Catchment Population Research Articles

Antibiotic Consumption in Vanuatu before and during the COVID-19 Pandemic, 2018 to 2021: An Interrupted Time Series Analysis.

The study objectives were to examine antibiotic consumption at Vila Central Hospital (VCH), Vanuatu between January 2018 and December 2021 and the influence of the COVID-19 pandemic on antibiotic consumption during this period. Data on antibiotic usage were obtained from the Pharmacy database. We used the WHO's Anatomical Therapeutic Classification/Defined Daily Dose (ATC/DDD) index, VCH's inpatient bed numbers and the hospital's catchment population to calculate monthly antibiotic consumption. The results were expressed as DDDs per 100 bed days for inpatients (DBDs) and DDDs per 1000 inhabitants per day for outpatients (DIDs). Interrupted time series (ITS) was used to assess the influence of COVID-19 by comparing data before (January 2018 to January 2020) and during (February 2020 to December 2021) the pandemic. Ten antibiotics were examined. In total, 226 DBDs and 266 DBDs were consumed before and during COVID-19 by inpatients, respectively with mean monthly consumption being significantly greater during COVID-19 than before the pandemic (2.66 (p = 0.009, 95% CI 0.71; 4.61)). Whilst outpatients consumed 102 DIDs and 92 DIDs before and during the pandemic, respectively, the difference was not statistically significant. Findings also indicated that outpatients consumed a significantly lower quantity of Watch antibiotics during COVID-19 than before the pandemic (0.066 (p = 0.002, 95% CI 0.03; 0.11)). The immediate impact of COVID-19 caused a reduction in both inpatient and outpatient mean monthly consumption by approximately 5% and 16%, respectively, and this was followed by an approximate 1% monthly increase until the end of the study. By mid-2021, consumption had returned to pre-pandemic levels.

Assessing travel time-based accessibility to outdoor ice skating fields for children in Helsinki during the COVID-19 pandemic

Informal sport is central to Finnish children’s leisure and physical activity time. This paper aims to build a better understanding of the travel time-based accessibility to informal sports facilities, specifically to ice skating fields, for children and adolescents (aged 7–19) in the city of Helsinki. We focused on the winter of 2020–2021 because COVID-19 restrictions on indoor activities resulted in ice skating fields being among the few public facilities that could remain open. Additionally, the weather was favourable for maintaining outdoor ice skating fields. We analysed if there would be a difference in children’s independent travel times by public transport or walking to ice skating fields due to the COVID-19 pandemic related recommendations by Helsinki Region Transport to avoid public transport. Children in Finland usually travel to and from school independently. Hence we focused on the transition from public transport to walking and omitted car usage, which would require an adult. We also looked at the potential differences in travel time to ice skating fields by analysing different types of fields separately. This difference would be of significance if climate change resulted in warmer winters in Finland. Helsinki has two types of ice skating fields: naturally frozen and mechanically frozen, of which only the mechanically frozen fields would be used during a warmer winter that is above zero degrees Celsius. We took a geographic information systems (GIS) analysis approach using travel time and population catchments. The study’s main findings show that during a milder winter and by walking, the accessibility for children is greatly reduced to 55.2%; that is, children face an increased travel time when naturally frozen ice skating fields are not in use. However, almost 100% of the child population can access both types of fields within a travel time of 30 minutes by public transport.

External validation of the GCS-Pupils Score as an outcome predictor after traumatic brain injury in adults: a single-center experience

