Lower Case Rate Research Articles

Impact of COVID-19 Preventative Measures on Otolaryngology in Taiwan: A Nationwide Study

Taiwan always had low case rates of COVID-19 compared with other countries due to its immediate control and preventive measures. However, the effects of its policies that started on 2020 for otolaryngology patients were unknown; therefore, the aim of this study was to analyze the nationwide database to know the impact of COVID-19 preventative measures on the diseases and cases of otolaryngology in 2020. A case-compared, retrospective, cohort database study using the nationwide database was collected from 2018 to 2020. All of the information from outpatients and unexpected inpatients with diagnoses, odds ratios, and correlation matrix was analyzed. The number of outpatients decreased in 2020 compared to in 2018 and 2019. Thyroid disease and lacrimal system disorder increased in 2020 compared to 2019. There was no difference in carcinoma in situ, malignant neoplasm, cranial nerve disease, trauma, fracture, and burn/corrosion/frostbite within three years. There was a highly positive correlation between upper and lower airway infections. COVID-19 preventative measures can change the numbers of otolaryngology cases and the distributions of the disease. Efficient redistribution of medical resources should be developed to ensure a more equitable response for the future.

The Preference of Domestic Tourist Towards the Tourism Destination During Pandemic Period in Bali

The COVID-19 Pandemic that occurred around the world had an impact on the decrease in people's income which has implications for changing behavior in choosing tourist destinations. This study aims to: 1) analyze the relative importance attribute from Indonesian tourists who came to Bali during the COVID - 19 Pandemic 2.) Get the most optimal combination of tourist destination products choice based on the preferences of Indonesian tourists during the COVID – 19 Pandemic. The research was conducted at Benoa Harbour, I Gusti Ngurah Rai Airport and Kuta Beach from January to April 2021 through the dissemination of questionnaires to 160 Indonesian tourists by accidental sampling. Data analysis by conjoin method and analyzed with SPSS 2.0 program. The results showed that the relative importance attribute sorted from the highest value to the lowest value is cleanliness, price, attractiveness, service, recommendations, security, and promotion. Tourists' preference is the willingness of hygiene facilities, the price of > Rp.50.000, flexible artificial tour booking, friends/family, low case rates and discounts on airline tickets.
 Keywords: importance; preferences; travel; Bali.

COVID-19 in Immunocompromised Children and Adolescents.

COVID-19 in Immunocompromised Children and Adolescents.

The Republic of Buryatia population malignant neoplasms rate

The degree of morbidity of the population of the Republic of Buryatia with malignant neoplasms without subdivision by localization from 1996 to 2019 was analyzed according to the data of the Republican Clinical Oncological Dispensary. Material and methods. The data on the incidence of malignant neoplasms in the population of municipalities of the Buryat Republican Clinical Oncological Dispensary, expressed in intensive («rough») indicators (PI) per 100 thousand population (ppm, 0/0000) have been analyzed. The zoning of the incidence of the population has been based on the approach of medico-geographical typification of the territory. The range of indicators of the incidence of cancer in the population served as the basis for identifying four types of territories by the levels of cancer pathology: low – medium – high – very high. The dynamics of morbidity was analyzed by the average indicators of four 5-year periods (1996–2000, 2001–2005, 2006–2010, 2011–2015) and one 4-year period (2016–2019). Cartographic processing of the material was performed using Paint.NET. The comparison of morbidity in 21 municipal districts has been carried out. In period 1, there were 4 districts with low pathology (90–134 people): Okinsky, Muisky, Tunkinsky, Zakamensky districts, and with very high pathology (225–277 cases) – 4 districts: Pribaikalsky, Kabansky, Zaigraevsky, Bauntovsky. In the second period, the Okinsky, Tunkinsky, Dzhidinsky districts had low rates (100–158 cases), and the North-Baikalsky, Ivolginsky, Selenginsky, Kurumkansky, Mukhorshibirsky districts had very high level (257 and more). In the third period: low incidence rate (100–150 cases) has been determined in Muisky, Kizhinginsky districts, very high rate (274–331 cases) – in Bauntovsky, Kabansky, Zaigraevsky, Tarbagataisky districts. In the fourth period: low pathology rate (155–212 people) was in Okinsky, Zakamensky, Muisky, Eravninsky, Ivolginsky districts, very high level (329 cases) was in Bauntovsky district. In the last four years: low case rate (138–204) was only in Okinsky district, very high pathology level (339–405 people) was in 5 districts, to Bauntovsky, Kabansky, Pribaikalsky districts were added the northern districts: Severo-Baikalsky and Barguzinsky. Territories with high indicators of malignant neoplasms include: Pribaikalsky (393.5 ± 39.9 0/0000), Kabansky (397.5 ± 21.9 0/0000), Zaigraevsky (318.2 ± 13.6 0/0000), Bauntovsky (403.6 ± 51.6 0/ 0000); with reduced ones – Zakamensky (241.1 ± 17.4 0/0000), Tunkinsky (215.9 ± 6.8 0/0000), Eravinsky (214.3 ± 16.5 0/0000), Okinsky (137.8 ± 6.1 0/0000) districts. The malignant neoplasms incidence of the population of the Republic Buryatia is high, and it is growing every year.

