The influence of influenza A (H1N1) virus on creatinine and cystatin C

BackgroundIn March 2009, the novel 2009 influenza A (H1N1) virus was first reported in the southwestern USA and Mexico. It rapidly spread to China and worldwide. We investigated possible kidney injury in patients with the 2009 influenza A (H1N1) virus in China.MethodsThis study was a retrospective cohort investigation of the potential renal injury in patients of influenza. One hundred and seventy-two patients confirmed to have the 2009 influenza A (H1N1) virus but who had different levels of severity (non-severe, severe, and critically severe) and 21 cases who were influenza A (H1N1)-negative but who had an influenza-like illness were investigated. Blood samples were obtained for the measurement of creatinine (Cr) and cystatin C (Cy-C).ResultsThe influenza A (H1N1) virus caused more illness in middle-aged people in all groups. The patients in the non-severe group were younger than those in the severe group (p < 0.05) and the non-influenza A (H1N1) group (p < 0.01). Four subjects in the critically severe group died (3 due to respiratory failure, 1 heart injury). A significant difference in the levels of Cr and Cy-C between the groups was not observed (p > 0.05).ConclusionThe 2009 influenza A (H1N1) virus did not cause severe kidney injury in the acute phase in adult patients.     

Clinical features of the 2009 swine-origin influenza A (H1N1) outbreak in Japan

To clarify the clinical symptoms of the influenza A virus during the 2009 pandemic influenza outbreak, we describe the clinical features of outpatients diagnosed with type A influenza by use of the rapid influenza diagnostic test (RIDT) from September to December 2009. Questionnaires were used to collect prospective data on 1,122 cases with influenza-like illness at our medical institutions. The independent predictors of influenza A virus were identified on the basis of demographic features and the clinical symptoms of the patients who tested positive for influenza A virus in the RIDT test. Of the 1,122 cases tested, 389 (34.7%) were positive for the influenza A virus. The median age of the influenza-positive patients was 14, and 58.9% of the patients were male. The symptoms fever, cough, rhinorrhea, and headache were statistically dominant. A history of recent contact with persons suffering from influenza or influenza-like illness at home, school, or in the workplace was significantly more common in the positive group than in the negative group. Pneumonia was observed in 2 (0.5%) of the positive patients, but the symptoms were only severe enough to require hospitalization in 1 of the 2. No deaths were observed among the 389 RIDT-positive patients. Although the spread of influenza A virus was both rapid and extensive, mainly among children under the age of 18, it seemed to be mild. Appropriate interpretation of the RIDT on the basis of recent clinical information, and early treatment with antiviral drugs might help to prevent severe illness from influenza pandemics in the future.     

The Effect of Preoperative Oral Carbohydrate on the Incidence of Complications in PACU After General Anesthesia: A Prospective Cohort Study

PurposeThis study aimed to investigate the effect of preoperative oral carbohydrate (POC) loading on the occurrence of complications in the postanesthesia care unit (PACU) after general anesthesia.DesignProspective observational cohort studyMethodsPatients who were scheduled for abdominal surgery under general anesthesia at our institution were divided into the POC group and control group based on whether they drank carbohydrate solution 2 hours before surgery. POC loading of the patients was decided by the responsible surgeon. In PACU, the occurrence of postoperative complications including delayed emergence, emergence agitation, hypoxemia, hypertension, hypotension, moderate to severe postoperative pain, nausea and vomiting, hypothermia, shivering, and time to awakening, time to extubation, length of PACU stay were recorded.FindingsData from 307 patients (n = 154 in POC group and n = 153 in control group) were included in the final analysis. Compared to the control group, POC led to a near-significant reduction in the overall incidence of complications in PACU after surgery (37.0% vs 47.7%, P = .058). The POC group had a lower incidence of hypothermia and shorter mean time to awakening when compared to control group (6.5% vs 16.3%, P = .007 and 19 min vs 21 min, P = .007, respectively). No statistical differences were detected in other outcome measurements between the POC group and the control group.ConclusionsPOC is associated with a trend to decrease the overall incidence of complications during recovery period after general anesthesia in patients who underwent abdominal surgery. Moreover, POC could reduce the risk of hypothermia in PACU and shorten the time to awakening.     

