National Population Estimates Research Articles

An Economic Cost Analysis of Implementing a Frailty Care Bundle to Reduce Risk of Hospital Associated Decline Among Older Patients.

To conduct an economic cost analysis and budget impact assessment (BIA) of implementing the Frailty Care Bundle (FCB) intervention nationally over five-years for hip fracture patients. The FCB was designed to reduce hospital associated decline in older hospitalised patients. The FCB was delivered in two Irish hospitals on two wards per hospital. A micro level cost analysis, from the Irish health service perspective was undertaken. Direct costs of the FCB were considered (personnel, training, resources), expressed in Euros (2020). For the BIA national population estimates for hip fracture and costs avoided were based on 18% difference in patients returning to their baseline capability in the post compared to pre-intervention group, valued using cost estimates of functional decline. We estimated total intervention costs at €53,619 (89% for personnel) and the average cost per patient was €156.03. The expected costs of implementing the FCB nationally over 12-months was €57,274 per hospital (€72.92 per patient). The BIA for an expected targeted population (16,000 over 5 years), estimated that the cost of implementing the FCB (€1.2m) was less than the expected value of functional decline avoided owing to the intervention (€3.6m), suggesting a positive net effect (€2.4m). Investment in the FCB can be offset with more rapid patient return to baseline functional capability, reducing health care costs. Trial and Protocol Registration (retrospective): BMC ISRCTN 15145850, (https://doi.org/10.1186/ISRCTN15145850).

Risk of Obstructive Sleep Apnea, Chronic Dizziness, and Sleep Duration.

Although it is recommended that obstructive sleep apnea (OSA) be screened for using a validated self-report questionnaire in patients experiencing dizziness, there is still a lack of research on the relationship between high risk of OSA and chronic dizziness. The study aimed to examine the relationship between the high risk of OSA and chronic dizziness and investigate how this relationship is affected by sleep duration. This cross-sectional study used data from the 8th Korea National Health and Nutrition Examination Survey (2019-2021). Adults aged 40 years or older were included and divided into two groups using the STOP-Bang Questionnaire (SBQ): a high-risk group for OSA or not. Complex samples logistic regression analyses were performed to examine the odds ratios of chronic dizziness based on the national population estimates. Our findings showed that individuals in the high-risk group for OSA were significantly more likely to experience chronic dizziness. Specifically, among subgroups based on sleep duration, the high-risk group for OSA with a short sleep duration of ≤5 hours demonstrated the highest odds of chronic dizziness, showing a significantly 2.48-fold increased likelihood compared to the non-high risk for OSA with a sleep duration of 5-9 hours. The SBQ can be beneficial when other causes do not explain chronic dizziness, helping to rule in the possibility of OSA. Educating individuals suspected of having OSA or who have been diagnosed with OSA about the importance of adequate sleep duration may help reduce the risk of chronic dizziness.

Improving national bird population estimates in Europe: insights from comparisons with atlas abundance data

Summary In Europe, population estimates of breeding birds are produced nationally and are periodically compiled at EU or pan-European scales. Until now, no other source was available to explore the robustness of these estimates. In this study, we compared population sizes reported in the latest edition of the European Red List of Birds (ERLoB) with those produced using data from the second European Breeding Bird Atlas (EBBA2) to assess their consistency and determine parameters behind variability in population estimates that deserve further attention in the future. In general, European population estimates derived from summing local abundance data from EBBA2 were similar to those obtained from ERLoB, although for some species they differed considerably, particularly in those distributed mainly in southern Europe. National population estimates from EBBA2 also did not differ markedly from those in ERLoB. However, we found that EBBA2 provided larger national population sizes than ERLoB for widespread species, suggesting that spatial information is more relevant for properly assessing their population size than for localised species. Our analysis also showed that, in general, population estimates based on robust methodological protocols (e.g. complete counts, statistical inference) contributed to reducing differences between ERLoB and EBBA2 values. Interestingly, EBBA2 and ERLoB estimates were quite similar for species classified in Europe as “Threatened” or “Near Threatened”, whereas the values for “Least Concern” species were consistently different between these two sources. Our results indicate which type of species would benefit from additional efforts to improve national population estimates and their consistency across countries, issues that are of paramount importance for guiding conservation strategies in Europe.

