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Annals of Surgery Open : Perspectives... Jun 2024This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes...
OBJECTIVE
This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery.
BACKGROUND
ERPs improve outcomes for surgical patients. While preoperative education is an essential component of ERPs, its relationship with other components is unclear.
METHODS
This was a retrospective cohort study of all ERP patients undergoing elective colorectal surgery from 2019 to 2022. Our institutional ERP database was linked with American College of Surgeons National Surgical Quality Improvement Program data and stratified by adherence to preoperative education. Primary outcomes included adherence to individual ERP components and secondary outcomes included high-level ERP adherence (>70% of components), length of stay (LOS), readmissions, and 30-day complications.
RESULTS
A total of 997 patients were included. The mean (SD) age was 56.5 (15.8) years, 686 (57.3%) were female, and 717 (71.9%) were white. On adjusted analysis, patients who received preoperative education (n = 877, 88%) had higher adherence rates for the following ERP components: no prolonged fasting (estimate = +19.6%; 0.001), preoperative blocks (+8.0%; 0.02), preoperative multimodal analgesia (+18.0%; 0.001), early regular diet (+15.9%; 0.001), and postoperative multimodal analgesia (+6.4%; 0.001). High-level ERP adherence was 13.4% higher ( 0.01) and LOS was 2.0 days shorter ( 0.001) for those who received preoperative education. Classification and regression tree analysis identified preoperative education as the first-level predictor for adherence to early regular diet, the second-level predictor for LOS, and the third-level predictor for ERP high-level adherence.
CONCLUSION
Preoperative education is associated with adherence to ERP components and improved surgical outcomes.
PubMed: 38911622
DOI: 10.1097/AS9.0000000000000432 -
Palliative Care and Social Practice 2024The growing burden of life-threatening illnesses and advancements in care interventions call for the intentional integration of palliative care services into existing...
BACKGROUND
The growing burden of life-threatening illnesses and advancements in care interventions call for the intentional integration of palliative care services into existing care systems. The absence of active, functioning palliative care services in most hospitals in Ghana is a major concern. This study explored the factors influencing the integration of palliative care services in one of such institutions.
OBJECTIVES
The aim of the study was to explore the institutional drivers of palliative care integration in a military health facility.
DESIGN
Exploratory qualitative study.
METHODS
We employed a qualitative exploratory study design situated within a constructivist paradigm. A purposive sampling method was used to select and interview 11 healthcare professionals. A semistructured interview was used to conduct face-to-face, in-depth interviews with participants between April and May 2022. A thematic data analysis was done based on the Braun and Clarke analysis process with the aid of QSR NVivo-12.
RESULTS
The six themes that describe the institutional driving factors for integrating palliative care services were cognitive restructuring, supportive logistics and infrastructure, staffing, healthcare professional skills, institutional policies and priorities, and utilization of focal persons. It was observed that a paradigm shift in the mindset of healthcare professionals and administrators was a major driver that would determine the integration of palliative care services. A cognitive restructuring will facilitate a more aggressive integration of palliative care services because logistics, staffing, and medication access will be prioritized.
CONCLUSION
Institutions have the responsibility of aligning with the WHO policy on palliative care service access and must invest in training, staffing, prioritizing palliative care needs and policies, procurement of essential drugs, and the provision of logistics and supportive infrastructure to scale up the implementation of palliative care services.
PubMed: 38911601
DOI: 10.1177/26323524241262327 -
Journal of Cancer 2024: The association of socioeconomic status and individual behavior (SES/IB) with human health is receiving increasing attention. However, the causal effects between...
