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Kim T, Choi H, Kim SH, Yang B, Han K, Jung JH, Kim BG, Park DW, Moon JY, Kim SH, Kim TH, Yoon HJ, Shin DW, Lee H. Increased Risk of Incident Chronic Obstructive Pulmonary Disease and Related Hospitalizations in Tuberculosis Survivors: A Population-Based Matched Cohort Study. J Korean Med Sci 2024; 39:e105. [PMID: 38529575 DOI: 10.3346/jkms.2024.39.e105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/29/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) survivors have an increased risk of developing chronic obstructive pulmonary disease (COPD). This study assessed the risk of COPD development and COPD-related hospitalization in TB survivors compared to controls. METHODS We conducted a population-based cohort study of TB survivors and 1:1 age- and sex-matched controls using data from the Korean National Health Insurance Service database collected from 2010 to 2017. We compared the risk of COPD development and COPD-related hospitalization between TB survivors and controls. RESULTS Of the subjects, 9.6% developed COPD, and 2.8% experienced COPD-related hospitalization. TB survivors had significantly higher COPD incidence rates (36.7/1,000 vs. 18.8/1,000 person-years, P < 0.001) and COPD-related hospitalization (10.7/1,000 vs. 4.3/1,000 person-years, P < 0.001) than controls. Multivariable Cox regression analyses revealed higher risks of COPD development (adjusted hazard ratio [aHR], 1.63; 95% confidence interval [CI], 1.54-1.73) and COPD-related hospitalization (aHR, 2.03; 95% CI, 1.81-2.27) in TB survivors. Among those who developed COPD, the hospitalization rate was higher in individuals with post-TB COPD compared to those with non-TB COPD (10.7/1,000 vs. 4.9/1,000 person-years, P < 0.001), showing an increased risk of COPD-related hospitalization (aHR, 1.84; 95% CI, 1.17-2.92). CONCLUSION TB survivors had higher risks of incident COPD and COPD-related hospitalization compared to controls. These results suggest that previous TB is an important COPD etiology associated with COPD-related hospitalization.
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Affiliation(s)
- Taehee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hayoung Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sang Hyuk Kim
- Deparment of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk Univiersity College of Medicine, Gyeongju, Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo-Guen Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Won Park
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji Yong Moon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Heon Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae-Hyung Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Polkowska-Kramek A, Begier E, Bruyndonckx R, Liang C, Beese C, Brestrich G, Tran TMP, Nuttens C, Casas M, Bayer LJ, Huebbe B, Ewnetu WB, Agudelo JLR, Gessner BD, von Eiff C, Rohde G. Estimated Incidence of Hospitalizations and Deaths Attributable to Respiratory Syncytial Virus Infections Among Adults in Germany Between 2015 and 2019. Infect Dis Ther 2024:10.1007/s40121-024-00951-0. [PMID: 38520629 DOI: 10.1007/s40121-024-00951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/22/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) burden in adults is underestimated mainly due to unspecific symptoms and limited standard-of-care testing. We estimated the population-based incidence of hospitalization and mortality attributable to RSV among adults with and without risk factors in Germany. METHODS Weekly counts of hospitalizations and deaths for respiratory, cardiovascular, and cardiorespiratory diseases were obtained (Statutory Health Insurance database, 2015-2019). A quasi-Poisson regression model was fitted to estimate the number of hospitalizations and deaths attributable to RSV as a function of periodic and aperiodic time trends, and viral activity while allowing for potential overdispersion. Weekly counts of RSV and influenza hospitalizations in children < 2 years and adults ≥ 60 years, respectively, were used as viral activity indicators. Models were stratified by age group and risk status (defined as presence of selected comorbidities). RESULTS Population-based RSV-attributable hospitalization incidence rates were high among adults ≥ 60 years: respiratory hospitalizations (236-363 per 100,000 person-years) and cardiorespiratory hospitalizations (584-912 per 100,000 person-years). RSV accounted for 2-3% of all cardiorespiratory hospitalizations in this age group. The increase in cardiorespiratory hospitalization risk associated with underlying risk factors was greater in 18-44 year old persons (five to sixfold higher) than in ≥ 75 year old persons (two to threefold higher). CONCLUSIONS This is a first model-based study to comprehensively assess adult RSV burden in Germany. Estimated cardiorespiratory RSV hospitalization rates increased with age and were substantially higher in people with risk factors compared to those without risk factors. Our study indicates that RSV, like other respiratory viruses, contributes to both respiratory and cardiovascular hospitalizations. Effective prevention strategies are needed, especially among older adults ≥ 60 years and among adults with underlying risk factors.
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Affiliation(s)
| | | | | | - Caihua Liang
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA.
| | | | | | | | | | - Maribel Casas
- P95 Pharmacovigilance and Epidemiology Services, Leuven, Belgium
| | | | | | | | | | | | | | - Gernot Rohde
- Medical Clinic I, Department of Respiratory Medicine, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
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Kothari DJ, Sheth SG. Innovative pathways allow safe discharge of mild acute pancreatitis from the emergency room. World J Gastroenterol 2024; 30:1475-1479. [PMID: 38617458 PMCID: PMC11008414 DOI: 10.3748/wjg.v30.i11.1475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/22/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024] Open
Abstract
Acute pancreatitis (AP) is a leading cause of gastrointestinal-related hospitalizations in the United States, resulting in 300000 admissions per year with an estimated cost of over $2.6 billion annually. The severity of AP is determined by the presence of pancreatic complications and end-organ damage. While moderate/severe pancreatitis can be associated with significant morbidity and mortality, the majority of patients have a mild presentation with an uncomplicated course and mortality rate of less than 2%. Despite favorable outcomes, the majority of mild AP patients are admitted, contributing to healthcare cost and burden. In this Editorial we review the performance of an emergency department (ED) pathway for patients with mild AP at a tertiary care center with the goal of reducing hospitalizations, resource utilization, and costs after several years of implementation of the pathway. We discuss the clinical course and outcomes of mild AP patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital, and identify predictors of successful ED discharge to select patients who can potentially be triaged to the pathway. We conclude that by implementing innovative clinical pathways which are established and reproducible, selected AP patients can be safely discharged from the ED, reducing hospitalizations and healthcare costs, without compromising clinical outcomes. We also identify a subset of patients most likely to succeed in this pathway.
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Affiliation(s)
- Darshan J Kothari
- Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States
| | - Sunil G Sheth
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
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Friedlander A, Sinai D, Zilcha-Mano S, Weiser M, Caspi A, Lichtenberg P, Amitai Z, Tzur Bitan D. Development of the Therapeutic Alliance in Alternative Settings to Psychiatric Hospitalization: An Open Comparative Study. Psychiatr Serv 2024:appips20230009. [PMID: 38500450 DOI: 10.1176/appi.ps.20230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Patient-therapist alliance in two alternative treatment settings developed similarly to that in traditional psychiatric hospitalization.
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Affiliation(s)
- Avraham Friedlander
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Dana Sinai
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Sigal Zilcha-Mano
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Mark Weiser
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Asaf Caspi
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Pesach Lichtenberg
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Ziv Amitai
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
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Zhao J, Shi K, Zhang N, Chen X, Yu J. The changing pattern of pediatric burns in a territory burn center before and during the COVID-19 pandemic in China: A retrospective study. J Tissue Viability 2024:S0965-206X(24)00035-4. [PMID: 38521680 DOI: 10.1016/j.jtv.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 03/10/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Pediatric burn patients are an essential part of burn populations. However, there is limited publicly available data on the epidemiological impact of COVID-19 on pediatric burns in China. OBJECTIVE In this paper, pediatric burn patients admitted to the Department of Burn Surgery of the First Hospital of Jilin University before and during COVID-19 were retrospectively investigated to determine the impact of COVID-19 on pediatric burn inpatients. METHODS The information of inpatients from July 2017 to December 2019 (pre-COVID-19 group) and from January 2020 to June 2022 (COVID-19 group) in the Department of Burn Surgery at the First Hospital of Jilin University was retrospectively investigated. Demographic information of patients, length of hospital stay, total body surface area (TBSA) of burn injury, post-injury visit time, comorbidity, surgical methods, etc., were statistically analyzed. RESULTS The COVID-19 group included 154 (10.2%) patients, and the pre-COVID-19 group included 335 (19.4%) patients (P<0.001). There were no differences in gender, age, length of hospital stay, or etiology of burns between the two groups. Compared to the pre-COVID-19 group, patients in the pre-COVID-19 group experienced a significant delay in presentation (P<0.001), had a larger TBSA of burn wound (P < 0.001), were more prone to sustaining major burns (P < 0.001), a higher likelihood of undergoing operations (P = 0.03), higher cost (P<0.001) and more complications (P<0.001). Additionally, upper extremities were the most commonly part involved in both groups (P = 0.004), with the lower extremities showed a significant increase to be involved in burn injury during COVID-19 pandemic (P = 0.007). Furthermore, the majority of guardians did not take first aid measures in both groups following burn injury (P = 0.102). CONCLUSIONS During the COVID-19 pandemic period, scalds remained the main reason for hospitalization. The number of hospitalized patients has decreased dramatically, while the severity of burns has significantly increased, with a notable delay in hospital visits and an increased occurrence of complications.
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Affiliation(s)
- Jingchun Zhao
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun, 130021, China.
| | - Kai Shi
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun, 130021, China.
| | - Nan Zhang
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun, 130021, China.
| | - Xinxin Chen
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun, 130021, China.
| | - Jiaao Yu
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun, 130021, China.
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Rząd M, Kanecki K, Lewtak K, Tyszko P, Gorynski P, Nitsch-Osuch A. Hospitalizations of patients with herpes zoster in Poland during 2012-2021: A population-based study. Vaccine 2024; 42:1928-1933. [PMID: 38368221 DOI: 10.1016/j.vaccine.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The varicella-zoster virus (VZV) is an infectious agent that causes both chickenpox and herpes zoster/shingles (HZ). This infection can take various clinical forms, result in permanent complications, and be a marker of immunosuppression, e.g. in the course of a neoplastic disease. The aim of this study is to analyze epidemiological trends in hospitalization and hospital mortality rate among HZ patients in Poland (2012-2021). METHODS Our study is a population-based, retrospective analysis of hospital discharge records of patients with HZ. Data were obtained from the National Institute of Public Health in Poland, and they covered the period from 2012 to 2021. All hospitalization records with primary or secondary ICD-10 B02 code diagnosis were included in the study. RESULTS We analyzed the total number of 23,432 hospital discharge records of HZ patients in 2012-2021. The study group consisted of 22,169 (94.6 %) hospitalization records of first-time diagnosis of HZ in hospitalized patients: 9,309 males (42 %) and 12,860 females (58 %). In this group, 70.3 % were patients over 60 years old. The mean and median age was 64 and 69 years, respectively. The mean annual first-time hospitalization rate for HZ was estimated to be 5.8 per 100,000 person-years (95 % CI: 4.8-6.7 per 100,000 person-years). The hospitalization rate for HZ was similar during 2012-2019. There was a significant decrease in hospitalizations in 2020-2021 in comparison with the previous years (R2 = 0.42, p < 0.05). Women showed a higher hospitalization rate than men (p < 0.001). Urban residents had a higher hospitalization rate than rural residents (p < 0.001). In the analyzed period, 246 deaths were recorded (1.1 % of all hospitalized HZ patients) -119 males and 127 females. CONCLUSIONS The HZ-related number of hospitalizations and mortality in Poland are relatively low, but HZ is still a significant health problem. Risk factors include female gender, older age and residence in urban areas.
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Affiliation(s)
- Michał Rząd
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-091Warsaw, 3 Oczki Street, Poland
| | - Krzysztof Kanecki
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-091Warsaw, 3 Oczki Street, Poland
| | - Katarzyna Lewtak
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-091Warsaw, 3 Oczki Street, Poland.
| | - Piotr Tyszko
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-091Warsaw, 3 Oczki Street, Poland; Institute of Rural Health in Lublin, 2 Jaczewskiego Street, 20-090 Lublin, Poland
| | - Paweł Gorynski
- National Institute of Public Health NIH - National Research Institute, 24 Chocimska Street, 00-791 Warsaw, Poland
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-091Warsaw, 3 Oczki Street, Poland
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Mancini V, Borellini M, Belardi P, Colucci MC, Kadinde EY, Mwibuka C, Maziku D, Parisi P, Di Napoli A. Factors associated with hospitalization in a pediatric population of rural Tanzania: findings from a retrospective cohort study. Ital J Pediatr 2024; 50:53. [PMID: 38500138 PMCID: PMC10949679 DOI: 10.1186/s13052-024-01622-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/24/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Despite pediatric acute illnesses being leading causes of death and disability among children, acute and critical care services are not universally available in low-middle income countries, such as Tanzania, even if in this country significant progress has been made in child survival, over the last 20 years. In these countries, the hospital emergency departments may represent the only or the main point of access to health-care services. Thus, the hospitalization rates may reflect both the health system organization and the patients' health status. The purpose of the study is to describe the characteristics of clinical presentations to a pediatric Outpatient Department (OPD) in Tanzania and to identify the predictive factors for hospitalization. METHODS Retrospective cohort study based on 4,324 accesses in the OPD at Tosamaganga Voluntary Agency Hospital (Tanzania). Data were collected for all 2,810 children (aged 0-13) who accessed the OPD services, within the period 1 January - 30 September 2022. The association between the hospitalization (main outcome) and potential confounding covariates (demographic, socio-contextual and clinical factors) was evaluated using univariate and multivariate logistic regression models. RESULTS Five hundred three (11.6%) of OPD accesses were hospitalized and 17 (0.4%) died during hospitalization. A higher (p < 0.001) risk of hospitalization was observed for children without health insurance (OR = 3.26), coming from more distant districts (OR = 2.83), not visited by a pediatric trained staff (OR = 3.58), and who accessed for the following conditions: burn/wound (OR = 70.63), cardiovascular (OR = 27.36), constitutional/malnutrition (OR = 62.71), fever (OR = 9.79), gastrointestinal (OR = 8.01), respiratory (OR = 12.86), ingestion/inhalation (OR = 17.00), injury (OR = 6.84). CONCLUSIONS The higher risk of hospitalization for children without health insurance, and living far from the district capital underline the necessity to promote the implementation of primary care, particularly in small villages, and the establishment of an efficient emergency call and transport system. The observation of lower hospitalization risk for children attended by a pediatric trained staff confirm the necessity of preventing admissions for conditions that could be managed in other health settings, if timely evaluated.
