History Of Chronic Conditions Research Articles

Long-Term Symptoms Associated With SARS-CoV-2 Infection Among Blood Donors

Long-term symptoms, lasting more than 4 consecutive weeks after acute COVID-19 disease, are an important consequence of SARS-CoV-2 infection. Many prior studies have lacked a non-SARS-CoV-2-infected control population to distinguish background prevalence of symptoms from the direct impact of COVID-19 disease. To examine the prevalence of long-term physical and mental health symptoms associated with SARS-CoV-2 infection in a large population of blood donors based on self-report and serologic test results. This cross-sectional study included American Red Cross blood donors (aged ≥18 years) who were surveyed between February 22 and April 21, 2022, about new long-term symptoms arising after March 2020 and their SARS-CoV-2 infection status. All participants underwent at least 1 serologic test for antinucleocapsid antibodies between June 15, 2020, and December 31, 2021. SARS-CoV-2 infection as defined by a self-reported, confirmed acute infection or antinucleocapsid antibody positivity. New long-term symptoms since March 2020, including 5 symptom categories (neurologic, gastrointestinal, respiratory and cardiac, mental health, and other). Among 818 361 individuals who received the survey, 272 965 (33.4%) responded, with 238 828 meeting the inclusion criteria (138 576 [58.0%] female; median [IQR] age, 59.0 [47.0-67.0] years). Of the 83 015 individuals with a history of SARS-CoV-2 infection, 43.3% reported new long-term symptoms compared with 22.1% of those without a history of SARS-CoV-2 infection. After controlling for age, sex, race and ethnicity, and number of underlying conditions, those with a history of SARS-CoV-2 infection had an increased odds of new long-term symptoms compared with those without (adjusted odds ratio [AOR], 2.55; 95% CI, 2.51-2.61). Female sex and a history of chronic conditions were associated with new long-term symptoms. Long-term symptoms in the other category (AOR, 4.14; 95% CI, 4.03-4.25), which included changes in taste or smell, and the respiratory and cardiac symptom categories (AOR, 3.21; 95% CI, 3.12-3.31) were most associated with prior SARS-CoV-2 infection. Mental health long-term symptoms were also associated with prior SARS-CoV-2 infection (AOR, 1.05; 95%, CI, 1.02-1.08). This study's findings suggest that long-term symptoms lasting more than 4 weeks are common in the adult population, but there is a significantly higher prevalence among those with SARS-CoV-2 infection. Continued efforts to define and track long-term sequelae of SARS-CoV-2 using a control group without infection and serologic information to include those who had asymptomatic or unidentified infections are needed.

Exposure to early-life adversity and long-term trajectories of multimorbidity among older adults in China: analysis of longitudinal data from the China Health and Retirement Longitudinal Study

ObjectivesThis study aimed to identify long-term distinct trajectories of multimorbidity with ageing from 50 to 85 years among Chinese older adults and examine the relationship between exposure to early-life adversity...

Parents' Intentions and Associated Factors to Vaccinating Their Children Aged 12-17 Years with COVID-19 Vaccines: A Cross Sectional Study.

No available vaccine against COVID-19 had yet been proven for 12–17-year-olds in Egypt during the study period. This is the first study to assess Egyptian parents’ intentions and associated factors in relation to vaccinating their children with COVID-19 vaccines. A cross-sectional study using a questionnaire was conducted between 17 October and 17 November 2021, via social media platforms. The target group was parents with children aged 12–17 years. Parents’ intention to vaccinate their children and factors associated with vaccinating their children, reasons for not intending to vaccinate their children, and circumstances whereby the parents would change their mind were recorded. Among the 1458 parents recruited, 65.6% were planning to vaccinate their children. The main concerns were fear of the vaccine’s side-effects (68.3%) and conspiracy theories (18%). The factors associated with parents’ intention to vaccinate their children were mother’s older age (40–49 years: aOR = 1.45, 95% CI = 1.05–1.99; ≥50 years: aOR = 2.09, 95% CI = 1.16–3.75), high family income (aOR = 1.99, 95% CI = 1.41–2.79), and children with a history of chronic conditions (aOR = 2.02, 95% CI = 1.25–3.25), while higher mother’s education level was negatively associated (aOR = 0.41, 95% CI = 0.27, 0.64). A comprehensive health education program regarding vaccinating children with COVID-19 vaccines is highly recommended for parents, particularly for young and highly educated mothers, to enhance children vaccination rate when the vaccine becomes available.

