DO PATIENTS WITH VARYING DEMOGRAPHIC AND REGIONAL CHARACTERISTICS EQUALLY MISS APPOINTMENTS ACROSS DENTAL SPECIALTIES?

Objectives: Since dental practice is unique and procedure-based, understanding the problem of missed dental appointment among patients in Health care facilities is crucial. The main purpose of this study was to understand whether patients with varying demographic, regional, and appointment characteristics equally missed dental appointments across dental specialties at King Faisal Specialist Hospital & Research Center (KFSH&RC), Riyadh. Method: After institutional approval, we retrospectively analyzed patients’ missed dental appointments. We selected a sample of 3185 patients with “No show” or missed dental appointments for 2012. We employed chi-square goodness of fit test to establish whether there were statistically significant relationships between the type of dental specialty a patient missed and various patient characteristics. Additionally, we employed Cramer’s V to measure the strength of the relationship. Both techniques were useful in making statistical inferences from the data about the larger population based on the sample. Results: The findings showed that there are statistically significant relationships between the type of dental specialty a patient missed and various patient characteristics. Demographic, regional, registration characteristics of patients, appointment seasons and sessions, and chance of missed appointment in the various dental specialties are associated. However, with exception of age, all the other factors appear to have small effect on chance of missed appointments across dental specialties. Conclusion: With current problem of ‘no show’, the findings of this study is expected to inform KFSH&RC and other institutions to establish policies and guidelines to improve both the rate of "honored" appointments and minimize the many unused visit hours

DO PATIENTS WITH VARYING DEMOGRAPHIC AND REGIONAL CHARACTERISTICS EQUALLY MISS APPOINTMENTS ACROSS DENTAL SPECIALTIES?

Objectives: Since dental practice is unique and procedure-based, understanding the problem of missed dental appointment among patients in Health care facilities is crucial. The main purpose of this study was to understand whether patients with varying demographic, regional, and appointment characteristics equally missed dental appointments across dental specialties at King Faisal Specialist Hospital & Research Center (KFSH&RC), Riyadh. Method: After institutional approval, we retrospectively analyzed patients’ missed dental appointments. We selected a sample of 3185 patients with “No show” or missed dental appointments for 2012. We employed chi-square goodness of fit test to establish whether there were statistically significant relationships between the type of dental specialty a patient missed and various patient characteristics. Additionally, we employed Cramer’s V to measure the strength of the relationship. Both techniques were useful in making statistical inferences from the data about the larger population based on the sample. Results: The findings showed that there are statistically significant relationships between the type of dental specialty a patient missed and various patient characteristics. Demographic, regional, registration characteristics of patients, appointment seasons and sessions, and chance of missed appointment in the various dental specialties are associated. However, with exception of age, all the other factors appear to have small effect on chance of missed appointments across dental specialties. Conclusion: With current problem of ‘no show’, the findings of this study is expected to inform KFSH&RC and other institutions to establish policies and guidelines to improve both the rate of "honored" appointments and minimize the many unused visit hours

The global fatty liver disease Sustainable Development Goal country score for 195 countries and territories

Background and aims: Fatty liver disease is highly prevalent, resulting in overarching wellbeing and economic costs. Addressing it requires comprehensive and coordinated multisectoral action. We developed a fatty liver disease Sustainable Development Goal (SDG) country score to provide insights into country-level preparedness to address fatty liver disease through a whole-of-society lens. Approach and results: We developed 2 fatty liver disease-SDG score sets. The first included 6 indicators (child wasting, child overweight, noncommunicable disease mortality, a universal health coverage service coverage index, health worker density, and education attainment), covering 195 countries and territories between 1990 and 2017. The second included the aforementioned indicators plus an urban green space indicator, covering 60 countries and territories for which 2017 data were available. To develop the fatty liver disease-SDG score, indicators were categorized as "positive" or "negative" and scaled from 0 to 100. Higher scores indicate better preparedness levels. Fatty liver disease-SDG scores varied between countries and territories (n = 195), from 14.6 (95% uncertainty interval: 8.9 to 19.4) in Niger to 93.5 (91.6 to 95.3) in Japan; 18 countries and territories scored > 85. Regionally, the high-income super-region had the highest score at 88.8 (87.3 to 90.1) in 2017, whereas south Asia had the lowest score at 44.1 (42.4 to 45.8). Between 1990 and 2017, the fatty liver disease-SDG score increased in all super-regions, with the greatest increase in south Asia, but decreased in 8 countries and territories. Conclusions: The fatty liver disease-SDG score provides a strategic advocacy tool at the national and global levels for the liver health field and noncommunicable disease advocates, highlighting the multisectoral collaborations needed to address fatty liver disease, and noncommunicable diseases overall

