Number Of Health Care Contacts Research Articles

Covid-19 vaccine effectiveness against post-covid-19 condition among 589 722 individuals in Sweden: population based cohort study

ObjectiveTo investigate the effectiveness of primary covid-19 vaccination (first two doses and first booster dose within the recommended schedule) against post-covid-19 condition (PCC).DesignPopulation based cohort study.SettingSwedish Covid-19 Investigation for Future...

Identifying Predictors of First-Line Subcutaneous TNF-Inhibitor Persistence in Patients with Inflammatory Arthritis: A Decision Tree Analysis by Indication.

Treatment persistence is a proxy for efficacy, safety and patient satisfaction, and a switch in treatment or treatment discontinuation has been associated with increased indirect and direct costs in inflammatory arthritis (IA). Hence, there are both clinical and economic incentives for the identification of factors associated with treatment persistence. Until now, studies have mainly leveraged traditional regression analysis, but it has been suggested that novel approaches, such as statistical learning techniques, may improve our understanding of factors related to treatment persistence. Therefore, we set up a study using nationwide Swedish high-coverage administrative register data with the objective to identify patient groups with distinct persistence of subcutaneous tumor necrosis factor inhibitor (SC-TNFi) treatment in IA, using recursive partitioning, a statistical learning algorithm. IA was defined as a diagnosis of rheumatic arthritis (RA), ankylosing spondylitis/unspecified spondyloarthritis (AS/uSpA) or psoriatic arthritis (PsA). Adult swedish biologic-naïve patients with IA initiating biologic treatment with a SC-TNFi (adalimumab, etanercept, certolizumab or golimumab) between May 6, 2010, and December 31, 2017. Treatment persistence of SC-TNFi was derived based on prescription data and a defined standard daily dose. Patient characteristics, including age, sex, number of health care contacts, comorbidities and treatment, were collected at treatment initiation and 12months before treatment initiation. Based on these characteristics, we used recursive partitioning in a conditional inference framework to identify patient groups with distinct SC-TNFi treatment persistence by IA diagnosis. A total of 13,913 patients were included. Approximately 50% had RA, while 27% and 23% had AS/uSpA and PsA, respectively. The recursive partitioning algorithm identified sex and treatment as factors associated with SC-TNFi treatment persistence in PsA and AS/uSpA. Time on treatment in the groups with the lowest treatment persistence was similar across all three indications (9.5-11.3months), whereas there was more variation in time on treatment across the groups with the highest treatment persistence (18.4-48.9months). Women have low SC-TNFi treatment persistence in PsA and AS/uSpA whereas male sex and golimumab are associated with high treatment persistence in these indications. The factors associated with treatment persistence in RA were less distinct but may comprise disease activity and concurrent conventional systemic disease-modifying anti-rheumatic drug (DMARD) treatment.

Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark: a nationwide register study

BackgroundWhile underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark.MethodsWe identified all children diagnosed with a cancer at ages 0–15 years in 1998–2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage.ResultsWe found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease.ConclusionFamilies with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time.

Consumption of healthcare services and antibiotics in patients with presumed disseminated Lyme borreliosis before and after evaluation of an infectious disease specialist

Our objective was to study the consumption of healthcare services and antibiotics in patients with suspicion of disseminated Lyme borreliosis (LB) before and after consultation of an infectious disease specialist. We evaluated retrospectively all presumed disseminated LB patients (n = 256) with a referral to the Department of Infectious Diseases (DID) in Helsinki University Hospital in 2013. Medical records from all healthcare providers in the area were reviewed and the number of physician contacts because of symptoms leading to LB suspicion and antimicrobial purchases were calculated 1 year before and after consultation or treatment at the DID. Patients were divided into three groups according to certainty of LB: unlikely, possible or probable/definite LB. The number of healthcare contacts 1 year before referral was higher among 121 patients with unlikely LB (6; interquartile range [IQR] 3–10), than 65 possible (4; IQR 2.5–7; p = 0.018) or 66 probable/definite LB patients (4; IQR 2.8–7; p = 0.010). The median number of contacts to healthcare during one year after consultation or treatment was 3 (IQR 0.5–7), 1 (IQR 0–3) and 0.5 (IQR 0–2.3), respectively, with a statistically significant difference between the groups (p<0.001). Antibiotics were purchased by 151 (60%) patients one year before referral and by 127 (50%) patients year after consultation or treatment at DID without statistically significant difference between groups with different LB certainty. These antibiotic purchases do not include the treatments prescribed by infectious disease specialists. In the case of 27 patients, an antimicrobial treatment was recommended in the consultation reply. In conclusion, patients with unlikely LB used more healthcare services than patients with possible or probable/definite LB. Antimicrobial consumption was similar between groups of different LB certainty.

