Basic Data Set Research Articles

Disease burden of influenza in Spain: A five-season study (2015–2020)

ABSTRACT Influenza accounts for 30% of the total morbidity and mortality in the European Union. However, the specific burden in different European countries is largely unknown, and more research is needed to ascertain the reality of this disease. In this retrospective study, we analyzed the burdens of hospitalization, intensive care unit (ICU) admission and in-hospital mortality in Spain over five seasons (2015–2020) via publicly available Minimum Basic Datasets (MDBS). The data revealed that influenza had a major impact in Spain, with approximately 29,000 hospitalizations, 2,200 ICU admissions, and 1,600 deaths each season. In this period, approximately 7.8% of those hospitalized required ICU admission, and 5.7% died in the hospital due to influenza, with wide differences in these parameters depending on the season due to the virological characteristics of the major circulating viruses. More than 60% of those hospitalized were over 65 years of age, and approximately 82% of those who died were elderly, demonstrating that the greatest burden of hospitalization and mortality is centered on this age group. The annual direct cost of influenza was approximately €128 million per season, with more than 80% of this cost centered on people over 45 years of age.

Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients, this study examines the strain these conditions impose on healthcare systems at a local level, focusing on a pilot program. Chronic diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient outcomes. If proven effective, this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid patients. AIM To evaluate the effectiveness of the high complexity unit (HCU) in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital care. METHODS The study employed a descriptive longitudinal approach, analyzing data from the Basic Minimum Data Set (BMDS) to compare hospitalization variables among the HCU, the Internal Medicine Service, and other services at Antequera Hospital throughout 2022. The HCU, designed for patients with complex chronic conditions, integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge. RESULTS The study employed a descriptive longitudinal approach, analyzing data from the BMDS to compare hospitalization variables among the HCU, the Internal Medicine Service, and other services at Antequera Hospital throughout 2022. The HCU, designed for patients with complex chronic conditions, integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge. CONCLUSION This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary approach. The coordinated care provided by the HCU results in improved patient outcomes, reduced unnecessary hospitalizations, and better management of patient complexity. The superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction, reinforcing its value as a model of care to be replicated.

Hospital discharges (MBDS) for Takotsubo syndrome in Spain. Regional differences (2008-2021).

Takotsubo syndrome (TTS) is an infrequent cause of acute coronary syndrome much better diagnosed in recent years. This study sought to assess the clinical profile of patients admitted with TTS in Spain and to elucidate potential regional differences in admissions and in-hospital mortality between the years 2008 and 2021. Retrospective observational study of patients admitted to acute general hospitals of the Spanish National Health System with a main or secondary diagnosis of STT, using the minimum basic data set. A total of 12.952 hospitalization for TTS were identified. The number of hospital admissions increased exponentially from 210 in the year 2008 to 1,918 in 2021. Most patients (79.1%) were women and mean age was 72.0 ± 12,5 years (72.5 ± 12,2 in female; 69.9 ± 13,4 in men; P < .001). Associated comorbidities were frequent (44.9% arterial hypertension, 31.2% heart failure) and differed in men and women. Overall, crude in-hospital mortality was 7%. Notably, admission and in-hospital mortality rates, adjusted by age and gender, were different among the different autonomous communities. TTS usually presents in elderly women with associated comorbidities and has a significant in-hospital mortality. Age and comorbidities differ between men and women. Relevant regional differences exist regarding admission and in-hospital mortality rates.

Atrial fibrillation in young stroke patients: Associated factors and outcomes in a nationwide analysis.

