Monopolar and Bipolar Combination Injuries of the Clavicle: Retrospective Incidence Analysis and Proposal of a New Classification System

Clavicle injuries are common, but only few case reports describe combined clavicular injuries (CCI). CCI include combinations between clavicular fractures and acromioclavicular/sternoclavicular joint dislocations (SCJD). We present the first general therapeutic recommendations for CCI based on a new classification and their distribution. A retrospective, epidemiological, big data analysis was based on ICD-10 diagnoses from 2012 to 2014 provided by the German Federal Statistical Office. CCI represent 0.7% of all clavicle-related injuries (n = 814 out of 114,003). SCJD show by far the highest proportion of combination injuries (13.2% of all SCJD were part of CCI) while the proportion of CCI in relation to the other injury entities was significantly less (p < 0.023). CCIs were classified depending on (1) the polarity (monopolar type I, 92.2% versus bipolar type II, 7.8%). Monopolar type I was further differentiated depending on (2) the positional relationship between the combined injuries: Ia two injuries directly at the respective pole versus Ib with an injury at one end plus an additional midshaft clavicle fracture. Type II was further differentiated depending on (3) the injured structures: IIa ligamento-osseous, type IIb purely ligamentous (rarest with 0.6%). According to our classification, the CCI severity increases from type Ia to IIb. CCI are more important than previously believed and seen as an indication for surgery. The exclusion of further, contra-polar injuries in the event of a clavicle injury is clinically relevant and should be focused.

Efficiency Analysis of Scientific and Technological Innovation in Grain Production Based on Improved Grey Incidence Analysis

Analyzing and evaluating the efficiency of scientific and technological innovation in grain production is conducive to the rational allocation of resources, promoting the development of scientific and technological innovation in grain production and providing guarantee for grain security. By refining the elements of grain production and scientific and technological innovation, an evaluation system of scientific and technological innovation in grain production is constructed. Firstly, combining linear programming together with the traditional grey synthetic incidence analysis model, a incidence analysis of the scientific and technological innovation indicators of grain production is carried out, and the key and secondary indexes affecting grain outputs are screened by an improved grey incidence analysis model. Secondly, based on DEA-Malmquist index model and taking the grain production process as the research object, the scientific and technological achievement transformation indicators are divided into pre-production, in-production and post-production indicators. The key indicators and secondary indicators of scientific and technological innovation of grain production in various cities of Henan Province from 2010 to 2019 are used to analyze the efficiency of scientific and technological innovation in each stage of grain production. The results show that: (1) The type of basic ability of scientific and technological innovation indicators and the transformation ability of scientific and technological innovation achievements are the major indicators influencing grain outputs, and the investment of basic resources of scientific and technological innovation and the transformation of scientific and technological innovation achievements are the most important to improve grain outputs. (2) In addition, the study reveals that the secondary indicators of the technological innovation efficiency of grain production based on the DEA-Malmquist index model are more efficient than the key indicators in the pre-production, in-production and post-production stages. And there are gaps in the scientific and technological innovation performance of grain production among cities in Henan Province, and the index of technological progress is the leading factor for the gap.

Improving equity in the distribution and financing of health services in Mauritius, a small island state with deeply rooted welfare state standards

BackgroundEnsuring benefits of free healthcare services are accessible to those in need is essential to achieve universal health coverage (UHC). Mauritius has sustained a welfare state over four decades with free health services in all public facilities. However, paradoxically, the national UHC service coverage index stood at only 63 in 2017. An assessment of who benefits from health interventions is, therefore, vital to shape future health financing strategies.MethodsThe study applied benefit incidence analysis (BIA) to understand the distribution of healthcare utilisation and spending in comparison to income distribution. Also, a financial incidence analysis (FIA) was conducted to assess the progressivity of the health financing systems. Data from the national survey on household out-of-pocket (OOP) expenditure for health were used for the purpose of BIA and FIA. Concentration curves and concentration indices (CI) were nationally estimated and disaggregated to rural/urban levels. Kakwani index (KI) was calculated to assess the progressivity of private healthcare financing.ResultsThe CI for outpatient, inpatient and day care within the public health sector is estimated at −0.33, –0.14 and −0.14, respectively. Overall, CI in the public sector is −0.26. Benefit distribution in the private sector is pro-rich with CI of 0.27. Healthcare financing is regressive as demonstrated by a KI of −0.004, with the poorest population groups contributing a large share, in terms of taxes and OOP, to finance the health system.ConclusionThe BIA posits that government spending on public healthcare has resulted in significant pro-poor services distribution. This is largely offset by pro-rich distribution in the private sector. Thus, implying health financing strategies must be reviewed to promote financial protection against catastrophic health payments and bolster efforts to improve UHC service coverage index and achieve UHC Target 3.8 under Sustainable Development Goal 3.

