scholarly journals The Seasonal Variability in Surgical Site Infections and the Association With Warmer Weather: A Population-Based Investigation

2017 ◽  
Vol 38 (7) ◽  
pp. 809-816 ◽  
Author(s):  
Chris A. Anthony ◽  
Ryan A. Peterson ◽  
Linnea A. Polgreen ◽  
Daniel K. Sewell ◽  
Philip M. Polgreen
Keyword(s):  
Cohort Analysis ◽  
Surgical Site Infections ◽  
Population Level ◽  
Population Based ◽  
Primary Diagnosis ◽  
Climatic Data ◽  
Hospital Discharges ◽  
National Climatic Data Center ◽  
Temperature Group ◽  
Type Of Institution

OBJECTIVETo determine whether the seasonality of surgical site infections (SSIs) can be explained by changes in temperature.DESIGNRetrospective cohort analysis.SETTINGThe National Inpatient Sample database.PATIENTSAll hospital discharges with a primary diagnosis of SSI from 1998 to 2011 were considered cases. Discharges with a primary or secondary diagnoses of specific surgeries commonly associated with SSIs from the previous and current month served as our “at risk” cohort.METHODSWe modeled the national monthly count of SSI cases both nationally and stratified by region, sex, age, and type of institution. We used data from the National Climatic Data Center to estimate the monthly average temperatures for all hospital locations. We modeled the odds of having a primary diagnosis of SSI as a function of demographics, payer, location, patient severity, admission month, year, and the average temperature in the month of admission.RESULTSSSI incidence is highly seasonal, with the highest SSI incidence in August and the lowest in January. During the study period, there were 26.5% more cases in August than in January (95% CI, 23.3–29.7). Controlling for demographic and hospital-level characteristics, the odds of a primary SSI admission increased by roughly 2.1% per 2.8°C (5°F) increase in the average monthly temperature. Specifically, the highest temperature group, >32.2°C (>90°F), was associated with an increase in the odds of an SSI admission of 28.9% (95% CI, 20.2–38.3) compared to temperatures <4.4°C (<40°F).CONCLUSIONSAt population level, SSI risk is highly seasonal and is associated with warmer weather.Infect Control Hosp Epidemiol2017;38:809–816

scholarly journals The predictive utility of functional status at discharge: a population-level cohort analysis

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Mats L. Junek ◽  
Aaron Jones ◽  
George Heckman ◽  
Catherine Demers ◽  
Lauren E. Griffith ◽  
...  
Keyword(s):  
Functional Status ◽  
Long Term Care ◽  
Care Home ◽  
Cohort Analysis ◽  
Care Facility ◽  
Population Level ◽  
Population Based ◽  
Post Discharge ◽  
Term Care

Abstract Background Functional status is a patient-important, patient-centered measurement. The utility of functional status measures to inform post-discharge patient needs is unknown. We sought to examine the utility of routinely collected functional status measures gathered from older hospitalized patients to predict a panel of post-discharge outcomes. Methods In this population-based retrospective cohort study, Adults 65+ discharged from an acute hospitalization between 4 November 2008 and 18 March 2016 in Ontario, Canada and received an assessment of functional status at discharge using the Health Outcomes for Better Information and Care tool were included. Multivariable regression analysis was used to determine the relationship between functional status and emergency department (ED) re-presentation, hospital readmission, long term care facility (LTCF) admission or wait listing (‘LTCF readiness’), and death at 180 days from discharge. Results A total of 80 020 discharges were included. 38 928 (48.6%) re-presented to the ED, 24 222 (30.3%) were re-admitted, 5 037 (6.3%) were LTCF ready, and 9 047 (11.3%) died at 180 days. Beyond age, diminished functional status at discharge was the factor most associated with LTCF readiness (adjusted Odds Ratio [OR] 4.11 for those who are completely dependent for activities of daily living compared to those who are independent; 95% Confidence Interval [CI]: 3.70-4.57) and death (OR 3.99; 95% CI: 3.67-4.35). Functional status also had a graded relationship with each outcome and improved the discriminability of the models predicting death and LTCF readiness (p<0.01) but not ED re-presentation or hospital re-admission. Conclusion Routinely collected functional status at discharge meaningfully improves the prediction of long term care home readiness and death. The routine assessment of functional status can inform post-discharge care and planning for older adults.

scholarly journals The association of preoperative blood markers with postoperative readmissions following arthroplasty

2021 ◽  
Vol 2 (6) ◽  
pp. 388-396
Author(s):  
Amir Khoshbin ◽  
Graeme Hoit ◽  
Lauren Leone Nowak ◽  
Anser Daud ◽  
Martine Steiner ◽  
...  
Keyword(s):  
At Risk ◽  
Cohort Analysis ◽  
Healthcare Providers ◽  
Population Level ◽  
Population Based ◽  
National Quality ◽  
Blood Marker ◽  
Risk Patients ◽  
Improvement Programme ◽  
The Mean

