Association Between ICD-10 Codes for Social Needs and Subsequent Emergency and Inpatient Use.

BACKGROUND: International Classification of Diseases, 10th revision Z codes capture social needs related to health care encounters and may identify elevated risk of acute care use. OBJECTIVES: To examine associations between Z code assignment and subsequent acute care use and explore associations between social need category and acute care use. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: Adults continuously enrolled in a commercial or Medicare Advantage plan for ≥15 months (12-month baseline, 3-48 month follow-up). OUTCOMES: All-cause emergency department (ED) visits and inpatient admissions during study follow-up. RESULTS: There were 352,280 patients with any assigned Z codes and 704,560 sampled controls with no Z codes. Among patients with commercial plans, Z code assignment was associated with a 26% higher rate of ED visits [adjusted incidence rate ratio (aIRR) 1.26, 95% CI: 1.25-1.27] and 42% higher rate of inpatient admissions (aIRR 1.42, 95% CI: 1.39-1.44) during follow-up. Among patients with Medicare Advantage plans, Z code assignment was associated with 42% (aIRR 1.42, 95% CI: 1.40-1.43) and 28% (aIRR 1.28, 95% CI: 1.26-1.30) higher rates of ED visits and inpatient admissions, respectively. Within the Z code group, relative to community/social codes, socioeconomic Z codes were associated with higher rates of inpatient admissions (commercial: aIRR 1.10, 95% CI: 1.06-1.14; Medicare Advantage: aIRR 1.24, 95% CI 1.20-1.27), and environmental Z codes were associated with lower rates of both primary outcomes. CONCLUSIONS: Z code assignment was independently associated with higher subsequent emergency and inpatient utilization. Findings suggest Z codes' potential utility for risk prediction and efforts targeting avoidable utilization.

Understanding COVID-19 Vaccine Effectiveness Against Death Using a Novel Measure: COVID Excess Mortality Percentage.

COVID-19 vaccines have saved millions of lives and prevented countless adverse patient disease outcomes. Understanding the long-term effectiveness of these vaccines is imperative to developing recommendations for precautions and booster doses. Comparisons between more and less vaccinated groups may be misleading due to selection bias, as these groups may differ in underlying health status and thus risk of adverse COVID-19 outcomes. We study all adult deaths over April 1, 2021-June 30, 2022 in Milwaukee County, Wisconsin, linked to vaccination records, use mortality from other natural causes to proxy for underlying health, and report relative COVID-19 mortality risk (RMR) for vaccinees versus the unvaccinated, using a novel outcome measure that controls for selection effects. This measure, COVID Excess Mortality Percentage (CEMP) uses the non-COVID natural mortality rate (Non-Covid-NMR) as a measure of population risk of COVID mortality without vaccination. We validate this measure during the pre-vaccine period (r = 0.97) and demonstrate that selection effects are large, with Non-Covid-NMRs for two-dose vaccinees less than half those for the unvaccinated, and Non-COVID NMRs still lower for three dose (booster) recipients. Progressive waning of two-dose effectiveness is observed, with relative mortality risk (RMR) for two-dose vaccinees aged 60 + versus the unvaccinated of 11% during April-June 2021, rising steadily to 36% during the Omicron period (January-June, 2022). Notably, a booster dose reduced RMR to 10-11% for ages 60+. Boosters thus provide important additional protection against mortality.

The Effect of the COVID-19 Pandemic on the Elderly: Population Fatality Rates, COVID Mortality Percentage, and Life Expectancy Loss.

