Average Annual Visit Research Articles

Impact of the COVID-19 Pandemic on Foodborne Disease Healthcare-Seeking Behavior and Diagnoses at a Large Academic Medical System.

The objective of this study was to examine changes in healthcare-seeking behaviors and diagnostic practices around foodborne illness during the COVID-19 pandemic in a large university-based health system. A retrospective cohort study of individuals diagnosed with pathogens commonly transmitted through food between 2015 and 2020 was undertaken using electronic medical record data. Regression models were used to compare measured incidence rates of various foodborne pathogens as well as associated healthcare-seeking behaviors during the pandemic year of 2020 to previous years. Incidence of campylobacteriosis, cholera, and norovirus in 2020 significantly decreased, respectively, by 65.5% (p < 0.01), 90.1% (p = 0.02), and 73.0% (p = 0.03) compared with an average from 2017- to 019. Average annual visits for patients included in our sample significantly increased by 8.0% when comparing the average from 2017-2019 to 2020 (p < 0.01). These results suggest that the pandemic impacted healthcare use related to foodborne disease either due to reduced exposure to foodborne pathogens or reduced willingness to seek healthcare.

Cancer Risk in Patients with Down Syndrome-A Retrospective Cohort Study from Germany.

Individuals with Down syndrome are thought to have a unique tumor profile. Using the IQVIA Disease Analyzer database, patients aged ≥18 years diagnosed with Down syndrome in German general practices between 2005 and 2021 were compared with patients without Down syndrome for cancer incidence, adjusting for age, sex, average annual visit frequency, and comorbidity. The 5-year cumulative incidence of cancer overall and specific cancers was analyzed using Kaplan-Meier curves and compared using the log-rank test. In addition, univariable Cox regression analysis was performed. A total of 2438 patients with Down syndrome and 12,190 patients without Down syndrome were included; 3.9% of patients without Down syndrome and 3.1% of patients with Down syndrome were diagnosed with cancer (p = 0.143). Regression analysis showed no significant association between Down syndrome and subsequent cancer in the total population (HR: 0.79; 95% CI: 0.57-1.09), in women (HR: 0.89; 95% CI: 0.56-1.37), or in men (HR: 0.69; 95% CI: 0.43-1.11). Analyses by cancer type and sex showed a strong but not significant negative association between Down syndrome and breast cancer in women (HR: 0.33; 95% CI: 0.12-0.93). Our results could form the basis for future studies to clarify whether and to what extent an adapted screening program needs to be modified for individuals with Down syndrome due to the particular cancer distribution pattern.

Age and sex trends among mental health-related emergency department visits in North Carolina

Whether patients present to the emergency department (ED) with physical ailments and comorbid psychiatric needs or primary psychiatric complaints, understanding differences in clinically relevant age and sex patterns over time is crucial to optimal psychiatric care in the ED setting. We used population-level surveillance data provided by the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) from January 1, 2008, through December 31, 2014. Mental health-related (MHR) ED visits were identified by International Classification of Diseases, Clinical Modification 9th revision (ICD-9-CM) codes analyzed in the Agency for Healthcare Research and Quality (AHRQ) clinical classification software groupings of related diagnostic categories. Trends were assessed based on total and average annual visit counts. We identified approximately 4 million MHR ED visits. The average number of visits per year was highest among 50-year-olds, while patients over the age of 90 had the highest proportion of their ED visits associated with an MHR code. Mood disorders were more prevalent among females, while substance use disorders were more prevalent among males. Within MHR categories, age-related peaks did not differ by sex except for suicide and self-inflicted injury. Whether it be a teenage boy presenting with suicidal ideation, a middle-aged man presenting with alcohol abuse, or an elderly female presenting with dementia, ED MHR visits’ needs vary across the lifespan. Understanding these trends is important to holistic patient care.

Relationship On Education Level and Environmental Attitude With Tourist Behavior in Kebun Teh Kabawetan

The purpose of this study was to determine the relationship between the level of education and the attitude of concern for the environment with the behavior of tourists in maintaining environmental cleanliness in the area of ​​the Kabawetan Tea Plantation tourism object, Kepahiang Regency, Bengkulu Province. Research that has been carried out using a quantitative approach, with descriptive methods. Based on data on average annual visits, the total population visited was 138 people. The sample of this research is random visitors who meet researchers who are willing to fill out a complete questionnaire. Behavior that can be observed as many as 53 people. Based on the results of the study, it shows that the relationship between knowledge about environmental protection and the behavior of maintaining environmental hygiene is very close, with a product torque correlation value of 0.787. This proves that the proposed hypothesis is accepted. Therefore, the authors draw the following conclusions: 1) There is a positive relationship between the level of education in maintaining environmental hygiene and behavior; 2) There is a positive relationship between environmental care and environmental protection behavior. environmental Hygiene; There is a positive correlation between attentiveness and hygiene behavior.

Twenty-Year Public Health Impact of 7- and 13-Valent Pneumococcal Conjugate Vaccines in US Children.

