Significant Change In Trend Research Articles

Evaluation of the impact before and after the application of an antimicrobial stewardship program at Dong Thap General Hospital, Vietnam, from 2017 to 2021

Vietnam has one of the highest rates of antibiotic resistance in Asia. In 2020, the Vietnam Minister of Health introduced new legislation for the implementation of an antimicrobial stewardship program (ASP). The evidence for the effectiveness of ASP in small hospitals and hospitals located in provinces was limited compared with larger-scale and central city hospitals. Evaluation of the impact before and after the introduction of an antimicrobial stewardship program at Dong Thap General Hospital, from 2017 to 2021. Retrospective data was collected from June 2017 to June 2021. The impact of the ASP on changes in antibiotic use and the clinical outcome associated with the implementation of the ASP was evaluated using autoregressive integrated moving average modelling of controlled interrupted time-series analysis. There was a significant and sustained decrease in antibiotic consumption level (step change) in 2 indicators, DOT/1000PD (129.55; P<0.01) and LOT/1000PD (99.95, P<0.01), immediately after the ASP intervention. There were no statistically significant changes identified in terms of consumption with DDD/1000PD, or in the clinical outcomes. The results showed no statistically significant change in consumption trend (ramps) in all evaluated indicators. No statistically significant changes in consumption levels and trends were observed in the control group. The ASP implemented in Dong Thap General Hospital from 2017 to 2021 showed a considerable influence on antibiotic consumption as indicated by the DOT/1000 PD and LOT/1000 PD during the initial stages. Moreover, controlling antibiotic consumption did not negatively impact patient outcomes.

Smoking cessation prevalence by menthol cigarette use and select demographics among adults in the United States, TUS-CPS, 2003–2019

People who smoke menthol cigarettes, particularly those who are non-Hispanic Black/African American, are less likely to achieve successful smoking cessation compared with people who smoke non-menthol cigarettes. This study examined the 2003–2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) harmonized data to estimate cross-sectional trends in cigarette smoking cessation among U.S. adults, stratified by menthol cigarette use, race/ethnicity, sex, and age. The analytic sample included respondents who smoked for ≥ 2 years (current users and former users who reported quitting during the past year). We tested cessation trends using orthogonal polynomial contrasts for overall, menthol, and non-menthol smoking cessation prevalence and stratified by race/ethnicity, sex, and age in logistic regression models. We also analyzed the 2018–2019 non-harmonized TUS-CPS data among recent quitters to examine differences in characteristics (e.g., demographic characteristics, smoking frequency, use of smoking cessation aids, switching to other tobacco products) by menthol cigarette use. We observed significant linear changes in prevalence trends for overall cigarette smoking cessation, menthol smoking cessation, and non-menthol smoking cessation (p < 0.0001 for all linear trends), and changes in menthol cessation among non-Hispanic White and non-Hispanic Other race/ethnicity categories during 2003–2019. In the 2018–2019 wave, we observed differences in menthol status for sex, race/ethnicity, age, and educational attainment. We did not observe differences for other characteristics. We observed changes in overall cigarette smoking cessation, menthol, and non-menthol smoking cessation prevalence during the study period; however, gains in cigarette smoking cessation were not experienced among non-Hispanic Black/African American adults who smoke.

Midwife-led pandemic telemedicine services for maternal health and gender-based violence screening in Bangladesh: an implementation research case study

