Lower Hospitalization Rates Research Articles

Health selection in three cohorts of outmigrants, return migrants and non-migrants

Abstract Background The two main hypotheses behind the healthy migrant effect are selection of healthier migrants and the salmon bias. However, these hypotheses have not been thoroughly and simultaneously investigated in distinct cohorts due to data limitations. Methods Linking national and provincial immigration registers with health care utilization datasets at the Manitoba Centre for Health Policy, we assembled a cohort of 816,185 adults who resided in Manitoba, Canada and were followed up for at least one year between 1985 to 2023 to outmigration, return migration or death. We included three subcohorts of international immigrants (16.4%), interprovincial migrants (10.8%) and all other Manitobans (AOM) (72.8%). Within each subcohort, we matched ‘stayers’ who never migrated, outmigrants and returnees on sex, birth year and place of residence and compared their hospitalization rates and Charlson and Elixhauser comorbidity scores 1-year before outmigration and 1-year after return migration. Results Outmigrants had lower hospitalization rates than stayers among AOM [Adjusted Relative Rate (RR): 0.80; 95% confidence interval (CI): 0.78, 0.82] and in the other two subcohorts. Comorbidity scores were also consistently lower among outmigrants compared to stayers in all three subcohorts, even after restricting to hospitalized cases. Outmigrants whose destination was another country were healthier than those who migrated to other provinces. Returnees had better health status than stayers upon return in the AOM subcohort only but lower than those who did not return at the time of outmigration in all three subcohorts. Conclusions Contrary to common belief, health selection is not restricted to international immigrants but also among interprovincial migrants and the local population. Migration dynamics may bias comparisons between population subgroups. Key messages • Migration is not only associated with positive health selection among international immigrants but also among interprovincial migrants and the local population. • Selective migration may represent a source of bias in health-related population-based studies.

Long-term heart failure risk after atrial septal defect closure in elderly

Abstract Background There is concern that atrial septal defect (ASD) closure will unmask underlying diastolic dysfunction or left heart disease in elderly causing heart failure. It is controversial whether fenestrated devices should be used in elderly patients. Purpose To assess the long-term heart failure risk after ASD closure in elderly and risk factors associated with heart failure hospitalization in a single centre. Method From 2003-2023, all elderly patients aged more that 60 years old who had ASD closure performed successfully in this centre were retrospectively studied. Baseline demographics, underlying risk factors and survival without heart failure hospitalization were analyzed. Result From 2003-2023, 73 patients aged more than 60 years old underwent successful ASD closure in our centre. None of these patients had balloon occlusion test for assessment of left atrial pressure. Median age was 66 years old (60-84) at operation and 27 (37.0%) of them were male. Common risk factors included diabetes (n=9, 12.3%), hypertension (n=31, 42.5%) and ischaemic heart disease (n=8, 11%). Thirty-nine (53.4%) patients had pre-existing atrial fibrillation and 17 (23.3%) of them had moderate to severe left sided valvular lesions. Heart failure symptoms were present in 31 (42.5%) of them (Figure 1). During a median follow-up time of 4 years (1-15 years), 80.8% of patients did not experience heart failure hospitalization (Figure 2). Pre-existing atrial fibrillation and left-sided valvular lesions were associated with higher risk of heart failure hospitalization (OR 4.06, 95% CI 1.03-16.06 p=0.036 and OR 4.9, 95% CI 1.41-17.09 p=0.009). Conclusion In a median follow-up time of 4 years, patients aged more than 60 years old had low rate of heart failure hospitalization after ASD closure. Pre-existing atrial fibrillation and left-sided moderate to severe valvular lesions were associated with higher risk of heart failure admission. Further studies should be conducted on ASD closure in these group of patients.Figure 1Figure 2

Effects of deferment of clinic visit on cardiovascular outcomes during COVID-19 outbreak: a prospective cohort study

