scholarly journals LESSONS FROM THE COVID-19 THIRD WAVE IN CANADA: THE IMPACT OF VARIANTS OF CONCERN AND SHIFTING DEMOGRAPHICS

2021 ◽  
Author(s):  
Finlay A McAlister ◽  
Majid Nabipoor ◽  
Anna Chu ◽  
Douglas Lee ◽  
Lynora Saxinger ◽  
...  
Keyword(s):  
Age Groups ◽  
Vaccine Hesitancy ◽  
First Year ◽  
Third Wave ◽  
Wild Type ◽  
Lengths Of Stay ◽  
Younger Age ◽  
Canadian Provinces ◽  
Event Rates ◽  
The Impact

Importance: With the emergence of more transmissible SARSCoV2 variants of concern (VOC), there is an urgent need for evidence about disease severity and the health care impacts of VOC in North America, particularly since a substantial proportion of the population have declined vaccination thus far. Objective: To examine 30day outcomes in Canadians infected with SARSCoV2 in the first year of the pandemic and to compare event rates in those with VOC versus wild type infection. Design: Retrospective cohort study using linked healthcare administrative datasets. Setting: Alberta and Ontario, the two Canadian provinces that experienced the largest third wave in the spring of 2021. Participants: All individuals with a positive SARSCoV2 reverse transcriptase polymerase chain reaction swab from March 1, 2020 until March 31, 2021, with genomic confirmation of VOC screen positive tests during February and March 2021 (wave 3). Exposure of Interest: VOC versus wild type SARSCoV2 Main Outcomes and Measures: All-cause hospitalizations or death within 30 days after a positive SARSCoV2 swab. Results: Compared to the 372,741 individuals with SARSCoV2 infection between March 2020 and January 2021 (waves 1 and 2 in Canada), there was a shift in transmission towards younger patients in the 104,232 COVID19 cases identified in wave 3. As a result, although third wave patients were more likely to be hospitalized (aOR 1.34 [1.29 to 1.39] in Ontario and aOR 1.53 [95%CI 1.41 to 1.65] in Alberta), they had shorter lengths of stay (median 5 vs. 7 days, p<0.001) and were less likely to die within 30 days (aOR 0.66 [0.60 to 0.71] in Ontario and aOR 0.74 [0.62 to 0.89] in Alberta). However, within the third wave, patients infected with VOC (91% Alpha) exhibited higher risks of death (aOR 1.52 [1.27 to 1.81] in Ontario and aOR 1.67 [1.13 to 2.48] in Alberta) and hospitalization (aOR 1.57 [1.47 to 1.69] in Ontario and aOR 1.88 [1.74 to 2.02] in Alberta) than those with wild-type SARSCoV2 infections during the same timeframe. Conclusions and Relevance: On a population basis, the shift towards younger age groups as the COVID19 pandemic has evolved translates into more hospitalizations but shorter lengths of stay and lower mortality risk than seen in the first 10 months of the pandemic in Canada. However, on an individual basis, infection with a VOC is associated with a higher risk of hospitalization or death than the original wild type SARSCoV2; this is important information to address vaccine hesitancy given the increasing frequency of VOC infections now.

The impact of a time target on older patients attending the emergency department

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A2.1-A2
Author(s):  
Sue Mason
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Age Groups ◽  
Unintended Consequences ◽  
Older Patient ◽  
Younger Patients ◽  
Patient Level ◽  
Level Data ◽  
Younger Age ◽  
The Impact

IntroductionThe 4 h emergency standard for English acute trusts was introduced in 2003 and became full established by 2008 at 98% for all Emergency Department (ED) patients to be seen and discharged. This study examined the impact of the target for older patients attending departments.MethodsRoutine patient level data was received from 15 English EDs representing 774 095 individual patient attendances during May and June for 2003 to 2006. The data were used to determine the distribution of the total time spent in the EDs. Attendances were compared for older patients (65 years and above) with younger age groups.ResultsA total of 145 596 attendances were for patients aged 65+ years (18.9%). Across each year analysed, these older patients have a significantly longer median total time in the ED than those younger than 65 years (162 min vs 103 min, p<0.001). In addition, older patients are significantly more likely to leave the emergency department in the last 20 min prior to 4 h (12.4% vs 5.2% in those <65 years, p<0.001). This proportion is growing year on year in both the admitted and discharged categories of patients. Finally, older patients are significantly more likely to breach the 4-h than their younger counterparts (16.6% vs 6.3%, p<0.001).ConclusionsThere are some unintended consequences of introducing the 4 h target in UK emergency departments. While the target has reduced overall time in departments, the older patient appears to be disadvantaged relative to younger patients. Older patients are more likely to be ‘rushed through’ to other unmonitored areas of the hospital just prior to the target or to breach the target altogether. This finding calls in to question the benefits that the target is conveying for individual patients, and especially the most vulnerable in society.

