Elderly People’s Access to Emergency Departments during the COVID-19 Pandemic: Results from a Large Population-Based Study in Italy

Across the world, people have avoided seeking medical attention during the coronavirus pandemic, resulting in a marked reduction in emergency department (ED) visits. This retrospective cohort study examines in detail how the present pandemic affects ED use by the elderly. The regional database on ED visits in Veneto (northeastern Italy) was consulted to extract anonymous data on all ED visits during 2019 and 2020, along with details concerning patients’ characteristics (access mode, triage code, chief complaint, and outcome). A year-on-year comparison was drawn between 2019 and 2020. There was a 25.3% decrease in ED visits in 2020 compared to the previous year. The decrease ranged from −52.4% in March to −18.4% in September when comparing the same months in the two years. This decrease started in late February 2020, with the lowest numbers of visits recorded in March and April 2020 (during the “first wave” of the COVID-19 pandemic in Italy), and in the autumn (during the “second wave”). The proportion of visits to the ED by ambulance has increased sharply since March 2020, and patients arrived more frequently with severe conditions (red or yellow triage tags) that often required a hospitalization. The greatest decrease was in fact observed for non-urgent complaints. This decreased concerned a wide range of conditions, including chest pain and abdominal pain. The sharp reduction observed in the present study is unlikely to be attributed entirely to the effect of lockdown measures. Individual psychological and media-induced fear of contagion most likely played a relevant role in leading people to avoid seeking medical attention.

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Headache

Reviews in Clinical Gerontology ◽

10.1017/s095925980201225x ◽

2002 ◽

Vol 12 (2) ◽

pp. 127-144

Author(s):

GJF Saldanha ◽

CG Clough ◽

N Ward

Keyword(s):

General Population ◽

Elderly Population ◽

Large Population ◽

The Elderly ◽

Epidemiological Studies ◽

Population Based ◽

Medical Attention ◽

Population Based Study ◽

The Usa ◽

One Year

Little is known about the frequency of headache in the elderly population as few epidemiological studies have been carried out. In one year in the USA, 70% of the general population had a headache, 5% of whom sought medical attention. In a large population-based study carried out in East Boston, US, some 17% of patients over 65 yrs of age reported frequent headache, with 53% of women and 36% of men reporting headache in the previous year.

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Prevalence of health services usage and associated factors in the Amazon region of Brazil: a population-based cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2017-017966 ◽

2017 ◽

Vol 7 (11) ◽

pp. e017966 ◽

Cited By ~ 9

Author(s):

Maria Elizete A Araujo ◽

Marcus T Silva ◽

Tais F Galvao ◽

Mauricio G Pereira

Keyword(s):

Health Services ◽

Associated Factors ◽

Prevalence Ratio ◽

The Elderly ◽

Population Based ◽

Cross Sectional Study ◽

Metropolitan Region ◽

Medical Attention ◽

Cross Sectional ◽

Physician Visits

ObjectivesTo estimate the prevalence of healthcare use and associated factors in the Manaus metropolitan region and to describe the reasons for lack of access.DesignCross-sectional population-based study.SettingA survey conducted between May and August of 2015 in eight cities from Manaus metropolitan region, Amazonas, Brazil.Participants4001 adults ≥18 years of age.Primary outcomes measuresPhysician visits, dentist visits and hospitalisations in the last 12 months were the primary outcomes. Associated factors were investigated through the calculation of prevalence ratio (PR) obtained by hierarchical Poisson regression modelling.Results4001 adults were included in the study, 53% of whom were women. The self-reported prevalence of medical visits was 77% (95% CI 75% to 77%); dentist visits, 36% (95% CI 34% to 37%) and hospital admission, 7% (95% CI 6% to 7%). Physician visits were higher in women PR=1.18 (95% CI 1.14 to 1.23), the elderly PR=1.18 (95% CI 1.10 to 1.26) and people with health insurance PR=1.14 (95% CI 1.10 to 1.19). Dentist visits declined with older age PR=0.38 (95% CI 0.30 to 0.49), lower education level PR=0.62 (95% CI 0.51 to 0.74) and lower economic class PR=0.65 (95% CI 0.57 to 0.75). Hospitalisations were found to be twice as frequent for women than for men and three times as frequent among those who reported very poor health status. Among the individuals who did not receive medical attention in the previous 2 weeks, 58% reported lack of facilities or appointment unavailable and 14% reported lack of doctors.ConclusionWhile more than half visited the doctor in the last year, a lower proportion of people with socioeconomic inequities visited the dentist. Organisational and service policies are needed to increase equity in health services in the region.