Pneumococcal conjugate vaccines (PCVs) have been used in the United States since 2000. To assess the cumulative 20-year effect of PCVs on invasive pneumococcal disease (IPD) incidence among children <5 years of age, we analyzed Active Bacterial Core Surveillance data, conducted a literature review, and modeled expected and observed disease. We found that PCVs have averted >282,000 cases of IPD, including ≈16,000 meningitis, ≈172,000 bacteremia, and ≈55,000 bacteremic pneumonia cases. In addition, vaccination has prevented 97 million healthcare visits for otitis media, 438,914–706,345 hospitalizations for pneumonia, and 2,780 total deaths. IPD cases declined 91%, from 15,707 in 1997 to 1,382 in 2019. Average annual visits for otitis media declined 41%, from 78 visits/100 children before PCV introduction to 46 visits/100 children after PCV13 introduction. Annual pneumonia hospitalizations declined 66%–79%, from 110,000–175,000 in 1997 to 37,000 in 2019. These findings confirm the substantial benefits of PCVs for preventing IPD in children.

Retrospective Study: Malassezia Folliculitis Profile

Background: Malassezia folliculitis (MF) is a chronic infectious disease of pilosebaceous follicles caused by Malassezia sp. Clinical features of MF include erythematous papules and itchy perifollicular pustules, especially on the upper body, neck, upper arms, and face. The disease is usually reported on adolescents. Objective: To evaluate the profile of MF patients in four years (2014-2017) period in the Mycology Division of Dermatovenerology Outpatient Clinic of Dr. Soetomo General Academic Hospital Surabaya. Methods: This study was a retrospective study to examine the medical records of MF patients in the Mycology Division of Dermatovenerology Outpatient Clinic General Academic Hospital Dr. Soetomo Surabaya from January 2014 to December 2017. Results: The number of new MF patient visits during 2014-2017 was 196 patients, and the average annual visit was 55 patients in 2014, 49 patients in 2015, 65 patients in 2016, and 27 patients in 2017. The majority of patients were males, were aged 15-24 years old. The chief complaint was reddish papules accompanied by moderate itching in the predilection area and most often found in the upper body. The Wood's lamp examination revealed greenish-yellow color, and 20% KOH examination showed spores. Most systemic therapies was ketoconazole and tretinoin 0.05% cream for topical therapy. Conclusions: There was a decrease in the number of MF patients. The diagnoses of MF were based on history taking, physical examination, 20% KOH, and Wood's lamp.

Accountability and utilization of diabetes care from 2005 to 2014 in Taiwan

Diabetes mellitus (DM) prevalence has been rapidly increasing in Taiwan and globally. Team care for DM has been provided through diabetes shared-care networks in Taiwan more than 20 years. The study analyzed the National Health Insurance (NHI) claims data from 2005 to 2014 to better understand diabetes care accountability and utilization in Taiwan. The completion rate of annual check-ups for various metabolic measurements increased significantly, which indicates improvement in diabetes management quality. The average annual visits and drug cost for each patient increased enormously from 2005 to 2014. The annual number of outpatient department/inpatient department (OPD/IPD) patients with diabetes undergoing dialysis increased. The number of OPD visits in patients with diabetes was 1.9 times higher than that in all patients in general. IPD cost appeared to increase, whereas both drug cost and the average length of hospitalization per patient decreased. Endocrine and metabolic diseases were still the leading cause of OPD expenses. The leading cause of IPD expenses was respiratory diseases. An increasing trend was noted in the medical cost for patients with microvascular instead of macrovascular complications. OPD care for patients with diabetes was rather evenly distributed since 2009. Regarding IPD care, medical centers and regional hospitals each hospitalized 37% of the diabetic outpatients in 2014. Accountability of diabetes care in Taiwan improved significantly till 2014. The ongoing fight against DM and tracing, examining and learning from the overall outcomes in future decades is still required.

Documentation of asthma control and severity in pediatrics: analysis of national office-based visits

Objective: To evaluate the extent of documentation of asthma control and severity and associated characteristics among pediatric asthma patients in office-based settings. Methods: This cross-sectional study utilized data from the 2012–2015 National Ambulatory Medical Care Survey (NAMCS). Patients aged 6–17 years with a diagnosis of asthma were included. Weighted descriptive analysis examined the extent of documentation and uncontrolled asthma; while logistic regression evaluated associated characteristics. Results: Overall, there were 2.47 million (95% confidence interval, 95% CI: 2.04–2.90) average annual visits with asthma as a primary diagnosis. Asthma control and severity was documented in only 36.1% and 33.8% of the visits, respectively. An established patient (odds ratio, OR = 3.81), Hispanic ethnicity (OR = 2.10), chronic sinusitis (OR = 5.59), and visits in the Northeast (OR = 2.12) and Midwest (OR = 2.25) regions had higher odds of documented asthma control status, whereas undocumented asthma severity (OR = 0.02), and visits in spring (OR = 0.34), had lower odds. Osteopathic doctors (OR = 0.18), visits in the Northeast region (OR = 0.23), chronic sinusitis (OR = 0.08), and undocumented asthma control status (OR = 0.03) had lower odds of documented asthma severity, whereas visits in spring (OR = 3.88) and autumn (OR = 3.32) had higher odds. Moderate/severe persistent asthma (OR = 15.35) had higher odds of uncontrolled asthma (as compared to intermittent asthma), while visits in the summer (OR = 0.14) had lower odds. Conclusion: The findings of this study suggest a critical need to increase the documentation of asthma severity and control to improve quality of asthma care in children.

