the metaphyseal region. This finding provides discriminatory information for stronger fixation of implants.
Collapse
Affiliation(s)
- Yeming Wang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China.
| | - Jian Li
- Department of Radiology, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jianhua Yang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jingming Dong
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
| |
Collapse
|
17
|
Lynch B, Fitzgerald AP, Corcoran P, Healy O, Buckley C, Foley C, Browne J. Case fatality ratios for serious emergency conditions in the Republic of Ireland: a longitudinal investigation of trends over the period 2002-2014 using joinpoint analysis. BMC Health Serv Res 2018; 18:474. [PMID: 29921263 PMCID: PMC6006987 DOI: 10.1186/s12913-018-3260-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 05/30/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In the past decade, the Republic of Ireland has undertaken significant reconfiguration programmes to improve emergency services. During this time the public healthcare system experienced a large real decrease in resources. This study assesses national and regional population outcomes over the period 2002-2014, and whether changes coincide with system reconfiguration and the financial restrictions imposed by the 2008 recession. METHODS Case fatality ratios (CFRs) were constructed for emergency conditions for 2002-2014. Total emergency conditions and individual condition trends were analysed nationally using joinpoint analysis. National results informed the investigation of trends at a regional and county level using an inverse standard error weighted generalised linear model with a log link to construct funnel plots. County-level CFRs were compared for the first and last 3 years of the period to further investigate the changes to county results over the 13 year period, specifically in comparison to the national-level CFR. RESULTS Nationally, there was an annual fall in CFRs (2.1%). The decline was faster from 2002 to 2007 (annual percentage change = - 3.4; 95% CI-4.4, - 2.4), compared to 2007-2014 (annual percentage change = - 1.2; 95% CI -1.9, - 0.5). The South-East had a lower rate of decrease and the West had a higher rate. Cross sectional analysis of two periods (2002-2004 and 2012-2014) showed high consistency in the counties performance relative to the national CFR in both periods. CONCLUSION Change in the national trend coincided with the onset of economic stress on the public health system. Attributing the decline in CFR improvement to economic factors is weakened by the uneven nature of the trend change. No distinct pattern of change was identified among regions which underwent substantial reconfiguration of emergency services.
Collapse
Affiliation(s)
- Brenda Lynch
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland.
| | - Anthony P Fitzgerald
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland
| | - Paul Corcoran
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland
| | - Orla Healy
- Health Service Executive, South/South West Hospital Group, Ernville, Western Road, Cork, Ireland
| | - Claire Buckley
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland.,Health Service Executive, South/South West Hospital Group, Ernville, Western Road, Cork, Ireland
| | - Conor Foley
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland
| | - John Browne
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland
| |
Collapse
|
18
|
Wang Y, Li J, Yang J, Dong J. Regional variations of cortical bone in the humeral head region: A preliminary study. Bone 2018; 110:194-198. [PMID: 29458122 DOI: 10.1016/j.bone.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Incidence of proximal humeral fractures dramatically increased over the last decade due to demographic changes. The goal of this study was to analyze regional characteristics of cortical bone in the humeral head region using cortical bone mapping (CBM) technique. METHODS The proximal humerus of 103 healthy volunteers was imaged by clinical computed tomography (CT) scans. Three groups of volunteers were identified according to age: group A (20-39years), group B (40-59years), and group C (>60years). CBM was applied to create color 3D thickness maps for each proximal humerus. Cortical parameters, including the cortical thickness (CTh), cortical mass surface density (CM), and the endocortical trabecular density (ECTD) were measured over humeral head region after nine regions of interest (ROI) were defined. RESULTS Cortical bone structure of the humeral head region varied dramatically in cross-section independent of age, with significant cortical thinning at the posterior wall. Particularly, notable cortical thinning was also found in the distal end of lateral wall at 60years of age or older. The degree of regional variability of cortical properties within lateral wall tended to diminish with age. CONCLUSION Substantial regional variations in cortical bone structure at humeral head region were observed quantitatively in this study. These morphologic data provided useful information on clinical medicine such as surgical fixation.
