Influenza cases in nine aged care facilities in Sydney,Australia over a three-year surveillance period, 2018—2020

BackgroundInfluenza outbreaks in aged care facilities are a major public health concern. In response to the severe 2017 influenza season in Australia, enhanced influenza vaccines were introduced from 2018 onwards for those over 65 and more emphasis was placed on improving vaccination rates among aged care staff. During the COVID-19 pandemic, these efforts were then further escalated to reduce the additional burden that influenza could pose to facilities.MethodsAn observational epidemiological study was conducted from 2018 to 2020 in nine Sydney (Australia) aged care facilities of the same provider. De-identified vaccination data and physical layout data were collected from participating facility managers from 2018 to 2020. Active surveillance of influenza-like illness was carried out from 2018 to 2020 influenza seasons. Correlation and Poisson regression analyses were carried out to explore the relationship between physical layout variables to occurrence of influenza cases.ResultsInfluenza cases were low in 2018 and 2019, and there were no confirmed influenza cases identified in 2020. Vaccination rates increased among staff by 50.5% and residents by 16.8% over the three-year period of surveillance from 2018 to 2020. For each unit increase in total number of beds, common areas, single rooms, all types of rooms (including double occupancy rooms), the influenza cases increased by 1.02 (95% confidence interval:1.018–1.025), 1.04 (95% confidence interval: 1.019–1.073), 1.03 (95% confidence interval: 1.016–1 0.038) and 1.02 (95% confidence interval:1.005–1.026) times which were found to be statistically significant. For each unit increase in the proportion of shared rooms, influenza cases increased by 1.004 (95% confidence interval:1.0001–1.207) which was found to be statistically significant.ConclusionsThere is a relationship between influenza case counts and aspects of the physical layout such as facility size, and this should be considered in assessing risk of outbreaks in aged care facilities. Increased vaccination rates in staff and COVID-19 prevention and control measures may have eliminated influenza in the studied facilities in 2020.     

Factors associated with repeated influenza vaccine uptake among aged care staff in an Australian sample from 2017 to 2019

Background/AimInfluenza vaccination is strongly recommended every year for aged care staff to protect themselves and minimise risk of transmission to residents. This study aimed to determine the factors associated with repeated annual influenza vaccine uptake among Australian aged care staff from 2017 to 2019.MethodsDemographic, medical and vaccination data collected from the staff, who participated in an observational study from nine aged care facilities under a single provider in Sydney Australia, were analysed retrospectively. Based on the pattern of repeated influenza vaccination from 2017 to 2019, three groups were identified: (1) unvaccinated all three years; (2) vaccinated occasionally(once or twice) over three years; and (3)vaccinated all three years. Multinomial logistic regression analysis was performed to better understand the factors associated with the pattern of repeated influenza vaccination.ResultsFrom a total of 138 staff, between 2017 and 2019, 28.9 % (n = 40) never had a vaccination, while 44.2 % (n = 61) had vaccination occasionally and 26.8 % (n = 37) had vaccination all three years. In the multinomial logistic regression model, those who were<40 years old (OR = 0.57, 95 % CI: 0.19–0.90, p < 0.05) and those who were current smokers (OR = 0.20; 95 % CI: 0.03–0.76, p < 0.05) were less likely to have repeated vaccination for all three years compared to the unvaccinated group. Those who were<40 years old (OR = 0.61; 95 % CI: 0.22–0.68, p < 0.05) and those who were born overseas (OR = 0.50; 95 % CI:0.27–0.69, p < 0.05) were more likely to be vaccinated occasionally compared to the unvaccinated group.ConclusionThe significant predictors of repeated vaccine uptake across the three-year study period among aged care staff were age, smoking status and country of birth (Other vs Australia). Targeted interventions towards the younger age group (<40 years old), smokers and those who were born overseas could improve repeated influenza vaccination uptake in the aged care workforce.     

老年尸检机化性肺炎临床病理分析

目的 探讨老年尸体解剖中遇到的机化性肺炎的临床病理特点及其可能的原因。方法 从1980—2003年635例老年人尸检资料中检出95例机化性肺炎,观察机化性肺炎的形态特点,并对其临床资料和影像学变化进行回顾分析。结果 机化性肺炎大多数病灶小、散在,经常出现在主要肺部疾病附近,不同病变相伴的机化性肺炎其病变特点也略有差别;95例机化性肺炎周围的主要肺部疾病有：(1)化脓性肺炎及肺脓肿以及慢性复发性肺炎(36例);(2)感染性疾病(真菌、病毒等17例);(3)吸人性肺炎(16例);(4)放射性肺炎(5例);资料还显示慢性胸膜炎、肺不张也常与机化性肺炎相伴。机化性肺炎肺部病变影像学表现呈多样性。结论 老年尸检中机化性肺炎是常见的伴发病变,与多种疾病相关,各种原因伴发的机化性肺炎形态学上大致相似。在相关因素分析中认为老年性机化性肺炎主要与细菌、真菌、病毒等感染有关;吸入性及放射性肺炎等也常伴发机化性肺炎。影像学上肺部感染患者长期不消散的阴影需考虑到出现机化性肺炎的可能。     

低分子肝素治疗老年人不稳定型心绞痛的疗效分析

目的 观察低分子肝素治疗老年人不稳定型心绞痛的疗效。方法 将１０１例不稳定型心绞痛患者随机分为Ａ、Ｂ两组。在常规治疗基础上Ａ组给予低分子肝素腹部皮下注射;Ｂ组给予等量生理盐水皮下注射。结果 Ａ组心绞痛发作频率比Ｂ组明显减少（Ｐ〈０．０１）。心电图ＳＴ段及Ｔ波较对照组明显改善。Ａ组总有效率９０％,Ｂ组总有效率５４％（Ｐ〈０．０１）。Ａ、Ｂ组治疗期间均未见出血等副作用。结论 低分子肝素治疗老年人不稳定     

