A proportional odds model of risk behaviors associated with recurrent road traffic crashes among young adults in Kuwait

Background The aims of this cross-sectional study were to i) assess one-year period prevalence of one, two, three or more road traffic crashes (RTCs) as an ordinal outcome and ii) identify the drivers’ characteristics associated with this ordinal outcome among young adult drivers with propensity to recurrent RTCs in Kuwait. Methods During December 2016, 1465 students, 17 years old or older from 15 colleges of Kuwait University participated in this cross-sectional study. A self-administered questionnaire was used for data collection. One-year period prevalence (95% confidence interval (CI)) of one, two, three or more RTCs was computed. Multivariable proportional odds model was used to identify the drivers’ attributes associated with the ordinal outcome. Results One-year period prevalence (%) of one, two and three or more RTCs respectively was 23.1 (95% CI: 21.2, 25.6), 10.9 (95% CI: 9.4, 12.6), and 4.6 (95% CI: 3.6, 5.9). Participants were significantly (p < 0.05) more likely to be in higher RTCs count category than their current or lower RCTs count, if they habitually violated speed limit (adjusted proportional odds ratio (pORadjusted) = 1.40; 95% Cl: 1.13, 1.75), ran through red lights (pORadjusted = 1.64; 95%CI: 1.30, 2.06), frequently (≥ 3) received multiple (> 3) speeding tickets (pORadjusted = 1.63; 95% CI: 1.12, 2.38), frequently (> 10 times) violated no-parking zone during the past year (pORadjusted = 1.64; 95% CI: 1.06, 2.54) or being a patient with epilepsy (pORadjusted = 4.37; 95% CI: 1.63, 11.70). Conclusion High one-year period prevalence of one, two and three or more RTCs was recorded. Targeted education based on identified drivers’ attributes and stern enforcement of traffic laws may reduce the recurrent RTCs incidence in this and other similar populations in the region.

Period Prevalence of Rheumatic Heart Disease and the Need for a Centralized Patient Registry in American Samoa, 2016 to 2018

Background Rheumatic heart disease (RHD) is a severe, chronic complication of acute rheumatic fever, triggered by group A streptococcal pharyngitis. Centralized patient registries are recommended for RHD prevention and control, but none exists in American Samoa. Using existing RHD tracking systems, we estimated RHD period prevalence and the proportion of people with RHD documented in the electronic health record. Methods and Results RHD cases were identified from a centralized electronic health record system, which retrieved clinical encounters with RHD International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD‐10‐CM ) codes, clinical problem lists referencing RHD, and antibiotic prophylaxis administration records; 3 RHD patient tracking spreadsheets; and an all‐cause mortality database. RHD cases had ≥1 clinical encounter with RHD ICD‐10‐CM codes, a diagnostic echocardiogram, or RHD as a cause of death, or were included in RHD patient tracking spreadsheets. Period prevalence per 1000 population among children aged <18 years and adults aged ≥18 years from 2016 to 2018 and the proportion of people with RHD with ≥1 clinical encounter with an RHD ICD‐10‐CM code were estimated. From 2016 to 2018, RHD was documented in 327 people (57.2%: children aged <18 years). Overall RHD period prevalence was 6.3 cases per 1000 and varied by age (10.0 pediatric cases and 4.3 adult cases per 1000). Only 67% of people with RHD had ≥1 clinical encounter with an RHD ICD‐10‐CM code. Conclusions RHD remains a serious public health problem in American Samoa, and the existing electronic health record does not include all cases. A centralized patient registry could improve tracking people with RHD to ensure they receive necessary care.

