scholarly journals COVID‐19 and Anticoagulation for Atrial Fibrillation: An Analysis of US Nationwide Pharmacy Claims Data

2021 ◽  
Author(s):  
Inmaculada Hernandez ◽  
Nico Gabriel ◽  
Meiqi He ◽  
Jingchuan Guo ◽  
Mina Tadrous ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Claims Data ◽  
Interrupted Time Series ◽  
World Health ◽  
Medicare Beneficiaries ◽  
Excess Supply ◽  
Pharmacy Claims ◽  
Time Series Analyses ◽  
Nationally Representative ◽  
Health Organization

Background Adherence to oral anticoagulation (OAC) is critical for stroke prevention in atrial fibrillation. However, the COVID‐19 pandemic may have disrupted access to such therapy. We hypothesized that our analysis of a US nationally representative pharmacy claims database would identify increased incidence of lapses in OAC refills during the COVID‐19 pandemic. Methods and Results We identified individuals with atrial fibrillation prescribed OAC in 2018. We used pharmacy dispensing records to determine the incidence of 7‐day OAC gaps and 15‐day excess supply for each 30‐day interval from January 1, 2019 to July 8, 2020. We constructed interrupted time series analyses to test changes in gaps and supply around the pandemic declaration by the World Health Organization (March 11, 2020), and whether such changes differed by medication (warfarin or direct OAC), prescription payment type, or prescriber specialty. We identified 1 301 074 individuals (47.5% women; 54% age ≥75 years). Immediately following the COVID‐19 pandemic declaration, we observed a 14% decrease in 7‐day OAC gaps and 56% increase in 15‐day excess supply (both P <0.001). The increase in 15‐day excess supply was more marked for direct OAC (69% increase) than warfarin users (35%; P <0.001); Medicare beneficiaries (62%) than those with commercial insurance (43%; P <0.001); and those prescribed OAC by a cardiologist (64%) rather than a primary care provider (48%; P <0.001). Conclusions Our analysis of nationwide claims data demonstrated increased OAC possession after the onset of the COVID‐19 pandemic. Our findings may have been driven by waivers of early refill limits and patients’ tendency to stockpile medications in the first weeks of the pandemic.

scholarly journals Insights on exclusive breastfeeding norms in Kinshasa: findings from a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Francine E. Wood ◽  
Anastasia J. Gage ◽  
Dieudonné Bidashimwa
Keyword(s):  
Social Norms ◽  
Exclusive Breastfeeding ◽  
Democratic Republic Of Congo ◽  
Cultural Beliefs ◽  
Optimal Growth ◽  
Capital City ◽  
World Health ◽  
Group Discussions ◽  
Nationally Representative ◽  
Health Organization

Abstract Background For optimal growth and development, the World Health Organization recommends that children be exclusively breastfed for the first 6 months of life. However, according to the nationally-representative 2013–2014 Demographic and Health Survey, under 50% of babies in the Democratic Republic of Congo are exclusively breastfed. Although breastfeeding was common in the capital city of Kinshasa, one in five newborns received alternatives to breastmilk during the first 3 days of life. This analysis aimed to identify social norms influencing exclusive breastfeeding, the role of a young first-time mother’s (FTM’s) social network for her choice to exclusively breastfeed, and perceived social sanctions associated with breastfeeding practices in Kinshasa. Methods The qualitative analysis was based on a vignette presented during 14 focus group discussions, with a purposively selected sample (n = 162) of FTMs age 15–24, and the male partners, mothers and mothers-in-law of FTMs age 15–24 in three health zones in Kinshasa in 2017. Thematic content analysis was performed to identify concepts and patterns in the participants’ discussions. Results Overall, community norms were not supportive of exclusive breastfeeding. The main barriers to exclusive breastfeeding were the belief held by most FTMs that exclusive breastfeeding was an uncommon practice; the desire to avoid negative sanctions such as name-calling and mockery for refusal to give babies water in the first 6 months of life; the desire to please key members of their social networks, specifically their mothers and friends, by doing what these influencers expected or preferred them to do; FTMs’ own lack of experience with infant feeding; and trust placed in their mothers and friends. Conclusion Social norms can be maintained by the belief about what others do, perceived expectations about what individuals ought to do, the negative sanctions they can face and their preference to conform to social expectations. Thus, addressing cultural beliefs and targeting sensitization efforts to key influencers that provide support to FTMs are needed to promote exclusive breastfeeding in Kinshasa. In doing so, strategies should address the barriers to exclusive breastfeeding including related misconceptions, and improve FTMs’ self-efficacy to overcome the influence of others.

scholarly journals The effect of a 5-year hand hygiene initiative, consisting of the 5 Components, the 5 Steps, and the Hand Hygiene Self-Assessment Framework, an interrupted time-series study.

