Effective Health Care Policies Research Articles

Public Health Professionals’ Perspectives on Research Utilization in Nigerian Health Systems

The integration of research evidence into healthcare decision-making is essential for improving health outcomes, particularly in low- and middle-income countries like Nigeria. This study investigates the perspectives of public health professionals on research utilization within the Nigerian health system, identifying barriers and facilitators to the application of evidence-based practices. Utilizing a cross-sectional descriptive design, data were collected from public health professionals and policymakers through a structured questionnaire distributed via Google Survey. The findings reveal a significant gap in the dissemination and utilization of research findings, with many professionals unaware of existing systems to facilitate this process. Despite recognizing the importance of research utilization for enhancing health and quality of life, barriers such as limited access to quality research publications and inadequate collaboration between researchers and policymakers impede effective implementation. Capacity-building initiatives, such as workshops and continuous professional development programs, were identified as key facilitators for promoting evidence-based practices. The study underscores the need for improved communication and tailored dissemination strategies to bridge the gap between research and practice, ensuring that findings are accessible and applicable to the specific needs of different professional groups. These results align with existing literature that highlights the crucial role of evidence-based practice in public health and the necessity of robust dissemination and implementation frameworks. Addressing these barriers and leveraging facilitators can significantly enhance the utilization of research findings, leading to better health outcomes and more effective healthcare policies in Nigeria.

Prevalence of Atopic Dermatitis: A Systematic Review and Meta-Analysis.

Background: Atopic dermatitis (AD) negatively affects quality of life and places a substantial financial burden on health care systems due to treatment costs and increased demand for services. Objective: To estimate the worldwide prevalence of AD, the proportion of severe cases worldwide and explore sources of heterogeneity. Methods: We searched MEDLINE, Embase, and Global Index Medicus from January 2012 up until August 30, 2022. We included primary prevalence studies published from 2012 onward. Study selection was conducted by two reviewers independently. One reviewer performed data extraction and assessed risk of bias using the JBI Critical Appraisal Checklist for Prevalence Studies, with independent checking by a second reviewer. Random-effects meta-analyses were conducted to pool results; subgroup analyses were conducted to evaluate potential modifiers. Certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Main outcomes were point prevalence and proportion of severe cases. Results: We identified 12,774 unique references and assessed 1029 full texts, ultimately resulting in the inclusion of 310 studies with 25.5 million individuals. Point prevalence was 11.1% (95% CI 9.4-13.1; 123 studies; 12,776,910 individuals; moderate certainty of evidence) in children and adolescents, and 6.3% (95% CI 5.0-7.8; 59 studies; 12,794,260 individuals; moderate certainty of evidence) in adults. Relatively similar results were observed for studies with low risk of bias. Proportion of severe cases varied from 1.9 to 7.2% in children and adolescents and 2.8% to 15.6% in adults. Conclusions: These findings may underpin effective health care policies, research initiatives, and clinical decision-making.

Perception of Korean healthy adolescents on cancer and adolescent cancer survivors: a cross-sectional survey

BackgroundAs the number of adolescent cancer survivors increases, detailed and effective healthcare policies on adolescent cancer survivors returning to school and workplace are needed. The study aimed to explore the perception of healthy adolescents on cancer and adolescent cancer survivors.MethodsThis study conducted a face-to-face cross-sectional study in the Republic of Korea in 2021 on adolescent selected through proportional population allocation sampling by sex, age, and region. According to research questions, survey questionnaire organized and collected data on adolescents' perceptions of cancer, differences in perceptions from tuberculosis, measles, asthma, perceptions of adolescent cancer survivors, and health information sources that led to these perceptions.ResultsOf the total 500 adolescents, less than 10% of healthy adolescents responded that cancer is contagious, while three-quarters of the respondents believed that cancer is preventable. In addition, compared to tuberculosis, measles, and asthma, they recognized differences by disease. The majority of healthy adolescents embraced community values advocating the return of adolescent cancer survivors to school and work. However, they expressed a negative view of the situation in which adolescent cancer survivors could interact with them as classmates or co-workers. Adolescents mainly obtained health information on cancer from the Internet and television,ConclusionsThe perception of healthy adolescents on cancer was relatively accurate; however, they have dualistic thinking involving living with adolescent cancer survivors. To facilitate reintegration of adolescent cancer survivors into daily lives, education is needed for healthy adolescents to live with cancer survivors.

