Increase in Achilles Tendon Rupture Surgery in Japan: Results From a Nationwide Health Care Database

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.

Gender inequality among medical, pharmaceutical and dental practitioners in French hospitals: Where have we been and where are we now?

Introduction Women are under-represented in senior academic and hospital positions in many countries. The authors aim to assess the place and the evolution of all appointed female and male health practitioners’ working in French public Hospitals. Materials and methods Data of this observational study were collected from the National Management Centre (Centre National de Gestion) from 2015 up to January 1, 2020. First, the authors described demographic characteristics and specialties of all appointed medicine, pharmacy, and dentistry doctors’ working as Hospital Practitioners, Associate Professors, and Full Professors in French General and University-affiliated Hospitals in 2020. Then, they retrospectively reported the annual incidence of new entrance according to gender and professional status from 1999 to 2019 thanks to the appointment date of all practitioners in activity between 2015 and 2020. Results In 2020, 51 401 appointed practitioners (49.7% of female) were in activity in French public hospitals with a large majority being medical doctors (92.4%) compared to pharmacists (6%) and dentists (1.6%). Women represented 52.5% of the Hospital Practitioners, 48.6% of the Associate Professors, and 22.0% of the Full Professors (p < 0.001). There were disparities between the rates of female Full Professors in medicine (20.6%), pharmacy (36.1%), and dentistry (44.3%, p < 0.001). Women were appointed Hospital Practitioners and Associate Professors earlier than men (respectively 37.1 versus 38.8 years, p < 0.001 and 36.1 versus 36.5 years, p = 0.04), and at a later age among Full Professors (43.7 versus 41.9 years, p < 0.001). Compared to men, the annual proportion of appointed women varied significantly between 1999 and 2019 from 47.6% to 60.4% for Hospital Practitioners, from 50.0% to 44.6% for Associate Professors, and from 11.2% to 33.3% for Full Professors (p < 0.001 for trend). Conclusions Although more and more women occupy positions in French hospitals, there is still a gender gap regarding access to Full Professor status in medicine and pharmacy, but not in dentistry. The disparity in numbers makes comparison difficult. Despite a trend towards gender equality during the last twenty years, it has not yet been achieved regarding access to the highest positions.

Pharmacogenomic Biomarkers in US FDA-Approved Drug Labels (2000–2020)

Pharmacogenomics (PGx) is a key subset of precision medicine that relates genomic variation to individual response to pharmacotherapy. We assessed longitudinal trends in US FDA approval of new drugs labeled with PGx information. Drug labels containing PGx information were obtained from Drugs@FDA and guidelines from PharmGKB were used to compare the actionability of PGx information in drug labels across therapeutic areas. The annual proportion of new drug approvals with PGx labeling has increased by nearly threefold from 10.3% (n = 3) in 2000 to 28.2% (n = 11) in 2020. Inclusion of PGx information in drug labels has increased for all clinical areas over the last two decades but most prominently for cancer therapies, which comprise the largest proportion (75.5%) of biomarker–drug pairs for which PGx testing is required. Clinically actionable information was more frequently observed in biomarker–drug pairs associated with cancer drugs compared to those for other therapeutic areas (n = 92 (59.7%) vs. n = 62 (40.3%), p < 0.0051). These results suggest that further evidence is needed to support the clinical adoption of pharmacogenomics in non-cancer therapeutic areas.

A ’Local-Global’ model for Seasonal Diseases: Influenza Subtypes Analysis Case Study

Influenza epidemics in temperate regions display dynamics that are characterized by pronounced seasonal peaks during the winter. The general lack of influenza cases during the off-season may result from the virus physically disappearing at the end of the season, in which case it must be imported annually. Alternatively, it may result from persistent asymptomatic carriers or unnoticed local transmission chains that develop into local epidemics as conditions become conducive. Here I attempt to understand these differing explanations by analyzing the global distribution of the four major subtypes that comprise influenza over a period of 18 years based on FluNet data, the surveillance network and database compiled by the WHO, and the NCBI influenza data resource, a repository of relevant genetic information. Examining the annual proportion of each subtype, I find considerable variations in subtype annual proportions between the regions. Moreover, I find that seasonal influenza subtypes can remain confined to specific temperate regions, without showing measurable global presence. These results indicate that although largely undetected during the off-season, influenza is likely to persist locally, and imply a &lsquo;local-global&rsquo; model where annual influenza epidemics are a mixture of local strains undergoing reactivation together with an influx of global variants.

