Exploring Access to Surgical Interventions for Hidradenitis Suppurativa: Retrospective Population-Based Analysis

Background Hidradenitis suppurativa (HS) is a painful inflammatory disorder that confers significant distress to patients, with surgery as an integral treatment modality. Objective To inform improvements in care, patterns in HS surgery were assessed. Methods A retrospective population-based analysis was performed on Ontario billing claims for HS surgery across a period of 10 years from January 1, 2008 to December 31, 2017. HS surgery was defined as the excision of inguinal, perineal, or axillary skin and sweat glands for hidradenitis. The top 5 billing specialties, including general and plastic surgery, were analyzed. The total number of procedures performed as well as the number performed per physician were investigated. Patient and physician locations were compared. Results A total of 7195 claims for the excision of inguinal, perineal, or axillary skin and sweat glands for HS were submitted across the study period. Annual HS surgery claims showed an increasing trend across 10 years, ranging between 4.9 and 5.8 per 100,000 population. However, overall, for every additional year, the number of claims per 100,000 population only increased slightly, by 0.03 claims. The number of providers steadily decreased, ranging between 1.7 and 1.9 per 100,000, with approximately twice as many general than plastic surgeons. However, again overall, for every additional year, the number of providers per 100,000 population decreased slightly, by 0.002 physicians. The mean annual number of procedures per physician rose from 2.8 to 3.1. In rural areas, analyzed per claim, general surgeons performed the majority of surgeries (1318/2003, 65.8%), while in urban areas, surgeries were more equally performed by general (2616/5192, 50.4%) and plastic (2495/5192, 48.1%) surgeons. Of HS surgery claims, 25.7%-35.9% were provided by a physician residing in a different area than the patient receiving care. Conclusions No significant improvements in access to HS surgery were seen across the study period, with access potentially worsening with annual HS claims rising overall and number of providers decreasing, with patients travelling further to access surgery. System barriers across the continuum of HS diagnosis and management must be evaluated to improve access to surgical care.

The Shape of Care: Patterns of Family Caregiving Among Chinese Adults in the Middle to Later Stage of Life

Due to the lack of institutional support, families have long been the primary caregivers in China. Most studies to date only focused on one single care activity during a particular life course stage. Nonetheless, older adults today are more likely to care for multiple family members concurrently or sequentially (serial caregivers). The studies on discrete snapshots of care activities failed to capture the patterns of family caregiving overtime. Utilizing four waves of longitudinal data from CHARLS (2011-2018, N=17,039), this study particularly focuses on care activities to grandchildren, parents, and spouse, and maps out the family caregiving patterns overtime. Using latent profile analysis, this study identifies five family caregiving patterns: 1). Light grandchild caregivers (27%), who on average provided 4.3 years’ grandchild care mostly; 2). Heavy grandchild caregivers (11%), who on average on provided 7 years’ grandchild care mostly; 3). Light caregivers for grandchildren and parents (7%), who sequentially provided 1-year care to grandchildren and parents; 4). Heavy serial caregiver (6%), who mostly provided care to spouse and grandchildren with higher overlapping years; 5). Overall light caregivers (49%), who on average provided less than one year of care to any recipient. The preliminary results suggest that heavy serial caregivers (6%) far worst in terms of depressive symptoms and more likely to report worsened self-rated health; and overall light caregivers (49%) have the lowest depressive symptoms and more likely to report good self-rated health.

