Information Department Research Articles

Temporal Pattern and Spatial Distribution of Tuberculosis Prevalence Associated with Multimorbidity in Brazil.

Four main chronic conditions may be involved in the tuberculosis pathogenic process and/or clinical evolution: HIV/AIDS, diabetes mellitus, mental illness, and Chronic Obstructive Pulmonary Disease. This study aimed to determine the spatiotemporal pattern of tuberculosis (TB) associated with multimorbidity in Brazil. Ecological study use data from the Notifiable Diseases Information System (SINAN), collected from the electronic portal of the Department of Informatics of the SUS (DATASUS). These data included TB cases that were reported between 2007 and 2021 and were associated with two or more chronic clinical health conditions (multimorbidity). A total of 7,795 cases of TB associated with multimorbidity were recorded, with an average growth trend of 4.6% per year (95% Confidence Interval (CI): 3.3-5.9; p<0.001) and higher growth in the first temporal segment (2007 to 2011) (8.9%; 95%CI: 4.2-13.9; p=0.002). The spatial analysis, after Bayesian smoothing, highlighted the main municipalities states of the study, namely: São Paulo (19.8%; n = 297), Porto Alegre (23.6%; n = 354), and Rio de Janeiro (44.8%; n = 672). The proportion of extremely poor (β=-0.002), the bolsa família program (β=0.002), the average per-person income (β=0.001), and the percentage of the population living in households with a density of more than 2 people per bedroom (β=0.001) were related to chronic health conditions. These findings will stimulate public action to manage this situation. However, as this is still a recent topic in the literature, we encourage the development of studies on the synergistic characteristics of TB and other clinical conditions.

Prevalence of Congenital Anomalies of the Upper Limbs in Brazil: a descriptive cross-sectional study.

Congenital Anomalies of the Upper Limb (CAUL) are a group of structural or functional abnormalities that develop during intrauterine life and can lead to limb dysfunction. To analyze the prevalence of congenital anomalies of the upper limbs in Brazil and assess maternal and neonatal variables. A cross-sectional, descriptive study was conducted on congenital upper limb malformations among live births across Brazil. The study spanned from 2010 to 2019. Data were sourced from the Department of Informatics of the Unified Health System (DATASUS) and the Live Birth Information System (SINASC) portal. Analyses focused on the information reported in field 41 of the Live Birth Declaration Form entered into the computerized system. The most common anomaly in Brazil was supernumerary fingers, classified as ICD-Q69.0, affecting 11,708 children, with a prevalence of 4.02 per 10,000 live births. Mothers aged over 40 years had a 36% higher prevalence of having children with CAUL than mothers under 40 years old (OR = 1.36; 95% CI 1.19-1.56). Newborns weighing ≥ 2,499 g were 2.64 times more likely to have CAUL compared to those weighing ≥ 2,500 g (OR = 2.64; 95% CI 2.55-2.73). There was an observed increase in the reporting of CAUL cases over the decade studied. This trend serves as an alert for health agencies, as understanding the prevalence of CAUL and its associated factors is crucial for preventive medicine.

Analysis of the epidemiological profile of congenital hip deformities, 2011-2021.

This study aimed to identify the relevance of hospitalizations for congenital hip deformities in Bahia. This is a retrospective epidemiological study in public databases. Descriptors in health sciences: "congenital hip dysplasia", "congenital hip dislocation", and "congenital dislocation hip". This is qualitative-quantitative research with the analysis of secondary data and cross-sectional typologies in the databases of the Ministry of Health - Health Information (TABNET), made available by the Department of Informatics of the Unified Health System (DATASUS). Bahia was the third Brazilian state with the highest number of hospitalizations, registering 1481 cases. The municipalities in Bahia with the highest prevalence were Itanhém, Salvador, and Barreiras, with 912, 445, and 20 cases, respectively. The elevated number of congenital hip deformities reflects a public health problem, requiring investments in public policies.

Structure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors.

