scholarly journals 827. Does Patient Location (Rural or Urban) influence risk factors and incidence rate for 30-day readmission after gram positive pneumonia?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S455-S455
Author(s):  
Anthony Kunnumpurath ◽  
Neal Mehta ◽  
Shoaib Khan ◽  
Gilbert-roy Kamoga
Keyword(s):  
Risk Factors ◽  
Incidence Rate ◽  
Healthcare Research ◽  
Index Admission ◽  
Multivariable Logistic Regression Model ◽  
Gram Positive ◽  
Urban Location ◽  
Rural Location ◽  
Rural And Urban ◽  
Significant Difference

Abstract Background In the US, pneumonia is the most common cause of a hospital admission. Prior analysis has shown that nearly one in six patients will have an all-cause 30-day readmission. Given the disparities in access to healthcare between rural and urban settings, we sought to see if patient location influenced the incidence rate for 30-day readmission after treatment for Gram Positive Pneumonia. Methods We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2014 Nationwide Readmission Database to identify index admissions with a principal diagnosis of Gram Positive Pneumonia (ICD-9 codes 482.3, 482.31, 482.32, and 482.39 for streptococcus and 482.40, 482.41, 482.42, and 482.49 for staphylococcus). The 2013 NCHS Urban-Rural Classification System was used to classify if originating from an urban or rural location. Applicable admissions were all adults (age >= 18) from January 1 to November 30, 2014. Patients who died during index admission and those with missing covariates were excluded. All-cause readmissions within 30-days of an index admission were analyzed. Predictors for readmission were determined using a multivariable logistic regression model. Results A total of 8,130 patients met criteria for inclusion of which 1,631 (20.06%) were readmitted (all-cause) within 30-days. There was no statistically significant difference in readmission between patients from a rural (18.7%) or urban (20.4%) location. The statistically significant predictors for readmission for patients from a rural location were those admitted on a weekend (OR: 1.41, CI: 1.04-1.90), discharged to short term hospital (OR: 2.70, CI: 1.18-6.19) or AMA (OR: 6.53, CI: 1.46-29.10), and those with a LOS between 7 and 14 days (OR: 1.48, CI: 1.10-2.00). For patients from an urban location, statistically significant predictors were those admitted on a weekend (OR: 1.17, CI 1.02-1.34), discharged AMA (OR: 2.89, CI: 1.74-4.78), LOS between 7 and 14 days (OR: 1.19, CI: 1.03-1.37) and those with CKD (OR: 1.20, CI: 1.03-1.39). Conclusion The risk factors for readmission after Gram Positive Pneumonia for patients from a rural and urban location are similar. More research is needed to develop interventions for those who are at risk for readmission after Pneumonia to reduce future morbidity and mortality. Disclosures All Authors: No reported disclosures

scholarly journals Knowledge of Pulmonary Tuberculosis among Urban Slum and Rural Population of West Tripura District - A Comparative Study

2021 ◽  
Vol 8 (12) ◽  
pp. 715-721
Author(s):  
Taranga Reang ◽  
Amar Tripura
Keyword(s):  
Risk Factors ◽  
Pulmonary Tuberculosis ◽  
Rural Population ◽  
Urban Slum ◽  
Family Type ◽  
Good Knowledge ◽  
Common Symptom ◽  
Rural And Urban ◽  
Significant Difference ◽  
Slum Population

BACKGROUND Globally, tuberculosis (TB) is one of the top 10 causes of death due to infectious diseases. TB continues to rank among world’s most serious health problems despite effective diagnostic & treatment measures. The objectives of the study were to asses and compare the knowledge of tuberculosis among rural and urban slum population and identify the factors associated with their knowledge of tuberculosis. METHODS A cross sectional study was conducted and multistage random sampling technique was applied for selection of the individual study subjects. Data was collected using a semi-structured and pre-tested interview schedule. RESULTS 200 individuals were included in the study with an overall mean age (SD) of the individuals of 36.66 (± 13.091) years. 189 (94.5) participants had heard of tuberculosis. 36 (37.9 %) urban slum and 20 (21.3 %) rural participants said that cough is the most common symptom of pulmonary tuberculosis. 42 (52.5 % among rural population was having good knowledge (rural vs. urban; 52.5 % vs. 47.5 %) compared to urban slum population. Literacy (P = 0.049) and family type (P = 0.044) have played a significant role in acquiring good knowledge of tuberculosis among the participants irrespective of their place of residence. CONCLUSIONS There was no significant difference in the knowledge of TB among rural and urban slum population. Literate persons were more aware compared to illiterate population irrespective of their place of living. In spite of having good awareness regarding TB, in general the knowledge level on risk factors was not satisfactory and needs further improvement. Therefore, a special drive has to be started for imparting knowledge to the community regarding risk factors as this could prevent further occurrence or progress of TB. KEYWORDS Tuberculosis, Knowledge of TB, Urban Rural Difference

