Representative Database Research Articles

Food, housing, and transportation insecurities among cancer survivors with concomitant caregiving roles.

476 Background: Cancer survivors (CSs) encounter significant challenges related to housing insecurity, food insecurity, and transportation, which are critical Social Determinants of Health (SDoH). As CSs’ life expectancy continues to rise, they start or resume caregiving roles, i.e., becoming dual-role CSs. Our prior study has shown that dual-role CSs experience a lower well-being status compared to their counterparts. However, it remains unknown whether the dual-role CS population faces additional social barriers. Methods: Adult CSs were obtained from the nationally representative cross-sectional database - the Health Information National Trends Survey (HINTS) 6 (March to November 2022). SDoH includes food insecurity, housing insecurities and transportation barriers. Self-reported comfort level when patients sharing their social barriers with health care providers was assessed. Chi-square tests were used to compare the weighted prevalence and logistic regression models were used to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI) comparing dual-role vs non-caregiver CSs. All calculations were weighted using SAS 9.4, with a significant level of p < 0.05. Results: Among the 18,386,583 weighted CSs, 20.5% of them were dual-role CSs. Dual-role CSs reported higher rates of food insecurity, housing insecurity, transportation barriers, or at least one of these challenges, compared to non-caregiver peers (p < 0.05). After controlling for confounders (Table), dual-role CSs were 7.5, 6.0, 4.8 and 6.9 times more likely to report food, housing, transportation, and any of the above barriers than their non-caregiver peers, respectively. However, there was no significant difference in their comfort level in sharing these social challenges with healthcare providers after adjusting for confounders. Conclusions: Our findings shed light on the profound social challenges faced by dual-role cancer survivors. The fact that nearly half of these individuals report experiencing at least one barrier underscores the significant unmet social needs within this population. Our results strongly advocate for proactive measures, including active initiation and comprehensive assessments of social needs, to effectively support dual-role cancer survivors.[Table: see text]

Telehealth use among cancer survivors.

493 Background: Telehealth use has risen steeply since the COVID-19 pandemic, alongside acceptability among patients and providers. Patients with cancer have reported positive experiences with telemedicine, although concerns of inequity in technology access and digital literacy remain. As cancer survivors (CS) are an older population, it is unknown if CS are less likely to utilize telehealth compared to the general population (GP). Methods: Adult participants were extracted from the nationally representative database Health Information National Trends Survey 6 (3/2022-11/2022). Chi-square tests compared the prevalence of telehealth use in the last 12 months, and logistic regression was used to calculate adjusted odds ratio (aOR) and 95% CI comparing CS vs the GP. We further explored reasons for telehealth visits and perceptions related to telehealth. All calculations were weighted using SAS 9.4. Significance level was set at 2-sided p < 0.05. Results: A total of weighted 239,557,883 individuals were extracted, with 7.7% CS. Adjusting for confounders, the use of telehealth was significantly higher in CS than the GP (Table). Among those who used telehealth, CS were more likely to have telehealth recommended/required by healthcare providers (HCP) and less likely to attribute their use of telehealth to infection concerns or privacy than their non-cancer peers. No difference was observed regarding using telehealth for convenience, including friends/families, technical difficulties, or equivalence with in-person visits between CS vs the GP. Conclusions: CS used telehealth in the last year significantly more than the GP even when controlling for age. Telehealth was more likely to be recommended or required by their HCP, which may be a driver behind increased usage in CS. Digital literacy may not be a barrier to telehealth use in CS, as they did not experience more difficulties in their telehealth visits. Over half of CS did not use telehealth, however, and research is needed to characterize predictors of telehealth use in CS.[Table: see text]