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Affiliation(s)
- Vincenzo Mancini
- Chair of Pediatrics, NESMOS department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
- Doctors with Africa CUAMM, Iringa, Tanzania
| | | | | | - Maria Carolina Colucci
- Chair of Pediatrics, NESMOS department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
| | | | | | | | - Pasquale Parisi
- Chair of Pediatrics, NESMOS department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
| | - Anteo Di Napoli
- Epidemiolgy Unit, National Institute for Health Migration and Poverty (INMP), Via di San Gallicano, 25a - 00153, Rome, Italy.
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Bruyndonckx R, Polkowska-Kramek A, Liang C, Nuttens C, Tran TMP, Gessner BD, Begier E. Estimation of Symptomatic Respiratory Syncytial Virus Infection Incidence in Adults in Multiple Countries: A Time-Series Model-Based Analysis Protocol. Infect Dis Ther 2024:10.1007/s40121-024-00948-9. [PMID: 38499832 DOI: 10.1007/s40121-024-00948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Estimating respiratory syncytial virus (RSV) burden in adults is challenging because of non-specific symptoms, infrequent standard-of-care testing, resolution of viral shedding before seeking medical care, test positivity that varies by specimen site in the upper airway and lower diagnostic test sensitivity compared to children. Conducting prospective observational studies to assess RSV burden in adults is time- and resource-intensive. Thus, model-based approaches can be applied using existing data to obtain more accurate estimates of RSV burden. This protocol establishes essential elements for estimating RSV incidence rate in adults using a time series model-based approach. It can be tailored to specific databases and applied globally across countries, enabling estimation of local RSV disease burden to inform public health decision-making, including immunization policy. METHODS Data are analysed using a quasi-Poisson regression model, considering the effect of baseline trends and pathogen co-circulation, stratified by age and risk status. Pathogen co-circulation is represented by viral proxies defined based on ICD code groupings indicating RSV and influenza-specific hospitalizations, lagged 0 up to 4 weeks based on the model selection. A final model is constructed in two steps: optimization of the time trend (using p-values) and selection of the viral proxy lag time (using test statistics, to prioritize the most biologically plausible option). The yearly incidence rate and percentage of events attributable to RSV are estimated from the final model. Confidence intervals are calculated using residual bootstrapping. PLANNED OUTCOMES Outcomes to be modelled are based on administrative ICD code groupings and include the number of cardiorespiratory, respiratory and cardiovascular events in a specific care setting (e.g., general practitioner visit, emergency department visit, hospitalization and death). Cardiovascular events are limited to those for which existing evidence suggests an association with RSV infection. Additional secondary outcomes are constructed as a subset of the primary outcomes based on specific ICD code groups.
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Affiliation(s)
| | | | | | | | | | | | - Elizabeth Begier
- Pfizer Inc, Dublin, Republic of Ireland.
- Pfizer Vaccines, 9 Riverwalk, Citywest Business Campus, Dublin 24, Republic of Ireland.
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Hernandes ECR, Aliberti MJR, Guerra RO, Ferriolli E, Perracini MR. Intrinsic capacity and hospitalization among older adults: a nationally representative cross-sectional study. Eur Geriatr Med 2024:10.1007/s41999-024-00933-y. [PMID: 38491314 DOI: 10.1007/s41999-024-00933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/04/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Monitoring intrinsic capacity (IC) in community-dwelling older people can be potentially used to alert for adverse health outcomes. However, whether there is an association between IC and hospitalization has yet to be fully explored. This study aimed to investigate the association of the IC composite measure and its 5 domains with hospitalization in the previous year and length of hospital stay. METHODS We conducted cross-sectional analyses using data from a representative sample of community-dwelling adults (≥ 65 years). We assessed the IC domains (vitality, locomotor, cognitive, sensory, and psychological) using validated self-reported information and performance tests. We calculated standardized estimated scores (z scores) for IC composite measure and domains and conducted multivariate logistic and ordinal regressions. The primary outcomes were hospitalizations in the previous year and length of hospital stay. RESULTS In a sample of 5354 participants (mean age = 73 ± 6 years), we found that participants with high IC composite z scores were less likely to have experienced hospitalization in the previous year (OR = 0.51; 95% CI = 0.44-0.58). Among those who were hospitalized, high IC scores were associated with short stays (OR = 0.87; 95% CI = 0.80-0.95). Cognitive and psychological domains were associated with hospitalizations, and the locomotor domain was related to length of hospital stay. The vitality domain was associated with both outcomes. CONCLUSION IC as a composite measure was associated with previous hospitalizations and length of stay. IC can help clinicians identify older people prone to adverse outcomes, prompting preventive integrated care interventions.
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Affiliation(s)
- Elisângela Cristina Ramos Hernandes
- Masters' and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesáreo Galeno, 448, Tatuapé, São Paulo, 03071-000, Brazil
| | - Márlon Juliano Romero Aliberti
- Laboratorio de Investigaçao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas, Disciplina de Geriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Research Institute, Hospital Sirio-Libanes, São Paulo, Brazil
| | - Ricardo Oliveira Guerra
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Eduardo Ferriolli
- Laboratorio de Investigaçao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas, Disciplina de Geriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Monica Rodrigues Perracini
- Masters' and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesáreo Galeno, 448, Tatuapé, São Paulo, 03071-000, Brazil.
- Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil.
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60
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Komagamine J. Prevalence of urgent hospitalizations caused by adverse drug reactions: a cross-sectional study. Sci Rep 2024; 14:6058. [PMID: 38480855 PMCID: PMC10937656 DOI: 10.1038/s41598-024-56855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024] Open
Abstract
Adverse drug reactions account for a substantial portion of emergency hospital admissions. However, in the last decade, few studies have been conducted to determine the prevalence of hospitalization due to adverse drug reactions. Therefore, this cross-sectional study was conducted to determine the proportion of adverse drug reactions leading to emergency hospital admission and to evaluate the risk factors for these reactions. A total of 5707 consecutive patients aged > 18 years who were emergently hospitalized due to acute medical illnesses between June 2018 and May 2021 were included. Causality assessment for adverse drug reactions was performed by using the World Health Organization-Uppsala Monitoring Centre criteria. The median patient age was 78 years (IQR 63-87), and the proportion of women was 47.9%. Among all the hospitalizations, 287 (5.0%; 95% confidence interval (CI) 4.5-5.6%) were caused by 368 adverse drug reactions. The risk factors independently associated with hospitalization due to adverse drug reactions were polypharmacy (OR 2.66), age ≥ 65 years (OR 2.00), and ambulance use (OR 1.41). Given that the population is rapidly aging worldwide, further efforts are needed to minimize hospitalizations caused by adverse drug reactions.
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Affiliation(s)
- Junpei Komagamine
- Department of Emergency and Critical Care Medicine, NHO Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro, Tokyo, Japan.
- Department of Clinical Research, NHO Tochigi Medical Center, Utsunomiya, Japan.
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61
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Zhu T, Chen C, Zhang X, Yang Q, Hu Y, Liu R, Zhang X, Dong Y. Differences in inpatient performance of public general hospitals following implementation of a points-counting payment based on diagnosis-related group: a robust multiple interrupted time series study in Wenzhou, China. BMJ Open 2024; 14:e073913. [PMID: 38471900 DOI: 10.1136/bmjopen-2023-073913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES This study measures the differences in inpatient performance after a points-counting payment policy based on diagnosis-related group (DRG) was implemented. The point value is dynamic; its change depends on the annual DRGs' cost settlements and points of the current year, which are calculated at the beginning of the following year. DESIGN A longitudinal study using a robust multiple interrupted time series model to evaluate service performance following policy implementation. SETTING Twenty-two public general hospitals (8 tertiary institutions and 14 secondary institutions) in Wenzhou, China. INTERVENTION The intervention was implemented in January 2020. OUTCOME MEASURES The indicators were case mix index (CMI), cost per hospitalisation (CPH), average length of stay (ALOS), cost efficiency index (CEI) and time efficiency index (TEI). The study employed the means of these indicators. RESULTS The impact of COVID-19, which reached Zhejiang Province at the end of January 2020, was temporary given rapid containment following strict control measures. After the intervention, except for the ALOS mean, the change-points for the other outcomes (p<0.05) in tertiary and secondary institutions were inconsistent. The CMI mean turned to uptrend in tertiary (p<0.01) and secondary (p<0.0001) institutions compared with before. Although the slope of the CPH mean did not change (p>0.05), the uptrend of the CEI mean in tertiary institutions alleviated (p<0.05) and further increased (p<0.05) in secondary institutions. The slopes of the ALOS and TEI mean in secondary institutions changed (p<0.05), but not in tertiary institutions (p>0.05). CONCLUSIONS This study showed a positive effect of the DRG policy in Wenzhou, even during COVID-19. The policy can motivate public general hospitals to improve their comprehensive capacity and mitigate discrepancies in treatment expenses efficiency for similar diseases. Policymakers are interested in whether the reform successfully motivates hospitals to strengthen their internal impetus and improve their performance, and this is supported by this study.
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Affiliation(s)
- Tingting Zhu
- Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinxin Zhang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qingren Yang
- School of Innovation and Entrepreneurship, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yipao Hu
- Health Information Center, Health Commission of Wenzhou, Wenzhou, Zhejiang, China
| | - Ruoyun Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiangyang Zhang
- Wenzhou Medical University First Affiliated Hospital, Wenzhou, Zhejiang, China
| | - Yin Dong
- Health Community Group of Yuhuan People's Hospital, Taizhou, Zhejiang, China
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Karra L, Radi R, Lyon C. Less Is More: Backing off Sliding Scale Insulin for Hospitalized Patients. J Am Board Fam Med 2024; 37:150-152. [PMID: 38448234 DOI: 10.3122/jabfm.2023.230349r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 03/08/2024] Open
Abstract
In hospitalized patients with type 2 diabetes (T2DM), a less aggressive supplemental insulin regimen is noninferior to a standard, more aggressive, supplemental regimen.
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Affiliation(s)
- Lakshmi Karra
- From the Denver Health Hospital Authority, Denver, CO (LK, RR); University of Colorado FMR, Denver, CO (CL)
| | - Roxanne Radi
- From the Denver Health Hospital Authority, Denver, CO (LK, RR); University of Colorado FMR, Denver, CO (CL)
| | - Corey Lyon
- From the Denver Health Hospital Authority, Denver, CO (LK, RR); University of Colorado FMR, Denver, CO (CL)
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63
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Garbin JRT, Leite FMC, Dell'Antonio CSS, Dell'Antonio LS, Dos Santos APB, Lopes-Júnior LC. Hospitalizations for coronavirus disease 2019: an analysis of the occurrence waves. Sci Rep 2024; 14:5777. [PMID: 38459098 PMCID: PMC10924092 DOI: 10.1038/s41598-024-56289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024] Open
Abstract
The pandemic has been characterized by several waves defined by viral strains responsible for the predominance of infections. We aimed to analyze the mean length of hospital stay for patients with COVID-19 during the first three waves of the pandemic and its distribution according to sociodemographic and clinical variables. This retrospective study used the notifications of patients hospitalized for COVID-19 in a Brazilian state during the period of the three waves of the disease as the data source. There were 13,910 hospitalizations for confirmed COVID-19 cases. The first wave was the longest, with 4101 (29.5%) hospitalizations, while the third, although shorter, had a higher number of hospitalized patients (N = 6960). The average length of stay in the hospital in all waves was associated with age groups up to 60 years old., elementary, high school and higher education, residents of the periurban area Regarding the presence of comorbidities, there was a statistically significant difference in the mean number of days of hospitalization among patients with chronic cardiovascular disease and obesity (P < 0.001). In conclusion, the COVID-19 pandemic has been distinctly revealed among the waves.
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Affiliation(s)
- Juliana Rodrigues Tovar Garbin
- Graduate Program in Public Health at the Universidade Federal do Espírito Santo (PPGSC/UFES), Vitória, ES, Brazil
- Instituto Federal de Educação, Ciência e Tecnologia do Espírito Santo (IFES Campus Vitória), Vitória, ES, Brazil
| | | | | | | | | | - Luís Carlos Lopes-Júnior
- Graduate Program in Public Health at the Universidade Federal do Espírito Santo (PPGSC/UFES), Vitória, ES, Brazil.
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Jayaraj VJ, Husin M, Suah JL, Tok PSK, Omar A, Rampal S, Sivasampu S. Effectiveness of COVID-19 vaccines among children 6-11 years against hospitalization during Omicron predominance in Malaysia. Sci Rep 2024; 14:5690. [PMID: 38454077 PMCID: PMC10920657 DOI: 10.1038/s41598-024-55899-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/28/2024] [Indexed: 03/09/2024] Open
Abstract
There is currently limited data on the effectiveness of COVID-19 vaccines for children aged 6-11 years in Malaysia. This study aims to determine vaccine effectiveness (VE) against COVID-19-related hospitalization after receipt of one- and two-doses of BNT162b2 mRNA (Comirnaty-Pfizer/BioNTech) vaccine over a duration of almost 1 year in the predominantly Omicron period of BA.4/BA.5 and X.B.B sub lineages. This study linked administrative databases between May 2022 and March 2023 to evaluate real-world vaccine effectiveness (VE) for the BNT162b2 mRNA (Comirnaty-Pfizer/BioNTech) vaccine against COVID-19-related hospitalization in the Omicron pre-dominant period with BA.4/BA.5 and X.B.B sub lineages. During the Omicron-predominant period, the cumulative hospitalization rate was almost two times higher for unvaccinated children (9.6 per million population) compared to vaccinated children (6 per million population). The estimated VE against COVID-19 hospitalization for one dose of BNT162b2 was 27% (95% CI - 1%, 47%) and 38% (95% CI 27%, 48%) for two doses. The estimated VE against hospitalization remained stable when stratified by time. VE for the first 90 days was estimated to be 45% (95% CI 33, 55%), followed by 47% (95% CI 34, 56%) between 90 and 180 days, and 36% (95% CI 22, 45%) between 180 and 360 days. Recent infection within 6 months does not appear to modify the impact of vaccination on the risk of hospitalization, subject to the caveat of potential underestimation. In our pediatric population, BNT162b2 provided moderate-non-diminishing protection against COVID-19 hospitalization over almost 1 year of Omicron predominance.
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Affiliation(s)
- Vivek Jason Jayaraj
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia.
