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Association of Time of Day with Delays in Antimicrobial Initiation among Ward Patients with Hospital-Onset Sepsis. 病房中的住院败血症患者每天使用抗菌药物的时间与延迟使用抗菌药物的关系
IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-09-01 DOI: 10.1513/AnnalsATS.202302-160OC
Jennifer C Ginestra, Rachel Kohn, Rebecca A Hubbard, Catherine L Auriemma, Mitesh S Patel, George L Anesi, Meeta Prasad Kerlin, Gary E Weissman

Rationale: Although the mainstay of sepsis treatment is timely initiation of broad-spectrum antimicrobials, treatment delays are common, especially among patients who develop hospital-onset sepsis. The time of day has been associated with suboptimal clinical care in several contexts, but its association with treatment initiation among patients with hospital-onset sepsis is unknown. Objectives: Assess the association of time of day with antimicrobial initiation among ward patients with hospital-onset sepsis. Methods: This retrospective cohort study included ward patients who developed hospital-onset sepsis while admitted to five acute care hospitals in a single health system from July 2017 through December 2019. Hospital-onset sepsis was defined by the Centers for Disease Control and Prevention Adult Sepsis Event criteria. We estimated the association between the hour of day and antimicrobial initiation among patients with hospital-onset sepsis using a discrete-time time-to-event model, accounting for time elapsed from sepsis onset. In a secondary analysis, we fit a quantile regression model to estimate the association between the hour of day of sepsis onset and time to antimicrobial initiation. Results: Among 1,672 patients with hospital-onset sepsis, the probability of antimicrobial initiation at any given hour varied nearly fivefold throughout the day, ranging from 3.0% (95% confidence interval [CI], 1.8-4.1%) at 7 a.m. to 13.9% (95% CI, 11.3-16.5%) at 6 p.m., with nadirs at 7 a.m. and 7 p.m. and progressive decline throughout the night shift (13.4% [95% CI, 10.7-16.0%] at 9 p.m. to 3.2% [95% CI, 2.0-4.0] at 6 a.m.). The standardized predicted median time to antimicrobial initiation was 3.2 hours (interquartile range [IQR], 2.5-3.8 h) for sepsis onset during the day shift (7 a.m.-7 p.m.) and 12.9 hours (IQR, 10.9-14.9 h) during the night shift (7 p.m.-7 a.m.). Conclusions: The probability of antimicrobial initiation among patients with new hospital-onset sepsis declined at shift changes and overnight. Time to antimicrobial initiation for patients with sepsis onset overnight was four times longer than for patients with onset during the day. These findings indicate that time of day is associated with important care processes for ward patients with hospital-onset sepsis. Future work should validate these findings in other settings and elucidate underlying mechanisms to inform quality-enhancing interventions.

