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To estimate prior severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among skilled nursing facility (SNF) staff in the state of Georgia and to identify risk factors for seropositivity as of fall 2020.
Baseline survey and seroprevalence of the ongoing longitudinal Coronavirus 2019 (COVID-19) Prevention in Nursing Homes study.
The study included 14 SNFs in the state of Georgia.
In total, 792 SNF staff employed or contracted with participating SNFs were included in this study. The analysis included 749 participants with SARS-CoV-2 serostatus results who provided age, sex, and complete survey information.
We estimated unadjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for potential risk factors and SARS-CoV-2 serostatus. We estimated adjusted ORs using a logistic regression model including age, sex, community case rate, SNF resident infection rate, working at other facilities, and job role.
Staff working in high-infection SNFs were twice as likely (unadjusted OR, 2.08; 95% CI, 1.45–3.00) to be seropositive as those in low-infection SNFs. Certified nursing assistants and nurses were 3 times more likely to be seropositive than administrative, pharmacy, or nonresident care staff: unadjusted OR, 2.93 (95% CI, 1.58–5.78) and unadjusted OR, 3.08 (95% CI, 1.66–6.07). Logistic regression yielded similar adjusted ORs.
Working at high-infection SNFs was a risk factor for SARS-CoV-2 seropositivity. Even after accounting for resident infections, certified nursing assistants and nurses had a 3-fold higher risk of SARS-CoV-2 seropositivity than nonclinical staff. This knowledge can guide prioritized implementation of safer ways for caregivers to provide necessary care to SNF residents.
Labour market marginalisation (LMM), i.e. severe problems in finding and keeping a job, is common among young adults with attention-deficit/hyperactivity disorder (ADHD). This study aimed to disentangle the extent of LMM as well as the heterogeneity in patterns of LMM among young adults with ADHD and what characterises those belonging to these distinct trajectories of LMM.
This population-based register study investigated all 6287 young adults, aged 22–29 years, who had their first primary or secondary diagnosis of ADHD in Sweden between 2006 and 2011. Group-based trajectory (GBT) models were used to estimate trajectories of LMM, conceptualised as both unemployment and work disability, 3 years before and 5 years after the year of an incident diagnosis of ADHD. Odds ratios (ORs) with 95% confidence intervals (CIs) for the association between individual characteristics and the trajectory groups of LMM were estimated by multinomial logistic regression.
Six distinct trajectories of LMM were found: ‘increasing high’ (21% belonged to this trajectory group) with high levels of LMM throughout the study period, ‘rapidly increasing’ (19%), ‘moderately increasing’ (21%), ‘constant low’ (12%) with low levels of LMM throughout the study period, ‘moderately decreasing’ (14%) and finally ‘fluctuating’ (13%), following a reversed u-shaped curve. Individuals with the following characteristics had an increased probability of belonging to trajectory groups of increasing LMM: low educational level (moderately increasing: OR: 1.4; CI: 1.2–1.8, rapidly increasing: OR: 1.7; CI: 1.3–2.1, increasing high: OR: 2.9; CI: 2.3–3.6), single parents (moderately increasing: OR: 1.6; CI: 1.1–2.4, rapidly increasing: OR: 2.0; CI: 1.3–3.0), those born outside the European Union/the Nordic countries (rapidly increasing: OR: 1.7; CI: 1.1–2.5, increasing high: OR: 2.1; CI: 1.4–3.1), persons living in small cities/villages (moderately increasing: OR: 2.4; CI: 1.9–3.0, rapidly increasing: OR: 2.1; CI: 1.6–2.7, increasing high: OR: 2.6; CI: 2.0–3.3) and those with comorbid mental disorders, most pronounced regarding schizophrenia/psychoses (rapidly increasing: OR: 6.7; CI: 2.9–19.5, increasing high: OR: 12.8; CI: 5.5–37.0), autism spectrum disorders (rapidly increasing: OR: 4.6; CI: 3.1–7.1, increasing high: OR: 9.6; CI: 6.5–14.6), anxiety/stress-related disorders (moderately increasing: OR: 1.3; CI: 1.1–1.7, rapidly increasing: OR: 2.0; CI: 1.6–2.5, increasing high: OR: 1.8; CI: 1.5–2.3) and depression/bipolar disorder (moderately increasing: OR: 1.3; CI: 1.0–1.6, rapidly increasing: OR: 1.7; CI: 1.4–2.2, increasing high: OR: 1.5; CI: 1.2–1.9).
