Factors associated with risk behavior in travelers to tropical and subtropical regions

BACKGROUND: Recent decades have seen a rise in population movements and, therefore, the spread of tropical diseases and changes in the epidemiology of global disease patterns. Only 50% of travelers to tropical areas receive pre-travel advice and most of them present risk behaviors for acquiring infections. The aim of this study was to describe the clinical and epidemiological characteristics of travelers and identify factors associated with risk behaviors. METHODS: We made a retrospective, descriptive and analytical study of 772 travelers consulting a tropical medicine clinic in Barcelona in 2010. Data on demographic and clinical variables, travel characteristics and risk behaviors were collected. RESULTS: Among all travelers studied, 65.8% (466/708) received pre-travel advice and 30.7% (209/680) took malaria prophylaxis. At least one risk behavior was reported by 82.6% (587/711) of travelers. People travelling for 1-6 months had a 3-fold higher likelihood of experiencing risk behaviors than people travelling for <1 month (95% CI 1.54-5.81, p=0.001), and those travelling for >6 months had a 13-fold higher likelihood (95% CI 3.11-56.14, p<0.001) compared with the same group. Increasing age was associated with presenting less risk behaviors. CONCLUSIONS: Younger travelers and those making longer trips have a higher number of risk behaviors. Strategies emphasizing advice on risk behavior should focus on these groups

Adaptació al català de l'enquesta per malalties respiratòries ATS-DLD-78: validació preliminar

L'objectiu del treball és validar un instrument de mesura per conèixer, més endavant, la prevalença de les bronquitis més cròniques en el nostre medi. Es tracta de l'enquesta per malalties respiratòries de l'American Thoracic Society for the Division of Lung Disease, que hem traduït al català. Respecte a les preguntes del test que defineixen les bronquitis cròniques, hem trobat una sensibilitat del 63,33% i una especificitat del 100% per la referida a la tos i una sensibilitat del 63,33% i una especificitat del 90% per la referida a l'expectoració. De les 124 preguntes, 55 s'hagueren de repetir. D'aquestes, 7 dues vegades i la resta (48) només una. La mitjana aritmètica de la durada del qüestionari és de 17,15 minuts. Pensem que aquesta enquesta, traduïda al català, és una bona eina per estudis de prevalença de malalties respiratòries en el nostre medi

Factors associated with 30-day readmission after hospitalisation for community-acquired pneumonia in older patients: a cross-sectional study in seven Spanish regions

Objective: Hospital readmission in patients admitted for community-acquired pneumonia (CAP) is frequent in the elderly and patients with multiple comorbidities, resulting in a clinical and economic burden. The aim of this study was to determine factors associated with 30-day readmission in patients with CAP. Design: A cross-sectional study. Setting: The study was conducted in patients admitted to 20 hospitals in seven Spanish regions during two influenza seasons (2013-2014 and 2014-2015). Participants: We included patients aged ≥65 years admitted through the emergency department with a diagnosis compatible with CAP. Patients who died during the initial hospitalisation and those hospitalised more than 30 days were excluded. Finally, 1756 CAP cases were included and of these, 200 (11.39%) were readmitted. Main outcome measures: 30-day readmission. Results: Factors associated with 30-day readmission were living with a person aged 3 hospital visits during the 90 previous days (aOR 1.53, 95% CI 1.01 to 2.34), chronic respiratory failure (aOR 1.74, 95% CI 1.24 to 2.45), heart failure (aOR 1.69, 95% CI 1.21 to 2.35), chronic liver disease (aOR 2.27, 95% CI 1.20 to 4.31) and discharge to home with home healthcare (aOR 5.61, 95% CI 1.70 to 18.50). No associations were found with pneumococcal or seasonal influenza vaccination in any of the three previous seasons. Conclusions: This study shows that 11.39% of patients aged ≥65 years initially hospitalised for CAP were readmitted within 30 days after discharge. Rehospitalisation was associated with preventable and non-preventable factor

Economic Impact of a New Rapid PCR Assay for Detecting Influenza Virus in an Emergency Department and Hospitalized Patients.

