scholarly journals Care Dependency in Non-Hospitalized Patients with COVID-19

2020 ◽  
Vol 9 (9) ◽  
pp. 2946 ◽  
Author(s):  
Anouk W. Vaes ◽  
Felipe V.C. Machado ◽  
Roy Meys ◽  
Jeannet M. Delbressine ◽  
Yvonne M.J. Goertz ◽  
...  
Keyword(s):  
Health Status ◽  
Treatment Strategies ◽  
Hospitalized Patients ◽  
Considerable Proportion ◽  
Level Of Care ◽  
Personal Care ◽  
Persistent Symptoms ◽  
Care Dependency ◽  
Before And After ◽  
The Impact

Background: A large sample of “mild” COVID-19 patients still experience multiple symptoms months after being infected. These persistent symptoms are associated with many clinically relevant outcomes, including poor health status and impaired functional status. To date, no information is available about care dependency. Therefore, we aimed to explore the level of care dependency and the need for assistance with personal care in non-hospitalized COVID-19 patients. Methods: Members of two Facebook groups for COVID-19 patients with persistent complaints in The Netherlands and Belgium, and from a panel of people who registered at a website of the Lung Foundation Netherlands, were assessed for demographics, pre-existing comorbidities, health status, and symptoms. In addition, patients were asked about their dependence on others for personal care before and after the infection. The level of care dependency was assessed with the Care Dependency Scale (CDS) in members of the Belgian Facebook group (n = 210). Results: The data of 1837 non-hospitalized patients (86% women; median (IQR) age: 47 (38–54)) were analyzed. Only a small proportion of patients needed help with personal care before COVID-19, but the care need increased significantly after the infection (on average 79 ± 17 days after the onset of symptoms; 7.7% versus 52.4%, respectively; p < 0.05). The patients had a median (IQR) CDS score of 72 (67–75) points, and 31% of the patients were considered as care-dependent (CDS score ≤ 68 points). Conclusions: COVID-19 has an important impact on care dependency in non-hospitalized patients. About three months after the onset of symptoms, a considerable proportion of non-hospitalized patients were to some degree dependent on others for personal care. This indicates that the impact of COVID-19 on patients’ daily lives is tremendous, and more attention is needed to identify optimal treatment strategies to restore patients’ independency.

Empirical analyses of dynamic categorical data

2015 ◽  
Author(s):  
◽  
Cai Hu
Keyword(s):  
Health Status ◽  
Social Security ◽  
Credit Rating ◽  
Cox Proportional Hazards Model ◽  
Retirement Decision ◽  
Current Health ◽  
Current Health Status ◽  
Before And After ◽  
The Impact ◽  
Health Deterioration

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] Essay 1 analyzes the married couples' retirement decision using the PSID data. I employ the proportional hazard model to examine the factors that influence the retirement decision of husband and wife, and focus on examining the correlation of husband and wife's retirement status. This essay finds that an individual is more likely to retire if his or her spouse has retired. The retirement hazard is higher if an individual is in worse health. The worse health status also affects the spouse's retirement hazard, but the spouse effect is asymmetry. With the wife in worse health, the husband's retirement hazard decreases. With the husband in worse health, the wife's retirement hazard increases. I also find that the greater the social security income or pension, the higher the retirement hazard. But for the spouse effect, the husband's social security income or pension has impact on the retirement schedule of his wife, while I find no significant impact of wife's retirement benefit on husband's retirement timing. Essay 2 explores the transitions of health status using PSID data from 1984 to 2011 with the ordered logit model and the Cox proportional hazards model. The result shows that the impact of current health status on future health status is relatively large. A worse current health status would lead to a smaller probability for health deterioration, but it is less likely to be in a good health status in the future. There is strong health persistence. Social economics factors' impact on latent health status is also significant, although the magnitude is relatively small. Higher income level and education level would decrease the likelihood of health deterioration, and individuals with high income and high education would be more likely to be in better health status. When comparing different occupations, white-collar job is less associated with health deterioration, and this type of worker is more likely to be in better health status. Essay 3 applies the competing risks model to estimate the movement of corporate credit ratings using WRDS COMPUSTAT data. The credit rating variable is the Standard and Poor's long-term domestic issuer credit rating. The explanatory variables contain measures of leverage, liquidity, current profitability and future profitability. I estimate the impacts of these financial ratios on the upward and downward of credit rating. In addition, I estimate samples before and after the 2008 subprime crisis to study the influence of financial crisis on the credit rating. The result shows that firms with a higher liquidity are more likely to be upgraded and less likely to be downgraded. The impact of liquidity is weaker after the crisis. I find that when the current level of profitability increases, the firm is more likely to be upgraded than to be downgraded. The effect of current profitability is larger after the crisis. Firms with higher leverage ratio are more likely to be upgraded and less likely to be downgraded. And the effect of leverage is similar before and after the crisis.