BackgroundThe COVID-19 pandemic disrupted maternal and newborn health services in Bangladesh, exacerbating the large gaps in service utilization that existed prior to the pandemic. As part of its response, Bangladesh initiated remote antenatal and postnatal care telemedicine services led by midwives in 36 sub-district hospitals across five of Bangladesh’s 64 districts. Gender-based violence screening and referral were integrated into the service to address a reported rise in violence following the country’s pandemic lockdown.MethodsMixed-methods implementation research was used to develop an intrinsic case study describing the design and implementation of the telemedicine program. Qualitative analysis comprised document review, key informant interviews, and focus group discussions. Quantitative analysis employed an interrupted time series analysis with segmented multi-variate regression to compare maternity care service use trends before and after implementation. Poisson regression analysis was used to examine the trend in number of gender-based violence remote screenings, sessions held, and cases identified.ResultsA statistically significant change in trend for onsite antenatal and postpartum care as well as women seeking care at the hospital as a result of postpartum hemorrhage arising in the community was observed following the introduction of telemedicine. Facility births and cases of eclampsia appropriately identified and managed also had significant increases. In addition, over 6917 women were screened for GBV, 223 received counseling and 34 referrals were made, showing a statistically significant increase in frequency over time following the implementation of the telemedicine program. Challenges included that not all midwives adopted GBV screening, some women were reluctant to discuss GBV, there was an unanticipated need to introduce a patient visit scheduling system in all intervention hospitals, and many women were not reachable by phone due to lack of access or network coverage.ConclusionsMaternal health and gender-based violence telemedicine led by midwives was an effective, low-cost intervention in Bangladesh for addressing pandemic and pre-pandemic gaps in service use. Other low and middle-income countries planning to implement remote maternal health interventions via midwives should consider whether a patient visit scheduling system needs to be introduced, as well as limitations around mobile phone access and connectivity. Future research should include care quality oversight and improvement, and a more well-informed strategy for facilitating effective GBV screening.

Population-based prevalence and trend of birth defects in Costa Rica from 2000 to 2019.

We aimed to analyze the prevalence and trend of birth defects (BDs) in Costa Rica, where BDs are the second leading cause of infant and under-five mortality. A descriptive analysis of selected BDs prevalence and trends from 2000 to 2019 was performed, based on data from the Costa Rican Birth Defects Register Center, the national BDs surveillance system with coverage of 98% of live births in the country. We used Joinpoint regression to identify any calendar year where a significant change in trend occurred; the annual percent change (APC) and the average annual percent change (AAPC) were determined. Marginal means and prevalence ratios by subperiod (2000-2009 as referent and 2010-2019) were estimated using Poisson regression, and compared using Wald's chi-square tests (alpha ≤0.05). From 2000 to 2019, BDs occurred in 2.3% of live births (95% CI: 2.3-2.4); 73% of which were major BDs. Males presented a significantly higher prevalence (sex ratio 1.13 males/females). The trend showed an AAPC of +3.7 (p < .05) with two joinpoints, 2005 and 2013. A significant APC (+11.3) was observed during 2005-2013, within the context of improvements in the surveillance system, such as the increase in the reporting age, and the incorporation of other data sources in addition to maternity hospitals. Most of the BDs groups presented a significant upward trend. The highest AAPC was observed for the respiratory system (+11.7), congenital heart defects (+9.5), and nervous system (+8.5). The BDs present a clear upward trend in the last two decades due, among other things, to a significant improvement in the surveillance system.

Impacts of the COVID-19 pandemic on enrollment in medications for opioid use disorder (MOUD) in Vancouver, Canada: An interrupted time series analysis.

In anticipation of COVID-19 related disruptions to opioid use disorder (OUD) care, new provincial and federal guidance for the management of OUD and risk mitigation guidance (RMG) for prescription of pharmaceutical opioids were introduced in British Columbia, Canada, in March 2020. This study evaluated the combined impacts of the COVID-19 pandemic and counteracting OUD policies on enrollment in medications for OUD (MOUD). Using data from three cohorts of people with presumed OUD in Vancouver, we conducted an interrupted time series analysis to estimate the combined effects impact of the COVID-19 pandemic and counteracting OUD policies on the prevalence of enrollment in MOUD overall, as well as in individual MOUDs (methadone, buprenorphine/naloxone, slow-release oral morphine) between November 2018 and November 2021, controlling for pre-existing trends. In sub-analysis we considered RMG opioids together with MOUD. We included 760 participants with presumed OUD. In the post-COVID-19 period, MOUD and slow-release oral morphine prevalence rates showed an estimated immediate increase in level (+7.6%, 95% CI: 0.6%, 14.6% and 1.8%, 95% CI: 0.3%, 3.3%, respectively), followed by a decline in the monthly trend (-0.8% per month, 95% CI: -1.4%, -0.2% and -0.2% per month, 95% CI: -0.4, -0.1, respectively). There were no significant changes in the prevalence trends of enrollment in methadone, buprenorphine/naloxone, or when RMG opioids were considered together with MOUD. Despite immediate improvements in MOUD enrollment in the post-COVID-19 period, this beneficial trend reversed over time. RMG opioids appeared to have provided additional benefits to sustain retention in OUD care.

