Respiratory syncytial virus (RSV) is increasingly recognized as an important cause of illness in adults; however, data on RSV disease and economic burden in this age group remain limited. We aimed to ...provide comprehensive estimates of RSV disease burden among adults aged ≥18 years.
During 2012-2015, population-based, active surveillance of acute respiratory infection (ARI) hospitalizations enabled estimation of the seasonal incidence of RSV hospitalizations and direct health costs in adults aged ≥18 years in Auckland, New Zealand.
Of 4,600 ARI hospitalizations tested for RSV, 348 (7.6%) were RSV positive. The median (interquartile range) length of hospital stay for RSV positive patients was 4 (2-6) days. The seasonal incidence rate (IR) of RSV hospitalizations, corrected for non-testing, was 23.6 (95% confidence intervals CI 21.0-26.1) per 100,000 adults aged ≥18 years. Hospitalization risk increased with age with the highest incidence among adults aged ≥80 years (IR 190.8 per 100,000, 95% CI 137.6-244.0). Being of Māori or Pacific ethnicity or living in a neighborhood with low socioeconomic status (SES) were independently associated with increased RSV hospitalization rates. We estimate RSV-associated hospitalizations among adults aged ≥18 years to cost on average NZD $4,758 per event.
RSV infection is associated with considerable disease and economic cost in adults. RSV disproportionally affects adult sub-groups defined by age, ethnicity, and neighborhood SES. An effective RSV vaccine or RSV treatment may offer benefits for older adults.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
In contrast with respiratory disease caused by influenza, information on the risk of respiratory syncytial virus (RSV) disease among adults with chronic medical conditions (CMCs) ...is limited.
Methods
We linked population-based surveillance of acute respiratory illness hospitalizations to national administrative data to estimate seasonal RSV hospitalization rates among adults aged 18–80 years with the following preexisting CMCs: chronic obstructive pulmonary disease (COPD), asthma, congestive heart failure (CHF), coronary artery disease (CAD), cerebrovascular accidents (CVA), diabetes mellitus (DM), and end-stage renal disease (ESRD). Age- and ethnicity-adjusted rates stratified by age group were estimated.
Results
Among 883 999 adult residents aged 18–80 years, 281 RSV-positive hospitalizations were detected during 2012–2015 winter seasons. Across all ages, RSV hospitalization rates were significantly higher among adults with COPD, asthma, CHF, and CAD compared with those without each corresponding condition. RSV hospitalization rates were significantly higher among adults with ESRD aged 50–64 years and adults with DM aged 18–49 years and 65–80 years compared with adults in each age group without these conditions. No increased risk was seen for adults with CVA. The CMC with the highest risk of RSV hospitalization was CHF (incidence rate ratio IRR range, 4.6–36.5 across age strata) and COPD (IRR range, 9.6–9.7). Among RSV-positive adults, CHF and COPD were independently associated with increased length of hospital stay.
Conclusions
Adults with specific CMCs are at increased risk of RSV hospitalizations. Age affects this relationship for some CMCs. Such populations maybe relevant for future RSV prevention strategies.
Bacteroides pyogenes is naturally found in the oral microbiome of cats and dogs and hence exposure, especially bites from these animals, is a major risk factor for human infections. B pyogenes is ...known to cause infections that persist despite antibiotic treatment and can have serious clinical outcomes. We present a novel case of complex lung abscesses associated with B pyogenes infection. A 55 year old man presents with a 3‐month history of productive cough, night sweats, and 5 kg weight loss. An initial chest radiograph revealed mass‐like opacities in the right upper lobe (RUL), right middle lobe (RML), and left lower lobe (LLL). Over the next 4 years the patient underwent multiple investigations and antimicrobial treatments until resolution of the abscesses. We believe that metronidazole in combination with moxifloxacin was a key component in the clinical cure of this patient.
We report a case of multiple lung abscesses associated with polymicrobial infection, including B. pyogenes, which were slow to resolve despite multiple courses of antibiotics . We believe that metronidazole in combination with moxifloxacin was a key component in the clinical cure of this patient.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Intrapleural tissue plasminogen activator (tPA)/deoxyribonuclease (DNase) therapy for pleural infection given at the time of diagnosis has been shown to significantly improve radiological outcomes. ...Published cases are limited to only a single randomized controlled trial and a few case reports.
Multinational observation series to evaluate the pragmatic "real-life" application of tPA/DNase treatment for pleural infection in a large cohort of unselected patients.
All patients from eight centers who received intrapleural tPA/DNase for pleural infection between January 2010 and September 2013 were included. Measured outcomes included treatment success at 30 days, volume of pleural fluid drained, improvement in radiographic pleural opacity and inflammatory markers, need for surgery, and adverse events.
