COVID-19 in persons aged 70+ in an early affected German district: Risk factors, mortality and post-COVID care needs—A retrospective observational study of hospitalized and non-hospitalized patients

Background Cohorts of hospitalized COVID-19 patients have been studied in several countries since the beginning of the pandemic. So far, there is no complete survey of older patients in a German district that includes both outpatients and inpatients. In this retrospective observational cohort study, we aimed to investigate risk factors, mortality, and functional outcomes of all patients with COVID-19 aged 70 and older living in the district of Tübingen in the southwest of Germany. Methods We retrospectively analysed all 256 patients who tested positive for SARS-CoV-2 in one of the earliest affected German districts during the first wave of the disease from February to April 2020. To ensure inclusion of all infected patients, we analysed reported data from the public health department as well as the results of a comprehensive screening intervention in all nursing homes of the district (n = 1169). Furthermore, we examined clinical data of all hospitalized patients with COVID-19 (n = 109). Results The all-cause mortality was 18%. Screening in nursing homes showed a point-prevalence of 4.6%. 39% of residents showed no COVID-specific symptoms according to the official definition at that time. The most important predictors of mortality were the need for inpatient treatment (odds ratio (OR): 3.95 [95%-confidence interval (CI): 2.00–7.86], p<0.001) and care needs before infection (non-hospitalized patients: OR: 3.79 [95%-CI: 1.01–14.27], p = 0.037, hospitalized patients: OR: 2.89 [95%-CI 1.21–6.92], p = 0.015). Newly emerged care needs were a relevant complication of COVID-19: 27% of previously self-sufficient patients who survived the disease were not able to return to their home environment after discharge from the hospital. Conclusion Our findings demonstrate the importance of a differentiated view of risk groups and long-term effects within the older population. These findings should be included in the political and social debate during the ongoing pandemic to evaluate the true effect of COVID-19 on healthcare systems and individual functional status.

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Hypertension and Related Comorbidities as Potential Risk Factors for COVID-19 Hospitalization and Severity: A Prospective Population-Based Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10061194 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1194

Author(s):

Ujué Fresán ◽

Marcela Guevara ◽

Camino Trobajo-Sanmartín ◽

Cristina Burgui ◽

Carmen Ezpeleta ◽

...

Keyword(s):

Risk Factors ◽

Potential Risk ◽

Kidney Diseases ◽

Risk Groups ◽

Population Based ◽

Hospitalized Patients ◽

Independent Effect ◽

Adjusted Relative Risk ◽

Chronic Kidney Diseases ◽

Potential Risk Factors

The independent role of hypertension for COVID-19 outcomes in the population remains unclear. We aimed to estimate the independent effect of hypertension and hypertension-related conditions, i.e., cardiovascular, cerebrovascular and chronic kidney diseases, as potential risk factors for COVID-19 hospitalization and severe COVID-19 (i.e., intensive care unit admission or death) in the population. The risk for severe COVID-19 among hospitalized patients was also evaluated. A Spanish population-based cohort of people aged 25–79 years was prospectively followed from March to May 2020 to identify hospitalizations for laboratory-confirmed COVID-19. Poisson regression was used to estimate the adjusted relative risk (aRR) for COVID-19 hospitalization and severe COVID-19 among the whole cohort, and for severe COVID-19 among hospitalized patients. Of 424,784 people followed, 1106 were hospitalized by COVID-19 and 176 were severe cases. Hypertension was not independently associated with a higher risk of hospitalization (aRR 0.96, 95% CI 0.83–1.12) nor severe COVID-19 (aRR 1.12, 95% CI 0.80–1.56) in the population. Persons with cardiovascular, cerebrovascular and chronic kidney diseases were at higher risk for COVID-19 hospitalization (aRR 1.33, 95% CI 1.13–1.58; aRR 1.41, 95% CI 1.04–1.92; and aRR 1.52, 95% CI 1.21–1.91; respectively) and severe COVID-19 (aRR 1.61, 95% CI 1.13–2.30; aRR 1.91, 95% CI 1.13–3.25; and aRR 1.78, 95% CI 1.14–2.76; respectively). COVID-19 hospitalized patients with cerebrovascular diseases were at higher risk of mortality (aRR 1.80, 95% CI 1.00–3.23). The current study shows that, in the general population, persons with cardiovascular, cerebrovascular and chronic kidney diseases, but not those with hypertension only, should be considered as high-risk groups for COVID-19 hospitalization and severe COVID-19.

