Respiratory Visits Research Articles

Changes in emergency department visits for respiratory and cardiovascular disease after closure of a coking operation near Pittsburgh, PA

Introduction: In Allegheny County (AC), PA, US, closure of a large coke plant in January 2016 presented an opportunity to investigate the contribution of air pollutants to health outcomes in a nearby community. Materials and methods: The Allegheny County Health Department, (ACHD), Division of Air Quality, had begun monitoring pollutants near the plant since June 2011. The rates of hospitalizations and ED visits for cardio- vascular and respiratory disease were compared in the exposed community and two control areas: exposed control, with another coking operation; and unexposed control. Results: Of the study and two control areas, particulate matter concentrations decreased the most in the study area, from 10.9 µg/m3 to 9.7 µg/m3. Benzene decreased substantially in that area, from 0.27 ppm to 0.10 ppm. ED visits for cardiovascular, respiratory, and asthma were significantly higher in the ex- posed group in 2015 compared to 2016. There were no temporal differences in either control groups. There was a 26.5% decrease in cardiovascular ED visits, a 37.9% decrease in respiratory ED visits, and a 3-5 fold decrease in ED visits due to asthma. These decreases were not seen in exposed and unex- posed control areas. A case-crossover analysis confirmed that daily ED visits were significantly associated with daily particulate matter levels, controlling for temperature. Conclusion: With the closure of a large Coke Plant facility, we found that a modest decrease in particulate matter and a notable decrease in benzene concentration were associated with a significant decrease in emergency room visits not previously documented in other studies.

Adult outcomes of childhood bronchiectasis

ABSTRACT Recent literature has highlighted the importance of transition from paediatric to adult care for children with chronic conditions. Non-cystic fibrosis bronchiectasis is an important cause of respiratory morbidity in low-income countries and in indigenous children from affluent countries; however, there is little information about adult outcomes of childhood bronchiectasis. We reviewed the clinical course of 31 Alaska Native adults 20–40 years of age from Alaska’s Yukon Kuskokwim Delta with childhood bronchiectasis. In patients with chronic suppurative lung disease, a diagnosis of bronchiectasis was made at a median age of 4.5 years by computerised tomography (68%), bronchogram (26%), and radiographs (6%). The patients had a median of 75 lifetime respiratory ambulatory visits and 4.5 hospitalisations. As children, 6 (19%) experienced developmental delay; as adults 9 (29%) experienced mental illness or handicap. Four (13%) patients were deceased, four (13%) had severe pulmonary impairment in adulthood, 17 (54%) had persistent or intermittent respiratory symptoms, and seven (23%) were asymptomatic. In adulthood, only five were seen by adult pulmonologists and most had no documentation of a bronchiectasis diagnosis. Lack of provider continuity, remote location and co-morbidities can contribute to increased adult morbidity. Improving the transition to adult care starting in adolescence and educating adult providers may improve care of adults with childhood bronchiectasis.

Time-series analysis of ambient PM2.5 and cardiorespiratory emergency room visits in Lima, Peru during 2010-2016.

IntroductionThere have been no time-series studies of air pollution in Peru. Here we evaluate the effect of ambient PM2.5 on emergency room (ER) visits in Lima.MethodsWe estimated daily PM2.5 levels at a 1 km2 resolution during 2010–2016 using ground measurements, satellite data, and chemical transport model simulations. Population-weighted average daily PM2.5 levels were calculated for each district in Lima (n=40), and assigned to patients based on residence. ER visits for respiratory and circulatory diseases were gathered from 9 large public hospitals. Poisson regression was used to estimate the rate ratio for daily ER visits with change in daily PM2.5, controlling for meteorology, time trends, and district.ResultsFor each interquartile range (IQR) increase in PM2.5, respiratory disease ER visits increased 4% (95% CI: 0–5%), stroke visits 10% (3–18%), and ischemic heart disease visits (adults, 18–64 years) 11% (−1%, 24%). Districts with higher poverty showed significantly stronger associations of PM2.5 and respiratory disease ER visits than districts with lower poverty. Effects were diminished 24–42% using Lima-wide instead of district-specific PM2.5 levels.ConclusionShort-term exposure to ambient PM2.5 is associated with increases in ER visits in Lima for respiratory diseases and stroke, and among middle-aged adults, ischemic heart disease.