About 61% of young adults were characterised by increasing LMM after a diagnosis of ADHD. To avoid marginalisation, attention should especially be given to young adults diagnosed with ADHD with a low educational level, that are single parents and who are living outside big cities. Also, young adults with comorbid mental disorders should be monitored for LMM early in working life.
A number of variable descriptive accounts of Aspersentis megarhynchus (von Linstow, 1892) Golvan, 1960 have been reported from specimens collected from many species of fish in various locations off Antarctic islands. We have described a new population from Notothenia coriiceps Richardson (Nototheniidae) off Galindez Island, West Antarctica, and features not previously reported, resolved the taxonomic controversies and nomenclature, and emended and updated the generic diagnosis taking into account the newly observed structures. These are depicted in microscopic images and include the outer spiral wall of the proboscis receptacle, the thicker dorsal wall of the receptacle compared to the ventral wall, parts of the female reproductive system, the separate cement gland ducts, the dorsal position of the male gonopore and more detail of proboscis hooks and trunk spines. It is surprising that the newly observed features were missed from the many descriptions of A. megarhynchus created since the original description. The variability in A. megarhynchus is noted with a comparison of the morphometrics of our specimens vs. those in six other descriptions. We also analysed the metal composition of hooks and spines using energy-dispersive X-ray analysis and concluded a molecular characterization of the species based on 18S DNA gene, with related phylogenetic analyses.
Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature. We aimed to investigate (1) the risk of suicide in refugees resident in Sweden and Norway, in general, and according to their sex, age, region/country of birth and duration of residence, compared with the risk of suicide in the respective majority host population; (2) if factors related to socio-demographics, labour market marginalisation (LMM) and healthcare use might explain the risk of suicide in refugees differently in host countries.
Using a nested case-control design, each case who died by suicide between the age of 18 and 64 years during 1998 and 2018 (17 572 and 9443 cases in Sweden and Norway, respectively) was matched with up to 20 controls from the general population, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide. Separate models were controlled for factors related to socio-demographics, previous LMM and healthcare use. Analyses were also stratified by sex and age groups, by refugees' region/country of birth and duration of residence in the host country.
The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI 0.5–0.6) and 0.3 (95% CI 0.3–0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI 0.7–1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age except for younger refugees aged 18–24 who did not have a statistically significant relative difference in suicide risk than their respective host country peers. Factors related to socio-demographics, LMM and healthcare use had only a marginal influence on the studied associations in both countries.
Refugees in Sweden and Norway had almost similar suicide mortality advantages compared with the Swedish-born and Norwegian-born population, respectively. These findings may suggest that resiliency and culture/religion-bound attitudes towards suicidal behaviour in refugees could be more influential for their suicide risk after resettlement than other post-migration environmental and structural factors in the host country.
Since the beginning of 2020, the coronavirus disease (COVID-19) pandemic has dramatically influenced almost every aspect of human life. Activities requiring human gatherings have either been postponed, canceled, or held completely virtually. To supplement lack of in-person contact, people have increasingly turned to virtual settings online, advantages of which include increased inclusivity and accessibility and a reduced carbon footprint. However, emerging online technologies cannot fully replace in-person scientific events. In-person meetings are not susceptible to poor Internet connectivity problems, and they provide novel opportunities for socialization, creating new collaborations and sharing ideas. To continue such activities, a hybrid model for scientific events could be a solution offering both in-person and virtual components. While participants can freely choose the mode of their participation, virtual meetings would most benefit those who cannot attend in-person due to the limitations. In-person portions of meetings should be organized with full consideration of prevention and safety strategies, including risk assessment and mitigation, venue and environmental sanitation, participant protection and disease prevention, and promoting the hybrid model. This new way of interaction between scholars can be considered as a part of a resilience system, which was neglected previously and should become a part of routine practice in the scientific community.
In the present work, the effect of annealing temperature on the microstructure, mechanical and tribological properties of NiCr–WC–Co coatings produced by the high-velocity oxy-fuel (HVOF) technique has been investigated. X-ray diffraction and scanning electron microscopy revealed the dissolution of WC into the NiCr matrix to form W2C and Cr3C2 with the annealing process. This dissolution became complete at 800 °C. The mechanical properties of the coatings were investigated using nano-indentation and Vickers fracture toughness measurements. These measurements suggested that the hardness, Young's modulus, and fracture toughness values increased because of the newly formed carbide phases as a result of the dissolution of the WC particles. The overall properties of the coatings were found to be optimum for annealing temperatures of 800 °C. The wear mechanism appears to be abrasive in the as-sprayed coating, and it becomes a combination of an abrasive and oxidative wear with increasing the annealing temperature.
