scholarly journals Assessment of nasopharyngeal Streptococcus pneumoniae colonization does not permit discrimination between Canadian children with viral and bacterial respiratory infection: a matched-cohort cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jeffrey M. Pernica ◽  
Kristin Inch ◽  
Haifa Alfaraidi ◽  
Ania Van Meer ◽  
Redjana Carciumaru ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Bacterial Infection ◽  
Viral Infection ◽  
Respiratory Illness ◽  
Categorical Variables ◽  
Healthy Children ◽  
Disease Category ◽  
Pneumococcal Carriage ◽  
Colonization Patterns ◽  
Pneumococcal Colonization

Abstract Background Readily-available diagnostics do not reliably discriminate between viral and bacterial pediatric uncomplicated pneumonia, both of which are common. Some have suggested that assessment of pneumococcal carriage could be used to identify those children with bacterial pneumonia. The objective of this study was to determine if nasopharyngeal pneumococcal colonization patterns differed between children with definite viral disease, definite bacterial disease, and respiratory disease of indeterminate etiology. Methods Three groups of subjects were recruited: children with critical respiratory illness, previously healthy children with respiratory illness admitted to the ward, and previously healthy children diagnosed in the emergency department with non-severe pneumonia. Subjects were categorized as follows: a) viral infection syndrome (eg. bronchiolitis), b) bacterial infection syndrome (ie. pneumonia complicated by effusion/empyema), or c) ‘indeterminate’ pneumonia. Subjects’ nasopharyngeal swabs underwent quantitative PCR testing for S. pneumoniae. Associations between categorical variables were determined with Fisher’s exact, chi-square, or logistic regression, as appropriate. Associations between quantitative genomic load and categorical variables was determined by linear regression. Results There were 206 children in Group 1, 122 children in Group 2, and 179 children in Group 3. Only a minority (227/507, 45%) had detectable pneumococcal carriage; in those subjects, there was no association of quantitative genomic load with age, recruitment group, or disease category. In multivariate logistic regression, pneumococcal colonization > 3 log copies/mL was associated with younger age and recruitment group, but not with disease category. Conclusions The nasopharyngeal S. pneumoniae colonization patterns of subjects with definite viral infection were very similar to colonization patterns of those with definite bacterial infection or indeterminate pneumonia. Assessment and quantification of nasopharyngeal pneumococcal colonization does not therefore appear useful to discriminate between acute viral and bacterial respiratory disease; consequently, this diagnostic testing is unlikely to reliably determine which children with indeterminate pneumonia have a bacterial etiology and/or require antibiotic treatment.

P007 CROHN’S DISEASE: PREDICTORS OF HOSPITAL DISPOSITION AND COSTS USING DEMOGRAPHIC, CLINICAL, AND TREATMENT DATA

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S48-S48
Author(s):  
Hartman Brunt ◽  
Mason Adams ◽  
Michael Barker ◽  
Diana Hamer ◽  
J C Chapman
Keyword(s):  
Logistic Regression ◽  
Crohn’S Disease ◽  
Abdominal Pain ◽  
Crohn's Disease ◽  
Hospital Admission ◽  
Categorical Variables ◽  
History Of ◽  
The Difference ◽  
The Impact ◽  
Total Charges

Abstract Purpose Crohn’s disease (CD) is an inflammatory bowel disease (IBD) caused by an abnormal immune response to intestinal microbes in a genetically susceptible host. The objective of this cohort analysis is to compare demographic characteristics, cost difference, and treatment modalities between patients who were discharged from the Emergency Department (ED) and those who were admitted to the hospital. Methods This study is a retrospective chart review of adult patients diagnosed with CD who were discharged from the ED and those who were admitted to the hospital between January 1, 2014 and January 1, 2017. We compared demographic and clinical characteristics as well as total charges incurred by these patients. A chi square test of independence and a Mann Whitney U-Test were used to compare categorical variables. Linear and logistic regression analyses were utilized to identify predictors of hospitalization and total charges. Results Of a total 195 patients, 97 were discharged from the ED and 98 were admitted to the hospital (Table 1). Patients who presented with fever, nausea/vomiting, or abdominal pain or who had a history of a fistula or stenosis were more likely to be hospitalized, as were patients who presented on steroids, 5-ASA compounds, or narcotics (Table 2). A logistic regression adjusted for these factors showed patients presenting with abdominal pain (OR=0.239, 95% CI 0.07 – 0.77) are less likely, while patients presenting with fever (OR=7.0, 95% CI 1.9 – 24.5) and history of stenosis (OR=17.8, 95% CI 5.7 – 55.9) are more likely to have a hospital admission. An increase in age and white blood cell count was associated with an increase in likelihood of admission (OR=1.04, 95% CI 1.01 – 1.07 and OR=1.2, 95% CI 1.1 – 1.4), while an increase in HGB was associated with a decrease in likelihood of admission (OR=0.682, 95% CI 0.55 – 0.83). Patients on 5-ASA compounds had the strongest association with hospital admission (OR=4.5, 95% CI 1.03 – 20.4). A linear regression analysis predicting total charges of hospitalization identified an increase of $37,500 (95% CI 6,600 – 68,489) for obese patients and of $29,000 (95% CI 20 – 57,000) for patients on narcotics prior to hospitalization. Notably, blacks were on average 6 years younger than whites (μ=36.2, st.d.=13.2 v μ=42.7, st.d.=18.2, p=0.031, respectively). No other differences in presentation or outcomes of CD were identified between these races. Conclusion This study describes the difference between CD patients who were admitted to the hospital compared to those who were discharged from the ED. The impact that 5-ASA compound, steroid, and narcotic use prior to presentation has on hospital admission and charges highlights the need for consistent outpatient care to manage the symptoms and disease progression in patients with CD in Baton Rouge. The difference in age at presentation between blacks and whites should also be considered in future research.