COVID-19 in US Youth Soccer Athletes During Summer 2020.

As sports are reinitiated around the United States, the incidence of COVID-19 among youth soccer athletes remains unknown. To determine the incidence of COVID-19 among youth soccer athletes and the risk-mitigation practices used by youth soccer organizations. Cohort study. Survey distributed to Elite Clubs National League member clubs. Youth soccer club directors throughout the United States. Surveys were completed in late August 2020 regarding the club's current phase of return to soccer (individual only, group noncontact, group contact), date of reinitiation, number of players, cases of COVID-19, and risk-reduction procedures being implemented. Case and incidence rates were compared with national pediatric data and county data from the prior 10 weeks. A negative binomial regression model was developed to predict club COVID-19 cases using the local incidence rate and phase of return as covariates and the log of club player-days as an offset. A total of 124 respondents had reinitiated soccer, representing 91 007 players with a median duration of 73 days (interquartile range = 53-83 days) since restarting. Of the 119 clubs that had progressed to group activities, 218 cases of COVID-19 were reported among 85 861 players. Youth soccer players had a lower case rate and incidence rate than children in the United States (254 versus 477 cases per 100 000; incidence rate ratio = 0.511, 95% CI = 0.40, 0.57; P < .001) and the general population in the counties where data were available (268 versus 864 cases per 100 000; incidence rate ratio = 0.202, 95% CI = 0.19, 0.21; P < .001). After adjusting for the local COVID-19 incidence, we found no relationship between the club COVID-19 incidence and the phase of return (noncontact: b = 0.35 ± 0.67, P = .61; contact: b = 0.18 ± 0.67, P = .79). Soccer clubs reported using a median of 8 (interquartile range = 6-10) risk-reduction procedures. The incidence of COVID-19 among youth soccer athletes was relatively low when compared with the background incidence among children in the United States during the summer of 2020. No relationship was identified between the club COVID-19 incidence and the phase of return to soccer.

A year like no other: introduction to a special issue on COVID-19 and pain.

A year like no other: introduction to a special issue on COVID-19 and pain.

COVID-19 outcomes among people with intellectual and developmental disability in California: The importance of type of residence and skilled nursing care needs

BackgroundPeople with intellectual and developmental disabilities (IDD) appear to be at greater risk for severe outcomes from COVID-19. The roles of congregate living and skilled nursing care needs in this disparity are unclear. ObjectiveTo determine the impact of residential setting and level of skilled nursing care on COVID-19 outcomes for people receiving IDD services, compared to those not receiving IDD services. MethodsUtilizing publicly available California data on COVID-19 outcomes for people receiving IDD services (early May through October 2, 2020), we report outcomes based on seven types of residence, differentiated by number of residents and level of skilled nursing care provided. We compared these results to the larger California published outcomes. ResultsCompared to Californians not receiving IDD services, in general, those receiving IDD services had a 60% lower case rate, but 2.8 times higher case-fatality rate. COVID-19 outcomes varied significantly among Californians receiving IDD services by type of residence and skilled nursing care needs: higher rates of diagnosis in settings with larger number of residents, higher case-fatality and mortality rates in settings that provided 24-h skilled nursing care. ConclusionsDiagnosis with COVID-19 among Californians receiving IDD services appears to be related to the number of individuals within the residence, while adverse COVID-19 outcomes were associated with level of skilled nursing care. When data is available, future research should examine whether these relationships persist even when controlling for age and pre-existing conditions.

Rabies-induced behavioural changes are key to rabies persistence in dog populations: Investigation using a network-based model.

Canine rabies was endemic pre-urbanisation, yet little is known about how it persists in small populations of dogs typically seen in rural and remote regions. By simulating rabies outbreaks in such populations (50–90 dogs) using a network-based model, our objective was to determine if rabies-induced behavioural changes influence disease persistence. Behavioural changes–increased bite frequency and increased number or duration of contacts (disease-induced roaming or paralysis, respectively)–were found to be essential for disease propagation. Spread occurred in approximately 50% of model simulations and in these, very low case rates (2.0–2.6 cases/month) over long durations (95% range 20–473 days) were observed. Consequently, disease detection is a challenge, risking human infection and spread to other communities via dog movements. Even with 70% pre-emptive vaccination, spread occurred in >30% of model simulations (in these, median case rate was 1.5/month with 95% range of 15–275 days duration). We conclude that the social disruption caused by rabies-induced behavioural change is the key to explaining how rabies persists in small populations of dogs. Results suggest that vaccination of substantially greater than the recommended 70% of dog populations is required to prevent rabies emergence in currently free rural areas.

