Unimed Recife's experience in treating 1,039 patients with Covid-19

ObjectiveTo describe the features related to patients with Covid-19 admitted to Unimed Recife hospitals, Recife, Brazil, evaluating demographic data, lethality, use of a mechanical ventilator, presence of associated diseases, the need to use the ICU, among other aspects related to the prognosis of these patients.MethodData were collected from the DRG Brazil health management platform, including the period from March 16, 2020, when the first patient with Covid-19 was admitted to the Hospital da Unimed III, until January 31, 2021. All patients admitted to one of the three hospitals of Unimed Recife - Hospital Unimed Recife I, Hospital Unimed Recife III, and Hospital Geral Unimed Recife – were included in the study. In the same period, we evaluated the number of patients with Covid-19 or suspected Covid-19 who were seen in the emergency room at Hospital Unimed Recife III.ResultsOne hundred twenty-six thousand five hundred fifty-three patients were seen in the Emergency Unit of Hospital Unimed Recife III in the period between March 26, 2020, and January 31, 2021; of those 126,553 patients seen in the emergency 39,340 (31.09%) patients were diagnosed with having Covid-19 or suspected of Covid-19. In the 10-month period, 1,039 patients with Covid-19 were hospitalized, 61% with hypertension, 31.1% with SARS, 30.0% with diabetes, and 9.9% were obese. The average hospital stay was 11.2 days. 342/1,039 (32.9%) patients were admitted to the ICU, and 57.9% of them had mechanical ventilation. The overall lethality was 13.76% (143 deaths/1,039 inpatients). An increase in lethality by Covid-19 was associated with increased age. Lethality in the first period of the Covid-19 pandemic was significantly higher when compared to the last 5 months of the pandemic(17.6% versus 9.7%). Obesity significantly increased lethality in patients with Covid-19 [120 deaths/1,016 non-obese patients (11.8%) versus 23 deaths/103 obese patients (22.3%), OR 2.15 (1.30 - 3.50), p = 0.005)].ConclusionWe conclude that Covid-19 is a disease with a poor prognosis, especially in the elderly and obese patients. In the second 5-month period of the Covid-19 pandemic, we noticed a significant reduction in lethality by Covid-19 in hospitalized patients. Covid-19 is a new disease and the mechanism by which the viruses multiply or how the pathophysiological process occurs in the infected organism are still barely understood.

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Hospital admissions and direct costs: A comparative study between paliperidone palmitate and oral antipsychotics

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.567 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s229-s229

Author(s):

A. Soler Iborte ◽

S. Galiano Rus ◽

J.A. Ruíz Sánchez

Keyword(s):

Hospital Stay ◽

Hospital Admissions ◽

Average Length ◽

Direct Costs ◽

Average Hospital Stay ◽

Average Hospital ◽

Number Of Patients ◽

Icd 10 ◽

Schizophrenic Patients ◽

Competing Interest

IntroductionThe total costs of schizophrenia increased to 2576 million Euros in 2013 in Spain, or 2.7% of the annual cost of health services. The hospitalizations, along with other intermediate resources, such as Day Hospital, etc., significantly contribute to the increase of economic burden. In Spain, the average hospital stay of schizophrenic patients is 18.24 days, totalling to an average cost of 6,753 Euros/patient (370.23 Euros/patient/day).Material and methodsThe sample selected included patients from both sexes, aged between 18 and 65 years old, with diagnostic criteria of schizophrenia (according to DSM-IV and ICD-10), admitted in the Mental Health Hospital Unit (MHHU), Úbeda between 2012 and 2013, with registered visits of at least 2 outpatient visits or 1 hospitalization related to the schizophrenia diagnosis (n = 48).ResultsAfter the start of treatment with the injectable antipsychotic drug of prolonged duration, the number of patients that required hospitalization for any psychiatric motive went from 24 patients (49.7%) to 11 patients (22.4%; P < 0.001). The patients who started treatment with PAP during hospitalization had an average stay of 15.7 days, as compared to 18.24 days of average hospital stay due to schizophrenia in Spain. The direct costs of hospitalization stays due to psychiatric reasons decreased from 162,071.88 Euros to 74,282.95 Euros (P < 0.001).ConclusionsThis observational study shows us that the treatment with PAP reduced the average length of the hospital stay, and resulted in a decreased percentage of re-admissions as compared to oral treatments for schizophrenia. These data led to savings of more than 50% of the direct costs of hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Optimization of a Wireless Sensor Network-Based Smart Elderly Location Management System

