scholarly journals Monitoring and predicting SARS-CoV-2 epidemic in France after deconfinement using a multiscale age-stratified rate model

2020 ◽  
Author(s):  
Juergen Reingruber ◽  
Andrea Papale ◽  
David holcman
Keyword(s):  
Health Care ◽  
Age Groups ◽  
Economic Life ◽  
Reproduction Rate ◽  
Age Group ◽  
Rate Model ◽  
Age Dependent ◽  
Predictive Approaches ◽  
The Impact ◽  
Second Peak

The entire world and France were strongly impacted by the SARS-COV-2 epidemic. Finding appropriate measures that effectively contain the spread of the epidemic without putting a too severe pressure on social and economic life is major challenge for modern predictive approaches. To assess the impact of confinement (March 17th till May 11th) and deconfinement, we develop a novel rate model to monitor and predict the spread of the epidemic and its impact on the health care system. The model accounts for age-dependent interactions between population groups and predicts consequences for various infection categories such as number of infected, hospitalized, load of intensive care units (ICU), number of death, recovered and more. We use online health care data for the five most infected regions of France to calibrate the model. At day of deconfinement (May 11th), we find that 13% (around 4.8M) of the population is infected in the five most affected regions of France (extrapolating to 5.8M for France). The model predicts that if the reproduction rate R0 is reduced by at least a factor of 2.5-3 for all age groups, which could be achieved by wearing masks and social distancing, a significant second peak could be prevented. However, if the reduction in R0 for the age group 0-25 would be less and below 2 (school openings), a second peak is unavoidable in which case the ICU will be saturated. In that context testing should be focused on children, but it will nevertheless have a limited impact on reducing the spread.

scholarly journals Impact of skull base development on endonasal endoscopic surgical corridors

2014 ◽  
Vol 13 (2) ◽  
pp. 155-169 ◽  
Author(s):  
Matei A. Banu ◽  
Amancio Guerrero-Maldonado ◽  
Heather J. McCrea ◽  
Victor Garcia-Navarro ◽  
Mark M. Souweidane ◽  
...  
Keyword(s):  
Skull Base ◽  
Developmental Process ◽  
Normal Population ◽  
Age Groups ◽  
Age Group ◽  
Restriction Sites ◽  
Age Dependent ◽  
Skull Base Lesions ◽  
The Impact ◽  
Anatomical Parameters

Object Scarce morphometric data exist on the developing skull base as a corridor for endonasal endoscopic approaches (EEAs). Furthermore, the impact of skull base lesions on its development has not been assessed. The authors describe a novel set of anatomical parameters characterizing the developmental process as well as the utility of these parameters in preoperative planning and a feasibility assessment of EEAs for neurosurgical treatment of skull base lesions in children. Methods Based on specific MRI sequences in 107 pediatric patients (2–16 years of age) without skull base lesions (referred to here as the normal population), 3 sets of anatomical parameters were analyzed according to age group and sex: drilling distance, restriction sites, and working distance parameters. A separate set of patients undergoing EEAs was analyzed in similar fashion to address the impact of skull base lesions on the developmental process. Results The volume of the sphenoid sinus significantly increases with age, reaching 6866.4 mm3 in the 14–16 years age group, and directly correlates with the pneumatization type (r = 0.533, p = 0.0001). The pneumatization process progresses slowly in a temporal-posterior direction, as demonstrated by the growth trend of the sellar width (r = 0.428, p = 0.0001). Nasal restriction sites do not change significantly with age, with little impact on EEAs. The intercarotid distance is significantly different only in the extreme age groups (3.9 mm, p = 0.038), and has an important impact on the transsphenoidal angle and the intracranial dissection limits (r = 0.443, p < 0.0001). The 14.9° transsphenoidal angle at 2–4 years has a 37.6% significant increase in the 11–13 years age group (p = 0.001) and is highly dependent on pneumatization type. Age-dependent differences between working parameters are mostly noted for the extreme age groups, such as the 8.6-mm increase in nare-vomer distance (p = 0.025). The nare-sellar distance is the only parameter with significant differences based on sex. Skull base lesions induce a high degree of variance in skull base measurements, delaying development and decreasing parameter values. Skull base parameters are interdependent. Nare-sellar distance can be used to assess global skull base development because it highly correlates with the intercarotid distance in both the normal population and in patients harboring skull base lesions. Conclusions Skull base development is a slow, gradual, age-dependent, sex-independent process significantly altering endonasal endoscopic corridors. Preoperative MRI measurements of the pediatric skull base are thus a useful adjunct in choosing the appropriate corridor and in assessing working angles and limits during dissection or reparative surgery. Skull base lesions can significantly impact normal skull base development and age-dependent growth patterns.

