Health Resources Research Articles

Temporal trends in rural vs urban colon cancer mortality in Texas: A SEER database analysis from 2012 to 2021.

36 Background: Colorectal cancer is a major concern for the U.S. healthcare system, being the fourth most common cancer by incidence in the country with 152,810 cases in 2024. Measuring the burden this disease places on patients and health resources may serve to optimize our approach to the detection, management and resource allocation for combating this ailment. Methods: Our study is a population-based study cohort of colon cancer deaths in Texas. We queried the National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) for colon cancer deaths in Texas over the most recent available decade, 2012 through 2021. The National Center for Health Statistics Urban-Rural Classification Scheme was used to classify counties according to the 2013 US Census classification: urban (≥ 50,000) and rural (< 50,000). We calculated age-adjusted mortality rates (AAMRs) per 100,000 population using the direct standardization method based on the age group weights from the 2000 standard US population. Confidence intervals for AAMR were derived by estimating the standard error as the AAMR divided by square root of number of mortalities. Differences between AAMR were tested by comparing the 95% confidence intervals (95% CI) for the individual rates. The annual percent change (APC) in AAMR was tested using negative binomial regression. Subgroup analyses included age group, sex, and race/ethnicity. Results: Over the study period, 10.8% of the study population lived in rural areas and 89.2% lived in urban areas. A total of 33,591 colon-cancer deaths were reported during the study period with 5,423 (16.1%) in rural counties and 28,168 (83.9%) in urban counties. At the beginning of the study period the rural AAMR (13.9 [12.7 to 15.1]) was significantly higher than urban AAMR 12.1 [95% CI 11.7 - 12.6]). The rural AAMR rose significantly over the study period (APC 1.1% [95% CI 0.3% - 1.9%]; p = 0.0050) to AAMR 14.9 (95% CI 13.7 to 16.1). In contrast, the urban AAMR did not change over study period (APC -0.3% [95% CI -0.7 to 0.1]; p = 0.1444) and was equal to the initial AAMR 12.1 (95% CI 11.7 to 12.5). On subgroup analyses, males, people ages 25-64 years, Hispanics, Non-Hispanic Blacks, Non-Hispanic Asians, and Non-Hispanic Native Americans in rural areas each had significant and increasing trends in AAMR. Conclusions: Our analysis revealed an increase in AAMR in rural counties of Texas, reflecting a concerning trend with regard to colorectal cancer in this region. This may be due to higher poverty rates, lower level of education, more distance from healthcare facilities and difficulties with transportation faced by rural counties. Furthermore, rural areas also report higher rates of obesity and poor dietary habits. Rural areas also face a shortage of Primary Care Physicians (PCP’s), with metropolitan counties retaining 1.7 times as many PCP’s as rural counties, and 82.5% of counties without a PCP being rural.

Dissemination through trusted credible messengers: 133 weeks of the Flint Community Webinar on COVID-19.

Community access to evidence-based information is critical, especially during a pandemic, as it can impact knowledge and adoption of health behaviors that affect health disparities. The field of dissemination and implementation (D&I) science is ideally positioned to address this need through its focus on reducing the research-to-practice gap through improved distribution of information. The purpose of this paper is to describe the creation of a weekly webinar series about COVID-19 directed toward community members, and the extent to which webinars were found useful and increased awareness of evidence-based information and services. Lessons learned about this dissemination strategy as well as the selection and involvement of trusted credible messengers (TCMs) to share information are discussed. Data were derived from Zoom attendance reports, YouTube views, and survey responses collected about the weekly webinar series over 133 weeks from March 20, 2020 through September 30, 2022. The webinar reached a minimum of 877 unique within-webinar participants, representing more than 9,190 in-webinar participant hours and an additional 17,303 YouTube views. A consistent base of weekly attendees (e.g., service providers, community members) reported increasing levels of satisfaction and utility over time. This study supports the use of a community webinar series to disseminate evidence-based, locally relevant information through TCMs to improve community access to knowledge of health information and resource utility.

Intention to utilize mental health and suicide prevention resources in a community sample during the first year of the COVID-19 pandemic

ObjectiveGiven the stressors experienced during the COVID-19 pandemic, it is critical to identify populations with elevated mental health needs during this crisis. This study investigated demographic correlates of reported intention to utilize mental health (MH) and suicide prevention (SP) resources in a community sample during the COVID-19 pandemic.MethodsA sample of 1,978 adults in the United States completed an anonymous online survey between June 2020 and February 2021.ResultsIntent to utilize MH resources was associated with younger age, single marital status, female gender, and Hispanic vs. White race/ethnicity. Intent to utilize SP resources was associated with younger age, single marital status, and was greater among Black and Hispanic vs. White race/ethnicity. Lower education was associated with MH and SP utilizers in bivariate analysis. Indirect effects of Suicide Crisis Syndrome (SCS) symptoms were found on the association of age, gender, and marital status with MH utilization and of age, marital status, and education with SP Utilization.ConclusionsSpecific demographic populations demonstrate greater interest in mental health care during the COVID-19 pandemic. These help-seeking patterns can be explained in part by an elevated level of SCS symptoms, suggesting greater levels of distress were driving expressed intention to utilize service referrals.

