French hospital discharge database (PMSI) and bacterial resistance: Is coding adapted to hospital epidemiology?

Objective

A preliminary analysis of data consistency on different types of bacterial resistance by infection site and causative agents was conducted using the French hospital discharge database (French acronym PMSI) to assess the use of the database in a national cartography tool.

Is hospital discharge administrative data an appropriate source of information for cancer registries purposes? Some insights from four Spanish registries

Background

Complementary and alternative medicine (CAM) use - of which naturopathy constitutes a significant proportion - accounts for approximately half of all health consultations and half of out-of-pocket expenditure in Australia. Data also suggest CAM use is highest amongst rural Australians. Unfortunately little is known about the grass-roots reality of naturopathy or other CAM use in rural regions.

Methods

Semi-structured interviews were conducted with 20 naturopaths practising in the Darling Downs region of South-East Queensland to assess their perceptions and experiences of rural patients and demand for their services.

Results

Naturopaths described strong demand in rural areas for their services and perceived much of this demand as attributable to cultural traits in rural communities that served as pull factors for their naturopathic services. Such perceived traits included a cultural affinity for holistic approaches to health and disease and the preventive philosophy of naturopathy and an appreciation of the core tenet of naturopathic practice to develop closer therapeutic relationships. However, cost and a rural culture of self-reliance were seen as major barriers to naturopathic practice in rural areas.

Conclusions

Demand for naturopathic services in rural areas may have strong underlying cultural and social drivers. Given the apparent affinity for and increasingly large role played by CAM services, including naturopathic medicine, in rural areas it is imperative that naturopathic medicine and the CAM sector more broadly become a core focus of rural health research.     

Socioeconomic trends and differentials in mortality due to cervical cancer in the State of Paraná (Brazil), 1980-2000

The scope of this paper is to discuss the evolution of mortality due to cervical cancer in the State of Paraná, Brazil, between 1980 and 2000 and analyze the socioeconomic differentials in each region of the State. Mortality data were gathered from the System for Information on Mortality by age and town of residence. Age-adjusted death rates were calculated for 22 regions of the state in each year. Comparative analysis evaluated socioeconomic indicators associated with regions that showed either stationary or increasing mortality trends. Cervical cancer deaths increased in the state of Paraná, with an annual percentage increase of 1.68% (1.20 to 2.17, 95% confidence interval). Most of the regions presented a stationary trend of cervical cancer deaths. The comparison of regions presenting an increasing trend indicated poorer socioeconomic indices for the former set: regions with an increase in cervical cancer mortality had a significantly higher illiteracy rate (p<0.001), percentage of individuals older than 15 years with less than 4 years schooling (p=0.001), and lower per-capita income (p=0.025) and human development index (p=0.023). An increasing mortality trend was thus observed throughout the State and areas with higher mortality rates had poorer socioeconomic indices.     

Can primary care and community-based models of emergency care substitute for the hospital accident and emergency (A & E) department?

This systematic review assesses the extent to which primary-secondary substitution is possible in the field of emergency care where the range of options for the delivery of care is increasing in the UK and elsewhere. Thirty-four studies were located which met the review inclusion criteria, covering a range of interventions. This evidence suggested that broadening access to primary care and introducing user charges or other barriers to the hospital accident and emergency (A & E) department can reduce demand for expensive secondary care, although the relative cost-effectiveness of these interventions remains unclear. On a smaller scale, employing primary care professionals in the hospital A & E department to treat patients attending with minor illness or injury seems to be a cost-effective method of substituting primary for secondary care resources. Interventions that addressed both sides of the primary-secondary interface and recognised the importance of patient preferences in the largely demand-driven emergency service were more likely to succeed in complementing rather than duplicating existing services. The evidence on other interventions such as telephone triage, minor injuries units and general practitioner out of hours co-operatives was sparse despite the fact that these interventions are growing rapidly in the UK. Quantifying the scope for substitution in any one health system is difficult since the evidence comes from international research studies undertaken in a variety of very different health settings. Simply transferring interventions which succeed in one setting without understanding the underlying process of change is likely to result in unexpected consequences locally. Nevertheless, the review findings clearly demonstrate that shifting the balance of care is possible. It also highlights a persistent gap in professional and lay perceptions of appropriate sources of care for minor illness and injury.     

