National Healthcare Research Articles

Zarażenia pasożytami jelitowymi u dzieci ukraińskich − uchodźców wojennych mieszkających w Warszawie

Introduction and objectiveThe war and the humanitarian crisis in Ukraine have resulted in a mass migration of millions of Ukrainians into the EU countries. According to the data obtained from Statistics Poland, a governmental agency collecting and publishing the country’s statistical data, the number of Ukrainian children currently living in Poland is approximately 500,000. The massive influx of immigrants into Poland poses a considerable challenge to the national health care sector. The aim of this study was to assess the prevalence of intestinal parasitic infections among Ukrainian child war refugees living in Warsaw.Material and methodsThe study involved a total of 25 Ukrainian children, patients of the Clinic of Paediatrics, Nephrology and Paediatric Allergology at the Military Institute of Medicine – National Research Institute in Warsaw. Parasitological diagnostic work-up was carried out in October 2023 at the Department of Epidemiology and Tropical Medicine, the Military Institute of Medicine – National Research Institute in Gdynia. Stool tests for the presence of intestinal parasites were conducted by light microscopy using three different methods (direct smear in Lugol’s solution, decantation with distilled water, Fülleborn’s flotation).ResultsA total of 20% of the children studied (5/25) were found to be infected with potentially pathogenic stramenopile <i>Blastocystis</i> spp. In addition, two of the children were also infected with non-pathogenic <i>Endolimax</i> nana and <i>Entamoeba</i> coli protozoa. There were no infections with nematodes, cestodes or trematodes among the study participants.ConclusionsThe confirmation of potentially pathogenic <i>Blastocystis</i> spp. in stool samples collected from Ukrainian children, war refugees living in Warsaw, justifies the necessity to re-introduce a large-scale routine screening for intestinal parasites in the paediatric population in Poland.

The epidemiology of geriatric fractures: A nationwide analysis of 1 million fractures

ObjectiveFractures among the geriatric population impose a substantial burden on healthcare systems. This study aims to investigate the incidence and distribution of fractures among geriatric individuals over seven years, analyzing changes by age and sex. The findings will inform national healthcare strategies for addressing the growing impact of geriatric fractures. Materials and methodsElectronic health records from a nationwide personal health records system were analyzed, focusing on ICD-10 codes for fractures. Recurrent codes for the same patients within three months were excluded. Patients were categorized into three age groups (65–74, 75–84, and 85+ years), and fractures were grouped anatomically. Incidence rates for specific fracture locations were calculated based on the actual population at risk annually. Incidence rates were further stratified by sex and age groups using Turkey's age- and sex-specific populations. ResultsA total of 1,004,663 geriatric fractures (66.9 % female, 33.1 % male) were identified over seven years. The overall fracture incidence among the geriatric population was 1.9 % (1910/100,000). Hip fractures were the most common (25.2 %), followed by wrist (15 %) and lumbar-pelvic fractures (11.9 %). Femur fractures were predominant in the 75–84 and 85+ age groups, while wrist fractures were more common in the 65–74 age group. Fracture incidences generally increased with age, except for ankle, foot, and toe fractures, which decreased with age for both sexes (p < 0.05). The male/female ratio was lowest for wrist, elbow, and humeral shaft fractures (1:3.2, 1:2.7, and 1:2.7, respectively). The lowest overall fracture incidence was observed in 2020 (1568/100,000), while the highest was in 2017 (2523/100,000). ConclusionWith Turkey's aging population, the socioeconomic impact of geriatric fractures is anticipated to rise. Fracture patterns and incidence vary by age and sex among geriatric individuals. These findings provide valuable insights for healthcare planning and the development of community-based preventive measures tailored to specific fracture locations and demographics.

