Dietary Diversity and Vegetable and Fruit Consumption of Households in a Resource-Poor Peri-Urban South Africa Community Differ by Food Security Status

Sociodemographic, living standard measure, consumption of vegetables and fruit, and dietary diversity in relation to household food security were assessed. Using a hunger score, households were categorized as food secure (n = 125) or food insecure (n = 273). Food secure respondents had a higher mean dietary diversity score (3.98; 95%CI [3.79, 4.18] versus 3.65; 95% [CI 3.53, 3.77]), were more likely to eat vitamin A–rich foods (OR 1.15; 95% CI [1.05, 1.26]), a more varied diet (DDS ≥ 4, OR 1.90; 95% CI [1.19, 3.13]), and vegetables daily (OR 3.37; 95% CI [2.00, 5.76]). Cost limited daily vegetable/fruit consumption in food insecure households. Respondents with ≥ 8 years of schooling were more likely (OR 2.07; 95% CI [1.22, 3.53]) and households receiving social grants were less likely (OR 0.37; 95% CI [0.19, 0.72]) to be food secure. Results highlight the association between dietary diversity and household food security.     

Annual Facility Treatment Volume and Patient Survival for Mycosis Fungoides and Sézary Syndrome

BackgroundManagement of mycosis fungoides and Sézary syndrome (MF/SS) is complex, and randomized evidence to guide treatment is lacking. The institutional treatment volumes for MF/SS might vary widely nationally and influence patient survival.Patients and MethodsUsing the National Cancer Database, we identified patients with a diagnosis of MF/SS from 2004 to 2011 in the United States who had received treatment at a reporting facility. The patients were grouped into quintiles according to their treatment facility's average annual treatment volume (ATV). The characteristics associated with ATV were identified and compared using χ² tests. Overall survival (OS) was compared among the ATV quintiles using the Kaplan-Meier method with log-rank tests and multivariable Cox regression with hazard ratios (HRs). OS was also analyzed using the annual patient volume as a continuous variable.ResultsA total of 2205 patients treated at 374 facilities were included for analysis. The ATV quintile cutoffs were 1, 3, 6, and 9 patients. With a median follow-up period of 59 months, the 5-year estimated OS survival increased with ATV from 56.7% in the lowest quintile (≤ 1 patient annually) to 83.8% in the highest quintile (> 9 patients annually; P < .001). On multivariable analysis, greater ATV was associated with improved survival when analyzed as a continuous variable (HR, 0.96 per patient per year; 95% confidence interval, 0.94-0.98; P < .001) and when comparing the highest quintile to the lowest quintile (HR, 0.46; 95% confidence interval, 0.39-0.55).ConclusionThe present national database analysis demonstrated that higher facility ATV is associated with improved OS for patients with MF/SS. Further study is needed to determine the underlying reasons for improved survival with higher facility ATV.     

中外医院评价模式分析与启示

以国际视野对包括国际医疗质量体系、美国医疗机构评审国际联合委员会医院评价、美国最佳医院、汤森路透百佳医院和我国海南省第三方医院评价在内的,全面应用安全与质量持续改进工具的中外医院评价模式进行系统的比较分析,总结梳理其基本经验和最新进展,为新一轮医院评价工作提供借鉴和参考。     

Natural Medicines Comprehensive Database

Abstract

Well-documented, up-to-date, scientific information regarding the use of herbal medicines can be difficult to find. This article reviews the Natural Medicines Comprehensive Database Web sites. The Web sites contain a large database of information regarding herbal medicines.     

Limitations of administrative databases in spine research: a study in obesity

Background contextThe use of national inpatient databases for spine surgery research has been increasing. Unfortunately, without firsthand knowledge of each specific database, it can be difficult to judge the validity of such studies. Large databases that rely on administrative data, such as International Classification of Diseases, Ninth Revision (ICD-9) codes, may misrepresent patient information and could thus affect the results of studies that use these data.PurposeThe present study uses obesity, an easily quantified and objective variable, as an example comorbidity to assess the accuracy of ICD-9 codes in the setting of their continued use in spine database studies.Study design/settingA cross-sectional study at a large academic medical center.Patient sampleAll patients spending at least one night in the hospital as an inpatient between April 1, 2013 and April 16, 2013. Obstetrics and gynecology, psychiatry, and pediatric patients were excluded.Outcome measuresProportion of patients for whom ICD-9 obesity diagnosis codes assigned at hospital discharge match chart-documented body mass index (BMI).MethodsThe medical record was reviewed for each patient, and obesity ICD-9 codes were directly compared with documented BMI.ResultsThe study included 2,075 patients. Of 573 “obese” patients (calculated BMI 30–39.9), only 109 received the correct code (278.00), giving this ICD-9 code a sensitivity of 0.19. Of 174 “morbidly obese” patients (calculated BMI >40), only 84 received the correct code (278.01), giving this ICD-9 code a sensitivity of 0.48.ConclusionsUsing obesity as an example, this study highlights the potential errors inherent to using ICD-9–coded databases for spine surgery research. Should a study based on such data use “obesity” as a variable in any analyses, the reader should interpret these results with caution. We further suggest that obesity is likely not the only comorbidity to which these results apply. As database research continues to represent an increasing proportion of publications in the field of spine surgery, it is important to realize that study outcomes can be skewed by data accuracy, and, thus, should not be blindly accepted simply by virtue of large sample sizes.     