A commercial porcine circovirus (PCV) type 2a-based vaccine reduces PCV2d viremia and shedding and prevents PCV2d transmission to naïve pigs under experimental conditions

Porcine circovirus type 2 (PCV2) vaccination has been effective in protecting pigs from clinical disease and today is used extensively. Recent studies in vaccinated populations indicate a major PCV2 genotype shift from the predominant PCV2 genotype 2b towards 2d. The aims of this study were to determine the ability of the commercial inactivated PCV2a vaccine Circovac® to protect pigs against experimental challenge with a 2013 PCV2d strain and prevent transmission. Thirty-eight pigs were randomly divided into four groups with 9–10 pigs per group: NEG (sham-vaccinated, sham-challenged), VAC (PCV2a-vaccinated, sham-challenged), VAC + CHAL (PCV2a-vaccinated and PCV2d-challenged), and CHAL (sham-vaccinated, PCV2d-challenged). Vaccination was done at 3 weeks of age using Circovac® according to label instructions. The CHAL and VAC + CHAL groups were challenged with PCV2d at 7 weeks of age and all pigs were necropsied 21 days post-challenge (dpc). The VAC-CHAL pigs seroconverted to PCV2 by 21 days post vaccination (dpv). At PCV2d challenge on 28 dpv, 3/9 VAC and 1/9 VAC + CHAL pigs were seropositive. NEG pigs remained seronegative for the duration of the study. Vaccination significantly reduced PCV2d viremia (VAC + CHAL) at dpc 14 and 21, PCV2d fecal shedding at dpc 14 and 21 and PCV2d nasal shedding at dpc 7, 14 and 21 compared to CHAL pigs. Vaccination significantly reduced mean PCV2 antigen load in lymph nodes in VAC + CHAL pigs compared to CHAL pigs. When pooled serum or feces collected from VAC + CHAL and CHAL pigs at dpc 21 were used to expose single-housed PCV2 naïve pigs, a pooled fecal sample from CHAL pigs contained infectious PCV2 whereas this was not the case for VAC + CHAL pigs suggesting reduction of PCV2d transmission by vaccination. Under the study conditions, the PCV2a-based vaccine was effective in reducing PCV2d viremia, tissue loads, shedding and transmission indicating that PCV2a vaccination should be effective in PCV2d-infected herds.     

Skin cancer rates in North Rhine-Westphalia,Germany before and after the introduction of the nationwide skin cancer screening program (2000–2015)

Germany is the first nation that implemented a nationwide skin cancer screening program in 2008. The aim is to study the effect of the program on skin cancer rates and to estimate the number needed to screen for an unselected and a hypothetical high-risk population in Germany. We used population-based data on skin cancer incidence (2000–2014), mortality, hospitalization and sick leave (2000–2015) from North Rhine-Westphalia, Germany (18 million population). We calculated annual age-standardized rates per 100,000 person years and calculated the relative change of the rates (%) including 95% confidence intervals (95% CI). Between 2007 and 2014, the estimated annual percentage change (EAPC) of the age-standardized incidence rate of skin melanoma was 3.8% among men and women. These increases were accompanied by increases of the age-standardized mortality rates (EAPC men 3.2%, women 2.0%) and age-standardized sick leave rates (EAPC men 11.0%, women 6.1%). Hospitalization rates showed barely any change. All types of rates for nonmelanoma skin cancer showed marked increases. The number needed to screen for skin melanoma death would be 34,000 if the risk reduction due to screening would be 50%. In a hypothetical high-risk approach with 10% of the population at high risk, that is, a relative risk of melanoma death of 4.0, a skin melanoma mortality risk reduction of 50% among these people due to screening would result in a reduction of the skin melanoma mortality by 15% in the total population. However, this reduction would require a number needed to screen of 11,141. Seven years after the introduction of the skin cancer screening program, there is no discernible beneficial effect at population level. The estimated number needed to screen for skin melanoma in an unselected approach is high and a realistic high-risk approach is currently not feasible.     

