scholarly journals Seroprevalence of Antibodies against Diphtheria, Tetanus and Pertussis in Adult At-Risk Patients

Vaccines ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 18
Author(s):  
Lise Boey ◽  
Eline Bosmans ◽  
Liane Braz Ferreira ◽  
Nathalie Heyvaert ◽  
Melissa Nelen ◽  
...  
Keyword(s):  
At Risk ◽  
Chronic Diseases ◽  
Age Groups ◽  
Chronic Obstructive ◽  
Solid Organ ◽  
Recent Infection ◽  
Vaccination Programs ◽  
Vaccine Preventable Diseases ◽  
Increased Risk ◽  
Risk Patients

Patients with chronic diseases are at increased risk of complications following infection. It remains, however, unknown to what extend they are protected against vaccine-preventable diseases. We assessed seroprevalence of antibodies against diphtheria, tetanus and pertussis to evaluate whether current vaccination programs in Belgium are adequate. Antibody titers were assessed with a bead-based multiplex assay in serum of 1052 adults with chronic diseases. We included patients with diabetes mellitus type 1 (DM1) (n = 172), DM2 (n = 77), chronic kidney disease (n = 130), chronic obstructive pulmonary disease (COPD) (n = 170), heart failure (n = 77), HIV (n = 196) and solid organ transplant (SOT) recipients (n = 230). Factors associated with seroprevalence were analysed with multiple logistic regression. We found seroprotective titers in 29% for diphtheria (≥0.1 IU/mL), in 83% for tetanus (≥0.1 IU/mL) and 22% had antibodies against pertussis (≥5 IU/mL). Seroprotection rates were higher (p < 0.001) when vaccinated within the last ten years. Furthermore, diphtheria seroprotection decreased with age (p < 0.001). Tetanus seroprotection was less reached in women (p < 0.001) and older age groups (p < 0.001). For pertussis, women had more often a titer suggestive of a recent infection or vaccination (≥100 IU/mL, p < 0.01). We conclude that except for tetanus, the vast majority of at-risk patients remains susceptible to vaccine-preventable diseases such as diphtheria and pertussis.

scholarly journals Prescribing Analgesics to Older People: A Challenge for GPs

2020 ◽  
Vol 17 (11) ◽  
pp. 4017
Author(s):  
Ljiljana Trtica Majnarić ◽  
Thomas Wittlinger ◽  
Dunja Stolnik ◽  
František Babič ◽  
Zvonimir Bosnić ◽  
...  
Keyword(s):  
Older People ◽  
Chronic Diseases ◽  
Musculoskeletal Diseases ◽  
Age Groups ◽  
Treatment Strategies ◽  
Opioid Analgesics ◽  
Psychotropic Medications ◽  
High Rate ◽  
Increased Risk ◽  
Study Results

Background: Due to population aging, there is an increase in the prevalence of chronic diseases, and in particular musculoskeletal diseases. These trends are associated with an increased demand for prescription analgesics and an increased risk of polypharmacy and adverse medication reactions, which constitutes a challenge, especially for general practitioners (GPs), as the providers who are most responsible for the prescription policy. Objectives: To identify patterns of analgesics prescription for older people in the study area and explore associations between a long-term analgesic prescription and comorbidity patterns, as well as the prescription of psychotropic and other common medications in a continuous use. Methods: A retrospective study was conducted in 2015 in eastern Croatia. Patients were GP attenders ≥40 years old (N = 675), who were recruited during their appointments (consecutive patients). They were divided into two groups: those who have been continuously prescribed analgesics (N = 432) and those who have not (N = 243). Data from electronic health records were used to provide information about diagnoses of musculoskeletal and other chronic diseases, as well as prescription rates for analgesics and other medications. Exploratory methods and logistic regression models were used to analyse the data. Results: Analgesics have been continuously prescribed to 64% of the patients, mostly to those in the older age groups (50–79 years) and females, and they were indicated mainly for dorsalgia symptoms and arthrosis. Non-opioid analgesics were most common, with an increasing tendency to prescribe opioid analgesics to older patient groups aged 60–79 years. The study results indicate that there is a high rate of simultaneous prescription of analgesics and psychotropic medications, despite the intention of GPs to avoid prescribing psychotropic medications to patients who use any option with opioid analgesics. In general, receiving prescription analgesics does not exceed the prescription for chronic diseases over the rates that can be found in patients who do not receive prescription analgesics. Conclusion: Based on the analysis of comorbidities and parallel prescribing, the results of this study can improve GPs’ prescription and treatment strategies for musculoskeletal diseases and chronic pain conditions.