Cost and utilization of healthcare services for persons with diabetes

AimsDescribe and compare healthcare costs and utilization for insured persons with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes in the United States. MethodsUsing a nationally representative healthcare claims database, we identified matched persons with T1D, T2D, and without diabetes using a propensity score quasi-randomization technique. In each year between 2009 and 2018, we report costs (total and out-of-pocket) and utilization for all healthcare services and those specific to medications, diabetes-related supplies, visits to providers, hospitalizations, and emergency department visits. ResultsIn 2018, we found out-of-pocket costs and total costs were highest for persons with T1D (out-of-pocket: $2,037.2, total: $25,652.0), followed by T2D (out-of-pocket: $1,543.3, total: $22,408.1), and without diabetes (out-of-pocket: $1,122.7, total: $14,220.6). From 2009 to 2018, out-of-pocket costs were increasing for persons with T1D(+6.5 %) but decreasing for T2D (−7.5 %) and without diabetes (−2.3 %). Medication costs made up the largest proportion of out-of-pocket costs regardless of diabetes status (T1D: 51.4 %, T2D: 55.4 %,without diabetes: 51.1 %). ConclusionsGiven the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (i.e., wide-ranging problems stemming from healthcare costs). In addition, policies that aim to lower out-of-pocket costs of cost-effective diabetes related healthcare are needed with a particular focus on medications.

Impact of the covid-19 pandemic on GP contacts for respiratory infections in children under 5 years

Abstract Background Social distancing measures to reduce transmission of SARS-CoV-2 during the covid-19 pandemic also impacted the transmission of many other respiratory pathogens. We describe the impact of the covid-19 pandemic on general practitioner (GP) contact rates for respiratory tract infections (RTIs) that may have been affected by social distancing in children <5 years in England. Methods Trends analysis from 1 April 2016 to 31 March 2021 using electronic health records from a nationally representative primary care database. We included all children aged <5 years registered with a primary care practice during the study period. Our main outcome was GP contact rates for transmissible RTIs including otitis media, tonsillitis, and pneumonia. We also calculated the rates of urinary tract infections as an index non-transmissible condition. We calculated annual rates for each year of age (<1, 1-<2, 2-<3, 3-<4, 4-<5) by summing the GP contacts divided by the number of days each child was registered with the GP practice. Results There were 415 622 RTIs among 1 955 946 children <5 years over the study period. From 2016-2020 GP contact rates for RTIs were falling steadily by ∼14%/ year in all age bands, with rates of otitis media, tonsillitis and pneumonia declining by 5-11% per year. However, in 2021 marked falls of around 80% occurred for all RTIs, otitis media, tonsillitis, and pneumonia. By contrast, trends for GP contact rates for urinary tract infections before and during the covid-19 pandemic steadily declined by ∼5%/year. Conclusions Our study shows major reductions in the incidence of RTIs in under 5s during the pandemic, probably a result of SARS-CoV-2 containment measures. The impact of reduced exposure to RTIs during childhood on long term respiratory health is unknown. At the conference, we will report results up to March 2023. Key messages • GP contacts for respiratory infections in under 5s fell during the covid-19 pandemic in England. • Fewer respiratory infections in childhood may impact future health service use and requires monitoring.

Rapid review: Guides and frameworks to inform planetary health education for health professions.

Human actions have led to a range of global environmental changes. Health professionals must be prepared to deliver systemic changes to mitigate and adapt to the ecological crisis. This rapid review aimed to describe exemplar frameworks that inform planetary health education across health professions. The rapid review methodology was informed by a scoping review process. A targeted search strategy was conducted using one representative database and additional strategies such as expert consultation and citation searching were used. Results are described narratively. Of the 11 637 articles, 17 were eligible for inclusion. The frameworks differed, with many recently developed for health professions broadly using a range of methodologies, including qualitative research, opinion/consensus data, literature reviews, and adaptation of previous models. Models such as metric-based scoring indicators and Sustainable Quality Improvement were featured in the frameworks, as were the application of First Nations Natural Laws. This rapid review identifies and showcases accessible, interdisciplinary frameworks to inform the integration of planetary health in curricula, highlighting a rapidly evolving field through which interdisciplinary collaborations in healthcare are important to inform its pedagogy and application. Health education is an important component of health promotion; and thus this rapid review offers a range of approaches that health professionals, health promotion practitioners, and educators can use to inform the integration of planetary health, including sustainable healthcare, into curricula. SO WHAT?: Educational frameworks are informed by research and practice and provide key guidance to practitioners and educators; summarising key available planetary health education frameworks consolidates and guides effective education and builds on the existing body of knowledge to support urgent pro-environmental change.