Collapse
Affiliation(s)
- Yeming Wang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China.
| | - Jian Li
- Department of Radiology, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jianhua Yang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jingming Dong
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
| |
Collapse
|
19
|
Hansen H, Pohontsch NJ, Bole L, Schäfer I, Scherer M. Regional variations of perceived problems in ambulatory care from the perspective of general practitioners and their patients - an exploratory focus group study in urban and rural regions of northern Germany. BMC Fam Pract 2017; 18:68. [PMID: 28545402 PMCID: PMC5445300 DOI: 10.1186/s12875-017-0637-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/11/2017] [Indexed: 08/26/2023]
Abstract
BACKGROUND Patients from rural and urban regions should have equitable access to health care. In Germany, the physician-patient-ratio and the supply of medical services vary greatly between urban and rural areas. The aim of our study was to explore the regional variations of the perceived health care problems in ambulatory care from the perspective of affected professionals and laypersons i.e. general practitioners and their patients. METHODS We conducted 27 focus groups with general practitioners (n = 65) and patients (n = 145) from urban areas, environs and rural areas in northern Germany. Discussions were facilitated by two researchers using a semi-structured guideline. The transcripts were content analyzed using deductive and inductive categories. RESULTS General practitioners and patients reported problems due to demographic change and patient behaviour, through structural inequalities and the ambulatory reimbursement system as well as with specialist care and inpatient care. A high physician density, associated with high competition between general practitioners, a high fluctuation of patients and a low status of general practitioners were the main problems reported in urban areas. In contrast, participants from rural areas reported an insufficient physician density, a lack of young recruits in primary care and a resulting increased workload as problematic. All regions are concerned with subjectively inadequate general practitioners' budgets, insufficiently compensated consultations and problems in the cooperation with specialists and inpatient care institutions. Most problems were mentioned by GPs and patients alike, but some (e.g. high competition rates in urban regions and problems with inpatient care) were only mentioned by GPs. CONCLUSIONS While many problems arise in urban regions as well as in rural regions, our results support the notion that there is an urgent need for action in rural areas. Possible measures include the support of telemedicine, delegation of medical services and reoccupation of vacant practices. The attractiveness of working in rural areas for general practitioners, specialists and clinicians must be increased by consolidating and expanding rural infrastructure (e.g. child care and cultural life). The above mentioned results also indicate that the ambulatory reimbursement system should be examined regarding the reported inequalities. Measures to further enhance the cooperation between general practitioners, specialists and inpatient care should be taken to solve supra-regionally reported problems. Problems showing regional variations indicate the need for measures to balance these variations between the regions. This is the first German study to analyze subjective views of the stakeholders concerned on regionally variating problems in ambulatory care. Further studies are needed to quantify the extent of the identified problems and differences. A corresponding survey is currently under way.
Collapse
Affiliation(s)
- H Hansen
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N J Pohontsch
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - L Bole
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Schäfer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Scherer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
20
|
Heyer K, Protz K, Glaeske G, Augustin M. Epidemiology and use of compression treatment in venous leg ulcers: nationwide claims data analysis in Germany. Int Wound J 2017; 14:338-343. [PMID: 27199102 PMCID: PMC7949887 DOI: 10.1111/iwj.12605] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/24/2016] [Accepted: 03/29/2016] [Indexed: 11/26/2022] Open
Abstract
Chronic venous diseases are the most common causes of leg ulcers. Compression treatment (CT) is a central component of venous leg ulcer (VLU) therapy along with prevention based on guidelines and clinical evidence. However, large-scale data on the use of CT are rare. In particular, there have not yet been published nationwide data for Germany. We analysed data from a large German statutory health insurance (SHI) on incident VLU between 2010 and 2012. VLUs were identified by ICD-10 diagnoses. The status of active disease was defined by wound-specific treatments. Compression stockings and bandages were identified by SHI medical device codes. The overall estimated incident rate of active VLU of all insured persons was 0·34% from 2010 to 2012. Adapted to the overall German population, n = 229 369 persons nationwide had an incident VLU in 2010-2012. Among all VLU patients, only 40·6% received CT within 1 year, including 83·3% stockings, 31·8% bandages and 3·1% multi-component compression systems. Compression rates showed significant differences by gender and age. Large regional variations were observed. Validity of data is suggested by high concordance with a primary cohort study. Although recommended by guidelines, there is still a marked under-provision of care, with CT in incident VLUs in Germany requiring active measures.