Very Early Health Technology Assessment for Potential Predictive Biomarkers in the Treatment of Advanced Non-Small Cell Lung Cancer.

Immune checkpoint inhibitor (ICI)-containing treatment is currently prescribed as first-line treatment for all patients with advanced non-small cell lung cancer (NSCLC) without targetable driver mutations. However, only 30-45% of patients show no progression within 12 months after treatment start. Various biomarkers are being studied to save costly and potentially harmful treatment in non-responders. We evaluated the cost-effectiveness of implementing a hypothetical predictive biomarker for ICI-containing treatment response compared with standard of care (e.g., no implemented biomarker) for pembrolizumab-containing treatment in patients with advanced NSCLC in the Netherlands. Standard-of-care-based and predictive-biomarker-based strategies were compared using Markov models for three first-line pembrolizumab-containing treatments depending on a patient's tumor programmed cell death ligand-1 (PD-L1) expression and histology. A Dutch healthcare system perspective was adopted. Assuming a receiver operating characteristic-area under the curve of 1.0 in identifying responders, alternative treatments were offered for non-responders in the predictive-biomarker-based strategy. Parameters and assumptions were based on real-world data from surveys, literature using a targeted search, expert opinion, and registries. Outcomes included differences in costs, survival (life years (LYs)), and survival corrected for health-related quality of life (QoL) quality-adjusted life-years (QALYs) between the predictive-biomarker- and standard-of-care-based strategy. Implementing a predictive biomarker in pembrolizumab-carboplatin-paclitaxel treatment led to a mean survival reduction of 24 days (- 0.067 LYs) (18 days corrected for QoL (- 0.049 QALYs)), with cost savings of €22,606 compared with standard of care. Pembrolizumab monotherapy and pembrolizumab-pemetrexed-platinum treatments showed survival reductions of 4.5 and 3.9 months, respectively (3.6 and 2.8 months corrected for QoL), with cost savings of €24,345 and €28,456. Sensitivity analyses confirmed consistent cost savings and survival reductions. Survival losses were mainly observed due to the lower survival rates associated with the alternative first-line treatment options available for non-responders in the predictive-biomarker-based strategy within each pembrolizumab-containing treatment regimen. Pembrolizumab-carboplatin-paclitaxel treatment also showed survival gains under certain conditions related to QoL and survival estimates. Our study highlights the importance of careful de-implementation of ICI-treatments in advanced NSCLC, balancing costs reductions and side effects without comprising survival. In the pembrolizumab-carboplatin-paclitaxel treatment regimen, the survival loss could be considered negligible. Future research should define acceptable tradeoffs and thresholds for de-implementation, considering factors such as survival of alternative treatments and responder classification to guide predictive biomarker implementation and optimize health resource allocation.

External beam radiation therapy versus radical prostatectomy for high-risk prostate cancer: protocol of the RECOVER study

BackgroundThis paper describes the rationale and design of the RECOVER study. Currently, there is no consensus regarding the optimal treatment for high-risk, non-metastatic prostate cancer (PCa). The study primarily aims to evaluate and compare the impact of treatment with robot-assisted radical prostatectomy (RP) versus external beam radiation therapy (EBRT) with androgen deprivation therapy (ADT) for men with high-risk, non-metastatic PCa regarding health-related quality of life (HRQoL) and functional outcomes. Secondary objectives are progression-free survival (PFS), distant metastasis-free survival (DMFS), costs and cost-effectiveness.MethodsThe RECOVER study is a comparative effectiveness study that prospectively includes newly diagnosed high-risk (cT3a-bN0M0, ISUP-grade ≥ 4 and/or PSA > 20 ng/mL), non-metastatic PCa patients. Four Dutch prostate cancer networks, comprising 29 hospitals, are currently participating in the study. Patient reported outcomes are collected before treatment initiation, 12 months and 36 months after treatment initiation and include the EORTC-QLQ-C30, the EPIC-26, an adapted version of the SCQ, an adapted version of the iMTA Productivity Cost Questionnaire and several specific questions regarding patient characteristics, treatment of PCa specific complaints and health resources used. Clinical data regarding patient-, tumor- and treatment characteristics and oncological outcomes are collected up to 5 years after diagnosis. For sufficient power, patient reported outcomes of 471 patients must be collected 36 months after treatment initiation. Descriptive statistics and mixed-effects models are used to assess differences in HRQoL and functional outcomes over time between the patients treated with radical prostatectomy versus EBRT (+ ADT). Inverse probability of treatment weighting or the g-formula are used to adjust for confounding covariates associated with treatment. Secondary endpoints PFS and DMFS are evaluated using a competing risk analysis and cost-utility and budget-impact analyses will be performed to determine cost and cost-effectiveness.DiscussionAn observational prospective design was chosen since a randomized controlled trial comparing surgery and radiotherapy was not deemed feasible. This study evaluates effectiveness of treatment in a routine clinical setting (with adjustment for confounding) and its findings will enhance patients’ and healthcare professionals’ awareness for the impact of both treatment modalities on (long-term) daily functioning and HRQoL and aid treatment decision making.Trial registrationThis study is registered at ClinicalTrials.gov (NCT05931419).