Aims While preoperative bloodwork is routinely ordered, its value in determining which patients are at risk of postoperative readmission following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is unclear. The objective of this study was to determine which routinely ordered preoperative blood markers have the strongest association with acute hospital readmission for patients undergoing elective TKA and THA. Methods Two population-based retrospective cohorts were assembled for all adult primary elective TKA (n = 137,969) and THA (n = 78,532) patients between 2011 to 2018 across 678 North American hospitals using the American College of Surgeons National Quality Improvement Programme (ACS-NSQIP) registry. Six routinely ordered preoperative blood markers - albumin, haematocrit, platelet count, white blood cell count (WBC), estimated glomerular filtration rate (eGFR), and sodium level - were queried. The association between preoperative blood marker values and all-cause readmission within 30 days of surgery was compared using univariable analysis and multivariable logistic regression adjusted for relevant patient and treatment factors. Results The mean TKA age was 66.6 years (SD 9.6) with 62% being females (n = 85,163/137,969), while in the THA cohort the mean age was 64.7 years (SD 11.4) with 54% being female (n = 42,637/78,532). In both cohorts, preoperative hypoalbuminemia (< 35 g/l) was associated with a 1.5- and 1.8-times increased odds of 30-day readmission following TKA and THA, respectively. In TKA patients, decreased eGFR demonstrated the strongest association with acute readmission with a standardized odds ratio of 0.75 per two standard deviations increase (p < 0.0001). Conclusion In this population level cohort analysis of arthroplasty patients, low albumin demonstrated the strongest association with acute readmission in comparison to five other commonly ordered preoperative blood markers. Identification and optimization of preoperative hypoalbuminemia could help healthcare providers recognize and address at-risk patients undergoing TKA and THA. This is the most comprehensive and rigorous examination of the association between preoperative blood markers and readmission for TKA and THA patients to date. Cite this article: Bone Jt Open 2021;2(6):388–396.

scholarly journals PL004: A population-based analysis of outcomes in patients with a primary diagnosis of hypertension in the emergency department, using linked datasets

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S30-S30
Author(s):  
S. Masood ◽  
C.L. Atzema ◽  
P. Austin
Keyword(s):  
Emergency Department ◽  
Population Level ◽  
Population Based ◽  
Primary Diagnosis ◽  
Emergency Department Visits ◽  
Annual Number ◽  
Complication Rates ◽  
Number Of Visits ◽  
Diagnosis Of Hypertension ◽  
Age And Sex

Introduction: Patients seen primarily for hypertension are common in the emergency department. The outcomes of these patients have not been described at a population level. In this study we describe the characteristics and outcomes of the patients making these visits, as well as changes over time. Methods: This retrospective cohort study used linked health databases from the province of Ontario, Canada, to assess emergency department visits made between April 1, 2002 and March 31, 2012 with a primary diagnosis of hypertension. We determined the annual number of visits as well as the age and sex standardized rates. We examined visit disposition and assessed mortality outcomes and potential hypertensive complications at 7, 30, 90, 365 days and 2 years subsequent to the ED visit. Results: There were 206,147 qualifying ED visits from 180 sites. Visits increased by 64% between 2002 and 2012, from 15793 to 25950 annual visits, respectively. The age- and sex-standardized rate increased from 170/100,000 persons to 228/100,000 persons over the same time period, a 34% increase. Eight percent of visits ended in hospitalization, but this proportion decreased from 9.9% to 7.1% over the study period. Mortality was very low, at less than 1% within 90 days, 2.5% within 1 year, and 4.1% within 2 years. Among subsequent hospitalizations for potential hypertensive complications, stroke was the most frequent admitting diagnosis, but the frequency was still <1% within 1 year. Together hospitalizations for stroke, heart failure, acute myocardial infarction, atrial fibrillation, renal failure, hypertensive encephalopathy and dissection were <1% at 30 days. Conclusion: The number of visits made primarily for hypertension has increased dramatically over the last decade. While some of the increase is due to aging of the population, other forces are contributing to the increase. Subsequent mortality and complication rates are low and have declined. With current practice patterns, the feared complications of hypertension are extremely infrequent.

scholarly journals Warmer weather as a risk factor for hospitalisations due to urinary tract infections

