Investigating the relationship between social care supply and healthcare utilization by older people in England

Since 2010, adult social care spending in England has fallen significantly in real terms whilst demand has risen. Reductions in social care supply may also have impacted demand for NHS services, particularly for those whose care is provided at the interface of the health and care systems. We analyzed a panel dataset of 150 local authorities (councils) to test potential impacts on hospital utilization by people aged 65 and over: emergency admission rates for falls and hip fractures (“front‐door” measures); and extended stays of 7 days or longer; and 21 days or longer (“back‐door” measures). Changes in social care supply were assessed in two ways: gross current expenditure (per capita 65 and over) adjusted by local labor costs and social care workforce (per capita 18 and over). We ran negative binomial models, controlling for deprivation, ethnicity, age, unpaid care, council class, and year effects. To account for potential endogeneity, we ran instrumental variable regressions and dynamic panel models. Sensitivity analysis explored potential effects of funding for integrated care (the Better Care Fund). There was no consistent evidence that councils with higher per capita spend or higher social care staffing rates had lower hospital admission rates or shorter hospital stays.     

Territorywide Study of Early Coronavirus Disease Outbreak,Hong Kong,China

Initial cases of coronavirus disease in Hong Kong were imported from mainland China. A dramatic increase in case numbers was seen in February 2020. Most case-patients had no recent travel history, suggesting the presence of transmission chains in the local community. We collected demographic, clinical, and epidemiologic data from 50 patients, who accounted for 53.8% of total reported case-patients as of February 28, 2020. We performed whole-genome sequencing to determine phylogenetic relationship and transmission dynamics of severe acute respiratory syndrome coronavirus 2 infections. By using phylogenetic analysis, we attributed the community outbreak to 2 lineages; 1 harbored a common mutation, Orf3a-G251V, and accounted for 88.0% of the cases in our study. The estimated time to the most recent common ancestor of local coronavirus disease outbreak was December 24, 2019, with an evolutionary rate of 3.04 × 10⁻³ substitutions/site/year. The reproduction number was 1.84, indicating ongoing community spread.     

Maternal Age at Menarche and Pubertal Timing in Boys and Girls: A Cohort Study From Chongqing,China

PurposeThis study explored the association of maternal age at menarche (AAM) with pubertal timing among girls and boys in Chongqing, China.MethodsPubertal development of 1,237 children (542 girls and 695 boys) were examined half-yearly through inspection and palpation from April 2014 to June 2019. Characteristics of parents and maternal AAM were collected by a parental questionnaire at baseline. Maternal AAM was used both as a continuous and a categorical variable in Cox regression models.ResultsA total of 1,198 children (528 girls and 670 boys) were included in the study. In the simple Cox model, earlier maternal AAM was associated with girls' earlier menarche, breast and pubic hair development, and boys' first ejaculation, testicular development, and genital development. When adjusting for children's body mass index z-scores (BMIz) and socioeconomic covariates, we found that girls whose mothers had early AAM had a higher risk of earlier onset of menarche (hazard ratio [HR]: .922, 95% confidence interval [CI]: .852–.998 for continuous maternal AAM, HR: 1.297, 95% CI: 1.041–1.616 for maternal AAM ≤13 years), and boys whose mother achieved menarche earlier experienced a higher risk of earlier onset of first ejaculation (HR: .896, 95% CI: .830–.968). Children's BMIz were related to all nine pubertal milestones. Parental education and relationship, birth weight, parity, and family type were also associated with pubertal timing.ConclusionsEarlier maternal AAM was related to earlier pubertal timing in both girls and boys in Chongqing, especially girls' age at menarche and boys' first ejaculation. Children's BMIz was the most consistent factor for pubertal timing. Children's BMIz and socioeconomic conditions had greater influence on most pubertal milestones than maternal AAM.     

Undocumented Migrants Reintroducing COVID-19, Yunnan Province,China

To limit the spread of severe acute respiratory syndrome coronavirus 2, the government of China has been monitoring infected travelers and minimizing cold-chain contamination. However, other factors might contribute to recurring outbreaks. We analyze the role of undocumented migrants as potential transmitters of severe acute respiratory syndrome coronavirus 2 in China.     