Since the fall of the Suharto government (New Order) in 1998, Indonesia has transitioned towards a democratic and decentralized government. This has given Indonesians greater freedom to express their religious identity. This has also given rise to a variety of Islamic orientation embedded into political parties, civil society organizations, cultural movements, lifestyles, and entertainment (Rakhmani 2016). For the last twenty years, Indonesian Islam is not exclusively represented by the two largest Islamic organizations, Muhammadiyah and Nahdlatul Ulama (NU). Since the 2000s, the Internet and other forms of information and communication technology (ICT) have created new forms of “public sphere” through the cyberspace (Lim 2003). With the Internet, global religious fundamentalist ideology reaches out to Indonesians too. It played a significant role facilitating communications among Muslim fundamentalists, allowing them to disseminate information through their mailing lists and websites, which eventually led to a resurgence of Islamic fundamentalism in the country (Lim 2004).
Indonesian Islam transformed significantly with the end of authoritarian regime and the expansion of the use of digital technology. With the rapid growth of Internet access and extensive usage of social media platforms among Indonesians, these enable the Muslim community to express their religiosity openly, offering Quranic exegesis (tafsir), and starting conversations on Islamic matters. Social media platforms and private chat groups, such as WhatsApp and Telegram, also inevitably provide supporters of extremist groups such as the Islamic State of Iraq and Syria (ISIS) the space to propagate their messages (Nuraniyah 2017). Are the conservatives, the “jihadists”, or the oppositional Islam (to be discussed shortly) threatening the authority of established state religious institutions, particularly Muhammadiyah and NU?
This chapter examines the current dynamics among Islamic-based groups in shaping the Indonesian Muslim identity. The first section defines “official” Islam and “oppositional” Islam and shows their distinctive characteristics. The next section addresses the problematic moves of recent oppositional Islam, using the 2017 Jakarta gubernatorial election as an example. The last section discusses existing challenges and internal reform that official Islam followers need to take so that they could lead the identity formation of Indonesian Islam that identifies with the universal values of inclusiveness, peace, and humanity.
Depression is a global public health problem with highest rates in women in low income countries including Pakistan. There are no treatment trials from such countries comparing the efficacy of antidepressant treatment with a group psychological intervention.
We conducted a preliminary RCT in an urban primary care clinic in Karachi, Pakistan. Consecutive eligible women scoring > 12 on the CIS-R and > 18 on HDRS (n=66) were randomly assigned to antidepressant or group psychosocial treatment. The primary outcome measure was HDRS score; secondary outcome measures were disability and quality of life.
96% patients were assessed at 3 & 6 months after baseline. At 6 months response (50% reduction of HDRS score) occurred in 20 (60.6%) and 22(66.7%) of the psychosocial and antidepressant groups respectively. There was also significant reduction in disability and improvement in health related quality of life in both groups.
Low costs antidepressants and group psychosocial treatment on the principles of CBT merit further assessment as primary treatments for depression in low income countries.
Little is known about the qualitative and quantitative differences in the use of antipsychotics in Arab countries. This study is aimed to examine and compare the prescribing pattern of antipsychotics in two different Arab settings and specifically determine the factors influencing polypharmacy.
Materials and methods:
This cross-sectional study was conducted in Jordan (National Center for Mental Health Hospital, Amman) and Egypt (Mansoura University Hospital, Mansoura) and included 162 inpatients [g1] with schizophrenia. Patients were surveyed using a standardized protocol.[g2]
There were no significant differences between Egyptians and Jordanians with respect to; demographic, anthropometric, polypharmacy or mean maximum dose of antipsychotics. Jordanians had significantly lower number of hospitalizations and relapses than Egyptian patients. Atypical than typical first antipsychotics were prescribed more to Jordanians compared to Egyptian patients. Irrespective of the patients’ nationalities, the mean hospitalizations, and relapse were predictors of polypharmacy.
Antipsychotic prescribing pattern differs between the Egyptians and Jordanian patients with schizophrenia[g3]. The risks with polytherbay calls for improving the prescribing patterns of antipsychotic drugs in Arab region to establish guidelines on the proper indications and uses for antipsychotic drugs.
