Health Information Center Research Articles

Low ambient temperature as a novel risk factor of oral diseases: A time-series study

BackgroundThe seasonal variation of oral diseases has been observed in life, but the influences of oral diseases associated with non-optimal ambient temperature were unknown. ObjectiveTo examine whether non-optimum ambient temperature is associated with increased risks of oral diseases. MethodsWe conducted a time series study based on outpatient data from the Shanghai Health Information Center, containing all public hospitals in Shanghai from 2016 to 2019. Generalized additive models with distributed lagged nonlinear models were applied to fit the data. ResultA total of 3,882,636 outpatient cases of oral diseases were collected. Low temperature (<7 °C) posed increased risks for oral diseases. Daily temperature above 7 °C had no effect on oral diseases. The excess risks were present on the lag 1 day and lasted till lag 7 day. Relative to referent temperatures, the cumulative risks of total oral diseases, pulpitis, periodontitis, gum pain, stomatitis, and glossitis at extreme low temperature (−3 °C, 1st percentile) over lag 0–7 day were 1.92 (95% confidence interval, CI: 1.40, 2.63), 2.40 (95% CI: 1.78, 3.25), 1.62 (95% CI: 1.15, 2.29), 1.75 (95% CI: 1.08, 2.83), 1.81 (95% CI: 1.30, 2.53), and 2.22 (95% CI: 1.23, 3.99). These associations were larger in patients who were above age 60. ConclusionThis study provided novel epidemiological evidence that low ambient temperature may increase the risks of oral diseases. The temperature thresholds for eight oral diseases range from 3 to 7 °C. The excess risks could last for 7 days and were larger in older patients.

Telehealth Clinical Practice Guide for Occupational Therapy, Physical Therapy, and Speech and Language Pathology: A Saudi and Middle Eastern Guide.

Telehealth refers to the application of telecommunications technology to deliver clinical services at a distance by linking clinician to patient, caregiver, or any person(s) involved in client care for assessment, intervention, consultation, and supervision. Telehealth for occupational therapy (OT), physical therapy (PT), and speech and language pathology (SLP) have produced service delivery venues that are of great benefit during the coronavirus disease 2019 pandemic. The concept of telehealth for rehabilitation services is relatively new in the Middle East, and no specialty-specific clinical practice standards or guidelines are published to guide the rehabilitation practitioners. Therefore, a specialty-specific telehealth practice guide for rehabilitation practitioners has been developed by an expert panel in the field of rehabilitation. This guide is documented in this article. Such a guide will be beneficial when providing tele-evaluation, teleintervention/telerehabilitation, teleconsultation, and telemonitoring through communication technologies. The purpose of this guide is to enable understanding of core telehealth clinical principles and aid the provision of OT, PT, and SLP telehealth services in Saudi Arabia. Also, the guide can potentially be implemented in other Middle Eastern countries. The guide is based on key telehealth guidelines involving the American Occupational Therapy Association telehealth resources, American Physical Therapy Association, American Speech and Hearing Association, telemedicine policies in Saudi Arabia by the national health information center at the Saudi Health Council, and a blueprint for telerehabilitation guidelines that are based on the American Telemedicine Association's Core Standards for Telemedicine Operations.

Air pollution and hospitalization of patients with idiopathic pulmonary fibrosis in Beijing: a time-series study