The COVID-19 pandemic has disproportionately affected the elderly. This Article provides a detailed analysis of those effects, drawing primarily on individual-level mortality data covering almost three million persons aged 65+ in three Midwest states (Indiana, Illinois, and Wisconsin). We report sometimes surprising findings on population fatality rates ("PFR"), the ratio of COVID to non-COVID deaths, reported as a percentage, which we call the "Covid Mortality Percentage," and mean life expectancy loss ("LEL"). We examine how these COVID-19 outcomes vary with age, gender, race/ethnicity, socio-economic status, and time period during the pandemic. For all persons in the three Midwest areas, COVID PFR through year-end 2021 was 0.22%, mean years of life lost ("YLL") was 13.0 years, the COVID Mortality Percentage was 12.4%, and LEL was 0.028 years (eleven days). In contrast, for the elderly, PFR was 1.03%; YLL was 8.8 years, the COVID Mortality Percentage was 13.2%, and LEL was 0.091 years (thirty-four days). Controlling for gender, PFR and LEL were substantially higher for Blacks and Hispanics than for Whites at all ages. Racial/ethnic disparities for the elderly were large early in the pandemic but diminished later. Although COVID-19 mortality was much higher for the elderly, the COVID Mortality Percentage over the full pandemic period was only modestly higher for the elderly, at 13.2%, than for non-elderly adults aged 25-64, at 11.1%. Indeed, in 2021, this ratio was lower for the elderly than for the middle-aged, reflecting higher elderly vaccination rates.

Diseño e implementación de OSCE para evaluar competencias de egreso en estudiantes de medicina en un consorcio de universidades chilenas / A standardized objective structured clinical examination to assess clinical competencies in medical students

Background: Outcomes-based education is a trend in medical education and its assessment is one of the main challenges. The Objective Structured Clinical Examination (OSCE) is one of the tools used to assess clinical competencies. Although Chilean medical schools have used OSCEs for 18 years, there is a vast variability in the way these examinations are administered. Aim: To design and implement an integrated OSCE to assess clinical competencies at the end of the medical program in Chilean medical schools, aiming to reduce variability between these schools. Material and Methods: Seven medical schools, supported by experts from the National Board of Medical Examiners, designed a 12 station OSCE to measure clinical outcomes at the end of the seventh year of medical training. Unlike traditional OSCEs, this new examination incorporated the assessment of clinical reasoning and communication skills, evaluated from patients' perspective. Results: One hundred twenty-five volunteers took the same exam at five different venues. The internal consistency was 0.62. Following a compensatory approach, 85% of students passed the exam. Communication assessment showed poorer results than those reported in the literature. Conclusions: Among Chilean medical students, the assessment of clinical outcomes in a collaborative way, through a valid and reliable exam, is feasible. A consensus on how to teach and assess clinical reasoning across the medical curriculum is required. The assessment of students' communication skills requires further development.

[A standardized objective structured clinical examination to assess clinical competencies in medical students]. / Diseño e implementación de OSCE para evaluar competencias de egreso en estudiantes de medicina en un consorcio de universidades chilenas.

BACKGROUND: Outcomes-based education is a trend in medical education and its assessment is one of the main challenges. The Objective Structured Clinical Examination (OSCE) is one of the tools used to assess clinical competencies. Although Chilean medical schools have used OSCEs for 18 years, there is a vast variability in the way these examinations are administered. AIM: To design and implement an integrated OSCE to assess clinical competencies at the end of the medical program in Chilean medical schools, aiming to reduce variability between these schools. MATERIAL AND METHODS: Seven medical schools, supported by experts from the National Board of Medical Examiners, designed a 12 station OSCE to measure clinical outcomes at the end of the seventh year of medical training. Unlike traditional OSCEs, this new examination incorporated the assessment of clinical reasoning and communication skills, evaluated from patients' perspective. RESULTS: One hundred twenty-five volunteers took the same exam at five different venues. The internal consistency was 0.62. Following a compensatory approach, 85% of students passed the exam. Communication assessment showed poorer results than those reported in the literature. CONCLUSIONS: Among Chilean medical students, the assessment of clinical outcomes in a collaborative way, through a valid and reliable exam, is feasible. A consensus on how to teach and assess clinical reasoning across the medical curriculum is required. The assessment of students' communication skills requires further development.

