To design a new risk assessment tool to identify patients at high risk for hospital-acquired pressure injuries.The researchers developed the Shieh Score using retrospective data of 406,032 hospital admissions from January 2014 to December 2016 with 1,299 pressure injury cases from the pressure injury registry. A decision tree and best subset logistic regression were used to select predictors from demographic and clinical candidate variables, which were then used to construct the Shieh Score.The final Shieh Score included the following measures: sex, age, diabetes, glomerular filtration rate, albumin level, level of function, use of IV norepinephrine, mechanical ventilation, and level of consciousness. The Shieh Score had a higher Youden Index, specificity, and positive predictive value than the Braden Scale. However, the Braden Scale had a higher sensitivity compared with the Shieh Score.The Shieh Score is an alternative risk assessment tool that may effectively identify a smaller number of patients at high risk for hospital-acquired pressure injuries with a higher specificity and positive predictive value than the Braden Scale.
To compare hospitalisation rates, intensive care unit (ICU) admissions and mortality for patients with COVID-19 who were consistently inactive, doing some activity or consistently meeting physical activity guidelines.We identified 48 440 adult patients with a COVID-19 diagnosis from 1 January 2020 to 21 October 2020, with at least three exercise vital sign measurements from 19 March 2018 to 18 March 2020. We linked each patient's self-reported physical activity category (consistently inactive=0-10 min/week, some activity=11-149 min/week, consistently meeting guidelines=150+ min/week) to the risk of hospitalisation, ICU admission and death after COVID-19 diagnosis. We conducted multivariable logistic regression controlling for demographics and known risk factors to assess whether inactivity was associated with COVID-19 outcomes.Patients with COVID-19 who were consistently inactive had a greater risk of hospitalisation (OR 2.26; 95% CI 1.81 to 2.83), admission to the ICU (OR 1.73; 95% CI 1.18 to 2.55) and death (OR 2.49; 95% CI 1.33 to 4.67) due to COVID-19 than patients who were consistently meeting physical activity guidelines. Patients who were consistently inactive also had a greater risk of hospitalisation (OR 1.20; 95% CI 1.10 to 1.32), admission to the ICU (OR 1.10; 95% CI 0.93 to 1.29) and death (OR 1.32; 95% CI 1.09 to 1.60) due to COVID-19 than patients who were doing some physical activity.Consistently meeting physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults. We recommend efforts to promote physical activity be prioritised by public health agencies and incorporated into routine medical care.
To identify correlates of nonadherence to the recommendation for routine second-dose varicella vaccination in a diverse sample of school-age children.A total of 67,977 children of 4-6 years (51% male, 50% Hispanic) were included in this retrospective cohort study. The second-dose varicella vaccination history was evaluated by using the Kaiser Immunization Tracking System. Correlation and multivariable regression analyses were used to test the association between potential correlates and nonadherence to the second-dose varicella vaccination.Four-year-old children had a significantly higher vaccination rate (76.1%) than 5-year-olds (43.2%) and 6-year-olds (17.3%) by 12 months after the implementation of routine second-dose varicella vaccination. Non-Hispanic white race [rate ratio (RR): 1.13 (95% CI: 1.11-1.15)], living in an area of >75% adults with a high-school diploma [RR: 1.17 (95% CI: 1.14-1.20)], and having a primary care provider specializing in family medicine [RR: 1.15 (95% CI: 1.11-1.18)] significantly correlated with nonadherence. Missed opportunity was found in 59.7% (n=20,465) of children who did not receive the second-dose varicella vaccine in spite of at least 1 outpatient visit and in 15.8% (n=5407) who received some other vaccines during the follow-up period.Efforts targeting non-Hispanic white and black children, parents with a high education level and family medicine physicians might improve uptake of the routine 2-dose varicella vaccination. Incorporation of a requirement for the second-dose varicella vaccine into the school law might help achieve high adherence to the routine 2-dose varicella vaccination in school-age children.
