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The objective of the present study was to evaluate the risk factors and outcomes associated with hyponatremia in patients with Guillain-Barré syndrome (GBS). We retrospectively studied 80 consecutive patients with GBS who visited our hospital and compared clinical, laboratory, and electrophysiological findings of patients with and without hyponatremia. Disability was evaluated using the Hughes grading system. Of the 80 patients, 18 (23%) had hyponatremia. Hyponatremia was significantly associated with older age (P = 0.003), urinary retention (P < 0.0001), Hughes grade ≥ 4 at admission and nadir (P = 0.003 and P < 0.001, respectively), acute inflammatory demyelinating polyneuropathy subtype (P = 0.017), sepsis (P = 0.001), mechanical ventilator support (P = 0.013), longer hospitalization length of stay (P < 0.0001), and inability to walk independently at 6 months (P < 0.001). Multivariate analysis performed to assess the risk factors of hyponatremia revealed that urinary retention (odds ratio [OR] 30.7, 95% confidence interval [CI] 3.6–264.4; P = 0.002) and mechanical ventilator support (OR 13.8, 95% CI 1.6–118.0; P = 0.017) were significant independent risk factors of hyponatremia. In assessing the outcomes of patients with hyponatremia, multivariate analysis showed that hyponatremia was independently associated with hospitalization length of stay ≥ 60 days and inability to walk independently at 6 month, with the former showing statistical significance but the latter not (OR 9.3, 95% CI 1.8–47.7; P = 0.007 and OR 4.9, 95% CI 0.9–26.3; P = 0.066, respectively). Therefore, we demonstrate that, along with mechanical ventilator support, urinary retention—possibly indicating autonomic dysfunction—is a risk factor of hyponatremia in GBS. Moreover, we confirm that hyponatremia is associated with poor outcome in GBS. [ABSTRACT FROM AUTHOR]

CONTEXT: The COVID-19 pandemic highlights the importance of strong public health (PH) and primary health care (PHC) systems to respond nimbly and effectively during times of crisis. Both play a crucial role in triage and prevention, management, vaccination, and communication. PH and PHC systems, however, often act in parallel streams, but rarely together. OBJECTIVE: This study aims to describe PH and PHC collaboration during the COVID-19 pandemic in eight high-income countries. METHODS: In-depth case study reports were generated for each country or jurisdiction. Reports searched both peer-review publications and grey literature on five dimensions identified by the World Health Organization regarding COVID-19 management. Reports included country-specific health system descriptions, PH and PHC actions during the pandemic, and an evaluation of strengths and weaknesses. Expert validation was conducted by internal country stakeholders prior to cross-jurisdiction analyses. ANALYSIS: Thematic content analysis was conducted on all reports to develop a coding framework. Codes were identified that were relevant to the research questions. The study team discussed and reconciled discrepancies in themes until consensus was reached. RESULTS: Data was collected from eight high-income countries (Belgium, Canada, Germany, Italy, Japan, the Netherlands, Norway, and Spain) from March 2020 to July 2021. Four key themes were identified along with respective strengths/weaknesses. 1) Health information systems: this played a critical role for disease containment and management when designed for efficient data management and cross-sectoral data-sharing. 2) Communication: In countries where PHC was engaged early on, PH messages were amplified; in other countries, a lack of cohesion in communication resulted in poor or delayed community-level responses. 3) Human resource capacity: Health human resources were overwhelmed, with many staff redeployed and undertrained. 4) Professional training: Health professionals who received dual training in PH and PHC acted as strong community champions and may be a bridge for future pandemics. CONCLUSION: Health system needs shifted dramatically throughout the COVID-19 pandemic. Our findings highlight four key lessons regarding PH and PHC collaboration from eight high-income countries. Future pandemic preparedness should focus on health information systems and data management, PH communication, health human resources, and education and training., Presenters Jane Zhao, MSc, Carnelle Lawes, MPH, BSW, Dorien Vanden Bossche, Sara Willems, PhD, Ayu Pinky Hapsari, MSc, Sara Ares Blanco, Maria Pilar Astier Pena, MD, PhD, Peter Decat, Naoki [...]

Objective This study aimed to establish prediction models for respiratory-related mortality in microscopic polyangiitis (MPA) complicated by interstitial lung disease (ILD) using clinical characteristics. Methods We enrolled patients with MPA with ILD between May 2005 and June 2021 in a multicentre cohort of Japanese patients with MPA (REVEAL cohort). We evaluated the demographic, clinical, laboratory, radiological findings, treatments and the presence of honeycombing 1 cm above the diaphragm using chest high-resolution CT (HRCT) on admission. We explored the risk factors predictive of respiratory-related mortality. Results Of 115 patients, 26 cases died of respiratory-related diseases during a median follow-up of 3.8 years. Eighteen patients (69%) died due to respiratory infection, three (12%) had diffuse alveolar haemorrhage, and five (19%) had exacerbation of ILD. In univariate analysis, older age, lower percent forced vital capacity (%FVC), lower percent diffusing capacity of carbon monoxide (%DLCO), and the presence of honeycombing in the right lower lobe were identified as risk factors. Additionally, in multivariate analysis adjusted for age and treatment, %FVC, %DLCO and the presence of honeycombing in the right lower lobe were independently associated with respiratory-related mortality. We created prediction models based on the values of %FVC, %DLCO and presence of honeycombing on chest HRCT (termed "MPF model"). The 5-year respiratory-related death-free rate was significantly different between patients with MPA with ILD stratified by the number of risk factors based on the MPF model. Conclusions Our study indicates that the MPF model may help predict respiratory-related death in patients with MPA with ILD. [ABSTRACT FROM AUTHOR]