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15–39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15–39 years to define adolescents and young adults. Findings: There were 1·19 million (95% UI 1·11–1·28) incident cancer cases and 396 000 (370 000–425 000) deaths due to cancer among people aged 15–39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5–65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8–57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9–15·6] per 100 000 person-years) and middle SDI (13·6 [12·6–14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9–25·2) DALYs to the global burden of disease, of which 2·7% (1·9–3·6) came from YLDs and 97·3% (96·4–98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Funding: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute

Indirect costs associated with deaths of children aged 0–14 years from measles in a weak health system and conflict and fragile zone: the case of Somalia

AbstractThis study recognises periodic outbreaks of measles continue to affect conflict and fragile zones in the least developed countries. This study set out to provide evidence for the indirect costs or economic loss associated with measles-related deaths among children aged 0–14 years in Somalia. Using epidemiologic and economic data, the indirect cost was calculated based on the framework of the World Health Organisation guide of identifying the economic consequences of disease and injury. The baseline indirect cost was computed as the product of discounted future productive years of life lost (PYLL), non-health gross domestic product per capita (NHGDPPC) and the estimated total measles deaths (ETMD). The model was adjusted for conflict and fragility conditions and further extension considered a finite and stable upper limit growth of the instability-adjusted NHGDPPC. To discount future costs, a rate of 3% was applied. Using a ±20% variability assumption of the epidemiologic and economic factor inputs, a sensitivity analysis was conducted to account for uncertainty. In 2015 values, the ETMD of 3723 measles deaths of children aged 0–14 years could decrease non-health GDP of the country by $23.46 million, a potential loss of$6303 per death over the discounted PYLL. The loss would increase by 5.3% when adjusted for conflict and fragility conditions. Assuming growth, the future adjusted loss is expected to be $35.91 million in 2015 values. Girl-child deaths accounted for 51.2% of the burden. Results are robust to the variations in the model inputs, although sensitivity analyses suggest the proportion of total measles deaths and the discount rate accounted for greater uncertainty of the loss than do the proportion of growth and instability assumption. Conflict and fragility accounted for the least uncertainty, perhaps confirming their relative perpetuity in Somalia. Results show significant indirect cost related to measles deaths of children, exacerbated by conflict and fragility. This is an economic burden, but one which the health system, policy-makers, government and other stakeholders should be prepared to colossally discount by collectively taking measles surveillance and security measures now to reduce further deaths in the future.</jats:p

Assessing comfort level of organ donation competencies among pediatric intensivists in Saudi Arabia: A national survey

Abstract Background: As increasing the number of organ donations presents a global challenge, Saudi Arabia is no different. Intensivists can play a major role in maximizing the organ donation process and minimize the challenges. The purpose of this study was to investigate Saudi pediatric intensivists’ comfort and importance levels of organ donation competencies.Methods: We conducted a cross-sectional survey whose sampling frame included 100 pediatric intensivists. The pediatrician intensivists were identified through an updated list provided by the Saudi Critical Care Society. We assessed 14 competencies categorized into four domains: the general donation, donation after brain death (DBD), neurological determination of death, and medicolegal, religious, and ethical domains. Then we investigated the association between these competencies and physicians’ characteristics.Results: With a response rate of 76%, we found that 40%–60% of the surveyed pediatric intensivists rated their comfort in 6 out of 14 competencies as high or very high. There was a statistically significant gap in the intensivists’ rating of 10 competencies (i.e., high importance but low comfort levels). Ordinal regression showed that comfort levels with the general donation, neurological determination of death, and medicolegal, religious, and ethical domains were higher in intensivists who were frequently involved with DBD than those who had never been exposed.Conclusions: Pediatric intensivists expressed low comfort levels to organ donation competencies that are essential for maximizing donation rates. Adapting mandatory comprehensive donation education programs and dedicated physician specialists may be beneficial in critical care units aiming to increase donation rates.</jats:p

Assessing comfort level of organ donation competencies among pediatric intensivists in Saudi Arabia: A national survey

Abstract Background: As increasing the number of organ donations presents a global challenge, Saudi Arabia is no different. Intensivists can play a major role in maximizing the organ donation process and minimize the challenges. The purpose of this study was to investigate Saudi pediatric intensivists’ comfort and importance levels of organ donation competencies.Methods: We conducted a cross-sectional survey whose sampling frame included 100 pediatric intensivists. The pediatrician intensivists were identified through an updated list provided by the Saudi Critical Care Society. We assessed 14 competencies categorized into four domains: the general donation, donation after brain death (DBD), neurological determination of death, and medicolegal, religious, and ethical domains. Then we investigated the association between these competencies and physicians’ characteristics.Results: With a response rate of 76%, we found that 40%–60% of the surveyed pediatric intensivists rated their comfort in 6 out of 14 competencies as high or very high. There was a statistically significant gap in the intensivists’ rating of 10 competencies (i.e., high importance but low comfort levels). Ordinal regression showed that comfort levels with the general donation, neurological determination of death, and medicolegal, religious, and ethical domains were higher in intensivists who were frequently involved with DBD than those who had never been exposed.Conclusions: Pediatric intensivists expressed low comfort levels to organ donation competencies that are essential for maximizing donation rates. Adapting mandatory comprehensive donation education programs and dedicated physician specialists may be beneficial in critical care units aiming to increase donation rates.</jats:p

International trade in genetically modified-sensitive industries: a cross-country analysis.