Abstract 395: State-Level CPR Education Legislation Associated With Higher Survival After Out-Of-Hospital Cardiac Arrest in Older Adults

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
David G Buckler ◽  
Megan Barnes ◽  
Tyler D Alexander ◽  
Marissa Lang ◽  
Alexis M Zebrowski ◽  
...  
Keyword(s):  
Older Adults ◽  
Logistic Regression ◽  
Cardiac Arrest ◽  
State Level ◽  
Categorical Variables ◽  
Multiple Logistic Regression ◽  
Education Legislation ◽  
Chi Squared ◽  
Patient State ◽  
Hospital Cardiac Arrest

Introduction: State-level legislation requiring CPR education prior to high school graduation (CPR Legislation) is associated with an increased likelihood of community-level CPR training. CPR Legislation has also been shown to be associated with increased bystander CPR. We hypothesized that states with recent CPR Legislation would be associated with higher survival in older adults following out-of-hospital cardiac arrest (OHCA). Methods: Utilizing 2014 Medicare Claims data for emergency department (ED) visits and inpatient stays, we identified OHCA via ICD-9-CM code. CPR Legislation data was collected through online statute review. Exposure to CPR Legislation was assessed using the patient state of residence reported on the first claim. Patient dispositions were coded as home, SNF, death/hospice, rehab or other. All categories were considered survival to discharge except for death/hospice. Associations between categorical variables were assessed by chi-squared test. Multiple logistic regression was used to calculate the odds ratio associated with OHCA survival and CPR Legislation, controlling for patient age and sex. Results: In 2014, 256,277 OHCAs were identified. Mean age was 79 ±8 y, 48% were female, 23% were non-white, and survival to discharge was 22%. Prior to 2013, 4 states had passed CPR Legislation and 6 others passed legislation in 2013. These states account for 12% of OCHA for the study year. States that passed CPR Legislation in 2013 had the highest survival compared to states with earlier passage or no CPR Legislation (22.2% vs 20.6% vs. 21.8%, respectively, p < 0.001). Among those who survived to discharge, more patients were discharged home from states with 2013 CPR Legislation, than earlier or no legislation (50.8% vs. 41.3% vs. 42.8%, p <0.001). Results of the multiple logistic regression showed CPR Legislation passed in 2013 was associated with a 12% increase in the odds of survival to discharge compared to states with CPR Legislation prior to 2013 (OR: 1.12, p <0.001). Conclusion: States with CPR Legislation passed in 2013 were associated with higher survival to discharge and discharge to home, compared to earlier adopters and states with no legislation. Further work is needed to assess the mechanisms underlying this relationship.

Physiological Exophoria Did Not Increase The Incidence of Myopia in Rural School Children in Taiwan

2021 ◽  
Author(s):  
Jui-Hung Hsu ◽  
Li-Ju Lai ◽  
Tao-Hsin Tung ◽  
Wei-Hsiu Hsu
Keyword(s):  
Elementary School ◽  
Logistic Regression ◽  
Elementary School Students ◽  
Multinomial Logistic Regression ◽  
Significant Risk ◽  
Epidemiological Data ◽  
Significant Risk Factor ◽  
Categorical Variables ◽  
School Students

