Retrospective Cohort
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2021 ◽  
Vol 9 (27) ◽  
pp. 8020-8026
Si-Yang Yao ◽  
Bin Liang ◽  
Yuan-Yuan Chen ◽  
Yun-Tian Tang ◽  
Xiao-Feng Dong ◽  

PLoS Medicine ◽  
2021 ◽  
Vol 18 (9) ◽  
pp. e1003789
Yiran E. Liu ◽  
Everton Ferreira Lemos ◽  
Crhistinne Cavalheiro Maymone Gonçalves ◽  
Roberto Dias de Oliveira ◽  
Andrea da Silva Santos ◽  

Background Mortality during and after incarceration is poorly understood in low- and middle-income countries (LMICs). The need to address this knowledge gap is especially urgent in South America, which has the fastest growing prison population in the world. In Brazil, insufficient data have precluded our understanding of all-cause and cause-specific mortality during and after incarceration. Methods and findings We linked incarceration and mortality databases for the Brazilian state of Mato Grosso do Sul to obtain a retrospective cohort of 114,751 individuals with recent incarceration. Between January 1, 2009 and December 31, 2018, we identified 3,127 deaths of individuals with recent incarceration (705 in detention and 2,422 following release). We analyzed age-standardized, all-cause, and cause-specific mortality rates among individuals detained in different facility types and following release, compared to non-incarcerated residents. We additionally modeled mortality rates over time during and after incarceration for all causes of death, violence, or suicide. Deaths in custody were 2.2 times the number reported by the national prison administration (n = 317). Incarcerated men and boys experienced elevated mortality, compared with the non-incarcerated population, due to increased risk of death from violence, suicide, and communicable diseases, with the highest standardized incidence rate ratio (IRR) in semi-open prisons (2.4; 95% confidence interval [CI]: 2.0 to 2.8), police stations (3.1; 95% CI: 2.5 to 3.9), and youth detention (8.1; 95% CI: 5.9 to 10.8). Incarcerated women experienced increased mortality from suicide (IRR = 6.0, 95% CI: 1.2 to 17.7) and communicable diseases (IRR = 2.5, 95% CI: 1.1 to 5.0). Following release from prison, mortality was markedly elevated for men (IRR = 3.0; 95% CI: 2.8 to 3.1) and women (IRR = 2.4; 95% CI: 2.1 to 2.9). The risk of violent death and suicide was highest immediately post-release and declined over time; however, all-cause mortality remained elevated 8 years post-release. The limitations of this study include inability to establish causality, uncertain reliability of data during incarceration, and underestimation of mortality rates due to imperfect database linkage. Conclusions Incarcerated individuals in Brazil experienced increased mortality from violence, suicide, and communicable diseases. Mortality was heightened following release for all leading causes of death, with particularly high risk of early violent death and elevated all-cause mortality up to 8 years post-release. These disparities may have been underrecognized in Brazil due to underreporting and insufficient data.

2021 ◽  
Vol 12 ◽  
Anas A. Khan ◽  
Ahmed A. Alahmari ◽  
Yasir Almuzaini ◽  
Fahad Alamri ◽  
Yousef Mohammad Alsofayan ◽  

BackgroundA growing number of experiments have suggested potential cross-reactive immunity between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and previous human coronaviruses. We conducted the present retrospective cohort study to investigate the relationship between previous Middle East respiratory syndrome-coronavirus (MERS-CoV) infection and the risk of SARS-CoV-2 infection as well as the relationship between previous MERS-CoV and COVID-19-related hospitalization and mortality.MethodsStarting in March 2020, we prospectively followed two groups of individuals who tested negative for COVID-19 infection. The first group had a previously confirmed MERS-CoV infection, which was compared to a control group of MERS-negative individuals. The studied cohort was then followed until November 2020 to track evidence of contracting COVID-19 infection.FindingsA total of 82 (24%) MERS-positive and 260 (31%) MERS-negative individuals had COVID-19 infection. Patients in the MERS-positive group had a lower risk of COVID-19 infection than those in the MERS-negative group (Risk ratio [RR] 0.696, 95% confidence interval [CI] 0.522-0.929; p =0.014). The risk of COVID-19-related hospitalization in the MERS-positive group was significantly higher (RR 4.036, 95% CI 1.705-9.555; p =0.002). The case fatality rate (CFR) from COVID-19 was 4.9% in the MERS-positive group and 1.2% in the MERS-negative group (p =0.038). The MERS-positive group had a higher risk of death than the MERS-negative group (RR 6.222, 95% CI 1.342-28.839; p =0.019). However, the risk of mortality was similar between the two groups when death was adjusted for age (p =0.068) and age and sex (p =0.057). After controlling for all the independent variables, only healthcare worker occupation and >1 comorbidity were independent predictors of SARS-CoV-2 infection.InterpretationIndividuals with previous MERS-CoV infection can exhibit a cross-reactive immune response to SARS-CoV-2 infection. Our study demonstrated that patients with MERS-CoV infection had higher risks of COVID-19-related hospitalization and death than MERS-negative individuals.