Social medicine education towards structural transformation in Palestine

IntroductionSocial medicine, a field of study that uniquely centers the social and structural drivers of health in society, has been increasingly integrated into medical professional education over the last several decades. In Palestine, due to the fragmentation of Palestinian geographies, education, culture, and health, integrating a social medicine approach for allied health care students has remained elusive. We seek to introduce the theoretical underpinnings and practical implementation of an experiential Palestine social medicine course. Materials and methods30 Students from the Gaza Strip, West Bank, and the United States convened at the Institute of Community and Public Health at Birzeit University, Palestine, for a three-week experiential social medicine course. The course introduced critical social and structural frameworks and utilized a biosocial model for training and education that included reflective knowledge acquisition and praxis. Pre- and post-course evaluations provided feedback and insight into the knowledge, attitudes, and learning evolution of the student cohort. ResultsParticipant experiences highlighted the importance of the critical reflective nature of the course and importance of practice through praxis. Students identified the convening of Palestinians from different regions and the focus on Palestinian-centered perspectives as foundational for the course. Tensions highlighted included the challenges and distress in identifying tangible next steps in addressing the identified structural determinants of Palestinian health. ConclusionThe Palestine social medicine course provided a Palestinian narrative-centered course that focused on critical structural frameworks to identify and clarify the overarching connections of various, fractured Palestinian health experiences. This course provides a model, and first step, towards meaningful decolonial education, partnership, and praxis, while also providing further evidence of the power of mobilizing in health solidarity and the transformative power of the social medicine movement.

A Descriptive Study to Assess the Level of Knowledge Regarding National Geriatric Health Care Policies Among Elderly People in a Selected Area of Haridwar

This descriptive study aimed to assess the level of knowledge regarding national geriatric health care policies among elderly people in a selected rural area of Haridwar. Geriatric health care is an important aspect of ensuring the well-being and quality of life for the elderly, a population that is often dependent on external support due to the aging process. The study was conducted among 80 participants aged 60 years and above using a non-probability purposive sampling technique. Data was collected through a self-structured questionnaire designed to evaluate knowledge of national policies such as the Indira Gandhi National Old Age Pension Scheme, Atal Pension Yojana, Ayushman Bharat Yojana, and others. The results indicated that the majority (65%) of the elderly had average knowledge, while 35% had poor knowledge of these policies, and no participant demonstrated a high level of knowledge. Further analysis revealed no significant association between the level of knowledge and demographic factors such as age, gender, education, and income. This lack of awareness suggests a pressing need for greater dissemination of information regarding geriatric health care policies in rural communities, where elderly people may be particularly vulnerable to poor health outcomes due to limited access to healthcare and support services. The study concludes that improving awareness and access to these policies can empower the elderly to better utilize available resources, ultimately improving their health and well-being. The findings highlight the need for targeted health education programs and policy-level interventions to bridge the knowledge gap in rural areas. Future research should explore larger populations and examine strategies to effectively increase policy awareness among the elderly.

National Trends in the Prevalence of Unmet Health Care and Dental Care Needs During the COVID-19 Pandemic: Longitudinal Study in South Korea, 2009-2022.

Although previous studies have investigated trends in unmet health care and dental care needs, most have focused on specific groups, such as patients with chronic conditions and older adults, and have been limited by smaller data sets. This study aims to investigate the trends and relative risk factors for unmet health care and dental care needs, as well as the impact of the COVID-19 pandemic on these needs. We assessed unmet health care and dental care needs from 2009 to 2022 using data from the Korea Community Health Survey (KCHS). Our analysis included responses from 2,750,212 individuals. Unmet health care or dental care needs were defined as instances of not receiving medical or dental services deemed necessary by experts or desired by patients. From 2009 to 2022, the study included 2,700,705 individuals (1,229,671 men, 45.53%; 673,780, 24.95%, aged 19-39 years). Unmet health care needs decreased before the COVID-19 pandemic; however, during the pandemic, there was a noticeable increase (βdiff 0.10, 95% CI 0.09-0.11). Unmet dental care needs declined before the pandemic and continued to decrease during the pandemic (βdiff 0.23, 95% CI 0.22-0.24). Overall, the prevalence of unmet dental care needs was significantly higher than that for unmet health care needs. While the prevalence of unmet health care needs generally decreased over time, the β difference during the pandemic increased compared with prepandemic values. Our study is the first to analyze national unmet health care and dental care needs in South Korea using nationally representative, long-term, and large-scale data from the KCHS. We found that while unmet health care needs decreased during COVID-19, the decline was slower compared with previous periods. This suggests a need for more targeted interventions to prevent unmet health care and dental care needs.

