Decreasing Time Trend Research Articles

Incidence of Clinically Diagnosed Psoriatic Arthritis in Sweden.

Prior incidence estimates of psoriatic arthritis (PsA) vary considerably. We aimed to assess the annual incidence of clinically diagnosed PsA among adults in Sweden in 2014-2016, overall and stratified by age/sex/education/geography, and to investigate potential time trends in incidence in 2006-2018. Use of disease-modifying antirheumatic drugs (DMARDs) during the 2 years after diagnosis was also examined. Patients (aged ≥ 18 years) with incident clinically diagnosed PsA in Sweden were identified from the National Patient Register (NPR) and/or the Swedish Rheumatology Quality Register (SRQ). Population statistics, stratification variables, and DMARD information were retrieved from other nationwide registers. Incidence was estimated according to a base case (BC) definition (ie, ≥ 1 main International Classification of Diseases, 10th revision, diagnosis of PsA [L40.5/M07.0-M07.3] from rheumatology/internal medicine in NPR, or a PsA diagnosis in SRQ during the relevant year, and no prior such diagnoses) and 4 different sensitivity analysis case definitions. The mean annual incidence of clinically diagnosed PsA among adults in Sweden in 2014-2016 was estimated at 21.77 per 100,000 person-years (PYs) at risk, according to the BC definition; 17.41 per 100,000 PYs at risk after accounting for diagnostic misclassification; and 15.78 to 28.83 per 100,000 PYs at risk across all sensitivity analyses. Incidence was slightly higher in female individuals, was lower in those with higher education (aged > 12 years), and peaked during the ages of 50 to 59 years. No apparent increasing or decreasing time trend was observed in 2006-2018. Within 2 years of diagnosis, 71.03% of patients had received DMARD therapy (22.37% biologic or targeted synthetic DMARDs). From 2014 to 2016, the annual incidence of clinically diagnosed PsA in the adult Swedish population was approximately 20 per 100,000 PYs at risk. Two years after diagnosis, almost three-quarters of patients had received DMARD therapy.

Cancer Patients' Social Relationships During 3 Years After Diagnosis-Generic and Cancer-Specific Social Networks.

Social relationships are important health resources and may be investigated as social networks. We measured cancer patients' social subnetworks divided into generic social networks (people known to the patients) and disease-specific social networks (the persons talked to about the cancer) during 3years after diagnosis. Newly diagnosed patients with localized breast cancer (n = 222), lymphoma (n = 102), and prostate cancer (n = 141) completed a questionnaire on their social subnetworks at 2-5months after diagnosis and 9, 18, and 36months thereafter. Generic and cancer-specific numbers of persons of spouse/partner; other family; close relatives, in detail; and friends were recorded as well as cancer-specific numbers of persons in acquaintances; others with cancer; work community; healthcare professionals; and religious, hobby, and civic participation. The data was analyzed with regression models. At study entry, most patients had a spouse/partner, all had close relatives (the younger, more often parents; and the older, more often adult children with families) and most also friends. The cancer was typically discussed with them, and often with acquaintances and other patients (74-86%). Only minor usually decreasing time trends were seen. However, the numbers of distant relatives and friends were found to strongly increase by the 9-month evaluation (P < 0.001). Cancer patients have multiple social relationships and usually talk to them about their cancer soon after diagnosis. Most temporal changes are due to the natural course of life cycle. The cancer widened the patients' social networks by including other patients and healthcare professionals and by an increased number of relatives and friends.

Epidemiological patterns of candidaemia: A comprehensive analysis over a decade.

