Annual Endovascular Thrombectomy Case Volume and Thrombectomy-capable Hospitals of Korea in Acute Stroke Care / 예방의학회지

Objectives@#Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume. @*Methods@#From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression. @*Results@#Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96). @*Conclusions@#The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.

How well does societal mobility restriction help control the COVID-19 pandemic? Evidence from real-time evaluation

ObjectivesTo determine the impact of restrictions on mobility on reducing transmission of COVID-19. DesignDaily incidence rates lagged by 14 days were regressed on mobility changes using LOESS regression and logit regression between the day of the 100th case in each country to August 31, 2020. Setting34 OECD countries plus Singapore and Taiwan. ParticipantsGoogle mobility data were obtained from people who turned on mobile device-based global positioning system (GPS) and agreed to share their anonymized position information with Google. InterventionsWe examined the association of COVID-19 incidence rates with mobility changes, defined as changes in categories of domestic location, against a pre-pandemic baseline, using country-specific daily incidence data on newly confirmed COVID-19 cases and mobility data. ResultsIn two thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased COVID-19 incidence, more so early in the pandemic. However, these decreases plateaued as mobility remained low or decreased further. We found smaller or negligible associations between mobility restriction and incidence rates in the late phase in most countries. ConclusionMild to moderate degrees of mobility restriction in most countries were associated with reduced incidence rates of COVID-19 that appear to attenuate over time, while some countries exhibited no effect of such restrictions. More detailed research is needed to precisely understand the benefits and limitations of mobility restrictions as part of the public health response to the COVID-19 pandemic. WHAT IS ALREADY KNOWN ON THIS TOPICSince SARS-CoV-2 became a pandemic, restrictions on mobility such as limitations on travel and closure of offices, restaurants, and shops have been imposed in an unprecedented way in both scale and scope to prevent the spread of COVID-19 in the absence of effective treatment options or a vaccine. Although mobility restriction has also brought about tremendous costs such as negative economic growth and other collateral impacts on health such as increased morbidity and mortality from lack of access to other essential health services, little evidence exists on the effectiveness of mobility restriction for the prevention of disease transmission. A search of PUBMED and Google Scholar for publications on this topic through Sep 20, 2020 revealed that most of the evidence on the effectiveness of physical distancing comes from mathematical modeling studies using a variety of assumptions. One study investigated only the combined effect of several interventions, including physical distancing, among SARS-CoV-2 infected patients. WHAT THIS STUDY ADDSThis is the first study to investigate the association between change in mobility and incidence of COVID-19 globally using real-time measures of mobility at the population level. For this, we used Google Global Mobility data and the daily incidence of COVID-19 for 36 countries from the day of 100th case detection through August 31, 2020. Our findings from LOESS regression show that in two-thirds of countries, reductions of up to 40% in commuting mobility were associated with decreased COVID-19 incidence, more so early in the pandemic. This decrease, however, plateaued as mobility decreased further. We found that associations between mobility restriction and incidence became smaller or negligible in the late phase of the pandemic in most countries. The reduced incidence rate of COVID-19 cases with a mild to moderate degree of mobility restriction in most countries suggests some value to limited mobility restriction in early phases of epidemic mitigation. The lack of impact in some others, however, suggests further research is needed to confirm these findings and determine the distinguishing factors for when mobility restrictions are helpful in decreasing viral transmission. Governments should carefully consider the level and period of mobility restriction necessary to achieve the desired benefits and minimize harm.

Association between Short Maternal Height and Low Birth Weight: a Hospital-based Study in Japan

Anthropometry measurements, such as height and weight, have recently been used to predict poorer birth outcomes. However, the relationship between maternal height and birth outcomes remains unclear. We examined the effect of shorter maternal height on low birth weight (LBW) among 17,150 pairs of Japanese mothers and newborns. Data for this analysis were collected from newborns who were delivered at a large hospital in Japan. Maternal height was the exposure variable, and LBW and admission to the neonatal intensive care unit were the outcome variables. Logistic regression models were used to estimate the associations. The shortest maternal height quartile (131.0-151.9 cm) was related to LBW (OR 1.91 [95% CI 1.64, 2.22]). The groups with the second (152.0-157.9 cm) and the third shortest maternal height quartiles (158.0-160.9 cm) were also related to LBW. A P trend with one quartile change also showed a significant relationship. The relationship between maternal height and NICU admission disappeared when the statistical model was adjusted for LBW. A newborn's small size was one factor in the relationship between shorter maternal height and NICU admission. In developed countries, shorter mothers provide a useful prenatal target to anticipate and plan for LBW newborns and NICU admission.

Horizontal Inequity in Elderly Health Care Utilization: Evidence from India

Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly.