Search

Study Design: National database study. Objective: Road traffic accidents (RTAs) are a common and challenging cause of facial fractures in the United States. The present study sought to utilize the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) to investigate national trends, injury patterns and disparities in facial fractures secondary to RTAs. To date, this is the first study to do so. Methods: A retrospective analysis was conducted of patients with primary facial fractures secondary to RTAs using the 2018-2021 HCUP-NIS. Patients were classified into the RTA and non-RTA group. Demographics, injury patterns, and inpatient outcomes were compared. Results: In total, 154,185 primary facial fractures were identified, of which 17% (n = 26,115) were associated with RTAs. RTAs commonly involved cars (41%), followed by motorcycles (15%), pedestrians (11%), and bicyclists (10%). The RTA group was younger (34% vs 24% < 25 years, P <.01) and more frequently Hispanic (18% vs 15%, P <.01). The most common fracture types were mandibular (23%), frontal (14%), and orbital fractures (14%). The RTA group was 50% more likely to have multiple facial fractures (OR = 1.5, P <.01). The RTA group had a longer length of stay (5.3 vs 4.0 days, P <.01), admission charge ($127,932 vs $79,414, P <.01), and mortality rate (1.9% vs 1.4%, P <.01) than the non-RTA group. Conclusions: The present findings provide valuable insights, informing early involvement of craniofacial surgeons for the assessment of combination facial fractures and tailored treatment approaches for RTA patients. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to investigate the effect of allergies on complications following total shoulder arthroplasty (TSA). Materials and Methods: All data were collected by using the PearlDiver national database to identify patients who had undergone TSA (anatomic or reverse) between 1 January 2010 and 31 October 2021. Patients were stratified into two groups: allergies and no allergies. Comparisons were made regarding complications and revision surgeries. Complications were compared at 30 and 90 days. Revisions were compared at 1, 5 and 10 years postoperatively. Results: This study identified 28,182 patients with allergies and 126,296 patients without allergies. Patients with allergies were more likely to require revision surgery at all time points analyzed (p < 0.001). Patients with allergies were more likely to have sepsis within 30 (OR 1.53 [1.30–1.80], p < 0.001) and 90 days (1.71 [1.51–1.94], p < 0.001) postoperatively. Patients with allergies were more likely to experience a wound complication within 30 (1.89 [1.58–2.26], p < 0.001) and 90 days (1.81 [1.58–2.08], p < 0.001). The allergy group experienced higher rates of prosthetic joint infections (PJI) (2.14 [1.81–2.54], p < 0.001) and implant complications at 90 days (1.52 [1.42–1.62], p < 0.001). Discussion: Patients with allergies were more likely to require revision surgery, experience wound complications, sepsis and PJI following TSA. [ABSTRACT FROM AUTHOR]

Abstract Background Physical activity inequalities are an important global concern; nonetheless, few studies have comprehensively examined the association between physical activity inequalities and related factors. We aimed to explore factors associated with regional inequalities in physical activity in Japan. Methods We investigated the relationship of individual, psychological/behavioral, social, and built‐environmental factors with the proportion of individuals with exercise habits across Japanese prefectures. We sourced data from open databases, including the Japanese National Health Insurance Claims and Nationwide Screening Program Database. We defined exercise habits as engaging in at least 30 min of moderate exercise at least twice a week. We employed multiple regression analysis to identify factors associated with prefectural level physical activity. Results The median proportion of individuals with exercise habits was 27% (interquartile range, 25–29). Higher frequency of exercise habits was associated with higher frequency of history of exercise (coefficients, 0.60; 95% confidence interval, 0.41–0.80) and lower proportion of female gender (coefficients, −1.74; 95% confidence interval, −2.80 to −0.69). Conclusions Exercise history and female gender may be related to prefectural level physical activity in Japan. Physical activity interventions should be promoted among women without exercise history.

Background: Physical activity inequalities are an important global concern; nonetheless, few studies have comprehensively examined the association between physical activity inequalities and related factors. We aimed to explore factors associated with regional inequalities in physical activity in Japan. Methods: We investigated the relationship of individual, psychological/behavioral, social, and built‐environmental factors with the proportion of individuals with exercise habits across Japanese prefectures. We sourced data from open databases, including the Japanese National Health Insurance Claims and Nationwide Screening Program Database. We defined exercise habits as engaging in at least 30 min of moderate exercise at least twice a week. We employed multiple regression analysis to identify factors associated with prefectural level physical activity. Results: The median proportion of individuals with exercise habits was 27% (interquartile range, 25–29). Higher frequency of exercise habits was associated with higher frequency of history of exercise (coefficients, 0.60; 95% confidence interval, 0.41–0.80) and lower proportion of female gender (coefficients, −1.74; 95% confidence interval, −2.80 to −0.69). Conclusions: Exercise history and female gender may be related to prefectural level physical activity in Japan. Physical activity interventions should be promoted among women without exercise history. [ABSTRACT FROM AUTHOR]

Objective: Physical inactivity increases the risk of mortality and chronic morbidity. Therefore, it is crucial to establish strategies to encourage individuals to increase their physical activity and develop exercise habits. The objective of this study was to explore factors associated with acquiring exercise habits using machine learning algorithms. Methods: The analyzed dataset was obtained from the Specific Health Guidance for metabolic syndrome systematically implemented by the Japanese Ministry of Health, Labor, and Welfare. We selected target individuals for health guidance without exercise habits in 2017 and assessed whether the participants acquired exercise habits through health guidance in 2018. We applied ten machine learning algorithms to build prediction models for acquiring exercise habits. Results: This study included 16,471 middle-aged Japanese workers (age, 49.5 ± 6.2 years). Among the machine learning algorithms, the Boosted Generalized Linear Model was the best for predicting the acquisition of exercise habits based on the receiver operating characteristic curve on the test set (ROC-AUCtest, 0.68). According to the analyses, the following factors were associated with the acquisition of exercise habits: being in the maintenance or action stage of changing exercise and eating behaviors based on the transtheoretical model; regular physical activity or walking; normal high-density lipoprotein cholesterol; and high alcohol consumption. Conclusions: Our findings can be used to establish an efficient strategy for encouraging individuals to acquire exercise habits through Specific Health Guidance or other health guidance. However, the lower ROC-AUCtest suggests that additional variables are necessary to enhance the prediction model.

Background: Peripheral nerve injury (PNI) following revision total hip arthroplasty (rTHA) can be a devastating complication. This study assessed the frequency of and risk factors for postoperative PNI following rTHA. Methods: Patients who underwent rTHA from 2003 to 2015 were identified using the National Inpatient Sample (NIS). Demographics, medical history, surgical details, and complications were compared between patients who sustained a PNI and those who did not, to identify risk factors for the development of PNI after rTHA. Results: Overall, 112,310 patients who underwent rTHA were identified, 929 (0.83%) of whom sustained a PNI. Univariate analysis found that younger patients (p < 0.0001), females (p = 0.025), and those with a history of flexion contracture (0.65% vs. 0.22%, p = 0.005), hip dislocation (24.0% vs. 18.0%, p < 0.001), and spine conditions (4.8% vs. 2.7%, p < 0.001) had significantly higher rates of PNI. In-hospital complications associated with PNI included postoperative hematoma (2.6% vs. 1.2%, p < 0.0001), postoperative seroma (0.75% vs. 0.30%, p = 0.011), superficial wound dehiscence (0.65% vs. 0.23%, p = 0.008), and postoperative anemia (36.1% vs. 32.0%, p = 0.007). Multivariate analysis demonstrated that a history of pre-existing spine conditions (aOR: 1.7; 95%-CI: 1.3–2.4, p < 0.001), prior dislocation (aOR 1.5; 95%-CI: 1.3–1.7, p < 0.001), postoperative anemia (aOR 1.2; 95%-CI: 1.0–1.4, p = 0.01), and hematoma (aOR 2.1; 95%-CI: 1.4–3.2, p < 0.001) were associated with increased risk for PNI. Conclusions: Our findings align with the existing literature, affirming that sciatic nerve injury is the prevailing neuropathic complication after total hip arthroplasty (THA). Furthermore, we observed a 0.83% incidence of PNI following rTHA and identified pre-existing spine conditions, prior hip dislocation, postoperative anemia, or hematoma as risk factors. Orthopedic surgeons may use this information to guide their discussion of PNI following rTHA, especially in high-risk patients. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to explore the associations between percutaneous ventricular assist device (pVAD) insertion timing relative to cardiac surgery and patient outcomes. Methods: The Nationwide Inpatient Sample was queried for patients undergoing cardiac surgery and pVAD insertion in the same admission from 2016 to 2019. Patients were stratified by timing of pVAD insertion. Preoperative characteristics, postoperative complications, and mortality were compared among groups. Results: Overall, 3695 patients underwent cardiac surgery and pVAD insertion during the same hospitalization (pre: 1130, intra: 1690, and post: 875). The distribution of cardiac surgery procedures was similar across groups. Median Elixhauser Comorbidity Index was 13 for pre-, 15 for intra-, and 17 for postoperative pVAD patients (P = .021). Patients who received a postoperative pVAD were associated with increased mortality (pre: 18%, intra: 39%, and post: 54%; P