Implementation of a Care Manager Organization and Its Association with Health Care Contacts and Psychotherapy: A Register-Based Study of Real-Life Outcomes at Primary Health Care Centers in Sweden.

BackgroundA care manager organization, based on a collaborative care model, was implemented in the primary health care service in Region Västra Götaland, Sweden, to improve the care of persons with common mental disorders (CMDs). We aimed to investigate the association between the care manager organization and number of health care contacts, and the extent of psychotherapy among female and male patients with CMD compared to primary health care centers (PHCCs) offering usual care, in the introductory year of implementation with one year follow-up.MethodsThis register-based study included all PHCCs in the region, which were analyzed in two groups depending on their care manager status. The study periods were 2015.09.01–2016.08.31 (first year) and 2016.09.01–2017.08.31 (second year). Data on health care contacts and psychotherapy per PHCC were obtained from a health care register. The mean number and proportion of visits to different health care professionals, and the proportion of patients with short-term versus long-term psychotherapy were measured. A linear mixed-effects model for cross-sectional and longitudinal analysis was implemented as well as a generalized linear regression model for possible interaction effects of PHCC characteristic on care manager status and outcomes.ResultsPHCCs with a care manager organization had more nurse contacts (p = 0.001 for both year 1 and year 2) compared to PHCCs with usual care. PHCCs with usual care had a significantly lower proportion of visits to psychotherapists and a higher proportion of both female and male patients receiving short-term psychotherapy (1–5 sessions vs ≥6) over time and compared to PHCCs with a care manager organization.ConclusionWith a care manager organization, nurse contacts increased at the PHCCs. However, this did not negatively influence the visits to a general practitioner and to psychotherapists. This evaluation showed that the care manager organization at PHCC level implies higher accessibility and sustainability of care for up to two years after implementation.

Disease prevalence and number of health care visits among members of a nationwide sports organization compared to matched controls

BackgroundPhysical activity has positive effects on several diseases and may reduce the risk of morbidity and the mortality rate. Whether the prevalence of disease and health care consumption differ between the members of sports organizations and the general population has not been established. Hence, this pilot study aimed to compare the prevalence of diseases known to be associated with physical inactivity and health care consumption in members of a large non-profit sports organization and an age-, sex- and geographically matched random sample from the general population.MethodsSubjects in two Swedish cities who exercised at least once a week and had been members for at least two years in the non-profit sports organization Friskis&Svettis were invited. A randomized age-, sex- and geographically matched sample was drawn from the general population. Data on disease prevalence (by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes) and health care consumption were retrieved using the members’ personal identification numbers through a regional health care database. Between-group differences in the prevalence of disease were compared using chi2-tests and logistic regression between members and controls. Health care consumption was defined as the number of visits, stratified by primary and hospital care, and was compared using chi2-tests and Mann-Whitney U-tests.ResultsIn total, 3015 subjects were included in each group (response rate 11%). Controls had higher prevalence rates of musculoskeletal diseases (13.3% vs. 11.6%, p = 0.047), metabolic disease (10.4% vs. 5.4%, p < 0.001), hypertension (16.6% vs. 11.7%, p < 0.001), psychiatric diseases (8.9% vs. 7.1%, p = 0.012) and lung cancer (0.4% vs. 0%, p = 0.001) than the members. The total number of health care contacts was 22% higher in the controls than in the members, whereas the proportion of subjects with at least one health care visit was larger in the members (89% vs. 79%, p < 0.001).ConclusionsThe prevalence rates of lifestyle diseases related to musculoskeletal, metabolic and psychiatric diseases, hypertension and lung cancer, and the overall health care consumption, were lower among members of a sports organization than among controls. However, longitudinal studies are needed to establish a cause-effect relationship between membership and disease development.

