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1.
JAMA ; 325(24): 2448-2456, 2021 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-33929487

RESUMO

Importance: Cerebral venous sinus thrombosis (CVST) with thrombocytopenia, a rare and serious condition, has been described in Europe following receipt of the ChAdOx1 nCoV-19 vaccine (Oxford/AstraZeneca), which uses a chimpanzee adenoviral vector. A mechanism similar to autoimmune heparin-induced thrombocytopenia (HIT) has been proposed. In the US, the Ad26.COV2.S COVID-19 vaccine (Janssen/Johnson & Johnson), which uses a human adenoviral vector, received Emergency Use Authorization (EUA) on February 27, 2021. By April 12, 2021, approximately 7 million Ad26.COV2.S vaccine doses had been given in the US, and 6 cases of CVST with thrombocytopenia had been identified among the recipients, resulting in a temporary national pause in vaccination with this product on April 13, 2021. Objective: To describe reports of CVST with thrombocytopenia following Ad26.COV2.S vaccine receipt. Design, Setting, and Participants: Case series of 12 US patients with CVST and thrombocytopenia following use of Ad26.COV2.S vaccine under EUA reported to the Vaccine Adverse Event Reporting System (VAERS) from March 2 to April 21, 2021 (with follow-up reported through April 21, 2021). Exposures: Receipt of Ad26.COV2.S vaccine. Main Outcomes and Measures: Clinical course, imaging, laboratory tests, and outcomes after CVST diagnosis obtained from VAERS reports, medical record review, and discussion with clinicians. Results: Patients' ages ranged from 18 to younger than 60 years; all were White women, reported from 11 states. Seven patients had at least 1 CVST risk factor, including obesity (n = 6), hypothyroidism (n = 1), and oral contraceptive use (n = 1); none had documented prior heparin exposure. Time from Ad26.COV2.S vaccination to symptom onset ranged from 6 to 15 days. Eleven patients initially presented with headache; 1 patient initially presented with back pain and later developed headache. Of the 12 patients with CVST, 7 also had intracerebral hemorrhage; 8 had non-CVST thromboses. After diagnosis of CVST, 6 patients initially received heparin treatment. Platelet nadir ranged from 9 ×103/µL to 127 ×103/µL. All 11 patients tested for the heparin-platelet factor 4 HIT antibody by enzyme-linked immunosorbent assay (ELISA) screening had positive results. All patients were hospitalized (10 in an intensive care unit [ICU]). As of April 21, 2021, outcomes were death (n = 3), continued ICU care (n = 3), continued non-ICU hospitalization (n = 2), and discharged home (n = 4). Conclusions and Relevance: The initial 12 US cases of CVST with thrombocytopenia after Ad26.COV2.S vaccination represent serious events. This case series may inform clinical guidance as Ad26.COV2.S vaccination resumes in the US as well as investigations into the potential relationship between Ad26.COV2.S vaccine and CVST with thrombocytopenia.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Trombose dos Seios Intracranianos/etiologia , Trombocitopenia/etiologia , Adolescente , Adulto , Cuidados Críticos , Evolução Fatal , Feminino , Cefaleia/etiologia , Humanos , Pessoa de Meia-Idade , Contagem de Plaquetas , Trombose dos Seios Intracranianos/terapia , Trombocitopenia/terapia
2.
MMWR Morb Mortal Wkly Rep ; 69(15): 446-450, 2020 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-32298246

RESUMO

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), has spread rapidly around the world since it was first recognized in late 2019. Most early reports of person-to-person SARS-CoV-2 transmission have been among household contacts, where the secondary attack rate has been estimated to exceed 10% (1), in health care facilities (2), and in congregate settings (3). However, widespread community transmission, as is currently being observed in the United States, requires more expansive transmission events between nonhousehold contacts. In February and March 2020, the Chicago Department of Public Health (CDPH) investigated a large, multifamily cluster of COVID-19. Patients with confirmed COVID-19 and their close contacts were interviewed to better understand nonhousehold, community transmission of SARS-CoV-2. This report describes the cluster of 16 cases of confirmed or probable COVID-19, including three deaths, likely resulting from transmission of SARS-CoV-2 at two family gatherings (a funeral and a birthday party). These data support current CDC social distancing recommendations intended to reduce SARS-CoV-2 transmission. U.S residents should follow stay-at-home orders when required by state or local authorities.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções Comunitárias Adquiridas/transmissão , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Chicago/epidemiologia , Criança , Pré-Escolar , Análise por Conglomerados , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Família , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , SARS-CoV-2 , Adulto Jovem
3.
J Asthma ; 57(8): 886-897, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31187658