2021 ◽  
Vorawee Varavithya ◽  
Chayanee Tirapat ◽  
Penpitcha Rojpibulstit ◽  
Panadda Poovichayasumlit ◽  
Vanida Prasert ◽  

Background: Older adults are at risk of receiving potentially inappropriate medications (PIMs) because their incidence of medical conditions and diseases is higher than younger individuals. This situation is of particular concern because the biological and physiologic changes in older adults make them vulnerable to PIMs. Thailand has become an aging society since the year 2002, so it is essential to evaluate the effect of PIMs in this age group. Objectives: This study examined the association between PIM use and the hospitalization rate in Thai older patients, in addition to identifying the factors associated with the hospitalization rate. Methods: In this retrospective cohort study, the electronic medical data of patients aged 60 years and older who visited the outpatient department (OPD) in 2015 were collected. The patients were categorized into PIM and non-PIM users according to the Beers 2019 criteria. An association between PIM use and the hospitalization rate was examined. Data were analyzed through descriptive and analytic statistics to examine the association between PIM use and the hospitalization rate via relative risk. Log-binomial regression was conducted to explore factors that impacted the hospitalization rate. Results: A total of 32,261 patients were collected, with the majority being female (59.65%) and the mean age of 70.21 ± 7.88 years. Overall, 63.98% of the patients (20,641 patients) were PIM users and 49.45% (15,952 patients) received polypharmacy (≥5 medications). The most common PIM prescription was Proton-pump inhibitors, making 27.51% of all medications prescribed. The results showed that PIM use increased the risk of hospitalization by 1.31 times (adjusted RR 1.31 95% CI 1.21-1.41, p-values < 0.001). Other factors affecting the rate of hospitalizations included age, gender, polypharmacy, and the number of OPD visits. Conclusions PIMs were commonly prescribed to older patients in the OPD and were significantly associated with subsequent hospitalization. A provision of an alternative drug list can help physicians avoid prescribing PIMs to older patients. If PIMs prescription is unavoidable, physicians should closely monitor drug-related problems and deprescribe when PIMs are not indicated.

2021 ◽  
Vol 11 (1) ◽  
Ryo Kamidani ◽  
Takahito Miyake ◽  
Hideshi Okada ◽  
Genki Yoshimura ◽  
Keigo Kusuzawa ◽  

AbstractTo evaluate the effect of cryoprecipitate (CRYO) transfusion in women referred for postpartum hemorrhage (PPH). This retrospective cohort study included patients with primary PPH referred to Gifu University Hospital between April 2013 and March 2020. We analyzed the effect of CRYO transfusion on fluid balance 24 h after the initial examination using a multivariable linear regression model adjusted for several confounding variables. To evaluate whether outcomes were modified by active bleeding, an interaction term of CRYO*active bleeding was incorporated into the multivariable model. We identified 157 women: 38 in the CRYO group (cases) and 119 in the control group. Fluid balance in the aforementioned period tended to decrease in the CRYO group compared with that in the control group (coefficient − 398.91; 95% CI − 1298.08 to + 500.26; p = 0.382). Active bleeding on contrast-enhanced computed tomography affected the relationship between CRYO transfusion and fluid balance (p = 0.016). Other outcomes, except for the overall transfusion requirement, were not significantly different; however, the interaction effect of active bleeding was significant (p = 0.016). CRYO transfusion may decrease the fluid balance in the first 24 h in PPH patients, especially in those without active bleeding.

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