Population Health Level Research Articles

Analysis of accidental transmission impacts in the chain «waste management system – public health»

The article summarises arguments and counter-arguments within the scientific debate on the generated waste impact on public health. The main goal of the conducted research is analysis of accidental transmission effects in the chain «waste management system – public health». The systematisation of sources and approaches to solving the problem of waste management system for the population health proved that over 900 publications on the researched topic were cited by in the Web of Science database. At the same time, there are the TOP-5 leading countries in which the problem of the generated waste impact on public health is actively studied: the USA (198 publications), India (107 publications), China (103 publications), England (86 publications), Italy (49 publications). The urgency of solving this scientific problem lies in the fact that in the process of urbanisation and constant industry development, the world waste level is increasing. It provokes a negative impact on the population health. In the article, the analysis of accidental transmission effects in the chain «waste management system – public health» is carried out in the following logical sequence: bibliometric analysis of publications on the researched topic; multiple correlation-regression analysis; check of the built model adequacy using the average approximation error. The conducted research tools were: VOSviewer (an application for producing and visualising bibliometric networks) and MS Excel. The study period was 2000-2019 before the COVID-19 pandemic. Dynamic indicators of the waste volume and disposal, number of the first-time registered disease cases in Ukraine were chosen as the study object. These indicators provide an opportunity to describe significance of the waste management system impact on the population morbidity level. The article presents results of the multiple correlation-regression analysis. It confirmed that with an increase in the waste volume by 1%, the number of the first-time registered disease cases will rise by 0.73%. The study empirically confirms the constructed model adequacy regarding influence of the generated and disposed waste volume and the population health level. The research results can be useful for further scientific activity on this topic.

Deep Dive into the Long Haul: Analysis of Symptom Clusters and Risk Factors for Post-Acute Sequelae of COVID-19 to Inform Clinical Care

Long COVID is a chronic condition characterized by symptoms such as fatigue, dyspnea, and cognitive impairment that persist or relapse months after an acute infection with the SARS-CoV-2 virus. Many distinct symptoms have been attributed to Long COVID; however, little is known about the potential clustering of these symptoms and risk factors that may predispose patients to certain clusters. In this study, an electronic survey was sent to patients in the UC San Diego Health (UCSDH) system who tested positive for COVID-19, querying if patients were experiencing symptoms consistent with Long COVID. Based on survey results, along with patient demographics reported in the electronic health record (EHR), linear and logistic regression models were used to examine putative risk factors, and exploratory factor analysis was performed to determine symptom clusters. Among 999 survey respondents, increased odds of Long COVID (n = 421; 42%) and greater Long COVID symptom burden were associated with female sex (OR = 1.73, 99% CI: 1.16-2.58; β = 0.48, 0.22-0.75), COVID-19 hospitalization (OR = 4.51, 2.50-8.43; β = 0.48, 0.17-0.78), and poorer pre-COVID self-rated health (OR = 0.75, 0.57-0.97; β = -0.19, -0.32--0.07). Over one-fifth of Long COVID patients screened positive for depression and/or anxiety, the latter of which was associated with younger age (OR = 0.96, 0.94-0.99). Factor analysis of 16 self-reported symptoms suggested five symptom clusters-gastrointestinal (GI), musculoskeletal (MSK), neurocognitive (NC), airway (AW), and cardiopulmonary (CP), with older age (β = 0.21, 0.11-0.30) and mixed race (β = 0.27, 0.04-0.51) being associated with greater MSK symptom burden. Greater NC symptom burden was associated with increased odds of depression (OR = 5.86, 2.71-13.8) and anxiety (OR = 2.83, 1.36-6.14). These results can inform clinicians in identifying patients at increased risk for Long COVID-related medical issues, particularly neurocognitive symptoms and symptom clusters, as well as informing health systems to manage operational expectations on a population-health level.