Of 107 patients treated, the majority (92.3%) were successfully managed without the need for surgical intervention. No patients died as a result of pleural infection. Most patients (84%) received tPA/DNase more than 24 hours after failing to respond to initial conservative management with antibiotics and thoracostomy. tPA/DNase increased fluid drained from a median of 250 ml (interquartile range IQR, 100-654) in the 24 hours preceding commencement of intrapleural therapy to 2,475 ml (IQR 1,800-3,585) in the 72 hours following treatment initiation (P < 0.05). We observed a corresponding clearance of pleural opacity on chest radiographs from a median of 35% (IQR 25-31) to 14% (7-28) of the hemithorax (P < 0.001), as well as significant reduction in C-reactive protein (P < 0.05). Pain necessitating escalation of analgesia occurred in 19.6% patients, and nonfatal bleeding occurred in 1.8%.
This large series of patients who received intrapleural tPA/DNase therapy provides important evidence that the treatment is effective and safe, especially as a "rescue therapy" in patients who do not initially respond to antibiotics and thoracostomy drainage.
Hypertrophic pulmonary osteoarthropathy (HPOA) is a well‐documented complication of pulmonary malignancy and cystic fibrosis (CF). However, HPOA associated with exacerbations of non‐CF bronchiectasis ...has only been reported once previously in an adolescent. We describe a case of an adult patient with bronchiectasis and HPOA, whose joint symptoms flared during pulmonary exacerbations and improved with treatment of each exacerbation.
We describe a case of an adult patient with bronchiectasis and hypertrophic pulmonary osteoarthropathy (HPOA), whose joint symptoms flared during pulmonary exacerbations and improved with treatment of each exacerbation.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Purpose: The Child Behavior Checklist (CBCL) is a widely used instrument of children psychosocial functioning. CBCL sleep items have been used in both clinical settings and research. To date, few ...empirical studies have examined the relationships between CBCL sleep items and other sleep measures such as actigraphy and validated sleep questionnaires. This study extends the literature by examining these relationships in a group of children of parents with an alcohol use disorder (COAs) and matched controls. Participants and Methods: Two hundred and forty-eight children aged 8-12 (48% COAs; 50% girls; Mean age =10.37 (Standard deviation = 1.47)), participated in this study. Data presented here were taken from Time 1 of a larger prospective study designed to understand the relationship between sleep and alcohol use. All participants were naive to alcohol and other illicit drugs. Parents completed the Achenbach CBCL and the Pediatric Sleep Questionnaire (PSQ). Participants wore an actigraph watch on their non-dominant wrists for one week and filled out the Youth Self-Report (YSR). Results: Multiple regression analyses showed that CBCL sleep items (eg, "trouble sleeping") correlated with related actigraphy (eg, shorter total sleep time and longer sleep onset latency) and Pediatrics Sleep Questionnaire (PSQ) items (eg, sleep difficulties and daytime sleepiness). Logistic regression analyses indicated that CBCL items (eg, "trouble sleeping) predicted similar items in the Youth Self Report (YSR) (eg, trouble sleeping). Structural equation modeling analyses showed that the latent variable "CBCL sleep" correlated significantly with the latent variables of actigraphy (r = -0.54, p < 0.001), PSQ (r = 0.93, p < 0.001) and YSR (r = 0.38, p< 0.01). These associations were largely the same for COAs and controls. Conclusion: CBCL items were significantly associated with actigraphy variables, a validated sleep measure (PSQ) and youth report of sleep for both COAs and non-COAs. Keywords: sleep measures, actigraph, parental ratings, Youth Self-Report, children
The majority of research on human immunodeficiency virus (HIV) disclosure utilizes the perspective from a single individual, which cannot be substantiated in the absence of supporting data such as ...from a primary partner.
The objectives of this study were to evaluate: (1) the extent to which self-reported HIV disclosure was confirmed by a primary partner; (2) individual and relationship-level predictors of self-reported versus confirmed disclosure; and (3) whether confirmed disclosure was a stronger predictor of correctly assessing a partner's HIV status compared to self-reported disclosure.
As part of an 8-wave longitudinal study from 2009 to 2011 in southern Malawi, 366 individuals (183 couples) were interviewed about their primary relationship (wave 3), individually tested for HIV (wave 4), and then asked whether they disclosed to their primary partner (wave 5).
While 93% of respondents reported that they disclosed, only 64% of respondents had confirmed reports from their partner. Having communicated with partner about HIV was positively associated with self-reported disclosure; this association remained significant but became more precise in the models for confirmed disclosure. Confirmed disclosure, but not self-report, was a significant predictor of correctly assessing a partner's HIV status. Being male, having lower perceived partner infidelity, having higher relationship unity, and testing HIV-negative were positively and significantly associated with correct assessment. Dyadic data from two partners provide an improved measure of disclosure as compared to a single individual's self-report and could be used to identify behavioral and biomedical opportunities to prevent HIV transmission within couples.
