Terms Of Health Outcomes Research Articles

How are social stressors at work related to well-being and health? A systematic review and meta-analysis

BackgroundSocial relationships are crucial for well-being and health, and considerable research has established social stressors as a risk for well-being and health. However, researchers have used many different constructs, and it is unclear if these are actually different or reflect a single overarching construct. Distinct patterns of associations with health/well-being would indicate separate constructs, similar patterns would indicate a common core construct, and remaining differences could be attributed to situational characteristics such as frequency or intensity. The current meta-analysis therefore investigated to what extent different social stressors show distinct (versus similar) patterns of associations with well-being and health.MethodsWe meta-analysed 557 studies and investigated correlations between social stressors and outcomes in terms of health and well-being (e.g. burnout), attitudes (e.g. job satisfaction), and behaviour (e.g. counterproductive work behaviour). Moderator analyses were performed to determine if there were differences in associations depending on the nature of the stressor, the outcome, or both. To be included, studies had to be published in peer-reviewed journals in English or German; participants had to be employed at least 50% of a full-time equivalent (FTE).ResultsThe overall relation between social stressors and health/well-being was of medium size (r = −.30, p < .001). Type of social stressor and outcome category acted as moderators, with moderating effects being larger for outcomes than for stressors. The strongest effects emerged for job satisfaction, burnout, commitment, and counterproductive work behaviour. Type of stressor yielded a significant moderation, but differences in effect sizes for different stressors were rather small overall. Rather small effects were obtained for physical violence and sexual mistreatment, which is likely due to a restricted range because of rare occurrence and/or underreporting of such intense stressors.ConclusionsWe propose integrating diverse social stressor constructs under the term “relational devaluation” and considering situational factors such as intensity or frequency to account for the remaining variance. Practical implications underscore the importance for supervisors to recognize relational devaluation in its many different forms and to avoid or minimize it as far as possible in order to prevent negative health-related outcomes for employees.

Longitudinal Health Care for Girls and Women With Turner Syndrome

Background Turner Syndrome (TS) is the most common chromosomal abnormality seen in females and is often diagnosed in childhood. The transition of patients with TS from pediatric to adult providers is characterized by inconsistency. As such, limited data are available to assess long term health outcomes of women with TS. Objectives: 1) To evaluate the long term health outcomes in women with TS followed at a single academic institution and 2) to establish clinical recommendations for evaluation, counseling, and planned transition of this population. Methods: A retrospective pilot study was performed by examining medical records of women with TS who presented with short stature or delayed puberty and were diagnosed with TS on the basis of cytogenetic analysis. Patients with monosomy X, mosaic monosomy X, or X chromosome structural abnormalities consistent with TS or mosaic TS diagnosis were included. Medical records from an academic children’s hospital and an affiliated women’s hospital were reviewed. Results: To date, 15 females aged 26-32 years were identified. Electronic records were available for 12/15 with age at diagnosis ranging from in utero to 15 years of age. Those with pediatric information available had documentation addressing use of growth hormone and pubertal hormone replacement therapies. Of the 12 patients, 11 had cardiac imaging performed; only one had an MRI. Consistent planned transition to adult health care providers was not evident. Of the 12 patients, 3 had consultation with a Reproductive Endocrinology and Infertility specialist; 3 had a diagnosis of anxiety or depression; 3 had a DEXA scan done (1 had osteopenia); 5 had dyslipidemia; and 2 developed insulin resistance. Conclusions: This pilot study confirms heterogeneity in practice patterns and variable interactions of women with TS with the healthcare system, especially as patients enter adulthood. Although some women were referred to subspecialists, our initial data uncover patient uncertainty about healthcare and transition recommendations. Our preliminary data indicate the need for early patient education in a collaborative, multi-disciplinary fashion. We plan to validate and extend our initial findings by reviewing additional medical records. Ultimately, we plan for expanded education, consistent surveillance recommendations, and planned transition of patients with TS from pediatrics to adult caregivers.

