Pre-existing Chronic Conditions Research Articles

A Study on Enumeration of Factors Prone to the Development of COVID-19-Associated Mucormycosis

Abstract Background Patients with pre-existing chronic medical conditions with altered immunity are prone to COVID-19-associated mucormycosis (CAM). Objective In this study, our objectives were to identify the risk factors that increase the chances of developing CAM and to determine the severity of the risk factors of CAM. Thereby, we can optimize the modifiable risk factors for developing CAM in coronavirus disease 2019 (COVID-19) patients. For instance, better control of blood glucose levels in COVID-19 patients can decrease the risk of developing CAM. Materials and Methods The data was collected retrospectively from 1000 COVID-19 infected patients, above the age of 18 years during the time period of March 2021 to August 2021, in which 86 patients had confirmed CAM. Statistical Analysis Binary logistic regression and curve estimation analysis were performed using SPSS software version 29 for identifying the associated risk factors of CAM with the significance of p-value less than 0.05. Results Factors such as severe inflammation (p = 0.048), high dose of steroid administration (p = 0.005), increasing age (p < 0.001), and prolonged hospital stay (p < 0.001) were statistically proven to be significant risk factors, associated with CAM. Conclusion Increasing age, severe inflammation, high dose of steroid administration, and prolonged hospital stay have association with occurrence of CAM.

Oncologists’ perceived confidence and attitudes toward managing pre-existing chronic comorbidities during patients’ active cancer treatment

PurposeTo examine practicing oncologists’ perceived confidence and attitudes toward management of pre-existing chronic conditions(PECC) during active cancer treatment(ACT). MethodsIn December 2018, oncologists in the National Cancer Institute's Community Oncology Research Program (NCORP) were invited to complete a was pilot-tested, IRB-approved online survey about their perceived confidence in managing PECC. Pearson chi-square test was used to identify oncologists’ differences in perceived confidence to manage PECC and attitudes toward co-management of patients’ PECC with non-oncologic care providers. Perceived confidence and attitudes were analyzed as a function of medical specialty while controlling demographic and medical practice variables. ResultsA total of 391 oncologists responded to the survey, 45.8% stated medical oncology as their primary specialty, 15.1% hematology oncology, 15.1% radiation oncology, 6.9% surgical oncology, and 17.1% other specialties such as gynecology oncology. Overall, 68.3% agreed (agree/strongly agree) that they were confident to manage PECC in the context of standard of care. However, only 46.6% and 19.7% remained confident when managing PECC previously managed by a primary care physician (PCP) and by a non-oncology subspecialist, respectively. Most oncologists (58.3%) agreed that patients’ overall care was well coordinated, and 63.7% agreed that patients had optimal cancer and non-cancer care when PECC was co-managed with a non-oncology care provider. ConclusionMost oncologists felt confident to manage all PECC during patients’ ACT, but their perceived confidence decreased for PECC previously managed by PCPs or by non-oncology subspecialists. Additionally, they had positive attitudes toward co-management of PECC with non-oncologic care providers. These results indicate opportunities for greater collaboration between oncologists and non-oncology care providers to ensure comprehensive and coordinated care for cancer patients with PECC.

Health Problems and Healthcare use During the COVID-19 Pandemic: Impact on Vulnerable Groups.

Introduction:The COVID-19 pandemic and the countermeasures taken form a threat to the physical and mental health of the population, especially for more vulnerable groups. In this study, which is part of the Integrated Health Monitor COVID-19, the impact of the COVID-19 pandemic on the healthcare use of the Dutch population and specific vulnerable groups was examined.Method:In this study two data-sources were combined. The first consists of electronic patient records of general practices (GP) participating in the Nivel Primary Care Database. These records are representative of the Dutch population and provide insight into acute complaints, chronic conditions, medication prescriptions and primary care use. For the current study, primary care use in pre-COVID years (2018 and 2019) was compared to that in 2021. This data was coupled with microdata from Statistics Netherlands, containing such information as socio-economic status and migration background. Analyses were conducted using longitudinal mixed-effects regression models.Results:Results show that risk factors play a role in the utilization of primary care. Women and those with a low household income visited the GP more often for mental complaints. Individuals with a migrant background visited the GP more often for coughing, fatigue, and social problems. Those with pre-existing chronic physical conditions were seen less often by their GP for shortness of breath. Among those with pre-existing mental problems GPs more often registered shortness of breath, yet less problems with access to care or social problems.Conclusion:Combining GP registry data with relevant background data has deepened our understanding of changes in health problems and healthcare use among the general population during the COVID-19 pandemic. This study provides insight into how specific vulnerable groups are affected more strongly, and emphasizes the importance of monitoring these groups during a health crisis.