BACKGROUND AND AIM: A few studies from high-income countries suggested that traffic-related air pollutants (e.g. nitrogen oxides, elemental carbon) were associated with morbidity and mortality from idiopathic pulmonary fibrosis (IPF), a severe respiratory disease but is relatively less studied in relation to air pollution. Air quality in Beijing has been progressively improving since the 2013 Clean Air Act. We compiled data five years before and after 2013, and ran time-series analyses for 2008-2012 and 2013-2017 separately to investigate acute effects of ambient air pollution on IPF hospitalization risk in Beijing. METHODS: Daily counts of IPF hospitalizations were obtained from Beijing Public Health Information Center for the period 2008-2017 while daily city-wide average concentrations of each air pollutant (PM2.5, NO2, Ozone, SO2) were obtained from a single monitoring station set up in the US Embassy for 2008-2012 (for PM2.5 only) and from 35 municipal monitoring stations for 2013-2017. The associations between daily IPF hospitalization and average concentration of each pollutant were analyzed with a generalized additive model (GAM) estimating Poisson distribution. RESULTS:Across Beijing, daily 24-hour mean PM2.5 concentration during 2008-2012 and 2013-2017 was 88.9 and 76.7 μg/m3 respectively. During 2008-2012, relative risk (RR) of IPF hospitalization at lag0 per interquartile range (IQR) increase (83 μg/m3) in PM2.5 was 1.062 (95%CI: 1.025-1.101). The RR was reduced at lag1, lag2 and lag3 but remained significantly positive. In contrast, during 2013-2017, the RR was 1.049 (95%CI: 1.024-1.074) at lag0, but no significant associations were seen for all other lags. No associations were seen for NO2 whilst significant associations were observed with both SO2 and cool-season ozone. CONCLUSIONS:Despite improvement in overall air quality, acute exposure to high-level air pollution is a risk factor for IPF hospitalization in Beijing. Air quality policy should be continuously enforced and carefully monitored to protect public health in the long-term. KEYWORDS: air pollution, respiratory disease, time-series, LMIC

Increasing frequency of hospital admissions for retinal detachment and vitreo-retinal surgery in England 2000-2018.

ObjectivesTo analyse the changes in reported frequency of retinal detachment admissions and vitreo-retinal surgery procedures performed between 2000 and 2018 in England. To obtain information useful to contribute towards the planning of service delivery.MethodsAnalysis of England’s Hospital Episode Statistics from the Health and Social Care Information Centre and population data from the United Kingdom’s Office for National Statistics.ResultsEpisodes of ‘retinal detachments with breaks’ increased year on year from 3447 (7.0/100 M) in 2000 to 10,971 (19.7/100 M) in 2018 (p < 0.001), whereas records of ‘tractional retinal detachment’ increased from 290 (0.6/100 M) to 910 (1.6/100 M) in the same period (p < 0.0001). The number of reported pars plana vitrectomies irrespective of indication increased over fourfold from 5761 to 26,900 (p < 0.0001), while the number of scleral buckling records decreased by two thirds from 2897 to 780 (p < 0.0001). During the same period, the population of England increased from 49.2 to 55.6 million, proportionally at a slower rate than that for recorded hospital episodes.ConclusionsThe frequency of admissions to hospital for surgically treated retinal detachment seems to have been increasing significantly since 2000. This effect is more marked in cases of rhegmatogenous retinal detachment. This may be explained by increased incidence of disease (due to increased rates of cataract surgery, increasing longevity and increasing rates of myopia) as well as repeat surgery in cases of recurrent retinal detachment. Other factors which may play a role include improvements in patient access, increased public awareness and improved local coding and reporting practice.

Factors Associated with Health Literacy, Self-Efficacy, Social Support, and Oral Health Care Behaviors Among Elderly in Northern Border Community Thailand.

BackgroundOral health problems among elderly people are an important public health issues worldwide. Oral healthcare is essential to the health and well-being of elders and is one of the key indicators determining their quality of life. This research aimed to study oral health literacy, self-efficacy, social support, and demographic characteristic factors associated with the oral health care behaviors of elderly people living in the rural areas of northern Thailand.MethodsThis research was a cross-sectional study that recruited 406 elderly participants using convenience and snowball samplings. Participants’ names were obtained from the registration list of the Java Health Center Information System (JHCIS) program, where they received a health service between 2018 and 2020. Data were obtained through face-to-face interviews with participants, while they were waiting to receive a health service or through a phone interview. Linear regression was analyzed to determine the factors associated with oral healthcare behaviors.ResultsThe majority of participants (85%) had inadequate functional health literacy, 52% had moderate self-efficacy toward oral health behaviors, 91.9% had moderate social support, and 53% admitted to moderate oral health behaviors. The results from the model show that self-efficacy, social support, and oral health literacy are positively associated with oral health care behaviors among the elderly (p-value < 0.05). The multiple regression model can account for 47.2% of the variance in oral health care behaviors.ConclusionImproving oral health care behaviors among elderly people should be considered by health care providers and those who provide social support. Self-esteem, communication skills among service providers and service receivers, and self-management of oral healthcare should receive special attention. Moreover, social support and relevant agencies can help promote oral healthcare by collaborating with other healthcare providers for better oral health outcomes among elderly people.