Dietary Fibre Intake and the 10-Year Incidence of Tinnitus in Older Adults

Tinnitus is the phantom perception of sound in the ears or head that increases in prevalence as age increases. With strong evidence supporting the benefits of dietary fibre for vascular health and hearing loss, intake of dietary fibre may also have a role in the prevention of tinnitus symptoms. This longitudinal study aims to determine the association between the intake of dietary fibre and other carbohydrate nutrition variables including glycaemic index (GI), glycaemic load (GL) and total carbohydrate intakes, and incident tinnitus over 10 years. Of the 1730 participants (aged ≥50 years) from the Blue Mountains Hearing Study with complete baseline data on tinnitus symptoms and carbohydrate intakes, 536 (31%) cases of tinnitus were identified and excluded from further incidence analysis. Dietary data were collected using a validated semi-quantitative food frequency questionnaire to determine intakes of total dietary fibre and fibre contributions from cereals, vegetables, and fruit. A purpose-built database based on Australian GI values was used to calculate mean GI. Lower versus higher intakes of fruit fibre (≤3.6 g/day vs. >3.6 g/day) and cereal fibre (≤4.2 g/day vs. >4.2 g/day) were significantly associated with a 65% (HR = 1.65; 95% CI: 1.15–2.36) and 54% (HR = 1.54; 95% CI: 1.07–2.22) increased risk of developing tinnitus over 10 years, respectively. Associations between intake of other carbohydrate nutrients and incident tinnitus were mostly non-significant. In summary, our study showed modest associations between intake of dietary fibre and incident tinnitus. The protective effects of fibre, particularly insoluble fibre, could underlie observed associations by reducing the risk of tinnitus via vascular risk factors such as cardiovascular disease. Further longitudinal studies evaluating different types and sources of fibre and tinnitus risk are needed to confirm our study findings.

Characterization of The Portuguese Population Diagnosed With Retinoblastoma

PurposeThe purpose of this study is to characterize demographically and genetically the Portuguese population with retinoblastoma; to report the clinical stage at presentation and its impact on survival and ocular preservation rate and, finally, to assess the incidence of retinoblastoma in Portugal.MethodsCohort retrospective observational study including children consecutively diagnosed with retinoblastoma at the Portuguese National Referral Center of Intraocular Tumors, between October 2015 and October 2020ResultsTwenty-eight children were diagnosed with retinoblastoma at our center, 15 hereditary from which 12 presented with bilateral retinoblastoma and 3 were unilateral. The overall mean age at diagnosis was 13.6 ± 11.1 months with hereditary retinoblastomas diagnosed slightly earlier at 9.6 ± 6.3 months. A familial history of retinoblastoma was found in only 4 (14.3%) of the cases. A pathogenic mutation in the RB1 gene was found in 13 (46.4%) of the children. The most frequent sign at referral was leukocoria in 71.4% of patients. Considering the ICRB classification of the tumors, 84.6% of non-hereditable hereditary retinoblastomas were referred to our center in advanced stages. In the group of hereditable retinoblastomas 86.7% presented with one of the eyes with advanced intraocular retinoblastoma. Fourteen children had one eye enucleated due to retinoblastoma. No deaths were registered during the study period. Considering the incidence analysis, we registered a year-of-birth controlled incidence analysis of 4.04 per 100.000 living births (IC 95% 1.59 – 6.49).Conclusion This is the first characterization of the Portuguese Population diagnosed with Retinoblastoma in the National Reference Center.