Abstract Background Current guidelines recommend 3-6 months interval outpatient follow-up for patients with cardiovascular (CV) diseases and risk factors such as hypertension, diabetes mellitus (DM) and dyslipidemia. The impact of longer follow-up intervals is unclear. From 2020 to 2022, due to the infection control measures for COVID-19 pandemic, many patients voluntarily deferred their scheduled clinic visits. This provided us with an opportunity to study the impact of prolonged visit intervals on management CV risk factors. Purpose We aimed to investigate the impact of prolonged clinic visit intervals on CV outcomes and CV risk factor management among patients with CV diseases. Methods Patients with at least 1 CV risk factor (DM, hypertension, dyslipidemia, or a history of CV disease) were recruited from cardiology outpatient clinics from a tertiary teaching hospital from 2020-2022. Patients who opted to defer their appointment (Deferred group) were compared to those who attended their scheduled appointment (Normal group). The primary outcomes were composite major adverse cardiovascular events (MACE) of myocardial infarction, stroke, or CV-related death. The secondary outcomes were any unscheduled hospitalizations, suboptimal DM control (haemoglobin A1C >7%) or hyperlipidemia (LDL > 1.4 mmol/L). Results Out of the 455 patients recruited from outpatient clinics, 162 patients (35.6%) opted to defer their scheduled clinic visit (mean age 64.7 ± 12, 37.7% female), and 293 patients (mean age 64.5 ± 10, 36.2% female) continued to attend their appointments. The mean appointment interval was 226 days for the normal group and 582 days for the deferred group (p< 0.001). There was no significant difference in the primary outcome of MACE between the ‘Normal’ group and the ‘Deferred’ group (2.5% vs 0.6%, p=NS). The number of patients with suboptimal DM control (11.4% vs 21.9%, p = 0.029) was higher in the deferred group, whereas suboptimal hyperlipidemia (73.1% vs 77.1%, p=NS) was not statistically different. There were a total of 27 of unscheduled hospitalizations, among which the majority was for CV-related events (63.0%). Patients in the ‘Deferred’ group had higher rates of unscheduled hospitalization (12.3% vs 2.4%, p < 0.001) and higher rate of CV-related hospitalization compared to the ‘Normal’ group (6.2% vs 2.4%, p=0.041). Conclusion Our prospective data demonstrates that a prolonged clinic visit interval of more than 365 days was not associated with significant increase in adverse CV event or worsening of lipid control. However, prolonged clinic visit interval was associated with worse DM control and more frequent unscheduled hospitalization. More frequent medical contact might allow timely management of medical emergency at the outpatient setting and contribute to the lower rate of hospitalization in the routine follow-up group.

Impact of Home Mobile Phone-Based Telemonitoring in Preventing Exacerbations and Hospitalizations Among Patients with Chronic Obstructive Pulmonary Disease: An IMTEC Study

COPD is a major public health problem due to its high morbidity and mortality. The evolution of COPD is marked by the occurrence of acute exacerbations (AECOPD). One of the major causes of AECOPD is non-adherence treatment. Telemedicine is an accessible educational tool that can help physicians to provide continuous, accessible educational support and monitoring for patients with COPD. Objectives: This study aimed to determine the impact of therapeutic education via phone-based telemedicine on ED visits and/or hospitalizations for AECOPD. Methods: This is a randomized controlled trial carried out in the emergency department (ED) of Fattouma Bourguiba Monastir over a period of 7 consecutive months, including patients admitted with a final diagnosis of AECOPD. Patients were randomly assigned to receive standard care (STD) or weekly phone-based telemonitoring (TLM). Outcomes (exacerbation and the need for hospitalization for AECOPD) were assessed at a 1-, 3-, and 6-month follow-up after being discharged from the hospital. Results: We included 163 patients (57 patients in the TLM group and 106 patients in the STD group). The mean age of the study population was 66.5 ± 12.5 years. The TLM group exhibited a significantly lower risk of ED visits for AECOPD compared to the STD group, with an odds ratio of 0.13 (95% CI: 0.04–0.40) and a p-value ≤ 0.001. Additionally, the TLM group had a notably lower hospitalization rate for AECOPD compared to the control group (15.8% vs. 44.3%, respectively), with an odds ratio of 0.23 (95% CI: 0.10–0.52) and a p-value < 0.001. The all-cause death rate was also lower in the TLM group at the 6-month follow-up. Conclusions: Telemedicine represents an innovative approach that could improve the management of patients with COPD.

Clinical characteristics and outcomes of COVID-19 in pediatric patients with rheumatic diseases.