Prevalence of Suicidal Ideation and Suicide Attempts Among Refugees: A Meta-analysis

Background: Suicidal ideation and attempts are one of the most serious mental health problems affecting refugees. Risk factors such as mental disorders, low socio-economic status, and stressful life events all contribute to making refugees a high-risk group. For this reason, this meta-analysis aims to investigate the prevalence of suicidal ideation and attempts among refugees in non-clinical populations.Method: All studies published in English up through August 2020 were considered for the analysis. We searched four databases for articles reporting (period) prevalence rates of suicidal ideation and attempts. Results: Of 294 hits, 11 publications met the inclusion criteria. Overall prevalence rates were calculated using Rstudio. The overall period prevalence of suicidal ideation was 20.5% (CI: 0.11-0.32, I²=98%, n=8), 22.3% (CI: 0.10-0.38, I²=97%, n=5) for women, and 23.3% for men (CI: 0.13-0.35, I²=87%, n=3). Suicide attempts had an overall prevalence of 0.57% (CI: 0.00-0.02, I²=81%, n=4). Conclusion: There is a great lack of epidemiological studies on suicidal ideation and attempts among refugees. The high prevalence of suicidal ideation indicates the existence of heavy psychological burden among this population. The prevalence of suicide attempts is similar to that in non-refugee populations. In addition, the results underline the need for systematic and standardized assessment and treatment of suicidal ideation and attempts.

Epidemiology of Treated Epilepsy in New Zealand Children: A Focus on Ethnicity

Objective:To determine the period prevalence and incidence of treated epilepsy in a New Zealand (NZ) pediatric cohort with a focus on ethnicity and socioeconomic status.Methods:This was a retrospective cohort study. The NZ Pharmaceutical Collection database was searched for individuals (≤18 years) dispensed an antiseizure medication (ASM) in 2015 from areas capturing 48% of the NZ pediatric population. Medical records of identified cases were reviewed to ascertain the indication for the ASM prescription. Population data was derived from the NZ 2013 Census.Results:3557 ASMs were prescribed during 2015 in 2594 children, of whom 1717 (66%) children had epilepsy. An indication for prescription was ascertained for 3332/3557 (94%) of ASMs. The period prevalence of treated epilepsy was 3.4 per 1000 children. Children in the most deprived areas had 1.9 times the rate of treated epilepsy (95% CI 1.6-2.2) than those from the least deprived areas. Prevalence was similar for most ethnic groups (European/Other - 3.7, 95% CI 3.4-3.9; Pacific Peoples - 3.6, 95% CI 3.2-4.1; Māori - 3.4, 95% CI 3.1-3.8) apart from Asians, who had a lower prevalence of 2.3 per 1000 (95% CI 2.0-2.6). However, when adjusted for socioeconomic deprivation, the prevalence of epilepsy was highest in Europeans and similar in Māori, Pacific and Asian children.Conclusions:This is the largest pediatric epidemiology epilepsy study where diagnosis of epilepsy was confirmed by case review. This is the first study to provide epidemiological information for pediatric epilepsy in Māori and Pacific children.

A cost–benefit analysis of hospital-wide medication reviews: a period prevalence study

Background For specific medical specialties it has been shown that clinical pharmacists can have a beneficial effect on the reduction of drug-related problems by performing medication reviews. However, little is known on the cost–benefit ratio of hospital-wide implementation of medication reviews. Aim To investigate the effect of conducting hospital-wide medication reviews on the detection and resolution of drug-related problems, and to calculate the cost–benefit ratio of the intervention. Method In this observational prospective period prevalence study, medication reviews were conducted during five consecutive working days in a Dutch university hospital. Patients admitted for more than 24 h were included. The cost–benefit ratio of conducting the medication reviews was calculated by dividing the total costs by the total savings. Results In 622 medication reviews, 709 potential drug-related problems (1.1 per patient) were detected. The most common advice was to stop medication (38.6%). Patients with a potentially drug-related problem were significantly older, had a higher median number of prescriptions, and the median number of days from admission to the time of medication reviews was longer. Conducting medication reviews showed a positive cost–benefit ratio of 9.7. Conclusions Hospital-wide medication reviews by clinical pharmacists have a positive cost–benefit ratio and contribute to the detection and the resolution of drug related problems (DRPs), mainly by reducing overtreatment.

