A neutrophil activation signature predicts critical illness and mortality in COVID-19

Pathologic immune hyperactivation is emerging as a key feature of critical illness in COVID-19, but the mechanisms involved remain poorly understood. We carried out proteomic profiling of plasma from cross-sectional and longitudinal cohorts of hospitalized patients with COVID-19 and analyzed clinical data from our health system database of over 3,300 patients. Using a machine learning algorithm, we identified a prominent signature of neutrophil activation, including resistin, lipocalin-2, HGF, IL-8, and G-CSF, as the strongest predictors of critical illness. Neutrophil activation was present on the first day of hospitalization in patients who would only later require transfer to the intensive care unit, thus preceding the onset of critical illness and predicting increased mortality. In the health system database, early elevations in developing and mature neutrophil counts also predicted higher mortality rates. Altogether, we define an essential role for neutrophil activation in the pathogenesis of severe COVID-19 and identify molecular neutrophil markers that distinguish patients at risk of future clinical decompensation.

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A neutrophil activation signature predicts critical illness and mortality in COVID-19

Blood Advances ◽

10.1182/bloodadvances.2020003568 ◽

2021 ◽

Vol 5 (5) ◽

pp. 1164-1177 ◽

Cited By ~ 5

Author(s):

Matthew L. Meizlish ◽

Alexander B. Pine ◽

Jason D. Bishai ◽

George Goshua ◽

Emily R. Nadelmann ◽

...

Keyword(s):

Critical Illness ◽

Health System ◽

Learning Algorithm ◽

Neutrophil Activation ◽

Lipocalin 2 ◽

Proteomic Profiling ◽

Cross Sectional ◽

System Database ◽

Mature Neutrophil ◽

Patients At Risk

Abstract Pathologic immune hyperactivation is emerging as a key feature of critical illness in COVID-19, but the mechanisms involved remain poorly understood. We carried out proteomic profiling of plasma from cross-sectional and longitudinal cohorts of hospitalized patients with COVID-19 and analyzed clinical data from our health system database of more than 3300 patients. Using a machine learning algorithm, we identified a prominent signature of neutrophil activation, including resistin, lipocalin-2, hepatocyte growth factor, interleukin-8, and granulocyte colony-stimulating factor, which were the strongest predictors of critical illness. Evidence of neutrophil activation was present on the first day of hospitalization in patients who would only later require transfer to the intensive care unit, thus preceding the onset of critical illness and predicting increased mortality. In the health system database, early elevations in developing and mature neutrophil counts also predicted higher mortality rates. Altogether, these data suggest a central role for neutrophil activation in the pathogenesis of severe COVID-19 and identify molecular markers that distinguish patients at risk of future clinical decompensation.

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Evaluating the readiness of mobile technology in Saudi Arabia: An Integrative Perspective with respect to e-health (Preprint)

10.2196/preprints.22896 ◽

2020 ◽

Author(s):

Fahad Alanezi

Keyword(s):

Saudi Arabia ◽

Health System ◽

Mobile Phones ◽

Personal Data ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Health Apps ◽

History Of ◽

Vision 2030 ◽

Awareness Programs

UNSTRUCTURED E-health system is emerging and providing health services and solutions through different electronic gadgets. Saudi Arabia has launched a program called Saudi Arabia vision 2030, in which providing state-of-the-art health facilities to their citizen is of topmost priority. After all the efforts, the residents of Saudi Arabia are still reluctant for the adaptation of e-health system. The current study was conducted to evaluate the obstacle in adoption of the e-health system through the mobile phones. The current study was cross-sectional survey and was conducted by developing a self-administered structured questionnaire asking the utilization of mobile phone in state of health emergency prior to ask any medical history. Majority of the participants was married and doing jobs in different firms and have their personal mobile phones (p = 0.100, > 0.05) which indicates easily access to the e-health apps. The majority of the participants suffers from either obesity or high blood pressure (p = 0.018, < 0.05) regardless of either history of mental disorder or other family history of mental diseases. The pattern of diseases with mental disorders correlate well with adoption of e-health in government policies. The obstacles in adopting e-health includes fear of the loss of personal data and information (p = 0.0401, < 0.05). Moreover, they did not trust on online medications as the doctor cannot prescribe medicines without seeing physical health of the patient. The current study concluded that by making improvement in policies and proper commercializing the e-health apps together with awareness programs can boast the adoption of e-health in Saudi Arabia.

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Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-10477-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sajad Vahedi ◽

Amin Torabipour ◽

Amirhossein Takian ◽

Saeed Mohammadpur ◽

Alireza Olyaeemanesh ◽

...