A comprehensive review of biological and genetic control approaches for leishmaniasis vector sand flies; emphasis towards promoting tools for integrated vector management.

Leishmaniasis is a health problem in many regions with poor health and poor life resources. According to the World Health Organization (WHO), an estimated 700,000-1 million new cases arise annually. Effective control of sand fly vector populations is crucial for reducing the transmission of this disease. Therefore, this review aims to comprehensively examine and evaluate the current methods for controlling sand fly populations, focusing on biological and gene drive techniques. A detailed, comprehensive literature search was carried out using databases including Google Scholar, PubMed, ScienceDirect, and the National Library of Medicine (NIH). These searches were done using specific keywords related to the field of study. This current review identified several promising methods, including genetically modified sand flies, using transgenic approaches by taking advanced gene editing tools like Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR/Cas9) and genetic modification of symbiotic microorganisms for controlling sand fly populations, which appeared to be proven under laboratory and field settings. Genetic control approaches have many benefits over chemical control, including long-lasting effects on targets, high specificity, and less environmental impact. Advances in genetic engineering technologies, particularly CRISPR/Cas9, sterile insect techniques, and gene drive insect modification, offer new avenues for precise and efficient sand fly management. Future research should prioritize optimizing rearing and sterilization techniques, conducting controlled field trials, and fostering collaboration across disciplines to realize the potential of genetic control strategies in combating leishmaniasis.

Revolutionizing public health through digital health technology

ABSTRACT The aging population and increasing chronic diseases strain public health systems. Advancements in digital health promise to tackle these challenges and enhance public health outcomes. Digital health integrates digital health technology (DHT) across healthcare, including smart consumer devices. This article examines the application of DHT in public health and its significant impact on revolutionizing the field. Historically, DHT has not only enhanced the efficiency of disease prevention, diagnosis, and treatment but also facilitated the equitable distribution of global health resources. Looking ahead, DHT holds vast potential in areas such as personalized medicine, telemedicine, and intelligent health management. However, it also encounters challenges such as ethics, privacy, and data security. To further advance DHT, concerted efforts are essential, including policy support, investment in research and development, involvement of medical institutions, and improvement of public digital health literacy.

Withholding diagnostic and prognostic information from patients in Pakistan: ethical and cultural perspectives

Dear Editor, I am writing to highlight a critical and often overlooked issue in our medical practice: withholding diagnostic and prognostic information from patients in favour of communicating primarily with family members. This practice raises significant ethical and legal concerns that merit urgent discussion. A significant portion of Pakistan's population—about 61%—resides in rural areas, where the literacy rate is approximately 59% [2,3]. Additionally, socio-economic factors play a major role, with over 37% of the population living below the poverty line [1]. Research indicates that patients with low literacy levels experience poorer health outcomes, including lower health knowledge, worse disease markers, higher morbidity, poorer general health status, and increased use of health resources. These patients are generally 1.5 to 3 times more likely to experience adverse health outcomes [4]. Consequently, medical decisions and treatment plans are frequently deferred to the household's primary earner rather than the patient, undermining the patient's autonomy. In countries such as the United States and Canada, patient autonomy is a fundamental principle of medical practice. Patients have the right to be fully informed about their health conditions and make care decisions. In his seminal work The Silent World of Doctor and Patient, bioethicists like Jay Katz argued that excluding patients from decision-making processes is a profound affront to their dignity and autonomy. Similarly, Beauchamp and colleagues, in Principles of Biomedical Ethics, stress the importance of respecting patient autonomy alongside beneficence and nonmaleficence. A recent cohort study concluded that when medical decision-making was conducted through shared decision-making, daily controller therapy adherence in patients with asthma was 84%, a considerable achievement [5]. Respecting patient autonomy does not mean indiscriminately sharing all information but fostering a trust-based relationship where the patient’s preferences for receiving information and involvement in clinical decisions are carefully considered. Healthcare providers must prioritize effective communication and uphold ethical standards by ensuring that patients are fully informed about their diagnoses and involved in their treatment plans. Educational institutions and healthcare organizations should emphasise the importance of these skills in medical training and continuing education programmes. I urge my fellow healthcare professionals to commit to promoting patient autonomy and transparency, ensuring that our patients are respected and their rights upheld in all aspects of their care.