Age Distribution of Epistaxis in Outpatient Pediatric Patients.

Objectives: Little is known about the prevalence of epistaxis in children. Existing reports focus on hospitalized children or those presenting to an emergency department. To better understand pediatric epistaxis in clinical practice, we sought out a searchable, representative outpatient database and examined the incidence of epistaxis in children of different ages. Methods: A cross-sectional analysis of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from the years 2007 to 2011 was performed. The NHAMCS is a Centers for Disease Control and Prevention-curated national sample of data from visits to non-federally employed office-based physicians and health centers. We queried the NHAMCS to determine the cumulative incidence of epistaxis in children of different age groups. The International Classification of Diseases Ninth Revision code 784.7 was chosen to identify epistaxis. Comparisons of rates were performed using the chi-squared test. A P-value of <.05 was considered statistically significant. Results: In total, 55,435,691 children [27,816,237 (50.2%) males, 55,435,691 (77.2%) white] were included. The overall cumulative incidence rate of epistaxis was 2.4/1000 children. Children in the 3- to 5-year range had the highest cumulative incidence of epistaxis (5.0/1000), followed by those in the 6 to 8 (3.0/1000), 9 to 11 (2.0/1000), 0 to 2 (1.9/1000), 12 to 14 (1.6/1000), and 15 to 17 (0.5/1000) year ranges (P < .001). Conclusion: Pediatric epistaxis is common in the office setting (2.4 per 1000 children)-and well above emergency department estimates (1.7 per 1000 people). Children between the ages of 3 to 5 years have the highest cumulative incidence. Epistaxis is sufficiently unusual in infants and the late teens that alternative causes for nasal bleeding should be included in the differential diagnosis.

Coupled discriminative manifold alignment for low-resolution face recognition

In practical applications, due to a long distance between the monitored population and monitoring equipment, the face images or human pose captured by the cameras often incur low-resolution (LR), small size, and poor quality, which leads to extreme difficulty in directly matching an LR face with the high-resolution (HR) ones in the gallery. In this paper, we propose a novel coupled discriminative manifold alignment (CDMA) method for LR face recognition. Specifically, in the training stage the principal component analysis (PCA) is first used to reduce the dimensional gap between LR and HR facial features. Next the LR face images and the corresponding HR face images are converted into a common shared feature subspace by learning two linear mappings in a supervised manner, where the neighborhood samples within the same class and from different classes are jointly exploited to align the manifold structures of LR and HR faces. In the test stage, for a given LR face in the probe set, two learned coupled mappings (CMs) are applied to match the HR images in the gallery set through the correlative metric. Thorough experimental results on three representative face databases verify the effectiveness of the proposed method in comparing with other state-of-the-art competitors. In particular, the proposed method is capable of yielding more competitive recognition performance than other predecessors when lower dimensional feature subspaces are applied to match the expected HR faces.

Potential beneficial effects of long-term aspirin use on the prevalence of colorectal cancer: a population-based study of the US Nationwide Inpatient Sample.

Whether long-term aspirin usage is associated with colorectal cancer (CRC) risk needs more evidence. The study evaluated the association between long-term aspirin use and prevalence of CRC in a large, nationally representative database. Hospitalized patients aged ≥ 50years during 2018 were identified in the United States (US) National Inpatient Sample (NIS). Patients without complete information of age, sex, race, income, and insurance status were excluded, as well as those with inflammatory bowel disease (IBD) or malignancies other than CRC. Propensity score matching (PSM) was applied to balance the characteristics between patients with and without long-term aspirin use. Logistic regressions were performed to determine the relationship between long-term aspirin use and the presence of CRC. CRC and aspirin use were identified through the administrative International Classification of Diseases (ICD) codes. Data from 3,490,226 patients were included, in which 688,018 (19.7%) had a record of long-term aspirin use. After 1:1 PSM, there remained 1,376,006 patients, representing 6,880,029 individuals in the US after weighting. After adjusting for confounders, long-term aspirin use was significantly associated with lower CRC odds (adjusted odds ratio [aOR] = 0.64, 95% confidence interval [CI] 0.62, 0.67). This association was not changed when stratified by age, sex, race, body mass index (BMI), and smoking. From a national inpatient dataset, US adults ≥ 50years on long-term aspirin are less likely to have CRC, regardless of age, sex, race, BMI, and smoking status.