CORRELATION OF POPULATION DENSITY AND HEALTH TO URBAN QUALITY OF LIFE IN SUMATRA ISLAND

This research aims to analyze the relationship between population density and health in the quality of life of 22 cities in Sumatra. The data used in this study are secondary and primary. This research is a qualitative descriptive analysis, to analyze the correlation between population density and health on the quality of life within a year (Cross Section) in 2020. The analytical model used in this research is the Klassen Typology model or the scatter plot. The results of this study indicate that several cities fall into different categories in each quadrant with descriptions: quadrant (1) region included in the classification of population density and high health, high quality of life; (2) regions in the second quadrant with low-level population density and health but high-level quality of life; (3) regions with a low level of population density and health and low level in the quality of life classifications; (4) regions that have high population density and health but low in the quality of life. It is recommended that the government set a policy to pay more attention to cities that are included in the quadrant IV category so that the high quality of life in quadrant I can be balanced with a low population density.

CORRELATION OF POPULATION DENSITY AND HEALTH TO URBAN QUALITY OF LIFE IN SUMATRA ISLAND*)

This research aims to analyze the relationship between population density and health in the quality of life of 22 cities in Sumatra. The data used in this study are secondary and primary. This research is a qualitative descriptive analysis, to analyze the correlation between population density and health on the quality of life within a year (Cross Section) in 2020. The analytical model used in this research is the Klassen Typology model or the scatter plot. The results of this study indicate that several cities fall into different categories in each quadrant with descriptions: quadrant (1) region included in the classification of population density and high health, high quality of life; (2) regions in the second quadrant with low-level population density and health but high-level quality of life; (3) regions with a low level of population density and health and low level in the quality of life classifications; (4) regions that have high population density and health but low in the quality of life. It is recommended that the government set a policy to pay more attention to cities that are included in the quadrant IV category so that the high quality of life in quadrant I can be balanced with a low population density.

Factors Related to Compliance of Mothers Consuming Kb Pills in Dameria Midwife Clinic Sembiring Karang Rejo Stabat Year 2021

The increase in population is one of the global problems that arise throughout the world, in addition to global warming, economic downturn, food problems and the declining level of population health. This study aims to determine the factors of maternal adherence to taking birth control pills at the Dameria Br Sembiring Karang Rejo Midwife Clinic in 2021. This type of research is an analytical survey research using a cross sectional design, which is a type of research that emphasizes measurement time or data observation of independent and dependent variables only once. at a certain point in time by measuring or simultaneously observing the risk/exposure factors with effects. The results of the study with the number of respondents as many as 32 people regarding the factors related to maternal adherence to taking birth control pills. The age factor, knowledge and husband's support are related to maternal compliance with taking birth control pills at the Dameria Midwife Clinic Br Sembiring Karang Rejo Stabat in 2021 with a p-value of 0.000 (p-value 0.05), the age factor of work and maternal compliance with taking birth control pills at the Dameria Midwife Clinic Br Sembiring Karang Rejo Stabat in 2021 with a p-value of 0.002 (p-value 0.05), the husband's support factor is a strong factor related to maternal compliance with taking birth control pills at the Dameria Midwife Clinic Br Sembiring Karang Rejo Stabat in 2021. From several factors, namely the husband's support factor, it is strong factors related to maternal adherence to taking birth control pills at the Dameria Clinic Br Sembiring Karang Rejo Stabat in 2021 with a logistic regression p-value It is hoped that the results of this study can be used as additional data for further researchers, especially factors related to adherence.

Educational guidelines for diversity and inclusion: addressing racism and eliminating biases in medical education

Racism and bias contribute to healthcare disparities at a patient and population health level and also contribute to the stagnation or even regression of progress toward equitable representation in the workforce and in healthcare leadership. Medical education and healthcare systems have expended tremendous efforts over the past several years to address these inequities. However, systemic racism continues to impact health outcomes and the future physician workforce. The Association of Professors of Gynecology and Obstetrics called for action to achieve a future free from racism in obstetrics and gynecology education and healthcare. As a result of this call to action, the Diversity, Equity, and Inclusion Guidelines Task Force was created. The mission of the Task Force was to support educators in their efforts to identify and create educational materials that augment antiracist educational goals and prepare, recruit, and retain a talented and diverse workforce. In this Special Report, the authors share these guidelines that describe best practices and set new standards to increase diversity, foster inclusivity, address systemic racism, and eliminate bias in obstetrics and gynecology educational products, materials, and environments.

Social Determinants of Health and Risk of Stillbirth in the United States.

