International Journal of Environmental Research and Public Health

Editorial

5 pages, 300 KiB

Open AccessEditorial

Population Health and Health Services: Old Challenges and New Realities in the COVID-19 Era

by Antonio Sarría-Santamera, Alua Yeskendir, Tilektes Maulenkul, Binur Orazumbekova, Abduzhappar Gaipov, Iñaki Imaz-Iglesia, Lorena Pinilla-Navas, Teresa Moreno-Casbas and Teresa Corral

Int. J. Environ. Res. Public Health 2021, 18(4), 1658; https://doi.org/10.3390/ijerph18041658 - 09 Feb 2021

Cited by 6 | Viewed by 3503

Abstract

(1) Background: Health services that were already under pressure before the COVID-19 pandemic to maximize its impact on population health, have not only the imperative to remain resilient and sustainable and be prepared for future waves of the virus, but to take advantage [...] Read more.

(1) Background: Health services that were already under pressure before the COVID-19 pandemic to maximize its impact on population health, have not only the imperative to remain resilient and sustainable and be prepared for future waves of the virus, but to take advantage of the learnings from the pandemic to re-configure and support the greatest possible improvements. (2) Methods: A review of articles published by the Special Issue on Population Health and Health Services to identify main drivers for improving the contribution of health services on population health is conducted. (3) Health services have to focus not just on providing the best care to health problems but to improve its focus on health promotion and disease prevention. (4) Conclusions: Implementing innovative but complex solutions to address the problems can hardly be achieved without a multilevel and multisectoral deliberative debate. The CHRODIS PLUS policy dialog method can help standardize policy-making procedures and improve network governance, offering a proven method to strengthen the impact of health services on population health, which in the post-COVID era is more necessary than ever. Full article

(This article belongs to the Special Issue Population Health and Health Services)

Research

Jump to: Editorial, Review

12 pages, 837 KiB

Open AccessArticle

Structure and Distribution of Health Care Costs across Age Groups of Patients with Multimorbidity in Lithuania

by Laura Nedzinskienė, Elena Jurevičienė, Žydrūnė Visockienė, Agnė Ulytė, Roma Puronaitė, Vytautas Kasiulevičius, Edita Kazėnaitė, Greta Burneikaitė and Rokas Navickas

Int. J. Environ. Res. Public Health 2021, 18(5), 2767; https://doi.org/10.3390/ijerph18052767 - 09 Mar 2021

Cited by 6 | Viewed by 2556

Abstract

Background. Patients with multimorbidity account for ever-increasing healthcare resource usage and are often summarised as big spenders. Comprehensive analysis of health care resource usage in different age groups in patients with at least two non-communicable diseases is still scarce, limiting the quality of [...] Read more.

Background. Patients with multimorbidity account for ever-increasing healthcare resource usage and are often summarised as big spenders. Comprehensive analysis of health care resource usage in different age groups in patients with at least two non-communicable diseases is still scarce, limiting the quality of health care management decisions, which are often backed by limited, small-scale database analysis. The health care system in Lithuania is based on mandatory social health insurance and is covered by the National Health Insurance Fund. Based on a national Health Insurance database. The study aimed to explore the distribution, change, and interrelationships of health care costs across the age groups of patients with multimorbidity, suggesting different priorities at different age groups. Method. The study identified all adults with at least one chronic disease when any health care services were used over a three-year period between 2012 and 2014. Further data analysis excluded patients with single chronic conditions and further analysed patients with multimorbidity, accounting for increasing resource usage. The costs of primary, outpatient health care services; hospitalizations; reimbursed and paid out-of-pocket medications were analysed in eight age groups starting at 18 and up to 85 years and over. Results. The study identified a total of 428,430 adults in Lithuania with at least two different chronic diseases from the 32 chronic disease list. Out of the total expenditure within the group, 51.54% of the expenses were consumed for inpatient treatment, 30.90% for reimbursed medications. Across different age groups of patients with multimorbidity in Lithuania, 60% of the total cost is attributed to the age group of 65–84 years. The share in the total spending was the highest in the 75–84 years age group amounting to 29.53% of the overall expenditure, with an increase in hospitalization and a decrease in outpatient services. A decrease in health care expenses per capita in patients with multimorbidity after 85 years of age was observed. Conclusions. The highest proportion of health care expenses in patients with multimorbidity relates to hospitalization and reimbursed medications, increasing with age, but varies through different services. The study identifies the need to personalise the care of patients with multimorbidity in the primary-outpatient setting, aiming to reduce hospitalizations with proactive disease management. Full article