Development and Preliminary Validation of Health Service Measurement Scale (HSMS) for Measuring Effectiveness of Health Care Services in Universities

The aim of this study was to develop and validate a Health Service Measurement Scale (HSMS) for measuring the effectiveness of health care services in public sector universities. For data collection, a deductive method was used. Based on review of literature, a survey questionnaire was developed and administered to 484 teachers from three public universities of Malakand division: university of Swat, university of Malakand and University of Sheringal (SBBU) upper Dir. The scale was developed based on DeVellis (2003) four phase scale development procedure. Factor Analysis technique was utilized for assessing factors which affect the health care services in universities. This study identified four important factors affecting the health care services in universities. These factor were clear communication skills, professional behavior, clinical competency and patient satisfaction. The scale may be used to enhance the effectiveness of the health care units inside the universities regarding provision of necessary treatment as per the approved protocol of health industry. The findings of this study further provide key insights to the management to review the health services and policy makers to enact effective health care policies for the universities. The limitations of the study along with recommendations are provided for future research.

Healthcare support for ukrainian refugees in the Czech Republic: a literature review

The article focuses on the analysis of "most common methods providing health care to migrants and refugees and on the other hand on the analysis of "most common health problems" of refugees and migrants especially in Europe after the outbreak of war in Ukraine. Stemming from the conflict since 2014, it has triggered the most significant wave of refugees in contemporary history. The method of analysis is a "literature review" created from available sources in Medline, Scopus, PubMed, and Web of Science, focusing on data systematization within the GAJU 101/2022/S project funded by the South Bohemian University in České Budějovice, Czech Republic. The search strategy included keywords such as "Ukrainian migrants," "refugees," "health data," "central registry," "healthcare crisis," and "aid provision," employing logical operators. We examined 41 literary sources from both Czech and international publications, as well as official institution websites. The study identifies the complex interplay between migration and health, revealing diverse needs among migrants and refugees. It emphasizes the necessity of developing effective healthcare policies, particularly in crisis situations. Understanding the implementation of legal provisions for healthcare access is crucial for adapting healthcare systems in Europe. Upholding the principles of the Universal Declaration of Human Rights during information gathering ensures equal access to medical assistance regardless of individuals' status or financial standing. Therefore, further research in this direction should not only deepen our understanding of the migration-health relationship but also translate knowledge into policies for improving healthcare conditions for migrants and refugees in Europe.

The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children

Background Since 2016 trans people in the UK, and particularly trans children, have experienced a sustained and escalating campaign to roll back trans freedoms, rights and access to healthcare. A series of legislative, politicized and media-driven campaigns have resulted in the year-by-year worsening of access to affirmative healthcare for trans children in the UK. Aim This study examines publications from the NHS-commissioned ‘Cass Review’ into children’s gender services, seeking to better understand what is happening in trans children’s healthcare in the UK. Methods Inductive and deductive reflexive thematic analysis was applied to a collection of Cass Review publications related to trans children’s healthcare published between January 2020 and May 2023. Results Four concerns are presented and explored: (1) prejudice; (2) cisnormative bias; (3) pathologization; and (4) inconsistent standards of evidence. Each of these concerns impacts the Cass Review’s approach to trans children’s healthcare, with negative repercussions for trans children’s healthcare rights and well-being. Discussion The Cass Review itself can be understood as an example of cis-supremacy, within a cis-dominant healthcare system lacking accountability to trans communities. These findings draw attention to systemic barriers to effective healthcare policy, with relevance for trans healthcare across and beyond the UK.

