Factors Associated with Influenza Vaccination of Hospitalized Elderly Patients in Spain

Vaccination of the elderly is an important factor in limiting the impact of influenza in the community. The aim of this study was to investigate the factors associated with influenza vaccination coverage in hospitalized patients aged ≥ 65 years hospitalized due to causes unrelated to influenza in Spain. We carried out a cross-sectional study. Bivariate analysis was performed comparing vaccinated and unvaccinated patients, taking in to account sociodemographic variables and medical risk conditions. Multivariate analysis was performed using multilevel regression models. We included 1038 patients: 602 (58%) had received the influenza vaccine in the 2013-14 season. Three or more general practitioner visits (OR = 1.61; 95% CI 1.19-2.18); influenza vaccination in any of the 3 previous seasons (OR = 13.57; 95% CI 9.45-19.48); and 23-valent pneumococcal polysaccharide vaccination (OR = 1.97; 95% CI 1.38-2.80) were associated with receiving the influenza vaccine. Vaccination coverage of hospitalized elderly people is low in Spain and some predisposing characteristics influence vaccination coverage. Healthcare workers should take these characteristics into account and be encouraged to proactively propose influenza vaccination to all patients aged ≥ 65 year

The 3-hydroxy fatty acids as biomarkers for quantification and characterization of endotoxins and Gram-negative bacteria in atmospheric aerosols in Hong Kong

Endotoxins from Gram-negative bacteria have received much attention because they could elicit strong pro-inflammatory responses in the human respiratory tract. In this study, 3-hydroxy fatty acids (3-OH FAs) with carbon chain lengths from 10 to 18 (C10-C18) were employed as biomarkers to quantify and characterize the endotoxins and Gram-negative bacterial community in atmospheric aerosols. Gas chromatography-mass spectrometry (GC-MS) was utilized for quantification of this biomarker in fine (PM2.5) and coarse (PM2.5-10) particulates collected by high volume samplers simultaneously at a rural and an urban site in Hong Kong. The geometric mean concentrations of the endotoxins were 5.5 and 1.35 ng m(-3) in fine and coarse particulates at the rural site, respectively. At the urban site, the corresponding concentrations were 9.4 and 2.80 ng m(-3) in fine and coarse particulates, respectively. It is found that 70-80\% of the total endotoxins are associated with the fine particulates. Significant higher endotoxin levels at the urban site were observed throughout the 8-month study period. This could possibly relate to the heavier human activities in the urban areas. The distribution patterns of the 3-OH FAs with respect to carbon number are similar between the rural and urban sites regardless of particle sizes. The C10 and C16 were predominant and accounted for about 40-50\% of the total 3-OH FAs. Furthermore, the odd carbon chain length 3-OH FAs constituted a non-negligible fraction (15-25\%) of the total 3-OH FAs. The biologically active endotoxins estimated as the sum of C12 and C14 portions in this study ranged from 0.6-3.7 and 1.9-4.8 ng m(-3) at the rural and urban sites, respectively. Applying the biomarker-to-microbial mass conversion factors, the dry mass loading of the Gram-negative bacteria are in the order of 10-10(2) ng m(-3) in atmospheric aerosol. This study also demonstrates that the biomarker (3-OH FAs) approach yields much more quantitative information such as the mass loading, total endotoxin concentration and estimation of potent endotoxin level in the atmospheric aerosol. (C) 2004 Elsevier Ltd. All rights reserved

Ergosterol as a biomarker for the quantification of the fungal biomass in atmospheric aerosols

The prevailing warm and humid climate in subtropical cities favors fungal growth in the ambient environment. Fungal growth has implications for public health because fungal cells, spores and their metabolites are allergenic and potential health hazards. In this regard, better and quicker alternatives than the available sampling and species identification methods are needed for quantifying fungal communities in atmospheric aerosols. In this study, the fungal membrane ergosterol was used as a biomarker for assessing the abundance and mass loading of fungi in atmospheric aerosols. Gas chromatography-mass spectrometry (GC-MS) was utilized for quantification of this biomarker in fine (PM2.5) and coarse (PM2.5-10) particulates collected by high volume samplers simultaneously at a rural site and an urban site in Hong Kong. The geometric means of the total ergosterol concentrations at the rural and urban sites were 120.2 and 93.9 pg m(-3) in the PM10 (calculated as the sum of PM2.5 and PM2.5-10) particulates. The significantly higher ergosterol loading at the rural site was related to the vegetation coverage around the sampling site. Ergosterol loading was higher in the autumn at both sites, which correlated with seasonal drops in the relative humidity below 70\%. Approximately 65-66\% of the ergosterol in PM10 is associated with fine particulates, indicating that atmospheric fungi likely lead to chronic respiratory symptoms. The mass loading of the fungal spores on the dry mass was on the order of 10-10(2) ng m(-3). The geometric mean concentration of the fungal spores was estimated as 46 and 36 spores m(-3), which was one-sixth of the measured viable samplings of 292 and 247 CFU m(-3) at the rural and urban sites, respectively. This underestimation leads to the need for establishing proper conversion factors from conditions identical to or simulating the study system of interest when markers are quantified and estimated for microbial mass loading in ambient aerosols. This study was the first to utilize the fungal biomarker ergosterol in monitoring and assessing ambient fungal loading and prevalence in atmospheric aerosols for a period of eight months. It confirms that biomarkers can provide quantitative information on microbial communities in atmospheric aerosols. (c) 2005 Elsevier Ltd. All rights reserved

