Does the structure of medical services affect the proportion of death in hospitals? An ecological analysis in the mobility regions of Switzerland?

Zusammenfassung Fragestellung Vor dem Hingtergrund der Diskussion über Massnahmen zum Abbau von überkapazit?ten im Gesundheitswesen untersuchten wir die Bedeutung von medizinischen Versorgungsstrukturen und Dienstleistungen für die Inanspruchnahme des Spitals unmittelbar vor dem Tode. Methoden Aufgrund der Angaben zum Sterbeort aus der Sterbefallstatistik ermittelten wir in einem ?kologischen Design für jede der 106 MS-Regionen der Schweiz die Anteile der Sterbef?lle im Spital von Personen ab 65-j?hrig in den Jahren 1979 bis 1980. Ergebnisse Diese Anteile variierten zwischen 27% und 81%. Trotz M?ngeln in den Daten zur station?ren und ambulanten Versorgungsstruktur konnte mittels einer multivariaten Regression mehr als die H?lfte der Varianz erkl?rt werden. Unsere Ergebnisse zeigen, dass der Anteil von Sterbef?llen im Spital umso tiefer ist, je mehr Konsultationen durch Grundversorger durchgeführt wurden, je mehr Alters-oder Pflegeheimbetten und je weniger Spitalbetten in den Regionen vorhanden waren (alle Angaben pro Einwohner gerechnet). Schlussfolgerungen In der Versorgungsplanung sollten solche systematischen Zusammenh?nge zwischen Angebot und Inanspruchnahme der station?ren sowie der ambulanten Versorgung berücksichtigt werden. Wir empfehlen, Unterschiede zwischen den Regionen in Angebot und Ergebnis medizinischer Leistungen regelm?ssig mit den jeweils aktuellsten Daten zu vergleichen.

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Does the structure of medical services affect the proportion of deaths in hospitals? An ecological analysis in the mobility regions of Switzerland

Summary Objectives With the discussion about measures to reduce over-capacities in the health services in mind, we examined the influence of medical supply structures and services on hospital utillisation directly before death. Methods Based on the specification of the place of dying from the death certificates, we determined the proportions of deaths in hospitals in an ecological study. We analysed deaths of persons above age 65 in each of the 106 mobility regions of Switzerland in the years 1979 to 1980. Results The proportion of deaths occuring in hospitals varied between 27% and 81%. Despite missing data regarding stationary and ambulatory care services, more than half of the variance could be explained by means of a multivariate regression analysis. Our results imply an inverse relation between the proportion of deaths in the hospital and the number of consultations provided by primary care physicians, as well as the number of nursing home beds. Further, we observe a direct relation to the number of hospital beds in a region. All indicators are calculated per inhabitant. Conclusions In health care supply planning, such systematic associations should be taken into account. We recommend to analyse regularly interregional differences in supply and outcome of medical performances with the best available data.

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Résumé Objectifs Dans le contexte de la discussion sur la reduction des surcapacités dans les services de santé nous avons examiné l'influence des structures et des services d'approvisionnement médicaux pour le recours à l'h?pital directement avant la mort. Méthodes Sur la base du certificat de décès où l'endroit de mort est enregistré, nous avons déterminé les proportions de décès à l'h?pital des personnes dans une analyse écologique pour chacune des 106 régions MS de la Suisse à partir de 65 ans de 1979 à 1980. Résultats Ces proportions ont varié entre 27% et 81%. Malgré la carence de les données en matière de approvisionnement stationnaire et ambulatoire, plus de la moitié de la variance est expliquée par une analyse de régression multivarie. Nos résultats démontrent que la proportion des décès à l'h?pital dans une région est d'autant plus basseque les consultations ont été exécutées par les médecins de premier recours, que plus de lits de maison de retraite ou le moins les lits d'h?pital étaient disponibles dans la région (tout les indicateurs calculé par habitant). Conclusions Dans la planification des services de santé de telles associations devraient être prises en considération. Nous recommandons de répéter régulièrement des analyses écologiques pour comparer des différences interrégionales entre l'offre et résultat de performances médicales avec des données mises à jour.