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Epidemiological differences and risk factors for hospitalization in people living with HIV in Istanbul, Turkey

International Journal of STD & AIDS ◽

10.1177/0956462419866326 ◽

2019 ◽

Vol 30 (13) ◽

pp. 1284-1289

Author(s):

Sevtap Şenoğlu ◽

Zuhal Yeşilbağ ◽

Hayat K Karaosmanoğlu ◽

Özlem A Aydın

Keyword(s):

Risk Factors ◽

Risk Groups ◽

Hospitalized Patients ◽

Older Age ◽

Initial Presentation ◽

People Living With Hiv ◽

Laboratory Findings ◽

Cd4 Cell Count ◽

Treatment Naïve ◽

Living With Hiv

We aimed to determine the risk factors for hospitalization in treatment-naïve people living with HIV (PLHIV) and also the frequency of HIV-related comorbidities in hospitalized patients. Sociodemographic, clinical, and laboratory findings of treatment-naïve PLHIV followed up in our department between January 2015 and July 2018 were retrospectively evaluated and risk factors for hospitalization at initial presentation were analyzed. A total of 629 patients were included. In all, 558 patients (88.7%) were male and 326 (51.8%) were men who have sex with men (MSM), and 8.6% of all patients were hospitalized at initial presentation. When comparing outpatient and inpatient groups, the mean age (p < 0.001), rates of having heterosexual (HS) intercourse (p < 0.001), low education level (p < 0.001), late presenters (p < 0.001), and CD4 cell count < 50 cells/mm3 (p < 0.001) were significantly higher in the inpatient group. In logistic regression analysis, older age and CD4 T lymphocyte count < 50 cells/mm3 were found to be independent risk factors for hospitalization. Among hospitalized patients, 55.5% had oropharyngeal/esophageal candidiasis, 38.9% had tuberculosis, corresponding to a HIV-related comorbidity in 118 patients, among whom a mortality rate of 9.2% was detected. The rate of hospitalization was high among our patients. The majority of the hospitalized patients were HS individuals with a relatively older age who had low educational level. A lower rate of hospitalizations in a higher risk group such as MSM suggests that educational and preventive activities are required to increase awareness and to encourage HIV testing, not only in high-risk groups, but also in the general population.

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The Pathophysiology of Virulence of the COVID-19 Virus

10.20944/preprints202004.0077.v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Joseph De Soto ◽

Shazia Hakim ◽

Frederick Boyd

Keyword(s):

Risk Factors ◽

Ethnic Groups ◽

Clinical Presentation ◽

Expression Patterns ◽

Health Department ◽

World Health ◽

Public Health Department ◽

Receptor Binding Site ◽

Treatment Protocols ◽

Underlying Pathophysiology

Background: On Dec 19, 2019 it was reported by the public health department of China that an outbreak of pneumonia was caused by a novel Coronavirus. The virulence of the new virus COVID-19 was much greater than either the SARs or MERSs viruses and on March 11, 2020 the World Health Department (WHO) declared world -wide pandemic. Understanding the pathophysiology of virulence of the COVID-19 virus is absolutely necessary in understanding the transmission, virulence factors, reduce risk factors, clinical presentation, predict outcomes of the disease and provide guidance to any current or future treatment protocols. Methodology: A PubMed search was performed utilizing the words: Wuhan Virus, COVID-19, SARs coronavirus, ACE2, S protein, virulence, clinical presentation, epidemiology, genome, treatment, structure, MERs, pathogenesis and/or pathology alone and in combination with other terms. Each paper was evaluated by three content experts for quality, reproducibility, credibility and reputation of the journal. Results: The COVID-19 virus is much more virulent than either the SARs or MERs virus and its ability to cause serious disease inversely corresponds to the person’s ability to produce T-cells which declines linearly with age. The ACE2 receptor binding site do not vary among different ethnic groups but do in expression levels. This variance in expression level may explain for different infectivity rates among men and women and predict and explain different susceptibilities to infection by different ethnic groups. Furthermore, by understanding the underlying pathophysiology one can explain and provide guidance to the clinical effectiveness of any treatment. Conclusions: The underlying pathophysiology of COVID-19 explains not only the virulence, and clinical presentation, but, explains at a molecular level the comorbidity risk factors such as hypertension, sex, and age. Ethnic and anatomic expression patterns of ACE-2 and associated pathophysiology suggests that Native Americans and Asians may be particularly susceptible to this disease.