The availability and distribution of health services and resources across different regions in Afghanistan

BackgroundEnsuring equitable access to healthcare services is fundamental to a robust healthcare system, especially during humanitarian crises. This study analyzes the availability and distribution of health resources across Afghanistan, aiming to provide a data-driven understanding of healthcare resource access and identify potential disparities, a critical aspect of effective humanitarian response planning.MethodsPrincipal investigators collated related data and literature from databases and data warehouses in a systematic approach using search strings and collection tools to query databases and available data warehouses to assess the availability and distribution of health services and resources across different regions in Afghanistan, with the principal database queried being the Afghanistan Health Resources Availability database (HeRAMS), an electronic and web-based system conceived by the World Health Organization. An Excel version was sourced.ResultsThe sub-health center represents 31.1% of the health facilities, followed by the basic health center (22.5%) and the mobile health team (17.1%). More than 85% of these facilities are fully operational, with the highest percentage observed in the Southern and Northeastern regions at 96.8%, followed closely by the central highland and Southeastern regions. Outpatient services for primary care are notably prevalent in the Northeastern, Southeastern, Southern, Eastern, and Northern region, conversely, the Capital and Central Highland regions demonstrate the lowest provision of primary care services. Antenatal care services are accessible at a level exceeding 70% in nearly all regions, with the highest accessibility in the Northeastern region at 91.3%, the prevalence of non-communicable illness clinics was observed to be below 50%, with the highest availability in the Southern region at 49.4%, followed by the Southeastern region. In terms of sanitation facilities, availability surpasses 70% across Afghanistan, with the highest observed in the Northeastern region at 89.2%.ConclusionThe study highlights significant disparities in healthcare access across various regions, with notable challenges in the availability of critical services. Furthermore, the study underscores the significant impact of financial constraints and equipment shortages on the functionality of healthcare facilities, particularly in the Northeastern and Western regions. This analysis emphasises the need for targeted resource allocation and infrastructure improvements to address inequities in access to essential healthcare services, particularly for underserved populations, thereby facilitating the achievement of equitable health outcomes in Afghanistan.

Evaluation the role of the nephrology team in the specific vascular access outpatient clinic. What can we contribute new?

The key points of a monographic vascular access (VA) consultation are an adequate preoperative assessment, as well as a correct management and optimization of waiting lists. Our main objective of present study was to evaluate the degree of exploratory-dependent concordance in outpatient clinics regarding implanted VA, between nephrology and vascular surgery. We analyzed VA created or surgically repaired between 2021 and 2022. We compared the differences in the preoperative variables between the groups in which the assessments between the two teams were coincident and non-coincident, and the primary (PP) and secondary (PS) patencies during the follow-up period (Kapplan-Meier curves and Log-rank test, and Cox regression analysis). Significant P ≤ 0.05. A total of 605 VA creations or repairs were analyzed: 74 ligations (12.2%), 207 distal arterio-venous fistulaes (AVF) (34.3%), 237 proximal AVF (39.2%), 35 repairs (5.7%), 41 grafts (6.7%) and 11 others (1.9%). After an average waiting list time of 16.5 ± 11.6 days, excluding ligations, adequate 1-month maturation was observed in 87.6% of cases. A total of 158 endovascular procedures and 17 surgical repairs were performed during postoperative follow-up. Primary (PP) and secondary (PS) patencies at 6, 12 and 24 months were PP: 76.2%, 64.9%, 57.5% and PS: 86.4%, 81.2%, 74.7%, respectively. Of the total number of procedures, nephrology obtained an adequate degree of agreement in 93.6% of the cases (kappa index: 0.886). The preoperative factors associated with greater discrepancies in assessments were age (P = 0.022) and arterial diameter (P = 0.032). The subgroup of non-matched assessments between nephrology and vascular surgery (39 cases) presented a similar PP (at 2 years: 59.2% vs 41.3%, P = 0.099) but worse PS (at 2 years: 76.6% vs 55.4%, P = 0.005). No significant observer-dependent differences (nephrologist vs. vascular surgeon) were observed in decision-making regarding the surgical procedure to be performed (93.6% agreement), and discordant cases presented worse secondary patency. After specific training, the nephrology coordination team can make a proper optimisation of social and health resources by reserving referrals to vascular surgery for those cases of greater complexity.