The prevalence of fungal bloodstream infections (BSI), especially candidaemia, has been increasing globally during the last decades. Fungal diagnosis is still challenging due to the slow growth of fungal microorganisms and need for special expertise. Fungal polymicrobial infections further complicate the diagnosis and extend the time required. Epidemiological data are vital to generate effective empirical treatment strategies. The overall aim of this project is to describe the epidemiology of monomicrobial candidaemia and polymicrobial BSI, both with mixed fungaemia and with mixed Candida/bacterial BSIs. We conducted a single-centre retrospective epidemiological study that encompasses 950,161 blood cultures during the years 2010 to 2020. The epidemiology of monomicrobial and polymicrobial candidaemia episodes were investigated from the electronic records. We found that 1334 candidaemia episodes were identified belonging to 1144 individual patients during 2010 to 2020. Candida albicans was the most prevalent species detected in candidaemia patients, representing 57.7% of these episodes. Nakaseomyces (Candida) glabrata and Candida parapsilosis complex showed an increasing trend compared to previous studies, whereas Candida albicans demonstrated a decrease. 19.8% of these episodes were polymicrobial and 17% presented with mixed Candida/bacterial BSIs while 2.8% were mixed fungaemia. C. albicans and N. glabrata were the most common combination (51.4%) in mixed fungaemia episodes. Enterococcus and Lactobacillus spp. were the most common bacteria isolated in mixed Candida/bacterial BSIs. Polymicrobial growth with candidaemia is common, mostly being mixed Candida/bacterial BSIs. C. albicans was detected in more than half of all the candidaemia patients however showed a decreasing trend in time, whereas an increase is noteworthy in C. parapsilosis complex and N. glabrata.

Use of surgical procedure manager to standardise operation steps and monitor surgeon performance in open repair of inguinal hernia

AbstractObjectivesTo study the feasibility of using surgical procedure manager (SPM), a digital checklist platform, to standardise surgical steps of open hernia repair and monitor the operative performance.MethodologyA retrospective study on all open mesh repair of inguinal hernia under local anaesthesia from September 2019 to November 2021 at the Prince of Wales Hospital was performed. The operative outcomes of patients having operations with or without the use of SPM were compared. Procedures using SPM had operation steps shown as a digital checklist inside the theatre. The time used for each surgical step was recorded and analysed. The operative performance of the surgeons was analysed by observing the trend of the mean operation time over time.ResultsA total of 123 patients were recruited, of which 52 were using the SPM. The median age of patients was 75 (range 49–93) years. A decreasing trend in the mean operation time for dissection, mesh placement, wound closure and total operation time was observed in surgeries using SPM. There was no significant difference in the operation time, theatre time, total length of stay, blood loss and readmission rate between the SPM and non‐SPM groups. The proportion of basic surgical trainees as coached surgeons in the SPM group was significantly higher (SPM = 52% vs non‐SPM = 28%, P = .07).ConclusionsThe use of SPM did not significantly prolong the operation time and produce comparable operative outcomes in open hernia repair. It provided the additional advantage of standardising operation steps and monitoring the performance of surgical trainees during their training.

Factors associated with homicides of women in Brazil, by race or colour, 2016-2020.

This ecological, time-trend study examined rates of homicide against women residing in Brazil, by state and race/colour, from 2016 to 2020, by performing. Multiple analysis by regression model on longitudinal data. During the study period, 20,405 homicides of women were recorded in Brazil. Standardised homicides rates were higher among black women (6.1/100,000) than among white women (3.4/100,000). From 2016 to 2020, rates decreased 25.2%, from 4.7 deaths per 100,000 women in 2016 to 3.5 in 2020, with a statistically significant downward trend among both black and white women. Statistically significant inverse relationships were found between female homicide rates and HDI, illiteracy rate and proportion of ill-defined causes. The average homicide rate decreased in 2019 and 2020, as compared with 2016. Despite the decreasing time trend in homicide rates for both black and white women, they differed substantially by race, with worse outcomes for black women.

Ten-year national trends in in-hospital mortality and functional outcomes after intracerebral hemorrhage by age in Japan: J-ASPECT study.