2020 ◽  
Author(s):  
Yumi Suzuki ◽  
Motoko Morino ◽  
Ichizo Morita ◽  
Shigenori Yamamoto
Keyword(s):  
Time Series ◽  
Hand Hygiene ◽  
Correlation Coefficients ◽  
Interrupted Time Series ◽  
World Health ◽  
Assessment Framework ◽  
Interrupted Time Series Analysis ◽  
Self Assessment ◽  
Consumption Change ◽  
Health Organization

Abstract Background:A World Health Organization (WHO) guideline-based multimodal hand hygiene (HH) initiative consisting of the 5 Components, the 5 Steps, and the HH Self-Assessment Framework (HHSAF) was introduced hospital-wide to a nonteaching Japanese hospital for 5 years. The objective of this study was to assess the effect of this initiative in terms of changes in alcohol-based hand rub (ABHR) consumption and HHSAF score.Methods:The consumption of monthly hospital-wide ABHR was calculated as ml per patient day (PD). The change in ABHR consumption was analysed by an interrupted time series analysis, with a preintervention period of 36 months and an intervention period of 60 months. The correlation between annual ABHR consumption and the HHSAF score was estimated using Pearson’s correlation coefficients.Results:A statistically significant increase was found in the monthly ABHR consumption (change in slope: + 0.479 ml/PD, p < 0.01). Annual ABHR consumption was strongly correlated with the annual HHSAF score (r = 0.971, p < 0.01).Conclusions:A 5-year, 5-step, WHO-based HH initiative significantly increased ABHR consumption. Our study suggested that the HHSAF score can be a good process measure to improve HH in a single facility, as ABHR consumption increased with the HHSAF score.

scholarly journals Trends in snakebite mortality in India from 2000 to 2019 in a nationally representative mortality study

2020 ◽  
Author(s):  
Wilson Suraweera ◽  
David Warrell ◽  
Romulus Whitaker ◽  
Geetha R Menon ◽  
Rashmi Rodrigues ◽  
...  
Keyword(s):  
Literature Review ◽  
Rural Areas ◽  
Treatment Strategies ◽  
World Health ◽  
The World ◽  
Prevention And Treatment ◽  
Substantial Progress ◽  
Low Altitude ◽  
Nationally Representative ◽  
Health Organization

The World Health Organization call to halve global snakebite deaths by 2030 will requires substantial progress in India. We analyzed 2,833 snakebite deaths from 611,483 verbal autopsies in the nationally representative Indian Million Death Study from 2001-14, and conducted a systematic literature review from 2000-19 covering 87,590 snakebites. We estimate that India had 1.2 million snakebite deaths (average 58,000/year) from 2000-19. Nearly half occurred at ages 30-69 years and over a quarter in children <15 years. Most occurred at home in rural areas. About 70% occurred in eight higher-burden states and half during the rainy season and at low altitude. The risk of an Indian dying from snakebite before age 70 is about 1 in 250, but notably higher in some areas. More crudely, we estimate 1.11-1.77 million bites occurred in 2015, of which 70% showed symptoms of envenomation. Prevention and treatment strategies might substantially reduce snakebite mortality in India.

scholarly journals The effect of a 5-year hand hygiene initiative based on the WHO Multimodal Hand Hygiene Improvement Strategy: an interrupted time-series study.