Moderate hot rather than extreme hot is mainly responsible for temperature-related excess outpatient visits for respiratory diseases

TPS 661: Climate change: temperature effects 1, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: Much evidence has revealed that there are significant associations between ambient temperature and human health. However, few studies have assessed the health burden of respiratory disease attributed to different temperature ranges in subtropical region. Methods: Daily outpatient visits, weather variables and air pollution data were collected from January 2013 to July 2017 in a hospital of Dongguan city. A standard time series quasi-Poisson regression with distributed lag non-linear model (DLNM) was applied to estimate the associations between daily mean temperature and morbidity for respiratory diseases, bronchiectasis, chronic obstructive pulmonary disease (COPD) and asthma. Attributable risks were then calculated to quantify the disease burdens from different temperature components. Finally, a stratified analysis by age groups was conducted. Results: Both low and high temperature were associated with an increased risk of morbidity of respiratory diseases. Compared with the optimum temperature, the accumulative relative risk (RR) during 7 lag days was 1.13 with 95% confidence interval (CI) 1.01 to 1.26 for extreme hot, and 1.02 (95%CI: 0.99 to 1.05) for extreme cold. Respiratory morbidity risk for young population mainly caused by hot weather, but a reverse J-shaped was observed for the elderly. About 8.4% (95%CI: 2.8% to 13.3%) of respiratory morbidity was attributed to non-optimal temperature. Out of them, moderate hot was responsible for the major part of excess respiratory visits, accounting for 7.5% (95% CI: 2.4% to 12.2%) of respiratory morbidity. Conclusions: We found that moderate hot contributed most of excess respiratory outpatient visits caused by ambient temperature exposure in subtropical region, which indicates more attention should be paid to this temperature range rather than extreme temperature in subtropical regions.

Assessing the impact of school socioeconomic status (SES) and school building conditions on student performance among upstate New York public schools

TPS 731: Neurological effects in children, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: In previous studies, low socioeconomic status (SES) and poor school building conditions (SBCs) have been associated with poor school outcomes such as low attendance and academic achievements. While a few attempts were made to understand the potential causal framework, the indirect effect of school SES and SBCs on student performance mediated by students’ respiratory health has not been tested. Methods: The mediating effects of students’ respiratory health on the relationships between school SES, SBCs and school outcomes were assessed using the counterfactual based mediation approach. Records of respiratory visits among children aged 4-18 were extracted from statewide hospital discharge data and school level hospital visit rates were calculated. Information on SBCs was collected from the 2010 school building condition survey for all public schools in upstate New York. School SES, attendance rate, and students’ scores in the standard test were obtained from school report cards. The associations between the mediator (students’ respiratory health) and outcomes (attendance/performance) were first assessed. Natural indirect and direct effects were then calculated for the outcomes showed significant associations with the mediator. Results: Schools with higher respiratory visits among students reported consistently lower attendance. Suggestive associations were also found between poor respiratory health and standard test scores but not with Regents exam scores. About a 7% decrease in school attendance due to low school SES, as indicated by the free lunch eligibility, was mediate through students’ respiratory health. While strong total effects were observed between school SES/SBCs and standard test scores, the mediating effect of respiratory health was insignificant. Conclusion: Poor respiratory health may be one of the most crucial issues to address in improving student attendance and academic performance. Future studies should further explore the mediating effect of other social or parental factors on the path from school SES/SBCs to school outcomes.

