Reducing the probability of falsely elevated HbA1c results in diabetic patients by applying automated and educative HbA1c re-testing intervals

IntroductionToo frequent HbA1c measurements may lead to unnecessary treatment modifications of diabetic patients. The aim of this study was to estimate the percentage of falsely elevated HbA1c results in two hospitals, Landeskrankenhaus/Uniklinikum Salzburg (LKH) and Landesklinik St. Veit (STV), as well as to retrospectively investigate the effect of an automated and an educative 60-day re-testing interval (RTI).MethodsThe amount of estimated falsely elevated results (eFER), based on odds calculated using the baseline and the follow-up values and the time between these measurements, the number of HbA1c re-testings within 60 days as well as the overall number of ordered and performed HbA1c analyses were calculated. In LKH, an automated algorithm cancelling inappropriate HbA1c testing was applied, and in STV, educational actions were taken.ResultsBefore RTI-implementation, eFER were 0.9% and 2.1% and within-60-days-re-testing were 15.0% and 7.4% of cases in LKH and STV, respectively. After RTI-implementation, these numbers decreased to 0.2% (p < .001) and 1.8% (p = .869) and within-60-days-re-testing decreased to 1.1% (p < .001) and 3.6% (p = .003) in LKH and STV, respectively. Median monthly HbA1c measurements decreased by 15.8% (p < .001) and 21.1% (p = .002) in LKH and STV, respectively.ConclusionBoth the educational and the automated 60-day-RTI were proven to be efficient in reducing overall HbA1c measurements, re-testing within 60 days and eFER.     

Recursos asistenciales en atención primaria para manejo del asma: proyecto Asmabarómetro

ObjectiveThe objective of this study was to describe the current provision of basic resources for asthma management in Primary Health Care (PHC).DesignCross-sectional study, with an ad hoc quantitative survey.Location and participantsA total of 380 primary healthcare physicians in Spain.Interventions and main measurementsAnalysis of perceptions of management and use of basic human, organisational and material resources to ensure appropriate care provision to asthma patients.ResultsSurvey respondents stated that their centre did not have a consultant doctor (64%) or nurse (62%) in respiratory disease. Almost all (92%) of the centres have spirometers, of which 70% have peak flow meters, and 93% have placebo inhalers. In the last year, respondents have received specific theoretical/practical training from the centre (46%), and by third parties (83%). More than three-quarters (78%) of the centres has educational material available for patients. There is no specific healthcare protocol in 36% of the centres, and 43% had no referral protocol. A clinical interview is conducted to monitor the patient (90%), but there are no validated questionnaires to measure therapeutic adherence (85%), or a checklist to check inhalation technique (83%). Differences are observed in the relevant variables in the analysis of each Spanish Autonomous Community.ConclusionsAccess to certain resources in the care of patients with asthma is limited in aspects of coordination between levels, varied according to Spanish Autonomous Community, and improved in most health resources in Asthma.     

The polio vaccination story of Pakistan

BackgroundTo describe in chronological detail Pakistan’s decades long battle against poliovirus and evaluate the multiple factors impacting it.Main bodyPakistan’s fight is documented through various published research articles and reports on Pakistan’s progress in eradication of polio published by international agencies involved in elimination of poliovirus worldwide. The socioeconomic, religious, and political factors, violent religious militancy, conspiracy theories resulting in vaccine refusals are documented in detail emphasizing the ups and downs in the fight at different times since 1994 to present. Pakistan and Afghanistan are the only two countries in the world reporting cases caused by wild polio virus type 1 (WPV1) since 2017 and the only two countries that have never stopped the transmission of WPV1 Pakistan needs to work on a war footing to eliminate the disease. The need to act urgently is now being increasingly recognized by the Pakistani Government.ConclusionMany difficulties still remain. Pakistan has reached a critical stage in the fight against polio. The world will not accept any further delay or complacency as there is apprehension around the world that Pakistan may “export” polio to other countries and undermine the worldwide success in eradicating polio.     

新疆健康扶贫模式:结核病精准服务平台

通过对国内尤其是新疆结核病现状进行分析,阐述通过大数据和人工智能技术构建结核病精准防控体系，搭建“大数据智能监测、AI辅助诊断、AI临床诊疗管理、康复随访干预”四位一体，探索临床诊疗和公共卫生数据整合衔接的新疆模式。认为精准平台有利于早发现、早诊断，使上报，转诊、治疗、随访实现全流程的闭环管理，为西部地区传染病防治提供借鉴     

La toma de decisiones en salud comunitaria a través del mapeo de activos en salud

This is a report about the experience on redefining the health asset mapping methodology. The aim of this experience consisted of making an analysis on health inequalities, as well as of using it as a tool in decision-making participative processes in the local administration area. Thus, a replicable procedure for all ages and groups was designed. Besides this, assets have been widely classified, in accordance with the territorial distribution, people's profiles and asset features. Both the upload of data to a geographical information system and the large amount of data gathered allowed us to enlarge the common interpretation of data and present the information in a dynamic way.     

One or two doses of hepatitis A vaccine in universal vaccination programs in children in 2020: A systematic review

BackgroundHepatitis A virus (HAV) is a global health concern as outbreaks continue to occur. Since 1999, several countries have introduced universal vaccination (UV) of children against HAV according to approved two-dose schedules. Other countries have implemented one-dose UV programs since 2005; the long-term impact of this schedule is not yet known.MethodsWe conducted a systematic literature search in four electronic databases for data published between January 2000 and July 2019 to assess evidence for one-dose and two-dose UV of children with non-live HAV vaccines and describe their global impact on incidence, mortality, and severity of hepatitis A, vaccine effectiveness, vaccine efficacy, and antibody persistence.ResultsOf 3739 records screened, 33 peer-reviewed articles and one conference abstract were included. Rapid declines in incidence of hepatitis A and related outcomes were observed in all age groups post-introduction of UV programs, which persisted for at least 14 years for two-dose and six years for one-dose programs according to respective study durations. Vaccine effectiveness was ≥95% over 3–5 years for two-dose programs. Vaccine efficacy was >98% over 0.1–7.5 years for one-dose vaccination. Antibody persistence in vaccinated individuals was documented for up to 15 years (≥90%) and ten years (≥74%) for two-dose and one-dose schedules, respectively.ConclusionExperience with two-dose UV of children against HAV is extensive, demonstrating an impact on the incidence of hepatitis A and antibody persistence for at least 15 years in many countries globally. Because evidence is more limited for one-dose UV, we were unable to draw conclusions on immune response persistence beyond ten years or the need for booster doses later in life. Ongoing epidemiological monitoring is essential in countries implementing one-dose UV against HAV. Based on current evidence, two doses of non-live HAV vaccines are needed to ensure long-term protection.