Improving Compliance with 24-H Urine Collections: Understanding Inadequacies in the Collection Process and Risk Factors for Poor Compliance

AbstractBackgroundOutbreaks of SARS-CoV-2 have occurred worldwide in Long Term Care Facilities (LTCFs), but the reasons why some facilities are particularly vulnerable to infection are poorly understood. We aimed to identify risk factors for SARS-CoV-2 infection and outbreaks in LTCFs.MethodsCross-sectional survey of all LTCFs providing dementia care or care to adults >65 years in England with linkage to SARS-CoV-2 test results. Exposures included: LTCF characteristics, staffing factors, and use of disease control measures. Main outcomes included risk factors for infection and outbreaks, estimated using multivariable logistic regression, and survey and test-based weighted estimates of SARS-CoV-2 prevalence.Findings5126/9081 (56%) LTCFs participated in the survey, with 160,033 residents and 248,594 staff. The weighted period prevalence of infection in residents and staff respectively was 10.5% (95% CI: 9.9-11.1%) and 3.8% (95%: 3.4-4.2%) and 2724 LTCFs (53.1%) had ≥1 infection. Odds of infection and/or outbreaks were reduced in LTCFs that paid sickness pay, cohorted staff, did not employ agency staff and had higher staff to resident ratios. Higher odds of infection and outbreaks were identified in facilities with more admissions, lower cleaning frequency, poor compliance with isolation and “for profit” status.InterpretationHalf of LTCFs had no cases suggesting they remain vulnerable to outbreaks. Reducing transmission from staff requires adequate sick pay, minimal use of temporary staff, improved staffing ratios and staff cohorting. Transmission from residents is associated with the number of admissions to the facility and poor compliance with isolation.FundingUK Government Department of Health & Social CareResearch in contextEvidence before this studyCOVID-19 outbreaks have occurred worldwide in long-term care facilities (LTCFs), which provide care to elderly and vulnerable residents, and are associated with high mortality. The reasons why LTCFs are particularly vulnerable to COVID-19 are poorly understood. Most studies of risk factors for COVID-19 to date have been limited by scale, and poor quality administrative, demographic and infection control data. We conducted a systematic search on 27 July 2020 in MEDLINE Ovid, WHO COVID-19 database and in MedRxiv to identify studies reporting risk factors for COVID-19 infection or outbreaks in LTCFs, with no date or language restrictions. We used the search terms “COVID-19”, “SARS-CoV-2”, “coronavirus” and “care home”, “nursing home”, “long term care facilit” and excluded studies that did not investigate LTCF-level risk factors. 14 studies met our inclusion criteria comprising 11 cross-sectional studies and 3 surveys. The largest cross-sectional study was conducted in 9395 specialised nursing facilities across 30 states in USA; the largest survey was conducted in 124 LTCFs in Haute-Garrone region of France. Risk of bias was high across all studies, and results could not be pooled due to heterogeneity between studies. Main risk factors for infection and/or outbreaks related to the size of the facility, lower ratios of staff to residents, urban location, higher occupancy, and the community prevalence of infection. Only one study collected data on the use of disease control measures during the pandemic, and no studies provided data on risk factors such as the use of temporary staff, or the impact of staff working across multiple locations.Added value of this studyWe conducted a national telephone survey with managers of all LTCFs in England which provided dementia care or care to residents aged > 65 years to collect data on the number of staff and residents in each facility, confirmed SARS-CoV-2 infections, characteristics of the facility e.g.size, staffing (use of temporary staff, staffing ratios, sickness pay) and disease control measures such as cohorting and isolation. We identified risk factors for infection in residents and staff, outbreaks (defined as ≥1 case per LTCF) and large outbreaks using logistic regression. We also estimated the proportion of staff and residents who had been infected with SARS-CoV-2. Responses were obtained from 5126 of out 9081 (56%) of eligible LTCFs. To our knowledge, this is the largest and most detailed survey of risk factors for SARS-CoV-2 infection and outbreaks that has been conducted in LTCFs.Implications of all the available evidenceAlmost half of LTCFs surveyed in this study did not report any cases of infection, and remain vulnerable to infection and outbreaks, highlighting the need for effective control measures. Reducing transmission from staff requires adequate sick pay, minimal use of temporary staff, improved staffing ratios and staff cohorting. Transmission from residents is associated with the number of admissions to the facility and poor compliance with control measures such as isolation.