Vaccine-preventable diseases screening and vaccination programs for healthcare professions students

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Letzgus ◽  
F De Nard ◽  
M Gaiazzi ◽  
S Rivolta ◽  
L Grimoldi ◽  
...  
Keyword(s):  
Medical Residents ◽  
Organizational Strategies ◽  
Serological Tests ◽  
Vaccination Programs ◽  
Healthcare Facilities ◽  
Lombardy Region ◽  
Vaccine Preventable Diseases ◽  
Increased Risk ◽  
Vaccination History ◽  
Healthcare Professions

Abstract Background Students in Healthcare Professions (SHPs) present an increased risk of contracting and transmitting Vaccine-Preventable Diseases (VPDs). Our study aimed to investigate the organizational strategies (screening and immunization for VPDs and vaccination promotion among SHPs) implemented by the healthcare facilities accredited with the University of Milan. Methods we sent an e-survey by e-mail to medical residents and first- and last-year students in nursing, midwifery and healthcare assistance. Results among 3397 invited SHPs, 645 participated. We included in the analysis 522 SHPs, distributed in 24 facilities across the Lombardy region (mean age 27,4 years; 69,5% female; 69% medical residents, 28% nursing, 2% healthcare assistance, and 1% midwifery students). Although most participants underwent occupational health visit before the traineeship start (47,5%) or within 6 months (29,5%), others hadn't undergone yet (15,1%). The visits included the collection of vaccination history (72,6%; 64,6% from written documentation), serological tests for VPDs (hepatitis B 76,1%, measles and rubella 58,4%, varicella 54,4%), and screening for latent TB (69,7%). Vaccinations were recommended to 226 participants, but only 173 fully (76,5%) or partially (8%) complied. Full compliance was associated with nudges like in-hospital (Chisq. 18,7; p = 0.00) and free vaccinations (Chisq. 31; p = 0.00). Reported facility vaccination policies included campaigns (posters 37,4%, intranet 39,5%, social media 11,5%, general/personalized letters 30,3%/11,5%), time-off incentives (7,7%), on-site (30,5%) and opinion leaders' vaccinations (9,8%). However, SHPs were often unaware of those strategies (mean 48,6%), and intra-facility answers were sometimes discordant (agreement &lt;70% for facilities with &gt;30 respondents). Conclusions SHPs are often unaware or discordant regarding vaccination policies carried out by traineeship facilities, suggesting the need of inclusive communication strategies. Key messages About half of students in healthcare professions are screened for VPDs after the start of the traineeship. Students in healthcare professions are often unaware of vaccination promotion strategies.

scholarly journals Factors Influencing Workplace Health Promotion Interventions for Workers in the Semiconductor Industry According to Risk Levels of Chronic Disease

2021 ◽  
Vol 18 (21) ◽  
pp. 11383
Author(s):  
Yun-Kyoung Song ◽  
Boyoon Choi ◽  
Kyungim Kim ◽  
Hyun Jin Park ◽  
Jung Mi Oh
Keyword(s):  
At Risk ◽  
Health Promotion ◽  
Chronic Diseases ◽  
Liquid Crystal Display ◽  
Workplace Health Promotion ◽  
Semiconductor Industry ◽  
Age Groups ◽  
Participation Rate ◽  
High Risk Group ◽  
Workplace Health