Keyword(s):

Health System ◽

Age Groups ◽

Unmet Need ◽

Healthcare Services ◽

Cross Sectional Study ◽

Outpatient Services ◽

Self Medication ◽

Cross Sectional ◽

Organizational Policies ◽

Utilization Of Healthcare

Abstract Background Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. Results About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. Conclusion It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.

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Sarcopenia and Malnutrition Screening in Female Osteoporosis Patients—A Cross-Sectional Study

Journal of Clinical Medicine ◽

10.3390/jcm10112344 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2344

Author(s):

Franca Genest ◽

Dominik Rak ◽

Elisa Bätz ◽

Kerstin Ott ◽

Lothar Seefried

Keyword(s):

At Risk ◽

Risk Groups ◽

Cross Sectional Study ◽

Mineral Density ◽

Cross Sectional ◽

Functional Deficits ◽

Complementary Approach ◽

Study Results ◽

Patients At Risk ◽

Not At Risk

Sarcopenia and malnutrition are important determinants of increased fracture risk in osteoporosis. SARC-F and MNA-SF are well-established questionnaires for identifying patients at risk for these conditions. We sought to evaluate the feasibility and potential added benefit of such assessments as well as the actual prevalence of these conditions in osteoporosis patients. We conducted a cross-sectional, single-center study in female osteoporosis patients ≥ 65 years (SaNSiBaR-study). Results of the sarcopenia (SARC-F) and malnutrition (MNA-SF) screening questionnaires were matched with a functional assessment for sarcopenia and data from patients’ medical records. Out of 107 patients included in the analysis, a risk for sarcopenia (SARC-F ≥ 4 points) and a risk for malnutrition (MNA-SF ≤ 11 points) was found in 33 (30.8%) and 38 (35.5%) patients, respectively. Diagnostic overlap with coincident indicative findings in both questionnaires was observed in 17 patients (16%). As compared to the respective not-at-risk groups, the mean short physical performance battery (SPPB) score was significantly reduced in both patients at risk for sarcopenia (7.0 vs. 10.9 points, p < 0.001) and patients at risk for malnutrition (8.7 vs. 10.5 points, p = 0.005). Still, confirmed sarcopenia according to EWGSOP2 criteria was present in only 6 (6%) of all 107 patients, with only 3 of them having an indicative SARC-F score. Bone mineral density was not significantly different in any of the at-risk groups at any site. In summary, applying SARC-F and MNA-SF in osteoporosis patients appears to be a complementary approach to identify individuals with functional deficits.

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Vaccination knowledge, attitudes and practices in patients with HIV: a cross-sectional survey

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.824 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S Rousset ◽

G Voglino ◽

E Boietti ◽

A Corradi ◽

M R Gualano ◽

...

Keyword(s):

Public Health ◽

Infectious Diseases ◽

Health System ◽

Vaccination Coverage ◽

Public Health System ◽

Cross Sectional Survey ◽

Hiv Patients ◽

Cross Sectional ◽

Contagion Risk ◽

High Level

Abstract Background Infectious diseases are more common and severe in patients with HIV, which show different response to vaccines and a diminished protection. It is therefore very important to assess knowledge and attitudes towards vaccination in people with HIV, since precise vaccination coverage and vaccine hesitancy are not well established in this subgroup of patients. Methods A sample of 119 patients with HIV completed a cross-sectional survey. Patients were recruited during their routine medical examination at the infectious diseases clinic in Turin. The survey explored these main areas: demographics and history of HIV infection, vaccination history, attitudes towards vaccination, confidence in the public health system, contagion risk and disease seriousness perception. In this preliminary phase descriptive analysis were conducted. Results Preliminary data show that mean age of the participants was 49.51 years, 80% were males. The median of HIV infection duration was 10 years, while the median of the lymphocyte count was 762.50 cells/mm3. The disease with the highest vaccination coverage was tetanus (88.7%), considered a serious or very serious disease by 85.6% of the participants, despite low or very low contagion risk perception (84.1%). The disease with the lowest vaccination coverage was Herpes Zoster (7.3%), despite high or very high seriousness perception (70%). Furthermore, 99.1% of the participants showed high or very high confidence toward public health system professionals, and the majority of them (59.5%) stated that vaccines are more useful for the community than for the single person. Conclusions Vaccination coverage is still not fully satisfactory regarding diseases considered infrequent or mild. Considering the high level of confidence toward the public health system that has emerged, it is necessary to implement informative and operative strategies about vaccination for European HIV patients, which are particularly at risk regarding infectious diseases. Key messages Vaccination coverage and risk perception in HIV patients is not satisfactory for many diseases and an effort to implement informative strategies in Europe is needed. The role of vaccination in preventing infectious diseases in HIV patients should be recognized and strengthened by relying on the high level of confidence toward European public health systems.