Bacteriology and trends of antimicrobial resistance of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus in otitis media: A retrospective data analysis.

Otitis media (OM) has a high prevalence worldwide and the treatment is crucial because hearing loss in children can lead to growth disorders such as language development disorders. The aim of this study is to analyse the changes in bacterial strains and the trends of antibiotic susceptibility in otitis media with effusion (OME), chronic otitis media (COM) and cholesteatomatous otitis media (Chole OM). This retrospective study involved 2926 patients diagnosed with OME, COM, or Chole OM between January 2000 and December 2020. The clinical data were collected and analysed through chart review from May 2021 to July 2021. Two tertiary medical centres. The 2926 OM patients. An otorrhea sample was collected on the first day of their hospital visit. Middle ear fluid samples for bacterial culture and antibiotics susceptibility test were collected from patients during middle ear surgery, including ventilation tube insertion. In each type of OM, the distribution of bacterial strains in the 2000s and the 2010s was compared. In addition, changes in the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PA) and trends in their antibiotic susceptibility over the last 10 years were analysed. The most frequently detected bacterial strains in OME, COM and Chole OM over the study period were coagulase-negative Staphylococcus (CNS) (29.6%), MRSA (24.1%), and PA (20.1%). Compared to the 2000s, the proportion of non-typable Haemophilus influenzae in OME and MRSA in COM increased in the 2010s (27.4%-31.6% and 1.5%-29.5%, respectively). In total three types of OM, although there was no significant trend of change in detection rates of MRSA, PA, and multidrug resistant-P. aeruginosa (MDR-PA) during the last 10 years, resistance to the Quinolone class of MRSA and PA tended to increase (P < .05). The composition of bacterial strains in each types of OM has changed over the past 20 years. Additionally, the antibiotic resistance of MRSA and PA has increased in the last decade. Therefore, when using empirical antibiotics in necessary situations, it is necessary to change to an appropriate antibiotic through a bacterial culture test and antimicrobial susceptibility test.

Suicide in first-generation Australian migrants, 2006–2019: a retrospective mortality study

This study addressed the limited understanding of suicide risk and patterns among migrants in Australia. It examined national-level suicide rates and trends in the Australian population to identify migrant groups which are disproportionately affected by suicide. The National Coronial Information System was used to identify suicide cases from 2006 to 2019. Incident rate ratios (IRR) with 95% confidence intervals (CI) evaluated suicide risk for migrant groups compared to Australian-born and migrants from English-speaking countries. Age-standardised suicide rates (ASR) per 100,000 and average annual percentage change (AAPC) were calculated to compare suicide rates and trends. Compared to the Australian-born population, all migrant males and females had significantly lower suicide risk, except females from Oceania countries. Females from European (IRR 1.28, 95% CI 1.13, 1.14) and Oceanian countries (IRR 1.25; 95% CI 0.95, 1.66) had an elevated suicide risk compared to female migrants from English-speaking countries. Male migrants from Oceania (ASR 20.4, AAPC 1.0 (-3.6, 5.8)) and Africa (ASR 18.0, AAPC-0.4 (-5.5, 4.9)) have high ASR with no significant changes in trend over the study duration. Female African migrants had an ASR of 5.3 per 100,000, which increased by 8% (95% CI 1.4, 15.0) between 2006 and2019. Migrants from Oceania and African countries are disproportionately affected by suicide mortality compared to other migrant groups in Australia. Further research is needed to identify the risk factors and develop suicide prevention strategies for these groups. Suicide Prevention Australia, Australian Research Council.

