Episodes Of Illness Research Articles

A methodology for the public health surveillance and epidemiologic analysis of outdoor falls that require an emergency medical services response

BackgroundFalls are a common cause of injury with significantly associated medical costs yet public health surveillance of injuries from falls is underdeveloped. In addition, the epidemiologic understanding of outdoor falls, which have been reported to account for 47% of all injurious falls, is scant. Here we present methods to use emergency medical services (EMS) data as a public health surveillance tool for fall injuries, including those that occur secondary to syncope and heat illness, with a focus on the scope and epidemiology of outdoor fall injuries.MethodsUsing the 2019 National Emergency Medical Services Information System (NEMSIS) data, we developed an approach to identify EMS encounters for fall injuries, syncope and heat illness. NEMSIS variables used in our algorithm included the EMS respondent’s impression of the encounter, the reported major symptoms and the cause of injury. With these data we identified injuries from falls and, using the NEMSIS data on the location of the encounter, we identified fall injuries as occurring indoors or outdoors. We present the descriptive epidemiology of the identified patients.ResultsThere were 1,854,909 injuries from falls that required an EMS response identified in the NEMSIS data, with 4% of those injuries secondary to episodes of syncope (n = 73,126) and heat illness. Sufficient data were available from 94% of injurious falls that they could be assigned to indoor or outdoor locations, with 9% of these fall injuries occurring outdoors. Among fall injuries identified as occurring outdoors, 85% occurred on streets and sidewalks. Patient age was the primary sociodemographic characteristic that varied by location of the injurious fall. Sixty-six percent of fall injuries that occurred indoors were among those age 65 years or older, while this figure was 34% for fall injuries occurring outdoors on a street or sidewalk.ConclusionThe occurrence of outdoor fall injuries identified in the NEMSIS data were substantially lower than reported in other data sets. However, numerically fall injuries occurring outdoors represent a substantial public health burden. The strengths and weaknesses of using this approach for routine public health surveillance of injuries from falls, syncope and heat illness are discussed.

Beyond the intensive care unit: ensuring the long term health of critically ill Indigenous people

An important aim after critically ill Indigenous people return home is to avoid the need for re-admission to hospital Evidence is growing that an episode of critical illness which requires admission to an intensive care unit (ICU) affects longer term health outcomes. More advanced age, chronic disease, and severity of the critical illness all influence long term outcomes, and the challenge is to identify modifiable factors and to design interventions that improve these outcomes.1 Identifying who is at risk of poorer long term outcomes would facilitate better targeting of surveillance and intervention after discharge from the ICU. Indigenous Australians have generally poorer health outcomes than non-Indigenous Australians, their median age at presentation with critical illness is lower, and have a greater burden of chronic disease, but their ICU and hospital outcomes are similar to those of non-Indigenous Australians.2, 3 However, longer term outcomes after ICU care have not previously been investigated in detail. The study reported by Secombe and colleagues in this issue of the MJA examined 330 712 admissions to Australian ICUs during 2017–2019 and compared 12-month mortality outcomes for Indigenous and non-Indigenous Australians.4 The authors found that the median age of Indigenous patients (51.2 years; interquartile range [IQR], 36.7–63.6 years) was lower than for non-Indigenous patients (66.5 years; IQR, 52.7–76.1 years). Unadjusted mortality risk was nevertheless similar for the two groups. After adjusting for age, admission diagnosis, illness severity, hospital type, jurisdiction, remoteness, and socio-economic status, mortality risk (hazard ratio, 1.20; 95% confidence interval [CI], 1.14–1.27) and 12-month mortality (adjusted odds ratio, 1.24; 95% CI, 1.16–1.33) were each higher for Indigenous than non-Indigenous patients.4 It is important that we understand the factors that contribute to poorer long term outcomes for Indigenous people after ICU admissions. Secombe and colleagues found that ICU, in-hospital, 30-day, and 90-day mortality were each similar for Indigenous and non-Indigenous critical care patients.4 The most important reasons for the higher 12-month mortality are likely to be found outside the walls of the ICU, and include differences in pre- and post-admission health care. Chronic disease burden is greater for Indigenous than non-Indigenous ICU patients;2 the proportions of Indigenous ICU patients with diabetes, chronic kidney disease, and liver disease are larger than for non-Indigenous ICU patients.2, 3, 5 Intensive care treatment has been described as an “ambulance at the bottom of a cliff”.3 The cultural and socio-economic determinants of the health of Indigenous people cause disadvantage that is carried through the ICU, and they are the principal determinants of long term health outcomes.3, 6 A larger proportion of Indigenous ICU patients are from outer regional, remote, and very remote locations, and areas of greater socio-economic disadvantage.7 Emergency ICU admissions are more frequent for Indigenous people than non-Indigenous Australians, and this has been attributed to health disparities reinforced by cultural and social determinants that delay early access to health care that could avert the development of critical illness requiring ICU care.2, 3, 6 The study by Secombe and colleagues is limited by its data sources, which do not capture pre-admission factors.4 Poorer long term outcomes for Indigenous Australians after ICU care may indicate health disparities and suboptimal performance of the Australian health system in providing care that meets their particular needs.3, 4 It is important to note that all people (Indigenous and non-Indigenous) admitted to ICU care who survive to discharge have poorer 12-month survival than the general population.8 Most of the increase in long term mortality may be attributable to pre-admission factors and the overall health trajectory of the patient, the ICU admission being just one of many factors that determine long term health status.9 Hospital and ICU admissions are opportunities for alleviating the chronic disease burden and disadvantage that affects long term outcomes for Indigenous people by connecting the patient and their family with community care systems that provide a multidisciplinary approach to long term health care.10, 11 Meaningful communication is the key to empowering the patient and their family to influence their health trajectory and wellbeing. An important aim after critically ill Indigenous people return home is to avoid the need for re-admission to hospital.11 Targeted research to identify modifiable factors and interventions that improve long term outcomes for Indigenous Australians after ICU admissions is the next step. No relevant disclosures. Commissioned; not externally peer reviewed.