Endovascular coiling for cerebral aneurysm: single-center experience in Egypt

BackgroundEndovascular management for cerebral saccular aneurysm has evolved in the last decade with evolution in both equipment and material. Coiling is still the mainstay of cerebral aneurysm endovascular management. In Egypt, practice outcome needs evaluation especially at low-volume centers.PurposeTo discuss the technical and management outcomes of our first symptomatic and asymptomatic cerebral saccular aneurysm case series treated with simple coiling.Patients and methodsClinical, treatment, and outcome variables of consecutive symptomatic and asymptomatic cerebral aneurysm cases treated with simple coiling between January 2011 and June 2016 in one center were analyzed.ResultsIn 31 patients, 35 aneurysms were found, 34 aneurysms (97.1%) were treated by endovascular coiling, and only one aneurysm (2.9%) was not fit for endovascular treatment. Total occlusion was achieved in 29 aneurysms (82.9%). Neck remnants were present in 4 aneurysms (11.4%). Partial coiling (incomplete occlusion) was achieved in 1 aneurysm (2.9%). Regarding functional outcome (mRS at discharge), 25 patients had good outcome (mRS = 0, 1, 2, 3) and 6 patients had poor outcome (mRS = 4, 5, 6).ConclusionThe endovascular coiling could be used as a first-choice option for treatment of saccular cerebral aneurysms at our center despite the low case rate.

The Effect of Case Rate and Coinfection Rate on the Positive Predictive Value of a Registry Data-Matching Algorithm

Statistical modeling has suggested that the prevalence of false matches in data matching declines as the events become rarer or the number of matches increases. We examined the effect of case rate and coinfection rate in the population on the positive predictive value (PPV) of a matching algorithm for HIV/AIDS and sexually transmitted disease (STD) surveillance registry data. We used LinkPlus™, a probabilistic data-matching program, to match HIV/AIDS cases diagnosed in New York City (NYC) from 1981 to March 31, 2012, and reported to the NYC HIV/AIDS surveillance registry against syphilis and chlamydia cases diagnosed in NYC from January 1 to June 30, 2010, and reported to the NYC STD registry. Match results were manually reviewed to determine true matches. With an agreement/disagreement comparison score cutoff value of 10.0, LinkPlus identified 3,013 matches, of which 1,582 were determined to be true by manual review. PPV varied greatly in subpopulations with different case rates and coinfection rates. PPV was the highest (91.6%) in male syphilis cases, who had a relatively low case rate but a high HIV coinfection rate, and lowest (18.0%) in female chlamydia cases, who had a high case rate but a low HIV coinfection rate. When the cutoff value was increased to 15.0, PPVs in male syphilis and female chlamydia cases increased to 98.3% and 90.5%, respectively. Case rates and coinfection rates have a significant effect on the PPV of a registry data-matching algorithm: PPV decreases as the case rate increases and coinfection rate decreases. Before conducting registry data matching, program staff should assess the case rate and coinfection rate of the population included in the data matching and select an appropriate matching algorithm.

Komplikationen und Komplikationsmanagement in der Ösophaguschirurgie

Prevention, early recognition and an adequate management of perioperative complications in resectional oesophageal surgery are the keys to an increased safety of these complex procedures. Preoperative registration and - if required - pretreatment of specific risk factors can considerably decrease the complication rate. The precise implementation of significant preoperative score systems in patients with high operative risk can lead to a negative risk-benefit consideration concerning the indication for an operation. The patients will then be assigned to an alternative treatment process. Anastomotic leakage is the most frequent technical-surgical complication. A precise suturing technique with the prevention of tension and the avoidance of reduction of perfusion of the conduit (stomach, colon, small intestine) can reduce the rate of such insufficiencies. The most frequent non-surgical complication is postoperative pneumonia, which can be avoided or combated through effective pain-relieving therapy like peridural anaesthesia and specific techniques of postoperative ventilation. It is of vital importance to identify, at the earliest possible timepoint, complications that might emerge after the operation. The occurrence of postoperative tachyarrhythmia has proven to be a frequent and early indicator of such complications. The treatment of complications after oesophageal resections includes adequate conservative, interventional, e. g., endoscopic placement of a stent in cases of covered insufficiency of the suture line, and operative procedures like reoperation in cases of uncovered leakage with pleural connection. All the other surgical complications like haemorrhage, tracheobronchial leak-ages or chylothorax are rarely seen and demand specific therapeutic procedures. It is not only the surgery that determines a high or low complication rate in oesophageal resectional procedures. It has clearly been proved that interdisciplinary management of complications after oesophagectomy is much more effective in high-volume centres, leading to a lower mortality, than in surgical departments with a lower case rate and thus with less experience in such complex operations.

Polytraumatisierte Brandverletzte

Most polytraumatized burn injury persons aged 30-40 years who have suffered a burn or a burn-like injury are stigmatized by serious functional deficits, temporary loss of their social independence, injury-associated psychological reactions of different levels, and unusual reversible deficits in their higher cortical functions. The result is a prolonged stage of acute treatment and rehabilitation as well as very often the lifelong need for highly specialized care by physicians and other medical professionals. Accordingly, the deficits in any individual case are high and in spite of the low case rate (approximately 300-400 cases/ year) these accidents have a high impact on society as a whole, resulting in a significant financial burden for the social security system, insurance funds, and pension funds.