Emergency Visits Research Articles

Clinical and demographic factors linked to low-value emergency department visits in pediatric patients with spina bifida.

Identifying factors associated with emergency visits that could be delivered at lower-cost sites may help guide population health strategies for pediatric patients with spina bifida. Emergency department encounters (2016-2023) by patients with spina bifida (< 18-years-old) in Pediatric Health Information System were identified. Absence of clinical and imaging charges was defined as low-value emergency visit. We utilized a control population of patients (<18-years-old) with obstructive/reflux uropathy who presented for emergency department encounters (2016-2023). Mixed effects (with repeated individual measurements as random effect) logistic regression was fitted to model odds of low-value emergency visit. In total, we included 22,672 emergency visits by patients with spina bifida. 20.7% of these emergency visits were low-value versus 17.7% in controls (p<0.001). Costs related to low-value emergency visits account for 3.8% of all costs for emergency visit-related encounters in patients with spina bifida. Low-value emergency visits were associated with younger age [OR 1.05 (1.04 - 1.06) per year younger], Hispanic/Latino [OR 1.21 (1.06 - 1.39) compared to non-Hispanics], black [OR 1.35 (1.16 - 1.58) compared to white], public insurance [OR 1.14 (1.01 - 1.29) compared to private insurance], and genitourinary encounter diagnosis [OR 1.16 (1.04 - 1.30)]. Using a standard patient, we found that the odds of low-value emergency visit across hospitals ranged from 0.31 to 5.36. Younger age, Hispanic/Latino ethnicity, black and other race, public insurance, and genitourinary encounter diagnosis were associated with higher odds for low-value emergency visits in pediatric patients with spina bifida. There was wide variation across hospitals that warrants further investigation to elucidate best practices.

Characteristics of ocular-related emergency department visits: Five-years data from a tertiary care center in Riyadh, Saudi Arabia.

Ocular emergencies (OE) include ocular trauma, infections, retinal detachment, and uveitis. Due to the limited number of studies describing ocular emergencies requiring Emergency Department (ED) visits in Saudi Arabia, there is a need for further studies addressing this topic. Therefore, this study aimed to assess and describe the incidence, clinical presentation, and causes of ocular-related ED visits at a tertiary hospital in Riyadh, Saudi Arabia. This was a retrospective cohort study. Medical records were reviewed for all patients (all age groups) patients presenting at the ED from 1 January 2019 to 31 October 2023 where data for patients with any ocular emergency was extracted using an Excel sheet. Data analysis was performed using RStudio (R version 4.3.1). Baseline information was described using frequencies and proportions. Types of Ocular emergencies were described using the International Classification of Diseases, 10th Revision (ICD-10) codes and presented using frequencies and proportions. The distribution of ocular emergencies across months and age groups was expressed using chart figures. A total of 15,321 ocular-related ED visits were included in this study. Almost 51% of patients were males. The mean age at diagnosis was 25.5 ± 22.1 years. More than half of the patients (51.0%) were diagnosed during childhood (<18 years), while proportions of older ages declined gradually. Average presentations of ocular emergencies in a single month ranged from 200 to 400. Conjunctival disorders including conjunctivitis (29.8%) were the most frequent ocular emergencies. The findings of this study showed that ocular emergencies are more prevalent in younger patients (aged <18 years), more commonly due to conjunctivitis. This highlights the need for policymakers to assess the causes of such emergency in this population and implement prevention strategies. Moreover, an average of 200 to 400 emergency visits per month are ocular-related. This finding could help policymakers understand the burden of ocular emergencies on the ED and the pressure that could add to the ED staff to provide appropriate care for these patients.

Health screening and its association with emergency department visits and related costs among home-dwelling older adults

Background The aim of this study was to evaluate the effectiveness of the health screening procedure for home-dwelling older adults in reducing emergency department visits and associated costs. Methods Data were derived from health screenings from 2020 to 2021 for 75-year-old home-dwelling residents of Western Finland. The study compared emergency department visits and associated costs between older adults who participated in the health screening (intervention group) and those who did not (non-intervention group). For each older adult, three non-intervention controls were matched according to age, sex, health screening year and wellbeing service county. Emergency department visits and International Classification of Diseases (ICD)-10 codes from one year before to two years after health screening were analyzed. Results In the non-intervention group, a 19% increase in emergency visit rates was seen (457–564 per 1000 person-years), while the intervention group showed a 67% decrease (165–23). Annual costs for the non-intervention group increased from 148 euros (€) to €183, a mean ratio increase of 1.24 per person-year (range 1.08–1.40). In contrast, the intervention group’s costs decreased from €53 to €8, a mean reduction ratio of 0.15 per person-year (range 0.10–0.71). The intervention group had lower frequency of visits for respiratory and circulatory diseases but higher for digestive and metabolic diseases, unlike the non-intervention group. Conclusions The implementation of the health screening is an effective strategy for reducing both the frequency of emergency department visits and associated costs in home-dwelling older adults in good condition.