     

Does dietary protein in early life affect the development of adiposity in mammals?

This article examines the proposition that dietary protein in pre- and early postnatal life influences the development of adiposity in later life. In rodents, low protein intake during gestation can result in low birth weight and subsequently leads to various metabolic disturbances in adulthood, such as high blood pressure, impaired glucose tolerance and insulin resistance. The few controlled studies conducted in animals suggest that high protein or energy intake during gestation leads to low birth weights. Observational studies in humans have been inconclusive in establishing a relationship between dietary protein intake in pregnancy and effects on birth weight and adiposity of the offspring later in life. There is only weak epidemiological evidence linking high protein intake during early childhood and the development of obesity. By contrast, studies in domestic animals have found that higher levels of protein intake are often associated with lower rates of fat accretion. Additional studies are proposed to explore claims linking protein nutrition in early life to the postnatal development of obesity and disease in humans.     

Identifying inequalities in childhood immunisation uptake and timeliness in southeast Scotland, 2008–2018: A retrospective cohort study

BackgroundIn 2018, there was a record incidence of measles and other vaccine-preventable diseases across developed countries. Declining childhood immunisation uptake in southeast Scotland—an area with a large, highly mobile, and socioeconomically diverse population—threatens regional herd immunity and warrants investigation of suboptimal coverage. As deprivation of social and material resources increases risk of non-vaccination, we examined here the relationship between deprivation, uptake, and timeliness for four routine childhood vaccines and identified trends over the past decade.MethodsThis retrospective cohort study analysed immunisation data from the Scottish Immunisation Recall System (SIRS) for four routine childhood vaccines in the UK: the third dose of the primary vaccine (TPV), both doses of measles, mumps, rubella (MMR 1 and MMR 2), and the preschool booster (PSB). Immunisations (N = 329,897) were administered between 2008 and 2018. Deprivation was measured via the Scottish Index of Multiple Deprivation (SIMD), ranking postcodes by deprivation decile. Chi-squared tests and cox proportional hazards models assessed the relationship between uptake, timeliness, and deprivation.ResultsThere is strong evidence for an association between deprivation, uptake, and timeliness. Uptake for all childhood immunisations are very high, especially for TPV and MMR 1 (>98.0%), though certain deprivation deciles exhibit increased risks of non-vaccination for all vaccines. Delay was pronounced for the 40% most deprived population and for immunisations scheduled at later ages. Absolute PSB and MMR 2 uptake has improved since 2008; however, disparities in uptake have increased for all vaccines since the 2006 birth cohort.ConclusionBoth timeliness and uptake are strongly associated with deprivation. While absolute uptake was high for all vaccines, relative uptake and timeliness has been worsening for most groups; the reason for this decline is unclear. Here we identified subgroups that may require targeted interventions to facilitate uptake and timeliness for essential childhood vaccines.     

Does hyperuricemia affect mortality? A prospective cohort study of Japanese male workers

A positive association between hyperuricemia and cardiovascular disease has been reported, but no study has evidenced yet the precise role of serum uric acid in the development of cardiovascular disease. In addition, no epidemiological studies have so far documented a decreased risk of cancer among people with hyperuricemia, even though the antioxidant action of uric acid has recently been stressed to inhibit DNA damage. The present prospective cohort study investigates the relationship between hyperuricemia and health hazards in a Japanese working population. The subjects were 49,413 Japanese male railroad workers, aged 25-60 years at enrollment. Serum uric acid and other baseline data were provided by annual health-survey records from 1975 to 1982. The vital status of the subjects was traced until the end of 1985 for those who remained alive. During an average 5.4-year study period, 984 deaths were recorded. Those with serum uric acid over 8.5 mg/dl showed elevated relative risks (RRs) of death in all causes (RR 1.62, p<0.01), coronary heart disease ( RR 1.52), stroke (RR 2.33, p<0.01), hepatic disease (RR 3.58, p<0.01), and renal failure ( RR 8.52, p<0.01), as compared with those with serum uric acid levels of 5.0-6.4mg/dl. The RR of death in all causes still remains statistically significant when adjusted by age and serum total cholesterol (2.00, p<0.01), age and alcohol intake (1.85, p<0.001), age and smoking (1.69, p<0.001), age and gout treatment (1.61, p<0.05), and also age and BMI (1.50, p< 0.05). On the other hand, the RR of all causes decreased but was still above 1.0 when adjusted by age and blood glucose (1.62), age and systolic blood pressure (1.32), age and GOT (1.23), and also age and history of cardiovascular disease (1.17). These results showed that hyperuricemia has a strong association with the RRs of death in all causes, coronary heart disease, stroke, hepatic disease and renal failure, and indicated that serum uric acid seems to be a considerable risk factor for reduced life expectancy.     