The early bird catches the worm: age-specific arrival time influences reproductive performance in the White Stork Ciconia ciconia

Bird Study ◽  
2019 ◽  
Vol 66 (1) ◽  
pp. 121-129
Author(s):  
Bourhane-Eddine Belabed ◽  
Mohammed Athamnia ◽  
Laïd Touati ◽  
Farrah Samraoui ◽  
Abdennour Boucheker ◽  
...  
Keyword(s):  
Reproductive Performance ◽  
Age Groups ◽  
Egg Laying ◽  
White Stork ◽  
Laying Date ◽  
First Year ◽  
Arrival Date ◽  
Breeding Colony ◽  
Ciconia Ciconia ◽  
The Impact

<sec><title>Capsule</title>Age, arrival date and egg laying date are essentially closely related and determine reproductive performance in the White Stork Ciconia ciconia.</sec><sec><title>Aims</title>To describe the impact of age, arrival date and egg laying date on breeding success in the White Stork.</sec><sec><title>Methods</title>Ringing data from a White Stork breeding colony of 212 nests at Dréan, Algeria, were used to model the relationship between age, arrival date, laying date and reproductive performance. Seventy breeders that were individually colour-ringed as nestlings were monitored.</sec><sec><title>Results</title>Birds breeding on the periphery of the colony had significantly smaller nests and showed a tendency towards later laying dates, but they did not differ from centrally nesting birds in age or arrival date. First year birds did not breed and second year birds were significantly more likely than older age groups to occupy nests but fail to lay eggs. Older birds arrived earlier at the breeding colony and had a higher probability of initiating laying than younger birds. They also had a higher probability of nesting successfully and fledging a larger number of young.</sec><sec><title>Conclusion</title>Age determined arrival and laying dates and influenced breeding performance in the White Stork.</sec>

scholarly journals Modelling the impact of extending dose intervals for COVID-19 vaccines in Canada

2021 ◽  
Author(s):  
Austin Nam ◽  
Raphael Ximenes ◽  
Man Wah Yeung ◽  
Sharmistha Mishra ◽  
Jianhong Wu ◽  
...  
Keyword(s):  
Time Horizon ◽  
Compartmental Model ◽  
Age Groups ◽  
Dose Interval ◽  
Base Case ◽  
Third Wave ◽  
Older Individuals ◽  
High Efficacy ◽  
The Impact ◽  
Epidemiologic Features

AbstractBackgroundDual dose SARS-CoV-2 vaccines demonstrate high efficacy and will be critical in public health efforts to mitigate the COVID-19 pandemic and its health consequences; however, many jurisdictions face very constrained vaccine supply. We examined the impacts of extending the interval between two doses of mRNA vaccines in Canada in order to inform deliberations of Canada’s National Advisory Committee on Immunization.MethodsWe developed an age-stratified, deterministic, compartmental model of SARS-CoV-2 transmission and disease to reproduce the epidemiologic features of the epidemic in Canada. Simulated vaccination comprised mRNA vaccines with explicit examination of effectiveness against disease (67% [first dose], 94% [second dose]), hospitalization (80% [first dose], 96% [second dose]), and death (85% [first dose], 96% [second dose]) in adults aged 20 years and older. Effectiveness against infection was assumed to be 90% relative to the effectiveness against disease. We used a 6-week mRNA dose interval as our base case (consistent with early program rollout across Canadian and international jurisdictions) and compared extended intervals of 12 weeks, 16 weeks, and 24 weeks. We began vaccinations on January 1, 2021 and simulated a third wave beginning on April 1, 2021.ResultsExtending mRNA dose intervals were projected to result in 12.1-18.9% fewer symptomatic cases, 9.5-13.5% fewer hospitalizations, and 7.5-9.7% fewer deaths in the population over a 12-month time horizon. The largest reductions in hospitalizations and deaths were observed in the longest interval of 24 weeks, though benefits were diminishing as intervals extended. Benefits of extended intervals stemmed largely from the ability to accelerate coverage in individuals aged 20-74 years as older individuals were already prioritized for early vaccination. Conditions under which mRNA dose extensions led to worse outcomes included: first-dose effectiveness < 65% against death; or protection following first dose waning to 0% by month three before the scheduled 2nd dose at 24-weeks. Probabilistic simulations from a range of likely vaccine effectiveness values did not result in worse outcomes with extended intervals.ConclusionUnder real-world effectiveness conditions, our results support a strategy of extending mRNA dose intervals across all age groups to minimize symptomatic cases, hospitalizations, and deaths while vaccine supply is constrained.