Investigating Nonadherence in an Integrated Diabetic Limb Salvage Programme: Reasons, Associated Factors, and Impacts on Care Outcomes.

Adherence to treatment plans is crucial for patients with diabetic foot ulcers (DFUs) to achieve positive outcomes. With limited understanding of nonadherence and its impacts on care outcomes, this study aimed to explore the reasons and factors associated with nonadherence in an integrated diabetic limb salvage (DLS) programme and evaluate its effects on care outcomes. This study included 2798 DFU patients who were enrolled in an integrated DLS programme across multiple institutions in central and northern Singapore from 2020 to 2021. Reasons for nonadherence were obtained via telephone interviews. Factors associated with nonadherence were identified using multiple logistic regression. Differences in one-year outcomes, including minor and major lower extremity amputation (LEA), mortality, LEA-free survival, and healthcare utilisation between adherent and nonadherent patients, were examined based on a significance level of P < .05. Nonadherence was observed in 40.2% of patients, with higher rates among younger patients, Malays and Indians, and those with higher HbA1c levels. Patient-related factors were the most commonly reported reasons for missed appointments (50.4%). Compared to adherent patients, nonadherent patients exhibited a relatively higher minor LEA rate (13.0% vs 10.2%, OR = 1.18, 95% CI: 0.93, 1.51), lower mortality rate (8.6% vs18.1%, OR = 0.50, 95% CI: 0.39, 0.65), higher overall LEA-free survival (76.4% vs 71.1%, OR = 1.27, 95% CI: 1.06, 1.53), and more hospitalisations (IRR = 1.22, 95% CI: 1.11, 1.33) and emergency visits (IRR = 1.27, 95% CI: 1.16, 1.39). While nonadherent patients showed relatively higher minor LEA rates and more healthcare utilisation, they also exhibited lower mortality and higher LEA-free survival. This suggests that nonadherence in this population may be associated with complex patient characteristics and behaviours that warrant further investigation to tailor interventions effectively.

Real-World Evaluation of Treatment Patterns, Healthcare Costs, and Healthcare Resource Utilization Among Patients with Non-small Cell Lung Cancer in the US Receiving Sotorasib.

Sotorasib was the first drug approved for adults with Kirsten rat sarcoma G12C-mutated locally advanced/metastatic non-small cell lung cancer (NSCLC) who received prior systemic therapy in the US. This study aimed to provide initial real-world evidence on patient characteristics, treatment patterns, healthcare resource utilization (HCRU), and healthcare costs (HCC) associated with sotorasib in US clinical practice. A retrospective observational study was conducted using the Optum Clinformatics® Data Mart US claims database spanning January 2016 to March 2023. The study population included adults with a diagnosis of lung cancer (diagnosis (Dx) date), claims for sotorasib on/post-Dx date (index date), Continuous enrollment for medical/pharmacy benefits from 180 days pre-Dx date to≥30 days post-index date was required. Patients receiving treatments for small-cell lung cancer (SCLC) pre-index were excluded. Outcomes were analyzed for patients receiving sotorasib as second or subsequent line (2L+) treatment and included adherence [proportion of days covered (PDC)], treatment duration, time to next treatment (TTNT), HCRU, and HCC during sotorasib treatment. Among 169 patients with lung cancer that met all inclusion criteria, 140 patients received sotorasib as 2L+ treatment (mean age: 71 years; 67.1% females). Mean PDC for sotorasib was 94.9%. Kaplan-Meier median treatment duration was 4.3 months. Median TTNT in patients with subsequent treatment (n=31) was 6.8 months. During sotorasib treatment, patients had a mean 3.87 outpatient, 0.09 inpatient, and 0.11 emergency visits per month. Mean monthly HCC during sotorasib treatment were US$23,063 versus $25,541 during the 180-day pre-index period. Patients in the US receiving sotorasib as 2L+ therapy for NSCLC in real-world clinical practice showed high adherence, TTNT comparable to progression-free survival observed in clinical trials, and HCC similar to those immediately prior to treatment demonstrating real-world benefits with no additional impact on healthcare resources with sotorasib.