理由:虽然脓毒症治疗的主要方法是及时开始使用广谱抗菌药物,但治疗延误的情况很常见,尤其是在医院发生的脓毒症患者中。在一些情况下,一天中的时间与次优临床护理有关,但其与医院脓毒症患者开始治疗的关系尚不清楚。目标:评估一天中的时间与脓毒症患者接受治疗的相关性:评估病房脓毒症患者开始使用抗菌药物的时间与治疗的相关性。方法:进行回顾性队列研究:这项回顾性队列研究纳入了从 2017 年 7 月到 2019 年 12 月在一个医疗系统的五家急症医院住院期间发生院内败血症的病房患者。院内脓毒症根据美国疾病控制和预防中心成人脓毒症事件标准进行定义。我们使用离散时间到事件模型估算了医院脓毒症患者的发病时间与抗菌药物使用之间的关系,并考虑了脓毒症发病后的时间。在二次分析中,我们采用了量值回归模型来估计脓毒症发病时间与开始使用抗菌药物时间之间的关系。分析结果在 1672 名住院败血症患者中,一天中任何一个小时开始使用抗菌药物的概率几乎相差五倍,从早上 7 点的 3.0%(95% 置信区间 [CI],1.8-4.1%)到下午 6 点的 13.9%(95% 置信区间 [CI],11.3-16.5%)不等、凌晨 7 点和晚上 7 点为最低点,在整个夜班期间逐渐下降(晚上 9 点为 13.4% [95% CI,10.7-16.0%],凌晨 6 点为 3.2% [95% CI,2.0-4.0])。白班(早 7 点至晚 7 点)和夜班(晚 7 点至早 7 点)脓毒症发病时间的标准化预测中位数分别为 3.2 小时(四分位数间距 [IQR],2.5-3.8 小时)和 12.9 小时(IQR,10.9-14.9 小时)。结论医院新发败血症患者开始使用抗菌药物的概率在换班和夜班时有所下降。脓毒症患者在夜间发病后开始使用抗菌药物的时间是白天发病患者的四倍。这些研究结果表明,对于病房中的住院败血症患者来说,一天中的时间与重要的护理流程有关。未来的工作应在其他环境中验证这些发现,并阐明潜在的机制,为提高质量的干预措施提供依据。
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引用次数: 0
When It's Not a Good Fit. 不合适的时候
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2023-09-01 DOI: 10.1513/AnnalsATS.202304-322CC
Sachin Shah, Ninotchka Liban Sigua, Stephanie Stahl
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引用次数: 0
Ultrasonic Elastography-guided Pleural Biopsy for the Diagnosis of Pleural Effusion: A Multicenter Prospective Study of Diagnostic Test Performance. 超声弹性成像引导胸膜活检诊断胸腔积液:诊断试验性能的多中心前瞻性研究。
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2023-09-01 DOI: 10.1513/AnnalsATS.202212-1047OC
Mingming Deng, Xianwei Ye, Jiangwei Ma, Yang Xia, Qin Zhang, Bin Jiang, Jie Wu, Qing Wen, Yujin Zheng, Yan Yin, Run Tong, Guowu Zhou, Hongmei Yao, Xuelian Li, Felix J F Herth, Gang Hou, Chen Wang

Rationale: The diagnostic yield of traditional ultrasound-guided pleural biopsy remains unsatisfactory, particularly when the pleural thickness is ⩽5 mm and/or no pleural nodules are detected. Pleural ultrasound elastography (UE) has a better diagnostic yield than traditional ultrasound for malignant pleural effusion (MPE). However, studies on UE-guided pleural biopsies are lacking. Objectives: To evaluate the feasibility and safety of UE-guided pleural biopsy. Methods: In this multicenter prospective single-arm trial, patients with pleural effusion whose pleural thickness was ⩽5 mm with no pleural nodules were enrolled between July 2019 and August 2021. The diagnostic yield of UE-guided pleural biopsy for pleural effusion and its sensitivity for detecting MPE were evaluated. Results: Ninety-eight patients (mean age, 62.4 ± 13.2 yr; 65 men) were prospectively enrolled. The diagnostic yield of UE-guided pleural biopsy for making any diagnosis was 92.9% (91/98), and its sensitivity for MPE was 88.7% (55/62). In addition, its sensitivity for pleural tuberculosis was 69.6% (16/23). The rate of postoperative chest pain was acceptable, and there was no pneumothorax. Conclusions: UE-guided pleural biopsy is a novel technique for diagnosing MPE with good diagnostic yield and sensitivity. Clinical trial registered with https://www.chictr.org.cn (ChiCTR2000033572).

