The case for continuity of care for people with chronic obstructive pulmonary disease

Introduction Continuity of care by family physicians in primary care settings may play a role in reducing health resource utilization and improving clinical outcomes and satisfaction of patients with chronic obstructive pulmonary disease. Clear evidence on the impact of continuity of care will support clinical programing and integration of services across health settings. Methods The association between continuity of care and unplanned health service utilization in persons with a diagnosis of chronic obstructive pulmonary disease in a rural region in Ontario, Canada was evaluated. A retrospective cohort study was conducted using population-level health administrative data. The main exposure variable was continuity of care. Results A continuity of care index was calculated for patients with at least five visits to a healthcare provider during the 5-year follow-up period ( n = 40,033). Higher continuity of care ( n = 20,008) and lower continuity of care ( n = 20,025), based on the median continuity of care score were calculated. Patients with lower continuity of care had an increased adjusted relative risk of 2.12 (2.08, 2.33) of an emergency department visit, 2.81 (2.72, 2.9) risk of hospitalization, and 3.52 (3.24, 3.82) of being readmitted to hospital compared to those with higher continuity of care. Discussion An association between continuity of care and unplanned health services utilization, where a lower use of unplanned health services was observed in the cohort of patients with chronic obstructive pulmonary disease experiencing higher continuity of care. Continuity of care makes philosophical and social sense in that care is provided by a known provider to a known patient and unnecessary investigations can be avoided.

Conditioning Intensity and Probability of Live Birth after Blood or Marrow Transplantation (BMT): a BMTSS Report

We examine the impact of conditioning intensity (low intensity: non-myeloablative/reduced intensity vs. high intensity: myeloablative) and total body irradiation (TBI) on the probability of live birth after blood or marrow transplantation (BMT). Study participants were drawn from the BMT Survivor Study (BMTSS), and included 1,607 survivors transplanted 1974-2014 at age ≤45, with survival ≥2y post-BMT and age at study ≥18. Closest-age, same-sex biologic siblings (n=172) were 1:1 matched with 172 survivors. Survivors and siblings self-reported information on sociodemographic, chronic health conditions, and pregnancies. Within survivor analysis: The association between the primary exposure variable (No TBI/low-intensity conditioning; 200-800cGy TBI/low-intensity conditioning; No TBI/ high-intensity conditioning; >800cGy TBI/ high-intensity conditioning) and the odds of no post-BMT live birth was examined using multivariable logistic regression, adjusting for clinical and demographic variables. Median age at BMT was 31y (IQR=0-45), and median length of follow-up was 14.3y (IQR=2.4-41.4); 39.3% were autologous BMT recipients and 46.6% were female. Overall, 120 (8.7%) survivors reported post-BMT live births. Receipt of >800cGy TBI/ high-intensity conditioning (OR=3.7, 95%CI=1.9-7.0; ref: no TBI/low-intensity conditioning) was associated with higher odds of reporting no live birth post-BMT. In contrast, 200-800cGy TBI/low-intensity conditioning (OR=1.3, 95%CI=0.5-3.3), and no TBI/high-intensity conditioning (OR=0.9, 95%CI=0.5-1.7) were at similar risk of reporting post-BMT live birth as no TBI/low-intensity conditioning. Comparison with biologic siblings: Using conditional logistic regression, we found that BMT survivors were more likely to report no live birth (OR=2.0, 95%CI: 1.2-3.3) compared with siblings. These findings could inform conditioning intensity options for patients wishing to preserve fertility post-BMT.

Association between olfactory dysfunction and COVID-19 severity: A prospective study in a highly complex hospital in Peru

