Catchment Population Research Articles

Institutionalising maternal and newborn quality-of-care standards in Bangladesh, Ghana and Tanzania: a quasi-experimental study

IntroductionFacility interventions to improve quality of care around childbirth are known but need to be packaged, tested and institutionalised within health systems to impact on maternal and newborn outcomes.MethodsWe conducted...

Comparing registered and resident populations in Primary Care Networks in England: an observational study.

Primary Care Networks (PCNs) were established in England in 2019 and will play a key role in providing care at a neighbourhood level within integrated care systems (ICSs). To identify PCN 'catchment' areas and compare the overlap between registered and resident populations of PCNs. Observational study using publicly available data on the number of people within each Lower layer Super Output Area (LSOA) registered to each general practice in England in April 2021. LSOAs were assigned to the PCN to which the majority of residents were registered. The PCN catchment population was defined as the total number of people resident in all LSOAs assigned to that PCN. The PCN catchment populations were compared with the population of people registered to a GP practice in each PCN. In April 2021, 6506 GP practices were part of 1251 PCNs, with 56.1% of PCNs having 30 000-50 000 registered patients. There was a strong correlation (0.91) between the total registered population size and catchment population size. Significant variation was found in the percentage of residents in each LSOA registered to a GP practice within the same PCN catchment, and strong associations were found with both urban and rural status, and socioeconomic deprivation. There exists significant variation across England in the overlap between registered and resident (catchment) populations in PCNs, which may impact on integration of care in some areas. There was less overlap in urban and more deprived areas, which could exacerbate existing health inequalities.

Temporal monitoring of pharmaceutical consumption using a wastewater-based epidemiologic approach

Temporal monitoring of antidepressants, opioids consumption through influent wastewater, before and during the COVID-19 pandemic in Leuven, Belgium. Introduction: Conventional epidemiologic data sources on pharmaceutical consumption include surveys, prescription, sales, and dispensing data. However, prescribed medication may not always be dispensed, and surveys are affected by bias (e.g., response, reporting). Furthermore, data on pharmaceutical dispensing in Belgium only covers public pharmacies, and only records reimbursed medication (e.g., over-the-counter medication, some opioids are unrecorded). In addition, patients may not take the dispensed drugs as prescribed, or incorrectly. There is also a long lag time such as three years for survey data, and over three months for dispensing data. Wastewater-based epidemiology (WBE) centres on the analysis of biomarkers, i.e., human metabolic excretion products of xenobiotics in influent wastewater. WBE complements existing drug utilisation approaches and provides valuable, objective, spatio-temporal information on the consumption of pharmaceuticals in the general population that may not be measured in other datasets. WBE was applied to 24-h composite influent wastewater samples from Leuven, Belgium. Daily samples were analysed from Sept 2019 to Dec 2019 ( n = 63), and on each Monday, Wednesday, and Saturday of the week from Jan 2020 to Dec 2021 ( n = 165). The sampled period also included several governmental restrictions (e.g., stay at home measures) to contain the spread of SARS-CoV-2. Sample preparation and analysis consisted of preconcentration with solid-phase extraction and liquid chromatography coupled to tandem mass spectrometry, respectively. Measured concentrations (ng/L) of 21 pharmaceutical biomarkers, i.e., parent compounds and metabolites, were converted to population normalised mass loads (PNML) by considering the flow rate and catchment population. To better capture population movements, mobile phone data was used in the back-calculations. Concentrations of bupropion, hydromorphone, melitracen, noroxycodone, oxycodone, and tilidine were negligible or below limit of quantification and therefore excluded from further analysis. The pharmaceuticals, amitriptyline, hydroxy-bupropion, N-desmethylcitalopram, citalopram, N-desmethyl-mirtazapine, mirtazapine, trazodone, O-desmethylvenlafaxine, codeine, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine, methadone, morphine, nortilidine, O-desmethyltramadol, and tramadol were detected and included in the temporal assessment. The PNML of most psychoactive pharmaceuticals remained stable throughout the entire sampling period. Highest median PNML levels by pharmaceutical class, respectively opioid and antidepressant, were obtained for tramadol (median 508 mg/day/1000 people) and O-desmethylvenlafaxine (median 392 mg/day/1000 people). Governmental measures appear to have minimal effect on the consumption. Several studies have described the psychological distress (e.g., anxiety, stress) of these measures on mental health (COVID-19 Impact, Sciensano; Mental Health Considerations during COVID-19, WHO). However, there is a long lag time between onset of mental distress, help seeking, and the actual start of pharmaceutical therapy. The sampled period may need to be extended to detect this. It remains important to monitor psychoactive pharmaceuticals with addiction potential (e.g., opioids), as they have led to health crisis in other countries. Throughout the sampled period, a small difference in week/weekend PNML is observed for all analysed pharmaceuticals. Antidepressants and opioids are indicated to be used consistently, and long-term in case of antidepressants. We hypothesize that this change may be explained due to a change in population demographics. Leuven has a large commuting student population, approx. 45% of census population, although it should be noted that the catchment area also encompasses nearby areas. This study shows the potential of WBE to monitor consumption trends of pharmaceuticals with high temporal resolution, may not be captured by other data sources. Furthermore, our findings demonstrate that care should be taken when interpreting WBE results in case of large population disruption, such as a large commuting population or COVID-19 governmental measures.

