COVID-19 risk prediction algorithms can be used to identify at-risk individuals from short-term serious adverse COVID-19 outcomes such as hospitalisation and death. It is important to validate these ...algorithms in different and diverse populations to help guide risk management decisions and target vaccination and treatment programs to the most vulnerable individuals in society.
To validate externally the QCOVID risk prediction algorithm that predicts mortality outcomes from COVID-19 in the adult population of Wales, UK.
We conducted a retrospective cohort study using routinely collected individual-level data held in the Secure Anonymised Information Linkage (SAIL) Databank. The cohort included individuals aged between 19 and 100 years, living in Wales on 24
January 2020, registered with a SAIL-providing general practice, and followed-up to death or study end (28
July 2020). Demographic, primary and secondary healthcare, and dispensing data were used to derive all the predictor variables used to develop the published QCOVID algorithm. Mortality data were used to define time to confirmed or suspected COVID-19 death. Performance metrics, including R
values (explained variation), Brier scores, and measures of discrimination and calibration were calculated for two periods (24
January-30
April 2020 and 1
May-28
July 2020) to assess algorithm performance.
1,956,760 individuals were included. 1,192 (0.06%) and 610 (0.03%) COVID-19 deaths occurred in the first and second time periods, respectively. The algorithms fitted the Welsh data and population well, explaining 68.8% (95% CI: 66.9-70.4) of the variation in time to death, Harrell's C statistic: 0.929 (95% CI: 0.921-0.937) and D statistic: 3.036 (95% CI: 2.913-3.159) for males in the first period. Similar results were found for females and in the second time period for both sexes.
The QCOVID algorithm developed in England can be used for public health risk management for the adult Welsh population.
The Data and Connectivity COVID-19 Vaccines Pharmacovigilance (DaC-VaP) UK-wide collaboration was created to monitor vaccine uptake and effectiveness and provide pharmacovigilance using routine ...clinical and administrative data. To monitor these, pooled analyses may be needed. However, variation in terminologies present a barrier as England uses the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), while the rest of the United Kingdom uses the Read v2 terminology in primary care. The availability of data sources is not uniform across the United Kingdom.
This study aims to use the concept mappings in the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) to identify common concepts recorded and to report these in a repeated cross-sectional study. We planned to do this for vaccine coverage and 2 adverse events of interest (AEIs), cerebral venous sinus thrombosis (CVST) and anaphylaxis. We identified concept mappings to SNOMED CT, Read v2, the World Health Organization's International Classification of Disease Tenth Revision (ICD-10) terminology, and the UK Dictionary of Medicines and Devices (dm+d).
Exposures and outcomes of interest to DaC-VaP for pharmacovigilance studies were selected. Mappings of these variables to different terminologies used across the United Kingdom's devolved nations' health services were identified from the Observational Health Data Sciences and Informatics (OHDSI) Automated Terminology Harmonization, Extraction, and Normalization for Analytics (ATHENA) online browser. Lead analysts from each nation then confirmed or added to the mappings identified. These mappings were then used to report AEIs in a common format. We reported rates for windows of 0-2 and 3-28 days postvaccine every 28 days.
We listed the mappings between Read v2, SNOMED CT, ICD-10, and dm+d. For vaccine exposure, we found clear mapping from OMOP to our clinical terminologies, though dm+d had codes not listed by OMOP at the time of searching. We found a list of CVST and anaphylaxis codes. For CVST, we had to use a broader cerebral venous thrombosis conceptual approach to include Read v2. We identified 56 SNOMED CT codes, of which we selected 47 (84%), and 15 Read v2 codes. For anaphylaxis, our refined search identified 60 SNOMED CT codes and 9 Read v2 codes, of which we selected 10 (17%) and 4 (44%), respectively, to include in our repeated cross-sectional studies.
This approach enables the use of mappings to different terminologies within the OMOP CDM without the need to catalogue an entire database. However, Read v2 has less granular concepts than some terminologies, such as SNOMED CT. Additionally, the OMOP CDM cannot compensate for limitations in the clinical coding system. Neither Read v2 nor ICD-10 is sufficiently granular to enable CVST to be specifically flagged. Hence, any pooled analysis will have to be at the less specific level of cerebrovascular venous thrombosis. Overall, the mappings within this CDM are useful, and our method could be used for rapid collaborations where there are only a limited number of concepts to pool.