Research note: The educational gradient of divorce in the Czech Republic during the late post-socialist transition

Objective: This study aims to describe the educational gradient and the role of educational homogamy in divorce risk in the Czech Republic. Background: The Czech Republic underwent a social transformation in the 1990s, which resulted in a significant change in many demographic trends. In contrast, the divorce trend seems to have been less affected. My aim is to describe the evolution of the patterns of the educational gradient of divorce during the late phase of the post-communist transformation. Method: Register data on marriages contracted in 1995, 2000, and 2005 were supplemented with divorce register records up to 2020. Besides the duration of the marriage, the data contains information on the education, age, and marital status of both partners at the time of marriage. The Kaplan-Meier curves and the Cox regression are used for the analysis. Results: The risk of divorce is substantially higher for the less educated, and this holds across all three marriage cohorts observed here. Homogamous marriages are not the most stable ones. From an individual's perspective, marriage with a more educated partner shows the highest stability. Conclusion: This analysis confirmed the stability of the negative educational gradient of marriages contracted during the late phase of the post-communist transition period in the Czech Republic. It refutes the notion that the higher relative education of the woman or man in the couple destabilises partnerships.

Utilization of Antiseizure Medications in Women of Childbearing Age With Epilepsy and Nonepilepsy Indications: A Retrospective Cohort Study.

Antiseizure medications (ASMs) are among the most commonly prescribed teratogenic drugs in women of childbearing age. Limited data exist on utilization patterns across different indications for therapy and for the newer-generation ASMs in this population. Thus, we assessed the pattern of ASM use in women of childbearing age with epilepsy and nonepilepsy indications (pain and psychiatric disorders). We conducted a retrospective analysis of deidentified administrative data submitted to the Optum Clinformatics database. Eligible participants included women aged 12-50 years who filled ASMs between year 2011 and 2017. Participants were followed from date of index prescription filled to study end or insurance disenrollment, whichever came first. For the overall cohort and potential therapy indications, we assessed the type and frequency of ASMs filled; proportion of participants on monotherapy, polytherapy, or treatment switching; and duration of continuous use. Trends were characterized using annual percent change from study start to study end. Our analysis included 465,131 participants who filled 603,916 distinct ASM prescriptions. At baseline, most of the participants had chronic pain (51.0%) and psychiatric disorders (32.7%), with epilepsy the least common (0.9%). The most frequently dispensed were diazepam (24.3%), lorazepam (20.1%), gabapentin (17.4%), clonazepam (12.7%), topiramate (11.3%), and lamotrigine (4.6%). Significant linear increase in trends were observed with gabapentin (annual percent change [95% CI]: 8.4 [7.3-9.4]; p < 0.001) and levetiracetam (3.4 [0.7-6.2]; p = 0.022) and decreasing trends for diazepam (-3.5 [-2.4 to 4.5]; p < 0.001) and clonazepam (-3.4 [-2.3 to 4.5]; p = 0.001). No significant change in trend was observed with valproate (-0.4 [-2.7 to 1.9]; p = 0.651), while nonlinear changes in trends were observed with lorazepam, topiramate, lamotrigine, and pregabalin. Decreasing trends were observed with older ASMs in the overall cohort and across the potential indications for therapy. Conversely, increasing trends were seen with the newer ASMs. Considering the risk of teratogenicity associated with the newer medications largely unknown, counseling and education in addition to a careful consideration of the benefits vs potential risks should remain pivotal when prescribing ASMs for women of childbearing age.

Breast cancer incidence in Yogyakarta, Indonesia from 2008-2019: A cross-sectional study using trend analysis and geographical information system.