TH6.7 Direct Streaming of Acute Surgical Patients to an Advanced Nurse Practitioner-led Service: A Prospective Audit of a Pilot Service to Improve Patient Flow

AimsThe ongoing uncertainty of the COVID-19 pandemic and recovery to re-establish elective services presents a major challenge to the NHS. Patient flow and bed capacity is now a priority for acute hospitals. We have implemented a new service model aimed at improving patient flow from A&E, where acute surgical patients are triaged and referred directly to the Advanced Nurse Practitioner (ANP) team for assessment and management. A criterion based on the presenting complaint and clinical observations was developed to identify suitable patients. The utilisation of this service was audited for its safety and impact on the Emergency General Surgical provision.MethodsThe setting is a busy University Teaching Hospital with a diverse catchment population of 75,000. A prospective audit identified the number of patients utilising the new care pathway and details of any adverse events or delays in treatment identified. All patients presenting with a General Surgical condition were included.ResultsBetween August and December 2021, 361 patients were referred directly from A&E (81% within first 2 hours of presentation) to the surgical ANP team for assessment. Of these, 85 (24%) were admitted for emergency treatment and 276 (76%) were discharged the same day for either ambulatory or outpatient follow-up, or back to Primary Care. There were no adverse events identified during the audit period.ConclusionDirect streaming of acute surgical patients within a defined criteria to an ANP-led service is safe and effective in helping to improve patient flow and experience within an acute care model.

Association of Younger vs Older Ages With Changes in Incidence of Stroke and Other Vascular Events, 2002-2018

Some studies have reported increasing stroke incidence at younger ages (<55 years) but have often relied only on administrative data, and more population-based studies of adjudicated stroke are required. An understanding of the drivers of any increase in incidence of young stroke also requires comparisons with stroke trends at older ages and with trends in incidence of other vascular events at younger ages. To determine temporal changes in incidence of stroke and other major vascular events at younger vs older ages. Prospective population-based incidence study conducted from April 2002 to March 2018 with a mean catchment population of 94 567 in Oxfordshire, England. Calendar time, premorbid vascular risk factors, and occupation. Changes in incidence of stroke, transient ischemic attack (TIA), and other major vascular events (myocardial infarction, sudden cardiac death, and peripheral vascular events) stratified by age, sex, diagnostic workup, etiology, and severity. A total of 2429 incident strokes were ascertained (mean age, 73.6 [SD, 14.4] years; 51.3% female). From 2002-2010 to 2010-2018, stroke incidence increased significantly among participants younger than 55 years (incidence rate ratio [IRR], 1.67; 95% CI, 1.31-2.14) but fell significantly among participants aged 55 years or older (IRR, 0.85; 95% CI, 0.78-0.92; P < .001 for difference). The significant increase in incidence at younger than 55 years was independent of sex, stroke severity, pathological subtype, and changes in investigation and was also seen for TIA (IRR, 1.87; 95% CI, 1.36-2.57) but not for myocardial infarction and other major vascular events (IRR, 0.73; 95% CI, 0.58-0.93). Although TIA and stroke at younger than 55 years were significantly associated with diabetes (risk ratio [RR], 3.47; 95% CI, 2.54-4.74), hypertension (RR, 2.52; 95% CI, 2.04-3.12), current smoking (RR, 2.38; 95% CI, 1.92-2.94), and obesity (RR, 1.36; 95% CI, 1.07-1.72), the significant increase in incidence from 2002-2010 to 2010-2018 was still seen in individuals without these risk factors. The increase was greatest in professional/managerial occupations (IRR, 2.52; 95% CI, 1.75-3.62) and least in partially skilled/unskilled occupations (IRR, 1.17; 95% CI, 0.79-1.74). The proportion of TIAs and strokes among those younger than 55 years without known vascular risk factors increased significantly over time (45 [30.4%] vs 115 [42.4%]; absolute difference, 12.0%; 95% CI, 2.6-21.5), especially in patients with cryptogenic events (10 [18.5%] vs 63 [49.2%]; absolute difference, 30.7%; 95% CI, 17.2-44.2; P < .001; P = .002 for heterogeneity). Comparing persons living in Oxfordshire, England, in 2002-2010 vs 2010-2018, there was a significant increase in stroke incidence in those younger than 55 years, but a decrease in those aged 55 years or older. Given the absence of this divergence for other vascular events, further research is needed to understand the causes of this difference.