Population-level information on dispensed medication provides insight on the distribution of treated morbidities, particularly if linked to other population-scale data at an individual-level.
To ...evaluate the impact of COVID-19 on dispensing patterns of medications.
Retrospective observational study using population-scale, individual-level dispensing records in Wales, UK. Total dispensed drug items for the population between 1
January 2016 and 31
December 2019 (3-years, pre-COVID-19) were compared to 2020 with follow up until 27
July 2021 (COVID-19 period). We compared trends across all years and British National Formulary (BNF) chapters and highlighted the trends in three major chapters for 2019-21: 1-Cardiovascular system (CVD); 2-Central Nervous System (CNS); 3-Immunological & Vaccine. We developed an interactive dashboard to enable monitoring of changes as the pandemic evolves.
Amongst all BNF chapters, 73,410,543 items were dispensed in 2020 compared to 74,121,180 items in 2019 demonstrating -0.96% relative decrease in 2020. Comparison of monthly patterns showed average difference (D) of -59,220 and average Relative Change (RC) of -0.74% between the number of dispensed items in 2020 and 2019. Maximum RC was observed in March 2020 (D = +1,224,909 and RC = +20.62), followed by second peak in June 2020 (D = +257,920, RC = +4.50%). A third peak was observed in September 2020 (D = +264,138, RC = +4.35%). Large increases in March 2020 were observed for CVD and CNS medications across all age groups. The Immunological and Vaccine products dropped to very low levels across all age groups and all months (including the March dispensing peak).
Reconfiguration of routine clinical services during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes.
Recently, there has been a great deal of interest in the use of the medicinal plants with high antioxidant compounds for curing liver injuries induced by hepatoxcitic agents. This study was to assess ...the protective effect of Carum carvi L. essential oil (E.O) on the hepatoxitic rats induced by overdose of iron oxide nanoparticles (NPs). The rats were distributed to 4 groups. In negative control group (NC), the rats received normal saline and DMSO daily for 3 days. In control group (C), iron oxide nanoparticles (Fe2O3) (200 mg/kg b.w) was injected daily for 3 days. In the treatment groups, iron oxide nanoparticles plus E.O at 100 & 200 mg/kg b.w were injected daily for 3 days. In following, cytochrome P450 (CYP450), glutathione S-transferase (GST), glutathione (GSH), aspartate transaminase (AST), alkaline phosphatase (ALP) and alanine transaminase (ALT) were estimated at 72 h after NP-treatment. The administration of the E.O could return considerably the decrease of the GST and GSH levels as well as the increase of the level of AST induced by iron oxide NPs. These results are in agreement with histopathological results. The data indicated that E.O provided an efficient prevention against iron oxide NPs-induced hepatotoxicity in rats.
IntroductionThe risk of cardiovascular events amongst people with epilepsy who are receiving enzyme-inducing anti-epileptic drugs (EIAEDs) seems to be higher than those on other medications and the ...general population. National-level record linkage enables development of case-control studies at a wider scope accounting for multiple factors.
Objectives and ApproachPeople with epilepsy were identified between 2003-01-01 and 2017-12-31 and were matched to a control group on: age, gender, deprivation quintile and year of diagnosis, accounting for any changes in clinical therapeutic guidelines. Primary and secondary care population records were linked to capture relevant comorbidities and major cardiovascular events. Annual district birth and death extract were used in combination with the Welsh Demographic Service (WDS) dataset to capture demographic and cardiovascular related death records. The WDS dataset was used to identify eligible control groups for each case and a linkage approach between the control and case database was developed for matching cases and controls with replacement and randomization. Survival analysis was conducted to evaluate the difference in time to first major cardiovascular event in patients receiving EIAED versus Non-EIAEDs and controls.
Results10,241 cases (mean age 49.6 years, 52.2% male) with diagnosis of epilepsy were matched to 35,145 controls. 3,180 (31.1%) cases received EIAEDs and 7,061 (68.9%) received non-EIAEDs. The risk of experiencing a major cardiovascular event was higher in cases compared to controls (adjusted hazard ratio 1.52,95%CI1.50–1.55;p<0.001). There was no significant difference in cardiovascular events between those treated with non-EIAEDs and EIAEDs (adjusted hazard ratio 1.04,95%CI0.95-1.12;p=0.407).
