Lessons To Be Learned: Identifying High-Risk Medication and Circumstances In Patients At Risk For Suicidal Self-Poisoning

Abstract BackgroundAlthough the total number of suicides decreased since the beginning of the 80s, the number of suicide-related behaviors using self-intoxication increased. Therefore, research on the characteristics of individuals committing self-intoxication becomes of growing importance for risk assessments and the development of preventive measures. MethodsIn this prospective, observational, monocentric cohort study, all incoming calls at our Poisons Control Centre reporting suicide-related behavior through self-intoxication, were analyzed via a standardized questionnaire over 12 months. Both univariate and bivariate analyses were performed.Results1238 cases of deliberate intoxication were included in the study. The majority of cases occurred in the age group between 18 and 44 (n=607/49%), two-thirds were female (n=817/66%). The main substances used were antidepressants (n=420/34%), peripheral analgesics (n=322/26%) and neuroleptics (n=282/23%). The majority of patients ingested substances from their prescribed medication (n=640/82%) with the highest proportion in the eldest (n=72/113; 91%, p<0.001). Addiction was reported for the minority of patients (n=175/23%). For 704 cases (57%), a psychiatric diagnosis was documented. Factors associated with recurrent suicide-related behaviors were: i) an underlying psychiatric diagnosis (OR=6.2; 95% CI 3.8-10.4); ii) addiction problems (OR=2.4; 95% CI 1.5-3.8); iii) ingestion of neuroleptics (OR=2.1, 95%-CI 1.4-3.0) or antidepressants (OR=1.6; 95% CI 1.2-2.3).ConclusionThis study might contribute to identifying individuals with an increased risk of suicide-related behaviors and to developing preventive strategies for future suicide attempt(s).

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Risk factors associated with failure of total ankle arthroplasty: a nationwide cohort study

Scientific Reports ◽

10.1038/s41598-021-82674-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Dong Hun Suh ◽

Kyungdo Han ◽

Jin Woo Lee ◽

Hak Jun Kim ◽

Bongsung Kim ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Service Failure ◽

Group Versus ◽

Population Based ◽

Total Ankle Arthroplasty ◽

Age Group ◽

Ankle Arthroplasty ◽

Factors Associated ◽

Increased Risk

AbstractWe conducted a nationwide population-based cohort study to identify the risk factors associated with failure of total ankle arthroplasty (TAA). We included 2,914 subjects who underwent primary TAA between January 1, 2010, and December 31, 2016, utilizing the database of the Korean National Health Insurance Service. Failure of TAA was defined as revision TAA or arthrodesis procedures. An increased risk of TAA failure was observed in the < 65 age group versus the ≥ 75 age group [adjusted hazard ratios (aHR) 2.273, 95% confidence interval (CI) 1.223–4.226 in the 60–64 age group; aHR 2.697, 95% CI 1.405–5.178 in the 55–59 age group; aHR 2.281, 95% CI 1.145–4.543 in the 50–54 age group; aHR 2.851, 95% CI 1.311–6.203 in the < 50 age group]. Conversely, the ≥ 65 age group displayed no increase in the risk of TAA failure. The risk of TAA failure was increased in the severely obese group with body mass index (BMI) of ≥ 30 kg/m2 versus the normal BMI group (aHR 1.632; 95% CI 1.036–2.570). This population-based longitudinal study demonstrated that age < 65 years and BMI of ≥ 30 kg/m2 were associated with increased risk of TAA failure.

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Factors associated with being lost to follow-up before completing tuberculosis treatment: analysis of surveillance data

Epidemiology and Infection ◽

10.1017/s095026881200163x ◽

2012 ◽

Vol 141 (6) ◽

pp. 1223-1231 ◽

Cited By ~ 6

Author(s):

E. R. C. MILLETT ◽

D. NOEL ◽

P. MANGTANI ◽

I. ABUBAKAR ◽

M. E. KRUIJSHAAR

Keyword(s):

Surveillance Data ◽

Sputum Smear ◽

Tuberculosis Patients ◽

Factors Associated ◽

Increased Risk ◽

Patients At Risk ◽

Treatment Analysis ◽

The Uk ◽

Lost To Follow Up

SUMMARYCompletion of treatment is key to tuberculosis control. Using national surveillance data we assessed factors associated with tuberculosis patients being lost to follow-up before completing treatment (‘lost’). Patients reported in England, Wales and Northern Ireland between 2001 and 2007 who were lost 12 months after beginning treatment were compared to those who completed, or were still on treatment, using univariable and multivariable logistic regression. Of 41 120 patients, men [adjusted odds ratio (aOR) 1·29; 95% confidence interval (CI) 1·23–1·35], 15- to 44-year-olds (P<0·001), and patients with pulmonary sputum smear-positive disease (aOR 1·25, 95% CI 1·12–1·45) were at higher risk of being lost. Those recently arrived in the UK were also at increased risk, particularly those of the White ethnic group (aOR 6·39, 95% CI 4·46–9·14). Finally, lost patients had a higher risk of drug resistance (aOR 1·41, 95% CI 1·17–1·69). Patients at risk of being lost require enhanced case management and novel case retention methods are needed to prevent this group contributing towards onward transmission.

