Sociodemographic, Circumstantial, and Psychopathological Predictors of Involuntary Admission of Patients with Acute Psychosis

Studies have consistently determined that patients with acute psychosis are more likely to be involuntarily admitted, although few studies examine specific risk factors of involuntary admission (IA) among this patient group. Data from all patients presenting in the psychiatric emergency department (PED) over a period of one year were extracted. Acute psychosis was identified using specific diagnostic criteria. Predictors of IA were determined using logistic regression analysis. Out of 2533 emergency consultations, 597 patients presented with symptoms of acute psychosis, of whom 118 were involuntarily admitted (19.8%). Involuntarily admitted patients were more likely to arrive via police escort (odds ratio (OR) 10.94) or ambulance (OR 2.95), live in a psychiatric residency/nursing home (OR 2.76), report non-adherence to medication (OR 2.39), and were less likely to suffer from (comorbid) substance abuse (OR 0.53). Use of mechanical restraint was significantly associated with IA (OR 13.31). Among psychopathological aspects, aggressiveness was related to the highest risk of IA (OR 6.18), followed by suicidal intent (OR 5.54), disorientation (OR 4.66), tangential thinking (OR 3.95), and suspiciousness (OR 2.80). Patients stating fears were less likely to be involuntarily admitted (OR 0.25). By understanding the surrounding influencing factors, patient care can be improved with the aim of reducing the use of coercion.

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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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Prevalence of Feline Immunodeficiency Virus and Toxoplasma gondii in Feral Cats on St. Kitts, West Indies

Veterinary Sciences ◽

10.3390/vetsci8020016 ◽

2021 ◽

Vol 8 (2) ◽

pp. 16

Author(s):

Xinyu Chi ◽

Kexin Fang ◽

Liza Koster ◽

Jevan Christie ◽

Chaoqun Yao

Keyword(s):

Toxoplasma Gondii ◽

Feline Immunodeficiency Virus ◽

Odds Ratio ◽

Protozoan Parasite ◽

Domestic Cat ◽

Feral Cats ◽

Immunodeficiency Virus ◽

Polymerase Chain ◽

One Year

Toxoplasma gondii (T. gondii) is a cosmopolitan protozoan parasite that infects all warm-blooded species including humans. The definitive hosts of T. gondii are felid vertebrates including the domestic cat. Domestic cats shed oocysts for approximately two weeks in their feces after the primary infection. It has been shown that feline immunodeficiency virus (FIV) positive cats have a higher prevalence of and a higher titer of antibodies to T. gondii than those of FIV-negative cats. The main purposes of this study were to determine FIV prevalence and to investigate the oocysts shedding in FIV-positive and FIV-negative feral cats on St. Kitts. Fecal samples were collected from feral cats while their FIV statues were determined using a commercial SNAP kit. Total fecal DNA of each cat was tested for the presence of T. gondii DNA using a polymerase chain reaction (PCR) consistently detecting one genome equivalent. A FIV-positive status was detected in 18 of 105 (17.1%, 95% confidence interval (CI): 9.9%−24.3%) feral cats sampled. Furthermore, males were three times more likely to be FIV positive than females (p = 0.017) with an odds ratio of 3.93 (95% CI: 1.20–12.89). Adults were found to have at least twice the prevalence of FIV compared to cats younger than one year of age (p = 0.056) with an odds ratio of 3.07 (95% CI: 0.94–10.00). Toxoplasma gondii DNA was not detected in the feces of any of the 18 FIV-positive (95% CI: 0%−0.18%) and 87 FIV-negative cats (95% CI: 0%−0.04%). A follow-up study with a much bigger sample size is needed to prove or disprove the hypothesis that FIV-positive cats have a higher prevalence of shedding T. gondii oocysts than FIV-negative cats.

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Does perianal disease influence the efficacy of combination therapy in Crohn’s disease?

Digestive Diseases ◽

10.1159/000513067 ◽

2020 ◽

Author(s):

Rui de Sousa Magalhães ◽

Sofia Xavier ◽

Tiago Cúrdia Gonçalves ◽

Francisca Dias de Castro ◽

Bruno Rosa ◽

...

