Prevalence of vitamin D deficiency in an inpatient population in the Swiss canton of Basel-Country

AIMS: Vitamin D deficiency remains very common in the general population. Adding to the importance of this issue is the discovery that vitamin D plays a role in many other tissues apart from the bone, including muscle, brain, prostate, breast and colon. In this study, we investigated the prevalence of vitamin D deficiency in a large group of patients hospitalised in the cantonal hospital Basel-Country, and analysed the dependence of serum vitamin D concentrations on gender, time of the year and age. METHODS: We retrospectively analysed anonymised data received from the central laboratory of the cantonal hospital Basel-Country. The pool of data contains values obtained between 2013 and 2017 from 8861 patients aged between 18 and 102 years. If sequential measurements were available from a patient, only the first was used for the analyses. Vitamin D deficiency was defined as a serum concentration of <50 nmol/l and severe deficiency as 75 nmol/l. RESULTS: Mean ± standard deviation serum vitamin D concentration was 52.5 ± 30.5 nmol/l, with women having a higher mean of 55.5 ± 31.5 nmol/l as compared with 48.1 ± 28.6 nmol/l in men (p <10-5). Of the 8861 first measurements taken within the observation period, 4527 (51%) were vitamin D deficient with levels <50 nmol/l, including 1860 (21.0%) with levels <25 nmol/l. There was only a weak positive association of average vitamin D levels with age (p = 0.06). Women reached peak concentrations of 56.9 ± 35.4 nmol/l in the age group 90-102 years, whereas men reached peaks of 50.3 ± 31.9 nmol/l in 50-59-year-olds. Mean autumn and spring concentrations differed less (51.6 ± 29.6 vs 52.7 ± 30.7 nmol/l, respectively, p = 0.38) than mean summer and winter concentrations (57.1 ± 29.5 vs 48.0 ± 31.2 nmol/l, respectively, p 75 nmol/l, only 22.1% of measured values indicated adequate vitamin D levels. This issue should be addressed in order to improve quality of life and reduce medical costs.

Health seeking behavior among adults and elderly with chronic health condition(s) in Albania

Aim: Assess the use of different health care service providers by adults (aged 18-59) and elderly (aged > =60) who suffer from non-communicable disease (NCD) and explore relationships between sociodemographic variables and care-seeking behaviors. Methods: A cross-sectional survey was conducted in the districts of Diber and Fier in December 2018, using random cluster sampling. Descriptive statistics were used to compare the care-seeking behaviors of adults and elderly people. We employed binary and multinomial logistic regression to assess factors associated with the type of health service provider used. Analyses were adjusted for clustering within districts of residence. Results: Out of 3,799 respondents, 1,116 (29.4%) suffered froman NCD. Of these, 95% sought to obtain care for their chronic condition through public healthcare providers. The elderly were more likely to use primary healthcare services (PHC) to initiate care when facing health problems (56%), compared to those aged 18-59 years (49%, p < 0,001). Over the last 8 weeks, 82% (914/1,116) of participants sought care. Binary and multinomial logistic regression analyses, adjusted for socio-demographic variables, showed that the elderly were more likely to choose PHC services (OR 1.56; 95% CI: 1.04; 2.35). Moreover, individuals who suffered from hypertension used PHC services more frequently than hospitals (OR 1.94; 95% CI: 1.32; 2.85). A positive association was found between living in an urban area and seeking care for NCDs at polyclinics (OR 10.1; 95% CI: 2.1; 50.1). There was no significant gender difference observed with regard to the type of provider consulted. Conclusion: Public facilities were reported as the main providers for initiating care and the main providers used in the 8 weeks prior to the interview. While a majority of elderly people visited a PHC to initiate treatment (and follow up) on their chronic conditions, a substantial proportion of adults (aged 18-59) initiated and sought regular NCD care at a hospital. Educating patients and caregivers on active participation in NCD prevention, management, and control through the PHC level should be a long-term effort, along with the establishment of well-structured referral mechanisms and integrated care systems

