Hip fractures in Norway – Inequity in treatment and outcomes

Målet med forskningsprosjektet var å belyse variasjon i behandling og utfall etter hoftebrudd i Norge, kartlegge forklaringer på og konsekvensene av variasjon, vurdere risikofaktorer for død etter hoftebrudd og deres relative betydning. I tillegg ønsket man å vurdere overlevelsesmønsteret og estimere varigheten av overdødelighet etter hoftebrudd. Prosjektet var en observasjonsstudie basert på 41699 hoftebrudd registrert i Nasjonalt hoftebruddregister fra 2014 til 2018, koblet med data fra Norsk Pasientregister og Statistisk sentralbyrå. Det ble også gjennomført en kartlegging av tjenestetilbudet ved sykehus som behandler hoftebrudd. Studien viste variasjon mellom norske sykehus med hensyn til etterlevelse av kunnskapsbaserte retningslinjer for behandling av hoftebrudd og 54,9% av pasientene fikk behandling som anbefalt. Manglende etterlevelse var knyttet til forlenget ventetid og bruk av usementert protesestamme. Avvik fra retningslinjene gav pasientene økt dødelighet og økt reoperasjonsrate. En økende andel av pasientene fikk anbefalt behandling mot slutten av studieperioden. Gjennomsnittlig ventetid fra innleggelse til operasjon var 23 timer. Ventetiden var lengst for pasienter med høy komorbiditet, og i sykehus med stort volum. Forlenget ventetid økte dødelighet. Pasientfaktorer (komorbiditet, sosioøkonomi og bostatus), og systemfaktorer (sykehusvolum og tilgjengelighet av ortogeriatriske tjenester) påvirket dødeligheten. Ikke-modifiserbare risikofaktorer var sterkere assosiert til død enn modifiserbare. Overdødeligheten målt med Standardiserte Mortalitets Rater (SMR) etter hoftebrudd var høy de første månedene etter operasjonen, med en SMR på 3,53 etter ett år. SMR falt mest de første 18-24 månedene, men flatet ut på klart høyere (SMR 2.48) nivå enn referansepopulasjonen etter 6 år. Etterlevelse av kunnskapsbaserte retningslinjer for behandling av hoftebrudd varierte betydelig, med økende etterlevelse i studieperioden. Ventetiden til operasjon ble påvirket av både pasient- og systemfaktorer. Økt ventetid medførte økt dødelighet. Pasient-, sosioøkonomiske og helsesystemfaktorer bidrar til økt dødelighet etter hoftebrudd. Hoftebruddpasienter opplever en betydelig overdødelighet sammenliknet med en kontrollpopulasjon, spesielt første året etter skade og operasjon.Hip fractures commonly affect frail elderly people and have significant consequences for the patient and society. The aim of this research project was to examine variation in treatment and outcomes after hip fracture in Norway, explore explanations for and consequences of variation of in-hospital waiting time, and assess risk factors for death after hip fracture and their relative importance. The survival pattern and duration of excess mortality after hip fractures were also assessed. The project was a retrospective study based on 41,699 recorded hip fractures in the National Hip Fracture Register (NHFR) from 2014 to 2018. Data from the NHFR were linked with data from the Norwegian Patient Registry and Statistics Norway. A survey of the services provided in all Norwegian hospitals treating hip fractures was also carried out. The study showed a clear variation between Norwegian hospitals regarding adherence to evidence-based guidelines for treatment of hip fractures. Only 54.9% of patients received treatment as recommended in the guidelines. A main proportion of non-adherence was related to preoperative waiting time before treatment and the use of uncemented prosthetic stems. The average waiting time from admission to surgery was 23 hours. The longest waiting time was observed for patients with high comorbidity, and in hospitals with high patient volumes. Deviations from guidelines had consequences for patients in the form of increased mortality and increased reoperation rates. An increasing proportion of patients received recommended treatment towards the end of the study period. Patient factors (comorbidity, socioeconomic and residential status), and system factors (hospital volume and availability of orthogeriatric services) affected mortality and hence survival after hip fractures. Non-modifiable risk factors were more strongly associated to death than modifiable ones. Excess mortality measured by standardized mortality ratios (SMR) after hip fractures was initially high, with a SMR of 3.53 at one year. SMR remained high but falling during the first 24 months, then levelling off but was higher than the reference population (SMR 2.48) at six years. Adherence to evidence-based guidelines for treatment of hip fractures varied considerably, with increasing adherence over the study period of five years. The waiting time from hospitalization to surgery was affected by both patient and system factors. Increased waiting time led to increased mortality for patients. Patient, socioeconomic and healthcare factors contributed to increased mortality after hip fractures. Hip fracture patients have significant excess mortality compared to the general population, especially the first year after the injury

Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study

Background: Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children. Methods: This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage. Results: There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9–91.4) in Aboriginal children and 44.9/1000 person-years (44.8–45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7–1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged <2 years to 5/1000 person-years and 1.8, respectively, for ages 12- < 14 years. Findings were similar for the subset of ambulatory care sensitive hospitalizations, but in contrast, non-avoidable hospitalization rates were almost identical in Aboriginal (10.1/1000 person-years, (9.6–10.5)) and non-Aboriginal children (9.6/1000 person-years (9.6–9.7)). Conclusions: We observed substantial inequalities in avoidable hospitalizations between Aboriginal and non-Aboriginal children regardless of where they lived, particularly among young children. Policy measures that reduce inequities in the circumstances in which children grow and develop, and improved access to early intervention in primary care, have potential to narrow this gap

eHealth interventions for people with chronic kidney disease

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to look at the benefits and harms of using eHealth interventions in the CKD population

Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty:A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Periprosthetic joint infections (PJIs) are dreaded complications of total joint arthroplasties. The risk of developing PJIs is likely to be influenced by several patient factors such as sociodemographic characteristics, body mass index (BMI), and medical and surgical histories. However, the nature and magnitude of the long-term longitudinal associations between these patient-related factors and risk of developing PJIs are uncertain.</p><p>Objective</p><p>To conduct a systematic review and meta-analysis to assess the associations between several patient-related factors and PJI.</p><p>Data Sources</p><p>MEDLINE, EMBASE, Web of Science, Cochrane Library, and reference lists of relevant studies from inception to September 2015.</p><p>Study Selection</p><p>Longitudinal studies with at least one-year of follow-up for PJIs after total joint arthroplasty.</p><p>Data Extraction and Synthesis</p><p>Two investigators extracted data on study characteristics, methods, and outcomes. A consensus was reached with involvement of a third. The relative risk (RR) with 95% confidence intervals was used as the summary measure of association across studies. Study-specific RRs with 95% confidence intervals were meta-analysed using random effect models and were grouped by study-level characteristics.</p><p>Results</p><p>Sixty-six observational (23 prospective cohort and 43 retrospective cohort or case-control) studies with data on 512,508 participants were included. Comparing males to females and smokers to non-smokers, the pooled RRs for PJI were 1.36 (1.18–1.57) and 1.83 (1.24–2.70) respectively. There was no evidence of any significant associations of PJI with age and high alcohol intake. Comparing BMI ≥ 30 versus < 30 kg/m²; ≥ 35 versus < 35 kg/m²; and ≥ 40 versus < 40 kg/m²; the pooled RRs were 1.60 (1.29–1.99); 1.53 (1.22–1.92); and 3.68 (2.25–6.01) respectively. Histories of diabetes, rheumatoid arthritis, depression, steroid use, and previous joint surgery were also associated with increased risk of PJI. The results remained similar when grouped by relevant study level characteristics.</p><p>Conclusions</p><p>Several potentially modifiable patient-related factors are associated with the risk of developing PJIs. Identifying patients with these risk factors who are due to have arthroplasty surgery and modulating these risk factors might be essential in reducing the incidence of PJI. Further research is however warranted to assess the potential clinical utility of these risk factors as risk assessment tools for PJI.</p><p>Systematic Review Registration</p><p>PROSPERO 2015: CRD42015023485</p></div

Lifestyle Factors and Risk of Heart Failure: A Prospective Cohort Study

Heart failure (HF) has become a major health problem with its high prevalence, poor clinical outcomes, and large health-care costs. Compared with medical intervention, the prevention of HF through lifestyle approaches is free of side effect. Therefore, the prevention of HF through lifestyle approaches is of special interest. In this project, we aim to investigate 1) the association of different levels of occupational, commuting and leisure-time physical activity with HF risk; 2) the association of coffee consumption with HF risk; 3) the role of lifestyle factors in explaining the risk of HF; and 4) the association between antihypertensive drug treatment and HF risk with the association between engaging in a healthy lifestyle and HF risk. We conducted prospective studies among Finnish men and women who were 25 to 74 years of age and free of HF at baseline. Cox proportional hazards regression models were used to estimate the associations of interest. Partial population attributable risk was calculated to estimate the proportion of new HF cases occurring in this population that hypothetically could have been prevented if all subjects had certain health lifestyle factors. Our study results showed that 1) moderate and high levels of occupational or leisure-time physical activity are associated with a reduced risk of HF in both sexes; A simultaneous engagement in two or three types of physical activity showed a slightly stronger protective effect than participation in only one type of physical activity; 2) coffee consumption does not increase the risk of HF in Finnish men and women; In women, we observed an inverse association between low-to-moderate coffee consumption and the risk of HF; 3) maintaining a body mass index ¡Ü25, consuming vegetable ¡Ý3 times a week, abstaining from smoking and engaging in moderate or high level of physical activity were individually and jointly associated with a decreased risk of HF among both men and women; The relationship between the number of healthy lifestyle factors one engaged in and HF risk was dose-response; and 4) HF risk was lower in hypertensive patients who engaged in a healthy lifestyle but higher in hypertensive people using antihypertensive drug treatment

