METHODS:A retrospective analysis of the HealthCore Integrated Research Database (HIRD) was conducted to estimate the incidence, costs, and predictors of COPD exacerbations. The study population included CB patients aged Ն40 years with Ն2 years of continuous enrollment in the HIRD, Ն1 hospitalization/emergency department (ED) visit or Ն2 outpatient visits with CB diagnosis (ICD-9-CM 491.xx) from January 1, 2004 to May 31, 2011, and Ն2 pharmacy fills for COPD medications during the follow-up year (the first fill served as the index date). Patients with asthma, cystic fibrosis, respiratory tract cancer, and long-term oral corticosteroid use were excluded. COPD exacerbations were categorized as severe (hospitalization with COPD as primary diagnosis) or moderate (ED visit with a primary COPD diagnosis or an oral corticosteroid filled within 7 days of a COPD-related office visit). When multiple exacerbations occurred within a 14-day window, only one (the most severe, if applicable) was counted. Prevalence, costs, and predictors of exacerbations were measured. RESULTS: A total of 17,382 treated CB patients met inclusion/ exclusion criteria (50.6% female, mean age 66.7Ϯ11.4 years). During pre-index year, 25% had moderate or severe and 14.3% had severe exacerbations. During the postindex year, the mean COPD maintenance medication fills number was 7.6Ϯ6.3; 42.6% experienced moderate or severe and 24.7% experienced severe exacerbations. Mean exacerbation-related healthcare costs were $8,219Ϯ$22,644 per moderate or severe and $18,120Ϯ$31,592 per severe exacerbation. Incidence of baseline exacerbation was the best predictor of post-index incidence of exacerbation (ϭ0.2595, pϽ0.0001) and also predicted post-index exacerbation-related costs (ϭ0.0870, pϽ0.0002). CONCLUSIONS: CB individuals' exacerbation rates remain high despite treatment with COPD maintenance medications. New treatment strategies designed to reduce CB exacerbations and associated costs should focus on patients with high prior-year exacerbation rates.OBJECTIVES: Invasive aspergillosis (IA) is a major infectious complication in inmonusupressed patients. Its incidence ranges from 5 percent to more than 20 percent A55
Este artículo evalúa la relación entre la política fiscal y la deuda pública en el marco de la financiarización de la economía. Se hace un estudio teórico-analítico, que se complementa con una regresión econométrica. La importancia de este análisis radica en que la deuda pública representa un problema para el desarrollo de los países periféricos y las soluciones propuestas no logran transformar esta realidad. Se concluye que, para el caso colombiano, la política fiscal es procíclica y que la política económica está supeditada al funcionamiento del capital financiero, por lo que la política fiscal no resuelve los problemas económicos del país.
En el siguiente trabajo nos proponemos analizar e1 proceso desarrollado en el marco del acuerdo EFI del 2014. Particularmente, nos centraremos en visibilizar y analizar la dimensión inter y transdiciplinaria del proyecto y las tensiones que se presentan en torno a las mismas para pensar las diferentes prácticas de extensión universitaria. De este modo, en la medida que, el proyecto es integrado por educación física, nos proponemos problematizar a partir de esta experiencia particular la tensión a la que desde la disciplina nos enfrentamos. Nos basamos, en tres documentos elaborados por el EFI Movimientos barriales y manifestaciones de la cultura, en los que se establecen los acuerdos de trabajo para la intervención de los servicios universitarios en el Programa Integral Metropolitano.
BackgroundIn Colombia, clinical characteristics related to invasive pneumococcal disease (IPD) and circulating pneumococcal serotypes (ST) in adults are scarce. We aimed to describe the clinical and microbiological characteristics of IPD in hospitalized adults ≥18 years old in 5 tertiary hospitals in Colombia from 2011 to 2017.MethodsA descriptive, observational, retrospective study was conducted in 5 tertiary care hospitals during a 7-year period. Demographic, clinical data and in-hospital outcomes were collected through chart review from all culture-confirmed invasive S. pneumoniae cases in each hospital. The National Health Institute laboratory database was assessed to obtain information about ST (Quellung) and antimicrobial susceptibility (Broth microdilution).Results128 cases of IPD were included in this interim analysis, 70(54.7%) were males. The median age was 58 ± 16.7 years. Main underlying conditions were cardiovascular disease (32%), smoking (27.9%), diabetes (20.3%), autoimmune diseases (18.8%), and cancer (18%). The main clinical presentation was bacteremic pneumonia (66.4%), followed by meningitis (14.8%), bacteremia (14.1%) and other (3.1%). Critical care management was required in more than half of the patients: ICU (60.2%), mechanical ventilation (53%) and inotropic support (51.6%). The overall in-hospital mortality rate was 43% and was 39%, 52.6% and 61% for pneumonia, meningitis and bacteremia, respectively. ST was known for 82(64%) cases, most frequent ST were: 3(10.9%), 14(7.3%), 19A(6,1%), 1(4.8%), 4/8/11A/22F (3.65% for each one). ST contained in 13-valent conjugate vaccine (PCV13), 23-valent pneumococcal vaccine (PPVS23) and non-vaccine serotypes accounted for 43.9%, 54.9%, and 40.2% of IPD cases, respectively (Figure 1). 83% and 80.7% strains were susceptible to penicillin and ceftriaxone, respectively.ConclusionPneumonia is the most common clinical presentation of IPD among adults. The clinical outcome was severe with high mortality rate and need of critical care management. ST contained in PCV13 and PPVS23 accounted for 43.9% and 54.9% of IPD cases. This study highlights the importance to strengthen local surveillance and the implementation of pneumococcal immunization programs in high-risk population. Disclosures All authors: No reported disclosures.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.