HRSA and SAMHSA tap SUPTRS BG for Ryan White services

In a “Dear Colleague” letter that went out on Friday, January 17, 2025, the Health Resources and Services Administration (HRSA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) called for using a federal block grant focused on substance use disorder (SUD) treatment and prevention to be used for HIV services in the Ryan White grant program.

Medicare Risk Arrangement and Use and Outcomes Among Physician Groups

Many physician groups are in 2-sided risk payment arrangements with Medicare Advantage plans (at-risk MA). Analysis of quality and health resource use under such arrangements may inform ongoing Medicare policy concerning payment and service delivery. To compare quality and efficiency measures under 2 payment models: at-risk MA and fee-for-service (FFS) MA. This cross-sectional study used Medicare encounter and enrollment data from 2016 to 2019 covering 17 physician groups, 15 488 physicians, and 35 health insurers to compare quality and health resource use for Medicare beneficiaries within the same physician groups. The data were analyzed between August 4 and October 30, 2024. Care delivered under at-risk MA and FFS MA payment arrangements by the same physicians and medical groups. Twenty quality and efficiency measures across 4 domains of patient care (hospital care, avoidance of the emergency department [ED], avoidance of disease-specific admissions, and outpatient care) were examined using logistic regression analysis. The overall sample comprised 5 278 717 person-years (37.7% at-risk MA and 62.3% FFS MA). The mean (SD) age of beneficiaries was 73.6 (9.2) years in the at-risk MA group (56.8% women) and 71.8 (10.4) years in the FFS MA group (57.4% women). For at-risk MA compared with FFS MA, inpatient admissions and 30-day readmissions per 1000 were 10.03 (95% CI, -10.61 to -9.44) and 1.95 (95% CI, -2.18 to -1.73) lower. ED use measures per 1000 ranged from 2.95 (95% CI, -3.28 to -2.63) lower for avoidable ED visits to 26.02 (95% CI, -26.92 to -25.12) lower for overall ED visits. Avoidance of disease-specific admissions per 1000 ranged from 0.24 (95% CI, -0.35 to -0.13) lower for composite diabetes-related admissions to 2.18 (95% CI, -2.43 to -1.94) lower for the composite of chronic disease-related admissions. High-risk drug use per 1000 was 14.26 (95% CI, -14.85 to -13.67) lower. Overall, compared with FFS MA, at-risk MA was associated with higher quality and efficiency in 18 of 20 measures after adjusting for differences in demographics, Hierarchical Condition Categories Risk Adjustment Factor scores, and other health characteristics. In this cross-sectional study, at-risk MA payment arrangements managed by physician groups were associated with higher quality and efficiency compared with FFS MA managed by the same groups. The population and methods used provide robust evidence that at-risk payment arrangements in MA may improve health care delivery for the MA population.

Equity and efficiency of public health resource allocation in China

ObjectiveTo analyze the equity and efficiency of public health resource allocation in China from 2018 to 2022, and to provide a scientific basis for promoting the development of public health resources in China.MethodsData on public health resources of 31 provincial-level administrative regions in mainland China were extracted from 2018 to 2022, and descriptive analysis, Theil index, and health resource agglomeration degree (HRAD) were used to analyze the equity, and data envelopment analysis (DEA) was used to analyze the efficiency.ResultsThe Theil index of public health resource allocation by population in China ranges from 0.006 to 0.049, and the Theil index contribution rate of the number of beds, health technicians, licensed (assistant) physicians, and registered nurses within region is less than 28.76%. The Theil index of public health resource allocation by geography in China ranges from 0.274 to 0.624, and the Theil index contribution rate of the number of institutions, the number of beds, health technicians, licensed (assistant) physicians, and registered nurses within region is more than 77.05%. The HRAD of public health resources is more than 2.18 in the eastern and central regions, while the HRAD of public health resources is less than 1 in the northeastern and western regions. The overall HRAD/population agglomeration degree (PAD) is less than 1 in the northeastern and eastern regions, and greater than 1 in the central and western regions overall. The scale efficiency and overall efficiency of public health resource allocation in China are not 1, the returns to scale are decreasing, and the DEA is relatively ineffective from 2019 to 2022.ConclusionThe equity by geography is slightly worse than the equity by population, and the inequity by population mainly comes from between regions, while the inequity by geography mainly comes from within regions. There is a contradiction in the equity by population and by geography allocation in the eastern and western regions, and a congruence in the equity by population and by geography allocation in the northeastern and central regions. The DEA of public health resource allocation in China is relatively ineffective in 2019–2022.