scholarly journals Relationship between Citizens’ Health Engagement and Intention to Take the COVID-19 Vaccine in Italy: A Mediation Analysis

Vaccines ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 576 ◽  
Author(s):  
Guendalina Graffigna ◽  
Lorenzo Palamenghi ◽  
Stefania Boccia ◽  
Serena Barello
Keyword(s):  
Age Groups ◽  
Path Model ◽  
Vaccine Hesitancy ◽  
Vaccination Programs ◽  
General Attitude ◽  
Actual Effectiveness ◽  
To Come ◽  
Educational Campaigns ◽  
The Impact

The actual effectiveness of the still-to-come vaccination against the coronavirus SARS-CoV-2 might be challenged by vaccine hesitancy, a rather common and known phenomenon whose psychological predictors are, nevertheless, still largely debated. Our study aims at understanding how adult citizens’ health engagement, perceived COVID-19 susceptibility and severity, and general vaccine-related attitudes affect the willingness to vaccinate against COVID-19. To that end, on a sample of Italian citizens, we implemented a path model to test the impact of health engagement on the willingness to vaccinate against SARS-CoV-2, and whether this relationship is direct or mediated by the general attitude towards vaccines and the risk perception. Moreover, we tested the configural and weak invariance of the model across gender and three age groups. Results show that health engagement is positively related to the intention to vaccinate and that this relationship is partially mediated by the general attitude towards vaccines. The model appears invariant across genders and partially invariant across age groups, showing some differences in the role of perceived susceptibility. These findings vouch for the implementation of educational campaigns aimed at sustaining future vaccination programs that also include health engagement promotion.

The Swedish Version of the Temperament and Character Inventory (TCI)

2008 ◽  
Vol 24 (1) ◽  
pp. 14-21 ◽  
Author(s):  
Sven Brändström ◽  
Sören Sigvardsson ◽  
Per-Olof Nylander ◽  
Jörg Richter
Keyword(s):  
Personality Assessment ◽  
Age Groups ◽  
Temperament And Character Inventory ◽  
Swedish Version ◽  
Age And Gender ◽  
Younger Age ◽  
Character Inventory ◽  
And Gender ◽  
Independent Effects ◽  
The Impact

Abstract. In order to establish new norms of the Swedish version of the Temperament and Character Inventory (TCI), data from 2,209 Swedish individuals (age between 13 and 80) was analyzed. The second aim was to evaluate the impact of age and gender on the questionnaire scores. The third aim was to investigate whether the TCI can be meaningfully applied to adolescents in personality assessment as a basis for further research and clinical studies. Age and gender showed independent effects on personality dimensions, which implies that age and gender specific norms have to be established for the TCI. Furthermore, the results in terms of inconsistencies in the correlational and factorial structure, as well as low internal consistency scores in the younger age groups, suggest that the adult version of the TCI should not be applied below the age of 17; for these age groups we recommend the use of the junior TCI (JTCI). The inventory is under further development and several items are in need of revision in order to create less complicated formulations, enabling an improvement in the psychometrics.

The impact of smoking in elderly people

1999 ◽  
Vol 9 (3) ◽  
pp. 273-280 ◽  
Author(s):  
Norman J Vetter
Keyword(s):  
Lung Cancer ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Causes Of Death ◽  
Age Groups ◽  
The Elderly ◽  
Death Rates ◽  
Younger Age ◽  
Prevention Programmes ◽  
The Impact

Smoking has been closely implicated in many cardiovascular, lung and other diseases which are prevalent in the elderly, but most prevention programmes tend to be aimed at younger age groups.The prevention of smoking in retired people is a subject which is not yet fully researched, but there is a little information which suggests that it may be a worthwhile pursuit. Certainly, work has shown that longevity can be improved even in older people by stopping smoking. Coronary heart disease death rates for 65-74 year olds who have recently given up are similar to non-smokers. For other causes of death, especially lung cancer and bronchitis, the benefits of stopping smoking take up to five years to appear. In terms of morbidity, there are suggestions that ex-smokers move reasonably quickly towards the state of non-smokers for bone density, pulmonary function and muscle strength.