Microbiome-Transcriptome Interactions Related to Severity of Respiratory Syncytial Virus Infection

Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections and hospital visits during infancy and childhood. Although risk factors for RSV infection have been identified, the role of microbial species in the respiratory tract is only partially known. We aimed to understand the impact of interactions between the nasal microbiome and host transcriptome on the severity and clinical outcomes of RSV infection. We used 16 S rRNA sequencing to characterize the nasal microbiome of infants with RSV infection. We used RNA sequencing to interrogate the transcriptome of CD4+ T cells obtained from the same set of infants. After dimension reduction through principal component (PC) analysis, we performed an integrative analysis to identify significant co-variation between microbial clade and gene expression PCs. We then employed LIONESS (Linear Interpolation to Obtain Network Estimates for Single Samples) to estimate the clade-gene association patterns for each infant. Our network-based integrative analysis identified several clade-gene associations significantly related to the severity of RSV infection. The microbial taxa with the highest loadings in the implicated clade PCs included Moraxella, Corynebacterium, Streptococcus, Haemophilus influenzae, and Staphylococcus. Interestingly, many of the genes with the highest loadings in the implicated gene PCs are encoded in mitochondrial DNA, while others are involved in the host immune response. This study on microbiome-transcriptome interactions provides insights into how the host immune system mounts a response against RSV and specific infectious agents in nasal microbiota.

Children with bronchiectasis have poorer lung function than those with cystic fibrosis and do not receive the same standard of care.

Children with cystic fibrosis (CF) are routinely managed in a multidisciplinary clinic at tertiary pediatric centers. However, children with bronchiectasis may not be managed in the same way. We sought to compare the management model and clinical outcomes of children with bronchiectasis with children diagnosed with CF, in a single pediatric center. We identified patients with bronchiectasis from hospital medical records at an urban tertiary pediatric hospital and identified a sex- and age-matched CF patient at the same center to compare lung function, nutritional status, frequency of physiotherapy and respiratory physician visits, and number of microbiological samples taken for bacterial culture. Twenty-two children with bronchiectasis were identified, mean (standard deviation [SD]) age was 11 (3) years. The most common known etiology for bronchiectasis was postinfective (6 of 22) but was unknown in 8 of 22. The cohort with bronchiectasis had poorer lung function (FEV1 mean [SD] percent predicted 78.6 [20.5] vs 94.5 [14.7], P = .005) and had less outpatient reviews by the respiratory physician (P < .001) and respiratory physiotherapist (P < .001) when compared to those with CF. Nutritional parameters did not differ between the groups. Many children (10 of 22, 45%) with bronchiectasis did not have any microbiological respiratory tract samples taken for evaluation. Children with bronchiectasis at this institution have poorer lung function than children with CF, and are deserving of improved multidisciplinary care.

Effect of intra-op morphine on children with OSA undergoing tonsillectomy

Objectives1. To compare outcomes after tonsillectomy for pediatric patients with obstructive sleep apnea (OSA) given morphine intra-operatively and post operatively compared to those who were not – specifically Recovery Room (RR) time, length of stay (LOS), Emergency Department (ER) visits. Study designRetrospective case series with chart review. SettingTertiary care children's hospital. Subjects and methodsAll children between 1 and 17 years old who had undergone tonsillectomy in a single institution from 2013 to 2016. Comparison between children who had received morphine intra-operatively was made for outcomes. Results556 patients were included, 73 patients had morphine intraoperatively and 483 did not; these latter children were older (8.8 vs 6.5 years, P < 0.001), and had fewer episodes of obstructive apnea and hypopnea (AHI 4.47 vs 10.15, p = 0.003) than children who did not receive intra-op morphine. There were no differences in co-morbidities including asthma, whether they had a sleep study, time in the operating room, emergence time, RR time, airway complications, IMC/PICU admission for respiratory distress, ER visits, readmissions, bleeding or post-discharge nurse phone calls. There was a longer LOS (25.9 vs 21.4 h, P = 0.011) for the group receiving intra-op morphine. ConclusionChildren with OSA who receive intra-op morphine have a longer LOS suggesting that its use should be examined more closely in this population.

Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment.