RESUMO

Objective: Asthma carries a high burden of disease for residents of Puerto Rico. We conducted this study to better understand asthma-related healthcare use and to examine potential asthma triggers.Methods: We characterized asthma-related healthcare use in 2013 by demographics, region, and date using outpatient, hospital, and emergency department (ED) insurance claims with a primary diagnostic ICD-9-CM code of 493.XX. We examined environmental asthma triggers, including outdoor allergens (i.e., mold and pollen), particulate pollution, and influenza-like illness. Analyses included descriptive statistics and Poisson time-series regression.Results: During 2013, there were 550,655 medical asthma claims reported to the Puerto Rico Healthcare Utilization database, representing 148 asthma claims/1,000 persons; 71% of asthma claims were outpatient visits, 19% were hospitalizations, and 10% were ED visits. Females (63%), children aged ≤9 years (77% among children), and adults aged ≥45 years (80% among adults) had the majority of asthma claims. Among health regions, Caguas had the highest asthma claim-rate at 142/1,000 persons (overall health region claim-rate = 108). Environmental exposures varied across the year and demonstrated seasonal patterns. Metro health region regression models showed positive associations between increases in mold and particulate matter <10 microns in diameter (PM10) and outpatient asthma claims.Conclusions: This study provides information about patterns of asthma-related healthcare use across Puerto Rico. Increases in mold and PM10 were associated with increases in asthma claims. Targeting educational interventions on exposure awareness and reduction techniques, especially to persons with higher asthma-related healthcare use, can support asthma control activities in public health and clinical settings.


Assuntos
Alérgenos/efeitos adversos , Asma/epidemiologia , Efeitos Psicossociais da Doença , Exposição Ambiental/efeitos adversos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Alérgenos/análise , Asma/imunologia , Asma/terapia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Monitoramento Ambiental/estatística & dados numéricos , Feminino , Geografia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Material Particulado/efeitos adversos , Material Particulado/análise , Porto Rico/epidemiologia , Fatores de Risco , Fatores Sexuais , Adulto Jovem
4.
J Allergy Clin Immunol Pract ; 7(6): 1771-1777, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30954466

RESUMO

Quality measures play a prominent role in the US health care system. They are used to monitor and report performance across health plans, providers, and health systems and are a foundational element of value-based payment. Measuring the quality of asthma care has been challenging because of a lack of reliable data to assess clinical processes and track patient-specific outcomes. Existing asthma Healthcare Effectiveness Data and Information Set measures rely on administrative claims-derived data on dispensed medications. These are proxy measures of appropriate prescribing but are not reflective of comprehensive asthma care. The increase in the volume and specificity of longitudinal clinical data in electronic health records, movement toward electronic quality measures, and advances in electronic clinical data systems enable the development of more meaningful measures. A patient-reported measure of asthma control would incorporate key clinical indicators such as a validated age- and culturally appropriate test, and would reflect the combined outcome of medical management, self-management education, reduction of environmental exposures, and appropriate support services. Although there is a current quality measure that includes a test of asthma control (the Optimal Asthma Control Measure), work is needed to address questions about usability, patient literacy, and the influence of setting on self-reported scores. Comprehensive reliability and validity testing of both clinical data and stratification across risk groups will be needed to determine whether a measure based on standardized assessments of asthma control indeed promote improved clinical outcomes.


Assuntos
Asma/terapia , Assistência Centrada no Paciente , Indicadores de Qualidade em Assistência à Saúde , Humanos
5.
Am J Prev Med ; 55(2): e49-e52, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29903566

