Impact of COVID-19 on hospitalisation for diverse conditions in European countries

Background

The COVID-19 pandemic has had an unprecedented impact on Europe. Health systems came under strain, with non-urgent treatments postponed and resources reserved for treatment of COVID-19 patients. Delayed care seeking has been reported, for fear of infection with SARS-CoV2. Yet, the scale of this impact remains under researched. This study aims to compare indirect effects of the pandemic in a European cross-country study aiming to highlight the potential of Population Health Information Research Infrastructures (www.phiri.eu).

Methods

Focusing on (i) major vascular events (MVE) and (ii) elective surgery for joint replacements (ESJR) as well as (iii) serious trauma this study analyses individual level hospital data in a standardised harmonised data model. We compared pre-pandemic incidence rates (2018-2019) with rates for 2020 and 2021. Analyses are systematically contrasted with SARS CoV2 incidence rates, and policy measures taken based on the OxCGRT index.

Results

A drop in hospital discharge rates was observed during the pandemic in all countries but differing by condition and month. Socio-economic differences also varied by condition. Our evidence suggests that periods of more severe policy measures also correlated with more dramatic drops in regular hospital activities.

Conclusions

Our findings provide new insights on the dramatic level of de-prioritisation of essential services faced by non-COVID-19 patients in Europe. From a public health perspective, hospital escalation plans should be developed early on to avoid negative mid and long-term health and financial consequences of indirect effects. The study demonstrates the tremendous potential in exploiting health information systems in a systematic way across countries and the value of the PHIRI system. Further research should investigate policy trade-offs involved in severe lockdown measures during a pandemic and variations in health service resilience for future pandemic preparedness.

Mapping variability in allocation of Long-Term Care funds across payer agencies in OECD countries

Background

Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). The objectives of this cross-country study is to highlight to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae.

Methods

Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries.

Results

11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations.

Conclusions

A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.

Key messages

A minority of LTC systems in OECD countries fully meet distributional equity in allocation of resources across payer agencies. Countries that value distributional equity should harmonize the eligibility criteria to LTC at the national level and allocate funds according to needs across regions.

[Caught between economic pressure and work-life balance--perspectives on emigration of German health professionals to Austria]

OBJECTIVE

Given the increasing lack of medical doctors in Germany, this study aimed to investigate the professional situation and the push and pull factors of German medical specialists working in Austrian hospitals.

METHODS

This explorative study is based on semi-structured interviews with 14 specialists working in Austria, who completed their education partly or fully in Germany. The material has been interpreted using qualitative content analysis.

RESULTS

Better work-life balance, higher quality of life and more favourable working conditions represent major reasons for German specialists to stay in Austria. Moreover, the higher density of medical doctors in Austrian hospitals can have an impact on the distribution of responsibilities among health-care personnel, and on hospital performance.

CONCLUSIONS

In the light of recent reforms in the German health-care system, the study underlines the importance of qualitative factors for the satisfaction of German medical doctors. These factors should be further analysed in order to avoid a brain drain of high-qualified health care staff in the future.

Factor IXa:factor VIIIa interaction. helix 330-338 of factor ixa interacts with residues 558-565 and spatially adjacent regions of the a2 subunit of factor VIIIa

The physiologic activator of factor X consists of a complex of factor IXa, factor VIIIa, Ca(2+) and a suitable phospholipid surface. In one study, helix 330 (162 in chymotrypsin) of the protease domain of factor IXa was implicated in binding to factor VIIIa. In another study, residues 558-565 of the A2 subunit of factor VIIIa were implicated in binding to factor IXa. We now provide data, which indicate that the helix 330 of factor IXa interacts with the 558-565 region of the A2 subunit. Thus, the ability of the isolated A2 subunit was severely impaired in potentiating factor X activation by IXa(R333Q) and by a helix replacement mutant (IXa(helixVII) in which helix 330-338 is replaced by that of factor VII) but it was normal for an epidermal growth factor 1 replacement mutant (IXa(PCEGF1) in which epidermal growth factor 1 domain is replaced by that of protein C). Further, affinity of each 5-dimethylaminonaphthalene-1-sulfonyl (dansyl)-Glu-Gly-Arg-IXa (dEGR-IXa) with the A2 subunit was determined from its ability to inhibit wild-type IXa in the tenase assay and from the changes in dansyl fluorescence emission signal upon its binding to the A2 subunit. Apparent K(d(A2)) values are: dEGR-IXa(WT) or dEGR-IXa(PCEGF1) approximately 100 nm, dEGR-IXa(R333Q) approximately 1.8 micrometer, and dEGR-IXa(helixVII) >10 micrometer. In additional experiments, we measured the affinities of these factor IXa molecules for a peptide comprising residues 558-565 of the A2 subunit. Apparent K(d(peptide)) values are: dEGR-IXa(WT) or dEGR-IXa(PCEGF1) approximately 4 micrometer, and dEGR-IXa(R333Q) approximately 62 micrometer. Thus as compared with the wild-type or PCEGF1 mutant, the affinity of the R333Q mutant for the A2 subunit or the A2 558-565 peptide is similarly reduced. These data support a conclusion that the helix 330 of factor IXa interacts with the A2 558-565 sequence. This information was used to model the interface between the IXa protease domain and the A2 subunit, which is also provided herein.