In 2011, the American Board of Medical Specialties established clinical informatics (CI) as a subspecialty in medicine, jointly administered by the American Board of Pathology and the American Board of Preventive Medicine. Subsequently, many institutions created CI fellowship training programs to meet the growing need for informaticists. Although many programs share similar features, there is considerable variation in program funding and administrative structures. The aim of our study was to characterize CI fellowship program features, including governance structures, funding sources, and expenses. We created a cross-sectional online REDCap survey with 44 items requesting information on program administration, fellows, administrative support, funding sources, and expenses. We surveyed program directors of programs accredited by the Accreditation Council for Graduate Medical Education between 2014 and 2021. We invited 54 program directors, of which 41 (76%) completed the survey. The average administrative support received was $27,732/year. Most programs (85.4%) were accredited to have two or more fellows per year. Programs were administratively housed under six departments: Internal Medicine (17; 41.5%), Pediatrics (7; 17.1%), Pathology (6; 14.6%), Family Medicine (6; 14.6%), Emergency Medicine (4; 9.8%), and Anesthesiology (1; 2.4%). Funding sources for CI fellowship program directors included: hospital or health systems (28.3%), clinical departments (28.3%), graduate medical education office (13.2%), biomedical informatics department (9.4%), hospital information technology (9.4%), research and grants (7.5%), and other sources (3.8%) that included philanthropy and external entities. CI fellowships have been established in leading academic and community health care systems across the country. Due to their unique training requirements, these programs require significant resources for education, administration, and recruitment. There continues to be considerable heterogeneity in funding models between programs. Our survey findings reinforce the need for reformed federal funding models for informatics practice and training.

Space-time analysis of work-related musculoskeletal disorders in Brazil: an ecological study.

This study aimed to analyze the incidence of work-related musculoskeletal disorders (WMSD) in Brazil from 2007 to 2019, examining the spatial, temporal, and spatiotemporal patterns of their occurrence. An ecological time series study was conducted using spatial analysis techniques. WMSD morbidity data from 2007 to 2019 were collected from the Brazilian Information System for Notificable Diseases of the Brazilian Health Informatics Department. Incidence rates were standardized and smoothed using the local empirical Bayes' theorem. Time trends were analyzed by segmented linear regression. Spatial analysis was performed using Moran's univariate global (I) and local (LISA) indexes. The spatiotemporal scan statistic was used to identify high-risk spatiotemporal clusters for WMSD. A total of 93,387 cases of WMSD were recorded in Brazil. Temporal trends showed an increase in all regions except the Northeast, which remained stable. The incidence of WMSD showed a spatial dependence, with spatial and space-time clusters identified, especially in the Southeast region, overlapping the largest economic-industrial center of the country. The spatiotemporal clustering observed in one region suggests the highest level of industrial and economic development. Our findings highlight the need to implement intersectoral surveillance policies, inspect working conditions, and invest in the prevention and promotion of workers' health.

Prediction of tuberculosis clusters in the riverine municipalities of the Brazilian Amazon with machine learning.

Tuberculosis (TB) is the second most deadly infectious disease globally, posing a significant burden in Brazil and its Amazonian region. This study focused on the "riverine municipalities" and hypothesizes the presence of TB clusters in the area. Wealso aimed to train a machine learning model to differentiate municipalities classified as hot spots vs. non-hot spots using disease surveillance variables as predictors. Data regarding the incidence of TB from 2019 to 2022 in the riverine town was collected from the Brazilian Health Ministry Informatics Department. Moran's I was used to assess global spatial autocorrelation, while the Getis-Ord GI* method was employed to detect high and low-incidence clusters. A Random Forest machine-learning model was trained using surveillance variables related to TB cases to predict hot spots among non-hot spot municipalities. Our analysis revealed distinct geographical clusters with high and low TB incidence following a west-to-east distribution pattern. The Random Forest Classification model utilizes six surveillance variables to predict hot vs. non-hot spots. The machine learning model achieved an Area Under the Receiver Operator Curve (AUC-ROC) of 0.81. Municipalities with higher percentages of recurrent cases, deaths due to TB, antibiotic regimen changes, percentage of new cases, and cases with smoking history were the best predictors of hot spots. This prediction method can be leveraged to identify the municipalities at the highest risk of being hot spots for the disease, aiding policymakers with an evidenced-based tool to direct resource allocation for disease control in the riverine municipalities.

