Prevention, Management and Risk Factors for Diarrhoeal Disease in under-Fives in Cape Town

2020 ◽  
Author(s):  
Joseph Freer ◽  
Hassan Mahomed ◽  
Anthony Westwood
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Informal Settlement ◽  
Cape Town ◽  
Diarrhoeal Disease ◽  
Severe Dehydration ◽  
Post Discharge ◽  
Hiv Exposed ◽  
Exposed Uninfected

Abstract Background In South Africa, Cape Town’s health facilities are stretched by the volume of cases of diarrhoea during the summer months, particularly with severely dehydrated children, who often require complex inpatient management. The prevalence of severe disease in children living in the settlements around Cape Town is particularly high. Methods An observational study of a systematic sample of children under 5 who presented to any primary care facility in Khayelitsha, an informal settlement of Cape Town, with diarrhoea and referred to secondary care between 1 November 2015 and 30 April 2016. We recruited participants from the sub-district office and identified risk factors associated with the index presentation, captured the triage and management of patients in primary care and investigated post-discharge follow-up. Results We recruited 87 children into the study, out of a total of 115 cases of severe dehydration. There was a significantly higher number of households in this group with no income than in Khayelitsha overall (65% vs. 47.4%; p < 0.001). In the sample, HIV-exposed, uninfected children were younger than unexposed children (median 9.44 months in exposed vs. 17.36 months in unexposed; p = 0.0015) and were more likely to be malnourished (weight-for-age Z-score; WAZ score < −2) [13 cases exposed vs. 8 cases unexposed (p = 0.04)]. Outreach staff were able to trace only 33.3% of children at home following discharge, yet 65% of children attended follow-up appointments in clinics. Conclusions This cohort of children with diarrhoeal disease complicated by severe dehydration was a particularly socially deprived group. The results demonstrating zero vertical transmission of HIV in this very socioeconomically deprived area of Cape Town are encouraging. In the HIV-exposed, uninfected group, children were younger and had a higher prevalence of malnutrition, which should be the subject of future research, especially given existing evidence for immunological differences in children exposed to HIV in utero. Locating children with severe diarrhoea post-discharge was challenging and further research is needed on the cost-effectiveness and outcomes of different follow-up approaches.

scholarly journals Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care—a cohort study

2019 ◽  
Vol 30 (3) ◽  
pp. 402-407
Author(s):  
Daphne M Stol ◽  
Monika Hollander ◽  
Ilse F Badenbroek ◽  
Mark M J Nielen ◽  
François G Schellevis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Cohort Study ◽  
High Risk ◽  
Newly Diagnosed ◽  
Additional Risk ◽  
High Risk Patients ◽  
Detection Program ◽  
Risk Patients

Abstract Background Early detection and treatment of cardiometabolic diseases (CMD) in high-risk patients is a promising preventive strategy to anticipate the increasing burden of CMD. The Dutch guideline ‘the prevention consultation’ provides a framework for stepwise CMD risk assessment and detection in primary care. The aim of this study was to assess the outcome of this program in terms of newly diagnosed CMD. Methods A cohort study among 30 934 patients, aged 45–70 years without known CMD or CMD risk factors, who were invited for the CMD detection program within 37 general practices. Patients filled out a CMD risk score (step 1), were referred for additional risk profiling in case of high risk (step 2) and received lifestyle advice and (pharmacological) treatment if indicated (step 3). During 1-year follow-up newly diagnosed CMD, prescriptions and abnormal diagnostic tests were assessed. Results Twelve thousand seven hundred and thirty-eight patients filled out the risk score of which 865, 6665 and 5208 had a low, intermediate and high CMD risk, respectively. One thousand seven hundred and fifty-five high-risk patients consulted the general practitioner, in 346 of whom a new CMD was diagnosed. In an additional 422 patients a new prescription and/or abnormal diagnostic test were found. Conclusions Implementation of the CMD detection program resulted in a new CMD diagnosis in one-fifth of high-risk patients who attended the practice for completion of their risk profile. However, the potential yield of the program could be higher given the considerable number of additional risk factors—such as elevated glucose, blood pressure and cholesterol levels—found, requiring active follow-up and presumably treatment in the future.

