Mapa bibliométrico de la investigación realizada en atención primaria en España durante el periodo 2013-2017

ObjectiveTo describe the Spanish scientific production of primary care during 2013-2017 and analyze their geographical distribution, impact factor, areas of research and involvement of different institutional sectors.DesignObservational study bibliometric.ParticipantsThe study focused on publications indexed in Medline.Main measurementsJournal and year of publication, first/last author, workplace and autonomous community. Later, articles were classified according to their content. The impact factor was obtained from the basis of bibliometric analysis Journal Citation Reports.ResultsUsing search criteria, were selected 980 documents. The transiency rate was 78,8%. The highest proportion of articles (43.2%) came from health centers, but we observed an increase of the articles from units or research institutes (14.9% in 2013, 19.1% in 2017). Of the total, 63.3% were classified as “clinical aspects”, 19.3% were published in the journal Atención Primaria, 40.6% in foreign journals and 72.4% in journals with impact factor, being this proportion significantly lower (p <0.001) in those coming from health centers (59.6%) or teaching units/management/health services (70.0%) with respect to those originated in research units/institutes (93.1%) or in universities (89.0%). In relation to population (articles/100.000 inhab.), the most productive communities were Cataluña (4.2), Aragón (3.9), e Islas Baleares (3.3).ConclusionsIn primary care publications there is great diversity in both research areas such as in journals where published. Most are from health centers, treat clinical aspects and published in Spanish journals. Differences in the volume of scientific production between regions are observed.     

Mapa bibliométrico de la investigación realizada en atención primaria en España durante el periodo 2008-2012

ObjectiveTo describe the Spanish scientific production of primary care during 2008-2012.DesignObservational study bibliometric.SettingSpanish scientific production in primary care.ParticipantsThe study focused on publications indexed in Medline.Main measurementsIn each record was obtained journal, year of publication, first/last author, workplace and autonomous community. Later, articles were classified according to their content or areas of research. The impact factor was obtained from the basis of bibliometric analysis Journal Citation Reports.ResultsUsing search criteria, were selected 1,048 documents. The transiency rate was 62.6%. Production increased from 170 papers in 2008 to 291 in 2012. Most (65.7%) came from health centers, but we observed a significant increase (P = .01) of the articles from units or research institutes (5.9% in 2008, 12.0% in 2012). Of the total, 61.6% were classified as «clinical aspects», 22.5% were published in the journal Atención Primaria, 80.5% in journals with impact factor and 33.49% in foreign journals, being higher this proportion (P < .001) in units or research institutes (70.5% vs. 29.8%). In relation to population (articles/100.000 inhab.), the most productive communities were Cataluña (4.1), Castilla-La Mancha (3.6), Aragón (3.4) and Navarra (3.4).ConclusionsIn primary care publications there is great diversity in both research areas such as in journals where published. Most are from health centers, treat clinical aspects and published in Spanish journals. Differences in the volume of scientific production between regions are observed.     

Has Female Authorship in Family Medicine Research Evolved Over Time?

PURPOSEStudies conducted in medical fields other than family medicine show that gender differences in publication rates are pronounced in many, but not all, fields of medicine. Our objective was to assess possible gender differences in publication rates in family medicine journals.METHODSUsing MEDLINE, we collected information on all journal articles published in 3 family medicine journals in the United States (Family Medicine, Journal of the American Board of Family Medicine, and Annals of Family Medicine) during the period 2008 to 2017. Gender of first and last author for each article was assigned using first names. The gender breakdown of the editorial boards during this time period was also examined.RESULTSFor the 3 journals combined during the period 2008 to 2017, 46.1% (1,209/2,623) of first authors were female, and 38.6% (857/2,223) of last authors were female. For all journals combined, there was a statistically significant increase in first authorship (43.2% in 2008 vs 52.1% in 2017; P<.001) and last authorship (28.8% in 2008 vs 41.8% in 2017; P <.001) over time. The editorial boards of the journals combined were 37.2% (279/749) female, and this did not increase significantly over the time period studied (35.5% in 2008 vs 39.2% in 2017; P=.49).CONCLUSIONSRepresentation of female authors in family medicine journals is increasing, yet last authorship remains low, and there is variation between journals in terms of gender equity. Future studies can evaluate the reason for these differences and offer solutions to publications as they try to increase their female authorship.Key words: bibliometrics, authorship, gender gap, academic medicine     