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Jing Lian Suah
- Data, Analytics and Research, Central Bank of Malaysia, Kuala Lumpur, Malaysia
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Azahadi Omar
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Practice, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
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Hong X, Jiang M, Kho AT, Tiwari A, Guo H, Wang AL, McGeachie MJ, Weiss ST, Tantisira KG, Li J. Circulating miRNAs associate with historical childhood asthma hospitalization in different serum vitamin D groups. Respir Res 2024; 25:118. [PMID: 38459594 PMCID: PMC10921757 DOI: 10.1186/s12931-024-02737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/17/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Vitamin D may help to alleviate asthma exacerbation because of its anti-inflammation effect, but the evidence is inconsistent in childhood asthma. MiRNAs are important mediators in asthma pathogenesis and also excellent non-invasive biomarkers. We hypothesized that circulating miRNAs are associated with asthma exacerbation and modified by vitamin D levels. METHODS We sequenced baseline serum miRNAs from 461 participants in the Childhood Asthma Management Program (CAMP). Logistic regression was used to associate miRNA expression with asthma exacerbation through interaction analysis first and then stratified by vitamin D insufficient and sufficient groups. Microarray from lymphoblastoid B-cells (LCLs) treated by vitamin D or sham of 43 subjects in CAMP were used for validation in vitro. The function of miRNAs was associated with gene modules by weighted gene co-expression network analysis (WGCNA). RESULTS We identified eleven miRNAs associated with asthma exacerbation with vitamin D effect modification. Of which, five were significant in vitamin D insufficient group and nine were significant in vitamin D sufficient group. Six miRNAs, including hsa-miR-143-3p, hsa-miR-192-5p, hsa-miR-151a-5p, hsa-miR-24-3p, hsa-miR-22-3p and hsa-miR-451a were significantly associated with gene modules of immune-related functions, implying miRNAs may mediate vitamin D effect on asthma exacerbation through immune pathways. In addition, hsa-miR-143-3p and hsa-miR-451a are potential predictors of childhood asthma exacerbation at different vitamin D levels. CONCLUSIONS miRNAs are potential mediators of asthma exacerbation and their effects are directly impacted by vitamin D levels.
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Affiliation(s)
- Xiaoning Hong
- Clinical Big Data Research Center, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Mingye Jiang
- Clinical Big Data Research Center, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Alvin T Kho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | - Anshul Tiwari
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Haiyan Guo
- Department of Respiratory and Critical Care Medicine, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Disease, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Sun Yat-Sen University, Shenzhen, China
| | - Alberta L Wang
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J McGeachie
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Partners Personalized Medicine, Partners Healthcare, Boston, MA, USA
| | - Kelan G Tantisira
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Pediatrics, Division of Respiratory Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Jiang Li
- Clinical Big Data Research Center, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China.
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Shenzhen Key Laboratory of Chinese Medicine Active Substance Screening and Translational Research, Shenzhen, Guangdong, China.
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66
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Fortunato F, Campanozzi A, Maffei G, Arena F, Carri VD, Rollo T, Lopalco PL, Martinelli D. Respiratory syncytial virus-associated hospitalizations among children: an Italian retrospective observational study. Ital J Pediatr 2024; 50:45. [PMID: 38454523 PMCID: PMC10921699 DOI: 10.1186/s13052-024-01617-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV), a single-stranded RNA virus, is a leading cause of hospitalization in infants, especially ≤ 2 months of life. In the light new immunization strategies adoption, we described epidemiological and clinical characteristics of RSV-associated hospitalizations in pediatric and neonatal intensive care units of the Policlinico Foggia Hospital, Apulia Region, Italy. METHODS Hospitalized children with a laboratory-confirmed RSV infection from 2011 to 2023 were retrospectively evaluated. Clinical information was collected from Hospital Discharge Registry in the period 2011-2020. The proportion of the hospitalization for acute respiratory infections (ARIs) associated to RSV was calculated and the hospitalization cost was analyzed by using the diagnosis-related group reimbursement rate. The anticipated impact of immunization either with monoclonal antibodies or maternal immunization on the number of hospitalizations was estimated. All analyses and quality assessment were performed using STATA/SE15.0. RESULTS A total of 1,005 RSV-cases were included in the study, of which 86.3% occurred between December-March. In the period 2011-2020, 832 RSV-cases were matched with the corresponding hospital admissions; 75.2% were aged < 1 year (49.6% 0-2 months). Bronchiolitis was the most frequent admission diagnosis occurring in 63.3% of patients; 25% of children were affected by a very severe RSV-disease. Younger age ≤ 2 months (OR:14.8, 95%CI:8.30-26.31, p = 0.000), higher length-of-hospital-stay (OR:1.01, 95%CI:1.0-1.02, p = 0.030) and history of prematurity (OR:4.4, 95%CI:1.57-12.11, p = 0.005) were associated with a higher disease severity. RSV caused 48.9% of ARIs among children < 1 year. The mean cost of an RSV-associated hospitalization was 3,036 euros/year, with the higher cost in the 0-2 months age group (4,225 euros/year). Immunization programs with nirsevimab could prevent 51.4 RSV hospitalizations/year and 18.1 very severe RSV disease/year in infants < 1 year of age. RSV vaccine could prevent 46.1 of hospitalizations/year caused by RSV within 180 days after birth. CONCLUSIONS Our study contributes to outlining the baseline profile of RSV-associated hospitalizations among Italian children by providing epidemiological/clinical/economic estimates. While awaiting new recommendations on immunization, healthcare-workers should persist in implementing public health measures and appropriate case management to control RSV seasonal epidemics. Strengthened laboratory RSV surveillance is needed to inform the implementation of the new immunization strategies.
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Affiliation(s)
- Francesca Fortunato
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy.
- Department of Medical and Surgical Sciences, Department of Hygiene, University of Foggia, Policlinico Riuniti University Hospital of Foggia, Ospedale "Colonnello D'Avanzo" Viale degli Aviatori, 2, 71122, Foggia, Italy.
| | - Angelo Campanozzi
- Pediatrics Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gianfranco Maffei
- Neonatology and Intensive Care Unit, Policlinico Foggia Hospital, Foggia, Italy
| | - Fabio Arena
- Microbiology and Virology Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Valeria Delli Carri
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
| | - Tiziana Rollo
- Microbiology and Virology Unit, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Domenico Martinelli
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
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Tian J, Wang X, Li Q, Zhang L, Ai J, Feng G, Zeng Y, Wang R, Xie Z. Clinical epidemiology of adenovirus pneumonia among Chinese hospitalized children. Arch Microbiol 2024; 206:135. [PMID: 38436806 DOI: 10.1007/s00203-024-03870-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 03/05/2024]
Abstract
Adenovirus pneumonia is a prevalent form of community-acquired pneumonia among children. Research on the epidemiology and economic burden of this disease is crucial for public health, yet comprehensive data remains scarce, making it crucial to highlight on this topic. In this study, the data were extracted from the face sheet of discharge medical records collected from 26 tertiary children's hospitals from January 2016 to December 2021. In total, 1854 children with laboratory-confirmed adenovirus pneumonia were hospitalized, accounting for 0.13% of the total number of hospitalized for pneumonia in the database during the period. In addition, this figure represents a meager 0.027% when compared to the total number of hospitalized children. The male-to-female ratio was 1.78:1. The 1-3-year age group had the highest number of inpatients for adenoviral pneumonia and the largest proportion of the total hospitalizations in the same age group. Overall, winter is the primary season for the prevalence of adenovirus pneumonia, however, in southern China, there are two peak seasons, winter and summer. Although patients with 3/4 adenovirus pneumonia had no significant complications, some patients had complications such as respiratory failure, diarrhea, and myocardial damage. The median length of stay of adenovirus pneumonia was 8 d [interquartile range (IQR) 6-11], and the median hospitalization cost was 1293.83 United States dollars (IQR 811.81-2472.51). These valuable epidemiological insights into adenovirus pneumonia in Chinese children can help direct the development of targeted prevention and control strategies and surveillance measures for HAdV infections in this demographic.
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Affiliation(s)
- Jiao Tian
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Rd 56#, Beijing, 100045, China
- Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinyu Wang
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qi Li
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Rd 56#, Beijing, 100045, China
- Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China
| | - Linlin Zhang
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Rd 56#, Beijing, 100045, China
- Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China
| | - Junhong Ai
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Rd 56#, Beijing, 100045, China
- Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China
| | - Guoshuang Feng
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yueping Zeng
- Medical Record Management Office, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ran Wang
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Rd 56#, Beijing, 100045, China.
- Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China.
| | - Zhengde Xie
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Rd 56#, Beijing, 100045, China.
- Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China.
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Hibbs AM, Chen Z, Minich NM, Martin RJ, Raffay TM, MacFarlane PM, Di Fiore JM. Association between Intermittent Hypoxemia and NICU Length of Stay in Preterm Infants. Neonatology 2024:1-9. [PMID: 38437802 DOI: 10.1159/000535264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/14/2023] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Length of hospitalization varies widely in preterm infants and can be affected by multiple maternal and neonatal factors including respiratory instability. Therefore, we aimed to determine the association between postnatal intermittent hypoxemia (IH) and prolonged hospitalization. METHODS This prospective single-center cohort study followed infants born at <31 weeks of gestational age through 2 years corrected age with detailed oxygen saturation data captured from days 7 to 30 of age. RESULTS 51/164 (31%) of infants were discharged after 400/7 weeks of corrected gestational age (CGA). A greater average daily number of IH events (OR per 10 events/day 1.33 [95% CI 1.03-1.72]), duration of events (OR per minute 1.14 [1.07-1.21]), and percent time with oxygen saturation <80% (OR per percent 1.88 [1.25-2.85]) on days 7-30 of age were all significantly associated with prolonged hospitalization past 400/7 weeks CGA. In survival analyses, infants with a greater average daily number of IH events (HR per 10 events/day 0.89 [0.81-0.98]), percent time with oxygen saturation <80% (HR per percent 0.79 [0.67-0.94]), and duration of events (HR per minute 0.93 [0.91-0.95]) on days 7-30 of age all had significantly lower probability of earlier discharge. In addition, there was a significant interaction with gestational age; the association between IH and prolonged hospitalization was stronger in more mature infants (p = 0.024). CONCLUSIONS Physiological instability on days 7-30 of age, as manifested by IH, is significantly associated with prolonged hospitalization. IH likely represents both a marker of initial severity of illness and the beginning of biological cascades, leading to prematurity-associated morbidities.
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Affiliation(s)
- Anna Maria Hibbs
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Zhengyi Chen
- Department of Population and Quantitative Health Sciences, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nori M Minich
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard J Martin
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Thomas M Raffay
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Peter M MacFarlane
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Juliann M Di Fiore
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
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69
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Griffin F, Ekblom-Bak E, Arvidsson D, Paulsson S, Börjesson M. Maintaining or increasing cardiorespiratory fitness is associated with reduced hospital admission rate. Eur J Prev Cardiol 2024; 31:436-444. [PMID: 38019572 DOI: 10.1093/eurjpc/zwad367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 11/30/2023]
Abstract
AIMS The aim of this study was to investigate the association between change in cardiorespiratory fitness (CRF) and cardiovascular disease (CVD)-related and all-cause hospital admission and explore if the association varies dependently on prior admission, baseline CRF, sex, and age. METHODS AND RESULTS A total of 91 140 adult participants (41.5% women) with two examinations from occupational health profile assessments between 1986 and 2019 were included (mean of 3.2 years between examinations). Cardiorespiratory fitness was assessed as maximal oxygen consumption and estimated through a submaximal cycle test. Cardiorespiratory fitness change was defined as annual percentage change in relative CRF (mL/min/kg) and further divided into 'decliners' (≤1%), 'maintainers' (-1% to 1%), and 'increasers' (>1%). Hospital admissions were followed over a mean of 7 years. Natural cubic splines and Cox proportional hazards model were applied. Additionally, prevented fraction for the population was calculated. Increase in CRF was associated with a lower risk of CVD [hazard ratio (HR) = 0.99] and all-cause hospital admission (HR = 0.99), after multilevel adjustment for confounders and change in smoking, diet, and stress. Compared with a decline, maintenance of CRF was associated with 9% and 7% lower risk of CVD and all-cause admission, respectively. Increase in CRF reduced the risk by 13% and 11% and, for individuals with prior admission, by 20% and 14%. The burden of CVD and all-cause admission was 6% and 5% lower than if the whole cohort had declined CRF, with large potential cost savings. CONCLUSION Efforts to maintain or improve CRF should be included in disease-preventive strategies, regardless of change in other lifestyle-related risk factors. Preventing the age-associated decline in CRF can lessen healthcare utilization and costs.
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Affiliation(s)
- Frida Griffin
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Elin Ekblom-Bak
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Daniel Arvidsson
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Sofia Paulsson
- Research Department, HPI Health Profile Institute, Stockholm, Sweden
| | - Mats Börjesson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden
- Centre for Lifestyle Intervention, Sahlgrenska University Hospital, Gothenburg, Sweden
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70
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López-Herrero R, Sánchez-de Prada L, Tamayo-Velasco A, Heredia-Rodríguez M, Bardají Carrillo M, Jorge Monjas P, de la Varga-Martínez O, Resino S, Sarmentero-López de Quintana G, Gómez-Sánchez E, Tamayo E. Epidemiology of fungal infection in COVID 19 in Spain during 2020 and 2021: a nationwide study. Sci Rep 2024; 14:5203. [PMID: 38433130 PMCID: PMC10909879 DOI: 10.1038/s41598-024-54340-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024] Open
Abstract
We realize a nationwide population-based retrospective study to analyze the characteristics and risk factors of fungal co-infections in COVID-19 hospitalized patients as well as describe their causative agents in the Spanish population in 2020 and 2021. Data were obtained from records in the Minimum Basic Data Set of the National Surveillance System for Hospital Data in Spain, provided by the Ministry of Health, and annually published with two years lag. The assessment of the risk associated with the development of healthcare-associated fungal co-infections was assessed using an adjusted logistic regression model. The incidence of fungal co-infection in COVID-19 hospitalized patients was 1.41%. The main risk factors associated were surgery, sepsis, age, male gender, obesity, and COPD. Co-infection was associated with worse outcomes including higher in-hospital and in ICU mortality, and higher length of stay. Candida spp. and Aspergillus spp. were the microorganisms more frequent. This is the first study analyzing fungal coinfection at a national level in hospitalized patients with COVID-19 in Spanish population and one of the few studies available that demonstrate that surgery was an independent risk factor of Aspergillosis coinfection in COVID-19 patients.
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Affiliation(s)
- R López-Herrero
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, 47003, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, 47005, Valladolid, Spain
| | - L Sánchez-de Prada
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005, Valladolid, Spain
- Microbiology Department, Hospital Universitario Río Hortega, 47012, Valladolid, Spain
| | - A Tamayo-Velasco
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005, Valladolid, Spain.
