Prevention and Treatment of Influenza in High‐Risk Groups: Children, Pregnant Women, Immunocompromised Hosts, and Nursing Home Residents

Abstract Background/Objectives Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents. Subjects/Methods NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m2) < 20 at FU) was analyzed in univariate generalized estimated equation (GEE) models. Significant (p < 0.1) variables were selected for multivariate GEE-analyses. Effect estimates are presented as odds ratios and their respective 99.5%-confidence intervals. Results Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56–4.98]), a quarter (2.15 [1.56–2.97]) or half of the meal eaten (1.72 [1.40–2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0–23.0) (1.86 [1.44–2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65–74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00–1.62]) (vs. mobile) predicted incident MN in the final model. Conclusion 10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.

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Precision shielding for COVID-19: metrics of assessment and feasibility of deployment

BMJ Global Health ◽

10.1136/bmjgh-2020-004614 ◽

2021 ◽

Vol 6 (1) ◽

pp. e004614

Author(s):

John P A Ioannidis

Keyword(s):

Nursing Home ◽

High Risk ◽

Risk Group ◽

Real Life ◽

Nursing Home Residents ◽

Group Versus ◽

Risk Groups ◽

Low Risk ◽

Home Setting ◽

Risk Of Death

The ability to preferentially protect high-risk groups in COVID-19 is hotly debated. Here, the aim is to present simple metrics of such precision shielding of people at high risk of death after infection by SARS-CoV-2; demonstrate how they can estimated; and examine whether precision shielding was successfully achieved in the first COVID-19 wave. The shielding ratio, S, is defined as the ratio of prevalence of infection among people in a high-risk group versus among people in a low-risk group. The contrasted risk groups examined here are according to age (≥70 vs <70 years), and institutionalised (nursing home) setting. For age-related precision shielding, data were used from large seroprevalence studies with separate prevalence data for elderly versus non-elderly and with at least 1000 assessed people≥70 years old. For setting-related precision shielding, data were analysed from 10 countries where information was available on numbers of nursing home residents, proportion of nursing home residents among COVID-19 deaths and overall population infection fatality rate (IFR). Across 17 seroprevalence studies, the shielding ratio S for elderly versus non-elderly varied between 0.4 (substantial shielding) and 1.6 (substantial inverse protection, that is, low-risk people being protected more than high-risk people). Five studies in the USA all yielded S=0.4–0.8, consistent with some shielding being achieved, while two studies in China yielded S=1.5–1.6, consistent with inverse protection. Assuming 25% IFR among nursing home residents, S values for nursing home residents ranged from 0.07 to 3.1. The best shielding was seen in South Korea (S=0.07) and modest shielding was achieved in Israel, Slovenia, Germany and Denmark. No shielding was achieved in Hungary and Sweden. In Belgium (S=1.9), the UK (S=2.2) and Spain (S=3.1), nursing home residents were far more frequently infected than the rest of the population. In conclusion, the experience from the first wave of COVID-19 suggests that different locations and settings varied markedly in the extent to which they protected high-risk groups. Both effective precision shielding and detrimental inverse protection can happen in real-life circumstances. COVID-19 interventions should seek to achieve maximal precision shielding.

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Precision shielding for COVID-19: metrics of assessment and feasibility of deployment

10.1101/2020.11.01.20224147 ◽

2020 ◽

Author(s):

John P.A. Ioannidis

Keyword(s):

Nursing Home ◽

High Risk ◽

Risk Group ◽

Nursing Home Residents ◽

Group Versus ◽

Risk Groups ◽

Low Risk ◽

Fatality Rate ◽

Home Setting ◽

Risk Of Death

ABSTRACTBackgroundThe ability to preferentially protect high-groups in COVID-19 is hotly debated. Here, the aim is to present simple metrics of such precision shielding of people at high-risk of death after infection by SARS-CoV-2; demonstrate how they can estimated; and examine whether precision shielding was successfully achieved in the first COVID-19 wave.MethodsThe shielding ratio, S, is defined as the ratio of prevalence of infection among people at a high-risk group versus among people in a low-risk group. The contrasted risk groups examined here are according to age (>=70 versus <70 years), and institutionalized (nursing home) setting. For age-related precision shielding, data were used from large seroprevalence studies with separate prevalence data for elderly versus non-elderly and with at least 1000 assessed people >=70 years old. For setting-related precision shielding, data were analyzed from 10 countries where information was available on numbers of nursing home residents, proportion of nursing home residents among COVID-19 deaths, and overall population infection fatality rate.FindingsAcross 17 seroprevalence studies, the shielding ratio S for elderly versus non-elderly varied between 0.4 (substantial shielding) and 1.6 (substantial inverse protection, i.e. low-risk people being protected more than high-risk people). Five studies in USA all yielded S=0.4-0.8, consistent with some shielding being achieved, while two studies in China yielded S=1.5-1.6, consistent with inverse protection. Assuming 25% infection fatality rate among nursing home residents, S values for nursing home residents ranged from 0.07 to 3.1. The best shielding was seen in South Korea (S=0.07) and modest shielding was achieved in Israel, Slovenia, Germany, and Denmark. No shielding was achieved in Hungary and Sweden. In Belgium (S=1.9), UK (S=2.2) and Spain (S=3.1), nursing home residents were far more frequently infected that the rest of the population.InterpretationThe experience from the first wave of COVID-19 suggests that different locations and settings varied markedly in the extent to which they protected high-risk groups. Both effective precision shielding and detrimental inverse protection can happen in real-life circumstances. COVID-19 interventions should seek to achieve maximal precision shielding.