Introduction Olfactory dysfunction has been included among the early symptoms of coronavirus disease (COVID-19). Evidence suggests that a relationship exists between the duration of olfaction disorders and the probability of developing severe COVID-19. Given the scope of the COVID-19 pandemic, this study aimed to determine the frequency of smell alteration and its association with the severity of COVID-19 in a referral hospital in Peru, which is one of the most affected countries in the Latin American region. Materials and Methods This study was an observational, prospective cohort study that included patients with COVID-19 who were treated at the Hospital Nacional Edgardo Rebagliati Martins from August to November 2020. To assess the association, the chi-square test of independence or Fisher’s exact test was performed. The outcome variable was COVID-19 severity, and the exposure variable was olfactory dysfunction. The first data collection was in the emergency department and the follow-up was via telephone. Results A total of 179 patients were included. The mean age was 61.6 ± 15.5 years, and 129 patients (72.1%) were male. Olfactory dysfunction was observed in 43 patients (24%). An inverse association was found between age and olfactory dysfunction ( P = .002). No significant association was found between COVID-19 severity level and olfactory alteration ( P = .056). However, a direct association was found between COVID-19 severity and age ( P = .003), cough ( P < .001), and respiratory distress ( P = .003). Conclusion This study did not find any association between the severity of COVID-19 and olfactory dysfunction. It showed a low incidence rate of smell alteration compared with studies from other regions. Moreover, smell alteration was associated with younger age.

Pengaruh Terpaan Akun Instagram @bekasifood Terhadap Preferensi dalam Memilih Kuliner di Bekasi

Instagram account @bekasifood is an account that often shares various culinary informations. This information can be used as a basis and reference for the tendency of the community or followers of the account in choosing the type of culinary. This study aims to determine the effect of exposure to the Instagram account @bekasifood on preferences in choosing culinary in Bekasi. The research method used is a quantitative method with the main theory of Uses and Gratification. Determination of the sample size in this study uses the Taro Yamane formula. Based on the result of hypothesis testing, namely the T test and F test, the result shows that preference in choosing culinary in Bekasi can be influenced by exposure to the Instagram account @bekasifood. Aimed at the simple linear regression test and t test that motives affect preference in choosing culinary in Bekasi. The hypothesis which states that “there is a significant effect of exposure to the @bekasifood Instagram account on preferences in choosing culinary in Bekasi for followers is accepted. In this study, it can be seen that the value of the coefficient of determination R Square is 0.733. These result explains the ability of the account exposure variable (X) to influence the preference variable in choosing culinary (Y) followers of the @bekasifood Instagram account, which is 73.3%, while the rest is explained by other factors not found in this study.

Frequent mask-wearing during the COVID-19 pandemic and acne: an infodemiology study from Google research trends (Preprint)

BACKGROUND Researchers have been increasingly using the internet as a major source of health-related information and infodemiological methods have provided new approaches for studying the impact of coronavirus disease (COVID-19). OBJECTIVE To verify whether frequent mask-wearing during the COVID-19 pandemic was associated with an increase in acne search popularity. METHODS Data for mask-wearing were obtained from a NYT survey, with 250,000 responses between July 2 and 14, 2020, and from Google COVID-19 symptoms dataset for weekly acne and anxiety search popularity. All data in the study were presented in relation to US county levels. Each county was classified in the frequent mask-wearing group if the proportion of frequent users was above the third quartile. To make search trends comparable from one week to another and from one county to another, search trends were normalized on a relative 100-point scale, with the maximum value corresponding to the highest search popularity for a particular term in a specific week and a specific county. Other sources of data included the US census bureau datasets. Acne search popularity outcome was analyzed using a logistic regression, with COVID-19 incidence, metropolitan status of the county and anxiety search popularity as covariates, and mask-wearing status as the exposure variable. 2019 data, no mask-wearing, was used as a calibration control for acne search weight. RESULTS The final dataset consisted of 2893 counties with complete cases. Frequent mask-wearing was associated with an important increase in acne search popularity (OR=1.69; 95% CI (1.30-2.21); P<.001). A high relative incidence of COVID-19 was associated with an even greater acne search popularity (OR=8.42; 95% CI (6.48-10.96); P<.001). CONCLUSIONS Despite various biases, the use of infodemiology will keep increasing. Observational statistical methods need to be adapted to manage the large amounts of bias concerning web-based information more efficiently.