Bibliometric analysis of published articles on perinatal depression from 1920 to 2020.

To analyze the characteristics and trends in published research on perinatal depression between 1920 and 2020. A search strategy in Web of Science identified all published literature on perinatal depression between January 1, 1920, and December 31, 2020. Output from Web of Science was used to analyze bibliometric information, and VOSViewer was used to visualize the networks of linkages between identified publications. There were 16,961 publications identified. Among these publications, there were 82,726 unique authors and 140 countries represented. The United States had the highest frequency of publications (44.6%). Most publications (69.8%) occurred between 2011 and 2020, with the first publication identified in 1928. There were 2197 unique journals identified, with over half publishing only one (n = 948, 43.2%) or two relevant publications (n = 314, 14.3%). Authors with the largest number of publications were Wisner (n = 115), Dennis (n = 95), and Murray (n = 92), while authors with the largest number of citations were Cox (n = 7225), Murray (n = 2755), and O'Hara (n = 2069). While the Web of Science is a representative database identifying the greatest number of relevant articles, it may be unrepresentative of all published literature. This is the first study mapping publications on perinatal depression between 1920 and 2020. The rate of publication on perinatal depression has been steadily increasing in recent years with a wide variety of authors, countries, and journals represented. As the field continues to grow, trends may shift as early career researchers emerge and the importance of mental health in low-income countries is prioritized.

One-year direct and indirect costs of ischaemic stroke in China

BackgroundThis is the first real-world study to estimate the direct costs and indirect costs of first-ever ischaemic stroke with 1-year follow-up in China, based on a nationally representative sample.MethodsPatients were...

Caring load and family caregivers' burden in China: the mediating effects of social support and social exclusion.

Caring for older adults with disabilities is a source of stress for family caregivers, and the lack of social support and the pressure of social exclusion might aggravate family caregiver burden. This study aimed to examine the association between caring load and family caregivers' burden, as well as the mediating effects of social support and social exclusion. Data used in this study was derived from the nationally representative database of the aged population in China, and 3,125 households with disabled old adults and their home-bound caregivers were eventually selected for this analysis. Regression methods and mediation analysis methods were employed in this study. The results indicated that there was a significant positive association between caring load and the caregiver burden, and specifically, social support intensity (rather than social support breadth) and passive social exclusion (rather than active social exclusion) played partial mediating effects. Furthermore, the contributions of mediating effects of social support intensity and passive social exclusion were 13-15 and 27-29%, respectively, and the total contribution of mediating effects was about 35-38%. Family caregivers' burden should be paid more attention to in the large population with rapidly aging speed like China, and more guidance services as well as support should be provided to family caregivers. In addition, it is crucial to focus on the community's social support and social exclusion in public policy innovation.

Appointment wait times for surgical care in the Veterans Health Administration and Community Care Program

BackgroundThe Veterans Health Administration has been criticized for long wait times; however, studies indicate that Veterans Health Administration wait times are shorter than those for the Veterans Health Administration’s Community Care Program. Previous studies have analyzed primary care wait times, but few have compared surgical specialties. MethodsUsing a publicly available data set of veteran appointments compiled from the Veterans Health Administration’s Corporate Data Warehouse, a nationally representative database containing 623,868 surgical consults from January 1 to June 30, 2021, mean differences in wait times between the Veterans Health Administration and the Community Care Program were calculated across surgical specialties. ResultsIn total, 49.6% of the surgical consults placed during the study period were for the Community Care Program. Across all surgical specialties, wait times were shorter in the Veterans Health Administration. Cardiothoracic surgery had the shortest mean wait times (23.1 days Veterans Health Administration; 30.0 days Community Care Program). The greatest difference in wait times was observed in plastic surgery, with Community Care Program appointments occurring 15.8 days later than Veterans Health Administration appointments on average. ConclusionAcross all surgical specialties, the Veterans Health Administration had shorter wait times than the Community Care Program during the study period.

