Hospitalizations related to meningococcal infection in Spain from 1997 to 2018

Background Baseline hospitalization, mortality, and in-hospital fatality rates for meningococcal infection are required to evaluate preventive interventions, such as the inclusion of the conjugated quadrivalent meningococcal vaccine and serogroup B based protein vaccines. Methods All meningococcal infection–related hospitalizations in any diagnostic position in Spain from 1st January 1997 through 31st December 2018 were analysed. The annual hospitalization rate, mortality rate and case-fatality rate were calculated. Results The average hospitalization rate for meningococcal infection was 1.64 (95% CI 1.61 to 1.66) hospitalizations per 100,000 inhabitants during the study period and significantly decreased from 1997 to 2018. Hospitalizations for meningococcal infection decreased significantly with age and were concentrated in children under 5 years of age (46%). The hospitalization rates reached 29 per 100,000 and 24 per 100,000 children under 1 and 2 years of age, respectively. The in-hospital case-fatality rate was 7.45% (95% CI 7.03 to 7.86). Thirty percent of the deaths occurred in children under 5 years of age, and more than half occurred in adults. The case fatality rate increased significantly with age (p < 0.001). Conclusion It is necessary to maintain epidemiological surveillance of meningococcal infection to determine the main circulating serogroups involved, track their evolution, and evaluate preventive measures whose effectiveness must be assessed in all age groups.

A64 HOSPITALIZATION IN INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COMPARISON OF DEFINITIONS

Background Most administrative studies of hospitalization in inflammatory bowel disease (IBD) use two definitions: IBD in any diagnostic position (IBD-ANY), and IBD as the most responsible diagnostic (IBD-MRD). There is a third less commonly used definition: total hospitalization; this definition captures all hospitalizations of prevalent IBD patients and therefore it can give a more realistic picture of the burden of IBD. Aims To compare differing definitions (total, IBD-ANY, and IBD-MRD) of hospitalizations. Methods A previously defined population-based IBD prevalent cohort for Alberta (n=30,698) was used to pull all hospital admissions from the Discharge Administrative Database (DAD; 2002–2015). Three hospitalization definitions were used: i. Total (all hospitalizations of prevalent cohort independent of presence of code for IBD); ii. IBD-ANY (code for IBD [K50.x; K51.x] contained in any diagnosis field); and, iii. IBD-MRD (most responsible diagnosis was IBD). Age- and sex- standardized rates (2015 Canadian population) were calculated using the prevalent population. Log-linear regression was performed to calculate Average Annual Percentage Change (AAPC) with associated 95% confidence intervals (CI) of each type of hospitalization. We assessed the top five most common most-responsible diagnosis codes for hospitalizations that were contained in the total hospitalizations but not an IBD-ANY hospitalization. Results From 2002 to 2015, 63.5% of IBD prevalent patients in AB had ≥1 hospitalization; 44.2% had ≥1 IBD-ANY hospitalization; 28.6% had ≥1 IBD-MRD hospitalization; and, 40.6% had a hospitalization that did not contain a code for IBD. All hospitalization rates decreased significantly over time. Of the top five most common most responsible diagnosis, contained in admissions that were not IBD-ANY, three were gastroenterological: i. K52.9 (non-infective gastroenteritis); ii. A09.9 (diarrhea and gastroenteritis of presumed infectious origin); and, iii. Z43.2 (attention to ileostomy). Conclusions Total hospitalizations is an important measure to report since accounting for all hospitalizations of IBD patients is necessary in order to allocate healthcare resources appropriately. To be able to ensure these patients receive the care they need we need to be able to accurately assess the true burden of IBD. Funding Agencies CIHR

Diagnostic station for a multibiometric system for a selected transport object

Multibiometric systems used in transport objects, in contradistinction to "ordinary" biometric systems, use several recognition techniques, e.g. fingerprint, iris, voice or face. Biometric devices are sometimes part of electronic security systems. These systems are currently installed in many transport facilities - stationary and non-stationary where there is a lot of personal traffic. These devices are most often used in extensive areas, airports, logistics bases or railway stations. The article presents issues concerning the diagnostic position for a biometric system which has in its structure several simple identification techniques.