EFEKTIVITAS DAUN KATUK (SAUROPUS ANDROGYNUS) TERHADAP KECUKUPAN ASI PADA IBU MENYUSUI DIMASA PANDEMI COVID-19

One of the inhibiting factors for stopping breastfeeding is insufficient milk production. The Ministry of Health's Data and Information Center in 2017 stated that only 35% of mothers provide exclusive breastfeeding in Indonesia. 50% of this figure is far below the recommendation of the WHO (World Health Organization). This is due to lack of family support, low knowledge of mothers and less food intake of nursing mothers. Breast milk really helps strengthen the immune system or immunity of babies, especially during the current Covid-19 pandemic. The current impact of Covid-19 has made the people's economy decline, many are unemployed. This results in the lack of adequate milk and the mother becomes worried about not being able to breastfeed her baby. Researchers want to help the community, especially breastfeeding mothers, to consume katuk leaf stew during the current Covid-19 pandemic, considering that katuk leaves are very easy to get in the market and the price is cheap. However, previously the researcher wanted to see how much influence the katuk leaf stew had on the adequacy of breast milk. The purpose of this study was to analyze the effect of katuk leaf decoction on the adequacy of breast milk in nursing mothers during the Covid-19 pandemic. This type of research is quantitative analytic with a Quasy-Experiment research design with One Group Pretest-Posttest. The study population was all mothers who had babies aged 0-2 years at Eka Sri Wahyuni ​​Maternity Clinic. Data analysis using the Wilxocon test was used to analyze how much influence the katuk leaf decoction had on the adequacy of breast milk. The results of this study were the effectiveness of katuk leaves on breastfeeding adequacy with a P-value of 0.002.

Empowerment of Posyandu Cadres in Early Detection of Child Growth Problems: Optimization of KIA Books

Posyandu (integrated health center) as a health information center for the community is expected to be the spearhead of early detection of developmental disorders in children under five. Posyandu activities are driven by cadres. Cadres monitor the growth of children under five through anthropometric measurements: body weight, height, head circumference and development milestones. Knowing how to measure anthropometric parameters, data plotting on a growth chart in the Maternal and Child Health (Kesehatan Ibu dan Anak=KIA) book, and interpret the results are very important. Cadres with good understanding and skills will greatly assist in monitoring child growth and development. This activity is expected to increase the knowledge and skills of cadres in monitoring child development. This activity was carried out through counseling, training, case study, and discussion. Pre-tests and post-tests were conducted to evaluate this activity. The mean pre-test was 40.00 ± 11.69, with the lowest value being 10.00 and the highest value being 60.00. The mean post-test was 54.10 ± 12.08, the lowest value was 30.00 and the highest was 90.00. The Wilcoxon test found p=000, where 20.5% participants' knowledge did not change while 69.23% had better knowledge compared to before the activity. Conclusion: This training can significantly improve cadres' knowledge and skills about the use of the KIA book.

Maternal Morbidity and Mortality.

Maternal Morbidity and Mortality.

PENYULUHAN TENTANG STUNTING PADA BALITA DIDESA LUBUK SUKON KECAMATAN INGIN JAYA ACEH BESAR

The first day of life is a critical period for the growth and development of children which begins during pre-pregnancy, pregnancy and lactation, this period is known as the First 1000 Days of Life (HPK). The nutritional problem that can occur at this time is stunting (short). The National Strategy for Accelerating Stunting Reduction in Indonesia targets in 2024 that the stunting prevalence rate can be reduced to 14%, this increase is higher than the target of 19% by Bappenas. In 2019, the national stunting prevalence rate fell to 27.67%. Stunting is a health problem that is a priority to create quality Indonesian human resources. The key to the success of stunting prevention can be done through nutritional monitoring and weight measurement of infants and toddlers by health workers and posyandu cadres. Data on the prevalence of stunting in children under five collected by the World Health Organization (WHO) released in 2018 states that Indonesia is included in the third country with the highest prevalence in the South-East Asian Region after Timor Leste (50.5%) and India (38.4%), which is 36.4% (Ministry of Health Data and Information Center, 2018). The stunting prevalence rate in Indonesia is still above 20%, meaning that it has not reached the WHO target of below 20%. Aceh Province is ranked third for stunting, after East Nusa Tenggara (NTT) and West Sulawesi (Sulbar). However, in the last 5 years the Aceh government was able to reduce the prevalence of stunting from 41.2% in 2013 to 37. The method used is Pre Test and Post Test using a questionnaire. Based on the results of the counseling there was an increase in respondents' knowledge of stunting, which was in the good category as much as 23 (53,49%). The conclusion is that there is a significant increase in respondents' knowledge after being given counseling.