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Continence Status and Presence of Pressure Skin Injury among Special Elderly Nursing Home Residents in Japan: A Nationwide Cross-Sectional Survey

Geriatrics ◽

10.3390/geriatrics6020034 ◽

2021 ◽

Vol 6 (2) ◽

pp. 34

Author(s):

Motofumi Suzuki ◽

Megumi Kodaira ◽

Keiko Suyama ◽

Taro Murata ◽

Haruki Kume

Keyword(s):

Risk Factors ◽

Nursing Homes ◽

Fecal Incontinence ◽

Significant Risk ◽

Care Needs ◽

Cross Sectional ◽

Double Incontinence ◽

Pressure Injury ◽

Continence Status ◽

Skin Pressure

Urinary and fecal incontinence as well as skin pressure injury are common healthcare problems in nursing homes; however, the prevalence and related risk factors were not well understood in the Japanese special elderly nursing home settings. We surveyed the prevalence of urinary, fecal and double incontinence, and skin pressure injury among the elderly living in special elderly nursing homes in Japan. A nationwide cross-sectional epidemiological survey was conducted with a total of 4881 residents. The prevalence of urinary, fecal and double incontinence was 82.9%, 68.9% and 64.9%, respectively. Skin pressure injury was found in 283 residents (283/4881, 5.8%). Age, Care-Needs level, loss of voiding desire, and fecal incontinence were significant risk factors for urinary incontinence. Residential period, Care-Needs level, loss of voiding and defecation desires, and urinary incontinence were significant risk factors for fecal incontinence. Only male sex was a significant risk factor for skin pressure injury. Our study revealed continence status and the prevalence of pressure skin injury among older adult residents who receive end-of-life care in special elderly nursing homes in Japan. Further studies should be conducted to examine whether recovery of urinary and fecal sensations improves continence status.

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The Pathophysiology of Virulence of the COVID-19

10.20944/preprints202004.0077.v2 ◽

2020 ◽

Author(s):

Joseph De Soto ◽

Shazia Hakim ◽

Frederick Boyd

Keyword(s):

Risk Factors ◽

Ethnic Groups ◽

Clinical Presentation ◽

Expression Patterns ◽

Health Department ◽

World Health ◽

Public Health Department ◽

Receptor Binding Site ◽

Treatment Protocols ◽

Underlying Pathophysiology

Background: On Dec 19, 2019, the public health department of China reported that an outbreak of pneumonia was caused by a novel Coronavirus. The virulence of the new virus COVID-19 was much greater than either the SARs and MERSs viruses and on March 11, 2020, the World Health Department (WHO) declared a worldwide pandemic. Understanding the pathophysiology of virulence of the SARS-COV-2 virus is absolutely necessary for understanding the transmission, virulence factors, reduce risk factors, clinical presentation, predict outcomes of the disease and provide guidance for any current or future treatment protocols. Methodology: A comprehensive PubMed search was performed during December 20, 2019 and April 03, 2020, utilizing the words: Wuhan Virus, COVID-19, SARs coronavirus, ACE2, S-protein, virulence, clinical presentation, epidemiology, genome, treatment, structure, MERs, pathogenesis and/or pathology alone and in combination with other terms. Each paper was evaluated by three content experts for quality, reproducibility, credibility and reputation of the journal. Results: The SARS-COV-2 virus is much more virulent than either the SAR’s or MER’s virus and its ability to cause serious disease inversely corresponds to the person’s ability to produce T-cells which declines linearly with age. The ACE2 receptor binding site does not vary among different ethnic groups but do in ACE-2 expression levels. This variance in expression level may explain for different infectivity rates among men and women and predict and explain different susceptibilities to infection by different ethnic groups. Furthermore, by understanding the underlying pathophysiology one can explain and provide guidance to the clinical effectiveness of any treatment. Conclusions: The underlying pathophysiology of COVID-19 explains not only the virulence, and clinical presentation, but, explains at a molecular level the comorbidity risk factors such as hypertension, sex, and age. Ethnic and anatomic expression patterns of ACE-2 and associated pathophysiology suggests that Native Americans and Asians may be particularly susceptible to this disease.