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Risk of Stroke in Nasopharyngeal Cancer Survivors: A National Registry-Based Population Cohort Study

Neurology ◽

10.1212/wnl.0000000000013058 ◽

2021 ◽

pp. 10.1212/WNL.0000000000013058

Author(s):

Teng Hwee Tan ◽

Huili Zheng ◽

Timothy Cheo ◽

Jeremy Tey ◽

Yu Yang Soon

Keyword(s):

Cohort Study ◽

General Population ◽

Nasopharyngeal Cancer ◽

Reference Population ◽

National Registry ◽

Age Group ◽

Post Stroke ◽

Risk Of Death ◽

Increased Risk ◽

Stage 1

BackgroundWe aim to determine the risk of stroke and death within 30 days post stroke in nasopharyngeal cancer (NPC) survivors.MethodsWe conducted a population-based cohort study of patients diagnosed with NPC from Jan 1, 2005 to Dec 31, 2017. Using the cancer and stroke disease registries and the Singapore general population as the reference population, we report the age-standardized incidence rate differences (SIRDs) ratios (SIRs) and the cumulative incidence of stroke and the standardized mortality rate differences (SMRDs) and ratios (SMRs) for all causes of death within 30 days post stroke for NPC survivors.FindingsAt a median follow up of 48.4 months (IQR 19.8 – 92.9) for 3849 patients diagnosed with NPC, 96 patients developed stroke. The overall SIRD and SIR for stroke was 3.12 (95% CI 2.09 – 4.15) and 2.54 (95% CI 2.08 – 3.10) respectively. The SIRD was highest for the age group 70 – 79 years old (8.84 cases per 1000 person-years (PY); 0.46 – 17.21) while the SIR was highest for the age group 30 – 39 years old (16.41; 6.01 – 35.82). The SIRD and SIR for stage 1 disease was (6.96 cases per 1000 PY; 2.16 – 11.77) and (4.15; 2.46 – 7.00) respectively. The SMRD and SMR for all cause deaths within 30 days of stroke was (3.20 cases per 100 persons; -3.87 – 10.28) and (1.34; 0.76 – 2.37) respectively.InterpretationThe overall risk of stroke was markedly elevated in survivors of NPC, especially in Stage 1 disease when compared to the general population. The risk of death within 30 days of stroke was not significantly higher for NPC survivors.Classification of EvidenceThis study provides Class II evidence of the increased risk of stroke in survivors of nasopharyngeal cancer compared to general population.

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Prolonged lockdown: psychological risk factors among children and their mental health

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1696 ◽

2021 ◽

Author(s):

Uzma Ilyas ◽

Rabia Farooqi ◽

Admin

Keyword(s):

Preventive Measures ◽

Dysfunctional Families ◽

Preventive Strategies ◽

Scientific Communities ◽

Reflective Listening ◽

Psychological Risk Factors ◽

Increased Risk ◽

Indirect Impact ◽

Psychological Risk

The most talked phenomenon and sui generis of the modern time, the coronavirus diseases-2019 impacted individuals in a variety of ways. Older adults had a higher risk of vulnerability, while there were negative ramifications among children due to indirect impact. The preventive measures, including closing down of schools, malls and playgrounds as well as practising social distancing served as a shield against the hazard of outbreak. On the contrary, these strategies inculcated fear, anxiety, ambiguous communication and manifestation of externalizing behaviours in children. Children living in dysfunctional families in underprivileged circumstances were more susceptible to abuse during the pandemic, and had increased risk of behavioural symptomology and psychological morbidities. Challenges brought by the new normal for children requires redefining the role of parenting for effective monitoring and intervention to mitigate the symptoms. Preventive strategies outlined by international scientific communities include reflective listening, debriefing and psychological first aid for effective

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Self-reported COVID-19 among physicians: An Egyptian online study during the pandemic