scholarly journals Discontinuation of Contact Precautions in Patients with Nosocomial MRSA and VRE Infections During the COVID-19 Pandemic

2021 ◽  
Vol 1 (S1) ◽  
pp. s24-s24
Author(s):  
Marisa Hudson ◽  
Mayar Al Mohajer
Keyword(s):  
Hand Hygiene ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Incidence Density ◽  
Contact Precautions ◽  
Before And After ◽  
Hospital Acquired ◽  
The Impact

Background: Gaps exist in the evidence supporting the benefits of contact precautions for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The Centers for Disease Control and Prevention allow suspending contact precautions for MRSA and VRE in cases of gown shortages, as we have seen during the COVID-19 pandemic. We evaluated the impact of discontinuing isolation precautions in hospitalized patients with MRSA and VRE infection, due to gown shortage, on the rate of hospital-acquired (HA) MRSA and VRE infections. Methods: A retrospective chart review was performed on adult patients (n = 2,200) with established MRSA or VRE infection at 5 hospitals in CommonSpirit Health, Texas Division, from March 2019 to October 2020. Data including demographics, infection site, documented symptoms, and antibiotic use were stratified based on patient location (floor vs ICU). Rates of hospital-acquired MRSA and VRE infection before and after the discontinuation of isolation (implemented in March 2020) were compared. Incidence density rate was used to assess differences in the rate of MRSA and VRE infections between pre- and postintervention groups. Results: The rate of hospital-acquired (HA) MRSA infection per 10,000 patient days before the intervention (March 19–February 20) was 12.19, compared to 10.64 after the intervention (March 20–July 20) (P = .038). The rates of HA MRSA bacteremia were 1.13 and 0.93 for the pre- and postintervention groups, respectively (P = .074). The rates of HA VRE per 10,000 patient days were 3.53 and 4.44 for the pre- and postintervention groups, respectively (P = .274). The hand hygiene rates were 0.93 before the intervention and 0.97 after the intervention (P = .028). Conclusions: Discontinuing isolation from MRSA and VRE in the hospital setting did not lead to a statistically significant increase in hospital-acquired MRSA or VRE infections. In fact, rates of hospital-acquired MRSA decreased, likely secondary to improvements in hand hygiene during this period. These results support the implementation of policies for discontinuing contact isolation for hospitalized patients with documented MRSA or VRE infection, particularly during shortages of gowns.Funding: NoDisclosures: None

scholarly journals Validating the CUIDARE Scale in Measuring the Impact on Patients and the Adaptation Process of their Family Caregivers.