National-level data on trends in the prognosis of age-stratified patients with intracerebral hemorrhage (ICH) are lacking. This study aimed to assess time trends in in-hospital mortality and functional outcomes of ICH patients by sex and age, and to explore factors associated with changes in in-hospital mortality trend. Using the largest nationwide, J-ASPECT stroke database in Japan, this serial cross-sectional study included ICH patients aged ⩾18 years who were hospitalized for non-traumatic ICH from April 2010 to March 2020. We examined trends in in-hospital mortality and functional outcomes using the modified Rankin Scale at discharge, as well as differences in in-hospital mortality change between age groups. Among 262,399 ICH patients from 934 hospitals, crude in-hospital mortality showed a significant decreasing time trend (from 19.5% to 16.7%), and this trend was consistent across sex and age groups. In addition, differences in in-hospital mortality change over the 10-year study period were significant between male patients aged ⩾75 years and those aged ⩽64 years (-3.9% [95% confidence interval, -5.4 to -2.4] for 75-84 years; -4.1% [-6.3 to -1.9] for ⩾85 years). On the other hand, the proportion of dependent patients (mRS 3-5) at discharge increased from 52.0% to 54.9% over the 10-year study period. The in-hospital mortality of ICH patients improved, whereas the proportion of patients with dependent functional outcome at discharge increased, over the 10-year study period. Elucidating the mechanism underlying differences in in-hospital mortality reduction in men may provide insights into effective interventions in the future.

Bayesian joint longitudinal models for assessing the exploitation rates of sardine stock in the Mediterranean Sea

AbstractThe European sardine is a pelagic species of great ecological importance for the conservation of the Mediterranean Sea as well as economic importance for the Mediterranean countries. Its fishing has suffered a significant decline in recent years due to various economic, cultural and ecological reasons. This paper focuses on the evolution of sardine catches in the Mediterranean Sea from 1985 to 2018 according to the fishing Mediterranean country and the type of fishing practised, artisanal and industrial. We propose three Bayesian longitudinal linear mixed models to assess differences in the temporal evolution of artisanal and industrial fisheries between and within countries. Overall results confirm that Mediterranean fishery time series are highly diverse along their dynamics and this heterogeneity is persistent throughout the time. Furthermore, our results highlight a positive correlation between artisanal and industrial fishing. Finally, the study observes a consistent decreasing time trend in the quantity of fish landings. Although the causes of this feature could be also linked to economic motivations (such as a reduction in demand or the reorientation of fleets towards more commercially beneficial species), it may indicate a potential risk to the stock of this species in the Mediterranean Sea.

Factors associated with homicides of women in Brazil, by race or colour, 2016-2020

Factors associated with homicides of women in Brazil, by race or colour, 2016-2020

Reduced HIV/AIDS diagnosis rates and increased AIDS mortality due to late diagnosis in Brazil during the COVID-19 pandemic

The COVID-19 pandemic has severely affected global health, leading to the suspension of numerous routine healthcare services and posing challenges in efforts to control other diseases, such as HIV/AIDS. This study aimed to assess the impact of the COVID-19 pandemic on HIV/AIDS diagnoses and mortality rates in Brazil during 2020 and 2021. The percentage change was calculated to determine whether there was an increase or decrease in HIV/AIDS diagnoses and mortality, considering the average numbers from the last 5 years. Additionally, a Joinpoint regression model and an interrupted time series analysis were applied to assess time trends before and after the onset of the pandemic. Lastly, choropleth maps were prepared. We observed a reduction of 22.4% (2020) and 9.8% (2021) in the diagnosis of HIV/AIDS in Brazil. Conversely, there was a significant increase in the percentage change of late diagnosis of AIDS deaths in 2020 (6.9%) and 2021 (13.9%), with some states showing an increase of over 87%. Decreasing time trends in the diagnosis of HIV/AIDS were identified before the pandemic in Brazil, especially in the Southeast and South regions, and then time trends stabilized after including the pandemic years. Along with the dissemination of COVID-19, there was a reduction in the diagnosis of HIV/AIDS and an increase in late diagnosis AIDS deaths, signaling a serious impact of the pandemic on HIV/AIDS control strategies in Brazil. Therefore, we highlight the need for continuous efforts to control both diseases, that is, maintaining regular health services even in crisis situations.

