scholarly journals Mortality trends and lengths of stay among hospitalized COVID-19 patients in Ontario and Québec (Canada): a population-based cohort study of the first three epidemic waves

2021 ◽  
Author(s):  
Yiqing Xia ◽  
Huiting Ma ◽  
David L Buckeridge ◽  
Marc Brisson ◽  
Beate Sander ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Mortality Risk ◽  
Temporal Trends ◽  
Population Based ◽  
Third Wave ◽  
Mortality Trends ◽  
Mortality Risks ◽  
The Third ◽  
Icu Stay ◽  
Over Time

AbstractBackgroundEpidemic waves of COVID-19 strained hospital resources. We describe temporal trends in mortality risk and length of stay in intensive cares units (ICUs) among COVID-19 patients hospitalized through the first three epidemic waves in Canada.MethodsWe used population-based provincial hospitalization data from Ontario and Québec to examine mortality risk and lengths of ICU stay. For each province, adjusted estimates were obtained using marginal standardization of logistic regression models, adjusting for patient-level characteristics and hospital-level determinants.ResultsUsing all hospitalizations from Ontario (N=26,541) and Québec (N=23,857), we found that unadjusted in-hospital mortality risks peaked at 31% in the first wave and was lowest at the end of the third wave at 6-7%. This general trend remained after controlling for confounders. The odds of in-hospital mortality in the highest hospital occupancy quintile was 1.2 (95%CI: 1.0-1.4; Ontario) and 1.6 (95%CI: 1.3-1.9; Québec) times that of the lowest quintile. Variants of concerns were associated with an increased in-hospital mortality. Length of ICU stay decreased over time from a mean of 16 days (SD=18) to 15 days (SD=15) in the third wave but were consistently higher in Ontario than Québec by 3-6 days.ConclusionIn-hospital mortality risks and lengths of ICU stay declined over time in both provinces, despite changing patient demographics, suggesting that new therapeutics and treatment, as well as improved clinical protocols, could have contributed to this reduction. Continuous population-based monitoring of patient outcomes in an evolving epidemic is necessary for health system preparedness and response.

scholarly journals Rapid Spread of the SARS-CoV-2 Variant of Concern 202012/01 in Southern Italy (December 2020–March 2021)

2021 ◽  
Vol 18 (9) ◽  
pp. 4766
Author(s):  
Daniela Loconsole ◽  
Francesca Centrone ◽  
Caterina Morcavallo ◽  
Silvia Campanella ◽  
Anna Sallustio ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Large Scale ◽  
Southern Italy ◽  
Whole Genome ◽  
Third Wave ◽  
Gene Target ◽  
The Third ◽  
Rapid Spread ◽  
Pharmaceutical Interventions ◽  
Over Time

Epidemiological and virological studies have revealed that SARS-CoV-2 variants of concern (VOCs) are emerging globally, including in Europe. The aim of this study was to evaluate the spread of B.1.1.7-lineage SARS-CoV-2 in southern Italy from December 2020–March 2021 through the detection of the S gene target failure (SGTF), which could be considered a robust proxy of VOC B.1.1.7. SGTF was assessed on 3075 samples from week 52/2020 to week 10/2021. A subset of positive samples identified in the Apulia region during the study period was subjected to whole-genome sequencing (WGS). A descriptive and statistical analysis of the demographic and clinical characteristics of cases according to SGTF status was performed. Overall, 20.2% of samples showed SGTF; 155 strains were confirmed as VOC 202012/01 by WGS. The proportion of SGTF-positive samples rapidly increased over time, reaching 69.2% in week 10/2021. SGTF-positive cases were more likely to be symptomatic and to result in hospitalization (p < 0.0001). Despite the implementation of large-scale non-pharmaceutical interventions (NPIs), such as the closure of schools and local lockdowns, a rapid spread of VOC 202012/01 was observed in southern Italy. Strengthened NPIs and rapid vaccine deployment, first among priority groups and then among the general population, are crucial both to contain the spread of VOC 202012/01 and to flatten the curve of the third wave.

scholarly journals Pandemic Fatigue: A Challenge in Combatting against COVID-19

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Mohd Rohaizat Hassan ◽  
Syed Sharizman Syed Abdul Rahim ◽  
Mohammad Saffree Jeffree
Keyword(s):  
Third Wave ◽  
Psychological Consequences ◽  
The Third ◽  
Social Structural ◽  
The World ◽  
Protective Behaviours ◽  
Over Time ◽  
Simple Definition