Clinical Characterization of Patients With COVID-19 in Primary Care in Catalonia: Retrospective Observational Study.

BackgroundThe country of Spain has one of the highest incidences of COVID-19, with more than 1,000,000 cases as of the end of October 2020. Patients with a history of chronic conditions, obesity, and cancer are at greater risk from COVID-19; moreover, concerns surrounding the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin type II receptor blockers (ARBs) and its relationship to COVID-19 susceptibility have increased since the beginning of the pandemic.ObjectiveThe objectives of this study were to compare the characteristics of patients diagnosed with COVID-19 to those of patients without COVID-19 in primary care; to determine the risk factors associated with the outcome of mortality; and to determine the potential influence of certain medications, such as ACEIs and ARBs, on the mortality of patients with COVID-19.MethodsAn observational retrospective study of patients diagnosed with COVID-19 in the Catalan Central Region of Spain between March 1 and August 17, 2020, was conducted. The data were obtained from the Primary Care Services Information Technologies System of the Catalan Institute of Health in Barcelona, Spain.ResultsThe study population included 348,596 patients (aged >15 years) registered in the Primary Care Services Information Technologies System of the Catalan Central Region. The mean age of the patients was 49.53 years (SD 19.42), and 31.17% of the patients were aged ≥60 years. 175,484/348,596 patients (50.34%) were women. A total of 23,844/348,596 patients (6.84%) in the population studied were diagnosed with COVID-19 during the study period, and the most common clinical conditions of these patients were hypertension (5267 patients, 22.1%) and obesity (5181 patients, 21.7%). Overall, 2680/348,596 patients in the study population (0.77%) died during the study period. The number of deaths among patients without COVID-19 was 1825/324,752 (0.56%; mean age 80.6 years, SD 13.3), while among patients diagnosed with COVID-19, the number of deaths was 855/23,844 (3.58%; mean age 83.0 years, SD 10.80) with an OR of 6.58 (95% CI 6.06-7.15).ConclusionsWe observed that women were more likely to contract COVID-19 than men. In addition, our study did not show that hypertension, obesity, or being treated with ACEIs or ARBs was linked to an increase in mortality in patients with COVID-19. Age is the main factor associated with mortality in patients infected with SARS-CoV-2.

Relationship Between Chronic Conditions and Balance Disorders in Outpatients with Dizziness: A Hospital-Based Cross-Sectional Study.

BackgroundBalance dysfunction is common in adult outpatients with dizziness, especially those who are older, which can lead to catastrophic outcomes such as falls. The aim of this study was to investigate the association between chronic conditions and balance disorders in patients with dizziness, especially those who are elderly.Material/MethodsA cross-sectional study was conducted in adult outpatients diagnosed with dizziness referred to the Department of Otolaryngology at Beijing Tongren Hospital from September 2017 to August 2018. All of the patients completed a self-administered, structured questionnaire. Demographic data and information on history of chronic conditions were collected and the patients were divided into 2 groups based on whether their balance was normal or abnormal.ResultsThree hundred and thirty-two patients were included in this study, 168 in the normal balance group and 164 in the abnormal balance group. The incidence of chronic conditions, including hypertension and diabetes, in the abnormal balance group was higher than that in the normal balance group (all P<0.05). In subgroup analysis based on age, in those who were aged ≥60 years, the prevalence of chronic diseases was higher in the abnormal balance group than in the normal balance group (P=0.002), while there was no difference in age between the groups with abnormal and normal balance. Hypertension (OR: 2.268; 95%CI: 1.038–4.957; P<0.05) was a risk factor for balance disorders in elderly patients rather than those who were younger (P>0.05).ConclusionsOur results show that chronic conditions are associated with balance function in older patients with dizziness. Thus, specialists should consider chronic conditions, especially hypertension, in elderly patients with dizziness.