Agribusiness and the COVID-19 syndemic: The unsustainable pathways.

It has been suggested that it would be more appropriate to term the COVID-19 pandemic a syndemic, as the infection interacts synergistically with pre-existing chronic conditions such as obesity. Both conditions occur with steep socio-economic inequalities, and Brazil is suffering a heavy burden from both. What and who drives the clustering and interaction of these disorders? In this commentary, we examine the pathways leading to the COVID-19 syndemic. Deforestation, declining biodiversity and factory farming are promoting the emergence of new pathogens. Widespread use of pesticides influences immune, endocrine and metabolic systems. The ingestion of ultra-processed food promotes malnutrition and obesity in a country where at the same time poverty and food insecurity is rising. Brazilian agribusiness is focused on the production and global export of agricultural commodities, mainly for animal food and meat production. It is made possible through a combination of expanded land use, with deforestation in Amazonas and other Brazilian biomes, and the intensification of land use and cultivation of genetically modified crops with fertilizers and pesticides. This development is not sustainable for either population health or the environment.

Community stressors and coping mechanisms in accessing the health system during a double crisis: a qualitative case study from Yangon Region, Myanmar

BackgroundDue to the COVID-19 pandemic and political crisis, Myanmar’s health system has suspended routine services while struggling to respond to the pandemic. Many people who need continuous care, like pregnant women and people with chronic illnesses, have been facing challenges in seeking and receiving essential health services. This study explored community health seeking practices and coping mechanisms, including their views on health system stressors.MethodsThis was a cross-sectional qualitative study based on 12 in-depth-interviews with pregnant people and persons with pre-existing chronic health conditions in Yangon. Sampling was purposive, convenience-based and snowball sampling was also used. The 3-delays framework was used to understand how persons were interacting with and accessing health care services; community and health system stressors and coping mechanisms in relation to COVID-19 were also identified.ResultsFindings showed that Yangon region was the hardest hit with both the pandemic and political crisis and its health system was greatly affected. People were unable to access essential health services on time. The health facilities were not available to see patients, with serious shortages in human resources, medicines and equipment, resulting in interruption of essential routine services. The prices of medicines and consultation fees, and transportation costs, increased during this period. Limited options for accessing care were available due to travel restrictions and curfews. It became challenging to receive quality care because of unavailable public facilities and private hospitals being costly.Despite these challenges, the Myanmar people and health system have shown resilience. Cohesive and organized family support structures and extended and deep social networks played an important role in accessing health care. At times of emergency, people relied on community-based social organizations for transportation and accessing essential medicines. The health system also showed resilience through establishing new service provision options, such as teleconsultations, mobile clinics, and sharing medical advice through social media.ConclusionsThis is the first study in Myanmar to explore peoples’ perceptions on COVID-19, the health system and their healthcare experiences during political crisis. Although there is no easy way to cope with this dual hardship, the people and the health system, even in a fragile and shock-prone setting like Myanmar, stayed resilient by developing alternative pathways for seeking and providing health services.

Explaining the higher COVID-19 mortality rates among disproportionately Black counties: A decomposition analysis

BackgroundWhy is COVID-19 mortality higher in counties with a disproportionately large (>13.4%) share of Black residents (hereafter “Black counties”) relative to others (“non-Black counties”)? Existing literature points to six categories of determinants: (1) social distancing, (2) COVID-19 testing, (3) socioeconomic characteristics, (4) environmental characteristics, (5) prevalence of (pre-existing) chronic health conditions, and (6) demographic characteristics. The relative importance of these determinants has not yet been thoroughly examined. MethodsWe built a dataset consisting of 21 sub-indicators across the six categories of determinants for 3108 US counties and their COVID-19 mortality over the period of January 22, 2020–December 31, 2020. Applying the Gelbach's decomposition, we quantified which determinants were most (or least) associated with the COVID-19 mortality disparity between Black and non-Black counties. ResultsWe find that COVID-19 death rates were 26 percent higher in Black counties compared to non-Black counties. This disparity was almost completely explained by the six categories of determinants included in our model. Decomposition analyses indicate that county-level demographic and population health characteristics explained most of this disparity. Among all sub-indicators considered, the greater proportion of females and smaller proportion of rural residents in Black counties were the two largest contributors to the COVID-19 mortality gap between Black and non-Black counties. Proportions of diabetic residents, uninsured residents, and the degree of income inequality also significantly contributed to the gap in COVID-19 mortality. ConclusionThe COVID-19 mortality gap between Black and non-Black counties was largely explained by pre-pandemic differences in demographic and population health characteristics. Policies aiming to reduce the prevalence of chronic conditions and uninsured residents in Black counties would have helped narrow the COVID-19 mortality gap between Black and non-Black counties in 2020.