Our aim was to evaluate the impact of social determinants of health (SDoH) risk factors on stillbirth among pregnancy-related hospitalizations in the United States. We conducted a cross-sectional analysis of delivery-related hospital discharges using annualized data (2016-2017) from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. The International Classification of Diseases, 10th Revision ICD-10-CM codes were used to select women with singleton stillbirth. Z-codes were utilized to identify SDoH risk factors and their subtypes. The association between SDoH risk factors and stillbirth was assessed using survey logistic regression models. We analyzed 8,148,646 hospitalizations, out of which 91,140 were related to stillbirth hospitalizations, yielding a stillbirth incidence of 1.1%. An increased incidence was observed for non-Hispanic (NH) Blacks (1.7%) when compared with NH Whites (1.0%). The incidence of stillbirth was greater in hospitalizations associated with SDoH risk factors compared with those without risk factors [2.0% vs. 1.1% (p <0.001)]. Among patients with SDoH risk factors, the rate of stillbirth was highest in those designated as NH other (3.0%). Mothers that presented with SDoH risk factors had a 60% greater risk of stillbirth compared with those without (odds ratio [OR] = 1.61 [95% confidence interval (CI) = 1.33-1.95], p < 0.001). The SDoH issues that showed the most significant risk for stillbirth were: occupational risk (OR = 7.05 [95% CI: 3.54-9.58], p < 0.001), upbringing (OR = 1.87 [95% CI: 1.23-2.82], p < 0.001), and primary support group and family (OR = 5.45 [95% 3.84-7.76], p < 0.001). We found pregnancies bearing SDoH risk factors to be associated with a 60% elevated risk for stillbirth. Future studies should target a variety of risk reduction strategies aimed at modifiable SDoH risk factors that can be widely implemented at both the population health level as well as in the direct clinical setting. · Health disparities exist in stillbirth rates, especially among NH Black women.. · Social determinants of health risk factors increase the risk of stillbirth.. · There is a need for further study on the impact of specific SDoH risk factors on stillbirth risk..

Virtual Care and the Inverse Care Law: Implications for Policy, Practice, Research, Public and Patients.

Virtual care spread rapidly at the outbreak of the COVID-19 pandemic. Restricting in-person contact contributed to reducing the spread of infection and saved lives. However, the benefits of virtual care were not evenly distributed within and across social groups, and existing inequalities became exacerbated for those unable to fully access to, or benefit from virtual services. This “perspective” paper discusses the extent to which challenges in virtual care access and use in the context of COVID-19 follow the Inverse Care Law. The latter stipulates that the availability and quality of health care is inversely proportionate to the level of population health needs. We highlight the inequalities affecting some disadvantaged populations’ access to, and use of public and private virtual care, and contrast this with a utopian vision of technology as the “solution to everything”. In public and universal health systems, the Inverse Care Law may manifests itself in access issues, capacity, and/or lack of perceived benefit to use digital technologies, as well as in data poverty. For commercial “Direct-To-Consumer” services, all of the above may be encouraged via a consumerist (i.e., profit-oriented) approach, limited and episodic services, or the use of low direct cost platforms. With virtual care rapidly growing, we set out ways forward for policy, practice, and research to ensure virtual care benefits for everyone, which include: (1) pay more attention to “capabilities” supporting access and use of virtual care; (2) consider digital technologies as a basic human right that should be automatically taken into account, not only in health policies, but also in social policies; (3) take more seriously the impact of the digital economy on equity, notably through a greater state involvement in co-constructing “public health value” through innovation; and (4) reconsider the dominant digital innovation research paradigm to better recognize the contexts, factors, and conditions that influence access to and use of virtual care by different groups.

