Correlates of satisfaction with pain treatment in the acute postoperative period: Results from the international PAIN OUT registry

Patient ratings of satisfaction with their postoperative pain treatment tend to be high even in those with substantial pain. Determinants are poorly understood and have not previously been studied in large-scale, international datasets. PAIN OUT, a European Union-funded acute pain registry and research project, collects patient-reported outcome data on postoperative day 1 using the self-reported International Pain Outcome Questionnaire (IPO), and patient, clinical, and treatment characteristics. We investigated correlates of satisfaction and consistency of effects across centres and countries using multilevel regression modelling. Our sample comprised 16,868 patients (median age 55 years; 55% female) from 42 centres in 11 European countries plus Israel, USA, and Malaysia, who underwent a wide range of surgical procedures, for example, joint, limb, and digestive tract surgeries. Median satisfaction was 9 (interquartile range 7–10) on a 0–10 scale. Three IPO items showed strong associations and explained 35% of the variability present in the satisfaction variable: more pain relief received, higher allowed participation in pain treatment decisions, and no desire to have received more pain treatment. Patient factors and additional IPO items reflecting pain experience (eg, worst pain intensity), pain-related impairment, and information on pain treatment added little explanatory value, partially due to covariate correlations. Effects were highly consistent across centres and countries. We conclude that satisfaction with postoperative pain treatment is associated with the patients’ actual pain experience, but more strongly with impressions of improvement and appropriateness of care. To the degree they desire, patients should be provided with information and involved in pain treatment decisions.     

Incidence and risks for surgical site infection after adult tibial plateau fractures treated by ORIF: a prospective multicentre study

Tibial plateau fractures are difficult to treat and more likely complicated by subsequent surgical site infection (SSI). There is limited information about its characteristics and related risk factors for SSI. This study was designed as a prospective and multicentre one to address this issue. From July to 15 November in 2014, 235 patients with tibial plateau fractures were treated by open reduction and internal fixation (ORIF) and followed up with complete data. Twelve patients (5·1%, 12/235) developed SSI, with 2·1% for deep SSI and 3·0% for superficial SSI. Most of them (10/12) occurred during the hospital stays. The median occurrence time was 6 days after operation (range, 2–26 days). We use univariate and multivariate logistic regression models to investigate the potential risk factors. In the univariate analysis, open fracture, prolonged preoperative stay, smoking habitus and preoperative abnormal neutrophil (NEUT) count were significant risk factors for SSI occurrence. However, in multivariate analysis, only open fracture (OR, 3·31; 95%, 1·06–1·84) and current smoking status (OR, 5·68; 95% CI, 1·56–20·66) remained significant. We recommend that smoking cessation programme is introduced at the time of admission to the hospital and elaborative evaluation of fracture severity and soft‐tissue damage is performed with an aim of reducing the risk of post‐operative SSI.     

人体测量指标对男性警察心血管病危险因素的适用性及筛检试验评价

目的：比较体质量指数（BMI）、腰围（WC）、腰臀比（WHR）、腰围身高比（WHtR）4项人体测量指标对男性公安民警心血管病（CVD）危险因素的预测和评价。方法：以4593名男性公安民警为研究对象，运用受试者特征曲线（ROC）比较4项人体测量指标对警察人群的适用性及CVD危险因素（高血压、糖尿病及血脂异常）的筛检试验评价。结果：该人群中，与WC、WHR和BMI相比，WHtR预测糖尿病、血脂异常及CVD高危人群的真实度较高，其ROC曲线下面积（AUC）较大（P分别〈0．05、〈0．01）：WHtR的灵敏度、约登指数及阴性预测值优于其他3项指标，分别为72．68％、0．35、58．9％。结论：应用WHtR在公安民警中进行筛检能够更全面地发现CVD高危人群，起到良好的预防效果。     

江苏两市MSM抗病毒治疗效果及其影响因素的研究

目的:分析江苏男男性行为(men who have sex with men,MSM)人群的艾滋病抗病毒治疗效果及其影响因素,首次建立江苏省MSM抗病毒治疗评价方法?方法:通过整群抽样的方式选取江苏两市接受免费高效抗逆转病毒治疗(highly active antiretroviral therapy,HAART)的MSM作为研究对象,进行生活史和用药情况的问卷调查;从江苏省艾滋病治疗信息库中获知其CD4值,采用Epidata 3.0和SAS 9.0分别进行资料录入与统计分析?结果:157例MSM总体CD4值提高,服药依从性低?经单因素及多因素分析,确诊后安全套使用水平低?吸烟量大?确诊至治疗时间间隔长是影响治疗效果的危险因素;首次CD4值较高及服药天数较长是保护因素?结论:江苏目前男男性行为人群抗病毒治疗效果显著,建议对符合治疗条件的MSM进行早期治疗,并提高患者服药依从性?     

