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Gong X, Jin S, Zhou Y, Lai L, Wang W. Impact of delirium on acute stroke outcomes: A systematic review and meta-analysis. Neurol Sci 2024; 45:1897-1911. [PMID: 38182844 DOI: 10.1007/s10072-023-07287-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
Delirium is a common complication in acute stroke patients. A 2011 meta-analysis showed an increased risk of in-hospital mortality and mortality within 12 months post-stroke, longer hospitalization durations, and increased likelihood of being discharged to a nursing home for patients experiencing post-stroke delirium. There is a need for an updated meta-analysis with several new studies having been since published. The PubMed and Scopus databases were screened for relevant studies. Inclusion criteria were as follows: retrospective or prospective studies reporting on the effects of delirium accompanying acute stroke on mortality, functional outcomes, length of hospital stay and need for re-admission. Strength of association was presented as pooled adjusted relative risk (RR) for categorical outcomes and weighted mean difference (WMD) for continuous outcomes. Statistical analysis was done using STATA version 16.0. The meta-analysis included 22 eligible articles. Eighteen of the 22 studies were prospective follow ups. Included studies were of good quality. Post-stroke delirium was associated with increased risk of in-hospital mortality, as well as mortality within 12 months post-stroke. Patients with delirium experienced increased hospital stay durations, were at greater risk for hospital readmission, and showed elevated risk for poor functional outcome. Compared to those who did not have delirium, stroke patients with delirium were 42% less likely to be discharged to home. Acute stroke patients with delirium are at an increased risk for poor short- and long-term outcomes. More research is needed to identify the best set of interventions to manage such patients and improve outcomes.
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Affiliation(s)
- Xiao Gong
- Department of Geriatry, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, No. 208, Huancheng East Road, Hangzhou, 310006, Zhejiang Province, China.
| | - Shu Jin
- Department of Geriatry, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, No. 208, Huancheng East Road, Hangzhou, 310006, Zhejiang Province, China
| | - Yong Zhou
- Department of Geriatry, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, No. 208, Huancheng East Road, Hangzhou, 310006, Zhejiang Province, China
| | - Lihua Lai
- Department of Geriatry, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, No. 208, Huancheng East Road, Hangzhou, 310006, Zhejiang Province, China
| | - Wanyi Wang
- Department of Geriatry, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, No. 208, Huancheng East Road, Hangzhou, 310006, Zhejiang Province, China
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Phongpreecha T, Berson E, Xue L, Shome S, Saarunya G, Fralick J, Ruiz-Tagle BG, Foody A, Chin AL, Lim M, Arthofer R, Albini C, Montine K, Folkins AK, Kong CS, Aghaeepour N, Montine T, Kerr A. Intra- and post-pandemic impact of the COVID-19 outbreak on Stanford Health Care. Acad Pathol 2024; 11:100113. [PMID: 38562568 PMCID: PMC10982550 DOI: 10.1016/j.acpath.2024.100113] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/12/2024] [Accepted: 02/03/2024] [Indexed: 04/04/2024] Open
Abstract
Stanford Health Care, which provides about 7% of overall healthcare to approximately 9 million people in the San Francisco Bay Area, has undergone significant changes due to the opening of a second hospital in late 2019 and, more importantly, the COVID-19 pandemic. We examine the impact of these events on anatomic pathology (AP) cases, aiming to enhance operational efficiency in response to evolving healthcare demands. We extracted historical census, admission, lab tests, operation, and AP data since 2015. An approximately 45% increase in the volume of laboratory tests (P < 0.0001) and a 17% increase in AP cases (P < 0.0001) occurred post-pandemic. These increases were associated with progressively increasing (P < 0.0001) hospital census. Census increase stemmed from higher admission through the emergency department (ED), and longer lengths of stay mostly for transfer patients, likely due to the greater capability of the new ED and changes in regional and local practice patterns post-pandemic. Higher census led to overcapacity, which has an inverted U relationship that peaked at 103% capacity for AP cases and 114% capacity for laboratory tests. Overcapacity led to a lower capability to perform clinical activities, particularly those related to surgical procedures. We conclude by suggesting parameters for optimal operations in the post-pandemic era.
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Affiliation(s)
- Thanaphong Phongpreecha
- Department of Pathology, Stanford University, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, USA
- Department of Biomedical Data Science, Stanford University, USA
| | - Eloise Berson
- Department of Pathology, Stanford University, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, USA
- Department of Biomedical Data Science, Stanford University, USA
| | - Lei Xue
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, USA
- Department of Biomedical Data Science, Stanford University, USA
- Department of Pediatrics, Stanford University, USA
| | - Sayane Shome
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, USA
- Department of Biomedical Data Science, Stanford University, USA
- Department of Pediatrics, Stanford University, USA
| | - Geetha Saarunya
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, USA
- Department of Biomedical Data Science, Stanford University, USA
- Department of Pediatrics, Stanford University, USA
| | | | | | | | | | - Michael Lim
- Department of Neurosurgery, Stanford University, USA
| | | | | | | | | | | | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, USA
- Department of Biomedical Data Science, Stanford University, USA
- Department of Pediatrics, Stanford University, USA
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Berthon W, McGurnaghan SJ, Blackbourn LAK, Mellor J, Gibb FW, Heller S, Kennon B, McCrimmon RJ, Philip S, Sattar N, McKeigue PM, Colhoun HM. Ongoing burden and recent trends in severe hospitalised hypoglycaemia events in people with type 1 and type 2 diabetes in Scotland: A nationwide cohort study 2016-2022. Diabetes Res Clin Pract 2024; 210:111642. [PMID: 38548109 DOI: 10.1016/j.diabres.2024.111642] [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: 01/31/2024] [Revised: 03/10/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
AIMS We examined severe hospitalised hypoglycaemia (SHH) rates in people with type 1 and type 2 diabetes in Scotland during 2016-2022, stratifying by sociodemographics. METHODS Using the Scottish National diabetes register (SCI-Diabetes), we identified people with type 1 and type 2 diabetes alive anytime during 2016-2022. SHH events were determined through linkage to hospital admission and death registry data. We calculated annual SHH rates overall and by age, sex, and socioeconomic status. Summary estimates of time and stratum effects were obtained by fitting adjusted generalised additive models using R package mgcv. RESULTS Rates for those under 20 with type 1 diabetes reached their minimum at the 2020-2021 transition, 30% below the study period average. A gradual decline over time also occurred among 20-49-year-olds with type 1 diabetes. Overall, females had 15% higher rates than males with type 2 diabetes (rate ratio 1.15, 95% CI 1.08-1.22). People in the most versus least deprived quintile experienced 2.58 times higher rates (95% CI 2.27-2.93) in type 1 diabetes and 2.33 times higher (95% CI 2.08-2.62) in type 2 diabetes. CONCLUSIONS Despite advances in care, SHH remains a significant problem in diabetes. Future efforts must address the large socioeconomic disparities in SHH risks.
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Affiliation(s)
- William Berthon
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK.
| | - Stuart J McGurnaghan
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Luke A K Blackbourn
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Joseph Mellor
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Brian Kennon
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Rory J McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Sam Philip
- JJR Macleod Centre for Diabetes & Endocrinology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Paul M McKeigue
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Helen M Colhoun
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK; Public Health Scotland, Glasgow, UK
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Liu Y, Guo M, Wang J, Gong Y, Huang C, Wang W, Liu X, Liu J, Ju C, Ba Y, Zhou G, Wu X. Effect of short-term exposure to air pollution on hospital admission for cardiovascular disease: A time-series study in Xiangyang, China. Sci Total Environ 2024; 918:170735. [PMID: 38325454 DOI: 10.1016/j.scitotenv.2024.170735] [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: 12/14/2023] [Revised: 01/23/2024] [Accepted: 02/03/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Data on the relationship between short-term exposure to air pollution and cardiovascular diseases (CVDs) and the potential modifying factors are limited and inconsistent. OBJECTIVE To explore the relationship between short-term exposure to air pollution and CVD risk, and potential modification effect factors. METHOD A time series study was conducted on 52,991 hospital admissions for CVD from 2015 to 2019 in Xiangyang City, China. Air pollution data from four national fixed monitoring stations were collected to estimate exposure level in Xiangyang City. A quasi-Poisson generalized additive model incorporating a distributed lag nonlinear model was applied to evaluate the association between air pollution and CVD risk. The potential modification effect of sex, age, and season on the above associations was also evaluated. RESULTS CVD risk was positively associated with air pollution. Peak associations in single lag day structures were observed for particulate matter ≤10 μm in aerodynamic (PM10; RR: 1.040, 95 % CI: 0.996-1.087), PM2.5 (1.025, 1.004-1.045), nitrogen dioxide (NO2; 1.074, 1.039-1.111), and sulfur dioxide (SO2; 1.079, 1.019-1.141) at Lag 0 and ozone (O3; 1.018, 1.004-1.031) at Lag 4. In cumulative lag day structures, the highest RRs were 1.225 (1.079,1.392) for PM10 at Lag 06, 1.054 (1.013, 1.098) for PM2.5 at Lag 03, 1.200 (1.119, 1.287) for NO2 at Lag 04, and 1.135 (1.025, 1.257) for SO2 at Lag 02. Moreover, the association between air pollution and CVD risk was modified by sex and age (P < 0.05). Females and individuals aged ≤65 years were more vulnerable to NO2 and had a higher CVD risk. CONCLUSION Short-term exposure to air pollution was positively associated with CVD risk. Moreover, sex and age could modify the effect of air pollution on CVD risk. Females and individuals aged ≤65 years had a higher NO2 exposure-induced CVD risk.
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Affiliation(s)
- Yangwenhao Liu
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, PR China
| | - Meng Guo
- Division of Cardiac Surgery, Wuhan Asia Heart Hospital Affiliated with Wuhan University of Science and Technology, Wuhan, Hubei 430022, PR China
| | - Junxiang Wang
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, PR China
| | - Yongxiang Gong
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, PR China.
| | - Chunrong Huang
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, PR China
| | - Wei Wang
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, PR China
| | - Xiaodong Liu
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, PR China
| | - Juming Liu
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, PR China
| | - Changyu Ju
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, PR China
| | - Yue Ba
- Department of Environmental Health, School of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, PR China
| | - Guoyu Zhou
- Department of Environmental Health, School of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, PR China; National Health Commission Key Laboratory of Birth Defects Prevention, Zhengzhou, Henan 450002, PR China
| | - Xiaolin Wu
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, PR China; Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441021, PR China.
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Rafferty C, O'Donnell A, Campbell S, Sun B, King J, Ali Z, Lynch D, Barrett E, Richardson S, Clifford M, McNicholas F. Eating disorders and COVID-19 - different or just more? Ir J Med Sci 2024:10.1007/s11845-024-03649-x. [PMID: 38492150 DOI: 10.1007/s11845-024-03649-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND COVID-19 saw an increase in child mental health presentations internationally. Clinicians analogised the exponential increase in anorexia nervosa to a 'tsunami' or 'outbreak', raising parallel concerns regarding medical and psychological risks (Marsh in The Guardian, 2021; Leask in NZ Herald, 2021; Monteleone et al. in Eat Weight Disord 26(8):2443-2452, 2021) . It is unclear whether Ireland emulated this picture of increased referrals with increased medical compromise. AIMS This paper examines both rates and clinical profiles of child eating disorder presentations in the Republic of Ireland (ROI), across different clinical settings. METHODS Following ethical approval, retrospective chart reviews were conducted in a community eating disorder service and in two paediatric hospital settings. The time frame of the different studies ranged from January 2016 to December 2022. RESULTS Community eating disorder services saw significantly higher referral rates post COVID-19 (3.78/month vs. 2.31/month, p = 0.02), with a shorter duration of illness (4.8 months vs. 7.4 months, p = 0.001), but no significant difference in ideal body weight % (IBW%) at referral (85.32% vs. 83.7%, p = 0.1). Both paediatric hospitals witnessed significantly increased referrals post-COVID-19 (hospital 1; 4.38/month vs. 1.93/month, p = 0.0001; hospital 2; 2.8/month vs. 0.92/month, p < 0.0001), but no significant difference in IBW% at assessment (hospital 1; 82.7% vs. 81.39%, p = 0.673; hospital 2; 81.5% vs. 83%, p = 0.563). There was no significant difference in clinical profile, management, or duration of hospital stay. CONCLUSIONS This study supports the growing consensus of a pandemic specific increase in eating disorder referrals to both medical and psychiatry services. However, there was little to indicate a change in clinical profile or severity. Ongoing monitoring of referrals is necessary to ensure adequate service availability and expertise.
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Affiliation(s)
- Cathal Rafferty
- School of Medicine, University College Dublin, Dublin, Ireland.
| | | | - Sally Campbell
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Bohan Sun
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jenny King
- Department of Paediatric Liaison Psychiatry, Children's Hospital Ireland, Crumlin Dublin 12, Dublin, Ireland
| | - Zeinab Ali
- Department of Paediatric Liaison Psychiatry, Children's Hospital Ireland, Crumlin Dublin 12, Dublin, Ireland
| | - Diarmuid Lynch
- Department of Paediatric Liaison Psychiatry, Children's Hospital Ireland, Crumlin Dublin 12, Dublin, Ireland
| | - Elizabeth Barrett
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Paediatric Liaison Psychiatry, Children's Hospital Ireland, Temple St. Dublin 2, Dublin, Ireland
| | - Sarah Richardson
- Department of Paediatric Liaison Psychiatry, Children's Hospital Ireland, Crumlin Dublin 12, Dublin, Ireland
| | | | - Fiona McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Paediatric Liaison Psychiatry, Children's Hospital Ireland, Crumlin Dublin 12, Dublin, Ireland
- Lucena CAMHS, SJOG, Rathgar Dublin 6, Dublin, Ireland
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Wu J, Wu Y, Wu Y, Yang R, Yu H, Wen B, Wu T, Shang S, Hu Y. The impact of heat waves and cold spells on pneumonia risk: A nationwide study. Environ Res 2024; 245:117958. [PMID: 38135100 DOI: 10.1016/j.envres.2023.117958] [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: 09/14/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
Climate change affects human health and has been linked to several infectious diseases in recent year. However, there is limited assessment on the impact of heat waves and cold spells on pneumonia risk. This study aims to examine the association of heat waves and cold spells with daily pneumonia hospitalizations in 168 cities in China. Data on pneumonia hospitalizations between 2014 and 2017 were extracted from a national claim database of 280 million beneficiaries. We consider combining temperature intensity and duration to define heat waves and cold spells.This association was quantified using a quasi-Poisson generalized linear model combined with a distributed lag nonlinear model. Exposure-response curves and potential effect modifiers were also estimated. We found that the peak relative risk (RR) of cold spells on daily hospitalizations for pneumonia was observed in relatively mild cold spells with a threshold below the 3 days at the 2nd percentile (RR = 1.69, 95% CI: 1.46-1.92). The risk of heat waves increased with the thresholds, and the greatest risk was found for extremely heatwave period of 4 days at the 98th percentile (RR = 1.69, 95% CI: 1.46-1.92). Heat waves and cold spells are more likely to adversely affect women. In conclusion, our study provided novel and strong evidence that exposure to heat waves and cold spells was associate with increased hospital visits for pneumonia, especially in females. This is the first national study in China to comprehensively evaluate the influence of heat waves and cold spells on pneumonia risk, and the findings may offer valuable insights into the impact of climate change on public health.
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Affiliation(s)
- Junhui Wu
- School of Nursing, Peking University, 38 Xueyuan Road, Hai Dian District, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 100191, Beijing, China.
| | - Yao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 100191, Beijing, China; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia; Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia
| | - Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 100191, Beijing, China
| | - Ruotong Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 100191, Beijing, China
| | - Huan Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 100191, Beijing, China
| | - Bo Wen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 100191, Beijing, China; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia; Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia
| | - Tao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 100191, Beijing, China
| | - Shaomei Shang
- School of Nursing, Peking University, 38 Xueyuan Road, Hai Dian District, Beijing, China.