Palliative care in public health: a formal and content-related analysis of European journals

Public health and health care science take on an important role in the further development of palliative care. This study examines to what degree palliative care is represented in the pertinent academic journals of public health and health care science and what the major subjects are. We analysed the European journals that were listed in the Journal Citation Reports in the categories health care science and services, public, environmental and occupational health, as well as health policy and services. The literature search was conducted in the journals identified for the years 1996 through 2005, using the terms palliative care*, palliative medicine*, terminal care* and hospice care*. The analyses were based on the quantity of publications in the journals, the publication years, the impact factors and the subjects focused on. There were 82 journals included. Altogether, 57,737 publications appeared during the analysis period; 166 papers were on palliative care (0.3% of all papers). The majority of palliative care articles (55%, n = 91) were concentrated in a very small circle of journals (4%, n = 3). The absolute quantity of palliative publications and their percentage among all publications have continuously increased from 0.1% in 1996/1997 to 0.4% in 2004/2005. The largest group of papers on the subject (42%, n = 70) appeared in journals with impact factors less than 1, whereas the largest group of all papers was found in journals with impact factors of 1–1.999 (51%, n = 15,732). Most papers focus on patient orientation and health professionals’ perspective and education; subjects such as health care utilization and barriers are less frequently covered. There is need for more research on palliative care relevant for public health and health care science in terms of reach and top-level impact. For example, the research questions should deal with health care utilization and potential social and cultural barriers. The interdisciplinary community of public health sets the stage for the required collaborative research activities.     

Research and Policy Impact of Trials Published by the UK National Institute of Health Research (2006-2015)

ObjectivesHealth technology assessment aims to inform and support healthcare decision making, and trials are part of that process. The purpose of this study was to measure the impact of a sample of trials in a meaningful but robust fashion.MethodsAll randomized controlled trials funded and published by the UK National Institute of Health Research in the Health Technology Assessment journal series and other peer-reviewed journals were identified for 2006 to 2015. Citation analysis was performed for all trials, and quantitative content analysis was undertaken on a purposive sample to determine whether impact could be categorized as “instrumental” (ie, having a clear influence on key research and policy publications).ResultsThe search identified 133 relevant trials. The citation rate per trial was 102.97. Of the 133 trials, 129 (98%) were cited in 1 or more systematic reviews or meta-analyses (mean per trial = 7.18, range = 0-44). Where they were cited, the trials were used in some form of synthesis 63% of the time. Ninety-one of the 133 (68%) trials were found to be cited in 1 or more guidance or policy document (mean per trial = 2.75, range = 0-26) and had an instrumental influence 41% of the time. The publication of these trials’ results in journals other than the Health Technology Assessment journal appears to enhance the discoverability of the trial data. Altmetric.com proved to be very useful in identifying unique policy and guidance documents.ConclusionThese trials have impressive citation rates, and a sizeable proportion are certainly being used in key publications in a genuinely instrumental manner.     

Evaluating the Health Information Technology Regional Extension Center in South Carolina

ObjectiveTo determine the impact of the South Carolina Regional Extension Center, Center for Information Technology Implementation Assistance (CITIA-SC), on physician practices engaged in the process of electronic medical record (EMR) adoption.Data sourcesData from a cross-sectional survey distributed in March 2011 to 1310 primary care practice groups throughout South Carolina was used to determine the degree of EMR adoption throughout the state (n=452 respondents; 34.5% response rate). Participation in CITIA-SC was determined by obtaining a list of practices from CITIA-SC.Study designA posttest-only design with nonequivalent groups was used to estimate the degree of EMR implementation, plans for and perceived barriers to implementation based on CITIA-SC participation.ResultsCITIA-SC practice sites faced similar barriers to EMR implementation as non-CITIA-SC participants, including initial or recurring cost of an EMR, low staff expertise with EMRs or computers, and productivity disruption. Additionally, CITIA-SC practice sites had fewer IT personnel on staff (p=0.0358) and were considering EMR implementation without a plan (p=0.0125). Despite these barriers, more practices participating in the CITIA-SC program were preparing to invest in an EMR system within one year when compared to nonparticipants (75.9% versus 28.3%, p<0.0001).ConclusionOur results indicated that the practice sites that participate in the REC had fewer IT resources and more perceived barriers to implementation. These results suggest that REC participant practice sites intend to implement an EMR, but recognize the need for technical assistance in the preparation and implementation of an EMR system.     

