Health Insurance Hospital Research Articles

Awareness of Females regarding Polycystic Ovarian Syndrome at Outpatient Clinics in Minya Health Insurance Hospital

Awareness of Females regarding Polycystic Ovarian Syndrome at Outpatient Clinics in Minya Health Insurance Hospital

Evaluation of the Role of Ultrasonography in Predicting a Metachronous Contralateral Inguinal Hernia in Children

Abstract Background Inguinal hernia remains one of the most common surgical disorders in children. Almost all pediatric hernias are indirect. The incidence of pediatric inguinal hernia is highest during the first year of life and then gradually decreases thereafter. The incidence of contralateral occurrence of an inguinal hernia after unilateral herniorrhaphy has been reported as 5.6 to 22%. The management of the contralateral inguinal hernia in a child with unilateral CIH has been always debated. Routine contralateral exploration of the inguinal canal has been practiced by many surgeons. Routine contralateral exploration may be associated with a high incidence of negative exploration and lengthening of the operative time in addition to possible increasing morbidity in those patients. Aim of the Work This study aims to evaluate the role of preoperative assessment by ultrasonography in predicting contralateral inguinal hernia in children with unilateral inguinal hernia without clinical evidence of contralateral inguinal hernia. Patients and Methods Fifty infants and children presented to pediatric surgery clinic at Ain Shams University and Nasr City Health Insurance Hospitals aged 1 month till 12 years of age complaining of unilateral inguinal hernia without clinical evidence of contralateral inguinal hernia underwent preoperative US. Results Cases with a width of the contralateral side >3.5 mm at the level of the internal ring determined using the US are likely to be at high risk of developing a contralateral hernia with a sensitivity of 80.0%, specificity of 77.5%, and area under the curve (AUC) of 78.4%. Conclusion Ultrasonography is a rapid, sensitive, convenient, and non-invasive method for screening patients with contralateral occult CIH. It is a reliable tool for preventing unnecessary exploration or additional operations at a later stage. It can be performed in all cases of inguinal hernia to determine the necessity for contralateral exploration. Children having a width of contralateral side >3.5 mm at the level of the internal ring determined using the US are likely to be at high risk of developing a contralateral hernia with a sensitivity of 80.0%, specificity of 77.5%, and area under the curve (AUC) of 78.4%.Therefore, we recommend routine preoperative use of ultrasonography for all patients with unilateral CIH to determine which patient should be subjected to a contralateral exploration.

Prognostic Utility of Ratio of Systolic Blood Pressure to Left Ventricular End- Diastolic Pressure Post Successful Primary Percutaneous Coronary Intervention in Prediction of Major Adverse Cardiac Events in Patients with ST-segment Elevation Myocardial Infarction

Abstract Background Of all causes of Cardiovascular disease (CVD), ischemic heart disease (IHD) remains the major contributor, accounting for half of all CVD-associated morbidity and mortality. IHD as measured by the Global Burden of Disease project is driven predominantly by acute myocardial infarction (MI) and, to a lesser extent, angina. Aim of the Work To evaluate the prognostic utility of the ratio of SBP/LVEDP at the time of PPCI in prediction of MACE both in-hospital and during 3-months follow up in patients presented with STEMI with a single vessel disease. Patients and Methods This was a prospective study that was conducted on 153 patients presented with STEMI and underwent successful PPCI for a single vessel disease in Ain-Shams University Hospitals and Nasr City Health Insurance Hospital in the period from March 2019 to March 2021. Results Our results demonstrated, that SBP/LVEDP ratio can be used to predict MACE occurrence at a cutoff level of ≤ 3.9, and can be used to predict patients who are MACE-free at cutoff level of ≥ 9.2. The lower ratio of SBP/LVEDP (≤3.9) was detected at 27 patients (17.6%) from the whole study population (153 patients) with higher statistical significance difference of older age group. Different risk factors and positive family history showed no statistical significance difference with lower ratio. In this study, lower ratio showed higher statistical significant difference in anterior STEMI group, lower EF% “Simpson”, higher LVESV, DD grade II, higher WMSI, with the culprit lesion vessel when its LAD, with higher LVEDP, lower invasive SBP, and lower invasive DBP. This study found that lower ratio had a better prognostic ability with a higher AUC (0.880) when compared to the widely used GRACE and TIMI risk scores. Lower ratio ≤3.9 showed higher statistical significant difference with higher GRACE RS and higher TIMI RS when compared with higher ratio. Our ratio had a strong prognostic ability in prediction of MACE with lower ratio with higher statistical significant difference of occurrence of MACE in 26 patients (96.3%, P = 0.000) when compared with patients with the same ratio but without occurrence of MACE in 1 patient (3.7%). Conclusion Our study concluded that SBP/LVEDP is an easily rapidly determined ratio at the time of PPCI that can provide important prognostic information regarding risk stratification of STEMI patients, with a high predictive ability for occurrence of MACE at a cutoff point of ≤ 3.9, during hospital stay and short term follow up.

