Tag: nevin manimala

N Z Med J. 2022 Apr 1;135:77-81.

ABSTRACT

AIMS: The global COVID-19 pandemic and lockdowns have affected the patterns of hospital presentations for non-COVID related illnesses. Apprehension and perceived risk of hospitalisation has been postulated to be a significant deterrent to presentation. This study aims to explore pandemic- and- lockdown-related concerns with regards to hospital admission from a patient’s perspective.

METHODS: A cross-sectional study was undertaken in the form of an inpatient questionnaire for patients admitted to a coronary care unit and the cardiology ward during the Level 4 lockdown. The questionnaire included six questions designed to gather patient perception of the impact of lockdown on their hospital presentation.

RESULTS: Out of 91 patients who completed the questionnaire, 41 (45%) were >70 years old. Twenty (22%) patients answered that lockdown delayed or affected their decision to present to hospital. Within this cohort, there was a statistical difference between those aged 70 years and younger, and those over 70 years old (16/50 (32%) versus 4/41 (10%), p=0.011).

CONCLUSIONS: Apprehension and concerns regarding the risk of COVID-19 was prevalent in a significant proportion of patients and affected/delayed their decision to present to hospital. This may partly explain lower rates of presentation during the pandemic.

PMID:35728186

N Z Med J. 2022 Apr 14;135(1553):10-18.

ABSTRACT

AIM: Our aim was to examine rate of recurrence of toxoplasmosis retinochoroiditis and risk factors for recurrence. No New Zealand epidemiological data on recurrence rates of toxoplasmosis retinochoroiditis have been previously published.

METHODS: Retrospective chart review of all patients with toxoplasmosis retinochoroiditis presented to Auckland District Health Board Department of Ophthalmology between 2006-2019.

RESULTS: One hundred and twenty-six eyes of 115 patients were included with a median age at initial diagnosis of 36.7 years (IQR 23.7-53.8). Fifty-nine patients were female (51.3%), and 16 patients (13.9%) were immunosuppressed. Twenty-six of the 86 patients tested (30.2%) were IgM positive at presentation. Mean follow-up was 6.1 years and 73 recurrences occurred during the follow-up period in 36 patients (31.3%). Treatment was initiated in 87.4% of cases, with oral cotrimoxazole or clindamycin the most common options. Recurrence occurred in 14.8% in the first year (95% CI 10.3%-21.0%), and the risk of recurrence was increased 2x for every previously documented recurrence (HR 2.00; p<0.001). There was no statistically significant increased risk of recurrence with age, IgM positivity, immunosuppression or macular involvement.

CONCLUSIONS: Toxoplasmosis retinochoroiditis had a 14.8% risk of recurrence in the first year, with each previous recurrence increasing the risk by two-times.

PMID:35728200

N Z Med J. 2022 Mar 11;135(1551):95-105.

ABSTRACT

AIM: Within New Zealand (NZ) there is limited research concerning demographics and utilisation of the Emergency Department (ED) for dental-related conditions. The aim of this research was to identify the prevalence of dental presentations to Waikato Hospital ED, defining patient demographics, discharge diagnoses, management, and re-presentation rates.

METHODS: Patients who presented to the Waikato Hospital ED from 2015 to 2019 with ICD-10 dental diagnoses were included in the study. Data collected included patient demographics, discharge diagnosis and management of these presentations. Statistical analysis was completed using IBM SPSS Statistical Version 26.0.

RESULTS: Over the five-year study period, 4030 presentations to Waikato Hospital ED were dentally related, making up 0.98% of all ED presentations. Patients were primarily male (54%), NZ European (45%) or Māori (42%), from regions of high deprivation, presenting outside of work hours (68%). Seventy-three percent of dental presentations were non-traumatic. Ninety percent of patients were discharged with symptomatic management. Of patients admitted only 4% required management under general anaesthesia (GA). Representation occurred in 6% of patients, primarily for non-traumatic dental disease (89%). Fifty-one percent of re-attenders were male, 42% Māori and 50% of patients had a deprivation index of 9 or 10. Forty-one percent of patients re-presented within a week.

CONCLUSION: At Waikato Hospital, males, NZ European, and patients of high deprivation most commonly presented to ED for dental related presentation, which were primarily non-traumatic in origin. Many patients did not require hospital care, and were managed by ED and discharged. Few patients re-presented to ED for further care. Dental presentations to ED are potentially preventable, and may be related to barriers such as cost, access or health knowledge, or an increased need. Further research is required on strategies to reduce ED presentations for dental conditions.