Knowledge about the prevalence of atrial fibrillation (AF) in young stroke patients, as well as its associated factors and outcomes, is scarce. Our objective was to analyse it. A retrospective analysis of the Spain Nationwide Minimum Basic Data Set (MBDS)(2016-2020), including ischaemic stroke (IS) patients aged 18 and 50 years, was conducted. Multivariate analyses were conducted to identify factors related to AF diagnosis. Amongst 11,615 young IS patients, 426 (3.7%) had AF. Patients with AF were older (median age 45, interquartile range 42-48 vs. 44, interquartile range 40-47 years, p < 0.001) and displayed more incapacitating symptoms, higher in-hospital complications and were less often discharged home (p < 0.001). Multivariate analyses showed that older age (odds ratio [OR] 1.053, 95% confidence interval [CI] 1.032-1.074), obstructive sleep apnoea (OR 1.508, 95% CI 1.018-2.233), hyperthyroidism (OR 3.741, 95% CI 1.798-7.783), valvular heart disease (OR 6.094, 95% CI 4.261-8.716), congenital (OR 2.386, 95% CI 1.146-4.969) and non-congenital (OR 4.446, 95% CI 3.149-6.278) cardiopathies and heart failure (OR 3.098, 95% CI 1.905-5.037) were independently associated with higher probability of AF, whereas female gender (OR 0.647, 95% CI 0.516-0.812), diabetes mellitus (0.487, 95% CI 0.339-0.699), smoking (OR 0.617, 95% CI 0.501-0.759), patent foramen ovale (OR 0.210, 95% CI 0.111-0.396) and arterial dissection (OR 0.294, 95% CI 0.130-0.668) were associated with a lower probability. In young IS patients, AF is associated with more in-hospital complications and disabling strokes. These findings emphasize the need to recognize AF in this demographic group, especially in patients with risk factors like hyperthyroidism and cardiomyopathies. Clinicians should assess these risk factors to ensure timely diagnosis and management of AF.

Comprehensive analysis of clinical characteristics, management, and prognosis in patients with dilated cardiomyopathy discharged from Spanish hospitals.

Dilated cardiomyopathy (DCM) is a leading cause of heart failure (HF) characterized by left ventricular dilatation and systolic dysfunction not explained by abnormal loading conditions. Despite its prevalence, DCM's epidemiology and prognosis remain poorly studied in our country. A retrospective observational study encompassed patients discharged from all Spanish public hospitals between 2016 and 2021 diagnosed with DCM. Data were extracted from the Minimum Basic Data Set. The study focused on hospital admissions, comorbidities, in-hospital mortality, and readmission rates for circulatory system diseases at 30 and 365days. Among 27,402 index episodes, DCM was the primary diagnosis in 12.4%, predominantly affecting men (72.5%). In-hospital mortality was 8.7%, with significant predictors including cardiogenic shock (OR: 12.4, 95%CI: 9.6-15.9), advanced or metastatic cancer (OR: 4.3, 95%CI: 3.8-5.0), renal failure (OR: 2.4, 95%CI: 2.2-2.7), and chronic liver disease (OR: 2.4, 95%CI: 2.1-2.8). Readmission rates were 7.9% at 30days and 25.5% at 365days, predominantly due to HF. Multivariate analysis identified age (IRR: 1.02, 95%CI: 1.01-1.02), female sex (IRR: 0.87, 95%CI: 0.79-0.96), severe hematological diseases (IRR: 2.12, 95%CI: 1.45-3.10), and metastatic cancer (IRR: 1.65, 95%CI: 1.31-2.07) as predictors of 30-day readmissions. At 365days, predictors included age (IRR: 1.02, 95%CI: 1.01-1.02), female sex (IRR: 0.80, 95%CI: 0.74-0.86), severe hematological diseases (IRR: 2.43, 95%CI: 1.66-3.56), and renal failure (IRR: 1.42, 95%CI: 1.31-1.55). This study highlights the substantial hospitalization burden and mortality risk among DCM patients, emphasizing the necessity for advanced management strategies and specialized cardiac care.

Application of a sEMG hand motion recognition method based on variational mode decomposition and ReliefF algorithm in rehabilitation medicine.

Hand motion intention recognition has been considered as one of the crucial research fields for prosthetic control and rehabilitation medicine. In recent years, surface electromyogram (sEMG) signals that directly reflect human motion information are ideal input sources for prosthetic control and rehabilitation. However, how to effectively extract components from sEMG signals containing abundant limb movement information to improve the accuracy of hand recognition still is a difficult problem. To achieve this goal, this paper proposes a novel hand motion recognition method based on variational mode decomposition (VMD) and ReliefF. First, VMD is used to decompose the sEMG signal into multiple variational mode functions (VMFs). To efficiently extract the intrinsic components of the sEMG, the recognition performance of different numbers of VMFs is evaluated. Then, four features representing hand motion intentions are extracted from the VMFs to form the initial feature space. Next, the ReliefF algorithm is used to remove redundant features from the feature space. In order to select a feature space that can effectively reflect the intention of hand movements, the hand movement recognition performance of 8 low-dimensional feature spaces is evaluated. Finally, three machine learning methods are used to recognize hand movements. The proposed method was tested on the sEMG for Basic Hand movements Data Set and achieved an average accuracy of 99.14%. Compared with existing research, the proposed method achieves better hand motion recognition performance, indicating the potential for healthcare and rehabilitation applications.