Attitudes Toward Using COVID-19 mHealth Tools Among Adults With Chronic Health Conditions: Secondary Data Analysis of the COVID-19 Impact Survey.

BackgroundAdults with chronic conditions are disproportionately burdened by COVID-19 morbidity and mortality. Although COVID-19 mobile health (mHealth) apps have emerged, research on attitudes toward using COVID-19 mHealth tools among those with chronic conditions is scarce.ObjectiveThis study aimed to examine attitudes toward COVID-19, identify determinants of COVID-19 mHealth tool use across demographic and health-related characteristics, and evaluate associations between chronic health conditions and attitudes toward using COVID-19 mHealth tools (eg, mHealth or web-based methods for tracking COVID-19 exposures, symptoms, and recommendations).MethodsWe used nationally representative data from the COVID-19 Impact Survey collected from April to June 2020 (n=10,760). Primary exposure was a history of chronic conditions, which were defined as self-reported diagnoses of cardiometabolic, respiratory, immune-related, and mental health conditions and overweight/obesity. Primary outcomes were attitudes toward COVID-19 mHealth tools, including the likelihood of using (1) a mobile phone app to track COVID-19 symptoms and receive recommendations; (2) a website to track COVID-19 symptoms, track location, and receive recommendations; and (3) an app using location data to track potential COVID-19 exposure. Outcome response options for COVID-19 mHealth tool use were extremely/very likely, moderately likely, or not too likely/not likely at all. Multinomial logistic regression was used to compare the likelihood of COVID-19 mHealth tool use between people with different chronic health conditions, with not too likely/not likely at all responses used as the reference category for each outcome. We evaluated the determinants of each COVID-19 mHealth intervention using Poisson regression.ResultsOf the 10,760 respondents, 21.8% of respondents were extremely/very likely to use a mobile phone app or a website to track their COVID-19 symptoms and receive recommendations. Additionally, 24.1% of respondents were extremely/very likely to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19. After adjusting for age, race/ethnicity, sex, socioeconomic status, and residence, adults with mental health conditions were the most likely to report being extremely/very or moderately likely to use each mHealth intervention compared to those without such conditions. Adults with respiratory-related chronic diseases were extremely/very (conditional odds ratio 1.16, 95% CI 1.00-1.35) and moderately likely (conditional odds ratio 1.23, 95% CI 1.04-1.45) to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19.ConclusionsOur study demonstrates that attitudes toward using COVID-19 mHealth tools vary widely across modalities (eg, web-based method vs app) and chronic health conditions. These findings may inform the adoption of long-term engagement with COVID-19 apps, which is crucial for determining their potential in reducing disparities in COVID-19 morbidity and mortality among individuals with chronic health conditions.

Comorbidity between depressive symptoms and chronic conditions – findings from the Indonesia Family Life Survey

PurposeTo estimate the prevalence of symptoms of depression in the population, and to identify patient groups with a history of chronic conditions with the highest risks of comorbid depression. MethodsData were drawn from a population-representative sample of 31,447 participants in The Fifth Wave of the Indonesia Family Life Survey (IFLS5) conducted in 2014-15. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale-Revised (CES-D-R 10) that measures symptoms defined by the Diagnostic and Statistical Manual (DSM). Socio-demographic variables controlled for in the adjusted analysis included age, sex, education, and ethnicity. ResultsWeighted prevalence of depressive symptoms, above the CES-D-R 10 cut-off, was 22.6% (females=23.0%, males=22.2%). Among those with a chronic condition, the highest risk of comorbid symptoms of depression was observed in those with a memory-related disease (OR=2.64 [1.49-4.68]) or stroke (OR=2.39 [1.75-3.27]). Depressive symptoms were also more commonly reported among people with hypertension, tuberculosis, asthma, other lung conditions, heart problems, liver diseases, arthritis or rheumatism, kidney diseases, stomach or digestive diseases. ConclusionsSymptoms of depression are common in the general Indonesian population, and comorbidities are high in those with a history of chronic conditions, supporting the need for mental health care in patients presenting for physical diseases. Future research of clinical and patient samples will provide data in those who may be at increased risks.

