Regional Health Care Research Articles

Co-designing restrictive practice elimination: A systems thinking approach with mental health service users and practitioners in rural/regional Australia.

Elimination of restrictive practices (physical/mechanical restraint and seclusion) from adult acute mental health care services has been demanded internationally for many decades. This study aimed to: (1) Identify priority issues in the elimination of and use of alternative approaches to restrictive practices (seclusion and physical/mechanical restraint) in rural/regional acute adult mental healthcare services, as told by mental healthcare service users and practitioners, (2) identify the community-based, system-level feedback loops that enhance or reduce the use of restrictive practices and viable alternatives and, (3) identify potential action areas to improve system structures to increase regional mental healthcare services' ability to eliminate restrictive practices and use alternative approaches. Group model building (GMB) workshops were held with a small group (n = 9) of mental healthcare practitioners and service users with lived experience of restrictive practice use. This participatory approach enables exploration and visual mapping of local structures causing behaviour patterns of practitioner and service user concern over time - in this case, the barriers, and enablers to alternative approaches to restrictive practices in adult acute mental healthcare services within the Geelong-Barwon region. This is the first study that specifically applies GMB in the discussion of the elimination of restrictive practices in mental health in the non-metropolitan regional/rural context. Participants identified four key priorities in relation to eliminating restrictive practices: (1) self-advocacy, (2) continuity of care, (3) early intervention, and (4) safety for all. The study findings were distilled into a novel preliminary set of mental healthcare practitioner and service user action ideas.

Long-Term Outcomes Associated With β-Lactam Allergies

β-lactam (BL) allergies are the most common drug allergy worldwide, but most are reported in error. BL allergies are also well-established risk factors for adverse drug events and antibiotic-resistant infections during inpatient health care encounters, but the understanding of the long-term outcomes of patients with BL allergies remains limited. To evaluate the long-term clinical outcomes of patients with BL allergies. This longitudinal retrospective cohort study was conducted at a single regional health care system in western Pennsylvania. Electronic health records were analyzed for patients who had an index encounter with a diagnosis of sepsis, pneumonia, or urinary tract infection between 2007 and 2008. Patients were followed-up until death or the end of 2018. Data analysis was performed from January 2022 to January 2024. The presence of any BL class antibiotic in the allergy section of a patient's electronic health record, evaluated at the earliest occurring observed health care encounter. The primary outcome was all-cause mortality, derived from the Social Security Death Index. Secondary outcomes were defined using laboratory and microbiology results and included infection with methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, or vancomycin-resistant Enterococcus (VRE) and severity and occurrence of acute kidney injury (AKI). Generalized estimating equations with a patient-level panel variable and time exposure offset were used to evaluate the odds of occurrence of each outcome between allergy groups. A total of 20 092 patients (mean [SD] age, 62.9 [19.7] years; 12 231 female [60.9%]), of whom 4211 (21.0%) had BL documented allergy and 15 881 (79.0%) did not, met the inclusion criteria. A total of 3513 patients (17.5%) were Black, 15 358 (76.4%) were White, and 1221 (6.0%) were another race. Using generalized estimating equations, documented BL allergies were not significantly associated with the odds of mortality (odds ratio [OR], 1.02; 95% CI, 0.96-1.09). BL allergies were associated with increased odds of MRSA infection (OR, 1.44; 95% CI, 1.36-1.53), VRE infection (OR, 1.18; 95% CI, 1.05-1.32), and the pooled rate of the 3 evaluated antibiotic-resistant infections (OR, 1.33; 95% CI, 1.30-1.36) but were not associated with C difficile infection (OR, 1.04; 95% CI, 0.94-1.16), stage 2 and 3 AKI (OR, 1.02; 95% CI, 0.96-1.10), or stage 3 AKI (OR, 1.06; 95% CI, 0.98-1.14). Documented BL allergies were not associated with the long-term odds of mortality but were associated with antibiotic-resistant infections. Health systems should emphasize accurate allergy documentation and reduce unnecessary BL avoidance.