scholarly journals Structure and Distribution of Health Care Costs across Age Groups of Patients with Multimorbidity in Lithuania

2021 ◽  
Vol 18 (5) ◽  
pp. 2767
Author(s):  
Laura Nedzinskienė ◽  
Elena Jurevičienė ◽  
Žydrūnė Visockienė ◽  
Agnė Ulytė ◽  
Roma Puronaitė ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Chronic Disease ◽  
National Health Insurance ◽  
Health Care Services ◽  
Age Groups ◽  
Age Group ◽  
Resource Usage ◽  
Care Services ◽  
Care Costs

Background. Patients with multimorbidity account for ever-increasing healthcare resource usage and are often summarised as big spenders. Comprehensive analysis of health care resource usage in different age groups in patients with at least two non-communicable diseases is still scarce, limiting the quality of health care management decisions, which are often backed by limited, small-scale database analysis. The health care system in Lithuania is based on mandatory social health insurance and is covered by the National Health Insurance Fund. Based on a national Health Insurance database. The study aimed to explore the distribution, change, and interrelationships of health care costs across the age groups of patients with multimorbidity, suggesting different priorities at different age groups. Method. The study identified all adults with at least one chronic disease when any health care services were used over a three-year period between 2012 and 2014. Further data analysis excluded patients with single chronic conditions and further analysed patients with multimorbidity, accounting for increasing resource usage. The costs of primary, outpatient health care services; hospitalizations; reimbursed and paid out-of-pocket medications were analysed in eight age groups starting at 18 and up to 85 years and over. Results. The study identified a total of 428,430 adults in Lithuania with at least two different chronic diseases from the 32 chronic disease list. Out of the total expenditure within the group, 51.54% of the expenses were consumed for inpatient treatment, 30.90% for reimbursed medications. Across different age groups of patients with multimorbidity in Lithuania, 60% of the total cost is attributed to the age group of 65–84 years. The share in the total spending was the highest in the 75–84 years age group amounting to 29.53% of the overall expenditure, with an increase in hospitalization and a decrease in outpatient services. A decrease in health care expenses per capita in patients with multimorbidity after 85 years of age was observed. Conclusions. The highest proportion of health care expenses in patients with multimorbidity relates to hospitalization and reimbursed medications, increasing with age, but varies through different services. The study identifies the need to personalise the care of patients with multimorbidity in the primary-outpatient setting, aiming to reduce hospitalizations with proactive disease management.

scholarly journals Vaccine impact and effectiveness of meningococcal serogroup ACWY conjugate vaccine implementation in the Netherlands: a nationwide surveillance study

2021 ◽  
Author(s):  
Milou Ohm ◽  
Susan J M Hahné ◽  
Arie van der Ende ◽  
Elizabeth A M Sanders ◽  
Guy A M Berbers ◽  
...  
Keyword(s):  
The Netherlands ◽  
Incidence Rate ◽  
Vaccination Programme ◽  
Screening Method ◽  
Age Groups ◽  
Incidence Rates ◽  
Age Group ◽  
Mass Campaign ◽  
Conjugate Vaccination ◽  
The Impact