: The association of socioeconomic status and individual behavior (SES/IB) with human health is receiving increasing attention. However, the causal effects between SES/IB and lymphomas remain unclear. A two-sample Mendelian randomization (MR) study was used to assess the causal effects of 25 SES/IB traits (dietary habits, physical activity, smoking/drinking behaviors, sleeping behaviors, leisure sedentary behaviors, risky behaviors, and reproductive behaviors) on six distinct types of lymphomas, including Hodgkin lymphoma (HL), follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), mature T/NK-cell lymphomas, marginal zone B-cell lymphoma (MZL), and mantle cell lymphoma (MCL). The inverse variance weighted (IVW) method was the primary approach used for the MR analysis. A series of sensitivity analyses were also conducted to ensure the robustness of the findings. : Two-sample MR revealed six SES/IB traits causally associated with lymphomas, including relative fat intake, drive time, television watching time, computer use time, vigorous physical activity, and number of children ever born. After false discovery rate (FDR) correction, the causal associations between longer television watching time and DLBCL (: 4.048, 95% CI: 1.688 to 9.708, =0.009), and the number of children ever born with both FL (: 0.008, 95% CI: 1.412E-04 to 0.484, =0.021) and DLBCL (: 0.001, 95% CI:1.587E-05 to 0.081, =0.002) were identified. : These findings suggest that certain lifestyle and behavioral factors have a measurable impact on specific lymphoma types.
PubMed: 38911370
DOI: 10.7150/jca.96413 -
Lancet Regional Health. Americas Jul 2024Reducing cigarette addictiveness has the potential to avert millions of yearly tobacco-related deaths worldwide. Substantially reducing nicotine in cigarettes decreases...
BACKGROUND
Reducing cigarette addictiveness has the potential to avert millions of yearly tobacco-related deaths worldwide. Substantially reducing nicotine in cigarettes decreases cigarette consumption, but no large clinical trial has determined the effects of reduced-nicotine cigarettes when other nicotine-containing products are available. The aim of this study was to examine the effects of reduced-nicotine cigarettes in the context of the availability of alternative nicotine delivery systems.
METHODS
In a U.S. six-site, open-label, parallel-arm study, smokers were randomized for twelve weeks to an experimental marketplace containing cigarettes with either 0.4 mg or 15.8 mg nicotine per gram of tobacco; all had access to non-combusted alternative nicotine delivery systems (e.g., e-cigarettes; medicinal nicotine). Group differences in the primary outcomes (cigarettes per day, number of smoke-free days) were examined using linear and negative binomial regression, respectively (Trial Registration: NCT03272685).
FINDINGS
Among 438 randomized participants (mean [standard deviation (SD), range] age, 44.5 [11.9, 20-73] years, 225 [51.4%] women, 282 [64.4%] White and 339 [77.4%] trial completers), those in the 0.4 mg vs. 15.8 mg nicotine cigarette condition experienced significantly lower cigarettes per day at the end of intervention (mean [SD], 7.05 [7.88] vs. 12.95 [9.07], adjusted mean difference, -6.21 [95% CI, -7.66 to -4.75], P < 0.0001) and greater smoke-free days during intervention (mean [SD], 18.59 [27.97] vs. 5.06 [13.77], adjusted rate ratio, 4.25 [95% CI, 2.58-6.98], P < 0.0001).
INTERPRETATION
A reduced-nicotine cigarette standard in the context of access to other non-combusted nicotine products has the potential to benefit public health.
FUNDING
U.S. NIH/FDA U54DA03165.
PubMed: 38911348
DOI: 10.1016/j.lana.2024.100796 -
SSM. Qualitative Research in Health Jun 2024The 2015-2018 revision of the European Union's Audiovisual Media Services Directive, which governs the marketing of alcohol and unhealthy food to minors, failed to align...
BACKGROUND
The 2015-2018 revision of the European Union's Audiovisual Media Services Directive, which governs the marketing of alcohol and unhealthy food to minors, failed to align with international best practice. Previous research has explained this 'missed opportunity' with reference to deficient political will, difficulties advocating for health, and industry pressure. We explore another explanation: the role of the impact assessment (IA) process in shaping decision-making.