F1000Research ◽

10.12688/f1000research.53931.1 ◽

2021 ◽

Vol 10 ◽

pp. 785

Author(s):

Hala Samir Abou-ElWafa ◽

Abdel-Hady El-Gilany ◽

Ahmed A. Albadry

Keyword(s):

Healthcare Workers ◽

Preventive Measures ◽

Risk Of Infection ◽

Vulnerable Group ◽

Factors Associated ◽

Online Study ◽

Increased Risk ◽

Laboratory Investigations ◽

Survey Monkey ◽

Frontline Healthcare Workers

Abstract: Background: COVID-19 causes a critical occupational risk to frontline healthcare workers (HCWs) who respond to the pandemic, as they are placed in environments with an increased risk of infection exposure. It is a public health priority to understand how transmission occurs to protect this vulnerable group of HCWs. This study was conducted to estimate the incidence of self-reported COVID-19 infection among physicians and its possible associated factors. Methods: An online national survey using Survey Monkey was initiated to collect sociodemographic e.g. age and sex, occupational e.g. place and duration of work, and clinical data e.g. COVID symptoms and laboratory investigations, and to describe affected physicians' diagnoses. Results: The self-reported incidence of COVID-19 infection was found to be 65.4% among studied physicians. The significant independent predictors of COVID-19 infection were smoking, working as a frontline physician, having contact with a COVID-19 case, and working for less than ten years [ARR (95% CI): 3.0(1.6-5.7), 2.3(1.4-3.8), 2.1(1.2-3.6), and 1.8(1.2-2.9); respectively]. Conclusions: The incidence of COVID-19 infection among Egyptian physicians is relatively high. Smoking, being a frontline physician, having contact with a COVID-19 case, and working for less than 10 years are all factors associated with an increased risk of infection. There should be strict application of preventive measures, periodic screening for COVID-19 for early detection and isolation of infected HCWs together with effective vaccination.

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Secondary attack rate of COVID-19 among contacts and risk factors, Tamil Nadu, March–May 2020: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-051491 ◽

2021 ◽

Vol 11 (11) ◽

pp. e051491

Author(s):

Kolandaswamy Karumanagoundar ◽

Mohankumar Raju ◽

Manickam Ponnaiah ◽

Prabhdeep Kaur ◽

Vidhya viswanathan ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Attack Rate ◽

Retrospective Cohort ◽

Tamil Nadu ◽

Significant Proportion ◽

Primary Case ◽

Factors Associated ◽

Household Contacts ◽

Increased Risk

ObjectiveTo describe the characteristics of contacts of patients with COVID-19 case in terms of time, place and person, to calculate the secondary attack rate (SAR) and factors associated with COVID-19 infection among contacts.DesignA retrospective cohort studySetting and participantsContacts of cases identified by the health department from 14 March 2020to 30 May 2020, in 9 of 38 administrative districts of Tamil Nadu. Significant proportion of cases attended a religious congregation.Outcome measureAttack rate among the contacts and factors associated with COVID-19 positivity.ResultsWe listed 15 702 contacts of 931 primary cases. Of the contacts, 89% (n: 14 002) were tested for COVID-19. The overall SAR was 4% (599/14 002), with higher among the household contacts (13%) than the community contacts (1%). SAR among the contacts of primary cases with congregation exposure were 5 times higher than the contacts of non-congregation primary cases (10% vs 2%). Being a household contact of a primary case with congregation exposure had a fourfold increased risk of getting COVID-19 (relative risk (RR): 16.4; 95% CI: 13 to 20) than contact of primary case without congregation exposure. Among the symptomatic primary cases, household contacts of congregation primaries had higher RR than household contacts of other cases ((RR: 25.3; 95% CI: 10.2 to 63) vs (RR: 14.6; 95% CI: 5.7 to 37.7)). Among asymptomatic primary case, RR was increased among household contacts (RR: 16.5; 95% CI: 13.2 to 20.7) of congregation primaries compared with others.ConclusionOur study showed an increase in disease transmission among household contacts than community contacts. Also, symptomatic primary cases and primary cases with exposure to the congregation had more secondary cases than others.