Circulating sTREM-1 as a predictive biomarker of pediatric multisystemic inflammatory syndrome (MIS-C).

The exacerbation of the inflammatory response caused by SARS-CoV-2 in adults promotes the production of soluble mediators that could act as diagnostic and prognostic biomarkers for COVID-19. Among the potential biomarkers, the soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) has been described as a predictor of inflammation severity. The aim was to evaluate sTREM-1 and cytokine serum concentrations in pediatric patients during the acute and convalescent phases of COVID-19. This was a prospective study that included 53 children/adolescents with acute COVID-19 (Acute-CoV group); 54 who recovered from COVID-19 (Post-CoV group) and 54 controls (Control group). Preexisting chronic conditions were present in the three groups, which were defined as follows: immunological diseases, neurological disorders, and renal and hepatic failures. The three groups were matched by age, sex, and similar preexisting chronic conditions. No differences in sTREM-1 levels were detected among the groups or when the groups were separately analyzed by preexisting chronic conditions. However, sTREM-1 analysis in the seven multisystemic inflammatory syndrome children (MIS-C) within the Acute-Cov group showed that sTREM-1 concentrations were higher in MIS-C vs non-MIS-C acute patients. Then, the receiver operating curve analysis (ROC) performed with MIS-C acute patients revealed a significant AUC of 0.870, and the sTREM-1 cutoff value of>5781pg/mL yielded a sensitivity of 71.4% and a specificity of 91.3% for disease severity, and patients with sTREM-1 levels above this cutoff presented an elevated risk for MIS-C development in 22.85-fold (OR=22.85 [95% CI 1.64-317.5], p=0.02). The cytokine analyses in the acute phase revealed that IL-6, IL-8, and IL-10 concentrations were elevated regardless of whether the patient developed MIS-C, and those levels decreased in the convalescent phase, even when compared with controls. Spearman correlation analysis generated positive indexes between sTREM-1 and IL-12 and TNF-α concentrations, only within the Acute-CoV group. Our findings revealed that sTREM-1 in pediatric patients has good predictive accuracy as an early screening tool for surveillance of MIS-C cases, even in patients with chronic underlying conditions.

Epidemic Features of COVID-19 and Potential Impact of Hospital Strain During the Omicron Wave - Australia, 2022.

Hospitals have experienced a surge in admissions due to the increasing number of Omicron cases. Understanding the epidemiological features of coronavirus disease 2019 (COVID-19) and the strain it places on hospitals will provide scientific evidence to help policymakers better prepare for and respond to future outbreaks. The case fatality rate of COVID-19 was 1.4 per 1,000 persons during the Omicron wave. Over 90% of COVID-19-related deaths occurred in individuals aged 60 years or older, with pre-existing chronic conditions such as cardiac conditions and dementia, particularly among males aged 80 years or older. Public health policy is essential for preparing and preserving medical resource capacity, as well as recruiting additional clinicians and front-line staff in hospitals to address the increased demand. High-risk individuals should be prioritized for healthcare, vaccines, and targeted interventions.

Effect of Pre-Existing Chronic Medical Conditions on Clinical Features and Disease Outcomes of COVID-19 Infection in Jordanian Children

Effect of Pre-Existing Chronic Medical Conditions on Clinical Features and Disease Outcomes of COVID-19 Infection in Jordanian Children

Double, Triple, and Quadruple Jeopardy: Entering Pregnancy With Two or More Multimorbid Diagnoses and Increased Risk of Severe Maternal Morbidity and Postpartum Readmission.