Mazor X Robot-Assisted Pedicle Screw Placement: A Case Series

Pedicle screw placement is a well-established procedure in spine surgeries, and the utilization of robots in spinal surgery has been on the rise. This study aims to investigate the accuracy and screw placement time associated with the use of Mazor X robots in robotic-assisted pedicle screw placement. A retrospective case study was conducted on 12 patients with lumbar spine disease who underwent Mazor X robot-assisted surgery. Screw placement accuracy was assessed using the Gertzbein-Robinson classification. Additionally, total screw placement time and fluoroscopy time were documented for analysis. A total of 60 screws were placed in the 12 patients who received robotic-assisted pedicle screw placement. Of these screws, 98.3% were found to be within the safe zone. As the cases progressed, there was a noticeable decrease in total screw placement time and fluoroscopy time. Our findings suggest that Mazor X robotic-assisted spine surgery boasts high accuracy rates and demonstrates a decreasing trend in screw placement time and fluoroscopy time. To the best of our knowledge, our institution is the first in China to employ the Mazor X robot for pedicle screw placement surgeries and to document its associated characteristics.

A multicenter study on the epidemiology of complicated parapneumonic effusion in the era of currently available pneumococcal conjugate vaccines

BackgroundParapneumonic effusion (PPE) is a common complication of pneumonia. Streptococcus pneumoniae is the most common cause of bacterial pneumonia. A reduction in pneumonia hospitalizations has been observed since the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). Despite this apparent benefit, an increase in the incidence of PPE was recorded in some countries following PCV7 implementation. As the 13-valent pneumococcal conjugate vaccine (PCV13) was expected to provide a wider protection against PPE, the aim of the present study was to evaluate the impact of PCV13 introduction on the epidemiology of complicated parapneumonic effusion (c-PPE) among children in the Athens greater area. MethodsAll cases of community-acquired pneumonia (CAP) with PPE requiring chest tube insertion (complicated PPE, c-PPE) hospitalized in the 3 public Children’s hospitals in Athens between 01/01/2004 and 31/12/2019 were included in the study. ResultsA total of 426 cases of c-PPE associated with pneumonia were recorded of which 198 were admitted during 2004–2010 (period A, prePCV13/PCV −7 introduction period) and 228 during 2011–2018 (period B, post - PCV13 period). A definite bacterial etiology was established in 44.4 % of all cases and of those 25.4 % were caused by S. pneumoniae. An increasing trend in c-PPE incidence was observed during period A; although, a significant decrease on c-PPE annual rates was observed during the period B (p = 0.011), a remarkable increase in serotype 3 cases was recorded. ConclusionA decreasing time trend in c-PPE cases among children was shown after the introduction of PCV13 in our area. However, serotype 3 is nowadays a common cause of PPE. Hence, continuous surveillance is imperative in order to follow c-PPE epidemiology over time.

Persistence of anxiety among Asian Americans: racial and ethnic heterogeneity in the longitudinal trends in mental well-being during the COVID-19 pandemic.

To examine within-individual time trends in mental well-being and factors influencing heterogeneity of these trends. Longitudinal telephone survey of adults over 3 waves from the New York City (NYC) Metropolitan area during the COVID-19 Pandemic. Participants reported depression using the Patient Health Questionnaire (PHQ)-8, anxiety using the Generalized Anxiety Disorder (GAD)-7, and past 30-day increases in tobacco or alcohol use at each wave. Adjusted mixed effects logistic regression models assessed time trends in mental well-being. There were 1227 respondents. Over 3 study waves, there were statistically significant decreasing time trends in the odds of each outcome (adjusted OR (95% CI) 0.47 (0.37, 0.60); p < 0.001 for depression; aOR (95% CI) 0.55 (0.45, 0.66); p < 0.001 for anxiety; aOR (95% CI) 0.50 (0.35, 0.71); p < 0.001 for past 30-day increased tobacco use; aOR (95% CI) 0.31 (0.24, 0.40); p < 0.001 for past 30-day increased alcohol use). Time trends for anxiety varied by race and ethnicity (p value for interaction = 0.05, 4 df); anxiety declined over time among white, Black, Hispanic, and Other race and ethnicity but not among Asian participants. In a demographically varied population from the NYC Metropolitan area, depression, anxiety and increased substance use were common during the first months of the pandemic, but decreased over the following year. While this was consistently the case across most demographic groups, the odds of anxiety among Asian participants did not decrease over time.