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Characteristics and related factors of emergency department visits, readmission, and hospital transfers of inpatients under a DRG-based payment system: A nationwide cohort study

PLoS ONE ◽

10.1371/journal.pone.0243373 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243373

Author(s):

Pei-Fang Huang ◽

Pei-Tseng Kung ◽

Wen-Yu Chou ◽

Wen-Chen Tsai

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Payment System ◽

Hospital Ownership ◽

Related Factors ◽

Factors Associated ◽

Increased Risk ◽

Comorbidity Index ◽

Ed Visits ◽

Monthly Salary

Objectives Taiwan has implemented the Diagnosis Related Groups (DRGs) since 2010, and the quality of care under the DRG-Based Payment System is concerned. This study aimed to examine the characteristics, related factors, and time distribution of emergency department (ED) visits, readmission, and hospital transfers of inpatients under the DRG-Based Payment System for each Major Diagnostic Category (MDC). Methods We conducted a retrospective cohort study using data from the National Health Insurance Research Database (NHIRD) from 2012 to 2013 in Taiwan. Multilevel logistic regression analysis was used to examine the factors related to ED visits, readmissions, and hospital transfers of patients under the DRG-Based Payment System. Results In this study, 103,779 inpatients were under the DRG-Based Payment System. Among these inpatients, 4.66% visited the ED within 14 days after their discharge. The factors associated with the increased risk of ED visits within 14 days included age, lower monthly salary, urbanization of residence area, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, Diseases and Disorders of the Kidney and Urinary Tract (MDC11) conferred the highest risk of ED visits within 14 days (OR = 4.95, 95% CI: 2.69–9.10). Of the inpatients, 6.97% were readmitted within 30 days. The factors associated with the increased risk of readmission included gender, age, lower monthly salary, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, the inpatients with Pregnancy, Childbirth and the Puerperium (MDC14) had the highest risk of readmission within 30 days (OR = 20.43, 95% CI: 13.32–31.34). Among the inpatients readmitted within 30 days, 75.05% of them were readmitted within 14 days. Only 0.16% of the inpatients were transferred to other hospitals. Conclusion The study shows a significant correlation between Major Diagnostic Categories in surgery and ED visits, readmission, and hospital transfers. The results suggested that the main reasons for the high risk may need further investigation for MDCs in ED visits, readmissions, and hospital transfers.

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Deep Venous Thrombosis and Risk of Consequent Sepsis Event: A Retrospective Nationwide Population-Based Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157879 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7879

Author(s):

Ying-Tung Yeh ◽

Sheng-En Tsai ◽

Ying-Cheng Chen ◽

Shun-Fa Yang ◽

Han-Wei Yeh ◽

...

Keyword(s):

Cohort Study ◽

Health Insurance ◽

Population Based ◽

Chronic Obstructive ◽

Research Database ◽

Obstructive Pulmonary Disease ◽

Adequate Treatment ◽

Vein Thrombosis ◽

Increased Risk ◽

Patients At Risk

Deep vein thrombosis causes several acute and chronic vessel complications and puts patients at risk of subsequent sepsis development. This unique study aimed to estimate the risk of sepsis development in DVT patients compared with non-DVT patients. This population-based cohort study used records of a longitudinal health insurance database containing two million patients defined in Taiwan’s National Health Insurance Research Database (NHIRD). Our study included patients aged over 20 years with a new diagnosis of DVT with at least two outpatient department visits or an admission between 2001 and 2014. Patients with a diagnosis of sepsis before the index date were excluded. Propensity score matching (PSM) was used to homogenize the baseline characteristics between the two groups. To define the independent risk of the DVT group, a multivariate Cox proportional hazard model was used to estimate the hazard ratios. After PSM, the DVT group (n = 5753) exhibited a higher risk of sepsis (adjusted hazard ratio, aHR, 1.74; 95% CI, 1.59–1.90) compared with non-DVT group (n = 5753). Patients with an increased risk of sepsis were associated with being elderly aged, male, having diabetes, chronic kidney disease, chronic obstructive pulmonary disease, stroke, malignancy, and use of antibiotics. In conclusion, this population-based cohort study demonstrated an increased risk of sepsis in DVT patients compared with non-DVT patients. Thus, early prevention and adequate treatment of DVT is necessary in clinical practice.

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Switching Between Second-Generation Antipsychotics in Patients with Schizophrenia and Schizoaffective Disorder: 10-Year Cohort Study in Brazil

Frontiers in Pharmacology ◽

10.3389/fphar.2021.638001 ◽

2021 ◽

Vol 12 ◽

Author(s):

Izabela Fulone ◽

Marcus Tolentino Silva ◽

Luciane Cruz Lopes

Keyword(s):