Analisis Tingkat Penerimaan dan Penggunaan Sistem Informasi Manajemen Puskesmas Di Kabupaten Jember

The Health Office (HE) in Jember District has conducted tests the operation of 40% Public Health Center Information System Management (SIMPUS). But from 20 public health centers (PHC), only 80% of the PHC ran it. The HE of Jember targets the end of 2019 SIMPUS will be fully operated in 50 PHC throughout the Jember district. The study aims to analyze the acceptance and use of technology systems in health center management by using the methods of the unified theory of acceptance and use of technology (UTAUT). The study examined variables of performance expectation, effort expectation, social impact, facilitating conditions, behavioral interest, and behavior of SIMPUS users. This study was analytic research. The data analysis technique used path analysis. The result explains the performance expectation is effected to the behavioral interest (t-value: 2,9); effort expectation is effected to the behavioral interest (t-value:1,01); social impact is effected to the behavioral interest (t-value: 9,47); facilitating conditions is effected to the user's behavioral (t-value:4,67); behavioral interest is effected to the user's behavior (t-value:8,54). Important for Health Office to maintain SIMPUS quality as well as to frequent SIMPUS updates in order to increase SIMPUS behavior

Stress urinary incontinence in the mesh complication era: current Australian trends.

To examine available data relating to the surgical management of stress urinary incontinence (SUI) in Australia before, during and after a well-publicized Senate Inquiry into transvaginal mesh use and to consider outcomes in the context of global guideline changes. The annual number of surgical procedures for the management of SUI by procedure type and age group for the years 2008/2009-2017/2018 was obtained from the Australian Government Department of Human Services database using Medicare Benefits Schedule item numbers. The data extracted were limited to women aged 25years and older. These data were used to calculate age-specific and age-standardized rates, so as to accurately analyse trends in the usage of different procedures. Hospital Episode Statistics for mid-urethral sling (MUS) insertions were obtained for England's National Health Service from the Health and Social Care Information Centre for the years 2008/2009-2016/2017. These data were also used to calculate annual age-standardized rates for comparison purposes. Rates declined for most SUI procedures over time (MUS, colposuspension, fascial slings) except for urethral bulking agents. The absolute number of MUSs implanted in 2008/2009 was 5729, which decreased to 3127 in the 2017/2018 financial year. Over the decade, the annual rate for MUS implantation per 100000 population halved from 78 to 36. Over this same period, the rate of usage of bulking agents doubled, although represented a low volume of procedures (overall numbers increased from 304 to 698, representing an increase from four to eight procedures per 100000 population). The age-specific peak rate for MUS and Burch colposuspension changed over the decade from 55-64years to 65-74years, suggesting that women are deferring surgical treatment until later in life. Over the last decade, the total number of surgical procedures performed in Australia to treat SUI has decreased markedly from 6812 to 4279. This represents a decrease in the annual rate per 100000 population from 93 to 49. There are clear changes evident for SUI management in the past decade in Australia, including an overall decline in operative numbers, which correlate with international advisory notifications and local investigations. The results of the Australian Senate inquiry, including removal of single-incision mini-slings, greater availability of patient resources, and greater regulation of SUI procedures, will probably have ongoing effects. Surgeons need to ensure that sufficient training and patient education continue in order to maintain appropriate access to treatment of SUI in the future.

Prognostic significance of regression and mitotic rate in head and neck cutaneous melanoma.