This study investigates the clinical characteristics and outcomes of pediatric patients with rheumatic diseases infected with COVID-19 in China. We conducted a retrospective analysis of pediatric patients with rheumatic diseases who contracted COVID-19. Data were collected via a comprehensive questionnaire with a 14-day follow-up. Multivariable logistic regression was used to assess severe outcomes, and network analyses evaluated symptom correlations. A total of 1070 cases were collected. Fever (88.05%) and cough (62.75%) were the most common symptoms. Cough, nasal congestion, and runny nose exhibited a stronger correlation with each other. A higher incidence of fever reduced the incidence of two single symptoms (nasal congestion [r = -0.833], runny nose [r = -0.762]). Vaccinated children showed a shorter time to negative COVID-19 conversion (7.21 days vs. 7.63 days, p < 0.05) and lower hospitalization rates (p = 0.025). Prolonged symptom duration was associated with older age (OR: 1.07 [1.04-1.11]; p < 0.001) and systemic lupus erythematosus (OR: 1.47 [1.01-2.12]; p = 0.046). Pediatric patients with rheumatic diseases exhibited a wide range of clinical symptoms after COVID-19 infection. The infection generally did not lead to severe outcomes in this study. COVID-19 vaccination was associated with reduced hospitalization risk and expediting the time to negativity for virus. This manuscript demonstrates a comprehensive analysis of the clinical characteristics and outcomes of COVID-19 infection in pediatric patients with rheumatic diseases in China. It provides critical insights into the specific challenges faced by this vulnerable population and offers practical recommendations for improving patient management during periods of increased infectious risk.

Enhanced Primary Care for Severe Mental Illness Reduces Inpatient Admission and Emergency Room Utilization Rates.

Cardiovascular disease (CVD) is a leading cause of premature mortality among patients with severe mental illness (SMI). Effective care delivery models are needed to address this mortality gap. This study examines the impact of an enhanced primary care (PC) program that specializes in the treatment of patients with SMI, called Medicine in Psychiatry Service-Primary Care (MIPS-PC). Using multipayer claims data in Western New York from January 1, 2016 to December 31, 2021, patients with SMI and CVD were identified using International Classification of Diseases, Tenth Revision codes. National Provider Identification numbers of MIPS-PC providers were then used to identify those patients who were treated by MIPS-PC during the period. These MIPS-PC-treated patients were compared against a cohort of one-to-one propensity score matched contemporaneous comparison group (ie, patients receiving PC from providers unaffiliated with MIPS-PC). A difference-in-difference approach was used to identify the treatment effects of MIPS-PC on all-cause emergency department (ED) visits and hospitalization rates. The MIPS-PC group was associated with a downtrend in the acute care utilization rates over a 3-year period following the index date (ie, date of first MIPS-PC or other PC provider encounter), specifically a lower hospitalization rate in the first year since the index date (25%; P < 0.001). ED visit rate reduction was significant in the third-year period (18%; P = 0.021). In summary, MIPS-PC treatment is associated with a decreasing trend in acute care utilization. Prospective studies are needed to validate this effect of enhanced PC in patients with SMI and CVD.

Nephrologist Visits Lower Rates of Hospitalization, Mortality, and ESKD Transition in Patients with CKD

Nephrologist Visits Lower Rates of Hospitalization, Mortality, and ESKD Transition in Patients with CKD

Analysis of Determining Inpatient Room Rates Using the Activity-Based Costing Method in a Healthcare Setting

Background: Hospitalization rate determination is crucial for healthcare cost management, yet traditional methods often lead to cost distortions. Specific Background: Muhammadiyah Tuban Hospital has historically utilized conventional costing methods, which have resulted in higher than necessary charges for hospital services. Knowledge Gap: There is limited research comparing traditional costing methods with more accurate and modern approaches like Activity Based Costing (ABC) in the Indonesian healthcare context. Aim: This study aims to compare hospitalization rates at Muhammadiyah Tuban Hospital using traditional methods and the ABC method, to highlight discrepancies and propose a more accurate costing framework. Results: The ABC method yielded significantly lower hospitalization rates across various classes (VIP, Class 1, Class 2, and Class 3) compared to traditional methods. For instance, the ABC rate for the VIP class was IDR 270,619, compared to IDR 495,000 set by traditional methods. Novelty: This study introduces the application of ABC in an Indonesian hospital setting, providing a clear contrast in cost-efficiency against traditional costing. Implications: The findings suggest that adopting the ABC method can lead to more precise and lower hospitalization rates, potentially reducing healthcare costs for patients and improving financial management within hospitals.Highlights: Cost Accuracy: ABC method offers more precise hospitalization rates than traditional methods. Economic Impact: Adoption of ABC can lower patient costs and improve hospital financial management. Innovation: Introduces a modern costing method to Indonesian healthcare, suggesting a shift from outdated practices. Keywords: Activity Based Costing, Hospitalization Rates, Cost Management, Healthcare Economics