METHODS
We first conducted an in-depth comparison of three versions of the IA report, employing qualitative content and framing analyses to establish in the substantive content, framing, and evidence cited. Second, we used process-tracing, a qualitative method drawing on multiple data sources, to explore causal mechanisms, to assess . Data sources include policy documents published proactively and obtained through access-to-document requests.
FINDINGS
Previously unpublished versions of the IA report show that stronger rules on advertising were preferred early in the policy process but later abandoned, and that concern for 'balancing' consumer protection and competitiveness shifted to focus on the latter. Following review by the Regulatory Scrutiny Board, a revised IA report narrowed the policy options, removing a requirement for member states to prevent childrens' exposure to alcohol advertising. Consequently, decision-makers were provided with an IA that did not offer adequate information on available measures to protect children.
INTERPRETATION
Changes made during the IA process, which determines the policy options presented to decision-makers, side-lined health concerns. We argue that engaging with the institutional structures which shape decision-making is crucial for those working to further public health.
PubMed: 38911290
DOI: 10.1016/j.ssmqr.2023.100369 -
The Lancet Regional Health. Western... Jun 2024The Australian population aged 70 and above is increasing and imposing new challenges for policy makers and providers to deliver accessible, appropriate and affordable...
Pre-COVID life expectancy, mortality, and burden of diseases for adults 70 years and older in Australia: a systematic analysis for the Global Burden of Disease 2019 Study.
BACKGROUND
The Australian population aged 70 and above is increasing and imposing new challenges for policy makers and providers to deliver accessible, appropriate and affordable health care. We examine pre-COVID patterns of health loss between 1990 and 2019 to inform policies and practices.
METHODS
Using the standardised methodology framework and analytical strategies from GBD 2019 methodologies, we estimated mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), life expectancy at age 70 and above (LE-70), and healthy life expectancy (HALE-70) in Australia comparing them globally and with high socio-demographic index (SDI) groups.
FINDINGS
DALY rates have been improving steadily over the past 30 years among Australians aged 70 and above. Decreases in DALY rates were primarily attributed to a fall in YLLs attributable to cardiovascular diseases (60%) and chronic respiratory disorders (30.2%) and transport injuries (56.9%), while the non-fatal burden remained stable from 1990 to 2019. According to the DALY rates, the top five leading causes are ischemic heart disease, Alzheimer's disease, COPD, stroke, and falls, where falls exhibited the largest increase since 1990.
INTERPRETATION
This study provides an in-depth report on the main causes of mortality and disability in Australia's population aged 70 and above. It sheds light on the shifts in burden over three decades, emphasising the need for the Australian health system to enhance its readiness in addressing the escalating demands of an ageing population. These findings establish pre-COVID baseline estimates for Australia's population aged 70 and above, informing healthcare preparedness.
FUNDING
Bill & Melinda Gates Foundation.
PubMed: 38911261
DOI: 10.1016/j.lanwpc.2024.101092 -
MDM Policy & Practice 2024To estimate the impact on mortality of nonpharmaceutical interventions (NPIs) implemented early in the COVID-19 pandemic. We implemented an agent-based modified SEIR...
UNLABELLED
To estimate the impact on mortality of nonpharmaceutical interventions (NPIs) implemented early in the COVID-19 pandemic. We implemented an agent-based modified SEIR model of COVID-19, calibrated to match death numbers reported in Pennsylvania from January 2020 to April 2021 and including representations of NPIs implemented in Pennsylvania. To investigate the impact of these strategies, we ran the calibrated model with no interventions and with varying combinations, timings, and levels of interventions. The model closely replicated death outcomes data for Pennsylvania. Without NPIs, deaths in the early months of the pandemic were estimated to be much higher (67,718 deaths compared to actual 6,969). Voluntary interventions alone were relatively ineffective at decreasing mortality. Delaying implementation of interventions led to higher deaths (∼9,000 more deaths with just a 1-week delay). School closure was insufficient as a single intervention but was an important part of a combined intervention strategy. NPIs were effective at reducing deaths early in the COVID-19 pandemic. Agent-based models can incorporate substantial detail on infectious disease spread and the impact of mitigations. The model supports the importance and effectiveness of NPIs to decrease morbidity from respiratory pathogens. This is particularly important for emerging pathogens for which no vaccines or treatments exist, but such strategies are applicable to a variety of respiratory pathogens.
HIGHLIGHTS
Nonpharmaceutical interventions were used extensively during the early period of the COVID-19 pandemic, but their use has remained controversial.Agent-based modeling of the impact of these mitigation strategies early in the COVID-19 pandemic supports the effectiveness of nonpharmaceutical interventions at decreasing mortality.Since such interventions are not specific to a particular pathogen, they can be used to protect against any respiratory pathogen, known or emerging. They can be applied rapidly when conditions warrant.
PubMed: 38911124
DOI: 10.1177/23814683241260744 -
BMC Health Services Research Jun 2024Global digitalization significantly impacts public health by improving healthcare access for marginalized populations. In China, socioeconomic disparities and the Hukou...
BACKGROUND
Global digitalization significantly impacts public health by improving healthcare access for marginalized populations. In China, socioeconomic disparities and the Hukou system create significant barriers for the migrant population to access basic public health services (BPHS). This study aimed to assess how digital infrastructure construction (DIC) affects BPHS utilization among China's migrant populations, filling a gap in the literature regarding the relationship between digital advancements and health service accessibility.
METHODS
This research used micro-level data from the 2018 China Migrants Dynamic Survey and incorporated variables aligned with the Broadband China policy to employ a comprehensive empirical strategy. It included baseline regressions, robustness checks through propensity score matching and machine learning techniques, and heterogeneity analysis to explore the differential impacts of DIC based on gender, age, education level, and Hukou status.
RESULTS
The findings revealed that DIC significantly enhances the likelihood of migrants establishing health records and registering with family doctors, demonstrating quantifiable improvements in health service utilization. Heterogeneity analysis further indicated that the beneficial impacts of DIC were more pronounced among female migrants, those with higher education levels, younger populations, and urban Hukou holders.
CONCLUSIONS
DIC plays a crucial role in bridging the accessibility gap to BPHS for migrant populations in China, contributing to narrowing health disparities and advancing social equity. These results emphasize the significance of digital infrastructure in public health strategies and offer valuable insights for policymakers, healthcare providers, and researchers. Future research should prioritize longitudinal studies on the sustained effects of DIC and tailor digital health initiatives to meet the unique needs of migrant populations, promoting inclusive health policy planning and implementation.
Topics: Humans; China; Transients and Migrants; Female; Male; Adult; Health Services Accessibility; Middle Aged; Young Adult; Adolescent; Patient Acceptance of Health Care; Public Health; Socioeconomic Factors
PubMed: 38910262
DOI: 10.1186/s12913-024-11221-7 -
Global Health Research and Policy Jun 2024Asthma is the most common chronic respiratory illness among children in Australia. While childhood asthma prevalence varies by region, little is known about variations...
BACKGROUND
Asthma is the most common chronic respiratory illness among children in Australia. While childhood asthma prevalence varies by region, little is known about variations at the small geographic area level. Identifying small geographic area variations in asthma is critical for highlighting hotspots for targeted interventions. This study aimed to investigate small area-level variation, spatial clustering, and sociodemographic risk factors associated with childhood asthma prevalence in Australia.
METHODS
Data on self-reported (by parent/carer) asthma prevalence in children aged 0-14 years at statistical area level 2 (SA2, small geographic area) and selected sociodemographic features were extracted from the national Australian Household and Population Census 2021. A spatial cluster analysis was used to detect hotspots (i.e., areas and their neighbours with higher asthma prevalence than the entire study area average) of asthma prevalence. We also used a spatial Bayesian Poisson model to examine the relationship between sociodemographic features and asthma prevalence. All analyses were performed at the SA2 level.