- Haematology and Hemotherapy Department, Hospital Clínico Universitario de Valladolid, 47003, Valladolid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - M Heredia-Rodríguez
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005, Valladolid, Spain
- Anesthesiology and Critical Care Department, Complejo Asistencial Universitario de Salamanca, 37007, Salamanca, Spain
| | - M Bardají Carrillo
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, 47003, Valladolid, Spain
| | - P Jorge Monjas
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, 47003, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, 47005, Valladolid, Spain
| | - O de la Varga-Martínez
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005, Valladolid, Spain
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, 28031, Madrid, Spain
| | - S Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - G Sarmentero-López de Quintana
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, 47003, Valladolid, Spain
| | - E Gómez-Sánchez
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, 47003, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, 47005, Valladolid, Spain
| | - E Tamayo
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, 47003, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, 47005, Valladolid, Spain
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Fang X, Tao G, Zhou H, Zhou Y. Vaccines reduced hospital length of stay and fraction of inspired oxygen of COVID-19 patients: A retrospective cohort study. Prev Med Rep 2024; 39:102632. [PMID: 38348219 PMCID: PMC10859302 DOI: 10.1016/j.pmedr.2024.102632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
Few studies have focused on the evaluation of vaccine effectiveness (VE) in mainland China. This study was to characterize the VE including the frequent symptoms, laboratory indices, along with endotracheal intubation, hospital length of stay (LoS), and survival status. This retrospective cohort study included patients with COVID-19 admitted to our hospital. Statistical comparisons of continuous variables were carried out with an independent Student's t-test or Mann-Whitney U test. For categorical variables, the Chi-square test and Fisher exact test were used. Multivariable regression analysis was performed to adjust the confounding factors such as age, gender, body mass index (BMI), residential area, smoking status, the Charlson comorbidity index (CCI) score, followed by investigating the effects of vaccination on critical ill prevention, reduced mortality and endotracheal intubation, LoS and inspired oxygen. This study included 549 hospitalized patients with COVID-19, including 222 (40.43 %) vaccinated participants and 327 (59.57 %) unvaccinated counterparts. There was no obvious difference between the two groups in typical clinical symptoms of COVID-19, clinical laboratory results and mortality. Multivariable analysis showed that COVID-19 vaccine obviously reduced LoS by 1.2 days (lnLoS = -0.14, 95 %CI[-0.24,-0.04]; P = 0.005) and decreased fraction of inspired oxygen by 40 % (OR: 0.60; 95 %CI[0.40,0.90]; P = 0.013) after adjusting age, gender, BMI, residential area, smoking status and CCI score. In contrast, vaccination induced reduction in the critically ill, mortality, and endotracheal intubation compared with the unvaccinated counterparts, but with no statistical differences. Vaccinated patients hospitalized with COVID-19 have a reduced LoS and fraction of inspired oxygen compared to unvaccinated cases in China.
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Affiliation(s)
- Xiaomei Fang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, P. R. China
| | - Guofang Tao
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, P. R. China
| | - Hua Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, P. R. China
| | - Yuxia Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, P. R. China
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Greer PJ, Gibson JM, Swoger J, Moore T, Whitcomb DC. The burden of recurrence acute pancreatitis and annual event rates are underestimated because of high rates of home self-management. Pancreatology 2024; 24:220-222. [PMID: 38199824 DOI: 10.1016/j.pan.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND/OBJECTIVES The event-rate of recurrent acute pancreatitis (RAP) in patient populations is critical for powering research studies. We hypothesize that some patients manage RAP attacks at home, reducing event rate estimations based on counting emergency department (ED) visits and hospitalizations only. The aim of this study was to determine the rates of home self-management of recurrent acute pancreatitis compared to ED visits and hospitalizations. METHODS An anonymous 8-question survey was sent to 1825 individuals on an email list of individuals with a history of acute pancreatitis (AP) or chronic pancreatitis or interest in pancreatic diseases. Question were designed to identify subjects with RAP within the past 2 years and to subdivide patients based on having a chronic pain syndrome or not. RESULTS After an initial email request and one reminder a total of 194 subjects responded with 98 RAP subjects suitable for analysis. Annual AP events included an average of 1.44 hospitalizations, 1.37 ED visits, 2.46 disrupted work/school/social engagements, and 3.95 pancreatitis-like pain attacks per year. Patients with RAP average 6.8 RAP events per year with 58.4 % managed at home. CONCLUSIONS The burden of disease in patients with RAP is significantly underestimated, especially for patients with chronic pain. Future studies should include measures to capture RAP events managed at home and utilize methods of documenting RAP events.
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Affiliation(s)
- Phil J Greer
- Ariel Precision Medicine, Pittsburgh, PA, United States.
| | | | | | - Tory Moore
- Ariel Precision Medicine, Pittsburgh, PA, United States.
| | - David C Whitcomb
- Ariel Precision Medicine, Pittsburgh, PA, United States; Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
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Arévalo Lorido JC, Carretero Gomez J, Vazquez Rodriguez P, Gómez Huelgas R, Marín Silvente C, Sánchez Lora FJ, Isaba Ares E, Pardo I Pelegrín A, Pérez Hernández O, Ena J. Glycemic control and prescription profiles in internal medicine inpatients: The role of frailty. Eur J Intern Med 2024; 121:103-108. [PMID: 37872036 DOI: 10.1016/j.ejim.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
AIM This work aims to characterize the clinical profile of individuals with frailty syndrome, diabetes mellitus (DM), and hyperglycemia during hospitalization in regard to glycemic control and treatment regimen. METHODS This cross-sectional multicentric study included patients with DM or hyperglycemia at admission. Demographic data, blood glucose values, treatment administered during hospitalization, and treatment indicated at discharge were analyzed. The sample was divided into three groups according to score on a frailty questionnaire. Generalized additive models were used to describe the relationship between either glycemic variability (GV) or minimum capillary blood glucose and hypoglycemia. Models were adjusted for age, comorbidity, and sarcopenia. RESULTS A total of 1,137 patients were analyzed. Patients with frailty syndrome had more comorbidity and sarcopenia, worse renal function, and lower albumin and lymphocyte levels. A GV between 21% and 60% was related to a higher probability of hypoglycemia, especially in patients with frailty. Regarding minimum capillary blood glucose, patients with frailty had the highest probability of hypoglycemia. This probability remained significant even in the group with frailty in which, with a reference value of 200 mg/dl, the adjusted odds ratio of a minimum capillary blood glucose of 151 mg/dL was 1.08 (95% confidence interval (1.12-1.05)). Baseline treatments showed a significant predominance of insulin use in the frailest groups. CONCLUSIONS Patients with frailty had more sarcopenia and undernourishment. These patients were managed in a similar manner during hospitalization to patients without frailty, despite their higher risk of hypoglycemia according to GV or minimum capillary blood glucose levels.
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Affiliation(s)
| | - Juana Carretero Gomez
- Internal Medicine Service, Hospital Universitario de Badajoz, Avda de Elvas, s/n, Badajoz 06080, Spain.
| | | | - Ricardo Gómez Huelgas
- Internal Medicine Service, Hospital Universitario de Málaga, Av. de Carlos Haya, 84, Málaga 29010, Spain
| | - Carmen Marín Silvente
- Internal Medicine Service, Hospital General Universitario Morales Meseguer, Av. Marqués de Los Vélez, s/n, Murcia 30008, Spain
| | | | - Elena Isaba Ares
- Internal Medicine Service, Hospital Universitario de Móstoles, C. Dr. Luis Montes, s/n, Móstoles, Madrid 28935, Spain
| | - Anna Pardo I Pelegrín
- Internal Medicine Service, Hospital Sant Rafael, Pg. de la Vall d'Hebron, 107, Barcelona 08035, Spain
| | - Onán Pérez Hernández
- Internal medicine Service, Hospital Universitario Nuestra Señora de la Candelaria, Ctra. Gral. del Rosario, 145, Santa Cruz de Tenerife 38010, Spain
| | - Javier Ena
- Internal Medicine Service, Hospital Marina Baixa, Av. Alcalde En Jaume Botella Mayor, 7, Villajoyosa, Alicante 03570, Spain
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Wu JY, Liu MY, Hsu WH, Tsai YW, Liu TH, Huang PY, Chuang MH, Chin SE, Lai CC. Association between vitamin D deficiency and post-acute outcomes of SARS-CoV-2 infection. Eur J Nutr 2024; 63:613-622. [PMID: 38112761 DOI: 10.1007/s00394-023-03298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES This study aimed to investigate the association between vitamin D deficiency (VDD) and post-acute outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS This retrospective study used the TriNetX research network to identify COVID-19 patients between January 1 and November 30, 2022. Patients were matched using propensity score matching (PSM) and divided into VDD (< 20 ng/mL) and control (≥ 20 ng/mL) groups. The primary outcome was a composite of post-COVID-19 condition (identified by ICD-10 code), all-cause emergency department (ED) visits, hospitalization, and death during the follow-up period (90-180 days) after the diagnosis of COVID-19. RESULTS From an initial recruitment of 42,674 non-hospitalized patients with COVID-19 and known 25(OH)D status, a VDD group of 8300 was identified and propensity matched with 8300 controls. During the follow-up period, the VDD group had a higher risk of the primary outcome than did the control group [hazard ratio (HR) = 1.122; 95% confidence interval (CI) = 1.041-1.210]. The VDD group also had a higher risk of all-cause ED visits (HR = 1.114; 95% CI = 1.012-1.226), all-cause hospitalization (HR = 1.230; 95% CI = 1.105-1.369), and all-cause death (HR = 1.748; 95% CI = 1.047-2.290) but not post-COVID-19 condition (HR = 0.980; 95% CI = 0.630-1.523), individually. CONCLUSION Among the COVID-19 patients, VDD might be associated with a higher risk of all-cause ED visits, hospitalization, and death during the post-acute phase.
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Affiliation(s)
- Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mei-Yuan Liu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
- Department of Nutrition and Health Sciences, Chang Jung Christian University, Tainan, Taiwan
- Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan
| | - Wan-Hsuan Hsu
- Department of General Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ya-Wen Tsai
- Center of Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ting-Hui Liu
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Min-Hsiang Chuang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Szu-En Chin
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan.
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Haeberer M, Bruyndonckx R, Polkowska-Kramek A, Torres A, Liang C, Nuttens C, Casas M, Lemme F, Ewnetu WB, Tran TMP, Atwell JE, Diez CM, Gessner BD, Begier E. Estimated Respiratory Syncytial Virus-Related Hospitalizations and Deaths Among Children and Adults in Spain, 2016-2019. Infect Dis Ther 2024; 13:463-480. [PMID: 38319540 DOI: 10.1007/s40121-024-00920-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) causes a substantial disease burden among infants. In older children and adults, incidence is underestimated due to nonspecific symptoms and limited standard-of-care testing. We aimed to estimate RSV-attributable hospitalizations and deaths in Spain during 2016-2019. METHODS Nationally representative hospitalization and mortality databases were obtained from the Ministry of Health and the National Statistical Office. A quasi-Poisson regression model was fitted to estimate the number of hospitalizations and deaths attributable to RSV as a function of periodic and aperiodic time trends and viral activity, while allowing for potential overdispersion. RESULTS In children, the RSV-attributable respiratory hospitalization incidence was highest among infants aged 0-5 months (3998-5453 cases/100,000 person-years, representing 72% of all respiratory hospitalizations) and decreased with age. In 2019, estimated rates in children 0-5, 6-11, 12-23 months and 6-17 years were approximately 1.3, 1.4, 1.5, and 6.5 times higher than those based on standard-of-care RSV-specific codes. In adults, the RSV-attributable cardiorespiratory hospitalization rate increased with age and was highest among persons ≥ 80 years (1325-1506 cases/100,000, 6.5% of all cardiorespiratory hospitalizations). In 2019, for persons aged 18-49, 50-59, 60-79, and ≥ 80 years, estimated rates were approximately 8, 6, 8, and 16 times higher than those based on standard-of-care RSV-specific codes. The RSV-attributable cardiorespiratory mortality rate was highest among ≥ 80 age group (126-150 deaths/100,000, 3.5-4.1% of all cardiorespiratory deaths), when reported mortality rate ranged between 0 and 0.5/100,000. CONCLUSIONS When accounting for under-ascertainment, estimated RSV-attributable hospitalizations were higher than those reported based on standard-of-care RSV-specific codes in all age groups but particularly among older children and older adults. Like other respiratory viruses, RSV contributes to both respiratory and cardiovascular complications. Efficacious RSV vaccines could have a high public health impact in these age and risk groups.
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Affiliation(s)
| | | | | | | | | | | | - Maribel Casas
- Epidemiology and Pharmacovigilance, P95, Leuven, Belgium
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Kubo Y, Noritake K, Noguchi T, Hayashi T. Phase Angle as a Nutritional Assessment Method in Patients with Hip Fractures: A Cross-Sectional Study. Ann Geriatr Med Res 2024; 28:95-100. [PMID: 38263547 PMCID: PMC10982439 DOI: 10.4235/agmr.23.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Phase angle, which is associated with cellular health, has attracted attention as a noninvasive and objective method for nutritional assessment. However, the association between malnutrition and phase angle in older inpatients with hip fractures has not been reported. Therefore, this study investigated this association in older inpatients (aged ≥65 years) with hip fractures and determined the cutoff phase angle for determining malnutrition. METHODS This cross-sectional study retrospectively analyzed the data of 96 inpatients with hip fractures who were hospitalized in rehabilitation units after surgery (male, 29.4%; mean age, 82.4±6.2 years). Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), with malnutrition defined as a GNRI ≥98. Bioelectrical impedance analysis was used to measure phase angles. RESULTS The phase angle was associated with malnutrition (B=-1.173; odds ratio=0.310; 95% confidence interval 0.58-0.83; p=0.015). The area under the receiver operating characteristic curve was 0.71. The cutoff phase angle for malnutrition was 3.96° (sensitivity=0.85, specificity=0.63). CONCLUSION Phase angle could be an indicator of malnutrition in older inpatients with hip fractures. Our findings will help formulate rehabilitation strategies for these patients.
