SAGE Open Medicine最新文献

Objectives: ICD-10-based approaches often provide the basis for retrospective estimation of potential palliative care need. Applying the ICD-10-based Murtagh et al. classification from 2014 (Murtagh classification), developed using mortality data, to administrative claims data leads to inconsistencies in estimating palliative care need. The aim of the study was to refine the classification for palliative care need estimation in deceased individuals with cancer and non-cancer diagnosis.

Methods: A retrospective population-based study comparing Murtagh classification to a new ICD-10-based classification (revised by expert opinion) was conducted using outpatient and inpatient claims data, including billing codes for palliative care. Palliative care need was estimated for diagnoses groups and was contrasted with palliative care utilization rates in the last year of life. Our dataset included records of 417,405 individuals who deceased in 2016-2019.

Results: Out of individuals deceased in 2019 (n = 117,436), 81.4% had at least one diagnosis from the new classification, while 97.0% had at least one diagnosis from the Murtagh classification. Classification revision thus identified fewer individuals as potentially in need of palliative care. Among individuals with cancer, 70.7% (vs. 55.7% via Murtagh classification) received palliative care. In non-cancer subgroups, the utilization rate was considerably lower, with a maximum of 36.7% (vs. 33.7% via Murtagh classification) in 2019. Similar results were observed for the other years.

Conclusion: Compared to the ICD10-based Murtagh classification, the revised ICD-10-based classification enables more realistic estimations if the cause of death is unavailable and reveals higher rates of palliative care coverage and differences especially in cancer versus non-cancer diseases. German Clinical Trials Register (DRKS00024133).

Background: Skin is the largest organ in the body and has multiple significant functions. A malformation or injury that compromises its integrity can lead to major issues or even mortality. Wound healing is a vital physiological process of the human skin which facilitates the repair of any damage and the preservation of homeostasis. Possible complications or infections that are fatal may ensue if the patient does not recover within the specified time. Therefore, it is essential to develop biomaterials which facilitate tissue regeneration and exhibit robust biological properties. We conducted a meta-analysis of randomized controlled trials to compare combinations of skin replacements and skin grafts to skin grafts alone for wound treatment, as measured by the Vancouver Scar Scale.

Methods: This meta-analysis utilized various databases, including as PubMed, ProQuest, Web of Science, Science Direct, Scopus, EBSCOhost, and ClinicalTrials.gov, to conduct a comprehensive search for randomized controlled trials that compared the effectiveness of combined skin substitutes and skin grafts to skin grafts alone in the treatment of wounds. The results primarily consisted of scar features assessed using the Vancouver Scar Scale.

Results: Meta-analysis was conducted on a sample of 216 participants from 7 randomized controlled trials. The trials were conducted from 2002 to 2015. The study demonstrated that the use of skin substitutes resulted in a statistically significant improvement in Vancouver Scar Scales ratings compared to skin grafts alone. The mean change was 1.38 (95% CI: 0.13-2.63; p = 0.03).

Conclusion: This meta-analysis indicates that the use of skin replacements provides substantial advantages and effectively aids in the closure of wounds. There is no inherent superiority among different skin substitutes. Instead, their suitability for specific patient wound circumstances is the determining factor. A comprehensive and advantageous skin substitute of significant magnitude is needed, rather than relying solely on grafts.

Aim: The purpose of this study was to explore the experiences of pregnant women who suffer the stressful effects of preeclampsia and eclampsia through pregnancy, delivery, and postpartum.

Methods: A descriptive exploratory approach was adopted to gather in-depth data from women diagnosed with preeclampsia and eclampsia during pregnancy from February to March 2022. Purposive sampling was used to enlist 12 participants from a Municipal Hospital in the Ahafo region of Ghana. Data were analyzed thematically following Braun and Clark approach.

Results: The study found that women had strong negative emotional reactions after being diagnosed with preeclampsia or eclampsia. They frequently felt guilty, angry, scared, in denial, or disbelief about their condition. Many women held mistaken beliefs about the diseases (they misconstrued eclampsia to be epilepsy) and isolated themselves, mainly because of false perceptions and stigma around their illness in the community. Participants expressed unfulfilled needs for informational and emotional support. The information they received about their condition was insufficient, contradictory, and confusing. Some women also felt pressured into having cesarean deliveries without enough discussion or say in the decision-making process.

Conclusion: These findings reveal important psychosocial impacts of preeclampsia/eclampsia and gaps in condition-specific education and empathetic, patient-centered communication. Improving provider knowledge and counseling skills along with community awareness may help address these unmet needs among Ghanaian women facing this threat to maternal health.

