scholarly journals COVID-19 Inmate Risk Appraisal (CIRA): Development and validation of a screening tool to assess COVID-19 vulnerability in prisons

2020 ◽  
Author(s):  
Leonel C. Gonçalves ◽  
Stéphanie Baggio ◽  
Michael Weber ◽  
Laurent Gétaz ◽  
Hans Wolff ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Medical Staff ◽  
Screening Tool ◽  
Control Sample ◽  
Case Control ◽  
Elevated Risk ◽  
World Health ◽  
Validation Sample ◽  
Risk Appraisal

Abstract Objectives. To develop and validate a screening tool designed to identify detained people at increased risk for COVID-19 mortality, the COVID-19 Inmate Risk Appraisal (CIRA). Design. Cross-sectional study with a representative sample (development) and a case-control sample (validation).Setting. The two largest Swiss prisons.Participants. (1) Development sample: all male persons detained in Pöschwies, Zurich (n=365); (2) Validation sample: case-control sample of male persons detained in Champ-Dollon, Geneva (n=192, matching 1:3 for participants at risk for severe course of COVID-19 and participants without risk factors).Main outcome measures. The CIRA combined seven risk factors identified by the World Health Organization and the Swiss Federal Office of Public Health as prognosis of severe COVID-19 to derive an absolute risk increase in mortality rate: Age ≥60, cardiovascular disease, diabetes, hypertension, chronic respiratory disease, immunodeficiency, and cancer. Results. Based on the development sample, we proposed a three-level classification: average (<3.7), elevated (3.7-5.7), and high (>5.7) risk. In the validation sample, the CIRA identified all individuals considered vulnerable by national recommendations (having at least one risk factor). The category “elevated risk” maximized sensitivity (1) and specificity (.97). The CIRA had even higher capacity in discriminating vulnerable individuals according to clinical evaluation (a four-level risk categorization based on a consensus of medical staff). The category “elevated risk” maximized sensitivity and specificity (both 1). When considering the individuals classified as extremely high risk by medical staff, the category “high risk” had a high discriminatory capacity (sensitivity=.89, specificity=.97). Conclusions. The CIRA scores have a high discriminative ability and will be important in custodial settings to support decisions and prioritize actions using a standardized valid assessment method. However, as knowledge on risk factors for COVID-19 mortality is still limited, the CIRA should be considered preliminary. Underlying data will be updated regularly on the website www.prison-research.com, where the CIRA algorithm is freely available.

scholarly journals 688 Pediatric Obstructive Sleep Apnea (OSA) and COVID-19-Related Adverse Clinical Outcomes

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A269-A269
Author(s):  
Vaishal Shah ◽  
Nancy Foldvary-Schaefer ◽  
Lu Wang ◽  
Lara Jehi ◽  
Cynthia Pena Obrea ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Pediatric Patients ◽  
Control Design ◽  
Supplemental Oxygen ◽  
Case Control ◽  
World Health ◽  
Invasive Ventilation ◽  
High Flow Oxygen

Abstract Introduction The relationship of OSA and human coronavirus (COVID-19) in the pediatric population is unknown. We postulate that OSA is associated with SARS-CoV-2 positivity and with adverse COVID-19 outcomes in children. Methods A retrospective review of 120 consecutive patients (&lt;18 years) with prior polysomnogram (PSG) and COVID-19 testing from the Cleveland Clinic COVID-19 registry was conducted. Using a case control design of SARS-CoV-2 positive and negative pediatric patients, we examined COVID-19 and pre-existing OSA (dichotomized AHI≥1) using logistic (OR,95%CI) regression and as continuous measures: AHI, oxygen(SpO2) nadir, %time SpO2&lt;90%) using linear regression(beta+/-SE). In those positive for SARS-CoV-2(cases only), we assessed the association of OSA and World Health Organization(WHO) COVID-19 clinical outcome composite score (hospitalization, requiring supplemental oxygen, non-invasive ventilation/high-flow oxygen, invasive ventilation/ECMO or death) using Wilcoxon rank sum test for ordinal data. Results Cases (n=36) were 11.8±4.4 years, 61% male, 27.8% black and 88.9% with OSA, while 85.7% of controls (n=84) had OSA. OSA was not associated with increased SARS-CoV-2 positivity: OR=1.33(0.40, 4.45,p=0.64). No significant difference between cases and controls for mean AHI 3.7(1.5,6.0) vs 3.5(1.5,7.1),p=0.91,SpO2 nadir 88.6±5.4 vs 89.1±4.4,p=0.58,%time SpO2&lt;90% 0.05[0.00,1.00) vs 0.10 (0.00,1.00, p=0.65) respectively was noted. WHO-7 COVID-19 clinical outcome did not meet statistical significance in relation to OSA due to the low event frequency (p=0.49). Of note, those with OSA vs without OSA had a higher WHO-7 outcome score of 2 vs 0 and prevalence of hospitalization: 12.5 vs 0% respectively. Of hospitalized patients, the following was observed: 23% had moderate/severe OSA vs 4.3% mild OSA, 50% required supplemental oxygen and 25% required intubation/invasive ventilation. No deaths or readmissions were reported. High risk conditions included: 75% obesity, 50% asthma, 25% sickle cell disease and 25% hypoplastic left heart. Conclusion In this first report of which we are aware focused on COVID-19 in pediatric OSA, we use a case control design leveraging COVID-19 and sleep laboratory registries. Albeit not statistically significant, pediatric patients with OSA had a higher percentage of worse clinical outcomes. Larger network studies are needed to clarify whether poorer COVID-19 outcomes may be attributable to OSA or modulated via high risk health conditions. Support (if any):

scholarly journals Risk factors of acute diarrhoea in summer – a nation-wide French case-control study