Student mood and responses to standing desks in the college classroom

&#x0D; &#x0D; &#x0D; Physical activity enhances physical health, reduces disease, and resists metabolic syndrome and obesity, while sitting for extended periods of time has a negative effect on long term health outcomes. Thus, reducing sitting time has been identified as a health-enhancing goal. The purpose of this study was to explore perceptions and responses of college students to sitting versus standing in class. Five standing desks were placed in a classroom of traditional sitting desks. In a counterbalanced, within subjects design, 88 undergraduate students (age M=21.64, SD=6.55 years) participated in the study. Some participating students first stood at a desk for three consecutive class meetings and then sat for three classes while others sat for three consecutive classes and then stood for three. Surveys were administered at the beginning and end of each class and at the end of six consecutive class sessions. Results indicated that mood was signifi- cantly higher on standing than sitting days, the majority of participants had a favorable perception of the standing-in-class experience, and would use standing stations if the option was available. This study is one of few to examine the viability and response to adding standing desks in college classrooms, and indicates standing desks may be perceived favorably and could be utilized to reduce sitting time.&#x0D; &#x0D; &#x0D;

Abstract No. 63 Comparative cost effectiveness of varicose vein treatment: a meta-analysis

Varicose veins are a common problem in the United States, affecting anywhere between 10% to 30% of adults. Traditionally, varicose vein therapy consisted of high ligation and surgical stripping (HL/S). Surgical correction of an incompetent great saphenous vein reduces reported pain and increases physical functioning.3However, more recent treatment modalities have emerged rivaling HL/S in terms of health outcomes and cost-effectiveness. These therapies include endovenous laser ablation, ultrasound-guided foam sclerotherapy, and radiofrequency ablation.There remains a lack of evidence demonstrating differences in efficacy or cost-effectiveness of these therapies in comparison to HL/S.

Impact of Pharmacists' Interventions and Patients' Decision on Health Outcomes in Terms of Medication Adherence and Quality Use of Medicines among Patients Attending Community Pharmacies: A Systematic Review.

Community pharmacists are responsible for providing the appropriate information on the use of medications to patients, which may enhance their medication adherence. The extent of control that patients have on their health care preferences creates many challenges for community pharmacists. This study aimed to determine the impact of pharmacist interventions and patient decisions on health outcomes concerning medication adherence and the quality use of medicines among patients attending community pharmacies. Appropriate studies were identified in a systematic search using the databases of Medline, Scopus, Google Scholar, and PubMed. The search included literature published between 2004 and 2019. The database searches yielded 683 titles, of which 19 studies were included after the full-text analysis with a total of 9313 participants. Metaprop command in Stata software version 14 was used for the analysis. This study was undertaken based on the general principles of the Cochrane Handbook for Systematic Reviews of Interventions and subsequently reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA) extension. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was directly used to rate the quality of evidence (high, moderate, low, or very low). The results revealed the effective interaction between patients and community pharmacists, the importance of pharmacist intervention on medication adherence and quality use of medicine, and the role of community pharmacists in counselling patients. Decision/choice of patients in self-care and self-medication is a factor contributing to health outcomes. Effective interaction of community pharmacists with patients in terms of medication adherence and quality use of medicines provided a better health outcome among patients. The community pharmacists influenced the decision/choice of patients in self-care and self-medications.

Telehealth and the digital divide as a social determinant of health during the COVID-19 pandemic.

Telehealth has been shown to have comparable health outcomes in terms of patient-physician communication, and patient satisfaction and engagement. Nevertheless, the digital divide has exacerbated the social and economic factors that create barriers to health and well-being. It, therefore, maybe a social determinant of health (SDOH). Such issues as decreased internet connectivity and a lack of Wi-Fi and video chat/webcam in both urban and rural areas can hinder the effectiveness of telehealth to its full capability, especially among communities of color, the poor, and medically underserved. The social aspects of the provision of health care by physicians and health care workers are utilized to combat mistrust and strengthen the physician–patient therapeutic relationship. Addressing policy changes to address the digital divide as a SDOH may strengthen existing health care and public health systems to allow for patient and community-centered approaches to expressing lived narratives, including in a digital format.