2020 ◽  
Author(s):  
Ana María Porcel Gálvez ◽  
Elena Fernández García ◽  
Eugenia Gil García ◽  
Juan Manuel Laguna Parra ◽  
Sergio Barrientos Trigo
Keyword(s):  
Factor Analysis ◽  
Family Caregivers ◽  
Explanatory Power ◽  
Hospitalized Patients ◽  
Public Hospitals ◽  
Psychometric Validation ◽  
Adaptation Process ◽  
Care Dependency ◽  
The Family ◽  
The Impact

Abstract Background: The family caregiving process requires adaptation and be evaluated to ensure a correct approach in supporting patients and their caregivers. The objective of the present study is to design and validate an instrument to determine the family caregivers’ adaptation to the caregiving process in relation to the care dependency of hospitalized patients. This paper presents CUIDARE, a validated scale based on the Nursing Outcomes Classification indicators and the Roy Adaptation Model, that evaluates the adaptation process of caregivers in hospital settings and its impact on hospitalized patients. Methods: A cross-sectional and psychometric validation study was carried out in ten public hospitals in the Andalusian Healthcare System. Data collection was undertaken between May 2016 and February 2017 in medical and surgical units, included 432 family caregivers. Results: The CUIDARE scale was shown to be internally consistent (Cronbach’s alpha = 0.818). The Exploratory Factor Analysis grouped 4 items into a single component with a variance-explanatory power of 65.6%. The Confirmatory Factor Analysis tested the unidimensionality of the scale with good fit model (CMIN/DF = 2.152; AGFI = 0.975; NFI = 0.993; CFI = 0.996; RFI = 0.979; RMSEA = 0.052). Conclusions: There is an association between the patients’ care dependency level and the family caregiver’s adaptation to caregiving (p-value <.001). Nursing professionals are encouraged to apply this instrument for the purpose of screening to facilitate the adaptation process of family caregivers and to improve the quality of care.

scholarly journals An investigation into adhesives to consolidate distemper paintings on canvas

2020 ◽  
Vol 18 (1) ◽  
pp. 123-135
Author(s):  
Cristina Castro Simarro
Keyword(s):  
Sixteenth Century ◽  
Special Reference ◽  
Treatment Strategies ◽  
Analytical Techniques ◽  
Painting Technique ◽  
The Past ◽  
Large Size ◽  
Historical Reconstructions ◽  
Before And After ◽  
The Impact

This article investigates traditional and modern adhesives used to consolidate distemper paintings on canvas, with special reference to sixteenth century Hispano-tüchlein paintings, also called sargas. Such artworks are not only difficult to handle due to their large size, but they are also inherently fragile and/or are highly hygroscopic. This sensitivity is caused in part by the nature of the painting technique as well as the lack of varnish, which might account for why conservation methods related to these works have not been addressed in the past. This investigation was conducted on historical reconstructions samples to assess and develop treatment strategies for distemper paintings, in particular issues linked to powdery/friable matte paint layers. The impact of several adhesives on the painted surface of historical reconstructions was evaluated before and after the samples were subjected to humidity cycling tests using a range of analytical techniques. Such information can be used to aid conservators who face consolidation issues related to underbound paintings or artworks with similar surfaces. The results reveal that there is no one perfect adhesive for matte paint nor one that can be removed completely, once applied. Aquazol® 200 and Funori performed the best, but still introduced changes in colour and gloss, even if minimal.

scholarly journals Nutrition and Obesity in the Pathogenesis of Youth-Onset Type 1 Diabetes and Its Complications

2021 ◽  
Vol 12 ◽  
Author(s):  
Christine A. March ◽  
Dorothy J. Becker ◽  
Ingrid M. Libman
Keyword(s):  
Type 1 Diabetes ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Cardiovascular Complications ◽  
Overweight And Obesity ◽  
Nutritional Interventions ◽  
Before And After ◽  
The Impact