Objective: This study aimed to assess hepatic fibrosis, using noninvasive tests, among patients with chronic hepatitis B virus infection in Nigeria.

Methods: The study was a retrospective cross-sectional, hospital-based, multicentered study. The data of adult Nigerians who were aged 18 years and above who had been diagnosed with chronic hepatitis B infection and were not on treatment were extracted from three tertiary health institutions across Nigeria. Sociodemographic and relevant clinical data were obtained from the case notes of the patients. Fibrosis-4 and aspartate aminotransferase platelet ratio index scores were calculated to determine the presence and severity of liver fibrosis in the patients. The data obtained were analyzed using Statistical Package for the Social Sciences (version 25.0). A p-value of less than 0.05 was considered as statistically significant.

Results: The data of a total of 234 patients were extracted for this study from across 3 tertiary hospitals in Nigeria. There were 132 (56.4%) males and 102 (43.6%) females in a ratio of 1.29:1 with a mean age of 37.92 ± 12.34 years. The fibrosis-4 score of the patients showed that 62.8% had "Normal/Mild Fibrosis," 25.6% had "Moderate Fibrosis," and 11.5% had "Severe Fibrosis/Cirrhosis." The aspartate aminotransferase platelet ratio index score of the patients showed that 64.1% had "No Fibrosis," 20.9% had "Mild Fibrosis," 6.4% had "Moderate Fibrosis," and 8.5% had "Severe Fibrosis/Cirrhosis." The median fibrosis-4 score of the patients was 1.18 (0.77-1.74), while the median aspartate aminotransferase platelet ratio index score was 0.40 (0.26-0.69). Liver ultrasonography detected cirrhosis in 8.5% of the patients. All the patients were not yet on treatment for hepatitis B infection.

Conclusion: The prevalence of hepatic fibrosis is high among patients with chronic hepatitis B virus infection in Nigeria and a large number of these patients were not yet on therapy. Noninvasive assessment of hepatic fibrosis should be considered as a critical part of the work-up of patients with chronic hepatitis B infection.

Objectives: In Pakistan, the degradation of drinking water quality is exacerbated by the increasing population size and rapid industrialization. Contaminated water serves as the predominant source of numerous diseases, including diarrhea, gastroenteritis, and typhoid. This article explores the evolution of waterborne diseases across 21 districts of the Khyber Pakhtunkhwa province in Pakistan by monitoring changes in the clustering solutions.

Methods: The data employed in this study were sourced from 21 districts of KP by the Director-General Health Services. Cluster analysis was utilized to uncover patterns in waterborne disease incidence, while principal component analysis was employed to reveal underlying patterns and reduce dimensionality. Additionally, the MONItoring Clusters (MONIC) framework was applied for change detection, facilitating the identification of significant shifts in disease patterns over time and aiding in the understanding of temporal dynamics.

Results: Our analysis indicates that two clusters survived consistently over time, while other clusters exhibited inconsistency. Profiling of the surviving clusters (C₁₂ → C₂₄ → C₃₂ → C₄₃) suggests a gradual increase in cases of bloody diarrhea in the Swat Valley, Hangu, Karak, and Lakki Marwat regions. Similarly, profiling of the surviving clusters (⊙→ C₂₂ → C₃₄ → C₄₄) suggests an increase in the acute watery diarrhea (non-cholera) and typhoid fever in the regions of Peshawar, Nowshera, and Swabi.

Conclusion: The findings of this study hold significant importance as they pinpoint the most vulnerable regions for various waterborne diseases. These insights offer valuable guidance to policymakers and health officials, empowering them to implement effective measures for controlling waterborne diseases in the respective regions of Khyber Pakhtunkhwa, Pakistan.

Background: Hepatitis B and C viruses are major global health problems with a high mortality rate, mostly due to serious liver diseases such as liver cirrhosis, liver failure, and hepatocellular carcinoma. The objective of this study was to determine the prevalence of the hepatitis B and C viruses and associated risk factors among clinically suspected patients attending Poly and Maraki Health Centers in Gondar City.

Methods: An institution-based cross-sectional study was conducted to recruit 422 clinically suspected patients attending Poly and Maraki Health Centers between June and August 2020. The blood sample was tested for hepatitis B surface antigen and anti-Hepatitis C virus antibodies using commercially available rapid test kits. We used logistic regression and chi-square analysis to assess factors associated with Hepatitis B virus and Hepatitis C virus infections.