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 100191, Beijing, China; Medical Informatics Center, Peking University, 100191, Beijing, China.
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Belau MH, Misselwitz B, Meyding-Lamadé U, Bassa B. Trends in stroke severity at hospital admission and rehabilitation discharge before and during the COVID-19 pandemic in Hesse, Germany: a register-based study. Neurol Res Pract 2024; 6:18. [PMID: 38449050 PMCID: PMC10918907 DOI: 10.1186/s42466-024-00308-5] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected acute stroke care, resulting in a decrease in stroke admissions worldwide. We examined trends in stroke severity at hospital admission, including (1) probable need for rehabilitation (National Institutes of Health Stroke Scale score > 6 points) and (2) probable need for assistance (modified Rankin Scale score > 2 points), and discharge to rehabilitation after acute care among inpatients with acute ischemic stroke and intracerebral hemorrhage. METHODS We compared quality assurance data for acute ischemic stroke and intracerebral hemorrhage during the pandemic with the period before the pandemic in Hesse, Germany, using logistic regression analyses. RESULTS Fewer inpatients with a probable need for rehabilitation were present at the beginning of the second wave of the COVID-19 pandemic in September 2020 (adjusted OR (aOR) 0.85, 95% CI [0.73, 0.99]), at the end of the second national lockdown in May 2021 (aOR 0.81, 95% CI [0.70, 0.94]), and at the approaching peak of COVID-19 wave 4 in November 2021 (aOR 0.79, 95% CI [0.68, 091]). Rates of probable need for assistance were significantly lower at the beginning of COVID-19 wave 2 in August 2020 (aOR 0.87, 95% CI [0.77, 0.99]) and at the beginning of COVID-19 wave 3 in March 2021 (aOR 0.80, 95% CI [0.71, 0.91]). Rates of discharge to rehabilitation were lower from the beginning in October 2020 to the peak of COVID-19 wave 2 in December 2020 (aOR 0.83, 95% CI [0.77, 0.90]), at the beginning and end of COVID-19 wave 3 in March 2021 and May 2021 (aOR 0.86, 95% CI [0.79, 0.92]), respectively, and at the beginning of COVID-19 wave 4 in October 2021 (aOR 0.86, 95% CI [0.76, 0.98]). CONCLUSIONS The results suggest that the COVID-19 pandemic had an impact on stroke management during the pandemic, but the absolute difference in stroke severity at hospital admission and discharge to rehabilitation was small.
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Affiliation(s)
- Matthias Hans Belau
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Björn Misselwitz
- Federal State Consortium of Quality Assurance Hesse, Eschborn, Germany
| | - Uta Meyding-Lamadé
- Department of Neurology, Krankenhaus Nordwest, Frankfurt (Main), Germany
| | - Burc Bassa
- Department of Neurology, Krankenhaus Nordwest, Frankfurt (Main), Germany
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Verschoor CP, Theou O, Ma J, Montgomery P, Mossey S, Nangia P, Saskin R, Savage DW. Age- and sex-specific associations of frailty with mortality and healthcare utilization in community-dwelling adults from ontario, Canada. BMC Geriatr 2024; 24:223. [PMID: 38438981 PMCID: PMC10913570 DOI: 10.1186/s12877-024-04842-4] [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: 11/16/2023] [Accepted: 02/23/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Understanding how health trajectories are related to the likelihood of adverse outcomes and healthcare utilization is key to planning effective strategies for improving health span and the delivery of care to older adults. Frailty measures are useful tools for risk stratification in community-based and primary care settings, although their effectiveness in adults younger than 60 is not well described. METHODS We performed a 10-year retrospective analysis of secondary data from the Ontario Health Study, which included 161,149 adults aged ≥ 18. Outcomes including all-cause mortality and hospital admissions were obtained through linkage to ICES administrative databases with a median follow-up of 7.1-years. Frailty was characterized using a 30-item frailty index. RESULTS Frailty increased linearly with age and was higher for women at all ages. A 0.1-increase in frailty was significantly associated with mortality (HR = 1.47), the total number of outpatient (IRR = 1.35) and inpatient (IRR = 1.60) admissions over time, and length of stay (IRR = 1.12). However, with exception to length of stay, these estimates differed depending on age and sex. The hazard of death associated with frailty was greater at younger ages, particularly in women. Associations with admissions also decreased with age, similarly between sexes for outpatient visits and more so in men for inpatient. CONCLUSIONS These findings suggest that frailty is an important health construct for both younger and older adults. Hence targeted interventions to reduce the impact of frailty before the age of 60 would likely have important economic and social implications in both the short- and long-term.
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Affiliation(s)
- Chris P Verschoor
- Health Sciences North Research Institute, Sudbury, ON, Canada.
- NOSM University, Sudbury/Thunder Bay, ON, Canada.
- , 56 Walford Road, Rm. 119, P3E 2H2, Sudbury, ON, Canada.
| | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Jinhui Ma
- Dept. of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Sharolyn Mossey
- School of Nursing, Laurentian University, Sudbury, ON, Canada
| | - Parveen Nangia
- School of Social Sciences, Laurentian University, Sudbury, ON, Canada
| | | | - David W Savage
- Health Sciences North Research Institute, Sudbury, ON, Canada
- NOSM University, Sudbury/Thunder Bay, ON, Canada
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9
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Kara SA, Cakir B. Variations in Hospital Admissions of Non-Communicable Disease Patients Before and During The COVID-19 Pandemic (A Tertiary Care Setting, January 2018-June 2021). J Epidemiol Glob Health 2024; 14:111-119. [PMID: 38190049 PMCID: PMC11043303 DOI: 10.1007/s44197-023-00174-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND This study aimed to analyze the variations (if any) in hospital admissions of patients with any of the five common non-communicable diseases (NCDs), based on secondary analysis of electronic health records of patients admitted to Hacettepe University Hospitals at least once, from January 1, 2018 through June 15, 2021. DESIGN Data were recruited from hospital's electronic health records on patients with diagnoses of ischemic heart disease, hypertension, diabetes, cancer, and chronic obstructive pulmonary disease, using relevant ICD-10 codes. RESULTS Compared to the corresponding time span in the pre-pandemic period, the number of hospital admissions of patients with selected five NCDs significantly decreased during the pandemic, with an official start in Turkey on March 11, 2020. Number of total-, out-patient-, and in-patient admissions of NCD patients were significantly lower in the pandemic period compared to the expected values in time series analysis, controlling for patient characteristics, and seasonality. CONCLUSIONS Study findings suggest that there has been a prominent impediment in NCD patients' access to, and/or use of health care services over the pandemic, which might evolve to higher admission rates, severity and fatality of such patients in the upcoming years. Further studies are warranted for confirmation of our findings in other care settings, with individual-based data on care compensation through settings other than regular admission sites (if any), and/or the reasons for under-use of services.
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Affiliation(s)
- Seyma Aliye Kara
- Pursaklar District Health Directorate, Republic of Turkey Ministry of Health, Ankara, Turkey.
| | - Banu Cakir
- Division of Epidemiology, Department of Public Health, Hacettepe University Faculty of Medicine, Ankara, Turkey
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10
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Sánchez Molla M, Candela García I, Orozco-Beltrán D, Gil-Guillén VF, Carratalá-Munuera C, García RN. [Predictive validity of Clinical Risk Groups in chronic patients in primary healthcare]. Aten Primaria 2024; 56:102814. [PMID: 38029654 PMCID: PMC10716497 DOI: 10.1016/j.aprim.2023.102814] [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: 07/21/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To analyse a prediction model for admissions and hospital emergencies based on Clinical Risk Groups, in a population of complex chronic patients demanding primary care. DESIGN A multicentric retrospective observational study, of a cohort of chronic patients with comorbidity, from January until December 2013. PLACE The study population was assigned to the Santa Pola and Raval health centres from the Health Department of Elche. PARTICIPANTS Cohort of chronic patients with comorbidity, from January to December 2013. INTERVENTIONS Data about the number of admissions, reasons and complexity level associated with the admission were collected by the review of medical records. MAIN MEASURES To determine the level of complexity, the classification included in the chronicity strategy of the Valencian Community based on Clinical Risk Groups was used. RESULTS Five hundred and four patients were recruited with a high complexity degree (N3) and 272 with moderate/low complexity (N1-N2). A higher comorbidity was observed in N3 patients with high complexity [Charlson 2.9 (DE 1.8) vs. 1.9 (DE 1.3); P<.001], and higher dependence degree for basic diary activities [Barthel 16.1 (n=81) vs. 7.3 (n=20); P<.001]. Association between the number of admissions [0.4 (DE 0.8) vs. 0.1 (DE 0.5); P<.001] and emergency visits [0.8 (DE 1.5) vs. 0.3 (DE 0.8), P<.001] was significatively higher in patients from N3 group than N1-N2 groups. CONCLUSIONS The predictive capacity of CRG grouper showed high sensibility for the patient classification with a high degree of complexity. Its specificity and positive predictive value were lower for the association of the N3 complexity stratum.
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Affiliation(s)
- Manuel Sánchez Molla
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España; Medicina Familiar y Comunitaria, Cap El Raval Elx-Centro, Elche, Alicante, España
| | - Inmaculada Candela García
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España
| | - Domingo Orozco-Beltrán
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España
| | - Vicente F Gil-Guillén
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Instituto de Salud e Investigación Biomédica de Alicante, Hospital General Universitario de Alicante, Centro de Diagnóstico, Alicante, España
| | - Concepción Carratalá-Munuera
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Instituto de Salud e Investigación Biomédica de Alicante, Hospital General Universitario de Alicante, Centro de Diagnóstico, Alicante, España.
| | - Rauf Nouni García
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Instituto de Salud e Investigación Biomédica de Alicante, Hospital General Universitario de Alicante, Centro de Diagnóstico, Alicante, España
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11
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Crilly J, Sweeny A, Muntlin Å, Green D, Malyon L, Christofis L, Higgins M, Källberg AS, Dellner S, Myrelid Å, Djärv T, Göransson KE. Factors predictive of hospital admission for children via emergency departments in Australia and Sweden: an observational cross-sectional study. BMC Health Serv Res 2024; 24:235. [PMID: 38388438 PMCID: PMC10885502 DOI: 10.1186/s12913-023-09403-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] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/13/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Identifying factors predictive of hospital admission can be useful to prospectively inform bed management and patient flow strategies and decrease emergency department (ED) crowding. It is largely unknown if admission rate or factors predictive of admission vary based on the population to which the ED served (i.e., children only, or both adults and children). This study aimed to describe the profile and identify factors predictive of hospital admission for children who presented to four EDs in Australia and one ED in Sweden. METHODS A multi-site observational cross-sectional study using routinely collected data pertaining to ED presentations made by children < 18 years of age between July 1, 2011 and October 31, 2012. Univariate and multivariate analysis were undertaken to determine factors predictive of hospital admission. RESULTS Of the 151,647 ED presentations made during the study period, 22% resulted in hospital admission. Admission rate varied by site; the children's EDs in Australia had higher admission rates (South Australia: 26%, Queensland: 23%) than the mixed (adult and children's) EDs (South Australia: 13%, Queensland: 17%, Sweden: 18%). Factors most predictive of hospital admission for children, after controlling for triage category, included hospital type (children's only) adjusted odds ratio (aOR):2.3 (95%CI: 2.2-2.4), arrival by ambulance aOR:2.8 (95%CI: 2.7-2.9), referral from primary health aOR:1.5 (95%CI: 1.4-1.6) and presentation with a respiratory or gastrointestinal condition (aOR:2.6, 95%CI: 2.5-2.8 and aOR:1.5, 95%CI: 1.4-1.6, respectively). Predictors were similar when each site was considered separately. CONCLUSIONS Although the characteristics of children varied by site, factors predictive of hospital admission were mostly similar. The awareness of these factors predicting the need for hospital admission can support the development of clinical pathways.
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Affiliation(s)
- Julia Crilly
- Department of Emergency Medicine, Gold Coast Health, 1 Hospital Blvd, Southport, QLD, 4215, Australia.
- School of Nursing and Midwifery, Griffith University, Southport, QLD, Australia.
| | - Amy Sweeny
- Department of Emergency Medicine, Gold Coast Health, 1 Hospital Blvd, Southport, QLD, 4215, Australia
- School of Nursing and Midwifery, Griffith University, Southport, QLD, Australia
| | - Åsa Muntlin
- Department of Medical Sciences/Clinical Epidemiology, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences/Health Services Research, Uppsala University, Uppsala, Sweden
| | - David Green
- Department of Emergency Medicine, Gold Coast Health, 1 Hospital Blvd, Southport, QLD, 4215, Australia
| | - Lorelle Malyon
- Emergency Department, Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Luke Christofis
- Emergency Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Malcolm Higgins
- Paediatric Emergency Department, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Ann-Sofie Källberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Emergency Medicine, Falun Hospital, Falun, Sweden
| | - Sara Dellner
- Maternal Health Care Unit, Region Stockholm, Stockholm, Sweden
| | - Åsa Myrelid
- Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Therese Djärv
- Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Katarina E Göransson
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
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12
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Lundgren M, Segernäs A, Nord M, Alwin J, Lyth J. Reasons for hospitalisation and cumulative mortality in people, 75 years or older, at high risk of hospital admission: a prospective study. BMC Geriatr 2024; 24:176. [PMID: 38378482 PMCID: PMC10877827 DOI: 10.1186/s12877-024-04771-2] [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: 06/01/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND A small proportion of the older population accounts for a high proportion of healthcare use. For effective use of limited healthcare resources, it is important to identify the group with greatest needs. The aim of this study was to explore frequency and reason for hospitalisation and cumulative mortality, in an older population at predicted high risk of hospital admission, and to assess if a prediction model can be used to identify individuals with the greatest healthcare needs. Furthermore, discharge diagnoses were explored to investigate if they can be used as basis for specific interventions in the high-risk group. METHODS All residents, 75 years or older, living in Östergötland, Sweden, on January 1st, 2017, were included. Healthcare data from 2016 was gathered and used by a validated prediction model to create risk scores for hospital admission. The population was then divided into groups by percentiles of risk. Using healthcare data from 2017-2018, two-year cumulative incidence of hospitalisation was analysed using Gray´s test. Cumulative mortality was analysed with the Kaplan-Meier method and primary discharge diagnoses were analysed with standardised residuals. RESULTS Forty thousand six hundred eighteen individuals were identified (mean age 82 years, 57.8% women). The cumulative incidence of hospitalisation increased with increasing risk of hospital admission (24% for percentiles < 60 to 66% for percentiles 95-100). The cumulative mortality also increased with increasing risk (7% for percentiles < 60 to 43% for percentiles 95-100). The most frequent primary discharge diagnoses for the population were heart diseases, respiratory infections, and hip injuries. The incidence was significantly higher for heart diseases and respiratory infections and significantly lower for hip injuries, for the population with the highest risk of hospital admission (percentiles 85-100). CONCLUSIONS Individuals 75 years or older, with high risk of hospital admission, were demonstrated to have considerable higher cumulative mortality as well as incidence of hospitalisation. The results support the use of the prediction model to direct resources towards individuals with highest risk scores, and thus, likely the greatest care needs. There were only small differences in discharge diagnoses between the risk groups, indicating that interventions to reduce hospitalisations should be personalised. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03180606, first posted 08/06/2017.
