scholarly journals Identification and management of frail patients in English primary care: an analysis of the General Medical Services 2018/2019 contract dataset

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e041091
Author(s):  
Khulud Alharbi ◽  
Thomas Blakeman ◽  
Harm van Marwijk ◽  
David Reeves
Keyword(s):  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Cross Sectional Study ◽  
Medical Services ◽  
Related Factors ◽  
Cross Sectional ◽  
Explanatory Factors ◽  
Medication Reviews ◽  
Management Contract ◽  
Contract Implementation

ObjectivesThe aim of this study was to explore the extent of implementation of the General Medical Services 2018/2019 ‘frailty identification and management’ contract in general practitioner (GP) practices in England, and link implementation outcomes to a range of practice and Clinical Commissioning Group (CCG) factors.DesignA cross-sectional study design using publicly available datasets relating to the year 2018 for all GP practices in England.SettingsEnglish general practices.DataThe analysis was conducted across 6632 practices in 193 CCGs with 9 995 558 patients aged 65 years or older.OutcomesFrailty assessment rates, frailty coding rates and frailty prevalence rates, plus rates of medication reviews, falls assessments and enriched Summary Care Records (SCRs).AnalysisSummary statistics were calculated and multilevel negative binomial regression analysis was used to investigate relationships of the six outcomes with explanatory factors.Results14.3% of people aged 65 years or older were assessed for frailty, with 35.4% of these—totalling 5% of the eligible population—coded moderately or severely frail. 59.2% received a medications review, but rates of falls assessments (3.7%) and enriched SCRs (21%) were low. However, percentages varied widely across practices and CCGs. Practice differences in contract implementation were most strongly accounted for by their grouping within CCGs, with weaker but still important associations with some practice and CCG factors, particularly healthcare demand-related factors of chronic caseload and (negatively) % of patients aged 65 years or older.ConclusionCCG appears the strongest determinant of practice engagement with the frailty contract, and fuller implementation may depend on greater engagement of CCGs themselves, particularly in commissioning suitable interventions. Practices understandably targeted frailty assessments at patients more likely to be found severely frail, resulting in probable underidentification of moderately frail individuals who might benefit most from early interventions. Frailty prevalence estimates based on the contract data may not reflect actual rates.

scholarly journals Differences in Results and Related Factors between Hospital-At-Home Modalities in Catalonia: A Cross-Sectional Study

2020 ◽  
Vol 9 (5) ◽  
pp. 1461
Author(s):  
Jorge Arias-de la Torre ◽  
Evangelia Anna María Zioga ◽  
Lizza Macorigh ◽  
Laura Muñoz ◽  
Oriol Estrada ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Related Factors ◽  
Cross Sectional ◽  
Outcome Indicators ◽  
Explanatory Factors ◽  
Hospital At Home ◽  
Effectiveness And Efficiency ◽  
At Home

Hospital-at-home (HaH) is a healthcare modality that provides active treatment by healthcare staff in the patient’s home for a condition that would otherwise require hospitalization. The aims were to describe the characteristics of different types of hospital-at-home (HaH), assess their results, and examine which factors could be related to these results. A cross-sectional study based on data from all 2014 HaH contacts from Catalonia was designed. The following HaH modalities were considered—admission avoidance (n = 7214; 75.1%) and early assisted discharge (n = 2387; 24.9%). The main outcome indicators were readmission, mortality, and length of stay (days). Multivariable models were fitted to assess the association between explanatory factors and outcomes. Hospital admission avoidance is a scheme in which, instead of being admitted to acute care hospitals, patients are directly treated in their own homes. Early assisted discharge is a scheme in which hospital in-care patients continue their treatment at home. In the hospital avoidance modality, there were 8.3% readmissions, 0.9% mortality, and a mean length of stay (SD) of 9.6 (10.6) days. In the early assisted discharge modality, these figures were 7.9%, 0.5%, and 9.8 (11.1), respectively. In both modalities, readmission and mean length of stay were related to comorbidity and type of hospital, and mortality with age. The results of HaH in Catalonia are similar to those observed in other contexts. The factors related to these results identified might help to improve the effectiveness and efficiency of the different HaH modalities.