Who can best recruit to randomized trials? Randomized trial comparing surgeons and nurses recruiting patients to a trial of treatments for localized prostate cancer (the ProtecT study)

BACKGROUND AND OBJECTIVE: Recruitment to randomized trials is often difficult, but few studies have investigated interventions to improve recruitment. In a randomized trial nested within a trial of treatments for localized prostate cancer, we investigated the comparative effectiveness and cost-effectiveness of nurses and surgeons in recruiting patients. METHODS: Men with localized prostate cancer were randomized to see a nurse or urologic surgeon for an "information appointment" in which they were asked to consent to the ProtecT treatment trial comparing surgery, radiotherapy, and active monitoring. Analysis was conducted by intention to treat using chi-square with 95% confidence intervals for proportions and differences between groups. An economic evaluation was performed using the duration of appointments and grade of recruitment staff. RESULTS: Case-finding identified 167 men with localized prostate cancer. One hundred fifty (90%) took part in the recruitment trial. There was a 4.0% difference between nurses and surgeons in recruitment rates (67% nurses, 71% urologists, 95% CI -10.8% to +18.8%, P=.60). Cost-minimization analysis showed that nurses spent longer times with patients but surgeon costs were higher and nurses often supported surgeon-led clinics. CONCLUSION: Nurses were as effective and more cost-effective recruiters than urologic surgeons. This suggests an increased role for nurses in recruiting patients to randomized trials.     

Immunogenicity and safety of a new live attenuated herpes zoster vaccine (NBP608) compared to Zostavax® in healthy adults aged 50 years and older

A multi-centre, randomised, double-blinded, active-controlled, parallel-group clinical trial was carried out to assess the immunogenicity and safety of NBP608—a newly developed live-attenuated zoster vaccine in Korea—relative to Zostavax® in healthy adults aged 50 years or older. Immune responses to the vaccine were evaluated by glycoprotein enzyme-linked immunosorbent assay (gpELISA) and enzyme-linked immunosorbent spot (ELISPOT) assays using the interferon (IFN)-γ and interleukin (IL)-2 FluoroSpot kit 6 weeks after vaccination. Safety was monitored for 26 weeks based on subjects’ diaries, spontaneous reports from subjects, and history taking by the investigators. A total of 845 subjects participated in the screening, and 823 received the vaccination (413 in the NBP608 group and 411 in the comparator group). The gpELISA-determined geometric mean fold rise from baseline to post NBP608 vaccination was 2.75 [95% confidence interval, CI (2.57, 2.94)]. The gpELISA-determined adjusted geometric mean titers (GMTs) of NBP608 and the comparator were 1346.37 [95% CI (1273.99, 1422.87)] and 1674.94 [95% CI (1585.35, 1769.58)], respectively. The adjusted GMT ratio of NBP608 to the comparator was 0.80 [95% CI (0.75, 0.87)]. There was no statistically significant difference between two groups in terms of the geometric mean spot numbers determined by IFN-γ and IL-2 ELISPOT assays at 6 weeks post vaccination (P = 0.7232, 0.3844). The incidence of adverse events (AEs) within 6 weeks post vaccination was 49.82% overall (410/823, 941 cases), 50.73% (209/412, 474 cases) in the NBP608 group, and 48.91% (201/411, 467 cases) in the comparator group. The difference in AE rate between the two groups was not statistically significant (P = 0.6010). Most AEs were mild, with a rate of 83.12% in the NBP608 group and 75.37% in the comparator group. Thus, NBP608 is non-inferior to Zostavax® in terms of inducing the immune response and can be safely administered to adults aged 50 years or older.ClinicalTrials.gov Identifier: NCT03120364.     

