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OBJECTIVES: This study aimed to develop a patient-centred approach to the burden of acute type A aortic dissection (ATAAD) through modelling. The main objective was to identify potential improvements in managing this life-threatening cardiovascular condition and to provide evidence-based recommendations to optimise outcomes. DESIGN: We developed a predictive model along patient pathways to estimate the burden of ATAAD through the years of life lost (YLLs) metric. The model was created based on a systematic review of the literature and was parameterised using demographic data from the German healthcare environment. The model was designed to allow interactive simulation of different scenarios resulting from changes in key impact factors. SETTING: The study was conducted using data from the German healthcare environment and results from the literature review. PARTICIPANTS: The study included a comprehensive modelling of ATAAD cases in Germany but did not directly involve participants. INTERVENTIONS: There were no specific interventions applied in this study based on the modelling design. PRIMARY AND SECONDARY OUTCOME MEASURES: The single outcome measure was the estimation of YLL due to ATAAD in Germany. RESULTS: Our model estimated 102 791 YLL per year for ATAAD in Germany, with 62 432 and 40 359 YLL for men and women, respectively. Modelling an improved care setting yielded 93 191 YLL or 9.3% less YLL compared with the current standard while a worst-case scenario resulted in 113 023 or 10.0% more YLL. The model is accessible at https://acuteaorticdissection.com/ to estimate custom scenarios. CONCLUSIONS: Our study provides an evidence-based approach to estimating the burden of ATAAD and identifying potential improvements in the management of pathways. This approach can be used by healthcare decision-makers to inform policy changes aimed at optimising patient outcomes. By considering patient-centred approaches in any healthcare environment, the model has the potential to improve efficient care for patients suffering from ATAAD.

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BACKGROUND: Patient-reported outcome measures - PROMs - have been developed to provide an assessment of patients' physical function, symptoms, and health-related quality of life. With patient-centered care becoming increasingly important, several national strategies have been initiated for PROM measurement. However, Germany is only at the beginning of this process. The objective of this study is to assess patients' experience with and perception of completing PROMs in patients undergoing knee and hip replacement in Germany. METHODS: This study used survey data from patients undergoing hip or knee replacement surgery in a hospital in Germany. Before surgery, patients completed a PROMs survey. After at least 6 months, patients were re-contacted to fill in a questionnaire about their experiences with and perception of the PROMs data collection. RESULTS: Most patients either agreed or totally agreed that the time to fill in the questionnaire was appropriate (89%), that the purpose of the PROMs collection was clear (85%), that the questionnaire's content applied to their appointment (73%), and that this systematic assessment was beneficial (81%). The corresponding proportions were 54% for feeling productive while waiting and 50% for feeling that the information in the questionnaire affected the patient-doctor interaction positively. Only few significant associations were found between patient characteristics and the favorability of patients' ratings. There were no significant differences between hip and knee replacement surgery patients regarding the favorability rating on any survey question. CONCLUSIONS: The results of this study suggest that PROMs collection in the context of hip and knee replacement surgery is practicable and partly also perceived beneficial by patients. Orthopedic procedures could serve as a starting point for broader use and routine PROMs collection in Germany.

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OBJECTIVE: To investigate how county and state-level estimates of Medicaid enrollment among the total, non-Hispanic White, non-Hispanic Black or African American, and Hispanic or Latino/a population are affected by Differential Privacy (DP), where statistical noise is added to the public decennial US census data to protect individual privacy. DATA SOURCES: We obtained population counts from the final version of the US Census Bureau Differential Privacy Demonstration Products from 2010 and combined them with Medicaid enrollment data. STUDY DESIGN: We compared 2010 county and state-level population counts released under the traditional disclosure avoidance techniques and the ones produced with the proposed DP procedures. DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: We find the DP method introduces errors up to 10% into counts and proportions of Medicaid participation rate accuracy at the county level, especially for small subpopulations and racial and ethnic minority groups. The effect of DP on Medicaid participation rate accuracy is only small and negligible at the state level. CONCLUSIONS: The implementation of DP in the 2020 census can affect the analyses of health disparities and health care access and use among different subpopulations in the United States. The planned implementation of DP in other census-related surveys such as the American Community Survey can misrepresent Medicaid participation rates for small racial and ethnic minority groups. This can affect Medicaid funding decisions.