Hepatitis B Virus-Related Cirrhosis and Hepatocellular Carcinoma Hospital Discharge Rates from 2005 to 2021 in Spain: Impact of Universal Vaccination.

Background: The main consequences of chronic hepatitis B virus (HBV) infections are cirrhosis and hepatocellular carcinoma (HCC), both associated with frequent hospitalization. The aim of this study was to analyze the impact of universal HBV vaccination in Spain on chronic HBV-related hospital discharges from 2005 to 2021. Methods: Using data from the Minimum Basic Data Set of the Spanish National Health System, we calculated the hospital discharge rate ratio (HDRR) and 95% confidence interval (CI) values for chronic HBV-related discharges between 2005 and 2021. For comparative purposes, we calculated the HDRR and 95% confidence interval (CI) values for the early (2005-2013) and later (2014-2021) periods and the vaccinated compared with unvaccinated cohorts for the 20-39 age group. Results: The hospital discharge rate per 1,000,000 people was 3.08 in 2005 and 4.50 in 2021 for HCC, and 4.81 in 2005 and 1.92 in 2021 for cirrhosis. Comparing the early and later periods, values were higher for HCC (HDRR 1.13; 95% CI: 1.06-1.20) and lower for cirrhosis (HDRR 0.56; 95% CI: 0.51-0.60). The rate for the 20-39 age group was lower for the vaccinated compared with the unvaccinated cohorts overall (HDRR 0.53; 95% CI: 0.45-0.62), for HCC (HDRR 0.66; 95% CI: 0.53-0.82), and for cirrhosis (HDRR 0.41; 95% CI: 0.33-0.53). Conclusions: This study describes the important impact, after 25 years, of universal HBV vaccination in Spain: cirrhosis hospital discharge rate was reduced, and the vaccinated cohorts, compared with the unvaccinated cohorts in the 20-39 age group, had a lower hospital discharge rate of both HCC and cirrhosis.

Inflation Threshold and Financial Sector Development in Uganda

Purpose: This paper empirically analyzes the inflation threshold for better financial sector development (FSD) in Uganda using the yearly trend data spanning over the period 1980 to 2020. The basic idea of the study was to affirm whether the 5-percent bank of Uganda (BOU) inflations rates target is correct. Design/methodology/approach: The analysis incorporates the Autoregressive Distributing Lags (ARDL) model. This is due to the fact that the variables of the study were not all stationary at the same levels but archived strong stationarity after differencing once. To capture the inflation threshold estimation, the Ordinary Least Square model was run with lag value of the dependence variable. Findings: The research indicates that the critical inflation threshold is 6 percent. Below 6 percent inflation, there is a positive and decreasing impact but a statistically insignificant connection between inflation and FSD. Beyond 6 percent, the relationship becomes negative and the intensity increases exponentially as the inflation rate increases. Specifically, the study estimates that at a 5% inflation rate, the FSD has the potential to grow by about 1.3 % and should the inflation rate increase from the optimal of 6% to 7%, it drops by the same magnitude. Research limitations/implications: Data Limitation. The time span of 1980-2020, is because of no data for some variables beyond the chosen time frame. Even if some data were available, some are inconsistence and varies within the available data base set. Originality/value: The study augment to the development of FSD in Uganda by furnishing the Monetary Authority with evidence that help fix the optimal inflation threshold in the country. Similarly, this research will contribute to the existing body of knowledge on how best to manage the inflation rate in the country.