Background: The 2011 Great East Japan Earthquake has resulted in a nuclear accident, forcing residents of the surrounding areas to evacuate. To determine any association between excessive drinking and hypertension in the setting of disaster, we assessed whether the proportion of excessive drinkers increased and if post-disaster excessive drinking was a risk factor for hypertension. Methods: This retrospective study assessed data from the Japanese National Database. Cumulative population data for Fukushima Prefecture (3,497,576 people) were analyzed by categorizing residents into four areas—evacuation, coastal, central, and mountainous—to calculate the proportion of excessive, heavy (equivalent to binge drinking), and at-risk drinkers for 2008–2017. The hazard ratios (HRs) for the incidence of hypertension for 2012–2017 were examined in association with changes in drinking status pre- and post-disaster, which included 136,404 people who received specific health checkups pre-disaster (2008–2010) and post-disaster (2011–2012). Results: The proportion of excessive drinkers among women increased after the disaster in all areas examined. The association between excessive drinking and the incidence of hypertension was determined among men and women in all areas; it was stronger among women in the evacuation areas, with the sex- and age-adjusted HRs for the incidence of hypertension of 1.41 for pre-disaster excessive drinking, 2.34 for post-disaster excessive drinking, and 3.98 for pre- and post-disaster excessive drinking, compared with not excessive drinking pre- and post-disaster. Conclusion: Excessive drinking post-disaster may be associated with an increased risk of hypertension among men and women, especially among women in the evacuation areas.

The Japanese National Database (NDB), a useful data source for epidemiological studies, contains information on health checkups, disease diagnoses, and medications, which can be used when investigating common cardiometabolic diseases. However, before the initiation of an integrated analysis, we need to combine several pieces of information prepared separately into an all-in-one dataset (AIOD) and confirm the validation of the dataset for the study. In this study, we aimed to confirm the degree of agreement in data entries between diagnoses and prescribed medications and self-reported pharmacotherapy for common cardiometabolic diseases in newly assembled AIODs. The present study included 10,183,619 people who underwent health checkups from April 2018 to March 2019. Over 95% of patients prescribed antihypertensive and antidiabetic medications were diagnosed with each disease. For dyslipidemia, over 95% of patients prescribed medications were diagnosed with at least one of the following: dyslipidemia, hypercholesterolemia, or hyperlipidemia. Similarly, over 95% of patients prescribed medications for hyperuricemia were diagnosed with either hyperuricemia or gout. Additionally, over 90% of patients with self-reported medications for hypertension, diabetes, and dyslipidemia were diagnosed with each disease, although the proportions differed among age groups. Our study demonstrated high levels of agreement between diagnoses and prescribed medications for common cardiometabolic diseases and self-reported pharmacotherapy in our AIOD.

Background: This study examined the association between neurological symptoms and quality of life (QoL) in patients with neurofibromatosis type 2 (NF2) using a national database of all patients who newly claimed for medical expense subsidies in Japan from 2015 to 2019. Methods: The Japanese Ministry of Health, Labour and Welfare provided access to the “National Database of Designated Intractable Diseases of Japan” containing the “Medical Certificates of Designated Intractable Diseases” of all patients with NF2. The database included information on five items of QoL: “mobility,” “self-care,” “usual activities,” “pain/discomfort,” and “anxiety/depression.” To examine the association between the presence/absence of neurological symptoms and QoL, multivariable logistic regression analyses were performed, adjusted for potential confounders. Results: Data from 187 patients (97 females and 90 males; mean (standard deviation) age, 43.1 (17.9) years) were analyzed. Overall, 31% to 55% of patients were recorded as having moderate/severe impairment of QoL. Spinal dysfunction was significantly associated with deterioration of all components of QoL, whereas speech dysfunction and hemiparesis were specifically associated with physical health-related components of QoL. Spinal dysfunction, facial nerve palsy, and age 25–64 years were significantly associated with “anxiety/depression.” Conclusions: In the present epidemiological study using a national database of NF2 in Japan, spinal dysfunction was significantly associated with deterioration of all components of QoL, including subjective and mental health-related components of QoL, whereas speech dysfunction and hemiparesis were specifically associated with physical health-related components of QoL.

Abstract Background Few reports have examined the localized regional disparity in representative surgical procedures in orthopaedics and general surgery globally. This study aimed to clarify the inter-prefectural regional disparity and relationships between healthcare resources and representative surgical procedures using a nationwide database in Japan. Methods The number of medical specialists in orthopaedics, general surgery, and anaesthesiology, as well as the number of hospitals, and the incidence of representative surgical procedures in orthopaedics and general surgery were evaluated annually per 100,000 inhabitants/people by prefecture in Japan during 2015–2019. Medium-sized regional disparities were evaluated using the Gini coefficient. Correlation coefficients were calculated for the defined variables and ageing rate. We also compared the urban and rural regional disparities in all study variables. Results The annual average number/incidence and Gini coefficients were 110.6 and 0.11 for femur fracture surgery, 106.3 and 0.09 for cholecystectomy, 14.2 and 0.11 for orthopaedic surgeon specialists, 17.6 and 0.09 for general surgeon specialists, 5.9 and 0.13 for anaesthesiology specialists, and 8.1 and 0.21 for hospitals, respectively. The correlation coefficients by the incidence of femur fracture surgery were 0.74 for orthopaedic surgeon specialists (p

Abstract Hepatitis is a major public health issue in Pakistan, with an estimated 11.55% prevalence of HCV infection in the adult population. The country ranks second globally in terms of hepatitis C virus (HCV) infections, with approximately one in every 20 Pakistanis already infected. The mortality rates due to HBV and HCV stand at 563,000 and 366,000 annually, respectively. However, the absence of a national registry or database system and the lack of coordination among provinces pose significant obstacles in combating this disease effectively. To address this issue, the establishment of a centralized national database registry is crucial, allowing comprehensive analysis, tracking of hepatitis prevalence, and identification of high-risk areas for targeted interventions. By fostering collaboration among provinces, the government, and non-governmental organizations, the registry would facilitate joint decision-making, minimize duplication of efforts, and address inconsistencies in diagnosis and treatment. Collaborating with student-run organizations and leveraging enhanced laboratory capacities post-COVID era can strengthen the hepatitis control program. The centralized approach and unified efforts are necessary to achieve the goal of a hepatitis-free Pakistan, where a healthier future can be realized.