2018 ◽  
Vol 146 (3) ◽  
pp. 386-393 ◽  
Author(s):  
J. E. Simmering ◽  
J. E. Cavanaugh ◽  
L. A. Polgreen ◽  
P. M. Polgreen
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Hospital Admissions ◽  
Population Level ◽  
The United States ◽  
Primary Diagnosis ◽  
Climatic Data ◽  
Dependent Manner ◽  
Average Temperature ◽  
Tract Infections

AbstractThe incidence of urinary tract infections (UTIs) is seasonal, and this seasonality may be explained by changes in weather, specifically, temperature. Using data from the Nationwide Inpatient Sample, we identified the geographic location for 581 813 hospital admissions with the primary diagnosis of a UTI and 56 630 773 non-UTI hospitalisations in the United States. Next, we used data from the National Climatic Data Center to estimate the monthly average temperature for each location. Using a case–control design, we modelled the odds of a hospital admission having a primary diagnosis of UTI as a function of demographics, payer, location, patient severity, admission month, year and the average temperature for the admission month. We found, after controlling for patient factors and month of admission, the odds of a UTI diagnosis increased with higher temperatures in a dose-dependent manner. For example, relative to months with average temperatures of 5–7.5 °C, an admission in a month with an average temperature of 27.5–30 °C has 20% higher odds of a primary diagnosis of UTI. However, in months with extremely high average temperatures (above 30 °C), the odds of a UTI admissions decrease, perhaps due to changes in behaviour. Thus, at a population level, UTI-related hospitalisations are associated with warmer weather.

Studying Populations of Online Communities

2019 ◽  
pp. 173-193
Author(s):  
Benjamin Mako Hill ◽  
Aaron Shaw
Keyword(s):  
Online Communities ◽  
Information Diffusion ◽  
Diffusion Processes ◽  
Empirical Studies ◽  
Population Level ◽  
Study Groups ◽  
Population Based ◽  
Large Majority ◽  
Community Processes ◽  
Published Research

While the large majority of published research on online communities consists of analyses conducted entirely within individual communities, this chapter argues for a population-based approach, in which researchers study groups of similar communities. For example, although there have been thousands of papers published about Wikipedia, a population-based approach might compare all wikis on a particular topic. Using examples from published empirical studies, the chapter describes five key benefits of this approach. First, it argues that population-level research increases the generalizability of findings. Next, it describes four processes and dynamics that are only possible to study using populations: community-level variables, information diffusion processes across communities, ecological dynamics, and multilevel community processes. The chapter concludes with a discussion of a series of limitations and challenges.

scholarly journals Immediate and Delayed Meteorological Effects on COVID-19 Time-Varying Infectiousness in Tropical Cities

Atmosphere ◽  
2021 ◽  
Vol 12 (4) ◽  
pp. 513
Author(s):  
Xerxes Seposo ◽  
Chris Fook Sheng Ng ◽  
Lina Madaniyazi
Keyword(s):  
Model Fitting ◽  
Additive Model ◽  
The Philippines ◽  
Air Pressure ◽  
Dew Point ◽  
Outcome Variable ◽  
Climatic Data ◽  
Time Varying ◽  
Rt Pcr ◽  
National Climatic Data Center

The novel coronavirus, which was first reported in Wuhan, China in December 2019, has been spreading globally at an unprecedented rate, leading to the virus being declared a global pandemic by the WHO on 12 March 2020. The clinical disease, COVID-19, associated with the pandemic is caused by the pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Aside from the inherent transmission dynamics, environmental factors were found to be associated with COVID-19. However, most of the evidence documenting the association was from temperate locations. In this study, we examined the association between meteorological factors and the time-varying infectiousness of COVID-19 in the Philippines. We obtained the daily time series from 3 April 2020 to 2 September 2020 of COVID-19 confirmed cases from three major cities in the Philippines, namely Manila, Quezon, and Cebu. Same period city-specific daily average temperature (degrees Celsius; °C), dew point (degrees Celsius; °C), relative humidity (percent; %), air pressure (kilopascal; kPa), windspeed (meters per second; m/s) and visibility (kilometer; km) data were obtained from the National Oceanic and Atmospheric Administration—National Climatic Data Center. City-specific COVID-19-related detection and intervention measures such as reverse transcriptase polymerase chain reaction (RT-PCR) testing and community quarantine measures were extracted from online public resources. We estimated the time-varying reproduction number (Rt) using the serial interval information sourced from the literature. The estimated Rt was used as an outcome variable for model fitting via a generalized additive model, while adjusting for relevant covariates. Results indicated that a same-day and the prior week’s air pressure was positively associated with an increase in Rt by 2.59 (95% CI: 1.25 to 3.94) and 2.26 (95% CI: 1.02 to 3.50), respectively. Same-day RT-PCR was associated with an increase in Rt, while the imposition of community quarantine measures resulted in a decrease in Rt. Our findings suggest that air pressure plays a role in the infectiousness of COVID-19. The determination of the association of air pressure on infectiousness, aside from the testing frequency and community quarantine measures, may aide the current health systems in controlling the COVID-19 infectiousness by integrating such information into an early warning platform.