Health-seeking Behavioural Practices of the Elderly in Rural Community of Ekiti State, Southwestern Nigeria

Abstract Background: The aging process increases the risks of contracting a disease among elderly people. Health-seeking behaviour is poor among the aged in sub-Saharan countries like Nigeria, escalating the burden of noncommunicable diseases and the cost of health care which further impact the utilisation of orthodox medicine. Aim: This study aims to assess the health-care-seeking behavioural practices and associated factors among elderly people in Ido-Ekiti. Materials and Methods: A descriptive cross-sectional study was conducted among 420 elderly respondents in Ido-Ekiti. An interviewer-administered semi-structured questionnaire was used to collect information. The data collected were analyzed using SPSS version 25 and results were presented in the form of tables and bar charts. Chi-square tests were used to test for associations. All data analysis was done at a 5% level of significance. Results: The age range of respondents was between 65 and 95 years, with a mean age of 73.88 ± 6.84 years and 64.0% within the age range of 65–75 years. About 63.3% of the respondents have had an episode of illness in the last year preceding the study and only 35.3% consulted a doctor for treatment (good health-seeking behaviour); however, 57.9% of the respondents admitted utilising any of the following: self-medication, consult spiritualist, and use of herbal medicine (poor health-seeking behaviour). The factors statistically significantly associated with respondents’ health-seeking behavioural practices are employment status (P < 0.001), educational level (P < 0.002), cost of health care, access to the health facility, length of time before consultation, beliefs, and lack of support from relations (P < 001). Conclusion: This study shows that the majority of the elderly had poor health-seeking behaviour due to educational and economic factors. Making the free or subsidized cost of health care for the elderly in rural communities and the provision of monthly financial support to the aged by the government will promote and encourage good health-seeking behaviour of old people.

Demographic, Clinical and Etiological Profile of Children Admitted with Febrile Seizures in a Tertiary Care Hospital of North India

This retrospective hospital-based study was conducted in Paediatric emergency from 1st June 2022 to 30th November2022 to study the clinical demographic and etiological profile of paediatric patients admitted with febrile seizures.Out of total enrolled 243 children, 153(63%) were male and 100(37%) were females. Mean age of the patients was23.5 months. Mean time interval between onset of fever and occurrence of seizures was 18 hours. Overall, 170(70%)patients had simple seizures. Only 85(35%) patients had positive family history and 73(30%) had recurrence ofseizures during the same episode of illness. Acute respiratory infection was the commonest cause for febrileseizure in 190(78%) children.