Space use and parental care behaviour in Andinobates claudiae (Dendrobatidae)

The selection of habitats with potential reproductive resources may maximize individual reproductive success and overall fitness. Dendrobatid frogs display remarkable parental care which is associated with water bodies (phytotelmata) contained in plants with characteristics that are important to offspring survival. It has been shown that the size of phytotelmata is a key factor that drove the divergence in parental care patterns in poison frogs and that the distribution of reproductive resources can influence space use in these species. Here, we investigated parental care strategies and the influence of reproductive resource distribution on space use patterns in a wild population of Andinobates claudiae in Bocas del Toro, Panama. We identified the phytotelmata characteristics that predict tadpole deposition and analysed the association between the spatial distribution of phytotelmata and spatial use of males and females. Our observations showed that this species mates polygamously and exhibits male parental care. We found that male frogs have smaller kernel density home ranges and core areas compared to females, and that space use is related to the density of Heliconia plants whose axil cavities are used for tadpole rearing. Furthermore, we found that tadpoles were more frequently found in phytotelmata that were at lower heights and contained larger water volumes. Fathers invested time inspecting multiple cavities and travelled further than predicted from their territories to find suitable deposition sites. Our observations suggest a selective choice of phytotelmata regarding tadpole deposition, where distribution and quality of cavities might influence parental care decisions.

Implementation of innovative medical technologies in German inpatient care: patterns of utilization and evidence development

Background Innovative medical technologies are commonly associated with positive expectations. At the time of their introduction into care, there is often little evidence available regarding their benefits and harms. Accordingly, some innovative medical technologies with a lack of evidence are used widely until or even though findings of adverse events emerge, while others with study results supporting their safety and effectiveness remain underused. This study aims at examining the diffusion patterns of innovative medical technologies in German inpatient care between 2005 and 2017 while simultaneously considering evidence development. Methods Based on a qualitatively derived typology and a quantitative clustering of the adoption curves, a representative sample of 21 technologies was selected for further evaluation. Published scientific evidence on efficacy/effectiveness and safety of the technologies was identified and extracted in a systematic approach. Derived from a two-dimensional classification according to the degree of utilization and availability of supportive evidence, the diffusion patterns were then assigned to the categories “Success” (widespread/positive), “Hazard” (widespread/negative), “Overadoption” (widespread/limited or none), “Underadoption” (cautious/positive), “Vigilance” (cautious/negative), and “Prudence” (cautious/limited or none). Results Overall, we found limited evidence on the examined technologies regarding both the quantity and quality of published randomized controlled trials. Thus, the categories “Prudence” and “Overadoption” together account for nearly three-quarters of the years evaluated, followed by “Success” with 17%. Even when evidence is available, the transfer of knowledge into practice appears to be inhibited. Conclusions The successful implementation of safe and effective innovative medical technologies into practice requires substantial further efforts by policymakers to strengthen systematic knowledge generation and translation. Creating an environment that encourages the conduct of rigorous studies, promotes knowledge translation, and rewards innovative medical technologies according to their added value is a prerequisite for the diffusion of valuable health care.

Exploring the Dynamics of Week-to-Week Blood Pressure in Nursing Home Residents Before Death

BACKGROUND Aging is accompanied by an overall dysregulation of many dynamic physiologic processes including those related to blood pressure (BP). While year-to-year BP variability is associated with cardiovascular events and mortality, no studies have examined this trend with more frequent BP assessments. Our study objective is to take the next step to examine week-to-week BP dynamics—pattern, variability, and complexity—before death. METHODS Using a retrospective study design, we assessed BP dynamics in the 6 months before death in long-term nursing home residents between 1 October 2006 and 30 September 2017. Variability was characterized using SD and mean squared error after adjusting for diurnal variations. Complexity (i.e., amount of novel information in a trend) was examined using Shannon’s entropy (bits). Generalized linear models were used to examine factors associated with overall BP variability. RESULTS We identified 17,953 nursing home residents (98.0% male, 82.5% White, mean age 80.2 years, and mean BP 125.7/68.6 mm Hg). Despite a slight trend of decreasing systolic week-to-week BP over time (delta = 7.2 mm Hg), week-to-week complexity did not change in the 6 months before death (delta = 0.02 bits). Average weekly BP variability was stable until the last 3–4 weeks of life, at which point variability increased by 30% for both systolic and diastolic BP. Factors associated with BP variability include average weekly systolic/diastolic BP, days in the nursing home, days in the hospital, and changes to antihypertensive medications. CONCLUSIONS Week-to-week BP variability increases substantially in the last month of life, but complexity does not change. Changes in care patterns may drive the increase in BP variability as one approaches death.