Effects of Combined Intrathecal Mesenchymal Stem Cells and Schwann Cells Transplantation on Neuropathic Pain in Complete Spinal Cord Injury: A Phase II Randomized Active-Controlled Trial

Neuropathic pain is a debilitating complication following spinal cord injury (SCI). Currently, effective treatments for SCI-induced neuropathic pain are highly lacking. This clinical trial aimed to investigate the efficacy of combined intrathecal injection of Schwann cells (SCs) and bone marrow–derived mesenchymal stem cells (BMSCs) in improving SCI-induced neuropathic pain. This study was a parallel-group, randomized, open-label, active-controlled phase II trial with two arms, including treatment and control groups. Patients with complete SCI-induced neuropathic pain in the treatment group received a single combined intrathecal injection of BMSCs and SCs. Study outcome measures were International SCI Pain Basic Data Set (ISCIPBDS) and World Health Organization (WHO) Quality of Life Assessment Instrument (WHOQOL-BREF). A total of 37 (55.2%) and 30 (44.8%) patients in the treatment and control groups were followed up for 6 months, respectively. Significant reductions in mean scores of interference items in the treatment group, including daily activities (P < 0.001), mood (P < 0.001), and sleep (P < 0.001), were found at 6 months after the injection compared with the control one. Similarly, pain frequency (P = 0.002), mean (P = 0.001), and worst (P = 0.001) numeric rating scale (NRS) pain intensity scores showed significant reductions in the treatment group after 6 months compared with the control one. Based on multiple regression analysis controlled for potential confounders, significant associations between changes in all outcome measures over the study period and the treatment group were found. This clinical trial indicated the efficacy of combined cell therapy in improving the neuropathic pain and quality of life in complete SCI patients. Future investigations should evaluate the effects of combination of this strategy with other existing therapies for SCI-induced neuropathic pain. This clinical trial was also registered prospectively at the Iranian Registry of Clinical Trials (IRCT20200502047277N8).

Outcomes of infective endocarditis in patients with end-stage renal disease and dialysis in Spain: a population-based study

Abstract Background Patients with end-stage renal disease (ESRD), particularly those undergoing dialysis, have a significantly higher risk of developing infective endocarditis (IE) compared to the general population. ESRD is not only related to a higher risk of infection, but also to a worse prognosis in IE. However, most data regarding the epidemiology and outcomes of patients with ESRD and IE is derived from noncontemporary population-based studies with limited clinical variables and lack of complete microbiological information, or from retrospective single-center cohorts. Purpose The aim is to describe the clinical characteristics and outcome of patients with IE and ESRD in Spain, compared to patients without ESRD, and to investigate potential differences between patients undergoing dialysis and the rest of patients with ESRD. Methods Retrospective observational population-based study. A total of 9,008 episodes of IE between 2016 and 2019 were analysed using information from the Spanish Minimum Basic DataSet. 428 patients had ESRD, of whom 332 were undergoing dialysis. A multivariable and multilevel logistic model was developed to evaluate the association of different variables with in-hospital mortality in ESRD patients. Results Compared to patients without ESRD, those with ESRD were younger, had more comorbidities, and had a higher incidence of Staphylococcus aureus (31.8% vs. 18.4%; p &amp;lt;0.001) and coagulase-negative staphylococci infections (19.2% vs. 14%; p =0.006). In terms of in-hospital complications, septic shock was more frequent in patients with ESRD (12.1% vs. 8.9%; p=0.007). Furthermore, ESRD patients underwent cardiac surgery less frequently than patients without ESRD (12.6% vs. 19.6%; p &amp;lt;0.001) and had significantly higher in-hospital mortality (33.4% vs. 26.9%; p =0.003). When comparing patients undergoing dialysis with the rest of ESRD patients, it was observed that those on dialysis had more comorbidities and a higher proportion of Staphylococcus aureus infections (36.1% vs. 16.7%; p &amp;lt;0.001). No differences were found in observed in-hospital mortality between patients on dialysis and the rest of ESRD patients. The multilevel analysis revealed that dialysis was not an independent risk factor for in-hospital mortality in patients with ESRD. Cardiac surgery was also not independently associated with higher in-mortality in ESRD patients. Conclusions Patients with ESRD and IE have a different clinical and microbiological profile than other patients with IE. Moreover, they undergo cardiac surgery less frequently and have significantly higher in-hospital mortality. Dialysis treatment and cardiac surgery were not independent risk factors for mortality in ESRD patients with IE.