Keyword(s):

Combination Therapy ◽

Clinical Remission ◽

Odds Ratio ◽

Perianal Disease ◽

Outcome Variable ◽

P Value ◽

Disease Relapse ◽

Endoscopic Remission ◽

Remission Rates ◽

One Year

Background: Perianal disease is associated with a disabling course of CD. We aim to study the impact of perianal disease on CD remission rates, after a one-year course of infliximab in combination therapy with azathioprine. Methods: Cohort, retrospective, single centre study, including consecutive CD patients on combination therapy, followed for one year since induction. The outcome variable was split into clinical and endoscopic remission. The correlation towards the outcome variable was assessed with univariate and multivariate analysis, and a survival assessment, using SPSS software. Results: We assessed 74 CD patients, of whom 41 (55.4%) were female, with a mean age of 36 years-old. Thirty-nine percent of the patients presented perianal disease at diagnosis (n=29). We documented 70.3% clinical and 47.2% endoscopic remissions. Several variables had statistical significance towards the outcomes (endoscopic and clinical remission) in the univariate analysis. After adjusting for confoundment, patients with perianal disease presented an odds ratio of 0.20 for achieving endoscopic remission (odds ratio 0.201 CI [0.054-0.75] p-value 0.017) and an odds ratio of 0.203 for achieving clinical remission (OR 0.203 CI [0.048-0.862] p-value 0.031). Sixty-six patients (89.2%) presented an initial response to treatment, from whom, 20 (30.3%) exhibited at least one disease relapse (clinical and/or endoscopic). Patients with perianal disease presented higher probability of disease relapse, displaying statistically significant difference on Kaplan-Meyer curves (Breslow p-value 0.043). Conclusion: In the first year of combination therapy, perianal disease is associated with an 80% decrease in endoscopic and clinical remission rates and higher ratio of disease relapse.

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One-Year Outcome After Endovascular Treatment for Acute Basilar Artery Occlusion

Stroke ◽

10.1161/strokeaha.120.033658 ◽

2021 ◽

Author(s):

Fengli Li ◽

Hongfei Sang ◽

Jiaxing Song ◽

Zhangbao Guo ◽

Shuai Liu ◽

...

Keyword(s):

Treatment Group ◽

Endovascular Treatment ◽

Basilar Artery ◽

Odds Ratio ◽

Conventional Treatment ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Modified Rankin Scale ◽

Common Odds Ratio ◽

One Year

Background and Purpose: The BASILAR registry, a nationwide prospective nonrandomized study conducted in China, enrolled consecutive patients with acute basilar artery occlusion receiving endovascular treatment or conventional-treatment from January 2014 to May 2019. This article aimed to report the results of clinical follow-up at one year among these patients. Methods: The primary outcome was the modified Rankin Scale at one year, assessed as a common odds ratio using ordinal logistic regression analysis adjusted for prespecified prognostic factors. Secondary outcomes included the modified Rankin Scale-based outcome group at one year (0–1, 0–2, or 0–3) and all-cause death. Results: Of the 829 patients enrolled in the original BASILAR registry, one-year data were available for 785 patients (94.7%). The distribution of outcomes on the modified Rankin Scale favored endovascular treatment over conventional-treatment (adjusted common odds ratio, 4.50 [95% CI, 2.81–7.29]; P <0.001). The cumulative one-year mortality rate was 54.6% in the endovascular treatment group versus 83.5% in the conventional-treatment group (adjusted odds ratio, 4.36 [95% CI, 2.69–7.29]; P <0.001). Conclusions: The beneficial effect of endovascular treatment on functional outcome at one year in patients with acute basilar artery occlusion is similar to that reported at 90 days in the original study. REGISTRATION: URL: http://www.chictr.org.cn ; Unique identifier: ChiCTR1800014759.

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Impact of seven years of mass drug administration and recrudescence of Schistosoma haematobium infections after one year of treatment gap in Zanzibar: Repeated cross-sectional studies

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009127 ◽

2021 ◽

Vol 15 (2) ◽

pp. e0009127

Author(s):

Lydia Trippler ◽

Shaali Makame Ame ◽

Jan Hattendorf ◽

Saleh Juma ◽

Salum Abubakar ◽

...