Multimorbidity, the presence of two or more chronic disease diagnoses, is associated with an increased risk of mortality and high health care costs in the general population and older adults. However, little evidence is available about the prevalence and impact of multimorbidity in obstetric populations. The goal of this analysis was to estimate the association between multimorbidity and severe maternal morbidity (SMM) and 90-day postpartum readmission in an obstetric cohort in Atlanta, Georgia. We conducted a retrospective cohort study of livebirths and stillbirths at Grady Memorial Hospital, from October 2015 to April 2021. To determine preexisting chronic conditions, we linked information on births to inpatient diagnoses within the prior year. Multimorbidity was defined as the presence of two or more chronic disease diagnoses at birth or within the prior year. We conducted multivariable log binomial regression to estimate risk ratios and 95% confidence intervals for the crude and adjusted (for age, race/ethnicity, parity, and insurance) association between multimorbidity (two or more chronic conditions vs. zero or one) and SMM (at or within 42days after birth) or 90-day postpartum readmission for any reason. Of 14,225 included births, 10.1% were to patients with multimorbidity. Overall, SMM complicated 7.5% of births, and the 90-day readmission rate was 2.4%. Both SMM and readmission were more common among women with multimorbidity (SMM, 18.6% among women with multimorbidity compared with 6.3% without; 90-day readmission, 5.4% compared with 2.1%). Adjusting for potential confounders, multimorbidity was associated with increased risk of SMM (adjusted risk ratio, 2.9; 95% confidence interval, 2.5-3.0) and readmission (adjusted risk ratio, 2.2; 95% confidence interval, 1.7-2.9). Individuals entering pregnancy with two or more chronic diseases were at an increased risk of SMM and postpartum readmission compared with individuals with one or zero chronic disease diagnoses.

Hospital Variation in Mortality After Inpatient Pediatric Surgery.

The aim was to determine the association between risk adjusted hospital perioperative mortality rates, postoperative complications, and failure to rescue (FTR) after inpatient pediatric surgery. FTR has been identified as a possible explanatory factor for hospital variation in perioperative mortality in adults. However, the extent to which this may be the case for hospitals that perform pediatric surgery is unclear. The Pediatric Health Information System database (2012-2020) was used to identify patients who underwent one of 57 high-risk operations associated with significant perioperative mortality (n=203,242). Academic, pediatric hospitals (n=48) were stratified into quintiles based on risk adjusted inpatient mortality [lower than average, quintile 1 (Q1); higher than average, quintile 5 (Q5)]. Multivariable hierarchical regression was used to evaluate the association between hospital mortality rates, complications, and FTR. Inpatient mortality, complication, and FTR rates were 2.3%, 8.8%, and 8.8%, respectively. Among all patients who died after surgery, only 34.1% had a preceding complication (Q1, 36.1%; Q2, 31.5%; Q3, 34.7%; Q4, 35.7%; Q5, 32.2%; trend test, P =0.49). The rates of observed mortality significantly increased across hospital quintiles, but the difference was <1% (Q1, 1.9%; Q5; 2.6%; trend test, P <0.01). Relative to Q1 hospitals, the odds of complications were not significantly increased at Q5 hospitals [odds ratio (OR): 1.02 (0.87-1.20)]. By comparison, the odds of FTR was significantly increased at Q5 hospitals [OR: 1.60 (1.30-1.96)] with a dose-response relationship across hospital quintiles [Q2-OR: 0.99 (0.80-1.22); Q3-OR: 1.26 (1.03-1.55); Q4-OR: 1.33 (1.09-1.63)]. The minority of pediatric surgical deaths are preceded by a postoperative complication, but variation in risk adjusted mortality across academic, pediatric hospitals may be partially explained by differences in the recognition and management of postoperative complications. Additional work is needed to identify children at greatest risk of postoperative death from perioperative complications as opposed to those at risk from pre-existing chronic conditions.

Unplanned Admissions, Emergency Department Visits, and Epilepsy After Critical Neurological Illness Requiring Prolonged Mechanical Ventilation in Children.