Seasonal influenza causes significant morbidity and mortality and has a substantial economic impact on the healthcare system. The main objective of this study was to compare the cost per patient for a rapid commercial PCR assay (Xpert1 Flu) with an in-house realtime PCR test for detecting influenza virus. Community patients with influenza like-illness attending the Emergency Department (ED) as well as hospitalized patients in the Hospital Clínic of Barcelona were included. Costs were evaluated from the perspective of the hospital considering the use of resources directly related to influenza testing and treatment. For the purpose of this study, 366 and 691 patients were tested in 2013 and 2014, respectively. The Xpert1 Flu test reduced the mean waiting time for patients in the ED by 9.1 hours and decreased the mean isolation time of hospitalized patients by 23.7 hours. This was associated with a 103 (or about $113) reduction in the cost per patient tested in the ED and 64 ($70) per hospitalized patient. Sensitivity analyses showed that Xpert1 Flu is likely to be cost-saving in hospitals with different contexts and prices

Viscerotropic disease: case definition and guidelines for collection, analysis, and presentation of immunization safety data

Viscerotropic disease (VTD) is defined as acute multiple organ system dysfunction that occurs following vaccination. The severity of VTD ranges from relatively mild multisystem disease to severe multiple organ system failure and death. The term VTD was first used shortly after the initial published reports in 2001 of febrile multiple organ system failure following yellow fever (YF) vaccination. To date, VTD has been reported only in association with YF vaccine and has been thus referred to as YF vaccine-associated viscerotropic disease (YEL-AVD)

Humoral and Cellular Immune Responses After a 3-dose Course of mRNA-1273 COVID-19 Vaccine in Kidney Transplant Recipients: A Prospective Cohort Study.

In kidney transplant recipients, there is discordance between the development of cellular and humoral response after vaccination against SARS-CoV-2. We sought to determine the interplay between the 2 arms of adaptive immunity in a 3-dose course of mRNA-1273 100 μg vaccine. Methods: Humoral (IgG/IgM) and cellular (N- and S-ELISpot) responses were studied in 117 kidney and 12 kidney-pancreas transplant recipients at the following time points: before the first dose, 14 d after the second dose' and before and after the third dose, with a median of 203 and 232 d after the start of the vaccination cycle, respectively. Results: After the second dose, 26.7% of naive cases experienced seroconversion. Before the third dose and in the absence of COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion occurred in 80.0% of patients. Naive patients who had at any time point a detectable positivity for S-ELISpot were 75.2% of the population, whereas patients who maintained S-ELISpot positivity throughout the study were 34.3%. S-ELISpot positivity at 42 d was associated with final seroconversion (odds ratio' 3.14; 95% confidence interval' 1.10-8.96; P = 0.032). Final IgG titer was significantly higher in patients with constant S-ELISpot positivity (P < 0.001). Conclusions: A substantial proportion of kidney transplant recipients developed late seroconversion after 2 doses. Cellular immunity was associated with the development of a stronger humoral respons

Incidence of severe breakthrough SARS-CoV-2 infections in vaccinated kidney transplant and haemodialysis patients

Introduction: Given the increased COVID-19 observed in kidney transplant recipients (KTRs) and haemodialysis patients, several studies have tried to establish the efficacy of mRNA vaccines in these populations by evaluating their humoral and cellular responses. However, there is currently no information on clinical protection (deaths and hospitalizations), a gap that this study aims to fill. Methods: Observational prospective study involving 1,336 KTRs and haemodialysis patients from three dialysis units affiliated to Hospital Clínic of Barcelona, Spain, vaccinated with two doses of mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 mRNA vaccines. The outcomes measured were SARS-CoV-2 infection diagnosed by a positive RT-PCR fourteen days after the second vaccine dose, hospital admissions derived from infection, and a severe COVID-19 composite outcome, defined as either ICU admission, invasive and non-invasive mechanical ventilation, or death. Results: Six per cent (18/302) of patients on haemodialysis were infected, of whom four required hospital admission (1.3%), only one (0.3%) had severe COVID-19, and none of them died. In contrast, 4.3% (44/1034) of KTRs were infected, and presented more hospital admissions (26 patients, 2.5%), severe COVID-19 (11 patients, 1.1%) or death (4 patients, 0.4%). KTRs had a significantly higher risk of hospital admission than HD patients, and this risk increased with age and male sex (HR 3.37 and 4.74, respectively). Conclusions: The study highlights the need for booster doses in KTRs. In contrast, the haemodialysis population appears to have an adequate clinical response to vaccination, at least up to four months from its administration