Sergey I. Tyulpanov — statesman and outstanding scientist: Historical role and academic legacy

Sergei Ivanovich Tyulpanov is an outstanding scientist, military leader, diplomat, citizen, an extraordinary person, born in 1901, who for more than eighty years shared the fate of his people and his Motherland. The article presents the joint work of N. P. Kuznetsova, one of Tyulpanov’s graduate students in the 70s of the last century, S. F. Sutyrin, head of the department of world economics, who took the baton from the school of the department of international economic relations and the department of modern capitalism economics in 1996, and professor L. D. Shirokorad, who spent his entire professional life working on the problems of the history of economic thought and the development of the Faculty of Economics at Leningrad State University — St. Petersburg State University. The article is divided into four parts: the initial stage of Tyulpanov’s military and academic career up to the WWII, military and ideological activity during the Great Patriotic war, the role of the Soviet military administration in Germany / SVAG Information Department in the formation of post-war Germany, the creation of the Department of Modern Capitalism Economics — a unique center for teaching and studying the economics and politics of developed and developing countries.

Interrupting Effect of Social Distancing on Ischemic Heart Disease, Asthma, Stroke, and Suicide Attempt Patients by PM2.5 Exposure.

This study aimed to examine the interrupting effect of social distancing (SD) on emergency department (ED) patients with ischemic heart disease (IHD), stroke, asthma, and suicide attempts by PM2.5 exposure in eight Korean megacities from 2017 to 2020. The study used National Emergency Department Information System and AirKorea data. A total of 469014 patients visited EDs from 2017 to 2020. Interrupted time series analysis was employed to examine changes in the level and slope of the time series, relative risk, and confidence intervals (CIs) by PM2.5 exposure. The SD level was added to the sensitivity analysis. The interrupted time series analysis demonstrated a significant increase in the ratio of relative risk (RRR) of IHD patients in Seoul (RRR=1.004, 95% CI: 1.001, 1.006) and Busan (RRR=1.007, 95% CI: 1.002, 1.012) post-SD. Regarding stroke, only patients in Seoul exhibited a significant decrease post-SD (RRR=0.995, 95% CI: 0.991, 0.999). No significant changes were observed for asthma in any of the cities. In the case of suicide attempts, Ulsan demonstrated substantial pre-SD (RR=0.827, 95% CI: 0.732, 0.935) and post-SD (RRR=1.200, 95% CI: 1.057, 1.362) differences. While the interrupting effect of SD was not as pronounced as anticipated, this study did validate the effectiveness of SD in modifying health behaviors and minimizing avoidable visits to EDs in addition to curtailing the occurrence of infectious diseases.

Epidemiology of Non-Emergent Cancer-Related Emergency Department Visits in Korea between 2016 and 2020.

As people living with cancer increase in the aging society, cancer-related emergency department (ED) visits are also increasing. This study aimed to investigate the epidemiologic characteristics of non-emergent cancer-related ED visits using a nationwide ED database. A cross-sectional study was conducted using the National Emergency Department Information System (NEDIS) database. All cancer-related ED visits between 2016 and 2020 were included. The study outcome was non-emergent ED visits, defined as patients triaged into non-emergent condition at both the time of arrival at ED and discharge from ED and were discharged without hospitalization. Among 1185871 cancer-related ED visits over 5 years, 19.0% (n=225491) were classified as non-emergent visits. While abdominal pain and fever are the top chief complaints in both emergent and non-emergent visits, non-emergent visits had high proportions of abdomen distension (4.8%), ascite (2.4%), and pain in lower limb (2.0%) compared with emergent visits. The cancer types with a high proportion of non-emergent visits were thyroid (32.4%) and prostate cancer (30.4%). Adults compared with children or older adults, female, medical aid insurance, urban/rural ED, direct-in compared with transfer-in, and weekend visit were associated with high odds for non-emergent visits. Approximately 20% of cancer-related ED visits may be potentially non-emergent. A significant number of non-emergent patients visited the ED due to cancer-related symptoms. To improve the quality of care for people living with cancer, the expansion of supportive care resources besides of ED, including active symptom control, is necessary.

Impact of the Early COVID-19 Pandemic on Emergency Department Visits of Adult Cancer Patients With Fever or Respiratory Symptoms: A Korean Nationwide Population-Based Study, 2016-2020.