Geriatric Patients With Breast Cancer: G8 as a Frailty Screening Tool

Purpose The highest incidence of breast cancer is in senile patients. Treatment decisions are often based on their age and ECOG. The implementation of the G8 in the oncology consultation is useful for timely referral of vulnerable patients to specialized care, in order to generate an improvement on their treatment and prognosis.The aim of this work is to determine, using the G8, the proportion of patients aged >65 years with breast cancer, which requires a comprehensive geriatric assessment (CGA).Material and methodsThe G8 questionnaire was applied to patients >65 years with breast cancer. The baseline characteristics were prospectively collected. Descriptive statistics were used for the characteristics of the patients and the assessment tools. The difference between groups was assessed using Pearson's chi square with Yates correction. Additional scores were calculated using the Kaplan-Meier method and compared between groups using the log rank test. The hazard ratio (HR) with a 95% confidence interval (CI) was estimated using a Cox proportional hazard analysis, considering an abnormal G8 score as an exposure variable. A Spearman correlation was made between age and G8 score. SPSS v22 software (IBM, USA) was used for all analyzes.ResultsFrom December 2019 to May 2020, 357 patients were recruited. The mean age was 73.57 years. Seventy-four percent had an ECOG 1; 44.3% required a CGA (n = 158), but only 55.1% (n = 87) were performed. The G8 most affected domains were polypharmacy (51%) and ingestion (28.3%). We found significant association between the requirement for CGA and ECOG, p <0.0001. ConclusionThe G8 is a tool that allows us to discern which patients require a CGA in order to carry out interventions to improve cancer treatment, so it should be implemented routinely in the oncology consultation.*ECOG: Eastern Cooperative Oncology Group

Soluble ST2 concentrations associate with in-hospital mortality and need for mechanical ventilation in unselected patients with COVID-19

ObjectiveSoluble ST2 (sST2) reflects inflammation, endothelial dysfunction and myocardial fibrosis, is produced in the lungs and is an established biomarker in heart failure. We sought to determine the role of sST2 in COVID-19 by assessing pathophysiological correlates and its association to in-hospital outcomes.MethodsWe enrolled 123 consecutive, hospitalised patients with COVID-19 in the prospective, observational COVID-19 MECH study. Biobank samples were collected at baseline, day 3 and day 9. The key exposure variable was sST2, and the outcome was ICU treatment with mechanical ventilation or in-hospital death.ResultsConcentrations of sST2 at baseline was median 48 (IQR 37–67) ng/mL, and 74% had elevated concentrations (>37.9 ng/mL). Higher baseline sST2 concentrations were associated with older age, male sex, white race, smoking, diabetes, hypertension and chronic kidney disease. Baseline sST2 also associated with the presence of SARS-CoV-2 viraemia, lower oxygen saturation, higher respiratory rate and increasing concentrations of biomarkers reflecting inflammation, thrombosis and cardiovascular disease. During the hospitalisation, 8 (7%) patients died and 27 (22%) survivors received intensive care unit (ICU) treatment. Baseline sST2 concentrations demonstrated a graded association with disease severity (median, IQR): medical ward 43 (36–59) ng/mL; ICU 67 (39–104) ng/mL and non-survivors 107 (72–116) ng/mL (p<0.001 for all comparisons). These associations persisted at day 3 and day 9 .ConclusionssST2 concentrations associate with SARS-CoV-2 viraemia, hypoxaemia and concentrations of inflammatory and cardiovascular biomarkers. There was a robust association between baseline sST2 and disease severity that was independent of, and superior to, established risk factors. sST2 reflects key pathophysiology and may be a promising biomarker in COVID-19.Trial registration numberNCT04314232.

COVID-19 pandemic modifies temperature and heat-related illness ambulance transport association in Japan: a nationwide observational study