The GCS-Pupils (GCS-P) score is a recently described scoring system to aid outcome prediction in patients with traumatic brain injury (TBI). The aim of this study was to provide the first external validation of the GCS-P score by identifying independent predictors of outcome in TBI patients. Review of prospective adult (≥ 16years) TBI database at a tertiary neurosurgical center with a catchment population of 1.5 million over a 12-month period commencing October 2016. Multivariate logistic regression was used to identify predictors of discharge destination and 30-day mortality. Three hundred and fifty-eight patients were included. The median age was 60years with a male predominance of 64%. The median GCS-P was 14 (interquartile range 12-15) and the commonest GCS-P category was mild (13-15; 238/358, 66%). Discharge destination was home in 69% of patients and rehab services or equivalent in 31%. Multivariate analysis identified age (p = 0.01), CT findings of an acute subdural hematoma (p = 0.01) or diffuse axonal injury (p = 0.02), and a neurosurgical operation (p = 0.02) as independent predictors of discharge destination. The 30-day mortality rate was 11%. Within the category of severe TBI (GCS-P ≤ 8), GCS-P was able to identify patients with a very high likelihood of 30-day mortality (GCS-P ≤ 4; 16/31, 52%). Multivariate analysis revealed the Charlson comorbidity score (p = 0.01), GCS-P (p = 0.02), and traumatic subarachnoid hemorrhage (p = 0.05) as independent predictors of mortality. The GCS-P is a useful predictor of 30-day mortality, although its usefulness for other clinical outcomes remains to be proven.

LINK-B: study protocol of a retrospective and prospective project for identification and linkage to care of people living with hepatitis B in a large health area of Barcelona

IntroductionAn estimated 290 million people are living with hepatitis B virus (HBV) worldwide; in Spain, the prevalence of hepatitis B virus surface antigen (HBsAg) is 0.4%. In our setting, many...

Ethnic Disparities in CT Aortography Use for Diagnosing Acute Aortic Syndrome.

To determine whether CT aortography was performed in proportion to patient risk for acute aortic syndrome (AAS) and incidence of AAS for different ethnic groups. All atraumatic thoracic aorta CT aortographic examinations performed in adults (age > 15 years) suspected of having AAS between January 2009 and December 2019 at Auckland City Hospital (New Zealand) were included. Patients were risk stratified using the aortic dissection detection risk score (ADD-RS). The primary outcomes were the ratio of CT aortography rates to rates of positive CT aortographic examinations and the incidence of AAS. Population census data were used to determine age-standardized incidence of AAS in the emergency department (ED). In total, 1646 CT aortographic examinations were performed in 1543 patients (mean age, 62 years ± 16 [SD]; 877 male patients). Māori (34% [68 of 203]) and Pacific Islanders (35% [80 of 229]) were more likely to be at high risk of AAS (ADD-RS > 1) compared with patients from other ethnic groups (25% [308 of 1214]); in the ED catchment population, age-standardized AAS incidence was significantly higher in Māori (6.9 per 100 000 person-years [95% CI: 4.3, 10.4]) and Pacific Islanders (5.3 [95% CI: 3.4, 7.8]) than in other ethnic groups (2.3 [95% CI: 1.8, 2.8]). Despite this higher incidence, disproportionately fewer CT aortographic examinations were requested in the ED for Māori (9.2 CT aortographic examinations per AAS diagnosis) and Pacific Islanders (9.2 CT aortographic examinations per AAS diagnosis) compared with other ethnic groups (13.8 CT aortographic examinations per AAS diagnosis). Māori and Pacific Islanders were at disproportionately higher risk of AAS but had fewer requested CT aortographic examinations compared with other ethnic groups. This increased risk of AAS in Pacific Islander and indigenous Māori patients should be considered by clinicians when investigating AAS.Keywords: Ethnicity, Māori, Pacific Islander, Aortic Dissection Detection Risk Score, Acute Aortic Syndrome, Aortic Dissection, CT Angiography Supplemental material is available for this article. © RSNA, 2022.

A wastewater-based evaluation of the effectiveness of codeine control measures in Australia.

From 1 February 2018, codeine was rescheduled from an over-the-counter (OTC) to a prescription-only medicine in Australia. We used wastewater-based epidemiology to measure changes in population codeine consumption before and after rescheduling. We analysed 3703 wastewater samples from 48 wastewater treatment plants, taken between August 2016 and August 2019. Our samples represented 10.6 million people, 45% of the Australian population in state capitals and regional areas in each state or territory. Codeine concentrations were determined by liquid chromatography-tandem mass spectrometry and converted to per-capita consumption estimates using the site daily wastewater volume, catchment populations and codeine excretion kinetics. Average per-capita consumption of codeine decreased by 37% nationally immediately after the rescheduling in February 2018 [95% confidence interval (CI) = 35.3-39.4%] and substantially in all states between 24 and 51% (95% CI = 22.4-27.0% and 41.8-59.4%). The decrease was sustained at the lower level to August 2019. Locations with least pharmacy access decreased by 51% (95% CI = 41.7-61.7%), a greater decrease than 37% observed for those with greater pharmacy access (95% CI = 35.1-39.4%). Regional areas decreased by a smaller margin to cities (32 versus 38%, 95% CI = 30.2-34.1% versus 34.9-40.4%, respectively) from a base per-capita usage approximately 40% higher than cities. Wastewater analysis shows that codeine consumption in Australia decreased by approximately 37% following its rescheduling as a prescription-only medicine in 2018. Wastewater-based epidemiology can be used to evaluate changes in population pharmaceutical consumption in responses to changes in drug scheduling.