Effectiveness of intravenous peramivir for the treatment of influenza A/H3N2 and influenza B/Victoria in hospitalized children

ObjectiveTo optimize the medication administered to children with influenza, we evaluated the effectiveness of peramivir in hospitalized children with influenza A/H3N2 and influenza B/Victoria.MethodsA retrospective study was conducted from October 2019 to March 2020 in children aged 29 days to 18 years with influenza A/H3N2 or B/Victoria. A total of 97 patients were enrolled and treated with intravenous infusion of peramivir.ResultsThe duration of influenza virus nucleic acid positivity in the influenza A/H3N2 group (3 days) was shorter than that in the influenza B/Victoria group (4 days) (P = 0.008). The remission time of fever symptoms in the influenza A/H3N2 group was 14 h, which was significantly shorter than that in the influenza B/Victoria group (26 h) (P = 0.042). In the 6–18 years age group, the median duration of virus nucleic acid positivity for children with influenza B/Victoria (4 days) was longer than that for children with influenza A/H3N2 (2 days) (P = 0.005). The incidence of adverse drug reactions (ADRs) with peramivir in the influenza A/H3N2 group and the influenza B/Victoria group was 2.04% (n = 1/49) and 4.17% (n = 2/48), respectively (P = 0.617).ConclusionsA difference in the effectiveness of peramivir against different subtypes of influenza was observed. Compared to those infected with influenza B/Victoria, the children infected with influenza A/H3N2 experienced a significantly shorter duration of influenza virus nucleic acid positivity and remission time of fever symptoms.     

Safety and efficacy of the neuraminidase inhibitor zanamivir in treating influenza virus infection in adults: results from Japan. GG167 Group

The study was carried out to evaluate the therapeutic effects of zanamivir, a highly selective, potent and specific inhibitor of influenza A and B virus neuraminidases, in adult patients with acute influenza-like illness. Patients who presented within 36 h of the onset of influenza-like symptoms were randomly assigned to receive one of three treatments, twice daily, for 5 days: 10 mg zanamivir powder for inhalation (zanamivir inhalation group), 10 mg zanamivir powder for inhalation plus 6.4 mg zanamivir nasal spray (zanamivir inhalation plus intranasal group) or placebo (placebo group). The primary end point was the time to alleviation of the three major symptoms (fever, headache and myalgia). The secondary end point was the time to alleviation of five influenza symptoms (fever, headache, myalgia, cough and sore throat). One hundred and sixteen patients with influenza-like illness were recruited to the study. No differences were observed between the two groups of patients who received zanamivir (inhalation group or inhalation plus intranasal group). Patients who received zanamivir recovered significantly faster (median 3 days to recovery) than the patients in the placebo group (median 4 days to recovery; P < 0.01). Topically administered zanamivir was well tolerated. This study confirms that in adults, topically administered zanamivir is well tolerated and is effective in reducing the time to alleviation of influenza symptoms.     

Cytokine markers as predictors of type of respiratory infection in patients during the influenza season

Objective

The objective of this study is to characterize the cytokine response among patients presenting with an influenza-like illness who are infected with the influenza virus, a bacterial pneumonia, or another viral infection. We hypothesize that there are differences in proinflammatory and anti-inflammatory cytokines in relation to cytokines associated with the humoral response during viral and bacterial respiratory infections.

Methods

We enrolled adults who presented to an urban academic emergency department during the 2008 to 2011 influenza seasons with symptoms of fever and a cough. Subjects had nasal aspirates tested by viral culture, and peripheral blood drawn to quantify cytokine concentrations. Cytokine concentrations were compared between groups using the Wilcoxon rank sum test, and receiver operating characteristic curves were calculated.