scholarly journals Prevalence and predictors of persistent HIV viremia and viral rebound following universal test and treat: a population-based study

2021 ◽  
Author(s):  
M Kate Grabowski ◽  
Eshan U Patel ◽  
Gertrude Nakigozi ◽  
Victor Ssempijja ◽  
Robert Ssekubugu ◽  
...  
Keyword(s):  
Population Level ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Viral Rebound ◽  
Hiv Viral Load ◽  
Test And Treat ◽  
Universal Test ◽  
Persistent Viremia ◽  
Universal Test And Treat

Abstract Background There are limited data on individual HIV viral load (VL) trajectories at the population-level following the introduction of universal test and treat (UTT) in sub-Saharan Africa. Methods HIV VLs were assessed among HIV-positive participants at three population-based surveys in four Ugandan fishing communities surveyed between November 2011 and August 2017. The unit of analysis was a visit-pair (two consecutive person-visits), which were categorized as exhibiting durable VL suppression, new/renewed suppression, viral rebound, or persistent viremia. Adjusted relative risks (adjRRs) and 95%CIs of persistent viremia were estimated using multivariate Poisson regression. Results There were 1,346 HIV-positive participants (n=1,883 visit-pairs). The population-level prevalence of durable VL suppression increased from 29.7% to 67.9% during UTT rollout, viral rebound declined from 4.4% to 2.7%, and persistent viremia declined from 20.7% to 13.3%. Younger age (15-29 vs. 40-49 years, adjRR=1.80 [95%CI=1.19-2.71]), male sex (adjRR=2.09 [95%CI=1.47-2.95]), never being married (vs. currently married; adjRR=1.88 [95%CI=1.34-2.62]), and recent migration to the community (vs. long-term resident; adjRR=1.91 [95%CI=1.34-2.73]) were factors associated with persistent viremia. Conclusions Despite increases in durable VL suppression during roll-out of UTT in hyperendemic communities, a substantial fraction of the population, whose risk profile tended to be younger, male, and mobile, remained persistently viremic.

A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Jimenez ◽  
M Cainzos-Achirica ◽  
D Monterde ◽  
L Garcia-Eroles ◽  
C Enjuanes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Conditions ◽  
Temporal Trends ◽  
Population Level ◽  
Population Based ◽  
Relative Increase ◽  
Funding Source ◽  
Private Company ◽  
Healthcare Database ◽  
Evolutionary Changes

Abstract Background Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts. Purpose To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions. Methods In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN). Results The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase). Conclusion In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.

scholarly journals Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population-Based Survey

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 214-215
Author(s):  
Rahul Sharma ◽  
Anil Lalwani ◽  
Justin Golub
Keyword(s):  
Hearing Loss ◽  
Pure Tone ◽  
Population Level ◽  
Population Based ◽  
National Database ◽  
Cross Sectional ◽  
Adult Lifespan ◽  
Pure Tone Average ◽  
Age Related ◽  
Public Datasets

Abstract The progression and asymmetry of age-related hearing loss has not been well characterized in those 80 years of age and older because public datasets mask upper extremes of age to protect anonymity. We aimed to model the progression and asymmetry of hearing loss in the older old using a representative, national database. This was a cross-sectional, multicentered US epidemiologic analysis using the National Health and Nutrition Examination Study (NHANES) 2005-2006, 2009-2010, and 2011-2012 cycles. Subjects included non-institutionalized, civilian adults 80 years and older (n=621). Federal security clearance was granted to access publicly-restricted age data. Outcome measures included pure-tone average air conduction thresholds and the 4-frequency pure tone average (PTA). 621 subjects were 80 years old or older (mean=84.2 years, range=80-104 years), representing 10,600,197 Americans. Hearing loss exhibited constant acceleration across the adult lifespan at a rate of 0.0052 dB/year2 (95% CI = 0.0049, 0.0055). Compounded over a lifetime, the velocity of hearing loss would increase five-fold, from 0.2 dB loss/year at age 20 to 1 dB loss/year at age 100. This model predicted mean PTA within 2 dB of accuracy for most ages between 20 and 100 years. There was no change in the asymmetry of hearing loss with increasing age over 80 years (linear regression coefficient of asymmetry over age=0.07 (95% CI=-0.01, 0.24). In conclusion, hearing loss steadily and predictably accelerates across the adult lifespan to at least age 100, becoming near-universal. These population-level statistics will guide treatment and policy recommendations for hearing health in the older old.

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