Healthcare Costs of Hospitalizations Due to Aspergillosis and 25-Year Trends in Spain, 1997-2021.

In the last 40 years, a significant increase in the incidence of lung infections by Aspergillus has been reported. The scarcity of studies that describe the costs of aspergillosis indicates that the economic impact of aspergillosis in the hospital environment is greater than that of other fungal infections. The objective of the study was to evaluate the direct healthcare costs associated with aspergillosis in the Spanish National Health System from 1997 to 2021. A retrospective nationwide longitudinal descriptive study was designed to review hospital records from the Minimum Basic Data Set of patients admitted to hospitals of the National Health System from 1997 to 2021, with a diagnosis of aspergillosis. A total of 44,586 patients were admitted for aspergillosis in the Spanish National Health System. There was a progressive increase in the average annual cost from 1997 to 2012, which reached a maximum peak, EUR 1,395,154.21 (±2,155,192.87). It decreased between 2014 and 2019, but increased again in 2020 and 2021, EUR 28,675.79 (±30,384.12). The Pearson correlation coefficient revealed a weak negative correlation between age and hospital costs and a moderate positive correlation between average length of stay and hospital costs. Our data show that the economic impact of hospitalizations for aspergillosis is significant and increasing at a rate proportionally higher than that of other prevalent diseases. Costs related to Aspergillus infection are associated mainly with respiratory diseases. The results of this economic evaluation may be useful for health authorities to develop a future economic strategy for managing this fungal infection.

Image segmentation of tunnel water leakage defects in complex environments using an improved Unet model

Computer vision technology provides an intelligent means for detecting tunnel water leakage areas. However, the accuracy of defect feature extraction and segmentation is limited by factors such as insufficient lighting and environmental interference inside tunnels. To address the problem, this paper proposes a tunnel water leakage area segmentation network model called Customized Side Guided-Unet (CSG-Unet), using Unet as the baseline model. The main contributions are: (1) To improve the accuracy of water leakage area extraction, a customized side guided term is introduced to direct the net’s attention to the changes in light and shade within the image. A parallel attention network module is designed to extract internal information from the guided term. Subsequently, a strengthened channel attention module aggregates the guided term and the original information to achieve accurate segmentation of water leakage areas; (2) To address the scarcity of tunnel water leakage area datasets, a basic dataset is constructed by collecting data from open-source datasets and manually gathered data in tunnels. On this basis, perspective transformation is used to change the camera viewpoint, gaussian noise is randomly added to the images in the dataset to simulate images taken in dimly lit scenes, thereby expanding the dataset and enhancing the network’s generalization. The CSG-Unet network was trained using the constructed training set, achieving a mean Intersection over Union (mi IoU) of 85.54%, a mean Dice coefficient (mi Dice) of 85.26%, and a mean Pixel Accuracy (mi PA) of 90.85%. Compared to its baseline network, U-Net (tiny), these metrics show an improvement of over 3.2% in each indicator. Finally, a visual comparison between the improved network and the baseline network further confirms that the proposed model can effectively adapt to the segmentation of water leakage areas in complex environments.

Influence of patient characteristics and discharge destination on circulatory system diseases readmissions among older heart failure patients

IntroductionHeart failure (HF) prevalence is rising, particularly among older people, constituting a significant cause of hospitalization. Discharge destinations, including nursing homes (NH), play a crucial role in post-hospitalization outcomes but remain underexplored. MethodsA retrospective study utilizing the Spanish National Health System's Minimum Basic Data Set identified older HF patients (≥75 years) discharged from acute hospitals between 2016 and 2019. Patient demographics, comorbidities, and discharge destinations were analyzed. Predictors of 30-day readmissions for circulatory system diseases and NH admission were assessed using multilevel logistic regression models. ResultsOf 157,330 index episodes, 2.8 % were discharged to NH, more frequently in females. Thirty-day readmission incidence was 9.3 %, with HF exacerbations accounting for 80.6 % of cases. Predictors of 30-day readmission included renal failure (OR: 1.38), severe hematological disorders (OR: 1.30), and history of coronary revascularization surgery (OR: 1.23), while discharge to NH lowered the risk (OR: 0.70). Admission to NH was associated with neurological diseases (OR: 3.27), cardiogenic shock (OR: 3.19), stroke (OR: 2.68), advanced cancer (OR: 2.51), with higher likelihood among females (OR: 1.23). After propensity score-matched analysis, patients discharged to NH had significantly lower 30-day readmission rates than those discharged home (6.4 % vs. 28.9 %, adjusted OR: 0.169). ConclusionDischarge to NH is infrequent but associated with lower readmission risk for older HF patients. Female gender, specific comorbidities, and acute conditions influence NH admission. Enhanced collaboration between HF units and NH is crucial for optimizing post-hospitalization outcomes. Further research and policy initiatives are needed to improve care coordination and reduce HF readmissions.