理由:传统的超声引导胸膜活检的诊断率仍然不令人满意,特别是当胸膜厚度≤5mm和/或未检测到胸膜结节时。胸膜超声弹性成像(UE)对恶性胸腔积液(MPE)的诊断率优于传统超声。然而,关于超声引导胸膜活检的研究还很缺乏。目的:评价超声引导胸膜活检的可行性和安全性。方法:在这项多中心前瞻性单臂试验中,于2019年7月至2021年8月招募胸膜厚度≥5 mm且无胸膜结节的胸腔积液患者。评价超声引导胸膜活检对胸腔积液的诊断率及其对MPE的敏感性。结果:98例患者(平均年龄62.4±13.2岁;65名男性)被纳入前瞻性研究。超声引导胸膜活检对任何诊断的诊断率为92.9%(91/98),对MPE的敏感性为88.7%(55/62)。对胸膜结核的敏感性为69.6%(16/23)。术后胸痛发生率可接受,无气胸发生。结论:超声引导胸膜活检是一种诊断MPE的新技术,具有良好的诊断率和敏感性。临床试验在https://www.chictr.org.cn注册(ChiCTR2000033572)。
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引用次数: 2
Gaps in Cystic Fibrosis Care Are Associated with Reduced Lung Function in the U.S. Cystic Fibrosis Foundation Patient Registry. 在美国囊性纤维化基金会患者登记中,囊性纤维化护理的空白与肺功能下降有关。
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2023-09-01 DOI: 10.1513/AnnalsATS.202211-951OC
Edmund H Sears, Alexandra C Hinton, Sara Lopez-Pintado, Christine W Lary, Jonathan B Zuckerman

Rationale: Cystic fibrosis (CF) is a genetic disease leading to progressive lung function loss and early mortality. Many clinical and demographic variables are associated with lung function decline, but little is known about the effects of prolonged periods of missed care. Objectives: To determine if missed care in the Cystic Fibrosis Foundation Patient Registry (CFFPR) is associated with decreased lung function at follow-up visits. Methods: Deidentified CFFPR data for 2004-2016 were analyzed, with the exposure of interest being ⩾12-month gap in CFFPR data. We modeled percentage predicted forced expiratory volume in 1 second using longitudinal semiparametric modeling with natural cubic splines for age (knots at quantiles) and with subject-specific random effects, adjusted for sex and CFTR (cystic fibrosis transmembrane conductance regulator) genotype, race, and ethnicity and included time-varying covariates for gaps in care, insurance type, underweight body mass index, CF-related diabetes status, and chronic infections. Results: A total of 24,328 individuals with 1,082,899 encounters in the CFFPR met inclusion criteria. In the cohort, 8,413 (35%) individuals had at least a single ⩾12-month episode of discontinuity, whereas 15,915 (65%) had continuous care. Of the encounters preceded by a 12-month gap, 75.8% occurred in patients 18 years and older. Compared with those with continuous care, those with a discontinuous care episode had a lower follow-up percentage predicted forced expiratory volume in 1 second at the index visit (-0.81%; 95% confidence interval, -1.00, -0.61) after adjustment for other variables. The magnitude of this difference was much greater (-2.1%; 95% confidence interval, -1.5, -2.7) in young adult F508del homozygotes. Conclusions: There was a high rate of ⩾12-month gap in care, especially in adults, documented in the CFFPR. Discontinuous care identified in the CFFPR was strongly associated with decreased lung function, especially in adolescents and young adults homozygous for the F508del CFTR mutation. This may have implications for identifying and treating people with lengthy gaps in care and may have implications for CFF care recommendations.

理由:囊性纤维化(CF)是一种遗传性疾病,可导致进行性肺功能丧失和早期死亡。许多临床和人口统计学变量与肺功能下降有关,但对长期错过护理的影响知之甚少。目的:确定囊性纤维化基金会患者登记(CFFPR)中遗漏的护理是否与随访时肺功能下降有关。方法:分析2004-2016年确定的CFFPR数据,感兴趣的暴露在CFFPR数据中大于或等于12个月的差距。我们采用纵向半参数模型,采用自然三次样条对年龄(分位数)和受试者特异性随机效应进行建模,对性别和CFTR(囊性纤维化跨膜传导调节因子)基因型、种族和民族进行调整,并纳入时变协变量,如护理差距、保险类型、体重不足体重指数、cf相关糖尿病状态和慢性感染。结果:在cfpr中,1,082,899例遭遇的24,328例个体符合纳入标准。在队列中,8,413(35%)个人至少有一次大于或等于12个月的不连续性发作,而15,915(65%)有持续护理。在间隔12个月之前的接触中,75.8%发生在18岁及以上的患者中。与连续护理的患者相比,有间断护理事件的患者在指标访视时预测1秒用力呼气量的随访百分比较低(-0.81%;95%置信区间,-1.00,-0.61)。这种差异的幅度要大得多(-2.1%;95%可信区间,-1.5,-2.7)。结论:在cfpr中记录的护理中有大于或等于12个月的间隔率,特别是在成人中。cfpr中发现的间断护理与肺功能下降密切相关,特别是在F508del CFTR突变纯合子的青少年和年轻人中。这可能对识别和治疗长时间护理间隔的人有影响,也可能对CFF护理建议有影响。