Results

A total of 80 patients were enrolled: 40 with influenza infection, 14 patients with a bacterial pneumonia as determined by infiltrate on chest x-ray, and 26 patients negative for influenza infection and infiltrate. There were differences between the bacterial pneumonia group, and all other viral infections grouped together with regard to interleukin (IL) 4 (2.66 vs 16.77 pg/mL, P < .001), IL-5 (20.57 vs 57.57 pg/mL, P = .006), IL-6 (403.06 vs 52.69 pg/mL, P < .001), granulocyte macrophage colony-stimulating factor (18.26 vs 66.80 pg/mL, P < .001), and interferon γ (0.0 vs 830.36 pg/mL, P < .001). Interleukin 10 concentrations were elevated in patients with influenza (88.69 pg/mL) compared with all other groups combined (39.19 pg/mL; P = .003).

Conclusion

Cytokines IL-4, IL-5, IL-6, granulocyte macrophage colony-stimulating factor, and interferon γ may serve as distinct markers of bacterial infection in patients with an influenza-like illness, whereas IL-10 is uniquely elevated in influenza patients.     

Is C-reactive protein associated with influenza A or B in primary care patients with influenza-like illness? A cross-sectional study

Objective Identifying influenza A or B as cause of influenza-like illness (ILI) is a challenge due to non-specific symptoms. An accurate, cheap and easy to use biomarker might enhance targeting influenza-specific management in primary care. The aim of this study was to investigate if C-reactive protein (CRP) is associated with influenza A or B, confirmed with PCR testing, in patients presenting with ILI.Design Cross-sectional study.Setting Primary care in Lithuania, Norway and Sweden.Subjects A total of 277 patients at least 1 year of age consulting primary care with ILI during seasonal influenza epidemics.Main outcome measures Capillary blood CRP analysed as a point-of-care test and detection of influenza A or B on nasopharyngeal swabs in adults, and nasal and pharyngeal swabs in children using PCR.Results The prevalence of positive tests for influenza A among patients was 44% (121/277) and the prevalence of influenza B was 21% (58/277). Patients with influenza A infection could not be identified based on CRP concentration. However, increasing CRP concentration in steps of 10 mg/L was associated with a significantly lower risk for influenza B with an adjusted odds ratio of 0.42 (0.25–0.70; p<.001). Signs of more severe symptoms like shortness of breath, sweats or chills and dizziness were associated with higher CRP.Conclusions There was no association between CRP and influenza A. Increased concentration of CRP was associated with a lower risk for having influenza B, a finding that lacks clinical usefulness. Hence, CRP testing should be avoided in ILI, unless bacterial pneumonia is suspected.

Key points

• Identifying influenza A or B as cause of influenza-like illness (ILI) is a challenge due to non-specific symptoms. There was no association between concentration of CRP and influenza A.
• Increased concentration of CRP was associated with a lower risk for having influenza B, a finding that lacks clinical usefulness.
• A consequence is that CRP testing should be avoided in ILI, unless bacterial pneumonia or similar is suspected.

     

Viral loads of parainfluenza virus type 3 and severity of respiratory diseases in children

BackgroundParainfluenza virus type 3 (PIV-3) is one of the common pathogens for respiratory infections in children. Whether viral load of PIV-3 is associated with severity of respiratory diseases in children is not yet known. Our aim was to determine significance of PIV-3 viral load among infected children.MethodsWe conducted a single-center, retrospective study at Tokyo Metropolitan.Children's Medical Center, Japan, from June to August 2021. Hospitalized children were screened with a posterior nasal swab for multiplex PCR, and viral load was subsequently measured from remained samples by real-time PCR. Demographic data were collected from digital charts. PIV-3 positive patients were categorized into mild group with no oxygen demand, moderate group with low-flow oxygen demand and severe group with high-flow nasal cannula oxygen or non-invasive positive pressure ventilation or mechanical ventilation. Viral loads were compared among mild, moderate and severe groups.Results151 patients were positive for PIV-3. We found no statistically significant association among PIV-3 viral load and severity of respiratory diseases (p = 0.35), and no statistically significant association between severity of illness and co-detection of other viruses. In each severity group, relatively high viral load per posterior nasal swab was observed at the time of testing.ConclusionAmong PIV-3 patients, we could not find statistically significant between viral load and their severity, therefore we could not conclude that viral load is a good surrogate marker for clinical severity of PIV-3.     