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Prediction of Treatment Failure and Compliance in Patients with Tuberculosis

10.21203/rs.3.rs-27791/v3 ◽

2020 ◽

Author(s):

Hyeon-Kyoung Koo ◽

Jinsoo Min ◽

Hyung Woo Kim ◽

Joosun Lee ◽

Ju Sang Kim ◽

...

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Lung Disease ◽

Treatment Success ◽

Multivariable Analysis ◽

Previous History ◽

Treatment Compliance ◽

Poor Compliance ◽

Cross Sectional ◽

History Of

Abstract Background To improve treatment outcomes for tuberculosis (TB) , efforts to reduce treatment failure are necessary. The aim of our study was to describe the characteristics of subjects who had failed treatment of tuberculosis and identify the risk factors for treatment failure and poor compliance using national data. Methods A multicenter cross-sectional study was performed on tuberculosis subjects whose final outcome was reported as treatment failure during 2015-2017. The same number of subjects with treatment success during the same study period were randomly selected for comparison. Demographics, microbiological, radiographic, and clinical data were collected based on in-depth interviews by TB nurse specialists at all Public Private Mix (PPM) participating hospitals in South Korea. Results A total of 52 tuberculosis patients with treatment failure were enrolled. In a multivariable analysis, the presence of diabetes, previous history of tuberculosis, and cavity were identified as risk factors for treatment failure; and Medicaid support was a favorable factor for treatment success (area under the curve [AUC]: 0.79). Age, low body mass index (BMI), presence of diabetes, preexisting lung disease, positive sputum acid-fast bacilli (AFB) smear result, and the presence of multidrug-resistant tuberculosis ( MDR-TB) were significantly associated with presence of cavities. Younger age, lower BMI and previous history of TB were associated with poor compliance during treatment (AUC: 0.76). Conclusion To reduce treatment failure, careful evaluation of the presence of diabetes, previous TB history, underlying lung disease, cavity, results of sputum AFB smears, and socioeconomic status are needed. To enhance treatment compliance, more attention should be paid to younger patients with lower BMIs during follow-up.

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Risk Factors for Poor Compliance With Postpartum Oral Glucose Tolerance Testing in Women With Gestational Diabetes Mellitus

Obstetrics and Gynecology ◽

10.1097/01.aog.0000447106.38544.e3 ◽

2014 ◽

Vol 123 ◽

pp. 135S

Author(s):

Jennifer M.H. Amorosa ◽

Samantha Do ◽

Mouen Son ◽

Laura Gilroy ◽

Cynthia Gyamfi Bannerman

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Gestational Diabetes Mellitus ◽

Poor Compliance ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Oral Glucose Tolerance Testing ◽

Tolerance Testing

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Risk Factors for Poor Compliance with Adjuvant S-1 Chemotherapy for Gastric Cancer: A Multicenter Retrospective Study

Annals of Surgical Oncology ◽

10.1245/s10434-017-5923-2 ◽

2017 ◽

Vol 24 (9) ◽

pp. 2639-2645 ◽

Cited By ~ 13

Author(s):

Kotaro Yamashita ◽

Yukinori Kurokawa ◽

Kazuyoshi Yamamoto ◽

Masashi Hirota ◽

Ryohei Kawabata ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Retrospective Study ◽

Poor Compliance

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Risk Factors Associated with Self-Removal of Shoulder Braces After Rotator Cuff Repair

10.21203/rs.3.rs-586808/v1 ◽

2021 ◽

Author(s):

Yoo-Sun Won ◽

Jae Sung Lee ◽

Hyoung-Seok Jung ◽

Ye-Hoon Jang ◽

Chan-Woo Jung ◽

...

Keyword(s):

Risk Factors ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Arthroscopic Surgery ◽

Poor Compliance ◽

Factors Affecting ◽

Repair Site ◽

Group A ◽

Open Versus ◽

Cuff Repair

Abstract Background: Rotator cuff repair is a widely performed surgery, with the re-tear rate reportedly above 20%. To protect the repair site, patients are instructed to wear braces for 4-6 weeks, but the compliance is known to be poor. This study aimed to identify the risk factors for poor compliance and to determine whether poor compliance leads to complications such as re-tears. Additionally, we planned to determine the patients’ subjective factors for self-removal of the brace.Method: This study included 101 patients who underwent rotator cuff repair between June 2019 and August 2020. The patients could select from two types of braces, namely, the sling-type and hard-type abduction brace. They were then instructed to wear the brace for 6 weeks postoperatively. During the follow-up, ultrasonography was performed to evaluate the repair site, and a questionnaire was administered to evaluate the compliance. Result: The participants were categorized into three groups (Groups A, B, and C) according to the degree of self-removal. Compliance was found to be poor, and only 35 patients met the standard of Group A. There were no statistically significant patient factors affecting the compliance. Re-tears were noted in 4 patients. Only the surgery type (open versus arthroscopic surgery) was a statistically significant factor for re-tears. Among the subjective factors, discomfort while sleeping was the most common complaint and the most common reason for the actual removal of the brace.Conclusion: Although the risk factors for self-removal of the braces could not be identified clearly and statistically, catastrophic re-tears requiring re-operation were observed in patients with poor compliance. For better compliance, the postoperative guidelines and education of the patients should be reviewed. Furthermore, the braces need to be modified to a more comfortable design.