RESUMO

INTRODUCTION: Exposure to air pollution negatively affects respiratory and cardiovascular health. The objective of this study was to describe the extent to which health professionals report talking about how to limit exposure to air pollution during periods of poor air quality with their at-risk patients. METHODS: In 2015, a total of 1,751 health professionals completed an online survey and reported whether they talk with their patients about limiting their exposure to air pollution. In 2017, these data were analyzed to assess the frequency that health professionals in primary care, pediatrics, obstetrics/gynecology, and nursing reported talking about limiting air pollution exposure with patients who have respiratory or cardiovascular diseases, were aged ≤18 years, were aged ≥65 years, or were pregnant women. Frequencies of positive responses were assessed across categories of provider- and practice-level characteristics. RESULTS: Overall, 714 (41%) respondents reported ever talking with their patients about limiting their exposure to air pollution. Thirty-four percent and 16% of providers specifically reported talking with their patients with respiratory or cardiovascular disease diagnoses, respectively. Percentages of health professionals who reported talking with their patients about limiting air pollution exposure were highest among respondents in pediatrics (56%) and lowest among respondents in obstetrics/gynecology (0%). CONCLUSIONS: Despite the well-described health effects of exposure to air pollution, the majority of respondents did not report talking with their patients about limiting their exposure to air pollution. These findings reveal clear opportunities to improve awareness about strategies to limit air pollution exposure among sensitive groups of patients and their healthcare providers.


Assuntos
Poluição do Ar/análise , Doenças Cardiovasculares/prevenção & controle , Exposição Ambiental/efeitos adversos , Relações Médico-Paciente , Doenças Respiratórias/prevenção & controle , Adolescente , Idoso , Idoso de 80 Anos ou mais , Poluição do Ar/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Internet , Masculino , Médicos/estatística & dados numéricos , Gravidez , Inquéritos e Questionários
7.
Ann Am Thorac Soc ; 15(6): 683-692, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29490150

RESUMO

Rationale: More information on risk factors for death from tuberculosis in the United States could help reduce the tuberculosis mortality rate, which has remained steady for more than a decade.Objective: To identify risk factors for tuberculosis-related death in adults.Methods: We performed a retrospective study of 1,304 adults with tuberculosis who died before treatment completion and 1,039 frequency-matched control subjects who completed tuberculosis treatment in 2005 to 2006 in 13 states reporting 65% of U.S. tuberculosis cases. We used in-depth record abstractions and a standard algorithm to classify deaths in persons with tuberculosis as tuberculosis-related or not. We then compared these classifications to causes of death as coded in death certificates. We used multivariable logistic regression to calculate adjusted odds ratios for predictors of tuberculosis-related death among adults compared with those who completed tuberculosis treatment.Results: Of 1,304 adult deaths, 942 (72%) were tuberculosis related, 272 (21%) were not, and 90 (7%) could not be classified. Of 847 tuberculosis-related deaths with death certificates available, 378 (45%) did not list tuberculosis as a cause of death. Adjusting for known risks, we identified new risks for tuberculosis-related death during treatment: absence of pyrazinamide in the initial regimen (adjusted odds ratio, 3.4; 95% confidence interval, 1.9-6.0); immunosuppressive medications (adjusted odds ratio, 2.5; 95% confidence interval, 1.1-5.6); incomplete tuberculosis diagnostic evaluation (adjusted odds ratio, 2.2; 95% confidence interval, 1.5-3.3), and an alternative nontuberculosis diagnosis before tuberculosis diagnosis (adjusted odds ratio, 1.6; 95% confidence interval, 1.2-2.2).Conclusions: Most persons who died with tuberculosis had a tuberculosis-related death. Intensive record review revealed tuberculosis as a cause of death more often than did death certificate diagnoses. New tools, such as a tuberculosis mortality risk score based on our study findings, may identify patients with tuberculosis for in-hospital interventions to prevent death.

8.
MMWR Morb Mortal Wkly Rep ; 66(24): 636-643, 2017 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-28640798

RESUMO

Zika virus infection during pregnancy can cause congenital microcephaly and brain abnormalities (1), and detection of Zika virus RNA in clinical and tissue specimens can provide definitive laboratory evidence of recent Zika virus infection. Whereas duration of viremia is typically short, prolonged detection of Zika virus RNA in placental, fetal, and neonatal brain tissue has been reported and can provide key diagnostic information by confirming recent Zika virus infection (2). In accordance with recent guidance (3,4), CDC provides Zika virus testing of placental and fetal tissues in clinical situations where this information could add diagnostic value. This report describes the evaluation of formalin-fixed paraffin-embedded (FFPE) tissue specimens tested for Zika virus infection in 2016 and the contribution of this testing to the public health response. Among 546 live births with possible maternal Zika virus exposure, for which placental tissues were submitted by the 50 states and District of Columbia (DC), 60 (11%) were positive by Zika virus reverse transcription-polymerase chain reaction (RT-PCR). Among 81 pregnancy losses for which placental and/or fetal tissues were submitted, 18 (22%) were positive by Zika virus RT-PCR. Zika virus RT-PCR was positive on placental tissues from 38/363 (10%) live births with maternal serologic evidence of recent unspecified flavivirus infection and from 9/86 (10%) with negative maternal Zika virus immunoglobulin M (IgM) where possible maternal exposure occurred >12 weeks before serum collection. These results demonstrate that Zika virus RT-PCR testing of tissue specimens can provide a confirmed diagnosis of recent maternal Zika virus infection.