A Study on Self Medication Practices During Covid-19 Pandemic

Self Medication(SM) “involves the use of medicinal products by the consumer to treat self recognized disordersor symptoms, or the intermittent or continued use of a medication prescribed by a physician for chronic orrecurring diseases or symptoms”. The objective of this study was to determine practices of Self Medication. Thepresent study was conducted in the field practice areas of the Department of Community Medicine, JawaharlalNehru Medical College, Aligarh Muslim University, Aligarh, from August 2021 to July 2022. It was a communitybased cross-sectional study.A total of 424 people was included.Simple Random Sampling was done. Individuals≥18 years of age from families of RHTC and UHTC,those who experienced an episode of illness after start ofCovid-19 pandemic and those who gave consent were included in the study. Patients who were bed-ridden and/or suffering from mental illness and those who did not give consent were excluded from the study. Data entryand analysis was done in IBM SPSS v 26.0. Relevant statistical tests were applied wherever required. Nearlyhalf of the study population practised Self Medication as a form of treatment at least once in the preceding 12months.The major source of information for the choice, dosage and duration of the medicines consumed for SelfMedication in our study was found to be the pharmacist ( 69.0%). It was followed by prior experience (31.0%) andprevious prescription (15.2%). In our study analgesics and antipyretics were found to be consumed by the highestpercentage of study participants. People should be made aware of the risks of Self Medication and should beguided on responsible Self Medication. Awareness campaigns may be organised in this regard

Mortality associated with Omicron and influenza infections in France before and during the COVID-19 pandemic.

For many deaths associated with influenza and Omicron infections, those viruses are not detected. We applied previously developed methodology to estimate the contribution of influenza and Omicron infections to all-cause mortality in France for the 2014-2015 through the 2018-2019 influenza seasons, and the period between week 33, 2022 and week 12, 2023. For the 2014-2015 through the 2018-2019 seasons, influenza was associated with annual average of 15,654 (95% CI (13,013, 18,340)) deaths, while between week 33, 2022 and week 12, 2023, we estimated 7,851 (5,213, 10,463) influenza-associated deaths and 32,607 (20,794, 44,496) SARS-CoV-2 associated deaths. For many Omicron-associated deaths for cardiac disease, mental&behavioural disorders, and other causes, Omicron infections are not characterised as a contributing cause of death - for example, between weeks 33-52 in 2022, we estimated 23,983 (15,307, 32,620) SARS-CoV-2-associated deaths in France, compared with 12,811 deaths with COVID-19 listed on death certificate. Our results suggest the need for boosting influenza vaccination coverage in different population groups in France, and for wider detection of influenza infections in respiratory illness episodes (including pneumonia) in combination with the use of antiviral medications. For Omicron epidemics, wider detection of Omicron infections in persons with underlying health conditions is needed.

Patients Managing Their Medical Data in Personal Electronic Health Records: Scoping Review.

Personal electronic health records (PEHRs) allow patients to view, generate, and manage their personal and medical data that are relevant across illness episodes, such as their medications, allergies, immunizations, and their medical, social, and family health history. Thus, patients can actively participate in the management of their health care by ensuring that their health care providers have an updated and accurate overview of the patients' medical records. However, the uptake of PEHRs remains low, especially in terms of patients entering and managing their personal and medical data in their PEHR. This scoping review aimed to explore the barriers and facilitators that patients face when deciding to review, enter, update, or modify their personal and medical data in their PEHR. This review also explores the extent to which patient-generated and -managed data affect the quality and safety of care, patient engagement, patient satisfaction, and patients' health and health care services. We searched the MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, and Google Scholar web-based databases, as well as reference lists of all primary and review articles using a predefined search query. Of the 182 eligible papers, 37 (20%) provided sufficient information about patients' data management activities. The results showed that patients tend to use their PEHRs passively rather than actively. Patients refrain from generating and managing their medical data in a PEHR, especially when these data are complex and sensitive. The reasons for patients' passive data management behavior were related to their concerns about the validity, applicability, and confidentiality of patient-generated data. Our synthesis also showed that patient-generated and -managed health data ensures that the medical record is complete and up to date and is positively associated with patient engagement and patient satisfaction. The findings of this study suggest recommendations for implementing design features within the PEHR and the construal of a dedicated policy to inform both clinical staff and patients about the added value of patient-generated data. Moreover, clinicians should be involved as important ambassadors in informing, reminding, and encouraging patients to manage the data in their PEHR.

