scholarly journals COVID-19 Mortality In Adult Congregate Living Settings Across Five U.S. States

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 523-523
Author(s):  
David Rein ◽  
Lindsey Shapiro ◽  
Mairin Mancino ◽  
Caroline Pearson
Keyword(s):  
Assisted Living ◽  
Independent Living ◽  
Death Rate ◽  
Regression Models ◽  
County Level ◽  
Inclusion Criteria ◽  
Individual Property ◽  
Public And Private ◽  
Logistic Regression Models ◽  
Memory Care

Abstract The magnitude of COVID-19 mortality in adult congregate living settings other than nursing homes (NH) is unknown. To address this, we created an individual property level dataset for five U.S. states (Colorado, Connecticut, Florida, Georgia, and Pennsylvania) using multiple public and private sources. The data included information on each observation’s state and county, level of care (LOC), the estimated number of residents, COVID-19 deaths through December 31, 2020, and county-level cases of COVID-19 per 100,000. We restricted our sample to market grade properties with 25+ residents, for which we able to estimate resident and LOC information. We defined LOC as County, non-congregate (CN), Independent Living (IL), Assisted Living (AL), Memory Care (MC), and Nursing Home (NH). We used multilevel, multivariable logistic regression models to estimate the expected death rate for each LOC controlling for differences in reported COVID-19 infections and county and state reporting differences. We identified 3,059 properties that met our inclusion criteria (69 CN, 477 IL, 1,118 AL, 179 MC, and 1,216 NH). We estimated deaths per 1,000 persons of 4.4 (95% CI: 4.0-4.8) for CN, 4.4 (3.9-4.9) for IL, 16.2 (14.7-17.9) for AL, 50.3 (44.4-56.8) for MC, and 32.0 (29.3-34.9) for NH. The order of death rate severity was the same in each state, except MC in Georgia. Additional research is needed to evaluate whether death rate differences resulted from congregate living risks, from COVID mortality risk factors at each LOC, or a combination of factors.

scholarly journals Self-Rated Health Status Based on the Type of Health Insurance: A Socioeconomic Perspective

2021 ◽  
Vol 58 ◽  
pp. 004695802110281
Author(s):  
Minsung Sohn ◽  
Minsoo Jung ◽  
Mankyu Choi
Keyword(s):  
Socioeconomic Status ◽  
Health Insurance ◽  
Health Status ◽  
Regression Models ◽  
Private Health Insurance ◽  
Public And Private ◽  
Logistic Regression Models ◽  
Self Rated Health ◽  
Interaction Terms ◽  
Healthcare Coverage

To investigate the effects of public and private health insurance on self-rated health (SRH) status within the National Health Insurance (NHI) system based on socioeconomic status in South Korea. The data were obtained from 10 867 respondents of the Korea Health Panel (2008-2011). We used hierarchical panel logistic regression models to assess the SRH status. We also added the interaction terms of socioeconomic status and type of health insurance as moderators. Medical aid (MA) recipients were 2.10 times more likely to have a low SRH status than those who were covered only by the NHI, even though the healthcare utilization was higher. When the interaction terms were included, those not covered by the NHI and had completed elementary school or less were 16.59 times more likely to have a low SRH status than those covered by the NHI and had earned a college degree or higher. Expanding healthcare coverage to reduce the burden of non-payment and unmet use to improve the health status of MA beneficiaries should be considered. Particularly, the vulnerability of less-educated groups should be focused on.

scholarly journals Pandemic Preparedness of Care Homes Serving Older Adults in the Wake of COVID-19: An Exploratory Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 482-482
Author(s):  
Iftekhar Amin
Keyword(s):  
Older Adults ◽  
Assisted Living ◽  
Independent Living ◽  
Adult Population ◽  
Sampling Technique ◽  
The United States ◽  
Care Homes ◽  
Snowball Sampling ◽  
Predominantly Minority ◽  
Memory Care

Abstract Recent COVID-19 pandemic has disproportionately affected the older adult population worldwide. According to CDC, among older adults over 60 years the risk increases with age, with the highest risk of serious illness and death among those over 80 years. While public has been receiving messages about the risks and how to take preventive measures, it is not clear how the care homes serving older adults have been preparing. Data have been collected as part of an ongoing study from 30 independent living, assisted living, and memory care facilities across the United States. The centers were selected with a snowball sampling technique. Administrators of the centers were interviewed with a semi-structured questionnaire. It was apparent that although awareness of risks was high, preparation appears to be inadequate with little resources available at the time of the survey. Variation of preparedness based on the sociodemographic characteristics of the residents suggests that homes that serve predominantly minority and economically disadvantaged have greater likelihood of lacking preventive resources. It is critical that facilities serving older adults be prepared to ensure an effective healthcare response in the wake of novel viruses, such as COVID-19.