6 Burn Patient Insurance Status Influences Hospital Discharge Disposition Locations

Abstract Introduction Post-discharge services, such as outpatient wound care, may affect long term health outcomes and post-recovery quality of life. Access to these services may vary according to insurance status and ability to withstand out-of-pocket expenses. Our objective was to compare discharge location between burn patients who were uninsured, publicly insured, or privately insured at the time of their burn unit admissions. We hypothesized that uninsured patients were more likely to be discharged to locations with fewer wound care resources. Methods A retrospective review from July 1, 2015 to November 1, 2019 was performed at an ABA-verified burn center. All inpatient burn admission patients were identified and categorized according to insurance payer type. Patient and burn characteristics were recorded. The primary outcome was discharge location, and secondary outcomes included readmission and outpatient burn care attendance. Results In total, 284 uninsured, 565 publicly insured and 293 privately insured patients were identified. There were no significant differences in TBSA (P=0.3), presence of full thickness burn (P=0.3), inhalation injury (P=0.3), ICU days (P=0.09), ventilator days (P=0.2), or need for grafting (P=0.1). Uninsured patients were found to be younger (P&amp;lt; 0.0001) and more likely to be male (P=0.03). For primary outcome, uninsured patients were more likely to be discharged without ancillary services (self-care) (80.3% vs. 66.7% vs. 66.9%, P&amp;lt; 0.0001). Publicly insured patients were more likely to receive skilled nursing care (1.1% vs. 6.6% vs. 2.4%, P=0.0007). Privately insured patients were more likely to receive homecare (3.2% vs. 5.8% vs. 10.9%, P=0.0005) or transfer to other institutions for ongoing inpatient care (2.5% vs. 5.1% vs. 11.6%, P&amp;lt; 0.0001). For secondary outcomes, there was no difference in burn unit readmission (P=0.5) while uninsured were more likely to follow up in the same institution’s outpatient burn clinic after discharge (82.4% vs. 72.0% vs. 75.4%, P=0.004). Conclusions Despite no differences in burn injury severity, uninsured patients were less likely to receive post-discharge resources. However, these patients were younger, which may partially explain their disproportionate discharge to self-care. Nevertheless, insured patients have greater access to non-emergent medical resources and a broader range of treatment options. Although there were no significant differences in hospital readmission, the long-term implication to differential post-discharge care is unknown. Additional studies are needed to better elucidate if discrepancies in long-term wound healing or perceived quality of life amongst these populations exist.

Feasibility and accuracy of ED frailty identification in older trauma patients: a prospective multi-centre study

BackgroundThe burden of frailty on older people is identifiable by its adverse effect on mortality, morbidity and long term functional and health outcomes. In patients suffering from a traumatic injury there is increasing evidence that it is frailty rather than age that impacts greatest on these outcomes and that early identification can guide frailty specific care. The aim of this study was to evaluate the feasibility of nurse-led assessment of frailty in older trauma patients in the ED in patients admitted to major trauma centres.MethodsPatients age 65 years and over attending the Emergency Departments (ED) of five Major Trauma Centres following traumatic injury were enrolled between June 2019 and March 2020. Patients were assessed for frailty whilst in the ED using three different screening tools (Clinical Frailty Scale [CFS], Program of Research to Integrate Services for the Maintenance of Autonomy 7 [PRIMSA7], and the Trauma Specific Frailty Index [TSFI]) to compare feasibility and accuracy. Accuracy was determined by agreement with geriatrician assessment of frailty. The primary outcome was identification of frailty in the ED using three different assessment tools.ResultsWe included 372 patients whose median age was 80, 53.8% of whom were female. The most common mechanism of injury was fall from less than 2 m followed by falls greater than 2 m. Completion rates for the tools were variable, 31.9% for TSFI, compared to 93% with PRISMA7 and 98.9% with the CFS. There was substantial agreement when using CFS between nurse defined frailty and geriatrician defined frailty. Agreement was moderate using PRISMA7 and slight using TSFI.ConclusionsThis prospective study has demonstrated that screening for frailty in older major trauma patients within the Emergency Department is feasible and accurate using CFS.Trial registrationISRCTN, ISRCTN10671514. Registered 22 October 2019

Effectiveness of Nurse Led Intervention Regarding Management of Hypertension on Awareness, Treatment Compliance, Life Style and Quality of Life among Hypertensive Adults: A Systematic Review

Introduction: Hypertension is one of the most common conditions affecting the health worldwide and isalso the leading cause of death around the globe. There is a persistent need for effective nurse led interventionfor interrupting the further spreading roots of the hypertension in the community. There is also a great needfor creating awareness, ensuring the compliance with the treatment, modification of lifestyle and improvingthe quality of life for the sufferers of this condition.Methods: The study design was systematic review and it includes studies from databases of PUBMED,MEDLINE, Cochrane library, SCOPUS, Science direct, and Google scholar (2008-2019). The includedstudies were focusing on the management of hypertension among hypertensive adults in terms of awareness,treatment compliance, life style and quality of life.Result: The data was grouped and analyzed in terms of meta-analysis. Total 20 relevant articles wereundertaken. Abstracted information is related to study design, population characteristics, intervention andoutcomes.Conclusion: The nurse led intervention in the management of hypertension is an effective strategy inimproving the health outcomes in terms of creating awareness, ensuring the compliance with the treatment,modification of life style and improving the quality of life among hypertensive adults.