Regional Comprehensive Care for People with Mental Disorders - An Opportunity for Transparency and Innovative Evaluation

Against the background of the discussion about a comprehensive regional mental health care service, the essay discusses the possibility of a comprehensive, transparent and meaningful evaluation. Proposals for how structures, processes, and outcomes may be assessed are presented. We argue for collecting data that are transparent and actionable on all levels of care organisations. The suggested evaluation would be innovative, meaningful for individual patients, services, health care organisations and whole regions, and thus a way for a data-driven ongoing quality improvement.

Influence of early use of sodium-glucose transport protein 2 inhibitors, glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors on the legacy effect of hyperglycemia.

A phenomenon known as legacy effect was observed that poor glycemic control at early stage of patients with newly-diagnosed type 2 diabetes (T2D) increases the risk of subsequent cardiovascular diseases (CVD). Early use of some novel anti-hyperglycemic agents, such as sodium-glucose transport protein 2 inhibitors (SGLT-2i), may attenuate this effect, but the evidence is limited. Two retrospective cohorts of newly diagnosed T2D patients from 2010-2023 were assembled using the Yinzhou Regional Health Care Database (YRHCD) with different definitions of the early exposure period - the 1-year exposure cohort and 2-year exposure cohort, which were comprised of subjects who had HbA1c measurement data within 1 year and 2 years after their T2D diagnosis, respectively. Using Cox proportional hazards models, we examined the association between high HbA1c level (HbA1c>7%) during the early exposure period and the risk of subsequent CVD. This analysis was performed in the overall cohort and three subpopulations with different treatments during the early exposure period, including patients initiating SGLT-2i or glucagon-like peptide-1 receptor agonists (GLP-1RA), patients using dipeptidyl peptidase-4 inhibitors (DPP-4i), and patients without using SGLT-2i, GLP-1RA, and DPP-4i. Besides, subgroup analyses were performed by stratifying patients into age <55 and ≥55 years. A total of 21,477 and 22,493 patients with newly diagnosed T2D were included in the two final cohorts. Compared with patients with mean HbA1c ≤ 7% during the early exposure period, those with HbA1c>7% had higher risks of incident CVD, with a HR of 1.165 (95%CI, 1.056-1.285) and 1.143 (95%CI, 1.044-1.252) in 1-year and 2-year exposure period cohort. Compared to non-users, in patients initiating SGLT-2i/GLP-1RA within 1 or 2 years after T2D diagnosis, higher HbA1c level at baseline was not associated with CVD in both two cohorts. In subgroup analyses, results were generally consistent with the main analysis. Poor glycemic control in the early stage of T2D increased later CVD risk in Chinese adults with newly diagnosed T2D. Compared to non-users, this association was smaller and non-significant in patients receiving SGLT-2i/GLP-1RA during the early stage of T2D, indicating early use of these drugs may have the potential to mitigate legacy effects of hyperglycemia.

A Web-Based Peer Support Network to Help Care Partners of People With Serious Illness: Co-Design Study.

Care partners of people with serious illness experience significant challenges and unmet needs during the patient's treatment period and after their death. Learning from others with shared experiences can be valuable, but opportunities are not consistently available. This study aims to design and prototype a regional, facilitated, and web-based peer support network to help active and bereaved care partners of persons with serious illness be better prepared to cope with the surprises that arise during serious illness and in bereavement. An 18-member co-design team included active care partners and those in bereavement, people who had experienced serious illness, regional health care and support partners, and clinicians. It was guided by facilitators and peer network subject-matter experts. We conducted design exercises to identify the functions and specifications of a peer support network. Co-design members independently prioritized network specifications, which were incorporated into an early iteration of the web-based network. The team prioritized two functions: (1) connecting care partners to information and (2) facilitating emotional support. The design process generated 24 potential network specifications to support these functions. The highest priorities included providing a supportive and respectful community; connecting people to trusted resources; reducing barriers to asking for help; and providing frequently asked questions and responses. The network platform had to be simple and intuitive, provide technical support for users, protect member privacy, provide publicly available information and a private discussion forum, and be easily accessible. It was feasible to enroll members in the ConnectShareCare web-based network over a 3-month period. A co-design process supported the identification of critical features of a peer support network for care partners of people with serious illnesses in a rural setting, as well as initial testing and use. Further testing is underway to assess the long-term viability and impact of the network.