Independent Predictors for Hospitalization-Associated Radiation therapy Interruptions

PurposeRadiation treatment interruption associated with unplanned hospitalization remains understudied. The intent of this study was to benchmark the frequency of hospitalization-associated radiation therapy interruptions (HARTI), characterize disease processes causing hospitalization during radiation, identify factors predictive for HARTI, and localize neighborhood environments associated with HARTI at our academic referral center. Methods and MaterialsThis retrospective review of electronic health records provided descriptive statistics of HARTI event rates at our institutional practice. Uni- and multivariable logistic regression models were developed to identify significant factors predictive for HARTI. Causes of hospitalization were established from primary discharge diagnoses. HARTI rates were mapped according to patient residence addresses. ResultsBetween January 1, 2015, and December 31, 2017, 197 HARTI events (5.3%) were captured across 3729 patients with 727 total missed treatments. The 3 most common causes of hospitalization were malnutrition/dehydration (n = 28; 17.7%), respiratory distress/infection (n = 24; 13.7%), and fever/sepsis (n = 17; 9.7%). Factors predictive for HARTI included African-American race (odds ratio [OR]: 1.48; 95% confidence interval [CI], 1.07-2.06; P = .018), Medicaid/uninsured status (OR: 2.05; 95% CI, 1.32-3.15; P = .0013), Medicare coverage (OR: 1.7; 95% CI, 1.21-2.39; P = .0022), lung (OR: 5.97; 95% CI, 3.22-11.44; P < .0001), and head and neck (OR: 5.6; 95% CI, 2.96-10.93; P < .0001) malignancies, and prescriptions >20 fractions (OR: 2.23; 95% CI, 1.51-3.34; P < .0001). HARTI events clustered among Medicaid/uninsured patients living in urban, low-income, majority African-American neighborhoods, and patients from middle-income suburban communities, independent of race and insurance status. Only the wealthiest residential areas demonstrated low HARTI rates. ConclusionsHARTI disproportionately affected socioeconomically disadvantaged urban patients facing a high treatment burden in our catchment population. A complementary geospatial analysis also captured the risk experienced by middle-income suburban patients independent of race or insurance status. Confirmatory studies are warranted to provide scale and context to guide intervention strategies to equitably reduce HARTI events.

Mapping the Swiss Vaccine Supply Chain.

ObjectivesThe design of the supply chain determines how effectively any vaccination campaign can be operated. This case study of Switzerland's vaccine supply chain compares its design with public health objectives. It maps the vaccine supply chain in Switzerland as it was set up to handle the first shipments of Covid-19 vaccine in 2021 to enable a more holistic view of supply and demand flows. Recommendations are made to improve emergency logistics of vaccines in the future.MethodsTwenty-six semi-structured interviews with international and Swiss stake-holders were coded and analyzed to arrive at a description of planning and distribution processes. The vaccine supply chain network structure was mapped, linking upstream and downstream flows of material and information. The visualization of nodes and flows was combined with spatial information, including population data. The results are summarized in narrative form to support decision-makers across disciplines.ResultsDespite adequate vaccine supply, abundant local endowments and high investment in infrastructure, the 2021 design of Switzerland's vaccine supply chain reduced the potential reach of target populations. The segmentation of catchment populations, collaboration between administrative units and better use of information on geolocation and material flows could have improved the speed and reach of vaccinations during the emergency response phase. Three recommendations are made for supply chain structures to support higher vaccination rates in the future.ConclusionsThe visualization identifies design alternatives which could have improved vaccination rates under the prevailing conditions. A supply chain map provides public health officials with a shared view of the vaccine supply chain in order to better match supply with demand. The case study contributes to developed country studies. In order to improve public health outcomes in Switzerland, investments to secure supply, strong national endowments, and excellent infrastructure must be combined with optimized supply chain design.