We performed a nationwide analysis to evaluate the impact of the early coronavirus disease 2019 (COVID-19) pandemic on emergency department (ED) visits by adult cancer patients having COVID-like symptoms. We analyzed the National Emergency Department Information System (NEDIS) data on ED visits by adult cancer patients who presented with chief complaints of fever or respiratory symptoms (FRS) indicative of COVID-19, from 2016 to 2020. An interrupted time series analysis with a quasi-Poisson regression model was performed, adjusting for seasonality and time, to evaluate whether underlying trends for monthly ED visits and the in-hospital mortality rate (%) per month changed with the pandemic among these patients. We also estimated the adjusted odds ratio (aOR) of in-hospital deaths among cancer patients using multivariable logistic regression analysis. ED visits by cancer patients with FRS decreased during the COVID-19 pandemic (relative risk [RR] with 95% confidence interval [CI]: slope change, 0.99 [0.98-1.00] and step change, 0.84 [0.76-0.92]). However, the in-hospital mortality rate (%) for these patients was increased (slope change, 1.14 [1.04-1.25] and step change, 0.99 [0.98-1.01]). Factors such as urgent triage status, ambulance use, and treatment in hospitals with fewer than 300 staffed beds significantly contributed to increased aOR of in-hospital deaths during the COVID-19 pandemic compared to the pre-pandemic period. Further studies are needed to highlight the importance of ED service preparation in planning and managing resources for cancer patients during future pandemics.

The Use of ChatGPT Applications in Learning: Impact on Understanding and Student Engagement in TVET Institutions

In the field of Technical and Vocational Education and Training (TVET), the use of artificial intelligence (AI) technology has the potential to enrich the learning experience. However, the challenge lies in determining the level of skills required by students to optimize the learning experience and enhance understanding of technical concepts and student engagement. The main objective of this study is to examine the relationship between students' understanding and engagement based on their skill levels in using ChatGPT application in the TVET education sector. A pilot study was conducted with 30 respondents for all 24 items to measure the reliability of the research instrument. The findings indicated a Cronbach's alpha value of 0.982, suggesting that all constructed items are suitable for use as a measurement tool in assessing the needs of the developed survey instrument. Independent sample t-test analyses were conducted to determine if there were significant differences in understanding and student engagement based on students' skills in using the ChatGPT application. A total of 173 respondents participated in this study, comprising 125 students from the Information and Communication Technology Department (ICTD) and 48 students from the Design and Visual Communication Department (DVCD) at Polytechnic Besut Terengganu (PBT). Data obtained from the survey were analyzed using Statistical Packages for Social Sciences version 26.0. Descriptive analysis of minimum comparisons showed a positive impact, indicating that students in TVET institutions agree that the use of the ChatGPT application in learning influences their level of understanding and engagement based on high minimum values. However, independent sample t-test analysis showed differing results. While there was no significant difference in understanding based on the skills of using the application, there was a significant difference in student engagement. This suggests that although students consider the ChatGPT application to have an overall positive impact, the benefits are consistent with students' understanding without making a difference to a specific group. Skills in using this application have a more significant impact on student engagement than on their understanding. Despite the overall positive impact of the application, a focus on student engagement may be a key factor in enhancing the effectiveness of this application in the TVET learning context. To improve the effectiveness of the ChatGPT application, further research on factors contributing to differences in students' engagement levels needs to be conducted. Further studies could also involve comparative research between TVET institutions to identify differences in perceptions and the use of the ChatGPT application. Long-term studies to measure the impact of the ChatGPT application on academic achievement could provide a deeper understanding of its long-term effectiveness in facilitating the learning process in TVET institutions. Opportunities and challenges related to AI in education should also be investigated to support and expand these findings in various technical disciplines and the TVET education context.

Demographic characteristics of patients admitted to the emergency department for intoxication and a time series analysis during the COVID-19 period

Purpose: This study investigated the characteristics and treatment outcomes of patients who visited the emergency department due to intoxication and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on their visits.Methods: A retrospective study was conducted using data from the National Emergency Department Information System (NEDIS) on patients who visited the emergency department due to intoxication between January 2014 and December 2020. In total, 277,791 patients were included in the study, and their demographic and clinical data were analyzed. A model was created from 2014 to 2019 and applied to 2020 (i.e., during the COVID-19 pandemic) to conduct a time series analysis distinguishing between unexpected accidents and suicide/self-harm among patients who visited the emergency department.Results: The most common reason for visiting the emergency department was unintentional accidents (48.5%), followed by self-harm/suicide attempts (43.8%). Unexpected accident patients and self-harm/suicide patients showed statistically significant differences in terms of sex, age group, hospitalization rate, and mortality rate. The time series analysis showed a decrease in patients with unexpected accidents during the COVID-19 pandemic, but no change in patients with suicide/self-harm.Conclusion: Depending on the intentionality of the intoxication, significant differences were found in the age group, the substance of intoxication, and the mortality rate. Therefore, future analyses of patients with intoxication should be stratified according to intentionality. In addition, the time series analysis of intentional self-harm/suicide did not show a decrease in 2010 in the number of patients, whereas a decrease was found for unintentional accidents.