Breast cancer is a significant public health concern worldwide, including in Indonesia. Little is known about the spatial and temporal patterns of breast cancer incidence in Indonesia. This study aimed to analyze temporal and spatial variations of breast cancer incidence in Yogyakarta Province, Indonesia. The study used breast cancer case data from the Yogyakarta Population-Based Cancer Registry (PBCR) from 2008 to 2019. The catchment areas of the PBCR included the 48 subdistricts of 3 districts (Sleman, Yogyakarta City, and Bantul). Age-standardized incidence rates (ASR) were calculated for each subdistrict. Joinpoint regression was used to detect any significant changes in trends over time. Global Moran's and Local Indicators of Spatial Association (LISA) analyses were performed to identify any spatial clusters or outliers. The subdistricts had a median ASR of 41.9, with a range of 15.3-70.4. The majority of cases were diagnosed at a late stage, with Yogyakarta City having the highest proportion of diagnoses at stage 4. The study observed a significant increasing trend in breast cancer incidence over the study period the fastest of which is in Yogyakarta City with an average annual percentage change of 18.77%, with Sleman having an 18.21% and Bantul having 8.94% average changes each year (p <0.05). We also found a significant positive spatial autocorrelation of breast cancer incidence rates in the province (I = 0.581, p <0.001). LISA analysis identified 11 subdistricts which were high-high clusters in the central area of Yogyakarta City and six low-low clusters in the southeast region of the catchment area in the Bantul and Sleman Districts. No spatial outliers were identified. We found significant spatial clustering of BC ASR in the Yogyakarta Province, and there was a trend of increasing ASR across the region. These findings can inform resource allocation for public health efforts to high-risk areas and develop targeted prevention and early detection strategies. Further res is needed to understand the factors driving the observed temporal and spatial patterns of breast cancer incidence in Yogyakarta Province, Indonesia.

Discovering fashion industry trends in the online news by applying text mining and time series regression analysis

The growth of digital media usage has accelerated the development of big data technology. According to the agenda-setting theory, news media inform the public regarding major agendas and business cycles. This study investigated 168,786 news documents from 2016 to 2020 related the South Korea fashion business using Python. A total of 19 topics were extracted through latent Dirichlet allocation and then transformed into structured data using a time series approach to analyze significant changes in trends. The results indicate that major fashion industry topics include business management strategies to increase sales, diversification of the retail structure, influence of CEOs, and merchandise marketing activities. Thereafter, statistically significant hot and cold topics were derived to identify the shifts in topic themes. This study expands the fashion business contexts with agenda-setting theory through big data time series analyses and can be referenced for the government agencies to support fashion industry policies.

The climatic and river runoff trends in Central Asia: The case of Zhetysu Alatau region, the south-eastern part of Kazakhstan

This study analyses, compares and correlates historical hydrometeorological data for the Zhetysu Alatau region and its main rivers (Lepsy, Sarykan, Koktal, Byzhy) to document characteristics and evidence of changes in climate change (temperature and precipitation) and its impact on annual and monthly river runoff. This study applies Andreyanov method for computation of runoff data and Mann-Kendall statistic method for assessing statistically significant or weak trends. The study reveals that the pattern of temperature for period of 1960–2020 and runoff for period of 1930–2019 has changed in the region. Mann-Kendall test result indicates a statistically significant increase in temperature at all meteorological stations (p<0.01), while the fluctuations in precipitation trends are not meaningful (p>0.05). Andreyanov method shows significant changes in intra-annual runoff trends, e.g., calculations for the period of 1965–2019 show a decrease of 5.3% in summer runoff in the Sarykan river, and the increase in runoff in the remaining months was 6.4% higher compared to the period of 1930–1965. Furthermore, the Mann-Kendall test confirms a significant positive trend in the change of seasonal runoff for the Sarykan, Byzhy, and Koktal rivers (p<0.02). The precipitation is one of the main factors influencing river runoff and the correlation coefficient between river runoff and precipitation for Lepsy river is r=0.81; for Byzhy river is r=0.70; for Koktal river is r=0.62; for Sarykan river is r=0.60.

