scholarly journals Effectiveness of Non-Pharmaceutical Interventions on Child and Staff COVID-19 Cases in US Summer Camps

2021 ◽  
Author(s):  
Helen H. Suh ◽  
Julianne Meehan ◽  
Laura Blaisdell ◽  
Laurie Browne
Keyword(s):  
Large Population ◽  
Relative Effectiveness ◽  
National Level ◽  
Population Based ◽  
Summer Camps ◽  
Limited Information ◽  
Effective Constant ◽  
New Information ◽  
The Us ◽  
Pharmaceutical Interventions

AbstractBackgroundMost camps remained closed during Summer 2020, due to concerns regarding child transmission of SARS-CoV-2 and limited information about the effectiveness of non-pharmaceutical interventions (NPIs) within child congregate settings.MethodsWe surveyed US camps about on-site operations, camper and staff demographics, COVID-19 cases amongst campers and staff, and NPI usage as related to pre-camp quarantines, facial coverings, physical distancing, cleaning, and facility modifications. For all NPIs, save quarantines, responses were provided on a 5-point Likert scale format.ResultsWithin 486 on-site camps, a range of NPIs were instituted, most often related to reduced camper interactions, staff face coverings, cleaning, and hand hygiene. Camper facial coverings were less common, with campers always wearing masks at ∼34% of the camps. Approximately 15% of camps reported 1+ confirmed COVID-19 case in either campers or staff, with three camps reporting a COVID outbreak. In both single and multi-NPI analyses, the risk of COVID-19 cases was lowest when campers always wore facial coverings. While less effective, constant use of staff facial coverings and targeted physical distancing measures, but not pre-camp quarantine, also reduced COVID-19 risks.ConclusionsWe found constant facial coverings, especially for campers, and targeted physical distancing measures to reduce risks of SARS-CoV-2 transmission within summer camps. Our findings provide valuable guidance for future operations of camp and other child congregate settings with regard to efficient and effective NPI usage to mitigate SARS-CoV-2 infection.What’s Known on This SubjectApproximately 82% of US overnight camps did not open during Summer 2020 due to concerns regarding children’s ability to transmit SARS-CoV-2. Camps that did operate during this time instituted varied non-pharmaceutical interventions (NPIs) to reduce SARS-CoV-2 transmission, with little information available on the effectiveness of these NPIs within child congregate settings. Large population-based studies are needed to improve our understanding of the extent of SARS-CoV-2 infection amongst children and their caregivers and to determine whether and to what degree child congregate programs can safely open during the pandemic.What This Study AddsOur study, the largest survey of COVID-19 cases in child congregate settings at the national level, provides new information on the relative effectiveness of NPIs on mitigating COVID cases among children and staff within camp settings. We showed COVID-19 case rates in campers and staff to be low relative to corresponding case rates in the US and found constant camper facial coverings to be the most effective risk reduction method for SARS-CoV-2 transmission within camps. While less effective, constant use of staff facial coverings and targeted physical distancing measures, but not pre-camp quarantines, were also shown to reduce COVID-19 risks. Our findings has important implications for child congregate settings, helping to guide their successful opening and operation.

Abstract P256: Association Between Antidepressants Use and Intracerebral Hemorrhage: Florida Stroke Registry

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mithilesh Siddu ◽  
Antonio Bustillo ◽  
Carolina M Gutierrez ◽  
Kefeng Wang ◽  
Hannah Gardener ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Oral Anticoagulants ◽  
Large Population ◽  
Multivariable Analysis ◽  
Population Based ◽  
Prior History ◽  
Stroke Registry ◽  
The Us ◽  
History Of ◽  
Antidepressant Use

