Improving fragility hip fracture care through data: a multicentre experience from a country with an emerging economy during the COVID-19 pandemic.

INTRODUCTION: In low-to-middle-income countries (LMIC), the orthogeriatric model of care is still in its early stages of development. This study describes the initial results of the first online fragility hip fracture database to be setup in the Philippines using a modified minimum common dataset to generate outcomes data based on current hospital practices. METHODS: A multicentre prospective cohort study among 12 Philippine hospitals was conducted from June 2020 to February 2021. Thirty-day mortality, morbidity and mobility were measured. Significant factors associated with mortality were determined. RESULTS: 158 elderly patients with fragility hip fractures were included in the study. Nine patients (5.7%) were confirmed or suspected to have COVID-19 infection. Median time of injury to admission was at least 3 days (IQR: 1.0-13.7). Overall, 80% of patients underwent surgical intervention with a median time from admission to surgery of at least 5 days (IQR: 2.5-13.6). Thirty-day mortality and morbidity rates for acute fragility fractures were 3.7%. Factors significantly associated with early mortality were poor prefracture mobility, COVID-19 infection, radiograph of the abnormal chest and conservative treatment. Non-surgical patients had no functional mobility or were wheelchair users and had a significantly higher morbidity rate than surgically treated patients (13.6% vs 1.8%; p=0.031). CONCLUSION: Despite treatment delays unique to an LMIC, short-term outcomes remain favourable for non-COVID-19 fragility hip fracture patients treated with surgery. Prompt admission and multidisciplinary care for elderly hip fracture patients while maintaining protective measures for COVID-19 infection control are recommended. The quality of data collected illustrates how this online database can provide a framework for a sustainable audit or registry as well as provide a platform for the introduction of orthogeriatric concepts at a multiregional scale.

Distance-based logistic model for cross-classified categorical data.

Logistic regression models are a powerful research tool for the analysis of cross-classified data in which a categorical response variable is involved. In a logistic model, the effect of a covariate refers to odds, and the simple relationship between the coefficients and the odds ratio often makes these the parameters of interest due to their easy interpretation. In this article we present a distance-based logistic model that allows a simple graphical interpretation of the association coefficients using the odds ratio in a contingency table. Two configurations are estimated, one for the rows and one for the columns, as the categories of a polytomous predictor and a nominal response variable respectively, such that the local odds ratio and the distances between the predictor and response categories are inversely related. The associations in terms of the odds ratios, or the ratios of the odds to their geometric means, are interpreted through distances for the most common coding schemes of the predictor variable, and the relationship between the distances related to different codings is investigated in its full dimension. The performance of the estimation procedure is analysed with a Monte Carlo experiment. The interpretation of the model and its performance, as well as its comparison with a two-step procedure involving first a logistic regression and then unfolding, is illustrated using real data sets.

A large self-transmissible resistance plasmid from Nigeria contains genes that ameliorate a carrying cost.

Antimicrobial resistance is rapidly expanding, in a large part due to mobile genetic elements. We screened 94 fecal fluoroquinolone-resistant Escherichia coli isolates from Nigeria for six plasmid-mediated quinolone resistance (PMQR) genes. Sixteen isolates harbored at least one of the PMQR genes and four were positive for aac-6-Ib-cr. In one strain, aac-6-Ib-cr was mapped to a 125 Kb self-transmissible IncFII plasmid, pMB2, which also bears blaCTX-M-15, seven other functional resistance genes and multiple resistance pseudogenes. Laboratory strains carrying pMB2 grew faster than isogenic strains lacking the plasmid in both rich and minimal media. We excised a 32 Kb fragment containing transporter genes and several open-reading frames of unknown function. The resulting 93 Kb mini-plasmid conferred slower growth rates and lower fitness than wildtype pMB2. Trans-complementing the deletion with the cloned sitABCD genes confirmed that they accounted for the growth advantage conferred by pMB2 in iron-depleted media. pMB2 is a large plasmid with a flexible resistance region that contains loci that can account for evolutionary success in the absence of antimicrobials. Ancillary functions conferred by resistance plasmids can mediate their retention and transmissibility, worsening the trajectory for antimicrobial resistance and potentially circumventing efforts to contain resistance through restricted use.

Skin color-specific and spectrally-selective naked-eye dosimetry of UVA, B and C radiations.