Drivers of respiratory syncytial virus seasonal epidemics in children under 5 years in Kilifi, coastal Kenya.

Respiratory syncytial virus (RSV) causes significant childhood morbidity and mortality in the developing world. The determinants of RSV seasonality are of importance in designing interventions. They are poorly understood in tropical and sub-tropical regions in low- and middle-income countries. Our study utilized long-term surveillance data on cases of RSV associated with severe or very severe pneumonia in children aged 1 day to 59 months admitted to the Kilifi County Hospital. A generalized additive model was used to investigate the association between RSV admissions and meteorological variables (maximum temperature, rainfall, absolute humidity); weekly number of births within the catchment population; and school term dates. Furthermore, a time-series-susceptible-infected-recovered (TSIR) model was used to reconstruct an empirical transmission rate which was used as a dependent variable in linear regression and generalized additive models with meteorological variables and school term dates. Maximum temperature, absolute humidity, and weekly number of births were significantly associated with RSV activity in the generalized additive model. Results from the TSIR model indicated that maximum temperature and absolute humidity were significant factors. Rainfall and school term did not yield significant relationships. Our study indicates that meteorological parameters and weekly number of births potentially play a role in the RSV seasonality in this region. More research is required to explore the underlying mechanisms underpinning the observed relationships.

Long-term data reflect nitrogen pollution in Estonian rivers

Abstract We analysed long-term (1992–2020) changes in fertiliser use, wastewater treatment, and river water nutrient status in Estonia (N-E Europe) in the context of changing socio-economic situations and legislation. We hypothesised that improved regulation of fertiliser usage and wastewater treatment are reflected as declining riverine nutrient concentrations, with the largest relative improvements occurring in catchments with initially high proportions of point source loading. We analysed nutrient dynamics in 16 rivers differing by catchment land use, population and livestock densities. Data on fertiliser use and wastewater treatment originated from the Statistics Estonia database, and riverine nutrient concentrations from the State Environmental Monitoring Database. We clustered the rivers by their catchment properties and analysed trends in their nutrient status. Point source nutrient loading reductions explained most of the decline in riverine nutrient concentrations, whereas application of mineral fertilisers has increased, hindering efforts to reach water quality and nutrient load targets set by the EU Water Framework Directive and the Baltic Sea Action Plan. Highest nitrogen concentrations and strongest increasing trends were found in rivers within the Nitrate Vulnerable Zone, indicating violation of the EU Nitrates Directive. To comply with these directives, resource managers must address non-point source nutrient loading from river watersheds.

Analysis of factors influencing technical efficiency of public district hospitals in KwaZulu-Natal province, South Africa

BackgroundDistrict hospitals are crucial in supporting primary health care and serve as a gateway to more specialist care through a referral system. Majority of South Africans access health care services through the public sector district health system. Given the enormous task assigned to the public district hospital within the country, this study examined factors influencing their technical efficiency.MethodData were collected for 38 public district hospitals in KwaZulu-Natal province from 2014/15 to 2016/17. Data envelopment analysis (DEA) was used to determine the technical efficiency of the hospitals, adopting both the constant return to scale (CRS) and variable return to scale (VRS) models. Tobit regression model was used to determine factors related to the technical efficiency of the district hospitals.ResultsThis study showed that a significant proportion of the district hospitals were technically inefficient. The Tobit regression model identified catchment population, the proportion of inpatients treated per medical personnel, the proportion of inpatients treated per nursing personnel and expenditure per patient day equivalent as factors influencing technical efficiency of the district hospitals.ConclusionFindings from this study suggest that the technical efficiency of the district hospitals can be enhanced through an effective referral system and improved peoples’ health-seeking behaviour. In addition, a standard mix of clinical staff toward efficient service delivery and periodic cost analysis of health services with the view to saving cost and maintaining the quality of health care should be considered.