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引用次数: 2
Identification of Environmental Exposures Associated with Risk of Sarcoidosis in African Americans. 确定与非裔美国人肉样瘤病风险相关的环境暴露。
IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-09-01 DOI: 10.1513/AnnalsATS.202208-722OC
Albert M Levin, Ruicong She, Yalei Chen, Indra Adrianto, Indrani Datta, Ian M Loveless, Lori Garman, Courtney G Montgomery, Jia Li, Michael C Iannuzzi, Benjamin A Rybicki

Rationale: Sarcoidosis is a racially disparate granulomatous disease likely caused by environmental exposures, genes, and their interactions. Despite increased risk in African Americans, few environmental risk factor studies in this susceptible population exist. Objectives: To identify environmental exposures associated with the risk of sarcoidosis in African Americans and those that differ in effect by self-identified race and genetic ancestry. Methods: The study sample comprised 2,096 African Americans (1,205 with and 891 without sarcoidosis) compiled from three component studies. Unsupervised clustering and multiple correspondence analyses were used to identify underlying clusters of environmental exposures. Mixed-effects logistic regression was used to evaluate the association of these exposure clusters and the 51 single-component exposures with risk of sarcoidosis. A comparison case-control sample of 762 European Americans (388 with and 374 without sarcoidosis) was used to assess heterogeneity in exposure risk by race. Results: Seven exposure clusters were identified, five of which were associated with risk. The exposure cluster with the strongest risk association was composed of metals (P < 0.001), and within this cluster, exposure to aluminum had the highest risk (odds ratio, 3.30; 95% confidence interval [95% CI], 2.23-4.09; P < 0.001). This effect also differed by race (P < 0.001), with European Americans having no significant association with exposure (odds ratio, 0.86; 95% CI, 0.56-1.33). Within African Americans, the increased risk was dependent on genetic African ancestry (P = 0.047). Conclusions: Our findings support African Americans having sarcoidosis environmental exposure risk profiles that differ from those of European Americans. These differences may underlie racially disparate incidence rates that are partially explained by genetic variation differing by African ancestry.

理由:肉样瘤病是一种具有种族差异的肉芽肿性疾病,可能是由环境暴露、基因及其相互作用引起的。尽管非裔美国人患病风险增加,但针对这一易感人群的环境风险因素研究却很少。研究目的确定与非裔美国人患肉芽肿病风险相关的环境暴露,以及那些因自我认同的种族和遗传血统而产生不同影响的环境暴露。研究方法:研究样本包括 2,096 名非裔美国人(1,205 人患有肉样瘤病,891 人不患有肉样瘤病),这些样本来自三项研究。采用无监督聚类和多重对应分析来确定环境暴露的潜在聚类。混合效应逻辑回归用于评估这些暴露集群和 51 种单成分暴露与肉样瘤病风险的关联。对 762 名欧洲裔美国人(388 人患有肉样瘤病,374 人未患有肉样瘤病)进行了病例对照比较,以评估不同种族暴露风险的异质性。结果显示确定了七个暴露群,其中五个与风险相关。风险关联性最强的暴露集群由金属组成(P P P P = 0.047)。结论:我们的研究结果表明,非裔美国人的肉样瘤病环境暴露风险特征与欧裔美国人不同。这些差异可能是造成不同种族发病率差异的原因,而非洲血统的遗传变异可以部分解释这种差异。
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引用次数: 0
Mechanical Ventilation after Traumatic Spinal Cord Injury-A Multicentric Cohort Study-based Prediction Model for Weaning Success: The BICYCLE Score. 创伤性脊髓损伤后机械通气——基于多中心队列研究的断奶成功预测模型:BICYCLE评分。
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202301-022OC
Annia F Schreiber, Jacopo Garlasco, Martin Urner, Amanda McFarlan, Andrew Baker, Andrea Rigamonti, Jeffrey M Singh, Demetrios James Kutsogiannis, Laurent J Brochard

