Epidemiology of influenza-associated hospitalization in adults, Toronto, 2007/8

The purpose of this investigation was to identify when diagnostic testing and empirical antiviral therapy should be considered for adult patients requiring hospitalization during influenza seasons. During the 2007/8 influenza season, six acute care hospitals in the Greater Toronto Area participated in active surveillance for laboratory-confirmed influenza requiring hospitalization. Nasopharyngeal (NP) swabs were obtained from patients presenting with acute respiratory or cardiac illness, or with febrile illness without clear non-respiratory etiology. Predictors of influenza were analyzed by multivariable logistic regression analysis and likelihoods of influenza infection in various patient groups were calculated. Two hundred and eighty of 3,917 patients were found to have influenza. Thirty-five percent of patients with influenza presented with a triage temperature ≥38.0°C, 80% had respiratory symptoms in the emergency department, and 76% were ≥65 years old. Multivariable analysis revealed a triage temperature ≥38.0°C (odds ratio [OR] 3.1; 95% confidence interval [CI] 2.3–4.1), the presence of respiratory symptoms (OR 1.7; 95% CI 1.2–2.4), admission diagnosis of respiratory infection (OR 1.8; 95% CI 1.3–2.4), admission diagnosis of exacerbation of chronic obstructive pulmonary disease (COPD)/asthma or respiratory failure (OR 2.3; 95% CI 1.6–3.4), and admission in peak influenza weeks (OR 4.2; 95% CI 3.1–5.7) as independent predictors of influenza. The likelihood of influenza exceeded 15% in patients with respiratory infection or exacerbation of COPD/asthma if the triage temperature was ≥38.0°C or if they were admitted in the peak weeks during the influenza season. During influenza season, diagnostic testing and empiric antiviral therapy should be considered in patients requiring hospitalization if respiratory infection or exacerbation of COPD/asthma are suspected and if either the triage temperature is ≥38.0°C or admission is during the weeks of peak influenza activity

Influenza Vaccine Effectiveness in the Elderly Based on Administrative Databases: Change in Immunization Habit as a Marker for Bias

Administrative databases provide efficient methods to estimate influenza vaccine effectiveness (IVE) against severe outcomes in the elderly but are prone to intractable bias. This study returns to one of the linked population databases by which IVE against hospitalization and death in the elderly was first assessed. We explore IVE across six more recent influenza seasons, including periods before, during, and after peak activity to identify potential markers for bias.Acute respiratory hospitalization and all-cause mortality were compared between immunized/non-immunized community-dwelling seniors ≥65 years through administrative databases in Manitoba, Canada between 2000-01 and 2005-06. IVE was compared during pre-season/influenza/post-season periods through logistic regression with multivariable adjustment (age/sex/income/residence/prior influenza or pneumococcal immunization/medical visits/comorbidity), stratification based on prior influenza immunization history, and propensity scores. Analysis during pre-season periods assessed baseline differences between immunized and unimmunized groups. The study population included ∼140,000 seniors, of whom 50-60% were immunized annually. Adjustment for key covariates and use of propensity scores consistently increased IVE. Estimates were paradoxically higher pre-season and for all-cause mortality vs. acute respiratory hospitalization. Stratified analysis showed that those twice consecutively and currently immunized were always at significantly lower hospitalization/mortality risk with odds ratios (OR) of 0.60 [95%CI0.48-0.75] and 0.58 [0.53-0.64] pre-season and 0.77 [0.69-0.86] and 0.71 [0.66-0.77] during influenza circulation, relative to the consistently unimmunized. Conversely, those forgoing immunization when twice previously immunized were always at significantly higher hospitalization/mortality risk with OR of 1.41 [1.14-1.73] and 2.45 [2.21-2.72] pre-season and 1.21 [1.03-1.43] and 1.78 [1.61-1.96] during influenza circulation.The most pronounced IVE estimates were paradoxically observed pre-season, indicating bias tending to over-estimate vaccine protection. Change in immunization habit from that of the prior two years may be a marker for this bias in administrative data sets; however, no analytic technique explored could adjust for its influence. Improved methods to achieve valid interpretation of protection in the elderly are needed