Tuberculosis in biologic users for rheumatic diseases: results from the South African Biologics Registry (SABIO)

2019 ◽  
Vol 79 (2) ◽  
pp. 292-299 ◽  
Author(s):  
Clive Pettipher ◽  
Romela Benitha
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Incidence Rate ◽  
South African ◽  
Rheumatic Diseases ◽  
Significant Risk ◽  
Tnf Inhibitors ◽  
Western Cape ◽  
The South ◽  
Significant Difference

ObjectivesTo evaluate the rate of tuberculosis (TB) in biologic users for rheumatic diseases in South Africa, the effectiveness of our latent TB infection (LTBI) programme, risk factors and outcome.MethodsTB cases were collected from the South African Biologics Registry (SABIO), rheumatologists and pharmaceutical companies. Demographics, LTBI screening and treatment, biological and disease modifying antirheumatic drug (DMARD) therapies, TB diagnosis and outcomes were recorded.Results96 TB cases were collected from 1999 to June 2017: rheumatoid arthritis 55, ankylosing spondylitis 27, psoriatic arthritis 4, and juvenile inflammatory arthritis 10. The TB rate was 1240/100 000 person years for biologic users (n=96) versus the biologic naive cohort of 0/100 000 years with an incidence rate difference of 0.0124 (p<0.0001). 60/96 had pulmonary and 36/96 had extra-pulmonary TB. Reactivation TB occurred in 45/96 cases. TB occurred in all biologics licenced in South Africa, the majority in monoclonal inhibitors (1683/100 000 person years) compared with etanercept (861/100 000 person years) and non-tumour necrosis factor (TNF) inhibitors (681/100 000 person years). The incidence rate ratio for monoclonal inhibitors compared with etanercept was 1.96 (p=0.005) and 2.47 (p=0.002) compared with non-TNF inhibitors with no significant difference between non-TNF inhibitors and etanercept (p=0.336). From those (12.9%) who screened LTBI positive, 14 developed TB, while the majority (77) screened LTBI negative. Black race, male sex, younger age and residence in the Western Cape were statistical risk factors. Two drug resistant TB cases and six deaths occurred.ConclusionReactivation and new onset TB is a significant risk for all biologics users in SA. Screening for LTBI is an imperative preventative strategy.

scholarly journals SUN-615 Does Patient Location (Urban or Rural) Influence Risk Factors and Incidence Rate for 30-Day Readmission for Diabetic Ketoacidosis?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ron Thomas Varghese ◽  
Diana G Jacob ◽  
Khaled Khasawneh ◽  
Roy Kamoga ◽  
Neal Mehta
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Diabetic Ketoacidosis ◽  
Readmission Rate ◽  
Healthcare Research ◽  
Index Admission ◽  
Principal Diagnosis ◽  
Patient Centered ◽  
Specific Patient ◽  
Rural Patients