Navigating Homeland Security: A Strategic Evolution Analysis of the Department of Homeland Security (DHS)

This article examines the strategic evolution of the Department of Homeland Security (DHS), a multifaceted government entity comprising 22 agencies and federal departments established in 2002. Initially tasked with enhancing homeland security, the DHS has undergone significant strategic changes in response to operational reviews and evolving national security challenges. A pivotal moment occurred in 2005 when Secretary Chertoff introduced a six-point agenda, addressing identified challenges through the Strategy Change Cycle. The DHS's strategic planning process, guided by a ten-step approach, emphasizes internal evaluations encompassing strengths, weaknesses, opportunities, and threats. The article also highlights the DHS's internal restructuring, specifically within the Department of Information, aimed at enhancing organizational competencies. With a workforce exceeding 24,000 individuals, the DHS addresses diverse aspects, including TSA, national security, immigration, FEMA, customs, and border protection. The external environment is analyzed through economic, political, technological, social, and educational trends, shaping the DHS's mission of preventing terrorism, securing borders, and strengthening national preparedness. Key resources, including clients, taxpayers, and collaborative forces among 22 unified agencies, contribute to the DHS's integrated and adaptive approach to homeland security. This strategic examination underscores the department's commitment to proactive adjustments, collaboration, and a holistic approach in safeguarding the nation's security. This article uses an example of the March of Dimes, which was established by FDR in 1932, and how an agency has changed when it has exhausted all resources and must change their purpose.

Factors associated with brain and pre-brain arteriovenous malformation: a case control study

Introduction. Brain and pre-brain arteriovenous malformations (BAVMs) are an important cause of hemorrhagic stroke among youth, although are normally a congenital condition, can easily pass unnoticed for years. Objective. To find predictors of BAVMs. Method. Case control study based in the database of the Health Information System (TABNET), made available by the Informatics Department of the Brazilian National Health System (DATASUS). Information of children born with BAVMs (ICD Q280 and Q282) ranging from 2010 to 2020 was collected and compared with all the other childrens born at the same period of time. Results. A total of 75 cases of BAVMs were found, with 21 being pre-cerebral and 54 cerebral. Females represented 55% (41) of the patients. A cohort of 40,588,143 babies was used as control. Preterm newborns had an approximate 10 times higher chance of having BAVMs (p&lt;0.001; OR:9.990; CI: 6.347-15.725). Cesarean birth was associated with 63% higher chance of BAVMs.(p&lt;0.001; OR: 0.372; CI: 0.219-0.632). Ethnicity was also associated with BAVMs, notably with white ones having 2,2 times more chances of having BAVM (p=0.001; OR: 2.242; CI:1.379-3.643). Twin pregnancy was marginally associated with BAVMs (p=0.063; OR: 0.361; CI: 0.132-0.989). Conclusion. Prematurity, cesarean birth, and white ethnicity were significantly associated with BAVMs. These findings are worth considering to guide screening strategies and clinical suspicion. Prospective cohort studies in the same topic are recommended.

Pemanfaatan Media Pembelajaran Berbasis Blog untuk Meningkatkan Kompetensi Mengetik serta Menyampaikan Ide Segala Pemikiran dalam Bentuk Ketikan pada Siswa Kelas IX pada Mata Pelajaran Informatika di MTsN 7 Agam

The use of web logs as a learning medium to increase interest in typing on mobile phones or computers and can issue all thoughts in the form of typing which is directly taught by UIN Sjech M. Djamil Djambek BUKITTINGGI students with the Department of Informatics and Computer Engineering Education, who are conducting Field Practice Implementation (PPL) at MTs N 7 AGAM on August 22 – November 10, 2023. manuskrip. Kemudian dilanjutkan dengan teks utama manuskrip. The use of blogs as a learning medium has not been carried out by educators with optimal informatics teachings. This is because many educators do not understand how and what steps must be taken in utilizing blogs as a learning medium. The use of blogs as a learning medium can be done at all levels both elementary, junior high, MTs, high school and vocational schools because students in general are accustomed to accessing information through the web. But in this paper, the use of blogs is more focused on junior high school / MTs and high school / vocational / MA education units because the planning of creating a blog is accompanied by steps to prepare online quizzes that will be embedded into the blog. This is done as an effort to prepare students to face UNBK. This study was conducted In this paper, described the steps in the use of blogs as a learning medium. This study begins by studying various literature and the results of similar studies to get an overview of the use of blogs as learning media. After this study, information was obtained that various problems in schools related to learning media can be overcome by utilizing blogs as learning media. In the future, it is hoped that educators can use blogs as a learning medium so that they can attract more interest and attention from students.

