Abstract P91: Excess Cerebrovascular Mortality in the U.S. During the Covid-19 Pandemic

Introduction: The magnitude and drivers of excess cerebrovascular-specific mortality during the coronavirus-19 (COVID-19) pandemic are unknown. We aim to quantify excess stroke-related death and characterize its association with psychosocial factors and emerging COVID-19 related mortality. Methods: U.S. and state-level excess cerebrovascular deaths from January-May 2020 were quantified by Poisson regression models built using National Center for Health Statistic (NCHS) data. Weekly excess cerebrovascular deaths in the U.S. were analyzed as functions of time-varying, weekly stroke-related EMS calls and weekly COVID-19 deaths by univariable linear regression. A state-level negative binomial regression analysis was performed to determine the association between excess cerebrovascular deaths and social distancing (degree of change in mobility per Google COVID-19 Community Mobility Reports) during the height of the pandemic after the first COVID-19 death (February 29, 2020), adjusting for cumulative COVID-19 related deaths and completeness of deaths attributable to COVID-19 in NCHS. Findings: There were 918 more cerebrovascular deaths than expected from January 1-May 16 th , 2020 in the U.S. Excess cerebrovascular mortality occurred during every week between March 28-May 2 nd , 2020, up to 7.8% during the week of April 18 th . Decreased stroke-related EMS calls were associated with excess stroke deaths one (β -0.06, 95% CI -0.11, -0.02) and two weeks (β -0.08, 95% CI -0.12, -0.04) later. There was no significant association between weekly excess stroke death and COVID-19 death. Twenty-three states and NYC experienced excess cerebrovascular mortality during the pandemic height. At the state level, a 10% increase in social distancing was associated with a 4.3% increase in stroke deaths (IRR 1.043, 95% CI 1.001–1.085) after adjusting for COVID-19 mortality. Conclusions: Excess U.S. cerebrovascular deaths during the COVID-19 pandemic were observed with decreases in stroke-related EMS calls nationally and less mobility at the state level. Public health measures are needed to identify and counter the reticence to seeking medical care for acute stroke during the COVID-19 pandemic.

Excess Cerebrovascular Mortality in the United States During the COVID-19 Pandemic

Background and Purpose: The magnitude and drivers of excess cerebrovascular-specific mortality during the coronavirus disease 2019 (COVID-19) pandemic are unknown. We aim to quantify excess stroke-related deaths and characterize its association with social distancing behavior and COVID-19–related vascular pathology. Methods: United States and state-level excess cerebrovascular deaths from January to May 2020 were quantified using National Center for Health Statistic data and Poisson regression models. Excess cerebrovascular deaths were analyzed as a function of time-varying stroke-related emergency medical service (EMS) calls and cumulative COVID-19 deaths using linear regression. A state-level regression analysis was performed to determine the association between excess cerebrovascular deaths and time spent in residences, measured by Google Community Mobility Reports, during the height of the pandemic after the first COVID-19 death (February 29). Results: Forty states and New York City were included. Excess cerebrovascular mortality occurred nationally from the weeks ending March 28 to May 2, 2020, up to a 7.8% increase above expected levels during the week of April 18. Decreased stroke-related EMS calls were associated with excess stroke deaths one (70 deaths per 1000 fewer EMS calls [95% CI, 20–118]) and 2 weeks (85 deaths per 1000 fewer EMS calls [95% CI, 37–133]) later. Twenty-three states and New York City experienced excess cerebrovascular mortality during the pandemic height. A 10% increase in time spent at home was associated with a 4.3% increase in stroke deaths (incidence rate ratio, 1.043 [95% CI, 1.001–1.085]) after adjusting for COVID-19 deaths. Conclusions: Excess US cerebrovascular deaths during the COVID-19 pandemic were observed and associated with decreases in stroke-related EMS calls nationally and mobility at the state level. Public health measures are needed to identify and counter the reticence to seeking medical care for acute stroke during the COVID-19 pandemic.