The Japanese National Database (NDB), a useful data source for epidemiological studies, contains information on health checkups, disease diagnoses, and medications, which can be used when investigating common cardiometabolic diseases. However, before the initiation of an integrated analysis, we need to combine several pieces of information prepared separately into an all-in-one dataset (AIOD) and confirm the validation of the dataset for the study. In this study, we aimed to confirm the degree of agreement in data entries between diagnoses and prescribed medications and self-reported pharmacotherapy for common cardiometabolic diseases in newly assembled AIODs. The present study included 10,183,619 people who underwent health checkups from April 2018 to March 2019. Over 95% of patients prescribed antihypertensive and antidiabetic medications were diagnosed with each disease. For dyslipidemia, over 95% of patients prescribed medications were diagnosed with at least one of the following: dyslipidemia, hypercholesterolemia, or hyperlipidemia. Similarly, over 95% of patients prescribed medications for hyperuricemia were diagnosed with either hyperuricemia or gout. Additionally, over 90% of patients with self-reported medications for hypertension, diabetes, and dyslipidemia were diagnosed with each disease, although the proportions differed among age groups. Our study demonstrated high levels of agreement between diagnoses and prescribed medications for common cardiometabolic diseases and self-reported pharmacotherapy in our AIOD. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims/Introduction We aimed to clarify the effectiveness of the Diabetic Nephropathy Aggravation Prevention Program in Japan by comparing the diabetes‐related medical visit behavior of individuals under the municipal national health insurance according to insurers' effort levels. Materials and Methods We assessed changes in medical visit behavior according to insurers' effort levels, “Full Efforts,” “Some Efforts” and “No Effort,” using longitudinal data from the National Database of Health Insurance Claims and Specific Health Checkups before 2015 and after 2018 regarding the national health insurance programs in Japan. We analyzed the effect of the Diabetic Nephropathy Aggravation Prevention Program using a generalized linear mixed model for 208,388 participants with diabetes. Results The additive effect on medical visit behavior was significantly higher for insurers with “Full Efforts” than for those with “No Effort;” the coefficient (log odds ratio) was 0.159 (95% confidence interval 0.063–0.256). The additive effects on medical visit behavior sizes for the people with hemoglobin A1c ≥7.0%, positive urinary protein and systolic blood pressure ≥140 mmHg were 0.508, 0.402 and 0.232, respectively, which were larger than the overall effect size (0.159) for insurers with “Full Efforts.” Conclusions Our findings showed that insurer efforts had an additive effect on the increase in the number of medical visits, suggesting that this national program could reduce the number of end‐stage renal failures or dialysis in Japan.

Background: Developmental dysplasia of the hip (DDH) is a cluster of hip development disorders that affects infants. The incidence of DDH-related dislocation (DDH-dislocation) is reportedly 0.1–0.3%; however, the nationwide incidence of DDH-dislocation in Japan has not been previously reported. The primary aim of this study was to report the nationwide incidence of DDH-dislocation in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), and to examine its regional variation across Japan. Methods: This was a retrospective birth cohort study using the NDB. Data on patients born between 2011 and 2013 and assigned DDH-dislocation-related disease codes during 2011–2018 were extracted. Among these, patients who underwent treatment for DDH-dislocation between 2011 and 2018 were defined as patients with DDH-dislocation. Results: Across the 2011, 2012, and 2013 birth cohorts, 2,367 patients were diagnosed with DDH-dislocation, yielding the nationwide incidence of 0.076%. Region-specific incidence rates were almost similar across Japan. Secondary analyses revealed that 273 (11.5%) patients were diagnosed at the age of ≥1 year. The effect of birth during the cold months on the incidence of DDH-dislocation was significant (relative risk [RR] = 1.89, 95% confidence interval [CI]: 1.75–2.06). The risk of DDH-dislocation among girls was approximately seven times higher than that among boys. Conclusion: This is the first study to report the nationwide incidence of DDH-dislocation in Japan, which was estimated at 0.076%. The regional variation was trivial and unlikely to be clinically significant. Thus, the incidence rates were approximately equal across all regions in Japan.

Living-donor lobar lung transplantation (LDLLT) is a well-established surgical procedure with favorable outcomes; however, the frequency of readmission and costs in LDLLT are poorly understood. Here, we aimed to compare health care costs and readmissions at 90 days and 1 year after the index discharge in LDLLT and cadaveric lung transplantation (CLT) and evaluate the reasons for readmission and in-hospital mortality. In this retrospective cohort study, we used the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan to obtain initial lung transplantation data for all patients from July 2010 to March 2020. Multivariable Poisson or multiple regression analyses after multiple imputation was performed to compare the cumulative number of readmissions and costs between patients receiving LDLLT and CLT. Among 514 recipients, 115 (22%) underwent LDLLT and 399 (78%) received CLT. Overall, in-hospital mortality after transplantation was 4.5%. The LDLLT group showed a significantly lower crude readmission rate (90 days, 22% vs 37%, p = 0.004; 1 year, 48% vs 62%, p = 0.031) and median readmission cost (90 days, United States dollar (USD) 0 vs 0, p = 0.003; 1 year, USD 1178 vs 4714, p = 0.005) than the CLT group. Multivariable regression analyses showed that the LDLLT group had a lower risk of readmission (incidence rate ratio, 0.59; 95% confidence interval, 0.38-0.92; p = 0.020) and lower costs at 90 days (difference, USD −11,629; 95% confidence interval, −5682 to −17,462; p

Background: Postoperative depression is not well characterised. We investigated the incidence of postoperative depression with the hypothesis that after controlling for confounders, new onset depression would vary significantly by surgical type. Methods: We conducted a retrospective cohort study using the Optum Clinformatics Datamart. The primary outcome was new onset postoperative depression, defined by a new diagnosis of depression or new prescription for an antidepressant in the year after surgery using International Classification of Diseases (ICD) 9/10 codes and drug names. Adjustment for preoperative comorbidities and predictors of depression was with multivariable Cox regression and propensity score matching. Sensitivity analyses defining new onset depression as both a new diagnosis of depression and a new prescription for an antidepressant, or either outcome separately, were conducted. Results: Data from 132 390 cardiac surgery, 12 538 thoracotomy, 32 630 video-assisted thoracoscopic surgery (VATS), 96 750 hip fracture surgery, 157 484 hip replacement, and 347 878 laparoscopic cholecystectomy patients from January 2004 to June 2021 were analysed. The incidence of new onset postoperative depression was 18.8% for hip fracture surgery, 16.1% for thoracotomy, 12.6% for cardiac surgery, 12.4% for VATS, 8.6% for laparoscopic cholecystectomy, and 6.8% for hip replacement. After multivariable adjustment, hip fracture surgery patients were most likely to develop new onset postoperative depression (hazard ratio [95% confidence interval]) 1.56 [1.45–1.68]), followed by thoracotomy (1.12 [1.03–1.22]), cardiac surgery (1.09 [1.04–1.12]), VATS (0.95 [0.90–1.00]), and hip replacement (0.55 [0.52–0.57]) compared with patients undergoing laparoscopic cholecystectomy (hazard ratio=1). Results from propensity score matched analyses and sensitivity analyses were similar. Conclusions: The risk of postoperative depression differs by surgical type after controlling for preoperative characteristics.