Drug overdose mortality rates by educational attainment and sex for adults aged 25–64 in the United States before and during the COVID-19 pandemic, 2015–2021

IntroductionDramatic increases in U.S. drug overdose deaths involving synthetic opioids, especially fentanyl, beginning around 2014 have driven a marked progression in overall drug overdose deaths in the U.S., which sharply rose to unprecedented levels amid the COVID-19 pandemic. Disparities in drug overdose deaths by educational attainment (EA) during the fentanyl era of the drug overdose epidemic and its intersection with the COVID-19 pandemic have not been widely scrutinized. MethodsUtilizing restricted-use mortality data from the National Vital Statistics System and population estimates from the American Community Survey, we estimated annual national age-adjusted mortality rates (AAMRs) from drug overdoses jointly stratified by EA and sex for adults aged 25–64 from 2015 to 2021. State-level AAMRs in 2015 and 2021 were also estimated to examine the geographic variation in the cumulative evolution of EA-related disparities over the course of the analysis period. ResultsNationally, AAMRs rose fastest among persons with at most a high school-level education, whereas little to no change was observed for bachelor’s degree holders, widening pre-existing disparities. During the analysis period, the difference in national AAMRs between persons with at most a high school-level education and bachelor’s degree holders increased from less than 8-fold (2015) to approximately 13-fold (2021). The national widening of EA-related disparities accelerated amid the COVID-19 pandemic, and they widened in nearly every state. Among non-bachelor’s degree holders, national AAMRs increased markedly faster for males. ConclusionsThe widening disparities in drug overdose deaths by EA are a likely indicator of a rapidly increasing socioeconomic divide in drug overdose mortality more broadly. Policy strategies should address upstream socioeconomic drivers of drug use and overdose, particularly among males.

Comparison of recurrent neural network and long-short term memory technique in predicting mortality rate in Malaysia

The Disease Control Division, Ministry of Health states that mortality data are a crucial tool for examining a community's health. Several studies have been conducted on developing a predictive model to predict the mortality rate but most of them are applying the standard machine learning models. Hence, this study is conducted with its main objective to develop the Recurrent Neural Network (RNN) and Long Short-Term Memory (LSTM) models in predicting the general mortality rate in Malaysia and compare the predicted mortality rates between data with and without post-pandemic statistics. The death rate was investigated using the 2022 Revision of World Population Prospects, the twenty-seventh edition of official United Nations population estimates and projections issued by the Population Division of the United Nations Secretariat's Department of Economic and Social Affairs. A Z-test was employed to investigate if the 2021 and 2022 mortality rates bring any significant difference to the predicted mortality rates. The findings confirm the superiority of the LSTM model in accurately predicting mortality rates compared to RNN with the inclusion of post-pandemic data did not significantly affect the model's predictions. Overall, this study contributes to the understanding of Malaysian mortality rates and provides a foundation for future investigations in this field. The accuracy in predicting the future mortality rates, particularly in pandemic scenarios, remains challenging and requires further research.

Down But Not Out: Vasectomy Is Faring Poorly Almost Everywhere-We Can Do Better To Make It A True Method Option.