Active Surveillance With Seroprevalence-based Infection Rates Indicates Racial Disparities With Pediatric SARS-CoV-2 Requiring Hospitalization in Mississippi, March 2020-February 2021.

Background:Racial disparities in SARS-CoV-2 infection, hospitalization, and multisystem inflammatory syndrome in children (MIS-C) have been reported. However, these reports have been based on incomplete data relying on passive reporting, unknown catchment populations, and unknown infection prevalence. We aimed to characterize population-based incidence of MIS-C and COVID-19 hospitalizations among non-Hispanic Black and White children using active surveillance based on seroprevalence-based cumulative incidence of pediatric SARS-CoV-2 infection in a defined catchment 16-county area of Mississippi.Methods:Active, population-based surveillance for MIS-C and acute COVID-19 hospitalizations meeting clinical and laboratory criteria was conducted by adjudicating clinicians at the major pediatric referral hospital for Mississippi, University of Mississippi Medical Center, from March 2020, to February 2021. Race-stratified SARS-CoV-2 seroprevalence was estimated using convenience samples from persons <18 years to calculate cumulative SARS-CoV-2 infections in the population.Results:Thirty-eight MIS-C cases and 74 pediatric acute COVID-19 hospitalizations were identified. Cumulative incidence of MIS-C was 4.7 times higher among Black compared with White children (40.7 versus 8.3 cases per 100,000 SARS-CoV-2 infections). Cumulative incidence of COVID-19 hospitalization was 62.3 among Black and 33.1 among White children per 100,000 SARS-CoV-2 infections.Conclusions:From the same catchment area, active surveillance, and cumulative incidence of infection estimated by seroprevalence, we show strikingly higher incidence of SARS-CoV-2-hospitalization and MIS-C in non-Hispanic Black children compared with White children before COVID-19 vaccination introduction in children. These disparities in SARS-CoV-2 manifestations cannot be accounted for by differences in exposure or testing. Targeted vaccine interventions will lessen disparities observed with SARS-CoV-2 manifestations in children.

Incidence of poststreptococcal glomerulonephritis in northwestern Ontario: Cross-sectional study at a tertiary care centre.

To measure the incidence of poststreptococcal glomerulonephritis (PSGN) and resulting complications in northwestern Ontario, including among Indigenous and rural populations. Cross-sectional study. As the only tertiary care hospital in northwestern Ontario, Thunder Bay Regional Health Sciences Centre (TBRHSC) functions as the primary referral centre for most of the region. The catchment population has substantial Indigenous (21.5%) and rural (34.2%) populations. All cases of PSGN managed at TBRHSC over an 8-year period from January 1, 2010, to December 31, 2017. Cases were classified as confirmed, probable, or possible based on the type of evidence available. Patients' rurality and Indigenous status were recorded. Incidence rates and incidence rate ratios of all, pediatric (<18 years), and adult PSGN cases were calculated, as were incidence rates and incidence rate ratios of those requiring dialysis. Linear interpolation and extrapolation were used to estimate the population in non-census years. Over the 8-year study period, 33 cases of PSGN were observed with annual incidence rates of 0.0 to 4.8 per 100,000 person-years and a mean annual incidence rate of 1.8 (95% CI 1.2 to 2.5) per 100,000 person-years. Of these 33 cases, 28 were confirmed with renal biopsy or clinical and laboratory data. Indigenous patients accounted for 61% (n=17) of confirmed cases and were 6.0 (95% CI 2.8 to 13, P<.001) times as likely to have PSGN and 9.6 (95% CI 3.0 to 31, P<.001) times as likely to require dialysis compared with non-Indigenous patients. Patients living in rural areas accounted for 71% (n=20) of confirmed cases and were 3.2 (95% CI 1.4 to 7.3, P=.006) times as likely to have PSGN and 3.9 (95% CI 1.0 to 10, P=.02) times as likely to require dialysis compared with patients in urban areas. The main burden of PSGN in northwestern Ontario occurs among Indigenous and rural populations. Additional research is required to investigate the true overall burden of PSGN in the region. In collaboration with regional Indigenous groups, advocacy is needed for PSGN to be made reportable and public health action must be taken to address these pronounced disparities.