Treatment organization of disabled veterans with mental illnesses in the post-war years (1945–1950) (based on the materials of the Tambov Psychiatric Hospital)

Importance. Studying the treatment features of participants and disabled veterans of the Great Patriotic War of 1941–1945, who were in regional psychiatric hospitals, allows not only to clarify the levels of medical care for such military veterans, but also to evaluate the results of public health organization in the postwar years through the prism of Soviet psychiatry development in the 20th century, as well as the results of medical care for war veterans. A detailed study of the situation of disabled veterans in psychiatric clinics in the post-war period is very useful, which will clarify many little-studied aspects not only of the history of medicine, but also of the development of interpersonal, group, and regional relations in socialist society.Research Methods. The methodological features of the study of the stated problems are based on the author’s concept of involving the works of contemporaries, primarily specialists in the field of psychiatry, practitioners of the Tambov region, as well as the actual case histories and anamnesis of mental illness. Materials from state and party archives of the Tambov region and memoirs of contemporaries were used, many of which were introduced into scientific circulation for the first time.Results and Discussion. In fact, patients of psychiatric hospitals in the post-war period received almost the entire necessary complex of therapeutic and preventive procedures and rehabilitation measures. At the same time, it must be borne in mind that the post-war devastation, lack of food, clothing, and a number of medicines seriously complicated the capabilities of medical organizations, which often did not have the necessary resources to fully organize the treatment of war veterans suffering from mental illness. In addition, there are often problems with heating, the supply of necessary equipment and supplies for the psychiatric hospital, which left an imprint on practical health care at the regional level. Nevertheless, Tambov psychiatrists used the full range of medical procedures and medicines available to them, both traditional and new, which gave a tangible therapeutic effect. It is important to note that in the post-war years there is a complete rejection of the elements of “punitive” psychiatry due to the cessation of placing patients in isolation, as well as wet wraps. In addition, the use of intensive treatment methods required coordination with the chief physician.Conclusion. The results of the study of the problem made it possible to assess these processes, viewed through the prism of the development of regional health care, to identify trends in the development of Soviet psychiatry in the first post-war decade. The development of an outpatient network for the provision of medical care to war invalids suffering from mental disorders and diseases is clarified. The assessment of the placement of military veterans in labor unions, enterprises and homes for the disabled is given. It is concluded that, in general, regional psychiatry has shown its capacity and effectiveness in terms of treatment and rehabilitation of military invalids who had mental illnesses.

LESSONS LEARNED FROM THE COVID-19 PANDEMIC: AN ANALYSIS OF REGIONAL PHILIPPINE DATA AND COVID-19 OUTCOMES

Abstract. Variations in indicators which may affect COVID-19 outcomes exist among regions in the Philippines. These variations suggest that the impacts of the pandemic differ not only between countries but also within regions and local areas in a country. This study aims to investigate COVID-19 outcomes (case fatality rate or CFR, incidence rate and hospitalization rate) over time and their correlation with regional healthcare and population factors during different phases of the pandemic across the 17 regions of the Philippines. These outcomes were chosen because they are readily available from government data sources, and are simple to work with. We mark five 100-day time periods of the COVID-19 pandemic in the country. The COVID-19 dataset was based on data maintained by the Department of Health (DOH). Spearman’s rank correlation coefficient analysis was used to examine the link between COVID-19 outcomes region-specific indicators referring to population and access to health care resources. Despite their higher vaccination coverage, regions with greater access to health care resources may still be susceptible to future COVID-19 outbreaks due to their urban and densely populated nature. However, vaccines remain effective in reducing COVID-19 hospitalizations in these regions. Therefore,it is crucial to focus on increasing vaccination coverage in rural, underserved regions and implement targeted outbreak control measures in densely populated areas.