749The global prevalence of Rheumatoid Arthritis: A meta-analysis

Background To determine the global prevalence of rheumatoid arthritis (RA) based on published studies and reveal factors which influence the RA prevalence estimates. Methods Four electronic databases- ProQuest Central, MEDLINE, Web of Science, and EMBASE were searched for publications from 1980 and 2019, reporting prevalence estimates of RA. A random-effect meta-analysis model was used to produce the pooled prevalence estimates. The potential sources of between-study heterogeneity were identified using sensitivity analysis, sub-group and meta-regression analyses. Results A total of 67 studies consisting of 212,335,171 patients were included in the meta-analysis. The global prevalence of RA was estimated 0.46% (95% CI: 0.39-0.54; I2=99.9%) with a 95% prediction interval (0.06–1.27). The point-prevalence of RA was 0.45% (95% CI: 0.38- 0.53%), while the pooled period-prevalence was 0.46% (0.36% and 0.57%). The highest RA pooled prevalence was estimated at 0.69% (95% CI: 0.47–0.95) derived from linked data sources studies. Based on subgroup analyses, the pooled prevalence of RA was influenced by geographical location, the risk bias of studies, period-prevalence method and urban population setting over the stratified periods. Conclusion The global prevalence of RA was 460 per 100,000 population from 1980–2018, with a 95% prediction interval (0.06– 1.27%). RA prevalence estimates were influenced by geographical location, the risk bias assessment of studies, period-prevalence method and urban population setting over time. Key messages The global prevalence of RA was 460 per 100,000 population from 1980–2018, with a 95% prediction interval (0.06– 1.27%).

Temporal and regional trends of antibiotic use in long-term aged care facilities across 39 countries, 1985-2019: Systematic review and meta-analysis

Background Antibiotic misuse is a key contributor to antimicrobial resistance and a concern in long-term aged care facilities (LTCFs). Our objectives were to: i) summarise key indicators of systemic antibiotic use and appropriateness of use, and ii) examine temporal and regional variations in antibiotic use, in LTCFs (PROSPERO registration CRD42018107125). Methods & findings Medline and EMBASE were searched for studies published between 1990–2021 reporting antibiotic use rates in LTCFs. Random effects meta-analysis provided pooled estimates of antibiotic use rates (percentage of residents on an antibiotic on a single day [point prevalence] and over 12 months [period prevalence]; percentage of appropriate prescriptions). Meta-regression examined associations between antibiotic use, year of measurement and region. A total of 90 articles representing 78 studies from 39 countries with data between 1985–2019 were included. Pooled estimates of point prevalence and 12-month period prevalence were 5.2% (95% CI: 3.3–7.9; n = 523,171) and 62.0% (95% CI: 54.0–69.3; n = 946,127), respectively. Point prevalence varied significantly between regions (Q = 224.1, df = 7, p<0.001), and ranged from 2.4% (95% CI: 1.9–2.7) in Eastern Europe to 9.0% in the British Isles (95% CI: 7.6–10.5) and Northern Europe (95% CI: 7.7–10.5). Twelve-month period prevalence varied significantly between regions (Q = 15.1, df = 3, p = 0.002) and ranged from 53.9% (95% CI: 48.3–59.4) in the British Isles to 68.3% (95% CI: 63.6–72.7) in Australia. Meta-regression found no association between year of measurement and antibiotic use prevalence. The pooled estimate of the percentage of appropriate antibiotic prescriptions was 28.5% (95% CI: 10.3–58.0; n = 17,245) as assessed by the McGeer criteria. Year of measurement was associated with decreasing appropriateness of antibiotic use over time (OR:0.78, 95% CI: 0.67–0.91). The most frequently used antibiotic classes were penicillins (n = 44 studies), cephalosporins (n = 36), sulphonamides/trimethoprim (n = 31), and quinolones (n = 28). Conclusions Coordinated efforts focusing on LTCFs are required to address antibiotic misuse in LTCFs. Our analysis provides overall baseline and regional estimates for future monitoring of antibiotic use in LTCFs.