  The COVID -19 pandemic has hit the world for a period of a year and a half; it has been a triple crisis, with medical, economic, and psychological consequences. After 18 months of going through a pandemic, this includes not only facing the transmission of SARS CoV-2 virus but also restricted movements. Communities are now facing pandemic fatigue starting as early as the third wave of increased cases in September 2020. Pandemic fatigue is the stage when the initial enthusiasm and eagerness to tackle the crisis is replaced by feelings of exhaustion. In a simple definition, pandemic fatigue is understood as demotivation to follow recommended protective behaviours. It is a natural and expected reaction to sustained and unresolved adversity in people’s lives, evolving gradually over time and affected by several emotions, experiences, and perceptions as well as the cultural, social, structural, and legislative environment.

scholarly journals Temporal Trends in Surgical Resection Rates and Biologic Prescribing in Crohn’s Disease: A Population-based Cohort Study

2020 ◽  
Vol 14 (9) ◽  
pp. 1241-1247
Author(s):  
P W Jenkinson ◽  
N Plevris ◽  
S Siakavellas ◽  
M Lyons ◽  
I D Arnott ◽  
...  
Keyword(s):  
Cohort Study ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Biologic Therapy ◽  
Temporal Trends ◽  
Cumulative Risk ◽  
Population Based ◽  
Cumulative Probability ◽  
Cox Regression Analysis ◽  
Over Time

Abstract Background The use of biologic therapy for Crohn’s disease [CD] continues to evolve, however, the effect of this on the requirement for surgery remains unclear. We assessed changes in biologic prescription and surgery over time in a population-based cohort. Methods We performed a retrospective cohort study of all 1753 patients diagnosed with CD in Lothian, Scotland, between January 1, 2000 and December 31, 2017, reviewing the electronic health record of each patient to identify all CD-related surgery and biologic prescription. Cumulative probability and hazard ratios for surgery and biologic prescription from diagnosis were calculated and compared using the log-rank test and Cox regression analysis stratified by year of diagnosis into cohorts. Results The 5-year cumulative risk of surgery was 20.4% in cohort 1 [2000–2004],18.3% in cohort 2 [2005–2008], 14.7% in cohort 3 [2009–2013], and 13.0% in cohort 4 [2014–2017] p &lt;0.001. The 5-year cumulative risk of biologic prescription was 5.7% in cohort 1, 12.2% in cohort 2, 22.0% in cohort 3, and 44.9% in cohort 4 p &lt;0.001. Conclusions The increased and earlier use of biologic therapy in CD patients corresponded with a decreasing requirement for surgery over time within our cohort. This could mean that adopting a top-down or accelerated step-up treatment strategy may be effective at reducing the requirement for surgery in newly diagnosed CD.

Party Systems in Latin America

2020 ◽  
Author(s):  
Laura Wills-Otero
Keyword(s):  
Latin America ◽  
Latin American ◽  
Party System ◽  
Party Systems ◽  
Third Wave ◽  
The Third ◽  
Voter Preferences ◽  
Political Configuration ◽  
American Party ◽  
Over Time

Since the beginning of the third wave of democratization in the late 1970s, Latin American party systems have confronted several challenges, and they have frequently been transformed. There have been various types of changes. While some systems collapsed in the 1990s (e.g., Venezuela and Peru), others realigned (Colombia, Chile, and Uruguay), or expanded (Argentina and Mexico), or were able to become consolidated and ensure their stability over time (e.g., Brazil). What factors explain the transformations in party systems during the past three decades, and how can Latin American party systems be classified according to their attributes? In trying to answer these questions, scholars of Latin America have undertaken studies that are both theoretically and empirically rich. Their work has increased our knowledge of the party systems and representative democracies in the region. Different factors have been highlighted in order to explain the changes these systems have undergone since the third wave of democratization. Some works emphasize the importance of institutional reforms introduced by politicians or by constitutional assemblies. The questions they address are the following: What political reforms have been introduced into Latin American political systems, and what effects have they had on the party systems in different countries? The researchers do not limit their attention to reforms of electoral systems. For example, some of them also study decentralization processes and their effects on party systems. From a different perspective, other authors focus on changes in electoral preferences and their effects on the configuration of political power, exploring how regional economic, political, and social changes have affected voter preferences and the political configuration of party systems. Still others consider the crises of democratic representation in these countries, underlining the decline in the programmatic character of parties as an explanatory variable for the crises and noting that the level of institutionalization of a party system declines when parties abandon this distinctive feature and become clientelistic or personalistic instead. On the other hand, in order to describe party systems and to observe the changes they have undergone, academics have proposed a set of concepts and measurements that make it possible to identify their levels of institutionalization (i.e., stability vs. volatility), nationalization, and programmatic structuration, among other aspects. The operationalization of these concepts has provided researchers with useful data for describing, comparing, and analyzing the party systems of the region transversely over time. Understanding the transformation and characteristics of Latin American party systems over time sheds light on both the progress democratic regimes have made and the setbacks they have suffered within specific countries and in the region at large.