ImportanceWhile regression is a commonly reported microscopic feature of melanoma, its prognostic significance is unclear.ObjectiveTo examine the impact of regression on sentinel node status and the likelihood of recurrence in primary cutaneous melanoma of the head and neck.DesignRetrospective analysis of 191 adults who underwent surgical management for primary cutaneous melanoma of the head and neck between May 2002 and March 2019.SettingTertiary academic center.ParticipantsPatients appropriate for the study were identified by the Academic Health Center Information Exchange using a list of current procedural terminology codes. One hundred and ninety‐one cases of invasive melanoma of the head and neck were included from 830 patients identified. Clinical features assessed for each patient included age, sex, location of primary lesion, date of diagnosis, and current disease status (alive with or without disease). Histologic features assessed were histological melanoma subtype (nodular vs non‐nodular), Breslow thickness, Clark level, presence/absence of ulceration, mitotic rate per square millimeter, and regression. If applicable, sentinel lymph node biopsy (SLNB) status, date of recurrence, interval treatments, and date of death related to melanoma were recorded. Exclusion criteria included melanoma outside the anatomic parameters of head and neck, ocular or choroidal melanoma, mucosal melanoma, metastatic melanoma to the head or neck with no known primary tumor, melanoma of the head or neck with no surgical intervention, and non‐melanoma skin cancers of the head and neck.Intervention/ExposureSurgery for cutaneous melanoma of the head and neck.Main Outcome(s) and Measure(s)The association between presence of regression and Breslow thickness, sentinel node status, and recurrence.ResultsOf the 191 patients identified, 30.9% were female and 69.1% were male with a mean age at diagnosis of 62.6 (range 20‐97) years. Mean Breslow thickness was 1.2 mm in those with regression and 2.0 mm in those without regression. In patients with regression, 17.6% had a positive sentinel node, and 13.0% experienced a recurrence. In patients without regression, 26.5% had a positive sentinel node, and 31.4% experienced a recurrence. When adjusted for other factors above, regression was not associated with positive sentinel node (odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.13‐2.00) or recurrence (OR = 0.33, CI = 0.07‐1.01). Mitotic rate >2 was associated with recurrence (OR = 2.71, CI = 1.11‐6.75, P = .03).Conclusions and RelevancePatients with presence of regression had thinner melanomas and trended toward decreased rates of sentinel node positivity and recurrence, suggesting regression may not be a negative prognostic indicator in patients with cutaneous melanoma of the head and neck.

Categorization of changes in the Oxford Knee Score after total knee replacement: an interpretive tool developed from a data set of 46,094 replacements

ObjectivesThe objective of the study was to create an interpretive categorical classification for the transition in the Oxford Knee Score (OKS) change score (ΔOKS) using the anchor-based method. Study Design and SettingRegistry data from 46,094 total knee replacements from the year 2014/15, were accessed via the Health and Social Care Information Center official website. Data included preoperative and 6-month follow-up OKS and response to the transition anchor question. Categories were determined using Gaussian approximation probability and k-fold cross-validation. ResultsFour categories were identified with the corresponding ΔOKS intervals: “1. much better” (≥16), “2. a little better” (7–15), “3. about the same” (1–6), and “4. much worse” (≤0) based on the anchor questions’ original five categories. The mean 10-fold cross-validation error was 0.35 OKS points (95% confidence interval 0.12 to 0.63). Sensitivity ranged from 0.34 to 0.68; specificity ranged from 0.74 to 0.95. ConclusionWe have categorized the change score into a clinically meaningful classification. We argue it should be an addition to the continuous OKS outcome to contextualize the results in a way more applicable to the shared decision-making process and for interpreting research results.

The impact of the COVID-19 outbreak on acute stroke care in Slovakia: Data from across the country.

A few studies using data from regional databases have recently pointed to a decreased number of patients with stroke. The aim of the present study was to describe country-level data (the number of patients with stroke, the proportion of patients with acute stroke and transient ischemic attack (TIA), the proportion of patients treated with intravenous thrombolysis [IVT] or mechanical thrombectomy [MT], the door-to-needle times [DNT], and the onset-to-needle time [ONT]) during the COVID-19 pandemic in Slovakia. The study examined data from the stroke register at the National Health Information Centre. Data from three time periods (March to April 2020; March to April 2019; January to February 2020) were compared using an independent samples t-test and the Wilcoxon-Mann-Whitney two-sample rank-sum test. The number of stroke patients admitted to hospitals in Slovakia during the COVID-19 period showed a decrease (1673 vs. 2328 in period 2 and 2155 in period 3). The proportions of patients with TIA remained the same in periods 1 and 2 (9.7% vs. 11.7%) and in periods 1 and 3 (9.7 vs. 11.8%). The percentage of patients treated with IVT during the pandemic (22.4%) did not differ from period 2 (20.0%) or period 3 (21.4%). No difference was found in the rate of MT between the COVID-19 period (10.2%) and the same period in 2019 (10.7%) and in January to February 2020 (13.1%). The median DNT remained unchanged in periods 1 (30min), 2 (35min) and 3 (30min), and no differences were found in median ONT in periods 1 (130min), 2 (130min) and 3 (140min). We found a decreased number of stroke patients during the COVID-19 outbreak in Slovakia, but no evidence of achange in the quality of acute stroke care.