Estimation of tuberculosis mortality burden in spain: a review of the major data sources

IntroductionIn Spain, notifications of cases of tuberculosis (TB) are registered through the National Epidemiological Surveillance Network (RENAVE). The Minimum Basic Data Set (CMBD) provides information on hospital discharge and the Statistics National Institute (INE) draws on medical death certificates. This study aimed to describe TB mortality in Spain and to compare estimates across data sources, as well as with EU/EEA countries.Material and MethodsA retrospective study of TB data between 2008 −2021 was performed. Mortality rates (MR) were calculated for the three databases as well as fatality rates (CFR) for TB location and HIV status using RENAVE data. Time trends were calculated and the average MR and annual average percentage change for Spain were compared with EU/EEA countries.ResultsBetween 2008 and 2021, 4127 TB deaths were reported to RENAVE, 3877 to INE and 4775 to CMBD. The MR was 0.62 per 100,000 inhabitants for RENAVE, 0.59 for INE and 0.72 for CMBD. A statistically significant downward annual trend was observed. Highest MR across all databases were found in men and in those over 80 years old. CFR was higher for meningeal TB and for HIV patients with a risk ratio of 2.02 (95%CI: 1.82-2.2; p&lt;0.05).ConclusionAlthough the TB MR in Spain has followed a downward annual trend, it is necessary to continue improving prevention, diagnosis and treatment. This will require comprehensive measurement, better knowledge and better use of all information to complement surveillance systems.

A search-and-fill strategy to code generation for complex software requirements

Context:The realm of software development has seen significant transformations with the rise of Low-Code Development (LCD) and the integration of Artificial Intelligence (AI), particularly large language models, into coding practices. The proliferation of open-source software also offers vast resources for developers. Objective:We aim to combine the benefits of modifying retrieved code with the use of an extensive code repository to tackle the challenges of complex control structures and multifunctional requirements in software development. Method:Our study introduces a Search-and-Fill strategy that utilizes natural language processing (NLP) to dissect complex software requirements. It extracts control structures and identifies atomic function points. By leveraging large-scale pre-trained models, the strategy searches for these elements to fill in the automatically transformed program structures derived from descriptions of control structures. This process generates a code snippet that includes program control structures and the implementations of various function points, thereby facilitating both code reuse and efficient development. Results:We have validated the effectiveness of our strategy in generating code snippets. For natural language requirements involving multifunctional complex structures, we constructed two datasets: the Basic Complex Requirements Dataset (BCRD) and the Advanced Complex Requirements Dataset (ACRD). These datasets are based on natural language descriptions and Python code that were randomly extracted and combined. For the code snippets to be generated, we achieved the best results with the ACRD dataset, with BLEU-4 scores reaching up to 0.6326 and TEDS scores peaking at 0.7807. Conclusion:The Search-and-Fill strategy successfully generates a comprehensive code snippets, integrating essential control structures and functions to streamline the development process. Experimental results substantiate our strategy’s efficacy in optimizing code reuse by effectively integrating preprocessing and selection optimization approach. Future research will focus on enhancing the recognition of complex software requirements and further refining the code snippets.