Automatic telephonic follow up in heart failure by a natural language processing artificial intelligence: pilot program

Abstract Introduction Heart failure (HF) burden on public health is substantial and efficient patient management strategies are needed. Traditional methods of HF monitoring face limitations in scalability and effectiveness. Artificial Intelligence (AI) might offer novel solutions for enhanced resource management and alleviation of healthcare burdens. Purpose To study the feasibility of implementing automatic remote monitoring via phone calls operated by AI in a HF unit. Methods We conducted a non-randomized, open, pilot trial employing an AI technology based on natural language processing for autonomous telephone outreach for the follow up of HF patients. 86 patients from a tertiary hospital HF unit undergoing pharmacological titration and education were enrolled. The AI conducted weekly calls to gather symptomatology, vital signs, and health status changes, which were then displayed on a virtual platform featuring alerts preconfigured by the research team. These alerts guided patient communication and intervention as deemed necessary by a specialized nurse. Results Characteristics of patients are shown in Table 1. The AI followed these patients for a median of 251.5 days. 2773 telephonic calls were performed. We estimate an equivalent to 1445h of work (17.2 days/month). Adherence was high during the study, with 98% of the calls completed. 1427 alerts were generated, being the most frequent weight change (251; 17.6%), orthopnea (220; 15.4%) and fatigue (187; 13.1%). It led to 487 remote interventions, most of them consisting in calling the patient for assessment (409; 84.0%), but also in adjusting medication remotely (34; 7.0%). See Figure 2. A HF telemedicine specialized nurse required 205min per week for alert review, 2.38min/patient-week. 2 patients died, one from cardiovascular causes, and 7 patients had a HF hospitalization, 42.9% with previous alarms. 20 events of worsening HF were recorded, comprising hospitalization, emergency visit or IV diuretic administration. Oral diuretic dose was increased in 22 occasions, 15 of them remotely in response to an alert raised by the AI operator. At 6 months functional class globally improved (p = 0.028), but NTproBNP increased (p=0.0472). Quality of life was evaluated at baseline and at 6 months, with no change in EQ5D5L (median 0.717, change -0.005, p 0.71) or PHQ4 (median 2.88, change -0.29, p 0.7792), but KCCQ12 total score worsened (median 74.49, change -2.32, p 0.048). Experience was rated with 8.97/10 in a satisfaction questionnaire. All patients recommended the program, remarking a closer follow up, better communication and a safety feeling. Conclusions AI enables closer monitoring of patients with HF, maintaining contact with stable patients while also allowing for resource allocation and tracking of higher-risk patients or those experiencing changes in symptoms. A randomized clinical trial comparing to standard follow-up is needed to evaluate this promising technology.Table 1Figure 2

Geographic Socioeconomic Influences on Disease Activity in Rheumatoid Arthritis in an Academic and Safety Net Hospital System.

The objective of this study was to analyze the impact of the Area Deprivation Index (ADI) on disease activity and cardiovascular comorbidity in rheumatoid arthritis (RA). A retrospective analysis of adult patients with RA was conducted to highlight differences in academic and safety net hospital clinics. Demographics, RA medication history, patient portal engagement, primary care presence, emergency or inpatient visits, RA disease activity and functional scores, Charlson Comorbidity Index (CCI), and cardiovascular disease (CVD) presence were captured. The ADI rank was assigned using nine-digit zip codes. Patients were stratified by the upper versus lower ADI decile group and matched by age, sex, race, ethnicity, insurance, and CCI using propensity score analysis. Patients with RA from the academic practice (n = 542) and the safety net hospital (n = 496) were assessed. In the academic cohort, those with high ADI scores (>8, more deprivation) had higher RA disease activity scores (Routine Assessment of Patient Index Data 3 mean ± SD: high 13.83 ± 6.94 vs low 11.17 ± 7.37, P < 0.0001; Clinical Disease Activity Index mean ± SD: high 11.97 ± 11.74 vs low 9.40 ± 7.97, P < 0.05), more functional impairment (Multidimensional Health Assessment Questionnaire mean ± SD: high 2.99 ± 2.29 vs low 2.34 ± 2.23, P < 0.01), lower MyChart use (P < 0.001), and different smoking history (P < 0.01) compared to those with low ADI scores (<3, less deprivation). In the safety net cohort, there was a statistically significant difference only in smoking status (P < 0.05). CVD was not significantly different in either cohort. The absence of differences in RA disease activity and functional impairment in patients suggests that the ADI may not be as effective at predicting RA disease activity specifically in a safety net health care context. Identifying the discrepancies between the two systems may elucidate areas of improvement for patient care.