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Pregnancy Experience after Delivery of a Child with a Major Birth Defect: A Population Study

PEDIATRICS ◽

10.1542/peds.95.1.59 ◽

1995 ◽

Vol 95 (1) ◽

pp. 59-65

Author(s):

Margarett K. Davis ◽

Muin J. Khoury ◽

J. David Erickson

Keyword(s):

Birth Defects ◽

Reproductive Behavior ◽

Birth Defect ◽

Large Population ◽

Population Based ◽

Subsequent Pregnancy ◽

Pregnancy Rates ◽

Wide Range ◽

First Year Of Life ◽

And Control

Objective. Data from a large population-based, case-control study were analyzed to determine whether women giving birth to children with major birth defects have different subsequent pregnancy patterns than those giving birth to live-born babies without defects. Other studies examining this phenomenon have been smaller, have not been population-based, or have not addressed the different effects that a wide range of major defects might have on mothers' subsequent pregnancy rates. Methods. Mothers of 4918 infants with major birth defects born from 1968 through 1980 in metropolitan Atlanta were compared with mothers of 3029 control infants, frequency-matched on birth year, birth hospital, and race. Results. The pregnancy rate in the first 3 years after the index birth was higher among case mothers (36%) than among control mothers (30%, P < .0001). This excess was seen for mothers of stillborn case infants (64%) and mothers of case infants who died in infancy (58%), but not for mothers of case infants who survived the first year of life (31%). Pregnancy rates varied by birth defect type. Maternal and infant factors varied among case and control subjects and influenced subsequent pregnancy rates. Conclusion. The reproductive behavior observed in this study supports the theory that mothers of nonsurviving children with birth defects compensate by acting to "replace" the lost child. Reproductive behavior was also strongly associated with having completed a previous pregnancy and by the type of birth defect.

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Definitions of medication-overuse headache in population-based studies and their implications on prevalence estimates: A systematic review

Cephalalgia ◽

10.1177/0333102413512033 ◽

2013 ◽

Vol 34 (6) ◽

pp. 409-425 ◽

Cited By ~ 64

Author(s):

Maria L Westergaard ◽

Ebba Holme Hansen ◽

Charlotte Glümer ◽

Jes Olesen ◽

Rigmor H Jensen

Keyword(s):

Medication Overuse ◽

Medication Overuse Headache ◽

Large Population ◽

Population Based ◽

Case Definition ◽

Practical Case ◽

Case Definitions ◽

Wide Range ◽

Concurrent Medication ◽

Over Time

Background Case definitions of medication-overuse headache (MOH) in population-based research have changed over time. This study aims to review MOH prevalence reports with respect to these changes, and to propose a practical case definition for future studies based on the ICHD-3 beta. Methods A systematic literature search was conducted to identify MOH prevalence studies. Findings were summarized according to diagnostic criteria. Results Twenty-seven studies were included. The commonly used case definition for MOH was headache ≥15 days/month with concurrent medication overuse ≥3 months. There were varying definitions for what was considered as overuse. Studies that all used ICHD-2 criteria showed a wide range of prevalence among adults: 0.5%–7.2%. Conclusions There are limits to comparing prevalence of MOH across studies and over time. The wide range of reported prevalence might not only be due to changing criteria, but also the diversity of countries now publishing data. The criterion “headache occurring on ≥15 days per month” with concurrent medication overuse can be applied in population-based studies. However, the new requirement that a respondent must have “a preexisting headache disorder” has not been previously validated. Exclusion of other headache diagnoses by expert evaluation and ancillary examinations is not feasible in large population-based studies.