Assuntos
Feto/virologia , Placenta/virologia , Complicações Infecciosas na Gravidez/diagnóstico , Infecção por Zika virus/diagnóstico , Zika virus/isolamento & purificação , District of Columbia , Feminino , Humanos , Gravidez , Reação em Cadeia da Polimerase em Tempo Real , Estados Unidos
9.
Am J Prev Med ; 51(1): 23-32, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26873793

RESUMO

INTRODUCTION: Asthma is a leading cause of chronic disease-related school absenteeism. Few data exist on how information on absenteeism might be used to identify children for interventions to improve asthma control. This study investigated how asthma-related absenteeism was associated with asthma control, exacerbations, and associated modifiable risk factors using a sample of children from 35 states and the District of Columbia. METHODS: The Behavioral Risk Factor Surveillance System Child Asthma Call-back Survey is a random-digit dial survey designed to assess the health and experiences of children aged 0-17 years with asthma. During 2014-2015, multivariate analyses were conducted using 2006-2010 data to compare children with and without asthma-related absenteeism with respect to clinical, environmental, and financial measures. These analyses controlled for sociodemographic and clinical characteristics. RESULTS: Compared with children without asthma-related absenteeism, children who missed any school because of asthma were more likely to have not well controlled or very poorly controlled asthma (prevalence ratio=1.50; 95% CI=1.34, 1.69) and visit an emergency department or urgent care center for asthma (prevalence ratio=3.27; 95% CI=2.44, 4.38). Mold in the home and cost as a barrier to asthma-related health care were also significantly associated with asthma-related absenteeism. CONCLUSIONS: Missing any school because of asthma is associated with suboptimal asthma control, urgent or emergent asthma-related healthcare utilization, mold in the home, and financial barriers to asthma-related health care. Further understanding of asthma-related absenteeism could establish how to most effectively use absenteeism information as a health status indicator.


Assuntos
Absenteísmo , Asma/economia , Asma/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Asma/tratamento farmacológico , Sistema de Vigilância de Fator de Risco Comportamental , Criança , Pré-Escolar , Doença Crônica , District of Columbia/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Instituições Acadêmicas , Inquéritos e Questionários , Estados Unidos/epidemiologia
10.
J Am Coll Health ; 64(5): 409-15, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26730492

RESUMO

OBJECTIVE: Colleges are at risk for communicable disease outbreaks because of the high degree of person-to-person interactions and relatively crowded dormitory settings. This report describes the US college student health screening requirements among US resident and international students for tuberculosis (TB) and vaccine-preventable diseases (VPDs) as they relate to the American College Health Association (ACHA) guidelines. Methods/Participants: In April 2012, US college health administrators (N = 2,858) were sent online surveys to assess their respective school's TB screening and immunization requirements. RESULTS: Surveys were completed by 308 (11%) schools. Most schools were aware of the ACHA immunization (78%) and TB screening (76%) guidelines. Schools reported having policies related to immunization screening (80.4%), immunization compliance (93%), TB screening (55%), and TB compliance (87%). CONCLUSION: Most colleges were following ACHA guidelines. However, there are opportunities for improvement to fully utilize the recommendations and prevent outbreaks of communicable diseases among students in colleges.


Assuntos
Surtos de Doenças/prevenção & controle , Programas de Rastreamento/legislação & jurisprudência , Estudantes , Tuberculose/diagnóstico , Vacinação/estatística & dados numéricos , Surtos de Doenças/estatística & dados numéricos , Feminino , Política de Saúde/legislação & jurisprudência , Humanos , Masculino , Serviços de Saúde para Estudantes/métodos , Serviços de Saúde para Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades/organização & administração
11.
J Asthma ; 52(9): 974-80, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26291134