Purpose: Global evidence-based treatment strategies for chronic obstructive pulmonary disease (COPD) recommend using long-acting bronchodilators (LABDs) as maintenance therapy. However, COPD patients are often undertreated. We examined COPD treatment patterns among Medicare beneficiaries who initiated arformoterol tartrate, a nebulized long-acting beta2 agonist (LABA), and identified the predictors of initiation.Methods: Using a 100% sample of Medicare administrative data, we identified beneficiaries with a COPD diagnosis (ICD-9 490–492.xx, 494.xx, 496.xx) between 2010 and 2014 who had ≥1 year of continuous enrollment in Parts A, B, and D, and ≥2 COPD-related outpatient visits within 30 days or ≥1 hospitalization(s). After applying inclusion/exclusion criteria, three cohorts were identified: (1) study group beneficiaries who received nebulized arformoterol (n=11,886), (2) a subset of the study group with no LABD use 90 days prior to initiating arformoterol (n=5,542), and (3) control group beneficiaries with no nebulized LABA use (n=220,429). Logistic regression was used to evaluate predictors of arformoterol initiation. Odds ratios (ORs), 95% confidence intervals (CIs), and p values were computed.Results: Among arformoterol users, 47% (n=5,542) had received no LABDs 90 days prior to initiating arformoterol. These beneficiaries were being treated with a nebulized (50%) or inhaled (37%) short-acting bronchodilator or a systemic corticosteroid (46%), and many received antibiotics (37%). Compared to controls, beneficiaries who initiated arformoterol were significantly more likely to have had an exacerbation, a COPD-related hospitalization, and a pulmonologist or respiratory therapist visit prior to initiation (all p<0.05). Beneficiaries with moderate/severe psychiatric comorbidity or dual-eligible status were significantly less likely to initiate arformoterol, as compared to controls (all p<0.05).Conclusion: Medicare beneficiaries who initiated nebulized arformoterol therapy had more exacerbations and hospitalizations than controls 90 days prior to initiation. Findings revealed inadequate use of maintenance medications, suggesting a lack of compliance with evidence-based treatment guidelines.

Increase in Pediatric Respiratory Visits associated with Wildfires in San Diego County

There is significant data that demonstrates increased ER visits and hospitalizations for cardiopulmonary causes during wildfire outbreaks. This utilization correlates with increased PM 2.5 and other airborne pollutants and has been demonstrated to affect vulnerable populations such as those with asthma. All Emergency Room and Urgent Care visits from 2011 to 2017 were collected from Rady Children’s Hospital. Specific data fields collected included date of visit, date of birth, zip code of residence, insurance type, language, respiratory/non- respiratory visit, and diagnosis. Air pollution data was provided by San Diego Air Pollution Control Division from the Camp Pendleton monitor from 2014 to 2017. Specific dates of interest included May 12-23, 2014 and December 6-16, 2017. A distinct and intense peak for PM 2.5 can be seen in May of 2014 consistent with the timing of the Bernardo fire. The majority of patients where younger, age 0-6 (70%) and had Medi-Cal insurance (74%).There was a significant deviation for respiratory visits for the May 2014 fires. By age group, there is a stronger signal for respiratory visits during the May 2014 fire for kids aged 0-6. To our knowledge this is one of the first studies to link an increase in pediatric urgent care and emergency room visits associated with wildfire-linked PM 2.5. Natural disasters such as wildfires are expected to increase in frequency and intensity in the future. Climate change will disproportionately affect young children, magnifying existing disparities. As these conditions compound and wild fires become more frequent, it is important for those at risk to be prepared.