scholarly journals Oral Morphine Use in South India: A Population-Based Study

2017 ◽  
Vol 3 (6) ◽  
pp. 720-727 ◽  
Author(s):  
M.R. Rajagopal ◽  
Safiya Karim ◽  
Christopher M. Booth
Keyword(s):  
Temporal Trends ◽  
Oral Morphine ◽  
Population Based ◽  
Private Institutions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Provider Characteristics ◽  
Regional Trends ◽  
Per Capita ◽  
Over Time

Purpose Access to opioids for pain control is recognized as an urgent issue in low- and middle-income countries. Here we report temporal and regional trends in morphine use in Kerala, India. Methods Oral morphine use data for the State of Kerala (2012 to 2015) was used to describe temporal trends, regional variation, and provider characteristics. Total morphine use was calculated for each district of Kerala to derive an annual per capita use rate (milligrams per capita). Each provider was classified as government, private, nongovernment organization (NGO), or NGO partnership. Results Oral morphine use for Kerala was 1.32 mg/capita and increased over the study period 27% (from 1.23 mg/capita to 1.56 mg/capita). There was substantial variation in morphine use across districts (range, 0.49 mg/capita to 2.97 mg/capita; six-fold difference). This variation increased over time (19-fold difference in 2015). In 2015, 31% of morphine providers (51 of 167) were government institutions; they delivered 48% of total morphine in Kerala. Corresponding data for other providers are private institutions, 23% of centers and 13% of morphine; NGOs, 41% of centers and 34% of morphine; and NGO partnerships, 5% of centers and 4% of morphine. From 2012 to 2015, the total number of centers increased by 35%, from 124 to 167. Conclusion Oral morphine use has increased over time in Kerala but remains substantially lower than estimated need. There is significant geographic variation of use. Efforts are needed to improve palliative care in Kerala and to reduce regional disparities in access to opioids.

scholarly journals Temporal Trends in Heat-Related Mortality: Implications for Future Projections

Atmosphere ◽  
2018 ◽  
Vol 9 (10) ◽  
pp. 409 ◽  
Author(s):  
Patrick Kinney
Keyword(s):  
Climate Change ◽  
High Temperatures ◽  
Temporal Trends ◽  
Premature Mortality ◽  
Mortality Risks ◽  
Exposure Response ◽  
Heat Effects ◽  
Trends Over Time ◽  
Over Time ◽  
Related Mortality

High temperatures have large impacts on premature mortality risks across the world, and there is concern that warming temperatures associated with climate change, and in particular larger-than-expected increases in the proportion of days with extremely high temperatures, may lead to increasing mortality risks. Comparisons of heat-related mortality exposure-response functions across different cities show that the effects of heat on mortality risk vary by latitude, with more pronounced heat effects in more northerly climates. Evidence has also emerged in recent years of trends over time in heat-related mortality, suggesting that in many locations, the risk per unit increase in temperature has been declining. Here, I review the emerging literature on these trends, and draw conclusions for studies that seek to project future impacts of heat on mortality. I also make reference to the more general heat-mortality literature, including studies comparing effects across locations. I conclude that climate change projection studies will need to take into account trends over time (and possibly space) in the exposure response function for heat-related mortality. Several potential methods are discussed.

scholarly journals Comprehensive analysis of in-hospital delirium after major surgical oncology procedures

2019 ◽  
Vol 14 (3) ◽  
Author(s):  
Marco Bandini ◽  
Michele Marchioni ◽  
Felix Preisser ◽  
Sebastiano Nazzani ◽  
Zhe Tian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Lung Resection ◽  
Temporal Trends ◽  
Surgical Oncology ◽  
Population Based ◽  
Hospital Charges ◽  
Weighted Estimate ◽  
Prolonged Length