2000 ◽  
Vol 124 (3) ◽  
pp. 409-416 ◽  
Author(s):  
Y. YAZDANPANAH ◽  
L. BEAUGERIE ◽  
P. Y. BOËLLE ◽  
L. LETRILLIART ◽  
J. C. DESENCLOS ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Case Control Study ◽  
National Level ◽  
Acute Diarrhoea ◽  
Case Control ◽  
French Case ◽  
Risk Areas ◽  
Matched Case ◽  
Control Study

The aim of this study was to identify risk factors for acute diarrhoea (AD) during the summer in France. A matched case-control study was conducted at a national level among patients of 500 general practitioners (GPs). From July to September 1996, 468 case-control pairs were included. Cases were more likely than controls (i) to live away from their main residence (OR 3·0; 95% CI 1·6–5·7), (ii) to have returned from a country at high risk of AD (OR 4·6; CI 0·9–23·1), and (iii) to have been in contact with a case of AD (OR 2·0; CI 1·3–3·1). A significantly decreased risk of AD was found for consumption of well-cooked chicken (OR 0·5; CI 0·3–0·8) and raw or undercooked home-made egg-containing products (OR 0·6; CI 0·4–0·8). These findings suggest that travel to high-risk areas, or travel within France, and being in contact with a case of AD, are risk factors for the occurrence of AD in summer in France.

scholarly journals Prevalence of diagnosed diabetes and associated risk factors: Evidence from the large-scale surveys in India

2017 ◽  
Vol 05 (01) ◽  
pp. 028-036 ◽  
Author(s):  
Saddaf Akhtar ◽  
Preeti Dhillon
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Large Scale ◽  
Multinomial Logistic Regression ◽  
Local Level ◽  
Diabetes Prevalence ◽  
World Health ◽  
Undiagnosed Diabetes ◽  
Newly Diagnosed ◽  
Associated Risk Factors

Abstract Context: India has observed the most devastating increases in the burden of diabetes in the contemporary era. However, so far, the comparable prevalence of diabetes is only available for limited geography. Aims: The present paper provides comparable estimates of diabetes prevalence in states and districts of India and examines the associated risk factors with newly diagnosed and self-reported diabetes. Setting and Design: The study uses clinical, anthropometric, and biochemical data from District Level Household and Facility Survey (2012–2013) and Annual Health Survey (2014). Subjects and Methods: The paper analyses the information on glucose level of the blood sample and defines diabetes as per the World Health Organization (1999) criteria. It applies multinomial logistic regression to identify the risk factors of diabetes. Results: The study estimates 7% adults with diabetes in India, with a higher level in urban (9.8%) than in the rural area (5.7%), a higher proportion of males (7.1%) than females (6.8%). Widowed, older persons, and persons with high blood pressure have very high risk of both diagnosed and self-reported diabetes. Comparing to Hindus, Muslims and Christians have higher, and Sikhs have less risk of diabetes. Further, corresponding to general caste, scheduled castes, and other backward classes have a high risk of newly diagnosed but the lower risk of self-reported diabetes. Conclusions: The list of districts and states with alarming diabetes prevalence is the valuable information for further programs and research. A significant population with undiagnosed diabetes reflects an urgent need to strengthen the diagnostics at the local level and for those who need them most.

scholarly journals Case-control study evaluating competing risk factors for angioedema in a high-risk population

2016 ◽  
Vol 126 (8) ◽  
pp. 1823-1830 ◽  
Author(s):  
Rebecca J. Kamil ◽  
Elina Jerschow ◽  
Patricia A. Loftus ◽  
Melin Tan ◽  
Marvin P. Fried ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Case Control Study ◽  
Case Control ◽  
Competing Risk ◽  
High Risk Population ◽  
Risk Population ◽  
Control Study

scholarly journals Negative latent tuberculosis at time of incarceration: identifying a very high-risk group for infection

2017 ◽  
Vol 145 (12) ◽  
pp. 2491-2499 ◽  
Author(s):  
L. ARROYAVE ◽  
Y. KEYNAN ◽  
L. LÓPEZ ◽  
D. MARIN ◽  
M. P. ARBELÁEZ ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Latent Tuberculosis ◽  
Risk Groups ◽  
High Risk Group ◽  
World Health ◽  
Formerly Incarcerated ◽  
Adjusted Risk ◽  
Number Needed To Screen ◽  
Health Organization

