scholarly journals Clinical prediction rules for childhood UTIs: a cross-sectional study in ambulatory care

BJGP Open ◽  
2022 ◽  
pp. BJGPO.2021.0171
Author(s):  
Hanne Ann Boon ◽  
Jan Y Verbakel ◽  
Tine De Burghgraeve ◽  
Ann Van den Bruel
Keyword(s):  
Area Under The Curve ◽  
High Specificity ◽  
Cross Sectional Study ◽  
Clinical Prediction ◽  
Sectional Study ◽  
Clinical Prediction Rules ◽  
Cross Sectional ◽  
Prediction Rules ◽  
Low Sensitivity ◽  
Tract Infections

BackgroundDiagnosing childhood urinary tract infections (UTI) is challenging.AimValidate clinical prediction rules (UTIcalc, DUTY, Gorelick) for paediatric UTIs in primary care.Design & settingPost-hoc analysis of a cross-sectional study in 39 general practices and 2 emergency departments (Belgium, March 2019 to March 2020).MethodPhysicians recruited acutely ill children ≤18 years and sampled urine systematically for culture. Per rule, we performed an apparent validation; calculated sensitivities and specificities with 95%CI per threshold in the target group. For the DUTY coefficient-based algorithm, we performed a logistic calibration and calculated the Area Under the Curve with 95%CI.ResultsOf 834 children ≤18 years recruited, there were 297 children <5 years. The UTIcalc and Gorelick score had high to moderate sensitivity and low specificity (UTIcalc ≥2%) 75%; and 16% respectively; Gorelick (≥2 variables) 91%; and 8%. In contrast, the DUTY score ≥5 points had low sensitivity (8%), but high specificity (99%). Urine samples would be obtained in 72% vs 38% (UTIcalc), 92% vs 38% (Gorelick) or 1% vs 32% (DUTY) of children, compared to routine care. The number of missed infections per score was 1/4 (UTIcalc), 2/23 (Gorelick) and 24/26 (DUTY). The UTIcalc+ dipstick model had high sensitivity and specificity (100%; and 91%); resulting in no missed cases and 59% (95%CI 49%–68%) of antibiotics prescribed inappropriately.ConclusionIn this study, the UTIcalc and Gorelick score were useful for ruling out UTI but resulted in high urine sampling rates. The DUTY score had low sensitivity, meaning that 92% of UTIs would be missed.

scholarly journals Adherence to guideline recommendations for urinary tract infections in adult women: a cross-sectional study

2021 ◽  
Vol 22 ◽  
Author(s):  
Rian Lelie- van der Zande ◽  
Marcel Bouvy ◽  
Martina Teichert
Keyword(s):  
Urinary Tract ◽  
Clavulanic Acid ◽  
Cross Sectional Study ◽  
Adult Women ◽  
Sectional Study ◽  
Cross Sectional ◽  
First Choice ◽  
Febrile Uti ◽  
Amoxicillin Clavulanic Acid ◽  
Tract Infections