Children and pregnant women are more likely to develop severe Mycoplasma pneumoniae Pneumonia：Mycoplasma pneumoniae infection in Suzhou: 2014 to 2018

Purpose To study the epidemic characteristics of Mycoplasma pneumonia(MP) in the whole population and the clinical characteristics of severe Mycoplasma pneumoniae pneumonia(SMMP). Methods We retrospectively analyzed 56474 patients with respiratory tract infections (RTIS) of the affiliated hospital of Nanjing medical university from 2014 to 2018. Serum particle agglutination (PA) was used to detect MP specific IgM antibody to confirm MP infection. Results A total of 56474 patients with RTIs were enrolled, and 15857 (28.13%) of patients with MP-IgM positive were detected. From 2014 to 2018, the annual proportion of MP RITs was 23.60%, 28.18%, 38.08%, 27.05% and 23.44%. In terms of seasonal distribution, April-June and September-November were the peak seasons each year. The proportion of MP RITs of children was significantly higher than that of adults in almost every year. The proportion of MP RITs of female was significantly higher in children and adults. The peak age of MP infection was between the age of 4 and 14 years old. There were 216 cases of SMPP patients, including 198 children and 18 adults (8 cases of pregnant women). Children and pregnant women were more likely to develop severe Mycoplasma pneumonia. SMMP patients had more extrapulmonary symptoms, multilobar infiltrates and pleural effusion, and increased CRP, LDH and WBC(p < 0.05). Conclusions This study shows that MP infection has a seasonal, gender, and age distribution trend, and SMMP is more likely to occur in children and pregnant women. Understanding these characteristics will contribute to timely diagnose and treat MP infection.

Evolution of practices in a French trauma centre: decrease in blood transfusions and fresh frozen plasma to red blood cell ratios.

Background: Uncontrolled haemorrhage is still the leading cause of preventable death following trauma. Coagulation resuscitation strategies can be plasma-based or fibrinogen concentrate-based. The aim of this study was to describe the evolution of transfusion practices following the introduction of tranexamic acid (TXA) and ROTEM® in a trauma centre from a teaching hospital.Methods: This is a single-centre, retrospective study at a Trauma Resuscitation Unit (TRU) from a French teaching hospital. All trauma patients aged 18 years or more and transfused with at least 4 red blood cells (RBCs) within 24 hours after trauma, from 2011 to 2016, were included. The primary objective was to analyse transfusion practices over this time period.Assessment of the annual proportion of patients transfused with more than 4 RBCs at 24h, proportion of application of high fresh frozen plasma (FFP):RBC ratio (≥ 1:2 ), and proportion of administration of fibrinogen with ROTEM® protocol and TXA was performed. The secondary objectives aimed at assessing differences between populations according to the FFP:RBC ratio applied and compare all-cause mortality at D30.Results: A total of 122 patients were included. Between 2011 and 2016, there was a significant decrease in the proportion of patients requiring at least 4 RBCs 24h after trauma (9% vs. 3%, Ptrend < 0.0001) as well as a decrease in the proportion of patients with a high FFP:RBC ratio (86% vs. 62% at 6h, Ptrend = 0.0056 and 86% vs. 56% at 24h, Ptrend = 0.0047). After 2013, fibrinogen was administered to more than 70% of patients and TXA to 100% of them. Adherence to the ROTEM® protocol for the administration of fibrinogen was significant. The observed mortality was lower than the predicted one, irrespective of FFP:RBC ratio.Conclusion: From 2011 to 2016, an important evolution of practices occurred in the TRU including a decrease in the proportion of transfusions and use of high FFP:RBC ratios. The origin of these changes is multifactorial, likely including the systematic use of TXA and optimisation of the ROTEM® protocol for fibrinogen administration.

Diabetes mellitus among adults with tuberculosis in the USA, 2010–2017

IntroductionTo describe diabetes trends among adults with incident tuberculosis (TB) disease and examine diabetes-associated TB characteristics and patient outcomes in the USA.Research design and methodsWe examined all 71 855 persons aged ≥20 years with incident TB disease reported to the National Tuberculosis Surveillance System during 2010–2017. We performed multivariable logistic regression, comparing characteristics and outcomes among patients with TB reported to have diabetes and those whose diabetes status was unknown.ResultsAn overall 18% (n=13 281) of the 71 855 adults with incident TB disease were reported as also having diabetes; the annual proportion increased from 15% in 2010 to 22% in 2017. Among patients aged ≥45 years with both TB and diabetes, the adjusted OR for cavitary or sputum smear-positive TB was 1.7 and 1.5, respectively (95% CIs 1.5 to 1.8 and 1.4 to 1.6). Patients with TB and diabetes had 30% greater odds of dying and took longer to achieve negative Mycobacterium tuberculosis cultures and complete treatment.ConclusionsThe prevalence of reported diabetes among adults with TB disease has increased. Having diabetes as a comorbidity negatively affects patient outcomes. In accordance with national recommendations, all patients aged ≥45 years and all younger patients who have risk factors for diabetes should be screened for diabetes at the start of TB treatment.