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Affiliation(s)
- Moa Lundgren
- Primary Health Care Centre Finspång, Finspång, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Anna Segernäs
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre Ekholmen, Linköping, Sweden
| | - Magnus Nord
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre Valla, Linköping, Sweden
| | - Jenny Alwin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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13
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Steinsdóttir HR, Sigurðsson MI, Björnsson ES, Jónsdóttir F. The incidence and prevalence of proton pump inhibitor usage among internal medicine patients after hospital admission: A retrospective cohort study. Eur J Clin Pharmacol 2024; 80:273-281. [PMID: 38105298 DOI: 10.1007/s00228-023-03607-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: 03/16/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The use of proton pump inhibitors (PPIs) has increased over the past decades. One potential gateway into new PPI use is following a hospital admission. The study aimed to examine the incidence of new PPI usage following admission to internal medicine services and the ratio of new persistent users. METHODS A retrospective descriptive study was conducted among all adults who had been admitted to internal medicine wards at the National University Hospital of Iceland from 2010-2020. Data was obtained from the Icelandic Internal Medicine Database. The proportion of patients who started treatment with PPI within 3 months of discharge (new users) and the proportion of patients who continued to use it after 3 months (persistent users) were examined. RESULTS Among 85.942 admissions during the study period, 7238 (15.6%) became new users, and of those 4942 (68%) were new persistent users. The incidence of new PPI use was highest for patients discharged from gastroenterology (32.2%), hematology (31.8%), and oncology (29.2%). Patients with new PPI use more commonly had a history of malignancy (19.5%) and liver disease (22.7%) and more commonly were admitted to the ICU during their hospitalization. The highest ratio of persistent usage was among patients discharged from geriatric medicine (84%). CONCLUSION One in every six patients admitted to internal medicine wards filled out a prescription for PPI within 3 months from discharge, and a large proportion of them became persistent users. The high rate of new PPI users from oncology and hematology is noteworthy and requires further research.
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Affiliation(s)
- Helga Rut Steinsdóttir
- Clinical Pharmacy Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Martin I Sigurðsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Division of Anesthesia and Intensive Care Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Einar Stefán Björnsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Internal Medicine, Division of Gastroenterology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Freyja Jónsdóttir
- Clinical Pharmacy Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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14
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Bedston S, Almaghrabi F, Patterson L, Agrawal U, Woolford L, Anand SN, Joy M, Crawford A, Goudie R, Byford R, Abbasizanjani H, Smith D, Laidlaw L, Akbari A, Sullivan C, Bradley DT, Lyons RA, de Lusignan S, Hobbs FR, Robertson C, Sheikh SA, Shi T. Risk of severe COVID-19 outcomes after autumn 2022 COVID-19 booster vaccinations: a pooled analysis of national prospective cohort studies involving 7.4 million adults in England, Northern Ireland, Scotland and Wales. Lancet Reg Health Eur 2024; 37:100816. [PMID: 38162515 PMCID: PMC10757260 DOI: 10.1016/j.lanepe.2023.100816] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
Background UK COVID-19 vaccination policy has evolved to offering COVID-19 booster doses to individuals at increased risk of severe Illness from COVID-19. Building on our analyses of vaccine effectiveness of first, second and initial booster doses, we aimed to identify individuals at increased risk of severe outcomes (i.e., COVID-19 related hospitalisation or death) post the autumn 2022 booster dose. Methods We undertook a national population-based cohort analysis across all four UK nations through linked primary care, vaccination, hospitalisation and mortality data. We included individuals who received autumn 2022 booster doses of BNT162b2 (Comirnaty) or mRNA-1273 (Spikevax) during the period September 1, 2022 to December 31, 2022 to investigate the risk of severe COVID-19 outcomes. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for the association between demographic and clinical factors and severe COVID-19 outcomes after the autumn booster dose. Analyses were adjusted for age, sex, body mass index (BMI), deprivation, urban/rural areas and comorbidities. Stratified analyses were conducted by vaccine type. We then conducted a fixed-effect meta-analysis to combine results across the four UK nations. Findings Between September 1, 2022 and December 31, 2022, 7,451,890 individuals ≥18 years received an autumn booster dose. 3500 had severe COVID-19 outcomes (2.9 events per 1000 person-years). Being male (male vs female, aHR 1.41 (1.32-1.51)), older adults (≥80 years vs 18-49 years; 10.43 (8.06-13.50)), underweight (BMI <18.5 vs BMI 25.0-29.9; 2.94 (2.51-3.44)), those with comorbidities (≥5 comorbidities vs none; 9.45 (8.15-10.96)) had a higher risk of COVID-19 hospitalisation or death after the autumn booster dose. Those with a larger household size (≥11 people within household vs 2 people; 1.56 (1.23-1.98)) and from more deprived areas (most deprived vs least deprived quintile; 1.35 (1.21-1.51)) had modestly higher risks. We also observed at least a two-fold increase in risk for those with various chronic neurological conditions, including Down's syndrome, immunodeficiency, chronic kidney disease, cancer, chronic respiratory disease, or cardiovascular disease. Interpretation Males, older individuals, underweight individuals, those with an increasing number of comorbidities, from a larger household or more deprived areas, and those with specific underlying health conditions remained at increased risk of COVID-19 hospitalisation and death after the autumn 2022 vaccine booster dose. There is now a need to focus on these risk groups for investigating immunogenicity and efficacy of further booster doses or therapeutics. Funding National Core Studies-Immunity, UK Research and Innovation (Medical Research Council and Economic and Social Research Council), Health Data Research UK, the Scottish Government, and the University of Edinburgh.
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Affiliation(s)
- Stuart Bedston
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Fatima Almaghrabi
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Lynsey Patterson
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Public Health Agency, Belfast, UK
| | - Utkarsh Agrawal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lana Woolford
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Sneha N. Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anna Crawford
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Rosalind Goudie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hoda Abbasizanjani
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Deb Smith
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Lynn Laidlaw
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | | | - Declan T. Bradley
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Public Health Agency, Belfast, UK
| | - Ronan A. Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK
- Public Health Scotland, Glasgow, Scotland, UK
| | - Sir Aziz Sheikh
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ting Shi
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
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15
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Rangchian M, Makhdoumi M, Zamanirafe M, Parvaneh E, Eshraghi A, Entezari-Maleki T, Mehrpooya M. Impact of Clinical Pharmacist-conducted Medication Reconciliation at Admission and Discharge on Medication Safety in Patients Hospitalized with Acute Decompensated Heart Failure. Curr Drug Saf 2024; 19:CDS-EPUB-137800. [PMID: 38299281 DOI: 10.2174/0115748863284257231212063959] [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: 10/16/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Most studies have focused on the impact of medication reconciliation on one of the points of hospital admission or discharge. In this study, we aimed to investigate the impact of medication reconciliation at both admission and discharge on medication safety in patients hospitalized with acute decompensated heart failure. METHODS This was a prospective, single-center, cohort study conducted in a tertiary care cardiovascular hospital from October 2022 to March 2023 on patients hospitalized with acute decompensated heart failure. Patients were considered eligible if they were taking at least five chronic medications prior to hospital admission. Medication reconciliation was carried out for the study patients by a clinical pharmacy team both at admission and discharge. Further, the study patients also received comprehensive discharge counseling as well as post-discharge follow-up and monitoring. RESULTS Medication reconciliation was applied for 129 patients at admission and 118 of them at discharge. The mean time needed for medication reconciliation presses was 32 min per patient on admission and 22min per patient on discharge. Unintentional medication discrepancies were relatively common both at admission and discharge in the study participants, but compared to admission, discrepancies were less frequent at discharge (178 versus 72). Based on the consensus review, about 30% of identified errors detected at both admission and discharge were judged to have the potential to cause moderate to severe harm to the patient, and most of the clinical pharmacists' recommendations on unintended discrepancies were accepted by physicians and resulted in changes in medication orders (more than 80%). Further, the majority of the participants were 'very satisfied' or 'satisfied' with the clinical pharmacy services provided to them during hospitalization and after hospital discharge (89.90%). CONCLUSIONS Our results demonstrated that heart failure patients are vulnerable to medication discrepancies both at admission and discharge and implementing a comprehensive medication reconciliation by clinical pharmacists could be helpful in improving medication safety in these patients.
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Affiliation(s)
- Maryam Rangchian
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mana Makhdoumi
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Zamanirafe
- Department of Cardiology, Hamedan University of Medical Sciences, Iran
| | - Erfan Parvaneh
- Department of Cardiology, Hamedan University of Medical Sciences, Iran
| | - Azadeh Eshraghi
- Clinical Pharmacy, Iran University of Medical Sciences , Iran
| | | | - Maryam Mehrpooya
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
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16
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Visser FCW, van Eersel MEA, Hempenius L, Verwey NA, Band C, van der Bol JM, Boudestein K, van Dijk SC, Gobbens R, van der Hooft CS, Kamper AM, Ruiter R, Sipers W, Spoelstra BNA, Stoffels J, Stolwijk-Woudstra DJ, van Stralen KJ, van Strien AM, Wijngaarden MA, Winters M, Strijkert F, van Munster BC. Recognition of cognitive dysfunction in hospitalised older patients: a flash mob study. BMC Geriatr 2024; 24:66. [PMID: 38229025 DOI: 10.1186/s12877-023-04588-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND It is important that healthcare professionals recognise cognitive dysfunction in hospitalised older patients in order to address associated care needs, such as enhanced involvement of relatives and extra cognitive and functional support. However, studies analysing medical records suggest that healthcare professionals have low awareness of cognitive dysfunction in hospitalised older patients. In this study, we investigated the prevalence of cognitive dysfunction in hospitalised older patients, the percentage of patients in which cognitive dysfunction was recognised by healthcare professionals, and which variables were associated with recognition. METHODS A multicentre, nationwide, cross-sectional observational study was conducted on a single day using a flash mob study design in thirteen university and general hospitals in the Netherlands. Cognitive function was assessed in hospitalised patients aged ≥ 65 years old, who were admitted to medical and surgical wards. A Mini-Cog score of < 3 out of 5 indicated cognitive dysfunction. The attending nurses and physicians were asked whether they suspected cognitive dysfunction in their patient. Variables associated with recognition of cognitive dysfunction were assessed using multilevel and multivariable logistic regression analyses. RESULTS 347 of 757 enrolled patients (46%) showed cognitive dysfunction. Cognitive dysfunction was recognised by attending nurses in 137 of 323 patients (42%) and by physicians in 156 patients (48%). In 135 patients (42%), cognitive dysfunction was not recognised by either the attending nurse or physician. Recognition of cognitive dysfunction was better at a lower Mini-Cog score, with the best recognition in patients with the lowest scores. Patients with a Mini-Cog score < 3 were best recognised in the geriatric department (69% by nurses and 72% by physicians). CONCLUSION Cognitive dysfunction is common in hospitalised older patients and is poorly recognised by healthcare professionals. This study highlights the need to improve recognition of cognitive dysfunction in hospitalised older patients, particularly in individuals with less apparent cognitive dysfunction. The high proportion of older patients with cognitive dysfunction suggests that it may be beneficial to provide care tailored to cognitive dysfunction for all hospitalised older patients.
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Affiliation(s)
- Fleur C W Visser
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands.
| | - Marlise E A van Eersel
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
| | - Liesbeth Hempenius
- Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Nicolaas A Verwey
- Neurology and Geriatric Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Caterina Band
- Spaarne Gasthuis Hospital, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | | | - Kris Boudestein
- Department of Geriatric Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Suzanne C van Dijk
- Department of Geriatric Medicine, Franciscus Gasthuis and Vlietland, Schiedam, The Netherlands
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | | | - Adriaan M Kamper
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Rikje Ruiter
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Walther Sipers
- Department of Geriatric Medicine, Zuyderland Medical Center Sittard-Geleen, Heerlen-Sittard-Geleen, The Netherlands
| | - Birgit N A Spoelstra
- Department of Geriatric Medicine, Meander Medisch Centrum, Amersfoort, The Netherlands
| | - Josephine Stoffels
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Aging & Later Life, Amsterdam, The Netherlands
| | | | | | - Astrid M van Strien
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marjolein A Wijngaarden
- Leiden University Medical Center, Internal Medicine, Section Geriatrics, Leiden, The Netherlands
| | - Marian Winters
- Departments of Internal Medicine and Geriatrics, Isala Hospital, Zwolle, The Netherlands
| | - Fijanne Strijkert
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
| | - Barbara C van Munster
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
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Flores-Cisneros L, Gutiérrez-Vargas R, Escondrillas-Maya C, Zaragoza-Jiménez C, Rodríguez GG, López-Gatell H, González- Islas D. Risk factors for severe disease and mortality in children with COVID-19. Heliyon 2024; 10:e23629. [PMID: 38192840 PMCID: PMC10772093 DOI: 10.1016/j.heliyon.2023.e23629] [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: 08/18/2023] [Revised: 08/29/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
Background Pediatric COVID-19 patients have lower rates of hospitalization and fatal outcomes compared to adults with COVID-19; however, children represent a challenge in the detection, diagnosis, and treatment of COVID-19. Our aim was to determine the risk factors for hospital admission, invasive mechanical ventilation, and mortality in pediatric COVID-19 patients in Mexico during the COVID-19 pandemic. Material and methods A retrospective cohort of pediatric patients with COVID-19 from February 2020 to April 2021 was reported on the National Epidemiological Surveillance System for Viral Respiratory Disease (SISVER) platform. Results Among the 104,133 patients included in our study, 6214 were hospitalized, and 621 patients underwent invasive mechanical ventilation. A total of 0.65 % died during hospitalization. Children aged <12 months (odds ratio [OR]: 17.1; 95 % confidence interval [CI]: 15.9-19.4, p < 0.001), 1-4 years (OR: 3.69; 95 % CI: 3.2-4.1, p < 0.001), 5-9 years (OR: 1.86; 95 % CI: 1.66-2.08, p < 0.001), and 10-14 years (OR: 1.23; 95 % CI: 1.11-1.37, p < 0.001), and those diagnosed with diabetes (OR: 2.32; 95 % CI 1.68-3.20, p < 0.001) and obesity (OR: 1.24; 95 % CI 1.04-1.48, p = 0.015) were associated with hospital admission. Renal disease (OR: 3.85; 95 % CI: 2.25-6.59, p < 0.001) was associated with invasive mechanical ventilation. Pneumonia (OR: 15.9; 95 % CI: 12.6-20.1, p < 0.001) and renal disease (OR: 3.85; 95 % CI: 2.25-6.59, p value < 0.001) were associated with death. Conclusion Pneumonia increases the risk of death. The youngest age group has a higher risk of hospital admission. Comorbidities such as renal disease or immunosuppression increase the risk of death in all age groups.