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Retrospective study of the distribution of doctors in municipalities of extreme poverty in Brazil

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.323 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

B L O Luizeti ◽

E M M Massuda ◽

L F G Garcia

Keyword(s):

Public Health ◽

Health System ◽

Cross Sectional Study ◽

Cross Sectional ◽

Extreme Poverty ◽

The Public ◽

The North ◽

Unified Health System ◽

Shortage Of Doctors ◽

Demographic Distribution

Abstract In view of the national scenario of scarcity of material and human resources in public health in Brazil, the survey verified the demographics of doctors who attend the Unified Health System (SUS) in municipalities of extreme poverty. An observational, analytical and cross-sectional study was carried out, based on secondary quantitative data from the Department of Informatics of the SUS using the TABNET of December 2019. The care networks variable was restricted to infer the number of physicians who attend the SUS in extreme poverty municipalities in Brazil. Municipalities of extreme poverty are those that at least 20% of the population have a household income of up to 145 reais per capita monthly. In Brazil, there are 1526 municipalities in extreme poverty, 27.4% of the country's total municipalities. 14,907 doctors linked to SUS work in this condition, 3.19% of the total of these professionals in Brazil. There is still disproportion between regions: North concentrates 11.2% of the municipalities in extreme poverty and 8.61% of the total number of doctors; Northeast, with 61.33% of these municipalities, for 61.5% of doctors; Southeast, with 15.46% of the municipalities in this condition, has 20.6% of doctors; South concentrates 10.87% of the municipalities under discussion with 5.61% of doctors and the Midwest, with 4.87% of these municipalities, has 3.54% of doctors. Between 2009 and 2018, there was a 39% increase in the number of doctors in these locations, however, for 2019, there was a decrease of 3.89%. The medical demographic distribution in Brazil is uneven, especially in the North. There is also the vulnerability of this population in view of the observed reduction in the number of professionals between 2018 and 2019 in municipalities of extreme poverty, for political reasons. It is evident the need to restructure the health system to guarantee access to health for this population, through the attraction and fixation of doctors in needy regions in Brazil. Key messages Shortage of doctors in extreme poverty municipalities reinforces the health vulnerability of the population in Brazil. The uneven medical demography in Brazil requires restructuring in the public health system.

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Women’s report of mistreatment during facility-based childbirth: validity and reliability of community survey measures

BMJ Global Health ◽

10.1136/bmjgh-2020-004822 ◽

2021 ◽

Vol 5 (Suppl 2) ◽

pp. e004822

Author(s):

Hannah Hogan Leslie ◽

Jigyasa Sharma ◽

Hedieh Mehrtash ◽

Blair Olivia Berger ◽

Theresa Azonima Irinyenikan ◽

...

Keyword(s):

Health System ◽

Physical Abuse ◽

Convergent Validity ◽

Healthcare Workers ◽

Post Partum ◽

Community Survey ◽

Professional Standards ◽

Validity And Reliability ◽

Cross Sectional ◽

Scale Scores

BackgroundAccountability for mistreatment during facility-based childbirth requires valid tools to measure and compare birth experiences. We analyse the WHO ‘How women are treated during facility-based childbirth’ community survey to test whether items mapping the typology of mistreatment function as scales and to create brief item sets to capture mistreatment by domain.MethodsThe cross-sectional community survey was conducted at up to 8 weeks post partum among women giving birth at hospitals in Ghana, Guinea, Myanmar and Nigeria. The survey contained items assessing physical abuse, verbal abuse, stigma, failure to meet professional standards, poor rapport with healthcare workers, and health system conditions and constraints. For all domains except stigma, we applied item-response theory to assess item fit and correlation within domain. We tested shortened sets of survey items for sensitivity in detecting mistreatment by domain. Where items show concordance and scale reliability ≥0.60, we assessed convergent validity with dissatisfaction with care and agreement of scale scores between brief and full versions.Results2672 women answered over 70 items on mistreatment during childbirth. Reliability exceeded 0.60 in all countries for items on poor rapport with healthcare workers and in three countries for items on failure to meet professional standards; brief scales generally showed high agreement with longer versions and correlation with dissatisfaction. Brief item sets were ≥85% sensitive in detecting mistreatment in each country, over 90% for domains of physical abuse and health system conditions and constraints.ConclusionBrief scales to measure two domains of mistreatment are largely comparable with longer versions and can be informative for these four distinct settings. Brief item sets efficiently captured prevalence of mistreatment in the five domains analysed; stigma items can be used and adapted in full. Item sets are suitable for confirmation by context and implementation to increase accountability and inform efforts to eliminate mistreatment during childbirth.