Cardiomyopathies, myocarditis, and the transplanted heart

Echocardiography is an excellent tool for the diagnosis and follow-up of patients with cardiomyopathies, myocarditis, and the transplanted heart. It is the preferred method for assessment of ventricular function and valvular dysfunction and is of great value in decision-making in these patients. The different types of cardiomyopathies can usually be differentiated by echocardiography. Speckle tracking echocardiography has increased our awareness on early staging of the disease and the progress of cardiomyopathies. This chapter will explain important features of the most common cardiomyopathies and how echocardiography should be utilized. Echocardiographic findings in myocarditis include non-specific features such as decreased left ventricular function, wall motion abnormalities, and texture changes. These findings will in certain circumstances often prompt the awareness of myocarditis. Echocardiography has an important diagnostic position in patients with end-stage heart failure. The chapter will explain how echocardiography can be used in the screening period of recipients and donors, and how it can be an essential diagnostic tool in the perioperative and postoperative phases of cardiac transplantation.

Cardiomyopathies, myocarditis, and the transplanted heart

Echocardiography is an excellent tool for the diagnosis and follow-up of patients with cardiomyopathies, myocarditis, and the transplanted heart. It is the preferred method for assessment of ventricular function and valvular dysfunction and is of great value in decision-making in these patients. The different types of cardiomyopathies can usually be differentiated by echocardiography. Speckle tracking echocardiography has increased our awareness on early staging of the disease and the progress of cardiomyopathies. This chapter will explain important features of the most common cardiomyopathies and how echocardiography should be utilized. Echocardiographic findings in myocarditis include non-specific features such as decreased left ventricular function, wall motion abnormalities, and texture changes. These findings will in certain circumstances often prompt the awareness of myocarditis. Echocardiography has an important diagnostic position in patients with end-stage heart failure. The chapter will explain how echocardiography can be used in the screening period of recipients and donors, and how it can be an essential diagnostic tool in the perioperative and postoperative phases of cardiac transplantation.

Doing Diagnosis: Autism, Interaction Order, and the Use of Narrative in Clinical Talk

This study, with an eye toward the social psychology of diagnosis more generally, is an investigation of how clinicians diagnose children with autism spectrum disorder (ASD). Responding to Hacking’s call for a Goffmanian mode of analysis to complement and balance the emphasis on large-scale transformations and discourses, we examine the narrative way in which clinicians provide evidence to support a diagnostic position. Using recordings and transcripts of clinical visits across two eras, our findings about the interaction order of the clinic show distinct story types and components that contribute to diagnostic narratives for ASD. These include stories about concrete “instantiations,” stories that propose “tendencies,” and “typifications” or generalizations regarding a specific child. This work contributes to interaction order theory, methodology, and other domains of social psychological research.

Trends in Hospitalizations With Primary Varicella and Herpes Zoster During the Prevaricella and Initial Postvaricella and Herpes Zoster Vaccine Eras, Connecticut, 1994–2012

Background. The introductions of the varicella vaccine in 1995 and herpes zoster (HZ) vaccine in 2006 have an ongoing potential to modify the epidemiology of both diseases. Analysis of data on hospitalizations can be conducted to examine trends in the occurrence of severe disease over time and to assess the possible impact of vaccination on the incidence of hospitalization. Methods. Statewide hospital discharge data 1994–2012 in Connecticut were used to ide.jpegy individuals discharged with a diagnosis of varicella and the initial admissions of persons with a discharge diagnosis of HZ in the first or second diagnostic position. Trends in overall age-standardized and age group-specific hospitalization rates for preselected time intervals before and after the introduction of vaccines were examined using Poisson regression models or Mantel–Haenszel χ2 tests. Results. Beginning in 2001, 5 years after the introduction of varicella vaccine, HZ hospitalization rates decreased significantly in individuals &lt;15 years at an average rate of 19.4% per year through 2012. Among individuals ≥60 years, HZ hospitalization rates increased by 5.1% per year from 2001 to 2006 but decreased by 4.2% per year from 2007 to 2012. Primary varicella hospitalization rates declined 82.9% from the prevaccine era (1994–1995) to the 1-dose era (2001–2005) (P &lt; .001). Rates further decreased significantly in the 2-dose era (2010–2012) among 5 to 9 year olds (100% decrease). Conclusions. Varicella vaccine seems to have had an impact on both varicella and HZ hospitalizations, and introduction of the HZ vaccine may be having an impact on HZ hospitalizations.