Physical Health, Economic Status, Social Relations, and Depression among Chinese Older Adults: A Structural Equation Modelling Analysis

This study aims to test an integrated model of physical health, economic status, social relations, and geriatric depression, and in particular to examine the stress-buffering role of social relations on the negative psychological effects of declining physical health and worsening economic status. Data from 5,316 older adults (≥60 years) from a nationally representative cross-sectional database in China were used. Social relations were measured by both the intergenerational relationship and the social network beyond family ties. Descriptive analysis, multivariable regression, and structural equation modelling were used in a stepwise fashion. The results showed that poor physical health (identified as more chronic diseases, worse daily living function, and worse sleep quality) and lower economic status (identified as lower income and more debt) were significantly associated with weaker social relations and higher depression scores. Both intergenerational relationship and social network appeared to mediate the effects of physical health and economic status on geriatric depression, but in slightly different ways. Social relations play an important role in buffering the negative psychological effects of declining physical health and worsening economic status on the older group in China. The findings suggest the importance of strengthening health care, compensating for economic disadvantage and improving social relations in protecting the mental health of older adults.

Health and well-being of the Portuguese citizens: impacts of the COVID-19

BackgroundCOVID-19 pandemic placed unprecedented pressure on societies and healthcare systems around the world. Over the last years, measures imposed in almost all countries dealing with the pandemic sent the entire world into an extensive crisis and thus into a deep global recession. Since the outbreak began, many European countries have faced three/four waves of pandemic. Portugal has mainly dealt with three waves (March/April’2020; October/November’2020; January/February’2021), the third being the deadliest one. The purpose of this article is to provide evidence on the impact of the COVID-19 on health-related quality of life (HRQol) and well-being (W-B) of Portuguese citizens. It aims to (i) characterize these outcomes during the COVID-19 pandemic; (ii) compare them to pre-COVID-19 Portuguese population; and (iii) identify the social determinants that may affect these outcomes during the COVID-19 pandemic.MethodsThis study used data from a survey that collected data on HRQoL, W-B, satisfaction with life, economic and labour impacts, access to healthcare, mental and physical health, amongst others. The survey was implemented by telephone to a representative random sample of 1,255 respondents from the general adult Portuguese population, stratified by sex, age group and region. Data was collected during the end of the second national lockdown. For comparison purposes, we have also used two other representative databases from the general Portuguese population: (i) data from before the pandemic (n = 1,006); and (ii) data from a survey conducted during the first lockdown, (n = 904).ResultsLooking at health and access to healthcare, 4% of citizens had their surgeries postponed or cancelled because of COVID-19, more than a quarter had medical appointments or complementary exams postponed or cancelled, with 7% over 65 years old with surgeries cancelled or postponed and 32% medical appointments. COVID-19 pandemic also impacted negatively on the HRQoL of citizens, especially in the first lockdown. Half of the respondents reported feeling nervous, anxious, or on edge, about 45% of citizens felt sad or depressed. Sleeping problems were reported for almost 39% of citizens, and loneliness is reported by 29% of citizens. For about 70–85% of citizens, these feelings were more so than before the pandemic. Citizens with fair/strong economic stability were the most economically affected by the pandemic.ConclusionsWe provided evidence on the impact of COVID-19 on health and W-B of Portuguese citizens. Their health was worse than before the pandemic and the access to healthcare was highly affected.