scholarly journals Social Networking Service as a Marketing Technology Tool and Sustainable Business in the Lodging Industry: Investigating the Difference across Older and Younger Age Groups among Tourists

2021 ◽  
Vol 13 (10) ◽  
pp. 5673
Author(s):  
Heesup Han ◽  
Linda Heejung Lho ◽  
Heekyoung Jung ◽  
Antonio Ariza-Montes ◽  
Luis Araya-Castillo
Keyword(s):  
Social Networking ◽  
Age Groups ◽  
Lodging Industry ◽  
Sustainable Business ◽  
Marketing Technology ◽  
Younger Age ◽  
The Difference ◽  
A Chain ◽  
Technology Tool ◽  
The Impact

Despite the importance of social networking services (SNSs), their engagement and their role as a critical marketing technology tool in explaining travellers’ approach behaviours are not well known. The present study investigated the influence of SNS engagement on traveller loyalty generation for a chain hotel brand and the health of this business by considering the roles of brand attitude, awareness, trust, and attachment and the impact of age. Fostering customers’ SNS engagement in the hospitality industry will be a vital constituent of hotels’ sustainable business. A quantitative process was used to meet the research objectives. The proposed research framework encompassing these variables was successfully developed. The framework’s efficiency in predicting brand loyalty was also demonstrated. Our results showed that SNS engagement considerably enhances loyalty and other study constructs. Attachment had a salient role in boosting loyalty. In addition, age had a moderating influence. The study constructs maximized the influence of SNS engagement on loyalty as mediators. Overall, our results considerably increase our understanding regarding the role of SNS engagement in the formation of traveller loyalty to chain hotel brands and the sustainability of such businesses.

scholarly journals Time to Treatment Initiation Predicts Overall Survival in Hospitalized Acute Myeloid Leukemia (AML) Patients: A California Population-Based Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3982-3982
Author(s):  
Tatini Datta ◽  
Brian A Jonas ◽  
Aaron S Rosenberg ◽  
Qian Li ◽  
Ann M Brunson ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Overall Survival ◽  
Older Patients ◽  
De Novo ◽  
Age Groups ◽  
Population Based ◽  
Age Group ◽  
Younger Age ◽  
De Novo Aml ◽  
The Impact

Abstract Background: The impact of time from diagnosis to chemotherapy initiation (time to treatment, TTT) for AML has been a topic of ongoing debate. A prior study reported that TTT ≥5 days adversely impacted overall survival in younger (<60 years of age), but not older (≥60 years of age), patients. However, subsequent studies found either no effect of TTT on overall survival, regardless of age, or an adverse impact of TTT on overall survival for both younger (>10 days) and older patients (>5 days). Prior data also showed no impact of TTT on early mortality. Given these conflicting findings, consensus on the impact of TTT on survival is lacking and warrants further study. Using prospectively collected population-based data, we analyzed a large cohort of adult AML patients to examine the effect of TTT on overall survival. Methods: Using data from the California Cancer Registry and Patient Discharge Dataset between 1999-2012, patients≥15years diagnosed with de novo AML and who received inpatient treatment between 1-90 days from diagnosis were identified (n=5337). Multivariable logistic regression was used to determine factors associated with TTT>5 days vs 1-5 days with data presented as odds ratios (OR) and 95% confidence intervals (CI). The effect of TTT on overall and 60-day survival was estimated using multivariable Cox proportional hazards regression with TTT (1-5, 6-10,>10 days)considered as a time-dependent variable. Patients were stratified by age group (<60,≥60 years) for all analyses.Multivariable models accounted for age, race/ethnicity, sex, number of comorbidities, marital status, neighborhood socioeconomic status, health insurance type, treatment at National Cancer Institute designated (NCI) vs non-NCI designated facility, use ofleukapheresis, and year of diagnosis. Results: Of the 2659 patients <60 years of age, 61.0% were treated within 5 days and 79.7% within 10 days of diagnosis, compared to 43.8% and 65.0%, respectively, of the 2678 patients≥60 years of age. Patients≥60 years were more likely to have 3+ comorbidities compared to the younger age group (43.3% vs 25.9%, P<0.001). The likelihood of TTT>5 days increased with age in both younger and older patients. Across both age groups, patients requiringleukapheresis(age<60: OR 0.19, CI 0.10-0.34; age≥60: OR 0.23, CI 0.12-0.45), treated at a non-NCI (vs NCI) center (age<60: OR 0.62, CI 0.52-0.73; age≥60: OR 0.64, CI 0.52-0.78) and with 1-2 (vs 0) comorbidities (age<60: OR 0.81, CI 0.67-0.98; age≥60: OR 0.69, CI 0.54-0.88) or 3+ (vs 0) comorbidities (age<60: OR 0.77, CI 0.62-0.97; age≥60: OR 0.52, CI 0.41-0.66) had a lower odds of TTT>5 days. Younger (age<60) African Americans (vs non-Hispanic whites) had a higher odds of TTT >5 days (OR 1.43, CI 1.04-1.97). Delaying chemotherapy >10 days (vs 1-5 days) adversely impacted overall survival in both age groups (age<60: HR 1.26, CI 1.11-1.43; age≥60: HR 1.17, CI 1.06-1.28) (Table). However, TTT of 6-10 days (vs 1-5 days) affected overall survival in young (age<60: HR 1.15, CI 1.02-1.31), but not older patients. A TTT of 6-10 days (vs 1-5 days) adversely impacted 60-day survival in both age groups (age<60: HR 1.70, CI 1.24-2.33; age≥60: HR 1.27, CI 1.05-1.54); 60-day survival results were similar for a TTT >10 days (vs 1-5 days) (Table). Conclusions: In a large cohort of patients with de novo AML, TTT of up to 10 days did not have a negative impact on overall survival in patients over the age of 60. In younger patients (<age 60), TTT >5 days was associated with decreased overall survival. Delaying chemotherapy over 5 days adversely impacted 60-day survival in both age groups. Our observation that patients were more likely to have a shorter TTT at non-NCI designated hospitals may relate to delays associated with transfer to or clinical trial enrollment at NCI centers. Our results suggest that waiting to get results of ancillary testing, such as cytogenetic and molecular mutation analyses, in order to inform treatment decisions for AML patients, may be feasible in some patients with AML. In an era of rapidly evolving prognostic and treatment landscapes for AML, our findings may have implications for personalized therapy, including novel targeted therapies, and clinical trial design for patients withAML. Disclosures No relevant conflicts of interest to declare.