(This article belongs to the Special Issue Population Health and Health Services)

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14 pages, 398 KiB

Open AccessArticle

Mir-1, miR-122, miR-132, and miR-133 Are Related to Subclinical Aortic Atherosclerosis Associated with Metabolic Syndrome

by Agnė Šatrauskienė, Rokas Navickas, Aleksandras Laucevičius, Tomas Krilavičius, Rūta Užupytė, Monika Zdanytė, Ligita Ryliškytė, Agnė Jucevičienė and Paul Holvoet

Int. J. Environ. Res. Public Health 2021, 18(4), 1483; https://doi.org/10.3390/ijerph18041483 - 04 Feb 2021

Cited by 12 | Viewed by 3070

Abstract

Previously, miR-1, miR-122, miR-126, miR-132, miR-133, and miR-370 were found to be related to coronary artery disease (CAD) progression. However, their relationship with subclinical atherosclerosis, especially in subjects with metabolic syndrome, is unknown. Therefore, our aim was to determine their relationship with arterial [...] Read more.

Previously, miR-1, miR-122, miR-126, miR-132, miR-133, and miR-370 were found to be related to coronary artery disease (CAD) progression. However, their relationship with subclinical atherosclerosis, especially in subjects with metabolic syndrome, is unknown. Therefore, our aim was to determine their relationship with arterial markers of subclinical atherosclerosis. Metabolic syndrome subjects (n = 182) with high cardiovascular risk but without overt cardiovascular disease (CVD) were recruited from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program. The ardio-ankle vascular index (CAVI), augmentation index normalized to a heart rate of 75 bpm (AIxHR75), aortic pulse wave velocity (AoPWV), and carotid artery stiffness were assessed. MicroRNAs (miRs) were analyzed in serum. Pearson correlation and a univariate linear regression t-test showed that miR-1, miR-133b, and miR-133a were negatively associated with CAVI mean, whereas miR-122 was positively associated. MiR-1, miR-133b and miR-133a, and miR-145 were negatively associated with AIxHR75. MiR-122 correlated negatively with AoPWV. In multivariate linear regression models, miR-133b and miR-122 predicted CAVImean, miR-133 predicted AIxHR75, and miR-122 predicted AoPWV. MiR-132 predicted right carotid artery stiffness, and miR-1 predicted left carotid artery stiffness. The addition of smoking to miR-133b and miR-122 enhanced the prediction of CAVI. Age and triglycerides enhanced the prediction of AoPWV by miR-122. A cluster of four miRs are related to subclinical atherosclerosis in subjects with metabolic syndrome. Combined, they may have a more substantial diagnostic or prognostic value than any single miR. Future follow-up studies are needed to establish their clinical relevance. Full article

(This article belongs to the Special Issue Population Health and Health Services)

12 pages, 1253 KiB

Open AccessArticle

Invasive Coronary Angiography after Chest Pain Presentations to Emergency Departments

by Frank M. Sanfilippo, Graham S. Hillis, Jamie M. Rankin, Donald Latchem, Carl J. Schultz, Jongsay Yong, Ian W. Li and Tom G. Briffa

Int. J. Environ. Res. Public Health 2020, 17(24), 9502; https://doi.org/10.3390/ijerph17249502 - 18 Dec 2020

Cited by 3 | Viewed by 2400

Abstract

We investigated patients presenting to emergency departments (EDs) with chest pain to identify factors that influence the use of invasive coronary angiography (ICA). Using linked ED, hospitalisations, death and cardiac biomarker data, we identified people aged 20 years and over who presented with [...] Read more.