Health Care Use Before First Heart Failure Hospitalization: Identifying Opportunities to Pre-Emptively Diagnose Impending Decompensation

ObjectivesThis study sought to describe the pattern of health care contacts in patients ultimately presenting with incident hospitalization for acute heart failure (HF) compared with chronic obstructive pulmonary disease (COPD) exacerbation or stable HF. BackgroundLittle is known about how effectively HF is detected before the first acute hospitalization. MethodsWe compared 79,389 patients divided into 3 matched population cohorts in Ontario, Canada (2006–2013) with incident acute HF hospitalization, incident COPD hospitalization, or stable HF. The outcome of interest was the aggregate number of health care contacts occurring in each of the thirteen 28-day periods in the year preceding the index hospitalization. Health care contacts were defined as the total number of outpatient physician visits, hospitalizations for unrelated conditions, or emergency department visits. ResultsAcutely hospitalized patients with HF had a significant increase in health care contacts as time approached the index hospitalization. Patients with acute HF had a 28% increase in health care contacts in the last time period before the index hospitalization (adjusted rate ratio [RR]: 1.28; 95% confidence interval [CI]: 1.25 to 1.31; p < 0.001) compared with matched COPD controls. Compared with stable HF, acutely hospitalized patients had a 75% increase in health care contacts during the same time period (RR: 1.75; 95% CI: 1.71 to 1.79; p < 0.001). HF patients 20 to 40 years of age had an accelerated increase in the rate of health care contacts compared with those ≥65 years of age before index HF hospitalization (RR: 1.18; 95% CI: 1.08 to 1.28; p < 0.001). ConclusionsPatients consulted physicians multiple times before their incident acute HF hospitalization. These health care contacts could represent missed opportunities to prevent hospitalizations for HF.

PCN200 REAL-WORLD HEALTHCARE RESOURCE UTILIZATION IN PATIENTS SUFFERING FROM MALIGNANT MELANOMA, A FINNISH REGISTRY STUDY

Real world data on healthcare resource utilization (HCRU) for melanoma patients is limited. This study aimed to analyze HCRU among melanoma patients in Finland. Data from electronic healthcare records on patients diagnosed with melanoma (ICD-10: C43) was retrieved from the Auria Biobank database covering the Hospital District of Southwest Finland (HDSWF) with roughly 470,000 inhabitants. Descriptive analyses of HCRU was conducted by dividing patients into cohorts according to the disease stages: Stage I & II, Stage III, and Stage IV. Each patient was classified into a one of the three cohorts and the classification was based on the worst stage recorded. Follow-up time was measured from the initial diagnosis. The number of healthcare contacts per patient was collected and by dividing by the mean follow-up, the mean HCRU per patient year was estimated. From 2004 to 2013, 979 patients (49.4% women) were diagnosed with melanoma in the HDSWF. The incidence increased from 50 cases in 2004 to more than 125 cases in 2013. 752 patients had Stage I or II melanoma and had a mean follow-up of 3.46 years, 142 patients with Stage III disease were followed a mean 2.95 years, and 85 Stage IV patients were followed a mean 1.33 years. For Stage I-II, Stage III and Stage IV patients the mean annual inpatients days per patient were 2.6, 5.3, and 21.5, respectively; the mean annual outpatient visits were 5.8, 9.6, and 23.2; the mean annual number of surgeries per patient were 1.4, 1.6, and 1.6. Real world data on HCRU among melanoma patients in show that all types of HCRU increased with worsening of the disease stage. As the Stage III and Stage IV cohorts contain follow-up from patients during earlier stages of their disease, the actual HCRU in Stage III-IV may be higher.