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Prediction of Treatment Failure and Compliance in Patients with Tuberculosis

10.21203/rs.3.rs-27791/v2 ◽

2020 ◽

Author(s):

Hyeon-Kyoung Koo ◽

Jinsoo Min ◽

Hyung Woo Kim ◽

Joosun Lee ◽

Ju Sang Kim ◽

...

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Lung Disease ◽

Treatment Success ◽

Multivariable Analysis ◽

Previous History ◽

Treatment Compliance ◽

Poor Compliance ◽

Cross Sectional ◽

History Of

Abstract Background: To improve treatment outcomes for tuberculosis (TB), efforts to reduce treatment failure are necessary. The aim of our study was to describe the characteristics of subjects who had failed treatment of tuberculosis and identify the risk factors for treatment failure and poor compliance using national data.Methods: A multicenter cross-sectional study was performed on tuberculosis subjects whose final outcome was reported as treatment failure during 2015-2017. The same number of subjects with treatment success during the same study period were randomly selected for comparison. Demographics, microbiological, radiographic, and clinical data were collected based on in-depth interviews by TB nurse specialists at all Public Private Mix (PPM) participating hospitals in South Korea. Results: A total of 52 tuberculosis patients with treatment failure were enrolled. In a multivariable analysis, the presence of diabetes, previous history of tuberculosis, and cavity were identified as risk factors for treatment failure; and Medicaid support was a favorable factor for treatment success (area under the curve [AUC]: 0.79). Age, low body mass index (BMI), presence of diabetes, preexisting lung disease, positive sputum acid-fast bacilli (AFB) smear result, and the presence of multidrug-resistant tuberculosis (MDR-TB) were significantly associated with presence of cavities. Younger age, lower BMI and previous history of TB were associated with poor compliance during treatment (AUC: 0.76). Conclusion: To reduce treatment failure, careful evaluation of the presence of diabetes, previous TB history, underlying lung disease, cavity, results of sputum AFB smears, and socioeconomic status are needed. To enhance treatment compliance, more attention should be paid to younger patients with lower BMIs during follow-up.

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Clinical Profiles and Prediction of Treatment Failure in Patients with Tuberculosis

10.21203/rs.3.rs-27791/v1 ◽

2020 ◽

Author(s):

Hyeon-Kyoung Koo ◽

Jinsoo Min ◽

Hyung Woo Kim ◽

Joosun Lee ◽

Ju Sang Kim ◽

...

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Lung Disease ◽

Treatment Success ◽

Multivariable Analysis ◽

Previous History ◽

Area Under The Curve ◽

Treatment Compliance ◽

Poor Compliance ◽

Cross Sectional

Abstract Background To improve the treatment outcomes for tuberculosis (TB) efforts to reduce treatment failure are necessary. The aim of our study was to describe the characteristics of subjects who had failed treatment of tuberculosis and identify the risk factors for treatment failure and poor compliance using national data.Methods A multicenter cross-sectional study was performed for tuberculosis subjects whose final outcome was reported as treatment failure during 2015–2017. The same number of subjects with treatment success during the same study period were randomly selected for comparison. Demographics, microbiological, radiographic, and clinical data were collected based on in-depth interviews by TB nurse specialists at all Public Private Mix (PPM) participating hospitals in South Korea.Results A total of 52 tuberculosis patients with treatment failure were enrolled. In a multivariable analysis, the presence of diabetes, previous history of tuberculosis, and cavity were identified as risk factors for treatment failure; and Medicaid support was a favorable factor for treatment success (area under the curve (AUC): 0.76). Age, diabetes, pre-existing lung disease, positive sputum acid-fast bacilli (AFB) smear result, and presence of multi-drug-resistant tuberculosis (MDR-TB) were significantly associated with presence of cavity. Younger age, and lower body mass index (BMI) were associated with poor compliance during treatment (AUC: 0.74).Conclusion To reduce treatment failure, careful evaluation for the presence of diabetes, underlying lung disease, cavity, results of sputum AFB smears, and socioeconomic status is needed. To enhance treatment compliance, more attention should be paid to younger patients with lower BMIs during follow-up.