Factors associated with the utilisation of primary care services: a cross-sectional study in public and private facilities in Albania

OBJECTIVES: To identify key factors influencing the utilisation of governmental and private primary healthcare services in Albania. DESIGN: A cross-sectional health facility survey using a 4-point Likert scale questionnaire to rank the importance of factors driving services utilisation. SETTING: Exit interviews with patients who consulted one of 23 primary care providers (18 public and 5 private) in Fier district of Albania from the period of July-August 2018. PARTICIPANTS: Representative sample of 629 adults >/=18 years of age. MAIN OUTCOMES MEASURES: (1) Factors influencing the decision to visit a governmental or private primary care provider and (2) the association of sociodemographic characteristics and patients' decision to attend a given provider. Data were analysed using mixed logistic regression models. RESULTS: Nearly half of the participants in this study were older than 60 years (45%). The majority (63%) reported to suffer from a chronic condition. Prevailing determinants for choosing a provider were 'quality of care' and 'healthcare professionals' attitudes. Solely looking at patients using a public provider, 'geographical proximity' was the most important factor guiding the decision (85% vs 11%, p<0.001). For private provider's patients, the 'availability of diagnostic devices' was the most important factor (69% vs 9%, p<0.001). The odds of using public facilities were significantly higher among the patients who perceived their health as poor (OR 5.59; 95% CI 2.62 to 11.92), suffered from chronic conditions (OR 3.13; 95% CI 1.36 to 7.24) or were benefiting from a socioeconomic aid scheme (OR 3.52; 95% CI 1.64 to 7.56). CONCLUSION: The use of primary healthcare is strongly influenced by geographical and financial access for public facility users and availability of equipment for private users. This study found that aspects of acceptability and adequacy of services are equally valued. Additional commitment to further develop primary care through engagement of local decision-makers and professional associations is needed

Out of pocket payments and access to NCD medication in two regions in Albania

OBJECTIVE: The financial burden from noncommunicable diseases (NCDs) is a threat worldwide, alleviated only when good social protection schemes are in place. Albeit the Government in Albania has committed to Universal Healthcare Coverage (UHC), Out-of-Pockets (OOPs) persist. Through this study, we aimed to assess the OOPs related to consultations, diagnostic tests, and medicine prescriptions as self-reported by people suffering from NCDs. METHODS: A household survey was conducted in two regions of Albania. The present analysis includes respondents who suffered from chronic health conditions and consulted a health care provider within the last 8 weeks (n = 898). Mixed logistic regression models with random intercepts at the level of communities were employed in order to assess the association of OOPs with age, gender, urban vs. rural residency, health insurance, marital status, barriers experienced, type of chronic condition(s) and region. RESULTS: Of those who consulted a provider, 95% also received a drug prescription. Among them, 94% were able to obtain all the drugs prescribed. Out-of-pocket payments occurred throughout the NCD treatment process; specifically, for consultation (36%), diagnostic tests (33%), and drugs purchased (88%). Drug expenditures accounted for 62% of all household expenditures. Respondents with health insurance were less likely to pay for consultation and drugs. The elderly (patients above 60 years old) were less likely to pay for consultations and tests. Those who lived in urban areas were less likely to pay for drugs and consultations. Patients encountering any form of barrier when seeking care had increased odds of OOPs for consultations (OR; 2.25 95%-CI; 1.57; 3.23) and tests (OR; 1.71 95%-CI; 1.19; 2.45). CONCLUSION: Out-of-pocket payments by NCD patients principally made up through the purchase of prescribed drugs, remain important. Tackling the high costs of drugs will be important to accelerate the UHC agenda. Here, it is important to raise the population's awareness on patients' knowledge of their entitlements to health insurance, and on the current health reforms

Perspectives of public and private primary healthcare users in two regions of Albania on non-clinical quality of care