Prevalence and characteristics of unipolar mania in a low-income country setting: population-based data from the Butajira cohort, rural Ethiopia

PurposePrevious research suggests unipolar mania, i.e., bipolar disorder without depression, to be more common in low-income countries. However, longitudinal population-based studies on unipolar mania from low-income countries are lacking. This study therefore examined unipolar mania, in Butajira, Ethiopia, and associations with possible determinants.MethodsKey informants and 68,378 screenings with the Composite International Diagnostic Interviews (CIDI 2.1) identified suspected cases of bipolar disorder. Diagnosis was confirmed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1) (n = 2,285). 315 participants with bipolar disorder were recruited and followed up for an average of 2.5 years. Unipolar mania was defined when illness episodes consisted of at least two manic relapses. 240 cases had sufficient data to ascertain course of disorder.Results41.7% (100 of 240 cases) of participants had unipolar mania. Unipolar mania was associated with less suicidal ideation (0% vs. 26.4%, p < 0.001), less suicidal thoughts (occasionally/often: 1%/3% vs. 19.6%/21%, p < 0.001), and less history of suicide attempt (2% vs. 11.6%, p = 0.01). The participants with unipolar mania tended to have better social functioning (OR = 2.05, p = 0.07) and less alcohol use (20.8% vs. 31.4%, p = 0.07). The study was partly based on retrospective data liable to recall bias. Some cases defined as unipolar mania in our study may later develop depression.ConclusionPrevious cross-sectional studies finding high proportions of unipolar mania in low-income countries appear supported. Unipolar mania trended towards better social functioning and was associated with lower suicidality. Future unipolar mania specifications could inform treatment and prognostic estimates of bipolar disorder.

1799. Impact of COVID 19 on urgent care diagnoses and stewardship metrics

Abstract Background The percentage of all respiratory diagnoses prescribed an antibiotic is an outpatient stewardship metric and was introduced as a HEDIS measure in 2022. Given a stable case mix, this metric is not affected by differences in coding practices between clinicians or health systems since all respiratory diagnoses are considered together. The onset of the COVID-19 pandemic introduced a high number of viral illness episodes where antibiotics are not recommended. The impact of this shift in case mix on respiratory diagnosis coding and prescribing metrics has not been explored. Methods We examined antibiotic prescribing rates for respiratory diagnoses in a network of urgent care clinics affiliated with the University of Utah during two periods. Pre-Pandemic was Mar 2019-Feb 2020 and Pandemic was Mar 2020-Mar 2022. Respiratory diagnoses were identified using ICD10 codes and further stratified into 3 Tiers (Tier 1: antibiotics indicated; Tier 2: antibiotics sometimes indicated; Tier 3: antibiotics not indicated). We examined trends in antibiotic prescribing across these periods including the percentage of all respiratory visits prescribed antibiotics and by Tier and the distribution of diagnoses by Tier. No formalized stewardship interventions were introduced during these periods. Results There were 146,897 urgent care visits during the study period (47,423 Pre Pandemic and 99,474 Pandemic). The respiratory prescribing rate declined from 42.3% Pre Pandemic to 26.2% during the Pandemic (Figure). The distribution of respiratory diagnoses by Tier and prescribing within Tier are shown in the Table. Tier 3 diagnoses increased from 48% to 67%, while Tier 2 diagnoses declined from 47% to 31%. Antibiotic prescribing declined for both Tier 2 and Tier 3 diagnoses. 15,429 (23%) of Tier 3 diagnoses during the Pandemic were coded as COVID-19. 50% of the reduction in prescribing is attributable to changes in Tiers alone. FigureTable Conclusion The COVID 19 pandemic was associated with a reduction in the percentage of respiratory diagnoses prescribed antibiotics. Half was due to an increase in Tier 3 encounters although declines in prescribing occurred with Tiers in addition. Using this metric for benchmarking requires accounting for the impact of case mix differences over time or between systems and clinicians. Disclosures All Authors: No reported disclosures.