In vitro testing of the bond between soft materials used for maxillofacial prostheses and cast titanium

STATEMENT OF PROBLEM

The choice of soft materials for maxillofacial prostheses is important for covering extraoral defects after tumor surgery or radiation therapy. The use of cast commercially pure titanium as reinforcement seems to be a suitable option.

PURPOSE

Making use of the advantages of titanium frameworks for maxillofacial prostheses requires exploring ways of combining it with soft materials. This study investigated such combinations and evaluated discoloration of the soft material to determine whether it was attributable to the titanium reinforcement.

MATERIAL AND METHODS

Five soft materials used for maxillofacial prostheses and their bond strengths to cast titanium were tested. Different ways of conditioning the titanium surface and different adhesives were used. Plain mechanical retention was also studied. The Gretag SPM 100 was used to determine the potential effects on coloring after 24 hours of radiation in the Suntest rapid exposure unit.

RESULTS

Suitable material combinations for bonding soft materials to titanium were found for all soft materials studied. Bond strength varied depending on the chemical basis of the soft material. Results indicated that maximal bond strengths were obtained by the combinations Supersoft with Super-Bond, Supersoft with subsequent silicoating, and bonding with Dentacolor connector. Few color shifts attributable to the titanium reinforcement were evident in the 2-mm layers of the soft materials applied.

CONCLUSION

The results of this study showed that it is possible to combine a titanium framework and soft silicone materials.

Plaque, gingival health and post-operative sensitivity in titanium inlays and onlays: a randomized controlled clinical trial

OBJECTIVES

Few clinical data on the use of titanium for restorative appliances are available. The aim of this study was to clinically evaluate titanium restorations compared to gold alloy restorations with regard to plaque, gingival health and post-operative sensitivity.

METHODS

In 54 patients, 99 titanium restorations were placed. The control group comprised 56 patients with 96 high gold alloy restorations. The material was chosen by random. Each patient received one or two Class II restorations. Plaque Index (Silness and Löe, 0-3), Gingival Index (Löe and Silness, 0-3), and post-operative sensitivity (1-4, 1=none) were rated at 2 weeks, 3 months, 6 months, 12 months, and 18 months, post-operatively.

RESULTS

The mean plaque scores ranged from 0.89 to 0.99 in the titanium group, and from 0.88 to 1.04 in the gold group. The mean gingival scores ranged from 0.91 to 1.07 in the titanium group, and from 0.82 to 0.99 in the gold group. The mean plaque and gingival scores of the titanium and gold group did not differ significantly at any visit (P>0.05). To evaluate post-operative sensitivity, patients with one MOD restoration each were included, resulting in 46 titanium and 44 high gold restored teeth. Mean values of the post-operative sensitivity scores in the titanium group were significantly higher than in the gold group (P<0.05). The restoration material was found to be the dominating variable with regard to post-operative sensitivity, which was not influenced by age, sex and the application of calcium hydroxide liner.

CONCLUSIONS

It is concluded that neither higher plaque scores nor adverse effects on gingival health are to be expected in titanium restorations.

Clinical fit of Procera AllCeram crowns

STATEMENT OF PROBLEM

Color stability, strength, and accuracy of fit are the main requirements for complete-ceramic crowns. The Procera AllCeram crown system is a CAD/CAM system used to fabricate individual complete-ceramic crowns that have a dry sintered, aluminum oxide core and appear to match clinical requirements. However, there are few articles about the clinical fit of all-ceramic crowns.

PURPOSE

This in vivo study measured the accuracy of fit of Procera AllCeram crowns in anterior and posterior teeth.

MATERIAL AND METHODS

The clinical fit of 80 anterior and posterior Procera AllCeram crowns was evaluated by a replica technique with a light body silicone to fill space between crown and tooth and a heavy body silicone to stabilize the light body film. After removal from the artificial crowns, the replicas were segmented, and measurements of the film thickness were performed with a light microscope.