Aplicación del protocolo de adecuación hospitalaria en la determinación de los días de estancia atribuibles a la bacteriemia nosocomial por "Staphylococcus aureus"

I.- INTRODUCCIÓN: Los países desarrollados han experimentado un progresivo crecimiento del gasto sanitario en los últimos años, a expensas fundamentalmente de la asistencia sanitaria. El análisis de los recursos económicos consumidos en asistencia sanitaria señala que el porcentaje más importante corresponde, con un 63 %, a la asistencia hospitalaria. Si la asignación de los recursos econ6micos públicos destinados a la sanidad tiene un límite, y la capacidad de crecimiento del sector es potencialmente ilimitada, la administración ha de potenciar y desarrollar iniciativas que traten de asegurar unos mínimos básicos equitativos para todos. Para poder afrontar este importante reto, los hospitales deberán renovar sus estructuras y procedimientos de funcionamiento para adaptarse y asimilarse a los de una empresa de servicios. Para ello, una de las innovaciones más necesarias es la introducción de instrumentos de revisión de su utilización como garantía de calidad y eficiencia. El "Appropriateness Evaluation Protocol" (AEP) presenta una consideración global muy favorable ya que es diagnóstico-independiente, tiene carácter genérico, consta de un número limitado de criterios explícitos, no cuestiona la necesidad de asistencia sanitaria y ha presentado una validez y fiabilidad más elevadas. El AEP fue diseñado por P. Gertmann y J. Restuccia a finales de los años setenta en la Universidad de Boston, valora de una parte el ingreso y de otra los diferentes días de estancia.II.- HIPOTESIS: 1. Las bacteriemias nosocomiales por "Staphylococcus aureus" (SA) comportan una prolongación adicional de la estancia hospitalaria que puede cuantificarse mediante la aplicación del AEP. 2. La utilización del AEP como instrumento para determinar las estancias atribuibles a las bacteriemias nosocomiales por SA presenta unos índices de fiabilidad aceptables.III.- OBJETIVOS: Con la finalidad de contribuir al desarrollo y la difusión de metodologías que permitan mejorar la calidad y la eficiencia de nuestros hospitales, los OBJETIVOS que se han planteado en la realización de este estudio han sido: l. Verificar la aplicabilidad del AEP en la determinación de los días de estancia atribuibles a la bacteriemia nosocomial en nuestro entorno sanitario. 2. Valorar el nivel de fiabilidad del AEP como instrumento de medida de las estancias atribuibles a las bacteriemias nosocomiales. 3. Cuantificar los días de estancia hospitalaria inadecuados en pacientes con bacteriemia nosocomial por SA. 4. Señalar las causas de inadecuación de las estancias en pacientes con bacteriemia nosocomial por SA. 5. Cuantificar los días de estancia atribuibles a las bacteriemias nosocomiales por SA. 6. Describir las características epidemiológicas de la bacteriemia nosocomial por SA en un hospital universitario. 7. Diferenciar la repercusión que sobre la calidad hospitalaria tienen los SA según sean sensibles o resistentes a la Methicillina. 8. Estimar el coste económico de las bacteriemias nosocomiales por SA derivado de la prolongación de estancias adicionales generadas. 9. Contribuir a potenciar los programas de garantía de calidad y de prevención y control de las infecciones nosocomiales en nuestroshospitales.IV.- MATERIAL Y METODOS: El diseño de este trabajo se corresponde con un estudio de Cohortes Retrospectiva, efectuando una revisión retrospectiva de las historias clínicas de los pacientes ingresados en el Hospital Clínic de Barcelona durante los años 1989, 1990 y 1991, y que en el transcurso de su estancia desarrollaron una bacteriemia de origen nosocomial por SA. El instrumento utilizado ha sido el AEP para las estancias, conforme a las siguientes etapas: l. Una primera revisión de las Historias mediante el AEP valorando la adecuación para cada uno de los días de la estancia hospitalaria el protocolo. La presencia de algún criterio califica el día de estancia como apropiado. La ausencia de todos los criterios califica el día de estancia como inapropiado. 2. Una segunda revisión de las mismas Historias mediante el citado protocolo, rechazando los días en los que el paciente es sometido, única y exclusivamente, a manipulaciones debidas a la infección nosocomial, identificados mediante una serie de criterios conocidos y objetivos previamente establecidos: Tratamiento antibiótico específico, Catéteres vasculares para administrar tratamientos específicos, Drenajes de abscesos relacionados con la infección, Desbridamientos de heridas quirúrgicas infectadas, Traslado a Salas de Aislamiento, Solicitud de pruebas complementarias para el diagnóstico de la infección (Cultivos, Radiografías, ... ). 3. Los días atribuidos a la infección se obtienen a partir de la diferencia entre los días de estancia adecuados obtenidos en la 1a revisión y los obtenidos en la 2a revisión. En este trabajo de investigación se ha analizado la fiabilidad del proceso mediante el cálculo de la concordancia global, el índice de Kappa, el coeficiente de correlación y el coeficiente de correlación intraclases. Para ello, 50 de las historias clínicas estudiadas han sido revisadas independientemente por dos observadores previamente entrenados en la aplicación del AEP y en epidemiología de la infección nosocomial.V.