Patient characteristics associated with retrospectively self-reported treatment outcomes following psychological therapy for anxiety or depressive disorders - a cohort of GLAD study participants

BackgroundProgress towards stratified care for anxiety and depression will require the identification of new predictors. We collected data on retrospectively self-reported therapeutic outcomes in adults who received psychological therapy in the UK in the past ten years. We aimed to replicate factors associated with traditional treatment outcome measures from the literature.MethodsParticipants were from the Genetic Links to Anxiety and Depression (GLAD) Study, a UK-based volunteer cohort study. We investigated associations between retrospectively self-reported outcomes following therapy, on a five-point scale (global rating of change; GRC) and a range of sociodemographic, clinical and therapy-related factors, using ordinal logistic regression models (n = 2890).ResultsFour factors were associated with therapy outcomes (adjusted odds ratios, OR). One sociodemographic factor, having university-level education, was associated with favourable outcomes (OR = 1.37, 95%CI: 1.18, 1.59). Two clinical factors, greater number of reported episodes of illness (OR = 0.95, 95%CI: 0.92, 0.97) and higher levels of personality disorder symptoms (OR = 0.89, 95%CI: 0.87, 0.91), were associated with less favourable outcomes. Finally, reported regular use of additional therapeutic activities was associated with favourable outcomes (OR = 1.39, 95%CI: 1.19, 1.63). There were no statistically significant differences between fully adjusted multivariable and unadjusted univariable odds ratios.ConclusionTherapy outcome data can be collected quickly and inexpensively using retrospectively self-reported measures in large observational cohorts. Retrospectively self-reported therapy outcomes were associated with four factors previously reported in the literature. Similar data collected in larger observational cohorts may enable detection of novel associations with therapy outcomes, to generate new hypotheses, which can be followed up in prospective studies.

Lifestyle, Type of Work, and Temporary Disability: An Incidence Study of the Working Population.

The objective of the study was to identify lifestyles associated with loss of health among workers. A retrospective longitudinal incidence study was carried out over a three-year period (2015, 2016, and 2017) among the working population. A total of 240 workers were analysed using information from occupational health assessments. The outcome variable was loss of health due to common illness or workplace injury, quantified by the number of days each episode lasted. Predictor variables were age, gender, type of work, tobacco use, alcohol consumption, physical activity (IPAQ), and adherence to the Mediterranean diet (AMD). An adjusted multiple linear regression was performed, determining the goodness of fit of the final model using the coefficient of determination adjusted r2. During the study, 104 men (58.8%) and 25 women (39.7%) suffered an episode of illness or workplace injury (p &lt; 0.05). The overall incidence was 17.9% people/year 95% CI [15, 21.3]. 4.6% of the workers were sedentary or engaged in light physical activity, and 59.2% maintained an adequate AMD. Workers who engaged in high levels of physical activity had an average of 36.3 days of temporary disability compared to 64.4 days for workers with low-moderate levels of physical activity (p &lt; 0.01).

Comprehensive profiling of the human viral exposome in households containing an at-risk child with mitochondrial disease during the 2020-2021 COVID-19 pandemic.

Viral infection is a major cause of morbidity in children with mitochondrial disease (MtD). As a result, families with children with MtD are highly adherent to risk mitigation behaviours (RMBs) advised by the Centers for Disease Control and Prevention during the COVID-19 pandemic that can modulate infection risk. Deep serologic phenotyping of viral infections was performed via home-based sampling by combining SARS-CoV-2 serologic testing and phage display immunoprecipitation and sequencing. Samples were collected approximately 1 year apart (October 2020 to April 2021 and October 2021 to March 2022) on households containing a child with MtD. In contrast to our first collection in 2020-2021, SARS-CoV-2 antibody profiles for all participants in 2021-2022 were marked by greater isotype diversity and the appearance of neutralizing antibodies. Besides SARS-CoV-2, households (N=15) were exposed to >38 different respiratory and gastrointestinal viruses during the study, averaging five viral infections per child with MtD. Regarding clinical outcomes, children with MtD (N=17) experienced 34 episodes of illness resulting in 6 hospitalizations, with some children experiencing multiple episodes. Neurologic events following illness were recorded in five patients. Infections were identified via clinical testing in only seven cases. Viral exposome profiles were consistent with clinical testing and even identified infections not captured by clinical testing. Despite reported adherence to RMBs during the COVID-19 pandemic by families with a child with MtD, viral infection was pervasive. Not all infections resulted in illness in the child with MtD, suggesting that some were subclinical or asymptomatic. However, selected children with MtD did experience neurologic events. Our studies emphasize that viral infections are inexorable, emphasizing the need for further understanding of host-pathogen interactions through broad serologic surveillance.

