scholarly journals Underscreening and undertreatment? Periodontal service provision in very old Germans

2020 ◽  
Author(s):  
Joachim Krois ◽  
Aleksander Krasowski ◽  
Jesus Gomez Rossi ◽  
Sebastian Paris ◽  
Adelheid Kuhlmey ◽  
...  
Keyword(s):  
Treatment Planning ◽  
Service Provision ◽  
Urban Areas ◽  
Multivariable Analysis ◽  
Related Services ◽  
Very Old ◽  
Periodontal Status ◽  
Services Utilization ◽  
Heart Insufficiency ◽  
Icd 10

Abstract Objectives We aimed to assess periodontal services utilization in very old Germans. Methods A comprehensive sample of very old (≥ 75 years), insured at a large Northeastern statutory insurer was followed over 6 years (2012–2017). We assessed periodontal service provision, entailing (1) periodontal screening index (PSI), (2) periodontal status/treatment planning, (3) periodontal therapy (scaling and root planning with or without access surgery), (4) postoperative reevaluation, and (5) any of these four services groups. Association of utilization with (1) sex, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses, and (6) diagnoses-related groups was explored. Results 404.610 individuals were followed; 173,733 did not survive follow-up. The mean (SD) age was 81.9 (5.4) years. 29.4% (119,103 individuals) utilized any periodontal service, nearly all of them the PSI. Periodontal status/treatment planning, treatment provision, and reevaluation were provided to only a small fraction (1.54–1.57%, or 6224–6345) of individuals. The utilization of the PSI increased between 2012 and 2017; no such increase was observed for treatment-related services. Utilization decreased with age; those aged > 85 years received nearly no services at all. Decreases were more pronounced for treatment-related services. Utilization was lower in rural than urban areas, those with hardship status, and those severely ill (e.g., dementia, heart insufficiency). In multivariable analysis, a previous PSI measurement tripled the odds of receiving treatment-related services (OR: 3.2; 95% CI: 3.0-3.4). Conclusions Periodontal services utilization was low. Screening for periodontal disease significantly increased therapy provision. Social, demographic, regional, and general health aspects were associated with utilization. Clinical significance The utilization of periodontal services in the very old in Northeast Germany was low, and even screening was only performed in a minority of individuals. Policies to increase identification and management of periodontitis especially in the most vulnerable individuals are needed.

scholarly journals Prosthetic treatment patterns in the very old: an insurance database analysis from Northeast Germany

2020 ◽  
Vol 24 (11) ◽  
pp. 3981-3995 ◽  
Author(s):  
Fabian M. Hempel ◽  
Joachim Krois ◽  
Sebastian Paris ◽  
Florian Beuer ◽  
Adelheid Kuhlmey ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Federal State ◽  
Very Old ◽  
Services Utilization ◽  
Federal States ◽  
Icd 10 ◽  
Life Threatening ◽  
Fixed Dental Prostheses ◽  
The Mean ◽  
High Age

Abstract Objectives We assessed dental prosthetic services utilization in very old Germans. Methods A comprehensive sample of 404,610 very old (≥ 75 years), insured at one large statutory insurer (Allgemeine Ortskrankenkasse Nordost, acting in the federal states Berlin, Brandenburg, Mecklenburg-Vorpommern), were followed over 6 years (2012–2017). Our outcome was the utilization of prosthetic services, in total and seven subgroups: (1) Crowns/partial crowns, (2) fixed dental prostheses (FDPs), (3) partial removable prostheses (RDPs), (4) full RDPs, (5) temporary services, (6) relining/rebasing/repairing/extending RDPs, (7) repairing FDPs. Association of utilization with (1) gender, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses and (6) German diagnoses related groups (G-DRG) was explored. Results The mean (SD) age of the sample was 81.9 (5.4) years; mean follow-up was 1689 (705) days. The mean utilization of any prosthetic service was 27.0%; the most often utilized service type were total RDPs (13.2% utilization), crowns (8.1%), and partial RDPs (7.1%). Utilization decreased with age for nearly all services (except relining/rebasing/repairing/extending RDPs) Utilization of prosthetic services was significantly higher in Berlin and most cities compared with rural municipalities and in individuals with common, less severe conditions according to ICD-10 and DRGs compared with life-threatening conditions or dementia. In multivariable analysis, gender (OR; 95% CI: 0.95; 0.93–0.98), social hardship status (1.19; 1.17–1.21), federal state (Brandenburg 0.57; 0.56–0.59; Mecklenburg-Vorpommern: 0.66; 0.64–0.67) and age significantly affected utilization (0.95; 0.95–0.95/year). Conclusions Patient-related and healthcare factors determine the utilization of prosthetic services in very old Germans. Interventions to maintain sufficient prosthetic care up to high age are required. Clinical significance The utilization of prosthetic services in the very old in Northeast Germany showed significant disparities within populations and service types. There seems to be great need to better understand the drivers of utilization, and to develop and evaluate interventions to maintain sufficient prosthetic care up to high age.