FedGTA: Topology-Aware Averaging for Federated Graph Learning

Federated Graph Learning (FGL) is a distributed machine learning paradigm that enables collaborative training on large-scale subgraphs across multiple local systems. Existing FGL studies fall into two categories: (i) FGL Optimization, which improves multi-client training in existing machine learning models; (ii) FGL Model, which enhances performance with complex local models and multi-client interactions. However, most FGL optimization strategies are designed specifically for the computer vision domain and ignore graph structure, presenting dissatisfied performance and slow convergence. Meanwhile, complex local model architectures in FGL Models studies lack scalability for handling large-scale subgraphs and have deployment limitations. To address these issues, we propose Federated Graph Topology-aware Aggregation (FedGTA), a personalized optimization strategy that optimizes through topology-aware local smoothing confidence and mixed neighbor features. During experiments, we deploy FedGTA in 12 multi-scale real-world datasets with the Louvain and Metis split. This allows us to evaluate the performance and robustness of FedGTA across a range of scenarios. Extensive experiments demonstrate that FedGTA achieves state-of-the-art performance while exhibiting high scalability and efficiency. The experiment includes ogbn-papers100M, the most representative large-scale graph database so that we can verify the applicability of our method to large-scale graph learning. To the best of our knowledge, our study is the first to bridge large-scale graph learning with FGL using this optimization strategy, contributing to the development of efficient and scalable FGL methods.

Investor profiles

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Healthcare expenditure trends among adult stroke patients in the United States, 2011-2020

BackgroundIn the US, between 2018 and 2019, approximately $57 billion were expended on stroke and related conditions. The aim of this study was to understand trends in direct healthcare expenditures among stroke patients using novel cost estimation methods and a nationally representative database. MethodsThis study was a retrospective analysis of 193,003 adults, ≥18 years of age, using the Medical Expenditure Panel Survey during 2009-2016. Manning and Mullahy's two-part model were used to calculate adjusted mean and incremental medical expenditures after adjusting for covariates. ResultsThe mean (Standard Deviation) direct annual healthcare expenditure among stroke patients was $16,979.0 ($16,222.0- $17,736.0) and was nearly 3 times greater than non-stroke participants which were $5,039.7 ($4,951.0-$5,128.5) and were mainly spent on inpatient services, prescription medications, and office-based visits. Stroke patients had an additional healthcare expenditure of $4096.0 (3543.9, 4648.1) per person per year, compared to participants without stroke after adjusting for covariates (P<0.001). The total mean annual direct healthcare expenditure for stroke survivors increased from $16,142.0 (15,017.0-17,267.0) in 2007-2008 to $16,979.0 (16,222.0-17,736.0) in 2015-2016. ConclusionOur study showed that stroke survivors had significantly greater healthcare expenses, compared to non-stroke individuals, mainly due to higher expenditures on inpatient services, prescription drugs, and office visits. These findings are concerning because the prevalence of stroke is projected to increase due to aging population and increased survival rates.

Free and bioavailable 25-hydroxyvitamin D thresholds for bone metabolism and their associations with metabolic syndrome in Chinese women of childbearing age.