Long-term outcomes after pediatric neurocritical illness are poorly characterized. This study aims to characterize the frequency and risk factors for post-discharge unplanned health resource use in a pediatric neurocritical care population using insurance claims data. Retrospective cohort study evaluating children who survived a hospitalization for an acute neurologic illness or injury requiring mechanical ventilation for >72hours and had insurance eligibility in Colorado's All Payers Claims database. Insurance claims identified unplanned readmissions and emergency department [ED] visits during the post-discharge year. For patients without pre-existing epilepsy/seizures, we evaluated for post-ICU epilepsy identified by claim(s) for a maintenance anti-seizure medication during months 6-12 post-discharge. Multivariable logistic regression identified factors associated with each outcome. 101 children, median age 3.7years (interquartile range (IQR) .4-11.9), admitted for trauma (57%), hypoxic-ischemic injury (17%) and seizures (15%). During the post-discharge year, 4 (4%) patients died, 26 (26%) were readmitted, and 48 (48%) had an ED visit. Having a pre-existing complex chronic condition was independently associated with readmission and emergency department visit. Admission for trauma was protective against readmission. Of those without pre-existing seizures (n = 86), 25 (29%) developed post-ICU epilepsy. Acute seizures during admission and prolonged ICU stays were independently associated with post-ICU epilepsy. Survivors of pediatric neurocritical illness are at risk of unplanned healthcare use and post-ICU epilepsy. Critical illness risk factors including prolonged ICU stay and acute seizures may identify cohorts for targeted follow up or interventions to prevent unplanned healthcare use and post-ICU epilepsy.

An international study of post-COVID sleep health

ObjectivesCOVID-19 has infected millions of people worldwide, with growing evidence that individuals with a history of infection may continue to show persistent post-COVID symptoms (long COVID). The aim of this study was to investigate sleep health in an international sample of individuals who reported previously testing positive for COVID-19. DesignCross-sectional. SettingOnline survey distributed online between March and June 2021. ParticipantsA total of 1001 individuals who reported a positive diagnosis of COVID-19 across different geographical regions, including North and South America, Sub-Saharan Africa, and Europe. MeasurementsSelf-reported sleep health, using the Regulatory Satisfaction Alertness Timing Efficiency Duration scale, as recalled before a COVID-19 diagnosis and also reported currently. ResultsIndividuals reported worse overall current sleep health, with lower ratings across the 6 dimensions of sleep health (sleep regularity, satisfaction, alertness, timing, efficiency, and duration) compared to their ratings as recalled before COVID-19 infection. Greater severity of COVID-19 symptoms was the strongest predictor of poor current sleep health (P < .001), independent of demographics, presence of a pre-existing chronic health condition, and time since infection. Poor current sleep health was associated with poorer current quality of life (P < .001). ConclusionsPoor current sleep health is evident in individuals with a history of COVID-19, particularly those with more severe symptoms at the time of their COVID-19 infection and is associated with a poorer quality of life. Clinicians and researchers should assess sleep health in COVID-19 patients and investigate long-term associations with their mental and physical health, as well as potential benefits of improving sleep in this population.

MONitoring Knockbacks in EmergencY (MONKEY) - An Audit of Disposition Outcomes in Emergency Patients with Rejected Admission Requests.

BackgroundEmergency Department (ED) clinicians commonly experience difficulties in referring patients to inpatient teams for hospital admission. There is limited literature reporting on patient outcomes following these complicated referrals, where ED requests for inpatient admission are rejected – which study investigators termed a “knockback”.PurposeTo identify disposition outcomes and referral accuracy in ED patients whose admission referral was initially rejected. Secondary objectives were to identify additional patient, clinician and systemic factors associated with knockbacks.Selection and MethodologyEmergency clinicians prospectively nominated a convenience sample of patients identified as having knockbacks over two time periods (Jan–Feb 2020 and Aug 2020 to Jan 2021) at a tertiary Australian ED. Data were analyzed with a mixed-methods approach and subsequent descriptive and thematic analyses were performed.ResultsA total of 109 patients were identified as knockbacks. The referrals were warranted, with 89.0% of cases (n = 97) ultimately requiring a hospital admission. In 60.6% (n = 66) of the admissions, patients were admitted under the inpatient team initially referred to by the ED, suggesting referrals were generally accurate. The number of in-hospital units involved in the admission process and ED length of stay were positively correlated (0.409, p < 0.001). Patient factors associated with knockbacks include pre-existing chronic medical conditions and presenting acutely unwell. Analysis of clinicians’ perspectives yielded recurring themes of disagreements over admission destination and diagnostic uncertainty.ConclusionIn this patient sample, emergency referrals for admission were mostly warranted and accurate. Knockbacks increase ED length of stay and may adversely affect patient care. Further focused discussion and clearer referral guidelines between ED clinicians and their inpatient colleagues are required.

Why Are Some Male Alcohol Misuse Disorder Patients High Utilisers of Emergency Health Services? An Asian Qualitative Study.