A substantial and confusing variation exists in handling of baseline covariates in randomized controlled trials: a review of trials published in leading medical journals

ObjectiveStatisticians have criticized the use of significance testing to compare the distribution of baseline covariates between treatment groups in randomized controlled trials (RCTs). Furthermore, some have advocated for the use of regression adjustment to estimate the effect of treatment after adjusting for potential imbalances in prognostically important baseline covariates between treatment groups.Study Design and SettingWe examined 114 RCTs published in the New England Journal of Medicine, the Journal of the American Medical Association, The Lancet, and the British Medical Journal between January 1, 2007 and June 30, 2007.ResultsSignificance testing was used to compare baseline characteristics between treatment arms in 38% of the studies. The practice was very rare in British journals and more common in the U.S. journals. In 29% of the studies, the primary outcome was continuous, whereas in 65% of the studies, the primary outcome was either dichotomous or time-to-event in nature. Adjustment for baseline covariates was reported when estimating the treatment effect in 34% of the studies.ConclusionsOur findings suggest the need for greater editorial consistency across journals in the reporting of RCTs. Furthermore, there is a need for greater debate about the relative merits of unadjusted vs. adjusted estimates of treatment effect.     

The utility of EMR address histories for assessing neighborhood exposures

PurposeElectronic medical records (EMRs) include residential address histories, which may alleviate exposure misclassification caused by exclusion of patient spatiotemporal location. EMR data are increasingly available but rarely leveraged as a measure of cumulative environmental exposure, in part due to limited understanding of the validity of EMR-derived address histories.MethodsWe compared EMR address histories to self-reported histories among 100 patients of a safety-net health care system completing a telephone survey. We assessed agreement and compared seven neighborhood-level environmental exposures as assessed using both data sources.ResultsWhile 17.1% of respondents did not live at the most recent EMR-derived address during the survey, nearly all (98%) lived there at some point. For respondents with more than one EMR-derived address (N = 64), 87.5% had once lived at the previous EMR address. Of these, 30.4% lived at 1 or more additional residences between the two most recent EMR address. For all measures, neighborhood-level environmental exposures did not differ when using EMR-derived versus self-report addresses.ConclusionsMore recent EMR-derived addresses are more accurate, and differences compared to self-reported addresses in neighborhood-level exposures are negligible. EMR-derived address histories are incomplete and likely suffer from collection bias; future research should further assess their validity and reliability.     

The quality of reporting of trial abstracts is suboptimal: Survey of major general medical journals

ObjectiveTo evaluate the quality of reporting of abstracts describing randomized controlled trials (RCTs) published in four major general medical journals.Study Design and SettingSystematic survey of published RCT abstracts, with two reviewers independently extracting data. We searched MEDLINE and identified 227 RCT abstracts published in the New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), British Medical Journal (BMJ), and The Lancet in the year 2006.ResultsMost abstracts identified the study as a randomized trial (98.7%), reported the objectives (92.5%), described the population (90.3%), detailed the intervention (81.5%), and defined the primary outcome (71.3%). Methodological quality was poorly reported: one (0.4%) described allocation concealment; 21 (9.3%) clearly specified blinding; 51 (22.5%) described intention-to-treat analysis; and 32 (14.1%) outlined losses to follow-up. Most of the abstracts reported the effect size and the confidence intervals (62.3%), but just half of them reported side effects or harms.ConclusionThe quality of reporting of RCT abstracts published in main general medical journals is suboptimal. Space limitations notwithstanding, with the recent recommendations from the CONSORT for Abstracts, it is expected that the transparency of abstract reporting can and should improve.     