Journal of Sensors ◽

10.1155/2021/2760746 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Biying Wang ◽

Dingzhuang Chen ◽

Liangpeng Xu

Keyword(s):

Neural Network ◽

Bp Neural Network ◽

Management System ◽

Health Management ◽

Location Management ◽

The Elderly ◽

Home Health ◽

Prediction Algorithm ◽

Unit Testing ◽

Management Platform

In this paper, wireless sensors are used to design and build a location management system for smart aging, and the optimization of this system is analysed. The function and structure of the positioning system are designed and implemented. Next, the system commissioning process and field implementation results are summarized and analysed to guarantee the reliability and integrity of the system. Finally, the system requirements and implementation are integrated to realize the basic requirements of the IoT-based elderly positioning management system and reserve the interface for later expansion. Finally, the system excellence and functional usability tested through unit testing as well as comprehensive testing. In this paper, a theoretical analysis of the prediction algorithm is carried out for the disease prediction module in the health monitoring software of the smart senior care system. To improve the accuracy of the prediction, the traditional BP neural network algorithm is optimized using DS evidence theory, thus fusing multiple sets of prediction results obtained from the BP neural network into a more accurate set of data, and the performance of the algorithm before and after the improvement is compared. The IoT-based home health management for the elderly starts from the health service demand of the elderly, explains the basic concept of IoT technology and home health management for the elderly, and analyses the feasibility of home health management for the elderly and the advantages of IoT technology in-home health management for the elderly; through the field research, the IoT-based home health management platform for the elderly is carried out from three aspects of users, business, and technology. The design covers the platform architecture and functional modules of the IoT-based senior home health management platform, which can solve the problem that the elderly can spend a comfortable life in their old age without going home.

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Körperliche Beschwerden bei älteren Migranten in Deutschland 1Erstellt unter Mitwirkung der Arbeitsgruppe «Abuse of the Elderly in the European Region» (ABUEL): Joaquim F. J. Soares, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Francisco Torres-González, Departmental Section of Psychiatry and Psychological Medicine, University of Granada, Spain; Elisabeth Ioannidi-Kapolou, National School of Public Health, Department of Sociology, Athens, Greece; Giovanni Lamura, Italian National Research Centre on Ageing Department of Gerontological Research, Unit of Health Economics, Ancona, Italy; Mindaugas Stankunas, Kaunas University of Medicine, Department of Health Management, A. Mickeviciaus, Kaunas, Lithuania; Henrique Barros, Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.

Zeitschrift für Psychiatrie Psychologie und Psychotherapie ◽

10.1024/1661-4747.a000028 ◽

2010 ◽

Vol 58 (3) ◽

pp. 199-206 ◽

Cited By ~ 3

Author(s):

Rosina-Martha Csöff ◽

Gloria Macassa ◽

Jutta Lindert

Keyword(s):