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Affiliation(s)
| | | | | | | | | | - Hugo López-Gatell
- Subsecretaria de Prevención y Promoción de La Salud, Secretaría de Salud, Mexico City, Mexico
| | - Dulce González- Islas
- Departamento de Cardiología, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Calz. de Tlalpan 4502 Del. Tlalpan, Col. Seccion XVI, CP:14080 Mexico City, Mexico
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Sharma K, Tak V, Nag VL, Bhatia PK, Kothari N. An observational study on carbapenem-resistant Enterobacterales (CRE) colonisation and subsequent risk of infection in an adult intensive care unit (ICU) at a tertiary care hospital in India. Infect Prev Pract 2023; 5:100312. [PMID: 37868258 PMCID: PMC10585280 DOI: 10.1016/j.infpip.2023.100312] [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: 07/25/2022] [Accepted: 02/26/2023] [Indexed: 10/24/2023] Open
Abstract
Background Carbapenem-resistant Enterobacterales (CRE) are a global health problem with a growing prevalence. India has a high prevalence of CRE. CRE infections are difficult to treat, and are associated with significant morbidity and mortality. Colonisation is generally a prerequisite for infection and the prevention of CRE colonisation is key to the prevention of CRE infection. Objectives To determine the prevalence of CRE colonisation and subsequent infections in an adult intensive care unit (ICU) in India. Methods We conducted a prospective observational study in which perirectal swabs were obtained along with relevant clinical details of consenting adult patients upon ICU admission between January 2019 and August 2020. Rectal screening was performed using MacConkey agar plates with ertapenem disks and further identification was performed using conventional microbiological techniques. Ertapenem minimum inhibitory concentration (MIC) was determined using an epsillometer (E) test. The modified carbapenem inactivation (mCIM) test and EDTA carbapenem inactivation test (eCIM) were performed to confirm carbapenem resistance using the Clinical Laboratory Standards Institute (CLSI) 2020 guidelines. Results 192 ICU patients were screened for CRE. 37 patients were found to be colonised with CRE. Klebsiella pneumoniae (N=25; 67.6%) was the most frequent CRE isolate, followed by Escherichia coli (N=11; 29.7%) and one Enterobacter species (N=1; 2.7%). 89.2% (33/37) patients developed CRE infection. Pneumonia was the most common CRE infection identified in 12/33 (36.4%) patients.during the hospital stay. The median duration of hospital stay was longer (17 days) for CRE colonised compared to CRE non-colonised patients (9 days) (P<0.001). Death occurred in 27 % (N=10/37) of CRE-colonised patients during the hospital admission. Conclusion CRE colonisation is associated with high risk of subsequent CRE infection and longer ICU and hospital admission.
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Affiliation(s)
- Kirtika Sharma
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Vibhor Tak
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Vijaya Lakshmi Nag
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | | | - Nikhil Kothari
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Chen S, Zhang Y, Wang Y, Lawrence WR, Rhee J, Guo T, Chen S, Du Z, Wu W, Li Z, Wei J, Hao Y, Zhang W. Long-term particulate matter exposure and the risk of neurological hospitalization: Evidence from causal inference of a large longitudinal cohort in South China. Chemosphere 2023; 345:140397. [PMID: 37838030 PMCID: PMC10841469 DOI: 10.1016/j.chemosphere.2023.140397] [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] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/12/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023]
Abstract
With limited evidence on the neurological impact of particulate matter (PM) exposure in China, particularly for PM1 which is smaller but more toxic, we conducted a large Chinese cohort study using causal inference approaches to comprehensively clarify such impact. A total of 36,271 participants in southern China were recruited in 2015 and followed up through 2020. We obtained the neurological hospitalizations records by linking the cohort data to the electronic reports from 418 medical institutions across the study area. By using high-resolution PM concentrations from satellite-based spatiotemporal models and the cohort data, we performed marginal structural Cox models under causal assumptions to assess the potential causal links between time-varying PM exposure and neurological hospitalizations. Our findings indicated that increasing PM1, PM2.5, and PM10 concentrations by 1 μg/m³ were associated with higher overall neurological hospitalization risks, with hazard ratios (HRs) of 1.10 (95% confidence interval (CI) 1.04-1.16), 1.09 (95% CI 1.04-1.14), and 1.03 (95% CI 1.00-1.06), respectively. PM1 appeared to have a stronger effect on neurological hospitalization, with a 1% and 7% higher impact compared to PM2.5 and PM10, respectively. Additionally, each 1-μg/m3 increase in the annual PM1 concentration was associated with an elevated risk of hospitalizations for ischemic stroke (HR: 1.15; 95% CI, 1.06-1.26), which tended to be larger than the estimates for PM2.5 (HR: 1.13, 95% CI, 1.04-1.23) and PM10 (HR: 1.05, 95% CI, 1.00-1.09). Furthermore, never-married or female individuals tended be at a greater risk compared with their counterparts. Our study provides important insights into the health impact of particles, particularly smaller particles, on neurological hospitalization risk and highlights the need for clean-air policies that specifically target these particles.
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Affiliation(s)
- Shimin Chen
- Department of Medical Statistics, School of Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuqin Zhang
- Department of Medical Statistics, School of Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ying Wang
- Department of Medical Statistics, School of Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wayne R Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Jongeun Rhee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Tong Guo
- Department of Medical Statistics, School of Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shirui Chen
- Department of Medical Statistics, School of Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wenjing Wu
- Department of Medical Statistics, School of Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhiqiang Li
- Department of Medical Statistics, School of Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, United States.
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, China.
| | - Wangjian Zhang
- Department of Medical Statistics, School of Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Xing DG, Horan T, Bhuiyan MS, Faisal ASM, Densmore K, Murnane KS, Goeders NE, Bailey SR, Conrad SA, Vanchiere JA, Patterson JC, Kevil CG, Bhuiyan MAN. Social-geographic disparities in suicidal ideations among methamphetamine users in the USA. Psychiatry Res 2023; 329:115524. [PMID: 37852161 PMCID: PMC10841467 DOI: 10.1016/j.psychres.2023.115524] [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: 05/22/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
IMPORTANCE Methamphetamine use is a growing public health concern nationwide. Suicide is the second leading cause of death in 2019 for US citizens aged 10-14 years and 25-34 years and is also a significant public health concern. Understanding the intersection of methamphetamine use and suicidal ideation (SI) is necessary to develop public health and policy solutions that mitigate these ongoing severe public health issues. OBJECTIVE Our objective was to examine SI in methamphetamine users to allow us to determine prevalence and trends by age, sex, race, and geographical region. DESIGN, SETTINGS, AND PARTICIPANTS Using data collected between 2008 and 2019 from the National Inpatient Sample (NIS) database, we identified hospital admissions (HA) of patients ≥18 years of age with a primary or secondary diagnosis of SI who were also diagnosed as methamphetamine users. Those who used other substances with methamphetamine were excluded from the analysis. MAIN OUTCOME AND MEASURES To determine the trend and prevalence of hospital admissions due to SI and SI among methamphetamine users, we used trend weights to calculate the national estimates and performed design-based analysis to account for complex survey design and sampling weights on data collected between 2008 and 2019 in the US. RESULTS The prevalence ratio (PR) of hospitalizations with concurrent SI and methamphetamine use increased 16-fold from 2008 to 2019. The most significant increase occurred between 2015 and 2016; the PR doubled from 6.07 to 12.14. The PR of hospitalizations with concurrent SI and methamphetamine use was highest in patients aged 26-40 (49.08%) and 41-64 (28.49%). Patients aged 41-64 showed the most significant increase from 2008 to 2019 (15.8-fold). While non-Hispanic White patients comprised most of these hospitalizations (77.02%), non-Hispanic Black patients showed the highest proportional increase (39.1-fold). The Southern and Western regions in the US showed the highest PR for these hospitalizations (34.86% and 34.31%, respectively). CONCLUSION AND RELEVANCE Our findings indicate that SI in methamphetamine users has been increasing for some time and is likely to grow. In addition, our results suggest that these patients are demographically different. Both conditions are associated with a lesser likelihood of seeking and receiving care. Therefore, when addressing increased SI or methamphetamine use, learning more about patients who share both conditions is necessary to ensure proper care.
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Affiliation(s)
- Diensn G Xing
- Department of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States
| | - Teresa Horan
- Department of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States
| | - Md Shenuarin Bhuiyan
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States; Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States
| | - Abu Saleh Mosa Faisal
- Department of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States
| | - Kenneth Densmore
- Office of Research, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States
| | - Kevin S Murnane
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States; Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States; Louisiana Addiction Research Center, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
| | - Nicholas E Goeders
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States; Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States; Louisiana Addiction Research Center, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
| | - Steven R Bailey
- Department of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States
| | - Steven A Conrad
- Department of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States; Department of Pediatrics, LSU Health Sciences Center Shreveport, Shreveport, LA, United States
| | - John A Vanchiere
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States; Department of Pediatrics, LSU Health Sciences Center Shreveport, Shreveport, LA, United States
| | - James C Patterson
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States; Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States; Louisiana Addiction Research Center, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States
| | - Christopher G Kevil
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States; Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States
| | - Mohammad Alfrad Nobel Bhuiyan
- Department of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, United States; Louisiana Addiction Research Center, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States.
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Gaertner F, Preissner S, Petri WA, Atolani O, Heiland M, Nahles S, Preissner R, Hertel M. Comparison of the risk of hospital admission, need for ventilation, sepsis, pneumonitis and death among the recent monkeypox outbreak and historical outbreaks. BMC Infect Dis 2023; 23:610. [PMID: 37723464 PMCID: PMC10506253 DOI: 10.1186/s12879-023-08599-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The course of monkeypox can be severe. Our aim was to retrospectively compare the risk of hospital admission, the need for ventilation, sepsis, pneumonitis and death between the recent outbreak and historical outbreaks. MATERIALS AND METHODS Cases of monkeypox were retrieved from the TriNetX database and assigned to either cohort I (recent outbreak between May 1st and September 16th, 2022) and cohort II (historical outbreaks before May 1st, 2022). After matching for age distribution, statistical analysis was performed. RESULTS Of 640 patients with monkeypox 81 subjects per cohort remained after matching (mean age±standard deviation = 36.1±18.3 years). Within 56 days after diagnosis 10 patients per cohort were hospitalized (12.4%) and/or developed sepsis (12.4%). The risk of ventilation and pneumonitis were significantly lower among cohort I compared with cohort II (0 vs. 10 cases; risk difference = 12.4%; p = 0.001; Log-Rank test). No cases of death were recorded. CONCLUSION Even though monkeypox provides a risk of severe courses, the infection is self-limiting in most cases. Unlike past outbreaks, the risk of ventilation and pneumonitis may be relatively low among recent outbreaks.
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Affiliation(s)
- Florian Gaertner
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Saskia Preissner
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - William Arthur Petri
- Department of Pathology, University of Virginia, 200 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
| | - Olubunmi Atolani
- Department of Chemistry, University of Ilorin, P.M.B. 1515, Ilorin, 24003, Kwara State, Nigeria
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Robert Preissner
- Institute of Physiology and Science-IT, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Philippstr. 12, 10115, Berlin, Germany
| | - Moritz Hertel
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Kolambage YD, Walpita YN, Liyanage UA, Dayaratne BMKDR, Dissanayake VHW. The burden of hospital admissions for skeletal dysplasias in Sri Lanka: a population-based study. Orphanet J Rare Dis 2023; 18:279. [PMID: 37684696 PMCID: PMC10485930 DOI: 10.1186/s13023-023-02884-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Skeletal dysplasias are a diverse group of rare disorders in the chondro-osseous tissue that can have a significant impact on patient's functionality. The worldwide prevalence of skeletal dysplasias at birth is approximately 1:5000 births. To date, disease burden and trends of skeletal dysplasias in the Sri Lankan population have not been described in any epidemiological study. Our aim was to evaluate the burden and the current trends in hospital admissions for skeletal dysplasias in the Sri Lankan population. A retrospective evaluation of hospital admissions for skeletal dysplasia during 2017-2020 was performed using population-based data from the eIMMR database which covers government hospitals in the entire country. The trends in hospital admissions for skeletal dysplasias by calendar year, age, and types of skeletal dysplasia were described using appropriate summary statistics. RESULTS Respective crude admission rates of skeletal dysplasias in the years 2017, 2018, 2019 and 2020 were 5.2, 8.1, 8.0, and 6.5 per million population. A female predominance (1.4:1) was noted during the studied period. Of all reported cases the majority (n = 268; 44.2%) were children less than 4 years. Each year, 0-4 years age group represented 40-47% of the total hospital admissions. More than half of the cases were reported from Colombo (28.1%) and Kandy (25.4%) districts combined. 60% of cases were diagnosed as osteogenesis imperfecta (OI). Rising trends were observed in the hospital admissions for osteogenesis imperfecta, achondroplasia and osteopetrosis, while other skeletal dysplasia types collectively showed a relatively stable trend. CONCLUSION This preliminary study revealed a female predominance of skeletal dysplasias and a relatively high admission rate of osteogenesis imperfecta in the Sri Lankan population. A distinct trend was not visible in the studied years probably due to the impact on hospital services due to COVID- Pandemic. Future research on the healthcare burden on families affected by skeletal dysplasia is required to better understand the overall cost of care and identify therapies that reduce admission rates. This study highlights the value of analysing population-based data on rare diseases to improve healthcare in low-resource countries.
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Affiliation(s)
- Yasas D Kolambage
- Department of Anatomy, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka.
- Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Yasaswi N Walpita
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Udari A Liyanage
- Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Vajira H W Dissanayake
- Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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23
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Varma A, Thysen SM, Martins JSD, Nanque LM, Jensen AKG, Fisker AB. Overall effect of a campaign with measles vaccine on the composite outcome mortality or hospital admission: A cluster-randomized trial among children aged 9-59 months in rural Guinea-Bissau. Int J Infect Dis 2023; 134:23-30. [PMID: 37182547 DOI: 10.1016/j.ijid.2023.05.011] [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] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES Campaigns with measles vaccine (C-MV) are conducted to eradicate measles, but prior studies indicate that MV reduces non-measles mortality and hospital admissions too. We hypothesized that C-MV reduces death/hospital admission by 30%. METHODS Between 2016-2019, we conducted a non-blinded cluster-randomized trial randomizing village clusters in rural Guinea-Bissau to a C-MV targeting children aged 9-59 months. In Cox proportional hazards models, we assessed the effect of C-MV, obtaining hazard ratios (HR) for the composite outcome (death/hospital admission). We also examined potential effect modifiers. RESULTS Among 18,411 children (9636 in 111 intervention clusters/8775 in 110 control clusters), 379 events occurred (208 intervention/171 control) during a median follow-up period of 22 months. C-MV did not reduce the composite outcome (HR 1.12, 95% confidence interval 0.88-1.41). Mortality among enrolled children (5.3 intervention and 4.6 control, per 1000 person-years) was approximately half the pre-trial mortality rate (11.1 intervention and 8.9 control, per 1000 person-years). Neither planned nor explorative analyses of potential effect modifiers explained the contrasting results to prior studies. CONCLUSION C-MV did not reduce overall mortality or hospital admission. This might be explained by changes in disease patterns, baseline differences in health status, and/or modifying effects of other campaigns during follow-up.
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Affiliation(s)
- Anshu Varma
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sanne M Thysen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Line M Nanque
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Aksel K G Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ane B Fisker
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Moamer S, Faradmal J, Leili M. Short-term effects of air pollution on hospital admissions of respiratory diseases in Hamadan, Iran, 2015 to 2021. Environ Sci Pollut Res Int 2023; 30:97900-97910. [PMID: 37603242 DOI: 10.1007/s11356-023-29328-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Abstract
The short-term effects of air pollution on respiratory diseases have been reported in many countries. Urban areas are most affected because of the many sources of pollution and the large number of people living there. This study aims to investigate the effect of short-term exposure to air pollutants on respiratory hospital admissions in the city of Hamadan. In this ecological study, daily hospital admission data were collected from Shahid Beheshti Hospital in Hamadan. Daily information on air pollutants (CO, SO2, NO2, O3, PM2.5 and PM10) from Hamadan Department of Environment (DoE) organization and of climate factors from Hamadan Meteorological Office were collected. A negative binomial regression model was used to examine the effect of air pollution on daily respiratory hospitalizations. The effect of exposure to pollutants was measured whit different time lags (0-7 days). Furthermore, the effect of meteorological variables was controlled. Subgroup analyses were performed by sex and age group. A total of 12,454 hospitalizations for respiratory diseases were recorded. Results showed a strong and immediate effect of CO on respiratory hospital admissions with highest association at lag 7 (relative risk (RR) = 1.38, 95% CI: 1.33, 1.42). The effects of CO and SO2 on respiratory hospitalizations are greater for men than women. Regarding the short-term effects of PM2.5, SO2 and O3, adults (aged less than 65) were more prone to hospitalization for respiratory diseases. These results show that exposure to air pollution, particularly CO, may increase hospital admissions due to respiratory illness. So reducing the concentration of these pollutants can reduce the number of hospital admissions.
