Changes in Acute Respiratory Infection Before and After COVID-19

Objective: During the outbreak of COVID-19,several coping strategies were implemented including strengthened social distancing, wearing masks and hand hygiene. Thisinfection control method might have been effective for other respiratory infections; however, it had not yet been clearly revealed. Therefore,we investigatedwhetherthe incidence of infectious respiratory diseases has reduced after excluding the effect of decreased medical utilization because of COVID-19 control measures.Design or methods: We used the Korean national claims data and analyzed incidences of acute respiratory infections (ARI) and diseases except ARI. The incidence rates of winter 2019 and 2020 were compared.Results: Excluding ARI,the reduction in overall hospital visits decreased by only 2%; however,the number of visits due to ARI decreased by 13%, and the number of visits due to influenza particularly decreased by 26%.Conclusions: Using national database, this study confirmed that a significant reduction in ARI, including influenza, occurred during the COVID-19 pandemic. Infection control measures including nationally enforced social distancing may be effective in controlling the transmission of other respiratory infections. Further studies are necessary to clarify the causal relationship.

Actual issues of staffing of primary health care by district paediatrician on the example of the region of the Russian Federation

Introduction. Eliminating the personnel shortage in medical institutions that provide primary health care (PHC) to children is one of the priority tasks of the state policy in healthcare. The purpose of the work was to assess the impact of changes in the system of training medical personnel and measures to provide primary care medical personnel, implemented in the Volgograd region, on the availability of PHC for children in 2016-2018. Material and methods. According to the data of Central Research Institute of Healthcare Organization and Informatization and Volgograd Regional Medical Information and Analytical Centre analyzed the indices of provision, staffing of district paediatricians, coefficients of concurrency and the level of availability of PHC to the children’s population. Results and discussion. The number of district paediatricians in medical institutions of the Volgograd region from the period 2016-2018 increased by only 46 people with the graduation of 356 specialists from Volgograd State Medical University, which led to a slight increase in the provision of district paediatricians. At the same time, the staffing rate for pediatric sites and the average number of visits per child decreased from 7.9 to 7.6 cases. The studied indices vary significantly in urban and rural medical institutions. There is a high proportion of pre-retirement and retirement age specialists in the village. Twenty-eight district paediatricians participated in training under the “Zemsky Doctor” program, but some left for various reasons. Conclusion. The presence of pronounced differences in the indicators of provision of paediatricians by district doctors in the number of visits per 1 child between cities and municipal districts indicates significant differences in the availability of medical care. It requires organizational measures to overcome this kind of inequality. Admission to work through the primary accreditation procedure in the speciality “Pediatrics” and the implementation of the program “Zemsky Doctor” have not significantly eliminated the personnel deficit at the primary level.

Evaluation of the Number of Visits to Chinese Medical Institutions Using a Logistic Differential Equation Model

In this study, we established a two-dimensional logistic differential equation model to study the number of visits in Chinese PHCIs and hospitals based on the behavior of patients. We determine the model's equilibrium points and analyze their stability and then use China medical services data to fit the unknown parameters of the model. Finally, the sensitivity of model parameters is evaluated to determine the parameters that are susceptible to influence the system. The results indicate that the system corresponds to the zero-equilibrium point, the boundary equilibrium point, and the positive equilibrium point under different parameter conditions. We found that, in order to substantially increase visits to PHCIs, efforts should be made to improve PHCI comprehensive capacity and maximum service capacity.

Empowering health cadres in managing maternal and child health in the Covid-19 pandemic era

The covid-19 pandemic has hampered the access of mothers and children to optimal health services. The decreasing number of visits to maternal and child health services has created new nutrition and health problems. However, the Posyandu as one of the health services for mothers and children in several locations were forced to close during the covid-19 pandemic, such as Posyandu RW 07, Cipayung Village. The purpose of this community service is to increase the capacity of the integrated services post (Posyandu) cadres to cadres for maternal and child health responses during the covid-19 pandemic. Service activities are carried out through 3 stages of activity which was starting with discussions with partners about the importance of re-activating the Posyandu for infants and toddlers during the covid-19 pandemic, then increasing the capacity of health cadres for babies and toddlers health services, then handbook creation and evaluation. The method used combines several approaches, such as discussions, socialization, workshop, and evaluation. The result is an increase in the capacity of health cadres and the guidebooks for services and the Posyandu visits during the covid-19 pandemic.