Prevalence of Diabetes among Adults and Risk Factors Associated With High Diabetes Prevalence in the United Arab Emirates: A Systematic Review

Abstract: Introduction: The widespread presence or prevalence of diabetes mellitus type 2 is increasing rapidly in the United Arab Emirates. An individual person with diabetes mellitus may get greater exposure for the complications in later life. It is known as the non-communicable modern epidemic which has become a global threat .The aim is to understand the high prevalence of diabetes mellitus type 2 and the effect of its risk factors among adults in the United Arab Emirates. Research design and methodology: We searched four electronic databases such as Medline Complete, PubMed, Web of Science, Scopus and suggested literature from experts also assessed. The searching keywords are prevalence, epidemiology, diabetes mellitus type 2, risk factors, modifiable risk factors, non-modifiable risk factors, population at risk, UAE, United Arab Emirates. One hundred fifty six articles found after primary search and eight articles were selected for the final review. Results: This research results revealed the prevalence varied in different parts of the UAE such as in the Northern Emirates (19.1%-25.1%), in Dubai (12.4%-14.7%) and (19.0%-19.3%) among adult residents and citizens, in Al Ain the (18.8%-40.7%) among residents. The factors such as aging >35 years among citizens and (41-60, 61 plus) among residents, obesity (BMI >30 for Arabs and Europeans and >27 for Asians), central obesity (>102 cm in men and >88 cm in women for Arabs and Europeans, > 90 cm in men and >80 cm in women for Asians), positive family history of diabetes mellitus type 2, ethnicity, suffering from dyslipidemia and hypertension, less physical activity, duration of staying in the UAE more than 10 years, unhealthy diet, being single (widow, separated, divorced) and stress were positively associated with high prevalence. Conclusion: The results considered planning for early screening, intervention, health resources allocation to pursue specific approaches to reduce high prevalence. Keywords: Diabetes mellitus type 2, epidemiology, prevalence, population at risk, risk factors, Systematic review, United Arab Emirates. Title: Prevalence of Diabetes among Adults and Risk Factors Associated With High Diabetes Prevalence in the United Arab Emirates: A Systematic Review Author: Dr. Tarana Bashar, Dr. Diana Lúcia Moura Pinho International Journal of Recent Research in Life Sciences (IJRRLS) ISSN 2349-7823 Vol. 10, Issue 3, July 2023 - September 2023 Page No: 29-39 Paper Publications Website: www.paperpublications.org Published Date: 21-September-2023 DOI: https://doi.org/10.5281/zenodo.8365814 Paper Download Link (Source) https://www.paperpublications.org/upload/book/Prevalence%20of%20Diabetes%20among%20Adults-21092023-1.pdfInternational Journal of Recent Research in Life Sciences (IJRRLS), ISSN 2349-7823, Paper Publications, Website: www.paperpublications.or

Disease management interventions for improving self-management in lower-limb peripheral arterial disease

The objective of this review is to systematically review, synthesise and quantify the effects of non-pharmacological and non-surgical chronic disease management interventions targeting self-management for people with lower-limb PAD

Improving Diabetes Self-Management with an Online Education and Group Coaching Program

Abstract Background: Type 2 diabetes is a growing epidemic in the United States and innovative programs are needed to improve care and reduce diabetic related complications. Purpose: To provide accessible education and coaching support to improve diabetes self-management and self-efficacy of Americans. Methods: Patients with diabetes and those at risk for diabetes were recruited from a Community Health Center in rural Massachusetts to participate in an online group coaching and education program. Participants completed pre- and post-intervention surveys on diabetes related self-care behaviors and self-efficacy. Online group coaching sessions were held once weekly in the month of January 2021. Each session included an educational, knowledge based lecture, barrier identification, goal session, and question and answer. Results: A total of 28 eligible participants gave informed consent and of these, 11 participants completed the pre-surveys, and 5 participants completed the program and the post-intervention surveys. Pre-and post-test results revealed a difference on average, of participants’ diabetes self-management behaviors increased by 4.00 points from pre-test (M = 26.60) to post-test (M = 30.60). Results did not show a significant change for self-efficacy for diabetes management from pre-test. Conclusion: Online diabetes coaching and support has potential to help people improve diabetes related self-care behaviors. Participants may need more time to improve self-efficacy. Keywords: diabetes, self-management, health coachin