Abstract Background In response to the recent serogroup W invasive meningococcal disease (IMD-W) epidemic in the Netherlands, meningococcal serogroup C (MenC) conjugate vaccination for 14-month-olds was replaced with a MenACWY conjugate vaccination, and a mass campaign targeting 14-18 year-olds was executed. We investigated the impact of MenACWY vaccination implementation in 2018-2020 on incidence rates and estimated vaccine effectiveness (VE). Methods We extracted all IMD cases diagnosed between July 2014 and December 2020 from the national surveillance system. We calculated age group-specific incidence rate ratios by comparing incidence rates before (July 2017-March 2018) and after (July 2019-March 2020) MenACWY vaccination implementation. We estimated VE in vaccine-eligible cases using the screening method. Results Overall, IMD-W incidence rate lowered by 61% (95%CI 40-74). It declined by 82% (95%CI 18-96) in vaccine-eligible age group (15-36 month-olds and 14-18 year-olds) and by 57% (95%CI 34-72) in vaccine non-eligible age groups. VE was 92% (95%CI -20-99.5) against IMD-W vaccine-eligible toddlers. No IMD-W cases were reported in vaccine-eligible teenagers after the campaign. Conclusions The MenACWY vaccination programme was effective in preventing IMD-W in the target population. The IMD-W incidence reduction in vaccine non-eligible age groups may be caused by indirect effects of the vaccination programme. However, disentangling natural fluctuation from vaccine-effect was not possible. Our findings encourage the use of toddler- and teenager MenACWY vaccination in national immunization programmes especially when implemented together with a teenager mass campaign during an epidemic.

scholarly journals Pedestrian Mortality Trends In Children Over Four Decades In Transitional Lithuania

2016 ◽  
Vol 26 (5) ◽  
pp. 13-19
Author(s):  
Birutė Strukčinskienė ◽  
Robert Bauer ◽  
Sigitas Griškonis ◽  
Vaiva Strukčinskaitė
Keyword(s):  
Time Series ◽  
Young People ◽  
Road Safety ◽  
Road Traffic ◽  
Age Groups ◽  
Age Group ◽  
Prevention Measures ◽  
Mortality Trends ◽  
Road Users ◽  
The Impact

The aim of the study was to examine the long-term trends in pedestrian mortality for children (aged 0 to 14 years) and young people (aged 15 to 19 years) over four decades in transitional Lithuania. Methods. Road traffic fatality data were obtained from Statistics Lithuania and the Archives of Health Information Centre. Trends were analysed by linear regression using “Independence” as a slopechanging intervention in 1991 and population as a further explanatory factor in structural time series models. Results. The impact of the interventions, along with the reforms and changes related with the Independence, on pedestrian fatality trends in our time series model was found highly statistically significant for children 0 to 14 years (p<0.001) and still significant for young people 15 to 19 years (p<0.05). No significant impact on the trend of road traffic deaths was found for the “control-groups” of non-pedestrian road users in the age group 0 to 14 years and adult pedestrians (over 19 years of age). For the age group 15 to 19 years the effect of reforms was also significant for non-pedestrians (p<0.05). These results indicate that the effect of measures and changes used in the post-independence period was more specific in children that participated in road traffic as pedestrians than in adult pedestrians, or in nonpedestrian road users. Conclusions. Pedestrian deaths in Lithuania fell significantly in the age groups 0-14 and 15-19 years. A declining trend was found in road traffic fatalities and in pedestrian deaths in transitional Lithuania in the post-independence period. Socioeconomic and political transformations, systematic reforms in healthcare along with sustainable preventive measures may have contributed to this decrease. Targeted road safety measures were road traffic regulations, pedestrian education and environmentally based prevention measures. As child pedestrians are the most vulnerable group of road users, continued road safety education and promotion are recommended in order to maintain this trend, and to involve adult pedestrians in this development.