Abstract Aim: To study whether changes in drug preferences in the Dutch guideline for the treatment of Urinary Tract Infection (UTI) for General Practitioners (GPs) in 2013, resulted in corresponding changes in antibiotic dispensing. Background: For the treatment of uncomplicated UTI, nitrofurantoin remained the first choice, while fosfomycin became the second choice and changed ranks with trimethoprim. For a subsequent febrile UTI, ciprofloxacin became the first choice and changed ranks with amoxicillin/clavulanic acid, co-trimoxazole remained the third choice. Methods: In this observational cross-sectional study, routinely collected dispensing data from the Dutch Foundation of Pharmaceutical Statistics from 2012 to 2017 were used. The number of women 18 years and older, treated with one of the guideline antibiotics for uncomplicated UTI and subsequent febrile UTI were analysed annually. Proportions were calculated. Data were stratified for age categories. Failure of uncomplicated UTI treatment was defined as the dispensing of an antibiotic for febrile UTI within 14 days after the dispensing of an antibiotic for uncomplicated UTI. Findings: Data were available from 81% of all pharmacies in 2012 to 89% in 2017. Percentages of women dispensed nitrofurantoin were relatively stable with 87.4% in 2012 and 84.4% in 2017. Percentages of women dispensed fosfomycin increased from 5.4% in 2012 to 21.8% in 2017, whereas percentages of women dispensed trimethoprim decreased from 17.8% to 8.0%. Within age categories, the percentage of women dispensed fosfomycin increased from 12.4% in women 18–30 years old to 36.7% in women above 80 years old. Percentages of women dispensed antibiotics for febrile UTI remained stable at 5% annually. Percentages of women receiving ciprofloxacin increased from 1.9% in 2012 to 3.3% in 2017, while those receiving amoxicillin/clavulanic acid decreased from 2.9% to 1.8%. New guideline recommendations resulted in corresponding changes in dispensed antibiotics for uncomplicated UTI and subsequent febrile UTI. Drug choices differed for age categories.

scholarly journals Associations between taste sensitivity, preference for sweet and salty flavours, and nutritional status of adolescents from public schools

2017 ◽  
Vol 30 (3) ◽  
pp. 369-375 ◽  
Author(s):  
Marize Melo dos SANTOS ◽  
Camila Santos MARREIROS ◽  
Herika Brenda Santana da SILVA ◽  
Ana Raquel Soares de OLIVEIRA ◽  
Kyria Jayanne Clímaco CRUZ
Keyword(s):  
Body Mass Index ◽  
Public Schools ◽  
Nutritional Status ◽  
Food Choices ◽  
Cross Sectional Study ◽  
Taste Sensitivity ◽  
Sectional Study ◽  
Cross Sectional ◽  
Sweet Foods ◽  
Low Sensitivity

ABSTRACT Objective This study aimed to investigate the associations between taste sensitivity, preference for sweet and salty flavours, and nutritional status of adolescents in public schools. Methods We used a cross-sectional study involving 1,036 adolescents of both sexes, aged 10-19 years. Preference for sweet or salty flavours and preference for foods high in sugar or sodium were evaluated. Measurements of body mass index and taste flavour intensity recognition were conducted. Results Most participants were unable to identify the flavours and/or intensities, and only 18.0% of participants were able to correctly identify both the flavour and intensity of the samples. Most participants (82.1%) preferring sweet foods had low sensitivity to this taste, just as a large proportion of individuals preferring saltiness (82.3%) were less sensitive to salt (p<0.001). Preference for saltiness was associated with pre-obesity. Conclusion We found an association between a preference for sweet or salty flavours and nutritional status, highlighting the importance of poor food choices in the development of obesity and other chronic diseases.

scholarly journals A cross-sectional study on morbidity status among school going adolescents in Thiruvallur district, Tamil Nadu

2019 ◽  
Vol 6 (12) ◽  
pp. 5201
Author(s):  
Sathish Dev D. ◽  
Sugantha Valli M. ◽  
Gnana Sezhian M. ◽  
Suganya E.
Keyword(s):  
Tamil Nadu ◽  
Gastrointestinal Disease ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Health Problems ◽  
Age Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Wide Range ◽  
Tract Infections

Background: Adolescents represent about 21.8 percent of India’s population. Various health risks with potentially life-threatening consequences become prominent in this age group. This study was undertaken with the objective to determine the morbidity profile of school going adolescents in Tamil Nadu.Methods: This descriptive, cross sectional study was planned and conducted from January 2016 to August 2017. The study population included 987 adolescent boys and girls aged between 10 to 19 years studying in high and higher secondary Government schools of Thiruvallur district of Tamil Nadu. Semi-structured questionnaire was used as data collection tool.Results: The mean age groups of this school going adolescent are 14.2 yrs. In the present study 583 (59%) of the study participants were affected by one or more morbidity condition. Among them, 395 (67.7%) were in the age group 10-14 years and 188 (32.2%) in the age group 15-19 years. 122 (21%) and 461 (79.1%) of male and female were affected respectively. In the present study, fever (21%) was the commonest reported morbidity followed by acute respiratory infection (15.7%) and acute gastrointestinal disease (13. 4%).Conclusions: This study shows that adolescents are prone to a wide range of morbidity conditions. Apart from respiratory and gastro intestinal diseases, reproductive tract infections and sexual health problems are important morbidities affecting this age group. There is strong need to sensitize health care practitioners at all levels, in both government and private sectors towards health problems in adolescent age groups.