Antivenom surveillance: An audit of antivenom stock within South Australia.

Antivenoms are important emergency medications to be held within Australia, particularly in regional and remote locations. We audited current antivenom holdings in hospitals and health services across South Australia (SA) and compared to recommendations in the 'Snakebite and Spiderbite Management Guidelines' from the State's Toxinology service. The process also assessed the feasibility of 'real-time' remote stock monitoring. Fifty-three sites listed in the guideline were recommended to hold antivenom, though only 49 are currently operational. Interrogation of antivenom stock for 29 sites was possible using electronic reports generated from the State Pharmacy database. The 20 remaining centres had their stock levels confirmed by calling the centres directly. Data obtained were then compared to recommended levels of antivenom holdings in the guideline with discrepancies and associated costs documented. A separate report verification process was used to determine 'real-time' accuracy of the electronic reports. Thirty-seven sites (75%) held more than the recommended number of antivenom vials, totalling 129 vials in excess with an approximate total cost of $110 000. Twelve sites (24%) held inadequate stock to deliver a treatment dose for 19 envenoming events. The report verification revealed variances in the electronic reports. This audit has demonstrated a significant disparity between recommended and actual antivenom holdings across most sites in SA and has also revealed that 'real-time' remote monitoring of state antivenom holdings is not currently feasible. Correction of stock levels to that recommended may result in financial benefit for State Health while also addressing inequity in regional and remote healthcare provision.

Interpretable machine learning in predicting drug-induced liver injury among tuberculosis patients: model development and validation study.

The objective of this research was to create and validate an interpretable prediction model for drug-induced liver injury (DILI) during tuberculosis (TB) treatment. A dataset of TB patients from Ningbo City was used to develop models employing the eXtreme Gradient Boosting (XGBoost), random forest (RF), and the least absolute shrinkage and selection operator (LASSO) logistic algorithms. The model's performance was evaluated through various metrics, including the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPR) alongside the decision curve. The Shapley Additive exPlanations (SHAP) method was used to interpret the variable contributions of the superior model. A total of 7,071TB patients were identified from the regional healthcare dataset. The study cohort consisted of individuals with a median age of 47years, 68.0% of whom were male, and 16.3% developed DILI. We utilized part of the high dimensional propensity score (HDPS) method to identify relevant variables and obtained a total of 424 variables. From these, 37 variables were selected for inclusion in a logistic model using LASSO. The dataset was then split into training and validation sets according to a 7:3 ratio. In the validation dataset, the XGBoost model displayed improved overall performance, with an AUROC of 0.89, an AUPR of 0.75, an F1 score of 0.57, and a Brier score of 0.07. Both SHAP analysis and XGBoost model highlighted the contribution of baseline liver-related ailments such as DILI, drug-induced hepatitis (DIH), and fatty liver disease (FLD). Age, alanine transaminase (ALT), and total bilirubin (Tbil) were also linked to DILI status. XGBoost demonstrates improved predictive performance compared to RF and LASSO logistic in this study. Moreover, the introduction of the SHAP method enhances the clinical understanding and potential application of the model. For further research, external validation and more detailed feature integration are necessary.

Factors associated with development of retinopathy in patients with type 2 diabetes mellitus at onset and within three years after diagnosis