Unveiling Opinions: Exploring the Public’s View on Clinical Autopsies

Background: Clinical autopsy is an invaluable tool useful to identify causes of death and to uncover unknown and unexpected diseases which aids in raising awareness of common and rare diseases in a community. Clinical autopsy is essential to study pattern of morbid diseases that aids in formation of effective healthcare policies. Aim: To investigate the views of the general public on clinical autopsies in order to determine general conceptions and misconceptions that may aid in further a discussion and investigations. Methodology: This prospective cross-sectional study was conducted at Department of Forensic Medicine, Dow International Medical College, Dow University of Health Sciences Karachi Pakistan from October 2022 till March 2023. Data was collected from 300 participants using a 15-item questionnaire distributed to general population from various parts of Karachi selected by convenient sampling. Results: 46% were aware of term clinical/medical autopsy. 77% acknowledged medical and social role of clinical autopsies. Less than 50% could differentiate between clinical and medico legal autopsy. 50% are of the opinion that autopsy should not be conducted in natural deaths. 55% and 64% of the participants were of the opinion that clinical autopsy can improve future lives of people and provide diagnostic and curative strategies respectively. Participants of the study were unsure about the Islamic perspective of autopsy. 57% agreed to give consent for autopsy in society’s best interest. Conclusion: The large majority is uncertain about autopsy given their religious and personal views but it also reveals many acknowledge its possible utility in medicine and in bereavement process. Therefore, despite lack of research and public discourse, it provides us with data that may encourage and aid further research and discussion about acceptance of autopsy as a viable diagnostic tool. Keywords: Autopsy, Clinical autopsy, Medical autopsy, Pakistan

Spinal cord injury: global burden from 1990 to 2019 and projections up to 2030 using Bayesian age-period-cohort analysis.

Spinal cord injuries, often resulting from spine fractures, can lead to severe lifelong symptoms such as paraplegia and even mortality. Over the past few decades, there has been a concerning increase in the annual incidence and mortality rates of spinal cord injuries, which has also placed a growing financial strain on healthcare systems. This review aims to offer a comprehensive overview of spinal cord injuries by estimating their global incidence, prevalence, and the impact in terms of years lived with disability, using data obtained from the 2019 Global Burden of Disease Study. In this study, we utilized data from the 2019 Global Burden of Disease Study, a widely recognized source for global health data. Our methodology involved estimating the global incidence and prevalence of spinal cord injuries while also assessing the impact on years lived with a disability. We analyzed this data comprehensively to identify patterns and trends and made predictions. This research delved into the evolving trends in the global burden of spinal cord injuries, identified key risk factors, and examined variations in incidence and disability across different Socio-demographic Index (SDI) levels and age groups. Briefly, in 2019, the global incidence and burden of YLDs of SCI significantly increased compared to 1990. While males had higher incidence rates compared to females. Falls were identified as the primary cause of SCI. Trend projections up to 2030 revealed a slight decrease in ASIR for males, an upward trend in age-specific incidence rates for both sexes and a similar pattern in age-standardized YLD rates. Additionally, our findings provided crucial groundwork for shaping future policies and healthcare initiatives, with the goal of mitigating the burden of spinal cord injuries, enhancing patient outcomes, and fortifying prevention efforts. Understanding the global burden of spinal cord injuries is essential for designing effective healthcare policies and prevention strategies. With the alarming increase in prevalence rates and their significant impact on individuals and healthcare systems, this research contributes vital insights to guide future efforts in reducing the incidence of spinal cord injuries, improving the quality of life for affected individuals, and reducing the economic burden on healthcare systems worldwide.

Revealing associations between spatial time series trends of COVID-19 incidence and human mobility: an analysis of bidirectionality and spatiotemporal heterogeneity

BackgroundUsing human mobility as a proxy for social interaction, previous studies revealed bidirectional associations between COVID-19 incidence and human mobility. For example, while an increase in COVID-19 cases may affect mobility to decrease due to lockdowns or fear, conversely, an increase in mobility can potentially amplify social interactions, thereby contributing to an upsurge in COVID-19 cases. Nevertheless, these bidirectional relationships exhibit variations in their nature, evolve over time, and lack generalizability across different geographical contexts. Consequently, a systematic approach is required to detect functional, spatial, and temporal variations within the intricate relationship between disease incidence and mobility.MethodsWe introduce a spatial time series workflow to investigate the bidirectional associations between human mobility and disease incidence, examining how these associations differ across geographic space and throughout different waves of a pandemic. By utilizing daily COVID-19 cases and mobility flows at the county level during three pandemic waves in the US, we conduct bidirectional Granger causality tests for each county and wave. Furthermore, we employ dynamic time warping to quantify the similarity between the trends of disease incidence and mobility, enabling us to map the spatial distribution of trends that are either similar or dissimilar.ResultsOur analysis reveals significant bidirectional associations between COVID-19 incidence and mobility, and we develop a typology to explain the variations in these associations across waves and counties. Overall, COVID-19 incidence exerts a greater influence on mobility than vice versa, but the correlation between the two variables exhibits a stronger connection during the initial wave and weakens over time. Additionally, the relationship between COVID-19 incidence and mobility undergoes changes in direction and significance for certain counties across different waves. These shifts can be attributed to alterations in disease control measures and the presence of evolving confounding factors that differ both spatially and temporally.ConclusionsThis study provides insights into the spatial and temporal dynamics of the relationship between COVID-19 incidence and human mobility across different waves. Understanding these variations is crucial for informing the development of more targeted and effective healthcare policies and interventions, particularly at the city or county level where such policies must be implemented. Although we study the association between mobility and COVID-19 incidence, our workflow can be applied to investigate the associations between the time series trends of various infectious diseases and relevant contributing factors, which play a role in disease transmission.