Incidence of Medical Malpractice Lawsuits and Its Relationship to the Growth of Private Hospitals

BackgroundDoctor-patient relationship has become an intense concern in public health in recent years. Medical malpractice lawsuits have presented an increasing trend over past decade. This study aims to describe distributions of medical malpractice lawsuits across different provinces and to investigate its relationship to the growth of private hospitals.MethodsData was drawn from China Judgments Online, the China Health Statistic Yearbooks and China Statistical Yearbooks between January 1, 2010 to December 31, 2016. Private hospitals expansion was measured by the number and proportion of private hospitals, the ratio of outpatient visits from private to public hospitals and the ratio of discharges from private to public hospitals. Fixed-effects negative binomial regressions were utilized to estimate the association between the growth of private hospitals and the number of medical malpractice lawsuits.ResultsIn total, we identified a total of 18220 lawsuits relevant to medical malpractices across China between 2010 and 2016. The regression results revealed that more private hospitals, larger proportion of private hospitals and higher ratio of discharges from private to public hospitals were significantly associated with fewer medical malpractice lawsuits. An increase of 100 private hospitals in health care market was associated with a decrease in the number of medical malpractice lawsuits by 21%. The ratio of outpatient visits from private to public hospitals was not significantly associated with the number of malpractice lawsuits. ConclusionsThere was great disparities of incidences of medical malpractice lawsuits across different provinces. Greater expansion of private hospitals was associated with fewer medical malpractice lawsuits at province level. This negative association indicated that more private hospitals in health care market might provide more incentives for hospitals to contain the incidences of medical malpractice cases.

An analysis of medical malpractice lawsuits and its relationship to the growth of private hospitals

Background Doctor-patient relationship has become an intense concern in public health in recent years. Medical malpractice lawsuits have presented an increasing trend over past decade. This study aims to describe distributions of medical malpractice lawsuits across different provinces and to investigate its relationship to the growth of private hospitals.Methods Data was drawn from China Judgments Online, the China Health Statistic Yearbooks and China Statistical Yearbooks between January 1, 2010 to December 31, 2016. Private hospitals expansion was measured by the number and proportion of private hospitals, the ratio of outpatient visits from private to public hospitals and the ratio of discharges from private to public hospitals. Fixed-effects negative binomial regressions were utilized to estimate the association between the growth of private hospitals and the number of medical malpractice lawsuits.Results In total, we identified a total of 18220 lawsuits relevant to medical malpractices across China between 2010 and 2016. The regression results revealed that more private hospitals, larger proportion of private hospitals and higher ratio of discharges from private to public hospitals were significantly associated with fewer medical malpractice lawsuits. An increase of 100 private hospitals in health care market was associated with a decrease in the number of medical malpractice lawsuits by 21%. The ratio of outpatient visits from private to public hospitals was not significantly associated with the number of malpractice lawsuits.Conclusions There was great disparities of incidences of medical malpractice lawsuits across different provinces. Greater expansion of private hospitals was associated with fewer medical malpractice lawsuits at province level. This negative association indicated that more private hospitals in health care market might provide more incentives for hospitals to contain the incidences of medical malpractice cases.

Child health research and planning in Europe disadvantaged by major gaps and disparities in published statistics

Background Population data, such as mortality and morbidity statistics, are essential for many reasons, including giving context for research, supporting action on health determinants, formulation of evidence-based policy for health care and outcome evaluation. However, when considering children, it is difficult to find such data, despite children comprising one-fifth of the European population and being in a key formative life stage and dependent on societal support. Moreover, it would be expected that there should be confidence in the key child health data available, with little to no discrepancy between recognized health statistic databases. Methods This study explored the main health databases in or including Europe to collate child mortality data, for both all-cause and specific-cause mortality. Tables were constructed for comparison of values and rankings. Results The results show that there are major differences in reported mortality data between two prominent health statistic databases, difference in coding systems, and unannounced changes within one of the databases. Conclusions The lack of health data for children seems compounded by challenges to the trust and credibility, which are vital if these data are to have utility. Children and society are the losers, and resolution is needed as a priority.