Introduction: Very few population-based assessments of delirium have been performed to date. These have not assessed the implications of delirium after major surgical oncology procedures (MSOPs). We examined the temporal trends of delirium following 10 MSOPs, as well as patient and hospital delirium risk factors. Finally, we examined the effect of delirium on length of stay, in-hospital mortality, and hospital charges. Methods: We retrospectively identified patients who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection, or pancreatectomy within the Nationwide Inpatient Sample (2003‒2013). We yielded a weighted estimate of 3 431 632 patients. Multivariable logistic regression (MLR) analyses identified the determinants of postoperative delirium, as well as the effect of delirium on length of stay, in-hospital mortality, and hospital charges. Results: Between 2003 and 2013, annual delirium rate increased from 0.7 to 1.2% (+6.0%; p<0.001). Delirium rates were highest after cystectomy (predicted probability [PP] 3.1%) and pancreatectomy (PP 2.6%) and lowest after prostatectomy (PP 0.15%) and mastectomy (PP 0.13%). Advanced age (odds ratio [OR] 3.80), maleness (OR 1.38), and higher Charlson comorbidity index (OR 1.20), as well as postoperative complications represent risk factors for delirium after MSOPs. Delirium after MSOP was associated with prolonged length of stay (OR 3.00), higher mortality (OR 1.15) and increased in-hospital charges (OR 1.13). Conclusions: No contemporary population-based assessments of delirium after MSOP have been reported. According to our findings, delirium after MSOP has a profound impact on patient outcomes that ranges from prolonged length of stay to higher mortality and increased in-hospital charges.

scholarly journals Time trends in social contacts of individuals according to comorbidity and vaccination status, before and during the COVID-19 pandemic: repeated cross-sectional population-based surveys

2021 ◽  
Author(s):  
Aurélie Godbout ◽  
Mélanie Drolet ◽  
Myrto Mondor ◽  
Marc Simard ◽  
Chantal Sauvageau ◽  
...  
Keyword(s):  
Time Trends ◽  
Population Based ◽  
Vaccination Status ◽  
Physical Contact ◽  
Third Wave ◽  
Cross Sectional ◽  
Social Contacts ◽  
The Third ◽  
Significant Difference ◽  
Second Wave

ABSTRACTObjectivesTo describe time trends in social contacts of individuals according to comorbidity and vaccination status before and during the first three waves of the COVID-19 pandemic in Quebec, Canada.DesignRepeated cross-sectional population-based surveys.SettingGeneral population.ParticipantsNon-institutionalized adults from Quebec, Canada, recruited by random digit dialling before (2018/2019) and during the pandemic (April 2020 to July 2021). A total of 1441 and 5185 participants with and without comorbidities, respectively, were included in the analyses.Main outcome measuresNumber of social contacts (two-way conversation at a distance ≤2 meters or a physical contact, irrespective of masking) documented in a self-administered web-based questionnaire. We compared the mean number of contacts according to the comorbidity status of participants (pre-existing medical conditions with symptoms/medication in the past 12 months) and 1-dose vaccination status during the third wave. All analyses were performed using weighted generalized linear models with a Poisson distribution and robust variance.ResultsContacts significantly decreased from a mean of 6.1 (95% confidence interval 4.9 to 7.3) before the pandemic to 3.2 (2.5 to 3.9) during the first wave among individuals with comorbidities, and from 8.1 (7.3 to 9.0) to 2.7 (2.2 to 3.2) among individuals without comorbidities. Individuals with comorbidities maintained fewer contacts than those without comorbidities in the second wave, with a significant difference before the Christmas 2020/2021 holidays (2.9 (2.5 to 3.2) v 3.9 (3.5 to 4.3); P<0.001). During the third wave, contacts were similar for individuals with (4.1, 3.4 to 4.7) and without comorbidities (4.5, 4.1 to 4.9; P=0.27). This could be partly explained by individuals with comorbidities vaccinated with their first dose who increased their contacts to the level of those without comorbidities.ConclusionsThe lower level of contacts maintained by individuals with comorbidities could have influenced the burden of hospitalisations and deaths of the second wave in Quebec. It will be important to closely monitor COVID-19-related outcomes and social contacts by comorbidity and vaccination status to inform targeted or population-based interventions.

scholarly journals COVID-19 Demographics, Acute Care Resource Use and Mortality by Age and Sex in Ontario, Canada: Population-based Retrospective Cohort Analysis

2020 ◽  
Author(s):  
Stephen Mac ◽  
Kali Barrett ◽  
Yasin A. Khan ◽  
David MJ Naimark ◽  
Laura Rosella ◽  
...  
Keyword(s):  
Acute Care ◽  
Resource Use ◽  
Cohort Analysis ◽  
Invasive Mechanical Ventilation ◽  
Temporal Trends ◽  
Age Groups ◽  
Population Based ◽  
Term Care ◽  
Over Time ◽  
Age And Sex