The division of child care during the coronavirus crisis in Germany: How did short-time work affect fathers' engagement?

Objective: This paper examines how participation in the short-time work scheme affected the gendered division of child care during the COVID-19 crisis in Germany. Background: Short-time work (Kurzarbeit) has been one of the main policies used to combat the economic and labour market repercussions of the coronavirus pandemic in Germany. We examine whether and, if so, how the growing prevalence of short-time work has affected care patterns. Method: We use data from the IAB-HOPP, a longitudinal study monitored by the German Institute for Employment Research (IAB). The analytical sample includes couples with children aged 12 and younger. We employ multinomial logistic regressions in which the outcome variable is the change in the division of care work from a period before to a period during the coronavirus crisis (June to October 2020). Results: We find that among men, receiving short-time work benefits resulted in more gender-equal care patterns. The positive effect of short-time work on the division of child care is moderated by the level of education. Fathers with low or medium education are more likely to increase their child care share when receiving short-time work benefits compared to fathers with high education. However, we also find that participating in the short-time work programme had no strong or significant effects on the gendered division of care among women. Conclusion: The evidence from this study suggests that men’s working time is a major vehicle to change the gendered division of care in couple households.

Incidence, predictors and patterns of care of patients with very severe hypertriglyceridemia in Ontario, Canada: a population-based cohort study

Background The incidence of severe (S-HTG) and very severe hypertriglyceridemia (VS-HTG) among Canadians is unknown. This study aimed to determine the incidence, characteristics, predictors and care patterns for individuals with VS-HTG. Methods Using linked administrative healthcare databases, a population-based cohort study of Ontario adults was conducted to determine incidence of new onset S-HTG (serum triglycerides (TG) > 10–20 mmol/L) and VS-HTG (TG > 20 mmol/L) between 2010 and 2015. Socio-demographic and clinical characteristics of those with VS-HTG were compared to those who had no measured TG value > 3 mmol/L. Univariable and multivariable logistic regression were used to determine predictors for VS-HTG. Healthcare patterns were evaluated for 2 years following first incidence of TG > 20 mmol/L. Results Incidence of S-HTG and VS-HTG in Ontario was 0.16 and 0.027% among 10,766,770 adults ≥18 years and 0.25 and 0.041% among 7,040,865 adults with at least one measured TG, respectively. Predictors of VS-HTG included younger age [odds ratios (OR) 0.64/decade, 95% confidence intervals (CI) 0.62–0.66], male sex (OR 3.83; 95% CI 3.5–4.1), diabetes (OR 5.38; 95% CI 4.93–5.88), hypertension (OR 1.69; 95% CI 1.54–1.86), chronic liver disease (OR 1.71; 95% CI 1.48–1.97), alcohol abuse (OR 2.47; 95% CI 1.90–3.19), obesity (OR 1.49; 95% CI 1.13–1.98), and chronic kidney disease (OR 1.39; 95% CI 1.19–1.63). Conclusion The 5-year incidence of S-HTG and VS-HTG in Canadian adults was 1 in 400 and 1 in 2500, respectively. Males, those with diabetes, obese individuals and those with alcohol abuse are at highest risk for VS-HTG and may benefit from increased surveillance.

VISEMURE: A Visual Analytics System for Making Sense of Multimorbidity Using Electronic Medical Record Data

Multimorbidity is a growing healthcare problem, especially for aging populations. Traditional single disease-centric approaches are not suitable for multimorbidity, and a holistic framework is required for health research and for enhancing patient care. Patterns of multimorbidity within populations are complex and difficult to communicate with static visualization techniques such as tables and charts. We designed a visual analytics system called VISEMURE that facilitates making sense of data collected from patients with multimorbidity. With VISEMURE, users can interactively create different subsets of electronic medical record data to investigate multimorbidity within different subsets of patients with pre-existing chronic diseases. It also allows the creation of groups of patients based on age, gender, and socioeconomic status for investigation. VISEMURE can use a range of statistical and machine learning techniques and can integrate them seamlessly to compute prevalence and correlation estimates for selected diseases. It presents results using interactive visualizations to help healthcare researchers in making sense of multimorbidity. Using a case study, we demonstrate how VISEMURE can be used to explore the high-dimensional joint distribution of random variables that describes the multimorbidity present in a patient population.