On the local time of a recurrent random walk on ℤ²

We prove a functional limit theorem for the number of visits by a planar random walk on Z 2 \mathbb {Z}^2 with zero mean and finite second moment to the points of a fixed finite set P ⊂ Z 2 P\subset \mathbb {Z}^2 . The proof is based on the analysis of an accompanying random process with immigration at renewal epochs in case when the inter-arrival distribution has a slowly varying tail.

Living in a pandemic: changes in mobility routines, social activity and adherence to COVID-19 protective measures

Non-Pharmaceutical Interventions (NPIs), aimed at reducing the diffusion of the COVID-19 pandemic, have dramatically influenced our everyday behaviour. In this work, we study how individuals adapted their daily movements and person-to-person contact patterns over time in response to the NPIs. We leverage longitudinal GPS mobility data of hundreds of thousands of anonymous individuals to empirically show and quantify the dramatic disruption in people’s mobility habits and social behaviour. We find that local interventions did not just impact the number of visits to different venues but also how people experience them. Individuals spend less time in venues, preferring simpler and more predictable routines, also reducing person-to-person contacts. Moreover, we find that the individual patterns of visits are influenced by the strength of the NPIs policies, the local severity of the pandemic and a risk adaptation factor, which increases the people’s mobility regardless of the stringency of interventions. Finally, despite the gradual recovery in visit patterns, we find that individuals continue to keep person-to-person contacts low. This apparent conflict hints that the evolution of policy adherence should be carefully addressed by policymakers, epidemiologists and mobility experts.

Estimated Annual Economic Burden of Dry Eye Disease Based on a Multi-Center Analysis in China: A Retrospective Study

Purpose: To conduct a multi-center analysis and assess the economic burden due to dry eye disease (DED) in China.Design: A retrospective and cross-sectional study.Methods: Patients (n = 598) with diagnosed DED were recruited from 3 eye centers (in central, southeast, and northeast China) from 1 January 2018 to 31 December 2018. Data were collected regarding the examination, pharmacological therapy, and non-pharmacological therapy fees. Sub-group analyses were stratified by eye center, DED severity, types of DED, number of visits to physicians, and residential area. A logistic regression analysis was conducted to investigate the variables influencing total costs.Results: The per capita costs devoted to DED at the 3 centers were 422.6, 391.3, and 265.4 USD, respectively. The costs of non-pharmacological therapy accounted the largest part in three centers (75.6, 76.4, 76.5%, respectively). Patients with severe DED sustained the largest economic burden. Patients with mixed type of DED spent the most comparing to patients with either evaporative or aqueous-deficient types of DED. Patients spent more during the first visit compared with subsequent visits. Patients living in urban areas spent significantly more than did those living in rural areas (P = 0.001). The logistics regression analysis showed that total costs were significantly influenced by DED severity, number of visits to physicians, and area of residence (beta = 2.83, 0.83, 1.48; P < 0.0001).Conclusions: DED is a chronic ocular disease that timely non-cost counseling, early diagnosis, and efficacious treatment can reduce its economic burden on patients and the society.