Background: Few reports have examined the localized regional disparity in representative surgical procedures in orthopaedics and general surgery globally. This study aimed to clarify the inter-prefectural regional disparity and relationships between healthcare resources and representative surgical procedures using a nationwide database in Japan. Methods: The number of medical specialists in orthopaedics, general surgery, and anaesthesiology, as well as the number of hospitals, and the incidence of representative surgical procedures in orthopaedics and general surgery were evaluated annually per 100,000 inhabitants/people by prefecture in Japan during 2015–2019. Medium-sized regional disparities were evaluated using the Gini coefficient. Correlation coefficients were calculated for the defined variables and ageing rate. We also compared the urban and rural regional disparities in all study variables. Results: The annual average number/incidence and Gini coefficients were 110.6 and 0.11 for femur fracture surgery, 106.3 and 0.09 for cholecystectomy, 14.2 and 0.11 for orthopaedic surgeon specialists, 17.6 and 0.09 for general surgeon specialists, 5.9 and 0.13 for anaesthesiology specialists, and 8.1 and 0.21 for hospitals, respectively. The correlation coefficients by the incidence of femur fracture surgery were 0.74 for orthopaedic surgeon specialists (p < 0.001), 0.63 for hospitals (p < 0.001), and 0.62 for the ageing rate (p < 0.001); those by the incidence of cholecystectomy were 0.60 for general surgeon specialists (p < 0.001) and 0.59 for hospitals (p < 0.001). The number/incidence of orthopaedic surgeon specialists, hospitals, femur fracture surgery, and cholecystectomy, as well as the ageing rate, were significantly higher in rural prefectures than in urban prefectures (p < 0.05). Conclusions: Inter-prefectural regional disparity was small, although certain items were unevenly distributed in the rural prefectures, which is contrary to our expectations. Higher prevalence was recognised in rural prefectures due to the higher ageing rate; however, supply and demand are balanced. This study provides basic data for healthcare policy development in a medium-sized community. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Hepatitis is a major public health issue in Pakistan, with an estimated 11.55% prevalence of HCV infection in the adult population. The country ranks second globally in terms of hepatitis C virus (HCV) infections, with approximately one in every 20 Pakistanis already infected. The mortality rates due to HBV and HCV stand at 563,000 and 366,000 annually, respectively. However, the absence of a national registry or database system and the lack of coordination among provinces pose significant obstacles in combating this disease effectively. To address this issue, the establishment of a centralized national database registry is crucial, allowing comprehensive analysis, tracking of hepatitis prevalence, and identification of high-risk areas for targeted interventions. By fostering collaboration among provinces, the government, and non-governmental organizations, the registry would facilitate joint decision-making, minimize duplication of efforts, and address inconsistencies in diagnosis and treatment. Collaborating with student-run organizations and leveraging enhanced laboratory capacities post-COVID era can strengthen the hepatitis control program. The centralized approach and unified efforts are necessary to achieve the goal of a hepatitis-free Pakistan, where a healthier future can be realized. [ABSTRACT FROM AUTHOR]

Nowadays, national security issues are increasing day by day in most countries. A multitude of measures to reduce the challenges have been presented and even implemented by many authors, but without exhaustive results. The use of computers and sophisticated IT tools by the terrorist group, increasing number of citizens, lack of social amenities and other factors have made some of them inadequate enough to control the problems in Nigeria. The purpose of this paper is to highlight national security challenges in Nigeria and how security oversight is operated. To achieve this, the authors analyze available secondary data, investigating national security modus operandi and presenting the general concept of surveillance. Related works were also investigated for discussion. Remote surveillance, wiretapping, geospatial intelligence and a consolidated national database are proposed to achieve digital intelligence collection for insecurity management.

The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) is a database including health insurance claim and specific health checkup data. Observational studies using real-world big data attract attention because they have certain strengths, including external validity and a large sample size. This review focused on research using the dental formula of the NDB because the number of teeth is an important indicator of oral health. The number of teeth present calculated using the dental formula of periodontitis patients was similar to that from the Survey of Dental Diseases. In addition, the graphs of the presence rates of tooth types by 5-year age groups from the NDB were smoother and had less overlap than those from the Survey of Dental Diseases, and they could detect slight changes in the presence rate that reflected sugar consumption before and after World War II. Using the NDB, a low number of teeth was associated with high medical care expenditures, high risk of aspiration pneumonia, and high risk of Alzheimer’s disease. Although there are some restrictions on the use of the NDB, we hope that dental research using the NDB will be further promoted in the future.

To assess the benefit of frozen vs. fresh elective single embryo transfer using traditional and novel methods of controlling for confounding. Retrospective cohort study using data from the National Assisted Reproductive Technology Surveillance System. Not applicable. A total of 44,750 women aged 20–35 years undergoing their first lifetime oocyte retrieval and embryo transfer in 2016–2017, who had ≥4 embryos cryopreserved. Fresh elective single embryo transfer and frozen elective single embryo transfer. The primary outcome was a singleton live birth. Secondary outcomes included rates of total live birth (singleton plus multiple gestations), twin live birth, clinical intrauterine gestation, total pregnancy loss, biochemical pregnancy, and ectopic pregnancy. Outcomes for infants included gestational age at delivery, birth weight, and being small for gestational age. The eligibility criteria were met by 6,324 fresh and 2,318 frozen cycles. Patients undergoing fresh and frozen transfer had comparable mean age (30.69 [standard deviation {SD} 0.08] years vs. 31.06 [SD 0.08] years) and body mass index (24.76 [SD 0.20] vs. 25.65 [SD 0.15]); however, women in the frozen cohort created more embryos (8.1 [SD 0.12] vs. 6.8 [SD 0.08]). Singleton live birth rates in the fresh vs. frozen groups were 51.4% vs. 48.8% (risk ratio 1.05; 95% confidence interval [CI], 1.00–1.10). After adjustment with a log-linear regression model and propensity score analysis, the difference in singleton live birth rates remained nonsignificant (adjusted risk ratio, 1.05; 95% CI, 0.97–1.14 and 1.02; 95% CI, 0.96–1.08, respectively). A novel dynamical model confirmed inherent fertility (probability of ever achieving a pregnancy) was balanced between groups (odds ratio, 1.23; 95% CI 0.78–1.95]). The per-cycle probability of singleton live birth was not different between groups (odds ratio 1.11 [95% CI 0.94–1.3]). In this retrospective cohort study of fresh vs. frozen elective single embryo transfer, there was no statistically significant difference in singleton live birth rate after adjustment using log-linear models and propensity score analysis. The successful application of a novel dynamical model, which incorporates multiple assisted reproductive technology cycles from the same woman as a surrogate for inherent fertility, offers a novel and complementary perspective for assessing interventions using national surveillance data. [ABSTRACT FROM AUTHOR]

The turn to evidence-based interventions is significant for Psychology in general and for Educational Psychology in particular. Although there is a great deal of published evidence for program validation, there is currently no protocol for the evaluation of educational psychology evidence-based intervention programs and there is no General Register of such programs to act as a central information depository. This article has four objectives: (1) To assess the significance of the turn to Evidence-Based Programs in the context of today's Knowledge Society and Research and Development, Transfer and Innovation (R&Di) activities; (2) To provide a Classification of Programs based on the degree of specialization required for appropriate professional use in line with the requirements of the Code of Ethics in Psychology; (3) To tentatively propose a Protocol for the Registration of Evidence-Based Educational Psychology Programs; and (4) Finally, to identify some implications of the protocol. We conclude that there is a need for a General Register of validated programs. [ABSTRACT FROM AUTHOR]

The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) is a database including health insurance claim and specific health checkup data. Observational studies using real-world big data attract attention because they have certain strengths, including external validity and a large sample size. This review focused on research using the dental formula of the NDB because the number of teeth is an important indicator of oral health. The number of teeth present calculated using the dental formula of periodontitis patients was similar to that from the Survey of Dental Diseases. In addition, the graphs of the presence rates of tooth types by 5-year age groups from the NDB were smoother and had less overlap than those from the Survey of Dental Diseases, and they could detect slight changes in the presence rate that reflected sugar consumption before and after World War II. Using the NDB, a low number of teeth was associated with high medical care expenditures, high risk of aspiration pneumonia, and high risk of Alzheimer's disease. Although there are some restrictions on the use of the NDB, we hope that dental research using the NDB will be further promoted in the future. [ABSTRACT FROM AUTHOR]