Abstract C005: Predictors of advance care planning documentation in female patients with breast cancer: A multilevel model analysis

Abstract Background: Advance care planning (ACP) is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. Likewise, ACP is associated with multiple benefits, such as lower rates of hospitalizations and reduced futile, aggressive cancer treatment at the end of life. However, ACP rates remain low in the U.S., especially for patients with advanced cancer. Despite being more likely to be diagnosed at advanced stages and hospitalized due to advanced cancer with poor prognosis, the Black and Hispanic/Latino populations continue to have meager rates of ACP. Research has shown that both individual-level and systems-level factors contribute to these racial disparities in ACP. Considering these disparities among vulnerable populations, interventions that increase ACP among minority patients with cancer are needed. Objective: To analyze using multilevel model analysis the predictors of ACP documentation in female patients with breast cancer over 5 years in the UChicago Health System. Methods: Using the Clinical Data Research Warehouse, this study included women diagnosed with breast cancer (N=7,814) from 2016 to 2021. Descriptive statistics were performed to characterize ACP, and potential differences in ACP rates among control variables were assessed using odds ratio (OR) estimations. Significantly correlated variables were included as covariates in the multivariate analyses through a logistic regression model. The multilevel random-effects (mixed-effects) model, using restricted maximum likelihood estimation, examined the pattern of ACP documentation; in the multilevel model, level 1 modeled the changes in individual ACP documentation, and level 2 included the between-subjects effects of the predictors of documentation. Results: 13.76% of women with breast cancer filled out at least one type of ACP documentation, 4.25% filled out the Power of Attorney, 5.75% filled out the Advance Directive, and 8.92% filled out the Code Status. Increasing age and being black/African-American seem to be related to an increased likelihood of completion of at least one type of ACP documentation. While increasing BMI and outpatient services seem to be related to a decrease in the likelihood of completing at least one type of ACP documentation. Conclusion: Understanding the factors related to ACP documentation will allow us to manage them and improve their completion. These results will help to inform the development of tools to increase the integration of ACP into care, especially those that are technology-based. Further work could include designing a predictive model to prioritize patients requiring ACP. Providing knowledge about ACP in nonclinical areas can lead to increased education about ACP and its benefits to families and communities. Citation Format: Andres Mauricio Garcia Sierra, Marcia Tan. Predictors of advance care planning documentation in female patients with breast cancer: A multilevel model analysis [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C005.

Clinical characteristics, treatment, and outcomes for elderly patients in a dedicated Covid-19 ward at a primary health care facility in western Norway: a retrospective observational study

BackgroundThe coronavirus pandemic has hit the oldest and frailest individuals hard, particularly patients and residents in nursing homes. In March 2020, we established a Covid-19 ward at a nursing home in Bergen, western Norway for elderly patients with Sars-CoV-2 infection and in the need of treatment and care in a primary health care facility. The aims of this study were to describe the organization of the ward, the clinical outcomes of infection, treatment, mortality rates in the population, the level of advanced care planning, and end-of-life care for those who died.MethodsWe present patient characteristics, outcomes, vaccination status, treatment, decisions regarding treatment intensity upon clinical deterioration, and mortality for the patients in the ward. Clinical factors possibly related to a fatal outcome were analysed with chi square test (categorical variables) or t-test (continuous variables).Results257 patients were included from March 2020 to April 2022. Fifty-nine patients (23.0%) developed respiratory failure. Ten patients (3.9%) were admitted to hospital. Advance care planning was undertaken for 245 (95.3%) of the patients. 30-day mortality rate decreased from 42 to 4% during the study period. Of the 29 (11.3%) patients who died, all were well alleviated in the terminal phase, and 26 (89.7%) of them had a Clinical Frailty Scale (CFS) value ≥ 7. A high score for CFS, respiratory failure and respiratory co-infection were significantly associated with Covid-19 related death within 30 days.ConclusionsCovid-19-related mortality markedly decreased during the study period, and a high score for CFS was related to a fatal outcome. Thorough planning of treatment intensity upon deterioration, low hospitalization rates, and good relief for those who died suggest that dedicated Covid-19 wards in nursing homes can provide good treatment for the patients and relieve other nursing homes and specialist health care services.

