COVID-19 trends and severity among symptomatic children aged 0–17 years in 10 European Union countries, 3 August 2020 to 3 October 2021

We estimated risks of severe outcomes in 820,404 symptomatic paediatric COVID-19 cases reported by 10 European Union countries between August 2020 and October 2021. Case and hospitalisation rates rose as transmission increased but severe outcomes were rare: 9,611 (1.2%) were hospitalised, 640 (0.08%) required intensive care and 84 (0.01%) died. Despite increased individual risk (adjusted odds ratio hospitalisation: 7.3; 95% confidence interval: 3.3–16.2; intensive care: 8.7; 6.2–12.3) in cases with comorbidities, most (83.7%) hospitalised children had no comorbidity.

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Disparities in the use of regular pap smears among migrant and non-migrant women in Austria: A population-based survey of 7633 women

Journal of Medical Screening ◽

10.1177/0969141320953450 ◽

2020 ◽

pp. 096914132095345

Author(s):

Patrick Brzoska ◽

Tugba Aksakal ◽

Yüce Yilmaz-Aslan

Keyword(s):

Cervical Cancer ◽

European Union ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Population Based ◽

Pap Smears ◽

Migrant Women ◽

European Union Countries ◽

Population Based Survey

Objective: Regular pap smears are effective in reducing cervical cancer incidence and mortality. Migrant women have been reported to utilize cervical cancer screening less often than non-migrant women. However, inconsistent results, e.g. from Germany, have also been reported. This study examines disparities in the use of annual pap smears among 20–69 year old migrant and non-migrant women in neighboring Austria. Method: Data from a nationwide population-based survey of 7633 women is used of whom 504 (6.6%) were migrants from European Union countries and 251 (3.3%) were migrants from non-European Union countries. Logistic regression analysis was conducted to account for socio economic and health differences between the three population groups. Results: The study shows that as compared to the non-migrant women, migrant women from European Union and non-European Union countries were at lower odds of having received a pap smear in the last 12 months (adjusted odds ratio = 0.80, 95% confidence interval = 0.66–0.96 and adjusted odds ratio = 0.74, 95%-confidence interval = 0.57–0.97, respectively). Disparities were similar with respect to utilization in the last 36 months (adjusted odds ratio = 0.60, 95% confidence interval = 0.46–0.77 and adjusted odds ratio = 0.58, 95% confidence interval = 0.40–0.82, respectively). Conclusions: The findings are in agreement with research from the majority of other countries. They suggest barriers that migrants encounter in the health system and highlight the need for diversity-sensitive health care strategies.

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Māori health outcomes in an intensive care unit in Aotearoa New Zealand

Anaesthesia and Intensive Care ◽

10.1177/0310057x21989715 ◽

2021 ◽

pp. 0310057X2198971

Author(s):

M Atif Mohd Slim ◽

Hamish M Lala ◽

Nicholas Barnes ◽

Robert A Martynoga

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

New Zealand ◽

Renal Replacement Therapy ◽

Confidence Interval ◽

Health Outcomes ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

One Year ◽

Maori Health

Māori are the indigenous people of New Zealand, and suffer disparate health outcomes compared to non-Māori. Waikato District Health Board provides level III intensive care unit services to New Zealand’s Midland region. In 2016, our institution formalised a corporate strategy to eliminate health inequities for Māori. Our study aimed to describe Māori health outcomes in our intensive care unit and identify inequities. We performed a retrospective audit of prospectively entered data in the Australian and New Zealand Intensive Care Society database for all general intensive care unit admissions over 15 years of age to Waikato Hospital from 2014 to 2018 ( n = 3009). Primary outcomes were in–intensive care unit and in-hospital mortality. The secondary outcome was one-year mortality. In our study, Māori were over-represented relative to the general population. Compared to non-Māori, Māori patients were younger (51 versus 61 years, P < 0.001), and were more likely to reside outside of the Waikato region (37.2% versus 28.0%, P < 0.001) and in areas of higher deprivation ( P < 0.001). Māori had higher admission rates for trauma and sepsis ( P < 0.001 overall) and required more renal replacement therapy ( P < 0.001). There was no difference in crude and adjusted mortality in–intensive care unit (16.8% versus 16.5%, P = 0.853; adjusted odds ratio 0.98 (95% confidence interval 0.68 to 1.40)) or in-hospital (23.7% versus 25.7%, P = 0.269; adjusted odds ratio 0.84 (95% confidence interval 0.60 to 1.18)). One-year mortality was similar (26.1% versus 27.1%, P=0.6823). Our study found significant ethnic inequity in the intensive care unit for Māori, who require more renal replacement therapy and are over-represented in admissions, especially for trauma and sepsis. These findings suggest upstream factors increasing Māori risk for critical illness. There was no difference in mortality outcomes.