Demand for vasectomy-1 of 2 contraceptive methods for men-has been low, with deep-seated myths, misconceptions, and provider bias against it widespread. Programmatic attention and donor funding have been limited and sporadic. We analyzed vasectomy use in 84 low- and middle-income countries (LMICs) plus the 11 high-income countries with vasectomy prevalence above 1%. These 95 countries comprise 90% of the world's population. Data come from United Nations survey compilations, population estimates, and gender inequality rankings. We also reviewed recent articles on vasectomy and analyses of chronic challenges to vasectomy service provision. Vasectomy use is 61% lower now than 2 decades ago. Of 922 million women using contraception worldwide, 17 million rely on vasectomy-27 million fewer than in 2001. In contrast, 219 million women use tubectomy-8 million more than in 2001. Of 84 LMICs, 7 report vasectomy prevalence above 2%. In 56 LMICs, no more than 1 in 1,000 women relies on vasectomy. Female-to-male disparities in permanent method use widened globally, from 5:1 to 13:1, and are much higher in some regions and countries (e.g., 76:1 in India). Countries with the highest vasectomy prevalence are among those with the highest gender equality and vice versa. Vasectomy use is surprisingly low globally and declining. Use remains negligible in almost all LMICs, reflecting low demand and program priority. For vasectomy to become an accessible, rights-based option, program efforts need to be holistic, ensuring an enabling environment while coordinating demand- and service-focused efforts. Vasectomy champions at all levels should be supported on a sustained basis. On the demand side, harnessing mass and social media to increase accurate knowledge and normalize vasectomy as a method and service will be particularly valuable. Evidence from Bolivia suggests relatively few trained providers and procedures could result in a country's attaining 1% vasectomy prevalence.

Estimating the population exposed to a risk factor over a time window: A microsimulation modelling approach from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

Burden of disease estimation commonly requires estimates of the population exposed to a risk factor over a time window (yeart to yeart+n). We present a microsimulation modelling approach for producing such estimates and apply it to calculate the population exposed to long working hours for one country (Italy). We developed a three-model approach: Model 1, a multilevel model, estimates exposure to the risk factor at the first year of the time window (yeart). Model 2, a regression model, estimates transition probabilities between exposure categories during the time window (yeart to yeart+n). Model 3, a microsimulation model, estimates the exposed population over the time window, using the Monte Carlo method. The microsimulation is carried out in three steps: (a) a representative synthetic population is initiated in the first year of the time window using prevalence estimates from Model 1, (b) the exposed population is simulated over the time window using the transition probabilities from Model 2; and (c) the population is censored for deaths during the time window. We estimated the population exposed to long working hours (i.e. 41-48, 49-54 and ≥55 hours/week) over a 10-year time window (2002-11) in Italy. We populated all three models with official data from Labour Force Surveys, United Nations population estimates and World Health Organization life tables. Estimates were produced of populations exposed over the time window, disaggregated by sex and 5-year age group. Our modelling approach for estimating the population exposed to a risk factor over a time window is simple, versatile, and flexible. It however requires longitudinal exposure data and Model 3 (the microsimulation model) is stochastic. The approach can improve accuracy and transparency in exposure and burden of disease estimations. To improve the approach, a logical next step is changing Model 3 to a deterministic microsimulation method, such as modelling of microflows.

A national-level analysis of life expectancy associated with the COVID-19 pandemic in India.

From a demographic perspective, the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on life expectancy is not clear. Hence, there is a need to study the number of years of life lost concerning the existing average life expectancy due to COVID-19 in India. This study aimed to estimate the impact of life expectancy due to the COVID-19 pandemic in India. We considered day-wise age-specific mortality due to COVID-19 which was extracted from the COVID-19 data repository from March 11, 2020, to June 30, 2021, in India. All-cause mortality was collected from the United Nations population estimates. An abridged life table technique was utilized for calculating life expectancies based on all-cause mortality and mortality due to COVID-19. MortPak software was used to calculate the life expectancy with and without the COVID-19 pandemic. Life expectancy at birth in different age groups was estimated with respect to with and without COVID-19. A total of 399,459 deaths due to COVID-19 were distributed age wise, and their corresponding life expectancy was calculated. The general mortality was compared with COVID-19 mortality for the various age groups, and it was observed that mortality due to COVID-19 was significantly higher among the elderly age group [i.e., 45 to 60 years (36%) and > 60 years (51%)] when compared with < 25 years (1%) and 26-44 years (11%) (trend Chi-square 7.59; p = 0.001). The life expectancy without and with COVID-19 was 69.28 years and 69.16 years, respectively. Overall, it was estimated that COVID-19 has an impact on life expectancy by 0.12 years during the study period. Even though mortality due to COVID-19 was high, factors such as lockdown, vaccination, and accidents also had an influence on mortality. Thus, there is a need to assess the impact of COVID-19 on life expectancy in future.