Since the 1980s, there has been a dramatic rise in the prevalence of overweight and obesity in pediatric populations, in large part driven by sedentary lifestyles and changing dietary patterns with more processed foods. In parallel with the rise in pediatric obesity in the general population, the prevalence of overweight and obesity has increased among children and adolescents with type 1 diabetes. Adiposity has been implicated in a variety of mechanisms both potentiating the risk for type 1 diabetes as well as exacerbating long-term complications, particularly cardiovascular disease. Treatment options targeting the unique needs of obese pediatric patients, both before and after diagnosis of type 1 diabetes, are limited. In this review, we discuss the history of the epidemiology of the obesity epidemic in the context of pediatric type 1 diabetes, highlight the possible role of obesity in type 1 diabetes pathogenesis and review the concept of “double diabetes”. The impact of obesity at and after diagnosis will be discussed, including noted differences in clinical and biochemical markers, lipid abnormalities, and long-term cardiovascular complications. Finally, we will review the existing literature on pharmacologic and nutritional interventions as potential treatment strategies for youth with coexisting type 1 diabetes and obesity.

The impact of persistent dysphagia (PD) after induction chemotherapy in patients with locoregionally advanced (LRA) adenocarcinoma (ACA) of the esophagus and gastroesophageal junction (E/GEJ) receiving a trimodality treatment regimen.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 160-160
Author(s):  
Michael J. McNamara ◽  
Lisa A. Rybicki ◽  
Cristina P. Rodriguez ◽  
Gregory M.M. Videtic ◽  
Kevin L. Stephans ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Alternative Treatment ◽  
Clinical Stage ◽  
Gastroesophageal Junction ◽  
Treatment Strategies ◽  
Operative Therapy ◽  
Residual Tumor ◽  
Persistent Symptoms ◽  
Pathologic Stage ◽  
The Impact

160 Background: For patients with LRA ACA of the E/GEJ who receive pre-operative therapy, advanced pathologic stage at surgery is strongly associated with recurrence and death. Identification of such patients prior to resection, however, is problematic. Given the morbidity of esophageal resection, alternative treatment strategies may be desirable in this patient population. Methods: Between 2/08 and 1/12, 60 evaluable patients with LRA ACA of the E/GEJ enrolled in single arm phase II trial of induction chemotherapy, surgery, and post-operative chemoradiotherapy. A clinical stage of T3, N1 or M1a (AJCC 6th) was required for eligibility. Induction chemotherapy with epirubicin 50mg/m2 d1, oxaliplatin 130mg/m2 d1, and fluorouracil 200mg/m2/day continuous infusion for 3 weeks, was given every 21 days for 3 courses and was followed by surgical resection. Adjuvant CRT consisted of 50-55Gy @ 1.8-2.0 Gy/d and 2 courses of cisplatin (20mg/m2/d) and fluorouracil (1000mg/m2/d) given as 96 hour infusions during weeks 1 and 4 of radiotherapy. Dysphagia was assessed at baseline and after induction chemotherapy. Updated results as of March 2014 are presented. Results: Of the 60 evaluable patients enrolled, 54 completed induction therapy and underwent surgery. Of these 54 patients, 44 patients experienced complete resolution of dysphagia, while 10 patients had persistent symptoms. PD was associated with worse distant metastatic control [HR 3.48 (1.43 – 8.43), p=0.006], recurrence free survival [HR 3.04 (1.34 – 6.92), p=0.008], and overall survival [HR 3.31 (1.43 – 7.66), p=0.005]. PD was associated with more advanced pathologic T-descriptor (pT) (p=0.048) and N-descriptor (pN) (p=0.002), a greater median number of involved lymph nodes (3 v 1, p=0.003), and greater residual tumor viability (p=0.05). No patients with PD had pT0-T2 or pN0 disease. Of the 9 patients with pN3 disease, 5 (56%) had PD. Conclusions: PD after induction chemotherapy is associated with more advanced pathologic stage and inferior outcomes. These patients may require alternative treatment strategies. Clinical trial information: NCT00601705.

scholarly journals 391. Small Towns, Big Cities: Rural and Urban Disparities Among Hospitalized Patients with COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S297-S298
Author(s):  
Caroline Hamilton ◽  
Deepak Nag Ayyala ◽  
David Walsh ◽  
Christian-Jevon Bramwell ◽  
Christopher Walker ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Census Data ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Level Of Care ◽  
P Value ◽  
Rural And Urban ◽  
The Impact