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Affiliation(s)
- Yuta Kubo
- Division of Occupational Therapy, Faculty of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
| | - Kento Noritake
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, Handa, Aichi, Japan
| | - Taiji Noguchi
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Takahiro Hayashi
- Division of Physical Therapy, Faculty of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
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Fichadiya A, Quinn A, Au F, Campbell D, Lau D, Ronksley P, Beall R, Campbell DJT, Wilton SB, Chew DS. Association between sodium-glucose cotransporter-2 inhibitors and arrhythmic outcomes in patients with diabetes and pre-existing atrial fibrillation. Europace 2024; 26:euae054. [PMID: 38484180 PMCID: PMC10939462 DOI: 10.1093/europace/euae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
AIMS Prior studies suggest that sodium-glucose cotransporter-2 inhibitors (SGLT2is) may decrease the incidence of atrial fibrillation (AF). However, it is unknown whether SGLT2i can attenuate the disease course of AF among patients with pre-existing AF and Type II diabetes mellitus (DM). In this study, our objective was to examine the association between SGLT2i prescription and arrhythmic outcomes among patients with DM and pre-existing AF. METHODS AND RESULTS We conducted a population-based cohort study of adults with DM and AF between 2014 and 2019. Using a prevalent new-user design, individuals prescribed SGLT2i were matched 1:1 to those prescribed dipeptidyl peptidase-4 inhibitors (DPP4is) based on time-conditional propensity scores. The primary endpoint was a composite of AF-related healthcare utilization (i.e. hospitalization, emergency department visits, electrical cardioversion, or catheter ablation). Secondary outcome measures included all-cause mortality, heart failure (HF) hospitalization, and ischaemic stroke or transient ischaemic attack (TIA). Cox proportional hazard models were used to examine the association of SGLT2i with the study endpoint. Among 2242 patients with DM and AF followed for an average of 3.0 years, the primary endpoint occurred in 8.7% (n = 97) of patients in the SGLT2i group vs. 10.0% (n = 112) of patients in the DPP4i group [adjusted hazard ratio 0.73 (95% confidence interval 0.55-0.96; P = 0.03)]. Sodium-glucose cotransporter-2 inhibitors were associated with significant reductions in all-cause mortality and HF hospitalization, but there was no difference in the risk of ischaemic stroke/TIA. CONCLUSION Among patients with DM and pre-existing AF, SGLT2is are associated with decreased AF-related health resource utilization and improved arrhythmic outcomes compared with DPP4is.
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Affiliation(s)
- Akash Fichadiya
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, AB, Canada
| | - Amity Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
| | - Flora Au
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
| | - Dennis Campbell
- Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350 - 83 Avenue NW, T6G 2G3 Edmonton, AB, Canada
| | - Darren Lau
- Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350 - 83 Avenue NW, T6G 2G3 Edmonton, AB, Canada
| | - Paul Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
| | - Reed Beall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
| | - David J T Campbell
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1 Calgary, AB, Canada
| | - Stephen B Wilton
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1 Calgary, AB, Canada
| | - Derek S Chew
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1 Calgary, AB, Canada
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Mota J, Teixeira P, Rodrigues T, Lourenço H, Moreira S, Martins D, Horta P, Quarenta J, Teixeira T. [Proposal of Admission Criteria for Psychiatric Hospitalization]. ACTA MEDICA PORT 2024; 37:160-162. [PMID: 38345395 DOI: 10.20344/amp.20500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/20/2023] [Indexed: 03/03/2024]
Affiliation(s)
- Jorge Mota
- Serviço de Saúde Mental. Unidade Local de Saúde do Médio Ave, EPE. Santo Tirso. Portugal
| | - Pedro Teixeira
- PortugServiço de Saúde Mental. Unidade Local de Saúde do Médio Ave, EPE. Santo Tirso. uês. Portugal
| | - Tiago Rodrigues
- Serviço de Saúde Mental. Unidade Local de Saúde do Médio Ave, EPE. Santo Tirso. Portugal
| | - Helder Lourenço
- Serviço de Saúde Mental. Unidade Local de Saúde do Médio Ave, EPE. Santo Tirso. Portugal
| | - Susana Moreira
- Serviço de Saúde Mental. Unidade Local de Saúde do Médio Ave, EPE. Santo Tirso. Portugal
| | - Daniela Martins
- Serviço de Saúde Mental. Unidade Local de Saúde do Médio Ave, EPE. Santo Tirso. Portugal
| | - Pedro Horta
- Serviço de Saúde Mental. Unidade Local de Saúde do Médio Ave, EPE. Santo Tirso. Portugal
| | - João Quarenta
- Serviço de Saúde Mental. Unidade Local de Saúde do Médio Ave, EPE. Santo Tirso. Portugal
| | - Tânia Teixeira
- Serviço de Saúde Mental. Unidade Local de Saúde do Médio Ave, EPE. Santo Tirso. Portugal
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Ceolin C, De Rui M, Simonato C, Vergadoro M, Cazzavillan S, Acunto V, Papa MV, Trapella GS, Zanforlini BM, Curreri C, Bertocco A, Devita M, Coin A, Sergi G. Sarcopenic patients "get even": The impact of COVID-19 vaccination on mortality. Exp Gerontol 2024; 187:112382. [PMID: 38369251 DOI: 10.1016/j.exger.2024.112382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Coronavirus Disease-2019 (COVID-19), driven by the SARS-CoV-2 virus, has disproportionately affected the elderly, with comorbidities like sarcopenia worsening prognosis. Considering the significant impact of RNA vaccines on survival rates in this population, our objective is to investigate the impact of vaccination on the survival of hospitalized elderly patients with COVID-19, considering the presence or absence of sarcopenia. METHODS Prospective study conducted on 159 patients aged>65 years from September 2021 to March 2022. Data about clinical and body composition, and mortality at 12-months after discharge were recorded. Sarcopenia was diagnosed according to the 2019 European Consensus criteria. RESULTS At the twelfth month post-discharge, vaccinated sarcopenic individuals exhibited a mortality risk similar to vaccinated non-sarcopenic individuals, and lower than unvaccinated non-sarcopenic patients. Cox regression analysis, adjusted for age, gender, comorbidity, functional and vaccinal status, showed that the presence of sarcopenia did not significantly impact the risk of death within 12-months post-discharge. DISCUSSION Vaccination emerges as a protective measure for sarcopenic patients, countering the potential adverse effects of sarcopenia on COVID-19 outcomes, underscoring the importance of immunization in the frail elderly with a call for meticulous monitoring of its benefits. CONCLUSIONS Our study represents the first attempt to analyze the vaccine's effect on survival in sarcopenic hospitalized older adults with COVID-19. The administration of vaccination to sarcopenic patients proves pivotal, as its omission could lead to notably unfavorable outcomes within this specific population.
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Affiliation(s)
- Chiara Ceolin
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy.
| | - Marina De Rui
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy
| | - Cristina Simonato
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy
| | - Margherita Vergadoro
- Department of Medicine (DIMED), Department of Women's and Children's Health, University of Padua, Italy
| | - Sara Cazzavillan
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy
| | - Vittorio Acunto
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy
| | - Mario Virgilio Papa
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy
| | | | | | - Chiara Curreri
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy
| | - Anna Bertocco
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy
| | - Maria Devita
- Department of General Psychology (DPG), University of Padua, Italy
| | - Alessandra Coin
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy
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Sethi I, Lam K, Sanicola C, Lee E, Tuppo C, Spaniolas K, Pryor AD. Efficacy of Bowel Regimen in Decreasing Postoperative Constipation in Bariatric Surgery Patients. Obes Surg 2024; 34:830-835. [PMID: 38285300 DOI: 10.1007/s11695-024-07073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Postoperative constipation after bariatric surgery is a common complaint, decreasing patient quality of life. No literature exists examining the efficacy of a preoperative bowel regimen in reducing postoperative constipation in this cohort. This study aims explore the efficacy of a well-established bowel regimen, polyethylene glycol (PEG), in reducing constipation frequency and severity after bariatric surgery. METHODS This was a retrospective study of adult patients undergoing primary and revisional bariatric procedures. The use of PEG bowel prep for bariatric patients was introduced as an institutional quality improvement measure. Patients during the first 3 months after PEG implementation were surveyed for postoperative constipation. For the year after implementation, patients were followed for 30-day emergency room visits or hospitalization secondary to constipation. This cohort was compared to historical controls from the previous year. Student t-tests were used for statistical analysis. RESULTS During the 3-month exploratory phase, 28/49 (57.14%) patients fully completed the bowel regimen. In total, 0/56 (0%) patients reported preoperative constipation, and 5/28 (17.9%) patients reported constipation at the 3-week follow-up. In the 1 year post-implementation cohort, 2/234 (0.85%) patients had constipation-related occurrences at 30-day follow-up, compared to 8/219 patients (3.65%) in the historical cohort (p = 0.04). CONCLUSIONS The implementation of a PEG-based bowel regimen did not eliminate self-reported constipation. However, there were significant differences in rates of constipation-related ED visits and hospital readmissions, suggesting that the bowel regimen decreases rates of severe constipation. Finally, patient compliance was limited. Future work should aim towards increasing compliance.
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Affiliation(s)
- Ila Sethi
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, 11790, USA.
| | - Katherine Lam
- Department of Surgery, Westchester Medical Center, Valhalla, NY, 15095, USA
| | - Caroline Sanicola
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, 11790, USA
| | - Edmund Lee
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, 11790, USA
| | - Catherine Tuppo
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, 11790, USA
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, 11790, USA
| | - Aurora D Pryor
- Department of Surgery, Long Island Jewish Medical Center, Northwell Health, Queens, NY, 11040, USA
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81
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Lim CC, Huang D, Huang Z, Ng LC, Tan NC, Tay WY, Bee YM, Ang A, Tan CS. Early repeat hospitalization for fluid overload in individuals with cardiovascular disease and risks: a retrospective cohort study. Int Urol Nephrol 2024; 56:1083-1091. [PMID: 37615843 DOI: 10.1007/s11255-023-03747-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
AIMS Fluid overload is a common manifestation of cardiovascular and kidney disease and a leading cause of hospitalizations. To identify patients at risk of recurrent severe fluid overload, we evaluated the incidence and risk factors associated with early repeat hospitalization for fluid overload among individuals with cardiovascular disease and risks. METHODS Single-center retrospective cohort study of 3423 consecutive adults with an index hospitalization for fluid overload between January 2015 and December 2017 and had cardiovascular risks (older age, diabetes mellitus, hypertension, dyslipidemia, kidney disease, known cardiovascular disease), but excluded if lost to follow-up or eGFR < 15 ml/min/1.73 m2. The outcome was early repeat hospitalization for fluid overload within 30 days of discharge. RESULTS The mean age was 73.9 ± 11.6 years and eGFR was 54.1 ± 24.6 ml/min/1.73 m2 at index hospitalization. Early repeat hospitalization for fluid overload occurred in 291 patients (8.5%). After adjusting for demographics, comorbidities, clinical parameters during index hospitalization and medications at discharge, cardiovascular disease (adjusted odds ratio, OR 1.66, 95% CI 1.27-2.17), prior hospitalization for fluid overload within 3 months (OR 2.52, 95% CI 1.17-5.44), prior hospitalization for any cause in within 6 months (OR 1.33, 95% CI 1.02-1.73) and intravenous furosemide use (OR 1.58, 95% CI 1.10-2.28) were associated with early repeat hospitalization for fluid overload. Higher systolic BP on admission (OR 0.992, 95% 0.986-0.998) and diuretic at discharge (OR 0.50, 95% CI 0.26-0.98) reduced early hospitalization for fluid overload. CONCLUSION Patients at-risk of early repeat hospitalization for fluid overload may be identified using these risk factors for targeted interventions.
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Affiliation(s)
- Cynthia C Lim
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore.
| | - Dorothy Huang
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Zhihua Huang
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
- Nursing, Singapore General Hospital, Singapore, Singapore
| | - Li Choo Ng
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
- Nursing, Singapore General Hospital, Singapore, Singapore
| | | | - Wei Yi Tay
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Andrew Ang
- SingHealth Polyclinics, Singapore, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
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Platas-Abenza G, Guerrero-Soler M, Silva-Afonso RDF, Gallardo-Rodriguez P, Gil-Sánchez F, Escribano-Cañadas I, Benito-Miralles CM, Solis-Aniorte N, Carnicer-Bueno R, Esclapez-Martínez A, Chico-Sánchez P, Sánchez-Payá J, Gras-Valentí P. Effectiveness of influenza vaccine in preventing severe cases of influenza: Season 2022/2023. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:140-145. [PMID: 38342648 DOI: 10.1016/j.eimce.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/04/2023] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Influenza poses a significant burden in terms of morbidity and mortality, with vaccination being one of the most effective measures for its prevention. Therefore, the aim of this study is to determine the effectiveness of the influenza vaccine in preventing cases of severe influenza in patients admitted to a tertiary hospital during the 2022/23 season. METHODS Case-control study. All hospitalised patients with a positive result in an RT-PCR for influenza were included. Those who met the criteria for a severe case (pneumonia, sepsis, multi-organ failure, admission to ICU or exitus) were considered cases. Those who did not meet these criteria were considered controls. Vaccine effectiveness (VE) to prevent severe cases and its 95% confidence interval were calculated. RESULTS A total of 403 patients were admitted with confirmed influenza. Of these, 98 (24.3%) developed severe influenza. Of the total, 50.6% were men and 47.1% were over 65 years of age. VE adjusted for influenza type, age and certain comorbidities was 40.6% (-21.9 to 71.1). In a segmented analysis, influenza vaccine was effective in preventing severe cases in all categories. It was particularly relevant in the 65+ age group (VEa = 60.9%; -2.0 to 85.0) and in patients with influenza A (VEa = 56.7%; 1.5-80.9). CONCLUSION Influenza vaccination markedly reduced the occurrence of severe cases of influenza in hospitalised patients, therefore, it remains the main strategy to reduce morbidity and mortality and associated costs.
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Affiliation(s)
- Guillermo Platas-Abenza
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - María Guerrero-Soler
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Raissa de Fatima Silva-Afonso
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Pilar Gallardo-Rodriguez
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Francisco Gil-Sánchez
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Isabel Escribano-Cañadas
- Servicio de Microbiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Carmen M Benito-Miralles
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Noemi Solis-Aniorte
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Rocio Carnicer-Bueno
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Ana Esclapez-Martínez
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Pablo Chico-Sánchez
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - José Sánchez-Payá
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Paula Gras-Valentí
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
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de la Fuente A, Postigo T, Sanus Ferri F, Domínguez-Gil M, Álvarez-Manzanares J, Eiros JM, Carbajosa Rodríguez V, Sanchez Ramon S, Ortega A, Fadrique Millán LN, Vaquero-Roncero LM, Esteban-Velasco C, Navarro-Matías E, Barbé F, Bermejo-Martin JF, Lopez-Izquierdo R. Synergistic impact of N-antigenemia profiled by a rapid antigen test and low anti-S1 antibodies on the risk of hospitalization in COVID-19. Int J Infect Dis 2024; 140:132-135. [PMID: 38311026 DOI: 10.1016/j.ijid.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024] Open
Abstract
OBJECTIVES Identifying patients with COVID-19 who are at risk of poor evolution is key to early decide on their hospitalization. We evaluated the combined impact of nucleocapsid (N)-antigenemia profiled by a rapid test and antibodies against the S1 subunit of the SARS-CoV S protein (S1) on the hospitalization risk of patients with COVID-19. METHODS N-antigenemia and anti-S1 antibodies were profiled at admission to the emergency department in 146 patients with COVID-19 using the Panbio® antigen Rapid Test and the SARS-CoV-2 immunoglobulin G II Quant/SARS-CoV-2 immunoglobulin G assay from Abbott. A multivariable analysis was used to evaluate the impact of these factors on hospitalization. RESULTS Patients with a positive N-antigen test in plasma and anti-S1 levels <2821 arbitrary units/mL needed hospitalization more frequently (20 of 23, 87%). A total of 20 of 71 (28.2%) of those showing a negative N-antigen test and anti-S1 ≥2821 arbitrary units/mL were hospitalized for 18 of 52 (34.6%) of the patients with only one of these conditions. Patients with a positive N-antigen test and low antibody levels showed an odds ratio, 95% confidence interval, and P-value for hospitalization of 18.21, 2.74-121.18, and 0.003, respectively, and exhibited the highest mortality (30.4%). CONCLUSIONS Simultaneous profiling of a rapid N-antigen test in plasma and anti-S1 levels could help to early identify patients with COVID-19 needing hospitalization.