scholarly journals Validity of four clinical prediction scores for pulmonary embolism in a sub-Saharan African setting: a protocol for a Cameroonian multicentre cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031322
Author(s):  
Agnès Esiéné ◽  
Paul Owono Etoundi ◽  
Joel Noutakdie Tochie ◽  
Junette Arlette Mbengono Metogo ◽  
Jacqueline Ze Minkande
Keyword(s):  
Pulmonary Embolism ◽  
Emergency Departments ◽  
Diagnostic Performance ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Receiver Operating Curve ◽  
Clinical Prediction ◽  
Sectional Study ◽  
Cross Sectional ◽  
Sub Saharan

IntroductionPulmonary embolism poses one of the most challenging diagnoses in medicine. Resolving these diagnostic difficulties is more crucial in emergency departments where fast and accurate decisions are needed for a life-saving purpose. Here, clinical pretest evaluation is an important step in the diagnostic algorithm of pulmonary embolism. Although clinical probability scores are widely used in emergency departments of sub-Saharan Africa, no study has cited their diagnostic performance in this resource-constrained environment. This study will seek to assess the performance of four routinely used clinical prediction models in Cameroonians presenting with suspicion of pulmonary embolism at the emergency department.Methods and analysisIt will be a cross-sectional study comparing the sensitivity, specificity, positive and negative predictive values and accuracy of the Wells, Simplified Wells, Revised Geneva and the Simplified Revised Geneva Scores to CT pulmonary angiography as gold standard in all consecutive consenting patients aged above 15 years admitted for clinical suspicion of pulmonary embolism to the emergency departments of seven major referral hospitals of Cameroon between 1 July 2019 and 31 December 2020. The area under the receiver operating curve, calibration plots, Hosmer and Lemeshow statistics, observed/expected event rates, net benefit and decision curve will be measured of each the clinical prediction test to ascertain the clinical score with the best diagnostic performance.Ethics and disseminationClearance has been obtained from the Institutional Review Board of the Faculty of medicine and biomedical sciences of the University of Yaounde I, Cameroon and the directorates of all participating hospitals to conduct this study. Also, informed consent will be sought from each patient or their legal next of kin and parents for minors, before enrolment into this study. The final study will be published in a peer-review journal and the findings presented to health authorities and healthcare providers.

scholarly journals Characteristics of prescriptions and costs for acute upper respiratory tract infections in Chinese outpatient pediatric patients: a nationwide cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shan Wang ◽  
Lihua Liu ◽  
Jianchao Liu ◽  
Likun Miao ◽  
Qian Zhuang ◽  
...  
Keyword(s):  
Outpatient Care ◽  
Pediatric Patients ◽  
Cross Sectional Study ◽  
Upper Respiratory Tract ◽  
Sectional Study ◽  
Cross Sectional ◽  
Short Supply ◽  
Upper Respiratory ◽  
Tract Infections ◽  
Clinical Records