•Self-reported HIV disclosure and a partner's confirmatory account are often discrepant.•Confirmatory reports of a partner's disclosure may improve the reliability of self-reports.•Confirmatory reports of a partner's disclosure predict correct assessment of HIV status.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Inhaled corticosteroids are absorbed into the systemic circulation, but the extent to which they have adverse effects on bone is uncertain. The question is important since 3% of the European ...population take an inhaled corticosteroid regularly and may do so for many years.
We studied the dose-response relation between cumulative inhaled corticosteroid dose and bone-mineral density at the lumbar spine and proximal femur in 196 adults (119 women) with asthma aged 20–40 years. Patients had taken an inhaled corticosteroid regularly for at least 6 months, and had had limited exposure to systemic steroids. Cumulative dose of inhaled corticosteroid was calculated from questionnaires and computerised and written general-practice records, and its effect on bone-mineral density was estimated by multiple regression analysis.
Median duration of inhaled corticosteroid treatment was 6 years (range 0·5–24), and median cumulative dose was 876 mg (87–4380). There was a negative association between cumulative dose of inhaled corticosteroid and bone-mineral density at the lumbar spine (L2–L4), femoral neck, Ward's triangle, and trochanter, both before and after adjustment for the effects of age and sex. A doubling in dose of inhaled corticosteroid was associated with a decrease in bone-mineral density at the lumbar spine of 0·16 SD (95% CI 0·04–0·28). Similar decreases were found at the femoral neck, Ward's triangle, and trochanter. Adjustment for potential confounding factors including physical activity and past oral, nasal, dermal, and parenteral corticosteroids did not weaken the associations.
This study provides evidence of a negative relation between total cumulative dose of inhaled corticosteroid and bone-mineral density in patients with asthma.
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DOBA, GEOZS, IJS, IMTLJ, IZUM, KILJ, KISLJ, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SIK, UILJ, UKNU, UL, UM, UPCLJ, UPUK, VSZLJ
The use of oral corticosteroids is associated with an increased risk of fracture, but there is limited information on the relationship between corticosteroid dose, bone mineral density (BMD), and ...fracture. We examined this relationship in a community population (more than 50 years) taking oral corticosteroids for chronic lung disease. Details of corticosteroid use and lifestyle were obtained by questionnaire, general practice records, and patient interview. BMD was assessed at the lumbar spine and femur and vertebral fracture by morphometric X-ray absorptiometry. Of the 117 patients who participated (median age, 69), 48% were female. Fifty-eight percent had osteoporosis (a T score of less than -2.5), and 61% had a vertebral fracture. The presence of vertebral fracture was related to BMD at the femoral neck, with an odds ratio of 1.6 for a 1 SD reduction in BMD. The cumulative prednisolone dose ranged from 3.4 to 175 g and was strongly associated with vertebral fracture, with the odds ratio between the highest and lowest dose quartiles being 4.4 (95% confidence interval, 1.04, 18.8). The difference in femoral neck BMD between the same dose quartiles was only modest, however (0.5 SD; 95% confidence interval, 0.09, 0.94). In patients taking long-term oral corticosteroids for chronic lung disease, the relationship between vertebral fracture risk and BMD is similar to that seen in other populations. Cumulative prednisolone dose is strongly related to fracture risk, and this effect is independent of its more modest impact on BMD.
Background
Past research has indicated that both sleep difficulties and a parental history of alcoholism increase the risk of behavioral problems. But it is not known whether sleep difficulties ...differentially increase the risk of problem behaviors among children of alcoholics (COAs) and controls. We compared multiple measures of sleep and the relationships between sleep and behavioral problems in these 2 groups of children.
Methods
One hundred and fifteen children aged 8 to 12 (67% COAs; 56% girls; Mage = 10.85, SDage = 1.51) participated in this study. Data presented here were taken from Time 1 of a larger prospective study designed to understand the relationship between sleep and alcohol use. All participants were naïve to alcohol and other illicit drugs. Participants were asked to wear an actigraph watch on their nondominant wrist for 1 week. Parents completed the Pediatric Sleep Questionnaire and the Achenbach Child Behavior Checklist.
Results
Parents of COAs were more likely to rate their children as overtired compared with parents of non‐COAs. Structural equation modeling analyses focusing on overall internalizing and externalizing problems did not reveal any group differences on the relationships between sleep measures and behavioral problems. Regression analyses focusing on specific behavioral problems showed that longer total sleep time, parental ratings of “sleep more” and “sleep less” than other children interacted with COA status to predict specific behavioral problems.
Conclusions
Sleep difficulties and duration appear to be a general risk factor for behavioral problems in both COAs and non‐COAs, yet the relationships between specific sleep parameters and behavioral problems appear to be different between the 2 groups.
We compared multiple measures of sleep and the relationships between sleep and behavioral problems in children of alcoholics and controls. One hundred and fifteen children aged 8 to 12 participated in this study. Sleep difficulties and duration appear to be a general risk factor for behavioral problems in both COAs and non‐COAs, yet the relationships between specific sleep parameters and behavioral problems appear to be different between the 2 groups.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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