Psychogenic nonepileptic seizures treated with psychotherapy: Long-term outcome on seizures and healthcare utilization

Psychogenic nonepileptic seizures (PNES) are known to be associated with significant costs of healthcare services. Here, we report the impact of psychotherapy on behavior surrounding healthcare utilization and the potential economic benefits associated with long-term seizure control. MethodsThis retrospective study describes patients seen between 2010 and 2016 at the epilepsy clinic at Glostrup University Hospital in Denmark and offered a psychotherapeutic treatment program for PNES. Forty-two patients were interviewed about seizure outcome 12–24 months after psychotherapy, and the annual changes in healthcare utilization and associated costs of services provided in a period of 24 months before and up to 24 months after treatment were compared. ResultsAt 12-month follow-up, 83% of the patients had achieved above 50% reduction in seizures. The 24-month pretreatment costs compared with the 24-month posttreatment costs directly associated with seizures dropped by 95.8%, and total healthcare costs were reduced by 63%. Estimation of annual savings from the program comes to 1060 € per patient. An association was found between seizure rate and number of healthcare contacts. ConclusionThis study adds to the evidence that psychotherapy is a cost-effective way of treating PNES. The economic benefits from this form of intervention appear not only to diminish costs directly associated with PNES, but also healthcare utilization in general.

Attachment style and symptom reporting in young persons with concussion

Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal disease associated with impaired quality of life and an increased use of healthcare services. Self-ratings of health have proven a powerful predictor of health outcomes. The aim of this study was to evaluate the unique impacts of comorbidities, gastrointestinal symptoms, perceived stress and sense of coherence on the number of healthcare contacts and self-rated health of IBS patients in Swedish primary care.In this cross-sectional study, 186 primary-care IBS patients and 360 non-IBS patients (as a reference group) were administrated a test battery of validated questionnaires. Data on comorbidities and healthcare-seeking frequency were obtained from a registry.In the reduced multivariable logistic regression model, average days of abdominal pain/week (OR = 0.83, 95% CI = 0.72–0.96), age (OR = 0.95, 95% CI = 0.92–0.97) and sense of coherence (OR = 1.07, 95% CI = 1.03–1.11) remained independent, statistically significant predictors of IBS (and non-IBS) patients reporting good health. Only the number of comorbidities in general (OR = 1.22, 95% CI = 1.14–1.32) and sleep disorders in particular (OR = 5.40, 95% CI = 1.85–15.76) independently predicted high levels of primary healthcare utilisation among IBS patients.Lack of gastrointestinal symptoms, a high sense of coherence and younger age were associated with better self-rated health in both IBS and non-IBS patients. The number of comorbidities in general and sleep disorders in particular were associated with frequent PHC contacts in IBS patients. The association between frequent primary-care contacts and sleep disorders was not seen in the control group, indicating a unique association with IBS patients.

Primary healthcare utilisation and self-rated health among patients with Irritable Bowel Syndrome: What are the impacts of comorbidities, gastrointestinal symptom burden, sense of coherence and stress?

ObjectivesIrritable Bowel Syndrome (IBS) is a chronic gastrointestinal disease associated with impaired quality of life and an increased use of healthcare services. Self-ratings of health have proven a powerful predictor of health outcomes. The aim of this study was to evaluate the unique impacts of comorbidities, gastrointestinal symptoms, perceived stress and sense of coherence on the number of healthcare contacts and self-rated health of IBS patients in Swedish primary care. MethodsIn this cross-sectional study, 186 primary-care IBS patients and 360 non-IBS patients (as a reference group) were administrated a test battery of validated questionnaires. Data on comorbidities and healthcare-seeking frequency were obtained from a registry. ResultsIn the reduced multivariable logistic regression model, average days of abdominal pain/week (OR = 0.83, 95% CI = 0.72–0.96), age (OR = 0.95, 95% CI = 0.92–0.97) and sense of coherence (OR = 1.07, 95% CI = 1.03–1.11) remained independent, statistically significant predictors of IBS (and non-IBS) patients reporting good health. Only the number of comorbidities in general (OR = 1.22, 95% CI = 1.14–1.32) and sleep disorders in particular (OR = 5.40, 95% CI = 1.85–15.76) independently predicted high levels of primary healthcare utilisation among IBS patients. ConclusionLack of gastrointestinal symptoms, a high sense of coherence and younger age were associated with better self-rated health in both IBS and non-IBS patients. The number of comorbidities in general and sleep disorders in particular were associated with frequent PHC contacts in IBS patients. The association between frequent primary-care contacts and sleep disorders was not seen in the control group, indicating a unique association with IBS patients.