Clinical characteristics and outcomes of bone marrow transplantation patients presenting to the ED of a tertiary care center

BackgroundBone marrow transplantation is a breakthrough in the world of hematology and oncology. In our region, there is scarce literature studying emergency department visits among BMT patients, as well as their predictors of mortality.ObjectivesThis study aimed to assess the frequency, reasons, clinical characteristics and outcomes of patients presenting to the ED after a BMT, and to study the predictors of mortality in those patients. This study also compares those variables among the different types of BMT.MethodsThis was a retrospective cohort study conducted on all adult patients who have completed a successful BMT and visited the ED.ResultsOur study included 115 BMT patients, of whom 17.4% died. Those who died had a higher median number of ED visits than those who did not die. Around 36.5% presented with fever/chills with 29.6% diagnosed with pneumonia on discharge. We found that the odds of mortality were significantly higher among those who presented with dyspnea (p < .0005) and AMS (p = .023), among septic patients (p = .001), those who have undergone allogeneic BMT (p = .037), and those who were admitted to the ICU (p = .002). Moreover, the odds of mortality were significantly higher among hypotensive (p ≤0005) and tachycardic patients (p = .015).ConclusionIn our study, we have shown that BMT patients visit the ED very frequently and have high risk of in-hospital mortality. Moreover, our study showed a significant association between mortality and patients with dyspnea, AMS, sepsis, allogeneic BMT type, ICU admission, hypotension and tachycardia.     

Ultrasound and Influenza: The Spectrum of Lung and Cardiac Ultrasound Findings in Patients with Suspected Influenza A and B

In patients with influenza, cardiac and lung ultrasound may help determine the severity of illness and predict clinical outcomes. To determine the ultrasound characteristics of influenza and define the spectrum of lung and cardiac findings in patients with suspected influenza A or B, we conducted a prospective observational study in patients presenting to the emergency department at a tertiary care academic institution. An ultrasound protocol consisting of cardiac, lung and inferior vena cava scans was performed within 6 h of admission. We compared the ultrasound findings in cases with positive and negative influenza polymerase chain reaction, while controlling for comorbidities. We enrolled 117 patients, 41.9% of whom (49/117) tested positive for influenza. In those with influenza, ultrasound confirmed preserved left ventricular and right ventricular (RV) function in 81.3% of patients. The most common cardiac pathology was RV dilation (10.4%), followed by left ventricular systolic dysfunction (8.3%). Patients with negative influenza polymerase chain reaction with RV dysfunction demonstrated higher hospital admission than those those with normal RV function (45.1%, 23/51, vs. 17.9%, 5/28; p = 0.016). B-lines were prevalent in both influenza and non-influenza groups (40.8% and 69.1%, respectively; p = 0.013). Lung consolidation was identified in only 8.25% of patients with influenza. In conclusion, in patients with influenza we were unable to define distinct ultrasound features specific to influenza A or B, suggesting that ultrasound may not be beneficial in diagnosing influenza nor in evaluating its severity.     

流感病毒快速诊断的临床应用价值

目的 评估流感病毒快速检测法在临床应用中的价值.方法 从2010年10月至2012年5月,在该院发热门诊每日随机选择年龄在2～8岁符合卫生部流感样病例患者7～10例留取鼻咽分泌物进行流感病毒抗原快速检测,同时调查患者基本信息、临床症状、诊治情况等,并对在该院流感病毒快速检测达到3次阳性的患者进行细菌培养和耐药性分析.另从在该院诊治为流感样病例3次及以上的2～8岁患者中随机选取从未进行流感病毒抗原快速检测的相同例数作为对照组,调查内容同实验组.结果 留取鼻咽分泌物进行流感病毒抗原快速检测人次为5 122例,阳性报告1 885例,阳性报告率为36.8%;达3次阳性的患者进行细菌培养和耐药分析最终有208例纳入分析.结果 如下:在对照组按流感病毒阳性报告率36.8%计算,实验组及对照组的抗菌药物使用率分别为5.8%(12/208)剧增至26.9%(56/208);细菌感染比例由4.3%(9/208)大幅提升到24.0%(50/208),耐药比例由2.9%(6/208)增加到13.9%(29/208),差异具有统计学意义(P<0.05).结论 对流感样病例进行流感病毒快速检测,可明显降低抗菌药使用率和患者的细菌感染率,并提高患者的药敏水平,降低患者的耐药程度.同时,有利于指导临床医生在患者临床早期进行有效的抗病毒治疗以减少目前医疗机构广泛存在的抗生素滥用现象.     