Background During the COVID-19 pandemic, several illnesses were reduced. In Japan, heat-related illnesses were reduced by 22% compared to pre-pandemic period. However, it is uncertain as to what has led to this reduction. Here, we model the association of maximum temperature and heat-related illnesses in the 47 Japanese prefectures. We specifically examined how the exposure and lag associations varied before and during the pandemic. Methods We obtained the summer-specific, daily heat-related illness ambulance transport (HIAT), exposure variable (maximum temperature) and covariate data from relevant data sources. We utilized a stratified (pre-pandemic and pandemic), two-stage approach. In each stratified group, we estimated the 1) prefecture-level association using a quasi-Poisson regression coupled with a distributed lag non-linear model, which was 2) pooled using a random-effects meta-analysis. The difference between pooled pre-pandemic and pandemic associations was examined across the exposure and the lag dimensions. Results A total of 321,655 HIAT cases was recorded in Japan from 2016 to 2020. We found an overall reduction of heat-related risks for HIAT during the pandemic, with a wide range of reduction (10.85 to 57.47%) in the HIAT risk, across exposure levels ranging from 21.69 °C to 36.31 °C. On the contrary, we found an increment in the delayed heat-related risks during the pandemic at Lag 2 (16.33%; 95% CI: 1.00, 33.98%). Conclusion This study provides evidence of the impact of COVID-19, particularly on the possible roles of physical interventions and behavioral changes, in modifying the temperature-health association. These findings would have implications on subsequent policies or heat-related warning strategies in light of ongoing or future pandemics.

Contribution of the Elevated Thrombosis Risk of Males to the Excess Male Mortality Observed in COVID-19: An Observational Study

Background: The mortality rate of COVID-19 is elevated in males compared to females.Objective: Determine the extent that the elevated thrombotic risk in males relative to females contributes to excess COVID-19 mortality in males.Design: Observational study.Setting: Data sourced from electronic medical records from over 200 US hospital systems.Participants: 60,877 patients hospitalized with COVID-19.Exposure: Exposure variable: biological sex; key variable of interest: thrombosis.Main outcome measures: Primary outcome was COVID-19 mortality. We measured: 1) mortality rate of males relative to females, 2) rate of thrombotic diagnoses occurring during hospitalization for COVID-19 in both sexes, and 3) mortality rate when evidence of thrombosis was present.Results: The COVID-19 mortality rate of males was 29.9% higher than that of females. Males had a 35.8% higher rate of receiving a thrombotic diagnosis compared to females. The mortality rate of all patients with a thrombotic diagnosis was 40.0%— over twice that of COVID-19 patients without a thrombotic diagnosis (adjusted OR 2.50 [2.37 to 2.64], p-value < .001). When defining thrombosis as either a documented thrombotic diagnosis or a D-dimer level ≥ 3.0 μg/mL, 16.4% of the excess mortality in male patients could be explained by increased thrombotic risk. Conclusions and Relevance: Our findings suggest the higher COVID-19 mortality rate in males may be significantly accounted for by the elevated risk for thrombosis among males. Understanding the mechanisms that underlie increased male thrombotic risk may allow for the advancement of effective anticoagulation strategies that reduce COVID-19 mortality in males.

Predictors of Perioperative Vasoactive Drug Requirement During Retroperitoneal Adrenalectomy for Pheochromocytoma: A Retrospective Exploratory Study

The aim of the present study was to test a hypothesis that baseline systemic vascular resistance index (SVRI) assessed by method of transpulmonary thermodilution predicts perioperative requirement for vasoactive drugs. The primary outcomes were: (1) peak vasoactive-inotropic score (VIS) and (2) peak dose of hypotensive drugs at any stage of surgery. The main exposure variable was baseline SVRI. Hemodynamics were retrospectively assessed by transpulmonary thermodilution in 50 adults who had undergone posterior retroperitoneal surgery for pheochromocytoma. Univariate linear regression analysis showed predictive value of SVRI on VIS [regression coefficient, 95% CI; 0.024 (0.005, 0.4), p=0.015]. Other significant factors were the history of peak diastolic pressure, baseline MAP, baseline betablocker therapy, and history of coronary artery disease (CAD). After adjustment of SVRI for the history of CAD, its prognostic value became non-significant [0.018 (0.008, 0.03), p=0.063 and 29.6 (19, 40.2), p=0.007 for SVRI and history of CAD, respectively]. Requirements of vasodilators were predicted by baseline adrenergic activity [0.37 (0.005, 0.74), p=0.047]. In conclusion, baseline SVRI is associated with perioperative requirement of vasopressor drugs, but history of CAD is a stronger prognostic factor for vasopressor support. Perioperative requirement in vasodilators is associated with baseline adrenergic activity.