Rationale: Limited information exists about the epidemiology, outcomes, and predictors of weaning from mechanical ventilation in patients with spinal cord injury. Objectives: Our aim was to investigate predictors of weaning outcomes for patients with traumatic spinal cord injury (tSCI) and develop and validate a prognostic model and score for weaning success. Methods: This was a registry-based, multicentric cohort study including all adult patients with tSCI requiring mechanical ventilation (MV) and admitted to one of the intensive care units (ICUs) of the Trauma Registry at St. Michael's Hospital (Toronto, ON, Canada) and the Canadian Rick Hansen Spinal Cord Injury Registry between 2005 and 2019. The primary outcome was weaning success from MV at ICU discharge. Secondary outcomes included weaning success at Days 14 and 28, time to liberation from MV accounting for competing risk of death, and ventilator-free days at 28 and 60 days. Associations between baseline characteristics and weaning success or time to liberation from MV were measured using multivariable logistic and competing risk regressions. A parsimonious model to predict weaning success and ICU discharge was developed and validated via bootstrap. A prediction score for weaning success at ICU discharge was derived, and its discriminative ability was assessed using receiver operating characteristic curve analysis and compared with the Injury Severity Score (ISS). Results: Of 459 patients analyzed, 246 (53.6%), 302 (65.8%), and 331 (72.1%) were alive and free of MV at Day 14, Day 28, and ICU discharge, respectively; 54 (11.8%) died in the ICU. Median time to liberation from MV was 12 days. Factors associated with weaning success were Blunt injury (odds ratio [OR], 2.96; P = 0.010), ISS (OR, 0.98; P = 0.025), Complete syndrome (OR, 0.53; P = 0.009), age in Years (OR, 0.98; P = 0.003), and Cervical LEsion (OR, 0.60; P = 0.045). The BICYCLE score showed a greater area under the curve than the ISS (0.689 [95% confidence interval (CI), 0.631-0.743] vs. 0.537 [95% CI, 0.479-0.595]; P < 0.0001). Factors predicting weaning success also predicted time to liberation. Conclusions: In a large multicentric cohort, 72% of patients with tSCI were weaned and discharged alive from the ICU. Readily available admission characteristics can reasonably predict weaning success and help prognostication.

理由:关于脊髓损伤患者脱离机械通气的流行病学、结局和预测因素的信息有限。目的:我们的目的是研究创伤性脊髓损伤(tSCI)患者断奶结局的预测因素,并开发和验证预后模型和断奶成功评分。方法:这是一项基于登记的多中心队列研究,包括所有需要机械通气(MV)的成年tSCI患者,并于2005年至2019年期间入住圣迈克尔医院(多伦多,安大略省,加拿大)创伤登记处和加拿大里克汉森脊髓损伤登记处的重症监护病房(icu)之一。主要结局是在ICU出院时成功脱机。次要结局包括第14天和第28天断奶成功、考虑竞争死亡风险的从MV中解脱的时间,以及第28天和第60天无呼吸机天数。基线特征与断奶成功或从MV中解脱的时间之间的关联使用多变量逻辑回归和竞争风险回归进行测量。我们开发了一个预测断奶成功和ICU出院的简约模型,并通过bootstrap进行了验证。推导出ICU出院时断奶成功的预测评分,采用受试者工作特征曲线分析评估其判别能力,并与损伤严重程度评分(ISS)进行比较。结果:在分析的459例患者中,第14天、第28天和ICU出院时,分别有246例(53.6%)、302例(65.8%)和331例(72.1%)患者存活和无MV;54例(11.8%)在ICU死亡。从MV中解脱的平均时间为12天。与断奶成功相关的因素有:钝性损伤(优势比[OR], 2.96;P = 0.010), iss (or, 0.98;P = 0.025),完全综合征(OR, 0.53;P = 0.009),年龄(OR, 0.98;P = 0.003),宫颈病变(OR, 0.60;p = 0.045)。BICYCLE评分显示曲线下面积大于ISS(0.689[95%可信区间(CI), 0.631-0.743]比0.537 [95% CI, 0.479-0.595];结论:在一项大型多中心队列研究中,72%的tSCI患者成功断奶并从ICU存活出院。容易获得的入院特征可以合理地预测断奶成功率并有助于预后。
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引用次数: 0
Nontuberculous Mycobacterial Infection in Wisconsin Adults and Its Relationship to Race and Social Disadvantage. 威斯康星州成年人的非结核分枝杆菌感染及其与种族和社会劣势的关系。
IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202205-425OC