(1) Background: This study aimed to analyze the risk of chronic diseases including hypertension, diabetes, and dyslipidemia in workers of a semiconductor manufacturing company and the factors associated with their participation in workplace health promotion (WHP) programs. (2) Methods: Subjects were workers in a semiconductor and liquid crystal display company in South Korea who had undergone regular health checkups. Data from regular health checkups and WHP interventions were analyzed. Health risk was classified based on the diagnosed disease, in-house classification criteria, and pooled cardiovascular risk score. (3) Results: The baseline characteristics of 39,073 participants included the following: male, 67.8%; between 30 and 40 years of age, 74.1%; <2 h of physical activities, 65.9%. Workers at risk of chronic diseases accounted for 22.2%, and 20.1% were suspicious cases of chronic diseases. Body mass index, and cholesterol level were relatively high in workers with the burden of chronic diseases. The participation rate in WHP programs was 28.8% in a high-risk group among workers at risk of chronic diseases. More participation was shown in male, older age groups, production work type, and single-person household. (4) Conclusions: Because of the low participation rate in WHP activities among workers with the burden of chronic diseases, it is necessary to establish measures to encourage their participation.

scholarly journals Predilection for developing a hematogenous orthopaedic implant-associated infection in older versus younger mice

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
John M. Thompson ◽  
Alyssa G. Ashbaugh ◽  
Yu Wang ◽  
Robert J. Miller ◽  
Julie E. Pickett ◽  
...  
Keyword(s):  
At Risk ◽  
Staphylococcus Aureus ◽  
Mouse Model ◽  
Ex Vivo ◽  
Kirschner Wire ◽  
Age Groups ◽  
Orthopaedic Implant ◽  
X Ray ◽  
Risk Patients

Abstract Background The pathogenesis of hematogenous orthopaedic implant-associated infections (HOIAI) remains largely unknown, with little understanding of the influence of the physis on bacterial seeding. Since the growth velocity in the physis of long bones decreases during aging, we sought to evaluate the role of the physis on influencing the development of Staphylococcus aureus HOIAI in a mouse model comparing younger versus older mice. Methods In a mouse model of HOIAI, a sterile Kirschner wire was inserted retrograde into the distal femur of younger (5–8-week-old) and older (14–21-week-old) mice. After a 3-week convalescent period, a bioluminescent Staphylococcus aureus strain was inoculated intravenously. Bacterial dissemination to operative and non-operative legs was monitored longitudinally in vivo for 4 weeks, followed by ex vivo bacterial enumeration and X-ray analysis. Results In vivo bioluminescence imaging and ex vivo CFU enumeration of the bone/joint tissue demonstrated that older mice had a strong predilection for developing a hematogenous infection in the operative legs but not the non-operative legs. In contrast, this predilection was less apparent in younger mice as the infection occurred at a similar rate in both the operative and non-operative legs. X-ray imaging revealed that the operative legs of younger mice had decreased femoral length, likely due to the surgical and/or infectious insult to the more active physis, which was not observed in older mice. Both age groups demonstrated substantial reactive bone changes in the operative leg due to infection. Conclusions The presence of an implant was an important determinant for developing a hematogenous orthopaedic infection in older but not younger mice, whereas younger mice had a similar predilection for developing periarticular infection whether or not an implant was present. On a clinical scale, diagnosing HOIAI may be difficult particularly in at-risk patients with limited examination or other data points. Understanding the influence of age on developing HOIAI may guide clinical surveillance and decision-making in at-risk patients.

scholarly journals Pre-existing Cardiovascular Disease in United States Population at High Risk for Severe COVID-19 Infection

2020 ◽  
Author(s):  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
At Risk ◽  
High Risk ◽  
Low Risk ◽  
Chronic Obstructive ◽  
Moderate Risk ◽  
High Risk Patients ◽  
Risk Patients