Stratification of malaria incidence in Papua New Guinea (2011-2019): Contribution towards a sub-national control policy.

Malaria risk in Papua New Guinea (PNG) is highly heterogeneous, between and within geographical regions, which is operationally challenging for control. To enhance targeting of malaria interventions in PNG, we investigated risk factors and stratified malaria incidence at the level of health facility catchment areas. Catchment areas and populations of 808 health facilities were delineated using a travel-time accessibility approach and linked to reported malaria cases (2011-2019). Zonal statistics tools were used to calculate average altitude and air temperature in catchment areas before they were spatially joined with incidence rates. In addition, empirical Bayesian kriging (EBK) was employed to interpolate incidence risk strata across PNG. Malaria annual incidence rates are, on average, 186.3 per 1000 population in catchment areas up to 600 m, dropped to 98.8 at (800-1400) m, and to 24.1 cases above 1400 m altitude. In areas above the two altitudinal thresholds 600m and 1400m, the average annual temperature drops below 22°C and 17°C, respectively. EBK models show very low- to low-risk strata (<100 cases per 1000) in the Highlands, National Capital District and Bougainville. In contrast, patches of high-risk (>200 per 1000) strata are modelled mainly in Momase and Islands Regions. Besides, strata with moderate risk (100-200) predominate throughout the coastal areas. While 35.7% of the PNG population (estimated 3.33 million in 2019) lives in places at high or moderate risk of malaria, 52.2% (estimated 4.88 million) resides in very low-risk areas. In five provinces, relatively large proportions of populations (> 50%) inhabit high-risk areas: New Ireland, East and West New Britain, Sandaun and Milne Bay. Incidence maps show a contrast in malaria risk between coastal and inland areas influenced by altitude. However, the risk is highly variable in low-lying areas. Malaria interventions should be guided by sub-national risk levels in PNG.

Dam-mediated flooding impact on outpatient attendance and diarrhoea cases in northern Ghana: a mixed methods study

BackgroundFloods are the most frequently occurring natural disaster and constitute a significant public health risk. Several operational satellite-based flood detection systems quantify flooding extent, but it is unclear how far the choice of satellite-based flood product affects the findings of epidemiological studies of associated public health risks. Few studies of flooding’s health impacts have used mixed methods to enrich understanding of these impacts. This study therefore aims to evaluate the relationship between two satellite-derived flood products with outpatient attendance and diarrhoeal disease in northern Ghana, identifying plausible reasons for observed relationships via qualitative interviews.MethodsA convergent parallel mixed methods design combined an ecological time series with focus group discussions and key informant interviews. Through an ecological time series component, monthly outpatient attendance and diarrhoea case counts from health facilities in two flood-prone districts for 2016–2020 were integrated with monthly flooding map layers classified via the Moderate Resolution Imaging Spectroradiometer (MODIS) and Landsat satellite sensors. The relationship between reported diarrhoea and outpatient attendance with flooding was examined using Poisson regression, controlling for seasonality and facility catchment population. Four focus group discussions with affected community members and four key informant interviews with health professionals explored flooding’s impact on healthcare delivery and access.ResultsFlooding detected via Landsat better predicted outpatient attendance and diarrhoea than flooding via MODIS. Outpatient attendance significantly reduced as LandSat-derived flood area per facility catchment increased (adjusted Incidence Rate Ratio = 0.78, 95% CI: 0.61–0.99, p < 0.05), whilst reported diarrhoea significantly increased with flood area per facility catchment (adjusted Incidence Rate Ratio = 4.27, 95% CI: 2.74—6.63, p < 0.001). Key informants noted how flooding affected access to health services as patients and health professionals could not reach the health facility and emergency referrals were unable to travel.ConclusionsThe significant reduction in outpatient attendance during flooding suggests that flooding impairs healthcare delivery. The relationship is sensitive to the choice of satellite-derived flood product, so future studies should consider integrating multiple sources of satellite imagery for more robust exposure assessment. Health teams and communities should plan spatially targeted flood mitigation and health system adaptation strategies that explicitly address population and workforce mobility issues.