Establishing a new university department of rural health: the first 2 years of the South Australian Centre for Rural and Remote Health

ABSTRACT: This study aimed to describe the establishment of a new University Department of Rural Health (UDRH) in South Australia and to report early achievements. In May 1997, the UDRH was established, key staff were recruited, infrastructure was developed and in April 1998 a Joint University Committee on Rural and Remote Health was formed. By mid-1999, 14 full-time equivalent staff were employed in Whyalla and Adelaide. Early achievements include: review of undergraduate rural placements; increased rural clinical placements by 1000 student-weeks; partnership with the Dental School resulting in training opportunities and falling public dental waiting lists; multidisciplinary teaching practices in four rural sites; priority public health projects established; competitive research grants won; and a capital grant to strengthen Aboriginal health services infrastructure secured. These early achievements demonstrate UDRH potential to have a real impact on health worker education, service delivery, and public health status in rural and remote areas. This strong foundation must now be built on.     

用Cox’s回归模型分析老年人舌鳞癌生存率

目的：探讨老年人舌鳞癌预后的影响因素。方法：收集经病理证实的６３例老年人舌鳞癌,对影响其生存率的众因素进行回归分析。结果：影响其预后的因素依次为①肿瘤的局部控制;②治疗方法;③颈部淋巴结的预防性根治术;④肿瘤大小;⑤年龄。结论：肿瘤的局部控制是影响其预后的关键;其次是颈部淋巴结的根治术;另外综合治疗明显优于单一治疗。建议尽可能选择综合治疗,特别要强调肿瘤的局部控制和预防性颈部淋巴结清扫术。     

尿激酶溶栓治疗高龄急性心肌梗塞的疗效观察

目的 为观察尿激酶 天普洛欣（ＵＫＴＰ）静脉溶栓治疗高龄急性心肌梗塞（ＡＭＩ）的临床有效性和安全性。方法 收集５０２例ＡＭＩ患者,按年龄分为３组：≥７０岁组（１１７例）,￣６８岁组（１５２例）和〈６５岁组（２３３例）,观察临床疗效,副作用及病死率等。ＵＫＴＰ剂量为２００万Ｕ至３００万Ｕ,采用Ｂｏｌｕｓ法３０ｍｉｎ内给药。结果 ①按临床梗塞相关血管（ＩＲＡ）再通标准,再通率依次为７０．９％,７９．６     

老年学习记忆减退大鼠空间参考记忆和工作记忆能力的改变

目的　探讨老年学习记忆损害鼠空间学习记忆能力的改变特征。方法　用改良Morris 水迷宫检测40 只老年SD 大鼠(24m) 的空间学习记忆能力,按通用标准将其分为老年学习记忆减退组和老年学习记忆正常组,与青年组对照,检测其空间参考记忆和空间工作记忆能力。结果　老年学习记忆损害大鼠的行为学改变特征为:1) 简单学习记忆任务的学习能力没有明显变化。2) 空间参考记忆能力明显减退,寻找平台所用的游泳时间(ST) ,40cm 环内游泳时间(A40T) 和平台跨越次数(PC) 是反映老年学习记忆害大鼠空间参考记忆能力的理想指标。3) 空间工作记忆能力减退不明显。结论　A40T,PC 是反映空间参考记忆能力的敏感指标,ST 结合A40T 可筛选出理想的老年学习记忆减退动物模型。     

老年自发性气胸误诊原因及影响疗效的因素分析

目的：为了分析老年人自发性气胸的临床特点,找出易发生误诊的原因以及影响疗效的因素;方法：对７５例老年人 性气胸的临床资料与同期６０例中青年人自发性气胸作对比分析;结果：老年气胸存在的基础病和发生并发症比例高,气急为最突出症状,以开放型,张力型气胸居多,与对照组有显著差异。老年气胸胸痛相对较轻,肺压缩程度显著低于对照组。老年气胸肺复张时间长,需行胸腔闭式引流术比例高。严重病例易发生呼吸衰竭和多器官衰     

High Cervical Disc Lesions in Elderly Patients – Presentation and Surgical Approach

Summary  The incidence of high cervical disc lesions is extremely rare, and the mechanism of their development is unclear. We report these three cases, and discuss the possible mechanisms. We also describe surgical strategies for these lesions.  The first and second cases were an 82-year-old male and an 84-year-old male with retro-odontoid disc hernia. The third was an 83-year-old female with a herniated disc at C2/C3. To investigate Aetiological mechanisms of these lesions, we examined the findings on cervical images in extension and flexion, and compared the results in a younger than 80-year-old group and an older than 80-year-old group.  The patients underwent surgery via a posterolateral intradural approach. Wide laminectomy and incision of the dentate ligaments enabled access to the ventral space of the upper cervical spinal canal and sufficient decompression. All patients became ambulatory postoperatively without special fixation of the cervical spine. In the younger group, the level mostly loaded during cervical movement was C5/6, however, the levels in the older group were C2/3 and C3/4.  In elderly patients, less mobilization of the middle and/or lower cervical spine due to spondylotic change causes overloading at higher levels resulting in high cervical disc lesions. Retro-odontoid disc lesions can be caused by a herniated disc at C2/C3, which migrates upward. Regarding surgical strategy, the posterolateral intradural approach is less invasive and more advantageous for these lesions.