Abstract P198: Daily Step Count at Two Months is the Strongest Predictor of Daily Steps at One Year Post-Stroke

For survivors of stroke, walking can improve endurance, community participation and decrease risk of subsequent stroke. Unfortunately, survivors take 4000 fewer steps per day compared to other adults. Early identification of survivors prone to long-term inactivity would be valuable, as interventions could be implemented to improve physical activity (PA) levels and reduce subsequent stroke risk. Secondary data from the Locomotor Experience Applied Post Stroke (LEAPS) trial was used. Included participants had walking speeds of &lt;0.80 m/s at 2 months post-stroke. Daily steps were assessed at 2 months and 1 year post-stroke using an activity monitor. Stepwise regression was used to predict daily step counts at 1 year based on modifiable (walking speed, endurance, balance, balance confidence, daily step counts) and nonmodifiable (age at time of stroke, gender, race, ethnicity, initial stroke severity, side of stroke and LEAPS intervention group) factors. Data was available for 206 survivors, mean age=63 (13) years, 43% female (88/206), mean walking speed=.41 (.22) m/s, mean step count=2922 (2749) steps per day. The strongest predictor of daily steps at 1 year was daily steps at 2 months (p=&lt;0.001, adjusted R 2 =.34). For every 1-step increase at 2 months, there was an increase of .54 (95% CI .38, .71) steps at 1 year. The next strongest predictor was walking endurance (Six Minute Walk), which significantly increased adjusted R 2 by .02 (p=.009). For every 1-meter increase in Six Minute Walk distance at 2 months, there was an increase of 8 (95% CI 2, 14) steps at 1 year. Together, baseline steps and Six Minute Walk distance explained 36% of the variance in daily steps at 1 year. No other factors significantly added to the prediction model. Daily steps at 2 months post-stroke was the strongest predictor (explaining 34% of the variance) of steps at 1 year. Survivors with low daily steps early after stroke may benefit from targeted walking interventions to increase PA and long term health outcomes.

Explaining regional variations in mother-child health: Additional identified determinants in India and Bangladesh

This paper explores the sources of spatial variation in child wasting and maternal anemia in three Indian states and six Bangladeshi divisions. Our initial probability models incorporate traditionally-cited variables from Demographic and Health Surveys such as mother’s education, mother’s age and household wealth, along with seasonal fluctuations and regional fixed effects. The regional fixed effects are highly significant, even after controlling for the traditionally-cited determinants. We then re-estimate our models, replacing regional fixed effects with measures of four factors that exhibit spatial clustering in the study area: provision of health services, political instability, religious culture, and flood-proneness. Our re-estimated models show highly significant effects for all four factors, thereby highlighting potential gains from more effective policy interventions at the regional level. Mothers and children whose socioeconomic status is identical have much better health outcomes in areas where health services are relatively plentiful, political stability prevails, key protein sources are more plentiful, and water is abundant. Our results also demonstrate a strong association of mother’s health status post-partum with long term health outcomes for children.

Characterisation of Textile Embedded Electrodes for Use in a Neonatal Smart Mattress Electrocardiography System.

Heart rate monitoring is the predominant quantitative health indicator of a newborn in the delivery room. A rapid and accurate heart rate measurement is vital during the first minutes after birth. Clinical recommendations suggest that electrocardiogram (ECG) monitoring should be widely adopted in the neonatal intensive care unit to reduce infant mortality and improve long term health outcomes in births that require intervention. Novel non-contact electrocardiogram sensors can reduce the time from birth to heart rate reading as well as providing unobtrusive and continuous monitoring during intervention. In this work we report the design and development of a solution to provide high resolution, real time electrocardiogram data to the clinicians within the delivery room using non-contact electric potential sensors embedded in a neonatal intensive care unit mattress. A real-time high-resolution electrocardiogram acquisition solution based on a low power embedded system was developed and textile embedded electrodes were fabricated and characterised. Proof of concept tests were carried out on simulated and human cardiac signals, producing electrocardiograms suitable for the calculation of heart rate having an accuracy within ±1 beat per minute using a test ECG signal, ECG recordings from a human volunteer with a correlation coefficient of ~ 87% proved accurate beat to beat morphology reproduction of the waveform without morphological alterations and a time from application to heart rate display below 6 s. This provides evidence that flexible non-contact textile-based electrodes can be embedded in wearable devices for assisting births through heart rate monitoring and serves as a proof of concept for a complete neonate electrocardiogram monitoring system.