scholarly journals Association of Early Post-Discharge Follow-Up by a Primary Care Physician and 30-Day Rehospitalization Among Older Adults

2014 ◽  
Vol 30 (5) ◽  
pp. 565-571 ◽  
Author(s):  
Terry S. Field ◽  
Jessica Ogarek ◽  
Lawrence Garber ◽  
George Reed ◽  
Jerry H. Gurwitz
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Primary Care Physician ◽  
Care Physician ◽  
Post Discharge

scholarly journals Risk factors for new depressive episodes in primary health care: an international prospective 12-month follow-up study

2002 ◽  
Vol 32 (4) ◽  
pp. 595-607 ◽  
Author(s):  
K. BARKOW ◽  
W. MAIER ◽  
T. B. ÜSTÜN ◽  
M. GÄNSICKE ◽  
H.-U. WITTCHEN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Depressive Episode ◽  
Icd 10 ◽  
Depressive Episodes ◽  
Psychiatric Problems

Background. Studies that examined community samples have reported several risk factors for the development of depressive episodes. The few studies that have been performed on primary care samples were mostly cross-sectional. Most samples had originated from highly developed industrial countries. This is the first study that prospectively investigates the risk factors of depressive episodes in an international primary care sample.Methods. A stratified primary care sample of initially non-depressed subjects (N = 2445) from 15 centres from all over the world was examined for the presence or absence of a depressive episode (ICD-10) at the 12 month follow-up assessment. The initial measures addressed sociodemographic variables, psychological/psychiatric problems and social disability. Logistic regression analysis was carried out to determine their relationship with the development of new depressive episodes.Results. At the 12-month follow-up, 4·4% of primary care patients met ICD-10 criteria for a depressive episode. Logistic regression analysis revealed that the recognition by the general practitioner as a psychiatric case, repeated suicidal thoughts, previous depressive episodes, the number of chronic organic diseases, poor general health, and a full or subthreshold ICD-10 disorder were related to the development of new depressive episodes.Conclusions. Psychological/psychiatric problems were found to play the most important role in the prediction of depressive episodes while sociodemographic variables were of lower importance. Differences compared with other studies might be due to our prospective design and possibly also to our culturally different sample. Applied stratification procedures, which resulted in a sample at high risk of developing depression, might be a limitation of our study.

scholarly journals A high number of diseases and consultations: a warning signal for GPs when following up a multimorbid patient

2019 ◽  
Author(s):  
Paul Aujoulat ◽  
Patrice NABBE ◽  
Sophie LALANDE ◽  
Delphine LE GOFF ◽  
Jeremy DERRIENIC ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Large Scale ◽  
Cox Model ◽  
Warning Signal ◽  
Research Network ◽  
P Value ◽  
Patients At Risk ◽  
Definition Of

Abstract Background: the European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. Detecting risk factors for decompensation would be an interesting challenge for family physicians (FPs) in the management of multimorbid patients. The purpose of the survey was to assess which items belonging to the EGPRN multimorbidity definition could help to identify patients at risk of decompensation in a cohort pilot study over a 24-month follow-up among primary care outpatients. Method : 131 patients meeting the multimorbidity definition were included using two inclusion periods between 2014 and 2015. Over a 24-month follow-up, the « decompensation » or « nothing to report » status was collected. A logistic regression, following a Cox model, was then performed to identify risk factors for decompensation. Results : After 24 months of follow-up, 120 patients were analyzed. 3 clusters were identified. 44 patients, representing 36.6 % of the population, were still alive and had not been hospitalized for a period exceeding 6 days. Two variables were significantly linked to decompensation: the number of visits to the FP per year (HR 1.06, IC 95 %, 1,03-1,10, p-value <0,001) and the total number of diseases (HR 1,12, IC 95 %, 1,013-1,33, p-value = 0,039). Conclusion: FPs should be aware that a high number of consultations and a high total number of diseases are linked to severe outcomes such as death or unplanned hospitalization. A large-scale cohort in primary care seems feasible to confirm these results.