Propaganda und Manipulation in der Sprache Anhand der offiziellen Stellungnahmen des Russischen Aussenministeriums

THE PROPAGANDA AND LINGUISTIC MANIPULATION IN THE LANGUAGE OF POLITICS ON THE BASIS OF THE OFFICIAL STATEMENTS OF THE RUSSIAN FOREIGN OFFICE ABOUT THE RUSSIAN INVASION OF UKRAINE (2022) Persuasion, disinformation, manipulation, censorship, which are elements of propaganda, can be regarded as central terms of the language of politics, especially during conflict situations and wars. The question of interest is in what ways the specific language techniques are used by the Russian Foreign Affairs Department for the purposes of propaganda in the context of the 2022 Russian invasion of Ukraine. The paper analyzes the official statements of Maria Zakharova, the Director of the Information and Press Department of the Ministry of Foreign Affairs of the Russian Federation that are available on the web page of the Embassy of Russia in Berlin. The following examinations are confronted with the well-documented nature of the persuasive language in Nazi propaganda before and during World War II. The aim of such analysis is to examine in what ways and to what extent the specific propaganda techniques they are used to justify the war that Russia has started by invading Ukraine.

Temporal analysis of therapeutic approaches to osteogenesis imperfecta in the context of pediatric orthopedics - an update

Osteogenesis Imperfecta (OI), popularly known as brittle bone disease, is characterized by bone fragility and deformities, as well as fractures caused by minor trauma. Prevention to reduce the number of fractures, treatment of fractures and surgical correction of deformities are a challenge for orthopaedic surgeons in their therapeutic management. The aim of this study is to analyze the therapeutic approaches to osteogenesis imperfecta in Brazil from 2013 to 2022. This is a retrospective qualitative and quantitative clinical investigation, in which the information was obtained from the Ministry of Health databases (TABNET), made available by the Department of Informatics of the Unified Health System (DATASUS), using the health science descriptors: "osteogenesis imperfecta", "pediatrics" and "bone fractures". It can be seen that between 2013 and 2022, 9,461 treatments for osteogenesis imperfecta were recorded in Brazil, so even though it is considered a rare pathology, it has a significant number of cases. Thus, the long-term aim of therapeutic interventions is for these children to live independently and develop the life skills that will enable them to coordinate their own care

A Research Study on Comparison of Prevalence and Outcome of Maxillofacial Odontogenic Space Infection between Diabetic and Non-Diabetic Patients

Background: Orofacial space infections are commonly encountered problems in dental practice. The highest prevalence is seen among South Asian population because of their negligence in seeking dental treatment. Diabetes is one of the most common systemic illnesses suppressing the immunity of individual and increasing their susceptibility to infections. Currently, immunocompromised situation (Diabetes mellitus) and space infection together leads to complexity to evaluate the overall outcome of the patients. Objective: Aim of this study is to compare the prevalence and outcome of maxillofacial odontogenic space infection between diabetic and non-diabetic patients. Materials and Methods: This cross sectional study was conducted in the Department of Oral and Maxillofacial Surgery, BSMMU and DMCH over a period of 15 Months, from June 2020 to August 2021.The selection of the patients was as per the inclusion and exclusion criteria. The study commenced after IRB clearance. All the patients enrolled in this study after proper counseling and informed written consent. A total of 63 patients were taken and divided in to two groups on the basis of presence or absence of diabetes mellitus, Group A (diabetic): N1 number of patients and Group B (non-diabetic): N2 number of patients. Results: Majority of the patients were from BSMMU (58.73%) followed by DMCH (41.26%). Male were more commonly affected than females. Submandibular space was most commonly involved. Streptococcus was the most commonly isolated organism in non-diabetics while Klebsiella in diabetic patients. Meropenem was the most sensitive antibiotic while Amoxicillin was least sensitive antibiotic against the organisms found. This data will be helpful for future research and that will be considered baseline information for public health department. Conclusion: Prevalence of MSI was 4.33 (per thousand) in the study centers of Dhaka. Submandibular space was most common involved space in both diabetic and non-diabetic patients. Streptococcus was the most commonly isolated organism in non-diabetics while Klebsiellain diabetic patients. Meropenam was the most sensitive antibiotic in both group while Amoxicillin was not found sensitive on any patient in group A while least sensitive in group B. Keywords: odontogenic infection, fascial spaces, culture and antibiotic sensitivity