The reorganisation of emergency general surgery services during the COVID-19 pandemic in the UK: outcomes of delayed presentation, socio-economic deprivation and Black, Asian and Minority Ethnic patients.

The COVID-19 pandemic is a global public health emergency. Lockdown restrictions and the reconfiguration of healthcare systems to accommodate an increase in critical care capacity have had an impact on 'non-COVID' specialties. This study characterises the utilisation of emergency general surgery (EGS) services during the UK lockdown period at a university teaching hospital with a catchment population that represents one of the most deprived and ethnically diverse areas in the UK. EGS admissions during the UK lockdown period (March to May 2020) were compared with the same period in 2019. Patient demographics were recorded together with clinical presentation, hospital stay and treatment outcomes, and readmission data. The study included 645 patients, comprising 223 in the COVID-19 period and 422 in the non-COVID-19 period. There was no difference in age, sex, comorbidity or socio-economic status. A lower proportion of patients of Black, Asian and Minority Ethnicity (BAME) were admitted during the pandemic (20.6% vs 35.4%, p<0.05). The duration of symptoms prior to presentation was longer, and admission clinical parameters and serum inflammatory markers. More patients presented with an acute kidney injury (9.9% vs 4.7%, p=0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, p=0.023). The reorganisation of EGS to a senior-led model has been successful in terms of outcomes and access to treatment despite a more unwell population. There was a significantly lower proportion of BAME admissions suggesting additional barriers to healthcare access under pandemic lockdown conditions.

An investigation of the relationship between the performance and management practices of health facilities under a performance-based financing scheme in Nigeria

Whereas the effect of performance-based financing (PBF) on improving the quantity and quality of health services has been established, little is known about what matters for health facilities to improve performance under a PBF scheme. This study examined the associations between management practices and the performance of primary healthcare centres (PHCCs) under a PBF scheme in Nigeria. This study utilized longitudinal data on monthly institutional deliveries and outpatient visits collected between December 2011 and March 2016 from 111 randomly selected PHCCs in Adamawa, Ondo and Nasarawa states of Nigeria. A management practices scorecard, based on a health facility survey conducted in April/May 2016, was used to derive management practices scores for the 111 PHCCs. The management practices examined included activities to recruit and retain clients, staff's attention to performance targets, listening and responding to client feedback, teamwork building and addressing low-performing staff. A multilevel, multilinear regression model was used to investigate the associations between health facility performance (monthly number of institutional deliveries and outpatient visits) and management practices at the PHCCs, adjusting for key control variables (number of skilled health workers, the size of PHCC catchment population, PHCC quality score, seasonality and states). Following PBF introduction, PHCCs with medium management scores had 0.42 (95% CI 0.18-0.65; P < 0.001) and 9.93 (95% CI 6.15-13.71; P < 0.001) higher monthly improvement rates for institutional delivery and outpatient visits, respectively, compared to the PHCCs with low management scores. Also, the PHCCs with high management scores had 0.49 (95% CI 0.28-0.70; P < 0.001) and 5.10 (95% CI 1.76-8.44; P < 0.003) higher monthly improvement rates for institutional delivery and outpatient visits compared to the PHCCs with low management scores. These findings suggest the importance of management practices in facilitating the effect of PBF on health facility performance and the need to strengthen PHCC management practices in low- and middle-income countries.

An Equity Evaluation on Accessibility of Primary Healthcare Facilities by Using V2SFCA Method: Taking Fukuoka City, Japan, as a Case Study