Global, regional and national burden of neuroblastoma and other peripheral nervous system tumors, 1990 to 2021 and predictions to 2035: visualizing epidemiological characteristics based on GBD 2021.

Neuroblastoma (NB) is the most common extracranial malignant solid tumor in children, accounting for >15 % of cancer-related deaths in children. We analyzed the epidemiological statistical indicators of neuroblastoma and other peripheral nervous system tumors patients from 1990 to 2021 in Global Burden of Disease (GBD) 2021 database, aiming to provide valuable insights for public health interventions and clinical practices. Based on the GBD 2021 database, this study analyzed the incidence, mortality, prevalence, and Disability-Adjusted Life-Years (DALYs) of neuroblastoma and other peripheral nervous system tumors from 1990 to 2021, stratified by sociodemographic development index (SDI) and geographic regions. Cross-country inequalities analysis was conducted to quantify the SDI-related inequality of disease burden across countries. In addition, the average annual percentage change (AAPC) and Age-Period-Cohort (APC) model were used to evaluate the trend of disease burden, while the global burden of disease to 2035 was predicted by Bayesian Age-Period-Cohort (BAPC) model. This study reported the disease burden of neuroblastoma and other peripheral nervous system tumors in GBD 2021 database for the first time. Globally, the incidence and mortality of neuroblastoma have increased year by year from 1990 to 2021, especially in regions with low SDI, such as South Asia and sub-Saharan Africa, where the burden of disease has increased significantly. Regions with high SDI, such as North America and Western Europe, have seen a reduction in disease burden due to higher levels of medical care and earlier diagnosis. The age distribution shows that children under 5 years of age are mainly affected, especially in low- and middle-income areas. In addition, the incidence is slightly higher in men than in women. The BAPC model predicts that the global incidence, mortality, and DALYs of neuroblastoma will continue to increase until 2035. Significant regional and population variation in neuroblastoma and other peripheral nervous system tumors worldwide, with a particularly high disease burden in low SDI areas with limited medical resources. This trend highlights the urgent need for global public health interventions and resource allocation, particularly in low-income countries. Future research should focus on improving early diagnosis, risk stratification and target therapy in order to reduce the global burden of disease and improve patients' prognosis. This study was supported by National Natural Science Foundation of China (No. 82293662, No 82172357 and No 81930066), Key project of Shanghai "Science and Technology Innovation Action Plan (22JC1402304) and Research fund of Shanghai Municipal Health Bureau (No. 2019cxjq03).

P0855 Rise in admissions for Acute Severe Ulcerative Colitis at an Australian tertiary IBD centre with a culturally and linguistically diverse population: Implications for health resource planning

Abstract Background Epidemiological data suggests greater risk of inflammatory bowel disease in first- and second-generation migrants from a low to high prevalence country, with risk of ulcerative colitis (UC) preceding Crohn’s disease. Little is known about the effect of this on hospitalisations for UC, including acute severe ulcerative colitis (ASUC). This study evaluated demographic trends of ASUC admissions in a metropolitan healthcare setting with an expanding culturally and linguistically diverse (CALD) population, with admission outcomes compared. Methods Demographic and disease characteristics of patients admitted with ASUC at a single tertiary metropolitan centre from January 2016 to October 2024 were recorded. Trends in presentation and outcomes in ASUC patients of European Caucasian and non-European background were compared. Results During this 9-year period, 210 patients (88 [41.9%] female, median age 34.5 [16-90] years) had a total of 261 admissions. The ethnicity of patients for UC admissions was 50.9% European Caucasian, 16.2% South Asian, and 13.8% Middle Eastern; ethnicity information was not available for 11% of patients. Of index admissions, 150 (71.4%) met Truelove and Witts criteria for ASUC (62 [41.3%] female, median age 33.5 [16-87] years); 51.3% European Caucasian, 16% South Asian, and 12% Middle Eastern; ethnicity information was not available for 12% of patients. For patients with recorded ethnicity, when comparing all UC admissions in 2016-2019 to 2020-2024, there was a significant increase in the proportion of non-European background patients, increasing from 32.1% to 47.3% (p=0.05), and an increasing trend in ASUC admissions from 29.0% to 46.8% (p=0.08). Median length of stay was 6 days (IQR 5-11) in European Caucasian patients and 6 days (IQR 4-7) in non-European background patients (p=0.11). 12-month steroid dosage was similar in both European Caucasian (median 1685mg) and non-European (median 1612.5mg) patients (p=0.45). 12-month readmission rate was significantly less in the non-European background ASUC population (10.0%) when compared with the European Caucasian population (30.1%), p = 0.02. 7.1% patients of European Caucasian background required inpatient colectomy, compared with 7.5% of non- European background (p=0.94). Conclusion There was an increase in proportion of patients of non-European background hospitalised with UC, including ASUC. In ASUC patients, 12 month-steroid usage, colectomy rates, and length of stay of index admission were similar across ethnicities, but patients of non-European background had lower readmission rates. Further studies are required for improved planning of healthcare resources and assessment of ASUC in CALD populations.