Bryan J Vonasek, Danièle Gusland, Kevin P Hash, Andrew L Wiese, Julie Tans-Kersten, Brad C Astor, Suzanne N Gibbons-Burgener, Elizabeth A Misch

Rationale: Population-based data on the epidemiology of nontuberculosis mycobacterial (NTM) infections are limited, particularly with respect to variation in NTM infection among racial groups and socioeconomic strata. Wisconsin is one of a handful of states where mycobacterial disease is notifiable, allowing large, population-based analyses of the epidemiology of NTM infection in this state. Objectives: To estimate the incidence of NTM infection in Wisconsin adults, describe the geographic distribution of NTM infection across the state, identify the frequency and type of infection caused by different NTM species, and investigate associations between NTM infection and demographics and socioeconomic status. Methods: We conducted a retrospective cohort study using laboratory reports of all NTM isolates from Wisconsin residents submitted to the Wisconsin Electronic Disease Surveillance System from 2011 to 2018. For the analyses of NTM frequency, multiple reports from the same individual were enumerated as separate isolates when nonidentical, collected from different sites or collected more than one year apart. Results: A total of 8,135 NTM isolates from 6,811 adults were analyzed. Mycobacterium avium complex accounted for 76.4% of respiratory isolates. The M. chelonae-abscessus group was the most common species isolated from skin and soft tissue. The annual incidence of NTM infection was stable over the study period (from 22.1 per 100,000 to 22.4 per 100,000). The cumulative incidence of NTM infection among Black (224 per 100,000) and Asian (244 per 100,000) individuals was significantly higher compared with that among their White counterparts (97 per 100,000). Total NTM infections were significantly more frequent (P < 0.001) in individuals from disadvantaged neighborhoods, and racial disparities in the incidence of NTM infection generally remained consistent when stratified by measures of neighborhood disadvantage. Conclusions: More than 90% of NTM infections were from respiratory sites, with the vast majority caused by M. avium complex. Rapidly growing mycobacteria predominated as skin and soft tissue pathogens and were important minor respiratory pathogens. We found a stable annual incidence of NTM infection in Wisconsin between 2011 and 2018. NTM infection occurred more frequently in non-White racial groups and in individuals experiencing social disadvantage, suggesting that NTM disease may be more frequent in these groups as well.

理由:基于人群的非结核分枝杆菌(NTM)感染流行病学数据非常有限,尤其是不同种族群体和社会经济阶层之间的 NTM 感染差异。威斯康星州是少数几个可以通报分枝杆菌疾病的州之一,因此可以对该州的非结核分枝杆菌感染流行病学进行大规模、基于人群的分析。研究目标估计威斯康星州成人非结核分枝杆菌感染的发病率,描述全州非结核分枝杆菌感染的地理分布情况,确定不同非结核分枝杆菌引起感染的频率和类型,并调查非结核分枝杆菌感染与人口统计学和社会经济状况之间的关联。研究方法我们利用 2011 年至 2018 年期间提交给威斯康星州电子疾病监测系统的威斯康星州居民所有 NTM 分离物的实验室报告开展了一项回顾性队列研究。在分析 NTM 频率时,如果来自同一人的多份报告不相同、收集自不同地点或收集时间相隔一年以上,则将其列为单独的分离物。结果:共分析了来自 6811 名成人的 8135 个 NTM 分离物。分枝杆菌复合体占呼吸道分离株的 76.4%。从皮肤和软组织中分离出的分枝杆菌中,最常见的是螯合分枝杆菌。在研究期间,NTM 感染的年发病率保持稳定(从每 10 万人 22.1 例到每 10 万人 22.4 例)。黑人(每 100,000 人中有 224 人)和亚裔(每 100,000 人中有 244 人)的 NTM 感染累计发病率明显高于白人(每 100,000 人中有 97 人)。NTM总感染率明显更高(P 结论:黑人和亚裔的NTM感染率明显高于白人:90%以上的非结核分枝杆菌感染来自呼吸道部位,其中绝大多数由复合鸟疫霉菌引起。快速生长的分枝杆菌主要是皮肤和软组织病原体,也是重要的呼吸道次要病原体。我们发现,2011 年至 2018 年期间,威斯康星州的 NTM 感染年发病率保持稳定。非白色人种群体和处于社会不利地位的人群中NTM感染的发生率更高,这表明NTM疾病在这些群体中的发生率也可能更高。