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Blood Pressure and White Matter Hyperintensity Volume - A Review of the Relationship and Implications for Stroke Prediction and Prevention

European Neurological Review ◽

10.17925/enr.2012.07.03.174 ◽

2012 ◽

Vol 7 (3) ◽

pp. 174 ◽

Cited By ~ 1

Author(s):

Royya Modir ◽

Hannah Gardener ◽

Clinton B Wright ◽

◽

...

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

White Matter ◽

Large Population ◽

Brain Perfusion ◽

The Elderly ◽

Vascular Cognitive Impairment ◽

Population Based ◽

White Matter Hyperintensity ◽

Prediction And Prevention

A heavy burden of white matter hyperintensities (WMH) is a risk factor for stroke and vascular cognitive impairment making it important to understand their pathophysiology, aetiology and clinical implications. Ageing studies suggest a linear relationship between blood pressure (BP) and both WMH and microstructural integrity in normal-appearing white matter and, after age, hypertension is the strongest risk factor for WMH. Numerous large population-based observational studies have reported significant associations between elevated BP and WMH burden, however, the relative importance of systolic versus diastolic BP remains controversial. Limitations of prior studies include the use of only a single measurement of BP and oversimplifying hypertension as a dichotomous variable. Race/ethnic differences in the association between BP and WMH have been suggested, but most studies only included older Caucasians. Antihypertensive treatment has been demonstrated to slow WMH progression, but lowering BP in the elderly may also reduce brain perfusion in those with poor autoregulation. Ongoing trials aim to clarify the effects of BP treatment on WMH progression in multi-ethnic populations and the implications of these findings for stroke prevention require further study.

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The Constances cohort

European Journal of Public Health ◽

10.1093/eurpub/ckz185.548 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Z Zins

Keyword(s):

Public Health ◽

Health Research ◽

Neuropsychological Testing ◽

Large Population ◽

Public Health Research ◽

Population Based ◽

Industrial Companies ◽

Wide Range ◽

Public Health Institutions

Abstract The overarching objective of CONSTANCES is to constitute a research infrastructure based on a large population-based cohort to serve as a versatile, high quality and efficient platform for population health research. Constances is designed as a representative sample of 200,000 adults aged 18-69 at inception living in different regions of France. CONSTANCES, which is accessible to the national and international research community, enables the conduct of valid and well-powered studies in a wide range of scientific domains. For each participant, it combines detailed data collection at baseline, englobing lifestyle, environmental, social, and medical history information, with medical examinations, neuropsychological testing with the added advantage of linkage with two major national administrative data bases (SNDS and CNAV). Further, CONSTANCES collects information about changing lifestyles, environments, health behaviors and health conditions on a prospective ongoing basis. A biobank of blood and urine samples is in the process of being constituted. As of April 2018, 85 nested projects designed by French and international teams in many areas of biomedical and public health research were initiated. Constances participates in several French and international consortiums. We established relationships with public health institutions and industrial companies. In the next years, we plan to continue longitudinal follow-up CONSTANCES along the same lines by extending the follow-up of the cohort and by developing innovative new themes prioritizing the strengthening of certain “niches” where CONSTANCES can have international leadership.

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Success Story of Targeted Therapy in Chronic Myeloid Leukemia: A Population-Based Study of Patients Diagnosed in Sweden From 1973 to 2008

Journal of Clinical Oncology ◽

10.1200/jco.2011.34.7146 ◽

2011 ◽

Vol 29 (18) ◽

pp. 2514-2520 ◽

Cited By ~ 137

Author(s):

Magnus Björkholm ◽

Lotta Ohm ◽

Sandra Eloranta ◽

Åsa Derolf ◽

Malin Hultcrantz ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Kinase Inhibitor ◽