Keyword(s):

Drug Administration ◽

Mass Drug Administration ◽

Odds Ratio ◽

Schistosoma Haematobium ◽

Treatment Gap ◽

Urogenital Schistosomiasis ◽

Cross Sectional ◽

Reagent Strips ◽

One Year ◽

Low Prevalence

Background Considerable progress towards the elimination of urogenital schistosomiasis was made by the Zanzibar Elimination of Schistosomiasis Transmission project from 2012 till 2016, when biannual praziquantel mass drug administration (MDA) alone or with additional snail control or behaviour change interventions were implemented. Annual MDA was continued in 2017 and 2018, but not in 2019, imposing a 16-month treatment gap. We monitored the Schistosoma haematobium prevalence from 2012 till 2020 and assessed recrudescence patterns with focus on 2020. Methodology Repeated cross-sectional surveys were conducted from 2011/12 till 2020 in 90 communities and 90 schools in Zanzibar. Annually, around 4,500 adults and up to 20,000 schoolchildren were surveyed. The S. haematobium prevalence was detected by urine filtration and reagent strips. In 2020, risk factors for infection were investigated using generalized estimated equation models. Principal findings In adults, the apparent S. haematobium prevalence was 3.9% in 2011 and 0.4% in 2020. In schoolchildren, the prevalence decreased from 6.6% in 2012 to 1.2% in 2019 with vicissitudes over the years. Prominent recrudescence of infection from 2.8% in 2019 to 9.1% (+225%) in 2020 was observed in 29 schools with historically moderate prevalences (≥10%). Compared with 2019, reinfection in 2020 was particularly striking in boys aged 9–16 years. Being male was a risk factor for infection in 2020 (adults: odds ratio (OR): 6.24, 95% confidence interval (95% CI): 1.96–19.60; schoolchildren: OR: 2.06, 95% CI: 1.52–2.78). Living near to a natural freshwater body significantly increased the odds of infection in adults (OR: 2.90, CI: 1.12–7.54). Conclusions/Significance After 11 rounds of MDA over 7 years and a 16-month treatment gap, the urogenital schistosomiasis prevalence considerably rebounded in hotspot areas. Future elimination efforts in Zanzibar should focus on re-intensifying MDA plus additional interventions in hotspot areas. In low-prevalence areas, the strategy might be adapted from MDA to targeted surveillance-response.

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Secondary Leukemia following Treatment for Hodgkin's Disease

Tumori Journal ◽

10.1177/030089169307900204 ◽

1993 ◽

Vol 79 (2) ◽

pp. 103-107 ◽

Cited By ~ 9

Author(s):

Luigi Salvagno ◽

Lorenzo Simonato ◽

Mariella Sorarù ◽

Antonio Bianco ◽

Vanna Chiarion-Sileni ◽

...

Keyword(s):

Hodgkin's Disease ◽

Odds Ratio ◽

Case Control Study ◽

Hodgkin’S Disease ◽

Treatment Modalities ◽

Secondary Leukemia ◽

Increased Risk ◽

Radiotherapy Alone ◽

One Year ◽

Control Study

Aims and Background Patients treated for Hodgkin's disease with chemotherapy or with the association of chemotherapy and radiotherapy have an increased risk of secondary leukemia. The aim of this study was to evaluate the leukemogenic risk due to these treatment modalities. Methods We performed a case-control study on a population of 1410 patients treated for Hodgkin's disease from 1970 to 1990 in our Institute. Among these patients, we identified 25 cases of secondary leukemia and 3 cases of myelodysplasia, all occurring more than one year after the diagnosis of Hodgkin's disease. Three cases occurred among the patients treated with radiotherapy alone. When we analyzed the risk in relation to the type of treatment (radiotherapy, chemotherapy, or both), the comparisons were relative to patients treated with radiotherapy alone. Results We found that chemotherapy alone is associated with a fivefold increased risk (odds ratio = 5.4) compared with radiotherapy alone. When both treatments are used, the risk is not further increased (odds ratio = 4.4). Patients receiving more than 6 courses of chemotherapy have an excess risk (relative risk = 2.5) compared with those treated with 6 courses or less. No increased risk was observed after splenectomy. Conclusions This study confirms an increased incidence of secondary leukemia occurring in patients treated for Hodgkin's disease. The increased risk seems to be correlated with the number of courses of alkylating agent therapy, whereas it is unaffected by the addition of radiotherapy.