Public Health ◽

Health Management ◽

The Elderly ◽

Health Department ◽

Research Unit ◽

Research Centre ◽

Public Health Department ◽

Karolinska Institute ◽

Psychological Medicine ◽

Körperliche Beschwerden

Körperliche Beschwerden sind bei Älteren weit verbreitet; diese sind bei Migranten bislang in Deutschland und international noch wenig untersucht. Unsere multizentrische Querschnittstudie erfasste körperliche Beschwerden bei Menschen im Alter zwischen 60 und 84 Jahren mit Wohnsitz in Stuttgart anhand der Kurzversion des Gießener Beschwerdebogens (GBB-24). In Deutschland wurden 648 Personen untersucht, davon 13.4 % (n = 87) nicht in Deutschland geborene. Die Geschlechterverteilung war bei Migranten und Nichtmigranten gleich; der sozioökonomische Status lag bei den Migranten etwas niedriger: 8.0 % (n = 7) der Migranten und 2.5 % (n = 14) der Nichtmigranten verfügten über höchstens vier Jahre Schulbildung; 12.6 % (n = 11) der Migranten und 8.2 % (n = 46) der Nichtmigranten hatten ein monatliches Haushaltsnettoeinkommen von unter 1000€; 26.4 % der Migranten und 38.1 % (n = 214) der Nichtmigranten verfügten über mehr als 2000€ monatlich. Somatische Beschwerden lagen bei den Migranten bei 65.5 % (n = 57) und bei den Nichtmigranten bei 55.8 % (n = 313). Frauen wiesen häufiger somatische Beschwerden auf (61.8 %) als Männer (51.8 %). Mit steigendem Alter nahmen somatische Beschwerden zu. Mit Ausnahme der Altersgruppe der 70–74-Jährigen konnte kein signifikanter Unterschied zwischen Migranten und Nichtmigranten hinsichtlich der Häufigkeit körperlicher Beschwerden gezeigt werden. Ausblick: Es werden dringend bevölkerungsrepräsentative Studien zu körperlichen Beschwerden bei Migranten benötigt.

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Neuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementia

Psychiatry ◽

10.30629/2618-6667-2020-18-4-6-15 ◽

2020 ◽

Vol 18 (4) ◽

pp. 6-15

Author(s):

I. V. Kolykhalov

Keyword(s):

Neuropsychiatric Symptoms ◽

The Elderly ◽

Psychotic Symptoms ◽

Mixed Dementia ◽

Short Term ◽

Antipsychotic Therapy ◽

Dementia Patients ◽

Frequency Of Use ◽

Number Of Patients ◽

High Incidence

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

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An Analysis of Dental Implants Survival and Success

Revista de Chimie ◽

10.37358/rc.18.9.6554 ◽

2018 ◽

Vol 69 (9) ◽

pp. 2465-2466

Author(s):

Iustin Olariu ◽

Roxana Radu ◽

Teodora Olariu ◽

Andrada Christine Serafim ◽

Ramona Amina Popovici ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Medical History ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Demographic Data ◽

Kaplan Meier ◽

Number Of Patients ◽

Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

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Letter to the Editor: Microbiota in the Respiratory System—A Possible Explanation to Age and Sex Variability in Susceptibility to SARS-CoV-2

Microbiology Insights ◽

10.1177/1178636120988604 ◽

2021 ◽

Vol 14 ◽

pp. 117863612098860

Author(s):

Vishal Shah

Keyword(s):

Respiratory System ◽

Elderly Population ◽

Age Groups ◽

The Elderly ◽

Elderly Adult ◽

Human Respiratory Tract ◽

System A ◽

Number Of Patients ◽

Children And Young Adults ◽

Age And Sex

The Human respiratory tract is colonized by a variety of microbes and the microbiota change as we age. In this perspective, literature support is presented for the hypothesis that the respiratory system microbiota could explain the differential age and sex breakdown amongst COVID-19 patients. The number of patients in the older and elderly adult group is higher than the other age groups. The perspective presents the possibility that certain genera of bacteria present in the respiratory system microbiota in children and young adults could be directly or through eliciting an immune response from the host, prevent full-fledged infection of SARS-CoV-2. The possibility also exists that the microbiota in older adults and the elderly population have bacteria that make it easier for the virus to cause infection. I call upon the scientific community to investigate the link between human microbiota and SARS-CoV-2 susceptibility to further understand the viral pathogenesis.

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Predictive Factors for Patients’ Failure to Show for Initial Outpatient Physical Therapist Evaluation

Physical Therapy ◽

10.1093/ptj/pzab047 ◽

2021 ◽

Author(s):

Matthew Briggs ◽

Christine Ulses ◽

Lucas VanEtten ◽

Cody Mansfield ◽

Anthony Ganim ◽

...