Prescription Psychotherapeutic Drug Use and Nicotine Use among Young People in the United States

Background: While prescription psychotherapeutic drug use (PPDU) and nicotine use pose substantial problems in isolation, they pose an increased risk in combination. This study aimed to estimate the prevalence of PPDU for young people, stratified by nicotine use status. A trend analysis was used to examine changes in PPDU and nicotine use over time. Methods: We used a cross-sectional population-based sample of young people aged 16–25 years (n = 10,454) from the National Health and Nutrition Examination Survey (NHANES, 2003–2018). For each data cycle, the prevalence of self-reported PPDU and nicotine including pain relievers, sedatives, stimulants, and tranquilizers was estimated. Using Joinpoint regression, we tested for significant changes in trends using a log-linear model and permutation test approach and produced the average data cycle percentage change (ADCPC). Results: From 2003 to 2018, 6.7% of young people had PPDU and 27.3% used nicotine. The prevalence of cigarette smoking decreased while other nicotine product use increased (p’s < 0.001). Those who used nicotine were more likely to have PPDU (8.2%; 95% CI = 6.5%, 9.8%) vs. non-nicotine use (6.1%; 95% CI = 5.1%, 7.0%; p = 0.01). Results indicated a decreasing trend for nicotine use (ADCPC = −3.8, 95% CI = −7.2, −0.3; p = 0.04), but not for PPDU (ADCPC = 1.3; 95% CI = −4.7, 7.8; p = 0.61). On further examination, opioid use decreased, sedative use remained stable, and stimulant and tranquilizer use increased over time. Conclusions: From 2003 to 2018, young people who used nicotine had a higher prevalence of PPDU than those who did not. Clinicians should communicate the association between nicotine use and prescription drugs when prescribing or managing young patients’ medications.

Modelling of hygro-mechanical behaviour of wooden panel paintings: model calibration and artworks characterisation

Wooden Panel Paintings (WPP) are among the most significant historical and artistic artifacts from the Middle Ages and Renaissance and pose a challenge to conservators and scientists in both their comprehension and conservation. From a structural point of view, they can be considered as multi-layered objects, consisting of a wooden support and several pictorial layers. The wooden support, hygroscopic in nature, constantly seeks equilibrium with the humidity of the environment, and consequently deforms. Based on a series of hygroscopic tests carried out on six original WPPs, the present work aims to model their deformation tendencies induced by moisture changes and to characterise them by means of an inverse identification process. The sensitivity analysis of this study provided valuable insights into the complexity of the phenomenon of WPP deformation: even small variations in input variables (board anatomy, stiffness and emissivity of pictorial layers) led to significant changes in the deformation trend over time, highlighting the high variability of the physical problem under investigation. Sobol's analysis variance confirmed this complexity, demonstrating the different levels of influence of input variables and the existence of interactions between them. Overall, the results of this analysis highlighted the need to carefully evaluate the interactions and uncertainties in input variables to fully understand the complexity of the system. The iterative optimization process led to numerical results tending to agree with experimental data, with most results showing a very high correlation. This suggests that the chosen variables and modelling assumptions sufficiently described the physical system and that numerical models can be accurately calibrated. The proposed concept of 'learning from objects', by conducting experimental investigations specifically dedicated to understanding the deformation tendencies of the artwork, is essential. In this approach, numerical analysis is used in conjunction with experiments to gain a deeper understanding of the artwork, characterise it and extract valuable information.

Assessing the Impact of 2-Step Clostridioides difficile Testing at the Healthcare Facility Level.

Two-step testing for Clostridioides difficile infection (CDI) aims to improve diagnostic specificity but may also influence reported epidemiology and patterns of treatment. Some providers fear that 2-step testing may result in adverse outcomes if C. difficile is underdiagnosed. Our primary objective was to assess the impact of 2-step testing on reported incidence of hospital-onset CDI (HO-CDI). As secondary objectives, we assessed the impact of 2-step testing on C. difficile-specific antibiotic use and colectomy rates as proxies for harm from underdiagnosis or delayed treatment. This longitudinal cohort study included 2 657 324 patient-days across 8 regional hospitals from July 2017 through March 2022. Impact of 2-step testing was assessed by time series analysis with generalized estimating equation regression models. Two-step testing was associated with a level decrease in HO-CDI incidence (incidence rate ratio, 0.53 [95% confidence interval {CI}, .48-.60]; P < .001), a similar level decrease in utilization rates for oral vancomycin and fidaxomicin (utilization rate ratio, 0.63 [95% CI, .58-.70]; P < .001), and no significant level (rate ratio, 1.16 [95% CI, .93-1.43]; P = .18) or trend (rate ratio, 0.85 [95% CI, .52-1.39]; P = .51) change in emergent colectomy rates. Two-step testing is associated with decreased reported incidence of HO-CDI, likely by improving diagnostic specificity. The parallel decrease in C. difficile-specific antibiotic use offers indirect reassurance against underdiagnosis of C. difficile infections still requiring treatment by clinician assessment. Similarly, the absence of any significant change in colectomy rates offers indirect reassurance against any rise in fulminant C. difficile requiring surgical management.