Agreement among sources of adult influenza vaccination in the age of immunization information systems

IntroductionMany vaccination studies rely on self-reported vaccination status, with its inherent biases. Accuracy of influenza vaccination self-report has been evaluated periodically, typically using the medical record as the gold standard. The burgeoning of electronic medical records (EMRs) and immunization information systems (IISs) and the rise of adult vaccine administration in community pharmacies suggest the need for a reevaluation of self-reported vaccination status.MethodsVaccination data from self-report, the state IIS, the health system EMR and other sources were compared for participants in outpatient and inpatient influenza vaccine effectiveness studies for four seasons (2016–2017 to 2019–2020). Agreement among the sources was calculated along with sensitivity and specificity. Tests for trend assessed changes in completeness of the Pennsylvania - Statewide IIS (PA-SIIS) data over time.ResultsWith self-report as the gold standard, agreement with the local EMR, PA-SIIS, and all sources was 62%, 77% and 85%, respectively. Sensitivity of the EMR was 42% (95% CI = 41, 43) and specificity was 91% (90, 92). With PA-SIIS-as the gold standard, agreement with the local EMR and all sources was 77% and 78%, respectively. Sensitivity of all sources combined was 96% (95, 97) and specificity was (63% (62, 64). Capture of influenza vaccinations in the IIS has not consistently improved over time, with a significant increase among children (P = 0.001), no change among working-age adults and a decrease among older adults (P = 0.004). However, PA-SIIS provided the largest percentage of verified vaccines (69.3%) compared with EMR (43.3%) and other sources (12.4%).ConclusionBoth self-report and PA-SIIS are good estimates of actual vaccine uptake. When high accuracy data are required, such as for vaccine effectiveness studies, triangulation using multiple sources should be conducted.     

Availability and Suitability of Digital Health Tools in Africa for Pandemic Control: Scoping Review and Cluster Analysis

BackgroundGaining oversight into the rapidly growing number of mobile health tools for surveillance or outbreak management in Africa has become a challenge.ObjectiveThe aim of this study is to map the functional portfolio of mobile health tools used for surveillance or outbreak management of communicable diseases in Africa.MethodsWe conducted a scoping review by combining data from a systematic review of the literature and a telephone survey of experts. We applied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching for articles published between January 2010 and December 2020. In addition, we used the respondent-driven sampling method and conducted a telephone survey from October 2019 to February 2020 among representatives from national public health institutes from all African countries. We combined the findings and used a hierarchical clustering method to group the tools based on their functionalities (attributes).ResultsWe identified 30 tools from 1914 publications and 45 responses from 52% (28/54) of African countries. Approximately 13% of the tools (4/30; Surveillance Outbreak Response Management and Analysis System, Go.Data, CommCare, and District Health Information Software 2) covered 93% (14/15) of the identified attributes. Of the 30 tools, 17 (59%) tools managed health event data, 20 (67%) managed case-based data, and 28 (97%) offered a dashboard. Clustering identified 2 exceptional attributes for outbreak management, namely contact follow-up (offered by 8/30, 27%, of the tools) and transmission network visualization (offered by Surveillance Outbreak Response Management and Analysis System and Go.Data).ConclusionsThere is a large range of tools in use; however, most of them do not offer a comprehensive set of attributes, resulting in the need for public health workers having to use multiple tools in parallel. Only 13% (4/30) of the tools cover most of the attributes, including those most relevant for response to the COVID-19 pandemic, such as laboratory interface, contact follow-up, and transmission network visualization.     