RESUMO

OBJECTIVE: Asthma self-management education improves asthma-related outcomes. We conducted this analysis to evaluate variation in the percentages of adults with active asthma reporting components of asthma self-management education by age at asthma onset. METHODS: Data from 2011 to 2012 Asthma Call-back Surveys were used to estimate percentages of adults with active asthma reporting six components of asthma self-management education. Components of asthma self-management education include having been taught to what to do during an asthma attack and receiving an asthma action plan. Differences in the percentages of adults reporting each component and the average number of components reported across categories of age at asthma onset were estimated using linear regression, adjusted for age, education, race/ethnicity, sex, smoking status, and years since asthma onset. RESULTS: Overall, an estimated 76.4% of adults with active asthma were taught what to do during an asthma attack and 28.7% reported receiving an asthma action plan. Percentages reporting each asthma self-management education component declined with increasing age at asthma onset. Compared with the referent group of adults whose asthma onset occurred at 5-14 years of age, the percentage of adults reporting being taught what to do during an asthma attack was 10% lower among those whose asthma onset occurred at 65-93 years of age (95% CI: -18.0, -2.5) and the average number of components reported decreased monotonically across categories of age at asthma onset of 35 years and older. CONCLUSIONS: Among adults with active asthma, reports of asthma self-management education decline with increasing age at asthma onset.


Assuntos
Asma/terapia , Autocuidado , Adolescente , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Asma/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Educação de Pacientes como Assunto , Fumar/epidemiologia , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
12.
Am J Public Health ; 105(5): 930-7, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25790407

RESUMO

OBJECTIVES: We compared mortality among tuberculosis (TB) survivors and a similar population. METHODS: We used local health authority records from 3 US sites to identify 3853 persons who completed adequate treatment of TB and 7282 individuals diagnosed with latent TB infection 1993 to 2002. We then retrospectively observed mortality after 6 to 16 years of observation. We ascertained vital status as of December 31, 2008, using the Centers for Disease Control and Prevention's National Death Index. We analyzed mortality rates, hazards, and associations using Cox regression. RESULTS: We traced 11 135 individuals over 119 772 person-years of observation. We found more all-cause deaths (20.7% vs 3.1%) among posttreatment TB patients than among the comparison group, an adjusted average excess of 7.6 deaths per 1000 person-years (8.8 vs 1.2; P < .001). Mortality among posttreatment TB patients varied with observable factors such as race, site of disease, HIV status, and birth country. CONCLUSIONS: Fully treated TB is still associated with substantial mortality risk. Cure as currently understood may be insufficient protection against TB-associated mortality in the years after treatment, and TB prevention may be a valuable opportunity to modify this risk.


Assuntos
Sobreviventes/estatística & dados numéricos , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Causas de Morte , Centers for Disease Control and Prevention, U.S. , Grupos de Populações Continentais , Feminino , Infecções por HIV/epidemiologia , Humanos , Tuberculose Latente/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tuberculose/mortalidade , Estados Unidos , Adulto Jovem
14.
Pediatr Infect Dis J ; 34(1): 35-9, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25093974

RESUMO

BACKGROUND: Centers for Disease Control and Prevention requirements for pre-immigration tuberculosis (TB) screening of children 2- to 14-years old permit a tuberculin skin test (TST) or an interferon-gamma release assay (IGRA). Few data are available on the performance of IGRAs versus TSTs in foreign-born children. METHODS: We compared the performance of TST and QuantiFERON-TB (QFT) Gold In-Tube in children 2- to 14-years old applying to immigrate to the United States from Mexico, the Philippines and Vietnam, using diagnosis of TB in immigrating family members as a measure of potential exposure. RESULTS: We enrolled 2520 children: 664 (26%) were TST+ and 142 (5.6%) were QFT+. One hundred and eleven (4.4%) were TST+/QFT+, 553 (21.9%) were TST+/QFT- and 31 (1.2%) were TST-/QFT+. Agreement between tests was poor (κ = 0.20). Although positive results of both tests were significantly associated with older age (relative risks [RR] TST+, 1.64; 95% confidence interval [CI]: 1.36-1.97; RR QFT+, 3.05; 95% CI: 1.72-5.38) and with the presence of TB in at least 1 immigrating family member (RR TST+, 1.40; 95% CI: 1.12-1.75; RR QFT+ 2.24; 95% CI: 1.18-4.28), QFT+ results were more strongly associated with both predictive variables. CONCLUSIONS: The findings support the preferential use of QFT over TST for pre-immigration screening of foreign-born children 2 years of age and older and lend support to the preferential use of IGRAs in testing foreign-born children for latent TB infection.