Incidence of Stroke in People With Diabetes Compared to Those Without Diabetes: A Systematic Review.

One of the goals of the St. Vincent Declaration was to reduce serious complications of diabetes, including strokes. However, it remains uncertain whether this goal has been achieved. To evaluate the incidence of stroke in the diabetic population and its differences regarding sex, ethnicity, age, and region, to compare the incidence rate in people with and without diabetes, and to investigate time trends. A systematic review was conducted according to the guidelines for meta-analysis of observational studies in epidemiology (the MOOSE group) and the PRISMA group guidelines. Nineteen of the 6.470 studies retrieved were included in the analysis. The incidence of stroke in the population with diabetes ranged from 238 per 100,000 person-years in Germany in 2014 to 1191 during the 1990s in the United Kingdom. The relative risk comparing people with diabetes to those without diabetes varied between 1.0 and 2.84 for total stroke, 1.0 and 3.7 for ischemic stroke, and 0.68 and 1.6 for hemorrhagic stroke. Differences between fatal and non-fatal stroke were significant, depending on the time period and the population. We found decreasing time trends in people with diabetes and stable incidence rates of stroke over time in people without diabetes. The considerable differences between results can partly be explained by differences in study designs, statistical methods, definitions of stroke, and methods used to identify patients with diabetes. The lack of evidence arising from these differences ought to be rectified by new studies.

P033 The assessment of serum cytokines at baseline could predict mucosal healing in patients with Crohn’s disease treated with ustekinumab. A prospective study.

Abstract Background Ustekinumab (UST) is a monoclonal IgG1 antibody binding the p40 subunit of IL-12 and IL-23. The blockage of the activation of the heterodimer IL-12/IL-23 inhibits the differentiation of Th1 and Th17 cells, reducing the inflammatory cascade typical of Crohn’s disease (CD). Some patients with CD achieve mucosal healing after one year of UST therapy, whereas others experience primary non-response or loss of response. No biomarkers are currently available to predict therapeutic response to UST. The aim of this prospective study was to identify one or more biomarkers able to predict mucosal healing in patients with CD treated with UST. Methods We prospectively enrolled all consecutive CD patients treated with UST, following the current guidelines. A blood sample was drawn before UST infusion at week 0 (baseline), 24 and 48, and serum cytokines IL1α, IL-1β, IL-6, IL-8, IL-10, IL-12, IL-13, IL-15, IL-17, IL-22, IL-23 and IL-33 were evaluated by a fluorescence assay. At the same timepoints, Fecal Calprotectin (FC) was assessed. A colonoscopy was performed before starting the treatment and at week 48, where therapeutic outcome was evaluated in terms of mucosal healing, defined as a Simple Endoscopic Score for CD &amp;lt;2. Results Out of 44 patients enrolled, 22 (50%) achieve mucosal healing at the end of follow up. Baseline IL-23 levels were higher in responders than in non-responders (Mann-Whitney test, p-value&amp;lt;0.001), whereas higher baseline levels of IL-1α are associated with non-response (p=0.03). We also observed a higher probability of mucosal healing in those with lower levels of IL-6 at baseline (p=0.05). A borderline statistically significant association was observed for baseline FC, which values were lower in responders than in non-responders (Mann-Whitney test, p=0.098). No significant differences were observed with regard to the baseline levels of the other cytokines. FC levels decreased over time in responders, whereas its values did not change over time in non-responders (test for the interaction between time and outcome, p&amp;lt;0.001). IL-13 presented a homogenously decreasing time trend regardless the outcomes (test for the association with time and outcome, p=0.019). No significant time trend was observed with regard to the other cytokines. Conclusion Baseline serum levels of IL-23, IL-1α and IL-6, as well as the decrease of FC over time, showed a good reliability in predicting therapeutic outcome to UST in CD in terms of mucosal healing. These biomarkers could help clinicians in the perspective of a better management of UST therapy, identifying early the patients with higher probability to respond to the treatment.