Meningkatkan Keamanan Sistem Informasi Puskesmas Terpadu dengan Metode Grey-Box Penetration Test Menggunakan Computer Assisted Audit Techniques

Keamanan sistem informasi merupakan hal yang wajib diperhatikan oleh pemiliknya agar terhindar dari kejahatan siber. Sistem informasi yang memiliki kerentanan keamanan dapat mengancam infrastruktur penting suatu organisasi. Kerentanan keamanan adalah segala jenis celah yang memungkinkan penyerang untuk dapat masuk kedalam sistem secara illegal dan melakukan tidakan yang tidak diinginkan. Penetration test pada sistem informasi perlu dilakukan untuk memastikan keamanannya. Penelitian ini bertujuan untuk meningkatkan keamanan sistem informasi puskesmas terpadu Kota Payakumbuh sehingga data dan informasi yang ada terjamin keamanannya. Metode yang digunakan adalah grey box penetration test menggunakan computer assisted audit techniques. Hasil penelitian ini ditemukan 97 kerentanan kategori tinggi, 1 kerentanan kategori sedang dan 26 kerentanan kategori rendah. Dinas Komunikasi dan Informatika Kota Payakumbuh dapat memanfaatkan hasil penetration test sebagai referensi untuk meningkatkan keamanan sistem informasi puskesmas terpadu Kota Payakumbuh.

PENGARUH METODE EMOTIONAL DEMONSTRATION TERHADAP PENINGKATAN CAKUPAN PENIMBANGAN BALITA DI POSYANDU

Abstract:Posyandu (Integrated Service Post) is one form of Community-based Health Efforts (UKBM) carried out by, from and with the community, to empower and provide facilities to the community to obtain health services for mothers, infants and toddlers. In Posyandu activities there are indicators that determine the success of activities, one of which is the coverage of weighing toddlers as a form of community presence. The problem of coverage of underfive weighing in Indonesia was found to be the difference between the number of toddlers and toddlers weighed, namely 12,817,382 toddlers. This data was obtained from info Datin (Health Data and Information Center of the Republic of Indonesia) in 2014. In East Java Province an estimated number of toddlers was 2,985,934, and the number of toddlers weighed 1,588,030 so that there were still 50% that were not included in the coverage of underfive weighing. The results of the preliminary study of the number of children under five were present 45% irregularly in attendance each month. Even though nutrition monitoring with weight weighing must be done every month. While the monthly attendance limit for 1 year is 8 x. This presence needs cadre participation as part of the community itself. This study aims to determine whether there is the influence of the emotional demonstration method on increasing the coverage of underfive weighing. This study uses a one shot case study pre-experimental research design. The population is all under-five mothers in Sidodadi Village, which number 333 people. The sampling technique used is simple random sampling. Test Statistics used to see the relationship between variables bound to independent variables. The analysis used was the chi-square statistical test of significance level of 95% (alpha 0.05) using SPSS. The results of 333 respondents, mothers of children under five who came to the Posyandu village of Sidodadi, Probolinggo Regency in December 2018 - June 2019 before the emodemo were attended by 153 mothers and when there was an emodemo activity the number of attendees increased to 285 mothers who attended Keposyandu .. Test results statistic is pvalue &lt;0.05. The conclusion of this study is that there is the influence of the emotional demonstration method on increasing the coverage of underfive weighing in the Posyandu village of Sidodadi.

Incidence of Tuberculosis in Inflammatory Rheumatic Diseases: Results from a Lithuanian Retrospective Cohort Study.