Severity of Cerebral Palsy—The Impact of Associated Impairments

2020 ◽  
Vol 51 (02) ◽  
pp. 120-128 ◽  
Author(s):  
Veronka Horber ◽  
Asma Fares ◽  
Mary Jane Platt ◽  
Catherine Arnaud ◽  
Ingeborg Krägeloh-Mann ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Birth Weight ◽  
Gestational Age ◽  
Age Groups ◽  
Walking Ability ◽  
Age Group ◽  
Intellectual Impairment ◽  
Weight Group ◽  
Birth Weight Group ◽  
The Impact

Abstract Objective This article describes associated impairments in children with cerebral palsy (CP) and its subtypes. Method Children born between 1990 and 2006 recorded in the Surveillance of Cerebral Palsy in Europe common database were studied. An “impairment index” characterized severity of impairments and their combinations. Results Amongst the 11,015 children analyzed, 56% (n = 5,968) could walk unaided, 54% (4,972) had normal or near-normal intellect (intelligence quotient ≥ 70). Except for ataxic CP, associated impairments were less frequent when walking ability was preserved. The impairment index was low (walking unaided and normal or near-normal intellect) in 30% of cases; 54% (n = 1,637) in unilateral spastic, 24% (n = 79) in ataxic, 18% (n = 913) in bilateral spastic, and 7% (n = 50) in dyskinetic CP. Around 40% had a high impairment index (inability to walk and/or severe intellectual impairment ± additional impairments)—highest in dyskinetic (77%, n = 549) and bilateral spastic CP (54%, n = 2,680). The impairment index varied little in birth weight and gestational age groups. However, significantly fewer cases in the birth weight group ≤ 1,000 g or gestational age group ≤ 27 weeks had a low impairment index compared to the other birth weight and gestational age groups (23 and 24% vs. between 27 and 32%). Conclusion Thirty percent of the children with CP had a low impairment index (they were able to walk unaided and had a normal or near-normal intellect). Severity in CP was strongly associated to subtype, whereas the association was weak with birth weight or gestational age.

scholarly journals Trends in Poliovirus Seroprevalence in Kano State, Northern Nigeria

2018 ◽  
Vol 67 (suppl_1) ◽  
pp. S103-S109
Author(s):  
Harish Verma ◽  
Zubairu Iliyasu ◽  
Kehinde T Craig ◽  
Natalie A Molodecky ◽  
Utibeabasi Urua ◽  
...  
Keyword(s):  
Old Age ◽  
Age Groups ◽  
Significant Risk ◽  
Immunization Coverage ◽  
Neutralizing Antibody ◽  
Age Group ◽  
Parental Consent ◽  
Population Immunity ◽  
Antibody Titres ◽  
The Impact

Abstract Background Kano state has been a protracted reservoir of poliovirus in Nigeria. Immunity trends have been monitored through seroprevalence surveys since 2011. The survey in 2015 was, in addition, intended to assess the impact of use of inactivated poliovirus vaccine (IPV). Methods It was a health facility based seroprevalence survey. Eligible children aged 6-9, 12-15 and 19-22 months of age brought to the paediatrics outpatient department of Murtala Mohammad Specialist Hospital between 19 October and 6 November 2015, were screened for eligibility. Eligible children were enrolled after parental consent, history taken, physical examination conducted, and a blood sample collected to test for neutralizing antibody titres against the three poliovirus serotypes. Results Overall, 365 results were available in the three age groups. In the 6-9-month-old age group, the seroprevalence was 73% (95% confidence interval [CI] 64-80%), 83% (95% CI 75-88%), and 66% (95% CI 57-73%) for serotypes 1, 2, and 3, respectively. In the 12-15- and 19-22-month-old age groups, seroprevalence was higher but still remained <90% across serotypes. Seroprevalence to serotypes 1 and 3 in 2015 was similar to 2014; however, for serotype 2 there was a significant improvement. IPV received in supplemental immunization activities was found to be a significant predictor of seropositivity among 6-9-month-old infants for serotypes 1 and 2. Conclusions Seroprevalence for serotypes 1 and 3 remains low (<80%) in 6-9-month-olds. This poses a significant risk for poliovirus spread if reintroduced into the population. Efforts to strengthen immunization coverage are imperative to secure and sustain high population immunity.