Healthcare providers' perceptions about the unmet needs of their patients with cancer across healthcare systems: results of the International Psycho-Oncology Society survivorship survey.

Systematic understanding of patients' unmet needs is essential for providing effective supportive care. This study sought to compare the unmet needs of patients with cancer identified by health care providers (HCPs) among four major healthcare systems. HCPs (n = 247) participated in the International Psycho-Oncology Society (IPOS) Survivorship Online Survey, evaluating their patients' unmet needs. The country of HCPs was grouped into four major healthcare systems: Beveridge model, Bismarck model, National Health Insurance model, and out-of-pocket model. Most HCPs were from countries with the Bismarck model. Substantial levels (> 50%) of unmet needs in all domains are reported across the four healthcare systems. Pediatric patients/survivors living in countries under out-of-pocket healthcare model were evaluated to have less unmet needs for managing decline in physical or cognitive functioning and insomnia/sleep difficulty/fatigue, than those in countries under Beveridge, Bismarck, and National Health Insurance models. Moreover, middle-aged patients/survivors under Beveridge and National Health Insurance models were likely to have greater unmet needs for dealing with cancer-related financial concerns than those under Bismarck model. This study provides valuable insights into the unmet needs of patients with cancer in different healthcare systems, highlighting the significance of targeted interventions to address the unique needs of patients across diverse healthcare systems. Further investigation is warranted to identify the system factors associated with patients' unmet needs, enabling the development of effective healthcare policies and interventions to comprehensively address the multifaceted needs of patients with cancer.

HEALTH TECHNOLOGY ASSESSMENT AS A TOOL FOR HEALTHCARE POLICY MAKING

Background. The article briefly describes the genesis of the concept of health technology assessment, which emerged in the 60s of the XX century. This was due to the emergence of technologies that gave rise to social, ethical, legal and political problems.
 Aim:To highlight the role of health technology assessment (HTA) in providing evidence-based information for health policy making. 
 Materials and methods. The object of the study was the information obtained from the relevant regulations and foreign and domestic literature sources describing the HTA process in terms of its impact on policy making.
 The basics of the HTA process and its purpose, which is to help develop safe and effective health care policies that focus on the needs of the patient and seek to achieve the best value for money, are established.
 Results. The list of factors that contribute to the use of HTA in health policy development, as well as the variety of models of real-world policy processes, is briefly reviewed. 
 It is emphasized that the interaction between policy makers and researchers, as well as the role of each party in the HTA process, especially the application of the results, depends on the social model of society. The introduction of a scientific approach inevitably leads to increased openness and accountability of government decisions and actions. In such a society, social and economic reforms become more successful. 
 Conclusion. It has been determined that the introduction of the HTA institute in Ukraine provides healthcare policy makers with a reliable resource for implementing healthcare reform.

Maternal Health Outcomes in a Somalia Post-war Context: a PhD thesis analyzing trends towards universal health coverage