scholarly journals Low hemoglobin and hematoma expansion after intracerebral hemorrhage

Neurology ◽  
2019 ◽  
Vol 93 (4) ◽  
pp. e372-e380 ◽  
Author(s):  
David J. Roh ◽  
David J. Albers ◽  
Jessica Magid-Bernstein ◽  
Kevin Doyle ◽  
Eldad Hod ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Mediation Analysis ◽  
Regression Models ◽  
Hematoma Expansion ◽  
Inclusion Criteria ◽  
Logistic Regression Models ◽  
Neuroimaging Data ◽  
Poor Outcomes ◽  
Ich Score ◽  
Antithrombotic Medication

ObjectiveStudies have independently shown associations of lower hemoglobin levels with larger admission intracerebral hemorrhage (ICH) volumes and worse outcomes. We investigated whether lower admission hemoglobin levels are associated with more hematoma expansion (HE) after ICH and whether this mediates lower hemoglobin levels' association with worse outcomes.MethodsConsecutive patients enrolled between 2009 and 2016 to a single-center prospective ICH cohort study with admission hemoglobin and neuroimaging data to calculate HE (>33% or >6 mL) were evaluated. The association of admission hemoglobin levels with HE and poor clinical outcomes using modified Rankin Scale (mRS 4–6) were assessed using separate multivariable logistic regression models. Mediation analysis investigated causal associations among hemoglobin, HE, and outcome.ResultsOf 256 patients with ICH meeting inclusion criteria, 63 (25%) had HE. Lower hemoglobin levels were associated with increased odds of HE (odds ratio [OR] 0.80 per 1.0 g/dL change of hemoglobin; 95% confidence interval [CI] 0.67–0.97) after adjusting for previously identified covariates of HE (admission hematoma volume, antithrombotic medication use, symptom onset to admission CT time) and hemoglobin (age, sex). Lower hemoglobin was also associated with worse 3-month outcomes (OR 0.76 per 1.0 g/dL change of hemoglobin; 95% CI 0.62–0.94) after adjusting for ICH score. Mediation analysis revealed that associations of lower hemoglobin with poor outcomes were mediated by HE (p = 0.01).ConclusionsFurther work is required to replicate the associations of lower admission hemoglobin levels with increased odds of HE mediating worse outcomes after ICH. If confirmed, an investigation into whether hemoglobin levels can be a modifiable target of treatment to improve ICH outcomes may be warranted.

Diabetes Insipidus After Endoscopic Transsphenoidal Surgery

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 949-955 ◽  
Author(s):  
William T Burke ◽  
David J Cote ◽  
David L Penn ◽  
Sherry Iuliano ◽  
Katie McMillen ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Transsphenoidal Surgery ◽  
Regression Models ◽  
Pituitary Tumors ◽  
Inclusion Criteria ◽  
Endoscopic Transsphenoidal Surgery ◽  
Logistic Regression Models ◽  
Rathke Cleft Cyst ◽  
Underlying Pathology

Abstract BACKGROUND Diabetes insipidus (DI) is a recognized transient or permanent complication following transsphenoidal surgery (TSS) for pituitary tumors. OBJECTIVE To describe significant experience with the incidence of DI after TSS, identifying predictive characteristics and describing our diagnosis and management of postoperative DI. METHODS A retrospective analysis was performed of 700 patients who underwent endoscopic TSS for resection of pituitary adenoma (PA), Rathke cleft cyst (RCC), or craniopharyngioma. Inclusion criteria included at least 1 wk of follow-up for diagnosis of postoperative DI. Permanent DI was defined as DI symptoms and/or need for desmopressin more than 1 yr postoperatively. All patients with at least 1 yr of follow-up (n = 345) were included in analyses of permanent DI. Multivariable logistic regression models were constructed to identify predictors of transient or permanent postoperative DI. RESULTS The overall rate of any postoperative DI was 14.7% (103/700). Permanent DI developed in 4.6% (16/345). The median follow-up was 10.7 mo (range: 0.2-136.6). Compared to patients with PA, patients with RCC (odds ratio [OR] = 2.2, 95% CI: 1.2-3.9; P = .009) and craniopharyngioma (OR = 7.0, 95% CI: 2.9-16.9; P ≤ .001) were more likely to develop postoperative DI. Furthermore, patients with RCC (OR = 6.1, 95% CI: 1.8-20.6; P = .004) or craniopharyngioma (OR = 18.8, 95% CI: 4.9-72.6; P ≤ .001) were more likely to develop permanent DI compared to those with PA. CONCLUSION Although transient DI is a relatively common complication of endoscopic and microscopic TSS, permanent DI is much less frequent. The underlying pathology is an important predictor of both occurrence and permanency of postoperative DI.