The trend of suicide and self-harm in the Chinese population from 2018 to 2022 based on ambulance medical emergency cases: a retrospective study

ObjectiveThis study investigates the trends of suicide and self-harm in Nanjing, China, through 4 years of data collection, aiming to provide valuable information for developing effective suicide prevention strategies.MethodsThis descriptive study analyzed Nanjing Emergency Medical Center (NEMC) ambulance records from Nanjing (2018–2022) to investigate suicide and self-harm events. Out of 689,305 records, 4,261 cases were included after exclusions. The study categorized incidents into 4,103 suicide events and 158 self-harm cases. Descriptive statistics and content analysis were conducted to identify characteristics and themes related to these events, with age groups defined according to American Medical Association standards.ResultsThe study highlights drug poisoning as the leading method, accounting for 63.56% of the 4,103 suicide events. It notes significant trends by age, gender, and season, with males showing higher rates of self-harm. The study emphasizes the need for targeted prevention strategies, particularly focusing on drug-related suicides among adults and adolescents, as well as the prevalence of various self-harming behaviors.ConclusionTo reduce self-harm and suicide, interventions must be strengthened for women, who experience higher rates. Key strategies include regulating pesticides and psychotropic drugs, increasing access to mental health resources, and launching community awareness campaigns. Additionally, training healthcare providers and promoting family education can enhance support for women facing mental health challenges.

P1203 Spatial mapping and geographic variation of inflammatory bowel disease in Canada: A population-based study using Statistics Canada data

Abstract Background Crohn’s Disease (CD) and Ulcerative Colitis (UC) pose significant challenges to patients and healthcare systems, with a rising incidence and prevalence globally1,2. To address the challenges of health resource allocation and understand the geographic distribution of these conditions in Canada, we conducted the spatial mapping of IBD across Canada using national population survey data available from Statistics Canada. Methods We utilized data from the 2009-2018 Canadian Community Health Survey (CCHS) to identify individuals with CD or UC. Prevalence rates, both crude and adjusted for age and sex, were calculated for each health region in Canada. Spatial dependencies between health regions were estimated using global Moran’s I and local indicators of spatial association (LISA) were used to identify clusters of health region (hot-spots) where the prevalence was significantly higher than in other areas. We further applied spatial simultaneous autoregressive lag models to explore the influence of region-level sociodemographic factors on identified spatial dependencies. Results A total of 492,560 individuals from 2010-2018 CCHS were included, representing 29,846,350 Canadians across 109 health regions. Survey data revealed that 0.38% of Canadians self-reported having CD and 0.47% reported having UC. The majority of respondents reported being urban-residing, middle-aged, and white. Across Canadian provinces, the age and sex-standardized prevalence of IBD ranged from 742 per 100,000 in Quebec to 1267 per 100,000 in Nova Scotia (Figure 1). Spatial analysis identified significant dependencies among health regions, but these spatial associations were explained by the differing distributions of sociodemographic characteristics in each health region (Table 1). Increased health region-level prevalence of CD and UC was associated with a larger proportion of individuals 30+ years, identifying as a female, immigrants, or as white (p<0.05 for each). Conclusion Data from this large, population-based Canadian national survey demonstrated significant geographic variation in the prevalence of CD and UC. However, after adjusting for patient demographic characteristics, the spatial dependency became non-significant. Key characteristics related to urbanization including the age distribution and proportion of immigrants in a health region were associated with increased prevalence rates. These results suggest that differences in CD and UC prevalence between geographic areas are primarily driven by individual demographics rather than differences in characteristics of local healthcare delivery systems and further support the notion that characteristics of urbanization increase the prevalence of IBD in an area1.

Wellbeing and quality of life among parents of individuals with Fontan physiology.