scholarly journals Factors associated with COVID-19 infections and mortality in Africa: a cross-sectional study using publicly available data

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e042750
Author(s):  
Charles Okeahalam ◽  
Victor Williams ◽  
Kennedy Otwombe
Keyword(s):  
Risk Factors ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Sectional Study ◽  
African Countries ◽  
Cross Sectional ◽  
Life Expectancy At Birth ◽  
Services Delivery

IntroductionThe current COVID-19 pandemic is a global threat. This elicits questions on the level of preparedness and capacity of health systems to respond to emergencies relative to other parts of the world.MethodsThis cross-sectional study uses publicly available core health data for 53 African countries to determine risk factors for cumulative COVID-19 deaths and cases per million in all countries in the continent. Descriptive statistics were determined for the indicators, and a negative binomial regression was used for modelling the risk factors.ResultsIn sub-Saharan Africa, an increase in the number of nursing and midwifery personnel decreased the risk of COVID-19 deaths (p=0.0178), while a unit increase in universal healthcare (UHC) index of service coverage and prevalence of insufficient physical activity among adults increased the risk of COVID-19 deaths (p=0.0432 and p=0.0127). An increase in the proportion of infants initiating breast feeding reduced the number of cases per million (p<0.0001), while an increase in higher healthy life expectancy at birth increased the number of cases per million (p=0.0340).ConclusionDespite its limited resources, Africa’s preparedness and response to the COVID-19 pandemic can be improved by identifying and addressing specific gaps in the funding of health services delivery. These gaps impact negatively on service delivery in Africa, which requires more nursing personnel and increased UHC coverage to mitigate the effects of COVID-19.

scholarly journals Association of Pre- Peri- and Postnatal Factors with Developmental Defects of Enamel in Schoolchildren

2018 ◽  
Vol 42 (2) ◽  
pp. 125-134 ◽  
Author(s):  
Fabiana Vargas-Ferreira ◽  
Marco Aurelio Peres ◽  
Samuel Carvalho Dumith ◽  
William Murray Thomson ◽  
Flávio Fernando Demarco
Keyword(s):  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Cross Sectional Study ◽  
Older Children ◽  
Cross Sectional ◽  
Developmental Defects ◽  
Enamel Defects ◽  
Regression Modelling ◽  
Binomial Regression ◽  
Developmental Defects Of Enamel

Objective: This study estimated the prevalence, extent, buccal distribution and associated factors involving enamel defects in Brazilian schoolchildren. Study design: A cross-sectional study using a multistage cluster random sample of 1,206 8–12-year-old Brazilian schoolchildren was carried out in Pelotas, Brazil. The prevalence of enamel defects in the permanent dentition was determined using the modified Developmental Defects of Enamel index (DDE). Sociodemographic and health data were collected from their mothers using a semi-structured questionnaire. Data were analyzed using Poisson regression modelling for DDE prevalence and negative binomial regression modelling for the extent of DDE. Results: The prevalence of any enamel defects was 64.0% (95% Confidence Interval: 61.4, 67.0); the main types were diffuse opacities (35.0%), demarcated opacities (29.5%) and hypoplasia (3.7%). In general, older children had a lower prevalence and extent of enamel defects than their counterparts (p&lt;0.001). There were no other significant associations. Conclusion: Enamel defects are common, especially among younger children, but the role of pre-, peri- and postnatal exposures remains unclear.

scholarly journals Contextual and individual determinants of tooth loss in adults: a population-based multilevel study

2020 ◽  
Author(s):  
Luana Leal Roberto ◽  
Marise Fagundes Silveira ◽  
Alfredo Mauricio Batista De Paula ◽  
Efigênia Ferreira Ferreira ◽  
Andréa Maria Eleutério De Barros Lima Martins ◽  
...  
Keyword(s):  
Oral Health ◽  
Tooth Loss ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Population Based ◽  
Cross Sectional Study ◽  
Social Characteristics ◽  
Dental Services ◽  
Cross Sectional ◽  
Individual Level