scholarly journals Treatment Trends, Complications, and Effects of Comorbidities on Distal Radius Fractures

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 534-539 ◽  
Author(s):  
William P. Mosenthal ◽  
Haroutioun H. Boyajian ◽  
Sandra A. Ham ◽  
Megan A. Conti Mica
Keyword(s):  
Distal Radius ◽  
Age Groups ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Age Group ◽  
Radius Fractures ◽  
Treatment Type ◽  
Closed Treatment ◽  
Open Treatment ◽  
The Impact

Background: Distal radius fractures (DRFs) are the most common upper extremity fractures in adults. This study seeks to elucidate the impact age, fracture type, and patient comorbidities have on the current treatment of DRFs and risk of complications. We hypothesized that comorbidities rather than age would relate to the risk of complications in the treatment of DRFs. Methods: A retrospective review of data was performed for patients treated between 2007 and 2014 using Truven Health MarketScan Research Databases. Patients who sustained a DRF were separated into “closed” versus “open” treatment groups, and the association between patient demographics, treatment type, and comorbidities with complication rates was analyzed, along with the trend of treatment modalities throughout the study time interval. Results: In total, 155 353 DRFs were identified; closed treatment predominated in all age groups with the highest percentage of open treatment occurring in the 50- to 59-year age group. Between 2007 and 2014, there was an increase in the rate of open reduction and internal fixation (ORIF) in all age groups <90 with the largest increase (11%) occurring in the 70- to 79-year age group. Higher complication rates were observed in the open treatment group in all ages <90 years with a trend toward decreasing complication rates as age increased. Comorbidities were more strongly associated with the risk of developing complications than age. Conclusions: Closed treatment of DRFs remains the predominant treatment method among all age groups, but DRFs are increasingly being treated with ORIF. Emphasis on the patients’ comorbidities rather than chronological age should be considered in the treatment decision-making process of elderly patients with DRFs.

Nuclear War: Fear of Children and Adolescents

1990 ◽  
Vol 7 (1) ◽  
pp. 2-4
Author(s):  
Neville J King ◽  
Kate Ollier ◽  
Eleonora Gullone
Keyword(s):  
Children And Adolescents ◽  
Middle Age ◽  
Age Groups ◽  
Psychological Development ◽  
Age Group ◽  
Nuclear War ◽  
Fear Survey Schedule ◽  
The Impact

ABSTRACTUsing an extended fear survey schedule, 72 per cent of a sample of 8 to 16 year old children and adolescents in Australia reported a lot of fear of nuclear war. Although a high proportion of respondents in all age groups expressed a lot of fear of nuclear war, significantly more respondents in the middle age group (11-13 years) were found to be afraid. Consistent with the findings on children's fears in general, significantly more females than males reported fear of nuclear war. Further research should be undertaken on the impact of the fear of nuclear war on the psychological development of children and adolescents.

scholarly journals The Impact and Consequences of SARS-CoV-2 Pandemic on a Single University Dermatology Outpatient Clinic in Germany

2020 ◽  
Vol 17 (17) ◽  
pp. 6182
Author(s):  
Rosi Wang ◽  
Charlotte Helf ◽  
Linda Tizek ◽  
Ruth Neuhauser ◽  
Kilian Eyerich ◽  
...  
Keyword(s):  
Health Care ◽  
Outpatient Clinic ◽  
Skin Diseases ◽  
Health Care Systems ◽  
Age Groups ◽  
Peak Time ◽  
Malignant Diseases ◽  
Inflammatory Skin Diseases ◽  
Care Systems ◽  
The Impact