{"title":"Nontuberculous Mycobacterial Infection in Wisconsin Adults and Its Relationship to Race and Social Disadvantage.","authors":"Bryan J Vonasek, Danièle Gusland, Kevin P Hash, Andrew L Wiese, Julie Tans-Kersten, Brad C Astor, Suzanne N Gibbons-Burgener, Elizabeth A Misch","doi":"10.1513/AnnalsATS.202205-425OC","DOIUrl":"10.1513/AnnalsATS.202205-425OC","url":null,"abstract":"<p><p><b>Rationale:</b> Population-based data on the epidemiology of nontuberculosis mycobacterial (NTM) infections are limited, particularly with respect to variation in NTM infection among racial groups and socioeconomic strata. Wisconsin is one of a handful of states where mycobacterial disease is notifiable, allowing large, population-based analyses of the epidemiology of NTM infection in this state. <b>Objectives:</b> To estimate the incidence of NTM infection in Wisconsin adults, describe the geographic distribution of NTM infection across the state, identify the frequency and type of infection caused by different NTM species, and investigate associations between NTM infection and demographics and socioeconomic status. <b>Methods:</b> We conducted a retrospective cohort study using laboratory reports of all NTM isolates from Wisconsin residents submitted to the Wisconsin Electronic Disease Surveillance System from 2011 to 2018. For the analyses of NTM frequency, multiple reports from the same individual were enumerated as separate isolates when nonidentical, collected from different sites or collected more than one year apart. <b>Results:</b> A total of 8,135 NTM isolates from 6,811 adults were analyzed. <i>Mycobacterium avium</i> complex accounted for 76.4% of respiratory isolates. The <i>M. chelonae-abscessus</i> group was the most common species isolated from skin and soft tissue. The annual incidence of NTM infection was stable over the study period (from 22.1 per 100,000 to 22.4 per 100,000). The cumulative incidence of NTM infection among Black (224 per 100,000) and Asian (244 per 100,000) individuals was significantly higher compared with that among their White counterparts (97 per 100,000). Total NTM infections were significantly more frequent (<i>P</i> < 0.001) in individuals from disadvantaged neighborhoods, and racial disparities in the incidence of NTM infection generally remained consistent when stratified by measures of neighborhood disadvantage. <b>Conclusions:</b> More than 90% of NTM infections were from respiratory sites, with the vast majority caused by <i>M. avium</i> complex. Rapidly growing mycobacteria predominated as skin and soft tissue pathogens and were important minor respiratory pathogens. We found a stable annual incidence of NTM infection in Wisconsin between 2011 and 2018. NTM infection occurred more frequently in non-White racial groups and in individuals experiencing social disadvantage, suggesting that NTM disease may be more frequent in these groups as well.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":null,"pages":null},"PeriodicalIF":6.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10405610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Morning Chronotype Is Associated with Improved Adherence to Continuous Positive Airway Pressure among Individuals with Obstructive Sleep Apnea. 晨起时间型与改善阻塞性睡眠呼吸暂停患者持续正压通气的依从性有关。
IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202210-885OC
Melissa P Knauert, Olurotimi Adekolu, Zhichao Xu, Annan Deng, Jen-Hwa Chu, Stephen R Baldassarri, Clete Kushida, H Klar Yaggi, Andrey Zinchuk