Antimicrobial resistance – causes, threats, solutions

Antimicrobial resistance (AMR) is one of the most serious problems requiring urgent solutions to protect public health, and has a negative impact on healthcare, veterinary medicine, and agricultural systems worldwide [6]. The increase in AMR may endanger the therapeutic effectiveness of antibiotics, increase treatment failures and lead to longer and more severe illness episodes with higher treatment costs and mortality rates. The World Health Organization (WHO) has already declared AMR a high-priority issue to be resolved by collective global action [8].

Prevalence and Characteristics of Persistent Symptoms in Children During the COVID-19 Pandemic: Evidence From a Household Cohort Study in England and Wales.

Prevalence and Characteristics of Persistent Symptoms in Children During the COVID-19 Pandemic: Evidence From a Household Cohort Study in England and Wales.

Longitudinal Household Assessment of Respiratory Illness in Children and Parents During the COVID-19 Pandemic

In the early COVID-19 pandemic, SARS-CoV-2 testing was only accessible and recommended for symptomatic persons or adults. This restriction hampered assessment of the true incidence of SARS-CoV-2 infection in children as well as detailed characterization of the SARS-CoV-2 disease spectrum and how this spectrum compared with that of other common respiratory illnesses. To estimate the community incidence of SARS-CoV-2 infection in children and parents and to assess the symptoms and symptom severity of respiratory illness episodes involving SARS-CoV-2-positive test results relative to those with SARS-CoV-2-negative test results. This cohort study randomly selected Dutch households with at least 1 child younger than 18 years. A total of 1209 children and adults from 307 households were prospectively followed up between August 25, 2020, and July 29, 2021, covering the second and third waves of the COVID-19 pandemic. Participation included SARS-CoV-2 screening at 4- to 6-week intervals during the first 23 weeks of participation (core study period; August 25, 2020, to July 29, 2021). Participants in all households finishing the core study before July 1, 2021, were invited to participate in the extended follow-up and to actively report respiratory symptoms using an interactive app until July 1, 2021. At new onset of respiratory symptoms or a SARS-CoV-2 positive test result, a household outbreak study was initiated, which included daily symptom recording, repeated polymerase chain reaction testing (nose-throat swabs and saliva and fecal samples), and SARS-CoV-2 antibody measurement (paired dried blood spots) in all household members. Outbreaks, households, and episodes of respiratory illness were described as positive or negative depending on SARS-CoV-2 test results. Data on participant race and ethnicity were not reported because they were not uniformly collected in the original cohorts and were therefore not representative or informative. SARS-CoV-2-positive and SARS-CoV-2-negative respiratory illness episodes. Age-stratified incidence rates, symptoms, and symptom severity for SARS-CoV-2-positive and SARS-CoV-2-negative respiratory illness episodes. Among 307 households including 1209 participants (638 female [52.8%]; 403 [33.3%] aged <12 years, 179 [14.8%] aged 12-17 years, and 627 [51.9%] aged ≥18 years), 183 household outbreaks of respiratory illness were observed during the core study and extended follow-up period, of which 63 (34.4%) were SARS-CoV-2 positive (59 outbreaks [32.2%] during the core study and 4 outbreaks [2.2%] during follow-up). SARS-CoV-2 incidence was similar across all ages (0.24/person-year [PY]; 95% CI, 0.21-0.28/PY). Overall, 33 of 134 confirmed SARS-CoV-2 episodes (24.6%) were asymptomatic. The incidence of SARS-CoV-2-negative respiratory illness episodes was highest in children younger than 12 years (0.94/PY; 95% CI, 0.89-0.97/PY). When comparing SARS-CoV-2-positive vs SARS-CoV-2-negative respiratory illness episodes in children younger than 12 years, no differences were observed in number of symptoms (median [IQR], 2 [2-4] for both groups), symptom severity (median [IQR] maximum symptom severity score, 6 [4-9] vs 7 [6-13]), or symptom duration (median [IQR], 6 [5-12] days vs 8 [4-13] days). However, among adults, SARS-CoV-2-positive episodes had a significantly higher number (median [IQR], 6 [4-8] vs 3 [2-4]), severity (median [IQR] maximum symptom severity score, 15 [9-19] vs 7 [6-11]), and duration (median [IQR] 13 [8-29] days vs 5 [3-11] days; P < .001 for all comparisons) of symptoms vs SARS-CoV-2-negative episodes. In this cohort study, during the first pandemic year when mostly partial or full in-person learning occurred, the SARS-CoV-2 incidence rate in children was substantially higher than estimated from routine testing or seroprevalence data and was similar to that of adult household members. Unlike in unvaccinated adults, SARS-CoV-2 symptoms and symptom severity in children were similar to other common respiratory illnesses. These findings may prove useful when developing pediatric COVID-19 vaccine recommendations.