Comorbidity of Type 2 Diabetes and Dementia among Hospitalized Patients in Los Angeles County: Hospitalization Outcomes and Costs, 2019–2021

Hospitalizations for diabetes and dementia can impose a significant health and economic toll on older adults in the United States. This study sought to examine differences in hospitalization characteristics and outcomes associated with diabetes and dementia, separately and together, using 2019–2021 discharge record data from the California Department of Health Care Access and Information. The sampled group were residents of Los Angeles County who were aged 50+ at the time of the study. The multivariable linear regression analysis showed that compared to those with no diabetes or dementia, patients with diabetes alone exhibited the highest total charges, while those with comorbid diabetes and dementia exhibited lower charges (p &lt; 0.05). The multinomial logistic regression found that patients with comorbid diabetes and dementia had the highest odds of having a length of stay of 7+ days (Adjusted Odds Ratio = 1.49; 95% Confidence Interval (CI) = 1.44–1.53). A matched case–control analysis revealed that comorbid diabetes and dementia were associated with significantly lower odds of hypertensive disease than diabetes alone (Matched Odds Ratio = 0.81; 95% CI = 0.67–0.97). Collectively, these results highlight the complex factors that may influence the variable hospitalization outcomes that are common occurrences in these three distinct disease profiles. Study findings suggest a need to consider these complexities when developing policies or strategies to improve hospitalization outcomes for these conditions.

Improving hospital quality risk-adjustment models using interactions identified by hierarchical group lasso regularisation

BackgroundRisk-adjustment (RA) models are used to account for severity of illness in comparing patient outcomes across hospitals. Researchers specify covariates as main effects, but they often ignore interactions or use stratification to account for effect modification, despite limitations due to rare events and sparse data. Three Agency for Healthcare Research and Quality (AHRQ) hospital-level Quality Indicators currently use stratified models, but their variable performance and limited interpretability motivated the design of better models.MethodsWe analysed patient discharge de-identified data from 14 State Inpatient Databases, AHRQ Healthcare Cost and Utilization Project, California Department of Health Care Access and Information, and New York State Department of Health. We used hierarchical group lasso regularisation (HGLR) to identify first-order interactions in several AHRQ inpatient quality indicators (IQI) - IQI 09 (Pancreatic Resection Mortality Rate), IQI 11 (Abdominal Aortic Aneurysm Repair Mortality Rate), and Patient Safety Indicator 14 (Postoperative Wound Dehiscence Rate). These models were compared with stratum-specific and composite main effects models with covariates selected by least absolute shrinkage and selection operator (LASSO).ResultsHGLR identified clinically meaningful interactions for all models. Synergistic IQI 11 interactions, such as between hypertension and respiratory failure, suggest patients who merit special attention in perioperative care. Antagonistic IQI 11 interactions, such as between shock and chronic comorbidities, illustrate that naïve main effects models overestimate risk in key subpopulations. Interactions for PSI 14 suggest key subpopulations for whom the risk of wound dehiscence is similar between open and laparoscopic approaches, whereas laparoscopic approach is safer for other groups. Model performance was similar or superior for composite models with HGLR-selected features, compared to those with LASSO-selected features.ConclusionsIn this application to high-profile, high-stakes risk-adjustment models, HGLR selected interactions that maintained or improved model performance in populations with heterogeneous risk, while identifying clinically important interactions. The HGLR package is scalable to handle a large number of covariates and their interactions and is customisable to use multiple CPU cores to reduce analysis time. The HGLR method will allow scholars to avoid creating stratified models on sparse data, improve model calibration, and reduce bias. Future work involves testing using other combinations of risk factors, such as vital signs and laboratory values. Our study focuses on a real-world problem of considerable importance to hospitals and policy-makers who must use RA models for statutorily mandated public reporting and payment programmes.