The Cost of Lipoedema Treatment Exceeds the DRG Revenues - Evaluation of the Surgical Treatment Costs of Lipoedema (Stage III) at a German University Clinic

Liposuction for stage III lipoedema is a guideline-based but also time-consuming treatment, which can be carried out under specific conditions at the expense of the German statutory health insurance companies (SHI) based on a decision made by the German Federal Joint Committee ("Gemeinsamer Bundesausschuss", G-BA), the highest decision-making body in the German healthcare system, in 09/2019. We postulate that the treatment is not reflected in a cost-covering manner in the university cost system. This monocentric, retrospective study examined the economic aspects of 92 cases in 48 lipoedema patients treated during the period from 09/2019 to 08/2023 at the expense of the SHI. These cases were filtered out using DRG coding and the Operation and Procedure Classification system ("Operationen- und Prozedurenschlüssel", OPS), and the costs and revenues per patient were calculated using the data from our internal service accounting. After an inpatient stay of 2.64±1.33 days, the total revenue was € 4,726.79±680.98. This included € 1,532.92±856.99 inpatient costs, € 2,686.02±1,174.70 in operating costs, € 940.76±189.18 in anaesthesia costs and € 63.19±125.38 in other costs that had to be paid within the clinic. On average across all treatments, this resulted in a loss of -€ 875.22 /case. In 54 cases (59%), the costs exceeded the revenue. In total, the calculation of all cases resulted in a loss of € -80,520.63. If medical personnel costs are included, this amount rises to over € 100,000. The results show that the surgical treatment of lipoedema in the German DRG and university cost systems is not cost-covering. This could be relevant in the final economic assessment of the G-BA, which may result in an adjustment of the DRG revenue.

Bénédict Augustin Morel (1809-1873): The Originator of the Degenerative Theory of the Heredity of Mental Disorders and the Pioneer of the Biological Approach to Psychiatry.

The concept of progressive hereditary degeneration, which significantly influenced medical, particularly psychiatric and in turn social thought of the second half of the 19th century, was articulated by Bénédict Augustin Morel. The distinguished French psychiatrist developed the theory of degeneration and created the nosological framework of the heredity of mental illness in order to explain the more frequent psychoses and nervous disorders. In the absence of patho-anatomical findings, Morel attributed these phenomena to hereditary causes. His theory was the first attempt to interpret insanity, mental disorders, and criminality, across generations, andformed the basis for the further development of psychiatry. It had a notable influence on many scientific disciplines of the time, such as criminology, anthropology, biology, and general pathology. It would later result in the emergence of eugenics, which raised several moral issues and would ultimately be used in many ways to justify segregation.Morel was mainly influenced by the monogenetic degenerative theory and believed that social progress could be achieved by the coupling of psychiatry, a social medicine, with philosophy and Christianity.

Цифровая трансформация здравоохранения: технологические и организационные аспекты

The article shows that the digital transformation of domestic healthcare leads to the emergence of new opportunities for its qualitative development and improvement of the efficiency of services provided, in this regard, such a transformation is one of the key directions of the national Healthcare project implemented in the Russian Federation. It shows how telemedicine, electronic medical records, artificial intelligence, big data analysis, etc. They provide an increase in the efficiency of medical services, allowing the formation of technological and organizational aspects for the effective development of the healthcare system within the framework of the so-called "4p medicine", which largely embodies the paradigm of its development in the digital age. The emergence of 4P medicine represents a transition from a reactive to a proactive model of the healthcare system, focusing on prevention, early detection and personalized treatment in order to improve the effectiveness of the healthcare system and reduce the cost of its operation.

Determinants of Healthcare-Associated Infections in King Abdulaziz Specialized Hospital in Taif, Saudi Arabia.