Community Garden Initiatives Addressing Health and Well-Being Outcomes: A Systematic Review of Infodemiology Aspects, Outcomes, and Target Populations.

Previous research has suggested that activities such as community gardens could offer a wide range of health benefits. The aim of the article is to systematically review the available literature to analyse the magnitude of the phenomenon, the geographical distribution, and the main characteristics in terms of health outcomes and target populations. The search addresses the question whether the activity in community gardens improves health and well-being outcomes of individuals. From the total amount of 7226, 84 selected articles showed that:(1) up to 50% are published by U.S. universities or institutions; (2) up to 44% of the studies considered “community gardens” as the main activity of the research focus; (3) one-third of the studies included adults; (4) almost 25% of the studies used “general health” as the main outcome when investigating the benefits of community gardens; (5) the percentage of studies that achieved their outcomes was heterogeneous among the different health dimensions. In conclusion, while a certain degree of heterogeneity in the used definition and outcome still exist, community gardens may be a viable strategy for well-being promotion in terms of psychological, social, and physical health and may be considered as an innovative urban strategy to promote urban public health.

Factors Affecting Mental Health Outcomes of Healthcare Workers During Coronavirus Disease (COVID-19) Pandemic at Cardinal Santos Medical Center

Background: The outbreak of the novel Coronavirus Disease (COVID-19) was declared a pandemic by the World Health Organization on March 2020. Studies show that healthcare workers from previous pandemics (A/H1N1 influenza; severe acute respiratory syndrome, SARS), have experienced high levels of stress, anxiety and low mood with negative psychological impacts sustained after one year. This paper aims to identify factors affecting mental health outcomes of healthcare workers during Coronavirus Disease (COVID-19) pandemic at Cardinal Santos Medical Center. Methods: This is a cross-sectional study of factors affecting mental health outcome of healthcare workers with direct contact to a patient with confirmed or suspected case Coronavirus Disease (COVID-19) at Cardinal Santos Medical Center from March 2020 to September 2020. The severity of mental health outcome in terms of depression, anxiety and distress were measured using the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, and the 22-item Impact of Event Scale–Revised, respectively. Binomial multiple logistic regression model was used to identify the factors associated with mental health outcome. Results: A total of 172 healthcare workers were included in this study. Prevalence of depression, anxiety and distress symptoms among all healthcare workers were 57%, 47.7%, 65.1%, respectively. After multivariate analysis, age and living with a family with comorbidities are significantly associated with depression and anxiety. Healthcare workers aged 31 years and above are 70% less likely to have depression symptoms (OR 0.278, CI 95%, 0.11-0.72 p=0.008 and OR 0.273, CI 95%, 0.12-0.61, p=0.002). Those living with relatives with comorbidities are 2.7 times more likely to experience depression symptoms (OR 2.731, CI 95%, 1.36-5.5, p=0.005). Healthcare workers age 31-40 years has 80% less likely to experience anxiety symptoms (OR 0.212, CI 95%, 0.09-0.5, p<0.001), and those age 41 and above have 73% less likely to have anxiety symptoms (OR 0.37, CI 95%, 0.14-0.98, p<0.045). Those living with relatives with comorbidities are 2.9 times more likely to have anxiety symptoms (OR 2.889, CI 95%, 1.46-5.73, p=0.002). Level of knowledge on COVID-19 among health care workers significantly differs across severity but has no significant association with prevalence of depression. No factors were associated with distress symptom. Conclusion: Emotional strain by health care workers during pandemic can cause adverse outcomes not only for individual wellbeing, but also for patient care and the healthcare system. Cognizant of high rates of depression, anxiety and distress among our younger health care workers living with relatives with comorbidities during this time will be a challenge to both hospital management and the government to establish and/or improve existing programs to promote mental wellbeing and address their mental health needs. These programs should be readily available and accessible to healthcare workers seeking psychological support. Psychological stress can accumulate over time and have an impact later in the outbreak, including posttraumatic stress disorder (PTSD), which should be investigated in future studies. Funding Statement: No Funding. Declaration of Interests: No conflict of interest. Ethics Approval Statement: The clinical protocol was reviewed and approved by the Research Ethics Review Committee (RERC) of Cardinal Santos Medical Center. The researchers ensured that all information gathered were kept strictly confidential and used solely for the purpose of the study. An informed consent was given is attached together with the questionnaire.