Does X(a) mark the spot? An indirect mixed treatment comparison of Xa inhibitors compared to warfarin for patients with atrial fibrillation

The study sets out to compare the safety and efficacy of oral Non-vitamin K antagonists and warfarin in patients with atrial fibrillation.BackgroundPatients with atrial fibrillation carry a higher than normal risk for stroke, thus making them dependent on long-term anticoagulation treatment. While warfarin is considered to be the gold standard, several of its attributes, hinder adherence of patients to the therapeutic regimen. A new therapeutic category, the oral Non-vitamin K antagonist oral anticoagulants, aims to provide better and safer care to patients presenting with atrial fibrillation.MethodAn indirect mixed treatment comparison using data from published randomised controlled trials.ResultsLooking at the primary efficacy endpoint of stroke or systematic embolism, apixaban, rivaroxaban and dabigatran, demonstrated significant superiority compared to warfarin, while a trend exists for edoxaban [OR: 0.84 (95% CI 0.74–1.02)]. At the primary safety endpoint of major bleeding, evidence suggest that apixaban and edoxaban are superior to warfarin. Warfarin proved to be safer regarding gastrointestinal bleeding, compared to rivaroxaban, dabigatran and edoxaban. At the secondary efficacy endpoints of hemorrhagic and intracranial stroke, all Non-vitamin K antagonists oral anticoagulants were related to reduced risk versus warfarin.ConclusionsThe Non-vitamin K antagonist oral anticoagulants constitute a new and promising category in the field of atrial fibrillation, even in the context of uncertainty, which an indirect comparison yields.     

Application of the Health Belief Model to U.S. Magazine Text and Image Coverage of Skin Cancer and Recreational Tanning (2000–2012)

The health belief model (HBM) has been widely used to inform health education, social marketing, and health communication campaigns. Although the HBM can explain and predict an individual’s willingness to engage in positive health behaviors, its application to, and penetration of the underlying constructs into, mass media content has not been well characterized. We examined 574 articles and 905 images about skin cancer and tanning risks, behaviors, and screening from 20 U.S. women’s and men’s magazines (2000–2012) for the presence of HBM constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Susceptibility (48.1%) and severity (60.3%) information was common in text. Perceived benefits (36.4%) and barriers (41.5%) to prevention of skin cancer were fairly equally mentioned in articles. Self-efficacy (48.4%) focused on sunscreen use. There was little emphasis on HBM constructs related to early detection. Few explicit cues to action about skin cancer appeared in text (12.0%) or images (0.1%). HBM constructs were present to a significantly greater extent in text versus images (e.g., severity, 60.3% vs. 11.3%, respectively, χ² = 399.51, p < .0001; benefits prevention, 36.4% vs. 8.0%, respectively, χ² = 184.80, p < .0001), suggesting that readers are not visually messaged in ways that would effectively promote skin cancer prevention and early detection behaviors.     

Residential exposure to overhead high-voltage lines and the risk of testicular cancer: results of a population-based case–control study in Hamburg (Germany)

Background: In a population-based case–control study we examined the association between residential exposure to overhead high-voltage lines and testicular cancer. Methods: We recorded the residential biography of cases with testicular cancer identified by the Hamburg Cancer Registry and of controls that were randomly selected from the mandatory registry of residents in Hamburg. The study included 145 incident cases between 15 and 69 years of age, diagnosed between 1995 and 1997, and 313 controls, matched for age in 5-year strata. In model A, exposure was defined by distance (ever vs never). Model B took into account residence time and the inverse distance from the nearest high-voltage line. It distinguished between low and high exposure, the never exposed persons serving as a reference group. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated by unconditional logistic regression. For men below the age of 40 years and men aged 40 years and over separate analyses were carried out. Results: Within a corridor of 100 m the prevalence of exposure to high-voltage lines in Hamburg was 6.9% in cases and 5.8% in controls (OR=1.3; 95% CI=0.56–2.80). In the more complex model B we found an OR of 1.2 (95% CI=0.60–2.47) for low exposure and 1.7 (95% CI=0.91–3.32) for high exposure. Younger men show slightly increased risks in both models. Conclusions: In all, residential exposure to high-voltage lines did not seem to be a major risk factor for testicular cancer in our study. Yet, the fact that risks for men below the age of 40 years were slightly increased in both exposure models deserves further attention.     