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Clostridium difficile in the Intensive Care Unit: Epidemiology, Costs, and Colonization Pressure

Infection Control and Hospital Epidemiology ◽

10.1086/511793 ◽

2007 ◽

Vol 28 (2) ◽

pp. 123-130 ◽

Cited By ~ 106

Author(s):

Steven J. Lawrence ◽

Laura A. Puzniak ◽

Brooke N. Shadel ◽

Kathleen N. Gillespie ◽

Marin H. Kollef ◽

...

Keyword(s):

Intensive Care Unit ◽

Risk Factor ◽

Intensive Care ◽

Clostridium Difficile ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Univariate Analysis ◽

Tertiary Care ◽

Colonization Pressure

Objective.To evaluate the epidemiology, outcomes, and importance of Clostridium difficile colonization pressure (CCP) as a risk factor for C. difficile–associated disease (CDAD) acquisition in intensive care unit (ICU) patients.Design.Secondary analysis of data from a 30-month retrospective cohort study.Setting.A 19-bed medical ICU in a midwestern tertiary care referral center.Patients.Consecutive sample of adult patients with a length of stay of 24 hours or more between July 1, 1997, and December 31, 1999.Results.Seventy-six (4%) of 1,872 patients were identified with CDAD; 40 (53%) acquired CDAD in the ICU, for an incidence of 3.2 cases per 1,000 patient-days. Antimicrobial therapy, enteral feeding, mechanical ventilation, vancomycin-resistant enterococci (VRE) colonization or infection, and CCP (5.5 vs 2.0 CDAD case-days of exposure for patients with acquired CDAD vs no CDAD; P = .001) were associated with CDAD acquisition in the univariate analysis. Only VRE colonization or infection (45% of patients with acquired CDAD vs 16% of patients without CDAD; adjusted odds ratio, 2.76 [95% confidence interval, 1.36-5.59]) and a CCP of more than 30 case-days of exposure (20% with acquired CDAD vs 2% with no CDAD; adjusted odds ratio, 3.77 [95% confidence interval, 1.14-12.49]) remained statistically significant in the multivariable analysis. Lengths of stay (6.1 vs 3.0 days; P < .001 by univariate analysis) and ICU costs ($11,353 vs $6,028; P < .001 by univariate analysis) were higher for patients with any CDAD than for patients with no CDAD.Conclusions.In this nonoutbreak setting, the CCP was an independent risk factor for acquisition of CDAD in the ICU at the upper range of exposure duration. Having CDAD in the ICU was a marker of excess healthcare use.

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Sex modulates the association of radial artery augmentation index with renal function decline in individuals without chronic kidney disease

International Urology and Nephrology ◽

10.1007/s11255-020-02776-5 ◽

2021 ◽

Author(s):

Qiao Qin ◽

Fangfang Fan ◽

Jia Jia ◽

Yan Zhang ◽

Bo Zheng

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Arterial Stiffness ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Augmentation Index ◽