Factors Associated with Chikungunya Relapse in Acapulco, Mexico: A Cross-Sectional Study.

Objective: To estimate the occurrence of self-reported chikungunya relapse and identify associated factors. Materials and Methods: A cross-sectional study in December 2015 included 1305 homes in eight urban clusters considered representative of Acapulco in southern Mexico. Administered questionnaires collated information on 5870 individuals, including sociodemographic variables, a history of chronic conditions, and the self-reporting of chikungunya. Bivariate and multivariate analyses relied on a cluster-adjusted Mantel-Haenszel procedure to identify the factors associated with chikungunya and its relapse. Results: Some 66% (3531/5870) of the population reported suffering chikungunya and 31.1% (1098/3531) reported a relapse. Factors associated with relapse included the severity of the chikungunya case (odds ratio [OR]: 3.35; clusters adjusted 95% confidence interval [95% CIca]: 3.16-3.55); history of arthralgia (OR: 2.96; 95% CIca: 2.27-3.86); age 30 years or older (OR: 1.85; 95% CIca: 1.72-1.98); female (OR: 1.64; 95% CIca: 1.42-1.90); and higher education households (OR: 1.18; 95% CIca: 1.11-1.27). Conclusions: The high occurrence of chikungunya and its relapse are a public health problem. The factors associated with relapse do not immediately suggest specific prevention strategies but emphasize the dire need for effective approaches to vector control.

Do disability, parenthood, and gender matter for health disparities?: A US population-based study

BackgroundExisting research has documented adverse health outcomes among parents with disabilities relative to parents without disabilities, but little is known about whether parenthood adds unique stress and health consequences for people with disabilities. Less is known about whether the effects of parenthood differ between mothers and fathers with disabilities. ObjectivesThis paper examined health-related quality of life, obesity, and health behaviors between US parents and nonparents with and without disabilities. We also explored differences in health outcomes separately for men and women by one's parental and disability status. MethodsAn analytic sample of parents and nonparents aged 18–64, with and without disabilities, were derived from the 2016 Behavioral Risk Factor Surveillance System (9,117 parents and 33,961 nonparents with disabilities). Multivariate logistic regression analyses were applied, controlling for individuals’ socio-demographic characteristics and their history of chronic conditions. ResultsParents with disabilities, compared to parents without disabilities and nonparents with and without disabilities, were at higher risk of reporting frequent physical distress, obesity, smoking, and insufficient sleep. Among those with disabilities, fathers were more likely than nonfathers to report poor or fair health, frequent physical and mental distress, and obesity; these differences were not evident between mothers and nonmothers with disabilities. ConclusionsThe findings suggest the urgent need for policies and programs to address the health-related needs of parents with disabilities, as well as the need for targeted programs to support fathers with disabilities.

The Variables Associated With Health Promotion Behaviors Among Urban Black Women.