scholarly journals Prevalence and risk factors of cytomegalovirus infection among HIV-infected and HIV-exposed uninfected infants in Nigeria

2015 ◽  
Vol 9 (09) ◽  
pp. 977-987 ◽  
Author(s):  
Emmanuel Ademola Anigilaje ◽  
Joseph Othniel Dabit ◽  
Nnamdi Okechukwu Nweke ◽  
Augustine Aondohemba Agbedeh
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Immunoglobulin M ◽  
Enzyme Linked Immunosorbent Assay ◽  
Oropharyngeal Candidiasis ◽  
Regression Analyses ◽  
Cmv Infection ◽  
Young Infants ◽  
Hiv Exposed ◽  
Exposed Uninfected

Introduction: Cytomegalovirus (CMV) co-infection increases morbidity and mortality in human immunodeficiency virus (HIV) disease. There has been no study on CMV infection and its risk factors among Nigerian HIV-infected and/or HIV-exposed uninfected infants. Methodology: This was a cross-sectional cohort study at the Federal Medical Center, Makurdi, between January 2012 and March 2013. Acute CMV infection among consecutive three-month- old HIV-infected and HIV-exposed uninfected infants was determined using the enzyme-linked immunosorbent assay of the CMV immunoglobulin M (IgM). The relationship between acute CMV infections in the infants and the potential risk factors was tested using logistic regression analyses. Results: The prevalence of acute CMV infection was 41.4% (91/220), including 12.1% (11/91) and 87.9% (80/91) among the HIV-infected and the HIV-exposed uninfected infants, respectively. In multivariate logistic regression analyses, oropharyngeal candidiasis in the infants, HIV co-infection in the infants, maternal mastitis during breastfeeding, and the absence of maternal chronic CMV infections significantly increased the risk of acute CMV in the young infants. Conclusions: In our setting, concerted efforts to prevent and/or promptly treat oropharyngeal candidiasis and mastitis during breastfeeding may reduce the burden of CMV among HIV-infected and HIV-exposed uninfected infants. Public enlightenment on the mode of CMV transmission and its prevention is also important.

scholarly journals High prevalence of cardiovascular risk factors and insulin resistance 6 years after hyperglycemia first detected in pregnancy in Cape Town, South Africa

2019 ◽  
Vol 7 (1) ◽  
pp. e000740
Author(s):  
Tawanda Chivese ◽  
Shane A Norris ◽  
Naomi S Levitt
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Cape Town ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Index Pregnancy ◽  
High Prevalence ◽  
In Pregnancy

ObjectiveTo investigate the prevalence and associated cardiovascular risk factors 6 years after hyperglycemia first detected in pregnancy (HFDP) in Cape Town, South Africa.Research design and methodsData were collected during the index pregnancy from all women diagnosed with HFDP at a major referral hospital in Cape Town. Participants were evaluated 6 years later using a cross-sectional study. At follow-up participants had a 75 g oral glucose tolerance test, fasting lipogram, blood pressure and anthropometric measurements, and a fieldworker administered the questionnaire. We used the Adult Treatment Panel III criteria for the diagnosis of metabolic syndrome and individual risk factors. Insulin resistance was assessed using the homeostatic model of insulin resistance.ResultsAt follow-up 220 women were reviewed. Their mean age at follow-up was 37.2 (SD 6.0) years. The prevalence of cardiovascular disease (CVD) risk factors was 60.9% (95% CI 54.3 to 67.2) for metabolic syndrome, 75% (95% CI 65.9 to 82.3) for insulin resistance, 62.3% (95% CI 55.6 to 68.5) for dysglycemia, 41.4% (95% CI 35.0 to 48.0) for raised blood pressure, and 74.6% (95% CI 683 to 79.9) for dyslipidemia. Women with diabetes in pregnancy compared with those with gestational diabetes during the index pregnancy had a higher prevalence of metabolic syndrome (74.3% vs 54.7%, p=0.010) and dysglycemia (88.6% vs 50.0%, p<0.001) at follow-up. Lower school education attainment, having a subsequent pregnancy, waist circumference at follow-up, and fasting blood glucose at HFDP diagnosis were associated with metabolic syndrome.ConclusionWe found a high prevalence of CVD risk factors in South African women within 6 years of HFDP, which highlights the need to develop and evaluate interventions optimizing the cardiometabolic health of this vulnerable group. The main limitations of our research are the lack of a comparative group of women without HFDP and that we did not assess for CVD risk factors before HFDP.