Epidemiology of SARS-CoV2 in Qatar’s primary care population aged 10 years and above

Background There is an urgent need to elucidate the epidemiology of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) and characterize its potential impact. Investing in characterising the SARS-CoV2 will help plan and improve the response to the pandemic. Furthermore, it will help identify the most efficient ways of managing the pandemic, avoiding public health policies and interventions that may be unduly restrictive of normal activity or unnecessarily costly. This paper describes the design and reports findings of a population based epidemiological study undertaken to characterise SARS-CoV2 in Qatar using limited resources in a timely manner. Methods Asymptomatic individuals ≥10 years registered with Qatar’s publicly funded primary health provider were eligible. A stratified random sampling technique was utilized to identify the study sample. Participants were invited to an appointment where they completed a questionnaire and provided samples for polymerase chain reaction and Immunoglobulin M and G immunoassay tests. Data collected were analyzed to calculate point and period prevalence by sociodemographic, lifestyle and clinical characteristics. Results Of 18,918 individuals invited for the study, 2084 participated (response rate 10.8%). The overall point prevalence and period prevalence were estimated to be 1.6% (95% CI 1.1–2.2) and 14.6% (95% CI 13.1–16.2) respectively. Period prevalence of SARS-CoV2 infection was not considerably different across age groups (9.7–19.8%). It was higher in males compared to females (16.2 and 12.7% respectively). A significant variation was observed by nationality (7.1 to 22.2%) and municipalities (6.9–35.3%). Conclusions The study provides an example of a methodologically robust approach that can be undertaken in a timely manner with limited resources. It reports much-needed epidemiological data about the spread of SARS-CoV2. Given the low prevalence rates, majority of the population in Qatar remains susceptible. Enhanced surveillance must continue to be in place, particularly due to the large number of asymptomatic cases observed. Robust contact tracing and social distancing measures are key to prevent future outbreaks.

Antimicrobial Resistance Trends in Urine Escherichia coli Isolates From Adult and Adolescent Females in the United States From 2011–2019: Rising ESBL Strains and Impact on Patient Management

Background Uncomplicated urinary tract infection (uUTI) is predominantly caused by Escherichia coli, which has increasing antimicrobial resistance (AMR) at the US-community level. As uUTI is often treated empirically, assessing AMR is challenging and there are limited contemporary data characterizing period prevalence in the US. Methods This was a retrospective study of AMR using Becton, Dickinson and Company Insights Research Database (Franklin Lakes, NJ) data collected 2011–2019. Thirty-day, non-duplicate Escherichia coli urine isolates from US female outpatients (aged ≥12 years) were included. Isolates were evaluated for not-susceptibility (intermediate/resistant) to trimethoprim-sulfamethoxazole, fluoroquinolones, or nitrofurantoin, and assessed for extended-spectrum β-lactamase production (ESBL+) and for ≥2 or ≥3 drug-resistance phenotypes. Generalized estimating equations were used to model AMR trends over time and by US census region. Results Among 1,513,882 Escherichia coli isolates, the overall prevalence of isolates not-susceptible to trimethoprim-sulfamethoxazole, fluoroquinolones, and nitrofurantoin was 25.4%, 21.1%, and 3.8%, respectively. Among the isolates, 6.4% were ESBL+, 14.4% had ≥2 drug-resistance phenotypes, and 3.8% had ≥3. Modelling demonstrated a relative average yearly increase of 7.7% (95% confidence interval [CI], 7.2–8.2%) for ESBL+ isolates and 2.7% (95% CI, 2.2–3.2%) for ≥3 drug-phenotypes (both p&lt;0.0001). Modelling also demonstrated significant variation in AMR prevalence between US census regions (p&lt;0.001). Conclusions Period prevalence of AMR among US outpatient urine-isolated Escherichia coli was high, and for multi-drug-resistance phenotypes increased during the study period with significant variation between census regions. Knowledge of regional AMR rates helps inform empiric treatment of community-onset uUTI and highlights the AMR burden to physicians.