Keyword(s):

Predictive Factors ◽

Employment Status ◽

Physical Therapist ◽

Demographic Data ◽

Binary Logistic Regression ◽

Final Analysis ◽

Outpatient Setting ◽

Binary Logistic Regression Model ◽

Number Of Patients ◽

Payer Source

Abstract Objective The objective of this study was to xamine primary factors which may predict patients’ failure to show at initial physical therapist evaluation in an orthopedic and sports outpatient setting. Methods A retrospective analysis of patients’ demographic data for physical therapist evaluations between January 2013 and April 2015 was performed. A binary logistic regression model was used to evaluate the odds of a no-show at evaluation. Demographic variables of age, employment status, days waited for the appointment, payer source, and distance traveled to clinic were analyzed. Independent variables were considered significant if the 95% Cis of the odds ratios did not include 1.0. Results A total of 6971 patients were included in the final analysis with 10% (n = 698) of the scheduled patients having a no-show event for their initial evaluation. The following factors increased the odds of patients having a no-show event: days to appointment (OR = 1.058; 95% CI = 1.042 to 1.074), unemployment status (OR = 1.96; 95% CI = 1.41 to 2.73), unknown employment status (OR = 3.22; 95% CI = 1.12 to 8.69), Medicaid insurance (OR = 4.87; 95% CI = 3.43 to 6.93), Medicare insurance (OR = 2.22; 95% CI = 1.10 to 4.49), unknown payer source (OR = 262.84; 95% CI = 188.72 to 366.08), and distance traveled ≥5 miles (OR = 1.31; 95% CI = 1.01 to 1.70). Female sex [OR = 0.73; 95% CI = 0.57 to 0.95) and age ≥ 40 years (OR = 0.44; 95% CI = 0.33 to 0.60) decreased the odds of a no-show event. Conclusion Results from this study indicate there may be some demographic factors that are predictive of patients failing to attend their first physical therapist visit. Impact Understanding the predictive factors and identifying potential opportunities for improvements in scheduling processes might help decrease the number of patients failing to show for their initial physical therapy appointment, with the ultimate goal of positively influencing patient outcomes.

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Abstract 274: Prevalence of undiagnosed non-valvular atrial fibrillation in the United States

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.274 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Mintu P Turakhia ◽

Jason Shafrin ◽

Katalin Bognar ◽

Jeffrey B Brown ◽

Jeffrey Trocio ◽

...

Keyword(s):

Atrial Fibrillation ◽

High Risk ◽

The Elderly ◽

The United States ◽

Risk Scores ◽

Chads2 Score ◽

Aged Patients ◽

Number Of Patients ◽

Working Age ◽

Back Calculation

Background: Because atrial fibrillation (AF) is often asymptomatic, clinically silent and therefore undiagnosed, the prevalence of AF is difficult to estimate. In fact, ischemic stroke is often the first clinical sign of AF among previously undiagnosed patients. In this study, we estimated the prevalence of undiagnosed AF using a back-calculation approach that relies on the fact that AF causes stroke but causality generally does not run from stroke to AF. Methods: We first estimated the prevalence of diagnosed non-valvular AF in the elderly (65+) and working age (18-64) U.S. population from a 5% Medicare sample and an OptumInsight commercial claims database from 2004-2010 using validated ICD9 algorithms. To estimate the prevalence of undiagnosed non-valvular AF, our back-calculation methodology used two measured inputs: (i) the number of patients who are diagnosed with new non-valvular AF in the current or subsequent quarter after a stroke; (ii) the probability that patients with non-valvular AF have a stroke, based on CHADS2 risk scores. We confirmed calibration by comparing our prevalence estimates of diagnosed AF with prior Medicare and commercial claims analyses. Results: Between 2005 and 2009, the estimated prevalence of AF gradually increased, reaching 9.9% of the elderly U.S. population and 0.88% of the working aged population by 2009. Among the Medicare AF cases in 2009, 11% of these cases (1.1% out of 9.9%) were undiagnosed; among working aged patients with AF, 8% of cases (0.07% out of 0.88%) were undiagnosed. In addition, a large share of the undiagnosed cases was at high risk of stroke. Among the undiagnosed AF cases for elderly and working age adults, 26% and 37%, respectively have a CHADS2 score of 1, and 68% and 26% have a CHADS2 score of 2+. Conclusions: Among elderly and working adult U.S. populations, a substantial proportion of individuals with undiagnosed AF have moderate to high risk of stroke. Screening for AF could favorably impact the disease burden.