- CONCLUSIONES: La realización de este trabajo de investigación ha permitido obtener las siguientes conclusiones: 1. El AEP es un instrumento aplicable para determinar los días de estancia atribuibles a la infección nosocomial en nuestro entorno sanitario. 2. La utilización del AEP en la epidemiología de la infección nosocomial ha proporcionado unos indicadores de fiabilidad muy aceptables: Concordancia global del 88 %, Índice de Kappa del 76%, Coeficiente de Correlación del 78%, Índice de Correlación Intraclases del 61 %. 3. El porcentaje de estancias inadecuadas al aplicar el protocolo AEP ha sido del 3,1 %. Considerando únicamente los enfermos con estancias inapropiadas, la media de días de estancia inadecuados es de 6,32 días. El alta diferida y la programación asistencial optimizable son los principales motivos de inadecuación. 4. La estancia media hospitalaria de los pacientes estudiados ha sido de 39,4±36,3 días, muy superior a la estancia media general correspondiente al HCP (11 días) y confirma la complejidad clínica de los pacientes. 5. La media de días de estancia atribuibles a las Bacteriemias Nosocomiales por SA es de 4,3±8,1. En las originadas por MRSA la prolongación de la estancia ha sido de 7,2± 11, y para las por MSSA ha sido de 3,3 ±6,4. 6. La media de los días de estancia atribuibles a la Bacteriemia Nosocomial por SA en aquellos enfermos que han presentado durante su estancia un período exclusivamente imputable a la infección es de 12,25±9,4. Para las originadas por MRSA la prolongación de la estancia ha sido de 17±11,2 y para las originadas por MSSA de 10±7,5. 7. El 81 % de las Bacteriemias estudiadas han sido de tipo secundario, siendo el catéter intravenoso su foco de origen más habitual (72,7%). 8. Las personas > de 65 años presentan un mayor riesgo de infección nosocomial. Considerando el progresivo envejecimiento de la población, y la necesaria optimización de los recursos hospitalarios mediante unas estancias mínimas indispensables, son recomendables programas sectoriales de control y prevención específicos en este colectivo. 9. La Bacteriemia Nosocomial por MRSA ha comportado una letalidad del 60,1 %, la originada por MSSA ha sido del 21,7%. 10. El coste medio suplementario, vinculado a la estancia adicional, atribuible a las Bacteriemias por SA en el HCP se sitúa alrededor de las 147.275 ptas. por infección y para los años estudiados (113.025 ptas. para MSSA y 246.600 para MRSA). 11. El impacto que sobre la mortalidad hospitalaria y la prolongación de la estancia tiene el MRSA hacen necesarias actividades de vigilancia epidemiológica específicas. 12. La vigilancia epidemiológica de la Infección Nosocomial han de contribuir a la instauración de registros hospitalarios de infección nosocomial, que permitan conocer su repercusión en la estancia hospitalaria. 13. Los Programas de Garantía de Calidad Hospitalaria y los Programas de Prevención y Control de la Infección Nosocomial han de incorporar aquellas metodologías que, como el AEP, proporcionen información objetiva del impacto sanitario, social y económico de este importante problema de salud pública.I.- INTRODUCTION: The inclusion of review tools for hospital use as a quality an efficiency guarantee is one the most necessary novelties in hospitals. Appropriateness Evaluation Protocol (AEP), designed by Gertmann and Restuccia, receives a very favourable global consideration, offering a high validity and reliability.II.- HYPOTHESIS: 1. Nosocomial bacteraemia caused by "Staphylococcus aureus" (SA) produce an additional extension of the stay in hospital that can be quantified by making use of AEP. 2. Using AEP as a tool to determine the number of days staying in hospital imputed to Nosocomial Bacteraemia caused by SA offers acceptable reliability ratios.III.- MATERIAL AND METHOOS: The design of this research work is based on a retrospective Cohorts essay, carried out by revising clinical histories from patients staying in Hospital Clinic of Barcelona through 1989, 1990 and 1991 and who suffered from Bacteraemia caused by SA during their stay. AEP has been the tool used for the extra days staying in the hospital. Reliability of the process has been analysed calculating the global concordance, Kappa Index, Correlation Coefficient and the intraclass correlation coefficient.IV.- CONCLUSIONS: This research work has led us to the following conclusions: l. Using AEP in nosocornial infections Epidemiology, we got acceptable reliability ratios: Global concordance of 88%, Kappa Index of 76%, The Correlation coefficient of 78%, The intraclass correlation coefficient of 61 %. 2. The mean for the extradays of stay in hospital imputed to Nosocomial Bacteraemia caused by SA was 4,3 ±8, 2. For those bacteraemia caused for MRSA the mean was 7,2 ± 11, and for those caused by MSSA, 3,3±6,4. </i