Assessing Associations between School Facility Condition, Neighborhood Environment, and Respiratory Health in Public Schools: An Application of Ultrahigh Dimensional Variable Selection Method on Big Data

Background: While poor school facility conditions were associated with impaired academic performance in large-scale studies, less research has assessed its health impact among students. Furthermore, strong correlations between variables made it difficult to assess a wide range of environmental factors in one model. In this study, we aim to assess the impact of school and home environmental factors on student's respiratory health in a multi-pollutant model by applying an innovative variable selection method.Method: A case-control study was conducted using statewide hospital records from patients aged 4 to 18 during 2010-2013 in upstate New York. Emergency department (ED) visits due to respiratory diseases were defined as cases, while visits due to gastrointestinal diseases, injury, and appendicitis were used as controls. Each patient was assigned to a school based on the information on patient's age, home address, and school zones. A set of 128 variables indicating school facility conditions and school or home neighborhood environmental hazards were included in the variable selection process. Iterative sure independence screening was applied to construct the final multi-pollutant regression model.Result: Eighteen environmental factors were chosen for the final model, including 11 indicators of school facility conditions and 7 indicators of traffic/industrial emission around the school/home. The strongest associations were found between respiratory ED visit and conditions of tile floor, foundation type, noise from air-conditioning or traffic, PM2.5 level in home neighborhood, active leak in classroom, and heating fuel system (increased risks ranged from 9% to 17%).Conclusion: Application of advanced variable selection method allows construction of multi-pollutant models with wide range of environmental factors. Specific school facility conditions potentially play a crucial role in student&amp;#8217;s respiratory health even after controlling for neighborhood environment.

Cardiovascular and Cerebrovascular Emergency Department Events Related to California Wildfires in 2015

Fine particulate matter (PM2.5) found in smoke can exacerbate respiratory conditions; however, evidence for cardiovascular and cerebrovascular events has been inconsistent.Methods: We conducted a time series analysis of adult cardiovascular and cerebrovascular events for the 2015 wildfire season in 8 California Air Basins. We used estimated fire-PM2.5 concentrations and satellite data from the Hazard Mapping System together with California statewide emergency department (ED) data at the ZIP code-level. Age- and gender-stratified population subsets were modeled with lags up to 5 days and models were adjusted for adjusted for seasonal trend, day of the week and heat index.Results: All-cause cardiovascular ED visits across all lags were elevated (RR of 1.07, 95%CI[1.05, 1.09]), as were all-cause cerebrovascular (1.13 [1.05-1.21]), and all-cause respiratory visits (1.10 [1.08,1.12]). No significant association was found for the control condition of acute appendicitis (0.93 [0.81,1.06]). Elevated individual diagnoses included ischemic heart disease (1.09 [1.05, 1.13]), heart failure (1.10 [1.06,1.14]), and dysrhythmia (1.14 [1.11,1.17]). Ischemic strokes were elevated up to 5 lag days for adults 65 years and older (1.21 [1.05, 1.37]). Dose-dependent responses were observed for fire-PM2.5 and nearly all diagnosis categories, across all 5 lags.Conclusions: Wildfire PM2.5 elevated the risk of cardiovascular and cerebrovascular ED visits.This abstract does not necessarily reflect US EPA views and policies.

Rational Design of the Minimal Requirement for Helix–Helix Peptide Interactions in the Trimer-of-Hairpins Motif of Pediatric Pneumonia RSV Fusion Glycoprotein

Human respiratory syncytial virus (RSV) is a primary cause of lower respiratory tract infections and hospital visits during infancy and childhood. RSV invades host cells via a type I fusion (F) glycoprotein that has been recognized as the major viral antigen and an attractive therapeutic target against RSV infection in pediatric pneumonia. Like other type I fusion proteins such as HIV-1 gp41 and influenza hemagglutinin, the post-fusion conformation of RSV F contains a functional trimer-of-hairpins (TOH) motif that is characterized by a six-helix bundle in which three HR-C peptides antiparallelly pack against a trimeric coiled-coil core assembled by three HR-N peptides. Here, the intermolecular interaction between single HR-N and HR-C helical peptides is investigated at molecular level. An all-residue pairwise interaction potential profile is created, from which it is revealed that the packing tightness and effectiveness are not distributed evenly along the panhandling HR-N–HR-C complex interface; an intense hydrogen-bonding network is identified at one side of the complex, while the hydrophobic forces and van der Waals contacts are presented across the whole interface. A helix–helix structural module that covers the hydrogen-bonding network is stripped from the complex to define a reduced rHR-N–rHR-C interaction, which can be further truncated to derive a core region termed as minimized mHR-N–mHR-C interaction and represents the minimal requirement for the TOH helix–helix interaction of RSV F protein.