Abstract Background More than half of all hospitals in the U.S. are rural hospitals. Frequently understaffed and resource limited, community hospitals serve a population that tends to be older and have less access to care with increased poverty and medical co-morbidities. There is a lack of data surrounding the impact of COVID-19 among rural minority communities. This study seeks to determine rural and urban disparities among hospitalized individuals with COVID-19. Methods This is a descriptive, retrospective analysis of the first 155 adult patients admitted to a tertiary hospital with a positive COVID-19 nasopharyngeal PCR test. Augusta University Medical Center serves the surrounding rural and urban counties of the Central Savannah River Area. Rural and urban categories were determined using patient address and county census data. Demographics, comorbidities, admission data and 30-day outcomes were evaluated. Results Of the patients studied, 62 (40%) were from a rural county and 93 (60%) were from an urban county. No difference was found when comparing the number of comorbidities of rural vs urban individuals; however, African Americans had significantly more comorbidities compared to other races (p-value 0.02). In a three-way comparison, race was not found to be significantly different among admission levels of care. Rural patients were more likely to require an escalation in the level of care within 24 hours of admission (p-value 0.02). Of the patients that were discharged or expired at day 30, there were no differences in total hospital length of stay or ICU length of stay between the rural and urban populations. Baseline Characteristics of Hospitalized Patients with COVID-19 Day 30 Outcomes and Characteristics Level of Care at Time of Admission Conclusion This study suggests that patients in rural communities may be more critically ill or are at a higher risk of early decompensation at time of hospitalization compared to patients from urban communities. Nevertheless, both populations had similar lengths of stay and outcomes. Considering this data is from an academic medical center with a large referral area and standardized inpatient COVID-19 management, these findings may prompt further investigations into other disparate outcomes. Disclosures All Authors: No reported disclosures

Strategic Role of Zakat in Multidimensional Quality of Life in Sijunjung, Indonesia

2018 ◽  
Vol 15 (1) ◽  
pp. 55-72
Author(s):  
Herlin Hamimi ◽  
Abdul Ghafar Ismail ◽  
Muhammad Hasbi Zaenal
Keyword(s):  
Quality Of Life ◽  
Positive Impact ◽  
Wealth Distribution ◽  
Absolute Poverty ◽  
Before And After ◽  
The Status ◽  
Being There ◽  
The Impact

Zakat is one of the five pillars of Islam which has a function of faith, social and economic functions. Muslims who can pay zakat are required to give at least 2.5 per cent of their wealth. The problem of poverty prevalent in disadvantaged regions because of the difficulty of access to information and communication led to a gap that is so high in wealth and resources. The instrument of zakat provides a paradigm in the achievement of equitable wealth distribution and healthy circulation. Zakat potentially offers a better life and improves the quality of human being. There is a human quality improvement not only in economic terms but also in spiritual terms such as improving religiousity. This study aims to examine the role of zakat to alleviate humanitarian issues in disadvantaged regions such as Sijunjung, one of zakat beneficiaries and impoverished areas in Indonesia. The researcher attempted a Cibest method to capture the impact of zakat beneficiaries before and after becoming a member of Zakat Community Development (ZCD) Program in material and spiritual value. The overall analysis shows that zakat has a positive impact on disadvantaged regions development and enhance the quality of life of the community. There is an improvement in the average of mustahik household incomes after becoming a member of ZCD Program. Cibest model demonstrates that material, spiritual, and absolute poverty index decreased by 10, 5, and 6 per cent. Meanwhile, the welfare index is increased by 21 per cent. These findings have significant implications for developing the quality of life in disadvantaged regions in Sijunjung. Therefore, zakat is one of the instruments to change the status of disadvantaged areas to be equivalent to other areas.

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