2020 ◽  
Author(s):  
Yumi Suzuki ◽  
Motoko Morino ◽  
Ichizo Morita ◽  
Shigenori Yamamoto
Keyword(s):  
Time Series ◽  
Hand Hygiene ◽  
Interrupted Time Series ◽  
World Health ◽  
Interrupted Time Series Analysis ◽  
Improvement Strategy ◽  
Hand Hygiene Improvement ◽  
Implementation Period ◽  
Consumption Change ◽  
Health Organization

Abstract Background: A World Health Organization (WHO) guideline-based multimodal hand hygiene (HH) initiative was introduced hospital-wide to a nonteaching Japanese hospital for 5 years. The objective of this study was to assess the effect of this initiative in terms of changes in alcohol-based hand rub (ABHR) consumption and the Hand Hygiene Self-Assessment Framework (HHSAF) score.Methods: The consumption of monthly hospital-wide ABHR was calculated in L per 1000 patient days (PDs). The change in ABHR consumption was analysed by an interrupted time series analysis with a pre-implementation period of 36 months and an implementation period of 60 months. The correlation between annual ABHR consumption and the HHSAF score was estimated using Pearson’s correlation coefficients.Results: The annual ABHR consumption was 4.0 (L/1000 PDs) to 4.4 in the pre-implementation period and 10.4 to 34.4 in the implementation period. The HHSAF score was 117.5 (out of 500) in the pre-implementation period and 267.5 to 445 in the implementation period. A statistically significant increase in the monthly ABHR consumption (change in slope: + 0.479 L/1000 PDs, p < 0.01) was observed with the implementation of the initiative. Annual ABHR consumption was strongly correlated with the annual HHSAF score (r = 0.971, p < 0.01).Conclusions: A 5-year WHO-based HH initiative significantly increased ABHR consumption. Our study suggested that the HHSAF assessment can be a good process measure to improve HH in a single facility, as ABHR consumption increased with the HHSAF score.

Is there a syndrome of bullying?

2012 ◽  
Vol 24 (1) ◽  
Author(s):  
Jorge Srabstein ◽  
Thomas Piazza
Keyword(s):  
Health And Safety ◽  
Physical Symptoms ◽  
World Health ◽  
Emotional Symptoms ◽  
Cross Sectional Survey ◽  
Psychosomatic Disorder ◽  
Cross Sectional ◽  
The Usa ◽  
Nationally Representative ◽  
Health Organization

Abstract Objective: We investigated the existence of a psychosomatic disorder associated with bullying by delineating its health and safety and correlates, and defining the demographic characteristics of the USA adolescents affected by this condition. Methods: This study was based on an analysis of USA data from the 1996 World Health Organization Health Behavior in School-aged Children survey. The survey provides nationally-representative, cross-sectional survey information on 9938 USA students in Grades 6–10. We examined those students who were involved in bullying as a victim and/or as a bully, with or without a self-reported cluster of depression, “bad mood”, “feeling low”, “feeling nervous” and sleeping difficulties, and one or more physical symptoms (headaches, stomach aches, back aches, dizziness). Results: A cluster of physical and emotional symptoms linked to their participation in bullying as bullies and/or victims was reported by 9.5% of adolescents, with a higher frequency of 8th Grade students and a predominance of females. These students were 8.14 times more likely to hurt themselves on purpose and 4.20 times more likely to hurt others purposely than their peers who were not involved in bullying and did not suffer from a cluster of physical and emotional symptoms. Conclusions: This study may elicit further examination and debate about the existence of a nosological entity linked to bullying. Pending further research, the present results should support the need to ascertain participation in bullying, as a bully and/or as a victim, in all pediatric visits. Furthermore, there is a need to enquire about symptoms and risks related to this form of abuse.

scholarly journals Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study

eLife ◽  
2020 ◽  
Vol 9 ◽  
Author(s):  
Wilson Suraweera ◽  
David Warrell ◽  
Romulus Whitaker ◽  
Geetha Menon ◽  
Rashmi Rodrigues ◽  
...  
Keyword(s):  
Literature Review ◽  
Rural Areas ◽  
Treatment Strategies ◽  
World Health ◽  
The World ◽  
Prevention And Treatment ◽  
Substantial Progress ◽  
Low Altitude ◽  
Nationally Representative ◽  
Health Organization