Frailty in Hemodialysis Patient

Abstract Background Frailty has been defined as a state of increased vulnerability to stressors as a consequence of degeneration in multiple systems. There remain two schools of thought with regard to frailty: one which sees frailty as a physical phenotype characterized by sarcopenia and another that views frailty as an accumulation of deficits across a variety of domains. Aim of the Work The aim of this study was to assess the prevalence of frailty among dialysis population. Patients and Methods This cross section study carried out in Hemodialysis Unit of the Nasr City Health Insurance Hospital between October 2020 and July 2021. The total number of the study was 325 hemodialysis patients, 25 were excluded from the study, thus the enrolled final number became 300 hemodialysis patients on maintenance hemodialysis therapy for at least 6 months. Results The mean age of the patients was 45.57±11.79 years (range 25-65 years) 50% of them were under 45 years of age. 258 (86%) of patients were males and 42 (14%) females, with male to female ratio about 6.14:1. 37 patients (12.3%) has positive HCV, while the results also show that none of the HBV and HIV of the study group. 10 patients (3.3%) of vulnerable, 89 (29.7%) patients at mild frailty, table also clarified that, 126 (42.0%) patients at moderat4e frailty, furthermore, 75 (25%) patients at severe frailty in Edmonton frail scale. There was significant positive association between frailty and age with p-value <0.001. Males more affected by frailty than females. Conclusion The differences in the frailty prevalence among CKD patients could be caused by the different definitions of frailty that each study adopted. It is important to prevent early-onset disability in end-stage renal disease, which may be accelerated by frailty in this patient population, which includes individuals who already carry a high risk of morbidity and mortality. We adopted the Edmonton Frail Scale (EFS) based on self-report, it is very simple to administer and can be carried out by hemodialysis nursing staff after minimal training, without the need for specialist medical staff, in less than 15 min. Its association with poor short-term outcome highlights its utility in detecting frail patients, but because it is a multi-domain test, it also gives health professionals information about which areas of frailty are affected. This would allow specialists to administer specific, more complex scales to detect deficits in independence for basic and instrumental activities of daily life, cognition, emotional status, and social support. Our findings allow us to recommend the inclusion of the frailty comprehensive assessment of patients starting the dialysis program to timely identification of frailty syndrome.

Gemcitabine versus Bacillus Calmette-Guérin (BCG) in Non Muscle Invasive Transitional Cell Carcinoma of the Bladder after Trans-Urethral Resection

Abstract Background To overcome Bacillus Calmette–Guérin (BCG) shortage and its side effect several studies have compared the safety and efficacy of intravesical gemcitabine with (BCG) for non-muscle invasive bladder cancer. The aim of this work is to evaluate the efficacy of Gemcetabine as a local intravesical treatment of superficial TCC in reducing the risk of recurrence and progression after TURBT in comparison to BCG. Patients and Methods This single blind controlled randomized study Included 82 patients which randomly divided into 2 groups by 1:1 method.Each group included 41 patients, group I will receive gemcitabine. Group II will receive BCG.These patients were diagnosed with superficial bladder tumor (TCC) after TURBT. These patients were followed in the out-patient clinic in the Department of Urology Ain Shams University Hospital and 6th October Health Insurance Hospital during the period from 2017 till 2021. Results After 1 year of follow up 67.6% of group I on the other hand 63.4% of group II were free of tumors. As regard tumor progression, only 2.7% of group I patient had tumor progression while 4.9% of group II had tumor progression but all of these results were statistically not-significant with P. value 0.475. As regard side effects after 1 year of follow up. Regarding dysuria 24 patients 96% in group (I) complained of mild dysuria. On the other hand, 39 patients 95.1 % in group (II) complained of dysuria, 9 of them 21.9 % had sever dysuria and 30 patients 73.2 % had mild dysuria. which was statistically not significant with P. value 0.078. Urine analysis was done after treatment. 33 patients (89.2%) had pus cells in the patients of group I while in group II, all patients had pus cells in urine analysis, which was statistically significant with (P. value 0.046). Conclusion Gemcitabine was associated with nearly similar efficacy and a clinically significant better toxicity profile compared with BCG. Intravesical gemcitabine is a promising drug that may be an option in treating patients with non muscle invasive bladder cancer.