Abstract Somalia has one of the highest maternal mortality ratios in the world and an inequitable distribution of maternal health outcomes and service utilisation. Like other developing countries, Somalia has adopted the global policy goal of attaining universal health coverage of health services and improved health outcomes across all populations. Although United Nations agencies track the progress towards achieving universal health coverage as part of health targets for achieving the Sustainable Development Goals, empirical case studies are rarely documented, especially in developing countries and even more so in post-war contexts such as Somalia. Literature shows the overall progress towards globally agreed-upon targets for maternal health lagging in war-affected countries, with persistent socioeconomic gradients in health outcomes. However, little is known about the mechanisms through which the social determinants of health impact on the distribution of maternal health outcomes. The aim of this study is to examine the mechanisms through which social determinants contribute to inequities in maternal health outcomes in Somalia. Specifically, the study will analyse the policy context and progress towards achieving universal health coverage of maternal health services in Somalia; analyse trends in maternal health outcomes and inequities in Somalia; and examine the mechanisms through which social determinants contribute to inequities in maternal health outcomes. A mixed-methods case study design will be adopted, employing both qualitative and quantitative approaches to data collection and analysis. The findings of this PhD research will contribute to the evidence base on pathways for achieving universal health coverage of maternal health outcomes in post-war countries like Somalia. This will facilitate development of effective health care policies and those addressing the social determinants, which if implemented will improve maternal health outcomes in Somalia and mark progress towards achieving the goal of universal maternal health coverage.

Exploration of knowledge, attitudes, and perceived benefits towards nurse managers' participation in the health policy-making process: a qualitative thematic analysis study.

Participation of nurse managers in policy-making could help policy-makers to propose relevant and effective policies and support other policy actors involved with these processes. This study aimed at exploring the attitudes and perceived benefits of nurse managers' participation in the health policy-making process. In this descriptive qualitative research, semi-structured interviews were conducted with 16 nurse managers, government officials, and faculty members. Recruitment was based on purposive sampling from different regions across Iran. A thematic analysis was performed in MAXQDA (version 2012). After analysis of the qualitative data, four themes and 13 sub-themes emerged. The themes were feelings about nurse managers' participation, advantages of nurse managers' participation, problems due to the non-participation of nurse managers, and recommendations for improvement of the policy-making process. The outcomes provided new insights into the perceived benefits of and attitudes towards nurse managers' participation in health policy making in the Iranian setting. It is crucial to strengthen the capacity for nurse managers' participation in health policy making to develop effective healthcare policies.

Systemic sustainability and resilience assessment of health systems, addressing global societal priorities: Learnings from a top nonprofit hospital in a bioclimatic building in Africa

Health services represent a cornerstone to ensure well-being and human rights, particularly in deprived areas. The resource cost and appropriate use for the implementation of a top-quality hospital in Sudan are here investigated. An emerging approach such as systems-based Emergy Accounting is applied to assess its sustainability and resilience, also relying on Life-Cycle Assessment data to calculate some new unit emergy values. Very few similar studies have addressed civil works so far, even less bioclimatic buildings, while the focus on health systems is an absolute novelty. Particular attention is paid to design in adverse climate and economic conditions, to the humanitarian nongovernmental organisation running the hospital, and to the cutting-edge medical staff and technologies imported from abroad, also letting local practitioners train in excellence medicine. The system's direct and indirect socio-ecological requirements are expressed as emergy (resource investment) per patient-day, per cardiac surgical operation, per outpatient visit, and per year. From a quantitative viewpoint, these indicators represent a benchmark for improvement scenarios, comparison with new studies in a deserving field, and future investments, driven by effective healthcare policies. They also provide an overview of the efforts required by nature and society to ensure a human right in conditions of scarcity. Besides the possibility to lower a hospital's environmental impact (sustainability-oriented) and to keep it functioning over time in changing climate, resource, societal, economic, and geo-political scenarios (resilience-oriented), this study leads to original remarks upon societal priorities and upon the challenges of guaranteeing high-quality health systems in an uncertain century.

Genetic aortic disease epidemiology, management principles, and disparities in care

Patients with syndromic and nonsyndromic heritable aortopathies (also known as genetic aortic disease) are a heterogeneous group of patients who present at younger ages with more rapid growth of aortic aneurysms and/or increased frequency of dissections compared with patients with atherosclerotic aortopathies. In this review, we describe the etiology, epidemiology, and appropriate care delivery for these conditions at each stage of management. Within each section, we discuss sex, gender, and race differences and highlight disparities in care and knowledge. We then discuss the role of the vascular team throughout the cycle of care and the evolving inclusion of patient input in research. This understanding is essential to the creation of effective health care policies that support equitable, appropriate, and patient-centered clinical practices.