Evaluating the technical efficiency of neonatal health service among primary hospitals of northwest Ethiopia: Using two-stage data envelopment analysis and Tobit regression model.

Most cases of neonatal mortality are preventable but a substantial number of cases get complicated and become irreversible not only due to scarcity but also due to inefficient utilization of available resources in the health service. However, limited evidence shows the efficiency level of health facilities in Ethiopia. Therefore, this study aimed to assess the technical efficiency of neonatal health service and its associated factors among primary hospitals in three zones of Northwest Ethiopia. A facility-based cross-sectional study was conducted among fifteen randomly selected primary hospitals from March 17 to April 17, 2021. Input data on non-salary recurrent costs, salary costs, and the number of beds, and output data on neonatal admissions, outpatient visits, and referrals for the 2019/20 fiscal year were collected using a document review. In the first stage of analysis, input-oriented data envelopment analysis with a variable return-to-scale assumption was employed to estimate the efficiency scores using DEAP 2.1. A Tobit regression model was fitted in the second stage to identify the associated factors with technical efficiency. Variables with a p-value <0.05 were declared as statistically associated factors. In this study, 80% of the primary hospitals were pure technical efficient whereas 46.67% of the facilities were scale efficient with all of the scale inefficient hospitals operating below their scale. The mean pure technical and scale efficiency score of primary hospitals was 0.948±0.113 and 0.887±0.143, respectively. Total catchment population, incentive packages for the clinical staff, and the educational status of the manager were positively associated with the technical efficiency of hospitals. On the other hand, technical efficiency was negatively associated with the presence of a health facility that provides neonatal health services near the hospital and the distance of the manager's residence. Though most of the primary hospitals in Northwest Ethiopia were technical efficient, more than half of them were working below their scale of operation. Our results also indicated that introducing the performance-based provision of incentive packages for clinical staff and employing master's and above-educated health professionals as a manager might improve the efficient utilization of resources in primary hospitals.

Polycentricity and accessibility in mountain areas: the Alpine case

ABSTRACT The concept of centrality focuses on fair accessibility to services of general interest. This is a considerable challenge in mountain regions due to low population density and morphological context. However, the centrality debate has hardly taken morphology into account, even though mountain areas require a specific form of spatial organization – a lower level of accessibility leads either to longer distances and travel times or (in the better case) to increased service supply in smaller settlements. In this paper, we examine small Alpine towns’ polycentricity at a micro scale and respond to the key question: What role does accessibility play in the centrality of small towns in the Alps? Our study builds on a comprehensive accessibility mapping of 780 towns in the Alps with more than 3,000 inhabitants. The study shows that the size of a settlement and its role in the settlement system are linked in a less linear way than polycentricity models postulate. Many small towns have to provide key functions for large catchment areas. We quantify this dimension by measuring population catchment intensities. Our approach combines demographic and accessibility analyses and is potentially applicable to other areas with geographical specificities that are relevant objects of cohesion policy.

Diabetic foot in primary and tertiary (DEFINITE) Care: A health services innovation in coordination of diabetic foot ulcer (DFU) Care within a healthcare cluster - 18-month results from an observational population health cohort study.