Cost-Effectiveness Analysis of 6 Tyrosine Kinase Inhibitors as First-Line Treatment for ALK-Positive NSCLC in China.

Lung cancer ranks first in both cancer incidence and mortality in China. The emergence of novel treatments for ALK-positive NSCLC led to an improvement in survival and quality of life for patients with advanced ALK mutation-positive non-small cell lung cancer (NSCLC). This study sought to assess the cost-effectiveness of 6 tyrosine kinase inhibitors (TKIs)-crizotinib, alectinib, ceritinib, brigatinib, ensartinib, and lorlatinib-as first-line treatments for ALK-positive NSCLC from the perspective of the Chinese health care system. A Markov model was developed to estimate the cost-effectiveness of these 6 TKIs. In this model, ALK-positive NSCLC patients were initially simulated to receive 1 of the 6 TKIs as first-line therapy, followed by different TKIs as subsequent treatment and salvage chemotherapy as last-line treatment. Survival data were sourced from the latest published clinical trials. Costs were derived from recent national health insurance negotiations and hospital information systems of selected health care facilities. Utilities for healthy states and adverse events were obtained from the literature. One-way and probabilistic sensitivity analysis as well as scenario analysis was conducted to assess the robustness of the results. Compared to ensartinib, crizotinib, alectinib, ceritinib, brigatinib, and lorlatinib demonstrated incremental quality-adjusted life years (QALYs) of -1.13, 0.39, -0.58, -0.09, and 0.35, respectively. The corresponding incremental costs were $10 677, $33 501, -$6426, $2672, and $24 358. This resulted in ICERs of -$9449/QALY, $85 900/QALY, $11 079/QALY, $29 689/QALY and $69 594/QALY, respectively. Crizotinib was considered to be absolutely dominated by ensartinib. Under a willingness-to-pay threshold of $38 223/QALY, ceritinib and brigatinib were cost-effective compared with ensartinib, while lorlatinib and alectinib were not cost-effective when compared with ensartinib. Overall, brigatinib emerged as the most cost-effective treatment among all the options considered.

Pediatric Nurses’ performance enhancement regarding management of quality Sensitive nursing Indicator: Pediatric IV infiltration in intensive care units

BackgroundIntravenous complications, especially pediatric IV infiltration, are common in pediatric departments because such complications occur more frequently in children than in adults. AimTo investigate the pediatric nurses’ performance enhancement regarding the management of Pediatric IV infiltration. Subjects and MethodA quasi-experimental study was conducted. The study was carried out at Pediatric and Neonatal Intensive Care Units in Port Said Universal Health Insurance Hospitals. Data was collected from 50 pediatric nurses by using the Pediatric Nurses’ Knowledge Assessment Questionnaire and an observational checklist schedule for nurses’ practice before and after the implementation of an educational program regarding intravenous infiltration management. ResultsNo statistically significant relationship between pediatric nurses’ knowledge before and after the program, while a statistically significant relation was evidenced between their practice before and after the program. Conclusionthe educational program was effective for pediatric nurses’ performance by increasing their knowledge and improving their practice, with only a statistically significant difference between nurses’ practice before and after the program. RecommendationsThe educational program should be periodically conducted for pediatric nurses to enhance their performance to achieve high-quality nursing care for pediatric patients.