scholarly journals Prevalence of acute diarrhea and associated factors among children under five in semi-urban areas of northeastern Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tarikuwa Natnael ◽  
Mistir Lingerew ◽  
Metadel Adane
Keyword(s):  
Acute Diarrhea ◽  
Urban Areas ◽  
Odds Ratio ◽  
Associated Factors ◽  
Multivariable Analysis ◽  
Water Sources ◽  
Children Under Five ◽  
Under Five ◽  
Under Five Children ◽  
Study Participants

Abstract Background Diarrheal disease is still one of the most common causes of mortality and morbidity in children under five in developing countries, including Ethiopia. Lack of specific data on the prevalence of acute diarrhea and associated factors among under-five children in the semi-urban areas of Gelsha, found in northeastern Ethiopia’s South Wollo zone, remains a major gap. Therefore, this study was designed to provide data that is important for proper planning of intervention measures to reduce the problem in this area. Methods A community-based cross-sectional study was conducted among 340 systematically selected children under five in semi-urban areas of Gelsha from January to March 2019. The data was collected using a structured questionnaire and an observational checklist. Bivariable (crude odds ratio [COR]) and multivariable analysis (adjusted odds ratio [AOR]) were employed using binary logistic regression model with 95% CI (confidence interval). Variables with a p-value < 0.05 from the multivariable analysis were declared as factors significantly associated with acute diarrhea. Result The prevalence of acute diarrhea among children under five in the study area was 11% (95%CI: 7.8–14.3%). About two-thirds (63.60%) of study participants used water from improved sources. About half (54.90%) of study participants practiced poor handwashing and 45.10% practiced good handwashing. We found that factors significantly associated with acute diarrhea were a child’s age of 12–23 months (AOR = 4.68, 95% CI: 1.45–1.50), the presence of two or more under-five children in the house (AOR = 2.84, 95% CI: 1.19–6.81), unimproved water sources (AOR = 2.97, 95% CI: 1.28–6.87) and presence of feces around the pit hole/slab/floor of the latrine (AOR = 3.34, 95% CI: 1.34–8.31). Conclusion The prevalence of acute diarrhea among children under five was relatively high. To reduce the problem, various prevention strategies are essential, such as the provision of health education to mothers/caregivers that focuses on keeping sanitation facilities clean and child care, and construction of improved water sources. Furthermore, implementing a strong health extension program, advocating an open defecation-free environment, and practicing a community-led total sanitation and hygiene approach might be helpful to sustainably reduce childhood diarrhea.

Gunshot Injuries of the Hand: Incidence, Treatment Characteristics, and Factors Associated With Healthcare Utilization

Hand ◽  
2021 ◽  
pp. 155894472199801
Author(s):  
Navapong Anantavorasakul ◽  
Ritsaart F. Westenberg ◽  
Arman T. Serebrakian ◽  
Meryam Zamri ◽  
Neal C. Chen ◽  
...  
Keyword(s):  
Motor Nerve ◽  
Multivariable Analysis ◽  
International Classification Of Diseases ◽  
Gunshot Injuries ◽  
Bullet Fragment ◽  
Treatment Characteristics ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Utilization Of Healthcare ◽  
Length Of Hospitalization

Background The objectives of this study are to: (1) describe the demographics, injury patterns, and treatment characteristics of patients who sustained a gunshot injury (GSI) of the hand; and (2) examine the utilization of healthcare resources in patients with a GSI of the hand. Methods We retrospectively identified 148 adult patients who were treated for a GSI of the hand between January 2000 to December 2017 using multiple International Classification of Diseases Ninth and Tenth Edition (ICD-9 and ICD-10) codes. We used bivariate and multivariable analysis to identify which factors are associated with unplanned reoperation, length of hospitalization, and number of operations. Results Multivariable logistic regression showed that fracture severity was associated with unplanned reoperation. Multivariable linear regression showed that fracture severity is associated with a higher number of hand operations after a GSI of the hand, and that a retained bullet (fragment) and patients having gunshot injuries in other regions than the hand had a longer length of hospitalization. Seventy (47%) patients had sensory or motor symptoms in the hand after their GSI, of which 22 (15%) patients had a transection of the nerve. Conclusions Sensory and motor nerve deficits are common after a GSI of the hand. However, only 31% of patients with symptoms had a transection of the nerve. A retained bullet (fragment), having more severe hand fractures, and GSI in other regions than the hand are associated with a higher number of operation and a longer period of hospitalization.