Background and Purpose There is increasing recognition of a relatively high burden of pre-existing cardiovascular disease in Corona Virus Disease 2019 (COVID 19) infected patients. We determined the burden of pre-existing cardiovascular disease in persons residing in United States (US) who are at risk for severe COVID-19 infection. Methods Age (60 years or greater), presence of chronic obstructive pulmonary disease, diabetes, mellitus, hypertension, and/or malignancy were used to identify persons at risk for admission to intensive care unit, or invasive ventilation, or death with COVID-19 infection. Persons were classified as low risk (no risk factors), moderate risk (1 risk factor), and high risk (two or more risk factors present) using nationally representative sample of US adults from National Health and Nutrition Examination Survey 2017 and 2018 survey. Results Among a total of 5856 participants, 2386 (40.7%) were considered low risk, 1325 (22.6%) moderate risk, and 2145 persons (36.6%) as high risk for severe COVID-19 infection. The proportion of patients who had pre-existing stroke increased from 0.6% to 10.5% in low risk patients to high risk patients (odds ratio [OR]19.9, 95% confidence interval [CI]11.6-34.3). The proportion of who had pre-existing myocardial infection (MI) increased from 0.4% to 10.4% in low risk patients to high risk patients (OR 30.6, 95% CI 15.7-59.8). Conclusions A large proportion of persons in US who are at risk for developing severe COVID 19 infection are expected to have pre-existing cardiovascular disease. Further studies need to identify whether targeted strategies towards cardiovascular diseases can reduce the mortality in COVID-19 infected patients.

P5586Predictors for not initiating anticoagulant treatment after incident venous thromboembolism: a Danish nationwide study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Albertsen ◽  
P B N Nielsen ◽  
T F O Overvad ◽  
T B L Larsen ◽  
M S Soegaard
Keyword(s):  
Venous Thromboembolism ◽  
Chronic Diseases ◽  
Lupus Erythematosus ◽  
Age Groups ◽  
Additional Patient ◽  
Major Surgery ◽  
Chronic Obstructive ◽  
Anticoagulant Treatment ◽  
Nationwide Study ◽  
Baseline Characteristics

Abstract Background Venous thromboembolism (VTE) is common and potentially fatal. Anticoagulation is the treatment cornerstone but up to one-third do not initiate treatment after incident VTE. Identification of patient characteristics associated with non-initiation may enable identification of individuals in need of additional patient education and intensified clinical follow-up. Purpose To investigate characteristics associated with not initiating anticoagulation after incident VTE in a Danish nationwide study. Methods We linked nationwide Danish health registries to identify consecutive patients with incident VTE between 2000–2016. The outcome was not initiating anticoagulant treatment (warfarin or NOAC) within 30 days after incident VTE diagnosis. Logistic regression was used to identify predictors of treatment non-initiation. Results Among 85,046 patients with incident VTE, 41% (n=34,877) patients had not redeemed a prescription of anticoagulation within 30 days after incident VTE. Age<65, female sex, unprovoked VTE, and chronic diseases were associated with non-initiation (Table). Table 1. Baseline characteristics for incident VTE* patients year 2000–2016 and associated adjusted odds ratios for not initiating anticoagulation† Patients with incident VTE (n=85,046) Adjusted‡ Odds Ratio (95% CI) for not initiating treatment Age, median (IQR), y 65.6 (50.8–77.3) – Age groups, n (%)   0–30 years 4,150 (4.9%) 1.55 (1.45; 1.66)   30–65 years 37,376 (43.9%) 1.24 (1.20; 1.27)   >65 years 43,520 (51.2%) Ref. Females, n (%) 45,119 (53.1%) 1.40 (1.36; 1.44) Unprovoked VTE§, n (%) 53,779 (63.2%) 1.08 (1.06; 1.12) Chronic diseases 10 years within incident VTE   Inflammatory disease¶, n (%) 7,374 (8.7%) 1.07 (1.02; 1.14)   Heart Failure, n (%) 6,242 (7.3%) 1.21 (1.11; 1.32)   Ischemic heart disease, n (%) 11,025 (13.0%) 1.25 (1.19; 1.32)   Chronic obstructive pulmonary disease, n (%) 8,385 (9.9%) 1.02 (0.96; 1.08)   Kidney disease, n (%) 2,626 (3.1%) 1.21 (1.12; 1.32)   Diabetes, n (%) 6,884 (8.1%) 1.13 (1.06; 1.20)   Hypertension, n (%) 233,651 (27.8%) 0.99 (0.94; 1.05) Chronic diseases, n (%)   0 chronic diseases 46,036 (54.1%) Ref.   1–2 chronic diseases 30,462 (35.8%) 1.09 (1.03; 1.15)   >3 chronic diseases 8,548 (10.1%) 1.12 (0.98; 1.28) *Venous thromboembolism. †Defined as not redeeming a prescription on anticoagulant medicine no later than 30 days after an incident VTE diagnosis. ‡Adjusted for age, sex and other baseline characteristics. §Defined as absence of: major surgery, nephrotic syndrome, hormonal replacement therapy, central venous catheter, fracture/trauma and immobilization within 3 months. ¶Combination of inflammatory bowel diseases, lupus erythematosus, psoriasis, rheumatic disorders. Conclusion As much as 41% of patients with a first diagnosis of VTE did not initiate anticoagulant treatment within 30 days after diagnosis. In order to optimize compliance, physicians may consider increased focus on identified predictors associated with non-initiation.