Background: Certain alcohol misuse patients heavily utilise the Emergency Department (ED) and Emergency Medical Services (EMS) and may present with intoxication or long-term sequelae of alcohol misuse. Our study explored reasons for repeated ED/EMS utilisation and sought to understand perpetuating and protective factors for drinking. Methods: Face-to-face semi-structured qualitative interviews were conducted. Participants were recruited from an ED in Singapore. Interviews were audio-recorded, transcribed verbatim and underwent manual thematic analysis. Emergent themes were independently reviewed for agreement. Data from medical records, interview transcripts, and field notes were triangulated for analysis. Results: All participants were male (n = 20) with an average age of 55.6 years (SD = 8.86). Most were unemployed (75%), did not have tertiary education (75%), were divorced (55%), and had pre-existing psychiatric conditions (60%) and chronic cardiovascular conditions (75%). Reasons for utilisation included a perceived need due to symptoms, although sometimes it was bystanders who called the ambulance. ED/EMS was preferred due to the perceived higher quality and speed of care. Persistent drinking was attributed to social and environmental factors, and as a coping mechanism for stressors. Rehabilitation programs and meaningful activities reduced drinking tendencies. Conclusion: ED/EMS provide sought-after services for alcohol misuse patients, resulting in high utilisation. Social and medical intervention could improve drinking behaviours and decrease overall ED/EMS utilisation.

Burden of mental distress in the United States is associated with delayed medical visits and missed prescription refills during the COVID-19 pandemic

The COVID-19 pandemic has contributed to poor health due to a decrease in healthcare utilization and those with mental health problems may be impacted.For this analysis, data came from a cross-sectional, nationally representative December 2020 survey. Logistic regression analyses examined associations between (1) mental distress and delayed medical visits, (2) mental distress and missed prescription refills, controlling for sociodemographics, pre-existing chronic conditions, and access to health insurance. We found that, compared to those that exhibited normal levels of mental distress, those with mild (aOR = 2.83, 95% CI = 2.47–3.24), moderate (aOR = 3.43, 95% CI = 2.95–3.99), and severe (aOR = 4.96, 95% CI = 4.21–5.84) mental distress showed greater odds of delaying medical visits. Similarly, compared to those that exhibited normal levels of mental distress, those with mild (aOR =3.93, 95% CI = 3.04–5.09), moderate (aOR =6.52, 95% CI = 5.07–8.43), and severe (aOR =8.69, 95% CI = 6.71–11.32) mental distress showed greater odds of missing prescription refills. Our study shows that individuals who showed signs of mental distress had increased odds of delayed medical visits and missed prescription refills, compared to those that showed normal levels of mental distress.

UTILITY OF APACHEII, SAPS II, AND SOFA SCORES AS INDICATORS OF SEVERITY OF SEPSIS AND PREDICTORS OF MORTALITY IN A TERTIARY CARE HOSPITAL

Objectives: The aim of the study was to predict the outcome and mortality of patients with sepsis in a tertiary care hospital using defined scores such as APACHE II, SAPS II, and SOFA scores. Methods: This prospective and observational study was carried out in intensive care units (ICUs) setup of multispecialty hospital in Western Maharashtra. Sample size was 90 patients with sepsis who were admitted to ICU (surgical) directly or indirectly, during the duration of 1 1/2 month. The study was approved by the Institutional Ethical Committee and written informed consent from all the patients or their guardians/legal representatives. The detailed history, clinical examination, and all the relevant laboratory investigations were done including blood culture. The parameters as mentioned in APACHEII, SAPS II, and SOFA scores were recorded daily. For statistical analysis, Chi-square test, Fisher’s exact test, MannWhitney test, and Binary Logistic Regression were used. SPSS software was used for analysis. Results: Out of these 90 patients, 64 (71.1%) were males and 26 (28.8%) were females. Mean age of the study population was 61.86 years. Mean duration of stay in the ICU was found out to be 3.33 days. Culture positivity was found in 53 cases (58.8%). Gram-negative organisms were responsible for 37 (69.8%) cases while Gram-positive organisms were responsible for 16 (30.1%) cases. Statistics of various variables among cases and other detailed results were studied. SOFA score (p=0.046) and APACHE II score (p=0.00042) have been found to be statistically significant predictors of “Death”; higher the SOFA score and APACHE II score-more probability of patient dying. However, mortality as per SAPS II (p=0.202) was not found to be statistically significant predictor of death. Conclusions: APACHE II, SAPS II, and SOFA scores can be used for prediction of mortality by using appropriate statistical tests. People of older age, male gender, and preexisting chronic health conditions are chiefly prone to develop Septic shock; hence, prevention strategies should be targeted at these susceptible populations. The epidemiology of Septic shock in developing countries warrants greater attention in the future studies.

