Do Daytime Activity, Mood and Unit Tumult Predict Nighttime Sleep Quality of Long-Term Care Residents?

Based on the premise that stressors can have a cumulative effect on people with dementia throughout the day that contributes to negative consequences later in the day, we examined if daytime activity, unit tumult, and mood were associated with sleep quality. A convenience sample of 53 long-term care (LTC) residents participated in this correlational study. Objective sleep quality was measured using actigraphy, and comorbid illness and level of dementia were control variables. Half of the sample had a sleep efficiency that was less than 80% and was awake for more than 90 min at night. Comorbid illness, negative mood at bedtime, and daytime activity level accounted for 26.1% of the variance in total sleep minutes. Census changes and the use of temporary agency staff were associated with poor sleep. Findings suggest daytime activity, mood at bedtime, and unit tumult should be considered when designing and testing interventions to improve sleep quality.

Clinical Non-adherence and Its Associated Factors Among HIV Positive Pediatrics Attending Care in South Gondar Zone Public Health Facilities, Northwest Ethiopia, 2021

Background: The most important factor in the success of HIV treatment is clinical adherence. Inadequate clinical adherence is one of the factors that affect the adherence level of highly active antiretroviral treatment and its effect on suppressed viral replication. Even though data from different settings are necessary to tackle it, pieces of evidence are limited especially in the case of clinical adherence level of HIV-infected children. Hence, this study aimed to assess clinical non-adherence level and its associated factors among HIV-positive children on HAART. Methods: A multicenter cross-sectional study was conducted from July 1 to August 30, 2021, among HIV-infected children on ART in South Gondar Zone. Data were entered into Epi Data Version 4.6 and analysis was done using Statistical Package for Social Science (SPSS) Version 25. Binary logistic regression was implemented to assess the association of factors against the outcome variable and variables with p-values ≤ 0.25 in the bivariable analysis were entered into the multivariable analysis. Finally, variables with p-values less than 0.05 were considered statistically significant factors.Result-out of 384 study participants, 383 were included in this study with a response rate of 99.7%. Nearly half of the study participants 190(49.6%) were girls. The majority, 291 (76%) of caretakers were biological mothers, and 203(53%) did not have treatment supporters. One hundred seventy-nine (46.7%) of caretakers did not disclose the status of the child about the illness. The overall prevalence of non-adherence among children on ART was 31.9 %( 95% CI: 27.2-36.6). Rural residency, diagnostic status non-disclosure, no adherence supporter, having no biological caretaker and comorbid illness were significantly associated with clinical non-adherence of HIV positive children.Conclusion-clinical non-adherence among children among HIV-positive children attending care in south Gondar zone health institutes is unacceptably high. Being rural residency, diagnostic status non-disclosure, no adherence supporter, having non-biological caretaker, and having comorbid illness were significantly associated with clinical non-adherence. Thus, attention shall be given to successful clinical adherence in HIV-positive children who uses the antiretroviral drug.

Do Daytime Activity, Mood at Bedtime and Unit Tumult Predict Nighttime Sleep Quality of Long-Term Care Residents?

Sleep quality declines in old age and is particularly poor for long-term care (LTC) residents with dementia. Compromised sleep quality is associated with severe cognitive and neuropsychiatric symptoms, agitation, aggressiveness, and poor quality of life. Based on the premise that stressors can have a cumulative effect on people with dementia throughout the day that contributes to negative consequences later in the day, we examined if daytime activity, mood, and unit tumult were associated with sleep quality. A convenience sample of 53 LTC residents with dementia participated in this correlational study. Objective sleep quality and activity variables were measured using Actigraphy, and mood was measured by the Observed Emotion Rating Scale. Unit tumult was defined as events in the residents living area that are deviations from the typical day (i.e., census changes, being cared for by a certified nursing assistant from a temporary staffing agency, and lower than usual staffing level). Comorbid illness and level of dementia were control variables. Half of the sample had a sleep efficiency that was less than .85 and were awake for more than 90 minutes at night. Comorbid illness, negative mood at bedtime, and daytime activity level accounted for 26.1% of the variance in total sleep minutes. Census changes and the use of temporary agency staff were associated with poor total sleep time and sleep efficiency. Findings suggest that daytime activity, mood at bedtime, and unit tumult should be considered when designing and testing interventions to improve sleep quality among LTC residents with dementia.