Objective To investigate the prevalence of diabetes retinopathy and evaluate the factors influencing its occurrence both at the onset of type 2 diabetes (T2D) and three years into its duration. Design Retrospective population-based study. Setting Data was retrieved from Regional Healthcare Information Platform in Region Halland 2016–2020. Subjects Patients 35-75 years old in Region Halland receiving first-time diabetes diagnosis according to ICD-code E11-14 in 2016–17. The total cohort consisted of 1659 patients. Main outcome measures The main outcome measure of the study was the occurrence of diabetes retinopathy at onset and within three years from the diabetes diagnosis. Multivariate logistic regression analysis was conducted for diabetes retinopathy at onset and within three years, adjusted for age, gender, comorbidities, levels of HbA1c, cholesterol, kidney functional and blood pressure. Results At onset, there were 12% with diabetes retinopathy and after three years, 32% of the patients had developed diabetes retinopathy. In the study cohort, 71 of patients who were examined with fundus photography within three years after onset, and 8% had had dietary recommendation without pharmacotherapy. High HbA1c levels, blood pressure values and impaired renal function already at onset were associated with development of diabetes retinopathy at onset and this association persisted after three years. The odds ratio for diabetes retinopathy was increased adjusted for HbA1c elevations, renal impairment, and increased blood pressure at index and when adjusted for these variables three years from index. Conclusion These findings indicate that the risk of developing diabetes retinopathy is present early on at onset and within the first three years of diabetes diagnosis. This highlights the importance of promptly regulating glucose- and blood-pressure levels and follow up kidney dysfunction to mitigate the risk of diabetes retinopathy.

Incidence and Risk Factors Epilepsy in Patients with Dementia: A Population-Based Study Using Regional Healthcare Databases in Umbria.

Dementia is prevalent among the elderly, also representing a risk for seizures/epilepsy. Estimations of epilepsy risk in dementia patients are not widely available. Our research aims to ascertain the incidence of epilepsy and its associated risk factors in subjects with dementia in the Umbria region, based on data from healthcare databases. In this retrospective study based on the healthcare administrative database of Umbria, we identified all patients diagnosed with dementia from 2013 to 2017, based on ICD-9-CM codes. For epilepsy ascertainment, we used a validated algorithm that required an EEG and the prescription of one or more anti-seizure medications post-dementia diagnosis. A case-control analysis was conducted, matching five non-dementia subjects by gender and age to each dementia patient. Cox proportional hazards models were then utilized in the analysis. We identified 7,314 dementia cases, also including 35,280 age- and sex-matched control subjects. Out of patients with dementia, 148 individuals (2.02%) were diagnosed with epilepsy. We observed a progressive increase in the cumulative incidence of seizures over time, registering 1.45% in the first year following the diagnosis, and rising to 1.96% after three years. Analysis using Cox regression revealed a significant association between the development of epilepsy and dementia (HR = 4.58, 95% CI = 3.67-5.72). Additional risk factors were male gender (HR = 1.35, 95% CI = 1.07-1.69) and a younger age at dementia onset (HR = 1.03, 95% CI=1.02-1.04). Dementia increases epilepsy risk, especially with early onset and male gender. Clinicians should have a low threshold to suspect seizures in dementia cases.

Are Generative Pretrained Transformer 4 Responses to Developmental Dysplasia of the Hip Clinical Scenarios Universal? An International Review.

There is increasing interest in applying artificial intelligence chatbots like generative pretrained transformer 4 (GPT-4) in the medical field. This study aimed to explore the universality of GPT-4 responses to simulated clinical scenarios of developmental dysplasia of the hip (DDH) across diverse global settings. Seventeen international experts with more than 15 years of experience in pediatric orthopaedics were selected for the evaluation panel. Eight simulated DDH clinical scenarios were created, covering 4 key areas: (1) initial evaluation and diagnosis, (2) initial examination and treatment, (3) nursing care and follow-up, and (4) prognosis and rehabilitation planning. Each scenario was completed independently in a new GPT-4 session. Interrater reliability was assessed using Fleiss kappa, and the quality, relevance, and applicability of GPT-4 responses were analyzed using median scores and interquartile ranges. Following scoring, experts met in ZOOM sessions to generate Regional Consensus Assessment Scores, which were intended to represent a consistent regional assessment of the use of the GPT-4 in pediatric orthopaedic care. GPT-4's responses to the 8 clinical DDH scenarios received performance scores ranging from 44.3% to 98.9% of the 88-point maximum. The Fleiss kappa statistic of 0.113 ( P = 0.001) indicated low agreement among experts in their ratings. When assessing the responses' quality, relevance, and applicability, the median scores were 3, with interquartile ranges of 3 to 4, 3 to 4, and 2 to 3, respectively. Significant differences were noted in the prognosis and rehabilitation domain scores ( P < 0.05 for all). Regional consensus scores were 75 for Africa, 74 for Asia, 73 for India, 80 for Europe, and 65 for North America, with the Kruskal-Wallis test highlighting significant disparities between these regions ( P = 0.034). This study demonstrates the promise of GPT-4 in pediatric orthopaedic care, particularly in supporting preliminary DDH assessments and guiding treatment strategies for specialist care. However, effective integration of GPT-4 into clinical practice will require adaptation to specific regional health care contexts, highlighting the importance of a nuanced approach to health technology adaptation. Level IV.