Abstract Background: Tooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35-44 years of age), in accordance with individual and contextual social characteristics. Methods: This was a multilevel cross-sectional study with data from 9,564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated. Results: Brazilian adults lost a mean of 7.57 (95% CI 7.1-8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males. Conclusions: The number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.

scholarly journals Psychological distress among Ethiopian migrant returnees who were in quarantine in the context of COVID-19: institution-based cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kassahun Habtamu ◽  
Yekoyealem Desie ◽  
Mulat Asnake ◽  
Endirias Gina Lera ◽  
Temesgen Mequanint
Keyword(s):  
Psychological Distress ◽  
Depressive Symptoms ◽  
Negative Binomial ◽  
Addis Ababa ◽  
Negative Binomial Regression ◽  
Cross Sectional Study ◽  
Anxiety Symptoms ◽  
Sectional Study ◽  
Cross Sectional ◽  
Stress Symptoms

Abstract Background In association with the novel coronavirus (SARS-CoV-2) disease 2019 (COVID-19) pandemic, many numbers of Ethiopian migrants are returning to their home country, and they are required to stay in mandatory quarantine centers. This results in severe disruptions of life routines, social isolation, and loss of freedom. Studies on psychological distress among Ethiopian migrant returnees in the context of COVID-19 are scarce. This study aimed to investigate the prevalence of psychological distress and associated factors among migrant returnees who were in quarantine during the time of COVID-19. Methods A cross-sectional study was conducted with 405 migrant returnees recruited from quarantine centers in Addis Ababa. We developed a structured questionnaire to collect data on sociodemographic, migration related, quarantine related and COVID-19 related characteristics of participants. We used the 21 item Depression, Anxiety and Stress Scale to assess psychological distress. Univariate and multivariable negative binomial regression models were fitted to assess the association between exposure variables with depression, anxiety and stress separately. Results A little more than half of the participants (55%) had depressive symptoms; around half had anxiety symptoms (48.9%) and more than a third (35.6%) experienced symptoms of stress. We found significantly higher prevalence of anxiety (ARR = 0.59; 95% CI = 0.39, 0.91) and depressive symptoms (ARR = 0.56; 95% CI = 0.39, 0.81) among women than men. Fear of discrimination after the quarantine was significantly associated with depressive (ARR = 0.76; 95% CI = 0.63, 0.92) and anxiety symptoms (ARR = 0.77; 95% CI = 0.62, 0.97). Experiencing COVID-19 like symptoms is associated with depressive (ARR = 0.40; 95% CI = 0.25, 0.65), anxiety (ARR = 0.35; 95% CI = 0.20, 0.62) and stress symptoms (ARR = 0.43; 95% CI = 0.28, 0.66). Have no a plan of what to do after the quarantine (ARR = 1.30; 95% CI = 1.09, 1.54) was significantly associated with increasing stress scores. Conclusions We found a very high prevalence of depressive, anxiety and stress symptoms among Ethiopian migrant returnees who were in quarantine due to the COVID-19 pandemic. Screening, integration of mental health services with other socioeconomic and psychosocial services, and effective and efficient referral may be useful to address the burden of psychological distress in this group.

scholarly journals Impact of long-term exposure to PM2.5 and temperature on coronavirus disease mortality: observed trends in France

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anastase Tchicaya ◽  
Nathalie Lorentz ◽  
Hichem Omrani ◽  
Gaetan de Lanchy ◽  
Kristell Leduc
Keyword(s):  
Air Pollution ◽  
Mortality Rate ◽  
Negative Binomial ◽  
National Level ◽  
Negative Binomial Regression ◽  
Cross Sectional Study ◽  
Annual Average ◽  
Cross Sectional ◽  
Binomial Regression