Space-Time Clustering and Socioeconomic Factors Associated with Mortality from Diarrhea in Alagoas, Northeastern Brazil: A 20-Year Population-Based Study.

Acute diarrhea is the second leading cause of death among children in developing countries and is strongly related with the socioeconomic conditions of the population. In Brazil, data show a drop in the diarrhea mortality rate. Nevertheless, the northeastern region still has the most deaths. Considering this, we analyze high-risk areas for diarrhea- and gastroenteritis-related deaths, and their association with social determinants of health (SDH) in the state with one of the worst human development indicators in Brazil (Alagoas) between 2000 and 2019. We applied temporal, spatial, and space–time risk modelling. We used a log-linear regression model to assess temporal trends and the local empirical Bayesian estimator, the global and local Moran indices for spatial analysis. Spearman’s correlation was used to correlate mortality rates with SDH. A total of 3472 diarrhea-related deaths were reported during this period in Alagoas. We observed a decreasing time trend of deaths in the state (9.41/100,000 in 2000 to 2.21 in 2019; APC = −6.7; p-value < 0.001), especially in children under one year of age. However, there was stability among adults and the elderly. We identified two high-risk spatiotemporal clusters of mortality in inland municipalities. Lastly, mortality rates correlated significantly with 90% of SDH. Taken together, these findings indicate that diarrhea diseases remain a serious public health concern in Alagoas, mainly in the poorest and inland municipalities. Thereby, it is urgently necessary to invest in measures to control and prevent cases, and improve the living conditions of the poorest populations and those with the highest social vulnerability index.

CO2 emissions persistence: Evidence using fractional integration

The main cause of climate change are carbon dioxide emissions. In the context of the COVID-19 pandemic, the number of emissions has been significantly reduced for the first time in many years. Now it is necessary to answer the question of whether CO2 emissions are stationary or not, because the results will let us know whether environmental policies have to be strengthened rather than relaxed in intensity. To this end, this paper investigates the persistence in CO2 emissions in a group of countries to determine if shocks in the series have permanent or transitory effects. The results, based on fractional integration indicate evidence of mean reversion, with values of the differencing parameter constrained between 0 and 1 in all cases, independently of the assumption made about the error term (white noise or autocorrelation). Focusing on the areas under examination, it is obtained that the EU27+UK, Japan and the US present the lowest degrees of integration, while Russia, China and India display the highest values. Decreasing time trends are only observed for the EU27+UK and US.

Evaluation of the Prevalence of Malaria and Cutaneous Leishmaniasis in the Pre- and Post-Disaster Years in Iran.

Natural disasters (NDs) are calamitous phenomena that can increase the risk of infections in disaster-affected regions. This study aimed to evaluate the frequency of malaria and cutaneous leishmaniasis (CL) before and after earthquakes, floods, and droughts during the past four decades in Iran. Malaria and CL data were obtained from the reports of the Ministry of Health and Medical Education in Iran for the years 1983 through 2017. The data of NDs were extracted from the Centre for Research on the Epidemiology of Disasters (CRED). Interrupted time series analysis with linear regression modeling was used to estimate time trends of mentioned diseases in pre- and post-disaster conditions. For the periods preceding the disasters drought and flood, a decreasing time trend for malaria and CL was found over time. The time trend of malaria rate preceding the 1990 earthquake was stable, a downward trend was found after 1990 disaster until 1997 (β coefficient: -10.7; P = .001), and this declining trend was continued after 1997 disaster (β coefficient: -2.7; P = .001). The time trend of CL rate preceding the 1990 earthquake had a declining trend, an upward trend was found after 1990 earthquake until 1999 (β coefficient: +8.7; P = .293), and a slight upward trend had also appeared after 1999 earthquake (β coefficient: +0.75; P = .839). The results of the current study indicated the occurrence of earthquakes, floods, and droughts has no significant effect on the frequency of malaria and CL in Iran.