Estimating the quantity of smokeless tobacco consumption among older adults in India

Problem consideredGlobally, smokeless tobacco (SLT) users are highest in India. Whilst, studies examined prevalence and determinants of SLT use, no evidence exists which examined the quantity of SLT consumed. MethodsStudy utilized national representative data from the Longitudinal Aging Study in India (LASI) which adopted a multistage stratified area probability cluster sampling design. First, we computed the average SLT consumption per day (in grams) from the LASI data. Consecutively, we further utilized the projected population approximations from the 26th round of the official United Nations population estimates and prevalence rate of current SLT use from the Global Adult Tobacco Survey (GATS-2) and LASI Survey, separately to estimate SLT use pattern for the entire Indian population aged 45 or above. ResultsThe prevalence of current SLT use among older adults was 17.2% wherein the SLT use is higher among men (20.8%). On average, an older adult consumes 1.01 g of SLT on a daily basis. The range of SLT quantity consumed by users’ according to the LASI and GATS-2 prevalence, varies from 65,000 kg to 85,000 kg per day whereas, annual consumption ranges from 23 million kilograms to 32 million kilograms, respectively. ConclusionThe development of SLT cessation services examining the quantitative aspects of SLT use would be beneficial in tackling the high SLT burden in India and improving the rates of intention to quit.

34857 Trends in dermatology programs and positions from 2016-2020

The number of dermatology programs and positions is not fixed. A previous article published in the Journal of the American Academy of Dermatology (JAAD) looked at trends in dermatology residency and fellowship positions from 2005 to 2016. They reported an increase in the number of dermatology positions, an increase in the number of procedural dermatology, and a decrease in the number of dermatopathology positions. No updated articles have been published since then. This paper is an update of the literature and provides data on dermatology trends from 2016 to 2020. We used the ACGME data on dermatology residency and fellowship for program and position numbers and to calculate the changes. We used the census bureau for national population estimates to make population adjustments. When adjusted for population, there was a 13.4% increase in GME positions, a 17.4% increase in dermatology residency positions, a 12.3% decrease in the dermatopathology fellowship positions, and a 17.4% increase in procedural dermatology fellowship positions. Interestingly, the number of procedural dermatology positions has increased and the number of dermatopathology positions has decreased, which is consistent with the previous trends. The exact reasons for these trends are unknown and more research is warranted. Fortunately, the increase in positions is beneficial because there is a growing need for dermatologists, and research shows this problem is improving and will likely continue to do so if the trends continue in the coming years.

Using linkage to assess coverage of population estimates.

ObjectivesThe Demographic Index (DI) comprises of five linked administrative datasets, used for population estimation. Current linkage methods are not ideal to utilise the power of this asset. Using the 2021 England and Wales Census, we are developing an innovative composite linkage method to fully utilise the power of the DI.&#x0D; ApproachUsing non-greedy deterministic and probabilistic linkage methods, we will link the DI to the Census at a composite level where we believe links exist – i.e., linking a Census cluster (consisting of linked Census and Census Coverage Survey (CCS) records) with a DI cluster (consisting of linked records from the data sources used to make the DI). We will then conduct a pairwise linkage of records from these linked clusters to link individual source records to the Census. We will utilise clerical review to resolve uncertain and conflicting links and to inform the quality of our linkage.&#x0D; ResultsWe anticipate producing a high-quality linkage that will inform how the coverage of the DI compares to Census (through the composite-level linkage) and the quality of the DI itself (through the pairwise-level linkage). We have developed a clerical matching system that can display composite-level linkage, i.e., candidate cluster-pairs. We will tailor our clerical review and quality assessment to records that fall within carefully chosen postcode areas, to ensure all hard-to-count groups and geographical areas are sampled. Working with large datasets is a challenge we are overcoming by using distributed computing and search space reduction.&#x0D; The 2021 Census has been previously linked to the CCS with high accuracy; these records are considered intrinsically linked.&#x0D; ConclusionTo assess national population estimates’ quality and the policy decisions based upon them, we are linking a key composite population-level dataset to the 2021 England and Wales Census. The presentation will showcase the methods we are developing and how we are ensuring the highest quality possible.