Linking air pollution and administrative health databases to examine health effects of wildfire smoke exposure in Calgary, Canada in 2015

IntroductionWildfires are increasing in frequency and severity due to climate change. Fine particulate matter (PM2.5) in wildfire smoke is an important indicator of health effects of most combustion sources. The evidence based on adverse health impacts of PM2.5 from wildfire smoke are increasingly being studied but some gaps still remain.&#x0D; Objectives and ApproachWe examined the association of PM2.5 from Pacific Northwest wildfires with multiple respiratory and cardiovascular morbidity events related physician and emergency department visits, hospital admissions, health-link calls and medications dispensed among Calgary city population from August 1 – September 30, 2015. Physician billing claims, discharge abstract, Pharmaceutical Information Network, Health-link calls databases were linked with the air quality monitoring information database. Quasi-Poisson regression model for time lags of zero to five days and a three-day moving average, and conditional logistic regression model was used with adjustment for air pollutants and meteorological variables. Age and disease-specific stratified analyses were performed.&#x0D; ResultsCompared to the pre-wildfire period (Aug 1 – Aug 23), a 10 µg/m3 increase in PM2.5 increased the risk for respiratory physician visits by 54.8% (95% CI: 41.6% - 69.3%) and 32.6% (95% CI: 10.4% - 58.9%) in the respective post (Sep 1- Sep 30) and during (Aug 24 – Aug 31) wildfire periods. The strongest association of PM2.5 with respiratory physician visits was observed for children aged 0-9 years in the post-wildfire period (Relative Risk [RR] = 2.11, 95% CI: 1.86 - 2.39) compared to during wildfire period (RR = 1.56, 95% CI: 1.21 - 2.02) and was consistent for asthma, acute bronchitis and acute respiratory infection. Statistically significant effects of PM2.5 on cardiovascular hospitalizations, ED and physician visits were not observed during the wildfire period.&#x0D; Conclusion/ImplicationsWildfire-related PM2.5 led to increased physician visits due to respiratory morbidity during and after the wildfires, particularly for asthma, acute bronchitis and acute respiratory infections in children. The absence of cardiovascular health impact in general population during wildfires provides useful information for targeted public health messaging during adverse air quality events.

Patterns of healthcare utilisation for respiratory complications of adults with neuromuscular disease: a population study.

Our objective was to quantify health service utilisation including monitoring and treatment of respiratory complications for adults with neuromuscular disease (NMD), identifying practice variation and adherence to guideline recommendations at a population level.We conducted a population-based longitudinal cohort study (2003-2015) of adults with NMD using hospital diagnostic and health insurance billing codes within administrative health databases.We identified 185 586 adults with NMD. Mean age 52 years, 59% female. 41 173 (22%) went to an emergency department for respiratory complications on average 1.6 times every 3 years; 14 947 (8%) individuals were admitted to hospital 1.4 times every 3 years. Outpatient respiratory specialist visits occurred for 64 084 (35%) with four visits every 3 years, although substantial variation in visit frequency was found. 157 285 (85%) went to the emergency department (all-cause) almost 4 times every 3 years, 100 052 (54%) were admitted to hospital. Individuals with amyotrophic lateral sclerosis/motor neurone disease (ALS/MND) had more emergency department visits compared with other types of NMD (p<0.0001).One-third of adults with NMD received respiratory specialist care at a frequency recommended by professional guidelines, although substantial variation exists. Emergent healthcare utilisation was substantial, emphasising the burden of NMD on the healthcare system and urgent need to improve community and social supports, particularly for ALS/MND patients.

Implementation of Duchenne Muscular Dystrophy Care Considerations.