To improve understanding of variables impacting health promotion behaviors among urban Black women. A cross-sectional survey was used. Urban Black women (N = 132) between the ages of 30 to 64 years participated. The study was conducted in a U.S. metropolitan region in 2015. Health literacy (Newest Vital Sign [NVS]), self-efficacy (New General Self-Efficacy Scale [NGSE]), and readiness for change (Health Risk Instrument [HRI]) were correlated with health promotion behaviors (Health Promotion Lifestyle Profile II [HPLPII]). Univariate statistics addressed demographic characteristics; bivariate/simultaneous linear regression determined the relationships between the NVS, NGSE, and HRI to health promotion behaviors (HPLPII). Demographics: 72.6% completed high school and 25% completed college, and the mean body mass index (BMI) was >32. Positive correlations existed between each variable to health promotion behaviors: NVS (r = .244, p < .002), NGSE (r = .312, p < .001), HRI (r = .440, p < .001), and accounted for 29.8% of variances in health promotion behaviors. Education and health literacy were also correlated (rs = .414, p = .001). Although health literacy, self-efficacy, and readiness for change are associated with health promotion behaviors, readiness for change was the most highly correlated. The development and incorporation of interventions to promote health promotion behaviors should include readiness for change, health literacy, BMI, and education, especially among urban Black women in order to reduce critical health disparities. Community-based and culturally relevant strategies in promoting health that are integrated into existing lifestyles and designed to impact readiness for change will have the greatest impact on reducing health disparities both in the United States and in countries experiencing rapid urbanization. For example, healthy eating behaviors or increased physical activity may be best adopted when integrated into existing community-based spiritual or cultural events via trusted community leaders. Replication of this study in other populations of Black women will improve the generalizability of this study, both in the United States and globally. However, the addition of other demographic variables, such as a history of chronic conditions, military service, domestic or other violence, spirituality, and the availability of community resources, would strengthen the results in future studies.

0766 RELATIONSHIP BETWEEN SLEEP DURATION AND SELF-REPORTED HEALTH-RELATED QUALITY OF LIFE AMONG US ADULTS WITH NO MAJOR CHRONIC DISEASES, 2014

Current literature shows a bidirectional association between sleep duration and health-related quality of life (HRQOL) among those with chronic diseases such as coronary heart disease (CHD), cancer, chronic obstructive pulmonary disease (COPD), diabetes, or asthma. However, research on the relationship among adults with no history of chronic conditions is limited. Using the 2014 Behavioral Risk Factor Surveillance System, we analyzed self-reported data from 172,528 adult respondents aged greater or equal to 18 years with no reported history of nine chronic conditions (CHD, stroke, cancer, COPD, diabetes, asthma, arthritis, depression, or chronic kidney disease). Multivariable logistic regressions were constructed to assess relationships between sleep duration and three self-reported HRQOL after adjustment for sociodemographics, body mass index, and smoking status. Among respondents with no chronic conditions reported, 8.3% usually slept for less than or equal to 5, 22.5% for 6, 32.6% for 7, 29.4% for 8, 4.2% for 9, and 2.7% for greater than or equal to 10 hours in a 24-hour period. Poor/fair general health was reported by 6.9%; 4.0% reported physical health was not good greater than or equal to 14 days; and 5.3% reported mental health was not good greater than or equal to 14 days; and 2.1% reported 14 or more days of activity limitation in the past 30 days. There were U-shaped relationships of sleep duration to the HRQOL indicators. Compared to adults sleeping 7 hours, those who slept less than or equal to 5 hours or greater than or equal to 10 hours were significantly more likely to report poor/fair general health (adjusted prevalence ratio (PR) [95% confidence interval]=1.71 [1.50–1.95] and 1.37 [1.06–1.77], respectively), physical health not good greater than or equal to 14 days (1.78 [1.50–2.12] and 1.28 [0.86–1.93], respectively), mental health not good greater than or equal to 14 days (2.84 [2.48–3.26] and 1.64 [1.19–2.26], respectively), 14 or more days of activity limitation (2.62 [2.48–3.26] and 1.64 [1.19–2.26], respectively). Our results indicate that public attention and physician-counseling on sleep and mental health are needed to improve quality of life even among adults with no history of nine chronic conditions.

Osteoporosis among hospitalized patients with proximal femoral fractures in Assiut University Trauma Unit, Egypt.

