Quickscan assesses risk factors of long-term sickness absence: A cross-sectional (factorial) construct validation study

BACKGROUND Movement of patients in a healthcare network poses challenges for the control of carbapenemase-producing Enterobacteriaceae (CPE). We aimed to identify intra- and inter-facility transmission events and facility type-specific risk factors of CPE in an acute care hospital (ACH) and its intermediate-term and long-term care facilities (ILTCFs). METHODS Serial cross-sectional studies were conducted in June-July of 2014-2016 to screen for CPE. Whole genome sequencing was done to identify strain relatedness and CPE genes (blaIMI; blaIMP-1; blaKPC-2; blaNDM-1; blaOXA-48). Multivariable logistic regression models, stratified by facility type were used to determine independent risk factors. RESULTS Of 5357 patients, half (55%) were from the ACH. CPE prevalence was 1.3% in the ACH and 0.7% in ILTCFs (p=0.029). After adjusting for socio-demographics, screening year, and facility type, the odds of CPE colonization increased significantly with hospital stay ≥ 3 weeks (aOR 2.67, 95%CI 1.17-6.05), penicillins use (aOR 3.00, 95%CI 1.05–8.56), proton pump inhibitors use (aOR 3.20, 95%CI 1.05–9.80), dementia (aOR 3.42, 95%CI 1.38–8.49), connective tissue disease (aOR 5.10, 95%CI 1.19-21.81), and prior carbapenem-resistant Enterobacteriaceae (CRE) carriage (aOR 109.02, 95%CI 28.47–417.44) in the ACH. For ILTCFs, presence of wound (aOR 5.30, 95%CI 1.01–27.72), respiratory procedures (aOR 4.97, 95%CI 1.09-22.71), vancomycin-resistant Enterococci carriage (aOR 16.42, 95%CI 1.52–177.48), and CRE carriage (aOR 758.30, 95%CI 33.86-16982.52) showed significant association. Genomic analysis revealed only possible intra-ACH transmission, and no evidence for ACH-to-ILTCFs transmission. CONCLUSIONS Although CPE colonization was predominantly in the ACH, risk factors varied between facilities. Targeted screening and precautionary measures are warranted.

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POLYPHARMACY IN DIABETIC PEOPLE: EVIDENCE FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING (ELSA)

Innovation in Aging ◽

10.1093/geroni/igz038.1794 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S482-S483

Author(s):

Yun-Ting Huang ◽

Paola Zaninotto ◽

Andrew Steptoe ◽

Li Wei

Keyword(s):

Risk Factors ◽

Older People ◽

Significant Risk ◽

Cross Sectional Study ◽

Health Condition ◽

Cross Sectional ◽

Nationally Representative ◽

English Longitudinal Study

Abstract Diabetes among older people is becoming more common worldwide, and usually accompanied by polypharmacy. However, the role of polypharmacy in older people with diabetes remains uncertain. A nationally representative cross-sectional study, ELSA 2012/2013, was used and 7729 participants aged 50-109 were investigated. Polypharmacy was defined as taking five to nine long-term used medications daily for chronic diseases or chronic symptoms, while using ten or more medications was excessive polypharmacy. The presence of illness was defined as either self-reported diagnosis or being prescribed specific medications for the condition. Data showed the prevalence of polypharmacy was 21.4%, and only 3% was excessive polypharmacy. 51.6% of diabetic people reported polypharmacy and 10.2% excessive polypharmacy. These rates were significantly higher than the 16.4% polypharmacy and 1.8% excessive polypharmacy among people without diabetes (p < 0.001). Among people with three or more comorbidities, polypharmacy was present in 61.5% of people with diabetes, compared with 36.0% in people without diabetes. Significant risk factors for polypharmacy were diabetes (Relative-risk ratios/RRR=4.06, 95% CI 3.38, 4.86), older age (RRR=1.02, 95% CI 1.01, 1.03), male (RRR=0.64, 95% CI 0.55, 0.75), more comorbidity (RRR=2.46, 95% CI 2.30, 2.62), living with a partner (RRR=1.20, 95% CI 1.01, 1.42), and less wealth (RRR=0.93, 95% CI 0.87, 0.98). However, age, cohabitation, and wealth were not significantly related to excessive polypharmacy. Diabetes and the number of comorbidities were predominant risk factors for excessive polypharmacy. Current evidences confirmed both health condition and socioeconomic status were associated with medication use in older adults.

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Short Paper: Risk Factors for Long-Term Persistent Symptoms in COVID-19 in an Outpatient Cohort (Preprint)

10.2196/preprints.22943 ◽

2020 ◽

Author(s):

James O'Keefe ◽

Ghazala A Datoo O’Keefe ◽

Anthony Mufarreh

Keyword(s):

Risk Factors ◽

Categorical Variables ◽

Short Paper ◽

Symptom Duration ◽

Continuous Variables ◽

Cross Sectional ◽

Persistent Symptoms ◽

Long Term Follow Up

BACKGROUND Symptom descriptions in outpatients with COVID-19 are limited to cross-sectional surveys and longitudinal follow-up of long term symptoms has not been reported. Symptom duration is important for patient and provider knowledge in managing outpatient COVID-19. OBJECTIVE Describe the presence of symptoms at long term follow-up of patients managed in an outpatient telemedicine program for acute COVID-19. METHODS Chart review of clinical notes for acute COVID-19 and long term follow-up calls. Descriptive analysis were conducted using Wilcoxon rank-sum for continuous variables and chi-square or Fisher’s Exact as appropriate for categorical variables. RESULTS Minor symptoms were reported by 55 patients (34.8%) and 7 (4.4%) reported major ongoing symptoms at follow-up call. Factors associated with prolonged symptoms include older age, provider reported higher symptom severity at intake visit, and BMI >30. Symptoms which persisted include shortness of breath on exertion, wheeze, nausea, and joint pain. CONCLUSIONS Persistence of symptoms after acute COVID-19 in outpatients is common. Risk factors may help predict which patients are more likely to have prolonged symptoms.

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