Spatial–Temporal Characteristics and Driving Factors of the Coupling Coordination between Population Health and Economic Development in China

Promoting the coordinated development of population health and the economy is an important part of building a “Healthy China” and promoting high-quality economic development. Based on the systematic construction of the population health and economic development evaluation index system, this paper uses the coupled coordination model, geodetector, and geographically weighted regression (GWR) to comprehensively measure the population health level and economic development level at the provincial scale in China in 2000 and 2015, and reveals the spatial and temporal evolution characteristics of the coupled coordination relationship between the population health level and economic development level at the provincial scale in China from 2000 to 2015 and its driving factors. The results show the following: (1) China’s population health and economic development are in a high-level coupling stage, and the coupling level increases slightly with time; spatially, two types of running-in coupling and high-level coupling coexist; the coupling degree in the eastern and central regions tends to increase, while the coupling degree in the western region tends to weaken. (2) China’s population health and economic development are in a good coupling coordination stage as a whole, and the coupling coordination degree has an increasing trend; spatially, the coupling coordination degree shows high spatial differentiation characteristics in the east and low in the west; the good and high-quality coupling coordination type area tends to expand to the west, while the moderate coupling coordination type area tends to shrink to the west; there is also positive spatial agglomeration of coupling coordination degree, and the spatial agglomeration is gradually enhanced. (3) The coupling coordination of China’s population health and economic development is driven by multiple factors such as natural conditions, health resources, culture quality, and urbanization level; the interaction between factors is stronger than that of a single factor, and the driving effect of each factor also shows significant spatial heterogeneity. This study is intended to provide a scientific basis for promoting harmonious population health and economic development.

Perspective: Novel Approaches to Evaluate Dietary Quality: Combining Methods to Enhance Measurement for Dietary Surveillance and Interventions

Refining existing dietary assessment methods to reduce measurement error and facilitate the routine evaluation of dietary quality is essential to inform health policy. Notable advancements in technology in the past decade have enhanced the precision and transformation of dietary assessment methods with applications toward both population health and precision nutrition. Within population health, innovative applications of big data including use of automatically collected food purchasing data, quantitative measurement of food environments, and novel, yet simplified dietary quality metrics provide important complementary data to traditional self-report methods. Precision nutrition is similarly advancing with greater use of validated biomarkers for assessing dietary patterns and understanding individual variability in metabolism. Concurrently enhancing our understanding of diet-disease relations at the population health and precision nutrition levels provides tremendous potential to generate evidence needed to advance public health nutrition policy. This commentary highlights the importance of these advances toward progressing the field of dietary assessment and discusses the application of food purchasing data, data analytics, alternative dietary quality metrics, and -omics technology in population and clinical medicine.

Informatics tools to implement late cardiovascular risk prediction modeling for population health management of high-risk childhood cancer survivors.

10048 Background: Marked improvements in outcomes for children with cancer and robust cohort studies with longitudinal follow-up inform evidence-based guidelines for survivors at risk for late cardiomyopathy. Clinical informatics tools to integrate data from multiple sources have the potential to catalyze population health management. Methods: The Oklahoma Childhood Cancer Survivor cohort was constructed from an institutional cancer registry of survivors diagnosed between 2005 and 2014 (n=382). Data elements (cumulative anthracycline, cumulative chest-directed radiotherapy, alkylator, and platinum exposures) were extracted from Passport for Care (PFC) to implement previously validated late cardiovascular risk prediction modeling from the Childhood Cancer Survivor Study (CCSS) for cardiomyopathy. Risk groups were compared to the Children’s Oncology Group (COG) Long-Term Follow-up Guidelines. Standard query language facilitated extraction of echocardiogram data from the electronic health record to determine adherence, defined as an echocardiogram within 27 months and 63 months from the last day of therapy for high and moderate risk survivors, respectively. Results: Sixty-nine percent (n=264) of survivors from the cancer registry were documented in PFC, of whom 29%, 56%, and 15% were classified as low, moderate, high risk, respectively, based on the CCSS late cardiomyopathy risk calculator. Concordance was modest for high and moderate risk groups (Kappa = 0.42 and 0.46, respectively) and good for the low risk group (Kappa = 0.77) compared to COG risk groups. There was excellent adherence to echocardiogram guidelines with 93% and 81% of moderate and high-risk survivors, respectively. There were significant differences based on risk group (p=0.02) and age at diagnosis (p&lt;0.01). Conclusions: Clinical informatics tools represent a feasible approach to leverage discrete data elements regarding key treatment exposures from PFC to successfully implement previously validated late cardiovascular risk prediction models on a population health level. PFC promotes adherence to echocardiogram surveillance and serves as a platform for future interoperability to generate real-world data to improve survivorship-focused care. [Table: see text]

919-P: Trends in Glycemic Control during the COVID-Pandemic in a Large Academic Health Care System