Renal Function Decline

Abstract Purpose An increase in arterial stiffness is associated with rapid renal function decline (RFD) in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether the radial augmentation index (rAI), a surrogate marker of arterial stiffness, affects RFD in individuals without CKD. Methods A total of 3165 Chinese participants from an atherosclerosis cohort with estimated glomerular filtration rates (eGFR) of ≥ 60 mL/min/1.73 m2 were included in this study. The baseline rAI normalized to a heart rate of 75 beats/min (rAIp75) was obtained using an arterial applanation tonometry probe. The eGFRs at both baseline and follow-up were calculated using the equation derived from the Chronic Kidney Disease Epidemiology Collaboration. The association of the rAIp75 with RFD (defined as a drop in the eGFR category accompanied by a ≥ 25% drop in eGFR from baseline or a sustained decline in eGFR of > 5 mL/min/1.73 m2/year) was evaluated using the multivariate regression model. Results During the 2.35-year follow-up, the incidence of RFD was 7.30%. The rAIp75 had no statistically independent association with RFD after adjustment for possible confounders (adjusted odds ratio = 1.12, 95% confidence interval: 0.99–1.27, p = 0.074). When stratified according to sex, the rAIp75 was significantly associated with RFD in women, but not in men (adjusted odds ratio and 95% confidence interval: 1.23[1.06–1.43], p = 0.007 for women, 0.94[0.76–1.16], p = 0.542 for men; p for interaction = 0.038). Conclusion The rAI might help screen for those at high risk of early rapid RFD in women without CKD.

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Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01368-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sara C. Auld ◽

Hardy Kornfeld ◽

Pholo Maenetje ◽

Mandla Mlotshwa ◽

William Chase ◽

...

Keyword(s):

Lung Function ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Logistic Regression Models ◽

Pulmonary Impairment ◽

Mixed Pattern

Abstract Background While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. Methods In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. Results Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78). Conclusions In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.

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Nonadherence to tuberculosis treatment and associated factors among patients using directly observed treatment short-course in north-west Nigeria: A cross-sectional study

SAGE Open Medicine ◽

10.1177/2050312121989497 ◽

2021 ◽

Vol 9 ◽

pp. 205031212198949

Author(s):

Cylia Nkechi Iweama ◽

Olaoluwa Samson Agbaje ◽

Prince Christian Ifeanachor Umoke ◽

Chima Charles Igbokwe ◽

Eyuche Lawretta Ozoemena ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cross Sectional Study ◽

Medication Nonadherence ◽

Cross Sectional ◽

Tuberculosis Patients ◽

North West ◽

Short Course ◽

Directly Observed Treatment

Introduction: Tuberculosis is a public health problem in Nigeria. One of the most effective ways of controlling tuberculosis is the directly observed treatment short-course. However, some factors influence tuberculosis patients’ treatment nonadherence via directly observed treatment short-course. The study objective was to assess medication nonadherence and associated factors among tuberculosis patients in north-west Nigeria. Methods: A cross-sectional study enrolled tuberculosis patients using directly observed treatment short-course in public health facilities in Kano and Kaduna States from January 2015 to June 2016. The sample selection was conducted via a multistage sampling procedure. Data were collected using tuberculosis patients’ demographic and clinical characteristics forms, well-validated structured instruments, and medical records. SPSS version 20 was used for data analysis. Logistic and multivariable logistic regression analyses to determine factors of medication nonadherence ( P < 0.05) Results: Complete responses from 390 patients out of the 460 patients recruited for the study were used for data analyses. The mean age was 51.5 (standard deviation = ±13.8) years. The mean tuberculosis medication adherence questionnaire score was 4.35 ± 1.12. The prevalence of nonadherence to tuberculosis medication was 30.5%. Multivariable logistic regression analysis showed that having a monthly income between #100,000 and #199, 000 (adjusted odds ratio = 0.01; 95% confidence interval: 0.00–0.13), being widowed (adjusted odds ratio = 26.74, 95% confidence interval: 2.92–232.9), being married (adjusted odds ratio = 120.49, 95% confidence interval: 5.38–271.1), having a distance <5 km to directly observed treatment short-course center from home (adjusted odds ratio = 0.06, 95% confidence interval: 0.00–0.01), having a tuberculosis/HIV co-infection (adjusted odds ratio = 0.01, 95% confidence interval: 0.12–0.35), use of antiretroviral treatment and cotrimoxazole prophylaxis therapy medications (adjusted odds ratio = 24.9, 95% confidence interval: 19.6–304.3) were associated with tuberculosis medication nonadherence. Conclusion: Tuberculosis medication nonadherence was high among the patients. Thus, patient-specific adherence education, attenuation of potential factors for tuberculosis medication nonadherence, and continual resource support for tuberculosis patients are needed to improve treatment outcomes.