Diabetic Foot in Primary and Tertiary (DEFINITE) Care is an inter-institutional and multi-disciplinary team (MDT) health systems innovation programme at a healthcare cluster in Singapore. We aim to achieve coordinated MDT care across primary and tertiary care for patients with diabetic foot ulcers (DFU), within our public healthcare cluster - an integrated network of seven primary care polyclinics and two acute care tertiary hospitals (1700-bed and 800-bed) with a total catchment population of 2.2 million residents. Results from prospective DEFINITE Care is referenced against a retrospective 2013-2017 cohort, which was previously published. Cardiovascular profile of the study population is compared against the same population's profile in the preceding 12 months. Between June 2020 and December 2021, there were 3475 unique patients with DFU with mean age at 65.9 years, 61.2% male, mean baseline HbA1c at 8.3% with mean diabetes duration at 13.3 years, mean diabetes complication severity index (DCSI) at 5.6 and mean Charlson Comorbidity Index (CCI) at 6.8. In the 12-months preceding enrolment to DEFINITE Care, 35.5% had surgical foot debridement, 21.2% had minor lower extremity amputation (LEA), 7.5% had major LEA whilst 16.8% had revascularisation procedures. At 18-months after the implementation of DEFINITE Care programme, the absolute minor and major amputation rates were 8.7% (n=302) and 5.1% (n=176), respectively, equating to a minor and major LEA per 100000 population at 13.7 and 8.0, respectively. This represents an 80% reduction in minor amputation rates (P < .001) and a 35% reduction in major amputation rates (P=.005) when referenced against a retrospective 2013-2017 cohort, which had minor and major LEA per 100000 population at 68.9 and 12.4, respectively. As compared to the preceding 12 months, there was also a significant improvement in cardiovascular profile (glycemic and lipid control) within the DEFINITE population, with improved mean HbAc1 (7.9% from 8.4%, P < .001), low-density lipoprotein (LDL) levels (2.1 mmol/L from 2.2, P < .001), total cholesterol (3.9 mmol/L from 4.1, P < .001) and triglycerides levels (1.6 mmol/L from 1.8, P=.002). Multivariate analysis revealed a history of minor amputation in the preceding 12 months to be an independent predictor for major and minor amputation within the study period of 18 months (Hazard Ratio 3.4 and 1.8, respectively, P < .001). In conclusion, within DEFINITE care, 18-month data showed a significant reduction of minor and major LEA rates, with improved medical optimisation and cardiovascular profile within the study population.

Trends in Adverse Drug Reactions Among Children: Evidence from Jiangsu Province of China, 2010-2019.

Medication safety among children represents an underrecognized public health concern worldwide, yet little evidence was found in China. This study aimed to examine trends in rates of pediatric adverse drug reaction (ADR) reports in Jiangsu Province of China with a catchment population of more than 11 million children. Data for children aged under 15 years were extracted from the spontaneous reporting system of ADR surveillance in Jiangsu Province. Suspected therapeutic agents for ADRs were coded using the Anatomical Therapeutic Chemical classification system. We used the Chinese modification of the International Classification of Diseases, Tenth Revision, to group primary diseases, and the Medical Dictionary for Regulatory Activities to classify the manifestation of ADRs. We used Joinpoint to estimate age-adjusted ADR rates stratified by sex from July 2010 to June 2019, and further by specific features, including patient characteristics, main suspected therapeutic medications, primary diseases, and ADRs. We used the percentage change annualized estimator to evaluate trends over time. A total of 79,903 ADR reports were identified among children aged under 15 years, which accounted for 11.4% of all ADRs reported in Jiangsu Province during the same period. The age-adjusted ADR report rates increased significantly from 66.20 to 96.76 per 100,000 children during the period July 2010-June 2019, with an annual increase of 4.9% (95% confidence interval 1.3-8.5%; p value 0.014). Of all ADR reports, there were 47,774 (59.8%) boys and 32,129 (40.2%) girls. Children aged 0-4 years accounted for more than half of the ADR reports (n=47,680, 59.7%). Skin and subcutaneous tissue disorders were the most frequently reported ADRs (45,773, 57.3%). Respiratory diseases were the most commonly observed medical conditions in relation to pediatric ADRs, accounting for 68.8% (n=54,940) of all ADR reports, and anti-infectives for systemic use consistently represented over time the most common medication group, contributing to 69.8% of all reports. A reduction in ADR report rates was observed for vaccines, with an annual decrease of 19% in children. ADRs remain a public health challenge among the vulnerable pediatric populations. Findings from the present study call for continuing efforts in ADR prevention and medication safety improvement in children.