Atypical idiopathic NBIA (neurodegeneration with brain iron accumulation) associated with treatment-resistant bipolar mania responding to clozapine.

Management of treatment-resistant bipolar mania has not been discussed much in the literature. The underlying degenerative neurological disorders could be one of the reasons for treatment resistance. A 27-year-old single male presented with 13 years of episodic illness characterised by typical manic symptoms with poor interepisodic recovery. His neurological examination was normal. Most of the commonly used antipsychotics, mood stabilizers and their combination failed to sustain the response to manic symptoms, including when psychotropics were combined with electroconvulsive therapy. Severe adverse effects such as pancreatitis with valproate and hyponatremia with oxcarbamazepine further challenged the management of treatment-resistant bipolar mania. Radiological evaluation revealed the presence of brain mineralisation in bilateral dentate, substantia nigra, red nuclei, globus pallidi and posterolateral putamen. Based on the clinical and radiological findings, a possibility of atypical idiopathic Neurodegeneration with Brain Iron Accumulation (NBIA) associated with treatment-resistant bipolar mania was made. Clozapine was initiated and titrated up to 300mg. Clinically significant improvement was seen in manic symptoms, and the response was sustained over two years. The presence of atypical idiopathic NBIA could be one of the factors for treatment resistance in bipolar mania. Clozapine has a good response in treatment-resistant bipolar disorder and can be effective even in the presence of the underlying neurodegenerative condition.

Comparison of Rhinovirus A-, B-, and C-Associated Respiratory Tract Illness Severity Based on the 5'-Untranslated Region Among Children Younger Than 5 Years.

BackgroundRhinoviruses (RVs) are among the most frequently detected viruses from hospitalized children with severe acute respiratory infections, being classified into RV-A, RV-B, and RV-C (4 clades: C, GAC1, GAC2, and A2). This study aimed to compare the clinical characteristics and respiratory tract illness severity between the RV species and RV-C clades in children in primary care and hospital settings in rural communities in the Philippines.MethodsClinical samples and information of children <5 years old in the Philippines were collected from 2014 to 2016. The samples were tested by reverse-transcription polymerase chain reaction (RT-PCR) targeting the 5′-untranslated region. PCR-positive samples were sequenced, and RV species were identified by phylogenetic analysis.ResultsOverall, 3680 respiratory tract illness episodes in 1688 cohort children were documented; 713 of those were RV positive and identified as RV-A (n = 271), RV-B (n = 47), and RV-C (n = 395: C [n = 76], GAG1 [n = 172], GAG2 [n = 8], A2 [n = 138], and unidentified [n = 1]). Severe illnesses, low oxygen saturation, cough, and wheezing were more common in patients with RV-C, especially with GAC1, than in those with RV-A or RV-B. Furthermore, severe illness was significantly more common in RV-C (GAC1)–positive cases than in RV-A–positive cases (odds ratio, 2.61 [95% CI, 1.17–4.13]).ConclusionsChildren infected with RV-C had more severe illnesses than children infected with RV-A and RV-B. Moreover, emerging clades of RV-C were associated with increased severity.

Drivers of respiratory health care demand in Acre state, Brazilian Amazon: a cross-sectional study