Objective Digital evacuation (DE) is an intervention used to address severe constipation. Literature exists on easily administered laxatives; however, reports on mildly invasive DE usage are limited. This study aimed to elucidate the fundamental data regarding constipation management using a comprehensive national database of DE incidence. Methods This observational epidemiological study analyzed the age- and sex-stratified DE incidence per 1,000 person-years during 2014-2021 using the medical receipt database in Japan. The annual trends were evaluated using Poisson regression models. We examined the month-stratified incidence during 2019-2021 to assess potential seasonal variations using a one-way analysis of variance and unpaired t-tests with the Bonferroni correction for comparisons across the four seasons. Correlation coefficients were calculated to determine the relationship between the meteorological variables and DE incidence. Results Over the 8-year period, the DE incidence amounted to 32,361,846 procedures, with a median of 10.3 procedures per 1,000 person-years. A demographic analysis revealed a minor peak, nadir, and progressive increase peaking in the 0-4-year (22.1 procedures), 5-9-year (1.5 procedures), and ≥90-year (370.7 procedures) age groups, respectively. The age-adjusted DE incidence across all age groups per 1,000 person-years showed a declining annual trend [incidence rate ratio: 0.971 (P<0.0001)]. A seasonal analysis revealed a significant increase in DE procedures during winter compared with summer (P<0.0125). A correlation was observed between the DE incidence and certain meteorological variables, particularly the temperature. Conclusion This study highlights the notable demographic patterns and the impact of seasonal and meteorological factors on the DE incidence.

In this study, the effect of the intensive "Quitter" intervention for smoking cessation was examined and compared to the standardized intensive intervention used in Denmark. The Quitter intervention, based on the Gold Standard Program (Q-GSP), involves large groups of approximately 70 participants, while the standardized GSP typically involves groups of 10-15 participants. In total, 105 and 14,289 smokers participated in the Q-GSP and the standardized GSP, respectively, between 2022 and 2023. Data from the Danish STOPbase database were used, with validated information from one municipality for the Q-GSP. Successful smoking cessation was defined as abstinence from smoking at the end of the intervention and continuous abstinence at the 6-month follow-up. The results showed that 73% of the participants in the Quitter group successfully stopped smoking at the end of the interventions, compared to 50% in the standardized I-SCI group. At the 6-month follow-ups, 49% of the Quitter intervention group members maintained abstinence versus 31% of the standardized I-SCI group, with a statistically significant relative risk (RR) of 2.18 (95% CI 1.48-3.22). Compliance and satisfaction were high in both groups. These findings indicate the potential for large group-based interventions to be broadly integrated into public health strategies.

Objective: Physical inactivity increases the risk of mortality and chronic morbidity. Therefore, it is crucial to establish strategies to encourage individuals to increase their physical activity and develop exercise habits. The objective of this study was to explore factors associated with acquiring exercise habits using machine learning algorithms., Methods: The analyzed dataset was obtained from the Specific Health Guidance for metabolic syndrome systematically implemented by the Japanese Ministry of Health, Labor, and Welfare. We selected target individuals for health guidance without exercise habits in 2017 and assessed whether the participants acquired exercise habits through health guidance in 2018. We applied ten machine learning algorithms to build prediction models for acquiring exercise habits., Results: This study included 16,471 middle-aged Japanese workers (age, 49.5 ± 6.2 years). Among the machine learning algorithms, the Boosted Generalized Linear Model was the best for predicting the acquisition of exercise habits based on the receiver operating characteristic curve on the test set (ROC-AUC test , 0.68). According to the analyses, the following factors were associated with the acquisition of exercise habits: being in the maintenance or action stage of changing exercise and eating behaviors based on the transtheoretical model; regular physical activity or walking; normal high-density lipoprotein cholesterol; and high alcohol consumption., Conclusions: Our findings can be used to establish an efficient strategy for encouraging individuals to acquire exercise habits through Specific Health Guidance or other health guidance. However, the lower ROC-AUC test suggests that additional variables are necessary to enhance the prediction model., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Yoshio Nakata reports financial support was provided by Japan Agency for Medical Research and Development. Kazuyo Tsushita reports financial support was provided by Japan Agency for Medical Research and Development. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

This study aimed to visualize the current situation and trends in radiation therapy in Japan using open data from the Japanese National Database of Health Insurance Claims and Specific Health Checkups (NDB). We downloaded the NDB open data from the website of Japan's Ministry of Health, Labor and Welfare and used Python libraries to analyze the receipt data related to radiation therapy from fiscal year 2014 to 2022. The number of radiation therapy plans peaked in 2019, temporarily declined and subsequently showed a gradual increase. Conversely, the total points associated with radiation therapy have consistently increased without any decline. The use of high-precision radiation therapies such as intensity-modulated radiation therapy (IMRT) has increased over time. Significant regional differences exist, with the Chubu and Kyushu regions showing higher total points and receipts per certified radiation oncologist. A correlation was observed between the number of IMRT plans per population and the number of certified radiation oncologists. Males exhibited a sharp peak in their early 70s, while females demonstrated a mild peak from their 40s to 80s. In recent years, the points for males in their early 70s have rapidly increased. We used the NDB open data to illustrate the current situation and trends in radiation therapy in Japan, highlighting reduced costs and workloads. This study underscored the regional differences in radiation therapy and emphasized the need to discuss strategies for meeting future demand., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology.)

The turn to evidence-based interventions is significant for Psychology in general and for Educational Psychology in particular. Although there is a great deal of published evidence for program validation, there is currently no protocol for the evaluation of educational psychology evidence-based intervention programs and there is no General Register of such programs to act as a central information depository. This article has four objectives: (1) To assess the significance of the turn to Evidence-Based Programs in the context of today’s Knowledge Society and Research and Development, Transfer and Innovation (R&Di) activities; (2) To provide a Classification of Programs based on the degree of specialization required for appropriate professional use in line with the requirements of the Code of Ethics in Psychology; (3) To tentatively propose a Protocol for the Registration of Evidence-Based Educational Psychology Programs; and (4) Finally, to identify some implications of the protocol. We conclude that there is a need for a General Register of validated programs.

The assessment of dairy cow welfare has become increasingly important in recent years. Welfare assessments that use animal-based indicators, which are considered the most direct indicators, are time consuming and therefore not feasible for assessments on a large number of farms. One approach to reducing this effort is the use of data-based indicators (DBIs) calculated from routine herd data. The aim of this study was to explore the relationship between common DBIs and the welfare of 35 dairy herds to evaluate the feasibility of a data-based welfare prediction method. For this purpose, the WelfareQuality® (WQ) protocol was used to assess the welfare of dairy cows on 35 Swiss farms, for each of which 10 commonly used DBIs were calculated from herd data. Spearman's rank correlations were used to investigate the relationship between DBIs and WQ criteria and measurements. The study found only a few statistically weak associations between DBIs and animal welfare, with no associations for measurements or criteria of resting comfort and appropriate behavior. Thus, the multidimensional welfare definition is insufficiently covered, and the present publication does not support the approach of a purely data-based prediction of dairy welfare status at the farm level. Instead, the regular calculation of DBIs that are indicative of isolated animal welfare problems or metrics of animal health could allow monitoring of these specific areas of animal welfare.