Constricting Gaps: Protocol development, implementation challenges and lessons learned for the reality map of unmet needs for Palliative Care Interventions in advanced cancer patients study in Romania and Switzerland

BackgroundPatients with advanced cancer experience many symptoms and needs requiring a Palliative Care Intervention (PCI). Identifying gaps between needs for PCIs and experienced delivery may improve health care, furthermore the association of gaps with quality indicators (QI). The multicentre Romanian (RO)-Swiss (CH) reality map study implemented a novel protocol based on needs concepts and culturally adapted quality indicators (QI). MethodsAn interactive mapping guide measuring unmet needs for PCIs monthly over six months, patient characteristics (cognition, EAPC basic data set, Cofactors) and QI (Inappropriate Anticancer Treatment, High Symptom Burden [IPOS, EQ5D], Repeated ER Admissions, Aggressive End-of-Life Care, and Quality of Death-and-Dying) were developed, applying swiss standards for quality assurance. A composite endpoint (QI, cofactors) was planned. Finally, local solutions responding to gaps were piloted. ResultsFrom 308 patients (RO: 262, CH: 46, age 62j [mean], 74 % ECOG PS 1&2, 81 % current anticancer treatment) baseline and first follow-up data revealed main gaps (symptom management, spiritual needs, family support), country differences (e.g. illness understanding, spiritual needs) and a significant association of the number of gaps with depression. Later data become less, and data quality on QI variable, revealing gaps in research conduct competences, resources, and applicability of over-sophisticated quality assurance tools. Nevertheless, the unmet needs data promoted local initiatives, 81 patients participated in feasibility studies. Finally, the joint experience stimulated academic developments and national integration of palliative care into oncology. ConclusionsPairing motivation and enthusiasm with more modest aims, feasibility testing of all outcomes and investment in research competences may disperse gaps.

Comprehensive analysis of multiple sclerosis hospitalization trends in Spain (1998–2022)

ObjectiveTo analyse the trends in MS hospitalization rates in Spain (1998–2022) considering age, period, and birth cohort (A-P-C) effects. MethodsThis retrospective study used data on MS hospitalizations from the Spanish National Health System Minimum Basic Data Set (CMBD). Age-Standardized Hospitalization Rates (ASHRs) and Joinpoint analysis were used to assess trends. A-P-C analysis was performed to estimate age-specific rates, period and cohort effects. ResultsFrom 1998 to 2022, MS hospital admissions in Spain declined annually by -2.1 %, with women showing a slightly greater decrease (-2.3 %) than men (-1.7 %). Joinpoint analysis revealed non-parallel trends, with three inflection points indicating distinct periods of stabilization and decline. ASHR showed an overall decrease, with -2.0 % for men and -2.2 % for women annually. Risk of hospitalization peaked in the 25–29-year age group for men and 30–34-year age group for women, declining with age. Women consistently had higher risk ratios across age groups. Cohort analysis showed periods of stabilization and decline in MS hospitalization risk, aligning with joinpoint analysis findings. Risk increased for cohorts born in the early 20th century, peaking around 1938, followed by a progressive decline in later cohorts. ConclusionsDespite an aging population, MS hospitalization rates in Spain decreased. The risk of hospitalization for MS is affected by a person's age, the time period they were born in, the historical context of healthcare received, and potentially their sex.

Population Distribution in Guizhou’s Mountainous Cities: Evolution of Spatial Pattern and Driving Factors

Guizhou is a typical mountainous province and is also one of the lowland regions in China that has attracted a population influx. Here, using population density data from 2000 to 2020 as the basic dataset and the coefficient of variation method and standard deviation ellipse analysis, we investigated the spatial characteristics across different years. The results show: Firstly, Guizhou’s population has a distinct spatial distribution, characterized by a lower population density in the southeast and a higher density in the northwest as well as an increasing polarization of population concentration toward the centers of prefecture-level cities and provincial capitals. Fluctuations in population density resemble a central siphon effect, which is particularly pronounced in the provincial capital and show a significant gravitational pull. Secondly, the coefficient of variation in population density across Guizhou’s counties is spatially divided by Guiyang, showing higher values in the east and lower values in the west. Furthermore, the ellipse of the standard deviation of population density is gradually shrinking, indicating an increasingly concentrated population distribution. Thirdly, the explanatory power of the population and socio-economic systems on the population distribution in Guizhou is significantly greater than that of the natural systems. Population distribution and migration patterns have shifted from purely “economic driven” to coexisting with “economic and comfort-oriented” trends, and there is an urgent need to improve the comfort level of public services as a typical supply, in order to boost Guizhou’s population attraction.