Introduction: SSRIs, the most commonly prescribed antidepressants (AD) in the US, are linked to an increased intracerebral hemorrhage (ICH) risk possibly related to impaired platelet function. In the Florida Stroke Registry (FSR), we studied the proportion of cases presenting with ICH amongst AD users and the rate of SSRI prescription amongst stroke patients discharged on AD. Methods: From Jan 2010 to Dec 2019 we included 127,915 cases from FSR in whom information on AD use was available. Multivariable logistic regression was used to evaluate ICH proportions amongst AD and non-AD users and rates of prescribed SSRIs at discharge. Results: The rate of ICH amongst prior AD users (n=17,009, median age 74, IQR=19) and non-AD users (n=110,906, median age 72, IQR=21) were 11% and 14% respectively. Prior AD users were more likely to be female (17% vs. 10% male), non-Hispanic White (16% vs. 8% non-Hispanic Black vs. 12% Florida Hispanic vs. 6% Puerto Rican Hispanic), have hypertension (HTN) (14.% vs. 10%), diabetes mellitus (DM) (16% vs.12%), use oral anticoagulants (OAC) (17 % vs. 13%), antiplatelets (AP; 17% vs. 11%), and statins (17% vs. 10%) prior to hospital presentation. In multivariable analysis adjusting for age, race, prior history of HTN, DM, prior OAC, AP and statin use, AD users just as likely to present with spontaneous ICH as compared to non-AD users (OR=0.92, 95% CI 0.85, 1.01). A total of 3.4% of all ICH patients and 9% of those in whom AD information was available were discharged home on an AD (74 % SSRI, 24% other AD). Conclusion: In this large population-based study, we did not find an association between prior AD use and an increased rate of ICH. Importantly AD (mostly SSRIs) are commonly prescribed to patients with ICH in routine clinical practice. The association between types, duration, and safety of antidepressant use in ICH patients deserves further studies.

Abstract P005: Comparative Effectiveness of Rivaroxaban versus Warfarin for the Treatment of Patients with Non-valvular Atrial Fibrillation

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Faye L Norby ◽  
Lindsay G Bengtson ◽  
Lin Y Chen ◽  
Richard F MacLehose ◽  
Pamela L Lutsey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Real World ◽  
Proportional Hazards ◽  
Large Population ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Gi Bleeding ◽  
Cox Proportional Hazards Models ◽  
The Us

Background: Rivaroxaban is a novel oral anticoagulant approved in the US in 2011 for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). Information on risks and benefits among rivaroxaban users in real-world populations is limited. Methods: We used data from the US MarketScan Commercial and Medicare Supplemental databases between 2010 and 2013. We selected patients with a history of NVAF and initiating rivaroxaban or warfarin. Rivaroxaban users were matched with up to 5 warfarin users by age, sex, database enrollment date and drug initiation date. Ischemic stroke, intracranial bleeding (ICB), myocardial infarction (MI), and gastrointestinal (GI) bleeding outcomes were defined by ICD-9-CM codes in an inpatient claim after drug initiation date. Cox proportional hazards models were used to assess the association between rivaroxaban vs. warfarin use and outcomes adjusting for age, sex, and CHA2DS2-VASc score. Separate models were used to compare a) new rivaroxaban users with new warfarin users, and b) switchers from warfarin to rivaroxaban to continuous warfarin users. Results: Our analysis included 34,998 rivaroxaban users matched to 102,480 warfarin users with NVAF (39% female, mean age 71), in which 487 ischemic strokes, 179 ICB, 647 MI, and 1353 GI bleeds were identified during a mean follow-up of 9 months. Associations of rivaroxaban vs warfarin were similar in new users and switchers; therefore we pooled both analyses. Rivaroxaban users had lower rates of ICB (hazard ratio (HR) (95% confidence interval (CI)) = 0.72 (0.46, 1.12))) and ischemic stroke (HR (95% CI) = 0.88 (0.68, 1.13)), but higher rates of GI bleeding (HR (95% CI) = 1.15 (1.01, 1.33)) when compared to warfarin users (table). Conclusion: In this large population-based study of NVAF patients, rivaroxaban users had a non-significant lower risk of ICB and ischemic stroke than warfarin users, but a higher risk of GI bleeding. These real-world findings are comparable to results reported in published clinical trials.