The primary healthcare facilities are among the most basic needs of the residents, huge in quantity and widespread. Their distributions are directly related to people’s health, which affects the sustainable development of cities. The accessibility calculation of primary level healthcare facilities and the equity evaluation of accessibility from the perspective of medical service category and urban population is very important for the decision-making of layout and configuration but has been ignored for a long time. This study took the primary healthcare facilities of Fukuoka city in Japan as research objects; it first used the variable two-step floating catchment area (V2SFCA) method to calculate the healthcare catchment areas (HCAs) of medical service providers and the population catchment area (PCAs) of medical demand locations, and then obtained the accessibility to primary healthcare facilities. Finally, the spatial disparities of accessibility were evaluated from three aspects: overall space distribution by using Global and Local Moran’s I, service quality, and the population to be served. The results showed that HCAs were from 500 m to 6400 m, PCAs ranged from 500 m to 3000 m, the use of variable catchments can improve the accuracy of accessibility assessment results; the accessibility of primary healthcare facilities was clustered and had significant spatial differences, which were high in urban center and low in suburban area; the obvious differences in the accessibility distribution characteristics of clinics in differential diagnosis and treatment departments led to different degrees of unsaturation in the types of medical services obtained by residents; although the elderly’s demand for basic medical care was many times higher than that of other age groups, the accessibility in high-demand areas was generally low, and the situation in severely high-demand areas was more serious. This work puts forward a multi-dimensional realistic evaluation system for equality accessibility of primary healthcare facilities, providing the data support for the medical resources and facilities’ allocation and the intensive land use.

Temporal monitoring of stimulants during the COVID-19 pandemic in Belgium through the analysis of influent wastewater.

Background and aimsWastewater-based epidemiology (WBE) is a complementary epidemiological data source to monitor stimulant consumption. The aims were to: (i) study intra- and inter-year temporal changes in stimulant use in Belgium during the first wave of the COVID-19 pandemic; and (ii) evaluate the effect of COVID-19 restrictive measures on stimulant consumption.MethodsThe study population corresponded to the catchments of four wastewater treatment plants corresponding with four Belgian cities (i.e., Antwerp-Zuid, Boom, Brussels, Leuven). Daily 24-h composite influent wastewater samples collected over one week in September 2019 and March through June 2020 during the first wave of the COVID-19 pandemic were analyzed for biomarkers of amphetamine, cocaine, methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA). Measured concentrations were converted to population-normalized mass loads by considering the daily flow rate and the catchment population size. Mobile network data was used to accurately capture population movements in the different catchment areas. Temporal changes were assessed with multiple linear regression models, and the effect of the COVID-19 interventions on stimulant consumption were investigated.ResultsAn increase in amphetamine use was observed in three cities during governmental restrictions, with highest consumption predominantly during lockdown. Similarly, cocaine consumption was higher after the pandemic started, with highest consumption noted during the lockdown period in Boom and Leuven. Consumption of MDMA was similar in Antwerp-Zuid, Brussels and Leuven throughout the entire sampled period. In Boom, the highest consumption was observed during the full lockdown period.ConclusionsThe present study shows the potential of WBE to assess the impact of stringent lockdown measures on stimulant use in Belgium. This paper shows that strong restrictive measures did not have a profound effect on stimulant consumption.

Incidence of hip fracture in Saudi Arabia and the development of a FRAX model

SummaryA prospective hospital-based survey in representative regions of Saudi Arabia determined the incidence of fractures at the hip. The hip fracture rates were used to create a FRAX® model to facilitate fracture risk assessment in Saudi Arabia.ObjectiveThis paper describes the incidence of hip fracture in the Kingdom of Saudi Arabia that was used to characterize the current and future burden of hip fracture, to develop a country-specific FRAX® tool for fracture prediction and to compare fracture probabilities with neighbouring countries.MethodsDuring a 2-year (2017/2018) prospective survey in 15 hospitals with a defined catchment population, hip fractures in Saudi citizens were prospectively identified from hospital registers. The number of hip fractures and future burden was determined from national demography. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Saudi Arabia. Fracture probabilities were compared with those from Kuwait and Abu Dhabi.ResultsThe incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 2,949 and is predicted to increase nearly sevenfold to 20,328 in 2050. Hip fracture rates were comparable with estimates from Abu Dhabi and Kuwait. By contrast, probabilities of a major osteoporotic fracture or hip fracture from the age of 70 years were much lower than those seen in Abu Dhabi and Kuwait due to higher mortality estimates for Saudi Arabia.ConclusionA country-specific FRAX tool for fracture prediction has been developed for Saudi Arabia which is expected to help guide decisions about treatment.