Takahisa Ogawa,1 Toshitaka Yoshii,1 Atsushi Okawa,1 Kiyohide Fushimi,2 Tetsuya Jinno1,3 1Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; 2Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; 3Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Saitama, JapanCorrespondence: Tetsuya JinnoDepartment of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, JapanTel +81-48-965-1111Email jinnot@dokkyomed.ac.jpTakahisa OgawaDepartment of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, JapanTel +81-3-3813-6111Email takahisa.o@gmail.comObjective: Cemented hemiarthroplasty is recommended for the vulnerable hip fracture population because of beneficial long-term outcomes. However, the association between cemented hemiarthroplasty and short-term mortality is controversial. To increase a preparedness of potential complication after cemented hemiarthroplasty, we aimed to evaluate the trajectory of the effect of cemented hemiarthroplasty on short-term in-hospital outcomes.Methods: We investigated in-hospital mortality and complications between cemented hemiarthroplasty and cementless hemiarthroplasty using a nationwide multicenter database from 2010 to 2016 with a propensity-score matching analysis. We analyzed in-hospital mortality from 1 to 14 days after surgery. We also investigated in-hospital complications that may associate with mortality.Results: After matching of 31,322 cases, we found no significant difference in 30-day in-hospital mortality between the cemented and cementless hemiarthroplasty groups (hazard ratio, HR [95% confidence interval, CI], 1.2 [0.89– 1.6], p = 0.23). However, the 1- to 10-day postoperative mortality rates were significantly higher in the cemented group and the association becomes weaker as the postoperative period increased (day 1; HR [95% CI]: 3.5 [1.6– 7.68]; day 10; HR [95% CI]: 1.59 [1.07– 2.37]). The incidence of stroke and intensive care unit (ICU) admission was also significantly higher in the cemented group.Conclusion: Cemented hemiarthroplasty was not significantly associated with an increase in overall in-hospital mortality but was significantly associated with short-term mortality from 1-day to 10-day after surgery. The incidence of stroke and ICU admission was also significantly higher in the cemented group. Surgeons should pay more attention to the risk of mortality and stroke in patients undergoing cemented hemiarthroplasty, especially in the early days of hospitalization.Keywords: national database, complication, geriatric fracture, stroke, intensive care unit admission, ICU admission

Biological invasions are one of the main drivers of modern human-induced species losses. Research on the distribution of alien species and their pathways of introduction is essential for understanding and tackling the invasion process. A comprehensive overview on invasive alien plant (IAP) species in Romania is lacking. With this paper, we aim to contribute to filling this gap and to provide a visualization of national patterns regarding plant species invasions, geographical origins and pathways of introductions. Based on plant species occurrence records in the published literature and herbaria we compiled a national database of 102 invasive and potentially invasive alien plant species. We georeferenced 42776 IAP species occurrences and performed an analysis of their spatial patterns. The spatial analyses revealed a biased sampling, with clear hotspots of increased sampling efforts around urban areas. We used chord diagrams to visualize the pathway of introduction and geographical origins of the IAP species, which revealed that species in Romania originate mainly in North and Central America, while the dominant pathway of plant introduction was horticulture. Our results provide an important baseline in drafting management and action plans, as invasive alien plant species represent a priority for the European Union through the Biodiversity Strategy for 2030, and a good starting point for various analyses as the database is further developed and regularly updated. [ABSTRACT FROM AUTHOR]

Drug lag refers to the difference in the time of a new drug's approval in different countries; the dissemination of the new drug after approval within the countries is another problem. We examined the nationwide dissemination of 11 cancer drugs approved in Japan between 2011 and 2015 using the National Database of Health Insurance Claims data. We extracted data on the number of cancer drug prescriptions from 47 prefectures and associated demographic information, such as age and sex. Eight diabetes drugs were also examined for comparison. We observed a lag between the marketing approval date of the drugs and their first use. To further explore the rise and pattern of each drug's dissemination, we analyzed the trend of the cumulative number and total of new prescriptions for each prefecture. The results showed that the first month of new cancer drug prescriptions varied across prefectures. On average, they lagged by up to 2 months in the slowest prefectures, whereas the variation was almost nonexistent for diabetes drugs. The patterns of dissemination varied more among cancer drugs across the seven Japanese geographical regions. After the initial prescription, the number of prescriptions showed a steep rise for most cancer drugs, whereas the increase was gradual for diabetes drugs. In conclusion, the dissemination of cancer drugs had a greater lag time than that of diabetes drugs. Further research is needed to explore the causative factors to ensure that all effective drugs are equally accessible for those who need them. [ABSTRACT FROM AUTHOR]

The authors used the BCIS (British Cardiovascular Intervention Society) database to define the factors associated with percutaneous coronary intervention (PCI) procedural complexity. Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly defined. The BCIS (British Cardiovascular Intervention Society) database was used to study all PCI procedures in the United Kingdom 2006-2016. A multiple logistic regression model was developed to identify variables associated with in-hospital major adverse cardiac or cerebrovascular events (MACCE) and to construct a CHIP score. The cumulative effect of this score on patient outcomes was examined. A total of 313,054 patients were included. Seven patient factors (age ≥80 years, female sex, previous stroke, previous myocardial infarction, peripheral vascular disease, ejection fraction <30%, and chronic renal disease) and 6 procedural factors (rotational atherectomy, left main PCI, 3-vessel PCI, dual arterial access, left ventricular mechanical support, and total lesion length >60 mm) were associated with increased in-hospital MACCE and defined as CHIP factors. The mean CHIP score/case for all PCIs increased significantly from 1.06 ± 1.32 in 2006 to 1.49 ± 1.58 in 2016 (P < 0.001 for trend). A CHIP score of 5 or more was present in 2.5% of procedures in 2006 increasing to 5.3% in 2016 (P < 0.001 for trend). Overall in-hospital MACCE was 0.6% when the CHIP score was 0 compared with 1.2% with any CHIP factor present (P < 0.001). As the CHIP score increased, an exponential increase in-hospital MACCE was observed. The cumulative MACCE for procedures associated with a CHIP score 4+ or above was 3.2%, and for a CHIP score 5+ was 4.4%. All other adverse clinical outcomes were more likely as the CHIP score increased. Seven patient factors and 6 procedural factors were associated with adverse in-hospital MACCE and defined as CHIP factors. Use of a CHIP score might be a future target for risk modification. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract Aim The advantages of laparoscopic right hemicolectomy over open surgery for colon cancer in general clinical practice are debated, as evidenced by the continued use of open surgery in a significant proportion of patients worldwide. This study aimed to assess and compare the clinical outcome of laparoscopic and open right hemicolectomy for colon cancer using data from the Japanese National Clinical Database. Methods A total of 72 299 patients who underwent laparoscopic (n = 46 084) and open (n = 26 215) right hemicolectomy for colon cancer between 2014 and 2018 were enrolled in this retrospective study. Short‐term outcome was compared between groups using propensity score matching analysis. Results The incidence of overall postoperative morbidity ≥ Clavien‐Dindo classification grade 3 was significantly higher in the open surgery group than the laparoscopic group (4.7% vs 3.2%, P

Background: The aim of this study was to examine the trends in the number and incidence of scapular fractures causing hospitalization in the Finnish adult population between 1998 and 2014. Methods: We assessed the number and incidence of scapular fractures resulting in hospital admission and fixation with a plate in Finland in 1998 through 2014 using the Finnish National Hospital Discharge Register as the database. In each year, the study included the entire Finnish adult population. Results: A total of 3843 adult patients with scapular fractures were hospitalized, and the incidence of fracture increased from 4.8 (per 100,000 person-years) in 1998 to 6.6 in 2014. The fracture was operated on with plating in 476 cases (12.4%). The annual number and incidence of scapular fixation with plates did not show constant trend changes during the study period except in the years 2011 through 2013, when there was a sudden increase in the number of these operations. This increase leveled off in 2014. Conclusion: The incidence of hospital-treated scapular fractures increased in Finland in 1998 through 2014. Treatment of scapular fractures with a plate did not show consistent trend changes in Finland during this period.