OpenSAFELY: Representativeness of electronic health record platform OpenSAFELY-TPP data compared to the population of England

Background: Since its inception in March 2020, data from the OpenSAFELY-TPP electronic health record platform has been used for more than 20 studies relating to the global COVID-19 emergency. OpenSAFELY-TPP data is derived from practices in England using SystmOne software, and has been used for the majority of these studies. We set out to investigate the representativeness of OpenSAFELY-TPP data by comparing it to national population estimates. Methods: With the approval of NHS England, we describe the age, sex, Index of Multiple Deprivation and ethnicity of the OpenSAFELY-TPP population compared to national estimates from the Office for National Statistics. The five leading causes of death occurring between the 1st January 2020 and the 31st December 2020 were also compared to deaths registered in England during the same period. Results: Despite regional variations, TPP is largely representative of the general population of England in terms of IMD (all within 1.1 percentage points), age, sex (within 0.1 percentage points), ethnicity and causes of death. The proportion of the five leading causes of death is broadly similar to those reported by ONS (all within 1 percentage point). Conclusions: Data made available via OpenSAFELY-TPP is broadly representative of the English population. Users of OpenSAFELY must consider the issues of representativeness, generalisability and external validity associated with using TPP data for health research. Although the coverage of TPP practices varies regionally across England, TPP registered patients are generally representative of the English population as a whole in terms of key demographic characteristics.

OpenSAFELY: Representativeness of electronic health record platform OpenSAFELY-TPP data compared to the population of England.

Background: Since its inception in March 2020, data from the OpenSAFELY-TPP electronic health record platform has been used for more than 20 studies relating to the global COVID-19 emergency. OpenSAFELY-TPP data is derived from practices in England using SystmOne software, and has been used for the majority of these studies. We set out to investigate the representativeness of OpenSAFELY-TPP data by comparing it to national population estimates. Methods:With the approval of NHS England, we describe the age, sex, Index of Multiple Deprivation and ethnicity of the OpenSAFELY-TPP population compared to national estimates from the Office for National Statistics. The five leading causes of death occurring between the 1st January 2020 and the 31st December 2020 were also compared to deaths registered in England during the same period. Results: Despite regional variations, TPP is largely representative of the general population of England in terms of IMD (all within 1.1 percentage points), age, sex (within 0.1 percentage points), ethnicity and causes of death. The proportion of the five leading causes of death is broadly similar to those reported by ONS (all within 1 percentage point). Conclusions: Data made available via OpenSAFELY-TPP is broadly representative of the English population. Users of OpenSAFELY must consider the issues of representativeness, generalisability and external validity associated with using TPP data for health research. Although the coverage of TPP practices varies regionally across England, TPP registered patients are generally representative of the English population as a whole in terms of key demographic characteristics.