Catchment‐scale distribution, abundance, habitat use, and movements of European eel (Anguilla anguilla L.) in a small UK river: Implications for conservation management

Abstract Effective conservation management of the Critically Endangered European eel (Anguilla anguilla) is hindered by incomplete understanding of distribution, abundance, and habitat requirements at the catchment scale. All habitats available to eels within a small, highly regulated river catchment, representative of many used across the species' range, were sampled using several methods (including point abundance sample electric fishing and fyke nets) and supplemented by individual telemetry to investigate movements. Eels were found throughout the catchment (59% of n = 131 sites) from the coastal marshes to the headwaters, although the probability of presence declined with distance from the estuary. The lack of a clear relationship with perceived barriers may illustrate a mismatch with the reality experienced by eels, as telemetry identified connectivity across obstacles between paludal habitat and estuary, and detected escapement of mature silver eels from both lotic and lacustrine habitat. Different size/age classes occurred in different parts of the catchment, partly linked to different habitat associations, with coastal paludal habitat supporting &gt;50% of the catchment population and especially smaller (possibly male dominated) yellow eels. Recently recruited elvers were most abundant in the lower reaches of lotic habitat. The largest (probably female) eels were concentrated in lacustrine sites, especially at the ‘end‐of‐the‐line’ in the headwaters. Experiences here suggest that conservation management for eels in small catchments is best focused on: (i) improving connectivity and assisting migration of elvers across ‘problem’ barriers that cannot be removed or modified, (ii) river restoration and rewilding, especially measures that increase instream woody material to provide refuge habitat and, (iii) enhancement or creation (where necessary) of suitable lacustrine habitat to benefit large females in particular. Such action across numerous small river catchments may ultimately help support the recovery of eel stocks.

Invasive infections of Bacillus species in Iceland, 2006-2018

The bacterial genus Bacillus is widely distributed environmentally and is usually considered a low-virulence organism, except for B. anthracis. A blood culture positive for Bacillus is often looked at as contamination. Nevertheless, B. cereus can cause invasive infections in humans and produces harmful toxins. The epidemiology of these infections remains poorly studied. All possible invasive infections caused by Bacillus during 2006-2018 at Landspitali University Hospital were identified from culture results. Clinical information was used to evaluate if there was a possible infection or confirmed infection. Here, the authors propose and use clinical criteria to categorize each case as contamination, possible infection or confirmed infection. The incidence of possible or confirmed infections was calculated using hospital catchment population data. Positive cultures of Bacillus sp. from sterile sites during 2006-2018 were identified from 126 patients; blood (116), synovial fluid (8) and cerebrospinal fluid (2). In total, 26 cases were confirmed infection (20.6%), 10 possible infection (7.9%) and 90 contamination (71.4%). The incidence was 1.4 cases/100.000 inhabitants/year. Injection drug use was a risk factor among 11/26 patients with confirmed infection. The most common clinical presentation was sepsis. In this study, Bacillus was resistant to beta-lactam antibiotics in 92% of confirmed infections and 66% of the cases considered contamination (p=0.02). Positive blood cultures of Bacillus sp. should be taken seriously, especially among patients with injection drug use, malignancy or immunocompromised state. It is important to draw two sets of blood cultures if there is a real suspicion of an infection to establish diagnosis and avoid unnecessary antibiotic therapy.

Prospective Elective Neurosurgical Theater Utilization Audit in Pakistan: Problems in a Public Tertiary Care Hospital and Proposed Solutions from Lower-Middle-Income Country.

Background In lower-middle-income countries such as Pakistan, public hospitals provide free healthcare but suffer from poor management and misgovernance, negatively impacting service provision. One aspect of this is operating theater time (OTT) utilization. In a 1,600-bed hospital with a 22 million catchment population, we noticed significant delays and inadequate OTT efficiency at the neurosurgery department of Jinnah Hospital, Lahore, Punjab, Pakistan. This audit aimed to analyze the neurosurgical OTT utilization, identify delays, and highlight managerial deficiencies and areas for improvement while comparing our workflow with contemporary international literature. Materials and Methods We prospectively audited OTT utilization at the neurosurgical department. All elective surgeries from January to April 2021 were included to identify delays concerning patient transfer, anesthesia team arrival, preparation and intubation time, operative time, and anesthesia extubation time. Results Fifty-six per cent of OTT was utilized operating. Sources of delay included the delayed arrival of anesthesia team (4.7%) and the delay in transferring patients to OT (9.7%). Anesthesia intubation and preparation time accounted for 23% of OT utilization and was significantly longer than the comparable international studies. Extubation time accounted for 5.7% of OT utilization. The issues surrounding transfer delays and prolonged anesthesia time were discussed, with strategies to address them developed with close vital input from our anesthesia colleagues and ward staff. Conclusion Gross delays relatively simple in nature were identified due to poor management and less than ideal interspecialty coordination. Most delays were avoidable and can be addressed by proper planning, optimization of patient transfer and resources, and, most importantly, improved communication between surgeons, anesthetists, and ward staff. This can ensure optimal use of theater time and benefit all specialties, including ancillary staff, and, most importantly, the patient. A reaudit is warranted to assess the impact of interventions on OTT utilization.