Healthcare-associated infections (HAIs) represent a significant challenge in hospital settings, contributing to increased morbidity, mortality, and healthcare costs. This study aimed to estimate the prevalence and socio-demographic and clinical determinants of HAIs at the King Abdulaziz Specialized Hospital (KAASH) in Taif, Saudi Arabia. A hospital-based cross-sectional study was conducted from March 2023 to January 2024targeting inpatients aged 18 and above in all units and wards. Data were collected using the National Healthcare Safety Network (NHSN) criteria for definitions of surveillance. A structured questionnaire gathered socio-demographic and clinical data from patients or next of kin if the patient was not fully oriented.Descriptive statistics were performed, and analytical methods used included Pearson chi-square test, Pearsoncorrelation, independent t-test, and one-way analysis of variance. Among 318 participants included in this study, the mean age of participants was 56.44 years, with a slight female predominance (n=164, 51.6%). Hypertension (n=162, 50.9%) and diabetes (n=126, 39.6%) were the most prevalent comorbidities. Pneumonia (n=60, 26.8%) and trauma (n=55, 17.4%) were the leading causes of admission. The two most common HAIs included catheter-associated urinary tract infections (CAUTI) (n=124, 39%) and central line-associated bloodstream infections (CLABSI) (n=74, 23.3%). The primary causative organisms were Klebsiella pneumoniae (n=96, 30.2%) and Acinetobacter baumannii (n=32, 10.1%). The most significant predictors of HAIs were as follows: For CLABSI, risk factors include having three or more comorbidities, fever above 37.8°C, chills or rigors, hypotension, and positive blood culture. For CAUTI, key predictors were urinary tract infection (UTI), positive urine culture, acute pain or swelling of the testes, suprapubic tenderness, visible hematuria, and leukocytosis. Significant predictors of bloodstream infections (BSI) include having a BSI, positive blood culture, chills or rigors, and hypotension. Fever and hypotension increased CLABSI and BSI risk but reduced the CAUTI risk. The study highlights a significant burden of HAIs at the KAASH, with multiple predictors. The findings underscore the need for robust infection control measures and targeted interventions to reduce HAI incidence and improve patient outcomes.

Temporal trends in mortality and causes of death in patients with incident atrial fibrillation: a nationwide register study from 2010 to 2018

ObjectivesAtrial fibrillation (AF) is associated with increased mortality. Previous studies have reported conflicting results in temporal trends of mortality after AF diagnosis. We aim to address this disparity by investigating...

Analysis of health claims data on vaccination coverage in older adults in Bavaria, Germany: Influenza, pneumococcus and herpes zoster

BackgroundVaccination is essential, especially in older adults whose immune system function declines with age. The COVID-19 pandemic and its associated lockdowns temporarily disrupted routine vaccination services. We aimed to assess vaccination coverage for Influenza, Pneumococcus, and Herpes zoster among older adults in Bavaria over time and investigate potential pandemic effects on these rates. MethodsBased on health claims data from the Bavarian Association of Statutory Health Insurance Physicians (KVB), we estimated the percentage of adults aged 60 years and older vaccinated following the German Standing Committee on Vaccinations (STIKO) recommendation for Influenza (2012−2021), Pneumococcus (2017–2021) and Herpes zoster (2019–2021), stratified by sex and 10-year age groups. Using time series regression analysis, we estimated the effect of the pandemic period (2020−2021) on quarterly Influenza and Pneumococcal vaccination rates. ResultsIn the first year of the pandemic (2020), Influenza, Pneumococcus and Herpes zoster coverage in both sexes increased by 9.9, 8.7, and 2.5 percentage points (pp), respectively. In 2021, Influenza coverage decreased by 4.7 pp., while Pneumococcus and Herpes zoster coverage increased by 2.7 and 3.8 pp., respectively. Influenza and Pneumococcal vaccinations showed a seasonal pattern, with vaccinations occurring mainly in the fourth quarter; this pattern was distorted for Pneumococcus during the pandemic. Per the time series regression analysis, Influenza vaccination rates in the fourth quarters of 2020 and 2021 were 7.86 (95 %CI: 5.10–10.62) and 8.87 (95 %CI: 5.80–11.54) pp. higher for males and females, respectively, compared to that of the pre-pandemic period. During the pandemic, the quarterly Pneumococcal vaccination rates increased by 0.68 (95 %CI: 0.19–1.18) pp. in males and 0.80 (95 %CI: 0.30–1.30) pp. in females. ConclusionThe heightened increase in vaccination rates observed in 2020 may have resulted from increased vaccination awareness during the pandemic. As the pandemic effect wanes, more efforts are needed to sustain and increase these vaccination rates.

The clinical and cost effectiveness of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Study protocol for a randomised controlled trial with ethnically diverse family carers