Impact of COVID-19 pandemic on healthcare-associated infections at intensive care units in South Korea: data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS)

The coronavirus disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. To evaluate the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in intensive care units (ICUs). A retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System was conducted. Comparisons between incidence rates and micro-organism distributions of bloodstream infection (BSI), central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before and during the COVID-19 pandemic were performed according to hospital size. The incidence rate of BSI significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period (1.38 vs 1.23 per 10,000 patient-days, relative change -11.5%; P < 0.001). The incidence rate of VAP (1.03 vs 0.81 per 1000 device-days, relative change -21.4%; P < 0.001) significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period, whereas rates of CLABSI (2.30 vs 2.23 per 1000 device-days; P= 0.19) and CAUTI (1.26 vs 1.26 per 1000 device-days; P= 0.99) were similar between the two periods. The rates of BSI and CLABSI significantly increased during the COVID-19 pandemic compared to the pre-COVID-19 period in large-sized hospitals, whereas these rates significantly decreased in small-to-medium-sized hospitals. The rates of CAUTI and VAP significantly decreased in small-sized hospitals. There were no significant changing trends in the rates of multidrug-resistant pathogens isolated from patients with HAI between the two periods. The incidence rates of BSI and VAP in ICUs decreased during the COVID-19 pandemic compared to the pre-COVID-19 period. This decrease was mainly seen in small-to-medium-sized hospitals.

Association between stopping universal SARS-CoV-2 admission testing and hospital-onset SARS-CoV-2 in England and Scotland

Background: Many hospitals test all patients for SARS-CoV-2 upon admission to prevent silent transmission to other patients and healthcare workers. The utility of universal admission testing has been questioned, however, due to resource constraints, care delays, and sparse data on its impact on nosocomial infections. England and Scotland stopped requiring universal admission testing on August 31, 2022, and September 28, 2022, respectively. We assessed associations between these changes and hospital-onset SARS-CoV-2 infection rates. Methods: We used public data from National Health Service England and Public Health Scotland on hospital-onset SARS-CoV-2 infections, defined as cases diagnosed &gt;7 days after admission, between July 1, 2021, and December 16, 2022. Because hospital-onset infections are driven by SARS-CoV-2 community incidence rates, we calculated the weekly ratio between hospital-onset versus community-onset SARS-CoV-2 admissions (diagnosed ≤7 days from admission) and assessed for temporal changes associated with stopping universal admission testing using interrupted time-series analysis. The study was divided into 3 periods: sARS-CoV-2 delta-variant dominance with admission testing, SARS-CoV-2 omicron-variant dominance with admission testing (starting December 14, 2021), and SARS-CoV-2 omicron-variant dominance without admission testing. Results: During the study period, there were 518,379 COVID-19 admissions in England, including 398,264 community-onset and 120,115 hospital-onset cases, and 46,517 COVID-19 admissions in Scotland, including 34,183 community-onset and 12,334 hospital-onset cases. The mean weekly ratio of new hospital-onset SARS-CoV-2 infections versus community-onset admissions in England rose from 0.12 during the SARS-CoV-2 delta-variant surge to 0.33 during the SARS-CoV-2 omicron-variant surge to 0.48 after universal admission testing ended (Fig.). There was a significant immediate level change both after the SARS-CoV-2 delta-to-omicron variant transition (92% relative increase; 95% CI, 58%–127%) and after admission testing ended (32% relative increase; 95% CI, 14%–50%). Likewise, the mean weekly ratios rose from 0.11 to 0.43 to 0.89 during their analogous periods in Scotland, with significant level changes both after SARS-CoV-2 delta-to-omicron variant transition (113% relative increase; 95% CI, 54%–172%) and after admission testing ended (72% relative increase; 95% CI, 43%–100%). No significant trend changes were observed. Conclusions: Stopping asymptomatic screening of hospitalized patients in 2 national health systems was associated with significant increases in hospital-onset SARS-CoV-2 infections. Nosocomial SARS-CoV-2 remains a common and potentially morbid complication, with reported mortality rates for nosocomial infections by SARS-CoV-2 omicron variant ranging from 5% to 13%. Preventing infections in vulnerable populations remains an important safety goal. Hospitals should exercise caution when considering reductions in SARS-CoV-2 admission screening.Disclosures: None