Rationale: Poor adherence limits the effectiveness of continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). A better understanding of CPAP adherence is needed to develop novel strategies to improve it. Objectives: To determine if the chronotype (morning, evening, or intermediate) of patients with OSA is associated with differences in CPAP adherence. If such an association exists, determine the mechanisms underlying this association. Methods: We performed a secondary analysis of the APPLES (Apnea Positive Pressure Long-term Efficacy Study) clinical trial. We assessed chronotype using the Morningness-Eveningness Questionnaire (MEQ) among participants randomized to the CPAP arm with daily adherence data (n = 469). Evening (MEQ ⩽ 41), intermediate (41 < MEQ < 59), and morning type (MEQ ⩾ 59) categories were the exposures. We modeled daily CPAP use (hours per night) over a 6-month period, using a linear mixed model, adjusted for covariates (e.g., age, sex, marital status). To assess mechanisms of the association, we performed mediation analyses using sleep duration, weekend catch-up sleep, depression, and other factors. Results: Most participants were obese men with severe OSA (body mass index of 32.3 ± 7.3 kg/m2, 65% male, and apnea-hypopnea index 39.8 ± 24.6/h). Participants were 44% morning, 47% intermediate, and 8% evening chronotype. Participants with the morning chronotype reported the shortest sleep duration on weekends (7.3 vs. 7.6 and 7.9 h/night) compared with the intermediate and evening types. Participants with the morning chronotype exhibited a 40-min/night higher CPAP use (P = 0.001) than persons with the intermediate chronotype. This relationship was mildly attenuated (32.8 min/night; P = 0.011) after adjustment for covariates. None of the selected factors (e.g., sleep duration, weekend catch-up sleep) exhibited a significant mediation effect. Conclusions: Morning chronotype is associated with a clinically meaningful increase in CPAP adherence compared with other chronotypes. Mechanisms of this association require further study. Chronotype may be a novel predictor of CPAP adherence. Clinical trial registered with www.clinicaltrials.gov (NCT00051363).

理由持续气道正压疗法(CPAP)对阻塞性睡眠呼吸暂停(OSA)的疗效因患者依从性差而受到限制。需要更好地了解 CPAP 的依从性,以制定新的策略来改善这种情况。研究目的确定 OSA 患者的时间类型(早晨、傍晚或中间)是否与 CPAP 依从性的差异有关。如果存在这种关联,则确定这种关联的内在机制。研究方法我们对 APPLES(呼吸暂停正压长期疗效研究)临床试验进行了二次分析。我们使用晨间活力问卷(MEQ)评估了随机加入 CPAP 治疗组并有每日坚持治疗数据的参与者(n = 469)的时间型。结果表明,在CPAP治疗组中,晨昏型(MEQ ⩽41)、中间型(41大多数参与者是患有严重 OSA 的肥胖男性(体重指数为 32.3 ± 7.3 kg/m2,65% 为男性,呼吸暂停-低通气指数为 39.8 ± 24.6/h)。44%的参与者为晨间型,47%为中间型,8%为晚间型。与中间型和傍晚型的参与者相比,早晨型的参与者在周末的睡眠时间最短(7.3 小时/晚,7.6 小时/晚和 7.9 小时/晚)。与中间时相型的人相比,早晨时相型的人使用 CPAP 的时间每晚高出 40 分钟(P = 0.001)。经协变因素调整后,这种关系轻度减弱(32.8 分钟/晚;P = 0.011)。所选因素(如睡眠时间、周末补觉)均未显示出显著的调节作用。结论与其他时间型相比,晨间时间型与坚持使用 CPAP 的临床意义增加有关。这种关联的机制需要进一步研究。时间型可能是预测是否坚持使用 CPAP 的新指标。临床试验注册于 www.clinicaltrials.gov (NCT00051363)。
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引用次数: 0
Delays in Follow-up after a Positive Lung Cancer Screening Exam: Is the Benefit of Screening Compromised? 肺癌筛查阳性后的随访延迟:筛查的益处是否受到损害?
IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202305-440ED
M Patricia Rivera, Louise M Henderson, Lori C Sakoda
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引用次数: 0
Low Participation in a Job Transfer Program Designed to Prevent Progression of Pneumoconiosis. 参与旨在预防肺炎进展的工作调动计划的人数较少。
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2023-08-01 DOI: 10.1513/AnnalsATS.202210-867RL
A Scott Laney, Noemi B Hall, Laura Reynolds, David J Blackley, David N Weissman
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引用次数: 0
期刊
Annals of the American Thoracic Society
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