Abstract Introduction Nearly 1 in 10 individuals in the US have Diabetes Mellitus [1]. One potential preventable complication is Diabetic Ketoacidosis (DKA). Urban and rural patients may have different mortality [2]. Better understanding of the risk factors for readmissions of DKA will allow the development and implementation of specific patient-centered interventions to decrease future readmissions. We determined the 30-day all-cause readmission rate for adults (age &gt;= 18) admitted with a principal diagnosis of DKA and compare the risk factors for urban and rural patients. Methods We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2014 Nationwide Readmission Database to identify admissions with a principal diagnosis of DKA related ICD-9 diagnosis (250.10, 250.11, 250.12, and 250.13) associated with both Type 1 and Type 2 Diabetes Mellitus. Applicable admissions were all adults (age &gt;= 18) with an index hospitalization between January 1 to November 30, 2014. Patients who died during index admission and those with missing covariates were excluded. The 2013 NCHS Urban-Rural Classification System was used to classify if originating from an urban or rural location. All-cause readmission within 30-days of DKA were analyzed. Predictors for readmission were determined using logistic regression model. Results A total of 65,249 patients met criteria for inclusion. Of which, there was 12,561 readmissions (19.25 %) within 30-days of the index admission. Patients originating from urban locations had a readmission rate of 19.36% compared to 18.56 % for patients from rural locations (p=0.07). Multivariate analysis showed patients from either rural or urban location each had a higher likelihood of readmission if their disposition was home health or AMA, younger age (&lt;65), female, Medicare as payer, LOS 7-14 days, absence of obesity, and presence of renal failure. In addition, disposition to short term hospital increased the odds for readmission from rural patients. Conclusion Almost 1 in 5 patients discharged with a principal diagnosis of DKA will be readmitted within 30 days. No difference was noted in rates of readmissions for patients originating from urban or rural locations. Risk factors are similar with further research needed to better understand the drivers of readmission. References: [1] CDC: National Diabetes Statistics Report (2017) [2] Ferdinand AO, et al. (2017). Diabetes-Related Hospital Mortality in Rural America: A Significant Cause for Concern. Policy Brief #3. Southwest Rural Health Research Center

Serum Retinol and β-carotene Levels and Risk Factors for Cardiovascular Disease in Morbid Obesity

2010 ◽  
Vol 80 (3) ◽  
pp. 159-167 ◽  
Author(s):  
Gabriela Villaça Chaves ◽  
Gisele Gonçalves de Souza ◽  
Andréa Cardoso de Matos ◽  
Dra. Wilza Abrantes Peres ◽  
Silvia Elaine Pereira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Morbid Obesity ◽  
Serum Levels ◽  
World Health ◽  
Morbidly Obese ◽  
Serum Retinol ◽  
Significant Difference ◽  
Β Carotene

Objective: To evaluate retinol and β-carotene serum levels and their relationship with risk factors for cardiovascular disease in individuals with morbid obesity, resident in Rio de Janeiro. Methodology: Blood serum concentrations of retinol and β-carotene of 189 morbidly obese individuals were assessed. The metabolic syndrome was identified according to the criteria of the National Cholesterol Education Program (NCEP) and World Health Organization (WHO). Lipid profile, insulin resistance, basal insulin, glycemia, blood pressure, and anthropometry and their correlation with retinol and β-carotene serum levels were evaluated. Results: Metabolic syndrome diagnosis was observed in 49.0% of the sample. Within this percentage the levels of β-carotene were significantly lower when body mass index increased. Serum retinol didn't show this behavior. Serum retinol inadequacy in patients with metabolic syndrome (61.3%), according to WHO criterion, was higher (15.8%) than when the whole sample was considered (12.7%). When metabolic syndrome was diagnosed by NCEP criterion, β-carotene inadequacy was higher (42.8%) when compared to the total sample (37.5%). There was a significant difference between average β-carotene values of patients with and without metabolic syndrome (p=0.048) according to the classification of the NCEP. Lower values were found in patients with metabolic syndrome. Conclusion: Considering the vitamin A contribution in antioxidant protection, especially when risk factors for cardiovascular disease are present, it is suggested that great attention be given to morbidly obese. This could aid in prevention and treatment of cardiovascular disease, which affects a significant part of the population.

The interaction between dietary approaches to stop hypertension and MC4R gene variant in predicting cardiovascular risk factors

2020 ◽  
pp. 1-9
Author(s):  
Habib Yarizadeh ◽  
Alireza Bahiraee ◽  
Sara Asadi ◽  
Niloofar Sadat Maddahi ◽  
Leila Setayesh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Model Assessment ◽  
Iranian Women ◽  
Cvd Risk ◽  
Dash Diet ◽  
Melanocortin 4 Receptor Gene ◽  
Significant Difference ◽  
High Adherence