scholarly journals Tackling Biological Risk in the Workplace: Updates and Prospects Regarding Vaccinations for Subjects at Risk of Occupational Exposure in Italy

Vaccines ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 141 ◽  
Author(s):  
Durando ◽  
Dini ◽  
Massa ◽  
La Torre
Keyword(s):  
At Risk ◽  
Healthcare Management ◽  
Occupational Physician ◽  
Work Processes ◽  
Biological Risk ◽  
Vaccination Programs ◽  
Vaccine Preventable Diseases ◽  
Coverage Rates ◽  
Occupational Settings ◽  
Prevention Plan

Occupational activities may expose workers to a variety of risks. Exposure to biological agents constitutes a traditional risk in numerous occupational settings. Legislative Decree (D.Lgs.) 81/2008 constitutes the main Italian legislative basis for the management and the prevention of biological risk in occupational settings and lists the available vaccinations against each single biological agent. The 2017–2019 National Vaccination Prevention Plan (PNPV) identifies some categories of workers for whom specific vaccinations are indicated. In this context, the occupational physician identifies work processes that are at risk—identifying susceptible workers and providing information on health monitoring—and is responsible for ensuring that vaccinations are carried out. Adequate and thorough evaluation of risk are indispensable to appropriate consultation by the occupational physician in order to enable the employer to provide efficacious vaccinations. Close collaboration among the services of occupational medicine, vaccination clinics, and healthcare management together with the implementation of vaccination programs that are agreed upon at the institutional level provides an opportunity to reduce the number of workers who are susceptible to vaccine-preventable diseases, thereby yielding benefits in terms of biological risk management in the workplace and contributing to increasing vaccination coverage rates, which in many cases are currently unsatisfactory.

scholarly journals Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

2018 ◽  
Vol 51 (4) ◽  
pp. 1702037 ◽  
Author(s):  
Kristian Hellenkamp ◽  
Piotr Pruszczyk ◽  
David Jiménez ◽  
Anna Wyzgał ◽  
Deisy Barrios ◽  
...  
Keyword(s):  
At Risk ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Adverse Outcome ◽  
Adverse Outcomes ◽  
Prognostic Impact ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients

To externally validate the prognostic impact of copeptin, either alone or integrated in risk stratification models, in pulmonary embolism (PE), we performed a post hoc analysis of 843 normotensive PE patients prospectively included in three European cohorts.Within the first 30 days, 21 patients (2.5%, 95% CI 1.5–3.8) had an adverse outcome and 12 (1.4%, 95% CI 0.7–2.5) died due to PE. Patients with copeptin ≥24 pmol·L−1 had a 6.3-fold increased risk for an adverse outcome (95% CI 2.6–15.5, p<0.001) and a 7.6-fold increased risk for PE-related death (95% CI 2.3–25.6, p=0.001). Risk classification according to the 2014 European Society of Cardiology (ESC) guideline algorithm identified 248 intermediate-high-risk patients (29.4%) with 5.6% (95% CI 3.1–9.3) at risk of adverse outcomes. A stepwise biomarker-based risk assessment strategy (based on high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and copeptin) identified 123 intermediate-high-risk patients (14.6%) with 8.9% (95% CI 4.5–15.4) at risk of adverse outcomes. The identification of patients at higher risk was even better when copeptin was measured on top of the 2014 ESC algorithm in intermediate-high-risk patients (adverse outcome OR 11.1, 95% CI 4.6–27.1, p<0.001; and PE-related death OR 13.5, 95% CI 4.2–43.6, p<0.001; highest risk group versus all other risk groups). This identified 85 patients (10.1%) with 12.9% (95% CI 6.6–22.0) at risk of adverse outcomes and 8.2% (95% CI 3.4–16.2) at risk of PE-related deaths.Copeptin improves risk stratification of normotensive PE patients, especially when identifying patients with an increased risk of an adverse outcome.

