Quelles indications d’hospitalisation d’un patient avec addiction ? Application du modèle des pathologies chroniques. Une étude de validité apparente

IntroductionThe medical identification of an addiction (use disorder) often results in inpatient admission with a view to its definitive suspension. However, for other chronic diseases, inpatient admission is indicated for specific situations and the objective is not the definitive suspension of the chronic disease. Our goal was to clarify addiction as a chronic disease and to determine explicit indications for inpatient admission.MethodThree-stage face validity study: (1) from the analysis of consensual definitions, search by the subset theory whether addiction can be considered as a chronic disease; (2) Develop generic indications for inpatient admissions based on the analysis of chronic disease care pathways validated by the HAS (French Health Agency) and apply them to addiction; (3) Validate by Delphi expert consensus method the determined indications.ResultsStep (1) showed that the definition of addiction allowed to include it in that of chronic disease. Step (2) determined 7 indications for inpatient admission of a patient with a chronic disease, and its application to addiction identified 15 indications for inpatient admission of a patient with addiction. In step (3), the Delphi method yielded consensus on 14 of the 15 indications.ConclusionBy clarifying addiction as a chronic disease, we were able to determine 14 indications for inpatient admission of a person with an addiction and to distinguish them from the long-term care of addiction. These explicit indications can help the general practitioner or community psychiatrist to better manage patients with addiction on the basis of their expertise with chronic diseases management.     

Distribution of pathogens and antimicrobial resistance in bacteraemia according to hospitalization duration: a nationwide surveillance study in Switzerland

ObjectivesChanging microorganism distributions and decreasing antibiotic susceptibility with increasing length of hospital stay have been demonstrated for the colonization or infection of selected organ systems. We wanted to describe microorganism distribution or antibiotic resistance in bacteraemia according to duration of the hospitalization using a large national epidemiological/microbiological database (ANRESIS) in Switzerland.MethodsWe conducted a nationwide, observational study on bacteraemia using ANRESIS data from 1 January 2008 to 31 December 2017. We analysed data on bacteraemia from those Swiss hospitals that sent information on a regular basis during the entire study period. We described the pathogen distribution and specific trends of resistance during hospitalization for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia marcescens and Staphylococcus aureus.ResultsWe included 28 318 bacteraemia isolates from 90 Swiss hospitals. The most common aetiology was E. coli (33.4%, 9459), followed by S. aureus (16.7%, 4721), K. pneumoniae (7.1%, 2005), Enterococcus faecalis (5.2%, 1473), P. aeruginosa (4.3%, 1228), Streptococcus pneumoniae (4.3%, 1208) and Enterococcus faecium (3.9%, 1101). We observed 489 (1.73%) S. marcescens isolates. We observed an increasing trend for E. faecium (from 1.5% at day 0 to 13.7% at day 30; p < 0.001), K. pneumoniae (from 6.1% to 7.8%, p < 0.001) and P. aeruginosa (from 2.9% to 13.7%, p < 0.001) with increasing duration of hospitalization; and decreasing trends for E. coli (from 41.6% to 21.6%; p < 0.001) and S. aureus (p < 0.001). Ceftriaxone resistance among E. coli remained stable for the first 15 days of hospitalization and then increased. Ceftriaxone resistance among K. pneumoniae and S. marcescens and oxacillin resistance among S. aureus increased linearly during the hospitalization. Cefepime resistance among P. aeruginosa remained stable during the hospitalization.DiscussionWe showed that hospitalization duration is associated with a species- and antibiotic class-dependent pattern of antimicrobial resistance.     

A real-life setting evaluation of the effect of remdesivir on viral load in COVID-19 patients admitted to a large tertiary centre in Israel

ObjectivesThe effectiveness of remdesivir, a Food and Drug Administration-approved drug for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been repeatedly questioned during the current coronavirus disease 2019 (COVID-19) pandemic. Most of the recently reported studies were randomized controlled multicentre clinical trials. Our goal was to test the efficiency of remdesivir in reducing nasopharyngeal viral load and hospitalization length in a real-life setting in patients admitted to a large tertiary centre in Israel.MethodsA total of 142 COVID-19 patients found to have at least three reported SARS-CoV-2 quantitative RT-PCR tests during hospitalization were selected for this study. Of these, 29 patients received remdesivir, while the remaining non-treated 113 patients served as controls.ResultsAmong the tested parameters, the control and remdesivir groups differed significantly only in the intubation rates. Remdesivir treatment did not significantly affect nasopharyngeal viral load, as determined by comparing the differences between the first and last cycle threshold values of the SARS-CoV-2 quantitative RT-PCR tests performed during hospitalization (cycle threshold 7.07 ± 6.85 vs. 7.08 ± 7.27, p 0.977 in the control and treated groups, respectively). Remdesivir treatment shortened hospitalization length by less than a day compared with non-treated controls and by 3.1 days when non-intubated patients from both groups were compared. These differences, however, were not statistically significant, possibly because of the small size of the remdesivir group.DiscussionRemdesivir was not associated with nasopharyngeal viral load changes, but our study had a significant disease severity baseline imbalance and was not powered to detect viral load or clinical differences.     

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.     