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Affiliation(s)
- Soraya Moamer
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Javad Faradmal
- Modeling of Noncommunicable Diseases Research Center, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Mostafa Leili
- Department of Environmental Health Engineering, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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Schwarz M, Schneider A, Cyrys J, Bastian S, Breitner S, Peters A. Impact of ultrafine particles and total particle number concentration on five cause-specific hospital admission endpoints in three German cities. Environ Int 2023; 178:108032. [PMID: 37352580 DOI: 10.1016/j.envint.2023.108032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/03/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Numerous studies have shown associations between daily concentrations of fine particles (e.g., particulate matter with an aerodynamic diameter ≤2.5 µm; PM2.5) and morbidity. However, evidence for ultrafine particles (UFP; particles with an aerodynamic diameter of 10-100 nm) remains conflicting. Therefore, we aimed to examine the short-term associations of UFP with five cause-specific hospital admission endpoints for Leipzig, Dresden, and Augsburg, Germany. MATERIAL AND METHODS We obtained daily counts of (cause-specific) cardiorespiratory hospital admissions between 2010 and 2017. Daily average concentrations of UFP, total particle number (PNC; 10-800 nm), and black carbon (BC) were measured at six sites; PM2.5 and nitrogen dioxide (NO2) were obtained from monitoring networks. We assessed immediate (lag 0-1), delayed (lag 2-4, lag 5-7), and cumulative (lag 0-7) effects by applying station-specific confounder-adjusted Poisson regression models. We then used a novel multi-level meta-analytical method to obtain pooled risk estimates. Finally, we performed two-pollutant models to investigate interdependencies between pollutants and examined possible effect modification by age, sex, and season. RESULTS UFP showed a delayed (lag 2-4) increase in respiratory hospital admissions of 0.69% [95% confidence interval (CI): -0.28%; 1.67%]. For other hospital admission endpoints, we found only suggestive results. Larger particle size fractions, such as accumulation mode particles (particles with an aerodynamic diameter of 100-800 nm), generally showed stronger effects (respiratory hospital admissions & lag 2-4: 1.55% [95% CI: 0.86%; 2.25%]). PM2.5 showed the most consistent associations for (cardio-)respiratory hospital admissions, whereas NO2 did not show any associations. Two-pollutant models showed independent effects of PM2.5 and BC. Moreover, higher risks have been observed for children. CONCLUSIONS We observed clear associations with PM2.5 but UFP or PNC did not show a clear association across different exposure windows and cause-specific hospital admissions. Further multi-center studies are needed using harmonized UFP measurements to draw definite conclusions on the health effects of UFP.
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Affiliation(s)
- Maximilian Schwarz
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Josef Cyrys
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Susanne Bastian
- Saxon State Office for Environment, Agriculture and Geology (LfULG), Dresden, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Nguyen PT, Nguyen TT, Huynh LT, Graham SM, Marais BJ. Clinical algorithm reduces antibiotic use among children presenting with respiratory symptoms to hospital in central Vietnam. Pneumonia (Nathan) 2023; 15:11. [PMID: 37488633 PMCID: PMC10367404 DOI: 10.1186/s41479-023-00113-9] [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: 10/23/2022] [Accepted: 06/29/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE To assess the safety and utility of a pragmatic clinical algorithm to guide rational antibiotic use in children presenting with respiratory infection. METHODS The effect of an algorithm to guide the management of young (< 5 years) children presenting with respiratory symptoms to the Da Nang Hospital for Women and Children, Vietnam, was evaluated in a before-after intervention analysis. The main outcome was reduction in antibiotic use, with monitoring of potential harm resulting from reduced antibiotic use. The intervention comprised a single training session of physicians in the use of an algorithm informed by local evidence; developed during a previous prospective observational study. The evaluation was performed one month after the training. RESULTS Of the 1290 children evaluated before the intervention, 102 (7.9%) were admitted to hospital and 556/1188 (46.8%) were sent home with antibiotics. Due to COVID-19, only 166 children were evaluated after the intervention of whom 14 (8.4%) were admitted to hospital and 54/152 (35.5%) were sent home with antibiotics. Antibiotic use was reduced (from 46.8% to 35.5%; p = 0.009) after clinician training, but adequate comparison was compromised. The reduction was most pronounced in children with wheeze or runny nose and no fever, or a normal chest radiograph, where antibiotic use declined from 46.7% to 28.8% (p < 0.0001). The frequency of repeat presentation to hospital was similar between the two study periods (141/1188; 11.9% before and 10/152; 6.6% after; p = 0.10). No child represented with serious disease after being sent home without antibiotics. CONCLUSIONS We observed a reduction in antibiotic use in young children with a respiratory infection after physician training in the use of a simple evidence-based management algorithm. However, the study was severely impacted by COVID-19 restrictions, requiring further evaluation to confirm the observed effect.
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Affiliation(s)
- Phuong Tk Nguyen
- Respiratory Department, Da Nang Hospital for Women and Children, Da Nang, Vietnam.
- Sydney Vietnam Initiative, The University of Sydney, Sydney, Australia.
| | - Tam Tm Nguyen
- Respiratory Department, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Lan Tb Huynh
- Respiratory Department, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Ben J Marais
- Discipline of Paediatrics and Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, Australia
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Malden S, Doi L, Ng L, Cuthill F. Reducing hospital readmissions amongst people experiencing homelessness: a mixed-methods evaluation of a multi-disciplinary hospital in-reach programme. BMC Public Health 2023; 23:1117. [PMID: 37308856 PMCID: PMC10258765 DOI: 10.1186/s12889-023-16048-1] [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: 10/13/2022] [Accepted: 06/03/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION People experiencing homelessness are at increased risk of experiencing ill-health. They are often readmitted to hospital after discharge, usually for the same or similar reasons for initial hospitalisation. One way of addressing this issue is through hospital in-reach initiatives, which have been established to enhance the treatment and discharge pathways that patients identified as homeless receive after hospital admission. Since 2020, the Hospital In-reach programme (which involves targeted clinical interventions and structured discharge support) has been piloted in two large National Health Service (NHS) hospitals in Edinburgh, United Kingdom (UK). This study describes an evaluation of the programme. METHODS This evaluation used a mixed method, pre-post design. To assess the effect of the programme on hospital readmission rates from baseline (12 months pre-intervention) and follow-up (12 months post-intervention), aggregate data describing the proportions of homeless-affected individuals admitted to hospital during the evaluation period were analysed using Wilcoxon signed rank test, with level of significance set at p = 0.05. Qualitative interviews were conducted with fifteen programme and hospital staff (nurses, general practitioners, homeless link workers) to assess the processes of the programme. RESULTS A total of 768 referrals, including readmissions, were made to the In-reach programme during the study period, of which eighty-eight individuals were followed up as part of the study. In comparison to admissions in the previous 12 months, readmissions were significantly reduced at 12 months follow-up by 68.7% (P = 0.001) for those who received an in-reach intervention of any kind. Qualitative findings showed that the programme was valued by hospital staff and homeless community workers. Housing services and clinical staff attributed improvements in services to their ability to collaborate more effectively in secondary care settings. This ensured treatment regimens were completed and housing was retained during hospital admission, which facilitated earlier discharge planning. CONCLUSIONS A multidisciplinary approach to reducing readmissions in people experiencing homelessness was effective at reducing readmissions over a 12-month period. The programme appears to have enhanced the ability for multiple agencies to work more closely and ensure the appropriate care is provided for those at risk of readmission to hospital among people affected by homelessness.
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Affiliation(s)
- Stephen Malden
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, EH8 9AG, Scotland.
| | - Lawrence Doi
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, EH8 9AG, Scotland
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Lauren Ng
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Fiona Cuthill
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
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Francis M, Francis P, Patanwala AE, Penm J. Obtaining medication histories via telepharmacy: an observational study. J Pharm Policy Pract 2023; 16:69. [PMID: 37291672 DOI: 10.1186/s40545-023-00573-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Medication reconciliation is an effective strategy to reduce medication errors upon hospital admission. The process involves obtaining a best possible medication history (BPMH), which can be both time-consuming and resource-intensive. During the COVID-19 pandemic, telepharmacy was used to reduce the risk of viral transmission. Telepharmacy is the remote provision of pharmacy-led clinical services, such as obtaining BPMHs, using telecommunications. However, the accuracy of telephone-obtained BPMHs has not yet been evaluated. Therefore, the primary aim of this study was to evaluate the proportion of patients who have an accurate BPMH from the telephone-obtained BPMH compared to an in-person obtained BPMH. METHODS This prospective, observational study took place in a large tertiary hospital. Recruited patients or carers had their BPMH obtained by a pharmacist over the telephone. The same patients or carers then had their BPMH conducted in-person to identify any deviations between the telephone-obtained and in-person obtained BPMH. All telephone-obtained BPMHs were timed with a stopwatch. Any deviations were categorised according to their potential consequence. An accurate BPMH was defined as having no deviations. Descriptive statistics were used to report all quantitative variables. A multivariable logistic regression was conducted to identify risk factors for patients and medications for having medication deviations. RESULTS In total, 116 patients were recruited to receive both a telephone-obtained and in-person obtained BPMH. Of these, 91 patients (78%) had an accurate BPMH with no deviations. Of the 1104 medications documented across all the BPMHs, 1064 (96%) had no deviation. Of the 40 (4%) medication deviations, 38 were deemed low-risk (3%) and 2 high-risk (1%). A patient was more likely to have a deviation if they are taking more medications (aOR: 1.11; 95% CI: 1.01-1.22; p < 0.05). A medication was more likely to have a deviation if it was regular non-prescription medication (aOR: 4.82; 95% CI: 2.14-10.82; p < 0.001) or 'when required' non-prescription medication (aOR: 3.12; 95% CI: 1.20-8.11; p = 0.02) or a topical medication (aOR: 12.53; 95% CI: 4.34-42.17; p < 0.001). CONCLUSIONS Telepharmacy represents a reliable and time-efficient alternative to in-person BPMHs.
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Affiliation(s)
- Martina Francis
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia.
| | - Peter Francis
- Department of Neurology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Asad E Patanwala
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia
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Yang XH, Bao WJ, Zhang H, Fu SK, Jin HM. The Efficacy of SARS-CoV-2 Vaccination in the Elderly: A Systemic Review and Meta-analysis. J Gen Intern Med 2023:10.1007/s11606-023-08254-9. [PMID: 37266884 DOI: 10.1007/s11606-023-08254-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Given the reduced immune response to vaccines in older populations, this study aimed to evaluate the efficacy of COVID-19 vaccinations and its impact on breakthrough infection, hospital admission, and mortality in the elderly. METHODS We carried out a systemic review and meta-analysis where MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and Cochrane Central Register for Controlled Trials were queried to identify relevant literature. We included randomized controlled trials (RCTs), non-randomized trials, prospective, observational cohort, and case-control studies assessing breakthrough infection, hospital admission, and mortality after coronavirus 2 (SARS-CoV-2) vaccination in the elderly (≥ 60 years old). RESULTS Overall, 26 studies were included in this meta-analysis. Compared with the unvaccinated group, the vaccinated group showed a decreased risk of SARS-CoV-2 infection after 28-34 (relative risk [RR] = 0.42, 95% confidence interval [CI] 0.37-0.49) and 35-60 days (RR = 0.49, 95% CI 0.37-0.62). There was a step-wise increase in efficacy with additional doses with the two-dose group experiencing decreased risk of breakthrough infection (RR = 0.37, 95% CI 0.32-0.42), hospital admissions (RR = 0.25, 95% CI 0.14-0.45), disease severity (RR = 0.38, 95% CI 0.20-0.70), and mortality (RR = 0.21, 95% CI 0.14-0.32) compared with those receiving one or no doses. Similarly three-dose and four-dose vaccine groups also showed a decreased risk of breakthrough infection (3-dose: RR = 0.14, 95% CI 0.10-0.20; 4-dose RR = 0.46, 95% CI 0.4-0.53), hospital admissions (3-dose: RR = 0.11, 95% CI 0.07-0.17; 4-dose: RR = 0.42, 95% CI 0.32-0.55), and all-cause mortality (3-dose: RR = 0.10, 95% CI 0.02-0.48; 4-dose: RR = 0.48, 95% CI 0.28-0.84) Subgroup analysis found that protection against mortality for vaccinated vs. unvaccinated groups was similar by age (60-79 years: RR = 0.59; 95% CI, 0.47-0.74; ≥ 80 years: RR = 0.76; 95% CI, 0.59-0.98) and gender (female: RR = 0.66; 95% CI, 0.50-0.87, male: (RR = 0.58; 95% CI, 0.44-0.76), and comorbid cardiovascular disease (CVD) (RR = 0.69; 95% CI, 0.52-0.92) or diabetes (DM) (RR = 0.59; 95% CI, 0.39-0.89. CONCLUSIONS Our pooled results showed that SARS-CoV-2 vaccines administered to the elderly is effective in preventing prevent breakthrough infection, hospitalization, severity, and death. What's more, increasing number of vaccine doses is becoming increasingly effective.
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Affiliation(s)
- Xiu Hong Yang
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Gong Wei Road, Shanghai, China
- Department of Nephrology, Affiliated the Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Jing Bao
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Gong Wei Road, Shanghai, China
| | - Hua Zhang
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Gong Wei Road, Shanghai, China
| | - Shun Kun Fu
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Gong Wei Road, Shanghai, China
| | - Hui Min Jin
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Gong Wei Road, Shanghai, China.
- Department of Nephrology, the People's Hospital Of Wenshan Prefecture, Wenshan, Yunnan Province, China.
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Wu M, Huang J, Fu H, Xie X, Wu S. Changes of equality of medical service utilization in China between 1993 and 2018: findings from six waves of nationwide household interview survey. Int J Equity Health 2023; 22:98. [PMID: 37217952 DOI: 10.1186/s12939-023-01909-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 05/06/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Changes in China's health care system in the last three decades was remarkable. The current study aims on examine the change of equality of health care utilization in mainland China based on a nationwide household interview survey. METHODS We used household interview data extracted from six waves of National Health Service Survey between 1993 and 2018. Changes of health care utilization were descripted. Equality of the utilization were examined with univariate meta-regression across urban and rural areas, socioeconomic development regions and income groups. RESULTS The proportion of outpatient visits within last two weeks experienced a decrease from 17.0% in 1993 to 13.0% in 2013 and bounced back to 24.0% in 2018. The age-standardized trend remained unchanged. Hospitalization in the last 12 month increased from 2.6% in 1998 to 13.8% in 2018. The perceived unmet need of hospital admission fell from 35.9% in 1998 to 21.5% in 2018. The gaps in health care utilization between urban and rural areas, across regions and by income groups have been narrowed, implying improved equality of using medical services in the last two and a half decades. CONCLUSION China has experienced significant increases in health care utilization over the past 25 years. Meanwhile, the unmet needs for health care decreased remarkably and the equality of health care utilization improved significantly. These results imply significant achievements in health service accessibility in China.
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Affiliation(s)
- Ming Wu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, P.R. China
| | - Ju Huang
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, P.R. China
| | - Xueqin Xie
- Center of Health Statistics Information, National Health Commission of the People's Republic of China, No. 38 Beilishi Road, Beijing, 100044, P.R. China
| | - Shiyong Wu
- Center of Health Statistics Information, National Health Commission of the People's Republic of China, No. 38 Beilishi Road, Beijing, 100044, P.R. China.