Cesarean section prevalence based on prenatal care provider, location, and wealth index: A comparative analysis in peru's healthcare systems

BackgroundCesarean section rates are increasing and surpassing WHO guidelines. While sometimes necessary, excessive use poses risks and additional costs to pregnant women and healthcare systems. AimTo evaluate the prevalence of cesarean section according to healthcare professionals, facility location, and the wealth index of pregnant women in each Peruvian healthcare system. MethodsA cross-sectional study analyzed 20,870 records of women aged 12 to 49 from the Demographic and Family Health Survey (ENDES). The evaluated healthcare systems were the Ministry of Health, Social Health Insurance, Armed Forces and National Police, and private institutions. FindingsThe highest cesarean section prevalence was observed in women receiving prenatal care in private hospitals or clinics (69.13%) and Social Health Insurance hospitals (51.54%). Urban settings, “richest” wealth index, and medical professional involvement increased the probability of cesarean sections. Conversely, the probability of cesarean section was reduced in Ministry of Health facilities when pregnant women belonged to the “poorest” or “poorer” wealth index category and when prenatal care was provided by a midwife in a private facility. ConclusionThe prevalence of cesarean sections in Peru during 2021 is 33.75%, warranting evaluation of strategies to regulate their indiscriminate use in each system.

The prevalence of congenital anomalies: nationwide study in 2020 in Estonia

Objective To assess the prevalence of congenital anomalies (CAs), chromosomal abnormalities and monogenic diseases among births and terminated pregnancies due to fetal anomalies (TOPFA) in 2020 in Estonia. Up to 2020 no data on prevalence of CAs in Estonia is reported. Methods For retrospective observational study data of all births and terminations of pregnancies after 12th gestational week from (i) the Estonian Medical Birth Registry, (ii) Abortion Registy, (iii) Health Insurance Fund and (iv) hospital records were linked. To calculate the total, live birth, stillbirth and TOPFA prevalence of CAs with 95% confidence intervals (CI), guidelines issued by EUROCAT, European network for the epidemiological surveillance of CAs, https://eu-rd-platform.jrc.ec.europa.eu/eurocat_en were followed. Results In 2020 the total prevalence of CAs, chromosomal abnormalities and monogenic diseases in Estonia was 378.6 per 10,000 births (95% CI 346.0, 413.5). The most prevalent CAs were heart defects, 163.7 cases per 10,000 births (95%CI 142.5, 187.2). The prevalence of chromosomal abnormalities and genetic diseases was 92.6 per 10,000 births (95%CI 76.8, 110.6), 80% of cases were among TOPFAs. No newborns with major aneuploidies (Trisomy 21, 18, 13, polyploidy) were reported in 2020. Live birth prevalence of CAs, including chromosomal abnormalities and genetic diseases was 258.4 per 10,000 live births (95%CI 231.5, 287.5) and stillbirth prevalence of CAs 0.8 per 10,000 births. Conclusions The prevalence of CAs and genetic disorders in Estonia is one of the highest compared to prevalence reported by other European regions. It indicates to high population coverage with prenatal diagnostics in Estonia. Low number of major aneuploidies among live births may reflect good detection rate of major chromosomal abnormalities and cultural preferences.

Predictors of the Need for Cerebrospinal Fluid Diversion in Patients with Myelomeningocele

Background There is no consensus about the optimal timing and the criteria for cerebrospinal fluid diversion in children with myelomeningocele (MM). The aim of this work is to assess the predictors of the need for cerebrospinal fluid diversion in patients with myelomeningocele to avoid the unnecessary shunting with its complications. Patients and Methods This prospective study included fifty infants with myelomeningocele that were managed in the Neurosurgical department in Ain shams University hospital and October health insurance hospital from August 2016 till December 2018. Results In this study, 22 (44%) patients needed a shunt surgery after repair of the myelomeningocele. The age at presentation was highly significant (HS) for the need for shunt (P-value 0.006), with median age of 4.25 months. There were 22 cases (44%) that crossed the head circumference percentile for age while 28 cases (56%) matched; This was statistically highly significant (P-value 0.000). All patients with lax anterior fontanel (AF) or with mild bulge didn’t need a shunt, while all patients with tense AF needed a shunt (P-value 0.000). It was noticed that persistent vomiting was a sensitive indicator of the increased intracranial pressure since it occurred in all the cases who required shunt, this was statistically highly significant (P-vale 0.000). Four cases (8% of the cases) suffered from cerebrospinal fluid leak from the myelomeningocele wound within the first week post MM repair. Conclusion AF status & HC percentile for age represent the most reliable clinical signs to identify those who will need & benefit from a CSF diversion. The VP shunt should be preserved for cases exhibiting progressive signs of increased ICP (moderate to severe AF bulge- HC crossing percentile for age), while cases showing ventriculomegaly on imaging without signs of increased ICP should be followed up.