Texting in the Fourth Trimester: mHealth for Postpartum Care.

Objective Rising maternal morbidity and mortality in the US is a complex problem and is often tied to the postpartum period. Postpartum visits are poorly attended leading to gaps in contraception, mental healthcare, and care for chronic conditions. mHealth, healthcare supported by mobile technologies, has been shown to improve antenatal care adherence. Our study aims to determine whether an mHealth intervention of interactive, educational text messages can improve care for women postpartum. Study Design We conducted a randomized-control trial of 191 women receiving OB/GYN care in our clinic from November 2019-April 2020. Patients were randomized postpartum to receive either routine care or routine care with mHealth text messages and appointment reminders specific to delivery type. The primary endpoint was attendance to the six-week postpartum visit with secondary endpoints of breastfeeding, contraception use, emergency visits, and postpartum depression scores (EPDS). A subgroup analysis was additionally conducted to assess the impact of some visits shifting to telehealth due to the timing of the COVID-19 pandemic. Results Patient demographics were similar between the two groups. There was no significant difference in postpartum appointment attendance between text message (n=57, 59%) and control groups (n=62, 66%, p=0.31). 117 patients were scheduled for in-person postpartum visits, and 74 for telehealth visits during the COVID-19 pandemic, with no significant difference in attendance rate between groups for either visit modality. Conclusion Automated text messages alone did not increase our primary outcome of adherence to postpartum care, even when visits were conducted by telehealth. While mHealth has proven successful in other care areas, such as antepartum follow-up, further research is needed to determine whether it is an effective method to improve adherence to postpartum care, or whether other strategies must be developed, including augmentation with human navigators.

Association of heat and cold waves with cause-specific mortality in Iran: a systematic review and meta-analysis

Despite the frequent occurrence of heat waves in the Middle East, there is a lack of evidence regarding the overall estimates for the effect of heat waves on mortality in this region. This study aimed to review the effect of exposure to heat and cold waves and daily cause-specific mortality. Four electronic databases were searched. The titles, abstracts, and full-texts of the articles were carefully reviewed by two researchers. Once eligible studies were identified, the required data were extracted. Separate meta-analyses were conducted based on gender, age group, and health endpoint combinations. According to the meta-analysis, heat waves had a statistically significant effect on all-cause mortality with an RR of 1.23 (CI 95%: 1.08, 1.39). Cardiovascular mortality significantly increased in heat waves with an RR of 1.08 (CI 95%: 1.05, 1.10). However, the increase in respiratory mortality was not statistically significant. Compared to young people (age < 65 years old) and women, elderly and men were more vulnerable to heat waves with RRs of 1.31 (95% CI: 1.05, 1.57) and 1.33 (95% CI: 1.08, 1.58), respectively. This study can be beneficial in developing response or adaptation plans for heat waves. Future studies should focus on other specific health endpoints like ischemic heart disease, chronic obstructive pulmonary diseases, etc., and other outcomes such as hospitalization and emergency visits.

Evaluation of Emergency Admissions Due to Animal-Related Incidents Based on Prehospital Emergency Medicine Data: A Retrospective Study.

Animal injuries, especially dog bites, are a major public health problem in both developed and developing countries. The majority of these injuries lead to emergency healthcare visits and may have serious consequences such as infection risk and organ injuries. There is a limited number of studies on the demographic and operational characteristics of animal-related 112 emergency visits in Turkey. In this study, we aimed to conduct research to fill this gap. This retrospective study included animal-caused cases received by Ankara 112 Emergency Health Services Emergency Health Automation System (ASOS) between January 1, 2019 and December 31, 2023. A total of 3457 cases were analyzed. Data were evaluated using theIBM SPSS 27.0 program. There was an overall decreasing trend in animal-related emergency admissions between 2019 and 2023. Most cases were recorded during the summer season, especially in July. Male patients predominated (61.2%), with the majority of cases (81.7%) occurring in urban areas. Dog bites were the most common cause, accounting for 49.3% of cases. In the majority of cases, transportation time was below the Ministry of Health quality standards. Dog bites account for the majority of animal-related emergency admissions. The increase in cases during thesummer months emphasizes the importance of social awareness and preventive strategies. The findings of the study provide an important reference for improving emergency health services and developing strategies to prevent such cases.