Relationship among academic engagement, burnout and student perceptions of curriculum delivery in Speech and Language Therapy Students from University of Concepcion, Chile.

OBJECTIVE: To relate engagement and academic burnout with curriculum evaluation among speech therapy students. METHODS: This observational, cross-sectional study was conducted at the end of the first academic semester for each level and at the end of a theoretical class in order to ensure the maximum participation rate at the University of Concepción, Concepción, Chile, and comprised students of a speech and language therapy programme.Curriculum evaluation scale, academic engagement and academic burnout questionnaires were used. STATA SE 11 was used for statistical analysis. RESULTS: Of the 200 participants, 157(78.50%) were women and 43(21.50%) men. The overall mean age was 20.81±2.15 years (range: 18-30 years). Emotional burnout was inversely correlated with the evaluation of teaching and evaluation methods, distribution of fields, teaching team and achievement of objectives (p<0.05 each). Depersonalisation was inversely associated with the distribution of teaching and learning activities (r=-0.13; p<0.05). Lack of personal accomplishment was also significantly and statistically associated with seven out of the eight factors of the curriculum evaluation scale (p<0.05 each). Involvement in studies was statistically and significantly related to all factors (p<0.05 each), except the achievement of objectives. Finally, satisfaction with studies was directly, statistically and significantly related to six of the eight factors (p<0.05 each). CONCLUSIONS: A more positive evaluation of the academic curriculum was associated with lower levels of burnout and higher levels of academic engagement.

Relación de antecedentes académicos y expectativas iniciales con el bienestar académico de alumnos de primer año de medicina / Relationship between previous academics background and initial expectations with academic well-being of first year of medical students

Introducción: Los estudiantes de primer año de medicina deben afrontar altas exigencias académicas y personales que influyen en el bienestar y el desempeño académico. Esta investigación analiza la relación de los antecedentes académicos y las expectativas académicas iniciales con el bienestar académico de alumnos de primer año de medicina. Sujetos y métodos: Estudio cuantitativo, transversal y correlacional. Se aplicaron los cuestionarios UWES-S17, MBI-HSS e involucramiento académico, versión expectativas. Se obtienen los antecedentes académicos y sociodemográficos de una base de datos oficial. Resultados: Se encontró una relación directa entre las notas de enseñanza media y la dimensión de involucramiento en los estudios del compromiso académico (engagement), una relación inversa con la falta de realización personal del desgaste académico (burnout) y relaciones directas entre las tres dimensiones de las expectativas académicas y el compromiso académico e inversas con la dimensión falta de realización personal del desgaste académico. Conclusión: Tanto los antecedentes académicos previos como las expectativas académicas iniciales se relacionan con el bienestar académico tras el primer semestre

Introduction: First year medical students face personal and high academic standards impacting the well-being and academic performance. This research examines the relationship of the academic background and the initial academic expectations with the academic well-being of first year medical students. Subjects and methods: Quantitative, transversal and correlational study. Applied the questionnaire UWES-S17, MBI-HSS and Academic Involvement, version Expectations. Academic and socio-demographic basis of official data are obtained. Results: We found direct relationships between the high school grades and dimension of involvement in studies of the academic engagement and inverse with the lack of fulfillment of academic burnout and direct relationships between the three dimensions of the academic expectations and academic engagement and reverse with the lack of personal fulfillment dimension of academic burnout. Conclusion: Both the previous academic background and initial academic expectations relate to the academic well-being after the first semester

[Relationship between self-directed learning and value profile in Chilean medical students]. / Aprendizaje autodirigido y su relación con el perfil valórico en estudiantes de medicina.