BACKGROUND; : Aiming to tackle the rise of non-communicable diseases and an ageing population, Albania is engaged in boosting primary healthcare services and quality of care. The patients' perspectives on their experience with public and private providers are, however, missing, although their viewpoints are critical while shaping the developing services. Consequently, we analyze perceptions of users of primary healthcare as it relates to non-clinical quality of care and the association to sociodemographic characteristics of patients and the type of provider.; METHODS; : A facility-based survey was conducted in 2018 using the World Health Organization responsiveness questionnaire which is based on a 4-point scale along with 8 non-clinical domains of quality of care. The data of 954 patients were analyzed through descriptive statistics and linear mixed regression models.; RESULTS; : Similar mean values were reported on total scale of the quality of care for private and public providers, also after sociodemographic adjustments. The highest mean score was reported for the domain "communication" (3.75) followed by "dignity" (3.65), while the lowest mean scores were given for "choice" (2.89) and "prompt attention" (3.00). Urban governmental PHC services were rated significantly better than private outpatient clinics in "coordination of care" (2.90 vs 2.12, P < .001). In contrast, private outpatient clinics were judged significantly better than urban PHC clinics in "confidentiality" (3.77 vs 3.38, P = .04) and "quality of basic amenities" (3.70 vs 3.02, P < .001). "Autonomy" was reported as least important attribute of quality.; CONCLUSION; : While the perception of non-clinical care quality was found to be high and similar for public and private providers, promptness and coordination of care require attention to meet patient's expectations on good quality of care. There is a need to raise the awareness on autonomy and the involvement of patients' aspects concerning their health

Non-Thermal Emission from Relativistic Electrons in Clusters of Galaxies: A Merger Shock Acceleration Model

We have investigated evolution of non-thermal emission from relativistic electrons accelerated at around the shock fronts during merger of clusters of galaxies. We estimate synchrotron radio emission and inverse Compton scattering of cosmic microwave background photons from extreme ultraviolet (EUV) to hard X-ray range. The hard X-ray emission is most luminous in the later stage of merger. Both hard X-ray and radio emissions are luminous only while signatures of merging events are clearly seen in thermal intracluster medium (ICM). On the other hand, EUV radiation is still luminous after the system has relaxed. Propagation of shock waves and bulk-flow motion of ICM play crucial roles to extend radio halos. In the contracting phase, radio halos are located at the hot region of ICM, or between two substructures. In the expanding phase, on the other hand, radio halos are located between two ICM hot regions and shows rather diffuse distribution.Comment: 19 pages, 5 figures, accepted for publication in Ap

Magellan Spectroscopy of the Galaxy Cluster RX J1347.5-1145: Redshift Estimates for the Gravitationally Lensed Arcs

We present imaging and spectroscopic observations of the gravitationally lensed arcs in the field of RX J1347.5-1145, the most X-ray luminous galaxy cluster known. Based on the detection of the [OII] 3727 emission line, we confirm that the redshift of one of the arcs is z = 0.806. Its color and [OII] line strength are consistent with those of distant, actively star forming galaxies. In a second arc, we tentatively identify a pair of absorption lines superposed on a red continuum; the lines are consistent with Ca II H & K at z = 0.785. We detected a faint blue continuum in two additional arcs, but no spectral line features could be measured. We establish lower limits to their redshifts based on the absence of [OII] emission, which we argue should be present and detectable in these objects. Redshifts are also given for a number of galaxies in the field of the cluster.Comment: To appear in The Astrophysical Journal (September 2002). 6 page

The Principal Axis of the Virgo Cluster

Using accurate distances to individual Virgo cluster galaxies obtained by the method of Surface Brightness Fluctuations, we show that Virgo's brightest ellipticals have a remarkably collinear arrangement in three dimensions. This axis, which is inclined by 10 to 15 degrees from the line of sight, can be traced to even larger scales where it appears to join a filamentary bridge of galaxies connecting Virgo to the rich cluster Abell 1367. The orientations of individual Virgo ellipticals also show some tendency to be aligned with the cluster axis, as does the jet of the supergiant elliptical M87. These results suggest that the formation of the Virgo cluster, and its brightest member galaxies, have been driven by infall of material along the Virgo-A1367 filament.Comment: 8 pages, 4 figures, accepted for publication in ApJ Letter