Size distributions and formation of ionic species in atmospheric particulate pollutants in Beijing, China: 2 - dicarboxylic acids

Sparse data on the size distributions of ionic species, especially organic ions, in atmospheric particles are available in the literature. To study the size distributions and the formation of atmospheric ionic species, 14 sets of measurements of the concentrations of the gases and size-segregated atmospheric particles were made in Beijing in the summer of 2001 and the spring of 2002. Significant differences of the size distribution characteristics and the formation mechanism of the ions in these two periods were found. Using the size distributions of SO42-, K+ and Ca2+ as references, the size distributions of oxalic, malonic and succinic acids were examined to investigate the formation of these acids in the atmospheric particles in Beijing. In the summer, oxalate was present mostly in the fine mode with an MMAD of 0.7+/-0.1 mum, coincident with the droplet mode of sulfate. The formation of fine mode oxalate, like sulfate, was attributed to in-cloud processes. Malonate was also present mostly in the fine mode with an MMAD of 0.8 +/- 0.2 mum and its formation was also attributed to in-cloud processes. The MMAD of fine mode malonate sometimes shifted to values larger than that of sulfate, which can be explained by a minor evaporation of malonate during water evaporation from cloud droplets. The size distribution and the formation of succinate are similar to those of oxalate. In the spring, oxalate sometimes dominated in the fine mode, where oxalate was highly correlated with sulfate (r = 0.86) and had an MMAD (0.45 +/- 0.05 mum) similar to sulfate, but it sometimes dominated in the coarse mode, in association with Ca2+. The fine mode oxalate was attributed to heterogeneous formation but the coarse mode oxalate was probably related to biological formation. (C) 2003 Elsevier Science Ltd. All rights reserved

Size distributions and formation of ionic species in atmospheric particulate pollutants in Beijing, China: 1 - inorganic ions

To study the formation of atmospheric sulfate, nitrate and chloride particulates in Beijing, China, 14 sets of measurements of the concentrations Of SO2, HNO3, NH3 and size-segregated particles were made in the summer of 2001 and the spring of 2002. Because of the very different humidity levels in Beijing in the summer and the spring, significant differences in the size characteristics and in the formation mechanisms of these ions were found. In the summer, the major fraction of sulfate was present in the fine mode with a mass median aerodynamic diameter (MMAD) of 0.7 +/- 0.1 mum. Its formation was attributed to in-cloud processing, which was supported by the observation of a large mole ratio of the sulfate at 0.54 - 1.0 mum to SO2, with a maximum value of 3.0. The major fraction of nitrate sometimes appeared in the fine mode with an MMAD of 0.7 +/- 0.1 mum and sometimes in the coarse mode with an MMAD of 6.0 +/- 1.5 mum. The coarse mode nitrate was associated with Ca2+. The major peak of chloride, in most cases, appeared in the coarse mode. Chloride was expected to have formation mechanisms similar to nitrate formation in the coarse mode. In the spring, the major fraction of sulfate was present in the fine mode with an MMAD of 0.45 +/- 0.05 mum and its formation was ascribed to non-cloud heterogeneous processes. A small mole ratio of the fine mode sulfate to SO2, with a maximum value of only 0.06, was observed. Nitrate and chloride generally have a similar MMAD as sulfate in the fine mode, suggesting that both may originate from atmospheric processes similar to sulfate formation. Alternatively, they could be formed by gas condensation onto existing sulfate particles. Overall, much more efficient sulfate formation by cloud processing led to a higher sulfate concentration in the summer than in the spring, although the SO2 concentration followed the reverse trend in Beijing. (C) 2003 Elsevier Science Ltd. All rights reserved

Association between educational level and cardiovascular disease and all-cause mortality in patients with type 2 diabetes: a prospective study in the Joint Asia Diabetes Evaluation Program