The effects of economic sanctions on disease specific clinical outcomes of patients with thalassemia and hemophilia in Iran

BackgroundThe sanctions applied by both the USA and the EU against Iran do not formally ban the exports of medicines; in practice, however, patients are experiencing great difficulty in securing the treatment. This article documents the impact of international sanctions on patients with thalassemia and hemophilia in southern Iran.MethodsThis survey examined the specific effects of external sanctions on the access of patients to their treatment between 2009 and 2012 from the point of view of patients with thalassemia (n = 69) and congenital coagulation disorders (n = 40) as well as related physicians (n = 20). Also, clinical manifestation and laboratory data of patients were compared in the same period.ResultsAccess to deferoxamine and Exjade as iron chelators in patients with thalasseamia, respectively, declined by almost 70% and half over this period. In addition, access to lyophilized coagulation factor VIII concentrate in hemophilia A dramatically dropped from 96.7% in 2009 to 3.3% in 2012. The clinical results showed a significant deterioration of arthropathy (P < 0.001) in hemophiliac patients and a significant increase in serum ferritin levels in thalassemia patients (P = 0.036).ConclusionSanctions had significant effect on public health on patients with thalassemia and hemophilia.     

There was evidence of convergent and construct validity of Physiotherapy Evidence Database quality scale for physiotherapy trials

ObjectiveTo evaluate the convergent and construct validity of the Physiotherapy Evidence Database (PEDro) scale used to rate the methodological quality of randomized trials in physiotherapy.Study Design and SettingPEDro total scores and individual-item scores were extracted from 9,456 physiotherapy trials indexed on PEDro. Convergent validity was tested by comparing PEDro total scores with three other quality scales. Construct validity was tested by regressing the PEDro score and individual-item scores with the Institute for Scientific Information Web of Knowledge impact factors (IF) and SCImago journal rankings (SJR) for the journals in which the trials were published.ResultsTesting of convergent validity revealed correlations with the other quality scales ranging from 0.31 to 0.69. The PEDro total score was weakly but significantly associated with IF and SJR (P < 0.0001). Eight of the 10 individual scale items that contribute to the PEDro total score were significantly associated with IF.ConclusionThis study provides preliminary evidence of the convergent and construct validity of the PEDro total score and the construct validity of eight individual scale items.     

Factors associated with the utilization of electronic medical records in the Eastern Region of Ghana

ObjectivesThis study examined the factors associated with the use of Electronic Medical Records (EMR) in public hospitals in the Eastern Region of Ghana.MethodsThree hundred and ninety-six (396) healthcare professionals were surveyed from the various public hospitals in the Eastern Region of Ghana. The participants included physicians, physician assistants, nurses, laboratory technicians, radiologists, pharmacists, record managers, and ICT staff. Frequency and Chi-Square analyses were performed on the data.ResultsThe results showed that approximately 59% (n=212) of health professionals indicated low use of EMR services in their hospitals. Lack of computer competence (p<0.001), poor communication between users (p=0.050), cost of EMR resources and facilities (p<0.001), lack of technical personnel to install and operate EMR technology resources (p<0.001), and lack of EMR software packages (p<0.001) had significant negative relationships with EMR utilization.ConclusionUtilization of EMR services is low among the healthcare professionals in the Eastern Region. Therefore, the Ghana Health Service needs to provide training to their employees and supply the needed resources to encourage and support the hospitals and healthcare workers to increase the utilization of the EMR services that improve healthcare delivery in the Region. To enhance EMR utilization, it will be essential that government supports health facilities who have challenges using EMR. To better understand the issues, a mixed method approach is recommended to be used to study healthcare workers from both private and public healthcare facilities in the Eastern Region of Ghana.     

Epidemiological,imaging, laboratory,and clinical characteristics and factors related to mortality in patients with COVID-19: a single-center study

ObjectivesCoronavirus disease 2019 (COVID-19) is a novel pandemic. Considerable differences in disease severity and the mortality rate have been observed in different parts of the world. The present study investigated the characteristics and outcomes of patients hospitalized with COVID-19 in Iran.MethodsWe established a retrospective cohort to study hospitalized COVID-19 patients in Iran. Epidemiological, imaging, laboratory, and clinical characteristics and outcomes were recorded from medical documents. The chi-square test, t-test, and logistic regression models were used to analyze the data. A p<0.05 was considered to indicate statistical significance.ResultsIn total, 364 cases (207 males and 157 females) were analyzed. The most common symptoms were cough, fever, and dyspnea. Multifocal bilateral ground-glass opacities with peripheral distribution were the predominant imaging finding. The mean age of patients was 54.28±18.81 years. The mean age of patients who died was 71.50±14.60 years. The mortality rate was 17.6%. The total proportion of patients with a comorbidity was 47.5%, and 84.4% of patients who died had a comorbidity. Sex, history of diabetes mellitus, and dyslipidemia were not significantly associated with mortality (p>0.05). However, mortality showed significant relationships with body mass index; age; history of hypertension, chronic kidney disease (CKD), ischemic heart disease, cerebrovascular accident (CVA), pulmonary disease, and cancer; and abnormal high-resolution computed tomography (HRCT) findings (p<0.05 for all). Cancer had the highest odds ratio.ConclusionComorbidities (especially cancer, CKD, and CVA), severe obesity, old age, and abnormal HRCT findings affected the health outcomes of patients hospitalized with COVID-19.     