Abstract Purpose:This study evaluated the incidence rate and risk factors for developing myopia in elementary school students in Chiayi, Taiwan.Methods:This prospective cohort study comprised 1816 students without myopia (grades 1 to 5 in Chiayi County). The students underwent a noncycloplegic ocular alignment examinations using an autorefractometer and completed a questionnaires at baseline and at a 1-year follow-up. A univariate logistic regression was used to assess the effects of the categorical variables on new cases of myopia. A multinomial logistic regression was then conducted. A chi-squared test was used to compare new cases of myopia in terms of ocular alignment. A Cox hazard ratio model was then used to validate factors associated with changes in ocular alignment. A P value of <.05 was considered significant.Results: In 370 participants with new cases of myopia out of 1816 participants, a spherical error of −1.51 ± 0.6 diopters was noted at follow-up. The baseline ocular alignment was not a significant risk factor for developing myopia (exophoria vs orthophoria: OR 1.26, 95% CI 0.97-1.62; other vs. orthophoria: OR 1.15, 95% CI 0.73-1.82). However, new cases of myopia (HR 1.36, 95% CI 1.14-1.61), and baseline ocular alignment (exophoria vs orthophoria: HR 3.76, 95% CI 3.20-4.42; other vs orthophoria: HR 3.02, 95% CI 2.05-4.45) were associated with exophoria at follow-up.Conclusions: This study provided epidemiological data on the incidence of myopia in elementary school students in Chiayi, Taiwan. It also demonstrated that physiological exophoria does not predispose patients to developing myopia.

Abstract WP220: Can’t Breathe, Can’t See, Can’t Think: Chronic Obstructive Pulmonary Disease Increases the Risk of Posterior Reversible Encephalopathy Syndrome

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Molly Bates ◽  
Kyle Darpel ◽  
Nneka Amadife ◽  
Adam Dugan ◽  
Jessica D Lee
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Endothelial Dysfunction ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Hypertensive Emergency ◽  
Categorical Variables ◽  
Multivariate Logistic Regression ◽  
P Values ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

Introduction: Several theories exist regarding the pathogenesis of posterior reversible encephalopathy syndrome (PRES). One theory suggests that PRES occurs when systemic blood pressure exceeds the upper limit of cerebral autoregulation. Endothelial dysfunction has been proposed as an alternative pathogenesis to account for PRES outside the setting of acute hypertension. This mechanism has been implicated in other conditions associated with PRES including autoimmune diseases, cytotoxic medications, sepsis, and eclampsia. The purpose of this study was to determine if COPD, a disease known to cause endothelial dysfunction, has a causative association with the development of PRES. Methods: A single center retrospective, age-matched, case-control study was performed from January 2013 to June 2019 comparing patients discharged with a primary diagnosis of PRES to a control group with acute ischemic stroke. Demographics, medical comorbidities, initial blood pressure, and clinical outcomes were compared between the two groups. For categorical variables, p-values were calculated using χ2 and Fisher’s exact tests. For continuous variables, p-values were calculated using two-sample t-tests. The effect of COPD and acute hypoxic respiratory failure on PRES status was investigated using multivariate logistic regression. Results: A total of 94 PRES subjects and 109 control subjects were included for analysis. Mean age did not differ between the two groups; however, the PRES group was more likely to be female (78.7% vs. 49.5%, p<0.001). COPD was present in 26.6% (n=25) of cases and 11% (n= 12) of controls (odds ratio 4.12, p=0.003). Occurrence of hypertension did not differ significantly between the two groups (78.0% vs 86.2%). Among patients with PRES in the setting of COPD (n=25), 60% (n=16) did not meet criteria for hypertensive emergency. Controlling for hypertensive emergency status in a multivariate logistic regression analysis, patients with COPD were 3.21 times more likely to develop PRES (p= 0.004). Conclusions: To our knowledge, very few reports of PRES in the setting of COPD have been described in the literature and no association of PRES and COPD has been defined to date. Our data support the role of COPD as a risk factor in the development of PRES.

Abstract 211: Association of Patient Characteristics With the Initiation of Dabigatran Versus Warfarin Among Anticoagulant Naive Patients With Non-valvular Atrial Fibrillation

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
David R Walker ◽  
Jasmina Ivanova ◽  
Keith A Betts ◽  
Sapna Rao ◽  
Eric Q Wu
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Regression Model ◽  
Primary Care Physicians ◽  
Online Survey ◽  
Logistic Regression Model ◽  
Stroke Risk ◽  
Dabigatran Etexilate ◽  
Patient Characteristics ◽  
Categorical Variables