Diabetes mellitus (DM-II) and hyperglycemia are of concern in persons with chronic psychiatric disorders. At our 485 patient state hospital, DM has increased over tenfold in recent years. Our routine “finger sticks” for glucose monitoring are commonly elevated and these tend to be treated aggressively. We observed that many patients with high routine glucose values seemed to display no clinical symptoms of hyperglycemia. Of 74 patients with >1fingerstick glucose levels >350 mg/dl during an 18 month period (1/08-6/09), complete charts were available for 25 of the 32 with the highest values (all >420). None of these records showed untoward medical or behavioral incidents on the day of the highest value for each patient. For the 17 with complete medication information for those dates, 13 were prescribed atypical antipsychotics. To explore hyperglycemia, demographic, clinical, and behavioral characteristics of the 32 patients with the highest glucose values were compared with 32 patients with the lowest peak values, and 32 with peak values closest to the overall median of 183 mg/dl. The high glucose group were similar to the others except for the prevalence of schizophrenia (87% vs 66% for the remainder) and less frequent required observation (t = 2.0, p < 0.05). There were no significant differences in behavioral or medical incident reports for the high glucose patients compared with the other groups. The findings suggest that many patients with hyperglycemia in psychiatric hospitals are at lesser risk for medical consequences than traditionally assumed. Less aggressive management of elevated fingerstick values may be indicated.
The department of Psychiatry at Hamad Medical Corporation (HMC) in Qatar, and guided by the national mental health plan, initiated a plan for suicide registry for the country.
Collect information on the patients presenting with self-harm and suicidal behaviors to the Emergency Department (ED), the primary emergency facility in Qatar.
Collection of data on the characteristics of the patients presenting to ED with intentional or accidental self-harm.
Retrospective chart review of all the cases presented to ED with self-harm, suicide attempts or committed suicide during the period between July 2011 and July 2012. Questionnaires were developed to collect the socio-demographic and clinical data available.
A total of 470 cases were identified (48 completed suicide, 165 admitted/suicide attempts, 105 intentional self-harm/not admitted and 152 accidental self harm). The majority of completed suicide were males, expatriates, in their mid 30s and died by hanging. In the admitted suicide attempters, the method was overdose; the male/female ratio was equal, mostly single, employed expatriates, and no past psychiatric diagnosis, substance abuse or previous suicide attempts. The majority of accidental self-harm were secondary to intake of high doses of non-opiate painkillers. Data on many variables were missing. More comparisons will be presented in relation to the demographics in Qatar.
The data suggest that the single male immigrants in Qatar should receive more support and more screening. More prospective data are needed with adequate collection of data to improve the quality of the registry and thus design better prevention programs.
Little is known about the Quality of Life (QoL) in mothers of Arab children with Autism Spectrum Disorders (ASD):
The aim of the present study was to assess QOL among mothers with children affected with ASD:
Socio-demographic variables and ASD history were assessed using personal interview with a structured questionnaire. HRQoL domains were assessed using SF-36 questionnaire, while maternal mental health was assessed using Mini-International Neuropsychaitric interview (MINI-Arabic Version).
Mothers of children with ASD group showed significant deterioration along the physical and social domains of HRQoL compared to mothers of apparently healthy children. Deterioration in HRQoL showed a positive correlation with the level of severity of the children's symptoms and to coexisting behavioral problems and lower socio-demographic profile.
Results of this study provide preliminary evidence that mothers of children in need of social support and clinical interventions which are family centered, rather than child focused.
Mental health among high school students represents an important and growing public health problem in developing countries particularly in Saudi Arabia.
The objectives of this study were to estimate the prevalence of mental health problems among high school students at Al-Hassa, Saudi Arabia and to determine the possible correlates of these disorders among them.
A self administered anonymous survey was administered to a multistage random sample of high school students. A total sample of 1652 were selected by multistage proportionate sampling method. Information about socio-demographics, presence of chronic disease conditions and other potential correlates as financial, personal, family problems were collected. Depressive and anxiety disorders were assessed using the Patient Health Questionnaire (PHQ).
The estimated prevalence of any depressive or anxiety disorder was 21.9%. Major depressive disorders have been encountered in 9.9%, other depression of 19.4% and any depression of 24.4%. Panic disorder was found in 4.0% and generalized anxiety disorders in 14.0%. Suicidal ideation in the past four weeks was reported by 1.1% of students. Mental health problems were more prevalent among students of scientific department. Major depression and depression and anxiety disorders were significantly higher among girls. Logistic regression revealed that the type of department, female gender, chronic disease condition, the presence of financial and personal problems were the significant predictors for major depressive disorders.