Abstract Background The outbreak of coronavirus disease (COVID-19) began in Wuhan, China in December 2019 and was declared a global pandemic on 11 March 2020. This study aimed to assess the effects of temperature and long-term exposure to air pollution on the COVID-19 mortality rate at the sub-national level in France. Methods This cross-sectional study considered different periods of the COVID-19 pandemic from May to December 2020. It included 96 departments (or NUTS 3) in mainland France. Data on long-term exposure to particulate matter (PM2.5), annual mean temperature, health services, health risk, and socio-spatial factors were used as covariates in negative binomial regression analysis to assess their influence on the COVID-19 mortality rate. All data were obtained from open-access sources. Results The cumulative COVID-19 mortality rate by department increased during the study period in metropolitan France—from 19.8/100,000 inhabitants (standard deviation (SD): 20.1) on 1 May 2020, to 65.4/100,000 inhabitants (SD: 39.4) on 31 December 2020. The rate was the highest in the departments where the annual average of long-term exposure to PM2.5 was high. The negative binomial regression models showed that a 1 μg/m3 increase in the annual average PM2.5 concentration was associated with a statistically significant increase in the COVID-19 mortality rate, corresponding to 24.4%, 25.8%, 26.4%, 26.7%, 27.1%, 25.8%, and 15.1% in May, June, July, August, September, October, and November, respectively. This association was no longer significant on 1 and 31 December 2020. The association between temperature and the COVID-19 mortality rate was only significant on 1 November, 1 December, and 31 December 2020. An increase of 1 °C in the average temperature was associated with a decrease in the COVID-19-mortality rate, corresponding to 9.7%, 13.3%, and 14.5% on 1 November, 1 December, and 31 December 2020, respectively. Conclusion This study found significant associations between the COVID-19 mortality rate and long-term exposure to air pollution and temperature. However, these associations tended to decrease with the persistence of the pandemic and massive spread of the disease across the entire country.

scholarly journals Contextual and individual determinants of tooth loss in adults: a multilevel study

2020 ◽  
Author(s):  
Luana Leal Roberto ◽  
Marise Fagundes Silveira ◽  
Alfredo Mauricio Batista De Paula ◽  
Efigênia Ferreira Ferreira ◽  
Andréa Maria Eleutério De Barros Lima Martins ◽  
...  
Keyword(s):  
Oral Health ◽  
Tooth Loss ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Cross Sectional Study ◽  
Social Characteristics ◽  
Dental Services ◽  
Cross Sectional ◽  
Individual Level ◽  
The Individual

Abstract Background: Tooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35-44 years of age), in accordance with individual and contextual social characteristics. Methods: This was a multilevel cross-sectional study with data from 9,564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated. Results: Brazilian adults lost a mean of 7.57 (95% CI 7.1-8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males. Conclusions: The number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.

scholarly journals Contextual and individual determinants of tooth loss in adults: a population-based multilevel study

2020 ◽  
Author(s):  
Luana Leal Roberto ◽  
Marise Fagundes Silveira ◽  
Alfredo Mauricio Batista De Paula ◽  
Efigênia Ferreira Ferreira ◽  
Andréa Maria Eleutério De Barros Lima Martins ◽  
...  
Keyword(s):  
Oral Health ◽  
Tooth Loss ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Population Based ◽  
Cross Sectional Study ◽  
Social Characteristics ◽  
Dental Services ◽  
Cross Sectional ◽  
Individual Level

Abstract Background: Tooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35-44 years of age), in accordance with individual and contextual social characteristics. Methods: This was a multilevel cross-sectional study with data from 9,564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated. Results: Brazilian adults lost a mean of 7.57 (95% CI 7.1-8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males. Conclusions: The number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.

scholarly journals Impact of long-term exposure to PM2.5 and temperature on coronavirus disease mortality: observed trends in France

2021 ◽  
Author(s):  
Anastase Tchicaya ◽  
Nathalie Lorentz ◽  
Hichem Omrani ◽  
Gaetan de Lanchy ◽  
Kristell Leduc
Keyword(s):  
Air Pollution ◽  
Mortality Rate ◽  
Negative Binomial ◽  
National Level ◽  
Negative Binomial Regression ◽  
Cross Sectional Study ◽  
Annual Average ◽  
Cross Sectional ◽  
Binomial Regression