Population Status, Breeding Biology and Diet of Norwegian Great Cormorants

Two subspecies of the Great Cormorant breed in Norway, the continental Phalacrocorax carbo sinensis in the south, along the Skagerrak coast, and the marine P. c. carbo from central Norway and northwards. Here we review the information existing until 2017 on population status and trends, breeding performance and diet of these two subspecies in Norway. The most recent national population estimates are approximately 2500 (in 2012) and 19,000 (in 2012–2014) breeding pairs of sinensis and carbo, respectively. The sinensis population established itself in 1996 in Rogaland at the south-western tip of Norway, and in 1997 in Østfold close to the Swedish border; in both areas it increased for about ten years. Since then, the numbers have stabilised. For carbo, the population increased from 21,000 pairs in the early 1980s to 27,000 in 1995, and then decreased to the current number of 19,000 pairs. Significant annual variations in clutch size and reproductive output have been observed, but the drivers of these changes have not been identified. Unidentified gadoids and Atlantic Cod Gadus morhua were the most common prey of carbo, whereas inshore species such as Corkwing Wrasse Symphodus melops, Rockcook Centrolabrus exoletus, Goldsinny Wrasse Ctenolabrus rupestris and Black Goby Gobius niger were the most common prey in the eastern Skagerrak caught by sinensis. Carbo took very large numbers of 1–3-year-old gadoids during the year, and we cannot exclude the possibility this can have local effects on fish mortality rates.

PD24-11 NATIONAL TRENDS IN READMISSIONS OF NEUROGENIC BLADDER PATIENTS UNDERGOING URINARY DIVERSION IN THE UNITED STATES 2016-2017: AN ANALYSIS USING THE NATIONAL READMISSIONS DATABASE

You have accessJournal of UrologyCME1 May 2022PD24-11 NATIONAL TRENDS IN READMISSIONS OF NEUROGENIC BLADDER PATIENTS UNDERGOING URINARY DIVERSION IN THE UNITED STATES 2016-2017: AN ANALYSIS USING THE NATIONAL READMISSIONS DATABASE Jazzmyne Montgomery, Tiffany Damm, and M. Francesca Monn Jazzmyne MontgomeryJazzmyne Montgomery More articles by this author , Tiffany DammTiffany Damm More articles by this author , and M. Francesca MonnM. Francesca Monn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002566.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Little is known regarding national numbers of patients undergoing urinary diversion for neurogenic bladder and their readmission rates outside of the Medicare population. We sought herein to evaluate the 90 day readmission rates using a nationally representative database. METHODS: Using 2016-2017 data from the National Readmissions Database (NRD), we identified adult neurogenic bladder patients who underwent hospitalization for urinary diversion without cancer and applied NRD discharge weights to generate national population estimates. Descriptive analysis was performed. A multivariate logistic regression model was used to evaluate odds of readmission controlling for clinically relevant variables. RESULTS: An estimated 296 urinary diversions for neurogenic bladder were performed in adults from 2016-2017 with average (SD) age of 50.4 (15.9). Fifty-seven percent were female. The primary payer was Medicare for 58.4%, Private insurance for 21.1%, and Medicaid or other for 20.5%. Sixty-six percent of patients lived in a county with more than 250,000 population. Ninety percent of cases were performed at teaching hospitals. Paraplegia or quadriplegia was listed as the etiology of neurogenic bladder for 32.5% of patients, spina bifida or cerebral palsy for 19.8% of patients, and unspecified etiology for the remaining. The mean (SD) Charlson Comorbidity Index score was 2.0 (1.9). Pre-admission to the hospital occurred for 46.9%. Cystectomy was performed in 33.5% of cases. Median (IQR) length of hospitalization was 7 (5-11) days. The most common dispositions at discharge were to home or acute rehab (25.9%), to a skilled nursing facility or intermediate care facility (26.1%), or home with home health care (48.0%). Too few mortalities were reported to include. Seventy-six patients were readmitted to the hospital an average (SD) 35.9 (21.7) days after surgery. Adjusting for comorbidities, etiology of neurogenic bladder, and discharge disposition, patients that were preadmitted to the hospital were at 11.0 times increased odds of readmission (p<0.001). Examining the impact of zip code income quartile and payer type, there were no differences in patients requiring readmission. CONCLUSIONS: One quarter of patients undergoing urinary diversion for neurogenic bladder required readmission to the hospital within 90 days of discharge, and nearly half of these are after the traditional 30 day window of readmission. Improved counseling of patients may assist with preventing readmissions. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e419 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jazzmyne Montgomery More articles by this author Tiffany Damm More articles by this author M. Francesca Monn More articles by this author Expand All Advertisement PDF downloadLoading ...