Background and Objective: Dabigatran etexilate (DE) and warfarin, both oral anticoagulants used for stroke risk reduction in patients with non-valvular atrial fibrillation (NVAF), have been or are being compared in several comparative effectiveness studies. Understanding patient characteristics of those prescribed DE vs. warfarin are important for interpreting such studies. The objective of this study is to identify the characteristics that differentiate NVAF patients prescribed DE versus warfarin as first-line anticoagulation. Methods: An online survey was administered in October 2012 to an established panel of cardiologists and primary care physicians (PCPs) in the US. Physicians were asked to identify medical charts of their patients diagnosed with NVAF and who had at least one prescription for DE or warfarin between 1/1/2011 and 6/30/2012. Patients were further required to be anticoagulant naïve prior to the first prescription of DE or warfarin. A computer generated random dice was applied to direct the random selection of the patients. Patient characteristics, comorbidities and clinical risk measures were compared between DE and warfarin patients using Chi-square tests for categorical variables and t-tests for continuous variables. A logistic regression model was utilized to evaluate patient characteristics associated with DE vs. warfarin use among anticoagulant naïve NVAF patients. Results: A total of 288 physicians (144 cardiologists and 144 PCPs) completed the survey. 262 medical records for DE patients and 247 for warfarin patients were randomly selected. The mean age of the DE and warfarin patients, respectively were 61.6 and 65.8 years (p < 0.01). The proportion of females was 20.6% and 41.7% in the DE and warfarin patients respectively (p<0.01). 86.3% of DE patients vs. 68.4% of warfarin patients were Caucasian (p<0.01). Other differences between DE and warfarin patients respectively included: previous myocardial infarction (3.8%, 9.3%; p<0.05), previous transient ischemic attack (8.4%, 16.2%; p <0.01), and CHA 2 DS 2 -VASc stroke risk score (2.21, 2.98; p<0.01). The logistic regression model found age (OR = 0.96; p=0.001), female gender (OR=0.46; p = 0.002), Hispanic/Latino (OR = 0.33; p=.007), Black (OR= 0.37; p = 0.006), and > 6 months and < 1 year for time from first NVAF diagnosis to first prescription date (OR = 0.38; p = 0.02) were associated with initiation of DE vs. warfarin. However, CHA 2 DS 2 -VASc was not found to be a significant predictor of anticoagulant prescription. Conclusions: Patients who are younger, male, Caucasian, and recently diagnosed with NVAF were significantly more likely to be initiated by their physician on DE vs. warfarin. These findings should be considered when doing comparative analyses of outcomes between patients on DE vs. warfarin.

Applying land use logistic regression models to assess different levels of air quality and to determine key environmental factors in Taiwan

2021 ◽  
Author(s):  
Cheng-Shin Jang
Keyword(s):  
Land Use ◽  
Air Pollution ◽  
Logistic Regression ◽  
Air Quality ◽  
Geographical Information ◽  
Categorical Variables ◽  
Anthropogenic Factors ◽  
Forest Land ◽  
Use Factors ◽  
Different Levels

&lt;p&gt;Due to fast industrialization and urbanization, air pollution is more and more serious in Taiwan. Generally, many anthropogenic factors can affect air quality; for example, &amp;#160;exhaust gas from automobiles and motorcycles, factory emissions, fossil fuels, burning straw, incinerators, etc. The factors are highly associated with land use. Previous studies typically used multiple linear regression model to analyze the relationships between air quality and land use. This study adopts multi-threshold land use logistic regression (LULR) models with several continuous and categorical variables to assess different levels of fine particulate matters (PM&lt;sub&gt;2.5&lt;/sub&gt;) in Taiwan and to determine key land-use factors controlling various levels of air PM&lt;sub&gt;2.5 &lt;/sub&gt;pollution. First, data on annual air PM&lt;sub&gt;2.5&lt;/sub&gt; pollution in the Taiwan Island are collected in 2017. Four thresholds of 16.37, 18.68, 21.83, 25.83 &amp;#181;g/m&lt;sup&gt;3 &lt;/sup&gt;are determined based on the 20th, 40th, 60th, and 80th percentiles, respectively, of observed data. Geographical information system is then adopted to analyze data on 29 environmental variables obtained from the three main dimensions&amp;#8211;information of land-use categories, amounts of specified pollution sources in townships, and geographical locations adjacent to monitoring stations of air quality. Finally, data in 2017 are employed to establish the LULR model and significant land-use factors causing air PM&lt;sub&gt;2.5&lt;/sub&gt; pollution are determined using stepwise LULR models for various levels of air PM&lt;sub&gt;2.5&lt;/sub&gt; pollution. Moreover, data in 2018 are used to verify the established LULR models. The analyzed results reveal that correct responses of the LULR models range from 83.6% to 100%. For the 20th-percentile threshold, locations and the industry land-use area are positively contributed to air pollution, while tempt densities and building, agriculture, forest land-use areas are negatively contributed to air pollution. For the 40th-percentile threshold, locations, plains with an elevation of less than 150 m, and agriculture land-use areas are related to air pollution. For the 60th-percentile threshold, locations are positively related to air pollution, while forest land-use areas are negatively related to air pollution. For the 80th-percentile threshold, locations and industry park areas associated with air pollution. According to the research results, a feasible strategy of environmental management and outdoor activities is proposed.&lt;/p&gt;

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