A diagnostic journey: Unraveling von Willebrand disease in a child with inconclusive initial testing

Background: Epistaxis attacks in childhood are an important reason for pediatric emergency visits, most of which are minor and infrequent. However, recurrent epistaxis can be a sign of an underlying bleeding disorder such as von Willebrand disease. This case report highlights controversies and obstacles that may arise during the diagnostic process, hindering a clear confirmation. Case presentation: An eight-year-old boy, who had a history of recurrent epistaxis and easy bruising since infancy, was presented to the Pediatric Emergency Department of Al Khor Hospital for a repeat episode of nosebleed. Local examination showed dilated capillaries in addition to nasal bleeding signs. Family history revealed similar past complaints in both his brother and his father. Previous epistaxis attacks were mostly left-sided. Blood workups were not diagnostic. Later, repeated blood tests led by high clinical suspicion resulted in the diagnosis of von Willebrand disease. The new diagnosis had a direct effect on the patient’s bleeding management. Nose bleeds peaked in frequency and severity over the next two years and decreased remarkably thereafter, the same pattern as before in the father and older brother. Discussion: The heterogeneous nature of von Willebrand disease, overlapping with the healthy population, creates a diagnostic dilemma. Therefore, balanced diagnostic approach is crucial. Bleeding history and family history provide invaluable clues but are not definitive. The blood workups may struggle with the variations in function and fluctuating levels of the von Willebrand factor molecule. Although genetic testing is helpful in some cases, it has its limitations. Conclusion: The diagnosis of von Willebrand’s disease generally follows the traditional approach. It begins with a detailed bleeding history combined with a focused family history that pinpoints potential cases, followed by blood testing. However, interpretation of blood workups can be challenging due to the patient-to-patient and within-patient variability of the disease, the wide panel of investigations, and the different cutoff levels in different guidelines. Despite all this, testing is irreplaceable. Management of bleeding should begin immediately and should not be affected by inconclusive blood workups.

Clinical Effectiveness and Safety of Dupilumab in Chronic Obstructive Pulmonary Disease Patients: A 7-Year Population-based Cohort Study

BackgroundPrevious randomized controlled trials had established the efficacy of dupilumab among patients with chronic obstructive pulmonary disease (COPD) treated with triple therapy over 52 weeks of follow-up. ObjectiveThis population-based cohort study aimed to explore the long-term clinical effectiveness of dupilumab in COPD patients. MethodsThis population-based cohort study included U.S. patients with COPD between April 2017 and August 2024. Patients initiating dupilumab and therapies that incorporated long-acting β2-agonists (LABA) inhalers were included. Patients with asthma or lung cancer were excluded. The risk of outcomes after the initiation of dupilumab versus LABA-containing therapies was measured. For detailed Methods, please see the Methods section in this article's Online Repository at www.jacionline.org. ResultsA total of 1,521 dupilumab initiators and 1,521 propensity score-matched patients receiving LABA-based therapies were included. Dupilumab recipients were associated with lower all-cause mortality (HR:0.53, 95% CI:0.43-0.65), emergency visits (HR:0.78, 95% CI:0.69-0.89), and acute exacerbation (AE) rates (HR:0.59, 95% CI:0.53-0.65). Dupilumab was also associated with reductions in the requirement of short-acting β2-agonists (HR:0.48, 95% CI:0.43-0.52), short-acting muscarinic antagonists (HR:0.43, 95% CI:0.37-0.49) for symptoms control. Additionally, dupilumab decreased subsequent pneumonia (HR:0.65, 95% CI:0.50-0.86), and COPD-relevant comorbidities including new-onset heart failure (HR:0.69, 95% CI:0.53-0.90) and new-onset anxiety (HR:0.70, 95% CI:0.53-0.93). ConclusionsDupilumab was associated with a lower rate of mortality, emergency visits, reduced risk of AEs, respiratory symptoms, and respiratory infections in COPD patients. More studies are required to validate the effectiveness of dupilumab among patients with COPD across various severities.

Sub-Optimal Disease Control and Low Blood Eosinophil Testing Frequency in Chinese Adult Patients with Asthma Receiving GINA Step 4/5 Treatment: A Real-World Study.