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Affiliation(s)
- Amanda de la Fuente
- Group for Biomedical Research in Sepsis (BioSepsis). Instituto de Investigación Biomédica de Salamanca, (IBSAL), Gerencia Regional de Salud de Castilla y León, Paseo de San Vicente, Salamanca, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES, CB22/06/00035), Instituto de Salud Carlos III, Madrid, Spain
| | - Tamara Postigo
- Group for Biomedical Research in Sepsis (BioSepsis). Instituto de Investigación Biomédica de Salamanca, (IBSAL), Gerencia Regional de Salud de Castilla y León, Paseo de San Vicente, Salamanca, Spain
| | - Francisco Sanus Ferri
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES, CB07/06/2008), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Domínguez-Gil
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES, CB22/06/00035), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Service, Hospital Universitario Rio Hortega, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain
| | - Jesús Álvarez-Manzanares
- Emergency Department, Hospital Universitario Rio Hortega, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain
| | - Jose María Eiros
- Microbiology Service, Hospital Universitario Rio Hortega, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain
| | - Virginia Carbajosa Rodríguez
- Emergency Department, Hospital Universitario Rio Hortega, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain
| | - Susana Sanchez Ramon
- Emergency Department, Hospital Universitario Rio Hortega, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain
| | - Alicia Ortega
- Group for Biomedical Research in Sepsis (BioSepsis). Instituto de Investigación Biomédica de Salamanca, (IBSAL), Gerencia Regional de Salud de Castilla y León, Paseo de San Vicente, Salamanca, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES, CB22/06/00035), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura N Fadrique Millán
- Emergency Department, Hospital Universitario Rio Hortega, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain
| | - Luis Mario Vaquero-Roncero
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES, CB22/06/00035), Instituto de Salud Carlos III, Madrid, Spain; Anaesthesiology and Reanimation Service, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Carmen Esteban-Velasco
- Department of General and Gastrointestinal Surgery, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL) and Universidad de Salamanca, Salamanca, Spain
| | - Elena Navarro-Matías
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Salamanca, Spain; Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Castilla and León Health Service-SACYL, Gerencia Regional de Salud, Valladolid, Spain
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES, CB07/06/2008), Instituto de Salud Carlos III, Madrid, Spain; Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain
| | - Jesús F Bermejo-Martin
- Group for Biomedical Research in Sepsis (BioSepsis). Instituto de Investigación Biomédica de Salamanca, (IBSAL), Gerencia Regional de Salud de Castilla y León, Paseo de San Vicente, Salamanca, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES, CB22/06/00035), Instituto de Salud Carlos III, Madrid, Spain; School of Medicine, Universidad de Salamanca, Salamanca, Spain.
| | - Raul Lopez-Izquierdo
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES, CB22/06/00035), Instituto de Salud Carlos III, Madrid, Spain; Emergency Department, Hospital Universitario Rio Hortega, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain
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Akenroye A, Marshall J, Simon AL, Hague C, Costa R, Jamal-Allial A, McMahill-Walraven CN, Haffenreffer K, Han A, Wu AC. Smaller Differences in the Comparative Effectiveness of Biologics in Reducing Asthma-Related Hospitalizations Compared With Overall Exacerbations. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00211-3. [PMID: 38431251 DOI: 10.1016/j.jaip.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Evidence on the comparative effectiveness of respiratory biologics remains sparse. OBJECTIVE We sought to evaluate the comparative effectiveness of omalizumab, mepolizumab, benralizumab, and dupilumab in a matched retrospective cohort of patients with asthma. METHODS We identified patients with asthma aged ≥18 years who were incident users of these biologics between November 1, 2018, and June 30, 2023, in administrative claims data from the Food and Drug Administration's Sentinel System and Merative MarketScan Commercial Database. We compared asthma-related exacerbations and hospitalizations in the 12 months since biologic prescription in pairwise comparisons of propensity score-matched cohorts. Covariates used in matching included age, sex, allergic comorbidities, baseline asthma medications use, and the Charlson Comorbidity Index. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using negative binomial regression models. RESULTS A total of 893 patients on mepolizumab, 1300 on benralizumab, 1170 on omalizumab, and 1863 on dupilumab were identified. The average age was 55 years, and two-thirds of the participants were female. At baseline, over 80% of these individuals had an active prescription for an inhaled corticosteroid. Almost half of patients on dupilumab had concomitant nasal polyposis compared with 6% to 13% of patients on the other biologics. Covariates were balanced after matching. In matched analyses, dupilumab was associated with the lowest incidence of exacerbations over the follow-up period (vs dupilumab): mepolizumab (IRR: 1.36; 95% CI: 1.12, 1.64), omalizumab (IRR: 1.33; 95% CI: 1.13, 1.58), benralizumab (IRR: 1.19; 95% CI: 1.00, 1.41). For exacerbations leading to hospitalizations, benralizumab and mepolizumab were associated with the lowest incidence of hospitalizations, and the greatest difference was between mepolizumab versus dupilumab (IRR: 0.76; 95% CI: 0.56, 1.03). CONCLUSIONS Dupilumab was associated with the lowest incidence of overall exacerbations, and mepolizumab with the lowest incidence of asthma hospitalizations in this administrative claims-based cohort of individuals with asthma. Despite matching propensity scores, residual confounding, such as baseline eosinophil count, may explain some of these findings.
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Affiliation(s)
- Ayobami Akenroye
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
| | - James Marshall
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Andrew L Simon
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Christian Hague
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Rebecca Costa
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | | | | | - Katie Haffenreffer
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Amy Han
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
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Marchili MR, Bozzola E, Guolo S, Marchesani S, Spina G, Mascolo C, Vicari S, De Jacobis IT, Raponi M, Villani A. Pediatric acute hospitalization for anorexia nervosa: an economic evaluation. Ital J Pediatr 2024; 50:33. [PMID: 38413993 PMCID: PMC10900686 DOI: 10.1186/s13052-024-01605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a psychiatric disorders which may potentially led to a high risk of health medical complications, suicide and self-harming behaviour. Since Covid-19 pandemic onset in March 2020, evidence suggested an increase occurrence of AN. The main aim of the retrospective analysis is to define the cost of hospitalization in the acute phase (HAP) at IRCCS Bambino Gesù Children Hospital, Rome, Italy, over 2 years study. Secondary purposes are defining the main risk factors for a prolonged hospitalization (including age, sex and comorbidities) and the possible influence of Covid-19 pandemic on AN admission and hospital stay. METHODS for the purpose of the study, we included children and adolescents aged less than 18 years, admitted to IRCCS Bambino Gesù Children Hospital, Rome, Italy, with a diagnosis of AN. Medical costs were calculated consulting the Lazio Regional Health Service Tariffs. Basing on the date of hospital admission, patients were later divided into two subgroups: subgroup A included patients hospitalized prior than Covid-19 onset (from March 2019 to February 2020) and subgroup B those admitted after (from March 2020 to October 2022). RESULTS a total of 260 patients has been included in the study with a median age of 15 years (range 6-18 years). The total health care cost of AN hospitalized patients was of EUR 3,352,333 with a median cost of EUR 11,124 for each admission (range EUR 930 - 45,739) and a median daily cost of EUR 593 (range EUR 557-930). Median cost was higher in case of comorbidities, guarded patients, enteral feeding. A prolonged hospitalization has been documented in subgroup A with a higher economic burden. CONCLUSIONS the economic burden of eating disorders is of note. Adequate sanitary policies as well as health economic analyses are required to gain insight into the cost-effectiveness of AN management. TRIAL REGISTRATION 2526-OPBG-2021.
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Affiliation(s)
| | - Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
- Child Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvio Marchesani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Spina
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristina Mascolo
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Sanitary Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Alberto Villani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Bueno Yáñez O, Calvo Aguirre JJ, Uranga Zaldua J, Alustiza Navarro J, Ugartemendia Yerobi M. [Alusti test as a premonitory variable of adverse health events in a nursing home. Two-years follow-up]. Rev Esp Geriatr Gerontol 2024; 59:101476. [PMID: 38417197 DOI: 10.1016/j.regg.2024.101476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Functional capacity is a good indicator of health, quality of life, and a good predictor of morbimortality. It is a priority to functionally assess the geriatric population through objective, precise, and simple instruments. The Alusti Test in its two versions, complete (TA) and abbreviated (TAA), is a scale that meets these criteria. OBJECTIVE To determine the usefulness of the Alusti Test as a predictor of adverse health events: falls, hospitalizations, cognitive deterioration, and mortality in the elderly institutionalized population, with a two-year follow-up. MATERIAL AND METHODS This observational study's sample included 176 persons admitted to a nursing home for 32months, with a mean age of 85.5years. The TA was performed on 138 and the TAA on 38. RESULTS The ratio of falls is much higher in residents with mild dependence than in those with total dependence (P<.001). Hospitalizations increase as the results of the Alusti Test are more favorable. The risk of hospitalization in dependent patients is 50% lower (P<.001) than in those with preserved mobility. Cognitive impairment is similar in all the populations with some mild-moderate level of functional dependence and decreases in the population with preserved mobility. Categorization as total and mild/severe dependence is related to a 3-4times higher mortality at six months follow-up. CONCLUSIONS A higher mild-moderate level of dependence on the AT correlates with a lower risk of falls, a lower rate of hospitalization, and a higher risk of mortality at six months.
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Affiliation(s)
- Olga Bueno Yáñez
- Osakidetza, Centro de Salud Beraun, Errenteria, Guipúzcoa, España
| | | | | | | | - Maider Ugartemendia Yerobi
- Departamento de Enfermería, Facultad de Medicina y Enfermería, Universidad del País Vasco UPV/EHU, San Sebastián, España.
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Wang L, Zhang X, Liu X. Association between the frailty index and readmission risk in hospitalised elderly Chinese patients: a retrospective cohort study. BMJ Open 2024; 14:e076861. [PMID: 38417955 PMCID: PMC10900421 DOI: 10.1136/bmjopen-2023-076861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/16/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES Frailty is a common and important concern of the ageing population. This study examined the association between the frailty index and negative outcomes of hospitalised elderly Chinese patients. DESIGN Retrospective cohort study. SETTING Geriatrics Department of Peking University First Hospital. PARTICIPANTS 470 hospitalised elderly patients. MAIN OUTCOMES AND MEASURES Frailty was measured using a 30-item deficit-accumulation frailty index. The outcomes were the hospitalisation duration and readmission. RESULTS The frailty index was available for 470 patients: 72 (15.32%) were categorised as robust, 272 (57.87%) as prefrail and 126 (26.81%) as frail. The frail group had a longer hospital stay than the robust and prefrail groups. After adjustment for age, sex and cause of hospitalisation at baseline, frailty remained a strong independent risk factor for all-cause readmission and cardiocerebrovascular disease readmission (HR 2.41, 95% CI 1.49 to 3.91, p<0.001; HR 4.92, 95% CI 1.47 to 6.31, p<0.001, respectively). CONCLUSIONS The frailty index predicted a longer length of stay and higher all-cause and cardiocerebrovascular disease readmission risk in hospitalised elderly patients.
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Affiliation(s)
- Lina Wang
- Geriatric Department, Peking University First Hospital, Beijing, China
| | - Xiaolin Zhang
- Geriatric Department, Peking University First Hospital, Beijing, China
| | - Xinmin Liu
- Geriatric Department, Peking University First Hospital, Beijing, China
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Cuerpo S, Aguiló S, Poblete-Palacios MF, Burillo-Putze G, Alquézar-Arbé A, Jacob J, Fernández C, Llorens P, Montero-Pérez FJ, Iglesias-Frax C, Quero-Motto E, Escudero-Sánchez C, Poch-Ferrer EA, Hong-Cho JU, Casado-Ramón B, Gayoso-Martín S, Sánchez-Sindín G, Fernández-Álvarez ME, Puiggali-Ballard M, Trejo O, Llauger L, Garrido-Acosta L, Calle-Fernández S, Molina L, Martínez-Juan M, Gómez-García G, Rivas Del Valle P, López-Grima ML, Rull-Bertrán P, González Del Castillo J, Miró Ò. Epidemiological and clinical management aspects of pneumonias diagnosed in the emergency department in elderly patients in Spain: Results of the EDEN-29 study. Enferm Infecc Microbiol Clin (Engl Ed) 2024:S2529-993X(24)00040-6. [PMID: 38395666 DOI: 10.1016/j.eimce.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVES To estimate the incidence of pneumonia diagnosis in elderly patients in Spanish emergency departments (ED), need for hospitalization, adverse events and predictive capacity of biomarkers commonly used in the ED. METHODS Patients ≥65 years with pneumonia seen in 52 Spanish EDs were included. We recorded in-hospitaland 30-day mortality as adverse events, as well as intensive care unit (ICU) admission among hospitalizedpatients. Association of 10 predefined variables with adverse events was calculated and expressed as odds ratio (OR) with 95% confidence interval (CI), as well as predictive capacity of 5 commonly used biomarkers in the ED (leukocytes, hemoglobin, C-reactive protein, glucose, creatinine) was investigated using area under the receiver operating characteristic curve (AUC-ROC). RESULTS 591 patients with pneumonia attended in the ED were included (annual incidence of 18,4 per 1000 inhabitants). A total of 78.0% were hospitalized. Overall, 30-day mortality was 14.2% and in-hospital mortality was 12.9%. Functional dependency was associated with both events (OR=4.453, 95%CI=2.361-8.400; and OR=3.497, 95%CI=1.578-7.750, respectively) as well as severe comorbidity (2.344, 1.363-4.030, and 2.463, 1.252-4.846, respectively). Admission to the ICU during hospitalization occurred in 3.5%, with no associated factors. The predictive capacity of biomarkers was only moderate for creatinine for ICU admission (AUC-ROC=0.702, 95% CI=0.536-0.869) and for leukocytes for post-discharge adverse event (0.669, 0.540-0.798). CONCLUSIONS Pneumonia is a frequent diagnosis in elderly patients consulting in the ED. Their functional dependence and comorbidity is the factor most associated with adverse events. The biomarkers analyzed do not have a good predictive capacity for adverse events.