scholarly journals The impact of young age (< 40 years) on the outcome of a cohort of patients with primary non-metastatic breast cancer: analysis of 10-year survival of a prospective study

BMC Cancer ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Youssef Bouferraa ◽  
Yolla Haibe ◽  
Andrea Chedid ◽  
Elio Jabra ◽  
Maya Charafeddine ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Prospective Study ◽  
Age Groups ◽  
Metastatic Breast ◽  
Young Age ◽  
Survival Outcomes ◽  
Tumor Characteristics ◽  
Younger Age ◽  
The Impact

Abstract Background The role of young age (< 40 years) at diagnosis as an independent risk factor for adverse outcomes in female patients with breast cancer has been highlighted in several studies. In this prospective study, we assessed the difference in 10-year survival between two groups of patients diagnosed with non-metastatic breast cancer based on an age cutoff of 40 years. We also assessed the impact of factors including tumor characteristics, molecular markers and immunohistochemical markers on survival outcomes, highlighting the interaction of those variables with age. Methods A total of 119 female patients with newly diagnosed non-metastatic breast cancer were recruited at the American University of Beirut Medical Center (AUBMC) between July 2011 and May 2014. Patients were recruited and divided into 2 age groups (< 40 and ≥ 40 years). In addition to clinical characteristics, we assessed immunohistochemistry including estrogen, progesterone and HER2 receptors, p53, cyclin B1, vascular endothelial growth factor receptor (VEGFR), and ki-67. Germline BRCA mutations were also performed on peripheral blood samples. Patient and tumor characteristics were compared between the age groups. 10-year overall survival (OS) and disease-free survival (DFS) were estimated accordingly. Cox regression analysis was performed in order to assess the effect of the different variables on clinical outcomes. Results After a median Follow-up of 96 (13–122) months, the estimated 10-year OS was 98.6% for patients ≥40 as compared to 77.6% in patients < 40 (p = 0.001). A similar trend was found for 10-year DFS reaching 90% for patients ≥40 and 70.4% for those < 40 (p = 0.004). On multivariate analysis for DFS and OS, only younger age (< 40 years), higher stage and triple negative phenotype among other parameters assessed significantly affected the outcome in this cohort. Conclusion This prospective study confirms the association between younger age and adverse survival outcomes in patients with non-metastatic breast cancer. Future studies of the whole genome sequences may reveal the genomic basis underlying the clinical differences we have observed.

Sign in / Sign up

Export Citation Format

Share Document