These findings highlight the need to address mental health in adolescent population, particularly among those of lower socioeconomic status.
Major depressive disorder (MDD) is a common mood disorder, with a heritability of around 34%. Molecular genetic studies made significant progress and identified genetic markers associated with the risk of MDD; however, progress is slowed down by substantial heterogeneity as MDD is assessed differently across international cohorts. Here, we used a standardized online approach to measure MDD in multiple cohorts in the Netherlands and evaluated whether this approach can be used in epidemiological and genetic association studies of depression.
Within the Biobank Netherlands Internet Collaboration (BIONIC) project, we collected MDD data in eight cohorts involving 31 936 participants, using the online Lifetime Depression Assessment Self-report (LIDAS), and estimated the prevalence of current and lifetime MDD in 22 623 unrelated individuals. In a large Netherlands Twin Register (NTR) twin-family dataset (n ≈ 18 000), we estimated the heritability of MDD, and the prediction of MDD in a subset (n = 4782) through Polygenic Risk Score (PRS).
Estimates of current and lifetime MDD prevalence were 6.7% and 18.1%, respectively, in line with population estimates based on validated psychiatric interviews. In the NTR heritability estimates were 0.34/0.30 (s.e. = 0.02/0.02) for current/lifetime MDD, respectively, showing that the LIDAS gives similar heritability rates for MDD as reported in the literature. The PRS predicted risk of MDD (OR 1.23, 95% CI 1.15–1.32, R2 = 1.47%).
By assessing MDD status in the Netherlands using the LIDAS instrument, we were able to confirm previously reported MDD prevalence and heritability estimates, which suggests that this instrument can be used in epidemiological and genetic association studies of depression.
Centrorhynchus globocaudatus (Zeder, 1800) Lühe, 1911 (Centrorhynchidae) was reported in birds of prey. Our population from Falco tinnunculus Linnaeus (Falconidae) and Buteo buteo Linnaeus (Accipitridae) in northern Italy was morphologically distinct from others described elsewhere. The worms are elongate and cylindrical. Proboscis long, apically truncated and bare, with wider base and variably faint constriction at point of attachment of receptacle. Large anterior hooks well rooted; posterior spiniform hooks with reduced roots; transitional hooks with scutiform roots in-between. Four tubular cement glands extend into prominent ducts overlapping a large Saefftigen's pouch. Bursa large, with sensory plates. Vagina with laterally slit orifice in sub-ventral pit of globular terminal extension. Thick-shelled eggs ovoid without polar prolongation of fertilization membrane. In our specimens, proboscis hooks, receptacle, male reproductive system, and lemnisci especially in males varied in size from those from Ukraine, India, Egypt, Kyrgystan, Russia, Georgia, Armenia and Asian Soviet Republics. Our description of the Italian specimens includes new morphological information supported by scanning electron microscopy and microscope images, molecular analysis and energy dispersive X-ray analysis (EDXA) of hooks. Additional new details of proboscis hook roots, micropores and micropore distribution are described. Metal composition of hooks (EDXA) demonstrated high levels of calcium and phosphorous, and high levels of sulphur in core and cortical layers of eggs. The molecular profile based on sequences of 18S and cytochrome c oxidase 1 genes is also provided, as well as phylogenetic reconstructions including all available sequences of the family Centrorhynchidae, although further sequences are needed in order to clarify their phylogenetic relationships.
We describe morphological features not previously reported for this old acanthocephalan Nephridiacanthus major (Bremser, 1811 in Westrumb, 1821) Golvan, 1962 first described over 200 years ago. Our specimens were collected from long-eared hedgehog Hemiechinus auritus (Gmelin, 1770) (Erinaceidae) in Iran. We compare the morphometrics of our material with others previously reported from the same host in Iran, Russia, central Asia and Europe. Our specimens had markedly smaller proboscides, proboscis hooks and lemnisci than those reported from Russia and central Asia, but comparable measurements of other structures with specimens previously described from other collections. We document our new observations with scanning electron microscopy features not previously demonstrable by other observers and provide a chemical analysis of proboscis hooks using energy-dispersive X-ray analysis for the first time. The molecular profile of this acanthocephalan, based on 18S rDNA and cox1 genes, was generated for the first time. The phylogenetic analysis showed that N. major is placed in a clade of the family Oligacanthorhynchidae, well separated from the families Moniliformidae and Gigantorhynchidae.