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Improved quality of life over one year is associated with improved adherence in patients with schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2013.03.002 ◽

2014 ◽

Vol 29 (3) ◽

pp. 191-196 ◽

Cited By ~ 24

Author(s):

K.P. Hayhurst ◽

R.J. Drake ◽

J.A. Massie ◽

G. Dunn ◽

T.R.E. Barnes ◽

...

Keyword(s):

Quality Of Life ◽

Depressive Symptoms ◽

Treatment Adherence ◽

Negative Symptoms ◽

Causal Effect ◽

Social Activity ◽

Adherence To Medication ◽

Quality Of Life Scale ◽

One Year

AbstractAim:Quality of life (QoL) is increasingly considered an important outcome in health research. We wished to explore the determinants of change in QoL in patients with schizophrenia over the course of a one-year RCT.Methods:Predictors of change in observer-rated QoL (Quality of Life Scale: QLS) were assessed in 363 patients with schizophrenia during the CUtLASS clinical trial.Results:Change in QLS score over the course of a year correlated with change in psychotic and depressive symptoms and treatment adherence. Linear regression showed that improvement in QoL was predicted by reduction in negative and depressive symptoms and improvement in adherence rating. These three change scores together explained 38% of the variance in QLS change. Exploration of the direction of any possible causal effect, using TETRAD, indicated that improved adherence leads to improved QoL, and that change in depression also leads to QoL change. The relationship between QoL and negative symptoms suggests that greater social activity (reflected as better QoL scores) improves negative symptoms. Such a direct relationship between treatment adherence and QoL has not been reported before.Conclusion:Improving adherence to medication would appear to be a key approach to improving measured quality of life in people with schizophrenia.

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Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients – real-world data from the Acute Coronary Syndrome Israeli Survey

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872616687097 ◽

2017 ◽

Vol 7 (6) ◽

pp. 497-503 ◽

Cited By ~ 1

Author(s):

Edward Koifman ◽

Roy Beigel ◽

Zaza Iakobishvili ◽

Nir Shlomo ◽

Yitschak Biton ◽

...

Keyword(s):

Myocardial Infarction ◽

Intensive Care Unit ◽

Intensive Care ◽

Odds Ratio ◽

St Elevation Myocardial Infarction ◽

Ischemic Time ◽

Mobile Intensive Care Unit ◽

St Elevation ◽

Mobile Intensive Care Units ◽

One Year

Background: Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients. Methods: Data from the Acute Coronary Survey in Israel registry 2000–2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes. Results: The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( p<0.001). Independent predictors of mobile intensive care unit use were Killip>1 (odds ratio=1.32, p<0.001), the presence of cardiac arrest (odds ratio=1.44, p=0.02), and a systolic blood pressure <100 mm Hg (odds ratio=2.01, p<0.001) at presentation. Patients arriving via mobile intensive care units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, p<0.001). Among ST-elevation myocardial infarction patients undergoing primary reperfusion, those arriving by mobile intensive care unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120–262) vs 195 (interquartile range 130–333) min, respectively ( p<0.001)). Upon a multivariate analysis, mobile intensive care unit use was the most important predictor in achieving door-to-balloon time <90 min (odds ratio=2.56, p<0.001) and door-to-needle time <30 min (odds ratio=2.96, p<0.001). One-year mortality rates were 10.7% in both groups (log-rank p-value=0.98), however inverse propensity weight model, adjusted for significant differences between both groups, revealed a significant reduction in one-year mortality in favor of the mobile intensive care unit group (odds ratio=0.79, 95% confidence interval (0.66–0.94), p=0.01). Conclusions: Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.