Clinical Outcomes of Continuation and Maintenance Electroconvulsive Therapy

Large-scale evidence for the efficacy of continuation and maintenance electroconvulsive therapy (c/mECT) is lacking. To provide an exhaustive and naturalistic insight into the real-world outcomes and the cost-effectiveness of c/mECT in a large dataset. This cohort study included all patients in the Danish National Patient Registry who initiated treatment with ECT from 2003 through 2022. The data were analyzed from October 2023 to February 2024. ECT. An algorithm to identify c/mECTs in the dataset was developed: (>3 treatments with ≥7 and <90 days between adjacent treatments, occurring within a time frame of 180 days [cECT] or more [mECT] after an acute [aECT] series). The association of c/mECT with subsequent 6- to 12-month risk of hospitalization or suicidal behavior using Cox proportional hazard regression with multiple adjustments and aECT only as a reference, propensity score matching, and self-controlled case series analysis using a Poisson regression model. A cost-effectiveness analysis based on hospitalization and ECT expenses was made. A total of 19 944 individuals were treated with ECT (12 157 women [61%], 7787 men [39%]; median [IQR] age, 55 [41-70] years). Of these, 1533 individuals (7.7%) received c/mECT at any time point (1017 [5.1%] cECT only and 516 [2.6%] mECT). Compared with patients receiving aECT only, c/mECT patients more frequently experienced schizophrenia (odds ratio [OR], 2.14; 95% CI, 1.86-2.46) and schizoaffective disorder (OR, 2.42; 95% CI, 1.90-3.09) and less frequently unipolar depression (OR, 0.56; 95% CI, 0.51-0.62). In all models, c/mECT was associated with a lower rate of hospitalization after finishing aECT (eg, 6-month adjusted hazard ratio, 0.68; 95% CI, 0.60-0.78 [Cox regression]; 6-month incidence rate ratio, 0.51; 95% CI, 0.41-0.62 [Poisson regression]). There was no significant difference in the risk of suicidal behavior. Compared with the periods before the end of aECT, c/mECT was associated with a substantial reduction in total treatment costs. In a nationwide and naturalistic setting, c/mECT after aECT was infrequently used but associated with a lower risk of readmission than aECT alone. The totality of the evidence indicates that c/mECT should be considered more often to prevent relapse after successful aECT in patients whose condition does not respond sufficiently to other interventions.

Health selection among outmigrants, return migrants and non-migrants in three subcohorts of international, interprovincial migrants and non-migrants in Manitoba, Canada

Objective and ApproachLinking national and provincial immigration registers with health care utilization datasets at the Manitoba Centre for Health Policy, we assembled a cohort of 816,185 adults who resided in Manitoba, Canada and were followed up for at least one year between 1985 to 2023 to outmigration, return migration or death. The cohort included three subcohorts of international immigrants (16.4%), interprovincial migrants (10.8%) and all other Manitobans (AOM) (72.8%). Within each subcohort, we matched ‘stayers’ who never migrated, outmigrants and returnees on sex, birth year and place of residence and compared their hospitalization rates and Charlson and Elixhauser comorbidity scores 1-year before outmigration and 1-year after return migration. ResultsOutmigrants had lower hospitalization rates than stayers among AOM [Adjusted Relative Rate (RR): 0.80; 95% confidence interval (CI): 0.78, 0.82] and in the other two subcohorts. Comorbidity scores were also consistently lower among outmigrants compared to stayers in all three subcohorts, even after restricting to hospitalized cases. Outmigrants whose destination was another country were healthier than those who migrated to other provinces. Returnees had better health status than stayers upon return in the AOM subcohort only but lower than those who did not return at the time of outmigration in all three subcohorts. ConclusionsMigration is associated with positive health selection among international immigrants, interprovincial migrants and the local population. ImplicationsContrary to common belief, health selection is not restricted to international immigrants. Selective migration may represent a source of bias in health-related population-based studies (e.g., sampling and informative censoring).