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Affiliation(s)
- Sandra Cuerpo
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | | | | | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Cesáreo Fernández
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | | | | | - Eva Quero-Motto
- Servicio de Urgencias, Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | - Olga Trejo
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lluís Llauger
- Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, Spain
| | | | - Sara Calle-Fernández
- Servicio de Urgencias, Hospital Virgen de Altagracia, Manzanares, Ciudad Real, Spain
| | - Laura Molina
- Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | | | | | | | | | - Pere Rull-Bertrán
- Servicio de Urgencias, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Òscar Miró
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain.
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Owachi D, Akatukunda P, Nanyanzi DS, Katwesigye R, Wanyina S, Muddu M, Kawuma S, Kalema N, Kabugo C, Semitala FC. Mortality and associated factors among people living with HIV admitted at a tertiary-care hospital in Uganda: a cross-sectional study. BMC Infect Dis 2024; 24:239. [PMID: 38388345 PMCID: PMC10885437 DOI: 10.1186/s12879-024-09112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Hospital admission outcomes for people living with HIV (PLHIV) in resource-limited settings are understudied. We describe in-hospital mortality and associated clinical-demographic factors among PLHIV admitted at a tertiary-level public hospital in Uganda. METHODS We performed a cross-sectional analysis of routinely collected data for PLHIV admitted at Kiruddu National Referral Hospital between March 2020 and March 2023. We estimated the proportion of PLHIV who had died during hospitalization and performed logistic regression modelling to identify predictors of mortality. RESULTS Of the 5,827 hospitalized PLHIV, the median age was 39 years (interquartile range [IQR] 31-49) and 3,293 (56.51%) were female. The median CD4 + cell count was 109 cells/µL (IQR 25-343). At admission, 3,710 (63.67%) were active on antiretroviral therapy (ART); 1,144 (19.63%) had interrupted ART > 3 months and 973 (16.70%) were ART naïve. In-hospital mortality was 26% (1,524) with a median time-to-death of 3 days (IQR 1-7). Factors associated with mortality (with adjusted odds ratios) included ART interruption, 1.33, 95% confidence intervals (CI) 1.13-1.57, p 0.001; CD4 + counts ≤ 200 cells/µL 1.59, 95%CI 1.33-1.91, p < 0.001; undocumented CD4 + cell count status 2.08, 95%CI 1.73-2.50, p < 0.001; impaired function status 7.35, 95%CI 6.42-8.41, p < 0.001; COVID-19 1.70, 95%CI 1.22-2.37, p 0.002; liver disease 1.77, 95%CI 1.36-2.30, p < 0.001; co-infections 1.53, 95%CI 1.32-1.78, p < 0.001; home address > 20 km from hospital 1.23, 95%CI 1.04-1.46, p 0.014; hospital readmission 0.7, 95%CI 0.56-0.88, p 0.002; chronic lung disease 0.62, 95%CI 0.41-0.92, p 0.019; and neurologic disease 0.46, 95%CI 0.32-0.68, p < 0.001. CONCLUSION One in four admitted PLHIV die during hospitalization. Identification of risk factors (such as ART interruption, function impairment, low/undocumented CD4 + cell count), early diagnosis and treatment of co-infections and liver disease could improve outcomes.
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Affiliation(s)
- Darius Owachi
- Kiruddu National Referral Hospital, Kampala, P.O. BOX 6588, Uganda.
| | | | | | | | | | - Martin Muddu
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - Samuel Kawuma
- Makerere University Joint AIDS Program, Kampala, Uganda
| | | | - Charles Kabugo
- Kiruddu National Referral Hospital, Kampala, P.O. BOX 6588, Uganda
| | - Fred C Semitala
- Makerere University Joint AIDS Program, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
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90
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Fattore G, Pongiglione B, Vezzosi L. Excess hospitalizations and in-hospital mortality associated with seasonal influenza in Italy: a 11-year retrospective study. BMC Infect Dis 2024; 24:227. [PMID: 38378487 PMCID: PMC10877853 DOI: 10.1186/s12879-024-09071-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Influenza and flu-like syndromes are difficult to monitor because the symptoms are not specific, laboratory tests are not routinely performed, and diagnosis codes are often lacking or incompletely registered in medical records. This may result in an underestimation of hospital admissions, associated costs, and in-hospital mortality. Therefore, this study aimed to estimate the public health and economic burden of hospitalisations associated with influenza in Italy, at the national and regional levels. METHODS This 11-year retrospective study included patients admitted to hospitals for influenza or diagnoses associated with influenza (including respiratory and cardiocirculatory conditions) from 2008/09 to 2018/19. Data on hospitalisations were extracted from the Italian Hospital Discharge Records. Information on weekly influenza-like syndrome incidence and weekly average temperature were used to estimate the burden of influenza in terms of hospital admissions in every Italian region and for different age groups by applying a negative binomial model. The model was also applied to estimate in-hospital mortality and the total costs of influenza and influenza-like hospital admissions. RESULTS Over the study period, in addition to 3,970 average seasonal admissions coded as influenza, we estimated an average of 21,500 excess hospitalization associated with influenza per season, which corresponds to 36.4 cases per 100,000. Most of the excess hospitalisations concerned older individuals (> 65 years) and children (0-4 years) with 86 and 125 cases per 100,000, respectively. Large variations were observed across regions. Overall, the total estimated hospital burden associated with influenza (including respiratory and cardiocirculatory conditions) was approximately €123 m per year. While the in-hospital mortality for admissions with a primary diagnosis of influenza was very low (~ 150 cases per season), cases increased dramatically for primary diagnoses of influenza and pneumonia (about 9,500 cases per season). The average seasonal in-hospital deaths attributable to influenza were equal to 2,775 cases. CONCLUSIONS Our findings suggest a remarkable underestimation of the burden of influenza, mostly in the older population but not neglectable in younger individuals. Our results may aid the management of current and future flu seasons and should be used for policy making (e.g., vaccine strategies) and operation management choices (e.g., planning and staffing beds during influenza peaks). Overall, the present study supports the need for increased testing for influenza in Italy to tackle the current underestimation of influenza burden.
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Affiliation(s)
- Giovanni Fattore
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management, Milan, Italy
| | - Benedetta Pongiglione
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management, Milan, Italy.
| | - Luigi Vezzosi
- Department of Hygiene and Health Prevention, Prevention of Infectious Diseases Unit, Health Protection Agency Val Padana, Mantua, Italy
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91
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Young DL, Hannum SM, Engels R, Colantuoni E, Friedman LA, Hoyer EH. Dynamic Prediction of Post-Acute Care Needs for Hospitalized Medicine Patients. J Am Med Dir Assoc 2024:104939. [PMID: 38387858 DOI: 10.1016/j.jamda.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/05/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Use patient demographic and clinical characteristics at admission and time-varying in-hospital measures of patient mobility to predict patient post-acute care (PAC) discharge. DESIGN Retrospective cohort analysis of electronic medical records. SETTING AND PARTICIPANTS Patients admitted to the two participating Hospitals from November 2016 through December 2019 with ≥72 hours in a general medicine service. METHODS Discharge location (PAC vs home) was the primary outcome, and 2 time-varying measures of patient mobility, Activity Measure for Post-Acute Care (AM-PAC) Mobility "6-clicks" and Johns Hopkins Highest Level of Mobility, were the primary predictors. Other predictors included demographic and clinical characteristics. For each day of hospitalization, we predicted discharge to PAC using the demographic and clinical characteristics and most recent mobility data within a random forest (RF) for survival, longitudinal, and multivariate (RF-SLAM) data. A regression tree for the daily predicted probabilities of discharge to PAC was constructed to represent a global summary of the RF. RESULTS There were 23,090 total patients and compared to PAC, those discharged home were younger (64 vs 71), had shorter length of stay (5 vs 8 days), higher AM-PAC at admission (43 vs 32), and average AM-PAC throughout hospitalization (45 vs 35). AM-PAC was the most important predictor, followed by age, and whether the patient lives alone. The area under the hospital day-specific receiver operating characteristic curve ranged from 0.76 to 0.79 during the first 5 days. The global summary tree explained 75% of the variation in predicted probabilities for PAC from the RF. Sensitivity (75%), specificity (70%), and accuracy (72%) were maximized at a PAC probability threshold of 40%. CONCLUSIONS AND IMPLICATIONS Daily assessment of patient mobility should be part of routine practice to help inform care planning by hospital teams. Our prediction model could be used as a valuable tool by multidisciplinary teams in the discharge planning process.
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Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
| | - Susan M Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca Engels
- Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Aronson Friedman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Torres Llergo J, Carrillo Bailén M, Segura Aumente JM, Fernández Olmo MR, Puentes Chiachío M, Fernández Guerrero JC, Ruiz Ortiz M. Incidence and prediction of hospitalization for heart failure in patients with atrial fibrillation: the REFLEJA scale. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00056-2. [PMID: 38382802 DOI: 10.1016/j.rec.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 02/23/2024]
Abstract
INTRODUCTION AND OBJECTIVES Hospitalization for heart failure (HHF) is common in patients with atrial fibrillation (AF) and is associated with increased mortality. The aims of this study were to determine the incidence of HHF, identify the clinical predictors of its occurrence, and develop a new risk scale. METHODS The incidence of HHF was estimated using data from the prospective single-center REFLEJA registry of outpatients with AF (October 2017-October 2018). A multivariate Cox regression model was calculated to detect HHF predictors, and a nomogram was created for individual risk assessment. RESULTS Of the 1499 patients included (mean age 73.8±11.1 years, 48.1% women), 127 had HHF (incidence rate of 8.51 per 100 persons/y) and 319 died (rate of death from any cause of 21.1 per 100 persons/y) after a 3-year follow-up. The independent predictors of HHF were age, diabetes, chronic kidney disease, pulmonary hypertension, previous pacemaker implantation, baseline use of diuretics, and moderate-severe aortic regurgitation. The c-statistic for predicting the event was 0.762 (95%CI after boostrapping resampling, 0.753-0.791). The cumulative incidences of the main outcome for the risk scale quartiles were 1.613 (Q1), 3.815 (Q2), 8.378 (Q3), and 20.436 (Q4) cases per 100 persons/y (P <.001). CONCLUSIONS HHF was common in this AF cohort. The combination of certain clinical characteristics can identify patients with a very high risk of HHF.
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Affiliation(s)
| | | | | | | | | | | | - Martín Ruiz Ortiz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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93
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Ferucci ED, Holck P. An assessment of cardiovascular disease hospitalizations and disparities by race in patients with rheumatic disease hospitalizations in Alaska, 2015-2018. BMC Rheumatol 2024; 8:7. [PMID: 38369541 PMCID: PMC10874531 DOI: 10.1186/s41927-024-00377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND There is an increased risk of cardiovascular disease in people with many rheumatic diseases. The primary objective of this study was to evaluate cardiovascular disease hospitalizations in Alaska for people with and without a rheumatic disease diagnosis and assess disparities by race, with a focus on Alaska Native and American Indian people. METHODS This study used the Alaska Health Facilities Data Reporting Program data on inpatient hospitalizations from 2015 to 2018. We identified people with a rheumatic disease diagnosis based on any hospitalization with a set of rheumatic disease diagnoses and compared them to people hospitalized but without a rheumatic disease diagnosis. We determined the odds of cardiovascular disease hospitalization by rheumatic disease diagnosis and assessed the influence of race and other factors, using univariate analyses and multivariable models. RESULTS People with a rheumatic disease diagnosis other than osteoarthritis had higher odds of cardiovascular disease hospitalization. The odds ratio was highest in people with gout compared to other rheumatic diseases. In multivariable models, there was an interaction between race and rheumatic disease status. Specifically, having gout increased the odds of cardiovascular disease hospitalization for people of all races, while having a rheumatic disease other than gout or osteoarthritis increased the odds of cardiovascular disease hospitalization in Alaska Native/American Indian people but not in people of other races. CONCLUSIONS The association between rheumatic disease status and cardiovascular disease hospitalization in Alaska varied by type of rheumatic disease and race. This adds substantially to the literature on associations between rheumatic disease and cardiovascular disease in Indigenous North American populations.
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Affiliation(s)
- Elizabeth D Ferucci
- Research Services Department, Division of Community Health Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Drive, 2nd floor Anchorage, 99508, Anchorage, AK, USA.
| | - Peter Holck
- Research Services Department, Division of Community Health Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Drive, 2nd floor Anchorage, 99508, Anchorage, AK, USA
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Rattananon P, Tienpratarn W, Yuksen C, Aussavanodom S, Thiamdao N, Termkijwanich P, Phongsawad S, Kaninworapan P, Tantasirin K. Associated Factors of Cardiopulmonary Resuscitation Outcomes; a Cohort Study on an Adult In-hospital Cardiac Arrest Registry. Arch Acad Emerg Med 2024; 12:e30. [PMID: 38572213 PMCID: PMC10988187 DOI: 10.22037/aaem.v12i1.2227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Introduction In-hospital cardiac arrest (IHCA) remains a substantial cause of morbidity and mortality for hospitalized patients worldwide. This study aimed to identify associated factors of return of spontaneous circulation (ROSC) and survival with favorable neurological outcomes of IHCA patients. Method A two-year retrospective cohort study was conducted at a university-based tertiary care hospital in Bangkok, Thailand, studying adult patients aged ≥ 18 years with IHCA from January 2021 to December 2022. The primary endpoint was sustained ROSC, and the secondary endpoint was survival with favorable neurological outcomes defined as Cerebral Performance Categories (CPC) Scale of 1 or 2 at discharge. Pre-arrest and intra-arrest variables were collected and analyzed using multivariable logistic regression to identify independent factors associated with the outcomes. Results During the study period, 156 patients were included in the study. 105 (67.3%) patients achieved sustained ROSC after the CPR, 28 patients (18.0%) were discharged alive, and 15 patients (9.6%) survived with a favorable neurological outcome at hospital discharge. Overall, sustained ROSC was higher in patients who had IHCA during the day shift (odds ratio (OR): 4.11; 95% confidence interval (CI): 1.05-16.06) and electrocardiogram (ECG) monitoring prior to arrest (OR: 6.38; 95% CI: 1.18-34.54). In contrast, higher adrenaline doses administrated, and increased CPR duration reduced the odds of sustained ROSC (OR: 0.72; 95% CI: 0.54-0.94 and OR: 0.92; 95% CI: 0.85-0.98, respectively). Arrest due to cardiac etiology was associated with increased discharged survival with favorable neurological outcomes (OR: 13.43; 95% CI: 2.00-89.80), while a higher Good Outcome Following Attempted Resuscitation (GO-FAR) score reduced the odds of the secondary outcome (OR: 0.89; 95% CI: 0.81-0.98). Conclusion The sustained ROSC was higher in IHCA during the daytime shift and under prior ECG monitoring. The administration of higher doses of adrenaline and prolonged CPR durations decreased the likelihood of achieving sustained ROSC. Furthermore, patients with cardiac-related causes of cardiac arrest exhibited a higher rate of survival to hospital discharge with favorable neurological outcomes.