To inform effective management strategies for severe asthma in China, this study aimed to comprehensively characterize clinical characteristics, treatment patterns, disease control status, and healthcare resource utilization among patients on GINA Step 4/5 therapies by analyzing data from the Adelphi Asthma Disease Specific Program conducted in China. All information was retrieved from medical records or collected from physicians and patients on the survey date (August-December 2018); no follow-up was conducted. Results were summarized descriptively for patients on GINA Step 4/5 therapies, who were pooled from a consecutive sample (comprising three or more consecutive patients with physician-diagnosed asthma from each participating physician) and an oversample (comprising the next two patients with physician-perceived severe asthma from each participating physician). Of the included patients (n=754), 51.5% had ever had a blood eosinophil measurement taken, 22.1% had available records for their most recent blood eosinophil measurements (68.9% of them had an elevated level ≥150 cells/µL), 39.9% had ever been tested for specific immunoglobulin E or radioallergosorbent, and 8.0% were prescribed maintenance oral corticosteroids. Asthma was not well controlled in 69.2% of patients. In the prior year, 27.1% experienced at least one severe exacerbation and 22.8% experienced at least one hospitalization (emergency visit or overnight stay) due to asthma. In Chinese patients with asthma on GINA Step 4/5 therapies, biomarker testing was underutilized, asthma was not well controlled, and severe exacerbations were not infrequent. These findings highlight the urgent need for optimized asthma management for patients on GINA Step 4/5 therapies in China.

Impact of respiratory syncytial virus infection among patients with hematological cancer in the era of post-coronavirus pandemic.

400 Background: Two vaccine is recently approved for elderly patient with compromised immunity. Despite the recommendation by Center for Disease Control and Prevention (CDC), RSV vaccination is remains low among patient with hematological malignancy, when compare to influenza vaccination. Thus, we conducted an observational study to estimate the impact of RSV infection among patients with hematological malignancy. Methods: We conducted a population-based retrospective cohort utilized the TritNetx dataset, which consist of patients across 63 U.S. healthcare organization. This study included patient who had respiratory viral infection after a diagnosis of hematological malignancy during 6/1/2022 - 4/1/2022. Hematological malignancy was identified using ICD-10 codes. CPT code and ICD-10 code were used to identify diagnosis of respiratory viral infection after respiratory pathogen panel testing. Patient who was diagnosed with RSV, influenza or COVID-19 were paired based on the following variable, including demographics, body mass index, comorbidities, and anti-neoplastic therapy. Hazard ratio (HR) was estimated by Cox proportional hazard regression models and log-rank test. Risk ratio (RR) was calculated by logistic regression. Results: A total of 6,088 patients with hematological malignancy contracted RSV, influenza or COVID during the observation period. When compare to influenza, patients with RSV infection were associate with high healthcare utilization, including emergency visit (HR: 1.20, 95% CI:[1.00-1.41]), and hospitalization (HR: 1.29, 95% CI:[1.06-1.57]). RSV infection was also resulted in higher acuity including viral pneumonia (HR: 15.42, 95% CI:[9.26-25.68]), use of antibiotics (HR: 1.54, 95% CI:[1.28-1.86]), renal replacement therapy (HR: 2.09, 95% CI:[1.10-3.96]), and acute respiratory failure (HR: 1.54, 95% CI:[1.14-2.07]). When compare to COVID-19, RSV infection showed similar trend including more frequent emergency visit (HR: 1.30, 95% CI:[1.10-1.54]), and high risk of developing viral pneumonia (HR 23.48, 95% CI: [12.79-43.09]). Interestingly, the intubation rate, 28 days all-cause mortality and 90 days all-cause mortality were similar between the three cohort. Conclusions: RSV infection was associated with higher rate of pneumonia and healthcare utilization. RSV vaccination should be considered to prevent RSV-associated morbidity among patients with hematological malignancy.

Cost-Effectiveness of Influenza Vaccination in Healthy Children: A 10-Year Population-Based Study