BackgroundFollowing the successful completion of feasibility and acceptability studies of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS), a full-scale randomised controlled trial (RCT) evaluating its clinical and cost effectiveness will be conducted. This paper describes the design and protocol for a multi-site, parallel, single-blind, 2-arm RCT evaluating the clinical and cost effectiveness of iACT4CARERS plus treatment-as-usual (TAU) in comparison to TAU alone for reducing anxiety in family carers of people with dementia. Methods496 family carers aged ≥18 years, who are caring for a person with dementia, will be recruited from national healthcare services, general practices and community groups in England. Participants randomised to the intervention arm will receive iACT4CARERS over 12 weeks. Participants will complete outcome measures at baseline (0 weeks) and at 12-weeks and 24-weeks post-randomisation. The primary outcome and timepoint will be anxiety at 12 weeks. Secondary outcomes will include psychological flexibility, depression, and cost-effectiveness (cost per quality adjusted life years). Primary analyses will be by intention-to-treat and data will be analysed using linear mixed models. Fidelity and quality of implementation will be assessed and contextual factors associated with variation in outcomes identified in a process evaluation. ConclusionIf iACT4CARERS is found to be effective and affordable, this self-help intervention, including minimal contact with minimally trained therapists, has the potential to be rolled out widely within healthcare services in the UK, reducing inequality in access to psychological services among this population.Clinical trials registration: ISRCTN registry identifier ISRCTN45995725.

Anti-Obesity Medication in the Management of Children and Adolescents With Obesity: Recent Developments and Research Gaps.

Paediatric obesity is a global public health concern. While in most countries the incidence keeps rising, the need for effective and long-term management for children and adolescents living with this chronic, relapsing disease is pressing. Health behaviour and lifestyle treatment (HBLT) is recommended as first-line treatment. Narrative review. A new generation of recently approved anti-obesity medications (AOM) now has the potential to fill the gap between limited effects on body mass index (BMI) by HBLT alone and large effects by metabolic and bariatric surgery in adolescents with obesity aged 12 years and older. While, for semaglutide and phentermine/topiramate, effectiveness is substantial with relevant, but mostly mild to moderate adverse events, there is a gap in evidence regarding long-term effects and safety, effects on outcomes beyond BMI reduction and data for certain groups of patients, such as children < 12 years and minority groups. When integrating AOM treatment into national healthcare systems it should be offered as part of a comprehensive patient-centred approach. This article summarizes recent AOM developments, integration into paediatric obesity management, and identifies research gaps.

Digital health applications-What we should know as rheumatologists

Digital health applications (DHAs) are revolutionising patient care by improving access to evidence-based therapy and promoting active self-management. The continuously growing number of DHAs enables patients to act more independently through digital support. The budget-neutral prescription and cost coverage by statutory health insurance companies reduce financial barriers for practitioners and patients. Initial studies show that DHAs can be used successfully to treat comorbidities and rheumatic diseases. Several DHAs for inflammatory rheumatic diseases are at an advanced stage of development. The identification of suitable patients and support through shared decision making are crucial for successful implementation. Challenges remain in adherence and acceptance of the applications. This article provides an overview of prescription in clinical routine, initial data and experiences from the reality of rheumatology care, and reports on current developments.

Poststroke seizures and epilepsy increase the risk of dementia among stroke survivors: A population-based study.

With global aging, the occurrence of stroke and associated outcomes like dementia are on the rise. Seizures and epilepsy are common poststroke complications and have a strong connection to subsequent dementia. This study examines the relationship between poststroke seizures (PSS) or poststroke epilepsy (PSE) and dementia using a national health care database. We conducted a retrospective study using data from the Taiwan National Health Insurance Research Database from 2009 to 2020. We identified acute stroke patients from 2010 to 2015, excluding those with pre-existing neurological conditions. Based on age, sex, stroke severity level, and the year of index stroke, patients with PSS or PSE were matched to those without. The main outcome was incident dementia. This study included 62 968 patients with an average age of 63 years, with males accounting for 62.9%. Of them, 60.3% had ischemic strokes, and 39.7% had hemorrhagic strokes. After an average follow-up period of 5.2 years, dementia developed in 15.9% of patients who had PSS or PSE, as opposed to 8.4% of those without these conditions. A time-dependent Fine and Gray competing risk analysis showed that PSS and PSE were significantly associated with dementia across all stroke types. Subgroup analyses revealed significantly increased risk of dementia across all age groups (<50, 50-64, and ≥65 years), sexes, and various stroke severity levels. The link between PSS or PSE and dementia was particularly pronounced in men, with a less distinct correlation in women. The risk of incident dementia was higher in patients with PSS or PSE. The potential for therapeutic interventions for seizures and epilepsy to reduce poststroke dementia underscores the importance of seizure screening and treatment in stroke survivors.

The Profile of the Italian Centers for Cognitive Disorders and Dementia in the Context of New Drugs in Alzheimer's Disease.