The pandemic outbreak of coronavirus disease 2019 (COVID-19) affects health care systems globally and leads to other challenges besides infection and its direct medical consequences. The aim of this study was to investigate the impact of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic on the university dermatology outpatient clinic (UDOC) of the Technical University of Munich, Germany. We analyzed datasets from 2015 until 2020 extracted from the hospital information system database and our documented outpatient files regarding patient numbers, gender, age, and diagnoses. In 2020, case numbers of outpatient care declined significantly (p = 0.021) compared to previous years and was related to the timing of political announcements answering SARS-CoV-2 pandemic. Additionally, during calendar week 10 to 15—the peak time of the spread of COVID-19 in Germany—the proportion of patients missing their consultation was significantly higher in 2020 than in 2019 (22.4% vs. 12.4%; p < 0.001). Gender-associated differences regarding absences were not detected, but patients aged 85 years or older were significantly more likely to miss their consultation compared to all other age groups (p = 0.002). Regarding different disease clusters, patients with chronic inflammatory skin diseases and infectious and malignant diseases were more likely to miss their consultation (p = 0.006). Noticeably, less patients with malignant diseases, and particularly malignant melanoma, were registered during this pandemic. Our data support the hypothesis that medically constructive prioritization might not be implemented properly by patients themselves. Identifying missed patients and catching up on their medical care apart from COVID-19 will pose an enormous challenge for health care systems globally.

Impact of genomic alterations (GAs) on outcomes and their distribution by age groups in metastatic colorectal cancer (mCRC) patients (pts).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 560-560 ◽  
Author(s):  
Ibrahim Halil Sahin ◽  
Wanqi H Chen ◽  
Zhengjia Chen ◽  
Mehmet Akce ◽  
Olatunji B. Alese ◽  
...  
Keyword(s):  
Survival Data ◽  
Cox Model ◽  
Prognostic Significance ◽  
Age Groups ◽  
Survival Outcomes ◽  
Age Group ◽  
Term Survival ◽  
Exact Test ◽  
Initial Stage ◽  
The Impact

560 Background: Although clinical outcomes has substantially improved over the last decade, long term survival in mCRC remains rare. Molecular profiling (MP) of CRC is routinely conducted to identify potential therapeutic targets. The aim of this project is to evaluate the impact of uncommon GAs on outcomes and characterize their distribution by age. Methods: Pts were eligible if they had mCRC (synchronous or metachronous) and underwent MP between 01/2013 and 05/2018. GAs were obtained from Foundation Medicine reports. Clinical data were collected by trained personnel by detailed chart review. Multivariable survival analyses (MA) with Cox model were conducted for survival outcomes and Fisher’s exact test was used to assess the differences among age groups (< 45, 45-60, > 60). The study was reviewed by Institutional IRB ( IRB00097021 ). Results: 161 patients with mCRC had MP, and 159 of those patients had survival data. The most commonly detected GAs were APC (133/161, 82.6%) TP53 (128/161, 79.5%). In univariate analyses mutations in BRCA 1/2, RB1, SOX9, CDK8, FLT3, and IRS2 amplification were associated with worse survival outcomes. In MA, including initial stage of disease, GAs in BRCA1/2, RB1, FLT3, SOX9, and IRS2 remained statistically significant (Table). When we performed MA by age groups, mutations SOX9 in age group < 45 and BRCA1/2 in age group 45-60 were significant predictors of worse outcomes. We also compared the frequency of mutations among age groups and FAM123B was significantly more common in age group 45-60 (P = 0.038). Conclusions: Our data suggests that GAs in BRCA1/2, RB1, FLT3, SOX9, and IRS2 may predict worse outcomes in mCRC. Therapeutic approaches targeting these pathways should be investigated. Differences in distribution and prognostic significance of mutations were observed based on age. [Table: see text]

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