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Mazzilli S, Scardina G, Collini F, Forni S, Gianolio G, Bisceglia L, Lopalco PL, Chieti A, Onder G, Vanacore N, Bonaccorsi G, Gemmi F, Tavoschi L. Hospital admission and mortality rates for non-Covid diseases among residents of the long-term care facilities before and during the pandemic: a cohort study in two Italian regions. Z Gesundh Wiss 2023:1-13. [PMID: 37361287 PMCID: PMC10185456 DOI: 10.1007/s10389-023-01925-1] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 04/28/2023] [Indexed: 06/28/2023]
Abstract
Aim Long-term-care facility residents are a vulnerable population who experienced reduced healthcare access during the pandemic. This study aimed to assess the indirect impact of the COVID-19 pandemic, in terms of hospitalisation and mortality rates, among this population in two Italian Regions, Tuscany and Apulia, during 2020 in comparison with the pre-pandemic period. Subject and methods We conducted a retrospective cohort study on people residing in long-term-care facilities from 1 January 2018 to 31 December 2020 (baseline period: 1 January 2018-8 March 2020; pandemic period: and 9 March-31 December 2020). Hospitalisation rates were stratified by sex and major disease groups. Standardised weekly rates were estimated with a Poisson regression model. Only for Tuscany, mortality risk at 30 days after hospitalisation was calculated with the Kaplan-Meier estimator. Mortality risk ratios were calculated using Cox proportional regression models. Results Nineteen thousand two hundred and fifty individuals spent at least 7 days in a long-term-care facility during the study period. The overall mean non-Covid hospital admission rate per 100 000 residents/week was 144.1 and 116.2 during the baseline and pandemic periods, with a decrease to 99.7 and 77.3 during the first (March-May) and second lockdown (November-December). Hospitalisation rates decreased for all major disease groups. Thirty-day mortality risk ratios for non-Covid conditions increased during the pandemic period (1.2, 1.1 to 1.4) compared with baseline. Conclusion The pandemic resulted in worse non-COVID-related health outcomes for long-term-care facilities' residents. There is a need to prioritise these facilities in national pandemic preparedness plans and to ensure their full integration in national surveillance systems. Supplementary information The online version contains supplementary material available at 10.1007/s10389-023-01925-1.
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Affiliation(s)
- Sara Mazzilli
- Scuola Normale Superiore, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuditta Scardina
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Collini
- Quality and Equity Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Silvia Forni
- Quality and Equity Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Giulio Gianolio
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Lucia Bisceglia
- Strategic Regional Health and Social Agency of Puglia (AReSS Puglia), Bari, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Antonio Chieti
- Strategic Regional Health and Social Agency of Puglia (AReSS Puglia), Bari, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, National Institute of Health, Rome, Italy
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | | | - Fabrizio Gemmi
- Quality and Equity Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Zheng M, Yin Z, Wei J, Yu Y, Wang K, Yuan Y, Wang Y, Zhang L, Wang F, Zhang Y. Submicron particle exposure and stroke hospitalization: An individual-level case-crossover study in Guangzhou, China, 2014-2018. Sci Total Environ 2023; 886:163988. [PMID: 37150464 DOI: 10.1016/j.scitotenv.2023.163988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Short-term exposure to ambient PM2.5 and PM10 (particulate matter with aerodynamic diameters ≤2.5 μm and 10 μm, respectively) has been linked with hospitalization and mortality from stroke. However, the effect of PM1 (≤1 μm) exposure on the risk of hospitalization from stroke and its subtypes has rarely been investigated, in particular, on the basis of fine-scale exposure assessment at the individual level. METHODS We collected data on hospital admissions due to stroke and its sub-types in Guangzhou, China from January 1, 2014 to December 31, 2018. Daily exposures to PM1, PM2.5, and PM10 were assessed from satellite-derived estimates at a 1-km2 spatial resolution based on residential addresses. A time-stratified case-crossover analysis combined with a conditional logistic regression model was performed to examine the associations of stroke hospitalization risks with short-term PM exposures. We conducted stratified analyses by sex, age, season, and ambient temperature. RESULTS A total of 178,586 stroke hospitalizations were recorded during the study period, among which 141,709 cases were ischemic stroke and 25,255 cases were hemorrhagic stroke. The mean concentrations on the day of hospitalization were 20.0 μg/m3 (control days: 19.9 μg/m3) for PM1, 37.6 μg/m3 (37.4 μg/m3) for PM2.5, and 59.3 μg/m3 (59.0 μg/m3) for PM10. Short-term exposure to size-fractional particles was significantly associated with increased risks of hospital admission for overall stroke and ischemic stroke, whereas null or negative associations were observed for hemorrhagic stroke. Compared with PM2.5 and PM10, PM1 was associated with greater excess risks of stroke hospitalizations. For each 10-μg/m3 increase in PM1, PM2.5, and PM10 exposure at lag 03-day, the odds ratios were 1.016 (95 % confidence interval: 1.008, 1.024), 1.007 (1.003, 1.011), and 1.007 (1.004, 1.010) for overall stroke hospitalization, and were 1.023 (1.014, 1.033), 1.010 (1.005, 1.014), and 1.009 (1.006, 1.013) for ischemic stroke, respectively. These associations were robust to co-pollutant adjustments and did not vary by sex and age, while significantly elevated risks were identified in cold months (October to March of the next year) and low-temperature days (<23.8 °C) only. CONCLUSIONS Short-term exposure to particulate matter air pollution, particularly PM1, was associated with increased risks of hospitalization for overall stroke and ischemic stroke.
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Affiliation(s)
- Murui Zheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Zhouxin Yin
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park 20742, USA
| | - Yong Yu
- School of Public Health, Hubei University of Medicine, Shiyan 442000, China
| | - Kai Wang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yang Yuan
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yaiqi Wang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Liansheng Zhang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China.
| | - Fang Wang
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China.
| | - Yunquan Zhang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China.
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Hasegawa K, Tsukahara T, Nomiyama T. Short-term associations of low-level fine particulate matter (PM 2.5) with cardiorespiratory hospitalizations in 139 Japanese cities. Ecotoxicol Environ Saf 2023; 258:114961. [PMID: 37137261 DOI: 10.1016/j.ecoenv.2023.114961] [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: 01/17/2023] [Revised: 04/09/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
There have been few studies in non-western countries on the relationship between low levels of daily fine particulate matter (PM2.5) exposure and morbidity or mortality, and the impact of PM2.5 concentrations below 15 μg/m3, which is the latest World Health Organization Air Quality Guideline (WHO AQG) value for the 24-h mean, is not yet clear. We assessed the associations between low-level PM2.5 exposure and cardiorespiratory admissions in Japan. We collected the daily hospital admission count data, air pollutant data, and meteorological condition data recorded from April 2016 to March 2019 in 139 Japanese cities. City-specific estimates were obtained from conditional logistic regression models in a time-stratified case-crossover design and pooled by random-effect models. We estimated that every 10-μg/m3 increase in the concurrent-day PM2.5 concentration was related to a 0.52% increase in cardiovascular admissions (95% CI: 0.13-0.92%) and a 1.74% increase in respiratory admissions (95% CI: 1.41-2.07%). These values were nearly the same when the datasets were filtered to contain only daily PM2.5 concentrations <15 μg/m3. The exposure-response curves showed approximately sublinear-to-linear curves with no indication of thresholds. These associations with cardiovascular diseases weakened after adjusting for nitrogen dioxide or sulfur dioxide, but associations with respiratory diseases were almost unchanged when additionally adjusted for other pollutants. This study demonstrated that associations between daily PM2.5 and daily cardiorespiratory hospitalizations might persist at low concentrations, including those below the latest WHO AQG value. Our findings suggest that the updated guideline value may still be insufficient from the perspective of public health.
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Affiliation(s)
- Kohei Hasegawa
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
| | - Teruomi Tsukahara
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan; Department of Occupational Medicine, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Tetsuo Nomiyama
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan; Department of Occupational Medicine, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Min J, Lee W, Bell ML, Kim Y, Heo S, Kim GE, Kim JH, Yun JY, Kim SI, Schwartz J, Ha E. Hospital admission risks and excess costs for neurological symptoms attributable to long-term exposure to fine particulate matter in New York State, USA. Environ Res 2023; 229:115954. [PMID: 37086882 DOI: 10.1016/j.envres.2023.115954] [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: 02/06/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Although emerging evidence suggests that PM2.5 is linked to neurological symptoms (NSs) via neuroinflammation, relevant studies are scarce. This study aimed to investigate the risks and excess costs of hospital admission for five NSs-fatigue, headache, dizziness, convulsion, and paralysis-attributable to long-term exposure to PM2.5 in New York State, USA. METHODS We analyzed the New York Statewide Planning and Research Cooperative System (SPARCS) from 2010 to 2016. A Bayesian hierarchical model with integrated nested Laplace approximations was performed to estimate the risks and excess costs of hospital admission for NSs due to long-term exposure to PM2.5 at the county level. RESULTS A 1 μg/m3 increase in lag 0-1 years PM2.5 was associated with an increased risk of headache and convulsion by 1.06 (1.01, 1.11) and 1.04 (1.01, 1.06), respectively. The excess hospital admission cost for five NSs attributable to lag 0-1 years PM2.5 above the new World Health Organization guideline (annual standard: 5 μg/m3) was $200.24 (95% CI: 6.00, 376.96) million during 2011-2016, recording the highest for convulsion ($153.73 [95% CI: 63.61, 244.19] million). CONCLUSIONS This study provides quantitative estimates of risks and excess costs for NSs attributable to long-term PM2.5 and suggests that policies that reduce long-term PM2.5 concentration in accordance with the new WHO air quality guidelines can yield substantial health and economic benefits related to NSs in the New York State population.
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Affiliation(s)
- Jieun Min
- Department of Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, North Korea; Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, North Korea; Institute of Ewha-SCL for Environmental Health (IESEH), Ewha Womans University College of Medicine, Seoul, North Korea.
| | - Whanhee Lee
- School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, North Korea.
| | - Michelle L Bell
- Yale School of the Environment, Yale University, New Haven, CT, USA.
| | - Yijun Kim
- Department of Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, North Korea.
| | - Seulkee Heo
- Yale School of the Environment, Yale University, New Haven, CT, USA.
| | - Ga Eun Kim
- Department of Psychiatry, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, North Korea.
| | - Jee Hyun Kim
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, North Korea.
| | - Ji Young Yun
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, North Korea.
| | - Soo In Kim
- Department of Psychiatry, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, North Korea.
| | - Joel Schwartz
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Eunhee Ha
- Department of Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, North Korea; Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, North Korea; Institute of Ewha-SCL for Environmental Health (IESEH), Ewha Womans University College of Medicine, Seoul, North Korea; Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, North Korea.
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Pradelli L, Zaniolo O, Sanfilippo A, Lezo A, Riso S, Zanetti M. Prevalence and economic cost of malnutrition in Italy: A systematic review and metanalysis from the Italian Society of Artificial Nutrition and Metabolism (SINPE). Nutrition 2023; 108:111943. [PMID: 36669368 DOI: 10.1016/j.nut.2022.111943] [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: 05/25/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Disease-related malnutrition (DRM) is a major public health issue with dramatic consequences on outcomes. However, in Italy a comprehensive and updated overview on national prevalence, in both the adult and pediatric populations, and its burden on the health care environment, is missing. The aim of this systematic literature review and meta-analysis was to identify and summarize the available evidence regarding the prevalence of DRM in Italy from pediatric to adult and older ages, and to project its global costs on the health care system. METHODS We performed a systematic literature search for articles on epidemiology of DRM in Italy published up to June 2021. Studies reporting data on the prevalence of DRM in community-dwelling individuals with chronic diseases, nursing home patients, and hospitalized patients (medical, surgery, and oncology patients), were selected for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria. An epidemiologic meta-analysis to obtain an aggregate estimate of prevalence of DRM was performed and a model for estimating the cost of illness, based on the application of epidemiologic results to official national hospitalization data, and attribution of relevant unit costs in the national context was constructed. RESULTS Sixty-seven studies reporting on the prevalence of DRM in Italian populations were included in the final selection; meta-analytical pooling yields mean prevalence estimates of about 50% and 30% in adult and pediatric hospitalized populations, respectively, with even higher findings for residents of long-term care facilities. Modeled projections of DRM-attributable yearly economic effects on the Italian health care system exceed 10 billion € in base case analysis, with the most optimistic estimate still exceeding 2.5 billion €. CONCLUSION Although comparable in magnitude to data from previous studies in analogous international settings, the diffusion and effects of DRM in the Italian setting is impressive. Increased awareness of these data and proactive fostering of clinical nutrition services are warranted, as prompt identification and treatment of malnutrition have been shown to effectively improve clinical and economic results.
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Affiliation(s)
| | | | | | - Antonella Lezo
- Clinical Nutrition Unit, Children's Hospital "Regina Margherita," AOU Città della Salute e della Scienza, Turin, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetic Unit - "Maggiore della Carità" University Hospital, Novara, Italy
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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Savić S, Arsenović D, Lužanin Z, Milošević D, Dunjić J, Šećerov I, Kojić M, Radić I, Harhaji S, Arsić M. Hospital admission tendencies caused by day-to-day temperature changes during summer: a case study for the city of Novi Sad (Serbia). Int J Biometeorol 2023; 67:695-704. [PMID: 36881173 DOI: 10.1007/s00484-023-02447-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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
Increased temperature risk in cities threatens the health and well-being of urban population and is fueled by climate change and intensive urbanization. Consequently, further steps must be taken for assessing temperature conditions in cities and their association with public health, in order to improve public health prevention at local or regional level. This study contributes to solving the problems by analyzing the connection between extreme temperatures and the tendencies of all-cause hospital admissions. The analyses used (a) 1-h air temperature data, and (b) daily data of all-cause hospital admissions. The datasets include the summer period (June, July, August) for the years 2016 and 2017. We tested the effects of two temperature indices, day-to-day change in maximum temperature - Tmax,c and daily temperature range - Tr, with all-cause hospital admission subgroups, such as all-cause cases - Ha, hospital admissions in the population below 65 - Ha<65, and hospital admissions in the population aged 65 and over - Ha≥65. The results show the highest values of Ha when Tmax,c is between 6 and 10 °C. Therefore, more intensive hospital admissions can be expected when Tmax increases from day-to-day (positive values of Tmax,c), and it is more visible for Ha and Ha<65 (1 °C = 1% increase in hospital admissions). Also, Tr values between 10 °C and 14 °C cause an increase in the number of hospital admissions, and it is more noticeable for Ha≥65.
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Affiliation(s)
- Stevan Savić
- Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia.
| | - Daniela Arsenović
- Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia
| | - Zorana Lužanin
- Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia
| | - Dragan Milošević
- Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia
| | - Jelena Dunjić
- Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia
| | - Ivan Šećerov
- Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia
| | - Milena Kojić
- Institute of Economic Sciences, Zmaj Jovina 12, Belgrade, 11000, Serbia
| | - Ivana Radić
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad, 21000, Serbia
- Institute of Public Health of Vojvodina, Futoška 121, Novi Sad, 21102, Serbia
| | - Sanja Harhaji
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad, 21000, Serbia
- Institute of Public Health of Vojvodina, Futoška 121, Novi Sad, 21102, Serbia
| | - Miodrag Arsić
- Institute of Public Health of Vojvodina, Futoška 121, Novi Sad, 21102, Serbia
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Francis M, Deep L, Schneider CR, Moles RJ, Patanwala AE, Do LL, Levy R, Soo G, Burke R, Penm J. Accuracy of best possible medication histories by pharmacy students: an observational study. Int J Clin Pharm 2023; 45:414-420. [PMID: 36515780 PMCID: PMC9749631 DOI: 10.1007/s11096-022-01516-2] [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: 06/30/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Medication reconciliation is an effective strategy to prevent medication errors upon hospital admission and requires obtaining a patient's best possible mediation history (BPMH). However, obtaining a BPMH is time-consuming and pharmacy students may assist pharmacists in this task. AIM To evaluate the proportion of patients who have an accurate BPMH from the pharmacy student-obtained BPMH compared to the pharmacist-obtained BPMH. METHOD Twelve final-year pharmacy students were trained to obtain BPMHs upon admission at 2 tertiary hospitals and worked in pairs. Each student pair completed one 8-h shift each week for 8 weeks. Students obtained BPMHs for patients taking 5 or more medications. A pharmacist then independently obtained and checked the student BPMH from the same patient for accuracy. Deviations were determined between student-obtained and pharmacist-obtained BMPH. An accurate BPMH was defined as only having no-or-low risk medication deviations. RESULTS The pharmacy students took BPMHs for 91 patients. Of these, 65 patients (71.4%) had an accurate BPMH. Of the 1170 medications included in patients' BPMH, 1118 (95.6%) were deemed accurate. For the student-obtained BPMHs, they were more likely to be accurate for patients who were older (OR 1.04; 95% CI 1.03-1.06; p < 0.001), had fewer medications (OR 0.85; 95% CI 0.75-0.97; p = 0.02), and if students used two source types (administration and supplier) to obtain the BPMH (OR 1.65; 95% CI 1.09-2.50; p = 0.02). CONCLUSION It is suitable for final-year pharmacy students to be incorporated into the BPMHs process and for their BPMHs to be verified for accuracy by a pharmacist.
