Relationship between continuity of care and emergency department utilization in children with attention deficit/hyperactivity disorder in British Columbia

Cxjntmuity of care with a primary care provider has long been thought to lead to improved health outcomes and greater patient and physician satisfaction. The benefits of continuity of care remain controversial, however, and have not been firmly established for pediatric patients. The objective of this study was to examine whether continuity of care with a primary care provider is associated with the number of emergency department (ED) visits in children and adolescents with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) in British Columbia We analyzed two years of physician claims records for over 4000 British Columbia children aged 4 to 16 to determine individual continuity of care (COC) scores for each study participant. Multinomial logistic regression analysis was then applied to determine if a relationship exists between COC computed during two years and number of ED visits made during the following year. Our results showed a weak association between continuity with a primary care provider and ED use. In multivariate analysis, continuity was associated with a lower likelihood of making a single ED visit (odds ratio, 0.85; 95% confidence interval, 0.70- 1.05) and is more strongly associated with a lower likelihood of making multiple E D visits (odds ratio, 0.81; 95% confidence interval, 0.62-1.05). Other variables that were associated with outcome include: age, socio-economic status, overall number of general practitioner visits, pediatrician visits, psychiatrist visits, and illness burden. This study demonstrates that high primary care provider continuity is associated with lower ED use for children aged 4 to 16 with ADHD in British Columbia. The results suggest that strategies to improve continuity of primary care provider among this population may lead to decreased ED utilization and should therefore be encouraged.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Journal of Immunology

Texto completo: acesso restrito. p. 498-505Persistent immunity against Leishmania infections in humans is mediated predominantly by CD4+ T cells of the Th1 phenotype. Herein we report the expression cloning of eight Leishmania Ags using parasite-specific T cell lines derived from an immune donor. The Ags identified by this technique include the flagellar proteins α- and β-tubulin, histone H2b, ribosomal protein S4, malate dehydrogenase, and elongation factor 2, as well as two novel parasite proteins. None of these proteins have been previously reported as T cell-stimulating Ags from Leishmania. β-tubulin-specific T cell clones generated against Leishmania major amastigotes responded to Leishmania-infected macrophages and dendritic cells. IFN-γ enzyme-linked immunospot analysis demonstrated the presence of T cells specific for several of these Ags in PBMC from self-healing cutaneous leishmaniasis patients infected with either Leishmania tropica or L. major. The responses elicited by Leishmania histone H2b were particularly striking in terms of frequency of histone-specific T cells in PBMC (1 T cell of 6000 PBMC) as well as the percentage of responding donors (86%, 6 of 7). Ags identified by T cells from immune donors might constitute potential vaccine candidates for leishmaniasis

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care