Evaluation of the WHO standards to assess quality of care for children with acute respiratory infections: findings of a baseline multicentre assessment (CHOICE) in Italy

BackgroundExperience is lacking on the implementation of the WHO standards for improving the quality of care (QOC) for children at facility level. We describe the use of 10 prioritised WHO...

Overview of Endovascular Treatment of Infra Renal Abdominal Aortic Aneurysms Over the Last 21 Years in Brazil

Introduction: Endovascular treatment of abdominal aortic aneurysms (EVAR) has emerged as an innovative therapeutic alternative with significant growth potential. Despite its advantages, factors such as costs, short- and long-term benefits and patient characteristics are still being analyzed and make it difficult to increase the number of these procedures when compared to the traditional open technique. Objectives: To describe the statistical behavior of endovascular treatment for AAA repair over the last 21 years in Brazil. Materials and Methods: Retrospective and descriptive study of data available in the DataSUS database, where variables relating to the number of hospitalizations, number of deaths, average length of stay and hospital and professional costs were analyzed. Results: Among the 1,618 hospitalizations for endovascular treatment of abdominal aortic aneurysms in Brazil between 2002 and 2023, 680 occurred in the South region, followed by the Southeast region with 674 hospitalizations. The mortality rate was 7.94% in this period and the number of deaths was 130. The highest number of deaths was recorded in the Southeast, while the highest mortality rates were in the North and Midwest, 66.67 and 47, respectively. Discussion: The results showed regional inequalities and the influence of socio-economic indices on access to healthcare in Brazil, so that the more economically developed regions showed better results in terms of hospitalizations and mortality. Conclusion: Although the study has limitations, it showed a growing trend in the use of EVAR in Brazil, with the South and Southeast regions having better results in terms of hospitalizations and mortality, while the North and Midwest regions had lower hospitalization rates and higher mortality rates, pointing to underreporting and limited access to advanced treatments.

End-of-Life Care during the COVID-19 Pandemic: Decreased Hospitalization of Nursing Home Residents at the End of Life.

(1) Background: Nursing homes (NHs) face unique challenges in end-of-life care for their residents. High rates of hospitalization at the end of life are frequent, often for preventable conditions. The increased clinical uncertainty during the pandemic, the high symptom burden of the COVID-19 disease, and the challenges in communication with families and between care teams might impact the option to hospitalize NH residents at the end of life. (2) Materials and methods: The study covered a 3-year period and compared the hospitalization rates of the NH residents of a sample of Portuguese NH during the last year of life before and during the pandemic. A total of 387 deceased residents were included in the study. (3) Results: There were fewer hospitalizations in the last year of life during the pandemic period, although the proportion of deaths at hospitals was the same. Hospitalizations occurred closer to death, and with more serious clinical states. The lower rate of hospitalization was due to lower hospitalization due to infection; (4) Conclusions: The data suggest an improvement in end-of-life care practices during the pandemic period, with the decrease in hospitalizations being due to potentially burdensome hospitalizations. The importance of the role of physicians, nurses, and caregivers in this setting may be relatively independent of each other, and each may be targeted in end-of-life care training. Further study is recommended to clarify the implications of the results and if the changes can be sustained in the long term.

Pertussis upsurge, age shift and vaccine escape post-COVID-19 caused by ptxP3 macrolide-resistant Bordetella pertussis MT28 clone in China