Ladybeetles are known beneficial insects, with a long history in augmentative and classical biological control. The ladybeetle Oenopia conglobata (L.) is a natural enemy of many herbivores, particularly aphids. The temperature-dependent development of O. conglobata was studied at six constant temperatures (22.5, 25, 27.5, 30, 32.5 and 35 °C) to understand its development rate and environmental constraints better. Linear and nonlinear (Lactin) models were fitted to the data. In the thermal range from 22.5 to 32.5 °C, the rate of development increased for all stages; 35 °C was lethal for all stages and no eggs hatched. The Tb and K values for the biological cycle (egg–adult) were 8.84 °C and 263.15 DD, respectively. Depending on the model, tmin values for the total development time of the coccinellid ranged from 8.45 to 8.82 °C. The nonlinear model of Lactin estimated the optimum and upper temperature thresholds for the total development time of the ladybeetle to be 33.2 and 35.0 °C, respectively. High R2 values and low residual sum of squares values revealed a good fit to the experimental data for total development and different developmental stages of O. conglobata. The results may contribute to the improvement of practical methods for mass rearing of O. conglobata.
Background: Continuous video-EEG (cvEEG) monitoring is the standard of care for diagnosis and management of neonatal seizures. However, it is labour-intensive. We aimed to establish consistency in monitoring of newborns utilising NICU nurses. Methods: Neonatal nurses were trained to apply scalp electrodes, troubleshoot technical issues. Guidelines, checklists and visual training modules were developed. A central network system allowed remote access to the cvEEGs by the epileptologist for timely interpretation and feedback. We compared 100 infants with moderate to severe HIE before and after the training program. Results: 192 cvEEGs were performed. Of the 100 infants compared; time to initiate brain monitoring decreased by average of 31.5 hours, in electrographic seizure detection increased(20% compared to 34% a), seizure clinical misdiagnosis decreased (65% compared to 36% ), and Anti-Seizure burden decreased. Conclusions: Training experienced NICU nurses to set-up, start and monitor cvEEG can decrease the time to initiate cvEEG which may lead to better seizure diagnosis and management.
Introduction: Delays in transfer to an in-patient bed of admitted patients boarded in the ED has been identified as one of the chief drivers of ED overcrowding. Our study aims to replicate findings from a previous study in identifying patient characteristics associated with increased boarding time, and the impact of increased boarding time on in-patient length of stay (IPLOS). Methods: We conducted a retrospective single-centre observational study during the period between January 1, 2015 December 31, 2015 at a very high volume community hospital (~ 75,000 ED visits/year). All patients admitted from the ED to Medicine, Pediatrics, Surgery, and Critical Care were identified. The mean time to in-patient bed (TTB), as well as patient-specific and institutional factors that were associated with prolonged boarding times ( 12 hours) were identified. Mean IP LOS was calculated for those with prolonged boarding times and compared to those without prolonged boarding times. Results: There were 8,096 unique admissions during the study period. Patients admitted to the Medicine service exhibited significantly higher boarding times than those admitted to other services, with a mean boarding time of 17.4 hrs, as compared to 4.2 hrs, 5.7 hrs, and 4.0 hrs for those admitted to Surgery, Critical Care and Pediatrics respectively. Within Medicine patients, there was a statistically significant greater odds of prolonged boarding time for patients who were older, had a greater comorbidity burden, and required more specialized in-patient care (i.e. an isolation bed or telemetry bed). Medicine patients with prolonged boarding times also experienced 0.7 days longer IP LOS, even after correcting for age and comorbidity (mean adjusted IP LOS 10.6 days versus 11.3 days). Conclusion: Within our study period, older, sicker patients and those patients requiring more resource-intensive in-patient care have the longest ED boarding times. These prolonged ‘boarding’ times are associated with significantly increased IP LOS.
To evaluate the effects of oral steroids alone or followed by intranasal steroids versus watchful waiting on the resolution of otitis media with effusion in children aged 2–11 years.
A total of 290 children with bilateral otitis media with effusion were assigned to 3 groups: group A was treated with oral steroids followed by intranasal steroids, group B was treated with oral steroids alone and group C was managed with watchful waiting. Patients were evaluated with audiometry and tympanometry.
The complete resolution rates of otitis media with effusion were higher in groups A and B than in group C at six weeks. There were no significant differences in otitis media with effusion resolution rates between the groups at three, six and nine months.
Oral steroids lead only to a quick resolution of otitis media with effusion, with no long-term benefits. There was no benefit of using intranasal steroids in the management of otitis media with effusion.