The Emory Diabetes Management Program is a chronic care management model aimed to reduce the proportion (%) of adult patients with HbA1c &amp;gt;9% within the Emory Healthcare System. We report the proportion of patients with poor glycemic control (HbA1c &amp;gt;9% or missing values for 6 months) before and during the Covid-pandemic, from 02/01/18 to 10/30/2021.Among 27,061 patients with diabetes before COVID-pandemic, the % of patients with poor glycemic control decreased from 19.5% to 14.35% in 12/2019. During the COVID-pandemic, the % of patients with poor control rapidly increase to 21.70% (Fig 1A) by 2/1/21, primarily due to a 275% increased of patients with missing HbA1c testing and a minor increase in % of patients with HbA1c &amp;gt;9% (Fig 1B) . Expansion of telemedicine programs, access to care and resource implementation to identify and facilitate HbA1c testing reduced the % of patients with poor control to pre-pandemic levels. Conclusion: At a population-health level, COVID-pandemic had a significant negative impact in % of patients with poor control primarily due to HbA1c testing (3-fold increase) rather than worsening A1c values. Innovative solutions to increase access to A1C testing in future pandemics may help to maintain undisrupted glucose monitoring and control in individuals with diabetes in large academic health systems. Disclosure G.E.Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. A.Adiga: None. B.Wylde: None. M.Gurtu: None. R.J.Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. T.Thompson: None. C.M.Masi: None. P.A.Castellano: None. F.E.Turton: None.

0722 Evaluation of Healthcare Insurance Claims Record based Artificial Intelligence Screening Tools for Undiagnosed Sleep Apnea

Abstract Introduction Healthcare insurance claims data contain an unrecognized wealth of structured data that can be leveraged to investigate epidemiologic and economic relationships in health and disease. We studied the feasibility for machine learning algorithms to improve upon screening for obstructive and central sleep apnea (SA) at the population health level using existing health insurance claims data. Methods A logistic regression model was trained to predict the presence or absence of SA from an aggregated healthcare insurance claims dataset. The dataset was composed of medical and pharmacy claims between the years 2016 and 2020 from the Wisconsin All-Payor claims database which included coverage of &amp;gt;4,000,000 patients, &amp;gt;10,000 ICD codes, and &amp;gt;$50 billion in medical spending. A total of 1,870,000 patients and 39,712 unique federal drug identification codes were included within 91.5 million pharmacy claims in the dataset. Input features were constructed by counting the total number of claims for each unique drug in each subject resulting in a patient-level feature vector of 39,712 drug frequencies. The positive SA population was defined by individuals who had both at least one medical claim for sleep apnea diagnosis (ICD codes G4733/G4731) and an appropriate sleep test (CPT codes 9580*/9581*). The logistic regression model was evaluated using randomized 10-fold cross-validation and performance reported using ROC-AUC statistics and top-10 feature importance analysis. Results The logistic regression model detecting SA based solely on observed medication frequencies produced a ROC-AUC of 0.77. In a feature importance analysis, three of the Top-10 most discriminative features were medications for the treatment of diabetes, hypertension, and hyperlipidemia. We hypothesize this drug-frequency based model functions by exploiting the strong correlation of SA with specific clusters of known co-morbid conditions and corresponding medication regimens. Conclusion We demonstrate health insurance claims records contain predictive information that can aid in more systematic screening of undiagnosed conditions like SA. Furthermore, in a statistical analysis of feature importance, we observed medications indicative of comorbidities with known association to SA. These findings are useful to clinicians and payers in identifying undiagnosed SA populations, including those responsible for value-based payment models. Support (If Any)

Race/Ethnicity and Duration of Anesthesia for Pediatric Patients in the US: a Retrospective Cohort Study.