COVID-19 critical care triage across Canada: a narrative synthesis and ethical analysis of early provincial triage protocols.

The COVID-19 pandemic created conditions of scarcity that led many provinces within Canada to develop triage protocols for critical care resources. In this study, we sought to undertake a narrative synthesis and ethical analysis of early provincial pandemic triage protocols. We collected provincial triage protocols through personal correspondence with academic and political stakeholders between June and August 2020. Protocol data were extracted independently by two researchers and compared for accuracy and agreement. We separated data into three categories for comparative content analysis: protocol development, ethical framework, and protocol content. Our ethical analysis was informed by a procedural justice framework. We obtained a total of eight provincial triage protocols. Protocols were similar in content, although age, physiologic scores, and functional status were variably incorporated. Most protocols were developed through a multidisciplinary, expert-driven, consensus process, and many were informed by influenza pandemic guidelines previously developed in Ontario. All protocols employed tiered morality-focused exclusion criteria to determine scarce resource allocation at the level of regional health care systems. None included a public engagement phase, although targeted consultation with public advocacy groups and relevant stakeholders was undertaken in select provinces. Most protocols were not publicly available in 2020. Early provincial COVID-19 triage protocols were developed by dedicated expert committees under challenging circumstances. Nonetheless, few were publicly available, and public consultation was limited. No protocols were ever implemented, including during periods of extreme critical care surge. A national approach to pandemic triage that incorporates additional aspects of procedural justice should be considered in preparation for future pandemics.

Psychosocial interventions for cardiac surgery patients: context of interdisciplinary interaction

IntroductionMulti-staged and personalized in nature, psychosocial interventions for cardiac surgery patients explain the necessity of relying on the potential of interdisciplinary interactionObjectivesTo present the review of the model of interdisciplinary interaction of experts and institutions in the course of psychosocial interventions for cardiac surgery patients, which is currently used in the Chuvash Republic.MethodsThis model involves the experts and institutions of the regional healthcare system, the regional system of social care, the regional and federal system of education, non-governmental medical and health resort institutions, and private practitioners.ResultsIn the center of this model is the Regional Cardiology Center, which interacts with the Psychotherapeutic Center and the Republican Mental Hospital’s Helpline. It also involves the town hospitals and the central district hospitals, non-governmental clinics and private practitioners. The process of rehabilitation and follow-up care continues in the regional health resorts. The social service centers provide additional support. The institute of chief experts of the regional Health Care Ministry, which includes a psychiatrist, cardiologist, psychotherapist, and psychologist, oversees the overall activity. The clinic faculty professors and associate professors are involved in the development of the programs.ConclusionsThe practical results of using the regional model of interdisciplinary interaction enhance the potential of psychosocial interventions for cardiac surgery patients.Disclosure of InterestNone Declared

Портрет регионального министра здравоохранения – 2023.

