Temporal Trends Between 2010 and 2015 in Intensity of Care at End-of-Life for Patients With Chronic Illness: Influence of Age Under vs. Over 65 Years

Context

Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65 years of age.

Evaluating Quality in Adult Cardiac Surgery

National and institutional quality initiatives provide benchmarks for evaluating the effectiveness of medical care. However, the dramatic growth in the number and type of medical and organizational quality-improvement standards creates a challenge to identify and understand those that most accurately determine quality in cardiac surgery. It is important that surgeons have knowledge and insight into valid, useful indicators for comparison and improvement. We therefore reviewed the medical literature and have identified improvement initiatives focused on cardiac surgery. We discuss the benefits and drawbacks of existing methodologies, such as comprehensive regional and national databases that aid self-evaluation and feedback, volume-based standards as structural indicators, process measurements arising from evidence-based research, and risk-adjusted outcomes. In addition, we discuss the potential of newer methods, such as patient-reported outcomes and composite measurements that combine data from multiple sources.     

Interplay between chronic hepatitis B and atherosclerosis: Innovative perspectives and theories

Elaboration of carotid atherosclerosis in the setting of hepatitis B virus(HBV)infection should emphasize the significance of extrahepatic manifestations of the infection pathogenesis.Diverse processes comprise the pathoevolution of HBV infection,rendering it a multi-systemic disease in its essence.Our work not only exemplified atherosclerosis as an often-underestimated contributor to the severity of HBV infection but has also highlighted the bidirectional relationship between the two.Therefore,it is suggested that HBV-induced inflammation is one of the root causes of atherosclerosis,which in turn has a consequent effect on the severity of the chronic infection disease state,creating a vicious cycle.Additionally,we coupled prior data with the current concepts of HBV infection to postulate intriguing perspectives and theories.     

1975—2009年台风导致死亡的时间趋势分析

目的分析全国受台风影响省份1975—2009年台风导致死亡的时间趋势,为有效制定台风应对措施提供科学依据。方法台风灾害的数据来自《中国气象灾害大典》和《全国气候影响评价》,将受台风影响省份按台风(首次登陆为12~13级)频次分为高发(10次)、中发(6~9次)和低发(5次)共三类省份,5年为周期统计死亡率。采用线性趋势卡方检验对全国1975—2009年台风导致平均死亡率随时间变化的趋势进行分析。结果台风高发省份共6个,其中广东、浙江、福建、海南、广西台风导致平均死亡率的时间趋势为降低(P0.05);台风中发和低发省份分别为3和7个,安徽省为上升,山东省下降(P0.05),上海市的时间趋势不能确定。其他受台风影响地区由于死亡数据较少,时间趋势不能确定。全国台风所致死亡率也呈总体下降趋势(P0.05)。结论全国1975—2009年台风导致死亡的时间趋势总体上是降低的,因个别年份发生强度相当大的台风故造成部分地区出现时间趋势的波动。     

Growth status of indigenous school children 6–14 years in the Tarahumara Sierra,Northern Mexico,in 1990 and 2007

Aims: The study evaluated the growth status and secular change in body size of indigenous Tarahumara children in northern Mexico.

Methods: Heights and weights of Tarahumara children 6–14 years were measured in 1990 (n = 601) and 2007 (n = 583); the BMI was calculated. International criteria defined weight status while United States reference data defined stunting.

Results: Estimated secular gains in height from 1990 to 2007 were greatest in 6–7 year-old boys and declined with age to a small, non-significant secular decline in boys 12–14 years. Among girls secular gains in height were similar at 6–7 and 8–9 years, largest at 10–11 years and small and non-significant at 12–14 years. Secular gains in weight were similar among 6–7 and 8–9 year-old boys and girls, were greater in girls than in boys at 10–11 years and showed a small, non-significant secular decline in boys and girls 12–14 years. Secular change in the BMI paralleled those for weight. The prevalence of stunting declined from 1990 to 2007 in both sexes and all age groups except 12–14 year youth. Overweight was more prevalent in girls than boys in both years and increased from 4% to 7% in boys and 9% to 13% in girls. Obesity was not common among boys and girls in each age group and in both years. Stunting and overweight/obesity were not related in either 1990 or 2007.