Previous literature has demonstrated adverse patient outcomes associated with racial/ethnic disparities in health services. Because patients/parents and providers care about the duration of anesthesia, this study focuses on this outcome. To determine the association between race/ethnicity and duration under anesthesia. In this retrospective cohort study of data from the Multicenter Perioperative Outcomes Group, White non-Latino was the reference and was compared with Black non-Latino children, Latino, Asian, Native American, Other, and "Unknown" race children. Children aged 3 to 17years. Induction duration (primary outcome), procedure-end duration, and total duration under anesthesia (secondary outcomes). Of 37,596 eligible cases, 9,610 cases with complete data were analyzed. The sample consisted of 6,894 White non-Latino patients, 1,021 Black non-Latino patients, 50 Latino patients, 287 Asian patients, 26 Native American patients, 57 "Other" race patients, and 1,275 patients of "Unknown" race. The mean induction time was 11.9min (SD 5.6min). In adjusted analysis, Black non-Latino patients had 5% longer induction and procedure-end durations than White non-Latino children (exponentiated beta coefficient [Exp (β)] 1.05, 95% CI: 1.02-1.08, p < 0.01 and Exp (β) 1.08, 95% CI 1.04-1.13, p < 0.01 respectively). White non-Latino children had shorter induction and procedure-end durations than Black children. The differences in induction and procedure-end time were small but may be meaningful on a population-health level.

Adverse pathological outcomes of patients with de novo muscle invasive bladder cancer in Northern Ontario.

This study aimed to investigate the clinical and pathological characteristics of patients with de novo muscle-invasive bladder cancer (MIBC) who underwent radical cystectomy in Northern Ontario. This is a retrospective cross-sectional study of patients with de novo T2 MIBC who underwent radical cystectomy over a 2-year-period in Thunder Bay Regional Health Sciences Centre. Clinical and pathological characteristics of Trans Urethral Resection of Bladder Tumors and cystectomy specimens were analyzed. Of the 59 patients aged 67 ± 8.8 years, predominated by males (80%), 27.1% were younger than age 60. After surgery, upstaging was noted in 59.3% (T3 in 27.1% and T4 in 32.2%) while node positive was noted in 36% of patients. Prostate adenocarcinoma was incidentally discovered in 20 (34%) of patients with 50% considered significant (Gleason score ≥ 7). Downstaging was found in those who had neoadjuvant chemotherapy (p = 0.001). The high prevalence of younger ages (less than 60), a high rate of upstaging, the presence of high-grade incidental prostate cancer, and lymph node positives in T2 de novo MIBC in Northern Ontario, warrants further investigation of potential causes and risk factors at individual, public, and population health levels in the region.

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In conditions of circular economy production and consumption procedures are implemented in a closed cycle, which enables to minimize the used resources and ensure zero waste industry. The introduced mechanisms are of high economic, social and environmental significance, since unlike the traditional linear economy, the wastes are turned into production resources in case of closed-loop economy. Thus, it is more efficient to apply the mechanisms of circular economy in the agricultural sector, as they promote the increase of food security level and protection of population health.

Соціальна безпека – запорука сталого розвитку національної економіки

The relevance of the article. Economic developments of the society is the top state priority in economy and guarantee of economic potential strengthening. The economic crisis caused by Covid-19 has revealed a number of social problems in Ukrainian society that prevent economic and social transformation and Ukraine integration into the international financial space. Purpose setting is in the studying deformations in the social sphere and assessment of the state of system threats to economic security of the country. Presentation of the main material. Threatening character of deformations in the Ukraine social sphere requires introduction of social indicators monitoring which have influence on the state of economic security. It is proved that social and demographic component of economic security characterizes the possibility of the state to guarantee adequate and qualitative standard of living for population, favorable conditions of human capital development and level of labor resources provision that provide its sustainable growing. It is found out that among social problems in the society, and then the threat to economic security is worsening population health level, reduction in life expectancy, availability of high-quality treatment, high death rate, and decrease of employable population. It is defined that the poverty is caused by deficient labor legislature and social vulnerability, and labor migration threats social security. According to different resources from three to five million Ukrainian citizens live outside the country. Assessing of a statistic reveals that population employment doesn’t protect families from poverty, and 93,5% of poor people are individual homes with a single employable person and this shows low wages. It was established that there is a great difference in payments for work in Ukraine and European countries for the current year. Conclusions. Economic growing and reforming of national economy is necessary for Ukraine for encouraging people to stay in the country and invest in their future in Ukraine. With implementation of comprehensive economic reforms Ukraine has the chance to create favorable conditions for economic strengthening and social development which can improve people expectations for their living in Ukraine in comparison with potential countries for employment. Key words: social security, wages, labor migration, poverty.