The wait for the upcoming disease-modifying therapies (DMT) for Alzheimer's disease in Europe is raising questions about the preparedness of national healthcare systems to conduct accurate diagnoses and effective prescriptions. In this article, we focus on the current situation in Italy. The primary goal is to propose a profile of the Italian Centers for Cognitive Disorders and Dementias (CCDDs) that could be taken into consideration by regional and autonomous provincial authorities when deciding on the prescribing centers for DMT. Based on responses to a national survey on CCDDs in Italy, we identified the CCDDs that meet the requirements for effective prescription: 1) Multidisciplinary team; 2) Minimum Core Test for the neuropsychological assessment; 3) PET, CSF, and Brain MRI assessments. Univariate and multivariate comparisons were conducted between CCDDs that met the criteria and the others. Only 10.4% of CCDDs met the requirements for effective DMT prescription, mainly located in Northern Italy. They are also characterized by longer opening hours, a higher number of professionals, a university location, and a higher frequency of conducting genetic tests, and could potentially result in prescribing centers. The findings suggest that the Italian national healthcare system may benefit from further enhancements to facilitate the effective prescription of DMTs. This could involve initiatives to reduce fragmentation, ensure adequate resources and equipment, and secure sufficient funding to support this aspect of healthcare delivery.

Social assessment of the population for the transition to Value- based healthcare model

Background: The advanced experience of implementing a value-based model in the practice of Moscow healthcare allowed us to identify a number of the most significant practices of its effectiveness, among which support for making an informed decision by the patient, as well as measuring satisfaction and analyzing the needs of patients were noted. In this regard, the transition of the entire national healthcare system to a value-based model requires the development of approaches to assessing the population’s compliance with such a transformation, taking into account socio-economic, demographic and psychological criteria. Aim: To consider possible predictors of the readiness of a social group of the population older than working age to transition to a value-based model of national health care. Materials and methods: A review of fundamental and modern works in the problem field was carried out. The empirical basis of the work was made up of data from the official website of the Federal Statistics Service with geographic coverage of the entire Russian Federation. Results: Analysis of data from a subjective assessment of the population's health on a national sample of the Russian Federation demonstrates the internal readiness of the population for a value-based healthcare model, despite the negative trends of aging. In the age groups 55-59, 60-64, 65-69, 70-74, 75-79, 80 and older, there is a general trend in assessing their health - the majority of respondents rated it as “satisfactory,” while the number of ratings was “very bad” is minimal. The positive dynamics of the formation of information and technical competence of the population 65+, who are experiencing difficulties in integrating into digital health services, is shown. Conclusion: The transition of national healthcare to a value-based model involves the active involvement of the patient and the formation of patient experience in assessing the outcome of medical care. In this regard, it is necessary to take into account the patient’s personal socio-psychological compliance profile, the elements of which determine the horizons of promising research in the problem field under consideration. As a possible patient profile module, a subjective assessment of health and an assessment of information technology competencies in a social group older than working age, whose work growth is determined by demographic realities, are used.

The Conservative and Operative Treatment of Carpal Fractures.

Carpal fractures (incidence: 30-60 per 100 000 persons per year) are one of the more commonly overlooked fracture types. They can have serious consequences, as the use of the hand is indispensable in everyday life. In the following article, we present the elements of the diagnosis and treatment of fractures of the carpal bones. This review is based on meta-analyses and randomized controlled trials (RCTs) published from 2013 to 2023 that were retrieved by a structured literature search, supplemented by guideline recommendations and expert consensus statements. In addition, data on the administrative prevalence of carpal fractures were obtained from the German Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung, KV) and from the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV). The administrative prevalence of carpal fractures in 2022 was 44 496 outpatient cases (KV, DGUV) in one year. After clinical history-taking, physical examination and x-ray have been performed, thin-slice computed tomography is recommended as part of the diagnostic evaluation. Treatment recommendations are based on evidence of levels II to IV. Multiple RCTs have been carried out on the treatment of scaphoid fractures, and a clinical guideline exists. Proximal, dislocated and unstable scaphoid fractures should be treated surgically. Non-displaced or minimally displaced fractures of the middle third of the scaphoid bone require a shorter period of immobilization with surgical treatment (2-4 weeks) than with conservative treatment (6-8 weeks). The use of plaster casts that do not hinder elbow and thumb mobility yields healing rates similar to those obtained with the immobilization of both of these joints. Failure to treat an unrecognized scaphoid fracture can lead to pseudarthrosis, avascular bony necrosis, and misalignment. Other, rarer types of carpal fractures must be managed on an individual basis, as the available evidence is limited to expert consensus. Early recognition and appropriate treatment of carpal fractures lead to healing in more than 90% of cases. Although the available evidence on their proper treatment is growing, many questions are subject to expert consensus, and decisions about treatment must be made individually.