In the context of the need to ensure appropriate signalling of the publication of high-quality, international-calibre publications in Vietnam, as well as new policies to improve the quality and effectiveness of scientific research in Vietnam, it is practical to investigate the possibility of developing a national open access database (NOAD). This study aims to answer the question of whether it is necessary to establish a NOAD in Vietnam. We used document analysis to evaluate issues related to NOADs. The results of this study show the complexity, lack of consistency, and difficulty in obtaining practical statistics and assessing research and scientific records in Vietnam today. Furthermore, the findings of this study imply that it is necessary to establish a NOAD of scientific research in Vietnam. The information in this report can be used to develop a NOAD for Vietnam in particular, and for any country that lacks one in general.

Gastrointestinal bleeding (GIB) is a significant public health concern, predominantly associated with high morbidity. However, there have been no reports investigating the trends of GIB in Japan using nationwide data. This study aims to identify current trends and issues in the management of GIB by assessing Japan's national data. We analyzed National Database sampling data from 2012 to 2019, evaluating annual hospitalization rates for major six types of GIB including hemorrhagic gastric ulcers, duodenal ulcers, esophageal variceal bleeding, colonic diverticular bleeding, ischemic colitis, and rectal ulcers. In this study, hospitalization rates per 100,000 indicated a marked decline in hemorrhagic gastric ulcers, approximately two-thirds from 41.5 to 27.9, whereas rates for colonic diverticular bleeding more than doubled, escalating from 15.1 to 34.0. Ischemic colitis rates increased 1.6 times, from 20.8 to 34.9. In 2017, the hospitalization rate per 100,000 for colonic diverticular bleeding and ischemic colitis surpassed those for hemorrhagic gastric ulcers (31.1, 31.3, and 31.0, respectively). No significant changes were observed for duodenal ulcers, esophageal variceal bleeding, or rectal ulcers. The findings of this study underscore a pivotal shift in hospitalization frequencies from upper GIB to lower GIB in 2017, indicating a potential shift in clinical focus and resource allocation., Competing Interests: No potential conflicts of interest were disclosed., (Copyright © 2024 JCBN.)

Background: Epilepsy is estimated to affect 70 million people worldwide and is medically refractory in 30% of cases. Methods: This is a retrospective cross-sectional study using a US database from 2012 to 2014 to identify patients aged ≥18 years admitted to the hospital with epilepsy as the primary diagnosis. The sampled population was weighted using Healthcare Cost and Utilization Project guidelines. Procedural ICD-9 codes were utilized to stratify the sampled population into two cohorts: resective surgery and implantation or stimulation procedure. Results: Query of the database yielded 152,925 inpatients, of which 8535 patients underwent surgical intervention. The nonprocedural group consisted of 76,000 White patients (52.6%) and 28,390 Black patients (19.7%) while the procedural group comprised 5550 White patients (64%) and 730 Black patients (8.6%) (P < 0.001). Patients with Medicare were half as likely to receive a surgical procedure (14.8% vs. 28.4%) while patients with private insurance were twice as likely to receive a procedure (53.4% vs. 29.3%), both were statistically significant (P < 0.01). Those in the lowest median household income quartile by zip code (<$40,000) were 68% less likely to receive a procedure (21.5% vs. 31.4%) while the highest income quartile was 133% more likely to receive a procedure (26.1% vs. 19.5%). Patients from rural and urban nonteaching hospitals were, by a wide margin, less likely to receive a surgical procedure. Conclusion: We demonstrate an area of need and significant improvement at institutions that have the resources and capability to perform epilepsy surgery. The data show that institutions may not be performing enough epilepsy surgery as a result of racial and socioeconomic bias. Admissions for epilepsy continue to increase without a similar trend for epilepsy surgery despite its documented effectiveness. Race, socioeconomic status, and insurance all represent significant barriers in access to epilepsy surgery. The barriers can be remedied by improving referral patterns and implementing cost-effective measures to improve inpatient epilepsy services in rural and nonteaching hospitals. [ABSTRACT FROM AUTHOR]

Background: Nationwide epidemiologic studies in Scandinavian countries have shown that the incidence of Achilles tendon ruptures (ATRs) has increased, and the rate of surgical treatment has declined markedly in the past decade. However, there is a lack of national-level data on the trend of ATRs and surgical procedures in other regions. Purpose: To clarify the trend in the incidence of ATRs and the proportion of surgery using the nationwide health care database in Japan. Study Design: Descriptive epidemiology study. Methods: Age- and sex-stratified data on the annual number of ATRs and surgical procedures between 2010 and 2017 were obtained from the Japanese national health care database, which includes almost all inpatient and outpatient medical claims nationwide. The Japanese population data were also obtained from the population census. The change in the annual incidence of ATRs per 100,000 people was assessed using a Poisson regression analysis. The trend in the annual proportion of surgeries relative to the occurrence of tendon ruptures was determined using a linear regression analysis. Results: A total of 112,601 ATRs, with men accounting for 67%, were identified over 8 years. Patients aged ≥60 years accounted for 27,106 (24%), while those aged 20 to 39 years and 40 to 59 years accounted for 36,164 (32%) and 49,331 (44%), respectively. The annual incidence of ATR ranged from 12.8/100,000 to 13.9/100,000 (women, 8.2-8.9/100,000; men, 17.2-19.5/100,000), which did not change over the study period (P =.82). Moreover, the annual incidences did not change across sexes and age categories. The annual proportion of surgery increased significantly, from 67% in 2010 to 72% in 2017 (P =.003). The annual proportions increased across sexes and age categories except for women aged 40 to 59 years. Conclusion: The incidence of ATR did not change between 2010 and 2017, according to the Japanese nationwide health care database. Furthermore, the proportion of surgical treatment increased during the study period. Overall, 70% of patients underwent surgical treatment. This study suggested that the trend in ATR and surgery differed across regions. [ABSTRACT FROM AUTHOR]

The aims of this study were to use a national percutaneous coronary intervention (PCI) registry to study temporal changes in procedure volumes of PCI using rotational atherectomy (ROTA-PCI), the patient and procedural factors associated with differing quartiles of operator ROTA-PCI volume, and the relationship between operator ROTA-PCI volumes and in-hospital patient outcomes. Whether higher operator volume is associated with improved outcomes after ROTA-PCI is poorly defined. Data from the British Cardiovascular Intervention Society national PCI database were analyzed for all ROTA-PCI procedures performed in the United Kingdom between 2013 and 2016. Individual logistic regressions were performed to quantify the independent association between annual operator ROTA-PCI volume and in-hospital outcomes. In total, 7,740 ROTA-PCI procedures were performed, with a negatively skewed distribution and an annualized operator volume median of 2.5 procedures/year (range 0.25 to 55.25). Higher volume operators undertook more complex procedures in patients with greater comorbid burdens than lower volume operators. A significant inverse association was observed between operator ROTA-PCI volume and in-hospital mortality (odds ratio [OR]: 0.986/case; 95% confidence interval [CI]: 0.975 to 0.996; p = 0.007) and major adverse cardiac and cerebral events (OR: 0.983/case; 95% CI: 0.975 to 0.993; p < 0.001). Additionally, lower rates of emergency cardiac surgery (OR: 0.964/case; 95% CI: 0.939 to 0.991; p = 0.008), arterial complications (OR: 0.975/case; 95% CI: 0.975 to 0.982; p < 0.001) and in-hospital major bleeding (OR: 0.985/case; 95% CI: 0.977 to 0.993; p < 0.001) were associated with higher ROTA-PCI operator volume. Sensitivity analyses in several subgroups demonstrated a consistency of improved outcomes as annual ROTA-PCI volume increased. An annual volume of <4 ROTA-PCI procedures/year was observed to be associated with increased major adverse cardiac and cerebral events, with 239 of 432 operators (55%) not exceeding this threshold. In-hospital adverse outcomes occurred less frequently as ROTA-PCI operator volume increased. These data suggest that operator volume is an important factor determining outcome after ROTA-PCI. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract Background Although a high number of wet compresses are prescribed daily in medical institutions in Japan, our understanding of the national burden of the cost of wet compresses and the details regarding their prescription is far from complete. We investigated the national burden of the annual pharmaceutical cost of wet compresses prescribed in Japan and estimated the predictors of this cost using nationwide health insurance claims data. Methods We extracted the records on wet compress products from summary table files obtained from the second version of the “NDB Open Data Japan” website and calculated the annual pharmaceutical cost of wet compresses by patients’ 5-year age group, sex, and prefecture. We also conducted an ecological study treating each prefecture as an individual unit and multiple linear regression analyses using the age-standardized cost of wet compresses per resident as a dependent variable. Results The annual pharmaceutical cost of wet compresses prescribed in Japan in fiscal year 2015 was 149.0 billion Japanese yen (1.18 billion euros; 1.33 billion USD). Multiple linear regression analyses showed that the number of orthopedists and rehabilitation physicians per 100,000 residents were significantly positively associated with the annual pharmaceutical cost of wet compresses per resident (P = 0.042 and P = 0.008, respectively). Conclusions The annual pharmaceutical cost of wet compresses prescribed in Japan has a considerable impact on the nation’s limited healthcare resources. The number of orthopedists and rehabilitation physicians per 100,000 residents may be independent predictors of the wet compress cost in Japan.