scholarly journals Social Activities in Community Settings: Impact of COVID-19 and Technology Solutions

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 957-957
Author(s):  
Anne Adams ◽  
Jenay Beer ◽  
Xian Wu ◽  
Jane Komsky ◽  
Jason Zamer
Keyword(s):  
Assisted Living ◽  
Independent Living ◽  
Negative Effects ◽  
Online Questionnaire ◽  
Skilled Nursing ◽  
Black African ◽  
Highly Educated ◽  
Assistive Robots ◽  
Phone Calls ◽  
Memory Care

Abstract COVID-19 has created challenges for staff in promoting resident activity. To better understand the pandemic-related challenges that Activity Professionals are facing, we asked COVID-19 specific questions as part of a larger survey. The overall survey focused on identifying challenges and potential technology solutions (e.g., socially assistive robots) to assist Activity Professionals in their job duties. Activity Professionals (N=19) completed the online questionnaire. Respondents (aged M=48.00, SD=12.87; 95% female, 100% native English speakers, 68% White/Caucasian, 21% Black/African American) were highly educated/experienced: 68% had a Bachelor’s degree or above, and 53% had 10-35 years of experience. Respondents worked in Independent Living (68%), Assisted Living (37%), Memory Care (26%), Skilled Nursing (21%), or Personal Care (11%). All Activity Professionals reported impact by COVID-19, as follows: 1) Cancelled activities: Group activities/gatherings; hosting outside entertainment; fewer volunteers, vendors, paid sources. 2) New restrictions: Number of people in elevators, rooms; no contact with residents. 3) Unexpected new tasks: More 1:1 meetings; video conferencing; additional phone calls with residents, staff, and families; ordering groceries online. Daily duties changed significantly with less help and limited availability of technology. 4) Effect: Fewer activities and new delivery models (online, TV). Concerns about potential negative effects on residents while trying to meet the creativity challenge: “This has caused lots of “out of the box” thinking for ways to engage residents and keep things upbeat despite the challenges.” Results illustrate the breadth of challenges that staff are facing, some of which can be addressed by technology.

Ambient Assisted Living Systems: The Scope of Research and Development

2017 ◽  
Vol 3 (2) ◽  
pp. 21
Author(s):  
Ashish D Patel ◽  
Jigarkumar H. Shah
Keyword(s):  
Assisted Living ◽  
Independent Living ◽  
Intelligent Systems ◽  
New Technologies ◽  
Ambient Assisted Living ◽  
Smart Devices ◽  
Economic Changes ◽  
Aged Population ◽  
The People ◽  
Living Person

The aged population of the world is increasing by a large factor due to the availability of medical and other facilities. As the number grows rapidly, requirements of this segment of age (65+) are increasing rapidly as well as the percentage of aged persons living alone is also increasing with the same rate due to the inevitable socio-economic changes. This situation demands the solution of many problems like loneliness, chronic conditions, social interaction, transportation, day-to-day life and many more for independent living person. A large part of aged population may not be able to interact directly with new technologies. This sought some serious development towards the use of intelligent systems i.e. smart devices which helps the people with their inability to use the available as well future solutions. Ambient Assisted Living (AAL) is the answer to these problems. In this paper, issues related to AAL systems are studied. Study of challenges and limitations of this comparatively new field will help the designers to remove the barriers of AAL systems.

The impact of SPY angiography on intraoperative decision making and outcomes for post-mastectomy reconstruction

2019 ◽  
pp. 1-5
Keyword(s):  
Decision Making ◽  
Logistic Regression ◽  
Skin Necrosis ◽  
Regression Models ◽  
Multivariable Analysis ◽  
P Value ◽  
Flap Necrosis ◽  
Single Institution ◽  
Logistic Regression Models ◽  
The Impact