The transformation of Jordan’s healthcare system in an area of conflict

BackgroundThe Jordanian healthcare system has evolved over the past decades expanding its services, technological, and educational resources. A comprehensive view of this system is lacking. The objective of this report is to describe the structure of the Jordanian healthcare system, the challenges facing it, and the current and recommended health policies.Materials and methodsThis study reviewed the current status of the Jordanian healthcare system. The following parameters were analyzed: health indicators, infrastructure, human resources, insurance system, pharmaceutical expense, health education system, and medical tourism. Data were collected from various relevant official institutions and related published literature.ResultsJordan has a young population with a median age of 23.8 years. Life expectancy is 78.8 years for females and 77.0 years for males. The Jordanian healthcare system is divided into three major categories: (1) Governmental Insurance (i.e., the Ministry of Health (MOH), the Royal Medical Services (RMS) and semi-governmental insurance); (2) Private Insurance; and (3) Refugee Insurance, including the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the United Nations High Commissioner for Refugees (NHUR). The Governmental Insurance covers 64.30% of the total population. Health expenditure is 6.37% of the gross domestic product (GDP). Pharmaceutical expenses make up 26.6% of the total national healthcare budget. Human resource assessment shows a high ratio of medical staff per 10.000 inhabitants, especially concerning physicians (31.7), dentists (7.9), and pharmacists (15.1). However, the ratio of nursing staff per 10.000 inhabitants is considered low (37.5). The Hospital bed/1000 population ratio is also relatively low (1.4). Healthcare accreditation is implemented through the Joint Commission International (JCI) accreditation which was achieved by 7 hospitals and by the National Health Care Accreditation Certificate (HCAC) achieved by 17 hospitals and 42 primary healthcare centers. Postgraduate medical education covers almost all medical and surgical fields. Medical tourism is currently well-established.ConclusionsAssessment of the Jordanian healthcare system shows high ratios of physicians, dentists, and pharmacists but a low ratio of nursing staff per 10.000 inhabitants. The hospital bed/1000 population ratio is also relatively low. Pharmaceutical expenses are significantly high and medical tourism is well-developed.

The impact of Germany’s human papillomavirus immunization program on HPV-related anogenital diseases: a retrospective analysis of claims data from statutory health insurances

PurposeHuman papillomavirus (HPV) is the most common sexually transmitted infection, responsible for multiple HPV-related diseases, including almost all cervical cancers. The highly effective HPV vaccination has been recommended under the German HPV national immunization program (NIP) since 2007 and is reimbursed by health insurances. Vaccination uptake rates, however, remain suboptimal and data on the real-world impact of HPV vaccination in Germany are lacking. This study aims to demonstrate the population-level impact of Germany’s NIP on HPV-related anogenital diseases among young women.MethodsRetrospective claims data analysis using a classic impact study design comparing disease prevalence among 28- to 33-year-old women before and after introduction of the HPV-immunization program in Germany. Claims data representing approximately two thirds of German health insurances were used. HPV-related disease outcomes included cervical cancer and high grade precancers (cervical intraepithelial neoplasia (CIN) 2+), anogenital warts, as well as vulvar, vaginal, and anal precancer/cancer.ResultsSignificant declines were seen for CIN2+, anogenital warts, and vaginal precancer/cancer. Prevalence of CIN2+ declined 51.1% from 0.92% (95% CI = 0.78%, 1.08%) to 0.45% (95% CI = 0.38%, 0.53%). There was a 38.6% decline in anogenital warts prevalence from 0.44% (95% CI = 0.36%, 0.54%) to 0.27% (95% CI = 0.22%, 0.32%) and 75.0% decline in vaginal precancer/cancer prevalence from 0.04% (95% CI = 0.02%, 0.07%) to 0.01% (95% CI = 0.00%, 0.02%).ConclusionThe German HPV-immunization program has led to significant declines in female anogenital disease among young women in Germany, highlighting the importance of the vaccination. Moreover, the data suggest that increasing vaccination coverage in Germany could further strengthen the public-health impact of its HPV-immunization program.