Background/Objectives: Seasonal influenza annually puts a significant burden on the pediatric population, especially the youngest, causing severe illness and death. Additionally, associated healthcare costs cause a significant financial strain on healthcare systems. While vaccination is the most effective prevention method, its cost-effectiveness for healthy children remains unassessed. Methods: Using the Pedianet database spanning from 2009 to 2019, we analyzed influenza cases among 6-month-olds to 14-year-olds in Italy. Data included influenza-related medical visits, prescriptions, exams, emergency visits, hospitalizations, and costs. Adverse events and quality-adjusted life years (QALYs) were considered from the existing literature. A static decision-tree model compared annual vaccination strategies, assessing probabilities for influenza or influenza-like illnesses by vaccination status. Incremental cost-effectiveness ratios (ICERs) were calculated, along with sensitivity analyses and cost-effectiveness acceptability curve generation. Results: Mean total influenza costs for vaccinated children averaged EUR 18.6 (range 0–3175.9, including EUR 15.79 for the influenza vaccination), whereas costs for unvaccinated children were consistently lower at around EUR 4.6 (range 0–3250.1). The average ICER for years where vaccine and virus strains are matched was EUR 29,831 per QALY, which is below the EUR 40,000 threshold set by the Italian National Health Services. The ICER values range from EUR 13,736 (2017/2018) to EUR 72,153 (2013/2014). Averted influenza costs averaged EUR 23 per case, with fluctuations over the years. In most observed years, influenza vaccination was cost-effective from the healthcare providers’ standpoint. The exception was 2009–2010, due to a mismatch between vaccine and virus strains. Conclusions: This study highlights the economic viability of influenza vaccination, especially when virus and vaccine strains align. It demonstrates the potential of vaccination programs in preserving children’s health and well-being while managing healthcare costs.

Efficiency of clear aligners vs fixed appliances: A narrative review

Clear aligner therapy has emerged as a popular alternative to traditional fixed orthodontic treatment, particularly among adult patients seeking aesthetic and comfortable options. These aligners, made of clear thermoformed plastic, offer advantages such as improved aesthetics, comfort, oral hygiene, and periodontal health compared to fixed appliances. Recent studies have shown that clear aligners can be equally effective as fixed appliances, if not more so, for treating mild to moderate malocclusions, with shorter treatment durations, fewer appointments, and reduced emergency visits. While clear aligners may not be as effective for complex cases requiring additional techniques, advancements in technology have expanded their applicability, allowing for the incorporation of methods used in traditional braces. However, more extensive research is needed to fully understand their impact on oral health and the oral microbiome, spanning all treatment phases from initiation to maintenance. Additionally, various brands of clear aligners with different materials and designs have entered the market, offering alternatives to the widely known Invisalign™, though scientific literature on these alternatives remains limited. This article discusses about the efficacy of clear aligners as compared to fixed appliances in orthodontic treatment.

Predictors of diagnostic delays and loss to follow-up in women with von Willebrand disease: a single-center retrospective cohort study

BackgroundWomen with von Willebrand disease (VWD) often face diagnostic delays, leading to increased bleeds, stress, and healthcare use. The factors influencing these delays and their effects on gynecologic outcomes are not well understood. ObjectivesThis study aimed to 1) identify the prevalence and predictors of diagnostic delays and loss to follow-up in women with VWD and 2) determine how these delays affect severe gynecologic bleeding, emergency visits, transfusions, and hysterectomies. MethodsWe conducted a single-center retrospective cohort study and included women aged ≥18 years diagnosed with VWD. Delayed diagnosis was defined as ≥3 bleeding events prior to VWD diagnosis, excluding easy bruising due to its subjectivity. Loss to follow-up was defined as ≥5 years since the last hematology visit. We used logistic regression for analysis. ResultsAmong 178 diagnosed women (median age, 27 years), 71 (40%) experienced ≥3 bleeding events before diagnosis. The median time from the first bleeding event to VWD diagnosis was 14.2 years. Severe bleeding events significantly predicted diagnostic delays (adjusted odds ratio, 3.1; 95% CI, 1.5-6.2). Fifty-four (30%) women were lost to follow-up, with remote era of initial bleed and VWD type identified as significant predictors. Delays were associated with increased risks of hysterectomies (odds ratio, 2.7; 95% CI, 1.2-6.3) and other gynecologic procedures. ConclusionDelayed diagnosis and loss to follow-up in VWD are common even in a specialized Hemophilia Treatment Centre. Such delays lead to more severe bleeding and increased gynecologic interventions. Prompt diagnosis is paramount for better patient outcomes and reduced healthcare utilization.

Does change in area-level deprivation, change health outcomes? A latent class growth analysis of population data.