We investigated patients presenting to emergency departments (EDs) with chest pain to identify factors that influence the use of invasive coronary angiography (ICA). Using linked ED, hospitalisations, death and cardiac biomarker data, we identified people aged 20 years and over who presented with chest pain to tertiary public hospital EDs in Western Australia from 1 January 2016 to 31 March 2017 (ED chest pain cohort). We report patient characteristics, ED discharge diagnosis, pathways to ICA, ICA within 90 days, troponin test results, and gender differences. Associations were examined with the Pearson Chi-squared test and multivariate logistic regression. There were 16,974 people in the ED chest pain cohort, with a mean age of 55.6 years and 50.7% males, accounting for 20,131 ED presentations. Acute coronary syndrome was the ED discharge diagnosis in 10.4% of presentations. ED pathways were: discharged home (57.5%); hospitalisation (41.7%); interhospital transfer (0.4%); and died in ED (0.03%)/inpatients (0.3%). There were 1546 (9.1%) ICAs performed within 90 days of the first ED chest pain visit, of which 59 visits (3.8%) had no troponin tests and 565 visits (36.6%) had normal troponin. ICAs were performed in more men than women (12.3% vs. 6.1%, p < 0.0001; adjusted OR 1.89, 95% CI 1.65, 2.18), and mostly within 7 days. Equal numbers of males and females present with chest pain to tertiary hospital EDs, but men are twice as likely to get ICA. Over one-third of ICAs occur in those with normal troponin levels, indicating that further investigation is required to determine risk profile, outcomes and cost effectiveness. Full article

(This article belongs to the Special Issue Population Health and Health Services)

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10 pages, 315 KiB

Open AccessArticle

Treatment Preferences of Residents Assumed to Have Severe Chronic Diseases in China: A Discrete Choice Experiment

by Yinghao Lv, Qiang Fu, Xiao Shen, Erping Jia, Xianglin Li, Yingying Peng, Jinghong Yan, Mingzhu Jiang and Juyang Xiong

Int. J. Environ. Res. Public Health 2020, 17(22), 8420; https://doi.org/10.3390/ijerph17228420 - 13 Nov 2020

Cited by 5 | Viewed by 1724

Abstract

Objectives: This study aims to elicit the relative importance of treatment attributes that influence residents’ choice, assuming they are suffering severe non-communicable diseases (NCDs), to explore how they make trade-offs between these attributes and to estimate the monetary value placed on different attributes [...] Read more.

Objectives: This study aims to elicit the relative importance of treatment attributes that influence residents’ choice, assuming they are suffering severe non-communicable diseases (NCDs), to explore how they make trade-offs between these attributes and to estimate the monetary value placed on different attributes and attribute levels. Methods: A discrete choice experiment (DCE) was conducted with adults over 18 years old in China. Preferences were evaluated based on four treatment attributes: care provider, mode of service, distance to practice and cost. A mixed logit model was used to analyze the relative importance of the four attributes and to calculate the willingness to pay (WTP) for a changed attribute level. Results: A total of 93.47% (2019 of 2160) respondents completed valid questionnaires. The WTP results suggested that participants would be willing to pay CNY 822.51 (USD 124.86), CNY 470.54 (USD 71.41) and CNY 68.20 (USD 10.35) for services provided by experts, with integrated traditional Chinese medicine (TCM) and Western medicine (WM) and with a service distance <=30 min, respectively. Conclusions: The results suggested that mode of service, care provider, distance to practice and cost should be considered in priority-setting decisions. The government should strengthen the curative service capability in primary health facilities and give full play to the role of TCM in the prevention and treatment of severe chronic diseases. Full article

(This article belongs to the Special Issue Population Health and Health Services)