University of Minnesota Ph.D. dissertation. January 2011. Major: Applied Economics. Advisor: Dr. Pamela J. Smith. 1 computer file (PDF); xiv, 216 pages. Ill. (some col.)This dissertation analyzes the effects of non-traditional endowments (R&D stock and biotech land) on trade of genetically-modified sensitive industries. The study also explores the effects of differences in institutional endowments (intellectual property rights and regulatory regimes) on genetically modified sensitive industries. In particular, I ask, do the non-traditional endowments confer comparative advantage to a country in exporting to the rest of the world (ROW)? I pursue this hypothesis by looking at whether a country's true non-traditional endowments (R&D and biotech land) correspond with net export of embodied non-traditional endowments. I employ the factor-content model of the Heckscher-Ohlin-Vanek (HOV) as the underlying theoretical framework. The empirical implementation and method include examination of this relationship via non-parametric and parametric methods using 2006 cross-section data of three-digit level of the Standard International Trade Classification (SITC). Further, I examine the causal relationship between non-traditional endowments and countries' bilateral trade of genetically modified-based industries. In addition, I analyze the effect of institutional measures of policy on bilateral trade in GMO-based industries and account for ways in which these institutional factors interact with non-traditional endowments (R&D and biotech land). I employ the Gravity model of international trade to examine these relationships. Findings show countries with higher non-traditional endowments than the world average have embodied net exports of these endowments. In other words, this finding is an indication that such countries have revealed comparative advantage in goods that make intensive use of these factors. In particular, results show that the causal relationship between trade in genetically modified-sensitive products and biotech land of a country is informative. In aggregate and subaggregates trade, the biotech land factor consistently shows positive and statistically significant parameter estimates indicating that indeed it confers comparative advantage. Accordingly, the relationship between trade in GMO-based industries and GMO land is genuinely causal rather than just correlation. This implies that the variation of trade in GMO-based industries is not attributable to either unmeasured characteristics or the traditional endowments. However, the relationship between trade in genetically modified-sensitive industries and R&D stock is less definitive. R&D stock confers comparative advantage in one (fats or vegetable related) of the four main subaggregates while it neither confers comparative advantage nor comparative disadvantage in others. There is evidence that R&D stock (knowledge capital) does not fit the traditional immobility assumption. Knowledge capital spillovers may take place. Thus, the importance of knowledge capital is not showing up in the statistical results. I found mixed evidence on the effect of institutional endowments (relevant regulatory regimes and intellectual property rights) on bilateral trade in GMO-based industries. Using different levels of data aggregations (for comparability and concordance) and estimation methods (for robustness checks), the results showed that strengthening of patent protection in the destination country relative to the source country reduces exports of genetically modified-sensitive products. This demonstrates a market power effect where strengthening intellectual property protection grants monopoly power to economic agents of importing country relative to exporting country. Finally, results show that even when there are marked regulatory differences and policies, there is little evidence of diversion of trade in GMO-sensitive industries. The dissertation is organized as follows. Chapter 1 provides an introduction and overview of GMO-intensive industries. This chapter also summarizes patterns of international data on trade in GMO-intensive industries, R&D, GMO land use, and policies including regulatory regimes and intellectual property rights. Chapter 2 then analyzes determinants of trade in GMO-intensive industries using the Heckscher-Ohlin model. This analysis focuses on determinants of a country's trade with the rest of the world. Chapter 3 analyzes determinants of trade in GMO-intensive industries using the Gravity model. This analysis focuses on the determinants of a country's bilateral trade with each trading partner. Chapter 2 and 3 both focus on the role of the non-traditional endowments as determinants of trade. These non-traditional endowments include: (1) the knowledge stock of countries, (2) the land endowments of countries including the GMO component of land, (3) regulatory regimes of countries related to GMO policies, and (4) the intellectual property right policies of countries. I refer to the knowledge stock variable as an R&D stock through much of the dissertation. I also refer to the two policy variables as `institutional endowments' throughout the dissertation. Chapter 4 then provides a conclusion, discussion of policy implications of the research, elucidates the limitations, and proposes areas of further research.Da'ar, Omar Bundid. (2011). International trade in genetically modified-sensitive industries: a cross-country analysis.. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/101511