This study aims to identify osteoporosis prevalence in hip fracture admissions at the Trauma Unit of Assiut University Hospitals and to study the independent correlates of osteoporosis-related fracture. A prospective cross-sectional study was carried out in 275 hip fracture patients admitted to the Trauma Unit of Assiut University Hospitals from January through December 2014 of both sexes aged 50years and older. Exclusion criteria were polytrauma, major accidents, and history of chronic conditions and long-term medication associated with osteoporosis risk increase and bilateral hip fractures. For every patient, weight, height, and bone mineral density by dual-energy x-ray absorptiometry (DEXA) were recorded. Tests of significance for non-parametric data were used. The questionnaire included sociodemographic characteristics, dietary habits, lifestyle factors such as smoking and physical activity, and female obstetric and gynecological factors. Mean age was 70.82±11.02 SD; 51.6% were males and 8.4% were obese. Fall on ground was in 81.1% of fractures. Osteoporosis (femoral neck T score≤-2.5 SD) prevalence was 74.9%. By univariable analysis, significant correlates were female gender, older age, normal BMI, and fall on the ground. Milk and cheese daily intake was significantly associated with lower prevalence of osteoporosis. In a multivariable logistic regression model, female sex, older age, low BMI, and fall on the ground were associated with osteoporosis. Osteoporosis prevalence is high among hip fracture patients and associated with female sex, increase in age, low BMI, and fall on ground. Strategies to prevent osteoporosis are needed to decrease hip fracture rates.

Obesity and associated factors--Kingdom of Saudi Arabia, 2013.

IntroductionData on obesity from the Kingdom of Saudi Arabia (KSA) are nonexistent, making it impossible to determine whether the efforts of the Saudi Ministry of Health are having an effect on obesity trends. To determine obesity prevalence and associated factors in the KSA, we conducted a national survey on chronic diseases and their risk factors.MethodsWe interviewed 10,735 Saudis aged 15 years or older (51.1% women) through a multistage survey. Data on sociodemographic characteristics, health-related habits and behaviors, diet, physical activity, chronic diseases, access to and use of health care, and anthropometric measurements were collected through computer-assisted personal interviews. We first compared sociodemographic factors and body mass index between men and women. Next, we conducted a sex-specific analysis for obesity and its associated factors using backward elimination multivariate logistic regression models. We used SAS 9.3 for the statistical analyses and to account for the complex sampling design.ResultsOf the 10,735 participants evaluated, 28.7% were obese (body mass index ≥30 kg/m2). Prevalence of obesity was higher among women (33.5% vs 24.1%). Among men, obesity was associated with marital status, diet, physical activity, diagnoses of diabetes and hypercholesterolemia, and hypertension. Among women, obesity was associated with marital status, education, history of chronic conditions, and hypertension.ConclusionObesity remains strongly associated with diabetes, hypercholesterolemia, and hypertension in the KSA, although the epidemic’s characteristics differ between men and women.

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Introduction: Children with chronic conditions exhibit an increased rate of severe acute illnesses requiring pediatric critical care. Some of these children receive mechanical ventilation; however, the subcategory of chronic conditions requiring mechanical ventilation and associated with mortality risk in children remains unclear. Hypothesis: The objective of this study was to delineate the risk of PICU mortality and prolonged duration of mechanical ventilation and PICU stay in children with chronic conditions requiring mechanical ventilation in the PICU. Methods: A retrospective cohort study was conducted in a 10-bed PICU in a tertiary children’s hospital in Japan. We reviewed all intubation cases in the PICU between April 2008 and July 2012. We recorded age, sex, Pediatric Index of Mortality 2 (PIM2) scores, main reason for admission, history of chronic conditions, duration of mechanical ventilation, duration of PICU stay, and mortality throughout the study period. Results: During the study period, 351 children underwent mechanical ventilation, of which 10.0% exhibited more than two chronic conditions, 40.4 % exhibited one chronic condition, and 49.6 % exhibited no chronic condition. Children with chronic conditions were not associated with mortality or prolonged duration of PICU stay. Of the various chronic subcategories, the subcategory of hematological/oncological chronic conditions was associated with significantly greater odds of PICU mortality [odds ratios, 4.77; 1.18–12.5); p < 0.01] and significantly longer duration of mechanical ventilation (p = 0.021) compared with non-hematological/oncological chronic conditions. There was no difference in PIM2 scores between the two groups (p = 0.251). Respiratory, cardiac, central nervous, gastrointestinal, and other chronic conditions were not associated with increased odds of PICU mortality and duration of mechanical ventilation. Conclusions: Children with one or more than two chronic conditions are not at a greater risk for PICU mortality and prolonged duration of PICU stay compared with children with no chronic condition. PIM2 scores were not increased in either group; however, hematological/oncological chronic conditions were associated with an adverse outcome.