Cohort Study ◽

Schizoaffective Disorder ◽

Second Generation ◽

Real Life ◽

Assistance Program ◽

Northeast Region ◽

Factors Associated ◽

Increased Risk ◽

Second Generation Antipsychotics ◽

Brazilian Northeast

Objective: Switching between second-generation antipsychotics (SGAs) is a common clinical practice in the treatment of schizophrenia and schizoaffective disorders due to differences in the drugs’ tolerability and safety profiles as well as the challenge of obtaining an ideal response. However, the factors associated with SGA switching remain uncertain and related real-world data are scarce. The main objective was to identify the factors associated with the switching of SGAs in patients with schizophrenia or schizoaffective disorder.Methods: We conducted a retrospective cohort study of outpatients with schizophrenia or schizoaffective disorder, who were aged ≥18 years and received a SGA (clozapine, olanzapine, risperidone, quetiapine or ziprasidone) from a Brazilian pharmaceutical assistance program for at least 3 months. We identified SGA users from 2008 to 2017 by using a national administrative database (Ambulatory Information System-SIA/SUS). The factors associated with the switches were evaluated by Cox proportional hazards regression and adjusted for sex and age; the confidence interval was set at 95% (95% CI).Results: In total, 563,765 patients were included. Female sex, advanced age of ≥70 years, residence in the Brazilian northeast region, and the type of antipsychotic used were associated with an increased risk of switching (p < 0.001). The incidence of switching ranged from 37.6/100 person-years for clozapine users to 58.2/100 person-years for risperidone users. Compared to the adjusted hazard ratio, for clozapine users, the corresponding ratios for risperidone, ziprasidone, quetiapine and olanzapine were 1.59 (95% CI, 1.57–1.61), 1.41 (95% CI, 1.39–1.44), 1.25 (95% CI, 1.23–1.26) and 1.11 (95% CI, 1.10–1.12) respectively.Conclusion: The groups most susceptible to SGA switching in real-life setting were older individuals, women, and those living in the Brazilian northeast region. Risperidone was associated with the highest risk of switching and as expected, clozapine was associated with the lowest risk of switching than that associated with the other SGAs.

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Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in a multi-country cohort study: US-PEPFAR PROMOTE study

10.1101/688945 ◽

2019 ◽

Author(s):

Patience Atuhaire ◽

Sherika Hanley ◽

Nonhlanhla Yende-Zuma ◽

Jim Aizire ◽

Lynda Stranix-Chibanda ◽

...

Keyword(s):

Cohort Study ◽

Scale Up ◽

Sub Saharan Africa ◽

African Women ◽

Targeted Interventions ◽

Factors Associated ◽

Women Living With Hiv ◽

Increased Risk ◽

Sub Saharan ◽

Living With Hiv

AbstractBackgroundDespite recent efforts to scale-up lifelong combination antiretroviral therapy (cART) in sub-Saharan Africa, high rates of unsuppressed viremia persist among cART users, and many countries in the region fall short of the UNAIDS 2020 target to have 90% virally suppressed. We sought to determine the factors associated with unsuppressed viremia (defined for the purpose of this study as >200 copies/ml) among African women on lifelong cART.MethodsThis analysis was based on baseline data of the PROMOTE longitudinal cohort study at 8 sites in Uganda, Malawi, Zimbabwe and South Africa. The study enrolled 1987 women living with HIV who initiated lifelong cART at least 1 year previously to assesses long-term safety and effectiveness of cART. Socio-demographic, clinical, and cART adherence data were collected. We used multivariable Poisson regression with robust variance to identify factors associated with unsuppressed viremia.ResultsAt enrolment, 1947/1987 (98%) women reported taking cART. Of these, HIV-1 remained detectable in 293/1934 (15%), while 216/1934 (11.2%) were considered unsuppressed (>200 copies/ml). The following factors were associated with an increased risk of unsuppressed viremia: not having household electricity (adjusted prevalence rate ratio (aPRR) 1.74, 95% confidence interval (CI) 1.28-2.36, p<0.001); self-reported missed cART doses (aPRR 1.63, 95% CI 1.24-2.13, p<0.001); recent hospitalization (aPRR 2.48, 95% CI 1.28-4.80, p=0.007) and experiencing abnormal vaginal discharge in the last three months (aPRR 1.88; 95% CI 1.16-3.04, p=0.010). Longer time on cART (aPRR 0.75, 95% CI 0.64-0.88, p<0.001) and being older (aPRR 0.77, 95% CI 0.76-0.88, p<0.001) were associated with reduced risk of unsuppressed viremia.ConclusionSocioeconomic barriers such as poverty, not being married, young age, and self-reported missed doses remain key predictors of unsuppressed viremia. Targeted interventions are needed to improve cART adherence among women living with HIV with this risk factor profile.

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