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Are nursing-home residents at high risk of warfarin-related complications?

Nature Clinical Practice Cardiovascular Medicine ◽

10.1038/ncpcardio1092 ◽

2007 ◽

Vol 5 (3) ◽

pp. 126-127 ◽

Cited By ~ 1

Author(s):

Rebecca J Beyth

Keyword(s):

Nursing Home ◽

High Risk ◽

Nursing Home Residents

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1035-P: HbA1c Does Not Identify Nursing Home Residents at High Risk of Hypoglycemia and Hyperglycemia

Diabetes ◽

10.2337/db21-1035-p ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 1035-P

Author(s):

ALEXANDRA K. LEE ◽

SEI J. LEE ◽

BOCHENG JING ◽

MEDHA MUNSHI ◽

ANDREW J. KARTER

Keyword(s):

Nursing Home ◽

High Risk ◽

Nursing Home Residents

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Prevention and treatment of vitamin D deficiency in Dutch psychogeriatric nursing home residents by weekly half-body UVB exposure after showering: a pilot study

Age and Ageing ◽

10.1093/ageing/afq159 ◽

2010 ◽

Vol 40 (2) ◽

pp. 211-214 ◽

Cited By ~ 19

Author(s):

V. G. M. Chel ◽

M. E. Ooms ◽

S. Pavel ◽

F. de Gruijl ◽

A. Brand ◽

...

Keyword(s):

Vitamin D ◽

Nursing Home ◽

Pilot Study ◽

Vitamin D Deficiency ◽

Nursing Home Residents ◽

Prevention And Treatment ◽

Uvb Exposure

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Hospitalization for Pneumonia Carries High Risk of Severe Disability and Death for Nursing Home Residents

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2020.01.086 ◽

2020 ◽

Vol 21 (3) ◽

pp. B31

Author(s):

Matthew Griffith ◽

Cari Levy ◽

Toral Parikh ◽

Pedro Gozalo ◽

...

Keyword(s):

Nursing Home ◽

High Risk ◽

Nursing Home Residents ◽

Severe Disability

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Screening for atrial fibrillation in high-risk nursing home residents

Heart Rhythm O2 ◽

10.1016/j.hroo.2020.02.003 ◽

2020 ◽

Vol 1 (1) ◽

pp. 10-13

Author(s):

Hassan A. Khan ◽

Nader Hanna ◽

Michael J. Chaskes ◽

Gregory D. Gudleski ◽

Piotr Karmilowicz ◽

...

Keyword(s):

Atrial Fibrillation ◽

Nursing Home ◽

High Risk ◽

Nursing Home Residents

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Comparação da Aplicação da EER Hema-Obs a 250 Gestações da Consulta de Hematologia-Obstetrícia do Centro Hospitalar São João, Portugal Versus EER Galit Sarig a 90 Gestações no Rambam Health Care Campus, Israel

Acta Médica Portuguesa ◽

10.20344/amp.5200 ◽

2015 ◽

Vol 28 (2) ◽

pp. 189

Author(s):

Ana Salselas ◽

Inês Pestana ◽

Francisco Bischoff ◽

Mariana Guimarães ◽

Joaquim Aguiar Andrade

Keyword(s):

High Risk ◽

Risk Stratification ◽

Pregnant Women ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Characteristic Curve ◽

Risk Groups ◽

Low Risk ◽

Very High ◽

Receiver Operating

Introduction: Pregnant women with thromboembolic diseases, previous thrombotic episodes or thrombophilia family history were supervised in a multidisciplinary Obstetrics/ Hematology consultation in Centro Hospitalar São João EPE, Porto, Portugal. For the evaluation and medication of these women, a risk stratification scale was used. Purposes: The aim of this study was to validate a Risk Stratification Scale and thromboprophylaxis protocol by means of comparing it with a similar scale, developed and published by Sarig. Material and Methods: We have compared: The distribution, by risk groups, obtained through the application of the two scales on pregnant women followed at Centro Hospitalar São João, Porto, Portugal, consultation; the sensibility and specificity for each one of the scales (DeLong scale, applied to Receiver Operating Characteristic) curves; the outcomes in pregnancies followed in Hospital São João, Porto, Portugal Results: According to our Hema-Obs risk stratification scale, 29% were allocated to low-risk, 47% to high-risk and 24% to very-high-risk groups. According to Galit Sarig risk stratification scale, 24% were considered low-risk, 53% moderate, 16% high-risk and 7% as very high-risk group. In our study we observed 9% of spontaneous abortions, in comparison with 18% in the Galit Sarig cohort. From the application of Receiver Operating Characteristic curve to both risk stratification scales, the results of the calculated areas were 58,8% to our Hema-Obs risk stratification scale and 38,7% to Galit Sarig risk stratification scale, with a Delong test significancie of p = 0.0006. Conclusions: We concluded that Hema-Obs risk stratification scale is an effective support for clinical monitoring of therapeutic strategies.

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