Does salt intake in the first two years of life affect the development of cardiovascular disorders in adulthood?

Excess salt intake impacts on blood pressure (BP) and the pathogenetic mechanisms of atherosclerosis predisposing to stroke and other cardiovascular disorders. The influence of salt starts early in life. Two randomized controlled trials in newborn infants suggest a direct association between dietary sodium intake and BP since the first few months of life. Newborn infants display aversion to the salt taste to develop a "preference" for salt only at age 2-3 years, in part in relation to post-natal events: this preference might be associated with later development of hypertension. The amount of sodium to be retained by an infant for proper physiological growth is largely covered by breast feeding (or low sodium formula milk) in the first six months, and later on by the gradual implementation of complementary feeding, without the need for any added salt upon food preparation. Given the lack of dose-dependence data, reference nutrient intakes (RNI) or adequate intakes (AI) for sodium have been established by national health institutions in various countries. The U.K. RNI was set at 242?mg a day for infants 0-6 months with gradual increase to?0.5?g up until age 3. The U.S. AI is somewhat lower for age 0-6 months but larger for age 1-3 years. According to a recent report, the average sodium intake in U.S. children is close to the AI up to age 2 years, to become progressively greater exceeding the Institute of Medicine recommendation later on.     

Diversity gain? An exploration of inclusive and exclusive perceptions in early years settings in England

This article explores inclusive and exclusive perceptions within early years practice settings in England. Inclusion is understood to involve the acknowledgement and celebration of difference, rather than its problematization. A deficit-based discourse regarding diversity is challenged and the concept of diversity gain is explored. A study was undertaken involving seven early years practice settings. The study involved the use of a critical communicative methodological approach due to its focus on exploration and listening with a view to understanding. The results and data analysis supplied three key findings. Firstly, practitioners are able to articulate their understanding of diversity gain and a desire for inclusion to a far greater extent than parents involved in the settings. Secondly, parental involvement within the settings is fundamental to authentic inclusion. Finally, practitioners felt that there was a distinct lack of resources, including funding, time and expertise, to support inclusive practice appropriately.     

Does visual impairment affect social ties in late life? Findings of a multicenter prospective cohort study in Germany

Objective

To investigate how visual impairment affects social ties in late life longitudinally.

Design

Population-based prospective cohort study.

Setting

Individuals in old age were recruited via general practitioners’ offices (at six study centers) in Germany. They were interviewed every 18 months.

Participants

Individuals aged 75 years and above at baseline. Follow-up wave 2 (36 months after baseline, n=2,443) and wave 4 (72 months after baseline, n=1,618) were used for the analyses presented here.

Measurements

Social ties were assessed using the 14-item form of the questionnaire for social support (F-SozU K-14). Visual impairment was self-rated on a three level Likert scale (no impairment, mild visual impairment, or severe/profound visual impairment).

Results

Adjusting for sociodemographic factors, hearing impairment and comorbidity, fixed effects regressions revealed that the onset of mild visual impairment decreased the social support score, in particular the emotional support score. Additionally, the onset of mild hearing impairment decreased the social support score in men. Moreover, increasing age decreased the social support score in the total sample and in both sexes. Loss of spouse and increasing comorbidity did not affect the social support score.

Conclusion

Our results highlight the importance of visual impairment for social ties in late life. Consequently, appropriate strategies in order to delay visual impairment might help to maintain social ties in old age.