Abstract Background To understand the characteristics of prescriptions and costs in pediatric patients with acute upper respiratory infections (AURI) is important for the regulation of outpatient care and reimbursement policy. This study aims to provide evidence on these issues that was in short supply. Methods We conducted a retrospective cross-sectional study based on data from National Engineering Laboratory of Application Technology in Medical Big Data. All outpatient pediatric patients aged 0–14 years with an uncomplicated AURI from 1 January 2015 to 31 December 2017 in 138 hospitals across the country were included. We reported characteristics of patients, the average number of medications prescribed per encounter, the categories of medication used and their percentages, the cost per visit and prescription costs of drugs. For these measurements, discrepancies among diverse groups of age, regions, insurance types, and AURI categories were compared. Kruskal-Wallis nonparametric test and Student-Newman-Keuls test were performed to identify differences among subgroups. A multinomial logistic regression was conducted to examine the independent effects of those factors on the prescribing behavior. Results A total of 1,002,687 clinical records with 2,682,118 prescriptions were collected and analyzed. The average number of drugs prescribed per encounter was 2.8. The most frequently prescribed medication was Chinese traditional patent medicines (CTPM) (36.5% of overall prescriptions) followed by antibiotics (18.1%). It showed a preference of CPTM over conventional medicines. The median cost per visit was 17.91 USD. The median drug cost per visit was 13.84 USD. The expenditures of antibiotics and CTPM per visit (6.05 USD and 5.87 USD) were among the three highest categories of drugs. The percentage of out-of-pocket patients reached 65.9%. Disparities were showed among subgroups of different ages, regions, and insurance types. Conclusions The high volume of CPTM usage is the typical feature in outpatient care of AURI pediatric patients in China. The rational and cost-effective use of CPTM and antibiotics still faces challenges. The reimbursement for child AURI cases needs to be enhanced.

Local characteristics associated with higher prevalence of ESBL-producing Escherichia coli in community-acquired urinary tract infections: an observational, cross-sectional study

2020 ◽  
Author(s):  
Stéphanie Larramendy ◽  
Aurélie Gaultier ◽  
Jean-Pascal Fournier ◽  
Jocelyne Caillon ◽  
Leïla Moret ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Agricultural Land ◽  
Cross Sectional Study ◽  
Urine Samples ◽  
Sectional Study ◽  
Cross Sectional ◽  
E Coli ◽  
Animal Farming ◽  
Tract Infections

Abstract Objectives The prevalence of ESBL-producing Escherichia coli (ESBL-E. coli) in community-acquired urinary tract infections (UTI) has been increasing worldwide since 2000, but with large geographical variations. The aim of this study was to determine whether the ESBL-E. coli rate in urine samples from individuals with community-acquired UTI was associated with the local socio-economic, environmental, agricultural and healthcare characteristics. Methods This was a cross-sectional study in western France using data on antibiotic susceptibility of E. coli isolated from urine samples of individuals with community-acquired UTI analysed in non-hospital laboratories from 2015 to 2017. The ESBL-E. coli rate was calculated for each laboratory. Data on socio-economic characteristics, human antibiotic consumption, hospital bed density, animal farming density and percentage of agricultural land and surface water were retrieved at the municipality level and aggregated by study area. Their association with ESBL-E. coli prevalence was quantified using multivariate linear regression models with a backward selection. Results From 358 291 E. coli isolates from urine samples tested in 92 laboratories, the mean ESBL-E. coli prevalence for the study period was 3.30%. In an adjusted model, the ESBL-E. coli rate was significantly (P &lt; 0.05) and positively associated with the local percentage of people &gt;65 years old, third-generation cephalosporin use (DDD/1000 inhabitants), number of hospital beds/km2, poultry density, pig density and percentage of agricultural land. Lower deprivation was associated with a higher ESBL-E. coli rate. Conclusions Several anthropogenic factors (primary care, hospitals and animal farming) are associated with the local ESBL-E. coli rate in community-acquired UTI. These results could contribute to improve risk management, including identification of at-risk patient groups.

scholarly journals Immunosenescence in persons with spinal cord injury in relation to urinary tract infections -a cross-sectional study-

2017 ◽  
Vol 14 (1) ◽  
Author(s):  
David Pavlicek ◽  
Jörg Krebs ◽  
Simona Capossela ◽  
Alessandro Bertolo ◽  
Britta Engelhardt ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Cord Injury ◽  
Tract Infections
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