Association of Dietary Fiber Intake with All-Cause Mortality and Cardiovascular Disease Mortality: A 10-Year Prospective Cohort Study.

Although previous studies have established that dietary fiber (DF) intake reduces the total cardiovascular disease (CVD) mortality in general populations, limited studies have been conducted in individuals with pre-existing chronic conditions, especially in Asian countries. We aimed to investigate the association of DF intake with all-cause and CVD mortality in the general population and in the subpopulation with hypertension, diabetes, and dyslipidemia. We examined the relationship between DF intake and all-cause and CVD mortality using the Korean genome and epidemiology study. Diet was assessed using a food-frequency questionnaire at baseline. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) after adjusting for confounders. During the mean 10.1 years of follow-up, higher DF intake was significantly associated with a lower risk of all-cause mortality after adjusting for confounders (HR and 95% CIs for Q5 vs. Q1: 0.84 (0.76–0.93); p < 0.001). DF intake was inversely associated with a lower risk of CVD mortality after adjusting for the same confounders (HR and 95% CIs for Q5 vs. Q1: 0.61 (0.47–0.78); p < 0.001). Total DF intake was inversely associated with all-cause and CVD mortality in middle-aged and older adults.

Modeling the Likelihood of Low Birth Weight: Findings from a Chicago-Area Health System.

This study presents a statistical model of the incidence of low birth weight (LBW) births in a large, Chicago-area hospital system. The study was undertaken to provide a strategic framework for future health system interventions. Administrative and electronic health records were matched to census Zip Code Tabulation Area (ZCTA) household poverty data for 42,681 births in 2016-2019 at seven system hospitals, serving a diverse patient population. A logistic regression model of LBW incidence was estimated to test the independent significance of maternal sociodemographic characteristics after controlling for clinical risk factors. The incidence of LBW was 6.3% overall but 11.3% among non-Hispanic Black patients as compared to 5.1% among non-Hispanic White patients. LBW incidence ranged from 9.2% for patients from the poorest ZCTA (20% + poor households) compared to 5.6% of patients from the most affluent (< 5% poor) ZCTA. Nulliparous patients, patients with pre-existing chronic conditions, and patients with hypertensive disorders of pregnancy were significantly more likely to have LBW births. After controlling for clinical risk factors and poverty level, non-Hispanic Black patients were still over 80% more likely and to have a LBW birth. Studyfindings reveal the joint effects of social and clinical risk factors. Findings profile our highest-risk populations for targeted interventions. Promising prenatal care redesign programs include pregnancy patient navigators, home and group visits, eHealth telemonitoring, improved mental health screening, and diversification of the maternity care workforce. Decreasing LBW births should be a national public health policy priority and will require major investments in the most impacted communities.

COVID-19 Pandemic and International Students' Mental Health in China: Age, Gender, Chronic Health Condition and Having Infected Relative as Risk Factors.

International students in China were among the first group of individuals to be affected by the COVID-19 pandemic. However, the pandemic’s impact on their mental health is underexplored. This study—utilizing web-based survey data (N = 381), presents preliminary reports using ANOVA and MIMIC analytic approaches. Following the clinical demarcation of the 21-item version of the Depression Anxiety Stress Scales (DASS-21), we found 24.6%, 38.3%, and 43.6% of the students to suffer mild to extreme stress, anxiety, and depression, respectively. Female students reported significantly higher levels of stress and depression than males. Older students’ reports of stress were more substantial than younger students. Students who reported having a relative infected with the virus (vs. those without) experienced significantly higher anxiety and stress. Those who reported having pre-existing chronic health condition(s) (vs. those without) also reported significantly higher stress, anxiety, and depression levels. Moreover, students with an exercise routine (vs. those without) experienced significantly lower levels of stress, anxiety, and depression. Last, our MIMIC model results indicate that foreign students’ age, gender, chronic health status, and having a relative infected with the virus constitute significant risk factors explaining variations in foreign students’ experience of psychological distress. Implications for international students’ management have been thoroughly discussed.