scholarly journals Risk-factors for re-admission and outcome of patients hospitalized with confirmed COVID-19

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hefziba Green ◽  
Dafna Yahav ◽  
Noa Eliakim-Raz ◽  
Nitzan Karny-Epstein ◽  
Shiri Kushnir ◽  
...  
Keyword(s):  
Risk Factors ◽  
Solid Organ Transplantation ◽  
Interquartile Range ◽  
Solid Organ ◽  
Post Discharge ◽  
Economic Implications ◽  
Admission Rates ◽  
Discharge Outcomes ◽  
Comorbidity Index

AbstractBurden of COVID-19 on Hospitals across the globe is enormous and has clinical and economic implications. In this retrospective study including consecutive adult patients with confirmed SARS-CoV-2 who were admitted between 3/2020 and 30/9/20, we aimed to identify post-discharge outcomes and risk factors for re-admission among COVID-19 hospitalized patients. Mortality and re-admissions were documented for a median post discharge follow up of 59 days (interquartile range 28,161). Univariate and multivariate analyses of risk factors for re-admission were performed. Overall, 618 hospitalized COVID-19 patients were included. Of the 544 patient who were discharged, 10 patients (1.83%) died following discharge and 50 patients (9.2%) were re-admitted. Median time to re-admission was 7 days (interquartile range 3, 24). Oxygen saturation or treatment prior to discharge were not associated with re-admissions. Risk factors for re-admission in multivariate analysis included solid organ transplantation (hazard ratio [HR] 3.37, 95% confidence interval [CI] 2.73–7.5, p = 0.0028) and higher Charlson comorbidity index (HR 1.34, 95% CI 1.23–1.46, p < 0.0001). Mean age of post discharge mortality cases was 85.0 (SD 9.98), 80% of them had cognitive decline or needed help in ADL at baseline. In conclusion, re-admission rates of hospitalized COVID-19 are fairly moderate. Predictors of re-admission are non-modifiable, including baseline comorbidities, rather than COVID-19 severity or treatment.

Determinants of Significant Out-Of-Hospital Bleeding in Patients Undergoing Percutaneous Coronary Intervention

2018 ◽  
Vol 118 (11) ◽  
pp. 1997-2005 ◽  
Author(s):  
Sabato Sorrentino ◽  
Usman Baber ◽  
Bimmer Claessen ◽  
Anton Camaj ◽  
Birgit Vogel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Inclusion Criteria ◽  
Post Discharge ◽  
Free Trial ◽  
Tertiary Centre ◽  
Percutaneous Coronary ◽  
One Year