中孕期胎儿染色体异常高危孕妇羊水细胞胎儿染色体核型及介入性产前诊断指征的大样本分析

目的探讨中孕期胎儿染色体异常(FCA)高危孕妇羊水细胞胎儿染色体核型(FK)及其介入性产前诊断(IPD)指征。方法选择2014—2018年,在四川大学华西第二医院产前诊断中心进行羊膜腔穿刺术羊水细胞FK检测的63581例FCA高危孕妇(孕龄为19~27+6孕周)为研究对象。回顾性分析孕妇不同IPD指征及其胎儿染色体核型异常(FKA)检测结果。本研究遵循的程序符合四川大学华西第二医院伦理委员会所制定的伦理学标准,并通过该伦理委员会批准[审批文号:医学科研2019伦审批第(077)号]。结果①本组63581例中孕期孕妇的FKA检出率为3.13%(1989/63581)。这63581例孕妇的IPD指征分别为高龄(预产期年龄≥35岁)(25648例)、血清学筛查高风险(29009例)、无创产前筛查(NIPT)高风险(333例)、夫妇一方为染色体异常携带者(603例)、超声筛查发现胎儿结构异常及超声软指标异常(2647例)、异常儿生育史(1546例)、于外院进行羊水细胞FK分析结果异常者(7例)、孕妇智力低下及合并智力低下家族史(149例)、孕妇早孕期有害物质接触史(1400例)、其他(2239例),FKA检出率分别为3.26%(836/25648)、2.04%(593/29009)、65.17%(217/333)、34.33%(207/603)、3.51%(93/2647)、1.68%(26/1546)、85.71%(6/7)、4.03%(6/149)、0.14%(2/1400)、0.13%(3/2239)。②351例孕妇的IPD指征为超声筛查发现胎儿结构异常中,IPD指征为胎儿淋巴水囊瘤、皮肤水肿的FKA检出率最高,为26.09%(6/23)。2296例孕妇的IPD指征为胎儿超声软指标异常中,IPD指征为胎儿颈项透明层(NT)值≥2.5 mm的FKA检出率最高,为7.74%(66/853)。结论孕妇高龄、血清学筛查高风险、NIPT高风险、夫妇一方为染色体异常携带者、超声筛查发现胎儿结构异常及超声软指标异常等,均为中孕期孕妇FCA的IPD指征,孕妇IPD指征类型不同,FCA风险不同。羊膜腔穿刺术羊水细胞FK检测,可预测有IPD指征孕妇的妊娠结局,为降低FKA出生率提供参考。     

《2020 ACOG实践简报:孕龄≤70 d药物流产(No.225)》解读

药物流产(MA)是早孕期避孕失败的补救措施,主要药物为米非司酮和米索前列醇,二者联合使用,可使早孕期孕妇完全终止妊娠率达到90%。但是,MA导致的患者阴道流血时间长、量多,甚至阴道大流血,而需采取急诊刮宫术治疗等,尚未被彻底解决。如何安全、有效终止早孕期妊娠,保护女性生殖健康是目前国内外该领域的研究重点。美国妇产科医师学学会(ACOG)发布的《2020 ACOG实践简报:孕龄≤70 d药物流产(No.225)》对早孕期孕妇终止妊娠,具有重要指导作用。笔者拟就该简报对MA用于孕龄≤70 d孕妇的临床效果评估,MA用药方案、禁忌证、适应证,MA前咨询和检查,MA疼痛管理,MA后观察、预防性抗菌药物使用、随访管理、避孕措施9个方面基于循证医学推荐进行解读。     

TT分析法在头颈肿瘤体外药敏试验中的应用

为了选择有效抗癌药提供临床使用以提高化疗疗效 ,用MTT分析 ,对 32例头颈肿瘤术后切下的标本进行体外细胞培养 ,再用 5 -Fu ,VCR ,MTX ,BLM ,DDP ,ADM ,PYM和CTX进行药敏试验 .结果 :对 5 -Fu敏感 2 7例 ,占 84 4% ,VCR敏感 7例 ,占 2 1 9% ;MTX敏感 2 0例 ,占 6 2 5 % ;BLM敏感 2 6例 ,占 81 3% ;DDP敏感 2 6例 ,占 81 3% ;ADM敏感 13例 ,占 40 6 % ;PYM敏感 2 1例 ,占 6 5 6 % ;CTX敏感 1例 ,占 3 1% .32例患者化疗效果满意 ,未出现明显的副作用 ,均存活 3a以上 ,术后常规检查及复查未见复发或转移 .结果表明 :MTT法用于肿瘤细胞药敏试验是一种准确、快速、简便、经济 ,不需放射性同位素 ,结果重复性好的方法 ,值得推广应用 .