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Affiliation(s)
- Martina Francis
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia.
| | - Louise Deep
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Carl R Schneider
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Rebekah J Moles
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Asad E Patanwala
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Linda L Do
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Russell Levy
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Garry Soo
- Department of Pharmacy, Concord Repatriation Geriatric Hospital, Concord, NSW, Australia
| | - Rosemary Burke
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia
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Khan P, Selvarajah K, Gohel S, Sidhu BS, Cannatà A, Bromage DI, McDonagh T, Murgatroyd F, Scott PA. Syncope in ICD recipients: a single centre experience. Europace 2023; 25:940-947. [PMID: 36638366 PMCID: PMC10062314 DOI: 10.1093/europace/euac281] [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: 05/04/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
AIMS There is little evidence of the impact of syncope in implantable cardioverter-defibrillator (ICD) patients in routine community hospital care. This single-centre retrospective study sought to evaluate the incidence and prognostic significance of syncope in consecutive ICD patients. METHODS AND RESULTS Data were collected on consecutive patients undergoing first ICD implantation between January 2009 and December 2019. The primary endpoints were the first occurrence of all-cause syncope, all-cause mortality, and all-cause hospitalization. Multivariate Cox proportional hazard models were used to identify risk factors associated with syncope and to analyse the subsequent risk of mortality and hospitalization. 1003 patients (58% primary prevention) were included in the final analysis. During a mean follow-up of 1519 ± 1055 days, 106 (10.6%) experienced syncope, 304 died (30.3%), and 477 (47.5%) were hospitalized for any cause. In an analysis adjusted for baseline variables, the first occurrence of syncope was associated with a significantly increased risk of mortality (HR 2.82, P < 0.001) and the first occurrence of hospitalization (HR 2.46, P = 0.002). CONCLUSION Syncope in ICD recipients is common and associated with a poor prognosis irrespective of baseline variables and ICD programming. The occurrence of syncope is associated with a significant increase in the risk of mortality and hospitalization.
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Affiliation(s)
- Parisha Khan
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Karshana Selvarajah
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Sheena Gohel
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Baldeep S Sidhu
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Antonio Cannatà
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, James Black Centre, London SE5 9NU, UK
| | - Daniel I Bromage
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, James Black Centre, London SE5 9NU, UK
| | - Theresa McDonagh
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, James Black Centre, London SE5 9NU, UK
| | - Francis Murgatroyd
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Paul A Scott
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
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Schoenling A, Frisch A, Callaway CW, Yealy DM, Weissman A. Home oxygen therapy from the emergency department for COVID-19 an observational study. Am J Emerg Med 2023; 68:47-51. [PMID: 36933333 PMCID: PMC9993732 DOI: 10.1016/j.ajem.2023.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/02/2022] [Revised: 02/21/2023] [Accepted: 03/04/2023] [Indexed: 03/14/2023] Open
Abstract
STUDY OBJECTIVE During the COVID-19 pandemic, prescribing supplemental oxygen was a common reason for hospitalization of patients. We evaluated outcomes of COVID-19 patients discharged from the Emergency Department (ED) with home oxygen as part of a program to decrease hospital admissions. METHODS We retrospectively observed COVID-19 patients with an ED visit resulting in direct discharge or observation from April 2020 to January 2022 at 14 hospitals in a single healthcare system. The cohort included those discharged with new oxygen supplementation, a pulse oximeter, and return instructions. Our primary outcome was subsequent hospitalization or death outside the hospital within 30 days of ED or observation discharge. RESULTS Among 28,960 patients visiting the ED for COVID-19, providers admitted 11,508 (39.7%) to the hospital, placed 907 (3.1%) in observation status, and discharged 16,545 (57.1%) to home. A total of 614 COVID-19 patients (535 discharge to home and 97 observation unit) went home on new oxygen therapy. We observed the primary outcome in 151 (24.6%, CI 21.3-28.1%) patients. There were 148 (24.1%) patients subsequently hospitalized and 3 (0.5%) patients who died outside the hospital. The subsequent hospitalized mortality rate was 29.7% with 44 of the 148 patients admitted to the hospital dying. Mortality all cause at 30 days in the entire cohort was 7.7%. CONCLUSIONS Most patients discharged to home with new oxygen for COVID-19 safely avoid later hospitalization and few patients die within 30 days. This suggests the feasibility of the approach and offers support for ongoing research and implementation efforts.
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Affiliation(s)
- Andrew Schoenling
- University of Pittsburgh Medical Center, Department of Critical Care, 3550 Terrace St, Alan Magee Scaife Hall, Suite 600, Pittsburgh, PA, USA.
| | - Adam Frisch
- University of Pittsburgh Medical Center, Department of Emergency Medicine, 3600 Forbes Meyran Ave, Forbes Tower, Suite 10028, Pittsburgh, PA, USA
| | - Clifton W Callaway
- University of Pittsburgh Medical Center, Department of Emergency Medicine, 3600 Forbes Meyran Ave, Forbes Tower, Suite 10028, Pittsburgh, PA, USA
| | - Donald M Yealy
- University of Pittsburgh Medical Center, Department of Emergency Medicine, 3600 Forbes Meyran Ave, Forbes Tower, Suite 10028, Pittsburgh, PA, USA
| | - Alexandra Weissman
- University of Pittsburgh Medical Center, Department of Emergency Medicine, 3600 Forbes Meyran Ave, Forbes Tower, Suite 10028, Pittsburgh, PA, USA
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Murphy GL, Beridze G, Vetrano DL, Calderón-Larrañaga A. Social network and severe lower respiratory tract infections in older adults: findings from a Swedish longitudinal population-based study. Int J Infect Dis 2023; 128:176-183. [PMID: 36587838 DOI: 10.1016/j.ijid.2022.12.031] [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: 07/17/2022] [Revised: 12/07/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To investigate the association between social network and the risk and prognosis of severe lower respiratory tract infections (LRTIs) in older adults. METHODS Data from Swedish hospital records were matched with the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Social network was operationalized as social connections and social support, based on different self-reported variables, and categorized as low, medium, and high. The risk of severe LRTI and related outcomes were assessed using Cox, Poisson, and logistic regression models where appropriate. RESULTS A total of 362 individuals experienced LRTI-related hospitalizations between 2001 and 2016 (479 total hospitalizations). High levels of social support decreased the hazard of incident LRTI by 29% (hazard ratio 0.71, 95% confidence interval [CI] 0.52-0.96), the hospital length of stay by 21% (incidence rate ratio 0.79, 95% CI 0.65-0.97), and the risk of 30-day mortality by 92% (odds ratio 0.08, 95% CI 0.01-0.68), but was a risk factor for 30-day readmission (odds ratio 3.16, 95% CI 1.38-7.24). High levels of social connections were associated with a higher risk of incident LRTI in women and those with dementia and/or slow walking speed (Pinteraction <0.05). CONCLUSION Older individuals' quality of social support seems to be a stronger determinant of LRTI incidence and prognosis than the quantity of their social connections. These findings may inform evidence-based policies aimed at preventing LRTIs in older adults.
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Affiliation(s)
- Gillian L Murphy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
| | - Giorgi Beridze
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
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Lu YZ, Huang CW, Koyama S, Taitano M, Lee EA, Shen E, Nguyen HQ. Dementia and readmission risk in patients with heart failure participating in a transitional care program. Arch Gerontol Geriatr 2023; 110:104973. [PMID: 36870185 DOI: 10.1016/j.archger.2023.104973] [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: 09/12/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Cognitive impairment is prevalent in patients hospitalized for heart failure (HF). We aimed to generate further evidence on the value of dementia screening in hospitalized HF patients by examining whether and when dementia would be an independent risk factor for 30-day readmission while modeling permutations of known risk factors such as patient demographics, disease burden, prior utilization, and index hospitalization characteristics. METHODS AND RESULTS A retrospective cohort study was employed, consisting of 26,128 patients (2,075 or 7.9% with dementia) in a transitional care program post HF hospitalization. The overall 30-day all-cause readmission rate was 18.1%. Patients with dementia had higher unadjusted rates of readmission (22.0 vs 17.8%) and death (4.5 vs. 2.2%) within 30 days post hospitalization, compared to those without dementia. Hierarchical multivariable proportional hazards regression results showed that dementia independently predicted readmission when both patient demographics and disease burden variables were controlled for (HR=1.15, p=0.02). However, the association between dementia and readmission was attenuated in the full model when prior utilization and index hospitalization characteristics were added (HR=1.04, p=0.55). For dementia patients, Charlson comorbidity index, prior ED visits, and length of stay were significant risk factors of readmission. CONCLUSIONS The presence of dementia and the predictors of 30-day readmission in those with dementia may help identify this subset of high-risk HF patients for potential efforts to improve their prognosis.
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Affiliation(s)
- Yang Z Lu
- Department of Health Care Administration, California State University - Long Beach, United States
| | - Cheng-Wei Huang
- Los Angeles Medical Center, Kaiser Permanente Southern California, United States
| | - Sandra Koyama
- Baldwin Park Medical Center, Kaiser Permanente Southern California, United States
| | - Maria Taitano
- South Bay Medical Center, Kaiser Permanente Southern California, United States
| | - Eric A Lee
- West Los Angeles Medical Center, Kaiser Permanente Southern California, United States
| | - Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente Southern California, United States
| | - Huong Q Nguyen
- Department of Research and Evaluation, Kaiser Permanente Southern California, United States; Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, United States.
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Gobbato M, Clagnan E, Toffolutti F, Del Zotto S, Burba I, Tosolini F, Polimeni J, Serraino D, Taborelli M. Vaccination against SARS-CoV-2 and risk of hospital admission and death among infected cancer patients: A population-based study in northern Italy. Cancer Epidemiol 2023; 82:102318. [PMID: 36566579 PMCID: PMC9760613 DOI: 10.1016/j.canep.2022.102318] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The risks of hospital admission for COVID-19-related conditions and all-cause death of SARS-CoV-2 infected cancer patients were investigated according to vaccination status. METHODS A population-based cohort study was carried out on 9754 infected cancer patients enrolled from January 1, 2021 to June 30, 2022. Subdistribution hazard ratio (SHRs) or hazard ratios (HRs) with 95 % confidence intervals (CI), adjusted for sex, age, comorbidity index, and time since cancer incidence, were computed to assess the risk of COVID-19 hospital admission or death of unvaccinated vs. patients with at least one dose of vaccine (i.e., vaccinated). RESULTS 2485 unvaccinated patients (25.5 %) were at a 2.57 elevated risk of hospital admission (95 % CI: 2.13-2.87) and at a 3.50 elevated risk of death (95 % CI: 3.19-3.85), as compared to vaccinated patients. Significantly elevated hospitalizations and death risks emerged for both sexes, across all age groups and time elapsed since cancer diagnosis. For unvaccinated patients, SHRs for hospitalization were particularly elevated in those with solid tumors (SHR = 2.69 vs. 1.66 in patients with hematologic tumors) while HRs for the risk of death were homogeneously distributed. As compared to boosted patients, SHRs for hospitalization and HRs for death increased with decreasing number of doses. CONCLUSIONS Study findings stress the importance of SARS-CoV-2 vaccines to reduce hospital admission and death risk in cancer patients.
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Affiliation(s)
- Michele Gobbato
- Agenzia Regionale di Coordinamento per la Salute, Udine, Italy.
| | - Elena Clagnan
- Agenzia Regionale di Coordinamento per la Salute, Udine, Italy
| | - Federica Toffolutti
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | | | - Ivana Burba
- Agenzia Regionale di Coordinamento per la Salute, Udine, Italy
| | - Francesca Tosolini
- Direzione Generale, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | - Joseph Polimeni
- Agenzia Regionale di Coordinamento per la Salute, Udine, Italy
| | - Diego Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | - Martina Taborelli
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
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da Silva SHK, de Oliveira LC, E Silva Lopes MSDM, Wiegert EVM, Motta RST, Ferreira Peres WA. The patient generated-subjective global assessment (PG-SGA) and ECOG performance status are associated with mortality in patients hospitalized with breast cancer. Clin Nutr ESPEN 2023; 53:87-92. [PMID: 36657935 DOI: 10.1016/j.clnesp.2022.11.019] [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: 06/20/2022] [Revised: 10/22/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
AIM This study evaluated the association between risk of malnutrition and performance status, and mortality in hospitalized breast cancer patients. METHODS Prospective cohort study with hospitalized breast cancer patients evaluated at a referral Cancer Center. The Risk of malnutrition was assessed by the Patient-Generated Subjective Global Assessment (PG-SGA) and performance status was determined using the Eastern Cooperative Oncology Group Performance Status Scale (ECOG PS). Logistic regression was used to analyze the factors associated with death, using the odds ratio (OR) with a 95% confidence interval (CI) as an effect measure. RESULTS A total of 195 woman were included, with a mean age of 56.3 (±12.6) years. Patients with an overall PG-SGA score ≥18 (OR: 2.11; 95% CI: 1.03-4.62) and ECOG PS ≥ 3 (OR: 3.34; 95% CI: 1.48-7.52) had a higher occurrence of death during hospitalization, regardless of age or disease stage. The concomitant presence of these two factors improved the accuracy of the association (OR: 5.32; 95% CI: 3.11-9.76) and showed good predictive accuracy (C-statistics: 0.77). CONCLUSION Nutritional risk and poor performance status were associated with a higher occurrence of death in women with breast cancer. The use of these two indicators improves their predictive accuracy for mortality.