An exploration of challenges associated with machine learning for time series forecasting of COVID-19 community spread using wastewater-based epidemiological data

Wastewater-based epidemiology (WBE) has gained increasing attention as a complementary tool to conventional surveillance methods with potential for significant resource and labour savings when used for public health monitoring. Using WBE datasets to train machine learning algorithms and develop predictive models may also facilitate early warnings for the spread of outbreaks. The challenges associated with using machine learning for the analysis of WBE datasets and timeseries forecasting of COVID-19 were explored by running Random Forest (RF) algorithms on WBE datasets across 108 sites in five regions: Scotland, Catalonia, Ohio, the Netherlands, and Switzerland. This method uses measurements of SARS-CoV-2 RNA fragment concentration in samples taken at the inlets of wastewater treatment plants, providing insight into the prevalence of infection in upstream wastewater catchment populations. RF's forecasting performance at each site was quantitatively evaluated by determining mean absolute percentage error (MAPE) values, which was used to highlight challenges affecting future implementations of RF for WBE forecasting efforts. Performance was generally poor using WBE datasets from Catalonia, Scotland, and Ohio with ‘reasonable’ or better forecasts constituting 0 %, 5 %, and 0 % of these regions' forecasts, respectively. RF's performance was much stronger with WBE data from the Netherlands and Switzerland, which provided 55 % and 45 % ‘reasonable’ or better forecasts respectively. Sampling frequency and training set size were identified as key factors contributing to accuracy, while inclusion of too many unnecessary variables (or e.g., flow data) was identified as a contributing factor to poor performance. The contribution of catchment population on forecast accuracy was more ambiguous. This study determined that the factors governing RF's forecast performance are complicated and interrelated, which presents challenges for further work in this space. A sufficiently accurate further iteration of the tool discussed within this study would provide significant but varying value for public health departments for monitoring future, or ongoing outbreaks, assisting the implementation of on-time health response measures.

Lost in translation: Telephone referrals to a tertiary neurology referral centre.

Cork University Hospital acts as the tertiary referral centre for the HSE southern area, with a catchment population of 1.2 million [1]. The neurology registrars receive telephone consultations from hospitals and primary care practices in the region. While there have been a number of studies examining inpatient neurology consultations in Irish hospitals [2-6], there is a paucity of data examining the support provided by tertiary referral centres to other acute hospitals and primary care centres in their region. The aim of this study is to define the workload of the neurology registrar with respect to telephone consultations and to examine the quality of these referrals. All calls received from the 19th of October 2021 to the 25th of February 2022 were logged by the receiving registrar. Information collected pertained to the nature of the consult and completeness of the referral. The average volume of calls during the study period was six per week. The median call duration was 8min. The cumulative time spent resolving outside calls during the study period was at least 41.25hours. Sixty-three per cent of calls were from other acute hospitals in the region. Thirty-nine per cent of referrals were deemed incomplete with respect to either history, collateral history or examination. This is a necessary service in a system that is not adequately resourced to provide specialist led care in all hospitals. A greater emphasis on complete and accurate referrals, along with robust communication and documentation, could reduce the inherent risk associated with such consultations.

Temporal trends of suicidality among adolescents in the last decade in Piedmont, Northwestern Italy

Abstract Background Over the last decade, trends of suicidality among adolescents remain unclear. We conducted a cross-sectional study using surveillance data collected over the past 10 years in the Piedmont region, Italy, to explore temporal trends in suicidality among hospitalized adolescents. Methods This was a retrospective study over an 11-year period of time. The target cohort was adolescents aged 13-19 discharged from inpatient/day-hospital care with at least one suicidality-related ICD9-CM code (i.e., suicidal ideation-SI, suicidal risk-SR and suspected suicide-SS) between 2011 and 2021 in Piedmont (Northwestern Italy). Social-economic related data is available from Census 2011. Yearly incidence rates (IR) were calculated based on the overall hospitals’ catchment population and by sex. Poisson regression model was estimated to evaluate the trend over time and the association with sex, and a potential effect of the COVID-19 pandemic. A non-linear trend was allowed by modelling natural splines. Results We included 490 adolescents (median age: 15 years, IQR: 13-16), 380 girls and 110 boys, with ICD9-CM codes for SI (264; 53.9%), SR (142; 29%), SS (90; 18.4%) at first discharge. Girls showed a higher risk of repeated inpatient care than boys (19.2% vs 7.3%, p &amp;lt; 0.01). Since 2013, yearly suicidality IRs started increasing linearly in boys (+1.7/100,000 per year, 95%CI: 0.7-2.8). Apparently, suicidality IRs increasing in girls were observed since 2011 (+5.8/100,000 per year, 95%CI 2.8-8.9) and were significantly higher than in boys (p &amp;lt; 0.001). Conclusions Suicidality among young inpatients increased in Piedmont during the last decade. Females seemed to be more affected than males. Further research is needed to better understand gender-related risk factors for suicidality. Key messages • There has been an increase in the number of adolescents reporting suicidal ideation in the last decade, especially in girls. • Intervention strategies are urgently needed to reverse a potentially alarming trend in suicidality among young people.