SUMMARYThe main aim was to measure the incidence of latent tuberculosis infection (LTBI) and identify risk factors associated with infection. In addition, we determined the number needed to screen (NNS) to identify LTBI and active tuberculosis. We followed 129 prisoners for 2 years following a negative two-step tuberculin skin test (TST). The cumulative incidence of TST conversion over 2 years was 29·5% (38/129), among the new TST converters, nine developed active TB. Among persons with no evidence of LTBI, the NNS to identify a LTBI case was 3·4 and an active TB case was 14·3. The adjusted risk factors for LTBI conversion were incarceration in prison number 1, being formerly incarcerated, and overweight. In conclusion, prisoners have higher risk of LTBI acquisition compared with high-risk groups, such as HIV-infected individuals and children for whom LTBI testing should be performed according to World Health Organization guidance. The high conversion rate is associated with high incidence of active TB disease, and therefore we recommend mandatory LTBI screening at the time of prison entry. Individuals with a negative TST at the time of entry to prison are at high risk of acquiring infection, and should therefore be followed in order to detect convertors and offer LTBI treatment. This approach has a very low NNS for each identified case, and it can be utilized to decrease development of active TB disease and transmission.

scholarly journals Molecular genetic case-control women investigation from the first Brazilian high-risk study on functional psychosis

2008 ◽  
Vol 30 (4) ◽  
pp. 341-345 ◽  
Author(s):  
Renata Krelling ◽  
Quirino Cordeiro ◽  
Elisabete Miracca ◽  
Elisa Kijner Gutt ◽  
Sandra Petresco ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
High Risk ◽  
Molecular Genetic ◽  
Control Sample ◽  
Epidemiological Studies ◽  
Case Control ◽  
High Risk Population ◽  
Brazilian Sample ◽  
Functional Polymorphisms ◽  
Functional Psychosis

OBJECTIVE: Data from epidemiological studies have demonstrated that genetics is an important risk factor for psychosis. The present study is part of a larger project, pioneer in Brazil, which has been conducted by other researchers who intend to follow a high-risk population (children) for the development of schizophrenia and bipolar disorder. In this first phase of the project, the objective was to investigate the distribution of four candidate genetic polymorphisms for functional psychosis (Ser9Gly DRD3, 5HTTLPR, the VNTR 3'-UTR SLC6A3 and Val66Met BDNF) in a case-control sample. METHOD: A total of 105 women (58 with schizophrenia and 47 with bipolar disorder) and 62 gender-matched controls were investigated. RESULTS: Allele and genotype distributions of all identified functional polymorphisms did not differ statistically between cases and controls. CONCLUSIONS: These results suggest that the investigated polymorphisms were not related to susceptibility to functional psychoses in our Brazilian sample. These findings need to be validated in larger and independent studies.

scholarly journals Open secret, or imagined problem: Drug and alcohol use in Tanzanian road traffic accident drivers

2020 ◽  
Author(s):  
Adeline Rose Dozois ◽  
Paulina Nkondora ◽  
Erin E Noste ◽  
Juma Mfinanga ◽  
Hendry R Sawe ◽  
...  
Keyword(s):  
Substance Use ◽  
High Risk ◽  
Alcohol Use ◽  
Drug Use ◽  
Alcohol Use Disorder ◽  
Screening Tool ◽  
Road Traffic ◽  
World Health ◽  
Urine Drug Screen ◽  
Research Assistants

Abstract Background Road traffic accidents (RTAs) have emerged as an important public health problem in low and middle-income countries, where 90% of RTA deaths occur. The World Health Organization has suggested strategies to address excess mortality from RTAs including efforts to combat driving while intoxicated. The association between substance use and RTAs is well known in high-income countries, but data is more limited in low-resource settings including Tanzania. The objective of this study is to examine the prevalence of drug use, alcohol use, and substance use disorders in Tanzanian RTA drivers. Methods This prospective observational study was conducted in the Emergency Department of Muhimbili National Hospital, a national referral hospital in Dar es Salaam, Tanzania. Research assistants available 24 hours per day enrolled adult drivers who presented within 24 hours of an RTA. In eligible patients, research assistants collected a saliva test of blood alcohol content (BAC) and a urine drug screen (UDS), and administered a validated substance abuse screening tool, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Patients were excluded from individual analyses if they could not produce a saliva or urine test or answer questions. Primary outcomes were rates of positive BAC, UDS and self-reported high-risk alcohol and drug use patterns. Descriptive statistics were calculated using Excel. Results We screened 5264 trauma patients and enrolled 538, in whom 191 had a BAC, 362 had a UDS, and 417 had a complete ASSIST. Fifteen of 191 patients (7.8%) had a positive BAC, and 68/362 (18.7%) patients had a UDS that was positive for at least one drug. Based on the ASSIST, 104/417 (24.5%) of patients were at moderate or high risk for alcohol use disorder. Few were at risk for disordered use of other non-tobacco substances. Conclusion In our population of drivers presenting within 24 hours of an RTA, positive BAC and UDS tests were rare. A substantial portion of the population was at moderate to high risk for an alcohol use disorder. Ideal screening for substance use in trauma populations may involve a verbal screening tool, particularly when the time between injury and hospital arrival is delayed.

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