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Bacterial infection in exacerbated COPD with changes in sputum characteristics

Epidemiology and Infection ◽

10.1017/s0950268803008872 ◽

2003 ◽

Vol 131 (1) ◽

pp. 799-804 ◽

Cited By ~ 46

Author(s):

E. MONSÓ ◽

J. GARCIA-AYMERICH ◽

N. SOLER ◽

E. FARRERO ◽

M. A. FELEZ ◽

...

Keyword(s):

Risk Factors ◽

Lung Function ◽

Bacterial Infection ◽

Pathogenic Bacteria ◽

Poor Compliance ◽

Inhalation Therapy ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Medical Visits ◽

Severe Impairment

We examined the risk factors for bacterial exacerbation, defined as the presence of pathogenic bacteria in sputum, in 90 chronic obstructive pulmonary disease (COPD) patients with an exacerbation and changes in sputum characteristics. Smoking, alcohol, lung function, body mass index, medical visits and treatments were the independent variables assessed using multivariable logistic regression modelling (OR, 95% CI). A bacterial exacerbation was diagnosed in 39 (43·3%) of 90 patients. Bacterial exacerbations were more prevalent among current smokers (OR 3·77, 95% CI 1·17–12·12), in patients with poor compliance with inhalation therapy (OR 3·25, 95% CI 1·18–8·93) and with severe lung function impairment (FEV1 OR 0·96, 95% CI 0·93-1·00). Prior use of antibiotics was a risk factor for Pseudomonas aeruginosa infection (OR 6·06, 95% CI 1·29–28·44) and influenza vaccination appeared to have a protective effect against this infection (OR 0·15, 95% CI 0·03–0·67). We conclude that severe impairment of lung function, smoking and poor compliance with therapy are risk factors for bacterial infection in COPD, and P. aeruginosa should be suspected in patients who have been treated with antibiotics and in those not vaccinated against influenza.

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Elevated level of circulatory sTLT1 induces inflammation through SYK/MEK/ERK signalling in coronary artery disease

Clinical Science ◽

10.1042/cs20190999 ◽

2019 ◽

Vol 133 (22) ◽

pp. 2283-2299

Author(s):

Apabrita Ayan Das ◽

Devasmita Chakravarty ◽

Debmalya Bhunia ◽

Surajit Ghosh ◽

Prakash C. Mandal ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Chronic Inflammation ◽

Ex Vivo ◽

Human Subjects ◽

Critical Role ◽

Atherosclerotic Cardiovascular Disease ◽

Tnf Α ◽

Artery Disease

Abstract The role of inflammation in all phases of atherosclerotic process is well established and soluble TREM-like transcript 1 (sTLT1) is reported to be associated with chronic inflammation. Yet, no information is available about the involvement of sTLT1 in atherosclerotic cardiovascular disease. Present study was undertaken to determine the pathophysiological significance of sTLT1 in atherosclerosis by employing an observational study on human subjects (n=117) followed by experiments in human macrophages and atherosclerotic apolipoprotein E (apoE)−/− mice. Plasma level of sTLT1 was found to be significantly (P<0.05) higher in clinical (2342 ± 184 pg/ml) and subclinical cases (1773 ± 118 pg/ml) than healthy controls (461 ± 57 pg/ml). Moreover, statistical analyses further indicated that sTLT1 was not only associated with common risk factors for Coronary Artery Disease (CAD) in both clinical and subclinical groups but also strongly correlated with disease severity. Ex vivo studies on macrophages showed that sTLT1 interacts with Fcɣ receptor I (FcɣRI) to activate spleen tyrosine kinase (SYK)-mediated downstream MAP kinase signalling cascade to activate nuclear factor-κ B (NF-kB). Activation of NF-kB induces secretion of tumour necrosis factor-α (TNF-α) from macrophage cells that plays pivotal role in governing the persistence of chronic inflammation. Atherosclerotic apoE−/− mice also showed high levels of sTLT1 and TNF-α in nearly occluded aortic stage indicating the contribution of sTLT1 in inflammation. Our results clearly demonstrate that sTLT1 is clinically related to the risk factors of CAD. We also showed that binding of sTLT1 with macrophage membrane receptor, FcɣR1 initiates inflammatory signals in macrophages suggesting its critical role in thrombus development and atherosclerosis.

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