20 pages, 397 KiB

Open AccessArticle

Shaping Policy on Chronic Diseases through National Policy Dialogs in CHRODIS PLUS

by Dorota Sienkiewicz, Alison Maassen, Iñaki Imaz-Iglesia, Elisa Poses-Ferrer, Helen McAvoy, Rita Horgan, Miguel Telo de Arriaga and Andrew Barnfield

Int. J. Environ. Res. Public Health 2020, 17(19), 7113; https://doi.org/10.3390/ijerph17197113 - 28 Sep 2020

Cited by 4 | Viewed by 3547

Abstract

Policy dialogs are deliberative dialogue that gather policy makers and relevant stakeholders from across disciplines to discuss a topic of mutual interest. They typically serve as a single element in a broader policymaking cycle, either informing the content of new policy or forming [...] Read more.

Policy dialogs are deliberative dialogue that gather policy makers and relevant stakeholders from across disciplines to discuss a topic of mutual interest. They typically serve as a single element in a broader policymaking cycle, either informing the content of new policy or forming a component of policy evaluation and review. In the joint action CHRODIS PLUS, national policy dialogs were conducted in fourteen EU Member States. The aim of the dialogs was to identify new policies or changes to existing policies and legislation that are capable of tackling major risk factors for chronic disease, to strengthen health promotion and prevention programs and to ensure health systems are equipped to respond to priority issues within the chronic diseases field. In this paper, we present the CHRODIS PLUS policy dialog methodology, as well as results and lessons learnt from three national policy dialogs held in Ireland, Portugal and Spain. After discussion of the results, we conclude that the CHRODIS PLUS methodology is an effective mechanism to provoke deliberative discussion around chronic disease prevention and management in different countries. However, it is essential to ensure adequate human and financial resources—as well as political commitment—to accomplish objectives set out during the policy dialogs. We argue that priority-setting across sectors can improve the resilience of health systems and opportunities for investment in Health in All Policies (HiAP), both at European Union and Member State levels. Full article

(This article belongs to the Special Issue Population Health and Health Services)

15 pages, 370 KiB

Open AccessArticle

Adherence to Clinical Practice Guidelines and Colorectal Cancer Survival: A Retrospective High-Resolution Population-Based Study in Spain

by Francisco Carrasco-Peña, Eloisa Bayo-Lozano, Miguel Rodríguez-Barranco, Dafina Petrova, Rafael Marcos-Gragera, Maria Carmen Carmona-Garcia, Josep Maria Borras and Maria-José Sánchez

Int. J. Environ. Res. Public Health 2020, 17(18), 6697; https://doi.org/10.3390/ijerph17186697 - 14 Sep 2020

Cited by 8 | Viewed by 2440

Abstract

Colorectal cancer (CRC) is the third most common cancer worldwide. Population-based, high-resolution studies are essential for the continuous evaluation and updating of diagnosis and treatment standards. This study aimed to assess adherence to clinical practice guidelines and investigate its relationship with survival. We [...] Read more.

Colorectal cancer (CRC) is the third most common cancer worldwide. Population-based, high-resolution studies are essential for the continuous evaluation and updating of diagnosis and treatment standards. This study aimed to assess adherence to clinical practice guidelines and investigate its relationship with survival. We conducted a retrospective high-resolution population-based study of 1050 incident CRC cases from the cancer registries of Granada and Girona, with a 5-year follow-up. We recorded clinical, diagnostic, and treatment-related information and assessed adherence to nine quality indicators of the relevant CRC guidelines. Overall adherence (on at least 75% of the indicators) significantly reduced the excess risk of death (RER) = 0.35 [95% confidence interval (CI) 0.28–0.45]. Analysis of the separate indicators showed that patients for whom complementary imaging tests were requested had better survival, RER = 0.58 [95% CI 0.46–0.73], as did patients with stage III colon cancer who underwent adjuvant chemotherapy, RER = 0.33, [95% CI 0.16–0.70]. Adherence to clinical practice guidelines can reduce the excess risk of dying from CRC by 65% [95% CI 55–72%]. Ordering complementary imagining tests that improve staging and treatment choice for all CRC patients and adjuvant chemotherapy for stage III colon cancer patients could be especially important. In contrast, controlled delays in starting some treatments appear not to decrease survival. Full article