Abstract Background: The effect of alcohol consumption on lung cancer risk has been controversial. We investigated the effects of different types of alcoholic beverage as well as total alcohol consumption on risk of lung cancer in the VITamins And Lifestyle (VITAL) Study. Methods: The VITAL study is a prospective cohort of 77,719 men and women aged 50-76 years who were residents of Washington State and completed the study questionnaire mailed between 2000-2002. Incident lung cancer cases (N= 812) were identified through the Washington Surveillance, Epidemiology and End Results cancer registry through December 2007. Data collection was accomplished at baseline using a self-administered, gender-specific questionnaire that covered diet, supplement use, health history and risk factors. Diet was assessed by a food frequency questionnaire that captures detailed information on alcoholic beverage use. Persons with any previous cancer (except non-melanoma skin cancer) or lung cancer diagnosed within 6 months post study baseline were excluded. As white account for 93% of the cohort, non-white race was excluded from the analysis to avoid residual confounding by race. Cox's regression was used to examine the effects of beer, red wine, white wine, liquor, and total alcoholic beverage intake on risk of overall lung cancer as well histologic subtypes. The effects of former drinking at age 30 and 45 on lung cancer risk were also assessed. Gender, education, household income, body mass index, history of COPD/emphysema, smoking duration, pack-years, pack-years squared (these three smoking variables constitute the smoking model with best model fit in VITAL), family history of lung cancer, physical activity, fat and fruit and vegetable intake were adjusted for in the multivariable analyses. Results: After applying the exclusion criteria, 60,556 subjects (533 lung cancer cases) remained eligible for the analyses. There was no clear association between lung cancer and moderate intake of beer, red wine, white wine or liquor up to ≥ 1 drink/day (average intake was 2 drinks/day in this category). Total alcoholic beverage intake of up to ≥4 drink/day was not associated with elevated overall lung cancer risk [Hazard ratio (HR) = 1.16, 95% confidence interval 0.75-1.78]. Heavy consumption (≥4 drink/day) of alcohol was, however, associated with a doubling of risk for squamous cell carcinoma [HR = 2.45 (1.12-5.37), p-value for linear trend=0.003], but not for adenocarcinoma [HR=1.32 (0.64-2.70)]. Total alcohol intake at age 30 was not associated with risk of overall lung cancer or any histologic subtype, while a significant linear dose-response was detected for total alcohol intake at age 45, primarily for squamous cell carcinoma [p-value for linear trend =0.02]. Conclusion: Heavy alcohol consumption in later adulthood (e.g., age 45 and greater), but not in early adulthood, may be associated with risk of lung squamous cell carcinoma. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-398.
Obesity has been recognised as a risk factor for poor outcomes associated with COVID-19. Ethnic minorities with COVID-19 have been independently found to fare poorly. We aim to determine if ethnic minorities with severe obesity-defined as a body mass index (BMI) above 40 kg/m²-experience higher rates of hospitalisation, invasive ventilation and death.
Background: Little is known concerning the relative effectiveness of LTRAs compared to ICSs as monotherapy or LABA as add-on therapy in the Asian population. Objectives:In this retrospective cohort study, we examined the comparative effectiveness of montelukast to ICS as a first-line monotherapy and as an add-on in comparison with LABA on asthma exacerbations among Asian and non -Hispanic white persistent asthma patients in a large managed care organization. Methods:The three add-on comparisons were montelukast plus low-dose ICS versus LABA plus low-dose ICS, montelukast plus low-dose ICS versus medium-dose ICS, and montelukast plus medium-dose ICS versus LABA plus medium-dose ICS.Patients were identified based on ICD-9 diagnosis codes and administrative pharmacy dispensing.Exacerbations were defined as asthma emergency department visit or hospitalization, or asthma outpatient visits requiring systemic corticosteroid dispensing.Patient demographic and clinical characteristics were balanced by using inverse probability treatment weighting.Multivariable robust Poisson and Cox-proportional hazards regression models were applied to estimate rate ratios and hazard ratios.Results: Compared with low-dose ICS monotherapy, montelukast monotherapy evidenced a lower incidence rate (RR 0.89, CI 0.79-0.99,p=0.03) but similar hazard rate (HR 0.96, CI 0.86-1.06,p=0.43) of asthma exacerbation in white patients 12 years of age or older.No difference was observed in Asian patients or in white children 4-11 years of age.All other comparisons did not reveal a statistically significant difference in incidence or hazard rate. Conclusion:In a real-world comparative effectiveness study, asthma exacerbation rates were similar among guideline alternative controller regimens in Asians and whites.
Introduction: Patients who present to a PSC with a large vessel occlusion are often transferred to hospitals with thrombectomy capability. Inequities in rates of hospital transfer amongst patients across various gender, racial background, and socioeconomic status are well established. A common metric used to determine quality of care in such transfers is the Door In Door Out (DIDO) time. We hypothesized that there would be no difference in the DIDO using an established systematic approach to transfers in our 14-hospital integrated healthcare system. Methods: All interhospital transfers for thrombectomy across our 14 PSCs were examined from 10/2020 - 4/2023. Age, gender, race/ethnicity, and insurance status were abstracted and used to assess if disparities in DIDO were present. ANOVA and Chi-Square were used for statistical analysis. Results: 307 patients were identified over a 3-year period across all our sites. 48.9% were female with a mean age of 69.7 (±16.2). The median NIHSS was 13 (IQR 7 - 20) and the median DIDO was 96 mins (IQR 74 - 131 mins). There was no difference in median DIDO between females 94 mins (IQR 74 - 132 mins) and males 98 mins (IQR 73 - 98 mins) (p = 0.2). When compared to White patients, there was no difference in median DIDO for Asian American/Pacific Islander (AAPI) (12.6 mins, p = 0.6), Black (-2.1 mins, p = 1.0), or Hispanic patients (7.6 mins, p = 0.7). The insurance status of our patient population was predominantly Medicare (56.4%), followed by Commercial (26.4%), Medicaid (8.1%), and Self- Pay (2.9%). The remainder were classified as Other/Missing (6.2%). When compared to the remainder of the population, we found no difference in median DIDO for patients on Medicare (-2.0 mins, p = 0.7) or Medicaid (10.8 mins, p = 0.3). Conclusions: A Southern California integrated healthcare system’s approach to thrombectomy transfers enables the removal of disparities in DIDO regardless of gender, racial background, and insurance status.