A re-assessment of 4CMenB vaccine effectiveness against serogroup B invasive meningococcal disease in England based on an incidence model

BackgroundThe four-component serogroup B meningococcal 4CMenB vaccine (Bexsero, GSK) has been routinely given to all infants in the United Kingdom at 2, 4 and 12 months of age since September 2015. After 3 years, Public Health England (PHE) reported a 75% [95% confidence interval 64%; 81%] reduction in the incidence of serogroup B invasive meningococcal disease (IMD) in age groups eligible to be fully vaccinated. In contrast, vaccine effectiveness (VE) evaluated in the same immunization program applying the screening method was not statistically significant. We re-analyzed the data using an incidence model.MethodsAggregate data—stratified by age, year and doses received—were provided by PHE: serogroup B IMD case counts for the entire population of England (years 2011–2018) and 4CMenB vaccine uptake in infants. We combined uptake with national population estimates to obtain counts of vaccinated and unvaccinated person-time by age and time. We re-estimated VE comparing incidence rates in vaccinated and non-vaccinated subjects using a Bayesian Poisson model for case counts with person-time data as an offset. The model was adjusted for age, time and number of doses received.ResultsThe incidence model showed that cases decreased until 2013–2014, followed by an increasing trend that continued in the non-vaccinated population during the immunization program. VE in fully vaccinated subjects (three doses) was 80.1% [95% Bayesian credible interval (BCI): 70.3%; 86.7%]. After a single dose, VE was 33.5% [12.4%; 49.7%]95%BCI and after two doses, 78.7% [71.5%; 84.5%]95%BCI. We estimated that vaccination averted 312 cases [252; 368]95%BCI between 2015 and 2018. VE was in line with the previously reported incidence reduction.ConclusionsOur estimates of VE had higher precision than previous estimates based on the screening method, which were statistically not significant, and in line with the 75% incidence reduction previously reported by PHE. When disease incidence is low and vaccine uptake is high, the screening method applied to cases exclusively from the population eligible for vaccination may not be precise enough and may produce misleading point-estimates. Precise and accurate VE estimates are fundamental to inform public health decision making. VE assessment can be enhanced using models that leverage data on subjects not eligible for vaccination.

Trends in the prevalence of microscopically-confirmed schistosomiasis in the South African public health sector, 2011-2018.

BackgroundSchistosomiasis, also known as bilharzia, is a chronic parasitic blood fluke infection acquired through contact with contaminated surface water. The illness may be mild or can cause significant morbidity with potentially serious complications. Children and those living in rural areas with limited access to piped water and services for healthcare are the most commonly infected. To address the prevalence of the disease in parts of South Africa (SA) effective national control measures are planned, but have not yet been implemented. This study aimed to estimate the prevalence and trends of public sector laboratory-confirmed schistosomiasis cases in SA over an eight-year (2011–2018) period, to inform future control measures.Methodology & principal findingsThis is a descriptive analysis of secondary data from the National Health Laboratory Service (NHLS). The study included all records of patients for whom microscopic examination detected Schistosoma species eggs in urine or stool specimens from January 2011 to December 2018. Crude estimates of the prevalence were calculated using national census mid-year provincial population estimates as denominators, and simple linear regression was used to analyse prevalence trends. A test rate ratio was developed to describe variations in testing volumes among different groups and to adjust prevalence estimates for testing variations.A total number of 135 627 schistosomiasis cases was analysed with the highest prevalence observed among males and individuals aged 5–19 years. We describe ongoing endemicity in the Eastern Cape Province, and indicate important differences in the testing between population groups.ConclusionWhile there was no overall change in the prevalence of schistosomiasis during the analysis period, an average of 36 people per 100 000 was infected annually. As such, this represents an opportunity to control the disease and improve quality of life of affected people. Laboratory-based surveillance is a useful method for reporting occurrence and evaluating future intervention programs where resources to implement active surveillance are limited.