Results: The overall prevalence of hepatitis B surface antigen and anti-Hepatitis C virus antibodies was 29 (6.9%) and 5 (1.2%), respectively. The prevalence of Hepatitis B virus and Hepatitis C virus was found to be significantly higher at Maraki Health Center. Multiple sexual partners (adjusted odd ratio (AOR = 12.299; 95% CI = 2.515-60.142), history of delivery by traditional birth attendants (AOR = 6.284; 95% CI = 2.373-16.637), surgical history (AOR = 3.679; 95% CI = 1.009-13.417), previous hepatitis infections (AOR = 10.374; 95% CI = 1.128-95.444), and upper abdominal pain (AOR = 3.382; 95% CI = 1.215-9.414) were significantly associated with an increased risk of Hepatitis B virus infections. On the other hand, a history of blood transfusion (AOR = 43.132; 95% CI = 1.385-1343.176) and a history of kidney dialysis (AOR = 71.199; 95% CI = 2.074-2444.646) were significantly associated with Hepatitis C virus infection.

Conclusions: According to the WHO endemicity classification, the prevalence of the hepatitis B virus was intermediate, while that of the hepatitis C virus was low. Therefore, it is necessary to strengthen the efforts to control and prevent Hepatitis B virus and Hepatitis C virus infections.

Objectives: This study aims to assess access to essential medicines used in the management of noncommunicable diseases through analysis of the availability, prices, and affordability of these essential medicines in Arba Minch town, Gamo Zone, Southern Ethiopia.

Methods: A cross-sectional design was carried out using the World Health Organization/health action international methodology between 2 March and 2 May 2023, within public and private healthcare facilities located in Arba Minch town, Southern Ethiopia. The median price ratio served as a metric. Statistical tests like the Shapiro-Wilk and Kolmogorov-Smirnov were utilized to assess the normal distribution of price data. The Wilcoxon-Mann-Whitney U test was also employed to compare median buyer's prices (patient prices) between public and private healthcare institutions. Treatment affordability was determined by estimating the number of days' wages required by the lowest-paid government employee in Ethiopia to afford the prescribed medication regimen.

Results: Among 23 health facilities surveyed, the pooled availability of essential medicine used in the management of noncommunicable diseases was 18.7% (range: 0%-30.1%), with the public and private facilities contributing 16.3% and 38.3%, respectively. The overall percentage of availability originator brand versions was 1.1% for overall health sectors, 0.6% for public sectors, and 1.2% for private sectors. The overall percent availability of lowest price generics was 36.2% (range: 0%-26.2%; public: 32.0%; private: 37.1%). Only seven lowest price generics satisfied the World Health Organization target of 80% and above. The overall median price of lowest price generic medicines in private was two times higher than in public sectors. The top five median price scorers were amlodipine, furosemide, insulin, beclomethasone, and salbutamol. The Mann-Whitney U test showed that 11.6% of lowest price generics medicines had a statistically significant median price disparity between the public and private sectors (p < 0.05). The overall percent of unaffordability was found to be 100.0%, (public: 70.4; private: 100.0%).

Conclusions: This study revealed the limited availability and potential financial burdens on patients seeking essential noncommunicable disease medications. Limited availability suggests the need for better supply chain management and consistent stock availability. The price disparities and affordability challenges identified underscore the necessity for policy interventions such as price regulation and subsidized programs to ensure equitable access to essential noncommunicable disease medications in Arba Minch town, Southern Ethiopia.

Background: Venous thromboembolism is the third most common cause of cardiovascular death and is responsible for more than 3 million deaths annually worldwide. Despite high rates of morbidity and mortality associated with venous thromboembolism, limited studies have been conducted on in-hospital mortality and its associated factors in Ethiopia, particularly in study settings.

Objective: To assess in-hospital mortality and associated factors among patients admitted with venous thromboembolism at selected public hospitals of Harar town, Eastern Ethiopia, from 10 March 2018 to 8 March 2022.

Methods: A retrospective cohort study design was conducted among 502 patients admitted with venous thromboembolism at Hiwot Fana Comprehensive Specialized Hospital and Jugal General Hospital using a simple random sampling technique. Data extraction formats were used to collect data from patient medical record cards. Then data were coded and entered into EpiData version 3.1 computer programs and exported to SPSS version 26 for analysis. Bivariate and multivariate backward Cox regression analysis was used to verify the associated factors of in-hospital mortality among venous thromboembolism patients. A p-value of less than 0.05 at a 95% confidence interval was used to establish a statistically significant association.