Effectiveness of medical fee revisions for psychotropic polypharmacy in patients with mood disorders in Japan: An interrupted time-series analysis using a nationwide inpatient database.

This study aimed to evaluate the effects of medical fee revisions aimed to reduce psychotropic polypharmacy in Japan on the proportion of psychotropic polypharmacy in discharge prescriptions for patients with major depressive disorder (MDD) or bipolar disorder (BD) using a nationwide inpatient database. In this retrospective cohort study, we used the Diagnosis Procedure Combination database to identify patients with MDD or BD discharged between April 2012 and March 2021. We targeted medical fee revisions in October 2014, April 2016, and April 2018. The major outcome was the monthly proportion of psychotropic polypharmacy in prescription at discharge using the criteria following the April 2018 revision (antidepressants ≥3, antipsychotics ≥3, anxiolytics ≥3, hypnotics ≥3, or sum of anxiolytics and hypnotics ≥4). We performed interrupted time series analyses to evaluate the changes in level and trend between pre- and post-revisions. We identified 63,289 and 33,780 patients with MDD and BD respectively in the entire study period. In both the patient groups, there were significant decreases in the proportion of psychotropic polypharmacy at revision in October 2014, and no significant trend and level change at revision were observed in April 2016 and April 2018, with a few exceptions. The medical fee revisions aimed to reduce psychotropic polypharmacy in Japan might have had a limited impact on discharge prescriptions for patients with MDD and BD.

Risk factors for misdiagnosis in children with developmental dysplasia of the hip: a retrospective single centre study

ObjectiveTo investigate risk factors of misdiagnosis at the first visit of children with developmental dysplasia of the hip (DDH) who did not participate in hip ultrasound screening.MethodsA retrospective review was...

Trends and factors associated with secondhand smoke exposure among US cancer survivors, 2013-2020.

Secondhand smoke (SHS) poses a significant public health threat. Cancer survivors are at a greater risk of adverse health outcomes from SHS because of its association with poor prognosis and other downstream clinical events. A nationally representative sample of US adults aged 20years and older was analyzed from the National Health and Nutrition Examination Survey between 2013 and 2020. Data on indoor SHS exposure were reported by 16,778 adults who were not currently smoking (1775 cancer survivors; 15,003 individuals without a cancer history). The weighted prevalence of SHS exposure was estimated and compared across sociodemographic and health-related characteristics. Multivariable logistic regression models were fitted to identify correlates of SHS exposure. Of the 1775 nonsmoking cancer survivors (mean age, 64.9years; 57.0% female; 84.4% non-Hispanic Whites), 15.8% reported SHS exposure. No significant change in trends of SHS exposure was observed during the study period. The prevalence of SHS exposure was higher in cancer survivors who were younger, racial minorities, and had a household income below 130% of the federal poverty level. After adjustment for multiple correlates, age below 40 years, low income, smoking history, and diagnosis within 2 years were associated with SHS exposure. Cancer survivors were most likely to report that SHS exposure occurred at home or in a car. The prevalence of SHS exposure among cancer survivors remained steady in the past decade. However, disparities exist in SHS exposure among cancer survivors across sociodemographic characteristics and smoking status. Smoking cessation programs should be promoted among caregivers and families of cancer survivors.