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Factors affecting self-reported medication adherence and hypertension knowledge: A cross-sectional study in rural villages, Yogyakarta Province, Indonesia

Chronic Illness ◽

10.1177/1742395317739092 ◽

2017 ◽

Vol 14 (3) ◽

pp. 212-227 ◽

Cited By ~ 3

Author(s):

Riana Rahmawati ◽

Beata Bajorek

Keyword(s):

Medication Adherence ◽

Confidence Interval ◽

Odds Ratio ◽

Healthcare Services ◽

Knowledge Gaps ◽

Good Adherence ◽

Cross Sectional ◽

Rural Villages ◽

Adherence To Medication ◽

Hypertension Knowledge

Objectives This study assessed medication adherence and hypertension knowledge, and their predictive factors, in people with hypertension, living in rural communities in Indonesia. Methods Data were acquired from 384 people living in eight rural villages via a researcher-administered questionnaire, a validated adherence scale, and a standardized hypertension knowledge survey. Multivariate analysis was used to identify the predictors of adherence and knowledge. Results Fifty-nine (15%) participants had good hypertension knowledge (score ≥ 8 out of 10). Compared to participants with poor knowledge, these participants had higher formal education (odds ratio = 2.7, 95% confidence interval = 1.5–4.7), and lived closer to a community health center (odds ratio = 1.8, 95% confidence interval = 1.0–3.3). Knowledge gaps about the need for long-term medication, hypertension complications, and the target blood pressure were identified. Good hypertension knowledge predicted good adherence to medication (odds ratio = 7.1, 95% confidence interval = 3.3–15.2). Only 42 (11%) participants were considered to have good adherence. Reasons for intentional nonadherence were beliefs that medicines should be taken only when symptoms are evident, limited access to healthcare services, and a preference using traditional medicines. Conclusion Strategies for addressing knowledge gaps and misconceptions about hypertension medication are needed, particularly for people with a low educational level and those living some distances from healthcare facilities.

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Multispecialty pulmonary hypertension clinic in the VA

Pulmonary Circulation ◽

10.1177/2045893217726063 ◽

2017 ◽

Vol 7 (4) ◽

pp. 758-767 ◽

Cited By ~ 1

Author(s):

Matthew Jankowich ◽

Ryan Hebel ◽

Jennifer Jantz ◽

Siddique Abbasi ◽

Gaurav Choudhary

Keyword(s):

Pulmonary Hypertension ◽

Odds Ratio ◽

Medical Center ◽

Randomized Study ◽

Right Heart Catheterization ◽

Morbidity And Mortality ◽

Heart Catheterization ◽

One Year ◽

The One ◽

Few Data

Pulmonary hypertension (PH) is often associated with cardiopulmonary co-morbidities, especially in older adults. A multispecialty approach to suspected PH is recommended, but there are few data on adherence to guidelines or outcomes in such patients. This was a single-center retrospective study of consecutively evaluated Veteran patients with suspected PH evaluated in a multispecialty PH clinic at a Veterans Affairs Medical Center, evaluating clinical characteristics, workup outcomes, and prognosis. The referral population (n = 125) was older (mean ± SD age = 73.6 ± 9.8 years) with frequent co-morbidities (e.g. COPD 60%) and obesity (mean ± SD BMI = 32.8 ± 8.1 kg/m2). Of 94 patients undergoing right heart catheterization (RHC), 73 (78%) had confirmed PH (mean pulmonary artery pressure ≥ 25 mmHg). PH was associated with higher BMIs (odds ratio [95% CI] for PH per 1 unit increase = 1.10 [1.02–1.19]) and brachial pulse pressures (odds ratio per 1 mmHg increase = 1.07 [1.02–1.13]). Seventy out of 73 were classifiable by WHO PH groupings. Most patients underwent guideline-recommended PH evaluation. Observed one-year mortality was high (17.8%); the one-year hospitalization rate was 34.2%. These results compare favorably to observations from the VA Clinical Assessment, Reporting, and Tracking cohort of Veterans with PH by RHC (19.1% and 60.9% one-year mortality and hospitalization rates, respectively). Multispecialty PH clinic evaluation revealed a high prevalence of co-morbidities in veterans with suspected PH; PH was prevalent in this referral population. PH patients had significant morbidity and mortality but supportive care measures improved following PH evaluation. Further prospective randomized study is needed to determine if a multispecialty clinic approach improves PH morbidity and mortality in veterans.

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