Abstract. Objective: The genetic variants near the melanocortin-4 receptor gene (MC4R), a key protein regulating energy balance and adiposity, have been related to obesity and cardiovascular risk factors. However, qualitative and quantitative aspects of diet may modulate the association of this polymorphism with obesity and cardiovascular diseases (CVDs). The aim of this study was to evaluate interactions among MC4R rs17782313, the Dietary Approaches to Stop Hypertension (DASH) diet and risk factors for CVDs. Method: This cross-sectional study was conducted on 266 Iranian women categorized by body mass index (BMI) range of 25–40 kg/m2 as overweight or obese. CVD risk factors included waist circumference (WC), lipid profile, blood pressure, insulin circulation and fasting blood sugar (FBS). Insulin and FBS were used to calculate homeostatic model assessment insulin resistance (HOMA-IR) Body composition was assessed by a multi-frequency bioelectrical impedance analyzer, InBody 770 scanner. Results: The findings of this study show that high adherence to the DASH diet in the CC groups were associated with decreased SBP and DBP compared to the TT group. In addition, a significant difference between women with high adherence to the DASH diet compared to low adherence was observed for body weight (p < 0.001), fat free mass (FFM) (p = 0.01) and BMI (p = 0.02). Women with the CC genotype had higher insulin (mg/dl) (mean and SD, for TT: 14.6 ± 4.6, TC: 17.3 ± 9.2, CC: 15.3 ± 4.8, p = 0.04) and HOMA-IR (mean for and SD, TT: 3.1 ± 1.07, TC: 3.9 ± 2.4, CC: 3.2 ± 1.1, p = 0.01) than TT group. Inclusion of potential confounding variables (age, physical activity, BMI and daily caloric intake) did not attenuate the difference. Conclusion: Among overweight/obese Iranian women with the CC genotype, incorporating the DASH diet may serve as a dietary prescription to decrease CVD risk. A dietary intervention trial is warranted.

Risk Factors in Diabetes and Pregnant Women with Urinary Tract Infections Compared to Younger Aged Female.

2018 ◽  
Vol 1 (3) ◽  
pp. 26-38
Author(s):  
Abdulghani Mohamed Alsamarai ◽  
Shler Ali Khorshed
Keyword(s):  
Risk Factors ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Pregnant Women ◽  
Female Student ◽  
Mean Value ◽  
Infected Female ◽  
Significant Difference ◽  
Tract Infections

Background: Urinary tract infection is common with health impact in women and characterised by failure to treatment and recurrent episodes. Aim: This study was conducted to determine the risk factors for the development of urinary tract infection in diabetic and pregnant women in comparison to student female. Materials and methods: A prospective cross-sectional study conducted during the period from 1st of June 2015 to the end of January 2016. The population included in the study are 563 women, of them 425 were outpatients, and 138 were inpatients. Their age range between 18 and 80 years, with a mean age of 33.59±15.29 years. Urine samples collected and cultured on blood agar and MacConkey agar by spread plate technique. Bacterial colonies with different morphology were selected, purified and identified according to their biochemical characteristics using conventional standard methods. Results: In diabetic women, there were no significant difference in mean age and BMI values between culture positive and culture negative groups. However, pus cell mean scale was significantly higher [P=0.000] in women with urinary tract infection [1.76±1.25] than in those with negative culture [0.69±1.00]. In pregnant women, BMI mean value was significantly [P=0.013] lower in pregnant women with UTI [26.14] as compared to those without infection [26.99]. Pus cell scale mean value was significantly [P=0.000] higher in pregnant women with UTI [1.55] than women with negative UTI [0.85]. While there was no significant difference in mean age between UTI positive and negative pregnant women. In female student, there was a significant difference between UTI infected and non-infected in mean age [P=0.041] and pus cell scale [P=0.000]. However, BMI was not significantly different between infected and non-infected female student. Other risk factors association are variables in the 3 groups when analysed using X2, while AUC and OR show different trends of association between risk factors and UTI. Conclusion: BMI, pus cell scale, child number, delivery method, operation history and hospital setting were significantly associated with culture positivity in the 3 studied groups as determined by AUC. While OR confirmed association with pus sale scale in the 3 groups.

Regional Cervical Plexus Blockage for Carotid Endarterectomy in Patients with Cardiovascular Risk Factors

2015 ◽  
Vol 18 (4) ◽  
pp. 140 ◽  
Author(s):  
Mehmet Taşar ◽  
Mehmet Kalender ◽  
Okay Güven Karaca ◽  
Ata Niyazi Ecevit ◽  
Salih Salihi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Carotid Artery Disease ◽  
Risk Groups ◽  
Cardiac Risk ◽  
Cervical Plexus ◽  
Cardiac Risk Factors ◽  
Significant Difference

Background: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. <br />Methods: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared.<br />Results: Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P &gt; .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection.<br />Conclusion: Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed. <br /><br />

Comparative study of Clinical Characteristics in Patients with Mild and Severe Reflux Esophagitis