Excess Mortality Among Patients Hospitalized During the COVID-19 Pandemic

BACKGROUND: The extent to which the COVID-19 pandemic has affected outcomes for patients with unplanned hospitalizations is unclear. OBJECTIVE: To examine changes in in-hospital mortality for patients without COVID-19 during the first 10 months of the pandemic (March 4, 2020 to December 31, 2020). DESIGN, SETTING, AND PARTICIPANTS: Observational study of adults with unplanned hospitalizations at 51 hospitals across 6 Western states. EXPOSURES: Unplanned hospitalizations occurring during the spring COVID-19 surge (March 4 to May 13, 2020; Period 1), an intervening period (May 14 to October 19, 2020; Period 2), and the fall COVID-19 surge (October 20 to December 31, 2020; Period 3) were compared with a pre-COVID-19 baseline period from January 1, 2019, to March 3, 2020. MAIN OUTCOMES AND MEASURES: We examined daily hospital admissions and in-hospital mortality overall and in 30 conditions. RESULTS: Unplanned hospitalizations declined steeply during Periods 1 and 3 (by 47.5% and 25% compared with baseline, respectively). Although volumes declined, adjusted in-hospital mortality rose from 2.9% in the pre-pandemic period to 3.5% in Period 1 (20.7% relative increase), returning to baseline in Period 2, and rose again to 3.4% in Period 3. Elevated mortality was seen for nearly all conditions studied during the pandemic surge periods. CONCLUSION: Pandemic COVID-19 surges were associated with higher rates of in-hospital mortality among patients without COVID-19, suggesting disruptions in care patterns for patients with many common acute and chronic illnesses.

POLA ASUH GRANDPARENTING DALAM MEMBENTUK KEPRIBADIAN ANAK USIA 4-6 TAHUN (Studi Kasus Di RT/04 RW/02 Kelurahan Dusun Besar Kota Bengkulu)

Grandparenting parenting pattern is childcare done by grandparents. Childcare should be the responsibility of both parents, but because there are several factors, namely: both parents are busy working, the economic state of the family and there is no parental trust in others in the care of the child except from a close family, so the responsibility is transferred to grandparents. In RT/04 RW/02, there are 7 families who transfer temporary parenting roles to grandparents. The types of parenting patterns applied are: democratic, authoritarian and permissive parenting patterns. From this type of parenting pattern, it will affect the personality of the child. There are 5 personality types: sanguin, phlegmatic, melancholic, cholelic and arsetif types. In childcare each grandparent has its own parenting pattern but the more instrumental in parenting is grandmotherhood. Parenting patterns are influenced by educational background, knowledge, activities, socioeconomic circumstances and so on. But the supporting factor in the implementation of parenting patterns well depends not only on the type of parenting pattern applied by grandparents, but also on the characteristics in the family and community environment. The forms of foster care patterns that are applied are very closely related to the personality of the child after becoming an adult. This research method uses qualitative research, with a type of qualitative descriptive research to describe the findings in the field. Data collection in this study uses three techniques, namely: observation, interview and documentation. From the findings of the researchers parenting patterns in 7 families RT/04 RW/02 dusun besar kota bengkulu 4 families who apply democratic parenting patterns and 3 families applying permissive patterns. for child personality, 3 children who have sanguin personality, 1 child flegmatic personality, 2 children choleric personality and 1 child aresif personality.Keywords: Parenting Patterns Grandparenting, Personality Of Children Aged 4-6 Years