Sex Similarities in Postoperative Recovery and Health Care Contacts Within 14 Days With mHealth Follow-Up: Secondary Analysis of a Randomized Controlled Trial

BackgroundPrevious studies have shown that women tend to have a poorer postanesthesia recovery than men. Our research group has developed a mobile phone app called Recovery Assessment by Phone Points (RAPP) that includes the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire to monitor and assess postoperative recovery.ObjectiveThe aim of this study was to investigate sex differences in postoperative recovery and the number of health care contacts within 14 postoperative days in a cohort of day-surgery patients using RAPP.MethodsThis study was a secondary analysis from a single-blind randomized controlled trial. Therefore, we did not calculate an a priori sample size regarding sex differences. We conducted the study at 4 day-surgery settings in Sweden from October 2015 to July 2016. Included were 494 patients (220 male and 274 female participants) undergoing day surgery. The patients self-assessed their postoperative recovery for 14 postoperative days using the RAPP.ResultsThere were no significant sex differences in postoperative recovery or the number of health care contacts. Subgroup analysis showed that women younger than 45 years reported significantly higher global scores in the SwQoR questionnaire (hence a poorer recovery) on postoperative days 1 to 10 than did women who were 45 years of age or older (P=.001 to P=.008). Men younger than 45 years reported significantly higher global scores on postoperative days 2 to 6 than did men 45 years of age or older (P=.001 to P=.006). Sex differences in postoperative recovery were not significant between the age groups.ConclusionsThis study found sex similarities in postoperative recovery and the number of health care contacts. However, subgroup analysis showed that age might be an independent factor for poorer recovery in both women and men. This knowledge can be used when informing patients what to expect after discharge.Trial RegistrationClinicalTrials.gov NCT02492191; https://clinicaltrials.gov/ct2/show/NCT02492191 (Archived by WebCite at http://www.webcitation.org/6y2UtMbvz)

Treatment of Severe Pain and Opioid-induced Constipation: An Observational Study of Quality of Life, Resource Use, and Costs in Sweden.

IntroductionOpioid-induced constipation (OIC) is a common and costly side effect of opioid treatment affecting patients’ quality of life (QoL). The combination oxycodone/naloxone reduces OIC while providing effective analgesia in patients with moderate to severe pain. The objective of this observational study was to compare health-related quality of life (HRQoL), healthcare resource use, and costs in patients with severe pain who were initially treated with oxycodone and laxatives and then subsequently switched to treatment with oxycodone/naloxone.MethodsData were collected by means of questionnaires completed by patients with OIC before and after the initiation of oxycodone/naloxone treatment at different clinical centers in Sweden. The questionnaires included questions on healthcare resource use and absence from work and also consisted of the Patient Assessment of Constipation-QoL (PAC-QoL) instrument, the EuroQol five dimensions questionnaire (EQ‐5D), the Patient Assessment of Constipation Symptoms (PAC-SYM) instrument, and the Bowel Function Index (BFI).ResultsThe analysis included 37 patients. Resource utilization was lower after treatment with oxycodone/naloxone, in terms of both the number of healthcare contacts and the purchases of medicine for the treatment of constipation. According to the BFI score, patients had fewer problems with OIC after the initiation of oxycodone/naloxone. The PAC-QoL score showed a positive change for patients in both the 96-point dissatisfaction index and the 16-point satisfaction index. PAC-SYM scores was lower after the initiation of oxycodone/naloxone treatment, indicating fewer constipation-related problems.ConclusionTreatment with oxycodone/naloxone had an overall positive effect on patients, consisting mainly of decreasing the severity of the constipation problems, increasing HRQoL, and decreasing the use of healthcare resources. Funding: Mundipharma AB, Gothenburg, Sweden.