Hongjiang Wu,1,2 Eric SH Lau,3 Alice PS Kong,2,4 Ronald CW Ma,2,4 Risa Ozaki,4 Kitty KT Cheung,4 Elaine Chow,4 Chiu Chi Tsang,5 Kam Piu Lau,6 Eric MT Hui,7 Wing Yee So,8 Danijela Gasevic,1,9 Sarah H Wild,1 Juliana CN Chan,2–4 Andrea Luk2–4 1Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK; 2Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; 3Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China; 4Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; 5Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China; 6Northern District Hospital, Fanling, Hong Kong SAR, China; 7Department of Family Medicine, Prince of Wales Hospital, Hong Kong SAR, China; 8Hospital Authority Head Office, Hong Kong SAR, China; 9School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Purpose: The aim of this study was to describe the association between educational level and incident cardiovascular disease (CVD) and all-cause mortality in Hong Kong Chinese patients with type 2 diabetes.Patients and methods: We included 12,634 patients with type 2 diabetes who were enrolled into the Joint Asia Diabetes Evaluation Program between June 1, 2007, and June 30, 2017. We classified patients’ educational level into the following three groups: ≤6 years, 6–13 years, and >13 years. Incident CVD events were identified using hospital discharge diagnoses. Death was identified from Hong Kong Death Register. We estimated HRs for incident CVD and all-cause mortality using Cox regression models.Results: Patients with the highest educational level were younger and had shorter diabetes duration and better glycemic control at enrollment than those with the lowest educational level. During the median follow-up of 6.2 years for CVD and 6.4 years for all-cause mortality, 954 CVD events and 833 deaths were recorded. HRs for CVD and all-cause mortality were 0.73 (95% CI: 0.57, 0.94) and 0.71 (95% CI: 0.54, 0.94) for the highest educational level compared to the lowest educational level, after adjustment for age, sex, diabetes duration, and family history of diabetes.Conclusion: Educational level is inversely associated with the risk of CVD and all-cause mortality among Hong Kong Chinese patients with type 2 diabetes. Hong Kong Chinese patients with type 2 diabetes and low educational level should be given special attention for the prevention of key complications of diabetes. Keywords: socioeconomic status, educational level, diabetes, cardiovascular disease, all-cause mortalit

Association of technologically assisted integrated care with clinical outcomes in type 2 diabetes in Hong Kong using the prospective JADE Program: A retrospective cohort analysis

BACKGROUND: Diabetes outcomes are influenced by host factors, settings, and care processes. We examined the association of data-driven integrated care assisted by information and communications technology (ICT) with clinical outcomes in type 2 diabetes in public and private healthcare settings. METHODS AND FINDINGS: The web-based Joint Asia Diabetes Evaluation (JADE) platform provides a protocol to guide data collection for issuing a personalized JADE report including risk categories (1-4, low-high), 5-year probabilities of cardiovascular-renal events, and trends and targets of 4 risk factors with tailored decision support. The JADE program is a prospective cohort study implemented in a naturalistic environment where patients underwent nurse-led structured evaluation (blood/urine/eye/feet) in public and private outpatient clinics and diabetes centers in Hong Kong. We retrospectively analyzed the data of 16,624 Han Chinese patients with type 2 diabetes who were enrolled in 2007-2015. In the public setting, the non-JADE group (n = 3,587) underwent structured evaluation for risk factors and complications only, while the JADE (n = 9,601) group received a JADE report with group empowerment by nurses. In a community-based, nurse-led, university-affiliated diabetes center (UDC), the JADE-Personalized (JADE-P) group (n = 3,436) received a JADE report, personalized empowerment, and annual telephone reminder for reevaluation and engagement. The primary composite outcome was time to the first occurrence of cardiovascular-renal diseases, all-site cancer, and/or death, based on hospitalization data censored on 30 June 2017. During 94,311 person-years of follow-up in 2007-2017, 7,779 primary events occurred. Compared with the JADE group (136.22 cases per 1,000 patient-years [95% CI 132.35-140.18]), the non-JADE group had higher (145.32 [95% CI 138.68-152.20]; P = 0.020) while the JADE-P group had lower event rates (70.94 [95% CI 67.12-74.91]; P < 0.001). The adjusted hazard ratios (aHRs) for the primary composite outcome were 1.22 (95% CI 1.15-1.30) and 0.70 (95% CI 0.66-0.75), respectively, independent of risk profiles, education levels, drug usage, self-care, and comorbidities at baseline. We reported consistent results in propensity-score-matched analyses and after accounting for loss to follow-up. Potential limitations include its nonrandomized design that precludes causal inference, residual confounding, and participation bias. CONCLUSIONS: ICT-assisted integrated care was associated with a reduction in clinical events, including death in type 2 diabetes in public and private healthcare settings