Background and objective: With an increase in survival rates among rheumatic patients, comorbidities and infections, in particular, have gained more importance, especially after the introduction of biologicals to the treatment algorithms. Tuberculosis (TB) infection has always been given a special attention in patients with rheumatic diseases (RD). Although Lithuanian population has one of the highest TB incidence rates among European countries, the incidence of TB in the rheumatic patients’ population is still unknown. The aim of this study was to assess the incidence rate of TB in an inflammatory RD retrospective cohort and to compare that rate with a rate in a general population. Material and Methods: Patients with the first-time diagnosis of inflammatory RD during the period between 1 January 2012 and 31 December 2017 were identified from the Lithuanian Compulsory Health Insurance Information System database SVEIDRA. All cases were cross-checked with Health Information center at the Institute of Hygiene, for the vital status of these patients and date of death if the fact of death was documented, and with Tuberculosis Register operated by Vilnius University Hospital Santaros Klinikos, for the confirmation of TB cases. Sex and age standardized incidence ratios (SIR) were calculated by dividing the observed numbers of TB among rheumatic patients by the expected number of cases, calculated using national rates from Lithuanian Department of Statistics Official Statistics website. Results: Overall, 8779 patients with newly diagnosed RD were identified during the 2013–2017 period, these included 458 patients who used biological disease modifying drugs (bDMARDs). The mean duration of the follow-up period was 2.71 years. The cohort consisted mainly of women (70%) and a half of the cohort were rheumatoid arthritis (RA) patients (53%). Mean age of patients at the time of RD diagnosis was 56 years (range = 18–97 years). There were 9 TB cases identified during 23,800 person years of follow-up: 2 cases among them were treated with bDMARDs. The mean calculated annual TB incidence in RD cohort was 37.81 per 100,000 person years, which is consistent with the incidence rate predicted by national estimates, with a resultant SIR of 0.90 (0.41–1.70). The unadjusted hazard ratio for bDMARD use versus no bDMARD use was 4.54 (0.94; 21.87) in a total cohort and very similar in rheumatoid arthritis cohort; in both cohorts, it was not a statistically significant risk. Conclusions: Here, we present the first nationwide cohort study to assess the incidence of TB in a broad spectrum of inflammatory RD. Although limited by short follow-up period, this study shows that TB incidence in RD cohort does not exceed TB incidence in the general Lithuanian population.

Diseases of the circulatory system in the Kyrgyz Republic in the period of 2002-2017

Aim To analyze a tendency in circulatory system diseases (CSD) in the Kyrgyz Republic (KR).Materials and methods Medical statistics on morbidity, prevalence, mortality, and primary disability related with CSD in the adult population was obtained from the National Health Information Center (NHIC) of the Ministry of Health of the KR and the National Statistical Committee of the KR. For the purpose of comparative analysis, relative values were calculated per 100,000 and 10,000 population. A retrospective epidemiological study of prevalence, morbidity, mortality, and primary disability related with CSD for 2002-2017 was performed with calculation of the increase/decrease rate using the least square method for aligning the dynamic row. Also, the epidemiological situation of CSD was analyzed by sex and in 9 administrative divisions of the KR with calculation of the mean long-term incidence (MLTI) of CSD from 2007 through 2017. Statistical analysis was performed with specialized Statistica 10.0 and SPSS 11.5 software.Results CSD remain the major cause of death (51.6 % in 2017) and primary disability (19.68 % of overall primary disability) in the Kyrgyz population. Prevalence of CSD shows a pronounced upward trend (6.8% increment rate relative to 2002) whereas the incidence rate has increased with a moderate trend (3.5 % increment rate). The major structure of CSD is determined by essential hypertension (51.2 %), ischemic heart disease (28.0 %), and cerebrovascular diseases (10.0 %). CSD is more frequently observed in women (mean value for 2007-2017, 59.0%) than in men (41.0 %) (р&lt;0.001). Mean long-term indexes of CSD significantly differ in different regions and cities of the KR. The highest primary morbidity and prevalence of CSD is observed in Bishkek (1546.90 / 0000 and 12415.40 / 0000). Relatively low levels of these values are found in the Talas Region (720.70 / 0000 and 3675.10 / 0000, respectively).Conclusion CSD remains the major cause of death and primary disability in the population of the KR. Prevalence of CSD shows a pronounced increasing trend whereas the increase in incidence rate is moderate. The major structure of CSD is determined by essential hypertension, ischemic heart disease, and cerebrovascular diseases. Incidence of CSD is statistically significantly higher for women than for men. Mean long-term indexes of CSD significantly differ in different regions and cities of the KR. Therefore, it is essential to enhance preventive measures in the KR; to identify individuals with hypertension at the level of primary care; and to motivate healthcare professionals to improve the quality of healthcare (CSD prevention, detection, and treatment).