Feasibility of a hybrid clinical trial for respiratory virus detection in toddlers during the influenza season

Background Traditional clinical trials are conducted at investigator sites. Participants must visit healthcare facilities several times for the trial procedures. Decentralized clinical trials offer an interesting alternative. They use telemedicine and other technological solutions (apps, monitoring devices or web platforms) to decrease the number of visits to study sites, minimise the impact on daily routine, and decrease geographical barriers for participants. Not much information is available on the use of decentralization in randomized clinical trials with vaccines. Methods A hybrid clinical trial may be assisted by parental recording of symptoms using electronic log diaries in combination with home collected nasal swabs. During two influenza seasons, children aged 12 to 35 months with a history of recurrent acute respiratory infections were recruited in 12 primary health centers of the Valencia Region in Spain. Parents completed a symptom diary through an ad hoc mobile app that subsequently assessed whether it was an acute respiratory infection and requested collection of a nasal swab. Feasibility was measured using the percentage of returned electronic diaries and the validity of nasal swabs collected during the influenza season. Respiratory viruses were detected by real-time PCR. Results Ninety-nine toddlers were enrolled. Parents completed 10,476 electronic diaries out of the 10,804 requested (97%). The mobile app detected 188 potential acute respiratory infections (ARIs) and requested a nasal swab. In 173 (92%) ARI episodes a swab was taken. 165 (95.4%) of these swabs were collected at home and 144 (87.3%) of them were considered valid for laboratory testing. Overall, 152 (81%) of the ARIs detected in the study had its corresponding valid sample collected. Conclusions Hybrid procedures used in this clinical trial with the influenza vaccine in toddlers were considered adequate, as we diagnosed most of the ARI cases on time, and had a valid swab in 81% of the cases. Hybrid clinical trials improve participant adherence to the study procedures and could improve recruitment and quality of life of the participants and the research team by decreasing the number of visits to the investigator site. This report emphasises that the conduct of hybrid CTs is a valid alternative to traditional CTs with vaccines. This hybrid CT achieved high adherence of participant to the study procedures. Trial registration 2019–001186-33 (EudraCT).