Interdependence among mental health care providers: evidence from a spatial dynamic panel data model with interactive fixed effects

Understanding the pricing and operation mechanism of community mental health (CMH) providers is important for designing effective health care policies as the CMH system has been playing an essential role in providing mental health services. This paper studies the delivery of community-based mental health care and interdependence among CMH providers by investigating the pricing patterns of CMH providers in the Detroit-Wayne County of Michigan. We employ a spatial dynamic panel data model with interactive fixed effects to identify the strategic interactions among the providers, along both dimensions of time-series and cross-section spatial variations. We find evidence for significant spatial interdependence among the CMH providers, even after controlling for the interactive fixed effects. In contrast, the coefficient on the spatial-dynamic term is insignificant, suggesting that no time-space simultaneous effects exist. We also find the pure dynamic effect to be positive and significant. These findings provide important implications for mental health care policy and practice decisions.

Knowledge, attitudes, and practices about COVID-19 among Kashmiri population: A cross-sectional study.

Background:Nations across the globe are investing enormous resources to contain the coronavirus disease 2019 (COVID-19) pandemic. Assessing community knowledge and behavior could help in designing effective health-care policies tailored to the need of target population.Aims:We aimed to assess the knowledge, attitudes, and practices (KAP) about COVID-19 among Kashmiri population and to determine the association of KAP scores with the sociodemographic variables.Settings and Design:This was a cross-sectional study conducted via various online platforms.Materials and Methods:A structured questionnaire was formulated which was divided into three scoring sections assessing KAP about COVID-19 and a nonscoring section assessing individual reactions. A link to the survey was disseminated through social media platforms. A total of 1051 individuals participated.Statistical Analysis:Descriptive statistics were used for assessing the demographic characteristics of participants. Inferential statistics (Mann–Whitney U-test and Kruskal–Wallis test) were used for comparison.Results:Majority of the participants belonged to the age group of 20–39 years (75.4%), were unmarried (66.6%), were from urban background (54.9%), and had education of above high school (96.3%). In general, scores suggested that participants possessed adequate knowledge (mean ± standard deviation: 10.07 ± 1.134), had good attitudes (11.85 ± 1.42), and followed good practices (12.26 ± 1.42) regarding COVID-19. However, we found the correlations between KAP scores to be weak.Conclusions:A knowledge–praxis gap was highlighted in the studied population which was especially true for the vulnerable age group of > 60 years. The findings call for attention of health-care policymakers to design need-based, locally adaptable, and practicable interventional strategies for target population.

Health in All Policy Making Utilizing Big Data.

Introduction:Health in all Policies (HiAP) is a valuable method for effective Healthcare policy development. Big data analysis can be useful to both individuals and clinicians so that the full potential of big data is employed.Aim:The present paper deals with Health in All Policies, and how the use of Big Data can lead and support the development of new policies.Methods:To this end, in the context of the CrowdHEALTH project, data from heterogeneous sources will be exploited and the Policy Development Toolkit (PDT) model will be used. In order to facilitate new insights to healthcare by exploiting all available data sources.Results:In the case study that is being proposed, the NOHS Story Board (inpatient and outpatient health care) utilizing data from reimbursement of disease-related groups (DRGs), as well as medical costs for outpatient data, will be analyzed by the PDT.Conclusion:PDT seems promising as an efficient decision support system for policymakers to align with HiAP as it offers Causal Analysis by calculating the total cost (expenses) per ICD-10, Forecasting Information by measuring the clinical effectiveness of reimbursement cost per medical condition, per gender and per age for outpatient healthcare, and Risk Stratification by investigating Screening Parameters, Indexes (Indicators) and other factors related to healthcare management. Thus, PDT could also support HiAP by helping policymakers to tailor various policies according to their needs, such as reduction of healthcare cost, improvement of clinical effectiveness and restriction of fraud.

546. Seasonal Changes in the Prevalence of Antibiotic-Susceptible Acinetobacter baumannii Results in Increased Multidrug Resistance Rates During Winter Months