Longitudinal impacts of grandparent caregiving on cognitive, mental, and physical health in China

Objectives Although studies have documented the effects of grandparenting, little is known about grandparents’ long-term health outcomes in terms of optimal engagement with grandchildren, and whether age, gender, or location make a difference. This study explores the longitudinal impacts of grandparenting on health, with considerations for subgroup differences. Methods Using three waves of China Health and Retirement Longitudinal Study, we used propensity score analysis combined with multilevel analysis to examine the longitudinal effect of grandparenting (no, low-, moderate-, and high-intensity) on health (self-rated health, mobility limitations, depressive symptoms, and cognition) among 4,925 grandparents with at least one grandchild, and how impact varies by age, gender, and urban/rural areas. Results A nonlinear relationship between grandparenting and health was observed. Compared to those not providing care, grandparents who provided care at a low-to-moderate level were more likely to have fewer mobility limitations and depressive symptoms and better cognition. High intensity had no positive impacts on health. The effects of grandparenting on health operated differently across subgroups. Older grandparents showed better physical, mental, and cognitive health compared to their younger counterparts. Both genders had fewer mobility limitations if they provided care at a low-to-moderate level, although females reported better self-rated health. Rural grandparents reported better physical health; whereas urban grandparents reported better cognition. Conclusion Grandparenting could improve health in later life; however, there are complex interactions at play. Policies aimed at supporting grandparenting should consider optimal hours of care relevant to age, gender, and urban/rural contexts.

The lower COVID-19 related mortality and incidence rates in Eastern European countries are associated with delayed start of community circulation.

The purpose of this analysis was to assess the variations in COVID-19 related mortality in relation to the time differences in the commencement of virus circulation and containment measures in the European Region. The data for the current analysis (N = 50 countries) were retrieved from the John Hopkins University dataset on the 7th of May 2020, with countries as study units. A piecewise regression analysis was conducted with mortality and cumulative incidence rates introduced as dependent variables and time interval (days from the 22nd of January to the date when 100 first cases were reported) as the main predictor. The country average life expectancy at birth and outpatient contacts per person per year were statistically adjusted for in the regression model. Mortality and incidence were strongly and inversely intercorrelated with days from January 22, respectively -0.83 (p<0.001) and -0.73 (p<0.001). Adjusting for average life expectancy and outpatients contacts per person per year, between days 33 to 50 from the 22nd of the January, the average mortality rate decreased by 30.1/million per day (95% CI: 22.7, 37.6, p<0.001). During interval 51 to 73 days, the change in mortality was no longer statistically significant but still showed a decreasing trend. A similar relationship with time interval was found for incidence. Life expectancy and outpatients contacts per person per year were not associated with mortality rate. Countries in Europe that had the earliest COVID-19 circulation suffered the worst consequences in terms of health outcomes, specifically mortality. The drastic social isolation measures, quickly undertaken in response to those initial outbreaks appear effective, especially in Eastern European countries, where community circulation started after March 11th. The study demonstrates that efforts to delay the early spread of the virus may have saved an average 30 deaths daily per one million inhabitants.

Abstract 15477: Association With Post Discharge Adherence to Guideline Directed Medical Therapy and Long Term Health Outcome