BackgroundWhile the link between deprivation and health is established, little is known about the association of persistent deprivation or deprivation trajectories over time with adverse health outcomes. AimTo examine latent class trajectories of area level-deprivation from 2010-2016 and their association with social distress indicators from 2017-2021. MethodAnalysis was based on linked administrative data (N=1,569,110) from NI GP Registrations Index, emergency department records (2017-21), enhanced prescribing data (2017-21) and biennial area-level deprivation (2010-2016). Latent class growth analysis (LCGA) identified deprivation trajectories between 2010 and 2016; and regression-based models, adjusted for age, sex and urbanicity, examined their association with indicators of individual level distress: occurrence of death, any accident and emergency (A&amp;E) visit, and any psychotropic medication between 2017 and 2021. ResultsBased on comparison of models and fit statistics, a non-linear LGCA model identified six trajectories: consistently deprived (21.2%); slight improvement (7.1%); substantial improvement (1.2%); consistently average deprivation (31.7%); slight worsening (18.5%); and consistently non-deprived (20.4%). Consistently living in a deprived area was associated with higher likelihood of death, A&amp;E visits and receipt of hypnotics, anxiolytics, and anti-depressants. Compared to consistent deprivation, slight improvement was associated with lower likelihood of death (OR=0.94, CI: 0.91-0.97) and all psychotropic medication in the follow-up period. ImplicationsFindings indicate that even a slight improvement in deprivation status can have a positive influence on health outcomes. Further population-wide analysis of deprivation trajectories, their determinants and associated health impact will inform targeted interventions that promote social mobility and improved health.

Unlocking data to inform public health policy and practice: A pilot study on utilising police data for linked population data research

ObjectiveThe UK Government increasingly emphasises a comprehensive, multi-agency approach to tackling crime. This pilot study explores the feasibility of integrating police data with routine health data to develop a holistic understanding of the predictors of domestic abuse (DA). ApproachThe study encompasses three work-packages a) coding the narrative data from Domestic Abuse, Stalking and Harassment (DASH) risk assessment report from Public Protection Notifications (PPNs), which are information-sharing documents recording safeguarding concerns and shared with partner agencies b) exploring to identify what works to harmonise different software systems within police data-sharing approach, c) constructing a case study by linking PPN DASH data with routine health and administrative records. These efforts illustrate the potential of national data-sharing initiatives. Results a) Text mining methods successfully identified and coded (with over 95% accuracy) 17 refereed/involved agencies from the PPN DASH data. b) Barriers to data sharing were attributed to a lack of clarity and consensus regarding appropriate information sharing, rather than technical obstacles. This barrier can be overcome by an unambiguous framework, endorsed at an elevated level, highlighting which data should be shared. c) The data-linkage study revealed that victims of DA had prior interactions with healthcare services before their initial PPN, and younger pregnant victims had higher risk of future healthcare emergency visits. Conclusion and ImplicationPolice and health data integration enhances evidence-based prevention and early identification of vulnerable individuals by both law enforcement and public health services.

Healthcare utilization and economics evaluation of paliperidone palmitate once-monthly in schizophrenia: a one-year, real-world, and retrospective mirror image study in China.

Investigation and analysis of the changes in healthcare resources and burden of schizophrenia in the real world before and after switching from oral antipsychotics (OAPs) to paliperidone palmitate once-monthly (PP1M) could provide evidence to clinicians and patients for choosing treatment modality and data support for health policy optimization. The first dosage of PP1M was set as mirror point, and patients with mirror point between January 2020 and June 2022 were recruited in the study. The differences in treatment patterns, healthcare resource utilization, and costs within one year before and after the mirror point were compared. A total of 72 patients transitioning from OAPs to PP1M (mean age, 35.33 years; 43.06% female) were included in the study. Of the 72 patients, the application of PP1M resulted in a significant reduction in the hospitalization times, emergency room visits, and direct medical costs (P < 0.001), while the pharmacy cost and total cost increased by 222.57% (P < 0.001) and 16.35% (P < 0.001), respectively; PP1M accounted for 88.48% of the pharmacy cost. For patients with ≥1 hospitalization during the OAPs phase (n = 25), the number of hospitalizations, hospitalization days and hospitalization expenses decreased by more than 90% (P < 0.001). Total one-year expenses decreased by 37.67% (P < 0.001), and pharmacy expenses increased by 185.21% (P < 0.001). For patients with no hospitalizations during the OAPs phase (n = 47), emergency and outpatient visits decreased by 70% (P < 0.001) and 30.27% (P < 0.05), respectively, while the total cost increased by 117.56% (P < 0.001), and the pharmacy cost increased by 260.15% (P < 0.001) after initiation of PP1M treatment. After the transition to PP1M, the number of hospitalizations and outpatient and emergency department visits reduced, and healthcare resources were conserved. Switching to PP1M may be more economically beneficial for patients with prior hospitalizations while on OAP regimens. The high price of PP1M might be an obstacle to its widespread use.