Dynamic process of adverse selection: Evidence from a subsidized community-based health insurance in rural China

This article examines the changes of adverse selection over time during a 3-year subsidized, voluntary-based Community Health Insurance (CHI) scheme in rural China. The data came from a 4-year longitudinal social experimental study (2002–2006) on the CHI in Fengsan Township, Guizhou Province of China. A panel of 8198 observations (average of 2730 individuals) was analyzed using random effect logit model. We found that the effect of health status on the enrollment choice of the CHI scheme was significant. People with chronic condition history, with fair health, and with poor health were more likely to enroll in the scheme than those without chronic condition and with good health status. In addition, we found that almost all of the interaction terms of the health status variables and CHI wave variable were not significant, which indicates that the effects of adverse selection have not significantly changed over time. Furthermore, people with medium income and high income were more likely to enroll in the scheme compared to those with low income. This shows that adverse selection persisted in the subsequent enrollments of the CHI scheme, even with the government subsidy to the premium. However, adverse selection did not become more or less severe over time and worked through to a steady state. In addition, inequity of enrollment still exists under the current premium subsidy policy. Based on the findings, relevant policy implications are put forward to further improve the CHI scheme.

Concurrent acute illness and comorbid conditions poorly predict antibiotic use in upper respiratory tract infections: a cross-sectional analysis

BackgroundInappropriate antibiotic use promotes resistance. Antibiotics are generally not indicated for upper respiratory infections (URIs). Our objectives were to describe patterns of URI treatment and to identify patient and provider factors associated with antibiotic use for URIs.MethodsThis study was a cross-sectional analysis of medical and pharmacy claims data from the Pennsylvania Medicaid fee-for-service program database. We identified Pennsylvania Medicaid recipients with a URI office visit over a one-year period. Our outcome variable was antibiotic use within seven days after the URI visit. Study variables included URI type and presence of concurrent acute illnesses and chronic conditions. We considered the associations of each study variable with antibiotic use in a logistic regression model, stratifying by age group and adjusting for confounders.ResultsAmong 69,936 recipients with URI, 35,786 (51.2%) received an antibiotic. In all age groups, acute sinusitis, chronic sinusitis, otitis, URI type and season were associated with antibiotic use. Except for the oldest group, physician specialty and streptococcal pharyngitis were associated with antibiotic use. History of chronic conditions was not associated with antibiotic use in any age group. In all age groups, concurrent acute illnesses and history of chronic conditions had only had fair to poor ability to distinguish patients who received an antibiotic from patients who did not.ConclusionAntibiotic prevalence for URIs was high, indicating that potentially inappropriate antibiotic utilization is occurring. Our data suggest that demographic and clinical factors are associated with antibiotic use, but additional reasons remain unexplained. Insight regarding reasons for antibiotic prescribing is needed to develop interventions to address the growing problem of antibiotic resistance.

Cancer Screening among Native Americans in Eastern North Carolina

The purpose of the study is to explore cancer screening predictors and practices among Lumbee Indians in eastern North Carolina. Interviewers from the community conducted phone interviews with 333 men and 456 women aged 40 and older randomly selected from the Lumbee Tribal roll as part of the Lumbee Diabetes and Health Survey. The survey has sections on demographic information and health conditions, family history of chronic conditions, and health behaviors. This paper reports on cancer screening behaviors. Rates of ever being screened for breast, cervical, prostate and colon cancer were relatively high compared with overall national rates. Predictors included younger age, better health, more education, and lifestyle factors such as engaging in regular physical activity and not smoking. Future research should focus on developing culturally appropriate campaigns to increase the frequency of cancer screening to conform to guidelines, and educational programs and interventions to reach Lumbee Indians most at risk for not being screened.