Influence of a Mine Tailing Accident Near Doñana National Park (Spain) on Heavy Metals and Arsenic Accumulation in 14 Species of Waterfowl (1998 to 2000)

This article presents the impact on waterbirds in Doñana National Park (Spain) of an accidental release of 5 million m³ acid waste produced by the processing of pyrite ore. Heavy metals (zinc, copper, cadmium, and lead) and arsenic were measured in several soft tissues (liver, kidney, and muscle) taken from 14 waterfowl species collected between April 1998 and May 2000. The main source of copper and zinc found in the waterfowl species examined was the spill waste, whereas cadmium, lead, and arsenic could also came from other sources. Kidney was the primary organ for cadmium and lead accumulation, whereas liver accumulated the most zinc and copper. Arsenic was concentrated in both muscle and liver tissue. The degree of contamination of the area where the birds lived, their age, their sex their size, and the time since the spill were found to have less influence than species and trophic level on the accumulation of metal in organs and tissues. Four species (Anser anser, Ciconia ciconia, Larus ridibundus, and Porphyrio porphyrio) were found to have the highest levels of the 5 elements.     

Antibody persistence at 18-20 months of age and safety and immunogenicity of a booster dose of a combined DTaP-IPV//PRP∼T vaccine compared to separate vaccines (DTaP, PRP∼T and IPV) following primary vaccination of healthy infants in the People's Republic of China

This study assessed the antibody persistence, and the immunogenicity and safety of a booster dose of a DTaP-IPV//PRP∼T (Pentaxim^®, Sanofi Pasteur's AcXim family) combined vaccine and of standalone vaccines one year after primary vaccination in the People's Republic of China. Participants (N = 719) previously primed with DTaP-IPV//PRP∼T at 2, 3, 4 months (Group A, N = 255), 3, 4, 5 months (Group B, N = 233), or DTaP (Wuhan Institute of Biological Products), PRP-T (Act-Hib^®) and IPV (Imovax^® Polio) at 3, 4, 5 months (Group C, N = 231) received boosters of the same vaccines at 18-20 months of age. Seroprotection (SP) and seroconversion (SC) were determined before and 1 month after the booster. Safety was monitored from parental reports. In all groups 87.6-100% of participants had pre-booster protective anti-PRP, -diphtheria, -tetanus and -poliovirus antibody titers; post-booster, all SP rates were 100% and SC was ≥80.4% for anti-pertussis titers ≥ 4-fold increase. Reactogenicity was low for each group. These data support the use of the DTaP-IPV//PRP∼T vaccine in the People's Republic of China compared to separate DTaP, IPV, and PRP∼T administration in terms of both safety and immunogenicity.     

The Caregiver Quality of Life Index–Cancer (CQOLC) scale: development and validation of an instrument to measure quality of life of the family caregiver of patients with cancer

Family caregivers have become increasingly responsible for providing home care for cancer patients. Research has documented the distress of family caregivers; however, little has been done to evaluate the broader impact of caregiving on quality of life (QoL). The objectives of this study were to evaluate the reliability and validity of the Caregiver Quality of Life Index–Cancer (CQOLC), a new self-report instrument. Two hundred and sixty-three family caregivers of patients with lung, breast or prostate neoplasms participated. Test–retest reliability was 0.95 and internal consistency was 0.91. As expected, there were moderate correlations with overall mental health (r=0.64), emotional distress (r=–0.50 to –0.52), burden (r=–0.65) and patient's performance status (r=–0.47) and low correlations with overall physical health (r=0.13), social support (r=0.22) and social desirability (r=0.08). These results show that increased overall mental health is associated with better QoL, while more emotional distress and worsening patient performance status are associated with poorer QoL. Thus, the CQOLC appears to possess adequate validity, test-retest reliability and internal consistency. Future directions include further evaluation of sensitivity to change and factor analysis to determine the principal health-related QoL domains evaluated by the CQOLC.