Effect of aerobic exercise program on neuropathic pain and quality of life in person with paraplegia: study protocol for a randomized controlled trial

BackgroundIndividuals with spinal cord injury (SCI) often suffer from neuropathic pain which is often disabling and negatively affects function, participation, and quality of life (QoL). Pharmacological treatments lack efficacy in neuropathic pain reduction hence studying alternatives to drug treatment is necessary. Preclinical evidence of various aerobic exercises has shown positive effects on neuropathic pain but scientific studies investigating its effect in the SCI human population are limited.MethodologyThis study is a double-blind, parallel, two-group, randomized controlled trial with an interventional study design that aims to evaluate the effectiveness of aerobic exercise program on neuropathic pain and quality of life (QoL) in individuals with chronic paraplegia. Thirty individuals with chronic paraplegia with the neurological level of injury from T2 to L2 will be recruited from the rehabilitation department at a super specialty hospital based on the inclusion criteria. Using a 1:1 allocation ratio, the participants will be randomly assigned to one of the two groups. The intervention group will perform high-intensity interval training (HIIT) aerobic exercise using an arm ergometer based on their peak heart rate, and the control group will perform free-hand arm aerobic exercise. In both groups, the intervention will be delivered as 30-min sessions, four times a week for 6 weeks.Outcome measuresInternational Spinal Cord Injury Pain Basic Data Set Version 3.0 will be used for diagnosing and assessing neuropathic pain and its interference with day-to-day activities, mood, and sleep. The International Spinal Cord Society (ISCoS) QoL basic data set will be used to assess QoL, and 6-min push test distance will be used to assess peak heart rate and aerobic capacity.DiscussionThe effectiveness of the aerobic exercise program will be assessed based on the changes in neuropathic pain score and its interference with day-to-day activities, mood, sleep, QoL, and aerobic capacity after 3 weeks mid-intervention and after 6 weeks post-intervention. The trial will provide new knowledge about the effectiveness of the aerobic exercise program in improving neuropathic pain and QoL in individuals with chronic paraplegia.Trial registrationClinical Trials Registry-India CTRI/2023/08/056257. Registered on 8 August 2023.

Exoskeleton Training for Spinal Cord Injury Neuropathic Pain (ExSCIP): Protocol for a Phase 2 Feasibility Randomised Trial.

Following Spinal Cord Injury (SCI), 53% of people develop neuropathic pain (NP). NP can be more debilitating than other consequences of SCI, and a persistent health issue. Pharmacotherapies are commonly recommended for NP management in SCI, although severe pain often remains refractory to these treatments in many sufferers. Furthermore, poor medication adherence exists, stemming from unacceptable side-effects and fear of dependency.Sensorimotor stimulation using active walking with robotic assistance has not been well studied in NP after SCI, despite convincing locomotor-based pre-clinical studies, identifying prevention and reversal of NP.Our primary aim is to assess the impact of exoskeleton-based walking on NP intensity and interference after SCI and examine feasibility outcomes for progression to a definitive trial. This is a phase 2 single-blinded, randomised feasibility study. It will test the feasibility and acceptability of exoskeleton-based walking 3 times per week for 12 weeks (intervention), as a mechanistic-based intervention for NP after SCI. The comparator will be an equally dosed, blended relaxation programme devoid of motor imagery prompts. 40 participants with moderate-to-severe NP post SCI will be recruited and randomised to intervention and comparator groups.The primary outcomes are feasibility outcomes for progression to definitive trial which include recruitment and retention rates, adverse events and acceptability of the intervention.Secondary outcomes explore changes in NP intensity and interference as measured by the International Spinal Cord Injury Pain Basic Data Set 3.0 (ISCIPBDS) at baseline, post-intervention (week 13) and at 6-month follow-up. There is a need to explore non-pharmacological management of NP after SCI. The findings of this feasibility trial will inform the development of a future multicentre, international RCT. NCT06463418, 08/07/2024, https://clinicaltrials.gov/study/NCT06463418.