The Relation between Job Attitude and Organizational Citizenship Behavior among Staff Nurses in Health Insurance Hospital

The Relation between Job Attitude and Organizational Citizenship Behavior among Staff Nurses in Health Insurance Hospital

What constitutes adequate legal protection for the collection, use and sharing of mobility and location data in health care in South Africa?

Mobile phone technology has been a catalyst that has added an innovative dimension in health care and created new opportunities for digital health services. These digital devices can be viewed as an extension of the person using them due to the deluge of personal information that can be collected and stored on them. Data collected on mobile phones are used extensively in health services and research. Personal, mobility and location data are constantly collected. The unique mobile phone architecture provides for an easy flow of data between various role players such as application developers and phone manufacturers. The collection, storage and sharing of personal information on mobile phones elicit various legal questions relating to the protection of privacy, consent, liability and the accountability of stakeholders such as health insurance providers, hospital groups and national departments of health. Significance: We analyse the major legal concerns of mobility and location data collection and processing through mobile phones in the context of health care and provide recommendations to develop data protection guidelines that are built on the principles of lawfulness, fairness and transparency. The issues explored are of relevance in an African context and to a broader international audience.

Characterization of adverse events to hydroxychloroquine, ivermectin, azithromycin and tocilizumab in patients hospitalized due to COVID-19 in a Peruvian Social Health Insurance hospital.

To characterize the adverse events (AEs) related to the off-label use of hydroxychloroquine (HQ), azithromycin (AZI), tocilizumab (TOB) and ivermectin (IVM) for the treatment of COVID-19 in hospitalized patients. We conducted a secondary cross-sectional analysis of the Peruvian Social Health Insurance (EsSalud) pharmacovigilance system database of AE notifications to HQ, AZI, TOB and IVM in the Edgardo Rebagliati Martins National Hospital from April to October 2020. Information was collected from digital medical records. We estimated AE reporting rates and evaluated their characteristics by drug type, time of occurrence, type by the affected organ-system, severity and causality. We identified 154 notifications describing a total of 183 AE possibly related to HQ, AZI, TOB and IVM; the reporting rate was 8%. The median time of AE occurrence was 3 days (IQR: 2-5). Most were cardiovascular events; prolongation of the QT interval was the most frequent. Hepatobiliary AEs were mainly associated with TOB. Most cases were moderate, however, 10.4% were severe. We found AEs potentially associated with the use of HQ, AZI, TOB and IVM against COVID-19; cardiovascular events were the most frequent. Although AZI, HQ and IVM have known safety profiles, their use against COVID-19 could increase the occurrence of AE due to the risk factors inherent to this infection. Surveillance systems must be improved, especially those for TOB.

Impact of Social Isolation Due to COVID-19 on Daily Life Activities and Independence of People over 65: A Cross-Sectional Study.

A cross-sectional study. Private's health insurance Hospital, Córdoba, Argentina. A total of 193 participants with mean age of 76.56 years (121 women and 72 men) who met inclusion criteria were included in the study. A personal interview was conducted between July and December 2020. Sociodemographic data were collected, and perceived independence was assessed. The Barthel index and the Lawton and Brody scale were used to assess independence of basic and instrumental activities of daily living. Minimal limitations were noted with function. The activities that represented the greatest difficulties were going up and down stairs (22%) and moving around (18%), and the greatest difficulties in instrumental activities of daily living were shopping (22%) and preparing food (15%). COVID-19 has caused isolation, leading to functional limitations for many, especially older adults. Perceived declines in function and mobility may lead to decreased independence and safety for the older adult; therefore, preventative planning and programming should be considered.