338Modelling the population distribution of patient-reported outcomes using electronic health records: a UK study

Abstract Background Patient Reported Outcome Measures (PROM) collected in surveys allow understanding of the health at the population-level. We aimed to test the feasibility of estimating health status as measured by PROMs through ecological prediction models which use local linked survey and primary care electronic health records (EHR) and applying the models to national EHR. Methods 3,710 musculoskeletal consulters registered in 11 general practiced in North Staffordshire, UK and consented the linkage of their survey PROM (high impact pain, (HICP)) with EHR were included in this study. HICP was modelled by EHR predictors covering demographic, lifestyle risk factors, musculoskeletal diagnostic/problems, analgesic prescriptions, comorbidities, and deprivation. Final set of predictors were selected through backward elimination (p &amp;gt; 0.1). Individual-level prediction models (binary logistic regression) were fitted and evaluated in terms of model fit statistics (AIC, BIC, R-square), discrimination (C-statistics) and calibration-slope with internal validation. The final model was cross-mapped to a national UK primary EHR database (Clinical Practice Research Database) to obtain national population estimates of high impact pain. Results The C-statistics and calibration-slope of the final model was 0.77 (95% confidence interval: 0.70-0.79) and 1.00 (0.92-1.08), respectively. The estimated HICP was 51.2% overall among 49,788 UK musculoskeletal consulters and matched hypothesised variation by gender, age, deprivation and geographical regions. Conclusions Estimation of population-level health status as measured by PROM using EHR appears feasible and has potential application in assessing health inequalities. Further independent external validation studies are warranted. Key messages Primary care EHR data could be modelled to predict population-level PROMs.

Changes in medical use of central nervous system stimulants among US adults, 2013 and 2018: a cross-sectional study

ObjectiveTo assess the 5-year changes in the adult medical use of central nervous system (CNS) stimulants with higher risk of dependence and evaluate the population characteristics of users and their...

Science Alone Won’t Do It! South Africa’s Endangered Humpback Dolphins Sousa plumbea Face Complex Conservation Challenges

The Indian Ocean humpback dolphin (Sousa plumbea) is “endangered” with likely less than 500 animals remaining in South African waters. Established in 2016, the SouSA Consortium is a formalised network of scientists and conservationists to combine knowledge and research efforts, and make coordinated decisions with the aim of conserving the species. The first collaborative project collated available photo-identification data in an attempt to refine a national population estimate and investigate movements between research sites. This work was able to identify 250 uniquely marked individuals, with the population divided into the south-coast (Agulhas bioregion) and east-coast (Natal bioregion) populations. Environmental factors almost certainly play a role in the declining numbers of the species in South African waters. However, individual threats and solutions are challenging to identify as the South African marine environment is undergoing significant natural and anthropogenic changes with major shifts in the distribution and numbers of some prey, competitor and predator species. Therefore, we believe that a continued investigation of potential contributing factors and their interaction will take too long, inevitably resulting in another case of documenting extinction. With this in mind, we present the results of a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis in an effort to help us identify the next steps to take toward the conservation of humpback dolphins in South African waters. We unanimously conclude that no single cause for the rapid decline of humpback dolphins in South African waters can be identified, and that the cumulative effects of multiple stressors, which are difficult to pinpoint and mitigate, are impacting population numbers. While highlighting the need for continued research, we suggest a shift toward more action-focused conservation efforts, the first concrete steps being the development of a Conservation Management Plan with input from other stakeholders.