ObjectivesChina has experienced a notable upsurge in pertussis cases post-COVID-19, alongside an age shift to older children, increased vaccine escape, and a notable rise in the prevalence of macrolide-resistant Bordetella pertussis. Here, we present a genomic epidemiological investigation of these events. MethodsWe performed a retrospective observational study using culture-positive B pertussis isolated in Shanghai, China, from 2016 to 2024. We analysed strain and pertussis epidemiology dynamics by integrating whole-genome sequencing of 723 strains with antimicrobial susceptibility, transcriptomic profile, and clinical data. We compared the genome sequences of Shanghai strains with 6450 Chinese and global strains. ResultsFrom pre-COVID-19 (before December 2019) to post-COVID-19, patients shifted from predominantly infants (90%, 397/442) to a higher proportion of infections in older children (infant: 16%, 132/844), with the share of vaccinated individuals surging from 31% (107/340) to 88% (664/756). The macrolide-resistant Bordetella pertussis prevalence increased from 60% (267/447) to 98% (830/845). The emergence and expansion of a ptxP3-lineage macrolide-resistant clone, MR-MT28, which is uniquely capable of causing substantial infections among older children and vaccinated individuals, was temporally strongly associated with the pertussis upsurge and epidemiological transition. Although MR-MT28 showed increased expression of genes encoding pertussis toxin, it was associated with significantly milder clinical symptoms and a lower hospitalization rate. MR-MT28 likely originated in China around 2016, after acquiring several key mutations, including a novel prn150 allele, and has been detected across multiple regions in China. In addition, 26% (50/195) of MR-MT28 has evolved into predicted Pertactin (PRN)-deficient strains, with an IS481 insertion being the predominant mechanism. Discussion: We report that the post-COVID-19 upsurge of pertussis in China is associated with ptxP3-MR-MT28, and provide evidence that pathogen evolution is likely the primary factor driving + pertussis upsurge, age shift, and vaccine escape. MR-MT28 poses a high risk of global spread and warrants global surveillance.

Increased Mortality in a Nationwide Study of Gastrointestinal Hospitalizations in the United States During the 2020 Coronavirus Pandemic.

Background The impact of the coronavirus disease-2019 (COVID-19) pandemic on patients with acute gastrointestinal (GI) presentations including acute pancreatitis, diverticulitis, and GI bleeding, requiring hospitalization, has not been fully characterized at the population level in the United States. Aims We used the National Inpatient Sample to describe inpatient gastroenterology outcomes in the United States during the first year of the pandemic (2020), using 2018 and 2019 as comparator years. Methods Using the National Inpatient Sample, we explored year-to-year and month-to-month trends in hospitalizations, length of stay, and inpatient mortality for GI presentations, including luminal, biliary, infectious, inflammatory, and pancreatic diseases, with regression modeling. Relative change was used to compare time periods. Results We observed significantly lower rates of hospitalization for most acute GI conditions in 2020 relative to 2019. Despite this, we noted an increase in all-cause mortality (0.9% in 2019 and 1.1% in 2020, p<0.001) and hospital costs for patients hospitalized with acute presentations of GI-related conditions in 2020 relative to 2019. Importantly, we also observed increased mortality among COVID-19-positive patients who were hospitalized foracute pancreatitis (OR 2.56; 95% CI 1.37-6.53), variceal upper GI bleeding (OR 2.88; 95% CI 1.29-3.84), ulcerative colitis (OR 4.50; 95% CI 1.14-7.74), and acute cholangitis (OR 2.43; 95% CI 1.14-4.93). In 2020, the lowest number of admissions for all conditions occurred in April, coinciding with lockdowns ordered by most state governments. Conclusions Acute GI-related hospitalizations, in general, decreased in 2020but this was associated with higher hospital costs and all-cause mortality increased compared with the pre-pandemic period.

Long-COVID olfactory dysfunction: allele E4 of apolipoprotein E as a possible protective factor.

Olfactory dysfunction (OD) represents a frequent manifestation of the coronavirus disease 2019 (COVID-19). Apolipoprotein E (APOE) is a protein that interacts with the angiotensin-converting enzyme receptor, essential for viral entry into the cell. Previous publications have suggested a possible role of APOE in COVID-19 severity. As far as we know, no publications found significant associations between this disease's severity, OD, and APOE polymorphisms (E2, E3, and E4). To analyze the epidemiology of OD and its relationship with APOE polymorphisms in a cohort of Long-COVID patients. We conducted a prospective cohort study with patients followed in a post-COVID neurological outpatient clinic, with OD being defined as a subjective reduction of olfactory function after infection, and persistent OD being defined when the complaint lasted more than 3 months after the COVID-19 infection resolution. This cross-sectional study is part of a large research with previously reported data focusing on the cognitive performance of our sample. The final sample comprised 221 patients, among whom 186 collected blood samples for APOE genotyping. The persistent OD group was younger and had a lower hospitalization rate during the acute phase of the disease (p < 0.001). Furthermore, the APOE variant E4 allele frequency was lower in this group (p = 0.035). This study evaluated OD in an outpatient population with COVID-19. In the current literature on this disease, anosmia is associated with better clinical outcomes and the E4 allele is associated with worse outcomes. Our study provides new information to these correlations, suggesting APOE E4 as a protective factor for OD.