Long-Term Trends in Hospitalization and Outcomes in Adult Patients with Exacerbation of Chronic Obstructive Pulmonary Disease in Beijing, China, from 2008 to 2017.

Background and ObjectiveChronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. We aimed to evaluate the temporal trends in hospitalization and mortality from acute exacerbation of COPD (AECOPD) and the associated financial costs over a 10-year period in Beijing, China.MethodsHospital admission records from 2008 to 2017 for all patients aged ≥20 years with a primary discharge diagnosis of AECOPD were retrieved from the Beijing Public Health Information Center Database. Joinpoint regression was used to analyze trends and calculate the annual percentage change (APC) and average annual percent change (AAPC) for AECOPD hospitalization and mortality.ResultsA total of 337,802 AECOPD cases were recorded from 2008 to 2017. An inverse U-shaped trend in the AECOPD hospitalization rate was observed, showing an increase from 150.2 per 100,000 inhabitants in 2008 to 218.7 per 100,000 inhabitants in 2014 (APC: 5.5%, 95% CI: 2.9–8.2), before declining to 161.13 per 100,000 inhabitants in 2017 (APC: −9.7%, 95% CI: −16.0 to-2.9). In-hospital mortality from AECOPD decreased significantly from 3.91% to 2.21% (AAPC: −11.4%, 95% CI: −15.5 to−7.0). A decline in the median length of hospital stay from 13.0 days in 2008 to 12.0 days in 2017 (Ptrend < 0.001) was accompanied by a decrease in the use of mechanical ventilation from 2012 to 2017 (Ptrend < 0.001). However, the total hospitalization cost per case increased from 15953.5 yuan (USD $2281.4) to 19874.5 yuan ($2842.1) during the same period.ConclusionAECOPD remains a heavy burden on the health care system in Beijing. Strategies to better manage COPD and reduce hospitalizations from AECOPD are needed.

Short-term effects of extreme temperatures on cause specific cardiovascular admissions in Beijing, China

Extreme temperature-related cardiovascular diseases (CVDs) have become a growing public health concern. However, the impact of temperature on the cause of specific CVDs has not been well studied in the study area. The objective of this study was to assess the impact of temperature on cause-specific cardiovascular hospital admissions in Beijing, China. We obtained data from 172 large general hospitals from the Beijing Public Health Information Center Cardiovascular Case Database and China. Meteorological Administration covering 16 districts in Beijing from 2013 to 2017. We used a time-stratified case crossover design with a distributed lag nonlinear model (DLNM) to derive the impact of temperature on CVD in hospitals back to 27 days on CVD admissions. The temperature data were stratified as cold (extreme and moderate ) and hot (moderate and extreme ). Within five years (January 2013–December 2017), a total of 460,938 (male 54.9% and female 45.1%) CVD admission cases were reported. The exposure-response relationship for hospitalization was described by a “J” shape for the total and cause-specific. An increase in the six-day moving average temperature from moderate hot (30.2 °C) to extreme hot (36.9 °C) resulted in a significant increase in CVD admissions of 16.1%(95% CI = 12.8%–28.9%). However, the effect of cold temperature exposure on CVD admissions over a lag time of 0–27 days was found to be non significant, with a relative risk of 0.45 (95% CI = 0.378–0.55) for extreme cold (−8.5 °C)and 0.53 (95% CI = 0.47–0.60) for moderate cold (−5.6 °C). The results of this study indicate that exposure to extremely high temperatures is highly associated with an increase in cause-specific CVD admissions. These finding may guide to create and raise awareness of the general population, government and private sectors regarding on the effects of current weather conditions on CVD.