Background Although several variables have been identified as bleeding determinants (BDs), their occurrence and predictive value in patients undergoing percutaneous coronary intervention (PCI) in the real world remain unclear. We aimed to characterize the rate of BDs in patients undergoing PCI with stent implantation in a large volume tertiary centre. Methods We included patients undergoing coronary stenting at our institution from January 2012 to December 2016, and defined post-discharge bleeding (PDB) as bleeding requiring hospitalization or transfusion. Several BDs, identified by the PARIS bleeding and PRECISE-DAPT scores and inclusion criteria of the LEADERS FREE trial, were analysed. Results In a population of 10,406 subjects who underwent PCI, 2,938 patients (28.2%) had 1, 2,367 (22.8%) had 2 and 2,913 (28.0%) had ≥3 pre-specified BD. Compared with patients without PDB, subjects who experienced PDB were older (70.43 ± 11.94 vs. 65.90 ± 11.54 years, p < 0.0001) with a higher prevalence of common cardiovascular risk factors. One-year PDB occurred in 177 patients (2.4%), and consistently increased according to the number of BDs involved (1.12, 2.11 and 4.35%, respectively; p < 0.0001). Analogously, 1-year rates of post-discharge myocardial infarction or stent thrombosis increased according to the number of BDs (2.44, 3.38 and 4.87%, respectively; p < 0.0001). Only 7 BDs remained independently associated with PDB at 1 year, with anaemia, oral anticoagulant at discharge and malignancy representing the strongest predictors of such risk. Conclusion Many risk factors predispose to PDB; they were often clustered together and conferred additive PDB risk at 1-year of follow-up.

P0697IDENTIFYING PATIENTS SUITABLE FOR PRIMARY CARE FOLLOW-UP IN A LARGE NON-DIALYSIS CKD COHORT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sophia Mohammed ◽  
Philip A Kalra ◽  
Rajkumar Chinnadurai
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Primary Care ◽  
Prediction Models ◽  
Economic Cost ◽  
Health Concern ◽  
Rapid Progression ◽  
Value Analysis ◽  
Significant Difference

Abstract Background and Aims Chronic Kidney Disease (CKD) is a growing public health concern, affecting approximately 13.4% of the global population. Due to the rising burden of CKD and its economic cost, there is a pressing need to identify the risk factors which can predict CKD progression and thereby enable us to manage these patients in the community under primary care follow-up. Our study aimed to identify risk factors that can predict outcomes in patients with stable CKD. Method The study was conducted on patients recruited in the Salford Kidney Study, (a large prospective CKD database recruiting patients since 2002). From a total of 2952 recruited between 2002 and the year 2016, 1023 patients with a diagnosis of hypertension, diabetes or pyelonephritis were sampled for this study. Based on the annual rate of progression of estimated glomerular filtration rate (delta eGFR), 140 patients were identified as stable CKD patients (delta eGFR -0.50 and 0.50 ml/min/1.73m2/year). The characteristics of this group was compared with 277 rapid progressors (RP) (delta eGFR&lt;-3) and 212 patients in the improved group (delta eGFR&gt;0.50). Negative predictive value analysis was performed on all patients with an outcome of a GFR &lt; 30ml/min/1.73m2. Results Stable CKD patients had a significantly higher age compared to RP ( 69 vs 62, p&lt;0.001). Further patients in the stable CKD group had a comparatively lower median blood pressure (141.5 vs 137, p&lt;0.001). Other factors which were identified as risk factors for rapid progression included history of diabetes (177 vs 73, p=0.021), low albumin (41 vs 44, p&lt;0.001), raised urine protein creatinine ratio (154.6 vs 18.8, p&lt;0.001) and phosphate (1.24 vs 1.12, p&lt;0.001) (Table-1). Comparing outcomes showed rapid progression reached ESRD (172 vs 18, p&lt;0.001) but no significant difference in mortality (93 vs 55, p=0.25). Characteristics that were statistically different for stable CKD patients in this large cohort were identified: age, systolic blood pressure, diastolic blood pressure, diabetes, albumin, UPCR and phosphate. NPV analysis did not identify reveal any clear predictors for progression in stable CKD patients. Conclusion Several risk factors were identified to distinguish between stable, rapid and improved group. NPV did not identify any predictors in stable group. Further risk prediction models incorporating biomarkers are warranted to identify factors that can guide prognosis thereby stable CKD patients can be managed in the community.

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