Cytomorphology review of 100 newly diagnosed lower-risk MDS patients in the European LeukemiaNet MDS (EUMDS) registry reveals a high inter-observer concordance

The European LeukemiaNet MDS (EUMDS) registry is collecting data of myelodysplastic syndrome (MDS) patients belonging to the IPSS low or intermediate-1 category, newly diagnosed by local cytologists. The diagnosis of MDS can be challenging, and some data report inter-observer variability with regard to the assessment of the MDS subtype. In order to ensure that correct diagnoses were made by the participating centres, blood and bone marrow slides of 10% of the first 1000 patients were reviewed by an 11-person panel of cytomorphologists. All slides were rated by at least 3 panel members (median 8 panel members; range 3–9). Marrow slides from 98 out of 105 patients were of good quality and therefore could be rated properly according to the WHO 2001 classification, including assessment of dysplastic lineages. The agreement between the reviewers whether the diagnosis was MDS or non-MDS was strong with an intra-class correlation coefficient (ICC) of 0.85. Six cases were detected not to fit the entry criteria of the registry, because they were diagnosed uniformly as CMML or AML by the panel members. The agreement by WHO 2001 classification was strong as well (ICC = 0.83). The concordance of the assessment of dysplastic lineages was substantial for megakaryopoiesis and myelopoiesis and moderate for erythropoiesis. Our data show that in general, the inter-observer agreement was high and a very low percentage of misdiagnosed cases had been entered into the EUMDS registry. Further studies including histomorphology are warranted.     

Public engagement in setting healthcare priorities: a ranking exercise in Cyprus

Background

In countries such as Cyprus the financial crisis and the recession have severely affected the funding and priority setting of the health care system. There is evidence highlighting the importance of population’ preferences in designing priorities for health care settings. Although public preferences have been thorough analysed in many countries, there is a research gap in terms of simultaneously investigating the relative importance and the weight of differing and competing criteria for determining healthcare priority settings. The main objective of the study was tο investigate public preferences for the relative utility and weight of differing and competing criteria for health care priority setting in Cyprus.

Methods

The ‘conjoint analysis’ technique was applied to develop a ranking exercise. The aim of the study was to identify the preferences of the participants for alternative options. Participants were asked to grade in a priority order 16 hypothetical case scenarios of patients with different disease and of diverse socio-economic characteristics awaiting treatment. The sample was purposive and consisted of 100 Cypriots, selected from public locations all over the country.

Results

It was revealed that the “severity of the disease” and the “age of the patient” were the key prioritization criteria. Participants assigned the smallest relative value to the criterion “healthy lifestyle”. More precisely, participants older than 35 years old assigned higher relative importance to “age”, while younger participants to the “severity of the disease”. The “healthy lifestyle” criterion was assigned to the lowest relative importance to by all participants.

Conclusion

In Cyprus, public participation in health care priority setting is almost inexistent. Nonetheless, it seems that the public’s participation in this process could lead to a wider acceptance of the healthcare system especially as a result of the financial crisis and the upcoming reforms implemented such as the establishment of the General System of Health Insurance.

     

Acculturation Strategies Among South Asian Immigrants: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

In the past, epidemiologic research on acculturation and health has been criticized for its conceptual ambiguity and simplistic measurement approaches. This study applied a widely-used theoretical framework from cross-cultural psychology to identify acculturation strategies among South Asian immigrants in the US and to examine sociodemographic correlates of acculturation strategies. Data were from the Mediators of Atherosclerosis in South Asians Living in America study. We used latent class analysis to identify groups of individuals that were similar based on cultural attitudes and behaviors. We used latent class regression analysis to examine sociodemographic correlates of acculturation strategies. We found that South Asian immigrants employed three acculturation strategies, including separation (characterized by a relatively high degree of preference for South Asian culture over US culture), assimilation (characterized by a relatively high degree of preference for US culture over South Asian culture), and integration (characterized by a similar level of preference for South Asian and US cultures). Respondents with no religious affiliation, those with higher levels of income, those who lived a greater percentage of their lives in the US, and those who spoke English well or very well were less likely to use the separation strategy than the assimilation or integration strategies. Using epidemiologic cohort data, this study illustrated a conceptual and methodological approach that addresses limitations of previous research on acculturation and health. More work is needed to understand how the acculturation strategies identified in this study affect the health of South Asian immigrants in the US.     

Correlates and pattern of physical activity among urban and suburban Iranian adults: a population-based study

Background

Considering the important role of physical activity in prevention of chronic disease, the aims of the present study were investigating the socio-demographic and lifestyle determinants and also pattern of the physical activity in urban and suburban Iranian adults.

Method

A sample of 2135 adults from suburban and urban areas of East Azerbaijan, Iran, participated in the present study. The Persian form of International Physical Activity Questionnaire was completed for evaluation of the physical activity level. The demographic characteristics including age, gender, educational level, marriage status, and residential area were recorded and BMI was calculated. The determinants of physical activity level were assessed using logistic regression.

Results

Of the study population, 28.47% were inactive, 27.96% were minimally active, and 43.55% had health-enhancing physical activity (HEPA). Residents of suburban areas (P < 0.001) and normal-weight adults (P < 0.001) were significantly more likely to participate in a high intense physical activity. Compared with men, women had significantly lower odds of being physically active [odds ratio (OR) 0.57; 95% CI 0.46–0.71]. In comparison with residents of urban areas, residents of suburban areas (OR 2.68; 95% CI 2.18–3.30) significantly had higher odds of being physically active. In women, most of the total MET-min/week occurred through walking (36.35%) and moderate intensity physical activities (53.86%). However, in men, the proportion of all domains of physical activity in men was almost equal.

Conclusion

In conclusion, it was illustrated that physical inactivity was more prevalent among obese individuals, women, and urban residents. These findings have important implications for developing physical activity promotion programs considering the individual differences.