     

Does innovation in obesity drugs affect stock markets? An event study analysis

Objective

This study empirically analyzes the effects of public information about the pharmaceutical R&;D process on the market valuation of the sponsoring firm. We examined the market's response to scientific news and regulatory decisions about an antiobesity drug, rimonabant, and the effects on the sponsoring company (Sanofi-Aventis) and its incumbent competitors (Abbott and Roche).

Methods

Event study methodology was used to test the null hypothesis of no market response. We covered the full life cycle of rimonabant (1994-2008), using a data set of daily closing price and volume.

Results

The results suggest that scientific news in the initial stages of the drug R&;D process (i.e., drug discovery, preclinical and clinical trials) had no significant effects. However, news related to regulatory decisions, such as recall or safety warning, had significant negative effects on the company's market value. No spillover/contagion effects on competitor firms were detected.

Conclusion

Market reactions occur at the time when the regulator takes decisions about drugs. Scientific news, even those of high-impact, may pass unnoticed.     

Does MRSA affect patient outcomes in the elderly? A retrospective pilot study

We retrospectively studied admissions to our geriatric acute assessment and rehabilitation ward over a one-year period, to identify those with Methicillin-resistant Staphylococcus aureus (MRSA) and determine whether this affected outcomes. Two hundred and thirty eight admissions of 204 patients were analysed and 9.8% of patients were MRSA positive. Demographics did not differ between MRSA positive and negative patients. Respiratory co-morbidity was more common in MRSA positive patients. Rates of functional decline did not differ between the two groups. Those colonized or infected by MRSA had a significantly longer stay (51.4 vs. 32.2 days, P=0.03), perhaps due to isolation and limited rehabilitation. The virulence of MRSA may be less in these patients, therefore isolation may be inappropriate and counter-productive.     

Is inter-school variation in smoking uptake and cessation due to differences in pupil composition? A cohort study

The aims of this study were to determine if inter-school variation in smoking prevalence was due to differences in pupil composition or other school-level factors. A cohort of 13-14-year-olds (n = 7147) from 52 schools was followed-up 1 year later. Random effects logistic regression was used to examine school variation in smoking uptake and cessation, with and without adjustment for pupil composition. Inter-school variation in smoking prevalence is not caused by differences in pupil composition but is due to differences in the onset of smoking arising because of unmeasured school contextual or collective factors operating on pupils' decisions.     

What influences diet in early old age? Prospective and cross-sectional analyses of the Boyd Orr cohort

BACKGROUND: The aim of this study is to identify the socio-economic and health-related factors in childhood and later life associated with healthy eating in early old age. METHODS: The study is based on surviving members of the Boyd Orr cohort aged 61-80 years. Data are available on household diet and socio-economic position in childhood and on health and social circumstances in later life. A 12-item Healthy Diet Score (HDS) for each subject was constructed from food frequency questionnaire responses. Complete data on all exposures examined were available for 1234 cohort members. RESULTS: Over 50% of study members had inadequacies in at least half of the 12 markers of diet quality. In multivariable models having a childhood diet which was rich in vegetables was associated with a healthy diet in early old age. The HDS for those in the upper quartile of childhood vegetable intake was 0.30 (95% confidence interval -0.01 to 0.61) higher than those with the lowest intake levels (P-trend across quartiles = 0.04). The adult factors that were most strongly associated with a healthy diet were not smoking, being an owner-occupier, and taking anti-hypertensive medication. CONCLUSION: Our analysis indicates that diet in early old age is influenced by childhood vegetable consumption, current socio-economic position, and smoking. Interventions for improving the diet of older people could usefully focus on both encouragement of healthy diet choices from an early age and higher levels of income or nutritional support for older people.     