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Comminuted Patella Fracture in Elderly Patients: A Systematic Review and Case Report

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458517710517 ◽

2017 ◽

Vol 8 (3) ◽

pp. 135-144 ◽

Cited By ~ 4

Author(s):

Brent Matthews ◽

Kaushik Hazratwala ◽

Sergio Barroso-Rosa

Keyword(s):

Case Report ◽

Elderly Patients ◽

Treatment Options ◽

The Elderly ◽

Fracture Pattern ◽

Patella Fracture ◽

Level Of Evidence ◽

Fixation Failure ◽

Number Of Patients ◽

Mesh Augmentation

Objectives: To review comminuted patella fracture in the elderly patients and examine the surgical options to avoid complications such as fixation failure and poor functional outcome. To provide an example of mesh augmentation in comminuted patella fracture in the elderly patients. Data Sources: A literature review was conducted by the authors independently using Ovid, Medline, Cochrane, PubMed, and Clinical Key in English. We aimed to review data on patients older than 65 with comminuted patella fracture. Search conducted between July and December 2015. Study Selection: Search terms included patella fracture, elderly, and fixation failure. Abstracts were included if they were a case report, cohort series, or randomized control trial. Further inclusion criteria were that they were available in full text and included patient age(s), operative details, follow-up, and outcome discussion. Data Extraction: Each study was assessed according to its level of evidence, number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized. Data Synthesis: Paucity of data and heterogeneity of studies limited statistical analysis. Data are presented as a review table with the key points summarized. Conclusion: In patella fracture, age >65 years and comminuted fracture pattern are predictors of increased fixation failure and postoperative stiffness, warranting special consideration. There is a trend toward improved functional outcomes when augmented fixation using mesh or plates is used in this group. Further level 1 studies are required to compare and validate new treatment options and compared them to standard surgical technique of tension band wire construct.

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Clinical diagnosis of 80 cases of dementia in a university hospital

Jornal Brasileiro de Psiquiatria ◽

10.1590/s0047-20852013000200007 ◽

2013 ◽

Vol 62 (2) ◽

pp. 139-143 ◽

Cited By ~ 1

Author(s):

Renata Teles Vieira ◽

Norami de Moura Barros ◽

Leonardo Caixeta ◽

Sergio Machado ◽

Adriana Cardoso Silva ◽

...

Keyword(s):

Demographic Data ◽

Lewy Body Dementia ◽

The Elderly ◽

Healthcare Services ◽

Epidemiological Studies ◽

University Hospital ◽

Functional Activities ◽

Considerable Impact ◽

The City ◽

State Examination

OBJECTIVE: This study aims to estimate the prevalence of dementia subtypes and to assess the socio-demographic data of patients attending the outpatient clinic of dementia at Hospital das Clínicas from January 2008 to December 2009, in the city of Goiânia-GO, Brazil. METHODS: Procedures provided for diagnosis included physical and neurological examination, laboratory tests, neuroimaging and DSM-IV. The functional capacity and level of cognitive deficit were assessed by Pfeffer Functional Activities Questionnaire (Pfeffer-FAQ) and Mini-Mental State Examination (MMSE), respectively. RESULTS: Eighty patients met the criteria for dementia. The mean age was 63.48 (± 16.85) years old, the schooling was 3.30 (± 3.59) years old, the MMSE was 13.89 (± 7.79) and Pfeffer 17.73 (± 9.76). The Vascular Dementia (VD; 17.5%) was the most frequent cause of dementia, followed by Lewy body dementia (LBD) and Alzheimer's disease (AD) (12.25%). CONCLUSION: Considering entire sample and only the elderly over 60 years, VD, AD and LBD are the most common subtypes observed at both groups. Further epidemiological studies are necessary to confirm such rates, which may have a considerable impact on the organization and planning of healthcare services in our country.

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