scholarly journals Comparison of The Risk Factors For Falls Among Older Adults Between Urban and Rural Areas of Shantou City, China

2020 ◽  
Author(s):  
Xiaodong Chen ◽  
Zeting Lin ◽  
Ran Gao ◽  
Yijian Yang ◽  
Liping Li
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Fall Prevention ◽  
Rural Areas ◽  
Urban Areas ◽  
Multivariable Analysis ◽  
Living Environment ◽  
Balance Function ◽  
Urban And Rural Areas ◽  
Risk Factors For Falls

Abstract Background: To investigate the prevalence of falls and risk factors among older adults in urban and rural areas and to facilitate the design of fall prevention interventions.Methods: We used cluster random sampling to investigate the sociodemographic information, living habits, medical history, and falls among 649 older adult participants. Univariable and multivariable logistic regression was used to examine fall risk factors in urban and rural areas.Results: The fall rate and rate of injury from falls among older adults in urban areas were 27.3% and 18.6%, respectively, which were higher than those in rural areas (17.0% and 12.2%; P<0.05). Multivariable analysis showed that the risk factors for falls among urban older adults included a high school or below education level (OR=3.737, 95% CI: 1.503~9.291); diabetes medicine use (OR=4.518, 95% CI: 1.228~16.626); incontinence (OR=8.792, 95% CI: 1.894~40.824); lack of fall prevention education (OR = 11.907, 95% CI: 1.321～107.354); and reduced balance function (OR = 3.901, 95% CI: 1.894~7.815). The risk factors among rural older adults included a previous nonfarming occupation (OR=2.496, 95% CI: 1.416~4.398); incontinence (OR =11.396, 95% CI: 1.901~68.327); poor living environment (OR=3.457, 95% CI: 1.488~8.033); and reduced balance function (OR =4.260, 95% CI: 2.361~7.688).Discussion: The rate of falls among older adults in urban areas is higher than that in rural areas of Shantou City. Fall prevention in urban areas should target older adults with low education and modify the diabetes medication use. Interventions should focus on improving the home environment of older adults in rural areas.

scholarly journals Factors associated with low birth weight in Afghanistan: a cross-sectional analysis of the demographic and health survey 2015

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e025715 ◽  
Author(s):  
Rajat Das Gupta ◽  
Krystal Swasey ◽  
Vanessa Burrowes ◽  
Mohammad Rashidul Hashan ◽  
Gulam Muhammed Al Kibria
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Health Survey ◽  
Urban Areas ◽  
Maternal Education ◽  
Multivariable Analysis ◽  
Demographic And Health Survey ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Factors Associated

ObjectivesThis study aimed to investigate the factors associated with low birth weight (LBW) in Afghanistan.DesignCross-sectional study.SettingThis study used data collected from the Afghanistan Demographic and Health Survey 2015.ParticipantsFacility-based data from 2773 weighted live-born children enrolled by a two-stage sampling strategy were included in our analysis.Primary and secondary outcome measuresThe primary outcome was LBW, defined as birth weight <2.5kg.ResultsOut of 2773 newborns, 15.5% (n=431) had LBW. Most of these newborns were females (58.3%, n=251), had a mother with no formal schooling (70.5%, n=304), lived in urban areas (63.4%, n=274) or lived in the Central region of Afghanistan (59.7%, n=257). In multivariable analysis, residence in Central (adjusted OR (AOR): 3.4; 95% CI 1.7 to 6.7), Central Western (AOR: 3.0; 95% CI 1.5 to 5.8) and Southern Western (AOR: 4.0; 95% CI 1.7 to 9.1) regions had positive association with LBW. On the other hand, male children (AOR: 0.5; 95% CI 0.4 to 0.8), newborns with primary maternal education (AOR: 0.5; 95% CI 0.3 to 0.8), birth interval ≥48 months (AOR: 0.4; 95% CI 0.1 to 0.8), belonging to the richest wealth quintile (AOR: 0.2; 95% CI 0.1 to 0.6) and rural residence (AOR: 0.3; 95% CI 0.2 to 0.6) had decreased odds of LBW.ConclusionsMultiple factors had association with LBW in Afghanistan. Maternal, Neonatal and Child Health programmes should focus on enhancing maternal education and promoting birth spacing to prevent LBW. To reduce the overall burden of LBW, women of the poorest wealth quintiles, and residents of Central, Central Western and South Western regions should also be prioritised. Further exploration is needed to understand why urban areas are associated with higher likelihood of LBW. In addition, research using nationally representative samples are required.