Inequity and benefit incidence analysis in healthcare use among Syrian refugees in Egypt

Background The Syrian conflict has created the worst humanitarian refugee crisis of our time, with the largest number of people displaced. Many have sought refuge in Egypt, where they are provided with the same access to healthcare services as Egyptian citizens. Nevertheless, in addition to the existing shortcomings of the Egyptian health system, many obstacles specifically limit refugees’ access to healthcare. This study looks to assess equity across levels of care after observing services utilization among the Syrian refugees, and look at the humanitarian dilemma when facing resource allocation and the protection of the most vulnerable. Methods A cross‐sectional survey was used and collected information related to access and utilization of outpatient and inpatient health services by Syrian refugees living in Egypt. We used concentration index (CI), horizontal inequity (HI) and benefit incidence analysis (BIA) to measure the inequity in the use of healthcare services and distribution of funding. We decomposed inequalities in utilization, using a linear approximation of a probit model to measure the contribution of need, non-need and consumption influential factors. Results We found pro-rich inequality and horizontal inequity in the probability of refugees’ outpatient and inpatient health services utilization. Overall, poorer population groups have greater healthcare needs, while richer groups use the services more extensively. Decomposition analysis showed that the main contributor to inequality is socioeconomic status, with other elements such as large families, the presence of chronic disease and duration of asylum in Egypt further contributing to inequality. Benefit incidence analysis showed that the net benefit distribution of subsidies of UNHCR for outpatient and inpatient care is also pro-rich, after accounting for out-of-pocket expenditures. Conclusion Our results show that without equitable subsidies, poor refugees cannot afford healthcare services. To tackle health inequities, UNHCR and organisations will need to adapt programmes to address the social determinants of health, through interventions within many sectors. Our findings contribute to assessments of different levels of accessibility to healthcare services and uncover related sources of inequities that require further attention and advocacy by policymakers.

Functional and Anthropometrical Screening Test among High Performance Female Football Players: A Descriptive Study with Injury Incidence Analysis, the Basque Female Football Cohort (BFFC) Study

The main objectives of the present study were to describe the injury incidence and to analyze the anthropometric and physical characteristics of players from three high-level women’s football teams. The present study involved 54 female football players (21.9 ± 4.9 years old) from three different teams competing in the Spanish Reto Iberdrola-Segunda División PRO league. A battery of tests was carried out to determine the anthropometric and physical performance characteristics of the players along with an injury incidence record during a full competitive season. The obtained results showed that there was a high incidence of injury, as 38% of the players suffered some type of injury during the season (range 1–5; 1.75 ± 1.02 injuries per player). Injuries occurred in both matches and during training at a similar percentage (48.6 vs. 51.4%), and the majority of the registered episodes were graded as moderate or severe injury types (60%). Players suffering from an injury accumulated a total of 1587 chronological days off work due to injury during the season, with a recurrence rate of 55%. Considering the high incidence of injury, and the injury burden and the reinjure rate observed in this research, it seems necessary to apply the most efficient prevention and recovery measures possible in these female football teams. These descriptive data could serve athletic trainers and medical staff of female football teams to better understand their own screening procedure-derived data.

Impact of Electrification on African Development‐Analysis with Using Grey Systems Theory

In this paper, the authors discuss the problem of the influence of the level of electrification in African countries on their sustainable development. The first aim of the article is to determine the relationship between changes in the electrification index and changes in the indicators showing individual components of sustainable development for African countries. The analyzed indicators of sustainable development include GDP per capita, Human Deveopment Index (HDI), and the CO2 emissions per capita indicator. The second goal of the article was to develop a synthetic indicator of sustainable development. This study uses the method of relationship research based on Gray Systems Theory—Gray Incidence Analysis. The main conclusion from the research carried out is that improving access to electricity is a necessary condition for the sustainable development of African countries. The lack of improvement in the availability of electricity is a basic barrier to development, especially in the poorest African countries.

EXPERIENCE WITH PANCREATOGASTROSTOMY AS RECONSTRUCTION FOR PANCREATODUODENECTOMY

The article represents results of the study held by the personnel of the National Institute of Surgery and Transplantology after A.A. Shalimov and National Institute of Cancer, with a total of 35 pancreatoduodenectomies performed, followed by reconstruction pancreatogastrostomy. Key advantages of the pancreatogastrostomy method from both anatomical-physiological and surgical difficulty views are described in the article. Aims: To analyze the pancreatogastrostomy efficiency as reconstruction stage by assessment of its technical aspects and postoperative complication incidence analysis.