BACKGROUND: Medical education should prepare students to face a dynamic environment, through competencies that allow them to learn independently. AIM: To evaluate the relationship between self-directed learning and value profile of undergraduate first year students in a medical school in Chile. MATERIAL AND METHODS: Self-Directed Learning Scale and Schwartz's Values Questionnaire were applied to 235 medical students from the University of Concepción, Chile. RESULTS: Self-direction and Security are value types that correlate directly and significantly with the overall scale and with the five subscales of Self-Directed Learning. CONCLUSIONS: In first year medical students ofUniversity of Concepcion, Chile, Self-direction and Security are values that facilitate Self-directed Learning.

Aprendizaje autodirigido y su relación con el perfil valórico en estudiantes de medicina / Relationship between self-directed learning and value profile in Chilean medical students

Background: Medical education should prepare students to face a dynamic environment, through competencies that allow them to learn independently. Aim: To evaluate the relationship between self-directed learning and value profile of undergraduate first year students in a medical school in Chile. Material and Methods: Self-Directed Learning Scale and Schwartz's Values Questionnaire were applied to 235 medical students from the University of Concepción, Chile. Results: Self-direction and Security are value types that correlate directly and significantly with the overall scale and with the five subscales of Self-Directed Learning. Conclusions: In first year medical students ofUniversity of Concepcion, Chile, Self-direction and Security are values that facilitate Self-directed Learning.

A note on the use of optimal control on a discrete time model of influenza dynamics.

A discrete time Susceptible - Asymptomatic - Infectious - Treated - Recovered (SAITR) model is introduced in the context of influenza transmission. We evaluate the potential effect of control measures such as social distancing and antiviral treatment on the dynamics of a single outbreak. Optimal control theory is applied to identify the best way of reducing morbidity and mortality at a minimal cost. The problem is solved by using a discrete version of Pontryagin's maximum principle. Numerical results show that dual strategies have stronger impact in the reduction of the final epidemic size.

Adaptive human behavior in epidemiological models.

The science and management of infectious disease are entering a new stage. Increasingly public policy to manage epidemics focuses on motivating people, through social distancing policies, to alter their behavior to reduce contacts and reduce public disease risk. Person-to-person contacts drive human disease dynamics. People value such contacts and are willing to accept some disease risk to gain contact-related benefits. The cost-benefit trade-offs that shape contact behavior, and hence the course of epidemics, are often only implicitly incorporated in epidemiological models. This approach creates difficulty in parsing out the effects of adaptive behavior. We use an epidemiological-economic model of disease dynamics to explicitly model the trade-offs that drive person-to-person contact decisions. Results indicate that including adaptive human behavior significantly changes the predicted course of epidemics and that this inclusion has implications for parameter estimation and interpretation and for the development of social distancing policies. Acknowledging adaptive behavior requires a shift in thinking about epidemiological processes and parameters.

Aspergilose em avestruz (Struthio camelus) no Brasil / Aspergillosis in an ostrich (Struthio camelus) in Brazil

Criatórios de avestruz têm se tornado comuns no Brasil, mas por se tratar de espécie exótica, as informações sobre as doenças desses animais no nosso ambiente são escassas. Um avestruz de cinco meses de idade apresentou tosse, anorexia, perda de peso, dispnéia discreta, temperatura corporal normal e morreu oito dias após o início dos sinais clínicos. Macroscopicamente foram observados nódulos múltiplos no pulmão e nos sacos aéreos. Histolopatogicamente, observou-se pneumonia granulomatosa e necrosante multifocal com hifas ramificadas e septadas intralesionais com características morfológicas de Aspergillus sp. Nos sacos aéreos, além das hifas e processo inflamatório adjacente haviam vários micélios com conidióforos na superfície interna. Foi isolado Aspergillus fumigatus dos tecidos afetados. De acordo com os achados histopatológicos e micológicos firmou-se o diagnóstico de pneumonia e aerossaculite micótica severa causada por Aspergillus fumigatus. Com base nas informações disponíveis na literatura, esse é o primeiro caso de aspergilose em avestruz documentado no Brasil.