To examine global and health-related quality of life (QOL) among parents of individuals with Fontan physiology and determine associations with sociodemographic, parent and child-related health, psychological, and relational factors. Parents participating in the Australian and New Zealand Fontan Registry (ANZFR) QOL Study (N = 151, Parent Mean age = 47.9 ± 10.2years, age range: 31.6-79.6years, 66% women; child Mean age = 16.3 ± 8.8, age range: 6.9-48.7years, 40% female) completed a series of validated measures. Health-related QOL was assessed using the PedsQL 4.0 Core Generic Scales for adults and global QOL was assessed using a visual analogue scale (0-10). Most parents (81%) reported good global QOL (≥ 6), consistent with broader population trends. Nearly one-third of parents (28%) reported at-risk health-related QOL (based on total PedsQL scores) with physical functioning most affected (44%). Psychological factors, including psychological stress and sense of coherence, emerged as the strongest correlates of global and health-related QOL, explaining an additional 16 to 30% of the variance (using marginal R2). Final models explained 35 and 57% and of the variance in global and health-related QOL, respectively (marginal R2). Relational factors, including perceived social support and family functioning contributed minimally when analyzed alongside psychological variables. While parents of individuals with Fontan physiology report good global QOL, challenges in health-related QOL exist. We identified key psychological, sociodemographic, and health-related factors associated with parental QOL outcomes. These data may aid early identification of physical and psychosocial difficulties and guide targeted health resource allocation for this population.

Analysis of equity in the distribution of human resources and hospital beds and its association with the COVID-19 mortality rate: a case of Iran

Background and objectiveEquitable distribution of health resources is important to achieving equity, guaranteeing access to healthcare services, and improving societies’ health status. This study aimed to examine equity in the distribution of health resources and its association with the mortality caused by COVID-19 in South Khorasan province, east Iran.MethodThis was a secondary analysis of data from a cross-sectional study conducted in South Khorasan province in 2022. Data were drawn from an existing online database (Farabar) provided by the Public Health Department of the Ministry of Health in Iran. Data related to the number of hospital beds, medical specialists and practitioners, nurses, paramedical workers, health watch, community health workers (Behvarz), healthcare financial resources, and COVID-19 mortality rate were extracted from the Farabar system for each city separately. The equity in the distribution of resources was analyzed by calculating the Gini Coefficient index and using EXCEL software. The Gini Coefficient was used to measure the distribution of health resources and services (i.e. financial resources, human resources, hospital beds, ICU beds) against population size and geographic size. Data were analyzed using SPSS software, version 25.ResultsThe Gini Coefficient ranged between 0.006 and 0.320. The Gini Coefficient of health care system financial (0.006) resources distribution was more equitable, while that of hospital beds (0.229) and intensive care beds (0.320) was more inequitable. The Gini Coefficient of the distribution of human resources was estimated at less than 0.3, which is relatively equitable. The COVID-19 mortality rate per 100,000 population was estimated at 113.6, lower than the national average. After controlling the confounding variable (rural population (as % of the total population)), there was no significant correlation between COVID-19 mortality and the distribution of human resources, hospital beds, and healthcare financial resources.ConclusionAccording to the results, the distribution of resources relative to the province’s population was relatively equitable, and there was no significant correlation between the COVID-19 mortality rate and the distribution of human resources, hospital beds, and healthcare financial resources. This can be due to the equitable distribution of health resources. Having a better and deeper understanding of the regions and populations disproportionately impacted by COVID-19 can help with intervention and resource allocation.

Long-term outcome and predictors of vagus nerve stimulation for drug-resistant epilepsy: Real-world evidence from the Korean national hospital consortium.

This study aimed to assess the long-term outcome and prognostic factors of vagus nerve stimulation (VNS) for drug-resistant epilepsy (DRE) using real-world data. We included 189 DRE patients who underwent VNS implantation between 2005 and 2018 at nine national hospitals in Korea. Seizure-frequency data obtained quarterly one year before and after surgery and annually up to four years after surgery were collected from medical records. Health resource utilization trends over the four years preceding and following surgery were assessed through linkage with national health insurance data. We performed interrupted time series analysis to examine the trend in seizure frequency before and after one year following surgery. The seizure frequency exhibited a decreasing trend in 27.5 % and an increasing trend in 3.8 % during the first year following VNS implantation without a significant change in efficacy over the subsequent three years. Patients with focal spikes with secondary bilateral synchrony (SBS) in electroencephalography had a higher responder rate (adjusted odds ratio (aOR)= 3.06 [1.36-6.90]), whereas those with Lennox-Gastaut syndrome had a lower responder rate (aOR=0.38 [0.15-0.94]). One-year seizure-freedom was achieved in 6.0 % of patients at some point during the four-year follow-up. Over an eight-year period, the number of antiseizure medications (ASMs) tended to increase before surgery and remained at a median of 5 [4-6] after surgery. While the total medical and epilepsy-related costs tended to decrease after surgery, the ASM cost continued to increase. VNS was substantially beneficial for one in four patients with DRE, offering the chance of seizure-freedom. However, the efficacy of VNS fell within the efficacy range of recently introduced medical treatments and did not lead to a decrease in the ASM burden. Focal spike with SBS is a potential biomarker for a favorable response to VNS.