(This article belongs to the Special Issue Population Health and Health Services)

20 pages, 1137 KiB

Open AccessArticle

Recommendations for Effective Intersectoral Collaboration in Health Promotion Interventions: Results from Joint Action CHRODIS-PLUS Work Package 5 Activities

by Djoeke van Dale, Lidwien Lemmens, Marieke Hendriksen, Nella Savolainen, Péter Nagy, Edit Marosi, Michela Eigenmann, Ingrid Stegemann and Heather L. Rogers

Int. J. Environ. Res. Public Health 2020, 17(18), 6474; https://doi.org/10.3390/ijerph17186474 - 05 Sep 2020

Cited by 16 | Viewed by 6065

Abstract

The burden of chronic disease in Europe continues to grow. A major challenge facing national governments is how to tackle the risk factors of sedentary lifestyle, alcohol abuse, smoking, and unhealthy diet. These factors are complex and necessitate intersectoral collaboration to strengthen health [...] Read more.

The burden of chronic disease in Europe continues to grow. A major challenge facing national governments is how to tackle the risk factors of sedentary lifestyle, alcohol abuse, smoking, and unhealthy diet. These factors are complex and necessitate intersectoral collaboration to strengthen health promotion, counter-act the social determinants of health, and reduce the prevalence of chronic disease. European countries have diverse intersectoral collaboration to encourage health promotion activities. In the Joint Action CHRODIS-PLUS success factors for intersectoral collaboration within and outside healthcare which strengthen health promotion activities were identified with a mixed method design via a survey of 22 project partners in 14 countries and 2 workshops. In six semi-structured interviews, the mechanisms underlying these success factors were examined. These mechanisms can be very context-specific but do give more insight into how they can be replicated. In this paper, 20 health promotion interventions from national programs in CHRODIS PLUS are explored. This includes community interventions, policy actions, integrated approaches, capacity building, and training activities. The interventions involved collaboration across three to more than six sectors. The conclusion is a set of seven recommendations that are considered to be essential for fostering intersectoral collaboration to improve health-promoting activities. Full article

(This article belongs to the Special Issue Population Health and Health Services)

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14 pages, 492 KiB

Open AccessArticle

Analysis of the Influencing Factors on the Preferences of the Elderly for the Combination of Medical Care and Pension in Long-Term Care Facilities Based on the Andersen Model

by Yong Wei and Liangwen Zhang

Int. J. Environ. Res. Public Health 2020, 17(15), 5436; https://doi.org/10.3390/ijerph17155436 - 28 Jul 2020

Cited by 21 | Viewed by 3527

Abstract

Background: The purpose of this study is to evaluate the status quo and factors that influence the preferences of the elderly for the combination of medical care and pension (CMCP) in long-term care (LTC) facilities and to provide an evidence-based basis for building [...] Read more.