Cardiorenal syndrome in COVID-19

SARS-CoV-2 preferentially targets the human’s lungs, but it can affect multiple organ systems. We report a case of cardiorenal syndrome in a 37-year-old man who had symptoms of fever, myalgia and cough. He tested positive for COVID-19 and presented 5 days later with acute heart failure. Work up was done including echocardiography showing reduced ejection fraction. Later in the hospital course he developed acute renal failure and was treated with intermittent renal replacement therapy. No other definite cause of cardiorenal complications was identified during the course of the disease. A possible link with COVID-19 was considered with underlying mechanisms still needed to be explored. This case highlights the potential of SARS-CoV-2 affecting heart and kidneys. The disease not only involves the organs directly but can exacerbate the underlying comorbid illness.

SENSITIVITY OF SELF-REPORTED COMORBIDITIES COMPARED TO MEDICARE CLAIMS IN OLDER ADULTS WITH TRAUMATIC BRAIN INJURY

Patient reported history of comorbid illness may be the only information available to the treatment team during an acute injury admission. Nevertheless, acute injury, particularly traumatic brain injury (TBI) which affects cognition, may decrease the patient’s ability to accurately report medical history. Thus, the objective of this study was to evaluate the accuracy of patient-reported comorbid illness burden compared to the patient’s Medicare administrative claims. Records of older adults treated for TBI at an urban level 1 trauma center 2006-2010 were linked to their Medicare administrative. Comorbidities were recorded in Medicare claims based on ICD9 codes and were reported in the trauma registry (TR) based on patient medical history recorded by a physician or nurse. Prevalence of each of the following comorbidities was calculated using information from the TR and claims: Alzheimer’s disease and related dementias, chronic kidney disease, COPD, heart failure, diabetes, depression, stroke, and hypertension. Sensitivity of each patient-reported comorbidity was calculated using Medicare claims as the gold standard. We identified patient factors associated with accurate self-report using logistic regression. Among 408 older adults with TBI that linked to their Medicare claims, prevalence of each comorbidity was higher in Medicare claims compared to the TR, except for hypertension. Sensitivity for detecting these comorbidities using the TR ranged from 2% to 68%, with the highest sensitivity observed for hypertension. Older age and race were predictors of less accurate reported medical history. Reconciling self-reported patient history of these comorbidities with those reported in claims can better inform decisions regarding treatment.

Analisis Pola Penyakit Hipertensi Menggunakan Algoritma C4.5

There are approximately 95% of cases of unknown cause of hypertension, while the rest caused by other diseases such as coronary heart disease, impaired kidney function, and impaired cognitive function or stroke. RSUD Embung Fatimah is an Indonesian hospital located in Batam Island Riau Province. In 2015, the total number of inpatients for hospitalization reaches 10,317 inhabitants. With the large number of patients per year it causes patient data is increasing. To overcome the problem in tackling people with hypertension disease, it is necessary to analyze the existing disease data, to predict the patient's illness which must be handled based on the pattern of the disease. In data mining there is a model that can be used to predict a pattern in a condition that is predictive or prediction model. One of the algorithms that can be used to create a decision tree (decission tree) is the C4.5 algorithm. The C4.5 algorithm is a method used for predictive classification. Using C4.5 algorithm method, the researcher can classify the pattern of hypertension as a comorbid illness of heart failure, kidney failure, diabetes, stroke and hypoglycemia. In this study, researchers used WEKA (Waikato Environment for Knowledge Analysis) software as tools or tools used to perform testing in order to obtain the pattern of disease from hypertension. From the research findings in the find that in the prediction of hypertension disease as a disease, the attributes that are very influential to hypertension are heart failure.