Assuntos
Emigrantes e Imigrantes , Testes de Liberação de Interferon-gama/métodos , Tuberculose Latente/diagnóstico , Programas de Rastreamento/métodos , Teste Tuberculínico/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Prospectivos , Testes Cutâneos/métodos , Estados Unidos
15.
Pediatrics ; 134(3): 546-54, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25113302

RESUMO

BACKGROUND: Hospitalization for lower respiratory tract infections (LRTIs) among children have been well characterized. We characterized hospitalizations for severe LRTI among children. METHODS: We analyzed claims data from commercial and Medicaid insurance enrollees (MarketScan) ages 0 to 18 years from 2007 to 2011. LRTI hospitalizations were identified by the first 2 listed International Classification of Diseases, Ninth Revision discharge codes; those with ICU admission and/or receiving mechanical ventilation were defined as severe LRTI. Underlying conditions were determined from out- and inpatient discharge codes in the preceding year. We report insurance specific and combined rates that used both commercial and Medicaid rates and adjusted for age and insurance status. RESULTS: During 2007-2011, we identified 16797 and 12053 severe LRTI hospitalizations among commercial and Medicaid enrollees, respectively. The rates of severe LRTI hospitalizations per 100000 person-years were highest in children aged <1 year (commercial: 244; Medicaid: 372, respectively), and decreased with age. Among commercial enrollees, ≥ 1 condition increased the risk for severe LRTI (1 condition: adjusted relative risk, 2.68; 95% confidence interval, 2.58-2.78; 3 conditions: adjusted relative risk, 4.85; 95% confidence interval, 4.65-5.07) compared with children with no medical conditions. Using commercial/Medicaid combined rates, an estimated 31289 hospitalizations for severe LRTI occurred each year in children in the United States. CONCLUSIONS: Among children, the burden of hospitalization for severe LRTI is greatest among children aged <1 year. Children with underlying medical conditions are at greatest risk for severe LRTI hospitalization.


Assuntos
Hospitalização/tendências , Medicaid/tendências , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/terapia , Índice de Gravidade de Doença , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais/tendências , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Infecções Respiratórias/diagnóstico , Estados Unidos/epidemiologia
16.
Lung ; 192(5): 693-700, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24952247

RESUMO

INTRODUCTION: Despite the considerable overlap of asthma and chronic obstructive pulmonary disease (COPD), the extent to which the two diagnoses are the manifestations of the same disease remains unresolved. We conducted these analyses to evaluate the role of active asthma in the prevalence of physician-diagnosed COPD. METHODS: From 2006 through 2010, 74,209 adults aged 18-99 years and with a history of asthma participated in the Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey and responded to interview-administered questionnaires via telephone. We used publicly available data from 71,639 (97%) participants to identify respondents with and without active manifestations of asthma and self-reported, physician-diagnosed COPD. We generated population-weighted estimates of physician-diagnosed COPD prevalence and conducted linear regression to estimate associations between active asthma status and the prevalence of COPD among current smokers, former smokers, and lifetime nonsmokers separately. RESULTS: Physician-diagnosed COPD was reported in an estimated 29% of the population with any history of asthma, including both active and inactive asthma. Age-specific prevalences of physician-diagnosed COPD were consistently higher among adults with active asthma than adults without active asthma. Compared to inactive asthma, active asthma was associated with an 8.3% [95% confidence interval (CI) 6.1, 10.5] higher prevalence of physician-diagnosed COPD among lifetime nonsmokers, a 20.6% (95% CI 18.0, 23.3) higher prevalence among former smokers, and a 26.7% (95% CI 22.5, 30.9) higher prevalence among current smokers. CONCLUSIONS: Among adults with a history of asthma, active manifestations of asthma may play an important role in the epidemiology of COPD.