Collapse
Affiliation(s)
- Kristina Heyer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Kerstin Protz
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Gerd Glaeske
- Centre for Social Policy ResearchUniversity of BremenBremenGermany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| |
Collapse
|
21
|
Gajendran M, Umapathy C, Loganathan P, Hashash JG, Koutroubakis IE, Binion DG. Analysis of Hospital-Based Emergency Department Visits for Inflammatory Bowel Disease in the USA. Dig Dis Sci 2016; 61:389-99. [PMID: 26423080 DOI: 10.1007/s10620-015-3895-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 09/18/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a chronic, debilitating condition with high emergency department (ED) utilization. We aimed to investigate the utilization patterns of ED by IBD patients and measure hospitalization and surgical rates following ED visits. METHODS We conducted a cross-sectional study of adults with IBD listed as the primary ED diagnosis from the 2009 to 2011 Nationwide Emergency Department Sample. The characteristics of the IBD-related ED visits in relation to following hospitalizations and surgeries were analyzed. RESULTS Adult IBD patients constitute 0.09 % of the total ED visits. Crohn's disease (CD) contributed to 69 % of the IBD-ED visits. The hospitalization rate from ED was 59.9 % nationally, ranging from 56 % in west to 69 % in northeast. The most significant factors associated with hospitalization were intra-abdominal abscess [odds ratio (OR) 24.22], bowel obstruction (OR 17.77), anemia (OR 7.54), malnutrition (OR 6.29), hypovolemia/electrolyte abnormalities (OR 5.57), and fever/abnormal white cell count (OR 3.18). Patients with CD (OR 0.66), low-income group (OR 0.90), and female gender (OR 0.87) have a lower odds of getting hospitalized. Age above 65 years (OR 1.63), CD (OR 1.89), bowel obstruction (OR 9.24), and intra-abdominal abscess (OR 18.41) were significantly associated with surgical intervention. CONCLUSION The IBD-related ED visits have remained relatively stable from 2009 to 2011. The presence of anemia, malnutrition, hypovolemia, electrolyte abnormalities, fever, abnormal white cell count, bowel obstruction, or intra-abdominal abscess during the ED visit was associated with hospitalization. The presence of bowel obstruction and intra-abdominal abscess was strongly associated with surgical intervention.
Collapse
Affiliation(s)
- Mahesh Gajendran
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Priyadarshini Loganathan
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Jana G Hashash
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Ioannis E Koutroubakis
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.,Department of Gastroenterology, University Hospital Heraklion, Crete, Greece
| | - David G Binion
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
22
|
Gao J, Gong H, Zhang R, Zhu D. Age-related regional deterioration patterns and changes in nanoscale characterizations of trabeculae in the femoral head. Exp Gerontol 2015; 62:63-72. [PMID: 25582596 DOI: 10.1016/j.exger.2015.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/03/2014] [Accepted: 01/08/2015] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the mechanical properties and features of bone materials at the nanoscale level in different regions of the femoral head in elderly patients with femoral neck fracture. Ten femoral heads from female patients with femoral neck fractures were extracted during surgery (five for the Aged group, aged 65-66 years; five for the Advanced aged group, aged 85-95 years). The femoral head was divided into three equal layers (anterior, central, and posterior) in the coronal view, and each layer was segmented into five regions (superior, central, inferior, medial, and lateral). Nanoindentation testing and atomic force microscopy imaging were used to study the mechanical properties and surface morphology of the specimens. No statistical differences in grain size were found between age groups, which suggested that the nanostructure of trabeculae in the femoral heads of postmenopausal women cannot be used to predict age-related bone loss and fracture risk. Mechanical properties in the longitudinal direction deteriorated more quickly than those in the transverse direction for the whole femoral head. Comparisons between layers showed a higher deterioration rate with aging in the anterior layer than in other layers. In different regions, mechanical properties of the medial and lateral regions deteriorated more quickly than those in the three other regions, and deterioration in the longitudinal direction was more serious than that in the transverse direction. The regional deterioration patterns and material properties with aging observed in this study contribute to an understanding of the age-related fracture mechanism and provide a basis for predicting age-related fracture risk and decreasing early fixation failure in the proximal femur.