Field performance of clinical case definitions for influenza screening during the 2009 pandemic

Purpose

The aim of this study was to assess the performance of 3 different influenza-like illness (ILI) case definitions, adopted by the European (European-CDC), USA (USA-CDC), and Taiwan Centers for Disease Prevention and Control (Taiwan-CDC), as screening tools for influenza during the 2009 H1N1 pandemic.

Methods

From August 15 to 30, 2009, all emergency department patients with clinical symptoms or at epidemiologic risk for influenza were enrolled in an observational cohort study. Influenza diagnosis was established by positive rapid influenza diagnostic test or virus isolation. Sensitivity, specificity, positive predictive value, and negative predictive value of the European-, USA, and Taiwan-CDC ILI case definitions for screening were determined.

Results

A total of 870 patients were screened during the study period. Rapid influenza diagnostic test was positive in 315 patients, 273 (85.6%) of whom had fever duration less than 72 hours. Virus isolation identified 4 more patients with influenza A initially negative by rapid influenza diagnostic test. The mean (SD) age of these 319 patients was 24.3 (18.1) years. Of the 870 screened patients, 670 (77.0%), 476 (54.7%), and 325 (37.4%) met the European-, USA-, and Taiwan-CDC ILI case definition, respectively. Screening sensitivity was 95%, 77.7%, and 57.7% and specificity was 33.4%, 58.6%, and 74.4%, respectively. Differences in sensitivity and specificity between any 2 of the 3 groups were statistically significant (P < .05).

Conclusion

First-line physicians should recognize the advantage and limitation of different ILI case definitions in influenza screening, especially confronted by pandemic or highly pathogenic avian influenza in the future.     

Predictors of seizure recurrence in emergency department pediatric patients with first-onset afebrile seizure: A retrospective observational study

IntroductionThe primary goals of emergency department (ED) clinicians when dealing with a pediatric patient experiencing a seizure are to control the seizure and prevent seizure-related complications. After stabilizing the patient, the clinician should determine whether the patient is likely to have recurrent seizures that may need treatment such as antiepileptic drugs (AEDs). The early identification of pediatric seizure patients at high risk for recurrence can be of great help in consulting with their parents. This study aimed to identify predictors of seizure recurrence in pediatric patients who visited the ED for first-onset afebrile seizure.MethodsThis retrospective study was conducted with pediatric patients aged 1 month to 18 years who visited our ED for afebrile seizure from January 2016 to March 2020. Children with a known seizure disorder, known underlying genetic or metabolic disorder, or acute trauma history, and those lost to follow-up were excluded. Multivariable logistic regression analysis was performed to identify factors associated with seizure recurrence.ResultsA total of 253 pediatric patients were included in the study. Seizure recurrence was observed in 117 patients (46.3%). From the multivariable logistic regression analysis, older age at onset (11–15 years, odds ratio [OR] 5.781, p = 0.001; 16–18 years, OR 6.223, p = 0.002), a longer seizure duration (1–5 min, OR 3.043, p = 0.002; 6–10 min, OR 5.629, p = 0.002; >10 min, OR 8.882, p = 0.002), blood pH under 7.2 (OR 8.308, p = 0.015), and a glucose level over 144 mg/dL (OR 6.408, p = 0.030) were significantly associated with seizure recurrence. The area under the receiver operating characteristic curve for the multivariable logistic regression analysis was 0.774.ConclusionAge at onset ≥11 years, a longer seizure duration, acidosis, and hyperglycemia were predictors of seizure recurrence in children who had experienced first-onset afebrile seizure.     