Factors associated with risk behavior in travelers to tropical and subtropical regions

BACKGROUND: Recent decades have seen a rise in population movements and, therefore, the spread of tropical diseases and changes in the epidemiology of global disease patterns. Only 50% of travelers to tropical areas receive pre-travel advice and most of them present risk behaviors for acquiring infections. The aim of this study was to describe the clinical and epidemiological characteristics of travelers and identify factors associated with risk behaviors. METHODS: We made a retrospective, descriptive and analytical study of 772 travelers consulting a tropical medicine clinic in Barcelona in 2010. Data on demographic and clinical variables, travel characteristics and risk behaviors were collected. RESULTS: Among all travelers studied, 65.8% (466/708) received pre-travel advice and 30.7% (209/680) took malaria prophylaxis. At least one risk behavior was reported by 82.6% (587/711) of travelers. People travelling for 1-6 months had a 3-fold higher likelihood of experiencing risk behaviors than people travelling for <1 month (95% CI 1.54-5.81, p=0.001), and those travelling for >6 months had a 13-fold higher likelihood (95% CI 3.11-56.14, p<0.001) compared with the same group. Increasing age was associated with presenting less risk behaviors. CONCLUSIONS: Younger travelers and those making longer trips have a higher number of risk behaviors. Strategies emphasizing advice on risk behavior should focus on these groups

Factors associated with 30-day readmission after hospitalisation for community-acquired pneumonia in older patients: a cross-sectional study in seven Spanish regions

Objective: Hospital readmission in patients admitted for community-acquired pneumonia (CAP) is frequent in the elderly and patients with multiple comorbidities, resulting in a clinical and economic burden. The aim of this study was to determine factors associated with 30-day readmission in patients with CAP. Design: A cross-sectional study. Setting: The study was conducted in patients admitted to 20 hospitals in seven Spanish regions during two influenza seasons (2013-2014 and 2014-2015). Participants: We included patients aged ≥65 years admitted through the emergency department with a diagnosis compatible with CAP. Patients who died during the initial hospitalisation and those hospitalised more than 30 days were excluded. Finally, 1756 CAP cases were included and of these, 200 (11.39%) were readmitted. Main outcome measures: 30-day readmission. Results: Factors associated with 30-day readmission were living with a person aged 3 hospital visits during the 90 previous days (aOR 1.53, 95% CI 1.01 to 2.34), chronic respiratory failure (aOR 1.74, 95% CI 1.24 to 2.45), heart failure (aOR 1.69, 95% CI 1.21 to 2.35), chronic liver disease (aOR 2.27, 95% CI 1.20 to 4.31) and discharge to home with home healthcare (aOR 5.61, 95% CI 1.70 to 18.50). No associations were found with pneumococcal or seasonal influenza vaccination in any of the three previous seasons. Conclusions: This study shows that 11.39% of patients aged ≥65 years initially hospitalised for CAP were readmitted within 30 days after discharge. Rehospitalisation was associated with preventable and non-preventable factor