Objectives: Exemption from paying dental care costs among recipients of public assistance contributes to universal health care coverage. Although this system might reduce the financial barriers to dental care among patients, there are still several other barriers for public assistance recipients. Therefore, this study examined whether receiving public assistance was associated with a higher prevalence of dental visits for any reason, treatment and prevention. Methods: Data were obtained from 16 366 respondents from the 2019 wave of a nationwide cohort study on older adults in Japan. Poisson regression analyses with robust error variance were used to examine the associations between receiving public assistance and dental visits, adjusting for number of teeth, dental pain, periodontal conditions, age, sex, number of family members, education, equivalent household income, working status, instrumental activities of daily living, medical conditions, depressive symptoms, instrumental support and geographical variations. Results: More than half of the non‐recipients of public assistance visited a dentist for some reason in the past 6 months. Meanwhile, only 37% of the recipients visited a dentist. In addition, almost half of the non‐recipients had treatment visits, while only 34% of the recipients visited. Furthermore, 46% of the non‐recipients had dental visits for prevention, while 32% of the recipients had preventive visits. In the fully adjusted models, compared to non‐recipients, public assistance recipients were 24% (Prevalence Ratio [PR]: 0.76, 95% Confidence Intervals [CI]: 0.64, 0.90), 23% (PR: 0.77, 95% CI: 0.65, 0.92) and 21% (PR: 0.79, 95% CI: 0.65, 0.95) less likely to have dental visits for any reason, treatment, and prevention, respectively. Conclusions: Although recipients were exempted from dental treatment fees, receiving public assistance was associated with a lower prevalence of dental visits for any reason, treatment and prevention. Future studies should identify the barriers to accessing dental care among public assistance recipients to improve dental visits. [ABSTRACT FROM AUTHOR]

Background: We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. Methods: This single‐center, ambidirectional cohort study of 548 consecutive patients ≥20 years of age was performed in the ED of a university hospital in Japan over a 13‐month period. Pairs of blood samples were collected for aerobic and anaerobic cultures from patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. Results: Potential contamination was identified in 110 of the 548 patients (20.1%). One hundred fourteen (20.8%) patients showed true‐positive results for bacteremia, and 324 (59.1%) patients showed true‐negative results. Multivariate analysis revealed more frequent contamination when puncture sites were disinfected with povidone‐iodine (PVI) than with alcohol/chlorhexidine (ACHX) (adjusted risk difference, 19.1%; 95% confidence interval [CI]), 15.7–22.6; p < 0.001). In terms of blood collection sites, femoral and central venous (CV) catheter with PVI disinfection showed more frequent contamination than venous sites with ACHX (adjusted risk differences: 26.6%, 95% CI 21.3–31.9, p < 0.001 and 41.1%, 95% CI 22.2–59.9, p < 0.001, respectively). Conclusion: Rates of contaminated blood cultures were significantly higher when blood was collected from the CV catheter or femoral sites with PVI as the topical disinfectant. [ABSTRACT FROM AUTHOR]

The aim of this multi-centre retrospective study was to clarify the prognostic factors for respiratory-related death in patients with interstitial lung disease (ILD) complicated rheumatoid arthritis (RA). Patient background data, treatment regimen, and disease activity indicators of RA and ILD at baseline, 6 months after the diagnosis of ILD, and at the last follow-up visit were extracted. A total of 312 patients with RA-ILD (17 patients who died from respiratory-related causes and 295 survivors) were included. Patients who died from respiratory-related causes had an older median age, a higher proportion of being male, and a higher anti-cyclic citrullinated peptide antibody positivity rate than survivors (p =.0001, .038, and .016, respectively); they also had significantly higher baseline serum levels of Krebs von den Lungen-6 (KL-6) than survivors (p =.013). Patients who died from respiratory-related causes showed significantly greater changes in serum KL-6 levels between the 6-month time point and the last visit [ΔKL-6 (6 months - last)] than survivors (p =.011). Multivariate analysis showed that the ΔKL-6 (6 months - last) corrected by disease duration was a predictor of respiratory-disease-related death in patients with RA-ILD (p < .0001). Long-term increase in serum KL-6 levels is associated with respiratory-disease related death in patients with RA-ILD. [ABSTRACT FROM AUTHOR]