Conclusion / ImplicationsData linkage provides a unique opportunity and insight into studying disease risk factors. We have shown that individuals with epilepsy prescribed antiepileptic drugs, re at an increased risk of a major cardiovascular events regardless of treatment type (EIAED,NEIAED) compared with a matched control population.
During the last three decades, the Total Fertility Rate (TFR) in Iran has fallen considerably; from 6.5 per woman in 1983 to 1.89 in 2010. This paper analyzes the extent to which economic ...determinants at the micro and macro levels are associated with the number of children in Iranian households.
Household data from the 2010 Household Expenditure and Income Survey (HEIS) is linked to provincial data from the 2010 Iran Multiple-Indicator Demographic and Health Survey (IrMIDHS), the National Census of Population and Housing conducted in 1986, 1996, 2006 and 2011, and the 1985-2010 Iran statistical year books. Fertility is measured as the number of children in each household. A random intercept multilevel Poisson regression function is specified based on a collective model of intra-household bargaining power to investigate potential determinants of the number of children in Iranian households.
Ceteris paribus (other things being equal), probability of having more children drops significantly as either real per capita educational expenditure or real total expenditure of each household increase. Both the low- and the high-income households show probabilities of having more children compared to the middle-income households. Living in provinces with either higher average amount of value added of manufacturing establishments or lower average rate of house rent is associated to higher probability of having larger number of children. Higher levels of gender gap indices, resulting in household's wife's limited power over household decision-making, positively affect the probability of having more children.
Economic determinants at the micro and macro levels, distribution of intra-household bargaining power between spouses and demographic covariates determined fertility behavior of Iranian households.
IntroductionAtrial Fibrillation (AF) is a common abnormal heart rhythm that is associated with five times the risk of stroke and twice the risk of death. However, this risk can be reduced by ...approximately two thirds through the appropriate use of anticoagulation (AC).
Objectives and ApproachReducing the incidence of stroke through effective management of AF is a priority recognised by Abertawe Bro Morgannwg University Health Board (ABMUHB), in Wales, UK. An understanding of how closely services follow appropriate clinical guidelines for stroke prevention allows identification of opportunities to improve stroke outcomes and service efficiency. This study was commissioned to describe the nature of antithrombotic drug prescribing in ABMUHB patients with AF according to thromboembolic and bleeding risk status, and the numbers of non-anticoagulated patients with AF presenting with stroke. This study was completed using linked data held in the Secure Anonymised Information Linkage (SAIL) databank.
ResultsAF was identified in 12,778 ABMUHB patients (approximately 3% of the population), with 97% providing linked primary care records for our required period of follow-up. Of the AF patients with linked prescribing data, 60.5% were prescribed anticoagulants, 15.8% were prescribed antiplatelet agents and 23.7% received no antithrombotic medication. Notably, the thromboembolic risk and bleeding risk profiles (characterised by modified CHA2DS2-VASc and HAS-BLED scores respectively, implemented within the SAIL databank data) were remarkably similar in those receiving and those not receiving AC. 965 patients were admitted to ABMUHB hospitals with a stroke during 2015. AF was previously diagnosed in 18% of these patients, of whom just over half (50.3%) were not being prescribed AC during the 3 months prior to their stroke.
Conclusion/ImplicationsThis study demonstrates under prescribing of AC in patients with AF, which is not explained by stroke risk or bleeding scores. ABMUHB colleagues are developing strategies for service improvements, with plans for further sequential analysis to evaluate the effectiveness of implemented measures for outcome monitoring and reporting purposes.
Knowledge is becoming a valuable asset for most organizations and the quest to manage this asset is gaining popularity among researchers and management. Organizational management’s main objective is ...to ensure effective and efficient use of its diverse resources such as labor, capital, materials, energy and information in their quest to achieve competitiveness as well as to increase productivity that must be managed. In today’s rapid technological change, companies are in constant struggle to maintain competitive advantage through market differentiation by providing superior products and services. The management in organizations is increasing their focus on employees’ know-how, past experiences and expertise in their quest to excel in achieving their goal. In short, Knowledge has become an integral asset for most organizational functionalities. Knowledge management promises to create the proper structure and the necessary technological infrastructure in organizations and human-driven placement. This research investigates the role of “tacit” knowledge sharing on organizational productivity. Accordingly, a framework was developed and hypotheses were drawn and tested where results demonstrated interesting insights into the role of sharing on organizational productivity. The survey, which was conducted at Koosa Bank of Iran, demonstrated that the employees’ intension to share and consequently the sharing of tacit knowledge has direct positive impacts on productivity. In addition, our analysis demonstrated that not only productivity would increase as a result of knowledge sharing, but also employees’ innovative contributions increased as a result of exposure to others’ knowledge, expertise, and experiences.