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Factors associated with parental traditional medicine use for children in Fagita Lekoma Woreda Northwest Ethiopia: A cross-sectional study

SAGE Open Medicine ◽

10.1177/2050312120978008 ◽

2020 ◽

Vol 8 ◽

pp. 205031212097800

Author(s):

Damtew Asrat ◽

Atsede Alle ◽

Bekalu Kebede ◽

Bekalu Dessie

Keyword(s):

Confidence Interval ◽

Traditional Medicine ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cross Sectional Study ◽

Medicine Use ◽

Community Based ◽

Cross Sectional ◽

Traditional Medicines ◽

Factors Associated

Background: Over the last 100 years, the development and mass production of chemically synthesized drugs have revolutionized health care in most parts of the world. However, large sections of the population in developing countries still depend on traditional medicines for their primary health care needs. More than 88% of Ethiopian parents use different forms of traditional medicine for their children. Therefore, this study aimed to determine factors associated with parental traditional medicine use for children in Fagita Lekoma Woreda. Method: Community-based cross-sectional study was conducted from 1 to 30 March 2019 in Fagita Lekoma Woreda. Data collection tool was a structured interviewer-administered questionnaire. Both descriptive and inferential statistics were used to present the data. Odds ratio and binary and multiple logistic regression analysis were used to measure the relationship between dependent and independent variables. Results: Among 858 participants, 71% of parents had used traditional medicine for their children within the last 12 months. Parents who cannot read and write (adjusted odds ratio = 6.42, 95% confidence interval = 2.1–19.7), parents with low monthly income (adjusted odds ratio = 4.38, 95% confidence interval = 1.58–12.1), and those who had accesses to traditional medicine (adjusted odds ratio = 2.21, 95% confidence interval = 1.23–3.98) were more likely to use traditional medicine for their children. Urban residents (adjusted odds ratio = 0.20, 95% confidence interval = 0.11–0.38) and members of community-based health insurance (adjusted odds ratio = 0.421, 95% confidence interval = 0.211–0.84) were less likely to use traditional medicine for their children. Conclusions: Our study revealed that the prevalence of traditional medicine remains high. Educational status, monthly income, residence, accessibility to traditional medicine, and being a member of community-based health insurance were predictors of potential traditional medicine use. Therefore, the integration of traditional medicine with modern medicine should be strengthened. Community education and further study on efficacy and safety of traditional medicines should be also given great attention.

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Risk Factors for a Positive Hepatitis C Status in Fishermen in Kuantan Malaysia

Asia Pacific Journal of Public Health ◽

10.1177/1010539519841294 ◽

2019 ◽

Vol 31 (3) ◽

pp. 227-237

Author(s):

Priya Lall ◽

Rumana Saifi ◽

Diva Baggio ◽

Samantha Fitzsimmons Schoenberger ◽

Martin Choo ◽

...

Keyword(s):

Hepatitis C ◽

Confidence Interval ◽

Risk Taking ◽

Odds Ratio ◽

Large Scale ◽

Adjusted Odds Ratio ◽

Environmental Drivers ◽

Negative Effects ◽

Risk Taking Behaviors ◽

Risk Communities

Malaysia currently has an estimated hepatitis C virus (HCV) prevalence of 1.3% with an infected population of 384,000. Fishermen in Malaysia are at risk of HCV infection due to injection drug use and disproportionately high rates of incarceration. This study used quantitative data from Project WAVES, a large-scale mixed methods project charting environmental drivers of risk-taking behaviors among a respondent-driven sample of 406 fishermen in Malaysia. Over a quarter of participants (27.9%) reported injecting drugs in the past month; 49.8% of the sample tested positive for HCV. Respondents who had previously been arrested displayed increased odds of being HCV-positive (adjusted odds ratio = 4.79, confidence Interval = 2.46-9.35). Participants who reported being in lock-up displayed close to 6-fold odds of being HCV-infected (adjusted odds ratio = 5.49, confidence interval = 2.77-10.90, P < .001). These findings underscore the need for policies and structural interventions targeting the negative effects of aggressive incarceration contributing to the burden of HCV among high-risk communities.