BackgroundThe scarce knowledge about the drivers of demand for respiratory health care in the Brazilian Amazon, where the gap of human and physical health care resources is wide, is expanded with two surveys conducted in the west of the region, in Acre state. Potential drivers, informed by a review of twelve recent papers, were classified into seven categories capturing the individual, household, community and macroeconomic dimensions.MethodsQuantitative field surveys were conducted in 2017 and 2019 based on coupled conglomerate-quota randomization sampling. Adults responded about their own health or their children’s health. The probability of seeking physician care for the latest episode of respiratory illness or dry cough was analysed with multiple nonlinear regressions, having as covariates the potential predictors informed by the literature.ResultsThe propensity to seek health care and to purchase medication was larger for children. Influenza-like illness (Despite the exact diagnostic stated by respondents being “influenza”, a virus detection test (such as the PCR test) is not commonly applied, as informed by the Acre state public health service. In consistency, the term “influenza-like illness” is used.) was the most frequently diagnosed disease, followed by pneumonia, suggesting that a health care-seeking rate below 40% may perpetuate health impairment and local contagion. Illnesses’ severity, including the pain experienced, was the main predictor, revealing that subjective perception was more influential than objective individual and household characteristics.ConclusionsThe results suggest that subjective underestimation of respiratory illnesses’ consequences for oneself and for local society could prevent health care from being sought. This is in line with some previous studies but departs from those emphasizing the role of objective factors. Social consequences, of, for instance, a macroeconomic nature, need to be highlighted based on studies detecting long-run relationships among health care demand, health and economic performance at the national level. Depending on the intensity of the trade-off between the costs imposed on the health system by increased demand and on the economy by the reduced productivity of the ill, policy could be adopted to change subjective perceptions of illnesses with nudges and educational and informational interventions.

Association between maternal depression and neonatal outcomes: Evidence from a survey of nationally representative longitudinal studies.

Background and aimsMaternal depression before and after delivery has dramatically increased in China. Therefore, this study aimed to examine the association between antepartum and postpartum depression and neonatal outcomes.DesignA population-based retrospective cohort study.SettingChina.ParticipantsData were obtained from China Family Panel Studies (CFPS). Different mother-child/infant samples were included in this study. Mother in CFPS2012 and CFPS2016 were linked with 1–2-year-old children in CFPS2014 and CFPS2018, respectively. Besides, and mothers in CFPS2012, CFPS2016, and CFPS2018 were linked with 0–1-year-old infants in CFPS2012, CFPS2016, and CFPS2018, respectively.MethodsMaternal depression was measured using the Center for Epidemiologic Studies Depression Scale. The neonatal outcomes included duration of gestational days, preterm birth, birth weight, birth weight z-score, weight, weight z-score, illness in the past month, and hospitalization in the past year. Propensity score matching was used to balance maternal, family, and infant/child characteristics between the maternal depression and non-maternal depression groups.ResultsMultivariable regression analysis of matched samples estimated that antepartum depression was associated with a shorter duration of gestation by 3.99 days (95% confidence interval [CI] = −7.21, −0.78). The association between antepartum depression and preterm birth, birth weight and birth weight z-score were not statistically significant. Postpartum depression was associated with more episodes of illness in the last month by 0.23 times (95% CI = 0.11, 0.36) and a higher odd of hospitalization in the previous year (OR = 1.59, 95% CI = 1.15, 2.20). The association between postpartum depression and weight or the weight z-score was not significant.ConclusionMaternal depression appears to be associated with worse neonatal outcomes.

Illness behaviour and influencing aspects of general practitioners in Germany and their use of the health care system: a qualitative study.

ObjectivesThe aim of this study was to explore aspects that play a role when general practitioners (GPs) become ill and thus gain a more comprehensive understanding of the overall illness behaviour of GPs and their use of the healthcare system.SettingPrimary care practices in Thuringia, Germany.ParticipantsConvenience sample of 16 GPs.DesignQualitative study design with semistructured interviews and content analysis.ResultsUsing our approach of having participants report their own episodes of illness, we found that self-treatment was practised and accepted by all 16 participants. The widespread use of naturopathy and complementary methods seems to be a special feature of German GPs. Formal use of the healthcare system mainly took place through direct consultation with specialists.Our study revealed various aspects influencing the illness behaviour of the GPs and their use of the healthcare system. Some aspects also apply to lay patients, but it became clear how strongly illness behaviour is influenced by participants’ activities as physicians. Noteworthy and less described aspects are especially the influence of patients and practice staff, the influence of biographical and professional imprint and the attitudes and values of the physicians.Complex inter-relationships were found between illness behaviour and influencing aspects; these are subjected to a dynamic and recursive process.ConclusionsThe illness behaviour of German GPs seems to be comprehensively influenced by their activities as responsible healthcare providers. The ability to perceive and reflect in this regards should already be actively promoted in studies and further education. Further research is needed for a better understanding of the inter-relationships.