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A retrospective analysis of hospital discharge records for S. pneumoniae diseases in the elderly population of Florence, Italy, 2010-2012.

ABSTRACT: Invasive pneumococcal diseases (IPD) and community acquired pneumonia (CAP) represent two of the major causes of out-patient visits, hospital admissions and deaths in the elderly. In Tuscany (Italy), in the Local Health Unit of Florence, a project aimed at implementing an active surveillance of pneumococcal diseases in the hospitalized elderly population started in 2013. The aim of this study is to show the results of the retrospective analysis (2010-2012) on hospital discharge records (HDRs) related to diseases potentially due to S. pneumoniae, using a selection of ICD9-CM codes. All ordinary hospitalizations (primary and secondary diagnoses) of the elderly population were included (11 245 HDRs). Among a population of about 200 000 inhabitants ≥65 y, the hospitalization rate (HR) increased with increasing age and was higher in males in all age groups. Almost all hospitalizations (95%) were due to CAP, only 5% were invasive diseases. Only few cases of CAP were specified as related to S. pneumoniae, the percentage was higher in case of meningitis (100%) or septicemia (22%). In-hospital deaths over the three-year period were 1703 (case fatality rate: 15%). The risk of dying, being hospitalized for a disease potentially attributable to pneumococcus (as primary diagnosis) increased significantly with age (P < 0.001), the odds ratio (OR) per increasing age year was 1.06 (95% CI 1.05-1.07) and was higher in patients with co-existing medical conditions with respect to patients without comorbidities. Currently, an active surveillance system on S. pneumoniae diseases with the inclusion of bio-molecular tests (RT-PCR), is a key step to assess the effectiveness of the PCV13 vaccine (13-valent pneumococcal conjugate vaccine) in the elderly population after implementation of vaccination policies. The results of this study will provide the comparator baseline data for the evaluation of a possible immunization programme involving one or more cohorts of the elderly in Tuscany.

SUBMITTER: Bechini A

PROVIDER: S-EPMC4514361 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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Project description:Dietary cholesterol intake increased dramatically over the past two decades in the elderly Chinese population. However, the nationwide dietary cholesterol intake and its related factors seldom been investigated. Based on data from 16,594 participants aged 60 years or older (49.0% male, 54.8% urban residents) from the China National Nutrition and Health Survey (CNHS) 2010-2012, we aimed to describe the intake of cholesterol and major food contributions, as well as its association with serum cholesterol level and relationship with protein intake. Mean daily cholesterol intake for all participants was 217.4 mg, the mean cholesterol intakes in urban and rural areas were 264.0 mg and 168.8 mg, respectively. Cholesterol intake levels varied by age, gender, BMI and region (p < 0.001). In addition, the proportion of all participants who consumed greater than 300 mg of cholesterol per day was 26.6%. Eggs, red meats, and seafood were the top three food sources and their contributions to total daily cholesterol intake were 57.7%, 24.0% and 10.9% respectively. Serum total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were related to dietary cholesterol intake, with each 100 mg increase in dietary cholesterol intake apparently leading to a 0.035 mmol/L (p = 0.001) increase in serum TC and a 0.038 mmol/L (p < 0.001) increase in LDL-C. The partial correlation coefficients between dietary cholesterol and total protein, high-quality protein, intake of protein per kilogram body weight (BW), and high-quality protein percentage were 0.538, 0.580, 0.426, and 0.548, respectively, after adjusting for age, gender, and energy, fat and carbohydrate intakes (p < 0.001). In conclusion, there was a substantial urban-rural difference in cholesterol intake. Eggs and red meat were the main sources of dietary cholesterol intake. Serum TC and LDL-C were associated with dietary cholesterol and the response was linear. Dietary cholesterol intake was closely related to the intake of high-quality protein.

Project description:BackgroundIdiopathic cardiomyopathy (ICM) is a rare disease affecting numerous physiological and biomolecular systems with multimorbidity. However, due to the small sample size of uncommon diseases, the whole spectrum of chronic disease co-occurrence, especially in developing nations, has not yet been investigated. To grasp the multimorbidity pattern, we aimed to present a multidimensional model for ICM and differences among age groups.MethodsHospital discharge records were collected from a rare disease centre of ICM inpatients (n = 1036) over 10 years (2012 to 2021) for this retrospective analysis. One-to-one matched controls were also included. First, by looking at the first three digits of the ICD-10 code, we concentrated on chronic illnesses with a prevalence of more than 1%. The ICM and control inpatients had a total of 71 and 69 chronic illnesses, respectively. Second, to evaluate the multimorbidity pattern in both groups, we built age-specific cosine-index-based multimorbidity networks. Third, the associated rule mining (ARM) assessed the comorbidities with heart failure for ICM, specifically.ResultsThe comorbidity burden of ICM was 78% larger than that of the controls. All ages were affected by the burden, although those over 50 years old had more intense interactions. Moreover, in terms of disease connectivity, central, hub, and authority diseases were concentrated in the metabolic, musculoskeletal and connective tissue, genitourinary, eye and adnexa, respiratory, and digestive systems. According to the age-specific connection, the impaired coagulation function was required for raising attention (e.g., autoimmune-attacked digestive and musculoskeletal system disorders) in young adult groups (ICM patients aged 20-49 years). For the middle-aged (50-60 years) and older (≥70 years) groups, malignant neoplasm and circulatory issues were the main confrontable problems. Finally, according to the result of ARM, the comorbidities and comorbidity patterns of heart failure include diabetes mellitus and metabolic disorder, sleeping disorder, renal failure, liver, and circulatory diseases.ConclusionsThe main cause of the comorbid load is aging. The ICM comorbidities were concentrated in the circulatory, metabolic, musculoskeletal and connective tissue, genitourinary, eye and adnexa, respiratory, and digestive systems. The network-based approach optimizes the integrated care of patients with ICM and advances our understanding of multimorbidity associated with the disease.

Project description:BACKGROUND:Ageing patients are discharged from the hospital 'quicker and sicker' than before, and hospital discharge is a critical step in patient care. Older patients form a particularly vulnerable group due to multimorbidity and frailty. Patient participation in healthcare is influenced by government policy and an important part of quality improvement of care. There is need for greater insights into the complexity of patient participation for older patients in discharge processes based on aggregated knowledge. OBJECTIVE:The aim of this study was to review reported evidence concerning the experiences of older patients aged 65 years and above regarding their participation in the hospital discharge process. METHODS:We conducted a qualitative metasummary. Systematic searches of Medline, Embase, Cinahl, PsycINFO and SocINDEX were conducted. Data from 18 studies were included, based on specific selection criteria. All studies explored older patients' experience of participation during the discharge process in hospital, but varied when it came to type of discharge and diagnosis. The data were categorised into themes by using thematic analysis. RESULTS:Our analysis indicated that participation in the discharge process varied among elderly patients. Five themes were identified: (1) complexity of the patients state of health, (2) management and hospital routines, (3) the norm and preference of returning home, (4) challenges of mutual communication and asymmetric relationships and (5) the significance of networks. CONCLUSIONS:Collaboration between different levels in the health systems and user-friendly information between staff, patient and families are crucial. The complexity of patient participation for this patient group should be recognised to enhance user involvement during discharge from hospital. Interventions or follow-up studies of how healthcare professionals can improve their communication skills and address the tension between client-centred goals and organisational priorities are requested. Organisational structure may need to be restructured to ensure the participation of elderly patients.

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A retrospective analysis of hospital discharge records for S. pneumoniae diseases in the elderly population of Florence, Italy, 2010-2012.

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