Prenatal maternal alcohol consumption and hospitalization with asthma in childhood: a population-based follow-up study

BACKGROUND: Asthma may have a prenatal origin. We examined whether maternal alcohol consumption during pregnancy increases the risk of hospitalization with asthma in children. METHODS: We conducted a follow-up study on 10,440 singletons born at approximately 36 weeks of gestation or later to mothers attending midwife centers between April 1984 and April 1987 in Denmark. The mothers completed a questionnaire regarding lifestyle and socioeconomic factors, including alcohol consumption. The children were followed up through the Danish Hospital Discharge Registry. We determined the first hospitalization with a discharge diagnosis of asthma as recorded in the Danish Hospital Discharge Registry. RESULTS: Most pregnant women (81.5%) drank at least some alcohol during pregnancy, but only a few (2.1%) consumed 120 g or more per week. In total, 307 children were hospitalized at least once with a discharge diagnosis of asthma during follow-up (the cumulative incidence risk was 3.5% from birth to 12 years of age or the end of follow-up). After adjusting for maternal socioeconomic factors, dietary components, and other lifestyle factors, children whose mothers drank alcohol during pregnancy did not have an increased risk of hospitalization with asthma compared with the children of mothers who reported no alcohol consumption during pregnancy (adjusted incidence rate ratio, 0.95; 95% confidence interval, 0.70-1.29). Further analyses showed no association with the dose and type of alcohol or with binge drinking. CONCLUSIONS: The study provides no support for a causal link between maternal alcohol intake during pregnancy and asthma in childhood.     

Severity of Gastrointestinal Bleeding in Patients Treated with Direct-Acting Oral Anticoagulants

Background

Direct-acting oral anticoagulants (DOACs), which have gained approval for stroke prevention in nonvalvular atrial fibrillation and treatment of venous thromboembolism, have become increasingly preferred over warfarin given their predictable pharmacodynamics, lack of required monitoring, and superior outcomes. Direct-acting oral anticoagulants have been shown to be associated with an increased frequency of gastrointestinal bleeding compared with warfarin, but the severity and characteristics of gastrointestinal bleeding in these patients is poorly understood.

The Heart Failure Association Atlas: rationale,objectives, and methods

Heart failure (HF) constitutes the growing cardiovascular burden and the major public health issue, but comprehensive statistics on HF epidemiology and related management in Europe are missing. The Heart Failure Association (HFA) Atlas has been initiated in 2016 in order to close this gap, representing the continuity directly rooted in the European Society of Cardiology (ESC) Atlas of Cardiology. The major aim of the HFA Atlas is to establish a contemporary dataset on HF epidemiology, resources and reimbursement policies for HF management, organization of the National Heart Failure Societies (NHFS) and their major activities, including education and HF awareness. These data are gathered in collaboration with the network of NHFS of the ESC member and ESC affiliated countries. The dataset will be continuously improved and advanced based on the experience and enhanced understanding of data collection in the forthcoming years. This will enable revealing trends, disparities and gaps in knowledge on epidemiology and management of HF. Such data are highly needed by the clinicians of different specialties (aside from cardiologists and cardiac surgeons), researchers, healthcare policy makers, as well as HF patients and their caregivers. It will also allow to map the snapshot of realities in HF care, as well as to provide insights for evidence‐based health care policy in contemporary management of HF. Such data will support the ESC/HFA efforts to improve HF management ant outcomes through stronger recommendations and calls for action. This will likely influence the allocation of funds for the prevention, treatment, education and research in HF.     

医保减贫视角下中老年慢性呼吸道疾病患者的健康贫困特征与影响因素研究

背景　在我国,慢性呼吸道疾病（CRD）已成为影响中老年人健康状况的主要慢性病之一,长期的医疗费用支出给其及家庭造成巨大的经济负担,使其陷入贫困的风险增大。在医保制度实现人口宽度全民覆盖的背景下,是否有效缓解了中老年CRD患者的疾病负担,减轻了因病致贫风险（IME）等问题已然成为掣肘社会可持续发展的焦点问题。目的　通过多维度分析,系统把脉和精准锁定我国中老年CRD患者这一健康贫困高危群体发生致贫的脆弱特征及影响因素。方法　本研究于2019年7月利用2015年中国健康与养老追踪调查（CHARLS）微观数据,以920户（2 106例）中老年CRD患者为调查对象,采用WHO推荐的灾难性卫生支出（CHE）、IME方法测算其疾病经济负担,并采用多因素Logistic回归分析中老年CRD患者发生CHE的影响因素。结果　920户家庭总体CHE发生率为20.65%（190/920）,IME发生率为7.83%（72/920）,其中合并3种及以上慢性病的家庭CHE发生率最高,为44.00%（11/25）。不同性别、受教育程度、自评健康状况户主,家庭是否有住院患者、合并其他慢性病种类,户主参加保险类型CHE发生率比较,差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示：户主为女性、受教育程度为高中及以上、家庭有住院患者、合并3种及以上慢性病、其他和未参保户主是灾难性卫生支出高发的影响因素（P<0.05）。结论　CRD患者自身健康能力的缺失,叠加住院、合并其他类慢性病等多种健康脆弱性,加剧CHE发生风险。现有医保制度,仅保障了老年CRD患者进入卫生领域的权利,缺乏对CRD患者中,其他和未参保家庭、新型农村合作医疗保险参保家庭的制度倾斜和贫困人口的精准锁定,需进一步加强对高卫生服务利用群体的医保覆盖深度与高度,加强基本医保、大病医保、医疗救助与疾病应急救助等多路径健康保障体系的协调与统一。