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Affiliation(s)
- Parin Rattananon
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Welawat Tienpratarn
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiyaporn Yuksen
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Supassorn Aussavanodom
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natthaphong Thiamdao
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phatcha Termkijwanich
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suraphong Phongsawad
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 111 Moo 14, Bang Pla, Bang Phli, Samut Prakarn 10540, Thailand
| | - Parama Kaninworapan
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kanda Tantasirin
- Ramathibodi Life Support Training Unit, Medical Services Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Söderberg A, Lindgren BM, Looi GME, Bäckström J, Gabrielsson S. Psychiatric inpatient care for persons with dissociative identity disorder: a scoping review protocol. BMJ Open 2024; 14:e079207. [PMID: 38365290 DOI: 10.1136/bmjopen-2023-079207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Psychiatric inpatient care (PIC) is often characterised by high pressure and thresholds for admission, brief periods of care and limited time for caring activities. Dissociative identity disorder (DID) is a contested diagnosis, and persons with DID are at risk of not receiving adequate support when cared for in PIC. Because the limited literature addressing the topic includes no overview on how persons with DID are cared for in psychiatric inpatient settings, the aim of this scoping review is to map the area of knowledge on PIC for persons experiencing DID. This scoping review will provide an overview with the possibility to elucidate gaps in the evidence base and needs for future research on PIC for persons experiencing DID. METHODS AND ANALYSIS This scoping review will follow Preferred Reporting Items for Systematic Review and Meta-Analysis for Scoping Reviews and steps 1-5 described in the established method for scoping reviews: identifying research question, identifying relevant studies, study selection, charting the data and collating, summarising and reporting results. ETHICS APPROVAL Not applicable. DISSEMINATION This scoping review will be submitted for publication in an international, peer-reviewed journal.
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Affiliation(s)
- Anja Söderberg
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | | | - Git-Marie Ejneborn Looi
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Josefin Bäckström
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Sebastian Gabrielsson
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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96
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Beydoun HA, Beydoun MA, Eid SM, Zonderman AB. Pulmonary artery catheter receipt among cardiac surgery patients from the national inpatient sample (1999-2019): Prevalence, predictors and hospitalization charges. Heliyon 2024; 10:e24902. [PMID: 38317919 PMCID: PMC10839978 DOI: 10.1016/j.heliyon.2024.e24902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Despite limited evidence to support its efficacy, use of pulmonary artery catheter (PAC), a relatively expensive medical device, for monitoring clinical status and guiding therapeutic interventions, has become standard of care in many settings, and especially during and after cardiac surgery. We examined the prevalence and predictors of PAC use and its association with hospitalization charges among cardiac surgery patients generally and for each selected subgroup of high-risk or complex surgical procedures. We conducted an analysis on 1,442,528 records from the National Inpatient Sample (1999-2019) that included cardiac surgery patients ≥18 years of age. Subgroups were categorized based on the presence of specific disorders like tricuspid or mitral valve disease, pulmonary hypertension, heart failure, or cardiac surgery combinations. Multivariable regression models were constructed to assess predictors of PAC use as well as PAC use as a predictor of loge hospitalization charges controlling for patient and hospital characteristics. Based on International Classification of Diseases procedure codes, PAC use was prevalent among 7.15 % of cardiac surgery hospitalizations, and hospitalization charges were estimated at $191,345, with no differences according to PAC use. Overall, being female, having Charlson comorbidity index (CCI) > 0, and non-payer (versus Medicare) status were independently associated with PAC use. Among the subgroup with the selected conditions, being female, having CCI>0, and being a Medicaid (versus Medicare) recipient were independently associated with PAC use, whereas elective admission was inversely related to PAC use. Among the subgroup without the selected conditions, having a CCI >0, elective admission, and non-payer (vs. Medicare) status were independently associated with PAC use. PAC use was not independently related to hospitalization charges overall or among subgroups. In conclusion, approximately 7 % of cardiac surgery hospitalizations received a PAC, with no differences in charges according to PAC use and disparities in PAC use driven by sex, elective admission, CCI and health insurance status. Large randomized trials are required to characterize the safety, efficacy, and cost-effectiveness of PAC use among distinct groups of patients undergoing cardiac surgery.
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Affiliation(s)
- Hind A. Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Shaker M. Eid
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
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97
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Adatia A, Moolji J, Satia I. Acuity of asthma exacerbations in Alberta, Canada is increasing: a population-based study. Allergy Asthma Clin Immunol 2024; 20:13. [PMID: 38347595 PMCID: PMC10863092 DOI: 10.1186/s13223-024-00872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/01/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Asthma is a common respiratory illness affecting 2.8 million Canadians, including 9.7% of Albertans. Prior studies showed a substantial decrease in ED visits for asthma in the decade preceding 2010, followed by a stabilization. This was attributed to improvements in the pharmacologic and non-pharmacologic treatments for asthma during that period followed by a balance between epidemiologic drivers and protective factors in the population. METHODS We assessed whether this trend continued in Alberta from 2010 to 2022 using population level data for the volume of daily ED visits, acuity of asthma exacerbations in the ED, and hospitalization rate. RESULTS The mean number of ED visits decreased from 4.5 to 2.2 per million persons per day, but the acuity of exacerbations and the proportion requiring hospitalization increased. The number of patients presenting with the highest level of acuity increased by over 300%, and the percentage of patients requiring hospitalization increased from 6.8 to 11.3%. CONCLUSION Total ED visits for asthma exacerbations continues to decline in Alberta. The reasons for an increase in more severe exacerbations requires further attention.
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Affiliation(s)
- Adil Adatia
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
- Alberta Respiratory Centre, Edmonton, AB, Canada.
| | - Jalal Moolji
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Imran Satia
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Jiampo P, Tangkittikasem T, Boonyapiphat T, Senthong V, Torpongpun A. Real-World Heart Failure Burden in Thai Patients. Cardiol Ther 2024:10.1007/s40119-024-00355-8. [PMID: 38326588 DOI: 10.1007/s40119-024-00355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Heart failure (HF) is one of the leading causes of hospitalization worldwide. In Thailand, data on HF burden remains limited. This study aimed to describe comprehensive evidence detailing the HF prevalence, hospital admission rates, in-hospital mortality, and overall mortality rates at the hospital level. METHOD All eligible adult patients' medical records from 2018 and 2019 were analyzed retrospectively at five hospitals in different regions. The patients were diagnosed with HF, as indicated by the International Classification of Diseases (ICD)-10 code I50. Descriptive statistics were used to examine the hospital burden as well as patients' clinical and outcome data. RESULTS A total of 7384 patients with HF were identified from five tertiary hospitals. Around half of the patients were male. The mean age was 67 years, and the main health insurance scheme was the Universal Coverage Scheme. The prevalence of HF was 0.1% in 2018 and 0.2% in 2019. Heart failure with preserved ejection fraction (HFpEF) was the most common type of HF in both visits, followed by heart failure with reduced ejection fraction (HFrEF) and heart failure with mildly reduced ejection fraction (HFmrEF). The proportion of HF hospitalizations was 1.2% in 2018 and 1.5% in 2019. The proportion of HF rehospitalizations versus hospitalizations in patients with HF was 22.7% in 2018 and 23.9% in 2019. The risk of rehospitalization was highest at 180 days after hospital discharge (87.8%). Among the patients with HF, the proportion of all-cause mortality was 9.1% in 2018 and 8.0% in 2019. Most of the deaths occurred within 30 days after hospitalization. CONCLUSION Our study demonstrated that the burden of HF in terms of hospitalization and in-hospital mortality was notably high when compared to similar studies conducted in Thailand and other countries.
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Affiliation(s)
- Panyapat Jiampo
- Bhumibol Adulyadej Hospital, Sai Mai District, Bangkok, Thailand
| | | | | | - Vichai Senthong
- Queen Sirikit Heart Center of the Northeast, Khon Kaen University, Mueang, Khon Kaen, Thailand
| | - Artit Torpongpun
- Chonburi Hospital, 69 Moo 2, Sukhumvit Road, Ban Suan, Mueang Chon Buri, Chon Buri, 20000, Thailand.
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Müller J, Chakarov I, Halbfass P, Nentwich K, Berkovitz A, Sonne K, Barth S, Lehrmann H, Deneke T. Epicardial ventricular tachycardia ablation: safety and efficacy of access and ablation using low-iodine content. Clin Res Cardiol 2024:10.1007/s00392-024-02378-6. [PMID: 38324039 DOI: 10.1007/s00392-024-02378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Epicardial ablation has become an integral part of the treatment of ventricular tachycardias (VT). This study reports the safety of epicardial access as well as the efficacy of epicardial ablation of structural heart disease in a tertiary single-center experience. METHODS Between January 2016 and February 2022, consecutive patients undergoing an epicardial access for VT ablation were included. Different puncture techniques and occurrence of epicardial access-related complications as well as the safety of ablation using non-ionic 5% dextrose in water (D5W) compared to standard 0.9% normal saline (NS) irrigation were analyzed. VT recurrence rates during a mean follow-up of 37 ± 23 months were reported. RESULTS In total, 197 patients undergoing a total of 239 procedures were included (59.8 ± 15.3 years, 86% males). A total of 154 patients (78%) had non-ischemic cardiomyopathies with a mean LVEF of 37 ± 14. Anterior-oriented epicardial access was aimed for in all cases and was successful in 217 (91%) of all procedures, whereas access was achieved in 19 procedures (8%) only using an inferior oriented access and in three procedures (1%) using surgical access due to severe adhesions or anatomical requirements. Overall epicardial puncture-related complications occurred in 18 (8%) of all procedures with minor pericardial bleeding in nine, pericardial tamponade in one, pneumothorax in five, pneumopericardium in one, and abdominal puncture in two cases. Presence of adhesions could be identified as the only independent predictor of epicardial access-related complications. D5W was used in 79 cases and regular 0.9% saline in 117 procedures. No differences were seen regarding acute ablation success or complications. During follow-up, 47% of all patients were free from any VTs (56% D5W vs. 40% NS; log-rank p = 0.747) and 92% of clinical VTs (98% D5W vs. 91% NS; log-rank p = 0.139). CONCLUSIONS In this large single-centre experience, epicardial access and ablation were safe and feasible. Although long-term clinical VT recurrence rates were low, overall VT recurrences as well as mortality were high advocating for a highly experienced, interdisciplinary approach including intense management of underlying cardiac disease/heart failure. Routine usage of D5W was safe and associated with comparable short- or long-term clinical or overall VT freedom.
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Affiliation(s)
- Julian Müller
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany.
- Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg, Germany.
| | - Ivaylo Chakarov
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany
| | - Philipp Halbfass
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
- Department of Cardiology, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Carl Von Ossietzky University, Oldenburg, Germany
| | - Karin Nentwich
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Artur Berkovitz
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany
| | - Kai Sonne
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany
| | - Sebastian Barth
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Heiko Lehrmann
- Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany
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Razimoghadam M, Yaseri M, Rezaee M, Fazaeli A, Daroudi R. Non-COVID-19 hospitalization and mortality during the COVID-19 pandemic in Iran: a longitudinal assessment of 41 million people in 2019-2022. BMC Public Health 2024; 24:380. [PMID: 38317148 PMCID: PMC10840276 DOI: 10.1186/s12889-024-17819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND During a COVID-19 pandemic, it is imperative to investigate the outcomes of all non-COVID-19 diseases. This study determines hospital admissions and mortality rates related to non-COVID-19 diseases during the COVID-19 pandemic among 41 million Iranians. METHOD This nationwide retrospective study used data from the Iran Health Insurance Organization. From September 23, 2019, to Feb 19, 2022, there were four study periods: pre-pandemic (Sept 23-Feb 19, 2020), first peak (Mar 20-Apr 19, 2020), first year (Feb 20, 2020-Feb 18, 2021), and the second year (Feb 19, 2021-Feb 19, 2022) following the pandemic. Cause-specific hospital admission and in-hospital mortality are the main outcomes analyzed based on age and sex. Negative binomial regression was used to estimate the monthly adjusted Incidence Rate Ratio (IRR) to compare hospital admission rates in aggregated data. A logistic regression was used to estimate the monthly adjusted in-hospital mortality Odds Ratio (OR) for different pandemic periods. RESULTS During the study there were 6,522,114 non-COVID-19 hospital admissions and 139,679 deaths. Prior to the COVID-19 outbreak, the standardized hospital admission rate per million person-month was 7115.19, which decreased to 2856.35 during the first peak (IRR 0.40, [0.25-0.64]). In-hospital mortality also increased from 20.20 to 31.99 (OR 2.05, [1.97-2.13]). All age and sex groups had decreased admission rates, except for females at productive ages. Two years after the COVID-19 outbreak, the non-COVID-19 hospital admission rate (IRR 1.25, [1.13-1.40]) and mortality rate (OR 1.05, [1.04-1.07]) increased compared to the rates before the pandemic. The respiratory disease admission rate decreased in the first (IRR 0.23, [0.17-0.31]) and second years (IRR 0.35, [0.26-0.47] compared to the rate before the pandemic. There was a significant reduction in hospitalizations for pneumonia (IRR 0.30, [0.21-0.42]), influenza (IRR 0.04, [0.03-0.06]) and COPD (IRR 0.39, [0.23-0.65]) during the second year. There was a significant and continuous rise in the hematological admission rate during the study, reaching 186.99 per million person-month in the second year, reflecting an IRR of 2.84 [2.42-3.33] compared to the pre-pandemic period. The mortality rates of mental disorders (OR 2.15, [1.65-2.78]) and musculoskeletal (OR 1.48, [1.20-1.82), nervous system (OR 1.42, [1.26-1.60]), metabolic (OR 1.99, [1.80-2.19]) and circulatory diseases (OR 1.35, [1.31-1.39]) increased in the second year compare to pre-pandemic. Myocardial infarction (OR 1.33, [1.19-1.49]), heart failure (OR 1.59, [1.35-1.87]) and stroke (OR 1.35, [1.24-1.47]) showed an increase in mortality rates without changes in hospitalization. CONCLUSIONS In the era of COVID-19, the changes seem to have had a long-term effect on non-COVID-19 diseases. Countries should prepare for similar crises in the future to ensure medical services are not suspended.
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Affiliation(s)
- Mahya Razimoghadam
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rezaee
- Department of Orthopedics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Aliakbar Fazaeli
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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