Background: The purpose of this study is to evaluate the status quo and factors that influence the preferences of the elderly for the combination of medical care and pension (CMCP) in long-term care (LTC) facilities and to provide an evidence-based basis for building a multi-tiered, continuous LTC system with CMCP. Methods: Using a multi-stage sampling method, face-to-face questionnaire surveys were conducted on 3260 elderly people aged 60 years or over in 44 communities in 16 sub-districts in six districts in Xiamen. Based on the Andersen model, the chi-square test was used to analyze differences in population distribution, and binary logistic regression analysis was used to analyze the factors affecting the elderly’s preference for CMCP in LTC institutions in terms of the factors of predisposition, enablement, and personal needs. Results: Most elderly people choose traditional home care (82.01%), and only 12.89% choose LTC facilities with CMCP. This choice is influenced by a number of predisposing factors. The elderly who are at the upper end of the age range, have a higher education level, and live in rural areas are more likely to choose CMCP (odds ratio (OR) value greater than 1, p < 0.05). With regard to enabling factors, the elderly who were married, mainly taken care of by spouses, and had better economic status also tended to choose CMCP (OR > 1, p < 0.01). In terms of personal needs, the elderly with worse self-care status tended to choose CMCP (OR > 1, p < 0.01). Enabling factors have the largest contribution to the model, and they have the greatest impact on elder preference for CMCP services. In addition, the elderly with higher age and education level, non-remarried, with better economic status, and with poorer health status have a demand for a wider variety of CMCP services. Compared to those in urban areas, the elderly in rural areas have greater needs, mainly related to personal care, medical care, and psychological counseling. Conclusion: The preference of the elderly for CMCP are lower compared to their preference for home care in Xiamen, China. Preference for CMCP is affected by a range of factors such as age, education level, residence, income, and self-care ability, among which the enabling factors have the greatest impact. Full article

(This article belongs to the Special Issue Population Health and Health Services)

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14 pages, 1105 KiB

Open AccessArticle

Assessing the Pilot Implementation of the Integrated Multimorbidity Care Model in Five European Settings: Results from the Joint Action CHRODIS-PLUS

by Carmen Rodriguez-Blazquez, Maria João Forjaz, Antonio Gimeno-Miguel, Kevin Bliek-Bueno, Beatriz Poblador-Plou, Sara Pilar Luengo-Broto, Inmaculada Guerrero-Fernández de Alba, Ana Maria Carriazo, Carmen Lama, Rafael Rodríguez-Acuña, Inmaculada Cosano, Juan José Bedoya, Carmen Angioletti, Angelo Carfì, Antonella Di Paola, Rokas Navickas, Elena Jureviciene, Laimis Dambrauskas, Ida Liseckiene, Leonas Valius, Gediminas Urbonas, Graziano Onder and Alexandra Prados-Torres Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2020, 17(15), 5268; https://doi.org/10.3390/ijerph17155268 - 22 Jul 2020

Cited by 9 | Viewed by 3758

Abstract

Multimorbidity, the coexistence of several chronic conditions in a patient, represents a great challenge for healthcare systems and society. The Integrated Multimorbidity Care Model (IMCM) was recently designed within the Joint Action on chronic diseases and promoting healthy ageing across the life cycle [...] Read more.

Multimorbidity, the coexistence of several chronic conditions in a patient, represents a great challenge for healthcare systems and society. The Integrated Multimorbidity Care Model (IMCM) was recently designed within the Joint Action on chronic diseases and promoting healthy ageing across the life cycle (CHRODIS) to ensure the continuity of care for patients with multimorbidity. The IMCM was implemented in five European pilot sites in Spain, Italy, and Lithuania, within the Joint Action CHRODIS-PLUS. The effect of these pilot interventions was assessed pre- and post-implementation by 17 healthcare managers, using the Assessment of Chronic Illness Care (ACIC) measure, and by 226 patients with the Patient Assessment of Care for Chronic Conditions (PACIC+) survey. The ACIC total score significantly increased (5.23 to 6.71, p = 0.022) after the intervention, with differences across sites. A significant increase in the PACIC+ summary score was found ranging from 3.25 at baseline to 4.03 after the intervention (p < 0.001), and 58% of the sample perceived an improvement in care. Higher PACIC+ scores after the intervention were associated to lower baseline values in the respective PACIC+ dimension and to greater changes in ACIC Part 1 (delivery system organization). The IMCM implementation can help improve the quality of care for patients with multimorbidity. Full article

(This article belongs to the Special Issue Population Health and Health Services)