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Sugar-sweetened beverages (SSBs) are associated with increased body weight and obesity, which induce a wide array of health impairments such as diabetes or cardiovascular disorders. Excise taxes have been introduced to counteract SSB consumption. We investigated the effect of sugar taxes on SSB sales in Hungary and France using a synthetic control approach. For France, we found a slight decrease in SSB sales after tax implementation while overall soft drink sales increased. For Hungary, there was only a short-term decrease in SSB sales which disappeared after 2 years, leading to an overall increase in SSB sales. However, both effects are characterized by great uncertainty.

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BACKGROUND: Fragility fractures of the pelvis (FFP) show a notable rise in prevalence. Minimally invasive surgical fixation of FFP is increasingly advocated for its obvious advantages with reference to early mobilization and weight bearing. Concerns regarding the holding power of osteosynthetic materials in osteoporotic bone led to the development of cementing techniques. However, the role of cement augmentation in the surgical treatment of FFP has yet to be defined. Therefore, the aim of this study was to conduct a systematic review of the current literature concerning studies that are comparing the performance of cement augmented versus non-augmented sacroiliac (SI) screws. METHODS: We conducted a systematic literature review from 01/01/2000 onwards. Inclusion criteria were randomized controlled studies, case series (n>3), biomechanical studies and reviews, comparing augmented and non-augmented SI screws. Only papers in German or English language were included. RESULTS: Out of 1247 initial hits, eleven studies met the inclusion criteria. Out of those, six were biomechanical studies and five were clinical case series. Most biomechanical studies showed cement augmented screws to have a greater mechanical stability, both regarding pull-out force and resistance to cyclic loading. The five case studies reported on a total of 98 patients with 122 screw fixations. Three cases of cement leakage into neuroforamina occurred, however, none of these patients showed clinical symptoms. CONCLUSION: In clinical case series, cement augmentation of SI screws appears to be a safe surgical technique without relevant complications and biomechanical studies demonstrate greater pull-out forces of augmented SI screws but no advantage in regard of cyclic loading. Hence, applicability of the mechanical testing results on the clinical situation are debatable. So far, there are neither retrospective nor randomized controlled studies comparing the performance of cemented and non-cemented SI screws in FFP. Therefore, the clinical benefit of SI screw cement augmentation is unclear and their use remains experimental.

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BACKGROUND: Diagnosis and treatment of children with mild traumatic brain injury (mTBI) remain a challenge since initial signs and symptoms do not always indicate the severity of the trauma. Therefore, guidelines regarding the decision upon imaging methods and ambulatory or hospitalized treatment are needed. The goal of our study was to investigate if the standard that was allied from the PECARN rules and is applied in this study can ensure that patients with clinically important brain injury are recognized and leads to outcomes with a low complication rate, a high patient satisfaction and minimal post-concussion syndrome incidence. METHODS: We enrolled 478 children with mTBI and contacted their families with a questionnaire. Out of these, 267 valid questionnaires were received. Patient records and questionnaires were analyzed yielding a number of 140 ambulatory and 127 hospitalized patients. RESULTS: Patients with mild TBI were admitted according to the above-mentioned guidelines or sent home for observation through their parents after thorough patient examination and information. Among ambulatory patients only 13 children (9%) underwent any imaging procedure; however, none of those showed any pathological findings. Next, in 41 of 127 hospitalized patients (32.2%) an imaging study was performed and of these only 3 according to 2.4% of hospitalized patients showed pathological findings, namely a skull fracture, two of them in combination with an intracranial hemorrhage. The duration of inpatient observation was 48 h in most cases (55.3%). Moreover, a majority of all patients (72.4%) did not seek any follow-up visit and did not need any further treatment. Of all patients in the study, only 10 patients according to 3.7% developed a post-concussion syndrome. Patient satisfaction was very high in both, the ambulatory and hospitalized patient group. CONCLUSION: This study confirms that PECARN rules as administered in this study can ensure safe decision-making regarding ambulatory or inpatient treatment.