The heads of regional executive authorities in the sphere of health protection are key figures in the implementation of the health care development strategy of the Russian Federation. The effective management of the healthcare system, as well as the achievement of national goals and target indicators of federal projects, requires highly qualified managerial staff. The annual study of the level of knowledge, skills, work experience and professional skills of regional ministers makes it possible to update information on the human resource potential of the top managers of regional health care systems, assess the changes and timely develop measures aimed at its improvement. The aim of the study was to assess the changes in human resource potential of the heads of regional executive authorities in the sphere of health protection of the Russian Federation in 2021–2023. Materials and methods. A single-stage, continuous sociological study was planned and conducted using a questionnaire developed by the experts of the Institute, which allows to assess changes in such characteristics as: age and gender composition of respondents, the level of higher and additional education, the professional competencies, and length of service in managerial positions. Results. We achieved a response from 86 respondents. It was found that during the last three years, there has been a significant decrease in the rate of rotation of the heads of regional health protection systems with a simultaneous increase in the level of their professional qualifications. The revealed trends are reflected in the growth of the average length of service as a regional minister (2021–2.1+1.9 years, 2022–2.3+2.5 years, 2023–2.9+2.2 years), 3,5 reduction in the number of respondents in the group with a length of service as a regional minister up to one year, an increase in the proportion of managers with professional qualification «Health Care Organization and Public Health». Conclusions. The study allowed to identify the key trends and changes that have occurred over the past three years in terms of the qualitative characteristics of the managerial human resource potential of regional health care systems in the Russian Federation. The heads of regional executive authorities in the sphere of health protection represent the most important resource of the field. Consistent and reliable decrease in the rotation of regional health care system managers is reflected in the growth of their professional skills, knowledge and experience, which allows to achieve the national goals in healthcare set by the President and the Government of the Russian Federation.

Optimizing Healthcare Finance: A Predictive Modeling Approach to Medical Insurance Premium

Abstract: This research delves into optimizing healthcare finance through predictive modeling to forecast medical insurance premiums accurately. By harnessing a robust dataset and integrating advanced analytics, this study meticulously constructs models that allow insurance companies to price their policies competitively, ensuring both profitability and fairness. Employing a variety of machine learning algorithms, including linear regression, decision trees, random forests, and gradient boosting, we thoroughly assess the influence of critical factors such as age, BMI, gender, and regional healthcare costs on premium costs. Our analysis not only showcases the precision of predictive modeling in refining insurance pricing strategies and risk management but also illuminates its broader implications for the healthcare insurance sector. By systematically exploring the factors affecting premiums, identifying the most efficacious modeling techniques, and delineating the potential benefits for insurers and policyholders, this paper significantly contributes to the ongoing discourse on leveraging data-driven approaches to enhance the insurance industry's operational efficiency and promote equitable access to healthcare coverage.

Does preterm birth increase the initiation of antidepressant use during the postpartum? A population-based investigation.

Preterm birth may affect maternal mental health. We explored the relationship between preterm birth and the risk of initiating antidepressant use during the year after birth. We conducted a population-based investigation using regional healthcare utilization databases. The exposure considered was preterm birth. The outcome was having at least one prescription for antidepressant medications during the year after birth. We used a log-binomial regression model including terms for maternal age at birth, nationality, educational level, parity, modality of conception, modality of delivery, use of other psychotropic drugs, and diabetes to estimate relative risk (RR) and 95% confidence intervals (CI) for the association between preterm birth and the initiation of antidepressant use. In addition, the absolute risk differences (ARD) were also computed according to the timing of birth. The cohort included 727,701 deliveries between 2010 and 2020 in Lombardy, Northern Italy. Out of these, 6,522 (0.9%) women had at least one prescription for antidepressant drugs during the year after birth. Preterm births were related to a 38% increased risk of initiation of antidepressant use during the year after birth (adjusted RR = 1.38; 95% CI: 1.25-1.52) for moderate to late preterm and to 83% (adjusted RR = 1.83; 95% CI: 1.46-2.28) for extremely and very preterm. Excluding women with only one antidepressant prescription, the association was consistent (adjusted RR = 1.41, 95%CI: 1.23-1.61 for moderate to late preterm and adjusted RR = 1.81, 95% CI: 1.31-2.49 for extremely and very preterm). Also, excluding women who used other psychotropics, the association remained consistent (adjusted RR = 1.39, 95%CI: 1.26-1.54 and adjusted RR = 1.91, 95% CI: 1.53-2.38, respectively for moderate to late and extremely and very preterm). Women who delivered preterm may have an excess risk of initiation of antidepressant consumption during the first year after birth.