Recreational Demand for Equestrian Trail-Riding

Using data collected from a combination of on-site and on-line surveys, this study examines recreational demand for equestrian trail-riding in Kentucky. A truncated, negative binomial regression is applied to analyze individuals’ visitation behavior consistent with a travel cost model. Results suggest that distance is the most significant determinant of average annual visits to a particular site. Various trail site characteristics, such as trail length, scenic overlooks, and trail markers, affect the number of visits an individual takes. Geographic information system (GIS) analysis permits the identification of equestrian population centers. Information obtained from this study offers a decision base for policymakers to use to manage existing equestrian trails and locate new ones.

Trends in prescribing for vulvovaginal candidiasis in the United States.

To describe trends in visits to office-based physicians in the United States by females 15-64 years of age for vulvovaginal candidiasis and related antifungal prescribing. Since January 1991, intravaginal antifungal medications have been available over-the-counter in the United States to treat vulvovaginal candidiasis. Data from the 1985 through 2001 National Ambulatory Medical Care Surveys (NAMCS) were examined. NAMCS is an annual national probability sample survey that collects data on the utilization of services provided by office-based physicians. The average annual visit rates for symptoms of vaginitis and a diagnosis of vulvovaginal candidiasis decreased by 55 and 72%, respectively. The intravaginal antifungal prescribing rate for vulvovaginal candidiasis declined by 41%. No trend was found for total antifungal prescribing; however, during the late 1990s, fluconazole was prescribed at approximately one-third of visits with a diagnosis of vulvovaginal candidiasis. These data suggest an increased trend in self-diagnosis and use of over-the-counter intravaginal antifungal medications. The shift from prescribing intravaginal antifungal preparations to fluconazole raises concern about the possible development of azole drug resistance. Educational efforts are needed to counter potential misuse of these medications that may contribute to increased infection with innately azole resistant non-albicans Candida species and chronic infection.

Chronic migraineurs: An important subgroup of patients who visit emergency departments frequently

Study objective We examine whether patients with frequent migraines represent a distinct subgroup of patients who visit emergency departments (EDs) frequently. Methods This population-based, cross-sectional study used fiscal year 1998 physician billing data from Ontario, Canada. “Frequent ED visitors” were individuals with at least 12 ED visits per year and were classified as either “frequent migraineurs” (≥50% of ED visits for migraine) and “other frequent ED visitors.” Results There were 2,158,291 ED visitors, of whom 6,839 were frequent ED visitors. These individuals accounted for 3.5% of all ED visits. Among frequent ED visitors, 478 were frequent migraineurs. The proportion of patients who were female was 79% among frequent migraineurs, 53% among other frequent ED visitors, and 50% among patients who were not frequent ED visitors. The proportions between ages 30 and 54 years for these 3 groups were 79%, 43%, and 31%, respectively. Average annual visits to EDs were 26, 18, and 1.7, respectively, and average visits to family physicians were 40, 20, and 5.9, respectively. Despite heavy health care use, frequent migraineurs sought 83% of their ED care from their most frequently visited ED and 71% of their primary care from their main family physician. Conclusion Frequent migraineurs are predominantly women aged 30 to 54 years and with a particularly intense use of health care services. Management strategies may require targeted interventions for these individuals. Because these patients seek most of their care from 1 main ED and 1 principal primary care physician, coordination of care may be easier than expected.

Health status and health care utilization among New York City home attendants: an illustration of the needs of working poor, immigrant women.

In this paper, the health needs and health care utilization patterns of home attendants and their families have been studied as an illustration of those likely to be found among working poor, immigrant women and their children. Despite tremendous growth in the number of immigrants, studies to date provide only limited information regarding the specific health needs and patterns of health care utilization among such women and their children. As part of a longitudinal study on the impact of insurance on health status and health care utilization, 387 female, immigrant home attendants were interviewed. Data were also gathered on 355 of their minor children. These women and children were found to be less likely than other Americans to make use of basic health services, despite the fact that they are more likely to indicate fair or poor health status. This is true even in comparison to poor or uninsured Americans. Immigrant attendants in fair or poor health report an average annual visit rate of 4.1 ambulatory care visits for themselves and 2.2 for their children, as compared to 8.4 for poor adults and 4.4 for poor children in national samples. These findings illustrate the likelihood that poor, immigrant women make limited use of American medical care, and face barriers to health care that appear even greater than those faced by the uninsured and the poor.