Collapse
Affiliation(s)
- Jiazi Gao
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China
| | - He Gong
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China.
| | - Rui Zhang
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China
| | - Dong Zhu
- Traumatic Orthopedics, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
| |
Collapse
|
23
|
Kobayashi D, Otsubo T, Imanaka Y. The effect of centralization of health care services on travel time and its equality. Health Policy 2014; 119:298-306. [PMID: 25480458 DOI: 10.1016/j.healthpol.2014.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 10/15/2014] [Accepted: 11/12/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze the regional variations in travel time between patient residences and medical facilities for the treatment of ischemic heart disease and breast cancer, and to simulate the effects of health care services centralization on travel time and equality of access. METHODS We used medical insurance claims data for inpatients and outpatients for the two target diseases that had been filed between September 2008 and May 2009 in Kyoto Prefecture, Japan. Using a geographical information system, patient travel times were calculated based on the driving distance between patient residences and hospitals via highways and toll roads. Locations of residences and hospital locations were identified using postal codes. We then conducted a simulation analysis of centralization of health care services to designated regional core hospitals. The simulated changes in potential spatial access to care were examined. RESULTS Inequalities in access to care were examined using Gini coefficients, which ranged from 0.4109 to 0.4574. Simulations of health care services centralization showed reduced travel time for most patients and overall improvements in equality of access, except in breast cancer outpatients. CONCLUSION Our findings may contribute to the decision-making process in policies aimed at improving the potential spatial access to health care services.
Collapse
Affiliation(s)
- Daisuke Kobayashi
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Tetsuya Otsubo
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| |
Collapse
|
24
|
Gómez-Barrena E, Padilla-Eguiluz NG, García-Rey E, Cordero-Ampuero J, García-Cimbrelo E. Factors influencing regional variability in the rate of total knee arthroplasty. Knee 2014; 21:236-41. [PMID: 23528444 DOI: 10.1016/j.knee.2013.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/26/2012] [Accepted: 01/21/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Geographic variations in knee arthroplasty have been detected through international surveys. We aim to investigate in this study the influence of aging index, health budget, and number of orthopedic surgeons in the regional variations of the primary and revision TKA rate in a single European country, Spain. MATERIAL AND METHODS Inpatient database of knee arthroplasty procedures for years 1997 to 2010 was obtained from the Spanish Ministry of Health, including 393,714 primaries and 37,037 revisions, segregated for each of the 17 regional health services in Spain. Crude and adjusted rates (direct method with total Spanish population per year) were calculated and used as dependent variables. Aging index, regional health budget, and number of orthopedic surgeons per region were used as independent variables in a Kruskal-Wallis test and a negative binomial regression analysis model. RESULTS AND CONCLUSIONS With a mean crude rate for Spain of 76 primary TKA and 7 revision surgeries per 10(5) population and year, the mean adjusted rate per region oscillated between 702 and 27 primary TKA and 87 and 3 revisions per 10(5). A model was adjusted confirming the influence of aging index, health budget, and number of surgeons, but regional variations remained partly unexplained by these factors.