Duchenne muscular dystrophy (DMD) is an X-linked disorder characterized by progressive muscle weakness and multisystem involvement. Recent advances in management of individuals with DMD have prolonged survival. Lack of standardized care spurred an international collaboration to develop consensus-based care considerations for diagnosis and management. In this study, we evaluate adherence to considerations at selected sites. We collaborated with the Muscular Dystrophy Surveillance, Tracking, and Research Network. Our sample included males with DMD and Becker muscular dystrophy <21 years as of December 31, 2010, with 1 health care encounter on or after January 1, 2012. We collected data from medical records on encounters occurring January 1, 2012, through December 31, 2014. Adherence was determined when frequency of visits or assessments were at or above recommendations for selected care considerations. Our analytic sample included 299 individuals, 7% of whom (20/299) were classified as childhood-onset Becker muscular dystrophy. Adherence for neuromuscular and respiratory clinician visits was 65% for the cohort; neuromuscular assessments and corticosteroid side effect monitoring measures ranged from 16% to 68%. Adherence was 83% for forced vital capacity and ≤58% for other respiratory diagnostics. Cardiologist assessments and echocardiograms were found for at least 84%. Transition planning for education or health care was documented for 31% of eligible males. Medical records data were used to identify areas in which practice aligns with the care considerations. However, there remains inconsistency across domains and insufficiency in critical areas. More research is needed to explain this variability and identify reliable methods to measure outcomes.

Tonsillectomy increases the risk of retropharyngeal and parapharyngeal abscesses in adults, but not in children: A national cohort study.

ObjectivesThe purpose of this study is to evaluate the risk of retropharyngeal and parapharyngeal abscesses (deep neck infection) after tonsillectomy in Koreans using national cohort data.MethodsUsing the national cohort study from the Korean Health Insurance Review and Assessment Service, participants who had undergone a tonsillectomy (5,299) and control participants (21,196) were selected and matched 1:4 (for age, sex, income, region of residence, and pre-operative upper respiratory infection visits). The Cox-proportional hazard model was used. A crude model and an adjusted model for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia were used in this analysis. For the subgroup analyses, the participants were divided into 2 groups: children (≤ 14 years old) and adolescents and adults (≥ 15 years old).ResultsThe adjusted hazard ratio of deep neck infection after tonsillectomy was 1.43 (95% confidence interval, CI = 1.18–1.72, P < 0.001). In subgroup analysis, this ratio was 1.12 (95% CI = 0.86–1.47, P = 0.390) in children and 1.87 (95% CI = 1.43–2.45, P < 0.001) in adolescents and adults. The crude hazard ratios were almost the same as the adjusted ratios.ConclusionThe risk of deep neck infection was higher in the tonsillectomy group. The subgroup analysis showed a similar finding in the adolescent and adult group but not in the child group.

Impact of home remediation and household education on indoor air quality, respiratory visits and symptoms in Alaska Native children

ABSTRACTAlaska Native children experience high rates of lower respiratory tract infections (LRTIs) and lung conditions, which are associated with substandard indoor air quality (IAQ). We conducted an intervention of home remediation and education to assess the impact on IAQ, respiratory symptoms and LRTI visits. We enrolled households of children 1–12 years of age with lung conditions. Home remediation included improving ventilation and replacing leaky woodstoves. We provided education about IAQ and respiratory health. We monitored indoor airborne particles (PM2.5), CO2, relative humidity and volatile organic compounds (VOCs), and interviewed caregivers about children’s symptoms before, and for 1 year after intervention. We evaluated the association between children’s respiratory visits, symptoms and IAQ indicators using multiple logistic regression. A total of 60 of 63 homes completed the study. VOCs decreased (coefficient = −0.20; p < 0.001); however, PM2.5 (coeff. = −0.010; p = 0.89) did not decrease. Burning wood for heat, VOCs and PM2.5 were associated with respiratory symptoms. After remediation, parents reported decreases in runny nose, cough between colds, wet cough, wheezing with colds, wheezing between colds and school absences. Children had an age-adjusted decrease in LRTI visits (coefficient = −0.33; p = 0.028). Home remediation and education reduced respiratory symptoms, LRTI visits and school absenteeism in children with lung conditions.