2020 ◽  
Vol 66 (1) ◽  
pp. 19-22
Author(s):  
Melania Macarie ◽  
Simona Maria Bataga ◽  
Monica Pantea ◽  
Razvan Opaschi ◽  
Simona Mocan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sex Ratio ◽  
Hiatal Hernia ◽  
Statistical Significance ◽  
Erosive Esophagitis ◽  
Male Gender ◽  
Consecutive Series ◽  
Study Group ◽  
Entire Study ◽  
Significant Difference

AbstractObjective: This study aims to determine the correlation between risk factors and erosive esophagitis development.Methods: We conducted a retrospective observational study on a consecutive series of 19.672 patients who underwent upper gastrointestinal endoscopy between 01.01.2011-31.12.2017. A total of 3005 patients, diagnosed with erosive esophagitis, were included in the present study and stratified according to Los Angeles classification.Results: During the studied period we found 3005 patients with erosive esophagitis, sex ratio male to female was 1.3/1, the most common forms of esophagitis being grade A and B: 74.54% patients with esophagitis grade A, 14.80% patients with grade B; 5.29% patients were with grade C and 5.35% patients with esophagitis grade D. In severe esophagitis the male predominance was more prevalent (249 males, 71 female), with a sex ratio 3.50/1. The correlation of male gender with severe esophagitis was highly statistically significant (p < 0.0001, OR 2.97; 95% CI 2.25-3.91). Hiatal hernia was diagnosed in 1171 patients, the presence of large hiatal hernias, being an important predictor, with statistical significance (p < 0.0001, OR 3.41; 95% CI 2.22-5.21), for severe esophagitis development. Incidence of Helicobacter pylori infection was 11.51%, in the entire study group, with no statistical significant difference between patients with mild or severe esophagitis (12.02% vs 7.18%).Conclusion: Erosive esophagitis is a frequent disease, the most common forms being grade A and B. Male gender and the presence of hiatal hernia are the most important risk factors for erosive esophagitis development, in our study group.

Investigation of the Association Between Carotid Artery Intima-Media Thickness (IMT) and Cardiac Risk Factors in Patients with Systemic Lupus Erythematosus

2020 ◽  
Vol 16 (2) ◽  
pp. 125-133
Author(s):  
Zahra Rezaieyazdi ◽  
Sima Sedighi ◽  
Masoumeh Salari ◽  
Mohammadreza H. Fard ◽  
Mahmoud R. Azarpazhooh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Lupus Erythematosus ◽  
Serum Insulin ◽  
Venous Blood ◽  
Test Group ◽  
Control Groups ◽  
Significant Difference ◽  
The Mean ◽  
And Control

Background: The relationship between SLE and traditional risk factors for cardiovascular events was evaluated. Methods: The data regarding sixty patients with SLE and 30 healthy controls (age and sex matched) were gathered using SLEDAI forms. Venous blood (10mL) from all the participants was examined for hs-CRP, homocysteine, VCAM1, CBC, anti-DNA antibody, C3, C4, low-density lipoprotein (LDL), cholesterol, FBS and triglyceride. : The IMT of carotid arteries was determined bilaterally by ultrasound. Other measurements included insulin levels via Elisa (Linco/Millipore Corp) and the HOMA-IR index for insulin resistance. Results: The mean age (in years) in the test and control groups was 28.8±10.3 (18-52) and 33.8±9.13 (18-48), respectively. Results: The mean age (in years) in the test and control groups was 28.8±10.3 (18-52) and 33.8±9.13 (18-48), respectively. : The average IMT in the test group was directly related to serum levels of VCAM1 (p<0.001), homocysteine (p<0.001), cholesterol (p<0.009), LDL (p<0.001), TG (p<0.001), and FPG (p=0.004). The association between other risk factors, insulin resistance, carotid IMT and SLEDAI, was nonexistent. Mean insulin and insulin resistance levels in all the participants were 0.43±2.06 µU/mL and 0.09±0.44, respectively. There was no significant difference between the test and control groups regarding serum insulin and insulin resistance levels (p=0.42 and p=0.9, respectively). None of the risk factors, such as hsCRP, VCAM1, or homocysteine, were shown to be related to insulin resistance (p=0.6, p=0.6, p=0.09, respectively). Conclusion:: Our findings did not show an increase in the prevalence of atherosclerosis in patients with SLE. There was no association between IMT and insulin resistance. However, the former was associated with FPG, total cholesterol, LDL, TG, homocystein and VCAM1.

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