Risk stratification for COVID-19 hospitalization: a multivariable model based on gradient-boosting decision trees.

Background:The COVID-19 pandemic has led to an increased demand for health care resources and, in some cases, shortage of medical equipment and staff. Our objective was to develop and validate a multivariable model to predict risk of hospitalization for patients infected with SARS-CoV-2.Methods:We used routinely collected health records in a patient cohort to develop and validate our prediction model. This cohort included adult patients (age ≥ 18 yr) from Ontario, Canada, who tested positive for SARS-CoV-2 ribonucleic acid by polymerase chain reaction between Feb. 2 and Oct. 5, 2020, and were followed up through Nov. 5, 2020. Patients living in long-term care facilities were excluded, as they were all assumed to be at high risk of hospitalization for COVID-19. Risk of hospitalization within 30 days of diagnosis of SARS-CoV-2 infection was estimated via gradient-boosting decision trees, and variable importance examined via Shapley values. We built a gradient-boosting model using the Extreme Gradient Boosting (XGBoost) algorithm and compared its performance against 4 empirical rules commonly used for risk stratifications based on age and number of comorbidities.Results:The cohort included 36 323 patients with 2583 hospitalizations (7.1%). Hospitalized patients had a higher median age (64 yr v. 43 yr), were more likely to be male (56.3% v. 47.3%) and had a higher median number of comorbidities (3, interquartile range [IQR] 2–6 v. 1, IQR 0–3) than nonhospitalized patients. Patients were split into development (n = 29 058, 80.0%) and held-out validation (n = 7265, 20.0%) cohorts. The gradient-boosting model achieved high discrimination (development cohort: area under the receiver operating characteristic curve across the 5 folds of 0.852; validation cohort: 0.8475) and strong calibration (slope = 1.01, intercept = −0.01). The patients who scored at the top 10% captured 47.4% of hospitalizations, and those who scored at the top 30% captured 80.6%.Interpretation:We developed and validated an accurate risk stratification model using routinely collected health administrative data. We envision that modelling such risk stratification based on routinely collected health data could support management of COVID-19 on a population health level.

Measuring the Burden of Disease in Korea, 2008-2018.

The study aims to examine the current status and differences in the burden of disease in Korea during 2008-2018. We calculated the burden of disease for Koreans from 2008 to 2018 using an incidence-based approach. Disability adjusted life years (DALYs) were expressed in units per 100 000 population by adding years of life lost (YLLs) and years lived with disability (YLDs). DALY calculation results were presented by gender, age group, disease, region, and income level. To explore differences in DALYs by region and income level, we used administrative district and insurance premium information from the National Health Insurance Service claims data. The burden of disease among Koreans showed an increasing trend from 2008 to 2018. By 2017, the burden of disease among men was higher than that among women. Diabetes mellitus, low back pain, and chronic lower respiratory disease were ranked high in the burden of disease; the sum of DALY rates for these diseases accounted for 18.4% of the total burden of disease among Koreans in 2018. The top leading causes associated with a high burden of disease differed slightly according to gender, age group, and income level. In this study, we measured the health status of Koreans and differences in the population health level according to gender, age group, region, and income level. This data can be used as an indicator of health equity, and the results derived from this study can be used to guide community-centered (or customized) health promotion policies and projects, and for setting national health policy goals.

Clinical pharmacy definition, required education, training and practice in Saudi Arabia: A position statement by the Saudi society of clinical pharmacy

The Saudi Society of Clinical Pharmacy (SSCP) is a scientific and professional society in the field of clinical pharmacy that operates under the Saudi Commission for Health Specialties governance. The SSCP believes that there is a need to define and describe many aspects related to the clinical pharmacy profession in Saudi Arabia. Moreover, there is an increasing demand for promoting the concept of clinical pharmacy and developing a consensus regarding the scope of practice and clinical pharmacist's required postgraduate education and training in Saudi Arabia. This paper is intended to present several position statements by the SSCP that define the concept of clinical pharmacy, describe the required education and training, and highlight clinical pharmacists' scope of practice in Saudi Arabia. This paper calls for further investigations that examine the impact of clinical pharmacists on individual and population health levels.