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Perspectives of pharmaceutical stakeholders on determinants of medicines accessibility at the primary care level

Journal of Egyptian Public Health Association ◽

10.1186/s42506-020-00062-x ◽

2021 ◽

Vol 96 (1) ◽

Author(s):

Hoda Ibrahim Rizk ◽

Monira Mahmoud Elkholy ◽

Abeer Abdou Barakat ◽

Raghda Mostafa Mostafa Elsayed ◽

Shaimaa A. M. Abd El Fatah

Keyword(s):

Health System ◽

Access To Medicines ◽

Generic Medicine ◽

Essential Medicines ◽

Cross Sectional ◽

Urban Group ◽

Rural And Urban ◽

External Stakeholders ◽

Assessment Approach ◽

The Government

Abstract Background Equitable access to essential medicines of maintained efficacy, safety, quality, and cost-effectiveness must be ensured by a well-functioning health system. This study aims to identify the determinants of patients’ access to medicines at the primary health care (PHC) level from the perspectives of various (internal and external) stakeholders of the pharmaceutical system. Methods The study employed both quantitative and qualitative components. Quantitative component applied a descriptive a cross-sectional design and qualitative component applied an in-depth interview design. It was a health system research conducted at two (PHC) facilities (one urban and the other rural) in Egypt. It inquired upon political, economic, and managerial aspects of the pharmaceutical system utilizing the “Health System Assessment Approach: a How-To Manual” and the “WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations.” Results Analysis of the quantitative data extracted from the cross-sectional component with external stakeholders (patients) revealed that about one-third of patients in both facilities were unable to pay for the medicine. Patients in both settings took less than an hour to reach the PHC facility. The Percent of patients who believe that the private pharmacies’ medicine is better than the PHC one was significantly higher in rural than urban group (24% and 10% respectively) and the percent of medicines dispensed was 50% and 66.7% in rural and urban groups respectively. Analysis of the qualitative data extracted from in-depth interviews with internal stakeholders (key informants from regulatory agencies, pharmaceutical industry, academia, pharmacists, and physicians) were summarized utilizing Strengths-Weaknesses-Opportunities-Challenges (SWOC) analysis approach. Various viewpoints toward the determinants of patients’ access to medicines were disclosed. Conclusions The Percent of medicines dispensed was insufficient in both rural and urban facilities. There is a need to invest in building trust in generic medicine quality in the government health facilities focusing on improving medicine availability and ensuring enough amounts of high-quality drugs. Although there are drug committees in the two studied PHC facilities for demonstrating the prescribing and dispensing policies, yet the system required to enforce these policies is still deficient.

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Changes in contraception use among Brazilian women after childbirth, 2006-2013

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.981 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Felisbino-Mendes ◽

B Barrozo Siqueira

Keyword(s):

Health System ◽

Secondary Data ◽

Reproductive Age ◽

Cross Sectional ◽

Regional Inequalities ◽

Unified Health System ◽

Contraception Use ◽

High Prevalence ◽

Modern Methods ◽

Low Prevalence

Abstract Introduction There are gaps in knowledge regarding the neglected and vulnerable subgroups of FP actions in Brazil, such as postpartum women and women in general, regardless of their marital status. Objective To assess changes in the prevalence of use and in the contraceptive pattern of Brazilian women up to two years after pregnancy, between 2006 and 2013. Methods Cross-sectional, descriptive and analytical study which used secondary data from national surveys. We studied Brazilian women with up to 2 years postpartum, of reproductive age, sexually active, non-pregnant and menstruating, and compared them with all the other women. We estimated the prevalence of use, contraception pattern of contraception and ranking of modern methods. Percentual change in indicators between the years was evaluated by calculating the difference between estimates. Results 85% of Brazilian women used CM, remaining stable in 2006 and 2013, with a high prevalence of modern methods use. An increase in the use of CM was observed among those with up to six months postpartum (71.0% to 89.0%). Pills and condoms accounted for about 60% of modern methods used in the postpartum period in both surveys. There was an increase in dual protection (2.9% to 10.1%) and contraceptive insecurity (1.6% to 5.7%) and a reduction in sterilization (16.2% to 13.4%) and traditional methods (2.1% to 1.4%). Conclusions Even with the maintenance of a high prevalence of use of CM and with the increase in contraception among women with up to six months postpartum, regional inequalities in access to CM and low prevalence of the use of other methods made available by the Unified Health System (SUS) persist, pointing out the maintenance of the insufficient care, failures in the means to regulate fertility and that public policies still hinder to guarantee the sexual and reproductive rights of the most vulnerable population. Key messages Regional inequalities in access to contraceptive methods and low prevalence of other methods made available by the Unified Health System (SUS) persist. There was an increase in contraception use among women with up to six months postpartum in Brazil.

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