RESULTS

Medians of mean marginal gap widths were between 80 and 95 microm in anterior teeth and between 90 and 145 microm in posterior teeth. Medians of maximal marginal gap widths ranged from 80 to 180 microm in anterior teeth and from 115 to 245 microm in posterior teeth.

CONCLUSION

The accuracy of fit achieved by Procera AllCeram was comparable to other conventional and innovative systems.

Cloning and characterization of the EAP30 subunit of the ELL complex that confers derepression of transcription by RNA polymerase II

The product of the human oncogene ELL encodes an RNA polymerase II transcription factor that undergoes frequent translocation in acute myeloid leukemia (AML). In addition to its elongation activity, ELL contains a novel type of RNA polymerase II interaction domain that is capable of repressing polymerase activity in promoter-specific transcription. Remarkably, the ELL translocation that is found in patients with AML results in the deletion of exactly this functional domain. Here we report that the EAP30 subunit of the ELL complex has sequence homology to the Saccharomyces cerevisiae SNF8, whose genetic analysis suggests its involvement in the derepression of gene expression. Remarkably, EAP30 can interact with ELL and derepress ELL's inhibitory activity in vitro. This finding may reveal a key role for EAP30 in the pathogenesis of human leukemia.

Margin quality of titanium and high-gold inlays and onlays--a clinical study

OBJECTIVES

Unalloyed titanium may be an economical substitute for gold alloys. The purpose of this study was to evaluate the suitability of unalloyed titanium as an alternative to gold alloys for posterior inlay and onlay restorations.

METHODS

Fifty-four patients received 99 titanium restorations, 56 patients 96 gold alloy restorations. All titanium restorations were cast in a vacuum-pressure casting machine. Two weeks after insertion the clinical margin integrity was evaluated by replica technique. The maximum marginal gaps were assessed under the optical measuring microscope. The two tailed t-test for independent samples was used for statistical analysis.

RESULTS

Accuracy of fit was significantly better in gold alloy than in titanium restorations. Mean maximum marginal gap between restoration margin and tooth structure were 72 +/- 18 microns (mean +/- S.D.) for titanium and 64 +/- 18 microns (mean +/- S.D.) for gold restorations.

SIGNIFICANCE

Though marginal gap widths in titanium restorations did not yet match the gold standard, the data justify the use of titanium as an alternative to gold alloy for inlay and onlay restorations.

[Production of slides using a microdatamat]

For production of dias for presentation of scientific data, a personal computer, a dias programme and a camera are necessary. A microdatamat with a 80286 precessor, 20 MB hard disc and an EGA colour screen are the minimum configurations which can be recommended. A hard disc between 40 and 85 MB and a VGA screen provide a better solution. Out of the numerous dias programmes, Harvard Graphics appears to be suitable for production of dias for scientific use. In this programme, it is easy to combine text, graphic and hand drawing. Many other excellent programmes such as 35 mm Express and Mirage are also available. In the choice of camera, a solution of at least 4,000 x 4,000 lines is required and the camera concerned must be capable of working with recognized statistical and graphic parcels as more special graphs cannot be produced in ordinary dias programmes. Among the numerous cameras, the following may be mentioned: Montage which costs of 70,000 Danish crowns (approximately 6,000 pounds), Matrix PCR at 100,000 Danish crowns (approximately 9,000 pounds), Matrix QCR-Z at 200,000 Danish crowns (approximately 18,000 pounds) and Lasergraphic's two models at 60,000 and 120,000 Danish crowns, respectively (approximately 5,000 pounds and 10,000 pounds). In the price class of about 100,000 Danish crowns, Matrix PCR can be recommended particularly as this camera has an excellent optic and advanced self calibrating system. Among the cheaper cameras. Montage is recommended which e.g. functions well with Harvard Graphics.(ABSTRACT TRUNCATED AT 250 WORDS)

Ovarian steroid secretion changes after hCG stimulation in early pregnant pigs

Administration of human chorionic gonadotropin (hCG) to promote ovarian steroid secretion near the time of recognition of pregnancy was evaluated. Neither 500 or 1000 IU of hCG caused a significant increase in luteal function as determined by progesterone (P(4)) concentrations in peripheral blood following treatment on Day 12. Estradiol concentrations were elevated (P<0.01) for the 500 IU hCG group on Days 13, 14, 15 and 16 versus the control group. The 1000 IU of hCG group had three-to five-fold greater (P<0.01) estradiol concentrations than controls on Days 14, 15 and 16 post mating. Treatment with hCG also reduced (P<0.05) the number of resorbed embryos. The results suggest that hCG treatment on Day 12 of pregnancy reduced embryo loss and influenced peripheral estradiol secretion patterns.