Mental health care use and quality among Medicaid adults with serious mental illness receiving care at Federally Qualified Health Centers vs. other settings

BackgroundFederally Qualified Health Centers (FQHCs) are a critical source of care for medically underserved populations and often serve as medical homes for individuals with serious mental illness (SMI). Many FQHCs provide mental health services and could facilitate access to mental health treatment within and outside of FQHCs. This study compared mental health care utilization and acute care events for adult Medicaid enrollees with SMI who receive care at Federally Qualified Health Centers (FQHCs) vs. other settings.MethodsThis study used the 2015–2016 Massachusetts All-Payer Claims Database to examine outpatient mental health care and acute care events for 32,330 Medicaid adults, ages 18–64 and with major depressive, bipolar, or schizophrenia spectrum disorders (SSD), who resided in FQHC service areas and received care from FQHCs vs. other settings in 2015. Multivariable linear regressions assessed associations between receiving care at FQHCs and outpatient mental health visits, psychotropic medication fills, and acute care events in 2016.ResultsThere were 8,887 (27.5%) adults in the study population (N = 32,330) who had at least one FQHC visit in 2015. Those who received care at FQHCs were more likely to have outpatient mental health visits (73.3% vs. 71.2%) and psychotropic medication fills (73.2% vs. 69.0%, both p < .05), including antidepressants among those with depressive disorders and antipsychotics among those with SSD. They were more likely to have ED visits (74.0% vs. 68.7%), but less likely to be hospitalized (27.8% vs. 31.9%, both p < .05). However, there was no significant difference in the likelihood of having an acute psychiatric hospitalization (9.5% vs. 9.8%, p = .35).ConclusionsAmong Medicaid enrollees with SMIs who had access to care at FQHCs, those receiving care at FQHCs were more likely to have outpatient mental health visits and psychotropic medication fills, with lower rates of hospitalization, suggesting potentially improved quality of outpatient care. Higher ED visit rates among those receiving care at FQHCs warrant additional investigation.

Sodium Bicarbonate Treatment and Clinical Outcomes in Chronic Kidney Disease with Metabolic Acidosis: A Meta-Analysis.

In patients with chronic kidney disease (CKD), impaired kidney acid excretion leads to the onset of metabolic acidosis (MA). However, the evidence is not yet conclusive regarding the effects of sodium bicarbonate in treating CKD with MA. Databases with PubMed, Embase, and the Cochrane Library were used to search for randomized controlled trials from the inception until November 11, 2023 to identify randomized controlled trials investigating the effect of sodium bicarbonate in participants with CKD and MA. The primary outcome was the change in estimated glomerular filtration rate (eGFR). Secondary outcomes included hospitalization rates, change in systolic blood pressure (SBP), all-cause mortality, and mid-arm muscle circumference (MAMC). A random-effects model was applied for analysis, and subgroup, sensitivity analyses were also performed. Fourteen RCTs comprising 2,037 patients demonstrated that sodium bicarbonate supplementation significantly improved eGFR (standardized mean difference [SMD]: 0.33, 95% CI: 0.03 to 0.63, P = 0.03). The group receiving sodium bicarbonate had a lower hospitalization rate (odds ratio: 0.37, 95% CI: 0.25 to 0.55, P < 0.001). Higher MAMC was observed with sodium bicarbonate treatment compared with those without (SMD:0.23, 95% CI: 0.08 to 0.38, P = 0.003, I2 < 0.001). However, higher risk of elevated SBP was found with sodium bicarbonate treatment (SMD:0.10, 95% CI: 0.01 to 0.20, P = 0.03). No significant difference in all-cause mortality was noted. In patients with CKD and MA, sodium bicarbonate supplementation may provide potential benefits in preventing the deterioration of kidney function and increasing muscle mass. However, treatment may be associated with higher blood pressure. Due to the risk of bias stemming from the absence of double-blinded designs and inconsistencies in control group definitions across the studies, further research is crucial to verify these findings.