Collapse
Affiliation(s)
- E Gómez-Barrena
- Department of Orthopaedic Surgery, Hospital La Paz, Autónoma University of Madrid, Madrid, Spain; IDIPAZ, Research Institute at Hospital La Paz and Autónoma University of Madrid, Madrid, Spain.
| | - N G Padilla-Eguiluz
- IDIPAZ, Research Institute at Hospital La Paz and Autónoma University of Madrid, Madrid, Spain
| | - E García-Rey
- Department of Orthopaedic Surgery, Hospital La Paz, Autónoma University of Madrid, Madrid, Spain; IDIPAZ, Research Institute at Hospital La Paz and Autónoma University of Madrid, Madrid, Spain
| | - J Cordero-Ampuero
- Department of Orthopaedic Surgery, Hospital La Princesa, Autónoma University of Madrid, Madrid, Spain
| | - E García-Cimbrelo
- Department of Orthopaedic Surgery, Hospital La Paz, Autónoma University of Madrid, Madrid, Spain; IDIPAZ, Research Institute at Hospital La Paz and Autónoma University of Madrid, Madrid, Spain
| |
Collapse
|
25
|
Krumbholz A, Joel S, Neubert A, Dremsek P, Dürrwald R, Johne R, Hlinak A, Walther M, Lange J, Wutzler P, Sauerbrei A, Ulrich RG, Zell R. Age-related and regional differences in the prevalence of hepatitis E virus-specific antibodies in pigs in Germany. Vet Microbiol 2013; 167:394-402. [PMID: 24238666 DOI: 10.1016/j.vetmic.2013.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/27/2013] [Accepted: 10/04/2013] [Indexed: 01/15/2023]
Abstract
An increasing number of acute autochthonous human hepatitis E virus (HEV)-infections was noticed in Germany and other developed countries, most likely the result of a zoonotic virus transmission from pig, wild boar and deer. Currently there is still a lack of profound data concerning the actual prevalence of HEV-specific antibodies in domestic pig herds in Germany, in particular for regions with high pig density, and its age-dependency. 2273 domestic pig sera were collected in 2011 mainly from Bavaria, North Rhine-Westphalia and Lower Saxony from areas having a high pig density. Initially, 420 randomly selected pig sera were tested in three commercially available and in two in-house HEV-antibody ELISAs. 43.6% (183/420) to 65.5% (275/420) of the sera were demonstrated to be reactive against human pathogenic HEV genotypes 1 and/or 3. The majority of sera reacted only weakly or not at all with the rat HEV antigen with very few sera showing a stronger reactivity to this antigen compared to the genotype 3 antigen. The results of all three HEV-IgG tests, i.e. the PrioCHECK(®) HEV Ab porcine ELISA kit, the ID Screen(®) Hepatitis E Indirect Multi-species ELISA kit and the genotype 3 in-house ELISA were in good accordance. Therefore, the remaining sera were tested using the PrioCHECK(®) HEV Ab porcine ELISA kit. Samples with a borderline result were finally determined by application of the conjugate-modified recomLine HEV IgG assay. A total of 1065 of the 2273 sera (46.9%) were found to be anti-HEV IgG-positive. While 38.4% (306/796) of fatteners (age between 3 and 9 months) exhibited HEV-specific antibodies, 51.4% (759/1477) of sows (age older than 9 months) exhibited anti-HEV antibodies (P<0.001). Fatteners kept in Southern Germany had a significantly higher HEV IgG prevalence compared to fatteners kept in the high pig density federal states North Rhine-Westphalia and Lower Saxony but also in German federal states with a low pig density. In conclusion, the present study clearly demonstrates that a high percentage of domestic pigs in Germany have had contact with HEV. Seroprevalence depends on the pig's age and herd origin with the most significant regional variations for fatteners. The presence of anti-HEV-free herds may indicate that it is feasible to establish and sustain HEV-free pig herds. HEV seroprevalence still depends on the assay used for testing. This demonstrates an urgent need for test validation.
Collapse
Affiliation(s)
- Andi Krumbholz
- Institute for Infection Medicine, Christian Albrecht University of Kiel and University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; Department of Virology and Antiviral Therapy, Jena University Hospital, Friedrich Schiller University Jena, 07740 Jena, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|