AlzEye: longitudinal record-level linkage of ophthalmic imaging and hospital admissions of 353 157 patients in London, UK

PurposeRetinal signatures of systemic disease (‘oculomics’) are increasingly being revealed through a combination of high-resolution ophthalmic imaging and sophisticated modelling strategies. Progress is currently limited not mainly by technical issues,...

Predicted Global Spread of SARS-CoV-2 Alpha Variant of Concern via Air Travel

PurposeTo predict the global spread of SARS-CoV-2 Alpha Variant of Concern (VoC) from England via air travel and compare against observed importation.Methods & MaterialsRisk models were used to estimate a country's likelihood of importing at least one traveller infected with the Alpha VoC from England by January 19, 2021.First, the prior 60-day incidence of Alpha VoC associated with each English airport was estimated using cumulative Alpha VoC cases reported by Public Health England between September 20, 2020 – January 4, 2021 proportionately allocated to each airport. Each airport's catchment population was derived from a probabilistic Huff model. Next, the prevalence of the Alpha VoC for each airport was derived from the estimated incidence to represent the probability that at least one departing traveller was infected with the Alpha VoC for each English airport. The prevalence and forecasted flight volumes were used to estimate the likelihood of each destination airport receiving at least one infected traveller from England. Forecasted flight volumes were based on historical passenger volumes data from the International Air Transport Association and prospective flight schedules from CIRIUM. All airport-level likelihoods were aggregated to the country-level.Each country's predicted likelihood was compared against observed cases of Alpha VoC by January 25, 2021, collected by cov-lineages.org and a manual search of online sources.ResultsAmong 211 countries, the median likelihood was 1.6% (interquartile range: 17.5%) and the mean was 13.9% (SD: 23.5%). In total, 28.9% (n=55) of countries had observed importation of the Alpha VoC by January 25th. Fifteen of 16 countries with a predicted likelihood of importation greater than 50% had reported at least one case (kappa = 0.88), while 31 of 39 countries with a predicted likelihood lower than 1% did not detect a case (kappa = 0.92).ConclusionRisk models based on air travel to inform public health preparedness accurately identified most potential destinations at highest risk of importing the SARS-CoV-2 Alpha VoC.

The impact of COVID-19 on a cohort of origin residents and internal migrants from South Africa's rural northeast

South Africa has a large temporary migrant population with people commonly moving to metropolitan areas to access employment, while maintaining links with their rural origin households. The COVID-19 pandemic has impacted patterns of movement, livelihoods and health seeking, and the effects on internal, temporary migrants are unclear. Using longitudinal data spanning 2018 to 2020, this paper employs descriptive statistics and regression analyses to assess the impacts of COVID-19 on a cohort of 2971 persons aged 18–40 at baseline, both residents and migrants, from a rural district in South Africa's northeast. In contrast with 2018–2019, in 2020 the share of rural residents initiating a migration decreased by 11 percentage points (p<0.001), while the share of temporary migrants returning to origin households increased by 5 percentage points (p<0.001). Study participants who were continuing migrants reported fewer job losses in comparison with rural-stayers, while 76% of return migrants who were employed in 2019 were no longer employed in 2020. Further, among those who did not experience food shortages in 2019, rural-stayers had 1.42 times the odds of continuing migrants of suffering shortages in 2020. In 2020 health service use in the cohort decreased overall, with return migrants having still lower odds of utilising health services. The results highlight the differential geographic and socioeconomic manifestations of the pandemic, with worsening socioeconomic circumstances observed for rural-staying (disproportionately female) and returning populations, while continuing migrants fared relatively better. It is vital that a COVID-19 response considers the potentially heterogeneous impact of the pandemic on mobile and stable populations. Policy responses may include targeting migrants at their destinations in health promotion of COVID-19 messaging, and strengthening health care and social support in origin communities in recognition that these areas receive return migrants into their catchment population.