Pneumococcal serotypes and risk factors in adult community-acquired pneumonia 2018-20; a multicentre UK cohort study.

Background: Higher-valency pneumococcal vaccines are anticipated. We aimed to describe serotype distribution and risk factors for vaccine-serotype community-acquired pneumonia (CAP) in the two years pre-SARS-CoV-2 pandemic. Methods: We conducted a prospective cohort study of adults hospitalised with CAP at three UK sites between 2018 and 2020. Pneumococcal serotypes were identified using a 24-valent urinary-antigen assay and blood cultures. Risk factors associated with vaccine-type pneumonia caused by serotypes in the 13-, 15- and 20-valent pneumococcal conjugate vaccines (PCV13, PCV15, PCV20) and 23-valent pneumococcal polysaccharide vaccine (PPV23) were determined from multivariable analysis. Findings: Of 1921 adults hospitalised with CAP, 781 (40.7%, 95% confidence intervals (CI) 38.5-42.9%) had pneumococcal pneumonia. A single PCV13-serotype was detected in 242 (31.0%, 95% CI 27.8-34.3%) pneumococcal CAP patients, mostly serotype 3 (171/242, 70.7%, 95% CI 64.5-76.0%). The additional two PCV15-serotypes were detected in 31 patients (4%, 95% CI 2.8-5.6%), and PCV20-non13-serotypes in 192 (24.6%), with serotype 8 most prevalent (123/192, 64.1%, 95% CI 57.1-70.5%). Compared to PCV13-serotype CAP, people with PCV20-non13 CAP were younger (median age 62 versus 72 years, p < 0.001) and less likely to be male (44% versus 61%, p = 0.01). PPV23-non13-serotypes were found in 252 (32.3%, 95% CI 29.1-35.6%) pneumococcal CAP patients. Interpretation: Despite mature infant pneumococcal programmes, the burden of PCV13-serotype pneumonia remains high in older adults, mainly due to serotype 3. PCV20-non13-serotype pneumonia is more likely in younger people with fewer pneumococcal risk factors. Funding: Unrestricted investigator-initiated research grant from Pfizer, United Kingdom; support from National Institute for Health Research (NIHR) Biomedical Research Centre, Nottingham.

Children overclaim more knowledge than adults do, but for different reasons.

Overclaiming is the phenomenon whereby people claim more knowledge of a topic than they actually have. In adults, this behavior is related to the extent to which they consider themselves an expert on that topic and may be related to impression management. We investigated the emergence of this phenomenon by developing a child-friendly overclaiming questionnaire (OCQ)-the Child-OCQ. We measured the tendency of children (5-10 years of age old; N = 94) to claim knowledge of items that did not exist for a variety of topics (places, characters, animals, food, and musical instruments). We also examined the relationship between children's overclaiming of knowledge and their self-perceived liking of, and expertise in, the topics. To validate our scale, an adult sample (N = 51) completed both the Child-OCQ and a standardized adult OCQ, the OCQ-150, showing similar overclaiming patterns on both measures. Although overclaiming behaviors decreased throughout childhood, even children as old as 10 years were not adult-like and were more likely to overclaim knowledge than adults. In addition, we did not find strong evidence that children's perceived expertise on a topic influenced their tendency to overclaim knowledge, suggesting that the mechanisms behind the overclaiming phenomenon are different in children and do not reflect impression management until later during adolescence or adulthood.

High impact actions: discharge planning.

This article, the first in a series on the NHS Institute for Innovation and Improvement's eight high impact actions, presents three case studies of how senior nurses in acute and community settings have developed hospital discharge arrangements to improve patient flow and ensure more effective use of bed capacity.