Spectrally-selective monitoring of ultraviolet radiations (UVR) is of paramount importance across diverse fields, including effective monitoring of excessive solar exposure. Current UV sensors cannot differentiate between UVA, B, and C, each of which has a remarkably different impact on human health. Here we show spectrally selective colorimetric monitoring of UVR by developing a photoelectrochromic ink that consists of a multi-redox polyoxometalate and an e- donor. We combine this ink with simple components such as filter paper and transparency sheets to fabricate low-cost sensors that provide naked-eye monitoring of UVR, even at low doses typically encountered during solar exposure. Importantly, the diverse UV tolerance of different skin colors demands personalized sensors. In this spirit, we demonstrate the customized design of robust real-time solar UV dosimeters to meet the specific need of different skin phototypes. These spectrally-selective UV sensors offer remarkable potential in managing the impact of UVR in our day-to-day life.

Cost-effectiveness of the third-agent class in treatment-naive human immunodeficiency virus-infected patients in Portugal.

INTRODUCTION: Current Portuguese HIV treatment guidelines recommend initiating antiretroviral therapy with a regimen composed of two Nucleoside Reverse Transcriptase Inhibitors plus one Non-nucleoside Reverse Transcriptase Inhibitor (2NRTI+NNRTI) or two Nucleoside Reverse Transcriptase Inhibitors plus one boosted protease inhibitor (2NRTI+PI/r). Given the lower daily cost of NNRTI as the third agent when compared to the average daily costs of PI/r, it is relevant to estimate the long term impact of each treatment option in the Portuguese context. METHODS: We developed a microsimulation discrete events model for cost-effectiveness analysis of HIV treatment, simulating individual paths from ART initiation to death. Four driving forces determine the course of events: CD4+ cell count, viral load, resistance and adherence. Distributions of time to event are conditional to individuals' characteristics and past history. Time to event was modeled using parametric survival analysis using Stata 11®. Disease progression was structured according to therapy lines and the model was parameterized with cohort Portuguese observational data. All resources were valued at 2009 prices. The National Health Service's perspective was assumed considering a lifetime horizon and a 5% annual discount rate. RESULTS: In this analysis, initiating therapy with two Nucleoside Reverse Transcriptase Inhibitors plus one Non-nucleoside Reverse Transcriptase Inhibitor reduces the average number of switches by 17%, saves 19.573€ per individual and increases life expectancy by 1.7 months showing to be a dominant strategy in 57% of the simulations when compared to two Nucleoside Reverse Transcriptase Inhibitors plus one boosted protease inhibitor. CONCLUSION: This study suggests that, when clinically valid, initiating therapy with two Nucleoside Reverse Transcriptase Inhibitors plus one Non-nucleoside Reverse Transcriptase Inhibitor is a cost-saving strategy and equally effective when compared to two Nucleoside Reverse Transcriptase Inhibitors plus one boosted protease inhibitor as the first regimen.

Estado de la salud en el Peru y distribución y uso de recursos en el sector

Este documento fue preparado para el Seminario que oganizo ESAN con la Universidad Peruana Cayetano Heredia sobre financiamiento del Sector Salud y tiene dos objetivos fundamentales: presentar en un solo volumén los resultados de los siete componentes de ANSSA, trabajo que quedo pediente cuando se realizo el proyecto ANSSA-PERU, de tal modo que se tenga un diagnóstico integral del sector, y servir de base para la discusión sobre el financiamiento para el sector salud, para propiciar una mayor racionalidad del gasto y explorar formas alternativas de financiamiento. Con estas premisas el trabajo ha sido dividido en nueve capitulos. En el primero se desarrollo el marco concecptual que guio los trabajos dentro del proyecto ANSSA, marco que no quedo plasmado en ningún documento final. En los capitulos segundo al octavo se ha sintetizado los principales hallazgos de cada uno de los componentes, así como sus principales recomendaciones. Y finalmente en el capitulo noveno se efectúa un analisis cruzado de las implicancias del financiamiento de la salud en la distribución de recursos - personal, infraestructura, medicinas - frente a la real situación de la salud de la población peruana, con el proposito de observar si se esta asígnando sus "escasos recursos" a las areas geográficas y grupos poblacionales más necesitados de atención y si existe eficiencia en el uso de los mismos

Factibilidad económica de planes médicos con pago anticipado en el sector privado en el área metropolitana de Lima, Perú. Informe preliminar (Lima, 26 de setiembre de 1986)

Explora las posibilidades de reducir el costo del financiamiento de los servicios de salud actualmente a cargo del estado mediante sistemas alternativos, lo que permitiría reducir la presión en el sector gubernamental y asignar mayores recursos a servicios preventivos y curativos a quienes no los pueden pagar