scholarly journals Largely varying patterns and trends of primary cancer-directed resection for gastric carcinoma with synchronous distant metastasis in Europe and the US: a population-based study calling for further standardization of care

2021 ◽  
Vol 13 ◽  
pp. 175883592110278
Author(s):  
Lei Huang ◽  
Lina Jansen ◽  
Rob H.A. Verhoeven ◽  
Jelle P. Ruurda ◽  
Liesbet Van Eycken ◽  
...  
Keyword(s):  
Gastric Carcinoma ◽  
Distant Metastasis ◽  
Associated Factors ◽  
Large Population ◽  
Population Based ◽  
Primary Cancer ◽  
Association Patterns ◽  
Adjacent Structures ◽  
The Us

Aims: The role of resection remains debated in cases of metastatic gastric carcinoma (mGC). Some mGCs are technically resectable. At the population level, the real-world application of resection for mGC remains largely unclear in most Western countries. This large, population-based international investigation aimed to reveal the resection patterns and trends for mGC and the treatment-associated factors in Europe and the US. Methods: Data on cases with microscopically-confirmed primary invasive stomach carcinoma with distant metastasis were obtained from the nationwide cancer registries of the Netherlands, Belgium, Norway, Sweden, Estonia, and Slovenia and the US Surveillance, Epidemiology, and End Results-18 database. We calculated age-standardized rates of primary cancer-directed resection and assessed resection trends using linear regression. We investigated associations of treatment with patient and cancer factors using multivariable-adjusted log-binomial regression. Results: Among 133,321 patients with gastric cancer, overall, 40,215 cases with mGC diagnosed between 2003–2017 were investigated. Age-standardized resection rates significantly declined over time in the US, Belgium, Sweden, and Norway (by 5–14%). Resection rates greatly differed from 5% to 16% in 2013–2014. Cases with older ages, cardia tumors, or tumors involving adjacent structures were significantly less often operated across most countries. Sex was not significantly associated with resection. Across countries the association patterns and strengths differed largely. With multivariable adjustment, resection rates decreased significantly in all countries except Slovenia and Estonia (prevalence ratio per year = 0.90–0.98), and the decreasing trends were consistently observed in various stratifications by age and location. Conclusion: In Europe and the US, resection patterns and trends largely varied across countries for mGCs, which were mostly less often resected in the early 21st century. Various resection-associated factors were shown, with greatly varying association patterns and strengths. Our report could aid to identify discrepancies in clinical practice and highlight the great need for further clarifying the role of resection in mGCs to enhance standardization of care.

scholarly journals Non-pharmaceutical interventions and COVID-19 cases in US summer camps: results from an American Camp Association survey

2021 ◽  
pp. jech-2021-216711
Author(s):  
Helen H Suh ◽  
Julianne Meehan ◽  
Laura Blaisdell ◽  
Laurie Browne
Keyword(s):  
Hand Hygiene ◽  
Likert Scale ◽  
Summer Camps ◽  
Limited Information ◽  
Child Transmission ◽  
Scale Format ◽  
Pharmaceutical Interventions

BackgroundMost camps remained closed during Summer 2020, due to concerns regarding child transmission of SARS-CoV-2 and limited information about the effectiveness of non-pharmaceutical interventions (NPIs) within child congregate settings.MethodsWe surveyed US camps about on-site operations, camper and staff demographics, COVID-19 cases among campers and staff, and NPI usage as related to pre-camp quarantine, facial coverings, physical distancing, cleaning and facility modifications. For all NPIs, save quarantine, responses were provided on a 5-point Likert scale format.ResultsWithin 486 on-site camps, a range of NPIs were instituted, most often related to reduced camper interactions, staff face coverings, cleaning and hand hygiene. Camper facial coverings were less common, with campers always wearing masks at ~34% of the camps. Approximately 15% of camps reported 1+ confirmed COVID-19 case in either campers or staff, with three camps reporting a COVID-19 outbreak. In both single and multi-NPI analyses, the risk of COVID-19 cases was lowest when campers always wore facial coverings. Constant use of staff facial coverings and targeted physical distancing measures, but not pre-camp quarantine, also reduced COVID-19 risks.ConclusionsWe found constant facial coverings, especially for campers, and targeted physical distancing measures to reduce risks of SARS-CoV-2 transmission within summer camps. Our findings provide valuable insights for future operations of summer camps and other child congregate settings regarding the use of NPIs to reduce the risk of SARS-CoV-2 infection.