AbstractBackgroundUnderstanding resource use for COVID-19 is critical. We conducted a population-based cohort study using public health data to describe COVID-19 associated age- and sex-specific acute care use, length of stay (LOS), and mortality.MethodsWe used Ontario’s Case and Contact Management (CCM) Plus database of individuals who tested positive for COVID-19 in Ontario from March 1 to September 30, 2020 to determine age- and sex-specific hospitalizations, intensive care unit (ICU) admissions, invasive mechanical ventilation (IMV) use, LOS, and mortality. We stratified analyses by month of infection to study temporal trends and conducted subgroup analyses by long-term care residency.ResultsDuring the observation period, 56,476 COVID-19 cases were reported (72% < 60 years, 52% female). The proportion of cases shifted from older populations (> 60 years) to younger populations (10-39 years) over time. Overall, 10% of individuals were hospitalized, of those 22% were admitted to ICU, and 60% of those used IMV. Mean LOS for individuals in the ward, ICU without IMV, and ICU with IMV was 12.8, 8.5, 20.5 days, respectively. Mortality for individuals receiving care in the ward, ICU without IMV, and ICU with IMV was 24%, 30%, and 45%, respectively. All outcomes varied by age and decreased over time, overall and within age groups.InterpretationThis descriptive study shows acute care use and mortality varying by age, and decreasing between March and September in Ontario. Improvements in clinical practice and changing risk distributions among those infected may contribute to fewer severe outcomes among those infected with COVID-19.

Surgical treatment for infective endocarditis over three decades: a nationwide study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Dalsgaard Jensen ◽  
M.H Smerup ◽  
H Bundgaard ◽  
J.H Butt ◽  
N.E Bruun ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mortality Risk ◽  
Temporal Trends ◽  
Valve Surgery ◽  
Annual Number ◽  
Nationwide Study ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
First Time ◽  
Over Time

Abstract Background An increasing number of patients with infective endocarditis (IE) are treated surgically over time. It is important to know how this affects patient outcome. Current studies are mainly from tertiary centres which may bias estimations of outcomes. We have therefore conducted a nationwide study of surgical outcomes during admission for IE over three decades. Purpose We set out to examine temporal trends in use of valve surgery for IE and these patients' characteristics and related outcomes in Denmark in the period 1998–2017. Methods Using Danish nationwide registries, we included patients with first-time IE (1998–2017). The study population was categorized into four groups of five-year intervals (1998–2002, 2003–2007, 2008–2012, 2012–2017). Annual number of patients with IE and the proportion who underwent valve surgery during admission were reported. Kaplan-Meier estimates and multivariable logistic regression analyses were used to compare the associated 30-day mortality risk between calendar periods. Kaplan-Meier estimates and multivariable adjusted Cox proportional hazard analyses were used compare the associated 1-year mortality risk between calendar periods. Results A total of 8,455 patients with first-time IE were identified in the period of 1998–2017 of which 1,906 (22.5%) underwent valve surgery (1998–2002; N=320, 2003–2007; N=468, 2008–2012; N=528, 2013–2017; N=595). The proportion of patients who underwent surgery was 21.5% in 1998 and 19.4% in 2017 (P=0.02 for trend). See figure. For patients undergoing surgery, the median age and proportion of males increased from 58.3 years (P25-P75: 48.2–67.4) and 69.1% to 66.7 years (P25-P75: 55.2–73.0) and 73.1% in 1998–2002 and 2013–2017, respectively. Patients had an increasing burden of comorbidities including diabetes (10.3% to 14.3%), hypertension (16.9% to 37.5%) and renal disease (9.1% to 9.6%) across calendar periods. The 30-day mortality risk for patients with IE who underwent valve surgery was 10.0% (1998–2002), 10.8% (2003–2007), 6.4% (2008–2012) and 8.5% (2013–2017), respectively (P=0.09). One-year mortality risk for patients with IE who underwent valve surgery was 16.7% (1998–2002), 21.2% (2003–2007), 15.2% (2008–2012) and 16.6% (2013–2017), respectively (P=0.08). The declining 30-day and 1-year mortality was statistically significant over time when adjusting for patient characteristics (P=0.01 and P≤0.0001, respectively). Conclusion From a nationwide, unselected cohort of patients with first-time IE, around 1/5 undergo surgery during admission. Surgical IE-cases are older and sicker now compared to 10–20 years ago. In spite of this, there was a trend towards a decreased associated 30-day and 1-year mortality over time. Our data show a lower rate of surgery in IE than in most prior studies and we believe that this is due to the nationwide, unselected nature of our study. Infective endocarditis and surgery Funding Acknowledgement Type of funding source: None

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