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Regular STI testing amongst men who have sex with men and use social media is suboptimal – a cross-sectional study

International Journal of STD & AIDS ◽

10.1177/0956462416636780 ◽

2016 ◽

Vol 28 (6) ◽

pp. 573-583 ◽

Cited By ~ 6

Author(s):

Jamie Frankis ◽

Lisa Goodall ◽

Dan Clutterbuck ◽

Abdul-Razak Abubakari ◽

Paul Flowers

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Anal Intercourse ◽

Sex Partners ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Sti Testing ◽

Male Sex ◽

Sex With Men

Sexually transmitted infections (STIs) disproportionately affect men who have sex with men, with marked increases in most STIs in recent years. These are likely underpinned by coterminous increases in behavioural risks which have coincided with the development of Internet and geospatial sociosexual networking. Current guidelines advocate regular, annual sexually transmitted infection testing amongst sexually active men who have sex with men (MSM), as opposed to symptom-driven testing. This paper explores sexually transmitted infection testing regularity amongst MSM who use social and sociosexual media. Data were collected from 2668 men in Scotland, Wales, Northern Ireland and the Republic of Ireland, recruited via social and gay sociosexual media. Only one-third of participants report regular (yearly or more frequent) STI testing, despite relatively high levels of male sex partners, condomless anal intercourse and high-risk unprotected anal intercourse. The following variables were associated with regular STI testing; being more ‘out’ (adjusted odds ratio = 1.79; confidence interval = 1.20–2.68), HIV-positive (adjusted odds ratio = 14.11; confidence interval = 7.03–28.32); reporting ≥10 male sex partners (adjusted odds ratio = 2.15; confidence interval = 1.47–3.14) or regular HIV testing (adjusted odds ratio = 48.44; confidence interval = 28.27–83.01). Men reporting long-term sickness absence from work/carers (adjusted odds ratio = 0.03; confidence interval = 0.00–0.48) and men aged ≤25 years (adjusted odds ratio = 0.36; 95% confidence interval = 0.19–0.69) were less likely to test regularly for STIs. As such, we identify a complex interplay of social, health and behavioural factors that each contribute to men’s STI testing behaviours. In concert, these data suggest that the syndemics placing men at elevated risk may also mitigate against access to testing and prevention services. Moreover, successful reduction of STI transmission amongst MSM will necessitate a comprehensive range of approaches which address these multiple interrelated factors that underpin MSM's STI testing.

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An epidemiological investigation of the 2019 suspected pertussis outbreak in northwestern Nigeria

SAGE Open Medicine ◽

10.1177/20503121211008344 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110083

Author(s):

Omoleke Semeeh ◽

Biniam Getachew ◽

Yusuf Taofik ◽

Lukman Surajudeen ◽

Assad Hassan ◽

...

Keyword(s):

Confidence Interval ◽

Disease Transmission ◽

Attack Rate ◽

Odds Ratio ◽

Case Fatality Rate ◽

Adjusted Odds Ratio ◽

Case Fatality ◽

Immunization Coverage ◽

Fatality Rate ◽

Vaccine Preventable Diseases

Introduction: In 2019, we investigated the profile of the cases and controls and the determinants of pertussis transmission in Kebbi State, Northwestern Nigeria, to inform better immunization and surveillance strategies. Methods: Community-based unmatched case–control study and review of the 2019 pertussis routine surveillance data in the affected settlements in the state were conducted. A total of 52 suspected cases of pertussis and 107 control from two local government areas in Kebbi State were recruited. Data were analyzed using descriptive and inferential statistics. Results: The highest attack rate was observed among between 1- and 4-year age group followed by children less than 1-year old, and the least attack rate was among those above 15 years. The overall attack rate and the case fatality rate were 2.10% and 0.10%, respectively. A higher attack rate was observed among women, whereas the case fatality rate was more among males. From the community survey, we observed that the cases were less likely to have pertussis vaccination history (adjusted odds ratio = 0.28, 95% confidence interval = 0.11–0.74) compared with the controls. Knowing pertussis prevention methods were found protective for pertussis transmission (adjusted odds ratio = 0.14, 95% confidence interval = 0.04–0.45). Conclusion: This study showed the vulnerability of children under 5 years, especially under 1 year, to vaccine-preventable diseases in rural populations, where “real” immunization coverage is sub-optimal, and the dominant socio-demographic factors are supportive of disease transmission. We found immunization and knowledge of the preventive measures to be protective against pertussis outbreaks. Therefore, routine immunization services must be intensified to improve coverage and prevent future pertussis outbreak(s).

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