CONJOINT ANALYSIS IN THE DECISION-MAKING FOR CHOOSING CAFE IN BANGKOK METROPOLIS: การวิเคราะห์ร่วมในการตัดสินใจเลือกใช้บริการร้านกาแฟ ของผู้บริโภคในเขตกรุงเทพมหานคร

The purpose of this research is to study the important factors that influence consumers' decision-making in choosing a cafe in the Bangkok Metropolitan area, and to compare the demographic characteristics and lifestyle patterns that affect the choice. This research was conducted using multiple methods. Part 1 Qualitative Research; Key information regarding who has used a cafe in the Bangkok Metropolitan area at least once, totaling 21 people. There were divided into three different age groups, then put through semi-structured online interviews. The data from these interviews was analyzed and concluded. Part 2: Quantitative Research; data was collected through questionnaires from a sample group of 200 cafe customers within the Bangkok Metropolitan area. The statistic used in the data analysis were: conjoint analysis, descriptive statistics and inferential statistics. The research findings indicate that the sample groups ranked the importance of decision-making factors for choosing cafe in the following order: convenient location for traveling to the cafe, cafe decoration, availability of parking space near the cafe, advertising, and taste of the coffee. The hypothesis testing results reveal the following: 1) Consumers of different genders gave unequal importance to taste of coffee and cafe decoration. Whereas, consumers whose ages, education level and average monthly income were different all gave unequal importance to cafe decoration, and availability of parking space near the cafe. Furthermore, Consumers of differing occupations gave unequal importance to the taste of coffee, advertising and availability of parking space near the cafe. 2) Consumers with different frequencies of service usage gave unequal importance to the advertising. 3) Customers with differing lifestyles and opinions gave unequal importance to the cafe decoration and availability of parking space. This study demonstrates the overall preference scores and the ranking of decision-making factors among consumers. Therefore, the research data will enable business owners to identify the importance of each factor that influence consumers' decision-making in choosing cafe and develop strategies accordingly. This information can be used to improve and enhance their businesses in the future

Effectiveness of simple balancing training program in elderly patients with history of frequent falls

Vilai Kuptniratsaikul1, Rungnirand Praditsuwan2, Prasert Assantachai3, Teerada Ploypetch1, Suthipol Udompunturak4, Julaporn Pooliam41Department of Rehabilitation Medicine, 2Department of Medicine, 3Department of Preventive Medicine, 4Office for Research and Development, Siriraj Hospital, Mahidol University, ThailandObjective: To study the effectiveness of simply-performed balancing exercises in fall prevention.Design: Pre- and post-trial.Setting: University hospital from January 2009 to May 2010.Participants: Elderly with falls in the previous year.Intervention: Simple balancing exercise was performed at home every day and was recorded in the booklet.Measurements: New falling events and a battery of balancing abilities including the Timed Up and Go Test (TUGT), chair stand, functional reach, and Berg balance scale-short form were evaluated at baseline, 3-, 6-, 9-, and 12-month periods. Fear of falling and quality of life scores were assessed at baseline and 12-month periods.Results: 146 subjects were recruited, 116 female (79.5%) with a mean age of 67.1 years. At the end of the study, 49% of participants had not fallen. All of the balancing abilities were compared between frequent and infrequent fallers and were significantly improved (P < 0.001) except for functional reach in the frequent fall group. Most subjects (72%–79%) complied well with the exercise program. However, compliance had no effect on balancing abilities. About 36.4% of participants had adverse events from exercise, of which knee pain was the top ranked. The quality of life and the fall efficacy scores increased significantly at the end of the study. Factors affecting falling were compliance with exercise (adjusted odds ratio [OR]: 2.55, 95% confidence intervals [CI]: 1.04, 6.30) and a history of falling ≥3 times in the previous year (adjusted OR: 3.76, 95% CI: 1.18, 11.98).Conclusion: Performing simply-designed balancing exercises, at least 3 days per week, can increase balancing abilities, and decrease fall rates in the elderly with a history of previous falls. However, strategies to encourage elderly compliance may prevent falling.Keywords: balancing training, exercise, fall prevention, frequent fall, elderl