Clinical prediction rule is more useful than qSOFA and the Sepsis-3 definition of sepsis for screening bacteremia

BackgroundClinical guidelines recommend blood cultures for patients suspected with sepsis and bacteremia. Sepsis-3 task force introduced the new definition of sepsis in 2016; however, the relationship between the Sepsis-3 definition of sepsis and bacteremia remains unclear. This study aimed to investigate how to detect patients who need blood cultures.MethodsConsecutive patients who visited the emergency department in our hospital with suspected symptoms of bacterial infection and with collected blood culture were retrospectively examined between April and September 2019. The relationship between bacteremia and Sepsis-3 definition of sepsis, and the relationship between bacteremia and clinical scores (quick-Sequential Organ Failure Assessment [qSOFA], systematic inflammatory response syndrome [SIRS], and Shapiro's clinical prediction rule) were investigated. In any scores used, ≥2 points were considered positive.ResultsAmong the 986 patients who met the inclusion criteria, 171 (17%) were complicated with bacteremia and 270 (27%) were patients with sepsis. Sepsis was more frequent (61% vs. 20%, P < 0.001) and all clinical scores were more frequently positive in patients with bacteremia than in those without (qSOFA, 23% vs. 9%; SIRS, 72% vs. 58%; Shapiro's clinical prediction rule, 88% vs. 49%; P < 0.001). Specificity to predict bacteremia was high in sepsis and positive qSOFA (0.80 and 0.91, respectively), whereas sensitivity was high in positive SIRS and Shapiro's clinical prediction rule (0.72 and 0.88, respectively); however, no clinical definitions and scores had both high sensitivity and specificity. The area under the receiver operating characteristic curves were 0.59 (95% confidence interval, 0.55–0.64), 0.60 (0.56–0.65), and 0.78 (0.74–0.82) in qSOFA, SIRS, and Shapiro's clinical prediction rule, respectively.ConclusionBlood cultures should be obtained for patients with sepsis and positive qSOFA because of its high specificities to predict bacteremia; however, because of low sensitivities, Shapiro's clinical prediction rule can be more efficiently used for screening bacteremia.     

Three-year epidemiological analysis of Clostridioides difficile infection and the value of hospital-infection control measures in a tertiary-care teaching hospital in Japan using PCR-based open-reading frame typing

IntroductionClostridioides difficile is an important causative pathogen in antibiotic-associated colitis and nosocomial infections. This study aimed to assess immunochromatographic test results for C. difficile infection and the utility of PCR-based open-reading frame typing (POT) for potentially controlling the intra-ward transmission of C. difficile.MethodsWe conducted a molecular epidemiological analysis using POT to investigate 102 inpatients who tested positive for the C. difficile toxin using immunochromatography in a tertiary-care teaching hospital in Japan between 2016 and 2018; isolates from the patients were obtained and cultured.ResultsThe number of POT numbers detected in 2016, 2017, and 2018 were 27 (among 34 patients), 20 (among 31 patients), and 28 (among 37 patients), respectively. During this three-year period, there were seven cases whose bacterial strains with the same POT number was identified in the same ward within 6 months. The intra-ward transmission rate was the highest in 2017 (16.1%). Intra-ward transmission was identified at a higher rate in patients whose sample cultures tested toxin-positive than in patients whose sample cultures tested toxin- and glutamate-dehydrogenase-positive via immunochromatography (16% vs. 3%, p < 0.05).ConclusionsWe conclude that the use of immunochromatographic tests for C. difficile diagnosis and epidemiological analyses via POT may be helpful for evaluating intra-ward transmission of C. difficile.     