Looking both ways before crossing the street: Assessing the benefits and risk of opioids in treating patients at risk of sleep disordered breathing for pain and dyspnea

2017 ◽  
Vol 13 (3) ◽  
pp. 183 ◽  
Author(s):  
Mellar P. Davis, MD, FCCP, FAAHPM ◽  
Bertrand Behm, MD ◽  
Diwakar Balachandran, MD
Keyword(s):  
At Risk ◽  
Sleep Apnea ◽  
Cardiovascular Events ◽  
Sleep Disordered Breathing ◽  
Central Sleep Apnea ◽  
Chronic Obstructive ◽  
Chronic Noncancer Pain ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Disordered Breathing

Opioids adversely influence respiration in five distinct ways. Opioids reduce the respiratory rate, tidal volume, amplitude, reflex responses to hypercapnia and hypoxia, and arousability related necessary for respiratory adaptive responses. Opioids cause impairment of upper pharyngeal dilator muscles leading to obstructive apnea. Opioids cause complex sleep disordered breathing (SDB) consisting of central sleep apnea and obstructive sleep apnea. Clinically opioids worsen preexisting SDB. Recent studies have shown increased morbidity and mortality in patients receiving opioids for chronic noncancer pain and chronic obstructive pulmonary disease, which appear to be related to cardiovascular events, not overdose. Both patient populations are at risk for sleep disordered breathing and increased risk for adverse cardiovascular events on opioids for dyspnea or pain. This review discusses the influence of opioids on respiration and SDB and will review the adverse respiratory and cardiovascular effects of opioid use in at risk populations. Recommendations regarding management will follow as a summary.

scholarly journals Critical Analysis of Strattice Performance in Complex Abdominal Wall Reconstruction: Intermediate–Risk Patients and Early Complications

2013 ◽  
Vol 98 (4) ◽  
pp. 379-384 ◽  
Author(s):  
Ketan M. Patel ◽  
Frank P. Albino ◽  
Maurice Y. Nahabedian ◽  
Parag Bhanot
Keyword(s):  
Abdominal Wall ◽  
Perioperative Complications ◽  
Abdominal Wall Reconstruction ◽  
Wound Dehiscence ◽  
Fascial Closure ◽  
Chronic Obstructive ◽  
Intermediate Risk ◽  
Dermal Matrix ◽  
Increased Risk ◽  
Risk Patients

Abstract The purpose of this study was to analyze the performance of a porcine-derived acellular dermal matrix (Strattice Reconstructive Tissue Matrix) in patients at increased risk for perioperative complications. We reviewed medical records for patients with complex abdominal wall reconstruction (AWR) and Strattice underlay from 2007 to 2010. Intermediate-risk patients were defined as having multiple comorbidities without abdominal infection. Forty-one patients met the inclusion criteria (mean age, 60 years; mean body mass index, 35.5 kg/m2). Comorbidities included coronary artery disease (63.4%), diabetes mellitus (36.6%), and chronic obstructive pulmonary disease (17.1%). Fascial closure was achieved in 40 patients (97.6%). Average hospitalization was 6.4 days (range, 1–24 days). Complications included seroma (7.3%), wound dehiscence with Strattice exposure (4.9%), cellulitis (2.4%), and hematoma (2.4%). All patients achieved abdominal wall closure with no recurrent hernias or need for Strattice removal. Patients with multiple comorbidities at intermediate risk of postoperative complications can achieve successful, safe AWR with Strattice.

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