Objective: While the use of intraoperative laser angiography (SPY) is increasing in mastectomy patients, its impact in the operating room to change the type of reconstruction performed has not been well described. The purpose of this study is to investigate whether SPY angiography influences post-mastectomy reconstruction decisions and outcomes. Methods and materials: A retrospective analysis of mastectomy patients with reconstruction at a single institution was performed from 2015-2017.All patients underwent intraoperative SPY after mastectomy but prior to reconstruction. SPY results were defined as ‘good’, ‘questionable’, ‘bad’, or ‘had skin excised’. Complications within 60 days of surgery were compared between those whose SPY results did not change the type of reconstruction done versus those who did. Preoperative and intraoperative variables were entered into multivariable logistic regression models if significant at the univariate level. A p-value <0.05 was considered significant. Results: 267 mastectomies were identified, 42 underwent a change in the type of planned reconstruction due to intraoperative SPY results. Of the 42 breasts that underwent a change in reconstruction, 6 had a ‘good’ SPY result, 10 ‘questionable’, 25 ‘bad’, and 2 ‘had areas excised’ (p<0.01). After multivariable analysis, predictors of skin necrosis included patients with ‘questionable’ SPY results (p<0.01, OR: 8.1, 95%CI: 2.06 – 32.2) and smokers (p<0.01, OR:5.7, 95%CI: 1.5 – 21.2). Predictors of any complication included a change in reconstruction (p<0.05, OR:4.5, 95%CI: 1.4-14.9) and ‘questionable’ SPY result (p<0.01, OR: 4.4, 95%CI: 1.6-14.9). Conclusion: SPY angiography results strongly influence intraoperative surgical decisions regarding the type of reconstruction performed. Patients most at risk for flap necrosis and complication post-mastectomy are those with questionable SPY results.

Demographic factors associated with missed follow-up among solid tumor patients treated at a large multi-site academic institution

2020 ◽  
Vol 16 (32) ◽  
pp. 2635-2643
Author(s):  
Samantha L Freije ◽  
Jordan A Holmes ◽  
Saleh Rachidi ◽  
Susannah G Ellsworth ◽  
Richard C Zellars ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Odds Ratio ◽  
Regression Models ◽  
Tumor Patients ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Follow Up Care ◽  
Risk Patients ◽  
African American Race

Aim: To identify demographic predictors of patients who miss oncology follow-up, considering that missed follow-up has not been well studies in cancer patients. Methods: Patients with solid tumors diagnosed from 2007 to 2016 were analyzed (n = 16,080). Univariate and multivariable logistic regression models were constructed to examine predictors of missed follow-up. Results: Our study revealed that 21.2% of patients missed ≥1 follow-up appointment. African–American race (odds ratio [OR] 1.33; 95% CI: 1.17–1.51), Medicaid insurance (OR 1.59; 1.36–1.87), no insurance (OR 1.66; 1.32–2.10) and rural residence (OR 1.78; 1.49–2.13) were associated with missed follow-up. Conclusion: Many cancer patients miss follow-up, and inadequate follow-up may influence cancer outcomes. Further research is needed on how to address disparities in follow-up care in high-risk patients.

scholarly journals COVID-19 Preventive Behaviours in Cameroon: A Six-Month Online National Survey

2021 ◽  
Vol 18 (5) ◽  
pp. 2554
Author(s):  
Joseph Nelson Siewe Fodjo ◽  
Leonard Ngarka ◽  
Wepnyu Y. Njamnshi ◽  
Leonard N. Nfor ◽  
Michel K. Mengnjo ◽  
...  
Keyword(s):  
Regression Models ◽  
Health Personnel ◽  
Online Survey ◽  
Preventive Measures ◽  
Face Mask ◽  
Logistic Regression Models ◽  
Adherence Score ◽  
Preventive Behaviour ◽  
Predictors Of Adherence

Since March 2020, the Cameroonian government implemented nationwide measures to stall COVID-19 transmission. However, little is known about how well these unprecedented measures are being observed as the pandemic evolves. We conducted a six-month online survey to assess the preventive behaviour of Cameroonian adults during the COVID-19 outbreak. A five-point adherence score was constructed based on self-reported observance of the following preventive measures: physical distancing, face mask use, hand hygiene, not touching one’s face, and covering the mouth when coughing or sneezing. Predictors of adherence were investigated using ordinal logistic regression models. Of the 7381 responses received from all ten regions, 73.3% were from male respondents and overall mean age was 32.8 ± 10.8 years. Overall mean adherence score was 3.96 ± 1.11 on a scale of 0–5. Mean weekly adherence scores were initially high, but gradually decreased over time accompanied by increasing incidence of COVID-19 during the last study weeks. Predictors for higher adherence included higher age, receiving COVID-19 information from health personnel, and agreeing with the necessity of lockdown measures. Meanwhile, experiencing flu-like symptoms was associated with poor adherence. Continuous observance of preventive measures should be encouraged among Cameroonians in the medium- to long-term to avoid a resurgence in COVID-19 infections.

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