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15 pages, 1011 KiB

Open AccessArticle

Multimorbidity Patterns in the General Population: Results from the EpiChron Cohort Study

by Ignatios Ioakeim-Skoufa, Beatriz Poblador-Plou, Jonás Carmona-Pírez, Jesús Díez-Manglano, Rokas Navickas, Luis Andrés Gimeno-Feliu, Francisca González-Rubio, Elena Jureviciene, Laimis Dambrauskas, Alexandra Prados-Torres and Antonio Gimeno-Miguel

Int. J. Environ. Res. Public Health 2020, 17(12), 4242; https://doi.org/10.3390/ijerph17124242 - 14 Jun 2020

Cited by 37 | Viewed by 3436

Abstract

The correct management of patients with multimorbidity remains one of the main challenges for healthcare systems worldwide. In this study, we analyze the existence of multimorbidity patterns in the general population based on gender and age. We conducted a cross-sectional study of individuals [...] Read more.

The correct management of patients with multimorbidity remains one of the main challenges for healthcare systems worldwide. In this study, we analyze the existence of multimorbidity patterns in the general population based on gender and age. We conducted a cross-sectional study of individuals of all ages from the EpiChron Cohort, Spain (1,253,292 subjects), and analyzed the presence of systematic associations among chronic disease diagnoses using exploratory factor analysis. We identified and clinically described a total of 14 different multimorbidity patterns (12 in women and 12 in men), with some relevant differences in the functions of age and gender. The number and complexity of the patterns was shown to increase with age in both genders. We identified associations of circulatory diseases with respiratory disorders, chronic musculoskeletal diseases with depression and anxiety, and a very consistent pattern of conditions whose co-occurrence is known as metabolic syndrome (hypertension, diabetes, obesity, and dyslipidaemia), among others. Our results demonstrate the potential of using real-world data to conduct large-scale epidemiological studies to assess the complex interactions among chronic conditions. This could be useful in designing clinical interventions for patients with multimorbidity, as well as recommendations for healthcare professionals on how to handle these types of patients in clinical practice. Full article

(This article belongs to the Special Issue Population Health and Health Services)

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9 pages, 300 KiB

Open AccessArticle

Differences in Body Composition among Patientsafter Hemorrhagic and Ischemic Stroke

by Jacek Wilczyński, Marta Mierzwa-Molenda and Natalia Habik-Tatarowska

Int. J. Environ. Res. Public Health 2020, 17(11), 4170; https://doi.org/10.3390/ijerph17114170 - 11 Jun 2020

Cited by 2 | Viewed by 2290

Abstract

The aim of the study was to assess differences in the body composition of patients after hemorrhagic and ischemic stroke. There were 74 male participants in the study, of which 13 (18%) experienced hemorrhagic stroke, while 61 (82%) were after ischemic stroke. Significantly [...] Read more.

The aim of the study was to assess differences in the body composition of patients after hemorrhagic and ischemic stroke. There were 74 male participants in the study, of which 13 (18%) experienced hemorrhagic stroke, while 61 (82%) were after ischemic stroke. Significantly (p < 0.05) higher values of body composition variables were noted for ischemic compared to hemorrhagic strokes, and concerned: body mass (BM) (kg), basal metabolic rate (BMR) (kJ), fat-free mass (FFM) (kg), total body water (TBW) (kg), muscle mass (MM) (kg), visceral fat level (VFL), bone mass (BoM) (kg), extracellular water(ECW) (kg),intracellular water (ICW) (kg), trunk fat-free mass (TFFM) (kg) and trunk muscle mass (TMM) (kg)in the paretic upper limb; FFM (kg) and MM (kg) in the non-paretic upper limb; FFM (kg) and MM (kg) in the paretic lower limbas well as FFM (kg) and MM (kg) in the non-paretic lower limb without paresis. Only for the variables fat mass (FM) (kg), body mass index (BMI), metabolic age (MA), trunk fat mass (TFM) (kg), and FM (kg) in the paretic upper limb and FM (kg) in the non-paretic upper limb were there no significant differences. Significant differences in body composition of patients after hemorrhagic and ischemic stroke have been demonstrated. Individuals after ischemic stroke had significantly worse body composition. Incorrect body composition is a significant risk factor, especially of ischemic stroke. Full article