scholarly journals Risk and Prognosis of Secondary Bladder Cancer After Radiation Therapy for Rectal Cancer: A Large Population-Based Cohort Study

2021 ◽  
Vol 10 ◽  
Author(s):  
Xu Guan ◽  
Ran Wei ◽  
Runkun Yang ◽  
Zhao Lu ◽  
Enrui Liu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Bladder Cancer ◽  
Radiation Therapy ◽  
General Population ◽  
Large Population ◽  
Population Based ◽  
Competing Risk ◽  
Increased Risk ◽  
The Us ◽  
The Impact

BackgroundAlthough radiation therapy (RT) improves local control for rectal cancer (RC), the long-term risks from RT, including development of a secondary malignancy, are controversial. The risk and prognosis of secondary bladder cancer (SBC) in RC patients undergoing RT have not been adequately studied. Our goal is to investigate the impact of RT on the risk of developing SBC and assess their survival outcomes.MethodsThis large population-based study included RC patients as their initial primary cancer from nine registries of the Surveillance, Epidemiology and End Results (SEER) database between 1973 and 2015. The cumulative incidence of SBC was assessed by using Fine and Gray’s competing risk regression. The standardized incidence ratio (SIR) was used to compare the incidence of SBC in RC survivors to the US general population. The Kaplan-Meier method was used to evaluate the 10-year overall survival (OS) and 10-year cancer specific survival (CSS) for patients with SBC.ResultsOf 74,646 RC patients, 24,522 patients were treated with surgery and RT and 50,124 patients were treated with surgery alone. The incidence of SBC was 1.85% among patients who received RT and 1.24% among patients who did not. The incidence of SBC in RC patients who received RT was higher than the US general population (SIR, 1.35; 95% CI, 1.19-1.53, P<0.05), and decreased with increasing age at diagnosis, and increased with time since diagnosis. In competing risk regression analysis, undergoing RT was associated with a higher risk of SBC (hazard ratio [HR], 1.443, 95% confidence interval [CI], 1.209-1.720; P<0.001). The results of the dynamic SIR for SBC revealed that a slightly increased risk of SBC was observed after RT in the early latency, and was significantly related to the variations of age at RC diagnosis and decreased with time progress. The 10-year OS and CSS among SBC patients after RT were comparable to SBC patients after NRT.ConclusionRadiation was associated with an increased risk of developing SBC in RC patients, and special attention should be paid to the surveillance of these patients.

A simple but effective model to decrease early deaths in acute promyelocytic leukemia (APL).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6573-6573
Author(s):  
Anand P. Jillella ◽  
Ibrahim Sadek ◽  
Devi Morrison ◽  
Kavita Natrajan ◽  
Farrukh Tauseef Awan ◽  
...  
Keyword(s):  
High Risk ◽  
Large Scale ◽  
Causes Of Death ◽  
Large Population ◽  
Treatment Algorithm ◽  
Treatment Protocol ◽  
Population Based ◽  
Low Risk ◽  
Recent Analysis ◽  
The Us