National medical eligibility criteria for contraceptive use 2023: review

Individual sexual and reproductive life management has been сonfirmed by medical and state communities since 1990s. Every citizen officially received rights for access to appropriate goods and services. Such international agreements as 1994 International Conference on Population and Development (ICPD, Cairo, Egypt) and 2004 WHO Reproductive health strategy, estimated reproductive health and family planning as priorities. Worldwide agreement on the 2005 summit declares achieving of female reproductive health before year 2015 as worldwide progress.WHO created complex of international eligibility criteria for male and female contraception with the aim of medical aid improvement. According to WHO plan, those criteria should be used by countries considering policy, needs, priorities and resources of national healthcare programs. For example, USA, United Kingdom, Russia etc. have successfully adopted medical eligibility criteria for contraception on the national level.The present review is summary product created by interdisciplinary expert group including representers of federal and regional healthcare establishments, medical universities, and international medical organizations.

Assessing Futile Trauma Transfers in Rural Appalachia Following a Regional Health Care System Consolidation.

This study sought to define and analyze rates of futile trauma transfers (FTTs) after the consolidation of two rural level 1 trauma centers into one. Data was extracted from the regional trauma registry for a period of 5years (2017-2022) for all trauma patients transferred into our level 1 trauma center (n = 3369). An FTT was defined as a transfer that (1) received no major interventions and (2) died or was discharged to a hospice facility within 72 hours. Out of the 3369 transfer patients analyzed during the 33-month pre-consolidation and 33-month post-consolidation periods, 34 patients met the criteria of an FTT within the transfer-to-discharge window. The pre-consolidation category contained 12, and the post-consolidation category contained 22. Chi-square analysis indicated no significant difference in FTT rate between categories. Furthermore, the post-consolidation FTT rate of 1.1% remained consistent with the estimated national average of 1.5%.

Comparison of the Effect of Cumin Cyminum and Nettle Oral Drops on the Breast Milk Sufficiency Indicators in New Mothers.

This study aimed to compare the effects of green cumin (Cuminum cyminum) and nettle (Urtica dioica L.) oral drops on the indicators of breast milk adequacy in lactating mothers. Due to the presence of phytoestrogens in the combinations of cumin and nettle, it is stipulated that they may have milk-increasing properties. A triple-blind, randomised, controlled clinical trial was conducted on 117 lactating mothers who had given birth to healthy infants aged 10-15 days and who received cumin oral drops (n = 39), nettle oral drops (n = 39) or placebo (n = 39) from August 2020 to March 2021. The participants were recruited from a regional public health care centre affiliated with Iran University of Medical Sciences of Tehran, Tehran, Iran. The 3 study groups received 15 drops thrice a day for 4 weeks. Infant weight, breastfeeding frequency, number of wet diapers, diaper weight and frequency of infant defecation were evaluated before and after the intervention. At the beginning of the trial, no statistically significant differences were observed between the 3 groups for infant weight (P = 0.891), breastfeeding frequency (P = 0.921), number of wet diapers (P = 0.783), diaper weight (P = 0.841) and frequency of infant defecation (P = 0.898). However, following the intervention, the mean scores of all indicators were significantly higher in the experimental groups than in the placebo group (P <0.001). In addition, all the indicators in the cumin group increased significantly compared to those in the nettle group (P <0.001). Considering the effectiveness of cumin and nettle drops in increasing milk and the availability of these native plants in Iran, it is suggested that they, especially cumin, be used postpartum to increase breast milk production.