Penerapan Learning Vector Quantization (LVQ) untuk Klasifikasi Status Gizi Anak

AbstrakPenentuan klasifikasi status gizi anak yang sering dilakukan adalah berdasarkan indeks berat badan menurut tinggi badan (BB/TB). Pada Puskesmas Batupanjang, indeks antropometri tersebut dihitung secara manual untuk menilai status gizi anak sekolah dasar dengan menggunakan daftar tabel z-skor atau simpangan baku / standar deviasi (SD) WHO NCHS (National Centre for Health Statistic). Metode Learning Vektor Quantization (LVQ) dan salah satu algoritma pengembangannya yaitu LVQ3 digunakan dalam penelitian ini untuk menangani penilaian status gizi anak berdasarkan simpangan baku rujukan terhadap indeks berat badan dan tinggi badan tersebut. Variabel yang digunakan dalam penilaian status gizi anak adalah jenis kelamin, berat badan, tinggi badan, penyakit infeksi, nafsu makan, dan pekerjaan kepala keluarga (KK). Berdasarkan dari hasil penelitian dan pembahasan yang dilakukan, algoritma LVQ3 lebih baik diterapkan untuk klasifikasi status gizi anak dibandingkan dengan algoritma LVQ1. Penggunaan parameter window (ε) pada jaringan syaraf tiruan LVQ3 memberikan pengaruh positif yakni dapat meningkatkan performa dalam klasifikasi jika dibandingkan tanpa menggunakan window (LVQ1). Kata kunci— Antropometri, Learning Vektor Quantization, Z-skor. AbstractThe shortest path determination of child nutrient that common uses is based on body weight index by body high level (BB/BT). In Batupanjang Puskesmas, that anthropometry index is calculated manually for assessing the nutrition of children in elementary school by used z-score table list or deviation standard (SD) WHO NCHS (National Centre for Health Statistic).Learning Vektor Quantization (LVQ) Method and one of its algorithm, LVQ3 is used for this research to handle appraisal of children nutrition status based on deviation standard reference for that weight and high index. The variable that used in this appraisal are genre, body weight, body high, infection disease, appetite, and father work.Based on result of this research and discuss that has been done, LVQ3 algorithm is better applied for children nutrient status classification than LVQ1 algorithm. Using of window parameter (ε) in neural network LVQ3 effect positive impact, that is can increase perform in classification than without used window (LVQ1). Keywords—Anthropometry, Learning Vektor Quantization, Z-score.

Perfil antropométrico de pré-escolares de uma creche em Duque de Caxias, Rio de Janeiro

OBJETIVO: Descrever o perfil antropométrico de pré-escolares matriculados em uma creche de Duque de Caxias, Rio de Janeiro. MÉTODOS: Estudo transversal descritivo, com aferição de medidas antropométricas (peso e estatura) e preenchimento de um questionário socioeconômico. A população estudada foi composta por 33 pré-escolares menores de seis anos de idade matriculados na creche. A população de referência para comparação do grupo estudado foi a do National Center for Health Statistic (NCHS) e da Organização Mundial de Saúde (OMS). RESULTADOS: Observou-se que a maioria (48,5%) das crianças fazia parte da classe econômica C. Nenhuma delas apresentou deficit pôndero-estatural (Z escore<-2) de acordo com os índices estatura/idade (E/I), peso/idade (P/I) e peso/estatura (P/E). Entretanto, 21,2% apresentaram risco de baixa estatura (Z escore entre -2 e -1); 15,2 e 9,1% mostraram risco de baixo peso, segundo os índices P/I e P/E, respectivamente; 21,2% para sobrepeso (Z escore entre +1 e +2) tanto para o índice P/I quanto para o índice P/E e, finalmente, 3,0 e 6,1% apresentaram obesidade (Z escore >+2) segundo os índices P/I e P/E, respectivamente. CONCLUSÕES: Reflexos da transição nutricional foram observados neste estudo, no qual se encontrou ausência de deficits pôndero-estaturais indicativos de desnutrição e um considerável excesso de peso, indicativo de sobrepeso e obesidade.