PMID:35728173

N Z Med J. 2022 Mar 11;135(1551):54-67.

ABSTRACT

AIM: To examine the spatial equity, and associated health equity implications, of the geographic distribution of COVID-19 vaccination services in Aotearoa New Zealand.

METHOD: The distribution of Aotearoa’s population was mapped, and the enhanced two-step floating catchment method (E2SFCA) applied to estimate spatial access to vaccination services. The Gini coefficient and spatial autocorrelation measures assessed the spatial equity of vaccination services. Additional statistics included an analysis of spatial accessibility for priority populations, and by District Health Board (DHB) region.

RESULTS: Spatial accessibility to vaccination services varies across Aotearoa, and appears to be better in major cities than rural regions. A Gini coefficient of 0.426 confirms that spatial accessibility scores are not shared equally across the vaccine-eligible population. Furthermore, priority populations including Māori, Pasifika, and older people have statistically significantly lower spatial access to vaccination services. This is also true for people living in rural areas. Spatial access to vaccination services also varies significantly by DHB region as does the Gini coefficient, and the proportion of DHB priority population groups living in areas with poor access to vaccination services. A strong and significant positive correlation was identified between average spatial accessibility and the Māori vaccination rate ratio of DHBs.

CONCLUSION: COVID-19 vaccination services in Aotearoa are not equitably distributed. Priority populations, with the most pressing need to receive COVID-19 vaccinations, have the worst access to vaccination services.

PMID:35728170

N Z Med J. 2022 Mar 11;135(1551):7-12.

ABSTRACT

Nil.

PMID:35728166

N Z Med J. 2022 Jan 21;135(1548):42-53.

ABSTRACT

AIMS: Dementia is an important health concern for Māori and therefore it is essential to explore the extent and impact of dementia in this community. The 10/66 dementia protocol, a widely used research tool for measuring the prevalence of dementia, was developed to minimise cultural and educational bias in comparisons of dementia prevalence across different countries and/or cultures. The aims of this study are to (i) adapt the 10/66 dementia protocol for use in research within the Māori community and (ii) test the diagnostic accuracy of the adapted (ie, Māori-friendly) 10/66 dementia protocol against the reference standard of a clinical diagnosis of dementia (or no dementia).

METHOD: The sample included Māori aged 65 and over who had been assessed at a local memory service. Ten dementia cases and 10 controls were included. The sample was further enriched by the inclusion of 6 controls from a concurrent dementia-prevalence feasibility study in the local community. The Māori-friendly 10/66 dementia protocol was measured against the reference standard. Sensitivity, specificity, positive and negative predictive values and Youden’s Index were calculated.

RESULTS: The Māori-friendly 10/66 dementia protocol had a sensitivity of 90.0% (95% CI 62.8-99.4), specificity of 93.8% (95% CI 75.3-99.6), positive predictive value of 90.0% (95% CI 62.8-99.4), negative predictive value of 93.8% (95% CI 75.3-99.6) and Youden’s Index of 0.83.

CONCLUSIONS: Our study results provide preliminary evidence that the Māori-friendly 10/66 dementia protocol has adequate discriminatory abilities for the diagnosis of dementia. Our study also demonstrates that the Māori-friendly 10/66 dementia protocol has the potential to be used in a dementia-population-based study for Māori in Aotearoa New Zealand.

PMID:35728129

N Z Med J. 2021 Dec 17;134(1547):71-84.

ABSTRACT

AIM: In August 2016, a large waterborne campylobacteriosis outbreak occurred in Havelock North, New Zealand. This analysis describes the clinical complications of cases admitted to hospital as a result of acute infection, identifies risk factors for hospitalisation and compares deaths between hospitalised and non-hospitalised cases. Hospital admissions with post-infectious sequelae were excluded as they are the subject of a separate analysis.

METHODS: A case series analysis was undertaken by reviewing the electronic medical records of 933 residents of Hawke’s Bay District Health Board with probable and confirmed campylobacteriosis linked to the Havelock North Campylobacter outbreak.

RESULTS: A total of 67 hospital admissions, among 58 individuals, are described. Pre-existing comorbidity and advanced age were significant risk factors for hospital admission in univariate analysis. Dehydration (74.1%), electrolyte imbalance (35.8%) and acute kidney injury (27.6%) were common among hospitalised cases. The proportion of hospitalised cases that died within one year was significantly higher when compared to deaths among non-hospitalised cases (OR 5.0, 95% CI: 2.3-10.7), although this trend was not statistically significant after adjusting for age and comorbidity (OR 2.3, 95% CI: 0.96-5.3).