The effect of a nurse led telephone supportive care programme on patients’ quality of life, received information and health care contacts after oesophageal cancer surgery—A six month RCT-follow-up study

BackgroundFollowing oesophagectomy, a major surgical procedure, it is known that patients suffer from severely reduced quality of life and have an unmet need for postoperative support. Still, there is a lack of research testing interventions aiming to enhance the patients’ life situation after this surgical procedure. AimThe aim of the study was to evaluate the effect of a nurse led telephone supportive care programme on quality of life (QOL), received information and the number of healthcare contacts compared to conventional care following oesophageal resection for cancer. MethodThe study was designed as a randomized controlled trial (RCT) aiming to test the effect of a nurse led telephone supportive care program compared to conventional care. Patient assessments were conducted at discharge, 2 weeks, 2, 4 and 6 months after discharge and comprised evaluation of QOL, received information and the number of health care contacts. Statistical testing were conducted with repeated measurements analysis of variance to test if there were differences between the groups during follow-up. ResultThe results show that the intervention group was significantly more satisfied with received information for items concerning the information they received about things to do to help yourself, written information and for the global information score. The control group scored significantly higher on the item regarding wishing to receive more information and wish to receive less information. No effect of the intervention was shown on QOL or number of health care contacts. ConclusionProactive nurse-led telephone follow-up has a significant positive impact on the patients’ experience of received information. This is likely to have a positive effect on their ability to cope with a life that may include remaining side effects and adverse symptoms for a long time after surgery.

The Prevalence and Associated Distress of Physical and Psychological Symptoms in Patients With Advanced Heart Failure Attending a South African Medical Center.

Despite the high prevalence of heart failure in low- and middle-income countries, evidence concerning patient-reported burden of disease in advanced heart failure is lacking. The aim of this study is to measure patient-reported symptom prevalence and correlates of symptom burden in patients with advanced heart failure. Adult patients diagnosed with New York heart Association (NYHA) stage III or IV heart failure were recruited from the emergency unit, emergency ward, cardiology ward, general medicine wards, and outpatient cardiology clinic of a public hospital in South Africa. Patients were interviewed by researchers using the Memorial Symptom Assessment Scale-Short Form, a well-validated multidimensional instrument that assesses presence and distress of 32 symptoms. A total of 230 patients (response, 99.1%), 90% NYHA III and 10% NYHA IV (12% newly diagnosed), with a mean age of 58 years, were included. Forty-five percent were women, 14% had completed high school, and 26% reported having no income. Mean Karnofsky Performance Status Score was 50%. Patients reported a mean of 19 symptoms. Physical symptoms with a high prevalence were shortness of breath (95.2%), feeling drowsy/tired (93.0%), and pain (91.3%). Psychological symptoms with a high prevalence were worrying (94.3%), feeling irritable (93.5%), and feeling sad (93.0%). Multivariate linear regression analyses, with total number of symptoms as dependent variable, showed no association between number of symptoms and gender, education, number of healthcare contacts in the last 3 months, years since diagnosis, or comorbidities. Increased number of symptoms was significantly associated with higher age (b = 0.054, P = .042), no income (b = -2.457, P = .013), and fewer hospitalizations in the last 12 months (b = -1.032, P = .017). Patients with advanced heart failure attending a medical center in South Africa experience high prevalence of symptoms and report high levels of burden associated with these symptoms. Improved compliance with national and global treatment recommendations could contribute to reduced symptom burden. Healthcare professionals should consider incorporating palliative care into the care for these patients.