Conclusion: Positive secular changes in growth status have occurred in Tarahumara children 6–11 years in contrast to negligible changes among children 12–14 years. The results suggest recent improvements in health and nutrition sufficient to support a positive secular trend in younger children.     

Menarche,pregnancy, birth spacing and menopause among the Agta women foragers of Cagayan Province,Luzon, the Philippines

The reproductive histories of 74 post-menarcheal Agta Negrito women, tropical foragers of Cagayan province, north-eastern Luzon, the Philippines are described and analysed in comparison with data collected by Howell on Dobe! Kung hunter-gatherers. Among the Agta, mean age at menarche is 17, mean age at first live birth is 20·14 years, mean completed parity is 6·53 and mean age at menopause is 44. Average height is 141·24cm and average weight 36·72 kg. No time trends were detected in age at menarche and age at first live birth among the Agta. Average spacing between live births where an infant survives until the birth of the next sibling was 2·85 years. Compared to the Dobe !Kung, Agta women have later menarche, but shorter birth spacing and a longer active childbearing span.     

Secular change in the growth status of urban and rural schoolchildren aged 6–13 years in Oaxaca,southern Mexico

Background: Populations in the state of Oaxaca in southern Mexico are at high risk for malnutrition and marginalization.

Aim: The study compared secular changes in the growth status of urban and rural schoolchildren in the Valley of Oaxaca between the 1970s and 2000.

Subjects and methods: Cross-sectional surveys of boys and girls aged 6–13 years (n = 1472) were carried out in an urban colonia populares in 1972 and 2000 and a rural indigenous community in 1978 and 2000. Height, sitting height and weight were measured; leg length, sitting height ratio, BMI, and prevalence of stunting, underweight, overweight and obesity were calculated. Sex-specific ANCOVA controlling for age was used.

Results: Both urban and rural children experienced significant secular gains in linear dimensions, body weight and the BMI between the 1970s and 2000. Estimated rates of secular gain overlapped considerably between urban and rural children. Secular gains in the BMI are significantly greater in urban than rural boys and girls. Urban–rural differences in linear dimensions and body weight in 2000 compared to the 1970s do not differ in either sex, but urban–rural differences in the BMI are greater in boys and girls in 2000 compared to the 1970s. The prevalence of stunting declined while that of overweight and obesity increased.

Conclusions: Significant secular increases in body size occurred between the 1970s and 2000, but there was considerable overlap between urban and rural children. Only secular gains in the BMI were significantly greater in urban than rural boys and girls and the magnitudes of urban–rural differences in the BMI were greater in 2000 than in the 1970s.     

Has the prevalence of health care services use increased over the last decade (2001–2009) in elderly people? A Spanish population-based survey

Objectives

(1) To describe the prevalence of general practitioner visits and hospitalization according to sex and age groups; (2) to identify which factors are independently associated with a higher use of health care services among elderly Spanish; and (3) to study the time trends in the prevalence of use of health care services 2001–2009.

Study Design

Observational study. We analyzed data from the Spanish National Health Surveys conducted in 2001 (n = 21,058), 2003 (n = 21,650), 2006 (n = 29,478) and 2009 (n = 22,188). We included responses from adults aged 65 years and older.

Outcome measures

The main variables were the number of general practitioner visits in the last 4 weeks and hospitalization in the past year. We stratified the adjusted models by the main variables. We analyzed socio-demographic characteristics, health related variables, using multivariate logistic regression models.

Results

The total number of subjects was 24,349 (15,041 woman, 9309 men). Women were significantly older than men (P < 0.001). Women had higher prevalence of general practitioner visits than men in all surveys. Men had significantly higher prevalence of hospitalizations than women in the years 2001, 2006 and 2009. When we adjusted the hospitalization by possible confounders using logistic regressions, men had a higher probability of being hospitalized than women (OR 1.53, 1.39–1.69). The variables that were significantly associated with a higher use of health care services were lower educational level, worse self-rated health, chronic conditions, polypharmacy, and the level of disability. The number of general practitioner visits among women and men significantly increased from 2001 to 2009 (women: OR 1.43, 1.27–1.61; men: OR 1.71, 1.49–1.97).

Conclusions

The current study revealed an increase in health care services utilization from 2001 to 2009 in the older Spanish population.