Defining Textbook Outcome in liver surgery and assessment of hospital variation: A nationwide population-based study

IntroductionTextbook outcome (TO) is a composite outcome measure covering the surgical care process in a single outcome measure. TO has an advantage over single outcome parameters with low event rates, which have less discriminating impact to detect differences between hospitals. This study aimed to assess factors associated with TO, and evaluate hospital and network variation after case-mix correction in TO rates for liver surgery.MethodsThis was a population-based retrospective study of all patients who underwent liver resection for malignancy in the Netherlands in 2019 and 2020. TO was defined as absence of severe postoperative complications, mortality, prolonged length of hospital stay, and readmission, and obtaining adequate resection margins. Multivariable logistic regression was used for case-mix adjustment.Results2376 patients were included. TO was accomplished in 1380 (80%) patients with colorectal liver metastases, in 192 (76%) patients with other liver metastases, in 183 (74%) patients with hepatocellular carcinoma and 86 (51%) patients with biliary cancers. Factors associated with lower TO rates for CRLM included ASA score ≥3 (aOR 0.70, CI 0.51–0.95 p = 0.02), extrahepatic disease (aOR 0.64, CI 0.44–0.95, p = 0.02), tumour size >55 mm on preoperative imaging (aOR 0.56, CI 0.34–0.94, p = 0.02), Charlson Comorbidity Index ≥2 (aOR 0.73, CI 0.54–0.98, p = 0.04), and major liver resection (aOR 0.50, CI 0.36–0.69, p < 0.001). After case-mix correction, no significant hospital or oncological network variation was observed.ConclusionTO differs between indications for liver resection and can be used to assess between hospital and network differences.     

Review of Rare Diseases Resources: National Organization for Rare Disorders (NORD) Rare Disease Database,NIH Genetic and Rare Diseases Information Center,and Orphanet

This column profiles three important online resources for rare disorder information. The National Organization for Rare Disorders (NORD) Rare Disease Database set the standard for thorough, detailed monographs on rare diseases starting in the 1990s. The NORD Database is complemented by the National Institutes of Health (NIH) Genetic and Rare Diseases Information Center online and the European resource, Orphanet, both of which provide much broader coverage, if less in depth than NORD’s. Reading level for all three information sources is high, and there are occasional issues with currency. However, consumer health librarians should find these organizations’ web-based databases to be reliable sources of information on health conditions that can be perplexing for both patient and health care providers alike.     

Collection,verification, sharing and dissemination of data: the CONTRAST experience

The scientific community is charged with growing demands regarding the management of project data and outputs and the dissemination of key results to various stakeholders. We discuss experiences and lessons from CONTRAST, a multidisciplinary alliance that had been funded by the European Commission over a 4-year period, in order to optimize schistosomiasis control and transmission surveillance in sub-Saharan Africa. From the start, project partners from Europe and Africa set out an ambitious goal: to sample data following standard protocols at all field sites and then sharing the data in a way that would enable all project partners to have access through a password-protected Internet-based data portal. This required anonymous agreement on several common standardized sample forms, ranging from the mundane but important issue of using the same units of measurement to more complex challenges, for instance agreeing on the same protocols for double-treatment of praziquantel in different settings. With the experiences gained by the CONTRAST project, this paper discusses issues of data management and sharing in research projects in the light of the current donor demand, and offers advice and specific suggestions for similar interdisciplinary research projects.     

An overview of biosecurity in Australia

Threats of natural and deliberate biological agent release are very real and are of serious concern within Australia and internationally, having the potential to substantially impact human, plant and animal health as well as agriculture, trade relations, infrastructure and the economy. Biosecurity programmes and policies are essential for counteracting these threats and enabling a nation to effectively prevent and/or respond to the natural, accidental and deliberate release of a biological agent. The major biosecurity focus in Australia is the protection against invasive animal, plant and insect species; however, more recently, the threat of microbiological agents has become a priority for Australia’s national security. Australia’s biosecurity capabilities are maintained through a coordinated effort, involving national, state and local government and non-government agencies. Communication and collaboration between all parties, at both a national and international level, is the key to an effective response. The threat from biological agents is a very real concern and Australia must maintain its preparedness in order to ensure its capacity to respond to biological threats. This review provides a contemporary overview of biosecurity in Australia and the role of forensic science in the investigation of biosecurity incidents.