(This article belongs to the Special Issue Population Health and Health Services)

10 pages, 848 KiB

Open AccessArticle

Age and Sex Differences in the Use of Emergency Telephone Consultation Services in Saitama, Japan: A Population-Based Observational Study

by Akihisa Nakamura, Toshie Manabe, Hiroyuki Teraura and Kazuhiko Kotani

Int. J. Environ. Res. Public Health 2020, 17(1), 185; https://doi.org/10.3390/ijerph17010185 - 26 Dec 2019

Cited by 4 | Viewed by 4559

Abstract

The frequency of use of emergency telephone consultation (ETC) services, which is a telephone triage system in Japan, was explored to determine age- and sex-related trends on symptoms/events among Japanese adults. Data were obtained from records of the initial year of ETC services [...] Read more.

The frequency of use of emergency telephone consultation (ETC) services, which is a telephone triage system in Japan, was explored to determine age- and sex-related trends on symptoms/events among Japanese adults. Data were obtained from records of the initial year of ETC services in Saitama Prefecture (from October 2014 to September 2015). Residents who used the ETC services were divided into four age groups (20–39, 40–64, 65–74, and ≥75 years old). The number of calls per 1000 persons (call rate, CR) was compared between the groups. The annual CR for the top 10 symptoms/events were assessed. The annual CR was 2.6/1000 persons. The annual CR was significantly higher for women (2.9) than for men (2.3) (p < 0.05). ETC use was the highest in the 20–39 age group for both sexes (3.3 and 4.4 in men and women, respectively). All groups had fever, abdominal pain, and nausea/vomiting in common. In older adults, the frequency of events such as bruises and head injury was high. Women and younger adults tended to use ETC services. There were similarities and differences in symptoms/events among the groups, which should be recognized by call centers to help foster call center staff. Full article

(This article belongs to the Special Issue Population Health and Health Services)

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Review

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18 pages, 1053 KiB

Open AccessReview

The Identification of Diabetes Mellitus Subtypes Applying Cluster Analysis Techniques: A Systematic Review

by Antonio Sarría-Santamera, Binur Orazumbekova, Tilektes Maulenkul, Abduzhappar Gaipov and Kuralay Atageldiyeva

Int. J. Environ. Res. Public Health 2020, 17(24), 9523; https://doi.org/10.3390/ijerph17249523 - 18 Dec 2020

Cited by 30 | Viewed by 3594

Abstract

Diabetes Mellitus is a chronic and lifelong disease that incurs a huge burden to healthcare systems. Its prevalence is on the rise worldwide. Diabetes is more complex than the classification of Type 1 and 2 may suggest. The purpose of this systematic review [...] Read more.

Diabetes Mellitus is a chronic and lifelong disease that incurs a huge burden to healthcare systems. Its prevalence is on the rise worldwide. Diabetes is more complex than the classification of Type 1 and 2 may suggest. The purpose of this systematic review was to identify the research studies that tried to find new sub-groups of diabetes patients by using unsupervised learning methods. The search was conducted on Pubmed and Medline databases by two independent researchers. All time publications on cluster analysis of diabetes patients were selected and analysed. Among fourteen studies that were included in the final review, five studies found five identical clusters: Severe Autoimmune Diabetes; Severe Insulin-Deficient Diabetes; Severe Insulin-Resistant Diabetes; Mild Obesity-Related Diabetes; and Mild Age-Related Diabetes. In addition, two studies found the same clusters, except Severe Autoimmune Diabetes cluster. Results of other studies differed from one to another and were less consistent. Cluster analysis enabled finding non-classic heterogeneity in diabetes, but there is still a necessity to explore and validate the capabilities of cluster analysis in more diverse and wider populations. Full article

(This article belongs to the Special Issue Population Health and Health Services)

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