Abstract Background The outbreak of coronavirus disease (COVID-19) began in Wuhan, China in December 2019 and was declared a global pandemic on 11 March 2020. This study aimed to assess the effects of temperature and long-term exposure to air pollution on the COVID-19 mortality rate at the sub-national level in France.Methods This cross-sectional study considered different periods of the COVID-19 pandemic from May to December 2020. It included 96 departments (or NUTS 3) in mainland France. Data on long-term exposure to particulate matter (PM2.5), annual mean temperature, health services, health risk, and socio-spatial factors were used as covariates in negative binomial regression analysis to assess their influence on the COVID-19 mortality rate. All data were obtained from open-access sources.Results The cumulative COVID-19 mortality rate by department increased during the study period in metropolitan France—from 19.8/100,000 inhabitants (standard deviation (SD): 20.1) on 1 May 2020, to 65.4/100,000 inhabitants (SD: 39.4) on 31 December 2020. The rate was the highest in the departments where the annual average of long-term exposure to PM2.5 was high. The negative binomial regression models showed that a 1 µg/m³ increase in the annual average PM2.5 concentration was associated with a statistically significant increase in the COVID-19 mortality rate, corresponding to 24.4%, 25.8%, 26.4%, 26.7%, 27.1%, 25.8%, and 15.1% in May, June, July, August, September, October, and November, respectively. This association was no longer significant on 1 and 31 December 2020. The association between temperature and the COVID-19 mortality rate was only significant on 1 November, 1 December, and 31 December 2020. An increase of 1°C in the average temperature was associated with a decrease in the COVID-19-mortality rate, corresponding to 9.7%, 13.3%, and 14.5% on 1 November, 1 December, and 31 December 2020, respectively.Conclusion This study found significant associations between the COVID-19 mortality rate and long-term exposure to air pollution and temperature. However, these associations tended to decrease with the persistence of the pandemic and massive spread of the disease across the entire country.

Factors Contributing to Deer–Vehicle Crashes on Rural Two-Lane Roadways in Michigan

2019 ◽  
Vol 2673 (10) ◽  
pp. 214-224 ◽  
Author(s):  
Steven York Stapleton ◽  
Anthony Ingle ◽  
Timothy J. Gates
Keyword(s):  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Peak Level ◽  
The United States ◽  
Vehicle Crashes ◽  
Federal Aid ◽  
Related Factors ◽  
Cross Sectional ◽  
Rural Highways ◽  
Lane Width

Deer–vehicle crashes (DVCs) continue to be a problem in the United States, with 1.2 million such crashes occurring annually. DVCs are a particular issue on two-lane rural highways in Michigan, accounting for more than 60% of crashes. Such a high proportion of DVCs limits the transferability of existing safety models, including those found in the Highway Safety Manual (HSM), that are often based on data from states with considerably lower proportions of deer crashes. To counter this, a cross-sectional analysis of deer crashes was performed using data from Michigan. The data were analyzed across four categories of rural two-lane roadways, including: state highways, federal aid county roadways, non-federal aid county roadways, and unpaved (gravel) county roadways. Mixed effects negative binomial regression models utilizing spatial and temporal random effects were generated separately for each of the rural two-lane roadway types. Results showed speed-related factors, including lane width, shoulder width, horizontal curvature, and peak level of service, had a significant effect on DVC occurrence for most types of rural two-lane roadways in Michigan. Wider lanes were associated with a greater occurrence of deer crashes, perhaps because of higher prevailing travel speeds. Conversely, horizontal curves with design speeds lower than the statutory speed limit were associated with fewer deer crashes, perhaps because of lower travel speeds through curves. Wider shoulders, which afford greater separation between the travel lanes and the roadside, were found to have significantly lower deer crash occurrence. The number of available hunting licenses did not have a consistent effect on DVCs.

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