Two contrasting replacement strategies are used by Irish beef farmers to select replacement females – animals sourced from within the suckler beef herd and sourced from the dairy herd. The objective of this study was to investigate the effect of replacement strategy (i.e. beef v. beef×dairy (BDX)) on cow and calf performance using data from the national beef database across a range of beef and dairy breeds. The association between replacement strategy and calving difficulty score, calving interval, weaning weight, weaning price and all carcass traits was investigated using a mixed model. The effect of replacement strategy on cow survival, calving dystocia and calf perinatal mortality was quantified using logistic regression. Beef cows were older (10.92 days; P

Rheumatoid arthritis (RA) is being increasingly recognized as an important contributor to chronic obstructive pulmonary disease (COPD). Although smoking is a major risk factor, other factors may play a role. We used National Inpatient Sample (NIS) from 2013 to explore this relationship. We used propensity matching with a 1:3 nearest-neighbor-matching algorithm to match 1 RA hospitalization to 3 age- and-sex-matched comparators. In the age- and-sex-matched population, RA had a higher odds of COPD (OR 1.20, 95% CI: 1.17–1.22, p

Aim: The advantages of laparoscopic right hemicolectomy over open surgery for colon cancer in general clinical practice are debated, as evidenced by the continued use of open surgery in a significant proportion of patients worldwide. This study aimed to assess and compare the clinical outcome of laparoscopic and open right hemicolectomy for colon cancer using data from the Japanese National Clinical Database. Methods: A total of 72 299 patients who underwent laparoscopic (n = 46 084) and open (n = 26 215) right hemicolectomy for colon cancer between 2014 and 2018 were enrolled in this retrospective study. Short‐term outcome was compared between groups using propensity score matching analysis. Results: The incidence of overall postoperative morbidity ≥ Clavien‐Dindo classification grade 3 was significantly higher in the open surgery group than the laparoscopic group (4.7% vs 3.2%, P <.001). The incidence of most individual morbidities, including surgical site infection, anastomotic leakage, and ileus, was higher in the open surgery group. Short‐term outcomes, including intraoperative blood loss, postoperative hospital stay, reoperation rate, 30‐day mortality, and in‐hospital mortality, were superior in the laparoscopic group, except for operative time. Subgroup analyses showed that the incidence of postoperative morbidity was lower in the laparoscopic group for all prespecified subgroups. Conclusion: Laparoscopic right hemicolectomy has an advantage over open surgery for colon cancer with respect to short‐term outcome. [ABSTRACT FROM AUTHOR]

Purpose: Volume-outcome relationship is well established in elective colorectal surgery for cancer, but little is known for patients managed for obstructive colon cancer (OCC). We aimed to compare the management and outcomes according to the hospital volume in this particular setting. Methods: Patients managed for OCC between 2005 and 2015 in centers of the French National Surgical Association were retrospectively analyzed. Hospital volume was dichotomized between low and high volume on the median number of patients included per center during the study period. Results: A total of 1957 patients with OCC were managed in 56 centers with a median number of 28 (1–123) patients per center: 298 (15%) were treated in low-volume hospitals (LVHs) and 1659 (85%) in high-volume hospitals (HVHs). Patients in LVH were significantly younger, and had fewer comorbidities and synchronous metastases. Proximal diverting stoma was the preferred surgical option in LVH (p < 0.0001), whereas tumor resection with primary anastomosis was more frequently performed in HVH (p < 0.0001). Cumulative morbidity (59 vs. 50%, p = 0.003), mortality (13 vs. 8%, p = 0.03), and length of hospital stay (22 ± 19 vs. 18 ± 14 days, p = 0.002) were significantly higher in LVH. At multivariate analysis, LVH was a predictor for cumulative morbidity (p < 0.0001) and mortality (p = 0.03). There was no difference between the two groups for tumor resection and stoma rates, and for oncological outcomes. Conclusions: The hospital volume has no impact on outcomes after the first-stage surgery in OCC patients. When all surgical stages are considered, hospital volume influences cumulative postoperative morbidity and mortality but has no impact on oncological outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the outpatient glaucoma care provided by Finnish private ophthalmologists and to compare this information with the data obtained from national databases. Methods: The data were collected by 13 investigators in 27 centres in southern Finland. Patient demography, relevant systemic diseases, possible history of ocular surgery, duration of glaucoma, intraocular pressure (IOP) and type of glaucoma were registered. Ocular hypertensive medication(s) used during the last 6 months were recorded using the generic name coded by the current ATC/DDD index. The data were compared with a dataset obtained from the IMS Health database and the Social Insurance Institution of Finland (Kela). Results: In total, 568 patients from private ophthalmology clinics were included. Mean age was 70 years (range 30–90 years), and the mean duration of glaucoma was 8.3 years. In general, IOP control was good (mean 16.9 mmHg). The average cost of glaucoma treatment for a single study patient was 336 euros per year. The findings obtained from the survey were similar to those of the nationwide databases, although fewer of the more aggressive glaucoma cases were managed in the private clinics examined during the study. Conclusion: The study patients were treated effectively by private ophthalmologist. Their medication and the cost of medication were the same as in public clinics. Patients with aggressive glaucoma seem to be generally managed by public hospitals. [ABSTRACT FROM AUTHOR]

Background and Aim: Periodic assessment of medical sciences databases is a necessary principle of the process of enhancement these databases. The aim of this study was to Comparatively evaluate structural features of medical bibliographic databases including MedLib, Barakat knowledge network system, Irandoc, SID, Magiran and PubMed, based on Gulliver criteria. Materials and Methods: This survey was carried out in accordance with Gulliverchr('39')s assessment checklist 2002. This checklist consists of 12 sections including entry page, searching, limiting, record viewing and manipulating, graphics, record retrieval, selective dissemination of information services, general design, terminology, icon design and placement, help and advanced features. The study was conducted on five national databases and one foreign database. Results: Among the databases, PubMed gained the first ranking with a score of 89.16 percent. Among the national databases, new SID database with a score of 57.5 percent gained the top rank. Other databases including Irandoc (56.25%), Magiran (54.58 %), Barkat knowledge network system (52.91 %), MedLib (51.25%) and old SID (47.5 %) obtained next ranking respectively. Conclusion: Despite improvements indices in updated national databases, many of the indicators are far from prestigious databases such as PubMed. It is recommended that in development of national databases, features such as search, help, SDI, entry page, advanced features and record retrieval should be considered.