Ten years of progress in the Hokkaido birth cohort study on environment and children’s health: cohort profile—updated 2013

The Hokkaido Study on Environment and Children’s Health is an ongoing cohort study that began in 2002. The study consists of two prospective birth cohorts, the Sapporo cohort (n = 514) and the Hokkaido large-scale cohort (n = 20,940). The primary goals of this study are to first examine the potential negative effects of perinatal environmental chemical exposures on birth outcomes, including congenital malformations and growth retardation; second, to evaluate the development of allergies, infectious diseases and neurodevelopmental disorders and perform longitudinal observations of the children’s physical development to clarify the causal relationship between these outcomes and environmental chemicals; third, to identify individuals genetically susceptible to environmental chemicals; finally, to identify the additive effects of various environmental factors in our daily life, such as secondhand smoke exposure or low folate intake during early pregnancy. In this paper, we introduce our recent progress in the Hokkaido study with a cohort profile updated in 2013. For the last ten years, we followed pregnant women and their offspring, measuring various environmental chemicals, i.e., PCB, OH-PCB and dioxins, PFCs (Perfluorinated Compounds), Organochlorine pesticides, Phthalates, bisphenol A and mercury. We discovered that the concentration of toxic equivalents (TEQ) of dioxin and other specific congeners of PCDF or PCDD have effects on birth weight, infants’ neurodevelopment and immune function. There were significant gender differences in these effects; our results suggest that male infants have more susceptibility to those chemical exposures than female infants. Interestingly, we found maternal genetic polymorphisms in AHR, CYP1A1 or GSTs that significantly modified the dioxin concentrations in maternal blood, suggesting different dioxin accumulations in the bodies of individuals with these genotypes, which would lead to different dioxin exposure levels. These genetic susceptibility factors influenced the body size of children born from mothers that either smoked or were passively exposed to tobacco smoke. Further studies investigating the correlation between epigenetics, the effects of intrauterine exposure to environmental chemicals and developmental factors related to health and disease are warranted.     

Does male age affect the risk of spontaneous abortion? An approach using semiparametric regression

Couples in industrialized countries tend to delay attempting to have children, which may lower their chances of livebirth. The authors assessed the association between male age and the risk of spontaneous abortion between weeks 5 and 20 of pregnancy, controlling for female age. They interviewed by telephone a random cross-sectional population of 1,151 French women who had been pregnant between 1985 and 2000 (participation rate, 73%). A total of 12.2% of the 2,414 pregnancies resulted in spontaneous abortion. Semiparametric regression was used to define a discrete time survival model with a random effect taking into account induced abortions, in which female age was coded by a third-degree polynomial. This final model predicted that the risk (rate ratio) of spontaneous abortion was 2.13-fold higher for women age 25 years whose partner was age 35 years or older than for women age 25 years whose partner was younger than age 35 years (95% confidence interval: 1.07, 4.26). No such increased risk of spontaneous abortion with male age was estimated when the woman was age 35 years (rate ratio = 0.61, 95% confidence interval: 0.35, 1.07). Thus, increasing male age could increase the risk of spontaneous abortion when the female partner is less than 30 years of age.     

Are dietary patterns stable throughout early and mid-childhood? A birth cohort study

This study assesses the stability of dietary patterns obtained using principal components analysis (PCA) through early to mid-childhood. Dietary data were collected from children in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Frequency of consumption of a range of food items was recorded by mothers using self-completion postal questionnaires when their children were 3, 4, 7 and 9 years of age. Dietary patterns were identified using PCA and component scores were calculated at each time-point. In total 6177 children had data available at all four time-points. Three patterns were consistently seen across time: the 'processed', 'traditional' and 'health conscious' patterns. At 3 years an additional 'snack' pattern was obtained and at 9 years the 'health conscious' pattern was slightly modified (meat products were negatively associated). High correlations were evident for all three scores between each pair of time-points. The widest limits of agreement were seen for all pairings between the 3 and 9 years data, whilst the narrowest were seen between the 4 and 7 years data. A reasonable level of agreement was seen with the categorised component scores from each time-point of data (kappa ranging from 0.28 to 0.47). Virtually identical dietary patterns were obtained at the ages of 4 and 7; however, periods of change were apparent between the ages of 3 and 4 and the ages of 7 and 9. It is important to make regular dietary assessments during childhood in order to assess accurately the effects of diet on future health outcomes.