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Körperliche Beschwerden bei älteren Migranten in Deutschland 1Erstellt unter Mitwirkung der Arbeitsgruppe «Abuse of the Elderly in the European Region» (ABUEL): Joaquim F. J. Soares, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Francisco Torres-González, Departmental Section of Psychiatry and Psychological Medicine, University of Granada, Spain; Elisabeth Ioannidi-Kapolou, National School of Public Health, Department of Sociology, Athens, Greece; Giovanni Lamura, Italian National Research Centre on Ageing Department of Gerontological Research, Unit of Health Economics, Ancona, Italy; Mindaugas Stankunas, Kaunas University of Medicine, Department of Health Management, A. Mickeviciaus, Kaunas, Lithuania; Henrique Barros, Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.

Zeitschrift für Psychiatrie Psychologie und Psychotherapie ◽

10.1024/1661-4747.a000028 ◽

2010 ◽

Vol 58 (3) ◽

pp. 199-206 ◽

Cited By ~ 3

Author(s):

Rosina-Martha Csöff ◽

Gloria Macassa ◽

Jutta Lindert

Keyword(s):

Public Health ◽

Health Management ◽

The Elderly ◽

Health Department ◽

Research Unit ◽

Research Centre ◽

Public Health Department ◽

Karolinska Institute ◽

Psychological Medicine ◽

Körperliche Beschwerden

Körperliche Beschwerden sind bei Älteren weit verbreitet; diese sind bei Migranten bislang in Deutschland und international noch wenig untersucht. Unsere multizentrische Querschnittstudie erfasste körperliche Beschwerden bei Menschen im Alter zwischen 60 und 84 Jahren mit Wohnsitz in Stuttgart anhand der Kurzversion des Gießener Beschwerdebogens (GBB-24). In Deutschland wurden 648 Personen untersucht, davon 13.4 % (n = 87) nicht in Deutschland geborene. Die Geschlechterverteilung war bei Migranten und Nichtmigranten gleich; der sozioökonomische Status lag bei den Migranten etwas niedriger: 8.0 % (n = 7) der Migranten und 2.5 % (n = 14) der Nichtmigranten verfügten über höchstens vier Jahre Schulbildung; 12.6 % (n = 11) der Migranten und 8.2 % (n = 46) der Nichtmigranten hatten ein monatliches Haushaltsnettoeinkommen von unter 1000€; 26.4 % der Migranten und 38.1 % (n = 214) der Nichtmigranten verfügten über mehr als 2000€ monatlich. Somatische Beschwerden lagen bei den Migranten bei 65.5 % (n = 57) und bei den Nichtmigranten bei 55.8 % (n = 313). Frauen wiesen häufiger somatische Beschwerden auf (61.8 %) als Männer (51.8 %). Mit steigendem Alter nahmen somatische Beschwerden zu. Mit Ausnahme der Altersgruppe der 70–74-Jährigen konnte kein signifikanter Unterschied zwischen Migranten und Nichtmigranten hinsichtlich der Häufigkeit körperlicher Beschwerden gezeigt werden. Ausblick: Es werden dringend bevölkerungsrepräsentative Studien zu körperlichen Beschwerden bei Migranten benötigt.

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Regional Cervical Plexus Blockage for Carotid Endarterectomy in Patients with Cardiovascular Risk Factors

The Heart Surgery Forum ◽

10.1532/hsf.1385 ◽

2015 ◽

Vol 18 (4) ◽

pp. 140 ◽

Cited By ~ 2

Author(s):

Mehmet Taşar ◽

Mehmet Kalender ◽

Okay Güven Karaca ◽

Ata Niyazi Ecevit ◽

Salih Salihi ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Carotid Endarterectomy ◽

Regional Anesthesia ◽

Carotid Artery Disease ◽

Risk Groups ◽

Cardiac Risk ◽

Cervical Plexus ◽

Cardiac Risk Factors ◽

Significant Difference

Background: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. Methods: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared. Results: Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P > .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection. Conclusion: Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed.

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