Educational Services for Students with Intellectual Disabilities in Rural and Urban Areas of the Republic of Ireland

1996 ◽  
Vol 15 (3) ◽  
pp. 20-24 ◽  
Author(s):  
Hugh Gash ◽  
Mark O'reilly ◽  
Patricia Noonan Walsh
Keyword(s):  
Intellectual Disabilities ◽  
Service Provision ◽  
Urban Areas ◽  
Educational Services ◽  
Educational Systems ◽  
Republic Of Ireland ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
History Of ◽  
The Republic

We have examined the history of education service provision in the Republic of Ireland for persons with intellectual disabilities. We distinguished between children with mild or general learning difficulties and those with severe and profound intellectual disabilities as the development of educational services for these two groups has differed dramatically. Distinctions between rural and urban educational systems were made where appropriate. We have purposefully neglected to address services for students with moderate intellectual disabilities as we believe that those services for students with mild and severe intellectual disabilities will give the reader an overall flavour of educational services in Ireland within the context of this brief report. The current context of educational service provision in Ireland has also been highlighted with recent debates and suggestions for future development presented.

Individualized Prediction of Colon Cancer Recurrence Using a Nomogram

2008 ◽  
Vol 26 (3) ◽  
pp. 380-385 ◽  
Author(s):  
Martin R. Weiser ◽  
Ron G. Landmann ◽  
Michael W. Kattan ◽  
Mithat Gonen ◽  
Jinru Shia ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Treatment Planning ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Cancer Recurrence ◽  
Significant Heterogeneity ◽  
Continuous Variables ◽  
Concordance Index ◽  
Curative Surgery ◽  
Colon Cancer Recurrence

PurposeEstimates of recurrence after curative colon cancer surgery are integral to patient care, forming the basis of cancer staging and treatment planning. The categoric staging system of the American Joint Committee on Cancer (AJCC) is commonly used to convey risk by grouping patients based on anatomic elements. Although easy to implement, there remains significant heterogeneity within each stage grouping. In the era of multimodality treatment, a more refined tool is needed to predict recurrence.MethodsAn institutional database of 1,320 patients with nonmetastatic colon cancer was used to develop a nomogram to estimate recurrence after curative surgery. Prognostic factors were assessed with multivariable analysis using Cox regression, whereas nonlinear continuous variables were modeled with cubic splines. The model was internally validated with bootstrapping, and performance was assessed by concordance index and a calibration curve.ResultsThe colon cancer recurrence nomogram predicted relapse with a concordance index of 0.77, improving on the stratification provided by either the AJCC fifth or sixth staging scheme. Factors in the model included patient age, tumor location, preoperative carcinoembryonic antigen, T stage, numbers of positive and negative lymph nodes, lymphovascular invasion, perineural invasion, and use of postoperative chemotherapy.ConclusionUsing common clinicopathologic factors, the recurrence nomogram is better able to account for tumor and patient heterogeneity, thereby providing a more individualized outcome prognostication than that afforded by the AJCC categoric system. By identifying both the high- and low-risk patients within any particular stage, the nomogram is expected to aid in treatment planning and future trial design.

scholarly journals A Cross-sectional Survey of Rehabilitation Service Provision for Children with Brain Injury in Selangor, Malaysia

2018 ◽  
Vol 1 (2) ◽  
pp. 45-58
Author(s):  
Ee Lin Tay ◽  
Chee Piau Wong
Keyword(s):  
Brain Injury ◽  
Rural Areas ◽  
Service Provision ◽  
Urban Areas ◽  
Urban Poor ◽  
Service Providers ◽  
Rehabilitation Service ◽  
Rehabilitation Services ◽  
Unequal Distribution ◽  
Persons With Disabilities