Role of Color Doppler Ultrasonography in evaluation of hemodialysis AV fistula

Background: A significant percentage of the Egyptian population is affected by end-stage kidney disease, which requires long-term hemodialysis. For patients receiving regular hemodialysis, the arteriovenous fistula is now the method most frequently employed to provide vascular access. Objective: The current study's objective was to assess the role and utility of CDUS in assessing vascular access and identifying shunt complications for hemodialysis. Patients and methods: This prospective, randomized controlled trial investigation has been carried out at the Health Insurance Hospital Nasr City's radio-diagnosis department. We included a sample size of thirty patients who needed an arteriovenous fistula in the upper limb for hemodialysis. Patients ranged in age from 8 to 70 and were both male and female. Results: The majority of patients had normal vessel diameters. 6 patients (20%) have a BB fistula, 8 patients (26.7%) have an RC fistula, and 15 patients (50%) have a BC fistula. The study showed a mean age of AVF maturation occurs 2.17 ± 0.379 weeks after its 1st creation. 3 patients had an uncomplicated 10% and 27 patients had shunt complications of 90%. The investigation revealed a significant percentage of venous thrombosis (12 patients, 40%), stenosis (9 patients, 30%), aneurysmal dilatation (6 patients, 20%), pseudoaneurysmal formation (3 patients, 10%), and finally steal syndrome (3.3%, 1 patient). Conclusion: Early identification and repair of a failing hemodialysis fistula can improve the quality of hemodialysis treatment. For patients having AV dysfunction, the CDUS results from this series were useful in determining further treatment care.

Role of intra-articular tranexamic acid in reducing blood loss in total knee arthroplasty

Abstract Background Total knee arthroplasty (TKA) is associated with postoperative blood loss. Tranexamic acid (TXA) administration is an effective strategy used to reduce the blood loss. This study aimed to evaluate the effect of intra-articular injection of TXA on blood loss and transfusion rate after an elective TKA. Patients and methods This was a randomized controlled clinical trial adopted to fulfill the purpose of this study. The study was conducted at Benha Health Insurance Hospital and Benha University Hospitals. It was conducted on 42 adult patients who underwent an elective primary unilateral total knee arthroplasty (TKA) through midline incision with medial parapatellar approach after tourniquet application. Patients were categorized into two groups: control group (without TXA), and intra-articular (IA) group who received 1.5 gm of TXA in 10 ml of normal saline injected into the joint after packing, lavage, hemostasis and closure of the muscle layer just before the deflation of the tourniquet to guarantee maintenance of the injected fluid inside the joint. Demographic data and age, sex, comorbidities, and preoperative hemoglobin levels were collected. The maximum hemoglobin decline was the primary outcome, while the drain’s blood amount (cc/day), the rate of blood transfusion, and the duration of hospital stay were secondary outcomes. Results Patients who received Intra-articular TXA had statistically significant lower drop in hemoglobin level (0.99 + 0.45 mg/dl) compared to their control group (2.14 + 1.07 mg/dl) (P<0.001). Conclusion TXA is a safe and efficient way to reduce overall blood loss in TKA patients, according to data from this study and the literature. Administration intraarticular seems to be significantly effective in reducing postoperative blood loss without increasing the risk of thrombotic events.

Association of Remdesivir Treatment With Mortality Among Hospitalized Adults With COVID-19 in the United States