Reconstruction of Daily Courses of SO42−, NO3−, NH4+ Concentrations in Precipitation from Cumulative Samples

It is important to study precipitation chemistry to comprehend both atmospheric and environmental processes. The aim of this study was the reconstruction of daily concentration patterns of major ions in precipitation from samples exposed for longer and differing time periods. We explored sulphates (SO42−), nitrates (NO3−) and ammonium (NH4+) ions measured in precipitation within a nation-wide atmospheric deposition monitoring network in the Czech Republic during 1980–2020. We visualised the long-term trends at selected individual years for four stations, Praha 4-Libuš (LIB), Svratouch (SVR), Rudolice v Horách (RUD) and Souš (SOU), differing in geographical location and reflecting different environments. We found anticipated time trends reflecting the emission patterns of the precursors, i.e., sharp decreases in SO42−, milder decreases in NO3− and steady states in NH4+ concentrations in precipitation. Statistically significant decreasing time trends in SO42− and NO3− concentrations in precipitation between 1990 and 2015 were revealed for the LIB and SVR sites. Spring maxima in April were found for all major ions at the LIB site and for NO3− for the SVR site, for both past and current samples, whereas no distinct seasonal behaviour was recorded for NH4+ at the RUD and SO42− at the SVR sites. By applying Bayesian modelling and the Integrated Nested Laplace Approximation approach, we were able to reconstruct the daily patterns of SO42−, NO3− and NH4+ concentrations in precipitation, which might be further utilised for a wide range of tasks, including comparison of magnitudes and shapes between stations, grouping the decomposed daily data into the ecologically motivated time periods, as well as for logical checks of sampling and measurement reliability.

Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015–2019)

Background and objectiveInappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs). ObjectiveSurveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015–2019. MethodDescriptive population-based study. Setting: ‘València-Clínic-Malvarrosa’ Health Department, Valencia, Spain. Period: 2015–2019. Subjects: Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate. Analyses: frequencies and time trends, both overall and by specific type. ResultsOverall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: “≥75 years of age with inappropriate medication”, which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics). ConclusionsIP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs.

Data-driven case fatality rate estimation for the primary lineage of SARS-CoV-2 in Poland.

After more than one and a half year since the COVID-19 pandemics outbreak the scientific world is constantly trying to understand its dynamics. In this paper of the case fatality rates (CFR) for COVID-19 we study the historic data regarding mortality in Poland during the first six months of pandemic, when no SARS-CoV-2 variants of concern were present among infected. To this end, we apply competing risk models to perform both uni- and multivariate analyses on specific subpopulations selected by different factors including the key indicators: age, sex, hospitalization. The study explores the case fatality rate to find out its decreasing trend in time. Furthermore, we describe the differences in mortality among hospitalized and other cases indicating a sudden increase of mortality among hospitalized cases at the end of the 2020 spring season. Exploratory and multivariate analysis revealed the real impact of each variable and besides the expected factors indicating increased mortality (age, comorbidities) we track more non-obvious indicators. Recent medical care as well as the identification of the source contact, independently of the comorbidities, significantly impact an individual mortality risk. As a result, the study provides a twofold insight into the COVID-19 mortality in Poland. On one hand we explore mortality in different groups with respect to different variables, on the other we indicate novel factors that may be crucial in reducing mortality. The later can be coped, e.g. by more efficient contact tracing and proper organization and management of the health care system to accompany those who need medical care independently of comorbidities or COVID-19 infection.