Purpose:  Rehabilitation services in Malaysia are provided by both governmental and non-governmental agencies but there are challenges, such as the lack of integration between agencies, and accessibility barriers to services especially for the population of urban poor and people in the rural areas. With the help of a survey, this project aimed to gain a better understanding of rehabilitation services provided for children with brain injury within the state of Selangor and Federal Territories of Kuala Lumpur and Putrajaya.Method:  A list of 205 organisations that provide rehabilitation services for children with neurological injuries was compiled. The researchers attempted to verify the services by visiting the facilities or via telephone or email communication if visits were not possible.Results: The researchers were able to verify 83% of the organisations identified. There are 40 hospitals and 17 service providers for acute and / or chronic physical rehabilitation services for persons with disabilities of all ages, including children.Conclusion: Findings showed the unequal distribution of rehabilitation service provision by districts. Service providers were concentrated in the urban areas. Setting up new healthcare facilities is one of the solutions but the costs for development, construction, and manpower could be high. An alternative solution is proposed, namely, the use of a home-based virtual rehabilitation programme.

scholarly journals The Mortality burden of hematological malignancies in Ecuador

2021 ◽  
Vol 11 (2) ◽  
pp. 1040-1048
Author(s):  
David Israel Garrido ◽  
Andres Orquera ◽  
Johanna Rojas ◽  
Manuel Granja
Keyword(s):  
Urban Areas ◽  
Mortality Rates ◽  
Cross Sectional Study ◽  
National Registry ◽  
National Database ◽  
Lymphoid Tissues ◽  
Cross Sectional ◽  
Hematological Neoplasms ◽  
Specific Mortality ◽  
Icd 10

Background: The Hematological neoplasms (HN) are a heterogeneous group of cancers that originated in the hematopoietic or lymphoid tissues. There is reduced information published regarding HN mortality in Ecuador. This study aims to present the crude and age-specific mortality rates for HN in the Ecuadorian population. Methods: We performed a cross-sectional study through the national database of defunctions published by the Ecuadorian National Institute of Statistics and Census, 2019. We used the ICD-10 codes to classify the HN. Results: During 2019, 1462 deaths were reported, 53.83% were males, 87.96% of mestizo ethnicity, and 78.32% residents in urban areas. The median age was 62 years, with an interquartile range of 34. The crude mortality rate obtained was 8.49 per 100000 inhabitants, and the higher age-specific mortality rates was 43.29 per 100000 inhabitants aged ≥ 60 years, contrasting with the 2.63 per 100000 inhabitants in people aged < 20 years. Considering each ICD-10 group, we found the following rates by 100000 inhabitants; C85 2.04, C91 1.92, C92 1.46, C90 1.11, C83 0.70, C95 0.48, C81 0.38, C84 0.16, C82 0.10, C96 0.05, C93 0.04, C86 and C94 0.02, and C88 0.01. Conclusion: In Ecuador, during 2019, approximately eight people died due to HN by 100000 inhabitants, affecting mainly people aged ≥ 60 years. The most frequent neoplasms were Non-Hodgkin lymphomas, similar to other reports globally. These results should be analyzed considering some deficiencies in the Ecuadorian health system and the national registry. Therefore, we suggest conducting more studies regarding HN.

scholarly journals Making doctors stay: Rethinking doctor retention policy in a contracted-out primary healthcare setting in urban Bangladesh

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262358
Author(s):  
Farzana Bashar ◽  
Rubana Islam ◽  
Shaan Muberra Khan ◽  
Shahed Hossain ◽  
Adel A. S. Sikder ◽  
...  
Keyword(s):  
Service Delivery ◽  
Primary Healthcare ◽  
Service Provision ◽  
Urban Areas ◽  
Financial Incentives ◽  
Clinical Skills ◽  
Healthcare Services ◽  
Working Environment ◽  
Staff Retention ◽  
Contracting Out

Background “Contracting Out” is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge. This paper highlights the issues influencing doctor’s retention both in managerial as well as service provision level in the contracted-out setting. Methodology In this qualitative study, 42 Key Informant Interviews were undertaken with individuals involved with UPHCP in various levels including relevant ministries, project personnel representing the City Corporations and municipalities, NGO managers and doctors. Verbatim transcripts were coded in ATLAS.ti and analyzed using the thematic analysis. Document review was done for data triangulation. Results The most cited problem was a low salary structure in contrast to public sector pay scale followed by a dearth of other financial incentives such as performance-based incentives, provident funds and gratuities. Lack of career ladder, for those in both managerial and service delivery roles, was also identified as a factor hindering staff retention. Other disincentives included inadequate opportunities for training to improve clinical skills, ineffective staffing arrangements, security issues during night shifts, abuse from community members in the context of critical patient management, and lack of job security after project completion. Conclusions An adequate, efficient and dedicated health workforce is a pre-requisite for quality service provision and patient utilization of these services. Improved career development opportunities, the provision of salaries and incentives, and a safer working environment are necessary actions to retain and motivate those serving in managerial and service delivery positions in contracting out arrangements.

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