SARS-CoV-2, which causes COVID-19, poses considerable morbidity and mortality risks. Studies using data collected during routine clinical practice can supplement randomized clinical trials to provide needed evidence, especially during a global pandemic, and can yield markedly larger sample sizes to assess outcomes for important patient subgroups. To evaluate the association of remdesivir treatment with inpatient mortality among patients with COVID-19 outside of the clinical trial setting. A retrospective cohort study in US hospitals using health insurance claims data linked to hospital chargemaster data from December 1, 2018, to May 3, 2021, was conducted among 24 856 adults hospitalized between May 1, 2020, and May 3, 2021, with newly diagnosed COVID-19 who received remdesivir and 24 856 propensity score-matched control patients. Remdesivir treatment. All-cause inpatient mortality within 28 days of the start of remdesivir treatment for the remdesivir-exposed group or the matched index date for the control group. A total of 24 856 remdesivir-exposed patients (12 596 men [50.7%]; mean [SD] age, 66.8 [15.4] years) and 24 856 propensity score-matched control patients (12 621 men [50.8%]; mean [SD] age, 66.8 [15.4] years) were included in the study. Median follow-up was 6 days (IQR, 4-11 days) in the remdesivir group and 5 days (IQR, 2-10 days) in the control group. There were 3557 mortality events (14.3%) in the remdesivir group and 3775 mortality events (15.2%) in the control group. The 28-day mortality rate was 0.5 per person-month in the remdesivir group and 0.6 per person-month in the control group. Remdesivir treatment was associated with a statistically significant 17% reduction in inpatient mortality among patients hospitalized with COVID-19 compared with propensity score-matched control patients (hazard ratio, 0.83 [95% CI, 0.79-0.87]). In this retrospective cohort study using health insurance claims and hospital chargemaster data, remdesivir treatment was associated with a significantly reduced inpatient mortality overall among patients hospitalized with COVID-19. Results of this analysis using data collected during routine clinical practice and state-of-the-art methods complement results from randomized clinical trials. Future areas of research include assessing the association of remdesivir treatment with inpatient mortality during the circulation of different variants and relative to time from symptom onset.

The economic burden of malaria inpatients and its determinants during China's elimination stage.

Malaria burden is still worrisome, while empirical evidence from malaria-eliminated countries including China may provide inspiration for the world. This study aimed to investigate China's malaria hospitalization costs and explore its determinants. Stratified multistage sampling across provincial, municipal, and county hospitals was conducted in 2017. All the malaria medical records were retrieved from 2014 to 2016 in 70 hospitals. Parametric and non-parametric methods were employed to estimate hospitalization costs, and the non-parametric bootstrap was used to compare hospitalization costs among sample areas and assessed the uncertainty of its differences. Quantile regressions were conducted to identify the determinants of hospitalization costs. The median hospitalization costs of 1633 malaria inpatients were 628 USD. Medication and laboratory tests accounted for over 70% of total expenditure. The median reimbursement rate was 41.87%, and this number was even lower in higher-level hospitals (<35%) and among the New Rural Cooperative Medical Scheme (<40%). Finally, health insurance type, hospital tier, clinical units, unknown fever, and comorbidity were the main determinants of hospitalization costs. The disparity of health protection for malaria hospitalization between rural and urban areas was noteworthy. Equivocal diagnosis and comorbidity are contributors of high cost as well. A reasonable payment system and enhanced capacities to treat malaria in a cost-effective way are suggested to reassure malaria economic burden.

Surveillance for Sickle Cell Disease - Sickle Cell Data Collection Program, Two States, 2004-2018.

Surveillance for Sickle Cell Disease - Sickle Cell Data Collection Program, Two States, 2004-2018.

Effect of self-management intervention on the quality of life among women with endometriosis

Background: Endometriosis is a painful, chronic, and inflammatory disease that is characterized by the growth of endometrial-like tissue outside uterus that affects approximately 190 million women in world. Aim of the study to evaluate the effect of self-management interventions on the quality of life among women with endometriosis. Design: Quasi experimental design was used to achieve the aim of the study (pre- post test). Setting: The current study was conducted at the outpatient clinic for obstetrics and gynecology at El Mansoura Health Insurance Hospital, Dakahlia Governorate, Egypt. Sample: A convenience sample composed of 40 women suffering from endometriosis was included in the study. Tools: four tools for data collection Tool I: A structured interviewing questionnaire included two parts (socio-demographic characteristics –obstetric and gynecological history) Tool II; Numerical rating scale (NRS), to measure the severity of pain symptoms associated with endometriosis. Tool III; Endometriosis Health Profile Questionnaire, to determine wellbeing quality of life of endometriosis female. Tool IV; Self-management interventions, include: (physical activity -sleep -exercise -mood-dietary choices-medication). Results: The majority of the studied women with endometriosis had severe pain at pre intervention in compares to one fifth of studied women post intervention.