6573 Background: Recent reports suggest that approximately 30% of patients with APL die during induction. This has been confirmed in large population-based studies in Sweden and the US. A recent analysis of SEER data from 13 population-based cancer registries with 1400 APL patients in the US showed that 17% of all patients and 24% of patients greater than 55 years of age die within one month of diagnosis. The most common causes of death are bleeding, infection, differentiation syndrome and multi-organ failure. Patients who survive induction have an excellent cure rate with few late relapses. Hence, decreasing early deaths is a high priority both at experienced as well as smaller centers with limited leukemia treatment experience in this highly curable disease. Methods: At Georgia Health Sciences University, between 7/2005 and 6/2009, 19 patients were diagnosed with APL. Seven patients (5 high-risk and 2 low-risk) died during induction resulting in an unusually high mortality rate of 37%. All patients who survived induction are still in remission at present. The high early death rate prompted us to develop a simple, 2 page treatment algorithm that focuses on quick diagnosis, prompt initiation of therapy, and proactive and aggressive management of all the major causes of death during induction. We also made our treatment protocol available to smaller treatment centers and helped the treating oncologists manage the patient during the first few days after diagnosis. Results: From 11/2010 to 12/2011, we treated 4 patients at GHSU and helped manage 4 patients at 2 outreach sites. The age range was 30 to 60; two patients were high-risk, 5 intermediate- and one low-risk. There were no deaths during induction and all eight patients proceeded to consolidation treatment. Conclusions: While we recognize that this is a small cohort, our own experience and a similar approach pioneered by investigators in Brazil clearly shows this to be an effective intervention to decrease early deaths in APL. We believe our experience warrants large scale implementation of our protocol in an attempt to reduce early APL mortality.

scholarly journals P-OGC15 Impact of postoperative systemic treatment on survival for oesophageal adenocarcinoma after preoperative chemotherapy and oesophagectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Saqib Rahman ◽  
Betsan Thomas ◽  
Nick Maynard ◽  
Min Hae Park ◽  
Muhammed Wahedally ◽  
...  
Keyword(s):  
Preoperative Chemotherapy ◽  
Oesophageal Cancer ◽  
Surgical Complications ◽  
Large Population ◽  
National Level ◽  
Population Based ◽  
Postoperative Chemotherapy ◽  
Oesophageal Adenocarcinoma ◽  
Survival Times ◽  
Postoperative Therapy

Abstract Background Perioperative chemotherapy is widely used in the treatment of oesophageal cancer with substantial survival benefit over surgery alone. However, the postoperative part of these regimens is given in less than half of cases, reflecting uncertainty about its benefit. This study estimates the effect of postoperative chemotherapy after surgery for oesophageal cancer using a large population-based dataset and modern statistical methods. Methods Patients with oesophageal adenocarcinoma diagnosed between 2012 and 2018 and underwent preoperative chemotherapy followed by surgery, were identified from a national level audit in England and Wales (National Oesophagogastric Cancer Audit). Postoperative therapy was defined as the receipt of at least one cycle of systemic chemotherapy within 90 days of surgery. The comparative effectiveness of postoperative chemotherapy compared to observation was estimated using inverse propensity treatment weighting (IPTW). Results The study included 2,814 patients, in whom postoperative therapy was given to 1,054 (37.5%). Patients who received postoperative therapy were younger, with a lower ASA grade and were less likely to have surgical complications of any type, including anastomotic leak (all p < 0.001). Tumour characteristics were similar in both groups. Weighted median survival times for patients having no treatment or postoperative chemotherapy were 45.4 months and 57.5 months respectively. There was a life expectancy difference at five years of 2.9 months in favour of postoperative chemotherapy (95%CI 1.1–4.8 months, p < 0.001) with a Hazard Ratio of 0.80 (95%CI 0.70-0.91, p < 0.001). Conclusions Among patients with oesophageal adenocarcinoma treated with preoperative chemotherapy and surgery, improved overall survival was observed in those patients who received postoperative chemotherapy. Minimising surgical complications and improving patient fitness could increase the use of postoperative chemotherapy, leading to better outcomes for patients with oesophageal adenocarcinoma. 

Sign in / Sign up

Export Citation Format

Share Document