Sydänkuntoutus ja erikoissairaanhoidon palvelujen käyttö

Sydänkuntoutuksen vaikuttavuutta on perinteisesti arvioitu käyttäen osoittimina vaaratekijöiden alenemista, kuolleisuutta, työkyvyn palautumista sekä elämänlaadun kohenemista. Huomattavasti vähemmän on selvitetty sitä, onko sydänkuntoutuksella yhteyttä myöhempään terveyspalvelujen käyttöön. Tämä tutkimus on toinen osa hanketta, jossa selvitettiin yli 60-vuotiaiden sepelvaltimotautipotilaiden kuntoutusohjelman toimivuutta ja vaikuttavuutta satunnaistetulla, kontrolloidulla tutkimusasetelmalla. Tämän tutkimuksen toisen vaiheen tavoitteena oli selvittää iäkkäille sydänpotilaille suunnatun kuntoutusohjelman mahdollinen yhteys myöhempään erikoissairaanhoidon palvelujen käyttöön sekä tutkia, mitkä perussairauteen, vaaratekijöihin tai toimintakykyyn liittyvät tekijät voisivat selittää palvelujen käyttöä. Hankkeeseen osallistui kaikkiaan 312 sepelvaltimotautipotilasta, jotka oli satunnaistettu kuntoutusryhmään ja vertailuryhmään. THL:n Hilmo-tietokannasta laskettiin kahden ja puolen vuoden ajalta erikoissairaanhoidon toimenpiteiden ja käyntimäärien summa, jossa otettiin huomioon sydän- ja verisuonitautien hoidon vuoksi tapahtuneet käynnit ja toimenpiteet. Tulokset osoittivat, että lähes puolella osallistujista (44,8 %) ei ollut lainkaan rekisteriin merkittyjä erikoissairaanhoidon käyntejä tai toimenpiteitä 2,5 vuoden seurantajakson aikana. Palveluja käyttäneiden käyntimäärät vaihtelivat yleisimmin (41,7 %) välillä 1–5/seurantajakso, ja vain 13,3 %:n osalta käyntejä tai toimenpiteitä oli tätä enemmän. Kajoavien toimenpiteiden osuus kaikista käynneistä oli vain 1,6 %. Kuntoutusinterventioon osallistuneiden ja verrokkien välillä ei ollut eroa palvelujen käytössä. Voimakkaimmin käyntimääriä selittäväksi tekijäryhmäksi osoittautuivat fyysistä suoritus- ja toimintakykyä kuvaavat muuttujat, erityisesti rasituskokeen tulos. Kuntoutuksen menetelmien kehittämisen kannalta tämän tutkimuksen tulokset tukevat tuoreimpia suosituksia, jotka korostavat fyysisen toimintakyvyn kohentamisen ja säilyttämisen merkitystä myös iäkkäämpien sepelvaltimotautipotilaiden kohdalla. AbstractRehabilitation of elderly coronary heart disease patients and use of special health care services. Results of a randomized, controlled trial Risk factor levels, mortality, and physical as well as psycho-social functioning have traditionally been used as out-come criteria for efficacy of cardiac rehabilitation. Less is known about the possible impact of cardiac rehabilitation on use of later health care services. This report is the second part of a project where the feasibility and efficacy of an age-tailored rehabilitation program for cardiac patients over 60 years of age was evaluated. A controlled, randomized design was used. Subjects in the intervention group participated in a weekly organized, ten-day rehabilitation program. Control group participated in same assessments (including risk factor evaluation with laboratory tests and questionnaires, and exercise test), otherwise they were treated and followed-up according to usual care. The aim of this second part of the study was to evaluate if the applied rehabilitation program had any impact on the use of special health care services during the following two and half years. And, furthermore, to investigate which disease related, risk factors and/or indicators of functional capacity might predict use of services. Participants were 312 coronary heart disease patients (mean age 69,5 yrs, women 46,8 %) recruited from health centers in cities of Helsinki and Vantaa. For each patient, the number of visits or interventions related to vascular health, and recorded as a special health care service was calculated from the Hilmo-register, provided by the National Institute for Health and Wellfare. Also, data of mortality and causes of death were received from Statistics Finland data base. Results showed that nearly half (44,8 %) of the participants had no registered visits or interventions in special health care because of vascular health problems. The number of visits for those who had used special health care varied usually (41,7 %) between one to five, and only for 13,3 % of participants the total number of visits exceeded five. The total number of invasive interventions was only 11, i.e., 1,6 % of all visits. Between the two study groups there was no difference in the number of special health care visits or interventions. The most significant predictors of high number of visits were factors related to poor physical functioning, especially a low functional capacity in the clinical exercise test. Even statistically significant raw correlations of some socio-demographic factors such as old age and living alone for men with the number of visits lost their significance when analyzed together with indicators of physical functioning. In sum, the results of this study support the recent recommendations for cardiac rehabilitation which underline the importance of promotion and maintenance of good physical functioning also among elderly coronary patients. Key words: coronary heart disease; cardiac rehabilitation; health services; ageing; physical fitness

Real-time bidding campaigns optimization using user profile settings

Real-Time bidding is nowadays one of the most promising systems in the online advertising ecosystem. In the presented study, the performance of RTB campaigns is improved by optimising the parameters of the users’ profiles and the publishers’ websites. Most studies about optimising RTB campaigns are focused on the bidding strategy; estimating the best value for each bid. However, our research is focused on optimising RTB campaigns by finding out configurations that maximise both the number of impressions and the average profitability of the visits. An online campaign configuration generally consists of a set of parameters along with their values such as {Browser = “Chrome”, Country = “Germany”, Age = “20–40” and Gender = “Woman”}. The experiments show that, when the number of required visits by advertisers is low, it is easy to find configurations with high average profitability, but as the required number of visits increases, the average profitability diminishes. Additionally, configuration optimisation has been combined with other interesting strategies to increase, even more, the campaigns’ profitability. In particular, the presented study considers the following complementary strategies to increase profitability: (1) selecting multiple configurations with a small number of visits rather than a unique configuration with a large number of visits, (2) discarding visits according to certain cost and profitability thresholds, (3) analysing a reduced space of the dataset and extrapolating the solution over the whole dataset, and (4) increasing the search space by including solutions below the required number of visits. The developed campaign optimisation methodology could be offered by RTB and other advertising platforms to advertisers to make their campaigns more profitable.