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Affiliation(s)
| | | | | | | | | | - Wilza Arantes Ferreira Peres
- Department of Nutrition and Dietetics, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Huang Y, Song H, Cheng Y, Bi P, Li Y, Yao X. Heatwave and urinary hospital admissions in China: Disease burden and associated economic loss, 2014 to 2019. Sci Total Environ 2023; 857:159565. [PMID: 36265638 DOI: 10.1016/j.scitotenv.2022.159565] [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: 05/06/2022] [Revised: 10/15/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Many studies have shown that heatwaves are associated with an increased prevalence of urinary diseases. However, few national studies have been undertaken in China, and none have considered the associated economic losses. Such information would be useful for health authorities and medical service providers to improve their policy-making and medical resource allocation decisions. OBJECTIVES To explore the association between heatwaves and hospital admissions for urinary diseases and assess the related medical costs and indirect economic losses in China from 2014 to 2019. METHODS Daily meteorological and hospital admission data from 2014 to 2019 were collected from 23 study sites with different climatic characteristics in China. We assessed the heatwave-hospitalization associations and evaluated the location-specific attributable fractions (AFs) of urinary-related hospital admissions due to heatwaves by using a time-stratified case-crossover method with a distributed lag nonlinear model. We then pooled the AFs in a meta-analysis and estimated the national excess disease burden and associated economic losses. We also performed stratified analyses by sex, age, climate zone, and urinary disease subtype. RESULTS A significant association between heatwaves and urinary-related hospital admissions was found with a relative risk of 1.090 (95 % confidence interval (CI): 1.050, 1.132). The pooled AF was 8.27 % (95%CI: 4.77 %, 11.63 %), indicating that heatwaves during the warm season (May to September) caused 248,364 urinary-related hospital admissions per year, with 2.42 (95%CI: 1.35, 3.45) billion CNY in economic losses, including 2.23 (95%CI: 1.29, 3.14) billion in direct losses and 0.19 (95%CI, 0.06, 0.31) billion in indirect losses, males, people aged 15-64 years, residents of temperate continental climate zones, and patients with urolithiasis were at higher risk. CONCLUSION Tailored community health campaigns should be developed and implemented to reduce the adverse health effects and economic losses of heatwave-related urinary diseases, especially in the context of climate change.
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Affiliation(s)
- Yushu Huang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hejia Song
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yibin Cheng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Bi
- School of Public Health, The University of Adelaide, South Australia, Australia
| | - Yonghong Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Xiaoyuan Yao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
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Tian Y, Wu J, Liu H, Wu Y, Si Y, Wang X, Wang M, Wu Y, Wang L, Li D, Wang W, Chen L, Wei C, Wu T, Gao P, Hu Y. Ambient temperature variability and hospital admissions for pneumonia: A nationwide study. Sci Total Environ 2023; 856:159294. [PMID: 36209884 DOI: 10.1016/j.scitotenv.2022.159294] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/22/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Few investigations have assessed the impact of short-term ambient temperature change on pneumonia risk. We aimed to study the relation of temperature variability (TV) with daily hospitalizations for pneumonia in China. We conducted a time-series study in 184 major cities by extracting daily hospital data between 2014 and 2017 from a medical insurance claims database of 0.28 billion beneficiaries. TV was calculated as standard deviation of daily minimum and maximum temperatures over exposure days. We estimated associations of pneumonia admissions with TV for each city using over-dispersed generalized linear models controlling for weather conditions and ambient air pollution, and pooled city-specific estimates using random effects meta-analyses. We also investigated exposure-response relationship curve and potential effect modifiers. We identified 4.2 million pneumonia hospitalizations during the study period. TV was positively related to daily pneumonia admissions. At the national-average level, each 1-°C increase in TV at 0-6 days' exposure corresponded to a 0.65 % (95 % CI: 0.34 %-0.96 %) increase in pneumonia admissions. An approximately linear exposure-response curve for the relation of TV with pneumonia admission was noted. The relations were more evident in cities with larger average age (P = 0.038). As the first study in China to assess the impact of temperature change on pneumonia on a national scale, our results indicated that acute TV exposure was related to higher admissions for pneumonia. Our findings should provide new insight into the health impacts associated with climate change.
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Affiliation(s)
- Yaohua Tian
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, 430030 Wuhan, China; Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, 430030 Wuhan, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China
| | - Junhui Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China; School of Nursing, Peking University, No. 38 Xueyuan Road, Beijing 100191, China
| | - Hui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China; Medical Informatics Center, Peking University, No.38 Xueyuan Road, 100191 Beijing, China
| | - Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China
| | - Yaqin Si
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China
| | - Xiaowen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China
| | - Mengying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China
| | - Yao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China
| | - Lulin Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, 430030 Wuhan, China; Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, 430030 Wuhan, China
| | - Dan Li
- School of Nursing, Peking University, No. 38 Xueyuan Road, Beijing 100191, China
| | - Weixuan Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Beijing 100191, China
| | - Libo Chen
- Beijing HealthCom Data Technology Co. Ltd, No. 18 Fengtai North Road, 10/F Hengtai Plaza Block C, 100071 Beijing, China
| | - Chen Wei
- Beijing HealthCom Data Technology Co. Ltd, No. 18 Fengtai North Road, 10/F Hengtai Plaza Block C, 100071 Beijing, China
| | - Tao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China; Key Laboratory of Molecular Cardiovascular (Peking University), Ministry of Education, Beijing
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China; Medical Informatics Center, Peking University, No.38 Xueyuan Road, 100191 Beijing, China.
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Koester SW, Catapano JS, Rumalla K, Srinivasan VM, Rhodenhiser EG, Hartke JN, Benner D, Winkler EA, Cole TS, Baranoski JF, Jadhav AP, Ducruet AF, Albuquerque FC, Lawton MT. Analysis of the Weekend Effect at a High-Volume Center for the Treatment of Intracranial Aneurysms. World Neurosurg 2023; 169:e83-e88. [PMID: 36272725 DOI: 10.1016/j.wneu.2022.10.054] [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: 08/16/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The "weekend effect" is the negative effect on disease course and treatment resulting from being admitted to the hospital during a weekend. Whether the weekend effect is associated with worse outcomes for patients treated for aneurysmal subarachnoid hemorrhage (aSAH) is unknown. We assessed neurologic outcomes of patients with aSAH admitted during the weekend versus during the week. METHODS A retrospective database was reviewed to identify all patients with aSAH who received open or endovascular treatment from August 1, 2007, to July 31, 2019, at a quaternary center. The primary outcome was a poor neurologic outcome (modified Rankin Scale score >2). Propensity adjustment included age, sex, treatment type, Hunt and Hess grade, and Charlson Comorbidity Index. RESULTS A total of 1014 patients (women, 703 [69.3%]; men, 311 [30.7%]; mean age, 56 [standard deviation, 14]) met inclusion criteria; 726 (71.6%) had weekday admissions, and 288 (28.4%) had weekend admissions. There was no significant difference between patients with a weekday versus a weekend admission in mean (standard deviation) time to treatment (0.85 [1.29] vs. 0.93 [1.30] days, P = 0.10) or length of stay (19 [9] vs. 19 [9] days, P = 0.04). Total cost and rates of delayed cerebral ischemia and vasospasm were similar between the admission groups, both overall and within the open and endovascular treatment cohorts. After propensity adjustment, weekend admission was not a significant predictor of a modified Rankin Scale score greater than 2 (odds ratio [95% confidence interval]; 1.12 [0.85-1.49]; P = 0.4). CONCLUSION No difference in neurologic outcomes was associated with weekend admission among this cohort of patients with aSAH.
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Affiliation(s)
- Stefan W Koester
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Emmajane G Rhodenhiser
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joelle N Hartke
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Dimitri Benner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ethan A Winkler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Jin J, Meng X, Wang D, Han B, Wu T, Xie J, Zhang Q, Xie D, Zhang Z. Association between ambient temperature and cardiovascular diseases related hospital admissions in Lanzhou, China. Heliyon 2023; 9:e12997. [PMID: 36747948 PMCID: PMC9898685 DOI: 10.1016/j.heliyon.2023.e12997] [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: 08/09/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, ranking first in the global disease burden. Evidence on association between temperature and cardiovascular disease is insufficient and inconsistent in developing countries. In this study, a distributed lag nonlinear model (DLNM) was used to determine the association between daily mean temperature and cardiovascular diseases (CVD) related admission in Lanzhou 2015-2019. We included 41,389 patients with CVD in this study. The relative risk (RR) of CVD admission increased significantly with temperature in lag 5-10 days, and we found harvesting effect of temperature in the study, shown as decreased RR in lag 15-30 days. The maximum RR was 1.15 (95% confidence interval [CI]: 1.03-1.30), corresponding to 24 °C. Both cold and heat effects of temperature could impact the CVD admission. Compared with the 25th percentile of temperature (2 °C), the cumulative relative risk (cumRR) of extreme cold (-5 °C, the 2.5th percentile of the temperature) was 0.69 (95% CI: 0.51-0.94) in lag 0-14, whereas the cumRR of moderate cold (-2 °C, the 10th percentile) was 0.83 (95% CI:0.71-0.97). Compared with the 75th percentile of temperature (20-°C), the cumRR of extreme heat (27 °C, the 97.5th percentile) was 0.93 (95% CI: 0.78-1.10) in lag 0, whereas the cumRR of moderate heat (24 °C, the 90th percentile) was 1.01 (95% CI: 0.94-1.08). In the stratified analysis, cold decreased RR significantly in female and ≥65 years, whereas heat increased it more obviously in male and ≥65 years. Ambient temperature and CVD admissions were positively associated, with the harvesting effect. Our findings demonstrate the adaption of residents in Lanzhou to cold temperature. Public and environmental policies and measures aimed at moderate heat may minimize CVD burden effectively.
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Affiliation(s)
- Jianjian Jin
- The First Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Xiaoxue Meng
- The First Clinical Medical School, Lanzhou University, Lanzhou, China
- Heart Center, The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Cardiovascular Disease of Gansu Province, Lanzhou, China
- Cardiovascular Clinical Research Center of Gansu Province, China
| | - Dongmei Wang
- Department of Cardiology, Zhang Ye People's Hospital Affiliated to Hexi University, Zhangye, China
| | - Bing Han
- The First Clinical Medical School, Lanzhou University, Lanzhou, China
- Heart Center, The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Cardiovascular Disease of Gansu Province, Lanzhou, China
- Cardiovascular Clinical Research Center of Gansu Province, China
| | - Tingting Wu
- The First Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Jing Xie
- Department of Ultrasound Medicine, Lanzhou First People's Hospital, Lanzhou, China
| | - Qi Zhang
- Department of Geriatrics, Gansu Provincial People's Hospital, Lanzhou, China
| | - Dingxiong Xie
- Gansu Provincial Institute of Cardiovascular Diseases, Lanzhou, China
- The Second Clinical Medical School, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Zheng Zhang
- The First Clinical Medical School, Lanzhou University, Lanzhou, China
- Heart Center, The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Cardiovascular Disease of Gansu Province, Lanzhou, China
- Cardiovascular Clinical Research Center of Gansu Province, China
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Beleva N. Change in hospital admissions in dental diseases before and during the COVID-19 pandemic. Appl Nanosci 2023; 13:2179-2185. [PMID: 35155059 PMCID: PMC8820364 DOI: 10.1007/s13204-021-02106-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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022]
Abstract
In this retrospective cross-sectional study, it was aimed to evaluate the negative effects of the pandemic process in the field of oral health by revealing the characteristics of applications made to a hospital related to oral health before and during the pandemic. Patient records who applied to Cyprus Science University Dentistry Hospital between October 2019 and March 2021 were included in the study. Gender, age, applied unit, applying frequency and procedure records were evaluated. Ethical approval was taken from Cyprus Science University. Patient records were divided into two groups as before pandemic (n = 338) and during pandemic (n = 1517). Results of the study showed that gender, age and applied unit distributions were not significantly different between before and during pandemic (p > 0.05). Female and prosthesis applied patients were more common before and after COVID-19 pandemic. Detertrage, tooth extraction, night plaque, temporary cron, metal supported porcelain crown on implant, compomer filler and orthodontic diagnosis rates were decreased during pandemic, compared to before pandemic. Panaromic X-ray was the most common process before and during the pandemic. The differences between before and during pandemic were statistically significant (p < 0.05). The results of the research show that the pandemic process in terms of oral health caused significant differences in the reasons for application, even in the population aged 34-36, the majority of whom are women.
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Affiliation(s)
- Nadejda Beleva
- Health and Social Sciences, University of Cyprus, Nicosia, Cyprus
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Palungwachira P, Montimanutt G, Musikatavorn K, Savatmongkorngul S. Reducing 48-h emergency department revisits and subsequent admissions: a retrospective study of increased emergency medicine resident floor coverage. Int J Emerg Med 2022; 15:66. [PMID: 36474146 PMCID: PMC9724369 DOI: 10.1186/s12245-022-00471-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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Early unexpected hospital admission after emergency department (ED) discharge is an important topic regarding effective preventive measures. Reducing avoidable return visits can improve ED effectiveness and emergency care. This study evaluated the effects of an increase in the number of physicians and the 24-h coverage of emergency physicians on 48-h ED revisits with subsequent hospital admission. The characteristics and risk factors of the patients were also investigated. RESULTS This was a retrospective analysis performed 2 years before and 2 years after the implementation of an intervention in a tertiary care hospital in Thailand. The medical records of adult patients who revisited the ED within 48 h for related complaints were reviewed. The effect of the intervention was analyzed, and a prediction model was developed based on logistic regression. After implementing the intervention, the hospital admission rate at the second ED visit decreased from 44.5 to 41.1%; no significant difference was found (95% confidence interval (CI) - 5.05 to 11.78). Patients who required hospital admission had a significantly higher comorbidity score, more ED visits, and more hospitalizations within the past 12 months. A significantly higher hospital admission rate was also observed among patients older than 60 years, those who had an initial infectious diagnosis, and those who had a higher triage severity level (ESI II) at their first visit. The odds ratio (OR) showed lower odds of hospital admission at the second visit in the postintervention period; this difference was not significant (OR 0.87; 95% CI 0.61 to 1.23). CONCLUSION Our intervention did not significantly decrease the incidence of admission at an ED revisit. However, some factors identified in this study seem to have some benefits and might be helpful for preventing errors and constructing a standard discharge care plan for patients with these risk factors.
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Affiliation(s)
- Pakhawadee Palungwachira
- grid.419934.20000 0001 1018 2627Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Gunnaree Montimanutt
- grid.419934.20000 0001 1018 2627Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Khrongwong Musikatavorn
- grid.419934.20000 0001 1018 2627Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Sorravit Savatmongkorngul
- grid.10223.320000 0004 1937 0490Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
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Hasegawa K, Tsukahara T, Nomiyama T. Short-term associations of ambient air pollution with hospital admissions for ischemic stroke in 97 Japanese cities. Environ Sci Pollut Res Int 2022; 29:78821-78831. [PMID: 35701697 DOI: 10.1007/s11356-022-21206-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/05/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
The short-term association between ambient air pollution and hospital admissions for ischemic stroke is not fully understood. We examined the association between four regularly measured major ambient air pollutants, i.e., sulfur dioxide (SO2), nitrogen dioxide (NO2), photochemical oxidants (Ox), and particulate matter with aerodynamic diameters ≤ 2.5 μm (PM2.5), and hospital admissions for ischemic stroke by analyzing 3 years of nationwide claims data from 97 cities in Japan. We first estimated city-specific results by using generalized additive models with a quasi-Poisson regression, and we obtained the national average by combining city-specific results with the use of random-effect models. We identified a total of 335,248 hospital admissions for ischemic stroke during the 3-year period. Our analysis results demonstrated that interquartile range increases in the following four ambient air pollutants were significantly associated with hospital admissions for ischemic stroke on the same day: SO2 (1.05 ppb), 1.05% (95% CI: 0.59-1.50%); NO2 (6.40 ppb), 1.10% (95% CI: 0.61-1.59%); Ox (18.32 ppb), 1.43% (95% CI: 0.81-2.06%); and PM2.5 (7.86 μg/m3), 0.90% (95% CI: 0.35-1.45%). When the data were stratified by the hospital admittees' medication use, we observed stronger associations with SO2, NO2, and PM2.5 among the patients who were taking antihypertensive drugs and weaker associations with SO2, NO2, and Ox among those taking antiplatelet drugs. Short-term exposure to ambient air pollution was associated with increased hospital admissions for ischemic stroke, and medication use and season may modify the association.
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Affiliation(s)
- Kohei Hasegawa
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Teruomi Tsukahara
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- Department of Occupational Medicine, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tetsuo Nomiyama
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- Department of Occupational Medicine, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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