Abstract 17263: Healthcare Contacts Before Sudden Out-of-Hospital Cardiac Arrest Can Help Identify Young Patients at Risk of Sudden Cardiac Death

Background The underlying etiology of sudden cardiac death varies with age and is likely to be reflected in type and number of healthcare contacts. We aimed to determine the specific type of healthcare contact shortly before out-of-hospital cardiac arrest (OHCA) across ages. Methods Patients with OHCA were identified in the nationwide Danish Cardiac Arrest Register and Copenhagen Medical Emergency Care Unit from 2001-2006. We matched every OHCA patients with 10 controls on sex and age. Healthcare contacts were evaluated 30 days before event by individual-level-linkage of nationwide registers. Healthcare contact associations to OHCA were evaluated using conditional multivariate logistic regression. Results We identified 16,924 OHCA patients, median age was 70.0 years (IQR: 59-80) and 65.8% were male. In general, the association between OHCA and hospital admissions and pharmacotherapy was more pronounced among the youngest (14-34 years) OHCA patients 30 days before OHCA compared to older patients (≥75 years): antidepressants (OR=4.5, CI:2.7-7.5 and OR=1.1; CI:1.0-1.2), sedatives and anxiolytics (OR=11.1, CI:6.8-18.4 and OR=1.1, CI:1.0-1.2), anti-psychotic medication (OR=5.6, CI:2.9-11.7 and OR=1.5, CI:1.3-1.7), bronchial dilators (OR=3.4, CI:1.9-6.0 and OR=2.1, CI:1.9-2.3), and corticosteroids (OR=4.0, CI:1.0-16.4 and OR=1.8, CI:1.6-2.0). Furthermore, patients aged &lt;40 years were &gt;6 times more likely to be in contact with the healthcare services (than the control population whereas OHCA patients &gt;60 years were only 2 times more likely to be in contact with the healthcare services shortly before OHCA compared to the control population (Figure 1). Conclusion Young OHCA patients are far more likely to be in contact with the healthcare services compared with an age and sex matched control population suggestive of traits that make them stand out from the general population and make them potentially identifiable before cardiac arrest.

Hospital admissions and pharmacotherapy before out-of-hospital cardiac arrest according to age

BackgroundThe underlying etiology of sudden cardiac death varies with age and is likely to be reflected in type and number of healthcare contacts. We aimed to determine the specific type of healthcare contact shortly before out-of-hospital cardiac arrest (OHCA) across ages. MethodsOHCA patients were identified in the nationwide Danish Cardiac Arrest Register and Copenhagen Medical Emergency Care Unit (2001–2006). We matched every OHCA patients with 10 controls on sex and age. Healthcare contacts were evaluated 30 days before event by individual-level-linkage of nationwide registers. ResultsWe identified 16,924 OHCA patients, median age 70.0 years (Q1–Q3: 59–80). OHCA patients had a higher number of hospitalizations and received more pharmacotherapy compared to the control population across all ages (p for difference <0.001). OHCA patients aged 70–79 and 80–89 years had the highest proportion of hospitalizations (70%) and pharmacotherapy (73%), respectively. In general, the association between OHCA and hospitalizations and pharmacotherapy was more pronounced among the youngest OHCA patients compared to controls. OHCA patients in age groups 14–19, 20–29, 30–39 were ∼5 times more likely to be in contact with the healthcare service than the control population (p for difference <0.001). Similarly, OHCA patients in the oldest age groups (60–69, 70–79, 80–89, >89) were <2 times more likely to be in contact with the healthcare services shortly before OHCA compared to the control population (p for difference <0.001). ConclusionYoung OHCA patients are more likely to be in contact with the healthcare services compared with an age and sex matched control population suggestive of traits that make them stand out from the general population.