Background
: The future development of children is considered more than ever now due to the advances in medical knowledge and thus the increase in survival rates of high-risk infants.
This study ...investigated the correlation between high-risk pregnancy and developmental delay in children aged 4-60 months.
Methods
: This descriptive study was conducted on 401 mothers and their children (4-60 months) who visited health service centers affiliated to Isfahan University of Medical Sciences, Iran, in 2011. Sampling was carried out in several stages, and the Ages and Stage Questionnaire was completed by the participants. Data were analyzed with SPSS 18 software and independent t-test; Mann-Whitney and logistic-regression tests were used.
Results
: The average age of children in the low-risk pregnancy group was 22±16 months, and that in the high-risk pregnancy group was 18.9±14.8 months. The majority of children were female (53.1%). The prevalence of high-risk pregnancies was 80.5%, and the prevalence of developmental delay was 18.7%. Multiple pregnancies, low birth weight, habitual abortions, maternal medical disorders in pregnancy, and gestational diabetes had significant correlations with developmental delay in children (P<0.04). In the logistic model, male gender, low birth weight, family marriage, and maternal medical disorders during pregnancy showed significant correlations with developmental delay in children (P<0.05). Additionally, abnormal body mass index (BMI) and social and economic status showed probability values close to the significance level (P = 0.05), whereas other high-risk pregnancy variables had no correlation with developmental delay in children. A correlation between high-risk pregnancy and developmental delay (P = 0.002) and fine motor delay was observed (P = 0.02), but no correlation was observed between high-risk pregnancy and other developmental domains.
Conclusion
: This study showed that some high-risk pregnancy variables had a significant correlation with developmental delay. Moreover, a significant correlation was observed between high-risk pregnancy and fine motor developmental delay.
The role of mental health is crucial in maintaining the dynamism and productivity of any given society. In contemporary times, a significant proportion of the workforce is comprised of women and ...mothers. Working in healthcare facilities, where exposure to pathogenic agents is an everyday nuisance, can have detrimental effects on mothers' stress and anxiety levels. Furthermore, such exposure can also endanger the health of both the family and society. Conversely, the employment of mothers could positively impact their social well-being. The primary objective of this study is to assess and compare the stress, anxiety, and social well-being scores of mothers employed in healthcare facilities and stay-at-home mothers during the COVID pandemic.
This study is a cross-sectional analysis of 246 mothers, equally divided into two groups: Mothers who work in health centers and stay-at-home mothers (123 individuals in each group). The study was conducted from 2021 to 2022, a multistage sampling method was utilized and two questionnaires were administered: The DASS 21 (21 questions) and the social well-being questionnaire (48 questions). The data were analyzed using SPSS 18, and descriptive and analytical tests (Independent Samples T-Test, Mann-Whitney) were employed.
The mean age was 35.7 ± 7.1 for working mothers and 34.3 ± 6.3 for stay-at-home mothers. The average stress score for employed mothers was 5.72 ± 4.7, and for stay-at-home mothers, it was 7.16 ± 4.3, which indicates a statistically significant difference in stress levels between the two groups (
= 0.04). However, the two groups had no significant difference in the mean anxiety score (
= 0.08). The mean score for social well-being was 165.5 ± 18.4 for working mothers and 162.17 ± 21.2 for stay-at-home mothers. This difference was not statistically significant (
= 0.18). Except for the social acceptance dimension (
= 0.003), no statistically significant differences were observed in the social well-being dimension between the two groups.
The social acceptance of working mothers appears to be greater than that of stay-at-home mothers. Higher social acceptance suggests that they hold a more positive outlook on people and are at ease in social situations, which may have helped to alleviate their stress and anxiety.
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