CONCLUSIONS: This study highlights the serious health impacts that occurred from a campylobacteriosis outbreak of this magnitude.

PMID:35728111

N Z Med J. 2021 Dec 17;134(1547):48-62.

ABSTRACT

AIM: This survey aimed to investigate patient perspectives, including preferences, needs and concerns, on the use of, and access to, individual healthcare information.

METHOD: A mixed-methods cross-sectional survey of adult patients (n=1,377) in Waitematā District Health Board inpatient and outpatient services during November-December 2020. The survey was online and on paper and available in 10 languages.

RESULTS: Over 80% of participants were comfortable with their health information being used across the scenarios presented (range: 81-89%). Māori were significantly more likely than non-Māori to be comfortable with their health information being combined with the health information of others to better understand population needs (p=0.006). The level of comfort with the use of individual health information was related to assurances that its use was for public good, data were stored securely, individual privacy was maintained, the information was accurate and there was communication on how it was used.

DISCUSSION: This study has shown that most healthcare consumers are comfortable with the health service using their de-identified health information beyond their care if it benefits others.

PMID:35728109

J Am Coll Health. 2022 Jun 21:1-7. doi: 10.1080/07448481.2022.2086010. Online ahead of print.

ABSTRACT

OBJECTIVE: This longitudinal study tested the relationship between cigarette and e-cigarette use and SARS-CoV-2 seroconversion among US college students.

PARTICIPANTS: Undergraduate students (n = 764), drawn from a randomly selected invitation-only pool from a large Midwestern university, that were initially negative for SARS-CoV-2 antibodies and were re-tested in November were included in this study conducted in Fall 2020.

METHODS: Demographics and cigarette and e-cigarette use behaviors (nicotine use) were collected in a baseline survey. SARS-CoV-2 antibody tests were administered in September (baseline) and November (endline) of 2020. Log-binomial regression analyses were conducted to test the association between nicotine use and SARS-CoV-2 seroconversion.

RESULTS: SARS-CoV-2 seroconversion was 5.2%. No statistically significant associations were found between nicotine use and SARS-CoV-2 seroconversion.

CONCLUSIONS: Contrary to prior results, we found no association between nicotine use and SARS-CoV-2 seroconversion. Nicotine use may not be a key risk factor for COVID-19 acquisition in predominantly healthy college-aged populations.

PMID:35728069 | DOI:10.1080/07448481.2022.2086010

Cancer Nurs. 2022 Feb 28. doi: 10.1097/NCC.0000000000001049. Online ahead of print.

ABSTRACT

BACKGROUND: In persons with lung cancer, sex and race are independent predictors of comorbidities and are associated survival. It is unclear how comorbidity profiles differ across sex and race.

OBJECTIVE: The objective was to examine comorbidity differences between men and women and Blacks and Whites.

METHODS: Data from the 2014, 2016, 2017, and 2018 Behavioral Risk Factor Surveillance System were analyzed using descriptive statistics, χ2 test of independence, and multiple logistic regression. Variables included sociodemographics and comorbidities.

RESULTS: Among individuals with lung cancer (N = 594), men were more likely to experience a heart attack (odds ratio [OR], 3.59; 95% confidence interval [CI], 1.62-7.96) and diabetes (OR, 2.83; 95% CI, 1.57-5.10) and less likely to experience depressive disorder (OR, 0.360; 95% CI, 0203-0.637). Black men (OR, 28.57; 95% CI, 9.22-88.55) and women (OR, 2.48; 95% CI, 1.02-6.05) were more likely to have a history of stroke.

CONCLUSION: Findings show that there may be differences in patterns of comorbidities among individuals with lung cancer. As we continue to move toward individualized medicine in cancer care, future work in this area should examine social determinants of health and how they may influence the patterns of comorbidities.

IMPLICATION FOR NURSES: Although nurses may be aware that certain groups have an increased risk for certain comorbid conditions, this study highlights what groups with lung cancer may be more likely to have certain comorbidities. Nurses can assess individuals for comorbidities and provide education on how to manage comorbidities during cancer treatment.

PMID:35728011 | DOI:10.1097/NCC.0000000000001049