Shelters Reflect but Cannot Solve Underlying Problems with Relinquished and Stray Animals—A Retrospective Study of Dogs and Cats Entering and Leaving Shelters in Denmark from 2004 to 2017

Data covering about 90% of the estimated intake of dogs and cats to Danish shelters from 2004 to 2017 were used to study the effects of tight control of dogs and of efforts to increase shelter services for unwanted or stray cats. During the period, there was a low and decreasing intake of dogs, while the annual proportion of euthanised dogs increased from 6% to 10%. The number of cats entering shelters increased by about 250%, while the annual proportion of euthanised cats increased from 15% to about 29%. At the same time, there seemed to be a decrease in the population of stray cats. The major increase in cat intake may be due to animal protection non-governmental organizations (NGOs) making it easier to relinquish cats into shelters. Dog shelters can successfully handle surplus animals because dogs are well controlled by owners and are tightly regulated. Cats are more difficult to confine, are often allowed to roam freely and are less regulated. Therefore, cat shelters cannot solve the problem of surplus cats on their own. It is argued that an economic analysis may serve as a point of departure for a discussion on better policy making for NGOs in charge of shelters.

A 20-Year Evaluation of LOINC in the United States' Largest Integrated Health System

Context.— Clinical laboratories are obligated to implement Logical Observation Identifier Names and Codes (LOINC), an informatics standard used to uniquely identify laboratory tests. The historical progress of laboratories in achieving this goal is unknown. Objective.— To evaluate the implementation of LOINC by clinical laboratories with attention to LOINC's adoption, diversity, and correctness over time. Design.— We aggregated data from 130 facilities within the Veterans Health Administration (VA), an early adopter of LOINC, during a 20-year period (1999–2018). To assess the adoption of LOINC, we calculated the annual proportion of tests and results without a LOINC. To assess the diversity of LOINC, we counted the yearly number of distinct LOINCs in active use. To assess the correctness of LOINC over time, we compared the assigned LOINCs to a manually reviewed gold standard for each year. Results.— We reviewed a total of 586 000 tests and 9.162 billion results. LOINC adoption, measured as a proportion of both tests and results, improved over time (P &lt; .001). In the final year reviewed, 85% (172 142 of 202 125) of laboratory tests and 99% (547 229 066 of 551 205 087) of results had LOINCs. The number of distinct LOINCs in active use from 1999 to 2018 increased 2.78-fold from 4502 to 12 503 (P &lt; .001). Correctness generally improved but varied considerably by test and across time. Conclusions.— The adoption of LOINC has improved during the past 2 decades. More diverse LOINCs were associated with increased adoption and were a challenge to keep up-to-date. The correctness of LOINCs has improved but remains an issue that likely necessitates supplemental review for most applications.

Characterization of MRSA in Canada from 2007 to 2016

Objectives This study assessed the demographic and molecular characteristics of community-associated (CA) and healthcare-associated (HA) MRSA genotypes in Canadian hospitals between 2007 and 2016. Methods A total of 1963 MRSA were identified among 9103 Staphylococcus aureus isolates collected from inpatients and outpatients presenting to tertiary-care medical centres across Canada. Antimicrobial susceptibility testing was performed by broth microdilution in accordance with CLSI standards (M7 11th edition, 2018). PCR was performed to detect the Panton–Valentine leucocidin (PVL) genes and molecular analysis was performed by spa typing. Results Between 2007 and 2016, the annual proportion of S. aureus that were MRSA decreased from 26.1% to 16.9% (P < 0.0001). The proportion of CA-MRSA genotypes increased significantly from 20.8% in 2007 to 56.3% in 2016 (P < 0.0001) while HA-MRSA genotypes decreased from 79.2% to 43.8% throughout the study period (P < 0.0001). Predominant genotypes included HA genotype CMRSA2 (USA100/800) (53.6%) and CA genotype CMRSA10 (USA300) (24.9%). PVL was present in 30.1% of all MRSA isolates, including 78.4% of CA-MRSA and 1.7% of HA-MRSA genotypes. Resistance to clarithromycin, clindamycin, trimethoprim/sulfamethoxazole and fluoroquinolones decreased significantly over time (P < 0.0001). Conclusions The proportion of MRSA in Canada declined between 2007 and 2016. In contrast, the proportion of CA-MRSA strain types, particularly CMRSA10 (USA300), continues to increase. In 2016, CA-MRSA genotypes surpassed HA-MRSA as the most common cause of MRSA infections in Canadian hospitals.