Investigating health service availability and readiness for antenatal testing and treatment for HIV and syphilis in Papua New Guinea

BackgroundPapua New Guinea (PNG) has one of the highest burdens of HIV and syphilis in pregnancy in the Asia-Pacific region. Timely and effective diagnosis can alleviate the burden of HIV and syphilis and improve maternal and newborn health. Supply-side factors related to implementation and scale up remain problematic, yet few studies have considered their impact on antenatal testing and treatment for HIV and syphilis. This study explores health service availability and readiness for antenatal HIV and/or syphilis testing and treatment in PNG.MethodsUsing data from two sources, we demonstrate health service availability and readiness. Service availability is measured at a province level as the average of three indicators: infrastructure, workforce, and antenatal clinic utilization. The readiness score comprises 28 equally weighted indicators across four domains; and is estimated for 73 health facilities. Bivariate and multivariate robust linear regressions explore associations between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis.ResultsMost provinces had fewer than one health facility per 10 000 population. On average, health worker density was 11 health workers per 10 000 population per province, and approximately 22% of pregnant women attended four or more antenatal clinics. Most health facilities had a composite readiness score between 51% and 75%, with urban health facilities faring better than rural ones. The multivariate regression analysis, when controlling for managing authority, catchment population, the number of clinicians employed, health facility type and residence (urban/rural) indicated a weak positive relationship between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis.ConclusionThis study adds to the limited evidence base for the Asia-Pacific region. There is a need to improve antenatal testing and treatment coverage for HIV and syphilis and reduce healthcare inequalities faced by rural and urban communities. Shortages of skilled health workers, tests, and medicines impede the provision of quality antenatal care. Improving service availability and health facility readiness are key to ensuring the effective provision of antenatal care interventions.

Land Use Pattern Affects Microplastic Concentrations in Stormwater Drains in Urban Catchments in Perth, Western Australia

Stormwater drains act as important vectors for microplastics, enabling the transportation of microplastic polymers from terrestrial systems where they are produced and consumed to aquatic and marine ecosystems. In this study, microplastic concentrations and their size fractions were measured in six stormwater catchments in the Perth and Peel region of Western Australia. Stormwater drains with contrasting land uses and catchment characteristics were selected and two sites along each drain were sampled. Water samples were filtered in situ with a purpose-built fractionation device. Catchment boundaries and contributing drainage areas were derived from a hydrologically enforced digital elevation model. Microplastic concentrations within the sites varied from 8.8 to 25.1 microplastics/L (mean 14.2 microplastics/L). Fibrous microplastics were the most common morphology, followed by fragments. Polymer types identified using Raman spectroscopy included polypropylene (64.6% of samples), polyethylene (64.7%), polytetrafluoroethylene (5.9%) and polyvinylidene fluoride (5.9%). There was no statistically significant variation in microplastic concentrations across or within stormwater catchments. A linear mixed-effect model showed that several components of the land use pattern: catchment area, catchment population, and the proportion of industrial land, natural land and public open space, were positively related to microplastic concentrations. The proportion of residential land was negatively related to microplastic concentrations. The lack of significant variation in microplastic concentration observed both across and within the catchments points to their ubiquitous presence in stormwater systems in the region. This study is the first to examine microplastic contamination in the water of stormwater drainage systems in Perth, Western Australia. These stormwater systems contain considerable concentrations of microplastics, confirming their importance as transport mechanisms for plastics into aquatic and marine ecosystems.