Estimated rates of influenza-associated outpatient visits during 2001-2010 in 6 US integrated healthcare delivery organizations.

BackgroundPopulation‐based estimates of influenza‐associated outpatient visits including both pandemic and interpandemic seasons are uncommon. Comparisons of such estimates with laboratory‐confirmed rates of outpatient influenza are rare.ObjectiveTo estimate influenza‐associated outpatient visits in 6 US integrated healthcare delivery organizations enrolling ~7.7 million persons.MethodsUsing negative binomial regression methods, we modeled rates of influenza‐associated visits with ICD‐9‐CM‐coded pneumonia or acute respiratory outpatient visits during 2001‐10. These estimated counts were added to visits coded specifically for influenza to derive estimated rates. We compared these rates with those observed in 2 contemporaneous studies recording RT‐PCR‐confirmed influenza outpatient visits.ResultsOutpatient rates estimated with pneumonia visits were 39 (95% confidence interval [CI], 30‐70) and 203 (95% CI, 180‐240) per 10 000 person‐years, respectively, for interpandemic and pandemic seasons. Corresponding rates estimated with respiratory visits were 185 (95% CI, 161‐255) and 542 (95% CI, 441‐823) per 10 000 person‐years. During the pandemic, children aged 2‐17 years had the largest increase in rates (when estimated with pneumonia visits, from 64 [95% CI, 50‐121] to 381 [95% CI, 366‐481]). Rates estimated with pneumonia visits were consistent with rates of RT‐PCR‐confirmed influenza visits during 4 of 5 seasons in 1 comparison study. In another, rates estimated with pneumonia visits during the pandemic for children and adults were consistent in timing, peak, and magnitude.ConclusionsEstimated rates of influenza‐associated outpatient visits were higher in children than adults during pre‐pandemic and pandemic seasons. Rates estimated with pneumonia visits plus influenza‐coded visits were similar to rates from studies using RT‐PCR‐confirmed influenza.

The January 2013 Beijing "Airpocalypse" and its Acute Effects on Emergency and Outpatient Visits at a Beijing Hospital.

Severe air pollution episodes in Europe and the USA in the early- to mid-twentieth century caused large health impacts, spurring national legislation. Similarly severe episodes currently affect developing regions, as exemplified by a particularly extreme episode in January 2013 in Beijing, China. We investigated associations between this episode and medical visits at a Beijing hospital. We obtained fine particulate matter (PM2.5) measurements from the US State Department's Embassy monitor and daily counts of all-cause, cardiovascular, and respiratory emergency visits, and outpatient visits from a nearby hospital in the Liufang Nanli community. We analyzed whether risks increased during this episode (with daily PM2.5 ≥ 350 μg/m3) using generalized linear modeling, controlling for potential confounders. The episode brought exceptionally high PM2.5 (peak daily average, 569 μg/m3). Risk increased during the episode for all-cause (relative risk 1.29 [95% CI 1.13, 1.46]), cardiovascular (1.55 [0.90, 2.68]) and respiratory (1.33 [1.10, 1.62]) emergency medical visits, and respiratory outpatient visits (1.16 [1.00, 1.33]). Relative risks of all-cause (0.95 [0.82, 1.10]) and cardiovascular (0.83 [0.67, 1.02]) outpatient visits were not statistically significant. Results were robust to modeling choices and episode definitions. This episode was extraordinarily severe, with maximum daily PM2.5 concentration nearly 22-fold above the World Health Organization guideline. During the episode, risk increased for all-cause, cardiovascular, and respiratory emergency medical visits, and respiratory outpatient visits, consistent with previous US-based research. However, no association was found for all-cause or cardiovascular outpatient visits. China-based studies like this one provide critical evidence in developing efforts regarding air pollution remediation in China.