Assuntos
Asma/epidemiologia , Médicos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Asma/diagnóstico , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
17.
J Asthma ; 51(9): 956-63, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24894742

RESUMO

BACKGROUND: Evaluation of the prevalence and incidence of asthma and research into its etiology often rely on self-reported information. We conducted this analysis to investigate reliability in reporting asthma history across categories of demographic and socio-economic characteristics. METHODS: We analyzed data from 3109 participants in the Coronary Artery Risk Development in Young Adults study, a longitudinal study of African-American and white adults. Responses to self-administered questionnaires completed at 15- and 20-year follow-up exams were used to evaluate agreement in reporting asthma history and age at diagnosis and assess variation in agreement across categories of demographic and health-related characteristics. RESULTS: A history of asthma was reported by 12% of participants at the 15-year exam and 11% of participants at the 20-year exam, with 97% agreement and an overall Kappa coefficient of 0.845 (95% confidence interval: 0.815-0.874). Kappa coefficients were higher among women than men and increased monotonically across categories of educational attainment. One-hundred eight participants (35%) reported exactly the same age at diagnosis at the two time points; for another 120 (39%), the difference in reported ages was ≤2 years. Age at asthma diagnosis reported at the 20-year exam was, on an average, 1 year (SD: 5.2) older than that reported at the 15-year exam. CONCLUSIONS: Five-year reliability in self-reported asthma history is high, and variation in reporting age at diagnosis is low across categories of participant characteristics. Nevertheless, agreement in responses at two times does not guarantee that self-administered questionnaires are sensitive tools for detecting a true asthma history.


Assuntos
Asma/diagnóstico , Asma/epidemiologia , Autorrelato , Adulto , Afro-Americanos , Fatores Etários , Asma/etnologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Fatores Sexuais
18.
Respir Med ; 107(12): 1829-36, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24139624

RESUMO

INTRODUCTION: Little is known about the extent to which the age at which asthma first began influences respiratory health later in life. We conducted these analyses to examine the relationship between age at asthma onset and subsequent asthma-related outcomes. METHODS: We used data from 12,216 adults with asthma who participated in the 2010 Behavioral Risk Factor Surveillance System Asthma Call-back Survey to describe the distribution of age at asthma onset. Linear regression was used to estimate associations of age at asthma onset with asthma-related outcomes, including symptoms in the past 30 days and asthma-related emergency visits. RESULTS: Asthma onset before age 16 was reported by an estimated 42% of adults with active asthma, including 14% with onset at 5-9 years of age who reported experiencing any asthma symptoms on 21% of days in the past month. Compared to this group, the percentage of days in the past month with any asthma symptoms was 14.8% higher (95% confidence interval (CI): 5.4, 24.1) among those whose asthma onset occurred at <1 year. When age at onset occurred at 10 years or older there was little change in the prevalence of asthma-related emergency visits across age at onset categories. CONCLUSION: Age at asthma onset may affect subsequent asthma-related outcomes.


Assuntos
Asma/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Asma/complicações , Criança , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Porto Rico/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
20.
Public Health Rep ; 124(6): 868-74, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19894430

RESUMO

OBJECTIVES: Acinetobacter baumannii (A. baumannii) is a well-described cause of nosocomial outbreaks and can be highly resistant to antimicrobials. We investigated A. baumannii outbreaks at two Kentucky hospitals to find risk factors for Acinetobacter acquisition in hospitalized patients. METHODS: We performed case-control studies at both hospitals. We defined a case as a clinical culture growing A. baumannii from a patient from August 1 to October 31, 2006 (Hospital A), or April 1 to October 31, 2006 (Hospital B). RESULTS: Twenty-nine cases were identified at Hospital A and 72 cases were identified at Hospital B. The median case patient age was 42 years in Hospital A and 46 years in Hospital B. The majority of positive cultures were from sputum (Hospital A, 51.7%; Hospital B, 62.5%). The majority of case patients had multidrug-resistant A. baumannii (Hospital A, 75.9%; Hospital B, 70.8%). Using logistic regression, controlling for age and admitting location, mechanical ventilation (Hospital A odds ratio [OR] = 21.6; 95% confidence interval [CI] 3.5, 265.9; Hospital B OR = 4.5, 95% CI 1.9, 11.1) was associated with A. baumannii recovery. Presence of a nonsurgical wound (OR = 6.6, 95% CI 1.2, 50.8) was associated with recovery of A. baumannii at Hospital A. CONCLUSIONS: We identified similar patient characteristics and risk factors for A. baumannii acquisition at both hospitals. Our findings necessitate the importance of review of infection control procedures related to respiratory therapy and wound care.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/isolamento & purificação , Infecção Hospitalar/microbiologia , Surtos de Doenças , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/etiologia , Acinetobacter baumannii/efeitos dos fármacos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Humanos , Lactente , Kentucky/epidemiologia , Pessoa de Meia-Idade , Respiração Artificial/efeitos adversos , Fatores de Risco , Ferimentos e Lesões/microbiologia , Adulto Jovem
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