Continued effectiveness of laninamivir octanate hydrate for influenza treatment in Japan: Comparison between the 2011–2012 and 2012–2013 influenza seasons

The clinical effectiveness of Laninamivir octanoate hydrate (laninamivir) was investigated in the Japanese 2012–2013 influenza season for comparison with that of the Japanese 2011–2012 influenza season. A total of 235 patients were enrolled, of whom 210 were evaluated for the duration of fever and other symptoms. The median durations of fever for A(H3N2) were 32.0 and 38.0 h and the median durations of symptoms for the A(H3N2) were 102.0 and 84.0 h for patients aged under 10 and 10 years or older, respectively. All four influenza B patients were 10 years or older, and their median duration of fever was 43.0 h and the median duration of symptoms was 71.0 h. There was no significant difference in the duration of fever or symptoms between the two seasons. The rates of patients A(H3N2) virus positive at day 5 were 37.2% (16/43) and 12.8% (18/141) for those aged under 10 years and 10 years or older, respectively. The virus positive rate was significantly higher for the patients under 10 years than for the patients aged 10 years or older (p < 0.0001). No significant change in IC₅₀ value was found between days 1 and 5. Adverse drug reactions were reported by 2 of the 231 patients (0.87%), but neither was serious. These results suggest that laninamivir continued to be effective against influenza A(H3N2) with no safety issues and that it is unlikely that the clinical use of laninamivir will lead to virus resistance.     

Risk factors in pediatric hospitalization for influenza A and B during the seven seasons immediately before the COVID-19 era in Japan

IntroductionThe risk factors in pediatric influenza immediately before the COVID-19 era are not well understood. This study aims to evaluate the risk factors for hospitalization in pediatric influenza A and B for the recent seasons.MethodsChildren with a fever of ≥38 °C and laboratory-confirmed influenza at 20 hospitals in outpatient settings in Japan in the 2013/14 to 2019/20 seasons were retrospectively reviewed. Possible risk factors, including gender, age, comorbidities, nursery school or kindergarten attendance, earlier diagnosis, no immunization, lower regional temperature, earlier season, and period of onset, were evaluated using binary logistic regression methods.ResultsA total of 13,040 (type A, 8861; B, 4179) children were evaluated. Significant risk factors (p < 0.05) in multivariate analyses were young age, lower regional temperature, earlier season, respiratory illness (adjusted odds ratio [aOR]:2.76, 95% confidence interval [CI]:1.84–4.13), abnormal behavior and/or unusual speech (aOR:2.78, 95% CI:1.61–4.80), and seizures at onset (aOR:16.8, 95% CI:12.1–23.3) for influenza A; and young age, lower regional temperature, respiratory illness (aOR:1.99, 95% CI:1.00–3.95), history of febrile seizures (aOR:1.73, 95% CI:1.01–2.99), and seizures at onset (aOR:9.74, 95% CI:5.44–17.4) for influenza B.ConclusionsIn addition to previously known factors, including young age, seizures, and respiratory illness, abnormal behavior and/or unusual speech and lower regional temperature are new factors. Negative immunization status was not a risk factor for hospitalization. A better understanding of risk factors may help improve the determination of indications for hospitalization during the future co-circulation of influenza and COVID-19.     

The effectiveness of illness management and recovery program in patients with schizophrenia

AimThis study was conducted to determine the effect of the illness management and recovery program in patients with schizophrenia.MethodsThis study was conducted using a pretest, posttest and follow up experimental design with randomized controlled. The sample of this study consisted of patients with schizophrenia (n = 50). The patients were assigned to intervention (n = 25) and control (n = 25) groups using the randomisation method. The intervention group consisted of 10 modules and 20 sessions of Illness Management and Recovery Program, while in the control group, a face-to-face interview. Data were collected by the Illness Management and Recovery Scale-Patient Form (IMRS-P) and Social Functioning Scale-Patient Form (SFS-P).ResultsThere were significant differences in posttest and 1-month follow-up IMRS-P points between the intervention and control groups. There was no significant difference in post-test and 1-month follow-up SFS-P total points between the intervention and control groups. There were only significant differences for the pro-social activities' subscale of SFS-P.ConclusionThe Illness Management and Recovery Program have a positive effect on illness management and social functionality in patients with schizophrenia. In the light of this study, it was suggested that this structured program should be used by mental health and psychiatric nurses.