The World Health Organization call to halve global snakebite deaths by 2030 will require substantial progress in India. We analyzed 2833 snakebite deaths from 611,483 verbal autopsies in the nationally representative Indian Million Death Study from 2001 to 2014, and conducted a systematic literature review from 2000 to 2019 covering 87,590 snakebites. We estimate that India had 1.2 million snakebite deaths (average 58,000/year) from 2000 to 2019. Nearly half occurred at ages 30–69 years and over a quarter in children < 15 years. Most occurred at home in the rural areas. About 70% occurred in eight higher burden states and half during the rainy season and at low altitude. The risk of an Indian dying from snakebite before age 70 is about 1 in 250, but notably higher in some areas. More crudely, we estimate 1.11–1.77 million bites in 2015, of which 70% showed symptoms of envenomation. Prevention and treatment strategies might substantially reduce snakebite mortality in India.

scholarly journals Anticipatory changes in British household purchases of soft drinks associated with the announcement of the Soft Drinks Industry Levy: A controlled interrupted time series analysis

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003269
Author(s):  
David Pell ◽  
Tarra L. Penney ◽  
Oliver Mytton ◽  
Adam Briggs ◽  
Steven Cummins ◽  
...  
Keyword(s):  
Time Series ◽  
Interrupted Time Series ◽  
Soft Drinks ◽  
World Health ◽  
Interrupted Time Series Analysis ◽  
Sugar Sweetened Beverage ◽  
The United Kingdom ◽  
Nutritional Data ◽  
Health Organization ◽  
The Uk

Background Sugar-sweetened beverage (SSB) consumption is positively associated with obesity, type 2 diabetes, and cardiovascular disease. The World Health Organization recommends that member states implement effective taxes on SSBs to reduce consumption. The United Kingdom Soft Drinks Industry Levy (SDIL) is a two-tiered tax, announced in March 2016 and implemented in April 2018. Drinks with ≥8 g of sugar per 100 ml (higher levy tier) are taxed at £0.24 per litre, drinks with ≥5 to <8 g of sugar per 100 ml (lower levy tier) are taxed at £0.18 per litre, and drinks with <5 g sugar per 100 ml (no levy) are not taxed. Milk-based drinks, pure fruit juices, drinks sold as powder, and drinks with >1.2% alcohol by volume are exempt. We aimed to determine if the announcement of the SDIL was associated with anticipatory changes in purchases of soft drinks prior to implementation of the SDIL in April 2018. We explored differences in the volume of and amount of sugar in household purchases of drinks in each levy tier at 2 years post announcement. Methods and findings We used controlled interrupted time series to compare observed changes associated with the announcement of the SDIL to the counterfactual scenario of no announcement. We used data from Kantar Worldpanel, a commercial household purchasing panel with approximately 30,000 British members that includes linked nutritional data on purchases. We conducted separate analyses for drinks liable for the SDIL in the higher, lower, and no-levy tiers controlling with household purchase volumes of toiletries. At 2 years post announcement, there was no difference in volume of or sugar from purchases of higher-levy-tier drinks compared to the counterfactual of no announcement. In contrast, a reversal of the existing upward trend in volume (ml) of and amount of sugar (g) in purchases of lower-levy-tier drinks was seen. These changes led to a −96.1 ml (95% confidence interval [CI] −144.2 to −48.0) reduction in volume and −6.4 g (95% CI −9.8 to −3.1) reduction in sugar purchased in these drinks per household per week. There was a reversal of the existing downward trend in the amount of sugar in household purchases of the no-levy drinks but no change in volume purchased. At 2 years post announcement, these changes led to a 6.1 g (95% CI 3.9–8.2) increase in sugar purchased in these drinks per household per week. There was no evidence that volume of or amount of sugar in purchases of all drinks combined was different from the counterfactual. This is an observational study, and changes other than the SDIL may have been responsible for the results reported. Purchases consumed outside of the home were not accounted for. Conclusions The announcement of the UK SDIL was associated with reductions in volume and sugar purchased in lower-levy-tier drinks before implementation. These were offset by increases in sugar purchased from no-levy drinks. These findings may reflect reformulation of drinks from the lower levy to no-levy tier with removal of some but not all sugar, alongside changes in consumer attitudes and beliefs. Trial registration ISRCTN Registry ISRCTN18042742.

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