BackgroundUnderstanding the seasonal behavior of infections (“seasonality”) caused by Gram-negative pathogens, including Acinetobacter baumannii, is essential for the design of effective healthcare policies; however, the factors mediating seasonality remain elusive.MethodsOver 2,000 A. baumannii cases identified in the BJC Health System between 2007 and 2017, were retrospectively analyzed according to isolation month, hospital acquisition, anatomical source, and antibiotic susceptibility profile.ResultsCompared with quarter 1 (Q1, December–February), A. baumannii case incidence was similar in Q2 (March–May) but significantly higher in Q3 (June–August) and Q4 (September–November). This seasonality was exhibited by antibiotic-susceptible but not antibiotic-resistant isolates. This was independent of tested antibiotic, anatomic source, or hospital vs. community acquisition.ConclusionSeasonality is absent from antibiotic-resistant A. baumannii cases. Selective decrease of antibiotic-susceptible cases in Q1/Q2 results in 50–100% increase in resistance rates compared with Q3/Q4. A. baumannii seasonality is possibly linked to the increased use of antibiotics during winter. As resistance determinants tend to be genetically linked in A. baumannii, pressure from community antibiotics may have the inadvertent effect of selecting for multidrug resistance. This link must be further studied, as it may also explain seasonality in other, more antibiotic-susceptible Gram-negative pathogens.Disclosures All authors: No reported disclosures.

Reflex Testing of Free Prostate-Specific Antigen as Effective Health Care Policy

To the Editor.—We read with interest the article by Schifman et al1 dealing with the utilization of measurement of free prostate-specific antigen (fPSA). We would like to contribute by reporting our experience about the management of fPSA requests by using a reflex testing approach and briefly discuss the status of the analytic control of this measurement.Guidelines recommend testing fPSA to differentiate benign hyperplasia from prostate cancer only when total PSA (tPSA) concentrations in serum range between 4 and 10 μg/L (ng/mL) (revised after the assay recalibration, using the World Health Organization standards, to 3–10 μg/L [ng/mL]).2 Studies have identified the optimal fPSA/tPSA cutoff as 20%, which effectively reduces the number of unnecessary biopsies.3 In 2006, by auditing fPSA requests in our institution, we reported that only 16% (352 of 2247) of those requests complied with this recommendation, with an economic waste for our health care system of ∼$56,250 USD per year.4 These data supported the activation of an automatic reflex test allowing fPSA determination only when tPSA falls within the recommended concentration interval and labelling as “inappropriate” the fPSA requests in samples with tPSA out of the recommended limits. This reflex testing was first introduced for inpatients and 6 years later for outpatients, for whom the rate of inappropriate requests was even higher, with a tPSA ordering associated to fPSA in approximately 44% (2160 of 4871) of cases.After 12 years, we recently audited our laboratory data showing that the fPSA reflex testing works very well in decreasing the test inappropriateness, 95.9% (1772 of 1848) being the rate of appropriately measured fPSA. Considering the last 6-month data, the distribution of detectable fPSA values (limit of detection, 0.01 μg/L [ng/mL]; Cobas e801, Roche Diagnostics, Mannheim, Germany) showed a median value (25–75th percentiles) of 0.70 (0.54–0.99) μg/L (ng/mL). Regarding the quality of measurements, we resorted to results from external quality assessment (EQA) to define (1) the actual state of harmonization of running fPSA assays at the concentrations mentioned above, and (2) whether the concentrations of distributed EQA samples fit with them. Data from the national Qualimedlab EQA (www.qualimedlab.it) (2016–2018 exercises) for the 4 most popular assays (Abbott Architect, Beckman Coulter Access/Dx, Roche Modular/Elecsys/Cobas, and Siemens Advia Centaur) on overall concentration means of fPSA <1 μg/L (ng/mL) showed a marked positive bias for Beckman Coulter systems (on average +25%), with other assays being characterized by a negative bias ranging from −1.4% to −10%.5 According to these data and to the recently published specifications for fPSA bias (≤11.7%),6 we can conclude that the harmonization of fPSA results obtained by the commercially available measuring systems is acceptable enough, with some exceptions. However, we should observe that in EQA schemes only fewer than 50% (8 of 18 per year) of exercises account for samples with fPSA concentrations below 1 μg/L (ng/mL), which mirror the distribution of fPSA concentrations in appropriate orders.In conclusion, the use of reflex testing practice for fPSA should be strongly recommended as health care policy and implemented to pursue appropriate ordering and maximize clinical effectiveness. EQA providers should, however, pay more attention to fPSA concentrations of control materials to better evaluate the clinical suitability of available assays.The authors are grateful to Giancarlo Zucchelli and Rudina Ndreu (CNR, Istituto di Fisiologia Clinica and QualiMedLab Srl, Pisa, Italy) for providing data of the EQA Immunocheck.