Home visits by family physicians during the end-of-life: Does patient income or residence play a role?

BACKGROUND: With a growing trend for those with advanced cancer to die at home, there is a corresponding increase in need for primary medical care in that setting. Yet those with lower incomes and in rural regions are often challenged to have their health care needs met. This study examined the association between patient income and residence and the receipt of Family Physician (FP) home visits during the end-of-life among patients with cancer. METHODS: Data Sources/Study Setting. Secondary analysis of linked population-based data. Information pertaining to all patients who died due to lung, colorectal, breast or prostate cancer between 1992 and 1997 (N = 7,212) in the Canadian province of Nova Scotia (NS) was extracted from three administrative health databases and from Statistics Canada census records. Study Design. An ecological measure of income ('neighbourhood' median household income) was developed using census information. Multivariate logistic regression was then used to assess the association of income with the receipt of at least one home visit from a FP among all subjects and by region of residency during the end-of-life. Covariates in the initial multivariate model included patient demographics and alternative health services information such as total days spent as a hospital inpatient. Data Extraction Methods. Encrypted patient health card numbers were used to link all administrative health databases whereas the postal code was the link to Statistics Canada census information. RESULTS: Over 45% of all subjects received at least one home visit (n = 3265). Compared to those from low income areas, the log odds of receiving at least one home visit was significantly greater among subjects who reside in middle to high income neighbourhoods (for the highest income quintile, adjusted odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.15, 1.64; for upper-middle income, adjusted OR = 1.19, 95%CI = 1.02, 1.39; for middle income, adjusted OR = 1.33, 95%CI = 1.15, 1.54). This association was found to be primarily associated with residency outside of the largest metropolitan region of the province. CONCLUSION: The likelihood of receiving a FP home visit during the end-of-life is associated with neighbourhood income particularly among patients living outside of a major metropolitan region

High preterm birth at Cipto Mangunkusumo Hospital as a national referral hospital in Indonesia

Background: Preterm birth is the leading direct that causes neonatal death. Indonesia was listed as one of the countries with the greatest number of preterm birth in 2010. This study aims to identify the prevalence and the potential risk factors of preterm birth among women underwent delivery in Cipto Mangunkusumo Hospital, an Indonesian national reference hospital. Methods: This retrospective cohort study involved 2,612 women who delivered between January and December 2013. Any clinical data which related to the potential risk factors and outcomes were recorded. The data were managed using chi-square for bivariate analysis and t-test or Mann-Whitney for numerical data followed by multiple logistic regression for multivariate analysis in SPSS version 20.0. Results: Preterm birth affected 1,020 of 2,616 pregnancies (38.5%). Non-booked patients increased nearly twice risk for preterm delivery (OR 1.89, 95% CI 1.37–2.61). While women with singleton pregnancy (OR 0.17, 95% CI 0.12–0.25), head presentation (OR 0.75, 95% CI 0.63–0.89), and regular ANC (OR 0.67, 95% CI 0.54–0.84) had lower risk for preterm birth. Apgar score, birthweight, and mode of delivery were significantly different between the pre-term group and the full-term group. Conclusion: Prevalence of preterm birth in Cipto Mangunkusumo Hospital was approximately 2.5 times higher compared to the national number. Several factors reducing preterm birth rate include singleton pregnancy, head presentation, and regular ANC

Fetal biometry: a comparison between experienced sonographers and automated measurements

Objective. We compared the performance between sonographers and automated fetal biometry measurements (Auto OB) with respect to the following measurements: biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Methods. The first set of experiments involved assessing the performance of Auto OB relative to the five sonographers, using 240 images for each user. Each sonographer made measurements in 80 images per anatomy. The second set of experiments compared the performance of Auto OB with respect to the data generated by the five sonographers for inter-observer variability (i.e., sonographers and clinicians) using a set of 10 images per anatomy. Results. Auto OB correlated well with manual measurements for BPD, HC, AC and FL (r > 0.98, p < 0.001 for all measurements). The errors produced by Auto OB for BPD is 1.46% (σ = 1.74%), where σ denotes standard deviation), for HC is 1.25% (σ = 1.34%), for AC is 3% (σ = 6.16%) and for FL is 3.52% (σ = 3.72%). In general, these errors represent deviations of less than 3 days for fetuses younger than 30 weeks, and less than 7 days for fetuses between 30 and 40 weeks of age. Conclusion. The measurements produced by Auto OB are comparable to the measurements done by sonographers. Read More: http://informahealthcare.com/doi/abs/10.1080/14767050802415736Ivica Zalud, Sara Good, Gustavo Carneiro, Bogdan Georgescu, Kathleen Aoki, Lorry Green, Farzaneh Shahrestani, & Russell Okumur