Large Population ◽

Age Groups ◽

Relative Survival ◽

The Elderly ◽

Population Based ◽

Population Based Study ◽

First Line Therapy

Purpose Chronic myeloid leukemia (CML) management changed dramatically with the development of imatinib mesylate (IM), the first tyrosine kinase inhibitor targeting the BCR-ABL1 oncoprotein. In Sweden, the drug was approved in November 2001. We report relative survival (RS) of patients with CML diagnosed during a 36-year period. Patients and Methods Using data from the population-based Swedish Cancer Registry and population life tables, we estimated RS for all patients diagnosed with CML from 1973 to 2008 (n = 3,173; 1,796 males and 1,377 females; median age, 62 years). Patients were categorized into five age groups and five calendar periods, the last being 2001 to 2008. Information on use of upfront IM was collected from the Swedish CML registry. Results Relative survival improved with each calendar period, with the greatest improvement between 1994-2000 and 2001-2008. Five-year cumulative relative survival ratios (95% Cls) were 0.21 (0.17 to 0.24) for patients diagnosed 1973-1979, 0.54 (0.50 to 0.58) for 1994-2000, and 0.80 (0.75 to 0.83) for 2001-2008. This improvement was confined to patients younger than 79 years of age. Five-year RSRs for patients diagnosed from 2001 to 2008 were 0.91 (95% CI, 0.85 to 0.94) and 0.25 (95% CI, 0.10 to 0.47) for patients younger than 50 and older than 79 years, respectively. Men had inferior outcome. Upfront overall use of IM increased from 40% (2002) to 84% (2006). Only 18% of patients older than 80 years of age received IM as first-line therapy. Conclusion This large population-based study shows a major improvement in outcome of patients with CML up to 79 years of age diagnosed from 2001 to 2008, mainly caused by an increasing use of IM. The elderly still have poorer outcome, partly because of a limited use of IM.

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Blood Pressure and White Matter Hyperintensity Volume - A Review of the Relationship and Implications for Stroke Prediction and Prevention

European Neurological Review ◽

10.17925/enr.2012.07.04.224 ◽

2012 ◽

Vol 7 (4) ◽

pp. 224

Author(s):

Royya Modir ◽

Hannah Gardener ◽

Clinton B Wright ◽

◽

...

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

White Matter ◽

Large Population ◽

Brain Perfusion ◽

The Elderly ◽

Vascular Cognitive Impairment ◽

Population Based ◽

White Matter Hyperintensity ◽

Prediction And Prevention

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The CONSTANCES Cohort Biobank: An Open Tool for Research in Epidemiology and Prevention of Diseases

Frontiers in Public Health ◽

10.3389/fpubh.2020.605133 ◽

2020 ◽

Vol 8 ◽

Author(s):

J. Henny ◽

R. Nadif ◽

S. Le Got ◽

S. Lemonnier ◽

A. Ozguler ◽

...

Keyword(s):

Public Health ◽

Quality Management System ◽

Large Population ◽

Population Based ◽

General Purpose ◽

Buffy Coat ◽

Integrative Approach ◽

Health Examination ◽

Wide Range

“General-purpose cohorts” in epidemiology and public health are designed to cover a broad scope of determinants and outcomes, in order to answer several research questions, including those not defined at study inception. In this context, the general objective of the CONSTANCES project is to set up a large population-based cohort that will contribute to the development of epidemiological research by hosting ancillary projects on a wide range of scientific domains, and to provide public health information. CONSTANCES was designed as a randomly selected sample of French adults aged 18–69 years at study inception; 202,045 subjects were included over an 8-year period. At inclusion, the selected participants are invited to attend one of the 24 participating Health Prevention Centers (HPCs) for a comprehensive health examination. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HPC. Procedures have been developed to use the national healthcare databases to allow identification and validation of diseases over the follow-up. The biological collection (serum, lithium heparinized plasma, EDTA plasma, urine and buffy coat) began gradually in June 2018. At the end of the inclusions, specimens from 83,000 donors will have been collected. Specimens are collected according to a standardized protocol, identical in all recruitment centers. All operations relating to bio-banking have been entrusted by Inserm to the Integrated Biobank of Luxembourg (IBBL). A quality management system has been put in place. Particular attention has been paid to the traceability of all operations. The nature of the biological samples stored has been deliberately limited due to the economic and organizational constraints of the inclusion centers. Some research works may require specific collection conditions, and can be developed on request for a limited number of subjects and in specially trained centers. The biological specimens that are collected will allow for a large spectrum of biomarkers studies and genetic and epigenetic markers through candidate or agnostic approaches. By linking the extensive data on personal, lifestyle, environmental, occupational and social factors with the biomarker data, the CONSTANCES cohort offers the opportunity to study the interplays between these factors using an integrative approach and state-of-the-art methods.

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