Factors associated with transmission of COVID-19 in long-term care facility outbreaks.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a disproportionate impact on residents in long-term care facilities (LTCFs). AIM: To identify risk factors associated with outbreak severity to inform current outbreak management and future pandemic preparedness planning efforts. METHODS: A retrospective cohort study design was used to evaluate the association between non-modifiable factors (facility building, organization level, and resident population characteristics), modifiable factors (measured through an assessment tool for infection prevention and control (IPC) and pandemic preparedness), and severity of COVID-19 outbreaks (attack rate) in LTCFs. FINDINGS: From March 1st, 2020 to January 10th, 2021, a total of 145 exposures to at least one confirmed case of COVID-19 in 82 LTCFs occurred. Risk factors associated with increased outbreak severity were older facility age, a resident (vs staff) index case, and poorer assessment tool performance. Specifically, for every item not met in the assessment tool, a 22% increase in the adjusted rate ratio was observed (1.2; 95% confidence interval: 1.1-1.4) after controlling for other risk factors. CONCLUSION: Scores from an assessment tool, older building age, and the index case being a resident were associated with severity of COVID-19 outbreaks in our jurisdiction. The findings reinforce the importance of regularly assessing IPC measures and outbreak preparedness in preventing large outbreaks. Regular, systematic assessments incorporating IPC and outbreak preparedness measures may help mitigate impacts of future outbreaks and inform future pandemic preparedness planning.

Outcomes of patients with Parkinson disease and pathological gambling.

OBJECTIVE: To determine the outcomes of patients with Parkinson disease (PD) with pathological gambling (PG) from one Canadian Movement Disorders Clinic. METHODS: Assessments were performed in-person during routine clinic visits of all patients currently followed by one neurologist (OS). Pathological gambling was defined according to DSM-IV-TR criteria. Chart review was performed to obtain details on medication use, dosages, and patient demographics. Follow-up of patients with PG collected information on gambling behavior, PG management interventions, medications, treatment, and psychosocial outcomes. RESULTS: 146 patients were surveyed with an overall prevalence of PG of 4.1% (6/146). The rate of pathological gambling for those patients on dopamine agonist therapy (DA) was 8.1% (6/74). Only patients who were recreational gamblers prior to starting DA developed PG. All PG patients discontinued, decreased, or switched to another DA, and experienced a partial or full remission of PG. 3 (50%) patients described financial losses of $100,000 or more, and 75% (3/4) patients described significant marital stresses. At follow-up (August 2008), 4 of the 6 patients with PG continued to gamble in a controlled fashion despite medication changes. No significant difference in levodopa equivalent daily dose (LEDD) pre- and post-PG were observed; however, the relative amount of DA was decreased (p= 0.0593), while levodopa was relatively increased (p= 0.5277). Despite control of PG, patients still experience financial and marital strains. CONCLUSIONS: DA (in combination with levodopa) was associated with a significantly higher prevalence of PG in PD, particularly in patients who were recreational gamblers previously. Despite control of PG, patients continued to experience significant financial and marital stresses that should be regularly enquired upon in follow-up care and managed appropriately.