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Estudo exploratório descritivo, qualitativo, cujo objetivo foi analisar e comparar as representações sociais de adolescentes primíparas, acerca de "ser mãe", antes e após o nascimento dos bebês. Foram informantes, cinco adolescentes, que realizavam o pré-natal num Posto de Saúde, da periferia do Rio Grande RS, no período de agosto a novembro de 2006 .: Utilizou-se entrevista semi-estruturada na coleta de dados e análise de conteúdo no tratamento. Apreendeu-se no pré-natal, que todas demonstraram satisfação com a gravidez, orgulho com a barriga e o enxoval. Tinham a representação de mãe ancorada na imagem da mulher bondosa e abnegada, sendo a maternidade algo natural e irrefletidamente maravilhoso. Desconheciam os compromissos advindos da maternidade e limitavam seus sonhos e expectativas aquele momento de vida. Após o nascimento, referiram que a nova realidade foi impactante desencadeando inúmeras modificações em seus projetos de vida. Para tentarem assumir a condição de mãe, para a qual não tinham condições psicológicas nem sociais, cogitaram duas possibilidades, a de procurar um emprego e a de abandonar os estudos, ambas interferindo no processo de adolescer saudável e dificultando o vislumbramento de oportunidades. Acredita-se que, oportunizar o compartilhamento de tais representações com outras adolescentes possa diminuir a vulnerabilidade à gravidez precoce.

The present paper is a descriptive, qualitative study carried out to identify, analyze, and compare primipara adolescents' social representation of "being mothers", before and after the childbirth process. The subjects were five students who did their prenatal care in a health service institution on the outskirts of Rio Grande/RS, in the period between August and November of 2006. The data was collected by means of a semi-structured interview and content analysis in the treatment. It was noticed that all the girls seemed to be satisfied with their pregnancy and were proud of their appearance and to show the baby's trousseau. All of them correlated the social representations of "mothers" with the image of kind, abnegated women. In their opinion, maternity is natural and wonderful, something beautiful and great. They did not consider the commitment entailed by maternity and limited their dreams and expectations to that restricted moment of life. After the babies were born, reported that facing this new reality had a profound impact and unchained numerous changes in their personal expectations. In an attempt to assume the role of mothers, for which they were socially and psychologically unprepared, they came up with two alternatives: finding a job or quitting school, both interfering with the natural process of adolescence and impairing the outlook on opportunities. It is believed that giving the opportunity to the sharing of these representations with other adolescents can decrease the vulnerability to the premature pregnancy.

Estudio exploratorio descriptivo, cualitativo, realizado con el objetivo de analizar y comparar las representaciones sociales de adolescentes primíparas, acerca del "ser madre", antes y después del nacimiento de los bebes. Fueron informantes, cinco adolescentes, que realizaban el prenatal en una Unidad de Salud, de la periferia de Rio Grande RS, en el período de agosto a noviembre de 2006. Se realizó la colecta de datos, por medio de entrevista medio estructurada y el análisis del contenido para el tratamiento. Se aprendió que antes del parto, todas demostraron satisfacción con el embarazo, orgullo con la barriga y con el ajuar del bebe. Que tenían la representación social del "madre" anclada en el imagen de la mujer buena y abnegada. Para ellas la maternidad era algo "natural" y sin reflexión, maravillosa. Desconocían los compromisos relativos a la maternidad y limitaban sus sueños y expectativas a aquel momento de la vida. Después del nacimiento, refirieron que la nueva realidad fue impactante y desencadenó varias modificaciones en sus proyectos de vida. Intentando asumir la condición de madre, a la cual no tenían condiciones psicológicas ni sociales, mencionaron dos posibilidades, la de buscar un empleo y la de abandonar los estudios, ambas interfiriendo en el proceso del adolecer saludable y dificultando la visión de las oportunidades. Se acredita que, oportunizar el compartijamiento de tales representaciones con otras adolescentes, pueda disminuir la vulnerabilidad a la gravidez precoz.

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