Results: A total of 502 patient medical record cards with outcome variables were included in the study. More than half of the patients 350 (69.7%) were females. Among the 502 patients who were admitted with venous thromboembolism, 8.2% (95% CI: 5.6-10.6) of patients had in-hospital mortality. DM (AHR = 4.28, 95% CI: 1.80-10.15, p = 0.001) and unfractionated heparin duration (AHR = 10.26, 95% CI: 2.45-43.01, p = 0.001) were statistically significant association with venous thromboembolism mortality.

Conclusion: Approximately 8.2% of venous thromboembolism patients died in the hospital. Diabetes and heparin were independently associated with higher mortality. Therefore, it is better to give more attention to the patients co-morbid with diabetes mellitus and for unfractionated heparin treatment duration to reduce venous thromboembolism mortality.

Introduction: The National AIDS Program in Jordan has faced numerous challenges, including insufficient funding, limited resources, and complexities brought on by refugee influxes. The absence of a reliable HIV/AIDS surveillance system further complicates tracking and responding to the epidemic. This study aimed to evaluate the performance and functionality of the National AIDS Program and the HIV/AIDS surveillance system.

Methods: A qualitative study was conducted to evaluate the National AIDS Program and the HIV/AIDS Surveillance System in Jordan. The study involved 14 key informants specialized in HIV/AIDS Surveillance Systems. Interviews were guided by an interview guide based on the Updated Centers for Disease Control and Prevention Guidelines for Evaluating Public Health Surveillance Systems. Data analysis was performed through directed content analysis.

Results: The Voluntary Counseling and Testing Center in Jordan confronts multiple challenges, including poor infrastructure, limited accessibility, and inadequate facilities. Additionally, there is a lack of effective coordination between the Voluntary Counseling and Testing center and the Chest Diseases and Migrant Health Directorate, particularly regarding testing for Tuberculosis. HIV screening in Jordan is hindered by various factors, including disease sensitivity. Voluntary Counseling and Testing lacks HIV/AIDS specialists AND staff adequate training and fails to adhere to updated treatment guidelines. Persistent deficiencies in human resources, equipment, and training continue to plague the HIV/AIDS Surveillance System. Key informants expressed dissatisfaction with the data's usefulness, citing concerns over poor data quality. The data were seldom used for prioritizing resources, identifying at-risk individuals, assessing HIV/AIDS risk factors, or evaluating prevention and control measures.

Conclusion: The National AIDS Program and HIV/AIDS Surveillance System activities in Jordan are unstructured, poorly coordinated, and inefficient. Many gaps related to National AIDS Program and HIV/AIDS Surveillance System performance and data were identified. Recommendations include developing an electronic surveillance system for data collection, notification, and reporting, and building the capacities of HIV/AIDS healthcare providers in screening, diagnosis, and management.

Objective: The COVID-19 pandemic has brought severe health consequences among older adults and posed ethical challenges. The aim of this study was to explore the impacts of COVID-19 on the health and medical care of older adults in Ethiopia and associated ethical implications, regardless of older adults' COVID-19 infection status.

Methods: In this qualitative study, we followed an inductive exploratory approach based on reflexive thematic analysis. We conducted semistructured interviews between March 2021 and November 2021 with 20 older adults and 26 health professionals who were selected from healthcare facilities and communities in Ethiopia using purposive and snowball sampling techniques. We audio-recorded, transcribed, translated, and inductively analyzed the interviews using thematic analysis.

Results: Participants reported that the pandemic compromised the accessibility and quality of both COVID and non-COVID healthcare services for older adults, which negatively impacted older adults' health conditions and medical care. Moreover, participants elaborated on the health conditions and care of older patients with COVID-19 and highlighted that older COVID-19 patients often have severe health conditions, do not get adequate COVID-19 care, and may receive lower priority for admission to intensive care units compared to younger patients when resources are limited.

Conclusions: Results of this study showed that practices of COVID-19 care and measures may have led to adverse consequences such as limited availability and access to aged care in Ethiopia, which could have further health consequences on older patients. Our results contribute to a better understanding of ethical issues such as distributive justice and prioritization arising in the healthcare of older patients in times of global pandemic. It is imperative for local and international health policymakers and ethicists to further analyze and address the challenges that compromise the accessibility and continuity of quality care for older persons during a public healthcare crisis.