Introduction: Statin, beta-blocker and Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers have been advocated by guideline as secondary prevention medications to improve long term outcome post myocardial infarction for years. However, in reality, adherence to these medications have always been challenging and different treatment regimen adherence might lead to divergent outcomes which remains unclear in current AMI standard care. Hypothesis: To investigate the association between different guideline-directed medication regimen adherence post myocardial infarction and long-term outcomes. Methods: This cohort study used data files from Taiwan National Health Insurance Research Database (NHIRD). A total of 77520 survivors of hospitalization with AMI between 2002 and 2015 were assessed. Base on adherence to individual medications, eight treatment groups were estimated in this study. We investigate the association of adherence to different treatment groups and all-cause mortality in 24 months. Results: 51322 STEMI patients and 26198 NSTEMI patients were included in the study. All treatment groups had significant higher mortality compare with patients who adhered to all 3 medications in 24 months follow-up. Patients not adherence to any medications had the highest mortality in 24 months (adjusted HR: 1.78; 95% CI: 1.64 to 1.93). Conclusions: In this large population base real-world data study, we found that adherence to all 3 secondary prevention medications in post myocardial infarction survivor was associated lower rate of all cause mortality.

Factors affecting in-hospital cost and mortality of patients with stroke: Evidence from a case study in a tertiary hospital in China.

The study aims to investigate the factors causing the difference of stroke patients' in-hospital cost and study these factors on health outcome in terms of mortality. Eight hundred and sixty-two in-patients with stroke in a tertiary hospital in China from 2017 to 2019 were included in the database. Descriptive statistics indexes were used to describe patients' in-hospital cost and mortality. Based on Elixhauser coding algorithms, multiple linear regression and logistic regressions (LRs) were used to evaluate the impact of factors identified from univariate analysis on in-hospital cost and mortality, respectively. In addition to LRs, a comparison study was then carried out with random forest, gradient boosting decision tree and artificial neural network. Factors affecting both cost and mortality are age, discharged day-of-week, length of stay, stroke subtype, other neurological disorders, renal failure, fluid and electrolyte disorders and total number of comorbidities. With the increase of age, the mortality rate of in-patients (except for the juvenile) with stroke increases and the cost of hospitalization decreases. Intracerebral haemorrhage is the most devastating stroke for its highest mortality in short length of stay. Medical services should focus on these specific comorbidities.

A comparison of eating disorder symptomatology, psychological distress and psychosocial function between early, typical and later onset anorexia nervosa

ObjectiveEpidemiological studies suggest that the incidence of anorexia nervosa (AN) is increasing in younger populations, with some evidence that clinical differences occur according to age of onset (AOO), which may impact prognostic outcomes. The current study sought to compare eating disorder (ED) symptomatology, psychological distress and psychosocial function between early onset (EO), typical onset (TO) and later onset (LO) AN in a large sample of treatment-seeking patients with a diagnosis of AN.MethodsParticipants included 249 individuals with a diagnosis of AN who were assessed at an outpatient ED service. The sample was divided into three groups based on AOO; those with an AOO ≤14 years (N = 58) were termed ‘EO-AN’, those with an AOO between 15 and 18 years (N = 113) were termed ‘TO-AN’ and those with an AOO of > 18 years (N = 78) were termed ‘LO-AN’. Comparisons were made between AOO groups on assessments of ED symptomatology, psychological distress and psychosocial function.ResultsEO-AN patients reported a significantly longer illness duration than both TO-AN and LO-AN groups. After controlling for effect of illness duration, the EO-AN group demonstrated significantly higher ED symptomatology and dysmorphic concern compared to the LO-AN group. The EO-AN group demonstrated significantly decreased cognitive flexibility compared to both the TO-AN and LO-AN groups.DiscussionThese findings suggest that clinical differences do occur according to AOO in AN whereby EO-AN may represent a more severe form of illness that is not attributable to increased illness duration. Treatment strategies which specifically address patients with EO-AN may improve long term health outcomes and recovery.

Evaluating Progress towards Universal Health Coverage in Ukraine

The healthcare system of Ukraine is characterized by low ratings, not only in terms of health outcomes, but also in terms of access to services, where one of the main obstacles is the financial problem, equity and justice, as well as the lack of implementation of measures aimed at positively stimulating the health potential of the population countries. The latest political revolution in Ukraine (2014) once again opened up the possibility of implementing a project of deep modernization of the Ukrainian state. However, at this time, we can witness the birth of an entirely new system of healthcare in Ukraine formed “from scratch”: with new priorities as well as completely new approaches and management principles. The transformation of the health care system began to develop gradually, with a focus on primary health care. Significant progress has been made over the past few years towards a human-centered model for the provision of health services. The process to build the National Health Service has started, which should fundamentally change the funding system by focusing not on beds (as was the case before) but on the principle “money follows the patient,” thereby planning to gradually transfer to insurance medicine.