Automated Travel History Extraction From Clinical Notes for Informing the Detection of Emergent Infectious Disease Events: Algorithm Development and Validation

BackgroundPatient travel history can be crucial in evaluating evolving infectious disease events. Such information can be challenging to acquire in electronic health records, as it is often available only in unstructured text.ObjectiveThis study aims to assess the feasibility of annotating and automatically extracting travel history mentions from unstructured clinical documents in the Department of Veterans Affairs across disparate health care facilities and among millions of patients. Information about travel exposure augments existing surveillance applications for increased preparedness in responding quickly to public health threats.MethodsClinical documents related to arboviral disease were annotated following selection using a semiautomated bootstrapping process. Using annotated instances as training data, models were developed to extract from unstructured clinical text any mention of affirmed travel locations outside of the continental United States. Automated text processing models were evaluated, involving machine learning and neural language models for extraction accuracy.ResultsAmong 4584 annotated instances, 2659 (58%) contained an affirmed mention of travel history, while 347 (7.6%) were negated. Interannotator agreement resulted in a document-level Cohen kappa of 0.776. Automated text processing accuracy (F1 85.6, 95% CI 82.5-87.9) and computational burden were acceptable such that the system can provide a rapid screen for public health events.ConclusionsAutomated extraction of patient travel history from clinical documents is feasible for enhanced passive surveillance public health systems. Without such a system, it would usually be necessary to manually review charts to identify recent travel or lack of travel, use an electronic health record that enforces travel history documentation, or ignore this potential source of information altogether. The development of this tool was initially motivated by emergent arboviral diseases. More recently, this system was used in the early phases of response to COVID-19 in the United States, although its utility was limited to a relatively brief window due to the rapid domestic spread of the virus. Such systems may aid future efforts to prevent and contain the spread of infectious diseases.     

Global output of research on the health of international migrant workers from 2000 to 2017

Background

Approximately 150 million international migrant workers work under conditions that increase their risk of illness and injuries. The current study aimed to assess and analyze the global output of research on the health of international migrant workers to promote national and international policies that could help improve the health of international migrant workers.

Methods

A bibliometric methodology was implemented using Scopus database after retrieving documents relevant to the health of migrant workers during the study period from 2000 to 2017.

Results

In total, 955 documents were retrieved. The mean number of authors per document was 4.5 while the mean number of citation per document was 10.2. The retrieved documents were mainly in health policy and systems (n?=?452; 47.3%), infectious diseases (n?=?252; 26.4%), and mental and psychosocial health (n?=?239; 25.0%). The health of Latino migrant farmworkers represented the largest cluster of keywords. The USA led (n?=?389; 40.7%) with regard to the number of publications followed by China (n?=?86; 9.0%) and the UK (n?=?66; 6.9%). Researchers from the USA and Spain dominated the field. There were limited international research collaboration and a limited number and size of research networks. The American Journal of Industrial Medicine was most active (7.1%; n?=?68) in publishing documents on health of migrant workers while the Wake Forest University was the most active (10.9%; n?=?104) institution in this topic.

Conclusion

The volume of global research output on the health of migrant workers was low. There was inadequate research on non-communicable diseases and maternal health of migrant workers. International research collaboration and the number of research networks were limited. Role of several world regions, particularly Arab region with 11% of international migrant workforce was also limited. There is an urgent need to prioritize research on migrant workers, especially female migrant workers in regions with low research contribution.