The free hormone hypothesis suggests that free and bioavailable 25-hydroxyvitamin D [25(OH)D] may better reflect vitamin D bioactivity. This study aimed to determine the free and bioavailable 25(OH)D characteristics, estimate their thresholds based on parathyroid hormone (PTH) and bone turnover markers (BTMs), assess their associations with the risk of metabolic syndrome (MetS), and evaluate their potential advantages. A cross-sectional study was conducted using a nationally representative database (n = 1,505, female, 18-45 years). Serum total 25(OH)D, vitamin D-binding protein, albumin, PTH, and BTMs [osteocalcin, β-CrossLaps of type 1 collagen containing cross-linked C-telopeptide (β-CTX), and procollagen type 1 N-terminal propeptide (P1NP)] were measured. Free 25(OH)D and bioavailable 25(OH)D were calculated. The threshold associations of 25(OH)D with PTH and BTMs were analyzed. The relationship between 25(OH)D and MetS risk was examined. An intervention study was then performed in 39 women (18-47 years) to assess the associations of increasing 25(OH)D with PTH and BTMs after vitamin D supplementation. In the cross-sectional study, the three forms of 25(OH)D were found to have similar distribution characteristics. Free and bioavailable 25(OH)D correlated well with total 25(OH)D. Significant total 25(OH)D cutoffs were observed for PTH (14.19 ng/mL and 18.03 ng/mL), osteocalcin (15.14 ng/mL), β-CTX (14.79 ng/mL), and P1NP (15.08 ng/mL). Free and bioavailable 25(OH)D cutoffs were only found for P1NP (3.47 pg/mL and 1.66 ng/mL, respectively). A total 25(OH)D of <15.14 ng/mL was marginally associated with a higher risk of reduced high-density lipoprotein cholesterol (HDL-C) [odd ratios (OR) = 1.371 (0.991-1.899)]. The ORs of higher versus lower free and bioavailable 25(OH)D levels for reduced HDL-C were 0.770 (0.621-0.956) and 0.772 (0.622-0.958), respectively. The results of the intervention study indicated that PTH and BTMs responded more sensitively to total 25(OH)D than to free or bioavailable 25(OH)D. Free and bioavailable 25(OH)D only had a threshold effect on P1NP. The active 25(OH)D thresholds could be used for risk assessment of reduced HDL-C. However, no superiority of free or bioavailable 25(OH)D was found based on the response of PTH and BTMs to changes in 25(OH)D in Chinese women of childbearing age following vitamin D supplementation. http://www.chictr.org.cn, ChiCTR2200058290.

Limited access to liver transplantation and TIPS despite high mortality, healthcare resource use and costs of cirrhosis in Germany.

Data on number of patients with cirrhosis in Germany are limited. We therefore aimed to estimate prevalence, comorbidities, mortality, utilization of healthcare resources and costs of patients with cirrhosis and incidence of decompensation of cirrhosis in Germany. This longitudinal observational study was based on an anonymized representative claims database including 4.9 million persons insured by a statutory health insurance (SHI) between 2015-2020. Patients with decompensated and compensated cirrhosis were selected via diagnostic ICD codes and followed for 2 years. Prevalence of cirrhosis in 2015 was 250/100 000, resulting in 201 747 (95% CI: 197 540-206 040) patients extrapolated to the German population. Out of all patients with compensated cirrhosis in 2015 who did not deceased, 16.0% developed a decompensation within 3 years. Overall, 978 patients (Ø-age: 68 years; 60% male) were included in the decompensated, and 5135 patients (Ø-age: 66 years; 59% male) in the compensated cirrhosis cohort. Patients with decompensated cirrhosis had a higher burden of comorbidities (Charlson Comorbidity Index 7.3 vs. 4.4) and 3 times higher costs per quarter (7172 € vs. 2213 €) than patients with compensated cirrhosis. 1-year mortality after decompensation was 51% compared to 8% in compensated cirrhosis. Of note, only few patients with decompensated cirrhosis received a liver transplantation or transjugular intrahepatic portosystemic shunts (TIPS) (1% and 5%). Patients with cirrhosis have a high healthcare burden in especially decompensated stage. Accordingly, 1-year mortality of decompensated cirrhosis in Germany is high. Despite high health resource utilization, only few patients have access to liver transplantation or TIPS.

Representative Survey for Evaluating Housing and Manure Handling Technologies of the Hungarian Pig Sector.

In Hungary, there is a lack of information on the pig production technologies in place in the base year of 2005 and changes since then, as well as a lack of information on the number of pigs kept in different age and production categories, which makes it difficult to calculate ammonia emissions and reductions in the national inventories. Our research team conducted a representative survey of pig farms to assess housing and manure management technologies in the Hungarian pig sector in 2005 and 2015. Novel expert-based calculation methods were developed to convert farm data on pig populations into daily average numbers (DAN) of animals in different statistical categories and feeding phases. The survey resulted in a representative database of housing, manure handling, storage and manure application practices in Hungarian pig production. The data and methodology from the survey helped to develop an ammonia emission calculator and knowledge transfer tool (AGEM-S) for use by farmers.