Socioeconomic factors and low birth weight in Mexico

BackgroundLow birth weight (LBW) is a public health problem linked to lack of equity in populations. Despite efforts to decrease the proportion of newborns with LBW, success has been quite limited. In recent years, studies focused on explaining how social factors influence this problem have shown that populations with greater inequities have a greater proportion of newborns with LBW.MethodsThe objective was to describe socioeconomic factors related to LBW adjusted by demographic, reproductive and health services variables in Mexico City. A case-control study was carried out in three hospitals with gynaecological and obstetrics services in Mexico City during the first half of 1996. During the recruiting period all children with LBW (cases), defined as newborns weighing <2500 grams, were matched with children born on the same day to control for time of birth. Upon arrival at the hospital for delivery, women were interviewed to determine if they met our inclusion criteria. Women with a history of chronic conditions and those with twin or multiple pregnancies were excluded. Variables with clinical and statistical significance were included in a multivariate model (logistic regression).ResultsWe found that low socioeconomic level was the most important risk factor for LBW and was independent of other factors, including those related to reproduction and nutrition, smoking, morbidity during pregnancy, accessibility to health services and prenatal care (OR 2.68; 95% CI 1.19, 6.03).ConclusionWe found that socioeconomic factors are relevant to LBW. However further research should be done in different population groups as well as developing precise ways of measuring socioeconomic factors and their role in reproductive health.

Factors predictive of mortality and mortality prediction models in patients with ARF during the first 24 hours of intensive care unit admission

We examined outcomes for patients with ARF identified from a national comparative audit of adult general ICUs in England, Wales and Northern Ireland, the Case Mix Programme. Over an 8-year period ARF was present during the first 24 hours of admission in 17,326 of 276,731 admissions to the ICU. In 14,118 (81.5%) sufficient data were present to predict mortality using the Stuivenberg Hospital ARF (SHARF), UK APACHE II, and Mehta mortality prediction models. Discrimination was assessed by the area under the receiver operating characteristic curve (ROC), calibration by the mortality ratio (observed versus predicted mortality), and overall fit by the R-statistic from Shapiro's Q representing the geometric mean of the probability assigned to the true outcome. Factors predicting > 50% increased mortality risk were: history of chronic condition, CPR, IPPV, oliguria, prior hospital stay of 7+ days, MAP < 50 mmHg, acidosis, and reduction of GCS by 2. UK APACHE II scores showed the best discrimination and calibration, although the null hypothesis of perfect calibration was strongly rejected (P < 0.001) by both the Hosmer–Lemeshow test and Cox's calibration regression. UK APACHE II and Mehta underpredicted the number of deaths while SHARF T0 overpredicted (Table ​(Table1).1). SHARF T0 and Mehta's model showed poor overall fit by Shapiro's Q, with an R value < 0.5. Table 1 Although UK APACHE II scores performed best, none of the existing mortality prediction models reliably predict those who will survive to leave hospital following an episode of ARF in the ICU. Traditional risk factors such as oliguria, CPR, LOS > 7 days prior to admission to ICU and extremes of physiology continue to be associated with the greatest increased risks of mortality.

Intensive Care Society's APACHE II study in Britain and Ireland--I: Variations in case mix of adult admissions to general intensive care units and impact on outcome.

To describe the extent of variation in the case mix of adult admissions to general intensive care units in Britain and Ireland and investigate the impact of such variation on outcome. Prospective, cohort study of consecutive admissions to intensive care units. 26 general intensive care units in Britain and Ireland. 9099 admissions to the intensive care units studied. Death or survival at discharge before and after adjustment of case mix (age, history of chronic conditions, surgical status, diagnosis, and severity of illness) according to the APACHE II method. Important differences in case mix were found, with large variations between the units. Hospital mortality was significantly associated with most of the case mix factors investigated. Comparing crude death rates in hospital between intensive care units may be misleading indicators of performance. The collection of data on case mix needs to be standardised and differences in case mix adjusted for when comparing outcome between different intensive care units.