RESULTS
Data were analysed from 4,621,716 children aged 0-14 years from 2,321 SA2s across the whole country. Overall, children's asthma prevalence was 6.27%, ranging from 0 to 16.5%, with significant hotspots of asthma prevalence in areas of greater socioeconomic disadvantage. Socioeconomically disadvantaged areas had significantly higher asthma prevalence than advantaged areas (prevalence ratio [PR] = 1.10, 95% credible interval [CrI] 1.06-1.14). Higher asthma prevalence was observed in areas with a higher proportion of Indigenous individuals (PR = 1.13, 95% CrI 1.10-1.17).
CONCLUSIONS
We identified significant geographic variation in asthma prevalence and sociodemographic predictors associated with the variation, which may help in designing targeted asthma management strategies and considerations for service enhancement for children in socially deprived areas.
Topics: Asthma; Humans; Child; Child, Preschool; Adolescent; Infant; Australia; Male; Prevalence; Female; Cluster Analysis; Infant, Newborn; Socioeconomic Factors; Spatial Analysis; Risk Factors; Bayes Theorem; Sociodemographic Factors
PubMed: 38910250
DOI: 10.1186/s41256-024-00361-2 -
BMC Public Health Jun 2024There has been extensive research conducted on open defecation in Ethiopia, but a notable gap persists in comprehensively understanding the spatial variation and...
INTRODUCTION
There has been extensive research conducted on open defecation in Ethiopia, but a notable gap persists in comprehensively understanding the spatial variation and predictors at the household level. This study utilizes data from the 2021 Performance Monitoring for Action Ethiopia (PMA-ET) to address this gap by identifying hotspots and predictors of open defecation. Employing geographically weighted regression analysis, it goes beyond traditional models to account for spatial heterogeneity, offering a nuanced understanding of geographical variations in open defecation prevalence and its determinants. This research pinpoints hotspot areas and significant predictors, aiding policymakers and practitioners in tailoring interventions effectively. It not only fills the knowledge gap in Ethiopia but also informs global sanitation initiatives.
METHODS
The study comprised a total weighted sample of 24,747 household participants. ArcGIS version 10.7 and SaT Scan version 9.6 were used to handle mapping, hotspots, ordinary least squares, Bernoulli model analysis, and Spatial regression. Bernoulli-based model was used to analyze the purely spatial cluster detection of open defecation at the household level in Ethiopia. Ordinary Least Square (OLS) analysis and geographically weighted regression analysis were employed to assess the association between an open defecation and explanatory variables.
RESULTS
The spatial distribution of open defecation at the household level exhibited clustering (global Moran's I index value of 4.540385, coupled with a p-value of less than 0.001), with significant hotspots identified in Amhara, Afar, Harari, and parts of Dire Dawa. Spatial analysis using Kuldorff's Scan identified six clusters, with four showing statistical significance (P-value < 0.05) in Amhara, Afar, Harari, Tigray, and southwest Ethiopia. In the geographically weighted regression model, being male [coefficient = 0.87, P-value < 0.05] and having no media exposure (not watching TV or listening to the radio) [coefficient = 0.47, P-value < 0.05] emerged as statistically significant predictors of household-level open defecation in Ethiopia.
CONCLUSION
The study revealed that open defecation at the household level in Ethiopia varies across the regions, with significant hotspots identified in Amhara, Afar, Harari, and parts of Dire Dawa. Geographically weighted regression analysis highlights male participants lacking media exposure as substantial predictors of open defecation. Targeted interventions in Ethiopia should improve media exposure among males in hotspot regions, tailored sanitation programs, and region-specific awareness campaigns. Collaboration with local communities is crucial.
Topics: Ethiopia; Humans; Male; Female; Adult; Defecation; Sanitation; Middle Aged; Young Adult; Spatial Regression; Spatial Analysis; Family Characteristics; Toilet Facilities; Adolescent
PubMed: 38910246
DOI: 10.1186/s12889-024-19222-1