Comparing health care use and related costs between groups with and without hearing impairment

This study aims to compare the use (and related costs) of different health care resources between groups of normally-hearing and hearing-impaired people. A distinction was made between hearing-related and other health care contacts. Data were collected at the baseline measurement of the national longitudinal study on hearing, and at each month during a subsequent period of six months. Hearing status was determined using an internet speech-in-noise test. The sample comprised 1295 normally-hearing and hearing-impaired subjects, aged 18–65 years. Adjusting for confounders, regression models showed that hearing-impaired respondents had significantly more contacts and higher costs for primary, secondary, and occupational care than normally-hearing respondents during the period under investigation. The differences were due to a larger number of health care contacts for which hearing impairment was the main motive to seek help. After excluding these contacts, the differences in health care use and costs between the groups were not significant. This suggests that besides hearing-related contacts, adults with hearing impairment do not make more use of health care resources than adults without hearing difficulties.SumarioEl objetivo de este estudio fue comparar el uso (y sus costos) de diferentes formas de cuidados de la salud entre grupos con audición normal o con impedimentos auditivos. Se hizo una distinción entre proveedores de servicios de salud relacionados con la audición u otros. Se colectaron datos con las mediciones de base del estudio longitudinal nacional sobre la audición y subsecuentemente cada mes, durante un período de seis meses. Se determinó la condición auditiva usando una prueba de lenguaje-en-ruido por internet. La muestra comprendió a 1295 normo-oyentes e hipoaúsicos, con edades entre 18–65 años. Con ajustes contra elementos de confusión, los modelos de regresión mostraron que los hipoacúsicos tenían significativamente más contactos y mayores costos de cuidados primarios, secundarios y ocupacionales que los oyentes durante el período de la investigación. Las diferencias se debieron a un mayor número de contactos para cuidados de la salud, que en el caso de los hipoacúsicos, fue el principal motivo de búsqueda de ayuda. Después de excluir esos contactos, las diferencias en uso y costos de cuidados de la salud entre ambos grupos no fue significativa. Esto sugiere que aparte de los contactos relacionados con la audición, los adultos con impedimentos auditivos no hacen más uso de los recursos para cuidados de la salud que los adultos que no tienen dificultades auditivas.

The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment

BackgroundThe role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts.MethodsIn this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms.ResultsFive main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, Staphylococcus aureus (S. aureus), Group B streptococci (GBS) and Enterococcus faecalis. More women with mastitis had S. aureus and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured S. aureus and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with ≥ 107 cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003).ConclusionMany healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.

Psychosocial predictors of health-related quality of life and health service utilisation in people with chronic low back pain

Psychological and social factors have been shown, separately, to predict outcome in individuals with chronic low back pain. Few previous studies, however, have integrated both psychological and social factors, using prospective study of clinic populations of low back pain patients, to identify which are the most important targets for treatment. One hundred and eight patients with chronic low back pain, newly referred to an orthopaedic outpatient clinic, completed assessments of demographic characteristics, details of back pain, measures of anxiety and depression (Hospital Anxiety and Depression Scale, HADS), fearful beliefs about pain (Fear Avoidance Beliefs Questionnaire), social stresses (Life Events and Difficulties Schedule) and physical aspects of health-related quality of life [SF-36 Physical Component summary Score scale (PCS)]. Six months later subjects completed the SF-36 PCS and the number of healthcare contacts during follow-up was recorded. Independent predictors of SF-36 PCS at 6-month follow-up were duration of pain [(standardised regression coefficient (β)=−0.18, p=0.04), HADS score (β)=−0.27, p=0.003] and back pain related social difficulties (β=−0.42, p<0.0005). Number of healthcare contacts over the 6 months ranged from 1 to 29, and was independently predicted by perceived cause of pain [Incident Rate Ratio (IRR)=1.46, p=0.03], Fear Avoidance Beliefs about work (IRR=1.02, p=0.009) and back pain related social difficulties (IRR=1.16, p=0.03). To conclude, anxiety, depression, fear avoidance beliefs relating to work and back pain related stresses predict impairment in subsequent physical health-related quality of life and number of healthcare contacts. Interventions targeting these psychosocial variables in clinic patients may lead to improved quality of life and healthcare costs.